Abstract P4-08-30: Prognostication of immune related gene expression in patients with triple negative breast cancer

Introduction: To date, the role of immunotherapy with check point inhibitors and/or vaccines in the treatment of breast cancer (BC) is still debating, and the main focus of immunotherapy in BC is on triple negative subtype as a target population in many ongoing clinical trials. Translational research into identifying predictive and prognostic immune biomarkers is of particular clinical relevance, but, there are currently no definite prognostic and predictive immune biomarkers in BC, especially in triple negative breast cancer(TNBC). We investigated the expression profiles of immune genes in patients with TNBC to identify the prognostic value of immune genes in search of clinical implications.

Methods : We investigated expression profiles of 770 pan-cancer immune related genes using the nCounter mRNA expression assay (NanoString®) from paraffin-embedded tumor tissues in 200 patients diagnosed as TNBC who received curative surgery at Samsung Medical Center from 2000 to 2004. We analyzed the relationship between stage adjusted level of gene expressions and patients' survival outcomes using Cox regression model.

Results: Of 770 genes, 186 genes were selected from univariate analysis with clinical stage adjustment. In multivariate analysis using Cox regression, expressions of CD1B, CD45, CD53, CT45A1, GTF3C1, IL11RA, IL1RN, LRRN3, MAPK1, NEFL, PRKCE, SPACA3 and RANKL were associated with distant recurrence free survival (p<0.05, respectively). Among these 13 genes, expression of MAPK1, NEFL, CD45, SPACA3 and RANKL were correlated with favorable outcome in terms of distant recurrence free survival (p<0.05, respectively). In terms of overall survival, C3, IL1RL1, IL1RN, IL7 and PRKCE were associated with poor prognosis (p<0.05, respectively) and expression of SAA1 CXCL9 and RANKL resulted in favorable outcome (p<0.05, respectively).

Table 1ParameterParameter EstimateStandard Errorp-valueHazard Ratio95% Confidence Interval(a) distant recurrence free survival     Stage2.487350.680570.000312.0293.169, 45.661CD1B1.141910.2753<.00013.1331.826, 5.374CD531.531650.34851<.00014.6262.336, 9.159CT45A10.426110.134210.00151.5311.177, 1.992GTF3C11.193110.579720.03963.2971.059, 10.271IL11RA1.671120.461750.00035.3182.151, 13.146IL1RN0.980280.24657<.00012.6651.644, 4.321LRRN31.424170.28742<.00014.1542.365, 7.297MAPK1-0.542740.258240.03560.5810.35, 0.964NEFL-1.12170.335610.00080.3260.169, 0.629PRKCE2.378340.49659<.000110.7874.076, 28.549CD45-2.736780.43154<.00010.0650.028, 0.151SPACA3-0.745930.272270.00610.4740.278, 0.809RANKL-1.288920.2976<.00010.2760.154, 0.494(b) overall survival     Stage1.359280.497810.00633.8931.468, 10.329C30.329830.150350.02831.3911.036, 1.867CXCL9-0.379190.100680.00020.6840.562, 0.834IL1RL10.679360.262940.00981.9731.178, 3.303IL1RN0.437130.172370.01121.5481.104, 2.171IL70.507280.206250.01391.6611.109, 2.488PRKCE0.835340.272910.00222.3061.35, 3.936SAA1-0.564250.13449<.00010.5690.437, 0.74RANKL-0.604990.234510.00990.5460.345, 0.865

Conclusion: High expression of IL1RN, PRKCE were associated with short distant recurrence free survival and overall survival in patients with TNBCs who received curative surgery. In contrast, RANKL expression resulted in prolonged distant recurrence free survival and overall survival.

Citation Format: Kim J-Y, Jung HH, Lim JE, Cho EY, Lee SK, Yu JH, Lee JE, Kim SW, Nam SJ, Park YH, Ahn JS, Im Y-H. Prognostication of immune related gene expression in patients with triple negative breast cancer [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 P4-08-30.

Abstract P2-08-52: A predictive model for distant metastasis in breast cancer patients using machine learning

Introduction

Tumor metastasis is a major clinical challenge accounting for the vast majority of cancer related deaths.In previous studies, prediction of distant metastasis was based on subtypes,clinical status and sometimes gene expression were used however clinical application was difficult.

In this study, we develop the easy to use prediction tool for distant metastasis using clinical characteristics and gene profiles which came from CancerSCANTM, Next Generation Sequencing based targeted-sequencing platform designed at Samsung Medical Center(SMC).

Methods

We performed a retrospective chart review of 326 breast cancer patients who underwent surgery and CancerSCAN TM between Jan 2001 and Dec 2014 at SMC. Median follow up period was 83 months (Range 1˜190). Cancer scanTM cover 381 genes but 27 genes and 34 occasions (loss of function, mutation or copy number variation) were selected for analysis through gradient boosting and Wilcoxon Signed rank test. Azure Machine Learning is a cloud service that enables the execution of machine learning processes.This was accomplished using the steps of (1) edit the data, (2) split the data, (3) train the model, (4) score the model, and (5) evaluate the model. We split the modeling data into training and testing sets using a randomized 50–50 split. Two-class Decision Forest method was used. After deploying the Azure ML predictive model as a web service, we used a Representational State Transfer application programming interface to send data and obtained predictions in real-time.

Results

No distant metastasis group and distant metastasis group consisted of 267 and 59 patients, respectively. HR-/HER2+ and 50 years old and over patients were higher in metastasis group (p-value = 0.003 and p-value = 0.000). Nuclear grade 3 and N2,3 were higher in metastasis group (p-value = 0.010 and p-value = 0.000, p-value = 0.001 respectively). Stage III was also higher in metastasis group (p-value = 0.000). Among 59 patients with distantmetastasis, multiple sites metastasis was 21 cases (35.6%) and then lung metastasis was 19 cases (32.2%). In the 21 cases of multiple sites metastasis, triple sites was 6 cases (28.6%) and double sites was 15 cases (71.4%). PIK3CA mutation was the most frequent gene variation in all patients (34.5% of no metastasis group and 27.1% of metastasis group) but there was no difference between two groups(p-value = 0.278). BRCA 1 loss of function and BRCA2 loss of function were more frequent in metastasis group than no metastasis group(p-value = 0.033 and p-value = 0.024, respectively) but total counts was too small. We assessed the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for predictive value. The AUC of ROC curve was 1.000 and also accuracy, precision, recall were 1.000. In addition, we conducted internal validation using 83 patients during 2015. When we applied a 0.5 threshold value with our predictive model, true negative was 81 and true positive was 2 among 83 patients. Finally, the accuracy of validation was 1.000.

