179 Improving Operative Notes in Upper GI Surgery: An Innovative QI Project Utilising Existing Electronic Hospital Systems

Introduction

Operative notes play a valuable role in ensuring that surgical patients receive consistent and adequate care. There are many inherent difficulties affecting their quality. We performed a QI project to improve surgical operative notes at our centre.

Method

A questionnaire assessing subjective quality of operative notes was sent to all foundation doctors delivering post-operative care. Compliance to each inclusion recommendation in the RCS guidelines was analysed. A standardised template for operative notes was incorporated into the hospital’s electronic records system, compliance was then reassessed.

Results

Questionnaire responses (16) were better for typed vs hand-written notes in all domains: ease of accessing notes, following intra-operative steps, following post-operative plans and frequency of asking for additional information regarding plans. After implementation of the template, mean compliance across 19 RCS parameters improved from 69% (55 operations) to 89% (46 operations). Number of parameters with 100% compliance improved from 2/19 to 8/19. Compliance increased in 14/19 parameters, there was no change in 2/19 (already 100%) and a reduction was seen in 3/19.

Conclusions

Results from our analysis and questionnaire showed that typed notes were favourable when compared to hand-written. The introduction of a standardised electronic template, without investment in new software, improved compliance to RCS guidelines.

Abstract 5211: Targeting Neddylation synergistically augments the activity of cisplatin in head and neck cancer models to yield long-term survival by modulating key DNA damage and redox pathways

Head and neck cancer is a broad term for neoplasms of the epithelial lining of the anatomical sites of the upper aerodigestive tract. Very few novel therapeutics have been developed for the treatment of advanced head and neck cancer with cisplatin continuing to be a key standard of care agent. Innovative and more effective therapeutic strategies are urgently needed. The inappropriate loss of several NEDD8-cullin-RING ubiquitin ligase (CRL) targets has been linked to cancer progression and drug resistance. Our data show that overexpression of NEDD8 activating enzyme (NAE), a key proximal regulator of the NEDDylation cascade, is correlated with inferior survival in head and neck cancers suggesting that this pathway may be a promising new therapeutic target. We hypothesized that disrupting NEDDylation with the first-in-class NAE inhibitor pevonedistat (MLN4924, PEV) would be an effective new approach for the treatment of head and neck cancers. Initial testing demonstrated that PEV potently impaired the NEDDylation cascade as evidenced by decreased NEDDylated cullins and upregulation of the CRL target cell cycle inhibitors, p21 and p27. In addition, PEV induced a dramatic G2 cell cycle arrest, polyploidy, and activation of the DNA damage response. PEV treatment also potently decreased cell viability and induced apoptosis in a panel of head and neck cancer cell lines with diverse genetic features. Given the potent DNA damage-related aspects of PEV's mechanism of action, we hypothesized that it would be a rational combination partner for standard cisplatin therapy. Consistent with this hypothesis, co-treatment with PEV and cisplatin promoted synergistic levels of DNA damage as measured by comet assay, an accumulation of gamma-H2AX, and quantification of DNA fragmentation. The combination also cooperated to promote redox alterations that were necessary for apoptosis induction and linked to the DNA damaging effects of both drugs. Importantly, synergistic anticancer activity was observed in cell lines from multiple anatomical sites, suggesting that this combination has broad efficacy across many subtypes of head and neck cancer. To further evaluate the therapeutic benefit of the PEV and cisplatin combination, we determined its safety and efficacy in a head and neck cancer xenograft model. Consistent with our in vitro data, the combination significantly decreased tumor proliferation, induced apoptosis, and augmented DNA damage in vivo. While both PEV and cisplatin displayed significant activity as monotherapies, combination treatment resulted in a dramatic decrease in tumor burden and also led to long-term animal survival in every treated animal (10/10 mice remained disease-free at day 100). Importantly, the PEV and cisplatin combination was therapeutically selective and very well tolerated in mice. Our collective data provide a strong rationale for the clinical investigation of NAE inhibition as a novel strategy to augment cisplatin efficacy in patients with head and neck cancer.

Citation Format: Trace Jones, Claudia Espitia, Jennifer Carew, Steffan T. Nawrocki. Targeting Neddylation synergistically augments the activity of cisplatin in head and neck cancer models to yield long-term survival by modulating key DNA damage and redox pathways [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5211.

