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Supplementary Table S1. Primer pairs used for quantitative real-time PCR analysis. Supplementary Table S2. Summary of the gene expression datasets used for meta-analysis. Supplementary Table S3. Expression levels of LOX-like mRNAs in Hct116 cells transduced for LOX overexpression (LOX+) or silencing (LOX-), compared to mock-transduced Hct116 cells (Ctrl).

Lysyl oxidase (LOX) is a secreted copper-dependent amine oxidase whose primary function is to drive collagen crosslinking and extracellular matrix stiffness. LOX in colorectal cancer synergizes with hypoxia-inducible factor-1 (HIF-1) to promote tumor progression. Here we investigated whether LOX/HIF1 endows colorectal cancer cells with full competence for aggressive colonization in bone. We show that a high LOX expression in primary tumors from patients with colorectal cancer was associated with poor clinical outcome, irrespective of HIF-1. In addition, LOX was expressed by tumor cells in the bone marrow from colorectal cancer patients with bone metastases. In vivo experimental studies show that LOX overexpression in colorectal cancer cells or systemic delivery of the conditioned medium from LOX-overexpressing colorectal cancer cells promoted tumor cell dissemination in the bone marrow and enhanced osteolytic lesion formation, irrespective of HIF-1. Conversely, silencing or pharmacologic inhibition of LOX activity blocked dissemination of colorectal cancer cells in the bone marrow and tumor-driven osteolytic lesion formation. In vitro, tumor-secreted LOX supported the attachment and survival of colorectal cancer cells to and in the bone matrix, and inhibited osteoblast differentiation. LOX overexpression in colorectal cancer cells also induced a robust production of IL6. In turn, both LOX and IL6 were acting in concert to promote RANKL-dependent osteoclast differentiation, thereby creating an imbalance between bone resorption and bone formation. Collectively, our findings show that LOX supports colorectal cancer cell dissemination in the bone marrow and they reveal a novel mechanism through which LOX-driven IL6 production by colorectal cancer cells impairs bone homeostasis. Cancer Res; 77(2); 268–78. ©2016 AACR.

Supplementary figure legends from S1 to S7

Figure S1: LOX expression and clinical outcomes. Figure S2:The LOX inhibitor βAPN inhibits osteolytic lesion formation in vivo. Figure S3: Measurement of LOX enzymatic activity. Figure S4: Correlation analysis of the expression intensity of LOX and IL-6. Figure S5: Effects of LOX expression on EMT in Hct116 colorectal cancer cells. Figure S6: Effect of LOX on attachment of colorectal cancer cells to fibronectin. Figure S7: LOX enhances survival of Hct116 colorectal cancer cells.

Significant rational is available for specific targeting of PI3K/AKT/mTOR pathway in the treatment of non-small cell lung cancer (NSCLC). However, almost all clinical trials that have evaluated Pi3K pathway-based monotherapies/combinations did not observe an improvement of patient's outcome. The aim of our study was therefore to define combination of treatment based on the determination of predictive markers of resistance to the mTORC1 inhibitor RAD001/Everolimus. An in vivo study showed high efficacy of RAD001 in NSCLC Patient-Derived Xenografts (PDXs). When looking at biomarkers of resistance by RT-PCR study, three genes were found to be highly expressed in resistant tumors, i.e., PLK1, CXCR4, and AXL. We have then focused our study on the combination of RAD001 + Volasertib, a PLK1 inhibitor, and observed a high antitumor activity of the combination in comparison to each monotherapy; similarly, a clear synergistic effect between the two compounds was found in an in vitro study. Pharmacodynamics study demonstrated that this synergy was due to (1) tumor vascularization decrease, increase of the HIF1 protein expression and decrease of the intracellular pH, and (2) decrease of the Carbonic Anhydrase 9 (CAIX) protein that could not correct intracellular acidosis. In conclusion, all these preclinical data strongly suggest that the inhibition of mTORC1 and PLK1 proteins may be a promising therapeutic approach for NSCLC patients.

