Development of a novel lung-stabilizing device for VATS procedures

BACKGROUND

The use of video-assisted thoracoscopic surgery (VATS) has substantially increased in recent years. These procedures involve the insertion of specialized devices into the thoracic cavity via access ports. However, conventional devices such as cotton-tipped applicators and graspers can limit the field of view and injure the fragile lung tissue. The aim of this study was to develop a novel lung-stabilizing device for VATS that provides a good surgical field of view without causing lung injury.

METHODS

We developed a novel suction-based lung-stabilizing device equipped with three hemispheric 20-mm-diameter silicon suction cups. The utility and safety of the novel device were evaluated using a resected pig lung and canine models. In order to assess potential organ damage arising from the use of the novel device, canine lung parenchyma and pleura were macroscopically and microscopically examined after the device had been continuously applied under negative pressure conditions of -400 or -540 mmHg for 1 h.

RESULTS

To assess the utility of the novel device, we performed lobectomies in the resected pig lung and VATS in canine models. The device demonstrated sufficient power to stabilize the lungs and provided a clear field of view during surgery, which enabled us to perform VATS lobectomies more easily than conventional stabilizing forceps. Assessment of the dogs' lungs immediately after detaching the suction-based device revealed no complications such as hemorrhage, air leaks, and bullae formation. Pathological examination after 7 days also showed no substantial damage, except for a small impression in the parenchyma and pleura of the surface layer where the device had contacted the lung tissue.

CONCLUSIONS

Although further validation studies in clinical settings are required, our study indicates that the novel lung-stabilizing device has potentially useful applications in VATS procedures.

Multi-point measurement using two-channel reflectometer with antenna switching for study of high-frequency fluctuations in GAMMA 10

A two-channel microwave reflectometer system with fast microwave antenna switching capability was developed and applied to the GAMMA 10 tandem mirror device to study high-frequency small-amplitude fluctuations in a hot mirror plasma. The fast switching of the antennas is controlled using PIN diode switches, which offers the significant advantage of reducing the number of high-cost microwave components and digitizers with high bandwidths and large memory that are required to measure the spatiotemporal behavior of the high-frequency fluctuations. The use of two channels rather than one adds the important function of a simultaneous two-point measurement in either the radial direction or the direction of the antenna array to measure the phase profile of the fluctuations along with the normal amplitude profile. The density fluctuations measured using this system clearly showed the high-frequency coherent fluctuations that are associated with Alfvén-ion-cyclotron (AIC) waves in GAMMA 10. A correlation analysis applied to simultaneously measured density fluctuations showed that the phase component that was included in a reflected microwave provided both high coherence and a clear phase difference for the AIC waves, while the amplitude component showed neither significant coherence nor clear phase difference. The axial phase differences of the AIC waves measured inside the hot plasma confirmed the formation of a standing wave structure. The axial variation of the radial profiles was evaluated and a clear difference was found among the AIC waves for the first time, which would be a key to clarify the unknown boundary conditions of the AIC waves.

Quasiparticle Scattering off Defects and Possible Bound States in Charge-Ordered YBa_{2}Cu_{3}O_{y}

We report the NMR observation of a skewed distribution of ^{17}O Knight shifts when a magnetic field quenches superconductivity and induces long-range charge-density-wave (CDW) order in YBa_{2}Cu_{3}O_{y}. This distribution is explained by an inhomogeneous pattern of the local density of states N(E_{F}) arising from quasiparticle scattering off, yet unidentified, defects in the CDW state. We argue that the effect is most likely related to the formation of quasiparticle bound states, as is known to occur, under specific circumstances, in some metals and superconductors (but not in the CDW state, in general, except for very few cases in 1D materials). These observations should provide insight into the microscopic nature of the CDW, especially regarding the reconstructed band structure and the sensitivity to disorder.

