Radiomic phenotyping of the lung parenchyma in a lung cancer screening cohort

High-throughput extraction of radiomic features from low-dose CT scans can characterize the heterogeneity of the lung parenchyma and potentially aid in identifying subpopulations that may have higher risk of lung diseases, such as COPD, and lung cancer due to inflammation or obstruction of the airways. We aim to determine the feasibility of a lung radiomics phenotyping approach in a lung cancer screening cohort, while quantifying the effect of different CT reconstruction algorithms on phenotype robustness. We identified low-dose CT scans (n = 308) acquired with Siemens Healthineers scanners from patients who completed low-dose CT within our lung cancer screening program between 2015 and 2018 and had two different sets of image reconstructions kernel available (i.e., medium (I30f.), sharp (I50f.)) for the same acquisition. Following segmentation of the lung field, a total of 26 radiomic features were extracted from the entire 3D lung-field using a previously validated fully-automated lattice-based software pipeline, adapted for low-dose CT scans. The lattice in-house software was used to extract features including gray-level histogram, co-occurrence, and run-length descriptors. The lattice approach uses non-overlapping windows for traversing along pixels of images and calculates different features. Each feature was averaged for each scan within a range of lattice window sizes (W) of 4, 8 and 20 mm. The extracted imaging features from both datasets were harmonized to correct for differences in image acquisition parameters. Subsequently, unsupervised hierarchical clustering was applied on the extracted features to identify distinct phenotypic patterns of the lung parenchyma, where consensus clustering was used to identify the optimal number of clusters (K = 2). Differences between phenotypes for demographic and clinical covariates including sex, age, BMI, pack-years of smoking, Lung-RADS and cancer diagnosis were assessed for each phenotype cluster, and then compared across clusters for the two different CT reconstruction algorithms using the cluster entanglement metric, where a lower entanglement coefficient corresponds to good cluster alignment. Furthermore, an independent set of low-dose CT scans (n = 88) from patients with available pulmonary function data on lung obstruction were analyzed using the identified optimal clusters to assess associations to lung obstruction and validate the lung phenotyping paradigm. Heatmaps generated by radiomic features identified two distinct lung parenchymal phenotype patterns across different feature extraction window sizes, for both reconstruction algorithms (P < 0.05 with K = 2). Associations of radiomic-based clusters with clinical covariates showed significant differences for BMI and pack-years of smoking (P < 0.05) for both reconstruction kernels. Radiomic phenotype patterns were more similar across the two reconstructed kernels, when smaller window sizes (W = 4 and 8 mm) were used for radiomic feature extraction, as deemed by their entanglement coefficient. Validation of clustering approaches using cluster mapping for the independent sample with lung obstruction also showed two statistically significant phenotypes (P < 0.05) with significant difference for BMI and smoking pack-years. Radiomic analysis can be used to characterize lung parenchymal phenotypes from low-dose CT scans, which appear reproducible for different reconstruction kernels. Further work should seek to evaluate the effect of additional CT acquisition parameters and validate these phenotypes in characterizing lung cancer screening populations, to potentially better stratify disease patterns and cancer risk.

Abstract 661: Robust feature selection and ComBat-based harmonization to improve survival prediction in stage III lung cancer using radiomic phenotypes

Background: Tumoral molecular characterization and genomic analysis is required for appropriate choice of therapy, requiring tumor biopsies which are invasive and associated with life-threatening complications. Standard of care computed tomography (CT) acquired during lung cancer management has a yet untapped wealth of information on in situ tumor architecture, heterogeneity and peritumoral environment which have prognostic implications. Previously published literature on overall survival (OS) prediction in stage III non-small cell lung cancer (NSCLC) on CT are limited by use of heterogeneous tumor histology, therapy, imaging technique and imaging scanner type, all of which can impact radiomic features and hence potentially obscure a discernible predictive radiomic signature. To address these challenges, we 1) used a well-curated cohort of stage III NSCLC patients, 2) developed radiomic phenotypes predictive of OS, and 3) accounted for differences across image acquisition modalities and vendors.

Methods: We retrospectively analyzed 110 thoracic CT scans (82 non-contrast, 28 contrast enhanced; from three vendors) from stage III lung adenocarcinoma patients (68 female, 42 male) acquired between April 2012−October 2018, with median age of 66 (range 60−71) years, and 56 identified events of death. Isotropic interpolation (3mm) was implemented to account for variations in image spatial resolution. Tumor segmentations were performed by one of three experienced radiologists using itk-SNAP. A set of 107 radiomic features subdivided into first order statistics, shape-based and textural, were extracted for each tumor using the Pyradiomics package. Radiomic features with different distributions across vendors were identified and discarded using the Kruskal-Wallis test. Harmonization of radiomic features based on radiocontrast agents was performed using ComBat batch effect correction. Radiomic phenotypes were derived through unsupervised hierarchical clustering of the main principal components of the radiomic features. A baseline Cox model based on the established tumor volume and ECOG status was built and compared with a model integrating such clinical covariates with the radiomic phenotypes using C-statistics.

