Gastrodin Attenuates Colitis and Prevents Tumorigenesis in Mice by Interrupting TLR4/MD2/NF-ΚB Signaling Transduction

INTRODUCTION

Chronic inflammation is one of the causative factors for tumorigenesis. Gastrodin is a main active ingredient isolated from Gastrodia elata Blume, a famous medicinal herb with a long edible history.

AIM

This study aimed to explore the effects of gastrodin on colitis-associated carcinogenesis (CRC) in mice and to elucidate its potential molecular mechanisms.

METHODS

Balb/c mice were induced with azoxymethane (AOM) and dextran sulfate sodium (DSS) for 12 weeks. Gastrodin (50 mg/kg) was administered via oral gavage three times per week until the end of the experiment. Disease indexes, including body weight, bloody diarrhea, colon length, histopathological score, and tumor size, were measured. Tumor cell proliferation was evaluated by BrdU incorporation assay and tumor cell cytotoxicity was assessed by cell counting kit (CCK-8). The expression levels of toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-ΚB) signaling molecules, NF-ΚB luciferase, and pro-inflammatory cytokines were determined by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), immunoblotting, immunohistochemistry (IHC), enzyme-linked immunosorbent assay (ELISA), or reporter gene assays. The binding affinity between gastrodin and myeloid differentiation protein-2 (MD2) was analyzed by molecular docking and cellular thermal shift assay (CETSA).

RESULTS

Gastrodin administration was demonstrated to mitigate various CRC-related symptoms in mice, including weight loss, diarrhea, and tissue abnormalities. Notably, gastrodin suppressed tumor cell growth during colitis- associated tumorigenesis, resulting in fewer and smaller adenomas in the colon. Unlike irinotecan, a broadspectrum antitumor drug, gastrodin did not exhibit apparent cytotoxicity in various colorectal adenocarcinoma cell lines. Additionally, gastrodin downregulated TLR4/NF-ΚB signaling molecules and pro-inflammatory mediators in mice and macrophages. Molecular docking and CETSA experiments suggested that gastrodin binds to the MD2 protein, potentially interfering with the recognition of lipopolysaccharide (LPS) by TLR4, leading to NF-ΚB pathway inhibition.

CONCLUSION

This study provides evidence for the first time that gastrodin attenuated colitis and prevented colitisrelated carcinogenesis in mice, at least partially, by diminishing tumor-promoting cytokines through the interruption of TLR4/MD2/NF-ΚB signaling transduction.

Nuciferine alleviates collagen-induced arthritic in rats by inhibiting the proliferation and invasion of human arthritis-derived fibroblast-like synoviocytes and rectifying Th17/Treg imbalance

Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by persistent synovial inflammation and joint degradation, posing challenges in the development of effective treatments. Nuciferine, an alkaloid found in lotus leaf, has shown promising anti-inflammatory and anti-tumor effects, yet its efficacy in RA treatment remains unexplored. This study investigated the antiproliferative effects of nuciferine on the MH7A cell line, a human RA-derived fibroblast-like synoviocyte, revealing its ability to inhibit cell proliferation, promote apoptosis, induce apoptosis, and cause G1/S phase arrest. Additionally, nuciferine significantly reduced the migration and invasion capabilities of MH7A cells. The therapeutic potential of nuciferine was further evaluated in a collagen-induced arthritis (CIA) rat model, where it markedly alleviated joint swelling, synovial hyperplasia, cartilage injury, and inflammatory infiltration. Nuciferine also improved collagen-induced bone erosion, decreased pro-inflammatory cytokines and serum immunoglobulins (IgG, IgG1, IgG2a), and restored the balance between T helper (Th) 17 and regulatory T cells in the spleen of CIA rats. These results indicate that nuciferine may offer therapeutic advantages for RA by decreasing the proliferation and invasiveness of FLS cells and correcting the Th17/Treg cell imbalance in CIA rats.

Notoginsenoside R1 promotes Lgr5+ stem cell and epithelium renovation in colitis mice via activating Wnt/β-Catenin signaling

Inflammatory bowel disease (IBD) is characterized by persistent damage to the intestinal barrier and excessive inflammation, leading to increased intestinal permeability. Current treatments of IBD primarily address inflammation, neglecting epithelial repair. Our previous study has reported the therapeutic potential of notoginsenoside R1 (NGR1), a characteristic saponin from the root of Panax notoginseng, in alleviating acute colitis by reducing mucosal inflammation. In this study we investigated the reparative effects of NGR1 on mucosal barrier damage after the acute injury stage of DSS exposure. DSS-induced colitis mice were orally treated with NGR1 (25, 50, 125 mg·kg-1·d-1) for 10 days. Body weight and rectal bleeding were daily monitored throughout the experiment, then mice were euthanized, and the colon was collected for analysis. We showed that NGR1 administration dose-dependently ameliorated mucosal inflammation and enhanced epithelial repair evidenced by increased tight junction proteins, mucus production and reduced permeability in colitis mice. We then performed transcriptomic analysis on rectal tissue using RNA-sequencing, and found NGR1 administration stimulated the proliferation of intestinal crypt cells and facilitated the repair of epithelial injury; NGR1 upregulated ISC marker Lgr5, the genes for differentiation of intestinal stem cells (ISCs), as well as BrdU incorporation in crypts of colitis mice. In NCM460 human intestinal epithelial cells in vitro, treatment with NGR1 (100 μM) promoted wound healing and reduced cell apoptosis. NGR1 (100 μM) also increased Lgr5+ cells and budding rates in a 3D intestinal organoid model. We demonstrated that NGR1 promoted ISC proliferation and differentiation through activation of the Wnt signaling pathway. Co-treatment with Wnt inhibitor ICG-001 partially counteracted the effects of NGR1 on crypt Lgr5+ ISCs, organoid budding rates, and overall mice colitis improvement. These results suggest that NGR1 alleviates DSS-induced colitis in mice by promoting the regeneration of Lgr5+ stem cells and intestinal reconstruction, at least partially via activation of the Wnt/β-Catenin signaling pathway. Schematic diagram of the mechanism of NGR1 in alleviating colitis. DSS caused widespread mucosal inflammation epithelial injury. This was manifested by the decreased expression of tight junction proteins, reduced mucus production in goblet cells, and increased intestinal permeability in colitis mice. Additionally, Lgr5+ ISCs were in obviously deficiency in colitis mice, with aberrant down-regulation of the Wnt/β-Catenin signaling. However, NGR1 amplified the expression of the ISC marker Lgr5, elevated the expression of genes associated with ISC differentiation, enhanced the incorporation of BrdU in the crypt and promoted epithelial restoration to alleviate DSS-induced colitis in mice, at least partially, by activating the Wnt/β-Catenin signaling pathway.

Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

Medicinal and edible plant Allium macrostemon Bunge for the treatment of testosterone-induced androgenetic alopecia in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Allium macrostemon Bunge (AMB), a widely distributed wild garlic plant, possesses a variety of health-promoting properties. Androgenetic alopecia (AGA) is a common disorder that affects quality of life.

AIM OF THE STUDY

We sought to investigate whether AMB stimulates hair regrowth in AGA mouse model, and clarify the underlying molecular mechanisms.

MATERIALS AND METHODS

The chemical constituents of AMB water extract were identified by ultra-high performance liquid chromatography-quadrupole-time of flight-mass spectrometry (UPLC-Q/TOF-MS) analysis. Cell viability assay and Ki-67 immunostaining were undertaken to evaluate the impacts of AMB on human hair dermal papilla cell (HDPC) proliferation. Wound-healing assay was undertaken to assess cell migration. Flow cytometry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay were performed to examine cell apoptosis. Western blotting, real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and immunostaining assays were undertaken to determine the impacts of AMB on Wnt/β-catenin signaling and growth factors expression in HDPC cells. AGA mouse model was induced by testosterone treatment. The effects of AMB on hair regeneration in AGA mice were demonstrated by hair growth measuring and histological scoring. The levels of β-catenin, p-GSK-3β, and Cyclin D1 in dorsal skin were measured.

RESULTS

AMB promoted proliferation and migration, as well as the expression of growth factors in cultured HDPC cells. Meanwhile, AMB restrained apoptosis of HDPC cells by increasing the ratio of anti-apoptotic Bcl-2/pro-apoptotic Bax. Besides, AMB activated Wnt/β-catenin signaling and thereby enhancing growth factors expression as well as proliferation of HDPC cells, which was abolished by Wnt signaling inhibitor ICG-001. In addition, an increase of hair shaft elongation was observed in mice suffering from testosterone-induced AGA upon the treatment of AMB extract (1% and 3%). Consistent with the in vitro assays, AMB upregulated the Wnt/β-catenin signaling molecules in dorsal skin of AGA mice.

