Risk of acute coronary events associated with glyburide compared with gliclazide use in patients with type 2 diabetes: a nested case-control study

AIM

Sulfonylureas might increase the risk of adverse cardiovascular events; however, emerging evidence suggests there may be important differences amongst these drugs. Some, like glyburide, inhibit KATP channels in the heart and pancreas, while others, like gliclazide, are more likely to selectively inhibit KATP channels in the pancreas. We hypothesized that the risk of acute coronary syndrome (ACS) events would be higher in patients using glyburide compared with gliclazide.

METHODS

This nested case-control study used administrative health data from Alberta, Canada. New users of glyburide or gliclazide aged ≥66 years between 1998 and 2010 were included. Cases were individuals with an ACS-related hospitalization or death. Up to four controls were matched based on birth year, sex, cohort-entry year and follow-up time. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (OR), controlling for baseline drug use and co-morbidities.

RESULTS

Our cohort included 7441 gliclazide and 13 884 glyburide users; 51.4% men, mean (s.d.) age 75.5 (6.6) years and mean (s.d.) duration of follow-up 5.5 (4.0) years. A total of 4239 patients had an ACS-related hospitalization or death and were matched to 16 723 controls. Compared with gliclazide use, glyburide use was associated with a higher risk (adjusted OR 1.14; 95% CI 1.06-1.23) of ACS-related hospitalization or death over 5.5 years (number needed to harm: 50).

CONCLUSION

In this observational study, glyburide use was associated with a 14% higher risk of ACS events compared with gliclazide use. Although the difference is small and probably to have implications at the population level rather than the individual patient or clinician, any causal inferences regarding sulfonylurea use and adverse cardiovascular risk should be tested in a large-scale randomized controlled trial.

Three-dimensional segmentation of three-dimensional ultrasound carotid atherosclerosis using sparse field level sets

PURPOSE

Three-dimensional ultrasound (3DUS) vessel wall volume (VWV) provides a 3D measurement of carotid artery wall remodeling and atherosclerotic plaque and is sensitive to temporal changes of carotid plaque burden. Unfortunately, although 3DUS VWV provides many advantages compared to measurements of arterial wall thickening or plaque alone, it is still not widely used in research or clinical practice because of the inordinate amount of time required to train observers and to generate 3DUS VWV measurements. In this regard, semiautomated methods for segmentation of the carotid media-adventitia boundary (MAB) and the lumen-intima boundary (LIB) would greatly improve the time to train observers and for them to generate 3DUS VWV measurements with high reproducibility.

METHODS

The authors describe a 3D algorithm based on a modified sparse field level set method for segmenting the MAB and LIB of the common carotid artery (CCA) from 3DUS images. To the authors' knowledge, the proposed algorithm is the first direct 3D segmentation method, which has been validated for segmenting both the carotid MAB and the LIB from 3DUS images for the purpose of computing VWV. Initialization of the algorithm requires the observer to choose anchor points on each boundary on a set of transverse slices with a user-specified interslice distance (ISD), in which larger ISD requires fewer user interactions than smaller ISD. To address the challenges of the MAB and LIB segmentations from 3DUS images, the authors integrated regional- and boundary-based image statistics, expert initializations, and anatomically motivated boundary separation into the segmentation. The MAB is segmented by incorporating local region-based image information, image gradients, and the anchor points provided by the observer. Moreover, a local smoothness term is utilized to maintain the smooth surface of the MAB. The LIB is segmented by constraining its evolution using the already segmented surface of the MAB, in addition to the global region-based information and the anchor points. The algorithm-generated surfaces were sliced and evaluated with respect to manual segmentations on a slice-by-slice basis using 21 3DUS images.

RESULTS

The authors used ISD of 1, 2, 3, 4, and 10 mm for algorithm initialization to generate segmentation results. The algorithm-generated accuracy and intraobserver variability results are comparable to the previous methods, but with fewer user interactions. For example, for the ISD of 3 mm, the algorithm yielded an average Dice coefficient of 94.4% ± 2.2% and 90.6% ± 5.0% for the MAB and LIB and the coefficient of variation of 6.8% for computing the VWV of the CCA, while requiring only 1.72 min (vs 8.3 min for manual segmentation) for a 3DUS image.

