Delayed Activation of T Cells at the Site of Infection Facilitates the Establishment of Trypanosoma cruzi in Both Naive and Immune Hosts

Although parasite entry through breaks in the skin or mucosa is one of the main routes of natural transmission of Trypanosoma cruzi, little is known about the host cell types initially invaded nor the ability of those host cells to initiate immune responses at the site of infection. To gain insights into these early events, we studied the fate of fluorescently tagged T. cruzi delivered subcutaneously in mouse footpads or ears. We demonstrate that the majority of parasites introduced into the skin initially proliferate there until 8 to 10 days postinfection, when the parasite load decreases. This decline in parasite numbers is dependent on the presence of an intact T cell compartment and on the ability of hosts to produce gamma interferon (IFN-γ). Many of the parasite-containing cells at the initial infection site display a macrophage/monocyte phenotype but with low expression of activation markers, suggesting that these cells provide an early niche for T. cruzi proliferation, rather than being active in parasite control. It is only after the first round of T. cruzi replication and release from host cells that signs of immune activation and control of parasites become apparent. The delay in the activation and failure to rapidly control parasite replication are observed even when T. cruzi-primed T cells are present, such as in chronically infected mice. This failure of a primed immune system to recognize and react prior to extensive parasite expansion at the infection site likely poses a significant challenge for the development of vaccines aiming to prevent T. cruzi infection. IMPORTANCE Trypanosoma cruzi, the parasite causing Chagas disease, usually infects through the mucosa or breaks in the skin, but little is known about the parasite's fate at the site of entry or the early events involving immune control there. Here, we track the local proliferation and subsequent dissemination of fluorescently tagged T. cruzi and the initial immune response at the point of entry. We show that T. cruzi preferentially infects innate immune cells in the skin and that the stimulation of an adaptive T cell response does not occur until after the release of parasites from this first round of infected host cells. This first immunologically "silent" proliferation occurs even in the presence of a strong immune T cell memory generated by previous infection. This capacity of T. cruzi to establish infections while avoiding initial immune recognition has important implications for the potential to develop vaccines to prevent T. cruzi infection.

Two novel pathogenic variants in MED13L: one familial and one isolated case

BACKGROUND

Genetic variants involving the MED13L gene can lead to an autosomal dominant syndrome characterised by intellectual disability/developmental delay and facial dysmorphism.

METHODS

We investigated two cases (one familial and one isolated) of intellectual disability with speech delay and dysmorphic facial features by whole-exome sequencing analyses. Further, we performed a literature review about clinical and molecular aspects of MED13L gene and syndrome.

RESULTS

Two MED13L variants have been identified [MED13L(NM_015335.5):c.4417C>T and MED13L(NM_015335.5):c.2318delC] and were classified as pathogenic according to the ACMG (American College of Medical Genetics and Genomics) guidelines. One of the variants was present in sibs.

CONCLUSIONS

The two pathogenic variants identified have not been previously reported. Importantly, this is the first report of a familial case of MED13L nonsense mutation. Although the parents of the affected children were no longer available for analysis, their apparently normal phenotypes were surmised from familial verbal descriptions corresponding to normal mental behaviour and phenotype. In this situation, the familial component of mutation transmission might be caused by gonadal mosaicism of a MED13L mutation in a gonad from either the father or the mother. The case reports and the literature review presented in this manuscript can be useful for genetic counselling.

Transcriptome of iPSC-derived neuronal cells reveals a module of co-expressed genes consistently associated with autism spectrum disorder

Evaluation of expression profile in autism spectrum disorder (ASD) patients is an important approach to understand possible similar functional consequences that may underlie disease pathophysiology regardless of its genetic heterogeneity. Induced pluripotent stem cell (iPSC)-derived neuronal models have been useful to explore this question, but larger cohorts and different ASD endophenotypes still need to be investigated. Moreover, whether changes seen in this in vitro model reflect previous findings in ASD postmortem brains and how consistent they are across the studies remain underexplored questions. We examined the transcriptome of iPSC-derived neuronal cells from a normocephalic ASD cohort composed mostly of high-functioning individuals and from non-ASD individuals. ASD patients presented expression dysregulation of a module of co-expressed genes involved in protein synthesis in neuronal progenitor cells (NPC), and a module of genes related to synapse/neurotransmission and a module related to translation in neurons. Proteomic analysis in NPC revealed potential molecular links between the modules dysregulated in NPC and in neurons. Remarkably, the comparison of our results to a series of transcriptome studies revealed that the module related to synapse has been consistently found as upregulated in iPSC-derived neurons-which has an expression profile more closely related to fetal brain-while downregulated in postmortem brain tissue, indicating a reliable association of this network to the disease and suggesting that its dysregulation might occur in different directions across development in ASD individuals. Therefore, the expression pattern of this network might be used as biomarker for ASD and should be experimentally explored as a therapeutic target.

