Targeting Tri-Methyl-Histone H3 (Lys27) in Rectal Cancer: A Novel Strategy to Enhance Radiosensitivity and Predict Response to Neoadjuvant Therapy

PURPOSE/OBJECTIVE(S)

Tri-Methyl-Histone H3 (Lys27) is a modification of histone H3 involved in gene regulation and chromatin organization. It plays a crucial role in cell response to ionizing radiation and affects DNA damage repair, with altered levels being linked to decreased radiation sensitivity. Our hypothesis is that high levels of Tri-Methyl-Histone H3 (Lys27) in rectal tumors can predict response to neoadjuvant chemoradiation, and targeting SETD2, the histone methyltransferase responsible for adding the tri-methyl group to Lys27 of histone H3, may enhance radiosensitivity in rectal cancer cells.

MATERIALS/METHODS

Biopsy samples from 25 patients with locally advanced rectal adenocarcinoma (Stage II-III) were obtained for analysis. Immunohistochemistry (IHC) was used to evaluate Tri-Methyl-Histone H3 (Lys27) expression levels in the tumor biopsies. The staining intensity was scored semi-quantitatively. Samples with 100% positive staining were grouped as "Tri-Methyl-High," and all others were grouped as "Tri-Methyl-Low." Fisher's exact test was used to analyze the data to determine the correlation between Tri-Methyl-Histone H3 (Lys27) levels and response to neoadjuvant chemoradiation. The primary endpoint was either a sustained clinical complete response (cCR) at one year or a pathological complete response (pCR). To further understand the role of Tri-Methyl-Histone H3 (Lys27) in response to ionizing radiation (IR), clonogenic assays, γH2aX foci staining, and western blot analysis of DNA damage response proteins and histones were performed on two established human rectal cancer cell lines following either RNA inhibition (RNAi) or drug targeting of SETD2.

RESULTS

Twenty-five patients with rectal cancer had pre-treatment biopsies analyzed for Tri-Methyl-Histone H3 (Lys27) levels, 11 were classified as Tri-Methyl-High and 14 as Tri-Methyl-Low. The groups were well balanced in terms of age, sex, clinical T/N stage, and neoadjuvant treatment approach. The overall combined complete response (cCR/pCR) rate was 36%, while the rate for Tri-Methyl-High patients was 9% (1/11) compared to 57% (8/14) in Tri-Methyl-Low patients (p = 0.03). After treating two colorectal cancer cell lines (SW837 and HCT116) with IR (5 Gy) in vitro, Tri-Methyl-Histone H3 (Lys27) levels increased 3-fold. SETD2 RNAi reduced Tri-Methyl-Histone H3 (Lys27) and increased cell death when combined with IR. In vitro treatment with a novel SETD2 inhibitor, EZM0414, led to a 2-fold increase in DNA damage following IR (5 Gy) as measured by γH2aX foci staining. EZM0414 treatment showed a 37% improvement in the dose enhancement ratio.

CONCLUSION

Our study uncovers a new biomarker, Tri-Methyl-Histone H3 (Lys27), that could be used to predict response to neoadjuvant chemoradiation in rectal cancer patients. Our preclinical data indicates that targeting SETD2 to reduce Tri-Methyl-Histone H3 (Lys27) mediated DNA repair could improve the efficacy of radiation therapy for rectal cancer patients.

Eating flowers? Exploring attitudes and consumers' representation of edible flowers

Edible flowers have gained more attention in recent years thanks to their perceived health benefits. Despite this attention, it seems that edible flowers are not popularized for consumption in South America, being considered unfamiliar for some cultures from this continent. In this context, the general goal of the present study was to investigate the three dimensions of social representation theory, the representational field, the information and the attitude of the two conditions of edible flowers: a more general "food made with flowers" and more directional product "yoghurt made with flowers", using Brazilian consumers. To achieve this goal, a free word association task was applied. A total of 549 consumers participated in this study. Participants were divided into two conditions, in which the inductor expressions for the free word association task changed: (a) food products made with flowers and (b) yoghurt made with flowers. Results showed a very positive attitude to both situations, and consumers associated Food products made with flowers to "health care" while the central core of yoghurt made with flowers reflected the innovative condition of this product, supported here by their unpredictable character (information generated).

