Abstract P3-10-23: Caveolin 1 and Patient Outcomes in Breast Cancer

Introduction: Caveolin 1 (Cav1) protein is a structural component of caveolae in cell membranes and is also present in the cell cytoplasm, nucleus and extracellular milieu. It regulates multiple cellular processes and has been reported to both positively and negatively effect tumour progression. In normal and malignant breast tissue Cav1 is immunohistochemically expressed in myoepithelial and stromal cells but rarely in luminal epithelial or breast cancer cells. Recent reports have correlated Cav1 expression in the stromal tumour microenvironment with lower tumor stage, grade and improved prognosis. This suggests a separate role for Cav 1 in influencing tumour behaviour by regulating the tumour microenvironment. Our aim was to further investigate the role of Cav1 in breast cancer by for the first time analysing its expression by reverse phase protein array(RPPA). Methods: We examined expression levels of Cav1 in 52 breast cancer cell lines and a large human early breast cancer cohort(n=712) with cancer cells composing 70% of the macrodissected breast cancer specimens used. Data was recorded when available for each case on standard clinical, pathological and survival endpoints. We examined the effect of Cav1 expression on tumour biology and patient survival. Results: High levels of Cav1 expression in breast cancer cell lines was strongly correlated with a TN phenotype (P<0.001). Cav 1 expression was more strongly associated with the stromal subtype rather than basal subtype of TN cell lines (p=0.02).

In contrast, in human tumour tissue high levels of Cav1 correlated with the hormone receptor positive(ER) phenotype. There was also an association between Cav 1 expression and lower grade (P<0.001), lower T stage (P<0.001) and lower N stage (P<0.001).

Cav 1 was significantly associated with improved relapse-free (RFS) and overall survival (OS) in the human cohort. On multivariate(MV) analysis Cav1 was associated with OS(HR 0.91/95% CI 0.82-1/p=0.05) but not RFS. In the subset of ER patients who only received adjuvant tamoxifen (n=199) Cav1 was also significantly associated with improved RFS and OS. MV analysis again showed this correlation to remain for OS (HR 0.81/95% CI 0.65-1/p=0.05) but not for RFS. In the TN subset (n=161) Cav1 expression did not have any survival impact. Discussion: Our results show different expression patterns of Cav1 in vitro and in vivo. TN tumors are thought to originate from the myoepithelial or stromal component of breast tissue which may explain the high levels of Cav1 in this subgroup of breast cancer cell lines. On the other hand, human tumour tissue showed an association between high Cav1 levels and ER tumours. Analysis of these macrodissected samples likely included stromal tissue surrounding the epithelial tumour cells which may explain this discrepancy.

Our data also show a correlation between high in vivo levels of Cav1 and less aggressive tumours with improved prognosis. On MV analysis Cav1 was an independent predictor of outcome in the whole cohort and in the ER subset treated with adjuvant tamoxifen only. Expression of stromal Cav1 measured by RPPA may again partly explain these findings. Further analysis with fully microdissected human breast tissue and immunohistochemical analysis of both stromal and cancer cell Cav1 expression is planned.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-23.

Knowledge, awareness and compliance with universal precautions among health care workers at the University Hospital of the West Indies, Jamaica

BACKGROUND

Universal precautions are not well understood or implemented by health care practitioners, though crucial in the prevention and transmission of blood-borne pathogens like HIV.

OBJECTIVE

To assess knowledge, awareness and compliance of universal precautions among health care workers at the University Hospital of the West Indies, Jamaica.

METHODS

A cross-sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to 200 health care workers including medical doctors, medical technologists, nurses and porters to assess their knowledge, awareness and practice towards universal precautions.

RESULTS

Almost two-thirds (64.0%) of the respondents were very knowledgeable of universal precautions with significantly more females (75.4%) than males (42.9%) (p<0.0001). More nurses (90.0%), medical doctors (88.0%) and medical technologists (70%) were very knowledgeable of universal precautions (p<0.0001). More respondents (92.9%) who were employed in the health sector for 16 years and over reported high levels of awareness of universal precautions than those who were employed for less than five years (p<0.0001). 28.6% of males and only 6.2% of females reported that they do not use protective gear. More nurses reported frequent use of protective equipment followed by medical technologists and medical doctors (p<0.0001).

CONCLUSION

There was adequate knowledge and a fair level of awareness among medical doctors, medical technologists, and nurses towards universal precautions.

