Progress in The Research of Lactate Metabolism Disruption And Astrocyte-Neuron Lactate Shuttle Impairment in Schizophrenia: A Comprehensive Review

Schizophrenia (SCZ) is a complex neuropsychiatric disorder widely recognized for its impaired bioenergy utilization. The astrocyte-neuron lactate shuttle (ANLS) plays a critical role in brain energy supply. Recent studies have revealed abnormal lactate metabolism in SCZ, which is associated with mitochondrial dysfunction, tissue hypoxia, gastric acid retention, oxidative stress, neuroinflammation, abnormal brain iron metabolism, cerebral white matter hypermetabolic activity, and genetic susceptibility. Furthermore, astrocytes, neurons, and glutamate abnormalities are prevalent in SCZ with abnormal lactate metabolism, which are essential components for maintaining ANLS in the brain. Therefore, an in-depth study of the pathophysiological mechanisms of ANLS in SCZ with abnormal lactate metabolism will contribute to a better understanding of the pathogenesis of SCZ and provide new ideas and approaches for the diagnosis and treatment of SCZ.

Gut bacteria-driven homovanillic acid alleviates depression by modulating synaptic integrity

The gut-brain axis is implicated in depression development, yet its underlying mechanism remains unclear. We observed depleted gut bacterial species, including Bifidobacterium longum and Roseburia intestinalis, and the neurotransmitter homovanillic acid (HVA) in individuals with depression and mouse depression models. Although R. intestinalis does not directly produce HVA, it enhances B. longum abundance, leading to HVA generation. This highlights a synergistic interaction among gut microbiota in regulating intestinal neurotransmitter production. Administering HVA, B. longum, or R. intestinalis to mouse models with chronic unpredictable mild stress (CUMS) and corticosterone (CORT)-induced depression significantly improved depressive symptoms. Mechanistically, HVA inhibited synaptic autophagic death by preventing excessive degradation of microtubule-associated protein 1 light chain 3 (LC3) and SQSTM1/p62 proteins, protecting hippocampal neurons' presynaptic membrane. These findings underscore the role of the gut microbial metabolism in modulating synaptic integrity and provide insights into potential novel treatment strategies for depression.

Online mindfulness-based stress reduction improves anxiety and depression status and quality of life in caregivers of patients with severe mental disorders

OBJECTIVES

To explore the effects of online mindfulness-based stress reduction (MBSR) on the anxiety and depression status, and quality of life in the caregivers of patients with severe mental disorders.

METHODS

Ninety-three caregivers for patients with schizophrenia or bipolar disorder, who were hospitalized in Yunnan Provincial Mental Hospital in March 2021, were enrolled and randomly divided into control group (n=47) and MBSR intervention group (n=46). Both groups received basic health education and rehabilitation skill training, while the intervention group received additional online MBSR for 8 weeks. The anxiety and depression status, and the quality of life of the caregivers were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and the 36-item Short Form Health Survey (SF-36) before and 8 weeks after intervention, respectively.

RESULTS

Thirteen caregivers dropped out of the study, and 80 subjects (40 in each group) were included in the final analysis. At the baseline, there were no significant differences in SAS, SDS and SF-36 scores between two groups (all P>0.05). Compared with the baseline, SAS and SDS scores in the intervention group significantly decreased after 8 weeks of intervention (both P<0.01) and were significantly lower than those in the control group (both P<0.01). There were no significant changes in the control group (all P>0.05). Except the physiological function dimension, the total score and the scores of each dimension of SF-36 in the intervention group were significantly increased after 8-week intervention (all P<0.05), and were significantly higher than those in the control group (all P<0.01). There were no significant changes in the control group before and after intervention (all P>0.05).

CONCLUSIONS

Online MBSR can reduce the anxiety and depression levels, improve the quality of life in the caregivers of patients with severe mental disorders.

Machine Learning Study of SNPs in Noncoding Regions to Predict Non-small Cell Lung Cancer Susceptibility

Non-small cell lung cancer (NSCLC) is the most common pathological subtype of lung cancer. Both environmental and genetic factors have been reported to impact the lung cancer susceptibility. We conducted a genome-wide association study (GWAS) of 287 NSCLC patients and 467 healthy controls in a Chinese population using the Illumina Genome-Wide Asian Screening Array Chip on 712,095 SNPs (single nucleotide polymorphisms). Using logistic regression modeling, GWAS identified 17 new noncoding region SNP loci associated with the NSCLC risk, and the top three (rs80040741, rs9568547, rs6010259) were under a stringent p-value (<3.02e-6). Notably, rs80040741 and rs6010259 were annotated from the intron regions of MUC3A and MLC1, respectively. Together with another five SNPs previously reported in Chinese NSCLC patients and another four covariates (e.g., smoking status, age, low dose CT screening, sex), a predictive model by machine learning methods can separate the NSCLC from healthy controls with an accuracy of 86%. This is the first time to apply machine learning method in predicting the NSCLC susceptibility using both genetic and clinical characteristics. Our findings will provide a promising method in NSCLC early diagnosis and improve our understanding of applying machine learning methods in precision medicine.

[Biomechanical analysis of miniplate fixation systems in restorative laminoplasty for spinal canal reconstruction]

OBJECTIVE

To investigate the biomechanical properties of H-shaped and L-shaped miniplate fixation systems (H-MFS and L-MFS, respectively) in restorative laminoplasty for spinal canal reconstruction (RL-SCR).

METHODS

Laminectomy was performed in a 3D printed L4 vertebral model followed by RL-SCR using H-MFS or L-MFS, and the biomechanical properties of the reconstructed models were evaluated using static and dynamic compression tests. Biomechanical analyses of RL-SCR were also conducted in finite element models of the L3-L5 vertebrae with normal assignment (NA), laminectomy, or fixation with H-MFS or L-MFS, and the range of motion (ROM) of L3-L4 and L4-L5 was evaluated.

RESULTS

In static compression test, the sustained yield load, compression stiffness, yield displacement and axial displacement- axial load were all significantly greater in H-MFS group (P < 0.05). Door closing, lamina collapse and plate breakage occurred in all the models in L-MFS group, and only some models in H-MFS group showed plate cracks and screw loosening. In dynamic compression tests, the peak load in H-MFS group reached 873 N (which was 95% of the average yield load in static compression), significantly greater than that in L-MFS group (P < 0.05). The ultimate load in L-MFS group was only 46.59% of that in H-MFS group (P>0.05). In finite element analysis, the ROM of the L3-L4 and L4- L5 segments were significantly smaller in NA, H-MFS and L-MFS groups than in laminectomy group. Compared with NA group, H-MFS group showed a greater ROM during extension, and L-MFS group showed greater ROM in flexion, extension, bending, and rotation; The overall ROM of the vertebral segments decreased in the order of laminectomy group, L-MFS group, H-MFS group, and NA group.

CONCLUSION

Laminectomy causes structural destruction of the posterior column of the spine to affect its biomechanical stability. RL-SCR can effectively maintain the biomechanical stability of the spine, and H-MFS is superior to L-MFS in maintaining the integrity and biomechanical properties of the reconstructed spinal canal.

The Connection of Early Life Adversity and Post Traumatic Stress Disorder: an Updated Review

Human beings develop a highly coordinated and flexible system of social behavior and threat evaluation. In this review we focus on the unique role of early life adversity (ELA) in programming deficits in social behavior and threat processing, and provides guidance on future investigations in the areas of stress reactivity and mental health. We propose that neuroendocrine perturbations of hypothalamus-pituitary-adrenal (HPA) axis and gene activity by epigenetic mechanisms may explain how early adverse circumstances may lead to post traumatic stress disorder (PTSD). The detailed exploration of the interaction of stress as environmental factor and epigenetic and genetic regulation in HPA axis may improve targeted interventions among vulnerable individuals. We are convinced that further studies following these directions will contribute to effective prevention and treatment of PTSD in early traumatized patients.

