Polyunsaturated fatty acids in relation to incident mobility disability and decline in gait speed; the Age, Gene/Environment Susceptibility-Reykjavik Study

BACKGROUND/OBJECTIVES

Low intake of long chain polyunsaturated fatty acids (PUFAs) are associated with physical disability; however, prospective studies of circulating PUFAs are scarce. We examined associations between plasma phospholipid n-3 and n-6 PUFAs with risk of incident mobility disability and gait speed decline.

SUBJECTS/METHODS

Data are from a subgroup of the Age, Gene/Environment Susceptibility-Reykjavik Study, a population-based study of risk factors for disease and disability in old age. In this subgroup (n = 556, mean age 75.1 ± 5.0 years, 47.5% men), plasma phospholipid PUFAs were assessed at baseline using gas chromatography. Mobility disability and usual gait speed were assessed at baseline and after 5.2 ± 0.2 years. Mobility disability was defined as the following: having much difficulty, or being unable to walk 500 m or climb up 10 steps; decline in gait speed was defined as change ⩾ 0.10 m/s. Logistic regression analyses were performed to determine associations between sex-specific s.d. increments in PUFAs with risk of incident mobility disability and gait speed decline. Odds ratios (95% confidence intervals) adjusted for demographics, follow-up time, risk factors and serum vitamin D were reported.

RESULTS

In women, but not men, every s.d. increment increase of total n-3 PUFAs and docosahexaenoic acid (DHA) was associated with lower mobility disability risk, odds ratio 0.48 (0.25; 0.93) and odds ratio 0.45 (0.24; 0.83), respectively. There was no association between n-6 PUFAs and the risk of incident mobility disability or gait speed decline.

CONCLUSIONS

Higher concentrations of n-3 PUFAs and, particularly, DHA may protect women from impaired mobility but does not appear to have such an effect in men.

Genome-wide association study of myelosuppression in non-small-cell lung cancer patients with platinum-based chemotherapy

Platinum-induced myelosuppression severely impedes successful chemotherapy in non-small-cell lung cancer (NSCLC) patients. Hence, it is clinically important to identify the patients who are at high risk for severe toxicity to certain chemotherapy. We first carried out a genome-wide scan of 906 703 single-nucleotide polymorphisms (SNPs) to identify genetic variants associated with platinum-induced myelosuppression risk in 333 NSCLC patients with chemotherapy. Then, we replicated 24 SNPs that had P<1 × 10(-4) in another independent cohort of 876 NSCLC patients. With P<0.05 as the criterion of statistical significance, we found that rs13014982 at 2q24.3 and rs9909179 at 17p12 exhibited consistently significant associations with myelosuppression risk in both the genome-wide association studies (GWAS) scan and the replication stage (rs13014982: odds ratio (OR)=0.55, 95% confidence intervals (CIs): 0.41-0.74, P=7.29 × 10(-5) for GWAS scan and OR=0.77, 95% CI: 0.65-0.93, P=0.006 for replication stage; rs9909179: OR=0.51, 95% CI: 0.37-0.70, P=4.60 × 10(-5) for GWAS scan and OR=0.82, 95% CI: 0.68-0.99, P=0.040 for replication stage; both in additive model). In combined samples of genome-wide scan and replication samples, the minor alleles of rs13014982 and rs9909179 remained significant associations with the decreased risk of myelosuppression (rs13014982: OR=0.71, 95% CI: 0.61-0.83, P =1.36 × 10(-5); rs9909179: OR=0.76, 95% CI: 0.65-0.89, P=0.001). Rs13014982 at 2q24.3 and rs9909179 at 17p12 might be independent susceptibility markers for platinum-induced myelosuppression risk in NSCLC patients.

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans

BACKGROUND AND AIMS

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial.

METHODS AND RESULTS

Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24-99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m(2) for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m(11/6) kg(-2/3) for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m(2) for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality.

CONCLUSION

All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Comparison of extraction methods of total microbial DNA from freshwater

The demand for molecular analysis of aquatic microbial communities in freshwater has highlighted the need for efficient methods of DNA extraction. The centrifugation method and filtration-membrane method are 2 widely used methods for extracting DNA. The objective of this study was to compare the extraction efficiency of 3 methods, including the centrifugation method, filtration-membrane method, and modified filtration-membrane method, by evaluating the quantity and purity of DNA extracts obtained from water. DNA extraction was analyzed by agarose gel electrophoresis, ultraviolet-spectroscopy, restriction enzyme digestion, and polymerase chain reaction. The results showed that the modified filtration-membrane method was the most efficient for extracting microbial DNA from freshwater with high integrity and purity and is suitable for molecular applications.

An evaluation comparing Californium252 neutron brachytherapy with neoadjuvant intra-arterial embolism chemotherapy assisted surgery effect for treating advanced cervical carcinoma patients

PURPOSE OF INVESTIGATION

To compare the therapeutic and side effects of using Californium252 (252Cf) neutron brachytherapy with neoadjuvant intra-arterial embolism chemotherapy in combination with surgery for treating Stage Ib2-IIb cervical cancers (CCs).

MATERIALS AND METHODS

Thirty-two Stage Ib2-IIb CC patients were enrolled and randomly divided into two groups from January 2007 to April 2010 in the present Hospital. Prior to surgery within four weeks, a total of 17 cases were treated with 252Cf neutron brachytherapy (700-800 cGy doses at point A) once a week (Group A), and 15 cases were treated by neoadjuvant intra-arterial embolism chemotherapy using a combination of bleomycin, carboplatin, and cyclophosphamide twice (Group B). The clinical symptoms and signs, side effects, and relapse condition follow up until July 2013 were compared between the two groups for the perioperation.

