COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

BACKGROUND

Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19.

OBJECTIVE

To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients.

METHODS

In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed.

RESULTS

CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality.

CONCLUSION

Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study

BACKGROUND

Amivantamab plus carboplatin-pemetrexed (chemotherapy) with and without lazertinib demonstrated antitumor activity in patients with refractory epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC) in phase I studies. These combinations were evaluated in a global phase III trial.

PATIENTS AND METHODS

A total of 657 patients with EGFR-mutated (exon 19 deletions or L858R) locally advanced or metastatic NSCLC after disease progression on osimertinib were randomized 2 : 2 : 1 to receive amivantamab-lazertinib-chemotherapy, chemotherapy, or amivantamab-chemotherapy. The dual primary endpoints were progression-free survival (PFS) of amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy. During the study, hematologic toxicities observed in the amivantamab-lazertinib-chemotherapy arm necessitated a regimen change to start lazertinib after carboplatin completion.

RESULTS

All baseline characteristics were well balanced across the three arms, including by history of brain metastases and prior brain radiation. PFS was significantly longer for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy [hazard ratio (HR) for disease progression or death 0.48 and 0.44, respectively; P < 0.001 for both; median of 6.3 and 8.3 versus 4.2 months, respectively]. Consistent PFS results were seen by investigator assessment (HR for disease progression or death 0.41 and 0.38 for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy, respectively; P < 0.001 for both; median of 8.2 and 8.3 versus 4.2 months, respectively). Objective response rate was significantly higher for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (64% and 63% versus 36%, respectively; P < 0.001 for both). Median intracranial PFS was 12.5 and 12.8 versus 8.3 months for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (HR for intracranial disease progression or death 0.55 and 0.58, respectively). Predominant adverse events (AEs) in the amivantamab-containing regimens were hematologic, EGFR-, and MET-related toxicities. Amivantamab-chemotherapy had lower rates of hematologic AEs than amivantamab-lazertinib-chemotherapy.

CONCLUSIONS

Amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy improved PFS and intracranial PFS versus chemotherapy in a population with limited options after disease progression on osimertinib. Longer follow-up is needed for the modified amivantamab-lazertinib-chemotherapy regimen.

Pre-processing Applied to Instrumental Data in Analytical Chemistry: A Brief Review of the Methods and Examples

The field of analytical chemistry has been significantly advanced by the availability of state-of-the-art instrumentation, allowing for the development of novel applications in this field. However, in many cases, the direct interpretation of the recorded data is often not straightforward, hence some level of pre-processing is required (e.g., baseline correction, derivatives, normalization, smoothing). These techniques have become a critical first step for the successful analysis of the data recorded, and it is recommended to use them before the application of chemometrics (e.g., classification, calibration development). The aim of this paper is to provide with an overview of the most used pre-processing methods applied to instrumental analytical methods (e.g., spectroscopy, chromatography). Examples of their application in near infrared and UV-VIS spectroscopy as well as in gas chromatography will be also discussed. Overall, this paper provides with a comprehensive understanding of pre-processing techniques in analytical chemistry, highlighting their importance during the analysis and interpretation of data, as well as during the development of accurate and reliable chemometric models.

Molecular imaging of experimental atherosclerosis using anti-malondialdehyde-modified low-density lipoprotein humanised antibody fragment targeted nanoparticles

Introduction

Oxidative modification of low-density lipoprotein (LDL), for example by malondialdehyde (MDA) adduction with subsequent uptake by macrophages to form foam cells and later the plaque necrotic core, is a key initiating event in atherogenesis. Accordingly, a larger lipid necrotic core is a key plaque vulnerability factor, predisposing plaques to rupture and subsequent thrombosis and development of an acute coronary syndrome. Thus, MDA-LDL is an attractive focus for the molecular targeting of atherosclerotic plaques.

Purpose

To develop antibody fragment-targeted nanoparticles that can be utilised for both the molecular imaging and therapeutics of vulnerable atherosclerotic plaques.

Methods

LO1 is an IgG3k natural monoclonal murine antibody that reacts with MDA-LDL. Humanised LO1Fab fragments have been engineered to reduce immunogenicity and improve lesion penetration. These humanised LO1Fab fragments were used to functionalise fluorescent poly(lactic-co-glycolic acid) (PLGA) - polyethylene glycol (PEG) nanoparticles. Nanoparticle in vitro function was assessed, prior to fluorescence molecular tomography (FMT) co-registered with micro-CT, four-hours after iv injection in atherosclerotic LDL-receptor−/− mice fed a high-fat diet for 40-weeks.

Results

Humanised LO1Fab fragment conjugated fluorescent PLGA-PEG nanoparticles were formulated with 210nm size and polydispersity index (variability of nanoparticle size around the average) of &lt;0.2. Antibody conjugation efficiency was 30%. In vitro function was confirmed on ELISA versus the blank untargeted nanoparticles with MDA-LDL on solid phase, detecting nanoparticle presence via the conjugated LO1Fab, PEG corona or fluorescence. Fluorescence microscopy on stained aortic root cryosections from atherosclerotic mice confirmed binding to fatty lesions. Construct in vivo in half-life was 90-minutes for both the targeted and untargeted nanoparticles in a two-phase model in LDL-receptor−/− mice, based on fluorescence analysis of serial tail vein blood samples. There was greater uptake in the region-of-interest (heart and aortic arch vessels) in mice injected with LO1Fab-conjugated nanoparticles versus untargeted nanoparticles (mean ± standard deviation) (64.7±22.9 versus 25.2±26.5pmol of Cy5; n=7; p=0.02). Ex vivo analysis fluorescence reflectance imaging and quantitative FMT of the extracted aortae confirmed these findings (1.0±0.3 versus 0.5±0.2pmol of Cy5; n=7; p=0.002; Figure 1).