Association of Essential Tremor With Dementia and Affective Disorders: A Meta-Analysis

Background

The dementia and affective disorders are common non-motor features in patients with essential tremor (ET). However, the relationship of ET with cognitive impairments and affective disorders remains controversial. This meta-analysis aimed to analyze the association of ET with dementia and affective disorders.

Methods

Original studies published from January 1999 to October 2019 were systematically searched from the database of Medline (OvidSP), EMBASE (OvidSP), and the Cochrane Central Register of Controlled Trials. Pooled standard mean difference (SMD, random effect model), odds ratios (ORs), relative risk (RR), and 95% CI were calculated.

Results

Compared with the Non-ET group, patients with ET had significantly lower Mini-Mental State Examination (MMSE) score (SMD, −1.16; 95% CI, −1.75 to −0.58; p = 0.0001) and had significantly higher depressive and anxiety symptoms scale score (SMD, 0.55; 95% CI, 0.22–0.87; p = 0.0009). The OR for dementia and affective disorders in individuals with ET compared with individuals without ET was 2.49 (95% CI, 2.17–2.85, p &lt; 0.00001). While there was no significant difference in Montreal Cognitive Assessment (MoCA) score between ET and Non-ET groups (SMD, −0.52; 95% CI, −0.16 to 0.13; p = 0.23), there was a significant difference in the risk of mortality between ET and Non-ET groups (RR = 4.69, 95% CI, 2.18–10.07).

Conclusion

The non-motor symptoms should not be neglected among patients with ET. However, the causal relationship between ET and dementia, depression, and anxiety is unclear.

Integrated analysis of ceRNA network reveals potential prognostic Hint1-related lncRNAs involved in hepatocellular carcinoma progression

Background

Hint1 is a novel tumor suppressor gene, and inactivation of its expression is closely associated with the carcinogenesis of a variety of malignancies. The effects of Hint1 deficiency on the competing endogenous RNA (ceRNA) regulatory network in the context of HCC remains to be fully characterized. This study aims to explore Hint1-related hub lncRNAs in HCC and to establish a reliable prognostic model for HCC patients based on these hub lncRNAs.

Methods

lncRNA + mRNA microarray was used to identify differentially expressed (DE) lncRNAs and mRNAs in Huh7 cells before and after Hint1 knockdown. A Hint1-related ceRNA network was mapped by bioinformation technology. The DEmRNAs in the network were analyzed via GO and KEGG enrichment analyses. Hub DElncRNAs associated with HCC patient prognosis were then detected through univariate and multivariate Cox regression analyses and were incorporated into a prognostic model. The prognostic value of this model was then assessed through the use of Kaplan-Meier curves, time-related ROC analyses, and nomograms. We also utilized Kaplan-Meier curves to validate the relationship between hub lncRNAs and the overall survival (OS) of HCC patients. Finally, A Hint1-related core ceRNA network based on the hub DElncRNAs and DEmRNAs was mapped.

Results

We identified 417 differentially expressed DElncRNAs and 2096 DEmRNAs in Huh7 cells before and after Hint1 knockdown. Three hub DElncRNAs (LINC00324, SNHG3, and DIO3OS) in the Hint1-associated ceRNA network were screened out using univariate and multivariate Cox regression analyses. A hepatocellular carcinoma (HCC) prognostic risk-scoring model and nomogram were constructed using these three hub lncRNAs, and it was confirmed that the risk score of the model could be used as an independent predictor of HCC prognosis. A Hint1-related core ceRNA network based on the hub DElncRNAs and DEmRNAs was also mapped.

Conclusion

We constructed a reliable prognostic model for HCC patients based on three Hint1-related hub lncRNAs, and we believe these three hub lncRNAs may play critical roles in hepatocarcinogenesis, and progression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-022-02535-z.

Abstract ES4-1: Acupuncture

Acupuncture is a Traditional Chinese Medicine technique that involves inserting and manipulating filiform needles into specific points on the body to alleviate symptoms. Although its mechanisms are not fully established, acupuncture appears to interact with and modulate the functioning of nerves, neurotransmitters, and neurohormones. Acupuncture has been used as a complementary therapy to treat a wide range of conditions experienced by breast cancer survivors. In this education session, I will discuss the use of acupuncture to reduce breast cancer treatment-related toxicities such as chemotherapy-induced nausea, vomiting, peripheral neuropathy, and cognitive-impairment; insomnia; hot flashes; and aromatase inhibitor-associated arthralgias. I will start by discussing the definition and mechanisms of acupuncture. I will then share clinical evidence and ongoing trials supporting and investigating the use of acupuncture for these toxicities, and end with a summary of my recommendations.

Citation Format: T Bao. Acupuncture [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES4-1.

Standing balance of vehicle passengers: The effect of vehicle motion, task performance on post-drive balance

BACKGROUND

Motion platforms and driving simulators have been shown to contribute to motion sickness and a short-term increase in standing postural sway. However, no studies to date have investigated how the motion of a passenger vehicle and the performance of a task during a drive on a closed test track affects post-drive standing balance.

RESEARCH QUESTIONS

What are the effects of (1) a continuous, scripted drive on a closed test track, and (2) the performance of a handheld tablet-based task during the scripted drive, on post-drive standing balance?

METHODS

Fifty adults (23 males, 27 females; 40.0 ± 20.6 yr) rode in the front passenger seat of a midsized sedan on a scripted drive. Participants were assigned to one of the acceleration levels (Low, Moderate) and completed both Task and No-Task test conditions, involving a visual-based task on a handheld tablet device. Before and after each scripted drive, participants completed two standing balance exercises: 1) feet tandem, eyes open, on firm support, and 2) feet together, eyes closed, on foam support. An inertial measurement unit (IMU) captured estimates of postural trunk sway. Root-mean-square (RMS) of angular position and velocity in the anteroposterior (A/P) and mediolateral (M/L) directions, and elliptical fit and path length of sway trajectory were computed. A nonparametric analysis was performed on the balance metrics.

RESULTS

Exposure to a scripted drive in a vehicle affected participants' postural sway, especially after using a handheld device during the drive. M/L RMS sway velocity and path length increased for both exercises following the scripted drive with task. Additionally, M/L RMS sway increased for the more challenging balance exercise, during which participants stood with feet together on foam support with eyes closed.

SIGNIFICANCE

This study is the first to explore balance following a scripted drive on a closed test track. Changes in post-drive balance introduces potential risks to vehicle passengers; concurrent performance of a task on a handheld device further increases the likelihood that post-drive balance will be negatively affected.

[Suggestions for thoracic surgery clinical practice in non-epidemic area of 2019 coronavirus disease]

In this paper, the mechanism of destroying human alveolar epithelial cells and pulmonary tissue by 2019 novel coronavirus (2019-nCoV) was discussed firstly. There may be multiple mechanisms including killing directly the target cells and hyperinflammatory responses. Secondly, the clinical features, CT imaging, short-term and long-term pulmonary function damage of the 2019 coronavirus disease (COVID-19) was analyzed. Finally, some suggestions for thoracic surgery clinical practice in non-epidemic area during and after the epidemic of COVID-19 were provided, to help all the thoracic surgery patients receive active and effective treatment.