Effective management of accelerated phase myelofibrosis with low-dose splenic radiotherapy

The main cause of hepatosplenomegaly in primary (PMF), post polycythemia vera (post-PV MF), and post essential thrombocythemia (post-ET MF) myelofibrosis (MF) is extramedullary hematopoiesis (EMH). Drug-refractory symptomatic splenomegaly in MF is usually managed by splenectomy or involved-field radiotherapy. The latter is most effective in the treatment of MF-associated bone pain and pulmonary hypertension.Our previous experience with hepatosplenic radiotherapy in MF showed efficacy in the majority of treated patients but its utility was limited by the transient nature of its benefit and the occurrence of treatment-related pancytopenia. In an effort to address these issues,we have adopted an induction-maintenance treatment strategy that utilizes lower radiation doses-induction with 100 cGy total in four daily doses of 25 cGy and maintenance with either the same or lower intensity regimen. Herein, we report our most recent experience using this treatment plan in two cases, who in addition to their expected response from the standpoint of splenomegaly, also unexpectedly showed a marked response of their underlying accelerated phase disease,including clearance of circulating blasts and basophilia.

High frequencies of leukemia stem cells in poor-outcome childhood precursor-B acute lymphoblastic leukemias

In order to develop a xenograft model to determine the efficacy of new therapies against primary human precursor-B acute lymphoblastic leukemia (ALL) stem cells (LSCs), we used the highly immunodeficient non-obese diabetic (NOD).Cg-Prkdc(scid)IL2rg(tmlWjl)/SzJ (NOD-severe combined immune deficient (scid) IL2rg(-/-)) mouse strain. Intravenous transplantation of 2 of 2 ALL cell lines and 9 of 14 primary ALL cases generated leukemia-like proliferations in recipient mice by 1-7 months after transplant. Leukemias were retransplantable, and the immunophenotypes, gene rearrangements and expression profiles were identical or similar to those of the original primary samples. NOD-scid mice transplanted with the same primary samples developed similar leukemias with only a slightly longer latency than did NOD-scid-IL2Rg(-/-) mice. In this highly sensitive NOD-scid-IL2Rg(-/-)-based assay, 1-100 unsorted primary human ALL cells from five of five tested patients, four of whom eventually experienced leukemia relapse, generated leukemias in recipient mice. This very high frequency of LSCs suggests that a hierarchical LSC model is not valuable for poor-outcome ALL.

F-Prostaglandin receptor regulates endothelial cell function via fibroblast growth factor-2

Background

Prostaglandin (PG) F_2α is a key regulator of endometrial function and exerts its biological action after coupling with its heptahelical G protein-coupled receptor (FP receptor). In endometrial adenocarcinoma the FP receptor expression is elevated. We have shown previously that PGF_2α-FP receptor signalling in endometrial adenocarcinoma cells can upregulate several angiogenic factors including fibroblast growth factor-2 (FGF2). In the present study, we investigated the paracrine effect of conditioned medium produced via PGF_2α-FP receptor signalling in endometrial adenocarcinoma cells stably expressing the FP receptor (Ishikawa FPS cells), on endothelial cell function.

Results

Conditioned medium (CM) was collected from FPS cells after 24 hrs treatment with either vehicle (V CM) or 100 nM PGF_2α (P CM). Treatment of human umbilical vein endothelial cells (HUVECs) with P CM significantly enhanced endothelial cell differentiation (network formation) and proliferation. Using chemical inhibitors of intracellular signalling, we found that P CM-stimulated endothelial cell network formation was mediated by secretion of endothelial PGF_2α and activation of endothelial FP receptors, following FGF2-FGFR1 signalling, phosphorylation of ERK1/2 and induction of COX-2. Whereas, P CM stimulation of endothelial cell proliferation occurred independently of PGF_2α secretion via an FGF2-FGFR1-ERK1/2 dependent mechanism involving activation of the mTOR pathway.

Conclusions

Taken together, we have shown a novel mechanism whereby epithelial prostaglandin F_2α-FP signalling regulates endothelial cell network formation and proliferation. In addition we provide novel in vitro evidence to suggest that prostaglandin F_2α can directly regulate endothelial cell network formation but not endothelial cell proliferation. These findings have relevance for pathologies where the FP receptor is aberrantly expressed, such as endometrial adenocarcinoma, and provide in vitro evidence to suggest that targeting the FP receptor could provide an anti-angiogenic approach to reducing tumour vasculature and growth.