Conclusions

Humanised antibody Fab fragment fluorescent nanoparticles have been developed that successfully target MDA-LDL and localise to atherosclerotic plaques in murine experimental atherosclerosis. These targeted nanoparticles have the potential to amplify fluorescent signal for imaging and carry a therapeutic cargo for targeted drug delivery direct to atherosclerotic plaques.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Wellcome Trust Clinical Research Fellowship

Projecting the effect of climate change on residential property damages caused by extreme weather events

New Zealand's public insurer for natural hazards, the Earthquake Commission (EQC), provides residential insurance for some weather-related damage. Climate change and the expected increase in intensity and frequency of extreme weather-related events are likely to translate into higher damages and thus an additional financial liability for the EQC. We project future insured damages from extreme precipitation events associated with future projected climatic change. We first estimate the empirical relationship between extreme precipitation events and the EQC's weather-related insurance claims based on a complete dataset of all claims from 2000 to 2017. We then use this estimated relationship, together with climate projections based on future greenhouse gases concentration scenarios from six different dynamically downscaled Regional Climate Models, to predict the impact of future extreme precipitation events on EQC liabilities for different time horizons up to the year 2100. Our results show predicted adverse impacts that vary over time and space. The percent change between projected and past damages-the climate change signal-ranges between an increase of 7%-8% in liabilities for the period 2020 to 2040, and between 9% and 25% higher for the period 2080 to 2100. We also provide detail caveats as towhy these quantities might be mis-estimated. The projected increase in the public insurer's liabilities could also be used to inform private insurers, regulators, and policymakers who are assessing the future performance of both the public and private insurers that cover weatherrelated.

TNF-derived peptides inhibit tumour growth and metastasis through cytolytic effects on tumour lymphatics

Tumour necrosis factor (TNF) is a multi-functional cytokine with profound and diverse effects on physiology and pathology. Identifying the molecular determinants underlying the functions and pathogenic effects of TNF is key to understanding its mechanisms of action and identifying new therapeutic opportunities based on this important molecule. Previously, we showed that some evolutionarily conserved peptides derived from TNF could induce cell death (e.g. apoptosis and/or necrosis), a feature of immune defence mechanisms shared by many vertebrates. In this study, we demonstrated that necrosis-inducing peptide P16 kills human glioblastoma cancer cells and primary human hepatoma or renal cancer cells isolated from patients who had not responded to standard treatments. Importantly, we show that the necrosis-inducing peptide P1516 significantly improves survival by inhibiting tumour metastasis in a 4T1 breast cancer syngeneic graft mouse model. Because the lymphatic system is an important metastatic route in many cancers, we also tested the effect of TNF-derived peptides on monolayers of primary human lymphatic endothelial cells (hDLEC) and found that they increased junctional permeability by inducing cytoskeletal reorganization, gap junction formation and cell death. Transmission electron microscopy imaging evidence, structural analysis and in-vitro liposome leakage experiments strongly suggest that this killing is due to the cytolytic nature of these peptides. P1516 provides another example of a pro-cytotoxic TNF peptide that probably functions as a cryptic necrotic factor released by TNF degradation. Its ability to inhibit tumour metastasis and improve survival may form the basis of a novel approach to cancer therapy.

Abstract P2-01-08: The potential role of CTNND1 (catenin (cadherin-associated protein), Delta 1) in breast cancer bone metastasis

Background:

The bone is a frequently visited site by breast cancer cells. Most women who die of metastatic breast cancer would already have bone metastases, whether they are micro- or macro-metastases. Metastatic bone metastasis from breast cancer is mostly osteolytic, with reasons unclear and little in vitro and in vivo studies exploring the osteolytic nature of bone metastasis. In the present study, we investigated the potential role of CTNND1, Catenin (Cadherin-Associated Protein) Delta 1, in the context of bone metastasis of breast cancer.

Materials and Methods:

In order to identify potential genes involved in bone metastasis, we established a novel in vitro model named Bone Matrix Extract (BME) which was extracted from human femur and used to mimic the bone environment. Full profile of gene expression in response to BME was conducted using Ampliseq technology. Potential genes associated with bone metastasis was examined in a clinical breast cohort containing both cancer and normal tissues (n = 103), collected immediately following surgery. Gene transcript levels were quantified using QPCR and analysed against patient's pathological information and clinical outcome. We generated a series of cell models by knocking down and over-expressing one of the most relevant genes, CTNND1, using siRNA, sh-RNA, ribozyme transgenes and insertion of full coding sequence containing plasmids. Function assays including Matrigel based-adhesion, cancer cell-osteobalstic cell contact, proliferation, transwell invasion and migration were used to investigate the changes of biological features after interfering with CTNND1 expression in relation to BME / co-culture models.

Results:

CTNND1 was down regulated in all breast epithelial cells following BME treatment at both mRNA and protein level. From the clinical cohort, we found that compared with benign tissue, breast cancer tissues had significantly decreased CTNND1 transcript expression. Reduced CTNND1 was associated with advanced TNM stage and poor distant metastasis, local recurrence and bone metastasis. We went on to knockdown CTNND1 by siRNA, ribozyme as well as lenti-shCTNND1 transfection in MCF-10A and MDA-231 cells and overexpressed CTNND1 in MCF-7 cells. In vitro study demonstrated that knockdown of CTNND1 expression led to decreased capacity of Matrigel-adhesion, migration and invasion but increased cancer cell-osteobalstic cell adhesion. No effects were observed on cell proliferation after altering CTNND1 expression, in the presence or absence of BME.

