IL10 promoter polymorphisms are associated with systemic onset juvenile idiopathic arthritis (SoJIA)

OBJECTIVES

Juvenile idiopathic arthritis (JIA) is a rare, but severe cause of childhood disability. Systemic onset JIA (SoJIA) accounts for approximately 5.8% of all JIA cases and is associated with cytokine dysregulation, including interleukin (IL-)1, IL-6 and tumour necrosis factor (TNF-)α. IL-10 is an immuno-regulatory cytokine, which in part regulates inflammation by controlling inflammatory cytokine expression. Dysregulation in IL-10 expression and certain single nucleotide polymorphisms (SNPs) in the IL-10 promoter were shown to be associated with autoimmune and infectious diseases.

METHODS

Genomic DNA-samples from SoJIA patients from two German Paediatric Rheumatology centres, and healthy controls were analysed for three well defined IL-10 promoter SNPs (-1082G>A, -819C>T, and -592C>A). These SNPs are in tight linkage disequilibrium, and result in three predominant (or 'classical') haplotypes: ATA, ACC, and GCC. ATA and ACC are associated with low and medium, GCC is associated with high IL-10 expression.

RESULTS

Here, we show a strong association of IL-10 promoter polymorphisms with SoJIA. We demonstrate a significantly increased frequency of low IL-10 expressing -1082A/A alleles, the medium IL-10 expressing ACC haplotype (p=0.01), and an enrichment of the rare GTC haplotype (p<0.001) in patients with SoJIA. Heterozygous -1082G/A alleles (p<0.001), and the GCC haplotype (p<0.001) on one allele protect from developing SoJIA.

CONCLUSIONS

This suggests a central role of the immuno-regulatory cytokine IL-10 in the pathogenesis of SoJIA.

3 ANALYSIS OF HOX EXPRESSION IN BOVINE OOCYTES AND EARLY EMBRYOS

HOX genes encode transcription factors known to play a major role in patterning the main body axis of vertebrate embryos from the gastrulation stage onward. A few studies have provided evidence that some HOX genes might be expressed before implantation in mammalian embryos. Translation of maternally inherited transcripts is regulated by modifications of the poly(A) tail length until embryonic genome activation (EGA), occurring during the 4th cell cycle in the bovine. The objective of this work was to establish the expression pattern of various HOX genes and to study the polyadenylation of their transcripts during oocyte maturation and early embryonic development. Pools of 20 bovine oocytes before and after in vitro maturation and 20 in vitro-produced embryos at different stages of development up to the blastocyst stage were collected. Three to 12 pools were used for each stage. RNA was extracted and reverse transcribed (RT) using random hexamers. Quantitative real-time PCR (qPCR) was performed to establish expression profiles of 4 HOX genes: HOXD1, HOXA3, HOXB9, and HOXC9. Two distinct patterns of expression were observed. First, relative amounts of HOXD1, HOXA3, and HOXC9 were lower in morulae and blastocysts than in oocytes. On the other hand, relative expression of HOXB9 increased between the 5 to 8 cell stage and the morula stage (Mann-Whitney, P < 0.05). Those expression patterns were not modified when embryos were cultured in presence of α-amanitin, a RNA polymerase II inhibitor, indicating the maternal origin of the transcripts until EGA. Total amount of mRNAs, estimated by RT-qPCR with random hexamers, was stable for all studied genes during oocyte maturation. The relative amount of polyadenylated GAPDH mRNAs, estimated by RT-qPCR with poly(dT), decreased greatly in mature oocytes compared with immature oocytes indicating massive deadenylation of those transcripts. The relative amount of polyadenylated HOXC9 transcripts decreased slightly but significantly during oocyte maturation (Mann-Whitney, P < 0.05).The relative amount of polyadenylatedm RNAs corresponding to HOXD1, HOXA3, and HOXB9 was stable during oocyte maturation. This indicates that those transcripts escape the default deadenylation pathways followed by housekeeping genes. This experiment has been repeated 3 to 4 times. In conclusion, we confirmed the presence of HOXD1, HOXA3, HOXB9, and HOXC9 transcripts in bovine oocytes and early-stage embryos. Their role during oocyte maturation and the first stages of embryonic development will be investigated through loss of function studies. This work is funded by the Fonds National de la Recherche Scientifique (Belgium).