Conclusion

Our predicted model could represent a useful and easy-to-access tool for the selection of patients with distant metastasis. After additional evaluation with large data and external validation, worldwide use of our model could be expected.

Citation Format: Kim I, Choi HJ, Ryu JM, Lee SK, Yu JH, Kim SW, Nam SJ, Seo SW, Lee JE. A predictive model for distant metastasis in breast cancer patients using machine learning [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 P2-08-52.

Abstract PD5-08: Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers

Understanding how standard-of-care drug treatments affect tumor intrinsic biology and microenvironment is critical for elucidating drug resistance mechanisms and developing better combination therapies as well as new therapies. To characterize the effects of neoadjuvant chemotherapy (NAC) on the genome, transcriptome and tumor infiltrating leukocytes (TILs), we have conducted whole exome and whole transcriptome sequencing of a large longitudinal breast cancer cohort consisting of 146 cases and 281 paired tumor samples. In total, 52 (38%) patients achieved pathologic complete response (pCR) while 85 patients (62%) had residual disease with standard chemotherapy regimen. Tumor biopsies were collected for each patient at three time points – pre-treatment, three weeks after the first cycle of anthracycline and cyclophosphamide (AC) and at the time of surgery after 3 more cycles of AC followed by 4 cycles of taxane or taxane plus Herceptin in case of HER2+ subtype. We detected 5,955 protein-altering somatic mutations affecting 4,414 genes in pretreatment samples and 502 acquired mutations in surgery samples affecting 477 genes including 19recurrently mutated genes such as TP53 and NOTCH1. Across all subtypes, 4,346 genes were differentially expressed (DE) following NAC treatment and significantly enriched in pathways such as cell cycle, ER signaling, PI3K/mTOR, immune and metabolism. Expression-based virtual microdissection analysis indicated that NAC treatment induced an increase in the fractions of stromal and adjacent normal tissue compartment, consistent with observed reduction in tumor cellularity. To assess the NAC induced changes in the molecular landscape of these tumors, we compared molecular features including gene expression signatures, mutation prevalence and copy number alteration between three time points while adjusting for confounding effects of molecular subtype and tumor cellularity. We found that NAC induced dynamic changes in gene expression signatures associated with proliferation and immunomodulatory treatment response. We further validated the observed pattern of change in TILs through histopathology and digital imaging analyses. In pretreatment tumors, 116 genes were DE between patients with pCR vs. those with residual disease with significant enrichment in immune/inflammatory pathways. Further, pre-treatment TIL levels were found to be significantly associated with pCR, echoing previous reports in breast cancers that implicated anti-tumor immunity in mediating the efficacy of chemotherapies. Our analyses also revealed associations between NAC response and baseline genomic attributes such as genomic alterations that affect DNA damage repair pathways. Taken together, these results suggest that NAC induced a multitude of changes on the genomic landscape and immune microenvironment of breast cancers, some of which point to combination strategies with immunomodulatory therapies and therapies that target DNA damage repair.

Citation Format: Kan Z, Lal S, Ding Y, Lee JE, Lee S-H, Lee SK, Yu JH, Choi Y-l, Kim SW, Nam SJ, Kim J-Y, Ram S, Powell E, Ching K, Cho SY, Bonato V, Deng S, Park W-Y, Rejto P, Bienkowska J, Park Y-H. Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers [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 PD5-08.

Abstract P4-01-11: Genomic alterations of cell-free DNA in early breast cancer patients with recurrence

Cell-free DNA (cfDNA), as a non-invasive strategy, provides substantial benefit to overcome tumor heterogeneity. Surveillance of recurrence after standard treatment in early breast cancer (BC) using cfDNA, enables to detect minimal residual disease (MRD), also to identify genomic alterations driving recurrences. We aimed to assess the role of cfDNA in detecting MRD by investigating genomic alterations of 1)primary, recurred tumor and 2)cfDNA at time of recurrence using deep targeted sequencing. Fifty-four early BC patients were enrolled prospectively between 2014 and 2017 at time of recurrence. Median disease free interval was 28.5 months (rage 6.2-49.8). 62.7% (32/51) were hormone receptor (HR) positive (28 HRpos/HER2neg, 4 HRpos/HER2pos), 11.8% (6/51) were HRneg/HER2pos and 25.5% (13/51) were triple negative BCs. 59.3% (32/54) patients developed loco-regional recurrence (15 local recurrence only, 13 regional only, 4 with both) and distant metastasis was observed among 40.7% (22/54) patients. Cell-free DNA was extracted from 5cc blood at time of recurrence. Deep targeted sequencing was performed using customized NGS panel –encompassing 426 cancer-related target coding region, 242 fusion and amplification-related region- of cfDNA and FFPE(formalin fixed paraffin embedded) tumor samples archived from surgical resection or biopsy. Deep targeted sequencing data was successfully performed in 72.1% (31/43) plasma samples and sequencing yield was significantly lower when stored for more than 2yrs (46.2% vs 83.3%).

Mutations of cfDNA and tumor (primary, recurred) were analyzed. Mean sequencing depth of cfDNA and FFPE were x425.7 and x777.6 respectively. Median number of pathogenic mutations found in primary tumor, cfDNA and recurred tumor were 27(range 12-99), 25(range 8-85) and 9(range 0-23). Among mutations found in primary tumor, 27.4% were shared mutations (range 8.1%-72.7%) with recurred tumor and 26.1% were shared mutations (range 4.7%-69.2%) observed in cfDNA sample. Among mutations found in recurred tumor, 40.9% were observed in cfDNA (range 17.7-87.5%). In primary tumor, median number of mutations with allelic fraction (MAF)>10% were 12 (range 4-21) and at least one mutation was found in cfDNA at time of recurrence. Among mutations with MAF>10%, 59.4% and 69.1% were found in cfDNA and recurred tumor. Known oncogenic mutations of PIK3CA, TP53, GATA3, AKT1, ESR1, RELN, ERBB2, ERBB3, BRCA1 mutation were found. PIK3CA gene (p.H1047R) was found in two cases both in primary tumor and cfDNA at recurrence (MAF 11.4% vs 5.3% and 12.3% vs 15.4%) suggesting de novo driver mutation. One patient developed regional recurrence during adjuvant aromatase inhibitor with ESR1 V392I mutation in both cfDNA and recurred tumor (MAF 48.1 and 54.5%), while another patient's recurred tumor during aromatase inhibitor harbored ESR1 D538G mutation exclusively in recurred tumor with MAF <1%. Both patients had no ESR1 hotpot mutation in primary tumor.

