P2Y2 purinergic receptor gene deletion protects mice from bacterial endotoxin and sepsis-associated liver injury and mortality

The liver plays a significant role in regulating a wide range of metabolic, homeostatic, and host-defense functions. However, the impact of liver injury on the host's ability to control bacteremia and morbidity in sepsis is not well understood. Leukocyte recruitment and activation lead to cytokine and chemokine release, which, in turn, trigger hepatocellular injury and elevate nucleotide levels in the extracellular milieu. P2Y2 purinergic receptors, G protein-coupled and activated by extracellular ATP/UTP, are expressed at the cell surface of hepatocytes and nonparenchymal cells. We sought to determine whether P2Y2 purinergic receptor function is necessary for the maladaptive host response to bacterial infection and endotoxin-mediated inflammatory liver injury and mortality in mice. We report that P2Y2 purinergic receptor knockout mice (P2Y2-/-) had attenuated inflammation and liver injury, with improved survival in response to LPS/galactosamine (LPS/GalN; inflammatory liver injury) and cecal ligation and puncture (CLP; polymicrobial sepsis). P2Y2-/- livers had attenuated c-Jun NH2-terminal kinase activation, matrix metallopeptidase-9 expression, and hepatocyte apoptosis in response to LPS/GalN and attenuated inducible nitric oxide synthase and nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing 3 protein expression in response to CLP. Implicating liver injury in the disruption of amino acid homeostasis, CLP led to lower serum arginine and higher bacterial load and morbidity in the WT mice, whereas serum arginine levels were comparable to sham-operated controls in P2Y2-/- mice, which had attenuated bacteremia and improved survival. Collectively, our studies highlight the pathophysiological relevance of P2Y2 purinergic receptor function in inflammatory liver injury and dysregulation of systemic amino acid homeostasis with implications for sepsis-associated immune dysfunction and morbidity in mice.NEW & NOTEWORTHY Our studies provide experimental evidence for P2Y2 purinergic receptor-mediated potentiation of inflammatory liver injury, morbidity, and mortality, in two well-established animal models of inflammatory liver injury. Our findings highlight the potential to target P2Y2 purinergic signaling to attenuate the induction of "cytokine storm" and prevent its deleterious consequences on liver function, systemic amino acid homeostasis, host response to bacterial infection, and sepsis-associated morbidity and mortality.

Localization of macrophage subtypes and neutrophils in the prostate tumor microenvironment and their association with prostate cancer racial disparities

BACKGROUND

Black men are two to three times more likely to die from prostate cancer (PCa) than White men. This disparity is due in part to discrepancies in socioeconomic status and access to quality care. Studies also suggest that differences in the prevalence of innate immune cells and heightened function in the tumor microenvironment of Black men may promote PCa aggressiveness.

METHODS

We evaluated the spatial localization of and quantified CD66ce⁺ neutrophils by immunohistochemistry and CD68⁺ (pan), CD80⁺ (M1), and CD163⁺ (M2) macrophages by RNA in situ hybridization on formalin-fixed paraffin-embedded tissues from organ donor "normal" prostate (n = 9) and radical prostatectomy (n = 38) tissues from Black and White men. Neutrophils were quantified in PCa and matched benign tissues in tissue microarray (TMA) sets comprised of 560 White and 371 Black men. Likewise, macrophages were quantified in TMA sets comprised of tissues from 60 White and 120 Black men. The phosphatase and tensin homolog (PTEN) and ETS transcription factor ERG (ERG) expression status of each TMA PCa case was assessed via immunohistochemistry. Finally, neutrophils and macrophage subsets were assessed in a TMA set comprised of distant metastatic PCa tissues collected at autopsy (n = 6) sampled across multiple sites.

RESULTS

CD66ce⁺ neutrophils were minimal in normal prostates, but were increased in PCa compared to benign tissues, in low grade compared to higher grade PCa, in PCa tissues from White compared to Black men, and in PCa with PTEN loss or ERG positivity. CD163⁺ macrophages were the predominant macrophage subset in normal organ donor prostate tissues from both Black and White men and were significantly more abundant in organ donor compared to prostatectomy PCa tissues. CD68,⁺  CD80,⁺ and CD163⁺ macrophages were significantly increased in cancer compared to benign tissues and in cancers with ERG positivity. CD68⁺ and CD163⁺ macrophages were increased in higher grade cancers compared to low grade cancer and CD80 expression was significantly higher in benign prostatectomy tissues from Black compared to White men.

