Gene Expression Ratios Lead to Accurate and Translatable Predictors of DR5 Agonism across Multiple Tumor Lineages

Death Receptor 5 (DR5) agonists demonstrate anti-tumor activity in preclinical models but have yet to demonstrate robust clinical responses. A key limitation may be the lack of patient selection strategies to identify those most likely to respond to treatment. To overcome this limitation, we screened a DR5 agonist Nanobody across >600 cell lines representing 21 tumor lineages and assessed molecular features associated with response. High expression of DR5 and Casp8 were significantly associated with sensitivity, but their expression thresholds were difficult to translate due to low dynamic ranges. To address the translational challenge of establishing thresholds of gene expression, we developed a classifier based on ratios of genes that predicted response across lineages. The ratio classifier outperformed the DR5+Casp8 classifier, as well as standard approaches for feature selection and classification using genes, instead of ratios. This classifier was independently validated using 11 primary patient-derived pancreatic xenograft models showing perfect predictions as well as a striking linearity between prediction probability and anti-tumor response. A network analysis of the genes in the ratio classifier captured important biological relationships mediating drug response, specifically identifying key positive and negative regulators of DR5 mediated apoptosis, including DR5, CASP8, BID, cFLIP, XIAP and PEA15. Importantly, the ratio classifier shows translatability across gene expression platforms (from Affymetrix microarrays to RNA-seq) and across model systems (in vitro to in vivo). Our approach of using gene expression ratios presents a robust and novel method for constructing translatable biomarkers of compound response, which can also probe the underlying biology of treatment response.

Hope, optimism and survival in a randomised trial of chemotherapy for metastatic colorectal cancer

PURPOSE

Psychological responses to cancer are widely believed to affect survival. We investigated associations between hope, optimism, anxiety, depression, health utility and survival in patients starting first-line chemotherapy for metastatic colorectal cancer.

METHODS

Four hundred twenty-nine subjects with metastatic colorectal cancer in a randomised controlled trial of chemotherapy completed baseline questionnaires assessing the following: hopefulness, optimism, anxiety and depression and health utility. Hazard ratios (HRs) and P values were calculated with Cox models for overall survival (OS) and progression-free survival (PFS) in univariable and multivariable analyses.

RESULTS

Median follow-up was 31 months. Univariable analyses showed that OS was associated negatively with depression (HR 2.04, P < 0.001) and positively with health utility (HR 0.56, P < 0.001) and hopefulness (HR 0.75, P = 0.013). In multivariable analysis, OS was also associated negatively with depression (HR 1.72, P < 0.001) and positively with health utility (HR 0.73, P = 0.014), but not with optimism, anxiety or hopefulness. PFS was not associated with hope, optimism, anxiety or depression in any analyses.

CONCLUSIONS

Depression and health utility, but not optimism, hope or anxiety, were associated with survival after controlling for known prognostic factors in patients with advanced colorectal cancer. Further research is required to understand the nature of the relationship between depression and survival. If a causal mechanism is identified, this may lead to interventional possibilities.

Monocytes and macrophages, implications for breast cancer migration and stem cell-like activity and treatment

Macrophages are a major cellular constituent of the tumour stroma and contribute to breast cancer prognosis. The precise role and treatment strategies to target macrophages remain elusive. As macrophage infiltration is associated with poor prognosis and high grade tumours we used the THP-1 cell line to model monocyte-macrophage differentiation in co-culture with four breast cancer cell lines (MCF7, T47D, MDA-MB-231, MDA-MB-468) to model in vivo cellular interactions. Polarisation into M1 and M2 subtypes was confirmed by specific cell marker expression of ROS and HLA-DR, respectively. Co-culture with all types of macrophage increased migration of ER-positive breast cancer cell lines, while M2-macrophages increased mammosphere formation, compared to M1-macrophages, in all breast cancer cells lines. Treatment of cells with Zoledronate in co-culture reduced the "pro-tumourigenic" effects (increased mammospheres/migration) exerted by macrophages. Direct treatment of breast cancer cells in homotypic culture was unable to reduce migration or mammosphere formation.Macrophages promote "pro-tumourigenic" cellular characteristics of breast cancer cell migration and stem cell activity. Zoledronate targets macrophages within the microenvironment which in turn, reduces the "pro-tumourigenic" characteristics of breast cancer cells. Zoledronate offers an exciting new treatment strategy for both primary and metastatic breast cancer.

Blood cultures in acute surgical admissions

INTRODUCTION

Obtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions.

METHODS

Data on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management.

RESULTS

Of 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%).

CONCLUSIONS

Blood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.

