AACR Cancer Progress Report 2014

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions

INTRODUCTION

Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation).

METHODS

This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium.

RESULTS

We found that greater PRS-BMI was significantly associated with more reports of discrimination (β = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively.

CONCLUSION

Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.

Moderate wine consumption and cancer risk in context

There is no doubt that excessive consumption of alcoholic beverages and binge drinking patterns increase the risk for cancer and many other diseases. Regarding the safety of light to moderate consumption of wine/alcoholic beverages, however, mixed messages exist. For decades, the potential health benefits of moderate wine consumption have been consistently shown, in particular for reducing cardiovascular mortality and morbidity. On the other hand, some population studies suggested that there is no safe limit of alcohol and ANY consumption is harmful to health, because of an increased cancer risk. Cancer is a multifactorial disease and it is increasingly accepted that certain lifestyle choices can affect the risk of developing cancer. Individuals do not drink only wine/alcoholic beverages, they eat different foods and have particular lifestyle habits. Besides several unmodifiable risk factors (age, sex, ethnicity and genetic disposition), improving lifestyle habits may contribute to reduce the risk of cancer. According to the World Health Organisation (WHO) and the World Cancer Research Fund (WCRF), one third of the cancers could be prevented by adopting a healthy lifestyle (such as avoiding smoking, maintaining a normal body weight, being physically active, avoiding excessive consumption of alcoholic beverages and keeping a healthy dietary pattern). Furthermore, the Mediterranean Diet is considered as one of the healthiest in the world by the WHO and is directly associated with a lower rate of mortality thanks to its effects on disease prevention. However, moderate consumption of wine is an important component of that diet. So recommendations for a healthy lifestyle which include a healthy, balanced diet and avoidance of any alcoholic beverage may be confusing. Can moderate wine drinkers still enjoy a glass of wine with the meal without jeopardizing their health? A detailed analysis of the scientific evidence will be provided and the risk of moderate wine consumption within the context of lifestyle will be examined.

The Cancer Prevention Project of Philadelphia: preliminary findings examining diversity among the African diaspora

Objective: Cancer mortality inequity among persons of African Ancestry is remarkable. Yet, Black inclusion in cancer biology research is sorely lacking and warrants urgent attention. Epidemiologic research linking African Ancestry and the African Diaspora to disease susceptibility and outcomes is critical for understanding the significant and troubling health disparities among Blacks. Therefore, in a cohort of diverse Blacks, this study examined differences in genetic ancestry informative markers (AIMs) in the DNA repair pathway and the cancer related biomarker 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: Participants completed a questionnaire and provided bio-specimens. AIMs in or around DNA repair pathway genes were analyzed to assess differences in minor allele frequency (MAF) across the 3 ethnic subgroups. NNAL concentration in urine was measured among current smokers.Results: To date the cohort includes 852 participants, 88.3% being Black. Of the 752 Blacks, 51.3% were US-born, 27.8% were Caribbean-born, and 19.6% were Africa-born. Current and former smokers represented 14.9% and 10.0%, respectively. US-born Blacks were more likely to be smokers and poor metabolizers of NNAL. Two-way hierarchical clustering revealed MAF of AIMs differed across the 3 ethnic subgroups.Conclusion: Our findings are consistent with the emerging literature demonstrating Black heterogeneity underscoring African Ancestry genetic subgroup differences - specifically relevant to cancer. Further investigations, with data harmonization and sharing, are urgently needed to begin to map African Ancestry cancer biomarkers as well as race, and race by place\region comparative biomarkers to inform cancer prevention and treatment in the era of precision medicine.

Nanoliposomal Cercodemasoide A and Its Improved Activities Against NTERA-2 Cancer Stem Cells

