O11: MYOFERLIN: A NOVEL BIOMARKER OF RADIOSENSITIVITY IN LOCALLY ADVANCED RECTAL CANCER

Introduction

Our proteomic data has validated that high levels of the protein myoferlin confers poorer response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Myoferlin plays a role in membrane repair and VEGF signal transduction, and is associated with worse prognosis in numerous other epithelial cancers. We aim to assess the impact of myoferlin on the radiosensitivity of rectal cancer.

Method

Clonogenic assays were performed using immortalised colorectal cancer cells (HCT116,HT29,LIM,MDST8) to assess survival at escalating radiation doses following knockdown with myoferlin siRNA or a small molecular inhibitor(WJ460). 3D models (spheroids) were used to examine the effect of WJ460 on tumour growth.

Result

Quantification of myoferlin using immunoblotting demonstrated that MDST8 and LIM were higher expressors than HCT116 and HT29. Higher levels correlated with increasing radio-resistance as calculated by colony formation efficiency (CFE). Using clonogenic assays, cells treated with myoferlin siRNA or WJ460 demonstrated increased radiosensitivity compared to controls across all radiation doses, most significantly at 4Gy. Treatment of spheroids with WJ460 significantly reduced growth compared to controls at all radiation doses (p<0.05), with WJ460 limiting growth considerably more than treatment with the current gold standard 5-FU. HCT116 spheroid volume day 15; WJ460 4.96um3,5-FU 6.74um3,DMSO 24.9um3.

Conclusion

Inhibition of myoferlin is associated with increased radiosensitivity of colorectal cancer cells, and treatment with a small molecular inhibitor significantly reduces growth in spheroid models. Further work is required further validate its potential use as a biomarker in locally advanced rectal cancer.

Take-home message

We have found that myoferlin is a protein associated with poor response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Manipulation of this protein sensitises the cancer cells to radiotherapy.

O48: MYOFERLIN: A NOVEL PREDICTIVE BIOMARKER AND THERAPEUTIC TARGET IN ADVANCED COLORECTAL CANCER

Introduction

Myoferlin is a protein involved in cell proliferation, migration and angiogenesis, which are essential in tumour metastasis. Its expression correlates with a poorer prognosis in various epithelial cancers, but has yet to be associated with survival in colorectal cancer. We aim to investigate myoferlin's role in cell migration, and the development of metastases in our patients with rectal cancer.

Method

Tissue Microarrays (TMAs) of matched tumour and lymph node samples from 111 patients with rectal cancer were stained for myoferlin. Expression profiles were examined and correlated with clinical outcomes. Wound healing assays were used to assess the rate of migration in immortalised colorectal cells (HCT116, HT29) following myoferlin knockdown with siRNA.

Result

Our TMAs demonstrated that high myoferlin expression in rectal tumour samples was associated with metastatic spread to local lymph nodes (p<0.05). Positive lymph nodes had significantly higher levels of myoferlin than non-involved lymph nodes (p<0.001). The positive predictive value (PPV) of a highly expressing lymph node containing metastatic spread was 100%, negative predictive value (NPV) 88.41%, 95% CI [80.81, 93.24]. Wound healing assays demonstrated a decreased ability of cells to migrate following myoferlin knockdown with siRNA, compared to controls (p<0.05).

Conclusion

Our results demonstrate that high myoferlin expression is associated with metastatic spread to local lymph nodes, and increased migration and proliferation of cells. It is a predictor of poor clinical outcomes, and therefore warrants further investigation as a potential therapeutic target in both locally advanced and metastatic rectal cancer.

Take-home message

We have demonstrated that the protein myoferlin is associated with metastatic spread of rectal cancer to local lymph nodes. Therefore it is a potential predictive biomarker and therapeutic target in advanced rectal cancer.

Does tamoxifen have a therapeutic role outside of breast cancer? A systematic review of the evidence

INTRODUCTION

Tamoxifen is a widely used hormonal based therapy for breast cancer in the adjuvant and metastatic setting, prolonging overall and recurrence-free survival. There has been increasing interest in the potential for novel "off-target" effects of tamoxifen and its metabolite N-desmethyltamoxifen across a number of cancer types. We aim to review the current literature regarding the potential use of tamoxifen in other primary malignancies.

METHOD

A qualitative systematic review was performed according to the PRISMA guidelines using pre-set search criteria across the PubMed, Cochrane and Scopus databases from 1985 to 2019. Additional results were generated from included papers references.