RESULTS

Reductions in tumor mass and CR+PR were not significantly different between the groups before the surgery (p > 0.05). Abdominal pain and pelvic adhesions were significantly more severe in Group B (p < 0.05). There were no significant differences in surgical time, blood loss or the other side effects between Groups A and B (p > 0.05). The percentage of pelvic tumor recurrences in Group A was lower than that of the patients in Group B (11.8% vs 20.0%) although with no significant difference at present. No distant metastasis has been found in both two groups.

CONCLUSION

Except for less abdominal pain and pelvic adhesions, 252Cf neutron brachytherapy has perioperative effects similar to those of neoadjuvant intra-arterial embolism chemotherapy.

Role of AMP-activated protein kinase in cross-talk between apoptosis and autophagy in human colon cancer

Unresectable colorectal liver metastases remain a major unresolved issue and more effective novel regimens are urgently needed. While screening synergistic drug combinations for colon cancer therapy, we identified a novel multidrug treatment for colon cancer: chemotherapeutic agent melphalan in combination with proteasome inhibitor bortezomib and mTOR (mammalian target of rapamycin) inhibitor rapamycin. We investigated the mechanisms of synergistic antitumor efficacy during the multidrug treatment. All experiments were performed with highly metastatic human colon cancer CX-1 and HCT116 cells, and selected critical experiments were repeated with human colon cancer stem Tu-22 cells and mouse embryo fibroblast (MEF) cells. We used immunochemical techniques to investigate a cross-talk between apoptosis and autophagy during the multidrug treatment. We observed that melphalan triggered apoptosis, bortezomib induced apoptosis and autophagy, rapamycin caused autophagy and the combinatorial treatment-induced synergistic apoptosis, which was mediated through an increase in caspase activation. We also observed that mitochondrial dysfunction induced by the combination was linked with altered cellular metabolism, which induced adenosine monophosphate-activated protein kinase (AMPK) activation, resulting in Beclin-1 phosphorylated at Ser 93/96. Interestingly, Beclin-1 phosphorylated at Ser 93/96 is sufficient to induce Beclin-1 cleavage by caspase-8, which switches off autophagy to achieve the synergistic induction of apoptosis. Similar results were observed with the essential autophagy gene, autophagy-related protein 7, -deficient MEF cells. The multidrug treatment-induced Beclin-1 cleavage was abolished in Beclin-1 double-mutant (D133A/D146A) knock-in HCT116 cells, restoring the autophagy-promoting function of Beclin-1 and suppressing the apoptosis induced by the combination therapy. These observations identify a novel mechanism for AMPK-induced apoptosis through interplay between autophagy and apoptosis.

Efficient inhibition of intraperitoneal human ovarian cancer growth by short hairpin RNA targeting CD44

CD44 is one member of a big glycoprotein family involved in adhesion of cells or cells and extracellular matrix (ECM). The heavily glycosylated CD44 has been proved to be a major receptor of hyaluronan and a marker of stem cells in ovarian cancer. Here, using short hairpin (shRNA) against CD44, we demonstrate that knockdown CD44 could inhibit cancer growth efficiently compared with controls. Plasmid targeting CD44 gene (pshCD44) or non-relative control sequences (pshHK) was constructed and delivered to ovarian cancer by biodegradable poly D, L-Lactide-co-glycolide acid nanoparticles (PLGANPs). Nude mice were utilized in an intraperitoneal model of ovarian carcinomatosis to assess antitumor efficacy in vivo. Antitumor efficacy was estimated by changes in tumor weights, proliferation (Ki-67), apoptosis (TUNEL) and angiogenesis (CD31 staining and alginate-encapsulated tumor beads assay) in tumor cells. As results, pshCD44 or pshHK could be effectively transfected into SKOV-3 cells by PLGANPs. Tumor weight in pshCD44/PLGANPs group was suppressed by 45% and 50% compared with those in pshHK/PLGANPs and untreated group, respectively (Ps < 0.001). Inhibition of cell proliferation, induction of apoptosis and reduction of angiogenesis in tumor cells of pshCD44/PLGANPs group also show significant difference compared with those in control groups (Ps < 0.05), respectively. These results indicate that pshCD44 delivered by PLGANPs might be a potential approach in ovarian cancer therapy, and point towards a mechanism involving the inhibition of angiogenesis, cellular proliferation and the induction of apoptosis.

Graphene optomechanics realized at microwave frequencies

Cavity optomechanics has served as a platform for studying the interaction between light and micromechanical motion via radiation pressure. Here we observe such phenomena with a graphene mechanical resonator coupled to an electromagnetic mode. We measure thermal motion and backaction cooling in a bilayer graphene resonator coupled to a microwave on-chip cavity. We detect the lowest flexural mode at 24 MHz down to 60 mK, corresponding to 50±6 mechanical quanta, which represents a phonon occupation that is nearly 3 orders of magnitude lower than that which has been recorded to date with graphene resonators.

