Combined loss of CDH1 and downstream regulatory sequences drive early-onset diffuse gastric cancer and increase penetrance of hereditary diffuse gastric cancer

BACKGROUND

Germline CDH1 pathogenic or likely pathogenic variants cause hereditary diffuse gastric cancer (HDGC). Once a genetic cause is identified, stomachs' and breasts' surveillance and/or prophylactic surgery is offered to asymptomatic CDH1 carriers, which is life-saving. Herein, we characterized an inherited mechanism responsible for extremely early-onset gastric cancer and atypical HDGC high penetrance.

METHODS

Whole-exome sequencing (WES) re-analysis was performed in an unsolved HDGC family. Accessible chromatin and CDH1 promoter interactors were evaluated in normal stomach by ATAC-seq and 4C-seq, and functional analysis was performed using CRISPR-Cas9, RNA-seq and pathway analysis.

RESULTS

We identified a germline heterozygous 23 Kb CDH1-TANGO6 deletion in a family with eight diffuse gastric cancers, six before age 30. Atypical HDGC high penetrance and young cancer-onset argued towards a role for the deleted region downstream of CDH1, which we proved to present accessible chromatin, and CDH1 promoter interactors in normal stomach. CRISPR-Cas9 edited cells mimicking the CDH1-TANGO6 deletion display the strongest CDH1 mRNA downregulation, more impacted adhesion-associated, type-I interferon immune-associated and oncogenic signalling pathways, compared to wild-type or CDH1-deleted cells. This finding solved an 18-year family odyssey and engaged carrier family members in a cancer prevention pathway of care.

CONCLUSION

In this work, we demonstrated that regulatory elements lying down-stream of CDH1 are part of a chromatin network that control CDH1 expression and influence cell transcriptome and associated signalling pathways, likely explaining high disease penetrance and very young cancer-onset. This study highlights the importance of incorporating scientific-technological updates and clinical guidelines in routine diagnosis, given their impact in timely genetic diagnosis and disease prevention.

[URISCAM project: Multicenter evaluation of the UF-Series cytometer in the urinary tract infections screening]

OBJECTIVE

Urine culture, the gold standard to confirm the presence of urinary tract infection (UTI), is the most requested assay in the microbiology department. Our objective was to determine the diagnostic yield of the UF-Series cytometer as a screening method for UTI.

METHODS

All the urine samples sent to the six Microbiology Laboratories participating in a period of 5 working days were analyzed. We collected demographic variables, apart from those variables related to urine samples: source and sample type (midstream, catheterized or nephrostomy urines), collection with/without boric acid, cytometer parameters (leukocyturia, bacteriuria, bacteria morphology and epithelial cells) and urine culture results. ROC curves were plotted to determine predictive capacity of the cytometer.

RESULTS

A sample of 2,468 patients with average age of 53 years were processed (ratio women:men 2:1). Urine culture detected 23% of positive urine samples. The predictor variables of UTI were: morphology of bacilli, bacteriuria ≥21 bacteria/µL, age ≥65 years, samples collected in the emergency service and hospitalization and preserving conditions. With 21 bacteria/µL as a cut-off point, we obtained a sensitivity of 93.3% and 94.5% negative predictive value, then reducing the samples to be cultured by 28.9% with 1.6% false negatives.

CONCLUSIONS

We consider that the UF-Series is a valid and accurate tool for the detection of UTI. Therefore, it could be used as screening method in the clinical practice prior to the urine culture, reducing culture requirement by approximately 30%, with a low false negative rate.

Sysmex UF-1000i flow cytometer to screen urinary tract infections: the URISCAM multicentre study

The new Sysmex UF-1000i analyzer - which incorporates bacteria morphology distinction - allows to automatically screen samples to be cultured at microbiology laboratories. We have evaluated the feasibility and accuracy of Sysmex UF-1000i to screen urinary tract infections (UTIs). A total amount of 2468 urine samples from six Spanish hospitals were analysed. Demographic and clinical data such as age, gender, source and sample type, preserving conditions, cytometer parameters (bacteria, leucocytes and bacteria morphology) as well as urine culture results (gold standard) were recorded. After applying data mining techniques, the variables of age, bacteria count and rod morphology were defined as predictive variables of UTIs. By using the UF-1000i in combination with a predictive algorithm of three decision rules, we could identify 94·9 and 47·4% positive and negative urine samples, respectively, with a negative predictive value of 97 and only 1·17% diagnostic error. This error was reduced down to 0·4% when contaminated samples were excluded. Our results show that flow cytometry parameters together with age, by means of a predictive algorithm model, can be used to screen UTIs. Its implementation would avoid culturing 38% of urine samples, and therefore, would reduce time to diagnosis with a discrete false negative ratio.

