A prospective study on tumour response assessment methods after neoadjuvant endocrine therapy in early oestrogen receptor-positive breast cancer

BACKGROUND

Neoadjuvant endocrine therapy (NET) in oestrogen receptor-positive (ER+) /HER2-negative (HER2-) breast cancer allows real-time evaluation of drug efficacy as well as investigation of the biological and molecular changes that occur after estrogenic deprivation. Clinical and pathological evaluation after NET may be used to obtain prognostic and predictive information of tumour response to decide adjuvant treatment. In this setting, clinical scales developed to evaluate response after neoadjuvant chemotherapy are not useful and there are not validated biomarkers to assess response to NET beyond Ki67 levels and preoperative endocrine prognostic index score (mPEPI).

METHODS

In this prospective study, we extensively analysed radiological (by ultrasound scan (USS) and magnetic resonance imaging (MRI)) and pathological tumour response of 104 postmenopausal patients with ER+ /HER2- resectable breast cancer, treated with NET for a mean of 7 months prior to surgery. We defined a new score, tumour cellularity size (TCS), calculated as the product of the residual tumour cellularity in the surgical specimen and the tumour pathological size.

RESULTS

Our results show that radiological evaluation of response to NET by both USS and MRI underestimates pathological tumour size (path-TS). Tumour size [mean (range); mm] was: path-TS 20 (0-80); radiological-TS by USS 9 (0-31); by MRI: 12 (0-60). Nevertheless, they support the use of MRI over USS to clinically assess radiological tumour response (rad-TR) due to the statistically significant association of rad-TR by MRI, but not USS, with Ki67 decrease (p = 0.002 and p = 0.3, respectively) and mPEPI score (p = 0.002 and p = 0.6, respectively). In addition, we propose that TCS could become a new tool to standardize response assessment to NET given its simplicity, reproducibility and its good correlation with existing biomarkers (such as ΔKi67, p = 0.001) and potential added value.

CONCLUSION

Our findings shed light on the dynamics of tumour response to NET, challenge the paradigm of the ability of NET to decrease surgical volume and point to the utility of the TCS to quantify the scattered tumour response usually produced by endocrine therapy. In the future, these results should be validated in independent cohorts with associated survival data.

Identification of fatty acid amide hydrolase as a metastasis suppressor in breast cancer

Clinical management of breast cancer (BC) metastasis remains an unmet need as it accounts for 90% of BC-associated mortality. Although the luminal subtype, which represents >70% of BC cases, is generally associated with a favorable outcome, it is susceptible to metastatic relapse as late as 15 years after treatment discontinuation. Seeking therapeutic approaches as well as screening tools to properly identify those patients with a higher risk of recurrence is therefore essential. Here, we report that the lipid-degrading enzyme fatty acid amide hydrolase (FAAH) is a predictor of long-term survival in patients with luminal BC, and that it blocks tumor progression and lung metastasis in cell and mouse models of BC. Together, our findings highlight the potential of FAAH as a biomarker with prognostic value in luminal BC and as a therapeutic target in metastatic disease.

Willingness to vaccinate children against COVID-19 declined during the pandemic

OBJECTIVES

To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3).

RESULTS

Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively).

CONCLUSIONS

COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Germline gain-of-function MMP11 variant results in an aggressive form of colorectal cancer

Matrix metalloproteinase-11 (MMP11) is an enzyme with proteolytic activity against matrix and nonmatrix proteins. Although most MMPs are secreted as inactive proenzymes and are later activated extracellularly, MMP11 is activated intracellularly by furin within the constitutive secretory pathway. It is a key factor in physiological tissue remodeling and its alteration may play an important role in the progression of epithelial malignancies and other diseases. TCGA colon and colorectal adenocarcinoma data showed that upregulation of MMP11 expression correlates with tumorigenesis and malignancy. Here, we provide evidence that a germline variant in the MMP11 gene (NM_005940: c.232C>T; p.(Pro78Ser)), identified by whole exome sequencing, can increase the tumorigenic properties of colorectal cancer (CRC) cells. P78S is located in the prodomain region, which is responsible for blocking MMP11's protease activity. This variant was detected in the proband and all the cancer-affected family members analyzed, while it was not detected in healthy relatives. In silico analyses predict that P78S could have an impact on the activation of the enzyme. Furthermore, our in vitro analyses show that the expression of P78S in HCT116 cells increases tumor cell invasion and proliferation. In summary, our results show that this variant could modify the structure of the MMP11 prodomain, producing a premature or uncontrolled activation of the enzyme that may contribute to an early CRC onset in these patients. The study of this gene in other CRC cases will provide further information about its role in CRC development, which might improve patient treatment in the future.