CONCLUSIONS

Innate immune cell infiltration is increased in the prostate tumor microenvironment of both Black and White men, however the composition of innate immune cell infiltration may vary between races.

P2 purinergic receptor dysregulation in urologic disease

P2 purinergic receptors are involved in the normal function of the kidney, bladder, and prostate via signaling that occurs in response to extracellular nucleotides. Dysregulation of these receptors is common in pathological states and often associated with disease initiation, progression, or aggressiveness. Indeed, P2 purinergic receptor expression is altered across multiple urologic disorders including chronic kidney disease, polycystic kidney disease, interstitial cystitis, urinary incontinence, overactive bladder syndrome, prostatitis, and benign prostatic hyperplasia. P2 purinergic receptors are likewise indirectly associated with these disorders via receptor-mediated inflammation and pain, a common characteristic across most urologic disorders. Furthermore, select P2 purinergic receptors are overexpressed in urologic cancer including renal cell carcinoma, urothelial carcinoma, and prostate adenocarcinoma, and pre-clinical studies depict P2 purinergic receptors as potential therapeutic targets. Herein, we highlight the compelling evidence for the exploration of P2 purinergic receptors as biomarkers and therapeutic targets in urologic cancers and other urologic disease. Likewise, there is currently optimism for P2 purinergic receptor-targeted therapeutics for the treatment of inflammation and pain associated with urologic diseases. Further exploration of the common pathways linking P2 purinergic receptor dysregulation to urologic disease might ultimately help in gaining new mechanistic insight into disease processes and therapeutic targeting.

Modeling Human Prostate Cancer Metastasis in Mice via Resection of Subcutaneous Allografts

The 5-year survival rate for patients diagnosed with distant metastatic prostate cancer in the United States is 30.6%. Therefore, there is a great need to develop in vivo model systems to study prostate cancer metastasis and to test potential therapeutics. Most murine prostate cancer metastatic models involve intracardiac or intraosseous implantation of cancer cells, which bypass the early stages of tumor cell migration and invasion. Herein we provide a detailed protocol for a novel method of resecting subcutaneous prostate cancer allografts in immunocompetent mice to produce spontaneous metastases and describe a pilot study using this method of tumor resection. Intact male FVB/NCrl mice (n = 9) were inoculated subcutaneously with Myc-CaP cells. Tumors were surgically resected, and mice were monitored for tumor recurrence. Animals were euthanized or died, and a full set of tissues was collected for histopathologic examination. Tumors took an average of 44 days (range 23–61) to reach 1.7 cm in any direction. All tumors were resectable, and resection of the tumors increased the study length by 70 days (range 30–121). One mouse was euthanized early of an unrelated cause, and of eight remaining mice, four developed tumor recurrence at the site of resection. One mouse developed bone metastases, one mouse developed metastases to the abdominal cavity, and two mice showed signs of local invasion. This study demonstrates that resection of subcutaneous Myc-CaP cell allografts in mice results in local tumor recurrence and the development of distant metastases, providing a new model system to study prostate cancer metastasis in vivo.

Association of B7-H3 expression with racial ancestry, immune cell density, and androgen receptor activation in prostate cancer

Background

B7 homolog 3 (B7‐H3) is an immunomodulatory molecule that is highly expressed in prostate cancer (PCa) and belongs to the B7 superfamily, which includes PD‐L1. Immunotherapies (antibodies, antibody‐drug conjugates, and chimeric antigen receptor T cells) targeting B7‐H3 are currently in clinical trials; therefore, elucidating the molecular and immune microenvironment correlates of B7‐H3 expression may help to guide trial design and interpretation. The authors tested the interconnected hypotheses that B7‐H3 expression is associated with genetic racial ancestry, immune cell composition, and androgen receptor signaling in PCa.

Methods

An automated, clinical‐grade immunohistochemistry assay was developed by to digitally quantify B7‐H3 protein expression across 2 racially diverse cohorts of primary PCa (1 with previously reported transcriptomic data) and pretreatment and posttreatment PCa tissues from a trial of intensive neoadjuvant hormonal therapy.