Rapamycin-enhanced mitomycin C-induced apoptotic death is mediated through the S6K1-Bad-Bak pathway in peritoneal carcinomatosis

Peritoneal carcinomatosis (PC) is the most common secondary cancerous disease, and more effective novel regimens are needed. In this study, we identified a novel combination treatment for PC, chemotherapeutic agent mitomycin C in combination with mTOR (mammalian target of rapamycin) inhibitor rapamycin. We observed that the combination of mitomycin C and rapamycin induced synergistic cytotoxicity and apoptosis, which was mediated through an increase in caspase activation. The combination of mitomycin C and rapamycin inactivated p70 S6 ribosomal kinase (S6K1) and dephosphorylated Bad, leading to dissociation of Bcl-xL from Bak, which resulted in Bak oligomerization, mitochondria dysfunction and cytochrome c release. PF-4708671, a S6K1-specific inhibitor, enhanced the combination treatment-induced apoptosis, whereas S6K1 E389 DeltaCT-HA (S6K1 active form) dramatically decreased the induction of apoptosis. In addition, the combination treatment significantly inhibited LS174T intraperitoneal tumor growth in vivo. This study provides a preclinical rationale for apoptosis induction linked with the mTOR pathway through a combination of chemotherapeutic agents and mTOR inhibitor, and will support this combinatorial strategy to PC patients.

Knockdown of cancerous inhibitor of protein phosphatase 2A may sensitize NSCLC cells to cisplatin

Cancerous inhibitor of protein phosphatase 2A (CIP2A) is a recently identified human oncoprotein that can stabilize some proteins by inhibiting degradation mediated by protein phosphatase 2A (PP2A) and it increases the proliferation of several cancer cells. Recent studies have highlighted a potential role for CIP2A in promoting tumor progression and metastasis. However, whether CIP2A could increase chemoresistance of cancer cells to chemotherapeutic agent cisplatin remains unclear. To determine whether CIP2A serves as a potential therapeutic target of human non-small-cell lung cancer (NSCLC), we utilized small interference RNA (siRNA) to knock down CIP2A expression in human NSCLC cells and analyzed their phenotypic changes. The data demonstrated that CIP2A silencing led to decreased proliferation, impaired clonogenicity and enhanced chemosensitivity and apoptosis to cisplatin in human NSCLC cells, as well as reduced Akt phosphorylation. In addition, overexpression of CIP2A diminished NSCLC cell chemosensitivity to cisplatin by inducing activation of Akt pathway, suggesting critical roles of CIP2A in NSCLC cell chemoresistance to cisplatin and rasing the possibility of CIP2A inhibition as a promising approach for lung cancer therapy.

Resveratrol reduces morphine tolerance by inhibiting microglial activation via AMPK signalling

BACKGROUND

Evidence has accumulated indicating that microglia within the spinal cord play a critical role in morphine tolerance. The present study investigated the effects and possible mechanisms of 5' adenosine monophosphate-activated protein kinase (AMPK) activator resveratrol and AICAR to inhibit microglial activation and to limit the decrease in antinociceptive effects of morphine.

METHODS

The microglial cell line BV-2 was used. Cytokine expression was measured using quantitative polymerase chain reaction. Cell signalling was assayed by Western blot and immunohistochemistry. The antinociception and morphine tolerance were assessed in CD-1 mice using the hot plate and tail-flick tests.

RESULTS

(1) Morphine induces robust BV-2 cell activation, as evidenced by increased p38 mitogen-activated protein kinase phosphorylation, nuclear factor-κB translocation and mRNA expression of pro-inflammatory cytokines [including interleukin-1β (IL-1β), IL-6 and tumour necrosis factor-α], inducible nitric oxide synthase and Toll-like receptor-4, and these changes are inhibited by resveratrol. (2) Resveratrol activates AMPK to suppress morphine-induced BV-2 cell activation. AICAR, another AMPK activator, can mimic the effects of resveratrol, whereas compound C, an AMPK inhibitor, reverses the inhibitory effects of resveratrol treatment. (3) Systemic or spinal administration of resveratrol with morphine significantly blocks microglial activation in the spinal cord and then attenuates the development of acute and chronic morphine tolerance in both male and female mice.

CONCLUSION

Resveratrol directly suppresses morphine-induced microglial activation through activating AMPK, resulting in significant attenuation of morphine antinociceptive tolerance.

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.

Evaluation of common structural brain changes in aging and Alzheimer disease with the use of an MRI-based brain atrophy and lesion index: a comparison between T1WI and T2WI at 1.5T and 3T

BACKGROUND AND PURPOSE

The Brain Atrophy and Lesion Index combines several common, aging-related structural brain changes and has been validated for high-field MR imaging. In this study, we evaluated measurement properties of the Brain Atrophy and Lesion Index by use of T1WI and T2WI at 1.5T and 3T MR imaging to comprehensively assess the usefulness of the lower field-strength testing.

MATERIALS AND METHODS

Data were obtained from the Alzheimer's Disease Neuroimaging Initiative. Images of subjects (n = 127) who had T1WI and T2WI at both 3T and 1.5T on the same day were evaluated, applying the Brain Atrophy and Lesion Index rating. Criterion and construct validity and interrater agreement were tested for each field strength and image type.

RESULTS

Regarding reliability, the intraclass correlation coefficients for the Brain Atrophy and Lesion Index score were consistently high (>0.81) across image type and field strength. Regarding construct validity, the Brain Atrophy and Lesion Index score differed among diagnostic groups, being lowest in people without cognitive impairment and highest in those with Alzheimer disease (F > 5.14; P < .007). Brain Atrophy and Lesion Index scores correlated with age (r > 0.37, P < .001) and cognitive performance (r > 0.38, P < .001) and were associated with positive amyloid-β test (F > 3.96, P < .050). The T1WI and T2WI Brain Atrophy and Lesion Index scores were correlated (r > 0.93, P < .001), with the T2WI scores slightly greater than the T1WI scores (F > 4.25, P < .041). Regarding criterion validation of the 1.5T images, the 1.5T scores were highly correlated with the 3T Brain Atrophy and Lesion Index scores (r > 0.93, P < .001).

