Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial

BACKGROUND: Bone metastases frequently cause skeletal events in patients with metastatic castration-resistant prostate cancer. Radium-223 dichloride (radium-223) selectively targets bone metastases with high-energy, short-range α-particles. We assessed the effect of radium-223 compared with placebo in patients with castration-resistant prostate cancer and bone metastases.

METHODS: In this phase 3, double-blind, randomised ALSYMPCA trial, we enrolled patients who had symptomatic castration-resistant prostate cancer with two or more bone metastases and no known visceral metastases, who were receiving best standard of care, and had previously either received or were unsuitable for docetaxel. Patients were stratified by previous docetaxel use, baseline total alkaline phosphatase level, and current bisphosphonate use, then randomly assigned (2:1) to receive either six intravenous injections of radium-223 (50 kBq/kg) or matching placebo; one injection was given every 4 weeks. Randomisation was done with an interactive voice response system, taking into account trial stratification factors. Participants and investigators were masked to treatment assignment. The primary endpoint was overall survival, which has been reported previously. Here we report on time to first symptomatic skeletal event, defined as the use of external beam radiation to relieve bone pain, or occurrence of a new symptomatic pathological fracture (vertebral or non-verterbal), or occurence of spinal cord compression, or tumour-related orthopeadic surgical intervention. All events were required to be clinically apparent and were not assessed by periodic radiological review. Statistical analyses of symptomatic skeletal events were based on the intention-to-treat population. The study has been completed and is registered with ClinicalTrials.gov, number NCT00699751.

FINDINGS: Between June 12, 2008, and Feb 1, 2011, 921 patients were enrolled, of whom 614 (67%) were randomly assigned to receive radium-223 and 307 (33%) placebo. Symptomatic skeletal events occurred in 202 (33%) of 614 patients in the radium-223 group and 116 (38%) of 307 patients in the placebo group. Time to first symptomatic skeletal event was longer with radium-223 than with placebo (median 15·6 months [95% CI 13·5-18·0] vs 9·8 months [7·3-23·7]; hazard ratio [HR]=0·66, 95% CI 0·52-0·83; p=0·00037). The risks of external beam radiation therapy for bone pain (HR 0·67, 95% CI 0·53-0·85) and spinal cord compression (HR=0·52, 95% CI 0·29-0·93) were reduced with radium-233 compared with placebo. Radium-223 treatment did not seem to significantly reduce the risk of symptomatic pathological bone fracture (HR 0·62, 95% CI 0·35-1·09), or the need for tumour-related orthopaedic surgical intervention (HR 0·72, 95% CI 0·28-1·82).

INTERPRETATION: Radium-223 should be considered as a treatment option for patients with castration-resistant prostate cancer and symptomatic bone metastases.

FUNDING: Algeta and Bayer HealthCare Pharmaceuticals.

PTEN mRNA detection by chromogenic, RNA in situ technologies: a reliable alternative to PTEN immunohistochemistry

Immunohistochemical staining for phosphatase and tensin homolog (PTEN) does not have either an acceptable standard protocol or concordance of scoring between pathologists. Evaluation of PTEN mRNA with a unique and verified sequence probe may offer a realistic alternative providing a robust and reproducible protocol. In this study, we have evaluated an in situ hybridization (ISH) protocol for PTEN mRNA using RNAScope technology and compared it with a standard protocol for PTEN immunohistochemistry (IHC). PTEN mRNA expression by ISH was consistently more sensitive than PTEN IHC, with 56% of samples on a mixed-tumor tissue microarray (TMA) showing high expression by ISH compared with 42% by IHC. On a prostate TMA, 49% of cases showed high expression by ISH compared with 43% by IHC. Variations in PTEN mRNA expression within malignant epithelium were quantifiable using image analysis on the prostate TMAs. Within tumors, clear overexpression of PTEN mRNA on malignant epithelium compared with benign epithelium was frequently observed and quantified. The use of SpotStudio software in the mixed-tumor TMA allowed for clear demonstration of varying levels of PTEN mRNA between tumor samples by the mRNA methodology. This was evident by the quantifiable differences between distinct oropharyngeal tumors (up to 3-fold increase in average number of spots per cell between 2 cases). mRNA detection of PTEN or other biomarkers, for which optimal or standardized immunohistochemical techniques are not available, represents a means by which heterogeneity of expression within focal regions of tumor can be explored with more confidence.