Stromal Oncostatin M cytokine promotes breast cancer progression by reprogramming the tumour microenvironment

The tumor microenvironment (TME) is reprogrammed by cancer cells and participates in all stages of tumor progression. The contribution of stromal cells to the reprogramming of the TME is not well understood. Here, we provide evidence of the role of the cytokine oncostatin M (OSM) as central node for multicellular interactions between immune and nonimmune stromal cells and the epithelial cancer cell compartment. OSM receptor (OSMR) deletion in a multistage breast cancer model halted tumor progression. We ascribed causality to the stromal function of the OSM axis by demonstrating reduced tumor burden of syngeneic tumors implanted in mice lacking OSMR. Single-cell and bioinformatic analysis of murine and human breast tumors revealed that OSM expression was restricted to myeloid cells, whereas OSMR was detected predominantly in fibroblasts and, to a lower extent, cancer cells. Myeloid-derived OSM reprogrammed fibroblasts to a more contractile and tumorigenic phenotype and elicited the secretion of VEGF and proinflammatory chemokines CXCL1 and CXCL16, leading to increased myeloid cell recruitment. Collectively, our data support the notion that the stromal OSM/OSMR axis reprograms the immune and nonimmune microenvironment and plays a key role in breast cancer progression.

Abstract P2-15-01: Conversion from luminal to normal intrinsic subtype by PAM50 after neoadjuvant endocrine therapy is associate with biomarkers of good prognosis in luminal breast cancer

Background. Neoadjuvant endocrine therapy (NET) in luminal breast cancer (LBC) is the perfect scenario for real-time evaluation of the biological and molecular changes that occur after estrogenic deprivation. This evaluation is mainly performed in surgical specimens after NET and has been used as a research tool to obtain prognostic and predictive information using tumor response to decide adjuvant treatment. Nevertheless, there are not many validated biomarkers in this setting to predict response beyond Ki67 levels and modified Preoperative Prognostic Index (mPEPI score) after treatment. Hence, the aim of this study is to determine if changes in mRNA-based PAM50 analysis (intrinsic subtype) after NET in LBC correlate with such biomarkers. Methods. We collected a series of postmenopausal ER+/HER2- breast cancer patients (n=58) treated for at least 4 months with NET before surgery. Next, we performed gene expression analysis by PAM50 accompanied by pathological characterization of surgical tumor specimens and immunohistochemistry characterization of ER and Ki67 levels, both at diagnosis and in surgery specimen. Finally, we studied the association of our results with clinical and histopathological features and with validated biomarkers for endocrine response, such as mPEPI score and changes in Ki67 levels. Results. The distribution of changes in intrinsic subtype determined by PAM50 after NET is presented in Table 1. We observed that tumors that changed from luminal to a normal intrinsic subtype showed larger changes in Ki67 levels after NET and reduced percentage of Ki67 positive cells at surgery, compared to those that presented a luminal persistent status: both analysis P<0.0001 (Mann-Whitney test). Similarly, we found a statistical association between lower mPEPI score in those tumors that change from luminal to a normal intrinsic subtype compared to those that presented a luminal persistent status: P=0.0034 (Mann-Whitney test). Moreover, in agreement with these results, we also studied ROR-P (PAM50 risk of recurrence (ROR) of subtype plus proliferation) in tumors that change from luminal to a normal intrinsic subtype and in those that presented a luminal persistent status. Results showed the same trends as the ones observed for Ki67-related parameters and mPEPI. Conclusions. PAM50 analysis revealed that changes from luminal A and luminal B to normal intrinsic subtype are associated with response to NET, measured by different well-established parameters. This result gives us clues to further explore which genes are orchestrating these changes and their impact on clinical outcomes. However, more analyses should be performed to determine the relationship between ROR and parameters used to measure response in NET in order to validate the results presented. In conclusion, our data support that the determination of the changes in gene expression profile using PAM50, before and after NET, can be used as a tool to predict response, conjointly with other clinical parameters.

Table 1.- Intrinsic subtypes determined by PAM50 in samples pre and post NETPAM50 PREPAM50 POSTNO.%PERSISTANT LUMINAL STATUSCHANGE FROM LUMINAL TO A NOLMAL INTRINSIC SUBTYPELumALumA2136YESLumANormal1526YESLumALumB35YESLumBLumA610YESLumBNormal35YESLumBLumB59YESHER2HER223NANAHER2LumA12NANALumAHER212NANANormalNormal12NANATOTAL58100Lum=LuminalNA= Not applicable

Citation Format: Joanna Ines Lopez Velazco, María Otaño, Inazio Lacambra, Kepa Elorriaga, Ainhara Lahuerta, Ana Martínez, Virginia Segur, Sara Manzano, Aleix Prat, María Caffarel, Ander Urruticoechea. Conversion from luminal to normal intrinsic subtype by PAM50 after neoadjuvant endocrine therapy is associate with biomarkers of good prognosis in luminal breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-15-01.