Recently, saponins derived from marine sources have received much attention because of their promising bioactivities, such as anticancer, anti-angiogenesis, and anti-inflammation. In particular, a triterpene saponin from the sea cucumber Cercodemas anceps Selenka, cercodemasoide A (CAN1), showed potent cytotoxicity against various cancer cell lines. Recent evidence has indicated that cancer stem cells (CSCs) could be a novel target for efficient cancer therapies. In order to improve the biopharmaceutical properties of CAN1, the compound was loaded into nanoliposomes as an ideal drug carrier. CAN1 was successfully incorporated into nanoliposomes as small unilamellar liposome vesicles with an average size of 73.39 ± 1.57 nm, zeta potential of −0.299 ± 0.046 mV, polydispersity index of 0.336 ± 0.038, and with an encapsulation efficiency of up to 62.9%. For the first time, CAN1 and its nanoliposomal forms have been shown to have a promising cytotoxic activity against NTERA-2 CSCs, with half-maximal inhibitory concentration (IC50) =1.03 ± 0.04 and 0.41 ± 0.03 µM, respectively. The CAN1 nanoliposomes also presented significantly improved activities in suppressing the growth of NTERA-2 3-dimensional tumorspheres (IC50 = 1.71 ± 0.06 µM) in comparison with the free form ( P < .05). The anti-CSC effects of CAN1 nanoliposomes on NTERA-2 cells were due to their apoptotic induction through enhancing caspase-3 activity (more than 2-fold) and arresting the cell cycle at the S phase ( P < .05). The obtained CAN1-encapsulated nanoliposomes suggest valuable applications in CSC-targeting treatment for more efficient clinical therapy.

Alcohol and Human Health: What Is the Evidence?

Alcohol consumption has long been a part of human culture. However, alcohol consumption levels and alcohol consumption patterns are associated with chronic diseases. Overall, light and moderate alcohol consumption (up to 14 g per day for women and up to 28 g per day for men) may be associated with reduced mortality risk, mainly due to reduced risks for cardiovascular disease and type-2 diabetes. However, chronic heavy alcohol consumption and alcohol abuse lead to alcohol-use disorder, which results in physical and mental diseases such as liver disease, pancreatitis, dementia, and various types of cancer. Risk factors for alcohol-use disorder are largely unknown. Alcohol-use disorder and frequent heavy drinking have detrimental effects on personal health.

The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity.

METHODS

We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors.

RESULTS

The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001].

CONCLUSION

Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.

Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis

PURPOSE

Multiple health behaviours (not smoking, minimal alcohol consumption, and maintaining a healthy weight by having a healthy diet and regular physical activity) improve quality of life and longevity of cancer survivors. Despite international guidelines, there are no existing reviews that synthesise cancer survivors' adherence to healthy lifestyle recommendations.

METHOD

Five databases (Embase, MEDLINE, PsycINFO, Web of Science, and Google Scholar) were searched for relevant articles published from 2007 until January 2018. Studies reporting adult cancer survivors' adherence to at least two lifestyle behaviours (body mass index, physical activity, smoking, fruit and vegetable intake, fiber intake, red meat intake, caloric intake, sodium intake, and alcohol consumption) based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations were included in the review. The pooled prevalence of adherence to single and multiple behaviours was calculated using a random-effects model. Subgroup analysis (mean years of survival and publication year) was undertaken.

RESULTS

A total of 3322 articles were identified. Of these, 51 studies matched the inclusion criteria, presenting data from 2,620,586 adult cancer survivors. Adherence to single behaviours, which was estimated from studies that assessed at least two health behaviours, was highest for not smoking (PE 87%; 95% CI, 85%, 88%) and low or no alcohol intake (PE 83%; 95% CI, 81%, 86%), and lowest for fiber intake (PE 31%; 95% CI, 21%, 40%). Adherence to multiple healthy behaviours (13 studies), ranged from 7 to 40% (pooled estimate (PE) 23%; 95% CI, 17%, 30%). Recent survivors (< 5-year survival time) had relatively better adherence to multiple behaviours (PE 31%; 95% CI, 27%, 35%) than long-term (> 5 years) survivors (PE 25%; 95% CI, 14%, 36%). Adherence to multiple behaviours improved over time since 2007.

CONCLUSION

Adherence to physical activity, dietary, and multiple lifestyle behaviours recommendations was low amongst cancer survivors. Recent cancer survivors were relatively more adherent to WCRF/AICR recommendations compared to long-term survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Health promotion programs help support healthy lifestyle behaviours of cancer survivors. PROSPERO registration number: CRD42018091663.

