Successes and challenges of latent TB screening and treatment in a high-prevalence US region

BACKGROUND: South Texas has higher TB disease incidence than much of the United States. We evaluated a multi-site South Texas interferon-gamma release assay (IGRA)-based testing and latent TB infection (LTBI) treatment program targeting high-risk populations.METHODS: Number of IGRA tests, test results, LTBI confirmation, and treatment outcomes were collected over 2.5 years. Sixteen semi-structured patient interviews and 10 site-based focus groups were conducted with providers, nurses, and administrators. Grounded theory identified themes associated with successful outcomes.RESULTS: Of 9,050 IGRA tests, 687 (8%) were positive; 340 (49%) confirmed as LTBI; 191 initiated LTBI treatment; and 130 (68% of initiators) completed treatment. Patient barriers to treatment completion included lack of knowledge, misconceptions, and treatment toxicities. Clinic staff concurred that toxicity was a barrier to treatment and requiring new processes with limited resources were implementation barriers.CONCLUSIONS: Over 9,000 patients were screened with a high prevalence of IGRA positivity, but confirming LTBI, initiating, and completing treatment were challenging. Qualitative evaluation supports low literacy patient education on LTBI and toxicities and expanded support for process implementation and provider training. These findings highlight challenges at all levels of the LTBI care cascade and provide patient, staff, and provider perspectives on implementation of these programs.

Presence of three mutations in the fumarylacetoacetate hydrolase gene in a patient with atypical symptoms of hereditary tyrosinemia type I

Hereditary tyrosinemia type 1 (HT1), the most severe disease of the tyrosine catabolic pathway, is caused by a deficiency of fumarylacetoacetate hydrolase (FAH). More than 90 disease-causing variants have been identified in the fah gene. We investigated the molecular defect in a patient who presented atypical symptoms for the disease. No immunoreactive FAH was found in the liver and RNA analysis by RT-PCR suggested the presence of splicing mutations. Indeed, the patient was revealed to be a compound heterozygote for IVS6-1 g- > t and two new variants, namely p.V259L and p.G398E. Using splicing minigene constructs transfected in HeLa cells, the c.775G > C variant (p.V259L) was shown to affect partially exon 9 splicing thereby allowing the production of some full-length double-mutant FAH transcripts. The p.G398E variant had a major impact on enzyme activity, which was worsened by the p.V259L variant. Surprisingly, the double mutant protein was expressed to similar level as the wild-type protein upon transfection in HeLa cells but was absent in the patient liver extract, suggesting a higher propensity to be degraded in the hepatocellular context.

Age Dependent Dysfunction of Mitochondrial and ROS Metabolism Induced by Mitonuclear Mismatch

Mitochondrial and nuclear genomes have to coevolve to ensure the proper functioning of the different mitochondrial complexes that are assembled from peptides encoded by both genomes. Mismatch between these genomes is believed to be strongly selected against due to the consequent impairments of mitochondrial functions and induction of oxidative stress. Here, we used a Drosophila model harboring an incompatibility between a mitochondrial tRNA^tyr and its nuclear-encoded mitochondrial tyrosine synthetase to assess the cellular mechanisms affected by this incompatibility and to test the relative contribution of mitonuclear interactions and aging on the expression of impaired phenotypes. Our results show that the mitochondrial tRNA mutation caused a decrease in mitochondrial oxygen consumption in the incompatible nuclear background but no effect with the compatible nuclear background. Mitochondrial DNA copy number increased in the incompatible genotype but that increase failed to rescue mitochondrial functions. The flies harboring mismatch between nuclear and mitochondrial genomes had almost three times the relative mtDNA copy number and fifty percent higher rate of hydrogen peroxide production compared to other genome combinations at 25 days of age. We also found that aging exacerbated the mitochondrial dysfunctions. Our results reveal the tight interactions linking mitonuclear mismatch to mitochondrial dysfunction, mitochondrial DNA regulation, ROS production and aging.

Identification of proteins interacting with the mitochondrial small heat shock protein Hsp22 of Drosophila melanogaster: Implication in mitochondrial homeostasis

The small heat shock protein (sHsp) Hsp22 from Drosophila melanogaster (DmHsp22) is part of the family of sHsps in this diptera. This sHsp is characterized by its presence in the mitochondrial matrix as well as by its preferential expression during ageing. Although DmHsp22 has been demonstrated to be an efficient in vitro chaperone, its function within mitochondria in vivo remains largely unknown. Thus, determining its protein-interaction network (interactome) in the mitochondrial matrix would help to shed light on its function(s). In the present study we combined immunoaffinity conjugation (IAC) with mass spectroscopy analysis of mitochondria from HeLa cells transfected with DmHsp22 in non-heat shock condition and after heat shock (HS). 60 common DmHsp22-binding mitochondrial partners were detected in two independent IACs. Immunoblotting was used to validate interaction between DmHsp22 and two members of the mitochondrial chaperone machinery; Hsp60 and Hsp70. Among the partners of DmHsp22, several ATP synthase subunits were found. Moreover, we showed that expression of DmHsp22 in transiently transfected HeLa cells increased maximal mitochondrial oxygen consumption capacity and ATP contents, providing a mechanistic link between DmHsp22 and mitochondrial functions.