CONCLUSIONS

The higher field and T2WI more sensitively detect subtle changes in the deep white matter and perivascular spaces in particular. Even so, 1.5T Brain Atrophy and Lesion Index scores are similar to those obtained by use of 3T images. The Brain Atrophy and Lesion Index may have use in quantifying the impact of dementia on brain structures.

Abstract P6-07-01: Are patient perceptions and expectations about peri-operative imaging for metastatic breast cancer in keeping with current guidelines?

Background: The probability of detecting radiologically evident distant metastatic disease in asymptomatic women with primary operable breast cancer is low. Because of this, evidence-based guidelines have been developed to guide physicians on whom to image. Despite these guidelines, peri-operative staging imaging is frequently over-utilized. Relatively little is known about what patients’ perceptions and expectations are regarding peri-operative imaging and whether or not their views are in concordance with the guidelines. We undertook this study in an attempt to answer this question.

Methods: A questionnaire on peri-operative imaging to look for distant metastatic disease was given to women with early stage breast cancer who had completed their surgery. The survey questions were developed in a collaborative effort amongst oncologists, epidemiologists and knowledge translation experts.

Results: Over a 3 month period, 234 surveys were completed at a large Canadian academic cancer centre. The use of peri-operative imaging to assess the skeleton (e.g. bone scan), thorax (e.g. CT, xray), and abdomen (e.g. CT, MRI or ultrasound) is summarized in Table 1 for the 187 patients (80%) who identified their disease stage.

Patient reported perioperative imaging by disease stage Stage 1Stage 2Stage 3No. of patients (%)82/187 (44%)67/187 (36%)38/187 (20%)Median age (range)59 (29-80)57 (27-77)56 (49-65)Peri-operative imaging done for   Skeleton in (%)41/82 (50%)47/67 (70%)33/38 (87%)Thorax in (%)48/82 (59%)53/67 (79%)30/38 (79%)Abdomen in (%)34/82 (41%)42/67 (63%)27/38 (71%)

The relative proportion of patients undergoing imaging increased with advancing stage. Of the 187 patients, 66% indicated they would want imaging if the chance of finding metastatic disease was ≤10% and half of these patients (i.e. 33%) indicated they would want imaging if the chance was &lt;1%. The most common factors identified as being either extremely (EI) or very important (VI) by patients were: catching the spread of cancer to other parts of the body early (93%), reducing the chance of dying (90%), and providing peace of mind (77%). Avoiding inconvenience, exposure to scans, and extra imaging that will not change length or quality of life, and false alarms were EI or VI in ∼50%. Perceptions of these factors did not differ across disease stage. Although 85% indicated doing whatever their doctor recommended was either EI or VI to them, 72% indicated that they would feel very or somewhat uncomfortable if their physician did not order imaging to look for metastatic disease, even if this was in keeping with the guideline recommendation.

Conclusion: Irrespective of evidence-based guidelines, many patients undergo peri-operative imaging. While guidelines tend to address physician behaviour it is evident that patient perceptions and expectations are divergent from the evidence-based guidelines. If patient expectations are, in part, driving excessive imaging, new strategies targeting patient expectations and knowledge are required.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-01.

Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations

BACKGROUND/OBJECTIVES

Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction.

SUBJECT/METHODS

A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test.

RESULTS

During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women.

CONCLUSIONS

Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

The isolation and characterization of a telomerase immortalized goat trophoblast cell line

Trophoblast cells play vital roles in the processes of embryonic implantation and placentation. Many toxicological compounds can induce the malfunction of trophoblast cells, resulting in implantation failure or early embryonic loss. The finite lifespan of primary trophoblast cells limits investigation of the long-term effects of some toxicological compounds on trophoblast cells in vitro. In this study, primary goat trophoblast cells were purified by density gradient centrifugation and specific immuno-affinity purification. Then, the purified cells were immortalized through transfection of a plasmid containing the human telomerase reverse transcriptase (hTERT) gene. hTERT-transfected goat trophoblast cells (hTERT-GTCs) could steadily express hTERT gene and exhibit higher telomerase activity, and persistently proliferate without any signs of senescence up to 50 passages. The immortalized goat trophoblast cells still possessed the basic and key properties of normal primary goat trophoblast cells to express the specific intracellular marker cytokeratin 7 (CK-7) and secrete chorionic gonadotrophin β-subunit (CG-β) and placental lactogen (PL). Further studies showed that the immortalized goat trophoblast cells expressed vimentin and non-classical MHC class I antigen and exhibited invasive phenotype, suggesting that the immortalized goat trophoblasts resembled human extravillous trophoblasts. In addition, this cell line did not show neoplastic transformation either in vivo or in vitro. We concluded the immortalized goat trophoblast cells by hTERT transfection retained the basic and key characteristics of primary trophoblast cells and may provide a useful model to study the effects of some toxicological compounds on trophoblast cells.

Association between copy number variations of HLA-DQA1 and ankylosing spondylitis in the Chinese Han population

Ankylosing spondylitis (AS) is a chronic inflammatory disease with complex genetic traits. Multiple sequence variations have been associated with AS, but explained only a proportion of heritability. The studies herein aimed to explore potential associations between genomic copy number variation (CNV) and AS of Han Chinese. Five AS patients were examined with the high-density comparative genomic hybridization (CGH) microarrays in the first screen test for AS associated CNVs. A total of 533 AS patients and 792 unrelated controls were examined in confirmation studies with the AccuCopy assays. A significant association was observed between the CNV of the HLA-DQA1 and AS. Comparing with controls, AS patients showed an aberrant copy number (CN), and significantly increased number of patients had more than 2 copies of the HLA-DQA1. Therefore, CNV of the HLA-DQA1 may play an important role in susceptibility to AS in Han Chinese population.