Results: The OS predictive performance of the Cox model integrating radiomic phenotypes and clinical covariates had C-index = 0.68, (95%) CI = [0.61,0.76], an improvement since the baseline model alone had C-index = 0.65, CI = [0.58,0.73]. Radiomic phenotypes derived from non-harmonized features did not add value to the predictive performance of the baseline model.

Conclusions: Accounting for differences related to image acquisition, vendors and radiocontrast agents through feature harmonization, can substantially improve the predictive performance of well-known clinical covariates using standard CT used in NSCLC management.

Citation Format: Jose M. Luna, Andrew R. Barsky, Russell T. Shinohara, Alexandra D. Dreyfuss, Hannah Horng, Leonid Roshkovan, Michelle Hershman, Babak Haghighi, Peter B. Noel, Keith A. Cengel, Sharyn I. Katz, Eric S. Diffenderfer, Despina Kontos. Robust feature selection and ComBat-based harmonization to improve survival prediction in stage III lung cancer using radiomic phenotypes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 661.

Longitudinal Imaging-Based Clusters in Former Smokers of the COPD Cohort Associate with Clinical Characteristics: The SubPopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

PURPOSE

Quantitative computed tomography (qCT) imaging-based cluster analysis identified clinically meaningful COPD former-smoker subgroups (clusters) based on cross-sectional data. We aimed to identify progression clusters for former smokers using longitudinal data.

PATIENTS AND METHODS

We selected 472 former smokers from SPIROMICS with a baseline visit and a one-year follow-up visit. A total of 150 qCT imaging-based variables, comprising 75 variables at baseline and their corresponding progression rates, were derived from the respective inspiration and expiration scans of the two visits. The COPD progression clusters identified were then associated with subject demography, clinical variables and biomarkers.

RESULTS

COPD severities at baseline increased with increasing cluster number. Cluster 1 patients were an obese subgroup with rapid progression of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%). Cluster 2 exhibited a decrease of fSAD% and Emph%, an increase of tissue fraction at total lung capacity and airway narrowing over one year. Cluster 3 showed rapid expansion of Emph% and an attenuation of fSAD%. Cluster 4 demonstrated severe emphysema and fSAD and significant structural alterations at baseline with rapid progression of fSAD% over one year. Subjects with different progression patterns in the same cross-sectional cluster were identified by longitudinal clustering.

CONCLUSION

qCT imaging-based metrics at two visits for former smokers allow for the derivation of four statistically stable clusters associated with unique progression patterns and clinical characteristics. Use of baseline variables and their progression rates enables identification of longitudinal clusters, resulting in a refinement of cross-sectional clusters.

Differences in Particle Deposition Between Members of Imaging-Based Asthma Clusters

Background: Four computed tomography (CT) imaging-based clusters have been identified in a study of the Severe Asthma Research Program (SARP) cohort and have been significantly correlated with clinical and demographic metrics (J Allergy Clin Immunol 2017; 140:690-700.e8). We used a computational fluid dynamics (CFD) model to investigate air flow and aerosol deposition within imaging archetypes representative of the four clusters. Methods: CFD simulations for air flow and 1-8 μm particle transport were performed using CT-based airway models from two healthy subjects and eight asthma subjects. The subject selection criterion was based on the discriminant imaging-based flow-related variables of J(Total) (average local volume expansion in the total lung) and Dh*(sLLL) (normalized airway hydraulic diameter in the left lower lobe), where reduced J(Total) and Dh*(sLLL) indicate reduced regional ventilation and airway constriction, respectively. The analysis focused on the comparisons between all clusters with respect to healthy subjects, between cluster 2 and cluster 4 (nonsevere and severe asthma clusters with airway constriction) and between cluster 3 and cluster 4 (two severe asthma clusters characterized by normal and constricted airways, respectively). Results: Nonsevere asthma cluster 2 and severe asthma cluster 4 subjects characterized by airway constriction had an increase in the deposition fraction (DF) in the left lower lobe. Constricted flows impinged on distal bifurcations resulting in large depositions. Although both cluster 3 (without constriction) and cluster 4 (with constriction) were severe asthma, they exhibited different particle deposition patterns with increasing particle size. The statistical analysis showed that Dh*(sLLL) plays a more important role in particle deposition than J(Total), and regional flow fraction is correlated with DF among lobes for smaller particles. Conclusions: We demonstrated particle deposition characteristics associated with cluster-specific imaging-based metrics such as airway constriction, which could pertain to the design of future drug delivery improvements.

