Machine learning-based immune phenotypes correlate with STK11/KEAP1 co-mutations and prognosis in resectable NSCLC: a sub-study of the TNM-I trial.

BACKGROUND: We aim to implement an immune cell score model in routine clinical practice for resected non-small-cell lung cancer (NSCLC) patients (NCT03299478). Molecular and genomic features associated with immune phenotypes in NSCLC have not been explored in detail. PATIENTS AND METHODS: We developed a machine learning (ML)-based model to classify tumors into one of three categories: inflamed, altered, and desert, based on the spatial distribution of CD8+ T cells in two prospective (n = 453; TNM-I trial) and retrospective (n = 481) stage I-IIIA NSCLC surgical cohorts. NanoString assays and targeted gene panel sequencing were used to evaluate the association of gene expression and mutations with immune phenotypes. RESULTS: Among the total of 934 patients, 24.4% of tumors were classified as inflamed, 51.3% as altered, and 24.3% as desert. There were significant associations between ML-derived immune phenotypes and adaptive immunity gene expression signatures. We identified a strong association of the nuclear factor-κB pathway and CD8+ T-cell exclusion through a positive enrichment in the desert phenotype. KEAP1 [odds ratio (OR) 0.27, Q = 0.02] and STK11 (OR 0.39, Q = 0.04) were significantly co-mutated in non-inflamed lung adenocarcinoma (LUAD) compared to the inflamed phenotype. In the retrospective cohort, the inflamed phenotype was an independent prognostic factor for prolonged disease-specific survival and time to recurrence (hazard ratio 0.61, P = 0.01 and 0.65, P = 0.02, respectively). CONCLUSIONS: ML-based immune phenotyping by spatial distribution of T cells in resected NSCLC is able to identify patients at greater risk of disease recurrence after surgical resection. LUADs with concurrent KEAP1 and STK11 mutations are enriched for altered and desert immune phenotypes.

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery.

Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery.

Medical, psychological and intellectual development of 5-year-old children born after intracytoplasmic sperm injection.

BACKGROUND: The neurodevelopmental outcome of children born after intracytoplasmic sperm injection (ICSI) is controversial. PATIENTS AND METHODS: Thus, we compared the medical and developmental outcome at a mean age of 5 years and 6 months of 35 singletons born after an ICSI procedure performed at the Tübingen Medical Center with those of 37 naturally conceived (NC) matched control singletons born at the Tübingen Medical Center. Children with congenital anomalies which could interfere with mental development were excluded, these were reported earlier. Each child was assessed neurologically and physically. Cognitive function was assessed using the Kaufman assessment battery for children (K-ABC). Behaviour was tested using a German behavioural questionnaire for preschoolers (VBV). RESULTS: Medical and cognitive outcome, and behaviour pattern were similar in both groups. Nevertheless, there were sex-related differences in favour of ICSI children: ICSI boys had better social competence than the control boys, while ICSI girls had less emotional problems than the control girls. CONCLUSIONS: Once severe congenital anomalies were excluded, there were no differences in physical and neurodevelopmental outcome of 5-year-old ICSI children compared with controls.With regard to behaviour and emotional development, ICSI children seem to be similar or might be even more stable and socially competent than the control children. As our study is limited by the small sample size, further research is needed to confirm our results.

Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail.

BACKGROUND: Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. EBUS has also proved to be a valuable diagnostic tool for patients with different intrathoracic lesions who remain undiagnosed despite bronchoscopy and CT-guided fine-needle aspiration. OBJECTIVE: The present study focused on EBUS for diagnosing sarcoidosis. DESIGN: During a 3-year period 308 of 601 patients who underwent EBUS at our institution were referred for further diagnostic of a radiologically suspicious lesion in the lung parenchyma (n = 195), enlarged lymph nodes in the mediastinum (n = 89), a suspicious tumor in the mediastinum or pleural disease (n = 24) but no one had a definite histological diagnosis. All charts were reviewed retrospectively. RESULTS: Of the 308 patients 43 (14%) were eventually diagnosed with sarcoidosis. Thirty-three (77%) were diagnosed with EBUS. In the remaining 10 patients EBUS did not provide adequate tissue samples in 4 (9%) and in 6 patients (14%) EBUS provided adequate tissue but no definite diagnosis. EBUS was significantly better to establish the diagnosis in patients with enlarged mediastinal lymph nodes compared with isolated lung parenchymal involvement (85% vs 63%, p < 0.05). CONCLUSION: EBUS is a valuable minimally invasive diagnostic modality to establish the diagnosis of sarcoidosis of unselected patients with undiagnosed intrathoracic lesions after conventional work up--particularly if patients have enlarged mediastinal lymph nodes. This minimally invasive procedure provides a final diagnosis without exposing the patient to the risk of complications from more invasive procedures.

