Multicentric study to evaluate the effectiveness of Thermalytix as compared with standard screening modalities in subjects who show possible symptoms of suspected breast cancer

INTRODUCTION

Machine learning in computer-assisted diagnostics improves sensitivity of image analysis and reduces time and effort for interpretation. Compared to standard mammograms, a thermal scan is easily scalable and is a safer screening tool. We evaluate the performance of Thermalytix (an automated thermographic screening algorithm) compared with other standard breast cancer screening modalities.

METHODS

A prospective multicentre study was conducted to assess the non-inferiority of sensitivity of Thermalytix (test device) to that of standard modalities in detecting malignancy in subjects who show possible symptoms of suspected breast cancer. Standard screening modalities and Thermalytix were obtained and interpreted independently in a blinded fashion. A receiver operating characteristic (ROC) curve was constructed to identify the best cut-off point, non-inferiority margin of ≥10% to demonstrate the non-inferiority.

RESULTS

We recruited 258 symptomatic women who first underwent a thermal scan, followed by mammogram and/or ultrasound. At Youden's Index of ROC curve, the test device had a sensitivity of 82.5% (95% CI 73.2 to 91.9) and specificity of 80.5% (95% CI 75.0 to 86.1) as compared with diagnostic mammogram, which had sensitivity of 92% (95% CI 80.7 to 97.8) and specificity of 45.9% (95% CI 34.3 to 57.9) when BI-RADS 3 (Breast Imaging-Reporting and Data System) was considered as test-positive. The overall area under the curve (AUC) was 0.845. For women aged <45 years, the test device had a sensitivity and specificity of 87.0% (95% CI 66.4 to 97.2) and 80.6% (95% CI 72.9 to 86.9), respectively. For women aged ≥45 years, the sensitivity and specificity were 80.5% (95% CI 65.1 to 91.2) and 86.5% (95% CI 78.0 to 92.6, respectively).

CONCLUSION

We evaluated Thermalytix, a new AI-based modality for detecting breast cancer. The high AUC in both women under 45 years and above 45 years shows the potential of Thermalytix to be a supplemental diagnostic modality for all ages. Further evaluation on larger sample size is needed.

TRIAL REGISTRATION NUMBER

CTRI/2017/10/0 10 115.

Diabetes and COVID-19: Role of insulin resistance as a risk factor for COVID-19 severity

Patients with diabetes are more susceptible to coronavirus disease 2019 (COVID-19), and as a consequence, develop more severe form of disease. This is partly due to a systemic inflammatory state and pro thrombotic milieu seen in metabolic syndrome. In this review, we attempt to explore the pathogenetic links between insulin resistance and COVID-19 disease severity. Insulin resistance is an underlying condition for metabolic syndromes, including type 2 diabetes, which impairs insulin signaling pathways affecting metabolic and cardiovascular homeostasis. A high concentration of circulating insulin shifts the balance to mitogen activated protein kinase (MAPK)-dependent signaling and causes endothelial cell damage. The phosphatidylinositol 3 kinase and MAPK dependent signaling pathways maintain a balance between nitric oxide-dependent vasodilator and endothelin-1 dependent vasoconstriction actions of insulin. Vascular smooth muscle cell dysfunction is responsible for inflammation and blood coagulation leading to microvascular and macrovascular complications in diabetes. Hyperactivity in renin-angiotensin system is implicated in development of islet oxidative stress and subsequent β-cell dysfunction, as it alters the islet blood flow. These deleterious effects of insulin resistance involving altered blood pressure, vascular dysfunction, and inflammation could be associated with increased severity in COVID-19 patients. We conclude that clinical and/or biochemical markers of insulin resistance should be included as prognostic markers in assessment of acute COVID-19 disease.

Biobanking for Translational Diabetes Research in India

India is declared as the diabetic capital of the world. Clinically well-annotated blood samples will advance diabetes research for better diagnostic and treatment methods. Building a disease-specific biobank with high-quality peripheral blood mononuclear cells (PBMCs) and clinical follow-up data system will serve as a good platform for clinical research in diabetes. Processing and storage of high-quality biospecimen for translational research in diabetes demand the implementation of good clinical laboratory practices. “Certification or accreditation programs” that improve biorepository processes and frameworks are lacking in Indian context. To sustain and translate the research into clinical practice, good governance of the biobank and financial resources is required. For ethical issues related to health needs of the people and participants in the research, issues related to research process, translational research, and commercialization, data sharing should be addressed. For India to be an innovation and sustainable country Indian government is supporting translational research facilities, including biobanks. India has developed biobanks for various diseases; however, diabetes-specific research biorepository is lacking. Given the dangers of diabetic burden, India should set up a diabetes disease-specific repository learning from the global organizations and customize to the needs of Indian context. It is important to have private agencies get involved to develop biobanks and future research as there are commercial goals to translate research into practice. New technologies of specimen storing and preservation, data management, and data sharing should be adopted for developing cost-effective long-standing disease-specific population biobank in India.

