Kinesin Facilitates Phenotypic Targeting of Therapeutic Resistance in Advanced Prostate Cancer

Understanding the mechanisms underlying resistance is critical to improving therapeutic outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC). Previous work showed dynamic interconversions between epithelial-mesenchymal transition (EMT) to mesenchymal-epithelial transition (MET) defines the phenotypic landscape of prostate tumors, as a potential driver of emergence of therapeutic resistance. In this study, we use in vitro and in vivo preclinical MDA PCa PDX models of resistant human prostate cancer to determine molecular mechanisms of cross-resistance between anti-androgen therapy and taxane chemotherapy, underlying the therapeutically resistant phenotype. Transcriptomic profiling revealed that resistant and sensitive prostate cancer C4-2B cells have a unique differential gene signature response to cabazitaxel. Gene pathway analysis showed that sensitive cells exhibit increase in DNA damage, while resistant cells express genes associated with protein regulation in response to cabazitaxel. These PDX specimens are from patients who have metastatic lethal CRPC, treated with androgen-deprivation therapy (ADT), antiandrogens and chemotherapy including 2nd line taxane chemotherapy, cabazitaxel. Immunohistochemistry revealed high expression of E-cadherin and low expression of vimentin resulting in re-differentiation toward an epithelial phenotype. Furthermore, the mitotic kinesin-related protein (HSET) involved in microtubule binding and the SLCO1B3 transporter (implicated in cabazitaxel intracellular transport), associated with resistance in these prostate tumors. Combinational targeting of kinesins (ispinesib) with cabazitaxel was more effective than single monotherapies in inducing cell death in resistant prostate tumors. Implications: Our findings are of translational significance in identifying kinesin as a novel target of cross-resistance, towards enhancing therapeutic vulnerability and improved clinical outcomes in patients with advanced prostate cancer.

Bone mimetic environments support engineering, propagation, and analysis of therapeutic response of patient-derived cells, ex vivo and in vivo

Bone metastases are the most common milestone in the lethal progression of prostate cancer and prominent in a substantial portion of renal malignancies. Interactions between cancer and bone host cells have emerged as drivers of both disease progression and therapeutic resistance. To best understand these central host-epithelial cell interactions, biologically relevant preclinical models are required. To achieve this goal, we here established and characterized tissue-engineered bone mimetic environments (BME) capable of supporting the growth of patient-derived xenograft (PDX) cells, ex vivo and in vivo. The BME consisted of a polycaprolactone (PCL) scaffold colonized by human mesenchymal stem cells (hMSCs) differentiated into osteoblasts. PDX-derived cells were isolated from bone metastatic prostate or renal tumors, engineered to express GFP or luciferase and seeded onto the BMEs. BMEs supported the growth and therapy response of PDX-derived cells, ex vivo. Additionally, BMEs survived after in vivo implantation and further sustained the growth of PDX-derived cells, their serial transplant, and their application to study the response to treatment. Taken together, this demonstrates the utility of BMEs in combination with patient-derived cells, both ex vivo and in vivo. STATEMENT OF SIGNIFICANCE: Our tissue-engineered BME supported the growth of patient-derived cells and proved useful to monitor the therapy response, both ex vivo and in vivo. This approach has the potential to enable co-clinical strategies to monitor bone metastatic tumor progression and therapy response, including identification and prioritization of new targets for patient treatment.

Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study

PURPOSE

Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023.

MATERIALS AND METHODS

This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences.

RESULTS

Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward.

CONCLUSION

This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.

ETV4 mediates dosage-dependent prostate tumor initiation and cooperates with p53 loss to generate prostate cancer

The mechanisms underlying ETS-driven prostate cancer initiation and progression remain poorly understood due to a lack of model systems that recapitulate this phenotype. We generated a genetically engineered mouse with prostate-specific expression of the ETS factor, ETV4, at lower and higher protein dosage through mutation of its degron. Lower-level expression of ETV4 caused mild luminal cell expansion without histologic abnormalities, and higher-level expression of stabilized ETV4 caused prostatic intraepithelial neoplasia (mPIN) with 100% penetrance within 1 week. Tumor progression was limited by p53-mediated senescence and Trp53 deletion cooperated with stabilized ETV4. The neoplastic cells expressed differentiation markers such as Nkx3.1 recapitulating luminal gene expression features of untreated human prostate cancer. Single-cell and bulk RNA sequencing showed that stabilized ETV4 induced a previously unidentified luminal-derived expression cluster with signatures of cell cycle, senescence, and epithelial-to-mesenchymal transition. These data suggest that ETS overexpression alone, at sufficient dosage, can initiate prostate neoplasia.

Abstract 142: Candidate measures of lineage plasticity in aggressive phenotypes of prostate cancer

Lineage plasticity in cancer reflects the property of neoplastic cells to adapt to external pressures by switching between different developmental pathways. While some prostate cancers appear “constrained” to a luminal epithelial lineage despite progression on androgen signaling inhibitors, others exhibit a “lineage-promiscuous” phenotype under the pressures of these therapies. However, a clinically applicable marker that quantifies lineage plasticity has yet to be developed. To address this knowledge gap, we applied single-cell genomics and bulk epigenetic profiling to two patient derived xenografts (PDXs) derived before and after chemotherapy from the castration-resistant prostate tumor of a 42-year-old with a PSA 486, Gleason 5+4, cT4N1M1b PCa, who succumbed to his disease within 21 months of diagnosis. We reasoned that the two PDXs, MDA PCa 177-B (AR negative, basal transcriptional profile) and MDA PCa 189-1 (AR positive, luminal transcriptional profile), should share the property of lineage plasticity and serve to define candidate measurable signatures of this property. Targeted and single-cell DNA sequencing showed that the two models share 66.8% of their annotated mutations, 71.5% of copy number variations, and a common ancestor in their phylogeny, confirming their common clonal origin. Single-cell RNA sequencing revealed the presence of a cluster of cells shared by both PDXs that contained a highly mixed program, similar to a “high-plasticity cell state” (HPCS) previously implicated in the emergence and maintenance of cellular heterogeneity in genetically engineered mouse models of lung cancer (Marjanovic et al PMID: 32707077). H3K27ac, H3K27me3 and H3K4me3 chromatin immunoprecipitation followed by sequencing and reduced representation bisulfite sequencing performed in triplicates revealed chromatin profiles shared by both PDX models, and being absent from normal prostate specimens in publicly available datasets. In conclusion, our data supports the hypothesis that the property of lineage plasticity can be reflected in a biomarker signature and used as a measurable metric. Ongoing are evaluation of the candidate signatures in publicly available datasets representative of the spectrum of the disease in patient samples, and assessment of the effects of systemic therapies (including epigenetic modulators) on the property of lineage plasticity in clinical and co-clinical samples.

