An integrated analysis identifies STAT4 as a key regulator of ovarian cancer metastasis

Epithelial ovarian cancer (EOC) is one of the most common gynecological cancers, with diagnosis often at a late stage. Metastasis is a major cause of death in patients with EOC, but the underlying molecular mechanisms remain obscure. Here, we utilized an integrated approach to find potential key transcription factors involved in ovarian cancer metastasis and identified STAT4 as a critical player in ovarian cancer metastasis. We found that activated STAT4 was overexpressed in epithelial cells of ovarian cancer and STAT4 overexpression was associated with poor outcome of ovarian cancer patients, which promoted metastasis of ovarian cancer in both in vivo and in vitro. Although STAT4 mediated EOC metastasis via inducing epithelial-to-mesenchymal transition (EMT) of ovarian cancer cells in vivo, STAT4 failed to induce EMT directly in vitro, suggesting that STAT4 might mediate EMT process via cancer-stroma interactions. Further functional analysis revealed that STAT4 overexpression induced normal omental fibroblasts and adipose- and bone marrow-derived mesenchymal stem cells to obtain cancer-associated fibroblasts (CAF)-like features via induction of tumor-derived Wnt7a. Reciprocally, increased production of CAF-induced CXCL12, IL6 and VEGFA within tumor microenvironment could enable peritoneal metastasis of ovarian cancer via induction of EMT program. In summary, our study established a model that STAT4 promotes ovarian cancer metastasis via tumor-derived Wnt7a-induced activation of CAFs.

Discordance between patient and clinician reports of adverse reactions to MDR-TB treatment

SETTING

An urban out-patient clinic in Durban, South Africa, providing community-based treatment for drug-resistant tuberculosis (TB).

OBJECTIVE

To describe concordance between patient report and clinician documentation of adverse drug reactions (ADRs) to treatment for multidrug-resistant TB (MDR-TB).

DESIGN

ADRs were documented by interview using an 18-item symptom checklist and medical record data abstraction during a cross-sectional parent study with 121 MDR-TB patients, 75% of whom were co-infected with the human immunodeficiency virus. Concordance was analyzed using Cohen's κ statistic, Gwet's agreement coefficient (AC) 1, and McNemar's test.

RESULTS

ADRs were reported much more frequently in patient interviews (μ = 8.6) than in medical records (μ = 1.4). Insomnia was most common (67% vs. 2%), followed by peripheral neuropathy (65% vs. 18%), and confusion (61 vs. 4%). κ scores were very low, with the highest degree of concordance found in hearing loss (κ = 0.23), which was the only ADR not found to be significantly different between the two data sources (P = 0.34).

CONCLUSIONS

Our study showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect patients' experiences during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.

Identification of novel variants associated with warfarin stable dosage by use of a two-stage extreme phenotype strategy

Essentials Required warfarin doses for mechanical heart valves vary greatly. A two-stage extreme phenotype design was used to identify novel warfarin dose associated mutation. We identified a group of variants significantly associated with extreme warfarin dose. Four novel identified mutations account for 2.2% of warfarin dose discrepancies.

SUMMARY

Background The variation among patients in warfarin response complicates the management of warfarin therapy, and an improper therapeutic dose usually results in serious adverse events. Objective To use a two-stage extreme phenotype strategy in order to discover novel warfarin dose-associated mutations in heart valve replacement patients. Patients/method A total of 1617 stable-dose patients were enrolled and divided randomly into two cohorts. Stage I patients were genotyped into three groups on the basis of VKORC1-1639G>A and CYP2C9*3 polymorphisms; only patients with the therapeutic dose at the upper or lower 5% of each genotype group were selected as extreme-dose patients for resequencing of the targeted regions. Evaluation of the accuracy of the sequence data and the potential value of the stage I-identified significant mutations were conducted in a validation cohort of 420 subjects. Results A group of mutations were found to be significantly associated with the extreme warfarin dose. The validation work finally identified four novel mutations, i.e. DNMT3A rs2304429 (24.74%), CYP1A1 rs3826041 (47.35%), STX1B rs72800847 (7.01%), and NQO1 rs10517 (36.11%), which independently and significantly contributed to the overall variability in the warfarin dose. After addition of these four mutations, the estimated regression equation was able to account for 56.2% (R2Adj = 0.562) of the overall variability in the warfarin maintenance dose, with a predictive accuracy of 62.4%. Conclusion Our study provides evidence linking genetic variations in STX1B, DNMT3A and CYP1A1 to warfarin maintenance dose. The newly identified mutations together account for 2.2% of warfarin dose discrepancy.