Abstract W P412: Metabolic Syndrome Alters Cerebrovascular Architecture: Relevance to Cognitive Deficits and Stroke Outcomes

Introduction: Diet-induced metabolic syndrome (MetS) is an increasing risk factor for stroke. We have previously shown that high fat diet 1) increases infarct size and hemorrhagic transformation and worsens functional outcome after stroke and 2) impairs neurovascular function even before stroke. However, the impact of MetS on cerebrovascular architecture remained unknown. Hypotheses: 1) Diet-induced MetS causes pathological neovascularization; and 2) these changes lead to cognitive deficits at baseline and poor recovery after stroke. Methods: Male Wistar rats were given a control diet or low dose streptozotocin (30mg/kg) plus high fat (45%) diet for a period of eight weeks (n=4-8/group). Animals were then subjected to sham or middle cerebral artery occlusion (MCAO) surgery. Motor and cognitive functions were assessed by at Days 1, 3, 10 and 14 after stroke using Bederson’s Score, Beam Walking Test, and Novel Object Recognition. Vascular indices (branch density, tortuosity, vascular volume and surface area) were then measured in cortex and striatum using confocal imaging of FITC-filled vasculature. Results: Branch density was higher and recognition index was lower in the sham MetS group compared to sham control group. Stroke significantly reduced vascular volume and surface area in both groups, which was more prominent in the MetS group. Branch density was increased after stroke in the control group only. At Day 14, motor and cognitive scores in the sham MetS group were lower than control. Conclusion: Cerebrovascular structure, function, and cognition are impaired from diet-induced MetS alone . Collectively, these data suggest that cerebrovasculature is an early target in MetS and vasculoprotective strategies are needed to prevent cerebral complications.

17β-estradiol regulates giant vesicle formation via estrogen receptor-alpha in human breast cancer cells

A significant proportion of the genes regulated by 17-beta-estradiol (E2) via estrogen receptor alpha (ERα) have roles in vesicle trafficking in breast cancer. Intracellular vesicle trafficking and extracellular vesicles have important roles in tumourigenesis. Here we report the discovery of giant (3-42μm) intracellular and extracellular vesicles (GVs) and the role of E2 on vesicle formation in breast cancer (BC) cell lines using three independent live cell imaging techniques. Large diameter vesicles, GVs were also identified in a patient-derived xenograft BC model, and in invasive breast carcinoma tissue. ERα-positive (MCF-7 and T47D) BC cell lines demonstrated a significant increase in GV formation after stimulation with E2 which was reversed by tamoxifen. ERα-negative (MDA-MB-231 and MDA-MB-468) BC cell lines produced GVs independently of E2 and tamoxifen. These results indicate the existence of both intracellular and extracellular vesicles with considerably larger dimensions than generally recognised with BC cells and suggest that the GVs are regulated by E2 via ERα in ERα-positive BC but by E2-independent mechanisms in ER-ve BC.

Importance of grass-legume choices on cattle grazing behavior, performance, and meat characteristics

We determined if tall fescue in a mixture with either tannin-containing sainfoin or saponin-containing alfalfa affected cattle foraging behavior, performance, meat quality, and consumer acceptance of meat. Foraging behavior, BW, and pasture biomass before and after grazing were monitored when cattle strip-grazed 3 replications of 2 treatments from May through September 2010 (12 calves/replication) and from June through September 2012 (8 calves/replication). Animals were allowed a choice between tall fescue and sainfoin (SAN) or tall fescue and alfalfa (ALF) growing in strips (fescue, legume, and fescue-legume mixture). Incidence of use (scan samples) of legumes increased from the beginning to the end of the trials (P < 0.05), suggesting that cattle learned to mix legumes with tall fescue. Scan samples and assessments of pasture biomass removal revealed greater use of sainfoin than alfalfa when both legumes were abundant in the spring (P < 0.05); that pattern reversed toward the end of the growing season (P < 0.05) as the abundance of sainfoin declined more than that of alfalfa. Intake of forage per kilogram of gain was greater for SAN than for ALF in 2010 (P = 0.0003) and showed a tendency to be greater for SAN than ALF in 2012 (P = 0.19). There were no differences in ADG between SAN and ALF in either year (1 kg/d; P > 0.05). No incidences of bloat were detected. When cattle (3 calves/treatment in 2010 and 8 calves/treatment in 2012) were slaughtered in September to assess meat quality and consumer acceptance, carcasses were lean (4% to 6% fat content of the longissimus muscle), but compared with ALF, SAN had higher marbling scores, quality grades (Select versus Standard), and back fat thicknesses (P < 0.05) in 2012. Steaks from cattle finished on SAN were redder in color than steaks from cattle finished on ALF (P < 0.05; 2012). Meat samples from SAN and ALF showed some differences in unsaturated fatty acid profiles and volatiles concentrations (P < 0.05), but consumer acceptance did not differ between SAN and ALF (P > 0.05). Thus, cattle incorporated a lower-quality grass into their diets even when legumes were available ad libitum during most grazing trials. Choices between tall fescue and legumes differing in the type of secondary compound (tannins vs. saponins) and bloating potential influenced patterns of forage use by cattle and led to differences in meat quality.

