Decreased AdipoR1 signaling and its implications for obesity-induced male infertility

Obesity is among the risk factors for male infertility. Although several mechanisms underlying obesity-induced male subfertility have been reported, the entire mechanism of obesity-induced male infertility still remains unclear. Here, we show that sperm count, sperm motility and sperm fertilizing ability were decreased in male mice fed a high-fat diet and that the expression of the AdipoR1 gene and protein was decreased, and the expression of pro-apoptotic genes and protein increased, in the testis from mice fed a high-fat diet. Moreover, we demonstrate that testes weight, sperm count, sperm motility and sperm fertilizing ability were significantly decreased in AdipoR1 knockout mice compared to those in wild-type mice; furthermore, the phosphorylation of AMPK was decreased, and the expression of pro-apoptotic genes and proteins, caspase-6 activity and pathologically apoptotic seminiferous tubules were increased, in the testis from AdipoR1 knockout mice. Furthermore, study findings show that orally administrated AdipoRon decreased caspase-6 activity and apoptotic seminiferous tubules in the testis, thus ameliorating sperm motility in male mice fed a high-fat diet. This was the first study to demonstrate that decreased AdipoR1/AMPK signaling led to increased caspase-6 activity/increased apoptosis in the testis thus likely accounting for male infertility.

Abstract P2-09-28: New quantitative diagnostic method by fluorescence nanoparticle for HER2 positive breast cancer treated with neoadjuvant lapatinib and trastuzumab: The Neo LaTH study (JBCRG-16TR)

Background: HER2 (human epidermal growth factor receptor 2) testing performed by IHC (immunohistochemical) methods and FISH (fluorescence in situ hybridization) is semi-quantitative. Exact quantification of HER2 is needed to predict which patients are more or less likely to response to anti HER2 therapy. To improve the method for cancer patients' HER2 status, we developed a novel fluorescence IHC method using new fluorescence nanoparticle. The fluorescent intensity of this new nanoparticles, termed phosphor-integrated dot (PID), was approximately 100-fold brighter than that of Quantum dots. Because of its increased brightness and analyzing technology, this PID-based fluorescent IHC(IHC-PIC) has an ability of quantifying the biomarker protein in the cancer tissue sample at single particle level. In this study, the primary objective was to investigate if pathological complete response (pCR) rate in HER2- positive breast cancer treated by trastuzumab and lapatinib containing neoadjuvant systemic therapy would depend on the level of HER2, EGFR, HER3, Ki67, ER and PgR protein quantified by this new method.

Methods: The Neo-LaTH study is a randomized phase II multicenter trial evaluating the efficacy and safety of lapatinib and trastuzumab followed by lapatinib and trastuzumab plus weekly paclitaxel with or without prolongation of anti-HER2 therapy prior to chemotherapy (18 weeks vs. 6 weeks). The primary endpoint was the comprehensive pCR rate. We evaluated the HER2, EGFR, HER3, Ki67, ER and PgR amount by nano-patho method using PID in formalin-fixed paraffin-embedded core biopsy samples taken at diagnosis retrospective analysis. Univariate and multivariate analyses were performed to determine the association between pCR and variables, including HER2, EGFR, HER3, Ki67, ER and PgR nano-patho score and clinicopathological factors including histological grade, tumor status, nodal status and HER2 FISH ratio.

Results: A total of 96 tumor samples from patients were used for the present analysis.The pCR rate was 60.4%. We obtained the images of only PID signal by the image analyses, and calculated the number of PID particles in a cell and defined it as IHC-PID score that reflects the level of HER2, EGFR, HER3, Ki67, ER and PgR protein expression in cancer cells. Univariate analysis showed that HER2 IHC-PID score(p<0.0001), ER IHC-PID score(p=0.009) and PgR IHC-PID score(p=0.019) were associated with pCR and multivariate analysis showed that HER2 IHC-PID score was significantly associated with pCR (adjusted odds ratio, 0.990 [95% CI, 0.984–0.996]; P < .0001).

Conclusion: We successfully performed the quantitative IHC-PID for HER2, EGFR, HER3, Ki67, ER and PgR. And we propose using HER2 IHC-PID score as a predictive factor for trastuzumab and lapatinib containing neoadjuvant systemic therapy. This quantitative diagnostic method would be expected to contribute to the development of a molecular therapeutic strategy.

Citation Format: Tada H, Miyashita M, Gonda K, Watanabe M, Suzuki A, Watanabe G, Harada N, Sato A, Hamanaka Y, Masuda N, Toi M, Ohno S, Bando H, Ishiguro H, Inoue K, Yamamoto N, Kuroi K, Ohuchi N, Ishida T. New quantitative diagnostic method by fluorescence nanoparticle for HER2 positive breast cancer treated with neoadjuvant lapatinib and trastuzumab: The Neo LaTH study (JBCRG-16TR) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-28.

Overcoming an Extremely Drug Resistant (XDR) Pathogen: Avibactam Restores Susceptibility to Ceftazidime for Burkholderia cepacia Complex Isolates from Cystic Fibrosis Patients

Burkholderia multivorans is a significant health threat to persons with cystic fibrosis (CF). Infections are difficult to treat as this pathogen is inherently resistant to multiple antibiotics. Susceptibility testing of isolates obtained from CF respiratory cultures revealed that single agents selected from different antibiotic classes were unable to inhibit growth. However, all isolates were found to be susceptible to ceftazidime when combined with the novel non-β-lactam β-lactamase inhibitor, avibactam (all minimum inhibitor concentrations (MICs) were ≤8 mg/L of ceftazidime and 4 mg/L of avibactam). Furthermore, a major β-lactam resistance determinant expressed in B. multivorans, the class A carbapenemase, PenA was readily inhibited by avibactam with a high k₂/K of (2 ± 1) × 10⁶ μM^-1 s^-1 and a slow k_off of (2 ± 1) × 10^-3 s^-1. Mass spectrometry revealed that avibactam formed a stable complex with PenA for up to 24 h and that avibactam recyclized off of PenA, re-forming the active compound. Crystallographic analysis of PenA-avibactam revealed several interactions that stabilized the acyl-enzyme complex. The deacylation water molecule possessed decreased nucleophilicity, preventing decarbamylation. In addition, the hydrogen-bonding interactions with Lys-73 were suggestive of a protonated state. Thus, Lys-73 was unlikely to abstract a proton from Ser-130 to initiate recyclization. Using Galleria mellonella larvae as a model for infection, ceftazidime-avibactam was shown to significantly (p < 0.001) improve survival of larvae infected with B. multivorans. To further support the translational impact, the ceftazidime-avibactam combination was evaluated using susceptibility testing against other strains of Burkholderia spp. that commonly infect individuals with CF, and 90% of the isolates were susceptible to the combination. In summary, ceftazidime-avibactam may serve as a preferred therapy for people that have CF and develop Burkholderia spp. infections and should be considered for clinical trials.

Abstract P5-12-01: Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia

Purpose: Arthralgia sometimes occurs in the breast cancer patients treated with aromatase inhibitors (AIs). It is one of the most important reasons for poor AIs adherence.

Background; The HOPE study previously demonstrated that exercise was effective in improving AI-induced arthralgia in breast cancer patients. However, recruitment to this study was limited to severe cases (Criteria; physically inactive, &gt;6 months AT treatment, &gt;2 months arthralgia). To asses if these findings were more generalizable to all breast cancer contexts we conducted a randomized trial of exercise intervention using wider eligibility criteria that the hope study to assess the impact on AI induced arthralgia in breast cancer patients.