CONCLUSION

This study demonstrated that AMB promoted HDPC cell proliferation and stimulated hair regrowth in AGA mice. Wnt/β-catenin signaling activation, which induced production of growth factors in hair follicles and, eventually, contributed to the influence of AMB on the hair regrowth. Our findings may contribute to effective utilization of AMB in alopecia treatment.

[Pathological features of early gastric cancer and its background mucosa after eradication of Helicobacter pylori and their implications for biopsy diagnosis]

Objective: To investigate the clinicopathological changes of early gastric cancer, especially its background mucosa, after the eradication of Helicobacter pylori (H. pylori), and to investigate the causes of underdiagnosis in preoperative biopsy pathology. Methods: Ninety cases of early gastric cancer after H. pylori eradication and 120 cases of endoscopic submucosal dissection (ESD) specimens without H. pylori eradication and their corresponding biopsy specimens were collected from Beijing Friendship Hospital Affiliated to Capital Medical University during 2016-2021. The clinicopathological data of the patients were analyzed, and the histopathological characteristics and immunophenotypic results compared. Results: Compared with the early gastric cancer without H. pylori eradication history, the histopathological type of early gastric cancer after H. pylori eradication was differentiated adenocarcinoma, with staggered distribution of cancerous and non-cancerous epithelium in the tumor area. The morphologic characteristics of gastric mucosa in the background of early gastric cancer after H. pylori eradication, were distinctive, including widening of the opening of enterosylated glandular ducts, serrated change of luminal margin, eosinophilic and microvesicular cytoplasm of enterosylated epithelium. Low-grade atypia existed in gastric cancer epithelial cells after sterilization, which might lead to underdiagnosis or missed diagnosis in biopsy pathology. Conclusions: Early gastric cancer and its background mucosa after H. pylori eradication have unique morphological characteristics, which can be used as a clue for pathological diagnosis, improve the accuracy of biopsy pathology and reduce the underdiagnosis.

Berberine Improves Irinotecan-Induced Intestinal Mucositis Without Impairing the Anti-colorectal Cancer Efficacy of Irinotecan by Inhibiting Bacterial β-glucuronidase

Irinotecan (CPT11), a broad-spectrum cytotoxic anticancer agent, induces a series of toxic side-effects. The most conspicuous side-effect is gastrointestinal mucositis, including nausea, vomiting, and diarrhea. A growing body of evidence indicates that bacteria β-glucuronidase (GUS), an enzyme expressed by intestinal microbiota, converts the inactive CPT11 metabolite SN38G to the active metabolite SN38 to ultimately induce intestinal mucositis. We sought to explore the potential efficacy and underlying mechanisms of berberine on CPT11-induced mucositis. Our study showed that berberine (50 mg/kg; i. g.) mitigated the CPT11-induced loss of mucosal architecture, ulceration, and neutrophil infiltration. Meanwhile, berberine improved mucosal barrier function by increasing the number of globlet cells, protecting trans-endothelial electrical resistance (TEER), reducing permeability and increasing tight junction proteins expression. LC-MS analysis showed that berberine decreased the content of SN38 in feces, which correlated with decreases in both GUS activity and GUS-producing bacteria. Further molecular docking and Lineweaver-Burk plots analyses suggested that berberine functions as a potential non-competitive inhibitor against GUS enzyme. Of note, berberine maintained the anti-tumor efficacy of CPT11 in a tumor xenograft model while abrogating the intestinal toxicity of CPT11. Overall, we identified for the first time the remission effects of berberine on intestinal mucositis induced by CPT11 without impairing the anti-colorectal cancer efficacy of CPT11 partially via inhibiting bacterial GUS enzyme.

Microbiota-Host-Irinotecan Axis: A New Insight Toward Irinotecan Chemotherapy

Irinotecan (CPT11) and its active metabolite ethyl-10-hydroxy-camptothecin (SN38) are broad-spectrum cytotoxic anticancer agents. Both cause cell death in rapidly dividing cells (e.g., cancer cells, epithelial cells, hematopoietic cells) and commensal bacteria. Therefore, CPT11 can induce a series of toxic side-effects, of which the most conspicuous is gastrointestinal toxicity (nausea, vomiting, diarrhea). Studies have shown that the gut microbiota modulates the host response to chemotherapeutic drugs. Targeting the gut microbiota influences the efficacy and toxicity of CPT11 chemotherapy through three key mechanisms: microbial ecocline, catalysis of microbial enzymes, and immunoregulation. This review summarizes and explores how the gut microbiota participates in CPT11 metabolism and mediates host immune dynamics to affect the toxicity and efficacy of CPT11 chemotherapy, thus introducing a new concept that is called "microbiota-host-irinotecan axis". Also, we emphasize the utilization of bacterial β-glucuronidase-specific inhibitor, dietary interventions, probiotics and strain-engineered interventions as emergent microbiota-targeting strategies for the purpose of improving CPT11 chemotherapy efficiency and alleviating toxicity.

Alantolactone exhibits antiproliferative and apoptosis-promoting properties in colon cancer model via activation of the MAPK-JNK/c-Jun signaling pathway

Colorectal cancer (CRC) is one of the most common human malignancies in the digestive tract with high mortality. Alantolactone (ATL), as a plant-derived sesquiterpene lactone, has shown a variety of pharmacological activities, such as antibacterial, anti-inflammatory, anti-virus and so on. However, the exact molecular mechanism of ATL in colorectal cancer remains largely unknown. Here, we performed a study to explore the effect and mechanism of ATL on colorectal cancer. The CCK-8 assay, colony formation assay, Wound-healing and Transwell assays were performed to evaluate the cytotoxic effect, antiproliferative effect, anti-migratory and anti-invasive properties of ATL respectively. The xenograft tumor model was established in Balb/c mice to evaluate the anti-tumor effect. The expression levels of proteins involved the MAPK-JNK/c-Jun signaling pathway were measured by Western blot and RT-qPCR both in cells and tumor tissues. The results showed that ATL could inhibit the cells activities of various colon cancer cell lines. Moreover, ATL could induce HCT-116 cells nuclear pyknosis, mitochondrial membrane potential loss, G0/G1 phase arrest, as well as enhance the proportion of apoptosis cells and inhibit colony formation. The migration distance and invasion rate of cells were significantly reduced after treated with ATL. Additionally, in the xenograft model, ATL (50 mg/kg) significantly decreased the tumor tumor volume and weight (p < 0.001). For the anti-colon cancer mechanism, the ATL showed the anti-proliferative and pro-apoptosis effect by activating MAPK-JNK/c-Jun signaling pathway. In conclusion, ATL exhibits anti-proliferation and apoptosis-promoting potential in colon cancer via the activation of MAPK-JNK/c-Jun signaling pathway.

Use of traditional Chinese medicine as an adjunctive treatment for COVID-19: A systematic review and meta-analysis

BACKGROUND

This review aims to evaluate the supportive effects of frequently used traditional Chinese medicine (TCM) for the treatment of coronavirus disease 2019 (COVID-19).

METHODS

Five databases were searched through July 7, 2020. Randomized controlled trials investigating the efficacy of TCM for use in the treatment of COVID-19 were included. Newcastle-Ottawa Scale (NOS) and modified Jadad score were used for the evaluation of the methodological quality of the included studies. Weighted mean difference, odds ratio (OR), and 95% confidence interval (95% CI) were calculated for pooling out results. Data were extracted for conducting a meta-analysis using STATA version 12.0.

RESULTS

Eight studies with a total of 750 patients were included in this meta-analysis. All included trial groups involved treatment with TCM and Western medicine, while the control groups were treated only with Western medicine. The intervention therapy significantly improved the overall effective rate (n = 346, OR = 2.5, 95% CIs = 1.46-4.29), fever symptom disappearance rate (n = 436; OR = 3.6; 95% CIs = 2.13-6.08), fatigue symptom disappearance rate (n = 436; OR = 3.04; 95% CIs = 1.76-5.26), cough symptom disappearance rate (n = 436; OR = 2.91; 95% CIs = 1.36-6.19), and sputum production reduction (n = 436; OR = 5.51; 95% CIs = 1.94-15.64). Based on the Newcastle-Ottawa Scale assessment, 6 studies received a score of 4, and 1 study achieved a score of 5. One study was assessed using the modified Jadad score, achieving a score of 6.

