Variation in US acute ischemic stroke treatment by hospital regions: limited endovascular access despite evidence

BACKGROUND

Although national organizations recognize the importance of regionalized acute ischemic stroke (AIS) care, data informing expansion are sparse. We assessed real-world regional variation in emergent AIS treatment, including growth in revascularization therapies and stroke center certification. We hypothesized that we would observe overall growth in revascularization therapy utilization, but observed differences would vary greatly regionally.

METHODS

A retrospective cross-sectional analysis was carried out of de-identified national inpatient Medicare Fee-for-Service datasets from 2016 to 2019. We identified AIS admissions and treatment with thrombolysis and endovascular thrombectomy (ET) with International Classification of Diseases, 10th Revision, Clinical Modification codes. We grouped hospitals in Dartmouth Atlas of Healthcare Hospital Referral Regions (HRR) and calculated hospital, demographic, and acute stroke treatment characteristics for each HRR. We calculated the percent of hospitals with stroke certification and AIS cases treated with thrombolysis or ET per HRR.

RESULTS

There were 957 958 AIS admissions. Relative mean (SD) growth in percent of AIS admissions receiving revascularization therapy per HRR from 2016 to 2019 was 13.4 (31.7)% (IQR -6.1-31.7%) for thrombolysis and 28.0 (72.0)% (IQR 0-56.0%) for ET. The proportion of HRRs with decreased or no difference in ET utilization was 38.9% and the proportion of HRRs with decreased or no difference in thrombolysis utilization was 32.7%. Mean (SD) stroke center certification proportion across HRRs was 45.3 (31.5)% and this varied widely (IQR 18.3-73.4%).

CONCLUSIONS

Overall growth in AIS treatment has been modest and, within HRRs, growth in AIS treatment and the proportion of centers with stroke certification varies dramatically.

α-Tocopherol Restriction Exacerbated Lipopolysaccharide-Induced Inflammatory Response in α-Tocopherol Transfer Protein-Null Mice

Objectives

The α-tocopherol transfer protein-null (Ttpa^−/−) mouse model is a valuable tool for studying the molecular and functional consequences of vitamin E (α-tocopherol, αT) deficiency. Our objective was to assess how dietary αT restriction, followed by lipopolysaccharide (LPS) exposure affected the inflammatory response in Ttpa^−/− and wild-type (Ttpa^+/+) mice.

Methods

After weaning (3 weeks of age), male Ttpa^+/+ and Ttpa^−/− littermates (n = 36/genotype) were fed an αT deficient diet ad libitum for 4 weeks. At 7 weeks of age, mice were injected with LPS (1 or 10 µg/mouse) or saline (control) intraperitoneally and sacrificed 4 hours post-injection. Brain and heart IL-6 levels, a marker of inflammatory response, and serum and tissue αT concentrations were measured via ELISA and HPLC-PDA, respectively. Hippocampal Il6, Tnf, and Gpx1 expression, markers of inflammatory and oxidative stress response, were measured via RT-qPCR, and blood immune cell profiles were measured via a hematology analyzer.

Results

αT concentrations in serum and most analyzed tissues were below the limit of detection in Ttpa^−/− mice but not Ttpa^+/+ mice. Circulating white blood cell levels, particularly lymphocytes, were lower in all LPS groups compared to controls (P < 0.01). The 10 µg LPS groups had elevated IL-6 in the cerebellum and heart compared to controls, confirming an acute inflammatory response (P < 0.01). Hippocampal Il6 and Tnf expression were significantly increased in Ttpa^−/− mice that received 10 µg LPS compared to those that received saline (∼20- and ∼3-fold higher, respectively) (P < 0.01). Comparing expression patterns by genotype, the 10 µg LPS-Ttpa^−/− mice had ∼2-fold lower Gpx1 and ∼2-fold higher Il6 expression than the 10 µg LPS-Ttpa^+/+ mice. Hippocampal Il6 expression was increased by LPS in a dose-dependent manner (P < 0.05).

Conclusions

LPS, especially at the higher dose, altered inflammatory markers in the brain, heart, and serum. αT restriction further exacerbated the expression of select hippocampal genes.

Funding Sources

Abbott Nutrition via the Center for Nutrition, Learning and Memory, University of Illinois, Urbana-Champaign; Division of Nutritional Sciences Vision 20/20 and Margin of Excellence Research grants.

Impact of Carotenoid Cleaving Enzymes on Lycopene Accumulation in Transgenic Mice

Objectives

To evaluate the role of β-carotene oxygenase 1 (BCO1) and BCO2 on lycopene tissue distribution.

Methods

Three-week old C57BL/6 male and female mice (wild type [WT], Bco1−/−, Bco2−/−, Bco1−/− × Bco2−/− double knock out [DKO]) were divided into groups based on genotype (n = 16 per group split evenly by sex) and fed a powdered AIN 93G control diet for 2 weeks. After this period, mice were gavaged daily for 2 weeks with 1 mg of lycopene dissolved in cottonseed oil. 12 h-fasted mice were then sacrificed, and liver, serum, heart, kidney, intestine, gonadal adipose, prostate, spleen, and testes were harvested. Tissues were preserved in liquid nitrogen and stored at −80 until analyses. We measured lycopene levels in all samples by using high-performance liquid chromatography. Data analyses were performed using two-way ANOVA, followed by the Sidaks test with a statistical significance threshold of P &lt; 0.05.