Citation Format: Souzana Logotheti, Haswanth Vundavilli, Eugenia Papadaki, Yuehui Zhao, Marcos Roberto Estecio, Rama Soundararajan, Peter Shepherd, Jiabin Dong, Anh Hoang, Shuai Guo, Nora Navone, Vasiliki Tzelepi, Christopher Logothetis, Yue Lu, Aristidis Vrahatis, Wenyi Wang, Ana Aparicio. Candidate measures of lineage plasticity in aggressive phenotypes of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 142.

Abstract 4760: KDM4A promotes NEPC progression through regulation of MYC expression

Despite advancements in treatment, prostate cancer (PCa) remains the second leading cause of death among men. Neuroendocrine prostate cancer (NEPC) represents one of the most lethal forms of PCa and lacks life-prolonging treatment. Here we identified histone lysine demethylase KDM4A as a driver in NEPC progression and an effective therapeutic target. KDM4A mRNA and protein are overexpressed in human and mouse NEPC compared to adenocarcinoma. Knockdown or knockout of KDM4A in NEPC cell lines suppressed cancer cell growth in vitro and in vivo. Importantly, the inactivation of Kdm4a in a genetically engineered mouse model of prostate cancer reduces tumor burden, reduces the incidence of NEPC, and prolongs overall survival. Mechanistically, KDM4A directly regulates the transcription of MYC, which is hyper-activated in human and mouse NEPC. Furthermore, a potent pan-KDM4 inhibitor QC6352 significantly reduces NEPC cell growth in vitro and in vivo. Taken together, we demonstrate that KDM4A promotes NEPC progression through regulation of MYC expression and targeting KDM4A can be an effective therapeutic strategy for NEPC.

Citation Format: Celia Sze Ling Mak, Ming Zhu, Xin Liang, Feng Wang, Anh G. Hoang, Xinzhi Song, Peter Shepherd, Derek Liang, Jessica Suh, Jiwon Park, Miao Zhang, Eric Metzger, Roland Schule, Abhinav K. Jain, Ellen Karasik, Barbara A. Foster, Min Gyu Lee, Paul Corn, Christopher J. Logothetis, Ana Aparicio, Nora Navone, Patricia Troncoso, Jianhua Zhang, Sue-Hwa Lin, Guocan Wang. KDM4A promotes NEPC progression through regulation of MYC expression. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4760.

A 3D Perfusable Platform for In Vitro Culture of Patient Derived Xenografts

Many advanced cancer models, such as patient-derived xenografts (PDXs), offer significant benefits in their preservation of the native tumor's heterogeneity and susceptibility to treatments, but face significant barriers to use in their reliance on a rodent host for propagation and screening. PDXs remain difficult to implement in vitro, particularly in configurations that enable both detailed cellular analysis and high-throughput screening (HTS). Complex multilineage co-cultures with stromal fibroblasts, endothelium, and other cellular and structural components of the tumor microenvironment (TME) further complicate ex vivo implementation. Herein, the culture of multiple prostate cancer (PCa)-derived PDX models as 3D clusters within engineered biomimetic hydrogel matrices, in a HTS-compatible multiwell microfluidic format, alongside bone marrow-derived stromal cells and a perfused endothelial channel. Polymeric hydrogel matrices are customized for each cell type, enabling cell survival in vitro and facile imaging across all conditions. PCa PDXs demonstrate unique morphologies and reliance on TME partners, retention of known phenotype, and expected sensitivity or resistance to standard PCa therapeutics. This novel integration of technologies provides a fully human model, and expands the information to be gathered from each specimen, while avoiding the time and labor involved with animal-based testing.

The lessons learned working in diagnostic and therapeutic radiography departments through the COVID-19 pandemic in Northern Ireland, UK. What can we do differently the next time?

INTRODUCTION

Following the emergence of the COVID-19 pandemic in January 2020, a radical restructure of NHS services occurred, prioritising the acute needs of infected patients. This included suspending routine procedures, leading to an inevitable resurgence in the future, placing increased demands on the NHS, including diagnostic and therapeutic radiographers. With radiography departments already experiencing staff shortages due to COVID-19 related illnesses and vulnerable staff shielding, there is a need to implement plans within radiography departments to ensure their sustainability in the future.

METHODS

A mixed methods study was undertaken in Northern Ireland, involving distribution of a survey to diagnostic and therapeutic radiographers alongside conducting interviews with radiography department managers.

RESULTS

106 radiographers completed the survey, with 9 radiography managers and 2 band eight superintendents participating in interviews. Over 60% of participants felt that morale declined in their departments, with the majority feeling that the pandemic had a negative impact on their physical or mental health and wellbeing. Managers felt that to improve staff morale and motivation, incentives need to be offered including remuneration, flexible working and support for professional development.

CONCLUSION

Whilst predicting when the next wave of a COVID-19 variant or the next pandemic will occur is impossible, preparation and planning will help manage the situation better. This requires identifying clinical areas for expansion/retraction and having access to additional staff to meet the demands on the service to ensure all patients receive care not just those acutely ill.

IMPLICATIONS FOR PRACTICE

This study has identified key lessons learned from the pandemic within the radiography departments. This will enable preparation and strategic planning for future pandemics.

The impact of COVID-19 on the mental health of radiography staff and managers in Northern Ireland, UK: The radiography managers’ perspective

Introduction

Increasing evidence suggests that the COVID-19 pandemic has influenced the mental health of health professionals, including radiographers. Less is known about the effect of the pandemic on the mental health of radiography managers. Radiography managers have led their teams through the pandemic, making unpopular decisions to safeguard staff and patients. This study explores radiography managers’ perceptions regarding the impact of the COVID-19 pandemic on the mental health of themselves and their staff.

Methods

Ethical approval was obtained from the NHS Research Ethics Committee (ID 287032). Eleven interviews were conducted with therapeutic and diagnostic radiography managers between March–April 2021. Written information was also included from a paediatric diagnostic radiography manager. Data was analysed independently by 2 researchers using thematic analysis.

Results

Three central themes emerged:

1) Factors perceived to have negatively influenced mental health, which included changing PPE guidance, restructuring of work conditions, social isolation, challenges to patient care and lack of quality vacation leave.

2) Factors perceived to have positively influenced mental health, which included witnessing staff resilience and team camaraderie.

3) Support provided for mental health.

Conclusion

Managers felt that they had implemented appropriate strategies to support their staff throughout the first year of the pandemic and expressed feeling responsible for the wellbeing of their staff. Strong empathy was evident towards staff and their experiences. Despite the availability of mental health support services, managers felt that resources were underutilised by radiography teams.

Implications for practice

Managers should be proactive in communicating their appreciation for their staff in an era where remote working can add to disconnect between staff and management. Mental health support services should be promoted and continually reviewed, to ensure that appropriate support services are maintained.

