Motor Evoked Potential-A Pilot Study Looking at Reliability and Clinical Correlations in Multiple Sclerosis

PURPOSE

Multiple sclerosis (MS) is a clinically heterogeneous disease. Biomarkers that can assess pathological processes that are unseen with conventional imaging remain an unmet need in MS disease management. Motor evoked potentials (MEPs) could be such a biomarker. To determine and follow longitudinal MEP reliability and correlations with clinical measures in MS patients.

METHODS

This is a single-center study in alemtuzumab-treated MS patients to evaluate temporal reliability of MEPs, identify MEP minimum detectible differences, and explore correlations with existing clinical scales. Ten MS patients recently treated with alemtuzumab were evaluated every 6 months over 3 years. Clinical evaluations consisted of expanded disability status scale, timed 25-foot walk, 6-minute walk, and nine-hole peg test. MEPs were measured twice, 2 weeks apart, every 6 months.

RESULTS

Eight patients completed all 3 years of study. The intraclass correlation coefficient for MEP parameters ranged from 0.76 to 0.98. TA latency and amplitude with facilitation significantly and strongly correlated with all clinical measures, whereas the MEP duration modestly correlated. Biceps latency with facilitation significantly and moderately correlated with 9-hole peg test. Longitudinal correlations demonstrated good predictive values for either clinical deterioration or improvement.

CONCLUSIONS

MEPs have excellent intrapatient and intrarater reliability, and TA MEPs significantly and strongly correlated with expanded disability status scale, 6-minute walk, and timed 25-foot walk, whereas biceps MEPs significantly and moderately correlated with nine-hole peg test. Further studies using larger cohorts of MS patients are indicated.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT02623946.

Mutant IDH inhibitors induce lineage differentiation in IDH-mutant oligodendroglioma

A subset of patients with IDH-mutant glioma respond to inhibitors of mutant IDH (IDHi), yet the molecular underpinnings of such responses are not understood. Here, we profiled by single-cell or single-nucleus RNA-sequencing three IDH-mutant oligodendrogliomas from patients who derived clinical benefit from IDHi. Importantly, the tissues were sampled on-drug, four weeks from treatment initiation. We further integrate our findings with analysis of single-cell and bulk transcriptomes from independent cohorts and experimental models. We find that IDHi treatment induces a robust differentiation toward the astrocytic lineage, accompanied by a depletion of stem-like cells and a reduction of cell proliferation. Furthermore, mutations in NOTCH1 are associated with decreased astrocytic differentiation and may limit the response to IDHi. Our study highlights the differentiating potential of IDHi on the cellular hierarchies that drive oligodendrogliomas and suggests a genetic modifier that may improve patient stratification.

Tumor-specific cholinergic CD4+ T lymphocytes guide immunosurveillance of hepatocellular carcinoma

Cholinergic nerves are involved in tumor progression and dissemination. In contrast to other visceral tissues, cholinergic innervation in the hepatic parenchyma is poorly detected. It remains unclear whether there is any form of cholinergic regulation of liver cancer. Here, we show that cholinergic T cells curtail the development of liver cancer by supporting antitumor immune responses. In a mouse multihit model of hepatocellular carcinoma (HCC), we observed activation of the adaptive immune response and induction of two populations of CD4+ T cells expressing choline acetyltransferase (ChAT), including regulatory T cells and dysfunctional PD-1+ T cells. Tumor antigens drove the clonal expansion of these cholinergic T cells in HCC. Genetic ablation of Chat in T cells led to an increased prevalence of preneoplastic cells and exacerbated liver cancer due to compromised antitumor immunity. Mechanistically, the cholinergic activity intrinsic in T cells constrained Ca2+-NFAT signaling induced by T cell antigen receptor engagement. Without this cholinergic modulation, hyperactivated CD25+ T regulatory cells and dysregulated PD-1+ T cells impaired HCC immunosurveillance. Our results unveil a previously unappreciated role for cholinergic T cells in liver cancer immunobiology.

