The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region

INTRODUCTION

The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma.

MATERIALS AND METHODS

This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated.

RESULTS

Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d).

CONCLUSION

Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

Dual inhibition of MEK1/2 and MEK5 suppresses the EMT/migration axis in triple-negative breast cancer through FRA-1 regulation

Triple-negative breast cancer (TNBC) presents a clinical challenge due to the aggressive nature of the disease and a lack of targeted therapies. Constitutive activation of the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) pathway has been linked to chemoresistance and metastatic progression through distinct mechanisms, including activation of epithelial-to-mesenchymal transition (EMT) when cells adopt a motile and invasive phenotype through loss of epithelial markers (CDH1), and acquisition of mesenchymal markers (VIM, CDH2). Although MAPK/ERK1/2 kinase inhibitors (MEKi) are useful antitumor agents in a clinical setting, including the Food and Drug Administration (FDA)-approved MEK1,2 dual inhibitors cobimetinib and trametinib, there are limitations to their clinical utility, primarily adaptation of the BRAF pathway and ocular toxicities. The MEK5 (HGNC: MAP2K5) pathway has important roles in metastatic progression of various cancer types, including those of the prostate, colon, bone and breast, and elevated levels of ERK5 expression in breast carcinomas are linked to a worse prognoses in TNBC patients. The purpose of this study is to explore MEK5 regulation of the EMT axis and to evaluate a novel pan-MEK inhibitor on clinically aggressive TNBC cells. Our results show a distinction between the MEK1/2 and MEK5 cascades in maintenance of the mesenchymal phenotype, suggesting that the MEK5 pathway may be necessary and sufficient in EMT regulation while MEK1/2 signaling further sustains the mesenchymal state of TNBC cells. Furthermore, additive effects on MET induction are evident through the inhibition of both MEK1/2 and MEK5. Taken together, these data demonstrate the need for a better understanding of the individual roles of MEK1/2 and MEK5 signaling in breast cancer and provide a rationale for the combined targeting of these pathways to circumvent compensatory signaling and subsequent therapeutic resistance.

SAT-337 Disruption Of The Circadian Melatonin Signal By Dim Light At Night Promotes Bone-lytic Breast Cancer Metastases

Breast cancer metastasis to bone is a major source of morbidity and mortality in women with advanced metastatic breast cancer. Morbidity from metastasis to bone is compounded by the fact that they cannot be surgically removed and can only be treated with chemotherapy and/or radiation therapy. Thus, there is critical need to develop new treatment strategies that kill bone metastatic tumors and reduce osteolytic lesions to improve patient quality of life and extend patient survival. Circadian rhythms are daily cycles of ~24 h that control many if not most physiologic processes and their disruption by exposure to light at night (LAN) or jet lag has been shown to be strongly associated with the development of cancer, particularly breast cancer. We have found that disruption of the anti-cancer circadian hormone melatonin (MLT) by light at night can significantly enhance the metastatic potential in breast cancer cells. Our work supports the report of the International Agency for Research on Cancer that shift work is a “probable human carcinogen” and highlights the association between exposure to light at night and invasive breast cancer. We recently reported that human breast tumor xenografts grown in athymic nude female rats housed in a photoperiod of 12h light at day: 12h dim light at night (dLAN, 0.2 lux - blocks the nighttime circadian MLT signal), display resistance to doxorubicin (Dox). More importantly, tumor growth and drug resistance could be blocked by the administration of Dox in circadian alignment with nocturnal MLT during dLAN. Our recent preliminary studies show that poorly invasive ERα positive MCF-7 breast cancer cells, when injected into the tibia (to mimic bone metastatic disease) of Foxn1^nu athymic nude mice (which produce a strong circadian nighttime melatonin signal) housed in a dLAN photoperiod (suppressed nocturnal MLT production) developed full blown breast cancer tumors in bone (P<0.05) that are highly osteolytic (P<0.05). Moreover, patients with metastatic breast cancer are routinely treated with doxorubicin, which itself can promote bone damage. Our studies demonstrate that MLT slows the growth of metastatic breast cancer in bone but that the chrono-therapeutic use of doxorubicin in circadian alignment with melatonin in Foxn1^nu mice with tibial breast tumors, reduced tumor growth in bone, reduced bone erosion, and promoted the formation of new bone. Successful use of this chronotherapeutic use of Dox and MLT in clinical trials increasing efficacy in preventing or suppressing breast cancer metastasis to bone while decreasing toxic side effects of doxorubicin would provide a revolutionary advancement in the treatment of bone metastatic breast cancer and decrease the morbidity and mortality associated with breast cancer metastasis to bone. Acknowledgements: Louisiana Clinical and Translational Science Center (LACATS) visiting scholar program award and pilot grant to MA.

