Detection of Microdeletions by Non-Invasive Prenatal Testing

Background: Non-invasive prenatal testing (NIPT) is currently offered for the detection of Trisomy 21, 13, 18 and sex chromosome aneuploidy. The test is unique because it reaches nearly diagnostic levels of accuracy, otherwise achieved only by invasive procedures like chorionic villus sampling or amniocentesis, but requires only a sample of maternal blood. The NIPT technology continues to advance and a greater variety of genomic alterations can be detected. This research study describes the detection of two different fetal microdeletions using NIPT, which includes whole genome next-generation sequencing, and targeted region capture and sequencing methods. Methods: Whole genome next-generation sequencing, and targeted region capture and sequencing methods, were used on samples of maternal plasma obtained from pregnancies with confirmed microdeletions. The DNA of these samples was compared to control DNA libraries to identify the fetal microdeletions. Results: We were able to identify statistically significant differences between samples to detect fetal microdeletions on chromosome 12p12.1-p11.22 from maternal plasma samples. Identification of a fetal microdeletion on 5p15.33 from maternal plasma samples was achieved, but highlighted the difficulties in detection, and future challenges for NIPT. Conclusion: Our research has demonstrated the ability to detect microdeletions by whole genome next-generation sequencing and targeted region capture and sequencing methods of NIPT. The findings indicate the ability of NIPT to detect a wide range of genomic alterations, which will impact prenatal care in the future if the technology improves. Development and expansion of NIPT has significant public health implications due to its high levels of accuracy as compared to current screening, and safety for the pregnancy as compared to current diagnostic testing options. NIPT could have major ethical implications, and could impact the role of prenatal genetic counselors and physicians

ASSESSING THE READINESS OF RELATIVES TO UNDERGO CASCADE GENETIC TESTING FOR INHERITED PREDISPOSITIONS TO CANCER USING THE TRANSTHEORETICAL MODEL STAGES OF CHANGE

National guidelines recommend cascade genetic testing (CGT) for blood relatives after a cancer predisposition gene mutation is identified in an individual. Despite recommendations for CGT, only 30-60% of first-degree relatives (FDRs) complete CGT. The proportion of untested relatives who are planning to have CGT is unknown. We used the Transtheoretical Model to assess the readiness (stage of change) for CGT among living, untested FDRs at-risk for a hereditary predisposition to cancer. An anonymous, online survey was open to U.S. adults with an autosomal dominant, adult-onset, hereditary predisposition to cancer. Participants reported demographic information, their genetic testing information, and information on FDRs (the number of each relative, vital status, uptake of CGT, and readiness for CGT among those alive and untested). Data were analyzed using descriptive statistics, non-parametric McNemar, Friedman, Wilcoxon Signed Rank, Kruskal-Wallis, and Mann-Whitney tests. A two-sided p-value of 0.05 was considered statistically significant

Untold Perspectives: The Impact of the Closure of a Health Institution in a Black Community in North St. Louis County

Based on the literature of social determinants of health, health equity, and anchor institutions, it is evident that hospitals have a role to play in ensuring the health of their community. However, our understanding of the impact of hospital closures is limited, especially when it comes to Black communities. The purpose of this study is to examine the relationship of the closure of the Normandy Osteopathic Hospital to the social determinants of health—specifically access to care and economic stability as it relates to income and wealth generation—for a Black community in one near-North suburb of St. Louis. Ten individuals with a connection to the Normandy Osteopathic Hospital were interviewed using qualitative methods and an oral history protocol. Data was coded and analyzed using thematic analysis. Findings showed layers of disinvestment over time through national and local health care management decisions. Findings also showed that the hospital closure not only had an impact on access to health care, but also on community self-worth and economic wellbeing. As a result of these findings, policy implications and recommendations are explored

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication

Experiences of Family Communication and Cascade Genetic Testing for Hereditary Cancer in Medically Underserved Populations-A Qualitative Study

UNLABELLED: We sought to explore the intrafamilial communication and cascade genetic testing (CGT) experiences of patients with hereditary cancer from diverse, medically underserved populations and their relatives. Participants included patients receiving oncology care at an urban, safety net hospital in Texas or comprehensive cancer center in Alabama and their first-degree relatives. In-depth semi-structured qualitative interviews were completed wherein patients shared their experiences with genetic counseling (GC), genetic testing (GT), and communicating their results to relatives. Relatives shared their experiences receiving information from the patient and considering CGT. Interviews were transcribed, coded, and themes were identified. Of 25 participating patients, most recalled key aspects of GC and their GT results. Most (80%) patients shared their results with relatives, but only some relatives underwent CGT; patients reported low perceived susceptibility to hereditary cancer as a common barrier to CGT for their relatives. Of 16 participating relatives, most reported feeling distress upon learning the patient\u27s GT results. Relatives were fearful of learning their own CGT results but identified prevention and early detection as CGT benefits. Interviews identified opportunities during family communication to improve relatives\u27 perceived susceptibility to hereditary cancer. Tailored resources may support patients and relatives experiencing distress and fear during GT. PREVENTION RELEVANCE: This study of intrafamilial communication and cascade genetic testing experiences of patients with hereditary cancer and their relatives from diverse, medically underserved populations identified relatives\u27 perceived susceptibility to hereditary cancer risks, distress, and fear as frequent reactions and barriers to testing. These results may inform future hereditary cancer prevention efforts

