Chrysanthemum zawadskii extract protects osteoblastic cells from highly reducing sugar-induced oxidative damage

In this study, Chrysanthemum zawadskii extract (CZE) was investigated to determine its effects on 2-deoxy-D-ribose (dRib)-induced oxidative damage and cellular dysfunction in the MC3T3-E1 mouse osteoblastic cell line. Osteoblastic cells were treated with the highly reducing sugar, dRib, in the presence or absence of CZE. Cell viability, apoptosis and reactive oxygen species (ROS) production were subsequently examined. It was observed that dRib reduced cell survival, while it markedly increased the intracellular levels of ROS and apoptosis. However, pre-treatment of the cells with CZE attenuated all the dRib-induced effects. The antioxidant, N-acetyl-L-cysteine (NAC), also prevented dRib-induced oxidative cell damage. In addition, treatment with CZE resulted in a significant increase in alkaline phosphatase (ALP) activity and collagen content, as well as in the expression of genes associated with osteoblast differentiation [ALP, collagen, osteopontin (OPN), osteoprotegerin (OPG), bone sialoprotein (BSP), osteocalcin (OC) and bone morphogenetic protein (BMP)2, BMP4 and BMP7]. In mechanistic studies of the antioxidative potential of CZE, we found that CZE reversed the dRib-induced decrease in the expression of phosphatidylinositol 3-kinase (PI3K) and protein kinase B (AKT)1 and AKT2 genes, which are master regulators of survival-related signaling pathways. CZE also upregulated the gene expression of the antioxidant enzymes, superoxide dismutase (SOD)2, SOD3 and glutathione peroxidase 4 (GPx4), which was inhibited by dRib. Taken together, these results suggest that CZE attenuates dRib-induced cell damage in osteoblastic cells and may be useful for the treatment of diabetes-associated bone disease.

A cross-sectional analysis of the relationship between daily alcohol consumption and serum adiponectin levels among adults aged 40 years or more in a rural area of Korea

BACKGROUND/OBJECTIVES

Light-to-moderate alcohol consumption has been proposed to raise serum adiponectin levels, but this view is controversial. There is little information on the effect of heavy drinking. The aim of this study was to examine the relationship between alcohol consumption and serum adiponectin levels in healthy Koreans.

SUBJECTS/METHODS

The design of the study was cross-sectional, using data from the Korean Multi-Rural Communities Cohort Study (MRCohort), which is a part of the Korean Genome Epidemiology Study (KoGES). The subjects were 1542 individuals (635 men and 907 women) aged ≥ 40 years who were recruited in Yangpyeong-Gun, Kyunggi province, South Korea, in 2005 and 2006. Daily alcohol consumption was calculated from average frequency of alcohol consumption and the amount of alcohol consumed per occasion using a structured questionnaire and serum adiponectin levels were measured.

RESULTS

Although adiponectin levels appeared to be higher in those consuming moderate levels of alcohol than in nondrinkers, the difference was not statistically significant. Heavy drinking (≥ 90.0 g/day) was significantly related to reduced serum adiponectin levels (P=0.003), although the significance of the relationship was reduced after adjusting for potential confounders (P=0.061) such as age, waist/hip ratio, blood pressure, fasting blood glucose, current smoker, higher education, protein intake, vitamin C intake and vitamin E intake in men. The relation seemed to be stronger in individuals consuming alcohol in the form of takju (Korean rice wine; P=0.022).

CONCLUSIONS

Heavy alcohol drinking (≥ 90.0 g/day) may be related to lower serum adiponectin levels in Korean men.

Abstract 4659: Phase II study of a weekly liposomal paclitaxel formulation (Genexol®-PM) and gemcitabine® combination chemotherapy in patients with advanced biliary cancer

OBJECTIVE: Advanced biliary cancer is associated with a poor prognosis due to wide resistance to chemotherapeutic agents. This phase II clinical trial was conducted to determine the efficacy and safety of weekly gemcitabine and liposomal paclitaxel in patients with unresectable of metastatic biliary cancer.

METHODS: The eligibility criteria were patients 1) with pathologically proven biliary cancer, 2) with an ECOG performance status 0 to 2, 3) aged more than 18, 4) with measurable lesions, 5) with adequate hematologic, renal and liver functions, and 6) who provided written informed consent. Each treatment cycle was consisted of gemcitabine 1000 mg/m² and liposomal paclitaxel (Genexol-PM)100 mg/m² on days 1, 8 followed by rest perioid of 14 days. It was repeated until the appearance of disease progression or unacceptable toxicity up to maximal 10 cycles. The primary end point of this study was reponse rate, and secondary end points included toxicity, progression free survival and overall survival.

RESULTS: Forty five patients were enrolled; median age was 63 years; male (n=33) and female (n=12). The median number of cycles administered was 4.0 (range,1-10). Thirty nine patients were assessable for efficacy. Ten partial responses and 18 stable diseases were confirmed. Giving an overall response rate was 25.6% and disease control rate was 71.8% in per-protocol population. The median time to progression and median overall survival was 4.0 (95% CI; 3.17∼4.83) months and 8.13 (95% CI; 4.76∼11.51) months, respectively. MUC4 expression was not significantly correlated with overall survival and progression free survival (p=0.391).

CONCLUSION: Weekly gemcitabine combined with Genexol-PM® appears to be effective against advanced biliary cancers. Further randomized trials are needed to confirm this finding.

Citation Format: Keon Uk Keon Uk, Jin Young Kim, Young Rok Do, Hong Suk Song, Young June Jeon, Hun Mo Ryoo, Sung Hwa Bae, Jong Gwang Kim, Jin Ho Baek, Yee Soo Chae, Min Kyoung Kim, Kyung Hee Lee, Yoon Young Cho. Phase II study of a weekly liposomal paclitaxel formulation (Genexol®-PM) and gemcitabine® combination chemotherapy in patients with advanced biliary cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4659. doi:10.1158/1538-7445.AM2013-4659

Effects of ethanol exposure during early pregnancy in hyperactive, inattentive and impulsive behaviors and MeCP2 expression in rodent offspring

Prenatal exposure to alcohol has consistently been associated with adverse effects on neurodevelopment, which is collectively called fetal alcohol spectrum disorder (FASD). Increasing evidence suggest that prenatal exposure to alcohol increases the risk of developing attention deficit/hyperactivity disorder-like behavior in human. In this study, we investigated the behavioral effects of prenatal exposure to EtOH in offspring mice and rats focusing on hyperactivity and impulsivity. We also examined changes in dopamine transporter and MeCP2 expression, which may underlie as a key neurobiological and epigenetic determinant in FASD and hyperactive, inattentive and impulsive behaviors. Mouse or rat offspring born from dam exposed to alcohol during pregnancy (EtOH group) showed hyper locomotive activity, attention deficit and impulsivity. EtOH group also showed increased dopamine transporter and norepinephrine transporter level compared to control group in the prefrontal cortex and striatum. Prenatal exposure to EtOH also significantly decreased the expression of MeCP2 in both prefrontal cortex and striatum. These results suggest that prenatal exposure to EtOH induces hyperactive, inattentive and impulsive behaviors in rodent offspring that might be related to global epigenetic changes as well as aberration in catecholamine neurotransmitter transporter system.