CONCLUSIONS

The integration of TCM with Western medicine has significantly improved the treatment for COVID-19 patients compared to Western medicine treatment alone. Combined therapy using TCM and Western medicine revealed the potential adjunctive role of TCM in treating COVID-19. However, high-quality clinical studies are still required to further evaluate the efficacy and safety of TCM in the treatment of COVID-19.

Acacetin Ameliorates Experimental Colitis in Mice via Inhibiting Macrophage Inflammatory Response and Regulating the Composition of Gut Microbiota

Acacetin, a natural dietary flavonoid abundantly found in acacia honey and citrus fruits, reportedly exerts several biological effects, such as anti-tumor, anti-inflammatory, and anti-oxidative effects. However, the effects of acacetin on intestinal inflammation remain unclear. We sought to investigate whether acacetin ameliorates inflammatory bowel disease (IBD) in mice with dextran sulfate sodium (DSS)-induced ulcerative colitis (UC). Our results suggest that acacetin alleviates the clinical symptoms of DSS-induced colitis, as determined by body weight loss, diarrhea, colon shortening, inflammatory infiltration, and histological injury. Further studies showed that acacetin remarkably inhibited both the macrophage inflammatory response in vitro and levels of inflammatory mediators in mice with colitis. In addition, some features of the gut microbiota were disordered in mice with DSS-induced colitis, as evidenced by a significant reduction in microbiota diversity and a marked shift in bacterial profiles. However, acacetin treatment improved this imbalance and restored gut microbiota to levels that were similar to those in normal mice. In conclusion, our work presents evidence that acacetin attenuates DSS-induced colitis in mice, at least in part, by inhibiting inflammation and regulating the intestinal microbiota.

Obacunone reduces inflammatory signalling and tumour occurrence in mice with chronic inflammation-induced colorectal cancer

CONTEXT

Obacunone, a limonoid abundantly found in Citrus fruits, exhibits a variety of bioactivities.

OBJECTIVE

To investigate the effects of obacunone on a colorectal cancer (CRC) mouse model, and clarify its potential molecular mechanisms.

MATERIALS AND METHODS

The male Balb/c mice were induced with azoxymethane and dextran sulfate sodium for 12 weeks. Obacunone (50 mg/kg) was administered via oral gavage three times every week until the end of the experiment. Disease indexes including body weight, spleen weight, bloody diarrhea, colon length, histopathological score, and tumor size were measured. The anti-proliferation activities of obacunone were analyzed by MTT or flow cytometry. The expression of protein and mRNA related to cell proliferation or inflammatory cytokines was determined by Western blot, q-PCR and IHC.

RESULTS

Obacunone significantly alleviated bloody diarrhea, colon shortening (7.35 ± 0.2128 vs. 8.275 ± 0.2169 cm), splenomegaly, histological score (9 ± 0.5774 vs. 6 ± 0.5774) and reduced tumor size (4.25 ± 0.6196 vs. 2 ± 0.5669). Meanwhile, the expression of protein and mRNA related to cell proliferation or inflammatory cytokines was remarkably decreased in tumor tissue. Obacunone inhibited the proliferation activities of colorectal cancer cells. Moreover, obacunone induced colorectal cancer cells G1 and G2 phases arrest, and suppressed the expression of cell cycle genes.

CONCLUSIONS

Obacunone could alleviate CRC via inhibiting inflammatory response and tumor cells proliferation. The results may contribute to the effective utilization of obacunone or its derivatives in the treatment of human CRC.

Gender differences in spontaneous coronary artery dissection: a nationwide analysis

Background

Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. Unfortunately, SCAD can result in significant morbidities and mortality. The pathological mechanism has not been fully clarified yet but hormonal changes might represent a sufficiently convincing explanation for some patients with SCAD. We hypothesized that gender difference in mortality in SCAD patients.

Methods

Data for this retrospective cohort study were extracted from the Nationwide Inpatient Sample for 2014 using the 9th revision of the International Classification of Diseases (ICD) 414.12 (spontaneous coronary artery dissection). Demographics, in-hospital mortality, conventional risk factors (diabetes, hypertension, hyperlipidemia, alcohol and tobacco abuse), acute critical illnesses like sepsis, septic shock, stroke, acute respiratory insufficiency, acute renal failure, and chronic conditions (anxiety, depression, malignancy and metastatic diseases) were studied. Univariate and multivariate logistic regression modeling were performed to determine predictors associated with the development of inpatient mortality in SCAD patients. All analyses were conducted using R 3.4.0 and STATA/MP 14.2. All p-values were two-sided, and statistical significance was determined at the level of p&lt;0.05.

Result

A total of 270 SCAD patients were identified. Of those SCAD patients, no fibromuscular dysplasia (FMD) or pregnancy were identified. Patients were predominantly women (71%) and the mean age was 53 years. Overall in-hospital mortality was 5.6%, with 6.6% in male and 5.3% in female. Ethnicity, gender, stroke, acute renal failure, anxiety and depression did not predict mortality, length of stay, annual income, total hospital charge (all p&gt;0.05). Multivariate analysis revealed no gender difference in SCAD patients and no independent predictors of mortality were identified.

Conclusions

This large nationwide study reveals that SCAD may be underdiagnosed but underutilization of work up such as FMD. SCAD is thought to be hormone related likely associated with female gender. Our results showed that no gender difference in mortality. Further large prospective studies are needed to determine gender difference in mortality and other predictors in mortality.

Funding Acknowledgement

Type of funding source: None

Breast cancer patients have lower in-hospital mortality after acute coronary syndrome, a 5 year nationwide analysis

Background

Breast cancer and cardiovascular disease (CVD) share common risk factors, and breast cancer therapies are well known to cause cardiotoxicity. Prior studies highlighted the higher burden coronary artery disease and the importance to further assess its consequences on breast cancer patients.

Purpose

We sought to evaluate the revascularization rate and in-hospital short-term outcomes of breast cancer patients following acute coronary syndrome (ACS) compared to the general female population.

Methods

We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify female patients with principal diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina). Two subgroups were identified, women with a history of breast cancer and women without, and were propensity matched.

Multivariate regression analyses were performed to evaluate the impact of breast cancer on primary outcome (in-hospital mortality) and secondary outcomes: occurrence of shock, acute kidney injury (AKI), mechanical ventilation (MV), and length of stay (LOS). We also compared the rate of cardiac procedures. Statistical significance of odd ratios (OR) is defined with p-value&lt;0.05 and reported 95% confidence intervals (CI).

Results

We identified a total of 245,563 female patients with primary diagnosis of ACS, among them 10,625 (4.3%) had a history of breast cancer. The comorbidity of breast cancer was associated with statistically significant lower rates of mortality (OR 0.83, CI 0.74–0.94), shock (OR 0.87, CI 0.77–0.99), AKI (OR 0.90, CI 0.82–0.98), MV (OR 0.81, CI 0.71–0.92) and relative 5.4% decrease in LOS (CI: −7.8%, −3.0%). The cardiac procedural rates were similar for left heart catheterization (OR 0.96, CI 0.90–1.02), for percutaneous coronary intervention (OR 0.95, CI 0.89–1.02) and for CABG (OR 0.88, CI 0.78–1.00) compared to control group.

Conclusion

Breast cancer patients received a comparable catheterization and revascularization procedure rate and exhibited a statistically significant lower morbidity and mortality rates during hospitalization after an ACS event compared to the general female population.

Funding Acknowledgement

Type of funding source: None

Correlation of serum vitamin A, D, and E with recurrent respiratory infection in children

OBJECTIVE

To investigate the correlation of serum vitamin A, D, and E levels with a recurrent respiratory infection (RRI) in children.

PATIENTS AND METHODS

The medical records of 422 children with RRI (a study group) in Cangzhou Central Hospital from January 2015 to December 2018 were retrospectively analyzed (the study group was divided into an active group and a stable group). Further 100 healthy children who underwent physical examination at the same time were enrolled as a control group. High-performance liquid chromatography (HPLC) was used to determine vitamin A, D, and E levels, so as to analyze their differences between the groups.

RESULTS

Vitamin A, D, and E in the active and stable groups were significantly lower than those in the control group (p < 0.001); in the active group they were significantly lower than those in the stable group (p < 0.001). According to partial correlation analysis, in children with active RRI, vitamin A was respectively positively correlated with vitamin D (r=0.945, p < 0.001), and vitamin E (r=0.988, p < 0.001). Moreover, vitamin E was positively correlated with vitamin D (r=0.959, p < 0.001).