A Phase I/II Trial of MEC (Mitoxantrone, Etoposide, Cytarabine) in Combination with Ixazomib for Relapsed Refractory Acute Myeloid Leukemia

PURPOSE

The prognosis of patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) remains poor, and novel therapies are needed. The proteasome pathway represents a potential therapeutic target. A phase I trial of the second-generation proteasome inhibitor ixazomib in combination with MEC (mitoxantrone, etoposide, and cytarabine) was conducted in patients with R/R AML.

PATIENTS AND METHODS

Dose escalation of ixazomib was performed using a standard 3 × 3 design. Gene-expression profiling was performed on pretreatment and posttreatment bone marrow or blood samples.

RESULTS

The maximum tolerated dose of ixazomib in combination with MEC was 1.0 mg. The dose limiting toxicity was thrombocytopenia. Despite a poor risk population, the response rate [complete remission (CR)/CR with incomplete count recovery (CRi)] was encouraging at 53%. Gene-expression analysis identified two genes, IFI30 (γ-interferon inducible lysosomal thiol reductase) and RORα (retinoic orphan receptor A), which were significantly differentially expressed between responding and resistant patients and could classify CR.

CONCLUSIONS

These results are encouraging, but a randomized trial is needed to address whether the addition of ixazomib to MEC improves outcome. Gene-expression profiling also helped us identify predictors of response and potentially novel therapeutic targets.

Future of Personalized Therapy Targeting Aberrant Signaling Pathways in Multiple Myeloma

Multiple myeloma (MM) is a genetically complex disease. Identification of mutations and aberrant signaling pathways that contribute to the progression of MM and drug resistance has potential to lead to specific targets and personalized treatment. Aberrant signal pathways include RAS pathway activation due to RAS or BRAF mutations (targeted by vemurafenib alone or combined with cobimetinib), BCL-2 overexpression in t(11:14) (targeted by venetoclax), JAK2 pathway activation (targeted by ruxolitinib), NF-κB pathway activation (treated with DANFIN combined with bortezomib), MDM2 overexpression, and PI3K/mTOR pathway activation (targeted by BEZ235). Cyclin D1 (CCND1) and MYC are also emerging as key potential targets. In addition, histone deacetylase inhibitors are already in use for the treatment of MM in combination therapy, and targeted inhibition of FGFR3 (AZD4547) is effective in myeloma cells with t(4;14) translocation. Bromodomain and extra terminal (BET) protein antagonists decrease the expression of MYC and have displayed promising antimyeloma activity. A better understanding of the alterations in signaling pathways that promote MM progression will further inform the development of precision therapy for patients.

Plinabulin, an inhibitor of tubulin polymerization, targets KRAS signaling through disruption of endosomal recycling

Constitutive activation of Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most common oncogenic event in certain types of human cancer and is associated with poor patient survival. Small molecule signaling inhibitors have improved the clinical outcomes of patients with various cancer types but attempts to target KRAS have been unsuccessful. Plinabulin represents a novel class of agents that inhibit tubulin polymerization with a favorable safety profile in clinical trials. In the present study, the potency of plinabulin to inhibit tubulin polymerization and growth of KRAS-driven cancer cells was characterized. In vivo efficacy of plinabulin was tested in two different mouse models; one being the RCAS/t-va gene transfer system and the other being a xenograft model. In vitro cell culture tubulin polymerization assays were used to complement the mouse models. There was improved survival in a KRAS-driven mouse gene transfer glioma model, but lack of benefit in a similar model, without constitutively active KRAS, which supports the notion of a KRAS-specific effect. This survival benefit was mediated, at least in part, by the ability of plinabulin to inhibit tubulin polymerization and disrupt endosomal recycling. It was proposed a mechanism of compromised endosomal recycling of displaced KRAS through targeting microtubules that yields inhibition of protein kinase B, but not extracellular signal regulated kinase (ERK) signaling, therefore lending rationale to combination treatments of tubulin- and ERK-targeting agents in KRAS-driven cancer.