Fludarabine, cytarabine, and attenuated-dose idarubicin (m-FLAI) combination therapy for elderly acute myeloid leukemia patients

We performed a phase II trial to evaluate the efficacy and safety of the modified fludarabine, cytarabine, and attenuated-dose idarubicin (m-FLAI) regimen in elderly acute myeloid leukemia (AML) patients. Elderly (≥60 years) AML patients who had not previously received chemotherapy were enrolled in the study. Patients received two consecutive cycles of m-FLAI chemotherapy as an induction. The m-FLAI regimen comprised fludarabine (25 mg/m(2) , days 1-4), cytarabine (1,000 mg/m(2) , days 1-4), and attenuated-dose idarubicin (5 mg/m(2) , days 1-3). The primary end point was complete remission (CR) rate. Secondary end points were overall survival (OS), event-free survival (EFS), and treatment-related mortality (TRM). There were 108 patients (median age 68.4 years, M:F = 64:44) enrolled in the study. CR was achieved in 56.5% of patients, and the TRM rate was 21.3%. Median OS and median EFS were 10.2 and 6.6 months, respectively. The mortality at 30 and 60 days was 15 and 21%, respectively. Performance status and comorbidity did not have prognostic value in this patient cohort. Bone marrow expression of CD117 was associated with increased EFS and OS. m-FLAI is an effective induction regimen for previously untreated AML in elderly patients. In addition, bone-marrow CD117 expression is an independent favorable prognostic factor in elderly AML patients. (ClinicalTrials.gov number, NCT01247493).

Growth after hematopoietic stem cell transplantation in children with acute myeloid leukemia

Previous studies have shown that hematopoietic stem cell transplantation (HSCT) may result in growth impairment. The purpose of this study was to evaluate the growth during 5 yr after HSCT and to determine factors that influence final adult height (FAH). We retrospectively reviewed the medical records of acute myeloid leukemia (AML) patients who received HSCT. Among a total of 37 eligible patients, we selected 24 patients who began puberty at 5 yr after HSCT (Group 1) and 19 patients who reached FAH without relapse (Group 2). In Group 1, with younger age at HSCT, sex, steroid treatment, hypogonadism and hypothyroidism were not significantly associated with growth impairment 5 yr after HSCT. History of radiotherapy (RT) significantly impaired the 5 yr growth after HSCT. Chronic graft-versus-host disease (cGVHD) only temporarily impaired growth after HSCT. In Group 2, with younger age at HSCT, steroid treatment and hypogonadism did not significantly reduce FAH. History of RT significantly reduced FAH. Growth impairment after HSCT may occur in AML patients, but in patients without a history of RT, growth impairment seemed to be temporary and was mitigated by catch-up growth.

Abstract P1-14-16: Young age: predicts poor response rate after neoadjuvant chemotherapy in endocrine-responsive breast cancer

Background: Breast cancer rarely occurs in very young women(age<35years), its diagnosis and management could sometimes be difficult. Especially, the patients with positive hormone receptors have significantly lower overall and disease-free survival rates in very young age group than in the older age group. In the previous study, adjuvant tamoxifen therapy might provide less survival benefit when added to chemotherapy in very young breast cancer patients. This study was to compare the response to neoadjuvant chemotherapy for HR-positive breast cancer patients according to the age.

Patients and Methods: A total of 551 consecutive patients were evaluated, received preoperative chemotherapy and referred to surgery at the Seoul National University Hospital from January 2001 to December 2010. The clinicopathologic factors and the response to neoadjuvant chemotherapy between the very young age group and the older age group were retrospectively compared. A pCR was defined as the absence of residual invasive carcinoma in the breast.

Results: Among the 551 patients who received neoadjuvant chemotherapy, 297 patients revealed HR-positive. The median age of all patients was 42 (range, 24∼67)years and very young age group accounted for 17.2%(51/297). Of 297 patients, 262 (88.2%) received taxane-containing regimen pre-operatively, and there's no difference of chemotherapeutic regimen between two age groups. There were no differences noted between two age groups about clinicopathologic characteristics. The univariate and multivariate analysis of variables related to ORR(CR+PR vs SD+PD) to neoadjuvant chemotherapy showed that very young age at diagnosis was independent predictive factor for poor neoadjuvant chemotherapeutic response.(p = 0.043, OR = 0.528) And this tendency was observed more significantly in age under 30.(p = 0.001, OR = 0.147) Only thirteen patients(4.4%) achieved pCR, which is relatively lower rate, reflective poor chemotherapeutic response in HR-positive group, and there was no relations between pCR rate and the two age groups(p = 0.861) in this study. Taxane-containing regimen(p = 0.004) and Ki67 level(p = 0.005) were related to pCR statistically significantly. Breast conservation rate is not significantly different between two age groups.(age<35: age>35= 51.2% vs 41.3%, p = 0.150)

Conclusions: The very young age group showed lower ORR(CR+PR) to neoadjuvant chemotherapy, although there was no significant difference in pCR rate between the two age groups in HR-positive breast cancer patients. We might have to consider and revalue the chemotherapeutic role as neoadjuvant therapy in very young age, HR-positive group, since they had lower survival rate than others.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-16.

Abstract PD05-07: Detection of fusion transcripts among 100 breast cancer samples by next generation sequencing

Introduction Fusions genes and it's products are widely applied as biomarker and therapeutic target in hematopoietic cancers. It's role as a “driver” of oncogenic pathway have also been proved in several epithelial solid cancers including prostate, lung and breast cancer. We performed high throughput next generation sequencing technique (RNA-Seq) to identify the novel fusion transcript(FT) in a large set of primary breast cancer samples.

Materials and Method Total RNA was prepared using the Illumina® TrueSeq™ RNA sample Preparation Kit and TrueSeq mRNA library was constructed. Clustering was done with HiSeq 2000 and Solexa's sequencing was performed. We used tissues extracted from previously collected 100 fresh-frozen primary breast cancer samples obtained after surgical resection. Among 100 samples, 1 failed to pass the process of RNA sequencing and no expression of fusion transcripts were observed in 7 samples resulting in 92 samples with mRNA-Seq data of fusion transcripts. Fourteen(15.2%) samples were cases with distant metastasis during follow up. Estrogen receptor(ER) was positive in 40(43.5%) samples and 23(25%) were triple negative breast cancer.

Results and discussion We detected 958 fusion transcripts among 92 tumors and 58 were chosen for tumor-specific fusion transcript candidate (Fragments per kilo-base of exon per million fragments mapped, FPKM>500 and 3 times higher than average, probability>0.6). Most of the fusion transcripts were “private”, expressed only in one sample. Estrogen receptor(ER) positive breast cancer samples had 29 fusion transcripts and ER negative had 25 fusion transcripts among the 58 tumor-specific candidates. HER2 negative samples exhibited 29 fusion transcripts while 15 were identified in HER2 negative samples. Triple negative sample showed 4 TF candidates. Among the 17 recurrence samples 190 fusion transcripts were identified. Of the 190 fusion transcripts in recurred samples, 24 candidates of recurrence-specific FTs were chosen by it's high expression level (FPKM>300 and 2 times higher than average, probability>0.5). Eight were expressed both in recurred, non-recurred samples and 16 were exclusively expressed in recurred samples. No fusion transcript matched directly with the currently known actionable gene-list owing to the limited number while majority is unexploited. Further validation and functional pathway analysis is under progress to ascertain the role of highly suspected fusion transcripts with oncogenic property. Considering the high incidence of breast cancer world-wide, identification of TF expressed even in only a minor percentage among the whole breast cancer population, if druggable, it can be applicable to large number of patients.

Conclusion We performed a whole-transcriptome sequencing with a large set of primary breast cancer samples and detected abundant fusion transcripts. The majority of breast cancer(92.9%, 92/99) had at least one fusion transcript suggesting it's role during the tumorigenesis and progression process. With scarce evidence and confirmed data of actionable fusion gene and it's product, data interpretation for it's clinical utility is rather complicated. Accumulation of these large set data of fusion transcript must serve as a groundwork for future work.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD05-07.

Up-regulation of p27Kip1 protects hES cells from differentiation-associated and caspase 3-dependent apoptosis

Recently, it has been suggested that p27Kip1, the cell cycle regulatory protein, plays a pivotal role in the progression of normal differentiation in murine embryonic stem (mES) cells. In the current study, we investigated the role of p27Kip1 in the regulation of differentiation and apoptotic induction using Western blotting, quantitative real-time RT-PCR, and small interfering RNA (siRNA) assays and confocal laser scanning microscopic analysis of H9 human ES (hES) cells and H9-derived embryoid bodies (EBs) grown for 10 (EB10) and 20 days (EB20). Our results demonstrate that the proteins p27Kip1 and cyclin D3 are strongly associated with cellular differentiation, and, for the first time, show that up-regulation of p27Kip1 protects hES cells from inducing differentiation-associated and caspase 3-dependent apoptosis.

