Racial/Ethnic and Sex Differences in Somatic Cancer Gene Mutations among Patients with Early-Onset Colorectal Cancer

Molecular features underlying colorectal cancer disparities remain uncharacterized. Here, we investigated somatic mutation patterns by race/ethnicity and sex among 5,856 non-Hispanic white (NHW), 535 non-Hispanic Black (NHB), and 512 Asian/Pacific Islander (API) patients with colorectal cancer (2,016 early-onset colorectal cancer patients: sequencing age <50 years). NHB patients with early-onset nonhypermutated colorectal cancer, but not API patients, had higher adjusted tumor mutation rates than NHW patients. There were significant differences for LRP1B, FLT4, FBXW7, RNF43, ATRX, APC, and PIK3CA mutation frequencies in early-onset nonhypermutated colorectal cancers between racial/ethnic groups. Heterogeneities by race/ethnicity were observed for the effect of APC, FLT4, and FAT1 between early-onset and late-onset nonhypermutated colorectal cancer. By sex, heterogeneity was observed for the effect of EP300, BRAF, WRN, KRAS, AXIN2, and SMAD2. Males and females with nonhypermutated colorectal cancer had different trends in EP300 mutations by age group. These findings define genomic patterns of early-onset nonhypermutated colorectal cancer by race/ethnicity and sex, which yields novel biological clues into early-onset colorectal cancer disparities.

SIGNIFICANCE

NHBs, but not APIs, with early-onset nonhypermutated colorectal cancer had higher adjusted tumor mutation rates versus NHWs. Differences for FLT4, FBXW7, RNF43, LRP1B, APC, PIK3CA, and ATRX mutation rates between racial/ethnic groups and EP300, KRAS, AXIN2, WRN, BRAF, and LRP1B mutation rates by sex were observed in tumors of young patients. See related commentary by Shen et al., p. 530 . This article is highlighted in the In This Issue feature, p. 517.

A Liquid Biopsy Signature for the Detection of Patients With Early-Onset Colorectal Cancer

BACKGROUND & AIMS

Early-onset colorectal cancer (EOCRC) is a distinct clinical and molecular entity with poor survival outcomes compared with late-onset CRC. Although the incidence of EOCRC is rising, current CRC screening strategies have several limitations in diagnostic performance for EOCRC. In view of this clinical challenge, novel and robust biomarkers for detection of EOCRC are necessary. The aim of this study was to develop a circulating micro RNA (miRNA) signature for the diagnosis of patients with EOCRC.

METHODS

A systematic discovery approach by analyzing a large, publicly available, noncoding RNA expression profiling dataset (GSE115513) was used. A panel of miRNAs was identified, which was subsequently validated in blood samples from patients with EOCRC in 2 independent cohorts (n = 149) compared with controls (n = 110) and pre/postoperative plasma specimens (n = 22) using quantitative reverse-transcription polymerase chain reaction assays.

RESULTS

In the discovery phase, 4 miRNAs were found to be expressed in blood samples. A combination signature of these 4 miRNAs (miR-193a-5p, miR-210, miR-513a-5p, and miR-628-3p) yielded an area under the curve of 0.92 (95% confidence interval, 0.85-0.96) for identification of EOCRC in the training cohort. The miRNA panel performance was then confirmed in an independent validation cohort (area under the curve, 0.88; 95% confidence interval, 0.82-0.93). Moreover, the miRNA panel robustly identified patients with early-stage EOCRC (P < .001). The decreased expression of miRNAs in postsurgery plasma specimens indicated their tumor specificity.

CONCLUSIONS

Our novel miRNA signature for the diagnosis of EOCRC has the potential to identify patients with EOCRC with high accuracy for clinical application in the noninvasive diagnosis of EOCRC.

Role of three-dimensional imaging techniques in the management of transcatheter closure of complex atrial septal defects

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Reina Sofia. Instituto de investigación biomédica Maimonides

Introduction

Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD) but complex defects may be a challenging. In the last years, the imaging techniques used for ASD assessment have improved considerably, allowing therapeutic approaches in patients with complex morphological features particularly in those with absence of rims. However, there are no studies about the impact of 3D imaging techniques on transcatheter closure of ASD as compared with 2D imaging along time .

Purpose

To compare the impact of real time 3D Transesophageal echocardiography (3D-RT TEE) and cardiac computed tomography (CCT) on the profile as well as on the success rate of transcatheter closure of complex ASD as compared to 2D imaging.

Methods

We selected 106 adults patients suffering from ASD of complex anatomy (large≥30 mm, multiple, multifenestrated, aneurysmal, or deficiency of posterior or inferior rims) from 1998 to 2020. Along this time, we compared closure success rate, morphological characteristics, and procedure complications after ASD transcatheter closure. We defined closure success rate as a complete closure without complications. In our study, ASD assessment and further intervention was performed by two-dimensional transesophageal echocardiography (2D-TEE) from 1998 to 2007 (n = 66), whereas 3D-RT TEE and CCT was performed from 2008 to 2020 (n= 40).

