Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan

OBJECTIVE

We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic.

STUDY DESIGN AND METHODS

This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality.

RESULTS

The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality.

CONCLUSION

Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

Cardiopulmonary arrest and in-hospital outcomes in young patients with acute myocardial infarction: insights from the Japanese nationwide registry

Background

Cardiopulmonary arrest (CPA) is the most serious presentation of acute myocardial infarction (AMI). However, the frequency and prognostic impact of CPA in young patients with AMI have been still unclear.

Objectives

This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention using large-scale nationwide all-comer registry data in Japan (J-PCI registry).

Methods

Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed within the J-PCI registry between 2014 and 2018.

Results

Among 213,297 patients with AMI, 23,985 (11.2%) were young (age, 20–49 years). Compared with the older group (age, 50–79 years; n=189,312), the young group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with CPA (Figure 1). Further, concomitant CPA was strongly associated with in-hospital mortality in the young group (Table 1).

Conclusions

Young patients with AMI presented a higher risk of CPA than older patients, which was strongly associated with in-hospital mortality.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Observation of Coulomb-Assisted Nuclear Bound State of Ξ^{-}-^{14}N System

In an emulsion-counter hybrid experiment performed at J-PARC, a Ξ^{-} absorption event was observed which decayed into twin single-Λ hypernuclei. Kinematic calculations enabled a unique identification of the reaction process as Ξ^{-}+^{14}N→_{Λ}^{10}Be+_{Λ}^{5}He. For the binding energy of the Ξ^{-} hyperon in the Ξ^{-}-^{14}N system a value of 1.27±0.21  MeV was deduced. The energy level of Ξ^{-} is likely a nuclear 1p state which indicates a weak ΞN-ΛΛ coupling.

Efficacy of guselkumab in a subpopulation with pustulotic arthro-osteitis through week 52: an exploratory analysis of a phase 3, randomized, double-blind, placebo-controlled study in Japanese patients with palmoplantar pustulosis

Background

Previous studies of guselkumab have demonstrated clinical benefits in patients with plaque‐type psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and palmoplantar pustulosis (PPP).

Objective

The aim of this exploratory analysis of a double‐blind, multicenter, placebo‐controlled, phase 3 study in Japanese patients with PPP was to evaluate the efficacy of guselkumab in the subset of patients with pustulotic arthro‐osteitis (PAO).

Methods

Patients were randomized to receive guselkumab 100 or 200 mg at weeks 0, 4, 12 and every 8 weeks, or placebo with cross‐over to guselkumab 100 or 200 mg at week 16 (placebo group). Efficacy endpoints were changes from baseline in magnetic resonance imaging (MRI) score, EuroQOL‐5 dimensions (EQ‐5D) index score, EQ‐5D pain/discomfort dimension score and C‐reactive protein (CRP, mg/L) level in all PAO patients through week 52. Data from both guselkumab groups were combined and presented as results for a single overall guselkumab group.

Results

Among 159 patients with PPP, 66 with PAO were randomized across treatment groups. For patients with MRI data for all regions assessed, the proportion of patients in the guselkumab group with PAO characterized as severe decreased from 23.8% (10/42) at baseline to 5.4% (2/42) at week 52. The mean (SD) change from baseline at week 52 in EQ‐5D index score was 0.20 (0.17) among PPP patients with PAO and 0.15 (0.17) among those without PAO in the guselkumab group. Among all PAO patients, the proportions with an EQ‐5D pain/discomfort dimension score of no or slight pain/discomfort in the guselkumab group increased from baseline to week 52 [33.3% (7/21) vs. 87.5% (35/40)]. The mean (SD) CRP levels decreased in all PAO patients in the guselkumab group at week 52 compared to baseline [−1.71 (8.16) mg/L].

Conclusion

Guselkumab treatment showed beneficial outcomes for PAO signs and symptoms in Japanese patients with PPP.

Abstract P4-08-16: Validation of the AJCC eighth edition prognostic stage compared with the anatomic stage for breast cancer with a Japanese single-institutional cohort

Background: The American Joint Committee for Cancer (AJCC) 8th edition cancer staging system for breast cancer incorporated biologic factors in addition to the 7th edition anatomic stage. We analyzed how the new AJCC 8th edition prognostic stage refined its stratification compared with the anatomic stage.

Methods: We reviewed the data of 4,134 patients with stage I to III breast cancer who underwent surgery at Tokyo Metropolitan Komagome Hospital between 2000 and 2016. The anatomic stage and prognostic stage were re-staged according to the AJCC 8th edition staging manual. Patients who received neoadjuvant chemotherapy or had bilateral breast cancer and those with unknown clinicopathologic factors were excluded. The 21-gene Oncotype DX breast recurrence score was not used for staging in this study.