Modulation of ER alpha transcriptional activity by the orphan nuclear receptor ERR beta and evidence for differential effects of long- and short-form splice variants

Oestrogen receptor related proteins (ERRs) affect target gene expression without binding oestradiol. We investigated the functional activity of two splice variant isoforms of ERR beta (ERR beta S [short], ERR beta L [long]) expressed in human endometrium, where they are coexpressed with the oestrogen receptor alpha (ER alpha). Over-expression of ERRbetaL enhanced ER alpha-dependent ligand-induced activation of an ERE-luciferase reporter construct, altered the induction of c-myc mRNA and increased proliferation of Ishikawa cells whereas ERR beta S was found to reduce these endpoints. Fluorescent recovery after photobleaching (FRAP) revealed that intra-nuclear mobility of YFP-ERR beta S was more rapid than YFP-ERR beta L. Fluorescence resonance energy transfer (FRET) assays revealed a close association between ERR beta L and ER alpha following addition of ligand. We speculate that ERR beta L may alter ER alpha-dependent gene activation by enhancing the recruitment of co-activators. In conclusion, variant isoforms of ERR beta have differential effects on ER alpha-dependent gene expression and this has implications for human endometrial cell function.

An historical perspective on efforts to treat transmissible spongiform encephalopathy

Efforts to treat transmissible spongiform encephalopathy (TSE) date back to the middle of the 20(th) century. Early studies were colored by the belief that TSE was caused by a 'slow' or 'unconventional' virus, and a variety of anti-infective agents, together with scores of drugs drawn at random from other categories, predictably failed to provide any benefit, apart from polyanionic compounds and polyene antibiotics that prolonged the incubation period of disease in experimental animals. With the discovery in the 1980's that TSE apparently results from the malformation of a normal host protein, attempts at treatment could at last be rationally focused, and can be broadly categorized as genetic, immunologic, and pharmacologic. Genetic 'neutralization' of the pathogen has shown excellent results in experimental animals but is unlikely to be useful until the same kind of engineering can be effectively applied to humans. Immunologic methods to accomplish the same result have also shown some success in animals, but forays into the pharmacologic realm have been generally disappointing. Most reported 'successes' have been limited to prolonged incubation periods, and even then only when the treatment was begun at or near the time of infection, which is not known in sporadic or familial human disease. However, a few methods using the more rigorous model of treatment nearer the onset of symptomatic disease have begun to yield promising results that, if coupled with a practical screening test for pre-clinical infection, would be the optimal strategy for prevention or cure.

A Single Nucleotide Polymorphism in Steroid Receptor Coactivator-1 Diminishes the Coactivation of ERα

Estrogen signaling is critical in the progression of a large fraction of breast cancers as well as in the maintenance of bone mineral density. Generally speaking, Tamoxifen, a selective estrogen receptor modulator (SERM), blocks estrogen signaling in the breast by acting as an antagonist at the same time as promoting estrogen signaling in the bone by acting as an agonist. This tissue specific action characteristic of SERMs is thought to be maintained by the balance of levels and/or activities of estrogen receptor (ER) coregulators. Because of this critical role, single nucleotide polymorphisms (SNPs) in ER coregulators could have a dramatic effect on tamoxifen action.Previous studies have implicated steroid receptor coactivator-1 (SRC-1) as a critical coregulator for the mixed antagonist-agonist specificity of tamoxifen. By using an ERE-Tk-Luciferase transient transfection assay, we have shown that a SNP causing the amino acid change P1272S in SRC-1 dramatically reduces its ability to coactivate ERα.To assess the impact of this SNP on tamoxifen action in breast cancer we decided to genotype the SRC-1 P1272S SNP in a breast tumor DNA bank. This bank was generated from archived tumors from individuals either exclusively receiving adjuvant tamoxifen or not receiving any adjuvant therapy following surgical resection. Currently, the bank is composed of 1000 samples divided equally among the two groups. Genotyping for the SRC-1 P1272S SNP is currently underway.Since SRC-1 has also been shown to be important in proper maintenance of bone mineral density (BMD) and in the agonist action of tamoxifen in certain tissues, we also assessed the impact of the P1272S SNP in bone following tamoxifen therapy. We genotyped breast cancer patients exclusively receiving tamoxifen therapy (i.e. no chemotherapy, no radiation) who had lumbar (n=113) and/or hip (n=108) BMD scans before and after 12 months of tamoxifen therapy. We observed a significant association between the SNP and bone loss; women harboring the P1272S SNP lost 6.4% of their lumbar BMD, while women with the WT version lost only 1.3% of their lumbar BMD.These findings illustrate the critical role of SRC-1 in tamoxifen action in bone, and potentially other hormone responsive tissues. Studies are ongoing to decipher the mechanism for decreased coactivation activity of the SNP, and also to extend the clinical association studies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 66.