Results

The type of ASD complexity was different between the two diagnostic approaches. Thus, those patients management by 2D-TEE showed more number in large ASD (40,9%), multiple-ASD (34,8%), fenestrated (10,6%), aneurysmal (7,6%) and with lower ring deficiency (6,1%) as compared to those with 3D-RT TEE and CCT (10%, 25%, 15%, 15%, and 35%, respectively, p &lt; 0,05). Although no significant differences were observed, patients from the 2D group needed a second surgical closure more frequently than those treated with 3D-RT TEE and CCT (12,1% vs 5%, p = 0.31). In our study, there were few complications (10 (9,4%), with no significant differences according to the imaging technic used (2D-TEE group: 3 device embolisms, 2 cardiac tamponade, 2 complications of the femoral access; 3D-RT TEE and CCT group: 2 device embolisms and 1 complication of the femoral access. All of them were resolved intraprocedure. Importantly, closure success was higher in those patients manage by 3D-RT TEE and CCT in comparison to 2D-TEE (88% vs. 67%, respectively, p &lt;0.05).

Conclusion

Transcatheter closure of complex ASD is a secure procedure. However, the use of 3D TEE and cardiac CT improves the success rate of this approach as compared to 2D-TEE and changes the profile of complex ASD treated by transcatheter closure in favor of those with absence of some rims

Cohort profile: the Spanish Early-onset Colorectal Cancer (SECOC) cohort: a multicentre cohort study on the molecular basis of colorectal cancer among young individuals in Spain

Purpose

The Spanish Early-onset Colorectal Cancer (SECOC) study is a multicentre prospective cohort established in Spain to investigate the molecular basis of early-onset colorectal cancer (EOCRC), including metabolic alterations.

Participants

220 patients with EOCRC have been enrolled since January 2019 through 18 centres across Spain. Individual-level data were collected by questionnaire, including lifestyle and other colorectal cancer-related factors. Medical record review was performed to capture clinical, histopathological and familial cancer history data. Biospecimen collection (blood, stool, tissue) at diagnosis and at various time points across treatment, as applicable, is also completed.

Findings to date

Participants had a median age of 44 years (range 14–49), and the majority are men (60%), with individuals age 40–49 years at EOCRC diagnosis being over-represented. Forty-three per cent of participants were diagnosed with a tumour in the rectosigmoid junction/rectum. Nearly two-thirds of EOCRC cases (64%) were diagnosed with advanced stage (III–IV) disease, and 28% of cases had no reported familial history of cancer.

Future plans

We are actively recruiting and observing participants; we plan to administer follow-up questionnaires and perform additional biospecimen collection. This prospective cohort offers a unique, rich resource for research on EOCRC aetiologies and will contribute to larger international efforts to disentangle the rising disease burden.

Gallbladder disease and pancreatic cancer risk: a multicentric case-control European study

BACKGROUND AND AIMS

The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection).

METHODS

Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders.

RESULTS

Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33-2.16). The ORs were 4.84 (95% CI 2.96-7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79-1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15-2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87-1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13-2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62-1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14-2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88-1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity.

CONCLUSION

Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.

Impact of canagliflozin in natriuretic peptides in patients with type 2 diabetes after hospitalization for acute heart failure

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2D). We aimed to assess the changes in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) concentrations in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge.

Methods

This cohort study included all patients with T2D admitted for HF from January 2017 to December 2019 in a single center. We excluded patients whose treatment with SGLT2 inhibitors were contraindicated (eGFR ≤45 ml/min/1.73 m2) and those who had other SGLT2 inhibitors than canagliflozin in their treatment at discharged. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of NT-ProBNP of 1400 pg/mL at least. NT-ProBNP concentrations were collected at 3 months, 6 months, and 1 year after hospitalization with laboratory records if available. The aim of this study is to compare mean NT-ProBNP levels at hospital discharge and 3, 6 and 12 moths of follow-up in patients treated with and without canagliflozin.

Results

We included a total of 102 patients, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). There were no significant differences in clinical and comorbidities in both groups, except for age; slightly younger in the canagliflozin group (69,2±10,3 vs 73,2±11,1; p=0,04). Treatment at discharge was also similar, patients in the control group received more dipeptidyl peptidase-4 (DPP-4) inhibitors (21.1% vs 6.7%; p=0.04). Low rate of patients received sacubitril-valsartan (15,6%) in the canagliflozin group and 14% in the control group. More than a half of patients in both groups have HF with reduced ejection fraction. Mean levels of peptides were similar in both groups at hospital admission and discharge. During the first period of 3 months, we observed a decreased of NT-ProBNP concentration in both groups, but significantly inferior in canagliflozin group (p&lt;0,001). At 6 and 12 months, NT-ProBNP levels were practically maintained in patients treated with canagliflozin, whereas levels in patients in the control group were increased. Difference in both groups at a 12 month-period was significantly superior (p=0,004), with a median reduction of concentration levels at discharge of 64.3% in the canagliflozin group and 15,8% in control group. There were no differences in patients with HF from those with reduced ejection fraction and preserved.