Commissioning dose computation models for spot scanning proton beams in water for a commercially available treatment planning system

PURPOSE

To present our method and experience in commissioning dose models in water for spot scanning proton therapy in a commercial treatment planning system (TPS).

METHODS

The input data required by the TPS included in-air transverse profiles and integral depth doses (IDDs). All input data were obtained from Monte Carlo (MC) simulations that had been validated by measurements. MC-generated IDDs were converted to units of Gy mm(2)/MU using the measured IDDs at a depth of 2 cm employing the largest commercially available parallel-plate ionization chamber. The sensitive area of the chamber was insufficient to fully encompass the entire lateral dose deposited at depth by a pencil beam (spot). To correct for the detector size, correction factors as a function of proton energy were defined and determined using MC. The fluence of individual spots was initially modeled as a single Gaussian (SG) function and later as a double Gaussian (DG) function. The DG fluence model was introduced to account for the spot fluence due to contributions of large angle scattering from the devices within the scanning nozzle, especially from the spot profile monitor. To validate the DG fluence model, we compared calculations and measurements, including doses at the center of spread out Bragg peaks (SOBPs) as a function of nominal field size, range, and SOBP width, lateral dose profiles, and depth doses for different widths of SOBP. Dose models were validated extensively with patient treatment field-specific measurements.

RESULTS

We demonstrated that the DG fluence model is necessary for predicting the field size dependence of dose distributions. With this model, the calculated doses at the center of SOBPs as a function of nominal field size, range, and SOBP width, lateral dose profiles and depth doses for rectangular target volumes agreed well with respective measured values. With the DG fluence model for our scanning proton beam line, we successfully treated more than 500 patients from March 2010 through June 2012 with acceptable agreement between TPS calculated and measured dose distributions. However, the current dose model still has limitations in predicting field size dependence of doses at some intermediate depths of proton beams with high energies.

CONCLUSIONS

We have commissioned a DG fluence model for clinical use. It is demonstrated that the DG fluence model is significantly more accurate than the SG fluence model. However, some deficiencies in modeling the low-dose envelope in the current dose algorithm still exist. Further improvements to the current dose algorithm are needed. The method presented here should be useful for commissioning pencil beam dose algorithms in new versions of TPS in the future.

[Residues affecting hydrolysis of soy isoflavone glycosides, stability and catalytic properties of Thermotoga maritime β-glucosidase]

The thermostable β-glucosidase A (TmBglA) from Thermotoga maritime is a promising biocatalyst for production of isoflavone aglycones. Use of enzymes with high specificity for soy isoflavone conjugates is however essential for efficient hydrolysis. The effect of the amino acids located in the aglycone binding pocket with non-conserved residues between specificity groups in family 1 glycoside hydrolase (GH1) was studied using wild-type TmBglA and 3 exchange mutants (MI-TmBglA, M2-TmBglA, M1M2-TmBglA). Three mutants were expressed in Escherichia coli, purified and characterized. They had shifts in both optimum tem- perature and thermal stability, and their narrowing pH-activity curve caused by removing the ionized side chain in mutation. All mutants demonstrated the decreased catalytic efficiency more effectively revealed with natural glycoside, salicin, than with artificial substrate, p-nitrophenyl-β-D-glucopyranoside, suggesting that' these amino acids are the key residues to determine aglycone specificity. A lower hydrolysis of genistin and daidzin for M2-TmBglA than M1-TmBglA indicated that L400, A407 and E408 being preferable to V170, A171, V173, G 174 and H180 residues of Tm-BglA could be essential for soy isoflavone glycoside binding and catalysis.

Orientation and Phase Analysis of Nanoscale Grains Using Transmission Electron Microscopy

The nanostructuring of materials is a process which enables their properties to be drastically changed as compared to their coarse crystalline condition. For example, peculiar features were achieved, e.g. extremely high yield and ultimate strengths. The structure of such nanoscale materials has not been characterized yet in detail as compared to materials of a coarser crystalline structure because an appropriate analytical technique did not exist. Nano beam diffraction (NBD) by transmission electron microscopy (TEM) makes possible a local resolution up to 1 nm and, thus, a diffraction analysis of individual nanograins. A recently developed method based on NBD allows determining crystallographic orientation relationships and analyzing the phases of individual nanograins. This article below sets forth the analytical possibilities of this method by way of a complete evidence of twin and small-angle grain boundaries in nanocrystalline copper and a phase identification of precipitates in an AlMg5Si2 alloy.

B4GALT family mediates the multidrug resistance of human leukemia cells by regulating the hedgehog pathway and the expression of p-glycoprotein and multidrug resistance-associated protein 1

β-1, 4-Galactosyltransferase gene (B4GALT) family consists of seven members, which encode corresponding enzymes known as type II membrane-bound glycoproteins. These enzymes catalyze the biosynthesis of different glycoconjugates and saccharide structures, and have been recognized to be involved in various diseases. In this study, we sought to determine the expressional profiles of B4GALT family in four pairs of parental and chemoresistant human leukemia cell lines and in bone marrow mononuclear cells (BMMC) of leukemia patients with multidrug resistance (MDR). The results revealed that B4GALT1 and B4GALT5 were highly expressed in four MDR cells and patients, altered levels of B4GALT1 and B4GALT5 were responsible for changed drug-resistant phenotype of HL60 and HL60/adriamycin-resistant cells. Further data showed that manipulation of these two gene expression led to increased or decreased activity of hedgehog (Hh) signaling and proportionally mutative expression of p-glycoprotein (P-gp) and MDR-associated protein 1 (MRP1) that are both known to be related to MDR. Thus, we propose that B4GALT1 and B4GALT5, two members of B4GALT gene family, are involved in the development of MDR of human leukemia cells, probably by regulating the activity of Hh signaling and the expression of P-gp and MRP1.