PRSS23 Is an Estrogen Induced, AP-1-Dependent Gene in MCF-7 Breast Cancer Cells

Background: Breast cancer is the second leading cause of cancer related deaths among women in the United States. While estrogens have been documented to play a role in the etiology and progression of breast cancer through a “classical” pathway by binding to the estrogen receptor which in turn binds at estrogen response elements (EREs) within gene promoters, the mechanisms by which estrogens stimulate breast cancer growth are poorly understood. Estrogens have also been shown to stimulate transcription by interacting with other transcription factors such as AP-1, SP-1 or NFκB through a “non-classical” pathway. We have shown previously that estrogen can stimulate breast cancer cell growth by activating gene expression independently of ERα binding directly to the DNA. We also previously used microarray analysis to identify a set of genes that are induced by estrogen and that are dependent on AP-1 for their induction. One of these ER and AP-1-dependent genes is PRSS23. We hypothesized that many growth regulatory estrogen-induced genes are induced through these non-classical pathways via crosstalk with the AP-1 transcription factor. To test this hypothesis, we investigated the role of AP-1 in the up-regulation of one estrogen responsive gene, PRSS23.Methods: qPCR was used to establish the estrogen and AP-1 responsiveness of PRSS23 following treatment of MCF7 cells with 1nM estradiol (E2) and 100nM TPA respectively. Antibodies specific to ERα (Santa Cruz), cJun/AP-1 (Oncogene), cFos (Santa Cruz), and pan-Fos (Santa Cruz), with rabbit IgG (Santa Cruz) as a control, were used in chromatin immunoprecipitation (ChIP) assays to identify the transcription factors recruited to the PRSS23 promoter after estrogen stimulation. siRNA knockdown studies were used to assess the requirement of specific transcription factors for estrogen-induction of PRSS23.Results: qPCR analysis confirmed that PRSS23 mRNA levels are induced following both E2 and TPA stimulation. These studies also demonstrated that the induction of PRSS23 by estrogen mRNA is reduced by expression of a dominant-negative form of cJun (TAM67), showing that estrogen induction of PRSS23 is AP-1-dependent. siRNA experiments identified that members of both ERα and AP-1 (cFos and Jun) are required for estrogen induction of PRSS23 mRNA expression. ChIP assays demonstrated that estrogen induces ERα recruitment to an upstream enhancer region. We are now investigating the location of recruitment of the AP-1 transcription factors to the PRSS23 promoter after estrogen stimulation.Conclusion: Our results demonstrate that PRSS23 is a “non-classical”, estrogen-induced gene that requires ERα and AP-1 family members for its induction by estrogen. The mechanism by which ER and these AP-1 proteins cooperate to induce the expression of this gene is now being investigated. Data generated from this study may yield a new therapeutic target that could have a broad application to the diagnosis and treatment of breast cancer. Support: NCI R01 CA123246 (PHB), NIH/NCI T32 CA909221 (JAM)

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1131.

Identification of Critical Transducers of Rexiniod-Mediated Growth Suppression in Normal Breast Cells

Background: Targeted agents against the estrogen receptor are effective in treating and preventing many breast cancers, but these agents are not effective for the treatment or prevention of estrogen receptor-negative (ER-neg) breast cancer. Our laboratory has demonstrated that rexinoids are capable of preventing ER-neg breast cancer in transgenic mice; however, this treatment is not 100% effective. Therefore, it is imperative to delineate the mechanism by which rexiniods prevent breast cancer to develop more effective prevention strategies. We hypothesized that rexinoids are specifically able to prevent breast cancer by suppressing growth though interactions with key nuclear hormone receptors. To test this hypothesis we conducted high-throughput screens to determine which nuclear hormone receptors are critical to transduce the growth suppressive effects of rexinoids.Methods: We used quantitative RT-PCR to determine the quantity of mRNA transcripts for all 48 nuclear hormone receptors in human mammary epithelial cells (HMECs). To identify nuclear hormone receptors that when knocked-down reverse the effects of rexiniod treatment, a final concentration of 30nM of pools of three independent siRNAs specific to each nuclear hormone receptor was used. High-throughput microscopy of the siRNA-treated HMECs stained with DAPI (1μg/mL) and EdU (10mM) was used to analyze growth. If a receptor's corresponding siRNA reversed the growth inhibitory effects of rexinoids 75% or greater, it was considered for further investigation. Receptors that did not reverse the effect of rexiniods or enhanced growth suppression when knocked-down were identified, but were not studied further in this analysis. Co-immunoprecipitation (coIP) and GST pull-down assays are being conducted to investigate whether the identified nuclear hormone receptors form a complex with, or bind to, RXR proteins.Results: qRT-PCR analysis confirmed that many of known RXR-binding nuclear hormone receptors are expressed in HMECs. High-throughput screens indicate that knockdown of most receptors alone (including COUP TF1, EAR1 and ERRβ) affect growth of HMECs but do not reverse the effects of rexinoid treatment. Loss of ERRα and AR induced growth, but rexiniod treatment suppressed growth to a greater extent than controls. Receptors that appeared to reverse the growth suppressive effect of rexiniods include GCNF1, THRα, PNR and PPARγ. Loss of PPARγ alone stimulated growth, but reversed effects of rexiniod-induced growth suppression. Currently, we are further investigating these receptors in HMECs and other cell types.Conclusions: These experiments have identified nuclear hormone receptors that are critical for the growth suppressive effects of rexiniods in normal human breast cells. Identification of such receptors provides possible targets for preventative therapy used alone, or in combination with rexinoids, to increase the efficacy of rexinoids for more effective prevention of estrogen receptor-negative breast cancer. Support: NCI R01 CA78480 (PHB, IPU) and NIH/NCI T32 CA90221 (JMR)

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3134.