Conclusions

Canagliflozin therapy at discharge was associated with a significant reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF.

Funding Acknowledgement

Type of funding sources: None. NT-ProBNP according to canagliflozin

Abstract 101: Racial differences in somatic mutations among patients with early-onset colorectal cancer

Colorectal cancer incidence among individuals age younger than 50 (early-onset CRC) continues to rise with etiologies unknown. Synchronously, early-onset CRC disparities have grown more pronounced. Molecular characteristics underlying CRC disparities among young adults remain uncharacterized. In a study of 5,292 patients (1,483 early-onset; 28.0%) with CRC and clinical-grade targeted sequencing data from AACR Project GENIE, we explored tumor mutational burden (TMB) and genomic patterns of early-onset CRC by race/ethnicity using multivariable regression models adjusted for sex, histology, sequencing assay, primary sample type and TMB. In total, 9.4% of CRCs (n=500) were hypermutated (&gt;17.77 mutations/Mb). Excluding the hypermutated cancers, early-onset CRCs had 5.6 mutations/Mb versus 6.2 mutations/Mb among CRCs from late-onset cases. Moreover, among young patients, Blacks (n=115), but not Asians (n=122), had significantly higher TMB compared with Whites (n=1,245) with non-hypermutated CRC (P=0.02 and 0.38, respectively). Overall, young patients with non-hypermutated CRCs had significantly higher odds of presenting with nonsilent mutations in TP53 (Odds Ratio [OR]=1.26, 95%CI: 1.08-1.47, P=0.003) and SMAD2 (OR=1.69, 95%CI: 1.19-2.40, P=0.003) versus late-onset cases after adjustment for sex, race, histology, sequencing assay, sample type and TMB. In contrast, young patients had a 40% and 44% decreased odds of presenting with KDR and FLT4 nonsilent mutations, respectively, compared with patients with late-onset non-hypermutated CRC (KDR: OR=0.60, 95%CI: 0.38-0.95, P=0.03; FLT4: OR=0.56, 95%CI: 0.33-0.94, P=0.03). Mutation heterogeneity in TGFBR2 (Cochran's Q test: P=0.003) and NOTCH1 (P=0.02) was also observed between early-onset and late-onset cases. By race, distinct genomic patterns of early-onset CRC emerged. Young Whites with non-hypermutated CRC had higher odds of presenting with SMAD2 and TP53 mutations (SMAD2: OR=1.88, 95%CI:1.28-2.78, P=0.001; TP53: OR=1.25, 95%CI:1.06-1.48, P=0.007), and decreased odds of presenting with FLT4 mutations (OR=0.56, 95%CI: 0.32-0.99, P=0.04) versus late-onset non-hypermutated CRC cases. Among Black individuals, early-onset non-hypermutated CRC cases had significantly higher odds of presenting with TGFBR2 nonsilent mutations versus late-onset cases (OR=61.37, 95%CI:2.24-1680.45, P=0.01). Young Asians had 6-fold increased odds of presenting with nonsilent mutations in NOTCH1 versus Asians with non-hypermutated late-onset CRC (OR=6.26, 95%CI:1.32-29.68, P=0.02). By race, distinct TGFBR2 (P=0.0001) and NOTCH1 (P=0.02) mutation frequencies were observed in non-hypermutated CRCs among young patients. Together, this study provides initial evidence that molecular features of early-onset CRC may differ by race/ethnicity, which could provide insight into biological mechanisms underlying early-onset CRC disparities.

Citation Format: Andreana N. Holowatyj, Wanqing Wen, Timothy Gibbs, Kay M. Washington, Paulette D. Chandler, Cathy Eng, Jose Perea, Wei Zheng, Xingyi Guo. Racial differences in somatic mutations among patients with early-onset colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 101.

Gut instinct: a call to study the biology of early-onset colorectal cancer disparities

Colorectal cancer (CRC) incidence among individuals age younger than 50 years continues to rise with etiologies unknown. Synchronously, early-onset CRC disparities have grown more pronounced. As translational research across diverse populations has been limited, we advocate for mechanistic studies that address this challenge to mitigate CRC disparities among young adults.

Cinética de degradación ruminal in situ de ensilado de rastrojo de maíz (Zea mays) con niveles crecientes de urea

Se estudió el efecto de la inclusión de urea sobre la composición y cinética de degradación ruminal in situ en el ensilado de rastrojo de maíz. Se partió de cuatro de tratamientos al adicionar el 0, 1, 2 y 3% de urea a una mezcla de rastrojo de maíz con el 10% de melaza. Se elaboraron 128 microsilos (3 kg/unidad y 4 repeticiones por tratamiento). La apertura de los silos se realizó a los 7, 14, 21, 28, 35, 42, 49 y 56 días. Se determinó el contenido de la materia seca (MS), materia orgánica (MO), proteína bruta (PB), FND y FAD. La degradabilidad in situ se obtuvo mediante el método de Mehrez y Orskov y la degradabilidad de MS y PB mediante el análisis de los residuos con el método Kjeldhal. Los datos se analizaron con el procedimiento GLM y el test de Tukey (P±

