THU0048 THE FUNCTION CHANGES OF SNPS IN THE P2X7 RECEPTOR BY ALA348TO THR, GLU496TO ALA AND ARG307TO GLN IN THP-1 CELLS WITH HIGH URIC ACID

Background:

Previous studies[1] have shown that ATP acts on the sputum receptor P2X ligand-gated ion channel 7 (P2X7R) as a second signal to induce gouty arthritis.

Objectives:

In this study, the functional changes of three SNP genotypes, Ala348 to Thr, Glu 496 to Ala and Arg307 to Gln, in P2X7R were analyzed with high uric acid.

Methods:

After transfection of HEK-293T cells by lentivirus, observing the uptake ability of HEK-293T cells to ethidium bromide. The effect of three different mutants on the P2X7 receptor was thus observed on the P2X7 channel. In addition, THP-1 cells were also transfected, stable expression of a THP-1 cell line that has been transfected with a wild-type or different mutants and thus established. Then three types were set up separately, and each type was randomized into three groups: MSU(labeled M), MSU+ATP (labeled MA), and unstimulated control group (labeled C).Detection of IL-1β protein expression level in serum by ELISA and NLRP3, ASC and Caspase-1 mRNA levels in transfected THP-1 cells by qRT-PCR.

Results:

1.These three variants have different effects on the uptake function of ATP-induced ethidium+bromide in transfection of HEK-293T cells by lentivirus. Ala348to Thr increased P2X7-dependent ethidium+bromide uptake (145% of wild-type P2X7response, P<0.001). In contrast, Absent or very reduced P2X7function was found in Glu496to Ala and Arg307to Gln subjects, appeared to abolish P2X7-dependent dye uptake (38% and 32% of wild-type P2X7responses, P<0.001,), who were compared with wild-type.

2.Compared the IL-1β levels of the three variants with the wide-type and empty virus in THP-1 cells, the Ala348to Thr mutation significantly up-regulated the serum levels of IL-1β compared with the wide-type and empty virus in group MA with high uric acid (P=0.0007;P=0.013, respectively). Moreover, similar results have also been shown in IL-1β mRNA expressions (P=0.0334; P=0.0307, respectively). The Glu496to Ala and Arg307to Gln mutations down-regulated the serum levels of IL-1β compared with the wide-type in group MA (P=0.0189;P=0.0164, respectively).

3.NLRP3 mRNA was significantly increased in the Ala348to Thr mutation compared with the wide-type and empty virus in group MA (p =0.0003;P=0.0001, respectively). However, NLRP3 mRNA was significantly reduced in the Glu496to Ala and Arg307to Gln mutations compared with the wide-type in group MA (p =0.0294;P=0.0279, respectively).

4.Wild-type was signifcantly higher than empty virus in the ASC gene expression in group MA(P=0.0022). Morever, the Ala348to Thr mutation was higher than empty virus while Arg307to Gln mutation was lower than that in group MA (P=0.0138;P=0.0283, respectively).

5.Unlike NLRP3 gene expression, the data showed that the expression of caspase-1 mRNA in group C, M and MA all with no statistical significance, respectively (P>0.05).

Conclusion:

Our data revealed that Ala348to Thr up-regulate the functional status of P2X7R and Glu496to Ala and Gln460to Arg down-regulate the functional status of P2X7R, which resulted in a significant increase or decrease in IL-1β and NLRP3 expression levels with high uric acid.

References:

[1]Tao JH, Zhang Y, Li XP, et al. P2X7R: a potential key regulator of acute gouty arthritis[J].Semin Arthritis Rheum, 2013,43(3):376–380.