Data analysis algorithm for the development of extracellular miRNA-based diagnostic systems for prostate cancer

Urine of prostate cancer (PCa) carries miRNAs originated from prostate cancer cells as a part of both nucleoprotein complexes and cell-secreted extracellular vesicles. The analysis of such miRNA-markers in urine can be a convenient option for PCa screening. The aims of this study were to reveal miRNA–markers of PCa in urine and design a robust and precise diagnostic test, based on miRNA expression analysis. The expression analysis of the 84 miRNAs in paired urine extracellular vesicles (EVs) and cell free urine supernatant samples from healthy donors, patients with benign and malignant prostate tumours was done using miRCURY LNA miRNA qPCR Panels (Exiqon, Denmark). Sets of miRNAs differentially expressed between the donor groups were found in urine EVs and urine supernatant. Diagnostically significant miRNAs were selected and algorithm of data analysis, based on expression data on 24-miRNA in urine and obtained using 17 analytical systems, was designed. The developed algorithm of data analysis describes a series of steps necessary to define cut-off values and sequentially analyze miRNA expression data according to the cut-offs to facilitate classification of subjects in case/control groups and allows to detect PCa patients with 97.5% accuracy.

Tobacco smoking and cessation and PD-L1 inhibitors in non-small cell lung cancer (NSCLC): a review of the literature

BACKGROUND

Programmed death ligand 1 (PD-L1) targeting immunotherapies, as pembrolizumab and nivolumab, have significantly improved outcome in patients with non-small cell lung cancer (NSCLC). Tobacco smoking is the number one risk factor for lung cancer and is linked to 80%-90% of these cancers. Smoking during cancer therapy may influence on radiotherapy and chemotherapy outcome. We aimed to review the knowledge in immunotherapy.

PATIENTS AND METHODS

A systematic review was done. We searched for documents and articles published in English language and registered in Cochrane Library, National Health Service (NHS) Centre for Reviews and Dissemination (CRD), Embase or Medline. The search terms were (A) (Lung cancer or NSCLC) with (pembrolizumab or nivolumab) with PD-L1 with (tobacco or smoking) and (B) Lung Neoplasms and Immunotherapy and (smoking cessation or patient compliance). 68 papers were detected and two more were added during review process (references) and six based on information from the manufacturers.

RESULTS

Nine papers were selected. High PD-L1 expression (≥50%) was correlated with current/ever smoking history in three studies. Six studies revealed a higher overall response rate (ORR) among current/former smokers. The ORR was generally (six studies) better among the current/former smoker group. So also when tumours had a molecular 'smoking signature' (one study). This was probably due to a higher mutational burden. In two studies, minor or no difference was revealed.One study (KEYNOTE-024) compared former and current smokers, and documented pembrolizumab being more effective among former smokers than current smokers.

CONCLUSIONS

Tobacco smoking patients with NSCLC generally have a higher PD-L1 tumour proportion score and experience a better ORR of immunotherapy than no smokers. There is little evidence on the effect of smoking during immunotherapy, but one study (KEYNOTE-024) may indicate survival gains of smoking cessation.

AHNAK enables mammary carcinoma cells to produce extracellular vesicles that increase neighboring fibroblast cell motility

Extracellular vesicles play important roles in tumor development. Many components of these structures, including microvesicles and exosomes, have been defined. However, mechanisms by which extracellular vesicles affect tumor progression are not fully understood. Here, we investigated vesicular communication between mammary carcinoma cells and neighboring nontransformed mammary fibroblasts. Nonbiased proteomic analysis found that over 1% of the entire proteome is represented in these vesicles, with the neuroblast differentiation associated protein AHNAK and annexin A2 being the most abundant. In particular, AHNAK was found to be the most prominent component of these vesicles based on peptide number, and appeared necessary for their formation. In addition, we report here that carcinoma cells produce vesicles that promote the migration of recipient fibroblasts. These data suggest that AHNAK enables mammary carcinoma cells to produce and release extracellular vesicles that cause disruption of the stroma by surrounding fibroblasts. This paradigm reveals fundamental mechanisms by which vesicular communication between carcinoma cells and stromal cells can promote cancer progression in the tumor microenvironment.

Combined use of insoluble β-glucan from the cell wall of Candida albicans and cyclophosphamide: Validation in S180 tumor-bearing mice

BACKGROUND

Cyclophosphamide (CTX) is a widely used antitumor drug that can suppress the immune system. The effects of regulating immune response and antitumor of β-glucan from the cell wall of Candida albicans (CAIBG) have been confirmed. However, the effects of the combined use of CAIBG and CTX remain unclear and warrant further investigation.