Collaborative annotation of genes and proteins between UniProtKB/Swiss-Prot and dictyBase

UniProtKB/Swiss-Prot, a curated protein database, and dictyBase, the Model Organism Database for Dictyostelium discoideum, have established a collaboration to improve data sharing. One of the major steps in this effort was the ‘Dicty annotation marathon’, a week-long exercise with 30 annotators aimed at achieving a major increase in the number of D. discoideum proteins represented in UniProtKB/Swiss-Prot. The marathon led to the annotation of over 1000 D. discoideum proteins in UniProtKB/Swiss-Prot. Concomitantly, there were a large number of updates in dictyBase concerning gene symbols, protein names and gene models. This exercise demonstrates how UniProtKB/Swiss-Prot can work in very close cooperation with model organism databases and how the annotation of proteins can be accelerated through those collaborations.

Prostaglandin F(2alpha)-F-prostanoid receptor regulates CXCL8 expression in endometrial adenocarcinoma cells via the calcium-calcineurin-NFAT pathway

Pro-inflammatory mediators, like prostaglandin (PG) and chemokines, promote tumourigenesis by enhancing cell proliferation, migration of immune cells and recruitment of blood vessels. Recently we showed elevated expression of the chemokine (C-X-C motif) receptor 2 (CXCR2) in endometrial adenocarcinomas localized to neutrophils and neoplastic epithelial and vascular cells. Furthermore we found that PGF_2α-F-prostanoid (FP) receptor regulates the expression of the CXCR2 ligand CXCL1, to promote neutrophil chemotaxis in endometrial adenocarcinomas. In the present study we identified another CXCR2 ligand, CXCL8 as a target for PGF_2α-FP receptor signalling which enhances epithelial cell proliferation in endometrial adenocarcinoma cells in vitro and in nude mice in vivo. We found that PGF_2α-FP receptor interaction induces CXCL8 expression in endometrial adenocarcinoma cells via the protein kinase C–calcium–calcineurin–NFAT signaling pathway. Promoter analysis revealed that CXCL8 transcriptional activation by PGF_2α signaling is mediated by cooperative interactions between the AP1 and NFAT binding sites. Furthermore, PGF_2α via the FP receptor induced the expression of the regulator of calcineurin 1 isoform 4 (RCAN1-4) via the calcineurin/NFAT pathway in a reciprocal manner to CXCL8. Using an adenovirus to overexpress RCAN1-4, we found that RCAN1-4 is a negative regulator of CXCL8 expression in endometrial adenocarcinoma cells. Taken together our data have elucidated the molecular and cellular mechanism whereby PGF_2α regulates CXCL8 expression via the FP receptor in endometrial adenocarcinomas and have highlighted RCAN1-4 as a negative regulator of CXCL8 expression which may be exploited therapeutically to inhibit CXCL8-mediated tumour development.

From high tech to high touch: integrating community voices in mobile mammography outreach

Providing mobile screening mammography services across the state of West Virginia (WV) presents unique challenges. The ability of new machines to screen for breast cancer is modern medicine at its best. The use of the mobile unit, "Bonnie's Bus", holds promise for getting this high tech equipment to women in rural areas of West Virginia where it is most needed. Cancer detected in early stages is more treatable and women have a better chance of becoming survivors. The key to the program's success resides with the women who come for the screening, the extension network of community members who help set up and assist women to access the screening system, and community health care providers who care for the women if cancer is found. Linking "community voices" with the programs funded under the WV Komen grant screening programs provides a winning solution for West Virginia and the women served by Bonnie's Bus. Information obtained from five focus groups of 58 community leaders and women residing in rural WV was used to develop the mobile program. Building upon established relationships with the West Virginia Breast and Cervical Cancer Screening Program (WV BCCSP) coordinators and providers, outreach and information gleaned from WV communities, is being used to develop community partnerships based on mutual trust and respect to advance the common goal of decreasing breast cancer related illness and death in West Virginia women.