Disclosure of Interests:

None declared

Self-made Salmonella Pullorum agglutination antigen development and its potential practical application

Pullorum disease caused by Salmonella Pullorum is one of the most important infectious diseases in the poultry industry worldwide, which leads to serious economic losses in many developing countries because of its high mortality rate in young chicks. The traditional slide agglutination test with low cost, fast reaction, and on-site detection has been widely used in the diagnosis of Pullorum disease. However, in practice, the test performance is with the disadvantages of false positive results and unstable detection results. In this paper, we developed self-made agglutination antigens prepared by local isolates in the poultry farm and compare the detection performance with commercial agglutination antigens (China Institute of Veterinary Drug Control) and Group D Salmonella ELISA kit (BioChek UK Ltd). The results of detecting 200 serum samples indicated that the consistency of commercial agglutination antigen detecting in 2 times was only 79.5%. Using the ELISA kit as the reference method, the commercial agglutination antigen detecting results of the Kappa test were only moderately consistent (0.58 ∼ 0.59). Meanwhile, positive and total coincidence rates of the self-made agglutination antigen test with more reliable repeat could reach 97.4 and 88%, respectively, and the result of Kappa test was highly consistent (0.75). The Receiver Operating Characteristic curve analysis clarified that the area under the receiver-operating-characteristic curve values of self-made and commercial agglutination antigen tests could reach 0.861 and 0.804, respectively. These results were coincident when detecting known positive serum from the infected chickens. It's worth mentioning that the visible positive reaction of self-made agglutination antigen test appeared faster and stronger than commercial antigen test. In conclusion, self-made Salmonella Pullorum agglutination antigen developed in this study was much better than commercial agglutination antigen and is expected to be a valuable tool in the diagnosis of the epidemiology of Salmonella Pullorum.

Observation of a Resonant Structure in e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}

A partial-wave analysis is performed for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} at the center-of-mass energies ranging from 2.000 to 2.644 GeV. The data samples of e^{+}e^{-} collisions, collected by the BESIII detector at the BEPCII collider with a total integrated luminosity of 300  pb^{-1}, are analyzed. The total Born cross sections for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}, as well as the Born cross sections for the subprocesses e^{+}e^{-}→ϕπ^{0}π^{0}, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), are measured versus the center-of-mass energy. The corresponding results for e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} and ϕπ^{0}π^{0} are consistent with those of BABAR with better precision. By analyzing the cross sections for the four subprocesses, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), a structure with mass M=(2126.5±16.8±12.4)  MeV/c^{2} and width Γ=(106.9±32.1±28.1)  MeV is observed with an overall statistical significance of 6.3σ, although with very limited significance in the subprocesses e^{+}e^{-}→K_{1}^{+}(1270)K^{-} and K^{*+}(892)K^{*-}(892). The resonant parameters of the observed structure suggest it can be identified with the ϕ(2170), thus the results provide valuable input to the internal nature of the ϕ(2170).

Positive intergroup contact modulates fusiform gyrus activity to black and white faces

In this study, we investigated the effect of intergroup contact on processing of own- and other-race faces using functional Magnetic Resonance Imaging (fMRI). Previous studies have shown a neural own-race effect with greater BOLD response to own race compared to other race faces. In our study, white participants completed a social-categorization task and an individuation task while viewing the faces of both black and white strangers after having answered questions about their previous experiences with black people. We found that positive contact modulated BOLD activity in the right fusiform gyrus (rFG) and left inferior occipital gyrus (lIOC), regions associated with face processing. Within these regions, higher positive contact was associated with higher activity when processing black, compared to white faces during the social categorisation task. We also found that in both regions a greater amount of individuating experience with black people was associated with greater activation for black vs. white faces in the individuation task. Quantity of contact, implicit racial bias and negatively valenced contact showed no effects. Our findings suggest that positive contact and individuating experience directly modulate processing of out-group faces in the visual cortex, and illustrate that contact quality rather than mere familiarity is an important factor in reducing the own race face effect.

[Feasibility and efficacy of percutaneous pulmonary vein stenting for the treatment of patients with severe pulmonary vein stenosis due to fibrosing mediastinitis]

Objective: To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods: This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results: All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83±16)% to (12±4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1)mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0±9.0)mmHg to (38.7±8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion: Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.

