Clinical characteristics and therapy exploration of active human cytomegalovirus infection in 105 lupus patients

Systemic lupus erythematosus (SLE) has protean clinical manifestations of varying severity over the course of its onset, exacerbation, remission and flare that could often pose significant challenges for clinicians in their decision making as to whether to treat aggressively or to look for concurrent conditions such as infection with opportunistic pathogens. Human cytomegalovirus (HCMV) is one of those pathogens and is frequently encountered in our daily management of lupus patients. To investigate the clinical characteristics and therapeutic options of active HCMV infection in patients with SLE, we retrospectively reviewed clinical data of 105 inpatients in our department of Rheumatology and Clinical Immunology of Peking Union Medical College Hospital (PUMCH) diagnosed with both SLE and active HCMV infection from January 2006 to January 2012. Three groups were designated that included 42 cases of HCMV triggering SLE, 31 cases of HCMV exacerbating SLE, and 32 cases of HCMV mimicking SLE flare based on the relationship of HCMV infection and SLE. 1) Hematocytopenia (81%), fever (73.3%) and liver dysfunction (54.3%) were the most common clinical manifestations. The differences among the three groups with regard to butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal involvement were statistically significant (p < 0.05). 2) Positive rate of HCMV-pp65, compared with HCMV-IgM and HCMV-DNA, was the highest (84.9%) in patients with SLE and active HCMV infection. 3) Following 14-21 days of inductive treatment with ganciclovir, a total of 26 out of 56 patients were still positive with HCMV-IgM (nine of 19, 47.6%) and pp65 (17/37, 45.9%). Among them, seven cases suffered HCMV relapses in three months with six cases of sustained HCMV-pp65 antigenemia. In conclusion, hematocytopenia, fever and liver dysfunction should remind us to consider HCMV infection. Butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal lesion were relatively characteristic symptoms of lupus activity. HCMV-pp65 is a sensitive indicator to guide antiviral therapy. Induction therapy using ganciclovir with a duration of 14∼21 days is not sufficient, and continued HCMV-pp65 positivity may require prolonged antiviral treatment in lupus patients.

Abstract P2-06-02: Pparg deacetylation by SIRT1 determines breast tumor lipid synthesis and growth

Peroxisome proliferator-activated receptorg (Pparγ) is a member of the nuclear receptor (NR) superfamily, which regulates diverse biological functions including lipogenesis and differentiation, anti-inflammation, insulin sensitivity, cellular proliferation, and autophagy. Independent lines of evidence support a role for Pparγ as either a collaborative oncogene or as a tumor suppressor. Heterozygous mutations of Pparγ have been detected in 4/55 patients with colon cancer and a chromosomal translocation between PAX8 and Pparγ in follicular thyroid cancer appeared to serve as a dominant inhibitor of endogenous Pparγ expression. Pparγ agonists reduced tumorigenesis in several in vivo models. In contrast, several studies suggest Pparγ may enhance tumor growth. Pparγ ligands increased polyp numbers in the Apc mouse model of familial adenomatosis. Pparγ and its ligands inhibit breast tumor growth; however, constitutively active Pparγ collaborated in mammary oncogenesis with polyoma middle T antigen or oncogenic ErbB2.

Pparγ activation involves post-translational modifications including phosphorylation and sumoylation upon growth factor or ligand stimulus. Mutation of the Pparγ1 sumoylation site at K77 and K365 demonstrated that K77 may either reduce Pparγ-dependent gene induction and enhance repression or reduce repression, depending upon the synthetic reporter gene used. Lysine residues of nuclear receptors also serve as substrates for acetylation and Pparγ binds co-activators and co-repressors with intrinsic or associated histone acetylase or deacetylase activity including NCoR, SMRT, SIRT1, and p300. Initially characterized for the ERα, AR and, subsequently, the orphan nuclear receptor steroidogenic factor 1 (SF-1), acetylation occurs at a conserved lysine motif shared amongst evolutionarily related nuclear receptors. Several nuclear receptors and co-integrators involved in lipid metabolism are regulated by acetylation including p300, PGC1α, FXR, LXR and RAR. Both TSA- and NAD-sensitive HDACs (e.g. SIRT1) regulate Pparγ function and SIRT1 inhibits Pparγ-dependent adipocyte differentiation. Whether Pparγ is acetylated in cancer cells and how Pparγ exerts it's crucial, though controversial, function in tumorigenesis have not been established.