Results

Female mice showed higher lycopene levels in the intestine (P &lt; 0.045) and liver (P &lt; 0.007) irrespective of genotype, while male mice had higher lycopene levels in serum (P &lt; 0.004). Intestine, serum, and kidneys exhibited higher lycopene levels in DKO mice compared to all other genotypes (P &lt; .0001), while having higher lycopene levels in testes (P &lt; 0.0001) compared to Bco2−/− and WT mice and adipose (P &lt; 0.005) only in comparison to Bco2−/− mice. DKO exhibited higher lycopene levels in the spleen compared to Bco1−/− mice (P &lt; 0.02). Lycopene levels in the liver (P &lt; 0.0001) were higher in Bco2−/− mice compared to Bco1 −/− and DKO mice, while Bco1−/− mice had lower hepatic lycopene levels compared to all other genotypes.

Conclusions

Female mice accumulated higher lycopene levels in most tissues compared to males. These results were consistent when data were corrected by total tissue weight. The data suggest the absence of BCO2 favors carotenoid accumulation in many extrahepatic tissues, an effect that is enhanced in the absence of both carotenoid cleaving enzymes.

Funding Sources

Internal funding, University of Illinois Urbana Champaign.

Dietary Tomato Inhibits Tumor Angiogenesis in the TRAMP Model of Prostate Cancer but Is Not Protective With a Western-Style Diet

Objectives

The objective of this study was to investigate the interplay between tomato powder (TP), incorporated into control (CON) and obesogenic (OB) diets, and PCa tumor growth and blood perfusion over time in a transgenic model of PCa. We hypothesized that TP would be protective against PCa growth.

Methods

Diets (either CON [17.2% kcal from fat] or OB [44.6% kcal from fat] both with and without 10% TP) were fed to transgenic adenocarcinoma of the mouse prostate (TRAMP) mice (n = 5/dietary group) from weaning. Tumor growth was monitored by weekly ultrasound scanning, at which time novel ultrasound microvessel images (UMI) were captured to quantitatively measure tumor blood perfusion over time. Animals were euthanized after 5 weeks of tumor growth, and tissues were collected for measurement of protein (HIF-1α, TNFα) and gene (ar, srd5a1, srd5a2) expression. Data were analyzed to determine differences between CON diets (without TP + with 10% TP) and OB diets (without TP + with 10% TP) and to evaluate the impact of 10% TP on outcome measures both independent of TP (No TP vs. TP) as well as within CON and OB diets (interaction effect of diet*TP) by mixed model ANCOVA with body weight as a covariate.

Results

UMI results showed good agreement with gold-standard immunohistochemistry quantification of endothelial cell density, indicating that this technique can be applied to non-invasively and longitudinally monitor tumor blood perfusion in vivo. Greater body weight (P = 0.029) and OB diets (P = 0.008) were associated with earlier age at tumor detection, and greater body weight was positively associated with tumor growth (P = 0.001). TP significantly inhibited prostate tumor angiogenesis (P = 0.043), but this inhibition differentially affected measured outcomes depending on CON or OB diets. TP led to reduced tumor growth (P = 0.004), intratumoral inflammation (TNFα; P = 0.019), and intratumoral androgen-regulated gene expression (srd5a1, srd5a2; P = 0.030 and P = 0.016, respectively) when incorporated with the CON diet but greater tumor growth and intratumoral gene expression when incorporated with the OB diet.

Conclusions

Results from this study show that protective benefits from dietary tomato are lost, or may become deleterious, when combined with a Western-style diet.

Funding Sources

CA was supported by the NIH NIBIB. MRL and PS were partially supported by NIH NCI.

Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly

OBJECTIVE

We sought to comprehensively evaluate predictors of poststroke depression (PSD) in the United States and to compare PSD to post-myocardial infarction (MI) depression to determine whether ischemic stroke uniquely elevates risk of depression.

METHODS

This is a retrospective cohort study of 100% deidentified inpatient, outpatient, and subacute nursing Medicare data from 2016 to 2017 for US patients ≥65 years of age from July 1, 2016, to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years after the index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years after stroke vs MI and independent predictors of PSD, and we controlled for patient demographics, comorbid conditions, length of stay, and acute stroke interventions.

RESULTS

In fully adjusted models, patients with stroke (n = 174,901) were ≈50% more likely than patients with MI (n = 193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596 ± 0.001 in patients with stroke vs 0.0973 ± 0.000778 in patients with MI, log-rank p < 0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients <75 years of age were more likely to be diagnosed with depression after stroke.

CONCLUSIONS

Despite the similarities between MI and stroke, patients with stroke were significantly more likely to develop depression. There were several predictors of PSD, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all patients with stroke.

Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

Background and Purpose

Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events.

Methods

The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere.

Results

Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25–1.79, p < 0.0001). History of depression (HR 3.70 [3.07–4.46]), alcoholism (2.04 [1.34–3.09]), and smoking (1.38 [1.15–1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37–0.56]) and discharge home (0.69 [0.57–0.83]) were associated with reduced hazards of readmission due to depression.

Conclusions

IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.