Epidemiology of gastroenteropancreatic neuroendocrine tumours

Gastroenteropancreatic neuroendocrine tumours are a heterogeneous group of tumours arising from diffuse endocrine cells, causing unique clinical syndromes. These tumours, formerly named carcinoid, can involve any part of the gastrointestinal tract and the endocrine pancreas and have a wide range of malignant potential: from benign to poorly differentiated tumours. In this review we will summarize the data available on the epidemiology of gastroenteropancreatic tumours as it is reported from around the world. This includes annual incidence rates at the various anatomic sites, and trends in incidence rates with time. In addition age and stage at presentation, gender and racial differences and finally prognosis and survival were collected when reported.

Randomized trial of myeloablative conditioning regimens: busulfan plus cyclophosphamide versus busulfan plus fludarabine

PURPOSE

We conducted a phase III randomized clinical trial to compare two myeloablative conditioning regimens for allogeneic hematopoietic cell transplantation (HCT) in patients with leukemia and myelodysplastic syndrome.

PATIENTS AND METHODS

After randomization, 64 patients received busulfan (3.2 mg/kg per day × 4 days) plus cyclophosphamide (60 mg/kg per day × 2 days; BuCy), and 62 patients received busulfan (same dose and schedule) plus fludarabine (30 mg/m(2) per day × 5 days; BuFlu).

RESULTS

The median age was 41 years (range, 17 to 59 years). Five patients in the BuFlu arm experienced graft failure (primary, n = 1; secondary, n = 4). At 4 weeks after HCT, the median percentage of recipient hematopoietic chimerism was significantly greater in the BuFlu arm (0% v 5.5%; P < .001), and complete donor chimerism was greater in the BuCy arm (97.2% v 44.4%; P < .001). Severe (grade 3 or higher) infection and gastrointestinal adverse events were significantly more common in the BuCy arm, but the frequencies of hepatic adverse events were similar in the two arms. Nonrelapse mortality was similar in the two arms, but the BuCy arm had better overall survival (OS), relapse-free survival (RFS), and event-free survival (EFS; OS at 2 years, 67.4% v 41.4%, P = .014; RFS, 74.7% v 54.9%, P = .027; EFS, 60.7% v 36.0%, P = .014).

CONCLUSION

Our results indicate that the BuFlu regimen is not a suitable replacement for the BuCy regimen in young adults who are eligible for myeloablative conditioning therapy for allogeneic HCT.

First Report of Cobweb Disease Caused by Cladobotryum mycophilum on the Edible Mushroom Pleurotus eryngii in Korea

Pleurotus eryngii is one of the most commercially important mushrooms in Korea. In May 2009, unusual symptoms were observed in P. eryngii grown in mushroom farms in Changnyeong and Hapcheon, in Gyeong-nam Province, Korea. One of the main symptoms was cobweb-like growth of fungal mycelia over the mushroom surface. Colonies on the surface rapidly overwhelmed the mushrooms, which turned pale brown or yellow. Mushrooms eventually turned dark brown and became rotten. Colonies of the isolates on potato dextrose agar (PDA) were yellowish, and a reddish or orange color was evident in the agar. The colonies grew 20 to 30 mm per day on PDA. Large spores with a single septum were produced on vertically branched conidiophores bearing two to four, mostly three to four, sporogenous cells, ranging from 17.2 to 20.5 μm long and 8.0 to 10.2 μm thick. The shape of the conidia was ellipsoid and obovoid. These morphological characteristics are consistent with descriptions of Cladobotryum mycophilum, a causal agent of cobweb disease in Agaricus bisporus (1,4). To identify the isolated fungal pathogen, the ITS region was amplified with ITS1 and ITS4 primers and sequenced. The sequence data from the isolate was deposited in GenBank (Accession No. JF693809). A BLAST search showed that the isolated strain belonged to a species of Cladobotryum. The highest similarity (99.5%) was to the ITS sequence of C. mycophilum (teleomorph Hypomyces odoratus) (GenBank Accession Nos. JF505112 and Y17096) (3,4). The strain that was tested for pathogenicity was grown on PDA at 25°C for 72 h. The inoculum was prepared by flooding the agar surface with 10 ml of sterilized double distilled water and scraping it with a spatula. The resulting spore suspension was filtered through three layers of cheesecloth. Conidial concentration was adjusted with a hemacytometer to 1 × 10⁶ conidia ml^-1. A conidia suspension was inoculated onto each of several stages of mushroom cultivation with a pipette. The control was spotted with double distilled water. In the case of infection during the inoculation and spawn running stages, the fungal mycelia colonized the media and hampered development of the mycelium of P. eryngii. In the regeneration and primordia formation stages of the host, the mycelium of the pathogen covered the surface of the plastic bottle containing the substrates and developed many spores. In the growing and harvesting stages, the surface of mushroom was overwhelmed by the mycelium of the fungal pathogen and turned pale or dark brown, accompanied by cracking of the stipe surface and finally rotting with a foul odor. These symptoms were similar to the observation from natural infection. The symptoms of the cobweb-like disease in A. bisporus (1,2) were observed within 5 to 7 days of inoculation with conidia suspensions of C. mycophilum. Fungi isolated from inoculated mushrooms were shown to be identical, based on phenotypic characteristic, to the inoculated strain used in these pathogenicity tests. No symptoms were observed on controls. To our knowledge, this is the first report on the occurrence of C. mycophilum on the edible mushroom P. eryngii in Korea. Based on the pathogenicity test results, the pathogen could attack P. eryngii in any cultivation stage, making it a potentially serious fungal pathogen in P. eryngii. References: (1) C. G. Back et al. J. Gen. Plant Pathol. 76:232, 2010. (2) R. H. Gaze. Mushroom J. 546:23, 1995. (3) F. J. Gea et al. Plant Dis. 95:1030, 2011. (4) H. M. Grogan and R. H. Gaze. Mycol. Res. 104:357, 2000.

Adenovirus adenine nucleotide translocator-2 shRNA effectively induces apoptosis and enhances chemosensitivity by the down-regulation of ABCG2 in breast cancer stem-like cells

Cancer stem cells (CSCs) are resistant to chemo- and radio-therapy, and can survive to regenerate new tumors. This is an important reason why various anti-cancer therapies often fail to completely control tumors, although they kill and eliminate the bulk of cancer cells. In this study, we determined whether or not adenine nucleotide translocator-2 (ANT2) suppression could also be effective in inducing cell death of breast cancer stem-like cells. A sub-population (SP; CD44⁺/CD24^-) of breast cancer cells has been reported to have stem/progenitor cell properties. We utilized the adeno-ANT2 shRNA virus to inhibit ANT2 expression and then observed the treatment effect in a SP of breast cancer cell line. In this study, MCF7, MDA-MB-231 cells, and breast epithelial cells (MCF10A) mesenchymally-transdifferentiated through E-cadherin knockdown were used. ANT2 expression was high in both stem-like cells and non-stem-like cells of MCF7 and MDA-MB-231 cells, and was induced and up-regulated by mesenchymal transdifferentiation in MCF10A cells (MCF10A^EMT). Knockdown of ANT2 by adeno-shRNA virus efficiently induced apoptotic cell death in the stem-like cells of MCF7 and MDA-MB-231 cells, and MCF10A^EMT. Stem-like cells of MCF7 and MDA-MB-231, and MCF10A^EMT cells exhibited increased drug (doxorubicin) resistance, and expressed a multi-drug resistant related molecule, ABCG2, at a high level. Adeno-ANT2 shRNA virus markedly sensitized the stem-like cells of MCF7 and MDA-MB-231, and the MCF10A^EMT cells to doxorubicin, which was accompanied by down-regulation of ABCG2. Our results suggest that ANT2 suppression by adeno-shRNA virus is an effective strategy to induce cell death and increase the chemosensitivity of stem-like cells in breast cancer.