Results

B7‐H3 protein expression was significantly lower in self‐identified Black patients and was inversely correlated with the percentage African ancestry. This association with race was independent of the significant association of B7‐H3 protein expression with ERG/ETS and PTEN status. B7‐H3 messenger RNA expression, but not B7‐H3 protein expression, was significantly correlated with regulatory (FOXP3‐positive) T‐cell density. Finally, androgen receptor activity scores were significantly correlated with B7‐H3 messenger RNA expression, and neoadjuvant intensive hormonal therapy was associated with a significant decrease in B7‐H3 protein expression.

Conclusions

The current data underscore the importance of studying racially and molecularly diverse PCa cohorts in the immunotherapy era. This study is among the first to use genetic ancestry markers to add to the emerging evidence that PCa in men of African ancestry may have a distinct biology associated with B7‐H3 expression.

Lay Summary

B7‐H3 is an immunomodulatory molecule that is highly expressed in prostate cancer and is under investigation in clinical trials.

The authors determined that B7‐H3 protein expression is inversely correlated with an individual's proportion of African ancestry.

The results demonstrate that B7‐H3 messenger RNA expression is correlated with the density of tumor T‐regulatory cells.

Finally, in the first paired analysis of B7‐H3 protein expression before and after neoadjuvant intensive hormone therapy, the authors determined that hormone therapy is associated with a decrease in B7‐H3 protein levels, suggesting that androgen signaling may positively regulate B7‐H3 expression.

These results may help to guide the design of future clinical trials and to develop biomarkers of response in such trials.

B7‐H3 protein expression was significantly lower in self‐identified Black patients and was inversely correlated with the percentage African ancestry. Androgen receptor activity scores were significantly correlated with B7‐H3 messenger RNA expression, and neoadjuvant intensive hormonal therapy was associated with a significant decrease in B7‐H3 protein expression, consistent with a presumed androgen receptor binding site upstream of the B7‐H3 promoter.

P2X4 purinergic receptors offer a therapeutic target for aggressive prostate cancer

Prostate cancer (PCa) remains a leading cause of cancer-related deaths in American men and treatment options for metastatic PCa are limited. There is a critical need to identify new mechanisms that contribute to PCa progression, that distinguish benign from lethal disease, and that have potential for therapeutic targeting. P2X4 belongs to the P2 purinergic receptor family that is commonly upregulated in cancer and is associated with poorer outcomes. We observed P2X4 protein expression primarily in epithelial cells of the prostate, a subset of CD66⁺ neutrophils, and most CD68⁺ macrophages. Our analysis of tissue microarrays representing 491 PCa cases demonstrated significantly elevated P2X4 expression in cancer- compared with benign-tissue spots, in prostatic intraepithelial neoplasia, and in PCa with ERG positivity or with PTEN loss. High-level P2X4 expression in benign tissues was likewise associated with the development of metastasis after radical prostatectomy. Treatment with the P2X4-specific agonist cytidine 5'-triphosphate (CTP) increased Transwell migration and invasion of PC3, DU145, and CWR22Rv1 PCa cells. The P2X4 antagonist 5-(3-bromophenyl)-1,3-dihydro-2H-benzofuro[3,2-e]-1,4-diazepin-2-one (5-BDBD) resulted in a dose-dependent decrease in viability of PC3, DU145, LNCaP, CWR22Rv1, TRAMP-C2, Myc-CaP, BMPC1, and BMPC2 cells and decreased DU145 cell migration and invasion. Knockdown of P2X4 attenuated growth, migration, and invasion of PCa cells. Finally, knockdown of P2X4 in Myc-CaP cells resulted in significantly attenuated subcutaneous allograft growth in FVB/NJ mice. Collectively, these data strongly support a role for the P2X4 purinergic receptor in PCa aggressiveness and identify P2X4 as a candidate for therapeutic targeting. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Castration-mediated IL-8 promotes myeloid infiltration and prostate cancer progression

Unlike several other tumor types, prostate cancer rarely responds to immune checkpoint blockade (ICB). To define tumor cell intrinsic factors that contribute to prostate cancer progression and resistance to ICB, we analyzed prostate cancer epithelial cells from castration-sensitive and -resistant samples using implanted tumors, cell lines, transgenic models and human tissue. We found that castration resulted in increased expression of interleukin-8 (IL-8) and its probable murine homolog Cxcl15 in prostate epithelial cells. We showed that these chemokines drove subsequent intratumoral infiltration of tumor-promoting polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs), which was largely abrogated when IL-8 signaling was blocked genetically or pharmacologically. Targeting IL-8 signaling in combination with ICB delayed the onset of castration resistance and increased the density of polyfunctional CD8 T cells in tumors. Our findings establish a novel mechanism by which castration mediates IL-8 secretion and subsequent PMN-MDSC infiltration, and highlight blockade of the IL-8/CXCR2 axis as a potential therapeutic intervention.