Patient-Derived Xenografts (PDXs) in the Chorioallantoic Membrane (CAM) are a representative model for studying human tumors. Circulating Tumor Cells (CTCs) are involved in cancer dissemination and treatment resistance mechanisms. To facilitate research and deep analysis of these few cells, significant efforts were made to expand them. We evaluated here whether the isolation of fresh CTCs from patients with metastatic cancers could provide a reliable tumor model after a CAM xenograft. We enrolled 35 patients, with breast, prostate, or lung metastatic cancers. We performed microfluidic-based CTC enrichment. After 48–72 h of culture, the CTCs were engrafted onto the CAM of embryonated chicken eggs at day 9 of embryonic development (EDD9). The tumors were resected 9 days after engraftment and histopathological, immunochemical, and genomic analyses were performed. We obtained in ovo tumors for 61% of the patients. Dedifferentiated small tumors with spindle-shaped cells were observed. The epithelial-to-mesenchymal transition of CTCs could explain this phenotype. Beyond the feasibility of NGS in this model, we have highlighted a genomic concordance between the in ovo tumor and the original patient’s tumor for constitutional polymorphism and somatic alteration in one patient. Alu DNA sequences were detected in the chicken embryo’s distant organs, supporting the idea of dedifferentiated cells with aggressive behavior. To our knowledge, we performed the first chicken CAM CTC-derived xenografts with NGS analysis and evidence of CTC dissemination in the chicken embryo.

Background EGFR mutant non-small cell lung cancer (NSCLC) is a heterogeneous disease. The treatment for frequent EGFR mutations relies on tyrosine kinase inhibitors (TKIs); the clinical and therapeutic significance of uncommon EGFR mutations is uncertain. Methods This is a single-center retrospective study of patients with EGFR-mutant lung cancer (2009-2017). Molecular analyses of EGFR exons 18-21 were performed. Only patients with uncommon mutations were included (p.Glu709X, p.Gly719X, p.Ala767_Val769 dup, p.Ser768Ile, and p.Leu861Gln). Results Among 6,747 tumor samples, 95 out 820 patients (11.6%) harbored 113 uncommon EGFR mutations. There were 50 metastatic NSCLC patients for whom the median OS was 18.0 months (95% CI: 15, 32). In this population, the p.Leu861Gln uncommon exon 21 EGFR mutation was associated with poor prognosis (HR: 2.96, 95% CI: 1.39, 6.31; P=0.003). Among those harboring a single uncommon EGFR mutation, median OS was 27.6 months (95% CI: 10.8, not attained) in patients who were treated by chemotherapy only (n=13) versus 6.0 months (95% CI: 2.4, not attained) in patients exclusively treated with a first or second-EGFR-TKI (n=9; HR: 0.27, 95% CI: 0.09, 0.78; P=0.01. In patients with a single uncommon EGFR mutation, first-line chemotherapy was associated with a better overall survival than TKIs (HR: 0.31, 95% CI: 0.15, 0.68; P=0.002). In patients who received first or second-EGFR-TKI as first-line treatment (n=26), OS was significantly better for those with two uncommon EGFR mutations than those with a single uncommon mutation (HR: 0.07, 95% CI: 0.009, 0.54; P=0.001). Conclusions In conclusion, uncommon EGFR mutations may be associated with a poor outcome and the data challenge the use of first-generation TKI in such patients, however first-line TKI is more effective in cases of double uncommon mutations and such patients should be treated accordingly.

International audience; In mouse embryonic stem cells (mESCs), chemical blockade of Gsk3α/β and Mek1/2 (2i) instructs a self-renewing ground state whose endogenous inducers are unknown. Here we show that the axon guidance cue Netrin-1 promotes naive pluripotency by triggering profound signalling, transcriptomic and epigenetic changes in mESCs. Furthermore, we demonstrate that Netrin-1 can substitute for blockade of Gsk3α/β and Mek1/2 to sustain self-renewal of mESCs in combination with leukaemia inhibitory factor and regulates the formation of the mouse pluripotent blastocyst. Mechanistically, we reveal how Netrin-1 and the balance of its receptors Neo1 and Unc5B co-regulate Wnt and MAPK pathways in both mouse and human ESCs. Netrin-1 induces Fak kinase to inactivate Gsk3α/β and stabilize β-catenin while increasing the phosphatase activity of a Ppp2r2c-containing Pp2a complex to reduce Erk1/2 activity. Collectively, this work identifies Netrin-1 as a regulator of pluripotency and reveals that it mediates different effects in mESCs depending on its receptor dosage, opening perspectives for balancing self-renewal and lineage commitment.