Sorting out mix-ups. The provenance of tissue sections may be confirmed by PCR using microsatellite markers

Standard identification systems usually ensure that biopsy material is correctly associated with a given patient. Sometimes, as when a tumor is unexpectedly found, the provenance (proof of origin) of a tissue sample may be questioned; the tissue may have been mislabelled or contaminated with tissue from another patient. Techniques used to confirm tissue provenance include comparing either tissue markers of gender or ABO blood groups; however, these methods have weak confirmatory power. Recently, the use of DNA-based polymerase chain reaction (PCR) techniques has been reported. Paired, formalin-fixed, paraffin-embedded, 10 microns tissue sections were selected from 17 patients, 8 of whom had carcinoma, either by dividing a biopsy section, using sequential biopsies, or sequential biopsy and autopsy tissue. The resulting 36 samples were coded before analysis. In two additional cases, 1-mm fragments of tumor from one patient were included in the tissue block of benign tissue from another patient, the tumor fragments were identified on hematoxylin-and-eosin-stained sections, separately scraped off the glass slide, and analyzed. Tissue from two clinical cases, one of suspected mislabelling and one with a suspected carry-over of malignant tissue were also investigated. Short tandem repeat sequences (STR) or microsatellites, are 2-5 base pair repeats that vary in their repeat number between individuals. This variation (polymorphism) can be assessed using a PCR. A panel of markers of 3 STRs; ACPP, INT 2, and CYP 19 (on chromosomes 3, 11, and 15, respectively) were used. DNA was isolated from the samples after xylene deparaffinization and proteinase digestion, and was then amplified in a radioactive PCR using primers selected to give a product size ranging from 136-178 bases. Amplified products were electrophoresed on denaturing polyacrylamide gels, dried, and autoradiographed. DNA segments were successfully extracted from all samples but one, which was fixed in Bouin's fluid. By comparing allele sizes from the panel, all tissue pairs (other than the Bouin's pair) were successfully matched, the 1-mm tumor fragments were correctly assigned, and the two clinical problems were solved. STRs are highly informative and robust markers, well suited to PCR of small portions of tissue sections, and are an effective method to confirm the provenance of benign and malignant biopsy and autopsy material.

Architecture as Pedagogy: Alive and Kicking

This workshop draws on an emerging collaborative body of research by Lovett, Morrow and McClean that aims to understand architecture and its processes as a form of pedagogical practice: a civic pedagogy.

Architectural education can be valued not only as a process that delivers architecture-specific skills and knowledges, but also as a process that transforms people into critically active contributors to society. We are keen to examine how and where those skills are developed in architectural education and trace their existence and/or application within practice. We intend to examine whether some architectural and spatial practices are intrinsically pedagogical in their nature and how the level of involvement of clients, users and communities can mimic the project-based learning of architectural education – in particularly in the context of ‘live project learning’

1. This workshop begins with a brief discussion paper from Morrow that sets out the arguments behind why and how architecture can be understood as pedagogy. It will do so by presenting firstly the relationship between architectural practice and pedagogy, drawing out both contemporary and historical examples of architecture and architects acting pedagogically. It will also consider some other forms of creative practice that explicitly frame themselves pedagogically, and focus on participatory approaches in architectural practice that overlap with inclusive and live pedagogies, concluding with a draft and tentative abstracted pedagogical framework for architectural practice.

2. Lovett will examine practices of architectural operation that have a pedagogical approach, or which recognise within themselves an educational subtext/current. He is most interested in a 'liveness' beyond the 'Architectural Education' of university institutions. The presentation will question the scope for both spatial empowerment / agency and a greater understanding and awareness of the value of good design when operating as architects with participant-clients younger than 18, older than 25 or across varied parts of society. Positing that the learning might be greatest when there are no prescribed 'Learning Outcomes' and that such work might depend on risk-taking and playfulness, the presentation will be a curated showcase drawing on his own ongoing work.

