Integration of copy number and transcriptomics provides risk stratification in prostate cancer: A discovery and validation cohort study

BACKGROUND: Understanding the heterogeneous genotypes and phenotypes of prostate cancer is fundamental to improving the way we treat this disease. As yet, there are no validated descriptions of prostate cancer subgroups derived from integrated genomics linked with clinical outcome.

METHODS: In a study of 482 tumour, benign and germline samples from 259 men with primary prostate cancer, we used integrative analysis of copy number alterations (CNA) and array transcriptomics to identify genomic loci that affect expression levels of mRNA in an expression quantitative trait loci (eQTL) approach, to stratify patients into subgroups that we then associated with future clinical behaviour, and compared with either CNA or transcriptomics alone.

FINDINGS: We identified five separate patient subgroups with distinct genomic alterations and expression profiles based on 100 discriminating genes in our separate discovery and validation sets of 125 and 103 men. These subgroups were able to consistently predict biochemical relapse (p = 0.0017 and p = 0.016 respectively) and were further validated in a third cohort with long-term follow-up (p = 0.027). We show the relative contributions of gene expression and copy number data on phenotype, and demonstrate the improved power gained from integrative analyses. We confirm alterations in six genes previously associated with prostate cancer (MAP3K7, MELK, RCBTB2, ELAC2, TPD52, ZBTB4), and also identify 94 genes not previously linked to prostate cancer progression that would not have been detected using either transcript or copy number data alone. We confirm a number of previously published molecular changes associated with high risk disease, including MYC amplification, and NKX3-1, RB1 and PTEN deletions, as well as over-expression of PCA3 and AMACR, and loss of MSMB in tumour tissue. A subset of the 100 genes outperforms established clinical predictors of poor prognosis (PSA, Gleason score), as well as previously published gene signatures (p = 0.0001). We further show how our molecular profiles can be used for the early detection of aggressive cases in a clinical setting, and inform treatment decisions.

INTERPRETATION: For the first time in prostate cancer this study demonstrates the importance of integrated genomic analyses incorporating both benign and tumour tissue data in identifying molecular alterations leading to the generation of robust gene sets that are predictive of clinical outcome in independent patient cohorts.

Challenging the cancer molecular stratification dogma: Intratumoral heterogeneity undermines consensus molecular subtypes and potential diagnostic value in colorectal cancer

Purpose:
A number of independent gene expression profiling studies have identified transcriptional subtypes in colorectal cancer (CRC) with potential diagnostic utility, culminating in publication of a CRC Consensus Molecular Subtype classification. The worst prognostic subtype has been defined by genes associated with stem-like biology. Recently, it has been shown that the majority of genes associated with this poor prognostic group are stromal-derived. We investigated the potential for tumor misclassification into multiple diagnostic subgroups based on tumoral region sampled.

Experimental Design:
We performed multi-region tissue RNA extraction/transcriptomic analysis using Colorectal Specific Arrays on invasive front, central tumor and lymph node regions selected from tissue samples from 25 CRC patients.

Results:
We identified a consensus 30 gene list which represents the intratumoral heterogeneity within a cohort of primary CRC tumors. Using a series of online datasets, we showed that this gene list displays prognostic potential (HR=2.914 (CI 0.9286-9.162) in stage II/III CRC patients, but in addition we demonstrated that these genes are stromal derived, challenging the assumption that poor prognosis tumors with stem-like biology have undergone a widespread Epithelial Mesenchymal Transition (EMT). Most importantly, we showed that patients can be simultaneously classified into multiple diagnostically relevant subgroups based purely on the tumoral region analysed.

Conclusions:
Gene expression profiles derived from the non-malignant stromal region can influence assignment of CRC transcriptional subtypes, questioning the current molecular classification dogma and highlighting the need to consider pathology sampling region and degree of stromal infiltration when employing transcription-based classifiers to underpin clinical decision-making in CRC.