METHODS

S180 tumor-bearing models were developed for CAIBG (100 mg/10 mL/kg) and CTX (30 mg/10 mL/kg) intervention. The weights of the body, tumor spleen, and Thymus were recorded to calculate the index of the spleen and Thymus. The spleen and Thymus were observed by hematoxylin and eosin staining, whereas the expression of tumor necrosis factor (TNF)-α and interleukin (IL)-1β was determined by Western blot. The survival times of mice were followed and recorded for analysis.

RESULTS

CAIBG, CTX, and combined use of CAIBG and CTX could down-regulate the tumor growth and prolong the survival time. The spleen and Thymus index significantly increased in the CAIBG + CTX group than in the CTX group, but it was lower than that in the CAIBG group. Moreover, the Thymus index was significantly lower in the CAIBG + CTX group than in the CAIBG group. The lymphocytes of the spleen and Thymus decreased significantly in the CTX group but improved significantly in the CAIBG and CAIBG + CTX groups. The expression level of TNF-α and IL-1β in the CTX+CAIBG group increased significantly compared with that in the CTX group. The survival time of the CAIBG group and CAIBG + CTX group was significantly higher than that of the CTX group.

CONCLUSIONS

CAIBG has strong treatment potential in combating tumor growth and prolonging survival time of S180 tumor-bearing mice. Combined use of CAIBG and CTX can compensate the CTX-induced immunosuppression and provide antitumor effects. Future studies are necessary to elucidate the underlying mechanism.

HPV positive neuroendocrine cervical cancer cells are dependent on Myc but not E6/E7 viral oncogenes

Using conditional cell reprogramming, we generated a stable cell culture of an extremely rare and aggressive neuroendocrine cervical cancer. The cultured cells contained HPV-16, formed colonies in soft agar and rapidly produced tumors in immunodeficient mice. The HPV-16 genome was integrated adjacent to the Myc gene, both of which were amplified 40-fold. Analysis of RNA transcripts detected fusion of the HPV/Myc genes, arising from apparent microhomologous recombination. Spectral karyotyping (SKY) and fluorescent-in-situ hybridization (FISH) demonstrated coordinate localization and translocation of the amplified Myc and HPV genes on chromosomes 8 and 21. Similar to the primary tumor, tumor cell cultures expressed very high levels of the Myc protein and, in contrast to all other HPV-positive cervical cancer cell lines, they harbored a gain-of-function mutation in p53 (R273C). Unexpectedly, viral oncogene knockdown had no effect on the growth of the cells, but it did inhibit the proliferation of a conventional HPV-16 positive cervical cancer cell line. Knockdown of Myc, but not the mutant p53, significantly inhibited tumor cell proliferation. On the basis of these data, we propose that the primary driver of transformation in this aggressive cervical cancer is not HPV oncogene expression but rather the overexpression of Myc.

Mechanisms and therapeutic effectiveness of pulsed electromagnetic field therapy in oncology

Cancer is one of the most common causes of death worldwide. Available treatments are associated with numerous side effects and only a low percentage of patients achieve complete remission. Therefore, there is a strong need for new therapeutic strategies. In this regard, pulsed electromagnetic field (PEMF) therapy presents several potential advantages including non-invasiveness, safety, lack of toxicity for non-cancerous cells, and the possibility of being combined with other available therapies. Indeed, PEMF stimulation has already been used in the context of various cancer types including skin, breast, prostate, hepatocellular, lung, ovarian, pancreatic, bladder, thyroid, and colon cancer in vitro and in vivo. At present, only limited application of PEMF in cancer has been documented in humans. In this article, we review the experimental and clinical evidence of PEMF therapy discussing future perspectives in its use in oncology.

Patients' experiences with continuity of cancer care in Canada: Results from the CanIMPACT study

OBJECTIVE

To explore patient perspectives on and experiences with the coordination and continuity of cancer care.

DESIGN

Qualitative study using semistructured telephone interviews.

SETTING

Canada.

PARTICIPANTS

Thirty-eight breast and colorectal cancer survivors 1 to 4 years after diagnosis.