Methods: We examined Japanese breast cancer patients operated at Nahanishi Clinic, Okinawa, Japan. Following the informed consent the patients were randomly assigned to a 3:1 ratio to exercise intervention or usual care, . Eligibility criteria included receiving an AI for 0-4 years, no metastases, any arthralgia level and any exercise habits. Following randomization participants could choose from 3 types of exercise including strong (120-150 minutes per week of walking or running), intermediate (gentle calisthenics (daily NIPPON HOSO KYOKAI: NHK broadcast exercise)) and weak (going up the stairs- frequency). Arthralgia was assessed using the Brief Pain Inventory (BPI), in which the patients completed a baseline, 6month and 12 month BPI assessment. Primary endpoint was BPI change at 12 months.

Results: Among 227 women screened, we randomized 108 women, with 80 to exercise intervention (46 of strong, 19 of intermediate and 15 of weak) and 28 to usual care. Base line BPI were well balanced between exercise intervention and usual care. Overall exercise intervention reduced BPI scores relative to control. The BPI changes of worst pain, least pain, average pain and pain right now were 0.09, -0.25, -0.14 and 0 for exercise intervention group and 0.21, 0.46, 0.07 and 0.61 for usual care group, respectively. There was a statistically significant difference of AIs adherence between exercise intervention group (99%) and usual care group (92%) (P=0.03).

Conclusion: Exercise intervention tends to improve the AI-induced arthralgia and has a positive effect on AIs adherence.

Citation Format: Tajaesu M, Tamaki K, Nagamine S, Kamada Y, Uehara K, Arakaki M, Tamatsu Y, Yamashiro K, Miyashita M, Ishida T, Ohuchi N, McNamara K, Terukina S, Sasano H, Tamaki N. Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-12-01.

Relationship Between Bile Duct Reconstruction and Complications in Living Donor Liver Transplantation

OBJECTIVES

In living donor liver transplantation (LDLT), the recipient bile duct is thin and short. Bile duct complications often occur in LDLT, with persistent long-term adverse effects. Recently, we began to perform microsurgical reconstruction of the bile duct. The purpose of this study was to investigate the relationship between bile duct reconstruction methods and complications in LDLT.

METHODS

From 1991 to 2014, we performed 161 LDLTs (pediatric:adult = 90:71; left lobe:right lobe = 95:66). In this study, we retrospectively investigated the initial bile duct complications in LDLT and performed univariate and multivariate analyses to identify the independent risk factors for complications.

RESULTS

The most frequent complication was biliary stricture (9.9%), followed by biliary leakage (6.8%). On univariate and multiple logistic regression analysis, the independent risk factors for biliary stricture were bile leakage (P = .0103) and recurrent cholangitis (P = .0077). However, there were no risk factors for biliary leakage on univariate analysis in our study. The reconstruction methods (hepaticojejunostomy or duct-to-duct anastomosis) and reconstruction technique (with or without microsurgery) were not risk factors for biliary stricture and leakage.

CONCLUSION

In this study, the most frequent complication of LDLT was biliary stricture. The independent risk factors for biliary stricture were biliary leakage and recurrent cholangitis. Duct-to-duct anastomosis and microsurgical reconstruction of the bile duct were not risk factors for biliary stricture and leakage.

The Significance of Screening for HLA Antibodies in the Long-Term Follow-up of Pediatric Liver Transplant Recipients

BACKGROUND

Post-transplant donor-specific anti-HLA antibodies (DSA) reportedly have detrimental effects on the outcomes of organ transplantation. However, the prevalence of post-transplant DSA in the long term after pediatric liver transplantation remains unclear, and the significance of post-transplant DSA is unknown. The aim of this cross-sectional study was to determine the prevalence of and characteristics of patients with post-transplant DSA.

MATERIALS AND METHODS

Of the 84 pediatric liver transplant recipients who were followed up in the outpatient department of our institution, 34 patients with available HLA typing data were included after they or their parent(s) provided informed consent for DSA evaluations. Luminex single-antigen bead assays were performed, and a mean fluorescence intensity of ≥1000 was used as the cut-off for a positive reaction.

RESULTS

No class I DSA were detected, whereas class II DSA were detected in 11 patients (32%). There were no differences in age at transplantation, immunosuppressive drugs, or follow-up period between the DSA-positive and DSA-negative patients. The rate of positive pre-transplant complement-dependent cytotoxicity crossmatch was higher with class II DSA than without, although the difference was not statistically significant.

CONCLUSIONS

The utility of screening for class I DSA was insignificant in the long-term follow-up of pediatric liver transplant recipients. The prevalence of class II DSA was relatively high; therefore, screening for class II DSA might be justified, although a follow-up survey of the association between post-transplant class II DSA and the long-term clinical course needs to be conducted.

A laser-induced pulsed water jet for layer-selective submucosal dissection of the esophagus

Background and aims: Conventional water jet devices have been used for injecting fluid to lift up lesions during endoscopic submucosal dissection or endoscopic mucosal resection procedures. However, these devices cannot dissect the submucosal layer effectively. Here we aim to elucidate the dissection capability of a laser-induced pulsed water jet and to clarify the mechanism of dissection with layer selectivity. Materials (Subjects) and methods: Pulsed water jets were ejected from a stainless nozzle by accelerating saline using the energy of a pulsed holmium: yttrium-aluminum-garnet laser. The impact force (strength) of the jet was evaluated using a force meter. Injection of the pulsed jet into the submucosal layer was documented by high-speed imaging. The physical properties of the swine esophagus were evaluated by measuring the breaking strength. Submucosal dissection of the swine esophagus was performed and the resection bed was evaluated histologically. Results: Submucosal dissection of the esophagus was accomplished at an impact force of 1.11-1.47 N/pulse (laser energy: 1.1-1.5 J/pulse; standoff distance: 60 mm). Histological specimens showed clear dissection at the submucosal layer without thermal injury. The mean static breaking strength of the submucosa (0.11 ± 0.04 MPa) was significantly lower than that of the mucosa (1.32 ± 0.18 MPa), and propria muscle (1.45 ± 0.16 MPa). Conclusions: The pulsed water jet device showed potential for achieving selective submucosal dissection. It could achieve mucosal, submucosal, and muscle layer selectivity owing to the varied breaking strengths.

Successful Case of Somatostatin Analog Stopping Gastrointestinal Bleeding, One of the Most Frequent Complications After Simultaneous Pancreas-kidney Transplantation: A Case Report

OBJECT

Pancreas transplantation has the highest surgical complication rate of all routinely performed organ transplantation procedures. The complications are not only caused by the pancreas itself but also occur due to issues with the transplant recipient. We report the case of a patient who experienced massive gastrointestinal bleeding after simultaneous pancreas-kidney transplantation (SPK), which was stopped successfully using somatostatin analog.

PATIENTS AND METHODS

The patient was a 45-year-old woman with diabetes mellitus type 1 who underwent SPK with enteric drainage. She had melena 5 days after SPK.

RESULTS

At first, we suspected that the melena was caused by the transplanted duodenum because of rejection and ischemic changes. The patient experienced severe bleeding 9 days after SPK. We quickly performed open surgery and inserted an endoscope from the recipient's ileum to investigate the transplanted duodenum. However, no bleeding source was found, including in the transplanted duodenum and the recipient's ileum end. We determined that the bleeding source was the recipient's ascending colon. We attempted to perform endovascular treatment but could not detect the source of the bleeding; therefore, we used somatostatin analog to let the blood vessels shrink and reduce pancreatic output. Thereafter, the function of the transplanted pancreas and kidney gradually recovered, and the recipient was discharged 154 days after SPK.

