Clinimetric properties of relevant criteria for assessing writing and drawing orientation after right hemisphere stroke

BACKGROUND

Writing and drawing orientation is rarely assessed in clinical routine, although it might have a potential value in detecting impaired verticality perception after right hemispheric stroke (RHS). Assessment tools and criteria must be conceived and validated. We therefore explored the clinimetric properties of a set of quantitative writing and drawing orientation criteria, their ranges of normality, and their tilt prevalence in RHS individuals.

NEW METHODS

We asked 69 individuals with subacute RHS and 64 matched healthy controls to write three lines and to copy the Gainotti Figure (house and trees). We determined six criteria referring to the orientation of writing and drawing main axes: for writing, the line and margin orientations, and for drawing, the tree, groundline, wall, and roofline orientations. Orientations were measured by using an electronic protractor from specific landmarks positioned by independent evaluators.

RESULTS

The set of criteria fulfilling all clinimetric properties (feasibility, measurability, reliability) comprised the line orientation of the writing and the wall and roofline orientations of the drawing. Writing and drawing tilts were frequent after RHS (about 30% by criterion).

COMPARISON WITH EXISTING METHODS

So far, graphomotor orientation was mostly tested qualitatively and could not be objectively appreciated in absence of validated tools and criteria, and without ranges of normality. Writing and drawing tilts may now be assessed both in routine clinical practice and research.

CONCLUSIONS

Our study paves the way for investigating the clinical determinants of graphomotor tilts, including impaired verticality perception, to better understand their underlying mechanisms.

Abstract P5-06-05: Palmitate induces a senescent-like phenotype in fibroblasts resulting in altered phenotypes in cells of the breast tumor microenvironment

Background: Obese breast cancer patients face a worse prognosis, including an increased risk of recurrence and mortality. While the causative mechanisms have yet to be fully uncovered, emerging evidence implicates palmitate, increased in the obese state, in development of cellular senescence, an inflammatory state associated with proliferation, metastasis, and tumor-associated neutrophil (TAN) polarization, among other measures of carcinogenesis. However, studies have yet to investigate the impact of palmitate on induction of senescence in breast fibroblasts, and no studies have assessed the effect of senescent fibroblasts on neutrophil polarization in the breast tumor microenvironment. This said, we hypothesize that palmitate alters breast cancer cell gene expression and neutrophil phenotype via induction of a senescent-like phenotype in fibroblasts. Methods: HCA2, IMR-90, and human mammary fibroblasts were exposed to palmitate or vehicle in media supplemented with 2% charcoal-stripped fetal bovine serum, after which the cells were measured through qPCR for expression of IL-1a, IL-6 and IL-8, some of the most prominent members of the senescence-associated secretory phenotype. Palmitate-exposed fibroblasts were also subjected to chromogenic staining for senescence-associated beta-galactosidase and immunoenzymatic BrdU analysis, two well-established measures of senescence. Next, in order to study the influence of these fibroblasts on other cells of the breast tumor microenvironment, we assessed their impact on polarization of DMSO-differentiated HL-60 neutrophils by using flow cytometry to measure neutrophil expression of CD54 and CD95, differentially expressed on N1 and N2 neutrophils. Finally, we employed PCR arrays to assess the impact of palmitate-exposed fibroblasts on the expression of 84 genes in MCF-7 and 231 breast cancer cells, measuring activation of pathways related to apoptosis, cell cycle, DNA damage, senescence, telomere maintenance, metabolism, angiogenesis, and the endothelial-to-mesenchymal transition. Results and Conclusions: Palmitate induced pro-inflammatory gene expression and SA-beta-gal activity and decreased BrdU incorporation in fibroblasts. Palmitate also exhibited non-cell-autonomous effects, as palmitate-exposed fibroblasts induced phenotypic changes in both neutrophils and breast cancer cells. These findings are among the first to implicate palmitate-induced fibroblast senescence in the stimulation of non-cell-autonomous changes in the breast tumor microenvironment and will ultimately inform our understanding of the mechanistic connection between the obesity-associated factor palmitate and breast tumorigenesis.

Citation Format: Brittany Susanne Harlow, Albert Davalos, Bryan McClellan, Andrew Brenner, Christopher Jolly, Stefano Tiziani, Steve Hursting, Linda deGraffenried. Palmitate induces a senescent-like phenotype in fibroblasts resulting in altered phenotypes in cells of the breast tumor microenvironment [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-06-05.

Abstract P5-05-07: An IGF-1R-mTORC1-SRPK2 signaling axis contributes to FASN regulation in breast cancer

BACKGROUND: FASN expression is associated with a more aggressive breast cancer phenotype and is both transcriptionally and post-transcriptionally regulated downstream of receptor tyrosine kinase signaling pathways. Moreover, 2nd and 3rd generation FASN inhibitors are showing promise for the treatment of breast cancer in clinical trials. Lipogenic transcripts, such as FASN, can be post-transcriptionally regulated through pre-mRNA splicing mediated through serine arginine rich protein kinases (SRPKs) and their respected substrates, serine-arginine rich splicing factors (SRSFs). Recent work has highlighted the mTORC1 signaling pathway as an upstream inducer of lipogenic pre-mRNA splicing, however, the role of extracellular environmental cues, such as growth factors and their respected receptors have not been explored. Here, an IGF-1-mTORC1-SRPK2 axis is demonstrated in the FASN regulation through SRSF-1 in breast cancer. METHODS: MDA-MB-231, MCF-7 breast cancer or MCF-10A non-transformed cells were exposed to IGF-1 followed by siRNA knockdown of IGF-1R, SRPK2, or SRSF-1. FASN expression was quantified by RT-qPCR or western blot analysis and de novo palmitate was measured by U-13C glucose incorporation followed by GS-MS. For mRNA stability, cells were pretreated with actinomycin-D with either vehicle or SRPK2 inhibitor for various timepoints followed by RT-qPCR for lipogenic and glycolytic mRNA abundance. eGFP-SRSF-1 was transfected in MDA-MB-231 and MCF-7 to visualize SRSF-1 localization in response to mTORC1 inhibition and/or SRPK2 knockdown and visualized by fluorescence microscopy. For intron retention, RT-PCR was performed with FASN intron and exon specific primers and resolved on a 2.5% agarose gel. RESULTS: Both IGF-1R and SRPK2 RNAi mediated knockdown significantly reduced FASN mRNA and protein and de novo synthesized palmitate levels. Similar results were obtained with mTORC1 inhibition. IGF-1 promoted the stabilization of FASN mRNA as well as reduced intron retention. This reduction of intron retention upon IGF-1 was abolished by SRPK2 knockdown. Additionally, IGF-1 contributed to a more diffuse localization in the nucleoplasm of SRSF-1, which become more retained in nuclear speckles upon both SRPK2 knockdown and mTORC1 inhibition. CONCLUSION: These current findings establish a potential IGF-1-mTORC1-SRPK2 axis in breast cancer that contributes to metabolic programming through FASN. More specifically, SRSF-1 is the potential mediator of FASN expression through this pathway, which could be a potential therapeutic target for breast cancers that overexpress FASN and components of the IGF-1R signaling axis.

Citation Format: Bryan Mcclellan, Paul Gries, Brittany Harlow, Andrew J Brenner, Stefano Tiziani, Christopher Jolly, Linda deGraffenried. An IGF-1R-mTORC1-SRPK2 signaling axis contributes to FASN regulation in breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-05-07.

Modulation of Breast Cancer Cell FASN Expression by Obesity-Related Systemic Factors

Purpose:

The objective of this study is to determine the impact of exposure to obesity-related systemic factors on fatty acid synthase enzyme (FASN) expression in breast cancer cells.

Methods:

MCF-7 breast cancer cells were exposed to sera from patients having obesity or not having obesity and subjected to quantitative reverse transcription polymerase chain reaction (RT-qPCR). Subsequent MTT and colony-forming assays using both MCF-7 and T-47D cells exposed to sera and treated with or without FASN inhibitor, TVB-3166, were used. MCF-7 cells were then treated with insulin and the sterol regulatory element–binding protein (SREBP) processing inhibitor, betulin, prior to analysis of FASN expression by quantitative RT-qPCR and western blot. Insulin-induced SREBP-FASN promoter binding was analyzed by chromatin immunoprecipitation with an anti-SREBP antibody.