Our data showed sequencing yield of 83.3% in plasma samples within 2yr. Pathogenic mutations in primary tumor, especially when MAF>10%, half of them was observed in cfDNA at time of recurrence. ESR1 mutation should be included in cfDNA surveillance for patients undergoing endocrine therapy even absent in primary tumor.

Citation Format: Kim J, Jo WK, Kim KY, Kim BJ, Lee SB, Lee HJ, Yu JH, Kim HJ, Chung IY, Ko BS, Kim S-B, Jung KH, Ahn JH, Chang S, Lee JW, Son BH, Ahn SH. Genomic alterations of cell-free DNA in early breast cancer patients with recurrence [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 P4-01-11.

Tuning the electrical and optical anisotropy of a monolayer black phosphorus magnetic superlattice

We investigate theoretically the effects of modulated periodic perpendicular magnetic fields on the electronic states and optical absorption spectrum in monolayer black phosphorus (phosphorene). We demonstrate that different phosphorene magnetic superlattice (PMS) orientations can give rise to distinct energy spectra, i.e. tuning the intrinsic electronic anisotropy. Rashba spin-orbit coupling (RSOC) develops a spin-splitting energy dispersion in this phosphorene magnetic superlattice. Anisotropic momentum-dependent carrier distributions along/perpendicular to the magnetic strips are demonstrated. The manipulations of these exotic electronic properties by tuning superlattice geometry, magnetic field and the RSOC term are addressed systematically. Accordingly, we find bright-to-dark transitions in the ground-state electron-hole pair transition rate spectrum and the PMS orientation-dependent anisotropic optical absorption spectrum. This feature offers us a practical way of modulating the electronic anisotropy in phosphorene by magnetic superlattice configurations and detecting this modulation capability by using an optical technique.

Abstract P6-09-08: Identification of ESR1 mutation in breast cancers using targeted ultra-deep sequencing data analysis

Introduction: Estrogen Receptor 1 (ESR1) gene encodes an estrogen receptor, which regulates cell proliferation and promotes tumor progression in estrogen receptor(ER)-positive breast cancer (BC). Therefore, endocrine therapy that inhibiting ER downstream signal, is the most effective treatment strategy in ER-positive BC. However, about 25% of patients with primary disease and almost all patients with metastases will present with or eventually develop endocrine resistance. And genetic alteration of ESR1 is now identified as the endocrine resistance mechanism. However, a few data from clinical trials or public data base exists and could not reflect real world clinic. Therefore, we aimed to identify the frequency and type of ESR1 genetic alterations in BCs through this large scaled study.

Methods: We performed targeted ultra-deep sequencing (CancerSCAN™) using BC tissue specimens. This sequencing was covered entire coding area of ESR1 gene and also detected copy number alteration and translocation of ESR1.

Results: Targeted ultra-deep sequencing of ESR1 was performed using 618 BC tissues. Of 618 tissue samples, 253(40.9%) were MBCs, 362(58.6%) were early BCs (EBCs) and 3 were not identified. In terms of subtypes, 220 ER-positive BCs, 122 ER-positive and HER2-positive BCs, 119 HER2-positive and 153 triple-negative BCs (TNBCs) were included. BCs from patients under 40 year-old were 277(44.8%)(Median: 43.0, range: 23.5 -75.6). ESR1 genetic alterations were identified in 21 BCs (5 EBCs and 16 MBCs). In EBCs, 3 cases were observed in TNBCs and 2 cases were in ER-positive BCs (2.6% and 1.2%, respectively). All five EBC were treatment naïve status. Of 16 cases of ESR1 alterations in MBCs, 10 cases of ESR1 alterations were detected in ER-positive BCs (17.6%), 5cases in ER and HER2-positive BCs(6.7%) and 1 in HER2-positive BCs (1.2%). All ER-positive MBCs were treated with more than one line of endocrine therapy. Most commonly detected genetic alteration was single nucleotide variant (SNV) (15 of 21, 71.4%). Thirteen were in ligand binding domain and two cases occurred in activation function-1 (AF-1) domain (P79A and G145S). D538G and V392I were most frequently mutated loci followed by Y537N (3, 3 and 2 cases, respectively) and only metastatic ER-positive BCs harbored ESR1 activating mutation. Four copy number (CN) amplification in 2 ER-positive and 2 ER and HER2-positive BCs, one CN deletion in TNBC and one ESR1 fusion in ER and HER2-positive BC were also detected (19.0%, 4.8% and 4.8%, respectively). In frame ESR1 fusion was occurred between ESR1 and NPHS1 genes.

Conclusion: In this experimental study, ESR1 genetic alterations were frequently detected in ER-positive MBC but ER-negative or EBC also harbored. The type of genetic alterations varied including SNVs, CN alterations and translocation and ESR1-NPHS1 fusion is the novel genetic alteration that has not been reported. To identify the role of ESR1 genetic alteration in ER-negative BCs and novel translocation, further functional validation would be warranted (Clinical trials.gov Number :NCT02591966).

Citation Format: Kim J-Y, Park K, Park W-Y, Nam SJ, Kim SW, Lee JE, Lee SK, Jung HH, Yu JH, Ahn JS, Im Y-H, Park YH. Identification of ESR1 mutation in breast cancers using targeted ultra-deep sequencing data analysis [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 P6-09-08.

Ovo-vegetarian diet is associated with lower systemic blood pressure in Taiwanese women

OBJECTIVE

This study was designed to investigate blood pressure (BP) profiles among Taiwanese women with different dietary patterns.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 269 non-hypertensive Taiwanese women, 40 years of age or older, were surveyed using structured questionnaires, and measurements of BP and physiological parameters were made. To assess differences among vegans, ovo-vegetarians, and meat eaters in terms of BP, demographic, and health behavior data, the chi-squared and Fisher's exact tests were employed for categorical variables, and analysis of variance and independent t-tests were performed for continuous variables. Multiple regression analysis was used to examine the relationship between BP and dietary patterns while controlling for potential confounding factors.

