Targeting PI3K/AKT/mTOR Pathway in Breast Cancer: From Biology to Clinical Challenges

Breast cancer (BC) is the most common women cancer and cause of cancer death. Despite decades of scientific progress in BC treatments, the clinical benefit of new drugs is modest in several cases. The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway mutations are frequent in BC (20-40%) and are significant causes of aggressive tumor behavior, as well as treatment resistance. Improving knowledge of the PI3K/AKT/mTOR pathway is an urgent need. This review aims to highlight the central role of PI3K-mTORC1/C2 mutations in the different BC subtypes, in terms of clinical outcomes and treatment efficacy. The broad base of knowledge in tumor biology is a key point for personalized BC therapy in the precision medicine era.

AB0661 NEUROPSYCHOLOGICAL OUTCOME OF CHILDREN BORN TO WOMEN WITH SYSTEMIC SCLEROSIS ASSESSED THROUGH A SELF-ADMINISTERED MULTIDISCIPLINARY QUESTIONNAIRE: RESULTS FROM A MONOCENTRIC COHORT

Background

In the last years, the rate of successful pregnancies has significantly increased in Systemic Sclerosis (SSc)1 women. However, the long-term outcome of their children remains an unexplored issue.

Objectives

To evaluate the neuropsychiatric (NP) outcome of children born to SSc mothers.

Methods

An ad-hoc questionnaire, regarding different aspects of child’s neurodevelopment (ND) (3 sections: childhood [0-5 years]; scholar age [6-11 years]; adolescence [12-18 years]), was created and administered to female SSc patients (ACR/EULAR 2013 criteria) attending our outpatient clinic during 2021 and who had at least 1 child. Children’s NP characteristics were compared between 3 subgroups: A) born >10 years before SSc diagnosis; B) born ≤10 years before SSc diagnosis; C) born after SSc diagnosis. Results below are expressed as number/total number of answers collected for each question.

Results

100 SSc women reported 189 pregnancies: 152 resulted in 154 live births (2 twin pregnancies).

At least one NP alteration was reported in 42/119 (35%) subjects, more frequently in group B (57%), as compared to group A (31%, p:0.07) and group C (30%, p:0.09) although not statistically significant (Figure 1). Sleep irregularities were the most frequently reported disorder (15/42, 36%). Comparisons between the 3 subgroups for every NP outcome evaluated are shown in Table 1: overall, a higher rate of NP alterations were reported in children belonging to group B.

Table 1.

Analysis of NP outcomes: comparison of the 3 subgroups.

A n=103B n=19C n=32N° of subjects evaluated forDISORDERS IN CHILDHOOD103/10319/1932/32Sleep irregularities6/79 (8)*4/13 (31)*5/27 (19)Motor difficulties0/77 (3)°2/13 (15)°2/26 (8)Difficulty in relationships0/78 (0)1/11 (9)2/26 (8)Difficulty in non-verbal communication skills0/78 (0)1/11 (9)2/26 (8)Difficulty in verbal communication skills1/77 (1)1/12 (8)2/26 (8)Difficulty in social integration6/77 (8)3/12 (25)1/25 (4)Cognitive difficulties0/77 (0)1/12 (8)0/26 (0)N° of subjects evaluated forDISORDERS IN SCHOLAR AGE103/10317/1917/32Difficulty in school lessons/homework7/77 (9)3/12 (25)0/15 (0)Behavioral problems during school period4/76 (5)1/12 (8)1/15 (7)School year repetition11/76 (15)2/13 (15)0/15 (0)N° of subjects evaluated forDISORDERS IN ADOLESCENCE101/10314/1911/32Difficulty in managing anger and aggression4/75 (5)0/11 (0)0/10 (0)Behavioral alterations0/75 (0)0/11 (0)0/10 (0)Difficulty in conduct2/73 (3)0/11 (0)2/10 (20)Mood alterations1/73 (1)1/11 (9)0/10 (0)Alterations of the feeding behavior1/75 (1)0/11 (0)0/10 (0)Anxiety problems1/75 (1)1/10 (10)0/10 (0)

Results are presented as number/total number (%) of answers collected for each question. Variables were compared with Chi Squared/exact Fisher test. *p=0.03; °p=0.02.

Figure 1.

Children with ≥1 NP alteration: comparison of the 3 subgroups.

