Gastrointestinal colonization by Diutina (Candida) rugosa in a 6-year-old Siberian Husky

A 6-year-old 21.5 kg castrated male Siberian Husky was presented for acute onset of lethargy, vomiting, hemorrhagic diarrhea, and inappetence. Physical examination revealed marked discomfort upon abdominal palpation and 5%-7% dehydration. The CBC and biochemical profile revealed changes consistent with mild to moderate inflammation, dehydration, and gastrointestinal (GI) disease. Despite aggressive gastrointestinal support, anorexia persisted, and an upper GI endoscopy was performed in conjunction with esophagostomy tube placement. Endoscopy revealed abnormal gastric mucosa characterized by moderately well-demarcated areas of blue-black discoloration. Impression smears of a gastric biopsy revealed abundant extracellular yeasts with morphology most consistent with Candida spp. and frequent extracellular cocci. Similar yeast and bacteria, in lower numbers, were observed on cytologic analysis of a direct smear of the rectal mucosa. A rectal swab submitted for fungal culture yielded pure growth of fungal yeasts identified as Diutina (formerly Candida) rugosa by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. The dog's clinical signs improved with fluconazole, and he was discharged. Follow-up fungal culture of a rectal swab showed no growth of D. rugosa. To the authors' knowledge, this is the first case report that describes the clinical, hematologic, cytologic, and gross findings of enteric colonization by D. rugosa in a dog.

Host-derived growth factors drive ERK phosphorylation and MCL1 expression to promote osteosarcoma cell survival during metastatic lung colonization

PURPOSE

For patients with osteosarcoma, disease-related mortality most often results from lung metastasis-a phenomenon shared with many solid tumors. While established metastatic lesions behave aggressively, very few of the tumor cells that reach the lung will survive. By identifying mechanisms that facilitate survival of disseminated tumor cells, we can develop therapeutic strategies that prevent and treat metastasis.

METHODS

We analyzed single cell RNA-sequencing (scRNAseq) data from murine metastasis-bearing lungs to interrogate changes in both host and tumor cells during colonization. We used these data to elucidate pathways that become activated in cells that survive dissemination and identify candidate host-derived signals that drive activation. We validated these findings through live cell reporter systems, immunocytochemistry, and fluorescent immunohistochemistry. We then validated the functional relevance of key candidates using pharmacologic inhibition in models of metastatic osteosarcoma.

RESULTS

Expression patterns suggest that the MAPK pathway is significantly elevated in early and established metastases. MAPK activity correlates with expression of anti-apoptotic genes, especially MCL1. Niche cells produce growth factors that increase ERK phosphorylation and MCL1 expression in tumor cells. Both early and established metastases are vulnerable to MCL1 inhibition, but not MEK inhibition in vivo. Combining MCL1 inhibition with chemotherapy both prevented colonization and eliminated established metastases in murine models of osteosarcoma.

CONCLUSION

Niche-derived growth factors drive MAPK activity and MCL1 expression in osteosarcoma, promoting metastatic colonization. Although later metastases produce less MCL1, they remain dependent on it. MCL1 is a promising target for clinical trials in both human and canine patients.

Osteosarcoma tumors maintain intra-tumoral transcriptional heterogeneity during bone and lung colonization

BACKGROUND

Tumors are complex tissues containing collections of phenotypically diverse malignant and nonmalignant cells. We know little of the mechanisms that govern heterogeneity of tumor cells nor of the role heterogeneity plays in overcoming stresses, such as adaptation to different microenvironments. Osteosarcoma is an ideal model for studying these mechanisms-it exhibits widespread inter- and intra-tumoral heterogeneity, predictable patterns of metastasis, and a lack of clear targetable driver mutations. Understanding the processes that facilitate adaptation to primary and metastatic microenvironments could inform the development of therapeutic targeting strategies.

RESULTS

We investigated single-cell RNA-sequencing profiles of 47,977 cells obtained from cell line and patient-derived xenograft models as cells adapted to growth within primary bone and metastatic lung environments. Tumor cells maintained phenotypic heterogeneity as they responded to the selective pressures imposed during bone and lung colonization. Heterogenous subsets of cells defined by distinct transcriptional profiles were maintained within bone- and lung-colonizing tumors, despite high-level selection. One prominent heterogenous feature involving glucose metabolism was clearly validated using immunofluorescence staining. Finally, using concurrent lineage tracing and single-cell transcriptomics, we found that lung colonization enriches for multiple clones with distinct transcriptional profiles that are preserved across cellular generations.

CONCLUSIONS

Response to environmental stressors occurs through complex and dynamic phenotypic adaptations. Heterogeneity is maintained, even in conditions that enforce clonal selection. These findings likely reflect the influences of developmental processes promoting diversification of tumor cell subpopulations, which are retained, even in the face of selective pressures.

