Targeting VEGF/Neuropilin-2 as a Novel Approach to Induce Radiosensitivity in Triple Negative Breast Cancer

PURPOSE/OBJECTIVE(S)

Triple-negative breast cancer (TNBC) is an aggressive phenotype with patients having more limited survival compared with other breast cancer subtypes. The high rate of locoregional/distant recurrence after primary management implies that additional treatment is necessary to optimize the sensitivity of TNBC tumors to therapy including radiation. Our lab studies the role of VEGF/Neuropilin-2 (NRP2) in mediating cancer stem cell properties such as self-renewal and therapy resistance. We sought to identify a new therapeutic approach that can induce radiosensitization in TNBC.

MATERIALS/METHODS

Cell viability in response to radiotherapy in patient-derived organoids (PDO) and xenografts (PDX) was determined using CellTiter-Glo. The VEGF/NRP2 pathway was disrupted in human BT549 and murine 4T1 models using RNA interference and a function blocking antibody (aNRP2-10) provided by aTyr Pharma. Nitrite levels, a surrogate marker for NOS2 activity, were measured using Measure-IT Nitrite Assay Kit. H2DCFDA was used to measure intracellular reactive oxygen species (ROS). Clonogenic survival assays were used to calculate radiosensitivity enhancement ratios (rER) in TNBC cell lines. For our in vivo models, 4T1 xenografts were given antibody treatment every 48 hours starting a day prior to 10Gy irradiation.

RESULTS

We identified a novel radioresistant population expressing high levels of NRP2 and NOS2 and observed that NOS2 expression was dependent on VEGF/NRP2 via Gli1 transcription. Interestingly, reducing NRP2 expression increased radiation-induced ROS because of reduced NOS2/NO levels. The downstream consequence of higher NOS2/NO was increased Nrf2 activation via KEAP1 S-nitrosylation; thus, inducing expression of antioxidant response elements. TNBC cells were radiosensitized by knocking down NRP2 (rER 1.19 - 1.34). We saw similar results when using aNRP2-10 vs IgG (rER 1.30 - 1.37). Ectopic expression of NOS2 and constitutively active Nrf2 rescued the radioresistance phenotype in the NRP2 knock-down cells (rER 0.73 - 0.82). Consistent with the cell line data, the clinically relevant models (PDOs and PDXs) had a synergistic reduction in cell viability in response to aNRP2-10 prior to radiotherapy. We also observed a significant reduction in tumor volume and increase in necrosis in vivo in response to VEGF/NRP2 inhibition during radiotherapy.

CONCLUSION

Inhibiting VEGF/NRP2 induces radiosensitization of TNBC by decreasing NOS2/NO levels and, consequently, Nrf2-mediated antioxidant gene expression. The role of Gli1 as a transcription factor for NOS2 is a novel finding that provides an unexpected link between VEGF/NRP2 and redox homeostasis in response to radiation. Current Nrf2 inhibitors are non-specific and have high toxicity; thus, making VEGF/NRP2 inhibition more favorable. Our data provide a novel therapeutic strategy for targeting TNBC breast cancer.

Association of MGMT Promoter Methylation With Survival in Low-grade and Anaplastic Gliomas After Alkylating Chemotherapy

Importance

O6-methylguanine-DNA methyltransferase (MGMT [OMIM 156569]) promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy for glioblastomas and is routinely used to guide treatment decisions. However, the utility of MGMT promoter status for low-grade and anaplastic gliomas remains unclear due to molecular heterogeneity and the lack of sufficiently large data sets.

Objective

To evaluate the association of mMGMT for low-grade and anaplastic gliomas with chemotherapy response.

Design, Setting, and Participants

This cohort study aggregated grade II and III primary glioma data from 3 prospective cohort studies with patient data collected from August 13, 1995, to August 3, 2022, comprising 411 patients: MSK-IMPACT, EORTC (European Organization of Research and Treatment of Cancer) 26951, and Columbia University. Statistical analysis was performed from April 2022 to January 2023.

