Cancer signalling pathway could lead to new cancer therapies

Researchers from the University of Wisconsin School of Medicine and Public Health and Carbone Cancer Center have better defined a pro-growth signalling pathway common to many cancers that, when blocked, kills cancer cells but leaves healthy cells comparatively unharmed.

The study could establish new avenues of therapeutic treatments for many types of solid tumours.

Growth signals typically come in the form of chemical agonists outside of cells that bind to protein receptors on cells. Activated receptors are responsible for transmitting the signal to the inside of the cell, ultimately generating a growth messenger called PIP3.

Two years ago, research out of UW–Madison professor Richard Anderson’s lab found that some of these agonist-stimulated receptors continue to transmit the signal even after they have been pulled into the cell, sequestered in vesicles called endosomes and presumably on their way to being degraded.

“According to dogma in the literature, receptors shouldn’t make PIP3 at these internal sites, but they were,” Anderson says. “We set out to ask, ‘Why is that?’”

In this new study, a postdoctoral fellow in Anderson’s lab, Suyong Choi, showed that the proteins known to be in this signal transmission cascade were all present on endosomes inside the cell, supporting the idea that the key growth message was being signalled from these internal compartments.

However, there was one fact which they could not biologically explain: In a typical signalling cascade, each step amplifies the signal, suggesting there should be more and more of the messenger molecules; but here, levels of PIP3 and other intermediary messengers were too low to be detected in endosomes.

“A scaffold completely solves this issue, because it acts like an assembly line, bringing together all of the proteins and passing one messenger molecule to the next protein in the cascade until the last protein, PI3K, is activated and generates PIP3,” Anderson says. “Suyong Choi found that the scaffolding protein IQGAP1 brings all of these proteins together like a happy family on the endosome. It’s an incredibly efficient mechanism.”

Choi discovered that the IQGAP1 complex pulls together all of the signalling components in the PI3K pathway. Remarkably, this assembly happens in response to nearly all agonists that switch on growth and cell survival signals in cells. Once Choi had established how the proteins in the complex interacted, he was able to block scaffold formation in cells by adding a small, competing fragment of the IQGAP1 protein.

“It worked beautifully to block assembly of IQGAP1 and PI3K complex,” Anderson says. “The really cool thing was, when we treated different cells with these inhibitory fragments, the disruption of IQGAP1 and PI3K complex formation had almost no effect on normal cells but it killed cancer cells very efficiently.”

PI3K is an essential protein, and cells (and whole organisms) die if they do not have any functional PI3K because the protein is involved in multiple signalling pathways. However, it is specifically this pathway, mediated through IQGAP1, that is required for the growth and survival of cancer cells but not normal cells. In fact, mice lacking IQGAP1 develop normally but are resistant to developing solid tumours.

“Pharmaceutical companies have developed PI3K inhibitors, but many of these have failed, likely because they’re hitting all PI3Ks and the different pathways,” Anderson said. “If you can specifically disrupt this agonist-activated PI3K pathway, the one that has a specific role in cancer, then you can effectively treat

University of Wisconsin School of Medicine and Public Health www.med.wisc.edu/news-events/cancer-signaling-pathway-could-lead-to-new-cancer-therapies/49720

Study supports lower cut-off point for defining pre-diabetes

The health risks and mortality associated with pre-diabetes seem to increase at the lower cut-off point for blood sugar levels recommended by some guidelines, finds a large study published.

Pre-diabetes is a ‘pre-diagnosis’ of diabetes — when a person’s blood glucose level is higher than normal, but not high enough to be considered diabetes. If left untreated, pre-diabetes can develop into type 2 diabetes. An estimated 79 million people in the US and 7 million people in the UK are thought to be affected.

Doctors define pre-diabetes as impaired fasting glucose (higher than normal blood sugar levels after a period of fasting), impaired glucose tolerance (higher than normal blood sugar levels after eating), or raised haemoglobin levels.

But the cut-off points vary across different guidelines and remain controversial.

For example, the World Health Organization (WHO) defines pre-diabetes as fasting plasma glucose of 6.1-6.9 mmol/L, while the 2003 American Diabetes Association (ADA) guideline recommends a cut-off point of 5.6-6.9 mmol/L.