Wireless Multichannel Neural Recording With a 128-Mbps UWB Transmitter for an Implantable Brain-Machine Interfaces

Simultaneous recordings of neural activity at large scale, in the long term and under bio-safety conditions, can provide essential data. These data can be used to advance the technology for brain-machine interfaces in clinical applications, and to understand brain function. For this purpose, we present a new multichannel neural recording system that can record up to 4096-channel (ch) electrocorticogram data by multiple connections of customized application-specific integrated circuits (ASICs). The ASIC includes 64-ch low-noise amplifiers, analog time-division multiplexers, and 12-bit successive approximation register ADCs. Recorded data sampled at a rate of 1 kS/s are multiplexed with time division via an integrated multiplex board, and in total 51.2 Mbps of raw data for 4096 ch are generated. This system has an ultra-wideband (UWB) wireless unit for transmitting the recorded neural signals. The ASICs, multiplex boards, and UWB transmitter unit are designed with the aim of implanting them. From preliminary experiments with a human body-equivalent liquid phantom, we confirmed 4096-ch UWB wireless data transmission at 128 Mbps for distances below 20 mm .

Infiltration of PD-1-positive cells in combination with tumor site PD-L1 expression is a positive prognostic factor in cutaneous angiosarcoma

Cutaneous angiosarcoma (CAS) is a malignant sarcoma with poor prognosis. Programmed cell death-1 (PD-1)/programmed cell death-1 ligand-1 (PD-L1) expression reflects antitumor immunity, and is associated with patient prognosis in various cancers. The purpose of this study is to investigate the relationship between PD-1/PD-L1 expression and CAS prognosis. CAS cases (n = 106) were immunohistochemically studied for PD-L1 and PD-1 expression, and the correlation with patient prognosis was analyzed. PD-L1 expression was assessed by flow cytometry on three CAS cell lines with or without IFNγ stimulation. A total of 30.2% of patients' samples were positive for PD-L1, and 17.9% showed a high infiltration of PD-1-positive cells. Univariate analysis showed a significant relationship between a high infiltration of PD-1-positive cells with tumor site PD-L1 expression and favorable survival in stage 1 patients (p = 0.014, log-rank test). Multivariable Cox-proportional hazard regression analysis also showed that patients with a high infiltration of PD-1-positive cells with tumor site PD-L1 expression were more likely to have favorable survival, after adjustment with possible confounders (hazard ratio (HR) = 0.38, p = 0.021, 95% confidence interval (CI) 0.16-0.86). Immunofluorescence staining of CAS samples revealed that PD-L1-positive cells were adjacent to PD-1-positive cells and/or tumor stroma with high IFNγ expression. In vitro stimulation with IFNγ increased PD-L1 expression in two out of three established CAS cell lines. Our results suggest that PD-1/PD-L1 expression is related to CAS progression, and the treatment with anti-PD-1 antibodies could be a new therapeutic option for CAS.

Multichannel neural recording with a 128 Mbps UWB wireless transmitter for implantable brain-machine interfaces

To realize a low-invasive and high accuracy BMI (Brain-machine interface) system, we have already developed a fully-implantable wireless BMI system which consists of ECoG neural electrode arrays, neural recording ASICs, a Wi-Fi based wireless data transmitter and a wireless power receiver with a rechargeable battery. For accurate estimation of movement intentions, it is important for a BMI system to have a large number of recording channels. In this paper, we report a new multi-channel BMI system which is able to record up to 4096-ch ECoG data by multiple connections of 64-ch ASICs and time division multiplexing of recorded data. This system has an ultra-wide-band (UWB) wireless unit for transmitting the recorded neural signals to outside the body. By preliminary experiments with a human body equivalent liquid phantom, we confirmed 4096-ch UWB wireless data transmission at 128 Mbps mode below 20 mm distance.

