[Clinical value of a rapid respiratory syncytial virus antigen detection in point-of-care testing]

Objective: To evaluate the clinical value of a rapid respiratory syncytial virus (RSV) antigen detection in point-of-care testing (POCT). Method: A total of 209 specimens, including 78 throat swabs (TS) and 131 nasopharyngeal aspirates (NPAs), were collected from inpatients who visited the Children's Hospital Affiliated to the Capital Institute of Pediatrics and were diagnosed as acute respiratory infection from 5 January to 7 February, 2015. These specimens were tested for RSV by a rapid antigen detection kit which was compared with reverse transcription polymerase chain reaction (RT-PCR) and direct immunofluorescence assay (DFA) for RSV detection. Result: Compared with DFA for NPAs, the sensitivity and specificity of rapid antigen detection were 83.9% and 97.3%, respectively, with Kappa value of 0.86; Compared with RT-PCR, the sensitivity (NPAs, 74.2%; TS, 77.8%) and specificity (NPAs, 100.0%; TS, 92.0%) of rapid antigen detection were high, too, with Kappa value of 0.74 in NPAs and 0.62 in TS. However, the RSV positive rate of rapid antigen detection in TS (21.7%) from pediatric patients with acute lower respiratory tract infection was lower than that in NPAs (78.3%), as well as that of RT-PCR (7.3% in TS verse 78% in NPAs). The RSV rapid antigen detection kit can be finished in about 10 minutes. Conclusion: With characteristics of high specificity, high sensitivity, being rapid, efficient and easy to operate in comparison with DFA and RT-PCR, RSV rapid antigen detection in this study is suitable for POCT. For pediatric patients with acute respiratory tract infection, NPA was better than TS for RSV detection.

Severe ovarian hyperstimulation syndrome in a naturally conceived singleton pregnancy after ovulation induction: a case report

OBJECTIVE

To present a case of severe ovarian hyperstimulation syndrome (OHSS) in a naturally conceived singleton pregnancy after ovulation induction.

CASE

A 31-year-old woman with polycystic ovarian syndrome (PCOS) underwent ovulation induction therapy. Six days later, she was admitted to the present hospital with the symptoms of OHSS. Ultrasonography confirmed the single live intrauterine pregnancy, as well as enlarged multicystic ovaries and marked ascites that required abdominal paracentesis. The woman was treated with intravenous infusion, exogenous colloid supplementation, essentiale liver treatment, rocephin anti-infective therapy for skin lymphangitis of left lower limb, and drainage of the ascites. She recovered by day 45 of admission.

CONCLUSION

Severe OHSS may develop in women with PCOS who undergo ovulation induction therapy. Serious complications may develop rapidly and therefore OHSS must be treated urgently and with multidisciplinary management.

Implication of Differential Peroxiredoxin 4 Expression with Age in Ovaries of Mouse and Human for Ovarian Aging

Ovarian aging has been associated with increased levels of reactive oxygen species and the deficiencies of antioxidant defense. The antioxidant peroxiredoxin 4 (Prdx4), as a member of Prdx protein family, controls cellular oxidative stress by reducing H2O2 levels. In previous studies, we provided evidence that Prdx4 was abundantly expressed in mouse and human ovaries and expression of Prdx4 in matured follicles was higher than that in immatured follicles. Accordingly, we speculated that Prdx4 expression could be associated with follicle development and it may be as a part of the antioxidative mechanism in follicular development. In this study, we demonstrated that Prdx4 was mainly expressed in the granulosa cells of mouse ovaries and the expression levels significantly increased along development of follicles. However, the expression levels of Prdx4 decreased when mice reached the aged stage (18 months old). Likewise a similar pattern that was observed in the mice study was also found in human ovaries where Prdx4 was expressed lower in premenopausal women than young women. Subsequent in vitro experiments indicated that Prdx4 mRNA and protein levels both increased with H2O2 in a concentrationdependent manner, but decreased rapidly with high concentration of H2O2, and the changes were closely related to cell proliferation. Taken together, these findings argue our understanding on the role of oxidative stress and antioxidant in follicular development and ovarian aging.

