Induction of Diabetes Abolishes the Antithrombotic Effect of Clopidogrel in Apolipoprotein E-Deficient Mice

Patients with acute coronary syndrome with diabetes mellitus (DM) exhibit an impaired platelet inhibitory response to clopidogrel which is only partially understood. DM was induced by the administration of streptozotocin (STZ) to 9-week-old mice. The antithrombotic effects of clopidogrel (10 mg/kg/d, orally × 5 days) were determined using a FeCl ₃ -induced thrombosis model employing wild-type (WT), apolipoprotein E (apoE)-deficient, and diabetic apoE-deficient mice at 21 weeks. Antiplatelet effects were determined using flow cytometry. The antithrombotic effects of clopidogrel were similar in WT and apoE-deficient mice but were attenuated in diabetic apoE-deficient mice with the percent inhibition of thrombus area (µm ² ) by clopidogrel being 85.5% (WT mice), 75.0% (apoE-deficient mice), and 1.9% (diabetic apoE-deficient mice). The time to first occlusion and lumen stenosis also reflected a significant loss of the antithrombotic effects of clopidogrel in diabetic apoE-deficient mice. Ex vivo platelet activation, which was assessed using ADP-induced expression of activated glycoprotein IIb/IIIa, was completely inhibited by clopidogrel in these three groups of mice. In contrast, the effect of clopidogrel on the ex vivo expression of platelet P-selectin induced by protease-activated receptor 4–activating peptide was diminished in diabetic apoE-deficient mice compared with that in WT and apoE-deficient mice. These data suggest that diabetic apoE-deficient mice may serve as a useful model to better understand the impaired responses to clopidogrel in patients with DM, which may partially reflect a reduction of the effect of clopidogrel on thrombin-induced platelet activation.

Abstract 2539: MiR-96-5p functions as an oncogenic miRNA by inhibiting apoptosis in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most aggressive cancers with high mortality worldwide. MicroRNAs (miRNAs) are small non-coding RNAs that have been used as cancer-related biomarkers and expected to be therapeutic agents. We performed genome-wide miRNA expression profiling of paired HCC tumors and non-tumorous liver tissues from patients with primary HCCs using the miRNA microarray (Agilent). We found that miR-96-5p was most significantly up-regulated in HCC tumors compared to non-tumor tissues. Although miR-96-5p is suggested to be an oncogenic miRNA, the function of miR-96-5p remains largely unknown. We identified the caspase-9 gene (CASP9) as a novel target of miR-96-5p, in addition to the forkhead box O1 gene (FOXO1) which is the known target of it. Caspase-9 protein is thought to play a central role in apoptosis and to be a tumor suppressor. Overexpression of miR-96-5p decreased caspase-9 protein expression and resulted in resistance to apoptosis induced by doxorubicin and UV in HCC cells. Our results suggested that miR-96-5p functions as an oncogenic miRNA by inhibiting apoptosis through decreasing caspase-9 expression in HCC.

Citation Format: Naoto Iwai, Kohichiroh Yasui, Akira Tomie, Kei Teasaki, Tomoko Kitaichi, Osamu Dohi, Yasuyuki Gen, Yoshito Ito. MiR-96-5p functions as an oncogenic miRNA by inhibiting apoptosis in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2539. doi:10.1158/1538-7445.AM2017-2539

Complete right- and left-sided thoracic ducts associated with aberrant left vertebral artery: unreported case with surgical implications

Anatomy is the keystone to an appropriate understanding of surgical and radiological sciences. Here the authors report on a rare case of complete right- and left-sided thoracic ducts (TDs) associated with aberrant left-vertebral artery (LVA) arising from the aortic arch. The TDs originated from right and left cisterna chyli and terminated separately close to the left venous angle. Superior to the aortic arch, the TDs showed different relationships to the LVA; the right TD was ventral, while the left was dorsal in position. This report is associated with other variations detailed below, and may have important implications in cervicothoracic surgery. (Folia Morphol 2018; 77, 1: 156-160).

Ethnic Difference in the Pharmacodynamics-efficacy Relationship of Dipeptidyl Peptidase-4 Inhibitors Between Japanese and non-Japanese Patients: A Systematic Review

A systematic review of the differences in the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors between Japanese and non-Japanese subjects was conducted. We searched for randomized controlled trials in patients with type 2 diabetes mellitus (T2DM) that studied the intervention of a DPP-4 inhibitor once-daily vs. placebo, as monotherapy or as add-on therapy. Data regarding placebo-corrected HbA1c reduction and trough DPP-4 inhibition rate after ≥12 weeks' treatment were extracted. In the 12 eligible studies, linear regression analysis revealed that the hemoglobin A1c (HbA1c) reduction at each DPP-4 inhibition level was larger in studies involving Japanese patients than in studies involving non-Japanese patients, with statistical significance between the two groups (P < 0.0001). Sensitivity analysis excluding studies of add-on therapies supported the robustness of the result. Our study indicated that DPP-4 inhibitors show greater efficacy in Japanese patients than in non-Japanese patients, which may be an important consideration in the global development strategy of new diabetic medications.