A retrospective epidemiological analysis of shared risk factors for bovine trichomoniasis and bovine genital campylobacteriosis in La Pampa province (Argentina)

The venereal diseases bovine trichomoniasis (BT) and bovine genital campylobacteriosis (BGC) cause economic losses in endemic areas like La Pampa province in Argentina, where beef cattle are usually managed extensively. The eradication of both diseases is a priority in Argentine. The aim of this case-control study was to identify shared and specific risk factors of both diseases from the data obtained from the Provincial Program for the Control and Eradication of BT and BGC in La Pampa (PCE). The study population included 5777 breeding beef herds tested for BT and BGC in 2013. The study comprised 3481 herds that were surveyed in situ by official PCE veterinarians, distributed as follows: 3159 negative herds (with no BT or BGC positive bulls), 121 BT case herds (with at least a BT positive bull), 170 BGC case herds (with at least a BGC positive bull) and 31 BT and BGC co-infected case herds (with at least a positive bull for each disease). Three multivariable analyses were performed in order to identify the risk factors using a logistic regression model. Results showed that the risk factors shared by both diseases were the number of bulls (OR for BT = 1.03, 95% CI: 1.02-1.04, p <  0.001; OR for BGC = 1.02, 95% CI: 1.01-1.03, p <  0.001; OR for BT and BGC co-infection = 1.02, 95% CI: 1.01-1.04, p =  0.003) and the presence in the previous year of each disease (OR for BT = 18.69, 95% CI: 11.82-29.57, p <  0.001; OR for BGC = 4.65, 95% CI: 3.18-6.81, p <  0.001; OR for BT and BGC co-infection = 39.18, 95% CI: 16.72-91.80, p <  0.001). Disease-specific risk factors were continuous breeding season for BT (OR = 1.59, 95% CI: 1.04-2.47, p =  0.034), and inadequate condition of the fences for BGC (OR = 1.51, 95% CI: 1.06-2.15, p =  0.022). An integrated approach to venereal disease management needs to consider the risk characteristics identified in this study. This could lead to reduce both diseases and improve the efficiency of BT and BGC control activities in La Pampa.

Risk of pancreatic cancer associated with family history of cancer and other medical conditions by accounting for smoking among relatives

Background

Family history (FH) of pancreatic cancer (PC) has been associated with an increased risk of PC, but little is known regarding the role of inherited/environmental factors or that of FH of other comorbidities in PC risk. We aimed to address these issues using multiple methodological approaches.

Methods

Case-control study including 1431 PC cases and 1090 controls and a reconstructed-cohort study (N = 16 747) made up of their first-degree relatives (FDR). Logistic regression was used to evaluate PC risk associated with FH of cancer, diabetes, allergies, asthma, cystic fibrosis and chronic pancreatitis by relative type and number of affected relatives, by smoking status and other potential effect modifiers, and by tumour stage and location. Familial aggregation of cancer was assessed within the cohort using Cox proportional hazard regression.

Results

FH of PC was associated with an increased PC risk [odds ratio (OR) = 2.68; 95% confidence interval (CI): 2.27-4.06] when compared with cancer-free FH, the risk being greater when ≥ 2 FDRs suffered PC (OR = 3.88; 95% CI: 2.96-9.73) and among current smokers (OR = 3.16; 95% CI: 2.56-5.78, interaction FHPC*smoking P-value = 0.04). PC cumulative risk by age 75 was 2.2% among FDRs of cases and 0.7% in those of controls [hazard ratio (HR) = 2.42; 95% CI: 2.16-2.71]. PC risk was significantly associated with FH of cancer (OR = 1.30; 95% CI: 1.13-1.54) and diabetes (OR = 1.24; 95% CI: 1.01-1.52), but not with FH of other diseases.

Conclusions

The concordant findings using both approaches strengthen the notion that FH of cancer, PC or diabetes confers a higher PC risk. Smoking notably increases PC risk associated with FH of PC. Further evaluation of these associations should be undertaken to guide PC prevention strategies.

Impact of Intraocular Pressure after Filtration Surgery on Visual Field Progression in Primary Open-Angle Glaucoma

PURPOSE

To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg.

METHODS

A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21 mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups.

RESULTS

Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant.

CONCLUSIONS

Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.

A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed in late adulthood; therefore, many patients suffer or have suffered from other diseases. Identifying disease patterns associated with PDAC risk may enable a better characterization of high-risk patients.

METHODS

Multimorbidity patterns (MPs) were assessed from 17 self-reported conditions using hierarchical clustering, principal component, and factor analyses in 1705 PDAC cases and 1084 controls from a European population. Their association with PDAC was evaluated using adjusted logistic regression models. Time since diagnosis of morbidities to PDAC diagnosis/recruitment was stratified into recent (<3 years) and long term (≥3 years). The MPs and PDAC genetic networks were explored with DisGeNET bioinformatics-tool which focuses on gene-diseases associations available in curated databases.

