Transcriptomic and clinical heterogeneity of metastatic disease timing within metastatic castration-sensitive prostate cancer.

BACKGROUND: Metastatic castration-sensitive prostate cancer (mCSPC) is commonly classified into high- and low-volume subgroups which have demonstrated differential biology, prognosis, and response to therapy. Timing of metastasis has similarly demonstrated differences in clinical outcomes; however, less is known about any underlying biologic differences between these disease states. Herein, we aim to compare transcriptomic differences between synchronous and metachronous mCSPC and identify any differential responses to therapy. PATIENTS AND METHODS: We performed an international multi-institutional retrospective review of men with mCSPC who completed RNA expression profiling evaluation of their primary tumor. Patients were stratified according to disease timing (synchronous versus metachronous). The primary endpoint was to identify differences in transcriptomic profiles between disease timing. The median transcriptomic scores between groups were compared with the Mann-Whitney U test. Secondary analyses included determining clinical and transcriptomic variables associated with overall survival (OS) from the time of metastasis. Survival analysis was carried out with the Kaplan-Meier method and multivariable Cox regression. RESULTS: A total of 252 patients were included with a median follow-up of 39.6 months. Patients with synchronous disease experienced worse 5-year OS (39% versus 79%; P < 0.01) and demonstrated lower median androgen receptor (AR) activity (11.78 versus 12.64; P < 0.01) and hallmark androgen response (HAR; 3.15 versus 3.32; P < 0.01). Multivariable Cox regression identified only high-volume disease [hazard ratio (HR) = 4.97, 95% confidence interval (CI) 2.71-9.10; P < 0.01] and HAR score (HR = 0.51, 95% CI 0.28-0.88; P = 0.02) significantly associated with OS. Finally, patients with synchronous (HR = 0.47, 95% CI 0.30-0.72; P < 0.01) but not metachronous (HR = 1.37, 95% CI 0.50-3.92; P = 0.56) disease were found to have better OS with AR and non-AR combination therapy as compared with monotherapy (P value for interaction = 0.05). CONCLUSIONS: We have demonstrated a potential biologic difference between metastatic timing of mCSPC. Specifically, for patients with low-volume disease, those with metachronous low-volume disease have a more hormone-dependent transcriptional profile and exhibit a better prognosis than synchronous low-volume disease.

Extracellular fluid conductivity analysis by dielectric spectroscopy for in vitro determination of cortical tissue vitality.

Brain tissue is extremely metabolically active in part due to its need to constantly maintain a precise extracellular ionic environment. Under pathological conditions, unhealthy cortical tissue loses its ability to maintain this precise environment and there is a net efflux of charged particles from the cells. Typically, this ionic efflux is measured using ion-selective microelectrodes, which measure a single ionic species at a time. In this paper, we have used a bio-sensing method, dielectric spectroscopy (DS), which allows for the simultaneous measurement of the net efflux of all charged particles from cells by measuring extracellular conductivity. We exposed cortical brain slices from the mouse to different solutions that mimic various pathological states such as hypokalemia, hyperkalemia and ischemia (via oxygen-glucose deprivation). We have found that the changes in conductivity of the extracellular solutions were proportional to the severity of the pathological insult experienced by the brain tissue. Thus, DS allows for the measurement of changes in extracellular conductivity with enough sensitivity to monitor the health of brain tissue in vitro.

Design and implementation of a novel superfusion system for ex vivo characterization of neural tissue by dielectric spectroscopy (DS).

Dielectric spectroscopy is a widely utilized electrophysiological characterization method. The obtained dielectric spectra and derived properties have the potential of providing significant information regarding changes in the physiological state of a biological system. However, since many of the dielectric properties are obtained in vitro from excised tissue far removed from physiological conditions, the value of the information obtained may be diminished. In this paper, we introduce a superfusion system that is designed to produce ex vivo dielectric spectroscopy measurements by providing the living tissue with a continuous and ample supply of nutrients and oxygen while removing metabolites and other waste. This superfusion system provides the convenience of in vitro measurement while concurrently producing results that can be more closely correlated with actual physiological changes in the biological system.