Fast electro-plasmonic detection of heart signal in Balb/C cells onto one-dimensional plasmonic grating

The heart is a vital and complex organ in the human body that forms with most organs between the second week of pregnancy, and fetal heart rate is an important indicator or biological index to know the condition of fetal well-being. In general, long-term measurement of fetal heart rate is the most widely used method of providing information about fetal health. In addition to fetal life, growth, and maturity, information such as congenital heart disease, often due to structural or functional defects in heart structure that often occur during the first trimester of pregnancy during fetal development, can be detected by continuous monitoring of fetal heart rate. The gold standard for monitoring the fetus's health is the use of non-invasive methods and portable devices so that while maintaining the health of the mother and fetus, it provides the possibility of continuous monitoring, especially for mothers who have a high-risk pregnancy. Therefore, the present study aimed to propose a low-cost, compact, and portable device for recording the heart rate of 18-day-old fetal mouse heart cells. Introduced device allows non-invasive heart rate monitoring instantly and without side effects for mouse fetal heart cells. One-dimensional gold-plated plasmonic specimens as a physiological signal recorder are mainly chips with nanoarray of resonant nanowire patterns perform in an integrated platform. Here the surface plasmon waves generated in a one-dimensional plasmonic sample are paired with an electrical wave from the heart pulse, and this two-wave pairing is used to record and detect the heart rate of fetal heart cells with high accuracy and good sensitivity. This measurement was performed in normal mode and two different stimulation modes. Stimulation of cells was performed once using adrenaline and again with electrical stimulation. Our results show that our sensor is sensitive enough to detect heart rate in both standard and excitatory states and is also well able to detect and distinguish between changes in heart rate caused by different excitatory conditions.

Input-decoupled discrete-time sliding mode control algorithm for servo multi-field multi-armature DC machine

The multivariable modeling of a servo actuating system consisting of multi-field multi-armature direct current (MFMADC) machine is extracted and a novel discrete time nonlinear algorithm is proposed for the corresponding system. The proposed control algorithm demonstrates robustness against modeling uncertainty and by utilizing its novel mathematical structure, decouples the dynamical interactions of the connected motors. The main contribution of this paper is the proposition of a new decoupling control algorithm that in which, the driving (commanding) voltages of the connected driving motors are extracted separately and independently using the Lyapunov principle in discrete time. In fact, the obtained coupled stabilizing convex inequalities of the controlling voltages, resulting from the evaluation of the Lyapunov functions, are analytically decoupled using elementary matrix operations. Consequently, each motor now has the capability to perform its controlling task (position control or torque control) with asymptotic stability and robustness against uncertainty. To assess the performance of the proposed controlling algorithm and its verification, a MFMADC machine is attached to a harmonic drive reducer (HDR) whose flex spline and circular spline are fabricated using viscoelastic polyesters PLA and thermoplastic PLA, respectively. A number of experiments are conducted where in the first test, the MFMADC is controlled in only-position mode while in the second test, the MFMADC is controlled in simultaneous position-torque control mode. Comparative assessments confirm that the MFMADC technology is needed when a high precision tracking of position, under high frequency disturbances, is desired.

Novel adsorptive PVC nanofibrous/thiol-functionalized TNT composite UF membranes for effective dynamic removal of heavy metal ions

The development of efficient strategies for the removal of heavy metal ions from aqueous solutions is rapidly demanded as these contaminants are very toxic and carcinogenic and show detrimental effects on the living creatures. The main focus of the current study is on the preparation and assessment of electrospun adsorptive nanofiber membranes for the removal of toxic Ni(II) and Cu(II) from wastewater in the ultrafiltration process. Hydrothermally synthesized titanate nanotubes (TNT) was modified with thiol functional groups and then directly incorporated to the polyvinyl chloride nanofiber matrices via electrospinning process to fabricate an adsorptive membrane. The as-prepared electrospun nanofiber membranes and the nanoadsorbents were characterized with respect to the physiochemical properties, surface structure and morphology, applying XPS, FTIR, FESEM, EDX and TEM analysis and then, the membranes were evaluated in terms of the removal of the heavy metal ions in a continuous ultrafiltration mode. In adsorptive filtration of the metal ions, the effective factors including nanoadsorbents loading (0.5-1.5 wt%), initial metal ion concentration (60-150 mg/L), feed temperature (~25 °C-45 °C), presence of competing ion and reusability were investigated in the UF system where the membranes containing 1.5 wt% thiol-modified TNT and virgin TNT adsorbents demonstrated excellent removal efficiency compared to the other membranes. The Cu(II) and Ni(II) removal efficiency of the membrane containing 1.5 wt% functionalized TNT was 90% and 86.7%, respectively which was the highest ones. As was expected and due to the uniform dispersion and less aggregation of the modified TNT adsorbents on the large surface area of the electrospun nanofibers, more adsorption capacity of the nanoparticles can be exploited. Moreover, the strong affinity of the thiol functional groups toward the metal cations, these membranes removed metal contaminants more efficiently. Besides, the Cu(II) removal efficiency of the fabricated membranes didn't show any drastic changes in the presence of the competing ions. Furthermore, acceptable performance was achieved for the prepared membranes even after four adsorption/regeneration cycles in the continuous UF experiments, demonstrating the feasibility and effectiveness of the prepared adsorptive nanofiber membranes for the removal of heavy metal ions.

Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review

CONTEXT

Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls.

METHODS

We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD.

FINDINGS

Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation.

CONCLUSIONS AND FUTURE DIRECTIONS

Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.

Effect of Amniotic Membrane Dressing on Pain and Healing of Palatal Donor Site: A Randomized Controlled Trial

BACKGROUND

Free gingival graft is the most commonly practiced predictable technique for gingival augmentation.

OBJECTIVE

To assess the effectiveness of human amniotic membrane, a biological dressing, on wound healing and post-operative pain after its application on the palatal donor site after free gingival graft surgery.

METHODS

Of 27 eligible patients, 15 were randomized into a test group and received human amniotic membrane dressing sutured over their palatal donor site; 12 were randomized into a control group in whom the palatal donor site was only sutured. Standard clinical photographs were taken at 7, 14, and 21 days post-operatively and evaluated by 3 periodontists. The pain score at the donor site was assessed by a visual analog score; the number of analgesics taken was also recorded.

RESULTS

The mean color match scores were higher in the test group than the control group at 14 (p<0.01) and 21 days after surgery (p=0.02). The difference in tissue texture (p=0.01) and inflammation (p=0.02) between the two groups was only significant on day 14 (p<0.05). The pattern of pain relief was better in the test group compared with the control group, especially in first days, although the differences were not significant in terms of the number of analgesics taken or the pain score.

CONCLUSION

Application of human amniotic membrane can accelerate wound healing and may decrease post-operative pain and discomfort by a limited amount.

Serum BTP concentrations are not affected by hepatic dysfunction

Background

Beta Trace Protein (BTP) is a promising marker of glomerular filtration rate (GFR). Equations to estimate GFR using BTP have been proposed. Very little is known about BTP’s production and metabolism. It has been hypothesized that the liver metabolizes certain BTP isoforms. As such, hepatic dysfunction may influence serum levels independently of GFR. This would impact on the accuracy and precision of GFR estimates using BTP. The purpose of this study was to assess the impact of cirrhosis on serum BTP concentrations.

Methods

BTP, cystatin C (cysC) and creatinine (Cr) were measured in 99 cirrhotic subjects and in matched controls. BTP/cysC and Cr/cysC ratios were compared between cases and controls. This was repeated after stratification by Child Pugh category. Comparisons of ratios between Child Pugh category A and combined B and C case subjects were also performed.

Results

There were no differences in BTP/cysC ratios between cases and controls for the entire cohort (0.80 vs 0.79) or for any of the Child Pugh categories (p > 0.10). There were significant differences between cases (1.09) and controls (0.73) for the BTP/Cr ratios (p < 0.001). The BTP/Cr ratio was higher in those with more advanced cirrhosis as compared to those with less severe cirrhosis (1.20 vs 1.03, p < 0.01). There were no differences in BTP/cysC ratios between those with less severe and more advanced cirrhosis (p = 0.25).

Conclusions

This study suggests that hepatic dysfunction does not influence serum BTP levels and argues against a significant role for the liver in BTP metabolism. Confirmation in a larger group of patients with advanced cirrhosis is required.

Podocyte-derived microparticles promote proximal tubule fibrotic signaling via p38 MAPK and CD36

Tubulointerstitial fibrosis is a hallmark of advanced diabetic kidney disease that is linked to a decline in renal function, however the pathogenic mechanisms are poorly understood. Microparticles (MPs) are 100–1000 nm vesicles shed from injured cells that are implicated in intercellular signalling. Our lab recently observed the formation of MPs from podocytes and their release into urine of animal models of type 1 and 2 diabetes and in humans with type 1 diabetes. The purpose of the present study was to examine the role of podocyte MPs in tubular epithelial cell fibrotic responses. MPs were isolated from the media of differentiated, untreated human podocytes (hPODs) and administered to cultured human proximal tubule epithelial cells (PTECs). Treatment with podocyte MPs increased p38 and Smad3 phosphorylation and expression of the extracellular matrix (ECM) proteins fibronectin and collagen type IV. MP-induced responses were attenuated by co-treatment with the p38 inhibitor SB202190. A transforming growth factor beta (TGF-β) receptor inhibitor (LY2109761) blocked MP-induced Smad3 phosphorylation and ECM protein expression but not p38 phosphorylation suggesting that these responses occurred downstream of p38. Finally, blockade of the class B scavenger receptor CD36 completely abrogated MP-mediated p38 phosphorylation, downstream Smad3 activation and fibronectin/collagen type IV induction. Taken together our results suggest that podocyte MPs interact with proximal tubule cells and induce pro-fibrotic responses. Such interactions may contribute to the development of tubular fibrosis in glomerular disease.