RESULTS

Three MPs were observed: gastric (heartburn, acid regurgitation, Helicobacter pylori infection, and ulcer), metabolic syndrome (obesity, type-2 diabetes, hypercholesterolemia, and hypertension), and atopic (nasal allergies, skin allergies, and asthma). Strong associations with PDAC were observed for ≥2 recently diagnosed gastric conditions [odds ratio (OR), 6.13; 95% confidence interval CI 3.01-12.5)] and for ≥3 recently diagnosed metabolic syndrome conditions (OR, 1.61; 95% CI 1.11-2.35). Atopic conditions were negatively associated with PDAC (high adherence score OR for tertile III, 0.45; 95% CI, 0.36-0.55). Combining type-2 diabetes with gastric MP resulted in higher PDAC risk for recent (OR, 7.89; 95% CI 3.9-16.1) and long-term diagnosed conditions (OR, 1.86; 95% CI 1.29-2.67). A common genetic basis between MPs and PDAC was observed in the bioinformatics analysis.

CONCLUSIONS

Specific multimorbidities aggregate and associate with PDAC in a time-dependent manner. A better characterization of a high-risk population for PDAC may help in the early diagnosis of this cancer. The common genetic basis between MP and PDAC points to a mechanistic link between these conditions.

Sustentabilidad social de agroecosistemas bovinos de doble propósito en México

El objetivo de este estudio fue identificar las diferencias existentes en la sustentabilidad social, de los pequeños productores de ganado de doble propósito en el trópico mexicano. En dos zonas ecológicas definidas: Trópico Seco (TS) y Húmedo (TH). Para ello se analizaron las variables socioeconómicas y los indicadores de desarrollo humano establecidos por el Programa de las Naciones Unidas para el Desarrollo (PNUD). Se encontraron diferencias significativas; tanto en los objetivos de la producción (carne y leche) y en los indicadores de desarrollo humano y marginación (p<0,05). Las diferencias encontradas han de ser consideradas para establecer distintas estrategias y políticas públicas para cada una de las zonas ecológicas del trópico mexicano.

Viabilidad del caracol terrestre (Cantareus aspersus) durante la época de descanso

Los periodos de estivación e hibernación del caracol son periodos críticos de en la producción helicícola y su conocimiento contribuye decisivamente a la organización productiva y los resultados económicos de las granjas. El objetivo de este estudio fue determinar la evolución del peso vivo y la viabilidad del caracol terrestre (Cantareus aspersus), en condiciones semicontroladas durante el periodo de reposo. La experiencia tuvo una duración de 32 semanas, desde septiembre de 2013 hasta mayo del 2014. Los resultados obtenidos muestran una disminución del peso vivo del 13,57 % y una perdida de la viabilidad en torno al 20 %. Este estudio abre nuevas líneas de investigación orientadas al conocimiento de la fase de hibernación de los caracoles que manejados adecuadamente permite establecer distintas estrategias reproductivas y de manejo en la producción industrial del caracol terrestre C. aspersus.

Genome-wide linkage analysis and tumoral characterization reveal heterogeneity in familial colorectal cancer type X

BACKGROUND

Familial colorectal cancer type X (FCCTX) fulfils clinical criteria defining Lynch syndrome (LS), but is not related to germline mutations in DNA mismatch-repair genes. Its aetiology remains unexplained and there is little evidence of involvement of the common colorectal carcinogenetic pathways. We aimed to identify susceptibility loci and gain insights into carcinogenic pathways involved FCCTX tumour development.

METHODS

We performed a linkage analysis in 22 FCCTX families. We also constructed a tissue microarray in order to define an immunohistochemical (IHC) profile for FCCTX tumours (N = 27) by comparing them to three other types of colorectal tumors: LS (N = 18), stable early-onset (N = 31) and other sporadic disease (N = 80). Additionally, we screened for BRAF/KRAS mutations and determined CpG island methylator phenotype (CIMP) status for all FCCTX tumours.

RESULTS

We found suggestive evidence of linkage at four chromosomal regions; 2p24.3, 4q13.1, 4q31.21 and 12q21.2-q21.31. We screened genes in 12q21 and ruled out the implication of RASSF9 and NTS, good candidates due to their potential involvement in carcinogenesis and colorectal epithelium development. Based on IHC profiles FCCTX tumours did not form a single, exclusive cluster. They were clearly different from LS, but very similar to stable early onset tumours. The CIMP and chromosomal instability pathways were implicated in one-third and one-quarter of FCCTX cases, respectively. The remaining cases did not have alterations in any known carcinogenic pathways.

CONCLUSIONS

Our results highlight the heterogeneity of FCCTX tumours and call into question the utility of using only clinical criteria to identify FCCTX cases.