OR30-4 Parathyroid Hormone-related Peptide Antagonist and Inverse Agonist Reduce Breast Cancer Metastasis to Bone and Bone Loss

Bone is the most frequent site for breast cancer metastasis. Metastatic cancer cells secrete parathyroid-hormone related peptide (PTHrP) that stimulates bone turnover, releasing growth factors and creating a cavity for tumor growth. Current treatments include bisphosphonates and the RANK Ligand inhibitors that have limited efficacy. PTHrP antagonists have failed clinically due to rapid drug turnover and kidney side effects causing hypocalcemia. We synthesized two novel PTHrP antagonists that are fused to an inert bacterial collagen binding domain (CBD) of colG collagenase from Clostridium histolyticum. The collagen binding activity directs PTH analogs to the bone matrix where it blocks PTHrP action. PTH(7-33)-CBD is an amino truncated PTHrP antagonist fused to the CBD that we previously showed reduced metastatic tumor burden in bone and prevented bone destruction. We now compare PTH(7-33)-CBD to [W2]PTH(1-33)-CBD, an inverse agonist at the PTH/PTHrP receptor. In vitro neither drug induced PTH receptor activation in SaOS-2 osteosarcoma cells as measured by cAMP accumulation. Both compounds partially antagonized PTH(1-34) agonist-induced cAMP accumulation. Importantly, [W2]PTH(1-33)-CBD reduced agonist-stimulated cAMP accumulation by >95% (vs. 71% for PTH(7-33)-CBD) exceeding that reported previously for any PTH antagonist. Both compounds induced apoptosis of MDA-MB-231 breast cancer cells in vitro. In vivo testing was performed with an established mouse model of breast cancer bone metastasis using a bone-trophic variant of MDA-MB-231 breast cancer cells expressing luciferase (MDA-MB-231-BM/luc+). 24 hours after drug administration (1000 µg/kg administered IP), MDA-MB-231-BM/luc+ cells were injected intratibially into nude mice. PTH(7-33)-CBD significantly reduced tumor burden in bone (P<0.05) compared to both vehicle control (VC) (weeks 4-8), and to control PTH(7-34) antagonist that lacks the CBD (weeks 6-7). [W2]PTH(1-33)-CBD showed a trend towards decrease in tumor burden but did not reach statistical significance. Both PTH(7-33)-CBD and [W2]PTH(1-33)-CBD significantly reduced osteolytic lesions (P<0.05) compared to VC and PTH(7-34) weeks 3-8 and weeks 6-8, respectively. Drug treatments did not significantly affect animal weight nor alter serum calcium, alkaline phosphatase or N-terminal propeptide of Type 1 procollagen (PN1P)&nbsp;bone formation marker. Tartrate resistant acid phosphatase (TRAP), a marker of bone removal, was significantly reduced by treatments. In summary, a new PTHrP inverse agonist, [W2]PTH(1-33)-CBD, partially suppressed basal signaling of the PTH/PTHrP receptor and demonstrated a higher degree of antagonist activity in-vitro than any PTH antagonist published to date. It is expected that the superior antagonist activity of [W2]PTH(1-33)-CBD will provide significant tumor protection against breast cancer metastasis to bone.

OR26-2 Phosphorylation of Estrogen Receptor Alpha is Required for Mammary Gland Development and MCF-7 Breast Tumor Response to Estradiol and Tamoxifen

Serine-167 (S167) is a major phosphorylation site in estrogen receptor alpha (ERα) and a predictor for endocrine therapy response in breast cancer. We previously showed using stable transfection that mutation of S167 to alanine (S167A) impacted MCF-7 breast cancer cell growth and morphology. Using CRISPR, we evaluated S167A mutation in the endogenous ERα gene in MCF-7 breast cancer cells and xenograft tumors. In vitro, MCF-7 cells with wildtype ERα (WT) exhibited >60% increase in growth after 4 days incubation with 10^-9 M 17-β estradiol (E2), and >300% decrease in growth after 4 days incubation with 10^-8 M 4-hydroxy-tamoxifen (TAM) as assessed by MTS assay. In marked contrast, S167A cells showed resistance to both E2 growth stimulation and TAM growth arrest. WT cells exhibited >300% increase in migration after 24 hr E2 as assessed by Boyden Chamber assay. S167A cells exhibited >3 fold increase in basal migration compared to WT cells but were insensitive to E2 stimulation of migration. RNAseq was performed on WT and S167A cells incubated with E2 or vehicle (6 hr). Sequencing data was assessed using FastQC and sequenced libraries mapped to the human genome (UCSC hg38) using STAR RNAseq aligner. RNASeq data was normalized using TMM. Differential expression analysis by edgeR revealed significant differences in gene expression between WT and S167A cells. Vehicle-treated S167A cells exhibited 623 differentially regulated genes compared to WT cells. Notably, S167A cells exhibited marked E2 resistance with only 9 genes regulated by E2 in S167A cells compare to 93 genes in WT cells. In tumor xenograft experiments using ovariectomized nude mice, similar to WT tumors the S167A tumors did not grow in the absence of implanted 17 beta-estradiol (0.72 mg/pellet; 60 day release) demonstrating dependency of S167A tumors on E2 for tumor establishment and growth. However, unlike WT tumors that exhibited tumor regression with E2 + TAM (5 mg/pellet;&nbsp;60 day release) treatment (week 4, P<0.05), S167A tumors were resistant to TAM and exhibited continued growth similar to E2 alone treatment. Serine-212 (S216 in mouse) is a phosphorylation site located between the two zinc fingers in the DNA binding domain and is highly conserved in the nuclear receptor superfamily. To understand the importance of ERα phosphorylation for mammary gland development, ERα knock-in (KI) mice (Esr1^S216A) that express the ERα S216A mutation were evaluated. Mammary glands were whole-mounted with carmine-alum from 5 week-old pubertal female ERα wildtype (WT) and KI mice (n=3). KI mice exhibited a significant decrease in ductal elongation (P<0.05), number of terminal end buds (P<0.01) and branching morphogenesis (P<0.01) compared to WT mice. Collectively, these results demonstrate that S216 phosphorylation is critical for mouse mammary gland development and S167 phosphorylation is required for MCF-7 breast tumor response to estradiol and tamoxifen.