Abstract 2533: MAPK-driven MCL1 expression promotes osteosarcoma survival in the metastatic niche

We sought to identify dependencies of slow growing, chemo-resistant osteosarcoma cells that anchor in the metastatic niche. These dependencies yield insight into what allows early cells to survive in the hostile lung environment, as well as potential therapeutic targets. In our studies of metastatic colonization, we identified two distinct populations of osteosarcoma cells. The first, dubbed “anchor cells”, are prevalent in the early metastatic niche where they are hypo-proliferative and hyper-secretory. The second subpopulation, “growth cells”, proliferate rapidly and predominate as lesions begin to grow rapidly. To identify genes and pathways that differentiate anchor cells, we performed scRNAseq on early and late metastases and confirmed these findings with tissue staining of time-matched metastases. To identify ligands that might facilitate survival of anchor cells in the lung microenvironment and their source, we performed scRNAseq on normal and metastasis-bearing lungs at different stages of metastasis. To confirm osteosarcoma cells express receptors for the identified lung growth factors, we used an immunoassay to evaluate tyrosine kinase receptor expression at baseline and in response to lung epithelial cell-conditioned medium. To confirm the growth factors increased MAPK activity in osteosarcoma cells, we used live cell imaging on fluorescent pERK reporter cells, followed by immunofluorescence to determine if increased MAPK activity was necessary for increased MCL1 expression. To determine if MCL1 is a viable therapeutic target and selective for anchor cells, we treated tumor-on-lung anchor cell-rich spheroid models with a MCL1-selective BH3 mimetic, AZD5991, and quantified cell death. To optimize dosing and determine tolerance in vivo, we treated metastasis-bearing mice with different doses of AZD5991 +/- cyclophosphamide. We found anchor cells have upregulated ERK activity and MCL1 expression compared to growth cells. This activity is associated with production of several growth factors in the metastatic niche that can activate receptors expressed by osteosarcoma cells. Growth-factor induced ERK activity is necessary for increased MCL1 expression in osteosarcoma cells. We found expression of many growth factors produced by niche cells becomes augmented as osteosarcoma cells colonize the lung. Additionally, host cells within the niche express comparatively more growth factors early in the metastatic process, with macrophages representing a predominant source of growth factors. We found cells expressing higher levels of MCL1 are vulnerable to its inhibition in vitro. Metastatic burden decreased as the number of AZD5991 doses increased in vivo. Our data suggest growth factors in the lung activate ERK in the early metastatic niche, and ERK-dependent MCL1 expression is required for survival of anchor cells. MCL1-targeting agents may have utility in disrupting colonization of the lungs.

Citation Format: Camille A. McAloney, Rawan Makkawi, Matthew V. Cannon, Amy C. Gross, Maren Cam, Emily Franz, Tatyana A. Vetter, Alexander E. Davies, Ryan D. Roberts. MAPK-driven MCL1 expression promotes osteosarcoma survival in the metastatic niche [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2533.

Pathology in Practice

In collaboration with the American College of Veterinary Pathologists.

Pathology in Practice

In collaboration with the American College of Veterinary Pathologists.

Comparison of pathologist review protocols for cytologic detection of prostatic and urothelial carcinomas in canines: A bi-institutional retrospective study of 298 cases

Urothelial carcinoma, also known as transitional cell carcinoma, is the most common primary bladder tumour in dogs, and can also involve the prostate gland. Cytology is a common diagnostic tool utilized for dogs with bladder or prostate gland lesions. The objectives of this retrospective study were to compare the sensitivity and specificity of cytologic evaluation for urothelial or prostatic carcinoma between two institutions with different cytology review protocols as well as determine if certain collection methods resulted in higher cytologic accuracy. A total of 298 cases met inclusion criteria. The overall sensitivity and specificity for institution 1 were 91.8% and 50%, respectively, compared to 31.1% and 97.4%, respectively, for institution 2. When the urine sample review protocol at institution 2 was matched to that of institution 1, sensitivity and specificity were more similar to institution 1 (71.2% and 88.9%, respectively). Our results show that the sensitivity and specificity of cytology are affected by screening and review protocols implemented by different institutions. The data also demonstrate that sensitivity and specificity vary by collection method. Diagnostic catheterization had the highest performance: of the 11 cases between two institutions, it had 100% sensitivity and specificity. In contrast, examination of urine sediment not collected via diagnostic catheterization had low sensitivity and specificity that varied greatly by institution. In summary, cytologic interpretation should be undertaken with consideration given to both processing and collection protocols.

