Cooperative involvement of NFAT and SnoN mediates transforming growth factor-β (TGF-β) induced EMT in metastatic breast cancer (MDA-MB 231) cells

Epithelial to mesenchymal transition (EMT) is a secondary phenomenon concomitantly associated with the tumor progression. The regulatory signals and mechanistic details of EMT are not fully elucidated. Here, we shared a TGF-β mediated mechanism of EMT in breast cancer (MDA-MB 231) cells. Initial exposure of TGF-β for 48 h, enhanced the rate of cell proliferation and associated with EMT of MDA-MB 231 cells. The EMT was characterized by observing the increased N-cadherin, fibronectin, Snail expression and associated with the morphological change with a reduced E-cadherin expression. NFAT, a transcription factor, alters tumor suppressive function of TGF-β towards tumor progression. Up regulation of NFAT, coupled with a foremost translocation of one oncogenic protein SnoN from cytoplasm to nucleus was noticed during this TGF-β mediated EMT. Silencing of NFAT also showed the inhibition of TGF-β mediated EMT characterized by down regulation of N-cadherin and associated with reduced expression of SnoN. In addition, it was also observed that NFAT sequestering the Smad3 prevents the proteasome mediated degradation of SnoN and this SnoN has a role on the regulation of MMP-2, MMP-9 activity. Increased Smad3-SnoN interaction and proteasome mediated degradation of SnoN were detected after silencing of NFAT with a reduced MMP-2, MMP-9 activity. All of these observations provide a fresh mechanism in which by a twofold involvement of NFAT and SnoN plays a crucial role in TGF-β mediated EMT by recruiting the effector molecules N-cadherin and MMP-2, MMP-9.

Mal-united fracture of calcaneum treated with lateral decompression

Fracture calcaneum is commonly complicated with mal-union. Mal-union is usually presented with broadening of the lateral wall of the calcaneum, irregularity of the sub-talar joint and loss of the vertical height of the body of calcaneum with varus rotation. In this study twenty three (n=23) patients underwent a lateral decompression for pain on lateral aspect of foot on walking and tip toeing, secondary to a mal-united calcaneal fracture with or without sub-talar intra-articular involvement. Almost every patient had ballooned out body of calcaneum with impingement of peroneal tendon sheath with its content and lateral heel pain as a result of deformity. So in current study the operative procedure selected was excision of a lateral calcaneal bony mass and decompression of the peroneal tendon to relieve pain. Peroneal tenogram was a routine procedure before surgery to detect presence and site of blockade within tendon sheath. The average follow-up was for a period of 31.6 months. Result was assessed according to American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale. Two patients (n=2, 8.69%) had excellent (Category 1) result, seventeen (n=17, 73.9%) were good (Category 2), two (n=2, 8.69%) were fair (Category 3) and rest two (n=2, 8.69%) were with poor (Category 4) outcome. Every four out of five patients got back painless Heel and Ankle after surgery. The results suggest that the lateral decompression procedure is a technically simpler yet viable alternative to late sub-talar fusion for lateral pain following a mal-united fracture of calcaneum.

Initiation of insulin aspart to Indian subjects on OADs show significant improvement in glycaemic outcomes: the A1chieve observational study