RESULTS

A significant difference was found among the three test groups in terms of age, education, employment, stress, and waist-hip ratio. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly differed among the three groups. After controlling for age, body weight, waist circumference, and hip circumference, the three groups were observed to be a significant risk factor of the SBP and DBP. The SBP and DBP of the ovo-vegetarian group were significantly lower than those of the meat-eater group. No significant differences were found between the vegan and meat-eater groups in terms of SBP and DBP.

CONCLUSION

Dietary pattern is a likely risk factor for SBP and DBP outcomes in Taiwanese women. In particular, the SBP and DBP of ovo-vegetarians are the lowest among the values observed for all dietary patterns. This finding suggests that an ovo-vegetarian diet is beneficial for long-term BP control and prevention of hypertension in females.

[Rhizosphere Microbial Diversity in Different Wetland Microcosms]

To investigate the rhizosphere microbial community structure characteristics in varying combinations of plants and filter materials in the process of aquaculture pond water treatment, six types of wetland microcosms were established using two kinds of plants (Zizania latifolia Turcz. and Sagittaria graminea) and two types of filter materials (garnet and magnetite). High-throughput sequencing technology was used to analyze the microbial structural features and composition diversity of the wetland rhizosphere. The results were as follows. The microorganisms recovered belonged to 52 phyla, 118 classes, 455 families, 905 genera, and 1426 species. Based on the Shannon index, Zizania latifolia Turcz. (average value: 5.77) had a higher capacity than Sagittaria graminea(average value: 5.29) in terms of microbial enrichment. However, the rate of Proteobacteria in the rhizosphere microorganism communities of the Sagittaria graminea and Zizania latifolia Turcz. microcosms were 61.97% and 51.78%, respectively, further showing that the roots of Sagittaria graminea in the wetland microcosms better enriched the Proteobacteria during the experimental period. The major bacterial groups of different plant roots were enriched with β-Proteobacteria in the experiment. The results of this study provide a theoretical basis for species optimization in artificial wetland systems and best combination of wetland construction that will be useful for future investigations.

Abstract P6-09-50: Impact of young age on recurrence and mortality after surgery in breast cancer: 15 years active surveillance

Introduction:Substantial efforts have been made to find factors associated with breast cancer (BC) recurrence and mortality after BC treatment. So far TNM stage, ER, PR, and HER2 status are considered as the major predictive markers of BC recurrence and used for treatment decision. However, most of these factors were evaluated independent from other important confounders such as age, stage, and various anti-cancer treatments because they were mostly derived from clinical trials. In Korea, up to 50% of BC patients are premenopausal women, it is not clear how age at diagnosis affect the progression and outcomes of the disease considering all known prognostic factors including TNM stage, ER, PR, and HER2 status. We aim to evaluate the impact of young age on recurrence and mortality after surgery among Korean women with BC.

Methods: This is a retrospective cohort study conducted using the data from BC registry from 2000 to 2016 at Samsung Medical Cancer, Seoul, Korea. Patients who received curative BC surgery and who had histologically-confirmed invasive BC between 2000 to 2011 were included in the study. Patients who second primary cancer or double primary cancer were excluded. Information local, regional, or distant recurrence and death until May 2016 was collected using electronic medical records and National Health Statistics. Cumulative incidence rates of distant recurrence and morality at 3-years, 5-years and 10-years were calculated using a competing-risk model. Cox proportional hazards analysis were conducted with 3 different models to take into account for potential confounding factors including age, body mass index (BMI), stage and subtype at breast cancer diagnosis, chemotherapy, radiotherapy and hormone therapy.

Results:There were 7360 BC patients with curative BC surgery between 2000 and 2011, and the average follow up duration was 75.4 months. The mean age at diagnosis was 48.4 years old (Standard deviation (SD)=±10), and 6.2% (n=459) was diagnosed younger than 35. Of total, 13.3% were stage III BC and 73.4% of patients had hormone receptor positive BC. The cumulative incidence (95%CI) of recurrence at 3, 5, and 10 years was 4.4% (3.9-4.9), 7.5% (6.8-8.2), and 14.8% (12.9-16.7) respectively. The incidence of mortality at 3, 5, and 10 years was 1.8% (1.5-2.1), 3.8% (3.3-4.3), and 10.2% (9.1-11.5) respectively. Patients who were diagnosed BC under 35 years of age had 2.14 (95% confidence interval (CI):1.74-3.10) and 1.62 (95% CI:1.02-2.56) times higher risk of distant recurrence and mortality compared to patients whose age at diagnosis were between 50 to 60 after adjusting all well-known prognostic factors including stage, subtype, and BMI at diagnosis, chemotherapy, radiotherapy and hormone therapy.

Conclusions: Young age at diagnosis (<35) was the most significant predictor on BC recurrence and mortality independently from BC stage and subtype. Further study is warranted to explain biologic background for the differences in outcomes in young women with BC.

Citation Format: Kim J-Y, Cho J, Kim H, Kang D, Jung HA, Lee S-H, Bae S, Yu JH, Lee SK, Kim SW, Lee JE, Nam SJ, Ahn JS, Im Y-H, Guallar E, Park YH. Impact of young age on recurrence and mortality after surgery in breast cancer: 15 years active surveillance [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-50.

Abstract P1-02-11: Clinical utility of serial monitoring of circulating tumor DNA (ctDNA)in patients with neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC)

Introduction: Circulating tumor DNA (ctDNA) is a new biomarker which could guide further treatment. Characterization of tumor mutation profiles is required for informed choice of therapy, given that biological agents target specific pathways and effectiveness may be modulated by specific mutations. It would have clinical utility for neoadjuvant setting also. Thus, we assess the potency of ctDNA to predict tumor response to neoadjuvant chemotherapy(NAC) in locally advanced breast cancer(LABC).

Methods: We performed targeted deep sequencing of 30 plasma DNAs and 10 matched germline DNAs from 10 LABC patients. Serial plasma DNAs were collected at diagnosis, after 1st NAC and curative surgery. For the target enrichment, we designed RNA baits covering a total of ~202kb regions of human genome including a total of 83 cancer-related genes. We constructed the sequencing libraries according to the optimized protocol that we recently reported and sequenced on Illumina HiSeq2500 aiming a mean sequencing depth of ~10,000. After excluding unmapped reads, PCR duplicates and off-target reads, the coverage depths for plasma DNA and germline DNA samples were 2,627x and 4,833x on average, respectively. NAC response was measured by residual cancer burden(RCB) score, calculated as a continuous index combining pathologic measurements of primary tumor and nodal metastases for prediction of distant relapse-free survival.