CONCLUSION

Gastrointestinal bleeding is a lethal complication and has several different causes, such as mucosal rejection, ischemic changes, and exocrine output of the pancreas graft. Somatostatin analog is one of the most acceptable treatments for patients who have gastrointestinal bleeding after SPK.

The influence of collagen III expression on the efficiency of cell isolation with the use of collagenase H

OBJECTIVE

We previously demonstrated that collagenase H (ColH) plays a crucial role in rat islet isolation, whereas collagenase G (ColG) plays only a supporting role. We also showed that collagen III appears to be one of the key targets of ColH based on a mass spectrometry analysis. In the present study, we investigated whether our novel findings in an islet isolation model are universally applicable for other types of cell isolation, such as a hepatocyte isolation, with the use of enzyme blends of recombinant collagenases.

METHODS

As the first step, the expression of one of the main matrix components, collagen III, on rat pancreatic and hepatic tissues was assessed with the use of immunohistochemical staining. ColG and ColH were expressed in recombinant E. coli carrying expression plasmids for each collagenase. Then the efficiency of the collagenase subtype on rat hepatocyte isolation was evaluated in terms of cell yield with the use of thermolysin combined with either ColG or ColH (n = 3, respectively).

RESULTS

The expression of collagen III on rat hepatic tissues was dramatically lower than that of rat pancreatic tissues. In the rat hepatocyte isolation, a substantial amount of hepatocytes (0.81 ± 0.11 × 10(6)) were obtained in the ColG group, whereas almost no hepatocytes were retrieved in the ColH group, indicating that the influence of the collagenase subtypes in rat hepatocyte isolation are completely opposite to that observed in rat islet isolation.

CONCLUSIONS

Considering that the expression of collagen III on hepatic tissues was relatively low and that almost no hepatocytes were retrieved when ColH and thermolysin were used, the present study supports our novel finding that collagen III appears to be one of the key targets of ColH in hepatocyte isolation. Therefore, the semiquantification of collagen III on the target tissues not only may positively contribute to efficient islet isolation, but also may affect other types of cell isolation by optimizing the ColH amount.

Donors' quality of life evaluated by short form-36 analysis after living donor liver transplantation in a single-center experience

BACKGROUND AND PURPOSE

The purpose of this study was to compare the quality of life of donors using the Short Form 36 (SF-36) analysis between the left and right graft periods of living donor liver transplantation.

PATIENTS AND METHODS

In the left graft period (July 1991 to July 2003), 68 donors were eligible for analysis and 76 were eligible in the right graft period (August 2003 to October 2010). Nine right lobe grafts were included in the left graft period, and 52 right lobe grafts were included in the right graft period. We investigated the risks of donation and evaluated the following: blood loss, operation time, postoperative liver function, and duration of hospitalization. We also assessed quality of life in donors, who were mailed a structured questionnaire and the SF-36.

RESULTS

Ten of the 68 donors in the left graft period and 12 of the 76 in the right graft period had postoperative complications. Most postoperative complications were treated without surgical procedures. There was no donor death in our series. Forty-eight donors in the left graft period and 36 in the right graft period responded to our investigation. Compared with published Japanese norms in SF-36, our donors scored similar or higher than the general population in both groups. Two donors in the left graft period and one in the right graft period regretted their decisions to donate. All donors returned to normalcy.

CONCLUSIONS

These results suggested that the donors' quality of life was guaranteed in terms of the SF-36 investigation regardless of the donation period in our series.

Fibrosing cholestatic hepatitis developing within one month after living donor liver transplantation for chronic hepatitis C-related cirrhosis: a case report

Fibrosing cholestatic hepatitis (FCH) is a life-threatening consequence of hepatitis C virus (HCV) infection occurring in a small minority of liver transplantation (LT) recipients. We herein report a case of early-onset FCH after living donor LT in a 47-year-old woman with HCV-related cirrhosis. The patient underwent balloon-occluded retrograde transvenous obliteration of a splenorenal shunt to treat an impaired portal flow on the sixth postoperative day (POD 6) and a bypass operation for hepatic artery thrombosis on POD 12. Thereafter, the serum bilirubin levels increased gradually; however, computed tomography revealed no evidence of biliary stricture. The serum HCV-RNA level on POD 27 was >7.8 log IU/mL. Histopathology of a needle graft biopsy performed on POD 28 revealed FCH with extensive portal fibrosis accompanied by mild inflammation, hepatocyte ballooning, and ductular proliferation with cholestasis. The patient received combination therapy with pegylated interferon, ribavirin, and double-filtration plasmapheresis for the treatment of early-onset FCH. Both the recipient and the donor carried the major genotype single nucleotide polymorphism (TT) at rs8099917 near the interleukin-28B gene. Furthermore, the HCV genotype was treatment-sensitive 2a. Nonetheless, the recipient died of hepatic failure on POD 211. Thus far, few cases of FCH occurring within 1 month after LT have been reported. In addition, the early onset of FCH may be an adverse prognostic factor.

Abstract P3-06-20: The correlation between body mass index (BMI) and breast cancer in both premenopausal and menopausal women in Okinawa

Introduction

Much of the longevity advantage in Okinawa is thought to be related to a healthy lifestyle including traditional foods which is low in calories and dense in nutrition. However, dietary change since World War II has been largely deleterious, with younger Okinawan people developing a higher risk of obesity and other chronic disease risk factors than older Okinawan people. In addition, breast cancer incidence and mortality are gradually increasing in Okinawa. Therefore we examined the correlation between BMI and breast cancer in both premenopausal and postmenopausal women in Okinawa.

Methods

The cases were 3422 female breast cancer patients without any previous breast cancer history, and the control subjects were 5622 women, who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 1996 and March 2013. The median ages were 53 years old (21-99) in the breast cancer group and 44 years old (18-90) in the control group. Based on the World Health Organization classification, 25≤BMI&lt;30 is considered as overweight and 30≤BMI as obesity. We examined the association between BMI and breast cancer risk by odds ratio. In addition, we also stratified and examined the BMI according to menstruation and age by student t test.

Results

Table.1 summarized the results of the association between BMI and breast cancer risk.

Association between BMI and breast cancer risk. CancerControlP ValueOdds[95%CI]All patients34225622  Overweght10201028p&lt;0.0011.89 [1.72-2.10]Obesity285253p&lt;0.0011.93[1.62-2.30]Overweight+Obesity13051281p&lt;0.0012.09[1.90-2.29]Premenopausal    Overweight146498p = 0.0021.37[1.12-1.67]Obesity44141p = 0.0641.41[0.99-1.99]Overweight+Obesity190639p&lt;0.0011.42[1.18-1.70]Postmenopausal    Overweight618527p&lt;0.0011.59[1.38-1.83]Obesity179112p&lt;0.0011.96[1.54-2.51]

Being overweight, or obese, increased the odds of breast cancer, as well as these put together, in the postmenopausal group (p&lt;0.001, respectively). As for the premenopausal group, being overweight and also overweight grouped with obese increased the odds of breast cancer significantly (p = 0.002 and p&lt;0.001, respectively) and a tendency was detected in the obese (p = 0.064). Table.2 summarized the results of BMI according to menstruation and age.

