Polymorphisms in the human ALOX12 and ALOX15 genes are associated with peak bone mineral density in Chinese nuclear families

SUMMARY

Association between ten single-nucleotide polymorphisms (SNPs) in the human ALOX12 and ALOX15 genes and variations in peak bone mineral density (BMD) in a large sample of Chinese nuclear families with female offspring using the quantitative transmission disequilibrium test (QTDT). Our results suggest that the genetic polymorphisms in both human ALOX12 and ALOX15 may contribute to variations in the peak BMD of Chinese women.

INTRODUCTION

The aim of this study was to investigate whether polymorphisms in the human ALOX12 and ALOX15 genes are associated with variations in peak BMD in Chinese nuclear families with female offspring.

METHODS

Each five SNPs in the ALOX12 and ALOX15 genes were genotyped in a total of 1,260 individuals from 401 Chinese nuclear families. The BMD of the lumbar spine, femoral neck and total hip was measured by dual-energy X-ray absorptiometry. We tested whether a single SNP or a haplotype was associated with peak BMD variations using the QTDT.

RESULTS

Using QTDT to measure within-family associations in ALOX15, we observed a significant association between rs916055 and BMD in the lumbar spine (p = 0.027 in the permutation 1,000 test). However, in ALOX12, rs312470 was significantly associated with BMD in the femoral neck (p = 0.029 and p = 0.036 in the permutation 1,000 test). The results of a haplotype analysis supported the findings of the single locus test for ALOX15.

CONCLUSIONS

Our results suggest that the genetic polymorphisms in both human ALOX12 and ALOX15 may contribute to variations in the peak BMD of Chinese women.

Treatment satisfaction and persistence among postmenopausal women on osteoporosis medications: 12-month results from POSSIBLE US™

SUMMARY

Women in POSSIBLE US™ who expressed greater treatment satisfaction at study entry were more likely to persist with osteoporosis therapy over a 1-year period. Lower satisfaction among women with moderate/severe side effects increased the risk of discontinuation/switching by 67%. Treatment satisfaction and side effect experience influence osteoporosis medication adherence.

INTRODUCTION

Non-adherence is common among women using postmenopausal osteoporosis (PMO) medications. We describe the association between treatment satisfaction, measured with the Treatment Satisfaction Questionnaire for Medication (TSQM), and the risk of discontinuation/switching PMO medications using patient-reported data from a large, longitudinal cohort study.

METHODS

Data from 2,405 participants in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™) Study were evaluated. Cox proportional hazards regression was used to estimate hazard ratios (HR) for the association between treatment satisfaction at study entry and self-reported discontinuation/switching of pharmacologic PMO medications over a 1-year follow-up period. Logistic regression was used to evaluate relationships between treatment satisfaction, lifestyle behaviors, and compliance with bisphosphonate dosing instructions.

RESULTS

Median TSQM scores were highest (indicating greatest satisfaction) for the side effects domain [n = 1,182; median = 87.5 (Q1 = 75.0, Q3 = 100.0)] and lowest for global satisfaction [n = 2,340; median = 64.0 (Q1 = 55.7, Q3 = 77.7)]. Median scores decreased for the side effects and global satisfaction domains as patient-reported side effect severity increased. Women with higher satisfaction were less likely to discontinue/switch medications than women with lower scores (adjusted HRs for convenience 0.73, 95% CI = 0.63-0.85; effectiveness 0.82, 95% CI = 0.70-0.97; and global satisfaction 0.73, 95% CI = 0.63-0.85). Lower treatment satisfaction was particularly influential among women who reported moderate/severe side effects (HR = 0.60, 95% CI = 0.37-0.97).

CONCLUSIONS

Lower treatment satisfaction was associated with a 22% (1/0.82) to 67% (1/0.60) increased risk of discontinuation/switching osteoporosis medication during 1 year of follow-up.