Results:

In response to sera exposure (body mass index [BMI] >30) there was an increase in FASN expression in breast cancer cells. Furthermore, treatment with the FASN inhibitor, TVB-3166, resulted in a decreased breast cancer cell survival and proliferation while increasing apoptosis upon sera exposure (BMI >30). Insulin-exposed MCF-7 cells exhibited an increased FASN messenger RNA and protein expression, which is abrogated upon SREBP inhibition. In addition, insulin exposure induced enhanced SREBP binding to the FASN promoter.

Conclusions:

Our results implicate FASN as a potential mediator of obesity-induced breast cancer aggression and a therapeutic target of patients with obesity-induced breast cancer.

Abstract CC02-01: Regulation of FASN expression through a novel IGF-1R-mTORC1-SRPK2-SRSF1 pathway

BACKGROUND FASN expression is associated with a more aggressive breast cancer phenotype and is both transcriptionally and post-transcriptionally regulated downstream of receptor tyrosine kinase signaling pathways. Lipogenic transcripts, such as FASN, can be post-transcriptionally regulated through pre-mRNA splicing mediated through serine arginine rich protein kinases (SRPKs) and their respected substrates, serine-arginine rich splicing factors (SRSFs). Recent work has highlighted the mTORC1 signaling pathway as an upstream inducer of lipogenic pre-mRNA splicing, however, the role of extracellular environmental cues, such as growth factors and their respected receptors have not been explored. Here, an IGF-1-mTORC1-SRPK2 axis is demonstrated in the FASN regulation through SRSF-1 in breast cancer. METHODS: MDA-MB-231, MCF-7 breast cancer or MCF-10A non-transformed cells were exposed to IGF-1 followed by siRNA knockdown of IGF-1R, SRPK2, or SRSF-1. FASN expression was quantified by RT-qPCR or western blot analysis and de novo palmitate was measured by U-13C glucose incorporation followed by GS-MS. For mRNA stability, cells were pretreated with actinomycin-D with either vehicle or SRPK2 inhibitor for various timepoints followed by RT-qPCR for lipogenic and glycolytic mRNA abundance. eGFP-SRSF-1 was transfected in MDA-MB-231 and MCF-7 to visualize SRSF-1 localization in response to mTORC1 inhibition and/or SRPK2 knockdown and visualized by fluorescence microscopy. For intron retention, RT-PCR was performed with FASN intron and exon specific primers and resolved on a 2.5% agarose gel. RESULTS: Both IGF-1R and SRPK2 RNAi mediated knockdown significantly reduced FASN mRNA and protein and de novo synthesized palmitate levels. Similar results were obtained with mTORC1 inhibition. IGF-1 promoted the stabilization of FASN mRNA as well as reduced intron retention. This reduction of intron retention upon IGF-1 was abolished by SRPK2 knockdown. Additionally, IGF-1 contributed to a more diffuse localization in the nucleoplasm of SRSF-1, which become more retained in nuclear speckles upon both SRPK2 knockdown and mTORC1 inhibition. CONCLUSION These current findings establish a potential IGF-1-mTORC1-SRPK2 axis in breast cancer that contributes to metabolic programming through FASN. More specifically, SRSF-1 is the potential mediator of FASN expression through this pathway, which could be a potential therapeutic target for breast cancers that overexpress FASN and components of the IGF-1R signaling axis.

Citation Format: Bryan Mcclellan, Paul Gries, Brittany Harlow, Andrew Brenner, Stefano Tiziani, Christopher Jolly, Linda deGraffenried. Regulation of FASN expression through a novel IGF-1R-mTORC1-SRPK2-SRSF1 pathway [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr CC02-01.

Identification of neutralising pembrolizumab anti-drug antibodies in patients with melanoma

Development of anti-drug antibodies (ADAs) can interfere with therapeutic monoclonal antibodies and may lead to drug neutralisation and clinical disease progression. Measurement of circulating drug levels and development of ADAs in the setting of anti-programmed cell death-1 agent pembrolizumab has not been well-studied. Enzyme-linked immunosorbent assays were used to measure pembrolizumab drug level and ADAs in 41 patients with melanoma at baseline, Time-point 1 (3 weeks) and Time-point 2 (21 weeks). Assay results were related to patient demographics and clinical outcome data at 6 months. The median pembrolizumab drug level at 3 weeks was 237 ng/μL and did not correlate with age, sex or body surface area.17/41 patients had an ADA detected at any timepoint, with the highest prevalence at Timepoint 1 (median concentration = 17 ng/μL). The presence of an ADA did not correlate with clinical progression at 6 months. 3/41 (7%) of patients displayed a falling pembrolizumab drug level and rising ADA titre between Timepoint 1 and 2 suggestive of a neutralising ADA. Pembrolizumab drug levels and ADAs can be readily measured. The rates of total and treatment-emergent ADAs may be higher in “real-word” settings than those previously reported. Larger studies are needed to determine effect of neutralising ADAs on long-term clinical outcome.

Abstract 2793: The role of IL-10 in obesity-induced T-cell polarization in the prostate tumor microenvironment

Background: Prostate cancer remains the second leading cause of cancer related deaths in men and obesity has been shown to severely impact its prognosis. Previous studies in our laboratory have shown that CD4+ T cells polarized under obese conditions are prostate cancer promoting and that this is due in part to suppression of IFNγ and induction of IL-6 in the T cells.

Objective: The goal of this study is to determine the role of IL-10 in mediating the impact of obese conditions on T cell phenotype.

Methods: A series of in vitro studies were conducted to evaluate the effects of obesity on T cell function and polarization. Splenic CD4+ T-cells from 10-week-old, male, C57BI/6 mice were isolated and stimulated with anti-CD3+/CD28+ antibodies under obese conditions. Gene expression was measured using qPCR and AKT phosphorylation was measured using Western blot analysis. In vivo T-cell function was compared between obese and non-obese male mice. Deletion assays were used to determine the role of IL-10 in mediating the effects observed on T cell phenotype in response to obese conditions.

Results: For both the in vitro and in vivo studies, obese conditions suppressed the expression of Th1 biomarkers (IFNγ, IL-2, and T-bet) and upregulated the expression of Th2 biomarkers (IL-6, IL-10, and GATA-3) in CD4+ T cells. Likewise, obese conditions in vitro and in vivo were associated with decreased AKT phosphorylation. Studies are on-going to determine whether inhibiting the IL-10 pathway restores proper T cell activation under obese conditions.

Conclusion: Obesity induces T cell dysfunction characterized by a Th1 to Th2 phenotypic shift, resulting in a pro-tumorigenic phenotype, potentially mediated by paracrine IL-10 signaling. These results are important in understanding the mechanisms by which obesity promotes a more aggressive disease, thereby identifying potential targets for improving outcomes. The results from these studies will provide a better understanding of the role of IL-10 as a novel target for preventing prostate cancer in obese subjects and improving overall survival.

Citation Format: Margaret Kappel, Michael Adkison, Alejandra De Angulo, Peyton Travis, Brittany Harlow, Christopher Jolly, Linda deGraffenried. The role of IL-10 in obesity-induced T-cell polarization in the prostate tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2793.

Abstract 2455: A potential FASN -IGF1R signaling loop in breast cancer

Background: The overexpression of the IGF-1R is correlated with an overall worse prognosis for breast cancer patients. IGF-1R contributes to an aggressive phenotype through its downstream signaling cascades, including the classical PI3K-Akt- mTORC1 pathway. Recent studies suggest another important target of IGF-1R regulation is the fatty acid synthase enzyme (FASN), leading to increased endogenous fatty acid synthesis. The importance of FASN activity to breast cancer progression is illustrated by the success of recent clinical trials investigating the efficacy of FASN inhibitors in refractory breast cancer. Previous studies in our lab and others have identified SREBP and SRPK2 as key IGF-1R targets regulating FASN expression. FASN expression can lead to excess palmitate, which can serve as a substrate for palmitoylation shown to aid in the membrane localization and function of various receptor tyrosine kinases, including IGF-1R. However, the role of FASN induced localization and activation of IGF-1R in breast cancer has not been investigated and is critical for a better understanding of the role of FASN in breast cancer progression.

Objective: The goal of this study is to investigate a potential feedforward signaling loop between IGF-1R and FASN and its contribution to breast tumorigenesis.