Low-risk papillary microcarcinoma of the thyroid: A review of active surveillance trials

Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.

Abstract P5-15-11: Eribulin should be a candidate strategy in combination with pertuzumab plus trastuzumab for taxane pretreated HER2 positive advance breast cancer

Background: Pertuzumab (P) improves clinical outcome when combined with docetaxel and trastuzumab (T). The efficacy of continuing multiple anti-HER2 therapy including P and/or T after initial progression is unclear. Eribulin mesylate (ERI) is able to overcome taxane (TAX) resistance advanced breast cancer (ABC). The objective of this study is to investigate the efficacy and safety of ERI plus P and T for both TAX and T pretreated HER2-positive ABC. Methods: This is a single institute, open-label, single-arm, Phase II study with pharmacokinetics (PK) of ERI (UMIN000012375). The initial dose of P is 840 mg, followed by 420 mg q3w; the initial dose of T 8 mg/kg, followed by 6 mg/kg q3w; ERI is administered at 1.4 mg on Days 1 and 8 of each cycle, q3w. Dose reductions of ERI (to 1.1 and 0.7 mg/m2) were permitted to manage any toxicity (more than grade 3). Patients (Pts) must have previous treatment with both TAX and T. The primary endpoint is assessed overall response rate (ORR). Secondary endpoints include progression-free survival (PFS), overall survival (OS), safety, and PK of ERI. Left ventricular ejection function (LVEF) was evaluated before and end of this study. Results: Thirty Pts were enrolled. Median age at baseline was 57 years. Half of Pts had endocrine positive. All Pts were treated with TAX and T. Twenty-one Pts were treated with anthracycline-based treatment (70%). Median number of previous chemotherapy was 4 (2-5). Pts had multiple metastases, 40% with bone, 36.7% with lung, 20% with liver, and 10% with brain. Pts received a median number of 8 cycles of ERI (mean dose 1.2 ± 0.19 mg/sqm), 8 cycles of both P and T. Total number of 27 Pts needed to reduce dose of ERI because of adverse events (AEs) especially grade 3 neutropenia. The ORR (CR+PR) was 34.8% (95% CI 16.4-57.3, n=23) with median PFS of 42.6 weeks (95% CI 20.3-51.9, n=30). Clinical benefit rate (CR+PR+≥6 month SD) was 60.9% (95% CI 16.4-57.3%). T-DM1 pretreated affected poor outcome than the other factors (p=0.0011). The most common grade 3/4 AEs were neutropenia in 20 Pts (66.7%) without febrile neutropenia. Grade 1/2 AEs were fatigue in 24 Pts (80%), anorexia in 23 Pts (76.7%), anemia in 22 Pts (73.3%), diarrhea in 20 Pts (66.7%), peripheral neuropathy in 16 Pts (53.3%), and hand-foot syndrome in 12 Pts (43.3%). Baseline LVEF was 67%. One Pt had asymptomatic LVEF decrease (below an absolute value of 55%). Otherwise, there was no overall decrease in mean LVEF from baseline. Nine points (pre-dose, end of infusion, 0.5, 1, 2, 4, 24, 72, and 168 h after ERI) of PK analyses were evaluated in 6 Pts, and 3 point (pre-dose, end of infusion, and 168 h after ERI) in 10 Pts. PK parameters of ERI were as follows; Maximum plasma concentration (Cmax) was 375.96 (257.6-531.8) ng/ml, terminal half-life was 36.807 (31.90-40.80) h, total clearance was 1.945 (1.15-3.15) L/h/m2. Cmax of ERI was not correlated with neutrophil count (R2=0.2338, n=16). Conclusions: The combination of ERI plus P and T was well tolerated; no new safety signals ware observed. PK parameter of ERI were as same as previous reports when combined with both P and T. ERI might be a one of strategy in combination with P plus T for TAX pretreated HER2 positive ABC.

Citation Format: Araki K, Fukada I, Kobayashi K, Takahashi S, Ito Y. Eribulin should be a candidate strategy in combination with pertuzumab plus trastuzumab for taxane pretreated HER2 positive advance breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-15-11.

