The Influence of Adipocyte Secretome on Selected Metabolic Fingerprints of Breast Cancer Cell Lines Representing the Four Major Breast Cancer Subtypes

Molecular subtype (MS) is one of the most used classifications of breast cancer (BC). Four MSs are widely accepted according to receptor expression of estrogen, progesterone, and HER2. The impact of adipose tissue on BC MS metabolic impairment is still unclear. The present work aims to elucidate the metabolic alterations in breast cancer cell lines representing different MSs subjected to adipocyte associated factors. Preadipocytes isolated from human subcutaneous adipose tissue were differentiated into mature adipocytes. MS representative cell lines were exposed to mature adipocyte secretome. Extracellular medium was collected for metabolomics and RNA was extracted to evaluate enzymatic expression by RT-PCR. Adipocyte secretome exposure resulted in a decrease in the Warburg effect rate and an increase in cholesterol release. HER2+ cell lines (BT-474 and SK-BR-3) exhibited a similar metabolic pattern, in contrast to luminal A (MCF-7) and triple negative (TN) (MDA-MB-231), both presenting identical metabolisms. Anaplerosis was found in luminal A and TN representative cells, whereas cataplerotic reactions were likely to occur in HER2+ cell lines. Our results indicate that adipocyte secretome affects the central metabolism distinctly in each BC MS representative cell line.

New CTX-M Group Conferring β-Lactam Resistance: A Compendium of Phylogenetic Insights from Biochemical, Molecular, and Structural Biology

The production of extended-spectrum β-lactamases (ESBLs) is the main defense mechanism found in Gram negative bacteria. Among all the ESBLs, the CTX-M enzymes appear as the most efficient in terms of dissemination in different epidemiological contexts. CTX-M enzymes exhibit a striking plasticity, with a large number of allelic variants distributed in several sublineages, which can be associated with functional heterogeneity of clinical relevance. This observational analytical study provides an update of this family, currently with more than 200 variants described, from a phylogenetic, molecular, and structural point of view through homology in amino acid sequences. Our data, combined with described literature, provide phylogenetic and structural evidence of a new group. Thus, herein, we propose six groups among CTX-M enzymes: the already stablished CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9, and CTX-M-25 clusters, as well as CTX-M-151 as the new cluster.

Understanding stress in patients with multiple sclerosis: The joint predictive role of disease characteristics and emotion regulation processes

Introduction

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. This condition is enhanced by stress. In turn, stress symptoms are a risk factor for the onset and progression of MS. However, knowledge about predictors of stress in patients with MS is scarce.

Objectives

This preliminary study aimed to verify whether the number of relapses, fatigue, physical disability (MS characteristics), experiential avoidance and self-judgment (emotion regulation processes) predict stress symptoms in patients diagnosed with MS.

Methods

A convenience sample of 101 patients diagnosed with MS and without other neurological diseases participated in this study. Participants completed the Depression Scale of the Depression, Anxiety and Stress Scales-21, Analog Fatigue Scale, World Health Organization Disability Assessment Schedule-12, Acceptance and Action Questionnaire-II, and Self-Judgment Subscale of the Self-Compassion Scale.

Results

All predictors initially hypothesized and years of education have significant correlations with stress symptoms. Simple linear regression analyses showed that the variables significantly predicted stress symptoms and were, therefore, included in the multiple linear regression model. This model explained 51.8% of the variance of the stress symptoms and showed that years of education, the number of relapses, fatigue, and experiential avoidance significantly predicted those symptoms.

Conclusions

The promotion of mental health mental in patients with MS must develop functional skills to deal with stress induced by years of education (possibly responsible for the degree of awareness about MS and its consequences), recurrence of relapses and fatigue, and should minimize emotion regulation strategies focused on experiential avoidance.

Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients

OBJECTIVES

Current knowledge of the cardiac manifestations of rheumatoid arthritis (RA) stems only from clinical and transthoracic echocardiography (TTE) studies. To determine the incidence and type of heart lesions in RA, we coupled TTE with transesophageal echocardiography (TEE), which is more sensitive and more accurate.

METHODS

Thirty unselected RA patients (26 women and 4 men aged 27 to 84 years, with a mean age of 57.8+/-15.1 years) free of known progressive heart disease underwent a chest radiograph, an electrocardiogram, laboratory tests, and TTE coupled with TEE. Results were compared with those in age- and sex-matched patients who were free of rheumatic disease and who underwent TEE to investigate a neurologic or cardiologic disorder.

