Development of a highly sensitive and specific intact proviral DNA assay for HIV-1 subtype B and C

INTRODUCTION

HIV reservoir quantification is essential for evaluation of HIV curative strategies and may provide valuable insights about reservoir dynamics during antiretroviral therapy. The Intact Proviral DNA Assay (IPDA) provides the unique opportunity to quantify the intact and defective reservoir. The current IPDA is optimized for HIV-1 subtype B, the dominant subtype in resource-rich settings. However, subtype C is dominant in Sub-Saharan Africa, jointly accounting for around 60% of the pandemic. We developed an assay capable of quantifying intact and defective proviral HIV-1 DNA of subtype B and C.

METHODS

Primer and probe sequences were strategically positioned at conserved regions in psi and env and adapted to subtype B&C. In silico analysis of 752 subtype B and 697 subtype C near-full length genome sequences (nFGS) was performed to predict  the specificity and sensitivity. Gblocks were used to determine the limit of blank (LoB), limit of detection (LoD), and different annealing temperatures were tested to address impact of sequence variability.

RESULTS

The in silico analysis showed that the HIV-1 B&C IPDA correctly identified 100% of the intact subtype B, and 86% of the subtype C sequences. In contrast, the original IPDA identified 86% and 12% of these subtype B and C sequences as intact. Furthermore, the HIV-1 B&C IPDA correctly identified hypermutated (87% and 88%) and other defective sequences (73% and 66%) for subtype B and C with comparable specificity as the original IPDA for subtype B (59% and 63%). Subtype B cis-acting sequences were more frequently identified as intact by the HIV-1 B&C IPDA compared to the original IPDA (39% and 2%). The LoB for intact proviral DNA copies was 0, and the LoD for intact proviral DNA copies was 6 (> 95% certainty) at 60 °C. Quantification of 2-6 copies can be performed with > 80% certainty. Lowering the annealing temperature to 55 °C slightly lowered the specificity but prevented exclusion of samples with single mutations in the primer/probe region.

CONCLUSIONS

We developed a robust and sensitive assay for the quantification of intact and defective HIV-1 subtype B and C proviral DNA, making this a suitable tool to monitor the impact of (large-scale) curative interventions.

Axenic green microalgae for the treatment of textile effluent and the production of biofuel: a promising sustainable approach

An integrated approach to nutrient recycling utilizing microalgae could provide feasible solutions for both environmental control and energy production. In this study, an axenic microalgae strain, Chlorella sorokiniana ASK25 was evaluated for its potential as a biofuel feedstock and textile wastewater (TWW) treatment. The microalgae isolate was grown on TWW supplemented with different proportions of standard BG-11 medium varying from 0 to 100% (v/v). The results showed that TWW supplemented with 20% (v/v) BG11 medium demonstrated promising results in terms of Chlorella sorokiniana ASK25 biomass (3.80 g L-1), lipid production (1.24 g L-1), nutrients (N/P, > 99%) and pollutant removal (chemical oxygen demand (COD), 99.05%). The COD level dropped by 90% after 4 days of cultivation, from 2,593.33 mg L-1 to 215 mg L-1; however, after day 6, the nitrogen (-NO3-1) and total phosphorus (TP) levels were reduced by more than 95%. The biomass-, total lipid- and carbohydrate- production, after 6 days of cultivation were 3.80 g L-1, 1.24 g L-1, and 1.09 g L-1, respectively, which were 2.15-, 2.95- and 3.30-fold higher than Chlorella sorokiniana ASK25 grown in standard BG-11 medium (control). In addition, as per the theoretical mass balances, 1 tonne biomass of Chlorella sorokiniana ASK25 might yield 294.5 kg of biodiesel and 135.7 kg of bioethanol. Palmitic acid, stearic acid, and oleic acid were the dominant fatty acids found in the Chlorella sorokiniana ASK25 lipid. This study illustrates the potential use of TWW as a microalgae feedstock with reduced nutrient supplementation (20% of TWW). Thus, it can be considered a promising feedstock for economical biofuel production.

Survey of ASCO Sponsored Oncology Interest Groups in the United States Assessing Medical Student Perceptions of Education in Radiation Oncology and Future Employment Prospects

PURPOSE/OBJECTIVE(S)

Over the last five years, applications to radiation oncology residency programs among graduates of medical schools in the United States (US) have declined by nearly 50% with a corresponding increase in unfilled positions in the National Resident Matching Program. This has led to ongoing concern regarding the future of the radiation oncology workforce and speculation regarding contributing factors. There are no published data substantiating medical student viewpoints on these issues. To better understand medical student perceptions of oncology specialties (medical oncology (MO), radiation oncology (RO), and surgical oncology/surgical subspecialties (SO)) and factors contributing to their career choices, we conducted a survey among oncology interest groups sponsored by the American Society of Clinical Oncology (ASCO). Survey content emphasized relative impressions of oncology specialties, exposure to these fields during medical school, and perceptions of future employment prospects.

MATERIALS/METHODS

An IRB-approved thirty-item questionnaire was distributed electronically via SurveyMonkey to US medical student members of ASCO sponsored interest groups. Participation was optional at the institutional and individual level and responses anonymous. Chi square test or Fisher's exact test was used to compare categorical variables.

RESULTS

Two-hundred seventy-nine students completed the survey (37% male, 62% female; 42% White, 40% Asian, 18% underrepresented minorities). Students report receiving less exposure to radiation oncology during medical school: 19% report RO is not included in their curriculum vs. 4% for MO (p<0.01); 77% report receiving lectures from MO faculty, 33% from RO, and 41% from SO (p <0.01); 41% were encouraged to consider RO as a specialty, compared to 62 % for MO and 42% for SO (p < 0.01); 45% report having a clear understanding of role of MO in oncology care vs. only 25% for RO and 38% for SO (p<0.01); 41% saw MO as leaders of the multidisciplinary cancer team, 1 % for RO, and 2% for SO, 47% felt all played equal roles (p<0.01). Students have more negative perceptions of future career prospects for RO: 81% feel that job prospects for MO are strong, 55% for RO and 73% for SO (p<0.01); 54% feel strongly that jobs are available in desirable geographic locations for MO, 36% for RO, 48% for SO (p<0.01); 27% of students report concerns about the future viability of RO, 10% for MO, and 11% for SO (p<0.01).