CONCLUSIONS

The deficiency of vitamin A, D, and E is positively correlated with the disease activity of children with RRI. Therefore, the supplement of vitamin A, D, and E through dietary adjustment is beneficial to the rehabilitation of the children.

Regulation of the intestinal microbiota: An emerging therapeutic strategy for inflammatory bowel disease

The rapid development of metagenomics, metabolomics, and metatranscriptomics provides novel insights into the intestinal microbiota factors linked to inflammatory bowel disease (IBD). Multiple microorganisms play a role in intestinal health; these include bacteria, fungi, and viruses that exist in a dynamic balance to maintain mucosal homeostasis. Perturbations in the intestinal microbiota disrupt mucosal homeostasis and are closely related to IBD in humans and colitis in mice. Therefore, preventing or correcting the imbalance of microbiota may serve as a novel prevention or treatment strategy for IBD. We review the most recent evidence for direct or indirect interventions targeting intestinal microbiota for treatment of IBD in order to overcome the current limitations of IBD therapies and shed light on personalized treatment options.

Activation of PXR by Alpinetin Contributes to Abrogate Chemically Induced Inflammatory Bowel Disease

Alpinetin is a naturally occurring flavonoid from the ginger plants. We previously reported the identification of alpinetin as a ligand of human pregnane X receptor (hPXR). The current study investigated the role of alpinetin as a putative PXR activator in ameliorating chemically induced inflammatory bowel disease (IBD). We found that oral administration of alpinetin significantly alleviated the severity of dextran sulfate sodium (DSS)-induced colitis in mice by decreasing the inflammatory infiltration, the levels of the pro-inflammatory mediators, and the PXR target genes in the colon. In vitro, alpinetin blocked the nuclear translocation of p-p65 in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. Further, alpinetin significantly upregulated PXR target genes and inhibited TNF-α-induced NF-κB-luciferase activity in LS174T colorectal cells; however, this regulatory effects were lost when cellular PXR gene was knocked down. In PXR transactivation assays, alpinetin increased both mouse and human PXR transactivation in a dose-dependent manner. Ligand occluding mutants, S247W/C284W and S247W/C284W/S208W, in hPXR-reporter assays, abrogated alpinetin-induced hPXR transactivation. Finally, alpinetin bound to the hPXR-ligand-binding domain (LBD) was confirmed by competitive ligand binding assay. The current study significantly extends prior observations by validating a PXR/NF-κB regulatory mechanism governing alpinetin's anti-inflammatory effects in a murine model of IBD.

Obacunone Protects Against Ulcerative Colitis in Mice by Modulating Gut Microbiota, Attenuating TLR4/NF-κB Signaling Cascades, and Improving Disrupted Epithelial Barriers

Obacunone, a natural limonoid compound abundantly distributed in citrus fruits, possesses various biological properties, such as antitumor, antioxidant, and antiviral activities. Recent studies suggested an anti-inflammatory activity of obacunone in vitro, but its efficacy on intestinal inflammation remains unknown. This study was designed to evaluate the effects and mechanisms of obacunone in ameliorating intestinal inflammation in a mouse model of ulcerative colitis (UC). We found that obacunone efficiently alleviated the severity of dextran sulfate sodium (DSS)-induced mouse UC by modulating the abnormal composition of the gut microbiota and attenuating the excessive activation of toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling. The intestinal epithelial barrier was disrupted in DSS colitis mice, which was associated with activation of inflammatory signaling cascades. However, obacunone promoted the expression of tight junction proteins (TJP1 and occludin) and repressed the activation of inflammatory signaling cascades. In summary, our findings demonstrated that obacunone attenuated the symptoms of experimental UC in mice through modulation of the gut microbiota, attenuation of TLR4/NF-κB signaling cascades, and restoration of intestinal epithelial barrier integrity.

Inflammatory Bowel Disease: A Potential Result from the Collusion between Gut Microbiota and Mucosal Immune System

Host health depends on the intestinal homeostasis between the innate/adaptive immune system and the microbiome. Numerous studies suggest that gut microbiota are constantly monitored by the host mucosal immune system, and any slight disturbance in the microbial communities may contribute to intestinal immune disruption and increased susceptibility to inflammatory bowel disease (IBD), a chronic relapsing inflammatory condition of the gastrointestinal tract. Therefore, maintaining intestinal immune homeostasis between microbiota composition and the mucosal immune system is an effective approach to prevent and control IBD. The overall theme of this review is to summarize the research concerning the pathogenesis of IBD, with particular focus on the factors of gut microbiota-mucosal immune interactions in IBD. This is a comprehensive and in-depth report of the crosstalk between gut microbiota and the mucosal immune system in IBD pathogenesis, which may provide insight into the further evaluation of the therapeutic strategies for IBD.

Abstract P2-02-10: Circulating level of GP88/Progranulin is associated with clinical outcome and overall survival in stage 4 breast cancer patients

Monitoring of disease status in metastatic breast cancer (MBC) patients is a necessary step for an optimal management of patients during and post-therapy. Imaging technologies are the methods of choice in the standard of care to monitor therapy response and disease status in MBC patients. These methods are expensive, time-consuming and have limited sensitivity for real time monitoring. Measurements of circulating tumor markers CA15-3, CA125 and CEA have contributed, albeit with limitation, minimally invasive methods for MBC disease management. It is our hypothesis that measuring biomarkers involved in tumor biological processes may provide better evaluation of the disease state and thus aid real-time clinical management of MBC patients. Thus, addition of such new circulating disease biomarkers may improve the management of MBC patients. The 88kDa glycoprotein Progranulin (GP88/PGRN) fit these criteria. GP88/PGRN is expressed in tumor tissue and not in normal mammary tissue counterpart and secreted in the circulation of BC patients. Biological studies have established GP88/PGRN as a critical driver of BC cell proliferation, survival, invasiveness and drug resistance. Clinical studies have demonstrated that high tumor GP88/PGRN expression was prognostic for recurrence and that breast cancer patients had a statistically elevated GP88/PGRN serum level compared to healthy individuals. In the present study, we examined whether GP88/PGRN serum levels were elevated in MBC patients and whether GP88/PGRN circulating levels were correlated with patient clinical outcome and overall survival.

Under an IRB approved protocol at the University of Maryland Greenebaum Comprehensive Cancer Center, 101 stage 4 BC patients undergoing standard of care therapy and meeting the inclusion criteria were consented and enrolled. MBC patients' demographics, clinical and disease characteristics and therapies were collected as part of the study. Blood samples were collected from each patient at specific times at follow-up visits during and post-therapy. The prepared serum was stored at -80C until tested for GP88 using a GP88 enzyme linked immunoassay developed in our laboratory.

Statistical analysis using Kaplan-Meier functions established whether there was a correlation between GP88/PGRN serum level and overall survival in MBC patients. MBC patients with distinct survival characteristics (P=0.0002) could be stratified based on their circulating GP88/PGRN levels. Analysis of this association was carried out in MBC patients based on their age, race, tumor characteristics, receptor status and metastatic burden (number and sites of metastasis) and will be reported. We conclude that circulating levels of GP88/PGRN in MBC patients are correlated with overall survival and that monitoring circulating GP88/PGRN levels would provide additional information and valuable insight into real-time MBC disease status.

This work was supported by grant R43 CA 210817-01A1 to GS.

Citation Format: Serrero G, Hawkins D, Hicks D, Rosenblatt P, Tait N, Yue B, Tkaczuk K. Circulating level of GP88/Progranulin is associated with clinical outcome and overall survival in stage 4 breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-10.

[A retrospective study of 54 cases with chronic otitis media prepared for staging tympanoplasty]

Objective:To analyze the clinical effect of 54 cases with chronic otitis media prepared for staging tympanoplasty and 19 cases finished staging ossicular reconstruction surgery, evaluate the advantages of different surgery technique.Method:Fifty-four cases with chronic otitis media were planned for staging tympanoplasty surgery and had been received the first stage surgery. Silicagel plates were placed in the tympanic cavity in order to prevent adhesions. Among them, 19 cases had received the second stage ossicular reconstruction, including 10 cases with TORPs and 9 cases with PORPs. The average air bone gaps (ABG) were measured at four frequencies: 500, 1 000, 2 000 and 4 000 Hz.Result:Among the 54 cases, 45 cases had swollen mucosa in the tympanic cavity and eustachian tube, 18 cases had tympanic fibrous adhesions, and 12 cases had fixed or sclerotic stapes. The preoperative ABG of the 54 cases were (38.26±7.88)dB. As for the 19 cases finished the second stage surgery, their preoperative ABG in the first stage were (39.21±7.05)dB, the preoperative ABG in the second stage were (38.82±11.43)dB, and the postoperative ABG after the second stage were (21.77±11.92)dB. The hearing function after staging tympanoplasty was significantly improved compared with the preoperative hearing in the first and the second stage operation (P< 0.01). In addition, the second stage surgery of three cases was postponed because of a good postoperative hearing with (10.42±10.63)dB ABG after the first stage surgery. Up to now, none of the 54 cases suffered from facial palsy, infection and other complications after surgery.Conclusion:Staging tympanoplasty is an important technique to improving hearing and reducing the complications, especially for the cases with chronic otitis media unsuitable for one stage reconstruction of ossicular chain.