Pparγ induces gene transcription through binding specific NR half-sites and through non-canonical binding sequences (such as CREB/AP-1 sites). Transcriptional repression involves Pparγ sumoylation at lysine 77 (K77). Herein, Pparγ was shown to be acetylated at nine distinct lysine residues. SIRT1 bound and deacetylated Pparγ at K154/155. ChIP-Seq analysis for genome-wide DNA binding demonstrated the acetylation site was required for binding NR half-sites, but was not required for non-canonical site binding. Breast tumor growth, de novo lipid synthesis, induction of autophagy and evasion of apoptosis was promoted by K154/155 and inhibited by K77 in vivo. Pparγ acetylation induced a gene signature that was increased in breast cancer, associated with a reduction in SIRT1 abundance and poor outcome. The Pparγ acetylation site determines binding to autophagy and apoptosis signaling to regulate breast tumor lipid metabolism and growth.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-06-02.

Note: Characterization of a high-photon-energy X-ray imager

The Bragg angle, rocking curve, and reflection efficiency of a quartz crystal x-ray imager (Miller indices 234) were measured at photon energy of 15.6909 keV, corresponding to the K(α2) line of Zr, using the X15A beamline at the National Synchrotron Light Source at Brookhaven National Laboratory. One flat and three spherically curved samples were tested. The peak reflectivity of the best-performing crystal was determined to be (3.6 ± 0.7) × 10(-4) with a rocking-curve full width at half maximum of 0.09°. The Zr K(α2) emission was imaged from a hot Zr plasma generated by a 10-J multiterawatt laser.

An initial evaluation of analyser-based phase-contrast X-ray imaging of carotid plaque microstructure

Carotid artery plaque instability can result in rupture and lead to ischaemic stroke. Stability of plaques appears to be a function of composition. Current non-invasive imaging techniques are limited in their ability to classify distinct histological regions within plaques. Phase-contrast (PC) X-ray imaging methods are an emerging class of techniques that have shown promise for identifying soft-tissue features without use of exogenous contrast agents. This is the first study to apply analyser-based X-ray PC imaging in CT mode to provide three-dimensional (3D) images of excised atherosclerotic plaques. The results provide proof of principle for this technique as a promising method for analysis of carotid plaque microstructure. Multiple image radiography CT (MIR-CT), a tomographic implementation of X-ray PC imaging that employs crystal optics, was employed to image excised carotid plaques. MIR-CT imaging yields three complementary images of the plaque's 3D X-ray absorption, refraction and scatter properties. These images were compared with histological sections of the tissue. X-ray PC images were able to identify the interface between the plaque and the medial wall. In addition, lipid-rich and highly vascularized regions were visible in the images as well as features depicting inflammation. This preliminary research shows MIR-CT imaging can reveal details about plaque structure not provided by traditional absorption-based X-ray imaging and appears to identify specific histological regions within plaques. This is the first study to apply analyser-based X-ray PC imaging to human carotid artery plaques to identify distinct soft-tissue regions.

Synthesis of graphene films by rapid heating and quenching at ambient pressures and their electrochemical characterization

We study the process of graphene growth on Cu and Ni substrates subjected to rapid heating (approximately 8 °C/s) and cooling cycles (approximately 10 °C/s) in a modified atmospheric pressure chemical vapor deposition furnace. Electron microscopy followed by Raman spectroscopy demonstrated successful synthesis of large-area few-layer graphene (FLG) films on both Cu and Ni substrates. The overall synthesis time was less than 30 min. Further, the as-synthesized films were directly utilized as anode material and their electrochemical behavior was studied in a lithium half-cell configuration. FLG on Cu (Cu-G) showed reduced lithium-intercalation capacity when compared with SLG, BLG and Bare-Cu suggesting its substrate protective nature (barrier to Li-ions). Although graphene films on Ni (Ni-G) showed better Li-cycling ability similar to that of other carbons suggesting that the presence of graphene edge planes (typical of Ni-G) is important in effective uptake and release of Li-ions in these materials.