On-farm Campylobacter and Escherichia coli in commercial broiler chickens: Re-used bedding does not influence Campylobacter emergence and levels across sequential farming cycles

Limitations in quality bedding material have resulted in the growing need to re-use litter during broiler farming in some countries, which can be of concern from a food-safety perspective. The aim of this study was to compare the Campylobacter levels in ceca and litter across three litter treatments under commercial farming conditions. The litter treatments were (a) the use of new litter after each farming cycle; (b) an Australian partial litter re-use practice; and (c) a full litter re-use practice. The study was carried out on two farms over two years (Farm 1, from 2009–2010 and Farm 2, from 2010–2011), across three sheds (35,000 to 40,000 chickens/shed) on each farm, adopting three different litter treatments across six commercial cycles. A random sampling design was adopted to test litter and ceca for Campylobacter and Escherichia coli, prior to commercial first thin-out and final pick-up. Campylobacter levels varied little across litter practices and farming cycles on each farm and were in the range of log 8.0–9.0 CFU/g in ceca and log 4.0–6.0 MPN/g for litter. Similarly the E. coli in ceca were ∼log 7.0 CFU/g. At first thin-out and final pick-up, the statistical analysis for both litter and ceca showed that the three-way interaction (treatments by farms by times) was highly significant (P < 0.01), indicating that the patterns of Campylobacter emergence/presence across time vary between the farms, cycles and pickups. The emergence and levels of both organisms were not influenced by litter treatments across the six farming cycles on both farms. Either C. jejuni or C. coli could be the dominant species across litter and ceca, and this phenomenon could not be attributed to specific litter treatments. Irrespective of the litter treatments in place, cycle 2 on Farm 2 remained Campylobacter-free. These outcomes suggest that litter treatments did not directly influence the time of emergence and levels of Campylobacter and E. coli during commercial farming.

Pre- and posttransplant monitoring of alloantibodies by complement-dependent cytotoxicity and luminex methodologies in liver transplantation

BACKGROUND

This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors.

METHODS

Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay).

RESULTS

The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017).

CONCLUSION

Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.

Etiology of bronchiolitis in a hospitalized pediatric population: prospective multicenter study

Background

In 2006, bronchiolitis due to adenovirus nosocomial infections resulted in the closure of a pediatric department in northern Portugal.

Objectives

To determine the etiology of bronchiolitis in northern Portugal.

Study design

It was a prospective multicenter study on the etiology of bronchiolitis during the respiratory syncytial virus (RSV) season (November–April). Children ≤24 months of age admitted for a first wheezing episode were included. Nasopharyngeal specimens were analyzed by an indirect immunofluorescent-antibody assay (IFA) for RSV, adenovirus (HAdV), parainfluenza (PIV) 1–3 and influenza (IV) A and B and by polymerase chain reaction (PCR) or reverse transcription-PCR for the same viruses and for human metapneumovirus (hMPV), bocavirus (HBoV), rhinovirus (HRV), coronaviruses (229/E; NL63; OC43; HKU1) and enterovirus.

Results

During this period, 253 children were included, 249 IFA analyses and 207 PCRs were performed. IFA detected RSV in 58.1%; PCR increased it to 66.7%. IFA detected HAdV in 3.2%, PCR 10.0%. PCR detected IV A in 5; IV B in 2; PIV 1 in 6, PIV 2 in 4 and PIV 3 in 11 cases. HBoV, as single agent in 2 cases, and HRV were positive in 8 samples and hMPV in 11. With this virus panel, 19.7% remained without etiology.

Conclusions

The most frequent agent was RSV, followed by HAdV. PCR can be cost-effective and more accurate than IFA, which is crucial for HAdV that may be associated with significant mortality (IFA alone did not detect 2/3 of the cases).

[Hybrid infrainguinal revascularization for critical limb ischemia]

The introduction of endovascular procedures in the routine of vascular surgery allowed for the expansion of therapeutic options in the diverse areas of vascular disease. Endoluminal revascularization can be regarded as a usefull complement of conventional surgical techniques. An above-knee femoro-popliteal bypass surgery ePTFE graft has been performed, followed by a sheath introduction on the graft body. This allows a simplified access to crural vessels, while providing efficient revascularization of the femoro-popliteal sector. Distal revascularization was performed using angioplasty and stenting when appropriate, as to insure continuous flux in at least one of the tibial or the peroneal arteries. The aim of this kind of procedure is to insure efficient femoro-popliteal revascularization and to achieve a run-off to the foot in at least one vessel. This type of intervention may be particularly attractive in Leriche-Fontaine's grade IV patients with no available autologous venous graft.