Results: A total of 2,469 patients with a median follow-up of 4.7 years (range 0.1-15.5 years) were identified. According to the anatomic stage, there were 1,259 patients of stage IA, 132 of IB, 591 of IIA, 206 of IIB, 130 of IIIA, 14 of IIIB and 73 of IIIC. According to the prognostic stage, there were 1,610 patients of stage IA, 331 of IB, 236 of IIA, 73 of IIB, 85 of IIIA, 43 of IIIB and 27 of IIIC. Sixty-four patients (2.6%) could not be assigned using the new staging system for the presence of micrometastases in lymph nodes with tumors larger than 2 cm. The 5-year disease-free survival (DFS) rates according to the anatomic stage were 97.4% for stage IA, 97.1% for IB, 95.8% for IIA, 86.5% for IIB, 77.9% for IIIA, 49.2% for IIIB and 54.9% for IIIC. According to the prognostic stage, the 5-year DFS rates were 97.9% for stage IA, 92.9% for IB, 91.2% for IIA, 79.8% for IIB, 67.4% for IIIA, 53.3% for IIIB and 38.7% for IIIC. Compared with the AJCC anatomic stage, the prognostic stage was increased in 148 patients (6.2%) and decreased in 808 patients (32.8%). For those in whom the stage changed, the change was by one stage up or down in 463 (19.3%), by 2 stages up or down in 401 (16.7%) and by 3 stages up or down in 92 (3.8%). Of the 1,842 patients with hormone receptor (HR)-positive and human epidermal growth factor 2 (HER2)-negative (HR+/HER2-) disease, 40.5% (745/1842) of cases were downstaged, and 0.7% (1/1842) were upstaged.

Discussion: The AJCC 8th edition prognostic staging system provided more refined stratification than the anatomic stage. In the Japanese cohort, the proportion of the downstaging rate was higher than the upstaging rate, and the prognostic evaluation of HR+ patients in particular was improved.

Citation Format: Miyamoto H, Saita C, Onishi M, Goto R, Iwamoto N, Honda Y, Aruga T. Validation of the AJCC eighth edition prognostic stage compared with the anatomic stage for breast cancer with a Japanese single-institutional cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-16.

Estimating the Net Utility Gains Among Donors and Recipients of Adult Living Donor Kidney Transplant

OBJECTIVES

Living donor kidney transplant relieves the disease burden of patients with end-stage renal disease but may shorten donor life expectancy; however, their quality of life (QOL) is preserved. Nevertheless, the magnitude of the net gain of this procedure is unknown. We evaluated the QOL of both donors and recipients concurrently and calculated the net utility gain.

METHODS

We recruited 210 subjects who visited the kidney transplantation clinic of a university hospital. Subjects were asked to complete the 5-level EQ-5D-based questionnaire, and patient characteristics were extracted from their medical records. We performed multivariate tobit models analysis to evaluate the QOL change caused by transplant surgery and subsequently ran computational simulations to determine the net utility gains of donors and recipients. We also performed sensitivity analyses.

RESULTS

After excluding 16 answers with missing data, we analyzed 203 answers in total. After the transplant surgery, recipients gained 0.07 in utility value while donors lost 0.04. In the net utility analysis, we found that the quality-adjusted life years gained ranged from 7.2 to 7.8 in the most favorable case observed in the combination of middle-aged recipients and elderly donors. Assuming no utility discount, the most favorable combination was that with older donors and younger recipients.

CONCLUSIONS

These findings indicated that the QOL improvement in recipients was larger than the loss among donors. When calculating the net utilities, a combination of middle-aged recipients and elderly donors yielded the largest net utility, but this was likely derived from assumption in the discount of QOL.

Abstract P3-01-09: Re-evaluating the “10% rule” for sentinel lymph node biopsy with radioactive method in breast cancer; a single institutional retrospective study

Background:

When multiple radioactive sentinel lymph nodes (SLNs) are present during sentinel lymph node biopsy (SLNB), excision of those SLNs with >10% radioactive count per minute (high-CPM) of the most radioactive node (“10% rule”) has been proposed. Although this “10% rule” may avoid excessive removal of SLNs,the risk of false negative and remnant positive SLNs in the patients who have SLNs with <10% CPM (low-CPM) remain unclear. The purpose of this analysis is to determine the clinical validity of this “10% rule” for early breast cancer patients.

Method:

We reviewed the records of successful SLNBs using the radioisotope (RI) method performed between January 2001 and December 2016 in our institution. The radioactive count from each excised SLN was measured. Non-radioactive lymph nodes were excluded from this analysis. All SLNs were pathologically assessed by 2mm serial section with hematoxylin and eosin staining.

Results:

In the 3,043 patients with successful SLNB,the median number of radioactive SLNs removed was 2 (mean, 1.8; range, 1-10) and 599 patients (19.7%) had SLNs with low-CPM. The total number of radioactive SLNs was 5,472, and 875 (16.0%) out of 5,472 SLNs were low-CPM. Sixty-one (7.0%) out of these 875 SLNs with low CPM in 56 patients (1.8%) had metastatic disease by pathological assessment. The number of metastatic SLN with low-CPM was one in 51 patients and two in 5 patients. Nineteen patients (0.6%) had no metastatic lesion in SLNs with high-CPM.

Discussion and Conclusions:

If SLNB was performed by RI method alone with “10% rule”, false negative rate increased by 0.6% and underestimation increased up to 1.8%. Furthermore, 19.7% of the patients have the benefit of avoiding excessive removal of SLNs.Considering the risk and benefit, “10% rule” is a high validitymethod to capture metastatic SLNs even in the setting that ALND will not be performed.

Citation Format: Miyamoto H, Aruga T, Onishi M, Goto R, Iwamoto N, Idera N, Horiguchi K, Honda Y. Re-evaluating the “10% rule” for sentinel lymph node biopsy with radioactive method in breast cancer; a single institutional retrospective study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-09.