Factors influencing epitaxial growth of three-dimensional Ge quantum dot crystals on pit-patterned Si substrate

We investigated the molecular beam epitaxy growth of three-dimensional (3D) Ge quantum dot crystals (QDCs) on periodically pit-patterned Si substrates. A series of factors influencing the growth of QDCs were investigated in detail and the optimized growth conditions were found. The growth of the Si buffer layer and the first quantum dot (QD) layer play a key role in the growth of QDCs. The pit facet inclination angle decreased with increasing buffer layer thickness, and its optimized value was found to be around 21°, ensuring that all the QDs in the first layer nucleate within the pits. A large Ge deposition amount in the first QD layer favors strain build-up by QDs, size uniformity of QDs and hence periodicity of the strain distribution; a thin Si spacer layer favors strain correlation along the growth direction; both effects contribute to the vertical ordering of the QDCs. Results obtained by atomic force microscopy and cross-sectional transmission electron microscopy showed that 3D ordering was achieved in the Ge QDCs with the highest ever areal dot density of 1.2 × 10(10) cm(-2), and that the lateral and the vertical interdot spacing were ~10 and ~2.5 nm, respectively.

The morphological, material-level, and ash properties of turkey femurs from 3 different genetic strains during production

Femoral fractures are observed in selective-bred commercial turkeys; however, the etiology of such fractures is unknown. The current study investigated the whole bone morphological, material-level mechanical, and bone ash properties to determine the effect of selective breeding on bone strength. Femora from 3 divergent strains of turkeys, a commercial line, a different selectively bred heavy line (F-line), and a lighter age or weight matched random-bred line (RBC2/R-EQ, respectively), were compared. Bone geometric properties were measured with micro-CT and bone mechanical properties were measured using 3-point bending tests. Whole bone ash quantities were also recorded. Statistics were run using a general linear model multivariate ANOVA (GLM ANOVA). Results showed that at similar ages, the faster growing birds (commercial and F-line) had femurs twice the size of the RBC2 line as measured by cross-sectional area as early as 8 wk into the study. The femurs of the commercial and F-lines also exhibited as much as 20% greater mechanical strength than femurs from the RBC2 line at 16 and 20 wk of age as measured by properties such as elastic modulus and ultimate tensile strength. However, at similar BW, the slower growing R-EQ line had higher mechanical properties than the other lines, with the elastic modulus being 40% greater and the ultimate tensile strength being 37% greater at weights equivalent to those of the commercial and F-lines at 12 wk of age. Moreover, it was observed that the morphological properties (i.e., cross-sectional area, moments of inertia) are largely governed by BW, as there is little difference in the amount gained per week of age across the different lines. Conversely, the mechanical properties, as well as the related ash content, appear to be governed at least in part by time. Therefore, whereas modulation of bone geometry is the key responder for changes in BW, sufficient time for matrix mineralization or maturation or both to occur is also essential for mechanical competence of bone.

Recombinant human endostatin combined with definitive chemoradiotherapy as primary treatment for patients with unresectable but without systemic metastatic squamous cell carcinoma of the oesophagus

OBJECTIVE

The objective of this study was to review the outcomes of recombinant human endostatin combined with chemoradiotherapy (CRT) as primary treatment for patients with unresectable but without systemic metastatic squamous cell carcinoma (SCC) of the oesophagus.

METHODS

A total of 38 patients with unresectable but without systemic metastatic SCC of the oesophagus (T(4) or stage IVA) were retrospectively studied. 18 patients were treated with recombinant human endostatin combined with 5-fluorouracil (5-FU)/cisplatin (CDDP)-based CRT and 20 were treated with 5-FU/CDDP-based CRT alone. Short- and long-term effects including initial treatment response, survival and treatment-related complications were assessed with a median follow-up period of 36.1 months.

RESULTS

CRT combined with endostatin resulted in a marked improvement in complete response rates (44.4% vs 30% in the CRT-alone group), and an increase in the 1-year and 3-year overall survival rates (72% vs 50.0% and 32% vs 22.0%, respectively), while the median time to progression was extended to 11.3 months in the combination group vs 8.1 months in the CRT-alone group. There were no treatment-related toxicities that could be attributed specifically to the endostatin, and the toxicities observed across the two groups are probably due to the CRT itself.

CONCLUSIONS

The short- and long-term effects of CRT combined with endostatin were an improvement over that of CRT alone in this retrospective cohort study. This combined treatment modality may be a promising treatment modality for the patients with unresectable but without systemic metastatic oesophageal cancer. Further prospective randomised control studies are needed to confirm this finding.