GSTP1 positive prostatic adenocarcinomas are more common in Black than White men in the United States

GSTP1 is a member of the Glutathione-S-transferase (GST) family silenced by CpG island DNA hypermethylation in 90-95% of prostate cancers. However, prostate cancers expressing GSTP1 have not been well characterized. We used immunohistochemistry against GSTP1 to examine 1673 primary prostatic adenocarcinomas on tissue microarrays (TMAs) with redundant sampling from the index tumor from prostatectomies. GSTP1 protein was positive in at least one TMA core in 7.7% of cases and in all TMA cores in 4.4% of cases. The percentage of adenocarcinomas from Black patients who had any GSTP1 positive TMA cores was 14.9%, which was 2.5 times higher than the percentage from White patients (5.9%; P < 0.001). Further, the percentages of tumors from Black patients who had all TMA spots positive for GSTP1 (9.5%) was 3-fold higher than the percentage from White patients (3.2%; P<0.001). In terms of association with other molecular alterations, GSTP1 positivity was enriched in ERG positive cancers among Black men. By in situ hybridization, GSTP1 mRNA expression was concordant with protein staining, supporting the lack of silencing of at least some GSTP1 alleles in GSTP1-positive tumor cells. This is the first report revealing that GSTP1-positive prostate cancers are substantially over-represented among prostate cancers from Black compared to White men. This observation should prompt additional studies to determine whether GSTP1 positive cases represent a distinct molecular subtype of prostate cancer and whether GSTP1 expression could provide a biological underpinning for the observed disparate outcomes for Black men.

Differential mast cell phenotypes in benign versus cancer tissues and prostate cancer oncologic outcomes

We reported previously that high numbers of mast cells in benign (extra-tumoral) regions of the prostate are associated with worse outcomes after radical prostatectomy including biochemical recurrence and the development of metastases. Herein, with a cohort of 384 men, we performed mast cell subtyping and report that higher minimum number of the tryptase-only (MC_T ) subset of extra-tumoral mast cells is associated with increased risk of biochemical recurrence (comparing highest to lowest tertiles: HR 2.32, 95% CI 1.37-3.93; P-trend = 0.002), metastases (HR 3.62, 95% CI 1.75-7.47; P-trend 0.001), and death from prostate cancer (HR 2.87, 95% CI 1.19-6.95; P-trend = 0.02). Preliminary RNA sequencing and comparison of benign versus cancer tissue mast cells revealed differential expression of additional site-specific genes. We further demonstrate that the genes CXCR4 and TFE3 are more highly expressed in tumor-infiltrating mast cells as well as other tumor-infiltrating immune cells and in tumor cells, respectively, and represent an altered tumor microenvironment. KIT variants were also differentially expressed in benign versus cancer tissue mast cells, with KIT variant 1 (GNNK⁺ ) mast cells identified as more prevalent in extra-tumoral regions of the prostate. Finally, using an established mouse model, we found that mast cells do not infiltrate Hi-Myc tumors, providing a model to specifically examine the role of extra-tumoral mast cells in tumorigenesis. Hi-Myc mice crossed to mast cell knockout (Wsh) mice and aged to 1 year revealed a higher degree of pre-invasive lesions and invasive cancer in wild-type mice versus heterozygous and knockout mice. This suggests a dosage effect where higher numbers of extra-tumoral mast cells resulted in higher cancer invasion. Overall, our studies provide further evidence for a role of extra-tumoral mast cells in driving adverse prostate cancer outcomes. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Abstract PO-226: Localization of macrophages and neutrophils in the prostate tumor microenvironment and their association with prostate cancer racial disparities

