Genetic depletion of Soat2 diminishes hepatic steatosis via genes regulating de novo lipogenesis and by GLUT2 protein in female mice

Depletion of the cholesterol esterifying enzyme acyl-Coenzyme A: cholesterol acyltransferase 2 (ACAT2, encoded by Soat2) protects mice from atherosclerosis, diet-induced hypercholesterolemia, and hepatic steatosis when fed high-cholesterol diet. The glucose transporter 2 (GLUT2) represents the main gate of glucose uptake by the liver. Lipid synthesis from glucose (de novo lipogenesis; DNL) plays a pivotal role in the development of hepatic steatosis. Inhibition of DNL is a successful approach to reverse hepatic steatosis, as shown by different studies in mice and humans. Here we aimed to investigate whether depletion of Soat2 per se can reduce hepatic steatosis, also in the presence of very low levels of cholesterol in the diet, and the underlying mechanisms. Female Soat2-/- and wild type mice were either fed high-fat or high-carbohydrate diet and both contained <0.05% (w/w) cholesterol. Analysis in serum, liver, muscles and adipose tissues were performed. We found Soat2-/- mice fed high-fat, low-cholesterol diet to have less hepatic steatosis, decreased expression of genes involved in DNL and lower hepatic GLUT2. Similar findings were found in Soat2-/- mice fed high-carbohydrate, low-cholesterol diet. CONCLUSION: Depletion of Soat2 reduces hepatic steatosis independently of the presence of high levels of cholesterol in the diet. Our study provides a link between hepatic cholesterol esterification, DNL, and GLUT2.

Audit of PPI Prescribing Practices: A Risk to Patient Safety?

Aim Proton pump inhibitors (PPIs) are frequently prescribed to surgical patients (50-60%) to prevent gastrointestinal bleeding. However, most surgical patients are at low risk of significant bleeds. The aim of this audit was to identify inappropriate PPI prescribing, if any, in a cohort of surgical inpatients. Methods This was a prospective analysis completed over a 4 month period. Data was collected via review of clinical notes and drug charts. The audit standard was the consensus guideline on indications for PPI use issued by Scarpignato et al (2016). Results In total 89 patients were included (n = 89). 73% were on PPI therapy. 30% had a documented indication for therapy which was concordant with recommendations. However, the majority of PPI prescriptions (70%) were inappropriate. Conclusion PPIs are frequently prescribed to surgical patients without an appropriate indication. Indiscriminate use of these drugs has implications in the form of costs and potential complications.

Abstract P2-02-08: Validation of an autoantibody blood test for the detection of early breast cancer (BC), particularly hormone receptor positive BC

Background: Breast cancer (BC) remains the most common type of cancer in women, with an incidence of 1.6 million cases per year worldwide. Early detection through mammographic screening reduces BC mortality by ˜20%, which while highly significant still leaves 80% of BC deaths unchanged. Furthermore, mammographic screening is only applicable to women between 50-70 years, in which only about one third of BCs occurs. There is an urgent need to identify a test, preferably a blood test showing high sensitivity and specificity for early BC across all ages of patients and all tumour types. Advances in understanding of the human autoantibody (AAB) response to early cancers has allowed us to harness this biological phenomenon for early cancer detection. .

Aim: To identify a panel of tumor associated antigens (TAAs) which would detect AABs in the blood with high sensitivity and specificity for early BC: enabling cancer/normal discrimination.

Methods: Serum samples from 120 BC patients and matched controls were tested against a panel of 60 multiple TAAs using an optimised new multiplex microarray platform. A sub-group of 60 samples were also tested for AABs to estrogen receptor (ER). The selected TAAs were spotted onto a glass slide surface in an automated, highly reproducible system platform. If serum autoantibodies are present they bind to one or more of the TAA spots. Bound antibodies are detected with a fluorescent reporter and signal intensity measured using GenePix pro-6.

Data analysis: A Monte Carlo Simulation method was employed to define the best panel of the antigens with optimised cutoff points in each assay that would yield the highest sensitivity and specificity to discriminate BC patients from controls.