Bioinformatics analysis of differentially expressed genes in hepatocellular carcinoma cells exposed to Swertiamarin

Aim: To explore gene expression profiling in hepatocellular carcinoma (HCC) cells exposed to swertiamarin.

Methods: Cell viability, apoptosis and invasion were examined in HepG2 cells after swertiamarin treatment. Tumor growth of SK-Hep-1 cells xenografted in nude mice was monitored after swertiamarin treatment. Total RNA was isolated from HepG2 cells treated with swertiamarin for microarray analysis. The data of microarray were analyzed by bioinformatics.

Results: Swertiamarin treatment decreased the viability and invasion while increased the apoptosis of HepG2 cells, and significantly inhibited the growth of SK-Hep-1 cells xenografted in nude mice. Pathway and biological process analysis of differentially expressed genes (DEGs) in swertiamarin treated HepG2 cells showed that PI3k-Akt was the most significant regulated pathway. 47 targets of swertiamarin were predicted by CGBVS while 21 targets were predicted by 3NN. Notably, 8 targets were predicted as the targets of swertiamarin by both programs, including two prominent targets JUN and STAT3. A large range of DEGs induced by swertiamarin could be regulated by JUN and STAT3.

Conclusion: Swertiamarin treatment led to significant changes in the expression of a variety of genes that modulate cell survival, cell cycle progression, apoptosis, and invasion. Moreover, most of these genes can be clustered into pathway networks such as PI3K, JUN, STAT3, which are predicted targets of swertiamarin. Further confirmation of these targets will reveal the anti-tumor mechanisms of swertiamarin and facilitate the development of swertiamarin as a novel agent for cancer prevention and treatment.

Abstract OT1-08-01: A pilot randomized usual care controlled study of yoga for persistent chemotherapy-induced peripheral neuropathy (CIPN) in breast and gynecological cancer survivors

Background: CIPN is a common, painful, and debilitating side effect of many standard chemotherapy regimens. Patients with CIPN typically experience paresthesia (tingling, numbness), pain, and muscle weakness, and may exhibit significant functional decline and diminished quality of life. Our prior study showed that more than half of breast cancer survivors experience persistent CIPN up to a mean duration of 5.6 years and that this symptom is associated with a doubled fall risk. There is an urgent need to identify nonpharmacological approaches to reduce CIPN symptoms and improve cancer survivors' functional outcomes. Yoga is a mind-body modality that includes stretching, flexibility, and balance training; however, little is known about its effects on symptoms and functional outcomes among cancer survivors with CIPN.

Trial Design: We are conducting a two-arm pilot randomized usual care controlled trial in breast and gynecological cancer survivors at Memorial Sloan Kettering Cancer Center (MSK), New York, NY. Eligible subjects in the intervention arm receive one-hour Hatha Yoga classes taught twice weekly for eight weeks, and practice home-based yoga for a total of 12 weeks. Subjects in the wait list control (WLC) arm continue usual care for 12 weeks, followed by eight weeks of yoga classes and home-based yoga.

Eligibility Criteria: 1) Patients with a primary diagnosis of stage I-III breast, ovarian, uterine, or endometrial cancer; 2) moderate to severe CIPN, defined by four or greater on a 0–10 Numeric Rating Scale (NRS); 3) completion of neurotoxic chemotherapy at least three months prior; 4) no changes in anti-neuropathy medications within three months of enrollment; and 5) an ECOG performance status of 0–2.

Specific Aims: The primary endpoint is safety, feasibility, and NRS changes at eight weeks (end of treatment). The secondary endpoints include the Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) at eight, 12, and 20 weeks.

Statistical Methods: We will accrue 40 patients to get 36 patients evaluable for the primary endpoint at eight weeks. Using an ANCOVA analysis with a sample size of 36, we will be able to detect an effect size of 00.58 standard deviations (SD) of NRS (moderate effect size) between yoga and WLC assuming a NRS correlation between pre- and post-yoga of 0.5 SD. If we assume a 10% dropout rate based on our recently completed trial, we will need to recruit 20 subjects per arm (total of 40) to fall within the precision noted in the sample size calculation. We recognize that the sample size calculation was based on detecting a moderate effect between yoga and WLC and may miss small but clinically meaningful effects that can be used to design a future trial that is sufficiently powered.

Present accrual and target accrual: 40 participants. We have accrued 25 participants as of June 2018 and anticipate accrual completion by October 2018.

Citation Format: Zhi WI, Leeolou MC, Piulson L, Chen P, Patterson C, Paul T, Patil S, Mao JJ, Bao T. A pilot randomized usual care controlled study of yoga for persistent chemotherapy-induced peripheral neuropathy (CIPN) in breast and gynecological cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-08-01.

Abstract P1-11-15: Chemotherapy-induced peripheral neuropathy in breast cancer survivors: Comparison of objective and subjective measures

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, potentially debilitating, and dose-limiting side effect experienced by breast cancer survivors. CIPN encompasses symptoms such as pain, numbness, and tingling, which can be measured subjectively by patient-reported outcomes (PRO), or objectively by quantitative sensory testing (QST); however, little is known how QST correlates with symptom profiles measured by PRO.

Methods: We conducted a cross-sectional analysis using baseline data of two ongoing clinical trials of breast cancer survivors who experienced moderate to severe CIPN defined by pain, numbness, or tingling ratings of four or greater on a numeric rating scale (NRS) after chemotherapy completion for at least three months. PRO measures of CIPN symptoms included Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy-Gynecologic Oncology Group/Neurotoxicity subscale (FACT/GOG-Ntx). QST included tactile threshold (TT) measured by Von Frey's filaments, and vibration threshold (VT) measured by biothesiometer. We ran a Spearman correlation to assess the relationship between the subjective measures (NPS and FACT/GOG-Ntx) and objective measures (TT and VT QST).

Results: We included 52 sets of baseline data on 50 unique patients; two patients were enrolled in both trials at different times. Mean age was 61 years (SD 10) and 66% were white. The mean NRS pain score was 3.9 (SD 2.8), numbness 5.7 (SD 2.2), and tingling 4.3 (SD 2.8) on a 0-10 scale. The mean NPS total score was 39.2 (SD 23.1) on a 0-100 scale, and FACT/GOG-Ntx was 26.2 (SD 6.8) on a 0-44 scale. High scores on NRS and NPS and low scores on FACT/GOG-Ntx signify more severe CIPN symptoms. See Table 1 for a summary of the correlation between two questions on FACT/GOG-Ntx on tingling/numbness in hands and feet, and NPS total score with QST. A moderate correlation was observed between FACT/GOG-Ntx and QST results, suggesting patient-reported hand and foot numbness or tingling is associated with decreased hand and foot tactile and vibration perception. NPS was positively correlated with tactile perception for the hand and foot, but not with vibration perception.

Table 1.Correlation between objective and subjective measures of CIPN Tactile QSTVibration QST HandFeetHandFeetFACT/GOG-Ntx-0.33 (P=0.018)-0.28 (P=0.045)-0.37 (P=0.008)-0.40 (P=0.0034)NPS0.34 (P=0.015)0.32 (P=0.022)0.22 (P=0.12)0.03 (P=0.81)

Conclusions: A mild to moderate correlation was observed between subjective and objective measurements of CIPN. As CIPN presents a diverse range of symptoms, better quantifying the subjective and objective measures of CIPN can help incorporate these tools in observational and intervention trials. Understanding the correlation between PRO and QST can help establish QST as a reliable objective measurement of CIPN symptoms, and enable targeted interventions to alleviate CIPN symptoms.

