BASIS FOR TARGETING MET ACTIVATION MEDIATED RESISTANCE TO PI3K INHIBITION IN BREAST CANCER

The identification of resistance mechanisms to emerging therapies, such as those targeting the PI3K pathway and the MET receptor, has the potential to benefit a significant number of patients with breast cancer. In this study we hypothesized that concurrent aberrations in PI3K and MET will render breast cancers resistant to therapies targeting each pathway, and that combination therapy targeting the PI3K and MET pathway will optimize therapy-effect by preventing the acquisition of resistance. We analyzed cMET and phospho-cMET levels in 257 breast cancer samples and found that high levels of both the proteins were seen in all breast cancer subtypes, which correlated with poor prognosis.(1) We also analyzed DNA from 971 FFPE early breast tumors, and showed that MET and PIK3CA are frequently co-amplified, and a high copy number of either gene is associated with poorer prognostic features and the triple negative disease.(2) Additionally, we determined the effect of MET-T1010I, MET-Y1253D and MET overexpression, found in breast cancers, on the activity of the two most common breast cancer PIK3CA mutations (E545K and H1047R), in a model of breast epithelial cells (MCF-10A) and a cell line breast cancer model (HCC1954). Our results suggest that tumors with concurrent aberrations in MET and PIK3CA are likely to be more aggressive and resistant to therapies targeting each pathway, and that combinatorial therapy (with MET and PI3K pathway inhibitors) could circumvent this resistance. This is the first study to investigate the significance of differential expression of cMET and p-cMET in different breast cancer subtypes, to report p-cMET levels as a prognostic factor in breast cancer, and also, the first to report MET gene copy number, its distribution by tumor subtype, and correlation with patient outcome.(2) Our study is also unique for showing that the presence of MET aberrations enhances the tumorigenic effects induced by the PIK3CA mutations in breast cancer/epithelial cells; results from our tumor xenograft models corroborate with these in vitro findings. Moreover, we are the first to provide evidence for the potential activity of combinatorial therapy using MET and PI3K pathway inhibitors against breast cancer

Anatomía foliar de especies predominantes en bosques y pastizales del Iberá

The Iberá macrosystem has several types of vegetation, where in addition to aquatic and marsh vegetation are found hydrophilic forests, savannahs with a predominance of grasses and grasslands with shrub species interspersed among the herbaceous species. Previous studies of leaf anatomy were only carried out on aquatic and marsh plants. In this work, leaf anatomy was studied in predominant or frequent species growing in grasslands and forests of the Iberá macrosystem, with the aim of detecting leaf structural characters that may represent adaptive value to these environments. Leaves of 42 species corresponding to 26 families were analyzed with optical and scanning electron microscopy. Statistical analysis was performed based on a data matrix of the anatomical characters analyzed, also including the environment types in which the species studied grow. The analyzed characters of the epidermis were: cuticle design, stomata, trichomes, design of epidermal cells of both epidermis, where a predominance of identical morphology on both sides was observed. In the mesophyll, the type, presence and form of calcium and inulin crystals, and distribution of glandular structures such as laticifers, cavities and secretory cells were evaluated. The data reported are discussed in relation to the available literature. No constant characters associated with a particular vegetation type are found. Species living in the same environment do not have similar anatomical features, as shown by clustering analysis (UPGMA).El macrosistema Iberá presenta diversos tipos de vegetación, donde además de las acuáticas y palustres hay bosques hidrófilos, sabanas con predominio de gramíneas y praderas con especies arbustivas intercaladas entre las herbáceas. Estudios previos de anatomía foliar solo fueron realizados en plantas acuáticas y palustres. En este trabajo se estudió la anatomía foliar en especies predominantes o frecuentes que crecen en pastizales y bosques del macrosistema Iberá, con el objetivo de detectar caracteres estructurales de las hojas que puedan representar valor adaptativo a estos ambientes. Se analizaron hojas de 42 especies correspondientes a 26 familias, con microscopía óptica y electrónica de barrido. Se realizó un análisis estadístico en base a una matriz de datos, compuesta por los caracteres anatómicos y el ambiente en que crecen las especies estudiadas. Los caracteres analizados de la epidermis fueron: diseño de la cutícula, estomas, tricomas, diseño de células epidérmicas de ambas epidermis, donde se observa un predominio de idéntica morfología en ambas caras. En el mesofilo se evaluó su tipo, presencia y forma de cristales de calcio e inulina, y distribución de estructuras glandulares como laticíferos, cavidades y células secretoras. Los datos reportados son discutidos en relación a la bibliografía disponible. El análisis de agrupamiento (UPGMA) muestra que las especies que habitan en los mismos ambientes no presentan características anatómicas similares

Functional consequence of the MET-T1010I polymorphism in breast cancer.