Detailed characterization of MLH1 p.D41H and p.N710D variants coexisting in a Lynch syndrome family with conserved MLH1 expression tumors

Lynch syndrome (LS) is an autosomal dominant cancer-susceptibility disease caused by inactivating germline mutations in mismatch repair (MMR) genes. Variants of unknown significance (VUS) are often detected in mutational analysis of MMR genes. Here we describe a large family fulfilling Amsterdam I criteria carrying two rare VUS in the MLH1 gene: c.121G > C (p.D41H) and c.2128A > G (p.N710D). Collection of clinico-pathological data, multifactorial analysis, in silico predictions, and functional analyses were used to elucidate the clinical significance of the identified MLH1 VUS. Only the c.121G > C variant cosegregated with LS-associated tumors in the family. Diagnosed colorectal tumors were microsatellite unstable although immunohistochemical staining revealed no loss of MMR proteins expression. Multifactorial likelihood analysis classified c.2128A > G as a non-pathogenic variant and c.121G > C as pathogenic. In vitro functional tests revealed impaired MMR activity and diminished expression of c.121G > C. Accordingly, the N710 residue is located in the unconserved MLH1 C-terminal domain, whereas D41 is highly conserved and located in the ATPase domain. The obtained results will enable adequate genetic counseling of c.121G > C and c.2128A > G variant carriers and their families. Furthermore, they exemplify how cumulative data and comprehensive analyses are mandatory to refine the classification of MMR variants.

Relationship between Paratuberculosis and the microelements Copper, Zinc, Iron, Selenium and Molybdenum in Beef Cattle

To study the deficiency of minerals and its relationship with Paratuberculosis, blood, serum, and fecal samples were obtained from 75 adult bovines without clinical symptoms of the disease and from two bovines with clinical symptoms of the disease, from two beef herds with a previous history of Paratuberculosis in the Province of Buenos Aires, Argentina. Serum samples were processed by ELISA and feces were cultured in Herrolds medium. Copper, zinc and iron in serum were quantified by spectrophotometry and selenium was measured by the activity of glutathione peroxidase. We also determined copper, zinc, iron and molybdenum concentrations in pastures and the concentration of sulfate in water. Mycobacterium avium subsp paratuberculosis (Map) was isolated from 17.3% of fecal samples of asymptomatic animals and from the fecal samples from the two animals with clinical symptoms. All the Map-positive animals were also ELISA-positive or suspect, and among them, 84.6% presented low or marginal values of selenium and 69.2% presented low or marginal values of copper. The two animals with clinical symptoms, and isolation of Map from feces and organs were selenium-deficient and had the lowest activity of glutathione peroxidase of all the animals from both herds. All the animals negative to Map in feces and negative to ELISA had normal values of Se, while 13.8% of animals with positive ELISA or suspect and culture negative presented low levels of Se. Half of the animals that were negative both for ELISA and culture in feces were deficient in copper but none of them presented low values of selenium. The content of molybdenum and iron in pasture was high, 2.5 ppm and 1.13 ppm in one herd and 2.5 ppm and 2.02 ppm in the other, respectively, whereas the copper:molybdenum ratio was 1.5 and 5.2, respectively. These results do not confirm an interaction between imbalances of the micronutrients and clinical Paratuberculosis, but show evidence of the relationship between selenium deficiencies in animals with Map infection and ELISA positive results.

Abstract 4010: New AXIN2 germline variant in a Spanish family with an attenuated form of FAP without oligondontia or ectodermal dysplasia signs

Familial Adenomatous Polyposis (FAP) is a colorectal cancer syndrome caused mainly by mutations in the APC gene (50-80% of the cases), and some mutations in MUTYH, usually in recessive and milder cases. Additionally, the genetic cause of 20% of classic forms and 50% of attenuated forms of the disease remain unclear. AXIN2 is a partner of the APC protein in the b-catenin destruction complex. Mutations in AXIN2 have been described in patients with oligodontia and other ectodermal dysplasia features in association with colorectal neoplasia or adenomatous polyps. We studied the AXIN2 gene in a series of APC/MUTYH mutation negative families and identified a novel variant, c.1387C&gt;T;p.R463P, as the possible genetic cause of an attenuated FAP phenotype (AFAP). The autosomal dominant AFAP phenotype was not associated with any extracholonic manifestations or ectodermal dysplasia features. However, hyperplastic polyps were observed in some AXIN2-variant carriers. Thus, from a clinical point of view this family displayed some features that differ from previously described families with AXIN2 mutations. The variant c.1387C&gt;T;p.R463P is located in the b-catenin binding domain, an area highly conserved throughout evolution. The variant segregates with the affected family members and was not present in 800 healthy Spanish controls. We were able to confirm loss of heterozygosity in 3 out of 5 polyps from the proband and his affected sister. AXIN2 and b-catenin expression patterns were tested by inmunofluorescence staining: both proteins are overexpressed in adenomatous polyps compared with normal colorectal ephitelium from the proband. Moreover, no colocalization of the two proteins could be observed by confocal microscopy. These results support a possible pathogenic role for this AXIN2 variant in our family and highlight the implication of AXIN2 in some cases of FAP syndrome. We argue comprehensives and functional studies will be necessary to clarify the role of AXIN2 in familial colorectal cancer predisposition.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4010. doi:1538-7445.AM2012-4010

Molecular basis of colorrectal cancer: towards an individualized management?