Both brief presentations will inform the basis of the workshop’s discussion which hopes to draw on participants views and expereinces to enrich the research process. The intention is that the overall workshop will lead to a call for contributors and respondents to a forthcoming publication on ‘Architecture as Pedagogy’.

Tyrosine phosphorylation and dephosphorylation in Burkholderia cenocepacia affect biofilm formation, growth under nutritional deprivation, and pathogenicity

Burkholderia cenocepacia, a member of the B. cepacia complex (Bcc), is an opportunistic pathogen causing serious chronic infections in patients with cystic fibrosis. Tyrosine phosphorylation has emerged as an important post-translational modification modulating the physiology and pathogenicity of Bcc bacteria. Here, we investigated the predicted bacterial tyrosine kinases BCAM1331 and BceF, and the low molecular weight protein tyrosine phosphatases BCAM0208, BceD and BCAL2200 of B. cenocepacia K56-2. We show that BCAM1331, BceF, BCAM0208 and BceD contributed to biofilm formation, while BCAL2200 was required for growth in nutrient-limited conditions. Multiple deletions of either tyrosine kinase or low molecular weight protein tyrosine phosphatases genes resulted in attenuation of B. cenocepacia intramacrophage survival and reduced pathogenicity in the Galleria mellonella larvae infection model. Experimental evidence indicates that BCAM1331 displays a reduced
tyrosine autophosphorylation activity compared to BceF. Using the artificial substrate p-nitrophenyl phosphate, the phosphatase activity of the three low molecular weight protein tyrosine phosphatases demonstrated similar kinetic parameters. However, only BCAM0208 and BceD could dephosphorylate BceF. Further, BCAL2200 becomes tyrosine phosphorylated in vivo and catalyzes its auto-dephosphorylation. Together, our data suggest that despite having similar biochemical activities low molecular weight protein tyrosine phosphatases and tyrosine kinases have both overlapping and specific roles in the physiology of B. cenocepacia.

IRS2 and PTEN are key molecules in controlling insulin sensitivity in podocytes

Insulin signaling to the glomerular podocyte is important for normal kidney function and is implicated in the pathogenesis of diabetic nephropathy (DN). This study determined the role of the insulin receptor substrate 2 (IRS2) in this system. Conditionally immortalized murine podocytes were generated from wild-type (WT) and insulin receptor substrate 2-deficient mice (Irs2−/−). Insulin signaling, glucose transport, cellular motility and cytoskeleton rearrangement were then analyzed. Within the glomerulus IRS2 is enriched in the podocyte and is preferentially phosphorylated by insulin in comparison to IRS1. Irs2−/− podocytes are significantly insulin resistant in respect to AKT signaling, insulin-stimulated GLUT4-mediated glucose uptake, filamentous actin (F-actin) cytoskeleton remodeling and cell motility. Mechanistically, we discovered that Irs2 deficiency causes insulin resistance through up-regulation of the phosphatase and tensin homolog (PTEN). Importantly, suppressing PTEN in Irs2−/− podocytes rescued insulin sensitivity. In conclusion, this study has identified for the first time IRS2 as a critical molecule for sensitizing the podocyte to insulin actions through its ability to modulate PTEN expression. This finding reveals two potential molecular targets in the podocyte for modulating insulin sensitivity and treating DN.

When the guardian becomes the enemy, targeting ATM in PTEN deficient cancers

Ataxia Telangiectasia Mutated (ATM) is an important signalling molecule in the DNA damage response and inhibitors of ATM are under clinical development. We identified a synthetic lethal interaction between ATM inhibition and Phosphatase and tensin homolog (PTEN) loss which was the result of increased oxidative stress. Inhibition of ATM therefore represents a novel strategy to target PTEN associated cancers.