Alleviation of Ferric Chloride-Induced Seizures and Retarded Behaviour in Epileptic Rats by Cortical Electrical Stimulation Treatment

OBJECTIVE: To study the effects of low-frequency cortical electrical stimulation (CES) on seizures and behaviour in a rat model of epilepsy induced by ferric chloride (FeCl3). METHODS: Rats were randomly assigned into four groups ( n = 8 per group): normal healthy rats; saline-treated control rats; FeCl3-induced epileptic rats; CES-treated FeCl3-induced epileptic rats. Behavioural tests, analysis of the levels of brain-derived neurotrophic factor (BDNF) protein in brain tissue, and ultrastructural studies using transmission electron microscopy (TEM) were undertaken. RESULTS: CES significantly decreased the number and grade of seizures, and improved rat behaviour, compared with untreated epileptic rats. CES reduced levels of BDNF protein in the forebrain and increased levels of BDNF protein in the hippocampus compared with untreated epileptic rats. TEM showed less damage and ultrastructural changes in the neurons of CES-treated epileptic rats. CONCLUSIONS: CES inhibited seizures in FeCl3-induced epileptic rats and improved their behaviour. These effects might be mediated by altering BDNF protein levels in the brain.

Implication of dysregulation of the canonical wingless-type MMTV integration site (WNT) pathway in diabetic nephropathy

AIMS/HYPOTHESIS

The wingless-type MMTV integration site (WNT) pathway mediates multiple physiological and pathological processes, such as inflammation, angiogenesis and fibrosis. The aim of this study was to investigate whether canonical WNT signalling plays a role in the pathogenesis of diabetic nephropathy.

METHODS

Expression of WNT ligands and frizzled receptors in the canonical WNT pathway in the kidney was compared at the mRNA level using real-time RT-PCR between Akita mice, streptozotocin-induced diabetic rats and db/db mice and their respective non-diabetic controls. Renal function was evaluated by measuring the urine albumin excretion. Human renal proximal tubular epithelial cells were treated with high-glucose medium and 4-hydroxynonenal (HNE). Levels of β-catenin, connective tissue growth factor and fibronectin were determined by western blot analysis.

RESULTS

Some of the WNT ligands and frizzled receptors showed increased mRNA levels in the kidneys of Akita mice, streptozotocin-induced diabetic rats and db/db mice compared with their non-diabetic controls. Renal levels of β-catenin and WNT proteins were upregulated in these diabetic models. Lowering the blood glucose levels by insulin attenuated the activation of WNT signalling in the kidneys of Akita mice. In cultured human renal proximal tubular epithelial cells, both high glucose and HNE activated WNT signalling. Inhibition of WNT signalling with a monoclonal antibody blocking LDL-receptor-related protein 6 ameliorated renal inflammation and fibrosis and reduced proteinuria in Akita mice.

CONCLUSIONS/INTERPRETATION

The WNT pathway is activated in the kidneys of models of both type 1 and 2 diabetes. Dysregulation of the WNT pathway in diabetes represents a new pathogenic mechanism of diabetic nephropathy and renders a new therapeutic target.

P3-16-08: A Phase 2, Randomized Open-Label Study of Iniparib, Administered Either Weekly or Twice-Weekly in Combination with Gemcitabine Plus Carboplatin in Patients with mTNBC

Background

Iniparib (BSI-201) is an investigational anticancer agent whose precise mechanism of action is under active investigation. In breast cancer cell lines and xenograft models of triple-negative breast cancer (TNBC), iniparib exhibits anti-proliferative activity and potentiates the cell cycle effects of some DNA damaging agents. In a randomized, open-label phase 2 study in pts with metastatic TNBC (mTNBC), iniparib combined with gemcitabine (G) and carboplatin (C) (GC) improved efficacy outcomes compared with GC alone. A confirmatory phase 3 study with GCI failed to meet pre-specified criteria for PFS and OS; however, an exploratory subset analysis demonstrated a potential benefit amongst 2nd/3rd line pts (O'Shaughnessy et al. ASCO 2011). Here we report results of a randomized phase 2 study (NCT01045304) in pts with mTNBC, which assesses efficacy and pharmacokinetics (PK) of iniparib administered either biw or qw in combination with GC.

