Development of a patient-derived explant model for prediction of drug responses in endometrial cancer

OBJECTIVE

To undertake a pilot study to develop a novel Patient-Derived-Explant (PDE) model system for use in endometrial cancer (EC) that is capable of monitoring differential drug responses in a pre-clinical setting.

METHODS

Fresh tumour was obtained post-hysterectomy from 27 patients with EC. Tumours were cut into 1-3 mm³ explants that were cultured at the air-liquid interface for 16-24 h in culture media. Explants were cultured in different media conditions to optimise viability. Explants were also treated with carboplatin/paclitaxel or pembrolizumab for 24 h and processed into histology slides. Multiplexed immunofluorescence for Ki67 (proliferation marker), cPARP (apoptosis marker) and CAM 5.2 (tumour mask) was performed followed by image analysis and quantitation of biomarker expression.

RESULTS

EC samples are amenable to PDE culture with preserved histological architecture and PDE viability for up to 48 h, with the addition of autologous serum in culture media facilitating EC-PDE viability. Our PDE platform provides evidence of differential drug-response to conventional chemotherapeutics and immune checkpoint inhibition, and these responses can be assessed in the context of a preserved tumour microenvironment.

CONCLUSIONS

Our PDE platform represents a rapid, low-cost pre-clinical model which can be easily integrated into drug development pipelines. PDE culture preserves original tumour architecture and enables evaluation of spatial relationships in the tumour microenvironment. PDE culture has the potential for personalised drug-testing in a pre-clinical setting which is increasingly important in an era of personalised medicine in the treatment of EC.

Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study

BACKGROUND

England and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations.

METHODS

In this single-centre (Leicester, UK), prospective, controlled study, we selected cases of natural and non-suspicious unnatural death referred to Her Majesty's (HM) Coroners. We excluded cases younger than 18 years, known to have had a transmittable disease, or who weighed more than 125 kg. Each case was assessed by PMCTA, followed by autopsy. Pathologists were masked to the PMCTA findings, unless a potential risk was shown. The primary endpoint was the accuracy of the cause of death diagnosis from PMCTA against a gold standard of autopsy findings, modified by PMCTA findings only if additional substantially incontrovertible findings were identified.

FINDINGS

Between Jan 20, 2010, and Sept 13, 2012, we selected 241 cases, for which PMCTA was successful in 204 (85%). Seven cases were excluded from the analysis because of procedural unmasking or no autopsy data, as were 24 cases with a clear diagnosis of traumatic death before investigation; 210 cases were included. In 40 (19%) cases, predictable toxicology or histology testing accessible by PMCT informed the result. PMCTA provided a cause of death in 193 (92%) cases. A major discrepancy with the gold standard was noted in 12 (6%) cases identified by PMCTA, and in nine (5%) cases identified by autopsy (because of specific findings on PMCTA). The frequency of autopsy and PMCTA discrepancies were not significantly different (p=0·65 for major discrepancies and p=0·21 for minor discrepancies). Cause of death given by PMCTA did not overlook clinically significant trauma, occupational lung disease, or reportable disease, and did not significantly affect the overall population data for cause of death (p≥0·31). PMCTA was better at identifying trauma and haemorrhage (p=0·008), whereas autopsy was better at identifying pulmonary thromboembolism (p=0·004).

INTERPRETATION

For most sudden natural adult deaths investigated by HM Coroners, PMCTA could be used to avoid invasive autopsy. The gold standard of post-mortem investigations should include both PMCT and invasive autopsy.

FUNDING

National Institute for Health Research.

Prevention of stroke in chronic and recurrent atrial fibrillation: role of the emergency department in identification of "at-risk" patients

The objective was to determine the proportion of patients presenting to the Emergency Department (ED) in atrial fibrillation (AF) who are at high risk of thromboembolic stroke as defined by the American Heart Association and who might benefit from anticoagulation therapy. We enrolled all patients identified as having AF between 28th June 1999 and 26th March 2000. Data collected included demographic information, presenting complaint, discharge diagnosis, risk factors for thromboembolic stroke, contraindications to anticoagulation (as defined by the Stroke Prevention in AF Investigators), admission and discharge medications, and cardiac rhythm on presentation and at discharge. 193 patients were identified within the study period. Two patient histories were not available for review. 121 patients had a prior history of AF. Of these, 65 patients were at high risk for thromboembolic stroke and had no contraindication to anticoagulation therapy 43 (66%) were on Warfarin at presentation but 14 (22%) were on Aspirin and 8 (12%) were on neither. 34% of patients with chronic atrial fibrillation presenting to the ED, at high risk of thromboembolic stroke and without contra-indication to anticoagulation, were not anticoagulated on presentation. ED attendance provides an opportunity for intervention for the prevention of stroke in this group.