Magnetic resonance imaging in the preoperative staging of endometrial carcinoma

PURPOSE OF INVESTIGATION

Magnetic resonance imaging (MRI) has emerged as an important imaging modality in the evaluation of the extension of endometrial carcinoma which is essential in planning treatment and predicting prognosis. This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma.

METHODS

We included in this study 162 patients with a histological diagnosis of endometrial carcinoma who underwent MRI pelvic imaging and surgical staging. MRI images were compared with pathological findings to measure MRI's sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in what concerns myometrial, cervical and lymph node invasion.

RESULTS

MRI differentiation of deep myometrial invasion from superficial disease agreed with pathological findings in 77% of cases, with a sensitivity of 83%, a specificity of 72% and a diagnostic accuracy of 77%. Concerning cervical invasion, MRI had a sensitivity, specificity and diagnostic accuracy of 42%, 92%, 81% respectively. In assessing lymph node invasion, MRI presented a sensitivity of just 17%, a specificity of 99% and a diagnostic accuracy of 89%.

CONCLUSION

Our study confirmed the high accuracy of MRI imaging in assessing myometrial and cervical invasion in endometrial carcinoma. When evaluating lymph node invasion, micrometastases are responsible for the low sensitivy of MRI.

An open-label, multicenter study of outpatient capecitabine monotherapy in 631 patients with pretreated advanced breast cancer

BACKGROUND

Phase II/III trials have shown that capecitabine is an active, well-tolerated therapy for metastatic breast cancer (MBC). We report clinical findings from an expanded access program enabling patients ineligible for investigative trials to receive capecitabine before its approval and availability.

METHODS

Patients pretreated with at least two chemotherapy regimens, including a taxane, for MBC received oral capecitabine until disease progression or unacceptable toxicity.

RESULTS

Six hundred and thirty-one patients received capecitabine (mean duration 3.8 months, range 0.1-24.7 months). The most common treatment-related grade 3/4 toxicities were diarrhea (9%) and hand-foot syndrome (8%). Grade 3/4 alopecia was absent and grade 3/4 myelosuppression was rare. Dose was modified in 172 patients (27%). Objective response rate in 349 evaluable patients was 35%. Median time to progression (n = 604) was 6.6 months (95% confidence interval, CI, 5.6-7.6) and median overall survival (n = 569) was 10.0 months (95% CI, 8.5-15.3).

CONCLUSIONS

Our findings in a cohort of patients with pretreated progressive breast cancer confirm the high efficacy and tolerability of outpatient capecitabine.

Normal vascular and biliary hepatic anatomy: 3D demonstration by multidetector CT

Due to constant innovations in radiological and surgical techniques, more accurate results are expected in the diagnostic and therapeutic procedures related to hepatic pathology. The aim of this work was to demonstrate the normal hepatic vascular and biliary anatomy using cadaveric livers and CT scans of the affected livers. Furthermore, using the CT scans, the authors intended to illustrate the most common morphological variations of the vascular and biliary anatomy. Four human cadaveric livers were injected with colored silicone mixed with radiological contrast solution in the common bile duct, in the proper hepatic artery, in the portal vein and in the inferior vena cava near the ostia of the hepatic veins (only one of these structures was injected in each liver). After obtaining the CT scans, 3D rendered models were created, which demonstrated the normal hepatic anatomy of the vascular and biliary structures. The International Anatomical Nomenclature was used for their classification (based on Couinaud's work). The 3D rendered CT models were also modified to illustrate the most common normal variations of the hepatic anatomy (found in the literature).

Clinical Relevance of Low Levels of Preformed Alloantibodies Detected by Flow Cytometry in the First Year Post–Kidney Transplantation

OBJECTIVE

To determine the prevalence of transplants performed with a false-negative cytotoxicity cross-match and to analyze the clinical relevance of alloantibodies (Ab) detected only by flow cytometry (flow).