Patients and methods: Eligible pts (N=163; median age 49 yrs) had documented and measurable TNBC, ECOG PS 0–1, normal organ/marrow function, and had received ≤2 prior chemotherapy (CT) regimens for metastatic disease. Pts were randomized (1:1) to receive G (1,000 mg/m2, IV, d 1, 8) plus C (AUC 2, IV, d 1, 8) and iniparib either biw (5.6 mg/kg, IV d 1,4,8,11) or qw (11.2 mg/kg, IV d 1,8) on a 21 d cycle. Pts were stratified according to prior CT for mTNBC (0 vs. 1–2). The primary efficacy endpoint was overall response rate (ORR; CR + PR); secondary endpoints included: clinical benefit rate (CBR; CR + PR + SD for 24 weeks), PFS, OS and PK.

Results: At the time of analysis, 23% of patients were still on treatment. The median number of cycles administered per patient was 6 in both arms; exposure to iniparib was identical. Safety data are not fully validated. All pts experienced at least 1 treatment emergent adverse event (TEAE). Grade (Gr) ≥3 TEAEs occurred in 94% and 85% of pts in the biw and qw arms, respectively. TEAEs Gr ≥3 occurring in ≥5% of pts regardless of relationship to study drug (biw vs qw) are as follows: blood and lymphatic 71% vs 67%; hepatobiliary 7.5% vs 9.8%; asthenia/fatigue 7.5% vs 11%; GI 8.8% vs 8.5%; infections 7.5% vs 3.7%; respiratory, thoracic and mediastinal 5% vs 8.5%, metabolism and nutrition 4% vs 6%. For response data see table.

Granzyme K inhibits replication of influenza virus through cleaving the nuclear transport complex importin α1/β dimer of infected host cells

The influenza A virus is a causative agent of influenza, which infects human cells and uses host factors to accomplish viral genome replication as part of its life cycle. The nucleoprotein (NP) and PB2 of the influenza virus associate with importin α1 to gain access to the host nucleus through a ternary import complex. Killer cell-mediated cytotoxicity is the primary mechanism of eliminating the influenza virus. Here, we showed that lymphokine-activated killer cells participated in the elimination of the influenza virus. Granzyme (Gzm) K inhibition elevated viral replication in vitro and aggravated viral infection in vivo. We identified that importin α1 and its transport partner protein importin β are physiological substrates of GzmK. Proteolysis of these two substrates wrecked their association to generate the importin α1/β dimer and disrupted transportation of viral NP to the nucleus, leading to inhibition of influenza virus replication.

ERK1/2 signaling pathway in mast cell activation-induced sensitization of esophageal nodose C-fiber neurons

Sensitization of esophageal nociceptive afferents by inflammatory mediators plays an important role in esophageal inflammatory nociception. Our previous studies demonstrated that esophageal mast cell activation increases the excitability of esophageal nodose C-fibers. But the intracellular mechanism of this sensitization process is still less clear. We hypothesize that extracellular signal-regulated kinases 1 and 2 (ERK1/2) signaling pathway plays an important role in mast cell activation-induced sensitization of esophageal nodose C-fiber neurons. Mast cell activation and in vivo esophageal distension-induced phosphorylations of ERK1/2 were studied by immuno-staining and Western blot in esophageal nodose neurons. Extracellular recordings were performed from nodose neurons using ex vivo esophageal-vagal preparations with intact nerve endings in the esophagus. Nerve excitabilities were compared by action potentials evoked by esophageal distensions before and after mast cell activations with/without pretreatment of mitogen-activated protein kinases (MAPK)/ERK kinase inhibitor U0126. The expressions of phospho-ERK1/2 (p-ERK1/2) in the same nodose ganglia were then studied by Western blot. Mast cell activation enhances in vivo esophageal distension-induced phosphorylation of ERK1/2 in nodose neurons. This can be prevented by pretreatment with mast cell stabilizer cromolyn. In ex vivo esophageal-vagal preparations, both mast cell activation and proteinase-activated receptor 2 (PAR2)-activating peptide perfusion increases esophageal distension-induced mechano-excitability of esophageal nodose C-fibers and phosphorylation of ERK1/2 in nodose neurons. Pretreatment with MAPK/ERK kinase inhibitor U0126 prevents these potentiation effects. Collectively, our data demonstrated that mast cell activation enhances esophageal distension-induced mechano-excitability and phosphorylation of ERK1/2 in esophageal nodose C-fiber neurons. This reveals a new intracellular pathway of esophageal peripheral sensitization and inflammatory nociception.