The prevalence of diabetes is increasing worldwide and India stands second next only to china. The management of diabetes in real life settings needs to be evaluated for deriving better management practices. A1chieve observational study evaluated the use of modern insulin in real life settings. This was a 24-week, international, prospective, multicenter, non-interventional, observational study of people with type 2 diabetes. India recruited with 20,554 subjects and a total of 1815 patients were enrolled to receive insulin aspart as bolus insulin therapy of whom 1450 (79.9%) were insulin naïve and 365 (20.1%) were insulin users. At the end of 24 weeks, only one SAE was reported in this study and overall hypoglycemia events per patient year decreased from 2.49 (348 episodes) to 0.17 (20 episodes). There were no major hypoglycemic episodes reported in either insulin naive or insulin treated subjects. There was a significant improvement in the HbA(1c) values from the baseline in both insulin naive and insulin users. The mean HbA(1c) value was reduced from 9.5 to 7.4 (p < 0.001) for insulin naïve subjects and from 9.2 to 7.7 (p < 0.001) in insulin experienced subjects. Fasting plasma glucose values decreased by 70 mg/dL and 50 mg/dL in insulin naive and insulin experienced, respectively and the difference from baseline was statistically significant (P < 0.001). The post prandial glucose value was also significantly (p < 0.001) reduced by 105 mg/dL for insulin naïve subjects and 55 mg/dL for insulin experienced subjects. The composite end point was achieved by 46.6% of insulin naive and 38.1% of insulin-experienced subjects. The study concluded with good HbA(1c) reduction along with lower incidence of hypoglycemia and better health related quality of life outcomes in both in insulin naive and insulin experienced subjects who used insulin aspart as bolus insulin treatment.

Fibrous dysplasia: rapid malignant transformation into osteogenic sarcoma - A rare occurance

Malignant transformation of fibrous dysplasia is rare, occurring in less than 1% of cases with a mean lag period of 13.5 years. We report a case of Osteogenic Sarcoma with chondroid differentiation in a pre-existing Fibrous Dysplasia occurring within one year of surgical resection and without any history of exposure to radiation. To the best of our knowledge and extensive search of literature, malignant transformation of Fibrous Dysplasia in such a short period of time, and without history of radiation exposure has never been reported from India.Journal of Pathology of Nepal (2012) Vol. 2, 335-337DOI: http://dx.doi.org/10.3126/jpn.v2i4.6891

P4-07-11: Circulating Tumor Cells after Neoadjuvant Therapy Predict Outcome in Stage I to III Breast Cancer

Introduction: Circulating tumor cells (CTCs) predict outcome in metastatic breast cancer, but their significance is unclear in non-metastatic patients. Furthermore, it is unclear if the presence of CTCs after completion of neoadjuvant chemotherapy (NACT) predicts worse outcome. The purpose of this study was to determine if CTCs after NACT predicts worse outcome.

Methods: Clinical stage I-III breast cancer patients seen at a single tertiary cancer center provided informed consent to participate in an IRB-approved study involving collection of blood (7.5 ml x 2 tubes) at the time of surgery for their primary breast cancer. CTCs were detected using the Cell SearchTM system. A positive result was defined as the presence of one or more cells per 7.5 ml blood since the threshold for positivity has not been established in non-metastatic breast cancer. Statistical analyses used chi-square and Fischer's exact test.

Results: One hundred and twenty patients were prospectively enrolled. Median age was 50 years and median follow-up was 33 months. Eight percent of patients had T1 disease, 35% T2, 18% T3, and 39% T4. Fifty-three percent of patients (63/120) had hormone receptor positive disease. Thirty-two percent of patients (38/120) were HER-2 positive. Thirty percent (36/120) were triple negative. Seventy-eight percent (91/120) had lymph node positive disease. Two or more CTCs were present in 9% of patients (11/120). Of the 11 patients who died, 3 had 2 or more CTCs (P=0.08). Of the 20 who relapsed, 6 had 2 or more CTCs (P=0.0019).

Conclusions: Presence of two or more CTCs after NACT predicted worse relapse free survival in patients with stage I-III breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-11.

P4-07-07: Circulating Tumor Cells Predict Survival in Non-Metastatic Breast Cancer

Background: Circulating tumor cells (CTCs) predict outcome in metastatic breast cancer (BC), but their prognostic significance in non-metastatic BC is unclear. This study determined whether CTCs could be identified in non-metastatic BC patients and 2) if CTCs predict relapse-free and overall survival.

Methods: Clinical stage I-III BC patients seen at a single tertiary cancer center provided informed consent to participate in an IRB-approved study involving collection of blood (7.5 ml x 2 tubes) before systemic therapy and at the time of surgery for their primary BC. CTCs were detected using the Cell SearchTM system. A positive result was defined as the presence of two or more cells per 7.5 ml blood since a threshold for positivity has not been established in primary BC. Statistical analyses were done using STATA-IC 11 software.