BMI according to menstruation and age CancerControlp valueTotal24.3±4.122.7±3.8p&lt;0.001Premenopausal22.9±3.922.1±3.7p&lt;0.001Postmenopausal25.4±4.123.9±3.7p&lt;0.001Year&lt;3021.1±0.520.7±0.1p = 0.53930≤year&lt;4022.5±3.921.7±3.6p&lt;0.00140≤year&lt;5023.2±3.822.7±3.5p&lt;0.00150≤year&lt;6024.6±0.123.7±6.1p&lt;0.00160≤year&lt;7025.5±3.924.5±3.8p&lt;0.00170≤25.7±4.224.7±3.5p&lt;0.001

The BMI of the breast cancer group were statistically higher than that of the control group in those over 30 years old, and in the pre and post menopausal (p&lt;0.001, respectively).

Conclusion

The results of this study suggested that weight gain and consequently being overweight or obese might increase the odds for breast cancer in both premenopausal and postmenopausal women ages over 30 years old in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-20.

Abstract P3-05-16: Quantitative diagnostic technology for HER2 positive breast cancer by molecular imaging: The potential predictive factor of anti-HER2 therapy

Background: Anti-HER2 therapy contributes to improvement of the clinical outcome in HER2-positive patients. However, current studies have reported the resistance to trastuzumab. To diagnose HER2 expression level, immunohistochemical (IHC) method with 3,3’-diaminobenzidine (IHC-DAB) staining is widely used, but is not quantitative and classifies tumors into only 4 categories. Additionally, the epitopes of trastuzumab and most antibodies used for IHC-DAB are different. These problems might induce a gap between diagnostics and therapeutic efficacy. To improve the method for cancer patients’ HER2 status, we developed a novel IHC method with trastuzumab conjugated with fluorescent nano-particles quantum dots (QDs) by single-particle imaging using tissue samples from patients with clinical information.

Methods: We prepared two kinds of QD-conjugated antibody complexes for IHC with QDs (IHC-QD). One was a QD-conjugated trastuzumab, the other was a QD-conjugated human IgG for control. We performed the several steps of antigen-antibody reaction by two kinds of QD-conjugated antibody probes for 37 human breast cancer specimens. The QD signal reflected HER2 expression level was observed by the optical system that consisted of an epi-fluorescent microscope with EM-CCD camera.

Results: We successfully obtained the images of only QDs signal by the image analyses, and calculated the number of QD particles in a cell and defined it as IHC-QD score that reflects the level of HER2 protein expression in cancer cells. In comparing IHC-QD scores with IHC-DAB scores, cases with a score of 0 and 1 by IHC-DAB had low scores of IHC-QD (0.01-0.67), being in narrow range. On the other hand, those with a score of 2 varied widely, with IHC-QD scores of 0.06 to 16.98, and those with a score of 3 also varied, from 0.18 to 18.81. In some of the sample with IHC-DAB score of 2 and 3, the binding of trastuzumab to these cancer cells is very weak although they are candidate for trastuzumab therapy in present HER2 diagnostic criteria. In comparison between FISH and IHC-QD scores, the straight-line approximation curve shows that both quantitative scores, FISH (0.96-8.76) and IHC-QD (0.01-18.81) are well correlated (R = 0.83, p&lt;0.001). In analyzing the therapeutic efficacy in 14 metastatic breast cancers treated with trastuzumab according to IHC-QD or FISH or IHC-DAB scores, IHC-QD score was correlated with time to progression (TTP) more than FISH and IHC-DAB scores.

Table 1Diagnostic methodsPatient numberTime to progression, median(range)P valueIHC-DAB  0.207Score 236 (3-9) Score 31112 (3-60) FISH  0.577Low score712 (5-60) High score79 (3-52) IHC-QD  0.094Low score76 (3-60) High score724 (3-52) Comparison between IHC-QD or FISH or IHC-DAB and the therapeutic efficacy with trastuzumab

Althogh the sample size was small, this result suggests that the IHC-QD score has a potential role as predictive factor for trastuzumab therapy.

Conclusion: We performed the precisely quantitative IHC using trastuzumab-conjugated QDs and single-particle imaging analysis, and propose using IHC-QD as a predictive factor for trastuzumab therapy. This new diagnostic method would be expected to contribute to the development of a therapeutic strategy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-05-16.

Abstract P5-09-10: Androgen receptor signal acquired oncogenic role in aromatase inhibitor resistant model of breast cancer cell

Aromatase inhibitors (AI) are the common treatment for postmenopausal estrogen receptor (ER) positive breast cancer. However, not a few of these patients acquire resistance to AI.To investigate this molecular mechanism of resistance, we have established several breast cancer cell lines as AI resistant models. Recently, we reported on AD-EDR cells (androgen metabolite-dependent and estrogen depletion resistant cells) derived from MCF-7, in which ER activity depends on one of androgen metabolite, 5a-androstane-3β, 17β-diol (3βdiol).

It is supposed that tumor heterogeneity contributes to the acquired resistance to drugs.To examine this diversity, we established another AI resistant model derived from T-47D, to compare characters of these AI resistant models from different parents. Then, we found that the androgen receptor (AR) signal acquired oncogenic role in this model in contrast to AD-EDR cells established from MCF-7.

We cultured ER positive breast cancer cells, T47D-TE8, stably transfected with ERE-GFP reporter into T47D, under estrogen-depleted and androgen-supplemented conditions for more than three months, simulating the AI treatment, and established estrogen deprivation-resistant cells (TE8-EDR cells).

TE8-EDR cells had little ERE-GFP activity and proliferation response to estrogen though estrogen stimulated proliferation of parental T47D-TE8. The mRNA for ER and progesterone receptor was hardly detected in TE8-EDR cells. These results suggested that they had lost the ER-mediated pathway of growth. On the contrary, Dihydrotestosterone (DHT) increased growth of T47D-TE8 cells, while it was more remarkable in TE8-EDR, and this proliferative effect was reduced by AR antagonist, bicalutamide. The mRNA expressions of AR and its target gene, PSA, were extremely increased in TE8-EDR cells. These results indicated that TE8-EDR enhanced AR-regulated pathway for growth.

Increased AR expression was presumed to be one of the factors elevating AR activity. To identify other elements enhancing AR-mediated signal, we compared the gene expression of TE8-EDR cells with that of T47D-TE8 by microarray analysis. The outcome showed that the expression of some well-known androgen-related genes were increased in TE8-EDR cells. Among these genes, we focused on DDC (L-dopa decarboxylase) which has been reported as one of the AR coactivator, and its overexpression increase proliferative effect in prostate cancer cell lines.By real-time RT-PCR, we confirmed that the mRNA expression of DDC in TE8-EDR was higher over one-hundred fold than T47D-TE8. In addition, DHT-induced proliferation was cancelled by DDC inhibitor, NSD-1015.

This study suggests that TE8-EDR cells shift their growth pathway from ER to AR signal, and the AR activity is enhanced by high-expression of DDC. Whereas, MCF7-derived AD-EDR cells still depends on ER signal for their proliferation. So far, few studies have shown the proliferative effects of androgen as AI resistant mechanism. Our results provide new mechanism of acquired AI-resistance in breast cancer. Moreover, the fact that the character of AI resistant models varied with their parent cells supports the hypothesis that tumor heterogeneity contributes to diversify the mechanism of acquired resistance to hormonal therapy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-10.