Imaging-based clusters in former smokers of the COPD cohort associate with clinical characteristics: the SubPopulations and intermediate outcome measures in COPD study (SPIROMICS)

Background

Quantitative computed tomographic (QCT) imaging-based metrics enable to quantify smoking induced disease alterations and to identify imaging-based clusters for current smokers. We aimed to derive clinically meaningful sub-groups of former smokers using dimensional reduction and clustering methods to develop a new way of COPD phenotyping.

Methods

An imaging-based cluster analysis was performed for 406 former smokers with a comprehensive set of imaging metrics including 75 imaging-based metrics. They consisted of structural and functional variables at 10 segmental and 5 lobar locations. The structural variables included lung shape, branching angle, airway-circularity, airway-wall-thickness, airway diameter; the functional variables included regional ventilation, emphysema percentage, functional small airway disease percentage, Jacobian (volume change), anisotropic deformation index (directional preference in volume change), and tissue fractions at inspiration and expiration.

Results

We derived four distinct imaging-based clusters as possible phenotypes with the sizes of 100, 80, 141, and 85, respectively. Cluster 1 subjects were asymptomatic and showed relatively normal airway structure and lung function except airway wall thickening and moderate emphysema. Cluster 2 subjects populated with obese females showed an increase of tissue fraction at inspiration, minimal emphysema, and the lowest progression rate of emphysema. Cluster 3 subjects populated with older males showed small airway narrowing and a decreased tissue fraction at expiration, both indicating air-trapping. Cluster 4 subjects populated with lean males were likely to be severe COPD subjects showing the highest progression rate of emphysema.

Conclusions

QCT imaging-based metrics for former smokers allow for the derivation of statistically stable clusters associated with unique clinical characteristics. This approach helps better categorization of COPD sub-populations; suggesting possible quantitative structural and functional phenotypes.

Electronic supplementary material

The online version of this article (10.1186/s12931-019-1121-z) contains supplementary material, which is available to authorized users.

Imaging-based clusters in current smokers of the COPD cohort associate with clinical characteristics: the SubPopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

BACKGROUND

Classification of COPD is usually based on the severity of airflow, which may not sensitively differentiate subpopulations. Using a multiscale imaging-based cluster analysis (MICA), we aim to identify subpopulations for current smokers with COPD.

METHODS

Among the SPIROMICS subjects, we analyzed computed tomography images at total lung capacity (TLC) and residual volume (RV) of 284 current smokers. Functional variables were derived from registration of TLC and RV images, e.g. functional small airways disease (fSAD%). Structural variables were assessed at TLC images, e.g. emphysema and airway wall thickness and diameter. We employed an unsupervised method for clustering.

RESULTS

Four clusters were identified. Cluster 1 had relatively normal airway structures; Cluster 2 had an increase of fSAD% and wall thickness; Cluster 3 exhibited a further increase of fSAD% but a decrease of wall thickness and airway diameter; Cluster 4 had a significant increase of fSAD% and emphysema. Clinically, Cluster 1 showed normal FEV1/FVC and low exacerbations. Cluster 4 showed relatively low FEV1/FVC and high exacerbations. While Cluster 2 and Cluster 3 showed similar exacerbations, Cluster 2 had the highest BMI among all clusters.

CONCLUSIONS

Association of imaging-based clusters with existing clinical metrics suggests the sensitivity of MICA in differentiating subpopulations.

A GPU-based symmetric non-rigid image registration method in human lung

Quantitative computed tomography (QCT) of the lungs plays an increasing role in identifying sub-phenotypes of pathologies previously lumped into broad categories such as chronic obstructive pulmonary disease and asthma. Methods for image matching and linking multiple lung volumes have proven useful in linking structure to function and in the identification of regional longitudinal changes. Here, we seek to improve the accuracy of image matching via the use of a symmetric multi-level non-rigid registration employing an inverse consistent (IC) transformation whereby images are registered both in the forward and reverse directions. To develop the symmetric method, two similarity measures, the sum of squared intensity difference (SSD) and the sum of squared tissue volume difference (SSTVD), were used. The method is based on a novel generic mathematical framework to include forward and backward transformations, simultaneously, eliminating the need to compute the inverse transformation. Two implementations were used to assess the proposed method: a two-dimensional (2-D) implementation using synthetic examples with SSD, and a multi-core CPU and graphics processing unit (GPU) implementation with SSTVD for three-dimensional (3-D) human lung datasets (six normal adults studied at total lung capacity (TLC) and functional residual capacity (FRC)). Success was evaluated in terms of the IC transformation consistency serving to link TLC to FRC. 2-D registration on synthetic images, using both symmetric and non-symmetric SSD methods, and comparison of displacement fields showed that the symmetric method gave a symmetrical grid shape and reduced IC errors, with the mean values of IC errors decreased by 37%. Results for both symmetric and non-symmetric transformations of human datasets showed that the symmetric method gave better results for IC errors in all cases, with mean values of IC errors for the symmetric method lower than the non-symmetric methods using both SSD and SSTVD. The GPU version demonstrated an average of 43 times speedup and ~5.2 times speedup over the single-threaded and 12-threaded CPU versions, respectively. Run times with the GPU were as fast as 2 min. The symmetric method improved the inverse consistency, aiding the use of image registration in the QCT-based evaluation of the lung.