Results: We prospectively evaluated 291 patients. Mean age was 54 years, and median follow-up was 30 months. 54% (157) had T1 tumors, 36%(104) T2, 6% (18) T3, and 4%(12) had T4 disease; 37% (107/289) were clinically node-positive (LNs) by axillary ultrasound and FNA. Two or more CTCs were identified in 10% (29) patients. Seventy-seven percent (225) patients were hormone receptor positive, 11% (32) were HER2 positive while 16% (48) expressed no receptors. Sixteen percent (48) were tumor grade 1, 50% (143) were grade 2 and 34% (98) were grade 3. Systemic chemotherapy and/or endocrine therapy were administered in 80% (233/289) of patients. Sixty-eight percent (167/244) of patients were post-menopausal. Additionally, there was no significant correlation between CTCs with primary tumor size, lymph node status, estrogen or progesterone receptor status, HER2 amplification or tumor grade. Thirty-eight percent (6/16) of all relapses occurred in patients with 2 or more CTCs (HR: 4.48 (95% C.I. 1.61−12.45), Logrank P 0.002) while 40% (4/10) of all deaths occurred in patients with 2 or more CTCs (HR: 4.54 (95% C.I. 1.27−16.25), Logrank P 0.011).

Conclusions: CTCs were a significant predictor of disease-free and overall survival in non-metastatic breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-07.

P5-01-17: HER2 Amplification in Primary Tumor: A Potential Marker for Presence of Circulating Tumor Cells in Inflammatory Breast Cancer Patients?

Background: Inflammatory breast cancer (IBC) is a rare but aggressive form of invasive breast cancer accounting for 3–6% of all cases and have higher rates of distant recurrence. Circulating tumor cells (CTCs) are known to predict outcome in metastatic breast cancer (BC) patients, but little is known about their prognostic significance in non-metastatic BC. We hypothesized that CTCs can be identified in patients with IBCs and may correlate with primary tumor characteristics. Methods: All patients had blood samples collected at the time of primary surgery. CTCs (per 7.5 ml blood) were detected using the Cell Search™ system (Veridex) and were defined as nucleated cells lacking CD45 but expressing cytokeratins (CK) 8, 18, or 19. The presence of ≥ 1 epithelial cells meeting morphologic criteria for malignancy was considered a positive result. Statistical analyses employed Chi square and Fisher's exact tests using STATA IC 11. Results: We prospectively evaluated 41 IBC patients enrolled in an IRB approved protocol undergoing surgery for stage I-III breast cancer. Median follow-up was 30 months. Mean age was 52 years. Thirty five patients (94%) had positive lymph nodes (LNs) at presentation, 30 (75%) had high-grade tumors and 20 (53%) had lymphovascular invasion. Eleven patients (28%) were ER positive, 11 (27%) were PR positive and 18 (44%) were HER2 positive. IBCs were more likely to be high grade (P&lt;0.0001), ER negative (P&lt;0.0001), PR negative (P&lt;0.0001), HER2 positive (P&lt;0.0001), High Ki-67 (P= 0.005) and had a BMI of more than 25kg/m2 (P=0.04). Eleven (27%) patients were CTC positive. CTCs were more likely be found in HER2 positive (8/18; 44%) vs. HER2 negative primary tumors (3/20; 15%) [OR= 4.53; 95% C.I. = 1.02−19.52; P= 0.04]. We found no statistically significant correlations between primary tumor characteristics (ER, PR, LNs, high grade) and presence of CTCs. Conclusions: About a quarter of IBC patients had CTCs at the time of primary surgery. In these patients HER2 overexpression predicted the presence of CTCs. Studies with longer follow-ups is needed to determine if CTCs predicted survival.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-01-17.