Citation Format: Bao T, Kwon A, Piulson L, Chen P, Li Q, Patil S, Seidman A, Blinder V, Vahdat L, Zhi WI, Mao JJ. Chemotherapy-induced peripheral neuropathy in breast cancer survivors: Comparison of objective and subjective measures [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-15.

Discs large homolog 5 decreases formation and function of invadopodia in human hepatocellular carcinoma via Girdin and Tks5

Invadopodium formation is a crucial early event of invasion and metastasis of hepatocellular carcinoma (HCC). However, the molecular mechanisms underlying regulation of invadopodia remain elusive. This study aimed to investigate the potential role of discs large homolog 5 (Dlg5) in invadopodium formation and function in HCC. We found that Dlg5 expression was significantly lower in human HCC tissues and cell lines than adjacent nontumor tissues and liver cells. Lower Dlg5 expression was associated with advanced stages of HCC, and poor overall and disease-free survival of HCC patients. Dlg5-silencing promoted epithelial-mesenchymal transition, invadopodium formation, gelatin degradation function, and invadopodium-associated invasion of HepG2 cells. In contrast, Dlg5 overexpression inhibited epithelial-mesenchymal transition, functional invadopodium formation, and invasion of SK-Hep1 cells. Both Girdin and Tks5, but not the Tks5 nonphosphorylatable mutant, were responsible for the enhanced invadopodium formation and invasion of Dlg5-silenced HepG2 cells. Furthermore, Dlg5 interacted with Girdin and interfered with the interaction of Girdin and Tks5. Dlg5 silencing promoted Girdin and Tks5 phosphorylation, which was abrogated by Girdin silencing and rescued by inducing shRNA-resistant Girdin expression. Moreover, Dlg5 overexpression significantly inhibited HCC intrahepatic and lung metastasis in vivo. Taken together, our data indicate that Dlg5 acts as a novel regulator of invadopodium-associated invasion via Girdin and by interfering with the interaction between Girdin and Tks5, which might be important for Tks5 phosphorylation in HCC cells. Conceivably, Dlg5 may act as a new biomarker for prognosis of HCC patients.

[Effect of inhibiting perivascular adhesion on intimal hyperplasia of the vein grafts in rabbits]

Objective: To investigate the effect of preventing perivascular adhesion with topical application of sodium hyaluronate on intimal hyperplasia of the vein grafts in rabbits. Methods: Twenty-four male New Zealand white rabbits, aged 5 months, were randomly divided into 2 groups: Group A and B (n=12 rabbits per group). Artery defect model was established by cutting about 1 cm artery from the middle part of the dissociated left common carotid artery. A section about 3 cm was cut from the right external jugular vein, and the harvested vein was inverted and end-to-end anastomosed to the artery defect. After anastomosis, the adventitia and two anastomosis of the grafted veins in group A was applied 0.2 ml sodium hyaluronate locally to, and corresponding site in Group B was served as a control, but with the sterile normal saline. The grafted veins were obtained 1, 2 and 4 weeks after operation, HE staining and Masson staining were preformed for histological changes of grafted vein wall, proliferating cell nuclear antigen (PCNA) and platelet-derived growth factor (PDGF) immunohistochemistry staining were conducted for proliferation and expression and distribution of PDGF of the grafted vein. Results: The macroscopic and histological observation showed that the perivascular adhesions in Group A were looser when compared with those in Group B. The thickness of the intima, the degree of intima hyperplasia of 2 groups at different time points were as follows: at 1 week after operation, group A[(25.5±3.9) μm, (1.2±0.1) ]and group B[(26.2±4.2)μm, (1.2±0.1)]; at 2 weeks after operation, group A[(44.3±2.5)μm, (1.2±0.1)]and group B[(51.0±3.8)μm, (1.4±0.0)]; at 4 weeks after operation, group A[(69.9±6.8)μm, (1.5±0.1)] and group B[(84.4±6.4)μm, (1.7±0.1)]. Group A was inferior to group B in terms of the above three parameters 2 and 4weeks after operation (P<0.05). Cell proliferation index of intima and that of media were as follows: at 1 week after operation, group A (7.4±2.2), (21.5±3.2) and group B (11.5±2.0), (28.6±4.5); at 2 weeks, group A (20.0±3.2), (35.8±3.4) and group B (26.8±4.1), ( 42.6±4.2); at 4 weeks, group A (11.4±2.0), (22.1±2.7) and group B (15.5±2.4, 28.6±3.9). Group A was inferior to group B in terms of cell proliferation index of intima and media 1, 2 and 4 weeks after operation (P<0.05). The percentage of PDGF-positive cells of intima, media and adventitia was as follows: at 1 week after operation, group A (7.7±1.6), (19.6±3.7), (2.5±1.5) and group B (7.6±2.4), (20.6±4.4), (10.3±2.3); at 2 weeks after operation, group A (11.4±2.6), (19.8±3.1), (12.9±3.3) and group B (19.5±3.5), ( 30.6±5.2), (30.5±5.8); at 4 weeks after operation, group A (6.2±1.9), ( 11.1±2.8), (10.2±2.4) and group B (10.5±2.0), (18.6±3.2), (26.5±3.8). Group A was inferior to group B in terms of the percentage of PDGF-positive cells of intima, media and adventitia 2 and 4 weeks after operation (P<0.05) and Group A was inferior to group B that of adventitia 1 week after operation (P<0.05). Conclusion: Preventing perivascular adhesion with topical application of sodium hyaluronate can inhibit intimal hyperplasia.

Abstract P5-13-16: Arthralgia-associated aging perceptions predict adherence to aromatase inhibitors among women with breast cancer

Background:Aromatase inhibitors (AIs) are associated with reduced risk of breast cancer recurrence, yet many women discontinue their treatment prematurely, often due to arthralgia. Empirically, breast cancer survivors who experience AI-associated arthralgia often report that they have aged quickly over a short period of time. Objective: We aimed to determine whether survivors with a heightened sense of aging due to arthralgia were more likely to non-adhere to their AI regimen. Methods: We conducted a prospective cohort study in an urban academic cancer center among post-menopausal women with hormone receptor positive breast cancer who were within the first two years of their aromatase inhibitor therapy. Perceptions of aging due to arthralgia were measured by the previously validated Penn Arthralgia Aging Scale. Non-adherence was defined as interrupting treatment or discontinuing the AI before the prescribed treatment length was over. Trained raters abstracted adherence data from medical charts. We performed Cox proportional hazards regression to evaluate the relationship between perceptions of aging due to arthralgia and time to non-adherence while adjusting for potential confounders. Results: Among 509 participants, most were White (81.2%) and had at least some college education (77.9%). The majority had been prescribed anastrozole (88.0%), followed by letrozole (9.0%), and exemestane (3.0%). During the follow up period, 144 (28.3%) did not adhere to the AIs as originally prescribed. In univariate analysis, women with a heightened sense of aging due to arthralgia were at more than twice the risk of non-adherence compared to women with low levels of aging perceptions (Hazard Ratio [HR], 2.20; 95% CI, 1.50 – 3.21; p &lt; 0.001). After adjusting for arthralgia pain severity, depression, and AI type, aging perceptions remained a statistically significant predictor of adherence (HR, 1.71; 95% CI, 1.10-2.67; p = 0.02). Depression status also uniquely predicted non-adherence risk (HR, 1.63; 95% CI, 1.03 – 2.59; p = 0.04). Arthralgia pain severity, which predicted adherence in univariate analysis, was not a significant predictor in the final model (HR, 1.21; 95% CI, 0.84 – 1.75; p = .30). Conclusions: Breast cancer survivors on AIs who have a heightened sense of aging due to arthralgia are at greater risk of non-adhering to their AI regimen. Interventions are needed to help survivors reduce arthralgia and develop adaptive appraisals of their AI experience to achieve optimal adherence.