Results of studies on the association between pre-diabetes and risk of cardiovascular disease and all cause mortality are also inconsistent. Furthermore, whether raised haemoglobin levels for defining pre-diabetes is useful for predicting future cardiovascular disease is unclear.

So a team of researchers from the affiliated Hospital at Shunde, Southern Medical University in China analysed the results of 53 studies involving over 1.6 million individuals to shed more light on associations between different definitions of pre-diabetes and the risk of cardiovascular disease, coronary heart disease, stroke, and all cause mortality.

They found that pre-diabetes, defined as impaired fasting glucose or impaired glucose tolerance, was associated with an increased risk of cardiovascular disease and all cause mortality.

The risk increased in people with a fasting glucose concentration as low as 5.6 mmol/L – the lower cut-off point according to ADA criteria.

Raised haemoglobin levels were also associated with an increased risk of cardiovascular disease and coronary heart disease, but not with an increased risk of stroke and all cause mortality.

The authors point to some study limitations that could have influenced their results, and say pulling observational evidence together in a systematic review and meta-analysis is a good way to consider all the evidence at once, ‘but we cannot make statements about cause and effect. We would need to look at experimental evidence for that.’

However, they say their findings ‘strongly support’ the lower cut-off point for impaired fasting glucose and raised haemoglobin levels proposed by the ADA guideline.

And they conclude that lifestyle change — eating a healthy balanced diet, keeping weight under control, and doing regular physical activity — is the most effective treatment.

EurekAlert www.eurekalert.org/pub_releases/2016-11/b-ssl112216.php

Biomarker identified to aid in prognosis of paediatric ependymomas

A multi-institutional group of researchers, led by investigators at Children’s Hospital Los Angeles and the University of Michigan, have identified a simple and inexpensive tool for assessing the prognosis of paediatric brain tumours called ependymomas. Their study, which demonstrates the epigenetic mechanism behind these tumours, may offer future opportunities for novel therapeutic options.

Childhood posterior fossa ependymomas (PF) are tumours found largely in the hind brain (consisting of the cerebellum, pons and the brainstem) of children. Routine assessment of tumour grade and other markers in PF ependymomas do not correlate well with outcomes in these tumours, highlighting the need for new prognostic markers. Genomic sequencing efforts have not identified mutations in these tumours, and the origin of PF ependymomas remains obscure.

While lacking recurrent genetic mutations, a subset of these tumours exhibit alterations in DNA methylation. In this study, the researchers looked at modification of histones – protein components of the chromatin around which DNA winds, and which play a role in gene regulation – in particular, histone H3.

Co-lead investigator, Sriram Venneti, MD, PhD, of the Department of Pathology at the University of Michigan, observed that histone H3 is modified differently in paediatric posterior fossa ependymoma. Specifically, 80 percent of these tumours exhibited loss of the H3K27me3 a repressive mark, while 20 percent of tumours retained H3K27me3.  Researchers went back and looked at MRIs and outcomes of children treated for these tumours and identified that tumours with loss of H3K27me3 tumours behaved more aggressively and showed poor overall survival.  This suggests that reduced H3K27me3 may be a prognostic indicator in PF ependymomas.

“Detection of H3K27me3 by immunohistochemical staining is a widely available and cost effective surrogate molecular marker.  This test can be readily implemented in most departments of pathology and provides a much-needed tool to risk stratify and identify ependymoma patients who would potentially benefit from epigenetic therapies,” said co-lead investigator Alexander R. Judkins, MD, of the Department of Pathology and Laboratory Medicine at CHLA and Keck School of Medicine of the University of Southern California.

This loss in H3K27me3, along with other epigenetic changes, was similar to that observed in another type of paediatric brain tumour of the hind brain region termed diffuse intrinsic pontine gliomas (DIPGs).  This suggests that both of these tumours arise from similar epigenetic states. Intriguingly, researchers found that certain progenitor cells in this part of the brain also showed low H3K27me3, suggesting – as both tumours share epigenetic similarities – that low methylation of H3K27me3 is important to the development of tumours in this region of the brain.