Exposure

MGMT promoter methylation status.

Main Outcomes and Measures

Multivariable Cox proportional hazards regression modeling was used to assess the association of mMGMT status with progression-free survival (PFS) and overall survival (OS) after adjusting for age, sex, molecular class, grade, chemotherapy, and radiotherapy. Subgroups were stratified by treatment status and World Health Organization 2016 molecular classification.

Results

A total of 411 patients (mean [SD] age, 44.1 [14.5] years; 283 men [58%]) met the inclusion criteria, 288 of whom received alkylating chemotherapy. MGMT promoter methylation was observed in 42% of isocitrate dehydrogenase (IDH)-wild-type gliomas (56 of 135), 53% of IDH-mutant and non-codeleted gliomas (79 of 149), and 74% of IDH-mutant and 1p/19q-codeleted gliomas (94 of 127). Among patients who received chemotherapy, mMGMT was associated with improved PFS (median, 68 months [95% CI, 54-132 months] vs 30 months [95% CI, 15-54 months]; log-rank P < .001; adjusted hazard ratio [aHR] for unmethylated MGMT, 1.95 [95% CI, 1.39-2.75]; P < .001) and OS (median, 137 months [95% CI, 104 months to not reached] vs 61 months [95% CI, 47-97 months]; log-rank P < .001; aHR, 1.65 [95% CI, 1.11-2.46]; P = .01). After adjusting for clinical factors, MGMT promoter status was associated with chemotherapy response in IDH-wild-type gliomas (aHR for PFS, 2.15 [95% CI, 1.26-3.66]; P = .005; aHR for OS, 1.69 [95% CI, 0.98-2.91]; P = .06) and IDH-mutant and codeleted gliomas (aHR for PFS, 2.99 [95% CI, 1.44-6.21]; P = .003; aHR for OS, 4.21 [95% CI, 1.25-14.2]; P = .02), but not IDH-mutant and non-codeleted gliomas (aHR for PFS, 1.19 [95% CI, 0.67-2.12]; P = .56; aHR for OS, 1.07 [95% CI, 0.54-2.12]; P = .85). Among patients who did not receive chemotherapy, mMGMT status was not associated with PFS or OS.

Conclusions and Relevance

This study suggests that mMGMT is associated with response to alkylating chemotherapy for low-grade and anaplastic gliomas and may be considered as a stratification factor in future clinical trials of patients with IDH-wild-type and IDH-mutant and codeleted tumors.

Depression after minor stroke: prevalence and predictors

BACKGROUND AND PURPOSE

Post-stroke depression (PSD) is one of the most frequent complications of stroke, with a prevalence ranging 20-60%. As PSD seems to be related to stroke severity, we hypothesized that the prevalence of PSD would be lower in patients with minor stroke.

METHODS

We investigated the prevalence and predictors of PSD over a 30-month follow-up period in a cohort of patients with minor ischaemic stroke (NIHSS≤5).

RESULTS

We enrolled 105 patients (mean age 64.38±11.2years, M/F 69/36). PSD was diagnosed in 43 (41%) patients, 40 (93%) of whom had dysthymia; 22% of patients were already depressed at 1month. The most frequent depressive symptoms (DSs) were working inhibition, indecisiveness, and fatigability. Patients who developed PSD were less educated (P=0.044) and diabetic (P=0.006). After excluding patients that were already depressed at 1month, we performed a logistic regression model to detect predictors of PSD. Crying (P=0.012, OR 1.067, CI 0.269-4.553) and guilt (P=0.007, OR 0.037, CI 0.02ì03-0.401) at baseline were two DSs found to be significantly correlated with PSD. Higher educational level (P=0.022, OR 0.084, CI 0.010-0.698) and diabetes (P=0.007, OR 14.361, CI 2.040-101.108) were the risk factors significantly correlated with PSD.