Chimney stents for endovascular repair of juxtarenal aortic aneurysms with unfavourable anatomy

AIM

The aim of this paper was to present our experience with the use of chimney grafts in endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms (JAA) with unfavourable anatomy.

METHODS

Between January 2001 and January 2011, 5 patients (4 men and 1 woman; mean age 78 years) with JAAs were treated with chimney grafts in the renal arteries. All the cases were at high risk for open repair and were unsuitable for standard endovascular abdominal aortic aneurysm repair because of short neck length, or large neck angulation. Six chimney stents (5 balloon expandable stents and 1 self-expandable stent) were implanted into the renal arteries.

RESULTS

The technical success was 100%. The final angiography showed excellent results, with good flow into the kidneys and complete exclusion of the aneurysm sac and no type I endoleaks. The average follow-up period was 15.8 months (range, 1-52 months). One patient died two months after surgery because of heart failure. An early small type II endoleak found in one patient resolved within three months without treatment. All chimney grafts were patent at the end of the follow-up period.

CONCLUSION

The chimney graft technique is an expansion of endovascular aortic repair (EVAR), especially suitable for juxtarenal aortic aneurysms in patients with a high surgical risk. The chimney graft technique is feasible, even in the setting of unfavourable aortic anatomy. Long-term results are still unknown.

Hyperthermia enhances mapatumumab-induced apoptotic death through ubiquitin-mediated degradation of cellular FLIP(long) in human colon cancer cells

Colorectal cancer is the third leading cause of cancer-related mortality in the world; the main cause of death of colorectal cancer is hepatic metastases, which can be treated with hyperthermia using isolated hepatic perfusion (IHP). In this study, we report that mild hyperthermia potently reduced cellular FLIP(long), (c-FLIP(L)), a major regulator of the death receptor (DR) pathway of apoptosis, thereby enhancing humanized anti-DR4 antibody mapatumumab (Mapa)-mediated mitochondria-independent apoptosis. We observed that overexpression of c-FLIP(L) in CX-1 cells abrogated the synergistic effect of Mapa and hyperthermia, whereas silencing of c-FLIP in CX-1 cells enhanced Mapa-induced apoptosis. Hyperthermia altered c-FLIP(L) protein stability without concomitant reductions in FLIP mRNA. Ubiquitination of c-FLIP(L) was increased by hyperthermia, and proteasome inhibitor MG132 prevented heat-induced downregulation of c-FLIP(L). These results suggest the involvement of the ubiquitin-proteasome system in this process. We also found lysine residue 195 (K195) to be essential for c-FLIP(L) ubiquitination and proteolysis, as mutant c-FLIP(L) lysine 195 arginine (arginine replacing lysine) was left virtually un-ubiquitinated and was refractory to hyperthermia-triggered degradation, and thus partially blocked the synergistic effect of Mapa and hyperthermia. Our observations reveal that hyperthermia transiently reduced c-FLIP(L) by proteolysis linked to K195 ubiquitination, which contributed to the synergistic effect between Mapa and hyperthermia. This study supports the application of hyperthermia combined with other regimens to treat colorectal hepatic metastases.

Aldo-keto reductase 1C3 may be a new radioresistance marker in non-small-cell lung cancer

Human aldo-keto reductase 1C3, type 2 3α-hydroxysteroid dehydrogenase (HSD)/type 5 17β-HSD (AKR1C3) is known to be involved in steroid, prostaglandin and lipid aldehyde metabolism. The role of AKR1C3 in the radiosensitivity to X-rays of human non-small-cell lung cancer (NSCLC) cells was explored. In this study, a specific small interfering RNA (siRNA) to target the AKR1C3 gene was used. A suite of readouts including cell survival were determined using a colony formation assay; apoptosis evaluated by Annexin V expression levels, irradiation-induced cytotoxicity established using a MTT cell viability assay and cell cycle distribution measured by flow cytometry were used in characterizing the role of the AKR1C3 gene. Although AKR1C3 was significantly overexpressed in both our radioresistant subclone cells and NSCLC tissues, a specific AKR1C3 siRNA significantly enhanced cell radiosensitivity and was concomitant with decreased expression of this gene. Furthermore, reduced interleukin-6 (IL-6)-mediated radioresistance was observed when siRNA was used to knock down AKR1C3 activity. This AKR1C3-mediated radioresistance was correlated with an arrest in the G2/M cell cycle and a decreased induction of apoptosis. AKR1C3 may present a potential therapeutic target in addressing radioresistance of NSCLC, and in particular in IL-6-mediated radioresistance.

Administration of PLGA nanoparticles carrying shRNA against focal adhesion kinase and CD44 results in enhanced antitumor effects against ovarian cancer

The two membrane-bound proteins, focal adhesion kinase (FAK) and CD44, are involved in processes critical to cancer progression. FAK has an active role in angiogenesis, cell proliferation and cell apoptosis, whereas the heavily glycosylated CD44 has been implicated in cancer metastasis. Here, using short hairpin RNA (shRNA) against FAK and CD44, we demonstrate that simultaneous knockdown of both these genes inhibits cancer growth more efficiently than knockdown of either gene individually. Plasmids targeting these genes or non-relative control sequences were constructed and delivered to ovarian cancer targets by biodegradable poly D,L-lactide-co-glycolide acid nanoparticles (PLGANPs). Nude mice were utilized in an intraperitoneal model of ovarian carcinomatosis to assess antitumor efficacy in vivo. Single gene knockdown resulted in significantly smaller tumors than those observed in the empty-vector control (P's<0.001). More importantly, knockdown of both genes resulted in tumors smaller than both the empty-vector group (P<0.0001) and the single gene knockdown groups (P's<0.001). Knockdown of both FAK and CD44 resulted in tumors with inhibited angiogenesis, reduced proliferation and increased apoptosis as compared with controls (P's<0.001) and single knockdown groups (P's<0.05). These results indicate that dual knockdown of FAK and CD44 in the tumors of patients with ovarian cancer may have an enhanced therapeutic effect, and point toward a mechanism involving the inhibition of angiogenesis, cellular proliferation and the induction of apoptosis.