Methods: The impact of suppression of mTOR, SREBP, and SRPK2 on FASN gene expression in response to IGF-1 stimulation in MCF-7 and T47D ER+ breast cancer cells over a course of time was evaluated using qPCR. The role of FASN in IGF-1R stabilization and signaling was determined in MCF-7 cells pretreated with 2-bromopalmitate (2-BP, a palmitoylation inhibitor) or the FASN inhibitor, TVB-3166. Colony formation and migration assays were performed for phenotypic analysis of breast cancer cells in response to IGF-1R and SRPK2 modulation.

Results: Inhibition of mTORC1 resulted in an attenuation of FASN expression in both MCF-7 and T47D cells upon IGF-1 exposure. Additionally, inhibition of palmitoylation and/or FASN resulted in a decreased stabilization and activation of IGF-1R in MCF-7 breast cancer cells. Further elucidation of specific mechanisms of post-transcriptional regulation of FASN through SRPK2 as well as effects of SRPK2 and IGF-1R inhibition on breast cancer cell migration and survival are on-going.

Conclusion: The results of this study suggest that a potential mechanism of breast cancer progression is through an autoregulatory loop between IGF-1R signaling and FASN activity, which can be effectively limited using the new class of FASN inhibitors. These data support the rationale for continued clinical studies evaluating the efficacy of FASN inhibitors in breast cancers driven, at least in part, by IGF-1 signaling.

Citation Format: Bryan McClellan, Brittany Harlow, Christopher Jolly, Linda deGraffenried. A potential FASN -IGF1R signaling loop in breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2455.

Abstract 2022: Palmitate promotes breast cancer progression in vitro through induction of a senescent-like phenotype in fibroblasts

Background: Obesity confers a worse breast cancer prognosis, including an increased risk of recurrence and mortality. While the causative mechanisms have yet to be fully uncovered, emerging evidence implicates palmitate, increased in the obese state, in development of cellular senescence, an inflammatory state associated with breast tumorigenesis in preclinical models. However, studies are warranted to corroborate the impact of palmitate on induction of a cohesive senescent-like phenotype as well as the extent to which palmitate-induced senescence impacts breast tumorigenesis either in vitro or in vivo. This said, we hypothesize that palmitate exposure induces a senescent-like phenotype in fibroblasts, contributing to measures of breast cancer progression.

Methods: HCA2, IMR-90, and human mammary fibroblasts were exposed to bovine serum albumin or palmitate in media supplemented with 2% charcoal-stripped fetal bovine serum, after which the cells were measured through qPCR for expression of IL-1a, IL-6 and IL-8, some of the most prominent members of the senescence-associated secretory phenotype. Palmitate-exposed fibroblasts were also stained for senescence-associated beta-galactosidase and BrdU incorporation, well-established senescence markers. Experiments were then repeated with administration of eicosapentaenoic and docosahaexanoic acids to evaluate the potential of omega-3 fatty acids to limit the effects of palmitate on fibroblast senescence. Finally, we assessed the tumor-promoting potential of these palmitate-exposed fibroblasts by culturing MCF-7 and T47D breast cancer cells in their conditioned media and assessing changes in carcinogenic measures.

Results and Conclusions: Palmitate induced pro-inflammatory gene expression and SA-beta-gal positivity and decreased proliferation in fibroblasts, while omega-3 fatty acid supplementation reversed these effects. These palmitate-exposed fibroblasts also appeared to be of pathological impact, as exposure to their CM increased proliferation in breast cancer cells. These findings are important in that they support emerging evidence implicating obesity-associated factors in the exacerbation of breast cancer progression as well as indicate the potential of omega-3 fatty acids to improve outcome.

Citation Format: Brittany Susanne Harlow, Albert R. Davalos, Andrew J. Brenner, Christopher Jolly, Stefano Tiziani, Stephen D. Hursting, Linda A. deGraffenried. Palmitate promotes breast cancer progression in vitro through induction of a senescent-like phenotype in fibroblasts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2022.

Obesity-Modified CD4+ T-Cells Promote an Epithelial-Mesenchymal Transition Phenotype in Prostate Cancer Cells

Obesity is associated with low-grade chronic inflammation, and metabolic dysregulation. Evidence shows that chronic inflammation inhibits protective immunity mediated by CD4+ T cells. Additionally, obesity-induced inflammation affects prostate cancer progression. However, the effect of obesity on CD4+ T-cell- response to prostate cancer is not well understood. To investigate whether obesity induces changes in CD4+ T cell cytokine profile, cytokine expression was measured in splenic CD4+ T-cells from 10-week-old male C57Bl/6 mice exposed to conditioned media (CM) from macrophages grown in sera from obese subjects. Additionally, expression levels of key regulators of Epithelial-Mesenchymal Transition (EMT) were measure in prostate cancer epithelial cells exposed to conditioned media from obesity-modified T-cells. Cell migration and invasion was measured in prostate cancer epithelial cells exposed to CM from obesity-modified CD4+ T-cells. Obesity suppressed the expression of IFNγ and IL-2 in CD4+ T-cells but up-regulated the expression of IL-6. Prostate epithelial cancer cells exposed to conditioned media from obesity-modified T cell increased the expression of EMT markers and showed a higher invasive and migratory capacity.

Abstract PS19-13: Palmitate exacerbates breast tumorigenesis in vitro via induction of a senescent-like phenotype in fibroblasts

Background: Obesity is associated with a worse breast cancer prognosis, conferring an increased risk of recurrence and mortality. At the same time, recent evidence suggests that obesity is also correlated with development of cellular senescence, an inflammatory state associated with exacerbation of breast tumorigenesis in preclinical models. As obese individuals present greater levels of inflammation at baseline, research efforts are warranted to examine the means by which obesity promotes the development of a senescent phenotype, which may further exacerbate inflammation. Additionally, studies have yet to determine whether obesity-induced senescence modulates the tumorigenic process in the context of breast cancer specifically. Methods: To this end, we exposed fibroblasts to the obesity-associated circulating factor palmitate and used qPCR and western immunoblotting to assess the expression of genes and proteins involved in the senescent state, including interleukin (IL)-1a, IL-6, IL-8, senescence-associated beta-galactosidase (SA-beta-gal), and matrixmetalloproteinase (MMP)-9. As a mechanistic investigation, we next assessed the impact of palmitate on activation of NF-kB signaling using western immunoblotting, immunofluorescence, and NF-kB luciferase reporter assays. Finally, we utilized cell counting, MTT, wound healing, and colony formation assays to examine the impact of these palmitate-exposed fibroblasts on breast cancer cell proliferation, viability, motility, and survival, respectively. Results: We found that palmitate induced fibroblast gene expression of IL-1a, IL-6, and IL-8, major components of the senescent secretome, as well as expression of the senescent markers SA-beta-gal and MMP-9. The mechanism at least partially involved activation of NF-kB, responsible for production of about 75% of senescent secretome components. More importantly, these palmitate-exposed fibroblasts were of pathological impact, exacerbating in vitro measures of breast cancer cell aggressiveness. Conclusions: These findings contribute to our understanding of the impact of obesity-associated factors on breast tumorigenesis, demonstrating a mechanistic link between palmitate and the pro-tumorigenic effects of senescent cells. Our studies will ultimately aid in the identification of a therapeutic target that can be used to improve the comparably worse outcomes of the obese breast cancer patient.

Citation Format: Brittany Susanne Harlow, Albert Davalos, Andrew Brenner, Christopher Jolly, Stefano Tiziani, Steve Hursting, Linda deGraffenried. Palmitate exacerbates breast tumorigenesis in vitro via induction of a senescent-like phenotype in fibroblasts [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS19-13.