FRI0095 SARILUMAB IMPROVED PATIENT-PERCEIVED IMPACT OF RHEUMATOID ARTHRITIS WHATEVER THE BASELINE DISEASE ACTIVITY: FIRST RESULTS FROM AN INTERVENTIONAL NON CONTROLLED STUDY: SARIPRO, IN MODERATE AND SEVERE RHEUMATOID ARTHRITIS PATIENTS

Background:

Sarilumab, an anti-IL-6R antibody, is approved for the treatment of moderate to severe RA and shown efficacy on disease activity and patient-reported outcomes (PROs). Detailed analyses of drug efficacy from the patient point of view is important. SariPRO is a pragmatic interventional study close to the daily practice.

Objectives:

To assess the effectiveness of sarilumab on several PROs using the RAID (Rheumatoid Arthritis Impact of Disease) score.

Methods:

The SariPRO study (NCT 03449758) was a French multicenter interventional study assessing the effects of sarilumab 200 mg on PROs in patients with moderately to severely active RA with an inadequate response or intolerance to conventional synthetic or biologic DMARDs. The primary endpoint was change in total RAID score from baseline to week 24 (RAID ranges 0-10 where 10 is maximal impact). Changes from baseline for RAID, DAS28-ESR and CDAI according to baseline disease activity were analyzed as secondary outcomes. Safety was assessed by monitoring adverse events (AE). All statistical analyses were descriptive, 95% CI was given when appropriate.

Results:

84 patients were included in 31 centers and 62 were evaluable and analyzed for effectiveness. They had similar characteristics to the 84 patients at baseline and were as expected for an RA population initiating a biologic: mean (SD) age: 59.9 (12.4) years, 71.0% female, disease duration 9.7 (10.3) years, rheumatoid factor positivity 82.5%, ACPA positivity 86.4%, and DAS28=4.9 (11). Total RAID score decreased significantly from 5.7 (2.0) at baseline to 3.3 (2.5) at W24; mean change was -2.4 [95% CI: -3.0; -1.8]. Furthermore, this improvement was noted both for highly and less active patients at baseline: for patients with DAS28-ESR < 5.1 (n=31), mean change was -1.56 [-2.28; -0.83] and for patients with DAS28-ESR≥5.1 (n=27), mean change was -1.98 [-2.91; -1.05]. Changes in DAS28-ESR and CDAI were significant (-2.8 [-3.2; -2.4] and -15.2 [-18.5; -11.8], respectively). AEs were consistent with the safety profile of anti-IL-6R antibodies and with results from RCTs (data not shown).

Conclusion:

In this real world study, treatment with sarilumab during 24 weeks in RA patients led to an improvement in the total RAID score irrespective of baseline levels of disease activity. This is the first time RAID score is used as the primary endpoint in a study.

References:

[1]Study was sponsored by Sanofi Genzyme

Disclosure of Interests:

Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Thierry Schaeverbeke: None declared, Christine Albert: None declared, Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, marie-Christophe Boissier: None declared, Cyrille Confavreux: None declared, Gregoire CORMIER: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Elisabeth Gervais Solau: None declared, Sophie Godot: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Slim Lassoued: None declared, Thierry Lequerre: None declared, Frederic Lioté Consultant of: CME: Nordic Pharma, Christian Marcelli: None declared, Yves Maugars: None declared, Minh Nguyen: None declared, Aleth Perdriger: None declared, Yves-Marie Pers: None declared, Edouard Pertuiset: None declared, Lucile Poiroux: None declared, Carole Rosenberg: None declared, Christian Roux: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Martin SOUBRIER: None declared, Pascale Vergne-Salle: None declared, Charles Zarnitsky: None declared, Eric Fakra Consultant of: Janssen, Lundbeck, Otsuka, Sanofi, Hubert MAROTTE Grant/research support from: Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Consultant of: AbbVie, Amgen, Bristol Myers Sqibb, Lilly France, MSD, Novartis, Nordic Pharma, Pfizer, SanofiAventis, Paid instructor for: Sanofi-Aventis, Speakers bureau: Sanofi-Aventis, Florence E Lévy-Weil Employee of: Sanofi Genzyme employee