The role of lipid peroxidation products and oxidative stress in activation of the canonical wingless-type MMTV integration site (WNT) pathway in a rat model of diabetic retinopathy

AIMS/HYPOTHESIS

Our recent studies suggest that activation of the wingless-type MMTV integration site (WNT) pathway plays pathogenic roles in diabetic retinopathy and age-related macular degeneration. Here we investigated the causative role of oxidative stress in retinal WNT pathway activation in an experimental model of diabetes.

METHODS

Cultured retinal pigment epithelial cells and retinal capillary endothelial cells were treated with a lipid peroxidation product, 4-hydroxynonenal (HNE), and an antioxidant, N-acetyl-cysteine (NAC). In vivo, rats with streptozotocin-induced diabetes were treated by NAC for 8 weeks. Activation of the canonical WNT pathway was measured by TOPFLASH assay and by western blot analysis of WNT pathway components and a WNT target gene, Ctgf. Oxidative stress in the retina was evaluated by immunostaining of HNE and 3-nitrotyrosine.

RESULTS

Levels of phosphorylated and total LDL receptor-related protein (LRP)6, and cytosolic β-catenin, as well as transcriptional activity of T cell factor (TCF)/β-catenin were significantly increased by HNE. The production of connective tissue growth factor (CTGF) was also upregulated by HNE. NAC blocked the WNT pathway activation induced by HNE. Furthermore, LRP6 stability was increased by HNE and decreased by NAC. Retinal levels of HNE and 3-nitrotyrosine were significantly increased in diabetic rats, compared with those in non-diabetic rats. In the same diabetic rat retinas, levels of LRP6, cytosolic β-catenin and CTGF were significantly increased. NAC treatment reduced HNE and 3-nitrotyrosine levels and attenuated the upregulation of LRP6, β-catenin and CTGF in diabetic rat retina.

CONCLUSIONS/INTERPRETATION

Lipid peroxidation products activate the canonical WNT pathway through oxidative stress, which plays an important role in the development of retinal diseases.

Investigating the spatial-temporal variation of nitrogen cycling in an urban river in the North China Plain

Urban rivers are essential in retaining nutrients, but little is known about nitrogen cycling in these rivers in semiarid areas. We measured chemical and isotopic compositions of ammonium (NH4(+)-N) and nitrate (NO3(-)-N) to investigate spatial-temporal variation of nitrogen cycling in the Fuhe River in the North China Plain. Nitrogen pollution in the river was mainly induced by extra NH4(+)-N inputs which come from the discharges of urban sewage and effluents of wastewater treatment plants in upstream. NH4(+)-N obtained from decomposing organic matter of sediments can diffuse into the overlying water. Intense nitrification then occurs at the terrestrial-aquatic interface. Due to less vegetation in spring and autumn, loss of NH4(+)-N is mainly caused by nitrification. In contrast, significant NH4(+)-N is absorbed by plants in summer. NO3(-)-N generated from nitrification can be denitrified during the study period. The highest NO3(-)-N loss (about 86.3%) was observed in summer. The contribution of NO3(-)-N loss due to denitrification is 44.6%. The remaining 55.4% is due to plant uptake. The results suggested that nitrogen cycling in the river is related to temperature and dry-wet cycles. And vegetation restoration along the river could benefit the incremental improvements to the aquatic ecosystem.

