Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control

Background

Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes.

Methods

The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life.

Results

The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan.

Conclusions

This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.

Charting Single Cell Lineage Dynamics and Mutation Networks via Homing CRISPR

Single cell lineage tracing, essential for unraveling cellular dynamics in disease evolution is critical for developing targeted therapies. CRISPR-Cas9, known for inducing permanent and cumulative mutations, is a cornerstone in lineage tracing. The novel homing guide RNA (hgRNA) technology enhances this by enabling dynamic retargeting and facilitating ongoing genetic modifications. Charting these mutations, especially through successive hgRNA edits, poses a significant challenge. Our solution, LINEMAP, is a computational framework designed to trace and map these mutations with precision. LINEMAP meticulously discerns mutation alleles at single-cell resolution and maps their complex interrelationships through a mutation evolution network. By utilizing a Markov Process model, we can predict mutation transition probabilities, revealing potential mutational routes and pathways. Our reconstruction algorithm, anchored in the Markov model's attributes, reconstructs cellular lineage pathways, shedding light on the cell's evolutionary journey to the minutiae of single-cell division. Our findings reveal an intricate network of mutation evolution paired with a predictive Markov model, advancing our capability to reconstruct single-cell lineage via hgRNA. This has substantial implications for advancing our understanding of biological mechanisms and propelling medical research forward.

[One case of acute severe nitrite poisoning with massive pulmonary thromboembolism]

This paper reported a case of acute severe nitrite poisoning with massive pulmonary thromboembolism (PTE), discussed the pathogenesis and summarized the treatment experience. Common symptoms of nitrite poisoning include headache, abdominal pain, shortness of breath, cyanosis, etc., which can be followed by encephalopathy, neurological dysfunction, hemolysis, etc. However, the cases of PTE are rare in clinical practice and are prone to missed diagnosis. Nitrite and methemoglobin may lead to vascular endothelial damage and promote thrombosis. In the diagnosis and treatment of acute severe nitrite poisoning patients, the targeted preventive measures should be taken.

Targeting Ribosome Biogenesis as a Novel Therapeutic Approach to Overcome EMT-related Chemoresistance in Breast Cancer

Epithelial-to-mesenchymal transition (EMT) contributes significantly to chemotherapy resistance and remains a critical challenge in treating advanced breast cancer. The complexity of EMT, involving redundant pro-EMT signaling pathways and its paradox reversal process, mesenchymal-to-epithelial transition (MET), has hindered the development of effective treatments. In this study, we utilized a Tri-PyMT EMT lineage-tracing model and single-cell RNA sequencing (scRNA-seq) to comprehensively analyze the EMT status of tumor cells. Our findings revealed elevated ribosome biogenesis (RiBi) during the transitioning phases of both EMT and MET processes. RiBi and its subsequent nascent protein synthesis mediated by ERK and mTOR signalings are essential for EMT/MET completion. Importantly, inhibiting excessive RiBi genetically or pharmacologically impaired the EMT/MET capability of tumor cells. Combining RiBi inhibition with chemotherapy drugs synergistically reduced metastatic outgrowth of epithelial and mesenchymal tumor cells under chemotherapies. Our study suggests that targeting the RiBi pathway presents a promising strategy for treating patients with advanced breast cancer.

Significance

This study uncovers the crucial involvement of ribosome biogenesis (RiBi) in the regulation of epithelial and mesenchymal state oscillations in breast cancer cells, which plays a major role in the development of chemoresistant metastasis. By proposing a novel therapeutic strategy targeting the RiBi pathway, the study offers significant potential to enhance treatment efficacy and outcomes for patients with advanced breast cancer. This approach could help overcome the limitations of current chemotherapy options and address the complex challenges posed by EMT-mediated chemoresistance.

Spatial Transcriptomics Depict Ligand-Receptor Cross-talk Heterogeneity at the Tumor-Stroma Interface in Long-Term Ovarian Cancer Survivors

Advanced high-grade serous ovarian cancer (HGSC) is an aggressive disease that accounts for 70% of all ovarian cancer deaths. Nevertheless, 15% of patients diagnosed with advanced HGSC survive more than 10 years. The elucidation of predictive markers of these long-term survivors (LTS) could help identify therapeutic targets for the disease, and thus improve patient survival rates. To investigate the stromal heterogeneity of the tumor microenvironment (TME) in ovarian cancer, we used spatial transcriptomics to generate spatially resolved transcript profiles in treatment-naïve advanced HGSC from LTS and short-term survivors (STS) and determined the association between cancer-associated fibroblasts (CAF) heterogeneity and survival in patients with advanced HGSC. Spatial transcriptomics and single-cell RNA-sequencing data were integrated to distinguish tumor and stroma regions, and a computational method was developed to investigate spatially resolved ligand-receptor interactions between various tumor and CAF subtypes in the TME. A specific subtype of CAFs and its spatial location relative to a particular ovarian cancer cell subtype in the TME correlated with long-term survival in patients with advanced HGSC. Also, increased APOE-LRP5 cross-talk occurred at the stroma-tumor interface in tumor tissues from STS compared with LTS. These findings were validated using multiplex IHC. Overall, this spatial transcriptomics analysis revealed spatially resolved CAF-tumor cross-talk signaling networks in the ovarian TME that are associated with long-term survival of patients with HGSC. Further studies to confirm whether such cross-talk plays a role in modulating the malignant phenotype of HGSC and could serve as a predictive biomarker of patient survival are warranted.

SIGNIFICANCE

Generation of spatially resolved gene expression patterns in tumors from patients with ovarian cancer surviving more than 10 years allows the identification of novel predictive biomarkers and therapeutic targets for better patient management. See related commentary by Kelliher and Lengyel, p. 1383.

Abstract 2382: Three-dimensional spatial phenotyping of cellular landscapes in the bone microenvironment of spontaneous metastases

Metastasis to distant organs is the major cause of cancer-related deaths, and bone is the most frequent destination of metastasis in many cancers. Recent studies have shown that the bone microenvironment, not only permits, but augments cancer cells’ invasion and spread within tissue. Recent evidence also suggests that NG2+ cells participate in the initiation of bone metastasis and enhance proliferation and migration via cell-to-cell interactions and often co-localize with early disseminated tumor cells (DTCs). Hence, we developed an imageomics framework to measure and model three-dimensional (3D) spatial relationships within the bone microenvironment using whole slide confocal imaging.

To investigate the progression of DTCs, we delivered Lewis Lung Carcinoma (LLC1) GFP+ cancer cells to hind limb bones through intra-iliac artery injection. We did not observe immunogenic rejection of the cells or loss of markers during tumor progression. We performed whole slide confocal imaging to reconstruct high, single-cell resolution, 3D images of femur bones using NG2-creER;ROSA26-LoxP-TdTomato mice. This allowed us to detect and localize single spontaneous DTCs and NG2+ cells within the overall structure of the bone using anti-RFP and anti-GFP fluorescent markers.

To quantify 3D spatial relationships in the bone microenvironment, cell positions were labeled within the image by setting a channel-specific minimum intensity threshold to remove background noise and weakly-stained objects, followed by removing all objects measuring <10 μm in more than one dimension. The remaining markers for DTCs were evaluated manually. DTCs were identified based on 3D shape, size, heterogeneity of stain markers, and absence of non-specific staining, while the coordinates (x,y,z) of each DTC were recorded. NG2+ cell positions were determined automatically; a black-hat transformation is used to remove background noise and enhance contrast, followed by thresholding to segment NG2+ cells. For segmented objects within the volume range of an expected cell (5-20 μm radius), the centroid coordinates of the resulting objects were recorded.

To evaluate the spatial relationships in the stationary point patterns (SPPs) generated from the DTC and NG2+ staining, we implemented a 3D Ripley’s cross-K function to indicate spatial clustering or dispersion within and between SPPs to quantitatively evaluate spatial relationships at various distances and statistically compare against random distributions.

We have developed an imageomics framework for 3D spatial relationships of different cells within the bone microenvironment using whole slide confocal imaging. Our framework can accurately assess the relationship between the two groups and evaluate additional elements within the bone microenvironment, and potentially other cancer-affected organ systems.

Citation Format: Daniel S. Kermany, Weijie Zhang, Jianting Sheng, Matthew Vasquez, Xiang Zhang, Stephen T. Wong. Three-dimensional spatial phenotyping of cellular landscapes in the bone microenvironment of spontaneous metastases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2382.

[Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema]

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ² test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ²=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ²=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ²=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

[Mechanism of Leakage in Phosphatidylserine-Containing Membranes by Melittin]

Phosphatidylserine (PS) is an important apoptotic-cell surface signal that exists in bacterial and cancer cells. The mechanism by which melittin interacts with the PS membrane remains unclear. Here, we revealed this mechanism by using a dual-channel fluorescence microscope to observe the concentration-dependent process of pore formation in giant unilamellar vesicles (GUVs) that were exposed to melittin solution. We found that unsaturated PS membranes differed significantly from saturated PS membranes in different phases. This study provides a reference for research and development of anticancer drugs.

[A protein complex recognition method based on spatial-temporal graph convolution neural network]

OBJECTIVE

To propose a new method for mining complexes in dynamic protein network using spatiotemporal convolution neural network.

METHODS

The edge strength, node strength and edge existence probability are defined for modeling of the dynamic protein network. Based on the time series information and structure information on the graph, two convolution operators were designed using Hilbert-Huang transform, attention mechanism and residual connection technology to represent and learn the characteristics of the proteins in the network, and the dynamic protein network characteristic map was constructed. Finally, spectral clustering was used to identify the protein complexes.

RESULTS

The simulation results on several public biological datasets showed that the F value of the proposed algorithm exceeded 90% on DIP dataset and MIPS dataset. Compared with 4 other recognition algorithms (DPCMNE, GE-CFI, VGAE and NOCD), the proposed algorithm improved the recognition efficiency by 34.5%, 28.7%, 25.4% and 17.6%, respectively.

CONCLUSION

The application of deep learning technology can improve the efficiency in analysis of dynamic protein networks.

Abstract 963: Targeting epithelial-mesenchymal plasticity via ribosome biogenesis inhibition reduces chemoresistant metastasis of breast cancer

Epithelial to mesenchymal transition (EMT) plays an important role in metastasis and chemoresistance. However, targeting EMT has been challenging due to the complex and redundant EMT signaling pathways. Moreover, EMT inhibition would unequivocally promote its reversed process, mesenchymal to epithelial transition (MET), which also favors malignancy progression. To solve this EMT targeting paradox, we proposed to target the ability of tumor cells to oscillate between epithelial and mesenchymal states, the epithelial to mesenchymal plasticity (EMP), which encompasses both EMT and MET. Using a SnailCre-ERT2 mediated EMT lineage-tracing model, we confirmed the involvement of EMP in chemoresistant metastasis of breast cancer. Single-cell transcriptome analyses of tumor cells in the transitioning phases of EMT or MET consistently revealed that ribosome biogenesis (RiBi) was specifically elevated regardless of their destined phenotypical fates. Further analyses delineated that the upregulation of RiBi and the subsequent nascent protein synthesis via the intensified ERK and mTOR signalings were vital for cancer cells to transit between epithelial and mesenchymal states. Importantly, inhibiting the excessive RiBi by either genetic or pharmacological means impaired EMP, as both EMT and MET processes were impeded, leading to significantly reduced metastatic outgrowth of chemoresistant tumor cells. Our studies revealed that elevated RiBi is required for tumor cells to “Ping Pong” between epithelial and mesenchymal states. Targeting the EMP via RiBi inhibition provides a feasible strategy to improve therapies for advanced breast cancers.

Citation Format: Yi Ban, Wenjuan Dong, Yue Zou, Sharrell B. Lee, Jianting Sheng, Yuliang Cao, Stephen T.C. Wong, Dingcheng Gao. Targeting epithelial-mesenchymal plasticity via ribosome biogenesis inhibition reduces chemoresistant metastasis of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 963.

Abstract 633: Delineating tumor-neural communication in brain metastasis with spatiotemporal transcriptomic analysis and multi-cellular crosstalk modeling

Brain metastases are diagnosed in 20-40% of all cancer patients. Despite the advancements in neurosurgery, radiotherapy, and chemotherapy, one-year survival of metastatic brain tumor patients still within a single digit such that brain metastases constitute about 20% of annual cancer deaths. These facts clearly indicate a critical need for better understanding of mechanisms that promote the growth of brain metastases. Emerging data, including ours, indicate that different types of metastatic cancer cells leverage dissimilar sets of neurotransmitters to favor their outgrowth in the brain. However, there are over sixty types of neurotransmitters in the brain being synthesized and released by various types of neural cells, we need a systemic investigation of how they mediate the pathogenesis of brain metastases in concert. Since neurotransmitters, gliotransmitters, neurotrophic factors, and neural cytokines, called neuroactive substances, are the most abundant and key intercellular communication signals in the brain, we hypothesize that tumor cells leverage these neuroactive substances to assimilate into neural circuitry via communicating with neural cells including neurons, astrocytes, microglia, oligodendrocyte, and others, in promoting the vicious circle of tumor-neural crosstalk during brain metastasis development. By performing spatial transcriptomics analysis on mouse brain sections bearing metastatic tumors, we found that tumor lesions at different locations and even tumor-surrounding areas in the brain regions could be differentiated into different cellular clusters based on gene transcriptomic expressions. We further predicted several paracrine and autocrine signaling between and within tumors as well as tumor-surrounding neural niches in different tumor locations (e.g., centers or edges), of different tumor sizes, and at various tumor development stages, using our Cell-Cell Communication Explorer (CCC-Explorer) modeling software. Functional experiments were conducted to demonstrate that cell type-specific depletion of the secreted NSs deactivated the activities of corresponding receptors and downstream signaling in co-cultured metastatic brain tumor cells. Characterizing spatiotemporal tumor-neural crosstalk in the brain metastatic niche would provide a new strategy in the development of novel and effective therapeutics of brain metastases.

Citation Format: Xin Wang, Ying Zhu, Jianting Sheng, Hong Zhao, Stephen Wong. Delineating tumor-neural communication in brain metastasis with spatiotemporal transcriptomic analysis and multi-cellular crosstalk modeling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 633.

Abstract P5-06-01: Spatiotemporal gene expression analysis to identify novel tumor-neural crosstalk in TNBC brain metastases

Brain metastasis (BrM) occurs in 25-40% of TNBC metastatic patients while one-year survival remains a single digit. In contrast to other primary subtypes, TNBC usually spreads to the brain rapidly at early stages or even before the diagnosis of primary cancer. The shorter development time of BrM in TNBC and shorter survival time after BrM diagnosis may indicate a certain innate ability of TNBC cells in adapting to the brain. Recent seminal findings and our studies identified enriched and diverse expressions of neurotransmitters receptors, transporters, and key synthesis enzymes in brain metastatic TNBC cells. Since neurotransmitters, gliotransmitters, neurotrophic factors, and neural cytokines, called neuroactive substances (NSs), are the most abundant and key intercellular communication signals in the brain, we hypothesize that tumor cells leverage NSs to assimilate into the neural circuitry via communicating with various types of neural cells, including astrocytes, microglia/macrophages, oligodendrocytes and so on, to reinforce tumor-neural crosstalk in the development of BrM. By performing spatial transcriptomics experiments on mouse brain tissue sections bearing TNBC metastatic tumors, we found that brain regions, tumor lesions at different locations, and even tumor-surrounding areas were well separated into different clusters based on the spatial gene expressions and further predicted several novel paracrine and autocrine signalings between/within tumors and tumor-surrounding neural niches under different conditions, including tumor locations, tumor sizes, tumor center vs. edges, and stages of tumor development using the Cell-Cell Communication Explorer (CCCExplorer), a computational modeling tool for multi-cellular crosstalk and intracellular signaling developed by our lab. We conducted functional experiments to demonstrate that cell type-specific depletion of the secreted NSs deactivated the activities of corresponding receptor and downstream signaling using a cellular co-culture BrM system. The presented study indicates that the characterization and identification of spatiotemporal tumor-neural crosstalk in the BrM metastatic niche would open up a new vista for discovering novel therapeutics targets for devastating metastatic brain tumor.

Citation Format: Hong Zhao, Xin Wang, Jianting Sheng, Shan Xu, Dongbing Gao, Stephen Wong. Spatiotemporal gene expression analysis to identify novel tumor-neural crosstalk in TNBC brain metastases [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 P5-06-01.

Abstract 2749: The unique tumor immune microenvironment of clear cell ovarian carcinoma

Based on differences in chemosensitivity and clinical outcomes, we hypothesize that clear cell ovarian carcinoma (CCCO) displays a unique tumor immune microenvironment (TIME) compared to high grade serous ovarian carcinoma (HGSOC). Microsatellite instability and ARID1DA mutations are more common in clear cell ovarian carcinoma suggesting improved outcomes with checkpoint blockade immunotherapy use. Our objective is to compare the TIME of CCCO to HGSOC using imaging mass cytometry (IMC).