Abstract P2-12-04: Evaluation of BRCA 1/2 mutation-carrier probability models, BRCAPRO and myriad II, in the Japanese population

Background:

It is important to select high-risk group with a BRCA1/2 mutation and recommend them to provide genetic counseling and genetic testing. BRCAPRO and Myriad II are widely used for predicting BRCA mutation-carrier probability and useful for selecting eligible person of genetic testing. However, It is reported that BRCAPRO tends to underestimate the risk of BRCA1/2 mutation probability in Asian. The validation of these models are not sufficiently known in Japanese population.

Methods:

Twenty-six hundred sixty-five people visited to Ishinomaki Red Cross Hospital between 2011 and 2012.They were surveyed family history as a risk factor of inheriting breast cancer according to NCCN guideline. We calculated BRCA1/2 mutation probability by BRCAPRO and Myriad II. Those who had more than 10% mutation probability and early-onset breast cancer, triple negative breast cancer were received genetic counseling and genetic testing for applicants. We analyzed association between family history of the probands and BRCA 1/2 mutation. We also calculated sensitivity, specificity and positive predictive value(PPV) at the10% threshold in BRCAPRO and Myriad II.

Results:

Two handred forty-three(9.1%) people were selected as a risk of inheriting breast cancer, of which sixty-eight people (2.5%) were constructed family tree. The number of people who had more than 10% and 30% mutation probability by BRCAPRO was eight (0.30%) and five (0.18%).Fourteen people performed BRCA1/2 genetic testing (proband : thirteen, relative: one). Seven people carried a deleterious BRCA mutation (BRCA1: five, BRCA2: two). In the cases which had more than 30% mutation probability, all of them carried a deleterious BRCA mutation. Most of their mutation site was L63X which was most frequent in Japan.

People who had personal or family history of breast and ovarian cancer, triple negative breast cancer were significantly associated with BRCA1/2 mutation.(p = 0.035,p = 0.015,p = 0.009)

Using a 10% threshold, sensitivity, specificity, positive predictive value in BRCAPRO was 75%,83%,85% and 63%,67%,71% in Myriad II respectively. When it comes to the cases which had more than 30% mutation probability, Sensitivity, specificity, positive predictive value were all 100% in BRCAPRO.

Conclusions:

It is recommended to perform genetic testing for especially those who have personal or family history of both breast and ovarian cancer, triple negative breast cancer. 10% threshold of BRCAPRO and Myriad II is generally applicable to selecting eligible person in the Japanese population. BRCAPRO is superior to Myriad II in terms of sensitivity, specificity, PPV in our study. The cases which have more than 30% mutation probability need to have genetic testing.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-04.

Abstract P2-03-02: A non-invasive modality the US virtual touch tissue quantification (VTTQ) for evaluation of breast cancer

Introduction

Acoustic radiation force impulse (ARFI) imaging is a newly developed ultrasound-based modality which could evaluate the wave propagation speed and tissue stiffness more precisely and objectively. ARFI does not require any external compression, and so even in deep tissues could, provide complementary information to conventional ultrasound (US), potentially improving the characterization of tissue and focal lesions. The generated waves can provide quantification of the shear wave velocity, termed Virtual Touch Tissue Quantification (VTTQ). VTTQ is an intrinsic and reproducible property of the tissue, and this tissue quantification could provide objective and reproducible data. This is the first study to evaluate the biological features of breast tissues using newly developed non-invasive diagnostic system VTTQ.

Methods

180 patients including 115 invasive ductal carcinoma (IDC), 30 ductal carcinoma in situ (DCIS), 4 mucinous carcinoma, 7 invasive lobular carcinoma (ILC), 8 fibroadenoma (FA), 12 fibrocystic change (FCC) and 4 intraductal papilloma were studied at Nahanishi Clinic Okinawa. We first compared results of VTTQ according to each histological subtype, and determined the optimal cutoff values for VTTQ to distinguish benign from malignant tissues using the receiver operating characteristic (ROC) method. In addition, we also examined the correlation between VTTQ velocities and Ki-67, estrogen receptor (ER), progesterone receptor (PgR) or human epidermal growth factor receptor 2 (HER2) in the cases of IDC using the linear regression analyses and Student's t test.

Results

There were statistically significant differences of VTTQ velocities between IDC and DCIS (P = 0.003), mucinous carcinoma (P = 0.009), FA (P&lt;0.001), papilloma (P&lt;0.001) or FCC (P&lt;0.001). There were significant differences between DCIS and FA (P = 0.016), papilloma (P&lt;0.001) or FCC (P&lt;0.001). Significant differences were also detected between mucinous carcinoma and papilloma (P&lt;0.001) or FCC (P = 0.003), between ILC and papilloma (P = 0.012) or FCC (P = 0.003) and between FA and papilloma (P = 0.030). VTTQ velocities were statistically higher in malignant cases than in benign cases (p&lt;0.05, respectively) and the best cutoff value for the VTTQ velocity which could differentiate benign from malignant cases was 2.89 m/second. There were statistically significant correlations between VTTQ velocity and Ki-67 labeling index (r = 0.338, r2 = 0.114 and P&lt;0.001), and significant inverse correlations between VTTQ and ER (r = -0.311, r2 = 0.097 and P&lt;0.001) or PgR (r = -0.361, r2 = 0.131 and P&lt;0.001) status of IDC. There was also a significant differences of the average velocities between HER2 positive (6.39±1.44 m/second) and negative (4.43±1.41 m/second) cases (P&lt;0.001).

Conclusion

VTTQ was valuable for examination of breast cancer pathology in a non-invasive fashion. The results still could suggest the value of VTTQ examination in the clinical management of breast cancer patients. VTTQ has huge potential for examining axillary lymph node status instead of sentinel lymph node biopsy, and examining the responsiveness of neoadjuvant chemotherapy in midcourse evaluation without invasive biopsy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-02.

A patient with hepatic artery thrombosis after living-donor liver transplantation survived the great East Japan earthquake 3 days after reoperation: a case report

BACKGROUND

On March 11, 2011, our hospital was severely damaged by the Great East Japan Earthquake. We report the rare case of a 5-month-old patient with hepatic artery thrombosis (HAT) after living donor liver transplantation (LDLT), who survived the earthquake that occurred 3 days after the reoperation; we were able to save this patient without abilities to perform blood tests or computed tomography (CT) for 4 days.

METHODS

This female infant with biliary atresia underwent LDLT 5 months after birth and developed peritonitis owing to perforation of the small intestine 7 days later. Her blood pressure decreased and she developed HAT. We performed emergency reconstruction of the hepatic artery and repair of the small intestine, and 3 days after surgery, the Great East Japan Earthquake occurred.

RESULTS

We could not perform blood tests or CT scans because the water supply was damaged. Gas supply lines were also damaged and sterilization was not possible; surgical tools were limited. However, emergency power was available, so we performed ultrasonography every 6 hours and predicted liver function from intrahepatic blood flow and monitored for Glisson's capsule edema. The blood examination system recovered 14 days after LDLT, and we confirmed improvement of liver function. The patient was extubated 37 days after LDLT and discharged on postoperative day 67.

CONCLUSIONS

Portable ultrasonography was useful in evaluating intrahepatic blood flow and Glisson's capsule edema. Furthermore, it was effective during a disaster because it required no water or gas.