IDH2 and TET2 mutations synergize to modulate T Follicular Helper cell functional interaction with the AITL microenvironment

Angioimmunoblastic T cell lymphoma (AITL) is a peripheral T cell lymphoma that originates from T follicular helper (Tfh) cells and exhibits a prominent tumor microenvironment (TME). IDH2 and TET2 mutations co-occur frequently in AITL, but their contribution to tumorigenesis is poorly understood. We developed an AITL mouse model that is driven by Idh2 and Tet2 mutations. Malignant Tfh cells display aberrant transcriptomic and epigenetic programs that impair TCR signaling. Neoplastic Tfh cells bearing combined Idh2 and Tet2 mutations show altered cross-talk with germinal center B cells that promotes B cell clonal expansion while decreasing Fas-FasL interaction and reducing B cell apoptosis. The plasma cell count and angiogenesis are also increased in the Idh2-mutated tumors, implying a major relationship between Idh2 mutation and the characteristic AITL TME. Our mouse model recapitulates several features of human IDH2-mutated AITL and provides a rationale for exploring therapeutic targeting of Tfh-TME cross-talk for AITL patients.

Distinct and opposite effects of leukemogenic Idh and Tet2 mutations in hematopoietic stem and progenitor cells

Mutations in IDH1, IDH2, and TET2 are recurrently observed in myeloid neoplasms. IDH1 and IDH2 encode isocitrate dehydrogenase isoforms, which normally catalyze the conversion of isocitrate to α-ketoglutarate (α-KG). Oncogenic IDH1/2 mutations confer neomorphic activity, leading to the production of D-2-hydroxyglutarate (D-2-HG), a potent inhibitor of α-KG-dependent enzymes which include the TET methylcytosine dioxygenases. Given their mutual exclusivity in myeloid neoplasms, IDH1, IDH2, and TET2 mutations may converge on a common oncogenic mechanism. Contrary to this expectation, we observed that they have distinct, and even opposite, effects on hematopoietic stem and progenitor cells in genetically engineered mice. Epigenetic and single-cell transcriptomic analyses revealed that Idh2^R172K and Tet2 loss-of-function have divergent consequences on the expression and activity of key hematopoietic and leukemogenic regulators. Notably, chromatin accessibility and transcriptional deregulation in Idh2^R172K cells were partially disconnected from DNA methylation alterations. These results highlight unanticipated divergent effects of IDH1/2 and TET2 mutations, providing support for the optimization of genotype-specific therapies.

A noncoding single-nucleotide polymorphism at 8q24 drives IDH1-mutant glioma formation

Establishing causal links between inherited polymorphisms and cancer risk is challenging. Here, we focus on the single-nucleotide polymorphism rs55705857, which confers a sixfold greater risk of isocitrate dehydrogenase (IDH)-mutant low-grade glioma (LGG). We reveal that rs55705857 itself is the causal variant and is associated with molecular pathways that drive LGG. Mechanistically, we show that rs55705857 resides within a brain-specific enhancer, where the risk allele disrupts OCT2/4 binding, allowing increased interaction with the Myc promoter and increased Myc expression. Mutating the orthologous mouse rs55705857 locus accelerated tumor development in an Idh1R132H-driven LGG mouse model from 472 to 172 days and increased penetrance from 30% to 75%. Our work reveals mechanisms of the heritable predisposition to lethal glioma in ~40% of LGG patients.

TMOD-18. DIRECT IN VIVO CRISPR SCREEN IDENTIFIES COOPERATING TUMOR SUPPRESSORS THAT DRIVE PROGRESSION OF IDH1-MUTANT LOW-GRADE GLIOMA TO AGGRESSIVE GLIOBLASTOMA