Primary untreated ovarian tumors were collected under an IRB-approved protocol. Formalin fixed paraffin embedded (FFPE) tissue sections were stained with 34 metal-tagged antibodies to detect various cell specific and immune related markers using the Fluidigm protocol. IMC data was obtained by the Fluidigm Helios CyTOF instrument utilizing the Hyperion Imaging System laser ablation module. Images from a 1mm2 area of each tissue section were processed and converted to tiff files using MCD Viewer (Fluidigm). Images were analyzed using a deep learning based data analytic pipeline beginning with cell segmentation then multiple rounds of phenotype clustering for cell type annotation. Various cell phenotypes were then measured for cell density analysis within a tumor enriched area. Spearman correlation was performed between cell densities of CCCO and HGSOC.

Samples from 51 patients were used for the study: 10 with CCCO and 41 with HGSOC. In the CCCO group, stage of disease ranged from stage I (70%) to III (10%), but all the HGSOC had stage III (92.7%) or IV (7.3%) disease (p<0.001).

Images were analyzed using 18 markers based on high signal-to-noise ratios. Following cell segmentation and phenotype clustering, 39 cell subtype clusters were identified including 6 macrophage cell subtypes, 11 T cell subtypes, and 12 tumor cell subtypes.

CCCO had a lower density of intratumoral activated CD8+ T cells (CD44+CD8a+CD45RO+) than the HGSOC (p=0.048). Tumor cell subtypes in the tumor-enriched areas differed between the two groups. CCCO had a higher density of B7-H4midKi67hi tumor cells (p=0.004), but had a lower density B7-H4hiKi67midKeratin8_18+ (p=0.027), B7-H4hiKeratin8_18+ (p=0.004), and B7-H4hiKi67midKeratin8_18+ tumor cells (p=0.007). CCCO had a lower density of CD31+CD73mid cells (p=0.034) but higher density of CD73hi (p=0.024) compared to HGSOC.

CCCO have a distinct TIME compared to HGSOC. In our cohort, despite most having stage I disease, CCCO showed features associated with poor prognosis including decreased intratumoral CD8+ T cells, higher density of a subtype of actively dividing B7-H4mid ki67hi cancer cells, and higher density of CD73hi cells. Since B7-H4 and CD73 both act as immune checkpoint inhibitors that can confer chemoresistance, therapeutic strategies to target these molecules may enhance CD8+ T cell mediated anti-tumor immune response and chemosensitivity to improve survival in patients with CCCO.

Citation Format: Han T. Cun, Ying Zhu, Sammy Ferri-Borgogno, Jianting Sheng, Rita Cheng, Jae-hoon Kim, Gwan Hee Han, Stephen T. Wong, Karen H. Lu, Samuel C. Mok. The unique tumor immune microenvironment of clear cell ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2749.

Abstract 103: Spatially resolved transcriptomics identified distinct tumor-stroma crosstalk networks in long term ovarian cancer survivors

The tumor microenvironment (TME), composed primarily of fibroblasts, endothelial cells, lymphocytic infiltrates and extracellular matrix proteins, can directly affect cancer cell growth, migration, differentiation as well as immune cell landscapes, thereby presenting a unique aspect of diagnosing and treating cancer. Cancer-associated fibroblasts (CAF) and immune cells are the main orchestrators of the ovarian cancer TME. We hypothesized that spatial transcriptomics (ST), which can provide a rich spatial context to gene expression, will identify crosstalk signaling networks among various cell types in the ovarian TME. Advanced stage high-grade serous ovarian cancer (HGSC) tissue frozen sections from two treatment naïve long-term survivors (LTS, overall survival ≥ 10 years) and two short-term survivors (STS, overall survival ≤ 2 years) were placed onto a ST expression slide pre-spotted with 1000 unique barcoded RNA-capturing probes. The ST slides were then stained with H&E and imaged. Tissue permeabilization and cDNA synthesis were then performed directly on the tissue section. The derived barcoded cDNA libraries from each sample were sequenced using Illumina NextSeq500 flow cells. After RNA-Seq analysis, supervised analysis was then performed by selecting different regions (based on tissue histology) in the tumor, tumor/stroma mixture, stroma close or far away from tumor areas to identify differentially expressed genes between STS and LTS. Stromal cells from different spatial locations had unique differentially expressed genes based on their proximity (11 genes in LTS; 11 genes in STS) or remoteness (18 genes in LTS; 10 genes in STS) to cancer cell compartments. Among the major modulated gene networks, higher levels of antigen-presenting molecules were found in the stroma in close proximity to the tumor cell nest than in stroma located far away in LTS tumor samples but not in the STS samples, suggesting an increased number of activated antigen-presenting cells in LTS tumors. In addition, higher levels of adhesion molecules and angiogenetic factors were found in the stroma in close proximity to the tumor cell nest than in stroma located far away in STS tumor samples but not in LTS samples, suggesting that adhesion molecules and angiogenetic factors produced by stromal cells may facilitate the invasiveness of the tumor cells, which subsequently leads to short term survival in patients with the disease. Our findings demonstrate for the first time that spatially resolved transcriptomics allows the identification of prognostic biomarkers associated with overall survival in HGSC patients. Further studies using deconvoluted ST data to further delineate the specific stromal cell subtypes in close proximity to tumors, and imaging mass cytometry (IMC) or multiplexed immunohistochemistry to validate the protein expression of the potential biomarkers are ongoing.

Citation Format: Sammy Ferri-Borgogno, Jianting Sheng, Ying Zhu, Kwong K. Wong, Stephen T. Wong, Samuel C. Mok. Spatially resolved transcriptomics identified distinct tumor-stroma crosstalk networks in long term ovarian cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 103.

Abstract 7: Modeling cell-cell crosstalk in TNBC brain metastasis

Brain metastasis (BrM) is a difficult clinical problem in triple-negative breast cancer (TNBC) patients: it occurs in 25% to 40% of metastatic patients while two-year survival rate stubbornly remains a single digit. TNBC usually spreads to the brain rapidly at earlier stages or before the diagnosis of primary cancer. The shorter development time of BrM in TNBC and shorter survival time after BrM diagnosis may indicate a unique innate ability of TNBC tumor cells in adapting to the brain. Indeed, emerging data including ours indicates that TNBC tumor cells have intrinsic brain-like traits resulting in brain-tropism metastasis. Our preliminary studies identified enriched and diverse expressions of receptors and transporters of various neuro-active substances in brain metastatic TNBC cells, including neurotransmitters, gliotransmitters, neurotrophic factors and neural cytokines. By immunopanning astrocytes and microglia/macrophages from mouse brains bearing TNBC brain metastatic tumors at day 3 post tumor cell injection through left cardiac ventricle, and use the CCCExplorer software in modeling the interactions among tumor cells, astrocytes, and microglia/macrophage with cell-type specific RNAseq data, we identified several novel crosstalk signaling, including tumor autocrine TPH1-HTR2, astrocyte→tumor PCDH7-EGFR, IL6-IL6R, CCL5-CCR5 and VGF-C3AR1, and microglia/macrophage→tumor ARTN-GFAR3. Functional experiments demonstrated that cell type-specific depletion of the secreted neuro-active substances deactivated the activities of corresponding receptor and downstream signaling in co-cultured BrM tumor cells. Given that more complex paracrine/autocrine signaling network may dynamically evolve during BrM development, we are characterizing the spatiotemporal cell-cell crosstalk in the BrM metastatic niche that will have important implications for novel therapeutics development.

Citation Format: Hong Zhao, Xin Wang, Nikola Liu, Jianting Sheng, Stephen Wong. Modeling cell-cell crosstalk in TNBC brain metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 7.

SIO: A Spatioimageomics Pipeline to Identify Prognostic Biomarkers Associated with the Ovarian Tumor Microenvironment

Stromal and immune cells in the tumor microenvironment (TME) have been shown to directly affect high-grade serous ovarian cancer (HGSC) malignant phenotypes, however, how these cells interact to influence HGSC patients' survival remains largely unknown. To investigate the cell-cell communication in such a complex TME, we developed a SpatioImageOmics (SIO) pipeline that combines imaging mass cytometry (IMC), location-specific transcriptomics, and deep learning to identify the distribution of various stromal, tumor and immune cells as well as their spatial relationship in TME. The SIO pipeline automatically and accurately segments cells and extracts salient cellular features to identify biomarkers, and multiple nearest-neighbor interactions among tumor, immune, and stromal cells that coordinate to influence overall survival rates in HGSC patients. In addition, SIO integrates IMC data with microdissected tumor and stromal transcriptomes from the same patients to identify novel signaling networks, which would lead to the discovery of novel survival rate-modulating mechanisms in HGSC patients.