Oligomerization and chaperone-like activity of Drosophila melanogaster small heat shock protein DmHsp27 and three arginine mutants in the alpha-crystallin domain

The small Hsp DmHsp27 from Drosophila melanogaster is one of the few small heat shock proteins (sHsps) found within the nucleus. We report that its dimerization is independent of disulfide bond formation and seems to rely on salt bridges. Unlike metazoan sHsps, DmHsp27 forms two populations of oligomers not in equilibrium. Mutations at highly conserved arginine residues in mammalian sHsps have been reported to be associated with protein conformational defects and intracellular aggregation. Independent mutation of three highly conserved arginines (R122, R131, and R135) to glycine in DmHsp27 results in only one population of higher molecular weight form. In vitro, the chaperone-like activity of wild-type DmHsp27 was comparable with that of its two isolated populations and to the single population of the R122G, R131G, and R135G using luciferase as substrate. However, using insulin, the chaperone-like activity of wild-type DmHsp27 was lower than that of R122G and R131G mutants. Altogether, the results characterize wild-type DmHsp27 and its alpha-crystallin domain (ACD) arginine mutants and may give insight into protection mechanism of sHsps.

Effect of N-terminal region of nuclear Drosophila melanogaster small heat shock protein DmHsp27 on function and quaternary structure

The importance of the N-terminal region (NTR) in the oligomerization and chaperone-like activity of the Drosophila melanogaster small nuclear heat shock protein DmHsp27 was investigated by mutagenesis using size exclusion chromatography and native gel electrophoresis. Mutation of two sites of phosphorylation in the N-terminal region, S58 and S75, did not affect the oligomerization equilibrium or the intracellular localization of DmHsp27 when transfected into mammalian cells. Deletion or mutation of specific residues within the NTR region delineated a motif (FGFG) important for the oligomeric structure and chaperone-like activity of this sHsp. While deletion of the full N-terminal region, resulted in total loss of chaperone-like activity, removal of the (FGFG) at position 29 to 32 or single mutation of F29A/Y, G30R and G32R enhanced oligomerization and chaperoning capacity under non-heat shock conditions in the insulin assay suggesting the importance of this site for chaperone activity. Unlike mammalian sHsps DmHsp27 heat activation leads to enhanced association of oligomers to form large structures of approximately 1100 kDa. A new mechanism of thermal activation for DmHsp27 is presented.

In Vitro Structural and Functional Characterization of the Small Heat Shock Proteins (sHSP) of the Cyanophage S-ShM2 and Its Host, Synechococcus sp. WH7803

We previously reported the in silico characterization of Synechococcus sp. phage 18 kDa small heat shock protein (HspSP-ShM2). This small heat shock protein (sHSP) contains a highly conserved core alpha crystalline domain of 92 amino acids and relatively short N- and C-terminal arms, the later containing the classical C-terminal anchoring module motif (L-X-I/L/V). Here we establish the oligomeric profile of HspSP-ShM2 and its structural dynamics under in vitro experimental conditions using size exclusion chromatography (SEC/FPLC), gradient native gels electrophoresis and dynamic light scattering (DLS). Under native conditions, HspSP-ShM2 displays the ability to form large oligomers and shows a polydisperse profile. At higher temperatures, it shows extensive structural dynamics and undergoes conformational changes through an increased of subunit rearrangement and formation of sub-oligomeric species. We also demonstrate its capacity to prevent the aggregation of citrate synthase, malate dehydrogenase and luciferase under heat shock conditions through the formation of stable and soluble hetero-oligomeric complexes (sHSP:substrate). In contrast, the host cyanobacteria Synechococcus sp. WH7803 15 kDa sHSP (HspS-WH7803) aggregates when in the same conditions as HspSP-ShM2. However, its solubility can be maintained in the presence of non-ionic detergent Triton^™X-100 and forms an oligomeric structure estimated to be between dimer and tetramer but exhibits no apparent inducible structural dynamics neither chaperon-like activity in all the assays and molar ratios tested. SEC/FPLC and thermal aggregation prevention assays results indicate no formation of hetero-oligomeric complex or functional interactions between both sHSPs. Taken together these in vitro results portray the phage HspSP-ShM2 as a classical sHSP and suggest that it may be functional at the in vivo level while behaving differently than its host amphitropic sHSP.

Identification of circulating microRNAs during the liver neoplastic process in a murine model of hereditary tyrosinemia type 1

Hereditary tyrosinemia type 1 (HT1) is a severe inborn error of metabolism, impacting the tyrosine catabolic pathway with a high incidence of hepatocellular carcinoma (HCC). Using a HT1 murine model, we investigated the changes in profiles of circulating and hepatic miRNAs. The aim was to determine if plasma miRNAs could be used as non-invasive markers of liver damage in HT1 progression. Plasma and liver miRNAome was determined by deep sequencing after HT1 phenotype was induced. Sequencing analysis revealed deregulation of several miRNAs including let-7/miR-98 family, miR-21 and miR-148a, during manifestation of liver pathology. Three miRNAs (miR-98, miR-200b, miR-409) presenting the highest plasmatic variations among miRNAs found in both plasma and liver and with >1000 reads in at least one plasma sample, were further validated by RT-qPCR. Two of these miRNAs have protein targets involved in HT1 and significant changes in their circulating levels are detectable prior an increase in protein expression of alpha-fetoprotein, the current biomarker for HCC diagnosis. Future assessment of these miRNAs in HT1 patients and their association with liver neoplastic lesions might designate these molecules as potential biomarkers for monitoring HT1 damage progression, improving diagnosis for early HCC detection and the design of novel therapeutic targets.