METHODS

Using a constructivist grounded theory approach, semistructured telephone interviews were conducted with the participants. The interviews were digitally recorded, transcribed verbatim, and proofread. Transcripts were reviewed to create a focused coding scheme that was used to develop categories for participants' experiences.

MAIN FINDINGS

Although this study focused on the continuity of cancer care, patients described their experiences with cancer care in general, concentrating predominantly on their relationships with individual health care providers (HCPs). Based on patients' experiences, several themes were identified as the core components of providing good continuity and well coordinated care. The most important overarching theme was communication, which overlapped with 4 other themes: patient-HCP relationships, the role of HCPs, lack of access to care, and timely and tailored information.

CONCLUSION

Patients believed that good communication between HCPs and patients was key to improving the overall continuity of cancer care. Continuity of care is an important theoretical concept in cancer care, but it is not easily recognized by patients. They perceive the cancer care continuum and continuity of care as cancer care in general, which is typically framed by the individual relationships with their HCPs. Future research and interventions need to focus on finding and testing ways to improve communication to enhance continuity of cancer care.

Systematic network assessment of the carcinogenic activities of cadmium

Cadmium has been defined as type I carcinogen for humans, but the underlying mechanisms of its carcinogenic activity and its influence on protein-protein interactions in cells are not fully elucidated. The aim of the current study was to evaluate, systematically, the carcinogenic activity of cadmium with systems biology approaches. From a literature search of 209 studies that performed with cellular models, 208 proteins influenced by cadmium exposure were identified. All of these were assessed by Western blotting and were recognized as key nodes in network analyses. The protein-protein functional interaction networks were constructed with NetBox software and visualized with Cytoscape software. These cadmium-rewired genes were used to construct a scale-free, highly connected biological protein interaction network with 850 nodes and 8770 edges. Of the network, nine key modules were identified and 60 key signaling pathways, including the estrogen, RAS, PI3K-Akt, NF-κB, HIF-1α, Jak-STAT, and TGF-β signaling pathways, were significantly enriched. With breast cancer, colorectal and prostate cancer cellular models, we validated the key node genes in the network that had been previously reported or inferred form the network by Western blotting methods, including STAT3, JNK, p38, SMAD2/3, P65, AKT1, and HIF-1α. These results suggested the established network was robust and provided a systematic view of the carcinogenic activities of cadmium in human.

The role of fine needle aspiration cytology and core biopsy in the diagnosis of palpable breast masses

Background:

The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses.

Materials and Methods:

Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010.

Results:

Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%.

Conclusion:

Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.

Circulating low IL-23: IL-35 cytokine ratio promotes progression associated with poor prognosisin breast cancer

The interleukin (IL)-12 family, composed of heterodimeric cytokines including IL-12 (formed by IL-12p35 and IL-12p40 subunits), IL-23 (formed by IL-23p19 and IL-12p40 subunits), IL-27 (formed by IL-27p28 and EBI3 subunits) and IL-35 (formed by IL-12p35 and EBI3 subunits), establishes a link between innate and adaptive immunity that involves different immune effector cells and cytokines to tumors. However, the role of IL-12 family in breast cancer (BC) progression and prognosis remains unclear. In the present study, we demonstrated evidence indicating that EBI3, IL-12p35 and IL-12p40 but not IL-23p19 or IL-27p28 were highly expressed in BC tissues, suggested that tumor derived EBI3, IL-12p35 and IL-12p40 were associated with tumor progression. Circulating IL-12 and IL-23 low expressed, but IL-27 and IL-35 high expressed in BC patients, especially circulating IL-23 associated with IL-35 to mediate BC tumor resection. Ki-67, p53 and EGFR expression on BC tissues, as well as CA125, CA153 and CA199 levels on BC bloods increased when circulating IL-23: IL-35 ratio decreased. Together, for the first time, our data suggest that circulating IL-23: IL-35 ratio may be an important indicator association with BC progression and prognosis. However, further research should be carried out to assess the implications of circulating IL-23: IL-35 ratio in a larger sample size.

The chemopreventive activity of butyrate-containing structured lipids in experimental rat hepatocarcinogenesis

SCOPE

Emerging evidence indicates that the use of bioactive food components is a promising strategy to prevent the development of liver cancer. The goal of this study was to examine the chemopreventive effect of butyrate-containing structured lipids (STLs) produced by an enzymatic interesterification of tributyrin and flaxseed oil on rat hepatocarcinogenesis.

