Proteomic analysis of brain metastatic lung adenocarcinoma reveals intertumoral heterogeneity and specific alterations associated with the timing of brain metastases

BACKGROUND

Brain metastases are associated with considerable negative effects on patients' outcome in lung adenocarcinoma (LADC). Here, we investigated the proteomic landscape of primary LADCs and their corresponding brain metastases.

MATERIALS AND METHODS

Proteomic profiling was conducted on 20 surgically resected primary and brain metastatic LADC samples via label-free shotgun proteomics. After sample processing, peptides were analyzed using an Ultimate 3000 pump coupled to a QExactive HF-X mass spectrometer. Raw data were searched using PD 2.4. Further data analyses were carried out using Perseus, RStudio and GraphPad Prism. Proteomic data were correlated with clinical and histopathological parameters and the timing of brain metastases. Mass spectrometry-based proteomic data are available via ProteomeXchange with identifier PXD027259.

RESULTS

Out of the 6821 proteins identified and quantified, 1496 proteins were differentially expressed between primary LADCs and corresponding brain metastases. Pathways associated with the immune system, cell-cell/matrix interactions and migration were predominantly activated in the primary tumors, whereas pathways related to metabolism, translation or vesicle formation were overrepresented in the metastatic tumors. When comparing fast- versus slow-progressing patients, we found 454 and 298 differentially expressed proteins in the primary tumors and brain metastases, respectively. Metabolic reprogramming and ribosomal activity were prominently up-regulated in the fast-progressing patients (versus slow-progressing individuals), whereas expression of cell-cell interaction- and immune system-related pathways was reduced in these patients and in those with multiple brain metastases.

CONCLUSIONS

This is the first comprehensive proteomic analysis of paired primary tumors and brain metastases of LADC patients. Our data suggest a malfunction of cellular attachment and an increase in ribosomal activity in LADC tissue, promoting brain metastasis. The current study provides insights into the biology of LADC brain metastases and, moreover, might contribute to the development of personalized follow-up strategies in LADC.

Antibody-Mediated Rejection in a Multiple Lung Transplant Patient: A Case Report

Lung transplant is an effective way to treat many end-stage lung diseases. However, one of the main barriers of allograft organ transplant is still the immunologic rejection of transplanted tissue, which is a response of the HLA molecules. Rejection is a complex process involving both T-cell-mediated delayed-type hypersensitivity reactions and antibody-mediated hypersensitivity reactions to histocompatibility molecules on foreign grafts. We report the case of a 25-year-old female patient with cystic fibrosis who underwent 2 lung transplants because of her initial diagnosis and appearance of bronchiolitis obliterans syndrome after the first transplant. Only 13 months after the second transplant, despite the therapies applied, a new rejection occurred associated with high mean fluorescent intensity donor-specific antibody levels, which resulted later in the death of the patient. The present case draws attention to the importance of matching HLA molecules between donor and recipient in addition to immunosuppressive therapy.

Granular cell tumour of the breast: case series and review of the literature

Granular cell tumours (GCTs) are uncommon rare neoplasms that may occur in any part of the body. Approximately 5-8% of granular cell tumours occur within the breast. Although nearly always benign in behaviour, granular cell tumours of the breast can often mimic breast malignancies both clinically and on the basis of imaging techniques. This article reports five cases of benign granular cell tumours appearing in the breast, mimicking a malignant breast lesion. In addition to reporting the cases, the relevant literature was reviewed.

Congenital complete heart block associated with QT prolongation

The coexistence of congenital complete heart block and QT prolongation represents a special type of arrhythmia. The electrophysiological and clinical characteristics of this syndrome were studied in eight patients suffering from congenital AV block and QT prolongation. Data from 22 patients suffering from congenital complete heart block only, served as a control. In the study group, the appearance of a torsade de pointes type of ventricular tachycardia could regularly be observed and the tachycardial attack could usually be provoked by ventricular extrastimuli. The corrected QT time was markedly prolonged; on ventricular stimulation, at higher pacing rates the QT interval shortened, but remained significantly higher than in the control group. Syncopal attacks--with the character of polymorphic tachycardia--appeared in each patient of the study group while occurring in only three patients from the control group. Patients were given pacemaker implants (using a higher pacing rate) and long-term administration of beta-receptor blockers. The outcome was favourable; no ventricular tachycardia or syncopal attack was observed in the follow-up period.