RESULTS

A total of 324 papers were identified, of which 47 were included; a further 29 articles were obtained from additional referencing to give a total of 76 articles. Clinical trials have demonstrated benefits with the use of tamoxifen in isolation and combination, specifically in patients with advanced non-resectable malignancy, however results are not consistent across the literature. In vivo data consistently suggests that off target effects of tamoxifen are mediated through the ceramide pathway or through inhibition of protein kinase C (PKC).

CONCLUSIONS

With increased focus upon the potential of repurposing drugs, tamoxifen may be a candidate for repurposing in the wider cancer setting. There is evidence to suggest that the ceramide or PKC pathway could act as a therapeutic target for tamoxifen or alternative chemotherapeutics and merits further investigation.

Sphingolipids and acid ceramidase as therapeutic targets in cancer therapy

BACKGROUND

Sphingolipids have been shown to play a key part in cancer cell growth and death and have increasingly become the subject of novel anti-cancer therapies. Acid ceramidase, a sphingolipid enzyme, has an important role in the regulation of apoptosis. In this review we aim to assess the current evidence supporting the role of sphingolipids in cancer and the potential role that acid ceramidase may play in cancer treatment.

METHODS

A literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string "acid ceramidase", "sphingolipid", "cancer". Additional papers were detected by scanning the references of relevant papers. A summary of the evidence for each cancer subgroup was then formed. Given the nature of the data extracted, no meta-analysis was performed.

RESULTS

Over expression of acid ceramidase has been demonstrated in a number of human cancers. In vitro data demonstrate that manipulation of acid ceramidase may present a useful therapeutic target. In the clinical setting, a number of drugs have been investigated with the ability to target acid ceramidase, with the most promising of those being small molecular inhibitors, such as LCL521.

CONCLUSION

The role of the sphingolipid pathway in cancer is becoming very clearly established by promoting ceramide accumulation in response to cancer or cellular stress. Acid ceramidase is over expressed in a variety of cancers and has a role as a potential target for inhibition by novel specific inhibitors or off-target effects of traditional anti-cancer agents. Further work is required to develop acid ceramidase inhibitors safe for progression to clinical trials.

Imaging of adult intestinal failure

Intestinal failure is the inability to maintain adequate nutrition or hydration through the gut. It is caused by a diverse range of benign and malignant aetiologies. Imaging takes a central role in the multidisciplinary assessment of patients with intestinal failure.

A high-strength silicide phase in a stainless steel alloy designed for wear-resistant applications

Hardfacing alloys provide strong, wear-resistant and corrosion-resistant coatings for extreme environments such as those within nuclear reactors. Here, we report an ultra-high-strength Fe-Cr-Ni silicide phase, named π-ferrosilicide, within a hardfacing Fe-based alloy. Electron diffraction tomography has allowed the determination of the atomic structure of this phase. Nanohardness testing indicates that the π-ferrosilicide phase is up to 2.5 times harder than the surrounding austenite and ferrite phases. The compressive strength of the π-ferrosilicide phase is exceptionally high and does not yield despite loading in excess of 1.6 GPa. Such a high-strength silicide phase could not only provide a new type of strong, wear-resistant and corrosion-resistant Fe-based coating, replacing more costly and hazardous Co-based alloys for nuclear applications, but also lead to the development of a new class of high-performance silicide-strengthened stainless steels, no longer reliant on carbon for strengthening.

Unlocking stories: Older women's experiences of intimate partner violence told through creative expression

WHAT IS KNOWN ON THE SUBJECT

Intimate partner violence (IPV) impacts significantly on the lives and health of those who experience abuse The impact of IPV exerts a detrimental impact on mental health as well as physical health, but this is often not recognized by professionals WHAT THE STUDY ADDS TO EXISTING KNOWLEDGE: This study highlights the impact of IPV on the lives and health of older women from the perspective of older women themselves The approach taken to the study illuminates the ways in which older women describe their experiences within the broader narratives of their experiences This study has explored the particular situation for older women as told through creative expression and their own stories of survivorship.