P4-06-02: Microscopic Disease in Blood and Bone Marrow Predicts Survival in Early Stage Breast Cancer

Background

Disseminated tumor cells (DTCs) in the bone marrow have been identified in 30% of stage I - III breast cancer (BC) patients and predict survival. Circulating tumor cells (CTCs) in the blood predict outcome in metastatic BC, but their prognostic significance in primary BC is unclear. This study determined whether: 1) DTCs and CTCs could be identified in significant numbers of non-metastatic BC patients and 2) if these cells predict relapse-free (RFS) and overall survival (OS).

Methods: Clinical stage I-III BC patients seen at a single tertiary cancer center provided informed consent to participate in an IRB-approved study involving collection of blood (7.5 ml x 2 tubes) and bone marrow (10 ml from bilateral iliac crests), and at the time of surgery for their primary BC. DTCs were assessed using an anti-cytokeratin antibody cocktail (MNF 116, CK 8,18, and 19, CAM 5.2, and AE1/AE3) following ficoll enrichment and cytospin. A positive result for DTCs was defined by presence of one or more CK-positive cells meeting morphologic criteria for malignancy. CTCs were detected using the Cell SearchTM system. A positive result was defined as the presence of one or more cells per 7.5 ml blood since a threshold for positivity has not been established in non-metastatic BC. Statistical analyses used chi-square and Fischer's exact test.

Results: We prospectively evaluated 313 patients. Mean age was 53 years, and median follow-up was 32 months. Forty-two percent of patients (131) had T1 tumors, 36% (112) T2, 10% (30) T3, and 13% (40) had T4 disease. Forty-five percent of patients (141/312) had positive lymph nodes. DTCs were identified in 29% (91/313) and CTCs in 25% (79/313) of all patients. Seven percent (21/313) of patients had both DTCs and CTCs. In the overall cohort, 26 (8%) patients relapsed and 15 (5%) died. Ten percent (9/91) of DTC positive patients died compared to 3% (6/222) of those who did not have DTCs (p=0.01). Similarly, 6% (7/79) of those who had CTCs died compared to 3% (8/234) of those who did not (p=0.03). Fifteen percent (12/79) of CTC positive patents relapsed compared to 6% (14/234, P=0.01) of those who were CTC negative. Simultaneous presence of DTCs and CTCs was a strong predictor of RFS (log rank p=0.030, HR= 2.8, 95% C.I. 1.20- 8.10) as well as OS (log rank p=0.026, HR= 3.66, 95% C.I. 1.03- 13.00) at 2 years. Combined presence of DTCs and CTCs was a predictor of outcome and these findings persisted after adjusting for variables including hormone receptor status, HER2 status, primary tumor size, grade, and preoperative lymph node status. There was no significant correlation between DTCs and/or CTCs with other primary tumor characteristics.

Conclusions: Circulating and disseminated tumor cells can be identified in a significant number of non-metastatic breast cancer patients. Both CTCs and DTCs predicted outcome, and their combined presence was an independent predictor of survival.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-06-02.

P4-06-04: Detection of HER2 Gene Amplification in Circulating Tumor Cells and Disseminated Tumor Cells by Fluorescence In Situ Hybridization Using OncoCEE™

BACKGROUND: The status of HER2 gene amplification in circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) might provide useful information for monitoring response to trastuzumab therapy, and may provide a basis for consideration of trastuzumab in patients with HER2 negative primary tumors who have HER2 positive CTCs and/or DTCs. The majority of techniques utilized for detection of minimal residual disease are limited in their ability to allow detailed phenotypic and genotypic evaluation of the cells. We report the utility of a microfluidic platform (OncoCEE™,Biocept, San Diego) for detecting HER2 gene amplification in CTCs and DTCs in patients with non-metastatic breast cancer.