[Coronary surgery at the Cardiovascular Surgical Clinic (1976-1990)]

In the Cardiovascular Surgical Clinic of the Semmelweis Medical University of Budapest the first coronary artery bypass grafting (CABG) procedure was performed in 1975. Since that time coronary artery surgery has become a routine everyday practice representing more than half of the total workload of adult cardiac surgery. The analysis of 1347 operations performed between 1976-1990 on patients with coronary heart disease showed the followings: the first few years--so called learning curve of CABG operations is characterised by high mortality. With passing time the number of cases performed each year increased rapidly and the surgical technique has improved too. At the same time the operative mortality figures showed decreasing tendency--it was 2.1% for the last 609 cases. All observed parameters showed some progress: in 1990 the average number of grafts per patient was 3.09, internal mammary artery usage 15 percent and the mean aortic cross clamp time per anastomosis 24.5 minutes. Complete myocardial revascularisation is the key point of coronary artery surgery. In order to achieve this target in all operated cases further technical improvement is necessary.

[Development and results of valve replacement surgery at the Városmajor Clinic 1976-1990 (retorospective clinical analysis)]

In Hungary valve replacement is still a major indication for heart surgery in adults. In the Cardiovascular Surgical Clinic of Semmelweis Medical University of Budapest from 1976 to 1990 2435 patients were operated for valve disease. Majority of the cases had single (aortic n = 856, mitral n = 912) or double (aortic + mitral n = 513) valve replacement. Over this 15 years period there have been many alterations in patients characteristics and surgical technique as well. In spite of the increasing mean age of patients the operative mortality has decreased (in the last 5 years period it was 2.7%, 5.5% and 7.9% in the three groups respectively). At the same time the number of patients requiring valve re-replacement or combined valve + coronary procedure has increased. The use of bioprosthetic valves has fallen below 10 percent from the 60--80 percent observed between 1976--1980. The analysis showes excellent surgical results in the field of valve replacement in Hungary.

Atrial standstill: an indication for rate responsive pacing

Atrial standstill (atrial paralysis) is a rare reason for permanent bradycardia. A case of atrial standstill is presented. A 35-year-old man had suffered from bradycardia since his childhood. For 2 years he had complaints (diminishment of his working capacity, and dyspnea occurred with effort) as well. On admission, a slow (38/min) junctional escape rhythm could be detected. There were no signs of atrial mechanical activity (atrial contraction) according to chest x ray, echocardiography, and the atrial pressure curve. The electrophysiological study revealed that the atria could not be electrically stimulated, and no P wave (A wave) could be recorded on right atrial electrograms. The patient received a rate responsive pacemaker. After pacemaker implantation, he became symptom-free; his working capacity improved markedly and his heart size decreased. Owing to the permanent bradycardia and the lack of atrial stimulation, the atrial standstill represents an indication for ventricular rate responsive pacing. Atrial standstill, permanent bradycardia, and the inability to stimulate the atrium are indications for ventricular rate responsive pacing.

[Successful surgical management of rupture of the papillary muscle diagnosed by ultrasound]

The rupture of the papillary muscle is an infrequent complication of myocardial infarction. Survival of the acute phase depends on the severity of the rupture and the remaining function of the left ventricle. Permanent survival may be ensured however only by surgical intervention. The authors present the case record of a patients whose disease in connection with a myocardial infarction was revealed by echocardiography and was operated on successfully. No such data were found in the Hungarian literature.

[Prevention of pyelonephritis]

The possibilities of the prophylaxis of pyelonephritis in the intrauterine life, in infancy and childhood, in internal medicine, gynaecology and urology are described. After explanation of the causes of pyelonephritis it is referred to the importance of the asymptomatic, significant bacteriuria and it is emphasized that there is no primary pyelonephritis, but every pyelonephritis is secondary.

[Hair loss following chronic hemodialysis]

Attention is drawn to the frequent occurrence of loss of hair in chronically dialysed patients. No examinations were undertaken to find the cause of this phenomenon. However it is possible that, besides insufficiently eliminated toxins, hypothyrosis is also involved.