Amphiregulin stimulates liver regeneration after small-for-size mouse liver transplantation

This study investigated whether amphiregulin (AR), a ligand of the epidermal growth factor receptor (EGFR), improves liver regeneration after small-for-size liver transplantation. Livers of male C57BL/6 mice were reduced to ~50% and ~30% of original sizes and transplanted. After transplantation, AR and AR mRNA increased in 50% but not in 30% grafts. 5-Bromodeoxyuridine (BrdU) labeling, proliferating cell nuclear antigen (PCNA) expression and mitotic index increased substantially in 50% but not 30% grafts. Hyperbilirubinemia and hypoalbuminemia occurred and survival decreased after transplantation of 30% but not 50% grafts. AR neutralizing antibody blunted regeneration in 50% grafts whereas AR injection (5 μg/mouse, iv) stimulated liver regeneration, improved liver function and increased survival after transplantation of 30% grafts. Phosphorylation of EGFR and its downstream signaling molecules Akt, mTOR, p70S6K, ERK and JNK increased markedly in 50% but not 30% grafts. AR stimulated EGFR phosphorylation and its downstream signaling pathways. EGFR inhibitor PD153035 suppressed regeneration of 50% grafts and largely abrogated stimulation of regeneration of 30% grafts by AR. AR also increased cyclin D1 and cyclin E expression in 30% grafts. Together, liver regeneration is suppressed in small-for-size grafts, as least in part, due to decreased AR formation. AR supplementation could be a promising therapy to stimulate regeneration of partial liver grafts.

SU-E-J-112: A Splatting Method to Generate DRRs for Deformed CT Volume

PURPOSE

To develop an efficient algorithm for generating high-quality digitally reconstructed radiographs (DRRs) for regularly and irregularly sampled volumes based on a splatting method with dynamic elliptical Gaussian kernels, and to evaluate this method using ray tracing.

METHODS

The traditional ray tracing method, which takes every intersected voxel into account, produces high quality DRRs but is very time consuming. Additionally, it is not suitable for handling irregularly-sampled volumes since it always requires image re-sampling, which leads to inaccuracy. We present a splatting approach to compute the 'footprint function', facilitating efficient perspective projection of elliptical Gaussian kernels at very low cost. This reported framework allows dealing with both regularly and irregularly sampled volumes effectively and efficiently. An XCAT digital phantom was used to generate 3D chest volumes at different respiratory phases, and CT projections are generated using ray tracing and the splatting method, respectively. Normalized cross correlation (NCC) is applied to evaluate the DRR similarity of two methods.

RESULTS

Respiratory Phases one and four are used as volume datasets from the 4D XCAT digital phantom as they represent the lung at end inhale and end exhale, respectively. The dataset of Phase one is the basic regularly-sampled volume while the dataset of Phase four is deformed from that of Phase one, and resampled to a regularly sampled dataset for the ray tracing method. NCC between splatting and ray tracing DRRs are 0.9980 and 0.9977 for Phase one and Phase four, respectively. The calculation speed of the splatting method is 3 times faster than that of ray tracing.

CONCLUSIONS

Our splatting approach can generate high-quality DRRs efficiently, and is a good alternative for current DRR generation techniques for deformed volume datasets. This research is supported by CPRIT Individual Investigator Award RP110329.

A randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade for insertion of double-lumen tubes

We performed a randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade in 170 patients undergoing double-lumen tube placement for thoracic surgery. Compared with the Macintosh laryngoscope blade, use of the CEL-100 resulted in significantly more patients with a Cormack and Lehane Grade-1 laryngeal view (90.4% vs 61.0%, p < 0.001), a higher rate of successful intubation on the first attempt (92.8% vs 79.3%, p = 0.012), a lower median (IQR [range]) intubation difficulty score (0 (0-0 [0-60]) vs 15 (0-30 [0-80]), p < 0.001), a higher incidence of correct positioning of the tube (90.3% vs 79.2%, p = 0.041) and significantly fewer patients requiring external laryngeal pressure (19.3% vs 32.9%, p = 0.046). Median (IQR [range]) time to successful intubation was 45 (38-55 [22-132]) s with the CEL-100 compared with 51 (40-61 [30-160] s using the Macintosh laryngoscope blade. We conclude that the CEL-100 videolaryngoscope is superior to the Macintosh laryngoscope blade for double-lumen tube insertion.