Autophagy inhibition (AI) as a novel treatment strategy in bladder cancer (BC)

449

Background: BC response to chemotherapy has reached a plateau; novel treatment targets are needed. Autophagy is an important protein degradation mechanism that may be involved in chemotherapy response/resistance. AI was shown to overcome drug resistance in preclinical studies, but has not been well studied in BC. We conducted comprehensive gene expression analysis in BC cell lines to define their autophagy pathway expression signatures. We then investigated the anti-tumor activity and pharmacodynamics (PD) of our novel autophagy inhibitor ROC-325 (superior to hydroxychloroquine) in preclinical BC models with high baseline autophagy levels. Methods: Baseline expression of autophagy-related genes was evaluated by RNASeq in 21 BC cell lines. Gene and protein expression of selected autophagy-related genes was confirmed by qRT-PCR and immunoblot. PD effects of ROC-325 on lysosomal protease cathepsin D (CTSD) were assessed in 2 selected BC cell lines: UM-UC-3 (mesenchymal), UM-UC-6 (epithelial). The ability of ROC-325 (72 hour treatment) to augment gemcitabine (G) and cisplatin (C) activity in the 2 cell lines was evaluated by MTT assay and combination index analyses, t- test with 2-sided comparison was used, experiments were in triplicate. Results: RNASeq showed significant heterogeneity in baseline expression of early and late autophagy-related genes among BC cell lines; elevated expression of multiple autophagy-related genes was a prevalent phenomenon. CTSD level was elevated in multiple cell lines. PD analysis showed dose-dependent increase of CTSD expression in UM-UC-3 cells after ROC-325 (1-10uM) treatment correlating with reduced cell viability. The activity of G and C was greater in UM-UC-6 vs UM-UC-3 cells. Both cell lines were sensitive to ROC-325. The addition of ROC-325 to G or C yielded additive benefit in both cell lines. In UM-UC-6, ROC-325 addition significantly increased the activity of GC combination vs GC alone (p = 0.0049). Conclusions: AI merits further investigation as new treatment strategy in BC. Evaluation of in vitro and in vivo efficacy/safety of ROC-325 with/without other agents, and assessment of putative predictive biomarkers is being pursued in BC models with genomic and transcriptomic annotation.

Abstract 5575: Obesity and genomic changes in patients with myelodysplastic syndromes

Obesity is rapidly overtaking smoking as the leading preventable cause of cancer, particularly in cancers of the breast and colon. In a large cohort of individuals participating in the National Institutes of Health-AARP Diet and Health Study, a higher incidence of MDS and an increased mortality was observed in individuals with body mass index (BMI) >30 compared to those with BMI <25 (HR 2.18 (95% CI: 1.51, 3.17; P < 0.001). The biology underlying these findings in MDS patients (pts) is not established. We hypothesized that genomic patterns may distinguish obese from non-obese pts with MDS and that these genomic changes may be associated with disease characteristics.

We performed genomic analyses by using next-generation targeted deep sequencing (NGS) and whole exome sequencing (WES) of 62 significantly affected genes that play an important role in MDS pathogenesis. Mutations were considered individually and grouped into several functional pathways. Overweight (BMI 25-29) and obese (BMI >30) were combined in one group (BMI-H).

Of 205 pts with MDS treated at our institution between 1/2000 - 1/2013, 146 (71%) were BMI-H. Interestingly, only 2 patients had BMI <18.5 (underweight) and were combined with normal BMI group (BMI-N). BMI-H pts presented with lower white blood count (median 3.6 vs. 4.4, p = .03), but other clinical characteristics were similar. With median follow up of 33.6 months (mo) (range 0.4-128.5), a trend toward inferior survival was observed in BMI-H group compared to BMI-N (32.9 mo vs. 34.8 mo, p = .07). Furthermore, higher rates of progression to acute myeloid leukemia (AML) were seen in the BMI-H as compared to BMI-N pts (23% vs. 19%, p = .02).

