Independent and Combined Effects of Prenatal Alcohol Exposure and Prenatal Stress on Fetal HPA Axis Development

Prenatal alcohol exposure (PAE) and prenatal stress (PS) are highly prevalent conditions known to affect fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The objectives of this study were to assess the effect of light PAE, PS, and PAE-PS interaction on fetal HPA axis activity assessed via placental and umbilical cord blood biomarkers. Participants of the ENRICH-2 cohort were recruited during the second trimester and classified into the PAE and unexposed control groups. PS was assessed by the Perceived Stress Scale. Placental tissue was collected promptly after delivery; gene and protein analysis for 11β-HSD1, 11β-HSD2, and pCRH were conducted by qPCR and ELISA, respectively. Umbilical cord blood was analyzed for cortisone and cortisol. Pearson correlation and multivariable linear regression examined the association of PAE and PS with HPA axis biomarkers. Mean alcohol consumption in the PAE group was ~2 drinks/week. Higher PS was observed in the PAE group (p < 0.01). In multivariable modeling, PS was associated with pCRH gene expression (β = 0.006, p < 0.01), while PAE was associated with 11β-HSD2 protein expression (β = 0.56, p < 0.01). A significant alcohol-by-stress interaction was observed with respect to 11β-HSD2 protein expression (p < 0.01). Results indicate that PAE and PS may independently and in combination affect fetal programming of the HPA axis.

Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation

BACKGROUND

Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction.

METHODS

The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes.

RESULTS

Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05).

CONCLUSIONS

Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation.

IMPACT

Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.

Manipulation of metabolic responses enhances SHetA2 efficacy without toxicity in cervical cancer cell lines and xenografts

OBJECTIVE

The high frequency of cervical cancer recurrence after primary therapy necessitates alternative treatments. High-risk human papillomavirus (HR-HPV) causes cervical cancer and it's continued presence supports elevated metabolism, proliferation and survival of cancer cells. The low-to-no toxicity new investigational drug, SHetA2, counteracts high-risk human papillomavirus (HR-HPV) effects on cell proliferation and survival in cervical cancer cells and xenograft tumors by disrupting heat shock protein 70 chaperone protection of oncogenic proteins. Our objective was to study the involvement of metabolism in SHetA2 effects on cervical cancer cells and tumors.

METHODS

SHetA2-mediated proteomic and metabolic effects were measured in HR-HPV-positive CaSKi and SiHa and HR-HPV-negative C-33 A cervical cancer cell lines. Combined treatment with 2-deoxyglucose (2-DG) was evaluated in cell culture and SiHa xenografts.

RESULTS

SHetA2 inhibited oxidative phosphorylation (OxPhos) and altered levels of proteins involved in metabolism, protein synthesis, and DNA replication and repair. Cervical cancer cells responded by elevating glycolysis. Inhibition of the glycolytic responses using galactose media or 2-DG increased SHetA2 sensitivity of two HR-HPV-positive, but not an HR-HPV-negative cervical cancer cell line. Interaction of 2-DG and SHetA2 was synergistic in HR-HPV positive cell lines in association with augmentation of SHetA2 ATP reduction, but not SHetA2 DNA damage induction. These results were verified in a SiHa xenograft tumor model without evidence of toxicity.

CONCLUSIONS

Compensatory glycolysis counteracts OxPhos inhibition in SHetA2-treated HR-HPV-positive cervical cancer cell lines. Prevention of compensatory glycolysis with 2-DG or another glycolysis inhibitor has the potential to improve SHetA2 therapy without toxicity.

Pharmacodynamics of Cyclin D1 Degradation in Ovarian Cancer Xenografts with Repeated Oral SHetA2 Dosing

SHetA2 is a promising, orally active small molecule with anticancer properties that target heat shock proteins. In this study, we aimed to investigate the pharmacodynamic (PD) effects of SHetA2 using preclinical in vitro and in vivo models of ovarian cancer and establish a physiologically based pharmacokinetic (PBPK)/PD model to describe their relationships with SHetA2 concentrations in mice. We found that daily oral administration of 60 mg/kg SHetA2 for 7 days resulted in consistent plasma PK and tissue distribution, achieving tumor drug concentrations required for growth inhibition in ovarian cancer cell lines. SHetA2 effectively induced cyclin D1 degradation in cancer cells in a dose-dependent manner, with up to 70% reduction observed and an IC50 of 4~5 µM. We identified cyclin D1 as a potential PD marker for SHetA2, based on a well-correlated time profile with SHetA2 PK. Additionally, we examined circulating levels of ccK18 as a non-invasive PD marker for SHetA2-induced apoptotic activity and found it unsuitable due to high variability. Using a PBPK/PD model, we depicted SHetA2 levels and their promoting effects on cyclin D1 degradation in tumors following multiple oral doses. The model suggested that twice-daily dosing regimens would be effective for sustained reduction in cyclin D1 protein. Our study provides valuable insights into the PK/PD of SHetA2, facilitating future clinical trial designs and dosing schedules.

MEDITERRANEAN DIET AND ITS IMPACT ON THE ILLNESS CHARACTERISTIC OF YOUTH WITH IRRITABLE BOWEL CONDITION

Irritable Bowel Disorder (IBD) is a prevalent digestive illness that frequently affects young people and drastically decreases the Quality of Life (QoL). Adults with IBD indications may find relief from their symptoms through nutritional changes like the Mediterranean-style diet. Concerning the seriousness of symptoms, QoL, and additional pertinent results in young people with IBD, this investigation seeks to determine the impact of the Mediterranean-style diet. 200 individuals with IBD who met the Rome-IV criterion and were between the ages of 13 and 19 were enrolled in the present research. A Mediterranean-style diet was provided to the Study Group (SG), which consisted of 100 individuals, while the Control Group (CG), which consisted of 100 patients, followed the usual diet. Various laboratory and clinical characteristics were also assessed at the beginning and end of the study, in addition to IBD values. The Mediterranean-style diet has been demonstrated to be effective and tolerated well in kids and teenagers with IBD. The IBD -SSS (from 148±42.3 to 224±71) IBD -QoL (from 76.7±8.1 to 61.3±9.8), and cumulative IBD rating (from 29.3±11.7 to 32.6±12.1) all showed notable increases in individuals who followed well to this diet. The CG, in comparison, did not show any significant enhancements in these factors. This indicates that a Mediterranean-style diet might provide therapeutic advantages for IBD individuals, especially those who keep adherent to it, concerning symptom severity and QoL. The Mediterranean-style diet proved to be both secure and associated with notable improvements in IBD rates in young and adolescents with IBD.

The role and participation of immune cells in the endometrial tumor microenvironment

The tumor microenvironment is surrounded by blood vessels and consists of malignant, non-malignant, and immune cells, as well as signalling molecules, which primarily affect the therapeutic response and curative effects of drugs in clinical studies. Tumor-infiltrating immune cells participate in tumor progression, impact anticancer therapy, and eventually lead to the development of immune tolerance. Immunotherapy is evolving as a promising therapeutic intervention to stimulate and activate the immune system to suppress cancer cell growth. Endometrial cancer (EC) is an immunogenic disease, and in recent years, immunotherapy has shown benefit in the treatment of recurrent and advanced EC. This review discusses the key molecular pathways associated with the intra-tumoral immune response and the involvement of circulatory signalling molecules. Specific immunologic signatures in EC which offer targets for immunomodulating agents, are also discussed. We have summarized the available literature in support of using immunotherapy in EC. Lastly, we have also discussed ongoing clinical trials that may offer additional promising immunotherapy options in the future. The manuscript also explored innovative approaches for screening and identifying effective drugs, and to reduce the financial burdens for the development of personalized treatment strategies. Collectively, we aim to provide a comprehensive review of the role of immune cells and the tumor microenvironment in the development, progression, and treatment of EC.

Dataset on mucin 1 and 4 proteins and SialyT and T antigens staining patterns in cervical cancer primary tumors and metastatic lymph nodes

The objective was to find an association between abnormal glycosylation, represented by Tn and STn antigens on mucin (MUC) proteins, in primary tumor specimens with lymph node metastasis or recurrence of cervical cancer patients. Prospectively collected specimens were obtained from the NRG Oncology/GOG clinical trial GOG 0221 patients with previously untreated stage IB-IVA primary cervical cancer, who underwent surgical resection and removal of associated para-aortic and pelvic lymph nodes. Immunohistochemical staining for mucin 1 and 4 (MUC1 and MUC4) proteins and surface glycoproteins Tn and Sialyl Tn were performed on sections cut from formalin-fixed, paraffin-embedded specimen blocks. Loss vs no loss, of immunohistochemical stain upon neuraminidase treatment was used to verify STn vs Tn positivity, respectively, in patient specimens and in colon tissue from wild-type and T-synthase knockout transgenic mice, which served as STn positive versus STn negative controls, respectively. H-scores of staining intensity and percentage of cells stained was performed by experienced gynecologic pathologists. An experienced gynecologic pathologist also selected photographed regions of interest associated with these cases. The photomicrographs presented in this data set highlight the spectrum of morphologic expression and variability in glycoprotein expression in primary tumors and cancer-positive lymph node specimens. Findings may prove useful in furthering the understanding of cervical cancer glycoproteins, creation of artificial intelligence immunohistochemical scoring systems, and the development of targeted drug therapy.