Abstract 2641: Development of a 3D in vitro model of the prostate tumor microenvironment

Prostate cancer (PCa) is the most common occurring cancer in men and the second-most leading cause of cancer-related deaths in the United States. To improve patient outcome, research tools which mimic the prostate tumor microenvironment (TME) and accurately predict drug response are urgently needed. However, current in vitro PCa models do not recapitulate the complexities of the prostate TME including three-dimensional (3D) orientation, perfusion, extracellular matrix (ECM), and the presence of multiple cell types such as tumor cells, fibroblasts, and endothelium. Further, many complex in vitro model systems fail to maintain the throughput required for robust drug screening. To address this need, here, we highlight the stepwise development of a 3D in vitro PCa model by optimizing the individual culture conditions for each cell type (PCa cells, fibroblasts (FB), endothelial cells (EC)) within MIMETAS' high throughput perfusable 3D cell culture platform, the OrganoPlate® 2-lane 96. All monocultures (PCa, fibroblast, endothelial cell) were viable and expressed respective phenotypic markers (PCa: AR and PSA; FB: vimentin; EC: CD-31, VE-cadherin) as detected by immunofluorescent staining and high-content imaging. To demonstrate the statistical retention of heterogeneity within PCa populations, PCa cells (MDA-PCa-2b) were pre-labeled with 4 different tracking dyes and clustered into multicellular aggregates using a multiwell, ultra-low attachment plate. After 3D encapsulation within a migration permissive hyaluronic acid (MP-HA) hydrogel, PCa clusters retained uniform size clusters and even distribution of the pre-labeled populations within each cluster. Additionally, use of this pre-clustering reduced cell debris in the encapsulated 3D cultures. 3D FB cultures, mimicking normal or reactive stroma, were established with bone stroma cell lines and primary human mesenchymal stem cells. The cells' phenotypic stretched morphology and migration through the ECM were tuned by tailoring the hydrogel crosslinking assessed further by measuring the permeability of 2,000 kDa FITC-dextran. EC (primary human lung microvascular endothelium) were seeded against MP-HA to form a tubule structure within the perfusion channel. Culture conditions were optimized to reduce the permeability of smaller molecules (4.4, 150 KDa Dextran) through EC barriers and further imaging revealed the formation of a 3D blood vessel-like structure within the perfusion channel. Studies are ongoing to combine all three cell types into a single model. This stepwise approach, for building a complex, 3D prostate tumor model, will enable the full incorporation of all cell types and ECM into a single model which will have the potential to better recapitulate the in vivo prostate TME and improve the predictivity of PCa in vitro models.

Citation Format: Divya Iyer, Andrei Bonteanu, Jedidiah Z. Zhu, Peter Shepherd, Rick Kittles, Nora M. Navone, Daniel A. Harrington, Dwayne Dexter, Kristin M. Bircsak. Development of a 3D in vitro model of the prostate tumor microenvironment [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 2641.

Abstract 2346: Prostate cancer castrate resistant progression usage of non-canonical androgen receptor signaling and ketone body fuel

Prostate cancer (PCa) that progresses after androgen deprivation therapy (ADT) remains incurable. The intricacy of metabolic pathways associated with PCa progression spurred us to develop a metabolism-centric analysis. Using PCa patient-derived xenografts (PDXs) we assessed the metabolic changes after castration of tumor-bearing mice. We found that relapsed tumors had a significant increase in fatty acids and ketone body content compared with baseline. We confirmed that critical ketogenic/ketolytic enzymes (ACAT1, OXCT1, BDH1) were significantly augmented after castrate-resistant progression. Further, these enzymes are increased in the human donor tissue after progressing to ADT. Increased ACAT1 and OXCT1 was also observed for a subset of PCa patients that relapsed with low AR and ERG expression. These factors were associated with decreased biochemical relapse and progression free survival. In summary, our studies reveal the key metabolites fueling castration resistant progression in the context of a partial or complete loss of AR dependence.

Citation Format: Estefania Labanca, Juan Bizzotto, Jun Yang, Pablo Sanchis, Peter Shepherd, Alejandra Paez, Valeria Antico-Arciuch, Nicolas Anselmino, Sofia Lage-Vickers, Anh Hoang, Mark Tituts, Eleni Efstathiou, Javier Cotignola, Christopher Logothetis, Elba Vazquez, Nora Navone, Geraldine Gueron. Prostate cancer castrate resistant progression usage of non-canonical androgen receptor signaling and ketone body fuel [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 2346.

Enhanced Viability for Ex vivo 3D Hydrogel Cultures of Patient-Derived Xenografts in a Perfused Microfluidic Platform

Patient-derived xenografts (PDX), generated when resected patient tumor tissue is engrafted directly into immunocompromised mice, remain biologically stable, thereby preserving molecular, genetic, and histological features, as well as heterogeneity of the original tumor. However, using these models to perform a multitude of experiments, including drug screening, is prohibitive both in terms of cost and time. Three-dimensional (3D) culture systems are widely viewed as platforms in which cancer cells retain their biological integrity through biochemical interactions, morphology, and architecture. Our team has extensive experience culturing PDX cells in vitro using 3D matrices composed of hyaluronic acid (HA). In order to separate mouse fibroblast stromal cells associated with PDXs, we use rotation culture, where stromal cells adhere to the surface of tissue culture-treated plates while dissociated PDX tumor cells float and self-associate into multicellular clusters. Also floating in the supernatant are single, often dead cells, which present a challenge in collecting viable PDX clusters for downstream encapsulation into hydrogels for 3D cell culture. In order to separate these single cells from live cell clusters, we have employed density step gradient centrifugation. The protocol described here allows for the depletion of non-viable single cells from the healthy population of cell clusters that will be used for further in vitro experimentation. In our studies, we incorporate the 3D cultures in microfluidic plates which allow for media perfusion during culture. After assessing the resultant cultures using a fluorescent image-based viability assay of purified versus non-purified cells, our results show that this additional separation step substantially reduced the number of non-viable cells from our cultures.

Abstract 5443: Modulating plasticity in aggressive variant prostate cancers

Aggressive Variant Prostate Cancers (AVPC) are a clinically and molecularly distinct subset of prostate cancers with a poor prognosis characterized by androgen-indifference, platinum-sensitivity and combined defects in Tp53, RB1 and PTEN, for which novel therapeutic approaches are urgently needed. Defects observed in these tumor suppressor pathways have been linked to lineage plasticity in genetically engineered mouse models. We hypothesized that this plasticity can be identified in human tumor samples, and can be modulated to serve as the foundation for effective combination therapies for the AVPC subset. We previously defined a gene expression signature derived from mouse embryonic day 6.5 that is representative of extensive cellular plasticity (PMID:26123483). We determined the plasticity scores in 12 patient-derived xenograft (PDX) models representative of the spectrum of prostate cancer biology (using available RNA sequencing profiles), and in 26 macrodissected tumor biopsies obtained from patients who received platinum-based chemotherapy for aggressive prostate cancer (using ALMAC Affymetrix gene expression microarray). As expected, the AVPC PDX models exhibited high plasticity scores as did 11 (42.3%) of the patient samples, associated with patient progression free- and overall survival. We next treated a well characterized AVPC PDX model (144-4) with the anti-EMT drug (p38MAPK inhibitor) SB203580 at 10mg/kg, and observed a decrease in stem-cell and EMT factors associated with plasticity. These data confirm the association between plasticity and AVPC in human tumor samples, and suggest that changes in plasticity can be measured in tumor samples to determine the value of its modulation in clinical trials.