METHODS

We studied 66 patients undergoing kidney transplantation from a cadaveric donor. All patients had a simultaneous negative T+AHG+DTT and B+DTT. Pretransplant sera were retrospectively analyzed by flow cytometry according to an Emory University protocol: (1) T+ and B-: Ab anti-class I; (2) T- and B+: anti-class II; (3) T+B+: anti-class I + II. Chi-square, Fisher exact, Student t test, and Kaplan Meier analyses were employed with significance assigned at P < or = .05.

RESULTS

The overall incidence of false-negative cytotoxicity was 33.3% (22/66), namely, 6.1% (n = 4) anti-class I; 9.1% (n = 6) anti-class II; and 18.2% (n = 12) anti-class I + II. Primary nonfunctioning grafts occurred in 6.8% (3/44) and 13.6% (3/22) negative and positive flow patients (two anti-class I + II and one class II; P = .39). The incidence of graft loss in the first year was respectively, 13.6% (6/44) and 18.2% (4/22; two anti-class II and two anti-class I + II; P = .72). Compared to flow-negative grafts, creatinine levels were significantly higher among flow-positive patients at 8 and 12 weeks. One-year graft survivals were 86.4% among negative versus 81.8% for the positive group (P = .67).

CONCLUSIONS

We observed that 33% of kidney transplant recipients had low levels of alloantibodies detected only by flow. This single factor was associated with the worst graft function in the first trimester with a suggestion of a higher risk for non-functioning graft.

Immunoglobulin G–Positive in B-Cell Cross-Match Decreases Kidney Allograft Survival

We retrospectively studied all 1149 transplants performed at our center between 1993 and 2003 to determine the incidence and clinical effect of pretransplant B-positive cross-match on kidney graft survival. The patients were divided in two groups: B-negative (n = 1102) and B-positive in current sera (n = 47; 4.1%). AB-positive test was more frequent among regrafted patients (14% vs 3%; P = .00). Demographic data were not different between the groups. The overall rate of graft loss was similar (26% vs 24%, respectively; P = .86). However, early nonsurgical graft losses were more frequent among B-positive patients (46% vs 20%, respectively; P = .04). IgM was the most frequent immunoglobulin in the B-positive group (76% IgM and 24% IgG). There was no significant difference between B-negative and B-positive groups in the 1-, 5-, and 10-year graft survival rates (87% vs 83%, 73% vs 78%, 64% vs 66%, respectively; P = .87). The graft survival was significantly reduced comparing an IgG anti-B cell to the B-negative group (P = .03) as well as IgG compared to IgM (P = .004). In conclusion, only B-positive cross-match due to IgG decreased graft survival. Even though it is an uncommon situation (0.9%), this study stressed the clinical value of the B-cell cross-match as a tool to identify patients with a higher immunological risk.

HER2 polymorphism and breast cancer risk in Portugal

Breast cancer is a major public health problem around the world, and its carcinogenesis is not yet well understood. The human epidermal growth factor Receptor 2 (HER2) seems to play an important role in the development of this neoplasia, and genetic alterations in this gene, such as point mutations and polymorphisms have been detected in breast cancer patients. We analysed the frequency of a single nucleotide polymorphism in the HER2 gene in blood samples from 152 breast cancer patients and 146 healthy controls using the polymerase chain reaction methodology, followed by restriction fragment length polymorphism (PCR-RFLP). We found a twofold increase in risk of breast cancer in women who are carriers of a Val allele genotype-Ile/Val and Val/Val genotypes [odds ratio (OR)=2.00; 95% confidence interval (CI) 1.23-3.25; P=0.005]. Our results indicate an association between the presence of the Val allele in the HER2 polymorphism and the risk of breast cancer. Further studies are needed to evaluate the role of this polymorphism in the behaviour of breast cancer.

Secretory breast carcinoma—case report and review of the medical literature

Secretory breast carcinoma (SBC) is a rare type of invasive breast cancer. Since little is known about the biology of this rare tumour, it is useful to report every such case, in order to make as much information as possible available in the medical literature. We present the case of an 18-year-old woman with a SBC treated by mastectomy (Madden) and axillary node dissection (stage pT3N1M0) followed by chemotherapy (FEC regimen) and radiotherapy. The patient has meanwhile completed 4 years of follow-up with no evidence of recurrence. The authors review the literature and summarize relevant findings concerning definition, pathology, clinical picture, treatment, and follow-up.

