Prognostic Significance of CSF-1R Expression in Early Invasive Breast Cancer

Colony-stimulating factor-1 receptor (CSF-1R) signaling promotes an immune suppressive microenvironment enriched in M2 macrophages. Given that CSF-1R inhibitors are under investigation in clinical trials, including in breast cancer, CSF-1R expression and association with immune biomarkers could identify patients who derive greater benefit from combination with immunotherapies. TIMER2.0 and bc-GenExMiner v4.7 were used to assess the correlation of CSF1R mRNA with immune infiltrates and prognosis. Following a prespecified training-validation approach, an optimized immunohistochemistry assay was applied to assess CSF-1R on carcinoma cells and macrophages on breast cancer tissue microarray series representing 2384 patients, coupled to comprehensive clinicopathological, biomarker, and outcome data. Significant positive correlations were observed between CSF1R mRNA and immune infiltrates. High carcinoma CSF-1R correlated with grade 3 tumors >2 cm, hormone receptor negativity, high Ki67, immune checkpoint biomarkers, and macrophages expressing CSF-1R and CD163. High carcinoma CSF-1R was significantly associated with poor survival in univariate and multivariate analyses. Adverse prognostic associations were retained in ER+ cases regardless of the presence of CD8+ T cells. CSF-1R+ macrophages were not prognostic. High carcinoma CSF-1R is associated with aggressive breast cancer biology and poor prognosis, particularly in ER+ cases, and identifies patients in whom biomarker-directed CSF-1R therapies may yield superior therapeutic responses.

Whole-proteome analysis of mesonephric-derived cancers describes new potential biomarkers

Mesonephric carcinomas (MEs) and female adnexal tumors of probable Wolffian origin (FATWO) are derived from embryologic remnants of Wolffian/mesonephric ducts. Mesonephric-like carcinomas (MLCs) show identical morphology to ME of the cervix but occur in the uterus and ovary without convincing mesonephric remnants. ME, MLC, and FATWO are challenging to diagnose due to their morphologic similarities to Müllerian/paramesonephric tumors, contributing to a lack of evidence-based and tumor-specific treatments. We performed whole-proteomic analysis on 9 ME/MLC and 56 endometrial carcinomas (ECs) to identify potential diagnostic biomarkers. Although there were no convincing differences between ME and MLC, 543 proteins showed increased expression in ME/MLC relative to EC. From these proteins, euchromatic histone lysine methyltransferase 2 (EHMT2), glutathione S-transferase Mu 3 (GSTM3), eukaryotic translation elongation factor 1 alpha 2 (EEF1A2), and glycogen synthase kinase 3 beta were identified as putative biomarkers. Immunohistochemistry was performed on these candidates and GATA3 in 14 ME/MLC, 8 FATWO, 155 EC, and normal tissues. Of the candidates, only GATA3 and EHMT2 were highly expressed in mesonephric remnants and mesonephric-derived male tissues. GATA3 had the highest sensitivity and specificity for ME/MLC versus EC (93% and 99%) but was absent in FATWO. EHMT2 was 100% sensitive for ME/MLC & FATWO but was not specific (65%). Similarly, EEF1A2 was reasonably sensitive to ME/MLC (92%) and FATWO (88%) but was the least specific (38%). GSTM3 performed intermediately (sensitivity for ME/MLC and FATWO: 83% and 38%, respectively; specificity 67%). Although GATA3 remained the best diagnostic biomarker for ME/MLC, we have identified EHMT2, EEF1A2, and GSTM3 as proteins of interest in these cancers. FATWO's cell of origin is uncertain and remains an area for future research.

Single cell transcriptomes of normal endometrial derived organoids uncover novel cell type markers and cryptic differentiation of primary tumours

Endometrial carcinoma, the most common gynaecological cancer, develops from endometrial epithelium which is composed of secretory and ciliated cells. Pathologic classification is unreliable and there is a need for prognostic tools. We used single cell sequencing to study organoid model systems derived from normal endometrial endometrium to discover novel markers specific for endometrial ciliated or secretory cells. A marker of secretory cells (MPST) and several markers of ciliated cells (FAM92B, WDR16, and DYDC2) were validated by immunohistochemistry on organoids and tissue sections. We performed single cell sequencing on endometrial and ovarian tumours and found both secretory-like and ciliated-like tumour cells. We found that ciliated cell markers (DYDC2, CTH, FOXJ1, and p73) and the secretory cell marker MPST were expressed in endometrial tumours and positively correlated with disease-specific and overall survival of endometrial cancer patients. These findings suggest that expression of differentiation markers in tumours correlates with less aggressive disease, as would be expected for tumours that retain differentiation capacity, albeit cryptic in the case of ciliated cells. These markers could be used to improve the risk stratification of endometrial cancer patients, thereby improving their management. We further assessed whether consideration of MPST expression could refine the ProMiSE molecular classification system for endometrial tumours. We found that higher expression levels of MPST could be used to refine stratification of three of the four ProMiSE molecular subgroups, and that any level of MPST expression was able to significantly refine risk stratification of the copy number high subgroup which has the worst prognosis. Taken together, this shows that single cell sequencing of putative cells of origin has the potential to uncover novel biomarkers that could be used to guide management of cancers. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Abstract B09: Single-cell RNA sequencing of normal endometrial organoids uncovers novel cell-type markers for prognostication of primary tumor samples