Overall, 74% of pts had at least one of the 62 screened mutations, the most common being: SF3B1 (17%), TET2 (17%), ASXL1 (14%), STAG2 (12%), DNMT3A (9%), U2AF1/2 (8%), GPR98 (8%), and RUNX1(7%). Mutations in IDH1/2 (5% vs. 0%), DNMT3A (11% vs. 5%), TET2 (18% vs. 14%) occurred more frequently in BMI-H, where SF3B1 (25% vs. 13%), and NRAS (7% vs. 2%) mutations were more common in BMI-N. Within functional groups, mutations in splicing machinery genes were less common in BMI-H compared to BMI-N (32% vs. 41%, p = .05) and mutations in DNA methylation genes were more common in BMI-H (20% vs. 34%, p = .02). Clonal architecture analysis points to the presence of different dominant clones between the two groups. In the dominant MDS clones, mutations in TET2 and DNMT3A were observed more frequently in pts with BMI-H, whereas mutations in SF3B1 were more frequently observed in BMI-N pts.

In conclusion, overweight and obese pts with MDS have a trend for inferior survival and higher rate of progression to AML as compared to MDS pts with normal weight. Genomic differences in clonal architecture and distribution of somatic mutations were observed in the BMI-H group. Further exploration including germline mutations and previously described familial obesity genes is needed to expound on the interaction between the biology of obesity and leukemogenesis of MDS.

Citation Format: Aziz Nazha, David Seastone, Hideki Makishima, Matt Kalaycio, Hetty E. Carraway, Anjali S. Advani, Ahamd Zarzour, Jennifer Carew, Aaron T. Gerds, Sudipto Mukherjee, Jaroslaw P. Maciejewski, Mikkael A. Sekeres. Obesity and genomic changes in patients with myelodysplastic syndromes. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5575. doi:10.1158/1538-7445.AM2015-5575

Abstract 1686: A Phase 1 dose escalation study to establish the maximum tolerated dose (MTD), pharmacokinetic (PK) and pharmacodynamic (PD) parameters of hydroxychloroquine (HCQ) in combination with vorinostat (V) in patients with advanced solid tumors - final results

Background: Autophagy is a cellular process that generates energy to assure cell survival in response to insults such as hypoxia, nutrient deprivation or cytotoxic mediators. Autophagy contributes to cancer cell survival as well as drug resistance. Several anticancer agents, including Vorinostat (V) are reported to induce autophagy as a cytoprotective mechanism. In preclinical models, the addition of Hydroxycholoquine (HCQ) to V inhibited autophagy and significantly increased the anticancer effects of V. The objectives of this trial were to determine the MTD of HCQ in combination with V both administered daily (QD) in patients (pts) with advanced solid tumors, to evaluate PK and PD parameters, and test anti-tumor activity. Biomarkers were evaluated in tumors and peripheral blood mononuclear cells (PBMC) to investigate synergistic antitumor activity of V in combination with HCQ.

Methods: We used a 3+3 dose escalation design of V at 300-400 mg QD plus HCQ QD at 400-1000 mg in 21 day cycles. Patients with advanced solid tumors and no available treatment with ECOG PS 0-2 and adequate organ function were eligible.

Results: 32 patients were enrolled with 27 evaluable for toxicity studies. No dose limiting toxicity (DLT) was observed in cohorts 1 or 2. In cohort 3 (400 mg V/600 mg HCQ), 1/6 pts had DLT of Gr 3 anemia and fatigue. In cohort 4 (400 mg V/800 mg HCQ), 4/8 pts had DLT with Gr 3 fatigue (3 pts) and Gr 2 seizure on C1D8 (1 pt). De-escalation to 400 mg V/600 mg HCQ resulted in no further DLTs, defining the MTD. 10 pts were treated at the MTD. Treatment-related toxicities were Gr 1-2: nausea (11 pts), diarrhea (8), fatigue (6), anorexia (4), weight loss (4), anemia (4), and elevated creatinine (4). Gr 3 toxicities were fatigue (3), anemia, thrombocytopenia and neutropenia (1 each). One pt (renal cell cancer) had a confirmed PR (cohort 2, completed 43 cycles), and 2 pts with colorectal cancer had prolonged SD (>4 cycles). HCQ trough and V plasma concentrations (preliminary) showed no drug interactions compared to previously published data. PD analyses of biomarkers of HCQ and V in PBMCs at baseline compared to weeks 1 and 6 confirmed the results from pre-clinical studies showing accumulation of autophagic vesicles and induction of LC3-II, p21 and cathepsin D. The results of biopsies from 3 patients at MTD demonstrated greater induction of these PD markers in tumor compared to PBMC.