Expression of microRNA let-7a positively correlates with hepatitis B virus replication in hepatocellular carcinoma tissues

Let-7a miRNA is downregulated in various cancers. However, in hepatocellular carcinoma (HCC) patients infected with hepatitis B virus (HBV), the relationship between let-7a and HBV replication has not been fully elucidated. Liver specimens were collected from 23 HCC patients with chronically active HBV. The serum levels of the HBV antigens hepatitis B surface antigen (HBsAg) and hepatitis B virus e antigen (HBeAg), and the HBV antibodies, anti-HBs, anti-HBe and anti-hepatitis B core antigen (anti-HBc) were measured using the microparticle enzyme immunoassay. Let-7a levels and HBV DNA copy numbers were measured by quantitative real-time PCR (qRT-PCR) and analyzed statistically. A let-7a specific antisense oligonucleotide was introduced to the HBV-producing cell line HepG2.2.15 and a change in HBV DNA copy numbers was assessed by qRT-PCR. HCC patients with highly active HBV replication (>10⁶ DNA copies/mL) showed higher levels of serum HBsAg and anti-HBc than patients with less active HBV replication (<10³ DNA copies/mL). The level of let-7a was lower in malignant tissues than in adjacent normal tissues. However, patients with highly active HBV replication demonstrated a significantly higher level of let-7a in hepatocarcinoma tissue than patients with less active HBV replication ( P < 0.05). A higher level of let-7a was observed in the HBV-producing cell line HepG2.2.15 than in HepG2 cells ( P < 0.05), and let-7a down-regulation by antisense oligonucleotides led to a reduction in HBV DNA copy numbers ( P < 0.05), indicating a correlation between the let-7a level and HBV replication. Down-regulation of let-7a reduces HBV replication and could prevent the development of HCC, suggesting it could be an effective therapeutic treatment for HBV infection. Impact statement Although interferon and nucleic acid analogues effectively suppress HBV replication in HBV patients, there is no treatment which eradicates the virus. Moreover, the therapeutic effect can be reduced by virus mutations or drug resistance. Let-7a is a miRNA initially found in the nematode as a master regulator of developmental processes, but also exists in humans. It has been reported that the transcription of let-7a was much lower in HCC than in normal liver tissues and specific miRNA could directly promote virus replication. Therefore we hypothesized that transcription of let-7a promotes HBV replication, which might compromise the therapeutic effects of antivirus treatments. In our present study, we demonstrated a correlation between let-7a transcription and HBV replication in surgical specimens obtained from patients with HCC, as well as in HCC cell lines. Our finding might be the base for a new approach to improve HBV infection treatments in the future.

Abstract 3982: Prediction and selection of cancer drug treatments using personalized tumor models or models with matching genomic profiles

The main purpose of precision medicine is to find the right drug for the right patient at the right time. Current progress in cancer drug target identification and development of new targeted drugs has presented many successful examples. However, for majority of patients, finding treatments based on the unique mutations in their own tumor cells are still hard. New approaches for precision medicine are in great needs and thus being investigated.

A mouse “avatar”, also known as Patient-Derived Xenograft (PDX) model, is a personalized cancer model derived from a patient tumor sample and used to test different drugs for the patient. “GIFTS” (or Genomic Information Fitting based Therapeutics Selection) is a method with which a patient's cancer genomic information is compared to PDX model genomic profiles to find the best genomic fit and related therapeutic options in GenenDesign Drug Response Database and Genomic Information database.

