A gene variant of PNPLA3, but not of APOC3, is associated with histological parameters of NAFLD in an obese population

OBJECTIVE

Mechanisms explaining the relationship in non-alcoholic fatty liver disease (NAFLD), obesity, and insulin resistance are poorly understood. A genetic basis has been suggested. We studied the association between the genes patatin-like phospholipase domain-containing protein 3 (PNPLA3) and apolipoprotein C3 (APOC3) and metabolic and histological parameters of NAFLD in obese patients.

DESIGN AND METHODS

Overweight and obese patients underwent a metabolic and liver assessment. If NAFLD was suspected, liver biopsy was proposed. APOC3 variant rs2854117 and PNPLA3 variant rs738409 were genotyped.

RESULTS

Four hundred seventy patients were included (61.1% had liver biopsy). The percentage of patients with non-alcoholic steatohepatitis (NASH) was significantly different according to the PNPLA3 variant. After adjustment for age and body mass index, the PNPLA3 variant was associated with alanine aminotransferase (P < 0.001) and aspartate aminotransferase (P < 0.001). The PNPLA3 variant was associated with more severe features of steatohepatitis: steatosis (P < 0.001), lobular inflammation (P < 0.001), and ballooning (P = 0.002), but not with liver fibrosis, anthropometry, or insulin resistance. No significant difference in liver histology, anthropometric, or metabolic parameters was found between carriers and non-carriers of the APOC3 variant.

CONCLUSIONS

PNPLA3 polymorphism rs738409 was associated with NASH and the severity of necroinflammatory changes independently of metabolic factors. No association between APOC3 gene variant rs2854117 and histological or metabolic parameters of NAFLD was found.

The immune reconstitution inflammatory syndrome: a cause of death in persons on antiretroviral therapy?

The availability of antiretroviral therapy (ART) has significantly improved the quality of life of persons with HIV infection. However, new problems have arisen as a consequence of this treatment. An immune reconstitution inflammatory syndrome (IRIS) in which patients experience a paradoxical worsening of their clinical condition may occur during recovery of the immunity. Thus far, there is no laboratory test available to diagnose IRIS. The diagnosis therefore remains clinical and by exclusion. In this paper, we describe the autopsy findings of three HIV-infected patients who died at the Antwerp University hospital directly or indirectly related to IRIS. One patient died following a disseminated cryptococcocal and Mycobacterium avium complex (MAC) infection. Two other patients died with a disseminated aspergillosis infection after receiving corticosteroids to decrease IRIS induced inflammatory signs. These three patients show the difficulties faced by clinicians in diagnosing IRIS and the importance of performing autopsies in persons with HIV infection who die despite receiving ART.

Excessive eosinophilia as paraneoplastic syndrome in a patient with non-small-cell lung carcinoma: a case report and review of the literature

Hypereosinophilia is a phenomenon which is associated with a broad variety of allergic, infectious, paraneoplastic and systemic diseases. Depending on the aetiology, these disorders differ in severity from self-limiting to life-threatening. Although it is well known that hypereosinophilia can occur in association with a solid tumour, exact numbers of incidence are lacking. We describe a patient with respiratory insufficiency and an elevated level of eosinophils in the peripheral blood. A diagnostic work-up revealed the presence of a disseminated non-small-cell carcinoma of the lung; an association not frequently described.

High prevalence of advanced fibrosis in association with the metabolic syndrome in a Belgian prospective cohort of NAFLD patients with elevated ALT. Results of the Belgian NAFLD registry

INTRODUCTION

Non-alcoholic Fatty Liver Disease (NAFLD) is increasingly recognised as a source of liver related morbidity and mortality. Hard data on epidemiology and natural history are scarce.

AIM

To study demographic and metabolic characteristics of the NAFLD patients seen by Belgian hepatologists.

METHODS

Belgian hepatologists filled in a questionnaire for every newly diagnosed NAFLD patient between January 1st and December 31st 2004. Liver biopsy was advised if ALT > 1.5 x ULN and if 3/5 of the criteria for the metabolic syndrome (MS) (ATPI-II) were present, but was not mandatory. Biopsy was scored using the Brunt classification.

RESULTS

230 patients were prospectively included in 9 centres; 54% were males; mean age was 49.4 +/- 13.9 y; mean BMI was 30.6 +/- 4.6 kg/m2. The MS was present in 53%. In 16% formerly undiagnosed diabetes was discovered. 51% had a liver biopsy: 25% met the criteria, 26% did not. Grading did not differ between patients with or without MS. Staging was significantly more severe in patients with MS (2.43 +/- 1.25 vs. 1.73 +/- 1.18, p < 0.001). A subgroup of patients with GGT > 5 x ULN were significantly older (55.9 vs. 47.64 y, p = 0.02), more frequently diabetic (53% vs. 23%, p = 0.01) and had more advanced fibrosis (3.42 vs. 1.08, p = 0.008). ALT levels were variable.

CONCLUSIONS

The MS is highly prevalent in Belgian NAFLD patients and is associated with more severe disease. Mild to moderate fibrosis is frequent, and the proposed criteria for liver biopsy are not accurate in selecting these patients. Patients with elevated GGT constitute a subgroup with more advanced disease.

Abstract P3-04-01: Integrated Analysis of Epigenetic Signatures Associated with Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is the most aggressive manifestation of primary epithelial breast cancer and differs from non-IBC both from a clinical and a biological perspective. The high metastatic potential of IBC is highlighted by the low 5-year survival rate of 50%. The biological features that make IBC unique are its rapid local growth, its high angioinvasive capability with early metastasis and its aggressive behavior from inception. These differences could be the result of key changes in the epigenetic profile of IBC.

To address this issue, we compared the levels of epigenetic regulation in IBC (N=19) and non-IBC (N=43) samples at the methylome (DNA methylation), miRome (miRNA) and transcriptome (mRNA) level using high-throughput molecular technologies.