4284The combined use of radiofrequency-ablation and balloon-dilation (CURB) in the creation of a stable inter-atrial communication: first-in-man use for patients with severe pulmonary arterial hypertension

Background

Recent preclinical research has suggested that combined use of radiofrequency-ablation and balloon-dilation (CURB) had the potential to create a stable inter-atrial communication. However, the related clinical data is still absent.

Purpose

This study describes the first-in-man use of CURB in the patients with severe pulmonary arterial hypertension (PAH).

Methods

Under the guidance of fluoroscopy and intra-cardiac echocardiography, CURB was attempted in 3 patients with severe PAH (age: 35.0±12.1 years, one idiopathic PAH and two PAH related to repaired congenital heart disease). With the aid of 3D location system, fossae ovalis was ablated with radiofrequency. Then the graded balloon-dilation was performed after transseptal puncture, and radiofrequency-ablation was repeated around the rim of fenestration created with balloon-dilation. The exercise capacity and fenestration-size were followed up.

Results

CURB was performed successfully in all 3 patients, and pulmonary vascular resistance was 30.3±10.9 Wood units. The fenestration size was 5.0±1.0 mm (range: 4–6 mm), and systemic arterial oxygen saturation decreased by 4.7±0.6% (range: 4–5%). World Health Organization functional class increased by 1.6±0.5 (P<0.001) and cardiac index increased by 0.58±0.34 L/min/m2 (P<0.001). In addition, exercise capacity improved significantly (+63.7 meters, P<0.001). Follow-up (6.0±1.0 months; range: 5–7 months) showed that all fenestrations were stable (P=0.808), and no complication occurred.

Figure 1. The combined use of radiofrequency-ablation and balloon-dilation (CURB) was performed in the patient with severe PAH. Left figures showed the procedure of CURB. Middle figures showed the created fenestration with MSCT, and the morphology and size of fenestration was provided in the right-inferior panel. In addition, the sizes of right atrium and ventricle were alleviated with increase of left atrium. Right figures indicated that the fenestration-size was stable during follow-up (one week, one month and six months, respectively).

Conclusions

In patients with severe PAH, CURB is feasible and effective to create a stable inter-atrial communication. Further research was required to evaluate the long-term result of this novel approach.

ClinicalTrials.gov ID: NCT03554330.

Acknowledgement/Funding

National Natural Science Foundation of China (81670283) and Beijing Natural Science Foundation (7162160)

Measurement of the cosmic ray proton spectrum from 40 GeV to 100 TeV with the DAMPE satellite

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 ¹/₂ years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

The LEPR K109R and Q223R Might Contribute to the Risk of NAFLD: A Meta-Analysis

BACKGROUND

Leptin and insulin resistance have been pointed out to play a role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Increasing genes were shown to be associated with the risk of NAFLD.

OBJECTIVE

The study aimed to investigate the genetic association between two leptin receptor (LEPR) polymorphisms (Q223R and K109R) and the NAFLD risk.

METHODS

Studies were retrieved and included by using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI) and EMBASE database. Genetic associations were assessed with pooled odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Five case-control studies with 1711 NAFLD patients and 1732 healthy controls were included in this meta-analysis. The K109R was significantly associated with NAFLD in allelic model in Southeast Asian subgroup (p=0.01, OR=0.59, 95% CI [0.39- 0.90]), but not in Chinese subgroup (p=0.24, OR=1.10, 95% CI [0.94-1.29]). The Q223R was significantly associated with NAFLD in both allelic and recessive models (allelic model: p<0.001, OR=0.57, 95% CI [0.50-0.65]; recessive model: p=0.001, OR=0.67, 95% CI [0.52-0.85]). However, subgroup analysis showed that the significant association between Q223R and NAFLD in allelic model cannot be found in Southeast Asians subgroup (p=0.07, OR=0.67, 95% CI [0.52-0.85]).

