Constriction Behavior, a Key Innovation In Snake Evolution: The Integration of Ethology and Physiology

Among living tetrapod vertebrates, snakes exhibit the most radical shifts in feeding biology and among limbless squamate reptiles, only snakes have undergone a substantial adaptive radiation. The behavioral innovation, constriction, has been associated with the success of this clade. Constriction is a prey restraint behavior that enabled snakes to immobilize and subdue extremely large prey items relative to their own body mass. This behavior pattern is associated with the incredible shifts observed in snake feeding biology from consuming small meals frequently to less frequent feeding on large prey. Although constriction is an ethological homology for the majority of snakes, variations of constriction postures have been documented in many derived snake lineages. Nevertheless, the mechanisms driving behavioral variation are not well understood. In this dissertation, I attempt to use a comparative hierarchical approach to examine constriction behavior at both the ethological and physiological levels in order to better understand the behavioral variation of this key innovation. As reviewed in Part 1, derived snake lineages seem to have several methods with which to restrain prey. Prey restraint methods appear to vary with respect to prey characteristics (size, shape, activity level). On the other hand, intermediate taxa (boas and pythons) are thought to be less variable in the prey restraint phase of feeding. The kinematics of loop application pattern also appears to differ between intermediate and derived snake groups. Derived snakes use the lateral part of their body to wind prey whereas boas tend to bend ventrally around prey. The polarity for variable prey restraint behavior and loop application patterns have not been determined as observations on feeding behavior for basal snake taxa are lacking. I report on stimulus control studies evaluating prey restraint behavior and loop application pattern for basal and intermediate snake taxa in Part 2. Testing for the effects of prey size and status on the prey restraint behavior enabled me to polarize variable prey restraint behavior and loop application pattern. Prey size and status had varying effects on the capture position, prey restraint method, prey restraint time and swallowing time for basal and semi-fossorial boas while individuals of B. constrictor only constricted prey. Looping one or more times around prey was observed during the intraoral transport (swallowing) phase of feeding in the majority of trials for L. bicolor and Erycine snakes (Eryx muelleri, Charina bottae, Lichanura triviragata). Loop application patterns varied across snake taxa with basal and semi-fossorial boas applying loops laterally around prey. Individuals of B. constrictor bent ventrally around prey. The ability to vary prey restraint behavior, in response to prey characteristics and applying loops laterally around prey is probably the ancestral condition in snakes. Intermediate taxa, such a boas exhibit a derived simplified behavioral repertoire. Examining the underlying physiology of a complex motor pattern, such as constriction behavior, can provide a better understanding of the hierarchical structure of organisms in nature. As an ethological homology, constriction behavior provides us with the opportunity to trace evolutionary change at other levels of biological organization and to examine how various levels within a hierarchy relate to one another. Although constriction is an important key innovation associated with the adaptive radiation of snakes, few studies have examined the underlying physiological patterns of this complex motor pattern that may account for the kinematic variability of constriction postures among snakes. In Parts 3 & 4, I comparatively examine the muscle activity patterns during constriction for basal and intermediate snake lineages. I specifically investigated how the underlying physiological mechanisms of constriction correspond to the postural changes observed at the behavioral level using electromyography. Lateral bending and unilateral muscle activity patterns were predominant in the basal taxon, Loxocemus bicolor. Lateral bending and unilateral muscle activity patterns were also observed in derived snake taxa previously documented. Ventral bending and bilateral epaxial muscle activity patterns were predominant in intermediate lineages and present in derived snake lineages. Therefore, similar to prey restraint behaviors, three epaxial muscle activity patterns were observed: 1) mostly lateral bending with unilateral epaxial muscle activity, 2) mostly ventral bending with bilateral muscle activity and 3) mostly lateral and some bilateral bends associated with both unilateral and bilateral epaxial muscle activity, “mixed”. The kinematic and muscle activity patterns correspond with the ethological data in Part 2. Lateral bending and unilateral epaxial muscle activity support the more variable prey restraint behaviors observed in basal and derived snake taxa. Ventral bending and bilateral activity supports the highly stereotyped behavior patterns observed in intermediate snake taxa. A ‘mixed’ kinematic and epaxial activity pattern supports highly variable prey restraint methods as observed from previous research on gopher snakes and kingsnakes. Thus the patterns of epaxial muscle activity underlying constriction behavior can be correlated with the variability in prey restraint postures. In Part 5, I integrate the behavioral, physiological, and ecological differences reported for L. bicolor and Boid snakes, from the stimulus control data and the physiological data collected in this study, to further discuss the origin and evolution of feeding behavior among basal, intermediate and derived snake taxa