Differentiation of quantitative CT imaging phenotypes in asthma versus COPD

Introduction

Quantitative CT (QCT) imaging-based metrics have quantified disease alterations in asthma and chronic obstructive pulmonary disease (COPD), respectively. We seek to characterise the similarity and disparity between these groups using QCT-derived airway and parenchymal metrics.

Methods

Asthma and COPD subjects (former-smoker status) were selected with a criterion of post-bronchodilator FEV₁ <80%. Healthy non-smokers were included as a control group. Inspiratory and expiratory QCT images of 75 asthmatic, 215 COPD and 94 healthy subjects were evaluated. We compared three segmental variables: airway circularity, normalised wall thickness and normalised hydraulic diameter, indicating heterogeneous airway shape, wall thickening and luminal narrowing, respectively. Using an image registration, we also computed six lobar variables including per cent functional small-airway disease, per cent emphysema, tissue fraction at inspiration, fractional-air-volume change, Jacobian and functional metric characterising anisotropic deformation.

Results

Compared with healthy subjects, both asthma and COPD subjects demonstrated a decreased airway circularity especially in large and upper lobar airways, and a decreased normalised hydraulic diameter in segmental airways. Besides, COPD subjects had more severe emphysema and small-airway disease, as well as smaller regional tissue fraction and lung deformation, compared with asthmatic subjects. The difference of emphysema, small-airway disease and tissue fraction between asthma and COPD was more prominent in upper and middle lobes.

Conclusions

Patients with asthma and COPD, with a persistent FEV₁ <80%, demonstrated similar alterations in airway geometry compared with controls, but different degrees of alterations in parenchymal regions. Density-based metrics measured at upper and middle lobes were found to be discriminant variables between patients with asthma and COPD.

A four-dimensional computed tomography comparison of healthy and asthmatic human lungs

The purpose of this study was to explore new insights in non-linearity, hysteresis and ventilation heterogeneity of asthmatic human lungs using four-dimensional computed tomography (4D-CT) image data acquired during tidal breathing. Volumetric image data were acquired for 5 non-severe and one severe asthmatic volunteers. Besides 4D-CT image data, function residual capacity and total lung capacity image data during breath-hold were acquired for comparison with dynamic scans. Quantitative results were compared with the previously reported analysis of five healthy human lungs. Using an image registration technique, local variables such as regional ventilation and anisotropic deformation index (ADI) were estimated. Regional ventilation characteristics of non-severe asthmatic subjects were similar to those of healthy subjects, but different from the severe asthmatic subject. Lobar airflow fractions were also well correlated between static and dynamic scans (R²>0.84). However, local ventilation heterogeneity significantly increased during tidal breathing in both healthy and asthmatic subjects relative to that of breath-hold perhaps because of airway resistance present only in dynamic breathing. ADI was used to quantify non-linearity and hysteresis of lung motion during tidal breathing. Non-linearity was greater on inhalation than exhalation among all subjects. However, exhalation non-linearity among asthmatic subjects was greater than healthy subjects and the difference diminished during inhalation. An increase of non-linearity during exhalation in asthmatic subjects accounted for lower hysteresis relative to that of healthy ones. Thus, assessment of non-linearity differences between healthy and asthmatic lungs during exhalation may provide quantitative metrics for subject identification and outcome assessment of new interventions.

Prussian blue modified glassy carbon electrodes-study on operational stability and its application as a sucrose biosensor