Acknowledgments: ALMAC Diagnostics Services, UK, and UTMDACC ATGC Core Lab (CCSG-CA016672-ATGC) for RNA sequencing services; UTMDACC Prostate Cancer SPORE (RS, SAM, AA), UTMDACC IRG (RS), and the UTMDACC Prostate Cancer Moonshot Program (AA) for financial support.

Citation Format: Rama Soundararajan, Petra den Hollander, Peter Shepherd, Nora Navone, Daniele Lorenzini, Caddie Laberiano-Fernandez, Wei Lu, Jianling Zhou, Jingjing Liu, Jianhua Zhang, Luisa Maren Solis-Soto, Sendurai A. Mani, Ana Aparicio. Modulating plasticity in aggressive variant prostate cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5443.

The Potential of Anti-Diabetic Rākau Rongoā (Māori Herbal Medicine) to Treat Type 2 Diabetes Mellitus (T2DM) Mate Huka: A Review

T2DM (type 2 diabetes mellitus, or Māori term “mate huka”) is a major long-term health issue in New Zealand particularly among the Māori community. Non-insulin drugs commonly used in New Zealand for the treatment of T2DM have limits to their efficacy as well as side effects, which are of concern for diabetics. As such, the potential for natural products such as traditional rākau rongoā are of interest for potentially preventing the development of T2DM or improving the treatment of the disease. In particular, anti-diabetic effects have been reported for rākau rongoā such as karamu, kūmarahou, and kawakawa. Natural products have been identified in karamu, kūmarahou, and kawakawa that have documented potential effects on glucose metabolism that could contribute to the anti-diabetic effect of these rākau rongoā. As such, this could provide scientific insight into the mātauranga (traditional knowledge) developed over generations by Māori. However, detailed laboratory based and clinical studies would be required to understand and validate these properties of karamu, kūmarahou, and kawakawa, and to understand how they can be used in T2DM treatment. Social determinants of indigenous health such as language, culture, traditional knowledge, and identity, are important in understanding the relationship Māori have with their land and the mātauranga they developed of the medicinal properties within their rākau rongoā, over many centuries. Interestingly, traditional Māori views towards scientific research using animal models to test rākau rongoā are varied but supportive. Furthermore, cultural issues surrounding Māori mana motuhake (self-determination) of traditional rongoā Māori healing practices and the inequity faced by many kairongoā (rongoā Māori practitioners) and tohunga (healers) compared to mainstream health are a current issue within the New Zealand health system. As such, a cultural holistic approach for T2DM care among Māori would be advantageous. This review will outline the available evidence supporting the anti-diabetic efficacy of karamu, kūmarahou, and kawakawa. Currently though there is a lack of molecular research to understand the mechanisms of this efficacy, as such this review will also outline Te Reo Tipu Research, a kaupapa Māori framework for molecular and genomic research on taonga flora.

Abstract 4674: Targeting cancer stem-cells in aggressive variant prostate cancers

Aggressive Variant Prostate Cancers (AVPC) are lethal variants of the disease and usually occur in the setting of castration-resistant prostate cancer (CRPC). These neuroendocrine tumors are currently incurable, with most patients dying within 12-24 months of diagnosis. AVPCs are androgen-indifferent, and therefore do not respond to Androgen-Deprivation-Therapy (ADT), the mainstay treatment for prostate cancers. We recently discovered that these tumors are enriched with cancer cells with stem-cell properties (CSCs) that lack expression of androgen-receptor (AR) (PMID 26804168). Importantly, we observed that CSCs are generated when prostate cancer cells undergo a cell biological process called epithelial-to-mesenchymal-transition (or EMT). We also demonstrated that it is CSCs that facilitate neuroendocrine trans-differentiation, and promote drug-resistance via p38MAPK signaling. In this project, we aimed to inhibit EMT in patient-derived AVPC tumors (using SB203580, a p38MAPK inhibitor and anti-EMT drug), and identify clinically-relevant biological pathways upon EMT inhibition, using RNA-Seq analyses. We also aimed to develop a diagnostic CSC gene-expression score to identify/predict AVPC tumors. We tested the effect of SB203580 in two well-validated AR-negative PDX models of human AVPC (144-4 and 177-B). These models effectively recapitulate the heterogeneity and complex biology of AVPC. We first determined the appropriate dosing for SB203580 in these models that resulted in statistically significant target (p38MAPK) inhibition. Our data indicated that 10mg/kg SB significantly inhibits p38 activity (as judged by loss in MSK1 phosphorylation - MSK1 is a direct target of p38, and its phosphorylation is dependent on p38 activity). EMT inhibition also resulted in a significant reduction in the expression of SOX2, a known CSC marker for aggressive prostate cancers. In parallel, we observed a simultaneous up-regulation in expression of FOXA1, suggesting a shift to luminal epithelial phenotype upon EMT inhibition. We also developed a novel CSC gene expression score based on p38MAPK signaling components critical for EMT and neuroendocrine trans-differentiation in prostate cancer. We validated it in the Beltran dataset (PMID 26855148), wherein patients are categorized into CRPC-Adenocarcinoma and CRPC-Neuroendocrine type (aggressive tumors displaying extensive RB loss and increased expression of clinical neuroendocrine markers). We observed that our CSC score is highly represented in the CRPC-Neuro group, thus validating our rationale for anti-EMT therapy. This study thus highlights a potentially targetable signaling pathway for treatment of AVPC.

Acknowledgements: We thank Dr. Mahajan (Washington University School of Medicine), Dr. Wistuba, Ms. Mino, Dr. Lin (UTMDACC) and Dr. Tang (Rosewell Park Cancer Institute) for their contributions, & UTMDACC Prostate Cancer SPORE for financial support (RS, SAM).

Citation Format: Rama Soundararajan, Paul Allegakoen, Petra den Hollander, Anurag Paranjape, Robiya Joseph, Sandhya Sundaram, Devarajan Karunagaran, Peter Shepherd, Nora Navone, Ana Aparicio, Sankar Maity, Bradley Broom, Christopher Logothetis, Sendurai Mani. Targeting cancer stem-cells in aggressive variant prostate cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4674.

