Testing of newly diagnosed advanced high grade ovarian cancer (OC) patients with the Myriad Genetics MyChoice CDx Plus next generation sequencing-based in vitro diagnostic test emphasizes the need for public insurance coverage of genetic testing: Results of a national program by the Hellenic Society of Medical Oncology (HeSMO)

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Background: Homologous Recombination deficiency (HRD) represents a distinct entity in OC. Clinical data suggest that treatment selection can be based on both BRCA1/2 mutations and bearing Genomic Instability Status (GIS). Testing for GIS is critical in order to expand patients’ pool for targeted treatment. Myriad my Choice, is currently the only FDA approved test that can detect HRD by assessing BRCA1/BRCA2 mutation and GIS status in OC tumor specimens using 3 biomarkers: loss of heterozygosity, telomeric allelic imbalance and large-scale state transitions. To address this need, HeSMO has initiated a national program to provide access to myChoice to newly diagnosed patients with high grade stage III/IV OC. Methods: Patients with newly diagnosed stage III/IV high grade OC were eligible to participate in this program. The specific performance characteristics of myChoice CDx assay were determined on FFPE tumor samples by the evaluation of a range of representative tumor BRCA1 and BRCA2 sequence variants (e.g. single nucleotide variants, insertions or deletions and variants in homopolymers), Large Rearrangements (e.g. deletions and duplications affecting single and multiple exons) and a representative range of GIS. The overall results are composed of two major components: GIS Status (positive or negative) and tumor (t) BRCA1/2 Status (positive or negative). The combined results form the basis of the overall interpretation of the myChoice CDx Myriad HRD Status. Results: From December 2020 to January 2022, 454 patients from all over the country were tested within this program. 220 patients (48.46%) had a positive GIS report and 179 (39.43%) had a negative one. Among GIS positive cases, 122 patients were tBRCAwt (26.87%) 78 patients were tBRCA mutated (17.18%) and 10 patients had suspected deleterious BRCA1/2 mutations (2.20%). Inconclusive was the report in 38 specimens (8.37%) and myChoice Lab failed to complete the analysis in 15 cases (3.30%). Furthermore, mutations were also detected in a number of other genes, including but not limited to, ATM, BRIP1, PALB2, RAD51C, RAD51D, FANCL, CHEK2. Conclusions: In our series, 48.46% of the patients with high grade OC tested as BRCA1/2 and/or GIS positive, in accordance with published data, underlying the clinical need to implement GIS testing in OC patients’ molecular evaluation. Apart from the significant implications for treatment possibilities in an expanded patients’ population, these results are important for cancer prevention. We strongly believe that our results will strengthen our efforts for reimbursement of such testing in high grade OC patients, and will serve as a roadmap for the establishment of local HRD testing solutions.

Environmental impact of phosphogypsum stockpile in remediated Schistos waste site (Piraeus, Greece) using a combination of γ-ray spectrometry with geographic information systems

From 1979 to 1989, ten million tons of phosphogypsum, a waste by-product of the Greek phosphate fertilizer industry, was disposed into an abandoned limestone quarry in Schistos former waste site, Piraeus (Greece). The quarry has been recently closed and remediated using geomembranes and thick soil cover with vegetation. A part of the deposited phosphogypsum has been exposed due to intense rainfall episodes leading to concerns about how could potentially released radioactivity affect the surrounding environment. This study seeks to assess the environmental impact of the phosphogypsum deposited in the Schistos quarry, using laboratory-based γ-ray spectrometry measurements and geographical information systems. Radioactivity concentrations were mapped onto spatial-data to yield a spatial-distribution of radioactivity in the area. The data indicate elevated (226)Ra concentrations in a specific area on the steep south-eastern cliff of the remediated waste site that comprises uncovered phosphogypsum and is known to be affected by local weather conditions. (226)Ra concentrations range from 162 to 629 Bq/kg, with an average activity being on the low side, compared to the global averages for phosphogypsum. Nevertheless, the low environmental risk may be minimized by remediating this area with geomembranes and thick soil cover with vegetation, a technique, which has worked successfully over the remainder of the remediated quarry.

Specific detection of blaVIM and blaIMP metallo-beta-lactamase genes in a single real-time PCR

This study describes the development of a real-time PCR protocol for rapid detection of the most common bla(VIM) (bla(VIM-1), bla(VIM-2), bla(VIM-3), bla(VIM-4), bla(VIM-5), bla(VIM-6), bla(VIM-10), bla(VIM-11), bla(VIM-12)) and bla(IMP) (bla(IMP-1), bla(IMP-2), bla(IMP-6), bla(IMP-8), bla(IMP-10), bla(IMP-15), bla(IMP-19), bla(IMP-20)) genes in a single reaction. The genes were specifically detected and clearly differentiated into four groups, i.e., (i) bla(VIM-1)-like (bla(VIM-1), bla(VIM-4), bla(VIM-5), bla(VIM-12)); (ii) bla(VIM-2)-like (bla(VIM-2), bla(VIM-3), bla(VIM-6), bla(VIM-10), bla(VIM-11)); (iii) bla(IMP-1)-like (bla(IMP-1), bla(IMP-6), bla(IMP-10)); and (iv) bla(IMP-2)-like (bla(IMP-2), bla(IMP-8), bla(IMP-15), bla(IMP-19), bla(IMP-20)), by melting curve analysis of the real-time PCR products. The protocol was used to screen positive bla(VIM-1), bla(VIM-2) and bla(IMP-1) control strains, 70 Gram-negative isolates resistant to carbapenems, and 30 Gram-negative isolates susceptible to carbapenems (negative controls).