African American (AA) men are two to three times more likely to die from prostate cancer (PCa) than European American (EA) men. This disparity may be due in part to socioeconomic status and discrepancies in access to quality care. Studies also suggest that differences in innate immune effector cells and function in the tumor microenvironment of AA men may promote PCa aggressiveness. Increased tumor- associated macrophages are associated with poorer outcomes and a high neutrophil- to-lymphocyte ratio is significantly associated with poorer survival in men with PCa. However, the prevalence of innate immune cells, their spatial localization, and their relationship to PCa racial disparities is largely unknown. We evaluated CD66ce+ neutrophils and CD68+ (pan), CD80+ (M1), and CD163+ (M2) macrophages using RNA in situ hybridization or immunohistochemistry on formalin-fixed paraffin-embedded whole tissue sections from prostate donor tissues with no cancer (n=4) and radical prostatectomy tissues from AA and EA men with low grade (Gleason ≤ 3+4) and higher grade (Gleason ≥ 4+3) PCa (n=38). Tissue microarray (TMA) sets containing radical prostatectomy tissues (n=932) or distant metastatic tissues obtained at autopsy (n=6) were also evaluated. Immune marker expression in TMAs was quantified using TMAJ and FrIDA software. CD66ce+ neutrophils were primarily localized to blood vessels in organ donor prostate specimens as well as normal appearing, non-inflamed regions of radical prostatectomy specimens. Increased CD66ce+ neutrophils were present in inflamed regions of benign tissues from both races. In analysis of TMAs, there was significantly increased CD66ce+ neutrophils in tissues from EA men compared to AA men (p &lt; 0.0001). There was also increased CD66ce expression in cancer compared to benign tissue spots (p &lt;0.01), in low grade compared to higher grade cancer (p &lt; 0.0001), in cancer with PTEN loss versus intact PTEN (p &lt; 0.0001), and in ERG positive versus ERG negative cancer (p = 0.0011).

There was no association between CD66ce+ neutrophils and risk of metastasis or biochemical recurrence. CD68+ and CD163+ macrophages were abundant in organ donor specimens, while CD80 expression was minimal. Similar expression patterns were observed in benign regions of radical prostatectomy specimens. In analysis of TMAs, CD68, CD80 and CD163 were significantly increased in cancer compared to benign tissues (p &lt; 0.0001). CD163 expression was comparable between races, while CD80 expression was significantly higher in benign tissues from AA men compared to EA men (p = 0.0004). CD68, CD80 and CD163 expression were all significantly increased in benign spots from ERG positive versus ERG negative cases. In conclusion, there is increased infiltration of innate immune cells in the prostate tumor microenvironment of both AA and EA men, however the composition of innate immune cell infiltration varies between races. Our future studies aim to determine the influence of innate immune effector cells on PCa aggressiveness and outcomes.

Citation Format: Janielle P. Maynard, Jiayun Lu, Igor Vidal, Corinne E. Joshu, Angelo M. De Marzo, Karen S. Sfanos. Localization of macrophages and neutrophils in the prostate tumor microenvironment and their association with prostate cancer racial disparities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-226.

Lactoferrin CpG Island Hypermethylation and Decoupling of mRNA and Protein Expression in the Early Stages of Prostate Carcinogenesis

Lactoferrin (LTF) is an iron-binding protein canonically known for its innate and adaptive immune functions. LTF may also act as a tumor suppressor with antiproliferative action. LTF is inactivated genetically or epigenetically in various cancers, and a CpG island spanning the transcriptional start site of LTF is hypermethylated in prostate cancer cell lines. We, therefore, hypothesized that LTF expression is silenced via CpG island hypermethylation in the early stages of prostate tumorigenesis carcinogenesis. Targeted methylation analysis was performed using a combination of methylated-DNA precipitation and methylation-sensitive restriction enzymes, and laser-capture microdissection followed by bisulfite sequencing on DNA isolated from prostate tissue samples, including both primary and metastatic disease. LTF mRNA in situ hybridization and LTF protein immunohistochemistry were also performed. We report that the LTF CpG island is frequently and densely methylated in high-grade prostatic intraepithelial neoplasia, primary prostate carcinoma, and metastases. We further report a decoupling of lactoferrin mRNA and protein expression, including in lesions where LTF mRNA has presumably been silenced via CpG island methylation. We conclude that LTF mRNA expression is silenced in prostate tumorigenesis via hypermethylation, supporting a role for LTF as a prostate cancer tumor suppressor gene. Likewise, the frequency at which the LTF CpG island is methylated across samples suggests it is an important and conserved step in prostate cancer initiation.