Abstract 3337: A racially/ethnically diverse 3D PDX model of prostate cancer

Prostate cancer (PCa) incidence and mortality rates in African American men are double that of any other race/ethnicity in the United States. Thorough understanding of the biological factors that contribute to this long-standing cancer health disparity (CHD) is required to improve the major public health concern and close this gap. However, few models exist that can compare racially-diverse specimens directly and provide a platform for dissecting the impact of ancestry-dependent factors on disease pathway selection and drug susceptibility. Both the conventional 2D culture of clonal human cell lines and the purely rodent-based in vivo models fail to reflect the heterogeneity of human tumors, often leading to inaccurate prediction of in vivo tumor response in patients, and confounding researchers’ ability to detect potentially subtle biological factors that may contribute to prostate CHD. PCa patient-derived xenografts (PDXs) offer substantially greater fidelity to original patient tumors but are non-adherent and ultimately non-viable in extended in vitro 2D culture. Therefore, a population-based PCa platform which accurately mimics the three-dimensional (3D) tumor microenvironment (TME) is urgently needed.

We have employed MIMETAS’ OrganoPlate®, a high throughput microfluidic culture platform containing 40-96 individual tissue chips, for ex vivo 3D culture of multiple racially/ethnically diverse PCa PDXs (African American, Caucasian, Hispanic) developed at MD Anderson Cancer Center (the MDA PCa PDXs series). MDA PCa PDX tumors were reconstituted from single-cell digestates into multicellular clusters, suspended within HyStem® hyaluronic acid hydrogel precursor solutions, and loaded into the OrganoPlate®. PDXs were maintained in 3D either as monocultures, as cocultures with bone marrow-derived stromal fibroblasts, or as tricultures with endothelial cell blood vessel mimics under continuous perfusion. High-content fluorescence imaging identified retention of stable, viable cultures for at least 7 days. Positive immunofluorescent staining for human nuclear antigen (HNA) confirmed that nearly 100% of encapsulated PCa cells were of human origin. For each PCa model developed, appropriate expression of phenotypic prostate-specific antigen (PSA) and androgen receptor (AR) was maintained over the life of the culture. PCa cultures were treated with various chemotherapeutic drugs and viability was monitored to generate dose response curves for comparison to clinical data. This engineered “tumor-on-a-chip” will better predict patient responses and, by incorporating PCa cells from patients with diverse ancestries, support CHD research.

Citation Format: Lindsey K. Sablatura, Kristin M. Bircsak, Peter Shepherd, Rick Kittles, Pamela E. Constantinou, Anthony D. Saleh, Nora M. Navone, Daniel A. Harrington. A racially/ethnically diverse 3D PDX model of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3337.

Genome-wide CRISPR screens reveal synthetic lethality of RNASEH2 deficiency and ATR inhibition

Ataxia telangiectasia mutated and RAD3 related (ATR) protein kinase plays critical roles in ensuring DNA replication, DNA repair, and cell cycle control in response to replication stress, making ATR inhibition a promising therapeutic strategy for cancer treatment. To identify genes whose loss makes tumor cells hypersensitive to ATR inhibition, we performed CRISPR/Cas9-based whole-genome screens in 3 independent cell lines treated with a highly selective ATR inhibitor, AZD6738. These screens uncovered a comprehensive genome-wide profile of ATR inhibitor sensitivity. From the candidate genes, we demonstrated that RNASEH2 deficiency is synthetic lethal with ATR inhibition both in vitro and in vivo. RNASEH2-deficient cells exhibited elevated levels of DNA damage and, when treated with AZD6738, underwent apoptosis (short-time treated) or senescence (long-time treated). Notably, RNASEH2 deficiency is frequently found in prostate adenocarcinoma; we found decreased RNASEH2B protein levels in prostate adenocarcinoma patient-derived xenograft (PDX) samples. Our findings suggest that ATR inhibition may be beneficial for cancer patients with reduced levels of RNASEH2 and that RNASEH2 merits further exploration as a potential biomarker for ATR inhibitor-based therapy.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Movember GAP1 PDX project: An international collection of serially transplantable prostate cancer patient-derived xenograft (PDX) models

BACKGROUND

While it has been challenging to establish prostate cancer patient-derived xenografts (PDXs), with a take rate of 10-40% and long latency time, multiple groups throughout the world have developed methods for the successful establishment of serially transplantable human prostate cancer PDXs using a variety of immune deficient mice. In 2014, the Movember Foundation launched a Global Action Plan 1 (GAP1) project to support an international collaborative prostate cancer PDX program involving eleven groups. Between these Movember consortium members, a total of 98 authenticated human prostate cancer PDXs were available for characterization. Eighty three of these were derived directly from patient material, and 15 were derived as variants of patient-derived material via serial passage in androgen deprived hosts. A major goal of the Movember GAP1 PDX project was to provide the prostate cancer research community with a summary of both the basic characteristics of the 98 available authenticated serially transplantable human prostate cancer PDX models and the appropriate contact information for collaborations. Herein, we report a summary of these PDX models.

METHODS

PDX models were established in immunocompromised mice via subcutaneous or subrenal-capsule implantation. Dual-label species (ie, human vs mouse) specific centromere and telomere Fluorescence In Situ Hybridization (FISH) and immuno-histochemical (IHC) staining of tissue microarrays (TMAs) containing replicates of the PDX models were used for characterization of expression of a number of phenotypic markers important for prostate cancer including AR (assessed by IHC and FISH), Ki67, vimentin, RB1, P-Akt, chromogranin A (CgA), p53, ERG, PTEN, PSMA, and epithelial cytokeratins.

RESULTS

Within this series of PDX models, the full spectrum of clinical disease stages is represented, including androgen-sensitive and castration-resistant primary and metastatic prostate adenocarcinomas as well as prostate carcinomas with neuroendocrine differentiation. The annotated clinical characteristics of these PDXs were correlated with their marker expression profile.

CONCLUSION

Our results demonstrate the clinical relevance of this series of PDXs as a platform for both basic science studies and therapeutic discovery/drug development. The present report provides the prostate cancer community with a summary of the basic characteristics and a contact information for collaborations using these models.

The estrogen receptor variants β2 and β5 induce stem cell characteristics and chemotherapy resistance in prostate cancer through activation of hypoxic signaling

Chemotherapy resistant prostate cancer is a major clinical problem. When the prostate cancer has become androgen deprivation resistant, one of the few treatment regimens left is chemotherapy. There is a strong connection between a cancer's stem cell like characteristics and drug resistance. By performing RNA-seq we observed several factors associated with stem cells being strongly up-regulated by the estrogen receptor β variants, β2 and β5. In addition, most of these factors were also up-regulated by hypoxia. One mechanism of chemotherapy resistance was expression of the hypoxia-regulated, drug transporter genes, where especially ABCG2 and MDR1 were shown to be expressed in recurrent prostate cancer and to cause chemotherapy resistance by efficiently transporting drugs like docetaxel out of the cells. Another mechanism was expression of the hypoxia-regulated Notch3 gene, which causes chemotherapy resistance in urothelial carcinoma, although the mechanism is unknown. It is well known that hypoxic signaling is involved in increasing chemotherapy resistance. Regulation of the hypoxic factors, HIF-1α and HIF-2α is very complex and extends far beyond hypoxia itself. We have recently shown that two of the estrogen receptor β variants, estrogen receptor β2 and β5, bind to and stabilize both HIF-1α and HIF-2α proteins leading to expression of HIF target genes. This study suggests that increased expression of the estrogen receptor β variants, β2 and β5, could be involved in development of a cancer's stem cell characteristics and chemotherapy resistance, indicating that targeting these factors could prevent or reverse chemotherapy resistance and cancer stem cell expansion.