CONCLUSIONS

The proposed 3D semiautomated segmentation algorithm yielded high-accuracy and high-repeatability, while reducing the expert interaction required for initializing the algorithm than the previous 2D methods.

Vitamin D related genes in lung development and asthma pathogenesis

Background

Poor maternal vitamin D intake is a risk factor for subsequent childhood asthma, suggesting that in utero changes related to vitamin D responsive genes might play a crucial role in later disease susceptibility. We hypothesized that vitamin D pathway genes are developmentally active in the fetal lung and that these developmental genes would be associated with asthma susceptibility and regulation in asthma.

Methods

Vitamin D pathway genes were derived from PubMed and Gene Ontology surveys. Principal component analysis was used to identify characteristic lung development genes.

Results

Vitamin D regulated genes were markedly over-represented in normal human (odds ratio OR 2.15, 95% confidence interval CI: 1.69-2.74) and mouse (OR 2.68, 95% CI: 2.12-3.39) developing lung transcriptomes. 38 vitamin D pathway genes were in both developing lung transcriptomes with >63% of genes more highly expressed in the later than earlier stages of development. In immortalized B-cells derived from 95 asthmatics and their unaffected siblings, 12 of the 38 (31.6%) vitamin D pathway lung development genes were significantly differentially expressed (OR 3.00, 95% CI: 1.43-6.21), whereas 11 (29%) genes were significantly differentially expressed in 43 control versus vitamin D treated immortalized B-cells from Childhood Asthma Management Program subjects (OR 2.62, 95% CI: 1.22-5.50). 4 genes, LAMP3, PIP5K1B, SCARB2 and TXNIP were identified in both groups; each displays significant biologic plausibility for a role in asthma.

Conclusions

Our findings demonstrate a significant association between early lung development and asthma–related phenotypes for vitamin D pathway genes, supporting a genomic mechanistic basis for the epidemiologic observations relating maternal vitamin D intake and childhood asthma susceptibility.

Gender comparisons in cardiogenic shock during ST elevation myocardial infarction treated by primary percutaneous coronary intervention

Among patients hospitalized with acute myocardial infarction (AMI), cardiogenic shock (CS) is the leading cause of death, complicating up to 10% of admissions. Introduction of early revascularization strategies and mechanical ventricular support have seen short-term mortality associated with CS fall from 70% to 80% in the 1970s to approximately 50% to 60% in the 1990s. Previous studies reported a higher incidence of CS after AMI in women (11.6% vs 8.3%). The aims of this study were to determine hospital mortality outcomes and gender differences following primary percutaneous coronary intervention (PPCI) in the setting of CS. Data were collected prospectively among all patients undergoing PPCI for AMI at a large UK tertiary cardiac center between April 2008 and October 2011. A sample of 2,864 patients (women: 844 [29.5%]) underwent PPCI, of which 141 (4.9%) had a confirmed diagnosis of CS. Eighty-one of 2,019 [4.0%] male patients (mean age: 64.2 years) and 60 of 844 [7.1%]) female patients (mean age: 69.9 years) with CS underwent PPCI (p <0.001). The overall hospital mortality was 35.5% with no gender difference (male: 35.8% vs female: 35%, p >0.99). In conclusion, this analysis demonstrates that in the contemporary PPCI era, there is a reduction in the incidence of CS with reduced hospital mortality rates and no gender difference. The absence of a gender difference is remarkable because higher proportions of women presented with CS and were older than their male counterparts. Long-term follow-up data are required to determine if this difference is sustained.

ITGB5 and AGFG1 variants are associated with severity of airway responsiveness

BACKGROUND

Airway hyperresponsiveness (AHR), a primary characteristic of asthma, involves increased airway smooth muscle contractility in response to certain exposures. We sought to determine whether common genetic variants were associated with AHR severity.