Abstract P1-03-06: Improvement in risk predictive value of Nottingham prognostic index by determining GP88 tumor tissue expression for estrogen receptor positive breast cancer patients

Background: The Nottingham Prognostic Index (NPI), which includes nodal status, tumor size and histological grade was established to provide predictive value information on post-surgery survival for primary breast cancer patients. Attempts to improve NPI's performance have included addition of other biomarker expression and morphological features such as vascular invasion. In the present study, we investigated whether expression of the autocrine growth and survival factor GP88 (progranulin), known to be overexpressed in breast cancer, whereas it is negative in normal mammary tissue, would improve NPI's predictive value.

Methods: We examined the tumor tissue GP88 expression by immunohistochemistry (IHC) in formalin fixed paraffin embedded tissue sections from 508 cases of estrogen receptor positive (ER+) invasive ductal carcinoma (IDC) with known clinical outcomes (disease-free and overall survivals) and with known NPI. GP88 IHC tumor tissue expression was determined using an anti-GP88 antibody (clone 6B3) developed in our laboratory. GP88 expression was scored (0, 1+, 2+, 3+) by two board certified pathologists and classified into two IHC score groups of GP88 &lt; 3+ (0, 1+, 2+) and GP88 = 3+. The correlation between GP88 scoring, NPI and disease-free (DFS) and overall survival (OS) outcomes was then examined by Kaplan Meier analysis, Cox proportional Hazard (CPH) ratio and Pearson's C2 test.

Results: Kaplan-Meier survival graphs categorized by NPI scores (&lt; 3.4, 3.4-5.4, and &gt;5.4) and by GP88 expression (&lt; 3+ and 3+) showed that for each NPI subgroup, patients with GP88 IHC score of 3+ had a worse disease-free survival (DFS) and overall survival (OS) than patients within the same NPI subgroup with tumors that had GP88 IHC score &lt; 3+. When adjusted for NPI, high GP88 score was highly significantly associated with recurrence with a hazard ratio of 3.30 (95% CI 2.12 to 5.14).

Conclusions: The data suggest that measuring GP88 tumor tissue expression by IHC at time of diagnosis for breast cancer patients with primary ER+ IDC could provide recurrence prediction and survival information complementary to that provided by the determination of NPI alone and thus may be useful for risk management of patients diagnosed with breast cancer.

Citation Format: Serrero G, Hawkins DM, Bejarano PA, Ioffe O, Tkaczuk KR, Elliott RE, Head JF, Phillips J, Godwin AK, Weaver J, Hicks D, Yue B. Improvement in risk predictive value of Nottingham prognostic index by determining GP88 tumor tissue expression for estrogen receptor positive breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-06.

Abstract P1-02-12: Determination of a serum progranulin (GP88/PGRN) level associated with overall survival in metastatic breast cancer patients

Imaging technologies are the methods of choice in the standard of care (SOC) to monitor therapy response in metastatic breast cancer (MBC) patients. However, such methods are expensive and have limited sensitivity to detect disease response in a timely manner. Measurement of the circulating tumor markers such as CA15-3, CA27.29 and CEA has provided additional minimally invasive methods in disease management of MBC patients. While useful, they have limitations in providing clinicians with a reliable insight into real-time disease monitoring. Understanding of real-time biological processes may provide better biomarkers of the disease state and thus aid real-time clinical management of MBC patients by identifying circulating disease associated biomarkers. Thus, addition of such new circulating biomarkers may improve the management of MBC patients. We have characterized a target biomarker that would fit these criteria, the 88kDa glycoprotein Progranulin (GP88). GP88 is expressed in tumor tissue and not in normal mammary tissue counterpart and is secreted in the circulation of BC patients. Biological studies have established GP88 as one of the critical drivers for breast cancer cell proliferation, survival, invasiveness and drug resistance. Clinical studies have demonstrated that elevated GP88 tumor levels were prognostic for recurrence and that breast cancer patients had a statistically elevated GP88 serum level than healthy individuals. Using tissue and serum tests to detect and quantify GP88 could provide an new strategies for identifying patients at high risk of recurrence and monitoring disease progression in BC patients undergoing therapy. In the present study, we examined whether GP88 serum levels were elevated in MBC patients and whether GP88 serum levels were correlated to patient overall survival.

Under an IRB approved protocol, 92 MBC patients that met the inclusion criteria and were undergoing therapy at the UMGCCC Breast Clinic were consented and enrolled. Clinical and disease characteristics along with serum CA15-3 values were collected as part of the study. Serum samples were collected from each patient during therapy and subsequently the patients were monitored. The serum was stored at -80C until tested for GP88 using a GP88 enzyme linked immunoassay developed in our laboratory.

Statistical analysis using Kaplan-Meier functions established whether there was a correlation between GP88 serum level and overall survival in MBC patients. By analyzing the KM plots at different GP88 cut points, we identified two populations with distinct survival characteristics. When examined more thoroughly the difference in overall survival of patients with &lt;60ng/ml and &gt;60ng/ml was statistically significant (P=0.0002). Correlation analysis of serum GP88 and CA15-3 were performed and will be presented.

We conclude that circulating levels of GP88 in MBC patients are correlated with overall survival. It would appear that patients that can be managed to have a GP88 below 60ng/ml will survive longer. Thus measuring circulating GP88 levels would provide additional information to that available in today's SOC for monitoring. This valuable insight into real-time disease status will assist clinicians in patient management.

Citation Format: Serrero G, Hawkins DM, Yue B, Hicks D, Tait N, Tkaczuk KR. Determination of a serum progranulin (GP88/PGRN) level associated with overall survival in metastatic breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-02-12.

Holocord spinal epidural abscess: Case report and literature review

Holocord spinal epidural abscess (SEA) is a rare condition. To our knowledge, five cases of SEA have been reported so far, and no consensus has been made on the treatment yet. In this article, we report a case of holocord SEA and review literature to further understanding of SEA. The advent of antibiotic treatment and the recognition of surgical debridement have been important in searching for alternatives to recovery, so the patient was treated surgically together with systemic antibiotics. The patient remained neurologically stable and continued to be clinically in good condition without any low back pain after 1 year. Surgical drainage, together with systemic antibiotics, is the main treatment choice for extensive SEAs. Although treatment should be considered that highlights the importance of examining the factors related to the health and condition of the patients and the anatomy and extent of the abscess, early surgical treatment associated with prolonged antibiotic treatment is necessary.

FERMT1 mediates epithelial-mesenchymal transition to promote colon cancer metastasis via modulation of β-catenin transcriptional activity

We previously demonstrated that fermitin family member 1 (FERMT1) was significantly overexpressed in colon cancer (CC) and associated with poor metastasis-free survival. This study aimed to investigate the precise role of FERMT1 in CC metastasis and the mechanism by which FERMT1 is involved in the epithelial-mesenchymal transition (EMT). Correlations between FERMT1 and EMT markers (E-cadherin, Slug, N-cadherin and β-catenin) were examined via immunohistochemistry in a cohort of CC tissues and adjacent normal colon mucosae. A series of in vitro and in vivo assays were performed to elucidate the function of FERMT1 in CC metastasis and underlying mechanisms. The upregulated expression of FERMT1 in CC tissues correlated positively with that of Slug, N-cadherin and β-catenin, but correlated inversely with E-cadherin expression. Altered FERMT1 expression led to marked changes in the proliferation, migration, invasion and EMT markers of CC cells both in vitro and in vivo. Investigations of underlying mechanisms found that FERMT1 interacted directly with β-catenin and activated the Wnt/β-catenin signaling pathway by decreasing the phosphorylation level of β-catenin, enhancing β-catenin nuclear translocation and increasing the transcriptional activity of β-catenin/TCF/LEF. Activation of the Wnt/β-catenin pathway by CHIR99021 reversed the effect of FERMT1 knockdown, whereas inhibition of the Wnt/β-catenin pathway by XAV939 impaired the effect of FERMT1 overexpression on EMT and cell motility. In conclusion, findings of this study suggest that FERMT1 activates the β-catenin transcriptional activity to promote EMT in CC metastasis.