Increased Protein Density During Weight Loss Is Correlated with Reduced Abdominal Obesity and Body Mass Index and Improved Body Composition

Objectives

There is a clear link between abdominal obesity and chronic diseases. Dietary changes leading to substantial weight loss reduce obesity and improve health; however, no viable dietary treatment program exists that produces clinically significant, cost-effective, and sustainable weight loss. To test the hypothesis that a diet dense in lean proteins and fiber is inversely associated with abdominal obesity while maintaining skeletal muscle mass (SMM), we evaluated the correlation between mean protein and fiber density and changes in BMI, waist circumference and SMM during weight loss.

Methods

Thirty adult males and females participated in this ongoing, 2-year dietary weight loss program. The Individualized Dietary Improvement Program focused on reducing caloric intake and increasing protein (7–11 g/100 kcal) and fiber (1.8–3.2 g/100 kcal) density to desired ranges. Participants attended 19 group educational sessions, 3 individual counseling appointments, self-weighed daily, and submitted monthly 24-hour dietary recalls. BMI, waist circumference and body composition (InBody) measurements were collected at baseline and after 6 months.

Results

At 6 months, 25 participants (24–70y) remained in the study with 18 completing all body measurements. Mean weight loss (n = 25) was −2.2 ± 0.5 BMI points (–5.2 ± 1.3% of initial body weight) and mean waist circumference reduction (n = 18) was −6.5 ± 1.3 cm from baseline. Significant increases in protein and fiber density were seen from baseline to month 2 (P &lt; 0.05). There were direct inverse associations between mean protein density and both reduced waist circumference (P &lt; 0.01) and reduced BMI (P &lt; 0.01). Fiber intake had no significant impact on weight loss, and maintenance of SMM did not significantly correlate with mean protein density. However, only 11.0 ± 3.2% of weight lost was due to the loss of SMM, supporting the efficacy of the program. A significant positive correlation (P &lt; 0.01) existed between fat mass loss and protein density, with 74.3 ± 4.7% of excess body fat accounting for total weight lost.

Conclusions

Increased protein density correlates with accelerated loss of fat mass, greater reductions in abdominal adiposity, and may protect SMM from degradation during weight loss.

Funding Sources

This research is supported by the NIBIB of the NIH and the USDA NIFA.

Effect of Natural Vs. Synthetic α-tocopherol on Neurogenesis-Related Genes in Cerebella of Juvenile α-tocopherol Transfer Protein-Null Mice

Objectives

Vitamin E (α-tocopherol, α-T) restriction during brain development alters the expression of neurogenesis-related genes in cerebella of juvenile α-tocopherol transfer protein-null (Ttpa−/−) mice. Synthetic α-T (SYN), compared to natural α-T (NAT), downregulates cerebellar myelin genes in adolescent Ttpa−/− mice. We studied how early-life exposure to SYN or NAT affects the expression of neurogenesis-related genes in juvenile Ttpa−/− mice.

Methods

Male and female Ttpa+/+ and Ttpa−/− mice were nursed by Ttpa+/−dams fed AIN-93G-based diets containing either SYN (∼816 mg α-T/kg diet) or NAT (∼600 mg α-T/kg diet). Homogenized brain tissues from 21 day old weanlings (n = 9/group) were used to measure total α-T concentrations via HPLC-PDA. The expression of genes critical for brain development (Rora, Shh), myelination (Plp1, Cntnap1, Mbp, Mobp, Nr1h3), and synaptic function (Cplx1, Necab1, Prkcg) were measured in the cerebellum via real-time qPCR.

Results

α-T concentrations were significantly lower in brains of Ttpa−/− mice (17.7 nmol/g) compared to Ttpa+/+ mice (37.5 nmol/g) (P &lt; 0.001). Exposure to SYN vs. NAT resulted in similar total α-T brain levels within each genotype (Ttpa−/−: 19.8 vs. 15.6 nmol/g; Ttpa+/+: 42.5 vs. 32.6 nmol/g). Consistent with previous studies, Necab1 was significantly downregulated in Ttpa−/− mice (P &lt; 0.05). The other selected neurogenesis-related genes were similarly expressed between all groups, regardless of genotype or dietary α-T source.

Conclusions

Brain α-T concentrations at weaning depended on the presence of Ttpa. α-T source did not modulate the selected neurogenesis genes, possibly because the natural and synthetic α-T diets each provided sufficient total α-T during development.

Funding Sources

Abbott Nutrition through the Center for Nutrition, Learning, and Memory (CNLM), Division of Nutritional Sciences Vision 20/20 Grant Program, and Division of Nutritional Sciences Margin of Excellence Research Program (all through the University of Illinois at Urbana-Champaign). KMR was supported by the AFRI NIFA Predoctoral Fellowships Grant Program (2019–67,011-29,514) from the U.S. Department of Agriculture, National Institute of Food and Agriculture.

Advising Based on Self-Experimentation Assignments Increases the Magnitude of Weight Loss

Objectives

Individualized Diet Improvement Program (iDip) has been developed for a sustainable diet for weight management through self-experimentation with emphasis on increasing protein and fiber and reducing caloric intake. Upon a successful feasibility test with the first study completed in 2018 (iDip 1), we hypothesized that assigning homework and advising based on response would improve weight loss along with the dietary changes.