Abstract P3-05-17: The numbers of Foxp3 positive cells in simultaneous bilateral breast cancer

Background

Evasion of the immune system is one of the hallmarks of malignant tumors, and recently blocking of such evasion has been used in clinical practice for the treatment of some types of cancers. Recruitment of regulatory T cells (Tregs), which express the specific marker Foxp3, is an established mechanism of escaping from the immune system. In breast cancer, it has been reported that the number of Tregs differs widely among breast cancer subtypes, and that patients who have many Tregs around the tumor tend to have a poor prognosis. However, the factors that are important for the recruitment of Tregs are not well known. Thus, factors that depend on the host (e.g., age or comorbidity), on the tumor (e.g., subtype, grade, or stage), or on measurement error might be the cause of the observed differences in the number of Tregs. In this study, we investigated the numbers of Tregs in simultaneous bilateral breast cancer patients in order to determine the factors that influence the recruitment of Tregs, while excluding differences in individuals as much as possible.

Material and methods

Patients who had breast cancer in both breasts and who underwent simultaneous surgery between January 2005 and September 2015 at two institutions were enrolled in this study. Patients who underwent primary systemic therapy who were diagnosed with ductal carcinoma in situ, or who were stage IV were excluded. The average numbers of Foxp3-positive (Foxp3+cells) were determined from scores of five high-power fields (HPFs). The association between the difference in Foxp3+ cell number between each breast in a single individual and clinicopathological features was examined.

Results

Seventy patients were included in this study. Their ages ranged from 39-85 (median 54) years old. Ninety five percent of the tumors were invasive ductal carcinoma non-special type. Eighty eight (62.9%), 43 (30.7%), and 9 (6.4%) of the tumors were T1, T2, and ≥T3, respectively, and 102 (72.9%) of the tumors were node-negative. Regarding nuclear grade (NG), 104 (74.3%), 21 (22.1%), and 7 (5%) of the tumors were NG1, 2, and 3, respectively. As for subtype, 124 (88.6%), 9 (6.4%), and 7 (5%) were ER-positive and HER2-negative(ER+/HER2-), ER-positive or negative and HER2-negative(ER±/HER2+), and ER-negative and HER2-negative(ER-/HER2-), respectively. The numbers of Foxp3+ cells ranged from 0 to 39.8 (median 3.3)/HPF, and difference in Foxp3+ cell number between each breast in a single individual ranged from 0 to 34 (median 3.9)/HPF.

Differences in tumor size and node status in individuals did not impact on the number of Foxp3+ cells. However, the number of Foxp3+ cells in tumors that were NG3 (P=0.00098) or ER±/HER2+ or ER-/HER2- type (P=0.00586) were statistically significantly increased compared with tumors that were NG1/2 or ER+/HER2- type in the same host.

Furthermore, the difference of Foxp3+ cells between each tumor in a single individual were quite small regarding tumor size and node status in 53 patients who had similar NG and subtype tumors in both breasts.

Conclusions

The number of Foxp3+ cells showed no relationship with tumor size, or lymph node status in simultaneous bilateral breast cancer patients. High NG, ER±/HER2+ or ER-/HER2- type of the tumor were involved with enhancement of the recruitment of Tregs.

Citation Format: Goto R, Hirota Y, Aruga T, Horiguchi S, Tazawa S, Nakamura S, Takimoto M. The numbers of Foxp3 positive cells in simultaneous bilateral breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-17.

De novo sequencing of highly modified therapeutic oligonucleotides by hydrophobic tag sequencing coupled with LC-MS

Correct sequences are prerequisite for quality control of therapeutic oligonucleotides. However, there is no definitive method available for determining sequences of highly modified therapeutic RNAs, and thereby, most of the oligonucleotides have been used clinically without direct sequence determination. In this study, we developed a novel sequencing method called 'hydrophobic tag sequencing'. Highly modified oligonucleotides are sequenced by partially digesting oligonucleotides conjugated with a 5'-hydrophobic tag, followed by liquid chromatography-mass spectrometry analysis. 5'-Hydrophobic tag-printed fragments (5'-tag degradates) can be separated in order of their molecular masses from tag-free oligonucleotides by reversed-phase liquid chromatography. As models for the sequencing, the anti-VEGF aptamer (Macugen) and the highly modified 38-mer RNA sequences were analyzed under blind conditions. Most nucleotides were identified from the molecular weight of hydrophobic 5'-tag degradates calculated from monoisotopic mass in simple full mass data. When monoisotopic mass could not be assigned, the nucleotide was estimated using the molecular weight of the most abundant mass. The sequences of Macugen and 38-mer RNA perfectly matched the theoretical sequences. The hydrophobic tag sequencing worked well to obtain simple full mass data, resulting in accurate and clear sequencing. The present study provides for the first time a de novo sequencing technology for highly modified RNAs and contributes to quality control of therapeutic oligonucleotides. Copyright © 2016 John Wiley & Sons, Ltd.