Abstract 1974: C3G down-regulation in glioblastoma induces a pro-invasive and glycolytic phenotype, accompanied by RTKs dysregulation

C3G is a guanine-nucleotide exchange factor (GEF) for Rap1, although it can act through GEF-independent mechanisms. C3G plays a dual role in cancer, acting as either a tumor suppressor or inducer depending on the tumor type/stage. It regulates different key aspects of the tumorigenic process such as invasion, apoptosis or proliferation. In colon carcinoma, C3G represses invasion through down-regulation of p38αMAPK activity and promotes tumor growth. We have now analyzed the role of C3G in glioblastoma (GBM), a tumor characterized by its aggressiveness and disseminative capacity. To do it, we have used different experimental approaches: permanent gene silencing, knock-out using CRISPR/Cas9 technology and transient overexpression in U87 cell line and patient-derived GBM cells. We found that C3G down-regulation enhances invasion through the induction of an epithelial/glial to mesenchymal transition-like process. C3G deficiency also facilitates foci generation in anchorage-dependent and independent growth assays, but with lower cell density as a consequence of a reduced proliferation. In in vivo analyses, cells with C3G knock-down generated larger tumors in xenografts and chick chorioallantoic membrane xenografts assays with increased angiogenesis and α-SMA+ fibroblasts, but a lower proliferation. Mechanistically, C3G down-regulation impairs EGF/EGFR signaling by decreasing EGFR cell membrane localization, leading to a reduction in EGF/EGFR-induced invasiveness. In contrast, C3G down-regulation promotes the activation of several receptor tyrosine kinases (RTKs) that might promote invasion. In particular, the enhanced FGF2/FGFR1 signaling increases invasion in C3G-silenced cells, through a mechanism likely dependent on ERKs. Moreover, a proteomic analysis revealed that C3G down-regulation increases the levels of different key glycolytic enzymes, such as aldolase, phosphoglycerate kinase, enolase and pyruvate kinase (PK). The activity of PK and lactate dehydrogenase as well as lactate release to the extracellular environment were also increased upon C3G silencing. In conclusion, our data demonstrate that C3G inhibits invasion of GBM cells, while increasing their proliferative capacity. Moreover, we show a distinct dependency on C3G for EGF/EGFR signaling versus other RTKs, suggesting that assessing C3G levels may discriminate GBM patient responders to different RTK inhibitors. In addition, our results indicate that C3G regulates not only GBM growth and invasiveness, but it also contributes to reprogram its glycolytic metabolism. Hence, low levels of C3G correlate with a more mesenchymal and glycolytic phenotype with enhanced aggressiveness and worse patient prognosis. This promising role of C3G as a key player in GBM should be further characterized to define its prognostic value and its potential relevance as a predictor of the response to therapy.

Citation Format: Sara Manzano, Óscar Herranz, Paloma Bragado, Patricia Jáuregui, María Rodrigo, Celia Sequera, Cristina Baquero, Nerea Palao, Ignacio Rubio, Álvaro Gutierrez-Uzquiza, Carmen Guerrero, Almudena Porras. C3G down-regulation in glioblastoma induces a pro-invasive and glycolytic phenotype, accompanied by RTKs dysregulation [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 1974.

Evaluation of an active yeast propagation system on fermentation traits and quality of C.V. Carmenère wine

Active dry yeasts (ADY, Saccharomyces cerevisiae) are widely used in oenology due to their potential benefits on the control of fermentation and quality reproducibility among other aspects. On the other hand, yeast propagation systems, so called Active Yeast Systems (AYS), can be useful to optimize the alcoholic fermentation (AF) initial lag phase and reduce production costs. The objective of this work was to determine the predominance of an ADY strain propagated by AYS and the impact of this inoculum on cv. Carmenère wine quality. Lalvin ICV D21 ADY strain was inoculate according to the protocol recommended by the manufacturer (T0), and in parallel, it was propagate by the AYS and then used as inoculum (T1). Yeast strain predominance analyzed by restriction fragment length polymorphism (RFLP) technique indicates that nine (out of 9) yeast colonies obtained from a single sample of the ADY, show the same electrophoretic pattern when compared to the ADY. The results show limited significant differences for the fermentation speed and the yeast cell counting. The result of the physicochemical analysis of the musts and resulting wines showed no significant differences between treatments. A triangular test showed no significant sensory differences between wines

