White matter microstructure asymmetry: effects of volume asymmetry on fractional anisotropy asymmetry

Diffusion tensor imaging (DTI) provides information regarding white matter microstructure; however, macroscopic fiber architectures can affect DTI measures. A larger brain (fiber tract) has a 'relatively' smaller voxel size, and the voxels are less likely to contain more than one fiber orientation and more likely to have higher fractional anisotropy (FA). Previous DTI studies report left-to-right differences in the white matter; however, these may reflect true microscopic differences or be caused purely by volume differences. Using tract-based spatial statistics, we investigated left-to-right differences in white matter microstructure across the whole brain. Voxel-wise analysis revealed a large number of white matter volume asymmetries, including leftward asymmetry of the arcuate fasciculus and cingulum. In many white matter regions, FA asymmetry was positively correlated with volume asymmetry. Voxel-wise analysis with adjustment for volume asymmetry revealed many white matter FA asymmetries, including leftward asymmetry of the arcuate fasciculus and cingulum. The voxel-wise analysis showed a reduced number of regions with significant FA asymmetry compared with analysis performed without adjustment for volume asymmetry; however, the overall trend of the results was unchanged. The results of the present study suggest that these FA asymmetries are not caused by volume differences and reflect microscopic differences in the white matter.

Renoprotective effects of telmisartan on renal injury in obese Zucker rats

The purpose of the present study was to investigate the renoprotective effect of telmisartan, an angiotensin II receptor antagonist, on the early stages of diabetic nephropathy in obese Zucker rats, which is a type 2-related diabetes mellitus model. Telmisartan 1, 3 or 10 mg/kg/day was orally administered to 7-week-old rats that demonstrated glucose tolerance without albuminuria or proteinuria, for 24 consecutive weeks (Experiment A). In another experiment (Experiment B), oral administration of telmisartan 10 mg/kg/day was initiated at the age of 16 weeks after the rats demonstrated marked proteinuria, and continued for 24 weeks. Telmisartan inhibited the increase in proteinuria and albuminuria in a dose-dependent manner, and the inhibition for all telmisartan groups was statistically significant by the completion of administration (Experiment A). Telmisartan also displayed similar inhibitory effects on proteinuria and albuminuria in Experiment B. Histologically, telmisartan [3 and 10 mg/kg/day] was associated with a significant decrease in the progression of glomerulosclerosis, and significantly improved interstitial cell infiltration, interstitial fibrosis and dilation and atrophy of renal tubules. Furthermore, telmisartan treatment was associated with a tendency towards normalized plasma lipids (total cholesterol and triglyceride). Our results suggest that telmisartan has a definite renoprotective effect against renal injury in type II diabetic nephropathy.

Small ion-temperature-gradient scale length and reduced heat diffusivity at large hydrogen isotope mass in conventional H-mode plasmas

The dependence of the ion-temperature-gradient scale length on the hydrogen isotope mass was examined in conventional H-mode plasmas in JT-60U tokamak. While identical profiles for density and temperature were obtained for hydrogen and deuterium plasmas, the ion conductive heat flux necessary for hydrogen to sustain the same ion temperature profile was two times that required for deuterium, resulting in a clearly higher ion heat diffusivity for hydrogen at the same ion-temperature-gradient scale length. On the other hand, the ion-temperature-gradient scale length for deuterium is less than that for hydrogen at a given ion heat diffusivity.

Linagliptin monotherapy provides superior glycaemic control versus placebo or voglibose with comparable safety in Japanese patients with type 2 diabetes: a randomized, placebo and active comparator-controlled, double-blind study

AIMS

To evaluate the efficacy and safety of linagliptin 5 and 10 mg vs. placebo and voglibose in Japanese patients with type 2 diabetes mellitus (T2DM).

METHODS

This study enrolled patients with inadequately controlled T2DM who were previously treated with one or two oral antidiabetics or were drug naÏve. After a 2 to 4-week washout and placebo run-in, 561 patients were randomized (2 : 2 : 2 : 1) to double-blind treatment with linagliptin 5 or 10 mg qd, voglibose 0.2 mg tid or placebo. The primary endpoint was the change from baseline in haemoglobin A1c (HbA1c) with linagliptin vs. placebo after 12 weeks and vs. voglibose after 26 weeks.