METHODS: Peripheral blood (10ml) and bone marrow (BM) (1-2ml) were collected from patients with clinical stage I-III breast cancer in acid citrate dextrose solution (BD, Franklin Lakes, NJ) and anti-clumping reagent (OncoCEE-Sure™). Mononuclear cells were recovered using a Percoll density gradient method, incubated with a mixture of 10 primary capture antibodies (Abs), introduced into CEE™ microchannels, stained with fluorescent anti cytokeratin (CK) and CD45 abs and finally processed for fluorescence in situ hybridization (FISH) using probes specific to centromere 17 (spectrum green) and HER2 (spectrum arrange). The ratio of HER2:CEP17 &gt;2.2 in any CK+/CD45- and CK-/CD45- cell was regarded as positive for HER2 gene amplification.

RESULTS: Peripheral blood and/or BM from 78 patients (65 BM; 70 blood; 57 matched blood and BM) with T1NO (39), T1N1 (8), T2N0 (12), T2N1 (2), T2N2 (1), T2N3 (3), T3N0 (2), T3N1 (2), T3N2 (1), T4N0(5), T4N1 (3), with HER2+ (n=12) and HER2− (n=58) primary invasive breast tumors were studied. The 12 patients with HER2+ primary tumors had HER2+ DTCs in 3/12 (25%) and HER2+ CTCs in 1/9 (11%) cases respectively. HER2+ DTCs and HER2+ CTCs occurred in 12/55 (24%) and in 4/63 (6%) of the patients with HER2− primary breast tumors. HER2+ CTCs and DTCs occurred simultaneously in only 2 patients and in either blood (3) or BM (13) in the remaining patients.

CONCLUSION: 1. The cell enrichment and extraction microfluidic technology (OncoCEE™) provides a sensitive platform for evaluation of HER2 gene amplification of CTCs and DTCs.

2. HER2+ primary tumors were associated with either HER2+ CTCs or DTCs in 25% of the patients.

3. HER2+ CTCs or DTCs occurred in 28% of patients with HER2−primary tumor.

4. Discordant HER2 status was contributed mainly by HER2+ DTCs occurring in HER2 - primary tumors.

5. The clinical significance of evaluating the status of HER2 gene amplification in CTCs and DTCs in the management of patients with breast cancer needs to be evaluated prospectively in larger clinical trials.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-06-04.

Differential regional expression patterns of α-synuclein, TNF-α, and IL-1β; and variable status of dopaminergic neurotoxicity in mouse brain after Paraquat treatment

Background

Paraquat (1, 1-dimethyl-4, 4-bipyridium dichloride; PQ) causes neurotoxicity, especially dopaminergic neurotoxicity, and is a supposed risk factor for Parkinson's disease (PD). However, the cellular and molecular mechanisms of PQ-induced neurodegeneration are far from clear. Previous studies have shown that PQ induces neuroinflammation and dopaminergic cell loss, but the prime cause of those events is still in debate.

Methods

We examined the neuropathological effects of PQ not only in substantia nigra (SN) but also in frontal cortex (FC) and hippocampus of the progressive mouse (adult Swiss albino) model of PD-like neurodegeneration, using immunohistochemistry, western blots, and histological and biochemical analyses.

Results

PQ caused differential patterns of changes in cellular morphology and expression of proteins related to PD and neuroinflammation in the three regions examined (SN, FC and hippocampus). Coincident with behavioral impairment and brain-specific ROS generation, there was differential immunolocalization and decreased expression levels of tyrosine hydroxylase (TH) in the three regions, whereas α-synuclein immunopositivity increased in hippocampus, increased in FC and decreased in SN. PQ-induced neuroinflammation was characterized by area-specific changes in localization and appearances of microglial cells with or without activation and increment in expression patterns of tumor necrosis factor-α in the three regions of mouse brain. Expression of interleukin-1β was increased in FC and hippocampus but not significantly changed in SN.

Conclusion

The present study demonstrates that PQ induces ROS production and differential α-synuclein expression that promotes neuroinflammation in microglia-dependent or -independent manners, and produces different patterns of dopaminergic neurotoxicity in three different regions of mouse brain.