METHODS

A genome-wide association study (GWAS) of AHR, quantified as the natural log of the dosage of methacholine causing a 20% drop in FEV1, was performed with 994 non-Hispanic white asthmatic subjects from three drug clinical trials: CAMP, CARE, and ACRN. Genotyping was performed on Affymetrix 6.0 arrays, and imputed data based on HapMap Phase 2, was used to measure the association of SNPs with AHR using a linear regression model. Replication of primary findings was attempted in 650 white subjects from DAG, and 3,354 white subjects from LHS. Evidence that the top SNPs were eQTL of their respective genes was sought using expression data available for 419 white CAMP subjects.

RESULTS

The top primary GWAS associations were in rs848788 (P-value 7.2E-07) and rs6731443 (P-value 2.5E-06), located within the ITGB5 and AGFG1 genes, respectively. The AGFG1 result replicated at a nominally significant level in one independent population (LHS P-value 0.012), and the SNP had a nominally significant unadjusted P-value (0.0067) for being an eQTL of AGFG1.

CONCLUSIONS

Based on current knowledge of ITGB5 and AGFG1, our results suggest that variants within these genes may be involved in modulating AHR. Future functional studies are required to confirm that our associations represent true biologically significant findings.

Observation of the three-state dressed states in circuit quantum electrodynamics

We have investigated the microwave response of a transmon qubit coupled directly to a transmission line. In a transmon qubit, owing to its weak anharmonicity, a single driving field may generate dressed states involving more than two bare states. We confirmed the formation of three-state dressed states by observing all of the six associated Rabi sidebands, which appear as either amplification or attenuation of the probe field. The experimental results are reproduced with good precision by a theoretical model incorporating the radiative coupling between the qubit and the microwave.

Gene expression analysis uncovers novel hedgehog interacting protein (HHIP) effects in human bronchial epithelial cells

Hedgehog interacting protein (HHIP) was implicated in chronic obstructive pulmonary disease (COPD) by genome-wide association studies (GWAS). However, it remains unclear how HHIP contributes to COPD pathogenesis. To identify genes regulated by HHIP, we performed gene expression microarray analysis in a human bronchial epithelial cell line (Beas-2B) stably infected with HHIP shRNAs. HHIP silencing led to differential expression of 296 genes; enrichment for variants nominally associated with COPD was found. Eighteen of the differentially expressed genes were validated by real-time PCR in Beas-2B cells. Seven of 11 validated genes tested in human COPD and control lung tissues demonstrated significant gene expression differences. Functional annotation indicated enrichment for extracellular matrix and cell growth genes. Network modeling demonstrated that the extracellular matrix and cell proliferation genes influenced by HHIP tended to be interconnected. Thus, we identified potential HHIP targets in human bronchial epithelial cells that may contribute to COPD pathogenesis.

ADAR1 is essential for intestinal homeostasis and stem cell maintenance

Adenosine deaminase acting on RNA 1 (ADAR1) is a double-stranded RNA-editing enzyme that converts adenosine (A) to inosine (I), and essential for normal development. In this study, we reported an essential role of ADAR1 in the survival and maintenance of intestinal stem cells and intestinal homoeostasis by suppressing endoplasmic reticulum (ER) stress and interferon (IFN) signaling. ADAR1 was highly expressed in the Lgr5+ cells, and its deletion in adult mice led to a rapid apoptosis and loss of these actively cycling stem cells in the small intestine and colon. ADAR1 deletion resulted in a drastic expansion of progenitors and Paneth cells but a reduction of three other major epithelial lineages. Moreover, loss of ADAR1 induced ER stress and activation of IFN signaling, and altered expression in WNT targets, followed by intestinal inflammation. An ER stress inhibitor partially suppressed crypt apoptosis. Finally, data from cultured intestinal crypts demonstrated that loss of ADAR1 in the epithelial cells is the primary cause of these effects. These results support an essential role of ADAR1 and RNA editing in tissue homeostasis and stem cells.