Modulatory effect of three probiotic strains on infants' gut microbial composition and immunological parameters on a placebo-controlled, double-blind, randomised study

The gut microbiota plays a crucial role in gastrointestinal health. Current use of probiotics is aimed at modulating the bacterial gut composition to alleviate specific diseases. The safety and tolerance of three probiotic strains (Bifidobacterium longum subsp. infantis R0033, Lactobacillus helveticus R0052 and Bifidobacterium bifidum R0071) has recently been described. The objective of the present study was to analyse the microbiological composition and immunological parameters of faecal samples obtained from healthy infants from 3 to 12 months of age after receiving either one of the three probiotic strains or placebo for 8 weeks. 16S ribosomal RNA gene sequencing and multiplexing technology was used for analysis. Faecal sample analysis showed that the most abundant genus in all four groups of infants pre- and post-intervention was Bifidobacterium, representing approximately 50% of the sequences. After the intervention period the microbial composition of faecal samples in the probiotic groups did not display notable changes. In contrast, a decrease in different Bifidobacterium species, such as B. bifidum and Bifidobacterium breve and an increase in Bacteroides, Blautia, Clostridium, Coprococcus and Faecalibacterium genera was observed in the placebo group. The analysis of a wide range of immune factors in faecal samples suggests a modulatory effect by these three probiotic strains during the intervention period. The anti-inflammatory ratio interleukin (IL)-10/IL-12 increased at the end of the intervention period in the B. infantis R0033 group while the TNF-α/IL-10 ratio increased in the L. helveticus R0052 group. The decrease of the IL-10/IL-12 ratio together with the increase of the tumour necrosis factor alpha (TNF-α)/IL-10 ratio demonstrated a pro-inflammatory profile in the placebo group. In conclusion, the species profile of the microbiome observed in all three probiotic groups resembled that of a younger infant, similar to an unweaned infant, when compared to the placebo group which may also be related with an anti-inflammatory effect.

How Rap and its GEFs control liver physiology and cancer development. C3G alterations in human hepatocarcinoma

Rap proteins regulate liver physiopathology. For example, Rap2B promotes hepatocarcinoma (HCC) growth, while Rap1 might play a dual role. The RapGEF, Epac1, activates Rap upon cAMP binding, regulating metabolism, survival, and liver regeneration. A liver specific Epac2 isoform lacking cAMP-binding domain also activates Rap1, promoting fibrosis in alcoholic liver disease. C3G (RapGEF1) is also present in the liver, but mainly as shorter isoforms. Its function in the liver remains unknown. Information from different public genetic databases revealed that C3G mRNA levels increase in HCC, although they decrease in metastatic stages. In addition, several mutations in RapGEF1 gene are present, associated with a reduced patient survival. Based on this, C3G might represent a new HCC diagnostic and prognostic marker, and a therapeutic target.

Transcriptomic changes in Cucurbita pepo fruit after cold storage: differential response between two cultivars contrasting in chilling sensitivity

Background

Zucchini fruit is susceptible to chilling injury (CI), but the response to low storage temperature is cultivar dependent. Previous reports about the response of zucchini fruit to chilling storage have been focused on the physiology and biochemistry of this process, with little information about the molecular mechanisms underlying it. In this work, we present a comprehensive analysis of transcriptomic changes that take place after cold storage in zucchini fruit of two commercial cultivars with contrasting response to chilling stress.

Results

RNA-Seq analysis was conducted in exocarp of fruit at harvest and after 14 days of storage at 4 and 20 °C. Differential expressed genes (DEGs) were obtained comparing fruit stored at 4 °C with their control at 20 °C, and then specific and common up and down-regulated DEGs of each cultivar were identified. Functional analysis of these DEGs identified similarities between the response of zucchini fruit to low temperature and other stresses, with an important number of GO terms related to biotic and abiotic stresses overrepresented in both cultivars. This study also revealed several molecular mechanisms that could be related to chilling tolerance, since they were up-regulated in cv. Natura (CI tolerant) or down-regulated in cv. Sinatra (CI sensitive). These mechanisms were mainly those related to carbohydrate and energy metabolism, transcription, signal transduction, and protein transport and degradation. Among DEGs belonging to these pathways, we selected candidate genes that could regulate or promote chilling tolerance in zucchini fruit including the transcription factors MYB76-like, ZAT10-like, DELLA protein GAIP, and AP2/ERF domain-containing protein.

Conclusions

This study provides a broader understanding of the important mechanisms and processes related to coping with low temperature stress in zucchini fruit and allowed the identification of some candidate genes that may be involved in the acquisition of chilling tolerance in this crop. These genes will be the basis of future studies aimed to identify markers involved in cold tolerance and aid in zucchini breeding programs.