CONCLUSION

LEPR K109R might be a susceptible factor for NAFLD in Southeast Asian population. And LEPR Q223R might be a susceptible factor for NAFLD in Chinese population.

[Expression of PD-1 and PD-L1 in the peripheral blood of advanced non-small-cell lung cancer patients and its implications]

Objective: To investigate the expression of programmed death 1(PD-1) and programmed death ligand 1 (PD-L1) on T lymphocyte and monocyte from peripheral blood of advanced non-small-cell lung cancer (NSCLC) patients and its potential role in immune escape of NSCLC. Methods: Forty-eight patients with advanced NSCLC (Lung Cancer Group) were included from the Department of Respiratory Diseases in The Second Affiliated Hospital of Soochow University from June 2014 to June 2015. Thirty-six healthy volunteers who received health examination at the same time, matching in sex, age were also enrolled as controls. The expression of PD-1 on peripheral blood CD4(+)T cells and CD8(+)T cells and PD-L1 on monocytes were detected by flow cytometry. Patients who received chemotherapy alone for 2-4 cycles and received sequential sampling were assessed with Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Seven cases of patients with significant response to treatment were selected as partial response (PR) group and ten patients with poor response to treatment were treated as progression disease(PD) group. The differences in the expression of PD-1 on the surface of CD4(+)T cells, CD8(+)T cells, and PD-L1 on the surface of monocyte before and after treatment were analyzed. Results: Compared with healthy control group, PD-1 expression level on both CD4(+) T and CD8(+) T cells from peripheral blood in lung cancer group were significantly increased [(25.9±7.4)% vs (20.6±6.2)%, (19.9±9.8)% vs (14.0±5.6)%, both P<0.05]. A higher level of PD-L1 expression on monocyte in lung cancer group was also found compared with the control group [(33.1±15.1)% vs (13.6±5.3)%, P<0.001]. The expression level of PD-1 on CD4(+)T and CD8(+)T cells and PD-L1 on monocytes in lung cancer group with good response to treatment was relatively lower than the baseline level of before treatment [(22.8±8.5)% vs (25.9±7.8)%, (17.1±8.4)% vs (20.4±8.6)%, (18.1±6.9)% vs (31.3±13.2)%, all P<0.05], but in lung cancer group with poor response to treatment, it was higher than the baseline level of before treatment [(33.5±6.5)% vs (23.9±4.2)%, (25.2±9.1)% vs (19.1±8.8)%, (43.1±18.3)% vs (29.7±10.6)%, all P<0.05]. Conclusion: Abnormal expression of PD-1 and PD-L1 exists in T cells and monocytes respectively, prompting PD-1/PD-L1 pathway may inhibit T cell proliferation during the interaction of T cell and monocyte, which may lead to non-small cell lung cancer immune escape.

Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

BACKGROUND AND PURPOSE

Tirofiban is used off-label in clinical practice for acute ischaemic stroke (AIS). However, it is unknown whether tirofiban increases the bleeding risk or improves the outcome of endovascular treatment (EVT) in AIS. This study evaluated the efficacy and safety of tirofiban in combination with EVT for AIS.

METHODS

Consecutive patients with AIS receiving EVT were included in the prospective stroke registry from 2015 to 2018. The efficacy outcomes were modified Rankin Scale (mRS) score at 3 months and National Institutes of Health Stroke Scale (NIHSS) score at 24 h. The safety outcomes were symptomatic intracerebral hemorrhage (sICH), any in-hospital intracerebral hemorrhage, in-hospital death and 3-month death.

