Abstract P1-12-03: Prevalence, predictive factors, and clinical outcomes of anthracycline induced cardiac dysfunction among patients with breast cancer in Japan, where the normal body weight (BMI < 25) is dominant

Objective: Cardiac dysfunction (CD) is a major clinical problem for survivors of breast cancer. ASCO released a guideline for prevention and monitoring CD in survivors of adult cancer in 2017. Exposure to anthracycline (A) and trastuzumab are both risk factor for CD, as well as obesity is a part of multiple risk factors in the guideline. Meta-analysis shown obesity itself increases risk of A induced CD (A-CD). Prevalence of obesity and CD among non-oncology patients vary in countries, as many Western countries have obesity dominant population. Then little is known about clinical characteristics of A-CD in survivors of adult cancer among normal weight dominant countries, especially in Asia. This study was conducted to understand characteristics of A-CD among patients with breast cancer in Japan.

Method: This study used electrical charts, breast oncology database, and cardiology database to find prevalence, predictive factors, and clinical outcomes of A-CD in Hyogo Cancer Center. The definition of CD is based on diagnosis by the cardiologist. Major Cardiac Events (MACE) is defined as cardiac death or emergency admission due to CD. Obesity is defined as BMI > 30, normal body weight is defined as BMI < 25, and elderly is defined as age > 60 years old, same as in ASCO guideline. Patients gave written informed consent. IRB approved this study.

Result: From Apr. 2006, to Mar. 2017, 855 patients received A for the treatment of breast cancer. Median body weight was 55 Kg, median BMI was 23, and 93.4 % of patients are non-obese. Half of patients (46.9 %) are elderly. Almost a quarter (24 %) of patients received trastuzumab. At the median follow up 60 months, 20 patients (2.3 %) experienced CD, one patient (0.11 %) passed away due to CD, and four patients were admitted as emergency, then five patients (0.58 %) experienced MACE. Median time to onset of CD after the last dose of A is seven months. Among patients with CD, 18 patients (90 %) recovered their ejection fraction (EF), and the median time to recover of EF was two months. Predictive factors for CD include usage of trastuzumab (15 patients), elderly (eight patients), high dose anthracycline (four patients), and multiple cardiac risk factors at base line (four patients). Among patients treated without trastuzumab, only five (0.76 %) patients experienced CD, but four of them experienced MACE.

Conclusion: Prevalence of A-CD in the normal weight dominant population was lower than reported in obesity dominant population, especially in patients treated without trastuzumab. In this population, clinical outcome such as prevalence of MACE may vary depending on the usage of trastuzumab. Further study is warranted to set an optimal strategy for the prevention and monitoring of A-CD in non-obese dominant population.

Citation Format: Matsumoto K, Nonaka A, Ogata T, Ogata M, Sakai H, Nishimura M, Onoe T, Soyama M, Hashimoto K, Tane K, Hirokaga K, Takao S. Prevalence, predictive factors, and clinical outcomes of anthracycline induced cardiac dysfunction among patients with breast cancer in Japan, where the normal body weight (BMI < 25) is dominant [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 P1-12-03.

Prospective predictors of exacerbation status in severe asthma over a 3-year follow-up

BACKGROUND

A predisposition to exacerbations is being recognized as a distinct phenotype with "previous exacerbations" representing the strongest clinical factor associated with future exacerbation. Thus, to identify additional novel biomarkers associated with asthma exacerbations, "past exacerbation status" must be included as a confounding factor.

OBJECTIVE

This study aimed to characterize the clinical and biomarker features associated with asthma exacerbations in severe asthma.

METHODS

We evaluated clinical parameters from 105 severe asthmatics yearly for 3 years, as well as their exacerbation status. We classified the subjects into 3 groups: (i) consistent non-exacerbators (CNE, subjects who did not experience any exacerbation over the 3-year period); (ii) consistent frequent exacerbators (CFE, subjects with frequent exacerbation, defined as those who had 2 or more exacerbations within 1 year, throughout the 3-year period); and (iii) intermittent exacerbators (IE). We conducted multivariate analysis for comparisons among the groups for multiple factors, including several Th2-related biomarkers, in addition to the "past exacerbation status."

RESULTS

Thirty-nine subjects were classified as CNE, 15 as CFE, and 51 as IE. Frequent exacerbations in the previous year predicted exacerbations for the following year (P < .001). Among the several Th2-related biomarkers, only FeNO was associated with exacerbation status. When we analysed the data after the second visit, the impact of FeNO on predicting future exacerbation remained significant, even after considering the exacerbation status during the first year (P < .05).

CONCLUSIONS AND CLINICAL RELEVANCE

Measurement of FeNO has a significant potential to predict future asthma exacerbation, which is independent of the "past exacerbation history."