Differences in gene expression profiles allowed the classification of samples according to tumor subtype (IBC vs non-IBC). The analysis of 27,578 CpG loci demonstrated that the largest variation in methylation levels between samples was attributable to differences in metastatic status (P=0.026) and patients’ age (P=0.049). About 2% of all interrogated CpG loci was differentially methylated in IBC and non-IBC (FDR &lt;0.1). Annotated gene functions for these CpG loci were enriched for biological processes related to inflammation and immune response. Using a whole genome approach, we observed significant, negative correlations between methylation and mRNA levels for 38% of genes. For 8% of genes, a significant, positive correlation was observed. Interrogated CpG loci for these genes were more frequently located in the gene body (&gt;500 bp from TSS) (P=0.008). Our analysis of 322 miRNAs showed that the largest variation in miRNA levels between samples was attributable to differences in ER status (P=0.001) and histological grade (P=0.002). About 4% of all miRNAs was expressed at different levels in IBC and non-IBC. Using a whole genome approach, we identified 17,295 of highly correlated miRNA-mRNA pairs for these IBC-associated miRNAs. Based on this miRNA target gene information, we were able to detect a variety of biological processes that may indicate function of these miRNAs and to indicate potential associations of these miRNAs with prognosis in breast cancer. Furthermore, the comparison of mRNA levels of key miRNA processing genes revealed the upregulation of Ago2 (P=0.002) and the downregulation of Dicer (P=0.004) in IBC when compared to non-IBC, which may suggest higher RISC activities and, therefore, that miRNAs regulate target gene expression in IBC with higher efficiency.

In conclusion, this study represents the first integrated analysis of epigenetic signatures in IBC. Using high-throughput technologies, we were able to identify a number of epigenetic markers specifically associated with IBC. A global initiative has been taken to set up an IBC tissue repository that will allow the confirmation of these kinds of studies on a larger IBC sample population.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-04-01.

KRAS mutation detection and prognostic potential in sporadic colorectal cancer using high-resolution melting analysis

BACKGROUND

The development of targeted therapies has created a pressing clinical need for molecular characterisation of cancers. In this retrospective study, high-resolution melting analysis (HRMA) was validated and implemented for screening of 164 colorectal cancer (CRC) patients to detect KRAS hot-spot mutations and to evaluate its prognostic value. Direct sequencing was used to confirm and characterise HRMA results.

METHODS

After establishing its sensitivity, HRMA was validated on seven cell lines and inter- and intra-variation were analysed. The prognostic value of KRAS mutations in CRC was evaluated using survival analysis.

RESULTS

HRMA revealed abnormal melting patterns in 34.1% CRC samples. Kaplan-Meier survival curves revealed a significantly shorter overall (OS) and disease-free survival (DFS) for CRC patients harbouring a KRAS mutation. In the Cox regression analysis, only when colon and rectal cancer were analysed separately, KRAS mutation was a negative predictor for OS in patients with rectal cancer and DFS in those with stage II colon cancer.

CONCLUSIONS

HRMA was found to be a valid screening method for KRAS mutation detection. The KRAS mutation came forward as a negative predictive factor for OS in patients with rectal cancer and for DFS in stage II colon cancer patients.

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

INTRODUCTION

We previously demonstrated in an animal model that steatosis, in the absence of fibrosis, induces a significant rise in portal pressure, indicating substantial changes in liver hemodynamics. As assessment of portal pressure is an invasive procedure, non-invasive parameters are needed to identify patients at risk.

AIMS

To study the portal pressure in nonalcoholic fatty liver disease patients and to identify factors that are possibly related to steatosis-induced changes in liver hemodynamics.

MATERIALS AND METHODS

Patients presenting with a problem of overweight or obesity, and in whom non-invasive investigations showed signs of liver involvement, were proposed for transjugular hepatic vein catheterization and liver biopsy. The biopsy was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network Scoring System.

RESULTS

A total of 50 consecutive patients were studied. Their mean age was 47.9 ± 1.8 years; 31 (62%) were female. Hepatic venous pressure gradient was normal in 36 (72%) and elevated in 14 (28%) patients. The degree of steatosis was the only histological parameter that differed significantly between the two groups (P=0.016), and was a predictor of the presence of portal hypertension (PHT) in regression analysis (P=0.010). Comparing normal versus portal hypertensive patients, waist circumference (117 ± 2 versus 128 ± 4 cm, P=0.005), waist-hip ratio (0.96 ± 0.06 versus 1.04 ± 0.03, P=0.003), visceral fat (229 ± 15 versus 292 ± 35 cm(2), P=0.022), fasting insulin (15.4 ± 1.7 versus 21.8 ± 2.4 μU ml(-1), P=0.032), fasting c-peptide (1.22 ± 0.06 versus 1.49 ± 0.09 nmol l(-1), P=0.035) and homeostasis model assessment-insulin resistance (HOMA IR) (3.28 ± 0.29 versus 4.81 ± 0.57, P=0.019) were significantly higher. Age, gender, liver enzymes, ferritin and high-sensitive C-reactive protein were not significantly different. In regression analysis, waist circumference (P=0.008) and HOMA IR (P=0.043) were independent predictors of PHT.

CONCLUSIONS

Estimates of both visceral adiposity and IR are predictors for the presence of PHT, related to the degree of steatosis, and may help in identifying patients who are at risk of developing steatosis-related complications.

Impairment of intestinal barrier and secretory function as well as egg excretion during intestinal schistosomiasis occur independently of mouse mast cell protease-1

Deposition of Schistosoma mansoni eggs in the intestinal mucosa is associated with recruitment of mucosal mast cells (MMC) expressing mouse mast cell protease-1 (mMCP-1). We investigated the involvement of mMCP-1 in intestinal barrier disruption and egg excretion by examining BALB/c mice lacking mMCP-1 (Mcpt-1(-/-)). Tissue and faecal egg counts from 6 weeks until 12 weeks post-infection (w p.i.) revealed no differences between wild type (WT) and Mcpt-1(-/-)mice. Using chamber experiments on ileal tissue revealed that at 8 w p.i., the epithelial barrier and secretory capacity were severely impaired, whereas no difference was found between WT and Mcpt-1(-/-)mice in this respect. However, a fragmented distribution of the tight junction (TJ) protein occludin, but not of claudin-3 or ZO-1, was observed in WT mice at 8 w p.i., while no changes in TJ integrity were seen in Mcpt-1(-/-)mice. Therefore, we conclude that in contrast to the situation in Trichinella spiralis-infected mice, in schistosomiasis, mMCP-1 is not a key mediator in egg excretion or impairment of the intestinal barrier. The marked decrease in ileal secretory capacity during S. mansoni egg excretion suggests that the mechanisms facilitating the passage of schistosoma eggs through the gut wall are directed more particularly at the epithelial cells.