Lessons learned from the development of a hidradenitis suppurativa xenograft mouse model

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease originating from the pilosebaceous unit, in which patients develop painful abscesses, sinus tracts, nodules and scarring, typically in intertriginous areas. Major gaps in our understanding of HS exist, and these may be partially due to the lack of an animal model for experimental studies. We developed an HS xenograft mouse model using human HS lesions grafted onto immunocompromised mice. Although the model had its limitations, several informative lessons were learned, which may contribute to future attempts at an HS animal model.

A role for paracrine interleukin-6 signaling in the tumor microenvironment in prostate tumor growth

BACKGROUND

Interleukin-6 (IL-6) is a mediator of inflammation that can facilitate prostate cancer progression. We previously demonstrated that IL-6 is present in the prostate tumor microenvironment and is restricted almost exclusively to the stromal compartment. The present study examined the influence of paracrine IL-6 signaling on prostate tumor growth using allograft models of mouse prostate cancer (TRAMP-C2), colon cancer (MC38), and melanoma (B16) cell lines in wildtype (WT) and IL-6 knockout (IL-6^-/- ) mice.

METHODS

Cells were implanted into WT or IL-6^-/- mice and tumor sizes were measured at a 3 to 4 day interval. Serum, tumors, and other organs were collected for IL-6 analysis by ELISA and RNA in situ hybridization (RISH).

RESULTS

There was a significant reduction in TRAMP-C2 and B16 tumor size grown in IL-6^-/- mice versus WT mice (P = 0.0006 and P = 0.02, respectively). This trend was not observed for the MC38 cell line. RISH analysis of TRAMP-C2 tumors grown in WT mice showed that cells present in the tumor microenvironment were the primary source of IL-6 mRNA, not the TRAMP-C2 cells. Serum IL-6 ELISA analyses showed an increase in the circulating levels of IL-6 in WT mice bearing TRAMP-C2 tumors. Similar phospho-STAT3 expression and tumor vascularization were observed in TRAMP-C2 tumors grown in WT and IL-6^-/- mice.

CONCLUSIONS

Our results are consistent with previous studies in prostate cancer patients demonstrating that paracrine IL-6 production in the tumor microenvironment may influence tumor growth. Additionally, these data provide evidence that elevated systemic IL-6 levels may be involved in tumor growth regulation in prostate cancer, and are not simply caused by or indicative of tumor burden.

Abstract B54: The inflammatory microenvironment in prostate cancer racial disparities

Introduction: Prostate cancer (PCa) is the third leading cause of cancer death in American men. African American (AA) men are more likely to be diagnosed with advanced prostate cancer and are 2-3 times more likely to die from the disease than Caucasian American (CA) men. Chronic inflammation is implicated as a major risk factor for PCa, and genes involved in inflammatory pathways are reported as more prevalent in tumors from AA men versus CA men. Specifically, interleukin-1β (IL-1β), IL-6, IL-8, and IL-10 have consistently been identified as overexpressed in the tumor microenvironment of AA men. These interleukins are in involved in the attraction, activation, or maintenance of innate immune cells such as neutrophils and macrophages. However, it is not well understood where these interleukins are expressed in the prostate and by what cell types they produced. We aim to address these specific questions using a novel in situ hybridization technique. Uncovering the inflammatory topography of PCa may contribute to our understanding of chronic inflammation in tumor development and progression, particularly among AA men.

Methods: The expression pattern and cellular localization of IL-1β, IL-6, IL-8, and IL-10 were evaluated using a highly specific RNA in situ hybridization assay (RNAscope) to analyze formalin-fixed, paraffin-embedded tissues of low-grade (Gleason ≤ 3+4) and higher-grade (Gleason ≥ 4+3) PCa from AA and CA men. Immunohistochemical analysis of neutrophils (CD66ce) and macrophages (CD68) was used to assess the expression pattern of these immune cells within the same cohort.

Results: Limited IL-1β and IL-10 expression was observed across all samples. Consistent with our previous reports in CA men, IL-6 mRNA is not expressed in tumor cells and is largely confined to the stromal compartment. IL-6 expression was predominantly in endothelial cells and to a lesser extent in atrophic epithelial cells of both AA and CA men. IL-6 is also highly expressed in stromal cells in areas of acute inflammation. IL-8 was the most abundantly detected cytokine within our cohort. In benign regions, IL-8 expression was predominantly observed in epithelial cells in regions of prostatic atrophy. IL-8 expression was also apparent in multiple tumors, both in tumor cells and infiltrating immune cells. We also observed marked IL-8 expression in urothelial cells in a subset of cases. Interestingly, tumor-infiltrating neutrophils and a marked increase in tumor-infiltrating macrophages were observed within tumors in a subset of cases.