Liquid-liquid extraction and flat sheet supported liquid membrane studies on Am(III) and Eu(III) separation using 2,6-bis(5,6-dipropyl-1,2,4-triazin-3-yl)pyridine as the extractant

Solvent extraction and supported liquid membrane transport studies for the preferential removal of Am(3+) from feeds containing a mixture of Am(3+) and Eu(3+) was carried out using 2,6-bis(5,6-dipropyl-1,2,4-triazin-3-yl)pyridine (n-Pr-BTP) as the extractant. Diluent plays an important role in these studies. It was observed that the distribution coefficients deteriorate significantly for both Am(3+) and Eu(3+) though the separation factors were affected only marginally. The transport studies were carried out at pH 2.0 in the presence of NaNO(3) to result in the preferential Am(3+) transport with high separation factors. Effect of different experimental parameters, viz. feed composition, stripping agents, diluents of the organic liquid membrane and membrane pore size was studied on the transport and separation behaviour of Am(3+) and Eu(3+). The supported liquid membrane studies indicated about 85% Am(3+) and 6% Eu(3+) transport in 6h using 0.03 M n-Pr-BTP in n-dodecane/1-octanol (7:3) diluent mixture for a feed containing 1M NaNO(3) at pH 2 and a receiver phase containing pH 2 solution as the strippant. Consequently, a permeability coefficient of (1.75 ± 0.21) × 10(-4)cms(-1) was determined for the Am(3+) transport. Stability of the n-Pr-BTP and its SLM was also studied by carrying out the distribution and transport experiment after different time intervals.

Studies on the selective Am3+ transport, irradiation stability and surface morphology of polymer inclusion membranes containing Cyanex-301 as carrier extractant

Transport behaviour of Am(3+) across cellulose triacetate (CTA) based polymer inclusion membranes (PIM) containing Cyanex-301 (bis(2,4,4-trimethylpentyl)dithiophosphinic acid) as the carrier extractant and tri-n-butyl phosphate (TBP) or 2-nitrophenyloctylether (NPOE) as the plasticizer was investigated from different feed and strip conditions. The TBP plasticized membrane resulted back transport of Am when alpha-hydroxy iso-butyric acid was used as the complexing agent in the strip phase while no such effect was seen when ethylene diamine tetraacetic acid (EDTA) was used as the complexant. Effect of varying Cyanex-301 concentration and bipyridyl (bipy) concentration on Am transport was also investigated. Long term reusability of the membrane was studied by measuring the permeability coefficient (P) after exposing the PIMs to a maximum gamma ray dose of ∼ 200 kGy. The surface morphology of the membranes was analyzed by atomic force microscopy and the roughness parameter was correlated to transport efficiency.

Thermodynamics of complexation of lanthanides with 2,6-bis(5,6-diethyl-1,2,4-triazin-3-yl) pyridine

Solvent extraction studies on separation of trivalent actinides from lanthanides using 2,6-bis(5,6-dialkyl-1,2,4-triazin-3-yl) pyridines have shown promising results with respect to separation factor and efficiency in acidic medium. In order to understand their complexation behavior, the stability constant (log β) of trivalent lanthanides (La, Nd, Eu, Tb, Ho, Tm, Lu) with 2,6-bis(5,6-diethyl-1,2,4-triazin-3-yl)pyridine (ethyl-BTP) have been determined in methanol medium (ionic strength 0.01 M) using spectrophotometric titrations. The stoichiometry of the complexes is found to vary with the ionic size of lanthanide ion. The variation in log β across the lanthanide series is attributed to variation in solvation characteristics of the metal ion. Comparison of log β for Ln(III)–ethyl-BTP complexes with other alkyl derivatives showed increase in the stability with increasing length of the alkyl group due to hydrophobic interaction. In the case of Eu(III), the speciation was also corroborated by time resolved fluorescence spectroscopy. The thermodynamic parameters (Δ G, Δ H, Δ S) for complexation of Eu(III) with ethyl-BTP, were determined by microcalorimetry, which revealed strong metal ion–ligand interaction with the reactions driven mainly by enthalpy.