Epilepsy is not caused by cysticercosis in The Gambia

OBJECTIVE

To determine whether epilepsy is caused by Taenia solium cysticercosis in The Gambia.

METHODS

Case-control study testing samples collected from 210 people with epilepsy and 420 matched controls by sex and age +/-5 years from 69 different places around the country during the period October 2008-March 2009. All serum samples were subjected to an antigen detection ELISA (Ag-ELISA) and electro-immunotransfer blot (EITB), and the seropositives were further CT-scanned to determine the presence of cysticerci in the brain.

RESULTS

Although not significantly different (P = 0.668), circulating Taenia antigen was found by Ag-ELISA in 1.4% (95% CI: 0.3-4.1) of people with epilepsy and in 1.9% (95% CI: 0.8-3.7) of the controls. A non-significant (P = 0.4718) odds ratio of association 0.75 (95% CI: 0.13-3.15) between epilepsy and the presence of Taenia antigens was found. All 630 serum samples turned out seronegative by the EITB test. There were no intracranial cysts or cyst-like structures detected among the nine CT-scanned Ag-ELISA seropositives.

CONCLUSION

Epilepsy appears not to be caused by cysticercosis in The Gambia.

A microRNA Expression Profile Consisting of 12 microRNAs Is Associated with Inflammatory Breast Cancer

Introduction: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a dismal clinical outcome. In the past we showed that IBC is characterized by a specific gene expression pattern. In this study, we investigate if microRNAs (miRNAs) are responsible for the specific IBC gene signature.Materials and methods: 377 miRNAs were profiled in 20 IBC tumor samples and 50 non-stage matched nIBC tumour samples using the human MicroRNA A Array Set version 2.0 (Applied Biosystems). The IBC and nIBC study populations are matched for tumor grade and ER status. All miRNAs with Ct-values less than 35 in 25% of the samples were included for analysis. Data normalization was performed relative to the median miRNA expression level per sample and expression values were log2-transformed. Principal component analysis (PCA) was performed to identify metagenes of miRNAs, associated with the IBC phenotype. Relevant metagenes were compared with prognostic/predictive gene signature-classifications (wound healing response, invasiveness gene signature, 70-gene prognostic signature, genomic grade index, recurrence score, HOXB13/IL17RB-expression ratio and the molecular breast cancer subtypes). Data were validated by analysing relevant miRNA target gene sets on an IBC/nIBC gene expression data set.Results: Using PCA, we identified a metagene associated with the IBC phenotype (Hazard Ratio: 4.500; P=0.011). This metagene was also significantly associated with the Luminal B phenotype, the IBC signature and with an elevated HOXB13/IL17RB-expresion ratio (range Rs = 0.302 – 0.366; P&lt;0.05). MiRNAs significantly (FDR&lt;0.1) associated with this metagene were: miR29A, miR544, miR574-3p, miR548C-3p, miR451, miR548B-5p, miR24, miR28-5p, miR137, miR302B, miR148A and miR302A (range Rs: -0.367 – 0.307). Cluster analysis using this miRNA signature identified two sample clusters, one containing 70% of the IBC samples and a second one containing 64% of the nIBC samples (Pearson X2; P=0.021). Using gene set enrichment analysis for miR24-, miR28-, miR29A-, miR137-, miR148A-, miR302A- and miR302B target gene sets, we confirmed the differential expression for the above mentioned miRNAs (P&lt;0.01) except for miR28. Using Oncomine analyses we were able to associate the identified miRNAs with NFkB activation (miR29, miR148), steroid receptor signalling (miR302A, miR302B, and miR137), cell adhesion (miR29), stem cell signalling (miR137, miR28) and regulation of the extracellular matrix composition (miR29, miR148).Discussion: Through PCA we identified a miRNA signature associated with IBC. The miRNA signature was partly validated on the gene expression level. Interestingly, most identified miRNAs regulate biological processes previously associated with IBC through gene expression analysis, confirming our results also at the biological level. The association of the IBC-specific miRNA-metagene with the Luminal B phenotype and elevated HOXB13/IL17RB-expression ratios confirms our data that ER+ IBC samples, which constitute the majority of the present IBC study population, generally belong to the Luminal B subtype and are associated with resistance to endocrine therapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6119.

A microRNA Expression Profile Consisting of 15 microRNAs, Including miR205, Is Associated with Poor Prognosis in Breast Cancer