Niclosamide causes lysosome-dependent cell death in endometrial cancer cells and tumors

Endometrial cancer is the most common female cancer showing continuous rise in its incidence and mortality rate. Despite the extensive research efforts in cancer therapeutics, still there is a lack of effective treatment options and the outcome is poor for patients with advanced and recurrent endometrial cancers. In this study, we aimed to evaluate the efficacy of niclosamide (NIC) against endometrial cancer. NIC is an FDA-approved anti-helminthic drug, which has been recently extensively studied as a potent anti-cancerous agent in several cancers. The anti-cancerous activity of NIC was analyzed in-vitro (ANC3A, Hec1B, and Ishikawa endometrial cancer cell lines) by cell viability-, soft agar-, invasion- and migration- assay. The action mechanism of NIC was demonstrated by western blot analysis and immune-fluorescence imaging and validated by specific inhibitors. The in-vivo efficacy of NIC was studied in the Ishikawa xenograft animal model. NIC effectively suppressed the viability (IC50<1 μM), colony formation ability, migration, and invasion of all endometrial cancer cells tested. We demonstrated that NIC inhibited AKT/mTOR signaling pathway and induced apoptosis and autophagy in endometrial cancer cells. Further study demonstrated that although NIC induced autophagosome formation, it inhibits autolysosome formation. In addition, we observed that NIC induced BAX co-localization with lysosome and inhibited Cathepsin B maturation from pro-cathepsin B, thereby inducing the lysosomal membrane permeability and release of hydrolytic enzymes from the lysosome to cytosol, which eventually contributed cell death. NIC also inhibited tumor weight and volume in the Ishikawa xenograft animal model without having any evidence of toxicity. Due to its potent anti-cancerous activity and safety profile, NIC seems to be a promising agent for human endometrial cancer therapeutics.

Association of Sialyl Tn antigen with cervical cancer lymph node status: An NRG oncology/GOG study

OBJECTIVE

Detection of lymph node metastases in cervical cancer patients is important for guiding treatment decisions, however accuracies of current detection methods are limited. We evaluated associations of abnormal glycosylation, represented by Tn and STn antigens on mucin (MUC) proteins, in primary tumor specimens with lymph node metastasis or recurrence of cervical cancer patients.

METHODS

Surgical specimens were prospectively collected from 139 patients with locally-advanced cervical cancer undergoing lymphadenectomy enrolled in a nation-wide clinical trial (NCT00460356). Of these patients, 133 had primary cervix tumor, 67 had pelvic lymph node (PLN) and 28 had para-aortic lymph node (PALN) specimens. Fixed tissue serial sections were immunohistochemically stained for Tn, STn, MUC1 or MUC4. Neuraminidase was used to validate Tn versus STn antibody specificity. Stain scores were compared with clinical characteristics.

RESULTS

Primary tumor STn expression above the median was associated with negative PLN status (p-value: 0.0387; odds ratio 0.439, 95% CI: 0.206 to 0.935). PLN had higher STn compared to primary tumor, while primary tumor had higher MUC1 compared to PALN, and MUC4 compared to PALN or PLN (p = 0.017, p = 0.011, p = 0.016 and p < 0.001, respectively). Tn and STn expression correlated in primary tumor, PALN, and PLN, Tn and MUC1 expression correlated in primary tumors only (Spearman correlation coefficient [r] = 0.301, r = 0.686, r = 0.603 and r = 0.249, respectively).

CONCLUSIONS

STn antigen expression in primary cervical tumors is a candidate biomarker for guiding treatment decisions and for mechanistic involvement in PLN metastases.

Distinct mechanism of cervical cancer cell death caused by the investigational new drug SHetA2

Drug-targetable vulnerabilities of cancer cells include their dependence on heat shock proteins (HSPs) to support elevated mitochondrial metabolism and counteract cell death factors. The investigational new drug SHetA2 targets these vulnerabilities in ovarian and endometrial cancer cells by disrupting complexes of the mortalin HSP with its client proteins (mitochondrial support proteins, metabolic enzymes, p53) leading to mitochondrial leakage of cytochrome c and apoptosis-inducing factor (AIF), and caspase-dependent apoptosis. Our objective was to evaluate the roles of mitochondrial damage and another SHetA2-target HSP protein, cytoplasmic heat shock cognate 70 (hsc70), in the mechanism of SHetA2 killing of cervical cancer cells. Cervical cancer cells responded to SHetA2 with excessive mitophagy that did not deter AIF leakage into the cytoplasm. Then, hsc70 was unable to prevent cytoplasmic AIF nuclear translocation and promotion of DNA damage and cell death, because SHetA2 disrupted hsc70/AIF complexes. The Cancer Genome Atlas analysis found that overexpression of hsc70, but not mortalin, was associated with worse cervical cancer patient survival. Use of specific inhibitors documented that AIF and mitophagy, but not caspases, contributed to the mechanism of SHetA2-induced cell death in cervical cancer cells. As validation, excessive mitophagy and lack of caspase activation were observed in SHetA2-inhibited xenograft tumors.

O-252 Next generation sequencing analysis of the seminal microbiome in male partners of women with idiopathic recurrent pregnancy loss: results of a prospective cohort study

Study question

Is there an association between the semen microbiome, seminal reactive oxygen species (ROS) and DNA fragmentation in men with recurrent pregnancy loss (RPL)?

Summary answer

This pilot study outlines the subtle role that microbiota play in influencing ROS and sperm DNA damage for male partners of women with RPL

What is known already

RPL is defined as the loss of two or more consecutive pregnancies. This devastating condition impacts approximately 1% of couples. Paternal causes are not routinely screened for and an underlying cause is not found in up to 50% of cases. Recent studies have reported an association between elevated seminal ROS and sperm DNA fragmentation in the male partner, and RPL. We hypothesised that seminal microbiota contribute to increased ROS and sperm DNA damage. To test this, we investigated the relationship between seminal bacterial composition and ROS levels in men with proven fertility versus men with a history of RPL.

Study design, size, duration

We conducted a prospective, case-control study and recruited participants between November 2018 and March 2020 at Imperial College Healthcare NHS Trust. A total of 109 men participated in the study; 46 men with RPL and 63 men with proven fertility and no history of RPL. Each participant attended for a single study visit which consisted of a full medical history, assessment of testicular volume, height, weight, blood samples and production of a semen sample.

Participants/materials, setting, methods

Routine semen analysis (WHO) and endocrine and lipid profiles were performed for all patients. Semen ROS and DNA fragmentation were performed (luminol and TUNEL methodologies, respectively). ROS were classified as high (&gt;3.77 RLU/s) or low (&lt;3.77 RLU/s). Metataxonomic profiling of samples was performed using Illumina Miseq-based sequencing of the V1-V2 hypervariable regions of bacterial 16S rRNA gene amplicons. Multivariate and univariate modelling was performed to explore associations between metataxonomic profiles, ROS levels and clinical metadata.

Main results and the role of chance

Men with RPL had higher mean semen volume (p = 0.02) and increased prevalence of high ROS (p = 0.02, Fisher's exact) compared with controls; but other clinical characteristics were similar between groups. A total of 3,700,136 high quality sequence reads were generated for the dataset with an average of 33,946 reads/sample. Hierarchical clustering of bacterial genera relative abundances identified 4 distinct microbial signatures characterised by high relative abundance of 1. Streptococcus, 2. Lactobacillus and Gardnerella, 3. polymicrobial (including Prevotella), and 4. Corynebacterium and Finegoldia. Prevalences of these groups were similar in control and RPL groups (p = 0.11). Additionally, no association between the bacterial genera groups and elevated ROS, DNA fragmentation, or clinical factors such as age, ethnicity, or semen volume were observed (chi-square tests). At species taxonomy level relative abundance of L. crispatus was higher in controls compared to RPL, but did not withstand false discovery rate correction for multiple testing (p = 0.006, q = 0.67). Higher relative abundance of Microbacterium was detected in semen samples with high DNA fragmentation (p = 8.7E-4, q = 0.08). This relationship was even stronger within the RPL cohort (p = 2.8E-5, q = 0.002). No significant enrichment of specific taxa was observed between high or low ROS samples however, low ROS was associated with Corynebacterium relative abundance &gt;20%.