So far we have successfully derived more than 1000 PDX models from patient tumor tissues of various cancer types including lung, gastric, liver, esophageal, colorectal, pancreatic and many other cancers. In some cases, both patients and their avatars were tested with same cancer drugs including targeted drugs and chemotherapies. By comparing drug responses in mouse avatars with patient clinical results, we found high correlations between them in both sensitivity and unresponsiveness.

We have also developed a bioinformatics algorithm to analyze PDX model genomic and drug response information. Both drug sensitivity and resistance biomarkers have been used in matching cancer patient genomic profiles to those of PDX models in GenenDesign database as a part of our GIFTS method. Our preliminary results show that there are high degree of similarities in drug response profiles between patients and their matched PDX models.

Avatar and GIFTS methods can provide predictions of therapeutic effectiveness on both targeted drugs and chemotherapies. Avatar is a drug screening based method, while GIFTS is a genomic profile matching based method. Both methods are especially useful for patients, whose tumors could not be treated with known targeted drugs.

Citation Format: Jingjing Jiang, Ying Yan, Zhongguang Luo, Jia He, Tengfei Yu, Wei Du, Xuqin Yang, Jiali Gu, Xin K. Ye, Guanglei Zhuang, Jie Liu, Zhenyu Gu. Prediction and selection of cancer drug treatments using personalized tumor models or models with matching genomic profiles. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3982.

Clinical efficacy of type-B ultrasound-guided intraperitoneal hyperthermic chemoperfusion combined with systemic chemotherapy in advanced gastric cancer patients with malignant ascites

OBJECTIVES

To evaluate the clinical efficacy of systemic chemotherapy combined with intraperitoneal hyperthermic perfusion in advanced gastric cancer patients with malignant ascites.

PATIENTS AND METHODS

Forty-eight gastric cancer patients with malignant ascites who were admitted to our hospital were selected and randomly divided into the hyperthermic perfusion and control groups. The control group only received systemic chemotherapy, and the hyperthermic perfusion group received systemic chemotherapy combined with intraperitoneal hyperthermic chemoperfusion. The therapeutic efficacy, the survival time and the associated toxicity were determined for the two groups.

RESULTS

The efficacy was significantly higher in the hyperthermic perfusion group (85.7%) than in the control group (30.0%) (P 0.05). The median progression-free survival (PFS) was significantly longer in the hyperthermic perfusion group (12 months) compared with the control group (6 months) (P < 0.05). The median overall survival (OS) was significantly longer in the hyperthermic perfusion group (21 months) compared with the control group (9 months) (P < 0.05). There was a significantly higher 1-year survival rate in the hyperthermic perfusion group (89.3%) than in the control group (36.4%) (P < 0.05); however, there was no significant difference in the 3-year survival rate (10.7% vs. 10.0%). The Karnofsky Performance Status (KPS) score in the hyperthermic perfusion group increased significantly from 62.8 ± 1.84 to 74.3 ± 5.0 after hyperthermic chemoperfusion (P < 0.05).

CONCLUSION

Systemic chemotherapy combined with intraperitoneal hyperthermic perfusion exhibited significant clinical efficacy in advanced gastric cancer patients with malignant ascites, helped control ascites, improved the quality of life and extended PFS and OS. This treatment regimen is worth promoting.

Targeting protein neddylation with an NEDD8-activating enzyme inhibitor MLN4924 induced apoptosis or senescence in human lymphoma cells