Abstract PS17-26: Fatty acid synthase inhibition targets ERα in tamoxifen-resistant breast cancer

INTRODUCTION: Estrogen receptor-positive (ER+) breast cancer accounts for nearly 70% of all cases. Common targeted anti-estrogen therapies such tamoxifen, fulvestrant and aromatase inhibitors have shown success in the clinic, but unfortunately, often lead to resistance. The fatty acid synthase enzyme (FASN) is responsible for endogenously synthesizing long-chain fatty acids, such as palmitate, which can contribute to protein modification, phospholipid biosynthesis for membranes, and lipid raft signaling that favors tumorigenesis. The depletion of intracellular palmitate leads to an alteration of lipid composition within lipid rafts of the plasma membrane as well as lipids within the endoplasmic reticulum membrane. Endoplasmic reticulum stress elicits an inhibition of protein translation through the phosphorylation of eukaryotic initiating factor 2-α (p-eIF2α) and is activated by various stimuli including altered phospholipid composition within the membrane. Our preliminary findings illustrated a degradation of the ERα upon treatment with the FASN inhibitor, TVB-3166, in tamoxifen-resistant breast cancer both in vivo and in vitro. Moreover, previous studies have illustrated FASN inhibition to induce endoplasmic reticulum stress concomitant with a loss of the androgen receptor (AR) in castration-resistant prostate cancer. Additionally, palmitate treatment rescued AR expression that was accompanied by an attenuation in endoplasmic reticulum stress. HYPOTHESIS: We hypothesize FASN inhibition leads to a degradation of ERα in tamoxifen-resistant breast cancer through the induction of endoplasmic reticulum stress. METHODS: Patient tumor explants were incubated for 72h on gelatin sponges in culture medium in the absence or presence of 200nM TVB-3166. Tissue were fixed in 10% formalin and processed into paraffin blocks and stained for ERα and Ki67. To investigate TVB induced endoplasmic reticulum stress, tamoxifen-Resistant (TamR) MCF-7 and MCF-7 cells were treated with TVB-3166 or vehicle control followed by treatment with either palmitate or ER stress inhibitor, 1,2-Bis(2-Aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid (BAPTA). Expression of ERα, p-eIF2α, eIF2α were measured by western blot. RESULTS: TVB-3166 treatment of primary tumor explants decreased their proliferation (Ki67) compared to untreated controls (14% vs 36%, p<0.01). Both IHC and Western blotting demonstrated a reduction in ERα upon treatment with TVB-3166. In addition to the decreased expression of ERα, there was an increase in the phosphorylation of eukaryotic initiation factor 2α (p-eIF2α). The expression of ERα was rescued upon palmitate treatment while resulting in decreased p-eIF2α. Inhibition of endoplasmic stress using BAPTA also rescued ERα expression after TVB-3166 treatment. CONCLUSION: FASN is a potentially viable target in tamoxifen-resistant breast cancer.

Citation Format: Bryan Mcclellan, Aleksandra Gruslova, Christopher Jolly, Linda deGraffenried, Andrew Brenner. Fatty acid synthase inhibition targets ERα in tamoxifen-resistant breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS17-26.

Abstract PS19-22: Fatty acid synthase enzyme as a mediator of obesity-induced breast cancer

INTRODUCTION: Breast cancer accounts for nearly 40,000 deaths annually with the overall prognosis worsened if the patient is obese. Reprogramming of lipid metabolism in cancer is an established hallmark and contributes to tumorigenesis and drug-resistance. The fatty acid synthase enzyme (FASN) is overexpressed in multiple solid and hematopoietic tumors and its expression is associated with tumor grade as well as resistance to therapy. Targeted therapies against the fatty acid synthase enzyme (FASN) are currently in phase II of clinical trials for the treatment of multiple solid tumors. Previously, our lab has shown enhanced expression of FASN in breast cancer cells exposed to obese sera as well as increased sensitivity to the FASN inhibitor, TVB-3166. The obese phenotype is characterized by increased circulating bioactive growth factors and hormones, such as insulin, estrogen, and insulin-like growth factor 1 (IGF-1), that are ligands for the insulin (IR) and insulin-like growth factor receptor-1 (IGF-1R). Activation of these receptors can lead to downstream signaling through the PI3K-Akt-mTOR pathway that mediates lipogenic gene expression through various transcription factors. Of these transcription factors, sterol regulatory element-binding protein-1 (SREBP-1), drives FASN gene expression and is activated downstream of both Akt and mTORC1. HYPOTHESIS: We hypothesize that obesity-induced breast cancer progression is mediated through an SREBP dependent overexpression of FASN. METHODS: MCF-7 cells were exposed to obese or non-obese sera and subjected to quantitative RT-PCR for FASN expression. MTT and colony-forming assays using both MCF-7 and T-47D breast cancer cells conditioned in 2% obese and 2% non-obese sera as well as treated with and without a FASN inhibitor (TVB-3166) were utilized to determine cell survival and viability in response to FASN inhibition. FASN expression in obesity-induced breast cancer was investigated by treating MCF-7 cells with either insulin or SREBP processing inhibitor (Betulin) and subjected to chIP-qPCR against anti-SREBP or normal rabbit IgG. RESULTS: In response to obese sera exposure, there was a nearly 3-fold increase (p=.010) in FASN expression compared to non -obese control. Obese sera exposure increased sensitivity and decrease cell viability to TVB-3166 treatment compared to non-obese sera. ChIP-qPCR against anti-SREBP showed an increase in FASN expression upon treatment with insulin compared to normal rabbit IgG control. This increase in FASN expression was attenuated upon treatment with the SREBP processing inhibitor, Betulin. CONCLUSION: The overexpression of FASN contributes to obesity-induced breast cancer aggression and is regulated by an insulin-SREBP-FASN signaling axis.

Citation Format: Bryan Mcclellan, Tommy Pham, Brittany Harlow, Gabby Lee, Duan Quach, Christopher Jolly, Andrew Brenner, Linda deGraffenried. Fatty acid synthase enzyme as a mediator of obesity-induced breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS19-22.

Mucosal-associated invariant T (MAIT) cells are activated in the gastrointestinal tissue of patients with combination ipilimumab and nivolumab therapy-related colitis in a pathology distinct from ulcerative colitis

The aim of this study was to investigate the pathogenesis of combination ipilimumab and nivolumab-associated colitis (IN-COL) by measuring gut-derived and peripheral blood mononuclear cell (GMNC; PBMC) profiles. We studied GMNC and PBMC from patients with IN-COL, IN-treated with no adverse-events (IN-NAE), ulcerative colitis (UC) and healthy volunteers using flow cytometry. In the gastrointestinal-derived cells we found high levels of activated CD8⁺ T cells and mucosal-associated invariant T (MAIT) cells in IN-COL, changes that were not evident in IN-NAE or UC. UC, but not IN-C, was associated with a high proportion of regulatory T cells (T_reg ). We sought to determine if local tissue responses could be measured in peripheral blood. Peripherally, checkpoint inhibition instigated a rise in activated memory CD4⁺ and CD8⁺ T cells, regardless of colitis. Low circulating MAIT cells at baseline was associated with IN-COL patients compared with IN-NAE in one of two cohorts. UC, but not IN-COL, was associated with high levels of circulating plasmablasts. In summary, the alterations in T cell subsets measured in IN-COL-affected tissue, characterized by high levels of activated CD8⁺ T cells and MAIT cells and a low proportion of T_reg , reflected a pathology distinct from UC. These tissue changes differed from the periphery, where T cell activation was a widespread on-treatment effect, and circulating MAIT cell count was low but not reliably predictive of colitis.

Abstract P1-08-02: Omega-3 fatty acids modulate the ability of obese conditions to induce of a proinflammatory phenotype in fibroblasts

Background: Approximately 40% of American women suffer from obesity, and about 1 in 8 women will be diagnosed with breast cancer during her lifetime. The concurrence of these trends has the potential to be particularly detrimental, as obesity confers a worse prognosis for both pre- and postmenopausal breast cancer patients. While the precise mechanisms by which obesity impacts breast cancer prognosis remain to be discovered, evidence suggests that obesity upregulates components of cancer-associated fibroblast (CAF) and senescent cell secretomes, both causally associated with carcinogenesis. Specifically, obesity has been shown to induce expression of the secretory products prostaglandin E2, high mobility group protein B1, interleukin (IL)-6, IL-1 beta, and matrix metalloproteinase-1, the expression of which can be modulated by omega-3 fatty acid-induced signaling. However, studies have yet to determine whether obesity imparts these proinflammatory phenotypes in any individual cell type in the breast tumor microenvironment as well as whether these phenotypes can be modulated by administration of omega-3 fatty acids. This said, we hypothesize that fatty acids modulate the ability of obese conditions to induce a proinflammatory senescent- or CAF-like fibroblast phenotype and thus impact breast cancer progression. Because fibroblasts constitute 80% of the tumor stromal mass, it is of the utmost importance to study obesity-stimulated changes in this cellular compartment and their effects on tumor progression.

Methods: Fibroblasts were exposed to sera derived from lean or obese women with and without omega-3 fatty acid supplementation and assessed for changes in expression of proinflammatory genes, including IL-1α, IL-6, and IL-8, as well as nuclear localization of p65, a subunit of the NF-kB transcription factor, which transcribes about 75% of genes related to the senescent secretome. Conditioned media (CM) from these fibroblasts were then applied to breast cancer cells to assess measures of cancer cell aggressiveness. Finally, as an ex vivo study, breast tissue samples from lean and obese women and mice were compared for concentration of proinflammatory, senescent fibroblasts by immunohistochemical analyses.