Changes in Drosophila mitochondrial proteins following chaperone-mediated lifespan extension confirm a role of Hsp22 in mitochondrial UPR and reveal a mitochondrial localization for cathepsin D

Hsp22 is a small mitochondrial heat shock protein (sHSP) preferentially up-regulated during aging in Drosophila melanogaster. Its developmental expression is strictly regulated and it is rapidly induced in conditions of stress. Hsp22 is one of the few sHSP to be localized inside mitochondria, and is the first sHSP to be involved in the mitochondrial unfolding protein response (UPR(MT)) together with Hsp60, mitochondrial Hsp70 and TRAP1. The UPR(MT) is a pro-longevity mechanism, and interestingly Hsp22 over-expression by-itself increases lifespan and resistance to stress. To unveil the effect of Hsp22 on the mitochondrial proteome, comparative IEF/SDS polyacrylamide 2D gels were done on mitochondria from Hsp22+ flies and controls. Among the proteins influenced by Hsp22 expression were proteins from the electron transport chain (ETC), the TCA cycle and mitochondrial Hsp70. Hsp22 co-migrates with ETC components and its over-expression is associated with an increase in mitochondrial protease activity. Interestingly, the only protease that showed significant changes upon Hsp22 over-expression in the comparative IEF/SDS-PAGE analysis was cathepsin D, which is localized in mitochondria in addition to lysosome in D. melanogaster as evidenced by cellular fractionation. Together the results are consistent with a role of Hsp22 in the UPR(MT) and in mitochondrial proteostasis.

Molecular changes associated with chronic liver damage and neoplastic lesions in a murine model of hereditary tyrosinemia type 1

Hereditary tyrosinemia type 1 (HT1) is the most severe inherited metabolic disease of the tyrosine catabolic pathway, with a progressive hepatic and renal injury and a fatal outcome if untreated. Toxic metabolites accumulating in HT1 have been shown to elicit endoplasmic reticulum (ER) stress response, and to induce chromosomal instability, cell cycle arrest and apoptosis perturbation. Although many studies have concentrated on elucidating these events, the molecular pathways responsible for development of hepatocellular carcinoma (HCC) still remain unclear. In this study the fah knockout murine model (fah(-/-)) was used to investigate the cellular signaling implicated in the pathogenesis of HT1. Fah(-/-) mice were subjected to drug therapy discontinuation (Nitisinone withdrawal), and livers were analyzed at different stages of the disease. Monitoring of mice revealed an increasing degeneration of the overall physiological conditions following drug withdrawal. Histological analysis unveiled diffuse hepatocellular damage, steatosis, oval-like cells proliferation and development of liver cell adenomas. Immunoblotting results revealed a progressive and chronic activation of stress pathways related to cell survival and proliferation, including several stress regulators such as Nrf2, eIF2α, CHOP, HO-1, and some members of the MAPK signaling cascade. Impairment of stress defensive mechanisms was also shown by microarray analysis in fah(-/-) mice following prolonged therapy interruption. These results suggest that a sustained activation of stress pathways in the chronic HT1 progression might play a central role in exacerbating liver degeneration.

Drosophila melanogaster Hsp22: a mitochondrial small heat shock protein influencing the aging process

Mitochondria are involved in many key cellular processes and therefore need to rely on good protein quality control (PQC). Three types of mechanisms are in place to insure mitochondrial protein integrity: reactive oxygen species scavenging by anti-oxidant enzymes, protein folding/degradation by molecular chaperones and proteases and clearance of defective mitochondria by mitophagy. Drosophila melanogaster Hsp22 is part of the molecular chaperone axis of the PQC and is characterized by its intra-mitochondrial localization and preferential expression during aging. As a stress biomarker, the level of its expression during aging has been shown to partially predict the remaining lifespan of flies. Since over-expression of this small heat shock protein increases lifespan and resistance to stress, Hsp22 most likely has a positive effect on mitochondrial integrity. Accordingly, Hsp22 has recently been implicated in the mitochondrial unfolding protein response of flies. This review will summarize the key findings on D. melanogaster Hsp22 and emphasis on its links with the aging process.

Small heat shock proteins: big folding machines

The workshop was entitled "The Small HSP World" and had the mission to bring together investigators studying small heat shock proteins (sHSPs). It was held at Le Bonne Entente in Quebec City (Quebec, Canada) from October 2 to October 5 2014. Forty-four scientists from 14 different countries attended this workshop of the Cell Stress Society International (CSSI). The small number of participants stimulated interesting discussions, and the resulting informal atmosphere was appreciated by everybody. This article provides highlights from talks and discussions of the workshop, giving an overview of the latest work on sHSPs.

Small heat shock protein expression and functions during development

The expression of small heat shock proteins is tightly regulated during development in multiple organisms. As housekeeping proteins, small heat shock proteins help protect cells from apoptosis, stabilize the cytoskeleton and contribute to proteostasis. Consistently, depletion of one small heat shock protein is usually not detrimental due to a certain level of redundancy between the functions of each small heat shock protein. However, while their stress-induced expression is regulated by heat shock factors, their constitutive expression is under the control of other specific transcription factors, suggesting the existence of very specialized functions. This review focuses on the expression patterns and functions of small heat shock proteins in various organisms during development. This article is part of a Directed Issue entitled: Small HSPs in physiology and pathology.

Identification of human fumarylacetoacetate hydrolase domain-containing protein 1 (FAHD1) as a novel mitochondrial acylpyruvase

The human fumarylacetoacetate hydrolase (FAH) domain-containing protein 1 (FAHD1) is part of the FAH protein superfamily, but its enzymatic function is unknown. In the quest for a putative enzymatic function of FAHD1, we found that FAHD1 exhibits acylpyruvase activity, demonstrated by the hydrolysis of acetylpyruvate and fumarylpyruvate in vitro, whereas several structurally related compounds were not hydrolyzed as efficiently. Conserved amino acids Asp-102 and Arg-106 of FAHD1 were found important for its catalytic activity, and Mg(2+) was required for maximal enzyme activity. FAHD1 was found expressed in all tested murine tissues, with highest expression in liver and kidney. FAHD1 was also found in several human cell lines, where it localized to mitochondria. In summary, the current work identified mammalian FAHD1 as a novel mitochondrial enzyme with acylpyruvate hydrolase activity.

