Department of Pathology and Laboratory Medicine

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    Myeloid-Derived Suppressor Cells Impair Alveolar Macrophages through PD-1 Receptor Ligation during Pneumocystis Pneumonia
    (American Society for Microbiology, 2015-02) Lei, Guang-Sheng; Zhang, Chen; Lee, Chao-Hung; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Myeloid-derived suppressor cells (MDSCs) were recently found to accumulate in the lungs during Pneumocystis pneumonia (PcP). Adoptive transfer of these cells caused lung damage in recipient mice, suggesting that MDSC accumulation is a mechanism of pathogenesis in PcP. In this study, the phagocytic activity of alveolar macrophages (AMs) was found to decrease by 40% when they were incubated with MDSCs from Pneumocystis-infected mice compared to those incubated with Gr-1+ cells from the bone marrow of uninfected mice. The expression of the PU.1 gene in AMs incubated with MDSCs also was decreased. This PU.1 downregulation was due mainly to decreased histone 3 acetylation and increased DNA methylation caused by MDSCs. MDSCs were found to express high levels of PD-L1, and alveolar macrophages (AMs) were found to express high levels of PD-1 during PcP. Furthermore, PD-1 expression in AMs from uninfected mice was increased by 18-fold when they were incubated with MDSCs compared to those incubated with Gr-1+ cells from the bone marrow of uninfected mice. The adverse effects of MDSCs on AMs were diminished when the MDSCs were pretreated with anti-PD-L1 antibody, suggesting that MDSCs disable AMs through PD-1/PD-L1 ligation during PcP.
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    Multicenter Evaluation of Candida QuickFISH BC for Identification of Candida Species Directly from Blood Culture Bottles
    (American Society for Microbiology, 2015-05) Abdelhamed, Ayman M.; Zhang, Sean X.; Watkins, Tonya; Morgan, Margie A.; Wu, Fann; Buckner, Rebecca J.; Fuller, DeAnna D.; Davis, Thomas E.; Salimnia, Hossein; Fairfax, Marilynn R.; Lephart, Paul R.; Poulter, Melinda D.; Regi, Sarah B.; Jacobs, Michael R.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Candida species are common causes of bloodstream infections (BSI), with high mortality. Four species cause >90% of Candida BSI: C. albicans, C. glabrata, C. parapsilosis, and C. tropicalis. Differentiation of Candida spp. is important because of differences in virulence and antimicrobial susceptibility. Candida QuickFISH BC, a multicolor, qualitative nucleic acid hybridization assay for the identification of C. albicans (green fluorescence), C. glabrata (red fluorescence), and C. parapsilosis (yellow fluorescence), was tested on Bactec and BacT/Alert blood culture bottles which signaled positive on automated blood culture devices and were positive for yeast by Gram stain at seven study sites. The results were compared to conventional identification. A total of 419 yeast-positive blood culture bottles were studied, consisting of 258 clinical samples (89 C. glabrata, 79 C. albicans, 23 C. parapsilosis, 18 C. tropicalis, and 49 other species) and 161 contrived samples inoculated with clinical isolates (40 C. glabrata, 46 C. albicans, 36 C. parapsilosis, 19 C. tropicalis, and 20 other species). A total of 415 samples contained a single fungal species, with C. glabrata (n = 129; 30.8%) being the most common isolate, followed by C. albicans (n = 125; 29.8%), C. parapsilosis (n = 59; 14.1%), C. tropicalis (n = 37; 8.8%), and C. krusei (n = 17; 4.1%). The overall agreement (with range for the three major Candida species) between the two methods was 99.3% (98.3 to 100%), with a sensitivity of 99.7% (98.3 to 100%) and a specificity of 98.0% (99.4 to 100%). This study showed that Candida QuickFISH BC is a rapid and accurate method for identifying C. albicans, C. glabrata, and C. parapsilosis, the three most common Candida species causing BSI, directly from blood culture bottles.
