Patient with Lobular Carcinoma of the Breast and Activating AKT1 E17K Variant

OBJECTIVE

To present the characteristics of the AKT1E117K gene variant and a description of the clinical application in a patient with metastatic breast cancer.

RESULTS

63 y/o woman with Stage IV Invasive lobular carcinoma at diagnosis was treated with Palbociclib and aromatase inhibitors (AI). At progression, tissue was sent for comprehensive genomic profiling to Foundation Medicine (FM) which revealed AKT1E17K mutation. In lieu of available clinical data within the patient's tumor type (HR+ HER2- breast cancer), extrapolated data from the Flatiron Health-FM (FH-FMI) Clinico-genomic Database (CGDB) was discussed at our Molecular Tumor Board (MTB). After multidisciplinary discussion, the consensus recommendation was to start treatment with the combination of mTOR inhibitor everolimus, and AI, exemestane. Patient tolerated treatment without major side effects. By the second clinical visit the patient's breast showed signs of improvement. PET/CT showed diminished left axillary uptake, decreased right paratracheal lymph node PET avidity, and stable bone disease consistent with a partial response. The most recent office visit in January 2021, breast exam revealed a normal-appearing skin with only faint erythema. All other skin lesions have resolved. Although, the role of AKT1 variant described here is not well defined and therapeutic significance of M-Tor inhibitors not established in metastatic breast cancers, comprehensive approach to this case unraveled new and successful therapeutic option in this patient.

CONCLUSION

This demonstrates that applying available Precision Medicine tools like MTB and real world data sets from patient populations with similar clinical and genomic profiles may provide more options for treatment.

Functional cardiac Na+ channels are expressed in human melanoma cells

Resting membrane potential (RMP) and intracellular Ca²⁺ concentration [(Ca²⁺)_i] are involved in tumorigenesis and metastasis. The present study investigated whether functional cardiac Na⁺ channels are expressed in human melanoma cells (WM 266-4) and its nonmalignant human melanocytes (HMC), as well as whether they participate in RMP maintenance and Ca²⁺ homeostasis. Confocal microscopy and western blot analysis were used to detect Na⁺ channels. The patch-clamp technique was employed to record Na⁺ currents and action potentials. Cytoplasmic Ca²⁺ was measured by loading Fluo-4. Cardiac (Na_v1.5) Na⁺ channels were expressed in HMCs and WM 266-4 cells. Tetrodotoxin (TTX) dose-dependently blocked Na⁺ currents in WM 266-4 while HMCs had no Na⁺ currents. Ultraviolet light induced similar action potentials in HMCs and WM 266-4 cells, which were abolished by transient receptor potential A1 channel-specific blocker, HC-030031. Compared with HMCs, RMP was substantially depolarized in WM 266-4. TTX hyperpolarized RMP in WM 266-4 cells at a concentration of 30 µM, which facilitated Ca²⁺ influx. Compared with HMCs, (Ca²⁺)_i was significantly higher in WM 266-4 cells and was elevated by 30 µM TTX. Collectively, Cardiac Na⁺ channels depolarize RMP and inhibit Ca²⁺ uptake in melanoma cells possibly contributing to tumorigenesis and metastasis. Na⁺ channel agonists may be developed to treat melanoma such as WM 266-4.

Abstract 234A: Aberrant sodium current contributes to constitutive mTOR activity in malignant melanoma cells

Transformation from disciplined melanocytes to untamed melanoma cells remains an enigma. Our previous studies have demonstrated that melanoma cells are more resistant to oxidative stress and melanoma cells exhibit constitutive mTOR activity. Surprisingly, further studies have failed to present the expression and activity of EGFR using conventional anti-EGFR antibodies. We hypothesized that constitutive mTOR activity in melanoma cells may be due to mutated EGFR variants and membrane channel activities. Using patch clamping technique, we have shown that melanoma cells (WM 266-4) but not human skin melanocytes exhibit Na+ current which is blocked by TTX. Interestingly, mTOR inhibitor, rapamycin, blocks Na+ current. Western blot and confocal microscopy data further revealed that Na+/Ca2+ exchanger blocker KB-R7943 (KBR), and L-type Ca2+ channel blocker Nifedipine (NIF) inhibits mTOR activity in melanoma cells in a dose dependent manner. To further characterize Na+ channels, we used commercially available channel antibodies. Western blot analysis data showed that melanoma cells but not human melanocytes express Na+ v1.5 and Na+ v1.6 and NCX3. Functional studies also indicated that KBR and NIF inhibit melanoma cell proliferation and migration. Taken all together, our data suggest that aberrant Na+ current contributes to constitutive mTOR activity in melanoma cells and channel blockers may be potential for the treatment of melanoma.

