Single-nucleotide polymorphism biomarkers of adjuvant anastrozole-induced estrogen suppression in early breast cancer

OBJECTIVES

Based on our previous findings that postmenopausal women with estrone (E1) and estradiol (E2) concentrations at or above 1.3 pg/ml and 0.5 pg/ml, respectively, after 6 months of adjuvant anastrozole therapy had a three-fold risk of recurrence, we aimed to identify a single-nucleotide polymorphism (SNP)-based model that would predict elevated E1 and E2 and then validate it in an independent dataset.

PATIENTS AND METHODS

The test set consisted of 322 women from the M3 study and the validation set consisted of 152 patients from MA.27. All patients were treated with adjuvant anastrozole, had on-anastrozole E1 and E2 concentrations and genome-wide genotyping.

RESULTS

SNPs were identified from the M3 genome-wide association study. The best model to predict the E1-E2 phenotype with high balanced accuracy was a support vector machine model using clinical factors plus 46 SNPs. We did not have an independent cohort that is similar to the M3 study with clinical, E1-E2 phenotypes and genotype data to test our model. Hence, we chose a nested matched case-control cohort (MA.27 study) for testing. Our E1-E2 model was not validated but we found the MA.27 validation cohort was both clinically and genomically different.

CONCLUSIONS

We identified a SNP-based model that had excellent performance characteristics for predicting the phenotype of elevated E1 and E2 in women treated with anastrozole. This model was not validated in an independent dataset but that dataset was clinically and genomically substantially different. The model will need validation in a prospective study.

THE HEMOCYTOLOGICAL CONSTITUTION OF ADULT MALE RABBITS FROM FIFTEEN STANDARD BREEDS

A study of the red blood cells, hemoglobin, blood platelets, and the total and individual white blood cells was made on 180 male rabbits of known age and representing fifteen standard breeds. An attempt was made to eliminate or bold constant such variables as age, sex, season, time of examination, technical errors, food, housing, and disease. The mean, variance of the mean, and standard deviation were calculated for each breed sample and for the group as a whole. An analysis of the variance showed that the variation between the breed samples was significantly greater than the variation within the breed samples for the red blood cells, hemoglobin, blood platelets, total white blood cells, basophiles, eosinophiles, and lymphocytes per cubic millimeter and in per cent and the neutrophiles in per cent. No significant variations were detected in the monocytes except when the breeds were divided into heavy and light breeds. No variation in the neutrophiles per cubic millimeter was detected; a large number of the breeds had exactly the same mean neutrophile level. Characteristic blood formulae were found for the various breed samples having an adequate numerical representation. It was concluded that the varying blood formulae could not be explained on any other, except an hereditary (genetic) basis.

STUDIES ON THE BLOOD CYTOLOGY OF THE RABBIT : VIII. THE BLOOD OF NORMAL RABBITS AS AN INDEX OF THEIR RESISTANCE TO A TRANSPLANTABLE NEOPLASM

1. The blood cytology of 91 rabbits was studied prior to inoculation with a transplantable malignant neoplasm. The following statements refer in each instance to the mean values of the pre-inoculation counts. 2. The animals which were most resistant to the malignant disease had, before inoculation, normal red and white cell counts, normal hemoglobin percentages, high eosinophile counts, and low counts of monocytes and lymphocytes. The relations of the neutrophile and basophile counts were irregular, but normal values also appeared to be associated with greater resistance. 3. The most susceptible animals were those which had, before inoculation, red cell counts above 5,500,000 or below 5,000,000 per c.mm.; hemoglobin above 70 per cent or below 60 per cent (Newcomer); white cell counts below 6,000 or above 8,500 per c.mm.; low eosinophile, high monocyte, or high lymphocyte counts. 4. No animal with any of the following findings prior to inoculation recovered completely from the tumor as determined by autopsy examination: red cells above 5,500,000 per c.mm. of blood; hemoglobin above 70 per cent; total white cells above 10,000 per c.mm.; eosinophiles below 120 per c.mm., or below the relative value of 1.5 per cent; basophiles below 400 per c.mm., or below the relative value of 6 per cent; lymphocytes above 3,600 per c.mm.; monocytes above 1,500 per c.mm.; neutrophiles above 5,000 per c.mm.; and total granular cells above 5,700 per c.mm. In the case of each of the following pre-inoculation values, only 1 animal was completely free from tumor at autopsy: hemoglobin below 60 per cent; red cells below 4,800,000 per c.mm.; total granular cells below 3,300 per c.mm.; total non-granular cells below 2,300 per c.mm.; total non-granular cells above 3,700 per c.mm. No animal with pre-inoculation eosinophiles above 3.9 per cent, or basophiles above 16 per cent died from the tumor. 5. The blood findings before inoculation could be related to the character and outcome of the malignant disease, from the standpoint of animal groups as well as in the case of individual rabbits. 6. From the results of the experiments here reported, it seems possible to predict with an accuracy of between 80 and 90 per cent the individual resistance or susceptibility of rabbits to the tumor by a study of their blood cells before inoculation.

STUDIES IN THE BLOOD CYTOLOGY OF THE RABBIT : I. BLOOD COUNTS IN NORMAL RABBITS

A study of the blood cytology of normal male rabbits was carried out from October 20, 1927 to November 22, 1928 in connection with an investigation of constitutional and environmental factors related to the occurrence and course of disease. In 1110 observations on 174 animals, total red and white cells counts, differential white cell counts by the supravital method, and hemoglobin estimations were made. A statistical analysis of the results obtained is presented. Attention is directed to the occurrence of wide variations in the numbers of the various white cells as contrasted with comparatively small variations in the numbers of red cells and of hemoglobin content. The results recorded are regarded as representing approximate rather than fixed values of normality.

Serum chemistry templates of disease in liver, pancreas, and gallbladder

On routine hospital admission, 23,714 patients received a 28-test serum metabolic profile. The 33 most common diseases (4,132 patients) of liver, pancreas, and gallbladder (LPG) had unique chemical templates averaging 15 significant serum deviations. Each LPG disease differed from all others by elevations of both leucine-aminopeptidase (LAP) and alkaline phosphatase (AP) levels. LAP level was low or normal and serum glutamic oxaloacetic transaminase (SGOT) and AP levels were elevated in 43 non-LPG diseases. Patients with acute and chronic pancreatitis had elevated amylase levels. The four nonmalignant diseases of the gallbladder were associated with normal levels of amylase and lactic dehydrogenase (LDH); except for silent cholelithiasis, each showed elevated total bilirubin (BIL) levels. Patients with solitary or scattered lesions of the liver had normal bilirubin levels (2,115 patients), and those with diffuse interstitial or parencymal disease had elevated BIL levels. Cancer patients had elevated LDH and alpha1 globulin (A1G) levels, but low albumin levels. The importance of comprehensive liver profiles in the treatment of psychoses is emphasized by significant liver damage in a number of these patients. A1G was normal and LDH was elevated in patients having mononucleosis, hepatitis, lupus erythematosus, alcoholism, and alcoholic cirrhosis.