Adipophilin expression in lung adenocarcinoma is associated with apocrine-like features and poor clinical prognosis: an immunohistochemical study of 328 cases

AIMS

The lipogenic pathway is up-regulated in proliferating cells. However, the clinical impact of neoplastic steatogenesis in lung cancer is unclear. The aim of the present study was to evaluate the association of intracytoplasmic lipids with the clinicopathological features of lung adenocarcinoma (ADC), by immunohistochemical analysis of adipophilin (ADP), a coating protein found on intracytoplasmic lipid droplets.

METHODS AND RESULTS

Tissue microarrays consisting of 328 primary lung ADCs surgically resected at Kyoto University Hospital were immunostained for ADP. Subsequently, correlations between ADP expression and clinical, molecular and survival data were performed. Fifty-one (15.5%) cases were ADP-positive. The presence of vascular invasion (P = 0.003), predominantly solid histology (P < 0.001), poorly differentiated type (P < 0.001), wild-type EGFR (P = 0.002), ALK fusion (P < 0.001), strong/diffuse mitochondrial staining (P < 0.001), a lack of surfactant protein B expression (P = 0.014) and a high Ki67 index (P < 0.001) were significantly correlated with ADP-positive ADC. In contrast, there were no correlations between ADP-positive ADC and sex, age, smoking history, tumour stage, thyroid transcription factor-1 expression, or KRAS mutational status. ADP-positive ADCs had apocrine-like features (P < 0.001). Patients with ADP-positive ADC had worse disease-free and overall survival (P = 0.047 and P = 0.013, respectively) than those with ADP-negative ADC.

CONCLUSIONS

ADP was expressed in a small proportion of lung ADCs. ADP-positive lung ADC was significantly associated with apocrine-like features, wild-type EGFR, and poor prognosis, suggesting that ADP-positive lung ADC could be a distinct subtype of lung adenocarcinoma, induced by up-regulation of the lipogenic pathway.

Studies on the validity of urinary enzyme assay in the diagnosis of drug-induced renal lesions in rats

The validity of urinary enzyme assays in the diagnosis of renal lesions was studied in rats for evaluation in comparison with other tests such as urinalysis and serum biochemical assay. Tubular damages of slight or severe degree were induced by daily intramuscular administration of 500 mg/kg or 1,000 mg/kg of kanamycin (KM) for 7 and 6 days respectively. Glomerular lesions were induced subcutaneous injection of 30 mg/kg of puromycin (PM) for 6 days. The enzymes, assayed daily before and after the onset of administration, were lactic dehydrogenase (LDH), aspartate aminotransferase (GOT), alkaline phosphatase (AI-P), acid phosphatase (Ac-P), leucin aminopeptidase (LAP) and γ-glutamyl transpeptidase (γ-GT). The distribution of these enzymic activities in the kidneys was histochemically examined. Assays of LDH and GOT on the kidney tissue homogenate were also conducted. Histological alterations of the kidneys were examined in the rats sacrificed after termination of administration.

Significant elevation of the LDH and GOT urine levels were observed within 24 hours in rats treated with 500 mg/kg of KM with the high enzyme levels being maintained throughout the administration period, while the other enzymes remained within pretreatment levels or were only slightly elevated. Serum urea nitrogen (BUN) and creatinine levels remained unchanged with no abnormality being found in the urinalysis of this group. In the group treated with 1,000 mg/ kg of KM, concomitant rising of all urine enzyme levels was observed, with elevation of the LDH and GOT levels being extreme while the BUN and serum creatinine levels rose only at the termination of the administration period. The BUN level rose earlier than did most of the urinary enzymes in puromycin-treated rats.

Depletion of LDH activity was histochemically demonstrated in the kidneys where no histological alteration was observable, while the activities of AI-P, γ-GT, and LAP showed no distinct changes until the tabular destruction became severe. Upon termination of both KM and PM administration, the depletion of LDH and GOT activities was noted in a kidney homogenate assay for the enzymes.

These results clearly showed that among the enzymes studied, the LDH and GOT urine levels are the most sensitive indicators for detecting proximal tubular lesions induced by KM. It was further demonstrated that the urinary enzyme assay in combination with serum BUN measurement is an effective examination for distinguishing tubular from glomerular lesions.