Drug resistance profiling of a new triple negative breast cancer patient-derived xenograft model

Background

Triple-negative breast cancer (TNBC) represents an aggressive subtype with limited therapeutic options. Experimental preclinical models that recapitulate their tumors of origin can accelerate target identification, thereby potentially improving therapeutic efficacy. Patient-derived xenografts (PDXs), due to their genomic and transcriptomic fidelity to the tumors from which they are derived, are poised to improve the preclinical testing of drug-target combinations in translational models. Despite the previous development of breast and TNBC PDX models, those derived from patients with demonstrated health-disparities are lacking.

Methods

We use an aggressive TNBC PDX model propagated in SCID/Beige mice that was established from an African-American woman, TU-BcX-2 K1, and assess its metastatic potential and drug sensitivities under distinct in vitro conditions. Cellular derivatives of the primary tumor or the PDX were grown in 2D culture conditions or grown in mammospheres 3D culture. Flow cytometry and fluorescence staining was used to quantify cancer stem cell-like populations. qRT-PCR was used to describe the mesenchymal gene signature of the tumor. The sensitivity of TU-BcX-2 K1-derived cells to anti-neoplastic oncology drugs was compared in adherent cells and mammospheres. Drug response was evaluated using a live/dead staining kit and crystal violet staining.

Results

TU-BcX-2 K1 has a low propensity for metastasis, reflects a mesenchymal state, and contains a large burden of cancer stem cells. We show that TU-BcX-2 K1 cells have differential responses to cytotoxic and targeted therapies in 2D compared to 3D culture conditions insofar as several drug classes conferred sensitivity in 2D but not in 3D culture, or cells grown as mammospheres.

Conclusions

Here we introduce a new TNBC PDX model and demonstrate the differences in evaluating drug sensitivity in adherent cells compared to mammosphere, or suspension, culture.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5401-2) contains supplementary material, which is available to authorized users.

Implementation of an Emergency Medical Card and a Continuity of Care

Objectives: To describe the design and implementation procedures for an emergency medical card (EMC) and a continuity of care (CoC) report using the continuity of care record (CCR) standard. We also describe studies to evaluate the effectiveness of these documents in Co C.

Methods: We convened weekly planning, design, development, implementation, and evaluation meetings, involving 25 outpatient clinics at Intermountain Healthcare. The CCR standard schema and documentation from American Society for Testing and Materials were used to develop the data model. An outside consultant provided further advice on committee-approved designs. We then developed a functional design document for the CCR application implementation. Healthcare professionals (medical doctors and physician assistants) and fourth-year medical students will simulate the will simulate the EMC and CoC report use and assess their usefulness in Co C. The reviewers will review three randomly selected patient cases, using patient information in the electronic medical record, EMC and CoC report. A structured questionnaire with Likert scale will assess the reviewers’ perceptions of the documents’ usefulness in medical decision making. Other studies will compare patient- and HCP-entered data to evaluate the effect of patient-entered data on the quality of HCP-entered data and assess user-satisfaction with the documents’ usefulness in Co C.

Results: An automated CCR application compliant with the CCR standard was developed and integrated in an already implemented patient portal at the Intermountain Healthcare clinics. Patients use the application to view, add, modify their information and use the data plus EMR data to create EMC and CoC report.

Conclusions: The CCR standard can be used to implement an application to enable patients to not only view but add or modify personal health records, and create, print and share paper EMC and CoC report with HCPs. The documents can be created using HCP-maintained EMR data, in addition to patient-entered data as is currently the norm.

Abstract 4897: Circadian/melatonin disruption by dim light at night drives human epithelial breast cancer to a metastatic phenotype

Cancer patients with disrupted 24-hour (circadian) rhythms are reported to have poorer survival as compared to those with normal

rhythms. Severe alterations in circadian rhythms predict an increased risk of death in patients with colorectal and breast cancer,

suggesting that circadian disruption may impact tumor progression and metastasis. We recently reported that circadian/melatonin

(MLT) disruption by exposure to dim light at night (dLAN) resulted in constitutive phospho-activation of ERK1/2, CREB, NF-kB,

and STAT3 in breast tumor xenografts promoting resistance to Tamoxifen and Doxorubicin therapy. Given that chemoresistant

breast cancer is frequently metastatic, this study examined if dLAN-induced circadian/MLT disruption can promote epithelial-to-

mesenchymal transition (EMT) of epithelial MCF-7 breast tumor xenografts leading to the development of metastatic foci in the

lungs, livers, and brains of circadian complete (MLT-producing) athymic nude female rats and mice.