Background Hemophilia is characterized by a compromised hemostatic response with delayed development of a clot and the formation of clots that are vulnerable to fibrinolysis. We proposed to study, in vitro and in factor VIII knockout mice (FVIII-KO), whether hemostasis is improved with the addition of tranexamic acid (TXA) to low FVIII plasma concentrations. Methods In vitro, blood samples from adults with severe hemophilia-A, spiked to final concentrations of 0-3-10 and 30IU.dL-1 of FVIII, were studied with and without TXA 0.1 mg/mL using thromboelastography in the presence of tPA (ROTEM-tPA), thrombin generation (TG) assay, and scanning electron microscopy. FVIII-KO mice received prophylaxis before trauma, to obtain circulating plasma FVIII at 3 IU.dL-1 or FVIII 3IU.dL-1 + TXA 0.1 mg/mL. After trauma-induced knee joint bleeding, magnetic resonance imaging, histological analysis, and tail clip assay were used to compare hemostastic efficacy of the two prophylactic strategies. Results A dose-dependent improvement of TG was observed with recombinant FVIII (rFVIII) alone (P = .024). As expected, no effect of TXA on TG capacity was observed. Fibrin fiber diameters were significantly decreased with TXA + rFVIII compared to rFVIII, suggesting a stronger fibrin network. Surprisingly, ROTEM-tPA was normalized with TXA alone. In FVIII-KO mice, blood loss after tail clip was lower after prophylaxis with rFVIII + TXA compared to rFVIII, with no statistical significance (P = .15). However, MRI results and histological analysis of knee joints showed that the addition of TXA significantly decreased joint bleeding (P = .022). Conclusion Our results suggest a potential benefit of TXA when used in combination with FVIII in prophylactic settings.

Bone marrow is a complex and dynamic microenvironment that provides essential cues to resident cells. We developed a standardized three-dimensional (3D) model to decipher mechanisms that control human cells during hematological and non-hematological processes. Our simple 3D-model is constituted of a biphasic calcium phosphate-based scaffold and human cell lines to ensure a high reproducibility. We obtained a minimal well-organized bone marrow-like structure in which various cell types and secreted extracellular matrix can be observed and characterized by

SummaryMalignant Pleural Mesothelioma (MPM) is an aggressive cancer with rising incidence and challenging clinical management. Using the largest series of whole-genome sequencing data integrated with transcriptomic and epigenomic data using multi-omic factor analysis, we demonstrate that MPM heterogeneity arises from four sources of variation: tumor cell morphology, ploidy, adaptive immune response, and CpG island methylator phenotype. Previous genomic studies focused on describing only the tumor cell morphology factor, although we robustly find the three other sources in all publicly available cohorts. We prove how these sources of variation explain the biological functions performed by the cancer cells, and how genomic events shape MPM molecular profiles. We show how these new sources of variation help understand the heterogeneity of the clinical behavior of MPM and drug responses measured in cell lines. These findings unearth the interplay between MPM functional biology and its genomic history, and ultimately, inform classification, prognostication and treatment.Graphical abstract

Objective Diffuse malignant peritoneal mesothelioma (DMPM), represents 30% of all malignant mesothelioma, and is characterised by a difficult diagnosis and different presentations. Immunohistochemistry has improved the diagnostic sensitivity and specificity in the differential diagnosis between metastatic adenocarcinoma and malignant mesothelioma, and loss of BRCA-1-associated protein 1 (BAP1) expression is correlated with BAP1 somatic or constitutional genetic defects. Furthermore, cyclin-dependent kinase inhibitor 2A (CDKN2A) is frequently lost in DMPM. In the present study, we assessed the value of integrating BAP1 in the panel of antibodies used for the diagnosis of DMPM in cytological samples. Since p16 fluorescent in situ hybridisation (FISH) assay could constitute an additional useful adjunct, results of BAP1 immunostaining and p16 FISH assays have been compared. Methods Forty-eight DMPM patients and 71 peritoneal carcinomatosis patients were included. BAP1 immunohistochemical and CDKN2A FISH techniques were performed on tissue specimens of DMPM (n = 48) and peritoneal carcinomatosis (n = 71) then on cell-block of DMPM (n = 16), peritoneal carcinomatosis (n = 25) and peritoneal benign effusion (n = 5). Results Loss of BAP1 expression was observed in 56.3% of DMPM while none of the peritoneal carcinoma specimens showed BAP1 loss of expression. CDKN2A loss was observed in 34.9% DMPM and 2.1% peritoneal carcinoma. Although BAP1 immunostaining was successful in 100% of cytological DMPM samples, CDKN2A deletion status could be obtained for 75% of DMPM cases. Conclusion BAP1 immunostaining represents an objective and reproducible diagnostic biomarker for peritoneal mesothelioma in effusion cytology specimens and should be preferred to CDKN2A FISH analysis on these precious samples.