Abstract 2870: A specific pan-FGFR inhibitor has antitumor activity against prostate cancer patient derived xenografts, PDX, expressing high FGFR1

Prostate Cancer (PCa) is one of the most commonly diagnosed malignancies in men. Patients with advanced metastatic PCa have effective treatment options, but none of them are curative. Androgen deprivation is the most effective therapy, but growth of the cancer resumes over time in most cases, and the disease progresses to castration-resistant PCa (CRPC). Bone is the main site of CRPC progression. Acquired (or inherent) resistance mechanisms to second line therapy options for CRPC eventually lead to disease recurrence and, ultimately, death. The underlying mechanisms of PCa progression to first or second line therapy options are diverse and include fibroblast growth factor (FGF) axis activation. Indeed, we previously reported that blockade of FGFRs with dovitinib (TKI258) (Novartis Pharmaceuticals), a receptor tyrosine kinase inhibitor (TKI) with potent activity against FGFR1-3 and vascular endothelial growth factor receptor (VEGFR) has clinical activity in men with CRPC and bone metastases (PMID: 25186177), thus providing direction for therapy development of FGFR blockade in PCa. Because dovitinib was withdrawn from the clinic by Novartis, we seek to identify an alternative agent with activity against FGFR1 as a candidate for therapy development. With that goal, we tested the antitumor activity of a specific pan-FGFR TKI, JNJ-42756493 (JNJ) (Janssen Pharmaceutical Companies of Johnson&Johnson) against PCa patients derived xenografts (PDXs) expressing high (MDA PCa 118b) and low (MDA PCa 183) endogenous levels of FGFR1. Because bone is the primary site of CRPC progression we tested the antitumor activity of JNJ against these PDXs growing in the bone of mice. By assessing tumor volume by MRI, we found that JNJ has antitumor activity against MDA PCa 118b but not MDA PCa 183. Immunohistochemical analysis of FGFR1 expression exhibited reduction of FGFR1 in tumors of the treated group compared with vehicle treated group in MDA PCa 118b samples. Both these evidences suggest that FGFR1 is the main driver of PCa progression in this PDX and that JNJ is a potent agent against PCas with high FGFR1 expression.Due to the important role that FGF axis has in bone biology, we assessed the effect of JNJ in the bones of mice without tumors by micro-CT analysis. Interestingly, we observed a reduction in bone parameters including bone volume/ total volume (BV/TV) and trabecular thickness (Tb.Th) in the treated group compared with the vehicle treated group, suggesting FGF axis blockade reduces bone mass. However, we identified an increase in the bone surrounding the tumors in the MDA PCa 118b tumor-bearing bones of mice treated with JNJ. These results highlight the complex role of FGF axis in the PCa-bone interaction and warrant further studies to identify candidate patients for this therapy and markers of response in men treated with FGFR inhibition.

Citation Format: Estefania Labanca, Jun Yang, Peter Shepherd, Xinhai Wan, Justin M. Roberts, Michael W. Starbuck, Nora M. Navone. A specific pan-FGFR inhibitor has antitumor activity against prostate cancer patient derived xenografts, PDX, expressing high FGFR1 [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 2870.

Abstract 5023: A 3D perfusable platform for high-throughput screening diverse racial/ethnic prostate cancer specimens

Prostate cancer (PCa) incidence and mortality in African American men is more than 1.5 times greater than men of other races/ethnicities (i.e., Caucasian, Hispanic, American Indian/Alaska Native, Asian/Pacific Islander) in the United States. While elucidating the underlying mechanisms for this cancer health disparity is critical to patient treatment and improved patient outcome, currently, there are no in vitro models available to adequately recapitulate the PCa tumor microenvironment (TME) and aid in this effort. Advanced in vitro culture conditions, such as extended ex vivo culture of patient-derived xenografts (PDXs), 3-dimensional (3D) culture of cells within a defined extracellular matrix (ECM), miniaturization to formats compatible with high-throughput screening (HTS), controlled media perfusion, and co-culture of cancer, stroma, and endothelium, are key elements for improving PCa study, but few systems include two or more of these features. We have optimized culture conditions of a 3D in vitro model system, the OncoPlate, which mimics the PCa TME. In the OncoPlate, cells are seeded in engineered HyStem® hyaluronic acid (HA)-enriched hydrogels, optionally modified with migration-permissive peptides to mimic the tumor ECM. PDX-derived PCa cells are seeded in 3D in MIMETAS' microfluidic OrganoPlate® platform and co-cultured with stromal fibroblasts and endothelial blood vessel mimics under continuous perfusion. We predict that this engineered “tumor-on-a-chip” will better predict patient responses and, by incorporating PCa cells from patients with diverse racial backgrounds, support cancer health disparity research. Here we report culture of several PDX-derived PCa models of diverse racial origin cultured in our OncoPlate format. Live/dead staining followed by automated high content fluorescence imaging was utilized at various time points to characterize viability and growth rate of each model. Immunofluorescent staining for PSA (PCa cells), FSP (cancer associated fibroblasts), and VE-cadherin (endothelial cells) was used to display phenotype and health of each cell type in the culture over a week and formation of 3D structures characteristic of prostate cancer histology. Studies are ongoing to screen each model with a panel of chemotherapeutic drugs for which in vivo mouse PDX response data is available with the goal to improve predictive accuracy by using our perfusable OncoPlate PCa models.

Citation Format: Lindsey Sablatura, Kristin M. Bircsak, Mary C. Farach-Carson, Nora Navone, Peter Shepherd, Thomas Zarembinski, Pamela E. Constantinou, Anthony Saleh, Daniel A. Harrington. A 3D perfusable platform for high-throughput screening diverse racial/ethnic prostate cancer specimens [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 5023.

Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes

AIMS

Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based.

METHODS

We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally.

RESULTS

Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%.

CONCLUSIONS

Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality.

Successful use of National Cancer Registry data to monitor the effective use of imatinib for treating chronic myeloid leukaemia

Imatinib is a tyrosine kinase inhibitor, which selectively antagonises the BCR-ABL molecular pathway which causes chronic myeloid leukaemia (CML). Imatinib was first approved by the Scottish Medicines Consortium (SMC) in January 2002 with the recommendation that its use be audited. The cost of the drug has major financial implications for health resources.