Stabilisation of electrochemically deposited Prussian blue (PB) films on glassy carbon (GC) electrodes has been investigated and an enhancement in the stability of the PB films is reported if the electrodes are treated with tetrabutylammonium toluene-4-sulfonate (TTS) in the electrochemical activation step following the electrodeposition. A multi-enzyme PB based biosensor for sucrose detection was made in order to demonstrate that PB films can be coupled with an oxidase system. A tri-enzyme system, comprising glucose oxidase, mutarotase and invertase, was crosslinked with glutaraldehyde and bovine albumin serum on the PB modified glassy carbon electrode. The deposited PB operated as an electrocatalyst for electrochemical reduction of hydrogen peroxide, the final product of the enzyme reaction sequence. The electrochemical response was studied using flow injection analysis for the determination of sucrose, glucose and H(2)O(2). The optimal concentrations of the immobilisation mixture was standardised as 8U of glucose oxidase, 8U of mutarotase, 16U of invertase, 0.5% glutaraldehyde (0.025mul) and 0.5% BSA (0.025mg) in a final volume of 5mul applied at the electrode surface (0.066cm(2)). The biosensor exhibited a linear response for sucrose (4-800muM), glucose (2-800muM) and H(2)O(2) (1-800muM) and the detection limit was 4.5, 1.5 and 0.5muM for sucrose, glucose and H(2)O(2), respectively. The sample throughput was ca. 60 samples h(-1). An increase in the operational and storage stability of the sucrose biosensor was also noted when the PB modified electrodes were conditioned in phosphate buffer containing 0.05M TTS during the preparation of the PB films.

Sequential flow injection analysis of ammonium and nitrate using gas phase molecular absorption spectrometry

A flow injection method on the basis of gas phase molecular absorption is described for the sequential determination of ammonium and nitrate. Two hundred microliters of sample solution is injected into the flow line. For ammonium determination, the sample zone is directed to a line in which reacts with NaOH (13M) and produces ammonia. But for nitrate determination, the sample zone is passed through the on-line copperized zinc (Zn/Cu) reduction column and produces ammonium ion and in the follows ammonia. The produced ammonia in both cases is purged into the stream of N(2) carrier gas. The gaseous phase is separated from the liquid phase using a gas-liquid separator and then is swept into a flow through cell, which has been positioned in the cell compartment of an UV-Vis spectrophotometer. The absorbance of the gaseous phase is measured at 194nm. Under selected conditions for sequential analysis of ammonium and nitrate, linear relations were found between the peak heights of absorption signals and concentrations of ammonium (10-650mugml(-1)) and nitrate (20-800mugml(-1)). The limit of detections for ammonium and nitrate analysis were 8 and 10mugml(-1), respectively. The relative standard deviations of repeated measurements of 50mugml(-1) of ammonium and nitrate were 2.0, 2.9%, respectively. Maximum sampling rate was about 40 samples/h. The method was applied to the determination of ammonium in pharmaceutical products and the sequential determination of ammonium and nitrate in spiked water samples.

Flow-injection analysis of nitrate by reduction to nitrite and gas-phase molecular absorption spectrometry

Two flow-injection manifolds have been investigated for the determination of nitrate. These manifolds are based on the reduction of nitrate to nitrite and determination of nitrite by gas-phase molecular absorption spectrophotometry. Nitrate sample solution (300 microL) which is injected to the flow line, is reduced to nitrite by reaction with hydrazine or passage through the on-line copperized cadmium (Cd-Cu) reduction column. The nitrite produced reacts with a stream of hydrochloric acid and the evolved gases are purged into the stream of O2 carrier gas. The gaseous phase is separated from the liquid phase using a gas-liquid separator and then swept into a flow-through cell which has been positioned in the cell compartment of an UV-visible spectrophotometer. The absorbance of the gaseous phase is measured at 204.7 nm. A linear relationship was obtained between the intensity of absorption signals and concentration of nitrate when Cd-Cu reduction method was used, but a logarithmic relationship was obtained when the hydrazine reduction method was used. By use of the Cd-Cu reduction method, up to 330 microg of nitrate was determined. The limit of detection was 2.97 microg nitrate and the relative standard deviations for the determination of 12.0, 30.0 and 150 microg nitrate were 3.32, 3.87 and 3.6%, respectively. Maximum sampling rate was approximately 30 samples per hour. The Cd-Cu reduction method was applied to the determination of nitrate and the simultaneous determination of nitrate and nitrite in meat products, vegetables, urine, and a water sample.

Co-expression of CD56 and CD30 in lymphomas with primary presentation in the skin: clinicopathologic, immunohistochemical and molecular analyses of seven cases

BACKGROUND

Natural killer and natural killer-like T-cell lymphomas presenting in the skin usually demonstrate aggressive behavior, an angiocentric distribution and a characteristic immunophenotype. In contrast, primary cutaneous CD30+ lymphoproliferative disorders form a heterogeneous spectrum including anaplastic large cell lymphomas, the majority of which display a good prognosis. Lymphomas with co-expression of CD56 and CD30 are extremely rare and the significance of this co-expression is unknown.

METHODS

Seven retrospectively identified cases of lymphomas with co-expression of CD56 and CD30 presenting in the skin comprise this study. Immunohistochemistry, in situ hybridization for Epstein-Barr virus and T-cell receptor gene rearrangement studies were performed on paraffin sections.

RESULTS

This subset of cutaneous lymphomas showed a variable clinical course that ranged from resolution without treatment, treatment-failure and recurrence, to death from disease. Histologic, immunophenotypic and molecular studies were of limited utility in predicting prognosis.

