Abstract 5673: The role of NMDA receptors subunits in the progression of inflammatory breast cancer (IBC)

Inflammatory Breast Cancer (IBC) has a 73% incidence of metastasis to the brain as compared to other cancer types like breast, lung, and bone cancer. Previous research showed that tumor cells from different breast cancer subtypes (-HR/-HER2) and (-HR/+ HER2) have a high incidence of crossing the blood-brain barrier and inducing increased expression of glutamate receptors NMDA subunits (NMDAR1 and NMDR2) in the brain. IBC is the most aggressive and rare type of breast cancer. The absence of a solid tumor is replaced by swelling, redness, and skin changes, resulting in many cases in misdiagnosis of an infection in the invasion and migration phase; this type of cancer blocks blood and lymphatic vessels in the breast's skin, causing local inflammation and rapid metastasis. However, little is known of the role that these glutamatergic receptors have in the development and/or progression of IBC. The present work provides a new understanding of the cellular and molecular effects NMDA receptors (NMDAR) have on oncogenic phenotypes in IBC. The detection and quantification of the NMDAR were evaluated by RT-qPCR, Western blot, and immunofluorescence (IF) techniques in deferments breast cancer cell lines (MCF7, MDA-MB-231) and IBC cell lines (SUM149, and SUM190). Also, NMDAR antagonists (memantine and dizocilpine "MK-801") were used in 2D and 3D cell cultures to see the pro-oncogenic effects of migration and proliferation in cell models. In addition to this, the autocrine regulation of Glutamate in IBC cell lines is verified. Results showed a significant increase in the expression of NMDARs in IBC cell lines. In the functional cell culture assays with NMDAR antagonists, a decrease in migration and proliferation in IBC cell lines was found. These findings may be related to the high aggressiveness and the high rate of metastasis by IBC within the brain. Our results have high clinical relevance since having extensive knowledge of the role of NMDARs in IBC progression could complement therapeutic approaches for patients with IBC.

Citation Format: Laura L. Mendez Santacruz, Xavier S. Bittman-Soto, Keishla M. Rodriguez-Martir, Jesus M. Padilla Escalona, Esther Peterson, Carmen Maldonado-Vlaar. The role of NMDA receptors subunits in the progression of inflammatory breast cancer (IBC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5673.

Global longitudinal strain to identify low-risk patients with suspected ACS

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Albert Einstein Society

Background

Determining which chest pain presentations should be treated and considered an acute coronary syndrome/myocardial infarction (ACS/MI) versus those with non-cardiac chest pain (NCCP) can be difficult. Initial evaluation of suspected ACS requires assessment of presenting symptoms, risk factors, ECG, and cardiac biomarkers. Bedside echocardiography can assist in rapid assessment of suspected ACS through measurement of echocardiographic wall motion score index and left ventricular ejection fraction, though the sensitivity of these measurements has been called into question. Global longitudinal strain (GLS) has been associated with significant CAD and has been found to be more reproducible than LVEF. However, its utility in rapid ED evaluation of chest pain remains under-explored.

Purpose

Assess the utility of speckle-tracking strain in addition to clinical and demographic factors in identification of low-risk patients among those presenting to the ED with suspected ACS.

Methods

This was a retrospective single center study of 434 hospitalized patients aged 18 years or older in whom ACS (excluding STEMI) was suspected by ED assessment, from 9/1/2015 – 12/31/2019. Echocardiography within 24 hours of admission was analyzed, with left ventricular global longitudinal strain (LVGLS) obtained via AutoSTRAIN software (TOMTEC Imaging Systems GmbH). Patients were identified as having NCCP (n = 158, 36%), myocardial injury (n = 110, 25%), or MI (n = 166, 38%; subdivided into NSTEMI [n = 74, 44.6%] and type II MI [n = 92, 55.4%]) according to the 4th universal definition of MI. Mean strain values were compared between study groups using Independent T tests. Logistic regression and ROC analysis was done to determine the value of LVGLS in the prediction of ACS.