Female nude rats with ERα+ MCF-7 or T47D human epithelial breast cancer xenografts were housed in LD,12:12 and

LD,12:12dLAN (dLAN) photoperiods or in dLAN supplemented with nighttime MLT (0.05 µg/ml) in the drinking water, with lights

on at 0600 hrs and off at 1800 hrs. Blood samples collected during the mid-dark phase (2400 hrs) showed elevated nocturnal

melatonin (118.4 pg/ml) in the LD,12:12 group, but significantly suppressed melatonin (10.0 pg/ml) in the dLAN group. Tumor

xenografts from rats housed in dLAN showed a ~3-fold decrease in latency-to-onset and a ~2.8-fold increase in growth rates vs.

those from rats in dLAN + MLT. Tumor cAMP levels, as well as numerous signaling pathways involved in promoting EMT

(Vimentin, β-catenin, and SNAIL) and metastasis (HER2/HER3, pCREB, pERK1/2, pRSK2, and pSTAT3), showed increased

expression/phospho-activation at 2400 hrs in response to dLAN but repressed expression in tumors from rats in dLAN + MLT.

Follow-up studies with Foxn1nude female mice implanted with non-metastatic luciferase expressing MCF-7 breast cancer

cells showed that exposure to dLAN suppressed the nighttime serum levels of MLT by 93% in these mice compared to those in a

LD,12:12 photoperiod. Exposure of mice to dLAN induced the rapid growth of MCF-7luc tumor xenografts and, after 5 weeks,

induced the metastatic outgrowth of MCF-7 xenografts to form luciferase identifiable metastatic foci in the lungs, livers, and brains

of all mice, as measured by IVIS small animal imaging system. Conversely, MCF-7luc tumor xenografts from mice exposed to

dLAN and supplemented with nighttime MLT showed a reduced tumor development, 3-fold slower tumor growth, and a small

metastatic lesion in one lung of a single mouse. This study is the first to show that circadian/MLT disruption by host exposure to

dLAN is able to drive EMT in human epithelial breast cancer xenografts to generate metastatic foci in lung, liver, and brain of mice.

Citation Format: Steven M. Hill, Shulin Xiang, Robert T. Dauchy, Melissa Wren-Dail, Murali Anbalagan, Brian Rowan, Tripp Frasch, David E. Blask. Circadian/melatonin disruption by dim light at night drives human epithelial breast cancer to a metastatic phenotype [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4897. doi:10.1158/1538-7445.AM2017-4897

A Multilevel, Multivariate Model for Studying School Climate With Estimation Via the EM Algorithm and Application to U.S. High-School Data

In many studies of school climate, researchers ask teachers a series of questions, and the responses to related questions are averaged or summed to create a scale score for each teacher on each dimension of climate under investigation. Researchers have disagreed, however, about the analysis of such data: Some have utilized the teacher as the analytic unit, and some have utilized the school as the unit. In this article, we propose a three-level, multivariate statistical modeling strategy that resolves the unit-of-analysis dilemma and unifies thinking about the analysis in such studies. A reanalysis of U. S. high-school data illustrates how to estimate and interpret: (a) the level of interteacher agreement on each climate dimension; (b) the internal consistency of measurement at the teacher and school levels; and (c) the correlations among “true” climate scores at each level. A linear model analysis utilized teacher control over school and classroom policy and teacher morale as bivariate latent outcomes to be predicted by school-level variables (e.g., sector, size, composition) and by teacher-level variables (e.g., education, race, sex, subject matter). Implications for conceptualization, design, analysis, and interpretation in future studies of school climate are considered.

Adipose-derived stromal/stem cells: a primer

Until recently, the complexity of adipose tissue and its physiological role was not well appreciated. This changed with the discovery of adipokines such as leptin. The cellular composition of adipose tissue is heterogeneous and changes as a function of diabetes and disease states such as diabetes. Tissue engineers view adipose tissue as a rich source of adult stromal/stem cells isolated by collagenase digestion. In vitro and in vivo studies have documented that adipose stromal/stem cells are multipotent, with the ability to differentiate along the adipocyte, chondrocyte, osteoblast and other lineage pathways. The adipose stromal/stem cells secrete a wide range of cytokines and growth factors with potential paracrine actions. Furthermore, adipose stromal/stem cells exert immunomodulatory functions when added to mixed lymphocyte reactions, suggesting that they can be transplanted allogeneically. This review article focuses on these mechanisms of adipose stromal/stem cell action and their potential utility as cellular therapeutics.

Abstract P6-08-01: Perceptions of breast cancer risk, psychological adjustment and behaviors in adolescent girls at high-risk and population-risk for breast cancer

BACKGROUND: Preliminary evidence suggests that many girls from breast cancer (BC) families are aware of their increased risk for BC. How this awareness impacts their psychosocial adjustment and health behaviors remains unknown.