High glucose increases the formation and pro-oxidative activity of endothelial microparticles

AIMS/HYPOTHESIS

Individuals with diabetes exhibit increases in circulating endothelial microparticles (eMPs, also referred to as endothelial microvesicles), which are associated with endothelial dysfunction and a heightened risk of cardiovascular complications. We have shown that eMPs are markers and mediators of vascular injury although their role in diabetes is unclear. We hypothesised that the composition and biological activity of eMPs are altered in response to high glucose exposure. We assessed the effects of high glucose on eMP formation, composition and signalling in cultured HUVECs.

METHODS

eMPs were isolated from the media of HUVECs cultured under conditions of normal glucose (eMP^NG), high glucose (eMP^HG) or osmotic control of L-glucose (eMP^LG). eMP size, concentration and surface charge were assessed by nanoparticle tracking analysis and flow cytometry. eMP protein composition was assessed by liquid chromatography-tandem mass spectrometry, and eMP-mediated effects on coagulation, reactive oxygen species (ROS) production and vessel function were assessed.

RESULTS

Exposure of HUVECs to high glucose for 24 h caused a threefold increase in eMP formation, increased mean particle size (269 ± 18 nm vs 226 ± 11 nm) and decreased surface charge. Compared with eMP^NG or eMP^LG, eMP^HG possessed approximately threefold greater pro-coagulant activity, stimulated HUVEC ROS production to a greater extent (~250% of eMP^NG) and were more potent inhibitors of endothelial-dependent relaxation. Proteomic analysis of eMPs identified 1212 independent proteins of which 68 were exclusively found in eMP^HG. Gene ontology analysis revealed that eMP^HG-exclusive proteins were associated with signalling pathways related to blood coagulation, cell signalling and immune cell activation.

CONCLUSIONS/INTERPRETATION

Our results indicate that elevated glucose is a potent stimulus for eMP formation that also alters their molecular composition leading to increased bioactivity. Such effects may contribute to progressive endothelial injury and subsequent cardiovascular complications in diabetes.

Microparticle Formation in Peritoneal Dialysis: A Proof of Concept Study

BACKGROUND

Injury to the mesothelial layer of the peritoneal membrane during peritoneal dialysis (PD) is implicated in loss of ultrafiltration capacity, but there are no validated biomarkers for mesothelial cell injury. Microparticles (MPs) are 0.1 to 1.0 µm membrane vesicles shed from the cell surface following injury and are sensitive markers of tissue damage. Formation of MPs in the peritoneal cavity during PD has not been reported to date.

METHODS

We designed a single-center, proof of concept study to assess whether peritoneal solution exposure induces formation of mesothelial MPs suggestive of PD membrane injury. We examined MP levels in PD effluents by electron microscopy, nanoparticle tracking analysis (NTA), flow cytometry, procoagulant activity, and Western blot.

RESULTS

NTA identified particles in the size range of 30 to 900 nm, with a mean of 240 (SE: 10 nm). MP levels increased in a progressive manner during a 4-hour PD dwell. Electron microscopy confirmed size and morphology of vesicles consistent with characteristics of MPs as well as the presence of mesothelin on the surface. Western blot analysis of the MP fraction also identified the presence of mesothelin after 4 hours, suggesting that MPs found in PD effluents may arise from mesothelial cells.

CONCLUSIONS

Our results suggest that MPs are formed and accumulate in the peritoneal cavity during PD, possibly as a stress response. Assessing levels of MPs in PD effluents may be useful as a biomarker for peritoneal membrane damage.

Molecular dynamics simulation of Keggin HPA doped Nafion® 117 as a polymer electrolyte membrane

Nafion®/heteropoly acid (HPA) composite membranes and the impact of the anionic charge of HPA on water and hydronium dynamics were investigated using molecular dynamics simulation.