Introduction: MicroRNAs (miRNA) are a class of non-coding RNAs able to regulate gene expression at the post-transcriptional level. In breast cancer, levels of specific miRNAs differ between malignant and normal breast tissue and are able to classify tumors according to clinicopathologic variables. This highlights the potential of miRNAs as novel prognostic and/or predictive indicators. In this study we sought for miRNAs denoting poor prognosis in breast cancer.Materials and methods: 377 miRNAs were profiled in 70 breast tumor samples using the human MicroRNA A Array Set version 2.0 (Applied Biosystems). All miRNAs with Ct-values less than 35 in 25% of the samples were included for analysis. Data normalization was performed relative to the median miRNA expression level per sample and expression values were log2-transformed. Principal component analysis (PCA) was performed to identify metagenes of miRNAs associated with clinicopathological variables (TNM-status, tumor stage, histological grade, ER-, PR-, ErbB2- and P53-status) and prognostic/predictive gene signature-classifications (wound healing response, invasiveness gene signature, 70-gene prognostic signature, genomic grade index, recurrence score, HOXB13/IL17RB-expression ratio and the molecular breast cancer subtypes). Results were validated by investigating relationships between the expression of a relevant miRNA target gene signature and clinicopathological variables in 5 publicly available breast cancer gene expression data sets.Results: Using PCA-analysis we identified a metagene significantly associated with the Luminal B phenotype, an elevated genomic grade index, an elevated recurrence score, an activated wound healing response, the invasiveness gene signature and poor prognosis according to the 70-gene prognostic profile (range Rs: 0.325-0.372; P&lt;0.05). Using multivariate regression analysis we demonstrated that this metagene was also associated with loss of PR expression (Hazard Ratio (HR): 9.00; P=0.0001) and the presence of metastases at time of diagnosis (HR: 18.9; P=0.0002). MiRNAs significantly (FDR&lt;0.1) associated with this metagene were: miR205, miR548C-5p, miR548D-5p, miR187, miR671-3p, miR492, miR365, miR499-5p, miR548D-3p, miR615-3p, miR193A, miR589, miR660, miR219-1-3p, miR888 (range Rs: -0.415 – 0.456). At the gene expression level, a miR205 target gene signature, composed of 173 unique genes, was associated with relapse-free survival (range HR: 1.225 – 1.387; P&lt;0.01) and distant metastasis-free survival (HR: 3.950; P=0.006) in respectively 3 and 1 independent breast cancer data set(s).Discussion: Through principal component analysis we identified a miRNA signature associated with poor prognosis in breast cancer. This signature was composed of 15 individual miRNAs, including miR205 which is known for its role in epithelial-to-mesenchymal transition and the induction of stem cell characteristics. The association of a miR205 target gene signature with relapse-free and distant metastases-free survival confirms our results on the gene expression level.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4062.

Treatment of chronic hepatitis C in patients with human immunodeficiency virus (HIV) with weekly peginterferon alpha-2b plus ribavirin: a multi-centred Belgian study

BACKGROUND AND STUDY AIMS

In Belgium, 10-15% of patients infected with the human immunodeficiency virus (HIV) are coinfected with hepatitis C virus (HCV). Because of increased incidence of antiretroviral drug-related hepatotoxicity and more rapid clinical evolution towards end-stage liver disease, treatment of chronic hepatitis C becomes a priority. We report the results of a multi-centred Belgian study evaluating efficacy and safety of peginterferon alpha-2b plus ribavirin in HIV-HCV co-infected patients without AIDS and without decompensated liver disease.

PATIENTS AND METHODS

Forty-one patients, all genotypes, were screened to participate. Eventually 37 received treatment with peginterferon alpha-2b (1.5 microg/kg/week) plus daily weight-based ribavirin for 52 weeks. About one third of the patients were genotypes 1, 2/3, and genotype 4, most of the latter being of Central African origin. About 56% of the patients had severe fibrosis (Metavir score > or = F3).

RESULTS

Sustained viral response (SVR) at 24 weeks of follow-up was observed in 10/37 (27%) of patients. SVR was higher in genotype 2/3 compared to genotype 1/4 (46.7% versus 13.6%; p = 0.06) and in low (F0-F1) versus high (F2-F4) grade fibrosis (p = 0.06). Treatment was withdrawn for side effects in 11/37 patients (30%). One Child A cirrhosis patient at the start of therapy died 7 months after treatment withdrawal as a result of severe haemolytic anaemia.

CONCLUSIONS

It can be concluded that weight-based peginterferon alpha-2b plus ribavirin can be successful in selected HIV-HCV co-infected patients. Caution should be applied in patients with advanced liver disease.

Association of serum tumor-related methylated DNA with circulating tumor cells in peripheral blood of breast cancer patients

Abstract #5017

Circulating tumor cells (CTC) and free tumor-related methylated DNA in blood have been separately associated with poorer disease outcome in breast cancer patients. However, no studies have looked into the relation between both molecular markers in breast cancer. In this study, we investigated the correlations between plasma total DNA, serum methylated DNA and CTC in blood from breast cancer patients.&#x2028; We simultaneously obtained matched triplets of peripheral blood, plasma and serum samples from 4 patients with localized breast cancer (group A), 59 patients with metastatic disease under treatment (group B), 16 untreated patients with metastatic disease (group C) and 20 healthy controls. CTC levels in blood were measured with the CellSearch System (Veridex). Plasma total DNA levels were determined by a qPCR method. Sera were analyzed by methylation-specific qPCR for three methylated markers: APC, RASSF1A and ESR1.&#x2028; Plasma total DNA levels in breast cancer patients were significantly increased when compared to healthy controls (P&lt;0.001). Differences between total DNA levels in different patient groups also reached statistical significance (P=0.04). The largest differences were measurable between groups A and C (median of 7 vs 29 ng/ml) (P=0.02) and groups B and C (median of 12 vs 29 ng/ml) (P=0.06). The sensitivity and the specificity of the total DNA assay for predicting malignancy was respectively 72.5% and 85%. Total DNA levels correlated with CTC (r=0.418, P&lt;0.001) and patient age (r=0.298, P=0.01), but not with other clinical variables. Hypermethylation of one or more genes was detected in 42 (53%) serum samples from breast cancer patients and in 3 (16%) serum samples of healthy controls (P=0.003). APC was hypermethylated in 23 (29%), RASSF1A in 28 (35%) and ESR1 in 16 (20%) breast cancer cases. CTC were detected in 19 (70%) patients with serum methylated DNA and in 8 (30%) patients without methylated DNA (P=0.03). The presence of methylated DNA markers was only associated with ER status. On univariate analysis, the detection of CTC, high levels of circulating DNA, methylation of RASSF1A and the combinations of APC or RASSF1A methylation with ESR1 methylation were significantly associated with progressive disease. Multivariate analysis indicated that only RASSF1A methylation, high total DNA levels, HER2 and PR status were significantly associated with disease status.&#x2028; The number of CTC was significantly increased in patients with high levels of total DNA and in patients with at least one methylated DNA marker in serum, suggesting that CTC might be a potential source of circulating tumor-related DNA. Only RASSF1A methylation and high DNA levels were independently associated with progressive disease. The combination assay of CTC and serum methylated DNA did not enable a more informative assessment of disease status.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5017.

