Cell-free DNA from nail clippings as source of normal control for genomic studies in hematologic malignancies.

Comprehensive genomic sequencing is becoming a critical component in the assessment of hematologic malignancies, with broad implications for patient management. In this context, unequivocally discriminating somatic from germline events is challenging but greatly facilitated by matched analysis of tumor:normal pairs. In contrast to solid tumors, conventional sources of normal control (peripheral blood, buccal swabs, saliva) could be highly involved by the neoplastic process, rendering them unsuitable. In this work we describe our real-world experience using cell free DNA (cfDNA) isolated from nail clippings as an alternate source of normal control, through the dedicated review of 2,610 tumor:nail pairs comprehensively sequenced by MSK-IMPACT-heme. Overall, we find nail cfDNA is a robust source of germline control for paired genomic studies. In a subset of patients, nail DNA may have tumor DNA contamination, reflecting unique attributes of the hematologic disease and transplant history. Contamination is generally low level, but significantly more common among patients with myeloid neoplasms (20.5%; 304/1482) compared to lymphoid diseases (5.4%; 61/1128) and particularly enriched in myeloproliferative neoplasms with marked myelofibrosis. When identified in patients with lymphoid and plasma-cell neoplasms, mutations commonly reflected a myeloid profile and correlated with a concurrent/evolving clonal myeloid neoplasm. For nails collected after allogeneic stem-cell transplantation, donor DNA was identified in 22% (11/50). In this cohort, an association with recent history of graft-vs-host disease was identified. These findings should be considered as a potential limitation for the use of nail as normal control but could also provide important diagnostic information regarding the disease process.

Enhanced clinical assessment of hematologic malignancies through routine paired tumor and normal sequencing.

Genomic profiling of hematologic malignancies has augmented our understanding of variants that contribute to disease pathogenesis and supported development of prognostic models that inform disease management in the clinic. Tumor only sequencing assays are limited in their ability to identify definitive somatic variants, which can lead to ambiguity in clinical reporting and patient management. Here, we describe the MSK-IMPACT Heme cohort, a comprehensive data set of somatic alterations from paired tumor and normal DNA using a hybridization capture-based next generation sequencing platform. We highlight patterns of mutations, copy number alterations, and mutation signatures in a broad set of myeloid and lymphoid neoplasms. We also demonstrate the power of appropriate matching to make definitive somatic calls, including in patients who have undergone allogeneic stem cell transplant. We expect that this resource will further spur research into the pathobiology and clinical utility of clinical sequencing for patients with hematologic neoplasms.

Temperature Variation under Continuous Light Restores Tomato Leaf Photosynthesis and Maintains the Diurnal Pattern in Stomatal Conductance.

The response of tomato plants (Solanum lycopersicum L. cv. Aromata) to continuous light (CL) in relation to photosynthesis, abscisic acid (ABA) and reactive oxygen species (ROS) was investigated to improve the understanding of the development and/or alleviation of CL-induced leaf injury in constant and diurnal temperature fluctuations with similar daily light integral and daily mean temperature. The plants were grown in three photoperiodic treatments for 15 days; One treatment with a 16/8 h light/dark period and a light/dark temperature of 27/17°C (Control), two CL treatments with 24 h photoperiods, one with a constant temperature of 24°C (CLCT) and the other one with variable temperature of 27/17°C for 16/8 ho, respectively (CLVT). A diurnal pattern of stomatal conductance (gs ) and [ABA] was observed in the plants grown in the control and CLVT conditions, while the plants in CLCT conditions experienced a significant decrease in stomatal conductance aligned with an increase in ABA. The net photosynthesis (A) was significantly reduced in CLCT, aligned with a significant decrease in the maximum rate of Rubisco carboxylation (Vcmax), the maximum rate of electron transport (Jmax) and mesophyll diffusion conductance to CO2 (gm) in comparison to the control and CLVT. An increased production of H2O2 and O2•- linked with increased activities of antioxidative enzymes was seen in both CL treatments, but despite of this, leaf injuries were only observed in the CLCT treatment. The results suggest that the diurnal temperature fluctuations alleviated the CL injury symptoms, probably because the diurnal cycles of cellular mechanisms were maintained. The ROS were shown not to be directly involved in CL-induced leaf injury, since both ROS production and scavenging was highest in CLVT without leaf chlorotic symptoms.

Continuous light increases growth, daily carbon gain, antioxidants, and alters carbohydrate metabolism in a cultivated and a wild tomato species.

Cultivated tomato species develop leaf injury while grown in continuous light (CL). Growth, photosynthesis, carbohydrate metabolism and antioxidative enzyme activities of a cultivated (Solanum lycopersicum L. 'Aromata') and a wild tomato species (Solanum pimpinellifolium L.) were compared in this study aiming to analyze the species-specific differences and thermoperiod effects in responses to CL. The species were subjected to three photoperiodic treatments for 12 days in climate chambers: 16-h photoperiod with a light/dark temperature of 26/16°C (P16D10 or control); CL with a constant temperature of 23°C (P24D0); CL with a variable temperature of 26/16°C (P24D10). The results showed that both species grown in CL had higher dry matter production due to the continuous photosynthesis and a subsequent increase in carbon gain. In S. lycopersicum, the rate of photosynthesis and the maximum photochemical efficiency of photosystem II declined in CL with the development of leaf chlorosis, reduction in the leaf chlorophyll content and a higher activity of antioxidative enzymes. The normal diurnal patterns of starch and sugar were only present under control conditions. The results demonstrated that CL conditions mainly affected the photosynthetic apparatus of a cultivated species (S. lycopersicum), and to a less degree to the wild species (S. pimpinellifolium). The negative effects of the CL could be alleviated by diurnal temperature variations, but the physiological mechanisms behind these are less clear. The results also show that the genetic potential for reducing the negative effects of CL does exist in the tomato germplasm.

A predictive model for intrathecal opioid dose escalation for chronic non-cancer pain.

BACKGROUND: Tolerance is defined as a phenomenon in which exposure to a drug results in a decrease of an effect or the requirement of a higher dose to maintain an effect. The fear of a patient developing opioid tolerance contributes regularly to the stigmatization and withholding of intrathecal opioid therapy for chronic pain of non-cancer origin. OBJECTIVES: The aim of this study was to describe the intrathecal opioid dose escalation throughout the years in chronic non-cancer pain patients. A secondary objective was the development of an intrathecal opioid dose predictive model. STUDY DESIGN: Retrospective assessment of medical records. SETTING: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. METHODS: Medical records were reviewed and pump refill notes screened from the date of implant through November 2010 for 31 patients undertaking continuous intrathecal opioid therapy. All the patients included had undertaken a minimum of 6 years of intrathecal therapy when the data were collected. RESULTS: Significant increases in the intrathecal morphine dose were verified between follow-up at one year and all subsequent observations, F (2.075, 62.238) = 13.858, 0 < 0.001, but ceased to be significant from year 3 onwards, indicating stability of the morphine dose, F (3, 90) = 2.516, P = 0.63. A model that accounts for 76% of the variability of morphine doses at year 6 based on year 2 assessment combined with duration of pain prior to initiation of intrathecal therapy was developed: year 6 dose = -0.509 + (1.296 x [year 2 dose]) + (0.061 x [duration of pain]). LIMITATIONS: Retrospective study. CONCLUSION: The opioid dose escalation observed throughout the years was modest and not significant following year 3 of therapy. The model developed has the potential to assist the physician in the identification of a need for alternative treatment strategies. Furthermore, since many of the pump replacements are performed prior to year 6, it can also assist in the informed decision of the benefits and risks of the maintenance of this therapy.