0576 Variation in Night to Night Home Sleep Testing

Introduction

Home sleep testing (HST) is becoming common in the evaluation of Obstructive Sleep Apnea (OSA). Studies confirmed good HST AHI correlations from different nights in a single patient. The following reviewed AHI and additional measures from HST’s. (Alice Night One))

Methods

We collected data from 20 patients from two consecutive nights of HST’s. 5 F 15 M, means AGE 49 (sd 14) and BMI 36 (sd 8). Both studies had over 4 hours of good sleep and acceptable data. Measures include abs(Night 1- Night 2) of AHI (Diff.AHI), of mean EKG (Diff.EKG) mean time SaO2 less than 90% (Diff.SaO2).

Results

These results reproduced the strong correlation of AHI, Time SaO2 less than 90 %: and mean EKG between two nights, .96, .72, .87 respectively. There was a strong correlation between Diff.AHI and Diff.SaO2, .63 (p .003). There were weaker correlations between AHI and Time SaO2 less than 90% on Night 1, .67 and Night 2, .75. Linear regression: Diff.AHI on Age (p=.2), BMI (p = .9), and Diff.EKG (p=.4).

Conclusion

These results again validate the small degree of AHI variation in night to night HST. They confirm a small degree of variation in the mean EKG and Time SaO2 less than 90%. There is a high correlation between AHI and time SaO2 less than 90% as these variables are dependent and the fall in SaO2 is used to define an event, especially on the HST. The BMI did not explain variation in AHI, there is a low correlation between AHI and BMI. Age could be a factor in AHI variation; yet, this is highly speculative with an N = 20. The correlations between AHI and Time SaO2 less than 90% are likely to be due to the relative health of the subjects and small number of subjects. One night of good, greater than 4 hours HST may be sufficient. This study did not evaluate success in meeting these parameters with a single night of testing.

Support

Louis B Stokes VHA, Cleveland, OH

Probabilistic Algorithms and the Interactive Museum Tour-Guide Robot Minerva

This paper describes Minerva, an interactive tour-guide robot that was successfully deployed in a Smithsonian museum. Minerva’s software is pervasively probabilistic, relying on explicit representations of uncertainty in perception and control. During 2 weeks of operation, the robot interacted with thousands of people, both in the museum and through the Web, traversing more than 44 km at speeds of up to 163 cm/sec in the unmodified museum.

LYR3, a high-affinity LCO-binding protein of Medicago truncatula, interacts with LYK3, a key symbiotic receptor

LYR3, LYK3, and NFP are lysin motif-containing receptor-like kinases (LysM-RLKs) from Medicago truncatula, involved in perception of symbiotic lipo-chitooligosaccharide (LCO) signals. Here, we show that LYR3, a high-affinity LCO-binding protein, physically interacts with LYK3, a key player regulating symbiotic interactions. In vitro, LYR3 is phosphorylated by the active kinase domain of LYK3. Fluorescence lifetime imaging/Förster resonance energy transfer (FLIM/FRET) experiments in tobacco protoplasts show that the interaction between LYR3 and LYK3 at the plasma membrane is disrupted or inhibited by addition of LCOs. Moreover, LYR3 attenuates the cell death response, provoked by coexpression of NFP and LYK3 in tobacco leaves.

On the history of medicine in the United States, theory, health insurance, and psychiatry: an interview with Charles Rosenberg

An interview with Charles Rosenberg conducted by Rafael Mantovani in November 2013 that addressed four topics. It first focused on the way in which Rosenberg perceived trends and directions in historical research on medicine in the United States during the second half of the twentieth century. The second focus was on his experience with other important historians who wrote about public health. Thirdly, he discussed his impressions about the current debate on health policy in his country. Finally, the last part explores some themes related to psychiatry and behavior control that have appeared in a number of his articles.

