Abstract 2872: Image analysis algorithms for whole-slide counting, regional assignment, and subtype classification of tumor-associated macrophages (TAMs)

Tumor-associated macrophages (TAMs) regulate cancer progression on multiple levels, including angiogenesis, treatment response, and metastasis. Additionally, multiple studies have demonstrated a significant association between clinical outcome and TAM abundance, M1 vs. M2 subtype, and intratumoral distribution into stromal or epithelial compartments. However, manual counting of TAMs and assignment into tumor stroma or epithelial nests is laborious, inaccurate, subjective, and does not provide a statistically optimal sample size. These pitfalls may be limiting its utility as a diagnostic tool or an endpoint in drug efficacy studies. Using tissue sections from human breast cancers as a model, we have developed image analysis algorithms for the rapid automated counting and compartmental assignment of total TAMs (CD68+) and TAMs of the more strongly tumor-promoting M2 subtype (CD163+). Using whole slide scanning and proprietary image analysis tools called Feature Analysis on Consectutive Tissue Sections (FACTS), we have developed an approach to not only tally but also map the location of CD68+ and CD163+ macrophages in serial tissue sections, align those sections, and provide information about regional distribution of these macrophages. These outcomes can also be aligned with other serial sections containing relevant biomarkers associated with macrophage infiltration such as hypoxia or angiongenesis, using our proprietary multivariate correlation analysis tool Multivariatemap. Additionally, we have begun investigations into the association of these regional macrophage densities with clinical outcome using patient data available for the model set. These approaches represent a powerful toolkit for elucidating significant quantitative associations between TAMs and tumor vasculature, hypoxia, or other relevant features or markers, for the determination of prognostic or drug efficacy endpoints.

Citation Format: Brian E. Laffin, Joseph Krueger, Mohamed Salama. Image analysis algorithms for whole-slide counting, regional assignment, and subtype classification of tumor-associated macrophages (TAMs). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2872. doi:10.1158/1538-7445.AM2013-2872

Neobladder long term follow-up

One of the commonest forms of orthotopic bladder substitution for bladder cancer survivors, used in our institute, is the use of ileocecal segment. Sometimes, the need for Indiana pouch heterotropic continent diversion arises.

AIM

To compare the long-term effect of orthotopic ileocecal bladder and heterotropic Indiana pouch following radical cystectomy in bladder cancer patients.

PATIENTS AND METHODS

Between January 2008 and December 2011, 91 patients underwent radical cystectomy/anterior pelvic exentration and orthotopic ileocecal bladder reconstruction (61 patients) and Indiana pouch (30 patients), when orthotopic diversion could not be technically or oncologically feasible.

RESULTS

Convalescence was uneventful in most patients. All minor and major urinary leakage cases, in both diversions groups, where successfully conservatively treated. Only one patient in the ileocecal group with major urinary leak required re-exploration with successful revision of uretro-colonic anastomosis. Only one patient in the Indiana pouch group had accidentally discovered sub-centimetric stone, which was simply expelled. The overall survival proportion of ileocecal group was 100% compared to 80% in the Indiana pouch group (p<0.001). The disease free survival proportion of ileocecal group was 90.8% compared to 80% in the Indiana pouch group (p=0.076). Effective comparative daytime and nighttime urinary continence as well as renal function deterioration were not statistically significant between both reconstruction types.

CONCLUSION

Both ileocecal bladder and Indiana pouch are safe procedures in regard to long-term effects over kidney function following radical cystectomy.