RESULTS

Mitral regurgitation (MR) was evidenced in 24 cases (80%). Among the controls, only 11 (37%) had MR (P < 0.001). Aortic regurgitation was found in 10 cases (33%), versus 7 controls (not significant-NS). Seven cases (23%) versus only 2 controls (7%) had tricuspid valve abnormalities (NS). Pericarditis was found in 4 cases (13%) and in none of the controls. Eleven cases had evidence of cardiomyopathy (37%) and 12 (40%) had atheroma of the aorta, this last being missed by TTE in 10 patients. Echo-generating nodules were seen on a mitral valve in 2 cases and on an aortic valve in 1. We found no correlations linking cardiac lesions to clinical or laboratory features of RA.

CONCLUSION

Our study demonstrated that cardiac involvement, particularly of the mitral valve, is extremely common in RA patients.

Prevalence of rheumatoid arthritis and spondyloarthropathy in Brittany, France. Société de Rhumatologie de l'Ouest

OBJECTIVE

To document the prevalence of rheumatoid arthritis (RA) and spondyloarthropathy (SpA) in Brittany, France.

METHODS

(1) Members of rheumatism self-help groups screened cases using questionnaires. (2) Rheumatologists in our unit contacted persons who had possible inflammatory rheumatic diseases and persons who refused the first interview. (3) When diagnosis remained unknown or discordant with the questionnaire, the general practitioner or the rheumatologist of these patients was interviewed. (4) Patients without diagnosis and who had not had a rheumatological examination were examined without charge by a rheumatologist.

RESULTS

An overall prevalence rate of 0.62% (0.33-0.91) and 0.47% (0.22-0.72) was found for RA and for SpA, respectively. The prevalence of RA and SpA was 0.86 (0.39-1.33) and 0.53 (0.16-0.9) in women and 0.32 (0.01-0.63) and 0.41 (0.05-0.77) in men. The minimum prevalence of RA and SpA calculated on the estimated initial group (3189 persons) was 0.53 (0.28-0.78) and 0.41 (0.18-0.63), respectively.

CONCLUSION

Our telephone survey revealed that the prevalences of RA and SpA are nearly similar among our population and that SpA is as common in women as in men.

Risk factors for radiographic articular destruction of hands and wrists in rheumatoid arthritis

OBJECTIVE

To carry out a cross sectional case-control study of the risk factors for articular destruction in a large sample of patients with a long history of rheumatoid arthritis (RA), presupposing that the variables we measured were unrelated to the duration of disease.

METHODS

Each inpatient with RA admitted to our department from January 1, 1985, to December 31, 1995, underwent standard examination, laboratory tests, and hand roentgenograms. We carried out a radiographic cross sectional study on 287 of them. Radiographic evaluation was performed by the same observer (correlation coefficient 0.97) using the modified Sharp method. To investigate an association between articular destruction and prognostic variables, a matched analysis of the case-control data and calculation of the odds ratio (OR) with 95% confidence intervals (CI) were carried out. For each patient with severe articular destruction, patients hospitalized during the study period with the same disease duration but without severe articular destruction were included as controls. The sample size was chosen to show an OR > 2 (1-alpha = 95%; 1-beta = 80%).

RESULTS

The risk of articular joint destruction was higher in women than in men (OR 2.72, CI 1.17-7.9, p<0.023), whereas age at onset or the presence of HLA-DR4, antiperinuclear factor, or antikeratin antibodies was not sufficiently strongly associated with the process of articular destruction to be considered relevant prognostic markers.

CONCLUSION

We conclude that female sex is significantly associated with a higher risk of articular destruction.

Mortality in rheumatoid arthritis

Rheumatoid arthritis reduces not only quality but also length of life. In the 14 main studies conducted since 1980, in a total of 13,424 patients, the mean standardized mortality ratio was 1.82 (range, 0.87-3) as compared to the population at large. Life expectancy was shortened by 5 to 10 years in most studies. The diversity of the methods used explains the discrepancies among results. Excess mortality may occur in only some subsets of patients. Both rheumatoid complications and an increase in nonspecific causes of death (e.g., infections) contribute to the excess mortality. Factors predictive of premature death are the same as those predictive of functional impairment. Many unknowns remain about the condition of rheumatoid arthritis patients at the end of their life.

Are tennis players at increased risk for low back pain and sciatica?

OBJECTIVE

Tennis practiced intensively is generally held to be a risk factor for low back pain. The objective of our study was to evaluate the prevalence of low back pain with or without sciatica during the last week in tennis players versus controls.

PATIENTS AND METHODS

During an international tennis competition held in Brest, France, ten physicians or medical students interviewed 633 spectators older than 18 years and divided them into tennis players and controls. The sample size was selected to allow detection of a twofold increase in the risk of low back pain in tennis players (with alpha = 5% and 1-beta = 80%).