Children’s Hospital of Los Angeles www.chla.org/press-release/biomarker-identified-aid-prognosis-pediatric-ependymomas

Genetic marker found for resistance to malaria treatment in Cambodia

Scientists at the Wellcome Trust Sanger Institute and their collaborators have discovered genetic markers in malaria parasites linked with resistance to the anti-malarial drug piperaquine. This research will allow health officials to monitor the spread of resistance, and help doctors and public health officers decide where the treatment is most likely to be effective.

Resistance to this key anti-malarial drug has recently emerged in Cambodia, leading to complete treatment failure there, threatening global efforts to treat and eliminate malaria.

Malaria is caused by Plasmodium parasites and in 2015, the World Health Organisation estimated that more than 200 million people were infected and nearly half a million people died worldwide from the disease. Children under the age of five made up 70 percent of these deaths. Malaria is a treatable disease when caught early enough, but is a huge problem in many areas due to drug resistance.

Piperaquine is a powerful drug, which is used in combination with another anti-malarial, artemisinin, as a first-line treatment in many areas of the world. Resistance to artemisinin emerged more than seven years ago in South East Asia, but until recently the combination of the drugs still successfully killed the malaria parasites there.  Now, the development of piperaquine resistance has led to complete failure of treatment in Cambodia.

Researchers carried out a genome-wide association study on approximately 300 Plasmodium falciparum samples from Cambodia to study the genetic basis behind piperaquine resistance. They looked at thousands of variations in the DNA sequence of the parasites, comparing these across samples with different levels of resistance to piperaquine.

“By studying the genomes of these parasites we found two genetic markers that are linked with piperaquine resistance. Not only can we now use these markers to monitor the spread of the drug resistant malaria, they will also help towards understanding as much as possible about the biology and evolution of the parasite.”

Dr Roberto Amato, lead author from the Wellcome Trust Sanger Institute
The scientists found that extra copies of the genes encoding two proteins of a family called plasmepsin, were linked with piperaquine resistance. Plasmepsins are part of a biological pathway that is targeted by other anti-malarial drugs, so this marker could also help the researchers understand the mechanism of the drug resistance. In addition to this, a mutation on chromosome 13 was found to be a second genetic marker linked with the resistance. Both markers were observed in parasites infecting patients who were not responding to treatment.

“The emergence of piperaquine resistance in these Cambodian parasites has led to complete treatment failure there. These malaria parasites are now resistant to both drugs, and since they are no longer being killed, resistance to both drugs will spread. This will threaten global attempts to eliminate malaria.”

Sanger Institute www.sanger.ac.uk/news/view/genetic-marker-found-resistance-malaria-treatment-cambodia

Strength test for platelets

Bleeding disorders could one day be diagnosed by putting platelets through strength tests, researchers have proposed. Biomedical engineers from Emory University and the Georgia Institute of Technology have devised a microfluidic testing ground where platelets can demonstrate their strength by squeezing two protein dots together. Imagine rows and rows of strength testing machines from a carnival, but very tiny. A platelet is capable of exerting forces that are several times larger, in relation to its size, than a muscle cells.
After a blood clot forms, it contracts, promoting wound closure and restoration of normal blood flow. This process can be deficient in a variety of blood clotting disorders. Previously, it was difficult to measure an individual platelet’s contributions to contraction, because clots’ various components got in the way.
“We discovered that platelets from some patients with bleeding disorders are ‘wimpier’ than platelets from healthy people,” says Wilbur Lam, an assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. “Our device may function as a new physics-based method to test for bleeding disorders, complementary to current methods.”
The first author of the paper is David Myers, an instructor at Emory’s medical school. Lam is also a physician in the Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta.
The scientists infer how strong or wimpy someone’s platelets are by measuring how far the protein dots move, taking a picture of the rows of dots, and then analysing the picture on a computer.
The dots are made of fibrinogen, a sticky protein that is the precursor for fibrin, which forms a mesh of insoluble strands in a blood clot.
In addition to detecting problems with platelet contraction in patients with known inherited disorders such as Wiskott Aldrich syndrome, Myers, Lam and colleagues could also see differences in some patients who had bleeding symptoms, but who performed normally on standard diagnostic tests.
The researchers also used chemical tools to dissect the process of platelet contraction. They showed that inhibitors of Rho/ ROCK enzymes shut down platelet contraction, but inhibitors of a related pathway, MLCK (myosin light chain kinase), did not. Individual platelet contraction could become an assay for development or refinement of blood thinning drugs, Lam says.