Colorectal cancer (CRC) has become a highly relevant condition nowadays. In this respect, advances in the understanding of its molecular basis are key for an adequate management. From the time when the adenoma-carcinoma sequence was formulated as a carcinogenesis model to this day, when -among other things- three major carcinogenic pathways have been identified, the CRC concept has evolved from that of a single disease to the notion that each CRC is a differentiated condition in itself. The suppressor or chromosome instability pathway, the mutator or microsatellite instability pathway, and the methylator or CpG island methylation pathway allow various phenotypes to be identified within CRC. Similarly, the presence of different changes in certain genes confers several behaviors on CRC from both the prognostic and responsive standpoints to specific therapies. However, this apparent complexity does help develop the clinical management of this disease through the identification of novel, more specific therapy targets, and also markers for various behaviors within the condition, which will most likely lead us to an individualized management for these patients.

Sustentabilidad de agroecosistemas

En este trabajo se revisan, desde la perspectiva de los agroecosistemas, los conceptos de susten-tabilidad reflejados en sus dimensiones: ecológica, social y económica, así como lo relativo al grado de sustitución entre capital natural y humano que se manifiesta en las versiones de la sustentabilidad: débil, que asume la capacidad de sustitución total entre estos recursos, y fuerte que postula que los sistemas naturales son de mayor entidad que los criterios de eficiencia económica. Entre las características principales de sustentabilidad de los agroecosistemas, la resiliencia, asociada a la estabilidad económica y la estabilidad social, debe ser considerada como la desencadenante de la continuidad o discontinuidad de los sistemas. La conveniencia debe ser abordada abandonando los conceptos antropocéntricos y productivistas del corto plazo en beneficio de una concepción holística de los sistemas de producción. Por último, la escala, espacial o temporal, es el factor que permite una cierta adaptación al sistema analizado, modulando la escala temporal a la jerarquización y complejidad de los sistemas agropecuarios y estableciendo como unidad espacial la explotación, sin olvidar la interacción con las actividades de explotaciones adyacentes.

Approach to early-onset colorectal cancer: Clinicopathological, familial, molecular and immunohistochemical characteristics

AIM: To characterize clinicopathological and familial features of early-onset colorectal cancer (CRC) and compare features of tumors with and without microsatellite instability (MSI).

METHODS: Forty-five patients with CRC aged 45 or younger were included in the study. Clinical information, a three-generation family history, and tumor samples were obtained. MSI status was analyzed and mismatch repair genes were examined in the MSI families. Tumors were included in a tissue microarray and an immunohistochemical study was carried out with a panel of selected antibodies.

RESULTS: Early onset CRC is characterized by advanced stage at diagnosis, right colon location, low-grade of differentiation, mucin production, and presence of polyps. Hereditary forms represent at least 21% of cases. Eighty-one percent of patients who died during follow-up showed a lack of expression of cyclin E, which could be a marker of poor prognosis. β-catenin expression was normal in a high percentage of tumors.

CONCLUSION: Early-onset CRC has an important familial component, with a high proportion of tumors showing microsatellite stable. Cyclin E might be a poor prognosis factor.

Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history

The importance of colorectal cancer (CRC) is increasing. A proportion show a hereditary component, as in Lynch syndrome and Familial Adenomatous Polyposis, and a recently defined entity as well, namely, Familial Colorectal Cancer type X. The high probability to develop CRC in these groups may, at the time of recognition, change surgical management, including its timing or even the surgical technique. In some cases prophylactic surgery can play an important role. The possibility of using tools that allow recognition of the aforementioned syndromes, including microsatellite instability, immunohistochemistry for DNA mismatch repair system proteins, and especially their mutations, is on the basis of therapeutic strategies that differ from those employed in sporadic CRC cases.

Evaluación de la sustentabilidad en agroecosistemas

La sustentabilidad requiere ser valorada con el propósito final de implementar técnicas o tecnologías que mejoren o minimicen el impacto ambiental, para ello deben emplearse escalas de medición ordinales, que permitan su categorización. Indicadores e índices surgen como la base de las metodologías de evaluación de sustentabilidad, debiendo cumplir una serie de requisitos para ser de utilidad. Entre estos requisitos, la integración de las tres dimensiones de la sustentabilidad (económica, social y ambiental) es básica. La evaluación se sustenta en el empleo de indicadores que describen una característica del estado de un sistema, generalmente a través de datos observados o estimados, e índices que consisten en una agregación cuantitativa de indicadores. Los indicadores se generan del análisis de los procesos que utilizan recursos ambientales para producir resultados y pueden ser medioambientales o de sustentabilidad (cuando se tienen en cuenta los factores de tiempo, límites y objetivos) Índices como la Huella Ecológica, el Índice de Desarrollo Humano, el Producto Interno Bruto, entre otros informan tanto del grado de inequidad global como de la sobreutilización de recursos por parte de las economías de algunos países, Pero también con aplicación a sectores productivos, como por ejemplo a la ganadería. En agroecosistemas se ha definido un gran número de indicadores dependientes del sistema en estudio, la mayor parte centrados en la productividad o los retornos económicos de la explotación. Tanto ecuaciones de regresión como modelos de simulación han sido utilizados para la estimación de indicadores, debido a la dificultad de obtención de medidas directas o con el propósito de descubrir qué efectos tendrá en el futuro una medida adoptada hoy.

