TONSL Is an Immortalizing Oncogene and a Therapeutic Target in Breast Cancer

Study of genomic aberrations leading to immortalization of epithelial cells has been technically challenging due to the lack of isogenic models. To address this, we used healthy primary breast luminal epithelial cells of different genetic ancestry and their hTERT-immortalized counterparts to identify transcriptomic changes associated with immortalization. Elevated expression of TONSL (Tonsoku-like, DNA repair protein) was identified as one of the earliest events during immortalization. TONSL, which is located on chromosome 8q24.3, was found to be amplified in approximately 20% of breast cancers. TONSL alone immortalized primary breast epithelial cells and increased telomerase activity, but overexpression was insufficient for neoplastic transformation. However, TONSL-immortalized primary cells overexpressing defined oncogenes generated estrogen receptor-positive adenocarcinomas in mice. Analysis of a breast tumor microarray with approximately 600 tumors revealed poor overall and progression-free survival of patients with TONSL-overexpressing tumors. TONSL increased chromatin accessibility to pro-oncogenic transcription factors, including NF-κB and limited access to the tumor-suppressor p53. TONSL overexpression resulted in significant changes in the expression of genes associated with DNA repair hubs, including upregulation of several genes in the homologous recombination (HR) and Fanconi anemia pathways. Consistent with these results, TONSL-overexpressing primary cells exhibited upregulated DNA repair via HR. Moreover, TONSL was essential for growth of TONSL-amplified breast cancer cell lines in vivo, and these cells were sensitive to TONSL-FACT complex inhibitor CBL0137. Together, these findings identify TONSL as a regulator of epithelial cell immortalization to facilitate cancer initiation and as a target for breast cancer therapy.

SIGNIFICANCE

The chr.8q24.3 amplicon-resident gene TONSL is upregulated during the initial steps of tumorigenesis to support neoplastic transformation by increasing DNA repair and represents a potential therapeutic target for treating breast cancer.

Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school

Objective

Evaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction.

Study design

A survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared.

Results

There were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84–88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities.

Conclusion

We identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration.

Implications

Despite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.

Truth and Transparency in Crisis Pregnancy Centers

The prevalence of crisis pregnancy centers (CPCs), their false claims, and the real harm they cause necessitate public education about their unethical practices. Also called “pregnancy resource centers” and “pregnancy support centers,” CPCs are nonmedical institutions designed to deceive women seeking comprehensive pregnancy care, as their volunteers are instructed to pedal misinformation about reproductive health care.