Intratumoral concentration of estrogens and clinicopathological changes in ductal carcinoma in situ following aromatase inhibitor letrozole treatment

Background:

Estrogens have important roles in ductal carcinoma in situ (DCIS) of the breast. However, the significance of presurgical aromatase inhibitor treatment remains unclear. Therefore, we examined intratumoral concentration of estrogens and changes of clinicopathological factors in DCIS after letrozole treatment.

Methods:

Ten cases of postmenopausal oestrogen receptor (ER)-positive DCIS were examined. They received oral letrozole before the surgery, and the tumour size was evaluated by ultrasonography. Surgical specimens and corresponding biopsy samples were used for immunohistochemistry. Snap-frozen specimens were also available in a subset of cases, and used for hormone assays and microarray analysis.

Results:

Intratumoral oestrogen levels were significantly lower in DCIS treated with letrozole compared with that in those without the therapy. A great majority of oestrogen-induced genes showed low expression levels in DCIS treated with letrozole by microarray analysis. Moreover, letrozole treatment reduced the greatest dimension of DCIS, and significantly decreased Ki-67 and progesterone receptor immunoreactivity in DCIS tissues.

Conclusion:

These results suggest that estrogens are mainly produced by aromatase in DCIS tissues, and aromatase inhibitors potently inhibit oestrogen actions in postmenopausal ER-positive DCIS through rapid deprivation of intratumoral estrogens.

Insights into β-lactamases from Burkholderia species, two phylogenetically related yet distinct resistance determinants

Burkholderia cepacia complex and Burkholderia pseudomallei are opportunistic human pathogens. Resistance to β-lactams among Burkholderia spp. is attributable to expression of β-lactamases (e.g. PenA in B. cepacia complex and PenI in B. pseudomallei). Phylogenetic comparisons reveal that PenA and PenI are highly related. However, the analyses presented here reveal that PenA is an inhibitor-resistant carbapenemase, most similar to KPC-2 (the most clinically significant serine carbapenemase), whereas PenI is an extended spectrum β-lactamase. PenA hydrolyzes β-lactams with k(cat) values ranging from 0.38 ± 0.04 to 460 ± 46 s(-1) and possesses high k(cat)/k(inact) values of 2000, 1500, and 75 for β-lactamase inhibitors. PenI demonstrates the highest kcat value for cefotaxime of 9.0 ± 0.9 s(-1). Crystal structure determination of PenA and PenI reveals important differences that aid in understanding their contrasting phenotypes. Changes in the positioning of conserved catalytic residues (e.g. Lys-73, Ser-130, and Tyr-105) as well as altered anchoring and decreased occupancy of the deacylation water explain the lower k(cat) values of PenI. The crystal structure of PenA with imipenem docked into the active site suggests why this carbapenem is hydrolyzed and the important role of Arg-220, which was functionally confirmed by mutagenesis and biochemical characterization. Conversely, the conformation of Tyr-105 hindered docking of imipenem into the active site of PenI. The structural and biochemical analyses of PenA and PenI provide key insights into the hydrolytic mechanisms of β-lactamases, which can lead to the rational design of novel agents against these pathogens.

Abstract P6-05-14: Estrogen-induced genes in ductal carcinoma in situ(DCIS): their comparison with invasive ductal carcinoma

It is well known that estrogens play important roles in both the pathogenesis and development of invasive ductal carcinoma (IDC) of human breast. However, molecular features of estrogen actions have remained largely unclear in pure ductal carcinoma in situ (pDCIS), regarded as a precursor lesion of many IDCs. This is partly due to the fact that gene expression profiles of estrogen-responsive genes have not been examined in pDCIS. Therefore, we first examined the profiles of estrogen-induced genes in estrogen receptor (ER)-positive pDCIS and DCIS (DCIS-c) and IDC (IDC-c) components of IDC cases (n = 4, respectively) by microarray analysis. Estrogen-induced genes identified in this study were tentatively classified into three different groups in the hierarchical clustering analysis, and 33% of the genes were predominantly expressed in pDCIS rather than DCIS-c or IDC-c cases. Among these genes, the status of MYB (c-MYB), RBBP7 (RbAp46) and BIRC5 (survivin) expression in carcinoma cells was significantly higher in ER-positive pDCIS(n = 53) than that in ER-positive DCIS-c (n = 27) or IDC-c (n = 27) by subsequent immunohistochemical analysis of the corresponding genes (P &lt; 0.0001, P = 0.03 and P = 0.0003, respectively). In particular, the status of c-MYB immunoreactivity was inversely (P = 0.006) correlated with Ki-67 in the pDCIS cases. These results suggest that expression profiles of estrogen-induced genes in pDCIS may be different from those in IDC, and c-MYB, RbAp46 and survivin may play particularly important roles among estrogen induced genes in ER-positive pDCIS.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-05-14.

Abstract P6-07-27: Body mass index and survival after breast cancer diagnosis in Japanese women

Background: Body mass index (BMI) may be an important factor affecting breast cancer outcome. Studies conducted mainly in Western countries have reported a relationship between higher BMI and a higher risk of all-cause death or breast cancer-specific death among women with breast cancer, but only a few studies have been reported in Japan so far. In the present prospective study, we investigated the associations between BMI and the risk of all-cause and breast cancer-specific death among breast cancer patients overall and by menopausal status and hormone receptor status.

Methods: The study included 653 breast cancer patients admitted to a single hospital in Japan, between 1997 and 2005. BMI was assessed using a self-administered questionnaire. The patients were completely followed up until December, 2008. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated according to quartile points of BMI categories, respectively: &lt;21.2, ≥21.2 to &lt;23.3 (reference), ≥23.3 to &lt;25.8 and ≥25.8 kg/m2.

Results: During the follow-up period, 136 all-cause and 108 breast cancer-specific deaths were observed. After adjustment for clinical and confounding factors, higher BMI was associated with an increased risk of all-cause death (HR = 2.61; 95% CI: 1.01–6.78 for BMI ≥25.8 vs. ≥21.2 to &lt;23.3 kg/m2) among premenopausal patients. According to hormonal receptor status, BMI ≥25.8 kg/m2 was associated with breast cancer-specific death (HR = 4.95; 95% CI: 1.05–23.35) and BMI &lt;21.2 kg/m2 was associated with all-cause (HR = 2.91; 95% CI: 1.09–7.77) and breast cancer-specific death (HR = 7.23; 95% CI: 1.57–33.34) among patients with ER+ or PgR+ tumors. Analysis by hormonal receptor status also showed a positive association between BMI and mortality risk among patients with ER+ or PgR+ tumors and with BMI ≥21.2 kg/m2 (p for trend: 0.02 and 0.031 for all-cause and breast cancer-specific death, respectively).

Abstract P2-10-43: The combination of immunohistochemistry for predicting TP53 mutation is useful prognostic marker in breast cancer

The comprehensive expression analysis classified subtypes of breast cancer which is clinically applied for immunohistochemistry (IHC) with ER, HER2 and Ki67. On the other hand, recent whole genome sequencing reveals a certain quantity of TP53 mutation in breast cancer, especially with ER negative tumor. Therefore, it is important for risk evaluation that TP53 mutation is applied for IHC. However, p53 IHC is not well correlated with TP53 mutation because of false negative (deletion mutant) and false positive (stabilization of p53). This study is initiated to improve accuracy to combine the IHC of p53 and p53-regulated protein for predicting TP53 mutation.