In addition, SSc mothers declared that 7/123 (6%) children underwent a NP evaluation leading to a diagnosis in 3 cases: 1 cognitive delay, 1 learning disorder (LD) and 1 autism spectrum disorder (ASD). These children were born 1 and 5 years before and 3 years after SSc diagnosis, respectively. The prevalence of these diagnoses (0.8%) does not differ from general pediatric population.

Conclusion

Children born to SSc mothers, had prevalence of major NP alterations (cognitive deficits, LDs, ASDs) similar to general pediatric population. A higher frequency of minor ND disorders, especially sleep irregularities, was observed in children within 10 years before maternal diagnosis, compared to the other groups, possibly suggesting an impact of maternal chronic disease on the relationship with child in the first years of life. To confirm these self-reported preliminary data, the extension of the study will consist in a systematic NP evaluation proposed to all the offspring of SSc mothers aged ≤18 years.

References

[1]Blagojevic J et al. 2019. J Rheumatol.

Acknowledgements

GILS (Gruppo Italiano Lotta Sclerodermia) is kindly acknowledged for supporting the study with a grant.

Disclosure of Interests

None declared

Effect of aging on clinical features and metabolic complications of women with polycystic ovary syndrome

PURPOSE

To assess the distribution of clinical features and metabolic abnormalities of polycystic ovary syndrome (PCOS) women according to their age.

METHODS

Retrospective study on 602 women (mean age 23.9 ± 6.2 years), diagnosed according to International PCOS Network Guidelines criteria as having PCOS in a University-based Hospital. Anthropometric features, hormonal and metabolic parameters were measured and compared between the different age groups (group A ≤ 20 years; group B 21-30 years; group C > 30 years).

RESULTS

Patients in group A were more often hyperandrogenic, while in group C hypertension, dyslipidemia, obesity, impaired fasting glucose, and insulin resistance (IR) were more prevalent. After adjusting for BMI, age correlated positively with sex hormone-binding globulin (SHBG), IR, total- and LDL-cholesterol, and negatively with DHEAS, insulin, and free androgen index (FAI). SHBG was significantly associated with IR and atherogenic dyslipidemia, while FAI levels were linked to hypertension, independently of other factors considered. Furthermore, the regression analysis showed a stronger relationship between BMI and metabolic outcomes, regardless of age.

CONCLUSION

Polycystic ovarian syndrome (PCOS) phenotype changes with age. Clinical and biochemical hyperandrogenism are a major concern in young PCOS women, while metabolic burden tends to increase with aging. Some of the cardiovascular risk factors are dependent on FAI and SHBG levels, whereas BMI confirms its key role in the genesis of most of the metabolic sequelae in PCOS, independently of age.

Genetic interaction analysis of VEGF-A rs3025039 and VEGFR-2 rs2071559 identifies a genetic profile at higher risk to develop nodular goiter

CONTEXT

Nodular goiter in patients from areas of iodine deficiency is due to the growth of follicular and endothelial cells, involving different vascular-related growth factors in its pathogenesis.

OBJECTIVE

The aim of our study was to examine the association of known single polymorphisms of vascular endothelial growth factor-A [VEGF-A], VEGF receptor-2 [VEGFR-2] and hypoxia-inducible factor-1α [HIF-1α] genes or their genetic interactions with the risk of nodular goiter development.

PATIENTS AND METHODS

116 normal subjects, without any thyroid disease, and 108 subjects with nodular goiter [subjects with goiter and at least one thyroid nodule of > 1 cm of maximum size and in absence of signs of autoimmunity] were selected from a homogeneous population living in a mild iodine deficiency geographic area. Analyses were performed on germline DNA obtained from blood samples and VEGF-A rs3025039, VEGFR-2 rs2071559, and HIF-1αrs11549465 SNPs were investigated by real-time PCR technique. The multifactor dimensionality reduction [MDR] methodology was applied to investigate the genetic interaction between SNPs. Hardy-Weinberg equilibrium was performed.

RESULTS

None of the studied polymorphisms were individually associated with a higher risk to develop nodular goiter [P > 0.05]. The combination of the VEGF-A rs3025039 and VEGFR-2 rs2071559 polymorphisms had the highest accuracy of 0.58 [P = 0.018] and the interaction of some genotypes was significantly associated with the risk of nodular goiter development.

CONCLUSIONS

Our results support a genetic interaction between the VEGF-A rs3025039 and VEGFR-2 rs2071559 polymorphisms as a predictor of the risk to develop nodular goiter in subjects coming from an area with mild iodine deficiency.

Family-centred care for children and young people with cerebral palsy: results from an Italian multicenter observational study

BACKGROUND

Family‐centred care (FCC) is recognized as the model of best practice for the provision of services for children who have physical disabilities and their families.