Protection from aging by small chaperones: A trade-off with cancer?

Aging is a complex process accompanied by a decreased capacity of cells to cope with random molecular damages. Damaged proteins can form aggregates and have cytotoxic properties, a feature of many age-associated diseases. Small Hsps are chaperones involved in the refolding and/or disposal of protein aggregates. In Drosophila melanogaster, the mitochondrial DmHsp22 is preferentially upregulated during aging. Its over-expression results in an extension of lifespan (>30%) and an increased resistance to stress. Although DmHsp22 has a chaperone-like activity in vitro, additional mechanisms by which it may extend lifespan in vivo are unknown. Genome-wide transcriptional analysis and comparative mitochondrial proteomic analysis by MALDI-TOF were performed to unveil differences in long-lived DmHsp22 over-expressing flies. Flies over-expressing DmHsp22 display an upregulation of genes normally downregulated with age and involved in energy production and protein biosynthesis. Interestingly, DmHsp22 over-expression extended lifespan of normal fibroblasts by slowing the aging process. However, its expression also increased the malignant properties of human transformed cells. The delicate balance between beneficial and noxious effects of this small chaperone are discussed.

Thermal sensitivity of mitochondrial metabolism in two distinct mitotypes of Drosophila simulans: evaluation of mitochondrial plasticity

The overall aim of this study was to (1) evaluate the adaptive value of mitochondrial DNA by comparing mitochondrial performance in populations possessing different haplotypes and distribution, and to (2) evaluate the sensitivity of different enzymes of the electron transport system (ETS) during temperature-induced changes. We measured the impact of temperature of mitochondrial respiration and several key enzymes of mitochondrial metabolism in two mitotypes (siII and siIII) of Drosophila simulans. The temperature dependencies of oxygen consumption for mitochondria isolated from flight muscle was assessed with complex I substrates (pyruvate + malate + proline) and with sn glycerol-3-phosphate (to reduce complex III via glycerophosphate dehydrogenase) in both coupled and uncoupled states. Activities of citrate synthase, cytochrome c oxidase (COX), catalase and aconitase, and the excess capacity of COX at high convergent pathway flux were also measured as a function of temperature. Overall, our results showed that functional differences between the two mitotypes are few. Results suggest that differences between the two mitotypes could hardly explain the temperature-specific differences measured in mitochondria performances. It suggests that some other factor(s) may be driving the maintenance of mitotypes. We also show that the different enzymes of the ETS have different thermal sensitivities. The catalytic capacities of these enzymes vary with temperature changes, and the corresponding involvement of the different steps on mitochondrial regulation probably varies with temperature. For example, the excess COX capacity is low, even non-existent, at high and intermediate temperatures (18°C, 24°C and 28°C) whereas it is quite high at a lower temperature (12°C), suggesting release of respiration control by COX at low temperature.

Expression of Inflammatory Molecules Among Breast Cancer Patients Receiving Different Chemotherapies:Implications for Chemobrain

Increased levels of MCP-1, IL-8 and IL-6 are associated with mild cognitive impairment, defined as frequent and irregular bouts of forgetfulness, difficulties with attention and/or difficulties with language-a condition with comparable symptomology reported by cancer patients experiencing chemobrain. High levels of these molecules may compromise neuronal and synaptic integrity, leading to cognitive impairment. Patients receiving doxorubicin-based (with cyclophosphamide, or cyclophosphamide and fluorouracil; AC/CAF) chemotherapy or a combination of cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy report experiencing chemobrain, but MCP-1, IL-8 and IL-6 may be differentially influenced by these regimens. The purpose of this study was to examine changes in expression of these molecules among breast cancer patients (N = 54) receiving combinations of AC/CAF or CMF. Changes in MCP-1, IL-8 and IL-6 were assessed at baseline (T1) and after 2 chemotherapy cycles (T2). T-tests were used to compare between group and within group differences on raw means and mean change (T2-T1). IL-6 significantly increased in the AC/CAF group (4.95 pg/mL,SEM = 2.31;P < 0.05), but MCP-1 (42.8 pg/mL;SEM = 40.36) and IL-8 (0.25 pg/mL;SEM = 1.19) did not. IL-6 (−1.46 pg/mL,SEM = 0.94), MCP-1 (−15.8 pg/mL,SEM = 49.95) and IL-8 (−0.79 pg/mL,SEM = 1.04) all decreased in the CMF group; however, none of these changes were significant. No significant differences in IL-6 (1.06 pg/mL, SEM = 1.05), MCP-1(73.48 pg/mL, SEM = 67.30), or IL-8 (−1.95 pg/mL, SEM = 3.28) at T1 were observed between AC/CAF and CMF groups. At T2, there was a significant difference in IL-6 (7.72 pg/mL,SEM = 3.82; P ≤ 0.05) between AC/CAF and CMF groups, but not in MCP-1 (131.91 pg/mL,SEM = 87.09) or IL-8 (5.72 pg/mL,SEM = 4.0). A significant change (T2-T1) in IL-6 (6.41 pg/mL,SEM = 2.57;P < 0.05) between AC/CAF and CMF groups was observed. Changes in MCP-1 (58.65 pg/mL,SEM = 63.94) and IL-8 (1.08 pg/mL,SEM = 1.58) between groups were not significant. These results suggest AC/CAF and CMF chemotherapy regimens elicit distinct inflammatory response patterns in MCP-1, IL-8 and IL-6 suggesting different mechanisms may be responsible for the development of chemobrain. Future research is needed to confirm these findings. Funding:NCI R25CA10618.