RESULTS

Of 211 patients, 82 (38.9%) received tirofiban. A total of 39 (48.1%) with tirofiban and 44 (36.1%) without tirofiban had mRS score 0-2 [adjusted odds ratio (OR), 2.41; 95% confidence interval (CI), 1.11-5.23, P = 0.026]. NIHSS score at 24 h was lower in the tirofiban group (9.5 vs. 12.0, adjusted P = 0.032). Five (6.1%) patients with tirofiban and 16 (12.4%) without tirofiban had sICH (adjusted OR, 0.54; 95% CI, 0.16-1.83, P = 0.32). In-hospital intracerebral hemorrhage occurred in 10 (12.2%) patients with tirofiban and 41 (31.8%) without tirofiban (adjusted OR, 0.32; 95% CI, 0.13-0.76, P = 0.01). In-hospital death occurred in 7 (8.5%) patients with tirofiban and 16 (12.4%) without tirofiban (adjusted OR, 0.69; 95% CI, 0.22-2.13, P = 0.52). A total of 13 (15.9%) patients with tirofiban and 22 (17.1%) without tirofiban were dead at 3 months (adjusted OR, 0.98; 95% CI, 0.40-2.40, P = 0.96).

CONCLUSIONS

Tirofiban in combination with EVT was associated with a lower mRS score at 3 months and NIHSS score at 24 h. It was not associated with a higher rate of sICH, in-hospital death and death at 3 months.

[Human ear finite element model study of the effects of ear canal and middle ear cavity on air conduction and bone conduction]

Objective:To study the influence of the ear canal and middle ear cavity on air conduction and bone conduction. Method:A finite element model of the human middle ear was established. By establishing the external ear canal and the middle ear cavity, we evaluated the effects of the external canal and the middle ear cavity on air conduction and bone conduction. Result:In air conduction, the external canal improved the stapes response at the frequency range of 0.5 kHz to 6 kHz, and the maximum increase was 11 dB at 3 kHz. The middle ear cavity mainly reduced the response of stapes at mid-low frequency, with the drops of 2-4 dB under 2 kHz; in bone conduction, ear canal slightly reduced the low-frequency response, but increased the response of the stapes at the mid-high frequency, with a maximum increase of 1.9 dB at 1.5 kHz. The middle ear cavity mainly increased the stapes response at mid-frequency near 1.5 kHz, with a maximum increase of 2.5 dB. Conclusion:Our results show that, in air conduction, the ear canal significantly increases the middle-frequency response, while the middle ear cavity decreases the low-mid frequency response. Whereas, the ear canal and the middle ear cavity have slightly effect on bone conduction.

Abstract P2-06-02: Development of a first-in-class small molecule inhibitor (EC359) targeting oncogenic LIF/LIFR signaling for the treatment of triple negative breast cancer

Background: Leukemia inhibitory factor (LIF) and its receptor LIFR are over-expressed in multiple solid tumors and play a key role in tumor growth, progression, and resistance to standard anti-cancer treatments. Triple-negative breast cancer (TNBC) lacks targeted therapies and represents a disproportional share of breast cancer (BCa) mortality. TNBC exhibits autocrine stimulation of the LIF/LIFR axis and overexpression of LIF is associated with poorer relapse-free survival in BCa patients. LIF signaling also promotes maintenance of stem cells. Therefore, targeting the LIF/LIFR axis may have therapeutic utility in TNBC.

Methods: We rationally designed a small organic molecule (EC359) that emulates the LIF/LIFR binding site and functions as a LIFR inhibitor from a library of compounds. In silico docking studies were used to identify the putative interaction of the EC359 and LIF/LIFR complex. Direct binding of EC359 to LIFR was confirmed using surface plasmon resonance (SPR) and microscale thermophoresis technique (MST) assays. In vitro activity was tested using Cell-Titer Glo, MTT, invasion, and apoptosis assays. Mechanistic studies were conducted using Western blot, reporter gene assays, and RNA-seq analysis. Xenograft, patient-derived xenograft (PDX), and patient-derived explant (PDEX) models were used for preclinical evaluation and toxicity.