Fine tuning of the Van Nuys prognostic index (VNPI) 2003 by using genomic grade index (GGI): a new tool for ductal carcinoma in situ (DCIS)

Abstract #2020

Introduction: DCIS is a heterogeneous malignant condition of the breast with no standard of care. The updated VNPI 2003 is a practical tool in treatment decision making. Recently, the introduction of GGI has been shown to be one of the most important prognostic indicators in invasive breast cancer. A GGI based on the expression of 4 genes using RT-PCR was developed and validated in invasive BC. The aim of this study was to assess its prognostic value in DCIS.&#x2028; Methods: Real Time Polymerase Chain Reaction-GGI (RT-PCR-GGI) was applied on a DCIS population. Patients were assigned into 3 subgroups according to VNPI [low risk (score 4-6), intermediate risk (score 7-9) and high risk (score 10-12)] based on nuclear grade ± necrosis, tumor size, margin width and age. The prognostic performance of GGI was assessed by replacing pathologically determined nuclear grade by GGI: VNPI-GGI. Disease free survival (DFS) was calculated by Kaplan-Meier survival plots with log-rank significance&#x2028; Results: A total of 90 patients with DCIS were analyzed. The number of recurrences per VNPI subgroup was 1/15 in subgroup 1, 5/53 in subgroup 2 and 6/22 in subgroup 3. Ten out of these 12 patients showed invasive recurrence. No statistical significance was reached (log rank 0.349; HR 3.69 [95% 0.620-21.923], p= 0.151). However, application of VNPI-GGI identified three distinct subgroups with statistically different DFS (HR = 8.887 [95% CI: 1.2–65.7], p= 0.03). Interestingly, when the VNPI-GGI was applied on the patients with low histological grade, 25% were redistributed to the high-risk group (p = 0.008). Of note, when PCR-GGI was applied to the recurrent cases (N= 12), the genomic grade status was preserved from DCIS to the recurrence disease in 83% of them.&#x2028; Conclusions: RT-PCR-GGI incorporated into the VNPI improved its prognostic value for DCIS. This method has the potential to provide a powerful tool in DCIS management. Further validation is planned in a prospective trial with a larger patient population.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2020.

Intrathoracic hibernoma: report of two cases

Hibernomas are uncommon benign soft tissue tumours mimicking brown fat. The most common anatomic locations include the neck, axilla, mediastinum, periaortic and perirenal zones. Intrathoracic and in particular pleural locations are exceptional. We report two cases of intrathoracic hibernoma with pleural involvement treated by surgical resection.

Distribution and expression levels of somatostatin and somatostatin receptors in the ileum of normal and acutely Schistosoma mansoni-infected SSTR2 knockout/lacZ knockin mice

We recently described the widespread expression of somatostatin (SOM) receptors (SSTRs) in the non-inflamed and inflamed murine ileum. Surprisingly, no significant changes were observed in the SSTR2 expression during intestinal inflammation. These data, combined with several recent independent lines of investigation, raised some question about the long presumed central role of SSTR2 in the SOM-mediated effects in the physiological and pathological activity of the gastrointestinal (GI) tract. To further unravel the role of SSTR2 in GI physiology, we studied the expression of SOM and SSTRs in the normal and inflamed SSTR2 knockout/lacZ knockin (SSTR2(-/-)) ileum. The SSTR2(-/-) ileum was characterized by a widespread distribution of multiple SSTR subtypes in non-inflamed and inflamed conditions. Moreover, the absence of SSTR2 did not induce any compensatory effect in the distribution pattern or expression level of any of the other SSTR subtypes. In contrast, the amount of SOM mRNA was significantly lower in SSTR2(-/-) ileum than that in wild type animals. Quantitative analysis revealed a decreased number of SOM-expressing neurons in both enteric plexuses of the knockout animals, implying a possible link between the number of SOM-expressing enteric neurons and the expression of SSTR2 in the enteric nervous system. In conclusion, these data show that a reconsideration of the role of SSTR2 in the GI somatostatinergic effects is in order and further corroborate recent data on the role of other SSTR subtypes in the inflammatory effects of SOM during intestinal inflammation.

Bartonella endocarditis mimicking adult Still's disease

We describe the case of a 39-year-old Caucasian woman who was admitted to the University Hospital of Antwerp with a clinical picture suggestive of adult Still's disease. Even though a transoesophageal echocardiography showed endocarditis of the aortic valve, blood cultures remained negative. Additional serological testing revealed a positive result for Bartonella henselae. Histology of the supraclavicular lymph node showed a reactive lymph node with a positive polymerase chain reaction (PCR) for Bartonella henselae. Prednisolone treatment was started in a dosage of 10 mg per day and rifampicin 600 mg/d in combination with doxycyclin 200 mg/d was given for 6 months. During therapy the patient gradually improved and signs of endocarditis disappeared on echocardiography.

Distinct angiogenic and non-angiogenic growth patterns of lung metastases from renal cell carcinoma

AIMS

We have recently evaluated a classification of non-small-cell lung cancer based upon the presence of an angiogenic or a non-angiogenic growth pattern. The aim of the present study was to test the hypothesis that lung metastases of clear cell renal cell carcinoma (RCC) can grow without eliciting angiogenesis and give rise to the same set of growth patterns.

METHODS AND RESULTS

Tissue sections of 24 patients with lung metastases from clear cell RCC were analysed. Haematoxylin and eosin and reticulin staining were performed to evaluate growth pattern. Double-labelling with antibodies to CD34 and proliferating cell nuclear antigen (PCNA) was performed to determine the endothelial cell proliferation fraction (ECPF) and the microvessel density (MVD). Three growth patterns were observed. In the destructive growth pattern (54%), the architecture of the lung was not preserved. In the alveolar (33%) and interstitial growth patterns (13%), the normal lung parenchyma was preserved within the metastases. MVD was higher in the destructive than in the alveolar growth pattern (P = 0.009). ECPF was higher in the destructive (mean 31.1 +/- 22.7%, median 30.0) than in the alveolar growth pattern (mean 3.6 +/- 2.8%, median 3.2; P = 0.005).