Age-dependent posttranslational modifications of voltage-dependent anion channel 1

The accumulation of oxidative damage in mitochondrial proteins, membranes and DNA during ageing is supposed to lead to mitochondrial inactivation, downstream molecular impairments and subsequent decline of biological systems. In a quantitative study investigating the age-related changes of mitochondrial proteins on the level of oxidative posttranslational modifications, we previously found a set of conserved biomarkers across ageing models in five species with consistent oxidative break-up of tryptophan residues and formation of N-formyl kynurenine. In an additional proteomic profiling of a long-living Drosophila mutant overexpressing mitochondrial Hsp22 and controls, we found age-related redundant isoforms of voltage-dependent anion channel 1 (VDAC-1). A re-examination of data from human umbilical vein endothelial cells (with normal and chemically accelerated in vitro ageing), revealed similar age-dependent alterations of voltage-dependent anion channel isoforms. Building on these results, we examined the expression of VDAC-1 in an in vitro model of excitotoxicity. We show that glutamate-induced calcium toxicity in neurons induces changes of voltage-dependent anion channel 1 related to downstream events of mitochondrial apoptosis like poly-ADP-ribosylation.

Proproliferative functions of Drosophila small mitochondrial heat shock protein 22 in human cells

Aging is a complex process accompanied by a decreased capacity of cells to cope with random damages induced by reactive oxygen species, the natural by-products of energy metabolism, leading to protein aggregation in various components of the cell. Chaperones are important players in the aging process as they prevent protein misfolding and aggregation. Small chaperones, such as small heat shock proteins, are involved in the refolding and/or disposal of protein aggregates, a feature of many age-associated diseases. In Drosophila melanogaster, mitochondrial Hsp22 (DmHsp22), is localized in the mitochondrial matrix and is preferentially up-regulated during aging. Its overexpression results in an extension of life span (>30%) (Morrow, G., Samson, M., Michaud, S., and Tanguay, R. M. (2004) FASEB J. 18, 598-599 and Morrow, G., Battistini, S., Zhang, P., and Tanguay, R. M. (2004) J. Biol. Chem. 279, 43382-43385). Long lived flies expressing Hsp22 also have an increased resistance to oxidative stress and maintain locomotor activity longer. In the present study, the cross-species effects of Hsp22 expression were tested. DmHsp22 was found to be functionally active in human cells. It extended the life span of normal fibroblasts, slowing the aging process as evidenced by a lower level of the senescence associated beta-galactosidase. DmHsp22 expression in human cancer cells increased their malignant properties including anchorage-independent growth, tumor formation in nude mice, and resistance to a variety of anticancer drugs. We report that the DmHsp22 interacts and inactivates wild type tumor suppressor protein p53, which may be one possible way of its functioning in human cells.

Neuroprotective effect of SSRI among 781 cancer patients receiving chemotherapy: A URCC CCOP Study

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Background: Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients effective psychosocial functioning and quality of life. Previous studies reported that 17% to 75% of cancer patients reported cognitive dysfunction during and after treatment. Few studies, however, have examined the effectiveness of pharmacological interventions to control cancer-related cognitive dysfunction (CRCD). The present study examines the effect of paroxetine hydrochloride (Paxil, P) on CRCD. Methods: The sample included 574 female and 207 male cancer patients between 22 and 87 years. Memory Problems was assessed using a Self-Reported Memory Problem (SRMP) measures derived from the Fatigue Symptom Checklist that relate to memory dysfunction. Cronbach coefficient alpha (α) and a principal components analysis (PCA) were conducted to determine reliability and appropriateness of the SRMP for this sample. A repeated measure ANOVA (r-ANOVA) and t-tests were used to assess changes in mean scores on the SRMP and the effect of P versus placebo. Depression was assessed using the CESD. Results: Scale reliability assessment showed α = .90, supporting the reliability of the SRMP. The PCA revealed a one-component structure that explained 72% of the variance. The r-ANOVA showed a significant difference between scores on the SRMP at baseline (after first chemotherapy cycle, and before P) and follow-up (after four cycles of chemotherapy, after P) (Wilks' Lambda = .99, F (1, 583) = 5.52, p = 0.02). The t-tests also showed a significant effect of P on CRMP (p < 0.05). P had a significant effect after controlling for depression (p < 0.001) Conclusions: CRCD is a serious problem for patients that can be alleviated by P. Future studies should examine the usefulness of other psychotropic agents and combined behavioral and pharmacologic interventions to control CRCD. Supported by NCI Grants U10CA37420, R25CA102618, and 3U01CA116924–04S1.

No significant financial relationships to disclose.