Results

Non-white subjects were over-represented in the NCCP group (92% vs 8%), versus the myocardial injury and MI groups (65% vs 35%, p < 0.001), and on average the NCCP group was younger (56.5 ± 14.5 vs 64.8 ± 15, p < 0.001). LVGLS was significantly higher for NCCP versus the MI group (17.7 ± 2.8 vs 14.9 ± 3.9, p < 0.001). ROC analysis (c-statistic = 0.72) identified an optimal cutoff at ≤15.6, with sensitivity of 56% and specificity of 82%. Logistic regression analysis, including demographic and clinical variables, identified age, LVGLS, LV end-diastolic volume and serum creatinine as significant independent predictors for NCCP vs ACS. The addition of these factors in the predictive analysis resulted in slightly improved model performance (c-statistic = 0.78).

Conclusions

LVGLS among patients with suspected ACS is significantly different between NCCP and MI; however, low sensitivity for MI makes it inadequate as a single test to discriminate between the two. Combining LVGLS with other clinical/laboratory factors may have potential utility and will be explored in future work. Abstract Figure. Distribution Plot for LVGLS  Abstract Figure. ROC Curve for LVGLS

Radial Long Sheath Angioplasty for Proximal Severe Flow Limiting Radial Artery Spasm Utilizing the Dotter Technique

BACKGROUND

Although studies continue to demonstrate the advantages of transradial access (TRA) for neurointerventions, radial artery spasm (RAS) remains a frequent cause of TRA failure. Dotter initially described a technique to dilate areas of peripheral vascular stenosis by advancing sequentially larger catheters across the lesion over a wire. We present our institutional experience performing a modified Dotter technique utilizing long radial sheaths to dilate areas of proximal flow limiting RAS.

OBJECTIVE

To review the use of the Dotter technique for alleviating RAS in patients undergoing TRA for neurointerventions.

METHODS

A retrospective review of all patients undergoing TRA for neurointerventions at our institution from 2018-2020 was performed to identify patients with proximal flow limiting RAS. In identified patients, a modified Dotter technique was employed to dilate the stenosis. Demographic and periprocedural data were assessed to identify any adverse outcomes.

RESULTS

Four patients with severe proximal flow limiting RAS were identified. In each case, a hydrophilic long radial sheath and vascular dilator were sequentially advanced through the stenosis. In all cases, repeat angiography demonstrated improvement of the spasm and final radial angiograms demonstrated persistent improvement in caliber and regularity of the vessel. Each procedure was also completed via TRA with no periprocedural complications.

CONCLUSIONS

Our modified Dotter technique is effective in bypassing areas of severe proximal flow limiting RAS thus obviating the need for access site conversion. Additional studies are warranted to understand the implication of the angioplasty-like effects seen within the radial artery following removal of the long radial sheaths.

Potentiating bisphosphonate-based coordination complexes to treat osteolytic metastases

The hydrothermal reaction between bioactive metal (Ca2+, Zn2+, and Mg2+) salts and a clinically utilized bisphosphonate, alendronate (ALEN), promotes the formation of several materials denominated as bisphosphonate-based coordination complexes (BPCCs). The systematic exploration of the effect of three variables, M2+/ALEN molar ratio, temperature, and pH, on the reaction yielded an unprecedented number of materials of enough crystal quality for structural elucidation. Five crystal structures were unveiled by single crystal X-ray diffraction (ALEN-Ca forms I and II, ALEN-Zn forms I and II, and ALEN-Mg) and their solid-state properties revealed in tandem with other techniques. The dissolution of these BPCCs was tested and contrasted to that of the commercially employed generic form of Fosamax® Alendronate Sodium, using fasted-state simulated gastric fluid and phosphate-buffered saline solution. Quantification of ALEN content was performed by derivatization with Cu2+, which produced a soluble complex suitable for quantification. The results show that these materials present a pH-dependent degradation. Moreover, a phase inversion temperature (PIT) nano-emulsion method was applied to the synthesis of ALEN-Ca form II. Size distribution analysis demonstrated the efficiency of the PIT-nano-emulsion method to decrease the particle size of this BPCC from ∼60 μm to ∼438 d nm. The cytotoxicity of ALEN, ALEN-Ca form II (bulk crystals), and nano-Ca@ALEN (nanocrystals) against the MDA-MB-231 cell line was investigated. Nano-Ca@ALEN form II presents higher cytotoxicity effects than ALEN and ALEN-Ca form II (bulk crystals), showing inhibition of cell proliferation at 7.5 μM. These results provide evidence of the structure, stability, dissolution and cytotoxicity properties of ALEN-based BPCCs and pave the way for better formulation strategies for this drug through the design of nano-sized BPCCs for the treatment of bone-related diseases.