Risk scores in acute coronary syndrome and percutaneous coronary intervention: a review

Patients with acute coronary syndrome (ACS) need to be risk stratified to deliver the most appropriate therapy. The GRACE and TIMI risk scores have penetrated contemporary guidelines with the former most commonly used in clinical practice. However, ACS prediction models need to be re-evaluated in contemporary practice with evolving diagnostic and treatment options. Moreover, the increased availability of percutaneous coronary intervention (PCI) as a treatment option for ACS combined with an expanding case mix and emphasis on quality control have triggered the creation of PCI specific prognostic models. These allow clinicians and patients to have an understanding of expected outcomes following PCI by predicting outcomes in-hospital to 5 years following intervention. The aim of this review is to evaluate the most recognized and studied ACS/PCI risk models, focusing on their strengths and limitations, and to assess the need for more robust tools to predict outcomes in a period of constantly advancing technologies and changing patient demographics.

Assessing discrimination of risk prediction rules in a clustered data setting

The AUC (area under ROC curve) is a commonly used metric to assess discrimination of risk prediction rules; however, standard errors of AUC are usually based on the Mann-Whitney U test that assumes independence of sampling units. For ophthalmologic applications, it is desirable to assess risk prediction rules based on eye-specific outcome variables which are generally highly, but not perfectly correlated in fellow eyes [e.g. progression of individual eyes to age-related macular degeneration (AMD)]. In this article, we use the extended Mann-Whitney U test (Rosner and Glynn, Biometrics 65:188-197, 2009) for the case where subunits within a cluster may have different progression status and assess discrimination of different prediction rules in this setting. Both data analyses based on progression of AMD and simulation studies show reasonable accuracy of this extended Mann-Whitney U test to assess discrimination of eye-specific risk prediction rules.

Motor neuron degeneration in a mouse model of seipinopathy

Heterozygosity for missense mutations (N88S/S90L) in BSCL2 (Berardinelli–Seip congenital lipodystrophy type 2)/Seipin is associated with a broad spectrum of motoneuron diseases. To understand the underlying mechanisms how the mutations lead to motor neuropathy, we generated transgenic mice with neuron-specific expression of wild-type (tgWT) or N88S/S90L mutant (tgMT) human Seipin. Transgenes led to the broad expression of WT or mutant Seipin in the brain and spinal cord. TgMT, but not tgWT, mice exhibited late-onset altered locomotor activities and gait abnormalities that recapitulate symptoms of seipinopathy patients. We found loss of alpha motor neurons in tgMT spinal cord. Mild endoreticular stress was present in both tgMT and tgWT neurons; however, only tgMT mice exhibited protein aggregates and disrupted Golgi apparatus. Furthermore, autophagosomes were significantly increased, along with elevated light chain 3 (LC3)-II level in tgMT spinal cord, consistent with the activation of autophagy pathway in response to mutant Seipin expression and protein aggregation. These results suggest that induction of autophagy pathway is involved in the cellular response to mutant Seipin in seipinopathy and that motoneuron loss is a key pathogenic process underlying the development of locomotor abnormalities.

Evaluating iterative algebraic algorithms in terms of convergence and image quality for cone beam CT

Cone beam computed tomography (CBCT) enables a volumetric image reconstruction from a set of 2D projection data. It plays an important role in image guided radiation therapy (IGRT). However, it is desirable to lower the patient radiation dose while maintaining good quality tomographic reconstructions. Hence, methods are needed even when the data is undersampled or there are limited projections. Iterative algorithms such as ART, SART and OS-SART are known to perform well under such circumstances. The performance of ART, SART and OS-SART is here studied based on a range of norm measurements (RMS reconstruction error, RMS projection error, and the L1 norm and L2 norm of the image error). Image quality measurements for uniformity and noise are also introduced. Since image quality often degrades as iterative algorithms converge, a simple function is used to trade off convergence with image quality. Investigations are performed using simulated and experimental data.

Characterization of the major histocompatibility complex class I A alleles in cynomolgus macaques of Vietnamese origin

Cynomolgus macaques (Macaca fascicularis, Mafa) have emerged as an important animal model for infectious disease and transplantation research. Extensive characterization of their major histocompatibility complex (MHC) polymorphism regions therefore becomes urgently required. In this study, we identified 41 MHC class I A nucleotide sequences in 34 unrelated cynomolgus macaques of Vietnamese origin farmed in Southern China, including eight novel Mafa-A sequences. We found two sequences with perfect identity and six sequences with close similarity to previously defined MHC class I alleles from other populations, especially from Indonesian-origin macaques. We also found three Vietnamese-origin cynomolgus macaque MHC class I sequences for which the predicted protein sequences identical throughout their B and F binding pockets to Mamu-A1*001:01 and Mamu-A3*13:03, respectively. This is important because Mamu-A1*001:01 and Mamu-A3*13:03 are associated with longer survival and lower set-point viral load in simian immunodeficiency virus (SIV)-infected rhesus monkeys. These findings have implications for the evolutionary history of Vietnamese-origin cynomolgus macaque as well as for the use of this model in SIV/SHIV (a virus combining parts of the HIV and SIV genomes) research.

Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians

Previous studies have associated higher milk intake with greater prostate cancer (PCa) incidence, but little data are available concerning milk types and the relation between milk intake and risk of fatal PCa. We investigated the association between intake of dairy products and the incidence and survival of PCa during a 28-y follow-up. We conducted a cohort study in the Physicians' Health Study (n = 21,660) and a survival analysis among the incident PCa cases (n = 2806). Information on dairy product consumption was collected at baseline. PCa cases and deaths (n = 305) were confirmed during follow-up. The intake of total dairy products was associated with increased PCa incidence [HR = 1.12 (95% CI: 0.93, 1.35); >2.5 servings/d vs. ≤0.5 servings/d]. Skim/low-fat milk intake was positively associated with risk of low-grade, early stage, and screen-detected cancers, whereas whole milk intake was associated only with fatal PCa [HR = 1.49 (95% CI: 0.97, 2.28); ≥237 mL/d (1 serving/d) vs. rarely consumed]. In the survival analysis, whole milk intake remained associated with risk of progression to fatal disease after diagnosis [HR = 2.17 (95% CI: 1.34, 3.51)]. In this prospective cohort, higher intake of skim/low-fat milk was associated with a greater risk of nonaggressive PCa. Most importantly, only whole milk was consistently associated with higher incidence of fatal PCa in the entire cohort and higher PCa-specific mortality among cases. These findings add further evidence to suggest the potential role of dairy products in the development and prognosis of PCa.

Systemic steroid exposure is associated with differential methylation in chronic obstructive pulmonary disease

RATIONALE

Systemic glucocorticoids are used therapeutically to treat a variety of medical conditions. Epigenetic processes such as DNA methylation may reflect exposure to glucocorticoids and may be involved in mediating the responses and side effects associated with these medications.

OBJECTIVES

To test the hypothesis that differences in DNA methylation are associated with current systemic steroid use.

METHODS

We obtained DNA methylation data at 27,578 CpG sites in 14,475 genes throughout the genome in two large, independent cohorts: the International COPD Genetics Network (n(discovery) = 1,085) and the Boston Early Onset COPD study (n(replication) = 369). Sites were tested for association with current systemic steroid use using generalized linear mixed models.

MEASUREMENTS AND MAIN RESULTS

A total of 511 sites demonstrated significant differential methylation by systemic corticosteroid use in all three of our primary models. Pyrosequencing validation confirmed robust differential methylation at CpG sites annotated to genes such as SLC22A18, LRP3, HIPK3, SCNN1A, FXYD1, IRF7, AZU1, SIT1, GPR97, ABHD16B, and RABGEF1. Functional annotation clustering demonstrated significant enrichment in intrinsic membrane components, hemostasis and coagulation, cellular ion homeostasis, leukocyte and lymphocyte activation and chemotaxis, protein transport, and responses to nutrients.

CONCLUSIONS

Our analyses suggest that systemic steroid use is associated with site-specific differential methylation throughout the genome. Differentially methylated CpG sites were found in biologically plausible and previously unsuspected pathways; these genes and pathways may be relevant in the development of novel targeted therapies.

Genome-wide association analysis of blood biomarkers in chronic obstructive pulmonary disease

RATIONALE

A genome-wide association study (GWAS) for circulating chronic obstructive pulmonary disease (COPD) biomarkers could identify genetic determinants of biomarker levels and COPD susceptibility.

OBJECTIVES

To identify genetic variants of circulating protein biomarkers and novel genetic determinants of COPD.