Parallel chemical switches underlying pollinator isolation in Asian Mitella

Floral scents are among the key signals used by pollinators to navigate to specific flowers. Thus, evolutionary changes in scents should have strong impacts on plant diversification, although scent-mediated plant speciation through pollinator shifts has rarely been demonstrated, despite being likely. To examine whether and how scent-mediated plant speciation may have occurred, we investigated the Asimitellaria plant lineage using multidisciplinary approaches including pollinator observations, chemical analyses of the floral scents, electroantennographic analyses and behavioural bioassays with the pollinators. We also performed phylogenetically independent contrast analyses of the pollinator/floral scent associations. First, we confirmed that the pairs of the sympatric, cross-fertile Asimitellaria species in three study sites consistently attract different pollinators, namely long-tongued and short-tongued fungus gnats. We also found that a stereoisomeric set of floral volatiles, the lilac aldehydes, could be responsible for the pollinator specificity. This is because the compounds consistently elicited responses in the antennae of the long-tongued fungus gnats and had contrasting effects on the two pollinators, that is triggering the nectaring behaviour of long-tongued fungus gnats while repelling short-tongued fungus gnats in a laboratory experiment. Moreover, we discovered that volatile composition repeatedly switched in Asimitellaria between species adapted to long-tongued and short-tongued fungus gnats. Collectively, our results support the idea that recurrent scent-mediated speciation has taken place in the Asimitellaria–fungus gnat system.

Abstract P2-10-04: The clinicopathological features of androgen receptor expression in primary HER2-positive breast carcinomas

Background: Human epidermal growth factor receptor 2 (HER2)-positive breast carcinomas are aggressive subtypes associated with a variable response to systemic therapies. HER2-positive breast carcinomas are not homogeneous, and it has been reported that androgen receptor (AR) signaling is an important determinant of cell growth and relation with HER3 expression. The aim of this study was to investigate the clinicopathological significance of AR expression in primary HER2-positive breast carcinomas.

Patients and Methods: 102 primary HER2-positive breast tumor samples were obtained from patients operated on at the Cancer and Infectious Disease Center, Tokyo Metropolitan Komagome Hospital from 2001 to 2010. 92 tumors were IHC (HercepTest) score 3, whereas 10 were IHC score 2 and FISH- positive. We evaluated AR using immunohistochemistry. Tumors with equal or more than 10% nuclear-stained cells were determined to be positive for AR and the relationship between AR and clinicopathological parameters was analyzed.

The expression of HER3 was evaluated by immunohistochemistry using the following scoring system: 0 (no staining), 1 (less than 20% of cells stained or weak staining), 2 (more than or equal to 20% of cells stained, or strong staining) and the relation with AR expression was examined.

The differences among variables were calculated by chi-square test.

Results: The median age of all patients was 56 years old (from 31 to 84). AR-positive carcinomas corresponded to 37(36.2%) of 102 HER2-positive breast carcinomas. The median age of AR-positive patients was 54 years old while that of AR-negative patients was 57 years old. There was no significant difference between the two groups.

AR-positive carcinomas were not associated with ER and progesterone receptor (PgR) co-expression and nuclear grade. The stage distribution of AR-positive patients was: stage I(n = 23), stage IIA(n = 11), stage IIB (n = 3), and averaged 18.5mm in tumor size, while AR-negative patients distributed as stage I(n = 16), stage IIA(n = 27), stage IIB (n = 15), stage IIIA(n = 5), stage IIIB(n = 2), and averaged 23.7mm in size. AR-positive carcinomas were associated with larger pathological tumor size and more advanced clinical stages, though lymph node involvement did not differ between the two groups.

The HER3 expression score distribution was: scrore 0 (n = 14), score 1 (n = 54), score 2 (n = 34). The expression of HER3 was not associated with clinicopathological parameters. Furthermore, there was no significant relation between AR expression and HER3 expression.

Median follow-up interval was 63 months. 20 patients (19.6%) suffered recurrence. Four patients suffered recurrence in the AR-positive group while there were 16 patients in the AR-negative group. AR-positive patients had significant better prognosis in recurrence than AR-negative patients.

Conclusion: Among HER2-positive breast carcinomas, AR-positive carcinomas have the tendency to be smaller in tumor size and of early clinical stage compared with those that are AR-negative. The expression of AR might be a better prognostic factor in HER2-positive breast carcinomas.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-10-04.

Abstract P6-11-11: Characteristics of long-term survivors after brain metastases in breast cancer patients

Background: Brain metastases (BM) occur in 10%-15% patients of breast cancer patients. It is associated with poor prognosis, requiring great effort to manage local and systemic treatment for BM. The purpose of this study was to analyze the clinico-pathological characteristics of long-term survivors with BM in breast cancer patients.

Method: 63 patients with breast cancer BM diagnosed from 2002 to 2010 at the Tokyo Metropolitan Komagome hospital were included. Long–term survival group (Long) was defined as to be consisted of the patients with survival duration more than 36 months after diagnosed with BM and the patients with less than 36 month was into Short-term survival group (Short) in this study. The clinico-pathological characteristics were compared between these two groups. Survival rate and prognostic factors of BM were analyzed by the Kaplan–Meier method and employed by Log–Rank test. Multivariate analysis was performed by the Cox proportional hazard model.