Cardiac Safety Results of a Phase II Trial of Adjuvant Docetaxel/Cyclophosphamide Plus Trastuzumab (Her TC) in HER2+ Early Stage Breast Cancer Patients

Background: Docetaxel/cyclophosphamide (TC) has superior activity to doxorubicin/cyclophosphamide (AC) in the adjuvant treatment of patients (pts) with early breast cancer and is devoid of known cardiac toxicity (Jones et al, JCO 27:1177-1183, 2009). Although the addition of trastuzumab (H) to anthracycline-based adjuvant regimens is effective, it is associated with increased cardiac toxicity. Therefore, a short course of the nonanthracycline TC regimen coupled with H appeared to be a logical combination for women with lower risk HER2+ breast cancer. We report the cardiac safety of the TC+H regimen for the first group of women to complete 1 year of treatment.Patients and Methods: 263 pts were registered to the study and stratified by nodal status (positive/negative). Pts must have had baseline left ventricular ejection fraction (LVEF) ≥50% by MUGA or ECHO. On Day 1 of each 21-day cycle for a total of 4 cycles, pts received: (T) 75 mg/m2 IV, followed by (C) 600 mg/m2 IV. Weekly (H) was also given at 4 mg/kg IV (loading dose, over 90 minutes Day 1, Cycle 1 only) and 2 mg/kg IV Days 1, 8, 15 thereafter throughout chemotherapy. After completion of chemotherapy, H was administered at 6 mg/kg IV every 3 weeks to complete 12 months of therapy with H. Decreased LVEF was defined as a decrease from baseline (start of treatment) to completion of TC+H, or when assessed at 3-month intervals until the completion of H treatment. H was withheld if there was a 15% or more decline in LVEF (absolute %). Treatment was discontinued after 2 or 3 treatment delays at investigator's discretion (same rules as prior studies). This report focuses on cardiac safety occurring during the 3 months of chemotherapy plus 1 year of H therapy.Results: To date, 260 pts completed 1 year of treatment and comprised the cardiac safety population; median age was 55 yrs (30-76); 90% of pts had ECOG 0; 64% were ER+, 47% were PR+, and 77% had no lymph node involvement. 184 pts (70%) completed planned treatment and 23 pts (9%) discontinued treatment due to adverse events. A total of 61 pts (23.5%) had declines of ≥10% LVEF; 8 pts (3.1%) had 2 or more LVEF declines ≥10% and were taken off treatment before 1 year of H was completed, and 16 pts (6.1%) had declines of LVEF below 50% during treatment. No patient had clinical CHF.Scheduled MUGA/ECHO ResultsMonthPatients, no.Median LVEF, % (range)Patients with decrease LVEF ≥10%, no.Patients with LVEF &lt;50%, no.Baseline26064 (49,89)––1-324163 (40,85)154-623062 (40,85)2157-921763 (36,89)265≥1018763 (48,80)131Conclusions: H combined with 4 cycles of the nonanthracycline TC regimen produced a low rate of cardiac events, mainly asymptomatic drops in LVEF, but no reported cases of CHF.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5082.

A 24-month subgroup analysis of the effect of denosumab on bone mineral density in women with breast cancer undergoing aromatase inhibitor therapy

Abstract #2106

Background: Accelerated bone loss and fracture risk are expected consequences of adjuvant aromatase inhibitor (AI) therapy. We previously showed that denosumab, a fully human monoclonal antibody that inhibits RANK ligand (RANKL), significantly increased bone mineral density (BMD) at the lumbar spine and at all measured skeletal sites at 12 months compared with placebo in women with breast cancer undergoing adjuvant AI therapy (Ellis et al, 2007 SABCS). In this analysis, we assessed covariates that may influence treatment effects on BMD at the lumbar spine, total hip, femoral neck, and 1/3 radius at 24 months.&#x2028; Methods: Adult patients (pts) with hormone receptor-positive breast cancer, who had evidence of low bone mass and were receiving adjuvant AI therapy, were enrolled in this randomized, double-blind, placebo-controlled, phase 3 study. Pts were stratified according to length of previous AI therapy (≤ 6 vs &gt; 6 months) and randomly assigned to receive, together with calcium and vitamin D, placebo (n=125) or denosumab 60 mg (n=127) subcutaneously every 6 months for 4 doses. Subgroup analysis was conducted using analysis of covariance and adjusted for treatment, stratification factor, baseline BMD value, densitometer type, and baseline BMD value-by-densitometer-type interaction.&#x2028; Results: At 24 months, greater increases in BMD were seen at all measured skeletal sites (both trabecular and cortical bone) for denosumab compared with placebo, regardless of the subgroup (table). Adverse events (AEs) occurred at a similar rate in both groups (91% denosumab, 90% placebo).&#x2028; Conclusion: In pts with breast cancer undergoing adjuvant AI therapy, twice-yearly denosumab treatment showed consistent increases in BMD across the skeleton at 24 months compared with placebo, regardless of subgroups.&#x2028; &#x2028;

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2106.