METHODS AND RESULTS

Male Wistar rats were subjected to a classic "resistant hepatocyte" model of liver carcinogenesis and treated with STLs, tributyrin or flaxseed oil during the initial phases of hepatocarcinogenesis. Treatment with STLs and tributyrin strongly inhibited the development of preneoplastic liver lesions. The chemopreventive activity of tributyrin was associated with the induction of apoptosis and reduction of the expression of major activated hepatocarcinogenesis-related oncogenes. Treatment with STLs caused substantially greater inhibitory effects than tributyrin on oncogene expression.

CONCLUSION

These results demonstrate that the tumor-suppressing activity of butyrate-containing STLs is associated with its ability to prevent and inhibit activation of major hepatocarcinogenesis-related oncogenes. Enrichment of histone H3K9me3 and H3K27me3 at the promoter of Myc and Ccnd1 genes may be related to the inhibitory effect on oncogene expression in the livers of STL-treated rats.

Sexual Violence in America: Public Funding and Social Priority

We compared lifetime risk, annual incidence, and annual economic burden of sexual violence with other major public health issues in the United States: cardiovascular disease, cancer, diabetes, and HIV/AIDS. With public funding data from 2013, we examined how much public funding is allocated to these public health issues as a proxy of the social priority of addressing each of them. Although sexual violence is as prevalent as and more costly than are these other major public health issues, it receives a fraction of the public funds that they receive.

Glycogen synthase kinase-3 inhibitor AR-A014418 suppresses pancreatic cancer cell growth via inhibition of GSK-3-mediated Notch1 expression

BACKGROUND

Glycogen synthase kinase-3 (GSK-3) can act as either a tumour promoter or suppressor by its inactivation depending on the cell type. There are conflicting reports on the roles of GSK-3 isoforms and their interaction with Notch1 in pancreatic cancer. It was hypothesized that GSK-3α stabilized Notch1 in pancreatic cancer cells thereby promoting cellular proliferation.

METHODS

The pancreatic cancer cell lines MiaPaCa2, PANC-1 and BxPC-3, were treated with 0-20 μM of AR-A014418 (AR), a known GSK-3 inhibitor. Cell viability was determined by the MTT assay and Live-Cell Imaging. The levels of Notch pathway members (Notch1, HES-1, survivin and cyclinD1), phosphorylated GSK-3 isoforms, and apoptotic markers were determined by Western blot. Immunoprecipitation was performed to identify the binding of GSK-3 specific isoform to Notch1.

RESULTS

AR-A014418 treatment had a significant dose-dependent growth reduction (P < 0.001) in pancreatic cancer cells compared with the control and the cytotoxic effect is as a result of apoptosis. Importantly, a reduction in GSK-3 phosphorylation lead to a reduction in Notch pathway members. Overexpression of active Notch1 in AR-A014418-treated cells resulted in the negation of growth suppression. Immunoprecipitation analysis revealed that GSK-3α binds to Notch1.

CONCLUSIONS

This study demonstrates for the first time that the growth suppressive effect of AR-A014418 on pancreatic cancer cells is mainly mediated by a reduction in phosphorylation of GSK-3α with concomitant Notch1 reduction. GSK-3α appears to stabilize Notch1 by binding and may represent a target for therapeutic development. Furthermore, downregulation of GSK-3 and Notch1 may be a viable strategy for possible chemosensitization of pancreatic cancer cells to standard therapeutics.

Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention

Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.

Noncommunicable Diseases of Major Public Health Interest and Prevention

Noncommunicable diseases (NCDs; mainly cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases) are now responsible for more than 35 million deaths per annum in the world; more than 80% of these deaths occur in low- and middle-income countries. Dramatic worldwide changes in lifestyle and in the prevalence and incidence of major chronic diseases lends credence to the causative role of modifiable risk factors. For the elucidation of modifiable risk factors, large-scale prospective cohort studies with biobanks often combined in consortia are of paramount importance. Associations between selected risk factors and development of NCDs will be reviewed. In addition to the contribution of treatment, even larger proportions of NCDs can be prevented had risk factors been reduced to the optimum levels or eliminated. Individual-based approaches should be complemented by administrative regulations.