Recent studies indicate that post-translational protein neddylation is required for the maintenance of cell viability in several lymphoma cell lines, while inhibition of the neddylation pathway with an NEDD8-activating enzyme (NAE) inhibitor MLN4924 induces apoptosis in lymphoma cells. However, the mechanism by which neddylation inhibition induces apoptosis in lymphoma cells has not been fully elucidated. Moreover, it is unknown whether neddylation inhibition triggers non-apoptotic cell-killing responses, such as cell senescence, in lymphoma cells. Here, we report that MLN4924 specifically inhibited protein neddylation, inactivated cullin-RING E3 ligase (CRL), the best-known neddylation substrate, and induced the accumulation of tumor-suppressive CRL substrates in lymphoma cells. Moreover, MLN4924 potently suppressed the growth of lymphoma cells by inducing G2 cell-cycle arrest, followed by apoptosis or senescence in a cell line-dependent manner. MLN4924-induced apoptosis was mediated by intrinsic apoptotic signaling with substantial up-regulation of pro-apoptotic Bik and Noxa as well as down-regulation of anti-apoptotic XIAP, c-IAP1 and c-IAP2, while senescence induction upon neddylation inhibition seemed dependent on the expression of tumor suppressor p21/p27. Together, these findings expand our understanding on how lymphoma cells respond to neddylation inhibition and support the development of neddylation inhibitors (e.g. MLN4924) for the treatment of lymphoma.

Antihyperglycemic and Antioxidant Activity of Fructus hordei Germinatus Extract on Streptozotocin-induced Diabetic Rats

Purpose: To explore the antihyperglycemic and antioxidant effects of Fructus Hordei Germinatus extract (FHGE) in diabetic rats.Methods: The aqueous extract of FHG was obtained by steeping the dried Fructus Hordei Germinatus in water at 60oC three times, each for 1 h before first drying in an oven and then freeze-drying the last extract thus obtained. Antihyperglycemic effect was measured by blood glucose and plasma insulin levels. Oxidative stress was evaluated in liver and kidney by antioxidant markers, viz, lipid peroxidation (LPO), superoxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GPx) and catalase (CAT), while blood serum levels of creatinine and urea were also determined in both diabetic control and treated rats.Results: Compared with diabetic rats, oral administration of FHGE at a concentration of 20, 40 and 80 mg/kg daily for 45 days showed a significant decrease in fasting blood glucose (p < 0.05) and increased insulin (p < 0.05) level,. Furthermore, it significantly reduced biochemical parameters (serum creatinine and serum urea, p < 0.05)). The treatment also resulted in significant increase in GSH, GPx (p < 0.05), SOD and CAT (p < 0.05), as well as decreased LPO (p < 0.05) level in the liver and kidney of diabetic rats.Conclusion: The results suggest that FHGE may effectively normalize the impaired antioxidant status in streptozotocin-induced diabetes in a dose-dependent manner. FHGE has a protective effect against lipid peroxidation by scavenging free radicals and is thus capable of reducing the risk of diabetic complications.Keywords: Fructus hordei Germinatus, Diabetic, Antihyperglycemic, Lipid peroxidation, Antioxidant, Fasting blood glucose, Creatinine, Urea

CD147 interacts with NDUFS6 in regulating mitochondrial complex I activity and the mitochondrial apoptotic pathway in human malignant melanoma cells

Malignant melanoma (MM) is one of the most lethal tumors and is characterized by high invasiveness, frequent metastasis, and resistance to chemotherapy. The risk of metastatic MM is accompanied by disordered energy metabolism involving the oxidative phosphorylation (OXPHOS) process, which is largely carried out in mitochondrial complexes. Complex I is the first and largest mitochondrial enzyme complex associated with this process. CD147 is a transmembrane glycoprotein mainly expressed on the cell surface, and also appears in the cytoplasm in some tumors. We found that CD147 is often translocated to the cytoplasm in metastatic MM specimens as compared to primary MM. We also demonstrated high expression of CD147 in isolated mitochondrial fractions of A375 cells. The yeast two-hybrid (Y2H) assay identified NDUFS6 (which encodes a subunit of mitochondrial respiratory chain complex I) as a candidate that interacts with CD147 and depletion of CD147 in A375 cells significantly decreased complex I enzyme activity. We also showed that CD147 increased the viability of A375 cells exposed to berberine-induced mitochondrial damage, and protected them from apoptosis through a mitochondrial-dependent pathway. This finding was confirmed by adding exogenous Bcl-2 to A375 cell cultures. In summary, our results identify the existence of CD147 in human melanoma cell mitochondria. They indicate that CD147 appears to regulate complex I activity and apoptosis in MM by interacting with mitochondrial NDUFS6. Our findings provide new insight into the function of CD147 and identify it as a promising therapeutic target in melanoma through disruption of the energy metabolism.