METHODS

GWAS was performed for two pneumoproteins, Clara cell secretory protein (CC16) and surfactant protein D (SP-D), and five systemic inflammatory markers (C-reactive protein, fibrinogen, IL-6, IL-8, and tumor necrosis factor-α) in 1,951 subjects with COPD. For genome-wide significant single nucleotide polymorphisms (SNPs) (P < 1 × 10(-8)), association with COPD susceptibility was tested in 2,939 cases with COPD and 1,380 smoking control subjects. The association of candidate SNPs with mRNA expression in induced sputum was also elucidated.

MEASUREMENTS AND MAIN RESULTS

Genome-wide significant susceptibility loci affecting biomarker levels were found only for the two pneumoproteins. Two discrete loci affecting CC16, one region near the CC16 coding gene (SCGB1A1) on chromosome 11 and another locus approximately 25 Mb away from SCGB1A1, were identified, whereas multiple SNPs on chromosomes 6 and 16, in addition to SNPs near SFTPD, had genome-wide significant associations with SP-D levels. Several SNPs affecting circulating CC16 levels were significantly associated with sputum mRNA expression of SCGB1A1 (P = 0.009-0.03). Several SNPs highly associated with CC16 or SP-D levels were nominally associated with COPD in a collaborative GWAS (P = 0.001-0.049), although these COPD associations were not replicated in two additional cohorts.

CONCLUSIONS

Distant genetic loci and biomarker-coding genes affect circulating levels of COPD-related pneumoproteins. A subset of these protein quantitative trait loci may influence their gene expression in the lung and/or COPD susceptibility. Clinical trial registered with www.clinicaltrials.gov (NCT 00292552).

Blockwise conjugate gradient methods for image reconstruction in volumetric CT

Cone beam computed tomography (CBCT) enables volumetric image reconstruction from 2D projection data and plays an important role in image guided radiation therapy (IGRT). Filtered back projection is still the most frequently used algorithm in applications. The algorithm discretizes the scanning process (forward projection) into a system of linear equations, which must then be solved to recover images from measured projection data. The conjugate gradients (CG) algorithm and its variants can be used to solve (possibly regularized) linear systems of equations Ax=b and linear least squares problems minx∥b-Ax∥2, especially when the matrix A is very large and sparse. Their applications can be found in a general CT context, but in tomography problems (e.g. CBCT reconstruction) they have not widely been used. Hence, CBCT reconstruction using the CG-type algorithm LSQR was implemented and studied in this paper. In CBCT reconstruction, the main computational challenge is that the matrix A usually is very large, and storing it in full requires an amount of memory well beyond the reach of commodity computers. Because of these memory capacity constraints, only a small fraction of the weighting matrix A is typically used, leading to a poor reconstruction. In this paper, to overcome this difficulty, the matrix A is partitioned and stored blockwise, and blockwise matrix-vector multiplications are implemented within LSQR. This implementation allows us to use the full weighting matrix A for CBCT reconstruction without further enhancing computer standards. Tikhonov regularization can also be implemented in this fashion, and can produce significant improvement in the reconstructed images.

Maternal allergen exposure reprograms the developmental lung transcriptome in atopic and normoresponsive rat pups

The "fetal origins hypothesis" argued that physiological changes consequent to in utero exposures ultimately contribute to disease susceptibility in later life. The dramatic increase in asthma prevalence is attributed to early exposures acting on preexisting asthma-susceptible genotypes. We showed previously that distinct transcriptome signatures distinguish the developmental respiratory phenotype of atopic (Brown Norway, BN) and normoresponsive (Lewis) rats. We aimed to determine whether maternal allergen exposure would influence asthma pathogenesis by reprogramming primary patterns of developmental lung gene expression. Postnatal offspring of dams sensitized to ovalbumin before mating and challenged during pregnancy were assessed for lung function, inflammatory biomarkers, and respiratory gene expression. Although maternal ovalbumin exposure resulted in characteristic features of an allergic response (bronchoalveolar lavage neutrophils, IgE, methacholine-induced lung resistance) in offspring of both strains, substantial strain-specific differences were observed in respiratory gene expression. Of 799 probes representing the top 5% of transcriptomic variation, only 112 (14%) were affected in both strains. Strain-specific gene signatures also exhibited marked differences in enrichment for gene ontologies, with immune regulation and cell proliferation being prominent in the BN strain, cell cycle and microtubule assembly gene sets in the Lewis strain. Multiple ovalbumin-specific probes in both strains were also differentially expressed in lymphoblastoid cell lines from human asthmatic vs. nonasthmatic sibling pairs. Our data point to the existence of distinct, genetically programmed responses to maternal exposures in developing lung. These different response patterns, if recapitulated in human fetal development, can contribute to long-term pulmonary health including interindividual susceptibility to asthma.