First, we explored p53-dependent down regulated proteins to rescue the false negative of p53 IHC cases. Using the microarray analysis and DNA sequencing of TP53 gene in 37 breast cancer patients, we extracted 97genes which were overexpressed in TP53 mutation breast cancer cases compared with TP53 wild cases. Furthermore, using the microarray analysis by two tet-inducible p53 cell lines, 597 genes were extracted for p53-dependent repressed genes. There were 29 common genes between both of them. In 29genes, we picked up three genes, BIRC5, BUB1 and PLK1 which were confirmed with p53-dependent repression by RT-PCR or luciferase assay. Next, the correlation of TP53 status and IHC of these genes products and p53 were evaluated. In 37 breast cancer patients, TP53 mutations were detected in 19 cases (51%). There were 11 missense mutations, 5 protein-truncating mutations and two splicing-site mutations. p53 IHC positive (&gt;10%) were 12 cases (32.4%) which included only 9 TP53 mutations. Five protein-truncating TP53 mutations were all negative staining of p53. Among BIRC5, BUB1 and PLK1 proteins, positive staining of PLK1 is the most correlated with TP53 mutations, sensitivity 0.78, specificity 0.84 and positive predictive value 0.78 (p &lt; 0.0001). Third, we tested well known p53-tageted gene product p21 IHC whether it is used for decreasing false positive of p53 IHC. Although strong staining of p21 is only 3 cases (8.1%), all of three were wild type TP53.

Therefore IHC of p53 + and p21 – (to decrease false positive of p53) or p53- and PLK1+ (to save false negative of p53) were defined as IHC-TP53 mutation+. The IHC-TP53 mutation + were strongly correlated with TP53 mutations, sensitivity 0.89, specificity 0.95 and positive predictive value 0.94 (p &lt; 0.0001). Furthermore, p53 IHC, TP53 mutation and IHC-TP53 mutation were evaluated as prognostic marker. In only 37 breast cancers, TP53 mutation and IHC-TP53 mutation+ were statistically significant for poor prognosis (log rank test, p = 0.005, p = 0.023, respectively) whereas p53 IHC was not. We next carried out IHC of other 157 breast cancers to validate IHC-TP53 mutation as prognostic marker. In this cases, p53 IHC had also statically significant for prognosis (p = 0.009), however IHC-TP53 mutation were more strong relation to prognosis (p = 0.0006).

The combination of p53, p21 and PLK1 IHC are well predicted TP53 mutations and is a useful biological, prognostic marker such as ER or HER2.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-43.

Novel hybrid laparoscopic sacrocolpopexy for pelvic organ prolapse with a severe paravaginal defect

Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect.

Evaluation of laparoendoscopic single-site gynecologic surgery with a multitrocar access system

OBJECTS

Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system.

METHODS

This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures.

RESULTS

Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min).

CONCLUSION

Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.

Novel hybrid mesh surgery combines sacrocolpopexy with transvaginal mesh placement for pelvic organ prolapse

Mesh surgeries, such as sacrocolpopexy and transvaginal mesh surgery, are commonly used to treat pelvic organ prolapse. Although mesh surgeries have a high success rate, they are unsuitable for some patients. For a patient with pelvic organ prolapse and highly calcified multiple fibroids, we performed hybrid sacrocolpopexy combined with transvaginal mesh surgery with a method modified for the patient's condition. Three months after surgery, the results were highly satisfactory. This approach is simple, secure, and versatile for patients who are not good candidates for conventional mesh surgeries. This novel hybrid mesh surgery is an option for treating various types of pelvic organ prolapse.

Abstract P3-10-38: Histopathological Subclassification of Triple Negative Breast Carcinoma Using Prognostic Scoring System

Purpose: Triple negative breast carcinoma (TNBC) is currently being required to be classified pluralistically in order to provide the most appropriate therapy to the patients. We attempted to subclassify TNBC cases into subgroups based on clinical outcome or prognosis of the patients with TNBC using archival specimens. Materials and Methods: We analyzed 102 Japanese cases of invasive TNBC who underwent surgery between January 1998 and December 2007. The clinicopathological factors and clinical information of these patients were retrospectively retrieved from charts of the patients. Immunohistochemical staining was performed for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor 1 (EGFR1), CK5/6, Ki-67 and CD31 for microvessel density (MVD). Results: Median follow-up time of the patients was 68.5 months. Multivariable analysis demonstrated that the pathologic node status was the most significantly associated with relapse-free survival (RFS) and breast cancer-specific survival (BCSS) of the patients. Pathological tumor size, basal-like type, Ki-67 labeling index (LI) and MVD were also independently associated with RFS and BCSS. Based on these results, we devised the Risk Score system reflecting Hazard ratios (HRs) of these prognostic factors above.

Multivariate analysis and the Risk Score for TNBC patients.

With this system, TNBC patients in this study were classified into three subgroups; patients with score 0-3 are in low risk group, score 4-7 in intermediate risk group and score 8- in high risk group. These three groups had statistically significant differences for risk of relapse and breast cancer-specific death, respectively.

Conclusions: We propose the Risk Score system, which incorporated pathologic nodal status, size of the primary tumor, the presence or absence of basal-like features, Ki67 LI and MVD of the patients in order to predict postoperative clinical course of the Japanese patients with TNBC. Such a classification which can be performed in diagnostic pathology laboratory can be useful as a decision-making tool for triple negative patients.

Abstract P1-02-01: Vasohibin-1 in Human Breast Carcinoma: A Potential Negative Feedback Regulator of Angiogenesis

Background: Vasohibin-1 is a recently identified negative feedback regulator of angiogenesis induced by vascular endothelial growth factor (VEGF)-A. This is the first study to evaluate immunoreactivity and mRNA expression of Vasohibin-1 in human breast disorders. Material and Methods: We examined 251 breast specimens including invasive ductal carcinoma (IDC: 148), ductal carcinoma in situ (DCIS:62), fibroadenoma (FA:16), inflammatory lesion (6), fibrocystic change(9) and non-pathological breast tissue(7). We immunolocalized vasohibin-1 and compared its immunoreactivity to that of VEGF-A, VEGF receptor 2 (Flk-1), CD31 and Ki-67. The correlation of vasohibin-1 immunoreactibity with overall survival (OS), and disease free survival (DFS) of the breast carcinoma patients was also evaluated. In addition, we evaluated Ki-67 and CD31, and Ki-67 and vasohibin-1 double-immunostaining for further characterization of neovascularization. We also evaluated mRNA expression of Vasohibin-1 using a real-time quantitative RT-PCR with LightCycler system.

Results: Vasohibin-1 was detected in endothelial cells of human breast and its immunodensity was significantly higher in IDC and inflammatory lesion than the other types (P&lt;0.001). As for DCIS, there was a significant positive correlation between vasohibin-1 expression level and nuclear grade or Van Nuys classification of carcinoma cells (P&lt;0.001). In addition, a significant positive correlation was detected between vasohibin-1 and VEGF-A, Flk-1 or Ki-67 (P&lt;0.001). There was also positive associations between vasohibin-1 and OS (P=0.004) and DFS (P&lt;0.001). Results of double-immunostaining demonstrated the ratio of Ki-67-positive cells among vasohibin-1-positive endothelial cells (46.5%) was significantly higher than those among CD31-positive cells (23.5%). In addition, there was a significant positive correlation between Vasohibin-1 mRNA level and Ki-67 or high nuclear grade(P&lt;0.001).

