A quick and easy method for the analysis of anticoagulant rodenticides in blood or tissue using principles of dispersive solid-phase extraction (dSPE), commonly known as QuEChERS (short for quick, ...easy, cheap, effective, rugged, and safe), was developed. Briefly, a combination of magnesium sulfate, PSA, florisil, and basic alumina was used to cleanup blood samples. Further, to clean up liver tissue samples, C18 sorbent was included along with the previously mentioned. The samples were analyzed using high-performance liquid chromatography equipped with a reversed-phase C18 column (150 × 4.6 mm, 5-µm particle size) and a UV and fluorescence detector. The mobile phase consisted of 0.03 M tetrabutylammonium hydroxide (TBA) adjusted to pH 7/methanol (1:1, v/v) as solvent A and methanol as solvent B in a gradient run. The method detection limit was as low as 10 ng/mL for brodifacoum and difenacoum in blood and 10 ng/g in liver; 50 ng/mL for bromadiolone, difethialone, and chlorphacinone in blood and similarly 50 ng/g in liver; and 100 ng/mL for coumafuryl, pindone, warfarin, and diphacinone in blood and 100 ng/g in liver samples. A number of clinical samples of both blood and liver were analyzed; the comparison of this modified QuEChERS and traditional solid-phase extraction data was found to be in close agreement. This method resulted in drastic reduction in processing time and solvent cost both in terms of consumption and disposal, thus making it an attractive alternative to the traditional solid-phase extraction.
Intrauterine levonorgestrel (LNG-IUD) is used to treat patients with endometrial adenocarcinoma (EAC) and endometrial hyperplasia with atypia (EHA) but limited evidence is available on its ...effectiveness. The study determined the extent to which LNG-IUD with or without metformin (M) or weight loss (WL) achieves a pathological complete response (pCR) in patients with EAC or EHA.
This phase II randomized controlled clinical trial enrolled patients with histologically confirmed, clinically stage 1 FIGO grade 1 EAC or EHA; a body mass index (BMI) >30 kg/m2; a depth of myometrial invasion of less than 50% on MRI; a serum CA125 ≤ 30 U/mL. All patients received LNG-IUD and were randomized to observation (OBS), M (500 mg orally twice daily), or WL (pooled analysis). The primary outcome measure was the proportion of patients developing a pCR (defined as absence of any evidence of EAC or EHA) after 6 months.
From December 2012 to October 2019, 165 patients were enrolled and 154 completed the 6-months follow up. Women were on average 53 years of age, with BMI 48kg/m2. A total of 96 patients were diagnosed with EAC (58%) and 69 patients with EHA (42%). A total of 35 participants were randomized to OBS, 36 to WL and 47 to M (10 patients were withdrawn). After 6 months, the rate of pCR was 61% (95% CI 42% to 77%) for OBS, 67% (95% CI 48% to 82%) for WL and 57% (95% CI 41% to 72%) for M. Across the 3 treatment groups, the pCR was 82% and 43% for EHA and EAC, respectively.
Complete response rates at 6 months were encouraging for patients with EAC and EHA across the three groups.
Evidence linking coding germline variants in breast cancer (BC)-susceptibility genes other than BRCA1, BRCA2, and CHEK2 with contralateral breast cancer (CBC) risk and breast cancer-specific survival ...(BCSS) is scarce. The aim of this study was to assess the association of protein-truncating variants (PTVs) and rare missense variants (MSVs) in nine known (ATM, BARD1, BRCA1, BRCA2, CHEK2, PALB2, RAD51C, RAD51D, and TP53) and 25 suspected BC-susceptibility genes with CBC risk and BCSS. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox regression models. Analyses included 34,401 women of European ancestry diagnosed with BC, including 676 CBCs and 3,449 BC deaths; the median follow-up was 10.9 years. Subtype analyses were based on estrogen receptor (ER) status of the first BC. Combined PTVs and pathogenic/likely pathogenic MSVs in BRCA1, BRCA2, and TP53 and PTVs in CHEK2 and PALB2 were associated with increased CBC risk HRs (95% CIs): 2.88 (1.70–4.87), 2.31 (1.39–3.85), 8.29 (2.53–27.21), 2.25 (1.55–3.27), and 2.67 (1.33–5.35), respectively. The strongest evidence of association with BCSS was for PTVs and pathogenic/likely pathogenic MSVs in BRCA2 (ER-positive BC) and TP53 and PTVs in CHEK2 HRs (95% CIs): 1.53 (1.13–2.07), 2.08 (0.95–4.57), and 1.39 (1.13–1.72), respectively, after adjusting for tumor characteristics and treatment. HRs were essentially unchanged when censoring for CBC, suggesting that these associations are not completely explained by increased CBC risk, tumor characteristics, or treatment. There was limited evidence of associations of PTVs and/or rare MSVs with CBC risk or BCSS for the 25 suspected BC genes. The CBC findings are relevant to treatment decisions, follow-up, and screening after BC diagnosis.