The Role of αA-Crystallin in Experimental Autoimmune Uveitis

Uveitis refers to a group of ocular inflammatory diseases that can lead to blindness. For years, researchers have been trying to decipher the underlying mechanisms and develop therapeutic strategies using the model of experimental autoimmune uveitis (EAU). Recently, αA-crystallin has been found to be upregulated in EAU and can even ameliorate its severity through different mechanisms, suggesting its use as a potent therapeutic factor against uveitis. Here we review the protective role of αA-crystallin and discuss its functional mechanisms in EAU.

Sleep duration and snoring associate with hypertension and glycaemic control in patients with diabetes

AIMS

Few studies have analysed the effect of sleep duration and snoring on hypertension and glycaemic control in patients with diabetes. This study aims to investigate the relationship of sleep duration and snoring on prevalent hypertension and glycaemic control in people with diabetes.

METHODS

In the baseline survey of the REACTION study, 56 032 patients with diabetes were categorized into four groups according to self-reported sleep duration: < 6, 6-7.9, 8-8.9 and ≥ 9 h. Snoring frequency was evaluated as 'usually', 'occasionally' or 'never'. Hypertension was assessed by systolic blood pressure, diastolic blood pressure, self-reported previous diagnosis and antihypertensive medications. 'Good' glycaemic control was defined as HbA1c < 53 mmol/mol (7.0%) and 'poor' glycaemic control as HbA1c ≥ 53 mmol/mol (7.0%).

RESULTS

Controlling for potential confounders and intermediates, sleep ≥ 9 h relative to intermediate sleep (6-7.9 h) was significantly associated with prevalent hypertension (OR: 1.25, 95% CI: 1.18-1.32) and poor glycaemic control (OR: 1.11, 95% CI: 1.05-1.18), and a U-shaped association was found between sleep duration and prevalent hypertension (P for quadratic trend = 0.019). Usually snoring was positively associated with prevalent hypertension (OR: 1.30, 95% CI: 1.23-1.37), whereas the association between snoring and poor glycaemic control was only on the borderline of statistical significance.

CONCLUSIONS

Compared with a sleep duration of 6-7.9 h, longer sleep duration was associated with a higher prevalence of hypertension and poor glycaemic control in people with diabetes. Moreover, the relationship between sleep duration and prevalent hypertension was U-shaped. These findings may propose important public health implications for diabetes management.

A novel HLA-A allele, HLA-A*02:544

The novel allele HLA-A*02:544 has two nucleotide changes from its most closely related allele, HLA-A*02:148. Firstly at nucleotide 255 where C → T (codon 60 GAC → GAT), resulting in a non-coding change as GAC and GAT both code for the same amino acid aspartic acid. Secondly at nucleotide 368 where T → G (codon 98 TTT → TGT) resulting in a coding change, 98 phenylalanine is changed to cysteine.

Mesenchymal stem cells regulate cytoskeletal dynamics and promote cancer cell invasion through low dose nitric oxide

Bone marrow-derived mesenchymal stem cells (BMSCs) can be recruited to tumor sites and integrate into the stroma of tumors. When co-cultured with BMSCs, otherwise weakly metastatic nasopharyngeal carcinoma cells (NPC) showed improved metastatic ability. BMSCs in the tumor environment displayed the characteristics of macrophages. Nitric oxide produced by BMSCs in tumor environment could translocate caldesmon to podosome in Ca2+/calmodulin manner and promoted metastatic ability of NPC cells through invadopodia formation, with which the NPC cells degrade the extracellular matrix. Thus, we concluded that the BMSCs promoted cell migration and invasion through nitric oxide-induced paracrine signals.