The impact of a serum based proteomic mass spectrometry test on treatment recommendations in advanced non-small-cell lung cancer.

OBJECTIVE: To assess the impact of a serum-based proteomic test for non-small-cell lung cancer (NSCLC) on physician treatment recommendations. RESEARCH DESIGN AND METHODS: A multivariate, serum-based proteomic test (VeriStrat) is commercially available to assist physicians when determining treatment using epidermal growth factor receptor inhibitor (EGFRi) therapy, such as erlotinib (Tarceva), by stratifying patients into two categories: those with significantly better ('good') and those with significantly worse ('poor') outcomes following treatment with EGFRi therapy. All tests ordered from August 9, 2011 to November 26, 2012, were considered for this study. Pre- and post-test treatment recommendations were prospectively collected from ordering physicians on a voluntary basis. Only those tests that had both pre- and post-test treatment information were included in the analysis group. MAIN OUTCOME MEASURES: Proportional change and correlation of treatment recommendations before and after receipt of the test results. RESULTS: Over the duration of the study, 724 physicians ordered 2854 tests. The analysis group comprised the 226 physicians who provided pre- and post-test treatment information (n = 403 tests). Following receipt of the test results, 90.3% (95% CI: 86.4-93.3%) of patients who tested as 'good' received erlotinib recommendations versus 9.6% (95% CI: 4.5-17.4%, p < 0.0001) of patients who tested as 'poor'. Ninety percent of post-test treatment recommendations positively correlated with test results, with 40% showing a change from pre-test considerations. STUDY LIMITATIONS: Data based on physicians willing to submit recommendations and endpoint limited to therapy recommendations. CONCLUSIONS: Among test orderers, serum-based proteomic mass spectrometry testing significantly influenced therapy recommendations in NSCLC. Usage patterns should be monitored as use expands.

Both insulin and calcium channel signaling are required for developmental regulation of serotonin synthesis in the chemosensory ADF neurons of Caenorhabditis elegans.

Proper calcium channel and insulin signaling are essential for normal brain development. Leaner mice with a mutation in the P/Q-type voltage-gated calcium channel, Cacna1a, develop cerebellar atrophy and mutations in the homologous human gene are associated with increased migraine and seizure tendency. Similarly, abnormalities in insulin signaling are associated with abnormal brain growth and migraine tendency. Previously, we have shown that in the ADF chemosensory neurons of Caenorhabditis elegans UNC-2/Ca(2+) channel function affects TGF-beta-dependent developmental regulation of tryptophan hydroxylase, the rate-limiting enzyme in serotonin synthesis. Here we show that developmental expression of a tryptophan hydroxylase: :GFP reporter construct is similarly decreased by reduction-of-function mutations in the daf-2/insulin receptor. This decreased expression of tryptophan hydroxylase observed in both the daf-2 and unc-2 mutant backgrounds is suppressible either genetically by reduction-of-function mutations in the daf-16/forkhead transcription factor, an effector of the DAF-2/insulin receptor, or pharmacologically by the serotonin receptor antagonist cyproheptadine. Overall, these data suggest that both UNC-2 and DAF-2 function are required in the developmental regulation of DAF-16 and serotonin-dependent inhibition of tryptophan hydroxylase expression.

The voltage-gated calcium channel UNC-2 is involved in stress-mediated regulation of tryptophan hydroxylase.

Migraine is an episodic pain disorder whose pathophysiology is related to deficiency of serotonin signaling and abnormal function of the P/Q-type calcium channel, CACNA1A. Because the relationship of the CACNA1A channel to serotonin signaling is unknown and potentially of therapeutic interest we have used genetic analysis of the Caenorhabditis elegans ortholog of this calcium channel, UNC-2, to help identify candidate downstream effectors of the human channel. By genetic dissection of the lethargic mutant phenotype of unc-2, we have established an epistasis pathway showing that UNC-2 function antagonizes a transforming growth factor (TGF)-beta pathway influencing movement rate. This same UNC-2/TGF-beta pathway is required for accumulation of normal serotonin levels and stress-induced modulation of tryptophan hydroxylase (tph) expression in the serotonergic chemosensory ADF neurons, but not the NSM neurons. We also show that transgenic expression of the migraine-associated Ca2+ channel, CACNA1A, in unc-2 animals can functionally substitute for UNC-2 in stress-activated regulation of tph expression. The demonstration that these evolutionarily related channels share a conserved ability to modulate tph expression through their effects on TGF-beta signaling provides the first specific example of how CACNA1A function may influence levels of the critical migraine neurotransmitter serotonin.