OBJECTIVE

To assess the overall perception of FCC provided in an Italian network of 17 rehabilitation services, as perceived by parents of children with cerebral palsy and professionals, and to explore whether children, families, service providers and service‐related characteristics influence parent satisfaction regarding service provision in an FCC practice.

METHODS

The Measure of Processes of Care (MPOC‐20) for parents/caregivers and the Measure of Processes of Care for Service Providers (MPOC‐SP) for healthcare providers were used. For the purposes of the study, an ad hoc information form was developed to collect information concerning children, families, service providers and services.

RESULTS

A total of 382 parents/caregivers and 269 healthcare providers completed the MPOC questionnaires. Parents and service providers both identified the domains for enabling partnerships and interpersonal sensitivity as a strength, while the domain relating to general information was always scored the lowest. An advanced maternal age, being a single parent, being unemployed and having lower socio‐economic status were factors identified as individually predictive of lower FCC scores on the MPOC‐20. Higher intensity treatment, inpatient services, primary healthcare settings and settings identified with limited financial resources and reduced space/time for each family were other variables significantly associated with less favourable MPOC‐20 ratings.

CONCLUSIONS

The perception of FCC provided was fairly positive, with some areas of improvement, such as the domain of provision of information. Professionals should, therefore, provide better communication and take more time in giving information and attention to parents. Potential sources of variation in parent perceptions of FCC based on family characteristics and the organization of services highlight the importance the need to support services through the provision of greater financial and human resources.

Abstract P2-05-06: Analytical and clinical validation of a fully automated tissue-based quantitative assay (MetaSite Breast™) to detect the likelihood of distant metastasis in hormone receptor (HR)-positive, HER2-negative early stage breast cancer (ESBC)

Background: MetaSite Breast™ is a validated assay to predict risk of distant breast cancer metastasis in patients with HR+/HER2- ESBC. The assay measures the number of MetaSites defined as tumor microanatomic structures composed of MENA protein expressing tumor cells in contact with CD31+ endothelial cells and CD68+ macrophages. Previous studies have demonstrated that an increased number of these microanatomic structures is associated with distant metastasis (DM) in HR+/HER2- ESBC independent of clinicopathologic features. Analytical validation of MetaSite Breast™ demonstrated precision of 97-99% (repeat image analysis of the same slide) and performance of 91-96% (staining and image analysis of serial tumor sections). We sought to further understand the importance of the MetaSite in predicting distant breast cancer metastasis utilizing a fully automated prognostic assay in an independent large patient cohort.

Methods: We conducted a nested case-control study within a cohort of 3,760 patients diagnosed between 1980 and 2000 with invasive breast cancer from the Kaiser Permanente Northwest health care system. Cases (n=259) were women who developed a subsequent distant metastasis; controls, selected using incidence density sampling, were matched closely to cases (1:1) on age at and calendar year of primary diagnosis. Of the 481 patient tumor samples evaluated in this study, 57% were HR+/HER2-, 19% were triple negative (TN), and 15% were HER2+ disease. Multivariate models were adjusted for clinical factors including: lymph node status, tumor size, tumor grade, and HRT; as well as matching variables: age and year of diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression.

Results: In the HR+/HER2- group, MetaSite Score (MS) ranged from 0-357 and the mean was 44.6. MS was a significant predictor of DM (P=0.039) in patients with HR+/HER2- disease. Cut-points based on tertiles of MS in all 259 controls defined intermediate (13-41) and high (>41) risk groups that were significantly associated with risk of DM versus the low risk group (OR=2.24; 95%CI=1.23-4.13, P=0.009) and (OR=2.94; 95%CI=1.62-5.41, P=0.0005), respectively. Univariate estimates of absolute risk of DM with cutoffs based on 90% sensitivity and specificity were 9.4% for the low risk group (MS<7), 14.1% for the intermediate (MS=7-91), and 23.4% for the high (MS>91). When adjusted for clinical factors, estimates of absolute risk of DM were 6.6%, 14.1%, and 33.0% for the low, intermediate, and high risk groups, respectively. A binary cut-point for the high risk group was determined (MS>14) and was significant with a 2-fold higher risk of DM versus the low risk group and adjusted for clinical covariates (P=0.036). MS was not positively associated with DM in TN or HER2+ disease.

Conclusions: MetaSite Breast™ significantly predicted the risk of distant breast cancer metastasis in ESBC patients with HR+/HER2-disease, independent of classical clinicopathologic features.