Stratification and peer effects: An analysis of Lisbon public schools

Educational stratification has been a difficult subject to deal with having yet no study shown a quantitative measure of it. Using the idea of distribution comparison a measure based on parents’ education is built for the primary schools in Lisbon. Upon the confirmation that Lisbon is stratified, I use the measure of peer effects based on stratification and determine its impact on test scores, concluding that the existence of stratification improves scores of students in schools with more educated parents and decreases scores of students in schools with less educated parents. Moreover, using fixed effects I derive the conclusion that the measure of peers’ characteristics helps explain most of differences among schools.

Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization.

AIMS: Estimates of the left ventricular ejection fraction (LVEF) in patients with life-threatening ventricular arrhythmias related to coronary artery disease (CAD) have rarely been reported despite it has become the basis for determining patient's eligibility for prophylactic defibrillator. We aimed to determine the extent and distribution of reduced LVEF in patients with sustained ventricular tachycardia or ventricular fibrillation. METHODS AND RESULTS: 252 patients admitted for ventricular arrhythmia related to CAD were included: 149 had acute myocardial infarction (MI) (Group I, 59%), 54 had significant chronic obstructive CAD suggestive of an ischaemic arrhythmic trigger (Group II, 21%) and 49 patients had an old MI without residual ischaemia (Group III, 19%). 34% of the patients with scar-related arrhythmias had an LVEF > or =40%. Based on pre-event LVEF evaluation, it can be estimated that less than one quarter of the whole study population had a known chronic MI with severely reduced LVEF. In Group III, the proportion of inferior MI was significantly higher than anterior MI (81 vs. 19%; absolute difference, -62; 95% confidence interval, -45 to -79; P < or = 0.0001), though median LVEF was higher in inferior MI (0.37 +/- 10 vs. 0.29 +/- 10; P = 0.0499). CONCLUSION: Patients included in defibrillator trials represent only a minority of the patients at risk of sudden cardiac death. By applying the current risk stratification strategy based on LVEF, more than one third of the patients with old MI would not have qualified for a prophylactic defibrillator. Our study also suggests that inferior scars may be more prone to ventricular arrhythmia compared to anterior scars.

Les assortiments éducationnels des unions exogames immigrants-natifs à titre d’indicateur de stratification sociale; une étude exploratoire à partir de données canadiennes

À l’aide des données du recensement canadien de 2006, ce mémoire examine les assortiments éducationnels des couples exogames immigrants-natifs à titre d’indicateur de stratification sociale. Premièrement, les résultats tirés de régressions logistiques multinomiales confirment la présence d’échange (social status exchange : Merton 1941; Davis 1941) entre les natifs et les immigrants, c’est-à-dire qu’un immigrant est davantage susceptible de s’unir avec un natif s’il est plus scolarisé que ce dernier. Ces résultats supportent l’existence d’une stratification sociale entre les immigrants et les natifs. Deuxièmement, l’analyse révèle que l’échange apparait chez les immigrants des deux sexes ayant au moins un baccalauréat, alors que chez les moins scolarisés l’échange ne ressort que chez les hommes. Troisièmement, chez les immigrants de minorité visible, l’échange perdure de la première à la deuxième génération d’immigrant, alors que parmi ceux n’appartenant pas à une minorité visible, l’échange ne concerne que les immigrants de première génération.

Social Stratification and Consumer Behaviour in Kerala-A Study with Special Reference to Consumer Durables