Methods

Thirty adults (BMI &gt;25 kg/m2) were enrolled in a 2-year study (iDip 2). The study comprised of 22 dietary sessions over 12 months, identical to iDip 1. Participants were assigned to complete a self-experimentation homework after each session and received advising based on responses. As visual feedback, weekly weight charts and dietary analyses in the form of Protein-Fiber (PF) plot were offered. Daily weights, body composition, waist circumference were collected and 24-hour dietary records were obtained.

Results

Six participants dropped out, leaving 24 participants (80%). Mean body weight change (n = 24) in iDip 2 at 8 months was −6.2 ± 1.5% while mean body weight change (n = 12) in iDip 1 was −5.2 ± 1.1%. Nine out of 24 participants (38%) achieved clinically meaningful weight loss (&gt;5% of initial body weight) with a mean body weight change of −12.9% ± 2.8. The magnitude of weight loss of the successful group in iDip 2 was significantly greater (P &lt; 0.05) than that of the successful group in iDip 1 where 5 out of 12 participants (42%) achieved &gt;5% weight loss (mean body weight change: −8.9 ± 1.3%). Skeletal muscle mass was well-maintained with a mean change (n = 18) of −0.7 ± 0.2% at 6 months. Waist circumference (n = 18) was significantly decreased (P &lt; 0.05) from baseline by −6.5 ± 1.3 cm. 24-hr records showed improvements in protein and fiber intake throughout the study. Although no significant differences were found in protein and fiber intake between two studies, higher mean protein and fiber intake were observed at 6 months in iDip 2.

Conclusions

Self-experimentation assignments followed by individualized feedback significantly increased the magnitude of weight loss over the previous study with protein intake to maintain skeletal muscle mass as evidenced by its minimal loss. The success rate of participants achieving &gt;5% weight loss did not improve in this study.

Funding Sources

USDA NIFA ILLU-698–908; NIBIB NIH (CA).

Tomato and Lycopene Feeding Impact Expression of Lipid and Cholesterol Metabolism Genes in Early TRAMP Mouse Model Prostate Carcinogenesis (OR05-05-19)

Objectives

Epidemiologic evidence suggests consuming tomato and lycopene are associated with a reduced risk of advanced and lethal prostate cancer. Prior studies of prostate cancer prevention in the TRAMP mouse model indicate that lifelong tomato- or lycopene-feeding reduce incidence of early carcinoma by up to 70%, and this effect is dependent on the expression of Bco2 (beta-carotene oxygenase 2, a carotenoid metabolic enzyme). We hypothesize that gene expression patterns will reveal the mechanisms by which these diets act to disrupt early carcinogenesis.

Methods

To define the early transcriptional responses in the dorsolateral mouse prostate, TRAMP and wild-type littermate mice were crossed with Bco2+/+ or Bco2−/− mice (C57/Bl6 background). All 4 crosses were fed either control, lycopene, or 10% tomato powder diets from weaning at 3 weeks until 8 weeks. Expression of 84 genes was measured by a prostate cancer-focused PCR array (n = 5/group). Protein expression was measured by Western blotting (n = 4/group) and serum carotenoids by HPLC (n = 3–4/group). Statistical effects of TRAMP and Bco2 genotypes and diet treatment on final body mass (n = 6/group), serum lycopene, and gene expression were analyzed by ANOVA (alpha = 0.05).

Results

Body masses were not influenced by genotypes or diets. Serum lycopene concentrations were subject to a Bco2 genotype effect (P = 0.004), with greater lycopene being present in Bco2−/− mice than Bco2 +/+mice, but did not differ by TRAMP genotype nor between lycopene vs tomato diets. The TRAMP genotype influenced the expression of 49 genes, diet impacted expression of 11 genes, and Bco2 genotype influenced expression of 2 genes. Expression of 4 genes, Apc, Mto1, Nfkb1, and Rbm39, were subject to a significant Bco2 x diet interaction. Expression of 5 genes related to lipid metabolism, Fasn, Acaca, Srebf1, Hmgcr, and Ptgs1, were impacted by a diet effect.

Conclusions

Semi-targeted analyses suggest tomato and lycopene may affect lipid metabolism in early carcinogenesis. Future studies may elaborate upon specific pathways modulated by tomato and lycopene in early prostate carcinogenesis.

Funding Sources

NIH/National Cancer Institute, NIH/National Center for Complementary and Integrative Health, USDA/Agricultural Research Service.

The Impact of External Beam Radiation Therapy on Oxidative Damage in the Transgenic Adenocarcinoma of the Mouse Prostate (TRAMP) Prostate Cancer Model (P05-022-19)

Objectives

External beam radiation therapy (EBRT) is one of the most common treatments for primary prostate cancer. The primary limitation for EBRT is the potential for damage to surrounding tissues. Epidemiological evidence indicates that tomato products are associated with reduced PCa progression. Tomatoes contain carotenoids and other potent antioxidants that may protect the surrounding tissue from the detrimental effects of EBRT. The objective of this pilot study is to determine if tomato feeding can alter early inflammatory and oxidative events following a single dose of radiation that may predict a more successful therapeutic outcome.