METHODS: 11–19 YO girls at high-risk (HR) or population-risk (PR) for BC completed self-administered quantitative surveys informed by the Self-Regulation Theory of Health Behavior. Girls with a first or second-degree relative with BC were classified as HR. For hypothesis testing, we used simple linear and logistic regressions. To account for correlation of responses within families, we used robust (cluster-corrected) standard errors or Generalized Estimating Equations.

RESULTS: 47 PR and 89 HR girls have completed surveys. Age did not differ between groups (Mage = 15.6; SD=2.4). 30% of HR girls have a mother with BC. 67% of HR girls vs. 30% of PR girls reported self-perceived risk for adult BC to be “higher than other girls my age,” (p = &lt;0.01, Table 1).

Using instructional logs to identify quality in educational settings

When attempting to identify educational settings that are most effective in improving student achievement, classroom process (that is, the way in which a teacher interacts with his or her students) is a key feature of interest. Unfortunately, high-quality assessment of the student-teacher interaction occurs all too infrequently, despite the critical role that understanding and measuring such processes can play in school improvement. This article discusses the strengths and weaknesses of two common approaches to studying these processes-direct classroom observation and annual surveys of teachers-and then describes the ways in which instructional logs can be used to overcome some of the limitations of these two approaches when gathering data on curriculum content and coverage. Classroom observations are expensive, require extensive training of raters to ensure consistency in the observations, and because of their expense generally cannot be conducted frequently enough to enable the researcher to generalize observational findings to the entire school year or illuminate the patterns of instructional change that occur across the school year. Annual surveys are less expensive but often suffer from self-report bias and the bias that occurs when teachers are asked to retrospectively report on their activities over the course of a single year. Instructional logs offer a valid, reliable, and relatively cost-effective alternative for collecting detailed information about classroom practice and can overcome some of the limitations of both observations and annual surveys.

Patient-perceived usefulness of an emergency medical card and a continuity-of-care report in enhancing the quality of care

OBJECTIVE

To evaluate the patients' opinion on the usefulness of the electronic medical card (EMC) and continuity-of-care report in enhancing quality of care, and to assess the effects of the patient-entered data on the quality of data in the electronic medical record (EMR).

DESIGN

A structured survey assessed patients' opinion on the usefulness of the EMC and continuity-of-care report. The accuracy of EMR data involved comparing the patient-entered data in the continuity-of-care report with the healthcare-provider-entered data in the EMR. The analysis assessed whether the EMR information was consistent with the patient-entered data. A data completeness evaluation compared data entries in the EMR collected before and after the use of continuity-of-care record application.

RESULTS

One hundred and thirty-three patients used the application, of which 76% who had actually used the EMC and continuity-of-care report to seek medical care and/or update EMR information were surveyed. Age was associated with the reported usefulness of the documents. Few users (16%) printed the continuity-of-care reports to take to their healthcare providers for data updates and fewer (9%) to correct errors in the EMR. Overall, 68% of patients found the documents to be useful.

CONCLUSIONS

Patients reported that the EMC and continuity-of-care report were useful in enhancing quality of care. They were able to identify missing or erroneous data in the EMR data, making them an important source of quality control for their information in the healthcare-provider-maintained EMR.

Melatonin inhibits mitogenic cross-talk between retinoic acid-related orphan receptor alpha (RORalpha) and ERalpha in MCF-7 human breast cancer cells

Luciferase reporter constructs and transient co-transfection approaches demonstrate that elevated expression of RORalpha1 augments 17-beta-estradiol (E(2))-induced transcriptional activation of the full-length ERalpha, but not truncated ERalpha constructs (ABCD or CDEF), in MCF-7 breast cancer and HEK293 embryonic kidney cells, and that physiologic concentrations of MLT inhibit the individual and combined transcriptional activity of ERalpha by RORalpha1 and E(2). Gel mobility shift and co-immunoprecipitation (IP)/pull-down assays demonstrate that RORalpha1 and ERalpha do not interact directly at the DNA-binding level or as heterodimers, however, RORalpha1 augments E(2)-induced pS2 and cyclin D1 mRNA expression while MLT inhibits RORalpha1/E(2)-induced expression of pS2 and cyclin D1 in MCF-7 cells.

Abstract 4282: The role of glycosphingolipids in the formation of cancer stem cells and drug resistance