AAB positivity in the BC group was analysed by tumor size (≤20mm versus &gt;20mm), histological grade, lymph node status (positive or negative) and ER status (positive or negative)

Results: Using a panel of 12 TAAs, AABs were detected in pre-op blood of 34/60 (57%) primary BC patients compared to 9/59 controls (15%) (p=0.000003); one control sample data was unavailable. This gave a sensitivity of 57% and specificity of 85%. Median age of BC patients was 59yrs (20-81) versus 59yrs (28-81) in controls. There was no significant difference for AAB detection when compared to tumour size, grade, lymph node status or ER status. In the sub-group of 60 patients where ER antigen was measured using a panel of 8 TAAs AABs were detected in 20/29 BC patients compared to 2/30 controls (p=3.5e-7). This represents a sensitivity of 69% with a specificity of 93%.

Conclusions: These results confirmed our hypothesis that AABs can be detected in women of all ages with early BC. AABs were not related to tumour size, grade, lymph node status or ER status. If a panel of AAB assays can be validated it opens the possibility of a blood test for detection of early BC. Future direction of this research will be i) validation studies of a panel of AABs for detection of early BC, ii) detection of AABs at the earliest stages of carcinogenesis and iii) a panel of AABs which detect ER positive BC thereby enabling stratified chemoprevention in a high risk group combined with mammographic screening.

Citation Format: Negm OH, Ahmed O, Figueredo GP, Hamed MR, Pollard L, Garibaldi J, Sewell H, Robertson JF. Validation of an autoantibody blood test for the detection of early breast cancer (BC), particularly hormone receptor positive BC [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 P2-02-08.

Primary constrained TIPS for treating refractory ascites or variceal bleeding secondary to hepatic cirrhosis

OBJECTIVE

To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding.

METHODS

All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Preprocedure demographics, Child-Pugh, model for end-stage liver disease and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (SD) and median follow-up was 237 (190) and 226 days.

RESULTS

All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms was 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mmHg compared with 10.6 mmHg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group [16.7% (3/18)] compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1 vs 22.2%, p = 0.63).

CONCLUSION

Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.

A false postoperative recurrence of intraductal and papillary mucinous neoplasm of the pancreas

Stenosis of pancreatico-digestive anastomoses following pancreaticoduodenectomy is frequently observed. In a patient operated on for intraductal papillary and mucinous neoplasm, it can induce a massive dilatation of the main pancreatic duct leading to the misdiagnosis of tumor recurrence with main duct involvement.

Primary constrained TIPS for treating refractory ascites or variceal bleeding secondary to hepatic cirrhosis

OBJECTIVE

To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding.

METHODS

All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Preprocedure demographics, Child-Pugh, model for end-stage liver disease and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (SD) and median follow-up was 237 (190) and 226 days.

RESULTS

All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms was 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mmHg compared with 10.6 mmHg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group [16.7% (3/18)] compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1 vs 22.2%, p = 0.63).

CONCLUSION

Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.

Clinical utility of abdominal and pelvic ultrasound in the evaluation of right iliac fossa pain in females

BACKGROUND

Ultrasound (US) is often the imaging modality of choice in women with acute right iliac fossa (RIF) pain, identifying the appendix in up to 99% of patients. The literature, however, lacks clear guidelines on how ultrasonography should be performed to maximise sensitivity and specificity in such patients. Many centres perform untargeted abdomino-pelvic scans, including organs such as the liver and spleen, which unlikely contribute to the presenting complaint.

AIMS

We aimed to evaluate the clinical utility of unfocussed abdominal and pelvic US in women of reproductive age with acute RIF pain.

METHODS

This multicentre study describes 501 women between the ages of 12 and 50, over a 3-year period from three institutions, presenting acutely with RIF pain and investigated with US abdomen and pelvis.

RESULTS

5.9% of cases confirmed appendicitis sonographically. A normal appendix was visualised in 0.2%. Over 10% identified gynaecological pathology, 41% relating to the right ovary. 10.4% incidental extra-pelvic findings were unrelated to the acute clinical presentation. 0.8% of patients had extra-pelvic findings meriting further clinical assessment.