Electronic supplementary material

The online version of this article (10.1186/s12864-018-4500-9) contains supplementary material, which is available to authorized users.

Safety and tolerance of three probiotic strains in healthy infants: a multi-centre randomized, double-blind, placebo-controlled trial

Some strains of species belonging to the genera Bifidobacterium and Lactobacillus are used in order to maintain health. Although these organisms have a long record of safe use, it is important to assess their safety and tolerance in potentially vulnerable populations, such as infants. The objective of this study was to evaluate the safety and tolerance of three probiotic strains (Bifidobacterium longum subsp. infantis R0033, Bifidobacterium bifidum R0071 and Lactobacillus helveticus R0052) in healthy infants aged 3 to 12 months. A multi-centre randomized, double-blind, placebo-controlled intervention study with 221 healthy full-term infants was conducted. Infants received either a placebo or one of the 3 probiotic strains (3×109 cfu) daily during an 8 week intervention period. Growth (weight, height and head circumference), adverse events (AEs)/serious adverse events (SAEs), concentrations of D-lactic acid in urine samples, characteristics of the stools and use of medication were collected for safety evaluation. All 4 groups were homogeneous with respect to age, gender, feeding type, ethnicity, height, weight and head circumference at the start of the study. The results showed that changes in growth (weight, height and head circumference) were equivalent in all 4 groups. No SAEs were reported. Total number of AEs recorded was equivalent in all groups. Thus, the use of B. infantis R0033, L. helveticus R0052 and B. bifidum R0071 in infancy is safe, and well tolerated.

Towards an unsupervised device for the diagnosis of childhood pneumonia in low resource settings: automatic segmentation of respiratory sounds

Pneumonia remains the worldwide leading cause of children mortality under the age of five, with every year 1.4 million deaths. Unfortunately, in low resource settings, very limited diagnostic support aids are provided to point-of-care practitioners. Current UNICEF/WHO case management algorithm relies on the use of a chronometer to manually count breath rates on pediatric patients: there is thus a major need for more sophisticated tools to diagnose pneumonia that increase sensitivity and specificity of breath-rate-based algorithms. These tools should be low cost, and adapted to practitioners with limited training. In this work, a novel concept of unsupervised tool for the diagnosis of childhood pneumonia is presented. The concept relies on the automated analysis of respiratory sounds as recorded by a point-of-care electronic stethoscope. By identifying the presence of auscultation sounds at different chest locations, this diagnostic tool is intended to estimate a pneumonia likelihood score. After presenting the overall architecture of an algorithm to estimate pneumonia scores, the importance of a robust unsupervised method to identify inspiratory and expiratory phases of a respiratory cycle is highlighted. Based on data from an on-going study involving pediatric pneumonia patients, a first algorithm to segment respiratory sounds is suggested. The unsupervised algorithm relies on a Mel-frequency filter bank, a two-step Gaussian Mixture Model (GMM) description of data, and a final Hidden Markov Model (HMM) interpretation of inspiratory-expiratory sequences. Finally, illustrative results on first recruited patients are provided. The presented algorithm opens the doors to a new family of unsupervised respiratory sound analyzers that could improve future versions of case management algorithms for the diagnosis of pneumonia in low-resources settings.

Inhomogeneous Response of Articular Cartilage: A Three-Dimensional Multiphasic Heterogeneous Study

Articular cartilage exhibits complex mechano-electrochemical behaviour due to its anisotropy, inhomogeneity and material non-linearity. In this work, the thickness and radial dependence of cartilage properties are incorporated into a 3D mechano-electrochemical model to explore the relevance of heterogeneity in the behaviour of the tissue. The model considers four essential phenomena: (i) osmotic pressure, (ii) convective and diffusive processes, (iii) chemical expansion and (iv) three-dimensional through-the-thickness heterogeneity of the tissue. The need to consider heterogeneity in computational simulations of cartilage behaviour and in manufacturing biomaterials mimicking this tissue is discussed. To this end, healthy tibial plateaus from pigs were mechanically and biochemically tested in-vitro. Heterogeneous properties were included in the mechano-electrochemical computational model to simulate tissue swelling. The simulation results demonstrated that swelling of the heterogeneous samples was significantly lower than swelling under homogeneous and isotropic conditions. Furthermore, there was a significant reduction in the flux of water and ions in the former samples. In conclusion, the computational model presented here can be considered as a valuable tool for predicting how the variation of cartilage properties affects its behaviour, opening up possibilities for exploring the requirements of cartilage-mimicking biomaterials for tissue engineering. Besides, the model also allows the establishment of behavioural patterns of swelling and of water and ion fluxes in articular cartilage.