RESULTS

Baseline characteristics were well balanced across treatment groups (overall mean HbA1c was 8.01%). The adjusted mean (95% confidence interval) treatment differences at week 12 were -0.87% (-1.04, -0.70; p < 0.0001) and -0.88% (-1.05, -0.71; p < 0.0001) for linagliptin 5 and 10 mg vs. placebo and at week 26 were -0.32% (-0.49, -0.15; p = 0.0003) and -0.39% (-0.56, -0.21; p < 0.0001) for linagliptin 5 and 10 mg vs. voglibose. At week 12, mean HbA1c was 7.58, 7.48 and 8.34% in patients receiving linagliptin 5 mg, linagliptin 10 mg and placebo, respectively. At week 26, mean HbA1c was 7.63% with linagliptin 5 mg, 7.50% with linagliptin 10 mg and 7.91% with voglibose. Drug-related adverse event rates were comparable across treatment groups over 12 weeks (9.4% linagliptin 5 mg, 8.8% linagliptin 10 mg and 10.0% placebo) and 26 weeks (11.3% linagliptin 5 mg, 10.6% linagliptin 10 mg and 18.5% voglibose). There were no documented cases of hypoglycaemia.

CONCLUSIONS

Linagliptin showed superior glucose-lowering efficacy and comparable safety and tolerability to both placebo and voglibose in Japanese patients with T2DM.

Efficacy and safety of telaprevir, a new protease inhibitor, for difficult-to-treat patients with genotype 1 chronic hepatitis C

The aims of this phase III study were to assess the efficacy and safety of telaprevir in combination with peginterferon alfa-2b (PEG-IFN) and ribavirin (RBV) for difficult-to-treat patients who had not achieved sustained virological response (SVR) to prior regimens in Japan. The subjects were 109 relapsers (median age of 57.0 years) and 32 nonresponders (median age of 57.5 years) with hepatitis C virus genotype 1. Patients received telaprevir (750 mg every 8 h) for 12 weeks and PEG-IFN/RBV for 24 weeks. The SVR rates for relapsers and nonresponders were 88.1% (96/109) and 34.4% (11/32), respectively. Specified dose modifications of RBV that differed from that for the standard of care were introduced to alleviate anaemia. RBV dose reductions were used for 139 of the 141 patients. The SVR rates for relapsers did not depend on RBV dose reduction for 20-100% of the planned dose (SVR rates 87.5-100%, P < 0.05). Skin disorders were observed in 82.3% (116/141). Most of the skin disorders were controllable by anti-histamine and/or steroid ointments. The ratios of discontinuation of telaprevir only or of all the study drugs because of adverse events were 21.3% (30/141) and 16.3% (23/141), respectively. A frequent adverse event leading to discontinuation was anaemia. Telaprevir in combination with PEG-IFN/RBV led to a high SVR rate for relapsers and may offer a potential new therapy for nonresponders even with a shorter treatment period.

Hsp27 silencing coordinately inhibits proliferation and promotes Fas-induced apoptosis by regulating the PEA-15 molecular switch