Abstract P1-14-05: Three distinct HER2 subtypes identified by BluePrint 80-gene functional subtyping predict treatment-specific response in the prospective neo-adjuvant NBRST registry

Background

Ideally classification by subtype predicts treatment response and overall outcome. BluePrint 80-gene functional molecular subtype is based on mRNA expression (as is intrinsic subtype) associated with intact translation to protein (unlike intrinsic subtype). BluePrint (BP) classifies patients into Luminal, Her2 or Basal-type. Presently subtype is approximated using conventional immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) ("conventional subtype") or assigned by gene expression profiling. The main objective of the prospective neo-adjuvant NBRST study is to compare drug sensitivity as defined by pathological Complete Response (pCR), using 80-gene functional subtype vs. conventional IHC/FISH subtyping. NBRST enrolled over 1,000 US patients between June 2011 and December 2014. In this analysis we present the results for IHC/FISH Her2-positive patients.

Methods

Here we report findings in the 260 NBRST patients who had IHC/FISH Her2+ breast cancer, according to ASCO CAP guidelines at the time of diagnosis. Treatment, including chemotherapy and HER2-targeted agents, was at the discretion of the physician adhering to NCCN approved or other peer-reviewed, established regimens over the course of the study. pCR was defined as T0/isN0. Fisher's exact test was used to compare pCR rates among IHC/FISH and functional subtypes and treatment groups.

Results

The 260 IHC/FISH Her2+ patients had median age 53 (range 23-81) and included T1-4, N0-3 tumors. Of 169 ER+/Her2+ tumors 49% were re-classified as BP Luminal, 43% as BP HER2, and 8% as BP Basal. The median ER% of ER+/Her2+/BP Luminal tumors was 93% (range 3-100), compared to 79% in ER+/Her2+/BP HER2 (range 1-91) and 8% in ER+/Her2+/BP Basal-type (range 2-99).The overall pCR rate in ER+/Her2+/BP Luminal was 17% (4% with chemo/trastuzumab; 39% chemo/trastuzumab/pertuzumab, p&lt;0.0001) and statistically inferior (p&lt;0.0001) to the 59% pCR rate in ER+/Her2+/BP HER2. Of 91 ER-/Her2+ tumors 74% were classified as BP HER2, 25% were re-classified BP Basal and &lt;1% was BP Luminal. NCT pCR rates for ER-/Her2+/BP HER2 was 67% (64% with chemo/trastuzumab; 77% chemo/trastuzumab/pertuzumab, p=0.40) and significantly superior (p=0.026) to the 39% pCR rate in ER-/Her2+/BP Basal (p=0.026).

Conclusions

In the NBRST study, BP 80-gene functional subtype (based on mRNA expression and translation): 1. Re-classifies over half of all IHC/FISH ER+/Her2+ patients; 2. Predicts treatment response or resistance in Her2+ patients not segregated by conventional IHC/FISH classification and 3. Identifies ER+/Her2+ tumors that are sensitive to chemo/trastuzumab/pertuzumab but resistant to chemo/trastuzumab.

Citation Format: Whitworth P, Beitsch P, Baron P, Beatty J, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Three distinct HER2 subtypes identified by BluePrint 80-gene functional subtyping predict treatment-specific response in the prospective neo-adjuvant NBRST registry. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-05.

Abstract P4-14-10: Pertuzumab overcomes chemotherapy/trastuzumab resistance in ER+/Her2+ tumors classified as luminal functional subtype by the 80-gene BluePrint assay in the prospective neo-adjuvant breast registry symphony trial (NBRST)

Background

The prospective Neo-adjuvant Breast Registry Symphony Trial (NBRST) enrolled over 1000 US patients between June 2011 and December 2014. The aim of NBRST study is to compare chemosensitivity as defined by pathological Complete Response (pCR) using the 80-gene BluePrint functional subtype profile vs. conventional IHC/FISH subtyping. Treatment was at the discretion of the physician utilizing standard NCCN regimens. Pertuzumab, a monoclonal antibody, inhibits the dimerization of HER2 with other HER receptors. Pertuzumab received US FDA approval for the neo-adjuvant treatment of HER2-positive breast cancer in September 2013. Essentially all patients with HER2 positive cancers were treated with chemotherapy + trastuzumab and after this date pertuzumab was added, creating 2 distinct groups of Her2 treated patients.

The aim of the current analysis is to compare the pCR rate of trastuzumab (H) vs trastuzumab and pertuzumab (H + P) by conventional and BluePrint functional subtype.

Methods

The current analysis includes women from the NBRST study, with histologically proven breast cancer, who received neo-adjuvant chemotherapy plus H or H + P and who provided written informed consent. Pathological assessment of Her2 was done according to ASCO CAP guidelines at the time of diagnosis. BluePrint (BP) classifies patients into Luminal, HER2 or Basal-type. pCR is defined as T0/isN0. All pCRs were verified with a de-identified copy of the surgical pathology report. Fisher's exact test was used to compare pCR rates within different subgroups.