Abstract OT3-03-03: A prospective study of glycoprotein 88 (GP-88) blood test in healthy women undergoing screening for breast cancer (BC) with mammography (MM)

Background: Population based BC screening with XRAY mammography (MM) has been widely accepted as standard of care for women aged 40+ with average risk of developing BC. Sensitivity and specificity of MM is dependent on breast tissue density and up to ∼20% of BC are undetected by MM. The development of a dependable, low cost blood-based BC screening test to increase the sensitivity and specificity of currently existing BC screening methods is needed.

Rationale: GP88 is expressed & secreted by BC cells & is not expressed by normal mammary epithelial cells, 2 retrospective randomized multi-site trials (a training study & a validation study of 300 cases each) demonstrated that elevated GP88 expression in estrogen positive (ER+) invasive BC was statistically correlated with a 4-fold increase in the risk of 5-yr BC recurrence. GP88 was an independent predictor of BC recurrence in multivariate analysis of other factors such as PR expression, tumor size, grade, lymph node status & stage. The quantitative GP88 EIA was developed to determine the amount of GP88 in biological fluids. The blood based EIA assay is highly specific for GP88 & both sensitive & linear over a wide dynamic range, i.e. detection of GP88 concentrations from 0.1 to 20ng/ml. A baseline GP-88 level of28.4 ± 5 ng/ml was established by us for healthy volunteers (HV). In BC pts a statistically significant increase of serum GP88 was observed in early stage pts (40.7 ± 16 ng/ml; p=0.007). Stratification of BC pts according to their clinical outcomes shows that pts having no evidence of disease (NED) have serum GP88 levels within the range of HV. These data suggest that pts with breast tumors express & secrete high levels of GP88.

Objectives: 1. To determine prospectively GP-88 blood levels in HV at average risk of developing BC screened by MM & in women with recently biopsy-confirmed BC. 2. To establish the statistical distribution of GP88 serum levels in subjects by baseline BIRAD classification (1-6). 3. To determine if the initial GP88 level is predictive of change in BIRADS classification from baseline to 12-mos follow-up. 4. To determine if baseline GP88 level is predictive of the appearance of BC at 12 mos follow-up in HV who were cancer-free at study entry.

Inclusion Criteria: Female, aged &gt;=40 yrs old, presenting for screening or diagnostic MM or diagnostic workup and/or biopsy due to abnormal MM &lt;= to 12 wks before study entry.

Study procedures: Serum levels of GP88 in subjects with average BC risk factors will be measured prospectively at baseline; 3-6 mos & 6-12 mos & correlated with BIRADS reading of the screening MM, BIRADS 1-6; GP88 serum level will be correlated with pathologic results of breast biopsies performed on subjects with suspicious BIRADS (4 & 5) MM & final pathologically confirmed diagnosis of breast cancer as BIRADS 6.

Study Progress: The study is ongoing; currently we have 308 subjects enrolled, the total number of subjects will be up to 725 & screened up to 1400. Study is UM IRB approved & is conducted at the University od Maryland Medical Center (UMMC) and UM Baltimore Washington Medical Center (BWMC). Funding is provided by Maryland Industry Partnership Grant (MIPS)& Avon Grant No. 02-2013-018.

Citation Format: Tkaczuk KHR, Campassi C, Kesmodel S, Bellavance E, Rosenblatt P, Nichols E, Feigenberg SJ, Coughlin P, Drogula C, Urban B, Galandak J, Dromi S, Kuo L, Yue B, Hicks D, Serrero G. A prospective study of glycoprotein 88 (GP-88) blood test in healthy women undergoing screening for breast cancer (BC) with mammography (MM). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-03-03.

Abstract P3-05-12: Combination of anti-progranulin (GP88/PGRN) antibody and letrozole inhibits tumor formation of letrozole resistant breast cancer cell lines

The 88 kDa glycoprotein GP88 (Progranulin, PCDGF, acrogranin) is the largest member of the granulin/epithelin family of growth modulators identified as a driver of tumorigenesis. GP88 (PGRN) was also shown to be overexpressed in invasive ductal carcinoma (IDC)whereas it was negative in benign tumors and normal mammry epithelial tissue, thereby establishing GP88 as a therapeutic and diagnostic target in breast cancer (BC). Our laboratory has developed validated tools to measure GP88 in tumor biopsies and biological fluids as well as blocking its action. WE showed that GP88 was secreted and detected in the serum of BC patients at an increased level when compared to healthy subjects. Pathological studies with 530 cases of ER+ IDC with clinical outcomes showed that GP88 tumor expression was an independent prognostic indicator of recurrence in early stage BC patients. Training study followed by an independent validation study demonstrated that high GP88 tissue expression (GP88 3+) was associated with a 4-fold increase in risk of recurrence at 5 years. A neutralizing anti-GP88 antibody AG1 was expressed in a high yield CHO cell line was developed. The present study examined the effect of AG1 in letrozole resistant cell line AGLetR developed by long term selection in letrozole supplemented medium. This cell line showed decreased letrozole responsiveness in vivo and therefore constituted an excellent model for investigating letrozole resistance in vitro as well as in vivo. Here we report the results of studies investigating the effect of various doses of AG1 on LetR tumor development in combination with letrozole for AGLetR. We show that treatment with AG1 (10 mg/kg i.p.) in combination with letrozole was efficient to maintain long term responsiveness and inhibit tumor growth. Letrozole alone (5mg/kg) was unable to inhibit tumor growth and showed a doubling of tumor volume. Interestingly, long term combination treatment lead to tumor regression and inhibited tumor growth.

These data suggest that inhibiting GP88 could provide a novel and alternative therapeutic strategy for patients with resistance to anti-estrogen therapy, being tamoxifen or letrozole.

This works is supported by 2R44CA124179, HHSN 261201200060C, and HHSN2612014400C from NCI.

Citation Format: Serrero G, Dong J, Yue B, Hicks D, Hayashi J. Combination of anti-progranulin (GP88/PGRN) antibody and letrozole inhibits tumor formation of letrozole resistant breast cancer cell lines. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-05-12.

Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs

BACKGROUND

The contralateral femur is often used as reference for reconstruction in unilateral hip joint pathology. The objective of this study was to quantify the side-to-side variation in proximal femur. We hypothesized that significant side-to-side differences exist between left and right femur with implications for preoperative planning and leg length discrepancy following hip arthroplasty.

MATERIALS AND METHODS

CT-based 3D femoral models were reconstructed for 122 paired femurs in 61 young healthy subjects (46.9±6.8 years) with no history of hip pathology. Side-to-side differences of several femoral morphologic parameters, including femoral head diameter, femoral anteversion, horizontal offset and femoral head center location, were compared and correlated with demographic factors using multiple linear regression.

RESULTS

Significant side-to-side differences (P<0.01) were found in femoral anteversion (4.3±3.8°; range: 0.2° to 17.3°), horizontal offset (2.5±2.1mm; range: 0.1 to 10.3mm), and femoral head center location (7.1±3.8mm; range: 0.5 to 19.4mm). The difference in femoral anteversion was strongly correlated with the difference in neck diameter (R(2)=0.79), whereas the difference in horizontal femoral offset was highly correlated with the head diameter difference (R(2)=0.72). Femoral head center difference was correlated with the femoral anteversion, horizontal offset and neck-shaft-angle difference (R(2)=0.82).

DISCUSSION

Relying on the anatomic landmarks of the contralateral femur during hip arthroplasty may not necessarily result in restoration of native anatomy and leg-length. Knowledge of the baseline side-to-side asymmetry could provide a range of error that would be tolerable following hip reconstruction.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Retrospective observational study.

Delayed healing of lower limb fractures with bisphosphonate therapy

INTRODUCTION

Bisphosphonate therapy (BT) is used commonly in the management of osteoporosis. A systematic review was conducted investigating delayed union of lower limb, long bone fractures in patients on BT. We specifically assessed whether BT increases the risk of delayed union or non-union in lower limb, long bone fractures.

METHODS

A literature search was conducted in the PubMed and Embase™ on 4 November 2014. Articles that investigated lower limb fractures, history of BT and fracture union were included in the review.