Citation Format: Mao JJ, Chambless DL, Chen J, Bao T, Brier MJ. Arthralgia-associated aging perceptions predict adherence to aromatase inhibitors among women with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-16.

Abstract P5-13-08: The perception of chronic pain among breast cancer survivors

Introduction: Breast cancer treatments may result in acute pain that, if untreated or undertreated, may lead to chronic pain. Twenty to thirty percent of patients who undergo mastectomy experience post-mastectomy pain syndrome, and up to 50% of breast cancer survivors taking aromatase inhibitors (AI) report aromatase inhibitor associated arthralgia (AIAA). The rates, experiences, and risk factors of the effects of breast cancer treatment on breast cancer survivors' perceptions of chronic pain are not well defined.

Methods: We conducted a cross-sectional survey among postmenopausal, hormone receptor-positive, breast cancer survivors who were currently taking or had previously taken an AI. The main outcome variable was the patient's perception of living with chronic pain. Variables including breast cancer treatment, socioeconomic and clinical factors, symptom burden, pain (measured by the Brief Pain Inventory [BPI]), and pain-related coping (measured by the Pain Catastrophizing Scale [PCS]) were measured. Univariate and multivariate logistic analyses were performed to identify the risk factors associated with patients' perceptions of living with chronic pain.

Results: Among 561 participants, 62 (11.1%) reported that they perceived themselves as living with chronic pain prior to their breast cancer diagnosis and 172 (30.8%) reported living with chronic pain during the past 6 months at the time of the survey. Compared with patients who did not perceive chronic pain, patients with the perception of chronic pain had significantly higher pain severity (4.15±0.17 vs. 1.54±0.09) and interference (3.47±0.2 vs. 0.97±0.08); higher pain medication usage (percentage of patients taking at least one pain medication over the past 7 days: 85.47% vs. 57.36%); and higher levels of negative coping with pain, including rumination (4.08±0.31 vs. 2.28±0.16), magnification (2.27±0.2 vs. 1.15±0.08), and helplessness (4.63±0.37 vs. 1.64±0.13). Among participants, 369 (65.78%) reported taking at least one pain medication over the past 7 days. In a multivariate analysis, age (&lt;56 or &gt;70), higher BMI (&gt;30), prior chemotherapy, currently experiencing AIAA, and the presence of chronic pain before cancer diagnosis were identified as risk factors associated with the perception of living with chronic pain.

Conclusion: One in three breast cancer survivors considered themselves to be living with chronic pain, and two-thirds developed such perceptions following their cancer diagnosis. Both chemotherapy and AI use were risk factors for perceptions of chronic pain. Those women who had chronic pain experienced greater pain severity, daily interference, and more negative coping. Better understanding of the risk factors and symptom burden associated with chronic pain perceptions among this population may allow for more targeted interventions to reduce chronic pain and its negative sequelae, including premature termination of AI treatment.

Citation Format: Bao T, Seluzicki C, Li Q, Mao J. The perception of chronic pain among breast cancer survivors [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-08.

Scutellarin suppresses migration and invasion of human hepatocellular carcinoma by inhibiting the STAT3/Girdin/Akt activity

Scutellarin is an active flavone from Erigeron breviscapine (vant) Hand Mass. This study aimed to investigate the potential role of scutellarin in migration and invasion of human hepatocellular carcinoma (HCC) cells and its possible mechanism. In comparison with the vehicle-treated controls, treatment with scutellarin (50 mg/kg/day) for 35 days significantly mitigated the lung and intrahepatic metastasis of HCC tumors in vivo. Scutellarin treatment significantly reduced HepG2 cell viability in a dose-dependent manner, and inhibited migration and invasion of HCC cells in vitro. Scutellarin treatment significantly reduced STAT3 and Girders of actin filaments (Girdin) expression, STAT3 and Akt phosphorylation in HCC cells. Introduction of STAT3 overexpression restored the scutellarin-downregulated Girdin expression, Akt activation, migration and invasion of HCC cells. Furthermore, induction of Girdin overexpression completely abrogated the inhibition of scutellarin on the Akt phosphorylation, migration and invasion of HCC cells. Scutellarin can inhibit HCC cell metastasis in vivo, and migration and invasion in vitro by down-regulating the STAT3/Girdin/Akt signaling.

Identification of the Lowest T=2, J^{π}=0^{+} Isobaric Analog State in ^{52}Co and Its Impact on the Understanding of β-Decay Properties of ^{52}Ni

Masses of ^{52g,52m}Co were measured for the first time with an accuracy of ∼10  keV, an unprecedented precision reached for short-lived nuclei in the isochronous mass spectrometry. Combining our results with the previous β-γ measurements of ^{52}Ni, the T=2, J^{π}=0^{+} isobaric analog state (IAS) in ^{52}Co was newly assigned, questioning the conventional identification of IASs from the β-delayed proton emissions. Using our energy of the IAS in ^{52}Co, the masses of the T=2 multiplet fit well into the isobaric multiplet mass equation. We find that the IAS in ^{52}Co decays predominantly via γ transitions while the proton emission is negligibly small. According to our large-scale shell model calculations, this phenomenon has been interpreted to be due to very low isospin mixing in the IAS.

Identification and characterization of a novel 2,3-butanediol dehydrogenase/acetoin reductase from Corynebacterium crenatum SYPA5-5

Acetoin and 2,3-butanediol are widely used in the chemical and pharmaceutical industries. The enzyme, 2,3-butanediol dehydrogenase/acetoin reductase (2,3-BDH/AR), plays a significant role in the microbial production of acetoin and 2,3-butanediol by catalysing a reversible reaction between acetoin and 2,3-butanediol. To date, a 2,3-BDH has not been characterized from Corynebacterium crenatum. 2,3-BDH was cloned from Coryne. crenatum SYPA5-5 and expressed in Escherichia coli BL21. Sequence analysis suggested that the 2,3-BDH from Coryne. crenatum SYPA5-5 belongs to the short-chain dehydrogenase/reductase superfamily. Its maximum specific activity was obtained at 35°C, however, it became very unstable when the temperature was above 35°C. Its optimal pH was 4·0 for reduction reaction and 10·0 for oxidation reaction. The 2,3-BDH activity was increased to some extent by Ca(2+) , Mg(2+) , Zn(2+) and Mn(2+) ions. In particular, Ca(2+) induced about 1·5-fold increase. The value of kcat /Km for diacetyl and acetoin are higher than for 2,3-butanediol indicating that 2,3-BDH can easily reduce diacetyl or acetoin to 2,3-butanediol under lower pH conditions. The characteristics of 2,3-BDH from Coryne. crenatum SYPA5-5 will give guide to further studies for the production of acetoin and 2,3-butanediol with engineered Coryne. crenatum SYPA5-5.

SIGNIFICANCE AND IMPACT OF THE STUDY

Acetoin and 2,3-butanediol are commonly used as platform chemicals and widely used in pharmaceutical industries. 2,3-butanediol dehydrogenase/acetoin reductase (2,3-BDH/AR) plays a significant role in the microbial production of acetoin and 2,3-butanediol. In this study, 2,3-BDH was cloned from Corynebacterium crenatum SYPA5-5, was expressed in Escherichia coli BL21 and characterized with respect to the optimal temperature, pH, substrate specificity and kinetics. The results will guide further studies in Coryne. crenatum SYPA5-5 for the production of acetoin and 2,3-butanediol.