Limitations, reasons for caution

More patients are required to enhance statistical power. Duplicate sample collection may establish the robustness of seminal compositions observed. Time since last sexual intercourse samples may affect the analysis. Concomitant analysis of the vaginal microbiome of female partners may improve our understanding of how partners may affect each other’s fertility.

Wider implications of the findings

Our data suggests interactions between microbiota composition, ROS and sperm DNA damage which may be implicated in the pathogenesis of recurrent miscarriage. Further studies are needed to determine if seminal microbiota play causal roles in RPL, and whether interventions modifying the seminal microbiome may modify pregnancy outcomes in affected couples

Trial registration number

not applicable

Abstract 3181: IL-23 knockdown profoundly suppresses intestinal tumorigenesis in APCmin mice

Colorectal cancer (CRC) is the 3rd most common cancer in the US with an estimated 149,500 new cases and 52,980 deaths in 2021. Studies show that Western-style diet-induced obesity promote CRC by modulating gut inflammatory mediators. We found significant increase in IL-23 levels (p&lt;0.0001) in obese human subjects' plasma (n=15/arm; BMI&gt;30) and its. over expression in colonic tumors (CT) from human and rodent models that highly correlated with, the TCGA gene expression & disease-free survival data. These findings suggested IL-23 as a possible important link between obesity and colon tumorigenesis. The present study was designed to understand the role of IL-23 in colorectal carcinogenesis by using genetic knockout (KO) approach. For this study, Apcmin/+ and IL-23 KO mice were crossbred to generate Apcmin/+ mice with IL-23 in heterozygous or KO conditions. To determine the effect of IL-23 on intestinal tumorigenesis, six-week-old Apcmin/+ mice (N≥15/gender) were grouped by IL-23 genotype i.e., normal (+/+), heterozygous (+/-) and KO (-/-) conditions, then maintained under standard conditions. At 20 weeks of age, all mice were euthanized and intestines were evaluated and compared for tumors incidence and multiplicity. Genetic ablation of IL-23 led to significant suppression of large and small intestinal tumors of APCmin/+ mice in both genders. CT multiplicity of male and female IL-23+/+ Apcmin/+ mice were 1.35±0.16 (Mean±SEM) and 0.61±0.13, respectively. Male and female IL-23+/- Apcmin/+ mice had 77% (0.31+0.15; p&lt;0.0001) and 90% (0.06+0.09; p&lt;0.002) inhibition of CTs, respectively. Interestingly, IL-23 KO led to further suppression in male mice (96% inhibition in male; 0.05+0.05; p&lt;0.0001 and 90% in females; 0.06+0.06; p&lt;0.0001). While IL-23+/+ Apcmin/+ mice was 91% and 52% CT incidence in the male and female mice, respectively. CT incidence was suppressed by 72% (male, p&lt;0.0001) & 88% (female, p&lt;0.005) in the IL-23+/- mice, with further suppression to 95% (male, p&lt;0.0001) & 89% (female, p&lt;0.0025) inhibition in IL-23 KO mice. The strong suppressive effect of IL-23 knockdown was also observed on the small intestinal polyps (SIP) multiplicity. There was a 54% (12.56±1.64; p&lt;0.0001) and 58% (11.45±1.03; p&lt;0.0001) reduction in SIP number in IL23+/- and IL23-/- male Apcmin/+ mice, compared to the IL-23+/+ control mice (27.48±2.38). In female, 55-59% (13.88±1.05 and 12.73±2.03; p&lt;0.0001) less SIP were observed with IL-23 ablation compared to control (30.90±2.54). Apcmin/+ with IL-23 KO showed significant reduction in circulating proinflammatory cytokine and chemokines (Ex: IL-1, IL-10, IL-17, IL-23, CCL-2, CCL-3, CCL-5, TNFa, IFNg) levels compared to IL-23 WT mice. These results clearly demonstrate the colon tumor-promoting role of IL-23 and strengthens our hypothesis to explore this target for CRC prevention in high-risk obese individuals. (Supported in part by P30 CA225520 and Kerley-Cade Endowed Chair)

Citation Format: Venkateshwar Madka, Srikanth Chiliveru, Gopal Pathuri, Janani Panneerselvam, Rajani Rai, Nicole C. Stratton, Nandini B. Kumar, Yuting Zhang, Chinthalapally V Rao. IL-23 knockdown profoundly suppresses intestinal tumorigenesis in APCmin mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3181.

Abstract 5951: Synergistic efficacy of sulforaphane and progesterone against endometrial cancer

Introduction: Worldwide, endometrial cancer (EC) is the most common gynecological malignancy with increasing rate of incidence and mortality. While progesterone-based hormone therapy is a well-accepted conservative therapeutic option for EC patients, loss of progesterone receptor (PR) in long-term treatment leading to hormonal resistance and disease recurrence is still an area of concern. We demonstrated potent anti-cancerous activity of sulforaphane against EC in vitro and in vivo and hypothesized that it will activate PR and overcome progesterone therapy limitations. The purpose of this study was to evaluate the interaction of sulforaphane and progesterone against EC.

Methods: The in vitro synergistic interaction between sulforaphane and progesterone was investigated with isobologram analysis of plotting MTT metabolic viability assay results of EC cells treated with drugs individually and in combination using CompuSyn software. ATP, soft-agar colony formation and invasion assays were performed to evaluate the combined drug effects on cell viability, anchorage independent colony formation and invasion properties, respectively. Mitochondrial membrane potential and caspase-3 activity were measured by JC-1 and caspase-3 detection ELISA kit, respectively. Protein expression was accessed by western blot. Progesterone resistant EC cells were developed by treating cells with 30µM of progesterone for more than 3 months.

Results: Sulforaphane demonstrated strong synergy or additive effects with progesterone in the EC cell lines tested. Sulforaphane in combination with progesterone significantly decreased levels of cellular ATP, anchorage-independent colony formation, invasion and mitochondrial membrane potential. Furthermore, combination of sulforaphane and progesterone increased caspase-3 activity as compared to individual drug or controls, suggesting induction of apoptosis. Western blot results demonstrated an increased expression of cleaved PARP, with reduced expression of total caspase-3 and PCNA in the combination groups as compared to control and individual drugs. Sulforaphane alone or in combination showed increased expression of PR-A while it had minimal effects on PR-B. Further, in all EC cell lines, the combination of sulforaphane and progesterone demonstrated upregulation of PR-A/PR-B ratio. The progesterone resistant cells demonstrated less sensitivity to progesterone as compared to parent cell lines, however it was found to be sensitive to sulforaphane.

Conclusions: Sulforaphane demonstrated synergistic activity with progesterone leading to increased apoptosis and reduced proliferation. Furthermore, sulforaphane exhibited potent toxicity to progesterone resistance cells. Sulforaphane in combination with progesterone could overcome progesterone therapy limitation by re-activation of PR.

Funding: Administrative Suppl (P30CA225520) and PHF (GRF00005456)

Citation Format: Rajani Rai, Swati Choudhary, Doris M. Benbrook, Vishal Chandra. Synergistic efficacy of sulforaphane and progesterone against endometrial cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5951.

Comment on: Multimodal analgesia with thoracic epidural after transthoracic oesophagectomy: Do we need more evidence?

This article is a response to the publication ‘Comparison of multimodal analgesia with thoracic epidural after transthoracic oesophagectomy’. It discuss the differing outcomes from using this technique in other publications.

Similarities and Differences of Hsp70, hsc70, Grp78 and Mortalin as Cancer Biomarkers and Drug Targets

Background: Upregulation of Heath Shock Protein 70 (HSP70) chaperones supports cancer cell survival. Their high homology causes a challenge to differentiate them in experimental or prevention and treatment strategies. The objective of this investigation was to determine similarities and differences of Hsp70, hsc70, Grp78 and Mortalin members of the HSP70 family encoded by HSPA1, HSPA8, HSPA5 and HSPA9 genes, respectively. Methods: Literature reviews were conducted using HSPA1, HSPA5, HSPA8 and HSPA9 gene or protein names or synonyms combined with biological or cancer-relevant terms. Ingenuity Pathway Analysis was used to identify and compare profiles of proteins that directly bind individual chaperones and their associated pathways. TCGA data was probed to identify associations of hsc70 with cancer patient survival. ClinicalTrials.gov was used to identify HSP70 family studies. Results: The chaperones have similar protein folding functions. Their different cellular effects are determined by co-chaperones and client proteins combined with their intra- and extra-cellular localizations. Their upregulation is associated with worse patient prognosis in multiple cancers and can stimulate tumor immune responses or drug resistance. Their inhibition selectively kills cancer over healthy cells. Conclusions: Differences in Hsp70, hsc70, Grp78 and mortalin provide opportunities to calibrate HSP70 inhibitors for individual cancers and combination therapies.