The effect of timing of administration of oestradiol benzoate on characteristics of oestrus, timing of ovulation and fertility in Bos indicus heifers synchronised with a progesterone releasing intravaginal insert

OBJECTIVE

To compare the timing of onset of oestrus and ovulation, characteristics of oestrus, and fertility in Bos indicus heifers synchronised with a progesterone releasing intravaginal insert (IVP4) and administration of oestradiol benzoate (ODB) either at the time of removal of the insert or 24 h later.

DESIGN

Cohort study.

PROCEDURE

Bos indicus and Bos indicus cross heifers were treated on two farms (Farm A, n = 273; Farm B, n = 47) with an IVP4 for 8 days with 1.0 mg of ODB administered at the time of device insertion and 250 mg of cloprostenol at the time of device removal. Heifers in the ODB-0 group were administered 0.75 mg of ODB at the time of device removal while heifers in the ODB-24 group were administered the same dose of ODB 24 h after device removal. Heifers were inseminated once daily after detection of oestrus. Heifers not detected in oestrus by 72 h after removal of inserts were inseminated at that time. Oestrus was detected in heifers on Farm A using heatmount detectors while on Farm B oestrus in heifers was monitored using radiotelemetry of mounting pressure. Ovarian follicular development was monitored daily in 30 heifers on Farm B from the time of administration of inserts until ovulation to a maximum of 96 h after removal of inserts, and again 11 days after removal of inserts (Day 19). A blood sample was collected from all heifers on Farm B on Day 19 and analysed for plasma concentration of progesterone. Pregnancy was diagnosed 6 to 8 weeks after insemination.

RESULTS

Administration of ODB at the time of removal of inserts shortened the time interval to oestrus and ovulation (P < 0.001), increased the number of mounts recorded during oestrus (P = 0.04) and reduced the odds of pregnancy (P = 0.03). The proportion of heifers ovulating on Farm B was 67% and was not affected by treatment group (P = 0.61). The mean diameter of the largest follicle measured in ovaries was greater at the time of removal of inserts (9.1 +/- 0.6 vs 10.7 +/- 0.4; P = 0.03) and at the expected time of the LH surge (8.1 +/- 0.4 vs 11.5 +/- 0.3 mm; P < 0.001) in heifers that ovulated compared to heifers that failed to ovulate, respectively. Emergence of a new follicular wave was not detected during the synchronisation treatment in heifers that failed to ovulate. Concentrations of progesterone in plasma on Day 19 were less in non-pregnant heifers (P = 0.05) compared to heifers subsequently diagnosed as pregnant to insemination and were affected by the diameter of the ovulatory follicle (P = 0.01).

CONCLUSION

Administration of ODB at the time of removal of inserts can shorten the time interval to oestrus and ovulation and can reduce fertility when insemination is carried out once daily. Further work is needed to determine if prolonged suppression of follicular development, anovulatory oestrus and premature ovulation occuring in some heifers is associated with administration of ODB.

A Model of Bone Adaptation Using a Global Optimisation Criterion Based on the Trajectorial Theory of Wolff

Julius Wolff originally proposed that trabecular bone was influenced by mechanical stresses during the formative processes of growth and repair such that trabeculae were required to intersect at right angles. In this work, we have developed an analytical parametric microstructural model, which captures this restriction. Using homogenisation theory, a global material model was obtained. An optimal structure constructed of the homogenised material could then be found by optimising a cost function accounting for both the structural stiffness and the biological cost associated with metabolic maintenance of the bone tissue. The formulation was applied to an example problem of the proximal femur. Optimal densities and orientations were obtained for single load cases. The situation of multiple loads was also considered. In this case, we observe that the alignment of principal strains with the material orthotropy direction is, in general, not possible for all load cases. Thus less restrictive microstructures (nonorthotropic) will yield higher structural stiffnesses than strictly orthotropic microstructures.

Gangrene of the fingertips after bleomycin and methotrexate

The increased use of cytostatic drugs, which are sometimes used in combination chemotherapy, may result in new and unusual cutaneous side effects. We describe a 57-year-old man with acral erythrocyanosis progressing to acute digital ischemia and gangrene that developed after combined chemotherapy (bleomycin and methotrexate) used to treat a metastatic squamous cell carcinoma of the hypopharynx. A leukocytoclastic vasculitis was found in both the acute phase and in the amputated fingertips. This supports the well-reported potential of bleomycin to trigger acral vascular toxicity.