Abstract OT3-2-11: A phase II study of letrozole and lapatinib followed by an addition of everolimus in postmenopausal women with advanced endocrine resistant breast cancer (BC)

Background: Several preclinical studies demonstrated that crosstalk between growth factor receptor pathways, particularly HER2, and ER signaling confers resistance to endocrine therapy (ET). There are emerging data showing the involvement of immune system and miRNA with endocrine resistance. EGF30008 trial showed a benefit of lapatinib in combination with letrozole, mainly in HER2-positive (HER+) metastatic BC (MBC) while a subset analysis of this trial showed that HER2-negative (HER2-) patients (pts) with acquired endocrine resistance may also benefit from this combination. Our preclinical study suggests that everolimus is synergistic with letrozole and lapatinib.

Trial Design: This is a single arm phase II study for postmenopausal women with hormone receptor-positive MBC progressing after aromatase inhibitor, tamoxifen, or fulvestrant. The total target accrual is 76 pts (38 HER2+ pts and 38 HER- pts). In the first phase of the study, pts will be treated with letrozole and lapatinib (1,500 mg daily). Upon disease progression, pts will enter the second phase where everolimus (5 mg daily) will be added to letrozole and the dose of lapatinib will be reduced to 1,250 mg daily. For correlative studies, peripheral blood samples will be serially collected to evaluate for serum HER2 extracellular domain (ECD), circulating miRNAs, PC cell-derived growth factor (GP88), immune regulatory cells including myeloid-derived suppressor cells, NK cells, and Treg cells. These parameters will be correlated with tumor response. In pts with accessible tumors, optional serial biopsies will be performed at baseline and upon progression in each phase of the study. The tumor tissue will be tested for total HER1, HER2, and HER2 expressions as well as HER2:HER2 homodimers, HER2:HER3 heterodimers, HER1:HER2 heterodimers, p95, and HER3/PI3K (p85 subunit) using VeraTag assay.

Statistical Method: The primary objective is to evaluate the clinical benefit rate (CBR: CR, PR, SD &gt; 24 weeks) of the combination of letrozole and lapatinib as well as the combination of everolimus, letrozole, and lapatinib. This is a three-stage design which is an extension of the Simon's two-stage design. The sample size is based on the assumption that a CBR below 10% (null hypothesis) would indicate ineffective therapy and the statistical power is set at a higher CBR of 30% which we consider is plausible. Therefore, if 0 of the first 10 pts in each cohort have clinical benefit, the study will be closed; otherwise additional 8 pts will be enrolled. If ≤ 1 of the total 18 pts has clinical benefit, the study will be closed; otherwise an additional 9 pts will be enrolled. If ≤ 5 pts have clinical benefit the therapy is considered not promising; and if ≥ 6 pts of the total of 27 have clinical benefit, the therapy is considered worth pursuing. This design has ∼90% probability to accept the therapy for further trials if the true CBR is indeed at least 30% and 10% probability to accept it if the true clinical benefit is indeed below 10%.

To date, there are a total of 6 pts enrolled. Accrual is currently ongoing. Please contact ntait@umm.edu for further information.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-2-11.

P4-12-13: A Multi-Center Randomized Controlled Double Blind Trial Assessing the Effect of Acupuncture in Reducing Musculoskeletal Symptoms in Breast Cancer Patients Taking Aromatase Inhibitors: First Interim Analysis

Background: Aromatase inhibitors (AIs) are recommended as first-line adjuvant hormonal therapy in postmenopausal women with hormone-receptor-positive breast cancer, as monotherapy or sequential therapy after tamoxifen. AI-associated musculoskeletal symptoms (AIMSS) occur in approximately 50% of women receiving AIs and in some may result in discontinuation of treatment. Symptom management is essential to ensure that breast cancer patients receive the full recommended duration of AI therapy. We conducted a randomized, placebo-controlled trial to evaluate the effect of acupuncture on AIMSS and report the first interim analysis.

Method: Postmenopausal women with early stage breast cancer, experiencing AIMSS, who had not had acupuncture in the year prior to the study, were eligible. Patients were randomized to 8 weekly acupuncture or sham acupuncture. Health assessment questionnaire disability index (HAQ-DI ranging 0–3.0) and pain visual analog scale (VAS ranging 0–100) were used to assess clinical musculoskeletal disorder severity at weeks 0, 4, 8, and 12 or 24. Change in HAQ-DI (ΔHAQ-DI) and VAS scores (ΔVAS) from baseline were compared between patients receiving acupuncture versus sham acupuncture using exact Wilcoxon rank sum test. Serum samples were collected for measurements of estrogens and beta endorphin concentrations and cytokine profile before and after the intervention to evaluate the etiology of AIMSS and the mechanism of acupuncture in treating AIMSS.

Results: Between May 2008 and June 2011, 48 patients were enrolled, 2 patients were not evaluable due to noncompliance to treatment and lost to follow up, 10 were still receiving treatment and therefore not evaluable. Thirty-six were evaluable, and were equally distributed between the real and sham acupuncture groups. Baseline characteristics were balanced between the two groups with regard to age, race, and body mass index (BMI) with the exception that baseline mean HAQ-DI was higher in the acupuncture group (0.9 vs 0.55, p=0.04). White/Black/Asian: 26/7/3, Median (range): age: 61 (45-82); BMI (kg/m2): 31.1 (22.9−59.6). At week 8, both groups showed a wide range of ΔHAQ-DI (ΔHAQ-DI =HAQ-DIweek8-HAQ-DIbaseline): from −1.38 to 0.5 in the acupuncture group versus from −1 to 0.12 in sham acupuncture group. There was no statistically significant difference in mean ΔHAQ-DI between the real and sham acupuncture groups (−0.33 vs −0.33, p=0.87). Eleven patients in each group (61%) reported decreased HAQ-DI scores, which correlated with improved function. There was no difference in mean ΔVAS between the real and sham acupuncture groups (−9.27 vs −13.82, p=0.67). No significant side effects were reported. Changes in other time points and in serum biomarkers will be presented at the meeting.

Conclusions: The majority of breast cancer patients experiencing AIMSS who participated in our study reported a reduced HAQ-DI score both from acupuncture and sham acupuncture. We did not observe significant differences between responses to real versus sham acupuncture after 8 weekly treatments. The study remains open to accrual to reach 50 evaluable patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-13.

P1-12-20: The Safety and Tolerability of Vorinostat in Combination with Lapatinib in Advanced Solid Tumors

Background: Lapatinib has been previously shown to markedly decrease cancer stem cells (CSC) in HER2−positive breast cancer. In preclinical models, we have demonstrated that histone deacetylase inhibitors (HDACi) such as vorinostat can induce differentiation and decrease CSC. The combination of vorinostat and lapatinib is synergistic with a combination index of 0.32 (synergism if CI &lt;1). We therefore undertook a pilot study to evaluate the combination of these two drugs in advanced solid tumors.

Method: Patients were eligible if they were: age ≥ 18 years with incurable solid tumors, ECOG PS 0–2, adequate organ function, and no prior exposure to HDACi. The first 3 patients received lapatinib at the dose of 1,250 mg continuous daily and vorinostat 300 mg 4 days on 3 days off. The second dose level with lapatinib 1,250 mg continuous daily and vorinostat 400 mg 4 days on 3 days off were administered in 6 patients. Cycles were repeated every 21 days until disease progression. Echocardiogram and radiologic evaluation were performed every 12 weeks. During the first cycle, pharmacokinetic (PK) evaluation was performed on days 18 and 21.