Lipo-chitooligosaccharidic symbiotic signals are recognized by LysM receptor-like kinase LYR3 in the legume Medicago truncatula

While chitooligosaccharides (COs) derived from fungal chitin are potent elicitors of defense reactions, structurally related signals produced by certain bacteria and fungi, called lipo-chitooligosaccharides (LCOs), play important roles in the establishment of symbioses with plants. Understanding how plants distinguish between friend and foe through the perception of these signals is a major challenge. We report the synthesis of a range of COs and LCOs, including photoactivatable probes, to characterize a membrane protein from the legume Medicago truncatula. By coupling photoaffinity labeling experiments with proteomics and transcriptomics, we identified the likely LCO-binding protein as LYR3, a lysin motif receptor-like kinase (LysM-RLK). LYR3, expressed heterologously, exhibits high-affinity binding to LCOs but not COs. Homology modeling, based on the Arabidopsis CO-binding LysM-RLK AtCERK1, suggests that LYR3 could accommodate the LCO in a conserved binding site. The identification of LYR3 opens up ways for the molecular characterization of LCO/CO discrimination.

Complex phenotype associated with 17q21.31 microdeletion

We report on a patient carrying a 17q21.31 microdeletion and exhibiting many common syndrome features, together with other clinical signs which have rarely or never been described to date. The detected 695-kb 17q21.31 deletion is larger than in most previously reported cases but is still probably the result of recombination between flanking low-copy repeats. Due to the complexity of the patient's clinical condition, together with the presence of 3 previously unreported symptoms, namely chronic anemia, cervical vertebrae arthrosis and vertebrae fusion, this case is an important addition to the existing knowledge about the 17q21.31 microdeletion syndrome.

The independent acquisition of plant root nitrogen-fixing symbiosis in Fabids recruited the same genetic pathway for nodule organogenesis

Only species belonging to the Fabid clade, limited to four classes and ten families of Angiosperms, are able to form nitrogen-fixing root nodule symbioses (RNS) with soil bacteria. This concerns plants of the legume family (Fabaceae) and Parasponia (Cannabaceae) associated with the Gram-negative proteobacteria collectively called rhizobia and actinorhizal plants associated with the Gram-positive actinomycetes of the genus Frankia. Calcium and calmodulin-dependent protein kinase (CCaMK) is a key component of the common signaling pathway leading to both rhizobial and arbuscular mycorrhizal symbioses (AM) and plays a central role in cross-signaling between root nodule organogenesis and infection processes. Here, we show that CCaMK is also needed for successful actinorhiza formation and interaction with AM fungi in the actinorhizal tree Casuarina glauca and is also able to restore both nodulation and AM symbioses in a Medicago truncatula ccamk mutant. Besides, we expressed auto-active CgCCaMK lacking the auto-inhibitory/CaM domain in two actinorhizal species: C. glauca (Casuarinaceae), which develops an intracellular infection pathway, and Discaria trinervis (Rhamnaceae) which is characterized by an ancestral intercellular infection mechanism. In both species, we found induction of nodulation independent of Frankia similar to response to the activation of CCaMK in the rhizobia-legume symbiosis and conclude that the regulation of actinorhiza organogenesis is conserved regardless of the infection mode. It has been suggested that rhizobial and actinorhizal symbioses originated from a common ancestor with several independent evolutionary origins. Our findings are consistent with the recruitment of a similar genetic pathway governing rhizobial and Frankia nodule organogenesis.