Study on mechanical and ablative properties of EPDM/OMMT thermal insulating nanocomposites

In order to enhance the elongation at break, the ablation resistant properties as well as the tensile strength of the thermal insulating materials, organo-montmorillonite (OMMT) was introduced into the short aramid fibers reinforced Ethylene-Propylene-Diene Monomer (EPDM) based nanocomposites. The effects of OMMT content on the mechanical and ablative properties of the nanocomposites were investigated systematically. X-ray diffraction (XRD) and transmission electron microscopy (TEM) confirm that EPDM-matrix has been intercalated into OMMT interlayers after a mixing process on a two-roll mill. The brittle fracture of nanocomposites also indicates that OMMT can lubricate aramid fiber to weaken the interfacial adhesive strength between the fibers and the matrix. As a result, the tensile strength and elongation at break are both improved sharply with OMMT content increasing from 1 phr to 7 phr. However, thanks to the inevitable agglomeration of OMMT with high loading inside the nanocomposites, the tensile strength and elongation at break reduce gently once OMMT is over 7 phr. Furthermore, the ablation resistant properties are improved greatly by increasing OMMT from 1 phr to 11 phr. Therefore, the optimal content of OMMT is 7-11 phr for the thermal insulating nanocomposites with big elongation and excellent ablation resistant properties.

Regression to normoglycaemia by fenofibrate in pre-diabetic subjects complicated with hypertriglyceridaemia: a prospective randomized controlled trial

AIMS

Lipotoxicity has recently been shown to be an important risk factor underlying the pathogenesis of pre-diabetes. However, clinical evidence supporting the treatment of pre-diabetes by improving lipotoxicity is lacking. Here, we conducted an open-label, randomized, controlled trial to investigate whether fenofibrate, the widely used hypolipidaemic agent, might benefit pre-diabetes, with metformin and diet control, the recommended intervention methods, as positive controls.

METHODS

Newly diagnosed pre-diabetes patients (n = 120) with hypertriglyceridaemia (plasma triglyceride levels between 1.8 and 4.5 mmol/l) were randomly assigned by computer-generated randomization sequence to either control group (no intervention), fenofibrate group (200 mg once a day), metformin group (500 mg three times a day) or diet-controlled group (diet recommendation). Plasma biochemistry examination was performed every 2 months. The primary endpoint was the outcome of the natural course of pre-diabetes, evaluated by oral glucose tolerance test after 6-month follow-up.

RESULTS

Twenty subjects in the fenofibrate group, 24 subjects in the metformin group and 25 subjects in both the diet-controlled group and the control group finished the trial. Fenofibrate, metformin and diet control had protective effects on hypertriglyceridaemic pre-diabetes, evidenced by 53.3, 70 and 30% participants regressed to normoglycaemia, respectively. The effects of fenofibrate and metformin were comparable (P > 0.05), while diet control was less effective (P < 0.05). Liver damage occurred in six subjects in the fenofibrate group and gastrointestinal symptoms occurred in four subjects in the metformin group. No serious adverse events occurred.

CONCLUSION

Controlling lipotoxicity by fenofibrate could effectively ameliorate the natural course of hypertriglyceridaemic pre-diabetes.

ALOX12 polymorphisms are associated with fat mass but not peak bone mineral density in Chinese nuclear families

OBJECTIVE

Arachidonate 12-lipoxygenase (ALOX12) is a member of the lipoxygenase superfamily, which catalyzes the incorporation of molecular oxygen into polyunsaturated fatty acids. The products of ALOX12 reactions serve as endogenous ligands for peroxisome proliferator-activated receptor γ (PPARG). The activation of the PPARG pathway in marrow-derived mesenchymal progenitors stimulates adipogenesis and inhibits osteoblastogenesis. Our objective was to determine whether polymorphisms in the ALOX12 gene were associated with variations in peak bone mineral density (BMD) and obesity phenotypes in young Chinese men.

METHODS

All six tagging single-nucleotide polymorphisms (SNPs) in the ALOX12 gene were genotyped in a total of 1215 subjects from 400 Chinese nuclear families by allele-specific polymerase chain reaction. The BMD at the lumbar spine and hip, total fat mass (TFM) and total lean mass (TLM) were measured using dual-energy X-ray absorptiometry. The pairwise linkage disequilibrium among SNPs was measured, and the haplotype blocks were inferred. Both the individual SNP markers and the haplotypes were tested for an association with the peak BMD, body mass index, TFM, TLM and percentage fat mass (PFM) using the quantitative transmission disequilibrium test (QTDT).