Somatic BRCA2 Mutation-Positive Concurrent Accessory Male Breast Cancer (BC) and Non-Small Cell Lung Cancer (NSCLC): Excellent Efficacy of Palbociclib, Fulvestrant and Leuprolide in Platinum-Exposed and Endocrine-Refractory BC Associated with Cyclin D1 and FGFR1 Amplification and of Carboplatin, Paclitaxel and Radiation in NSCLC.

Accessory male breast cancer (BC) is a rare entity and is associated with poor outcome. We report a 76-year-old patient who was diagnosed with concurrent accessory breast and primary lung cancer, both were positive for somatic BRCA-2 (E1593D) mutation. He received concurrent radiation and platinum-based chemotherapy for lung cancer with good response, but breast cancer progressed in about 8 months, and further progressed after single agent anastrozole in 10 months. Next Generation Sequencing (NGS) of breast cancer was also positive for CCND1 (Cyclin D1) and FGFR1 amplifications. Despite a poor molecular profile of breast cancer, and progression following platinum-based chemotherapy and anastrozole, he was successfully treated with the Cyclin-dependent kinase (CKD) 4/6 inhibitor palbociclib, estrogen-receptor down-regulator fulvestrant and luteinizing hormone-releasing hormone (LHRH) agonist leuprolide with the duration of response of 21 months which has exceeded duration of response to prior treatments. This case is of interest given FDA expanded the approval of palbociclib in combination with AI or fulvestrant for male patients with HR-positive, HER2-negative metastatic breast cancer in Apr. 2019 based on real-world data from electronic health records

An alternative flow cytometry strategy for peripheral blood dendritic cell enumeration in the setting of repetitive GM-CSF dosing

BACKGROUND: Enumeration of circulating peripheral blood dendritic cells (DCs) is complicated by the absence of a unique cell surface marker expressed on all DC subsets and by the use of various biological adjuvants to modulate the DC compartment, including granulocyte macrophage colony stimulating factor (GM-CSF). Common methods employ a cocktail of antibodies, typically including anti-CD14, to define a lineage negative, MHC class II positive, putative DC population. Reported flow cytometry protocols include highly variable gating strategies and DC identification criteria. Increasing appreciation of DC pleiomorphism, GM-CSF biology, and recognition of CD14 expression in some DC subsets led us to consider an alternative lineage cocktail to improve identification of the circulating DC pool. METHODS: Standard whole blood staining with appropriate fluorochrome conjugated antibodies to MHC class II and either standard CD14 containing, or an alternate CD66acde containing, lineage cocktail was performed on samples obtained from normal donors and breast cancer patients before and after administration of dose-dense, cytotoxic chemotherapy with daily GM-CSF hematopoetic growth factor support. Putative DCs were enumerated by standard flow cytometry. Data set differences were evaluated using two tailed Mann-Whitney or Wilcoxon signed rank tests. Cellular morphology was examined in cell-sorted populations from post GM-CSF samples. RESULTS: Use of either antibody cocktail defined comparably sized lineage negative, MHC class II positive populations in normal donors and at baseline in cancer patients. However, selection of lineage negative subsets with increasing MHC class II expression levels yielded larger putative DC populations identified with the alternate cocktail. Both cocktails yielded highly reproducible data. Use of the alternate cocktail: 1) yielded a putative DC population, post GM-CSF that was more homogenous and consistent with DCs, 2) resulted in less data variation across gating strategies, and 3) resulted in more uniform and concordant longitudinal data, consistent with established GM-CSF biological activity. CONCLUSION: An alternative lineage negative cocktail substituting anti-CD66 antibody for anti-CD14 is a viable option for enumerating the circulating DC population, potentially more accurately defining the circulating DC pool by including CD14 positive immature DCs, and thus, may give more reliable data, particularly in the setting of sustained GM-CSF administration

Orbital Metastases from Breast Cancer with BRCA2 Mutation: A Case Report and Literature Review.