Endometrial epithelium gives rise to both endometrial and ovarian cancers (of clear-cell and endometrioid subtypes), the latter arising from ectopic endometrium (endometriosis). Endometrial epithelium comprises mainly secretory cells, with a minor ciliated cell population. Due to their scarcity, little is known about the biology or function of endometrial ciliated cells. To understand the biology of endometrial epithelium, and by extension the cancers that arise from it, organoids derived from normal endometrial tissue were cultured. Notch signaling inhibitors were used to induce ciliated cell differentiation. Through single-cell RNA sequencing, distinct secretory and ciliated cell populations were observed, with the ciliated cell population increasing with Notch signaling inhibition. Many novel markers of ciliated cells were observed, but no highly specific markers of secretory cell differentiation. A marker of secretory cells (MST) and several markers of ciliated cells (FAM92B, WDR16 and DYDC2) were validated by immunohistochemistry on organoids and tissue sections. In endometrial tumors, both MST and FAM92B exhibited diffuse staining and were markers of better prognosis. This suggests that tumors expressing differentiation markers have better prognosis, whether it is a marker of secretory or ciliated cells. Interestingly, a small number of endometrial tumors stained positive for DYDC2; however, these tumors exhibited a variable staining pattern with 25-50% tumor cells staining intensely, and the remaining tumor cells not staining at all. A similar variable staining pattern had been observed previously with CTH, another ciliated cell marker. Endometrial and ovarian tumor tissue microarrays were stained with DYDC2, CTH and two ciliated cell markers, FOXJ1 and p73. For all these markers, a subset of tumors displayed a variable staining pattern and for endometrial cancers, the variable staining was a good prognostic indicator. Single-cell sequencing of endometrial tumors has been able to capture these two populations of tumor cells. In ovarian tumors, only variable CTH staining was a significant prognostic indicator. Normal endometrial secretory cells are able to differentiate into ciliated cells, and the variable staining pattern suggests that a subset of tumors retains this ability, and these are clinically less aggressive. Using single-cell sequencing technology on normal tissues to guide development of prognostic markers and provide insight into the biology of the tumors arising from these tissues may be useful for many other tumor types.

Citation Format: Dawn R. Cochrane, Kieran R. Campbell, Kendall Greening, Germain C. Ho, James Hopkins, Minh Bui, Vassilena Sharlandjieva, Daniel Lai, Maya DeGrood, Evan W. Gibbard, Samuel Leung, Angela S. Cheng, Jamie L.P. Lim, Samantha Neilson, David Farnell, Friedrich Kommoss, Jessica N. McAlpine, Sohrab P. Shah, David G. Huntsman. Single-cell RNA sequencing of normal endometrial organoids uncovers novel cell-type markers for prognostication of primary tumor samples [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr B09.

Proteomic analysis of transitional cell carcinoma-like variant of tubo-ovarian high-grade serous carcinoma

The current World Health Organization classification does not distinguish transitional cell carcinoma of the ovary (TCC) from conventional tubo-ovarian high-grade serous carcinoma (HGSC), despite evidence suggesting improved prognosis for patients with TCC; instead, it is considered a morphologic variant of HGSC. The immunohistochemical (IHC) markers applied to date do not distinguish between TCC and HGSC. Therefore, we sought to compare the proteomic profiles of TCC and conventional HGSC to identify proteins enriched in TCC. Prognostic biomarkers in HGSC have proven to be elusive, and our aim was to identify biomarkers of TCC as a way of reliably and reproducibly identifying patients with a favorable prognosis and better response to chemotherapy compared with those with conventional HGSC. Quantitative global proteome analysis was performed on archival material of 12 cases of TCC and 16 cases of HGSC using SP3 (single-pot, solid phase-enhanced, sample preparation)-Clinical Tissue Proteomics, a recently described protocol for full-proteome analysis from formalin-fixed paraffin-embedded tissues. We identified 430 proteins that were significantly enriched in TCC over HGSC. Unsupervised co-clustering perfectly distinguished TCC from HGSC based on protein expression. Pathway analysis showed that proteins associated with cell death, necrosis, and apoptosis were highly expressed in TCCs, whereas proteins associated with DNA homologous recombination, cell mitosis, proliferation and survival, and cell cycle progression pathways had reduced expression. From the proteomic analysis, three potential biomarkers for TCC were identified, claudin-4 (CLDN4), ubiquitin carboxyl-terminal esterase L1 (UCHL1), and minichromosome maintenance protein 7 (MCM7), and tested by IHC analysis on tissue microarrays. In agreement with the proteomic analysis, IHC expression of those proteins was stronger in TCC than in HGSC (p < 0.0001). Using global proteomic analysis, we are able to distinguish TCC from conventional HGSC. Follow-up studies will be necessary to confirm that these molecular and morphologic differences are clinically significant.