Heat shock protein 27 (Hsp27) is emerging as a promising therapeutic target for treatment of various cancers. Although the role of Hsp27 in protection from stress-induced intrinsic cell death has been relatively well studied, its role in Fas (death domain containing member of the tumor necrosis factor receptor superfamily)-induced apoptosis and cell proliferation remains underappreciated. Here, we show that Hsp27 silencing induces dual coordinated effects, resulting in inhibition of cell proliferation and sensitization of cells to Fas-induced apoptosis through regulation of PEA-15 (15-kDa phospho-enriched protein in astrocytes). We demonstrate that Hsp27 silencing suppresses proliferation by causing PEA-15 to bind and sequester extracellular signal-regulated kinase (ERK), resulting in reduced translocation of ERK to the nucleus. Concurrently, Hsp27 silencing promotes Fas-induced apoptosis by inducing PEA-15 to release Fas-associating protein with a novel death domain (FADD), thus allowing FADD to participate in death receptor signaling. Conversely, Hsp27 overexpression promotes cell proliferation and suppresses Fas-induced apoptosis. Furthermore, we show that Hsp27 regulation of PEA-15 activity occurs in an Akt-dependent manner. Significantly, Hsp27 silencing in a panel of phosphatase and tensin homolog on chromosome 10 (PTEN) wild-type or null cell lines, and in LNCaP cells that inducibly express PTEN, resulted in selective growth inhibition of PTEN-deficient cancer cells. These data identify a dual coordinated role of Hsp27 in cell proliferation and Fas-induced apoptosis via Akt and PEA-15, and indicate that improved clinical responses to Hsp27-targeted therapy may be achieved by stratifying patient populations based on tumor PTEN expression.

P4-16-02: Problems with Identifying Bone Metastasis-Specific Genes without Considering Biological Differences between ER-Positive and ER-Negative Breast Cancers

Background: Bone metastasis-specific genes in breast cancer have been reported without considering the significant differences in ER status between bone and non-bone metastases. The aims of this study were to validate genes that had been reported as bone metastasis-specific genes using our data set and to identify bone metastasis-specific genes on the basis of biological differences between ERpositive and ER-negative breast cancers.

Patients and Methods: We used Affymetrix GeneChip arrays to analyze tumor samples obtained from 365 primary invasive breast cancer patients who underwent surgery from 1999 to 2008. We excluded patients with HER2−positive breast cancer (normalized HER2 mRNA expression [probe set 216836_s_at] &gt; 12.54). We classified the samples into 3 cohorts according to first metastatic site: bone, non-bone, or no metastasis. Differential expression of genes between bone and non-bone cohorts that were differentially expressed was identified using the Cox proportional hazards model, and gene sets was assessed using gene-set analysis.

Results: Of the 365 patients, 34 (9.3%) were included in the bone cohort and 32 (8.8%) in the non-bone cohort. Two hundred fourteen (58.6%) had ER-positive and 151 (41.4%) had ER-negative breast cancer. First, we performed gene-set analysis using 5 gene sets that had been reported to be associated with bone metastasis. One gene set, which had been detected using an ER-negative breast cancer cell line, was validated as predicting bone metastasis in ER-positive breast cancer. None of the 5 gene sets predicted bone metastasis in ER-negative breast cancer. We then determined the levels of individual genes associated with bone metastasis by ER status using all 16,712 probe sets filtered by average gene expression level. When we analyzed all patients without any stratification by ER status, as in previous studies, 592 probe sets were significantly overexpressed in the bone cohort compared with the non-bone cohort, with a false discovery rate of ≤0.05. However, when we analyzed ER-positive and ER-negative breast cancers separately, no genes were found with significant differences between bone and non-bone cohorts. Finally, we used 2,246 functionally annotated gene sets assembled from Gene Ontology to examine possible biological differences between bone and non-bone cohorts. In the bone cohort, 151 and 125 gene sets were significantly overexpressed in ER-positive and ER-negative breast cancers, respectively (P ≤ 0.05). Ppathways related to Cellular growth and proliferation, and intracellular and second-messenger signaling were overexpressed in ER-positive breast cancer, whereas pathways related to nuclear receptor and cytokine signaling were overexpressed in ER-negative breast cancer. Most bone-metastasis-related pathways were different in ER-positive and ER-negative breast cancers (91.4% and 89.6% of the gene sets, respectively).

Discussion: No genes were found that can predict bone metastasis. ER-positive and ER-negative breast cancers have different biological potentials for bone metastasis. Therefore, we need to assess the prediction model of bone metastasis based on the biological features for each ER status separately.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-16-02.