Results: Gene and protein expression analyses demonstrated that obese conditions induced a proinflammatory phenotype in fibroblasts, an effect at least partially modulated by omega-3 fatty acids. These phenotypic changes were not without pathological consequence: CM from obesity-stimulated fibroblasts impacted in vitro measures of breast cancer cell aggressiveness to a greater degree than lean sera-stimulated fibroblasts.

Conclusions: While correlative, these data contribute to the identification of a link between obesity and proinflammatory, senescent phenotypes and will ultimately allow for elucidation of the means by which obese conditions confer a worse prognosis for breast cancer patients. In addition, these findings will contribute to our understanding of crosstalk within the tumor microenvironment and inform our pursuit for the development of novel therapeutic targets.

Citation Format: Brittany Harlow, Albert Davalos, Andrew Brenner, Christopher Jolly, Stefano Tiziani, Stephen Hursting, Linda deGraffenried. Omega-3 fatty acids modulate the ability of obese conditions to induce of a proinflammatory phenotype in fibroblasts [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-08-02.

Abstract 5131: Obese conditions induce changes in stromal fibroblast phenotype

Background: Over 40% of American women present a BMI ≥30, which is particularly alarming since obesity confers a worse prognosis for both pre- and postmenopausal breast cancer patients. Although the molecular mechanisms behind this remain unclear, obese conditions have been shown to upregulate certain components of the cancer-associated fibroblast (CAF) secretome and senescence associated secretory phenotype (SASP), both directly correlated with tumorigenesis. However, studies have yet to determine whether obesity induces a cohesive SASP or CAF-like phenotype from any one cell type of the breast tumor microenvironment. Because fibroblasts represent the most common breast tumor cell type, it is of particular importance to investigate obesity-induced changes in this cellular compartment and their effects on cancer cell behavior. Methods: Direct effects of obesity were examined by exposing IMR-90 and HCA2 human fibroblasts to media supplemented with 2% sera from obese women and measuring changes in gene and protein expression, while indirect effects were evaluated by exposing the fibroblasts to conditioned media (CM) from obesity-stimulated MCF-7 and T47D cells and assessing changes in expression of proinflammatory cytokines. Breast cancer cells were also exposed to CM from obesity-stimulated fibroblasts and measured for changes in proliferation, survival, motility, and invasion. Results and Conclusions: Obese conditions induced proinflammatory changes in fibroblasts both directly and indirectly and stimulated changes in the paracrine signaling between fibroblasts and breast cancer cells. These data contribute to the growing evidence implicating obesity in the promotion of breast cancer progression. Additionally, these findings provide a new line of research to develop potential therapeutic targets to improve outcome.

Citation Format: Brittany Harlow, Albert Davalos, Andrew Brenner, Christopher Jolly, Stephen Hursting, Linda deGraffenried. Obese conditions induce changes in stromal fibroblast phenotype [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5131.

Abstract 61: Obesity-induced T cell senescence contributes to prostate cancer progression

Obese men are at greater risk of developing an aggressive form of prostate cancer. The T cell population from obese subjects have shown signatures of cell senescence including shortened telomeres and elevated production of proinflammatory cytokines. The objective of our studies is to better understand the cellular and molecular basis for altered T cell anti-prostate tumor immunity in obesity, and whether this altered immune function contributes to the worse outcomes observed in obese patients. To investigate whether obesity induces a pro-inflammatory senescent phenotype in CD4+ T cells, splenic CD4+ T-cells from 10-week-old male C57Bl/6 mice were isolated and, either pre-stimulated or co-stimulated with anti CD3/CD28 and conditioned media (CM) from macrophages stimulated under obese or normo-weight conditions. After 24 hours conditioned media from these CD4+ T cells was collected, and their relative cytokine expression profile was analyzed. The CD28 receptor is expressed on CD4+ T cells and provides co-stimulatory signals required for T cell activation. CD28 activation results in phosphorylation of Akt. Lack of Akt phosphorylation in CD4+ T cells after CD3+/CD28+ stimulation indicates CD4+ T cell dysfunction and senescence. Fresh murine splenic CD4+ T cells were isolated and stimulated with anti CD3/CD28 under obese or control conditions. Akt1 phosphorylation levels were assessed using Western blot analysis. To determine if obese conditions modify the impact of CD4+ T cell dysfunction on prostate cancer cell signal transduction pathways, prostate cancer epithelial cells were exposed to obese or control CD4+ T-cells CM for 30 minutes and western blot analysis was used to evaluate the modulation of key pro- and anti-tumorigenic pathways. Matrigel Invasion chambers were used to determine if obesity-modified CD4+ T cell CM impacts the invasive capacity of prostate epithelial cells. Obese conditions suppressed the expression of IFN-γ and IL-2 in CD4+ T-cells. Data also suggests that T cells exposed to obese conditions suppress STAT1 activation in prostate cancer cells. Additionally, obese conditions up-regulated the expression of IL-6 and IL-10 in CD4+ T-cells when compared to control. Importantly our data also suggests that T cells exposed to obese conditions induce STAT3 activation in prostate cancer cells. Preliminary data also suggests that obesity-modified CD4+ T cell CM impacts the invasive capacity of prostate cancer cells. Obesity may induce CD4+ T cell dysfunction, limiting their tumor suppressing activity. Findings form this study could substantially advance fundamental understanding of the ways in which obesity alters T cells, thereby promoting uncontrolled tumor growth and mortality from prostate cancer. This study could also provide a framework for future translational research aimed at improving the effectiveness of therapies in obese patients.

Citation Format: Alejandra De Angulo, Peyton Travis, Christopher Jolly, Linda deGraffenried. Obesity-induced T cell senescence contributes to prostate cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 61.

Abstract P3-07-10: Modulation of FASN under obese conditions

Introduction: Obesity is known to be associated with a worse breast cancer prognosis, in part through altering metabolism in cells of the tumor microenvironment. In particular, changes in metabolism associated with fatty acid utilization have been noted in not only breast cancer, but also several other cancer types. This includes changes to both expression and activity of the Fatty Acid Synthase enzyme (FASN), which is responsible for production of long chain fatty acids, including palmitate. These changes in long chain fatty acid production can modulate tumor behavior through modulation of energy utilization such as beta-oxidation, as well as plasma membrane modulation with phospholipids. Our previous studies have demonstrated that exposure to obese conditions induces significant changes in breast cancer cell proliferation. Additionally, obesity modulates activity of other cells within the tumor microenvironment, including adipocytes, which might influence the cancer cell itself. We hypothesize one particular mechanism that supports these changes is obesity-induced upregulation of FASN and that FASN may be a viable target to limit obesity-induced progression.

Methods and Results: FASN has been shown to promote cancer cell proliferation through generating fatty acid precursors required for cell proliferation, altering membrane fluidity, and activating oncogenic signaling pathways. To determine if modulation of FASN is an important mechanism by which obesity promotes disease progression, MCF-7 breast cancer cells and human pre-adipocyte cells (ASC) were exposed to 2% sera from obese postmenopausal women and 2% sera from non-obese (control) women. Preliminary quantitative PCR results demonstrated that exposure to the obese sera resulted in increased expression of FASN in both the cancer cells as well as the ASC. Current studies are on-going to determine if 1) FASN up-regulation results in increased long-chain and free fatty acid production in both the cancer and adipocyte cells, 2) whether changes in long chain and free fatty acid production results in altered metabolism and plasma membrane status and 3) whether targeting FASN with a new generation of FASN inhibitors currently being investigated in the clinic can modulate obesity-induced disease progression.

Conclusions: Our findings indicate that obesity promotes upregulation of FASN in several cells within the tumor microenvironment, including adipocytes and the cancer cell itself. We have also found that using a FASN inhibitor is effective in limiting cancer cell viability and proliferation. Our on-going studies will confirm if this is an important mechanism by which obesity promotes disease progression. Since FASN inhibitors are currently being investigated in the clinic, the results of these studies will provide a better understanding of how obesity alters the biology of the disease, and may identify a novel target for improving patient outcomes.