Downregulation of miR-21 promotes tibial fracture healing in rabbits through activating ERK pathway

OBJECTIVE

The aim of this study was to investigate the effect of micro ribonucleic acid (miR)-21 on tibial fracture healing in rabbits by regulating the extracellular signal-regulated kinase (ERK) signaling pathway, and to explore its possible underlying mechanism.

MATERIALS AND METHODS

A total of 15 healthy male rabbits were randomly divided into three groups, including: model group A (fracture group, n=5), model group B (fracture treatment group, n=5), and model group C (miR-21 siRNA + treatment group, n=5). Fracture healing was observed by imaging. The content of the serum collagen I and collagen II in rabbits was detected via enzyme-linked immunosorbent assay (ELISA). The morphology of bone tissues was observed via staining. Moreover, the expressions of ERK, transforming growth factor-β1 (TGF-β1), and Smad in osteoblasts of tibia were observed via Western blotting and Reverse Transcription-Polymerase Chain Reaction (RT-PCR), respectively.

RESULTS

There was bony callus formation in group B and C when compared with group A. Compared with group B, bony callus formation was significantly accelerated in group C, while healing cycle was shortened. Hematoxylin-eosin (HE) staining and Masson staining indicated that compared with group A, group C had more fibrous calluses, new capillaries, and fibroblasts in tissues. Meanwhile, group C exerted better maturity of collagen tissues and higher osteoid content at 20 d after modeling. Compared with group C, there were more osteoid tissues with poor maturity in group B. Meanwhile, intramembranous bone formation was deformed, and collagen content was remarkably lower in group B. The content of serum collagen I and collagen II remarkably increased in group B compared with group A (p<0.05). However, it was significantly upregulated in group C compared with group B, showing statistically significant differences (p<0.05). According to the results of Western blotting, the protein expressions of TGF-β1, Smad, and ERK in osteoblasts were significantly upregulated in group B when compared with those in group A (p<0.05). However, they increased remarkably in group C when compared with group B (p<0.05). Besides, RT-PCR results revealed that the messenger RNA (mRNA) expressions of TGF-β1, Smad, and ERK in osteoblasts were significantly higher in group B than those in group A (p<0.05). However, they were markedly raised in group C in comparison with group B (p<0.05).

CONCLUSIONS

Down-regulation of miR-21 promotes tibial fracture healing in rabbits by activating the ERK signaling pathway.

[A birth cohort study of the association between prenatal serum bisphenol A concentration and infant neurobehavior development]

Objective: To explore the association between maternal bisphenol A (BPA) exposure during pregnancy and neurobehavioral development in infant. Methods: Participants were from the Ma'anshan Birth Cohort, which was established from October 2008 to October 2010 based on four municipal medical and health institutions in Ma'anshan. High-performance liquid chromatography-tandem mass spectrometry was applied for the determination of serum BPA concentration in 1 783 pregnant women sampled at their first filing, and during 2.97 to 28.1 months age of the infants. Neurobehavioral development were assessed by 0-6-year-old pediatric examination table of neuropsychological development. Generalized linear model was used to analyze the association between serum BPA levels during pregnancy and infants' neurobehavioral development. Results: A total of 931 mother-child pairs had complete data on serum BPA detection during pregnancy and assessment of infants' neurobehavioral development status. The age of pregnant women at their first filing was (26.67±3.45) years old, and the M (P₂₅,P₇₅) of serum BPA concentration (ng/ml) was 0.23 (0.11, 0.52), with a detection rate of 84.1% (783/931). The age of infants was (13.18±5.46) months, and 53.5% (498) were boys. The developmental quotient scores of large motor, fine motor, adaptive ability, language ability and social behaviors of infants were (97.88±16.32), (97.16±15.35), (99.64±15.47), (95.3±16.04) and (98.95±14.76) points, respectively. Generalized linear model showed that after adjusting for factors such as delivery mode, feeding mode, family per capita monthly income, preterm delivery, gender, maternal age, residence, pre-pregnancy body mass index and residence time, serum BPA level in pregnancy was negatively associated with infant's development of social behavior [β (95%CI):-2.42 (-4.71, -0.12)]. The post-stratification analysis by infant age revealed that the serum BPA level in pregnancy was only negatively associated with the development of language and social behavior developmental quotient scores in infants between the ages of 12 and 18 months, with β (95%CI) about -6.66 (-13.06, -0.25) and -7.401 (-12.97, -1.83), respectively. Conclusion: BPA exposure during pregnancy affects language and social behavior development in infants, and the detection window is between 12 and 18 months old of the infant.

Abstract 854: An artificial intelligence pipeline for imaging mass cytometry data analysis and its application in ovarian cancer prognostic biomarker discovery

Imaging mass cytometry (IMC) is a powerful platform which enables high-dimensional, single-cell analysis of cell type and state. However, reliable methods used to analyze the IMC data remain to be developed. We seek to build an artificial intelligence (AI)-based analytics pipeline for imaging mass cytometry (IMC) to increase the accuracy of cell segmentation and spatial information extraction and apply the AI pipeline to analyze the IMC data derived from high-grade serous ovarian cancer samples for patient overall survival prediction.

Multiplexed spatial analysis of the tumor microenvironment by IMC was performed on 41 formalin fixed paraffin embedded (FFPE) tissue samples obtained from treatment naïve high- grade serous ovarian cancer patients using a panel of 24 metal-tagged antibodies that are specific to tumor, immune and stromal cell markers. IMC data was collected using a a Helios CyTOF instrument equipped with Hyperion Imaging System (Fluidigm). Mask Region-Convolution Neural Network (Mask R-CNN) model was used for cell segmentation. Cell subtypes were derived by iterative phenograph clustering with different marker combinations and different subsets of cells in each iteration. Tumor area was calculated as a thresholded Gaussian blurred image of the density map of the center-of-mass of Keratin positive tumor cells. All cells with center-of-mass located within the tumor region were classified as intratumoral cells. The average cell composition in the nearest neighborhood of each cell type (distance between the center of mass of two cells &lt; 20 μm) in the tumor cell compartment was computed.

The results showed that cell segmentation by Mask R-CNN has a higher accuracy than traditional watershed segmentation. Significantly more granzymeB+ CD8+ T cells and CD11b+ Vista+ cells were found in long-term survivors comparing to short-term survivors in both tumor and stromal cell compartments of the tumor microenvironment. Additionally, CD196+, CD45RO+ and CD73+ cell densities in the tumor cell compartment were significantly lower in long-term than short-term survivors. Our results also showed that the mean numbers of CD73+ cells adjacent to Vista- CD4+ T cells, macrophages and B cells were significantly lower in long-term than short-term survivors. The mean number of granzymeB+ CD8+ T cells adjacent to Vista- CD4+ T cells was significantly higher in long-term than short-term survivors.

These data demonstrated that the deep learning-based cell segmentation method achieved higher accuracy than the conventional watershed segmentation method. Furthermore, our AI pipeline can automatically extract cell count and cell neighborhood information in tumor. The cell count and neighborhood information could be further employed as features for machine learning to generate predictive biomarkers for ovarian cancer patient survival.

Citation Format: Ying Zhu, Jianting Sheng, Sammy Ferri-Borgogno, Tsz-Lun Yeung, Jared K. Burks, Samuel C. Mok, Stephen T. Wong. An artificial intelligence pipeline for imaging mass cytometry data analysis and its application in ovarian cancer prognostic biomarker discovery [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 854.