Expression of oestrogen receptors, ERalpha, ERbeta, and ERbeta variants, in endometrial cancers and evidence that prostaglandin F may play a role in regulating expression of ERalpha

Background

Endometrial cancer is the most common gynaecological malignancy; risk factors include exposure to oestrogens and high body mass index. Expression of enzymes involved in biosynthesis of oestrogens and prostaglandins (PG) is often higher in endometrial cancers when compared with levels detected in normal endometrium. Oestrogens bind one of two receptors (ERα and ERβ) encoded by separate genes. The full-length receptors function as ligand-activated transcription factors; splice variant isoforms of ERβ lacking a ligand-binding domain have also been described. PGs act in an autocrine or paracrine manner by binding to specific G-protein coupled receptors.

Methods

We compared expression of ERs, progesterone receptor (PR) and cyclooxygenase-2 (COX-2) in stage 1 endometrial adenocarcinomas graded as well (G1), moderately (G2) or poorly (G3) differentiated (n ≥ 10 each group) using qRTPCR, single and double immunohistochemistry. We used endometrial adenocarcinoma cell lines to investigate the impact of PGF2α on expression of ERs and PR.

Results

Full length ERβ (ERβ1) and two ERβ variants (ERβ2, ERβ5) were expressed in endometrial cancers regardless of grade and the proteins were immunolocalised to the nuclei of cells in both epithelial and stromal compartments. Immunoexpression of COX-2 was most intense in cells that were ERα^neg/low. Expression of PR in endometrial adenocarcinoma (Ishikawa) cell lines and tissues broadly paralleled that of ERα. Treatment of adenocarcinoma cells with PGF2α reduced expression of ERα but had no impact on ERβ1. Cells incubated with PGF2α were unable to increase expression of PR mRNA when they were incubated with E2.

Conclusion

We have demonstrated that ERβ5 protein is expressed in stage 1 endometrial adenocarcinomas. Expression of three ERβ variants, including the full-length protein is not grade-dependent and most cells in poorly differentiated cancers are ERβ^pos/ERα^neg. We found evidence of a link between COX-2, its product PGF2α, and expression of ERα and PR that sheds new light on the cross talk between steroid and PG signalling pathways in this disease.

NCCTG phase I trial of temsirolimus (CCI-779) and temozolomide (TMZ) in combination with radiation therapy (RT) in newly diagnosed glioblastoma multiforme (GBM) patients

2019

Background: The mammalian target of rapamycin (mTOR) functions within the PI3K/Akt signaling pathway as a critical modulator of cell survival. We previously demonstrated significant synergy of the mTOR inhibitor sirolimus with RT in glioma xenografts. Methods: The standard cohorts of 3 design was applied with dose escalation of weekly IV CCI-779 in combination with standard TMZ/RT. CCI-779 was given during both RT (60 Gy)/TMZ (75 mg/m2 daily) and adjuvant TMZ (200 mg/m2 daily x 5 every 28 days). Results: A total of 17 patients were enrolled. CCI-779 therapy during RT/TMZ was well tolerated at dose level 0 (25 mg CCI-779, n = 3) and dose level 1 (50 mg CCI-779, n = 6) with 1 of 9 patients experiencing a DLT (Gr 3 fatigue). Dose level 2 (75 mg CCI-779) exceeded the maximally tolerated dose with two of six patients with DLT (<75% CCI-779 delivered; Gr 4 dyspnea). Despite reasonable tolerance during RT/TMZ, the overall regimen was associated with a high rate of infection associated with lymphopenia. After a patient died from PCP on cycle 2 of adjuvant TMZ/CCI-779, antibiotic prophylaxis was mandated. Two other patients died of gram-negative sepsis despite prophylaxis: one after their first dose of CCI-779 and one during cycle 4 of adjuvant therapy. In contrast to our 18% grade 5 infection rate, only 4% grade 3 (no grade 4/5) infections were observed in 26 other CTEP-sponsored clinical trials involving 1,006 patients treated with CCI-779. Results from translational studies evaluating the effects of treatment on immune function will be presented. Further infections were avoided on this trial after CCI-779 therapy was limited to RT/TMZ. Conclusions: Although CCI-779 in combination with RT/TMZ was well-tolerated, adjuvant therapy with TMZ/CCI-779 was associated with an increased risk of opportunistic infections.