Low-grade glioma (LGG) are generally slowly growing brain cancers, that frequently undergo malignant progression to aggressive, secondary glioblastoma with a dismal prognosis. By combining genetically engineered Idh1-mutant mice with in vivo CRISPR gene editing we generated a mouse model faithfully recapitulating the founder mutations of LGG. Clonal activation of the neomorphic Idh1 R132H mutation cooperates with Trp53 and Atrx mutations to trigger development of brain tumors but only with ~30% penetrance and very long latency. To elucidate the molecular mechanisms underlying the malignant progression of IDH1-mutant LGG, we devised and deployed a direct in vivo CRISPR screen targeting genes commonly mutated in human IDH-mutant secondary glioblastoma. Stereotaxic delivery of a lentiviral sgRNA library targeting the mouse orthologs of these genes into the brain of Idh1 R132H ;Trp53;Atrx;Cas9 and control Idh1 wt ;Trp53;Atrx;Cas9 compound mutant mice resulted in rapid formation of tumors that recapitulate human Idh1-mutant glioblastoma. Deconvoluting the screen showed that PI3K pathway members Pten and Pik3ca as well as Notch1, Smarca4 and Fat1 are preferentially enriched in Idh1 R132H-tumors, while Rb1 and NF2 were enriched in Idh1 wt tumors. Co-mutation analysis further identified additional co-occurring driver combinations such as Bcor-Met, Olig2-Met, Olig2-Med12 or Bcor-Olig2. We validated the tumor suppressive function of Notch1 and Pten using conventional floxed knock-out alleles and found that Notch1 functions in a haploinsufficient manner. Interestingly, Idh1 R132H did not alter tumor latency or pathology in a high grade p53;Pten;Rb1 mutant background, indicating that the neomorphic IDH-mutations can drive low but not high grade glioma development. Our study provides a functional landscape of gliomagenesis suppressors in vivo.

Level of processing's effect on episodic retrieval following traumatic brain injury in the elderly: An event-related potential study

Individuals who have sustained a traumatic brain injury (TBI) can suffer from episodic memory impairments. Until now, the neural correlates underlying episodic retrieval in individuals with TBI remained scarce, particularly in older adults. We aimed to fill this gap by recording event-related potentials during an old/new episodic recognition task in 26 older adults, 13 healthy and 13 with TBI. The task manipulated the level of processing in encoding with the use of semantic organizational strategies (deep guided, deep self-guided, and shallow encoding). For all encoding conditions, behavioral data analyses on the discrimination rate indicated that older adults with TBI were globally impaired compared with healthy older adults. The electrophysiological results indicated that the left-parietal effect was larger in the deep guided condition than in the shallow condition. In addition, the results show that the mid-frontal and left-parietal positive old/new effects were absent in both groups. The main findings are the observation, in the control group only, of an early frontal old/new effect (P200; 150-300 ms) and of a late frontal old/new effect on the left hemisphere, only in the Spontaneous condition. Together, results suggest an impairment of the allocation of attentional resources and working memory necessary for retrieving and monitoring items in the elderly with TBI.

Concerted roles of PTEN and ATM in controlling hematopoietic stem cell fitness and dormancy

In order to sustain proficient life-long hematopoiesis, hematopoietic stem cells (HSCs) must possess robust mechanisms to preserve their quiescence and genome integrity. DNA-damaging stress can perturb HSC homeostasis by affecting their survival, self-renewal, and differentiation. Ablation of the kinase ataxia telangiectasia mutated (ATM), a master regulator of the DNA damage response, impairs HSC fitness. Paradoxically, we show here that loss of a single allele of Atm enhances HSC functionality in mice. To explain this observation, we explored a possible link between ATM and the tumor suppressor phosphatase and tensin homolog (PTEN), which also regulates HSC function. We generated and analyzed a knockin mouse line (PtenS398A/S398A), in which PTEN cannot be phosphorylated by ATM. Similar to Atm+/-, PtenS398A/S398A HSCs have enhanced hematopoietic reconstitution ability, accompanied by resistance to apoptosis induced by genotoxic stress. Single-cell transcriptomic analyses and functional assays revealed that dormant PtenS398A/S398A HSCs aberrantly tolerate elevated mitochondrial activity and the accumulation of reactive oxygen species, which are normally associated with HSC priming for self-renewal or differentiation. Our results unveil a molecular connection between ATM and PTEN, which couples the response to genotoxic stress and dormancy in HSCs.