Role of L-thyroxin in counteracting rotenone induced neurotoxicity in rats

A key feature of Parkinson's disease is the dopaminergic neuronal cell loss in the substantia nigra pars compacta. Many triggering pathways have been incriminated in the pathogenesis of this disease including inflammation, oxidative stress, excitotoxicity and apoptosis. Thyroid hormone is an essential agent for the growth and maturation of neurons; moreover, it has variable mechanisms for neuroprotection. So, we tested the efficacy of (L)-thyroxin as a neuroprotectant in rotenone model of Parkinson's disease in rats. Thirty Sprague Dawley rats aged 3 months were divided into 3 equal groups. The first received daily intraperitoneal injections of 0.5% carboxymethyl cellulose (CMC) 3 mL/Kg. The second group received rotenone suspended in 0.5% CMC intraperitoneally at a dose of 3 mg/kg, daily. The third group received the same rotenone regimen subcutaneous l-thyroxine at a dose of 7.5 μg daily. All animals were evaluated regarding locomotor disturbance through blinded investigator who monitored akinesia, catalepsy, tremors and performance in open field test. After 35 days the animals were sacrificed and their brains were immunostained against anti-tyrosine hydroxylase and iba-1. Photomicrographs for coronal sections of the substantia nigra and striatum were taken and analyzed using image J software to evaluate cell count in SNpc and striatal fibers density and number of microglia in the nigrostriatal system. The results were then analyzed statistically. Results showed selective protective effects of thyroxin against rotenone induced neurotoxicity in striatum, however, failed to exert similar protection on SN. Moreover, microglial elevated number in nigrostriatal system that was induced by rotenone injections was diminished selectively in striatum only in the l-thyroxin treated group. One of the possible mechanisms deduced from this work was the selective regulation of microglia in striatal tissues. Thus, this study provides an insight into thyroxin neuroprotection warranting further investigation as therapeutic option for Parkinson's disease patients.

Female fertility loss and preservation: threats and opportunities

BACKGROUND

Ovarian aging and cytotoxic treatments are the most common causes for fertility loss in women. With increasing numbers of young female survivors following cytotoxic cancer treatments, the issue of fertility preservation has assumed greater importance.

METHODS

We review the literature on the causes of female fertility loss as well as the recent advances in fertility preservation options and strategies that might be of interest to oncologists. Currently, several methods and techniques exist for fertility preservation of female patients with cancer including embryo freezing, ovarian protection techniques, oocyte cryopreservation, ovarian tissue cryopreservation followed by autotransplantation, and recently in vitro culture of ovarian tissue, follicles, and oocytes. Each method or technique has advantages and disadvantages related to current success rate, required delay in cancer treatment, sperm requirement, and risk of reintroducing cancer cells.

RESULTS

To date, embryo freezing is the only established method successfully and widely used for fertility preservation of female patients with cancer. The other methods are promising but still considered experimental.

CONCLUSION

Patient awareness, physician knowledge, early counseling, costs management, international registry, interdisciplinary networks, and research development are necessary to improve the current care in the field of female fertility preservation.

Congenital and childhood myeloproliferative disorders with eosinophilia responsive to imatinib

Eosinophilia is seen in several myeloproliferative disorders (MPD). A subset of MPD involves the platelet-derived growth factor receptor beta (PDGFRB) gene. Imatinib mesylate has been efficacious in treating some of these MPDs. Here we describe two patients with MPD with eosinophilia and PDGFRB rearrangements, one of which was congenital. Both patients were treated with single agent imatinib and continue to be in clinical, hematologic, and cytogenetic remission despite weaning doses. No definite guidelines currently exist regarding the exact dosing and duration of imatinib therapy for these patients.

Regenerative effects of umbilical cord matrix cells (UCMCs) in a rodent model of rotenone neurotoxicity