Resume L’examen macroscopique est une des etapes essentielles de l’examen anatomopathologique d’un prelevement de chirurgie thoracique. Il comprend la description de la piece operatoire et des lesions et l’echantillonnage precis et exhaustif des territoires tumoraux et adjacents a la tumeur. Cet examen necessite une bonne connaissance de la classification pTNM actualisee. Les pathologistes du groupe PATTERN se sont associes a des chirurgiens thoraciques, sous l’egide de la Societe francaise de pathologie, pour proposer des recommandations sur la prise en charge macroscopique des pieces operatoires pulmonaires pour carcinome. Cette demarche s’inscrit dans le contexte de la reedition du compte rendu d’anatomie pathologique structure des carcinomes pulmonaires, recommande par la societe francaise de pathologie et necessaire a une prise en charge standardisee des patients.

International audience; L’os est la troisième localisation métastatique par ordre de fréquence après le foie et le poumon. Les métastases osseuses intéressent un cancer bronchopulmonaire sur trois et sont généralement ostéolytiques. Les métastases osseuses ostéolytiques sont à l’origine de fractures pathologiques du rachis et des os longs qui entraînent une restriction de la mobilité, le recours à la chirurgie et un risque de compression médullaire. Les métastases osseuses s’accompagnent d’une altération marquée de la qualité de vie et de surcoûts de santé importants. Au cours des dernières années, la RCP métastases osseuses ou RCP d’oncologie osseuse secondaire (RCP-OOS) a été mise en place dans le but de proposer, pour chaque patient, une prise en charge optimale des métastases osseuses en harmonie avec la prise en charge antitumorale. Dans cette revue, nous allons évoquer les différents aspects de la prise en charge des métastases osseuses regroupant le diagnostic et l’évaluation (TDM, scintigraphie osseuse au Technétium 99 m, TEP-FDG-(18F) et biopsie osseuse permettant le diagnostic moléculaire), les traitements osseux systémiques (acide zolédronique et dénosumab) et les traitements locaux (radiologie interventionnelle et radiothérapie). Les stratégies chirurgicales seront abordées dans un autre travail. À partir des référentiels Auvergne Rhône-Alpes en oncologie thoracique, édition 2017, nous présentons ici un arbre décisionnel pour aider les médecins dans la mise en place d’une stratégie personnalisée locomotrice pour chaque patient.

Background Malignant Pleural Mesothelioma (MPM) is an aggressive disease related to asbestos exposure, with no effective therapeutic options. Methods We undertook unsupervised analyses of RNA-sequencing data of 284 MPMs, with no assumption of discreteness. Using immunohistochemistry, we performed an orthogonal validation on a subset of 103 samples and a biological replication in an independent series of 77 samples. Findings A continuum of molecular profiles explained the prognosis of the disease better than any discrete model. The immune and vascular pathways were the major sources of molecular variation, with strong differences in the expression of immune checkpoints and pro-angiogenic genes; the extrema of this continuum had specific molecular profiles: a “hot” bad-prognosis profile, with high lymphocyte infiltration and high expression of immune checkpoints and pro-angiogenic genes; a “cold” bad-prognosis profile, with low lymphocyte infiltration and high expression of pro-angiogenic genes; and a “VEGFR2+/VISTA+” better-prognosis profile, with high expression of immune checkpoint VISTA and pro-angiogenic gene VEGFR2. We validated the gene expression levels at the protein level for a subset of five selected genes belonging to the immune and vascular pathways (CD8A, PDL1, VEGFR3, VEGFR2, and VISTA), in the validation series, and replicated the molecular profiles as well as their prognostic value in the replication series. Interpretation The prognosis of MPM is best explained by a continuous model, which extremes show specific expression patterns of genes involved in angiogenesis and immune response.

Bone is the third metastatic site after liver and lungs. Bone metastases occur in one out of three lung cancers and are usually of osteolytic aspect. Osteolytic bone metastases are responsible of long bone and vertebral fractures leading to restricted mobility, surgery and medullar compression that severely alter quality of life and that have a huge medico-economic impact. In the recent years, Bone Metastatic Multidisciplinary Tumour Board (BM2TB) have been developed to optimize bone metastases management for each patient in harmony with oncology program. In this review, we will go through all the different aspects of bone metastases management including diagnosis and evaluation (CT scan, Tc 99m-MDP bone scan, 18FDG-PET scan and biopsy for molecular diagnosis), systemic bone treatments (zoledronic acid and denosumab) and local treatments (interventional radiology and radiotherapy). Surgical strategies will be discussed elsewhere. Based on the last 2017-Lung Cancer South East French Guidelines, we present a practical decision tree to help the physicians for decision making in order to reach a personalized locomotor strategy for every patient.