Outcomes of the “BRCA Quality Improvement Dissemination Program”: An Initiative to Improve Patient Receipt of Cancer Genetics Services at Five Health Systems

OBJECTIVE: A quality improvement initiative (QII) was conducted with five community-based health systems\u27 oncology care centers (sites A-E). The QII aimed to increase referrals, genetic counseling (GC), and germline genetic testing (GT) for patients with ovarian cancer (OC) and triple-negative breast cancer (TNBC). METHODS: QII activities occurred at sites over several years, all concluding by December 2020. Medical records of patients with OC and TNBC were reviewed, and rates of referral, GC, and GT of patients diagnosed during the 2 years before the QII were compared to those diagnosed during the QII. Outcomes were analyzed using descriptive statistics, two-sample t-test, chi-squared/Fisher\u27s exact test, and logistic regression. RESULTS: For patients with OC, improvement was observed in the rate of referral (from 70% to 79%), GC (from 44% to 61%), GT (from 54% to 62%) and decreased time from diagnosis to GC and GT. For patients with TNBC, increased rates of referral (from 90% to 92%), GC (from 68% to 72%) and GT (81% to 86%) were observed. Effective interventions streamlined GC scheduling and standardized referral processes. CONCLUSION: A multi-year QII increased patient referral and uptake of recommended genetics services across five unique community-based oncology care settings

Bmi1 enhances tumorigenicity and cancer stem cell function in pancreatic adenocarcinoma.

Bmi1 is an integral component of the Polycomb Repressive Complex 1 (PRC1) and is involved in the pathogenesis of multiple cancers. It also plays a key role in the functioning of endogenous stem cells and cancer stem cells. Previous work implicated a role for cancer stem cells in the pathogenesis of pancreatic cancer. We hypothesized that Bmi1 plays an integral role in enhancing pancreatic tumorigenicity and the function of cancer stem cells in pancreatic ductal adenocarcinoma.We measured endogenous Bmi1 levels in primary human pancreatic ductal adenocarcinomas, pancreatic intraepithelial neoplasias (PanINs) and normal pancreas by immunohistochemistry and Western blotting. The function of Bmi1 in pancreatic cancer was assessed by alteration of Bmi1 expression in several cell model systems by measuring cell proliferation, cell apoptosis, in vitro invasion, chemotherapy resistance, and in vivo growth and metastasis in an orthotopic model of pancreatic cancer. We also assessed the cancer stem cell frequency, tumorsphere formation, and in vivo growth of human pancreatic cancer xenografts after Bmi1 silencing.Bmi1 was overexpressed in human PanINs, pancreatic cancers, and in several pancreatic cancer cell lines. Overexpression of Bmi1 in MiaPaCa2 cells resulted in increased proliferation, in vitro invasion, larger in vivo tumors, more metastases, and gemcitabine resistance while opposite results were seen when Bmi1 was silenced in Panc-1 cells. Bmi1 was overexpressed in the cancer stem cell compartment of primary human pancreatic cancer xenografts. Pancreatic tumorspheres also demonstrated high levels of Bmi1. Silencing of Bmi1 inhibited secondary and tertiary tumorsphere formation, decreased primary pancreatic xenograft growth, and lowered the proportion of cancer stem cells in the xenograft tissue.Our results implicate Bmi1 in the invasiveness and growth of pancreatic cancer and demonstrate its key role in the regulation of pancreatic cancer stem cells

The Notch pathway is important in maintaining the cancer stem cell population in pancreatic cancer.

BackgroundPancreatic cancer stem cells (CSCs) represent a small subpopulation of pancreatic cancer cells that have the capacity to initiate and propagate tumor formation. However, the mechanisms by which pancreatic CSCs are maintained are not well understood or characterized.MethodsExpression of Notch receptors, ligands, and Notch signaling target genes was quantitated in the CSC and non-CSC populations from 8 primary human pancreatic xenografts. A gamma secretase inhibitor (GSI) that inhibits the Notch pathway and a shRNA targeting the Notch target gene Hes1 were used to assess the role of the Notch pathway in CSC population maintenance and pancreatic tumor growth.ResultsNotch pathway components were found to be upregulated in pancreatic CSCs. Inhibition of the Notch pathway using either a gamma secretase inhibitor or Hes1 shRNA in pancreatic cancer cells reduced the percentage of CSCs and tumorsphere formation. Conversely, activation of the Notch pathway with an exogenous Notch peptide ligand increased the percentage of CSCs as well as tumorsphere formation. In vivo treatment of orthotopic pancreatic tumors in NOD/SCID mice with GSI blocked tumor growth and reduced the CSC population.ConclusionThe Notch signaling pathway is important in maintaining the pancreatic CSC population and is a potential therapeutic target in pancreatic cancer