CONCLUSION

Compared to other oncology specialties, students have less exposure to RO, less understanding of the role of RO in multidisciplinary cancer care, and more pessimism about the future job market/specialty viability. These are likely contributing factors to declining interest in RO among graduates of US medical schools. Current radiation oncologists should increase efforts to improve medical student interest and understanding of RO.

SEA-Net: Structure-Enhanced Attention Network for Limited-Angle CBCT Reconstruction of Clinical Projection Data

PURPOSE/OBJECTIVE(S)

Limited-angle CBCT (LA-CBCT) is of great clinical interest, because the scanning time and the patient dose are proportional to the scanning range of gantry rotation angles of CBCT. However, the image reconstruction for LA-CBCT remains technically challenging, which suffers from severe wedge artifacts and image distortions. This work aims to improve LA-CBCT by developing deep learning (DL) methods for real clinical CBCT projection data, which is the first feasibility study of clinical-projection-data-based LA-CBCT, to the best of our knowledge.

MATERIALS/METHODS

Targeting at real clinical projection data, we have explored various DL methods such as image/data/hybrid-domain methods and finally developed a so-called Structure-Enhanced Attention Network (SEA-Net) method that has the best image quality from clinical projection data among the DL methods we have implemented. Specifically, the proposed SEA-Net employs a specialized structure enhancement sub-network to promote texture preservation. Based on the observation that the distribution of wedge artifacts in reconstruction images is non-uniform, the spatial attention module is utilized to emphasize the relevant regions while ignores the irrelevant ones, which leads to more accurate texture restoration.

RESULTS

SEA-Net was validated in comparison with analytic (FDK), iterative (TV), image-domain DL (DDNet and FED-INet, data-domain DL (DCAR), dual-domain DL (Sam'Net), and various unrolling DL (hdNet, CTNet, FSR-Net, CasRedSCAN) methods. Among all methods, the SEA-Net had the best image reconstruction quality as quantified by root-mean-square error (RMSE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM), for various LA-CBCT problems of 90°-180° projection data. In addition, LA-CBCT via SEA-Net provided comparable accuracy for both patient setup (quantified by image registration accuracy from planning CT (pCT) to CBCT) and dose calculation (see the table), with full-view CBCT.

CONCLUSION

We explored various DL methods and developed an image-domain-based method termed SEA-Net that provided the best image quality for clinical projection data. To the best of our knowledge, this is the first feasibility study of the real clinical-projection-data-based LA-CBCT. Moreover, LA-CBCT via SEA-Net can potentially provide comparable accuracy for patient setup and dose calculation, with full-view CBCT.

HMGA1 induces FGF19 to drive pancreatic carcinogenesis and stroma formation

High mobility group A1 (HMGA1) chromatin regulators are upregulated in diverse tumors where they portend adverse outcomes, although how they function in cancer remains unclear. Pancreatic ductal adenocarcinomas (PDACs) are highly lethal tumors characterized by dense desmoplastic stroma composed predominantly of cancer-associated fibroblasts and fibrotic tissue. Here, we uncover an epigenetic program whereby HMGA1 upregulates FGF19 during tumor progression and stroma formation. HMGA1 deficiency disrupts oncogenic properties in vitro while impairing tumor inception and progression in KPC mice and subcutaneous or orthotopic models of PDAC. RNA sequencing revealed HMGA1 transcriptional networks governing proliferation and tumor-stroma interactions, including the FGF19 gene. HMGA1 directly induces FGF19 expression and increases its protein secretion by recruiting active histone marks (H3K4me3, H3K27Ac). Surprisingly, disrupting FGF19 via gene silencing or the FGFR4 inhibitor BLU9931 recapitulates most phenotypes observed with HMGA1 deficiency, decreasing tumor growth and formation of a desmoplastic stroma in mouse models of PDAC. In human PDAC, overexpression of HMGA1 and FGF19 defines a subset of tumors with extremely poor outcomes. Our results reveal what we believe is a new paradigm whereby HMGA1 and FGF19 drive tumor progression and stroma formation, thus illuminating FGF19 as a rational therapeutic target for a molecularly defined PDAC subtype.

Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis

BACKGROUND

To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC.

METHODS

A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions.

RESULTS

In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039).

CONCLUSION

Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.

Assessing the potential for nevirapine removal and its ecotoxicological effects on Coelastrella tenuitheca and Tetradesmus obliquus in aqueous environment

Remediation of the antiretroviral (ARV) drug, nevirapine (NVP) has attracted considerable scientific attention in recent years due to its frequent detection and persistence in aquatic environments and potential hazards to living organisms. Algae-based technologies have been emerging as an environmentally friendly option for the removal of pharmaceutical compounds, but their ARV drug removal potential has not been fully explored yet. This study aimed to explore the ecotoxicity and removal potential of NVP by two microalgal species, Coelastrella tenuitheca and Tetradesmus obliquus. Lower environmental concentrations (up to 200 ng L^-1) of NVP enhanced the microalgal growth, and the highest dry cell weight of 941.27 mg L^-1 was obtained in T. obliquus at 50 ng L^-1 NVP concentration. Both microalgae showed varying removal efficiencies (19.53-74.56%) when exposed to NVP concentration levels of up to 4000 ng L^-1. At the late log phase (day 8), T. obliquus removed the highest percentage of NVP (74.56%), while C. tenuitheca removed 48% at an initial NVP concentration of 50 ng L^-1. Photosynthetic efficiency (Fv/Fm and rETR) of the two microalgal species, however, was not affected by environmental concentrations of NVP (up to 4000 ng L^-1) at the mid log phase of growth. SEM analysis demonstrated that both algal species produced distinct ridges on their cell surfaces after NVP uptake. In the ecotoxicity study, the calculated IC₅₀ values of NVP (0-100 mg L^-1) after 96 h of exposure were 23.45 mg L^-1 (C. tenuitheca) and 18.20 mg L^-1 (T. obliquus). The findings of the present study may contribute to a better understanding of the environmental hazards associated with NVP and the efficacy of microalgae in removing this pharmaceutical from aquatic environments.

Senescent stroma induces nuclear deformations in cancer cells via the inhibition of RhoA/ROCK/myosin II-based cytoskeletal tension

The presence of senescent cells within tissues has been functionally linked to malignant transformations. Here, using tension-gauge tethers technology, particle-tracking microrheology, and quantitative microscopy, we demonstrate that senescent-associated secretory phenotype (SASP) derived from senescent fibroblasts impose nuclear lobulations and volume shrinkage on malignant cells, which stems from the loss of RhoA/ROCK/myosin II-based cortical tension. This loss in cytoskeletal tension induces decreased cellular contractility, adhesion, and increased mechanical compliance. These SASP-induced morphological changes are, in part, mediated by Lamin A/C. These findings suggest that SASP induces defective outside-in mechanotransduction from actomyosin fibers in the cytoplasm to the nuclear lamina, thereby triggering a cascade of biophysical and biomolecular changes in cells that associate with malignant transformations.