Rotenone is one of the pesticides thought to have neurotoxic effect that could potentially play a role in the development of Parkinson's disease (PD). The neurotoxic effects of rotenone have been used to induce PD model in animals that can help in testing suggested therapies. Cell replacement therapies are suggested as new promising approach for treating PD. This study was done to evaluate the regenerative effect of intrathecal administered umbilical cord matrix cells in a rotenone model of PD in mice. Thirty, male BALB/c mice were used and divided into 3 equal groups. The control group (G.1) received only carboxymethyl cellulose orally once daily at a volume of 10ml/kg. The second group was given a daily rotenone oral dose of 30mg/kg for 28days. The third group received rotenone (30mg/(kgday) orally for 28days) and in the 15th day 1×10(5) of UCMCs were given intrathecally and then they completed the rotenone course. At the 23rd day all the animals were evaluated regarding locomotor incoordination through behavioral tests for monitoring PD development. At the end of the 28days all animals were sacrificed by overdose of phenobarbital and their brain were subjected to immunohistochemical analysis for dopaminergic neurons staining for anti TH antibodies. Intrathecal UCMCs revealed regenerative effects in SNpc as evidenced by immunohistochemical staining; this was in parallel with better performance in behavioral tests. In conclusion, the results of this study revealed the regenerative capacities of UCMCs against rotenone neurotoxicity in mice.

Natural toxins implicated in the development of Parkinson's disease

Experimental models of Parkinson's disease (PD) are of great importance for improving the design of future clinical trials. Various neurotoxic models are available, including 6-hydroxydopamine (6-OHDA), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), paraquat and rotenone. However, no model is considered perfect; each has its own limitations. Based on epidemiological data, a new trend of using environmental toxins in PD modeling seems attractive and has dominated public discussions of the disease etiology. A search for new environmental toxin-based models would improve our knowledge of the pathology of the condition. Here, we discuss some toxins of natural origin (e.g. cycad-derived toxins, epoxomicin, Nocardia asteroides bacteria, Streptomyces venezuelae bacteria, annonacin and DOPAL) that possibly represent a contributory environmental component to PD.

Abstract 2683: Cellmap: Tumor cell subpopulation analysis in immunohistochemistry stained tumor tissue

All potential factors within individual patients which contribute to a lack of response to a given therapy are not known, but cancer biologists have long hypothesized that distinct and disparate populations within the tumor can be selected for by therapy to outgrow and emerge as a resistant tumor. As more targeted therapies are being developed, the understanding of these subpopulations of cells within a tumor has become very important to clinical strategy. Thus, there is a need to effectively distinguish and evaluate different populations of cells in a tumor within formalin fixed tissue. These contextual evaluations are important for understanding the biology of a target, evaluating pharmacodynamic or surrogate efficacy markers, or evaluating biomarkers for a companion diagnostic approach. Immunohistochemistry (IHC) remains the most direct approach to evaluating biomarkers within tissue context, but requires a pathologist to subjectively separate the complex components of tumor tissue and the compartments of the tumor cells themselves to deliver a numerical score that is based on the staining intensity of a cell and the percentage of cells which stain. This output is considered qualitative, due to pathologist subjectivity in scoring sample regions, the inability to effectively discriminate minor differences in staining intensities for a biomarker, and the inability to deliver a dataset with sufficient sample size to overcome bias deficiencies. Furthermore, a significant amount of information content is lost in this score, eliminating the potential to identify and analyze discrete cell populations within a tumor that may be leading to refractory to therapy. In contrast, modern image analysis (IA) approaches can deliver a far more quantitative IHC score by objectively distinguishing tumor components and cellular compartments, detecting minor differences in staining intensity, and by performing this function across the whole tumor section. However, current IA approaches are designed only to report an average or thresholded intensity across the analyzed region, without reporting the cell-by-cell statistics required to identify discrete cell populations within a tumor. To answer this, we have designed Cellmap, which can analyze an IHC stained tumor tissue section which has been digitally imaged, and make multiparametric measurements about cell morphology and biomarker staining in every cell individually. This information can be reported tumor-wide, or within a specific component of the tumor, and/or within a compartment of the cell simultaneously. Cellmap can be used to make quantitative measurements which identify specific cells with specific signaling processes, and determine their location within a tumor section. This information can be used to identify and quantify discrete cell populations relevant to a disease hypothesis which are associated with a specific tumor microenvironment.