Citation Format: Donovan MJ, Jones JG, Entenberg DR, Condeelis JS, D'alfonso TM, Gustavson M, Molinaro A, Oktay MH, Xue X, Sparano JA, Peterson MA, Podznyakova O, Rohan TE, Shuber AP, Gertler FB, Ly A, Divelbiss ME, Hamilton DA. Analytical and clinical validation of a fully automated tissue-based quantitative assay (MetaSite Breast™) to detect the likelihood of distant metastasis in hormone receptor (HR)-positive, HER2-negative early stage breast cancer (ESBC) [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 P2-05-06.

Occlusal traits in children with neurofibromatosis type 1

OBJECTIVES

Literature is poor of data about the occlusion in children affected by neurofibromatosis type 1 (NF1). This case-control study investigated the occlusal traits in a group of children with NF1.

SETTING AND SAMPLE POPULATION

A hundred and fifteen children with NF1 were enrolled; non-NF1 controls were sequentially selected among subjects referred to the Pediatric Dentistry Department.

MATERIAL AND METHODS

All patients underwent a clinical dental examination and a panoramic radiography. The following orthodontic variables were considered: molar relationship, overjet, overbite, cross-bite, scissor bite, and crowding/spacing.

RESULTS

Class III molar relationship resulted significantly (p = 0.01) more common in children with NF1 than in the control group as well as the unilateral posterior cross-bite (p = 0.0017). Forty-three children with NF1 (37.3%) showed radiographic abnormalities; in one case, a plexiform neurofibroma was detected.

CONCLUSIONS

An early orthodontic evaluation might be planned in the management of children with NF1 to prevent or decrease the need for extensive orthodontic interventions.

Predictive factors of recurrence of hepatocellular carcinoma after liver transplantation: a multivariate analysis

We analyzed predictive risk factors for recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). We retrospectively analyzed the clinical data from 109 consecutive HCC patients who underwent OLT at our center from 1988 to 2007. We excluded all patients who died due to factors other than tumor recurrence within the first year (n = 24). The remaining 85 patients were enrolled in either a recurrence group (A; n = 19) or a nonrecurrence group (B; n = 66). Upon univariate analysis, the 2 groups were significantly different for 11 parameters. Group A included more females (P = .05), noncirrhotic liver recipients (P = .003), "up-to 7 status" patients (HCC with 7 as the sum of the size of the largest tumor [cm] and the number of tumors, P < .0001), patients exceeding Milan criteria (MC; P < .0001) or University of California San Francisco (UCSF) criteria (P < .0001), and OLT performed before 1999 (P = .003). Group A also showed a higher number of lesions (P = .035), a greater sum of diameters of the lesions (P < .0001), a major number of macrovascular (P < .0001) and microvascular invasions (P < .0001), and an increased number of G3-G4 grading (P = .006). Only microvascular invasion (P = .007) and exceeding UCSF criteria (P = .003) were independent risk factors for recurrence upon multivariate analysis. Patients with both these parameters are not candidates for OLT. Microvascular invasion is a good predictive parameter, but is impossible to detect preoperatively. New pre-OLT predictive risk factors are needed to achieve optimal results.

Xanthomonas campestris lipooligosaccharides trigger innate immunity and oxidative burst in Arabidopsis

Plants lack the adaptive immunity mechanisms of jawed vertebrates, so they rely on innate immune responses to defense themselves from pathogens. The plant immune system perceives the presence of pathogens by recognition of molecules known as pathogen-associated molecular patterns (PAMPs). PAMPs have several common characteristics, including highly conserved structures, essential for the microorganism but absent in host organisms. Plants can specifically recognize PAMPs using a large set of receptors and can respond with appropriate defenses by activating a multicomponent and multilayered response. Lipopolysaccharides (LPSs) and lipooligosaccharides (LOSs) are major components of the cell surface of Gram-negative bacteria with diverse roles in bacterial pathogenesis of animals and plants that include elicitation of host defenses. Little is known on the mechanisms of perception of these molecules by plants and the associated signal transduction pathways that trigger plant immunity.Here we addressed the question whether the defense signaling pathway in Arabidopsis thaliana was triggered by LOS from Xanthomonas campestris pv. campestris (Xcc), using proteomic and transcriptomic approaches. By using affinity capture strategies with immobilized LOS and LC-MS/MS analyses, we identified 8 putative LOS protein ligands. Further investigation of these interactors led to the definition that LOS challenge is able to activate a signal transduction pathway that uses nodal regulators in common with salicylic acid-mediated pathway. Moreover, we proved evidence that Xcc LOS are responsible for oxidative burst in Arabidopsis either in infiltrated or systemic leaves. In addition, gene expression studies highlighted the presence of gene network involved in reactive oxygen species transduction pathway.

