Abstract PD4-06: PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data

Background: Breast cancer (BC) is one of the cancer types recognized as an obesity-associated disease. Current understandings of molecular mechanisms underlying the BC-obesity connection however largely came from experimental models while systematic investigation of the impact of obesity on BC biology in large patient series is still lacking. The purpose of this study is to discover changes in the transcriptomic profile of primary BC according to patients’ body mass index (BMI). Data and Methods: Bulk and single-cell gene expression data from treatment-naïve primary breast tumors from non-underweight patients were retrieved from the MINDACT trial (NCT00433589; N = 1481) and the pre-treatment cohort of the BioKey trial (NCT03197389, N = 36), respectively. Three categories were considered for BMI: lean, overweight and obese. The main analyses focused on the invasive carcinoma of no special type (NST) estrogen receptor-positive/HER2-negative (ER+/HER2-, N_bulk = 735, N_single-cell(sc) = 10) and NST ER-/HER2- (N_bulk = 118, N_sc = 15) subgroups. The bulk expression data was subjected to differential gene expression analyses according to BMI which was adjusted for menopausal status and tumor grade, then followed by gene set enrichment analyses. Clustering and cluster annotation were performed on the single-cell profiling data before differentially expressed genes according to BMI were identified for each of the present cell types. Results: Obesity-associated differences in the transcriptomic profile of breast tumors, which were subtle but potentially indicative of a biological relationship, were revealed by the bulk data. In both investigated subgroups, tumors from obese patients were shown to be enriched in cell cycle hallmarks. In ER-/HER2- tumors, adiposity further increased MYC signaling. We also observed different obesity-associated changes according to the ER status. Among ER+/HER2- tumors, those from obese patients were enriched in hallmarks related to inflammatory response compared to those from lean patients. In contrast, these hallmarks appeared to be enriched in the ER-/HER2- tumors from lean patients. Our investigation of the single-cell data further revealed shifts in the cell composition of tumor tissue and cell type-specific transcriptomic differences according to BMI which were more pronounced than those detected from the bulk data. ER+/HER2- tumors from obese patients have a higher frequency of immunosuppressive and pro-tumoral cell subpopulations such as dendritic cells (DC) enriched in immunoregulatory molecules (p = .03), LYVE1+ macrophages (p = .02) and myofibroblasts (p = .03) than those from lean patients. Overexpression of Cyclin D1 and CD24 was found in cancer cells in ER+/HER2- tumors from obese patients. A reduction in anti-tumor immune responses was evident with downregulation of multiple interferons in CD8+ and CD4+ T cells as well as B cells. We observed in the ER-/HER2- subgroup increased infiltration of plasmacytoid DC (p = .01), CCL2+ macrophages (p = .01) in tumors from obese versus lean patients, while fibroblasts showed an opposite tendency. Additionally, significant obesity-associated downregulation of major histocompatibility complex (MHC) molecules class I in cancer cells and MHC class II molecules in B cells could be suggestive of deficient antigen presentation and activation of cytotoxic and helper T cells. Conclusion: We highlighted the impact of obesity on the remodeling of tumor and tumor microenvironment which might generally lead to a suppression of anti-tumor immune responses, albeit potentially via diverse axes according to the ER status. Although investigation on a larger cohort is warranted, our current results suggest that obesity-associated transcriptomic changes in BC could be highly cell type-specific, hence we recommend single-cell approaches in addition to spatial multi-omics analysis to further elucidate the interplay between obesity and BC.

Citation Format: Ha-Linh Nguyen, Tatjana Geukens, Marion Maetens, Karen Van Baelen, Maxim De Schepper, Coralie Poncet, Mauro Delorenzi, Marjanka K. Schmid, Emiel Rutgers, Laura Van ’t Veer, Martine Piccart, Fatima Cardoso, Giuseppe Viale, Ayse Bassez, Hanne Vos, Patrick Neven, Ines Nevelsteen, Kevin Punie, Hans Wildiers, Giuseppe Floris, Diether Lambrechts, Ann Smeets, Elia Biganzoli, François Richard, Christine Desmedt. PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD4-06.