P5729Restricted mean survival time analysis to assess efficacy and safety of intensive vs standard blood pressure treatment goals as a function of age: insights from the SPRINT trial

Background

Blood pressure (BP) treatment targets in older adults (≥75 years) remain controversial. Restricted mean survival time (RMST) analysis is an alternative to hazard ratios (decreased reliance on proportional hazards assumption) with an intuitive interpretation of a gain or loss in event-free days. This may be valuable when assessing effectiveness and safety of BP treatment as a function of age.

Purpose

Determine differences in event-free time (days) between intensive (≤120 mm Hg) and conservative (≤140 mm Hg) BP treatment stratified by age categories.

Methods

Post hoc analysis to estimate RMST using publicly available SPRINT trial dataset for the primary SPRINT composite cardiovascular outcome and a 6-point secondary safety outcome (hypotension, syncope, bradycardia, electrolyte abnormality, injurious falls, or acute kidney injury) that resulted in emergency department visits or serious adverse events.

Results

In 9,361 participants the average age was 67.9±9.4 years (≤64 years: n=4,216; 65–74 years: n=2794, ≥75 years: n=2351). Over 5 years, participants in the intensive arm had an extra 13.8 cardiovascular event-free days [(3.9 to 23.6), p=0.006]; this increased to 28.6 days [(3.6 to 53.7), p=0.025] in those ≥75 years. For the 6-point composite safety outcome, participants in the intensive arm had on average significantly fewer safety event-free days compared to the control arm [−37.6 days (−54.2 to −21.1)], p<0.0001; this decreased to −8.6 days [(−43.2 to 26.1), p=0.63] in those ≥75 years.

Restricted Mean Survival Time Age Category RMST (Intensive) RMST (Control) RMST (Intensive-Control Difference) P-value (Days, 95% CI) (Days, 95% CI) (Days, 95% CI) Primary SPRINT MACE Outcome   All Ages 1441.9 (1435.3 to 1448.5) 1428.1 (1420.9 to 1435.3) 13.8 (3.9 to 23.6) 0.006   <65 years 1411.9 (1404.9 to 1419.0) 1401.8 (1393.4 to 1410.1) 10.2 (−0.7 to 21.1) 0.07   65–74 years 1375.2 (1363.9 to 1386.5) 1369.5 (1358.1 to 1380.9) 5.7 (−10.4 to 21.8) 0.49   ≥75 years 1393.7 (1376.9 to 1410.5) 1365.1 (1346.5 to 1383.7) 28.6 (3.6 to 53.7) 0.025 Primary Composite Safety Outcome   All Ages 1370.9 (1358.7 to 1383.3) 1408.6 (1397.5 to 1419.7) −37.6 (−54.2 to−21.1) <0.0001   <65 years 1396.9 (1380.7 to 1413.1) 1439.2 (1425.6 to 1452.8) −42.2 (−63.4 to −21.1) <0.0001   65–74 years 1299.7 (1279.7 to 1319.7) 1347.5 (1330.5 to 1364.5) −47.8 (−74.0 to −21.5) <0.0001   ≥75 years 1187.6 (1162.8 to 1212.4) 1196.2 (1171.9 to 1220.4) −8.6 (−43.2 to 26.1) 0.63 RMST = restricted mean survival time; MAC = major adverse cardiovascular events.