Results: Nine consented patients (7 with metastatic breast cancer, 1 with non-small cell lung cancer, and 1 with thyroid cancer) have been enrolled with the median age of 52 (range 25–66). Patients received an average of 6 prior treatments (range 2–10). No dose limiting toxicity or drug related death have been observed. Grade 1–2 toxicities including diarrhea, fatigue, muscle cramps and stomatitis were observed. No grade 3 or 4 hepatic, renal or cardiac toxicity were observed (including no QTc prolongation and no significant reduction in the left ventricular ejection fraction). Patients have received the maximum of 7 cycles (median 3 cycles, range 2–7). Response: as of June 2011, 2 patients are still on treatment. Two patients achieved stable disease (triple negative metastatic breast cancer and HER2−positive breast cancer), 6 patients with progressive disease, and 1 patient is too early to evaluate for response. PK analysis will be presented at the time of the meeting.

Conclusions: The combination of vorinostat and lapatinib is tolerable and has some antitumor activity in heavily pretreated advanced solid tumors. A phase II study in HER2−positive metastatic breast cancer is underway with lapatinib 1,250 mg continuous daily and vorinostat 400 mg 4 days on 3 days off.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-20.

Comparing survival with breast-conservation therapy or mastectomy in the management of young women with early-stage breast cancer

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Background: Previous studies have shown that young women with breast cancer treated with breast-conservation therapy (BCT) experience higher local recurrence rates. Whether such patients are better treated with mastectomy is unclear. The purpose of this study was to evaluate survival outcomes of young women with early-stage breast cancer treated with BCT or mastectomy using a large, population-based database.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients age 20 to 39 diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007 who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable analysis as well as a matched pair analysis were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy.

Results: 14,760 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range: 0.5 to 17.9 years). Multivariable analysis revealed year of diagnosis, age, race/ethnicity, grade, PR status, tumor size, number of lymph nodes positive, and number of lymph nodes examined were independent predictors of OS and CSS while ER status was of borderline significance. After accounting for all patient and tumor characteristics, multivariable analysis found that BCT resulted in similar OS (HR: 0.93; CI: 0.83-1.04; p = 0.16) and CSS (HR: 0.93, CI: 0.83-1.05; p = 0.26) as mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5/10/15-year OS for BCT and mastectomy were 92.5%/83.5%/77.0% and 91.9%/83.6%/79.1%, respectively (p = 0.99) and the 5/10/15-year CSS for BCT and mastectomy were 93.3%/85.5%/79.9% and 92.5%/85.5%/81.9%, respectively (p = 0.88).

Conclusions: Young women with early-stage breast cancer have equivalent survival whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options, and should not choose a mastectomy based on the assumption of improved survival.

Abstract P6-06-01: Relationship between Vitamin D Deficiency and Breast Cancer Histology: A Retrospective Database Review

Background: Vitamin D deficiency has recently been shown to be correlated with high rates of developing breast cancer (Chen P et al, Breast Cancer Res Treat; Oct 2009). However, the association between the degree of vitamin D deficiency and specific histological subtypes of breast cancer remains unclear. Preclinical data has suggested that vitamin D plays an essential role in the terminal differentiation of breast cancer cells, and thus vitamin D deficiency would be associated with the pathogenesis of estrogen receptor negative tumors (Welsh J et al, Journal of Steroid Biochem Mol Biol; Feb 2003), in particular triple-negative tumors, which are associated with a particularly aggressive clinical course. Methods: Beginning in July 2008, the majority of newly diagnosed breast cancer patients at University of Maryland Greenebaum Cancer Center had Vitamin D 25-OH levels testedon initial presentation to the clinic. We conducted a retrospective chart review to obtain information about tumor histology and vitamin D levels in these patients. Results: We include data on 71 patients who presented with newly-diagnosed breast carcinoma or DCIS between June 2008 and December 2009. Average age at diagnosis was 57 (range 36-87), and 58% of patients were African American. Stage distribution of the cohort included; DCIS-3%, stage I-15%, stage II-41%, stage III-28%, and stage IV-10%. Overall, 80% of the patients were vitamin D deficient at diagnosis, with vitamin D levels under 30 ng/ml, and 57% had levels under 20 ng/ml. Patients with triple-negative tumors were the most likely to be vitamin D deficient at diagnosis (90%) compared to hormone receptor-positive patients (75%), and they had the lowest mean and median vitamin D levels compared to all other patients.

Percentage of patients with Vitamin D deficiency

Vitamin D level by histological subtype

Hormone receptor-positive patients were significantly more likely to have normal vitamin D levels at diagnosis and significantly less likely to have severe deficiency (level &lt;10 ng/ml) than those with hormone receptor-negative tumors (p=0.037). African-American women in this cohort were also more likely to be severely vitamin D deficient, with levels &lt;10 ng/ml, than were Caucasian women (34% vs. 7%, p=0.048). Conclusion: Vitamin D deficiency is common among patients with newly-diagnosed breast cancer. Patients with triple-negative tumors may have a higher likelihood of being vitamin D deficient than patients with other histological subtypes.

Effect of simvastatin on the pharmacokinetics of anastrozole

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Background: When used in the adjuvant setting, aromatase inhibitors (AIs) reduce the incidence of contralateral breast cancer and are therefore under investigation for primary breast cancer prevention. Statins hold promise for chemoprevention based on preclinical and epidemiological data. Adding statin to AI has the potential to enhance breast cancer prevention and to protect women from AI-related side effects. Prior to initiating a chemoprevention trial of combination therapy, we evaluated the potential for pharmacokinetic drug-drug interaction between anastrozole and simvastatin in postmenopausal women taking adjuvant anastrozole to ensure that the combination will not influence anastrozole concentration or affect its ability to reduce estrogen. Methods: Postmenopausal women with hormone receptor-positive, stage 0-III breast cancer who had been on adjuvant anastrozole (1 mg/day) for at least 30 days were prescribed 14 days of simvastatin (40 mg/day). We collected serum at baseline (anastrozole alone) and after 14 days of simvastatin initiation (combination therapy). Anastrozole and hydroxyanastrozole, its hydroxylated metabolite, concentrations were determined using liquid chromatography-tandem mass spectrometry assay. Estrogen concentrations will be determined using radio-immunoassay. Significant change in anastrozole was predetermined to be greater than a 30% decrease in concentrations. Percent changes from baseline in anastrozole and hydroxyanastrozole were evaluated using Wilcoxon signed-rank tests. Results: From December 2006 to September 2008, 11 women (10 Caucasian, 1 Black, all reported non-Hispanic with a mean age of 60 yrs [range 51–69]) were enrolled in the study. Of these women, nine had evaluable anastrozole concentrations. After 14 days of simvastatin, there were nonsignificant changes in anastrozole (median percentage difference = 10.1% [-13.5%, 38.4%], p = 0.36) and hydroxyanastrozole (median percentage difference = -3.0% [-19.1%, 11.2%], p = 0.65). Estrogen data will be available for presentation. Conclusions: Simvastatin is unlikely to alter the pharmacokinetics of anastrozole in a clinically meaningful way. Combination studies to assess chemopreventive properties of the combination are planned.