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    Photo Quiz: Diarrhea and Fever in a Child Returning from Africa
    (American Society for Microbiology, 2015-04) Relich, Ryan F.; Manaloor, John J.; Fox, Thomas G.; Department of Pathology and Laboratory Medicine, IU School of Medicine
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    Inhibition of polo-like kinase 1 (Plk1) enhances the antineoplastic activity of metformin in prostate cancer
    (2015-01) Shao, Chen; Ahmad, Nihal; Hodges, Kurt; Kuang, Shihuan; Ratliff, Tim; Liu, Xiaoqi; Department of Pathology and Laboratory Medicine, IU School of Medicine
    The widely used anti-diabetic drug metformin has been shown to exert strong antineoplastic actions in numerous tumor types, including prostate cancer (PCa). In this study, we show that BI2536, a specific Plk1 inhibitor, acted synergistically with metformin in inhibiting PCa cell proliferation. Furthermore, we also provide evidence that Plk1 inhibition makes PCa cells carrying WT p53 much more sensitive to low-dose metformin treatment. Mechanistically, we found that co-treatment with BI2536 and metformin induced p53-dependent apoptosis and further activated the p53/Redd-1 pathway. Moreover, we also show that BI2536 treatment inhibited metformin-induced glycolysis and glutamine anaplerosis, both of which are survival responses of cells against mitochondrial poisons. Finally, we confirmed the cell-based observations using both cultured cell-derived and patient-derived xenograft studies. Collectively, our findings support another promising therapeutic strategy by combining two well tolerated drugs against PCa proliferation and the progression of androgen-dependent PCa to the castration-resistant stage.
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    Florbetaben PET imaging to detect amyloid beta plaques in Alzheimer disease: Phase 3 study
    (Elsevier, 2015) Sabri, Osama; Sabbagh, Marwan N.; Seibyl, John; Barthel, Henryk; Akatsu, Hiroyasu; Ouchi, Yasuomi; Senda, Kohei; Murayama, Shigeo; Ishii, Kenji; Takao, Masaki; Beach, Thomas G.; Rowe, Christopher C.; Leverenz, James B.; Ghetti, Bernardino; Ironside, James W.; Catafau, Ana M.; Stephens, Andrew W.; Mueller, Andre; Koglin, Norman; Hoffman, Anja; Roth, Katrin; Reininger, Cornelia; Schulz-Schaeffer, Walter J.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Background Evaluation of brain β-amyloid by positron emission tomography (PET) imaging can assist in the diagnosis of Alzheimer disease (AD) and other dementias. Methods Open-label, nonrandomized, multicenter, phase 3 study to validate the 18F-labeled β-amyloid tracer florbetaben by comparing in vivo PET imaging with post-mortem histopathology. Results Brain images and tissue from 74 deceased subjects (of 216 trial participants) were analyzed. Forty-six of 47 neuritic β-amyloid-positive cases were read as PET positive, and 24 of 27 neuritic β-amyloid plaque-negative cases were read as PET negative (sensitivity 97.9% [95% confidence interval or CI 93.8–100%], specificity 88.9% [95% CI 77.0–100%]). In a subgroup, a regional tissue-scan matched analysis was performed. In areas known to strongly accumulate β-amyloid plaques, sensitivity and specificity were 82% to 90%, and 86% to 95%, respectively. Conclusions Florbetaben PET shows high sensitivity and specificity for the detection of histopathology-confirmed neuritic β-amyloid plaques and may thus be a valuable adjunct to clinical diagnosis, particularly for the exclusion of AD.