Conclusions:

In this initial study on CTNND1 in breast cancer, our current data suggests that lower transcript expression of CTNND1 associates with a poorer patient prognosis. CTNND1 reduction may play a role in the progression of breast cancer bone metastasis.

Citation Format: Gong C, Andrew A, Feng Y, Owen S, Liang G, Davies E, Song E, Jiang W. The potential role of CTNND1 (catenin (cadherin-associated protein), Delta 1) in breast cancer bone metastasis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-01-08.

Real-world benefit of nivolumab in a Canadian non-small-cell lung cancer cohort

Background

Nivolumab was the first immuno-oncology agent available for the treatment of lung cancer in Canada. In the present study, we evaluated the real-world benefit of nivolumab in Canadian patients with lung cancer.

Methods

Patients included in the cohort were identified from a registry of patients treated through expanded access to nivolumab before and after Health Canada approval. Demographics were collected from the application forms. Outcome data for the duration of treatment and survival were collected retrospectively.

Results

In contrast to the randomized clinical trial populations, our study cohort included patients who were older (median age: 66 years; range: 36-92 years) and who had an Eastern Cooperative Oncology Group performance status of 2 (8.9%). Despite the poorer-prognosis cohort, median overall survival was 12.0 months, which is comparable to the survival demonstrated in the randomized phase iii trials of nivolumab in lung cancer. Median time to treatment discontinuation was 3.45 months and was similar for all patient subgroups, including poorer-prognosis groups such as those with a performance status of 2, those 75 years of age and older, and those with brain metastases.

Conclusions

Nivolumab given in a real-world clinical setting was associated with results similar to those reported in the phase iii clinical trial setting.

Abstract P3-07-07: The pan-HER inhibitor, neratinib and wingless-type MMTVs (Wnt)/Wnt regulators in human breast cancer; a biological and clinical perspective

Background. Neratinib is an orally available tyrosine kinase inhibitor that irreversibly binds and inhibits EGFR, HER2 and HER4 receptor tyrosine kinases. Neratinib has been shown to have clinical activity in HER2-amplified or overexpressed breast cancers and those with HER2 mutations. However, there are indications that it may also work on other subtypes that are not strongly positive for the receptors. The present study first screened the effects of neratinib on a range of kinase targets and identified that the Wnt signalling components are key factors that allow neratinib to interact and targets. These targets were also validated in a cohort of human breast cancer.

Methods. Human breast cancer cohorts (n=124) were tested for the transcript expression of HER family including EGFR, HER2, HER3 and HER4 and a number of Wnt family members and the Wnt signalling regulators, ie. GSK3, Axin-1, Axin-2 and β-catenin. The expression patterns were analysed against the clinicopathological and survival status of the patients. Neratinib was tested on a panel of breast cancer cell lines including triple negative cells for the effects on cytoxicity, cell growth, matrix adhesiveness and cellular migration. Signalling kinase pathways were screened using an antibody based kinase array. The effect of neratinib on multiple protein kinases was tested on the cell models, together with other kinase inhibitors.

Results. Neratinib had an inhibitory effect on the cellular migration and cell-matrix adhesiveness of breast cancers at non-toxic concentrations, an effect more profound with MCF-7 and T47D cell lines than with BT20 and MDA MB-231 which are negative for the ER/EGFR/HER2 receptors. Of the multiple kinase inhibitors tested, neratinib was found to exert inhibition on cell function in synergy with the Wnt/β-catenin inhibitor (FK535) and GSK3 inhibitor (TWS119). The expression of the HER and Wnt family members, Wnt Inhibitory Factor-1 and Wnt regulators varied in mammary and breast cancer tissues and in their correlation with the clinicopathological factors. Of the aberrantly expressed receptors, Wnts and Wnt regulators, HER-2 and 4 were found to significantly correlate with Wnt10b (p&lt;0.05), EGFR/HER1 was found significantly correlated with GSK3 (p&lt;0.05) and HER-3 with Wnt5a (p&lt;0.03). Furthermore, we identified that the integrated expression pattern of five of these factors, namely EGFR, HER2, HER4, Wnt5 and Wnt Inhibitory Factor-1 formed an expression signature that were significantly linked to the overall survival (survival time 148±3.7 vs 113.7 ±7.5 months for favourable and non-favourable pattern, respectively, p=0.002) and disease free survival (p=0.004) of the patients (median follow-up 120 months)

Conclusion. Neratinib, at non-toxic concentration levels, is a profound inhibitor of the migration and matrix adhesion of breast cancer cells, cell functions linked to the aggressiveness and metastasis of breast cancer cells. Its synergistic effects with the Wnt and GSK3 inhibitor, together with the prognostic value of the HER family/Wnt, indicate that the Wnt pathway together with the HER family forms a new molecular indicator and target when considering neratinib in the treatment patients with breast cancer.

Citation Format: Owen S, Ruge F, Lalani AS, Avogadri-Connors F, Bryce RP, Davies E, Jiang WG. The pan-HER inhibitor, neratinib and wingless-type MMTVs (Wnt)/Wnt regulators in human breast cancer; a biological and clinical perspective [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 P3-07-07.