Refractory supraventricular reentry tachycardia treated by radiofrequency atrial pacemaker

The authors report on a case of drug-resistant supraventricular tachycardia with frequent and long-lasting paroxysmal attacks. Electrophysiologic study revealed that the supraventricular tachycardia was based on a reentry circuit. The attack was regularly induced by premature delay 340-400 ms atrial stimulation and it could always be terminated by rapid atrial stimulation within 1-2 seconds. Atrioventricular 2:1 block occurred with very rapid atrial stimulation of greater than 190/min. The patient received a radiofrequency atrial pacemaker, and at the first sign of a tachyarrhythmia he switched on the instrument for 1-2 sec, and the attack was promptly terminated.

Adams-Stokes attacks associated with carotid sinus syncope. Pathogenesis and therapy of the carotid sinus syncopes

The pathophysiology and therapy of the carotid sinus syncope were studied by means of electrophysiological investigations and clinical observations in 84 patients suffering from carotid sinus syncope. The most important data and conclusions of the study are the following: 1. The most frequent cause of the carotid sinus syncope (Adams-Stokes) attack is the sinus arrest and a sinus block. 2 degrees-3 degrees av block can be observed less frequent in the course of syncope attack. 2. In a patient suffering from carotid sinus syncopes, disorders of impulse formation and impulse conduction of the heart are frequent. First of all, the association of the sick sinus syndrome and the carotid sinus syncope can be often detected. 3. It is not rare at all that the carotid sinus syncope occurs with extracranial obliterative disorders. Transitory cerebral ischaemic attack frequently develops on the stimulation of the carotid sinus area. 4. The drug -- atropine -- therapy of the carotid sinus syncope is usually insufficient. Generally, pacemaker implantation is the adequate treatment. Late results are very good after pacemaker implantation.

[Frequency of asymptomatic significant bacteriuria in bile duct and colon inflammations]

When investigating the asymptomatic significant bacteriuria in cholepathias and disease of the colon was stated that the asymptomatic significant bacteriuria is a frequent concomitant appearance of acute cholecystitis, of chronic cholangitis and ulcerous colitis. The asymptomatic significant bacteriuria does not mean pyelonephritis; but is a sign for the fact that the kidneys are in a condition endangered by pyelonephritis (potential pyelonephritis), that's why an aimed antibacterial treatment and subsequently bacteriological controls of the urine prove necessary.

[Primary pyelonephritis (the focal problem)]

On different experimental models of pyelonephritis in dogs and rabbits an experiment for the classification of the pathogenesis of this disease with the special questioning of the possible development of the so-called primary pyelonephritis was performed. A series of experiments consisted of 3 groups: 1. Injection of an E.-coli-suspension into the musculature of the urinary bladder of dogs and rabbits. 2. Injection of an E.-coli-suspension into the testicles of rabbits. 3. Injection of an E.-coli-suspension into the seminal bladders of rats. The experiments lasted 2 to 15 days and 16 to 110 days, respectively. In the second series of experiment in rats and rabbits an E.-coli-suspension was injected into the gall-bladder of rats and rabbits. Bacteriologic blood cultures and histologic investigations of the kidneys, the ureters, the wall of the urinary bladder and the adjacent lymphatic and fatty tissue as well as of the gall-bladders were performed. The results showed that the pyelonephritis developed secondarily after the infection of the other infected organs by haematogenic or interstitial dissemination of the pathogenic agents. Conclusions are drawn: 1. Every pyelonephritis, also the haematogenic, is a secondary process. 2. Therefore all must be done to find out the primary inflammatory change in the organism and to cure it. 3. Severe forms of the pyelonephritis may, on the other hand, effect as focus and evoke in inflammation of other organs on lymphogenic and haematogenic way. 4. Taking into consideration the facts mentioned perhaps the great number of pyelonephritiides having become latent might be reduced.

[Probability of electrode dislocation: the importance of threshold measurements during pacemaker implantation (author's transl)]

Myocardial stimulation thresholds were measured during 774 pacemaker implantations with endocardial electrodes. It was found that myocardial thresholds were higher when using electrodes with greater surface area and bipolar ones. Early electrode dislocations were more frequent at higher myocardial thresholds. There was no relationship between frequency of late electrode dislocations and the value of myocardial thresholds. The importance of measurement of myocardial stimulation threshold - as a guarantee of successful pacemaker therapy - is emphasized.

[Significance of atrial stimulation in the diagnosis and therapy of rhythm and latent conduction disorders of the heart]

Temporary atrial pacings were carried out at several sorts of heart blocks on diagnostic and curing purpose. The proceedings can be useful to detect the latent blocks with different etiology and to set up the indication of permanent pacemaker implantation.