Disseminated nontuberculous mycobacterial infection in a child with interferon-gamma receptor 1 deficiency

We describe the case of a 2-year-old boy with disseminated infection by a rapidly growing, poorly pathogenic mycobacterial species that belonged to the Mycobacterium fortuitum-Mycobacterium peregrinum complex. He had a severe course characterized by a poor response to treatment and recurrent lymph node abscess formation. Sequencing of the interferon-gamma receptor 1 gene (IFNgammaR1) revealed that he was homozygous for a novel null mutation, 453delT. Patients presenting with disseminated infections by rapidly growing environmental mycobacteria must be investigated for complete IFNgammaR1 deficiency. The spectrum of IFNgammaR1 genotypes associated with this immunological disorder is expanding.

The outcome of Leishmania major experimental infection in BALB/c mice can be modulated by exogenously delivered iron

We previously established that Leishmania promastigotes express a transferrin receptor and that iron chelators inhibit promastigote growth in vitro. Thus, we were interested in modulating the vertebrate host iron pool and to monitor whether such changes will affect the outcome of L. major infection in BALB / c mice, inoculated in the footpad with 106 stationary phase promastigotes. Treatment of mice with desferrioxamine resulted in a slight delay of the development of cutaneous lesions. In contrast and unexpectedly, systemic iron delivery, at early time points of parasite delivery, significantly limited footpad pathology. Accordingly, parasite loads at the site of parasite delivery, the draining lymph node, liver and spleen were significantly reduced in iron-loaded mice. Importantly, the "protective" effect of iron delivery correlated with the presence, at the site of inoculation, of lower levels of IL-4 and IL-10 transcripts while both IFN-gamma and inducible nitric oxide synthase transcripts were at higher levels. The presence of more type 1 cytokine transcripts was further supported by the increased levels of IgG2a in their sera. These data strongly suggest that susceptibility to L. major as assessed in the footpad model is modifiable by interventions that alter the iron status of the host at early time points of parasite delivery.

Correlation between serum IL-6 and CRP levels and severity of head injury in children

OBJECTIVE

To examine interleukin-6 (IL-6) and C-reactive protein (CRP) release in children with head injury (HI) and investigate if there is a correlation between the levels of these two proteins and the severity of HI.

DESIGN

Prospective clinical investigation.

SETTING

Eight-bed paediatric intensive care unit in a university hospital.

PATIENTS

Forty-five children were followed up for 4 days after HI and their serum IL-6 and CRP levels were measured.

MEASUREMENTS AND RESULTS

Peak serum IL-6 levels occurred 4 h postinjury, decreasing over time. CRP was normal 4 h after injury, then increased reaching peak levels in 48 h. Children with admission Glasgow Coma Scale (GCS) scores of 8 or less had higher IL-6 levels compared to children with GCS scores higher than 8, 4 and 12 h post-injury (p<0.01 and p<0.05, respectively). IL-6 was higher in children with admission PRISM scores of 10 or more than in those with PRISM scores lower than 10 at 4 and 12 h (p<0.05). CRP levels were higher in patients with GCS scores of 8 or less compared to patients with GCS scores higher than 8 at 24, 48 and 72 h (p<0.05, p<0.02 and p<0.02, respectively) . Patients with PRISM scores of 10 or more had higher CRP levels compared to those with PRISM scores lower than 10 at 24, 48 and 72 h (p<0.05). Peak CRP levels correlated well with peak IL-6 levels (r = 0.49, p<0.001). No correlation between IL-6 or CRP levels and mortality or clinical outcome was found.

CONCLUSIONS

Serum IL-6 and CRP levels are elevated in children with HI and there is a relation between the severity of HI and the levels of these proteins. There was no correlation between IL-6, CRP and outcomes of the patients.

Month of birth, atopic disease, and sensitization to common aeroallergens in Greece

The aim of the study was to evaluate the influence of the month of birth on the development of atopic disease and the rate of sensitization to common environmental allergens in Greece. Analysis of the month of birth of 1755 individuals with atopic disease (asthma, rhinitis, atopic dermatitis), out of whom 771 had positive skin tests/RAST to Dermatophagoides pteronyssinus and mixed grasses, in comparison to total live births (2,877,733) in Greece during 1968-88, was performed and showed significant correlation (p < 0.001) between month of birth and development of atopic disease in general. Months of birth May to August correlated best with bronchial asthma (p < 0.05) and rhinitis (p < 0.05), and July to August with atopic dermatitis (p < 0.05). Significantly greater than the expected frequency was found for D. pteronyssinus sensitivity for months of birth May to August (p < 0.01), for mixed grass pollen March to August (p < 0.01), and for Olea europaea pollen mainly March (p < 0.05). Our results indicate that in Greece high-risk birth months for development of atopy are May to August, whereas for sensitization to common aeroallergens they are March for O. europaea, March to August for mixed grasses, and May to August for D. pteronyssinus.