Cancer-related self-efficacy in African American prostate cancer patients compared to whites

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Background: African American (AA) men are nearly twice as likely as white (W) men to be diagnosed with prostate cancer. Cancer-related self-efficacy (i.e., confidence in one's ability to manage cancer) has been associated with better physical and psychosocial functioning, but little is known about self-efficacy in African American prostate cancer patients. This study compared AA and W ratings of cancer-related self-efficacy for 308 prostate cancer patients (M age = 66.13, SD = 8.48; 9% AA) who participated in a group therapy intervention. Method: Independent groups t-tests were used to determine whether there were significant differences at baseline in mean scores for each group on the Stanford Self-Efficacy Scale (SSE), which asks respondents to rate their confidence in the ability to cope with cancer on a 0–100 scale, with 0 indicating no confidence. SSE subscales measure self-efficacy in the ability to: a) communicate with family, friends, and healtcare providers; b) focus and relax; and c) cope with the possibility of dying. Results: A significant difference was observed on SSE total scores (AA mean = 60.39 vs. W mean = 72.70; t = 3.30; p = 0.003). There were also significant differences on the Focus/Relax (AA mean = 68.90 vs. W mean = 77.64; t = 2.04; p = 0.011) and Cope with Dying (AA mean = 49.72 vs. W mean = 70.12; t = 4.85; p = 0.001) subscales, with a trend towards significance on the Ability to Communicate (AA mean = 62.55 vs. W mean = 70.76; t = 3.36; p = 0.095). Conclusions: Results suggest that, compared to W men, AA men have less confidence in their ability to cope with prostate cancer following diagnosis. AA men report the least confidence in their ability to cope with the possibility of death as a result of cancer, and they also report less confidence in their ability to focus and relax. They may also have greater difficulty discussing their cancer with family, friends, and healthcare personnel. As cancer-related self-efficacy has been linked to symptom-related and psychological adjustment, interventions targeting self-efficacy in AA prostate cancer patients are needed that are tailored to their unique needs.

No significant financial relationships to disclose.

A phase III randomized prospective trial of the effect of psychotherapy on distress in 287 prostate cancer patients: A URCC CCOP Study

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Background: Cancer patients suffer from significant psychological distress, including mood and anxiety disorders. Psychiatric disorders are common in cancer and affect 22 to 43% of cancer patients. We previously showed that Supportive Expressive Group Therapy (SET) was effective in reducing distress in women with metastatic breast cancer. The current study expands our earlier research and examines the effect of SET on mood disturbance in prostate cancer patients. Methods: A sample of 318 cancer patients diagnosed with prostate cancer was assessed for mood disturbances by 9 geographically distinct URCC CCOP affiliates. The patients were randomly assigned to receive either 12 weeks of SET or education materials as a control. Patient-reported mood disturbance was assessed using the Profile of Mood States (POMS), a psychometrically valid and reliable measure of mood states, at baseline, 3, 6, 12, 18 and 24 months. Differences between treatment and control groups at follow-up were tested using a mixed-ANOVA model. The dependent variable was individual slopes on the POMS. Results: 287 patients (142 SET and 145 controls) provided complete data. No significant overall effect of intervention on mood was found (p=0.49) and the interaction between baseline mood scores and treatment arm was non-significant (p=0.075). There was a significant main effect for baseline mood (p<0.0001) suggesting that those who have the greatest mood disruption at baseline improve with time independently of treatment arm. Conclusions: This is the first large randomized clinical trial using group psychotherapy among men with prostate cancer. Results suggest that a brief SET intervention does not improve distress among men with prostate cancer. Future studies might consider recruiting patients with particular psychosymptomatology and tailoring interventions. Supported by U10 CA37420 and NCI 1R25CA102618.

No significant financial relationships to disclose.

Cytokine-mediated changes associated with improvements in cancer-related fatigue induced by exercise: Results from a randomized pilot study of cancer patients receiving radiotherapy

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Background: Radiation therapy (RTH) results in dysregulated inflammatory profiles which increase cancer-related fatigue (CRF). Research suggests physical exercise can have a positive influence on CRF during RTH. Exercise may mediate improvements in CRF through a self-regulating inflammatory exercise response involving cytokines and myokines (muscle contraction-induced cytokines known as exercise factors that mediate exercise benefits in other tissues) which help the body adapt to inflammation. We explored the influence of a home-based exercise intervention (HBEX), including resistance and aerobic training, on mediators of inflammation, as well as the association between changes in these mediators and CRF. Methods: Breast and prostate cancer patients (N=38; mean age=57; 71% breast/female), beginning at least 28 sessions of RTH, were randomized to a 4wk HBEX (7 days/wk) or standard care (SC; RTH with no exercise). Cytokines (IL-8, TNFα, TNFαr1, IL-8, IL-1β and IFNγ) and the myokine IL-6 were measured by enzyme-linked immunoassays and CRF was assessed via valid self-report questionnaires pre- and post-intervention. Results: ANCOVAs, controlling for baseline, revealed significant differences between groups in mean levels of IFNγ and IL-6 (p=<0.05) and a trend toward differences in IL-8 and TNFαr1 (p<0.10) with significant baseline interactions for IFNγ, IL-6 and IL-8 (p<0.05) post-intervention. ANCOVAs revealed no significant differences between groups in mean levels of TNFα and IL-1β. Pearson correlations revealed a significant inverse association between changes in IL-8 (p<0.05;r=-0.64) and CRF and a trend toward an inverse association between changes in IL-6 (p=0.10;r=-0.44) and CRF in the HBEX condition but not in the SC condition. Conclusions: These data suggest that exercise-induced changes in IL-8 and IL-6 may mediate improvements in CRF. Future phase III randomized controlled trials are needed with larger samples to fully investigate these relationships. Funded by NCI grant 1R25CA102618.

No significant financial relationships to disclose.