Significant rational is available for specific targeting of PI3K/AKT/mTOR pathway in the treatment of non-small cell lung cancer (NSCLC). However, almost all clinical trials that have evaluated Pi3K pathway-based monotherapies/combinations did not observe an improvement of patient’s outcome. The aim of our study was therefore to define combination of treatment based on the determination of predictive markers of resistance to the mTORC1 inhibitor RAD001/Everolimus. An in vivo study showed high efficacy of RAD001 in NSCLC Patient-Derived Xenografts (PDXs). When looking at biomarkers of resistance by RT-PCR study, three genes were found to be highly expressed in resistant tumors, i.e., PLK1, CXCR4, and AXL. We have then focused our study on the combination of RAD001 + Volasertib, a PLK1 inhibitor, and observed a high antitumor activity of the combination in comparison to each monotherapy; similarly, a clear synergistic effect between the two compounds was found in an in vitro study. Pharmacodynamics study demonstrated that this synergy was due to (1) tumor vascularization decrease, increase of the HIF1 protein expression and decrease of the intracellular pH, and (2) decrease of the Carbonic Anhydrase 9 (CAIX) protein that could not correct intracellular acidosis. In conclusion, all these preclinical data strongly suggest that the inhibition of mTORC1 and PLK1 proteins may be a promising therapeutic approach for NSCLC patients.

Colorectal cancer; FFPE clinical tissue samples; Microsatellite instability Cancer colorrectal; Muestras de tejido clínico FFPE; Inestabilidad de microsatélites Càncer colorectal; Mostres de teixit clínic FFPE; Inestabilitat del microsatèl·lits Microsatellite instability (MSI) is present in 15–20% of primary colorectal cancers. MSI status is assessed to detect Lynch syndrome, guide adjuvant chemotherapy, determine prognosis, and use as a companion test for checkpoint blockade inhibitors. Traditionally, MSI status is determined by immunohistochemistry or molecular methods. The Idylla™ MSI Assay is a fully automated molecular method (including automated result interpretation), using seven novel MSI biomarkers (ACVR2A, BTBD7, DIDO1, MRE11, RYR3, SEC31A, SULF2) and not requiring matched normal tissue. In this real-world global study, 44 clinical centers performed Idylla™ testing on a total of 1301 archived colorectal cancer formalin-fixed, paraffin-embedded (FFPE) tissue sections and compared Idylla™ results against available results from routine diagnostic testing in those sites. MSI mutations detected with the Idylla™ MSI Assay were equally distributed over the seven biomarkers, and 84.48% of the MSI-high samples had ≥ 5 mutated biomarkers, while 98.25% of the microsatellite-stable samples had zero mutated biomarkers. The concordance level between the Idylla™ MSI Assay and immunohistochemistry was 96.39% (988/1025); 17/37 discordant samples were found to be concordant when a third method was used. Compared with routine molecular methods, the concordance level was 98.01% (789/805); third-method analysis found concordance for 8/16 discordant samples. The failure rate of the Idylla™ MSI Assay (0.23%; 3/1301) was lower than that of referenced immunohistochemistry (4.37%; 47/1075) or molecular assays (0.86%; 7/812). In conclusion, lower failure rates and high concordance levels were found between the Idylla™ MSI Assay and routine tests.

Coordinated changes of cellular identity and plasticity are critical for pluripotent reprogramming (PR) and malignant transformation (MT). However, the molecular circuitries orchestrating these modifications, as well as their degree of analogy during reprogramming and transformation, remain unknown. To address this question, we generated “repro-transformable” mice models and dissected comparatively the early events underpinning PR - mediated by Oct4, Sox2, Klf4, c-Myc - and MT - triggered by oncogenic Ras and c-Myc. Transcriptomic analyses allowed the identification of a unique set of markers - the cell surface glycoprotein Thy1 and the transcription factor (TF) Bcl11b - that are commonly downregulated during PR and MT and delineate cellular intermediates (CI) highly amenable to generate pluripotent or malignant derivatives. Comprehensive transcriptomic, epigenomic and functional analyses of different CI, prone or refractory to PR/MT, unveiled that cellular plasticity acquisition precedes the broad extinction of cellular identity. It also demonstrated the existence of specific and shared molecular features of PR and MT while ensuring the identification of broad-range regulators of cellular plasticity. As a proof-of-concept, we revealed that the basic helix-loop-helix (bHLH) class A TF Atoh8 constrains rodent and human iPS cells generation as well as MT and direct neuron conversion. Mechanistically, this TF hampers the reactivation of the pluripotent network during PR and limits the acquisition of phenotypic plasticity during MT. Furthermore, an integrated analysis of Atoh8 genome-wide binding, alongside the other bHLH TFs c-Myc, Ascl1 and MyoD promoting reprogramming/transdifferentiation, unveiled how Atoh8 constrains cellular plasticity by occupying a specific subset of MEF enhancers and by finetuning WNT signalling activity. Collectively, by deconvoluting the early steps of the reprogramming and transformation roadmaps, this integrated study uncoupled changes of cellular plasticity and identity to shed light on novel insights into reprogramming and cancer biology.Graphical abstractOne-sentence summaryComparative roadmaps of cellular plasticity acquisition during pluripotent reprogramming and malignant transformation.