Results: Molecular docking studies showed that EC359 interacts at the LIF/LIFR binding interface. SPR and MST studies confirmed direct interaction of EC359 to LIFR. EC359 reduced the growth of TNBC cells with high potency (IC50 50-100nM) and promoted apoptosis. Further, EC359 treatment reduced invasion and stemness of TNBC cells. EC359 activity is dependent on the expression levels of LIFR and showed little or no activity on TNBC cells that have low levels of LIFR or ER+ve BCa cells. Further, EC359 significantly reduced the viability of cisplatin and taxane-resistant TNBC cells and enhanced the efficacy of HDAC inhibitors. Mechanistic and biochemical studies showed that EC359 interacts with LIFR and effectively blocking LIF/LIFR interactions. EC359 also blocked LIFR interactions with other LIFR ligands such as oncostatin M, ciliary neurotrophic factor, and cardiotrophin-1. EC359 treatment attenuated the activation of LIF/LIFR driven pathways including STAT3, mTOR, AKT, and MAPK. RNA-seq analysis identified regulation of apoptosis as one of the important pathway modulated by EC359. In TNBC xenograft and PDX assays, EC359 significantly reduced tumor progression. Further, using human primary BCa PDEX cultures, we demonstrated that EC359 has the potential to substantially reduce the proliferation of human BCa. Pharmacologically, EC359 exhibited high oral bioavailability and long half-life with a wide therapeutic window.

Conclusions: EC359 is a novel targeted therapeutic agent that inhibits LIF/LIFR oncogenic signaling in TNBC via a unique mechanism of action. EC359 has the distinct pharmacologic advantages of oral bioavailability, in vivo stability, and is associated with minimal systemic side effects. (DOD BCRP grant #BC170312)

Citation Format: Viswanadhapalli S, Luo Y, Sareddy GR, Santhamma B, Zhou M, Li M, Pratap UP, Altwegg KA, Li X, Srinivasan U, Ma S, Chang A, Riveros AC, Zhang KY, Dileep KV, Pan X, Murali R, Bajda M, Raj G, Brenner A, Manthati V, Rao M, Tekmal RR, Nair HB, Nickisch KJ, Vadlamudi RK. Development of a first-in-class small molecule inhibitor (EC359) targeting oncogenic LIF/LIFR signaling for the treatment of triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-02.

Abstract P1-12-13: Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for breast cancer

Objectives: Upper extremity dysfunction (UED) is a known side effect of breast cancer treatment. It is unclear, however, to what degree radiation contributes to this morbidity. We aimed to characterize the level of UED using patient-reported outcomes (PROs) prior to, during, and after treatment with radiation for breast cancer. Our secondary aims were to evaluate the association of UED with pain scores.

Methods: This is a single-institution, prospective, longitudinal cohort study of patients treated with radiation for breast cancer. The validated patient-reported outcome measure, Quick Disabilities of the Arm, Shoulder and Hand (QD) was used to capture UED prior to radiation, at the end of radiation, and 1 month following the completion of radiation. Pain scores were also collected at these intervals using the numeric pain reporting scale (NPRS) from 0 (no pain) to 10 (worst pain).

Results: Forty-four patients were enrolled on this study and 43 (97.7%) had completed radiation at the time of analysis. Thirteen patients (29.5%) were treated with mastectomy, axillary lymph node dissection and regional nodal irradiation in the supine position. The other 31 (70.5%) patients underwent lumpectomy and sentinel lymph node biopsy. Of these patients, 26 (83.9%) were treated in the prone position and 30 (96.8%) received whole breast irradiation. Median time from surgery to radiation was 69 days (range 35 – 212 days), 76 days for mastectomy and 68 days for lumpectomy. Median time from start to end of radiation was 38 days for mastectomy and 28 days for lumpectomy. Pre-treatment median QD score prior to radiation was 12.5 (11.4 for lumpectomy, 15.9 for mastectomy), 9.1 at the end of radiation (9.1 for lumpectomy, 18.2 for mastectomy), and 2.4 at 1 month after radiation (2.3 for lumpectomy, 2.5 for mastectomy). Median NPRS scores at pre-treatment, post-treatment and 1 month follow-up were 1, 1, and 1 for lumpectomy and 0, 1, 0 for mastectomy patients, respectively.