Results

252 IHC/FISH Her2+ patients received H (166) or H + P (86). The median age was 53 (range 23-81). 8% was stage I, 68% stage II and 24% stage III. 65% were ER positive.

BP classified 55% of patients as HER2, 32% as Luminal, and 14% as Basal-type.

The pCR rates and p-values within different subgroups of clinical Her2+ patients are provided in the table below.

pCR rates and p-values within different subgroups of clinical Her2+ patients(n)H (pCR rate)H + P (pCR rate)p-valueTotal (n=252)40%59%0.005IHC/FISH Her2+/ER+ (163)30%57%0.001IHC/FISH Her2+/ER- (89)69%63%0.82BP HER2 (138)57%78%0.01BP Luminal (80)4%38%0.0002BP Basal (34)47%38%0.69

Conclusions

Addition of pertuzumab to trastuzumab significantly increased response rate in ER+/Her2+, BP HER2 and BP Luminal patients but not in ER-negative and BP Basal patients.

Pertuzumab overcame resistance to NCT/trastuzumab in a substantial proportion of the IHC/FISH Her2+/BP Luminal subgroup; indicated by a significantly increased pCR rate.

Citation Format: Peter B, Pat W, Paul B, Jennifer B, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LL, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Pertuzumab overcomes chemotherapy/trastuzumab resistance in ER+/Her2+ tumors classified as luminal functional subtype by the 80-gene BluePrint assay in the prospective neo-adjuvant breast registry symphony trial (NBRST). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-10.

Abstract P4-14-29: One-third of HER2 positive patients have 80-gene luminal subtype that is resistant to chemo-trastuzumab but sensitive to chemo-trastuzumab-pertuzumab: Critical implications for the adjuvant setting from the NBRST phase 4 neoadjuvant study

Background

The phase 4 Neo-adjuvant Breast Registry Symphony Trial (NBRST) enrolled over 1,000 US patients between June 2011 and December 2014. The aim of NBRST study is to compare chemo-sensitivity as defined by pathological Complete Response (pCR) using the 80-gene BluePrint (BP) functional subtype profile vs. conventional IHC/FISH subtyping. Treatment was at the discretion of the physician utilizing standard NCCN regimens. Pertuzumab, a monoclonal antibody, inhibits the dimerization of HER2 with other HER receptors. Pertuzumab received US FDA approval for the neo-adjuvant treatment of HER2-positive breast cancer in September 2013. Essentially all patients with HER2 positive cancers were treated with chemotherapy + trastuzumab and after this date pertuzumab was added, creating 2 distinct groups of Her2-treated patients.

The aim of the current analysis is to compare the pCR rate of chemo-trastuzumab (c-t) vs chemo-trastuzumab plus pertuzumab (c-t-p) by conventional and 80-gene BP functional subtype. 80-gene BP functional subtype was derived by supervised cluster analysis for concordant mRNA and protein expression.

Methods

The current analysis includes women from the NBRST study, with histologically proven breast cancer, who received neo-adjuvant treatment, had 80-gene subtyping and provided written informed consent. Pathological assessment of HER2 was performed according to ASCO CAP guidelines at the time of diagnosis. 80-gene BluePrint (BP) classifies patients into Luminal, HER2 or Basal-type. pCR is defined as T0/isN0. All pCRs were verified with a de-identified copy of the surgical pathology report. Fisher's exact test was used to compare pCR rates within different subgroups.

Results

286 IHC/FISH HER2+ patients received c-t (175) or c-t-p (111). Of these 80-gene BP subtype classified 53% as HER2-type, 33% as Luminal-type and 14% as Basal-type. 64% were ER positive.

The pCR rates and p-values within different subgroups of clinical HER2+ patients are provided in the table below.

 c-tc-t-p (n)pCR ratep-valueTotal (n=286)41%57%0.01BP HER2 (153)58%73%0.06 BP Luminal (93) 6% 39% 0.0002BP Basal (40)45%1.0IHC/FISH HER2+/ER+ (183)31%53%0.003IHC/FISH HER2+/ER- (103)59%64%0.68

Conclusions

One-third of ASCO/CAP Her2+ patients had 80-gene BP Luminal subtype and demonstrated resistance to c-t (pCR 6%). Addition of Pertuzumab overcame resistance in this group (pCR 39%). This finding in the neoadjuvant setting suggests a substantial potential benefit in the adjuvant setting and thus an urgent need to consider treatment in at-risk patients as well as confirmatory tissue analysis from independently reported trials.