Abstract P4-07-10: Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers

Background: MicroRNA mediated molecular alterations are involved in the initiation and progression of cancer. Altered expression of multiple microRNAs is associated with endocrine resistance in hormone receptor positive HER2 negative (HR+/HER2-ve) cancer. The role of miR-221 in inducing epithelial to mesenchymal transition (EMT) is well documented especially in cell line model systems. However, the detailed mechanism of specific microRNAs in intrinsic and acquired resistance to endocrine therapy needs to be worked out. In addition, more needs to be done in the documentation of these mechanisms in human breast cancer specimens with complete clinical documentation and long-term follow-up. In this study, we have evaluated the clinical significance of miR-221 and its mechanistic role in EMT using human specimens and cell line models.

Materials and Methods: Formalin fixed paraffin embedded tumor from 129 HR+/HER2-ve breast cancer patients with a median follow up of 63 months were used for estimation of miR-221 by quantitative real time PCR. Expression levels of genes which are direct targets of miR-221 and related genes in EMT were analysed from these tumors. Survival between miR-221 high and low groups was compared by Kaplan Meier survival curves and prognostic relevance was estimated by Cox proportional hazard model.

Cell line experiments to investigate the role of miR-221 in inducing EMT through integrin β6 are underway in both wild type and tamoxifen resistant MCF-7 cell lines (A gift from Prof Ben Ho Park, Johns Hopkins University School of Medicine).

Results: A significant elevated level of miR-221 was observed in small proportion (14%) of HR+/HER2-ve tumors. miR-221 expression had an inverse correlation with both ER protein and ESR1 mRNA levels within HR+/HER2-ve tumors. Tumors with high levels of miR-221 showed significantly higher expression of integrin β6 which is a robust marker of EMT. Patients with high expression of miR-221 had a poorer survival in Kaplan Meier analysis.

Results of interrogation of EMT mediated through integrin related pathways involving miR-221 in cell line models will be presented.

Discussion: The association between miR-221 and integrin β6 in HR+/HER2-ve breast cancer with endocrine resistance suggests a potential link between an epigenetic regulator and a mediator of tumor-stromal interaction. The other mediators involved in this pathway are being investigated. miR-221 could be potentially used as a marker for identification of a poor prognostic subtype within HR+/HER2-ve breast cancers.

Citation Format: Prabhu JS, Kaul R, Korlimarla A, Desai K, Gangadharan C, Rajarajan S, Nair MG, Alexander A, Kaluve R, Manjunath S, Correa M, Prasad MSN, Patil S, Srinath BS, Sridhar TS. Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers [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 P4-07-10.

A study of nuclear transcription factor-kappa B in childhood autism

BACKGROUND

Several children with autism show regression in language and social development while maintaining normal motor milestones. A clear period of normal development followed by regression and subsequent improvement with treatment, suggests a multifactorial etiology. The role of inflammation in autism is now a major area of study. Viral and bacterial infections, hypoxia, or medication could affect both foetus and infant. These stressors could upregulate transcription factors like nuclear factor kappa B (NF-κB), a master switch for many genes including some implicated in autism like tumor necrosis factor (TNF). On this hypothesis, it was proposed to determine NF-κB in children with autism.

METHODS

Peripheral blood samples of 67 children with autism and 29 control children were evaluated for NF-κB using electrophoretic mobility shift assay (EMSA). A phosphor imaging technique was used to quantify values. The fold increase over the control sample was calculated and statistical analysis was carried out using SPSS 15.

RESULTS

We have noted significant increase in NF-κB DNA binding activity in peripheral blood samples of children with autism. When the fold increase of NF-κB in cases (n = 67) was compared with that of controls (n = 29), there was a significant difference (3.14 vs. 1.40, respectively; p<0.02).