Ras-association domain family 10 acts as a novel tumor suppressor through modulating MMP2 in hepatocarcinoma

Ras-Association Domain Family 10 (RASSF10) is the last identified member of the RASSF family. The functional characteristics of this new gene in human cancers remain largely unclear. Here, we examined RASSF10 for the biological functions and related molecular mechanisms in hepatocellular carcinoma (HCC). We found that RASSF10 is expressed in normal human liver tissue, but is silenced or down-regulated in 62.5% (5/8) of HCC cell lines. The mean expression level of RASSF10 was significantly lower in primary HCCs compared with their adjacent normal tissues (P<0.005, n=52). The promoter methylation contributes to the inactivation of RASSF10 as demonstrated by bisulfite genomic sequencing and demethylation treatment analyses. Transgenic expression of RASSF10 in silenced HCC cell lines suppressed cell viability, colony formation and inhibited tumor growth in nude mice (QGY7703, P<0.01; HepG2, P<0.05). Furthermore, RASSF10 was shown to induce the cell accumulation in G1 phase with the increase of p27, as well as the decrease of cyclinD1 and CDK2/CDK4. Over-expression of RASSF10 also inhibited HCC cells migration (P<0.01) or invasion (P<0.05). Adhesion genes array revealed that Matrix Metalloproteinase 2 (MMP2) was a downstream effector of RASSF10. RASSF10 acting as a tumor suppressor to inhibit HCC invasion partially mediated by Focal Adhesion Kinase or p38 MAPK to decrease the accumulation of MMP2. Our study suggests that RASSF10 acts as a tumor suppressor for HCC.

[Gas chromatography for measurement of chlorpyrifos in serum]

OBJECTIVE

To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography, and to provide a basis for emergency treatment of poisoning in clinical practice.

METHODS

Venous blood (3.0 ml) was collected from patients. After coagulation, the blood samples were centrifuged at 4 000 r/min for 5 minutes, and 0.5 ml of serum was placed in a glass test tube with a cork; 4.0 ml of ethyl acetate was then added and mixed rapidly, and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes. The ethyl acetate layer was placed in a conical tube and extracted twice with the same method. The extract was mixed and blow-dried with nitrogen, and the residue was dissolved with 50.0 μl ethanol. Gas chromatography was used for measurement, with a sample size of 1 μl and a retention time of 9.609 minutes.

RESULTS

The linear range of this method was 0.2~20.0 μg/ml, and the regression equation was y=2 372.6x+357.2(r=0.999 6). The detection limit of chlorpyrifos in serum was 0.05 μg/ml, and the recovery rate was 84.6%~102.4%. The relative standard deviation was 3.6%~4.8%, and the intra-day and inter-day relative standard deviations were 3.62%~5.10% and 3.77%~4.98%, respectively.

CONCLUSION

This detection method is accurate, simple, and convenient, and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Abstract P6-11-01: Cost-effectiveness of pertuzumab in HER2+ metastatic breast cancer

Purpose

The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab (P) to docetaxel and trastuzumab (TH) as first-line treatment for patients with HER2 overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of the addition of pertuzumab to docetaxel and trastuzumab.

Patient and Methods

We developed a decision-analytic Markov model to evaluate the cost-effectiveness of TH with or without P in U.S. patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included: stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. One-way and multi-way deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions.

Results

Modeled median survival was 39.4 months (TH) and 56.9 months (THP). The addition of pertuzumab resulted in an additional 1.81 life years gained (0.62 QALYs) at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost-effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost-effectiveness at a willingness-to-pay of $100,000 per QALY gained.

Conclusion

The addition of pertuzumab to docetaxel and trastuzumab in patients with metastatic HER2+ breast cancer is unlikely to be cost-effective in the United States.

Citation Format: Qian Y, Durkee BY, Pollom EL, King M, Dudley SA, Shaffer JB, Chang DT, Gibbs IC, Goldhaber-Fiebert JD, Horst KC. Cost-effectiveness of pertuzumab in HER2+ metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-11-01.

Physician preferences for bone metastasis drug therapy in Canada

BACKGROUND

Currently in Canada, several bone-targeted agents (btas) with varying characteristics are available for the prevention of skeletal-related events (sres) in patients with bone metastasis secondary to solid tumours. In the present study, we evaluated the preferences of physicians in Canada for the various attributes of the available btas.