[Table: see text]

LX1032: A potential new therapy for carcinoid syndrome (CS)

e14555

Background: Patients with metastatic CS experience a variety of symptoms due to increased serotonin (5-HT) produced by metastatic GI tumor cells. The enzyme tryptophan hydroxylase (TPH) catalyzes the rate-limiting step in the synthesis of 5-HT. Reducing 5-HT synthesis by TPH inhibition represents a new mechanism for potentially managing symptoms associated with CS. LX1032 is a novel, orally bioavailable TPH inhibitor designed to afford systemic exposure without affecting 5-HT synthesis in the CNS. Preclinical studies of LX1032 in multiple species confirmed systemic inhibition of 5-HT synthesis without changes in brain 5-HT levels. Methods: Single (n=47 subjects) and multiple (n=40 subjects) ascending dose studies with LX1032 were completed in normal volunteers; 24-hr urinary 5-HIAA and blood 5-HT were measured as biomarkers of 5-HT metabolism. Results: LX1032 produced a significant dose-dependent reduction in urinary 5-HIAA and blood 5-HT levels, with maximal reductions observed at doses at or above 500 mg, once daily, in the 14 day multiple ascending dose (MAD) study; the mean change from baseline in blood 5-HT was -30% for the 1500 mg (500 mg TID) dose group. Single doses up to 500 mg were well tolerated with no evidence of dose limiting toxicity or tolerability; GI related adverse events (nausea, emesis, and diarrhea) started to emerge at the 1,000 mg dose level and became dose-limiting at the 1,500 mg single dose level. Multiple doses were well tolerated at all dose levels up to 1.500 mg (500 mg TID). Adverse events (AEs) were mild to moderate and no serious AEs occurred; a dose-dependent, mild increase in hepatic transaminase levels was observed in the MAD study. Conclusions: Inhibiting TPH, and thereby reducing peripheral 5-HT production, represents a potential new approach for managing symptoms in CS patients. LX1032 is a novel, orally bioavailable TPH inhibitor that significantly reduced 5-HT production at well tolerated dose levels. The favorable safety profile and observed decrease in urinary 5-HIAA and blood 5-HT levels indicate that LX1032 could be used to lower 5-HT as a potential new approach for managing hyperserotoninemia-related complications of CS, and support studies of the compound in CS patients.

[Table: see text]

The analyses of antigen and DNA polymorphism within the bovine major histocompatibility complex: 1. The class I antigens

Serology, isoelectric focusing (IEF) of expressed antigens, and restriction fragment length polymorphisms (RFLP) were compared for the identification of BoLA class I haplotypes. Expressed antigens identified as bands by IEF correlated well with serological definition confirming and extending our earlier findings (Joosten et al. 1988). Comparison of serology and isoelectric focusing bands with restriction fragments was more complicated; fragments were found which correlated both with broadly reacting and antigen specific sera. We also found correlation of fragments with two or more sera which showed no cross-reactivity. Fragments unique to particular haplotypes were also observed. Serology remains the simplest method of typing BoLA class I antigens. Isoelectric focusing generally agrees with serological definition of antigens and detects antigens not yet defined by serology. It may also be useful in defining the products of other expressed BoLA class I loci. In order to identify RFLPs which could be used for typing, comparison with serology or IEF is essential. Haplotype specific RFLPs could be useful in identifying genes linked to the MHC.

Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states

Telephone interviews of health department personnel in six states and review of an immunization database from one state were conducted to assess human papillomavirus (HPV) vaccine availability, recommendations, cost, policies, and educational materials in health departments in seven Appalachian states. Most (99.1%) health departments (n=234) reported receiving patient requests for the HPV vaccine, and only two (1%) health departments reported that they did not provide the vaccine for patients. HPV vaccine supply was reported to not meet the demand in 10.5% (24/228) of health departments due to high costs. Level (state, region, county) at which policy about the HPV vaccine was determined, vaccine recommendations, costs, and available educational materials varied among states. This study documented variation in vaccine availability, recommendations, cost, policies, and educational materials in Appalachian health departments that could significantly affect vaccine distribution. Findings highlight the need for more comprehensive and consistent policies that maximize accessibility of the HPV vaccine to women, especially those in underserved areas.

Prokineticin 1 modulates IL-8 expression via the calcineurin/NFAT signaling pathway

Prokineticins and their receptors are expressed in various cellular compartments in human endometrium, with prokineticin 1 (PROK1) showing a dynamic pattern of expression across the menstrual cycle and during pregnancy. Previous studies suggest that PROK1 can play an important role in implantation and early pregnancy by inducing vascular remodeling and increasing vascular permeability. Here we demonstrate that PROK1 induces the expression of IL-8, a chemokine with angiogenic properties, in endometrial epithelial Ishikawa cells stably expressing prokineticin receptor 1 and in human first trimester decidua. We also show that IL-8 promoter activity is induced by PROK1 and that this requires the presence of AP1 and NFAT motifs. The role of calcineurin/NFAT signaling pathway is confirmed by the use of specific chemical inhibitors. Additionally, PROK1 induces the expression of the regulator of calcineurin 1 isoform 4 (RCAN1-4) via the calcineurin/NFAT pathway. A modulatory role for RCAN1-4 is demonstrated by RCAN1-4 overexpression which results in the inhibition of PROK1-induced IL-8 expression whereas reduction in RCAN1-4 endogenous expression results in an increase in PROK1-induced IL-8 production. Our findings show that in endometrial cells PROK1 can activate the calcineurin/NFAT pathway to induce IL-8 expression and that this is negatively modulated by the induction of expression of RCAN1-4.