Results: Median age of the 63 patients was 53 years (range, 35–78). Median survival time after BM was 12 months (range, 1–168), with about 90 percent of cause of death related to BM (e.g. failure of PS due to BM). As for ER and HER2 status, the number of ER+/HER2- (Luminal:Lum), ER+or-/HER2+ (HER2-enrich:Her2-E), ER-/HER2- (Basal:Bas) were 18, 27, 18, respectively. Among those 63 patients, 11 survived 36 months or more after BM. However, there was no difference in the rate of ER status between Long (55%) and Short (38%), there were significantly high rate of Her2-E case in Long (73%) as compared with Short (29%). Median survival duration after diagnosed with BM of Lum, Her2-E and Bas were 11, 37, 3 months, respectively. Prognosis of Bas was significantly poor (Bas vs. Her2-E p<0.001), and although Her2-E was not significant as compared with ER (p = 0.188), survival time after BM of Her2-E was the tendency to be long. In univariate analysis, Karnofsky performance status (KPS≥70 or <70), HER2 status, disease free interval (from initial diagnosis to first recurrence, DFI≥2years or <2years) had significant impact on survival time after BM. (p = 0.0458, 0.0398, 0.0385, respectively). Meningitis status was a borderline. (p = 0.052) In multivariate analysis, KPS, HER2 status and DFI were significant prognostic factors. (KPS: RR 2.08, 95% CI 1.08-4.07; HER2: RR 2.911, 95% CI 1.396- 6.484; DFI: RR 1.933, 95% CI 0.83-4.102)

Conclusions: Although, it was believed that the prognosis after BM was poor, Her2-E BM had a comparatively good prognosis. An existing report supports extension of the survival time after BM by HER2–targeted treatment in BM cases with Her2 positive breast cancer. This newest study reviles the median survival after BM as 37 months in Her2-E BM group, but that of Bas group was only 3 months and this is not improved at all compared with historically reported survival duration (2.4-4.9months). Our reports suggested that the innovation of Her2–targeted treatment leads this surprising improvement of life extension in HER2 positive BM patients but innovation of cytotoxic agents could not contribute toward improvement of clinical outcome in triple negative BM patients. So the necessity of examining the medical treatment of breast cancer BM according to subtype from now on is also considered.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-11.

Delayed anti-CD3 therapy results in depletion of alloreactive T cells and the dominance of Foxp3+ CD4+ graft infiltrating cells

The engineered Fc-nonbinding (crystallizable fragment-nonbinding) CD3 antibody has lower mitogenicity and a precise therapeutic window for disease remission in patients with type 1 diabetes. Before anti-CD3 can be considered for use in transplantation, the most effective timing of treatment relative to transplantation needs to be elucidated. In this study anti-CD3F(ab')2 fragments or saline were administered intravenously for 5 consecutive days (early: d1-3 or delayed: d3-7) to mice transplanted with a cardiac allograft (H2(b)-to-H2(k); d0). Survival of allografts was prolonged in mice treated with the early protocol (MST = 48 days), but most were rejected by d100. In contrast, in mice treated with the delayed protocol allografts continued to survive long term. The delayed protocol significantly inhibited donor alloreactivity at d30 as compared to the early protocol. A marked increase in Foxp3(+) T cells (50.3 ± 1.6%) infiltrating the allografts in mice treated with the delayed protocol was observed (p < 0.0001 vs. early (24.9 ± 2.1%)) at d10; a finding that was maintained in the accepted cardiac allografts at d100. We conclude that the timing of treatment with anti-CD3 therapy is critical for inducing long-term graft survival. Delaying administration effectively inhibits the alloreactivity and promotes the dominance of intragraft Foxp3(+) T cells allowing long-term graft acceptance.

Development of high-pressure and high-field ESR system using SQUID magnetometer

We have developed a high-pressure and high-field electron spin resonance (ESR) system using the combination of a commercially available superconducting quantum interference device (SQUID) magnetometer and a clamp-type piston cylinder pressure cell. The magnetic field range is up to 5 T, and the maximum pressure reaches 1.5 GPa. The most characteristic feature of this system is its easy handling as compared with other high-pressure ESR systems. Moreover, the macroscopic magnetization measurement can be performed simultaneously with the microscopic ESR measurement. In addition to these features, the well-established pressure calibration method utilizing the change of superconducting transition temperature of tin can be applied to this system. By using this system, we obtained pressure dependence of the single ion magnetic anisotropy parameter D of NiSnCl(6)·6H(2)O up to 1.5 GPa precisely, and the magnetization behavior of this material under pressure was explained well by its pressure dependence of the D value.

Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh

OBJECTIVE

To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children.

METHODS

The panel study involved a random sample of 895 households from over 50,000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households. The height, weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study (mean time: 10 weeks). Women reported 7-day household food expenditure and consumption on both occasions. Changes in parameters were compared between the two groups.

FINDINGS

At baseline, no significant difference existed between the groups. By the study end, the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight, by 0.88 kg. Among children, the difference in means between the two groups had also widened in favour of the intervention group for: height (0.08 cm; P<0.05), weight (0.22 kg; P<0.001), mid-upper arm circumference (1.41 mm; P<0.001) and z-scores for height-for-age (0.02; P<0.001), weight-for-age (0.17; P<0.001), weight-for-height (0.23; P<0.001) and mid-upper arm circumference (0.12; P<0.001). Intervention households spent more on food and consumed more protein-rich food at the end of the study.

CONCLUSION

The cash-for-work programme led to greater household food expenditure and consumption and women's and children's nutritional status improved.