Conclusions: The MTD was established as HCQ 600 mg + V 400 mg. Dose-dependent fatigue represented DLT in several patients. Anti-tumor activity was seen in one patient with RCC and 2 patients with CRC had prolonged SD. Based on these data phase II studies are planned in patients with renal and colorectal cancer.

Citation Format: Monica M. Mita, Devalingam Mahalingam, John Sarantopoulos, Ravi Amaravadi, Alain Mita, Tyler Curiel, Steffan Nawrocki, Frank Giles, Jennifer Carew. A Phase 1 dose escalation study to establish the maximum tolerated dose (MTD), pharmacokinetic (PK) and pharmacodynamic (PD) parameters of hydroxychloroquine (HCQ) in combination with vorinostat (V) in patients with advanced solid tumors - final results. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1686. doi:10.1158/1538-7445.AM2013-1686

Nilotinib: optimal therapy for patients with chronic myeloid leukemia and resistance or intolerance to imatinib

Chronic myeloid leukemia (CML) is the consequence of a single balanced translocation that produces the BCR-ABL fusion oncogene which is detectable in over 90% of patients at presentation. The BCR-ABL inhibitor imatinib mesylate (IM) has improved survival in all phases of CML and is the standard of care for newly diagnosed patients in chronic phase. Despite the very significant therapeutic benefits of IM, a small minority of patients with early stage disease do not benefit optimally while IM therapy in patients with advanced disease is of modest benefit in many. Diverse mechanisms may be responsible for IM failures, with point mutations within the Bcr-Abl kinase domain being amongst the most common resistance mechanisms described in patients with advanced CML. The development of novel agents designed to overcome IM resistance, while still primarily targeted on BCR-ABL, led to the creation of the high affinity aminopyrimidine inhibitor, nilotinib. Nilotinib is much more potent as a BCR-ABL inhibitor than IM and inhibits both wild type and IM-resistant BCR-ABL with significant clinical activity across the entire spectrum of BCR-ABL mutants with the exception of T315I. The selection of a second generation tyrosine kinase inhibitor to rescue patients with imatinib failure will be based on several factors including age, co-morbid medical problems and ABL kinase mutational profile. It should be noted that while the use of targeted BCR-ABL kinase inhibitors in CML represents a paradigm shift in CML management these agents are not likely to have activity against the quiescent CML stem cell pool. The purpose of this review is to summarize the pre-clinical and clinical data on nilotinib in patients with CML who have failed prior therapy with IM or dasatinib.

Emerging drugs in the treatment of pancreatic cancer

BACKGROUND

Pancreatic cancer is the fourth leading cause of cancer-related death in the US. However, there is a growing belief that novel biological agents could improve survival of patients with this cancer. Gemcitabine-based chemotherapy remains the cornerstone treatment for advanced pancreatic cancers. So far, the current targeted agents that have been used in combination with gemcitabine have failed to improve clinical outcomes. This failure may stem from the heterogeneous molecular pathogenesis of pancreatic cancers, which involves several oncogenic pathways and defined genetic mutations.

OBJECTIVE

The aims of this review are: i) to define the existing treatments available at present for patients with pancreatic cancers in the neo-adjuvant, adjuvant, locally advanced and metastatic settings; ii) to highlight the molecular heterogeneity of the cancers and the rationale for targeting specific oncogenic pathways; iii) to give an overview of targeted agents that may potentially have an impact in the treatment of pancreatic cancers.

CONCLUSIONS

Molecular pathogenesis of pancreatic cancer involves several pathways and defined genetic mutations. Targeting these complex molecular pathways with a combination of novel biological and chemotherapeutic agents could potentially improve patient outcome.

Diagnostic value of high-resolution MR imaging in giant cell arteritis

BACKGROUND AND PURPOSE

Clinical indications of giant cell arteritis may be unspecific, and noninvasive diagnosis is often difficult. This study investigated the hypothesis that high-resolution MR imaging of the superficial cranial arteries is a noninvasive imaging technique that can detect the occurrence of giant cell arteritis.

