A comparative analysis of immunohistochemistry and fluorescent in situ hybridization assay to detect anaplastic lymphoma kinase status in lung adenocarcinoma cases: A search for a testing algorithm

INTRODUCTION

Testing for echinoderm microtubule-associated protein-like 4 (EML4) anaplastic lymphoma kinase (ALK) translocation by fluorescence in situ hybridization (FISH) is well established whereas the Food and Drug Administration (FDA) ALK immunohistochemical (IHC) test is relatively new.

AIMS AND OBJECTIVE

The aim of this study is to compare FDA-approved ALK IHC test (D5F3 clone) with the standard ALK FISH test.

MATERIALS AND METHODS

A validation and a test arm with 100 and 200 cases of Formalin-Fixed, Paraffin-embedded blocks of lung adenocarcinoma, respectively, comprised the material. All cases had ALK IHC test on automated Ventana Benchmark XT IHC slide stainer using anti-ALK D5F3 rabbit monoclonal primary antibody; when positive tumor cells (any percentage) showed strong granular cytoplasmic staining. For the FISH test, Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.,) was used to detect ALK gene 2p23 rearrangements; when positive the red and green signals were split two signal diameter apart and/or isolated 3'red signal were detected in more than 15% tumor cells. The ALK FISH results were available in all 100 validation cases and 64-test arm cases which formed the basis of this analysis.

RESULTS

The ALK IHC test was positive in 16% cases; four discordant cases were ALK IHC positive but ALK FISH negative, but no case was ALK IHC negative and ALK FISH positive. There was 100% sensitivity, 90.5% specificity, and 93.75% accuracy.

CONCLUSION

A negative ALK IHC result obviates the need for a FISH test barring those with a strong clinical profile, and a positive ALK IHC result is sufficient basis for the initiation of treatment.

Desaturation of stearate is insufficient to increase the concentrations of oleate in cultured rat hepatocytes

Desaturation of stearate and palmitate and its effect on cellular accumulation of oleate were determined in primary culture of rat hepatocytes. The rate of oleate synthesis as measured by the formation of monounsaturated fatty acids from stearate was significantly higher than that from palmitate. The rate of [1-(14)C]stearate incorporation into oleate [1208 +/- 195 pmol/(mg protein x 4 h)] was 80% higher than that of [1-(14)C]palmitate [(672 +/- 82 pmol/(mg protein x 4 h)]. Despite the different rates of desaturation, the cellular oleate concentrations did not differ in the cells treated with stearate and palmitate (i.e., 42.5 +/- 4.5 vs. 40.8 +/- 5.2 nmol/mg protein). On the other hand, oleate concentration in the cells incubated with exogenous oleate was 198.1 +/- 9.5 nmol/mg protein. There was a dose-dependent increase in cellular stearate concentration by increasing stearate concentrations from 0.5 mmol/L to 4.0 mmol/L in culture medium. A linear increase in cellular stearate concentration was also achieved by increasing the duration of incubation with 1.0 mmol/L stearate from 2 to 24 h. Despite the marked increases in stearate concentrations under these conditions, oleate concentrations remained unchanged in the cells. These results do not support the contention that the hypocholesterolemic effect of stearate may be mediated by its conversion to oleate, although stearate is a more favorable substrate for desaturation than palmitate.

Stearic acid modifies very low density lipoprotein lipid composition and particle size differently from shorter-chain saturated fatty acids in cultured rat hepatocytes

Stearic acid as compared to myristate, palmitate, or oleate is poorly incorporated into triacylglycerol, a major lipid component of very low density lipoprotein (VLDL). The present study investigated the effects of these fatty acids on VLDL metabolism in cultured rat hepatocytes. All fatty acids stimulated [2-3H] glycerol incorporation into VLDL lipids and secretion of [3H]-labeled VLDL by hepatocytes. However, the rate of [3H]-labeled VLDL secretion in the presence of nonlabeled stearate (12.8 +/- 0.7 pmol/mg protein/4 h) was 46, 59, and 22% of that observed for those treated with myristate, palmitate, and oleate, respectively. [1-14C]Stearate as a substrate was also less effective than other labeled fatty acids to be incorporated into VLDL lipids. Of total VLDL lipids synthesized from [1-14C] stearate, triacylglycerol accounted for 78% as compared to 88-97% of that derived from palmitate, myristate, and oleate. The amounts of apoB100 and apoB48 were the same in hepatocytes treated with or without exogenous fatty acids. Similarly, the rate of apoB synthesis from [35S] methionine was not affected by exogenous fatty acids. The treatment of cells with various saturated fatty acids increased the particle size of VLDL to different extents. The largest particles of VLDL, with a mean diameter of 79.3 +/- 11.9 nm, were seen in the cells treated with stearate, followed by those treated with palmitate and myristate (45.5 +/- 9.8 and 38.6 +/- 6.8 nm, diameter, respectively). Clearly, hepatocytes treated with stearate secrete less VLDL and produce larger VLDL particles than those treated with shorter-chain saturated fatty acids.