[Table: see text]

New concepts in the treatment of acute myeloid malignancies: selected pathways for targeted therapy

Acute myeloid leukemia (AML) and myelodysplasia (MDS) continue to present formidable treatment challenges as there is not yet a "standard approach" that reliably and safely cures the majority of adults with these disorders. Understanding the basic cellular and molecular biology of leukemia is vital to the development of better treatment approaches. All malignant cells, including leukemias, carry survival advantages compared to their normal counterparts. These survival advantages are particularly evident when the cells face both normal environmental stressors as well as extreme stressors of potentially lethal DNA damage. The impact of such stressors is ultimately determined by the signaling pathways and resultant cellular activation, including alterations in cellular growth, differentiation, survival and death. It is our improving understanding of these signaling pathways, both normal and malignant, that provide the targets for novel therapies. In this review article, we will focus on several signaling pathways, as well as the regulation of the cell cycle, that not only represent potentially accessible sites for intervention in myeloid malignancies, but those that are actively being studied.

CordyMax Cs-4 improves steady-state bioenergy status in mouse liver

OBJECTIVE

To evaluate effects of CordyMax Cs-4, a mycelial fermentation product of Cordyceps sinensis, on energy metabolism.

DESIGN

An in vivo pharmacology study using 31P nuclear magnetic resonance (NMR) spectroscopy. SUBJECTS AND STUDY INTERVENTIONS: Adult male C57-BL/6 mice were given an aqueous extract of CordyMax, 200 or 400 mg/kg per day or placebo for 7 days.

OUTCOME MEASUREMENTS

Using 31P-NMR spectroscopy to measure cellular triphosphates and inorganic phosphate, expressed as a ratio to a reference peak, and calculate tissue pH.

RESULTS

Steady-state beta adenosine triphosphate (ATP) increased in the liver of mice that received CordyMax (200 or 400 mg/kg per day) for 7 days, by 12.3% +/- 0.8% and 18.4% +/- 0.9%, respectively, compared to placebo controls (both p < 0.001), suggesting a higher hepatic bioenergy status in CordyMax-treated animals. Hepatic inorganic phosphate (Pi) decreased by 24.5% +/- 0.9% and 17.6% +/- 1.7% in the two treatment groups, respectively, compared to placebo controls (p < 0.001). The ratio of beta-ATP:Pi increased by 47.7% +/- 1.6% and 41.4% +/- 2.4%, respectively, in the treatment groups (both p < 0.001 compared to placebo). After discontinuation of CordyMax for 7 days, beta-ATP and Pi returned towards baseline.

CONCLUSION

CordyMax is effective in improving bioenergy status in the murine liver, suggesting a mechanism underlying the known clinical effectiveness of CordyMax in alleviating fatigue and improving physical endurance, especially in elderly subjects.

[The effect of cardiopulmonary bypass on expression of myocardial nitric oxide synthase in patients for valve replacement]

The objective of this study was to assess the effect of cardiopulmonary bypass (CPB) on expression of nitric oxide synthase (NOS) in patients for valve replacement. Ten adult patients were included in this study. CPB was initiated with a bubble oxygenator, aorta was clamped, and cold crystalliod cardioplegia was delivered into the aortic root. The myocardium of atrial appendage was obtained pre-CPB and 45 minutes post-CPB. The expression of three kinds of NOS isoenzymes was assessed by immunohistochemistry and microcomputerized image analysis. The results demonstrate that there are expression of nNOS (nervous NOS), iNOS (inducible NOS) and eNOS (endothelial NOS) in the atrial myocardium of patients for valve replacement. Compared with the expressions of NOS pre-CPB, the post-CPB expression of nNOS increased and that of eNOS decreased (P < 0.05), but no significant change in expression of iNOS was noted(P > 0.5). We belive that the decreased expression of eNOS may be related with the deficiency of nitric oxide release and may be responsible for tissue damage during CPB.

[RP-HPLC determination of adenosine in fermented Cordyceps]

OBJECTIVE

A method for determination of adenosine in four fermented Cordyceps products by RP-HPLC is described.

METHOD

C18 column was used with methanol-0.06 mol/L potassium phosphate monobasic-tetrahydrofuran (10:150:1.5) as mobile phase. The flow rate was 1 ml/min and detected at 260 nm.

RESULTS

The average recovery was 98.7% and relative standard deviation was 1.10% (n = 5).

CONCLUSION

This method is simple, rapid and sensitive. The paper introduces the feasibility of supersonic extraction method taking the place of reflux method.

[The effect of electroacupuncture stimulation an neurotrophic substance in cat spinal dorsal horn]

For exploration of the mechanism of collateral sprouting from injured spinal cord, polyacrylamide gel electrophoresis (PAGE) and modified hanging drop culture method were used to examine the effect of acupuncture on the amount and the biological activity of neurotrophic substance in larger than 50 kd fraction of dorsal horn in cat subjected to partial dorsal rhizotomy. The results showed that the amount of protein in relative mobility (RM) 0.1 zone increased significantly in the acupuncture-operated group by PAGE and that of protein in RM 0.5 zone decreased significantly as compared with the unoperated group. While this data was compared with the data of another operated group in our lab, the amount of RM 0.1 protein of the acupuncture-operated group was significantly higher than that of the latter group; however, no obvious difference was noted between the two groups in the amount of RM 0.5 protein. It suggests that acupuncture may promote tha amount of RM 0.1 protein to increase, but acupuncture has no influence on the amount of RM 0.5 protein. Also, the results showed that, in culture, accompanying with the increase in amount, the activity of RM 0.1 protein for promoting DRG neurite-outgrowth increased. This indicates that the RM 0.1 protein has a function to promote DRG neurite-outgrowth, but the RM 0.5 protein has no obvious effect on DRG neurite-outgrowth.

[Expression of glial cells line-derived neurotrophic factor in the central nervous system of rat]

Glial cell line-derived neurotrophic factor (GDNF) iss a distant member of the transforming growth factor-beta, originally isolated by virtue of its ability to induce dopamine uptake and cell survival in cultures of embryonic ventral midbrain dopaminergic neurons, and more recently it has been shown to be a potent neurotrophic factor for motor neurons. However, the distribution of this molecule in the central nervous system (CNS) is not known yet. In the present study, the expression of GDNF of rat was investigated by using immunohistochemistry. GDNF immunoreactive fibers or bodies were found in molecular layer and Purkinje layer of cerebellum. In the spinal cord, neuronal expression was found widely, especially in ventral horn, Clarke's column. GDNF was also expressed in fiber terminals of I and II lamella of dorsal horn. Additionally, GDNA expression was found in the ependymal epithelium and neuroglia of spinal cord. The nuclei of neuroglia were stronger than perikaryon. The neurons in cerebral cortex showed very weak immunoreaction. We conclude that GDNF is expressed in many different cellular systems within the CNS, suggesting the multiple functions of GDNF in the adult CNS.

[Studies on all-spectrum analysis for X-ray diffraction of Chinese herbal medicine calculus bovis]

Investigation on famouse Chinese herbal medicine-Niu huang (calculus bovis) was carried out by all-spectrum X-ray diffraction analysis. Diffraction spectrums, as well as the specific symboling peaks of calculus bovis, artificial bezoar, bile ductstone, human gallstone and hog gallstone, were recognized. The error distribution curves of d-delta d for specific symboling peaks was also obtained by calculation under diffrent testing conditions, by which we identified successfully three samples provided by a pharmaceutical factory. This article shows that all-spectrum X-ray diffraction analysis can be used to identify Chinese traditional crude drug, and provides for morphological and microscopical study.