MATERIALS AND METHODS

Contrast-enhanced, high-resolution MR imaging was performed on 64 consecutive patients with suspected giant cell arteritis. Mural thickness, lumen diameter, and a mural contrast enhancement score were assessed with T1-weighted spin-echo images with submillimeter in-plane spatial resolution. The final rheumatologist's diagnosis according to the clinical criteria of the American College of Rheumatology including laboratory tests and results of temporal artery biopsies from 32 patients was used as a "gold standard" for the evaluation of the MR imaging findings.

RESULTS

All of the examinations provided diagnostic image quality. Evaluation of the mural inflammatory MR imaging signs for diagnosing vasculitis resulted in a sensitivity of 80.6% and a specificity of 97.0%. In comparison, histology results alone showed a sensitivity of 77.8% and specificity of 100%. The mean wall thickness increased significantly from 0.39 mm (+/-0.18 mm) to 0.74 mm (+/-0.32 mm; P < .001), and the lumen diameter decreased significantly from 0.84 mm (+/-0.29 mm) to 0.65 mm (+/-0.38 mm; P < .05) for patients with giant cell arteritis.

CONCLUSION

Contrast-enhanced, high-resolution MR imaging allows noninvasive assessment of mural inflammation in giant cell arteritis with good diagnostic certainty. Measures of mural thickening and contrast enhancement can be obtained in these small vessels and provide valuable vasculitic MR imaging findings.

Combination of 5-fluorouracil and N1,N11-diethylnorspermine markedly activates spermidine/spermine N1-acetyltransferase expression, depletes polyamines, and synergistically induces apoptosis in colon carcinoma cells

The thymidylate synthase inhibitor 5-fluorouracil (5-FU) is used widely for chemotherapy of colorectal carcinoma. Recent studies showed that 5-FU affects polyamine metabolism in colon carcinoma cells. We therefore examined whether combinations of 5-FU with drugs that specifically target polyamine metabolism, i.e. N1,N11-diethylnorspermine (DENSPM) or alpha-difluoromethylornithine (DFMO), have synergistic effects in killing HCT116 colon carcinoma cells with wild-type or absent p53. Our results showed that simultaneous 5-FU and DENSPM, a spermine analogue, synergistically increased transcript levels of the polyamine catabolism enzyme spermidine/spermine N1-acetyltransferase, depleted spermine and spermidine, increased acetylated spermidine, and produced synergistic tumor cell apoptosis in both p53 wild-type and p53-null variants. By contrast, simultaneous combination of 5-FU with DFMO, an inhibitor of the polyamine biosynthetic enzyme ornithine decarboxylase, depleted putrescine but did not produce synergistic cell killing. Some pre-treatment and post-treatment regimens of DENSPM and DFMO were antagonistic to 5-FU depending on cellular p53 status. Protein and transcriptome expression analysis showed that combined 5-FU and DENSPM treatment activated caspase 9, but not caspase 3, and significantly suppressed NADH dehydrogenases and cytochrome c oxidases, consistent with the observed increase in hydrogen peroxide, loss of mitochondrial membrane potential, and release of cytochrome c. Our findings demonstrate the importance of the polyamine pathway in 5-FU effects and suggest that the combination of 5-FU with DENSPM has potential for development as therapy for colorectal carcinoma.

c-Met tyrosine kinase receptor expression and function in human and canine osteosarcoma cells

To further characterize the role of hepatocyte growth factor-scatter factor (HGF-SF) and its receptor (c-Met) in osteosarcoma (OS), human OS cell lines with low (SAOS-2) and high (SAOS-LM2) metastatic potential, and cell lines derived from spontaneous canine OS were studied. All cell lines were evaluated for c-Met and HGF-SF expression and receptor activation using Northern, RT-PCR, and Western blot analyses, respectively. Functional activity of receptor-ligand interaction was measured using c-Met phosphorylation status, proliferation assays (anchorage-dependent and -independent), Matrigel invasion, modulation of urokinase plasminogen activator (uPA) expression, and cell dispersion (scattering). All cell lines exhibited steady-state mRNA expression of c-Met. The canine OS cell lines also expressed HGF-SF mRNA as determined by RT-PCR analysis. Western analysis showed c-Met protein expression and HGF-stimulated (human) or constitutive (canine) receptor autophosphorylation. Treatment with recombinant human HGF resulted in enhanced proliferation in 3 of 5 OS cell lines and enhanced colony formation in 2 of 5 OS cell lines. Matrigel invasion was significantly enhanced in 3 of the cell lines and uPA levels were significantly increased in the SAOS-2 cells following HGF treatment. Scattering was enhanced in both the SAOS-2 and SAOS-LM2 cells. These data support the involvement of c-Met and HGF-SF in the growth and progression of human and canine OS, and may offer new targets for the development of therapeutic strategies for OS.