Tumorigenesis and malignant progression of cancers rely on a small subset of cells known as cancer stem cells (CSCs). In addition to forming primary tumors, metastasis and relapse, CSCs always display resistance to cytotoxins and this resistant feature protects CSCs during the course of chemotherapy. Glucosylceramide synthase (GCS) is a limited enzyme catalyzing the first glycosylation in glycosphingolipids synthesis. Glycosphingolipids are likely to play an essential role in maintaining the stemness of stem cells, since that deletion of GCS induces apoptosis of embryonic stem cell and stops embryo development in GCS knockout mice. The stage-specific embryonic antigens (SSEA-3, SSEA-4) are glycosphingolipids and serve as common pluripotent markers for human embryonic stem cells. In the present study, we have found that GCS modulates the formation and maintenance of breast cancer stem cells. GCS overexpression was interrelated to the increase of breast cancer stem cells (BCSCs) and drug resistance in human breast cancer MCF-7 cell lines after doxorubicin induction. In MCF-7/Dox (doxorubicin-resistant) cells, GCS protein was increased by 39-fold accompanied with enhanced enzyme activity, as compared to wild-type MCF-7 cell. Analyzed by using flow cytometry and immunostaining, the BCSCs with CD44+/CD24-/ESA+ phenotype were increased by 5-fold, and 3-fold in MCF-7/Dox and NCI-ADR/RES cell lines, as compared to MCF-7 cell lines, respectively. In BCSCs, GCS enzyme activity was 2-fold greater than other populations sorted from MCF-7/Dox. Silencing GCS by using mixed-backbone oligonucleotide (MBO-asGCS) significantly decreased the numbers of BCSCs in MCF-7/Dox cells. We observed tumorigenesis of NCI/ADR-RE/GCS (GCS overexpressed) and NCI/ADR-RE/asGCS (GCS silenced) in athymic nude mice. Aggressive tumors were found in all mice inoculated with NCI/ADR-RES and NCI/ADR-RE/GCS cells that were BCSC-enriched; however, no tumor or metastasis was observed in mice injected with NCI-ADR/asGCS cells. Furthermore, MBO-asGCS treatment (1 mg/kg) significantly decreased the numbers of BCSCs isolated from tumors of NCI-ADR/RES, as compared with control groups. Furthermore, BCSCs after MBO-asGCS treatment were more sensitive to doxorubicin. These results, for the first time, demonstrate that glycosphingolipid is involved in the regulation of cancer stem cell formation. Silencing GCS eliminates BCSCs, that can reverses drug resistance as well as prevent tumor relapse.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4282.

KX-01, a Novel Src Kinase Inhibitor Directed towards the Peptide Substrate Site, Induces Robust Apoptosis and Synergizes with Tamoxifen and Chemotherapy in Breast Cancer

New therapeutic regimens that increase efficacy or reduce onset of resistance for endocrine therapy and chemotherapy are needed for better clinical management of breast cancer. c-Src is an oncogenic non-receptor tyrosine kinase that is up-regulated in approximately half of all breast cancer. However the efficacy of existing multi-kinase src inhibitors in breast cancer has been limited. KX-01 (Kinex Pharmaceuticals) is a novel class of non-ATP src inhibitor that targets the peptide binding site of src and is currently completing Phase-1 testing for solid tumors. In a panel of breast cancer cell lines, KX-01 resulted in dose dependent inhibition of growth and induction of apoptosis that was independent of p53 status, and was preceded by rapid inhibition of src activity. KX-01 induced apoptosis in two cell lines reported to be resistant to multi-kinase src inhibitors, MDA-MB-468 cells and BT-549. Cell cycle analysis revealed that KX-01 (50 nM, 6 hours) resulted in significant accumulation of MDA-MB-231 cells (ERα/PR/HER2/neu negative) and MCF-7 cells (ERα positive) in G2/M phase. Immunofluorescent staining for mitotic phase marker phospho-histone 3 indicated that cells had arrested in mitotic phase and many of the mitotic arrested cells were undergoing apoptosis (TUNEL), a novel cell death for a small molecule tyrosine kinase inhibitor. KX-01 induced nuclear accumulation of cyclin B1, and activation of CDK1, MPM2 and Cdc25C that is required for progression past the G2/M checkpoint. KX-01 resulted in cytochrome C release and activation of caspases 3, 6, 7, 8 and 9. A matrix design using the median-effect principle to delineate the interaction between two drugs was applied for KX-01 alone and in combination tamoxifen (TAM), paclitaxel (PAC) or doxorubicin (DOX). Combinations of KX-01 (5-75 nM) with each of these agents resulted in synergistic growth inhibition of MCF-7 cells (KX-01 + TAM) and MDA-MB-231 cells (KX-01 + DOX or PAC). In addition, synergistic induction of apoptosis was achieved by combining low doses of KX-01 with DOX, PAC or TAM. c-Src induces phosphorylation of ERα at serines 118 and 167, sites required for full receptor activity. KX-01 combined with TAM resulted in decreased phosphorylation at serine 167 that was associated with reduced transcriptional activity of ERα. In tumor xenograft models, KX-01 resulted in a dose dependent inhibition of MDA-MB-231 and MCF-7 tumor growth after 30 days (1, 2.5 or 5 mg/kg body weight, twice daily by oral gavage). In MDA-MB-231 xenografts, KX-01 reduced metastasis to bone (femur) and lung as measured by PCR for detection of human chromosome 17.These data define KX-01 as a potently active src kinase inhibitor that induces robust cell death, tumor growth inhibition and anti-metastatic effects. Combinations of KX-01 with endocrine therapy and chemotherapy present a promising new strategy for clinical management of breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6104.