Georgia Techhttp://tinyurl.com/j8byzzg

Aggressive form of leukemia linked to defective ‘protein factory’

Twenty to forty percent of the patients with the type of leukemia known as multiple myeloma have a defect in the ‘protein factory’ of the cell: the ribosome. These patients have a poorer prognosis than patients with intact ribosomes. At the same time, they respond better to a drug that already exists. These are the findings of a study by the KU Leuven Laboratory for Disease Mechanisms in Cancer, led by Professor Kim De Keersmaecker.
Multiple myeloma (MM, also known as Kahler’s disease) is a blood cancer whereby the plasma cells in the bone marrow start proliferating malignantly. MM cannot be cured and is most common among older people. Various treatments exist to temporarily suppress the disease, but the challenge is determining to which treatment the patient will respond best.
Doctoral student Isabel Hofman discovered defects in the ribosome of MM patients. “The ribosome is the protein factory of a cell. In MM patients, one part of the ribosome is produced less in 20 to 40 percent of the patients, depending on how aggressive the cancer is. We suspect that their cells are still producing protein, but that the balance is somewhat disrupted. In any case, we found that these people have a poorer prognosis than MM patients with an intact ribosome,” explains Professor De Keersmaecker.
One possible treatment for MM is the use of proteasome inhibitors. “The proteasome is the protein demolition machine in a cell. There’s a type of drugs, including Bortezomib, that inhibits its functioning. How the defects in the ribosome influence the proteasome is not quite clear yet. But we discovered that patients with a defective ribosome respond better to Bortezomib. In other words, their poorer prognosis can be offset by this treatment. On the basis of these findings, we can now develop tests to identify defects in the ribosome and thus determine which therapy will have most effect in a specific patient.”
The notion that cancer is related to ribosome defects is a relatively new concept in science. “A few years ago, we discovered defects in the ribosome of patients with acute lymphatic leukemia. Now we know that the same applies to MM. In all likelihood, this will also hold true for other types of cancer.

KU Leuven http://tinyurl.com/jnubnm7

Key regulator of bone development identified

Loss of a key protein leads to defects in skeletal development including reduced bone density and a shortening of the fingers and toes — a condition known as brachydactyly. The discovery was made by researchers at Penn State University who knocked out the Speckle-type POZ Protein (Spop) in the mouse and characterized the impact on bone development. The research redefines the role of Spop during bone development and provides a new potential target for the diagnosis and treatment of bone diseases such as osteoporosis.
“The Spop protein is involved in Hedgehog signalling — a well-studied cell-tocell communication pathway that plays multiple roles during development,” said Aimin Liu, associate professor of biology at Penn State and the corresponding author of the study. “Previous studies done in cell culture suggested that Spop negatively regulates or ‘turns down’ Hedgehog signalling. However, in our study, we show that Spop positively regulates the pathway downstream of a member of the Hedgehog family, a protein called Indian Hedgehog, during bone development. This new understanding adds to our knowledge of the genetic basis of bone development and could open new avenues to study bone disease.”
Indian Hedgehog (Ihh) plays an essential role in bone development. It is near the top of a hierarchical cascade of genes that program cells to produce cartilage and bone. Ihh controls gene expression by regulating the activity of the transcription factors — proteins that control the expression of other genes — Gli2 and Gli3. Gli2 acts mainly as an activator of gene expression and Gli3 acts mainly to repress gene expression. The Spop protein tags the Gli proteins to be degraded in the cell. “Previous studies led to a hypothesis that a loss of Spop function would increase Hedgehog signalling because the Gli activators were no longer being degraded,” said Hongchen Cai, a graduate student at Penn State and an author of the paper. “We were surprised to see in our study the repressor of gene expression, Gli3, built up in developing bone, but not the activator of gene expression, Gli2. This imbalance led to an overall decrease in Hedgehog signalling.”
In order to study the role of Spop in bone development more closely, the researchers knocked the gene out specifically in the limb. Limbs that lacked Spop had less dense bone, mimicking osteopenia — a human condition characterized by low bone density, but not as severe as osteoporosis. The limbs also had shorter than normal fingers and toes. The researchers also showed that the effects of losing Spop could be mitigated by simultaneously reducing the amount of Gli3 in the limbs.