Methods

To test this hypothesis, male TRAMP mice (n = 60) were provided a powdered AIN-93 G diet (Control) or an AIN-93 G diet modified to contain 10% lyophilized tomato paste (TP; n = 30) beginning at 4 weeks of age. Mice were monitored by ultrasound biweekly for in vivo tumor detection and 3-D volumetric growth measurement. Tumors were irradiated with 7.5 gy (n = 15 per diet) or 0 gy (sham, n = 15 per diet) of radiation by a Cobolt-60 source once the animal had a 1000 mm3 tumor. Animals were euthanized after 24 hours and carotenoids were measured by high performance liquid chromatography (HPLC) in the tumor and liver. Sections of tumor, liver, kidneys, bladder, lymph, bladder and intestines were stained by hematoxylin and eosin-stained (H&E) and were assessed for tumor grade and inflammatory markers. Pro-inflammatory cytokines (IL-6 and TNFα) will be measured from the serum and tumor tissues by ELISA. Oxidative damage will be analyzed through the γH2AX assay and through measurement of reduced glutathione.

Results

This study will be the first to explore the effects of tomato powder on the PCa tumor microenvironment following irradiation. We hypothesize that lifelong tomato consumption will delay tumor growth; will protect surrounding tissues from inflammatory and oxidative damage (reducing circulating pro-inflammatory cytokines); and will reduce histopathological markers of inflammation in surrounding tissues following a single exposure to 60-CO radiation in the TRAMP model.

Conclusions

This study will provide important preclinical data to inform future clinical trials that may positively affect dietary recommendations for EBRT to improve therapeutic outcomes.

Funding Sources

University of Illinois at Urbana-Champaign.

Dietary Tomato, but Not Lycopene Supplementation, Impacts Molecular Outcomes of Castration-resistant Prostate Cancer in the TRAMP Model (P05-015-19)

Objectives

The objective was to determine whether dietary tomato or lycopene supplementation impacted the expression of biomarkers associated with aggressive tumors and poorer prognostic outcomes in castration-resistant prostate cancer (CRPC).

Methods

Transgenic adenocarcinoma of the mouse prostate (TRAMP) mice were castrated at 12 weeks of age to mimic the effects of androgen deprivation therapy (ADT) leading to CRPC. Mice were separated into three dietary groups (n = 30/group) and fed powdered, modified AIN-93 G diets containing 10% tomato powder (TP), lycopene beadlets matched for lycopene content of TP (LYCO), or placebo beadlets (PLAC). Tumors were detected and monitored for growth by ultrasound scan. After 5 weeks of CRPC growth, mice were euthanized, and prostate and tumor tissues were collected. Histological analysis was used to identify presence of tumor neuroendocrine (NE) phenotype (by synaptophysin [syp] expression) and androgen receptor (AR) expression. ELISA and Western blot were used to quantify interleukin-6 (IL-6) and STAT3, and RT-PCR was used to measure downstream targets of both AR and STAT3.

Results

No differences were observed between AR expression or presence of the NE phenotype between dietary groups. However, lower tumor weight was associated with both AR and syp expression in mice fed TP. A positive correlation (P = 0.03) was observed between reduced tumor IL-6 (P = 0.012) and reduced phosphorylation (activation) of STAT3 (P = 0.017) in tumors of mice fed TP when compared to PLAC or LYCO. RNA analysis showed reduced expression of genes related to invasion (mmp-2; P = 0.006), cell proliferation (cdk1; P = 0.01), NE phenotype (ngfr; P = 0.001), and androgen metabolism (srd5a2; P = 0.03) in tumors of TP-fed mice.

Conclusions

Physiological levels of dietary tomato, but not lycopene supplementation, reduced the expression of molecular biomarkers typically upregulated in CRPC tissues that are associated with tumor growth and metastasis.

Funding Sources

This research is supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health.

Associations Between Serum Lutein and Human Gut Microbiota (P02-004-19)

Objectives

Lutein is a carotenoid found in green leafy vegetables, avocados, and eggs, and is purported to have protective effects against age-related macular degeneration (AMD) as well as benefits for visual and cognitive health. Recent studies have indicated significant variation in serum lutein among individuals and that gastrointestinal (GI) microbial profile may potentially contribute to lutein status. However, the extent to which the GI microbiota contribute to lutein is unclear. The current study aimed to determine GI microbial predictors of serum lutein in a healthy young adult population.

Methods

Among adults ages 25–45 years (N = 105), venous blood was collected following a 10-hour fast. Serum lutein was determined using HPLC. Fecal DNA was extracted and the V4 region of the 16S rRNA gene was amplified. Amplicon sequence variants were assigned using the GreenGenes 13-8 database and DADA2, followed by analysis in QIIME2 and LDA Effect Size (LEfSe). Participants underwent DXA scan for whole body % fat (%Fat) and completed a 7-day food record to assess lutein consumption. Demographic information on participant's age and sex was also assessed and included in the statistical models.

Results

Four genera (Dialister, Ruminococcus, Gemmiger, and Phascolarctobacterium) and two species (Bacteroides eggerthii, Ruminococcus torques) were different between individuals in the highest and lowest quartiles of serum lutein. The genera Ruminococcus (Rho = −0.24, P = 0.02) and Phascolarctobacterium (Rho = −0.21, P = 0.03) and species R. torques (Rho = −0.35, P < 0.001) were inversely related to serum lutein. Linear regression modelling, adjusted for age, sex, %Fat, and dietary lutein, revealed that R. torques was the only significant predictor of serum lutein concentrations, accounting for 8.4% of the variance.