A human anti-CD40 monoclonal antibody, 4D11, for kidney transplantation in cynomolgus monkeys: induction and maintenance therapy

Blockade of CD40-CD154 signaling pathway is an attractive strategy to induce potent immunosuppression and tolerance in organ transplantation. Due to its strong immunosuppressive effect shown in nonhuman primate experiments, anti-CD154 monoclonal antibodies (mAbs) have been tried in clinical settings, but it was interrupted by unexpected thromboembolic complications. Thus, inhibition of the counter molecule, CD40, has remained an alternative approach. In the previous preliminary study, we have shown that 4D11, a novel fully human anti-CD40 mAb, has a fairly potent immunosuppressive effect on kidney allograft in nonhuman primates. In this study, we aimed to confirm the efficacy and untoward events of the 2-week induction and 180-day maintenance 4D11 treatments. In both, 4D11 significantly suppressed T-cell-mediated alloimmune responses and prolonged allograft survival. Addition of weekly 4D11 administration after the induction treatment further enhanced graft survival. Complete inhibition of both donor-specific Ab and anti-4D11 Ab productions was obtained only with higher-dose maintenance therapy. No serious side effect including thromboembolic complications was noted except for a transient reduction of hematocrit in one animal, and decrease of peripheral B-cell counts in all. These results indicate that the 4D11 appears to be a promising candidate for immunosuppression in clinical organ transplantation.

Turbulence in boundary flow of superfluid 4He triggered by free vortex rings

The transition to turbulence in the boundary flow of superfluid 4He is investigated using a vortex-free vibrating wire. At high wire vibration velocities, we found that stable alternating flow around the wire enters a turbulent phase triggered by free vortex rings. Numerical simulations of vortex dynamics demonstrate that vortex rings can attach to the surface of an oscillating obstacle and expand unstably due to the boundary flow of the superfluid, forming turbulence. Experimental investigations indicate that the turbulent phase continues even after stopping the injection of vortex rings, which is also confirmed by the simulations.

Does the permanent portacaval shunt for a small-for-size graft in a living donor liver transplantation do more harm than good?

In order to obviate a small-for-size graft syndrome (SFSGS), a portacaval (PC) shunt had been considered in a case of adult-to-adult living donor liver transplantation (AA-LDLT). In a recent AA-LDLT case, we adopted the PC shunt to resolve SFSGS; however, graft atrophy was observed in the late period of LDLT, thereby resulting in liver dysfunction. Due to the surgical closure of the PC shunt at 11 months post-LDLT, the graft regenerated gradually and resulted in the recovery of the liver function. This experience indicates that the portacaval shunt would overcome SFSGS in the early period of LDLT, while it would cause the graft atrophy and the graft dysfunction in the late period of LDLT.

Prostate cancer screening strategies with re-screening interval determined by individual baseline prostate-specific antigen values are cost-effective

AIMS

To determine whether prostate cancer screening strategies with re-screening interval determined by individual baseline prostate-specific antigen values are cost-effective.

METHODS

Based on the results of an actual contemporary screening program, we established Markov decision analytic models of prostate cancer screening with personalized re-screening interval strategies using cutoff baseline PSA levels for biennial screening as well as a model of uniformly annual or biennial screening. These strategies were compared in terms of cumulative incidence of early cancer and cost-effectiveness.

RESULTS

Early cancer detection rates were similar among all strategies. Personalized strategies were more cost-effective compared to uniform screening strategies. If all participants with negative PSA results uniformly omit annual screening, it would be more costly but less effective (dominated). Contrary, annual screening for all participants would cost too much. These results were robust throughout sensitivity analysis incorporating every assumption in the models.

CONCLUSIONS

This study adds important evidence that personalized rescreening strategies based on individual baseline PSA have advantages of cost-effectiveness against conventional uniform strategies.

Inhibition of apoptosis by menadione on exposure to UVA

Quinones are widely distributed in the environment, both as natural products and as pollutants. This paper reports that one of the simplest quinones, 2-methyl-1,4-naphthoquinone (menadione), effectively inhibited apoptosis in the presence of UVA. Menadione suppressed the apoptosis induced by serum depletion and cell detachment. This effect was significantly enhanced by UVA irradiation. An antioxidant, N-acetylcysteine, completely inhibited the antiapoptotic effects of both menadione itself and menadione plus UVA, and peroxidation of the cells after treatment was observed using a probe to detect the intracellular production of peroxides. By contrast, 2-hydroxy-1,4-naphtoquinone (lawsone) showed no antiapoptotic effect in the presence or absence of UVA. Lawsone is reported not to undergo the redox process that produces reactive oxygen species. These results indicated that intracellular peroxidation contributed to the antiapoptotic effects of both menadione itself and menadione plus UVA. Dysregulation of the apoptotic process is critical to carcinogenesis. The photosensitization of quinone compounds as it relates to the inhibition of apoptosis should be examined in the future.

Repeated irradiations with gamma-rays at a Dose of 0.5 Gy may exacerbate asthma

We previously showed that 0.5 Gy whole-body gamma-ray irradiation with a single or small number of repeated exposures inhibits tumor growth in mice, via elevation of the IFN-gamma/IL-4 ratio concomitantly with a decrease in the percentage of B cells. Here we examined whether repeated 0.5 Gy gamma-rays irradiation can improve asthma in an OVA-induced asthmatic mouse model. We found that repeated irradiation (10 times) with 0.5 Gy of gamma-rays significantly increased total IgE in comparison with the disease-control group. The levels of IL-4 and IL-5 were also significantly higher in the gamma-ray-irradiated group, while that of IFN-gamma was significantly lower, resulting in a further decrease of the IFN-gamma/IL-4 ratio from the normal value. These results indicate that the repeated irradiation with gamma-rays may exacerbate asthma, and may have opposite effects on different immune reactions unlike the irradiation with a single or small number of repeated exposures.