Accuracy of Focal Laser Treatment Based on External Imaging (OCT) Using a Navigated Retinal Laser System - a Case Series

Background The navigated laser photocoagulation system (NAVILAS®, OD-OS GmBH, Teltow, Germany) is a laser treatment device that provides navigated laser treatment of the retina based on a fundus image. The purpose of this study was to investigate the accuracy of laser treatment based on external optical coherence tomography (OCT) images - a new application of the device. Patients and Methods This retrospective case series evaluated the accuracy of laser spot placement in 7 eyes after using overlaid external OCT images for planning NAVILAS laser treatment. After a mean time of 33 days, a post-treatment OCT was obtained and compared with the pretreatment plan on the previous OCT. Laser spots touching or overlapping the planned 100 µm laser spots were classified as "match" and invisible laser spots as "laser spot not evolved". Results A total of 477 laser spots in 7 eyes were evaluated (mean: 68 spots per eye). Of all planned laser spots, 361 (75.7 %) were visible on post-treatment OCT. 58.7 % of these spots matched the pretreatment plan. Non-matching laser spots showed no uniform pattern of dislocation. Conclusions Planning navigated NAVILAS Laser treatment based on manually imported OCT images seems to be less accurate than planning with NAVILAS integrated imaging. These findings warrant further evaluation, not only regarding the recently installed automated picture importing tool but also concerning its clinical impact, which is possibly outweighed by the advantages of the additional image information.

[Complications of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)]

BACKGROUND

Lamellar keratoplasties, e.g. Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) are considered the procedures of choice for corneal endothelial diseases. In comparison to penetrating keratoplasty (PK) they are associated with faster visual rehabilitation, a lower risk of complications and a decreased necessity for follow-up visits, which reduces the burden on quality of life in elderly patients. In order to advise patients regarding the indications for surgery and to facilitate the follow-up management, it is important to know the most important complications associated with these keratoplasty techniques.

RESULTS AND DISCUSSION

The most important preoperative complication is a delayed indication for the operation. In contrast to PK, DSAEK and DMEK surgery should be provided at an earlier stage of disease as chronic edema alters the stroma and reduces the speed of visual recovery. The most important complications during or early after surgery are detached lamellae, pupillary blocks with increased pressure or air bubbles in the vitreous cavity in patients with previous vitrectomy. The main long-term complications include chronic increased intraocular pressure and immune-mediated graft rejections in DSAEK patients after reducing or stopping topical corticosteroid therapy. This article describes the potential complications of endothelial keratoplasty and provides a detailed explanation of strategies to avoid these complications.

Blood flow velocity measured using the Retinal Function Imager predicts successful ranibizumab treatment in neovascular age-related macular degeneration: early prospective cohort study

PURPOSE

Anti-VEGF treatment has a potent vasoconstrictive effect. Early changes of retinal blood flow velocity (RBFV) measured using the Retinal Function Imager (RFI) combined with indicators of vascular status may help in predicting the visual outcome 1 month post injection in patients with neovascular age-related macular degeneration (nvAMD) under ranibizumab treatment. To develop a simple prediction model based on the change in RBFV 3 days post injection and indicators of a patient's vascular status to assess the probability of a successful visual outcome 1 month post injection.

METHODS

RBFV measured using RFI were prospectively collected pre-injection and 3 days post injection in 18 eyes of 15 patients. Indicators of vascular status (history of hypertension, diabetes mellitus without retinal affection, and smoking) were assessed by medical history. By univariate analyses, parameters associated with visual outcome were weighted (-1 to 6 points). A multivariate logistic regression model with the categorized visual outcome parameter (≥0 letters gained after 1 month) as the dependent variate and the sum score as the independent variate (continuous scale) was used to estimate the score value-specific probabilities of letters gained ≥0 1 month post injection.

RESULTS

The indicators of vascular status negatively influenced the likelihood of a letter gain ≥0 whereas an increase in the arterial RBFV strongly increased it. The area under the receiver operating characteristics curve for these parameters investigated was 0.71 (95% CI: 0.43-1.00).

CONCLUSION

Changes in the arterial RBFV following 3 days after ranibizumab injection combined with three indicators of the vascular status identified nvAMD patients with favorable visual outcome accurately.

Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

OBJECTIVE

To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD).

EVIDENCE ACQUISITION

Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate.