P–635 Standard versus mild ovarian stimulation in women with polycystic ovaries (PCO): Impact on outcomes in subsequent frozen embryo treatment cycles (FET)

Study question

Does mild ovarian stimulation in women with PCO result in higher live birth rates during subsequent FET cycles?

Summary answer

Mild ovarian stimulation with FSH doses &lt;150IU did not result in higher clinical pregnancy or livebirth rates in subsequent FET.

What is known already

Ovarian stimulation during IVF in women with PCO is associated with an exaggerated response, ovarian hyperstimulation syndrome, poor egg to follicle ratio, low fertilisation rates and poor blastocyst conversion. Mild ovarian stimulation, often referred to as protocols with FSH doses under 150IU, is often employed to overcome these challenges. One of the perceived benefits of this approach is improved oocyte and embryo quality reflected in lower aneuploidy rates.

Study design, size, duration

This was a retrospective observational study looking at 99 FET between January 2011 and Jan 2021 that followed a fresh cycle in women with a pre-treatment antral follicle count of 12 + 12 or greater. Patients were identified through the antral follicle count at the pre-treatment investigation ultrasound scan. Ultrasound findings, treatment cycle details and clinical outcomes were entered prospectively into a dedicated clinic database. Data was retrieved and analysed using SPSS V25.

Participants/materials, setting, methods

The study was conducted in a large IVF centre. Data on women with an AFC of 12 + 12 or above, undergoing an autologous FET cycle following a fresh cycle were collected. Women were split into those receiving &lt;150IU of FSH (Group1, n = 51) and those receiving FSH ³150 IU (Group 2, n = 48). Binary logistic regression analysis was performed to control for confounders. Live birth was the primary outcome, with biochemical and clinical pregnancy being secondary outcomes.

Main results and the role of chance

Women in Group 1 were younger (30.8±3.6 v 33.8±3.65, p &lt; 0.005) but had a similar antral follicle count (38.2±11.7 v 34.2±9.1, p = 0.07). The total number of eggs collected (24.1±13.8 v 25.9±8.8, p = 0.45) and fertilisation rate (0.59±0.2 v 0.58±0.18, p = 0.77) during their fresh cycle were comparable. Women in Group 2 had a larger number of embryos suitable for cryopreservation (7.36±4.2 v 4.8±3.5, p = 0.001)

In the subsequent frozen embryo replacement cycle, there was no difference in the number or quality of embryos transferred with most women having a single embryo transfer (63% v 48%, p = 0.14) and at least one top quality embryo transferred (68.6% v 81%, p = 0.15). There was a higher biochemical pregnancy rate in Group 1 (84% v 66%, p = 0.035) but with no difference in clinical pregnancy rate (53% v 44%, p = 0.37) or live birth rate (49% v 42%, p = 0.76). Live birth rates remained comparable even after controlling for age, and number and quality of embryos transferred (OR: 1.21 (95% CI 0.50–2.94).

Limitations, reasons for caution

This was a retrospective analysis raising the risk of allocation bias. This study was also at risk of information bias as it relied on accurate documentation of the AFC at the pre-treatment scan.

Wider implications of the findings: Patients can be reassured that both stimulation protocols result in similar live birth rates in subsequent frozen embryo replacement cycles.

Prospective trials using PGT-A are required to assess whether aneuploidy could account for the discrepancy in biochemical pregnancy rates in the two groups considering the subsequent comparable clinical pregnancy rates.

Trial registration number

Not applicable

Abstract 1252: The mechanism of the drug, SHetA2, in cervical cancer cells involves growth inhibition, mitochondria damage and release of AIF to cause caspase-independent cell death

Introduction SHetA2 is an orally-bioavailable, novel small-molecule drug that is entering first in human trials for gynecologic cancers. Upon binding to three related heat shock protein A chaperones (HSPA 5, 8 and 9 genes encoding BiP, hsc70 and mortalin proteins, respectively), SHetA2 causes release of their client proteins and inhibition of mortalin import into mitochondria. The purpose of this study was to evaluate the potential of SHetA2 for cervical cancer therapy and to explore its mechanism of action.

Methods: The cytotoxic effect of SHetA2 on cervical cancer cell lines, C33a, C-4 II, CaSki, ME-180 and SiHa was assessed using a MTT metabolic viability assay. The effects of SHetA2 on cell cycle arrest were evaluated by flow cytometric analysis of PI staining and western blots. SHetA2 effects on anchorage-independent growth and cell migration were analyzed using soft-agar colony formation and wound healing scratch assays, respectively. The effect of SHetA2 on mitochondria was assessed using the JC-1 dye, measurement of ATP, electron microscopy, confocal microscopy and Seahorse XF Cell Mito Stress.

Result: SHetA2 significantly reduced proliferation of all cervical cell lines in time- and dose- dependent manners. This drug also inhibited anchorage-independent growth, cell migration and cell cycle progression through G1-phase cell-cycle arrest in C-33 A and CaSki, and G2- arrest in SiHa, in association with relevant alterations of cell-cycle regulatory proteins. SHetA2 significantly decreased mitochondrial membrane potential and ATP production indicating mitochondrial toxicity. Electron microscopy demonstrated mitochondrial swelling and increased autophagic vesicles in SHetA2-treated SiHa cells. Confocal microscopy using mitochondria-specific dye demonstrated loss of mitochondrial networking and structural damage. Consistent with this, our western blot results demonstrated significant downregulation in the expression of proteins involved in mitochondrial fusion indicating that SHetA2 causes inhibition of mitochondrial fusion. Metabolic studies demonstrated that SHetA2 caused attenuation of efficient oxidative phosphorylation, ATP production, and elevation of basal glycolysis. Eventual SHetA2-induced cell death was not affected by a caspase inhibitor. Further mechanistic study demonstrated translocation of apoptosis inducing factor (AIF) from the mitochondria to the nucleus, along with nuclear DNA damage.

Conclusions: SHetA2 inhibits growth, migration and invasion of cervical cancer cell lines in association with cell cycle arrest and mitochondrial toxicity. SHetA2-induced mitochondrial damage in cervical cancer cell lines likely mediates release of AIF to cause cell death in a caspase-independent manner.

Citation Format: Rajani Rai, Vishal Chandra, Doris M. Benbrook. The mechanism of the drug, SHetA2, in cervical cancer cells involves growth inhibition, mitochondria damage and release of AIF to cause caspase-independent cell death [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 1252.

Utility and Mechanism of SHetA2 and Paclitaxel for Treatment of Endometrial Cancer

Simple Summary

Incidence and death rates for endometrial cancer are steadily rising world-wide. Endometrial cancer patients at high risk for recurrence are treated with chemotherapy, which causes significant toxicity. Molecularly targeted drugs have been found to cause less toxicity than chemotherapy. We studied a low-toxicity drug, called SHetA2, which targets three heat shock A proteins that are highly mutated in endometrial cancers. Our results demonstrated that SHetA2 inhibits endometrial cancer cells and tumors, and enhances therapeutic effects of paclitaxel without increasing toxicity. This information supports development of clinical trials to test if combining SHetA2 with paclitaxel can increase the paclitaxel therapeutic effect without increasing toxicity, or allows a lowered paclitaxel dose to achieve the same level of therapeutic effect, but with reduced toxicity. Our new knowledge about how SHetA2 works can be translated into development of biomarkers to predict with patients would most likely benefit from SHetA2-based therapy.