Discussion: This is the first study demonstrating the status of vasohibin-1 in human breast lesions, which indicates that vasohibin-1 is associated with neovascularization and may especially play important roles in the regulation of intratumoral angiogenesis in human breast cancer. Vasohibin-1 is supposed to be induced in the downstream of VEGF-A/Flk-1 signaling pathway and considered an appropriate biomarker for intratumoral neovascularization. In addition, these results clearly indicated that vasohibin-1 expression may become one of the prognostic markers for metastasis and prognosis, and also become one of the appropriate biomarker of the potential of subsequent stromal invasion of carcinoma cells.

Figures available in online version.

Adiposity, adult weight change and breast cancer risk in postmenopausal Japanese women: the Miyagi Cohort Study

Background:

The role of adult weight change in breast cancer (BC) risk is unclear in Japanese women.

Methods:

A total of 10 106 postmenopausal women aged 40–64 years (the Miyagi Cohort) were followed from 1990 to 2003, and 108 BC cases were identified. Hazard ratios (HRs) were estimated according to body mass index (BMI) at the current age and at the of age 20 years, and weight change since age 20 years.

Results:

Higher current BMI was associated with an increased risk of BC (P for trend=0.02), whereas higher BMI at the age 20 years was inversely associated with this risk (P for trend=0.002). There was a significant association between weight change since age 20 years and BC risk (P for trend=0.0086). Compared with stable weight, HR was 0.35 for weight loss of 5 kg or more (P for weight loss trend=0.04) and 1.55 for weight gain of 12 kg or more (P for weight gain trend=0.05).

Conclusion:

Adiposity at younger and current age has differential effects on BC risk among postmenopausal women; weight gain in adulthood being associated with an increased, and weight loss with a decreased risk.

Thrombin-stimulated proliferation is mediated by endothelin-1 in cultured rat gingival fibroblasts

Abstract Endothelin-1 (ET-1) appears to be involved in drug-induced proliferation of gingival fibroblasts. Thrombin induces proliferation of human gingival fibroblasts via protease-activated receptor 1 (PAR1). In this study, using cultured rat gingival fibroblasts, we investigated whether thrombin-induced proliferation of gingival fibroblasts is mediated by ET-1. Thrombin-induced proliferation (0.05-2.5 U/mL). Proliferation was also induced by a PAR1-specific agonist (TFLLR-NH(2,) 0.1-30 microm), but not by a PAR2-specific agonist (SLIGRL-NH(2)). Thrombin (2.5 U/mL) induced an increase in immunoreactive ET-1 expression, which was inhibited by cycloheximide (10 microg/mL), and an increase in preproET-1 mRNA expression, as assessed by reverse transcription polymerase chain reaction. TFLLR-NH(2) increased ET-1 release into the culture medium in both a concentration (0.01-10 microm)- and time (6-24 h)-dependent manner, as assessed by solid phase sandwich enzyme-linked immunosorbent assay. The thrombin (2.5 U/mL)-induced proliferation was inhibited by a PAR1-selective inhibitor, SCH79797 (0.1 microm) and an ET(A) antagonist, BQ-123 (1 microm), but not by an ET(B) antagonist, BQ-788 (1 microm). These findings suggest that thrombin, acting via PAR1, induced proliferation of cultured rat gingival fibroblasts that was mediated by ET-1 acting via ET(A).

Identification of AUF1 as a rapamycin-responsive binding protein to the 5'-terminal oligopyrimidine element of mRNAs

In vertebrates, mRNAs containing a 5'-terminal oligopyrimidine (TOP) motif are coordinately post-transcriptionally regulated. Binding of specific proteins to this element has been proposed to downregulate expression of TOP mRNAs at the level of translational initiation. We previously reported that rapamycin induces binding activity to the TOP element of ribosomal protein (r-protein) L32 mRNA. In this study, we adapt DEAE-cellulose/oligo dT-cellulose tandem column chromatography to purify TOP element-binding proteins from bovine submaxillary lymph nodes (SLN). We also show by northwestern blot analysis that two proteins of molecular weight 47kDa (47BP) and 43kDa (43BP) specifically bind to a (32)P-labeled riboprobe containing TOP regulatory element of the r-protein L32. Microsequencing of the purified 47BP revealed an internal sequence of 15 amino acids identical to the consensus sequence of the 2x RBD-Gly family. Western blot analysis of the cytoplasm fractions using an AUF1 antibody revealed that these two proteins are p45 AUF1 and p42 AUF1. Increases of the four isoforms of AUF1 protein were observed in 100,000g supernatant fractions of rapamycin-administered rat SLN. Furthermore, decreases of p45 AUF1 and p42 and/or p40 AUF1 were observed in the polysomal fractions of BJAB cells in which translation of TOP mRNAs was selectively suppressed by rapamycin treatment. Taken together, these results suggest that AUF1 is a TOP mRNA-binding protein that may participate in the translational suppression of TOP mRNAs resulting from rapamycin treatment.

Evidence of the purely leptonic decay B- --> tau- nu(tau)

We present the first evidence of the decay B- --> tau- nu(tau), using 414 fb(-1) of data collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+ e- collider. Events are tagged by fully reconstructing one of the B mesons in hadronic modes. We detect the signal with a significance of 3.5 standard deviations including systematics and measure the branching fraction to be B(B- --> tau- nu(tau)) = (1.79(-0.49) +0.56(stat)(-0.51) +0.46(syst)) x 10(-4). This implies that fB = 0.229(-0.031) +0.036(stat)(-0.037) +0.034(syst) GeV and is the first direct measurement of this quantity.

Expression signature of p53 status (p53 signature) for the prediction of TP53 mutation and prognosis in breast cancer

652

Background: The current risk evaluation criteria, such as the St. Gallen and NIH, are not sufficient for predicting which BC patients are at high risk for recurrence and mortality. The TP53 mutations are associated with worse RFS and OS, independent other risk factors in BC, but the p53 status is not simply determined and often determined incorrectly (Soussi et al. Nat Rev Cancer 2006). Our purpose was to identify the gene sets that determine expression signature of the p53 status and to correlate the gene expression profile (GEP) with clinical outcome. Methods: Comprehensive expression analysis (Agilent 41K human genome oligo microarray) and DNA sequencing of the TP53 gene in 38 Japanese BC (30 Stage I-II, 8 stage III-IV; 20 TP53 wt, 20 TP53 mt) were performed using RNA and DNA obtained from the microdissected frozen tumor samples. We determined a gene set consisted of 33 genes from differentially expressed genes depending on the p53 status in the 26 BC (training set) and validated the ability to predict p53 status in the remaining 12 BC (test set). Prognostic value of the gene set was analyzed in 29 BC (stage I or II), and were validated using publicly available dataset of the independent 295 BC (stage I or II), van de Vijver et al. NEJM 2002). Results: The GEP using the 33 genes, many of which related in cell cycle and cell division, predicted the p53 status (wt or mt p53 signature) accurately in the test set (accuracy: 83%, overall accuracy: 95%). The p53 signature has the ability to predict RFS of the 29 early BC (Log Rank, P=0.032). It divided the 295 early BC into 176 wt and 119 mt group, and also has the ability to predict both RFS and OS (Log Rank, both P<0.0001). This was also true when the cohort were stratified by ER status, LN status, St. Gallen criteria and NIH criteria, and retained the predicted value in ER+, LN+, LN-, St. Gallen (intermediate/high) and NIH (high) subgroups (Log Rank, P<0.0001). Conclusions: The p53 signature is a powerful and independent predictor of the outcome of disease in early breast cancer than standard systems based on clinical and histologic criteria.

No significant financial relationships to disclose.