The quality of meat from sheep treated with tannin- and saponin-based remedies as a natural strategy for parasite control

Lambs were assigned to four groups of seven and treated as follows for 12 days: control group (BP) was fed beet pulp; group T (tannin remedy) received the BP diet including 80 g/kg of quebracho extract; group S (saponin remedy) received the BP diet including 15 g/kg of quillaja extract; and group C had a free choice between T and S remedies. Lipid oxidation was lower in meat from S lambs compared to T lambs (P<0.05). Among the volatile compounds, lactate was lower in meat from S lambs compared to T animals (P=0.05). Metabolomic analysis showed that the T treatment increased ribose, fructose, glucose and sorbitol concentration in meat (P<0.05), while cholesterol was decreased by S and C treatments. The T treatment increased the concentration of C14:1 cis-9 (P<0.05). These findings indicate that treatments for parasite control containing tannins and saponins do not detrimentally affect sheep meat quality.

A comparison of screen and ram extrusion-spheronisation of simple pharmaceutical pastes based on microcrystalline cellulose

The performance of two laboratory-scale extrusion apparatuses used to approximate the action of an industrial screen extruder, namely a multi-holed die ram extruder and a roller screen extruder, were compared. Both devices featured short dies (ram 2mm, screen 1mm) with die diameter 1mm and hole area fraction approaching 0.25. A series of water/microcrystalline cellulose (MCC) pastes with water contents varying from 45 to 60 wt% were extruded and pellets obtained from subsequent spheronisation of the extrudates characterised in terms of size and shape. Each device exhibited a different range of processing windows for acceptable spheronised products, with the ram apparatus being able to extrude a wider range of paste water contents than the screen device. The pellets obtained from extrusion-spheronisation (E-S) of the pastes via the screen device were in general smaller, with a wider size distribution, than those from ram E-S. These results are attributed to the different mechanical histories experienced by the pastes in the two types of extruder, which lead to different extrudate densities being achieved. MCC/water/calcium carbonate pastes were also tested, where the latter component represented a 'hard' (non-deformable) active pharmaceutical ingredient. Addition of calcium carbonate increased the stiffness of the paste, which could be countered by adjusting the water content of the deformable MCC/water matrix within the extrudability limits of the latter material.

Biomechanical comparison of forward and lateral lunges at varying step lengths

AIM

Lunges are commonly included in rehabilitation and strength training programs; however limited information regarding differences between lateral and forward lunges with varying step lengths in young adults exists. The current study compared sagittal plane joint kinematics and kinetics between forward and lateral lunges using self-selected and standardized (60% height) step lengths.

METHODS

Thirty-two young adults (16 men, 16 women) completed six lunges of each direction/distance combination while stepping (dominant) limb ankle, knee, and hip peak flexion and net joint extensor moment impulse were quantified.

RESULTS

While lateral direction (P=0.063) step lengths were statistically equal between self-selected and standardized lunges, forward self-selected distances were 10% less than the standardized (P<0.001). Compared to forward lunges, lateral lunge ankle flexion was 83.5% greater (P<0.001) for standard and 55.3% greater (P<0.001) for self-selected distances. Knee flexion was 12.8% greater (P<0.001) during forward lunges compared to lateral lunges, with no significant hip direction differences. Ankle impulse during the lateral lunges was 71.3% greater (P<0.001) compared to forward lunges. Lateral lunge knee impulse was 47.6% greater (P<0.001) for standardized and 16.9% greater (P=0.001) for self-selected distances compared to forward lunges. Forward lunge hip impulse was 64.5% greater for the standardized (P<0.001) and 44.6% greater for self-selected (P<0.001) distances compared to lateral lunges.

CONCLUSION

Forward lunges, particularly using 60% body height step length, appear to place the greatest demands on the hip extensors. Lateral lunges prompted greater ankle flexion and greater ankle and knee extensor kinetic contributions. These data provide rationale for lunge variation selection for young adults.

Application of scientific criteria to food allergens of public health importance

Scientific criteria for identifying allergenic foods of public health importance (Björkstén, B., Crevel, R., Hischenhuber, C., Løvik, M., Samuels, F., Strobel, S., Taylor, S.L., Wal, J.-M., Ward, R., 2008. Criteria for identifying allergenic foods of public health importance. Regulatory Toxicology and Pharmacology 51(1), 42-52) have been further refined to incorporate an assessment of the strength of available scientific evidence (van Bilsen, J.H., Ronsmans, S., Crevel, R.W., Rona, R.J., Przyrembel, H., Penninks, A.H., Contor, L., Houben, G.F., 2011. Evaluation of scientific criteria for identifying allergenic food of public health importance. Regulatory Toxicology and Pharmacology 60, 281-289). A multi-disciplinary group was invited to critically test the refined approach. They independently evaluated selected publications on coconut, soy and/or peanut allergy, scored them using the newly developed level of evidence criteria, and debated proposed approaches for combining and utilising the scores to measure the overall impact of an allergen in public health impact assessments. The evaluation of selected publications using the modified criteria produced a relatively consistent result across the experts. These refined criteria were judged to be a way forward for the identification of allergenic foods of public health importance, and for prioritisation of allergen risk management and future data gathering. The debate to combine available evidence when assessing whether an allergenic food is of sufficient public health importance to warrant active management led to proposals on how to weight and combine evidence on allergen severity, potency and prevalence. The refined criteria facilitate a debate to find a meaningful sequence of steps to summarise the available information in relation to a food allergen.