Protein-truncating and/or (likely) pathogenic missense variants in BRCA1, BRCA2, CHEK2, PALB2, and TP53 were associated with 2- to 8-fold higher risk of contralateral breast cancer. Associations with breast cancer-specific survival were generally weaker. These findings are relevant to treatment decisions, follow-up, and screening after breast cancer diagnosis.
Aim
To catalogue and compare the pattern of metastatic disease in germline BRCA1/2 pathogenic mutation carriers and non‐carriers with breast, ovarian and prostate cancer from a rapid autopsy ...programme.
Methods and results
The number of metastases in the major body systems and the proportion of participants with metastases were documented in 50 participants (19 germline mutation carriers). Analysis was conducted on the participants’ pattern of disease for the different cancers and mutation subgroups. The four commonly affected organ systems were the digestive (liver only) (82%), respiratory (76%), gastrointestinal (65%) and reticuloendothelial (42%). There were significant differences in the pattern of metastatic breast cancer in BRCA1/2 germline carriers compared with non‐carriers. Breast cancer carriers had significantly fewer organ systems involved (median n = 3, range = 1–3) compared with non‐carriers (median n = 9, range = 1–7) (P = 0.03). BRCA1/2 carriers with ovarian carcinomas had significantly more organ systems with metastatic carcinoma (median n = 10, range = 3–8) than non‐carriers (median n = 5, range = 3–5) (P < 0.001). There were no significant differences in the number of involved systems in BRCA2 carriers compared with non‐carriers with prostate cancer (P = 1.0). There was an absence of locoregional disease (6.5%) compared with distant disease (93.5%) among the three cancer subtypes (P < 0.001). The majority of metastatic deposits (97%) collected during the autopsy were identified by recent diagnostic imaging.
Conclusion
Even though a major limitation of this study is that our numbers are small, especially in the breast cancer carrier group, the metastatic patterns of breast and ovarian cancers may be impacted by BRCA1/2 carrier status, suggesting that tumours derived from patients with these mutations use different mechanisms of dissemination. The findings may focus clinical diagnostic imaging for monitoring metastases where whole‐body imaging resources are scant.
This study catalogued and compared the pattern of metastatic disease in germline BRCA1/2 pathogenic mutation carriers and non‐carriers with breast, ovarian and prostate cancer from a rapid autopsy programme. Our findings suggest that metastatic patterns of breast and ovarian cancers maybe impacted by BRCA1/2 carrier status, suggesting that tumours derived from patients with these mutations use different mechanisms of dissemination.
Unlike the great advances that have been made in reducing breast cancer mortality through the multidisciplinary treatment of primary disease, much less is understood about the natural history of ...metastatic disease, despite this being the single most significant predictor of poor outcome for patients. Currently, much of treatment decision-making concerning a patient with metastatic disease is based on the biological characteristics of their primary tumour. There is a growing appreciation, however, that metastases arise from clonal subpopulations of cells from a primary tumour that may be genetically and phenotypically heterogeneous. The metastases may also undergo successive rounds of clonal expansion and adaptation in response to selective pressures endured in the foreign microenvironment of new tissues and treatment. In fact, cancer progression and colonisation is likely to be underpinned by a collective cooperation between cellular, genomic and microenvironmental factors that generate diversity to facilitate treatment resistance and metastatic capability. The extent and overall clinical significance of this diversity in metastatic progression is still unclear, owing to the scarcity of samples of metastases that are available for molecular analysis.