Aim: This retrospective, monocentric cohort study aimed at assessing clinical characteristics, lung function course and overall survival of patients with non-IPF PF-ILD in a real-world setting. Methods: All successive patients hospitalized in a French Rare Lung Disease Reference Centre between 2010 and 2017, aged ≥18 years, with at least 10% fibrosis extent at baseline high resolution computed tomography of chest (HRCT) were included. PF-ILD over a period of 2 years was defined as: relative decline in forced vital capacity (FVC) ≥ 10% with or without clinical deterioration (a); or a moderate relative decline between 5% and 10% associated with worsening respiratory symptoms or increased extent of fibrosis in HRCT (b); or increased extent of fibrosis on HRCT with worsening respiratory symptoms with or without FVC decline (c). Results: 165 patients (57% of women) were included with a mean age of 60 (±14 years). Most of patients (65%) were included with criterion (a), 24% with criterion (b) and 9% with criterion (c). Estimates of overall survival were 99%, 82%, and 66% at 1, 3 and 6 years, respectively. Mortality was significantly associated with FVC Conclusion: The natural history of non-IPF ILD in patients with PF phenotype follows a course characterized by worsening of respiratory symptoms, progressive lung function decline and early mortality despite appropriate management.

Introduction: Histopathological definition of bone and joint infection (BJI) is based on Mirra's criterion (≥ 5 polymorphonuclears (PMNs) per field in 5 high power fields (HPFs)). However, this definition does not seem appropriate for chronic BJIs caused by slow-growing germs such as Cutibacterium acnes (C. acnes). The aim of this study was to confirm that Mirra's criterion is not adequate for diagnosis of BJIs due to C. acnes. The second objective was to determine if plasma cell infiltration could be useful for the diagnosis of chronic BJIs due to C. acnes. Methods: We retrospectively selected 25 consecutive patients from 2009 to 2013 with chronic BJIs due to C. acnes. Histological analysis was performed on the 21 cases with at least two C. acnes positive cultures. In addition of Mirra's criterion, the number of plasma cells (≥5 plasma cells/5 HPFs, defined as “CRIOAc Lyon's criterion”) was implemented in the histopathological analysis. Patients were defined as infected, if at least one of the two criteria were present. Results: According to Mirra's and CRIOAc Lyon's criteria, positive histopathology was observed in 12 (57.1%) and 15 (71.4%) cases respectively. Considering the 9 cases with negative Mirra's criterion, high plasma cell infiltration (≥5 plasma cells per field/5 HPFs) was observed in 5 cases (55.6%), and low plasma cells infiltration (2-5 plasma cells per field/5 HPFs) was observed in 4 other cases (44.4%). Conclusions: Adding CRIOAc Lyon's criterion to Mirra's criterion might restore some histopathological diagnosis of chronic BJIs due to C. acnes when a chronic BJI is clinically suspected.