Ectodomain shedding by ADAM17 (a disintegrin and metalloproteinase 17) in canine neutrophils

ADAM17 is a transmembrane protease expressed by most cells in humans and mice that cleaves cell surface substrates primarily in a cis manner, a process referred to as ectodomain shedding. ADAM17 has numerous substrates and plays a broad role in various physiological processes, including as a key regulator of inflammation. At this time, little is known about ADAM17 expression and function in dogs. A well-established ADAM17 substrate is the leukocyte adhesion protein CD62L (L-selectin). We show that a selective inhibitor of ADAM17, but not an inhibitor of its most closely related family member ADAM10, blocks CD62L shedding upon canine neutrophil activation. We also tested several anti-human ADAM17 monoclonal antibodies (mAbs) for staining canine neutrophils. Although most did not recognize canine neutrophils, the mAbs MEDI3622 and D1(A12) did. They also blocked the downregulation of CD62L upon neutrophil activation. MEDI3622 is a human IgG antibody and we found that a canine chimeric version of this mAb also blocked CD62L shedding by canine leukocytes. Taken together, our findings provide the first direct evidence of ADAM17 expression and sheddase activity in dogs, establishing a potential therapeutic target for various inflammatory disorders.

Evaluation of the diagnostic utility of cytologic examination of renal fine-needle aspirates from dogs and the use of ultrasonographic features to inform cytologic diagnosis

OBJECTIVE To describe cytologic characteristics of renal fine-needle aspirate (FNA) samples from dogs, evaluate proportions of cytologic specimens deemed adequate for interpretation (diagnostic yield), assess diagnostic utility of cytologic examination for neoplastic and nonneoplastic diseases, and characterize ultrasonographic features of evaluated kidneys to determine whether the imaging characteristics could be used to inform cytologic interpretations. DESIGN Retrospective, observational study. SAMPLE 102 cytologic specimens and 97 ultrasonographic studies from 100 dogs. PROCEDURES Medical records were reviewed to identify dogs that underwent ultrasound-guided renal FNA. Slides were categorized as adequate or inadequate for interpretation; adequate slides were used for retrospective cytologic diagnosis. Sensitivity, specificity, and predictive values of cytologic examination for detection of neoplastic and nonneoplastic conditions were calculated by comparison with histologic or lymphoid cell clonality assay results. Ultrasonographic characteristics of neoplastic and nonneoplastic renal lesions were described. RESULTS 74 of 102 (72%) specimens had slides adequate for interpretation; 26 were included in the diagnostic accuracy analysis. Sensitivity of cytologic examination was 78% and 50% for detection of neoplastic and nonneoplastic conditions, respectively, with specificities of 50% and 77%, respectively; sensitivity for detection of lymphoma was 100%. Ultrasonographic appearance of kidneys with confirmed neoplasia varied; masses were most commonly found in kidneys with carcinoma (5/5), lymphoma (5/7), or other neoplasia (3/4) and absent in kidneys with nonneoplastic conditions (n = 5). CONCLUSIONS AND CLINICAL RELEVANCE Renal FNA specimens were adequate for interpretation at rates comparable with those reported for other organs and were considered clinically useful for diagnosis of neoplasia. Imaging characteristics may potentially aid differentiation between neoplastic and nonneoplastic lesions; however, further investigation is needed.

Diagnostic utility of renal fine-needle aspirate cytology and ultrasound in the cat

Objectives

The primary objective of this study was to retrospectively assess the diagnostic utility of feline renal fine-needle aspiration cytology by assessing diagnostic yield, cytologic characteristics and diagnostic accuracy. The secondary objective was to characterize ultrasonographic features of sampled kidneys to determine if they influenced diagnostic yield.

Methods

Slides, images and patient data were collected from the University of Minnesota Veterinary Medical Center database. Slides were designated as diagnostic or non-diagnostic. Non-diagnostic slides were used in calculating diagnostic yield and excluded from other analysis. Slides were evaluated for cytologic characteristics and assigned a single primary diagnosis. Ultrasound still images were evaluated for descriptive characteristics and characteristics of specific lesions were described. Cases with confirmatory testing were used to determine diagnostic sensitivity, specificity and positive and negative predictive values for detecting neoplasia.

Results

Of 96 cytologic submissions available for review, diagnostic yield was 68%; 48% of samples were at least moderately cellular. Of 87 cases with ultrasound data, kidneys showing subcapsular renal infiltrate, diffuse renal enlargement without pelvic dilation and infiltrative/nodular change were more likely to yield diagnostic samples. Of 12 confirmed cases, cytology was 100% sensitive and specific for the detection of neoplasia (four round-cell tumors and two carcinomas). Three cases with non-neoplastic histologic diagnoses were considered cytologically normal, two incorrectly diagnosed the pathology present, and one correctly diagnosed the pathology. While some imaging characteristics were more commonly seen in neoplastic vs non-neoplastic lesions, the sample size was insufficient for definitive correlation.

Conclusions and relevance

This is the first major analysis of feline ultrasound-guided renal fine-needle aspiration cytology. This technique generates adequate samples for interpretation at rates comparable to other soft tissues and is most useful in the diagnosis of neoplasia. Some imaging characteristics are indicative of the likelihood of obtaining an adequate sample for cytologic interpretation.