Antiviral Effect of Interferon Therapy for Patients with Chronic Hepatitis C

Thirty-two patients with chronic hepatitis who were positive for hepatitis C virus (HCV) RNA by polymerase chain reaction and had antibody to HCV (anti-HCV), were enrolled in this study. Twenty of them were also positive for antibody to the GOR epitope (anti-GOR). Sixteen of the enrolled patients were treated with human lymphoblastoid interferon for six months. Treatment was initiated with 3 million units of interferon daily for 2 weeks, followed by 3 million units three times a week for 6 weeks and 1.5 million units three times a week for 16 weeks. The efficacy of therapy was assessed by comparison with the results in 16 untreated patients. Aminotransferase values, titre of anti-HCV and anti-GOR antibodies showed significant decreases throughout the therapy compared with baseline levels and the untreated patients. After a 3 month follow-up, nine treated patients (56.3%) had normal aminotransferase activities and six of them eliminated HCV RNA from their sera (37.5%). Three of these six patients became negative for both anti-HCV and anti-GOR antibodies (18.8%). None of the untreated control patients had normal aminotransferase activities or became negative for HCV markers. The present study suggests that human lymphoblastoid interferon can control the disease activity and eliminate hepatitis C virus from patients with chronic hepatitis C.

NKp46 regulates the production of serine proteases and IL-22 in human mast cells in urticaria pigmentosa

NKp46 (natural cytotoxic receptor 1/CD335) is expressed on natural killer cells and Th2-type innate lymphocytes. However, NKp46 expression in human mast cells has not yet been reported. Here, we explored the expression of, and possible role played by, NKp46 in such cells. NKp46 protein was expressed in human mast cells in urticaria pigmentosa principally of the tryptase-positive/chymase-negative type (MCT), but not in human non-neoplastic skin mast cells of the tryptase-positive/chymase-positive (MCTC) type. NKp46 expression was also evident in the human neoplastic mast cell line HMC1.2. NKp46 knockdown changed the phenotype of this cell line from MCT to MCTC and downregulated GrB production, but did not influence IL-22 production. An agonistic anti-NKp46 antibody upregulated production of GrB and IL-22, but did not change the MCT-like phenotype of HMC1.2 cells. NKp46 was thus involved in the production of serine proteases and IL-22 in human mast cells.

Abstract 2357: Knockdown of neuropilin-1 in monocytes impaired lymphocyte migration and anti-tumor activity in a humanized mouse model

Background

Antibody therapy such as trastuzumab is imperative for HER2-positive breast cancer patients. Although its antitumor action is not completely understood, the role of immune cells in antibody therapy is indispensable. Neuropilin-1 (NRP1) in monocytes induces high in vitro anti-tumor activity. Here, we showed the role of NRP1 in monocytes in HER2-positive breast cancer, using a tumor-bearing NOD/Shi-SCID, IL-2Rγnull(NOG) mouse model.

Experimental procedures

A tumor-bearing NOG mouse was made using BT474-sGL containing transfected HER2-positive human breast cancer cell lines that secreted Gaussia luciferase (Gluc). Tumor volumes were measured, using Gluc relative light units (RLUs), in 5 treatment arms (Table). Each arm was allocated 5 NOG mice, randomized by body weight and RLUs. Cytokines released into culture supernatants were determined using human Bio- Plex Cytokine Assay Kits (Bio-Rad, Hercules, CA), according to the manufacturer's instructions. mRNA was measured using TAQMAN array (LifeTechnologies, Carlsbad, CA) gene expression studies, according to the manufacturer's instructions.

Results

Knockdown of NRP-1 in monocytes impaired anti-tumor activity: After 2 cycles of treatment, RLUs increased significantly from baseline in Arm E, compared with those in Arm D. There was no significant difference between Arms B and E.