International audience; BACKGROUND & AIMS:Glycogen storage disease type Ia (GSDIa) is a rare genetic disease associated with glycogen accumulation in hepatocytes and steatosis. With age, most adult patients with GSDIa develop hepatocellular adenomas (HCA), which can progress to hepatocellular carcinomas (HCC). In this study, we characterized metabolic reprogramming and cellular defense alterations during tumorigenesis in the liver of hepatocyte-specific G6pc deficient (L.G6pc-/-) mice, which develop all the hepatic hallmarks of GSDIa.METHODS:Liver metabolism and cellular defenses were assessed at pretumoral (four months) and tumoral (nine months) stages in L.G6pc-/- mice fed a high fat/high sucrose (HF/HS) diet.RESULTS:In response to HF/HS diet, hepatocarcinogenesis was highly accelerated since 85% of L.G6pc-/- mice developed multiple hepatic tumors after nine months, with 70% classified as HCA and 30% as HCC. Tumor development was associated with high expression of malignancy markers of HCC, i.e. alpha-fetoprotein, glypican 3 and β-catenin. In addition, L.G6pc-/- livers exhibited loss of tumor suppressors. Interestingly, L.G6pc-/- steatosis exhibited a low-inflammatory state and was less pronounced than in wild-type livers. This was associated with an absence of epithelial-mesenchymal transition and fibrosis, while HCA/HCC showed a partial epithelial-mesenchymal transition in the absence of TGF-β1 increase. In HCA/HCC, glycolysis was characterized by a marked expression of PK-M2, decreased mitochondrial OXPHOS and a decrease of pyruvate entry in the mitochondria, confirming a "Warburg-like" phenotype. These metabolic alterations led to a decrease in antioxidant defenses and autophagy and chronic endoplasmic reticulum stress in L.G6pc-/- livers and tumors. Interestingly, autophagy was reactivated in HCA/HCC.CONCLUSION:The metabolic remodeling in L.G6pc-/- liver generates a preneoplastic status and leads to a loss of cellular defenses and tumor suppressors that facilitates tumor development in GSDI.LAY SUMMARY:Glycogen storage disease type Ia (GSD1a) is a rare metabolic disease characterized by hypoglycemia, steatosis, excessive glycogen accumulation and tumor development in the liver. In this study, we have observed that GSDIa livers reprogram their metabolism in a similar way to cancer cells, which facilitates tumor formation and progression, in the absence of hepatic fibrosis. Moreover, hepatic burden due to overload of glycogen and lipids in the cells leads to a decrease in cellular defenses, such as autophagy, which could further promote tumorigenesis in the case of GSDI.

Multiple lung carcinomas are 5 to 11,5% of lung carcinomas. The distinction between primary lung carcinomas from carcinomas with intrapulmonary metastasis is essential for optimal patient management. The histopathological analysis is very useful but it has to be completed by genotypic assessment using molecular biology (NGS). Molecular biology can also identify genetic alterations with therapeutic implications. We present the case of a patient with a history of surgery for multiple lung carcinomas diagnosed from 2013 to 2017.

Introduction The systematic assessment of anti-programmed cell death ligand 1 (PD-L1) expression by immunohistochemistry (IHC) in lung adenocarcinomas is becoming standard practice. However, the assessment of PD-L1 expression on small tissue specimens needs to be evaluated and the association with other features more thoroughly analyzed. Methods This retrospective single center study evaluated the immunohistochemical expression of the SP263 anti-PD-L1 antibody on tissue microarrays (TMA) of 152 surgically resected lung adenocarcinomas, using a 25% positivity threshold. The positive cases and 50 randomly chosen negative cases in tissue microarray (TMA) were reassessed on whole tissue sections. The results were correlated to clinical, histopathological and to molecular data obtained through the screening of 214 mutations in 26 genes (LungCarta panel, Agena Biosciences). Results Among 152 primary lung adenocarcinomas, 19 cases (13%) showed PD-L1 expression. The agreement between TMA and whole tissue sections was 89%, specificity was 97%. PD-L1 expression was correlated to RAS mutations (p = .04), RAS/TP53 co-mutations (p = .01) and to the solid or acinar subtype (p = .048). Conclusions With the SP263 PD-L1 antibody, small samples appear as a reliable means to evaluate the PD-L1 status in lung adenocarcinoma. The association between PD-L1 expression and RAS/TP53 mutations may have clinical relevance to predict the efficacy of PD-1/PD-L1 immune checkpoints inhibitors.