Kinetics of fertilization and development, and sex ratio of bovine embryos produced using the semen of different bulls

The between bulls variation in in vitro fertility and the shift of sex ratio towards male embryos are two problems affecting the in vitro production (IVP) of bovine embryos. Our objective was to evaluate the kinetics of fertilization, embryo development and the sex ratio of the resulting embryos using the frozen/thawed semen of four different bulls. In a first experiment, the kinetics of pronucleus (PN) formation was evaluated at 8, 12 and 18 h post-insemination (hpi). Based upon the pronuclei sizes and the distance between the two pronuclei, inseminated oocytes were classified in three PN stages. Differences between bulls were observed at each time point, but were more important at 12 hpi. At 8 and 12 hpi bull III showed a significantly faster PN evolution by comparison with the three other bulls (P<0.05), while at 18 hpi, the proportion of the three PN stages was similar to those of bulls I and IV, bull II being delayed. In a second experiment, the kinetics of in vitro embryo development was compared using time-lapse cinematography. The analysis of embryos reaching the blastocyst stage revealed significant differences in the mean time of first cleavage (range of 22.7-25.6h, P<0.05), while the lengths of the subsequent three cell cycles did not differ between bulls. The early mean time of first cleavage with bull III was associated with an early blastulation and a high blastocyst rate at Day 7, in opposition to what was observed with bull II showing a later timing of first cleavage (first cleavage 22.1 hpi versus 25.5 hpi; blastulation 140.4 hpi versus 152.5 hpi; D7 blastocyst rates: 31.3% versus 21.9%; P<0.05). In a third experiment, 65-76 Day 8 blastocysts per bull were sexed by PCR. Only blastocysts obtained with bull III showed a shift in sex ratio towards male embryos (76% male embryos; P<0.05). Such shift was already observed at the 2-cell and morula stages. In conclusion, the bull influences the kinetics of PN formation, of embryo development and the sex ratio of the embryos. Moreover, those parameters might be related.

Magnetic Resonance Imaging Contrast Agent Targeted Toward Activated Platelets Allows In Vivo Detection of Thrombosis and Monitoring of Thrombolysis

Background— Platelets are the key to thrombus formation and play a role in the development of atherosclerosis. Noninvasive imaging of activated platelets would be of great clinical interest. Here, we evaluate the ability of a magnetic resonance imaging (MRI) contrast agent consisting of microparticles of iron oxide (MPIOs) and a single-chain antibody targeting ligand-induced binding sites (LIBS) on activated glycoprotein IIb/IIIa to image carotid artery thrombi and atherosclerotic plaques.

Methods and Results— Anti-LIBS antibody or control antibody was conjugated to 1-μm MPIOs (LIBS MPIO/control MPIO). Nonocclusive mural thrombi were induced in mice with 6% ferric chloride. MRI (at 9.4 T) was performed once before and repeatedly in 12-minute-long sequences after LIBS MPIO/control MPIO injection. After 36 minutes, a significant signal void, corresponding to MPIO accumulation, was observed with LIBS MPIOs but not control MPIOs ( P <0.05). After thrombolysis, in LIBS MPIO-injected mice, the signal void subsided, indicating successful thrombolysis. On histology, the MPIO content of the thrombus, as well as thrombus size, correlated significantly with LIBS MPIO-induced signal void (both P <0.01). After ex vivo incubation of symptomatic human carotid plaques, MRI and histology confirmed binding to areas of platelet adhesion/aggregation for LIBS MPIOs but not for control MPIOs.

Conclusions— LIBS MPIOs allow in vivo MRI of activated platelets with excellent contrast properties and monitoring of thrombolytic therapy. Furthermore, activated platelets were detected on the surface of symptomatic human carotid plaques by ex vivo MRI. This approach represents a novel noninvasive technique allowing the detection and quantification of platelet-containing thrombi.

Variable echo time imaging: signal characteristics of 1-M gadobutrol contrast agent at 1.5 and 3T

Gadobutrol (Gd-Bt; Gadovist(R), Schering AG) is a 1-M Gadolinium (Gd)-based contrast agent. Its higher Gd concentration allows for reduction of injection volumes in first pass contrast-enhanced MR angiography (CE-MRA) and should increase bolus sharpness and image quality. However, ambivalent results were reported. In order to explore the performance of 1-M contrast agents such as Gd-Bt and its dependence on molecular environment and temperature, signal characteristics were analyzed for a series of increasing Gd-Bt concentrations for different temperature-controlled samples in water and human blood plasma. Relaxation times, relaxivities, and signal-concentration curves were assessed for several Gd-Bt concentrations in water at 20 degrees C and 37 degrees C and in plasma at 37 degrees C for 1.5T and 3T. Gd-Bt concentration influence on signal intensity (SI) could be effectively simulated and compared with experimental measurements as well as simulations with other contrast agents at realistic in vivo concentrations. Particular attention was given to T(2)- and T(*) (2)-induced losses at high concentrations, which annihilate benefits from T(1) shortening. Based on these findings, variable echo time (VTE) approaches with readout bandwidth varying with k-space position were explored in order to enhance the signal to noise performance of gradient echo imaging at high contrast agent concentrations. Results indicate the potential of VTE for imaging with increased SNR at high contrast agent concentrations.