Abstract P4-05-03: Heat shock protein 27 (HSP27) and HER2 positively correlate in breast cancer and effect cell responsiveness to neratinib and cMET inhibitor

Background: Upregulation of heat shock protein-27 (HSP27), a key member of the HSP family, has been shown to confer resistance to chemotherapy and radiotherapy in solid tumours including breast cancer. Evidence is also emerging that HSP27 is linked to the metastatic spread of breast cancer and key cellular traits including cellular migration. Neratinib is an orally available tyrosine kinase inhibitor that irreversibly binds and inhibits EGFR, HER2 and HER4 receptor tyrosine kinases. cMET, the receptor for hepatocyte growth factor and target for cancer therapies, has been shown to be trans-phosphorylated by EGFR. In the current study, we evaluated HSP27 expression within a breast cancer cohort and its implications in cellular responsiveness to cMET inhibition and neratinib.

Methods: HSP27 transcript expression was analysed in our chemotherapy naïve breast cancer cohort (n=124) using quantitative PCR (qPCR) and compared to clinic-pathological information including long-term survival over a ten year follow up period. In addition, the correlation between HSP27 and HER2 expression was explored using Spearman Rank order. High-throughput cell migration analysis was performed using ECIS, on MCF-7 control and HSP27 siRNA knockdown cells in conjunction with neratinib and PHA 665752, a small molecule cMET inhibitor.

Results: In our primary breast cancer cohort, there were no significant associations between HSP27 transcript expression levels and tumour grade, TNM or estrogen receptor (ER) status. Combined survival expression analysis indicated that the worst patient prognosis was associated with high levels of both HER2 and HSP27 and high HER2 and low HSP27 whereas best patient prognosis was associated with low HER2 and low HSP27 expression. Knockdown of HSP27 in MCF7 cells brought about a reduction in cellular migration compared to the control. Additionally, this reduction was enhanced by the addition of neratinib, in a concentration dependent manner, and also cMET inhibition when individually treated. Furthermore, the greatest inhibitory effects on MCF-7 migration were seen following HSP27 knockdown and combined treatment with neratinib and PHA 665752.

Conclusions: Our current data suggests that HSP27 confers low sensitivity to drugs such as neratinib and PHA 665752, particularly in relation to cellular migration and hence potentially metastasis. Therefore, the targeting of HSP27, HER2 and cMET appear to act syngeristically to regulate cellular migration in vitro. Furthermore, clinically expression of HER2 and HSP27 may serve as a prognostic marker for breast cancer survival. Hence, combination therapies that target both HSP and HER2 pathways may provide new clinical opportunities for preventing breast cancer progression.

Citation Format: Owen S, Sanders AJ, Ruge F, Lalani AS, Avogadri-Connors F, Bryce RP, Jiang WG. Heat shock protein 27 (HSP27) and HER2 positively correlate in breast cancer and effect cell responsiveness to neratinib and cMET inhibitor [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 P4-05-03.

Abstract P3-06-10: The impact of the Chinese medicine ShenLingLan on triple negative breast cancer, the metabolic and signalling pathways and clinical implications

Background. Triple negative breast cancer (TNBC) is a challenging both in the choice of therapies and clinical outcomes. In the present study, we investigated the potential prospect of a Chinese medicine formation, ShenLingLan, shown to have benefit to patients with cancer and able to influence the biological behaviour of cancer cells, on breast cancer cells in particular the differential response from TNBC and non-TNBC cells and, on the discovery that TNBC cells were particularly sensitive to the medicine, we went on to determine the signalling and mechanism of action.

Methods. A panel of three TNBC (MDA MB-231, BT20 and BT549) and a panel of three non-TNBC (MCF-7, ZR 75-1 and T47D) cells were used. A soluble extract from ShenLingLan, designated as SLDM, was utilised during this study. The proliferation, cellular migration and adhesiveness were tested using conventional and biophysical methods. Signalling profiling was conducted using a protein kinase array platform (Kinexustm). Metabolic profiling was conducted using the Seahorse platform. Expression of insulin receptor (IR) and insulin-like growth factor receptor (IGFR) gene transcripts (quantitative transcript analysis) and proteins (IHC) were conducted using a fresh breast cancer cohort and tissue array, respectively.

Results. SLDM had little effects on the growth of breast cancer cells. However, it had profound inhibitory effects on the migration of both TNBC and non-TNBC cells in a concentration dependent manner. Interestingly, TNBC cells were 5-20 times more sensitive than the non-TNBC cells in their migration and cell adhesion responses to SLDM. The protein array platform further revealed that, of the wide range of protein kinases, IR and IGRR1 were the most affected in that SLDM resulted in 25-50% reduction in the phosphorylation of IR and IR substrate in TNBC cells. SLDM also caused a contrasting response in IGFR1 phosphorylation in TNBC and non-TNBC cells. Metabolically, TNBC and non-TNBC cells responded to SLDM in very different fashions. For example, in TNBC cells SLDM resulted in a significant decrease in glycolytic activities, in particular that driven by insulin (30.2±12.2 pmol/min in control, 47.7±10 pmol/min with insulin and 35.4±4.2 pmol/min with insulin/SLDM, p=0.01). There is evidence that the mitochondria oxygen consumption (OCR) was also affected by SLDM in TNBC cells (p=0.01). These changes induced by SLDM were in clear contrast to non-TNBC cells which did not respond with significant reduction. Both TNBC and non-TNBC breast cancer tissues have higher IR staining than normal mammary tissues (p&lt;0.001). TNBC tumours also demonstrated significantly more positive IR staining than the non-TNBC tumours (p=0.04).