Citation Format: Pham T, Oberman A, Kim I, Lee G, Quach D, Galván G, Jolly C, Cavazos D, Brenner A, deGraffenried L. Modulation of FASN under obese conditions [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 P3-07-10.

Abstract 233: The impact of omega-3 fatty acid supplementation on obesity-induced inflammatory signaling within the breast tumor microenvironment

The Impact of Omega-3 Fatty Acid Supplementation on Obesity-induced Inflammatory Signaling within in the Breast Tumor Microenvironnment. Obesity is associated with a worsened prognosis in breast cancer. This is in part due to the role of prostaglandin E2 (PGE2) in the obesity-inflammation-aromatase axis. Omega-3 polyunsaturated fatty acids (PUFAs) have demonstrated anti-cancer effects through multiple pathways, including suppression of the pro-inflammatory COX2-PGE2 pathway. In order to determine if supplementation with omega-3 fatty acids can effectively suppress PGE2 production in obese postmenopausal women, we conducted a 30 day non-interventional study with correlative biomarker endpoints. Forty (40) postmenopausal women were provided oral daily supplements of 1500mg of docosahexaoic acid (DHA) and 2500mg eicosapentanoic acid (EPA). Serum samples were collected prior to and on day 29 of taking the supplement and analyzed for PGE2 levels. Fifty-five percent (55%) of the subjects demonstrated a significant suppression of PGE2 levels. To test if response could be based upon the ratio of omega-6 to omega-3 fatty acids on inflammatory signaling within the breast, pre-clinical studies were performed on different cell types found in the tumor microenvironment. Macrophages, breast cancer epithelial cells and pre-adipocytes were exposed to omega-6 and omega-3 fatty acids at ratios of 46:1, 20:1, 10:1 and 1.3:1 for 24 hours. While breast cancer epithelial cells demonstrated limited response to PUFA concentrations, the macrophage and adipocyte cells produced high levels of PGE2 when exposed to higher ratios of omega-6 fatty acids, which was effectively suppressed in a dose-dependent manner with increasing levels of omega-3 fatty acids. These data suggest that obese breast cancer patients may have a particular benefit to omega-3 fatty acid supplementation. Ongoing studies will assess how PUFA-modulated changes in inflammatory signaling from different cells within the microenvironment impact breast cancer cell proliferation, therapeutic resistance, and migration as measures of breast cancer progression. These mechanistic studies, in combination with our on-going NCI-funded prospective clinical study in newly diagnosed breast cancer patients, will significantly contribute to understanding how ratios of omega-6 to omega-3 fatty acids can modulate inflammatory signaling within the tumor microenvironment, and if this can be used to improve therapeutic response in the obese breast cancer population.

Citation Format: Duan K. Quach, Brittany Harlow, Laura Winikka, Andrew Brenner, Murali Beeram, Stefano Tiziani, Lucy Lengfelder, Gloria Galvan, Christopher Jolly, Linda deGraffenried. The impact of omega-3 fatty acid supplementation on obesity-induced inflammatory signaling within the breast tumor microenvironment [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 233. doi:10.1158/1538-7445.AM2017-233

Abstract P6-17-03: The importance of the ultimate ratio of Omega-6 to Omega-3 fatty acids in the efficacy of fish oil supplements in suppressing inflammation in obese postmenopausal women

Over the last decade, a large body of evidence has established that obesity is associated with a worse breast cancer prognosis for both pre- and postmenopausal women. There are several mechanisms which have been proposed for promoting this effect, including stage of diagnosis and co-morbidities, but more recent evidence suggests that the obese state is associated with changes in the biology of the disease, promoting a more aggressive phenotype. Our recently published in vitro and retrospective studies suggest that this is due, at least in part, through cyclooxygenase 2 (COX-2)-derived prostaglandin E2 (PGE2), and that interventions that suppress COX-2 PGE2 production may provide significant benefit for the obese ER+ patient in preventing many of the cancer-promoting effects associated with obesity. Omega-3 fatty acids have demonstrated anti-cancer benefit through multiple mechanisms, including suppression of inflammation-related signaling. DHA and EPA (omega-3 PUFAs found in fish oil) modulate inflammatory responses through COX-2 dependent and independent mechanisms. However, previous studies investigating the potential anti-cancer benefit of omega-3 PUFA and fish oil supplementation have produced mixed results, and none have focused specifically on the obese patient population.

To determine if supplementation with non-steroidal anti-inflammatory drugs (NSAIDs), including omega-3 fatty acids, can effectively suppress PGE2 production in the obese postmenopausal patient, we conducted a double-blind, prospective Phase 0, comparative, 30 day, non-interventional study with correlative biomarker endpoints. One hundred twenty (120) postmenopausal women without breast cancer were randomized to three arms 1. ASA 81mg po daily, 2. 1500mg of docosahexaoic acid (DHA) and 2500mg eicosapentanoic acid (EPA) given daily and 3. Combined ASA and DHA/EPA at above doses. Serum samples were collected prior to and on day 29 of taking the supplements. PGE2 levels in the pre- and post-supplement serum samples were analyzed in triplicate by ELISA and presented as the percentage of change between post- and pre-supplement levels. Of the women in Arm 2 (DHA + EPA only), only 55% demonstrated a significant suppression of PGE2 levels after 30 day of supplements, compared to those in Arm 1 (ASA), in which 80% demonstrated a significant response.

We anticipate that the omega-3 fatty acid supplements were not as effective in as large a population as the aspirin due to a failure to reach a critical ratio between circulating levels omega-6 and omega-3 fatty acids, which has been shown by our own group and others to be a key determinant of cellular response. Studies are on-going to analyze the PUFA levels in both the pre and post supplement serum samples, and pre-clinical studies are being conducted to determine if the ratio of omega-6 to omega-3 PUFAs modulates PGE2 production in several different cell types, including macrophages, adipocytes and the breast cell itself. These results will be critical for moving clinical studies utilizing these agents forward, both in terms of elucidating the mechanism mediating an effect, and also in identifying an accurate biomarker for monitoring compliance and response.

Citation Format: Quach D, Lengfelder L, Winnika L, Harlow B, Galvan G, Jolly C, Brenner A, deGraffenried L. The importance of the ultimate ratio of Omega-6 to Omega-3 fatty acids in the efficacy of fish oil supplements in suppressing inflammation in obese postmenopausal women [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 P6-17-03.

Functional Characterisation of Eel Dopamine D2 Receptors and Involvement in the Direct Inhibition of Pituitary Gonadotrophins

In various vertebrate species, dopamine (DA) exerts an inhibitory action on reproduction. In the European eel, DA plays a pivotal role in the inhibitory control of gonadotroph function and the blockade of puberty. In vivo studies have suggested that this effect is mediated by receptors pharmacologically related to the D2 family. In the European eel, two distinct D2 receptor (D2-R) paralogous genes have been identified (D2A-R and D2B-R) and both were shown to be expressed in the pituitary. We investigated the potential role of each paralogue in the control of gonadotroph function in this species. Eel recombinant D2A-R or D2B-R were expressed in HEK 293 cells, with a universal Gα subunit, and receptor activation was followed by inositol phosphate production. Recombinant D2-Rs exhibited a comparable affinity for DA, although they had differential affinities for mammalian D2-R agonists and antagonists, supporting subtle structure/activity differences. Furthermore, using eel pituitary cell primary cultures, the expression by gonadotroph cells of both native eel D2-R paralogues was examined by in situ hybridisation of D2A-R or D2B-R transcripts, coupled with immunofluorescence of luteinising hormone (LH)β or follicle-stimulating (FSH)β. LH and to a lesser extent, FSH cells expressed both D2-R transcripts but with a clear predominance of D2B-R. Notably, D2B-R transcripts were detected for the majority of LH cells. Accordingly, using these cultures, we showed that DA potently inhibited basal and testosterone-stimulated LHβ expression and less potently basal and activin-stimulated FSHβ expression. We also tested some D2-R antagonists, aiming to select the most adequate one to be used in innovative protocols for induction of eel sexual maturation. We identified eticlopride as the most potent inhibitor of DA action on basal and stimulated LH expression in vitro. Our data suggest a differential functionalisation of the duplicated receptor genes and demonstrate that mainly D2B-R is involved in the dopaminergic inhibitory control of eel gonadotroph function.