The Rare Knowledge Mining Methodological Framework for the Development of Practice Guidelines and Knowledge Translation Tools for Rare Diseases

Rare diseases bring on a heavy health, social and economic burden that impacts patients' lives and puts pressure on the healthcare system. Furthermore, they are often associated with limited published studies to inform multidisciplinary clinical practice thus limiting evidence-based practice. Moreover, the development of knowledge translation products including clinical care guidelines are often very challenging based on the current available methodological frameworks relying mostly on critical appraisal of the published research evidence where randomized clinical trial design is considered as the gold standard. To overcome this barrier, we proposed the Rare Knowledge Mining Methological Framework (RKMMF). The RKMMF is one possible answer to improve the development of knowledge translation products for rare diseases. This framework includes other sources of evidence including registry information and qualitative studies and the involvement of expert patients. This article documents the RKMMF structure and its application is exemplified through knowledge translation products developed for a neuromuscular population.

Illuminating the cross-talk between tumor metabolism and immunity in IDH-mutated cancers

Mutations in the genes encoding isocitrate dehydrogenase 1 (IDH1) and 2 (IDH2) are key drivers of diverse cancers, including gliomas and hematological malignancies. IDH mutations cause neomorphic enzymatic activity that results in the production of the oncometabolite 2-hydroxyglutarate (2-HG). In addition to 2-HG's well-known effects on tumor cells themselves, it has become increasingly clear that 2-HG directly influences the tumor microenvironment (TME). In particular, the non-cell-autonomous impact of 2-HG on the immune system likely plays a major role in shaping disease development and response to therapy. It is therefore critical to understand how IDH mutations affect the metabolism, epigenetics, and functions of tumor-infiltrating immune cells. Such knowledge may point towards new therapeutic approaches to treat IDH-mutant cancers.

DIPG-41. DISSECTING THE MECHANISTIC BASIS FOR ACVR1 AND PIK3CA MUTATION CO-OCCURRENCE IN DIFFUSE MIDLINE GLIOMAS USING GENETICALLY ENGINEERED MOUSE MODELS

Diffuse midline gliomas (DMGs) are aggressive childhood brain tumors with a dismal prognosis. Most of these tumors carry K27M mutations in histone H3-encoding genes, particularly H3F3A and HIST1H3B. In addition, activating mutations in ACVR1 and PIK3CA co-occur in a subset of DMGs. To understand how these lesions drive the development of DMGs, we generated genetically engineered mouse models in which Acvr1G328V, Hist1h3bK27M, and Pik3caH1047R are targeted to the OLIG2-expressing cell lineage. Animals carrying Acvr1G328V and Pik3caH1047R, with (“AHPO”) or without (“APO”) Hist1h3bK27M, developed high-grade diffuse gliomas involving midline and forebrain regions. Neither Acvr1G328V nor Pik3caH1047R drove tumorigenesis by themselves, but Acvr1G328V was sufficient to cause oligodendroglial differentiation arrest, pointing to a role in the earliest stages of gliomas formation. Transcriptomic analyses of AHPO and APO tumors indicated a predominantly proneural and oligodendrocyte precursor-like gene expression signature, consistent with the corresponding human pathology. Genes encoding transcription factors (TFs) with dual roles in controlling glial and neuronal differentiation were upregulated in tumors. Some of these genes were mildly induced by Acvr1G328V alone. Functional experiments using CRISPR/Cas9-mediated gene editing in patient-derived cell lines confirmed a role for some of these TFs in controlling DMG cell fitness. Overall, our results suggest that Pik3caH1047R consolidates Acvr1G328V-induced glial differentiation arrest to drive DMG development and progression.

Earthquakes and extreme rainfall induce long term permeability enhancement of volcanic island hydrogeological systems

Earthquakes affect near-surface permeability, however temporal permeability evolution quantification is challenging due to the scarcity of observations data. Using thirteen years of groundwater level observations, we highlight clear permeability variations induced by earthquakes in an aquifer and overlaying aquitard. Dynamic stresses, above a threshold value PGV > 0.5 cm s⁻¹, were mostly responsible for these variations. We develop a new model using earth tides responses of water levels between earthquakes. We demonstrate a clear permeability increase of the hydrogeological system, with the permeability of the aquifer increasing 20-fold and that of the aquitard 300-fold over 12 years, induced by fracture creation or fracture unclogging. In addition, we demonstrate unprecedented observations of increase in permeability due to the effect of extreme tropical deluges of rainfall and hurricanes. The water pressure increase induced by the exceptional rainfall events thus act as piston strokes strong enough to unclog congested fractures by colloids, particles or precipitates. Lastly, an analysis of regional permeabilities also highlights a permeability increase over geological timeframes (× 40 per million years), corroborating the trend observed over the last decade. This demonstrates that permeability of aquifers of andesitic volcanic islands, such as the Lesser Antilles, significantly evolve with time due to seismic activity and extreme rainfall.