Conclusions

Our results reveal that individuals with lower serum lutein concentrations have a higher relative abundance of R. torques than those with higher lutein concentrations. As R. torques has been shown to be elevated in those with AMD, it is possible the relationship between this microbe and lutein is evident earlier in adulthood. However, further dietary intervention trials are warranted to clarify the relations among R. torques and serum lutein concentrations.

Funding Sources

This work was supported by funds provided by the Department of Kinesiology and Community Health at the University of Illinois and the USDA National Institute of Food and Agriculture, Hatch Project 1009249. Partial support was also provided by the Hass Avocado Board.

Examining the Role of Dietary Advanced Gycation End Products in Prostate Cancer Using Molecular Imaging Techniques (OR04-08-19)

Objectives

The Receptor for Advanced Glycation End Products (RAGE) and its ligands have been shown to be both over expressed and critical to prostate cancer (PCa) development. Importantly, the overexpression of both RAGE and its ligands is associated with poor PCa patient survival, suggesting its promise as a molecular target. Additionally, one of the largest sources of ligands for RAGE, advanced glycation end products (AGEs), come from one's diet and their concentrations are directly related to disease. We hypothesized that dietary AGEs (dAGEs) significantly contribute to the progression of PCa through interactions with RAGE. In this study we explore the use of a novel imaging strategy targeted at RAGE in combination with conventional imaging and histological techniques to assess the role of dAGEs on RAGE expression and PCa progression in murine xenografts.

Methods

To examine the impact of AGEs on PCa cell function, experiments were performed in two PCa cell lines. Cells were grown in growth media enriched with carboxymethyl-lysine-modified human serum albumin (CML) (the most common AGE) or a control protein, bovine serum albumin (BSA). Western blot, confocal microscopy, clonogenic assays, and proliferations assays were performed. To study the effects of an enhanced consumption of dAGEs on PCa growth and progression in vivo, NU/J mice were fed a modified Ain-93 G diet, which was either CML or BSA enriched. PCa tumors were then initiated. Their growth was monitored, their perfusion measured using Speckle Contrast Imaging, and their metabolic rate and RAGE content quantified using 18FDG and a novel RAGE-targeted tracer using PET-CT. Finally, the tissues were excised for histological analysis.

Results

CML significantly enhanced in vitro expression of both RAGE and proliferation marker KI-67. Cell doubling time was also significantly quickened, (1.5 vs 2.4 days) in the CML vs control. In vivo data demonstrated significant differences in tumor growth (CML group up to 2-fold increase) and successful tumor implantation rate (30% vs 60%). Perfusion, metabolism, and RAGE imaging demonstrated unique patterns which varied over the course of PCa progression.

Conclusions

These studies indicate that dAGEs may play a significant role in the progression of PCa. The data suggests that RAGE and its ligands are promising targets for further therapeutic investigations.

Funding Sources

University of Illinois at Chicago Cancer Center Pilot Grant.

Supporting Tables, Images and/or Graphs

α-Tocopherol Restriction Dysregulates Neurogenesis-Related Gene Expression in Brains of Weanling α-Tocopherol Transfer Protein Knockout Mice (P11-134-19)

Objectives

Humans with vitamin E (α-tocopherol, αT) deficiency develop neurological disorders. Similarly, α-tocopherol transfer protein knockout (Ttpa−/−) mice have low vitamin E status and exhibit neurodegeneration with age. Shifts in the transcriptome may precede behavioral manifestations of vitamin E deficiency, but it is unknown how early abnormalities occur. Aberrations during brain development could have lifelong implications. The study objective was to determine how αT restriction during early-life affects the expression of pre-selected neurogenesis-related genes in the cerebellum (CB) and cerebral cortex (CC) of Ttpa−/− weanlings.

Methods

Female Ttpa+/+ (n = 9) and Ttpa−/− (n = 10) mice were nursed by Ttpa+/−dams until postnatal day 21. Dams were fed AIN-93G diet (75 mg αT/kg diet) during days 1–9 of gestation, and αT-stripped diet for the rest of the study. Homogenized brain tissues from 21 day old weanlings were used to measure αT concentrations via HPLC-PDA. The expression of genes critical for brain development (Rora, Shh), myelination (Plp1, Cntnap1, Mbp, Mobp, Nr1h3), synaptic function (Cplx1, Cplx2, Vamp2, Necab1, Prkcg), and αT cellular uptake (Scarb1) were measured in the CB and CC via real-time qPCR.

Results

αT levels were significantly decreased in brains of Ttpa−/− mice (0.1 ± 0.1 nmol/g) compared to Ttpa+/+ mice (9.8 ± 1.4 nmol/g) (P < 0.001), confirming their low αT status. Rora, Shh, Cntnap1, and Mbp were significantly upregulated (P < 0.05) in both the CB and CC of Ttpa−/− mice, while several genes were only upregulated in one brain region (Plp1 in the CB, Mobp in the CC). Necab1 and Scarb1 were significantly downregulated in the CB of Ttpa−/− mice (P < 0.05).