Abstract P4-21-14: A randomized phase II trial of trastuzumab + capecitabine versus lapatinib + capecitabine in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and taxanes: WJOG6110B/ELTOP

Background: In patients with HER2-positive metastatic breast cancer (MBC) who progressed on trastuzumab (H)-based therapy, both continuing H beyond progression and switching to lapatinib (L) in combination with chemotherapy are valid options. However, it is unclear which strategy is more effective and how we can select a proper strategy in each patient.

Methods: We conducted an open label, multicenter, randomized phase II trial to comparatively evaluate efficacy and safety of H + capecitabine (X) (HX) or L + X (LX) in women with HER2-positive MBC who were previously treated with taxanes and progressed on H-containing regimens. Patients treated with more than two chemotherapy regimens for MBC were excluded. Those treated with pertuzumab and/or T-DM1 were allowed to enroll in this study. Patients with brain metastases were also included if they are asymptomatic. Patients received H (4mg/kg loading then 2mg/kg weekly or 8mg/kg loading then 6mg/kg every 3 weeks) and X (2500 mg/m2/day on days 1-14 every 3weeks) in HX arm and L (1250 mg/day) and X (2000 mg/m2/day on days 1-14 every 3weeks) in LX arm until progression or intolerable toxicity. The primary endpoint was progression-free survival (PFS) and secondary endpoints included overall survival (OS), objective response rate (ORR), proportion of subjects progressing with brain metastases as site of first progression, and safety.We also assessed biomarkers in tumor tissues and circulating cell-free DNA.

Results: Between May 2011 and December 2014, 86 patients (43 in HX arm and 43 in LX arm) were enrolled in this study. Median age was 58 years (range 34-81), ECOG performance status was 0 (63%), 1 (35%), or 2 (2%), 63% had hormone receptor-positive disease, 15% had brain metastases, 56% had relapsed after primary surgery, and 23% had received adjuvant or neo-adjuvant trastuzumab. Median follow-up time was 44.6 months. Median PFS was 6.1 months in HX arm and 7.1 months in LX arm (hazard ratio 0.81 90% CI 0.55-1.21; p=0.39), median OS was 31.0 months in HX arm and not reached in LX arm (hazard ratio 0.58 95% CI 0.26-1.31; p=0.18), ORR was 40% in HX arm and 41% in LX arm (p=1.00), disease control rate was 73% in HX arm and 92% in LX arm (p=0.038), and proportion of subjects progressing with brain metastases as site of first progression was 5% in HX arm and 5% in LX arm. Grade 3-4 toxicities included hand-foot syndrome (21% in HX arm and 21% in LX arm) and diarrhea (9% in HX arm and 16% in LX arm). In subgroup analyses, PFS benefit in LX arm compared to HX arm was significantly larger among patients who had received previous systemic treatment for metastatic disease for less than 1 year (interaction p=0.007). Subgroup analyses by biomarkers will be presented at the meeting.

Conclusions: In women with HER2-positive MBC previously treated with trastuzumab and taxanes, lapatinib + capecitabine tended to yield better PFS and OS than trastuzumab beyond progression + capecitabine, although they were not statistically significant.Background: In patients with HER2-positive metastatic breast cancer (MBC) who progressed on trastuzumab (H)-based therapy, both continuing H beyond progression and switching to lapatinib (L) in combination with chemotherapy are valid options. However, it is unclear which strategy is more effective and how we can select a proper strategy in each patient.

Methods: We conducted an open label, multicenter, randomized phase II trial to comparatively evaluate efficacy and safety of H + capecitabine (X) (HX) or L + X (LX) in women with HER2-positive MBC who were previously treated with taxanes and progressed on H-containing regimens. Patients treated with more than two chemotherapy regimens for MBC were excluded. Those treated with pertuzumab and/or T-DM1 were allowed to enroll in this study. Patients with brain metastases were also included if they are asymptomatic. Patients received H (4mg/kg loading then 2mg/kg weekly or 8mg/kg loading then 6mg/kg every 3 weeks) and X (2500 mg/m2/day on days 1-14 every 3weeks) in HX arm and L (1250 mg/day) and X (2000 mg/m2/day on days 1-14 every 3weeks) in LX arm until progression or intolerable toxicity. The primary endpoint was progression-free survival (PFS) and secondary endpoints included overall survival (OS), objective response rate (ORR), proportion of subjects progressing with brain metastases as site of first progression, and safety.We also assessed biomarkers in tumor tissues and circulating cell-free DNA.