CONCLUSIONS

Cutaneous lymphomas co-expressing CD56 and CD30 share many clinicopathologic features with natural killer and natural killer-like T-cell lymphomas or anaplastic large cell lymphomas, two entities with widely disparate clinical behavior. It is important to recognize that these lymphomas may behave more aggressively than primary cutaneous anaplastic large cell lymphomas do. Longer follow-up and further investigations on larger numbers of cases are necessary to fully characterize this rare subset of cutaneous lymphomas.

Pagetoid reticulosis (Woringer-Kolopp disease): an immunophenotypic, molecular, and clinicopathologic study

Pagetoid reticulosis (PR), also known as Woringer-Kolopp disease, is a form of cutaneous T-cell lymphoma that demonstrates striking epidermotropism on histologic examination. We present the histologic, immunologic, and molecular findings for seven patients who had PR. The patients ranged in age from 33 to 67 years. All patients presented with one or several thick plaques involving the distal extremities except for one patient, who presented with a tongue lesion. Immunohistochemical staining of the atypical lymphoid cells demonstrated a T-cell phenotype in all cases. In one of four frozen cases, the neoplastic cells were of T-helper cell phenotype (CD4 positive). Four of seven cases demonstrated a T-cytotoxic/suppressor cell phenotype (CD8 positive). The T-cell subset for the remaining two cases could not be determined. CD30 positivity and a high growth fraction as indicated by staining with Ki-67 were seen in three of seven and three of four cases, respectively. Genotypic analysis performed on three of our cases revealed T-cell receptor (gamma and/or beta) rearrangement, indicating a clonal proliferation. The clinical follow-up ranged from 15 months to 13 years. Four of seven patients are alive and free of disease after treatment with excision or local irradiation. One patient relapsed twice after treatment with radiation and photochemotherapy with 8-methoxypsoralen and UVA and was then lost to follow-up. The lesions of another patient resolved spontaneously but recurred at the same and in an additional site 5 years later. One patient recurred after electron beam therapy. The recurrent lesion improved with radiation therapy and local wound care but never resolved completely. The patient died of unrelated causes. Our findings suggest that PR is a distinct clinicopathologic entity, separate from unilesional mycosis fungoides, demonstrating a slow disease course. The disease is a clonal cutaneous T-cell lymphoma with relatively consistent clinical and histopathologic findings but a heterogeneous immunophenotypic profile.

IgM myeloma: case report with immunophenotypic profile

Immunoglobulin (Ig)M myeloma is a distinct subtype of multiple myeloma (MM) displaying clinical and pathologic features of both MM and Waldenström's macroglobulinemia (WM). Although the immunophenotypic characteristics of classic MM and WM have been reported, the surface antigen expression of IgM myeloma has not been reported. We report a case of IgM myeloma and describe its immunophenotypic profile using flow cytometry. The cells showed a hybrid MM-WM phenotype, strongly expressing CD38 but lacking CD45 and DR, typical for plasma cells; however, pan-B cell antigens CD20 and FMC7 as well as weak monoclonal surface Ig also were positive, resembling B-cell lymphoproliferative malignancies. Discordant B-cell antigen expression was present, in that pan-B antigens CD19 and CD22 were absent. In addition, B-cell activation antigen CD23, early B-precursor antigen CD10, and pan-T antigen CD5 were not expressed. Although CD20 and weak surface Ig expression have been reported in MM, FMC7 positivity has not been seen. The data therefore suggest that IgM myeloma may have a unique phenotype with characteristics of both MM and WM.

Immunohistochemical detection of aflatoxin B1-DNA adducts and hepatitis B virus antigens in hepatocellular carcinoma and nontumorous liver tissue

Monoclonal antibodies recognizing the stable imidazole ring-opened form of the major N7-guanine aflatoxin B1-DNA adduct have been used in competitive enzyme-linked immunosorbent assays (ELISA) and indirect immunofluorescence assays to quantitate adduct levels in liver tissue. Methods were developed in AFB1-treated animals, then applied to paired tumor and nontumor liver tissues of hepatocellular carcinoma patients from Taiwan. An avidin-biotin complex staining method was also used for of the detection of hepatitis B surface (HBsAg) and X (HBxAg) antigens in liver sections. A total of 8 (30%) hepatocellular carcinoma (HCC) samples and 7 (26%) adjacent nontumor liver tissue samples from Taiwan were positive for AFB1-DNA adducts. For HBsAg, 10 (37%) HCC samples and 22 (81%) adjacent nontumorous liver samples were positive, and 9 (33%) HCC samples and 11 (41%) adjacent nontumor liver samples were HBxAg positive. No association with AFB1-DNA adducts was observed for HBsAg and HBxAg. These methods should be useful in determining the role of exposure in the induction of HCC in Taiwan.