Conclusion. ShenLingLan has a profound inhibitory effect on the migration and cell-matrix adhesion of TNBC cells, with marked effect on the metabolics of these cells. This effect connects with reduction of the IR and IGFR activation, mainly through the reduction in glycolysis. Together with the clinical implication of IR and IGFR in breast cancer, ShenLingLan has an important role in the treatment of breast cancer with an emphasis in TNBCs.

Citation Format: Jiang WG, Owen S, Ruge F, Gao Y, Wang H, Wei C, Wu Y, Davies E. The impact of the Chinese medicine ShenLingLan on triple negative breast cancer, the metabolic and signalling pathways and clinical implications [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 P3-06-10.

Abstract P3-15-04: Signalling pathways targeted by the YangZheng Xiaoji extract and the therapeutic implications in human breast cancer

Background. Yangzheng Xiaoji is a formulation of Chinese medicine and has been used in the treatment of solid cancer as an adjuvant to chemotherapy by reducing the side effects to the patient. There has been evidence to show that the medicine has a direct biological role in cancer cells. In the present study, we sought to investigate the potential effects of the medicine on breast cancer cells and in particular aimed to identify the key targets and molecular pathways contributing to the anti-cancer effect of the medicine.

Methods. Human breast cancer cell lines (BT549, BT20, MDA MB-231, MCF-7 and ZR 75-1) with varying invasiveness and receptor status were used. The soluble extract of Yangzheng Xiaoji, namely DME25 was used in the study. The effects of DME25 on the growth, toxicity and cellular migration were assessed. Signalling kinase changes were screened using kinase antibody array based array technologies. Kinases were also validated using phosphorylation based protein blotting.

Results. Of the five breast cancer cell lines tested, Yangzheng Xiaoji extract DME25 showed little cytotoxicity over a broad range of concentrations. However, DME25 were able to markedly reduce the migration of the panel of breast cancer tested, without being toxic. Triple negative cells responded in a similar fashion with other cells. It was also noted that the adhesion of these cells were also inhibited by DME25. Using a protein kinase array, it was shown that a number of kinase complexes were inhibited by the medicine, notable ones including EGFR family kinases (reduced by 35%), Janus protein kinases (JAK) (by 57%), and Ras-related C3 botulinum toxin substrate (Rac1 or CDC42 GTPase) (by 49%) and Ribosomal protein S6 kinases (RSKs) (by 52%). Given the clinical significance of RSKs in human breast cancer, we further evaluated the role of RSK and RSK inhibitors in DME mediated cell functions and have demonstrated that both in triple negative breast cancer cells and receptor positive breast cancer cell lines, DME25 was able to synergistically enhance the effect of RSK2 inhibitor, SL1010-1, on the both the cellular migration and cell growth.

Conclusion. Yangzheng Xiaoji has a broad and direct effect on the migration of breast cancer, an effect unrelated to hormone receptor status and independent of cytotoxicity. The medicine appears to target kinase pathway, particularly for the RSK kinases, suggesting an important clinical implication in the treatment of breast cancer.

Citation Format: Jiang WG, Ye L, Owen S, Ruge F, Martin TA, Sanders AJ, Gao G, Wei C, Wu Y, Davies E. Signalling pathways targeted by the YangZheng Xiaoji extract and the therapeutic implications in human breast cancer [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 P3-15-04.

Abstract P1-07-27: Prognostic value of programmed death 1/Programmed death ligand 1/ mammalian target of rapamycin/Rictor/Tuberin in human breast cancer

Background:The Mammalian Target of Rapamycin (mTOR) regulates a multitude of cellular processes including metabolism, proliferation and growth. It is known to form two multi-protein complexes - complex 1 (mTORC1) and complex 2 (mTORC2) with Raptor and Rictor being their core proteins vital for their integrity.

Tuberin, the product of the Tuberous Sclerosis Complex gene 2, TSC2, has been characterized as a tumour suppressor and negatively regulates the mTOR pathway.

Programmed Death 1 (PD-1), a transmembrane protein particularly expressed on the surface of tumour cells, acts as an immune checkpoint receptor. Together with its ligand Programmed Death Ligand 1 (PDL-1) they form a pathway which when activated influences anti-tumour immunity and supresses anti-tumour adaptive responses. The expression of PD1/PDL-1 is lightly regulated by the mTOR pathway.

We investigated the value of expression patterns of all these molecules in breast cancer as potential prognostic factors.

Materials and Methods: Quantitative PCR (qPCR) analysis was used to determine the transcript expression profile of the five genes of interest (PD-1, PDL-1, mTOR, Rictor and Tuberin) in 128 breast cancer specimens.The correlation between PD-1 or PDL-1 with mTOR, Rictor and Tuberin was assessed using the Spearman Rank Order Correlation. Subsequently, a combined analysis was performed, where the influence of favourable expression in relation to patient overall (OS) and disease free survival (DFS) using the Kaplan Meier survival curves and multivariate analysis.

Results: The mRNA expression of the molecules showed a varying degree of association with the clinicopathological parameters. PD-1 transcript expression showed a significant correlation with mTOR expression (p &lt; 0.001). PDL-1 transcript expression was seen to correlate with mTOR (p &lt; 0.001), Rictor (p &lt; 0.001) and Tuberin (p &lt; 0.01) transcript expression. However, when the expression profile was analysed using an integrated expression score, the combined predictive value for the clinical outcome of the five genes was highly significant in terms of OS (p &lt; 0.001) and DFS (p = 0.001), and was found to be an independent prognostic factor (p&lt;0.001) for breast cancer related death using a multivariate analysis.