Effects of 4-week continuous ingestion of champignon extract on bowel movements and intestinal putrefaction products: a randomized, placebo-controlled, double-blinded, parallel-group comparative trial

Background: The aim of this study was to analyze the putrefaction products in the feces of subjects from a previous study (age range 50–79 years) which assessed the improvement of breath, body, and fecal odor after ingesting champignon extract.Methods: The study was designed as a randomized, placebo-controlled, double-blinded, and parallel-group comparative trial. Subjects were divided into four groups, including the placebo (n=20), champignon extract at 50 mg/day (n=20), champignon extract at 500 mg/day (n=20), and champignon extract at 1000 mg/day (n=20) for 4 weeks.Results: The results revealed significant reduction in ammonia and p-cresol levels (both of which are intestinal putrefaction products) among subjects who ingested 50, 500, and 1000 mg of champignon extract per day compared with subjects in the placebo group. Additionally, a significant difference was observed in indole levels in the group that consumed 500 mg/day of the extract compared to the placebo group.Conclusions: The re-analysis of bowel movement in each test group revealed that the extract improved the number of days with bowel movement, number of bowel movements, and stool volume, which suggests the intestinal environment was improved.Clinical trial registration: UMIN000014256Keywords: ammonia, champignon, fecal odor, p-cresol, putrefaction

A Randomized, Placebo-Controlled Study on the Safety and Efficacy of Daily Ingestion of Green Tea (Camellia sinensis L.) cv. "Yabukita" and "Sunrouge" on Eyestrain and Blood Pressure in Healthy Adults

The green tea (Camellia sinensis L.) cultivar “Sunrouge” contains anthocyanins, catechins and flavonols. To determine whether ingesting green tea containing anthocyanins improves visual function and blood pressure (BP) in healthy adults, a randomized, double-blind, placebo-controlled study was performed. A total of 120 healthy subjects, aged between 20 and 60 years and with a systolic BP (SBP) value of ≤125 and <155 and a diastolic BP (DBP) value <95, or a DBP of ≤75 mmHg and <95 mmHg and a SBP <155 mmHg, were randomly assigned to one of three groups. For 12 weeks, the placebo group received barley extract without catechin; another group received “Sunrouge” extract containing 11.2 mg anthocyanin and 323.6 mg epigallocatechin-3-O-gallate (EGCG); and a third group received “Yabukita” extract containing 322.2 mg EGCG. Home BP, accommodation ability, visual analog scale questionnaires for eyestrain, and metabolic-associated markers were analyzed at weeks 0, 4, 8, and 12 of the intake period. The ingestion of “Sunrouge” tea significantly improved accommodation ability and eyestrain in subjects younger than 45 years and in subjects who operated visual display terminals every day. It also elevated BP. “Yabukita” tea ingestion significantly increased serum adiponectin levels. No adverse effects were observed. We conclude that long-term intake of “Sunrouge” tea containing anthocyanins and flavonols might improve visual function.

Telomere length determined by the fluorescence in situ hybridisation distinguishes malignant and benign cells in cytological specimens

BACKGROUND

Telomeres are tandem repeats of TTAGGG at the end of eukaryotic chromosomes that play a key role in preventing chromosomal instability. The aim of the present study is to determine telomere length using fluorescence in situ hybridisation (FISH) on cytological specimens.

METHODS

Aspiration samples (n = 41) were smeared on glass slides and used for FISH.

RESULTS

Telomere signal intensity was significantly lower in positive cases (cases with malignancy, n = 25) as compared to negative cases (cases without malignancy, n = 16), and the same was observed for centromere intensity. The difference in DAPI intensity was not statistically significant. The ratio of telomere to centromere intensity did not show a significant difference between positive and negative cases. There was no statistical difference in the signal intensities of aspiration samples from ascites or pleural effusion (n = 23) and endoscopic ultrasound-guided FNA samples from the pancreas (n = 18).

CONCLUSIONS

The present study revealed that telomere length can be used as an indicator to distinguish malignant and benign cells in cytological specimens. This novel approach may help improve diagnosis for cancer patients.