Isolation of Tumor Initiating Cells with Metastatic Potential from Human Primary Invasive Ductal Carcinoma

Disseminated breast cancer cells may be present at distant sites at the time of primary diagnosis of breast cancer in patients that exhibit no outward signs of clinical metastasis. It is hypothesized that early breast cancer metastasis is initiated by a small population of breast tumor initiating cells (bTICs) within the primary tumor that are inherently resistant to chemotherapy and hormonal therapy. To better understand the biological pathways that permit bTICs to metastasize and to evade current breast cancer therapies, bTICs have been isolated from breast cancer biopsies from patients diagnosed with primary invasive ductal carcinoma. Breast cancer needle biopsies from primary tumors were obtained during the routine care of patients with consent and IRB approval. Core biopsies were mechanically and enzymatically dissociated, yielding a single cell suspension which was subsequently cultured under non-adherent and serum-free conditions to obtain tumorspheres. Injection of about 500 bTICs into the mammary fat pad of female nude mice resulted in tumor formation at the site of injection within two months that was maintained as a small palpable mass for at least six months. H+E staining of sections of the primary tumors revealed complex cellular organization and both microvascular and macrovascular structures. Serial transplantation of the primary tumors from the 6/7 samples resulted in tumor formation at the site of injection. Upon primary tumor formation in the mammary fat pad, metastatic human breast cancer cells were detected within the lungs, liver, brain and bone marrow (femur) from 5/7 tumors after six months. Metastatic cells were detected by PCR for an alpha-satellite sequence in the centromeric region in human Chromosome 17, and by in situ hybridization using an human specific Alu DNA oligonucleotide probe. Metastatic bTICs were mostly detected as single cells or small clustering of cells present throughout the metastatic organ. These data demonstrate that cells with the phenotype of “tumor initiating cells” can be isolated from primary biopsies of human invasive ductal carcinoma and cultured in vitro. Unlike direct heterotransplant tissues from primary tumor biopsies, the majority of bTICs samples form tumors when injected into immunodeficient mice and further exhibit a highly metastatic phenotype.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 504.

Bridging the divide: in search of common ground in mental health and education research and policy

There is growing evidence that mental health and school functioning for children are intertwined. This article summarizes historical perspectives on U.S. child mental health policies and their interface with education and discusses trends in educational policy relevant to children's mental health, specifically the Individuals With Disabilities Education Act and No Child Left Behind. The traditional approach of mental health research in schools, which focuses on program and intervention development, has become stagnant. New paradigms are needed. These include attending to indigenous school resources, to the organizational context of learning, and to participatory models for constructing environments conducive to mental health promotion and learning. Persistent underfunding and fragmented fiscal support, however, render new approaches meaningless. If progress is to be made, new funding structures to support integrative educational and mental health practices are needed.

Bridging the divide: in search of common ground in mental health and education research and policy

There is growing evidence that mental health and school functioning for children are intertwined. This article summarizes historical perspectives on U.S. child mental health policies and their interface with education and discusses trends in educational policy relevant to children's mental health, specifically the Individuals With Disabilities Education Act and No Child Left Behind. The traditional approach of mental health research in schools, which focuses on program and intervention development, has become stagnant. New paradigms are needed. These include attending to indigenous school resources, to the organizational context of learning, and to participatory models for constructing environments conducive to mental health promotion and learning. Persistent underfunding and fragmented fiscal support, however, render new approaches meaningless. If progress is to be made, new funding structures to support integrative educational and mental health practices are needed.

The Galphai and Galphaq proteins mediate the effects of melatonin on steroid/thyroid hormone receptor transcriptional activity and breast cancer cell proliferation

Melatonin, via its MT1 receptor, but not the MT2 receptor, can modulate the transcriptional activity of various nuclear receptors - estrogen receptor alpha (ERalpha) and retinoic acid receptor alpha (RARalpha), but not ERbeta- in MCF-7, T47D, and ZR-75-1 human breast cancer cell lines. The anti-proliferative and nuclear receptor modulatory actions of melatonin are mediated via the MT1 G protein-coupled receptor expressed in human breast cancer cells. However, the specific G proteins and associated pathways involved in the nuclear receptor transcriptional regulation by melatonin are not yet clear. Upon activation, the MT1 receptor specifically couples to the G(alphai2), G(alphai3), G(alphaq), and G(alphall) proteins, and via activation of G(alphai2) proteins, melatonin suppresses forskolin-induced 3',5'-cyclic adenosine monophosphate production, while melatonin activation of G(alphaq), is able to inhibit phospholipid hydrolysis and ATP's induction of inositol triphosphate production in MCF-7 breast cancer cells. Employing dominant-negative and dominant-positive) forms of these G proteins, we demonstrate that G(alphai2) proteins mediate the suppression of estrogen-induced ERalpha transcriptional activity by melatonin, while the G(q) protein mediates the enhancement of retinoid-induced RARalpha transcriptional activity by melatonin. However, the growth-inhibitory actions of melatonin are mediated via both G(alphai2) and G(alphaq) proteins.