Visual pathway-related horizontal reference plane for three-dimensional craniofacial analysis

OBJECTIVES

To construct three-dimensional (3D) horizontal reference planes based on visual pathway and to determine their stability and reliability by analyzing the structural patterns of normal and dysmorphology for 3D craniofacial analysis.

SETTING AND SAMPLE POPULATION

Thirty-six subjects with maxillofacial dysmorphology and malocclusion, and eight normal controls. MATERIALS AND METHODS POPULATION: On the 3D computed tomographic images of the subjects, the visual pathway-based planes, including the orbital axis plane (OAP), visual axis plane (VAP), and the optical axis plane (OpAP), were constructed and evaluated.

RESULTS

The OAP, but not the VAP and OpAP, showed the ideal relationship between the midsagittal and posterior maxillary plane, and properly described the different patterns of maxillofacial dysmorphology with craniofacial plane 1 of Delaire's analysis and the occlusal plane.

CONCLUSIONS

The proposed visual pathway-related horizontal reference planes, and in particular the OAP, seem to correctly express the visual axis and the position of the head in natural head position and can be used as a horizontal reference plane for the 3D analysis of craniofacial dysmorphology and anthropology.

Clinical effectiveness and safety of OROS® hydromorphone in break-through cancer pain treatment: a multicenter, prospective, open-label study in Korean patients

OBJECTIVE

To evaluate the effectiveness of OROS® hydromorphone in reducing breakthrough pain (BTP) medication frequency in Korean patients with chronic cancer pain.

SETTINGS AND DESIGN

Multicenter, prospective, open-label, phase IV study.

PARTICIPANTS

Patients with chronic malignant pain using immediate-release oxycodone more than two times per day for BTP.

INTERVENTIONS

Patients were stabilized on their ongoing drug for 3 days immediately before baseline measurements (day 0). Medication was changed to OROS® hydromorphone at a dose equianalgesic to oxycodone using a 2.5:1 controlled-release oxycodone to hydromorphone hydrochloride conversion ratio; the patients were observed for 7 days. Dose was titrated, if required, and the patients were observed for another 7 days. Effectiveness and safety parameters were measured at baseline, day 7, and day 14.

MAIN OUTCOMES

BTP medication frequency on days 7 and 14, compared to baseline.

RESULTS

Of the 141 patients screened, 114 received study drug and 98 completed the study. Compared to day 0, daily BTP medication frequency on day 14 decreased from 2.93 to 2.00 (p > 0.0001), daily BTP frequency decreased from 3.67 to 2.44 (p > 0.0001), and end-of-dose pain frequency decreased by 44 percent. Pain was controlled adequately during daytime and night-time. Pain intensity decreased by 11 percent as assessed using the Korean Brief Pain Inventory and by 17 percent as assessed using the numerical rating scale. About 61.2 percent patients and 60.2 percent physicians were satisfied with the treatment. Common adverse events, which occurred in 91.2 percent patients, were constipation, somnolence, and dizziness.

CONCLUSION

Once-daily OROS® hydromorphone is efficient in the reduction of cancer pain-related BTP episodes, including end-of-dose pain.

Effect of dose escalation with single opioid, fentanyl matrix, for current cancer pain management: Multicenter, prospective, observational study

e19538

Background: It is clinical experience that end-of-dose failure was commonly observed and many cancer patients increase the frequency of opioid administration because of that. Another treatment option could be to increase the dose of the opioid administered. High-dose fentanyl matrix use is known to be effective in controlling pain in cancer patients. To measure effectiveness of increase in single dose of fentanyl matrix in patients whose pain was not controlled sufficiently with the analgesic use in real practice at the investigator’s discretion, we perform the study. Methods: A multi-center, open-label, prospective, observational study was conducted in 30 hospitals in Korea between August and December 2008. Results: 452 patients were enrolled. A total 404 patients completed the study. Mean pain intensity decresed from 5.27 on the second to 3.37 at the end of the trial. There was significant difference in pain intensity (p < 0.001) between first and last visit. The percentage of pain intensity difference was 30.1%. The prevalence of end-of-dose-failure (EOD) at visit 1 was 73% of the enrolled 452 patients. After the use of the fentanyl patch EOD decreased from 73% to 56%. Pain intensity of patients experiencing EOD was 5.64 at baseline compared to 4.27 in patients without EOD. On Visit 2, pain intensity in patienst with and without EOD was 4.02 and 2.54. Of enrolled 404 patients, mean of increasing dose of fentanyl matrix was 55.6mcg/day. Satisfaction rate of investigator’s global assessment was 66.0%, and that of the patients’ global assessment was 63%. The rate of pain improvement was 33.7% by Clinical Global Improvement- Improvement after the use of the fentanyl patch. The observed adverse events were mainly nausea, asthenia, constipation and diarrhea. Conclusions: This study demonstrated that increasing dose of fentanyl patch decreased pain intensity, and decreased the rate of patients experiencing EOD. Also satisfaction rate was increasing after use fentanyl patch. Thus, fentanyl patch may be effective in cancer patients whose pain was previously not controlled sufficiently or who experienced EOD, the side effects were as could be expected with an opioid.

Multicenter randomized phase II study of weekly docetaxel alone versus weekly docetaxel plus oxaliplatin as a second-line chemotherapy in patients with advanced gastric cancer: Preliminary response and safety results

e14570

Background: Gastric cancer is a frequent malignancy with worldwide estimated incidence of 990,000 cases, representing 7.8% of all cancers in 2008. There are limited data suggesting a benefit for doublet second-line chemotherapy in advanced gastric cancer. Methods: The eligibility criteria were patients 1) with prior exposure to cisplatin based chemotherapy and advanced or recurrent stomach cancer 2) with pathologically proven gastric adenocarcinoma, 3) with an ECOG performance status 0 to 2, 4) with measurable lesions. Each treatment cycle was consisted of docetaxel 36 mg/m2 in docetaxel mono therapy group and docetaxel 36 mg/m2, oxaliplatin 80 mg/m2 in docetaxel/oxaliplatin doublet therapy group on days 1, 8. The primary end point of this study was response rate, and secondary end points included toxicity, progression free and overall survival. Results: Fifty two patients were enrolled; median age was 63 years; male (n=42) and female (n=10); docetaxel mono therapy (n=27) and docetaxel/oxalliplatin doublet therapy (n=25). The median number of cycles administered was 2.5 (range,1-9). Fourty eight patients were assessable for efficacy. Four partial responses, 7 stable diseases in mono therapy group (RR; 4/27, 14.8%) and 1 complete remission, 4 partial responses, 13 stable diseases in double therapy group (RR; 5/25, 20.0%) were confirmed (p=0.198). Median progression free survival was 1.97 months in the mono therapy group and 4.93 months in doublet therapy group (p=0.007). Median overall survival was 11.57 months in the mono therapy group and 8.13 months in doublet therapy group (p=0.650). Grade 3 or 4 adverse events were reported in 11 of 52 patients; G3 pain were in 2 patients and G3 pneumonia was in 1 patient in mono group, G3/4 neutropenia were 5 patients in the combination group, G3 nausea, vomiting, general weakness was 1 patient each group in combination group. Conclusions: Weekly docetaxel/oxaliplatin doublet therapy showed superior progression free survival to monotherapy group as second line therapy in cisplatin pretreated advanced gastric cancer patients.