Conclusions: Our study identifies a molecular signature of 5 genes as a powerful prognostic predictor of OS and DFS in patients with breast cancer.

Citation Format: Uhercik M, Sanders AJ, Owen S, Davies EL, Sharma AK, Jiang WG, Mokbel K. Prognostic value of programmed death 1/Programmed death ligand 1/ mammalian target of rapamycin/Rictor/Tuberin in human breast cancer [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 P1-07-27.

Progression pattern and adverse events with bevacizumab in glioblastoma

BACKGROUND

The use of bevacizumab in the management of glioblastoma multiforme (gbm) remains controversial. In Canada, bevacizumab is approved for the treatment of recurrent gbm. We describe a pattern of progression across treatment lines in gbm.

METHODS

During 2008-2014, 64 patients diagnosed with gbm were treated with bevacizumab at McGill University hospitals. Of those patients, 30 (46.9%) received bevacizumab in the first line (B1L), and 34 (53.1%) received it in the second line and beyond (B2L+). The average length of treatment with bevacizumab was 24.4 weeks (range: 0-232.7 weeks). The patterns of progression were categorized as local, distant, diffuse, multifocal, or multi-pattern.

RESULTS

Local progression was seen in 46.7% of B1L patients and 26.5% of B2L+ patients, distant in 3.3% and 2.9%, diffuse in 20% and 47%, multifocal in 10% and 8.8%, and multi-pattern in 3.3% and 11.8%. No differences between the groups were observed for the distant (p = 0.3) or diffuse (p = 0.4) patterns. Grades 3 and 4 adverse events in the B1L and B2L+ groups were fatigue (33.3% vs. 17.6% respectively), hypertension (26.7% vs. 5.9%), thrombocytopenia (26.7% vs. 11.8%), neutropenia (26.7% vs. 11.8%), anemia (23.3% vs. 11.8%), leucopenia (20% vs. 8.8%), deep vein thrombosis (23.3% vs. 5.9%), seizure (16.7% vs. 8.8%), brain hemorrhage (6.7% vs. <1%), and delayed wound healing (6.7% vs. 2.9%). More total grades 3 and 4 adverse events occurred in the B1L group (p = 0.000519).

CONCLUSIONS

In our cohort, patterns of progression were not different in B1L and B2L+ patients. Moreover, both groups experienced similar adverse events, although more grades 3 and 4 events occurred in the B1L group, implying that severe adverse events in B1L patients could negatively affect survival outcomes.

The clinical significance and impact of interleukin 15 on keratinocyte cell growth and migration

Chronic wounds represent a significant burden to health services and are associated with patient morbidity. Novel methods to diagnose and/or treat problematic wounds are needed. Interleukin (IL)-15 is a cytokine involved in a number of biological processes and disease states such as inflammation, healing and cancer progression. The current study explores the expression profile of IL-15 and IL-15 receptor α (IL-15Rα) in chronic wounds and its impact on keratinocytes. IL-15 and IL-15Rα expression were examined in healing and non-healing chronic wounds using qPCR and immunohistochemical analysis. The impact of recombinant IL-15 (rhIL-15) on human adult low calcium temperature (HaCaT) keratinocyte growth and migratory potential was further examined. IL-15 transcript expression was slightly, though non-significantly elevated in healing chronic wounds compared with non-healing chronic wounds. IL-15 protein staining was minimal in both subtypes of chronic wounds. By contrast, IL-15Rα transcript and protein expression were both observed to be enhanced in non-healing chronic wounds compared with healing chronic wounds. The treatment of HaCaT cells with rhIL-15 generally enhanced cell growth and promoted migration. Analysis with small molecule inhibitors suggested that the pro-migratory effect of rhIL-15 may be associated with ERK, AKT, PLCγ and FAK signalling. IL-15 may promote healing traits in keratinocytes and the differential expression of IL-15Rα is observed in chronic wounds. Together, this may imply a complex role for this interleukin in wound healing.

Comparing the Performance Status Scale and MD Anderson Dysphagia Inventory as swallowing outcome measures in head and neck cancer: a prospective cohort study

OBJECTIVES

To examine the relationship between the two disease-specific measures currently in use to assess swallowing outcomes following treatment in patients with head and neck cancer: the Performance Status Scale (PSS) and MD Anderson Dysphagia Inventory (MDADI).

DESIGN

A prospective cohort study.

SETTING

Four head and neck cancer multidisciplinary clinics in the North of England Cancer Network.

PARTICIPANTS

114 patients with cancers of the upper aerodigestive tract.

MAIN OUTCOME MEASURE

Measures of swallowing function administered prospectively across 4 timepoints

RESULTS

Spearman's correlation coefficients were used to measure the relationship between the two scales. There was statistically significant correlation between the two tools at pre-treatment (rs = 0.428, P < 0.000), 3 months post-treatment (rs = 0.454, P < 0.002), 6 months post-treatment (rs = 0.551, P < 0.000) and 12 months post-treatment (rs = 0.680, P < 0.000).

CONCLUSION

This is the first prospective study comparing the MDADI and PSS questionnaires at multiple time points. Our study shows that these different instruments have a good relationship in measuring swallowing function in patients with head and neck cancer in short and medium term after treatment.