Conclusions

Compared to controls, intensively treated older adults ≥75 years had larger gains in the primary cardiovascular outcome with similar losses in the composite safety outcome.

Acknowledgement/Funding

None

Risk stratification for the development of venous thromboembolism in hospitalized patients with cancer

Essentials The Khorana score is validated for risk of venous thromboembolism (VTE) in cancer outpatients. We conducted a multicenter analysis of medically hospitalized cancer patients. Patients with a higher Khorana score on admission were more likely to develop VTE. The Khorana score is predictive of in-hospital, symptomatic VTE development.

SUMMARY

Introduction The Khorana score is a validated risk assessment score for estimating the risk of symptomatic venous thromboembolism (VTE) in outpatients with cancer. The objective of this study was to assess the Khorana score for predicting the development of VTE in cancer patients during hospital admission. Methods We conducted an analysis of consecutive, adult cancer patients hospitalized for medical reasons between January and June 2010 in three academic medical centers. Information on objectively diagnosed, symptomatic VTE during hospitalization, use of anticoagulant thromboprophylaxis (TP) and Khorana score variables at the time of admission was collected. Results A total of 1398 patients were included. Mean age was 62 years, 51.2% were male, and mean BMI was 25.9 kg m-2 . The most frequent reasons for hospitalization were chemotherapy administration (22.3%), followed by pain control and palliation (21.4%). The overall incidence of VTE was 2.9% (95% CI, 2.0-3.8%), occurring in 5.4% (95% CI, 1.9-8.9%) of the high-, 3.2% (95% CI, 2.0-4.4%) of the intermediate- and 1.4% (95% CI, 0.3-2.6%), of the low-risk groups. High-risk patients were more likely than low-risk patients to have VTE (OR, 3.9; 95% CI, 1.4-11.2). Conclusion The Khorana score is predictive of in-hospital, symptomatic VTE development in cancer patients who are hospitalized for medical reasons and may be a useful tool for tailoring inpatient anticoagulant thromboprophylaxis.

Bi-allelic inactivation is more prevalent at relapse in multiple myeloma, identifying RB1 as an independent prognostic marker

The purpose of this study is to identify prognostic markers and treatment targets using a clinically certified sequencing panel in multiple myeloma. We performed targeted sequencing of 578 individuals with plasma cell neoplasms using the FoundationOne Heme panel and identified clinically relevant abnormalities and novel prognostic markers. Mutational burden was associated with maf and proliferation gene expression groups, and a high-mutational burden was associated with a poor prognosis. We identified homozygous deletions that were present in multiple myeloma within key genes, including CDKN2C, RB1, TRAF3, BIRC3 and TP53, and that bi-allelic inactivation was significantly enriched at relapse. Alterations in CDKN2C, TP53, RB1 and the t(4;14) were associated with poor prognosis. Alterations in RB1 were predominantly homozygous deletions and were associated with relapse and a poor prognosis which was independent of other genetic markers, including t(4;14), after multivariate analysis. Bi-allelic inactivation of key tumor suppressor genes in myeloma was enriched at relapse, especially in RB1, CDKN2C and TP53 where they have prognostic significance.