Results: We analyzed ctDNA and primary tumor tissues from 10 patients with LABC scheduled NAC followed by operation in Samsung Medical Center. Of ten LABCs, one excluded from analysis because of angiosarcoma of breast. Five samples were triple-negative breast cancers (BCs), 2 were HER2 positive BCs and others were ER positive BCs. In tumor response, 1 patient had pathologic complete response (pCR), 1 had RCB class I, 4 and 3 patients did RCB class II and III.

Of 83 genes, in analysis of ctDNA at BC diagnosis, we found 2 to 6 mutations in each samples and 3 mutations were detected averagely. Most common mutation was TP53 (6 patients), followed by PIK3CA mutation. By measuring these mutations in serial ctDNA, we found that ctDNA had disappeared after first cycle of NAC in patient with pCR. In two patients with RCB class I, ctDNA had decreased by more than 10 percent (the level of ctDNA(pg/ml): 455.9 to 30.4, 5.8 to 0.0) of primary plasma sample after first NAC. Two patients increased level of ctDNA had tumor response with RCB class III and one patient had distant tumor recurrence within 3 months after curative surgery. However, correlation between the level of ctDNA and initial stage was not observed.

Patient No.Initial stageSurgical stageRCB scoreRCB classct DNA at diagnosis (pg/5ml)ctDNA after 1st NAG (pg/5ml)Tumor recurrence12A11.3331455.930.4No22B00pCR446.60.0No33B2A1.31515.80.0No42A12.132246.255.4No52B11.7972107.811.6No63B3A4.09033401.15075.5Yes73A2B3.92235088.68536.7No

Conclusions: This preliminary result suggests that serial monitoring of ctDNA would be a potiential surrogate marker to predict tumor response and recurrence during NAC in LABC patients. Further results with long-term outcomes are warranted.

Citation Format: Kim J-Y, Park D, Jung HH, Bae SY, Yu JH, Lee SK, Kim SW, Lee JE, Nam SJ, Ahn JS, Im Y-H, Park YH. Clinical utility of serial monitoring of circulating tumor DNA (ctDNA)in patients with neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-02-11.

Abstract P6-09-36: Tamoxifen resistance: EGFR expression in hormone receptor-positive and HER2 negative breast cancer

Purpose: Crosstalk between growth factor receptor tyrosine kinases (RTKs) and the estrogen receptor (ER) represents one of the most important mechanisms of endocrine resistance. EGFR and HER2 have been recognized as prominent factors associated with endocrine resistance. Most previous studies did not identify subgroups by HER2 overexpression and/or included breast cancer with HER2 overexpression. Accordingly, we analyzed HR positive (HR+) tumors without HER2 overexpression (HER2-).

Methods: We analyzed the clinical data of 2,166 patients with HR+HER2- breast tumors, between January 2007 and July 2013.We included only patients who had endocrine therapy with tamoxifen. Immunostaining for EGFR was interpreted as positive when at least 10% of the tumor cells showed moderate to strong membrane staining.

Results: EGFR expression (EGFR+) was present in 109 patients (5%). EGFR expression was significantly associated with more advanced stage and higher grades. In the univariate analyses, EGFR+ tumors were associated with poorer prognosis than EGFR- tumors (5-year DFS, EGFR+ vs. EGFR-, 91.2% vs. 96.6%, P <0.001; 5-year OS, EFGR+ vs EGFR-, 93.1 % vs. 99.4%, P < 0.001). In the multivariate analysis, EGFR+ tumors had a hazard ratio of 2.63 (95% CI 1.14 -6.05) for DFS. EGFR+ tumors had a hazard ratio of 8.8 (95% CI 2.68-132.25) for OS.

Conclusion: EGFR expression could be prognostic factor in hormone receptor-positive and HER2 negative breast cancer, for tamoxifen resistance.

Citation Format: Bae SY, Nam SJ, Lee SK, Kim SW, Lee JE, Yu JH. Tamoxifen resistance: EGFR expression in hormone receptor-positive and HER2 negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-36.

[Recurrent syncope related to catecholaminergic polymorphic ventricular tachycardia due to de novo RyR2-R2401H mutation]

Objective: To explore the clinical and molecular genetic features of a Chinese patient with catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods: Clinical data including resting electrocardiography, echocardiography and treadmill exercise testing of a patient with CPVT admitted to our department in March 2013 were analyzed, and the peripheral venous blood samples of the patient and his family members and 400 ethnicity-matched healthy controls were obtained. All exons and exon-intron boundaries of the six CPVT-related genes including RYR2, CASQ2, TRDN, CALM1, KCNJ2 and ANKB were sequenced to detect the variants related to CPVT. The relationship between the genotypes and phenotypes was analyzed to direct the target therapy. Results: Recurrent syncope induced either by exercise or extreme frightened fear was observed in this patient. There was no positive family history of syncope or sudden death. The resting electrocardiography and echocardiography of the patient were normal, while the exercise testing revealed bidirectional and polymorphic ventricular tachycardia. A cardiac ryanodine receptor gene mutation (R2401H) was identified in this patient, while this mutation was absent in his parents and sister and 400 controls. No variant was detected in the remaining five candidate genes. Treatment with high dose of metoprolol succinate (118.75 mg/d) was effective and patient was free of syncopal attack during the 2 years follow-up. Conclusion: This is the first report on RyR2-R2401H mutation in Chinese patient with CPVT, and high dose of metoptolol is the effective therapy option for CPVT related to RyR2 mutation.

Insulin pump for the treatment of diabetes in combination with ulcerative foot infections

Ulcerative foot infection is a chronic complication frequently seen in diabetic patients, and can result in disability. To evaluate insulin pump treatment for type 2 diabetes in combination with ulcerative foot infection, we selected 168 diabetic patients who developed foot ulcers and received treatment from April 2012 to April 2014 in the People’s Hospital of Zhengzhou, Henan, China. The patients were divided into a treatment group and a control group, 84 in each group. Besides anti-infection treatment, patients in the control group were given multiple subcutaneous insulin injection (MSII), while patients in the treatment group were given continuous subcutaneous insulin infusion (CSII). Ulcer area, fasting plasma glucose (FPG), C-reactive protein (CRP) and count of white blood cells (WBC) were recorded before treatment, one week after treatment, two weeks after treatment and four weeks after treatment; moreover, ulcer healing condition was recorded four weeks after treatment and the related factors were analyzed. Patients in the treatment group showed an obviously narrowed ulcer area two and four weeks after treatment (P less than 0.05) and significantly lowered levels of FPG, CRP and WBC in the 1st, 2nd and 3rd weeks after treatment (P less than 0.05); four weeks after treatment, 88.1% of patients in the treatment group and 66.7% in the control group had healed well, and the difference between two groups was statistically significant (χ2=5.509, P=0.019). Multi-factor logistic regression analysis indicated that levels of FPG, CRP and WBC at baseline and four weeks after treatment had a positive correlation to ulcer healing (P less than 0.05). All the above findings suggest that insulin pump can improve ulcer healing of patients suffering from diabetic foot ulcers as it effectively controls blood glucose level, restrains inflammatory reaction and prevents spreading of infection.