Abstract

Endometrial cancer patients with advanced disease or high recurrence risk are treated with chemotherapy. Our objective was to evaluate the utility and mechanism of a novel drug, SHetA2, alone and in combination with paclitaxel, in endometrial cancer. SHetA2 targets the HSPA chaperone proteins, Grp78, hsc70, and mortalin, which have high mutation rates in endometrial cancer. SHetA2 effects on cancerous phenotypes, mitochondria, metabolism, protein expression, mortalin/client protein complexes, and cell death were evaluated in AN3CA, Hec13b, and Ishikawa endometrial cancer cell lines, and on growth of Ishikawa xenografts. In all three cell lines, SHetA2 inhibited anchorage-independent growth, migration, invasion, and ATP production, and induced G1 cell cycle arrest, mitochondrial damage, and caspase- and apoptosis inducing factor (AIF)-mediated apoptosis. These effects were associated with altered levels of proteins involved in cell cycle regulation, mitochondrial function, protein synthesis, endoplasmic reticulum stress, and metabolism; disruption of mortalin complexes with mitochondrial and metabolism proteins; and inhibition of oxidative phosphorylation and glycolysis. SHetA2 and paclitaxel exhibited synergistic combination indices in all cell lines and exerted greater xenograft tumor growth inhibition than either drug alone. SHetA2 is active against endometrial cancer cell lines in culture and in vivo and acts synergistically with paclitaxel.

Abstract PO040: Chemoprevention and regression of estrogen-induced atypical endometrial hyperplasia by oral SHetA2 in a rat model

Introduction: The purpose was to evaluate the chemoprevention efficacy of SHetA2 (NSC 726189) in a rat model of atypical endometrial hyperplasia (AEH). Methods: Female Sprague Dawley rats were ovariectomized, rested for 2 weeks, and subcutaneously implanted with placebo or slow-release estrogen (E2; 1.5 mg/90-day) pellets on the lateral side of the neck. The rats were randomly divided for two studies: 1) AEH prevention, in which SHetA2 treatment was started one day after E2 pellet implantation; 2) AEH regression, in which SHetA2 treatment was started after AEH development (12 weeks after E2 pellet implantation) and continued for 4 weeks. SHetA2 was orally given as a suspension at three different doses of 30, 60 or 90 mg/kg/day. The suspension was prepared by first micronizing SHetA2 powder to &lt; 63 µm and then ultrahomogenizing it in aqueous 30% Kolliphor HS15 until the size of drug particles in suspension was &lt; 20 µm. The presence of AEH in H&E stained uterine sections was evaluated by two pathologists as the study endpoint by the presence of abnormal cells (nuclear enlargement, nuclear membrane irregularities, prominent nucleoli, nuclear hyperchromasia, nuclear pleomorphism, mitotic activity and/or loss of axial polarity) within tissue areas that exhibit at least one of the following features: increased gland to stroma ratio of &gt;1:1, glandular complexity including irregular contours, and cribriform/papillary configurations. Results: E2-treated animals had reduced body weight gain compared to placebo-implanted animals (Repeated Measures ANOVA, p&lt;0.0001). There were no effects of SHetA2 on rat body weights. In the prevention study, uterine to body weight ratios were significantly higher in E2-treated animals compared to placebo (Repeated Measures ANOVA, p&lt;0.0001) and significantly reduced by 30 and 60 mg/kg/day SHetA2 doses (Repeated Measures ANOVA, p=0.0193 and 0.0108, respectively). Also, SHetA2 caused a dose-responsive decrease in AEH incidence in E2-implanted animals from 86.7% (13/15) in the untreated control to 53.3% (8/15), 26.7% (4/15) and 26.7% (4/15) in the 30, 60 and 90 mg/kg/day SHetA2 treatment groups, respectively (Chai Square Analysis p&lt;0.0022). In the regression study, there were no significant differences in uterine to body weight ratios across all groups. Also, SHetA2 caused dose-responsive regression of AEH to normal histology in E2-implanted animals observed by lack of AEH in 18.2% (2/11) of the untreated control group and 83.3% (10/12), 81.8% (9/11) and 75% (9/12) in the 30, 60 and 90 mg/kg/day SHetA2 treatment groups, respectively (Chai Square Analysis p&lt;0.0025). Conclusions: AEH can be induced by implantation of slow-release E2 pellets in ovariectomized rats. SHetA2 significantly prevented AEH development and caused AEH regression to normal endometrium histology in a dose-dependent manner. Further study is warranted to explore the mechanistic chemoprevention action of SHetA2 and translate these findings toward clinical trials. Funding: NCI PREVENT Program Contract HHSN26100008.

Citation Format: Vishal Chandra, Rajani Rai, Stan S. Lightfoot, Manolya Kukut Hatipoglu, Lucila Garcia-Contreras, Doris M. Benbrook. Chemoprevention and regression of estrogen-induced atypical endometrial hyperplasia by oral SHetA2 in a rat model [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO040.

Abstract PR001: Preclinical development of SHetA2 for endometrial cancer therapy

Introduction: SHetA2 (NSC 726189) is a novel drug that is entering first in human trials for gynecologic cancers. Upon binding to three related heat shock protein A chaperones proteins (HSPA5/Grp78, HSPA8/Hsc70, HSPA9/mortalin), SHetA2 causes release of their client proteins. Our objective was to evaluate the potential of SHetA2 for endometrial cancer therapy and to explore its mechanism of action.

Methods: Endometrial cancer cell lines, Ishikawa, MFE280, MFE296, Hec1a, Hec1B and AN3CA were evaluated for SHetA2 effects on cell growth with a MTT assay. Ishikawa, Hec1B and AN3CA were also evaluated for SHetA2 effects on cell cycle progression by flow cytometry analysis of PI staining; apoptosis by flow cytometry analysis of annexin/PI staining, anchorage-independent growth using an agar colony formation, invasive potential with an matrigel invasion assay, and protein levels (in Ishikawa only) by mass spec analysis of protein extracts using a 5% false discovery rate. The in vivo efficacy of SHetA2 and paclitaxel alone and in combination were evaluated in athymic nude mice bearing Ishikawa xenografts treated with oral 60 mg/kg/day SHetA2, intraperitoneal injection of 10 mg/kg/week of paclitaxel, the combination or vehicle controls.

Results: SHetA2 significantly reduced growth of all endometrial cancer cell lines in time- and dose- dependent manners. This inhibition occurred via G1 cell cycle arrest in Ishikawa and Hec-1b, and G2 arrest in AN3CA. SHetA2 inhibited anchorage-independent growth and invasive behaviors, and induced apoptosis in Ishikawa, Hec-1b and AN3CA. Proteomic analysis identified levels of 48 proteins to be significantly altered by SHetA2 in Ishikawa cells. Of these, 15, 10 and three are known to be bound by Hsc70, Grp78 and mortalin, respectively. Ingenuity analysis identified the top SHetA2-regulated canonical pathways to be EIF2 Signaling, Unfolded Protein Response, Glycolysis, ER Stress Pathway and Gluconeogenesis, and predicted the top upstream regulators of the proteomic changes to be three microtubule associated proteins (MAPT, PSEN1, APP), which also bind Hsc70. Since Hsc70 also binds paclitaxel, we predicted positive interaction between SHetA2 and paclitaxel on endometrial tumor growth. Both SHetA2 and paclitaxel significantly inhibited growth of Ishikawa xenografts, and the combination was more effective than either drug alone (Repeated Measures ANOVA p=0.0025). There were no significant effects of the treatments on mouse body weights.

Conclusions: SHetA2 inhibits growth, migration and invasion of endometrial cancer cell lines in association with cell cycle arrest, apoptosis and regulation of its Grp78/Hsc70/mortalin target protein networks. Pathways regulated by SHetA2 are consistent with disruption of chaperone proteins. The in vivo efficacy of SHetA2 alone and in combination with paclitaxel justifies further development of this drug and combination with paclitaxel for treatment of endometrial cancer.

Funding: Stephenson Cancer Center.

Citation Format: Vishal Chandra, Rajani Rai, Doris M. Benbrook. Preclinical development of SHetA2 for endometrial cancer therapy [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PR001.

Pelvic organ motion and dosimetric implications during horizontal patient rotation for prostate radiation therapy

PURPOSE

Gantry-free radiation therapy systems utilizing patient rotation would be simpler and more cost effective than the conventional gantry-based systems. Such a system could enable the expansion of radiation therapy to meet global demand and reduce capital costs. Recent advances in adaptive radiation therapy could potentially be applied to correct for gravitational deformation during horizontal patient rotation. This study aims to quantify the pelvic organ motion and the dosimetric implications of horizontal rotation for prostate intensity-modulated radiation therapy (IMRT) treatments.

METHODS

Eight human participants who previously received prostate radiation therapy were imaged in a clinical magnetic resonance imaging (MRI) scanner using a bespoke patient rotation system (PRS). The patients were imaged every 45 degrees during a full roll rotation (0-360 degrees). Whole pelvic bone, prostate, rectum, and bladder motion were compared to the supine position using dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Prostate centroid motion was compared in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) direction prior to and following pelvic bone-guided rigid registration. Seven-field prostate IMRT treatment plans were generated for each patient rotation angles under three adaption scenarios: No plan adaption, rigid planning target volume (PTV)-guided alignment to the prostate, and plan re-optimization. Prostate, rectum, and bladder doses were compared for each adaption scenario.