RESULTS

Using the QTDT, significant within-family association was found between the rs2073438 polymorphism in the ALOX12 gene and the TFM and PFM (P=0.007 and 0.012, respectively). Haplotype analyses were combined with our individual SNP results and remained significant even after correction for multiple testing. However, we failed to find significant within-family associations between ALOX12 SNPs and the BMD at any bone site in young Chinese men.

CONCLUSIONS

Our present results suggest that the rs2073438 polymorphism of ALOX12 contributes to the variation of obesity phenotypes in young Chinese men, although we failed to replicate the association with the peak BMD variation in this sample. Further independent studies are needed to confirm our findings.

Kinetic analysis of oxytetracycline residues in Chinese mitten crab, Eriocheir sinensis, muscle following intramuscular administration

Crab culture is a very important economic industry in China. An epidemic of tremor disease of Chinese mitten crabs, Eriocheir sinensis, has become a serious problem in recent years. A spiroplasm has been proved to be the causative agent of this disease. Oxytetracycline (OTC) is used widely in aquaculture and was confirmed to be very effective against this pathogen. In this study, the distribution and depletion patterns of OTC in crab muscle were evaluated following single intramuscular doses of 2, 8 and 40 mg kg(-1) body weight. OTC was detected with a validated HPLC method. Concentration-time profiles were well described by a three-compartment model with first-order absorption after a single dose of 8 and 40 mg kg(-1). For comparison, a non-compartment model was employed. A withdrawal time of 48.29 and 55.92 days was suggested prior to consumption after receiving 8 and 40 mg kg(-1). A recommended therapeutic dose of OTC in theory was calculated to be 36.37 mg kg(-1). OTC was distributed well throughout the body. The elimination of OTC in muscle was slower compared with fish and other crustaceans. A dose of 40 mg kg(-1) is suggested for practical use.

Simultaneous Estimation of Relative Permeability and Porosity/Permeability Fields by History Matching Production Data

Abstract

This paper presents a procedure to estimate relative permeability curves together with gridblock porosities and permeabilities by automatic history matching three-phase flow production data using the LBFGS algorithm for optimization and the adjoint method for generating sensitivity coefficients. Both power law and B-splines are considered for the representation of relative permeability curves. Power law functions provide a simple representation; however, B-splines have the advantage of being able to accurately represent any set of relative permeability curves. In the B-spline representation, we provide a simple procedure based on a transformation of parameters (control points) defining the B-splines to ensure that monotonic curves are obtained. Without this transformation, the automatic history-matching process fails. If endpoint saturations are included as parameters, we show how to modify the adjoint procedure to account for the fact that initial conditions are sensitive to endpoint saturations. While the history-matching process is inherently non-unique, we show that reasonable estimates of relative permeability curves and porosity/ permeability fields can be obtained for a synthetic reservoir example. We also provide a quantification of the uncertainty in model parameters and reservoir performance prediction using the randomized maximum likelihood (RML) method.

Introduction

Usually, the relative permeability curves are obtained from labs through coreflood tests. However, they can also be incorporated into the history matching procedure as model parameters. Archer and Wong(1) and Yang and Watson(2) were among the early researchers to consider the estimation of relative permeability curves by history matching laboratory coreflood data. A detailed literature review is given in Reynolds et al.(3). Reynolds et al.(3) also discussed the estimation of three-phase relative permeabilities by history matching production data.

The current work is a natural extension of Reynolds et al.(3). In this paper, we provide an alternative method for relative permeability estimation based on B-spline approximation. Compared to power law representation, B-splines have the advantage of being able to accurately represent any set of relative permeability curves.

Bacterial and archaeal assemblages in sediments of a large shallow freshwater lake, Lake Taihu, as revealed by denaturing gradient gel electrophoresis

AIMS

To explore the association of microbial community structure with the development of eutrophication in a large shallow freshwater lake, Lake Taihu.