Proximate constraints on the evolution of egg size, number, and total clutch mass in lizards.

Proximate constraints on egg size, number, and total clutch mass in side-blotched lizards were examined by experimentally reducing average clutch size from 4.6 eggs to one, two, and three eggs. Eggs from experimentally altered clutches were larger than those from controls, reflecting the trade-off between egg size and number. Moreover, the increased frequency of females with oviducally bound eggs or eggs that burst at oviposition suggests that egg size in clutches with very few eggs are at a functional upper size limit. These proximate constraints may also limit evolution of egg size in another group of lizards (Anolis) that only produces one-egged clutches.

Fatal sibling aggression, precocial development, and androgens in neonatal spotted hyenas.

Fatal neonatal sibling aggression is common in predatory birds but has not been previously reported in wild mammals. Spotted hyena females are strongly masculinized, both anatomically and behaviorally, apparently by high levels of androgens during ontogeny. Neonates display elevated androgen levels, precocial motor development, and fully erupted front teeth. Litters are usually twins, and siblings fight violently at birth, apparently leading to the death of one sibling in same-sex litters, whereas in mixed-sex litters both siblings usually survive.

Amphibian pituitary growth hormone and prolactin: immunochemical relatedness to rat growth hormone.

Growth hormone and prolactin were electrophoretically isolated from amphibian pituitaries and then were tested in a radioimmunoassay with labeled rat growth hormone and antiserum to the same hormone. This isolation and purification of the hormones increased the steepness of the slopes of competitive inhibition in this system when compared to those of crude extracts. Both hormones from most species tested showed high immunochemical cross-reactivity, indicating that amphibian growth hormone and prolactin are structurally related to rat growth hormone.

A mechanism for virilization of female spotted hyenas in utero.

Female spotted hyenas exhibit male-like genitalia and dominance over males. Hyena ovarian tissues incubated in vitro produced large quantities of the steroid hormone precursor androstenedione. The activity of aromatase, which converts androstenedione to estrogen, was one-twentieth as great in hyena versus human placental homogenates. In comparison, the activity of 17 beta-hydroxysteroid dehydrogenase, which converts androstenedione to testosterone, was equal in the two homogenates. The limited aromatase activity may allow the hyena placenta to convert high circulating concentrations of androstenedione to testosterone, which results in virilization of the fetal external genitalia and possibly destruction of fetal ovarian follicles. Androstenedione production by residual ovarian stromal cells during reproductive life accounts for the epigenetic transmission of virilization in female spotted hyenas.

Is human chorionic gonadotropin directly involved in the regulation of human implantation?

The regulation of human implantation is not fully understood. hCG as one of the earliest embryonal signals may be a major regulator in the parakrine embryo-endometrial communication. The expression of full-length hCG/LH-receptor mRNA could be demonstrated in human endometrium throughout the follicular and secretory phase of the menstrual cycle. In contrast, in early pregnancy decidua only truncated variants could be detected. To investigate direct effects of hCG on the human endometrium, an intrauterine microdialysis device was developed to measure parakrine mediators within the uterine cavity in vivo. Using this system, hCG was applied in the secretory phase and the endometrial response was evaluated. The administration of hCG (500 IU/ml) provoked a significant inhibition of intrauterine IGFBP-1 and M-CSF, while LIF, VEGF and MMP-9 were significantly stimulated. Taken together there appear to be multiple direct effects of hCG on the endometrium that precede the classical endocrine role of the hormone.

Evidence for a modulation of human chorionic gonadotropin (hCG) subunit messenger ribonucleic acid levels and hCG secretion by gamma-aminobutyric acid in human first trimester placenta in vitro.