Breast cancer is the second leading cause of cancer-related deaths in women in the United States. Of these women, 5-10% have an inherited form of breast cancer with a mutation in a major gene, such as the breast cancer susceptibility genes 1 or 2 (BRCA1 or BRCA2). Triple negative (the most common subtype of BRCA1-associated breast cancers) and Her2-positive breast cancer patients have more frequently been observed to develop central nervous system (CNS) metastases compared to other molecular subtypes of breast cancers. However, it remains an open question if BRCA2-associated breast cancers also have a higher propensity to develop CNS metastases. Here we report a rare case of recurrent BRCA2-associated breast cancer which manifested as orbital metastases. At the time of this publication, this is one of the first cases of BRCA2-associated breast cancer to present with orbital metastases. In this article, we discuss the diagnostic challenges and review the literature regarding this rare presentation

Radiation-Associated Angiosarcoma of the Breast: A Case Report and Literature Review.

In the last couple of decades, breast conservation therapy, which utilizes a combination of surgery, radiotherapy, and endocrine or chemotherapy, has become the standard of care for treating early-stage breast cancer. This practice has been greatly beneficial in the improvement of the patient's quality of life but has also led to the increased use of radiotherapy and associated soft-tissue sarcomas, with angiosarcoma being the most common malignancy. Radiation-associated angiosarcoma (RAS) of the breast is a rare phenomenon, which has been reported to occur in approximately 0.9 out of 1,000 cases, with a reported onset as late as 23 years following radiotherapy. Here we report 2 cases of RAS that occurred within 6 and 13 years following radiotherapy of their primary breast lesion. We discuss the diagnostic and therapeutic challenges regarding this disease and review the current literature. This case report serves as cautionary lessons on the importance of considering RAS of the breast in the differential diagnosis during evaluation for recurrent breast neoplasms. Ongoing clinical trials using combinations of vascular endothelial growth factor inhibitors and chemotherapy may provide future avenues of treatment for this difficult-to-treat disease

Diffuse optical spectroscopic imaging reveals distinct early breast tumor hemodynamic responses to metronomic and maximum tolerated dose regimens.

BACKGROUND:Breast cancer patients with early-stage disease are increasingly administered neoadjuvant chemotherapy (NAC) to downstage their tumors prior to surgery. In this setting, approximately 31% of patients fail to respond to therapy. This demonstrates the need for techniques capable of providing personalized feedback about treatment response at the earliest stages of therapy to identify patients likely to benefit from changing treatment. Diffuse optical spectroscopic imaging (DOSI) has emerged as a promising functional imaging technique for NAC monitoring. DOSI uses non-ionizing near-infrared light to provide non-invasive measures of absolute concentrations of tissue chromophores such as oxyhemoglobin. In 2011, we reported a new DOSI prognostic marker, oxyhemoglobin flare: a transient increase in oxyhemoglobin capable of discriminating NAC responders within the first day of treatment. In this follow-up study, DOSI was used to confirm the presence of the flare as well as to investigate whether DOSI markers of NAC response are regimen dependent. METHODS:This dual-center study examined 54 breast tumors receiving NAC measured with DOSI before therapy and the first week following chemotherapy administration. Patients were treated with either a standard of care maximum tolerated dose (MTD) regimen or an investigational metronomic (MET) regimen. Changes in tumor chromophores were tracked throughout the first week and compared to pathologic response and treatment regimen at specific days utilizing generalized estimating equations (GEE). RESULTS:Within patients receiving MTD therapy, the oxyhemoglobin flare was confirmed as a prognostic DOSI marker for response appearing as soon as day 1 with post hoc GEE analysis demonstrating a difference of 48.77% between responders and non-responders (p < 0.0001). Flare was not observed in patients receiving MET therapy. Within all responding patients, the specific treatment was a significant predictor of day 1 changes in oxyhemoglobin, showing a difference of 39.45% (p = 0.0010) between patients receiving MTD and MET regimens. CONCLUSIONS:DOSI optical biomarkers are differentially sensitive to MTD and MET regimens at early timepoints suggesting the specific treatment regimen should be considered in future DOSI studies. Additionally, DOSI may help to identify regimen-specific responses in a more personalized manner, potentially providing critical feedback necessary to implement adaptive changes to the treatment strategy