RESULTS

Pelvic bone motion within the PRS of up to 53 mm relative to the supine position was observed for some participants. Internal organ motion was greatest at the 180-degree PRS couch angle (prone), with prostate centroid motion range < 2 mm LR, 0 mm to 14 mm SI, and -11 mm to 4 mm AP. Rotation with no adaption of the treatment plan resulted in an underdose to the PTV -- in some instances up to 75% (D95%: 78 ± 0.3 Gy at supine to 20 ± 15.0 Gy at the 225-degree PRS couch angle). Bladder dose was reduced during the rotation by up to 98% (V60 Gy: 15.0 ± 9.4% supine to 0.3 ± 0.5% at the 225-degree PRS couch angle). In some instances, the rectum dose increased during rotation (V60Gy: 20.0 ± 4.5% supine to 25.0 ± 15.0% at the 135-degree PRS couch angle). Rigid PTV-guided alignment resulted in PTV coverage which, though statistically lower (P < 0.05 for all D95% values), was within 1 Gy of the supine plans. Plan re-optimization resulted in a statistically equivalent PTV coverage compared to the supine plans (P > 0.05 for all D95% metrics and all within ±0.4 Gy). For both rigid PTV-guided alignment and plan re-optimization, rectum dose volume metrics were reduced compared to the supine position between the 90- and 225-degree PRS couch angles (P < 0.05). Bladder dose volume metrics were not impacted by rotation.

CONCLUSION

Pelvic bone and internal organ motion are present during patient rotation. Rigid PTV-guided alignment to the prostate will be a requirement if prostate IMRT is to be safely delivered using patient rotation. Plan re-optimization for each PRS couch angle to account for anatomical deformations further improves the PTV coverage.

Abstract 27: Development of a rat model of atypical endometrial hyperplasia and a vaginal suppository formulation of SHetA2 for chemoprevention studies

Introduction: The purposes were to develop a rat model of atypical endometrial hyperplasia and a vaginal suppository of the drug SHetA2 (NSC 726189) for use in a chemoprevention study.

Methods: Female Sprague Dawley rats (150-250 g) were ovariectomized to prevent production of endogenous estrogen and progesterone. After a 2 wks rest, placebo or slow release estrogen (E2) pellets were implanted subcutaneously on the lateral side of the neck in the ovariectomized rats randomly assigned to 3 groups (N=25): 1) placebo, 2) 0.5 mg E2/90-day, 3) 1.5 mg E2/90-day. Pellets were replaced after ~10 wks. Rats were weighed wkly. Three rats in each group were sacrificed at 2, 4, 6, 8, 10, 12, 14, and 16 wks after pellet implantation. Organs were collected and weighed. The dimensions of the vaginal canals of six rats were measured to design an aluminum mold to prepare vaginal suppositories containing SHetA2. The mold was custom-made to have a conical shape with a 5.5 mm diameter base (average vaginal canal diameter) and 5 mm height (half of the total length of the vaginal canal - 10.10 mm). A pilot batch of 20 SHetA2 suppositories was prepared using a cocoa butter base, stored at 4°C in an air-tight and light-tight container and evaluated for SHetA2 stability at 1, 2 and 3 months.

Results: Rats with placebo implants exhibited continuous body weight gain. In comparison, both E2-treated groups had reduced weight gain (Repeated Measures ANOVA, p&lt;0.0001). At each time point, average uterine horn weights from the E2-treated groups were significantly higher than the placebo group (Repeated Measures ANOVA, p&lt;0.0001). Placebo group rats had normal endometrium with occasional glandular crowding. At 8-10 wks, focal atypia was observed in 1 of 6 rats in the 0.5 mg E2 group and in 4 of 6 rats in the 1.5 mg E2 group. At the 12-wk time point, atypical hyperplasia was observed in 7 of 9 rats in the 0.5 mg E2 group and in 8 out of 9 rats in the 1.5 g E2 group. Repeated measures ANOVA of organ/body weight ratios indicated that the E2-treated animals had significantly lower spleen weights (p=0.0019) and higher liver (p=0.0001), kidney (p&lt;0.0001) and pancreas (p=0.0004) weights. The reduced organ weights may be due to the significant reduction in body weight in the E2-treated rats. The SHetA2 suppositories were stable at -20°C for 3 months. Storage of individual suppositories in wells of 48-well plates prevented the twining together that occurred when stored in bulk, and allowed removal from packaging without damaging the suppositories.

Conclusions: A 1.5 mg slow release E2 pellet in ovariectomized rats caused development of atypical endometrial hyperplasia within a sufficient timeframe and incidence to allow a chemoprevention study. The mold was suitable to prepare rat-sized suppositories and the resulting SHetA2 suppositories can be safely stored for use within 3 months.

Funding: NCI PREVENT Program Contract HHSN26100008

Citation Format: Vishal Chandra, Rajani Rai, Sanam Hussain, Lucila Garcia, Manolya Hatipoglu, Doris Benbrook. Development of a rat model of atypical endometrial hyperplasia and a vaginal suppository formulation of SHetA2 for chemoprevention studies [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 27.

Abstract 2830: The impact of gut microbial toxins and PGE2 on IL-23 production and its role in obesity associated colorectal tumorigenesis

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Studies indicate that excessive intake of high-fat diet (HFD) promotes CRC by modulating gut microbiome-associated inflammatory mediators. Recent evidence suggests that interleukin-23 (IL-23) plays an important role in the impact of a HFD on obesity, the gut microbiome and colon carcinogenesis. Our study aimed to elucidate the role of IL-23 in obesity associated CRC and explore an anti-IL-23 approach for prevention and treatment. First we profiled human plasma (n=15/arm) for circulating IL-23 levels and found significantly higher levels (p&lt;0.0001) in obese individuals (BMI&gt;30). In addition, IL-23 expression was evaluated in colonic tumors from both humans and preclinical rodent models. Data from the Cancer Genome Atlas showed significant over expression (p&lt;0.0001) of IL-23A in CRC tumors (n=262) compared to normal tissue (n=41). This overexpression correlated with reduced disease free survival. Levels of both IL-23 and its receptor (IL23R) were evaluated in matched human CRC tissues by western blot and IHC and confirmed overexpression in CRC. IL-23 was also upregulated in colonic tumors from both sporadic (AOM-induced rat CRC) and FAP (Apcmin/+ mouse) rodent models when compared to matched normal mucosa. These data reveal a clear association of IL-23 overexpression with both obesity and colonic tumorigenesis.

To understand IL-23 production in the context of gut microbial toxins and prostaglandin (PG)E2 levels, we performed several mechanistic studies to mimic the tumor microenvironment. To elucidate PGE2-mediated regulation of IL-23 in colon tumorigenesis we studied both macrophages and dendritic cell lines in in vitro and ex vivo conditions. The immune cells treated with either PGE2 or bacterial toxins (LPA/LTA) showed a significant increase in IL-23 expression which associated with macrophage polarization and dendritic cell phenotypic changes. Interestingly, when CaCo2 cancer cells were co-cultured with PGE2/LTA-LPA-educated macrophages or dendritic cells, the cancer cells displayed enhanced IL-23 expression along with increased tumor cell proliferation and self-renewal. Upon addition of human recombinant IL-23 directly to cancer cells (CaCo2 and HCT116), the cells exhibited increased IL-23R expression along with enhanced self-renewal, cell migration and invasive properties as well as loss of epithelial barrier permeability. In ex-vivo experiments we found that treatment of rat colon tumors with PGE2 increased the expression of IL-23 compared to normal mucosa. Overall our study results demonstrate that IL-23 is associated with both obesity and poor survival of CRC patients and that PGE2 and gut microbe toxins play an important role in IL-23-associated colonic tumor progression. This newly identified nexus represents a potentially important target for prevention of obesity associated colorectal cancer.

Citation Format: Janani Panneerselvam, Venkateshwar Madka, Rajani Rai, Parthasarathy Chandrakesan, Courtney W. Houchen, Dharambir K. Sanghera, Katherine T. Morris, Chinthalapally V. Rao. The impact of gut microbial toxins and PGE2 on IL-23 production and its role in obesity associated colorectal tumorigenesis [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 2830.