Biocompatible materials developments for new medical implants

Recent work on modifying silicone rubber to improve water permeability and biocompatibility is described. In addition, modifications to the interface between an active implanted device and the body are reported, which have led to reduced power consumption and improved device performance.

An aboriginal and Torres Strait Islander oral health curriculum framework: development experiences in Western Australia

Indigenous oral health is widely acknowledged as paralleling the significant issues faced in general health. It is recognized that as part of the process of addressing these issues, practitioners need to be aware of the complex nature of working in an Indigenous social and cultural context, including issues beyond direct health care services. It is against this backdrop that collaborators from The University of Western Australia's (UWA) Centre for Rural and Remote Oral Health (CRROH) and Centre for Aboriginal Medical and Dental Health (CAMDH) developed a comprehensive, integrated Indigenous Oral Health Curriculum Framework for the Bachelor of Dental Science (BDSc) course. This development was based on the existing framework developed by the Committee of Deans of Australian Medical Schools (CDAMS) for medical education but was tailored to the specific issues and needs of oral health. Additional consultation with the Oral Health Centre of Western Australia (OHCWA), the School of Indigenous Studies (SIS) as well as Indigenous Australian groups occurred to ensure the development process was inclusive. The inclusion of an Indigenous Oral Health Curriculum Framework in the BDSc will enable UWA dental graduates to practise dentistry in a culturally appropriate manner. The framework provides the structure for students to develop and demonstrate an understanding of Indigenous histories, cultures and social experiences and how these impact on Indigenous peoples' health. It is anticipated that this will foster more positive and culturally secure patient-practitioner interactions between UWA dental graduates and Indigenous Australians, thereby making it more likely for Indigenous Australians to present for treatment. The increased awareness of Indigenous oral health issues will hopefully encourage more graduates to become involved in the treatment of Indigenous peoples. The combination of these factors could lead to an improvement in oral health outcomes for Australia's Indigenous peoples and a concomitant positive impact on the general health of Indigenous Australians.

Patient-centered validation of 11 symptom indices to evaluate response to chemotherapy for advanced cancer

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Background: Symptom burden in advanced disease has relevance both for clinical practice and in evaluating the efficacy of new chemotherapeutic agents. This study aimed to identify patients’ highest priority symptoms for 11 advanced cancers, compare priority ratings with those obtained from clinicians, and construct brief symptom indices based on their combined input. Methods: 534 patients with advanced bladder, brain, breast, colorectal, head/neck, hepatobiliary/pancreatic, kidney, lung, lymphoma, ovarian or prostate cancer from a subset of National Comprehensive Cancer Network (NCCN) member institutions and 4 Cancer Health Alliance of Metropolitan Chicago organizations completed a survey of priority symptoms and concerns and a disease-specific FACT QOL measure. 112 physicians at NCCN institutions completed a rating of whether symptoms and concerns were considered disease- or treatment-related. Symptoms endorsed more often than chance probability were retained. Expert clinician and patient ratings were equally weighted in item selection. Responses to symptom index items drawn from the QOL questionnaires allowed for validation analyses. Results: Items comprising 2 to 3 subscales (up to 20 items in length) were retained for each of the 11 disease-specific symptom indices. Content-determined subscales consisted of symptoms and concerns that were 1) exclusively or predominantly disease-related symptoms (DRS); 2) exclusively or predominantly treatment side effects (TSE); and 3) descriptive of general function or well-being (F/WB). For example, the NCCN/FACT Breast Cancer Symptom Index (FBSI) contains 17 items: 8 DRS, 4 TSE and 5 F/WB. Data on 14 of 17 FBSI items showed good internal consistency (a=.89). Correlations between FBSI and FACT-B scores were high for physical well-being, functional well-being and breast cancer subscales (r = 0.83, 0.77, and 0.61 respectively). Correlation with emotional well-being subscale was 0.55. FBSI scores differed across PSR groups in the appropriate direction (p<0.0001). Conclusions: NCCN/FACT disease-specific questionnaires have been transformed into brief, patient-centered symptom indices that can be used as stand-alone measures in oncology research and practice.

No significant financial relationships to disclose.