A randomized comparison of cyclophosphamide vs. reduced dose cyclophosphamide plus fludarabine for allogeneic hematopoietic cell transplantation in patients with aplastic anemia and hypoplastic myelodysplastic syndrome

Recently, a less toxic regimen comprising reduced cyclophosphamide (Cy), fludarabine, and anti-thymocyte globulin (ATG) (Cy-Flu-ATG) was used to condition high-risk patients scheduled for allogeneic hematopoietic cell transplantation (alloHSCT) instead of standard Cy-ATG in patients with severe aplastic anemia (AA). We performed a randomized phase III study to compare the regimen-related toxicities (RRTs) of two different conditioning regimens: Cy-ATG vs. Cy-Flu-ATG. Patients in the Cy-ATG arm received Cy at 200 mg/kg. Those in the Cy-Flu-ATG arm received fludarabine (Flu) at 150 mg/m(2) and Cy at 100 mg/kg. A total of 83 patients (40 in the Cy-ATG and 43 in the Cy-Flu-ATG) were enrolled. Seventy-nine patients had AA and four had MDS. All predefined RRTs were significantly lower in patients of the Cy-Flu-ATG arm (23.3 vs. 55.0 %; p = 0.003). Infection with identified causative organism and sinusoidal obstruction syndrome, hematuria, febrile episodes, and death from any cause tended to be more frequent in Cy-ATG arm but did not differ significantly between arms. There was no difference in neutrophil engraftment failure (2.5 vs. 2.33 %; p = 0.959), acute graft-versus-host disease (GvHD) (15.0 vs. 23.3 %; p = 0.388), and chronic GvHD (16.7 vs. 16.2 %; p = 0.961) between Cy-ATG and Cy-Flu-ATG arms. The 4-year survival rate did not differ between the Cy-ATG and Cy-Flu-ATG arms. Preconditioning with Cy-Flu-ATG was superior to that afforded by Cy-ATG in terms of reducing RRT levels without increasing engraftment failure.

Multiplication of Chromosome 17 Centromere Is Associated with Prognosis in Patients with Invasive Breast Cancers Exhibiting Normal HER2 and TOP2A Status

PURPOSE

This study aimed to investigate the clinical significance of chromosome 17 centromere (CEP17) multiplication (increased copy number of CEP17) related to human epidermal growth factor receptor 2 (HER2) and topoisomerase II alpha (TOP2A) status in patients with invasive breast cancer.

METHODS

We constructed tissue microarrays using 594 invasive breast cancer samples and performed single-color silver-enhanced in situ hybridization (SISH) assay for HER2, TOP2A, and CEP17 to assess for copy number aberrations. The association of CEP17 multiplication with patient survival was analyzed according to HER2 and TOP2A status.

RESULTS

Among 567 informative cases, HER2 amplification was noted in 22.8%, TOP2A amplification in 8.3% and TOP2A deletion in 11.1%. CEP17 multiplication was identified in 33.2% and was significantly associated with worse overall survival (OS) (p=0.02) and disease-free survival (DFS) (p=0.02). CEP17 multiplication correlated with patient survival in patients with normal TOP2A or non-amplified HER2 status, but the prognostic significance was lost in those with altered TOP2A or amplified HER2. On multivariate analyses, CEP17 multiplication was an independent prognostic factor for poorer OS (p=0.02) and DFS (p=0.01) in patients with normal TOP2A and non-amplified HER2.

CONCLUSION

CEP17 multiplication was identified as a promising prognostic marker in patients with invasive breast cancer exhibiting either non-amplified HER2 or normal TOP2A status.

Down-regulation of survivin suppresses uro-plasminogen activator through transcription factor JunB

Survivin, a member of the inhibitors of apoptosis protein family, is expressed during development and in various human cancers. However, the clinical relevance of survivin in cancer is still a matter of debate. Genes induced by hepatocyte growth factor (HGF) were screened using cDNA microarray technology in the stomach cancer cell lines, NUGC3 and MKN28. The levels of JunB, survivin, and uro-plasminogen activator (uPA) were up-regulated in cells treated with HGF in a dose-dependent manner. HGF-induced up regulation of JunB, survivin, and uPA was inhibited by pre-treatment with a MEK inhibitor (PD 98059). HGF-induced up-regulation of uPA was repressed by survivin knockdown. HGF enhanced the binding activity of JunB to the survivin promoter in control cells, but not in the JunB-shRNA cells. Transfection with survivin- shRNA resulted in a decrement of cell proliferation, as determined with MTT assays. In an in vitro invasion assay, significantly fewer cells transfected with survivin shRNA than control cells were able to invade across a Matrigel membrane barrier. In conclusion, survivin appeared to play an important role in the up-regulation of uPA induced by HGF via JunB and might contribute to HGF-mediated tumor invasion and metastasis, which may serve as a promising target for gastric cancer therapy.

VEGFA and VEGFR2 genetic polymorphisms and survival in patients with diffuse large B cell lymphoma

We evaluated the impact of functional polymorphisms in the vascular endothelial growth factor A (VEGFA) and vascular endothelial growth factor 2 (VEGFR2) genes on the survival of patients with diffuse large B cell lymphoma (DLBCL). Five potentially functional polymorphisms in the VEGFA (rs699947, rs2010963 and rs3025039) and VEGFR2 (rs1870377 and rs2305948) genes were assessed in 494 DLBCL patients treated with rituximab plus CHOP chemotherapy. The associations of genotype and haplotype with overall survival (OS) and progression-free survival (PFS) were analyzed. Of the five polymorphisms, VEGFR2 rs1870377T>A was significantly associated with both OS and PFS; in the dominant model, patients with the AA + TA genotypes had significantly better OS (P = 0.002) and PFS (P = 0.004) than those with the TT genotype. The association between significantly better OS and the AA + TA genotypes was observed separately in patients with low (0-2; P = 0.035) and high (3-5; P = 0.043) International Prognostic Index scores. Multivariate analysis showed that, relative to the AA + TA genotypes, the TT genotype was an independent prognostic factor for poor OS (HR, 1.71; 95% CI, 1.21-2.43; P = 0.002) and PFS (HR, 1.57; 1.13-2.17; P = 0.004). Other independent significant predictors of survival in patients with DLBCL were International Prognostic Index score, age > 60 years, lactate dehydrogenase concentration >normal, extranodal disease >1 and presence of B symptoms. The VEGFR2 rs1870377 polymorphism might affect survival in patients with DLBCL, suggesting that angiogenesis might be related to poor survival in these patients.

Influence of long-term statin use in type 2 diabetic patients on thyroid nodularity in iodine-sufficient area

Statins have marked beneficial effects on lipid profile, but also have pleiotropic actions. A previous study in an iodine-deficient area suggested that statin use is associated with reduced thyroid volume and nodularity. We performed this study to investigate how long-term statin use in type 2 diabetic patients affects thyroid nodularity in iodine-sufficient area.We recruited euthyroid type 2 diabetic patients, receiving statin therapy continuously for at least 5 years (statin group) and, age and sex matched statin-naive type 2 diabetic patients (control group). Subjects with past history of cancer, thyroid disease or treatment with lithium or amiodarone; family history of thyroid cancer; palpable goiter or thyroid nodule, and/or positive thyroperoxidase antibody were excluded. The prevalence, number, and volume of thyroid nodules, size of thyroid were evaluated in all subjects by high resolution ultrasound.Prevalence of non-palpable thyroid nodules of statin group (n=70) and control group (n=98) were 51 and 53%, respectively. There was no difference of prevalence, number, and volume of non-palpable thyroid nodules and size of thyroid between statin and control group. But, the patients aged between 60 and 65 years from statin group showed lower prevalence of non-palpable thyroid nodules than the patients with same age interval from control group (4 out of 12 patients, 33%, statin group; 19 out of 27 patients, 70%, control group; P=0.04).Long-term statin use in elderly type 2 diabetic patients was associated with lesser prevalence of thyroid nodules in an iodine-sufficient area. Our data might support a possible antiproliferative effect of statins on thyroid in old type 2 diabetic patients. But, the effect was not as strong as that in an iodine-deficient area and further studies with enough numbers of subjects and revised design will be needed.

Prevalence of echocardiographic criteria for the diagnosis of pulmonary hypertension in patients with Graves' disease: before and after antithyroid treatment

BACKGROUND

Right-sided heart failure with clinical manifestation is only occasionally seen in patients with Graves' disease (GD). Recent studies revealed that pulmonary hypertension (PHT) detected by echocardiography was not rare in patients with GD. We performed this study to investigate the prevalence of PHT in patients with GD before and after antithyroid treatment, and to assess potential mechanisms from the relationship with clinical and echocardiographic features.