IMPLICATIONS FOR PRACTICE

Nurses and other healthcare professionals need to be aware of the enduring impact of IPV for older women, particularly within the context of mental health Those working with older women also need to be alert to the potential barriers to disclosure and disjuncture between professional dialogue and personal narrative ABSTRACT: Introduction Intimate partner violence (IPV) exerts a detrimental impact on the lives and health of all who experience abuse. This includes both physical and mental health and well-being. The experiences of older women however may be different, and these differences may not be recognized or accounted for within existing care provision. Aim To explore the impact of IPV on the lives and health of older women told from the particular perspective of older women themselves as these accounts are largely absence from existing IPV discourse. Method An arts-based research approach with five older women survivors of IPV through the codevelopment and organization of an arts-based workshop. The workshop essentially encompassed four main arts strands and included the creation of clay models and poetry. Findings The findings of the study highlight the significant impact of IPV on the lives, mental health and well-being of older women. This included feelings of social isolation, inability to trust others and a loss of self-identity. Discussion Intimate partner violence is a global issue and as such of relevance for those working in healthcare contexts beyond the UK. While there is a growing body of evidence surrounding IPV and older women, this has largely been presented through researcher-led accounts and as such the narratives of women themselves may not have been adequately acknowledged. Unlike much of the existing evidence, this study has explored the particular situation for older women as told through creative expression and their own stories of survivorship. In this study, the fluidity of the potential materials available in the workshops meant that both the representations through which the women spoke and the primacy of their voices, over those of more traditional researcher accounts, were in evidence throughout. Implications for Practice Mental health nurses and practitioners are often on the front line for care and support for older client populations. IPV across the life span is a global issue for healthcare practitioners. It is anticipated that the findings of this study will provide the mechanism through which mental health nurses and other practitioners may reflect on older women's accounts of IPV as told by older women in this study in their own words. Reframing from dominant professional discourse to personal narrative is central to person-centred approaches and is central to contemporary practice. Ultimately, this has the potential to improve the effectiveness of care provision and support. Relevance to Mental Health Nursing The findings presented in this study have the potential to provide a powerful tool for those working within mental health contexts and healthcare professionals working with older populations more generally to consider both the hidden nature of IPV and the ways in which IPV can significantly impact on mental health and well-being in later life.

Haemoglobin disorders in Australia: where are we now and where will we be in the future?

Inherited disorders of haemoglobin (Hb), such as thalassaemia and sickle cell disease (SCD) are common and responsible for significant morbidity and mortality on a global scale. As Australia becomes increasingly ethnically diverse, their prevalence will increase. However, we lack important demographic and epidemiological data to manage these disorders and their consequences and to support affected individuals and communities. Thalassaemia and SCD are lifelong conditions. Affected individuals have reduced life expectancies, poorer quality of life and complex healthcare needs. Treatment strategies currently focus on prenatal diagnosis, red blood cell transfusion, iron chelation, management of iron-related complications, haemopoietic stem cell transplantation (HSCT) and hydroxyurea. Currently, the only curative therapy is HSCT; however, gene therapy offers the possibility of cure and trials are currently underway. These therapies are associated with significant complications and substantial costs; there is also evidence of variation in approaches to diagnosis and care. Optimal strategies for many aspects of management are not yet defined and more research is necessary to inform clinical care and health service delivery.

Thalassemia bone disease: the association between nephrolithiasis, bone mineral density and fractures

Thalassemia bone disease is well described, but the prevalence of nephrolithiasis has not been characterized. The association between nephrolithiasis, reduced bone density, and increased fractures has been demonstrated through this retrospective study of 166 participants with transfusion-dependent thalassemia. The findings support the need for increased vigilance of kidney and bone disease in this cohort.

INTRODUCTION

Previous studies have revealed that thalassemia is associated with reduced bone mineral density (BMD) and fractures. Many causes are implicated including hypogonadism, growth hormone deficiency, marrow expansion, and iron overload. Nephrolithiasis is associated with reduced BMD and increased fractures in the general population. However, the prevalence of nephrolithiasis and its association with bone density and fractures have not been characterized in thalassemia.

METHODS

We have addressed this question by performing a retrospective cohort study of 166 participants with transfusion-dependent thalassemia who had undergone dual-energy X-ray absorptiometry between 2009 and 2011. Logistic regression modeling was used to adjust for potential confounders.

RESULTS

We found a high prevalence of kidney stones (18.1 %) which was greater in males compared to females (28.7 vs 9.7 %, respectively). Renal stones were associated with reduced femoral neck Z-score and fractures in men after adjusting for potential confounders. These results indicate that nephrolithiasis is highly prevalent in patients with transfusion-dependent thalassemia and is significantly associated with reduced BMD and increased fractures.

CONCLUSIONS

The findings from this study strongly support the need for ongoing surveillance of BMD, fractures, and nephrolithiasis in the management of transfusion-dependent thalassemia.