Department of Applied Economics, Cochin University of Science and Technology

Thermohaline variability in the upper layers of the Arabian Sea

The Arabian Sea is an area of complex air-sea interaction processes with seasonal reversing monsoons. The associated thermohaline variability in the upper layers appears to control the large scale monsoon flow which is not yet completely understood. The variability in the thermohaline fields is known to occur in temporal domain ranging from intra-diurnal to inter-annual time scales and on spatial domains of few tens of kilometers to few thousands of kilometers. In the Arabian Sea though the surface temperature was routinely measured by both conventional measurements and satellites, the corresponding information on the subsurface thermohaline field is very sparse due to the lack cw adequate measurements. In such cases the numerical models offer promise in providing information on the subsurface features given an initial thermohaline field and surface heat flux boundary conditions. This thesis is an outcome of investigations carried out on the various aspects of the thermohaline variability on different time scales. In addition to the description of the mean annual cycle. the one dimensional numerical models of Miller (1976) and Price et a1 (1986) are utilised to simulate the observed mixed layer characteristics at selected locations in the Arabian Sea on time scales ranging from intra-diurnal to synoptic scales under variable atmospheric forcing.

Variability of the Atlantic thermohaline circulation described by three-dimensional empirical orthogonal functions

We describe the use of bivariate 3d empirical orthogonal functions (EOFs) in characterising low frequency variability of the Atlantic thermohaline circulation (THC) in the Hadley Centre global climate model, HadCM3. We find that the leading two modes are well correlated with an index of the meridional overturning circulation (MOC) on decadal timescales, with the leading mode alone accounting for 54% of the decadal variance. Episodes of coherent oscillations in the sub-space of the leading EOFs are identified; these episodes are of great interest for the predictability of the THC, and could indicate the existence of different regimes of natural variability. The mechanism identified for the multi-decadal variability is an internal ocean mode, dominated by changes in convection in the Nordic Seas, which lead the changes in the MOC by a few years. Variations in salinity transports from the Arctic and from the North Atlantic are the main feedbacks which control the oscillation. This mode has a weak feedback onto the atmosphere and hence a surface climatic influence. Interestingly, some of these climate impacts lead the changes in the overturning. There are also similarities to observed multi-decadal climate variability.

Enhancement of ENSO variability by a weakened Atlantic thermohaline circulation in a coupled GCM

A coupled ocean–atmosphere general circulation model is used to investigate the modulation of El Niño–Southern Oscillation (ENSO) variability due to a weakened Atlantic thermohaline circulation (THC). The THC weakening is induced by freshwater perturbations in the North Atlantic, and leads to a well-known sea surface temperature dipole and a southward shift of the intertropical convergence zone (ITCZ) in the tropical Atlantic. Through atmospheric teleconnections and local coupled air–sea feedbacks, a meridionally asymmetric mean state change is generated in the eastern equatorial Pacific, corresponding to a weakened annual cycle, and westerly anomalies develop over the central Pacific. The westerly anomalies are associated with anomalous warming of SST, causing an eastward extension of the west Pacific warm pool particularly in August–February, and enhanced precipitation. These and other changes in the mean state lead in turn to an eastward shift of the zonal wind anomalies associated with El Niño events, and a significant increase in ENSO variability. In response to a 1-Sv (1 Sv ≡ 106 m3 s−1) freshwater input in the North Atlantic, the THC slows down rapidly and it weakens by 86% over years 50–100. The Niño-3 index standard deviation increases by 36% during the first 100-yr simulation relative to the control simulation. Further analysis indicates that the weakened THC not only leads to a stronger ENSO variability, but also leads to a stronger asymmetry between El Niño and La Niña events. This study suggests a role for an atmospheric bridge that rapidly conveys the influence of the Atlantic Ocean to the tropical Pacific and indicates that fluctuations of the THC can mediate not only mean climate globally but also modulate interannual variability. The results may contribute to understanding both the multidecadal variability of ENSO activity during the twentieth century and longer time-scale variability of ENSO, as suggested by some paleoclimate records.