ANXA2 remodels the microstructures of caco2 cells

ANXA2 was reported as a multiple tumors relevant gene expressed excessively in many tumor tissue types, especially in the cancers from digestion system, and its aberrant expression enhances the malignant properties of cancer cells. We suppose that the microstructure heterogeneity is important to maintain the malignancy of cancer cells, and excessive ANXA2 expression enhance the malignancy by remodeling the microstructures of cancer cells. To validate the proposal, the ANXA2-/-caco2 cell line was generated and the changes of the microstructures in the ANXA2 deleted and wild type caco2 cells were observed under fluorescence microscope, laser scanning confocal microscope and electron microscope. We found that ANXA2 deletion induced the pseudopodia shorted and spared, non-stained areas increased, mitochondria decreased, and the expression and polymerization of F-actin and β-tubulin changed. By the findings above, it is firstly reported in this paper that the ANXA2 excessive expression induces the significant changes of the microstructures in cancer cells. Combining our previous data together, our results indicate that ANXA2 excessive expression enhances the malignancy of cancers partially by remodeling the cell microstructures.

Antiviral activity and mode of action of extracts from neem seed kernel against duck plague virus in vitro1

Four fractions obtained from alcohol extracts of neem (Azadirachta indica) seed kernel by column chromatography were investigated for antivirus activity against the duck plague virus (DPV) in vitro. Duck embryo fibroblasts (DEF) infected with DPV were treated with the neem seed kernel extracts, and the effect of antivirus was judged by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide colorimetric method assay and direct immunofluorescence assay. The mode of action was tested by the plaque reduction assay. The results showed that fractions 1 to 3 were inactive. The median inhibitory concentration (IC(50)) of fraction 4 was 10.9 μg/mL and inhibited the virus protein expression in the direct immunofluorescence assay. In the plaque reduction assay, fraction 4 could significantly reduce the number of plaques compared with the negative control (P < 0.01) in all modes of action. This study indicated that the fourth fraction obtained from neem seed kernel could improve the viability of infected cells, and reduce the cytopathic effects caused by DPV and the amount of the virus protein expressed in virus-infected cells. The antiviral activity works in the whole process of virus infecting the normal cells.

Abstract P2-11-10: Prospective memory impairment in early breast cancer survivors: Finally homing in on the real deficit?

Background There is still much debate about the impact of early breast cancer (EBC) treatment on memory functioning. One limitation of existing studies is that they are based on neuropsychological testing procedures which may not be sensitive enough to detect memory problems as encountered in daily life. In fact, no study has objectively assessed everyday memory performance in EBC. One crucial aspect of using memory in daily activities is to remember to do something at an appropriate time in the future without being asked to do so-defined as “prospective memory” (PM). Despite its importance for daily functioning, little is known about PM in EBC patients. Thus, we investigated whether EBC survivors who were within 1 year of having completed adjuvant chemotherapy have PM impairment in comparison to age-matched healthy controls. In addition, we evaluated the contributions of fatigue and depression to PM functioning.

Methods We undertook a cross sectional quantitative case-control study (n = 80) comparing EBC patients from the Ottawa Hospital Regional Cancer Centre with age and education-matched healthy controls from the community. A standardized test of PM (Memory for Intention Screening Test) was administered to both groups. Impairment was defined as a score that fell 2 standard deviations below the mean performance of the control group. Standardized measures of depression (CESD) and fatigue (Fact-F) were also completed.

Results Age was well balanced between the groups (case and control mean age 54y, p = .84). EBC patients performed more poorly than controls on the PM test (p &lt; .001) and had a significantly higher rate of impairment (23% vs. 5%, McNemar χ2, p &lt;.01, odds ratio=5.5, 95% CI=1.7745 to 17.1473). A series of hierarchical regressions showed that patients PM performance was affected by fatigue (p &lt;.05), but not depression (p = .51).

Conclusions The results demonstrate reduced memory performance in EBC survivors, with a specific impact on PM. Women who complain of ‘chemo fog’ should be evaluated carefully for PM deficits and their concerns should be acknowledged. An important finding from this study is the demonstration that fatigue is associated with memory deficits when memory as used in everyday life is evaluated. This finding which is suggestive of a common mechanism involved in fatigue symptoms and everyday memory disturbances raises the possibility that interventions targeted at improving fatigue may also improve memory functioning and quality of life in EBC survivors. Further longitudinal studies should be conducted to critically evaluate the role of chemotherapy by assessing PM before the initiation of chemotherapy and in EBC patients receiving only adjuvant hormonal therapy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-10.

Abstract P3-04-11: Systemic treatment decision making for patients with stage I and II, hormone receptor positive, her2/neu negative breast cancer

Background: Oncotype DX is a clinically validated risk stratification tool that can predict the risk of recurrence and the benefit of adjuvant chemotherapy in women with hormone receptor positive (HR+), HER2/neu negative early stage breast cancer (EBC). This tool has been available to oncologists in Ontario since April 2010 at significant cost, yet no guidelines exist regarding their use. This retrospective chart review examined the factors that were associated with use of Oncotype DX at a tertiary care cancer centre.