Immunostimulation and growth faltering in UK infants

The purpose of the study was to determine whether chronic immunostimulation could explain growth faltering in disadvantaged children in the UK, as it does in developing countries such as The Gambia. In all, 216 infants, age 10-21 months, were recruited when blood samples were taken for the routine or clinical purposes of a longitudinal study tracking a larger cohort of children. Aliquots of blood were collected on Guthrie cards to determine blood concentrations of albumin (Alb), alpha(1)-antichymotrypsin (ACT), and immunoglobulin G (IgG). Haemoglobin concentrations were determined by routine hospital laboratory analysis. Heights and weights were measured and converted to z-scores; birth weights were used with recruitment weight to calculate a 'thrive index' for each child. Age-corrected plasma IgG concentration was negatively associated with both height- and weight-for-age z-scores (P = 0.042 and 0.038, respectively) but not with the thrive index or body mass index z-scores. Blood haemoglobin levels were positively related to height- and weight-for age z-scores, as well as to the thrive index (P = 0.026, 0.014, and 0.007, respectively). Although significant, these relationships could only account for a small part the observed growth variation. Although the relationships were weak, the results suggest that some of the observed variation in growth of these UK infants may be explained on the basis of persistent immunostimulation or poor iron status. In terms of markers of immunostimulation (Alb, ACT, ACT:Alb ratio, IgG), both absolute levels and relationships with height-for-age are substantially different than those previously observed in cohort studies of infants in The Gambia.

Ionizing radiation-induced macrophage activation: augmentation of nitric oxide production and its significance

Radiation is an important therapy for many kinds of cancer. However, it can result in the inflammation and accompanying injury. Recently, it is being recognized that the nitric oxide (NO) produced in macrophages activated by ionizing radiation is an important mediator. Ionizing radiation has been confirmed to potentiate NO production in macrophages, though the mechanism is not clear. We have shown that the increase of NO production in irradiated macrophages contributed to tumoricidal activity, with the activation mechanisms differing between high-dose and low-dose irradiation. High-dose irradiation activates macrophages directly, whereas low-dose irradiation acts indirectly through interaction with neighboring cells and the paracrine induction of cytokines. In this review, we discuss the augmentation of NO production in macrophages by ionizing radiation and its mechanism and significance. In radiotherapy, the control of NO levels both in whole-body and in the tumor is important to prevent irradiation-induced injury and for the cancer to regress.

Susceptibility to vesicoureteral reflux in Japanese is linked to HLA-DR antigen

OBJECTIVES

To determine whether vesicoureteral reflux is associated with the human leukocyte antigen (HLA) genes.

METHODS

We evaluated 40 Japanese patients (27 males and 13 females) with reflux. HLA-DR low-resolution genotyping and high-resolution typing of HLA-DRB1 alleles were performed. The frequencies of the HLAs and alleles were calculated and compared with those previously reported in 493 healthy Japanese.

RESULTS

Low-resolution typing showed that the frequency of the HLA-DR11 antigen was significantly higher in the patients with reflux than in the control group. High-resolution typing revealed that the frequencies of HLA-DRB1*1101 and 1502 alleles were significantly higher in the patients with reflux than in the control group. In the patients with and without renal scarring, the frequencies of the HLA-DR11 antigens and HLA-DRB1*1101 alleles were significantly lower in those with renal scarring. In the patients with and without the chief complaint of urinary tract infection symptoms, the frequencies of HLA-DR13 antigens and HLA-DRB1*1302 alleles were significantly lower in those with that chief complaint.

CONCLUSIONS

The susceptibility to reflux is, in part, controlled by HLA genes themselves or an unknown gene or genes, the locus for which is located close to the DRB1 gene. The lack of a HLA-DRB1*1101 allele and DRB1*1302 allele in patients with reflux might be connected with renal scarring and urinary tract infection, respectively.

Phosphatidylserine induces apoptosis in CHO cells without mitochondrial dysfunction in a manner dependent on caspases other than caspases-1, -3, -8 and -9

Treatment of Chinese hamster ovary K1 cells with phosphatidylserine (PS) caused typical apoptosis with distinct morphological and biochemical features in a dose- and time-dependent manner. However, unlike camptothecin-induced apoptosis, changes in mitochondrial transmembrane potential were not observed. In addition, cytochrome c release did not occur in PS-induced apoptosis. A pan caspase inhibitor, Z-VAD, significantly inhibited the apoptosis, but inhibitors of caspase-1, -3, -8 and -9 did not. Activities of caspase-1, -3, -8 and -9 were increased by treatment of the cells with camptothecin, but not with PS. These results suggest that PS-induced apoptosis occurs without the collapse of mitochondrial transmembrane potential and without the release of cytochrome c, in a manner independent of caspase-1, -3, -8 and -9.