Cell autonomous and non-cell autonomous control of rhizobial and mycorrhizal infection in Medicago truncatula

Legumes can form a nitrogen fixing symbiosis with soil bacteria called rhizobia (the RL symbiosis). They can also, like most plants, form symbiotic associations with arbuscular mycorrhizal (AM) fungi, which facilitate plants' phosphate nutrition. In both interactions, the symbionts are hosted inside the plant root. Nitrogen-fixing rhizobia are housed in intracellular symbiotic structures within nodules, while AM fungi form intracellular symbiotic structures, called arbuscules, within cortical root cells. These two endosymbioses present other similarities, including production by the microsymbionts of lipo-chitooligosaccharidic signals (Nod Factors and Myc-LCOs), and the involvement of common plant signaling elements. In Medicago truncatula, DMI3 encodes a calcium and calmodulin dependent protein kinase that is part of this common signaling pathway, while NFP encodes a LysM domain receptor-like kinase involved in Nod Factor perception. Using tissue specific promoters, we recently uncoupled the roles of NFP and DMI3 in the cortex and the epidermis of the root during the RL symbiosis. (1) Here, we provide additional data showing a cell autonomous tissular contribution of DMI3 in the AM symbiosis, and we comment on a non-cell autonomous cortical role of NFP during rhizobial infection.

Epidermal and cortical roles of NFP and DMI3 in coordinating early steps of nodulation in Medicago truncatula

Legumes have evolved the capacity to form a root nodule symbiosis with soil bacteria called rhizobia. The establishment of this symbiosis involves specific developmental events occurring both in the root epidermis (notably bacterial entry) and at a distance in the underlying root cortical cells (notably cell divisions leading to nodule organogenesis). The processes of bacterial entry and nodule organogenesis are tightly linked and both depend on rhizobial production of lipo-chitooligosaccharide molecules called Nod factors. However, how these events are coordinated remains poorly understood. Here, we have addressed the roles of two key symbiotic genes of Medicago truncatula, the lysin motif (LysM) domain-receptor like kinase gene NFP and the calcium- and calmodulin-dependent protein kinase gene DMI3, in the control of both nodule organogenesis and bacterial entry. By complementing mutant plants with corresponding genes expressed either in the epidermis or in the cortex, we have shown that epidermal DMI3, but not NFP, is sufficient for infection thread formation in root hairs. Epidermal NFP is sufficient to induce cortical cell divisions leading to nodule primordia formation, whereas DMI3 is required in both cell layers for these processes. Our results therefore suggest that a signal, produced in the epidermis under the control of NFP and DMI3, is responsible for activating DMI3 in the cortex to trigger nodule organogenesis. We integrate these data to propose a new model for epidermal/cortical crosstalk during early steps of nodulation.

[Thoracic aortic interventions]

The treatment of thoracic aortic diseases has undergone a paradigm shift due to the introduction and further development of interventional techniques in recent years. Thoracic endovascular aortic repair (TEVAR) of the descending aorta has significantly lower mortality and complication rates compared to open repair. Meanwhile this endovascular approach is the first option for the treatment of the majority of thoracic aortic diseases.

A novel microdeletion syndrome at 3q13.31 characterised by developmental delay, postnatal overgrowth, hypoplastic male genitals, and characteristic facial features

BACKGROUND

Congenital deletions affecting 3q11q23 have rarely been reported and only five cases have been molecularly characterised. Genotype-phenotype correlation has been hampered by the variable sizes and breakpoints of the deletions. In this study, 14 novel patients with deletions in 3q11q23 were investigated and compared with 13 previously reported patients.

METHODS

Clinical data were collected from 14 novel patients that had been investigated by high resolution microarray techniques. Molecular investigation and updated clinical information of one cytogenetically previously reported patient were also included.

RESULTS

The molecular investigation identified deletions in the region 3q12.3q21.3 with different boundaries and variable sizes. The smallest studied deletion was 580 kb, located in 3q13.31. Genotype-phenotype comparison in 24 patients sharing this shortest region of overlapping deletion revealed several common major characteristics including significant developmental delay, muscular hypotonia, a high arched palate, and recognisable facial features including a short philtrum and protruding lips. Abnormal genitalia were found in the majority of males, several having micropenis. Finally, a postnatal growth pattern above the mean was apparent. The 580 kb deleted region includes five RefSeq genes and two of them are strong candidate genes for the developmental delay: DRD3 and ZBTB20.

CONCLUSION

A newly recognised 3q13.31 microdeletion syndrome is delineated which is of diagnostic and prognostic value. Furthermore, two genes are suggested to be responsible for the main phenotype.

P2-14-06: Clinical and Pathologic Characteristics of Haitian Breast Cancer Patients in a Tertiary Care Safety Net Hospital

Background: There is limited literature regarding Haitian women and breast cancer. What exists is based on screening with no literature on clinical or pathologic subtypes of breast cancer. We examined patient and tumor characteristics in Haitian born women with invasive breast cancer in our ethnically diverse tertiary care hospital.