Citation Format: Beitsch P, Whitworth P, Baron P, Beatty J, Pellicane JV, Murray MK, Dul C, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. One-third of HER2 positive patients have 80-gene luminal subtype that is resistant to chemo-trastuzumab but sensitive to chemo-trastuzumab-pertuzumab: Critical implications for the adjuvant setting from the NBRST phase 4 neoadjuvant study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-29.

Human endothelial colony-forming cells protect against acute kidney injury: role of exosomes

The administration of certain progenitor cells is protective in experimental acute kidney injury (AKI), and mechanisms may involve the release of paracrine factors. Endothelial colony-forming cells (ECFCs) are endothelial precursor cells with a high proliferative capacity and pro-angiogenic potential. We examined the effects of human umbilical cord blood-derived ECFCs and their extracellular vesicles in a mouse model of ischemic AKI and in cultured human umbilical vein endothelial cells subjected to hypoxia/reoxygenation. In mice with ischemic AKI, administration of ECFCs (i.v.) at the time of reperfusion significantly attenuated increases in plasma creatinine, tubular necrosis, macrophage infiltration, oxidative stress, and apoptosis, without cell persistence in the kidneys. In cultured human umbilical vein endothelial cells, hypoxia/reoxygenation stimulated apoptosis. This effect was inhibited by incubation with conditioned medium or exosomes (40- to 100-nm diameter) derived from ECFCs, but not by microparticles (100- to 1000-nm diameter) or vesicle-depleted conditioned medium. Administration of exosomes (i.v.) directly to mice with ischemic AKI attenuated renal injury, as assessed by plasma creatinine, tubular necrosis, and apoptosis. Taken together, these studies indicate protective effects of human cord blood-derived ECFCs in experimental AKI and suggest that ECFC-derived exosomes may mediate the protective response via inhibition of endothelial cell apoptosis.

Abstract P1-02-02: Concordance of microarray based determination of ER, PR and HER2 receptor status and local IHC/FISH assessment in the prospective neo-adjuvant breast registry symphony trial (NBRST)

Background

The level of estrogen receptor (ER), progesterone receptor (PR) and HER2 expression is predictive for prognosis and/or treatment response in breast cancer patients. However, differences in fixation and IHC and subjective interpretation can substantially affect the accuracy and reproducibility of the results. The commercially available TargetPrint test measures the mRNA expression level of ER, PR and HER2. Previously TargetPrint was shown to be strongly correlated with high quality IHC/FISH assessment, especially for ER and HER2. Concordance rates were 98% (k = 0.90) for ER; 85% (k = 0.62) for PR and 96% for HER2 (k = 0.78) in 619 patients (Viale et al., SABCS 2011).

This study compares results from the microarray-based TargetPrint with IHC and FISH conducted according to local standard procedures in the prospective NBRST study.

Methods

The NBRST study includes women aged 18–90 with histologically proven breast cancer, who are scheduled to start neo-adjuvant chemotherapy (CT) or neo-adjuvant endocrine therapy (ET), and who provide written informed consent. The mRNA level of ER, PR and HER2 (TargetPrint) was assessed at the Agendia laboratory (Agendia Inc, Irvine, CA) in fresh and formalin fixed paraffin embedded tumor samples submitted from 40 institutes in the US. The results of the IHC/FISH assessments conducted according to local standard procedures were compared to the quantitative gene expression readouts.

Results

There were 355 eligible patients enrolled. 67% of patients are IHC ER positive and 25% Her2 IHC/FISH positive. 11 patients were IHC/FISH HER2 equivocal (all TargetPrint HER2 negative). Comparison of IHC and gene expression read out by TargetPrint showed a concordance of 88% (k = 0.75)for ER; 83% (k = 0.66) for PR and 89% (k = 0.70) for HER2. The discordance range for institutes who submitted more than 10 samples was 0-30% for ER, 0-47% for PR and 0-28% for HER2. 16% of all IHC ER+ samples were classified negative by microarray. In contrast, 4% of IHC ER- samples were classified positive by microarray. However for HER2, as many as 33% of IHC/FISH HER2+ samples were classified negative by microarray; 3% of IHC/FISH HER2- samples were classified positive by microarray.

Conclusions

Microarray based readout of ER, PR and HER2 status using TargetPrint is comparable to local IHC and FISH analysis in 355 analyzed samples from 40 US institutes but the discordance range for individual institutes was up to 30% for ER and 28% for Her2.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-02-02.