Knockdown of NRP-1 in monocytes impaired migration activity: Staining for human-specific CD45 revealed that the tumor infiltrating lymphocytes of Arm E decreased compared with those of Arm D; CD45 mRNA was significantly lower in Arm E than in Arm D.

Chemokine secretion is regulated by NRP-1: Tumor chemokine (e.g., IP-10, MIP-1α, MIP-1β and RANTES) secretion was significantly decreased due to knockdown of NRP-1.

Conclusion

Our data suggest that NRP-1-expressing immune cells initiate anti-tumor activity via migration and chemokine secretion.

Summary of resultsArmHumanizedTrastuzumabNRP1 KD% change RLU (mean ± SEM)CD45 mRNA relative quantities (mean ± SEM)IP-10 pg/mL (mean ± SEM)MIP-1α pg/mL (mean ± SEM)MIP-1β pg/mL (mean ± SEM)RANTES pg/mL (mean ± SEM)ANoNoNo495 ± 76.00.75 ± 0.3822.2 ± 6.351.16 ± 0.013.51 ± 3.515.36 ± 2.68BNoYesNo49.6 ± 43.20.50 ± 0.2617.1 ± 13.91.20 ± 0.275.75 ± 5.757.87 ± 4.40CYesNoNo566 ± 145504 ± 2421361 ± 4538.31 ± 3.1582.9 ± 43.659.4 ± 42.6DYesYesNo-45.7 ± 12.91650 ± 4055880 ± 26006.43 ± 1.3767.0 ± 13.9171 ± 35.4EYesYesYes46.2 ± 15.4307 ± 121285 ± 73.21.60 ± 0.3010.7 ± 2.3229.7 ± 9.69p value of D vs. Ep &lt; 0.01p = 0.04p = 0.03p &lt; 0.01p &lt; 0.01p &lt; 0.01

Citation Format: Kosuke Kawaguchi, Eiji Suzuki, Isao Kii, Tatsuki R. Kataoka, Masahiro Hirata, Hironori Haga, Masatoshi Hagiwara, Masakazu Toi. Knockdown of neuropilin-1 in monocytes impaired lymphocyte migration and anti-tumor activity in a humanized mouse model. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2357. doi:10.1158/1538-7445.AM2015-2357

Abstract 2349: EGFR is transferred from triple negative breast cancer cells to immune cells via trogocytosis and expression of EGFR on immune cells is associated with high tumor grade of triple negative breast cancer patients

We and others previously reported that HER2 was transferred from HER2 overexpressing breast cancer cells to CD14+ monocytes via trastuzumab dependent trogocytosis. In the current study, we report that EGFR of MDA-MB-231 (triple negative human breast cancer cell line) is also transferred to immune cells via trogocytosis and those immune cells express EGFR on the cell surface without antibody administration. Interestingly, the EGFR-trogocytosed MDA-MB-231 cells reduced the expression of EGFR and changed their morphology to the spindle shape (well known as mesenchymal transition) and acquired greater cell motility. These cancer cell properties are representative as higher malignant potentials in breast cancer patients. Thus, we hypothesized that EGFR expression on tumor infiltrating lymphocytes (TILs), which probably is caused via EGFR trogocytosis by TILs, is correlated with higher tumor grade. We evaluated the EGFR expression of TILs in 36 triple negative breast cancer specimens and found the correlation between EGFR expression status on TILs and higher tumor grade (P = 0.02). These findings may explain the reason why triple negative breast cancer with greater proportion of TILs exhibit higher tumor grade and poor prognosis.