Milk and blood biomarkers associated to the clinical efficacy of a probiotic for the treatment of infectious mastitis

Previous studies have shown the efficacy of oral administration of selected lactobacilli strains to treat mastitis. The objective of this study was to find microbiological, biochemical and/or immunological biomarkers of the probiotic effect. Women with (n=23) and without (n=8) symptoms of mastitis received three daily doses (10(9) cfu) of Lactobacillus salivarius PS2 for 21 days. Samples of milk, blood and urine were collected before and after the probiotic intervention, and screened for a wide spectrum of microbiological, biochemical and immunological parameters. In the mastitis group, L. salivarius PS2 intake led to a reduction in milk bacterial counts, milk and blood leukocyte counts and interleukin (IL)-8 level in milk, an increase in those of immunoglobulin (Ig)E, IgG3, epidermal growth factor and IL-7, a modification of the milk electrolyte profile, and a reduction of some oxidative stress biomarkers. Such biomarkers will be useful in future clinical studies involving a larger cohort.

Parameter-dependent behavior of articular cartilage: 3D mechano-electrochemical computational model

BACKGROUND AND OBJECTIVE

Changes in mechano-electrochemical properties of articular cartilage play an essential role in the majority of cartilage diseases. Despite of this importance, the specific effect of each parameter into tissue behavior remains still obscure. Parametric computational modeling of cartilage can provide some insights into this matter, specifically the study of mechano-electrochemical properties variation and their correlation with tissue swelling, water and ion fluxes. Thus, the aim of this study is to evaluate the influence of the main mechanical and electrochemical parameters on the determination of articular cartilage behavior by a parametric analysis through a 3D finite element model.

METHODS

For this purpose, a previous 3D mechano-electrochemical model, developed by the same authors, of articular cartilage behavior has been used. Young's modulus, Poisson coefficient, ion diffusivities and ion activity coefficients variations have been analyzed and quantified through monitoring tissue simulated response.

RESULTS

Simulation results show how Young's modulus and Poisson coefficient control tissue behavior rather than electrochemical properties. Meanwhile, ion diffusivity and ion activity coefficients appear to be vital in controlling velocity of incoming and outgoing fluxes.

CONCLUSIONS

This parametric study establishes a basic guide when defining the main properties that are essential to be included into computational modeling of articular cartilage providing a helpful tool in tissue simulations.

Altered swelling and ion fluxes in articular cartilage as a biomarker in osteoarthritis and joint immobilization: a computational analysis

In healthy cartilage, mechano-electrochemical phenomena act together to maintain tissue homeostasis. Osteoarthritis (OA) and degenerative diseases disrupt this biological equilibrium by causing structural deterioration and subsequent dysfunction of the tissue. Swelling and ion flux alteration as well as abnormal ion distribution are proposed as primary indicators of tissue degradation. In this paper, we present an extension of a previous three-dimensional computational model of the cartilage behaviour developed by the authors to simulate the contribution of the main tissue components in its behaviour. The model considers the mechano-electrochemical events as concurrent phenomena in a three-dimensional environment. This model has been extended here to include the effect of repulsion of negative charges attached to proteoglycans. Moreover, we have studied the fluctuation of these charges owning to proteoglycan variations in healthy and pathological articular cartilage. In this sense, standard patterns of healthy and degraded tissue behaviour can be obtained which could be a helpful diagnostic tool. By introducing measured properties of unhealthy cartilage into the computational model, the severity of tissue degeneration can be predicted avoiding complex tissue extraction and subsequent in vitro analysis. In this work, the model has been applied to monitor and analyse cartilage behaviour at different stages of OA and in both short (four, six and eight weeks) and long-term (11 weeks) fully immobilized joints. Simulation results showed marked differences in the corresponding swelling phenomena, in outgoing cation fluxes and in cation distributions. Furthermore, long-term immobilized patients display similar swelling as well as fluxes and distribution of cations to patients in the early stages of OA, thus, preventive treatments are highly recommended to avoid tissue deterioration.

Structural biology response of a collagen hydrogel synthetic extracellular matrix with embedded human fibroblast: computational and experimental analysis

Adherent cells exert contractile forces which play an important role in the spatial organization of the extracellular matrix (ECM). Due to these forces, the substrate experiments a volume reduction leading to a characteristic shape. ECM contraction is a key process in many biological processes such as embryogenesis, morphogenesis and wound healing. However, little is known about the specific parameters that control this process. With this aim, we present a 3D computational model able to predict the contraction process of a hydrogel matrix due to cell-substrate mechanical interaction. It considers cell-generated forces, substrate deformation, ECM density, cellular migration and proliferation. The model also predicts the cellular spatial distribution and concentration needed to reproduce the contraction process and confirms the minimum value of cellular concentration necessary to initiate the process observed experimentally. The obtained continuum formulation has been implemented in a finite element framework. In parallel, in vitro experiments have been performed to obtain the main model parameters and to validate it. The results demonstrate that cellular forces, migration and proliferation are acting simultaneously to display the ECM contraction.