CONCLUSION

This finding has immense value in understanding many of the known biochemical changes reported in autism. As NF-κB is a response to stressors of several kinds and a master switch for many genes, autism may then arise at least in part from an NF-κB pathway gone awry.

Ras puts the brake on doxorubicin-mediated cell death in p53-expressing cells

Doxorubicin is one of the most effective molecules used in the treatment of various tumors. Contradictory reports often open windows to understand the role of p53 tumor suppressor in doxorubicin-mediated cell death. In this report, we provide evidences that doxorubicin induced more cell death in p53-negative tumor cells. Several cells, having p53 basal expression, showed increase in p53 DNA binding upon doxorubicin treatment. Doxorubicin induced cell death in p53-positive cells through expression of p53-dependent genes and activation of caspases and caspase-mediated cleavage of cellular proteins. Surprisingly, in p53-negative cells, doxorubicin-mediated cell death was more aggressive (faster and intense). Doxorubicin increased the amount of Fas ligand (FasL) by enhancing activator protein (AP) 1 DNA binding in both p53-positive and p53-negative cells, but the basal expression of Fas was higher in p53-negative cells. Anti-FasL antibody considerably protected doxorubicin-mediated cell death in both types of cells. Activation of caspases was faster in p53-negative cells upon doxorubicin treatment. In contrast, the basal expression of Ras oncoprotein was higher in p53-positive cells, which might increase the basal expression of Fas in these cells. Overexpression of Ras decreased the amount of Fas in p53-negative cells, thereby decreasing doxorubicin-mediated aggressive cell death. Overall, this study will help to understand the much studied chemotherapeutic drug, doxorubicin-mediated cell signaling cascade, that leads to cell death in p53-positive and -negative cells. High basal expression of Fas might be an important determinant in doxorubicin-mediated cell death in p53-negative cells.

Late phase activation of nuclear transcription factor kappaB by doxorubicin is mediated by interleukin-8 and induction of apoptosis via FasL

Doxorubicin is one of the most effective molecules used in the treatment of various tumors. Contradictory reports often open windows to understand the doxorubicin-mediated signaling to exert its apoptosis effect. In this report, we provide evidences that doxorubicin induced biphasic induction of nuclear factor kappaB (NF-kappaB) of immediate activation followed by decrease in the amount of RelA (p65) subunit possibly by inducing the activity of proteasome, but not proteases. Further induction of NF-kappaB was observed through interleukin 8 (IL-8), expressed by doxorubicin treatment. Increased amount of IL-8 induced apoptosis via increase in the releases of intracellular Ca(2+), activation of calcineurin, nuclear translocation of nuclear factor activated T cell (NF-AT), and NF-AT-dependent FasL expression. Anti-IL-8 or -FasL antibody, dominant negative TRAF6 (TRAF6-DN), or TRAF6 binding peptide (TRAF6-BP) inhibited doxorubicin-mediated late phase induction of NF-kappaB and diminished cell death. Thus, our study clearly demonstrated that doxorubicin-mediated cell death is obtained through expression of IL-8. IL-8-mediated calcification is required for enhancement of doxorubicin-mediated cell death. Overall, this study will help to understand the much studied chemotherapeutic drug, doxorubicin-mediated cell signaling cascade to exert its effect during chemotherapy.

Inhibition of constitutive activity of nuclear transcription factor kappaB sensitizes doxorubicin-resistant cells to apoptosis

Doxorubicin is one of the most effective agents used in the treatment of various tumors. Its use is restricted by the development of resistance to apoptosis, the mechanism of which is not fully understood. Nuclear transcription factor kappaB (NF-kappaB) has been shown both to block apoptosis and to promote cell proliferation, and hence has been considered as an important target for anticancer drug development. We found that in wild type and Dox-revertant MCF-7 cells, Doxorubicin induced NF-kappaB was transient and Dox-resistant cells showed high basal activity of NF-kappaB and expression of genes dependent on it. Moreover, in resistant cells Doxorubicin was unable to induce apoptosis as detected by assays for reactive oxygen intermediates generation, lipid peroxidation, cytotoxicity, PARP degradation and Bcl-2 expression. High basal expressions of multi-drug resistant protein and transglutaminase were found in Dox-resistant cells and inhibition of NF-kappaB decreased those amounts and also sensitized these cells by Doxorubicin. These observations collectively suggest that high NF-kappaB activity confers resistance to Doxorubicin and its inhibition potentiates apoptosis. This study indicates that NF-kappaB plays an important role in chemoresistance and establishes the fact that inhibition of NF-kappaB will be a novel approach in chemotherapy.