Correction to: Mismatch repair protein loss in breast cancer: clinicopathological associations in a large British Columbia cohort

In the original publication of the article, the funding statement was published incompletely. The corrected funding statement should read as below.

Abstract GMM-020: CELL OF ORIGIN, MUTATION AND MICROENVIRONMENT: MODELING EARLY EVENTS OF ENDOMETRIOSIS ASSOCIATED CANCERS

Both clear cell ovarian carcinoma (CCOC) and endometrioid ovarian carcinoma (ENOC) are associated with ovarian endometriotic cysts, which is believed to be their precursor lesion. However, genomic evidence is lacking which could explain how these two clinically distinct histotypes of ovarian cancer arise from the same precursor lesion. We therefore hypothesized that these cancers arise from distinct cells of origin within endometrial tissue. Global proteomic analysis of ovarian cancer histotypes identified CTH as a marker for CCOC. We further found that CTH is highly expressed in the ciliated cells of endometrium (both ectopic endometrium and endometriosis), and of the fallopian tube, with little expression in the secretory cells. We also find that other ciliated cell markers are expressed in CCOC, whereas endometrial secretory cell markers are expressed in ENOC. We propose a new model of CCOC and ENOC histogenesis wherein ENOC is derived from cells of secretory cell lineage whereas CCOC is derived from cells of ciliated cell lineage. However, it remains unclear how external factors in the endometriotic cyst cooperate with cell of origin and mutation to promote cancer formation. To study normal tissue biology, we are using organoid cultures of normal endometrium. As ciliated cells of the endometrium are rare, and we have a particular interest in determining whether they have other features that may link them to CCOC, we used a Notch inhibitor, DBZ, to force ciliated cell differentiation in the organoids. We observed a dramatic shift in the cellular content with DBZ treamtment towards ciliated cells. We performed single cell RNA sequencing (scRNAseq) on these endometrial organoids. In the normal endometrial organoids, cells were predominantly a secretory phenotype, characterized by high ESR1 expression, with a minor ciliated cell population. The ciliated cell population expressed several known ciliated markers (FOXJ1 and DNAH12). Upon treatment with DBZ, the number of secretory cells decreases dramatically and two populations of cells emerge which have ciliated cell markers. The larger ciliated cell population is similar to the ciliated cells in the untreated organoids. The smaller ciliated cell population in the DBZ treated organoids express some ciliated cell markers, but clusters separately from normal ciliated cells. We believe this population may reprepsent an intermediary population, which has not fully differentiated. Interestingly, this population expresses the cytokine IL6, while the normal ciliated cell population does not. This is of note because CCOCs express more IL6 compared to the other histotypes. Therefore, we can speculate that this intermediary ciliated cell population may represent cells from which CCOC arise, however more testing is needed. In the future, the scRNAseq data from organoids will be compared to CCOC and ENOC tumors to determine whether the tumors resemble more closely one population of normal cells. We will use viral transduction to introduce mutations into the organoid cultures to determine whether specific mutation leads to transformation towards a CCOC or ENOC-like phenotype. These studies will enable us to tease apart the relative contribution of mutation, microenvironment and the cell of origin to promote tumor formation.

Citation Format: Dawn R Cochrane, Basile Tessier-Cloutier, Germain Ho, Kieran Campbell, Evan Gibbard, Katherine M Lawrence, Tayyebeh Nazeran, Anthony N. Karnezis, Clara Salamanca, Angela S Cheng, Jessica N McAlpine, Sohrab Shah, Lien N Hoang, C Blake Gilks and David G Huntsman. CELL OF ORIGIN, MUTATION AND MICROENVIRONMENT: MODELING EARLY EVENTS OF ENDOMETRIOSIS ASSOCIATED CANCERS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr GMM-020.

Mismatch repair protein loss in breast cancer: clinicopathological associations in a large British Columbia cohort

Purpose

Alterations to mismatch repair (MMR) pathways are a known cause of cancer, particularly colorectal and endometrial carcinomas. Recently, checkpoint inhibitors have been approved for use in MMR-deficient cancers of any type (Prasad et al. in JAMA Oncol 4:157–158, 2018). Functional studies in breast cancer have shown associations between MMR loss, resistance to aromatase inhibitors and sensitivity to palbociclib (Haricharan et al. in Cancer Discov 7:1168–1183, 2017). Herein, we investigate the clinical meaning of MMR deficiency in breast cancer by immunohistochemical assessment of MSH2, MSH6, MLH1 and PMS2 on a large series of breast cancers linked to detailed biomarker and long-term outcome data.

Methods

Cases were classified as MMR intact when all four markers expressed nuclear reactivity, but MMR-deficient when at least one of the four biomarkers displayed loss of nuclear staining in the presence of positive internal stromal controls on the tissue microarray core.