Molecular epidemiology of Pseudomonas aeruginosa isolated from lower respiratory tract of ICU patients

Lower respiratory tract infections (LRTIs) caused by Pseudomonas aeruginosa are the most common infection among hospitalized patients, associated with increased levels of morbidity, mortality and attributable health care costs. Increased resistant Pseudomonas worldwide has been quite meaningful to patients, especially in intensive care unit (ICUs). Different species of Pseudomonas exhibit different genetic profile and varied drug resistance. The present study determines the molecular epidemiology through DNA fingerprinting method and drug resistance of P. aeruginosa isolated from patients with LTRIs admitted in ICU. A total of 79 P. aeruginosa isolated from patients with LRTIs admitted in ICU were characterized by Restriction Fragment Length Polymorphism (RFLP), Random Amplified Polymorphic DNA (RAPD) and Repetitive Extrapalindromic PCR (REP-PCR). Antibiotic resistance was determined by minimum inhibitory concentration (MIC) assay while MDR genes, viz, blaTEM, blaOXA, blaVIM, blaCTX-M-15 were detected by polymerase chain reaction (PCR). Of the 137 Pseudomonas sp isolated from ICU patients, 57.7% of the isolates were reported to be P. aeruginosa. The overall prevalence of P. aeruginosa among the all included patients was 34.5%. The RAPD analysis yielded 45 different patterns with 72 clusters with 57% to 100% similarity level. The RFLP analysis yielded 8 different patterns with 14 clusters with 76% to 100% similarity level. The REP PCR analysis yielded 37 different patterns with 65 clusters with 56% to 100% similarity level. There was no correlation among the different DNA patterns observed between the three different methods. Predominant of the isolates (46.8%) were resistant to amikacin. Of the 79 isolates, 60.8% were positive for blaTEM gene and 39.2% were positive for blaOXA gene. P. aeruginosa was predominantly isolated from patients with LRTIs admitted in ICU. The difference in the similarity level observed between the three DNA fingerprinting methods indicates that there is high inter-strain variability. The high genetic variability and resistance patterns indicates that we should continuously monitor the trend in the prevalence and antibiotic resistance of P. aeruginosa especially in patients with LRTIs admitted in ICU.

Systematic Identification of Druggable Epithelial-Stromal Crosstalk Signaling Networks in Ovarian Cancer

Background

Bulk tumor tissue samples are used for generating gene expression profiles in most research studies, making it difficult to decipher the stroma–cancer crosstalk networks. In the present study, we describe the use of microdissected transcriptome profiles for the identification of cancer–stroma crosstalk networks with prognostic value, which presents a unique opportunity for developing new treatment strategies for ovarian cancer.

Methods

Transcriptome profiles from microdissected ovarian cancer–associated fibroblasts (CAFs) and ovarian cancer cells from patients with high-grade serous ovarian cancer (n = 70) were used as input data for the computational systems biology program CCCExplorer to uncover crosstalk networks between various cell types within the tumor microenvironment. The crosstalk analysis results were subsequently used for discovery of new indications for old drugs in ovarian cancer by computational ranking of candidate agents. Survival analysis was performed on ovarian tumor–bearing Dicer/Pten double-knockout mice treated with calcitriol, a US Food and Drug Administration–approved agent that suppresses the Smad signaling cascade, or vehicle control (9–11 mice per group). All statistical tests were two-sided.

Results

Activation of TGF-β-dependent and TGF-β-independent Smad signaling was identified in a particular subtype of CAFs and was associated with poor patient survival (patients with higher levels of Smad-regulated gene expression by CAFs: median overall survival = 15 months, 95% confidence interval [CI] = 12.7 to 17.3 months; vs patients with lower levels of Smad-regulated gene expression: median overall survival = 26 months, 95% CI = 15.9 to 36.1 months, P = .02). In addition, the activated Smad signaling identified in CAFs was found to be targeted by repositioning calcitriol. Calcitriol suppressed Smad signaling in CAFs, inhibited tumor progression in mice, and prolonged the median survival duration of ovarian cancer–bearing mice from 36 to 48 weeks (P = .04).

Conclusions

Our findings suggest the feasibility of using novel multicellular systems biology modeling to identify and repurpose known drugs targeting cancer–stroma crosstalk networks, potentially leading to faster and more effective cures for cancers.

Association between Skeletal Muscle Strength and Dysphagia among Chinese Community-Dwelling Elderly Adults

OBJECTIVES

Swallowing disorder is a health burden for the elderly in China. This study aimed to investigate the prevalence of dysphagia and to test the association between skeletal muscle strength and swallowing problems among community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

Community-dwelling Chinese elderly in China.

PARTICIPANTS

3361 adults aged 65 years or above were involved, among which 1740 (51.8%) were female, with average age of 72.64 (Standard deviation, SD=6.10) years old.

MEASUREMENTS

Handgrip strength (HGS) was used to evaluate skeletal muscle strength. Dysphagia assessment was performed using the Eating Assessment Tool-10 (EAT-10) and the 30mL water swallow test (WST). Binary logistic regression was used to evaluate the relationship between skeletal muscle strength and dysphagia, and covariates as age, gender, material status, etc. were adjusted.

RESULTS

The prevalence of dysphagia were 5.5% and 12.9%, screened by EAT-10 and 30mL WST respectively. Participants with dysphagia showed lower HGS (21.73 ± 9.20 vs. 25.66 ± 11.32, p<0.001, by EAT-10; 20.26 ± 9.88 vs. 26.22 ± 11.28, p<0.001, by WST). The adjusted model suggested that muscle strength is a protective factor for swallowing disorders (adjusted OR=0.974, 95%CI: 0.950-0.999, by EAT-10; adjusted OR=0.952, 95%CI: 0.933-0.972, by WST). Subgroup analyses of WST found the effects were significant among participants aged in 70-74 years group and ≥75 years group, rather than those aged under 70.

CONCLUSION

Dysphagia was significantly associated with skeletal muscle strength among the community-dwelling elderly population. Effective interventions should be taken to manage the decline of muscle strength for the older adults, especially early prevention before 70 years old.

Abstract A140: Imatinib revives the therapeutics potential of metformin in Ewing sarcoma by attenuating tumor hypoxic response and inhibiting convergent signaling pathways

Background: Ewing sarcoma (EwS) is an aggressive pediatric tumor. The 5-year survival rate for localized disease has increased to 70-75%, attributed to an intensified use of multi-agent cytotoxic chemotherapies. However, severe toxicity and high rate of life-threatening late events are associated with such intensive chemotherapy. In addition, therapy amelioration in patients with metastatic or relapsed disease, whose overall survival is only 20-30%, is an unmet medical need. Metformin has long been perceived to be an attractive therapeutic option for EwS, but hypoxia limits its efficacy as EwS cells were reported to adapt to hypoxia by redefining their transcriptome and acquiring a distinct hypoxic phenotype. We hypothesize that another drug can be combined with metformin to reduce viability of EwS cells and bring forth in vivo efficacy of metformin. Methods: We assembled a pool of fifty-seven anti-EwS drugs reported in the literature and Clinicaltrial.gov and composed a customized drug library in a 96-well plate for drug screening to evaluate synergistic combinations under hypoxia. RNA-seq and reverse-phase protein array were generated and analyzed to delineate the underlying signaling pathways for synergistic combinations founded, followed by xenograft experiments to determine in vivo efficacy and mechanism. Results: Our drug combination screening results indicated the anti-proliferation effect of metformin was significantly enhanced by seven drugs. In particular, imatinib stands out as most potent and has a strong synergy with metformin in inhibiting cell growth on several EwS cell lines, as well as on clinically relevant plasma concentrations. Furthermore, the combination significantly enhances in vitro cell inhibition efficacy of two standard chemotherapeutics drugs, cyclophosphamide and ifosfamide, indicating a potential benefit of lower dosage and better outcomes. In vivo studies on two EwS xenograft mouse models confirmed superior anti-tumor efficacy of the metformin-imatinib combination. Functional evaluation revealed imatinib strikingly reversed the hypoxia-specific transcriptional signature in EwS cells while the drug combination notably induced cell cycle arrest and apoptosis. The drug combination regulated a network of sixty-one signaling molecules and inhibited the activity of PI3K-AKT-mTOR signaling pathway. These genes regulated by drug combination highly correlates with poor clinical outcome of reported clinical data of EwS and sarcoma. Conclusions: The novel drug combination identified revives the potential of metformin in treating EwS by using another known drug, imatinib, to attenuate tumor hypoxic response through a systematic integration of drug combination screening, bioinformatics studies, functional and in vivo validations, and clinical outcome correlation. The combination may also apply to localized disease to reduce adverse side effects of intensive cytotoxic chemotherapy.