EVIDENCE SYNTHESIS

Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modifications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a case-control design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% confidence intervals; 0.64-0.87), and the pooled specificity was 0.97 (95% confidence intervals; 0.91-0.99). The corresponding positive and negative likelihood ratios were 23.1 (95% confidence intervals; 8.4-64.0) and 0.23 (95% confidence intervals; 0.14-0.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% confidence intervals; 0.80-0.89), and specificity was 0.87 (95% confidence intervals; 0.82-0.91). The corresponding positive and negative likelihood ratios were 6.7 (95% confidence intervals; 4.6-9.8) and 0.17 (95% confidence intervals; 0.13-0.23). No pooling was possible for MCPT and M-charts.

CONCLUSION

Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these findings can be transferred to a real clinic practice still needs to be established.

["Floaterectomy"--pars-plana-vitrectomy for vitreous opacities]

BACKGROUND

Patients suffer from vitreous opacities, despite good visual acuity. The lack of objective measurements may make it difficult to justify the indication for vitreous surgery.

PATIENTS AND METHODS

We analysed retrospectively the outcome of 90 eyes/ 67 patients, age 20 - 86 years (mean 60 +/- 19) after pars plana vitrectomy (ppv) for vitreous opacities. Follow-up was 6 - 40 months (mean 19 +/- 9). Additional pathologies (except cataract) possibly affecting the functional outcome were present in 33 % (uveitis 8 %, premacular membrane 10 %, other 15 %). The technique consisted of a standard 3-port vitrectomy (44 % 25-gauge, 46 % 20-gauge). In 78 % ppv was combined with phacoemulsification + IOL implantation.

RESULTS

Mean preoperative visual acuity was 0.6, postoperative 1.0 (+ 2.3 lines, p > 0.0001). One eye lost 2 lines. Peripheral retinal tears occurred in 11 %. Long-term complications (12 - 31 months) consisted of premacular membrane formation (1), luxation of the IOL/capsular bag. Secondary interventions included YAG capsulotomy (4) and glaucoma surgery (1). 94 % of all patients (98 % if additional pathologies were excluded) were satisfied with the outcome.

CONCLUSIONS

Pars plana vitrectomy for vitreous opacities is safe and effective. Careful patient selection is crucial.

[Sclerochoroidal calcifications with vision-threatening choroidal neovascularisation]

BACKGROUND

Sclerochoroidal calcification is an uncommon ocular condition in elderly patients. The lesions are frequently bilateral and located at the superotemporal quadrant. The diagnosis is made by fundoscopic appearance, angiography and echography.

HISTORY AND SIGNS

A 75-year-old man was referred with bilateral choroidal lesions and visual deterioration in the right eye. Examination revealed apart from old signs of a multifocal choroiditis also bilateral, elevated, yellow lesions located at the upper temporal arcades. In the right eye one lesion was accompanied by hemorrhages, edema and lipid exudates. A subsequent fluorescein angiography disclosed choroidal neovascularisation. Ultrasonography showed the characteristic findings of highly reflective lesions with acoustic shadowing. Serum calcium and phosphate levels were normal.

THERAPY AND OUTCOME

Because of rapid visual deterioration on the right eye Ranibizumab (Lucentis) was injected intravitreal.

CONCLUSIONS

Despite their good prognosis, sclerochoroidal calcifications associated with neovascular membranes can become a vision-threatening disorder.

[Ocular barostress and barotrauma. A study of 15 scuba divers]

BACKGROUND

During SCUBA-diving, relative changes of the pressure in the diving mask, compared to the environmental pressure, are transmitted to the eye and to the periocular tissue. Barotrauma results from lack of pressure equilibration.

MATERIAL AND METHODS

In 15 divers (6 experienced, 9 beginners) the pressure difference (delta-p) between inside and outside of the diving mask was measured every second during recreational SCUBA-diving. Data were transmitted wireless to a modified standard diving computer. An overall dive time of 323 minutes was analysed.

RESULTS

Mean delta-p was 14.8 mbar (-44 to , std.dev. +/- 9), it was not dependent on the diving depth (r2 = 0.0004). Delta-p oscillated between 0 and 25 mbar (0-19 mm Hg), parallel to respiration. Negative delta-p values were 9.5 times more frequent in beginners than in experienced divers. Negative pressure peaks (changes > or = 10 mbar for more than 6 sec) occurred in the beginner group exclusively (p = 0.01).