PRL-3 activates mTORC1 in Cancer Progression

PRL-3, a metastasis-associated phosphatase, is known to exert its oncogenic functions through activation of PI3K/Akt, which is a key regulator of the rapamycin-sensitive mTOR complex 1 (mTORC1), but a coherent link between PRL-3 and activation of mTOR has not yet been formally demonstrated. We report a positive correlation between PRL-3 expression and mTOR phospho-activation in clinical tumour samples and mouse models of cancer and demonstrate that PRL-3 increased downstream signalling to the mTOR substrates, p70S6K and 4E-BP1, by increasing PI3K/Akt-mediated activation of Rheb-GTP via TSC2 suppression. We also show that PRL-3 increases mTOR translocation to lysosomes via increased mTOR binding affinity to Rag GTPases in an Akt-independent manner, demonstrating a previously undescribed mechanism of action for PRL-3. PRL-3 also enhanced matrix metalloproteinase-2 secretion and cellular invasiveness via activation of mTOR, attributes which were sensitive to rapamycin treatment. The downstream effects of PRL-3 were maintained even under conditions of environmental stress, suggesting that PRL-3 provides a strategic survival advantage to tumour cells via its effects on mTOR.

The importance of the gestation period for welfare of lambs: Maternal stressors and lamb vigour and wellbeing

The prenatal period is of critical importance in defining how individuals respond to their environment throughout life. Stress experienced by pregnant females has been shown to have detrimental effects on offspring behaviour, health and productivity. The sheep has been used extensively as a model species to inform human studies. However, in the farmed environment, the consequences for the lamb of the imposition of prenatal stresses upon the ewe have received much less attention. The stressors that pregnant ewes are most frequently exposed to include sub-optimal nutrition and those related to housing, husbandry and environment which may be either acute or chronic. A systematic review of the literature was adopted to identify material which had production-relevant maternal stressors and lamb outcomes. The current review focussed upon the lamb up to weaning around the age of 100 days and the results clearly demonstrate that stressors imposed upon the ewe have implications for offspring welfare and performance. Maternal under-nutrition (UN) in the last third of pregnancy consistently impaired lamb birth-weight and subsequent vigour and performance, while earlier UN had a variable effect on performance. Feeding the ewe above requirements did not have positive effects on lamb performance and welfare. Social and husbandry stressors such as transport, shearing, mixing and physiological treatments designed to mimic acute stress which would be considered disadvantageous for the ewe had positive or neutral effects for the lamb, highlighting a potential conflict between the welfare of the ewe and her lamb. This review also identified considerable gaps in knowledge, particularly in respect of the impact of disease upon the ewe during pregnancy and interactions between different stressors and the responses of ewe and lamb.

The sarcolemmal calcium pump inhibits the calcineurin/nuclear factor of activated T-cell pathway via interaction with the calcineurin A catalytic subunit

The calcineurin/nuclear factor of activated T-cell (NFAT) pathway represents a crucial transducer of cellular function. There is increasing evidence placing the sarcolemmal calcium pump, or plasma membrane calcium/calmodulin ATPase pump (PMCA), as a potential modulator of signal transduction pathways. We demonstrate a novel interaction between PMCA and the calcium/calmodulin-dependent phosphatase, calcineurin, in mammalian cells. The interaction domains were located to the catalytic domain of PMCA4b and the catalytic domain of the calcineurin A subunit. Endogenous calcineurin activity, assessed by measuring the transcriptional activity of its best characterized substrate, NFAT, was significantly inhibited by 60% in the presence of ectopic PMCA4b. This inhibition was notably reversed by the co-expression of the PMCA4b interaction domain, demonstrating the functional significance of this interaction. PMCA4b was, however, unable to confer its inhibitory effect in the presence of a calcium/calmodulin-independent constitutively active mutant calcineurin A suggesting a calcium/calmodulin-dependent mechanism. The modulatory function of PMCA4b is further supported by the observation that endogenous calcineurin moves from the cytoplasm to the plasma membrane when PMCA4b is overexpressed. We suggest recruitment by PMCA4b of calcineurin to a low calcium environment as a possible explanation for these findings. In summary, our results offer strong evidence for a novel functional interaction between PMCA and calcineurin, suggesting a role for PMCA as a negative modulator of calcineurin-mediated signaling pathways in mammalian cells. This study reinforces the emerging role of PMCA as a molecular organizer and regulator of signaling transduction pathways.

GEP analysis validates high risk MDS and acute myeloid leukemia post MDS mice models and highlights novel dysregulated pathways

BACKGROUND: In spite of the recent discovery of genetic mutations in most myelodysplasic (MDS) patients, the pathophysiology of these disorders still remains poorly understood, and only few in vivo models are available to help unravel the disease.