CONCLUSION

Post-stroke depression is frequent even in patients with minor stroke. Early detection of DSs might help to predict long-term development of PSD. No correlation was observed between lesion site or side and the development of PSD.

Combined Pharmacological and Short-Term Psychodynamic Psychotherapy for Probable Medication Overuse Headache: A Pilot Study

We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A ( P = 0.0108 and P = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P = 0.016, and 23%, OR 0.18, P = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P = 0.047) and 12 months (OR 2.75, P = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM.

Neurotrophic spread of both neuroblastoma and adenoid cystic carcinoma in the maxillofacial district: common aspects of pre- and postsurgical adjuvant treatment. Multidisciplinary study

We have studied a common aspect of both adenoid cystic carcinoma (ACC) and neuroblastoma (NB) with the purpose of finding the optimal medical and surgical treatment. This article is based on a case study involving 22 cases of ACC and NB performed at the University of Rome La Sapienza from 1993 to 2001. Of the 22 cases, 17 were diagnosed with ACC and 5 with NB. ACC largely involved the maxillae, having been detected in this location in eight cases. Two of these patients, one affected by ACC and the other affected by NB, received neoadjuvant treatment, whereas 14 were affected by ACC, and 3 with NB received adjuvant treatment. Despite the fact that the two neoplasms have different embryogenic structures, they share common aspects. Both spread invasively through the perineural sheets, and both are responsive to radiotherapy or chemotherapy. The common biologic behavior and the similar response that both show to neoadjuvant radiotherapy or chemotherapy may suggest a way to develop a more effective treatment protocol. The aim of this article is to suggest a line of research along that path.

Cancer-related patient education: an overview of the last decade of evaluation and research

PURPOSE/OBJECTIVES

To provide an overview of cancer-related patient-education research to determine future research needs.

DATA SOURCES

A literature search of peer-reviewed articles from 1989-1999. Databases that were searched included Medline, CINAHL, HealthStar, ERIC, CancerLit, and PubMed.

DATA SYNTHESIS

176 articles were analyzed and synthesized into narrative form.

CONCLUSIONS

Patients with cancer want and benefit from information, especially when making treatment decisions. Education helps patients manage side effects and improves adherence. Literacy is an important factor in materials development. The efficacy of computer-assisted learning, audio and video programs, and telephone interventions is supported in a variety of patient groups. Pain education can improve pain control, but the impact on fatigue has not been well researched.

IMPLICATIONS FOR NURSING PRACTICE

Patient education is an important component of nursing care. Research has confirmed its impact in many areas but questions still remain.

Sucrase-isomaltase is an independent prognostic marker for colorectal carcinoma

PURPOSE

Expression of disaccharidase sucrase-isomaltase (SI) is significantly enhanced during neoplastic transformation of colonic epithelium. Our study was designed to determine whether expression of SI within primary tumors was significantly associated with survival in patients with colorectal carcinoma (CRC).

METHODS

SI expression was analyzed by immunohistochemistry in paraffin sections from 182 Stage I to III CRC that had been resected for cure at the New England Deaconess Hospital between 1965 and 1977. Expression was scored as absent or present in 1 to 50 percent or more than 50 percent of tumor cells. Associations were explored among SI expression, other clinical or pathologic variables, and overall survival. The data set is mature, with 91 (56 percent) patients who had died of CRC at a median follow-up of 96 months.

RESULTS

Fifty-five percent of primary CRC expressed SI. When the multivariate Cox analysis was performed, nodal status, T stage, primary site, grade, and SI expression were independent covariates. SI expression was not associated with the expression of other clinicopathologic variables but increased the risk of death from colorectal carcinoma by 1.83-fold.

DISCUSSION

These results indicate that SI is a prognostic marker for CRC that is independent of stage-related variables in patients who have undergone potentially curative resections.