Development of microsatellite markers for the short-beaked echidna using three different approaches

We used three different methods, size-selected genomic library, cross-species amplification of a mammal-wide set of conserved microsatellites and genomic sequencing, to develop a panel of 43 microsatellite loci for the short-beaked echidna (Tachyglossus aculeatus). These loci were screened against 13 individuals from three different regions (Tasmania, Kangaroo Island, Perth region), spanning the breadth of the range of the short-beaked echidna. Nine of the 43 tested loci amplified reliably, generated clear peaks on the electropherogram and were polymorphic, with the number of alleles per locus ranging from two to eight (mean = 3.78) in the individuals tested. Polymorphic information content ranged from 0.16 to 0.78, and expected heterozygosity ranged from 0.19 to 0.84. One of the nine microsatellites showed a heterozygote deficit, suggesting a high probability of null alleles. The genomic sequencing approach using data derived from the Roche FLX platform is likely to provide the most promising method to develop echidna microsatellites. The microsatellite markers developed here will be useful tools to study population genetic structure, gene flow, kinship and parentage in Tachyglossus sp. and potentially also in endangered Zaglossus species.

Mitochondria and ageing in Drosophila

Studies in different organisms have revealed that ageing is a complex process involving a tight regulation of gene expression. Among other features, ageing organisms generally display an increased oxidative stress and a decreased mitochondrial function. The increase in oxidative stress can be attributable to reactive oxygen species, which are mainly produced by mitochondria as a by-product of energy metabolism. Consistent with these data, mitochondria have been suggested to play a significant role in lifespan determination. The fruitfly Drosophila melanogaster is a well-suited organism to study ageing as it is relatively short-lived, mainly composed of post-mitotic cells, has sequenced nuclear and mitochondrial genomes, and multiple genetic tools are available. It has been used in genome-wide studies to unveil the molecular signature of ageing, in different feeding and dietary restriction protocols and in overexpression and down-regulation studies to examine the effect of specific compounds or genes/proteins on lifespan. Here we review the various features linking mitochondria and ageing in Drosophila melanogaster.

Communication about physical activity in an underserved patient population

17012

Background: Promoting physical activity may help reduce the incidence of several cancers. The 5A model, used to promote other patient behavior changes in clinical practice, may be applicable to physical activity. Our goal was to determine clinicians’ use of the 5A (Ask, Advise, Agree, Assist, Arrange) guidelines when communicating about physical activity and cancer risk with an underserved patient population. Methods: Analysis of 50 audiotaped transcribed office visits with adult patients and their clinicians in two community health centers in Rochester, NY. We conducted post-visit interviews to assess patient recall of communication about physical activity.We used descriptive statistics to assess patient demographics and the frequency of each of the 5As occurring in the audiotaped visits. Analysis of the transcripts of the visits explored other contextual factors related to use of the 5As for communication about physical activity and cancer risk. Results: Patients were predominantly female (70%) and were African American (50%), Caucasian (35%) and other/mixed ethnicity (15%). In the 50 office visits, there were twelve (24%) Ask, twelve (24%) Advise, three (6%) Agree, two (4%) Assist, and one (2%) Arrange statement. Physical activity communication was mostly (92%) clinician-initiated; the only discussion which included all 5As was patient-initiated. No discussion linked physical activity to cancer risk or cancer prevention. Patients recalling the most communication about physical activity with their clinician reported that it was contextualized to their specific health needs, included support and encouragement, and consisted of clear, simple advice. Conclusions: Communication about physical activity incorporating the Agree and Arrange steps of the 5As was infrequent. Cancer prevention interventions should target these steps and prompt the patient to initiate communication to improve physical activity in underserved populations. This project was supported by a grant from the National Cancer Institute, R25- CA102618.

No significant financial relationships to disclose.

Feasibility of tailored exercise for improving sleep disruption in women with metastatic breast cancer

9129

Background: Women diagnosed with metastatic breast cancer (MBC) live for months and years. Long-term effects of cancer and its treatment result in chronic symptoms, such as sleep disruption (SDN) that diminish quality of life (QOL). Exercise reduces SDN and minimizes QOL deficits in women with early stage breast cancer during adjuvant treatment, but the feasibility and efficacy of exercise for women with advanced disease is not well established. This phase I pilot study assessed the feasibility and efficacy of a tailored exercise intervention for reducing SDN in women with MBC. Methods: Women with MBC (N=12; mean age=50; disease-free interval 0–10yrs) participated in an 8-week, low to moderately intense, exercise intervention (3x's/wk). The program included flexibility, core stability, aerobic, and resistance training. Results: The intervention was safe, well-tolerated with no adverse events, and well-liked by patients and oncologists. The participants exercised an average of 3.5 days (SD=1.5) a week for 58 minutes (SD=12.9) per exercise session at a moderate intensity (RPE of 3.6; SD=1.2) during the 8-week intervention. Patients spent an average of 25 minutes (SD=7.8) in cardiovascular exercise, 21 minutes (SD=5.5) in resistance exercise, and 10 minutes (SD = 2.2) in flexibility and core stability exercise per exercise session. Paired t-tests showed statistically significant improvements in SDN (Pittsburgh Sleep Quality Index) from baseline to week 4 (mean change=2.56; SE=.96; t1,8 = 2.70, p ≤.05). SDN Also improved from baseline to week 8 (mean change=2.13; SE=1.22). Conclusion: Phase II and III randomized, controlled trials are warranted to substantiate the efficacy of this tailored exercise intervention for improving SDN and, ultimately, QOL and survival among women with MBC. Supported by Roche Biomedical and NCI grant 1R25CA102618

No significant financial relationships to disclose.