Abstract P5-13-06: Concurrent gonadotropin-releasing hormone (GnRH) agonist administration with chemotherapy improves neoadjuvant chemotherapy responses in young premenopausal breast cancer patients

Background

Gonadotropin-releasing hormone (GnRH) agonist therapy for ovarian function preservation shows promising results. This study aimed to determine the oncologic efficacy of GnRH agonist treatment concurrent with chemotherapy in a neoadjuvant setting.

Patients and Methods

A retrospective analysis was performed on 332 cases of invasive breast cancer in patients who were <40 years old at diagnosis and received GnRH agonists concurrent with neoadjuvant chemotherapy (GnRH agonist group) or neoadjuvant chemotherapy alone (neochemotherapy-alone group) at Asan Medical Center from December 2010 to September 2014. Pathologic complete response rates (pCR) and Ki-67 changes were evaluated between the two groups. For hormone receptor (HR)-positive tumors, the clinical response and preoperative endocrine prognostic index (PEPI) score also were evaluated.

Results

The median age was 32 ± 3.9 and 36 ± 3.0 years old in the GnRH agonist group and neochemotherapy-alone group, respectively (P < .001). Adjusted for tumor size, grade, lymph node metastasis, HR status, and chemotherapy regimen, the GnRH agonist group exhibited a higher pCR rate with an odds ratio (OR) of 2.98 (95% CI, 1.37–6.34) and more decreased Ki-67 expression during treatment (P = 0.05) than the neochemotherapy-alone group. In HR-negative tumors, the GnRH agonist group showed a higher pCR rate (multivariate OR = 3.50; 95% CI, 1.37–8.95) and more decreased Ki-67 expression (P = 0.047). In HR-positive breast cancer, the pCR rate, change in Ki-67 index, and clinical response were higher and preoperative prognostic index (PEPI) scores were lower in the GnRH agonist group, but not significant between the two treatment groups.

Conclusion

Concurrent administration of GnRH agonists during neoadjuvant chemotherapy improved pCR rates and suppressed Ki-67 expression especially in HR-negative tumors.

Citation Format: Yoon TI, Kim HJ, Yu JH, Sohn G, Ko BS, Lee JW, Son BH, Ahn SH. Concurrent gonadotropin-releasing hormone (GnRH) agonist administration with chemotherapy improves neoadjuvant chemotherapy responses in young premenopausal breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-06.

Abstract P3-07-56: Predictive value of tertiary lymphoid structure assessed by high endothelial venule count in neoadjuvant setting of triple-negative breast cancer

Background

Tertiary lymphoid structure (TLS) is an ectopic lymph node-like structure characterized by lymphoid aggregation with high endothelial venules (HEVs), and is an important source of tumor-infiltrating lymphocytes (TILs). TILs have a strong prognostic and predictive significance, particularly in triple-negative breast cancer (TNBC). We previously analyzed expression of immune-related genes in pre-neoadjuvant chemotherapy (NAC) biopsy samples using NanoString assay and showed that gene expression of follicular helper T cell marker CXCL13, which is closely associated with TLSs, was an independent predictive factor for pathologic complete remission (pCR) in TNBC. However, measuring gene expression of biopsy sample is not easy to perform in daily pathology practice. Therefore, we evaluated TLSs by assessing hematoxylin and eosin (H&E) stained slides and immunohistochemistry, and investigated their clinical importance.

Methods

A total of 108 patients diagnosed with primary TNBC and treated with NAC (anthracycline, cyclophosphamide, and taxane) were included. The amounts of TILs and TLSs were histopathologically measured in H&E slides. Immunohistochemical studies were done in 55 cases with available tissue samples. The numbers of CD3-, CD8-, and CD20- immunopositive cells in tumor areas were counted by the image analyzer. MECA79- immunopositive HEV densities were calculated. Their relationship to CXCL13 gene expression by NanoString assay was also analyzed.

Results

The overall rate of pCR was 30.6% (33 of 108 tumors). Lower pre-NAC clinical T stage and higher level of TIL and TLS assessed by H&E slides were predictors of pCR in all cases. The mean number of MECA 79-immunopositive HEV in pre-NAC biopsy samples was 12 (range, 0-72). The amounts of TILs and TLSs, numbers of CD3-, CD8-, and CD20- positive cells, HEV density, and expression of CXCL13 showed good correlation with one another. Higher HEV density, CD20- positive cell number, and CXCL13 expression were predictors of pCR. Higher CD8- positive cell numbers and CXCL13 expression were associated with better disease-free survival rate.

Conclusion

The amount of TLSs assessed by H&E slides and MECA 79-immunopositive HEV densities was well correlated with level of TILs, numbers of CD3-, CD8-, and CD20-positive cells, and gene expression of CXCL13, and was significantly associated with pCR in TNBCs. Therefore, assessing HEV density by MECA 79 immunohistochemistry in pre-NAC biopsy samples might be an objective and valuable tool for predicting pCR of TNBC in routine pathology practice. Further investigation of mechanism of TLS development might help to improve immunotherapeutic strategy.

Citation Format: Song IH, Lee HJ, Park IA, Yu JH, Ahn J-H, Gong G. Predictive value of tertiary lymphoid structure assessed by high endothelial venule count in neoadjuvant setting of triple-negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-56.

Cardioprotection of ginsenoside Rb1 against ischemia/reperfusion injury is associated with mitochondrial permeability transition pore opening inhibition

OBJECTIVE

To investigate the role of ginsenoside Rb1 (Gs-Rb1) in cardioprotection against ischemia/reperfusion (I/R) or hypoxia/reoxygenation (H/R) injury and to explore whether the cardioprotective action is mediated via attenuating the formation of mitochondrial permeability transition pore (mPTP).