METHODS: We performed global specific gene expression profiling and functional pathway analysis in purified Sca1+ cells of two MDS transgenic mouse models that mimic human high-risk MDS (HR-MDS) and acute myeloid leukemia (AML) post MDS, with NRASD12 and BCL2 transgenes under the control of different promoters MRP8NRASD12/tethBCL-2 or MRP8[NRASD12/hBCL-2], respectively.

RESULTS: Analysis of dysregulated genes that were unique to the diseased HR-MDS and AML post MDS mice and not their founder mice pointed first to pathways that had previously been reported in MDS patients, including DNA replication/damage/repair, cell cycle, apoptosis, immune responses, and canonical Wnt pathways, further validating these models at the gene expression level. Interestingly, pathways not previously reported in MDS were discovered. These included dysregulated genes of noncanonical Wnt pathways and energy and lipid metabolisms. These dysregulated genes were not only confirmed in a different independent set of BM and spleen Sca1+ cells from the MDS mice but also in MDS CD34+ BM patient samples.

CONCLUSIONS: These two MDS models may thus provide useful preclinical models to target pathways previously identified in MDS patients and to unravel novel pathways highlighted by this study.

Vitamin D3 suppresses morphological evolution of the cribriform cancerous phenotype

Development of cribriform morphology (CM) heralds malignant change in human colon but lack of mechanistic understanding hampers preventive therapy. This study investigated CM pathobiology in three-dimensional (3D) Caco-2 culture models of colorectal glandular architecture, assessed translational relevance and tested effects of 1,25(OH)2D3, the active form of vitamin D. CM evolution was driven by oncogenic perturbation of the apical polarity (AP) complex comprising PTEN, CDC42 and PRKCZ (phosphatase and tensin homolog, cell division cycle 42 and protein kinase C zeta). Suppression of AP genes initiated a spatiotemporal cascade of mitotic spindle misorientation, apical membrane misalignment and aberrant epithelial configuration. Collectively, these events promoted “Swiss cheese-like” cribriform morphology (CM) comprising multiple abnormal “back to back” lumens surrounded by atypical stratified epithelium, in 3D colorectal gland models. Intestinal cancer driven purely by PTEN-deficiency in transgenic mice developed CM and in human CRC, CM associated with PTEN and PRKCZ readouts. Treatment of PTEN-deficient 3D cultures with 1,25(OH)2D3 upregulated PTEN, rapidly activated CDC42 and PRKCZ, corrected mitotic spindle alignment and suppressed CM development. Conversely, mutationally-activated KRAS blocked 1,25(OH)2D3 rescue of glandular architecture. We conclude that 1,25(OH)2D3 upregulates AP signalling to reverse CM in a KRAS wild type (wt), clinically predictive CRC model system. Vitamin D could be developed as therapy to suppress inception or progression of a subset of colorectal tumors.

Language Experience Affects Grouping of Musical Instrument Sounds

Language experience clearly affects the perception of speech, but little is known about whether these differences in perception extend to non-speech sounds. In this study, we investigated rhythmic perception of non-linguistic sounds in speakers of French and German using a grouping task, in which complexity (variability in sounds, presence of pauses) was manipulated. In this task, participants grouped sequences of auditory chimeras formed from musical instruments. These chimeras mimic the complexity of speech without being speech. We found that, while showing the same overall grouping preferences, the German speakers showed stronger biases than the French speakers in grouping complex sequences. Sound variability reduced all participants' biases, resulting in the French group showing no grouping preference for the most variable sequences, though this reduction was attenuated by musical experience. In sum, this study demonstrates that linguistic experience, musical experience, and complexity affect rhythmic grouping of non-linguistic sounds and suggests that experience with acoustic cues in a meaningful context (language or music) is necessary for developing a robust grouping preference that survives acoustic variability.