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 2683. doi:1538-7445.AM2012-2683

Serum glutathione S-transferase P1 1 in prediction of cardiac function

Background

Glutathione S-transferase P1 1 (GSTP1) belongs to the multigene isozyme family involved in cellular response to oxidative stress and apoptosis. Our initial retrospective proteomic analysis suggested that GSTP1 is associated with heart failure (HF). Although pro–B-type natriuretic peptide (proBNP) serves currently as a surrogate diagnostic and prognostic parameter in HF patients, its specificity remains uncertain. We hypothesized that GSTP1 might be a useful serum marker in the monitoring of HF patients.

Methods and Results

Serum GSTP1 and proBNP were prospectively measured in 193 patients subdivided based on their ejection fraction (EF) either in equal-sized quintiles or predefined EF groups >52%, 43%–52%, 33%–42%, 23%–32% and ≤22%. At a cutoff of ≥231 ng/mL, GSTP1 identified HF patients with EF ≤22% with 81% sensitivity and 83% specificity, and at a cutoff of ≥655 pg/mL, proBNP identified the same patient group with 84% sensitivity and 22% specificity. GSTP1 at a ≥126 ng/mL cutoff identified EF ≤42% with 90% sensitivity and 95% specificity, or proBNP at a ≥396 pg/mL cutoff had 97% sensitivity and 20% specificity. In regression analyses, GSTP1, but not proBNP, discriminated between EF ≤42% and EF >42% in HF patients.

Conclusions

These results suggest that GSTP1 is strongly associated with HF and could serve as a sensitive and specific marker to predict the ventricular function in HF patients.

Pramipexole protective effect on rotenone induced neurotoxicity in mice

Introduction:Pramipexole is a new dopaminergic drug which has been approved for PD treatment. However, we tried to find a new capacity for this drug rather than symptomatic effect.

Materials and Methods:

A chronic rotenone model with daily oral dose of 30mg/kg was induced in mice. Pramipexole was tried in a new approach where the treatment began in the middle of rotenone course with oral dose 1mg/kg/day of pramipexole.

Results:

Further analysis of behavioral tests and immunohistochemistry revealed success of pramipexole in improving the rotenone intoxicated mice.

Conclusion:

These results showed possible beneficial effects of pramipexole against rotenone-induced neurotoxicity.

The role of pramipexole in a severe Parkinson's disease model in mice

BACKGROUND

Pramipexole is one of a new generation of dopamine agonists. Recently there have been questions regarding its neuroprotective effects. These effects have been tested against various insults, which have yielded conflicting results.

METHODS

In this study, we introduced a combination of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)/paraquat to induce a severe Parkinson's disease model. The mice, after receiving the combination of toxins, were evaluated using mortality rates and immunohistochemistry for degenerating tyrosine hydroxylase-positive neurons.

RESULTS AND CONCLUSIONS

Pramipexole was tested for its capacity to offer protection against neurotoxic the effects of MPTP/paraquat in this model; however, the results showed no improvement with pramipexole therapy.

Over-expression of CKS1B activates both MEK/ERK and JAK/STAT3 signaling pathways and promotes myeloma cell drug-resistance

Here we demonstrate the crucial role of CKS1B in multiple myeloma (MM) progression and define CKS1B-mediated SKP2/p27^Kip1-independent down-stream signaling pathways. Forced-expression of CKS1B in MM cells increased cell multidrug-resistance. CKS1B activates STAT3 and MEK/ERK pathways. In contrast, SKP2 knockdown or p27^Kip1 over-expression resulted in activation of the STAT3 and MEK/ERK pathways. Further investigations showed that BCL2 is a downstream target of MEK/ERK signaling. Stimulation of STAT3 and MEK/ERK signaling pathways partially abrogated CKS1B knockdown induced MM cell death and growth inhibition. Targeting STAT3 and MEK/ ERK signaling pathways by specific inhibitors induced significant MM cell death and growth inhibition in CKS1B-overexpressing MM cells and their combinations resulted in synergy. Thus, our findings provide a rationale for targeting STAT3 and MEK/ERK/ BCL2 signaling in aggressive CKS1B-overexpressing MM.