BRAF mutation analysis in thyroid nodules with indeterminate cytology: our experience on surgical management of patients with thyroid nodules from an area of borderline iodine deficiency

PURPOSE

Fine-needle aspiration (FNA) with cytologic evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytologic diagnosis remains indeterminate for 12-18 % of nodules. BRAF V600E mutation has been reported to show a high specificity for malignant thyroid nodules and the use of this marker to refine indeterminate FNA cytology results may be a useful diagnostic adjunctive tool in the pre-operative evaluation of thyroid nodules. The aim of this study was to estimate the prevalence of BRAF exon 15 mutation (V600E) and its clinical value as a diagnostic tool in a series of thyroid nodules with indeterminate cytology from an area of borderline iodine deficiency.

SUBJECTS AND METHODS

One hundred and fifty-three thyroid samples obtained by FNA of thyroid nodules from 151 patients were subjected to the analysis of BRAF V600E mutation by direct sequencing. In the study 54 nodules with indeterminate cytology, 56 benign and 43 malignant thyroid nodules were included.

RESULTS

V600E BRAF gene mutation was demonstrated in 19/43 malignant nodules, in 0/56 benign nodules and in only 1/54 indeterminate nodules that, after histology, turned out to be at a papillary thyroid carcinoma.

CONCLUSIONS

The application of BRAF exon 15 analysis showed limitations when applied to discriminate thyroid nodules with indeterminate cytology if wild-type BRAF is found, and there is no role for avoiding diagnostic thyroid surgery.

A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the liver match study

BACKGROUND

To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry.

METHODS

Liver-Match included 1480 consecutive primary liver transplants performed from 2007 to 2009 and the United Network for Organ Sharing a time-matched series of 9740 transplants. There were 173 and 706 Early Graft Loss, respectively. Multivariate analysis identified as significant predictors of Early Graft Loss: donor age, donation after cardiac death, cold ischaemia time, donor body mass index and height, recipient creatinine, bilirubin, disease aetiology, prior upper abdominal surgery and portal thrombosis.

RESULTS

A Bayesian Cox model was fitted to Liver-Match data using the United Network for Organ Sharing findings as prior information, allowing to generate an Early Graft Loss-Donor Risk Index and an Early Graft Loss-Recipient Risk Index. A Donor-Recipient Allocation Model, obtained by adding Early Graft Loss-Donor Risk Index to Early Graft Loss-Recipient Risk Index, was then validated in a distinct United Network for Organ Sharing (year 2010) cohort including 2964 transplants. Donor-Recipient Allocation Model updating using the independent Turin Transplant Centre dataset, allowed to predict Early Graft Loss with good accuracy (c-statistic: 0.76).

CONCLUSION

Donor-Recipient Allocation Model allows a reliable donor and recipient-based Early Graft Loss prediction. The Bayesian approach permits to adapt the original Donor-Recipient Allocation Model by incorporating evidence from other cohorts, resulting in significantly improved predictive capability.

Genetic markers to discriminate benign and malignant thyroid nodules with undetermined cytology in an area of borderline iodine deficiency

BACKGROUND

Fine needle aspiration (FNA) with cytologic evaluation is the most reliable tool for malignancy prediction in thyroid nodules, but cytologic diagnosis remains undetermined for 20% of nodules.

AIM

We investigated the diagnostic potential of a set of 6 marker genes to distinguish benign and malignant thyroid nodules.

SUBJECTS AND METHODS

The prospective study included 153 thyroid samples obtained by FNA of thyroid nodules from 151 patients (56 benign, 43 malignant, and 54 nodules with undetermined cytology). Gene expression was evaluated by quantitative realtime PCR and statistical analysis of data was performed. All samples were analyzed for V600E BRAF mutation.

RESULTS

A decrease in TTF3 and HGD1 expression was observed in malignant nodules with respect to benign ones, while an increase in PLAB expression was demonstrated in these nodules. The decision model was valid for 88 of 99 cases of benign and malignant nodules, with a total of 11 false positive or negative predictions. The obtained malignant/benign phenotype prediction was also valid for 37 of 54 cases of nodules with undetermined cytology with a total of 8 false positive and 9 false negative predictions. V600E BRAF gene mutation was demonstrated in 19/43 malignant nodules, in 0/56 benign nodules, and in 1/54 undetermined nodules.