Methods: We expanded a pre-existing database to include all women diagnosed with breast cancer from 1998–2011. From the electronic medical record we documented age, body mass index (BMI), place of birth, self-identified race/ethnicity, date of diagnosis, T, N, M stage, grade, ER, PR, HER2 expression, recurrence and treatment data including neoadjuvant, surgical, adjuvant and radiation therapy and adequacy of treatment. We determined associations using contingency tables and multivariate logistic regression.

Results: 480 cases identified. Patients were racially diverse: 35% white (W), 41% black (B), 14% Hispanic and 10% other with 8% of patients self-identified as Haitian (Ha). Ha patients were younger at diagnosis, with mean age 55.1 vs. 59.4 overall p=0.04. Mean age W: 62 B: 58. Mean BMI was not significant. Ha women had an odds ratio (OR) of triple negative (Tneg) breast cancer: 3.078 (CI: 1.608−5.892, p=0.0007), B: 3.392 (CI: 2.113 - 5.441, p=&lt;0.0001), W: 0.339 (CI: 0.192−0.599, p=0.0002) when controlling for age and BMI. Ha OR of ER+: 0.459 (CI: 0.246−0.859, p=0.0149), B: 0.384 (CI: 0.257 - 0.575, p&lt;0.0001), W: 0.8771 (CI: 1.525 - 3.792 p=0.0002). Ha OR of PR+: 0.535 (CI: 0.288−0.995, p=0.0481) when controlling for age and BMI. Her2+ expression was not significantly different. OR of recurrence in Ha: 2.110 (CI: 1.068−4.171, p= 0.0317) controlling for age and BMI. When grade was added to the multiple regression model, the odds of recurrence in Ha women was no longer significant OR 1.845 (CI: 0.923−3.690, p=0.0833); however, recurrence appeared to be associated with grade OR 1.858 (CI: 1.273−2.711, p=0.0013). Higher grade was significantly associated with Ha status, controlling for categorical age and BMI (mean score differences p = 0.0086). Crude rates of each grade in Ha women were 4% grade 1, 38% grade 2, 58% grade 3 and the rates in non-Ha women were 14% grade 1, 48% grade 2, 38% grade 3. Exploring recurrence further, treatment records were reviewed and while a minority of patients did not receive adequate primary therapy, the majority of women did receive adequate therapy.

Conclusions: Ha women were younger at diagnosis, had a higher risk of triple negative, ER negative and PR negative tumors and had more grade 3 tumors when controlling for age and BMI. Rates of recurrence appeared higher in Ha women, but the association was no longer significant when controlling for grade in addition to age and BMI. Analysis is ongoing, and we expect to report data on survival and treatment adequacy when compared to other groups in our dataset.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-14-06.

P1-08-24: Clinical and Pathologic Characteristics of Diabetic Breast Cancer Patients in a Tertiary Care Safety Net Hospital

Background: Recent studies have indicated an increased risk of breast cancer in women with diabetes, and an increase in disease specific mortality in patients with diabetes and breast cancer. Clinical and pathologic features of diabetic women with breast cancer have not been described. We examine tumor characteristics in diabetic women in our ethnically diverse tertiary care hospital that may help explain the increased mortality seen in diabetic women diagnosed with breast cancer.

Methods: We expanded a pre-existing database to include all women diagnosed with breast cancer from 1998–2011. From the electronic medical record we documented age, body mass index (BMI), place of birth, self-identified race/ethnicity, date of diagnosis, T, N, M stage, grade, ER, PR, HER2 expression, presence of diabetes (DM) or thyroid disease at diagnosis, recurrence and treatment data including neoadjuvant, surgical, adjuvant and radiation therapy and adequacy of treatment. We determined associations using contingency tables and multivariate logistic regression.