Clinical impact of analgesic-sedative agents and peri-operative clinical status on white matter brain injury in preterm infants following surgical NEC

BACKGROUND

The potential influence of exposure to analgesic-sedative agents (ASA) before, during, and after surgical NEC and peri-operative clinical status on white matter injury (WMI) in preterm infants has not been fully defined, and a comprehensive evaluation may inform future research and clinical interventions.

METHODS

A retrospective study comparing ASA exposure before/during /after surgical NEC and peri-operative clinical status in neonates with and without WMI.

RESULTS

Infants with any WMI (grade 2-4, n = 36/67, 53.7%) had a higher number of surgical procedures receiving ASA (5 [IQR: 3, 8] vs. 3 [2, 4]; p = 0.002) and had a longer duration of hypotension during their first (48.0 hours [26.0, 48.0] vs. 15.5 [6, 48]; p = 0.009) and second surgery (20 hours [0, 48h] vs. 0 [0, 22]; p = 0.017), received more hydrocortisone (35% vs.13.3%,p = 0.04) than those without any WMI. There were no differences in fentanyl/morphine/midazolam exposure before/during/after the NEC onset in the two groups.Infants with severe WMI (19/67, 28.3%, grade 3/4) had a higher incidence of AKI (P = 0.004), surgical morbidity (p = 0.047), more surgical procedures (6.5 [3, 10] vs. 4 [2, 5]; p = 0.012), and received higher mean fentanyl doses(p = 0.03) from birth until NEC onset than those without severe WMI. The univariate associations between these factors and severe WMI remained insignificant after multivariable logistic regression.

CONCLUSION

Infants with WMI had more surgical procedures receiving ASA and had a longer duration of hypotension during surgeries. A large multicenter prospective study is needed to understand the full impact of ASA.

Efficacy of rh-PDGF-BB and Emdogain with or without DFDBA using M-MIST in the treatment of intrabony defects

Background

The versatile combination of emdogain or enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and demineralized freeze-dried bone allograft (DFDBA) has not been utilized in the treatment of intrabony defects yet.

Aim

The present study attempted to investigate the efficacy of a combination of simple, uncomplicated nature of modified minimally invasive surgical technique (M-MIST) with EMD, rhPDGF-BB, and DFDBA in the surgical management of intrabony defects and to assess the possible favorable effects for a period of 6 months.

Patients and Methods

Thirty healthy subjects were included in the present double-blind, randomized controlled, two-arm parallel study. The test group was treated with M-MIST by using rhPDGF-BB, EMD, and DFDBA, and the control group was treated with M-MIST by using rhPDGF-BB and EMD.

Results

Differences between the mean values of primary clinical parameters including relative attachment level, probing depth, and gingival recession at baseline and those at 6 months after surgery were statistically significant in both groups. Inter-group comparison for clinical attachment level gain, probing depth reduction, and change in the position of gingival margin revealed no statistically significant differences. Inter-group comparison revealed significant differences in linear bone growth (LBG) and percentage bone fill (% BF) but no significant differences in the residual defect depth and change in the alveolar crest position.

Conclusion

The additional use of DFDBA provides superior benefits in terms of LBG and % BF in intrabony defects. This improvement might be attributed to the use of an osteoinductive scaffold.

HMGA1 chromatin regulators induce transcriptional networks involved in GATA2 and proliferation during MPN progression

Myeloproliferative neoplasms (MPNs) transform to myelofibrosis (MF) and highly lethal acute myeloid leukemia (AML), although the actionable mechanisms driving progression remain elusive. Here, we elucidate the role of the high mobility group A1 (HMGA1) chromatin regulator as a novel driver of MPN progression. HMGA1 is upregulated in MPN, with highest levels after transformation to MF or AML. To define HMGA1 function, we disrupted gene expression via CRISPR/Cas9, short hairpin RNA, or genetic deletion in MPN models. HMGA1 depletion in JAK2V617F AML cell lines disrupts proliferation, clonogenicity, and leukemic engraftment. Surprisingly, loss of just a single Hmga1 allele prevents progression to MF in JAK2V617F mice, decreasing erythrocytosis, thrombocytosis, megakaryocyte hyperplasia, and expansion of stem and progenitors, while preventing splenomegaly and fibrosis within the spleen and BM. RNA-sequencing and chromatin immunoprecipitation sequencing revealed HMGA1 transcriptional networks and chromatin occupancy at genes that govern proliferation (E2F, G2M, mitotic spindle) and cell fate, including the GATA2 master regulatory gene. Silencing GATA2 recapitulates most phenotypes observed with HMGA1 depletion, whereas GATA2 re-expression partially rescues leukemogenesis. HMGA1 transactivates GATA2 through sequences near the developmental enhancer (+9.5), increasing chromatin accessibility and recruiting active histone marks. Further, HMGA1 transcriptional networks, including proliferation pathways and GATA2, are activated in human MF and MPN leukemic transformation. Importantly, HMGA1 depletion enhances responses to the JAK2 inhibitor, ruxolitinib, preventing MF and prolonging survival in murine models of JAK2V617F AML. These findings illuminate HMGA1 as a key epigenetic switch involved in MPN transformation and a promising therapeutic target to treat or prevent disease progression.

Pituitary metastasis: From pathology to clinical and radiological considerations

PURPOSE

A review of the literature with respect to pituitary metastases (PM) with clinical and radiological considerations are summarized to facilitate clinical decision making in the management of PM METHODS: A review of literature associated with PM and tumour to tumour metastases in the English literature was reviewed and summarized RESULTS: Pituitary metastases account for 1.0-3.6% of all surgically treated pituitary lesions. Often identified in parallel with extensive disseminated disease, once diagnosed, the prognosis is generally poor, although survival is highly heterogeneous and dependent on the primary tumor histology. Within this anatomical region is also the observation of tumor-to-tumor metastases and collision tumours. Both the tumor macro- and microenvironment play central roles to the progression of disease with distinctive radiological features that may suggest a metastatic sellar lesion as opposed to a primary pituitary lesion. Surgical resection is the first line of therapy followed by adjuvant chemoradiotherapy and endocrinological evaluation for hormonal supplementation CONCLUSION: PMs are relatively rare but important oncological entities representing disseminated disease in the majority of cases. Careful consideration of the relevant clinical history and radiological features can aid the clinician differentiate between a metastatic lesion to the pituitary region and a primary pituitary tumor. While surgical resection is first line therapy, stereotactic radiosurgery in carefully selected patients is emerging as a viable alternative.