Caracterización estructural de los sistemas ganaderos de las dehesas andaluzas

Mediante análisis multivariante se establecieron tres tipos de sistemas ganaderos en las dehesas andaluzas. En 49% de las explotaciones se detectó un sistema ganadero denominado conservacionista de dehesa que corresponde a pequeñas explotaciones de bovino y ovino con bajo nivel de intensificación y carga ganadera ajustada a la disponibilidad alimenticia usando ocasionalmente suplementación estratégica. Las explotaciones (21%) del sistema conservacionista de sierra y montaña son también de reducida dimensión, con predominio de pequeños rumiantes y bajo empleo de tecnología. El sistema productivista (30% de las explotaciones) corresponde a ganaderías con predominio de bovinos, de mayor dimensión y nivel tecnológico que utilizan elevados niveles de suplementación pues sus cargas ganaderas están por encima de la capacidad de la dehesa. Los tipos establecidos pueden servir de punto de partida para la caracterización técnica y económica de los sistemas ganaderos considerando su viabilidad actual y futura.

Clinicopathologic and pedigree differences in amsterdam I-positive hereditary nonpolyposis colorectal cancer families according to tumor microsatellite instability status

PURPOSE

To establish the clinicopathologic and familial differences within Amsterdam I-positive families, showing either tumor microsatellite instability (MSI) or microsatellite stability (MSS) in order to confirm or deny the existence of hereditary nonpolyposis colorectal cancer (HNPCC) without defects in the mismatch repair system.

PATIENTS AND METHODS

Sixty-four Amsterdam I-positive families were included in the study for which full, three-generation, family medical histories and colorectal paraffin-embedded tumors were obtained. Both personal and clinicopathologic information of patients were collected. In all cases, both the MSI status and the mismatch repair (MMR) protein expression were analyzed. MMR genetic testing was performed on the MSI families.

RESULTS

Of the Amsterdam I-positive families, 59.4% were tumor MSI, and 40.6% were tumor MSS. When comparing both groups, the statistical differences were observed in the age of onset (MSI, 41 years; MSS, 53 years); in the colorectal tumor location, more frequently proximal in MSI cases; in fewer mucinous tumors in MSS; and loss of MMR protein expression in the MSI tumors. Regarding the individual and familial cancer history, we observed a predominance of individuals with multiple primary tumors in MSI pedigrees, as well as differences in the type of tumors developed within the family.

CONCLUSION

Our findings support the suspicion of another hereditary colorectal syndrome different from HNPCC and characterized by MSS, the normal MMR immunohistochemical expression, the presence of only colorectal tumors, and the absence of individuals with multiple primary tumors. All these circumstances suggest the existence of a non-MMR gene being responsible for this new syndrome.

Surgical-glove-related diffuse lamellar keratitis after laser in situ keratomileusis: long-term outcomes

PURPOSE

To study the long-term refractive results in eyes that developed surgical-glove-related diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK).

SETTING

Department of Ophthalmology, Hospital Provincial, Toledo, Spain.

METHODS

This retrospective review analyzed an epidemic of surgical-glove-related DLK over a 5-month period at a single hospital. Twenty-four eyes (24 patients) that developed DLK (DLK group) were compared to 30 eyes (30 consecutive patients) that had surgery during the same time but had an uneventful postoperative course (control group). Follow-up was 12 months in all cases.

RESULTS

Twelve months after LASIK, the mean spherical equivalent was 0.14 diopter (D) +/- 0.36 (SD) in the DLK group and -0.07 +/- 0.33 D in the control group (P=.03). The mean uncorrected visual acuity was 0.91 +/- 0.18 and 0.90 +/- 0.17, respectively (P = .81). The mean best spectacle-corrected visual acuity (BSCVA) was 0.97 +/- 0.08 in the DLK group and 0.99 +/- 0.06 in the control group (P = .42). At 1 year, 91.7% of eyes in the DLK group and 93.3% of eyes in the control group were within +/-0.50 D of the attempted correction (P = .82). The BSCVA was 1.0 or better in 87.5% and 93.3%, respectively (P =.46).

CONCLUSIONS

Early diagnosis and appropriate treatment of glove-related DLK provided visual outcomes that were similar to those in eyes with an uneventful postoperative course. These good results are consistent with those in studies of classic DLK.