Aflatoxin B1-DNA adducts and hepatitis B virus antigens in hepatocellular carcinoma and non-tumorous liver tissue

Studies were carried out to test the hypothesis that exposure to aflatoxin B1 (AFB1) is common among individuals with hepatocellular carcinoma (HCC) who are also chronically infected with hepatitis B virus (HBV). Experiments were also carried out to determine whether there is a close association between the presence of AFB1-DNA adducts and the expression of one or more HBV antigens in the tumor or non-tumor regions of the liver. Twenty-seven paired tumor and non-tumor liver tissues of HCC patients from Taiwan were analyzed. Monoclonal antibody 6A10, generated against the imidazole ring-opened persistent form of the major N-7 guanine adduct of AFB1, was used for adduct detection by both indirect immunofluorescence and competitive enzyme-linked immunosorbent assay. An avidin-biotin complex staining method was used for the detection of HBsAg and HBxAg in liver sections. A total of 8 (30%) HCC samples and 7 (26%) adjacent non-tumor liver tissue samples from Taiwan were positive for AFB1-DNA adducts. For HBsAg, 10 (37%) HCC samples and 22 (81%) adjacent non-tumorous liver samples were positive while 9 (33%) HCC samples and 11 (41%) adjacent non-tumor liver samples were HBxAg-positive. No association with AFB1-DNA adducts was observed for HBsAg and HBxAg. These results suggest that both AFB1 exposure and carrier status of HBsAg/HBxAg may be involved in the induction of HCC in Taiwan.

Quantitation of aflatoxin B1-DNA adducts in woodchuck hepatocytes and rat liver tissue by indirect immunofluorescence analysis

A quantitative indirect immunofluorescence technique was developed utilizing a monoclonal antibody (6A10) recognizing the imidazole ring-opened form of the major N-7 guanine adduct of aflatoxin B1 (AFB1). This method was used to investigate adduct formation in woodchuck hepatocytes treated in culture and in liver tissue of rats treated i.p. with AFB1. Fluorescein isothiocyanate-labeled secondary antiserum was used for adduct localization in conjunction with 4',6-diamidino-2-phenylindole dihydrochloride staining to localize nuclei. Quantitation of AFB1-DNA adducts was carried out by densitometric analysis of photographic slides. Specific nuclear staining was observed in both woodchuck hepatocytes and rat liver tissue. There was a dose-response relationship between fluorescence intensity and AFB1 dose in treated animals. Turnover of adducts could also be followed in animals over 48 h with this method. DNA was isolated from liver tissue of treated animals and adduct levels were quantitated by competitive enzyme-linked immunosorbent assay with antibody 6A10 and by fluorescence spectroscopy. There was a significant correlation of the quantitative immunofluorescence intensity with levels of AFB1 adducts detected by enzyme-linked immunosorbent assay (r = 0.61, P less than 0.05) and spectrofluorescence (r = 0.78, P less than 0.01). This immunohistochemical method should be applicable to the detection of adducts in liver tissues of humans exposed to high levels of dietary AFB1.

Inhibitory effect of epinephrine on phosphatidate activity in isolated rat hepatocytes

The variations in phosphatidate phosphohydrolase activity were investigated in the post-mitochondrial fraction of isolated rat hepatocytes incubated for short periods with epinephrine, dibutyryl cyclic AMP or oleate. Epinephrine decreased the enzyme activity by 42% at 1 microM concentration. The inhibitory effect was abolished in the presence of a beta-adrenoceptor antagonist, propranolol, but was not affected by the alpha-adrenoceptor agonist, phenylephrine, or the agonist, phentolamine. Dibutyryl-cAMP inhibited the enzyme activity by 49%. The presence of the cyclic-AMP phosphodiesterase inhibitor, aminophyline, together with epinephrine slightly increased the enzyme inhibition. Oleate stimulated the enzyme activity (100%) and its effect was antagonized by dibutyryl-cyclic AMP (24%) and by epinephrine (15%). The results indicate that epinephrine acts on rat hepatocytes via beta-adrenoceptor activation and cAMP may be involved in the mechanism by which phosphatidate phosphohydrolase is regulated.

The effects of hydrazine on the phosphatidate phosphohydrolase activity in rat liver

Injection of hydrazine (0.7 mmole/kg) in the male fasting rats caused an increase in phosphatidate phosphohydrolase (PAP) activity in the soluble fraction of the liver. The increased PAP activity was parallel with a rise in hepatic triacylglycerol (TG) (3.5-fold) and in the catecholamine concentration (3.4-fold) in adrenal glands. Hydrazine also increased serum glucose. The hydrazine-induced increase in PAP activity and TG accumulation was completely prevented by adrenalectomy. The data suggest that increased PAP activity is at least partly responsible for hydrazine-induced fatty liver and that adrenal hormones may take part in the mechanism by which hydrazine exerts its effects on the liver.