A case report of naltrexone treatment of self-injury and social withdrawal in autism

The endogenous opiate release theory of self-injurious behavior (SIB) was investigated through double-blind placebo-controlled administration of naltrexone hydrochloride (Trexan) to a 14-year-old autistic and mentally retarded male for treatment of severe SIB. Results yielded a marked decrease in SIB during two phases of active drug treatment, though SIB did not revert to originally observed placebo levels during a second placebo phase. An increase in social relatedness also was observed during phases of active drug treatment. Opiate theories of self-injury and the possible interrelationship of self-injury with pituitary-adrenal arousal and with social relatedness are discussed.

Biological tissue simulation and standard testing material for MRI

The polyacrylamide gel is proposed here as a phantom material for NMR imaging. This substance has electrical and NMR relaxation characteristics very similar to those of biological tissues. The thermal and time stabilities also make this material a convenient standard for MRI.

Cellular localization and export of the soluble haemolysin of Vibrio cholerae El Tor

The cellular location of the haemolysin of Vibrio cholerae El Tor strain 017 has been analyzed. This protein is found both in the periplasmic space and the extracellular medium in Vibrio cholerae. However, when the cloned gene, present on plasmid pPM431, is introduced into E. coli K-12 this protein remains localized predominantly in the periplasmic space with no activity detected in the extracellular medium. Mutants of E. coli K-12 (tolA and tolB) which leak periplasmic proteins mimic excretion and release the haemolysin into the growth medium. Secretion of haemolysin into the periplasm is independent of perA (envZ) and in fact, mutants in perA (envZ) harbouring pPM431 show hyperproduction of periplasmic haemolysin. These results in conjunction with those for other V. cholerae extracellular proteins suggest that although E. coli K-12 can secrete these proteins into the periplasm, it lacks a specific excretion mechanism, present in V. cholerae, for the release of soluble proteins into the growth medium.

[Gastric lesions in closed abdominal injuries (considerations on 8 cases)]

The Authors present 8 cases of traumatic lesions of the stomach, during the course of closed abdominal trauma, observed in the First Aid and Emergency Surgery Division of the Niguarda Ca' Granda Hospital, Milan, in the years 1970-1979. They take this as the starting point for a re-examination of the etiopathogenetic and anatomopathological data, and for diagnostic, prognostic and therapeutic considerations.

[Considerations on two cases of spigelian hernia (author's transl)]

The Authors describe two cases of abdominal hernia through the linea semilunaris (spigelian hernia) of their own observation; they outline the anatomic substrate and clinical picture of this condition and conclude by advocating surgical correction as a constant indication.

Stress Relaxation Studies of Scission in Rubber Vulcanizates

Deterioration of many vulcanized hydrocarbon rubbers is known to be due to reaction with molecular oxygen. Such a process is independent of oxygen concentration down to several mm of oxygen pressure and hence proceeds quite readily in an air atmosphere provided that experiments are conducted with thin enough samples to eliminate oxygen diffusion effects. Two chemically distinct loci for attack by oxygen are available. These are the crosslinked sites which are added during the vulcanization process and the network chains which are essentially the same as in the unvulcanized material. The prime objective of this study is to show clearly that vulcanized natural rubber suffers oxidative scission predominantly along the polyisoprene chains and not at the crosslinked sites as proposed by Berry and Watson. Other literature has appeared which indicates that this important point needs further clarification. Stress relaxation experiments, which measure the rate of breaking of the weakest chemical bonds recurring throughout the structure, have been utilized. If the crosslinks are oxidized, then similar rates of scission should be obtained for different chain structures so long as the common crosslink is present in all of them. On the other hand, if chains are oxidized, then rates of scission should be essentially independent of the crosslinking agent used but rather depend markedly on each chain structure. The five chain structures used in this study are depicted in Table I. In each case at least a few per cent of double bond-containing segments are present in the main chain to allow for ordinary chemical vulcanization methods. All of these have been crosslinked by sulfur and by a nonsulfur containing agent.