Ginkgo may prevent genetic-associated ovarian cancer risk: multiple biomarkers and anticancer pathways induced by ginkgolide B in BRCA1-mutant ovarian epithelial cells

Women carrying BRCA1 mutations have a higher risk of developing ovarian cancers. Options to reduce this risk are largely limited to prophylactic surgery, which leads to a decrease in the quality of life and permanently damages fertility. There is a obvious and an urgent need to identify a noninvasive approach to effectively prevent the ovarian cancer risk, specifically for those women of reproductive age. Our previous studies showed that the use of the herbal remedy Ginkgo biloba may reduce the risk for nonmucinous ovarian cancer. Here, we explored whether Ginkgo biloba might also be an effective agent to reduce BRCA1-associated ovarian cancer (always serous-type) risk. A human ovarian surface epithelial cell line-636 was developed from a BRCA1-mutant carrier. Cells were treated with ginkgolide B (GB) or dimethyl sulfoxide, and protein lysates from the cells were applied to antibody microarrays to determine upregulated or downregulated protein expression patterns. Anticancer activities and the associated networking pathways with the altered proteins were analyzed by using the Pathway Studio software. After GB treatment, 28 proteins were shown to be consistently upregulated (1.5-15.5-fold), and 22 proteins were downregulated (1.5-28.3-fold). Bioinformatics software analysis indicated that multiple mechanisms and signal pathways are involved in anticancer activities in BRCA1-mutant cells induced by GB treatment. These pathways include cell proliferation, tumor suppression, and DNA damage repair. Our study suggested that GB found in the herbal Ginkgo biloba may have cancer-preventive activities in BRCA1-mutant ovarian epithelial cells.

An apoptosis-independent role of SMAC in tumor suppression

Reduced expression of the pro-apoptotic protein SMAC (second mitochondria-derived activator of caspase) has been reported to correlate with cancer progression, while its significance and underlying mechanisms are poorly understood. In this study, we investigated the role of SMAC in intestinal tumorigenesis using both human samples and animal models. Decreased SMAC expression was found to correlate with increased cIAP2 expression and higher grades of human colon cancer. In mice, SMAC deficiency significantly increased the incidence and size of colon tumors induced by azoxymethane (AOM)/dextran sulfate sodium salt (DSS), and highly enriched β-catenin hot spot mutations. SMAC deficiency also significantly increased the incidence of spontaneous intestinal polyps in APC(Min/+) mice. Loss of SMAC in mice led to elevated levels of cIAP1 and cIAP2, increased proliferation and activation of the NF-κB p65 subunit in normal and tumor tissues. Unexpectedly, SMAC deficiency had little effect on the incidence of precursor lesions, or apoptosis induced by AOM or DSS, or in established tumors in mice. Furthermore, SMAC knockout enhanced TNFα-mediated NF-κB activation via cIAP2 in HCT 116 colon cancer cells. These results demonstrate an essential and apoptosis-independent function of SMAC in tumor suppression and provide new insights into the biology and targeting of colon cancer.