Comparison of Lesbian and Bisexual Women to Heterosexual Women's Screening Prevalence for Breast, Cervical, and Colorectal Cancer in Missouri

Sexual minority women may be at higher risk of breast, cervical, and colorectal cancer compared to heterosexual women. In addition, sexual minority women may use preventive cancer-related screening services less than heterosexual women. Using a population-based probability sample of Missouri women, we compared cancer screening behavior of heterosexual (n=29,847), self-identified lesbian (n=114), and bisexual (n=162) women. Sexual minority women were significantly younger by approximately 10 years and comprised less than 1% of the sample. In this sample, sexual minority and heterosexual women did not differ in the proportion having ever obtained breast, cervical or colorectal cancer screenings.

Reprogramming of human cancer cells to pluripotency for models of cancer progression

The ability to study live cells as they progress through the stages of cancer provides the opportunity to discover dynamic networks underlying pathology, markers of early stages, and ways to assess therapeutics. Genetically engineered animal models of cancer, where it is possible to study the consequences of temporal-specific induction of oncogenes or deletion of tumor suppressors, have yielded major insights into cancer progression. Yet differences exist between animal and human cancers, such as in markers of progression and response to therapeutics. Thus, there is a need for human cell models of cancer progression. Most human cell models of cancer are based on tumor cell lines and xenografts of primary tumor cells that resemble the advanced tumor state, from which the cells were derived, and thus do not recapitulate disease progression. Yet a subset of cancer types have been reprogrammed to pluripotency or near-pluripotency by blastocyst injection, by somatic cell nuclear transfer and by induced pluripotent stem cell (iPS) technology. The reprogrammed cancer cells show that pluripotency can transiently dominate over the cancer phenotype. Diverse studies show that reprogrammed cancer cells can, in some cases, exhibit early-stage phenotypes reflective of only partial expression of the cancer genome. In one case, reprogrammed human pancreatic cancer cells have been shown to recapitulate stages of cancer progression, from early to late stages, thus providing a model for studying pancreatic cancer development in human cells where previously such could only be discerned from mouse models. We discuss these findings, the challenges in developing such models and their current limitations, and ways that iPS reprogramming may be enhanced to develop human cell models of cancer progression.

PACE Continuous Innovation Indicators-a novel tool to measure progress in cancer treatments

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about 'progress' and 'value' in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes 'value' to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer.

Interleukin-11 receptor predicts post-operative clinical outcome in patients with early-stage clear-cell renal cell carcinoma

OBJECTIVE

To investigate the prognostic value of interleukin-11 receptor α chain in patients with early-stage clear-cell renal cell carcinoma. Interleukin-11 receptor α chain, a member of the gp130-dependent receptors, exerts pleiotropic oncogenic activities by promoting proliferation, angiogenesis and metastasis in many cancers.

METHODS

We retrospectively enrolled 293 patients (130 in the training cohort and 163 in the validation cohort) with early-stage (TNM Stage I + II) clear-cell renal cell carcinoma undergoing nephrectomy at a single institution. Clinicopathologic features, recurrence-free survival and overall survival were recorded. Interleukin-11 receptor α chain intensities were assessed by immunohistochemistry in tumor tissues. Kaplan-Meier method was applied to compare survival curves between groups. Cox regression models were used to analyze the impact of prognostic factors on recurrence-free survival and overall survival. The concordance index was calculated to assess predictive accuracy.

RESULTS

In both training and validation cohorts, high interleukin-11 receptor α chain expression was associated with early recurrence (P = 0.004 and P = 0.015, respectively) and poor survival (P < 0.001 and P = 0.019, respectively) of patients with early-stage clear-cell renal cell carcinoma. Multivariate analyses confirmed that interleukin-11 receptor α chain expression was an independent prognostic factor for recurrence-free survival (P = 0.004) and overall survival (P = 0.001). The predictive accuracy of the Leibovich prognostic score was improved when interleukin-11 receptor α chain expression was incorporated. Notably, the improvement in prediction mainly took place in patients with low-risk disease defined by the Leibovich score.

CONCLUSION

High Interleukin-11 receptor α chain expression is an independent predictor of poor clinical outcome in patients with early-stage clear-cell renal cell carcinoma, and the prognostic value is more prominent in those with low-risk disease.