METHODS

All imatinib usage since its first prescription in Scotland in September 2000 to July 2003 was audited through pharmacy records and through the Scotland Leukaemia Registry (SLR), an existing national registry of patients with CML.

RESULTS

One hundred and four patients in Chronic Phase (CP), 36 in Accelerated Phase (AP) and five in Blast Phase (BP) received imatinib. The median duration of therapy was not reached for CFP 17 months for AFP and two months for BP patients. Major (complete) cytogenetic response rates were 74% (63%) and 38% (24%) respectively for CP and APR Overall survival for all CP patients from the start of imatinib therapy was 94% at one year, 91% at two years and 83% at three years. An audit of the effectiveness of the SLR as an auditing agency, showed complete registration in 95% of cases.

CONCLUSIONS

We believe such data collection should be an important ongoing resource for assessing outcomes in a rare form of leukaemia but one which already has major implications for health economics and will continue to do so given the future development of dual tyrosine kinase inhibitors for imatinib resistant cases.

Loss and representativeness in a biomedical survey at age 45 years: 1958 British birth cohort

OBJECTIVE

A biomedical survey of the 1958 British birth cohort at age 45 years provides a baseline for future studies of chronic disease. The extent and nature of bias in this sample was examined.

METHODS

Follow-up of all births in Great Britain in one week in March 1958. At 45 years the sample was compared with the surviving cohort on characteristics recorded at birth and seven years, and in adulthood (42 years).

RESULTS

Sample attrition to age 45 years was chiefly through avoidable (35.8%) than unavoidable loss through death or emigration (13.7%). 11 971 individuals were invited to participate at 45 years. Of 9377 participants (78.3%), most consented to, and had valid values for, physical and mental measurements, survey questionnaires, and blood and saliva sampling; 8302 (88.5%) provided a blood sample. Groups moderately underrepresented in the 45-year sample included those with externalizing or internalizing behaviours, poor reading or math scores, and shorter stature. For example, 8.8% of the 45-year sample had been poor readers at age seven years compared with 11.1% of the total surviving cohort; for shorter stature the figures were 7.2% versus 8.4%, respectively. There was also underrepresentation of some minority groups (non-whites, births in households with no male head and children in social care). Most bias was present before the 45-year survey.

CONCLUSION

The 45-year sample remains broadly representative of the surviving cohort, but specific biases may need to be taken into account in future research. Renewed efforts to re-engage all cohort members will improve the representativeness and value of the study.

Lifecourse influences on health among British adults: effects of region of residence in childhood and adulthood

BACKGROUND

It has been suggested that early life exposures are important determinants of geographical variations in adult diseases. We examined inter-regional migrants in Britain to evaluate the relative importance of early and recent exposures for adult cardiorespiratory risk factors, mental ill-health and sensory function.

METHODS

A total of 9023 persons born throughout England, Scotland and Wales during 1 week in 1958 were followed periodically through childhood into adulthood. At 44-45 years, height, body mass index (BMI), blood pressure (BP), glycosylated haemoglobin, total and high-density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold at 4 kHz, visual impairment, symptoms of depression and anxiety, and chronic widespread pain were measured. Analysis of migration between 12 regions included 3125 cohort members who were examined in a region different to their birthplace.

RESULTS

Height, BMI, diastolic BP (DBP), FEV1, log-transformed IgE and hearing threshold varied by region among non-migrants (each P < 0.05). Among inter-regional migrants, the spatial associations with current region, independent of birthplace, followed closely the geographical pattern shown among non-migrants for BMI, DBP and FEV1 (each P < 0.001). In contrast, of the 15 outcomes, only adult height was related to region of birth, after adjustment for region of examination (P = 0.002)

CONCLUSIONS

Although individual disease risk is predicted by early life factors, early exposures do not explain regional variations in cardiovascular and respiratory risk factors among middle-aged adults in Britain. Geographical inequalities in cardiorespiratory health are more strongly related to factors associated with region of examination that influence obesity, BP and ventilatory function.

Life-course influences on health in British adults: effects of socio-economic position in childhood and adulthood

BACKGROUND

Little evidence exists on the role of socio-economic position (SEP) in early life on adult disease other than for cardiovascular mortality; data is often retrospective. We assess whether childhood SEP influences disease risk in mid-life, separately from the effect of adult position, and establish how associations vary across multiple measures of disease risk.

METHODS

Prospective follow-up to adulthood of all born in England, Scotland and Wales during 1 week in 1958, and with medical data at age 45 years (n = 9377). Outcomes include: blood pressure, body mass index (BMI), glycosylated haemoglobin (HbA1c), total and high density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold (4 kHz), visual impairment, symptoms of depression and anxiety, chronic widespread pain.

RESULTS

Social class in childhood was associated with blood pressure, BMI, HbA1c, HDL cholesterol, triglycerides, fibrinogen, FEV1, hearing threshold, depressive symptoms and chronic widespread pain, with a general trend of deteriorating health from class I to V. Adult social class was also associated with these measures. Mutually adjusted analyses of child and adult social class suggest that both contribute to disease risk in mid-life: in general, associations for childhood class were as strong as for adult class. Individuals with a manual class at both time-points tended to have the greatest health deficits in adulthood.

CONCLUSIONS

Adverse SEP in childhood is associated with a poorer health profile in mid-adulthood, independently of adult social position, and across diverse measures of disease risk and physical and mental functioning.

An intergenerational and lifecourse study of health and mortality risk in parents of the 1958 birth cohort: (II) mortality rates and study representativeness

OBJECTIVES

We recently traced and flagged parents for the participants in the National Child Development Survey (NCDS, 1958 cohort). This paper evaluates the representativeness of the study population and assesses our success in identifying the biological parents.

STUDY DESIGN

Intergenerational cohort study.

METHODS

Parents for participants in the NCDS (born 1 week in March 1958) were traced and flagged for mortality follow-up (14 334 fathers, 15 076 mothers). Standardized mortality rates (SMRs) were calculated using data from England, Scotland and Wales during corresponding time periods.

RESULTS

By 31 December 2003, 6808 fathers and 4148 mothers (born 1890-1943) had died (569 918 and 645 354 years of follow-up, respectively). The overall mortality rate in this parent population was lower compared with the age-, gender-, period- and area-standardized reference rates (SMRs of 83 for fathers and 86 for mothers). Mortality rates for biological parents were higher if cohort members had had non-biological parent figures during the childhood surveys (SMRs of 135 for fathers and 374 for mothers). Parental smoking (in 1974) was strongly associated with lung cancer mortality among biological parents [HR 6.1, 95% confidence intervals (CI) 4.6-8.1 for fathers; HR 15.0, 95% CI 9.7-23 for mothers) but not among non-biological parents (HR 2.0, 95% CI 0.8-5.5; HR 1.8, 95% CI 0.4-7.9, respectively) which demonstrates that the tracing of the biological parents had been successful.