Results: 480 cases were identified. Patients were racially diverse: 35% white [W], 41% black [B], 14% Hispanic and 10% other. 23% had DM, 47% were obese (body mass index [BMI] &gt;30). Age in DM vs. non-DM were 63.327 vs. 57.729 (p= &lt; 0.0001) and BMI in DM vs. non-DM were 32.749 vs. 29.433 (p&lt;0.001). When exploring odds ratios (OR) of different tumor subtypes, none were statistically significant when controlling for age and BMI. The OR calculated were as follows: Triple negative 1.00 (confidence interval [CI]: 0.6−1.666, p = 0.9996), ER+ 1.063 (CI: 0.68−1.662, p=0.7877), PR+ 1.005 (CI: 0.67−1.506, p=0.9811), HER2+ 1.011 (CI: 0.578−1.768, p= 0.8535), recurrence: 1.090 (CI: 0.634−1.873, p= 0.7558). There were no significant interactions with DM and T, N stage when controlling for age and BMI. T stage: p=0.6962, N stage: p=0.7349 and recurrence p=0.5469 on recurrence controlling for age, BMI and grade: p=0.5462. There was no significant association between grade in DM vs. no DM with rates of grade in DM as follows: grade 1: 10.81%, grade 2: 49.55%, grade 3: 39.64% and in non-DM grade 1: 13.55%, grade 2: 45.8% and grade 3: 40.65%. Mean score difference p=0.7588. Conclusions: We did not find significant differences in our DM women compared with non-DM women when evaluating tumor subtype, T stage, N stage, grade or recurrence. In our patient population these factors do not play a role in the increased cause specific mortality in DM patients with breast cancer. Other factors must play a role in this and should be explored further.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-24.

[Medical and legal aspects of teleradiology in Germany]

In teleradiology, imaging data are transferred over a distance. This service is provided for the purpose of consulting or teleradiological reading in the narrower sense. Once a justification has been proposed in the latter, the examination is performed under the responsibility of a radiologist who is not present on site. The need for teleradiology services often derives from sparsely populated areas, a shortage of doctors, or the need for cost-efficient provision of radiological examinations. The providers and recipients of teleradiology services enter into an agreement specifying conditions for data transfer. The German ionizing radiation (medical exposure) regulations demand that the teleradiologist holds radiation protection qualifications and is able to reach the examination site within 45 - 60 minutes. In Germany, teleradiology services are still limited to nights, weekends, and vacations, although the German regulations allow an expansion under certain circumstances. Efforts to fundamentally change radiology in favor of teleradiology are putting the status of a radiological medical act as well as current teaching models at risk, thereby indirectly sustaining physician shortage. Transnational teleradiology services offer the possibility of cost reduction, taking advantage of out-of-hour reading and wage fluctuation. At the same time, such services are associated with deficits in quality and availability of personnel as well as the quality of medical services. In the long-term teleradiology concepts will fundamentally change radiology. Smaller radiology units will concentrate on daily business and fast reporting. Larger units also providing academic teaching can use teleradiology networks to offer specialized readings.

Constitutional haploinsufficiency of tumor suppressor genes in mentally retarded patients with microdeletions in 17p13.1

Chromosome microdeletions or duplications are detected in 10-20% of patients with mental impairment and normal karyotypes. A few cases have been reported of mental impairment with microdeletions comprising tumor suppressor genes. By array-CGH we detected 4 mentally impaired individuals carrying de novo microdeletions sharing an overlapping segment of approximately 180 kb in 17p13.1. This segment encompasses 18 genes, including 3 involved in cancer, namely KCTD11/REN, DLG4/PSD95, and GPS2. Furthermore, in 2 of the patients, the deletions also included TP53, the most frequently inactivated gene in human cancers. The 3 tumor suppressor genes KCTD11, DLG4, and GPS2, in addition to the GABARAP gene, have a known or suspected function in neuronal development and are candidates for causing mental impairment in our patients. Among our 4 patients with deletions in 17p13.1, 3 were part of a Brazilian cohort of 300 mentally retarded individuals, suggesting that this segment may be particularly prone to rearrangements and appears to be an important cause (approximately 1%) of mental retardation. Further, the constitutive deletion of tumor suppressor genes in these patients, particularly TP53, probably confers a significantly increased lifetime risk for cancer and warrants careful oncological surveillance of these patients. Constitutional chromosome deletions containing tumor suppressor genes in patients with mental impairment or congenital abnormalities may represent an important mechanism linking abnormal phenotypes with increased risks of cancer.