METHODS

Physicians treating patients with bone metastasis from solid tumours were invited to complete an online discrete-choice experiment. Respondents were asked to choose between pairs of hypothetical medications for virtual patients. Each hypothetical medication was described based on predefined key attributes: time until first sre, time until worsening of pain, medication-related annual risk of osteonecrosis of the jaw (onj), medication-related annual risk of renal impairment, and mode of administration. A random-parameters logit model was used to analyze the choices between hypothetical medications and thus infer physician preferences for medication attributes.

RESULTS

Responses from the 200 physicians who completed the discrete-choice experiment suggested that months until first sre, risk of renal impairment, and months until worsening of pain were considered the most important attributes affecting choice of bta. The annual risk of onj was considered the least important attribute.

CONCLUSIONS

When making treatment decisions about the choice of bta for patients with bone metastasis from solid tumours, delaying sres and worsening of pain, and reducing the risk of renal impairment are primary considerations for physicians in Canada.

Long-Acting Beta Agonists Enhance Allergic Airway Disease

Asthma is one of the most common of medical illnesses and is treated in part by drugs that activate the beta-2-adrenoceptor (β₂-AR) to dilate obstructed airways. Such drugs include long acting beta agonists (LABAs) that are paradoxically linked to excess asthma-related mortality. Here we show that LABAs such as salmeterol and structurally related β₂-AR drugs such as formoterol and carvedilol, but not short-acting agonists (SABAs) such as albuterol, promote exaggerated asthma-like allergic airway disease and enhanced airway constriction in mice. We demonstrate that salmeterol aberrantly promotes activation of the allergic disease-related transcription factor signal transducer and activator of transcription 6 (STAT6) in multiple mouse and human cells. A novel inhibitor of STAT6, PM-242H, inhibited initiation of allergic disease induced by airway fungal challenge, reversed established allergic airway disease in mice, and blocked salmeterol-dependent enhanced allergic airway disease. Thus, structurally related β₂-AR ligands aberrantly activate STAT6 and promote allergic airway disease. This untoward pharmacological property likely explains adverse outcomes observed with LABAs, which may be overcome by agents that antagonize STAT6.

Infusion of dendritic cells carrying donor lymphocytes treated with 8-methoxypsoralen and ultraviolet A light induces CD19+ IL-10+ regulatory B cells and promotes skin allograft survival

PUVA-SP DCs are immature dendritic cells (imDCs) that have taken up donor splenic lymphocytes treated with 8-methoxypsoralen and ultraviolet A light (PUVA-SPs). Phagocytosis of donor PUVA-SPs does not stimulate phenotype maturation of recipient imDCs, and infusion of PUVA-SP DCs can induce CD4(+)CD25(high)Foxp3(+) regulatory T cells (Treg). However, the regulatory effect of PUVA-SP DCs on B cells is poorly understood. In this study, we compared PUVA-SP DCs with imDCs in terms of lipopolysaccharide (LPS) responsiveness and flow cytometric analysis of interleukin (IL) 10 expression in splenic CD19(+)B cells. Our results demonstrate that PUVA-SP DCs can suppress subsequent LPS-induced DC maturation and that infusion of PUVA-SP DCs, in the absence of an immunosuppressant, significantly promotes skin allograft survival. This effect was associated with up-regulation of circulating regulatory B cells exhibiting preferential IL-10 secretion. Our results suggest that effective treatments involving infusion of PUVA-SP DCs is likely related to the modulation not only of T-cell and Treg functions but also of B-cell and regulatory B-cell (Breg) functions.

Glucose- and Triglyceride-lowering Dietary Penta-O-galloyl-α-D-Glucose Reduces Expression of PPARγ and C/EBPα, Induces p21-Mediated G1 Phase Cell Cycle Arrest, and Inhibits Adipogenesis in 3T3-L1 Preadipocytes