CONCLUSIONS

The expression profiles of genes (TFF3, HGD1, and PLAB) allowed a good prediction for the differentiation of benign thyroid lesions and thyroid cancer starting from cells of FNA; however, this assay showed limitations when applied to discriminate thyroid nodules with undetermined cytology.

Does caval reconstruction technique affect early graft function after liver transplantation? A preliminary analysis

BACKGROUND

In the past decades, the inferior vena cava (IVC) reconstruction technique has undergone several evolutions, such as biopump, piggyback technique (PB), and laterolateral approach (LLPB). Several advantages are reported comparing the PB technique to biopump use. However, comparison between PB and LLPB has not been as well investigated. The aim of this study was to compare the results in terms of immediate graft function and intermediate graft survival among 3 subgroups characterized by distinct caval reconstruction techniques.

METHODS

We retrospectively analyzed a cohort of 200 consecutive adult patients who underwent liver transplantation from January 2001 to December 2009. The patients were stratified according to 3 caval reconstructive techniques: biopump (n=135), PB (n=32) and LLPB (n=33).

RESULTS

The LLPB group showed the shortest cold and warm ischemia times and the best immediate postoperative graft function. Survival analysis revealed LLPB patients to present the best 1-year graft survival rates: namely, 90.9% versus 75.0% and 74.1% among the PB and biopump groups, respectively (log-rank tests: LLPB vs biopump: P=.03; LLPB vs PB: P=.05). In our experience, LLPB showed the best graft survivals with an evident reduction in both cold and warm ischemia times. However, it is hard to obtain an irrefutable conclusion owing to the retrospective nature of this study, the small sample, and the different periods in which the groups were transplanted.

CONCLUSIONS

LLPB technique was a safe procedure that minimized the sequelal of ischemia-reperfusion damage. This technique yielded results superior to venovenous bypass. No definitive conclusions can to be obtained in this study comparing classic PB or LLPB.

Impact of anti-hepatitis B core-positive donors in liver transplantation: a survival analysis

INTRODUCTION

The current shortage of organs for liver transplantation (OLT) requires expansion of the donor pools. A possible approach to this problem may be the use of donors positive for antibody against hepatitis B core antigen (anti-HBc). However, it is not clear whether recipients who receive anti-HBc-positive livers show worse survival. The aim of this study was to retrospectively analyze the patient and graft survivals of two groups of OLT recipients according to the anti-HBc status of their respective donors.

METHODS

We stratified 133 patients into group 1 (n = 120; anti-core-negative donors) versus group 2 (n = 13; anti-core-positive donors).

RESULTS

Comparing the two groups by univariate analysis, there was no significant differences with regard to recipient, donor, or transplant characteristics. Group 2 showed worse 5-year patient (46.2% vs 72.0%; P = .006) and graft survivals (38.5% vs 68.4%; P = .003). After adjustment for several risk factors for post-OLT death and graft failure, there was no significant difference between patients who received anti-core-positive versus anti-core-negative donors, in terms of patient and graft survivals, particularly only after adjustment for Model for End-stage Liver Disease (MELD) degree of severity.

CONCLUSION

The use of anti-HBc-positive donors resulted in worse post-OLT patient and graft survival rates. Unlike the results obtained in the United States, we did not find possible confounders in our results, excluding MELD ≥ 20. However, due to the small size of our cohort, future prospective multicenter studies are required to clarify the safety of anti-core-positive grafts.

Lipopolysaccharides and plant innate immunity

Plants posses an innate immune system that has many parallels with those found in mammals and insects. A range of molecules of microbial origin called Microbe Associated Molecular Patterns (MAMPs) act to trigger basal defense responses in plants. These elicitors include lipopolysaccharides (LPS) from diverse Gram-negative bacteria. Both core oligosaccharide and the lipid A moieties of LPS as well as synthetic O-antigen oligosaccharides have activity in inducing defense responses in the model plant Arabidopsis thaliana. Very little is known of the mechanism of LPS perception by plants, although plant receptors for other MAMPs such as flagellin have been described. Recent work has implicated the Arabidopsis syntaxin PEN1 as a potential actor in LPS induction of plant defenses, which may suggest a role for vesicle trafficking in the signalling process.