Results

Among the 1635 cases with interpretable staining, we identified 31 (1.9%) as MMR-deficient. In our cohort, MMR deficiency was present across all major breast cancer subtypes, and was associated with high-grade, low-progesterone receptor expression and high tumor-infiltrating lymphocyte counts. MMR deficiency is significantly associated with inferior overall (HR 2.29, 95% CI 1.02–5.17, p = 0.040) and disease-specific survival (HR 2.71, 95% CI 1.00–7.35, p = 0.042) in the 431 estrogen receptor-positive patients who were uniformly treated with tamoxifen as their sole adjuvant systemic therapy.

Conclusion

Overall, this study supports the concept that breast cancer patients with MMR deficiency as assessed by immunohistochemistry may be good candidates for alternative treatment approaches such as immune checkpoint or CDK4 inhibitors.

Electronic supplementary material

The online version of this article (10.1007/s10549-019-05438-y) contains supplementary material, which is available to authorized users.

Expression of L1 retrotransposon open reading frame protein 1 in gynecologic cancers

LINE-1 (L1) retrotransposons are mobile genetic elements capable of "copy-and-pasting" their own sequences into random genomic loci, and one of the proteins it uses to achieve mobility is LINE-1 open reading frame 1 protein (L1ORF1p). L1ORF1p expression is found across many epithelial cancers, including small cohorts of ovarian and endometrial cancers, and is highly expressed in cancers with mutant p53 expressions. Here we aimed to gain insights into L1ORF1p expression levels within specific histotypes of ovarian cancers: high-grade serous (n = 585), low-grade serous (n = 26), clear cell (n = 132), endometrioid (n = 148), and mucinous (n = 32) ovarian cancers, as well as endometrial cancers (n = 607) using tissue microarray (TMA's). We demonstrated that L1ORF1p expression is associated with advanced stage and serous histotype in gynecological cancers. Like previous studies, we found a higher proportion of L1ORF1p expression in cases with aberrant p53 expression. We evaluated the expression of L1ORF1p in serous tubal intraepithelial carcinomas (STICs) (n = 6) and p53 signature lesions (n = 2) in fallopian tubes. Three STIC cases displayed aberrant p53 overexpression with corresponding L1ORF1p expression in the same tissues, but such correlation was not seen in the two p53 signature lesions, suggesting that L1 protein may be expressed after dysplastic transformation. The remaining three STIC cases have TP53 nonsense mutations with absent p53 expression but a strong and clear L1ORF1p expression within the STIC lesions. While L1ORF1p may not be prognostic in gynecological cancers, it may be useful clinically as a diagnostic IHC marker for p53 null STIC lesions and this warrants further investigation.

Abstract P1-06-02: Mismatch repair protein loss in breast cancer: Clinicopathological associations in a large British Columbia cohort

Background: Alterations to mismatched repair (MMR) pathways are a known cause of cancer (particularly colorectal and endometrial). Recently, the FDA approved pembrolizumab for use in MMR-deficient (MMRD) cancers of any type, and the diagnosis can be made by immunohistochemistry (IHC) or genomic methods. In breast cancer, mutational process analyses indicate MMRD occurs in about 2% of breast cancer (Cancer Res; 77; 4755-62, 2017) and recent functional studies have shown associations with resistance to endocrine therapy and sensitivity to CDK4/6 inhibitors (Cancer Discov; 7; 1168-83, 2017). To date, insufficient cases have been assembled to power meaningful associative or survival studies. Herein, the strong correlation between IHC-determined loss of MLH1, PMS2, MSH2 or MSH6 and genomic evidence allowed the assessment of MMRD on a large tissue microarray (TMA) series linked to detailed biomarkers and long-term outcome data.

Methods: IHC markers MLH1, PMS2, MSH2 and MSH6 were optimized on the Ventana automated stainer for application to breast cancer TMAs. The patient cohort consists of females from British Columbia diagnosed with primary invasive breast carcinoma in 1986-1992, referred to the British Columbia Cancer Agency for treatment and follow-up. TMA blocks were sectioned and stained. Slides were scored by a pathologist and only nuclear positivity was evaluated positive. Loss of nuclear positivity for any one of the four tested marker defined MMRD. Clinicopathological associations were tested by Chi-square, and survival by Kaplan-Meier plot with log rank test.

Result: 1635 cases were interpretable for all MMR markers. 31 cases (1.9%) met criteria for MMRD. 6 cases had paired losses (4 MLH1-PMS2 loss, 2 MSH2-MSH6 loss) and the remaining 25 cases had singular MMR loss (11 PMS2 loss, 10 MLH1 loss, 3 MSH6 loss, 1 MSH2 loss). Deficiency of the the MutL complex (MLH1/PMS2) predominated over the MutS complex (MSH2/MSH6).

Among the demographic and pathological variables assessed – age, grade, tumour size, lymphovascular invasion, nodal and menstrual status – high grade is associated with MMRD (p=0.014). In terms of biomarker, MMRD is significantly associated with PR negativity (p=0.003) and PD-L1 expression (p=0.049), but not with ER, Her2, Ki67, or basal breast cancer IHC markers, nor does MMRD significantly correlate with any of the established major intrinsic subtypes of breast cancer. Tumor infiltrating lymphocyte (TIL) counts are higher in MMRD cases (p=0.009). Although statistically not significant (small numbers), Kaplan-Meier plots of survival analysis demonstrated a trend for MMR loss to be associated with decreased breast cancer disease-specific and overall survival.