Conclusions: There is differential expression of cytokines among men with PCa. Our future studies aim to determine whether our results could help to explain the disparate burden of advanced PCa among AA men.

Citation Format: Janielle P. Maynard, Angelo M. De Marzo, Karen S. Sfanos. The inflammatory microenvironment in prostate cancer racial disparities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B54.

Abstract 5069: Inflammatory cytokine localization in the prostate tumor microenvironment and their association with prostate cancer racial disparities

Prostate cancer (PCa) is the 3rd leading cause of cancer-related deaths in American men. The major risk factors for PCa development include advanced age, family history and African ancestry. Chronic inflammation has been implicated as a major contributor to PCa and genes involved in inflammatory pathways are reported as more prevalent in tumors from African American (AA) versus Caucasian American (CA) men. Specifically, interleukin-1β (IL1β), IL6, IL8, and IL10 have been identified as over-expressed in the tumor microenvironment of AA men. These interleukins are in involved in the attraction, activation or maintenance of innate immune cells such as neutrophils and macrophages. However, it is not well understood where these interleukins are expressed in the prostate and what cell types produce them. We aim to address these specific questions in this study. The expression pattern and cellular localization of IL1β, IL6, IL8 and IL10 were evaluated using a highly specific RNA in situ hybridization (RISH) assay to analyze formalin-fixed paraffin-embedded tissues of low grade (Gleason ≤ 3+4) and higher grade (Gleason ≥ 4+3) PCa from AA and CA men. IL8 expression was additionally assessed by RISH in two unique tissue microarray (TMA) sets; i) primary prostate tumors obtained by radical prostatectomy from AA and CA men, matched for patient age, tumor grade and stage; ii) distant metastatic tissues obtained by autopsy. Immunohistochemical analysis of neutrophils (CD66ce) and RISH for macrophages (CD68) was used to assess the expression pattern of these immune cells within the same cohorts. Limited IL1β and IL10 expression was observed across all cases. IL6 expression was largely confined to the stromal compartment in endothelial cells and areas of acute inflammation. Modest IL6 expression was observed in atrophic epithelial cells. IL6 was never seen in tumor cells. IL8 was the most abundantly detected cytokine within our cohort and was significantly increased in higher grade cases. In benign regions, IL8 expression was predominantly observed in epithelial cells in regions of prostatic atrophy and in areas surrounding corpora amylacea. We observed marked IL8 expression in urothelial cells in most cases. IL8 expression was also apparent in multiple tumors, both in tumor cells and infiltrating immune cells. Tumor-infiltrating macrophages were markedly increased within a subset of tumors, but did not appear to express IL8. Conversely, a subset of neutrophils expressed IL8. Neutrophils were significantly increased in benign tissues from men with higher grade PCa, particularly in AA men. IL8 expression was also observed in a subset of distant metastases, particularly in liver metastases. There is differential expression of cytokines among men with PCa, and IL8 is the most abundant among the ones we analyzed. Our future studies aim to determine a role for IL8 in prostate carcinogenesis.

Citation Format: Janielle P. Maynard, Onur Ertunc, Angelo M. De Marzo, Karen S. Sfanos. Inflammatory cytokine localization in the prostate tumor microenvironment and their association with prostate cancer racial disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5069.

P2X3 purinergic receptor overexpression is associated with poor recurrence-free survival in hepatocellular carcinoma patients

P2 purinergic receptors are overexpressed in certain cancer tissues, but the pathophysiologic relevance of purinergic signaling in hepatocellular carcinoma (HCC) remains unknown. To examine the role of P2 purinergic signaling in the pathogenesis of HCC and characterize extracellular nucleotide effects on HCC cell proliferation, two independent HCC patient cohorts were analyzed for P2 purinergic receptor expression, and nucleotide treated HCC cell lines were evaluated for effects on proliferation and cell cycle progression. Our studies suggest that multiple P2 purinergic receptor isoforms are overexpressed in liver tumors, as compared to uninvolved liver, and dysregulation of P2 purinergic receptor expression is apparent in HCC cell lines, as compared to human primary hepatocytes. High P2X3 purinergic receptor expression is associated with poor recurrence-free survival (RFS), while high P2Y13 expression is associated with improved RFS. Extracellular nucleotide treatment alone is sufficient to induce cell cycle progression, via activation of JNK signaling, and extracellular ATP-mediated activation of P2X3 receptors promotes proliferation in HCC cells.