The cytotrophoblasts are the site of production of liberins and statins in human placenta, whereas the syncytiotrophoblasts synthesize tropic hormones. These placental cell layers seem to interact like the hypothalamus and pituitary. In the central nervous system, gamma-aminobutyric acid (GABA)-ergic neurons represent one important control mechanism that seems to influence the lutropin biosynthesis indirectly (via gonadoliberin) and directly. It was the objective of the present study to find out whether GABA also may influence the biosynthesis and secretion of hCG by human first trimester placenta. Already one single pulse of GABA (1 h; 0.01-100 microM) stimulated hCG secretion significantly (P less than 0.0001). GABA also induced a marked increase in the mRNA levels of both subunits, with an optimum at 10 microM. The effect on hCG secretion was mimicked by the GABA-A receptor agonist muscimol (P less than 0.002), but under the experimental conditions used (multiple pulses; 1 microM), only the beta mRNA was increased. The GABA-A receptor antagonist bicuculline (two pulses; 10 microM) suppressed basal hCG secretion (P less than 0.001) and abolished the episodic secretion pattern observed in the control cultures. Applying a combination of equimolar amounts of GABA and bicuculline, hCG secretion and the episodic secretion pattern were similar as in control cultures. The data seem to suggest a regulation of hCG biosynthesis in human first trimester placenta in which GABA is involved, probably acting via GABA-A-like receptor sites.

Isolation and characterization of follicle-stimulating hormone and luteinizing hormone and its subunits from snapping turtle (Chelydra serpentina) pituitaries.

Highly purified luteinizing hormone and follicle-stimulating hormone have been isolated from extracts of snapping turtle (Chelydra serpentina) pituitaries. Both hormones are potent in non-mammalian gonadotropin bioassays (1.8 X NIH-LH-S1 and 30 X NIH-FSH-S1). The materials have been characterized by polyacrylamide gel electrophoresis, amino terminal group analysis, amino acid and carbohydrate content, and, in the case of turtle luteinizing hormone, ultracentrifugation. The luteinizing hormone was shown to dissociate and subunits were prepared by the countercurrent distribution technique and characterized. Biological activity of the hormone could be regenerated by recombination of the subunits. In addition, it was shown that the snapping turtle luteinizing hormone subunits could be combined with subunits from ovine luteinizing hormone with generation of significant biological activity. Comparisons in properties of the turtle gonadotropins have been made with ovine gonadotropins, showing, in many cases, similarities in properties, suggesting structural features which have been conserved during evolution.

Effect of the alpha subunit of equine LH on the FSH induced cAMP production in rat seminiferous tubule cells.

Previous observations from our laboratory have shown that equine LH can suppress the FSH induced cyclic AMP production in rat seminiferous tubule cells in vitro. The present investigation was carried out to determine the effect of various subunits in this system. The ratios (w/w) of subunits to equine FSH tested was 1:3, 3:1 and 30:1 with a standard dose of 0.3 microgram of the FSH. It was noted that equine LH-beta was not effective up to a 10 microgram concentration in inhibiting the cyclic AMP production induced by equine FSH. Under these conditions, equine LH-alpha suppressed the FSH activity in a dose dependent manner. However, alpha subunits derived from several other species of LH were without any effect on FSH action. Histidine modified derivative of equine LH and its alpha subunit, both of which lack biological activity in the rat Leydig cell assay for LH, were found to be inactive as inhibitors of the equine FSH response. Thus, these results show that the suppressive effect of equine LH on FSH action in the rat seminiferous tubule is a function of the equine LH alpha subunit.

Novel expression of human chorionic gonadotropin/luteinizing hormone receptor gene in brain.

LH from anterior pituitary and hCG from placenta bind to a common receptor in gonadal and nongonadal reproductive tissues. There have been numerous examples suggesting that the brain may also contain hCG/LH receptors, yet there has been no evidence for their existence so far. We now demonstrate by reverse transcription-nested polymerase chain reaction and northern blotting that the rat brain contains hCG/LH receptor mRNA. A major receptor transcript of 2.6 kilobases and minor transcripts of 1.8 and 4.4 kilobases were found. Western immunoblotting, ligand blotting, and covalent receptor cross-linking studies have shown that rat brain also contains an 80-kilodalton receptor protein that can bind hCG and hLH, but not hFSH. Rat testis used as a positive control showed a higher abundance of multiple transcripts and an 80-kilodalton receptor protein that can bind [125I]hCG. Rat liver used as a negative control did not contain any receptor transcripts or protein. In situ hybridization, dot blotting, immunocytochemistry, and topical autoradiography have revealed that hCG/LH receptors are present in rat hippocampus; dentate gyrus; hypothalamus; cerebellum; choroid plexus; ependymal cells of third, fourth, and lateral ventricles; cortex; brainstem; bovine hypothalamus; and human area postrema. These novel findings could potentially explain numerous previous observations and suggest new possibilities concerning the regulation of brain functions by hCG and LH.