Abstract 1991: Mutant GATA3 actively promotes the growth of normal and malignant mammary cells

GATA3 is a transcription factor expressed in luminal breast epithelial cells and is required for mammary gland development. Analysis of TCGA data reveals that somatic heterozygous mutations in GATA3 occur in up to 15% of estrogen receptor positive breast tumors, and that these tumors are diagnosed a median of eight years earlier than other estrogen receptor positive tumors, suggesting a more aggressive phenotype. These mutants have been proposed to be null alleles resulting in haploinsufficiency, however the mutation spectrum of GATA3 in breast cancer is in sharp contrast to that found in HDR syndrome, a true GATA3 haploinsufficiency disease. Based on this disparity, we propose that there is a selective pressure to mutate and retain a portion of the GATA3 in breast cancer. Here we focus on the GATA3 mutants which lack the second zinc finger which is responsible for GATA motif binding. Expression of these mutants accelerated xenograft tumor growth by ZR751 cells, and transgenic expression in mouse mammary glands promoted precocious lobuloalveolar development. We have used integrated gene expression and ChIP-Seq profiling to demonstrate that these zinc-finger deleted proteins retain the ability to associate with the genome by tethering to complexes associated with FOXA1 and AP-2gamma recognition motifs, where they modulate the expression of adjacent genes. These data support a model in which the GATA3 mutations recently observed in breast cancer encode for active transcription factors which elicit proliferative phenotypes in normal mammary epithelium and promote the growth of estrogen receptor positive breast cancer cell lines.

Citation Format: Natasha Chandiramani, Esther Peterson, Paraic A. Kenny. Mutant GATA3 actively promotes the growth of normal and malignant mammary cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1991.

Experimental Demonstration of the Collisionless Plasmoid Instability below the Ion Kinetic Scale during Magnetic Reconnection

The spontaneous formation of magnetic islands is observed in driven, antiparallel magnetic reconnection on the Terrestrial Reconnection Experiment. We here provide direct experimental evidence that the plasmoid instability is active at the electron scale inside the ion diffusion region in a low collisional regime. The experiments show the island formation occurs at a smaller system size than predicted by extended magnetohydrodynamics or fully collisionless simulations. This more effective seeding of magnetic islands emphasizes their importance to reconnection in naturally occurring 3D plasmas.

First Measurement of Electron Neutrino Appearance in NOvA

We report results from the first search for ν_{μ}→ν_{e} transitions by the NOvA experiment. In an exposure equivalent to 2.74×10^{20} protons on target in the upgraded NuMI beam at Fermilab, we observe 6 events in the Far Detector, compared to a background expectation of 0.99±0.11(syst) events based on the Near Detector measurement. A secondary analysis observes 11 events with a background of 1.07±0.14(syst). The 3.3σ excess of events observed in the primary analysis disfavors 0.1π<δ_{CP}<0.5π in the inverted mass hierarchy at the 90% C.L.

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

BACKGROUND AND PURPOSE

Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism.

MATERIALS AND METHODS

We identified 278 patients with primary hyperparathyroidism who had undergone 2-phase CT with surgical cure. All scans were read prospectively by board-certified neuroradiologists. A neuroradiology fellow retrospectively reviewed images and reports and classified suspected adenomas on the basis of anatomic location. Accuracy was determined by comparing imaging results with surgical findings. The ability of 2-phase CT to localize adenomas to 1 of 4 neck quadrants and lateralize them to the correct side was assessed. Accuracy of identifying multigland disease was also evaluated.

RESULTS

In patients with single-gland disease, the sensitivity and specificity of 2-phase CT to correctly localize the quadrant were 55.4% and 85.9%, respectively. The sensitivity and specificity of correct lateralization were 78.8% and 67.8%, respectively. The sensitivity and specificity to identify multigland disease were 22.9% and 79.5%, respectively.

CONCLUSIONS

While the 2-phase CT protocol in this study demonstrates lower accuracy compared with reports of other techniques, its lower radiation compared with 3- and 4-phase techniques may make it a feasible alternative for preoperative parathyroid localization. Further prospective studies are needed to identify patients for whom this technique is most suitable.

Influence of Beam and Target Properties on the Excimer Laser Deposition of Yba2Cu3O7−x Thin Films

Target modification by excimer laser exposure has been investigated. Under conditions typical in the fabrication of superconducting thin films, deposition rate decreases with exposure and significant physical and chemical modifications occur on the target surface. These modifications do not inhibit congruent evaporation.