Conclusion: In this initial pilot study with 1 month of follow up, patient-reported UED as demonstrated by QD scores were higher pre-radiation and decreased by one month after. This likely reflects recuperation after surgical procedure. Median average pain scores were low at all time points. Further evaluation of UED over time to characterize the long-term effect of radiation and correlation with quality of life and other clinical factors is planned.

Citation Format: Healy E, Pan X, Beyer S, Washington I, Bazan J, White J. Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-13.

Anterior Spinal Fusion and Posterior Spinal Fusion Both Effectively Treat Lenke Type 5 Curves in Adolescent Idiopathic Scoliosis: A Multicenter Study

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

Retrospective comparison of radiographic and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in surgical treatment of Lenke 5 curves.

SUMMARY OF BACKGROUND DATA

ASF and PSF are used for treatment of Lenke 5 curves in patients with adolescent idiopathic scoliosis (AIS). Currently, no consensus exists for optimal surgical treatment of Lenke 5 curves.

METHODS

Patients with Lenke 5 curves treated with either ASF or PSF were prospectively enrolled in a multicenter database and then retrospectively reviewed. Demographic data, perioperative measures, radiographic data, and SRS-22R scores were collected and compared for statistical significance.

RESULTS

A total of 149 patients were included in the study; 51 underwent PSF and 98 underwent ASF. There was no difference in demographics between groups. The PSF group was fused one level longer than the ASF group (5.9 levels PSF, 4.6 levels ASF, p < .0001). The PSF group had shorter operative times (223 minutes PSF, 297 minutes ASF; p < .0001) and a higher proportion of patients who received a postoperative blood transfusion (45% vs. 5%, p < .0001). PSF patients had longer hospital stays (6.1d PSF vs. 5d ASF, p = .031). The ASF group had larger preoperative major curve (48.2° ASF, 44.2° PSF; p < .01). Coronal balance, thoracolumbar/lumbar Cobb angle, shoulder height, trunk shift, and overall sagittal balance were not different between groups at two-year follow-up. Curve correction at two-year follow-up was similar between groups (66% ASF vs. 62% PSF). There were no significant differences in clinical outcomes or complication rates between groups.

CONCLUSION

There is no difference in radiographic or clinical outcomes in patients treated with ASF or PSF for Lenke 5 curves. ASF may save a fusion level, but has longer operative time than PSF. Ultimately, the risks and benefits of each approach merit consideration by surgeon and patient.

LEVEL OF EVIDENCE

Level II.

Targeting NEDD8-activating enzyme is a new approach to treat canine diffuse large B-cell lymphoma

Canine diffuse large B-cell lymphoma (DLBCL), the most common hematologic malignancy of dogs, is associated with poor overall survival. The lack of conventional chemotherapies with sustainable efficacy warrants investigation of novel therapies. Pevonedistat (MLN4924) is a potent and selective small molecule NEDD8-activating enzyme inhibitor. In human activated B-cell-like (ABC) diffuse large B-cell lymphoma, pevonedistat induces lymphoma cell apoptosis, DNA damage and G1 cell cycle arrest by inhibiting the nuclear factor-κB (NF-κB) pathway. Genomic and transcriptomic studies showed that the NF-κB pathway is deregulated in canine DLBCL. Our results showed that pevonedistat treatment significantly reduces the viability of canine DLBCL cells by inducing G1 cell cycle arrest and apoptosis. Pevonedistat treatment inhibits NF-κB pathway activation and downregulates NF-κB target genes in canine DLBCL. Moreover, administration of pevonedistat to mice bearing canine DLBCL xenograft tumours resulted in tumour regression. Our in vivo and in vitro studies provide justification for future clinical application of pevonedistat as a potential new anti-cancer therapy that may benefit both canine and human species.