Recognition of subtle and universal facial expressions in a community-based sample of adults classified with intellectual disability

BACKGROUND

Across the USA and UK, schemes now exist to aid the successful integration of adults with mild to moderate intellectual disabilities into general society. One factor that may prove important to the success of such schemes is social competence. Here, understanding the facial expressions of others is critical, as emotion recognition is a prerequisite to empathetic responding and an essential factor in social functioning. Yet research in this area is lacking, especially in community-based samples.

METHOD

We investigated the performance of 13 adults with mild to moderate intellectual disability (ID), relative to 13 age-matched controls, on three tasks of emotion recognition (emotion categorisation; recognition of valence; and recognition of arousal), using a number of 'basic' (angry and happy) and more 'subtle' (compassionate and critical) emotional expressions, as well as the posers face in a default relaxed (i.e. 'neutral') state. Importantly, the sample was drawn from a community-based initiative and was therefore representative of populations' government schemes target.

RESULTS

Across emotion recognition tasks, the ID adults, as compared with controls, were significantly impaired when labelling the emotions displayed by the poser as well as recognising the associated 'feelings' conveyed by these faces. This was especially true for the neutral, compassionate and angry facial expressions. For example, ID adults demonstrated deficits in categorising neutral and subtle emotional expressions, as well as assessing the valence of such facial expressions. In addition, ID adults also struggled to assess arousal levels; especially those associated with compassionate and angry faces.

CONCLUSION

Given both basic and subtle emotions are conveyed in a range of daily situations, errors in interpreting such facial expressions and, relatedly, understanding what potential behaviours such expressions signify could contribute to the social difficulties ID adults face. This is important because current initiatives such as 'personalisation' do not appear to have schemes supporting training in this area, and understanding the facial expressions of others is, after all, one of our most important non-verbal social communication tools.

Slip pulse and resonance of the Kathmandu basin during the 2015 Gorkha earthquake, Nepal

Detailed geodetic imaging of earthquake ruptures enhances our understanding of earthquake physics and associated ground shaking. The 25 April 2015 moment magnitude 7.8 earthquake in Gorkha, Nepal was the first large continental megathrust rupture to have occurred beneath a high-rate (5-hertz) Global Positioning System (GPS) network. We used GPS and interferometric synthetic aperture radar data to model the earthquake rupture as a slip pulse ~20 kilometers in width, ~6 seconds in duration, and with a peak sliding velocity of 1.1 meters per second, which propagated toward the Kathmandu basin at ~3.3 kilometers per second over ~140 kilometers. The smooth slip onset, indicating a large (~5-meter) slip-weakening distance, caused moderate ground shaking at high frequencies (>1 hertz; peak ground acceleration, ~16% of Earth's gravity) and minimized damage to vernacular dwellings. Whole-basin resonance at a period of 4 to 5 seconds caused the collapse of tall structures, including cultural artifacts.

Jet energy measurement and its systematic uncertainty in proton-proton collisions at [Formula: see text] TeV with the ATLAS detector

The jet energy scale (JES) and its systematic uncertainty are determined for jets measured with the ATLAS detector using proton-proton collision data with a centre-of-mass energy of [Formula: see text] TeV corresponding to an integrated luminosity of [Formula: see text][Formula: see text]. Jets are reconstructed from energy deposits forming topological clusters of calorimeter cells using the anti-[Formula: see text] algorithm with distance parameters [Formula: see text] or [Formula: see text], and are calibrated using MC simulations. A residual JES correction is applied to account for differences between data and MC simulations. This correction and its systematic uncertainty are estimated using a combination of in situ techniques exploiting the transverse momentum balance between a jet and a reference object such as a photon or a [Formula: see text] boson, for [Formula: see text] and pseudorapidities [Formula: see text]. The effect of multiple proton-proton interactions is corrected for, and an uncertainty is evaluated using in situ techniques. The smallest JES uncertainty of less than 1 % is found in the central calorimeter region ([Formula: see text]) for jets with [Formula: see text]. For central jets at lower [Formula: see text], the uncertainty is about 3 %. A consistent JES estimate is found using measurements of the calorimeter response of single hadrons in proton-proton collisions and test-beam data, which also provide the estimate for [Formula: see text] TeV. The calibration of forward jets is derived from dijet [Formula: see text] balance measurements. The resulting uncertainty reaches its largest value of 6 % for low-[Formula: see text] jets at [Formula: see text]. Additional JES uncertainties due to specific event topologies, such as close-by jets or selections of event samples with an enhanced content of jets originating from light quarks or gluons, are also discussed. The magnitude of these uncertainties depends on the event sample used in a given physics analysis, but typically amounts to 0.5-3 %.

Muon reconstruction efficiency and momentum resolution of the ATLAS experiment in proton-proton collisions at [Formula: see text] TeV in 2010

This paper presents a study of the performance of the muon reconstruction in the analysis of proton-proton collisions at [Formula: see text] TeV at the LHC, recorded by the ATLAS detector in 2010. This performance is described in terms of reconstruction and isolation efficiencies and momentum resolutions for different classes of reconstructed muons. The results are obtained from an analysis of [Formula: see text] meson and [Formula: see text] boson decays to dimuons, reconstructed from a data sample corresponding to an integrated luminosity of 40 pb[Formula: see text]. The measured performance is compared to Monte Carlo predictions and deviations from the predicted performance are discussed.