Large-scale gene-centric meta-analysis across 39 studies identifies type 2 diabetes loci

To identify genetic factors contributing to type 2 diabetes (T2D), we performed large-scale meta-analyses by using a custom ∼50,000 SNP genotyping array (the ITMAT-Broad-CARe array) with ∼2000 candidate genes in 39 multiethnic population-based studies, case-control studies, and clinical trials totaling 17,418 cases and 70,298 controls. First, meta-analysis of 25 studies comprising 14,073 cases and 57,489 controls of European descent confirmed eight established T2D loci at genome-wide significance. In silico follow-up analysis of putative association signals found in independent genome-wide association studies (including 8,130 cases and 38,987 controls) performed by the DIAGRAM consortium identified a T2D locus at genome-wide significance (GATAD2A/CILP2/PBX4; p = 5.7 × 10(-9)) and two loci exceeding study-wide significance (SREBF1, and TH/INS; p < 2.4 × 10(-6)). Second, meta-analyses of 1,986 cases and 7,695 controls from eight African-American studies identified study-wide-significant (p = 2.4 × 10(-7)) variants in HMGA2 and replicated variants in TCF7L2 (p = 5.1 × 10(-15)). Third, conditional analysis revealed multiple known and novel independent signals within five T2D-associated genes in samples of European ancestry and within HMGA2 in African-American samples. Fourth, a multiethnic meta-analysis of all 39 studies identified T2D-associated variants in BCL2 (p = 2.1 × 10(-8)). Finally, a composite genetic score of SNPs from new and established T2D signals was significantly associated with increased risk of diabetes in African-American, Hispanic, and Asian populations. In summary, large-scale meta-analysis involving a dense gene-centric approach has uncovered additional loci and variants that contribute to T2D risk and suggests substantial overlap of T2D association signals across multiple ethnic groups.

Characterisation of carotid atheroma in symptomatic and asymptomatic patients using high resolution MRI

BACKGROUND AND PURPOSE

To prospectively evaluate differences in carotid plaque characteristics in symptomatic and asymptomatic patients using high resolution MRI.

METHODS

20 symptomatic and 20 asymptomatic patients, with at least 50% carotid stenosis as determined by Doppler ultrasound, underwent preoperative in vivo multispectral MRI of the carotid arteries. Studies were analysed both qualitatively and quantitatively in a randomised manner by two experienced readers in consensus, blinded to clinical status, and plaques were classified according to the modified American Heart Association (AHA) criteria.

RESULTS

After exclusion of poor quality images, 109 MRI sections in 18 symptomatic and 19 asymptomatic patients were available for analysis. There were no significant differences in mean luminal stenosis severity (72.9% vs 67.6%; p = 0.09) or plaque burden (median plaque areas 50 mm(2) vs 50 mm(2); p = 0.858) between the symptomatic and asymptomatic groups. However, symptomatic lesions had a higher incidence of ruptured fibrous caps (36.5% vs 8.7%; p = 0.004), haemorrhage or thrombus (46.5% vs 14.0%; p<0.001), large necrotic lipid cores (63.8% vs 28.0%; p = 0.002) and complicated type VI AHA lesions (61.5% vs 28.1%; p = 0.001) compared with asymptomatic lesions. The MRI findings of plaque haemorrhage or thrombus had an odds ratio of 5.25 (95% CI 2.08 to 13.24) while thin or ruptured fibrous cap (as opposed to a thick fibrous cap) had an odds ratio of 7.94 (95% CI 2.93 to 21.51) for prediction of symptomatic clinical status.

CONCLUSIONS

There are significant differences in plaque characteristics between symptomatic and asymptomatic carotid atheroma and these can be detected in vivo by high resolution MRI.

Postmortem high-resolution 3-dimensional imaging of the primate brain: blockface imaging of perfusion stained tissue

Modern anatomy of the brain is primarily concerned with visualizing contrast between tissue elements and with 3-dimensional (3-D) reconstruction. The first objective relies on specific neuroanatomical and imaging protocols, the latter on proper alignment of serial cross-sectional anatomy. We present a method that meets these goals at a resolution that allows for the structural delineation in the primate central nervous system. Methylene blue was administered by perfusion to the intact brain of three rhesus macaques thereby staining the neuropil in the cortex and gray nuclei of the brain in situ. Subsequent dissection and serial sectioning revealed excellent contrast in the tissue and showed clear boundaries between anatomical structures. We captured sequential images of the block surface of the brain before each serial section was cut from the specimen by means of a digital camera mounted directly over the microtome stage and the brain. We developed a suite of algorithms to automate the alignment, segmentation, normalization, and intensity correction for the series of blockface images. These digital images were the basis for 3-D reconstruction of the brains.