METHODS AND RESULTS

The bacterial and archaeal assemblages in sediments of different lake areas were analysed using denaturing gradient gel electrophoresis (DGGE) of amplified 16S rDNA fragments. The bacterial DGGE profiles showed that eutrophied sites, grass-bottom areas and relatively clean sites with a eutrophic (albeit dredged) site are three respective clusters. Fifty-one dominant bacterial DGGE bands were detected and 92 corresponding clones were sequenced, most of which were affiliated with bacterial phylotypes commonly found in freshwater ecosystems. Actinobacteria were detected in the centre of the lake and not at eutrophied sites whereas the opposite was found with respect to Verrucomicrobiales. Twenty-five dominant archaeal DGGE bands were detected and 31 corresponding clones were sequenced, most of which were affiliated with freshwater archaeal phylotypes.

CONCLUSIONS

The bacterial community structures in the sediments of different areas with similar water quality and situation tend to be similar in Taihu Lake.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study may expand our knowledge on the relationship between the overall microbial assemblages and the development of eutrophication in the shallow freshwater lake.

A subject-specific technique for respiratory motion correction in image-guided cardiac catheterisation procedures

We describe a system for respiratory motion correction of MRI-derived roadmaps for use in X-ray guided cardiac catheterisation procedures. The technique uses a subject-specific affine motion model that is quickly constructed from a short pre-procedure MRI scan. We test a dynamic MRI sequence that acquires a small number of high resolution slices, rather than a single low resolution volume. Additionally, we use prior knowledge of the nature of cardiac respiratory motion by constraining the model to use only the dominant modes of motion. During the procedure the motion of the diaphragm is tracked in X-ray fluoroscopy images, allowing the roadmap to be updated using the motion model. X-ray image acquisition is cardiac gated. Validation is performed on four volunteer datasets and three patient datasets. The accuracy of the model in 3D was within 5mm in 97.6% of volunteer validations. For the patients, 2D accuracy was improved from 5 to 13mm before applying the model to 2-4mm afterwards. For the dynamic MRI sequence comparison, the highest errors were found when using the low resolution volume sequence with an unconstrained model.

Effects of denosumab treatment in breast cancer patients with bone metastases and elevated bone resorption levels after therapy with intravenous bisphosphonates: results of a phase 2 randomized trial

Abstract #1155

Background: Patients with breast cancer-induced bone disease and elevated urine-N-telopeptide (uNTx), a marker of bone resorption, are at increased risk for skeletal complications, disease progression, and death. Receptor activator of NF-kB ligand (RANKL) mediates osteoclastic bone resorption. Denosumab, a fully human monoclonal antibody, inhibits bone destruction by binding and neutralizing RANKL. Denosumab efficacy and safety were assessed in a phase 2, randomized, open-label, active-controlled trial in patients with bone metastases and elevated levels of uNTx after at least 8 weeks of intravenous (IV) bisphosphonate (BP) therapy. We report results in a subset of patients with breast cancer.&#x2028; Methods: Cancer patients with bone metastases and uNTx &gt;50 nM/mM creatinine [Cr] following at least 8 weeks of IV BP therapy were randomized to continue IV BP therapy every 4 weeks (Q4W) or switch to subcutaneous (SC) denosumab injection (180 mg) Q4W or every 12 weeks (Q12W). The primary endpoint was the proportion of patients who achieved uNTx &lt;50 nM/mM at week 13. Safety was also assessed.&#x2028; Results: The study population (N = 111) included 46 patients (41%) with breast cancer; the median time since diagnosis of bone metastases was approximately 1 year in both groups. At week 13, 76% of denosumab-treated patients and 33% of IV BP-treated patients had uNTx &lt; 50 nM/mM. Denosumab-induced suppression of uNTx was rapid (as early as 2 weeks after initial treatment), sustained through week 25, and unaffected by baseline uNTx (Table). In the total study population, adverse events of grade 3, 4, or 5 were reported in 25 (71%) IV BP-treated patients and 40 (55%) denosumab-treated patients.&#x2028; &#x2028; Discussion: Denosumab reduced bone turnover in breast cancer patients with bone metastases and elevated uNTx despite prior IV BP therapy. Phase 3 trials of denosumab in cancer patients with bone metastases are in progress.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1155.