CONCLUSION

Our analysis of HCC patient livers and HCC cells in vitro identifies a novel role for dysregulation of P2 purinergic signaling in the induction of hyper-proliferative HCC phenotype and identifies P2X3 purinergic receptors as potential new targets for therapy.

P2Y2 purinergic receptor activation is essential for efficient hepatocyte proliferation in response to partial hepatectomy

Extracellular nucleotides via activation of P2 purinergic receptors influence hepatocyte proliferation and liver regeneration in response to 70% partial hepatectomy (PH). Adult hepatocytes express multiple P2Y (G protein-coupled) and P2X (ligand-gated ion channels) purinergic receptor subtypes. However, the identity of key receptor subtype(s) important for efficient hepatocyte proliferation in regenerating livers remains unknown. To evaluate the impact of P2Y2 purinergic receptor-mediated signaling on hepatocyte proliferation in regenerating livers, wild-type (WT) and P2Y2 purinergic receptor knockout (P2Y2-/-) mice were subjected to 70% PH. Liver tissues were analyzed for activation of early events critical for hepatocyte priming and subsequent cell cycle progression. Our findings suggest that early activation of p42/44 ERK MAPK (5 min), early growth response-1 (Egr-1) and activator protein-1 (AP-1) DNA-binding activity (30 min), and subsequent hepatocyte proliferation (24-72 h) in response to 70% PH were impaired in P2Y2-/- mice. Interestingly, early induction of cytokines (TNF-α, IL-6) and cytokine-mediated signaling (NF-κB, STAT-3) were intact in P2Y2-/- remnant livers, uncovering the importance of cytokine-independent and nucleotide-dependent early priming events critical for subsequent hepatocyte proliferation in regenerating livers. Hepatocytes isolated from the WT and P2Y2-/- mice were treated with ATP or ATPγS for 5-120 min and 12-24 h. Extracellular ATP alone, via activation of P2Y2 purinergic receptors, was sufficient to induce ERK phosphorylation, Egr-1 protein expression, and key cyclins and cell cycle progression of hepatocytes in vitro. Collectively, these findings highlight the functional significance of P2Y2 purinergic receptor activation for efficient hepatocyte priming and proliferation in response to PH.

Toxic shock syndrome in a patient with breast cancer and systemic lupus erythematosus

A case is reported of a lady with systemic lupus erythematosus (SLE) who developed toxic shock syndrome following breast surgery. Staphylococcus aureus was cultured from the wound. The relative immunosuppression of SLE may have been a precipitating factor.

Pulmonary lavage in a case of alveolar proteinosis. The value of continuous display oxygen--haemoglobin saturation using ear-oximetry

A case of alveolar proteinosis is reported which was treated by lung lavage. The technique requires a Robertshaw double-lumen tube to isolate each lung. Initial ventilation with 100% oxygen removes lung nitrogen and the first 500 ml of saline occupies part of the functional reserve capacity and is not recovered. Lavage is then continued with 500-ml aliquots until the washings become clear. Monitoring the oxygen--haemoglobin saturation by ear-oximetry showed changes of between 15 and 20%, falling during suction and rising during infusion of lavage fluid. At the end of lavage, gas exchange is severely impaired by retained saline and a variable period of controlled ventilation may be required.

Pressure on the tracheal mucosa from cuffed tubes

During cuffed intubation, damage to the trachea is least likely when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. A study was carried out of eight different types of endotracheal tubes. At the seal point the traditional red rubber tube and the armoured latex and Softway tubes exerted pressures above the mean systemic arterial pressure. Although the Portex and Mallinckrodt tubes exerted pressures close to the mean capillary perfusion pressure, much higher pressures resulted if they were overinflated. The Lanz tube, however, with its over-pressure safety balloon, maintained a lateral wall pressure below the mean capillary perfusion pressure even when inflated considerably beyond the seal point. Endotracheal cuffs are often overinflated in clinical practice. Since cuff-induced tracheal damage is most influenced by the lateral wall pressure, these results suggest that the use of Lanz-type tubes should be mandatory in intensive care units or when a cuffed tracheostomy tube is required and they should also be considered for use in more routine anaesthetic practice.