SUBJECTS AND METHODS

Serial echocardiographic examinations were performed in 64 patients with newly diagnosed GD before and after antithyroid treatment to measure cardiac factors, such as pulmonary artery systolic pressure (PAPs), cardiac output, total vascular resistance, left ventricular filling pressure and right ventricular (RV) function. PHT was defined as PAPs of at least 35 mmHg.

RESULTS

The prevalence of PHT in untreated GD patients was 44% (28 out of 64 patients). The presence of systemic hypertension was associated with PHT, especially with pulmonary venous hypertension. GD patients with PHT showed reduced RV function represented by higher RV myocardial performance index without difference of pulmonary vascular resistance, RV wall thickness and peak systolic velocity of free wall side of tricuspid annulus. Follow-up echocardiography was performed in 20 out of 28 GD patients with PHT, and PHT disappeared in all except one patient.

CONCLUSION

PHT is a frequent and reversible complication in patients with GD. Our study suggests that PHT in GD may not be related to underlying autoimmune process and increased pulmonary blood flow from thyrotoxicosis might contributes to the pathogenesis of PHT related to GD.

Multicenter retrospective analysis of 581 patients with primary intestinal non-hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL)

Background

Primary intestinal non-Hodgkin lymphoma (NHL) is a heterogeneous disease with regard to anatomic and histologic distribution. Thus, analyses focusing on primary intestinal NHL with large number of patients are warranted.

Methods

We retrospectively analyzed 581 patients from 16 hospitals in Korea for primary intestinal NHL in this retrospective analysis. We compared clinical features and treatment outcomes according to the anatomic site of involvement and histologic subtypes.

Results

B-cell lymphoma (n = 504, 86.7%) was more frequent than T-cell lymphoma (n = 77, 13.3%). Diffuse large B-cell lymphoma (DLBCL) was the most common subtype (n = 386, 66.4%), and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) was the second most common subtype (n = 61, 10.5%). B-cell lymphoma mainly presented as localized disease (Lugano stage I/II) while T-cell lymphomas involved multiple intestinal sites. Thus, T-cell lymphoma had more unfavourable characteristics such as advanced stage at diagnosis, and the 5-year overall survival (OS) rate was significantly lower than B-cell lymphoma (28% versus 71%, P < 0.001). B symptoms were relatively uncommon (20.7%), and bone marrow invasion was a rare event (7.4%). The ileocecal region was the most commonly involved site (39.8%), followed by the small (27.9%) and large intestines (21.5%). Patients underwent surgery showed better OS than patients did not (5-year OS rate 77% versus 57%, P < 0.001). However, this beneficial effect of surgery was only statistically significant in patients with B-cell lymphomas (P < 0.001) not in T-cell lymphomas (P = 0.460). The comparison of survival based on the anatomic site of involvement showed that ileocecal regions had a better 5-year overall survival rate (72%) than other sites in consistent with that ileocecal region had higher proportion of patients with DLBCL who underwent surgery. Age > 60 years, performance status ≥ 2, elevated serum lactate dehydrogenase, Lugano stage IV, presence of B symptoms, and T-cell phenotype were independent prognostic factors for survival.

Conclusions

The survival of patients with ileocecal region involvement was better than that of patients with involvement at other sites, which might be related to histologic distribution, the proportion of tumor stage, and need for surgical resection.

Microbleeds and free active MMP-9 are independent risk factors for neurological deterioration in acute lacunar stroke

BACKGROUND AND PURPOSE

in this prospective study, we evaluated mutual relationships amongst microbleeds, matrix metalloproteinase-9 (MMP-9) and neurological deterioration in patients with their first acute lacunar stroke.

METHODS

based on diffusion-weighted image findings, we recruited 206 patients with their first acute lacunar stroke. Those without a MRI scan were excluded. Small (a maximum lesion diameter of 15 mm) areas of subcortical gray and white matter with increased signals were considered as lacunar infarctions. GRE images were obtained within 24 h of the onset of stroke symptoms. Venous blood was sampled at base line (within 24 h). Clinical, biochemical, rheological and inflammatory parameters, neurological scales and free, active MMP-9 levels were compared between patients with and without microbleeds. Neurological deterioration was defined as an increase in more than two points on the National Institutes of Health Stroke Scale Score baseline 14 days after the onset of lacunar stroke.

RESULTS

of the patients, 79 (38.3%) had microbleeds and 48 (23.3%) showed neurological deterioration. Free, active MMP-9 and C-reactive protein (CRP) levels were significantly increased amongst patients with microbleeds (P < 0.001 and P = 0.047, respectively). Existence of microbleeds (RR = 2.47, 95% CI = 1.25-3.83) and increased free, active MMP-9 (RR = 1.10 per 10 ng/ml, 95% CI = 1.03-1.19) were identified as independent risk factors for neurological deterioration after adjusting for potential confounders.

DISCUSSION

ncreased levels of active MMP-9 and the existence of microbleeds might be useful in predicting the deterioration following an initial acute lacunar stroke.

Imaging features of intradural spinal paragonimiasis: a case report

Spinal paragonimiasis is a rare form of ectopic infestation caused by Paragonimus westermani. We report a case of pathologically proven intradural paragonimiasis associated with concurrent intracranial involvement. MRI revealed multiple well-defined intradural masses that were markedly hypointense on T(2) weighted images and hypointense with a peripheral hyperintense rim on T(1) weighted images. Contrast-enhanced T(1) weighted images showed slight peripheral rim enhancement.

Abstract 2238: Clinical characteristics and outcome of patients with Rituximab-CHOP resistant/refractory DLBCL: Presence of B symptom and high LDH at diagnosis predict survival

Introduction: The addition of the anti-CD20 monoclonal antibody rituximab to conventional chemotherapy has dramatically improved overall survival (OS) in patients with diffuse large B-cell lymphoma (DLBCL), with more than 50% of these patients achieving long-term disease-free survival. However, approximately one-third of patients eventually die due to disease progression, treatment-related toxicities, another cancer, or other causes, and some patients show progression during or immediately after treatment. We sought to determine the characteristics of patients with DLBCL who were refractory or resistant to R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, prednisone) chemotherapy and the factors influencing patient outcomes.

Patients and Methods: Of all patients newly diagnosed with DLBCL at nine institutions in Korea and treated with R-CHOP with curative intent, 94 failed to achieve complete (CR) or partial response (PR) during or after R-CHOP chemotherapy or showed disease progression within 12 months of diagnosis.

Results: Median patient age was 53 years (range 18∼85 years), and median time to progression was 5.7 months (range 1.1∼11.2 months). According to the International Prognostic Index (IPI), 44 patients (46.8%) were of low risk (0 to 2) and 50 (53.2%) were of high risk (3 to 5). Of the 94 patients, 59 (62.8%) had progression of primary lesions, 19 (20.2%) had progression at other sites, and 16 (17%) had progression at both primary and other sites. Sixty-three patients (67%) had progression during R-CHOP treatment, including 22 (23.4%) with progression after no response and 41 (43.6%) with progression after CR or PR. The remaining 31 patients (33.0%) showed disease progression after 6∼8 cycles of R-CHOP chemotherapy. Of the 74 patients (78.7%) who received second-line chemotherapy, 8 (10.8%) achieved CR or unconfirmed CR (CRu), 14 (18.9%) achieved PR, 3 (4.1%) achieved stable disease and 36 (48.6%) showed progressive disease. The overall response rate was 29.7% and the median duration of response was 4.2 months. Median OS was 4.7 months and median progression-free survival (PFS) was 3.0 months. Median OS after diagnosis of lymphoma was 10.7 months. Multivariate analysis showed that normal (vs. elevated) LDH concentration and absence (vs. presence) of B symptoms were significant predictors of longer OS. However, other IPI variables, such as age, performance status, and extranodal disease, did not predict survival of R-CHOP resistant/refractory patients.