CONCLUSIONS

During SCUBA diving, ocular tissues undergo oscillating changes of environmental pressure, parallel to respiration. This may be important in eyes with previous surgery. Pressure peaks, leading to severe ocular barotrauma, are easily avoidable.

[Perioperative circulatory side effects of topical 5% phenylephrine for mydriasis]

PURPOSE

To study the systemic effects of topically applied 5% phenylephrine. To investigate intraoperative injection of epinephrine in the anterior chamber as an alternative.

METHOD

75 patients undergoing cataract surgery were randomized into three groups. In group 1, the pupil was dilated using topically 5% phenylephrine and 1% cyclopentolate, the patients blocked the lacrimal drainage system themselves by digital compression. Group 2 received the same drops, digital compression was performed by one of the investigators. In Group 3, no preoperative phenylephrine was used--instead, epinephrine 1:25,000 was injected in the anterior chamber at the beginning of surgery. Retrobulbar anesthesia was performed in a short narcosis with ketamine and propofol.

RESULTS

Mean preoperative blood pressure values were higher than the day before. They fell during narcosis, to increase significantly after the injection of the local anesthetics. At the beginning of surgery they were back to prenarcotic values. Intraoperative blood pressure remained stable. Preoperative day values were found two hours postop. There was no significant difference in the circulatory behavior between the three groups. For mydriasis, intraoperative intracameral epinephrine was not as effective as preoperative phenylephrine.

CONCLUSION

In normotonic or medically treated arterial hypertensive patients, preoperative mydriasis using 5% phenylephrine is safe--proceeding the way described above. Compression of the lacrimal drainage system can be performed by the patients effectively. Intraoperative intracameral epinephrine does not replace preoperative phenylephrine.

Interaction between silicone oil and silicone intraocular lenses: an in vitro study

The objective of this study was to examine the interaction between silicone oil and silicone intraocular lenses (IOLs) in vitro. Six types of silicone IOLs were placed in silicone oil (1000 or 5000 centistokes) for 1 minute, 7 days, and 420 days. Slit-lamp examination, target photographs, and opacity measurements were performed. Optical measurements were repeated in a balanced salt solution after removal from the oil. The IOL surface was examined through scanning electron microscopy, and surface irregularities underwent x-ray spectroscopy. No changes were observed while the IOLs were stored in silicone oil, but in the balanced salt solution, the IOLs were observed to have a layer of silicone oil droplets that reduced the optical quality. Scanning electron microscopy showed that oil-coated foreign body particles were simulating IOL surface defects. After ultrasonic cleaning with ethanol, the oil layer was broken, and no damage to the IOL surface could be detected. The length of exposure to silicone oil, the type of oil, and the type of IOL were found to have no bearing on the interaction between silicone oil and silicone IOLs. Although no surface damage is incurred by silicone IOLs from silicone oil, the reduction in optical quality and fundus view due to remnant oil droplets seems to indicate that complex cases requiring silicone oil injection may contraindicate IOLs made of silicone.

Reproducibility of the data determined by scanning laser polarimetry

BACKGROUND

Scanning laser polarimetry is a tool for measuring the retinal nerve fiber layer: both its cross-sectional surface (polarimetric data analysis) and its thickness (mean sector values).

METHODS

Two observers examined 56 normal volunteers twice by means of scanning laser polarimetry (Nerve Fiber Analyzer type 1, software version 1.6). Measurements of the retinal nerve fiber layer were carried out in four equal sectors of a circle around the optic nerve head. The measured values of the sectors and the calculated ratios among them were used for statistical analysis. Interobserver and intraobserver reproducibility were analyzed following a balanced random three-way cross classification with interactions. Interobserver reproducibility was defined as the part of variance not influenced by the observers. Intraobserver reproducibility was defined as the part of variance not influenced by the time.

RESULTS

For repeated measurements of the retinal nerve fiber layer, better intraobserver than interobserver reproducibility was found (0.57-0.79 vs 0.11-0.44). The interobserver reproducibility was improved (0.24-0.65) in comparison to the intraobserver reproducibility (0.32-0.68) by calculating the ratios of the measured values.

CONCLUSION

The instrument is clinically useful only if used by the same observer. If measurements are performed by different observers the ratios of the measurements must be used. Further development in the apparatus is needed to improve interobserver reproducibility.