Alport's Syndrome in Pregnancy

Background. Alport's syndrome is an X-linked hereditary disorder affecting the glomerular basement membrane associated with ocular and hearing defects. In women, the disease is much less severe compared to that in men. However, women with Alport's syndrome can have an accelerated form of their disease during pregnancy with worsening of kidney function and can also develop preeclampsia. There are only four described cases of Alport's syndrome in pregnancy. Case Presentation. 20-year-old woman with a history of Alport's syndrome, which during pregnancy worsened resulting in hypertension, proteinuria, and acute kidney injury. Fortunately, there was complete resolution of the proteinuria and kidney injury with delivery, and the patient did not require any renal replacement therapy. Conclusion. One of the four reported cases had an accelerated form of the disease during pregnancy with rapid progression of kidney injury and end-stage renal disease. There are no definite guidelines to monitor these patients during pregnancy. Further studies are required to understand the exact pathophysiology of kidney damage that occurs in pregnant women with Alport's syndrome. This may give us some insight into the prognostic predictors, so that we can monitor these women more thoroughly and prevent adverse outcomes

Benign Metastasizing Leiomyoma to the Lung and Spine: A Case Report and Literature Review.

Benign metastasizing leiomyomas (BML) represent a rare phenomenon consisting of the extra-uterine spread of smooth muscle cells with similar histological, immunological, and molecular patterns to those of benign uterine leiomyomas. They are considered benign based off their low mitotic activity, lack of anaplasia or necrosis, and limited vascularization. This condition represents an interesting diagnostic and treatment challenge based on their rarity and indolent nature. Our case represents a unique finding of BML in the thoracic spine in a postmenopausal woman many years after hysterectomy and partial oophorectomy. There are currently no standard guidelines for treatment of BML, given the rare nature of this condition, with most patients treated with a combination of surgical resection and radiotherapy, followed by hormonal treatment and radiological surveillance serving as the primary backbone of current management plans. Given that these patients present a unique clinical challenge in terms of diagnosis and management, it is important to delineate and further examine these rare entities

Background Parenchymal Enhancement of the Contralateral Normal Breast: Association with Tumor Response in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

AbstractPURPOSE: This study investigated the association between background parenchymal enhancement (BPE) and pathologic response to neoadjuvant chemotherapy (NAC). METHODS: A total of 46 patients diagnosed with invasive breast cancer were analyzed. Each patient had three magnetic resonance imaging (MRI) studies, one pre-treatment and two follow-up (F/U) MRI studies. BPE was measured as the averaged enhancement of the whole fibroglandular tissues. The pre-treatment BPE and the changes in the F/U MRI were compared between patients achieving pathologic complete response (pCR) versus those not. Subgroup analyses based on age, estrogen receptor (ER), and human epidermal growth factor receptor 2 (HER2) status of their cancers were also performed. RESULTS: The pre-treatment BPE was higher in the pCR group than that in the non-pCR group. Compared to baseline, BPE at F/U-1 was significantly decreased in the pCR group but not in the non-pCR group. In subgroup analysis based on age, these results were seen only in the younger group (<55 years old), not in the older group (≥55 years old). Older patients had a significantly lower pre-treatment BPE than younger patients. In analysis based on molecular biomarkers, a significantly decreased BPE at F/U-1 was only found in the ER-negative pCR group but not in the non-pCR, nor in the ER-positive groups. CONCLUSIONS: A higher pre-treatment BPE showing a significant decrease early after starting NAC was related to pCR in pre/peri-menopausal patients