Algae-mediated processes for the treatment of antiretroviral drugs in wastewater: Prospects and challenges

The prevalence of pharmaceuticals (PCs), especially antiretroviral (ARV) drugs in various aquatic ecosystems has been expansively reported, wherein wastewater treatment plants (WWTPs) are identified as the primary point source. Consequently, the occurrence, ecotoxicity and treatment of ARV drugs in WWTPs have drawn much attention in recent years. Numerous studies have shown that the widely employed activated sludge-based WWTPs are incapable of removing ARV drugs efficiently from wastewater. Recently, algae-based wastewater treatment processes have shown promising results in PCs removal from wastewater, either completely or partially, through different processes such as biosorption, bioaccumulation, and intra-/inter-cellular degradation. Algal species have also shown to tolerate high concentrations of ARV drugs than the reported concentrations in the environmental matrices. In this review, emphasis has been given on discussing the current status of the occurrence of ARV drugs in the aquatic environment and WWTPs. Besides, the current trends and future perspectives of PCs removal by algae are critically reviewed and discussed. The potential pathways and mechanisms of ARV drugs removal by algae have also been discussed.

Abstract 2414: HMGA1 induces FGF19 to drive tumor progression and recruit cancer associated fibroblasts in pancreatic adenocarcinoma

Pancreatic ductal adenocarcinomas (PDACs) are highly lethal tumors characterized by a dense desmoplastic stroma comprised of cancer associated fibroblasts (CAFs) and fibrotic scar tissue. While stromal CAFs act as a barrier to therapy and release signals promoting tumor growth and invasion, the stroma restricts tumor growth in mouse models. The High Mobility Group A1 (HMGA1) protein is an oncofetal protein and epigenetic regulator that amplifies signals from the microenvironment to foster stem cell properties within intestinal epithelium. Although HMGA1 is highly expressed in embryonic and adult stem cells, it is silenced postnatally in most differentiated cells. HMGA1 becomes aberrantly re-expressed in diverse tumors where high levels predict adverse clinical outcomes. In PDAC, HMGA1 is detected only in late-stage precursor lesions or invasive tumors, but not in normal pancreas nor in early precursor lesions. Moreover, high HMGA1 nuclear staining associates with poor differentiation status and decreased patient survival. Here, we discovered a novel epigenetic program whereby HMGA1 recruits stromal CAFs and drives tumor progression by inducing FGF19. Silencing HMGA1 in PDAC cell lines slows proliferation, disrupts oncogenic properties in vitro (migration, invasion, clonogenicity, 3D sphere formation), and depletes tumor initiator cells in xenograft assays. RNA sequencing revealed transcriptional networks up-regulated by HMGA1 that function in cell signaling and proliferation; we focused on FGF19 as a potential mediator of tumor-stromal crosstalk. HMGA1 binds directly to the FGF19 promoter and recruits active histone marks (H3K4me2, H3K27Aac) to induce gene expression and protein secretion from PDAC cells. Silencing FGF19 recapitulates effects of HMGA1 silencing, disrupting oncogenic and cancer stem cell properties in vitro while depleting tumor initiator cells in vivo. In co-culture experiments, FGF19 is required for CAF migration across a membrane towards PDAC cells. Silencing HMGA1, FGF19, or treatment with FGF19 inhibitors disrupts CAF recruitment. Silencing HMGA1 or FGF19 in PDAC cells also decreases both the desmoplastic stroma and tumor growth in mouse xenografts. In primary tumors, co-expression of HMGA1 and FGF19 predict decreased survival. Together, our results reveal a novel paradigm whereby tumor cells collaborate with CAFs via HMGA1 and FGF19 to drive progression, thus illuminating FGF19 as a rational therapeutic target for PDACs overexpressing HMGA1 and FGF19.

Citation Format: Lionel Chia, Shuai Shuai, Jung-Hyun Kim, Woo Jung Sung, Ruitao Zhang, Tait Huso, Leslie Cope, Karen Reddy, Linda M. Resar. HMGA1 induces FGF19 to drive tumor progression and recruit cancer associated fibroblasts in pancreatic adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2414.

Abstract 2666: HMGA1: An epigenetic switch required for MPN progression by inducing GATA-2 and cell cycle progression through enhancer rewiring

Myeloproliferative neoplasms (MPN) are clonal hematopoietic stem cell (HSC) disorders characterized by hyperactive JAK/STAT signaling and increased risk of transformation to myelofibrosis (MF) and acute myeloid leukemia (AML). However, mechanisms driving progression remain elusive and outcomes are poor after transformation. The High Mobility Group A1 (HMGA1) gene encodes chromatin regulators which are enriched in normal stem cells and aberrantly overexpressed in diverse, refractory tumors. Hmga1 also drives clonal expansion and leukemogenesis in transgenic mice when overexpressed in lymphoid cells. To investigate HMGA1 in MPN, we compared gene expression in CD34+ stem and progenitors from MPN patients and healthy controls. HMGA1 is overexpressed in MPN, with highest levels after transformation to MF or AML. To assess HMGA1 function in MPN progression, we silenced HMGA1 gene expression in two cell lines derived from patients with JAK2V617F mutant MPN after transformation to leukemia. Strikingly, silencing HMGA1 disrupts cell cycle progression, proliferation, and clonogenicity in vitro while preventing leukemia engraftment in immunodeficient mice. To assess HMGA1 in more indolent disease, we crossed a JAK2V617F mouse model of chronic MPN to an Hmga1 deficient background. Loss of one Hmga1 allele was sufficient to prevent progression to MF. Further, Hmga1 heterozygosity mitigates thrombocytosis and splenomegaly, while preventing expansion in long-term HSC, granulocyte-macrophage progenitors, and megakaryocyte-erythroid progenitors. Hmga1 heterozygosity also prolongs survival in a JAK2V617F murine model of fulminant leukemia and early mortality. To define mechanisms underlying HMGA1 in MPN progression, we performed RNA sequencing in human MPN- AML cell lines and identified HMGA1-dependent transcriptional networks involved in cell fate decisions and cell cycle progression, including the master regulator gene, GATA-2. Mechanistically, HMGA1 occupies a developmental GATA-2 enhancer (+9.5) and recruits active histone marks (H3K4me1, H3K4me3) to increase GATA-2 expression. Silencing GATA-2 recapitulates the anti-leukemia phenotypes observed with HMGA1 silencing while GATA-2 re-expression partially rescues pro-leukemogenic phenotypes that occur in MPN-AML cells after HMGA1 depletion. In matched, primary peripheral blood monocytes from patients with MF, HMGA1 and GATA-2 are co-expressed and both become markedly up-regulated after transformation to AML. Epigenetic drugs predicted to target HMGA1 transcriptional networks synergize with JAK inhibitors to disrupt proliferation in MPN-AML cells. Together, our studies reveal a new paradigm whereby HMGA1 up-regulates GATA-2 to drive leukemic transformation in MPN and illuminate HMGA1 networks as novel therapeutic targets required for MPN progression.