Computational analysis of cartilage implants based on an interpenetrated polymer network for tissue repairing

Interpenetrated polymer networks (IPNs), composed by two independent polymeric networks that spatially interpenetrate, are considered as valuable systems to control permeability and mechanical properties of hydrogels for biomedical applications. Specifically, poly(ethyl acrylate) (PEA)-poly(2-hydroxyethyl acrylate) (PHEA) IPNs have been explored as good hydrogels for mimicking articular cartilage. These lattices are proposed as matrix implants in cartilage damaged areas to avoid the discontinuity in flow uptake preventing its deterioration. The permeability of these implants is a key parameter that influences their success, by affecting oxygen and nutrient transport and removing cellular waste products to healthy cartilage. Experimental try-and-error approaches are mostly used to optimize the composition of such structures. However, computational simulation may offer a more exhaustive tool to test and screen out biomaterials mimicking cartilage, avoiding expensive and time-consuming experimental tests. An accurate and efficient prediction of material's permeability and internal directionality and magnitude of the fluid flow could be highly useful when optimizing biomaterials design processes. Here we present a 3D computational model based on Sussman-Bathe hyperelastic material behaviour. A fluid structure analysis is performed with ADINA software, considering these materials as two phases composites where the solid part is saturated by the fluid. The model is able to simulate the behaviour of three non-biodegradable hydrogel compositions, where percentages of PEA and PHEA are varied. Specifically, the aim of this study is (i) to verify the validity of the Sussman-Bathe material model to simulate the response of the PEA-PHEA biomaterials; (ii) to predict the fluid flux and the permeability of the proposed IPN hydrogels and (iii) to study the material domains where the passage of nutrients and cellular waste products is reduced leading to an inadequate flux distribution in healthy cartilage tissue. The obtained results show how the model predicts the permeability of the PEA-PHEA hydrogels and simulates the internal behaviour of the samples and shows the distribution and quantification of fluid flux.

Observed costs and health care use of children in a prospective cohort study on community-acquired pneumonia in Geneva, Switzerland

QUESTIONS UNDER STUDY

Despite various efforts to estimate cost-effectiveness of pneumococcal conjugate vaccines, only scarce information on the cost burden of paediatric community acquired pneumonia (CAP) exists. The objective of this study was to prospectively calculate direct and indirect costs associated with treatment of CAP from a society perspective in children between 2 months and 16 years of age seeking care at a tertiary hospital in Geneva, Switzerland between December 2008 and May 2010.

METHODS

This cost of illness study population comprised children aged from 2 months to 16 years of age seeking care for CAP at the University Children's Hospital Geneva from January 2008 through May 2010 (a subset of patients taken from a larger multicentre prospective cohort). Hospital-associated costs for episodes of pneumonia were computed according to the REKOLE® system. Non-hospital costs were estimated by parental interviews at baseline and follow-up on day 14.

RESULTS

The overall cost for one episode of CAP was 11'258 CHF; 23'872 CHF for inpatient treatment and 1009 CHF for outpatient treatment. Severe pneumonia cases per World Health Organisation (WHO) definition used significantly more hospital resources than non-severe cases: 21'842 CHF versus 3'479 CHF (p <0.0001).

CONCLUSION

Childhood CAP results in a significant medical cost burden that may have been underestimated in previous cost-effectiveness analyses of pneumococcal vaccine strategies.

[Experimental models in Alzheimer's disease]

INTRODUCTION

Alzheimer s disease (AD) is the most common neurodegenerative disease and (it accounts for 60-80 %). The certain diagnosis is made thanks to the brain patients study. Since 1970 there have been developed experimental models that have done a deep approach of this disease and new therapeutic researching.

METHODS

We review all the papers published about experimental models in AD, and all the new therapeutical approaches base don them using the database Pubmed.

RESULTS

Animal models aim to replicate the symptoms, the lesions or the cause(s) of AD. It has been described many experimental models in AD. There are animal models based on the metabolism of the amyloid precursor protein (APP) (human APPwild type wt- o the mutants forms), other based on Presenilin (PS) (transgenic mice that overexpress the form wild-type or the mutant ones), the double mutants PS/APP that develop the lesions earlier. There are other based on tau protein (tau-JNPL3) or the triple transgenic PS/APP/tau. There are also lines with altered expression of neprilysin, the main degrading enzyme of Abeta and also models based on APOE. Other models are rats, chick embryo, dog, primates and cetacean, cell culture of mature hippocampic neurons and the effects of the Abeta oligomers in them (soluble toxic species).