METHODS

A Langendorff-perfused model of rat heart was employed. I/R injury was induced by breaking off perfusion for 40 min then reperfusion for 60 min. Gs-Rb1 (100 μmol/L) were administrated for 10 min before I/R. Infarct size was estimated by the 2,3,5-triphenyl tetrazolium chloride (TTC) staining. Lactate dehydrogenase (LDH) and creatine kinase (CK) released from effluents were measured. Transmission electron microscopy was performed to assess morphological difference between cardiac mitochondrial isolated from I/R rats and Gs-Rb1 pretreated rats. Western blot analysis was used to determine phosphorylation of protein kinase B/Akt, and its downstream target glycogen synthase kinase 3β (GSK-3β). Incubation isolated cardiac mitochondria with Gs-Rb1, Ca2+-induced opening of the mPTP was assessed by the reduction of absorbance at 520 nm (A520). Neonatal rat cardiomyocytes were subjected to hypoxia 9 h followed by reoxygenation 4 h to induce H/R injury. After pretreated with different concentration of Gs-Rb1 (6.25, 25, 100 μmol/L ), cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) method. The membrane potential was estimated by Rh123 fluorescence. mPTP opening was measured using the probe calcein-AM.

RESULTS

Gs-Rb1 100 μmol/L significantly reduced the infarct size of hearts (26.39%±11.67% vs. I/R group 56.68%±5.88%, P<0.01). Compared with the I/R group, Gs-Rb1 pretreatment decreased LDH and CK levels in the coronary effluent (P<0.05 or P<0.01) as well as attenuated destructive ultrastructure induced by I/R. The protective effect of Gs-Rb1 involved in phosphorylating protein kinase B/PKB (Akt) and GSK-3β. In mitochondria isolated from rat hearts, significant inhibition of Ca2+-induced swelling was observed in samples that were pretreated with Gs-Rb1 (6.25, 25, 100, 400 μmol/L) for 10 min. When cardiomyocytes were isolated from neonatal rat and subjected to H/R, cell viability was increased with treatment of Gs-Rb1 (6.25, 25, 100 μmol/L ). Gs-Rb1 inhibited mPTP opening and restored subsequent loss of mitochondrial membrane potential.

CONCLUSION

Gs-Rb1 presents cardioprotective effect against I/R or H/R injury which involves in activating Akt, phosphorylating GSK-3β and inhibiting mPTP opening.

NAMPT suppresses glucose deprivation-induced oxidative stress by increasing NADPH levels in breast cancer

Nicotinamide phosphoribosyltransferase (NAMPT) is a rate-limiting enzyme involved in NAD+ biosynthesis. Although NAMPT has emerged as a critical regulator of metabolic stress, the underlying mechanisms by which it regulates metabolic stress in cancer cells have not been completely elucidated. In this study, we determined that breast cancer cells expressing a high level of NAMPT were resistant to cell death induced by glucose depletion. Furthermore, NAMPT inhibition suppressed tumor growth in vivo in a xenograft model. Under glucose deprivation conditions, NAMPT inhibition was found to increase the mitochondrial reactive oxygen species (ROS) level, leading to cell death. This cell death was rescued by treatment with antioxidants or NAD+. Finally, we showed that NAMPT increased the pool of NAD+ that could be converted to NADPH through the pentose phosphate pathway and inhibited the depletion of reduced glutathione under glucose deprivation. Collectively, our results suggest a novel mechanism by which tumor cells protect themselves against glucose deprivation-induced oxidative stress by utilizing NAMPT to maintain NADPH levels.

Association between expression of inflammatory factors and gastric and duodenal mucosa injury induced by radiotherapy in patients with pancreatic cancer

AIM: To investigate the relationship between the expression of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), interleukin-22 (IL-22) and radiation induced gastric and duodenal injury in pancreatic cancer patients.

METHODS: Twenty healthy adults and 30 pancreatic cancer patients were enrolled in the study. Peripheral blood samples were collected from these subjects before, in the middle of and after radiotherapy. Real-time quantitative PCR (QPCR) and enzyme linked immunosorbent assay (ELISA) were used to detect the mRNA and protein levels of IL-6, TNF-α and IL-22, respectively.

RESULTS: Expression of IL-6, TNF-α, and IL-22 mRNAs was significantly higher in the experimental group than in the normal control group (t = 4.404, P = 0.000; t = 2.250, P = 0.030; t = 2.178, P = 0.038). At the protein level, the expression of IL-6 was significantly higher in the experimental group than in the control group (t = 3.766, P = 0.001). The expression of IL-6 and TNF-α mRNAs showed a descending trend along with the accumulation of radiation dose. The expression level of IL-6 mRNA had a significant difference between before and after radiotherapy (t = 2.800, P = 0.007). The expression level of IL-22 was slightly higher in the experimental group than in the control group, though the difference was not statistically significant (P > 0.05). The incidence of mucosal injury was 40% (12 cases) in the study. The expression of IL-6 and TNF-α mRNAs in patients without mucosal injury group showed a gradually declining trend. The expression of IL-6 in patients differed between after and before radiotherapy (t = 2.439, P = 0.021). The expression of IL-6 in patients with mucosal injury was maintained at a relatively high level after radiotherapy. The mRNA expression of IL-22 in patients without mucosal injury decreased in the middle of radiotherapy. The expression of inflammatory factors in patients with mucosa injury was significantly lower than that in patients without mucosa injury (P > 0.05). Similarly, although protein expression of IL-6 in patients without mucosa injury seemed lower than that in patients with mucosa injury groups, and the expression of IL-22 seemed higher than that in the injury group, the differences were not statistically significant (P > 0.05).

CONCLUSION: IL-6, TNF-α and IL-22 are associated with the pathogenesis of radiation induced gastric and duodenal injury in patients with pancreatic cancer. These inflammatory factors may be used as predictors of radiation induced gastric and duodenal injury in pancreatic cancer patients.

Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy

AIM

To determine whether the use of normal saline for sealing the needle track can reduce the incidence of pneumothorax and chest tube placement after computed tomography (CT)-guided lung biopsy.

MATERIALS AND METHODS

A prospective, randomised, controlled trial enrolling 322 patients was conducted. All patients were randomly assigned to one of two groups: those in whom the needle track was not sealed with normal saline (n=161, Group A) and those who did receive normal saline (n=161, Group B). CT-guided biopsy was performed with coaxial technique. Normal saline, which ranged from 1-3 ml, was injected while the trocar needle was being withdrawn. Patient characteristics, lesion, and procedure variables were analysed as potential risk variables for occurrence of pneumothorax and chest tube placement.