Estudo de extractos de Genista tenera actividade antioxidante e inibição de enzimas do metabolismo da glucose

Objectivo: Estudar a actividade antidiabética e antioxidante de extractos de Genista tenera. Materiais e métodos: Investigou-se a actividade antioxidante pelo método das espécies reactivas ao ácido tiobarbitúrico e o método do MTT (3-(4,5- dimetiltiazol-2-il)-2,5-difenil brometo de tetrazolio). Procurou-se clarificar o mecanismo de acção antidiabética pelo estudo da actividade inibitória nas enzimas α-glucosidase, glucose-6-fosfatase e glicogénio fosforilase. Resultados: No ensaio de MTT os extractos em éter, butanol e acetato de etilo possuem boa actividade antioxidante (87,80 %, 67,82 % e 67,70 % de viabilidade celular respectivamente). Na α-glucosidase os extractos em butanol e acetato de etilo apresentaram inibição (0,97% e 2,36% de actividade enzimática). Os extractos em acetato de etilo, butanol e éter são inibidores da glucose-6- fosfatase (48,33%, 80,25% e 64,42% de actividade enzimática). Conclusões: Os extractos de Genista tenera em acetato de etilo, butanol e éter poderão ser no futuro incluídos em nutracêuticos para prevenir ou tratar a diabetes tipo 2.

Aß biology and its contribution to Alzheimer's disease

A doença de Alzheimer (DA) é uma desordem neurodegenerativa progressiva patologicamente caracterizada pela presença de placas de amilóide (placas senis) insolúveis e também pela presença de tranças neurofibrilhares,formadas pela proteína Tau hiperfosforiladada. O principal constituinte das placas senis é o peptídeo beta-amilóide (Ab), que deriva do processamento proteolítico da proteína precursora de amilóide de Alzheimer (APP). Embora Ab exista como um agregado pouco solúvel nas placas senis, ele é secretado pelas células como uma molécula solúvel. O Ab “per se” pode afectar o metabolismo da APP. Alguns autores sugerem que o Ab exerce o seu efeito alterando o processamento ou catabolismo da APP, outros sugerem que ele também induz a transcrição da APP, onde aumentando os níveis da APP pode estar a contribuir para a sua própria produção (mecanismo de “feedback” positivo). Assim sendo, torna-se difícil consolidar todas estas observações e identificar as potenciais funções fisiológicas do Ab “in vivo”, ou as consequências da sua produção. Neste trabalho caracterizaram-se os efeitos do Ab no metabolismo da APP. Os nossos estudos revelaram que um dos mecanismos induzidos pelo Ab é a acumulação intracelular do fragmento neuroprotector sAPP (isAPPa) em estruturas com características vesiculares associadas ao citosqueleto. Estudos adicionais em culturas primárias revelaram que o Ab estava a exercer o seu efeito ao nível da secreção vesicular, provavelmente interferindo com o transporte de APP/sAPP ao longo da rede do citosqueleto. Esta hipótese é sustentada pelo facto do Ab estar a afectar a estabilidade e a polimerização de proteínas envolvidas na dinâmica do citosqueleto. Contrariamente a publicações anteriores o Ab não induziu a transcrição da APP, na verdade em culturas primárias neuronais foi observado uma diminuição nos níveis de expressão da APP. Isto foi acompanhado por um aumento nos fragmentos C-terminais da APP (CTFs) e uma diminuição na localização nuclear do seu domínio intracelular (AICD), sugerindo alterações na sinalização nuclear da APP. O Ab pode afectar outras vias de sinalização, particularmente alterando o balanço entre as actividades das proteínas cinases e fosfatases, o que pode ter consequências para o desenvolvimento da doença. Os dados obtidos indicam que o Ab é capaz de inibir a actividade da proteína fosfatase1, a sua importância numa perspectiva de futuras terapias é discutida. Devido à relevância da agregação do Ab para a sua toxicidade, a formação de complexos com proteínas que promovem a sua desagregação/degradação e o seu efeito no processamento da APP foi avaliado. Na presença destes complexos observou-se uma reversão da acumulação isAPP, demonstrando o potencial terapêutico destas proteínas como moduladores do metabolismo da APP. Este trabalho permitiu compreender melhor os mecanismos envolvidos nos efeitos do Ab no processamento da APP e descobrir algumas moléculas que podem ser relevantes numa perspectiva de diagnóstico e terapia na DA.