Major breast cancer predisposition genes, only account for approximately 30% of high-risk breast cancer families and only explain 15% of breast cancer familial relative risk. The HGF growth factor receptor MET is potentially functionally altered due to an uncommon germline single nucleotide polymorphism (SNP), MET-T1010I, in many cancer lineages including breast cancer where the MET-T1010I SNP is present in 2% of patients with metastatic breast cancer. Expression of MET-T1010I in the context of mammary epithelium increases colony formation, cell migration and invasion in-vitro and tumor growth and invasion in-vivo. A selective effect of MET-T1010I as compared to wild type MET on cell invasion both in-vitro and in-vivo suggests that the MET-T1010I SNP may alter tumor pathophysiology and should be considered as a potential biomarker when implementing MET targeted clinical trials

Parasites in Mexican patients with irritable bowel syndrome: a case-control study

One hundred and fifteen patients with symptoms suggestive of irritable bowel syndrome (IBS) according to Rome III criteria and 209 patients with gastrointestinal symptoms different from IBS (control) were identified through medical records from the Gastroenterology Clinic of the "Dr. Manuel Gea Gonzalez General Hospital" from January 2008 to March 2010. No statistical differences in IBS data as compared with control groups were observed except in bloating, that was more frequent in the IBS group (P = 0.043). Although the pathogenicity of specific intestinal protozoa could not be demonstrated due to lack of association with the development of gastrointestinal symptoms, Blastocystis spp, in the IBS group, exhibited a trend of association to diarrhoea (odds ratio = 2.73, 95% confidence interval = 0.84-8.80, P = 0.053), while having any parasite and diarrhoea was significant (odds ratio = 3.38, 95% confidence interval = 1.33-8.57, P = 0.008). The association between Blastocystis and diarrhoea in IBS patients although not conclusive is an interesting finding; nonetheless more extensive case-controlled studies are required to clearly define the role of some "non-pathogenic" parasites in intestinal disease and IBS

PI3K Pathway Mutations and PTEN Levels in Primary and Metastatic Breast Cancer

The purpose of this work was to determine whether there are differences in PIK3CA mutation status and PTEN protein expression between primary and matched metastatic breast tumors as this could influence patient management. Fifty-micron paraffin sections were used for DNA extraction and 3-micron slides for immunohistochemistry (IHC) and fluorescent in-situ hybridization (FISH). ER, PR and HER2 IHC were repeated in a central laboratory for both primary and metastasis. PTEN levels were assessed by IHC and PI3K pathway mutations detected by a mass spectroscopy-based approach. Median age was 48 years (range, 30 to 83 years). Tumor subtype included 72% hormone receptor-positive/HER2-negative, 20% HER2-positive, and less than 7.8% triple receptor negative. Tissues were available for PTEN IHC in 46 primary tumors and 52 metastases. PTEN was lost in 14 (30%) primary tumors and 13 (25%) metastases. There were 5 cases of PTEN loss and eight cases of PTEN gain from primary to metastasis (26% discordance). Adequate DNA was obtained on 46 primary tumors and on 50 metastases for PIK3CA analysis. PIK3CA mutations were detected in 19 (40%) of primary tumors and 21 (42%) of metastases. There were five cases of PIK3CA mutation loss, and four cases of mutation gain (18% discordance). There was an increase of the level of PIK3CA mutations in four cases, and decrease in one from primary to metastasis. There is a high level of discordance in PTEN level, PIK3CA mutations, and receptor status between primary and metastatic disease that may influence patient selection and response to PI3K-targeted therapies

Determinants of Knowledge and Attitudes Towards Pain Among Nurses in a Tertiary Hospital in Spain

Background: All nurses should receive training and education regarding pain as part of their pre-graduate stage, as its assessment and appropriate management when treating patients largely depends on them. With the right knowledge it is possible to reduce its high prevalence, as well as the serious consequences it can lead to. Aim: To determine the level of knowledge and attitudes towards pain of final-year nursing students in Spain. Methods: Descriptive cross-sectional study using a convenience sample of five Spanish universities during the academic year 2020-2021. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) was used. In addition, socio-demographic variables such as age, sex, relationship status, employment status, and the number of dependants were collected. The specific palliative or oncology subjects of each university was also assessed. Results: A total of 224 questionnaires were collected. One of the nursing universities obtained the best score in the KASRP (59.75%) which was significant (p = .001). This university was the only one that offers specific subjects in palliative or oncologic care. A training deficit in aspects related to pain assessment and pharmacologic concepts was detected. We found no relationship between the KASRP and the different sociodemographic variables. Conclusions: Specific training in palliative care improves the students' knowledge regarding pain, although the results did not reach an acceptable minimum. The universities' training programs for Spanish students need to be adapted in order to achieve better results

Reconstruction of nuclear receptor network reveals that NR2E3 is a novel upstream regulator of ESR1 in breast cancer