CONCLUSIONS

The present study demonstrates that highly angiogenic primary tumours can give rise to non-angiogenic metastases. This type of metastasis may be resistant to antiangiogenic therapy.

Distinct molecular phenotype of inflammatory breast cancer compared to non-inflammatory breast cancer using Affymetrix-based genome-wide gene-expression analysis

The present study aims at a platform-independent confirmation of previously obtained cDNA microarray results on inflammatory breast cancer (IBC) using Affymetrix chips. Gene-expression data of 19 IBC and 40 non-IBC specimens were subjected to clustering and principal component analysis. The performance of a previously identified IBC signature was tested using clustering and gene set enrichment analysis. The presence of different cell-of-origin subtypes in IBC was investigated and confirmed using immunohistochemistry on a TMA. Differential gene expression was analysed using SAM and topGO was used to identify the fingerprints of a pro-metastatic-signalling pathway. IBC and non-IBC have distinct gene-expression profiles. The differences in gene expression between IBC and non-IBC are captured within an IBC signature, identified in a platform-independent manner. Part of the gene-expression differences between IBC and non-IBC are attributable to the differential presence of the cell-of-origin subtypes, since IBC primarily segregated into the basal-like or ErbB2-overexpressing group. Strikingly, IBC tumour samples more closely resemble the gene-expression profile of T1/T2 tumours than the gene-expression profile or T3/T4 tumours. We identified the insulin-like growth factor-signalling pathway, potentially contributing to the biology of IBC. Our previous results have been validated in a platform-independent manner. The distinct biological behaviour of IBC is reflected in a distinct gene-expression profile. The fact that IBC tumours are quickly arising tumours might explain the close resemblance of the IBC gene-expression profile to the expression profile of T1/T2 tumours.

Detection of DNA methylation in inflammatory breast tumours by a multiplex nested methylation-specific PCR

21027

Background: Hypermethylation of gene promoters is a common mechanism of loss of gene function in cancer cells. Few data on epigenetic alterations in inflammatory breast cancer (IBC) cells are available. Microarray studies have shown that IBC is characterised by a distinct gene expression profile when compared to non-IBC. We sought to determine whether the profiles of gene hypermethylation differ between IBC and non-IBC by using a multiplex nested methylation-specific PCR (MSP). We selected genes for which evidence exists for their involvement in breast carcinogenesis by means of methylation. Methods: The SLμCut system (MMI) was used for laser capture microdissection of paraffin-embedded tissues. 10-μm-thick sections from 10 patients with IBC and 12 patients with non-IBC were used. Genomic DNA from the microdissected tissue was extracted and treated with sodium bisulfite. The methylation status of the promoter regions of APC, E- cadherin, THBSP-1, DAPK, GSTP1, RASSF1A and BRCA1 were investigated using a multiplex nested MSP method. DNA isolated from normal peripheral lymphocytes from healthy individuals served as a negative methylation control. In vitro methylated DNA served as the positive methylation control. MSP products were analyzed on agarose gel electrophoresis, and were determined to have methylation if a visible band was observed in the methylation reaction. Results: Methylation of the APC gene promoter was observed in 33.3% (4/12) of non-IBC samples and 70% (7/10) of IBC samples. Methylation of the BRCA1 gene promoter was observed in 16.7% (2/12) of non-IBC samples and 30% (3/10) of IBC samples. Methylation of the DAPK gene promoter was observed in 16.7% (2/12) of non-IBC samples and 10% (1/10) of IBC samples. Methylation of the GSTP1 gene promoter was observed in 33.3% (4/12) of non-IBC samples and 30% (3/10) of IBC samples. No methylation of the E-cadherin and THBSP-1 gene promoters was observed in non-IBC samples or IBC samples. Conclusions: Also in this study, the multiplex nested MSP approach was proven to be very suitable for the detection of methylation in samples harbouring small amounts of poor quality DNA. In the near future, the methylation status of other genes will be determined and the study population will be enlarged.

No significant financial relationships to disclose.

How reliable are models for malaria vaccine development? Lessons from irradiated sporozoite immunizations

Models occupy a key position in the development of anti-parasitic vaccines, yet their relevance has been seldom addressed. It is customary to admit that malaria vaccine development requires easy-to-handle, laboratory models. Animal models involving predominantly inbred rodents and primates as parasite hosts are currently the basic tools for the study of host-parasite interactions. Literature however indicates that the induction of host protection is more difficult in natural host-parasite pairs than in experimental models of parasite infection. Moreover different models delineate a wide range of host-pathogen relationship profiles providing a mosaic of contradictory informations, yet there is little incentive to delineate their relevance or to exploit recent advances to develop improved model systems. In this context the analysis of natural host-parasite interactions between Plasmodium berghei and its mammalian host and reservoir, the tree rat Grammomys surdaster could ge of relevance in the study of host-parasite interactions.

Real-time RT-PCR detection of disseminated tumour cells in bone marrow has superior prognostic significance in comparison with circulating tumour cells in patients with breast cancer