RESULTS

A total of 9,809 papers were retrieved and 14 were deemed suitable for this review. The mean time to union in patients on BT was 8.5 months. A longer time to union was reported in a study investigating BT users versus controls (6.5 vs 4.8 months respectively). The mean rate of delayed or non-union for BT associated atypical fractures was 20% per fracture. Specifically in one study, delayed union was more common in the cohort with more than three years of BT (67%) than in the group with less than three years of BT (26%). Surgical fixation was associated with improved outcomes compared with non-operative management.

CONCLUSIONS

BT has been described to be associated with multiple adverse outcomes related to atypical fractures. Current evidence recommends operative management for this patient group. Further investigation is required to evaluate the exact effects of BT on lower limb fractures, in particular typical femoral fractures.

Comparison of 1-day vs 2-day dosing of high-dose melphalan followed by autologous hematopoietic cell transplantation in patients with multiple myeloma

High-dose melphalan at 200 mg/m(2) can be administered in 1 day or over 2 consecutive days before autologous hematopoietic cell transplantation (HCT) for multiple myeloma (MM). Limited data exist on the comparison of the two dosing schedules. A retrospective study of 278 consecutive MM patients receiving high-dose melphalan from January 2010 to December 2012 was conducted. Objectives were to compare the length of hospitalization, toxicity profile, response rates, PFS and OS. One hundred and eighty five patients received 2-day dosing and 93 received 1-day dosing. The two end points of the 95% confidence interval (CI) for the difference did not exceed the preselected margin, therefore the length of hospitalization was considered equivalent. No significant differences were found for response rates, PFS and OS.  The toxicity profile was similar with the exception of more frequent ⩾grade 3 oral mucositis in the 2-day group (13.5% vs 5.4%; odds ratio 3.07 (95% CI:1.11-8.48); P=0.03). High-dose melphalan, given either in 1 day or over 2 days, produced comparable treatment outcomes except for increased grade 3/4 mucositis in the 2-day regimen. One-day dosing could shorten the hospital stay by 1 day and may allow better resource utilization.

Comparative outcomes for three-dimensional conformal versus intensity-modulated radiation therapy for esophageal cancer

Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.

Knockdown of neuropilin-1 suppresses invasion, angiogenesis, and increases the chemosensitivity to doxorubicin in osteosarcoma cells - an in vitro study

OBJECTIVES

Neuropilin-1 (NRP-1) is a novel co-receptor for vascular endothelial growth factor (VEGF). NRP-1 expression in osteosarcoma tissues was significantly higher, and high NRP-1 expression was more frequently occurred in osteosarcoma tissues with advanced clinical stage, positive distant metastasis and poor response to chemotherapy. We tested a hypothesis that the NRP-1 gene plays a role in the invasiveness, angiogenesis and chemoresistance of human OS.

MATERIALS AND METHODS

To determine the role of NRP-1 in OS, NRP-1 was stably transfected into the human OS cell line MG-63 to increase the NPR-1 level, and NRP-1 siRNA was stably transfected into the human OS cell line SaOS-2 to knockdown of NRP-1. The effect of NRP-1 on invasion and angiogenesis was assessed by Matrigel invasion assay and in vitro angiogenesis assay. Chemosensitivity to doxorubicin was assessed by MTT assay in the MG-63 and SaOS-2 cells following NRP-1 overexpression or siRNA-induced downregulation of NRP-1.

RESULTS

The NRP-1 transfected MG-63 cells showed a markedly higher level of invasion in Matrigel invasion assay. The capillary-like structure formation of endothelial cells was also increased by coculture with the NRP-1 transfected MG-63 cells. On the contrary, the NRP-1 siRNA transfected SaOS-2 cells showed a markedly lower level of invasion in Matrigel invasion assay. The capillary-like structure formation of endothelial cells was also repressed by coculture with the NRP-1 siRNA transfected SaOS-2 cells. NRP-1 overexpression in MG-63 cells increased survival of cells after exposure to doxorubicin. In contrast, downregulation of NRP-1 expression in SaOS-2 cells markedly increased chemosensitivity after exposure to doxorubicin.

CONCLUSIONS

We suggest that NRP-1 could be used as a biomarker for OS progression and a novel therapeutic or chemopreventive target for human OS treatment.

ERK5 silencing inhibits invasion of human osteosarcoma cell via modulating the Slug/MMP-9 pathway

OBJECTIVE

ERK5 is over expressed in a many of human cancers and this overexpression has been associated with metastasis and invasion. Furthermore, ERK5 silencing inhibits aggressive phenotypes of cancer cells. However, mechanisms by which ERK5 regulates tumour progression or metastasis have not been elucidated. In this study, using human osteosarcoma cell lines U2OS as a model, we explored the involvement of ERK5 silencing on invasiveness of U2OS cells.

MATERIALS AND METHODS

ERK5 siRNA targeting ERK5 was stably transfected into the human osteosarcoma cell lines U2OS. ERK5 knocked-down U2OS cells was then transfected with Slug cDNA or MMP-9 cDNA plasmid to re-express Slug or MMP-9. Cell proliferation was detected by MTT assay. Cell invasion and metastasis was detected by Matrigel invasion and wound healing assay. An orthotopic nude mouse model of U2OS was applied for in vivo lung metastasis experiments. ERK5, Slug, MMP-9 and E-cadherin were analyzed by real-time PCR, and Western blotting.

RESULTS

ERK5 silencing by siRNA in U2OS cells decreased Slug and MMP-9 expression. Compared with the vector-transfected cells, ERK5 knocked-down cells showed reduced migration and invasion in vitro, as well as decreased metastatic potential in experimental metastasis. Re-expression of Slug or MMP-9 in ERK5 knocked-down cells restored the invasive phenotypes. We also discovered that Re-expression of Slug in ERK5 knocked-down cells restored the MMP-9 expression, and re-expression of MMP-9 in ERK5 knocked-down cells did not affect Slug and ERK5 expression.

CONCLUSIONS

Our data suggest that ERK5 knockdown inhibits aggressive behaviour of human U2OS cells through modulating Slug signaling and MMP-9 expression.

Abstract P5-09-05: Progranulin (GP88) expression and letrozole resistance in breast cancer

The 88 kDa glycoprotein GP88 (Progranulin, PCDGF, acrogranin) is the largest member of the granulin/epithelin family of growth modulators. GP88 was originally characterized in our laboratory through a biological screen to identify drivers of tumorigenesis. Published studies have established that GP88 represents an ideal therapeutic and diagnostic target in breast cancer (BC) leading to the development of validated tools to measure GP88 in tumor biopsies and biological fluids as well as blocking its action. It was shown that: 1) GP88 expression increases with tumorigenesis; 2) in ER+ breast cancer cells, GP88 stimulates proliferation and its overexpression confers estrogen independence and resistance to several anti-estrogens and aromatase inhibitor; 3) inhibition of GP88 expression by antisense transfection inhibited proliferation in vitro and in vivo; 4) In Her-2 overexpressing breast tumors, GP88 stimulated Her-2 phosphorylation and conferred trastuzumab resistance; 5) GP88 is expressed in 80% invasive ductal carcinoma (IDC) and 60% of ductal carcinoma whereas it is negative in lobular carcinoma, benign lesions and normal mammary tissues; 6) GP88 is secreted and can be detected in the serum of BC patients at an increased level when compared to healthy subjects; 7) Pathological studies with 530 cases of ER+ IDC with clinical outcomes showed that GP88 tumor expression was an independent prognostic indicator of recurrence in early stage BC patients. Training study followed by an independent validation study demonstrated that high GP88 tissue expression (GP88 3+) was associated with a 4-fold increase in risk of recurrence at 5 years.

Since GP88 displays not only diagnostic but also therapeutic potentials, we developed a neutralizing anti-GP88 antibody AG1 that inhibited GP88 biological effect (proliferation and migration) in a dose-dependent fashion in vitro. AG1 was expressed in a high yield CHO cell line and formulated. We have shown that in tamoxifen resistant cells, treatment with AG1 would inhibit tumor growth and restore tamoxifen sensitivity. The present study examined the effect of AG1 in letrozole resistant cells. We have developed from a letrozole sensitive cell ER+ BC cell line, a letrozole-resistant cell line by long term selection in letrozole-supplemented medium. This cell line (LetR) shows also decreased letrozole responsiveness in vivo and therefore constitutes an excellent model for investigating letrozole resistance in vivo as well as in vivo. Here we investigated the effect of various doses of AG1 on LetR tumor development alone or in combination with letrozole. Treatment with AG1 (10 mg/kg i.p.) in combination with letrozole was efficient to maintain long term responsiveness to letrozole and inhibited tumor growth. In addition to the mouse xenografts study, an IRB approved clinical study examines changes in GP88 circulating levels in patients with resistance to aromatase inhibitors. Preliminary data will be presented.