CONCLUSIONS

Experimental models in AD have supposed a key tool in order to know deeply about neurodegenerative diseases, over all AD. Besides they allow us design new therapeutic approaches.

[Genetics and Alzheimer's disease]

INTRODUCTION

Alzheimer's disease (AD) is the first cause of dementia (60-80%). The causal genes with autosomal dominant inheritance in the early onset forms (APP, PSEN-1, PSEN-2) and one susceptibility gene in the late onset forms (APOE) are described.

DEVELOPMENT

Causal genes involved in the early onset forms account for approximately 5% of the total. Among all the susceptibility genes, only the APOE gene, involved in the late onset forms, has been replicated in all the studies. However, it has not been possible to replicate the more than 200 genes in family or case-control studies. Nonetheless, the genetics of Alzheimer's disease is very complex. The models that have the most influence in its most frequent phenotypes are multifactorial ones (genetics and environmental ones).

CONCLUSIONS

AD is a disease with a complex inheritance. The early onset forms have supposed a great advance in the knowledge of the ethiopathogeny of the disease. However, especially valuable information could be extrapolated from knowledge on the late onset forms given its similarities with the most prevalence forms, that is, the sporadic ones.

Plant sex chromosomes: molecular structure and function

Recent molecular and genomic studies carried out in a number of model dioecious plant species, including Asparagus officinalis, Carica papaya, Silene latifolia, Rumex acetosa and Marchantia polymorpha, have shed light on the molecular structure of both homomorphic and heteromorphic sex chromosomes, and also on the gene functions they have maintained since their evolution from a pair of autosomes. The molecular structure of sex chromosomes in species from different plant families represents the evolutionary pathway followed by sex chromosomes during their evolution. The degree of Y chromosome degeneration that accompanies the suppression of recombination between the Xs and Ys differs among species. The primitive Ys of A. officinalis and C. papaya have only diverged from their homomorphic Xs in a short male-specific and non-recombining region (MSY), while the heteromorphic Ys of S. latifolia, R. acetosa and M. polymorpha have diverged from their respective Xs. As in the Y chromosomes of mammals and Drosophila, the accumulation of repetitive DNA, including both transposable elements and satellite DNA, has played an important role in the divergence and size enlargement of plant Ys, and consequently in reducing gene density. Nevertheless, the degeneration process in plants does not appear to have reached the Y-linked genes. Although a low gene density has been found in the sequenced Y chromosome of M. polymorpha, most of its genes are essential and are expressed in the vegetative and reproductive organs in both male and females. Similarly, most of the Y-linked genes that have been isolated and characterized up to now in S. latifolia are housekeeping genes that have X-linked homologues, and are therefore expressed in both males and females. Only one of them seems to be degenerate with respect to its homologous region in the X. Sequence analysis of larger regions in the homomorphic X and Y chromosomes of papaya and asparagus, and also in the heteromorphic sex chromosomes of S. latifolia and R. acetosa, will reveal the degenerative changes that the Y-linked gene functions have experienced during sex chromosome evolution.

Pustulose exanthématique aiguë généralisée : premier cas décrit en relation avec une infection à Chlamydia pneumoniae

Skin reactions to drugs or infections can be very important.

CASE REPORT

A 14-year-old boy developed fever, a diffuse pustular rash and a respiratory distress. Chest X-rays and serology were consistent with an acute Chlamydia pneumoniae infection. A skin biopsy revealed an acute generalized exanthematous pustulosis.

CONCLUSION

Acute generalized exanthematous pustulosis (AGEP) is a disease manifested by a diffuse eruption of follicular sterile pustules. Most of the cases are drug induced, but they may be secondary to viral or bacterial infections. We report the first case of AGEP in a child with an acute C. pneumoniae infection.

[Neuroimaging techniques in the Gilles de la Tourette syndrome]

Tourette's syndrome (GdT) is a chronic neuropsychiatric disorder of unclear etiology characterized clinically by the presence of motor and phonic tics as well as a variety of behavioral and cognitive abnormalities such as Obsessive-Compulsive Disorder (TOC) and Attention Deficit Hyperactivity Disorder (ADHD). Dopaminergic pathway and movement control related structures may have some implications for pathogenesis. Neuroimaging techniques may yield relevant data for a better understanding of the symptoms and physiopathology of this disease. Among them, functional isotopic techniques such as PET and SPECT and other like quantitative EEG are the most remarkable. In this article we intend to perform a thorough review of the most recent literature, contributing with our own experience and discuss the pathogenesis of GdT.