RESULTS

Of the 633 subjects, 388 were and 245 were not tennis players. There were 421 men with a mean age of 37 +/- 13.7 years and 212 women with a mean age of 34.3 +/- 12.7. Among the men, 49 of the 281 tennis players (17.4%) reported low back pain during the last week versus 26 of the 140 controls (18.6%). Corresponding figures in women were 20 of 107 tennis players (18.7%) and 29 of 105 controls (27.6%). Sciatica was not more common in tennis players (men, 20 of 281 tennis players [7.1%] versus 6 of 140 controls [4.3%]; women, 8 of 107 tennis players [7.5%] versus 10 of 105 controls [9.5%]). None of the differences between tennis players and controls were significant. The number of hours spent playing tennis per week was similar in tennis players with and without low back pain.

CONCLUSION

Our interview-based cross-sectional study found no evidence that playing tennis involves a higher risk of low back pain with or without sciatica.

HLA-B27 in French patients with rheumatoid arthritis

Aims were to determine the prevalence of the HLA-B27 phenotype in a group of patients with RA, and to evaluate the clinical, radiological and, serological characteristics of RA in relation to this phenotype. All relevant information was obtained retrospectively from the standardized clinical records of 311 RA in-patients first admitted to the Rheumatology Unit of the Brest University Medical School. In the control population of Britanny, the frequency of HLA-B27 has been shown to be 12%, while HLA-B27 was present in 30 (9.6%) of the 311 RA patients. There was no significant association between demographic, clinical, biological, or radiological characteristics of the patients on the one hand, and the presence of the HLA-B27 allele on the other. The subgroup of RA patients with HLA-B27 had however a slightly higher IgA level than that without HLA-B27. Ankylosing spondylitis were found to coexist in three patients who all were HLA-B27 positive. We conclude (1) that the prevalence of HLA-B27 is not higher in French RA patients than in the normal controls, and (2) that HLA-B27 typing is not useful in RA. HLA-B27 does not confirm nor does it reject the diagnosis of associated ankylosing spondylitis.

Prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis

OBJECTIVE

To evaluate the prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis.

METHODS

Cross-sectional retrospective study of 453 rheumatoid arthritis patients. All patients completed a questionnaire designed to detect manifestations of bronchiectasis and had a chest film taken. Computed tomography of the chest was performed in those patients whose chest film was normal.

RESULTS

Thirteen patients (2.9%), all female, had symptoms that met Walker's criteria for definite (n = 7) or probable (n = 6) bronchiectasis. Symptom onset was during childhood or adolescence in 69% of cases and antedated the first symptoms of rheumatoid arthritis in all patients but one. Six of the 13 patients (46%) had chest film abnormalities suggestive of bronchiectasis, and three of the remaining seven patients had abnormal computed tomography findings, yielding a total of nine cases of bronchiectasis confirmed by imaging studies among the 13 patients with suggestive symptoms (69%). This proportion rose to 90% when the three patients who failed to come to their computed tomography appointment were excluded.

CONCLUSION

Using a methodological approach similar to that previously used by pneumologists, we found a 2.9% prevalence of symptomatic bronchiectasis in a population of hospitalized rheumatoid arthritis patients, which is higher than the 0.03% prevalence previously reported in the population at large.

[Diagnostic value of the HLA phenotype in inflammatory rheumatic diseases]

OBJECTIVES

HLA phenotyping is usually considered as costly and unnecessary for the diagnosis of inflammatory rheumatoid diseases. The aim of our work was to assess the diagnostic value of HLA phenotyping compared with the diagnostic value of sex and age at the onset of disease in cases where there is a doubt between rheumatoid polyarthritis and spondyloarthropathy with peripheral involvement.

METHODS

The relative prevalence of inflammatory rheumatoid diseases was calculated for 138 patients hospitalized for diagnosis of rheumatoid disease. We considered however that in these patients the etiology of the inflammatory rheumatoid disease with synovitis, after search for etiology, could be either spondyloarthropathy with peripheral involvement or early-stage rheumatoid polyarthritis. Positive and negative predictive values were calculated by comparison between these two diseases. The sensitivity of HLA B27 in spondyloarthropathy with peripheral involvement was determined in a population of 83 hospitalized patients with confirmed diagnosis. The prevalence of HLA DR4 in rheumatoid polyarthritis was determined in 375 hospitalized patients with confirmed diagnosis. Predictive values were calculated using Bayes formula.