In conclusion, inhibiting GP88 could provide a novel and alternative therapeutic strategy for patients with resistance to anti-estrogen therapy, being tamoxifen or letrozole.

This work is supported by 2R44CA124179 and HHSN 261201200060C from NCI and 02- 2013-018 from the Avon Foundation for Women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-05.

Abstract P2-10-40: Correlation between expression of the prognostic marker Progranulin (GP88) with Oncotype Dx Recurrence Score in estrogen receptor positive breast tumors

Background: GP88 (Progranulin, acrogranin) is an 88kDa glycoprotein overexpressed in breast tumors and involved in their proliferation and survival. Biological studies have shown that GP88 in ER+ breast cancer cells was associated with estrogen independence and resistance to anti-estrogen therapies and aromatase inhibitors. In addition, GP88 stimulated migration, invasion and angiogenesis, hallmarks of metastasis. Pathological studies have demonstrated that GP88 was preferentially expressed in invasive ductal carcinoma while lobular carcinoma was mostly negative. No expression was found in normal mammary tissue. Two retrospective studies totaling 530 cases of ER+ formalin-fixed paraffin-embedded invasive ductal carcinoma (IDC) established that high GP88 expression was associated with a 4-fold increase in risk of recurrence and 2.5-fold increase in death when compared to low GP88 scores. Multivariate analysis showed that GP88 remains a predictor of recurrence even when adjusted for prognostic factors such as tumor size, grade, stage, lymph node status and age. High level of GP88 was also found to be elevated in the serum of breast cancer patients when compared to healthy individuals. Since GP88 tumor tissue expression appears as a prognostic factor for ER+ breast cancer, we proposed to investigate whether GP88 tumor tissue expression would correlated to Oncotype Dx® Recurrence Score which is now for early stage ER+ node negative breast cancer patients.

Methods: Eight five cases from women ages 37–77 with ER+ invasive mammary carcinoma from three different institutions and with an available Oncotype Dx recurrence score were selected with approval from each site's IRB. GP88 expression was determined by immunohistochemistry (IHC) using the anti-human GP88 6B3 monoclonal antibody (A&G) on a Ventana automated staining platform. For all cases examined, GP88 IHC scores (0, 1+, 2+, 3+) were compared to routine clinicopathologic factors (tumor size, grade, and stage), PR, HER2/neu and Ki67 expression (by image analysis) and to their Oncotype DX® recurrence score (Genomic Health). The associations of GP88 with the parameters described above were assessed by t test or ANOVA.

Results: The GP88 tissue expression correlated with Oncotype Dx Recurrence score (p &lt; 0.03) as well as with Ki-67 index (p &lt; 0.004). Age, HER2/neu and PR status did not correlate with GP88 expression. Details of these finding will be presented here.

Conclusion: This study shows that GP88, an important tumor aggressiveness indicator, significantly correlates with Oncotype DX score and confirms that GP88 correlates with other tumor clinicopathologic parameters and prognostic markers. Further studies are underway to determine whether GP88 in combination with routine markers, particularly Ki67, could be used instead of Oncotype DX Assay to predict outcome and provide information for the management of ER+ breast cancer patients.

This study is supported by grant 02–2010-010 from the Avon Foundation for Women.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-40.

P2-12-32: Association between Progranulin (GP88) Expression and Recurrence Risk for Breast Cancer Patients with Estrogen Receptor Positive Invasive Ductal Carcinoma

Purpose: GP88 (progranulin) is a critical player of breast tumorigenesis for estrogen receptor positive (ER+) breast cancer. Pathological studies showed that GP88 was expressed in invasive ductal carcinoma (IDC), but not in normal mammary tissue, benign lesions or lobular carcinoma. The present study examines GP88 prognostic significance in association with recurrence risk for patients with ER+ IDC.

Patients and Methods: Two retrospective multi-site clinical studies examined GP88 expression by immunohistochemistry (IHC) analysis in paraffin-embedded tumor tissues in correlation with patients’ survival outcomes. The training study established a GP88 cut-off value associated with decreased disease-free (DFS) and overall (OS) survivals. The validation study verified the GP88 cut-off value and compared GP88 prognostic information with other prognostic factors in multivariate analysis.

Results: GP88 expression is associated with a statistically significant increase in recurrence risk for ER+ IDC patients. The training study established that GP88 3+ score by IHC analysis was associated with decreased DFS (p=0.0004) and OS (p=0.0036). The independent validation study verified that GP88 3+ score for the high risk group and demonstrated that GP88 3+ score was associated with a 5.9-fold higher hazard of disease recurrence and a 2.5-fold higher mortality hazard compared to patients with tumor GP88&lt;3+. GP88 remained an independent risk predictor after considering age, nodal status, tumor size, tumor grade, progesterone receptor expression, treatment and disease stage.

Conclusion: Our training and validation studies demonstrate that the survival factor GP88 is a prognostic biomarker, predictive of recurrence risk and increased mortality for ER+ IDC patients, independent from other prognostic factors. These results provide support for measuring GP88 tissue expression for newly diagnosed early stage breast cancer patients.

This work was supported by grants R43CA124179, and U01CA113916 from the National Cancer Institute, grants 07-2007-064 and 02-2010-010 from the Avon Foundation for Women.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-32.

Isolation and characterization of twelve polymorphic microsatellite loci in the buff-throated partridge (Tetraophasis szechenyii)

Twelve polymorphic microsatellite markers were isolated from an AC-enriched genomic library of Buff-throated partridge (Tetraophasis szechenyii). The allele number of these loci ranged from three to 13 (average 7.75 per locus) in tested individuals. Polymorphism information content ranged from 0.532 to 0.882 with an average of 0.721. Average observed and expected heterozygosities were 0.559 (range from 0.240 to 0.792) and 0.772 (range from 0.621 to 0.910), respectively. These microsatellite markers will be useful for the assessment of genetic diversity, relatedness identification of family and analysis of population structure in wild buff-throated partridge.

GP88 Serum Level Is Increased in Breast Cancer Patients with Disease Progression

GP88 (progranulin) is an 88-kDa glycoprotein autocrine growth factor that plays a critical role in breast tumorigenesis. GP88 is expressed in human BC tumors in a positive correlation with their tumorigenicity. In estrogen receptor positive (ER+) cells, GP88 expression is low and is stimulated by estradiol whereas in ER negative (ER-) cells, it is constitutively overexpressed. In ER+ cells, increased GP88 expression was found to be associated with resistance to anti-estrogen therapy. In Her-2 overexpressing breast tumors, increased GP88 expression was associated with Herceptin resistance. Inhibition of GP88 expression in human breast adenocarcinoma cells resulted in a drastic reduction of tumor incidence and tumor growth in nude mice. Immunohistochemical studies carried out with 206 paraffin-embedded human breast biopsies have shown that GP88 is expressed in invasive ductal carcinomas in correlation with expression of markers of poor prognosis whereas normal tissues and benign breast lesions were negative. Importantly, high GP88 expression in tissue biopsies was accompanied by decreased disease-free and overall survival. Since GP88 contains a signal peptide for secretion, we have shown that GP88 can be found in serum. An IRB approve blood sampling study of 189 patients (Race: Caucasian- 91, African American-92, Asian-6; median age- 51 with a range from 26 to 81) established at the University of Maryland demonstrated that GP88 was measurable in serum and that GP88 serum level was statistically elevated in breast cancer patients when compared to healthy individuals. Median level of GP88 was 40.7 ng/ml (range 6.4-80) in early stage (stage 1 –3) BC pts (p- value = 0.007) and 45.3 ng/ml (range 9.8 to 158.4) in stage 4 metastatic BC patients (p-value= 0.0007). Statistically significant increase in circulating GP88 level was found in early stages as well as in metastatic disease when compared to healthy individuals.Since we have shown that GP88 tissue expression was associated with increased disease recurrence, the present study was focused on examining whether GP88 serum level was also increased in disease progression and could be used to monitor disease recurrence. Our data show that patients with disease recurrence or progression presented a 5 to 10 fold increase in their GP88 serum levels.This study identifies GP88 as a measurable biomarker for recurrence or disease progression not only at the tissue but also at the serum level.This study is supported by grants from MIPS, the Avon Foundation and from the National Cancer Institute.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6040.