Alternative splicing, muscle calcium sensitivity, and the modulation of dragonfly flight performance

Calcium sensitivity of myosin cross-bridge activation in striated muscles commonly varies during ontogeny and in response to alterations in muscle usage, but the consequences for whole-organism physiology are not well known. Here we show that the relative abundances of alternatively spliced transcripts of the calcium regulatory protein troponin T (TnT) vary widely in flight muscle of Libellula pulchella dragonflies, and that the mixture of TnT splice variants explains significant portions of the variation in muscle calcium sensitivity, wing-beat frequency, and an index of aerodynamic power output during free flight. Two size-distinguishable morphs differ in their maturational pattern of TnT splicing, yet they show the same relationship between TnT transcript mixture and calcium sensitivity and between calcium sensitivity and aerodynamic power output. This consistency of effect in different developmental and physiological contexts strengthens the hypothesis that TnT isoform variation modulates muscle calcium sensitivity and whole-organism locomotor performance. Modulating muscle power output appears to provide the ecologically important ability to operate at different points along a tradeoff between performance and energetic cost.

Eye injury and sport: sport-related eye injuries presenting to an eye casualty department throughout 1995

A survey was undertaken of all patients attending the Eye Casualty Department at Waterford Regional Hospital with sports injuries in the twelve-month period 1st January 1995 to 31st December 1995. Ninety eight patients had problems associated with sport. Hurling was responsible for the largest group (30%) and football of different codes accounted for 29%. The next largest group was the racquet sports (13%). The most common injuries were to the anterior chamber (hyphaema and microhyphaema: 36%). There were three orbital fractures. 26 patients (27%) were admitted. 83 patients (85%) were male. The median age was 20 years. Sport is a significant cause of eye injury, which is often serious, and affects mostly young healthy males.

Serum type III procollagen aminopeptide for assessing liver damage in methotrexate-treated psoriatic patients

This study was designed to establish whether measurement of a serological marker of fibrosis might reduce the need for liver biopsy in psoriatic patients receiving methotrexate (MTX). Levels of type III procollagen aminopeptide (PIIINP-O and PIIINP-B) and laminin P1 (LamP1-B) were measured in 147 serum samples taken at the time of liver biopsy in 87 patients receiving long-term MTX treatment for severe psoriasis. Biopsies were classified as: (1) normal, (2) steatosis, (3) inflammation, (4) fibrosis, or (5) cirrhosis. Groups 3-5 were considered to show clinically relevant abnormality. Compared with controls, PIIINP-O was significantly raised in the group of MTX-treated psoriatics (P < 0.001). Within this group, levels were significantly higher in patients with inflammation, fibrosis or cirrhosis compared with those with normal histology or steatosis alone (P < 0.0001). In contrast, PIIINP-B and LamP1-B did not distinguish between controls and MTX-treated patients or between histological groups. Forty-two patients had two or more biopsies with simultaneous PIIINP-O measurement. PIIINP-O levels at the time of the first biopsy were normal in six of the seven patients whose histology was initially normal and subsequently became abnormal. A single measurement of PIIINP-O thus did not predict which patients might develop abnormal histology following further MTX. In a group of 17 patients, PIIINP-O was measured 3-monthly for up to 6 years during MTX treatment. PIIINP-O was elevated at some time during follow-up in all three patients who developed abnormal histology but was consistently normal in eight of the 11 patients whose histology remained or became normal. Our findings indicate that PIIINP-O is of value in detecting liver damage and, particularly if measured serially, may reduce the need for liver biopsy in MTX-treated patients. Although the test does not detect all patients with fibrosis, it would appear that the risk of missing significant liver damage in patients with persistently normal PIIINP-O is low.

Abnormalities of serum type III procollagen aminoterminal peptide in methotrexate-treated psoriatic patients with normal liver histology do not correlate with hepatic ultrastructural changes

In a previous study, it was shown that the serum levels of type III procollagen aminoterminal peptide (P3NP) were significantly greater in patients receiving methotrexate (MTX) treatment for psoriasis than in untreated control patients with psoriasis. Although levels were highest in patients with hepatic fibrosis and cirrhosis, serum P3NP concentrations in those patients with normal liver histology on light microscopy were also shown to be significantly higher than in controls. In the present study, liver biopsies from 22 such 'normal' patients were examined by electron microscopy, in order to determine whether P3NP levels correlated with ultrastructurally demonstrable fibrosis. Fibrosis in the perisinusoidal space of Disse was present in as many as 82% of biopsies. Although the prevalence of such fibrosis in psoriasis patients who have not received MTX is unknown, the high prevalence of Disse space fibrosis and of raised P3NP in MTX-treated patients suggests that MTX causes subtle liver damage in a majority of treated patients. However, we were unable to show a statistical correlation between P3NP and the degree of Disse space fibrosis.

Serum type III procollagen peptide, dynamic liver function tests and hepatic fibrosis in psoriatic patients receiving methotrexate

The serum level of the aminoterminal peptide of type III procollagen (P3NP) was measured in 51 psoriatic patients on long-term, once weekly, low-dose methotrexate and in a control group of patients with extensive psoriasis who had never had systemic treatment. Serum P3NP levels were normal in all control patients, but were elevated in the majority of methotrexate-treated patients, even those with normal or non-specific liver histology. Although the highest P3NP values were found in the groups of patients with fibrosis and cirrhosis, isolated P3NP measurements did not discriminate between individuals with and without significant liver pathology. Neither standard nor dynamic liver function tests were able to identify patients with significant liver damage and in most cases results were in the normal range.