Liver samples from red-tailed hawks (Buteo jamaicensis) and great horned owls (Bubo virginianus) were analyzed for anticoagulant rodenticides. Residues of one or more second generation anticoagulant ...rodenticides (SGARs) were detected in 81 % of red-tailed hawks and 82 % of great horned owls. The most frequently detected SGAR was brodifacoum, which was detected in 76 % of red-tailed hawks and 73 % of great horned owls. Bromadiolone was detected in 20 % of red-tailed hawks and 27 % of great horned owls. Difenacoum was detected in one great horned owl. No other ARs were detected. There were no significant differences between species in the frequency of detection or concentration of brodifacoum or bromadiolone. There was a marginally significant difference (p = 0.0497) between total SGAR residues in red-tailed hawks (0.117 mg/kg) and great horned owls (0.070 mg/kg). There were no seasonal differences in the frequency of detection or concentration of brodifacoum in red-tailed hawks. The data suggest that SGARs pose a significant risk of poisoning to predatory birds in New Jersey.
Next generation sequencing has revolutionised genomic studies of cancer, having facilitated the development of precision oncology treatments based on a tumour's molecular profile. We aimed to develop ...a targeted gene sequencing panel for application to disparate cancer types with particular focus on tumours of the head and neck, plus test for utility in liquid biopsy. The final panel designed through Roche/Nimblegen combined 451 cancer-associated genes (2.01 Mb target region). 136 patient DNA samples were collected for performance and application testing. Panel sensitivity and precision were measured using well-characterised DNA controls (n = 47), and specificity by Sanger sequencing of the Aryl Hydrocarbon Receptor Interacting Protein (AIP) gene in 89 patients. Assessment of liquid biopsy application employed a pool of synthetic circulating tumour DNA (ctDNA). Library preparation and sequencing were conducted on Illumina-based platforms prior to analysis with our accredited (ISO15189) bioinformatics pipeline. We achieved a mean coverage of 395x, with sensitivity and specificity of >99% and precision of >97%. Liquid biopsy revealed detection to 1.25% variant allele frequency. Application to head and neck tumours/cancers resulted in detection of mutations aligned to published databases. In conclusion, we have developed an analytically-validated panel for application to cancers of disparate types with utility in liquid biopsy.
Though most colorectal cancers show allelic losses, a subset of colorectal cancers (microsatellite instability or MSI-positive cancers) develop numerous small insertion and deletion mutations in ...repetitive DNA. Some of these sequences occur in coding regions of cancer related genes which, when targeted by frameshift mutations, produce truncations in their protein product. Such a gene is the proapoptotic tumor suppressor, BAX, mutated by frameshifts within a polyG sequence in approximately 50% of MSI-positive colorectal cancers. BAX is directly transactivated by p53, a gene commonly mutated in colorectal cancers but not often in MSI-positive lesions. Here we sought to characterize the relationship between BAX and p53 by simultaneously analysing a selected series of 65 colorectal tumors for mutations in the entire coding regions of both genes. The tumors comprised 19 MSI-high, 12 MSI-low and 34 MSI-null cancers. Eight of 19 MSI-high sporadic colorectal cancers (42%) contained insertions and deletions at the polyG tract in the BAX gene. In addition, three somatic BAX missense mutations were identified in two tumors. A single missense mutation was detected in an MSI-high tumor that also contained a frameshift microdeletion, and two missense mutations were identified in an MSI-null tumor wild-type for p53. p53 mutations were detected in 5/12 MSI-low tumors (42%) and 12/34 MSI-null tumors (35%). Of significance, no p53 mutations were detected in MSI-high tumors. This study demonstrates that a reciprocal relationship exists between p53 and BAX in sporadic colorectal cancers, and further supports the hypothesis that MSI-low tumors are biologically similar to MSI-null tumors.
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