Conclusion: The prognosis of patients with R-CHOP refractory/resistant DLBCL was dismal, with conventional salvage chemotherapy having little effect on survival. Novel biomarkers and new treatment strategies are needed to further improve survival in R-CHOP refractory/resistant DLBCL patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2238. doi:10.1158/1538-7445.AM2011-2238

Abstract 998: Downregulation of survivin suppresses uPA through transcription factor JunB

Background: Survivin, identified member of the inhibitor apoptosis protein family, is expressed during development and in various human cancers. However, lts role of clinical relevance in cancers are sill debated.

Purpose: We investigated the role of HGF induced activation of a transcription factor JunB, in the expression of survivin and uPA.

Methods and Results: Genes induced by HGF were screened by using cDNA microarray technology in stomach cancer cell lines, NUGC3 and MKN28. Expression level of surviving and JunB was further confirmed by read time RT-RCR and western blot analysis. Roles of JunB and survivin in the levels of HGF induced up-regulation of uPA were measured by knock down of survivin with survivin siRNA and chromatic immuno- precipitation assay. The levels of JunB, survivin and uPA were up regulated in cells treated with HGF in a dose dependent manner. HGH-induced up regulations of JunB, surviving, and uPA were inhibited by the pretreatment with an MEK inhibitor, PD 098559. HGH-induced up-regulation of uPA were repressed by survivin knockdown. HGF enhanced the binding activity of JunB to the enhanced the binding activity of JunB to the survivin promoter in control cells, but not in the JunB-sh RNA cells. Transfection with survivin-sh RNA results in decrement of cell proliferation as determined with MTT assays. In an in vitro invasion assay, significantly fewer cells transfected with survivin sh-RNA than control cells were able to invade across a matrigel membrane barrier.Conclusion: Survivin might play an important role in the up-regulation of uPA induced by HGF via JunB and contribute to HGF-mediated tumor invasion and metastasis, which might be promising target for stomach cancer therapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 998. doi:10.1158/1538-7445.AM2011-998

Solitary small bowel metastasis from breast cancer

The common sites of metastasis of breast cancer are bone, lung, and liver, but gastrointestinal metastasis from breast cancer is rare. We experienced a case of solitary ileal metastasis from breast cancer. A 45-years-old woman presented with melena for several weeks. She showed no other abdominal symptoms. Colonoscopy findings showed an ulcerative mucosal lesion in the terminal ileum, and biopsy was performed. Pathologic examination revealed metastatic carcinoma, originated from breast. The tumor cells were positive for estrogen receptor and negative for Cdx-2. She had had a previous medical history of bilateral breast cancer and undergone breast conserving surgery with sentinel lymph node biopsy for both breasts. The torso positron emission tomography scan at 19 months after surgery showed mildly increased uptake in the terminal ileum which was considered as inflammation. Finally, she was diagnosed with solitary ileal metastasis from breast cancer at 22 months after surgery.

Hepatoma-derived growth factor regulates the bad-mediated apoptotic pathway and induction of vascular endothelial growth factor in stomach cancer cells

Hepatoma-derived growth factor (HDGF) is highly expressed in tumor cells and may play an important role in the development and progression of carcinomas. However, the molecular mechanism by which HDGF participates in gastric carcinomatosis requires further analysis. In this study, we determined the role of HDGF in tumorigenesis and elucidated the mechanisms of action. To determine aggressive biological behavior, we knocked down HDGF expression with HDGF-specific shRNA in two gastric cancer cell lines. First, using cDNA microarrary, we showed that hepatocyte growth factor (HGF) induced HDGF and confirmed this by Western blotting. HGF increased HDGF in a dose-dependent manner. We also determined whether HDGF induces angiogenic factor, and found the vascular endothelial growth factor (VEGF) was induced by HDGF. Downregulation of HDGF resulted in a decrement of VEGF. HDGF knock-down was found to induce the expression of the proapoptotic protein, Bad, and also inactivate ERK, which in turn led to dephosphorylation of Bad at ser112 and ser136, and induced apoptosis. Transfection with HDGF-siRNA resulted in a decrement of cell proliferation, as determined with a MMT assay. In an in vitro invasion assay, significantly fewer cells transfected with HDGF-siRNA than control cells were able to invade across a Matrigel membrane barrier. Our results suggest that HDGF is involved in cell growth, cell invasion, and apoptosis. These qualities may contribute to the HDGF-associated aggressive biological behavior of gastric cancer and thus serve as a potential target for cancer therapy.

A case of a giant mucocoele of the appendiceal stump presented with a palpable mass in the right thigh: pre-operative diagnosis based on characteristic multidetector CT findings

The pre-operative diagnosis of a mucocoele of the appendiceal stump (MAS) may be difficult owing to rarity and non-specific clinical presentation. However, a pre-operative diagnosis of a MAS is important to prevent widespread dissemination by inadvertent spillage of mucous contents. We describe a case of a MAS presenting with a palpable mass in the right thigh in which a pre-operative diagnosis was made by characteristic multidetector CT (MDCT) findings.

Variations in the STK10 gene and possible associations with aspirin-intolerant asthma in a Korean population

BACKGROUND AND OBJECTIVE

Lymphocyte-oriented kinase deficiency encoded by the serine/threonine kinase 10 (STK10) gene correlates with the intracellular adhesion molecule 1 (ICAM-1)/lymphocyte function associated antigen 1 (LFA-1) complex in aspirin hypersensitivity. This study investigated the association between single nucleotide polymorphisms (SNPs) of STK10 and aspirin-intolerant asthma (AIA).

METHODS

A total of 54 SNPs were genotyped in 163 AIA patients and 429 aspirin-tolerant asthma (ATA) controls.

RESULTS

Logistic regression revealed that a synonymous variant (rs2306961G>A) had the most significant association with AIA (P = .008 under the codominant model; P = .004 under the dominant model), suggesting that tissue-specific codon usage between Lys_TTT and Lys_CTT could play a role in regulating expression of STK10 in airway epithelium. Haplotype analysis revealed that 4 haplotypes, including STK10_BL4-ht1, which is unique to rs2306961G>A, were significantly associated with aspirin hypersensitivity in asthmatics (P < .05).

CONCLUSIONS

Although replications in independent cohorts and further functional evaluations are needed, our preliminary findings suggest that STK10 polymorphisms might be susceptible genetic markers of AIA and that gene expression could be mediated by tissue-specific codon usage.

Effect of probiotic-, bacteriophage-, or organic acid-supplemented feeds or fermented soybean meal on the growth performance, acute-phase response, and bacterial shedding of grower pigs challenged with Salmonella enterica serotype Typhimurium

A 28-d experiment evaluated the growth performance, acute-phase response, and bacterial shedding patterns in pigs (n = 108; initially, 38.7 ± 6.7 kg) fed 6 treatment diets, including a control diet with no antimicrobial agents (CON), a positive control diet containing chlortetracycline, 100 mg/kg (CT), a diet containing anti-Salmonella Typhimurium bacteriophage, 3 × 10(9) plaque-forming units/kg of feed (ASB), Lactobacillus plantarum CJLP56, 6.5 × 10(8) cfu/kg of feed (LP), 0.2% microencapsulated organic acids (MOA), or 5% fermented soybean meal (FSM). Pigs were fed the diets for 2 wk before and 2 wk after challenging orally with Salmonella enterica serotype Typhimurium (SalT). Before bacterial challenge, ADFI was similar in all groups. After SalT challenge, ADFI of CON pigs was less (P < 0.05) than all other groups. Before challenge, pigs on MOA, FSM, and CT diets had greater (P < 0.05) ADG and G:F than CON pigs. After challenge (wk 3 to 4) and during the overall experimental period (wk 1 to 4), ADG of all treatment groups and G:F of all treatment groups except the LP group were greater (P < 0.05) than those of CON pigs. Relative to all other treatments, CON and LP pigs had greater (P < 0.05) bacterial shedding scores on d 7 after SalT challenge. At d 14 postchallenge, shedding scores declined (P < 0.05) in all treatment groups compared with CON pigs. Serum haptoglobin for all treatment groups increased from d 0 concentrations on d 6 postchallenge and declined to prechallenge concentrations on d 13 (P < 0.05). Circulating IGF-I concentrations declined from 2 to 6 d postchallenge and increased again by d 13 in ASB and LP groups, did not decline in FSM and CT groups, and continuously declined through d 13 in CON and LP groups (P < 0.05). However, in MOA group, IGF-I concentrations declined from preinfection concentrations on d 2, increased on d 4, and declined again until d 13 (P < 0.05). The serum concentrations of the cytokines IL-6 and IL-1β were not generally affected by SalT challenge. In conclusion, acute infection of growing pigs with SalT was associated with short-term febrile responses in most pigs and reductions in ADFI and ADG of CON pigs. Compared with the CON diet, ASB, FSM, and MOA diets had a similar benefit to the antibiotic-supplemented diet in improving the performance of growing pigs, especially after bacterial challenge. However, further work needs to be done to better understand their mode of action in this class of pigs.