Construction of a five-marker protein-based model for stage-independent assessment of prognosis in breast cancer

11013

Background: While the TNM method for assessment of stage in breast cancer is simple and robust, molecular methods for limited patient subsets are gaining popularity (i.e Oncotype Dx or Mammaprint). We hypothesized that multiplexed quantitative measurement of proteins known to be involved in breast cancer signaling pathways of growth, proliferation, survival, and metastasis can enhance clinical methods of predicting prognosis in all patients. Methods: We assessed the expression of twenty-three proteins (ER, PR, EGFR, HER2, HER3, HER4, ERK, PTEN, PI3Kp85α, PI3Kp110α, p27/Kip1,EIF4E, FOXO3,AKT1, AKT2, AKT3, MYC, cyclinD1, FOXO1, mTOR, p70S6Kb, NFkB and BCL2) in four subcellular compartments by automated quantitative analysis of protein expression (AQUA) on tissue microarrays of the archival Yale breast cancer cohort (n=676). To project future performance of these markers including clinicopathological parameters, we constructed univariate and multivariate logistic regression models using leave-one-out cross-validation and calculated prediction error (PE) estimates of each model's value to predict a binary endpoint of 10 year survival. In addition, we constructed univariate and multivariate Cox models of ten year disease specific survival (DSS). Results: By Cox univariate analysis, ER, PR, PTEN, and BCL2 were directly correlated with DSS, while FOXO1, HER2, HER3, and PI3Kp110α were inversely correlated with DSS. A five-variable logistic regression model of 10 year survival including nuclear AKT1, BCL2, nuclear FOXO1, cytoplasmic mTOR, and nuclear p70S6Kb (prediction error= .274) surpasses performance of TNM staging (PE=.367) and the Nottingham Prognostic Index (PE=.326). The same model is associated with 10-year DSS by Cox proportional hazard (p=<.00001) independent of TNM stage and NPI. Conclusions: Our protein-based, multiplexed approach to prognostic classification was superior to traditional methods (TNM or NPI) and single biomarkers in this retrospective cohort. Current outcomes are influenced by modern therapies, limiting the direct impact of this analysis. However, molecular profiling of primary tumor linked to outcome paves the way for the incorporation of new prognostic models into prospective studies.

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Exopolysaccharides production in Lactobacillus bulgaricus and Lactobacillus casei exploiting microfiltration

The physiology of Lactobacillus delbrueckii ssp. bulgaricus and Lactobacillus casei, extensively used in the dairy industry, was studied in order to evaluate key parameters in the synthesis of exopolysaccharides and to improve their production through novel fermentation processes. Selected strains were studied in shake flasks and in fermentor experiments using glucose and lactose as main carbon sources and bacto casitone as the only complex component, in a temperature range between 35 and 42 degrees C. The production of exopolysaccharides was monitored and correlated to the growth conditions using both a colorimetric assay and chromatographic methods. Fermentor experiments in batch mode yielded 100 mg l(-1) of EPS from L. bulgaricus and 350 mg l(-1) from L. casei. Moreover, the use of a microfiltration (MF) bioreactor resulted in exopolysaccharides (EPS) concentrations threefold and sixfold those of batch experiments, respectively. The monosaccharidic composition of the two analyzed polymers differed from those previously reported. The optimization of the production of EPSs using the MF fermentation strategy could permit the use of these molecules produced by generally recognised as safe (GRAS) microorganisms in the place of other polysaccharides in the food industry.

Structural determination of the complex exopolysaccharide from the virulent strain of Cryphonectria parasitica

The structure of a new exopolysaccharide from the virulent strain of Cryphonectria parasitica was elucidated by means of 2D NMR spectroscopy and selective degradations (mild hydrolysis and acetolysis). The polysaccharide is built up of mannose, galactose and rhamnose and has a rather complex non-repetitive structure that can be idealised as follows:

Solvent effect on the isomeric equilibrium of carbohydrates: the superior ability of 2,2,2-trifluoroethanol for intramolecular hydrogen bond stabilization

The higher aptitude of 2,2,2-trifluoroethanol for intramolecular hydrogen bond stabilization in carbohydrates is suggested. This belief, arising from the analysis by 1H NMR spectroscopy of the solvent effect of D2O, DMSO-d6, and 2,2,2-trifluoroethanol-d3 on the isomeric equilibrium of caryophyllose, was also confirmed by shifting of the conformational equilibria of beta-ribopyranose and of its methyl glycoside.