RESULTS

The analysis of the positive and negative predictive values for HLA B27 showed that the diagnostic value of this allele was much greater than age at disease onset and sex in spondyloarthropathy with peripheral involvement. For rheumatoid arthritis, comparison of the diagnostic value of HLA DR4 versus age at disease onset and sex showed the lower performance of HLA DR4. However, the positive predictive value of HLA DR4 in rheumatoid polyarthritis was similar to that for these factors and equivalent to that of HLA B27. The positive predictive value for the combinations HLA DR4+ HLA B27- and HLA B27+ HLA DR4- was 0.90 for rheumatoid polyarthritis and spondyloarthropathy with peripheral involvement respectively.

CONCLUSION

The validity of these promising findings should be confirmed in prospective studies.

Clinical, laboratory, and radiographic features of rheumatoid arthritis with and without nodules

To determine the significance of nodules in rheumatoid arthritis, we reviewed the medical records of 420 patients who underwent standardized clinical, laboratory, and radiological investigations during a hospitalization for rheumatoid arthritis between January 1, 1981 and December 31, 1994. Sixty-six patients (16%) had nodules and 354 (84%) did not. Age and gender distributions were similar in the two groups. Disease duration was significantly longer in the nodular than in the nonnodular group (11.3 +/- 9.4 years versus 7.6 +/- 7.3 years; P = 0.0003). When patients were stratified into five-year disease duration groups, dryness of the eyes and mouth was found to be more common in the nodular group, with the difference being largest during the first five years. Patients with nodules were more likely to have vasculitis irrespective of disease duration (odds ratio, 6.08; P = 0.028). Lee's and Ritchie's indices and radiographic alterations were more severe in the nodular group, whereas tests for inflammation were not significantly different. Patients with rheumatoid factors accounted for a larger proportion of the nodular than of the nonnodular group (odds ratio 2.48; P = 0.017). When patients were dichotomized based on latex test results, nodules were not significantly associated with antiperinuclear factor or antikeratin antibodies, whereas patients with nodules were significantly more likely to have vasculitis (odds ratio 5.3; P = 0.035), antinuclear factors (odds ratio 1.82; P = 0.043), and cryoglobulinemia (odds ratio 4.86; P = 0.0029). As compared with nonnodular rheumatoid arthritis, nodular rheumatoid arthritis was associated with more severe extraarticular disease, faster radiographic progression and a greater likelihood of rheumatoid factor and antinuclear antibody production. Each of these characteristics was associated with the presence of nodules independently from disease duration and rheumatoid factor positivity.

Raynaud's phenomenon in rheumatoid arthritis

The aim of this study was to evaluate the prevalence of Raynaud's phenomenon in patients with rheumatoid arthritis (RA), and to relate this symptom to clinical, radiological and serological characteristics of the patients. All relevant information was retrospectively obtained from the standardized clinical records of 322 RA in-patients first admitted to the Rheumatology Unit of Brest University Medical School. Raynaud's phenomenon was found in 54 (17.2%) of 322 RA patients. There was no significant correlation between demographic, clinical or radiological characteristics. However, the subgroup of RA patients with Raynaud's phenomenon had a slightly higher prevalence of vasculitis than the subgroup without Raynaud's phenomenon. CRP level and C4 level were found to be lower in the former than in the latter group, whereas ESR and various serological findings (rheumatoid factor, antinuclear antibodies) were comparable in the two groups. We conclude that the prevalence of Raynaud's phenomenon is high in French RA in-patients, and that some clinical and biological abnormalities (vasculitis, low CRP level and low C4 level) suggest an association between Raynaud's phenomenon and vasculitis in a few cases, whereas this association might be fortuitous in the remainder.

Insufficiency fractures of the sacrum in elderly subjects

Elderly patients who develop insufficiency fractures of the sacrum usually have generalized bone loss and/or lesions of the pelvic bones (due to radiation therapy or previous fractures). The sacral fracture occurs either spontaneously or after a trivial traumatic episode. We compared patients admitted for sacral fractures (n = 12) or vertebral crush fractures (n = 56) in an effort to identify risk factors for sacral fractures. We conducted a retrospective review of the medical records of the 12 patients older than 70 years who were admitted to the rheumatology department of the Morvan Hospital between January 1, 1985 and December 31, 1994 for evaluation of a sacral fracture. The onset of symptoms was abrupt in 11 patients and occurred after an unremarkable fall in three. Patients admitted for sacral fractures were significantly more likely to have a positive history for a fracture, femoral surgery, or pelvic radiation therapy than patients admitted for vertebral fractures (58% versus 9%, p = 0.0005). In contrast, levels of calcium, phosphorus, 25-OH vitamin D and 1,25(OH)2 vitamin D were comparable in the two groups after exclusion of those patients with endocrine disorders or a history of calcium and vitamin D supplementation. In conclusion, populations of elderly patients with sacral fractures and crush fractures are comparable and the occurrence of a sacral fracture is dependent on the presence of pelvic and/or femoral osseous abnormalities.