Enhancement of Osteogenesis by Concanavalin a in Human Bone Marrow Mesenchymal Stem Cell Cultures

This study investigates concanavalin A (ConA) as a novel factor that may enhance osteogenesis of mesenchymal stem cells (MSCs) in vitro. Various factors, such as cytokine bone morphogenetic protein-2 (BMP-2), have been studied for their possible promotion of MSC osteogenesis in vivo and in vitro. However, the factor that might be safer, more effective, and less expensive than these has not been determined. We therefore cultured human MSCs in osteogenic medium in the presence or absence of ConA, and used calcium assays to compare the effects of ConA and BMP-2 on MSC calcification. We also used enzyme-linked immunosorbent assay (ELISA) and quantitative polymerase chain reaction (PCR) to evaluate the expression levels of bone-specific markers. ConA and BMP-2 enhanced calcification with comparable effectiveness. The combination of ConA and BMP-2 further enhanced calcification slightly but significantly. ConA also increased osteocalcin and BMP-2 protein levels in MSC culture medium. Furthermore, ConA increased osteocalcin, RUNX2, BMP-2, BMP-4, and BMP-6 mRNA expression levels. However, the gene expression pattern of ConA-stimulated MSCs was different from that of MSCs stimulated by BMP-2. Together, these results suggest that ConA and BMP-2 enhance MSC osteogenesis via different pathways. ConA-induced bone formation in MSC cultures may be useful in regenerative medicine or tissue engineering in clinical studies, as well as in basic research on bone formation.

Effects and safety of daily ingestion of plum extract on blood pressure: randomized, double-blinded, placebo-controlled parallel group comparison study

Background: Hypertension is an increasing health issue in Japan. Plums are widely consumed in Japan and are reported to have various health benefits, including improvements to blood flow. However, clinical trials investigating the effects of plum extract on blood pressure have not yet been conducted. Therefore, we evaluated the effects and safety of plum extract on blood pressure in this randomized, double-blinded, and placebo-controlled parallel group comparison study.Methods: Seventy-four healthy Japanese subjects with systolic blood pressure (SBP) ≥130 and <160 mmHg were randomly divided into test and placebo groups. Subjects were given either plum extract-processed food (3.0 g of plum extract, containing 30 mg of mumefural and 1.119 g of citric acid) or placebo food daily for 12 weeks. Physical examinations, blood measurements, and medical interviews were performed at weeks 0, 4, 8, and 12 and at 2 weeks after the intake period.Results: SBP and diastolic blood pressure (DBP) did not significantly differ between the groups. However, in subjects with grade I hypertension, DBP was significantly lower in the active test food group than in the placebo food group at week 12 and at 2 weeks after the intake period. An exploratory subgroup analysis revealed that plum extract improved DBP in subjects with normal to high obesity/class I obesity at week 12. Moreover, plum extract had positive effects on fatigue and bowel movements as determined by visual analog scale questionnaire evaluation. No abnormal changes or severe adverse events were observed in the physical examinations, blood measurements, or medical interviews in this trial.Conclusion: These results suggest that plum extract is safe for long-term intake and improves DBP in subjects with grade I hypertension.Keywords: blood pressure, clinical trial, mild hypertension, plum extract

Quercetin metabolism by fecal microbiota from healthy elderly human subjects

Quercetin is a polyphenol found in food that has numerous health benefits. This study investigated the relationship between quercetin metabolism, gut microbiota composition, and dietary intake in elderly Japanese subjects. A food frequency questionnaire was used to assess dietary intake during the week prior to stool sample collection. Fecal suspensions from 56 subjects were anaerobically incubated with quercetin and fecal microbiota composition was analyzed by next-generation sequencing. Inter-individual variations in quercetin concentration and fecal microbiota composition at family level suggested differences in microbial quercetin metabolism. The abundance of Sutterellaceae (r = -0.292) and Oscillospiraceae (r = -0.334) was negatively correlated whereas that of Fusobacteriaceae (r = 0.361) and Enterobacteriaceae (r = 0.321) was positively correlated with quercetin concentration. Niacin (r = -0.313), vitamin B6 (r = -0.297), vitamin B12 (r = -0.266), vitamin D (r = -0.301), and ratio of animal protein to total protein (r = -0.27) were also negatively correlated with quercetin concentration. Bacterial abundance was positively or negatively related to intake of food components. This is the first report describing the relationship between fecal quercetin metabolism, human microbiota, and dietary intake in the elderly.

Double-blind, parallel group, placebo-controlled study of Kjellmaniella crassifolia Miyabe (Gagome) in human: The potential of Gagome to activate the immune system