Abstract 4501: Energetic risk and prostate cancer-specific and all-cause mortality in two large cohorts of men with localized prostate cancer

Objective: To examine whether high energetic risk predisposes men with localized prostate cancer (PC) to higher risk of PC-specific mortality or all-cause mortality. Methods: Among men with localized PC, prediagnostic body mass index (BMI) and plasma C-peptide (a marker of insulin production) were available for 691 men (301 overall deaths, 78 PC deaths) in the Physicians’ Health Study (discovery set) and 1111 men (262 overall deaths, 56 PC deaths) in the Health Professionals Follow-up Study (validation set). High energetic risk was defined as BMI 25-29.9 kg/m2 and C-peptide in the highest quartile or BMIα30 kg/m2. We used the Cox-regression model to estimate risk, adjusting for age, smoking, diabetes, and D'Amico risk defined by stage, Gleason grade and prostate-specific antigen (PSA). Results: Results were similar in both cohorts; the combined hazard ratio (HR)s (95% confidence interval, CI) associated with high energetic risk (25% of study population) were 2.2 (1.5-3.3) for PC-specific mortality and 1.4 (1.1-1.7) for all-cause mortality. The risk of PC-specific mortality according to low- intermediate-, or high-D'Amico risk were 1.0 (reference), 2.6, 6.4 for low energetic risk, and 5.0, 6.1, 9.4 for high energetic risk. The corresponding HRs for all-cause mortality were 1.0 (reference), 1.3, 2.1, 2.1, 2.1, and 2.3. Compared to D'Amico risk alone, incorporating energetic risk significantly improved the predictability of PC-specific mortality (C-statistic from 0.72 to 0.78, P&lt;0.001). Conclusion: Adding energetic risk to D'Amico risk groups significantly improved prediction of PC-specific and all-cause mortality, and identifies 20% D'Amico “low-risk” patients who may be poor candidates for active surveillance.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4501. doi:1538-7445.AM2012-4501

Cigarette smoking behaviors and time since quitting are associated with differential DNA methylation across the human genome

The impact of cigarette smoking can persist for extended periods following smoking cessation and may involve epigenetic reprogramming. Changes in DNA methylation associated with smoking may help to identify molecular pathways that contribute to the latency between exposure and disease onset. Cross-sectional cohort data from subjects in the International COPD Genetics Network (n = 1085) and the Boston Early-Onset COPD study (n = 369) were analyzed as the discovery and replication cohorts, respectively. Genome-wide methylation data on 27 578 CpG sites in 14 475 genes were obtained on DNA from peripheral blood leukocytes using the Illumina HumanMethylation27K Beadchip in both cohorts. We identified 15 sites significantly associated with current smoking, 2 sites associated with cumulative smoke exposure, and, within the subset of former smokers, 3 sites associated with time since quitting cigarettes. Two loci, factor II receptor-like 3 (F2RL3) and G-protein-coupled receptor 15 (GPR15), were significantly associated in all three analyses and were validated by pyrosequencing. These findings (i) identify a novel locus (GPR15) associated with cigarette smoking and (ii) suggest the existence of dynamic, site-specific methylation changes in response to smoking which may contribute to the extended risks associated with cigarette smoking that persist after cessation.

Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome

BACKGROUND

Growing pains (GP) is a prevalent familial childhood disorder of unknown aetiology. Familial occurrence of GP, and individual and familial association of GP with restless legs syndrome (RLS) has been reported.

METHODS

We applied a twin family design to search for evidence of genetic susceptibility to GP, and for a genetic relationship between GP and RLS. The parents of 1843 twin pairs aged 3-16 years were administered a questionnaire, which identified 88 pairs with at least one twin individual fulfilling criteria for GP. Standard questionnaires for history of GP and RLS were completed for these twin pairs, their siblings and parents.

RESULTS

Twenty-five of 34 monozygotic (MZ) pairs were concordant for GP, compared with 12 of the 54 dizygotic (DZ) pairs. The casewise concordance was 0.85 and 0.36 for MZ and DZ pairs, respectively (p < 0.001). The lifetime GP prevalence for relatives of twins with GP was 51% for non-twin siblings, 47% for parents. Twenty-three percent of twin individuals with GP met RLS criteria compared with 8% of twin individuals without GP (p = 0.03). Of the twins with GP concordance, 19% met RLS criteria compared with 2% of twins with GP discordance (p = 0.01). In two MZ pairs, one had GP and the other RLS. The lifetime prevalence of RLS was 40% for mothers, and 24% for fathers and 18% for non-twin siblings.

CONCLUSION

This first twin family study of GP provides evidence for a genetic aetiology and for a genetic relationship to RLS.