ESR1 is one of the most important transcription factors and therapeutic targets in breast cancer. By applying systems-level re-analysis of publicly available gene expression data, we uncovered a potential regulator of ESR1. We demonstrated that orphan nuclear receptor NR2E3 regulates ESR1 via direct binding to the ESR1 promoter with concomitant recruitment of PIAS3 to the promoter in breast cancer cells, and is essential for physiological cellular activity of ESR1 in estrogen receptor (ER)-positive breast cancer cells. Moreover, expression of NR2E3 was significantly associated with recurrence-free survival and a favourable response to tamoxifen treatment in women with ER-positive breast cancer. Our results provide mechanistic insights on the regulation of ESR1 by NR2E3 and the clinical relevance of NR2E3 in breast cancer

Oxidative Phosphorylation Is a Metabolic Vulnerability in Chemotherapy-Resistant Triple-Negative Breast Cance

Oxidative phosphorylation (OXPHOS) is an active metabolic pathway in many cancers. RNA from pretreatment biopsies from patients with triple-negative breast cancer (TNBC) who received neoadjuvant chemotherapy demonstrated that the top canonical pathway associated with worse outcome was higher expression of OXPHOS signature. IACS-10759, a novel inhibitor of OXPHOS, stabilized growth in multiple TNBC patient-derived xenografts (PDX). On gene expression profiling, all of the sensitive models displayed a basal-like 1 TNBC subtype. Expression of mitochondrial genes was significantly higher in sensitive PDXs. An in vivo functional genomics screen to identify synthetic lethal targets in tumors treated with IACS-10759 found several potential targets, including CDK4. We validated the antitumor efficacy of the combination of palbociclib, a CDK4/6 inhibitor, and IACS-10759 in vitro and in vivo. In addition, the combination of IACS-10759 and multikinase inhibitor cabozantinib had improved antitumor efficacy. Taken together, our data suggest that OXPHOS is a metabolic vulnerability in TNBC that may be leveraged with novel therapeutics in combination regimens. SIGNIFICANCE: These findings suggest that triple-negative breast cancer is highly reliant on OXPHOS and that inhibiting OXPHOS may be a novel approach to enhance efficacy of several targeted therapies

MYC pathway activation in triple-negative breast cancer is synthetic lethal with CDK inhibition

Estrogen, progesterone, and HER2 receptor-negative triple-negative breast cancers encompass the most clinically challenging subtype for which targeted therapeutics are lacking. We find that triple-negative tumors exhibit elevated MYC expression, as well as altered expression of MYC regulatory genes, resulting in increased activity of the MYC pathway. In primary breast tumors, MYC signaling did not predict response to neoadjuvant chemotherapy but was associated with poor prognosis. We exploit the increased MYC expression found in triple-negative breast cancers by using a synthetic-lethal approach dependent on cyclin-dependent kinase (CDK) inhibition. CDK inhibition effectively induced tumor regression in triple-negative tumor xenografts. The proapoptotic BCL-2 family member BIM is up-regulated after CDK inhibition and contributes to this synthetic-lethal mechanism. These results indicate that aggressive breast tumors with elevated MYC are uniquely sensitive to CDK inhibitors

Perivascular M2 Macrophages Stimulate Tumor Relapse after Chemotherapy

Tumor relapse after chemotherapy-induced regression is a major clinical problem, because it often involves inoperable metastatic disease. Tumor-associated macrophages (TAM) are known to limit the cytotoxic effects of chemotherapy in preclinical models of cancer. Here, we report that an alternatively activated (M2) subpopulation of TAMs (MRC1(+)TIE2(Hi)CXCR4(Hi)) accumulate around blood vessels in tumors after chemotherapy, where they promote tumor revascularization and relapse, in part, via VEGF-A release. A similar perivascular, M2-related TAM subset was present in human breast carcinomas and bone metastases after chemotherapy. Although a small proportion of M2 TAMs were also present in hypoxic tumor areas, when we genetically ablated their ability to respond to hypoxia via hypoxia-inducible factors 1 and 2, tumor relapse was unaffected. TAMs were the predominant cells expressing immunoreactive CXCR4 in chemotherapy-treated mouse tumors, with the highest levels expressed by MRC1(+) TAMs clustering around the tumor vasculature. Furthermore, the primary CXCR4 ligand, CXCL12, was upregulated in these perivascular sites after chemotherapy, where it was selectively chemotactic for MRC1(+) TAMs. Interestingly, HMOX-1, a marker of oxidative stress, was also upregulated in perivascular areas after chemotherapy. This enzyme generates carbon monoxide from the breakdown of heme, a gas known to upregulate CXCL12. Finally, pharmacologic blockade of CXCR4 selectively reduced M2-related TAMs after chemotherapy, especially those in direct contact with blood vessels, thereby reducing tumor revascularization and regrowth. Our studies rationalize a strategy to leverage chemotherapeutic efficacy by selectively targeting this perivascular, relapse-promoting M2-related TAM cell population