Prevalence and severity of sleep disturbance in 596 cancer patients: A URCC CCOP study

9016

Background: Sleep disturbance is a prevalent and, potentially, chronic problem among cancer patients, persisting for many months and years after treatments. As part of a multi-center longitudinal survey of patients beginning cancer treatments, we prospectively investigated the prevalence and severity of self-reported sleep disturbance. Methods: 596 Cancer patients (mean age=61; 66.4%=female) receiving chemotherapy and/or radiation (37.1%=chemotherapy, 40.1%=radiation therapy, 22.8%=both) from 17 NCI CCOPs reported whether they experienced any sleep disturbance using an 11-point Likert Scale (0 = “Not present” to 10 = “As bad as you can imagine”) prior to treatments, during treatments, and 6 months after finishing treatments. A side effect level 7 was considered “severe.” Results: Sleep disruption was reported by 31.9% (median=2; 10.6% severe) at baseline, 77.2% (median=4; 28.5% severe) during treatment and 65.1% (median=2; 15% severe) at 6 months post-treatment. Repeated-measures ANOVAs revealed statistically significant treatment group (chemotherapy, radiation, or both), age (< 61 or ≥ 61 yrs), and gender by time interactions (all p<0.05). Sleep disturbance was significantly higher among survivors in the two groups receiving chemotherapy, younger survivors, and women (all p<0.05). Sleep disruption increased from baseline to post-treatment and decreased from post-treatment to 6 months post-treatment (all p<0.05). There were no significant differences between baseline and 6 months post-treatment. Conclusions: These results show that difficulties with sleep increase during cancer treatment. Patients who are at higher risk for having sleep problems are women, younger patients, and patients undergoing chemotherapy. Supported by NCI Grants U10-CA37420 and R25-CA102618

No significant financial relationships to disclose.

Health promotion and cancer screening services for African refugee women

6101

Background: Previous work has shown that refugee women do not receive adequate preventive healthcare services, especially cancer screening. To identify factors that could affect the provision of cancer screening services to African Somali refugee women living in Rochester, NY, we assessed beliefs these women have about health promotion, access to care and use of preventive healthcare services. Methods: Individual in-depth interviews were conducted on a community-based sample of 34 resettled Somali-born women who were older than 18 years. Interviews were audiotaped and transcribed verbatim. A professional interpreter listened to all audiotaped interviews to check accuracy of transcription and translation. Content was analyzed by a multidisciplinary team using a grounded theory approach. Results: Median age of the women was 27 years. Length of residence in US was two months to nine years. For these women, health maintenance for acute survival took precedence over long-term prevention of disease. All women were familiar with basic health promotion practices, immunizations and routine medical examinations, and participants used both US-based and traditional techniques to prevent illness. Most women (71%, n=24), recognized the importance of maintaining good hygiene (59%, n=20) understood the need to have an adequate source of safe food and water, (74%, n=25) saw the need for access to a regular source of healthcare and (65%, n=22) acknowledged the need to function well at home. Few women understood cancer prevention services. Only three (9%) women recognized that the purpose of the Papanicalaou test was to screen for cervical cancer. Only six women (18%) recognized mammography (either the term or the procedure) and all of them were English-speaking, had lived in the US five years or longer, and had worked in the healthcare field. Conclusions: While traditional beliefs about health promotion did not appear to impede delivery of most preventive services, and participants understood prevention of infectious disease, their familiarity with cancer and cancer screening services was poor. Future health promotion programs need to increase refugee women’s knowledge about these services while building on other positive health-promoting beliefs. Supported by AHRQ 5R03HS014105 and NCI 1R25CA102618

No significant financial relationships to disclose.

Differences in the chaperone-like activities of the four main small heat shock proteins of Drosophila melanogaster

The Drosophila melanogaster family of small heat shock proteins (sHsps) is composed of 4 main members (Hsp22, Hsp23, Hsp26, and Hsp27) that display distinct intracellular localization and specific developmental patterns of expression in the absence of stress. In an attempt to determine their function, we have examined whether these 4 proteins have chaperone-like activity using various chaperone assays. Heat-induced aggregation of citrate synthase was decreased from 100 to 17 arbitrary units in the presence of Hsp22 and Hsp27 at a 1:1 molar ratio of sHsp to citrate synthase. A 5 M excess of Hsp23 and Hsp26 was required to obtain the same efficiency with either citrate synthase or luciferase as substrate. In an in vitro refolding assay with reticulocyte lysate, more than 50% of luciferase activity was recovered when heat denaturation was performed in the presence of Hsp22, 40% with Hsp27, and 30% with Hsp23 or Hsp26. These differences in luciferase reactivation efficiency seemed related to the ability of sHsps to bind their substrate at 42 degrees C, as revealed by sedimentation analysis of sHsp and luciferase on sucrose gradients. Therefore, the 4 main sHsps of Drosophila share the ability to prevent heat-induced protein aggregation and are able to maintain proteins in a refoldable state, although with different efficiencies. The functional reasons for their distinctive cell-specific pattern of expression could reflect the existence of defined substrates for each sHsp within the different intracellular compartments.

Decreased lifespan in the absence of expression of the mitochondrial small heat shock protein Hsp22 in Drosophila

Aging is a well regulated biological process involving oxidative stress and macromolecular damages. Three main pathways have been shown to influence lifespan, the insulin/insulin-like growth factor-1 pathway, the silent regulator pathway, and the target of rapamycin pathway. Among many proteins influencing lifespan, two transcription factors, FOXO and the heat shock factor, have been shown to be involved in the aging process and in small heat shock proteins (sHsps) expression following stress and during lifespan. We have recently shown that overexpressing the mitochondrial Hsp22 increases Drosophila melanogaster lifespan by 32% and resistance to oxidative stress. Here we show that flies that are not expressing this mitochondrial small Hsp22 have a 40% decrease in lifespan. These flies die faster than their matched control and display a decrease of 30% in locomotor activity compared with controls. The absence of Hsp22 also sensitizes flies to mild stress. These data support a key role of sHsps in aging and underline the importance of mitochondrial sHsps in this process.