Conclusions

αT restriction during the fetal and postnatal periods alters the expression of neurogenesis-related genes. These findings support a role for αT in brain development.

Funding Sources

Abbott Nutrition through the Center for Nutrition, Learning and Memory, University of Illinois, Urbana-Champaign; USDA NIFA Hatch grant (ILLU-698-915); Division of Nutritional Sciences Vision 20/20 Grant Program; Division of Nutritional Sciences Margin of Excellence Research Program.

Effects of a 12-week Avocado Randomized-controlled Trial on Cognitive Function and Lutein Status Among Adults with Overweight and Obesity (OR05-01-19)

Objectives

Overweight and obesity affect over two-thirds of the US population. This is concerning, as excess adiposity increases risk for dementia in later life. Thus, it is important to elucidate dietary approaches that benefit cognition. Lutein is a xanthophyll carotenoid thought to impact cognitive function. Daily consumption of avocado has been shown to improve cognitive function and lutein status but it is not clear whether these benefits extend to populations with overweight and obesity. Thus, we evaluated the influence of daily avocado consumption on cognitive function, serum lutein concentrations, and retinal xanthophyll status among adults with overweight and obesity using a randomized-controlled study.

Methods

Adults (N = 72, 25–45 years, 31 males) with overweight or obesity (BMI 25 kg/m2) were randomized to an intervention group (N = 38) that received a daily meal with one avocado or a control group (N = 34) that received an isocaloric meal without avocado for 12 weeks. Fasting serum lutein concentrations were evaluated through high-performance liquid chromatography. Macular pigment optical density (MPOD) was assessed through heterochromatic flicker photometry. Selective attention was assessed by a modified Flanker task.

Results

Group by time interactions were seen for serum lutein concentrations (P = 0.002) and flanker accuracy (P = 0.006) whereby the intervention group exhibited a more substantial increase in serum lutein concentrations (0.04 ug/ml; 95% CI, 0.02 to 0.06) and overall task accuracy (2.4%; 95% CI, 0.4 to 4.5). However, there was no relationship between task performance and changes in serum lutein concentration (P = 0.23), nor changes in MPOD.

Conclusions

Daily consumption of a meal containing avocado improved selective attention and serum lutein concentrations among adults with overweight and obesity. The cognitive benefits of avocado consumption were apparent even prior to changes in retinal lutein status. Given that avocados are comprised of a variety of nutrients, additional work is necessary to determine non-carotenoid dependent mechanisms by which avocados may impact cognitive function.

Funding Sources

This work was supported by funds from the Hass Avocado Board, the Department of Kinesiology and Community Health at the University of Illinois, and the USDA National Institute of Food and Agriculture, Hatch project 1009249.

The Effect of an Unrestrictive Diet Program (iDip) on Weight Management with Primary Focus on Protein and Fiber Intake and Calorie Reduction (P21-010-19)

Objectives

To develop a cost-effective program for safe weight loss and sustainable maintenance for overweight adults with associated comorbidities through dietary modifications.

Methods

The approach of Individualized Diet Improvement Program (iDip) was to build knowledge of participants to enable personalized selection of food items for weight loss and maintenance with an emphasis on increasing protein and fiber intake and reducing calories. Fourteen adults with BMI ≥ 27 kg/m2 and associated comorbidities were recruited. The study comprised of 22 diet improvement education sessions over 12 months with follow-up for 6 months. Daily self-weighing was required via Wi-Fi scale. Food Frequency Questionnaire (FFQ) data was collected at baseline and at 12 months. Feedback was provided for 24-hour records in the form of a protein-fiber (PF) plot, in which a target weight loss (protein: 7–11 g/100 kcal, fiber: 1.8–3.2 g/100 kcal) and maintenance (protein: 4–8 g/100 kcal, fiber: 1.4–2.8 g/100 kcal) box were plotted for easy target visualization.

Results

Out of 14 participants, 12 (86%) completed all 22 diet improvement sessions and most of them weighed daily. All completers found the program beneficial. Mean weight loss at 6 months and 12 months was −6.1 kg ± 1.2 and −4.8 kg ± 1.4, respectively. Four participants did not lose weight but no significant weight gain from baseline was observed. Of these 4, 1 participant showed rebound weight gain (−14.5 kg at 6 months and + 0.7 kg at 12 months). Eight participants achieved weight loss with maintenance: mean weight loss at 6 months and at 12 months was −6.6 kg ± 1.1 and −7.8 kg ± 0.8, respectively. Although mean fiber intake showed no change from baseline (maintained at 1.3 g/100 kcal), overall PF plot dietary pattern moved toward the target weight loss box as the program continued. Mean protein intake at 6 months increased to 5.4 g/100 kcal ± 0.3 from 4.1 g/100 kcal ± 0.3 at baseline.

Conclusions

The majority (67%) of participants successfully lost weight and maintained losses for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach. Further studies will be required to improve weight loss rates and develop an approach to no-responders.

Funding Sources

USDA NIFA; NIBIB NIH (CA).

Effect of soy protein on endogenous hormones in postmenopausal women

BACKGROUND

The long-term clinical effects of soy protein containing various concentrations of isoflavones on endogenous hormones are unknown.