Abstract 6369: SHetA2 increases the activity of palbociclib in cervical cancer in vitro and in vivo

Introduction: Standard of care therapies for cervical cancer are harmful to normal cells and cause many side effects. New, less toxic treatments are needed in order to avoid these toxic effects. We are currently studying a promising low-toxicity drug, SHetA2. SHetA2 is a flexible heteroarotinoid that induces apoptosis and G1 cell cycle arrest in cancer cells, but only induces G1 cell cycle arrest in healthy cells. Part of the mechanism of SHetA2 is its degradation of cyclin D1. Cyclin D1 forms a complex with CDK 4/6 and is important for G1 progression. Therefore, we combined SHetA2 with palbociclib. Palbociclib is an FDA approved CDK 4/6 inhibitor that is currently used in the treatment of hormone positive breast cancers and is currently in clinical trials for the treatment of ovarian cancer. Therefore, we hypothesized that SHetA2 and palbociclib would synergistically inhibit growth of cervical cancer in vitro and in cervical cancer cell- derived xenograft tumors.

Methods: The effects of SHetA2 and palbociclib alone and in combination were tested on cervical cancer cell lines using the MTT assay. Synergy was evaluated in cervical cancer cell lines by treating the cells with the drugs alone and in combination, then plotting their effects in an isobologram. Protein expression of phosphorylated Rb, and cleaved PARP were measured using western blot. An athymic nude mouse model was utilized to test the SHetA2/palbociclib combination in vivo. Mice were treated every day for 24 days with control solvent, 60mg/kg SHetA2, 100mg/kg palbociclib, or in combination. Differences in tumor growth inhibition between the groups were analyzed using repeated measure one-way ANOVA with multiple comparosions post-hoc analysis. Tumors were evaluated by immunohistochemistry and stained with CD31 and cyclin D1 antibodies.

Results: The drug combination consistently demonstrated synergistic activity in three cervical cell lines (CI &lt; 0.5), with strong synergistic (CI &lt; 0.1) activity in two cell lines. There was a consistent increase in cleaved PARP expression and reduction in Rb phosphorylation in the combination group in comparison to all other groups. When compared to control, all treatment groups significantly reduced SiHa xenograft tumor growth (p&lt; 0.05). In post-hoc analysis, the growth inhibition in the combination group was significantly greater compared to the palbociclib only group (p=0.0127). In comparison to tumors in the control group, tumors in the combination treatment group exhibited dramatic reduction of cyclin D1 and angiogenesis.

Conclusions: The drug combination was synergistic in vitro and significantly effective in vivo. The mechanism of synergy appears to involve induction of apoptosis and reduction of cyclin D1, phosphorylated Rb, and angiogenesis.

Citation Format: Amy Bosley, Rajani Rai, Doris M. Benbrook. SHetA2 increases the activity of palbociclib in cervical cancer in vitro and in vivo [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 6369.

Preclinical Efficacy and Involvement of AKT, mTOR, and ERK Kinases in the Mechanism of Sulforaphane against Endometrial Cancer

Sulforaphane exerts anti-cancer activity against multiple cancer types. Our objective was to evaluate utility of sulforaphane for endometrial cancer therapy. Sulforaphane reduced viability of endometrial cancer cell lines in association with the G2/M cell cycle arrest and cell division cycle protein 2 (Cdc2) phosphorylation, and intrinsic apoptosis. Inhibition of anchorage-independent growth, invasion, and migration of the cell lines was associated with sulforaphane-induced alterations in epithelial-to-mesenchymal transition (EMT) markers of increased E-cadherin and decreased N-cadherin and vimentin expression. Proteomic analysis identified alterations in AKT, mTOR, and ERK kinases in the networks of sulforaphane effects in the Ishikawa endometrial cancer cell line. Western blots confirmed sulforaphane inhibition of AKT, mTOR, and induction of ERK with alterations in downstream signaling. AKT and mTOR inhibitors reduced endometrial cancer cell line viability and prevented further reduction by sulforaphane. Accumulation of nuclear phosphorylated ERK was associated with reduced sensitivity to the ERK inhibitor and its interference with sulforaphane activity. Sulforaphane induced apoptosis-associated growth inhibition of Ishikawa xenograft tumors to a greater extent than paclitaxel, with no evidence of toxicity. These results verify sulforaphane's potential as a non-toxic treatment candidate for endometrial cancer and identify AKT, mTOR, and ERK kinases in the mechanism of action with interference in the mechanism by nuclear phosphorylated ERK.

Complementary Targeting of Rb Phosphorylation and Growth in Cervical Cancer Cell Cultures and a Xenograft Mouse Model by SHetA2 and Palbociclib

Cervical cancer is caused by high-risk human papillomavirus (HPV) types and treated with conventional chemotherapy with surgery and/or radiation. HPV E6 and E7 proteins increase phosphorylation of retinoblastoma (Rb) by cyclin D1/cyclin dependent kinase (CDK)4/6 complexes. We hypothesized that cyclin D1 degradation by the SHetA2 drug in combination with palbociclib inhibition of CDK4/6 activity synergistically reduces phosphorylated Rb (phospho-Rb) and inhibits cervical cancer growth. The effects of these drugs, alone, and in combination, were evaluated in SiHa and CaSki HPV-positive and C33A HPV-negative cervical cancer cell lines using cell culture, western blots and ELISA, and in a SiHa xenograft model. Endpoints were compared by isobolograms, ANOVA, and Chi-Square. In all cell lines, combination indexes documented synergistic interaction of SHetA2 and palbociclib in association SHetA2 reduction of cyclin D1 and phospho-Rb, palbociclib reduction of phospho-Rb, and enhanced phospho-Rb reduction upon drug combination. Both drugs significantly reduced phospho-Rb and growth of SiHa xenograft tumors as single agents and acted additively when combined, with no evidence of toxicity. Dilated CD31-negative blood vessels adjacent to, or within, areas of necrosis and apoptosis were observed in all drug-treated tumors. These results justify development of the SHetA2 and palbociclib combination for targeting phospho-Rb in cervical cancer treatment.

Risk Factors for Adverse Outcome in Pregnant Women with Obstructed Labor

Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor.Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012.Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%.

Allosteric Site Inhibitor Disrupting Auto-Processing of Malarial Cysteine Proteases

Falcipains are major haemoglobinases of Plasmodium falciparum required for parasite growth and development. They consist of pro- and mature domains that interact via 'hot-spot' interactions and maintain the structural integrity of enzyme in zymogen state. Upon sensing the acidic environment, these interactions dissociate and active enzyme is released. For inhibiting falcipains, several active site inhibitors exist, however, compounds that target via allosteric mechanism remains uncharacterized. Therefore, we designed and synthesized six azapeptide compounds, among which, NA-01 & NA-03 arrested parasite growth by specifically blocking the auto-processing of falcipains. Inhibitors showed high affinity for enzymes in presence of the prodomain without affecting the secondary structure. Binding of NA-03 at the interface induced rigidity in the prodomain preventing structural reorganization. We further reported a histidine-dependent activation of falcipain. Collectively, for the first time we provide a framework for blocking the allosteric site of crucial haemoglobinases of the human malaria parasite. Targeting the allosteric site could provide high selectivity and less vulnerable to drug resistance.

Quantitative assessment of CD44 genetic variants and cancer susceptibility in Asians: a meta-analysis

CD44 is a well-established cancer stem cell marker playing a crucial role in tumor metastasis, recurrence and chemo-resistance. Genetic variants of CD44 have been shown to be associated with susceptibility to various cancers; however, the results are confounding. Hence, we performed a meta-analysis to clarify these associations more accurately. Overall, rs13347 (T vs. C: OR=1.30, p=<0.004, p_corr=0.032; CT vs. CC: OR=1.29, p=0.015, p_corr=0.047; TT vs. CC: OR=1.77, p=<0.000, p_corr=0.018; CT+TT vs. CC: OR=1.34, p=<0.009, p_corr=0.041) and rs187115 (GG vs. AA: OR=2.34, p=<0.000, p_corr=0.025; AG vs. AA: OR=1.59, p=<0.000, p_corr=0.038; G vs. A allele OR=1.56, p=0.000, p_corr=0.05; AG+GG vs. AA: OR=1.63, p=<0.000, p_corr=0.013) polymorphisms were found to significantly increase the cancer risk in Asians. On the other hand, rs11821102 was found to confer low risk (A vs. G: OR=0.87, p=<0.027, p_corr=0.04; AG vs. GG: OR=0.85, p=<0.017, p_corr=0.01; AG+AA vs. GG: OR=0.86, p=<0.020, p_corr=0.02). Based on our analysis, we suggest significant role of CD44 variants (rs13347, rs187115 and rs11821102) in modulating individual's cancer susceptibility in Asians. Therefore, these variants may be used as predictive genetic biomarkers for cancer predisposition in Asian populations. However, more comprehensive studies involving other cancers and/or populations, haplotypes, gene-gene and gene-environment interactions are necessary to delineate the role of these variants in conferring cancer risk.