Citation Format: Liping Li, Jung-Hyun Kim, Wenyan Lu, Donna Marie Williams, Lingling Xian, Joseph Kim, Ophelia Rogers, Raajit K. Rampal, Richard P. Koche, Leslie Cope, Karen Reddy, Daniel R. Matson, Joe Zhao, Jerry L. Spivak, Alison R. Moliterno, Linda Resar. HMGA1: An epigenetic switch required for MPN progression by inducing GATA-2 and cell cycle progression through enhancer rewiring [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2666.

Bacterial infection, antibiotic use and COVID-19: Lessons from the intensive care unit

BACKGROUND

Empirical broad-spectrum antibiotics are frequently prescribed to patients with severe COVID-19, motivated by concern about bacterial coinfection. There is no evidence of benefit from such a strategy, while the dangers of inappropriate antibiotics are well described.

OBJECTIVES

To investigate the frequency, profile and related outcomes of infections by bacterial pathogens in patients admitted to an intensive care unit (ICU) with severe COVID-19 pneumonia.

METHODS

This was a prospective, descriptive study in a dedicated COVID-19 ICU in Cape Town, South Africa, involving all adult patients admitted to the ICU with confirmed COVID-19 pneumonia between 26 March and 31 August 2020. We collected data on patient comorbidities, laboratory results, antibiotic treatment, duration of admission and in-hospital outcome.

RESULTS

We included 363 patients, who collectively had 1 199 blood cultures, 308 tracheal aspirates and 317 urine cultures performed. We found positive cultures for pathogens in 20 patients (5.5%) within the first 48 hours of ICU admission, while 73 additional patients (20.1%) had positive cultures later during their stay. The most frequently isolated pathogens at all sites were Acinetobacter baumannii (n=54), Klebsiella species (n=13) and coagulase-negative staphylococci (n=9). Length of ICU stay (p&lt;0.001) and intubation (p&lt;0.001) were associated with positive cultures on multivariate analysis. Disease severity (p=0.5), early antibiotic use (p=0.5), diabetes mellitus (p=0.1) and HIV (p=0.9) were not associated with positive cultures. Positive cultures, particularly for tracheal aspirates (p&lt;0.05), were associated with longer ICU length of stay and mortality. Early empirical antibiotic use was not associated with mortality (odds ratio 2.5; 95% confidence interval 0.95 - 6.81).

CONCLUSIONS

Bacterial coinfection was uncommon in patients at the time of admission to the ICU with severe COVID-19. Avoiding early empirical antibiotic therapy is therefore reasonable. Strategies to avoid coinfection and outbreaks in hospital, such as infection prevention and control, as well as the strict use of personal protective equipment, are important to improve outcomes.

Abstract 297: HMGA1 induces FGF-19 to foster tumor-stromal cell crosstalk and drive tumor progression in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinomas (PDACs) are highly lethal tumors characterized by a dense desmoplastic stroma comprised of cancer associated fibroblasts (CAFs) and fibrotic scar tissue. While stromal CAFs provide a barrier to therapy and release signals that foster tumor growth and invasion, the stroma also restrains tumor growth in murine models. The High Mobility Group A1 (HMGA1) chromatin remodeling gene encodes an oncofetal protein and epigenetic regulator that amplifies signals from the microenvironment to foster stem cell properties within intestinal epithelium. HMGA1 is also highly expressed during embryogenesis and in adult stem cells, but silenced postnatally in most differentiated cells. In diverse, aggressive cancers, HMGA1 becomes aberrantly re-expressed where high levels portend adverse clinical outcomes. In PDAC, HMGA1 protein is detected in late stage precursor lesions and invasive tumors, but not in normal pancreas nor in early precursor lesions. Furthermore, high HMGA1 levels correlate with poor differentiation status and decreased patient survival. Here, we discovered a novel epigenetic program mediated by HMGA1 that recruits CAFs to drive PDAC progression. We discovered that silencing HMGA1 in multiple PDAC cell lines halts proliferation and disrupts oncogenic properties, including migration, invasion, clonogenicity, and xenograft tumorigenesis. HMGA1 silencing also impairs three-dimensional sphere formation and depletes tumor initiator cells in limiting dilution assays. Through RNA sequencing analysis comparing PDAC cells overexpressing HMGA1 to those with HMGA1 silencing, we identified FGF-19 as a potential transcriptional target of HMGA1. HMGA1 binds specifically to the FGF-19 promoter and recruits the active histone mark, H3K4me3, to activate its expression. HMGA1 is also required for FGF-19 secretion from PDAC cells. Similar to HMGA1, silencing FGF-19 blocks oncogenic and cancer stem cell properties in vitro while disrupting tumorigenesis and depleting tumor initiator cells in vivo. In co-culture experiments, HMGA1 expressed in PDAC cells amplifies FGF-19 secretion, thereby stimulating CAF migration to tumor cells across a membrane. Silencing HMGA1 or FGF-19 prevents CAF recruitment to PDAC tumor cells. Furthermore, CAF recruitment is blocked by either FGF-19 blocking antibodies or an inhibitor to the FGF-19 receptor (FGR4). In murine models, silencing HMGA1 also decreases formation of a fibroblastic stroma. Moreover, overexpression of HMGA1 together with that of FGF-19 predict decreased survival in primary human PDAC. Our results reveal a novel paradigm whereby PDAC cells collaborate with stromal CAFs via HMGA1 and FGF-19 to drive tumor progression. These data also provide insight into mechanisms for tumor progression and illuminate FGF-19 as a rational therapeutic target in PDACs with up-regulation of HMGA1 and FGF-19.