The differential production cross section of the [Formula: see text](1020) meson in [Formula: see text] = 7 TeV [Formula: see text] collisions measured with the ATLAS detector

A measurement is presented of the [Formula: see text] production cross section at [Formula: see text] = 7 TeV using [Formula: see text] collision data corresponding to an integrated luminosity of 383 [Formula: see text], collected with the ATLAS experiment at the LHC. Selection of [Formula: see text](1020) mesons is based on the identification of charged kaons by their energy loss in the pixel detector. The differential cross section is measured as a function of the transverse momentum, [Formula: see text], and rapidity, [Formula: see text], of the [Formula: see text](1020) meson in the fiducial region 500 [Formula: see text] 1200 MeV, [Formula: see text] 0.8, kaon [Formula: see text] 230 MeV and kaon momentum [Formula: see text] 800 MeV. The integrated [Formula: see text]-meson production cross section in this fiducial range is measured to be [Formula: see text] = 570 [Formula: see text] 8 (stat) [Formula: see text] 66 (syst) [Formula: see text] 20 (lumi) [Formula: see text].

Search for quantum black hole production in high-invariant-mass lepton+jet final states using pp collisions at √s=8 TeV and the ATLAS detector

This Letter presents a search for quantum black-hole production using 20.3 fb-1 of data collected with the ATLAS detector in pp collisions at the LHC at √s = 8 TeV. The quantum black holes are assumed to decay into a final state characterized by a lepton (electron or muon) and a jet. In either channel, no event with a lepton-jet invariant mass of 3.5 TeV or more is observed, consistent with the expected background. Limits are set on the product of cross sections and branching fractions for the lepton+jet final states of quantum black holes produced in a search region for invariant masses above 1 TeV. The combined 95% confidence level upper limit on this product for quantum black holes with threshold mass above 3.5 TeV is 0.18 fb. This limit constrains the threshold quantum black-hole mass to be above 5.3 TeV in the model considered.

Search for dark matter in events with a hadronically decaying W or Z boson and missing transverse momentum in pp collisions at √s=8 TeV with the ATLAS detector

A search is presented for dark matter pair production in association with a W or Z boson in pp collisions representing 20.3  fb(-1) of integrated luminosity at √s=8  TeV using data recorded with the ATLAS detector at the Large Hadron Collider. Events with a hadronic jet with the jet mass consistent with a W or Z boson, and with large missing transverse momentum are analyzed. The data are consistent with the standard model expectations. Limits are set on the mass scale in effective field theories that describe the interaction of dark matter and standard model particles, and on the cross section of Higgs production and decay to invisible particles. In addition, cross section limits on the anomalous production of W or Z bosons with large missing transverse momentum are set in two fiducial regions.

Measurement of jet shapes in top-quark pair events at [Formula: see text] using the ATLAS detector

A measurement of jet shapes in top-quark pair events using 1.8 fb-1 of [Formula: see text]pp collision data recorded by the ATLAS detector at the LHC is presented. Samples of top-quark pair events are selected in both the single-lepton and dilepton final states. The differential and integrated shapes of the jets initiated by bottom-quarks from the top-quark decays are compared with those of the jets originated by light-quarks from the hadronic W-boson decays [Formula: see text] in the single-lepton channel. The light-quark jets are found to have a narrower distribution of the momentum flow inside the jet area than b-quark jets.

Measurement of top quark polarization in top-antitop events from proton-proton collisions at √s=7 TeV using the ATLAS detector

This Letter presents measurements of the polarization of the top quark in top-antitop quark pair events, using 4.7  fb(-1) of proton-proton collision data recorded with the ATLAS detector at the Large Hadron Collider at √s=7  TeV. Final states containing one or two isolated leptons (electrons or muons) and jets are considered. Two measurements of α(ℓ)P, the product of the leptonic spin-analyzing power and the top quark polarization, are performed assuming that the polarization is introduced by either a CP conserving or a maximally CP violating production process. The measurements obtained, α(ℓ)P(CPC)=-0.035±0.014(stat)±0.037(syst) and α(ℓ)P(CPV)=0.020±0.016(stat)(-0.017)(+0.013)(syst), are in good agreement with the standard model prediction of negligible top quark polarization.

Measurement of the azimuthal angle dependence of inclusive jet yields in Pb+Pb collisions at √(sNN)=2.76 TeV with the ATLAS detector

Measurements of the variation of inclusive jet suppression as a function of relative azimuthal angle, Δφ, with respect to the elliptic event plane provide insight into the path-length dependence of jet quenching. ATLAS has measured the Δφ dependence of jet yields in 0.14 nb(-1) of √(s(NN))=2.76 TeV Pb+Pb collisions at the LHC for jet transverse momenta p(T)>45 GeV in different collision centrality bins using an underlying event subtraction procedure that accounts for elliptic flow. The variation of the jet yield with Δφ was characterized by the parameter, v(2)(jet), and the ratio of out-of-plane (Δφ~π/2) to in-plane (Δφ~0) yields. Nonzero v(2)(jet) values were measured in all centrality bins for p(T)<160 GeV. The jet yields are observed to vary by as much as 20% between in-plane and out-of-plane directions.

Improved luminosity determination in pp collisions at [Formula: see text] using the ATLAS detector at the LHC

The luminosity calibration for the ATLAS detector at the LHC during pp collisions at [Formula: see text] in 2010 and 2011 is presented. Evaluation of the luminosity scale is performed using several luminosity-sensitive detectors, and comparisons are made of the long-term stability and accuracy of this calibration applied to the pp collisions at [Formula: see text]. A luminosity uncertainty of [Formula: see text] is obtained for the 47 pb-1 of data delivered to ATLAS in 2010, and an uncertainty of [Formula: see text] is obtained for the 5.5 fb-1 delivered in 2011.