The production of monovalent and anti-idiotype antivenom against Mesobuthus eupeus (Scorpionida: Buthidae) venom in rabbits

The antivenom production against poisonous creatures encounters a number of difficulties. Interestingly, according to the network theory the conventional antigens are not necessarily needed for producing antibodies against the venoms. In this investigation, the antivenom against Mesobuthus eupeus venom was produced based on the aforementioned theory. Polyclonal antibodies against M. eupeus venom were obtained from the immunized rabbits and the specific antibodies were isolated. After separation of Fab2, immunization process and production of the monovalent and anti-idiotype, these antivenoms were analyzed for the determination of their neutralizing power. The level of the produced antibodies in different stages of this study was also measured by ELISA assay. Four hundred and fifty micrograms of the venom can be neutralized by 4.2, 18 and 291 mg of monovalent, polyvalent and anti-idiotype antivenom, respectively. The ELISA results revealed that idiotypic antigens were six times more immunogenic than anti-idiotypes. The anti-idiotype antivenom can be produced on a large scale with minimum venom consumption. In addition, they are non-toxicant in immunized animals and can be used as a vaccine in people at the risk of scorpion stings.

Association between fetal overgrowth and metabolic parameters in cord blood of newborns of women with GDM

AIM

There is evidence that arthrosclerosis may originate at birth, so assessment of serum lipid levels in cord blood might be important. The aim of this study was to investigate the association between fetal overgrowth and metabolic parameters in cord blood of newborns of women with gestational diabetes mellitus (GDM) and to compare these parameters with those in newborns of non-diabetic.

METHODS

The study group included 112 women (singleton pregnancy, and GDM diagnosed following WHO criteria), and as controlled subjects, 159 matched healthy pregnant women and their newborn babies were selected. A sample of cord blood was obtained at delivery. The cord blood's insulin, glucose, and lipids (total cholesterol, high-density cholesterol, low- density cholesterol, and triglyceride) were determined. The relationships between these metabolic parameters and large for gestational age (LGA) were also assessed.

RESULTS

There were no significant differences between total cholesterol (TC), HDL cholesterol (HDL -C), triglyceride (TG) and glucose levels between two groups but the LDL-C level, LDL/HDL ratio and insulin level were significantly higher in newborns of mother with GDM. LGA newborns of diabetic mothers, show the HDL-C level were significantly lower and LDL-C level were significantly higher than AGA (Appropriate for Gestational Age).

CONCLUSION

These results show that GDM altered neonatal plasma lipids metabolism and so newborns of diabetic mothers may be predisposed early in life to LDL hypercholesterolemia and thus may be at a greater risk of developing coronary heart disease later in life.

Utility of filter paper for preserving insects, bacteria, and host reservoir DNA for molecular testing

BACKGROUND

Appropriate methodology for storage biological materials, extraction of DNA, and proper DNA preservation is vital for studies involving genetic analysis of insects, bacteria, and reservoir hosts as well as for molecular diagnostics of pathogens carried by vectors and reservoirs. Here we tried to evaluate the utility of a simple filter paper-based for storage of insects, bacteria, rodent, and human DNAs using PCR assays.

METHODS

Total body or haemolymph of individual mosquitoes, sand flies or cockroaches squashed or placed on the paper respectively. Extracted DNA of five different bacteria species as well as blood specimens of human and great gerbil Rhombomys opimus was pipetted directly onto filter paper. The papers were stored in room temperature up to 12 months during 2009 until 2011. At monthly intervals, PCR was conducted using a 1-mm disk from the DNA impregnated filter paper as target DNA. PCR amplification was performed against different target genes of the organisms including the ITS2-rDNA of mosquitoes, mtDNA-COI of the sand flies and cockroaches, 16SrRNA gene of the bacteria, and the mtDNA-CytB of the vertebrates.

RESULTS

Successful PCR amplification was observed for all of the specimens regardless of the loci, taxon, or time of storage. The PCR amplification were ranged from 462 to 1500 bp and worked well for the specified target gene/s. Time of storage did not affect the amplification up to one year.

CONCLUSION

The filter paper method is a simple and economical way to store, to preserve, and to distribute DNA samples for PCR analysis.

OT2-03-02: Prospective Neo-Adjuvant Registry Trial Linking MammaPrint, Subtyping and Treatment Response: Neoadjuvant Breast Registry – Symphony Trial (NBRST)

Background MammaPrint is performed on a diagnostic multi-gene array featuring &gt;4,500 genes. This platform enables additional gene expression profiles to be analyzed simultaneously on one tumor specimen. BluePrint, an eighty gene Molecular Subtyping Profile, discriminates between three distinctive subtypes; Basal-type, Luminal-type, and ERBB2 (HER2)-type. Studies have shown marked differences in response to neo-adjuvant treatment in groups stratified by MammaPrint and BluePrint.