Conclusion: This large series assessed by IHC corroborates findings from smaller genomic series that MMRD is present in about 2% of breast cancers. MMRD tumors are more likely to be high grade, low PR and immunologically active (higher PD-L1 expression and TIL counts). MMR deficiency is present across all major molecular subtypes (luminal, HER2, basal). Given the efficacy of PD1/PDL1 targeting agents in MMR deficient tumors of other types, evidence for the activity of these agents in MMR deficient breast cancers should be actively sought.

Citation Format: Cheng AS, Leung SC, Gao D, Anurag M, Nielsen T, Ellis MJ. Mismatch repair protein loss in breast cancer: Clinicopathological associations in a large British Columbia cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-06-02.

Clear cell and endometrioid carcinomas: are their differences attributable to distinct cells of origin?

Endometrial epithelium is the presumed tissue of origin for both eutopic and endometriosis-derived clear cell and endometrioid carcinomas. We had previously hypothesized that the morphological, biological and clinical differences between these carcinomas are due to histotype-specific mutations. Although some mutations and genomic landscape features are more likely to be found in one of these histotypes, we were not able to identify a single class of mutations that was exclusively present in one histotype and not the other. This lack of genomic differences led us to an alternative hypothesis that these cancers could arise from distinct cells of origin within endometrial tissue, and that it is the cellular context that accounts for their differences. In a proteomic screen, we identified cystathionine γ-lyase (CTH) as a marker for clear cell carcinoma, as it is expressed at high levels in clear cell carcinomas of the ovary and endometrium. In the current study, we analysed normal Müllerian tissues, and found that CTH is expressed in ciliated cells of endometrium (both eutopic endometrium and endometriosis) and fallopian tubes. We then demonstrated that other ciliated cell markers are expressed in clear cell carcinomas, whereas endometrial secretory cell markers are expressed in endometrioid carcinomas. The same differential staining of secretory and ciliated cells was demonstrable in a three-dimensional organoid culture system, in which stem cells were stimulated to differentiate into an admixture of secretory and ciliated cells. These data suggest that endometrioid carcinomas are derived from cells of the secretory cell lineage, whereas clear cell carcinomas are derived from, or have similarities to, cells of the ciliated cell lineage. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Abstract 2215: Detection of novel markers of transitional cell carcinoma of the ovary, the TCC-like variant of high grade serous carcinoma, using proteomics and immunohistochemistry

Background: The current WHO classification does not separate transitional carcinoma of the ovary (TCCO) from conventional high grade serous carcinoma of the ovary (HGSC). TCCO has a better prognosis, possibly due to better chemosensitivity or less infiltrative growth pattern. The available immunohistochemical (IHC) markers do not differentiate between the two subtypes. Therefore, we sought to compare the proteomic profiles of conventional HGSC and TCCO to identify surrogate biomarkers of good prognosis from TCCO that could identify conventional HGSC tumors with a better prognosis.

Design: Full proteome analysis of 12 cases of TCCO and 12 cases of HGSC was performed using SP3-clinical proteomics, run on an ThermoFisher Orbitrap Fusion. For validation, tissue microarrays of TCCO (n=89) and HGSC (n=237) were immunostained with antibodies against proteins found to be enriched in TCCO. All cases and immunostains were scored by a gynecologic pathologist. Univariate analysis was performed comparing IHC expression in TCCO vs. HGSC.

Results: We identified 1220 proteins that were significantly enriched in TCCO over HGSC. Claudin 4 and Ubiquitin carboxyl-terminal esterase L1 (UCHL1) were selected as potential markers of TCCO-like biology (p=0.0017, 0.0322). By IHC, Claudin 4 (95% confidence interval (CI) 0.171, 0.430) and UCHL1 (95% CI 0.291, 0.550) showed a significantly higher expression in TCCO as compared to HGSC (see table).

% of tumors with high immunoreactivity scoresClaudin 4UCHL1Pure TCCO34/59 (58%)26/59 (44%)Mixed TCCO-HGSC, TCCO component14/29 (48%)8/29 (28%)Mixed TCCO-HGSC, HGSC component19/28 (68%)6/28 (21%)Conventional HGSC33/235 (14%)32/237 (14%)

Legend: Mixed TCCO: TCCO with minor component of conventional HGSC

Conclusion: Proteomic analysis showed differing protein profiles for TCCO and HGSC. By IHC, Claudin 4 and UCHL1 were identified as potential markers for TCC-like differentiation of high-grade serous carcinomas. Further studies will focus on the prognostic significance of these and other markers in larger cohorts of HGSC. This study presents a novel approach at identifying potential diagnostic and prognostic biomarkers as well as therapeutic targets.