This study assessed the ability of real-time reverse transcription–polymerase chain reaction (RT–PCR) analysis to detect disseminated epithelial cells (DEC) in peripheral blood (PB) and bone marrow (BM) of patients with breast cancer (BC). Detection of DEC in BM is an obvious choice in BC, but blood sampling is more convenient. The aim of this study was to evaluate whether the detection of DEC in either PB or BM predicts overall survival (OS). Peripheral blood and BM samples were collected from 148 patients with primary (stage M0, n=116/78%) and metastatic (stage M+, n=32/21%) BC before the initiation of any local or systemic treatment. Peripheral blood of healthy volunteers and BM of patients with a nonmalignant breast lesion or a haematological malignancy served as the control group. Disseminated epithelial cells was detected by measuring relative gene expression (RGE) for cytokeratin-19 (CK-19) and mammaglobin (MAM), using a quantitative RT–PCR detection method. The mean follow-up time was 786 days (+/− 487). Kaplan–Meier analysis was used for predicting OS. By taking the 95 percentile of the RGE of CK-19 (BM: 26.3 and PB: 58.7) of the control group as cutoff, elevated CK-19 expression was detected in 42 (28%) BM samples and in 22 (15%) PB samples. Mammaglobin expression was elevated in 20% (both PB and BM) of the patients with BC. There was a 68% (CK-19) and 75% (MAM) concordance between PB and BM samples when classifying the results as either positive or negative. Patients with an elevated CK-19 or MAM expression in the BM had a worse prognosis than patients without elevated expression levels (OS: log-rank test, P=0.0045 (CK-19) and P=0.025 (MAM)). For PB survival analysis, no statistical significant difference was observed between patients with or without elevated CK-19 or MAM expression (OS: log-rank test, P=0.551 (CK-19) and P=0.329 (MAM)). Separate analyses of the M0 and M+ patients revealed a marked difference in OS according to the BM CK-19 or MAM status in the M+ patient group, but in the M0 group, only MAM expression was a prognostic marker for OS. Disseminated epithelial cells, measured as elevated CK-19 or MAM mRNA expression, could be detected in both PB and BM of patients with BC. Only the presence of DEC in BM was highly predictive for OS. The occurrence of DEC in the BM is probably less time-dependent and may act as a filter for circulating BC cells. The use of either larger volumes of PB or performing an enrichment step for circulating tumour in blood cells might improve these results.

Comparison of pap smear, visual inspection with acetic acid, human papillomavirus DNA-PCR testing and cervicography

OBJECTIVE

To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting.

METHOD

Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy.

RESULT

Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography.

CONCLUSION

The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests.

Merkel cell carcinoma and multiple basal cell carcinoma in an African albino woman with HIV infection

A 25-year-old HIV-infected African albino woman developed an aggressive Merkel cell carcinoma on her face and at least 10 basal cell carcinomas, mainly on sun-exposed parts of her body. HIV infection, immune deficiency and sun exposure are known risk factors for the development of Merkel cell carcinoma. Chemotherapy and radiotherapy were only temporarily successful. She died shortly after surgery was performed to remove the tumour.

Real-time RT-PCR correlates with immunocytochemistry for the detection of disseminated epithelial cells in bone marrow aspirates of patients with breast cancer

Real-time reverse transcriptase–polymerase chain reaction (RT–PCR) is a technique with the potential of improving the quantification of disseminated epithelial cells (DEC) in haematological tissues due to its exquisite sensitivity. This sensitivity may lead to false positivity. Immunocytochemistry (ICC) is regarded as the standard methodology to diagnose DEC. In this study, detection with ICC was compared with quantitative real-time RT–PCR for CK-19 and mammaglobin (hMAM) mRNA in bone marrow (BM) of patients with metastatic breast cancer (MBC). Bone marrow was aspirated from 14 control patients and from 29 patients with MBC. Mononuclear cells (MNC) were isolated. Immunostaining was carried out with the Epimet kit. Quantitative PCR was performed on the ABI Prism 7700. The CK-19 and hMAM mRNA quantities were normalised against β-Actin and calculated relative to a calibrator sample (relative gene expression). All controls were negative by ICC and for hMAM expression measured by RT–PCR, whereas the median RGE value for CK-19 was 0.57. For the MBC patients, the median RGE for hMAM was 0 and 10 out of 25 (40%) tested positive. Median RGE for CK-19 was 2.9 and 20 out of 25 (80%) tested positive. With ICC, the median value was 1 stained cell per sample, and 15 out of 24 (62%) samples were positive. A correlation was observed between CK-19 and hMAM expression (r=0.7; P=0.0003), and between hMAM expression and ICC (r=0.6; P=0.003). CK-19 expression and ICC (r=0.9; P<0.0001) showed the strongest correlation. Reverse transcriptase–polymerase chain reaction for CK-19 resulted in a higher number of positive BM samples of patients with MBC than ICC. Since an excellent correlation is observed between ICC and RT–PCR, and RT–PCR is probably more sensitive with the advantage of being less observer dependent and thus also more easy to automate, we consider our quantitative real-time RT–PCR method as validated for the detection of DEC in the bone marrow of breast cancer patients.

An unusual case of ectopic tungiasis with pseudoepitheliomatous hyperplasia

Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis, and subsequent hypertrophy of the parasite. In most cases lesions are confined to the feet. During a cross-sectional study, an unusual case of ectopic tungiasis in the inguinal area was detected. Histological examination of tissue samples showed a remarkable pseudoepitheliomatous aspect of the epidermis. Clinical features and differential diagnoses are discussed.

Prognostic value of nonangiogenic and angiogenic growth patterns in non-small-cell lung cancer

An essential prerequisite of nonangiogenic growth appears to be the ability of the tumour to preserve the parenchymal structures of the host tissue. This morphological feature is visible on a routine tissue section. Based on this feature, we classified haematoxylin and eosin-stained tissue sections from 279 patients with non-small-cell lung cancer into three growth patterns: destructive (angiogenic; n=196), papillary (intermediate; n=38) and alveolar (nonangiogenic; n=45). A Cox multiple regression model was used to test the prognostic value of growth patterns together with other relevant clinicopathological factors. For overall survival, growth pattern (P=0.007), N-status (P=0.001), age (P=0.020) and type of operation (P=0.056) were independent prognostic factors. For disease-free survival, only growth pattern (P=0.007) and N-status (P<0.001) had an independent prognostic value. Alveolar (hazard ratio=1.825, 95% confidence interval=1.117–2.980, P=0.016) and papillary (hazard ratio=1.977, 95% confidence interval=1.169–3.345, P=0.011) growth patterns were independent predictors of poor prognosis. The proposed classification has an independent prognostic value for overall survival as well as for disease-free survival, providing a possible explanation for survival differences of patients in the same disease stage.