Trial design A prospective observational, case-only study linking MammaPrint, BluePrint, TargetPrint, TheraPrint (together referred to as the Symphony suite) and possible additional profiles of interest to neoadjuvant treatment response and Distant Metastases Free Survival (DMFS) and Relapse Free Survival (RFS).

20-30 institutions in the US will be invited to contribute clinical patient data from enrolled patients after a MammaPrint, TargetPrint, BluePrint and TheraPrint (Symphony suite) has been successfully performed and the patient has started neo-adjuvant therapy. Treatment is at the discretion of the physician, adhering to NCCN approved regimens or a recognized alternative.

Eligibility criteria

Women with histologically proven breast cancer, who have started or are scheduled to start neo-adjuvant chemotherapy therapy or neo-adjuvant hormone therapy, after successful Symphony suite assessment Age 18–90 Written informed consent No excisional biopsy or axillary dissection No confirmed distant metastatic disease No prior therapy for the treatment of breast cancer

Scope

The scope of this registry study is to measure chemosensitivity as defined by pCR (primary endpoint), or endocrine sensitivity as defined by partial response, (a primary endpoint for neo-adjuvant endocrine therapy and a secondary endpoint for neoadjuvant chemotherapy), metastasis-free survival and relapse-free survival (secondary endpoints) in molecular subgroups, determined by the MammaPrint and BluePrint; as well as correlation to Targetprint and Theraprint read outs in addition to investigating novel response profiles.

Statistical methods

The response rate and corresponding confidence intervals will be presented as a proportion of all patients enrolled. The confidence intervals will be calculated using the normal approximation to the binomial distribution. Comparison of response rates between different molecular subgroups will be conducted using Pearson Chi-square test. Correlation of chemosensitivity and endocrine sensitivity (as defined by pCR) to TheraPrint will be determined using Pearson correlation and linear fit models.

Kaplan-Meier curves for RFS and DMFS will be calculated for different molecular subgroups.

Present accrual and target accrual

The target accrual is to enroll approximately 500 patients in 4 years.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-03-02.

MRP1 polymorphisms (T2684C, C2007T, C2012T, and C2665T) are not associated with multidrug resistance in leukemic patients

One of the main problems in treating cancer patients is that cancer cells can develop drug resistance. Resistance to multiple anticancer drugs, so called multidrug resistance (MDR), most likely involves a nonspecific mode of resistance, through drug-efflux transporters. One of the most extensively studied genes involved in MDR is multidrug resistance protein 1 (MRP1). We investigated a possible association between the expression level of MRP1 and the occurrence of MDR in leukemic patients, and we tested the hypothesis that MRP1 polymorphisms are predictive of MDR in patients with acute leukemia. The mRNA level of MRP1 was determined in 111 patients with acute leukemia (including 52 patients with acute myeloid leukemia and 59 patients with acute lymphoblastic leukemia), by quantitative real-time PCR, to determine how it affected the response to chemotherapy. We typed T2684C, C2007T, C2012T, and C2665T MRP1 polymorphisms in 111 patients classified as either drug-resistant or drug-responsive. We found that high expression of MRP1 was associated with the MDR phenotype in both acute myeloid leukemia and acute lymphoblastic leukemia patients. There was no effect of a particular genotype on the expression level of the MRP1 gene. We found no significant differences in chemosensitivity among any of these genotypes.

Three Michaelis-Menten pharmacokinetic dosing methods compared with physician dosing of phenytoin in an outpatient neurology practice

We compared predicted phenytoin serum concentrations using three Michaelis-Menten pharmacokinetic dosing methods with actual concentrations obtained from physician dosing in an outpatient neurology practice. Method 1 used population estimates for the Michaelis-Menten constant (Km) and maximum velocity (Vmax), method 2 used one dose and serum concentration pair to determine Vmax, and method 3 used two dose-concentration pairs to determine both Km and Vmax. In addition, physician doses were compared with pharmacokinetically calculated doses. Records of patients who received at least two phenytoin doses followed by two serum concentration determinations were reviewed. Data on age, gender, weight, physician doses, and resultant serum concentrations were collected. Pearson's correlation coefficient was used to compare physician maintenance doses with pharmacokinetically calculated predicted doses, whereas actual and predicted serum concentration data were used to determine precision and bias associated with each of the three methods. Actual serum concentrations fell into therapeutic range more frequently than predicted values in all but one comparison (method 3). Predicted and actual phenytoin doses were significantly correlated only with method 2. Only one of the three Michaelis-Menten pharmacokinetic dosing methods evaluated (method 3) was more predictive than physician phenytoin dosing.