Citation Format: Benjamin Gallant, Nicole Lizza, Ryan Garrity, Audrey Madigan, Zachary Jost, Alfredo Gonzalez, Jeanine Justiniano, An Xie, Yinsheng Wan. Aberrant sodium current contributes to constitutive mTOR activity in malignant melanoma cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 234A.

The effects of treatment with interleukin-1 receptor antagonist on the inflamed synovial membrane in rheumatoid arthritis

OBJECTIVE

To evaluate the effects of treatment with interleukin-1 receptor antagonist (IL-1Ra) on synovial tissue in rheumatoid arthritis (RA).

METHODS

Twelve patients with RA entering a randomized clinical trial of human recombinant IL-1Ra underwent synovial biopsies before and after treatment. Cellular infiltration and adhesion molecule expression were evaluated after immunohistochemical staining.

RESULTS

There was a notable reduction in intimal layer macrophages and subintimal macrophages and lymphocytes after treatment with IL-1Ra at 150 mg/day (n=3). Increased cellular infiltration was observed in all patients receiving placebo (n=3); variable changes were observed after IL-1Ra 30 mg/day (n=6). In a limited study of adhesion molecule expression, down-regulation of E-selectin and vascular cell adhesion molecule-1 was observed after treatment with IL-1Ra 150 mg/day, but not after IL-1Ra 30 mg/day or placebo. The apparent arrest of progressive joint damage seen in four patients after treatment with IL-1Ra was associated with reduced intimal layer macrophage accumulation in all patients.

CONCLUSION

Treatment of RA with IL-1Ra resulted in reduced mononuclear cell infiltration of synovial membrane, which may represent the in vivo inhibition of biologically relevant IL-1ss-mediated pathogenic effects.

Multidisciplinary patient care in rheumatoid arthritis: evolving concepts in nursing practice

Multidisciplinary patient care is essential in the management of rheumatoid arthritis (RA), a chronic potentially disabling, multisystem disease. Concepts of multidisciplinary care continue to evolve. While all team members can make valuable contributions to patient care, this chapter focuses in particular on continuing and changing aspects of team management. Of the many disciplines associated with rheumatology, nursing has undergone the most radical change in recent years. New roles have been defined and the nursing profession is now emerging with additional skills to support patients and their families. Concepts of patient education also continue to evolve. As the beneficial effects of education are demonstrated, a patient education programme should be seen as essential to the management of rheumatoid arthritis. Finally, the importance of counselling skills is emphasised.

Caries experience and cariogenic markers in HIV-positive children and their siblings

The purpose of this cross-sectional, masked study was to compare the oral status of perinatally HIV-infected children with their uninfected siblings living in the same environment. A secondary purpose was to compare HIV-positive children for differences in oral health with respect to disease advancement. One hundred forty-seven children were examined in their homes and meeting places, using NIH criteria for caries diagnosis. Significant differences were found in the number of caries-free children (P < 0.05), past caries experience (P < 0.003), subsurface demineralizations (P < 0.0001), and caries-related bacteria (P < 0.05). However, differences in caries prevalence were not found in the 3- to 6-year-old subgroup. Caries prevalence (P < 0.001) and levels of caries-related flora in saliva were correlated to years since diagnosis (mutans streptococci P < 0.008, lactobacilli P < 0.02). Children with a more advanced disease stage had significantly more caries (P < 0.02). Among the HIV-infected children, the frequency of carbohydrate intake was clearly correlated to caries (P < 0.003) and to lactobacilli levels (P < 0.0001). It is concluded that children with perinatally acquired HIV are at greater risk for caries than their siblings, more so with advancing disease.