Citation Format: Lionel Chia, Shuai Shuai, Lingling Xian, Jung-Hyun Kim, Ruitao Zhang, Tait Huso, David Huso, Leslie Cope, Karen Reddy, Linda Resar. HMGA1 induces FGF-19 to foster tumor-stromal cell crosstalk and drive tumor progression in pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 297.

Abstract 2595: HMGA1 induces the HOXB13 developmental gene to drive tumor progression in androgen receptor negative, castrate-resistant prostate cancer

While High Mobility Group A1 (HMGA1) chromatin remodeling proteins are frequently dysregulated in diverse cancers, their molecular underpinnings in carcinogenesis remain poorly understood. HMGA1 are small, non-histone proteins that bind to AT-rich regions in DNA, bend chromatin, and recruit transcriptional complexes to modulate gene expression. Prior studies in prostate cancer (PCa) suggest that HMGA1 overexpression associates with higher pathologic grades and increases in HMGA1 protein levels correlate with metastatic potential in rat PCa cells. Overexpression of HMGA1 in human PCa cell lines induces unbalanced chromosomal rearrangements in vitro. Thus, we hypothesized that HMGA1 drives PCa progression through epigenetic reprogramming of transcriptional networks involved in development and chromosomal instability. To test this, we focused on androgen receptor (AR)-negative, castrate-resistant PCa (CRPC) cell lines as tumors with these features are resistant to therapy and associated with metastatic progression and early death. Here, we uncover a novel role for HMGA1 in regulating HOXB13 to drive tumor progression and cancer stem cell properties. We found that silencing HMGA1 in patient-derived metastatic cell lines (PC3-Epi, PC3-EMT, DU145) halts proliferation. Cell morphology changed most dramatically in PC3-EMT cells, transforming spindle-shaped, mesenchymal cells to more cuboidal, epithelial-like cells. Both migration and invasion were disrupted, but primarily in more invasive, mesenchymal cell lines (PC-EMT, DU145). Colony formation and 3D sphere formation were also blocked in all CRPC lines. Immunohistologic analysis in primary tumors revealed that HMGA1 nuclear staining associates with more advanced Gleason scores in PCa. To elucidate transcriptional networks downstream of HMGA1, RNA-seq was performed in PC3-EMT and PC3-Epi cell lines + HMGA1 silencing. Intriguingly, HMGA1 regulates pathways involved in inflammation in the more epithelial PC3-Epi cells, while pathways involved in mitosis, cell cycle progression, DNA damage, and checkpoint regulation predominated in the mesenchymal PC3-EMT cells. Pathways involved in proliferation and development were regulated by HMGA1 in both settings. We focused on HOXB13, a developmental gene linked to cell fate and prostate carcinogenesis. Both HOXB13 and HMGA1 are co-regulated in CRPC cell lines at the gene expression and protein level. HMGA1 occupies at least 1 site within the HOXB13 promoter region by chromatin immunoprecipitation. Strikingly, silencing HOXB13recapitulates HMGA1 phenotypes, impairing proliferation, colony formation, and 3D sphere formation. These findings reveal a novel role for HMGA1 in CRPC progression by dysregulating developmental networks. Together, these results also suggest that targeting the HMGA1-HOXB13 pathway could be effective therapy in CRPC.

Citation Format: Lionel Chia, Guangjing Zhu, Mikhail Gorbounov, Lingling Xian, Briyana Chisholm, Mohammad Heydarian, Dorhyun Johng, William B. Isaacs, Karen Reddy, Linda S. Resar. HMGA1 induces the HOXB13 developmental gene to drive tumor progression in androgen receptor negative, castrate-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2595.

Psychometric evaluation of a measure of factors influencing hand hygiene behaviour to inform intervention

BACKGROUND

Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards).

AIM

To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour.

METHODS

The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs.

FINDINGS

In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model.

CONCLUSION

The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units.

Is there a role for perfusion imaging in assessing treatment response following ablative therapy of small renal masses-A systematic review

Aims

Ablation therapies are an innovative nephron-sparing alternative to radical nephrectomy for early stage renal cancers, although determination of treatment success is challenging. We aimed to undertake a systematic review of the literature to determine whether assessment of tumour perfusion may improve response assessment or alter clinical management when compared to standard imaging.

Material and Methods

Two radiologists performed independent primary literature searches for perfusion imaging in response assessment following ablative therapies (radiofrequency ablation and cryotherapy) focused on renal tumours.

Results

5 of 795 articles were eligible, totaling 110 patients. The study designs were heterogeneous with different imaging techniques, perfusion calculations, reference standard and follow-up periods. All studies found lower perfusion following treatment, with a return of ‘high grade’ perfusion in the 7/110 patients with residual or recurrent tumour. One study found perfusion curves were different between successfully ablated regions and residual tumour.

Conclusions

Studies were limited by small sample size and heterogeneous methodology. No studies have investigated the impact of perfusion imaging on management. This review highlights the current lack of evidence for perfusion imaging in response assessment following renal ablation, however it suggests that there may be a future role. Further prospective research is required to address this.