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    Expression of the platelet-activating factor receptor enhances benzyl isothiocyanate-induced apoptosis in murine and human melanoma cells
    (Spandidos, 2015-02) Sahu, Ravi Prakash; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Melanoma cells often express platelet‑activating factor receptor (PAF‑R), which has been demonstrated to increase metastatic behavior. However, the effect of PAF‑R on the responsiveness of melanoma to naturally occurring cytotoxic agents remains to be elucidated. The present study aimed to determine the relative cytotoxicity and mechanism of benzyl isothiocyanate (BITC), a component of cruciferous vegetables, in melanoma cells expressing PAF‑R. To evaluate the importance of PAF‑R signaling in melanoma cell growth, PAF‑R‑negative murine B16F10 cells were transduced with a retrovirus containing the cDNA for PAF‑R to generate cells stably expressing PAF‑R (B16‑PAF‑R) or an empty vector (MSCV) to generate PAF‑R‑deficient B16‑MSCV control cells. Activation of PAF‑R, using the PAF‑R agonist, 1‑hexadecyl‑2‑N‑methylcarbamoyl‑3‑glycerophosphocholine, induced an increase in the proliferation of B16‑PAF‑R cells compared with the B16‑MSCV cells. Reverse transcription quantitative polymerase chain reaction revealed the presence of functional PAF‑R in human melanoma SK23MEL cells, but not in SK5MEL cells. The present study investigated the effect of BITC treatments on the survival of murine and human melanoma cells, in the presence or absence of functional PAF‑R. The results revealed that treatment with BITC decreased the survival rate of the PAF‑R‑positive and negative murine and human melanoma cells. However, the expression of PAF‑R substantially augmented BITC‑mediated cytotoxicity in the PAF‑R‑positive cells at lower concentrations compared with the PAF‑R‑negative cells. In order to determine the underlying mechanism, flow cytometric analysis was used, which demonstrated a significant increase in the generation of reactive oxygen species (ROS) in the B16‑PAF‑R cells compared with the B16‑MSCV cells, which enhanced apoptosis by BITC, as measured by increased caspase‑3/7 luminescence. Notably, the BITC‑mediated decreased cell survival rate, increased ROS and increased apoptosis in the B16‑PAF‑R cells were significantly attenuated by the antioxidant, vitamin C, indicating ROS involvement. Additionally, the WEB2086 PAF‑R antagonist, inhibited the BITC‑mediated enhancement of apoptosis in the B16‑PAF‑R cells, indicating a role for PAF‑R‑signaling in the BITC‑mediated effects. These findings indicated that the selectivity of BITC towards PAF‑R in melanoma offers a promising chemopreventive agent for PAF‑R‑positive melanoma treatment.
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    Genomic Profiling of Advanced-Stage, Metaplastic Breast Carcinoma by Next-Generation Sequencing Reveals Frequent, Targetable Genomic Abnormalities and Potential New Treatment Options
    (2015-05) Ross, Jeffrey S.; Badve, Sunil; Wang, Kai; Sheehan, Christine E.; Boguniewicz, Ann B.; Otto, Geoff A.; Yelensky, Roman; Lipson, Doron; Ali, Siraj; Morosini, Deborah; Chliemlecki, Juliann; Elvin, Julia A.; Miller, Vincent A.; Stephens, Philip J.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Context.— Metastatic metaplastic breast carcinoma (MPBC) is an uncommon, but aggressive, tumor resistant to conventional chemotherapy. Objective.— To learn whether next-generation sequencing could identify potential targets of therapy for patients with relapsed and metastatic MPBC. Design.— Hybridization capture of 3769 exons from 236 cancer-related genes and 47 introns of 19 genes commonly rearranged in cancer was applied to a minimum of 50 ng of DNA extracted from 20 MPBC formalin-fixed, paraffin-embedded specimens and sequenced to high uniform coverage. Results.— The 20 patients with MPBC had a median age of 62 years (range, 42–86 years). There were 9 squamous (45%), 9 chondroid (45%), and 2 spindle cell (10%) MPBCs, all of which were high grade. Ninety-three genomic alterations were identified, (range, 1–11) with 19 of the 20 cases (95%) harboring an alteration that could potentially lead to a targeted treatment option. The most-common alterations were in TP53 (n = 69; 75%), PIK3CA (n = 37; 40%), MYC (n = 28; 30%), MLL2 (n = 28; 30%), PTEN (n = 23; 25%), CDKN2A/B (n = 19; 20%), CCND3 (n = 14; 15%), CCNE1 (n = 9; 10%), EGFR (n = 9; 10%), and KDM6A (n = 9; 10%); AKT3, CCND1, CCND2, CDK4, FBXW7, FGFR1, HRAS, NF1, PIK3R1, and SRC were each altered in a single case. All 16 MPBCs (100%) that were negative for ERBB2 (HER2) overexpression by immunohistochemistry and/or ERBB2 (HER2) amplification by fluorescence in situ hybridization were also uniformly (100%) negative for ERBB2 amplification by next-generation sequencing–based copy-number assessment. Conclusions.— Our results indicate that genomic profiling using next-generation sequencing can identify clinically meaningful alterations that have the potential to guide targeted treatment decisions in most patients with metastatic MPBC.