Citation Format: Basile Tessier-Cloutier, Jamie Magrill, Stefan Kommoss, Blake C. Gilks, David G. Huntsman, Dawn R. Cochrane, Aline Talhouk, Robert Soslow, Gregg B. Morin, Chris J. Hughes, Anthony N. Karnezis, Christine Chow, Angela S. Cheng, Andreas du Bois, Jacobus Pfisterer, Friedrich Kommoss. Detection of novel markers of transitional cell carcinoma of the ovary, the TCC-like variant of high grade serous carcinoma, using proteomics and immunohistochemistry [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2215. doi:10.1158/1538-7445.AM2017-2215

Transcriptional regulation of parathyroid hormone-related protein promoter P2 by NF-kappaB in adult T-cell leukemia/lymphoma

Parathyroid hormone-related protein (PTHrP) plays a primary role in the development of humoral hypercalcemia of malignancy (HHM) that occurs in the majority of patients with adult T-cell leukemia/lymphoma (ATLL) due to human T-cell lymphotropic virus type-1 (HTLV-1) infection. We previously showed that ATLL cells constitutively express high levels of PTHrP via activation of promoters P2 and P3, resulting in HHM. In this study, we characterized a nuclear factor-kappaB (NF-kappaB) binding site in the P2 promoter of human PTHrP. Using electrophoretic mobility shift assays, we detected a specific complex in Tax-expressing human T cells composed of p50/c-Rel, and two distinct complexes in ATLL cells consisting of p50/p50 homodimers and a second unidentified protein(s). Chromatin immunoprecipitation assays confirmed in vivo binding of p50 and c-Rel on the PTHrP P2 promoter. Using transient co-transfection with NF-kappaB expression plasmids and PTHrP P2 luciferase reporter-plasmid, we showed that NF-kappaB p50/p50 alone and p50/c-Rel or p50/Bcl-3 cooperatively upregulated the PTHrP P2 promoter. Furthermore, inhibition of NF-kappaB activity by Bay 11-7082 reduced PTHrP P2 promoter-initiated transcripts in HTLV-1-infected T cells. In summary, the data demonstrated that transcriptional regulation of PTHrP in ATLL cells can be controlled by NF-kappaB activation and also suggest a Tax-independent mechanism of activation of PTHrP in ATLL.

Inhibition of prostate cancer cell growth by human secreted PDZ domain-containing protein 2, a potential autocrine prostate tumor suppressor

A possible role of the PDZ domain-containing protein 2 (PDZD2) in prostate tumorigenesis has been suggested. Besides, PDZD2 is posttranslationally cleaved by a caspase-dependent mechanism to form a secreted PDZ domain-containing protein 2 (sPDZD2) with unknown functions in humans. In this study, we demonstrate the endogenous expression of PDZD2 and secretion of sPDZD2 in cancerous DU145, PC-3, 22Rv1, LNCaP, and immortalized RWPE-1 prostate epithelial cells. Inhibition of endogenous sPDZD2 production and secretion by DU145, PC-3, 22Rv1, and RWPE-1 cells via the caspase-3 inhibitor Z-DEVD-FMK resulted in increased cell proliferation, which was abrogated by treatment with exogenous recombinant sPDZD2. Whereas sPDZD2-induced antiproliferation in DU145, PC-3, and 22Rv1 cells, it induced apoptosis in LNCaP cells. The data suggest that endogenous sPDZD2, produced by caspase-3-mediated cleavage from PDZD2, may function as a novel autocrine growth suppressor for human prostate cancer cells. The antiproliferative effect of sPDZD2 was apparently mediated through slowing the entry of DU145, PC-3, and 22Rv1 cells into the S phase of the cell cycle. In DU145 cells, this can be attributed to stimulated p53 and p21(CIP1/WAF1) expression by sPDZD2. On the other hand, the apoptotic effect of sPDZD2 on LNCaP cells was apparently mediated via p53-independent Bad stimulation. Together our results indicate the presence of p53-dependent and p53-independent PDZD2/sPDZD2 autocrine growth suppressive signaling pathways in human prostate cancer cells and suggest a novel therapeutic approach of harnessing the latent tumor-suppressive potential of an endogenous autocrine signaling protein like sPDZD2 to inhibit prostate cancer growth.

A prospective study of early tactile stimulation after digital nerve repair

Forty-nine patients with 65 digital nerve injuries were randomized into two groups after nerve repair. Group 1 received early tactile stimulation and Group 2 was a control group. The patients were assessed prospectively for 6 months for recovery of functional sensibility. Tactile stimulation in Group 1 was provided from 3 weeks after nerve repair with a specially designed rotating tactile stimulator and a pocket tactile stimulator. Constant two-point discrimination, moving two-point discrimination, and cutaneous pressure threshold were measured and sensibility was graded with the Medical Research Council (UK) sensibility grading. At 6 months, 68.8% of patients in Group 1 had a Medical Research Council grading of S3+ or S4 sensibility compared with 36 % in Group 2. With this prospective randomized study, the value of sensory reeducation in improving sensibility after digital nerve injury was confirmed. Starting tactile stimulation from the early postoperative period is recommended; however, use of the rotating tactile stimulator and pocket tactile stimulation need additional study.