Bilateral testicular haemorrhage in a Bleu du Maine ram: clinical, ultrasonographic and histologic features

Bilateral testicular haemorrhage was detected in a 5-year-old Bleu du Maine ram in an abattoir survey of male reproductive tracts in sheep; the ultrasonographic and histologic features of the lesions are described.

Prokineticin 1 mediates fetal-maternal dialogue regulating endometrial leukemia inhibitory factor

Implantation requires communication between a receptive endometrium and a healthy blastocyst. This maternal-embryonic crosstalk involves local mediators within the uterine microenvironment. We demonstrate that a secreted protein, prokineticin 1 (PROK1), is expressed in the receptive endometrium and during early pregnancy. PROK1 induces expression of leukemia inhibitory factor (LIF) in endometrial epithelial cells and first trimester decidua via a Gq-Ca²⁺-cSrc-mitogen-activated protein kinase kinase-mediated pathway. We show that human embryonic chorionic gonadotropin (hCG) induces sequential mRNA expression of PROK1 and LIF in an in vivo baboon model, in human endometrial epithelial cells, and in first-trimester decidua. We have used micro RNA constructs targeted to PROK1 to demonstrate that hCG-mediated LIF expression in the endometrium is dependent on prior induction of PROK1. Dual immunohistochemical analysis colocalized expression of the luteinizing hormone/chorionic gonadotropin receptor, PROK1, PROKR1, and LIF to the glandular epithelial cells of the first trimester decidual tissue. PROK1 enhances adhesion of trophoblast cells to fibronectin and laminin matrices, which are mediated predominantly via LIF induction. These data describe a novel signaling pathway mediating maternal-embryonic crosstalk, in which embryonic hCG via endometrial PROK1 may play a pivotal role in enhancing receptivity and maintaining early pregnancy.—Evans, J., Catalano, R. D., Brown, P., Sherwin, R., Critchley, H. O. D., Fazleabas, A. T., Jabbour, H. N. Prokineticin 1 mediates fetal-maternal dialogue regulating endometrial leukemia inhibitory factor.

Functional connectivity between motor cortex and globus pallidus in human non-REM sleep

Recent evidence suggests that the motor system undergoes very specific modulation in its functional state during the different sleep stages. Here we test the hypothesis that changes in the functional organization of the motor system involve both cortical and subcortical levels and that these distributed changes are interrelated in defined frequency bands. To this end we evaluated functional connectivity between motor and non-motor cortical sites (fronto-central, parieto-occipital) and the globus pallidus (GP) in human non-REM sleep in seven patients undergoing deep brain stimulation (DBS) for dystonia using a variety of spectral measures (power, coherence, partial coherence and directed transfer function (DTF)). We found significant coherence between GP and fronto-central cortex as well as between GP and parieto-occipital cortex in circumscribed frequency bands that correlated with sleep specific oscillations in 'light sleep' (N2) and 'slow-wave sleep' (N3). These sleep specific oscillations were also reflected in significant coherence between the two cortical sites corroborating previous studies. Importantly, we found two different physiological activities represented within the broad band of significant coherence between 9.5 and 17 Hz. One component occurred in the frequency range of sleep spindles (12.5-17 Hz) and was maximal in the coherence between fronto-central and parieto-occipital cortex as well as between GP and both cortical sites during N2. This component was still present between fronto-central and parieto-occipital cortex in N3. Functional connectivity in this frequency band may be due to a common input to both GP and cortex. The second component consisted of a spectral peak over 9.5-12.5 Hz. Coherence was elevated in this band for all topographical constellations in both N2 and N3, but especially between GP and fronto-central cortex. The DTF suggested that the 9.5-12.5 Hz activity consisted of a preferential drive from GP to the fronto-central cortex in N2, whereas in N3 the DTF between GP and fronto-central cortex was symmetrical. Partial coherence supported distinctive patterns for the 9.5-12.5 and 12.5 and 17 Hz component, so that only coherence in the 9.5-12.5 Hz band was reduced when the effects of GP were removed from the coherence between the two cortical sites. The data suggest that activities in the GP and fronto-central cortex are functionally connected over 9.5-12.5 Hz, possibly as a specific signature of the motor system in human non-REM sleep. This finding is pertinent to the longstanding debate about the nature of alpha-delta sleep as a physiological or pathological feature of non-REM sleep.