Mutant ACVR1 Arrests Glial Cell Differentiation to Drive Tumorigenesis in Pediatric Gliomas

Diffuse intrinsic pontine gliomas (DIPGs) are aggressive pediatric brain tumors for which there is currently no effective treatment. Some of these tumors combine gain-of-function mutations in ACVR1, PIK3CA, and histone H3-encoding genes. The oncogenic mechanisms of action of ACVR1 mutations are currently unknown. Using mouse models, we demonstrate that Acvr1G328V arrests the differentiation of oligodendroglial lineage cells, and cooperates with Hist1h3bK27M and Pik3caH1047R to generate high-grade diffuse gliomas. Mechanistically, Acvr1G328V upregulates transcription factors which control differentiation and DIPG cell fitness. Furthermore, we characterize E6201 as a dual inhibitor of ACVR1 and MEK1/2, and demonstrate its efficacy toward tumor cells in vivo. Collectively, our results describe an oncogenic mechanism of action for ACVR1 mutations, and suggest therapeutic strategies for DIPGs.

Evaluation of the Assurance GDS® for Salmonella Method in Foods and Environmental Surfaces: Multilaboratory Collaborative Study

A multilaboratory collaborative study was conducted to compare the detection of Salmonella by the Assurance GDS® for Salmonella method and the Reference culture methods. Six foods, representing a variety of low microbial and high microbial load foods were analyzed. Seventeen laboratories in the United States and Canada participated in this study. No statistical differences (P < 0.05) were observed between the Assurance GDS for Salmonella and the Reference culture methods for any inoculation level of any food type or naturally contaminated food, except for pasta, for which the Assurance GDS method had a higher number of confirmed test portions for Salmonella compared to the Reference method.

Effects of low-voltage electrical stimulation and aging on lamb meat quality

Pouliot, E., Gariépy, C., Thériault, M., Avezard, C., Fortin, J., Simmons, N. J. and Castonguay, F. W. 2012. Effects of low-voltage electrical stimulation and aging on lamb meat quality. Can. J. Anim. Sci. 92: 59–66. The aim of this study was to evaluate the effect of electrical stimulation (ES) and aging time on meat quality of heavy lamb as produced in Quebec. Seventy-six Suffolk-sired crossbred male lambs were slaughtered at a target weight of 50±2 kg. Half of them were electrically stimulated (ES vs. control) at 5–10 min postmortem (21 V; 0.25 A; 60 s). Postmortem pH decline and temperature were monitored. After carcass cutting, longissimus dorsi sections were assigned to aging periods of 1, 3 or 8 d. Temperature decline was the same for both treatments (P=0.749). However, ES carcasses always had a lower pH value than controls during the first 24 h (P<0.001) while the ultimate pH was equivalent (P=0.803). Tenderness, as assessed by either Warner-Bratzler shear force (39 carcasses) or sensory evaluation (35 carcasses) was enhanced by both ES (P<0.001) and aging (P<0.001). At each aging time, tenderness was greater for ES meat. In addition, only 3 d of aging were necessary for ES meat to achieve the tenderness level attained by the controls after 8 d. Sarcomeres were longer (P<0.001) in ES meat than in controls while myofibrillar fragmentation index was not affected by ES treatment (P=0.743). Electrical stimulation also had small effects on color parameters (a*, b* and L*; P<0.01) and flavor (P=0.04). These results provide the first evidence that tenderness of the meat from heavy lambs produced and processed in Quebec could be enhanced by ES, mostly through cold shortening reduction.