Background: Marine brown algae, Kjellmaniella crassifolia Miyabe (Gagome) is extensively harvested in Northern Japan and is known to help improve the immune system and prevent lifestyle diseases by its functional constituents, particularly the polysaccharide fucoidan. However, since most scientific findings come from animal studies, we examined its potential effectiveness in humans to raise immune functions, using small amounts of Gagome to avoid overconsumption of iodide. Methods: We set up a double-blind, placebo-controlled clinical trial (n=30 subjects for Gagome consumption; n=30 for placebo), in which 0.8 gram/day of Gagome containing 200 mg as dietary fiber (ca. 80 mg as fucoidan) was ingested for 8 weeks. The primary end-point was natural killer (NK) cell activity while other immune-related biomarkers, such as immunoglobulins (IgM and IgA) and cytokines (IL-12 and IFN-g) were secondary end-points.Results: No adverse effects were observed during the course of the clinical trial. We found that 8-week daily Gagome intake raised NK cell activities for the group with a relatively higher baseline number of NK cells (p=0.03). We also demonstrated that Gagome intake exerted a tendency to stimulate IgA secretion. These results indicate the possibility that Gagome intake may potentiate host defense systems in human as seen in animal studies.Conclusion: In this study, we used small amounts of Gagome (0.8 g daily) as an active test sample to avoid overconsumption of iodide, and found that this amount could enhance NK cell activities, particularly in the subclass with initially higher NK cell numbers. We also found an appreciable increment of IgA. With all of these facts, it seems that Gagome intake activates immune responses that contribute to the promotion of health through stimulation of the immune system.Keywords: clinical trial, dietary fiber, fucoidan, Gagome, natural killer cells

A randomized, double-blind, placebo-controlled study to examine the effects of high-isoflavone soybeans “Yukipirika” in climacteric women

Background: Soy isoflavones belong to a class of plant-based compounds known as phytoestrogens and effect menopausal symptoms and bone metabolism. We evaluated the effects of high-isoflavone soybeans (“Yukipirika”) in climacteric women.Methods: In this randomized, double-blind, placebo-controlled study, we randomly selected 64 female subjects (aged 46–60 years) to consume products made from high-isoflavone soybeans (active test), low-isoflavone soybeans (Placebo 2), or wheat (Placebo 1). The simplified menopausal index (SMI) test, visual analog scale (VAS) of skin and hair conditions, joints functions, and bowel movements, hematological analysis, and urinalysis were performed at weeks 0, 4, and 8 during the study period. Results: Intake of high-isoflavone soybeans did not change bone metabolism parameters. However, a subsection of the SMI score was improved in the active test food group compared to the Placebo 2 food group. Additionally, VAS of skin conditions, joints functions, and bowel movements improved in the active test group compared to the Placebo 1 or Placebo 2 groups. Conclusion: These results suggest that the ingestion of high-isoflavone soybeans can improve skin conditions, joints functions, and bowel movements, in addition to menopausal symptoms.Keywords: bone metabolism; clinical trial; isoflavone; soybeans; menopausal symptoms; Yukipirika

A randomized, double-blind, placebo-controlled study evaluating the effects of quercetin-rich onion on cognitive function in elderly subjects

Background: Quercetin, a phenolic compound, has various functional effects, including anti-oxidant, anti-dyslipidaemic and anti-dysglycemic activities, and beneficial effects on cognitive function.Methods: We evaluated the effects of a powder made from quercetin-rich onions (‘Quergold’ and ‘Sarasara-gold’) on cognitive function. In this randomised, double-blind, placebo-controlled study, we randomised 50 adults (25 males and 25 females, aged 65–84 years) to consume products made from quercetin-rich (active) or quercetin-poor (placebo) onions. Cognitive function and haematological and biological examinations were performed at weeks 0, 12 and 24 of the study period.Results: There were no differences in Mini Mental State Examination (MMSE) and cognitive impairment rating scale scores between the two groups. However, in younger subjects, MMSE scores were significantly increased in the active test food group than in the placebo food group at week 24 (p = 0.019).Conclusion: These results suggest that the ingestion of quercetin-rich onion can improve cognitive function and prevent dementia in elderly people.Keywords: clinical trial; cognitive function; mild cognitive impairment; Mini Mental, State Examination; onion; quercetin

Multiple skin cancers in patients with mycosis fungoides after long-term ultraviolet phototherapy

Phototherapy is a useful noninvasive therapy, but it can induce cutaneous malignant tumours, including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). We report on a 79-year-old man who had long-standing mycosis fungoides for 40 years, which had been treated with psoralen ultraviolet A therapy for 37 years at a dose of approximately 5000 J/cm² . Approximately 6 years before presentation, numerous types of cutaneous malignancies, including actinic keratosis, BCC and SCC, had begun to develop all over the patient's body. We hypothesized that he was experiencing a pathogenesis similar to patients with xeroderma pigmentosum (XP), and we therefore assessed his DNA repair capacity. Based on these investigations, the patient was eventually diagnosed as non-XP, even though we detected that his DNA repair capacity was slightly lower than that of normal controls, which may have led to the skin cancers. We speculate that multiple skin malignancies can be induced by long-term phototherapy in patients with slightly impaired DNA repair capacity.