Penn State http://tinyurl.com/jx3y6nj

For invasive breast cancer, researchers identify biomarkers of treatment response

Why do some breast cancers respond to treatment while others resist it? A study led by researchers at the University of North Carolina Lineberger Comprehensive Cancer Center may provide insight into this important question.
The researchers report at the San Antonio Breast Cancer Symposium they have identified biomarkers they believe can be used as part of a larger model to predict how patients with HER2-positive operative breast cancer will respond to the targeted treatment trastuzumab, commercially known as Herceptin, and chemotherapy. “We’re trying to find biomarkers for resistance to trastuzumab treatment and chemotherapy,” said the study’s first author Maki Tanioka, MD, PhD, a postdoctoral research associate at UNC Lineberger. “What’s the cause of response? What’s the cause of resistance? That’s what we are trying to identify in this genomic study.”
Tanioka and his colleagues analysed multiple biologic features of cancer cells from 213 patients treated for HER2-positive breast cancer through a National Cancer Institute cooperative group clinical trial, CALGB 40601. The biologic features included multiple kinds of genetic information such as DNA mutations, DNA copy number and RNA gene expression data. The researchers found that certain gene signatures, and either having too many, or too few, of certain genes were predictive of whether patients responded to treatment, and that combining those two features was the most effective method of predicting response.
Examining features like mutations, amplifications or deletions of genes in tumour cells, the overall subtype of the tumour, as well as indicators of immune responses helped the researchers predict response. The researchers also determined that amplification of a specific chromosome, and a particular gene called MAPK14 on that chromosome, may be a predictor of sensitivity to treatment, while deletions of other genes predicted resistance.
The researchers say the next step is to identify another set of data to validate and broaden their findings.
“HER2-positive breast cancer is genomically heterogeneous,” Tanioka said. “Therefore, we need a model that incorporates all these different features. We are actively seeking a set of patient data that we can use to validate the biomarkers we have identified so we can create a comprehensive predictive model of response to allow us to better tailor treatment.”

University of North Carolina Lineberger Comprehensive Cancer Center http://tinyurl.com/grk84cg

Rapid test identifies disease pathogens

Researchers at the Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB in Stuttgart are developing a test which rapidly and cost-effectively identifies bacteria, fungi or viruses. It can be carried out directly in situ without laboratory equipment and specialist knowledge. “The ImmuStick can even detect pathogens outside the body – on medical devices or in hospital rooms for example. However, the technology would certainly also be of interest for testing human blood for germs or allergies“, says Dr. Anke Burger-Kentischer.
The method works as simply as a pregnancy test. The ImmuStick is a test strip onto which a few drops of fluid are applied. If the fluid contains pyrogens, fragments of pathogens, this is shown by a coloured strip in a viewing window. First of all, human immune receptors sensitive to certain pyrogens are applied to the surface of the stick. These are laboratory-produced immune receptors which are synthesized on the basis of the biological model. During production, at the docking point of the immune receptors to which the pyrogens normally bind, a type of placeholder is mounted which is marked with a dye. When drops of a fluid containing pyrogens are then applied to the test strip, the pyrogens rush to the docking point on the immune receptor. The placeholders marked with the dye migrate with the fluid through the test strip until they are visible in the viewing window. The colour signal thus indicates that pyrogens that have docked on the immune receptors are present.
The ImmuStick project was financed with money from the Discover programme. In this way the Fraunhofer-Gesellschaft is supporting projects for the duration of one year in order to demonstrate the feasibility of a technology. The ImmuStick has passed this test. “We were able to show that it works very well for the bacterial pyrogen LPS. Together with industrial partners, we now want to develop it into a product“, says project manager Burger-Kentischer. “We are currently testing further immune receptors that are specific for other pyrogens.“
Currently envisaged are applications in the food and pharmaceuticals sector or in medical technology, as a complete absence of germs or pyrogens is required there. In principle, the ImmuStick would also be of interest for blood analysis. Pyrogens in the blood often lead to blood poisoning, sepsis, from which many people still die today, especially weakened intensive care patients. “However, blood is a special challenge as it is complex and contains many constituent parts. But in the medium term we are aiming at blood analysis“, says Burger-Kentischer.
As pyrogens also include certain allergy trigger factors, an application here would also be conceivable. In the food and pharmaceutical industries, for example, it is important that products are free of allergens. With the ImmuStick these could be detected quickly, cost-effectively and simply. Costly and laborious laboratory tests would therefore no longer be needed or could be supplemented. At present the IGB researchers are seeking cooperation partners who want to further develop the ImmuStick to make it ready for the market.
Pyrogens become a problem when hygiene is of particular importance – in the food and pharmaceutical industries for example, or on intensive care wards in hospitals. Especially people with weakened immune systems can become severely ill. For this reason, tests are frequently carried out and the surfaces of machines or medical devices are tested for pyrogens using swabs. However, to date these tests have been costly and laborious as pyrogens can only be detected with laboratory equipment. A widely used standard test is the detection of LPS, a structure that is present in the membrane of certain bacteria. At present this test takes up around two hours. Other pyrogens can even only be detected in animal experiment.