UVA irradiation induces energy-independent phospholipid-flip in mammalian plasma membrane

Translocation from the outer to the inner membrane leaflet (flip) of phospholipids after ultraviolet A (UVA) irradiation was investigated in Chinese hamster ovary cells. Fluorescent 1-palmitoyl-2-[6-[(7-nitro-2-1,3-benzox- adiazol-4-yl)amino]caproyl]-sn-glycero-3-phosphoserine (NBD-labeled phosphatidylserine [NBD-PS]) was used to assay transbilayer lipid movement. A marked increase in flip of NBD-PS was observed immediately after low-dose UVA irradiation which was not lethal and returned to the basal level after 6 h. UVA-induced flip was not attributed to the increase of permeability by UVA irradiation because cells that were negative for staining with propidium iodide also showed increased flip of NBD-PS. Furthermore, the enhancement was independent of adenosine 5'-triphosphate, demonstrating the lack of involvement of phospholipid translocase. Marked increases were also observed in flip of both NBD-phosphatidylethanolamine and NBD-phosphatidylcholine immediately after UVA irradiation, showing that the increase was independent on the head groups of phospholipids. These findings indicated that UVA changes the flip-flop of phospholipids and that the cell membrane is a molecular and cellular target of UVA.

Purification of the major allergen of red soft coral (Dendronephthya nipponica)

Red soft coral (RSC; Dendronephthya nipponica, a marine coelenterate) causes spiny lobster fishermen living along the Pacific coast of Miyazaki Prefecture in Japan to develop occupational allergies, such as conjunctivitis, rhinitis, dermatitis and bronchial asthma. The aim of this study was to purify and to characterize RSC allergen, which causes occupational asthma in spiny lobster fishermen. The allergic responsiveness of spiny lobster fishermen to RSC was examined. The examinations included specific IgE production, skin test responses, lymphocyte stimulation tests and specific IgG production. We found that RSC has a strong sensitizing activity in humans at a molecular weight of 10 kD or more, while it has no IgE-producing activity at a molecular weight of less than 10 kD. Neither the nonatopic controls nor the atopic non-coral-allergic controls exhibited any RAST-binding activity to any fraction. For the purification and the identification of this new allergen component, repeated gel filtration of the RSC extract was performed on a Sephacryl S-200 column, followed by gel filtration on a Superose-6 column. The purified major allergen component Den n 1, which is separated on a Mono-Q column, showed intradermal responses, lymphocyte stimulating activity and specific IgG-producing activity in RSC-induced bronchial asthma patients. The 53-kD component was electroblotted on a polyvinylidene difluoride membrane. The N-terminal amino acid sequence of this new allergen component (Den n 1) was determined as Asp-Asp-Ile-Asn-Arg-Tyr-Ala-Phe-Asp-Asn-Lys-Ile-Asn- Asp-Lys-Leu-Phe-Asp-His-Trp-Gln-Ser.

Synthetic and theoretical studies on group-transfer imidoylation of organotellurium compounds. remarkable reactivity of isonitriles in comparison with carbon monoxide in radical-mediated reactions

Imidoylation of organotellurium compounds with isonitriles has been investigated in conjunction with the radical-mediated C1 homologation reaction by using CO and isonitriles. Carbon-centered radicals generated photochemically or thermally from organotellurium compounds react with isonitriles in a group-transfer manner to give the corresponding imidoylated products. Organotellurium compounds have been found to serve as effective precursors of a wide variety of stabilized radicals, namely benzyl, alpha-alkoxy, alpha-amino, and acyl radicals, which take part in the imidoylation with high efficiency. The reactions are compatible with various functional groups, and can be carried out in various solvents including environmentally benign water. The reactivity of isonitriles has been compared with that of CO through competition experiments, and the results indicate that isonitriles are superior to CO as radical acceptors in reactions with stabilized radicals. The origin of the differences has been addressed in theoretical studies with density functional theory calculations using the B3LYP hybrid functional. The calculations suggest that both carbonylation and imidoylation proceed with low activation energies, and that there are virtually no differences in the kinetic sense. Instead, it indicates that thermodynamic effects, namely differences in the stability of the acyl and the imidoyl radicals, control the overall course of the reactions.

Identification and cloning of genes associated with the guinea pig skin delayed-type hypersensitivity reaction

Although the cellular and molecular mechanisms underlying the delayed-type hypersensitivity (DTH) reaction have been investigated, the functions of infiltrating leukocytes and skin resident cells in the elicitation phase of the DTH reaction are not completely understood. To gain more insight into the role of these cells in the DTH reaction, we identified about 250 cDNA fragments showing elevated expression during the DNCB-induced guinea pig skin DTH reaction by differential display analysis. Characterization of 50 of them led to the identification of 28 genes whose expression was elevated in the DNCB-induced DTH reactive tissue. Sequencing of the 28 cDNA fragments and homology search analysis demonstrated that 10 of them represented known genes, some of which, in particular elafin (an elastase inhibitor) and ferritin, are considered to play roles in the DTH reaction. The other 18 fragments are probably derived from unknown genes. Cloning of the cDNAs of one of these genes indicated that it is that for guinea pig tryptophanyl-tRNA synthetase (WRS), a protein found to be induced by interferon-gamma and upregulated during the late stages of mononuclear phagocyte maturation in vitro. Strong induction of the WRS gene during the DTH reaction suggests its involvement in the in vivo immune response.

[A lung cancer patient whose renal scintigram showed transient renal dysfunction after administration of contrast material for CT]

We encountered a patient whose renal scintigram showed renal tubular damage four days after administration of contrast material for CT. As no secretion of radioisotope to the urinary tract was observed on the scintigram and the renogram did not show a secretionary phase, renal tubular damage was suspected. As the renal damage disappeared six days after administration of the contrast material, the damage seemed to be transient, disappearing within five days. Caution is needed with the use of renotoxic drugs such as anti-tumor drugs, especially within five days after administration of contrast materials.