Population-based validation of dihydrofolate reductase gene mutations for the prediction of sulfadoxine-pyrimethamine resistance in Uganda

Mutations in the dihydrofolate reductase gene (dhfr) of Plasmodium falciparum have been proposed as molecular markers for the surveillance of sulfadoxine-pyrimethamine (SP)-resistant malaria, but such proposals have not been validated. At 7 Ugandan sites in 1999, we determined the population-based prevalence of infections with mutations and the mutant allele frequency of dhfr codons 108, 51, and 59 using a random sample of infected individuals aged 1-45 years. Sulfadoxine-pyrimethamine treatment failure was independently estimated by in vivo tests in 327 children aged 6-59 months with clinical malaria. The prevalence of infections with the single point mutations and the dhfr codons 108 and 51 mutant allele frequency were not correlated to SP treatment failure. However, the dhfr codon 59 mutant allele frequency was positively correlated to SP treatment failure (r = 0.72, P = 0.06). The ratio of the infections with the mutant to wild genotype (M/W) and that of the mutant to wild allele (MA/WA) had the same values. Both dhfr codon 59 M/W and MA/WA ratio were significantly and positively correlated to SP treatment failure (r = 0.73, P = 0.05). Moreover, the prevalence of infections with only 2 mutations (Asn-108 plus Ile-51) was significantly and inversely correlated to the prevalence of infections with 3 mutations (Asn-108 plus Ile-51 plus Arg-59) (r = 0.92, P = 0.004), suggesting the stepwise accumulation of the dhfr mutations is Asn-108 Ile-51 Arg-59 and further supporting the idea of using the dhfr codon 59 M/W ratio as a molecular index for the prediction of SP treatment failure. Atthe population level, the dhfr codon 59 M/W ratio is a simple and stable index for the estimation of SP treatment failure.

Cyclooxygenase-2 expression and angiogenesis in squamous cell carcinoma of the skin and its precursors: a paired immunohistochemical study of 35 cases

BACKGROUND

Cyclooxygenase (COX)-2 expression and tumour-induced angiogenesis appear to be increased in squamous cell carcinoma (SCC) of the skin. In other cancers, COX-2 is a pro-angiogenic factor. The association between angiogenesis and COX-2 has not been studied in skin cancer.

OBJECTIVES

To assess the onset of increased COX-2 expression and angiogenesis in the multistage carcinogenesis of SCC as well as the correlation between those two parameters.

PATIENTS/METHODS

We performed a retrospective paired immunohistochemical analysis of normal skin, actinic keratosis (AK), Bowen's disease (BD) and SCC among 35 individuals. Specimens were considered COX-2 immunopositive when 5% or more of the tumour cells showed clear evidence of immunostaining. To quantify active angiogenesis, we used a Ki-67-CD34 double-labelling immunohistochemical stain and calculated the fraction of proliferating endothelial cells. The Chalkley method was used to determine the microvessel density. To detect hypoxia, a carboanhydrase IX immunostain was used.

RESULTS

Compared with normal epidermis (0%), AK (31%), BD (22%) and SCC (40%) were significantly more likely to be COX-2 immunopositive (P < 0.01). The fraction of proliferating endothelial cells and the Chalkley scores paralleled multistage carcinogenesis (P < 0.05 between different stages). COX-2 immunopositivity was fairly correlated with hypoxia and higher proliferating endothelial cell fractions but not with Chalkley counts.

CONCLUSIONS

Induction of COX-2 expression and angiogenesis are both early events in the development of SCC. In addition to ultraviolet light, hypoxia and COX-2 may be involved in skin tumour angiogenesis.

Determination of tumour prognosis based on angiogenesis-related vascular patterns measured by fractal and syntactic structure analysis

AIMS

Intratumoural micro-vessel density (IMD) has recently been shown to be a valuable prognostic tool in many tumours. Yet, IMD does not take into account the spatial arrangement of the vessels, therefore only partly reflecting the angiogenic situation. In order to describe contextual vascular relationships more accurately, we have used fractal and syntactic structure analysis (SSA) based on computerised image processing to quantify micro-vascular hot spots.

MATERIALS AND METHODS

The parametric performance in prediction of patients' outcome was evaluated by univariate analysis and compared with manually obtained IMDs, whereas an automated K-nearest-neighbour (KNN) classifier searched most discriminative parametric combinations. The method is based on analysis of vascular 'hot-spots' of paraffin-embedded tissue sections of invasive cervical carcinoma, colorectal carcinoma and malignant mesothelioma.

RESULTS

For all three cancers, prediction of prognosis based on SSA yielded in general much higher recognition scores compared with IMD or fractal dimension. Survival of cervical carcinoma was mostly correlated with clinical data, with the vascular permeation being the only parameter with independent value. Prognosis of colorectal carcinoma is best described by SSA, completed with IMD, indicating an inverse correlation of survival time with a more irregular pattern and a slight increase in vessel number. For mesothelioma, we found a strong correlation with SSA and patients' outcome, with two SSA-parameters having independent prognostic value.

CONCLUSIONS

The more accurate angiogenic description obtained with SSA may be useful for further exploitation as a prognosticator in a general diagnostic pathology service.

Angiogenesis and the role of bone marrow endothelial cells in haematological malignancies

Increased microvessel density (MVD) has been observed in the bone marrow (BM) of patients with multiple myeloma (MM), acute lymphoblastic leukaemia, acute myeloid leukaemia, and myelodysplastic and myeloproliferative syndrome. The MVD is the net result of cumulative phases of angiogenesis and angio-regression and is as such not an indicator of the ongoing angiogenesis at the time of biopsy. There is, therefore, a need for additional methods that allow the estimation of ongoing angiogenesis. Double immunostainings for CD34 and Ki-67 can be used on paraffin-embedded tissue to determine the endothelial proliferation fraction. The BM endothelial cells, as a component of the BM stroma, have a close interaction with the malignant cells. In MM, for example, they are involved in the specific homing and are a source of paracrine growth factors. Targeting the BM microvessels will not only influence the nutrient and oxygen supply, but will in addition reduce the growth stimuli provided by the EC.