Citation Format: Xiang Nan, Jiang Wang, Jianting Sheng, Ching C. Lau, Jason T. Yustein, Hong Zhao, Stephen Wong. Imatinib revives the therapeutics potential of metformin in Ewing sarcoma by attenuating tumor hypoxic response and inhibiting convergent signaling pathways [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A140. doi:10.1158/1535-7163.TARG-19-A140

Differential Contributions of Pre- and Post-EMT Tumor Cells in Breast Cancer Metastasis

Metastases are responsible for the majority of breast cancer-associated deaths. The contribution of epithelial-to-mesenchymal transition (EMT) in the establishment of metastases is still controversial. To obtain in vivo evidence of EMT in metastasis, we established an EMT lineage tracing (Tri-PyMT) model, in which tumor cells undergoing EMT would irreversibly switch their fluorescent marker from RFP⁺ to GFP⁺ due to mesenchymal-specific Cre expression. Surprisingly, we found that lung metastases were predominantly derived from the epithelial compartment of breast tumors. However, concerns were raised on the fidelity and sensitivity of RFP-to-GFP switch of this model in reporting EMT of metastatic tumor cells. Here, we evaluated Tri-PyMT cells at the single-cell level using single-cell RNA-sequencing and found that the Tri-PyMT cells exhibited a spectrum of EMT phenotypes, with EMT-related genes concomitantly expressed with the activation of GFP. The fluorescent color switch in these cells precisely marked an unequivocal change in EMT status, defining the pre-EMT and post-EMT compartments within the tumor. Consistently, the pre-EMT cells played dominant roles in metastasis, while the post-EMT cells were supportive in promoting tumor invasion and angiogenesis. Importantly, the post-EMT (GFP⁺) cells in the Tri-PyMT model were not permanently committed to the mesenchymal phenotype; they were still capable of reverting to the epithelial phenotype and giving rise to secondary tumors, suggesting their persistent EMT plasticity. Our study addressed major concerns with the Tri-PyMT EMT lineage tracing model, which provides us with a powerful tool to investigate the dynamic EMT process in tumor biology. SIGNIFICANCE: These findings confirm the fidelity and sensitivity of the EMT lineage tracing (Tri-PyMT) model and highlight the differential contributions of pre- and post-EMT tumor cells in breast cancer metastasis.See related commentary by Bunz, p. 153.

Anticancer Immunotherapy by MFAP5 Blockade Inhibits Fibrosis and Enhances Chemosensitivity in Ovarian and Pancreatic Cancer

PURPOSE

Recent studies demonstrate the role of the tumor microenvironment in tumor progression. However, strategies used to overcome the malignant phenotypes of cancer cells modulated by the microenvironment have not been thoroughly explored. In this study, we evaluated the therapeutic efficacy of a newly developed mAb targeting microfibril-associated protein 5 (MFAP5), which is secreted predominately by cancer-associated fibroblast (CAF), in ovarian and pancreatic cancer models.Experimental Design: MAbs were developed using human MFAP5 recombinant protein as an antigen in mice, and antibodies from hybridoma clones were evaluated for their specificity to human and murine MFAP5. An Octet RED384 system was used to determine the kinetics of binding affinity and the specificity of the antibody clones, which were followed by epitope mapping and functional characterization by in vitro assays. The therapeutic efficacy of a lead anti-MFAP5 antibody clone 130A in tumor suppression was evaluated by ovarian tumor- and pancreatic tumor-bearing mouse models.

RESULTS

Three hybridoma clones, which produced antibodies with high affinity and specificity to MFAP5, were selected for functional studies. Antibody clone 130A, which recognizes a common epitope shared between human and murine MFAP5 protein, was further selected for in vivo studies. Results showed that clone 130A downregulated MFAP5-induced collagen production in CAFs, suppressed intratumoral microvessel leakiness, and enhanced paclitaxel bioavailability in both ovarian and pancreatic cancer mouse models.

CONCLUSIONS

These data suggest that MFAP5 blockade using an immunologic approach inhibits fibrosis, induces tumor vessel normalization, and enhances chemosensitivity in ovarian and pancreatic cancer, and can be used as a novel therapeutic agent.

Histological study of intestinal goblet cells, IgA, and CD3+ lymphocyte distribution in Huang-huai white goat

BACKGROUND

Ten healthy adult Huang-huai white goats were selected and sacrificed by jugular vein bleeding after anaesthesia to observe the distribution characteristics of the histological structure of the intestinal mucosa, goblet cells, IgA, and CD3+ lymphocytes.

MATERIALS AND METHODS

Three sections of the duodenum, the jejunum, and the ileum were immediately collected and fixed with 4% paraformaldehyde for 72 h to prepare tissue sections. After haematoxylin and eosin, periodic acid Schiff, and immunohistochemical staining was performed, the distribution characteristics of goblet cells, IgA-positive cells, and CD3+ lymphocytes were observed. Results showed high columnar epithelial cells in the duodenum and jejunum of Huang-huai white goat and low columnar epithelial cells in the ileum mucosa.

RESULTS

Mucopolysaccharides secreted by intestinal goblet cells were mainly neutral, and the number of ileum goblet cells was significantly higher than that of the duodenum and the jejunum (p < 0.05). IgA-positive cells were distributed in the lamina propria of the duodenum, and the number of cells was significantly higher than that in the jejunum and the ileum (p < 0.01). The significant difference was found between the jejunum and the ileum (p < 0.01). The CD3+ cells in the intestinal mucosa were distributed in the lamina propria mucosae, and some of the positive cells in the jejunum were distributed between epithelial cells. CD3+ cells had the largest number in the jejunal lamina propria but had the lowest number in the ileum.

CONCLUSIONS

The jejunum was significantly higher than the duodenum (p < 0.05), and the ileum was much less than the jejunum (p < 0.01).

Abstract 3563: Exosomal transfer of tumor-associated macrophage derived miR-6068 promote ovarian cancer progression

Ovarian cancer, especially high-grade serous ovarian cancer (HGSOC), is the deadliest gynecological cancer with 50-70% 5-year mortality rates. Every year more than 22,000 new cases of ovarian cancer and 15,000 deaths are anticipated within the United States only. Recent clinical and experimental evidence indicates that tumor-associated macrophages (TAMs), the most abundant cells in the tumor microenvironment, play a significant role in tumor growth and progression by contributing to angiogenesis, invasion, metastasis, and drug resistance, leading to poor clinical outcomes and significantly shorter patient survival in HGSOC. More than 50% of cells in the peritoneal tumor microenvironment and malign ascites consist of TAMs in ovarian cancer (OC) patients. Especially, M2 macrophages have been shown to support tumor proliferation and promote tumor progression, angiogenesis, and drug resistance. But the mechanisms of these oncogenic effects are still not clear. The goal of our study to investigate the role of TAM-derived exosomes, which are 30-100nm microvesicles released from cells and are key factors in communication between cancer cells and the tumor microenvironment. To this end, we evaluated differentially expressed miRNAs in high-grade ovarian cancer cells (OVCAR3, OVCAR 432 and OVCAR5) after treatment with exosomes-derived from TAMs (M2 phenotype) using the Affymetrix Gene Chip miRNA 4.0 microarrays. We identified several miRNAs, including miR-6068 that we validated by qPCR and found it to be significantly upregulated in both HGSOC cells and their exosomes. We demonstrated that transfection of HGSOC cells with miR-6068 significantly increased proliferation, migration and invasion capacities of the cells in vitro, suggesting that this miR-6068 act as an oncogenic miR (oncomiR). Using in silico prediction algorithms we found that miR-6068 has binding sites on the 3’-untranslated region (3’-UTR) of PTPN4 gene encoding a phosphatase and demonstrated that it miR-6068 suppresses PTPN4 expression by Western blot and qPCR. Inhibition of PTPN4 by siRNA significantly induced cell proliferation in OC cells, suggesting that PTPN4 acts as a tumor suppressor. In conclusion, our results suggest that miR-6068 has an oncogenic role in ovarian cancer progression by targeting PTPN4 and may be a novel effective therapeutic target for ovarian cancer.

Citation Format: Seyda Baydogan, Jianting Sheng, Nermin Kahraman, Pinar Kanlikilicer, Hamada Ahmed Mokhlis, Sayra Dilmac, Stephen T. C. Wong, Bulent Ozpolat. Exosomal transfer of tumor-associated macrophage derived miR-6068 promote ovarian cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3563.