Plant polyphenols, such as hydrolysable tannins, are present in the human diet and known to exhibit anti-diabetic and anti-obesity activity. We previously reported that the representative hydrolysable tannin compound α-penta-galloyl-glucose (α-PGG) is a small molecule insulin mimetic that, like insulin, binds to insulin receptor (IR) and activates the IR-Akt-GLUT4 signaling pathway to trigger glucose transport and reduce blood glucose levels in db/db and ob/ob diabetic mice. However, its effects on adipogenesis and lipid metabolism were not known. In this study, high fat diet (HFD)-induced diabetic and obese mice were treated with α-PGG to determine its effects on blood glucose and triglycerides. 3T3-L1 preadipocytes were used as a cell model for identifying the anti-adipogenic activity of α-PGG at molecular and cellular levels as a first step in elucidating the mechanism of action of the compound. In vivo, oral administration of α-PGG significantly reduced levels of blood glucose, triglyceride, and insulin in HFD-induced diabetic/obese mice (P<0.05). In vitro, α-PGG inhibited the differentiation of 3T3-L1 preadipocytes into mature adipocytes. α-PGG suppressed the expression of positive adipogenic factors PPARγ C/EBPα and mTOR and augmented the negative adipogenic factor Pref-1. Furthermore, α-PGG induced upregulation of p21 and G1 phase cell cycle arrest. In contrast, adipogenic signaling pathways mediated by insulin, the cAMP response element binding protein (CREB) and glucocorticoid receptor (GR), were not inhibited. RNAi knockdown of p21 led to a 4-fold increase in triglyceride level in 3T3-L1 preadipocytes treated with MDI and α-PGG compared to regular preadipocytes. These results indicate, for the first time, that α-PGG is blood triglyceride- and glucose-lowering in HFD-induced obese and diabetic mice. It selectively inhibited some but not all major adipogenic pathways as well as the mTOR-p21-mediated cell cycle regulatory pathway. It is very likely that these apparently diverse but coordinated activities together inhibited adipogenesis. These results expand our knowledge on how PGG works in adipocytes and further confirm that α-PGG functions as an orally-deliverable natural insulin mimetic with adipogenetic modulatory functions.

DNA methylation profiles in placenta and its association with gestational diabetes mellitus

Emerging evidences indicate that placenta plays a critical role in gestational diabetes mellitus (GDM). DNA methylation could be associated with altered placental development and functions. This study is to uncover the genome-wide DNA methylation patterns in this disorder. DNA methylation was measured at >385,000 CpG sites using methylated DNA immunoprecipitation (MeDIP) and a huamn CpG island plus promoter microarray. We totally identified 6,641 differentially methylated regions (DMRs) targeting 3,320 genes, of which 2,729 DMRs targeting 1,399 genes, showed significant hypermethylation in GDM relative to the controls, whereas 3,912 DMRs targeting 1,970 genes showed significant hypomethylation. Functional analysis divided these genes into different functional networks, which mainly involved in the pathways of cell growth and death regulation, immune and inflammatory response and nervous system development. In addition, the methylation profiles and expressions of 4 loci (RBP4, GLUT3, Resistin and PPARα) were validated by BSP for their higher log2 ratio and potential functions with energy metabolism. This study demonstrates aberrant patterns of DNA methylation in GDM which may be involved in the pathophysiology of GDM and reflect the fetal development. Future work will assess the potential prognostic and therapeutic value for these findings in GDM.

MLK3 promotes melanoma proliferation and invasion and is a target of microRNA-125b

BACKGROUND

Metastatic melanoma is a disease with high mortality and limited therapeutic options. MicroRNAs (miRNAs) can be used to classify melanoma stage.

METHODS

Expression of the miRNA miR-125b and serine/threonine kinase mixed lineage kinase (MLK)3 was assessed in primary malignant melanoma tissues and several melanoma cell lines by quantitative reverse transcription PCR. The effect of MLK3 and miR-125b on cell proliferation was evaluated by MTS assay, and cell invasion was evaluated by Transwell invasion assays. Targeting of MLK3 by miR-125b was evaluated using luciferase reporter assay and western blotting.

RESULTS

We found significantly increased levels of MLK3 in metastatic primary malignant melanomas and melanoma cell lines, with levels being especially high in metastatic lines. To investigate the functional significance of MLK3, we used knockdown MLK3, which was found to suppress cell growth and invasion. Using bioinformatics, we identified MLK3 as one potential target of miR-125b. miRNA transfection and luciferase assay confirmed that MLK3 was regulated by miR-125b at both the transcriptional and translational levels. Cell proliferation and cell invasion was inhibited by overexpression of miR-125b.

CONCLUSIONS

MLK3 is upregulated in metastatic melanoma, and regulates cell proliferation and invasion in melanoma cells. MLK3 is a direct target of miR-125b.