British HIV Association and Children's HIV Association position statement on infant feeding in the UK 2011

To prevent the transmission of HIV infection during the postpartum period, the British HIV Association and Children's HIV Association (BHIVA/CHIVA) continue to recommend the complete avoidance of breast feeding for infants born to HIV-infected mothers, regardless of maternal disease status, viral load or treatment.

Growth performance, carcass traits and meat quality of heavy lambs reared in a warm or cold environment during winter

The goal of this study was to evaluate the impact of winter rearing environment on the growth performance and meat quality of heavy lambs. Half of sixty-four Dorset lambs (32 males and 32 females) were raised in each of two different environments: warm and cold with average temperature of 10.9 ± 0.7 °C and -2.0 ± 5.2 °C, respectively. The lambs were slaughtered at live weights of 41-45 kg for females and 46-50 kg for males. Cold environment had no adverse effect on either growth performance or carcass quality. The rate of longissimus dorsi muscle deposition (P = 0.049) and its depth at slaughter (P = 0.027) were rather greater in lambs reared in the cold environment and a higher proportion of oxido-glycolytic fibres (P = 0.047) was also observed in this muscle. Rearing environment had only a minor effect on the organoleptic qualities, with the cold environment promoting juiciness of the meat (P = 0.043). Therefore, cold environment rearing such as used in this study represents an economic advantage for lamb producers by reducing the costs associated with the construction of insulated barns, while maintaining growth performance, as well as carcass and meat quality. Key words: Lamb, rearing environment, temperature, growth, carcass, meat quality

Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops

A new method and apparatus for non-disruptive blood pressure (BP) recording in the finger based on the vascular unloading technique is introduced. The instrument, in contrast to intermittent set point readjustments of the conventional vascular unloading technique, delivers BP without interruptions, thus refining the Penáz' principle. The method is based on concentrically interlocking control loops for correct long-term tracing of finger BP, including automatic set point adaptation, light control and separate inlet and outlet valves for electro-pneumatic control. Examples of long-term BP recordings at rest and during autonomic function tests illustrate the potential of the new instrument.

Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement

The report describes a method of impedance cardiography using an improved estimate of thoracic volume. The formulas and their implementation in hardware and software are explained and new shortband electrodes are described which generate a good homogeneous thoracic field. Examples of stroke volume and cardiac output curves underline the capabilities of the monitoring system "Task Force Monitor". In several experiments, results are compared to thermodilution as well as to BioZ measurements: the new method excels in comparison with thermodilution and is comparable to the BioZ device. Compared to traditional electrodes, the new shortband electrodes are shown to provide better reproducibility.

Preferential bromide and pesticide movement to tile drains under different cropping practices

Subsurface drainage systems are useful tools to study chemical leaching in soils. Our objective was to compare the breakthrough behavior of bromide, atrazine (2-chloro-4-ethylamino-6-isopropylamino-s-triazine) and metolachlor [2-chloro-N-(2-ethyl-6-methylphenyl)-N-(2-methoxy-1-methylethyl) acetamid] to tile drains under two fall tillage practices (conventional tillage [CT] with a moldboard plow, and reduced tillage [RT] with a chisel plow) in field plots cultivated with corn (Zea mays L.). Leachate volume were greater in RT than in CT, with no statistical differences. Soil analysis showed that bromide migrated deeper in the soil profile than both herbicides, with little tillage effect. All chemicals were detected in drainage water at the same time and followed an event-driven behavior. Tillage had no effect on atrazine and metolachlor found in drainage water, while bromide concentration peaks were higher in RT than in CT in 1999. Concentration peaks were recorded earlier for atrazine and metolachlor than for bromide. Plots of cumulative relative chemical mass (cumulative mass divided by total mass measured in drainage) as a function of cumulative drainage were mostly linear for bromide, while they were S-shaped for both herbicides. Drainage that corresponded to 50% of relative cumulative mass ranged from 40 to 55% for bromide and from 5 to 28% for both herbicides. Rapid chemical movement to tile drains suggested that preferential flow was important in both CT and RT, and that these tillage practices had little influence on this phenomena.