Stearic acid unlike shorter-chain saturated fatty acids is poorly utilized for triacylglycerol synthesis and beta-oxidation in cultured rat hepatocytes

Utilization of stearate as compared to various saturated fatty acids for cholesterol and lipid synthesis and beta-oxidation was determined in primary culture of rat hepatocytes. At 0.5 mmol/L in the medium, stearate (18:0) adequately solubilized by albumin was less inhibitory to cholesterol synthesis from [2-14C] acetate than myristate (14:0) and palmitate (16:0) (68% vs. 91 and 88% inhibition, respectively). The rate of incorporation into cholesterol from [1-14C] stearate (3.0 +/- 0.6 nmol/mg protein/4 h) was 37-, 1.8-, and 7.8-fold of that from myristate, palmitate, and oleate, respectively. Conversely, the rate of [1-14C] stearate incorporation into total glycerolipids was 88-90% lower than that of labeled palmitate, myristate, and oleate. The rate of [1-14C] stearate incorporation into triacylglycerol (3.6 +/- 0.4 nmol/mg protein/4 h) was 6-8% of that from myristate, palmitate, oleate, and linoleate. The rate of stearate incorporation into phospholipids was the lowest among tested fatty acids, whereas the rate of mono- and diacylglycerol synthesis was the highest with stearate treatment. The rate of beta-oxidation as measured by CO2 and acid soluble metabolite production was also the lowest with [1-14C] stearate treatment at 22.7 nmol/mg protein/4 h, which was 35-40% of those from other [1-14C] labeled fatty acids. A greater proportion of stearate than other fatty acids taken up by the hepatocytes remained free and was not metabolized. Clearly, stearate as compared to shorter-chain saturated fatty acids was less efficiently oxidized and esterified to triacylglycerol in cultured rat hepatocytes.

Correspondence of left ventricular ejection fraction determinations from two-dimensional echocardiography, radionuclide angiography and contrast cineangiography

OBJECTIVES

This study assessed the agreement of left ventricular ejection fraction determinations from two-dimensional echocardiography, radionuclide angiography and contrast cineangiography.

BACKGROUND

Previously published reports suggest that two-dimensional echocardiography, radionuclide angiography and contrast cineangiography are equally acceptable methods of assessing left ventricular ejection fraction on the basis of high coefficients of correlation. However, correlation of methods does not necessarily imply agreement.

METHODS

In a prospective analysis, 25 consecutive subjects all had two-dimensional echocardiography and radionuclide angiography performed within 10 days of each other in the cardiology department of metropolitan community hospital. A retrospective computer search (Medline) revealed seven studies, using the coefficient of correlation (r), comparing two-dimensional echocardiographic left ventricular ejection fraction (n = 268) with radionuclide angiographic (n = 174) or contrast cineangiographic (n = 119) left ventricular ejection fractions.

RESULTS

The eight individual studies (n = 293) comparing two-dimensional echocardiography with either radionuclide angiography or contrast cineangiography exhibited coefficients of correlation ranging from 0.78 to 0.93. Agreement analysis using the method of Bland and Altman was performed by averaging the results obtained from the two techniques and determining how disparate any single ejection fraction was (with 95% confidence limits) from the mean value. Agreement ranged from 23% to 42% around the mean ejection fraction. The average lack of agreement between the two methods for all studies involved was 17%, with an average r value of 0.86.

CONCLUSIONS

Left ventricular ejection fraction determinations by means of two-dimensional echocardiography, radionuclide angiography and contrast cineangiography exhibit high correlation and only moderate agreement. High correlation does not always imply high agreement. These results suggest that, when validated by agreement analysis, multiple studies may not be necessary in appropriate clinical situations, potentially reducing costs.

Lymphatic absorption of enterally fed structured triacylglycerol vs physical mix in a canine model

The lymphatic absorption of a structured triacylglycerol vs an equivalent physical mixture of the constituent medium-chain triacylglycerol and fish oils was studied. Each of four canines served as its own control in a crossover feeding design with the investigators unaware of diet contents. Lymphatic absorption of n-3 and medium-chain fatty acids peaked within 4-8 h of feeding either diet. The lymph contained more 10:0 fatty acids than 8:0 despite an overall ratio of 10:0 to 8:0 of 0.3 for the diets. The mass of medium-chain fatty acids absorbed in the lymph at measured time points was 2.6 +/- 0.5-fold higher (mean +/- SE of 12 determinations) for the structured triacylglycerol compared with the physical mix. Molecular species analyses revealed that the medium-chain fatty acids in lymph were present as mixed triacylglycerols. The unique molecular structure of these mixed triacylglycerols and the fatty acids at the 2-position may account for the improved absorption.