RESULTS

The incidence of pneumothorax was 26.1% in Group A and 6.2% in Group B (p<0.001). Nine patients in Group A and one patient in Group B required chest tube placement (p=0.010). Using multiple logistic regression analysis, smaller lesion size, greater needle-pleural angle, longer lesion-pleural distance, presence of emphysema, and no sealing the needle track with normal saline were significantly associated with an increased risk of pneumothorax, and that the latter three factors were also associated with an increased risk of pneumothorax requiring chest tube placement.

CONLUSION

Normal saline for sealing the needle track significantly reduces the incidence of pneumothorax and prevents subsequent chest tube placement after CT-guided lung biopsy.

Effects of tryptophan supplementation on growth performance, antioxidative activity, and meat quality of ducks under high stocking density

High stocking density (STD) could affect duck welfare and production. The objective of our study was to investigate whether dietary tryptophan (TRP) supplementation could alleviate the detrimental effects of high STD on ducks. White Pekin ducks at 4 to 6 wk of age were raised at 11 birds/m(2) and fed diets containing 0.18, 0.48, 0.78, or 1.08% TRP for 21 d. Growth performance, concentrations of TRP and metabolites in the blood and hypothalamus, antioxidative activities in serum and tissue, meat quality, serum uric acid, and urea nitrogen were measured. Weight gain and feed efficiency were significantly improved by TRP supplementation at ≥ 0.48 and ≥ 0.78% (P < 0.05 and P < 0.001, respectively). Serum TRP, hypothalamic TRP, 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacitic acid (5-HIAA), and 5-HIAA/5-HT were also increased significantly (P < 0.01). These increases plateaued at 0.48% TRP, and no further improvement was obtained by adding more TRP to the diet. Dietary TRP supplementation significantly increased levels of total antioxidant capacity, glutathione peroxidase (GSH-Px), and catalase (CAT) in serum; GSH-Px in liver; and GSH-Px and CAT in breast muscle (P < 0.05). Malondialdehyde levels in breast muscle decreased (P < 0.001). Drip loss of breast muscle and pH decline at 45 min postmortem were reduced by TRP supplementation (P < 0.01 and P < 0.05, respectively). Meat color was similar among different treatments (P > 0.05). Breast muscle shear force was increased significantly when dietary TRP level increased to 1.08% (P < 0.01). For ducks raised at 11 birds/m², dietary TRP supplementation could alleviate stress and improve growth performance, antioxidative activity, and meat quality.

Association of apolipoprotein E (ApoE) polymorphisms with risk of primary hyperuricemia in Uygur men, Xinjiang, China

BACKGROUND

Apolipoprotein E (ApoE) participates in lipoprotein metabolism and immune regulation. This study assessed association between ApoE polymorphisms with hyperuricemia and uric acid metabolism in Uygur men, Xinjiang, China.

METHODS

A total of 474 hyperuricemia patients and 518 healthy male controls were recruited from the Health Screening Center, Uygur region of Xinjiang, China and subjected to ApoE genotyping using a multiplex amplification refractory mutation system PCR.

RESULTS

Apolipoprotein E3/3 genotype was the predominant type with a frequency of 67.7%, while E2/2 was lower than E4/4 in Uygur males. The frequencies of ApoE2, E3, and E4 alleles were 8.5%, 80.1% and 11.4%, respectively. Distribution of ApoE genotypes was significantly different in hyperuricemia patients from the healthy controls (p<0.001). Particularly, the frequency of ApoE E3/3 was 71.7%, E2/3 9.3%, E3/4 9.3%, E4/4 3.2%, E2/4 2.3%, and E2/2 0.2% in patients vs. 68.1%, 4.6%, 2.9%, 12%, 0.6%, and 4.6% in controls, respectively. Moreover, frequency of ApoE E2 allele was greater in the healthy controls than in patients (p<0.001) and the highest level of uric acid occurred in those with ApoE2/4 and E3/4 genotypes, whereas the lowest uric acid level occurred in those with ApoE E2/2 genotype. In addition, the subjects with the ApoE2 allele had a lower uric acid and LDL-C level than those with the ApoE3 allele and ApoE4 allele (p<0.05). The risk of developing hyperuricemia in subjects without the ApoE2 allele was 1.7 fold higher than those subjects with the ApoE2 allele.

CONCLUSIONS

This study revealed frequencies and distributions of ApoE alleles and genotypes in Uygur males, which are different from Han Chinese. ApoE E4 was associated with a slightly higher risk of primary hyperuricemia, whereas ApoE E2 was associated with reduced risk of primary hyperuricemia and LDL-C level.

Early third trimester maternal response to glucose challenge and pregnancy outcome in Chinese women-relationship between upper distribution level and recommended diagnostic criteria

BACKGROUND/OBJECTIVES

The objective of this study was to examine the relationship between upper distribution levels of glucose values in the 75-g oral glucose tolerance test (OGTT) and recommended diagnostic criteria for gestational diabetes mellitus (GDM) and adverse pregnancy outcomes.

SUBJECTS/METHODS

The distribution of the OGTT 2-h values of 13,501 pregnant women, which were below the World Health Organization (WHO) threshold for overt diabetes mellitus (DM), and managed in one teaching hospital in China, was reviewed and related to maternal characteristics and pregnancy outcomes.

RESULTS

For the entire group, the 90th and 95th percentile values of the OGTT 2-h glucose level, respectively, were close to the diagnostic cutoff values of the WHO and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. For adverse maternal outcomes, glucose level above the 90th percentile value was associated with increased hypertensive disorders, whereas no difference was seen with cutoff using the 95th percentile value. For perinatal outcomes, the 90th percentile was associated with increased neonatal intensive care unit admission and hypoglycemia, whereas the 95th percentile showed in addition association with phototherapy for jaundice and 5th-minute Apgar score <7. Although no differences in the incidence of adverse pregnancy outcomes were found using the different cutoffs, the >95th percentile cutoff value would have missed out 33.3-56.7% of the cases of adverse outcomes that would otherwise have been attributed to GDM.

CONCLUSIONS

Further studies are warranted to clarify which diagnostic criterion is most appropriate universally to identify adverse pregnancy outcomes attributed to GDM, and which could be mitigated with treatment specific for GDM.