Age-related increase in IL-17 activates pro-inflammatory signaling in prostate cells

BACKGROUND

A close relationship between aging, inflammation, and prostate cancer is widely accepted. Aging is accompanied by a progressive increase in pro-inflammatory cytokines, including interleukin 17 (IL-17), a key pro-inflammatory cytokine that becomes dysregulated with age. However, the contribution of IL-17 to age-related prostate tumorigenesis remains unclear. The aim of this study was to investigate the role of age-related IL-17 dysregulation in prostate tumorigenesis.

METHODS

Serum and splenic T-lymphocytes from young GPAT-1 knock-out aging-mimic T cell mice as well as young and aged wild-type mice were collected. shRNA was used to knock down the IL-17 receptor in LNCaP prostate cancer cells and RWPE-1 non-transformed prostate epithelial cells, which were then exposed to the mouse sera or conditioned media from stimulated T-lymphocytes. NF-κB activation, NF-κB target gene expression, and cell proliferation were all measured in these cells by luciferase assay, qPCR, Western blot analysis, and MTT assay, respectively.

RESULTS

T-lymphocyte-secreted IL-17 from aging-mimic mice induced NF-κB activity and target gene expression in LNCaP and RWPE-1 cells. It also promoted proliferation of these cells.

CONCLUSION

Aging-mimic T cell mice produce increased levels of IL-17, which stimulates the pro-inflammatory NF-κB pathway in prostate epithelial cells. NF-κB increases inflammation, carcinogenesis and metastatic potential in the prostate. These findings provide evidence that the dysregulation of cytokine production seen in aged T cells may directly contribute to the increased risk for prostate cancer in the elderly.

Anti-androgens act jointly in suppressing spiggin concentrations in androgen-primed female three-spined sticklebacks - prediction of combined effects by concentration addition

Increasing attention is being directed at the role played by anti-androgenic chemicals in endocrine disruption of wildlife within the aquatic environment. The co-occurrence of multiple contaminants with anti-androgenic activity highlights a need for the predictive assessment of combined effects, but information about anti-androgen mixture effects on wildlife is lacking. This study evaluated the suitability of the androgenised female stickleback screen (AFSS), in which inhibition of androgen-induced spiggin production provides a quantitative assessment of anti-androgenic activity, for predicting the effect of a four component mixture of anti-androgens. The anti-androgenic activity of four known anti-androgens (vinclozolin, fenitrothion, flutamide, linuron) was evaluated from individual concentration-response data and used to design a mixture containing each chemical at equipotent concentrations. Across a 100-fold concentration range, a concentration addition approach was used to predict the response of fish to the mixture. Two studies were conducted independently at each of two laboratories. By using a novel method to adjust for differences between nominal and measured concentrations, good agreement was obtained between the actual outcome of the mixture exposure and the predicted outcome. This demonstrated for the first time that androgen receptor antagonists act in concert in an additive fashion in fish and that existing mixture methodology is effective in predicting the outcome, based on concentration-response data for individual chemicals. The sensitivity range of the AFSS assay lies within the range of anti-androgenicity reported in rivers across many locations internationally. The approach taken in our study lays the foundations for understanding how androgen receptor antagonists work together in fish and is essential in informing risk assessment methods for complex anti-androgenic mixtures in the aquatic environment.

Age-related alterations in T-lymphocytes modulate key pathways in prostate tumorigenesis

BACKGROUND

The primary risk for prostate cancer is aging, often associated with inflammation. Evidence implicates progressive age-related immune dysfunction with increased prostate cancer incidence and mortality. The aged T-cell response is characterized by increased production of pro-inflammatory cytokines, which could significantly contribute to prostate tumorigenesis through induction of key inflammation-mediated pro-survival factors.

METHODS

T-cell function of the young (<6 month-old) glycerol-3-phosphate acyltransferase-1 (GPAT-1) knock-out mouse mimics many of the hallmarks observed in an aged (>22-month-old) mouse. Serum and splenic T-lymphocytes from young GPAT-1(-/-) (6 months) and aged wild type (22 months) mice were collected for in vitro studies, including a cytokine immunoarray for serum cytokine levels, luciferase assays for NF-κB activation and Western blot analyses for protein expression.

RESULTS

The T-cell cytokine profile of the GPAT-1(-/-) mice mirrored that observed in aged wild type mice, including higher expression levels of IL-17. Serum- and T-cell-derived factors induced NF-κB activity in normal, non-transformed and prostate cancer epithelial cells, correlating with re-localization of NF-κB and increased protein expression of downstream targets of NF-κB.

CONCLUSION

The aging and aging-mimic mice produced circulating factors that induce pro-inflammatory pathways in prostate cells, most notably NF-κB. These findings provide evidence that an aged T-cell may directly contribute to the increased risk for prostate cancer in the elderly and establish that the GPAT-1(-/-) model, which mimics many of the characteristics of an aged immune system, is a viable tool for investigating this novel area of cancer risk.

Myocarditis associated with Campylobacter jejuni

Myocarditis is frequently associated with a multitude of different viral infections but much less commonly a bacterial source. We present the case of a 33-year-old male with Campylobacter jejuni enteritis who subsequently developed myocarditis confirmed on cardiac MRI.

Abstract 5577: The role of age-related enhancements of IL-17 in prostate cancer initiation and progression

Background: Age is the single greatest risk factor for prostate cancer development. As men pass age 40, their chance of developing prostate cancer increases exponentially each year. The mechanism by which age influences the risk of prostate cancer remains largely unknown, hindering the development of effective preventive approaches. While local events are known to contribute to age-related prostate tumorigenesis, the role of the aging immune system in prostate cancer development has been largely understudied. The aging process affects the adaptive cell-mediated immune response and at the same time there is a shift to a more inflammatory cytokine profile. Recent studies have shown that age-related enhancements of Th17 might contribute to changes in immune function and prostate cancer development. The age-related shift in T-lymphocyte cytokine profile and the enhancement of TH17 generation might be significant contributing factors to the association between age and prostate tumorigenesis.

Methods: For our studies we have been using a unique animal model, the glycerol-3-phosphate acyltransferase-1 (GPAT-1) knock out mouse. The GPAT-1 KO young mouse T lymphocyte phenotype mimics old (&gt; 18 m) wild type mice. Preliminary data suggested that cytokines secreted from the GPAT-KO aging mimic T-lymphocytes can promote activation of the STAT3/NF-kB pathways. In order to test if IL-17 was responsible for the strong induction of NF-kB and STAT3, we repeated previous experiments that measured the activation of NF-kB and STAT3, but supplemented the experimental sera and conditioned media with depleting antibodies to IL-17. Successful inhibition of the NF-kB and STAT3 pathways was assessed by Western Blot analysis.

Conclusions: Depleting IL-17 in the GPAT-1 KO sera and conditioned media decreased NF-kB activity to the levels of the cells treated with wild-type sera. Sera from the old and GPAT-1 KO mice induced activation of downstream targets of IL-17. These results suggest that circulating factors from the GPAT-1 KO mice mimic those in aging mice and strongly induced signaling pathways involve in the development of prostate cancer. The age-related enhancements of IL-17 may play a key role in prostate cancer initiation and progression.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5577. doi:10.1158/1538-7445.AM2011-5577

Use of cutaneous flap for continent cystostomy (daoud technique)

PURPOSE

We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.

MATERIALS AND METHODS

A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.

RESULTS

Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.

CONCLUSIONS

We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

Electrode features for hearing preservation and drug delivery strategies

BACKGROUND/AIMS

Reducing the risk of hearing loss after cochlear implantation requires optimization of the electrode array to minimize the physical trauma caused by insertion and placement. Furthermore, the electrode design must be optimized for atraumatic surgical approaches. Even greater levels of protection may be achieved by the use of a drug during and after implantation. The electrode array offers a potential vehicle for drug delivery.

METHODS

This article reviews the laboratory and clinical data available thus far relating to the importance of electrode design parameters for trauma minimization, and the possibility of further reduction through pharmaceutical intervention. Candidate drugs were identified through literature review and laboratory evaluation. The most promising have been investigated in vitro and in animal models of implantation trauma. Three delivery devices are currently under development to satisfy the specific demands of different therapy regimes. The delivery profiles of each were evaluated through both modelling and bench testing and the concepts investigated in vitro and in vivo.

RESULTS

Current evidence favours a thin, flexible electrode array with wires in a zigzag shape. Steroids and an apoptosis inhibitor (AM111) performed well in animal models of electrode trauma and are both good drug candidates for reduction of the risk of hearing loss after implantation. Semi-chronic dexamethasone elution, acute drug delivery by intracochlear catheter, and longer-term delivery through diffusion from a reservoir were all shown to be feasible.