[Association between early pregnancy bisphenol A exposure and sleep problems among preschool children]

Objective: To analyze the association between maternal bisphenol A exposure during early pregnancy and sleep problems among preschool children. Methods: Research subjects were from one of the sub-cohorts(Ma'anshan Cohort) of the China-Anhui Birth Cohort Study (C-ABCS) in Ma'anshan city. The basic situation of pregnant women and sleep information of preschool children were investigated. We selected preschool children whose mother's maternal serum bisphenol A concentrations of the first trimester had been already detected between December 2012 to Januray 2014. 1 259 pairs of mothers and children were included. The concentrations of bisphenol A exposure during early pregnancy were divided into low, medium and high exposure groups according to 25(th) percentile (P(25)) and 75(th) percentile (P(75)) levels. Multivariate multinomial logistic regression model was used to analyze the association between maternal bisphenol A exposure during early pregnancy and sleep-related problems in preschool children. Results: The P(50) (P(25)-P(75)) of serum bisphenol A exposure level during early pregnancy was 0.231 (0.106-0.512) ng/ml. The sleep-related problems scores of 1 259 preschool children were (16.43±3.82) points. The occasional sleep-related problems were detected about 47.8% (602 cases) and frequent sleep-related problems were detected about 18.3% (230 cases). After the adjustment of the confounding factors such as children's gender, age, BMI, sleep position (lying down, sleeping on one's back), the length of time to sleep and the length of sleep at night, in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool children with occasional sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 1.44 (1.01-2.06). After the gender stratification, the results showed that in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool girls with occasional sleep-related problems in maternal bisphenol A medium and high exposure group during early pregnancy were 1.61 (1.05-2.46) and 2.40 (1.42-4.04), respectively. The OR (95%CI) value of preschool girls with frequent sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 2.64 (1.34-5.17). However, in boys, there was no statistically significant association between maternal bisphenol A exposure during early pregnancy and sleep-related problems (P>0.05). Conclusion: Maternal bisphenol A exposure during early pregnancy might be related to sleep-related problems in preschool children.

Abstract 2096: Multicellular modeling and identification of protein ligand-mediated and exosome-mediated crosstalk signaling cascades in the heterogeneous ovarian tumor microenvironment

Ovarian cancer is the most lethal gynecologic malignancy in the US. While research efforts have been dedicated to identify disease related genes and mutations in cancer cells, the stroma-tumor interactions in the tumor microenvironment and their roles in disease progression is relatively unexplored. The identification of stroma-tumor crosstalk networks with prognostic value presents a unique opportunity for developing new treatment strategies. To capture such an opportunity, a multicellular computational modeling platform, the Cell-Cell Communication Explorer (CCCExplorer), has been developed to identify novel ligand- and exosome-mediated crosstalk networks among different cell types within tumor microenvironment.

With transcriptome profiling data generated from laser microdissected ovarian cancer cells and cancer associated fibroblasts (CAFs) in high-grade serous ovarian caner tissue as inputs, CCCExplorer identified TGF-β–dependent and TGF-β–independent Smad signaling networks as protein ligand-mediated crosstalk signaling cascades activated in CAFs associated with poor patient survival rates. Validation studies by co-culturing ovarian cancer cells with CAFs indicated that activation of Smad signaling in CAFs promoted aggressive phenotypes of ovarian cancer cells while inhibition of Smad signaling in CAFs suppressed ovarian cancer progression both in vitro and in vivo. On the other hand, CCCExplorer used transcriptome data generated from exosomes isolated from CAFs and normal fibroblasts (NFs) as well as from CAF- and NF-derived exosomes treated ovarian cancer cells to compute and predict crosstalk cascades mediated by fibroblast-derived exosomes. Our results showed that CAF-derived exosomal microRNAs and LncRNAs promoted signaling cascade activation and the subsequent increase of chemoresistance, motility and proliferation in ovarian cancer cells. After functional validation of predicted crosstalk cascades, CCCExplorer can further be used to query underlying drug information databases to identify and rank candidate drug agents that could target cancer progression-associated crosstalk between ovarian cancer cells and CAFs.

Our findings demonstrate a powerful tool at the multi-cellular level of heterogeneous tumor microenvironment in which a computational platform can be used to understand, model, visualize, predict, and target crosstalk signaling cascades and coarse-grained behavior of heterogeneous tumor microenvironment. We are applying CCCExplorer to uncover activated crosstalk networks among ovarian cancer cells and stromal cells and to discover drug compounds targeting these pathways, potentially leading to faster cures for ovarian cancer after the validation and confirmation using in vitro and in vivo models.

Citation Format: Tsz-Lun Yeung, Jianting Sheng, Samuel C. Mok, Stephen T. C. Wong. Multicellular modeling and identification of protein ligand-mediated and exosome-mediated crosstalk signaling cascades in the heterogeneous ovarian tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2096.

Dual Suppressive Effect of miR-34a on the FOXM1/eEF2-Kinase Axis Regulates Triple-Negative Breast Cancer Growth and Invasion

Purpose: Recent studies indicated that dysregulation of noncoding RNAs (ncRNA) such as miRNAs is involved in pathogenesis of various human cancers. However, the molecular mechanisms underlying miR-34a are not fully understood in triple-negative breast cancer (TNBC).Experimental Design: We performed in vitro functional assays on TNBC cell lines to investigate the role of miR-34a in FOXM1/eEF2K signaling axis. TNBC tumor xenograft models were used for in vivo therapeutic delivery of miR-34a.Results: In this study, we investigated the role of p53-driven ncRNA miR-34a and found that miR-34a is associated with significantly longer patient survival in TNBC and inversely correlated with levels of proto-oncogenic eEF2K, which was associated with significantly shorter overall patient survival. We showed that miR-34a directly binds to the 3'-untranslated region of eEF2K and FOXM1 mRNAs and suppresses their expression, leading to inhibition of TNBC cell proliferation, motility, and invasion. Notably, restoring miR-34a expression recapitulated the effects of inhibition of eEF2K and FOXM1, the transcription factor for eEF2K and the direct target of p53, in TNBC cell lines, whereas overexpression of eEF2K and FOXM1 rescued the effects and signaling pathways mediated by miR-34a. Moreover, in vivo therapeutic delivery of miR-34a nanoparticles by systemic intravenous administration delayed tumor growth of two different orthotopic TNBC tumor xenograft models by inhibiting eEF2K and FOXM1, intratumoral proliferation and angiogenesis, and inducing apoptosis.Conclusions: Overall, our findings provide new insights into the tumor suppressor role of miR-34a by dual-targeting of FOXM1/eEF2K signaling axis and suggest that miR-34a-based gene therapy may be a potential therapeutic strategy in TNBC. Clin Cancer Res; 24(17); 4225-41. ©2018 AACR.

Targeting Brain-Adaptive Cancer Stem Cells Prohibits Brain Metastatic Colonization of Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) exhibits more traits possessed by cancer stem cells (CSC) than other breast cancer subtypes and is more likely to develop brain metastases. TNBC patients usually have shorter survival time after diagnosis of brain metastasis, suggesting an innate ability of TNBC tumor cells in adapting to the brain. In this study, we establish novel animal models to investigate early tumor adaptation in brain metastases by introducing both patient-derived and cell line-derived CSC-enriched brain metastasis tumorsphere cells into mice. We discovered astrocyte-involved tumor activation of protocadherin 7 (PCDH7)-PLCβ-Ca2+-CaMKII/S100A4 signaling as a mediator of brain metastatic tumor outgrowth. We further identified and evaluated the efficacy of a known drug, the selective PLC inhibitor edelfosine, in suppressing the PCDH7 signaling pathway to prohibit brain metastases in the animal models. The results of this study reveal a novel signaling pathway for brain metastases in TNBC and indicate a promising strategy of metastatic breast cancer prevention and treatment by targeting organ-adaptive cancer stem cells.Significance: These findings identify a compound to block adaptive signaling between cancer stem cells and brain astrocytes. Cancer Res; 78(8); 2052-64. ©2018 AACR.

[Association between the internal exposure levels of phthalates and executive function of preschool children]