Acetyl substitution of the O-specific polysaccharide caryophyllan from the phenol phase of Pseudomonas (Burkholderia) caryophylli

The intact O-specific caryophyllan polysaccharide of the lipopolysaccharide fraction from the bacterium Pseudomonas (Burkholderia) caryophylli was isolated for the first time. Its structure was clarified by means of chemical and spectroscopic analysis and consisted of a homopolymer of randomly acetylated caryophyllose units. The position of acetyl groups when present is not unique: all the hydroxyl-groups on the side chain of the sugar can be substituted with a slight preference for acetylation of the C-5-C-10 tail of this unusual monosaccharide

A very efficient method to cleave Lipid A and saccharide components in bacterial lipopolysaccharides

A novel mild procedure for the selective cleavage of ketosidic linkages is developed using ceric ammonium nitrate (CAN) in anhydrous N,N-dimethylformamide. Its application to lipopolysaccharides (LPS) is very significant because in the so far investigated LPS, the connection between the Lipid A region and the oligo(poly)saccharide part is always a keto-sugar. This procedure has been tested on LPS of Escherichia coli which contains Kdo as a linker between Lipid A and OPS and on Acinetobacter haemoliticus which contains D-glycero-D-talo-2-octulopyranosonic acid (Ko) as a linker and it performed efficiently in both cases.

Transition metals and carbohydrates: the methyl-4,6-O-benzylidene-2,3-diazo-2,3-dideoxy-alpha-D-mannopyranoside skeleton as building block for new chiral nitrogen chelates

This paper describes a straightforward strategy for the synthesis of new nitrogen chelates by employing the chirality of readily available sugars. Thus, diimino and diamino ligands can be attained easily by using the methyl-4,6-O-benzylidene-2,3-diazo-2,3-dideoxy-alpha-D-mannopyranoside skeleton. The coordinating ability of one ligand has also been assessed by preparing a square-planar palladium complex [PdCl2(N,N-chelate)].

Loss of chromosome 16q in lobular carcinoma in situ

Lobular carcinoma in situ (LCIS) and infiltrating lobular carcinoma may represent different forms of the same disease based on their frequent clinical association and similar histologic features. Patients with LCIS are at increased risk of multicentric and bilateral disease. Thus, LCIS may represent both a precursor to infiltrating lobular carcinoma and a marker of risk for breast cancer. To identify genomic alterations in LCIS, comparative genomic hybridization was performed on 17 cases without concurrent invasive carcinoma. Loss involving chromosome 16q was present in 88% of cases and was the sole detected alteration in 29%. Gain involving 1q was second in frequency, occurring in 41% of tumors, and in all cases was associated with loss of 16q. Other recurrent changes were loss involving 17p (18%), 8p (12%), and 12q24 (12%). E-cadherin immunohistochemistry was performed on all LCIS cases to evaluate the correlation of loss involving 16q22, the site of the E-cadherin gene, and altered protein expression. Most cases with 16q22 loss showed altered E-cadherin expression (12 of 13). These results in LCIS are similar to changes reported in infiltrating lobular cancer, confirming a genetic relationship between them. HUM PATHOL 32:292-296.

Structural determination of the phytotoxic mannan exopolysaccharide from Pseudomonas syringae pv. ciccaronei

The structural determination was performed of a mannan exopolysaccharide from the gram negative bacterium Pseudomonas syringae pv. ciccaronei, which is the pathogenic agent responsible for the leaf spots of carob plants. The structure, obtained by chemical, enzymatic and spectroscopic methods, consisted of a backbone of alpha-(1-->6)-linked mannopyranose units with 80% substituted at C-2 by mono-, di- and trisaccharide side chains. In addition, terminal glucose units and phosphate groups were found to be present. This is, to the best of our knowledge, the first report of a mannan exopolysaccharide structure from a phytopathogenic bacterium. The pure polysaccharide showed phytotoxic effects, i.e., chlorosis and necrosis on tobacco leaves.

Immunostimulant (1 --> 3)-D-glucans from the cell wall of Cryphonectria parasitica (Murr.) Barr strain 263

A (1 --> 3)-beta-D-glucan with approximately 30% of the residues having a beta-D-Glc-(1 --> 6) branch is the main water-soluble component of the cell wall polysaccharide of Cryphonectria parasitica (Murr.) Barr strain 263. A (1 --> 3)-glucan with both alpha and beta anomeric linkages was found in the water-insoluble polysaccharide fraction. Both fractions possess immunological activity, being able to induce the production of either tumour necrosis factor alpha (TNF-alpha) or nitrite (NO2-).