Stage IV marginal zone B-cell lymphoma--prognostic factors and the role of rituximab: Consortium for Improving Survival of Lymphoma (CISL) study

Stage IV marginal zone B-cell lymphomas (MZL) are detected in more than 25% of lymphoma patients. In this study, we conducted retrospective analyses of specific cases of stage IV MZL in order to assess their clinical features, as well as the treatments and prognoses of these cases. A total of 94 patients with histological diagnosis of stage IV-MZL from 17 different institutions in Korea were included. Multiple-mucosa-associated lymphoid tissue (MALT)-organs-involved MZL (M-MZL) was detected in 34 patients (36.2%). Bone-marrow-involved stage IV MZL (BM-MZL) was detected in 33 patients (35.1%). Median time to progression (TTP) was 2.4years (95% CI, 1.9-2.9). Five- and 10-year overall survival rates were 84.5% and 79.8%, respectively. Patients with lymph node involvement in stage IV MZL appeared to have worse prognoses in TTP (P=0.015). Thirty-one patients were treated with a regimen including rituximab (CTx-R[+]), and 31 with a regimen that did not include rituximab (CTx-R[-]). The CTx-R(+) group showed better responses than the CTx-R(-) group (83.9%versus 54.8%, P=0.026). However, no differences in TTP duration were detected (P=0.113). Stage IV MZL tend to follow an indolent disease course. Therefore, lymph node involvement is a more valuable prognostic factor for TTP. Rituximab appears to contribute to better responses, but not in cases of TTP.

Multiple mucosa-associated lymphoid tissue organs involving marginal zone B cell lymphoma: organ-specific relationships and the prognostic factors. Consortium for improving survival of lymphoma study

According to a previous review, multiple mucosa-associated lymphoid tissue (MALT)-organs involving marginal zone B cell lymphomas (MZLs) are present in 10-30% of patients. However, the clinical features and specific relationships among involved organs are yet to be clearly identified. In this study, we conducted retrospective analyses of multiple MALT organs involving MZLs (MM-MZLs) to identify their clinical features, treatment, prognosis, and specific relationships among involved organs. For analysis, between June 1987 and June 2009, a total of 55 patients from 17 different institutions in Korea, all of whom were histologically diagnosed with MM-MZL, were included in this study. MM-MZL was defined as MZL involving more than 2 different MALT organs. Multiple involvements within one MALT organ (e.g. both side ocular lesions, multiple lung nodules, and multiple stomach lesions, etc.) were excluded from this study. The male/female ratio of the 55 patients was 41/14. The median age of our subjects was 59 years (range 30-82 years). MM-MZL without lymph node (LN) was detected only in 9 patients (36.2%). Bone marrow (BM) involvement was observed in 17 patients (30.9%). The most common site of involvement was the gastrointestinal (GI) tract (25 patients, 45.5%) followed by the lung (40%), Waldeyer's ring (WR) (27.3%), and ocular area (25.5%). Ocular MZLs were commonly accompanied with WR- or lung-MZLs. GI-MZLs were WR or GI-MZLs. Lung-MZLs were frequently observed with ocular and GI-MZLs. WR-MZLs were ocular or GI-MZLs. A total of 53 patients were treated, and 2 on watchful wait. As much as 48 patients received chemotherapy-based treatment. Among them, CR or PR was achieved in 38 patients (79.2%, 95% CI 67-91%). Median time to progression (TTP) was 2.3 years (95% CI 1.4-3.2 years). Cause-specific overall survival (OS) did not reach the median value. The 5-year OS rate was 84.9%. MM-MZLs tend to be an indolent disease, characterized by prolonged survival with frequent relapses. The majority of cases could be controlled effectively via chemotherapy-based treatment, and prolonged survival was achieved in those patients. The GI, lung, WR, and ocular area were commonly presented with other MALT site MZLs, and an organ-specific relationship appears to be relevant to MM-MZLs.

Immunoglobulin D multiple myeloma: response to therapy, survival, and prognostic factors in 75 patients

BACKGROUND

To analyze the clinical features, outcomes including efficacy of treatment, and prognostic factors of patients with immunoglobulin D multiple myeloma (IgD MM).

DESIGN AND METHODS

Seventy-five patients diagnosed with IgD MM were selected from the Korean Myeloma Registry database (www.myeloma.or.kr).

RESULTS

Median age was 57 years and the main presenting features were bone pain (77%). Renal function impairment and hypercalcemia were present in 40 (53%) and 20 (27%) patients. Sixty-seven patients (89%) had lambda light chains. Forty-eight patients (64%) were of stage III by International Staging System. Twenty-six patients (53%) had chromosomal abnormalities mostly by conventional cytogenetics. Thirty-nine patients (54%) were treated with vincristine, adriamycin, and dexamethasone chemotherapy; the overall response rate (ORR) of 56%. Sixteen patients (22%) received first-line chemotherapy including new drugs (bortezomib or thalidomide), with an ORR of 81%. At a median follow-up time of 28.6 months, median overall survival (OS) was 18.5 months. Age, extramedullary plasmacytoma, del(13) or hypoploidy, serum β(2) microglobulin level, and platelet count were significant prognostic factors for OS.

CONCLUSIONS

IgD MM is an aggressive disease that is usually detected at an advanced stage. Despite a positive initial response, survival after relapse was dismal. Intensive treatment strategies before and following stem cell transplantation may improve outcomes in younger patients.

Inhibition of histone deacetylase activity down-regulates urokinase plasminogen activator and matrix metalloproteinase-9 expression in gastric cancer

Histone acetylation and deacetylaion play important roles in chromatin remodeling and gene expression. An imbalance of these reactions leads to aberrant behavior of the cells in the cell cycle, which in turn contributes to carcinogenesis. Histone deacetylase (HDAC) inhibitors have been shown to have anti-tumor effects in clinical trials. However, the exact mechanisms by which HDAC inhibitors exert anti-tumor effects and modulate gene expression are not completely understood, and remain a subject of intense investigation. In the current study, we determined whether HDACs regulate urokinase plasminogen activator (uPA), matrix metalloproteinase-9 (MMP-9), and tumor invasion. Using cDNA microarray analysis, we found that hepatocyte growth factor (HGF) induced HDAC5 expression in gastric cancer cell lines, NUGC-3 and MKN-28. TSA, a HDAC inhibitor, decreased HGF-induced HADC-5 expression and also repressed uPA and MMP-9 expression. TSA inhibited cell proliferation in both cell lines. In vitro Matrigel invasion assays showed that the HDAC inhibitor decreased cancer cell invasion. Furthermore, GO6976, a PKC inhibitor, significantly inhibited not only HGF-induced HDAC5 expression but also cell invasion. These results demonstrated that HDACs regulate HGF-induced uPA and MMP-9 expression through a PKC-dependent signal pathway in gastric cancer cells. Our data probably suggest that such activities serve as anti-tumor mechanisms of the HDAC inhibitor.