Objective: To investigate the association between the internal exposure levels of phthalic acid esters (PAEs) and executive function (EF) of preschool children. Methods: Between October 2008 and October 2010, pregnant women who accepted pregnancy health care services in four municipal medical and health institutions in Ma'anshan city, Anhui Province, were recruited as study objects. A total of 5 084 pregnant women and 4 669 singleton live births were enrolled in this cohort. The follow-up study was conducted from April 2014 to April 2015. A total of 3 725 data-completed preschool children aged 3 to 6 years older entered in this study. The method of analysis seven metabolites of phthalates in urine was high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and divided objects into low (P(0)-P(24)), medium (P(25)-P(74)) and high (P(75)-P(100)) groups according to their exposure concentrations. To investigate the executive function of preschool children, we used the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Univariate and multivariate statistical method was used to analyze the etiology association between the phthalate metabolites levels and preschool children's executive function. Results: In this study, 53.6% (1 997/3 725) of preschoolers were boys, children's age was (51.5±5.6) months. The detection rates of seven phthalate esters were: mono-n-methyl phthalate (MMP) was 99.89% (3 721/3 725); mono-ethyl phthalate (MEP) was 99.97% (3 724/3 725); mono-benzyl phthalate (MBzP) was 69.10% (2 574/3 725); mono-butyl phthalate (MBP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono- (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) were 100.00% and mono-ethylhexyl phthalate (MEHP) was 99.95% (3 723/3 725). The median concentrations of the seven phthalate metabolites were: 17.71, 15.36, 0.07, 155.24, 10.73, 14.67, 3.59 µg/L, respectively. The median concentrations corrected by urinary creatinine were 29.65, 26.65, 0.12, 257.73, 17.94, 24.80, 6.27 µg/g Cr, respectively. The P(25) and P(7)5 concentration of the total PAEs metabolites corrected by urinary creatinine were 1.20 µmol/g Cr and 3.04 µmol/g Cr. After adjusted the relevant demographic information: children sex, children age in month, maternal age, parental education levels, household exposure to secondhand smoke and whether the child is the only child as confounds, multivariate logistic regression model showed that the risk of inhibitory self-control index (ISCI) dysplasia in MEHHP high concentration group and MEOHP high concentration group were 1.71 and 1.54 times (OR=1.71, 95% CI: 1.11-2.62; OR=1.54, 95% CI: 1.01-2.34) than in low concentration group. The risk of ISCI dysplasia in total PAEs metabolites high concentration group was 1.55 times (OR=1.55, 95% CI: 1.00-2.38) than in low concentration group. Conclusion: Phthalates exposure may damage the executive function of preschool children.

Interpretation of liver stiffness measurement-based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2-year prospective study

Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan^® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen-positive treatment-naive patients receiving telbivudine-based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (-2.2 kPa/24 weeks) in parallel with alanine aminotransferase (ALT) from 8.6 (2.6-49.5) kPa at baseline to 6.1 (2.2-37.4) kPa at week 24. Interestingly, liver stiffness decreased slowly (-0.3 kPa/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kPa, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0-2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52-week liver stiffness from baseline was independently associated with 104-week liver fibrosis regression (odds ratio, 3.742; P = .016). Early decline of 52-week liver stiffness from baseline may reflect the remission of both liver inflammation and fibrosis and was predictive of 104-week fibrosis regression in treated patients with chronic hepatitis B.

[Surgical treatment of intractable odontoid fracture with atlantoaxial dislocation in children with spinal cord injury]

Objective: To discuss the surgical treatment and its effectiveness of odontoid fracture complicated with atlantoaxial dislocation in children with spinal cord injury. Methods: From January 2010 to December 2014, 10 cases of children under 14 years old, with intractable odontoid fracture with atlantoaxial dislocation were enrolled. The mean duration between injury and admission was 8.5 d (range 1-30 d). The surgery was performed using posterior reduction and internal fixation or anterior release combined with posterior fixation. The medical date including preoperative and postoperative neurological function, degree of reduction and fusion. Results: All cases were followed-up for 12-48 months. The last follow-up X ray and CT examinations showed good reduction and fusion. No fixation failure was observed among all the patients. According to the Frankel, the preoperative neurological function was C in 2 cases, D in 4 cases, and E in 4 cases. At the last follow-up, out of 2 cases with Frankel C improved to D, and the other 8 cases were back to normal. Conclusions: Diagnosis of odontoid fracture complicated with atlantoaxial dislocation is usually delayed in children. One-stage posterior reduction and internal fixation or anterior release combined with posterior fixation is an effective and safe surgical procedure for such cases.

Abstract P6-12-21: Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population

Background: Survivorship care plans (SCPs) are strongly recommended for all breast cancer survivors to address sequelae of cancer care, plan cancer surveillance and screening, and encourage health promotion and care coordination. Ongoing studies are evaluating the impact of SCPs in cancer survivor populations and the role of survivorship visits (SVs) as an intervention. Here we describe characteristics and outcomes of patients who participated in SVs at Johns Hopkins (JH).

Methods: We retrospectively reviewed the charts of patients who participated in a SV with one of two nurse practitioners ˜1-3 months after completion of locoregional therapy and initial systemic therapy, as referred by their JH breast cancer provider. We collected patient demographics, comorbidity status, tumor characteristics, treatments received, and responses to GAD7 (generalized anxiety disorder 7-item), PHQ9 (patient health questionnaire-9), and a symptom questionnaire. Characteristics of SV participants were compared to analytical breast cancer cases from the JH Cancer Registry (JHCR 2010-2015), matched for stage.

Results: 87 women (stages I-III) who participated in a SV in 2010-2016 were identified. Compared to patients in the JHCR (n=2,942), the SV cohort was younger (age ≤50, 43% v 34%, p=0.14), more likely to be African American (33% v 22%, p=0.04), and more likely to have a higher TNM stage (I, 26% v 49%; II, 48% v 37%; III, 25% v 15%, p&lt;0.001), node-positive status (60% v 33%, p&lt;0.001), hormone receptor-negative disease (44% v 18%, p&lt;0.001), and HER2-positive disease (38% v 14%, p&lt;0.001). The SV cohort was also more likely to receive chemotherapy (94% v 43%, p&lt;0.001) and undergo radiation therapy (78% v 54%, p&lt;0.001). The SV cohort had a higher recurrence event rate than the JHCR cohort (11.5% v 8.0%) and a shorter median follow-up (886 v 1292 days), suggestive of a higher risk profile. In the SV cohort, a comparison of comorbidities at breast cancer diagnosis versus time of SV visit identified a significant increase in the prevalence of peripheral neuropathy (9% v 73%, p&lt;.001), anemia (15% v 50%, p&lt;.001), lymphedema (0% v 28%, p&lt;.001), anxiety (15% v 38%, p&lt;.001), and depression (13% v 29%, p&lt;.001). Patients in the SV cohort were overweight at diagnosis (body mass index, median 29 [IQR 24, 32]). At the time of the SV, patients reported symptoms of sleep difficulty (53%), numbness or tingling (46%), weight changes (45%), muscle aches (44%), and pain (37%).

Conclusions: Patients who participated in SVs had high-risk cancers and, compared to baseline, a higher frequency of comorbidities that are potentially associated with breast cancer and its treatment. These data can inform future breast cancer survivorship care models as they describe a population that may be at greater risk for worse cancer and non-cancer outcomes, and that might benefit more from interventions like SCPs and SVs. Ongoing studies are identifying optimal target populations, appropriate timing of such interventions, and informative measures of patient-centered outcomes.

Funding: Komen Maryland/Komen Scholar SAC110053 (ACW).

Citation Format: Skuli SJ, Bantug ET, Zafman N, Riley C, Ruck JM, Sheng J, Smith KC, Snyder CF, Smith KL, Stearns V, Wolff AC. Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-21.

The impact of isolated maternal hypothyroxinaemia on the incidence of large-for-gestational-age infants: the Ma'anshan Birth Cohort study

OBJECTIVE

The purpose of this study was to investigate whether isolated maternal hypothyroxinaemia (IMH) is associated with risks of small/large-for-gestational-age (SGA/LGA) infants.

DESIGN

Population-based prospective cohort study.

SETTING

Ma'anshan Maternal and Child Health (MCH) clinics, China.

POPULATION

Pregnant women with singleton births (n = 3178).

METHODS

Descriptive statistics were calculated for the demographic characteristics of the mothers and their newborns. Linear regression was applied to estimate the association between thyroid hormone levels and birthweight. Logistic regression was performed to calculate the association between IMH and SGA/LGA.

MAIN OUTCOME MEASURES

Outcomes included SGA/LGA.

RESULTS

The prevalence of IMH, defined as a free thyroxine value (FT4) lower than the 2.5th percentile with normal thyroid stimulating hormone, was 2.5% (78/3080) and 2.5% (74/2999) in the first and second trimesters, respectively. Additionally, 306 (9.6%) and 524 (16.5%) infants were defined as SGA and LGA, respectively. No evidence supported the notion that IMH is associated with an increased risk for SGA in either the first [odds ratio (OR): 1.762, 95% confidence interval (CI): 0.759-4.089] or the second (OR: 0.763, 95% CI: 0.231-2.516) trimester. However, an increased risk of LGA was observed among IMH women in the second trimester (OR: 2.088, 95% CI: 1.193-3.654). Maternal TPO-Ab positivity in the second trimester increased the risk of SGA (OR: 2.094, 95% CI: 1.333-3.290).

CONCLUSION

This study provides evidence that IMH is associated with LGA.

FUNDING

This work was supported by the National Natural Science Foundation of China (No. 81330068).

TWEETABLE ABSTRACT

Isolated maternal hypothyroxinaemia may increase the risk of large-for-gestational-age infants.