Decrease in RelA phosphorylation by inhibiting protein kinase A induces cell death in NF-kappaB-expressing and drug-resistant tumor cells

The RelA (p65) is a subunit of nuclear transcription factor kappa B (NF-kappaB) and actively participates in expression of NF-kappaB-dependent genes involved in inflammation and tumorigenesis. Hence, the regulation of p65 is an important strategy to regulate those responses. In this study, we provide data that the dichlorophenyl derivative of 1,2,4-thiadiazolidine (known as P(3)-25) induced cell death in NF-kappaB-expressing and doxorubicin-resistant cells. P(3)-25 inhibited NF-kappaB DNA binding activity partially, but inhibited NF-kappaB-dependent genes expression completely. It inhibited phosphorylation of Rel A (p65) by inhibiting activity of protein kinase A (PKA). The PKA inhibition was independent of adenylate cyclase activity or cAMP level. The PKA activity decreased due to inhibition of catalytic subunit of PKA. P(3)-25 inhibited almost 80% PKA activity at 100 nM concentration, having an IC(50) at 10.5 nM. P(3)-25 potentiated different chemotherapeutic agents-mediated cell death. Our results suggest that P(3)-25 inhibits PKA activity followed by decreased phosphorylation of p65 and transcriptional activity of NF-kappaB thereby decreasing antiapoptotic proteins resulting in induction of apoptosis in NF-kappaB-expressing and doxorubicin-resistant cells. The study might help to understand the mechanism of P(3)-25-mediated apoptosis and to design it as new chemotherapeutic drug for tumor therapy.

Predictors of long-term event-free survival after percutaneous balloon mitral valvuloplasty

Previous studies have shown that long-term event-free survival after percutaneous balloon mitral valvuloplasty (PBMV) could be predicted by several baseline characteristics. However, the extent of the predictive variables has not been defined accurately yet. In this study, 40 baseline demographic, clinical, echocardiographic, and hemodynamic variables of 128 consecutive patients with mitral stenosis who underwent PBMV in a single institution, were analyzed in order to predict long-term event-free survival, defined as absence of death, mitral valve replacement, or repeat PBMV. Univariate survival analysis showed that age (p = 0.03), history of commissurotomy or mitral valvuloplasty (p = 0.05), calcium grade (p = 0.008), echo score (p = 0.0001), preprocedure cardiac output (p = 0.03), preprocedure valve area (p = 0.0007), postprocedure mean left atrial pressure (p = 0.0001), postprocedure valve area (p = 0.0001), postprocedure valve gradient (p = 0.013), and postprocedural mitral regurgitation (p = 0.01) were statistically significant predictors of event-free survival. Additionally, the absolute and/or relative procedural change of the following variables were found to be statistically significant predictors of event-free survival: left atrial pressure (p = 0.01), valve area (p = 0.0001), and valve gradient (p = 0.02). Multivariate Cox proportional hazard analysis indicated that when only variables available before the procedure were considered, echo score (p = 0.002) and preprocedure valve area (p = 0.0002) were found to be independent predictors of event-free survival. When both pre- and postprocedure variables were considered, echo score (p = 0.002) and postprocedure valve area (p = 0.0001) were found to be independent predictors of event-free survival. In conclusion, mitral valve morphology reflected by echo score, and baseline and postprocedure mitral valve area were found to be the strongest independent predictors of event-free survival after PBMV.

Vitiligoid Macules As Manifestation of Secondary Syphilis

A young man developed multiple, bilatera depigmented, vitihgoid macules on .his palm and soles. along with roseolar rashes on the trunk and generalize I as a anife tation of Ymthadenopathy secondary syphilis. There was no associated melanoderma. Blood VDRL was positive 1: 128 and histopathology was suggestive. AU the manifestations disappeared following treatment with penicillin.

Papulo Necrotic Tuberculid on Glans Penis

A case of papulo-necrotic tuberculids affecting only glans penis is described. A positive Mantoux test, characteristic histology and response to anti tuberculous drugs confirmed the diagnosis.

Concentric rings simulating tinea imbricata in secondary syphilis. A case report

A female patient with secondary syphilis presented with concentric rings of papules simulating tinea imbricata. To avoid the occurrence of "ping-pong" syphilis, it is stressed that both sexual partners should be treated simultaneously.