CONCLUSION

An extensive programme focussed on minimizing hearing loss through device optimization and the development of new technologies has yielded positive results and new concepts for further development and clinical application.

Measuring bidirectional mutation

The estimation of mutation rates is usually based on a model in which mutations are rare independent Poisson events. Back-mutation of mutants, an even rarer event, is ignored. In the hypermutating B cells of the immune system, mutation between phenotypes exhibiting, vs. not exhibiting, surface immunoglobulin is common in both directions. We develop three strategies for the estimation of mutation rates under circumstances such as these, where mutation rates in both directions are estimated simultaneously. Our model for the growth of a cell culture departs from the classical assumption of cell division as a memoryless (Poisson) event; we model cell division as giving rise to sequential generations of cells. On this basis, a Monte-Carlo simulation is developed. We develop also a numerical approach to calculating the probability distribution for the proportion of mutants in each culture as a function of forward- and backward-mutation rates. Although both approaches are too computationally intensive for routine laboratory use, they provide the insight necessary to develop and evaluate a third, 'hand-calculator' approach to extracting mutation rate estimators from experiments of this type.

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study

BACKGROUND

In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol.

METHODS

Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration.

RESULTS

Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy.

CONCLUSIONS

The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

High-resolution ultrasonography of subretinal structure and assessment of retina degeneration in rat

The purpose of this work was to evaluate the ability of 80 MHz ultrasonography to differentiate intra-retinal layers and quantitatively assess photoreceptor dystrophy in small animal models. Four groups of 10 RCS rats each (five dystrophic and five controls) were explored at 25, 35, 45 and 55 days post-natal (PN). A series of retina cross-sections were obtained ex vivo from outside intact eyes using an 80 MHz three-dimensional ultrasound backscatter microscope (20-microm-axial resolution). Ultrasound features of normal retina were correlated to those of corresponding histology and thickness measurements of photoreceptor segment and nuclear layers were performed on all groups. To show the ability of 80 MHz ultrasonography to distinguish the retinal degeneration in vivo, one RCS rat was explored at 25 and 55 days post-natal. Ultrasound image of normal retina displayed four distinct layers marked by reflections at neurites/nuclei interfaces and permitted to differentiate the photoreceptor segment and nuclear layers. The backscatter level from the retina was shown to be related to the size, density and organization of the intra-layer structure. Ultrasound thickness measurements highly correlated with histologic measurements. A thinning (p<0.05) of outer nuclear layer (ONL) was detected over time for controls and was thought to be assigned to retina maturation. Retinal degeneration started at PN35 and resulted in a more pronounced ONL thinning (p<0.05) over time. ONL degeneration was accompanied by segment layer thickening (p<0.05) at PN35 and thinning thereafter. These changes may indicate accumulation of outer segment debris at PN35 then progressive destruction. In vivo images of rat intra-retinal structure showed the ability of the method to distinguish the photoreceptor layer changes. Our results indicate that 80 MHz ultrasonography reveals intra-retinal layers and is sensitive to age and degenerative changes of photoreceptors. This technique has great potential to follow-up retinal dystrophy and therapeutic effects in vivo.

Movements of cochlear implant electrodes inside the cochlea during insertion: an x-ray microscopy study

BACKGROUND

There are no satisfactory, noninvasive techniques currently available to visualize the cochlear implant (CI) electrode in a dynamic state as it is advanced inside the cochlea.

OBJECTIVE

This study describes a radiologic technique that can be used in temporal bones to monitor the electrode position in real time and to visualize the basilar membrane.

METHODS

A cochleostomy was performed in accordance with the normal procedure for cochlear implantation in seven fresh cadaveric temporal bones. A special x-ray tube (Microfocus; Focus, Wunstorf, Germany) with a spot size of 1 microm and fluoroscopy were used for continuous videotape imaging of the advancing electrode in the cochlea. Conventional electrodes (MED-EL 40+; MED-EL, Innsbruck, Austria) and prototypes of perimodiolar electrodes (MED-EL), with varying thicknesses and angles of insertion, were used for the study. Finally, contrast liquid (Ultravist; Berlex Imaging, Schering, Germany) was injected into the scala vestibuli through the stapes footplate.

RESULTS

The advancing electrode carrier was clearly visible at x20 magnification. With the perimodiolar electrodes, deep insertion was impossible if the guiding wire was too rigid, and retraction occurred if the wire was soft. The intact nature of the basilar membrane could be confirmed by the sequential filling of scala vestibuli and the scala tympani.

CONCLUSION

To our knowledge, this is the first noninvasive study demonstrating continuous visualization with high-resolution and x-ray magnification of CI electrode advancement inside the intact cochlea. Our technique can be used for the development of CI electrodes with optimal design characteristics, especially stiffness. Visualization of the basilar membrane will influence the insertion techniques when CIs are developed for patients with residual hearing.

Insights into the catalytic mechanism of HlyC, the internal protein acyltransferase that activates Escherichia coli hemolysin toxin

Hemolysin, a toxic protein secreted by pathogenic Escherichia coli, is converted from nontoxic prohemolysin, proHlyA, to toxic hemolysin, HlyA, by an internal protein acyltransferase, HlyC. Acyl-acyl carrier protein (ACP) is the essential acyl donor. The acyltransferase reaction proceeds through two partial reactions and entails formation of a reactive acyl-HlyC intermediate [Trent, M. S., Worsham, L. M., and Ernst-Fonberg, M. L. (1999) Biochemistry 38, 9541-9548]. The ping pong kinetic mechanism implied by these findings was validated using two different acyl-ACP substrates, thus verifying the independence of the previously demonstrated two partial reactions. Assessments of the stability of the acyl-HlyC intermediate revealed an increased stability at pH 8.6 compared to more acidic pHs. Mutations of a single conserved histidine residue essential for catalysis gave minimal activity when substituted with a tyrosine residue and no activity with a lysine residue. Unlike numerous other His23 mutants, however, the H23K enzyme showed significant acyl-HlyC formation although it was unable to transfer the acyl group from the proposed amide bond intermediate to proHlyA. These findings are compatible with transient formation of acyl-His23 during the course of HlyC catalysis. The effects of several other single site-directed mutations of conserved residues of HlyC on different portions of the reaction progress were examined using a 39 500 kDa fragment of proHlyA which was a more effective substrate than intact proHlyA.

Stress-specific activation and repression of heat shock factors 1 and 2

Vertebrate cells express a family of heat shock transcription factors (HSF1 to HSF4) that coordinate the inducible regulation of heat shock genes in response to diverse signals. HSF1 is potent and activated rapidly though transiently by heat shock, whereas HSF2 is a less active transcriptional regulator but can retain its DNA binding properties for extended periods. Consequently, the differential activation of HSF1 and HSF2 by various stresses may be critical for cells to survive repeated and diverse stress challenges and to provide a mechanism for more precise regulation of heat shock gene expression. Here we show, using a novel DNA binding and detection assay, that HSF1 and HSF2 are coactivated to different levels in response to a range of conditions that cause cell stress. Above a low basal activity of both HSFs, heat shock preferentially activates HSF1, whereas the amino acid analogue azetidine or the proteasome inhibitor MG132 coactivates both HSFs to different levels and hemin preferentially induces HSF2. Unexpectedly, we also found that heat shock has dramatic adverse effects on HSF2 that lead to its reversible inactivation coincident with relocalization from the nucleus. The reversible inactivation of HSF2 is specific to heat shock and does not occur with other stressors or in cells expressing high levels of heat shock proteins. These results reveal that HSF2 activity is negatively regulated by heat and suggest a role for heat shock proteins in the positive regulation of HSF2.

Synthesis and biological evaluation of sialylmimetics as rotavirus inhibitors

Rotaviruses cause severe gastroenteritis in infants and are estimated to be responsible for over 600 000 deaths annually, primarily in developing countries. The development of potential inhibitors of this virus is therefore of great interest, particularly since the safety and efficacy of rotaviral vaccines has recently been questioned. This study describes the synthesis of a variety of compounds that can be considered as mimetics of N-acetylneuraminic acid thioglycosides and the subsequent in vitro biological evaluation of these sialylmimetics as inhibitors of rotaviral infection. Our results show that readily accessible carbohydrate-based compounds have the potential to act as inhibitors of rotaviral replication in vitro, presumably through inhibition of the rotaviral adhesion process.