Materials and methods: One hundred patients (pts) diagnosed with HR+, HER2/neu negative EBC (stage I-II), who underwent Oncotype DX testing between April 1, 2010, and June 30, 2011 were included in the study. A second control group of 100 patients with similar disease characteristics but who did not receive Oncotype DX testing were randomly selected. Data collection included demographics, tumor grade and stage, and Adjuvant! Online recurrence risk scores. The distribution of patients in each category was compared using the chi-square test to detect statistically significant differences between distributions.

Results: Median age in the Oncotype DX group was 58 years (r: 26–77) and 63 years (r: 30–81) in the control group. 20 patients in the Oncotype DX group were aged 35–49, 57 patients were aged 50–64, and 23 patients were aged 65 or older, while the control group had 16, 43, and 41 patients, respectively (p = 0.02). The Oncotype DX group had 72 pre- and perimenopausal pts and 28 postmenopausal patients, while the control group had 81 and 19 patients, respectively (p = 0.13). 20, 56, and 24 pts in the Oncotype DX group had grade 1, 2, and 3 histology, respectively, vs. 44, 44, and 12, respectively in the control group (p &lt; 0.01). The Oncotype DX group had 7 patients with tumors between 1–10 mm, 55 between 10.1–20 mm, 34 between 20.1–50 mm, and 4 greater than 50 mm, vs. 29, 42, 23, and 1, respectively in the control group (p &lt; 0.01). When 10-year Adjuvant Online recurrence scores were calculated using tamoxifen, 17, 67, and 16 patients in the Oncotype DX group had risk scores of &lt;15, 15–25, and &gt;25, respectively, vs. 62, 33, and 5 in the control group (p &lt; 0.01). When the scores were calculated using tamoxifen plus an aromatase inhibitor, 49, 42, and 9 patients in the Oncotype DX group, and 75, 24, and 1 patients in the control group fell into these categories, respectively (p &lt; 0.01). Median Oncotype DX recurrence score was 17 (r: 0–70), with 10-year recurrence risk of 11% (r:3–34%).

Conclusions: This single-centre series is aimed at identifying potential clinical and pathological factors which can influence physicians' decision to request Oncotype DX testing for pts with EBC. Physicians were more likely to request Oncotype DX testing for patients that were younger, had larger and higher grade tumors, and higher Adjuvant! Online recurrence risk scores. These results will be used to design a prospective study evaluating these factors and how Oncotype DX testing may influence treatment decision making.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-04-11.

Abstract P5-01-01: Predicting OncoDX Recurrence Scores with Immunohistochemical Markers

Background: Standard immunohistochemistry (IHC) performed for invasive breast carcinoma includes ER, PR and Her2/Neu status, and these markers are used in conjunction with other patient and tumour factors to determine prognosis and guide treatment. Many, but not all, low stage, lymph node (LN) negative, ER positive patients have a good prognosis without chemotherapy. Thus a demand exists for predictive tools to stratify patient risk within this subgroup. It has been reported that, for a subset of ER positive Her2/Neu negative patients, the 21 gene OncotypeDX recurrence score (Onco-RS) adds independent prognostic information to that obtained from these standard IHC markers (1). As several genes analyzed for the Onco-RS relate to ER, PR, HER2/neu and proliferative status, it is reasonable to try to incorporate clinical-pathological variables and these IHC scores into a predictive model. Indeed, recent studies suggest that most of the additional information provided by the OncoDX-RS may be obtained more cost effectively using the Ki-67 IHC based proliferation percentage combined with a semi-quantitative assessment of standard IHC markers including ER and PR and Her2/neu (2). The aim of this study is to assess the ability of a simple combined IHC recurrence score (IHC-RS) to predict Onco-RS. The IHC-RS was derived from a simple semi-quantitative assessment of ER and PR combined with Ki-67 proliferation percentage.

Design: A cohort of 159 women aged 27–78 with ER positive, HER2/neu negative breast cancer completed Oncodx testing between March 2010 and May 2012. This sample reflects the population selected at our institution for Oncotype testing. The variables investigated for inclusion in a model to predict RS score included tumor grade, stage, patient age, Allred ER & PR and Ki-67 percentage.

Results and Discussion: A predictive model was developed to generate a recurrence score (IHC-RS) using stepwise multiple regression incorporating Allred ER score, Allred PR score and Ki-67 percentage. The best subset model (Schwartz BIC) accounted for 60.7% of the Onco-RS variability (adjusted R2 = 60.7, p = 0.05).

In addition, analysis of individual cases where the IHC-RS was not in agreement with the Onco-RS reveals that the Onco-RS, although technically highly reproducible, may suffer from sampling error. The IHC-RS is more robust with respect to sampling error, owing to the retention of tumor architecture inherent in IHC. IHC, however, can lack the technical reproducibility and transportability inherent in the Onco-RS methodology. There are clearly advantages to an ICH derived multi-score such as IHC-4 (3) or the simpler IHC-RS proposed in this study. Full utility of any IHC-based recurrence score will require standardization of testing and scoring both within and across different testing laboratories. In addition, full utility of any IHC based model will require direct correlation to patient outcome, rather than to a surrogate marker such as the Onco-RS used in this study.

1. M Dowsett et al. J Clin Oncol. 2010 Apr 10; 1829–1834 2. Cuzick J et al. J Clin Oncol. 2011 Nov 10;4273-8. 3. S Barton et al. British Journal of Cancer (2012) 106, 1760–1765.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-01.