CONCLUSION

The results herein reflect findings from high volume emergency surgical departments, demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in reproductive women with RIF pain. Clinically relevant extra-pelvic US findings account for less than 1%, rarely contributing to the acute presentation. The appendix was only visualised in 6% of patients, suggesting that a focussed appendiceal and pelvic US would better assist diagnosis with a higher yield and increased sensitivity and specificity.

Hypoxia Marker GLUT-1 (Glucose Transporter 1) is an Independent Prognostic Factor for Survival in Bladder Cancer Patients Treated with Radical Cystectomy

BACKGROUND

Tumour hypoxia, which is frequent in many cancer types, is associated with treatment resistance and poor prognosis. The role of hypoxia in surgically treated bladder cancer (BC) is not well described. We studied the role of hypoxia in two independent series of urothelial bladder cancers treated with radical cystectomy.

METHODS

279 patients from the University Hospital Network (UHN), Toronto, Canada, and Turku University, Finland were studied. Hypoxia biomarkers (HIF1-α, CAIX, GLUT-1) and proliferation marker Ki-67 were analyzed with immunohistochemistry using defined tissue microarrays. Kaplan-Meier methods and Cox proportional hazards regression models were used to investigate prognostic role of the factors.

RESULTS

In univariate analyses, strong GLUT-1 positivity and a high Ki-67 index were associated with poor survival. In multivariate model containing clinical prognostic variables, GLUT-1 was an independent prognostic factor associated with worse disease-specific survival (HR 2.9, 95% CI 0.7-12.6, Wald p = 0.15 in the Toronto cohort and HR 3.2, 95% CI 1.3-7.5, Wald p = 0.0085 in the Turku cohort).

CONCLUSION

GLUT-1 is frequently upregulated and is an independent prognostic factor in surgically treated bladder cancer. Further studies are needed to evaluate the potential role of hypoxia-based and targeted therapies in hypoxic bladder tumours.

Long-term results of microcoil embolization for colonic haemorrhage: how common is rebleeding?

OBJECTIVE

To determine the long-term results of patients undergoing transcatheter coil embolization for the treatment of acute colonic haemorrhage.

METHODS

Patients undergoing angiography for suspected colonic bleeding between January 2002 and December 2012 were reviewed (average age, 60 years; 38.4% male). Baseline, procedural and outcome parameters were recorded following the Society of Interventional Radiology guidelines. Primary outcome measures included early (<30 days) and delayed (>30 days) rebleeding events and adverse procedure-related complication. Average follow-up time was 996 days (median, 232 days; range, 30-3663 days).

RESULTS

One or multiple sites of bleeding were identified in 40 cases. Coil embolization was performed in 39 patients, 26 (66.7%, 26/39) of whom were treated successfully without technical/clinical failure (n = 12) or loss to follow-up (n = 1). Three patients (11.5%, 3/26) rebled in the early period within 30 days; one patient went on to hemicolectomy. Four patients (15.3%, 4/26) experienced delayed rebleeding after 30 days; two of whom also underwent hemicolectomy. No major complication occurred. One minor complication of short segment arterial dissection was seen in the clinical failure group. One case of asymptomatic ischaemia was identified on a patient undergoing pre-operative colonoscopy for elective bowel resection. No instances of ischaemic stricture were seen. All-cause mortality of successfully treated and all patients at 1 year was 31% (8/26) and 30% (12/40), respectively.

CONCLUSION

Transcatheter coil embolization is a durable treatment option with a technical and clinical success rate of 67% in the setting of acute colonic haemorrhage. A modest level of rebleeding was seen among successfully treated patients in both the early and delayed periods; in the majority of patients, embolization proved to be definitive therapy.

ADVANCES IN KNOWLEDGE

Transcatheter coil embolization is a durable and potentially definitive therapy in the management of acute colonic haemorrhage.

Tissue transfer to post-chemoradiation salvage laryngectomy defects to prevent pharyngocutaneous fistula: single-centre experience

Background: In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure. Method: A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure. Results: The reconstruction closure group (n = 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n = 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively. Conclusion: The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.