Expression and cellular localization of COX-1 and -2 in Helicobacter pylori gastritis

BACKGROUND

There are conflicting reports on the expression of cyclooxygenase in Helicobacter pylori infection.

AIM

To evaluate the expression of COX-1 and COX-2 in H. pylori gastritis at messenger RNA (mRNA) and protein levels.

METHODS

Endoscopic gastric biopsies were obtained from patients with non-ulcer dyspepsia. The levels of COX-1 and COX-2 mRNA were compared between H. pylori-infected and uninfected specimens using reverse transcription-polymerase chain reaction. The immunohistochemical findings were correlated with the cellular localization of cyclooxygenase mRNA using in situ hybridization.

RESULTS

A total of 40 H. pylori-infected and 40 uninfected specimens were studied. mRNA of COX-2 but not COX-1 was elevated in H. pylori-infected mucosa. COX-1 was localized to the mononuclear inflammatory, endothelial and smooth muscle cells in the lamina propria. COX-2 was barely detectable in uninfected mucosa but was strongly expressed in the foveolar and glandular epithelia in H. pylori gastritis.

CONCLUSION

Cyclooxygenase-1 is expressed in the mononuclear inflammatory, endothelial and smooth muscle cells in the lamina propria irrespective of the H. pylori status. By contrast, H. pylori induces COX-2 expression in the foveolar and glandular epithelia.

Up-regulation of cyclooxygenase-1 and -2 in human gastric ulcer

BACKGROUND

The expression of cyclooxygenase (COX) in human gastric ulcers is unknown.

AIM

To study the expression and cellular localization of cyclooxygenase in human gastric ulcers.

METHODS

A total of 38 surgical gastric ulcer specimens were studied; 20 were Helicobacter pylori-positive and 18 were associated with NSAID use. Twenty non-ulcerated, histologically normal gastric specimens were used as controls. The cellular localization of COX-1 and COX-2 were determined by immunohistochemistry and double immunofluorescence. Cyclooxygenase messenger RNA (mRNA) was measured by reverse transcription-polymerase chain reaction and localized by in situ hybridization.

RESULTS

In control specimens, COX-1 was detected in stromal cells in the lamina propria. There was focal and weak immunostaining for COX-2 in the foveolar epithelium. At the ulcer edge, COX-1 was significantly increased in lamina propria cells whereas COX-2 was strongly expressed in the hyperplastic foveolar epithelium in H. pylori- and non-steroidal anti-inflammatory drugs (NSAID)-associated ulcers. At the ulcer base, there was strong expression of COX-1 and COX-2 in myofibroblasts, macrophages and endothelial cells in the granulation tissue, irrespective of H. pylori status or NSAID use. Messenger RNA of COX-1 and COX-2 were demonstrated by reverse transcription-polymerase chain reaction. Double immunofluorescence and in situ hybridization confirmed the cellular localization of cyclooxygenase at protein and mRNA levels, respectively.

CONCLUSION

Both COX-1 and COX-2 are up-regulated in human gastric ulcers.

Cyclooxygenase-2 expression in Helicobacter pylori-associated premalignant and malignant gastric lesions

Expression of cyclooxygenase-2 (COX-2) in various stages of the Helicobacter pylori-associated gastric carcinogenesis pathway has not been elucidated. We investigated the distribution and intensity of COX-2 expression in premalignant and malignant gastric lesions, and monitored the changes after H. pylori eradication. Gastric biopsies from H. pylori-infected patients with chronic active gastritis, gastric atrophy, intestinal metaplasia (IM), gastric adenocarcinoma, and noninfected controls were studied. Expression of COX-2 was evaluated by immunohistochemistry and in situ hybridization. Endoscopic biopsies were repeated 1 year after successful eradication of H. pylori in a group of IM patients for comparing COX-2 expression and progression of IM. In all H. pylori-infected patients, COX-2 expression was predominantly found in the foveolar and glandular epithelium and, to a lesser extent, in the lamina propria. In the noninfected group, only 35% of cases demonstrated weak COX-2 expression. Intensity of COX-2 was not significantly different between the chronic active gastritis, gastric atrophy, IM, and gastric adenocarcinoma groups. In 17 patients with IM, COX-2 expressions in the epithelial cells and stromal cells were reduced 1 year after H. pylori eradication. However, the changes in COX-2 expression did not correlate with progression/regression of IM. Both premalignant and malignant gastric lesions demonstrate strong COX-2 expression. Successful eradication of H. pylori leads to down-regulation of COX-2 expression but failed to reverse IM at 1 year.

Use of early tactile stimulation in rehabilitation of digital nerve injuries

OBJECTIVE

Digital nerves are the most frequently injured peripheral nerve. To improve the recovery of functional sensibility of digital nerve injuries, a prospective randomized controlled study was conducted to see the effect of using early tactile stimulation in rehabilitation of digital nerve injuries.