A genetic variant of human erythrocyte glucose 6-phosphate dehydrogenase

Human erythrocyte G6PD activity was measured in more than 500 subjects in Isfahan, Iran, and the percent of enzyme deficiency for males and females are reported. Some properties of the abnormal enzyme is compared with its normal counterpart. Apparent Km values of glucose 6-phosphate for the variant and normal enzymes were 37 and 101 microM, respectively. The variant enzyme was less resistant to inhibition by 40 microM NADPH (72% inhibition) than the normal enzyme (48% inhibition). The mode of inhibition for both enzymes was competitive with NADP+. ATP at 1.5 mM concentration also inhibited normal and variant enzymes at 17% and 10%, respectively. The inhibition was competitive with glucose 6-phosphate. Polyacrylamide gel electrophores showed that normal enzyme has one major and another weak active bands, while the variant enzyme under identical conditions shows only one active band corresponding to the major band of the normal enzyme. Thermostability of variant G6PD was slightly lower that normal but no significant differences observed in their energy of activation. The activity pH profile of the variant enzyme was truncate.

Glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides. Isolation and sequence of a peptide containing an essential lysine

Interaction of glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides with pyridoxal 5'-phosphate and sodium borohydride leads to inactivation and modification of two lysine residues per enzyme dimer that are thought to bind glucose 6-phosphate [Milhausen, M., & Levy, H.R. (1975) Eur. J. Biochem. 50, 453-461]. The amino acid sequence surrounding this lysine residue is reported. Following tryptic hydrolysis of the modified enzyme, two peptides, each containing one pyridoxyllysine residue, were purified to homogeneity and subjected to automated Edman degradation. The sequences revealed that one of these, a heptapeptide, was derived from the other, containing 11 amino acids. Supporting evidence for the role of the modified lysine is provided in the following paper [Haghighi, B., & Levy, H.R. (1982) Biochemistry (second paper of three in this issue)]. End-group analysis of the native enzyme revealed that valine is the N-terminal and glycine the C-terminal amino acid and provides support for the identity of the enzyme's two subunits.

Glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides. Kinetics of reassociation and reactivation from inactive subunits

Glucose-6-phosphate dehydrogenase from Leuconostoc mesenteroides is denatured in 8 M urea and dissociated into its two inactive subunits. Denaturation leads to an approximately 80% decrease in protein fluorescence and a 20-nm red shift in the emission maximum. Upon dilution, the urea-treated enzyme regains catalytic activity (approximately 70%). The reactivated enzyme is indistinguishable from the native enzyme based on a number of physicochemical and enzymological criteria. The kinetics of renaturation and reactivation were monitored by measuring the rates of regain of native fluorescence and appearance of activity and the accessibility of histidine residues toward diethyl pyrocarbonate modification. Regain of native fluorescence was too rapid to measure at 25 degrees C; at 5 degrees C the initial phase was also too rapid, but a slower phase was monitored and shown to obey first-order kinetics with k = (5.9 +/- 1.3) x 10(-3) s-1. Reappearance of activity was measured at several protein concentrations; reactivation followed second-order kinetics with k = (4.85 +/- 0.47) x 10(-3) M-1 min-1. Reactivation was stimulated to different degrees by either the initial or delayed addition of NAD+, NADP+, or glucose 6-phosphate. During the initial, rapid phase of renaturation, approximately 3 of the enzyme's 12 histidine residues become unreactive toward diethyl pyrocarbonate; concomitant with the subsequent reactivation, approximately 7 more histidines become inaccessible to diethyl pyrocarbonate. The data are consistent with a model for enzyme renaturation and reactivation in which the unfolded subunits rapidly refold to an inactive structure that can dimerize slowly to generate native enzyme. Specific ligands stimulate reactivation by binding to refolded subunits or incompletely folded dimers.

Development of a sensitive high-performance liquid chromatographic method for detection of aflatoxins in pistachio nuts

A very sensitive method is described for the detection of aflatoxins in pistachio nuts. The method employs the extraction procedure used in the BF method (described in the Association of Official Analytical Chemists' Book of Methods) followed by an acid alumina column clean-up to remove sample components which would otherwise interfere in the final determinative step. The quantitation of the aflatoxins is carried out by high-performance liquid chromatography on a C18 reversed-phase column after conversion of aflatoxins B1 and G1 to their more fluorescent derivatives, B2a and G2a. The limit of detection was found to be 0.5 microgram/kg. The chromatograms were found to be free of interfering peaks and multiple injections showed excellent reproducibility.