SIGNIFICANCE AND IMPACT OF THE STUDY

Fluorescent flow cytometry performance has recently spread for urine screening. However, controversy about cytometer results can be drawn from medical literature. This study shows the diagnosis accuracy of Sysmex UF-1000i analyzer by means of a group of decision rules encompassing both demographic variables (age) and cytometer parameters (bacteria, leucocytes and bacteria morphology). After applying the predictive algorithm, the UF-1000i could optimally identify 95% urinary tract infections with high negative predictive value and low diagnostic error. Implementation of UF-1000i would avoid culturing almost 38% of urine samples, thus reducing time to diagnosis, unnecessary antibiotic treatments and consequently improving cost-effectiveness.

Influence of EDTA on the Electrochemical Removal of Mercury (II) in Soil from San Joaquín, Querétaro, México

<p>The removal of mercury from soil and Ca-bentonite was performed using electrochemical treatment adding ethylendiaminetetra acetic acid (EDTA) as a complexing agent to improve the electrochemical removal of Hg (II) in soil from San Joaquín, Querétaro, México. During the electrokinetic treatment in the presence of 0.1 M EDTA, most of Hg (II) migrates toward the anode obtaining the highest removal efficiencies close to 70 % in bentonite after 9 h. Using 0.1M HCl only 65 % efficiency was attained after 13 h in the cathodic side. EDTA formed a negatively charged stable complex that migrates to the cathode by the application of the electrokinetic treatment across Hg – EDTA synthesized complex.</p>

Meningitis caused by Abiotrophia defectiva: case report and literature review

The genus Abiotrophia comprises fastidious Gram-positive bacteria previously classified as nutritionally variant streptococci (NVS). The isolation of NVS from the central nervous system (CNS) is very rare. We describe a case of meningitis due to Abiotrophia defectiva in a patient who underwent a total hip arthroplasty 4 days previously. It is possible that the organism could be introduced through the spinal anesthesia. We also review all cases of CNS infections caused by NVS.

Trapping of BTX compounds by SiO2, Ag-SiO2, Cu-SiO2, and Fe-SiO2 porous substrates

Adsorption isotherms of BTX aromatic hydrocarbons (benzene, toluene, and p-xylene) on pristine (SiO2) and metal-doped (Ag-SiO2, Cu-SiO2 and Fe-SiO2) mesoporous and microporous substrates were measured and interpreted. These adsorbents were synthesized by the sol-gel procedure and their BTX sorption isotherms were obtained by the gas chromatographic technique (GC) at several temperatures in the range 423-593 K. The uptake amount of these hydrocarbon adsorptives on SiO2, Ag-SiO2, Cu-SiO2 and Fe-SiO2 mesoporous and microporous substrates was temperature-dependent. Additionally, the interaction of BTX molecules with the pore walls was evaluated by means of the corresponding isosteric heat of adsorption (qst), which was found to follow the next increasing sequence: qst (benzene)<qst (toluene)<qst (p-xylene). In general, the isosteric heat of adsorption of aromatic BTX compounds on microporous silica depicted an increasing tendency when the amount adsorbed was raised. This was a consequence of the existence of cohesive interactions (adsorbate-adsorbate) besides of the adhesive ones (adsorbate-adsorbent). The inclusion of silver or iron atoms within the SiO2 structure leads to an increased adsorbed amount of BTX molecules on the solid surface if compared with the Cu-SiO2 adsorbent. The adsorption of benzene, but not of toluene and p-xylene, molecules on pristine SiO2 is facilitated by the pore size of this substrate since this is the highest of all materials.

Chlorobenzene, chloroform, and carbon tetrachloride adsorption on undoped and metal-doped sol-gel substrates (SiO(2), Ag/SiO(2), Cu/SiO(2) and Fe/SiO(2))

Adsorption isotherms of chlorobenzene, chloroform and carbon tetrachloride vapors on undoped SiO(2), and metal-doped Ag/SiO(2), Cu/SiO(2) and Fe/SiO(2) substrates were measured in the temperature range of 398-593K. These substrates were prepared from a typical sol-gel technique in the presence of metal dopants that rendered an assortment of microporous-mesoporous solids. The relevant characteristic of these materials was the different porosities and micropore to mesopore volume ratios that were displayed; this was due to the effect that the cationic metal valence exerts on the size of the sol-gel globules that compose the porous solid. The texture of these SiO(2) materials was analyzed by X-ray diffraction (XRD), FTIR, and diverse adsorption methods. The pore-size distributions of the adsorbents confirmed the existence of mesopores and supermicropores, while ultramicropores were absent. The Freundlich adsorption model approximately fitted the chlorinated compounds adsorption data on the silica substrates by reason of a heterogeneous energy distribution of adsorption sites. The intensity of the interaction between these organic vapors and the surface of the SiO(2) samples was analyzed through evaluation of the isosteric heat of adsorption and standard adsorption energy; from these last results it was evident that the presence of metal species within the silica structure greatly affected the values of both the amounts adsorbed as well as of the isosteric heats of adsorption.