METHOD

Two specific tactile stimulators were made and prescribed for patients with digital nerve-injury. Twenty-four participants with 32 digital nerve injuries received the prescribed tactile stimulators (experimental group), and another 25 participants with 33 digital nerve injuries received only routine conventional therapy (control group).

RESULTS

A significant difference (p < .05) was seen in the experimental group, although there were some variations between the different classes of associated injuries, with least benefit observed in the combined nerve, tendon, and bone injury class.

CONCLUSION

Use of early tactile stimulation as described in this study can be considered an effective way to improve both quality and quantity of recovery of functional sensibility in digital nerve injuries without combined nerve, tendon, and bone injuries.

State Forest Practice Regulatory Programs: An Approach to ImplementingEcosystem Management on Private Forest Lands in the United States

/ Implemented in the context of a long history ofintense public debate, forestry practices applied on private forest land areregulated in some form by 38 states. State regulatory activities can involvemany agencies implementing numerous regulatory laws, a single forestry agencyadministering a comprehensive regulatory program, or a combination of thetwo. Regulatory programs are designed to protect resources such as soils,water, wildlife, and scenic beauty. Program administration often involvesrule promulgation, harvest plan reviews, coordination of interagency reviews,and pre- and postharvest on-site inspections. Forest practice rules usuallyfocus on reforestation, forest roads, harvest procedures, and wildlifehabitat protection. Emerging regulatory trends include growth of multiagencyregulatory authority and associated jurisdictional conflicts, increasedtendencies to narrowly specify standards in statutes and rules, emergence ofcontingent regulations, growing sensitivity to processes enabling theadoption of new forest practice technologies and an ability to addresscumulative effects, interest in collaborative rule-making stemming fromheightened concern over legalization of administration processes, and growingconcern over the constitutional foundations for regulatory programs and thegovernment and private sector cost of implementing such programs.KEY WORDS: Ecosystem management; Forestry practices; Private landowners;Regulatory programs; State government

Preliminary results from a field study of wild Guizhou snub-nosed monkeys (Rhinopithecus brelichi)

The Guizhou snub-nosed monkey, Rhinopithecus brelichi, is a large-bodied colobine confined to the subtropical semi-deciduous forests of Fanjing Mountain Reserve in Guizhou province, southwest China. Field work beginning in 1979 and including 10 months of intensive study in 1991 has revealed several aspects of the behavior and ecology of this species that are distinct from other colobines, including the closely related species R. roxellana and R. bieti. The Guizhou snub-nosed monkey is arboreal, traveling through the trees by quadrupedal walking, climbing, leaping, semibrachiation and (occasionally) by full brachiation. Terrestrial locomotion is use occasionally. Social organization centers around family groups of 5-10 individuals with a single adult male. Many family groups range and rest together in large, semicohesive bands. These bands may split up or coalesce temporarily to form large aggregations of over 400 animals and perhaps more. All-male groups of 2-5 adult or subadult males are found on the periphery of the bands.

Visual losses in early age-related maculopathy

Age-related maculopathy (ARM) can be considered a transition from normal retinal changes to pathological processes. It is important to recognize patients who have progressed beyond a normal state in order to provide appropriate clinical management. This pilot study considers the clinical dilemma of diagnosing and monitoring early ARM. We carried out a controlled study and tested the visual functions of 11 pre-ARM (PARM) and 11 early ARM subjects. Apart from compromised visual acuity, losses in central visual field, color vision, and visual adaptation were also recorded in our ARM subjects. We found a low contrast (LC) Amsler grid to be most sensitive to central field defects and that the desaturated panel D-15 gave too many false positives among normal elderly subjects. Our results indicate foveal sparing in early ARM and question the capacity of acuity assessment to reflect early functional changes adequately. A clinical battery is recommended to detect and monitor ARM.

Relative legibility study using Chinese optotypes

Traditionally, visual acuity test charts have been constructed using the English alphabet. It is desirable to have charts made in the native language of the Chinese and Asian populations. Previous efforts in this respect have not considered the relative legibility of Chinese optotypes. In this study, twelve Chinese optotypes were constructed according to the Snellen principle and subjected to a relative legibility trial. This study provides a basis on which Chinese optotypes of near-equal legibility may be selected.

Immunologic changes in children with Henoch-Schonlein purpura in the acute stage

T-lymphocyte subsets, B-lymphocyte, immunoglobulins and complement were studied in 38 children with Henoch Schonlein Purpura (HSP) in the acute stage. They had significantly lower CD3 percentage and lymphocyte blastogenesis rate, greater CD8 variation coefficient and B-lymphocyte percentage and higher levels immunoglobulins (IgA, IgG, IgM) and complement 3 than the controls. 21 (55%) of them had a low CD8 percentage. The results indicated that children with HSP had low T-lymphocyte percentages and function, increased B-lymphocyte percentage and function, high immunoglobulins, normal or elevated complement. On the other hand, no significant differences were found in the T-lymphocyte subsets values among healthy children aged 7-11 years. The normal values of T cell subsets in 35 normal controls were CD3 66-70%, CD4 37-41%, CD8 28-32%, respectively.