Novel self-regulation of human chorionic gonadotropin biosynthesis in term pregnancy human placenta.

Term pregnancy human placenta contains hCG/LH receptor mRNA transcripts and immunoreactive receptor protein. Both the receptor transcripts and receptor proteins are present only in trophoblasts. These findings led us to investigate whether hCG can regulate its own synthesis in term pregnancy human placenta. Treatment of placental tissue in static cultures or in a dynamic superfusion system with increasing concentrations of highly purified hCG provoked a biphasic effect on the steady state hCG subunit mRNA levels. Although low concentrations of hCG (< 200 mIU/ml) were not effective, moderate concentrations (200-1000 mIU/ml) increased, and high concentrations (> or = 5000 mIU/ml) either had no effect or actually decreased mRNA levels relative to the control values. This response was specific, because none of the hCG concentrations tested had any effect on glyceraldehyde-3-phosphate dehydrogenase or beta-actin mRNA levels. The effects of hCG on steady state hCG subunit mRNA levels were paralleled by corresponding changes in tissue hCG protein levels. Endogenous hCG appears to down-regulate alpha-subunit mRNA levels and hCG secretion. The hCG effect is probably receptor mediated, because a receptor antagonist, deglycosylated hCG, partially antagonized the hCG action. Treatment with exogenous hCG also down-regulated its own receptor mRNA and receptor protein levels. hCG regulation of its alpha-subunit and receptor levels involved both transcriptional as well as posttranscriptional mechanisms. In summary, this is the first demonstration of hCG regulating its own synthesis in term pregnancy human placenta. The findings of this study could offer a potential molecular explanation for the profile of hCG levels in normal pregnant women.

The secretion of human chorionic gonadotropin as well as the alpha- and beta messenger ribonucleic acid levels are stimulated by exogenous gonadoliberin pulses applied to first trimester placenta in a superfusion culture system.

It is well documented that the hypothalamic decapeptide gonadoliberin (GnRH) controls the biosynthesis and secretion of pituitary gonadotropins; however, it is still unclear whether GnRH synthesized by the placenta plays the same role with respect to hCG. In the current study we have investigated the acute response of placenta tissue to a single GnRH pulse as well as the influence of GnRH pulses on the secretion of hCG and hCG mRNA concentrations elicited several hours after application of the peptide hormone. For this purpose we have used a superfusion culture model of first trimester placenta tissue (8-12 weeks of gestation). In the first hour after explantation of the tissue, hCG secretion was decreased, and increasing amounts of free subunits were released. Afterward, the original hCG secretion rates were recovered and maintained for several days, attended by decreased levels of free subunits in the culture medium. The superfusion model was superior to static incubations, since it showed approximately a 4-fold higher amount of hCG to be secreted within 24 h (day 3 of cultures). A single GnRH pulse (1 mumol/L; 30 min) caused a significantly increased transient release of hCG (P less than 0.0001). Two GnRH pulses (concentration range, 0.01-10 mumol/L; 30 min) applied 24 h after (first pulse) and in the interval between 36-48 h after (second pulse) the start of the superfusion culture elicited a long-lasting 2-fold increase in the hCG secretion rate, which rose approximately 6 h after the second GnRH pulse. This was correlated with increased mRNA concentrations measured by means of Northern blots of total RNA. At 0.02 mumol/L GnRH, 4-fold higher beta mRNA levels were observed. The alpha mRNA levels were 2.5-fold elevated. GnRH pulses of 0.01 and 10 mumol/L, respectively, were ineffective. A further effect of GnRH pulses was augmentation of the episodic character of hCG secretion. Our results suggest that GnRH causes different specific acute and late effects on the amount and pattern of hCG secretion as well as on hCG biosynthesis at the levels of both hCG subunit mRNAs.