CONCLUSIONS

Mortality is markedly reduced in a cohort of parents compared with the general population. The validity of identification of biological parents is demonstrated by the strong association between smoking and lung cancer.

An intergenerational and lifecourse study of health and mortality risk in parents of the 1958 birth cohort: (I) methods and tracing

OBJECTIVES

This paper describes the methods used to obtain information on mortality and cancer registrations for the parents of the British 1958 birth cohort, in order to create a dataset that can be used to examine intergenerational relationships on health and growth.

STUDY DESIGN

Intergenerational cohort study.

METHODS

The 1958 cohort includes all births occurring during 1 week in March 1958 in England, Scotland and Wales. For more than four decades of follow-up, information has been collected on cohort members, their parents and children. Information on the National Health Service (NHS) numbers of the parents was not available, but other details were collated for the Office for National Statistics to trace and flag the biological parents of the cohort members.

RESULTS

Tracing was successful in 90.2% of fathers (n = 14,334) and 94.9% of mothers (n = 15,076). The greatest success was achieved for parents in families where there was no indication for additional mother or father figures until the child was 16 years old (96.6% of the mothers traced, n = 14,274; 94.3% of the fathers traced, n = 13,256). Tracing rates were lower than average in unmarried mothers (59%) and for the small group who were separated, widowed or divorced in 1958 (81%); the rates were particularly poor for the corresponding fathers (24.4 and 54.7%, respectively). There were only small variations in tracing rates between different regions of Britain.

CONCLUSIONS

The tracing rates achieved were generally very high despite the lack of NHS number, especially where there was family stability throughout the childhood of cohort members. Parental status will need to be considered in future studies. With the high tracing rates achieved, the dataset provides an important resource with which to evaluate multigenerational associations with health and development in parents, their offspring and grandchildren.

Molecular cloning of CoA Synthase. The missing link in CoA biosynthesis

Coenzyme A functions as a carrier of acetyl and acyl groups in living cells and is essential for numerous biosynthetic, energy-yielding, and degradative metabolic pathways. There are five enzymatic steps in CoA biosynthesis. To date, molecular cloning of enzymes involved in the CoA biosynthetic pathway in mammals has been only reported for pantothenate kinase. In this study, we present cDNA cloning and functional characterization of CoA synthase. It has an open reading frame of 563 aa and encodes a protein of approximately 60 kDa. Sequence alignments suggested that the protein possesses both phosphopantetheine adenylyltransferase and dephospho-CoA kinase domains. Biochemical assays using wild type recombinant protein confirmed the gene product indeed contained both these enzymatic activities. The presence of intrinsic phosphopantetheine adenylyltransferase activity was further confirmed by site-directed mutagenesis. Therefore, this study describes the first cloning and characterization of a mammalian CoA synthase and confirms this is a bifunctional enzyme containing the last two components of CoA biosynthesis.

Deletions of the derivative chromosome 9 occur at the time of the Philadelphia translocation and provide a powerful and independent prognostic indicator in chronic myeloid leukemia

Chronic myeloid leukemia (CML) is characterized by formation of the BCR-ABL fusion gene, usually as a consequence of the Philadelphia (Ph) translocation between chromosomes 9 and 22. Large deletions on the derivative chromosome 9 have recently been reported, but it was unclear whether deletions arose during disease progression or at the time of the Ph translocation. Fluorescence in situ hybridization (FISH) analysis was used to assess the deletion status of 253 patients with CML. The strength of deletion status as a prognostic indicator was then compared to the Sokal and Hasford scoring systems. The frequency of deletions was similar at diagnosis and after disease progression but was significantly increased in patients with variant Ph translocations. In patients with a deletion, all Ph(+) metaphases carried the deletion. The median survival of patients with and without deletions was 38 months and 88 months, respectively (P =.0001). By contrast the survival difference between Sokal or Hasford high-risk and non-high-risk patients was of only borderline significance (P =.057 and P =.034). The results indicate that deletions occur at the time of the Ph translocation. An apparently simple reciprocal translocation may therefore result in considerable genetic heterogeneity ab initio, a concept that is likely to apply to other malignancies associated with translocations. Deletion status is also a powerful and independent prognostic factor for patients with CML. The prognostic significance of deletion status should now be studied prospectively and, if confirmed, should be incorporated into management decisions and the analysis of clinical trials.

Identification of photolabile outer membrane proteins of Porphyromonas gingivalis

As the prevalence of antibiotic-resistant strains of bacteria increases, novel ways of treating infections need to be developed. This is particularly pertinent with respect to the periodontal diseases--the most common chronic bacterial infections of man. The use of a photosensitizer in combination with red light has been demonstrated to be effective in killing several human pathogens, including the oral bacterium, Porphyromonas gingivalis, a major pathogen in periodontitis. Killing was associated with alterations in the molecular masses of several outer membrane and plasma membrane proteins and these may be therapeutic targets for photodynamic therapy and other antimicrobial approaches. To identify these photolabile proteins, we have used a panel of monoclonal antibodies raised to whole P. gingivalis. A number of the antibodies recognized various photolabile proteins. Using a combination of Western blotting and protein sequencing the predominant photolabile proteins in P. gingivalis have been identified as the major secreted/cell surface proteases--Lys and Arg gingipain.

p27 immunostaining is related to prognosis in malignant mesothelioma

AIMS

To evaluate the prognostic value of the proliferation-associated antigen p27 in malignant mesothelioma.

METHODS AND RESULTS

Sections from 36 patients with malignant mesothelioma were immunohistochemically stained for the p27 antigen. The results were quantified by recording the proportion of positively stained nuclei and these data were tested for association with patient survival. p27 expression was also compared with tumour type, MIB-1 expression, apoptotic and mitotic indices. Patients with pleural malignant mesothelioma showing low p27 expression (< 53% of cells positive) survived for significantly shorter periods of time than those with high p27 expression (> or = 53% of cells positive) (P=0.04). The 50% survival time of subjects with low p27 was 4-6 months whereas for those with high p27 expression it was 10-11 months. There was no significant association between p27 expression and MIB-1, apoptotic or mitotic indices.

CONCLUSIONS

Low p27 expression in pleural malignant mesothelioma is associated with a significantly worse prognosis. p27 appears to be an independent prognostic variable which may be of value in counselling patients with malignant mesothelioma.

Human papillomavirus antigens and T-cell recognition

This review will summarize what is known about natural T-cell responses to human papillomavirus infections, including potential mechanisms for their dysregulation which may lead to the development of disease. We will also describe new strategies to enhance human papillomavirus specific T-cell responses following vaccination that are currently in development and recent reports on human vaccine trials with particular regard to the generation of appropriate T-cell responses.