Abstract 4494: HMGA1 drives tumor progression and recruits cancer-associated fibroblasts in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinomas (PDACs) are highly lethal tumors for which there are no effective therapies. Emerging evidence suggests that the tumor stroma interacts with the cancer cells to induce cancer stem cell properties and drive tumor progression. In PDAC, the fibroblast stroma also provides a dense barrier preventing cytotoxic therapy from reaching PDAC cells. We previously discovered that high levels of High Mobility Group A1 (HMGA1) protein predict decreased survival in primary PDAC. Here, we report a novel role for HMGA1-FGF19 in mediating tumor-stromal interactions and tumor progression. Silencing HMGA1 in PDAC cell lines or low-passge, patient-derived cells abruptly halts proliferation. Spindle-shaped, mesenchymal cells became reprogrammed into cuboidal, more epithelial-like cells. Sensitivity to gemcitabine was enhanced and colony formation, migration, invasion, and three-dimensional (3D) sphere formation were all disrupted in cells with HMGA1 knock-down. Silencing HMGA1 also disrupted xenograft tumorigenesis and depleted cancer stem cells/tumor-initiator cells in limiting dilution tumorigenicity assays. To elucidate underlying molecular mechanisms mediating these striking phenotypes, we performed RNA-seq after silencing HMGA1 in invasive, highly metastatic, low-passage patient-derived PDAC cells (10.7). Among the genes regulated by HMGA1 were those encoding proteins involved in tumor-stromal signaling, including the fibroblast growth factor 19 (FGF19). The FGF19 gene is highly expressed in GI tumors (liver, colon, PDAC) and transgenic mice overexpressing Fgr15 (the murine homolog) in hepatocytes develop hepatocellular carcinoma (HCC). FGF19 also correlates with poor outcomes in human HCC and colon cancer, although it's role in PDAC was unknown. Here, we found that FGF19 expression is dependent upon HMGA1 in 3 different PDAC cell lines; silencing HMGA1 represses FGF19 in these cells. HMGA1 also binds directly to the FGF19 promoter at 2 predicted DNA binding sites as assessed by chromatin immunoprecipiation. To determine whether FGF19 plays a functional role in HMGA1-mediated tumor progression and cancer stem cell properties, we silenced FGF19 in PDAC cells. Similar to our results with HMGA1, silencing FGF19 impaired PDAC growth and 3D sphere formation in vitro. Because fibroblast growth factors interact with fibroblasts, we determined whether the HMGA1-FGF19 pathway was involved in tumor cell – stromal crosstalk. PDAC 10.7 cells recruit cancer-associated fibroblasts (CAFs) in a co-culture system, although this recruitment was abrogated when HMGA1 was silenced. CAF migration was also disrupted by anti-human FGF19 neutralizing antibodies. Together, these findings indicate that HMGA1 drive tumor progression and cancer stem cell properties through FGF19 and suggest that targeting the HMGA1-FGF19 pathway maybe efficaceous in PDAC.

Citation Format: Shuai Shuai, Lingling Xian, Tait Huso, Karen Reddy, Linda Resar. HMGA1 drives tumor progression and recruits cancer-associated fibroblasts in pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4494.

Abstract 3352: HMGA1 chromatin remodeling protein induces HOXB13 to drive cancer stem cell properties and tumor progression in prostate cancer models

Increasing evidence suggests that cancer cells undergo chromatin remodeling and epigenetic reprogramming during tumor progression, although the underlying mechanisms remain poorly understood. The High Mobility Group A1 (HMGA1) chromatin binding protein is an architectural transcription factor that binds to AT-rich regions in DNA where it displaces histone HI and recruits transcriptional complexes to modulate gene expression. The HMGA1 gene is highly expressed during embryogenesis and in adult stem cells, but silenced postnatally in differentiated tissues. HMGA1 becomes re-expressed in most high-grade cancers and high levels portend adverse clinical outcomes. In prostate cancer (PCa), HMGA1 overexpression and protein immunoreactivity associates with high pathologic grade, although its function in this setting is unknown. To gain mechanistic into the role of HMGA1 in PCa, we silenced HMGA1 in 2 human PCa cell lines: 1) PC3-Epi, a PCa clone selected for epithelial properties, and 2) PC3-EMT, a more invasive PCa clone with mesenchymal properties. Silencing HMGA1 halts proliferation in both PC3-Epi and PC3-EMT cells. Cell morphology changed most dramatically in the PC3-EMT cells, transforming spindle-shaped, mesenchymal cells to more cuboidal, epithelial-like cells. Both migration and invasion were disrupted, but only in the more invasive PC-EMT cells. Colony formation and the stem cell property, three-dimensional (3D) sphere formation, were also blocked in cells with HMGA1 knock-down. To elucidate transcriptional networks downstream of HMGA1, RNA-seq was performed in both cell lines + HMGA1 silencing. We identified genes involved in cell signaling, protein synthesis, post-translational modifications, cell motility, mitotic spindle formation, and development. We focused on the HOXB13 developmental gene, which encodes a transcription factor involved in prostate development. Intriguingly, HOXB13 germline mutations are linked to familial PCa. We found that HOXB13 and HMGA1 are co-regulated in PCa cells by quantitative RT-PCR. HMGA1 occupies 2 sites within the HOXB13 promoter region by chromatin immunoprecipitation. Strikingly, silencing HOXB13 recapitulates HMGA1 phenotypes, impairing proliferation, colony formation, and 3D sphere formation. This work not only reveals a novel role for HMGA1 in regulating both cancer stem cell properties and tumor progression in PCa through HOXB13, but also suggests that targeting the HMGA1-HOXB13 pathway could be effective therapy in invasive PCa.

Citation Format: Lionel Chia, Lingling Xian, Guangjing Zhu, Mohammad Heydarian, William B. Issacs, Karen Reddy, Linda Smith Resar. HMGA1 chromatin remodeling protein induces HOXB13 to drive cancer stem cell properties and tumor progression in prostate cancer models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3352.

Biohydrogen production from sugarcane bagasse hydrolysate: effects of pH, S/X, Fe2+, and magnetite nanoparticles

Batch dark fermentation experiments were conducted to investigate the effects of initial pH, substrate-to-biomass (S/X) ratio, and concentrations of Fe²⁺ and magnetite nanoparticles on biohydrogen production from sugarcane bagasse (SCB) hydrolysate. By applying the response surface methodology, the optimum condition of steam-acid hydrolysis was 0.64% (v/v) H₂SO₄ for 55.7 min, which obtained a sugar yield of 274 mg g^-1. The maximum hydrogen yield (HY) of 0.874 mol (mol glucose^-1) was detected at the optimum pH of 5.0 and S/X ratio of 0.5 g chemical oxygen demand (COD, g VSS^-1). The addition of Fe²⁺ 200 mg L^-1 and magnetite nanoparticles 200 mg L^-1 to the inoculum enhanced the HY by 62.1% and 69.6%, respectively. The kinetics of hydrogen production was estimated by fitting the experimental data to the modified Gompertz model. The inhibitory effects of adding Fe²⁺ and magnetite nanoparticles to the fermentative hydrogen production were examined by applying Andrew's inhibition model. COD mass balance and full stoichiometric reactions, including soluble metabolic products, cell synthesis, and H₂ production, indicated the reliability of the experimental results. A qPCR-based analysis was conducted to assess the microbial community structure using Enterobacteriaceae, Clostridium spp., and hydrogenase-specific gene activity. Results from the microbial analysis revealed the dominance of hydrogen producers in the inoculum immobilized on magnetite nanoparticles, followed by the inoculum supplemented with Fe²⁺ concentration. Graphical abstract ᅟ.