Informative enzyme/probe combinations for the multilocus DNA fingerprinting of marsupials

DNA fingerprinting has become an invaluable tool in the study of population genetics, paternity success, and individual identification; however, the species specificity of some methods has made the wide-range screening of many different species very time-consuming. In this study we describe the development and application of reliable and informative DNA fingerprinting techniques in a range of marsupial species using three different restriction enzyme and two oligonucleotide probe combinations. Six species from four marsupial families, the koala (Phascolarctidae), tammar wallaby (Macropodidae), southern hairy-nosed wombat (Vombatidae), kowari, and dusky and brown marsupial mice (Dasyuridae) were examined. Restriction enzymes HinfI AluI and HaeIII were used in combination with the digoxygenin (DIG)-labelled oligonucleotide probes (CAC)5 and (GGAT)4. The combinations of HinfI/(GGAT)4, AluI/ (CAC)5 and AluI/(GGAT)4 were the most informative, providing highly resolved bands, low background, and the lowest band sharing between individuals. The genetic diversity evident within the different species showed a clear relationship between the level of band sharing and population size. The greatest levels of band sharing were found in the kowaris (80%), which were part of a long-term captive colony originating from a few founders, and the lowest levels of band sharing were found in the marsupial mice (30-35%) and tammar wallaby (45%), which were caught from large outbred wild populations.

Risk management in the Health Service

Risk management is a relatively new concept in the National Health Service. David Bowden explains why, and describes what is being done to address this fundamental issue for all providers of health care.

Construction of a linkage map of the human genome, and its application to mapping genetic diseases

A powerful method for localizing the genes responsible for genetic diseases is to "mark" each chromosomal region so as to permit its inheritance to be tracked in families carrying the disease; the disease gene must lie in the same region as any marker with which it is co-inherited. Chromosomes can be efficiently marked in this way by using restriction fragment length polymorphisms (RFLPs). We describe the construction of a map of the human genome with over 550 RFLP markers, such that over 95% of the genome is detectably linked to one or more of these markers. This map will make possible efficient searches for genes underlying a variety of disorders, both simple and complex, and lead to the development of presymptomatic diagnostic tests for these diseases.

Management, the Institute and the NHS

Each year at the annual conference the in-coming President of the Institute of Health Service Management delivers an address which is a personal statement about current issues, not an official statement of Institute policy. This year the President discussed management in the NHS, current developments in the Institute and the future of the NHS in the light of the Institute's working party on the funding and delivery of health care.

Sources of normal variation of plasma l-aspartate:2-oxoglutarate aminotransferase in Hereford range cattle

1. Plasma levels of L-aspartate:2-oxoglutarate aminotransferase (AST) were estimated in Hereford cattle, 1 month to 12 years of age, kept under range conditions and in a group of Hereford x Angus cows kept on the same range. 2. Plasma levels of AST were estimated in a group of Crossbred cows and their calves fed a constant diet and kept in individual pens in the same geographic area as the Herefords. 3. Seasonal changes in mean plasma AST were observed in the Herefords corresponding with the change from dry winter grasses/hay and well water to fresh spring and summer grasses and slough water. No seasonal changes were observed in the Crossbreds given a constant dry diet and city water. 4. Plasma AST increased with age in calves 1 to 12 months of age in the Herefords but not in the Crossbreds. Mean plasma AST did not change with age in any of the adult cattle studied. 5. Small increases in plasma AST corresponding to increases in ambient temperature above - 12 degrees C were observed in the Crossbreds. 6. An increase in plasma AST was observed near the time of first ovulation in the confined cows. 7. No relationship could be demonstrated between plasma AST and sex, breed or time to parturition in the range cattle. Breed differences were observed in the Crossbred cows.

Sources of normal variation of plasma lactate dehydrogenase in range cattle

1. Plasma levels of lactate dehydrogenase (LD) were estimated in Hereford cattle of 1 month to 12 yr of age kept under range conditions. 2. Plasma levels of LD were estimated in a group of confined cows and their calves fed a constant diet and kept in individual pens in the same geographic area as the range Herefords. 3. Large seasonal changes in mean plasma LD were observed in the range cattle but not in the confined, constant diet group. The seasonal changes corresponded with the appearance of new growth on the range. 4. Changes in plasma LD were observed at weaning time in the range cattle but not in the confined group. 5. Sex had no effect upon plasma LD levels in the juvenile animals of either group. No comparison of adult animals could be made. 6. Mean plasma LD levels did not change with age but the seasonal effect decreased in magnitude as the animals matured. 7. An increase in plasma LD was observed around the first ovulation in the confined animals. 8. A decrease in plasma LD was observed during parturition in the confined group.