Citation Format: Eiji Suzuki, Ayane Yamaguchi, Tatsuki R. Kataoka, Masahiro Hirata, Kosuke Kawaguchi, Mariko Nishie, Masakazu Toi. EGFR is transferred from triple negative breast cancer cells to immune cells via trogocytosis and expression of EGFR on immune cells is associated with high tumor grade of triple negative breast cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2349. doi:10.1158/1538-7445.AM2015-2349

The Killer Cell Ig-like Receptor 2DL4 Expression in Human Mast Cells and Its Potential Role in Breast Cancer Invasion

The killer-cell Ig-like receptor (KIR) 2DL4 (CD158d) acts as a receptor for human leukocyte antigen (HLA)-G and is expressed on almost all human natural killer (NK) cells. The expression and function of KIR2DL4 in other hematopoietic cells is poorly understood. Here, we focused on human mast cells, which exhibit cytotoxic activity similar to that of NK cells. KIR2DL4 was detected in all examined human cultured mast cells established from peripheral blood derived from healthy volunteers (PB-mast), the human mast cell line LAD2, and human nonneoplastic mast cells, including those on pathologic specimens. An agonistic antibody against KIR2DL4 decreased KIT-mediated and IgE-triggered responses, and enhanced the granzyme B production by PB-mast and LAD2 cells, by activating Src homology 2-containing protein tyrosine phosphatase (SHP-2). Next, we performed a coculture assay between LAD2 cells and the HLA-G(+) cancer cells, MCF-7 and JEG-3, and showed that KIR2DL4 on LAD2 cells enhanced MMP-9 production and the invasive activity of both cell lines via HLA-G. Immunohistochemical analysis revealed that the direct interaction between HLA-G(+) breast cancer cells and KIR2DL4(+) tissue mast cells (observed in 12 of 36 cases; 33.3%) was statistically correlated with the presence of lymph node metastasis or lymph-vascular invasion (observed in 11 of 12 cases; 91.7%; χ(2) = 7.439; P < 0.01; degrees of freedom, 1) in the clinical samples. These findings suggest that the KIR2DL4 on human mast cells facilitates HLA-G-expressing cancer invasion and the subsequent metastasis.

Trogocytosis-mediated expression of HER2 on immune cells may be associated with a pathological complete response to trastuzumab-based primary systemic therapy in HER2-overexpressing breast cancer patients

Background

Trogocytosis is defined as the transfer of cell-surface membrane proteins and membrane patches from one cell to another through contact. It is reported that human epidermal growth factor receptor 2 (HER2) could be transferred from cancer cells to monocytes via trogocytosis; however, the clinical significance of this is unknown. The aim of this study is to demonstrate the presence and evaluate the clinical significance of HER2⁺ tumor-infiltrated immune cells (arising through HER2 trogocytosis) in HER2-overexpressing (HER2+) breast cancer patients receiving trastuzumab-based primary systemic therapy (PST).

Methods

To assess the trogocytosis of HER2 from cancer cells to immune cells, and to evaluate the up- and down-regulation of HER2 on immune and cancer cells, peripheral blood mononuclear cells from healthy volunteers and breast cancer patients were co-cultured with HER2+ and HER2-negative breast cancer cell lines with and without trastuzumab, respectively. The correlation between HER2 expression on tumor-infiltrated immune cells and a pathological complete response (pCR) in HER2+ breast cancer patients treated with trastuzumab-based PST was analyzed.

Results

HER2 was transferred from HER2+ breast cancer cells to monocytes and natural killer cells by trogocytosis. Trastuzumab-mediated trogocytosed-HER2⁺ effector cells exhibited greater CD107a expression than non-HER2-trogocytosed effector cells. In breast cancer patients, HER2 expression on tumor-infiltrated immune cells in treatment naïve HER2+ tumors was associated with a pCR to trastuzumab-based PST.

Conclusions

HER2-trogocytosis is visible evidence of tumor microenvironment interaction between cancer cells and immune cells. Given that effective contact between these cells is critical for immune destruction of target cancer cells, this interaction is of great significance. It is possible that HER2 trogocytosis could be used as a predictive biomarker for trastuzumab-based PST efficacy in HER2⁺ breast cancer patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1041-3) contains supplementary material, which is available to authorized users.