Epstein-Barr virus in squamous carcinoma of the anterior nasal cavity

Squamous carcinoma is the most common malignancy of the head and neck, but it rarely occurs in the nasal vestibule. Epstein-Barr virus (EBV) has been detected in and is causally linked to various head and neck tumors, particularly nasopharyngeal carcinoma. The possible role of EBV in squamous carcinoma of the anterior nasal cavity, particularly of the nasal vestibule, has not been previously investigated. Histologic sections from 17 patients with nasal vestibular squamous carcinoma were examined. Material for EBV detection by immunohistochemistry and by in situ hybridization was available in 15 of the 17 cases. The study group consisted of eight men and nine women ranging in age from 40 to 82 years (mean age, 64 years). None of the patients was of Asian descent. The squamous carcinomas were graded as well differentiated (one case), moderately differentiated (11 cases), and poorly differentiated (five cases). Fourteen patients were smokers; the history of smoking ranged from 20 to 60 pack-years. Treatment modalities included surgical resection, radiation, chemotherapy, or a combined approach. The clinical follow-up periods ranged from 7 months to 16 years. Three patients developed metastases, one of whom died of disease after 1 year. Epstein-Barr virus was not detected in any of the 15 of 17 cases tested by either immunohistochemistry or by in situ hybridization. Squamous carcinoma of the nasal vestibule is an uncommon cancer that is not causally related to EBV.

Calcineurin binds the transcription factor NFAT1 and reversibly regulates its activity

NFAT1 (previously termed NFATp) is a cytoplasmic transcription factor involved in the induction of cytokine genes. We have previously shown that the dephosphorylation of NFAT1, accompanied by its nuclear translocation and increased DNA binding activity, is regulated by calcium- and calcineurin-dependent mechanisms, as each of these hallmarks of NFAT1 activation is elicited by ionomycin and blocked by the immunosuppressive drugs cyclosporin A and FK506 (Shaw, K.T.-Y., Ho, A.M., Raghavan, A., Kim, J., Jain, J., Park, J., Sharma, S., Rao, A., and Hogan, P.G. (1995) Proc. Natl. Acad. Sci. U.S.A. 92, 11205-11209). Here we show that the activation state of NFAT1 in T cells is remarkably sensitive to the level of calcineurin activity. Addition of cyclosporin A, even in the presence of ongoing ionomycin stimulation, results in rephosphorylation of NFAT1, its reappearance in the cytoplasm, and a return of its DNA binding activity to low levels. Similar effects are observed upon removal of ionomycin or addition of EGTA. We also demonstrate a direct interaction between calcineurin and NFAT1 that is consistent with a direct enzyme-substrate relation between these two proteins and that may underlie the sensitivity of NFAT1 activation to the level of calcineurin activity. The NFAT1-calcineurin interaction, which involves an N-terminal region of NFAT1 conserved in other NFAT family proteins, may provide a target for the design of novel immunosuppressive drugs.

Success rates in psychiatry and neurology certification examinations

The authors traced the progress of a sample of 200 psychiatrists and 150 neurologists on the ABPN examination. Overall success rates were high-64% of psychiatrists and 75% of neurologists became Board-certified. Performance on the written exam was a significant predictor of outcome for both groups-88% of psychiatrists and 94% of neurologists who passed Part I on their first try eventually obtained certification. Given the criticism that has been directed toward the oral exam, it was interesting that only 10% of psychiatrists and 5% of neurologists failed to become diplomates because of difficulties with Part II. Future research will deal with the validity and reliability of the oral exam.