Results: Between May 2011 and December 2014, 86 patients (43 in HX arm and 43 in LX arm) were enrolled in this study. Median age was 58 years (range 34-81), ECOG performance status was 0 (63%), 1 (35%), or 2 (2%), 63% had hormone receptor-positive disease, 15% had brain metastases, 56% had relapsed after primary surgery, and 23% had received adjuvant or neo-adjuvant trastuzumab. Median follow-up time was 44.6 months. Median PFS was 6.1 months in HX arm and 7.1 months in LX arm (hazard ratio 0.81 90% CI 0.55-1.21; p=0.39), median OS was 31.0 months in HX arm and not reached in LX arm (hazard ratio 0.58 95% CI 0.26-1.31; p=0.18), ORR was 40% in HX arm and 41% in LX arm (p=1.00), disease control rate was 73% in HX arm and 92% in LX arm (p=0.038), and proportion of subjects progressing with brain metastases as site of first progression was 5% in HX arm and 5% in LX arm. Grade 3-4 toxicities included hand-foot syndrome (21% in HX arm and 21% in LX arm) and diarrhea (9% in HX arm and 16% in LX arm). In subgroup analyses, PFS benefit in LX arm compared to HX arm was significantly larger among patients who had received previous systemic treatment for metastatic disease for less than 1 year (interaction p=0.007). Subgroup analyses by biomarkers will be presented at the meeting.

Conclusions: In women with HER2-positive MBC previously treated with trastuzumab and taxanes, lapatinib + capecitabine tended to yield better PFS and OS than trastuzumab beyond progression + capecitabine, although they were not statistically significant.

Citation Format: Takano T, Tsurutani J, Takahashi M, Yamanaka T, Sakai K, Ito Y, Fukuoka J, Kimura H, Kawabata H, Tamura K, Matsumoto K, Aogi K, Sato K, Nishio K, Nakagawa K, Saeki T. A randomized phase II trial of trastuzumab + capecitabine versus lapatinib + capecitabine in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and taxanes: WJOG6110B/ELTOP [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-14.

Abstract P2-05-24: Prognostic value of circulating PIK3CA mutations revealed with digital PCR in patients with HER2-positive advanced breast cancer: Results of West Japan Oncology Group study 6110BTR

This abstract was withdrawn by the authors.

Charge transfer to ground-state ions produces free electrons

Inner-shell ionization of an isolated atom typically leads to Auger decay. In an environment, for example, a liquid or a van der Waals bonded system, this process will be modified, and becomes part of a complex cascade of relaxation steps. Understanding these steps is important, as they determine the production of slow electrons and singly charged radicals, the most abundant products in radiation chemistry. In this communication, we present experimental evidence for a so-far unobserved, but potentially very important step in such relaxation cascades: Multiply charged ionic states after Auger decay may partially be neutralized by electron transfer, simultaneously evoking the creation of a low-energy free electron (electron transfer-mediated decay). This process is effective even after Auger decay into the dicationic ground state. In our experiment, we observe the decay of Ne²⁺ produced after Ne 1s photoionization in Ne-Kr mixed clusters.

RUNX3 is oncogenic in natural killer/T-cell lymphoma and is transcriptionally regulated by MYC

RUNX3, runt-domain transcription factor, is a master regulator of gene expression in major developmental pathways. It acts as a tumor suppressor in many cancers but is oncogenic in certain tumors. We observed upregulation of RUNX3 mRNA and protein expression in nasal-type extranodal natural killer (NK)/T-cell lymphoma (NKTL) patient samples and NKTL cell lines compared to normal NK cells. RUNX3 silenced NKTL cells showed increased apoptosis and reduced cell proliferation. Potential binding sites for MYC were identified in the RUNX3 enhancer region. Chromatin immunoprecipitation-quantitative PCR revealed binding activity between MYC and RUNX3. Co-transfection of the MYC expression vector with RUNX3 enhancer reporter plasmid resulted in activation of RUNX3 enhancer indicating that MYC positively regulates RUNX3 transcription in NKTL cell lines. Treatment with a small-molecule MYC inhibitor (JQ1) caused significant downregulation of MYC and RUNX3, leading to apoptosis in NKTL cells. The growth inhibition resulting from depletion of MYC by JQ1 was rescued by ectopic MYC expression. In summary, our study identified RUNX3 overexpression in NKTL with functional oncogenic properties. We further delineate that MYC may be an important upstream driver of RUNX3 upregulation and since MYC is upregulated in NKTL, further study on the employment of MYC inhibition as a therapeutic strategy is warranted.