Abstract 1798: Mortalin precursor as potential marker for chemoprevention with SHetA2

Introduction: The flexible heteroarotinoid (Flex-Het), SHetA2, is a novel anticancer drug that induces both intrinsic and extrinsic apoptosis and autophagy in cancer cells, but not in normal cells. Protein isolation / mass spectrometry analysis using SHetA2-coupled polystyrene magnetic beads yielded three SHetA2-binding proteins all belonging to HSPA family namely, HSPA9/mortalin, HSPA8/Hsc70 and HSPA5/BiP. Mortalin, in addition to its vital chaperoning roles in other organelles of the cell, is essential for import and folding of nuclear-encoded mitochondrial proteins. The precursor form of mortalin has a 46-amino acid N-terminal region that functions as a mitochondrial localization sequence (MLS) and is cleaved by proteases after import into the mitochondrial matrix.

Hypothesis: SHetA2 binding to mortalin causes alterations that can be measured to study mechanism and monitor drug effects in animal models and clinical trials.

Methods: Western blots of whole cell or subcellular protein extracts made from cultures of normal human fallopian tube secretory or mammary epithelial cells, rat mammary tumors or human ovarian cancer cell lines treated with SHetA2 or solvent were probed with an antibody that recognizes total mortalin, a custom-made rabbit polyclonal antibody specific for the mortalin MLS (PA8238) or antibodies to loading control proteins. Immunocytochemistry using these antibodies was performed with an automated (Leica Bond III) IHC work station on cells treated with SHetA2 or solvent.

Results: Using a commercial antibody against total mortalin, we observed a lower-mobility band closely moving above the specific (mature) mortalin band in Western blots. Our mortalin MLS-specific antibody recognized only the lower-mobility band confirming it as the precursor form of mortalin in the SHetA2-treated cell extracts. Subcellular fractionation of the drug-treated cells revealed that the precursor protein accumulated only in the cytoplasm and not in the mitochondria. Staining of whole cells with an antibody to total mortalin showed no effect of SHetA2 treatment on the punctate pattern of expression consistent with mitochondrial localization. In contrast, staining with the mortalin MLS-specific antibody demonstrated that SHetA2 increased the intensity of the diffuse cytoplasmic staining consistent with localization of mortalin throughout the cytoplasm. These results were consistently observed among the various cell types.

Conclusions: SHetA2 is the only known drug that blocks the translocation of the precursor mortalin to mitochondria and its processing to mature protein. Such cytoplasmic accumulation of the precursor form of mortalin can potentially serve as pharmacodynamic endpoint to study SHetA2’s effect in laboratory experimental tumor models as well as in human clinical trials. Funding: NCI PREVENT Task Order HHSN26100002

Citation Format: Elangovan Thavathiru, Vishal Chandra, Rajani Rai, Doris Benbrook. Mortalin precursor as potential marker for chemoprevention with SHetA2 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1798. doi:10.1158/1538-7445.AM2017-1798

A Profile of Patients with Molar Pregnancy

Aims: This study was done to determine the incidence, modes of presentation and prognosis of molar pregnancy at B. P. Koirala Institute of Health Sciences.Methods: This was a prospective study done among patients with molar pregnancy admitted at BPKIHS from January 2010 to January 2011. The study was conducted after ethical clearance from Institutional Ethical Review Board of BPKIHS. Written informed consent was taken for enrollment in the study. Baseline information like age, address, race  and patient’s  presenting complaints, period of gestation and serial serum beta human chorionic gonadotropin (βhCG) were collected and analyzed after entering in excel sheet.Results: Total 48 cases of molar pregnancy were diagnosed during the study period. The incidence of molar pregnancy was found to be 5.58 per 1000 deliveries. The most common mode of presentation was per vaginal bleeding i.e. in  64.58% of cases. Majority of the patients were in the age group of 20-34 years (62.5%). Mean time for normalization of βhCG after suction evacuation was 10.19 weeks.Conclusions: Molar pregnancy is a pregnancy related problem which most commonly presents with per vaginal bleeding during first and second trimester. Most of the patients are treated with suction and evacuation but some develop persistent gestational trophoblastic disease.

Technical Note: Experimental results from a prototype high-field inline MRI-linac

PURPOSE

The pursuit of real-time image guided radiotherapy using optimal tissue contrast has seen the development of several hybrid magnetic resonance imaging (MRI)-treatment systems, high field and low field, and inline and perpendicular configurations. As part of a new MRI-linac program, an MRI scanner was integrated with a linear accelerator to enable investigations of a coupled inline MRI-linac system. This work describes results from a prototype experimental system to demonstrate the feasibility of a high field inline MR-linac.

METHODS

The magnet is a 1.5 T MRI system (Sonata, Siemens Healthcare) was located in a purpose built radiofrequency (RF) cage enabling shielding from and close proximity to a linear accelerator with inline (and future perpendicular) orientation. A portable linear accelerator (Linatron, Varian) was installed together with a multileaf collimator (Millennium, Varian) to provide dynamic field collimation and the whole assembly built onto a stainless-steel rail system. A series of MRI-linac experiments was performed to investigate (1) image quality with beam on measured using a macropodine (kangaroo) ex vivo phantom; (2) the noise as a function of beam state measured using a 6-channel surface coil array; and (3) electron contamination effects measured using Gafchromic film and an electronic portal imaging device (EPID).

RESULTS

(1) Image quality was unaffected by the radiation beam with the macropodine phantom image with the beam on being almost identical to the image with the beam off. (2) Noise measured with a surface RF coil produced a 25% elevation of background intensity when the radiation beam was on. (3) Film and EPID measurements demonstrated electron focusing occurring along the centerline of the magnet axis.

CONCLUSIONS

A proof-of-concept high-field MRI-linac has been built and experimentally characterized. This system has allowed us to establish the efficacy of a high field inline MRI-linac and study a number of the technical challenges and solutions.

Assessment of Risk Factors, Feasibility and Acceptability of VIA for Cervical Cancer Screening and Prevention

Aims – To assess feasibility of visual inspection with acetic acid and treatment with cryotherapy for cervical cancer screening and prevention and assess risk factors for cervical cancer in the screened population.Methods – A prospective analysis of all patients enrolled for cervical cancer screening by visual inspection, meeting the eligibility criteria for screening and treatment as per national guidelines 2011 was analyzed form March 2012 to April 2013.Results – A total of 4138 met the eligibility criteria and were counseled for screening, 33 rejected for screening. Out of 4105 screened 241 were visual inspection with acetic acid positive, 211 were treated with cryotherapy, 25 treated with LEEP, 5 rejected to  treatment.  Mean age of patient in year’s ± SD 41.48 ± 9.72. The visual inspection with acetic acidpositivity rate was 5.9 %Conclusion – Single visit approach is a feasible and acceptable form of cervical cancer screening strategy in our population.

Heterogeneous expression of cholecystokinin and gastrin receptor in stomach and pancreatic cancer: An immunohistochemical study

AIM

Cholecystokinin (CCK) and gastrin (Gs) are a well known trophic factor for the gastrointestinal tract and their trophic effects are shown mainly toward pancreas and stomach, respectively. Though, the exact characterization of CCK and Gs receptors subtype (cholecystokinin type A receptor [CCKAR] and cholecystokinin type B receptor/gastrin receptor [CCKBR/GR]) in stomach cancer (SC) and pancreatic cancer (PC) is still controversial and necessities further validation.

SUBJECTS AND METHODS

CCKAR and CCKBR/GR expression was analyzed by immunohistochemistry in 55 SC, 25 benign gastric diseases (BGDs), 38 PC (including periampullary carcinoma), and 10 normal pancreatic tissue. The results were statistically correlated with the patient's clinical history to observe the prognostic significance if any.

RESULT

CCKAR expression was detected in 18.2% of SC, 20% of BGD, 65.8% of PC, and 30.0% of normal pancreas tissue samples. The CCKBR/GR expression was detected in 58.2% of SC, 48.0% of BGD, 18.4% of PC, and 60.0% of normal pancreas tissue samples. CCKBR/GR expression was significantly high in well and moderately differentiated SC samples as compared to poorly differentiated samples.

CONCLUSION

Our study showed significantly higher expression of CCKAR and down regulation of CCKBR in PC as compared to control while CCKBR/GR was detected in majority of SC samples. Thus, our study suggests that CCK and Gs receptors may have diagnostic and therapeutic implications. However, study need to be validated in significantly bigger sample size and need to be replicated in different cohorts.