OBJECTIVE

We examined the effects of ingestion of soy protein containing various concentrations of isoflavones on hormone values in postmenopausal women.

DESIGN

Seventy-three hypercholesterolemic, free-living, postmenopausal women participated in a 6-mo double-blind trial in which 40 g protein as part of a National Cholesterol Education Program Step I diet was provided as casein from nonfat dry milk (control), isolated soy protein (ISP) containing 56 mg isoflavones (ISP56), or ISP containing 90 mg isoflavones (ISP90). Endogenous hormone concentrations were measured at baseline and at 3 and 6 mo.

RESULTS

The concentration of thyroxine and the free thyroxine index were higher in the ISP56 group, and the concentration of thyroid-stimulating hormone was higher in the ISP90 group than in the control group at 3 and 6 mo (P < 0.05). Triiodothyronine was significantly higher in the ISP90 group only at 6 mo. Thyroxine, free thyroxine index, and thyroid-stimulating hormone at 6 mo were inversely associated with measures of baseline estrogenicity. No significant differences were found for endogenous estrogens, cortisol, dehydroepiandrosterone sulfate, insulin, glucagon, or follicle-stimulating hormone after baseline hormone values were controlled for.

CONCLUSIONS

This study does not provide evidence that long-term ingestion of soy protein alters steroid hormone values, but it suggests that soy protein may have small effects on thyroid hormone values that are unlikely to be clinically important. The thyroid effects are, however, consistent with previous findings in animals and highlight the need for future research investigating possible mechanisms of action.

Tacrolimus vs. cyclosporine immunosuppression: results in advanced-stage disease compared with historical controls treated exclusively with cyclosporine

A phase HI comparative trial of tacrolimus- vs. cyclosporine-based graft-vs.-host disease (GVHD) prophylaxis for human leukocyte antigen (HLA)-identical sibling bone marrow transplantation showed less GVHD but poorer survival in the tacrolimus arm. To test the comparability of the two treatment arms with respect to baseline survival prognosis, a matched control study using exclusively cyclosporine-treated patients from the International Bone Marrow Transplant Registry (IBMTR) database was performed. Controls were matched (2:1) based on age (within 5 years), disease, and pretransplant disease status. Two-year survival for tacrolimus-treated clinical trial patients was similar to that of their cyclosporine-treated matched controls (27 and 24%, respectively), and 2-year survival of the cyclosporine-treated clinical trial patients was similar to that of their cyclosporine-treated matched IBMTR controls (42 and 45%, respectively). Consistent with the clinical trial results, the cyclosporine-treated IBMTR controls matched to the tacrolimus group had significantly poorer 2-year survival than the cyclosporine-treated IBMTR controls matched to the cyclosporine group (24 and 45%, respectively; p < 0.01). No significant difference was seen in GVHD between the cyclosporine-treated clinical trial patients and their matched controls; however, the tacrolimus-treated clinical trial patients had significantly less GVHD than their cyclosporine-treated IBMTR controls (p < 0.01). These results support the hypothesis that the survival difference in the phase III trial resulted from an imbalance in the underlying risk factors for death in the two groups rather than from the randomized immunosuppressive regimen.

Rehabilitation staff stress as it relates to patient acuity and diagnosis

Significant concern exists regarding occupational stress among nurses; the present study explored the ways in which nurses' clinical symptoms and coping styles may relate to their working on a brain injury unit or a general rehabilitation unit within an acute physical rehabilitation hospital. A comparison of rehabilitation nurses' responses with those of physical therapists within the same setting was also completed. Staff members completed questionnaires related to job stress and satisfaction, coping (Ways of Coping Checklist) and adjustment (Symptom Checklist-90). Staff groups differed with regard to symptomatology. Brain injury nurses reported higher psychological distress than physical therapists on subscales including depression, interpersonal sensitivity and the global severity index. While brain injury nurses' distress in several areas was higher than other staff groups and than a normal non-patient sample, it did not approach the levels reported by a psychiatric outpatient normative group. Although the three staff groups did not differ notably with regard to most styles of coping, data suggest that work with brain injury patients may foster use of a problem-solving style. Lower physical and cognitive functioning of brain patients as compared with general rehabilitation patients may influence the greater psychological distress reported by brain injury nurses. Job stress appears to relate specifically to the perceived stressfulness of cognitive behavioural aspects of care for all staff groups. Implications of these findings, particularly with regard to support interventions, are discussed.

Routing of transported materials in the dorsal root and nerve fiber branches of the dorsal root ganglion

After injection of the L7 dorsal root ganglion with 3H-leucine, fast axoplasmic transport carries some 3--5 x more labeled materials down the sensory fibers branches entering the sciatic nerve as compared to the dorsal root fiber branches of the neurons. Freeze-substitution preparations taken from the two sides of the lumbar seventh dorsal root ganglia of cats and monkeys showed little difference in the histograms of nerve fiber diameters of the sensory nerve fiber branch of these neurons as compared to the dorsal root fiber branches. A similar density of microtubules and of neurofilaments in the dorsal root and sensory nerve fiber branches over a wide range of fiber diameters was found in electron micrograph preparations. In the absence of an anatomical difference in the fibers to account for the asymmetrical outflow, a functional explanation based on the transport filament model was advanced.