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    Topical Application of a Platelet Activating Factor Receptor Agonist Suppresses Phorbol Ester-Induced Acute and Chronic Inflammation and Has Cancer Chemopreventive Activity in Mouse Skin
    (PLoS, 2014-11) Sahu, Ravi P.; Rezania, Samin; Ocana, Jesus A.; DaSilva-Arnold, Sonia C.; Bradish, Joshua R.; Richey, Justin D.; Warren, Simon J.; Rashid, Badri; Travers, Jeffrey B.; Konger, Raymond L.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Platelet activating factor (PAF) has long been associated with acute edema and inflammatory responses. PAF acts by binding to a specific G-protein coupled receptor (PAF-R, Ptafr). However, the role of chronic PAF-R activation on sustained inflammatory responses has been largely ignored. We recently demonstrated that mice lacking the PAF-R (Ptafr-/- mice) exhibit increased cutaneous tumorigenesis in response to a two-stage chemical carcinogenesis protocol. Ptafr-/- mice also exhibited increased chronic inflammation in response to phorbol ester application. In this present study, we demonstrate that topical application of the non-hydrolysable PAF mimetic (carbamoyl-PAF (CPAF)), exerts a potent, dose-dependent, and short-lived edema response in WT mice, but not Ptafr -/- mice or mice deficient in c-Kit (c-KitW-sh/W-sh mice). Using an ear inflammation model, co-administration of topical CPAF treatment resulted in a paradoxical decrease in both acute ear thickness changes associated with a single PMA application, as well as the sustained inflammation associated with chronic repetitive PMA applications. Moreover, mice treated topically with CPAF also exhibited a significant reduction in chemical carcinogenesis. The ability of CPAF to suppress acute and chronic inflammatory changes in response to PMA application(s) was PAF-R dependent, as CPAF had no effect on basal or PMA-induced inflammation in Ptafr-/- mice. Moreover, c-Kit appears to be necessary for the anti-inflammatory effects of CPAF, as CPAF had no observable effect in c-KitW-sh/W-sh mice. These data provide additional evidence that PAF-R activation exerts complex immunomodulatory effects in a model of chronic inflammation that is relevant to neoplastic development.
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    Prostate Cancer: Effects of tertiary Gleason pattern 5 on oncological outcome
    (Nature, 2015-04) Williamson, Sean R.; Cheng, Liang; Department of Pathology and Laboratory Medicine, IU School of Medicine
    The prognostic implications of a tertiary component of Gleason pattern 5 cancer at radical prostatectomy remain incompletely understood. A newly published study highlights the relationship between tertiary pattern 5 cancer, other risk factors and clinical outcomes. Authors propose a prognostic model to identify patients with the greatest need for adjuvant therapy.
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    Does prostate acinar adenocarcinoma with Gleason Score 3 + 3 = 6 have the potential to metastasize?
    (BioMed Central, 2014-10-18) Montironi, Rodolfo; Scarpelli, Marina; Mazzucchelli, Roberta; Lopez-Beltran, Antonio; Santoni, Matteo; Briganti, Alberto; Montorsi, Francesco; Cheng, Liang; Department of Pathology & Laboratory Medicine, School of Medicine
    Background: There is a worldwide debate involving clinicians, uropathologists as well as patients and their families on whether Gleason score 6 adenocarcinoma should be labelled as cancer. Case description: We report a case of man diagnosed with biopsy Gleason score 6 acinar adenocarcinoma and classified as low risk (based on a PSA of 5 ng/mL and stage cT2a) whose radical prostatectomy specimen initially showed organ confined Gleason score 3 + 3 = 6, WHO nuclear grade 3, acinar adenocarcinoma with lymphovascular invasion and secondary deposit in a periprostatic lymph node. When deeper sections were cut to the point that almost all the slice present in the paraffin block was sectioned, a small tumor area (<5% of the whole tumor) of Gleason pattern 4 (poorly formed glands) was found in an extraprostatic position. Conclusion: The epilogue was that the additional finding changed the final Gleason score to 3 + 3 = 6 with tertiary pattern 4 and the stage to pT3a. Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/ vs/13000_2014_190