Response of the Asian summer monsoon to a weakening of Atlantic thermohaline circulation

Various paleoclimate records have shown that the Asian monsoon was punctuated by numerous suborbital time-scale events, and these events were coeval with those that happened in the North Atlantic. This study investigates the Asian summer monsoon responses to the Atlantic Ocean forcing by applying an additional freshwater flux into the North Atlantic. The simulated results indicate that the cold North Atlantic and warm South Atlantic induced by the weakened Atlantic thermohaline circulation (THC) due to the freshwater flux lead to significantly suppressed Asian summer monsoon. The authors analyzed the detailed processes of the Atlantic Ocean forcing on the Asian summer monsoon, and found that the atmospheric teleconnection in the eastern and central North Pacific and the atmosphere-ocean interaction in the tropical North Pacific play the most crucial role. Enhanced precipitation in the subtropical North Pacific extends the effects of Atlantic Ocean forcing from the eastern Pacific into the western Pacific, and the atmosphere-ocean interaction in the tropical Pacific and Indian Ocean intensifies the circulation and precipitation anomalies in the Pacific and East Asia.

How does a weakened Atlantic thermohaline circulation lead to an intensification of the ENSO-south Asian summer monsoon interaction?

This study investigates the change of the El Niño–Southern Oscillation (ENSO)-South Asian summer monsoon interaction in response to a weakened Atlantic thermohaline circulation (THC) by applying an additional freshwater flux into the North Atlantic. The simulated results indicate that the weakened THC leads to intensified ENSO-South Asian summer monsoon relationship and enhanced South Asian summer monsoon interannual variability. Furthermore, it is suggested that this intensification of the ENSO-monsoon relationship is likely due to the enhanced ENSO variability induced by the weakened THC. This study indicates that the low frequency fluctuation of Atlantic SSTs might have an influence on South Asian summer monsoon interannual variability and the ENSO-monsoon interaction, and suggests a nonlocal mechanism for the observed decadal-multidecadal modulation of ENSO-monsoon relationship.

An Integrated Assessment of changes in the thermohaline circulation

This paper discusses the risks of a shutdown of the thermohaline circulation (THC) for the climate system, for ecosystems in and around the North Atlantic as well as for fisheries and agriculture by way of an Integrated Assessment. The climate model simulations are based on greenhouse gas scenarios for the 21st century and beyond. A shutdown of the THC, complete by 2150, is triggered if increased freshwater input from inland ice melt or enhanced runoff is assumed. The shutdown retards the greenhouse gas-induced atmospheric warming trend in the Northern Hemisphere, but does not lead to a persistent net cooling. Due to the simulated THC shutdown the sea level at the North Atlantic shores rises by up to 80 cm by 2150, in addition to the global sea level rise. This could potentially be a serious impact that requires expensive coastal protection measures. A reduction of marine net primary productivity is associated with the impacts of warming rather than a THC shutdown. Regional shifts in the currents in the Nordic Seas could strongly deteriorate survival chances for cod larvae and juveniles. This could lead to cod fisheries becoming unprofitable by the end of the 21st century. While regional socioeconomic impacts might be large, damages would be probably small in relation to the respective gross national products. Terrestrial ecosystem productivity is affected much more by the fertilization from the increasing CO2 concentration than by a THC shutdown. In addition, the level of warming in the 22nd to 24th century favours crop production in northern Europe a lot, no matter whether the THC shuts down or not. CO2 emissions corridors aimed at limiting the risk of a THC breakdown to 10% or less are narrow, requiring departure from business-as-usual in the next few decades. The uncertainty about THC risks is still high. This is seen in model analyses as well as in the experts’ views that were elicited. The overview of results presented here is the outcome of the Integrated Assessment project INTEGRATION.

The Effects of Stratification on Flow Separation

Separation of stratified flow over a two-dimensional hill is inhibited or facilitated by acceleration or deceleration of the flow just outside the attached boundary layer. In this note, an expression is derived for this acceleration or deceleration in terms of streamline curvature and stratification. The expression is valid for linear as well as nonlinear deformation of the flow. For hills of vanishing aspect ratio a linear theory can be derived and a full regime diagram for separation can be constructed. For hills of finite aspect ratio scaling relationships can be derived that indicate the presence of a critical aspect ratio, proportional to the stratification, above which separation will occur as well as a second critical aspect ratio above which separation will always occur irrespective of stratification.