P4-20-05: Inflammatory Breast Cancer: Comparison of Epidemiology, Biology, and Prognosis between Japan and the United States, a Hospital-Based Study

Background: Inflammatory breast cancer (IBC) is a challenging disease characterized by low incidence, rapid progression, and poor survival. The epidemiology of IBC has been slow to emerge, given that the rarity of IBC makes large prospective clinical trials difficult. Compared to non-IBC, well-established features of IBC include a younger age of onset and lower frequency of hormone receptor positivity. Higher body mass index (BMI) is a purported risk factor. Previous reports also suggest that IBC is associated with more racial disparities, including incidence and age at diagnosis. The epidemiology of IBC in East Asia, however, has not been investigated. We performed a comparative study of IBC in Japan versus the United States to determine its epidemiologic and clinical features and to evaluate the differences in epidemiological factors between the two countries.

Patients and Method: Patients who visited St. Luke's International hospital (SLIH) in Tokyo, Japan and The University of Texas MD Anderson Cancer Center (MDA) in Texas, USA between 2003 and 2009 were identified. Epidemiological and biological data were collected from electronic medical records. Patient and tumor characteristics were tabulated and stratified by hospital. Kaplan-Meier curves were created for survival estimates and log-rank test was used for cross-group comparisons. Cox proportional-hazard analysis was used to identify a subset of significant prognostic variables that related to overall survival.

Result: 34 patients at SLIH and 531 patients at MDA were identified. Mean age at diagnosis was 52 years old (range, 32–81, SD, 10.8) and 50 years old (range, 22–87, SD, 11.6), respectively (P=0.476). Mean BMI was 22.9 kg/m2 (range, 17.3−30.5, SD 3.3 ) and 31.0 kg/m2 (range, 13.6−88.9, SD, 7.8) respectively (P&lt;0.01). Clinical Staging was not significantly different; Stage IIIB 38.2%, Stage IIIC 26.5%, and Stage IV 32.4% at SLIH versus 48.6%, 23.7%, and 27.3% at MDA (P= 0.167). Estrogen receptor (ER) and progesterone receptor (PR) negative cases were, respectively, 50.0% and 64.7% at SLIH and 50.5% and 64.2% at MDA (ER, P= 0.935; PR, P=0.908). Her-2 over-expression cases were 38.2% at SLIH and 28.6% at MDA (P=0.174). A significant difference in nuclear grade was seen between SLIH and MDA: 20.6% at SLIH were Grade 3 versus 68.7% at MDA (P&lt;0.01). Median overall survival at SLIH was 3.6 years versus 2.3 years at MDA (P=0.570). No prognostic factors were associated with overall survival.

Conclusion: Though IBC at SLIH differed significantly from IBC at MDA by several epidemiologic and biologic factors, there was no significant difference in survival. To define the epidemiological, prognostic, and risk factors of IBC in Japan, as well as in the world, further studies are needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-20-05.

Effects of age and gender on white matter integrity

BACKGROUND AND PURPOSE

DTI provides a sensitive measure of change in the microstructure of white matter integrity. The purpose of our study was to investigate age-related changes, sex differences, and age-by-sex interactions in white matter integrity (FA, AD, and RD) across the whole brain with a large sample.

MATERIALS AND METHODS

A total of 857 healthy subjects (mean age = 56.1 ± 9.9 years; age range = 24.9-84.8 years) were included in this study. All subjects were scanned at 3T. With use of TBSS, we examined the effects of age and sex on FA, AD, and RD in the white matter.

RESULTS

Global FA was negatively correlated with age (R(2) = 0.18, P < .0001), and global AD and RD were positively correlated with age (AD: R(2) = 0.02, P < .0001; RD: R(2) = 0.19, P < .0001). The correlation between age and global AD, however, was weak. Voxelwise analysis revealed a number of regions where FA was negatively correlated with age, with most of these regions showing a significant positive correlation between RD and age. There was a significant age-related FA increase in several white matter regions. Voxelwise analysis also revealed many regions where FA, AD, or RD differed between men and women; however, no region showed a significant interaction between age and sex.

CONCLUSIONS

Our results suggest that age-related changes in white matter integrity are more strongly associated with myelin sheath degeneration than with axonal degeneration, and that, in some specific regions, the number of remyelinated axons might increase with age. Our results also suggest that there are no sex differences in the aging process of the white matter.