The High Mobility Group A1 (HMGA1) gene is highly overexpressed in human uterine serous carcinomas and carcinosarcomas and drives Matrix Metalloproteinase-2 (MMP-2) in a subset of tumors

OBJECTIVES

Although uterine cancer is the fourth most common cause for cancer death in women worldwide, the molecular underpinnings of tumor progression remain poorly understood. The High Mobility Group A1 (HMGA1) gene is overexpressed in aggressive cancers and high levels portend adverse outcomes in diverse tumors. We previously reported that Hmga1a transgenic mice develop uterine tumors with complete penetrance. Because HMGA1 drives tumor progression by inducing MatrixMetalloproteinase (MMP) and other genes involved in invasion, we explored the HMGA1-MMP-2 pathway in uterine cancer.

METHODS

To investigate MMP-2 in uterine tumors driven by HMGA1, we used a genetic approach with mouse models. Next, we assessed HMGA1 and MMP-2 expression in primary human uterine tumors, including low-grade carcinomas (endometrial endometrioid) and more aggressive tumors (endometrial serous carcinomas, uterine carcinosarcomas/malignant mesodermal mixed tumors).

RESULTS

Here, we report for the first time that uterine tumor growth is impaired in Hmga1a transgenic mice crossed on to an Mmp-2 deficient background. In human tumors, we discovered that HMGA1 is highest in aggressive carcinosarcomas and serous carcinomas, with lower levels in the more indolent endometrioid carcinomas. Moreover, HMGA1 and MMP-2 were positively correlated, but only in a subset of carcinosarcomas. HMGA1 also occupies the MMP-2 promoter in human carcinosarcoma cells.

CONCLUSIONS

Together, our studies define a novel HMGA1-MMP-2 pathway involved in a subset of human carcinosarcomas and tumor progression in murine models. Our work also suggests that targeting HMGA1 could be effective adjuvant therapy for more aggressive uterine cancers and provides compelling data for further preclinical studies.

One-year mortality in patients with bone and soft tissue sarcomas as an indicator of delay in presentation

INTRODUCTION

For many cancers, one-year mortality following diagnosis is a reflection of either advanced stage at diagnosis, multiple co-morbidities and/or complications of treatment. One-year mortality has not been reported for soft tissue or bone sarcomas. This study reports 1-year sarcoma mortality data over a 25-year period, investigates prognostic factors and considers whether a delay in presentation affects 1-year mortality.

METHODS

A total of 4,945 newly diagnosed bone sarcoma and soft tissue sarcoma patients were identified from a prospectively maintained, single institution oncology database. Of these, 595 (12%) died within 1 year of diagnosis. Both patient factors and tumour characteristics available at diagnosis were analysed for effect.

RESULTS

There was significant variation in one-year mortality between different histological subtypes. There has been no significant change in mortality rate during the last 25 years (mean: 11.7%, standard deviation: 2.8 percentage points). Soft tissue sarcoma patients who survived over one year reported a longer duration of symptoms preceding diagnosis than those who died (median: 26 vs 20 weeks, p<0.001). Prognostic factors identified in both bone and soft tissue sarcomas mirrored those for mid to long-term survival, with high tumour stage, large tumour size, metastases at diagnosis and increasing age having the greatest predictive effect.

CONCLUSIONS

One-year mortality in bone and soft tissue sarcoma patients is easy to measure, and could be a proxy for late presentation and therefore a potential performance indicator, similar to other cancers. It is possible to predict the risk of one-year mortality using factors available at diagnosis. Death within one year does not correlate with a long history but is associated with advanced disease at diagnosis.

A CLEAR CASE OF MRSA SEPSIS, OF AN UNEXPECTED ORIGIN

A 56-year-old man with a history of uncontrolled type 2 diabetes mellitus, benign prostatic hypertrophy and history of recent knee and elbow abscess presented to the emergency department with nausea, vomiting, and fevers. Two days prior, he presented to the ER and was diagnosed with acute presumed prostatitis and urinary retention. He was discharged on ciprofloxacin and an indwelling Foley catheter with urology follow-up. After being unable to tolerate oral medications, he presented again to the emergency department, at which time, he was febrile and tachycardic. Physical exam was benign except for a boggy and tender prostate and bilateral CVA tenderness. Labs demonstrated leukocytosis, elevated HbA1C, and pyuria on urinalysis. Urine cultures collected at the patient's earlier emergency department visit demonstrated no growth. Computed tomography indicated an enlarged prostate with patchy areas of low density. He was admitted with sepsis secondary to prostatitis. Blood cultures on day one showed gram-positive cocci , methicillin resistant staph aureus (MRSA isolate) and persistent bacteremia for three days despite therapy with vancomycin. After adequate dosing of vancomycin, sterilization of the blood was achieved, yet urine culture demonstrated growth of MRSA. Transthoracic rchocardiogram (TTE) showed no signs of endocarditis with good visualization of valves. He was successfully treated with 14 days of vancomycin.

Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study

We conducted a case-control study to examine the merit of silver-coated tumour prostheses. We reviewed 85 patients with Agluna-treated (silver-coated) tumour implants treated between 2006 and 2011 and matched them with 85 control patients treated between 2001 and 2011 with identical, but uncoated, tumour prostheses. In all, 106 men and 64 women with a mean age of 42.2 years (18.4 to 90.4) were included in the study. There were 50 primary reconstructions (29.4%); 79 one-stage revisions (46.5%) and 41 two-stage revisions for infection (24.1%). The overall post-operative infection rate of the silver-coated group was 11.8% compared with 22.4% for the control group (p = 0.033, chi-square test). A total of seven of the ten infected prostheses in the silver-coated group were treated successfully with debridement, antibiotics, and implant retention compared with only six of the 19 patients (31.6%) in the control group (p = 0.048, chi-square test). Three patients in the silver-coated group (3.5%) and 13 controls (15.3%) had chronic periprosthetic infection (p = 0.009, chi-square test). The overall success rates in controlling infection by two-stage revision in the silver-coated group was 85% (17/20) compared with 57.1% (12/21) in the control group (p = 0.05, chi-square test). The Agluna-treated endoprostheses were associated with a lower rate of early periprosthetic infection. These silver-treated implants were particularly useful in two-stage revisions for infection and in those patients with incidental positive cultures at the time of implantation of the prosthesis. Debridement with antibiotic treatment and retention of the implant appeared to be more successful with silver-coated implants.