Fraunhofer Institute for Interfacial Engineering and Biotechnology IGBhttp://tinyurl.com/jyrlqct

Blood-borne HPV antibodies indicate head, neck cancer prognosis

People with head and neck cancers with evidence of human papillomavirus (HPV) infection generally have a better prognosis than people without evidence of infection. A new study suggests that to produce a strong, reliable prognostic signal, all that’s needed is a blood serum test for two specific HPV antibodies, rather than lab work on a biopsy. Further, the researchers said, the study shows that this blood-based biomarker is predictive of outcome for all types of head and neck cancer.
“What this adds is that it helps us know how best to measure clinically the HPV contribution to this disease,” said study senior author Karl Kelsey, a professor of epidemiology and of pathology and laboratory medicine at Brown University. Kelsey collaborated with lead author Heather Nelson of the University of Minnesota Masonic Cancer Center in making the findings.
Moreover, Nelson, Kelsey and their colleagues wrote, referring to the common HPV16 strain of the virus: “These data are among the first to demonstrate a convincing relationship between HPV16 and improved patient survival for tumours of the larynx and oral cavity.”
The study examined blood serum samples and five-year survival rates among more than 1,000 Boston-area head and neck cancer patients diagnosed between 1999 and 2011. Overall, those who tested positive for antibodies to the oncogenic HPV proteins E6 or E7 were less likely to die during the five year follow-up period after diagnosis compared to those who tested negative for the antibodies. Based on the analysis, the researchers estimated that those with evidence of an immune response to HPV were 25% less likely to die during the course of follow-up compared to those with no immune response to HPV.
The study’s purpose was to determine whether the antibodies provide a reliable indication of prognosis. In ongoing trials, doctors are testing whether patients with HPV-associated cancers can be treated less aggressively — and hopefully with fewer negative side effects — than people with non-HPV-associated cancers, Kelsey said. If trials prove successful, then it will be particularly important to determine whether cancers are HPV-associated.
“The assessment of a patient’s HPV status likely will affect treatment,” he said. “That’s why there’s real interest in getting it right; for instance, how do you test?”
Prior studies have focused primarily on the role of HPV in the oropharynx — the area of the throat right behind the mouth. An important contribution of the current study, Nelson said, is demonstration that an immune response to HPV is important for all forms of head and neck cancer, although the benefit does show some variance based on the exact cancer location. Those patients with an HPV immune response with tumours located in the oropharynx and larynx had a similar risk of dying during the follow-up period, though the reduced risk was slightly attenuated for those patients with tumours located in the oral cavity.
The results didn’t depend significantly on whether people had high or low levels of the antibodies, so long as they had some, the researchers found, though testing positive for both E6 and E7 was better than for just one.
The reduced chance of dying by five years carried through for people who tested positive for the antibodies even if they consumed tobacco and alcohol. But the worst prognoses in the study were among smokers whose cancers could not be traced to HPV.
In all, the findings controlled for the statistical influences not only of tobacco and alcohol exposure, but also of age, race, gender, education and how far advanced the cancer was.
Kelsey said the findings could help bring head and neck cancer treatment closer into line with two emerging practices of fighting the disease: personalized medicine and immunotherapy.

Brown University http://tinyurl.com/z3n94a4