// Jessica Garcia 1, 2, 3, 4, ** , Eric Dusserre 1, 3, 4, ** , Valerie Cheynet 3, 5 , Pierre Paul Bringuier 6 , Karen Brengle-Pesce 3, 5 , Anne-Sophie Wozny 1, 7 , Claire Rodriguez-Lafrasse 1, 3, 4, 7 , Gilles Freyer 4, 8, 9 , Marie Brevet 4, 6, 9 , Lea Payen 1, 2, 3, 4, 7, * and Sebastien Couraud 4, 9, 10, * 1 Laboratoire de Biochimie et Biologie Moleculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Benite, France 2 Centre de Recherche en Cancerologie de Lyon, INSERM 1052, CNRS 5286, Universite Claude Bernard Lyon 1, Lyon, 69003, France 3 Laboratoire Commun de Recherche Hospices Civils de Lyon – BioMerieux, Centre Hospitalier Lyon Sud, 69310, Pierre Benite, France 4 Institut de Cancerologie des Hospices Civils de Lyon, CIRculating CANcer Program (CIRCAN), 69002 Lyon, France 5 Medical Diagnostic Discovery Department, BioMerieux, 69290 Craponne, France 6 Service d’Anatomie et de Cytologie Pathologiques, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500, Bron, France 7 Faculte de Pharmacie de Lyon (IPSB), Universite de Lyon1, Lyon, 69008, France 8 Service d’Oncologie Medicale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, 69003, France 9 EMR 3738 Ciblage Therapeutique en Oncologie, Faculte de Medecine Lyon Sud, Universite Lyon 1, 69600, Oullins, France 10 Service de Pneumologie Aigue Specialisee et Cancerologie Thoracique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, 69003, France * Authors share co-senior authorship ** Authors share co-first authorshop Correspondence to: Lea Payen, email: lea.payen-gay@chu-lyon.fr Keywords: lung cancer, EGFR mutation, circulating-free DNA, liquid biopsy, digital PCR Received: December 22, 2016 Accepted: June 26, 2017 Published: September 21, 2017 ABSTRACT Non invasive somatic detection assays are suitable for repetitive tumor characterization or for detecting the appearance of somatic resistance during lung cancer. Molecular diagnosis based on circulating free DNA (cfDNA) offers the opportunity to track the genomic evolution of the tumor, and was chosen to assess the molecular profile of several EGFR alterations, including deletions in exon 19 (delEX19), the L858R substitution on exon 21 and the EGFR resistance mutation T790M on exon 20. Our study aimed at determining optimal pre-analytical conditions and EGFR mutation detection assays for analyzing cfDNA using the picoliter-droplet digital polymerase chain reaction (ddPCR) assay. Within the framework of the CIRCAN project set-up at the Lyon University Hospital, plasma samples were collected to establish a pre-analytical and analytical workflow of cfDNA analysis. We evaluated all of the steps from blood sampling to mutation detection output, including shipping conditions (4H versus 24H in EDTA tubes), the reproducibility of cfDNA extraction, the specificity/sensitivity of ddPCR (using external controls), and the comparison of different PCR assays for the detection of the three most important EGFR hotspots, which highlighted the increased sensitivity of our in-house primers/probes. Hence, we have described a new protocol facilitating the molecular detection of somatic mutations in cancer patients from liquid biopsies, improving their diagnosis and introducing a less traumatic monitoring system during tumor progression.

45e Congrès de la Société de Biomécanique, Metz, France, 26-/10/2020 - 28/10/2020; Bones are the third most affected organs by metastasis (Du et al. 2010). The qualitative effect of cancer types on metastatic bone has been largely described. Bone metastases weaken bones (Coleman 1997) by creating lytic, blastic or mixt (i.e. lytic and blastic) lesions. The prediction of fracture risk is clinically assessed by evaluating several parameters such as the size and location of the lesion or the Mirels' score. However, it seems these predictions overestimate the risk of fracture and are not specific enough to produce a reliable prediction (Van Der Linden et al. 2004). A quantification of the effect of the different cancer types on mechanical properties of the bone should improve clinical evaluation of the fracture risk. As a first step, the goal of our study was to develop a better assessment of the bone fracture risk by evaluating the mechanical properties of mice tibia affected by three different human cancer cell lines.

Objectifs Cette etude de cohorte retrospective et monocentrique visait a evaluer les caracteristiques cliniques, l’evolution de la fonction pulmonaire et la survie globale des patients atteints d’une PID-FP autre que FPI en vie reelle. Methodes Tous les patients hospitalises dans un centre de reference des maladies pulmonaires rares entre 2010 et 2017, âges de 18 ans ou plus, presentant une fibrose pulmonaire d’au moins 10 % ont ete preselectionnes. Les patients presentant une PID-FP selon les criteres suivants ont ete inclus : – baisse relative de la capacite vitale forcee (CVF) ≥ 10 % avec ou sans deterioration clinique ; – ou baisse relative de la CVF entre 5 % et 10 % associee a une aggravation des symptomes respiratoires ou a une augmentation de l’etendue de la fibrose ; – ou augmentation de l’etendue de la fibrose avec aggravation des symptomes respiratoires avec ou sans diminution de la CVF. Un appariement probabiliste a ete realise afin de chainer les patients de cette cohorte au Systeme national des donnees de sante (SNDS) afin d’extraire les consommations de soins et de les valoriser. Resultats Au total, 165 patients (dont 57 % de femmes) ont ete inclus avec un âge moyen de 60 ans (± 14 ans). La plupart des patients (65 %) ont ete inclus avec le critere (a), 24 % avec le critere (b) et 9 % avec le critere (c). Les estimations de la survie globale etaient respectivement de 99 %, 82 % et 66 % a 1, 3 et 6 ans. La mortalite etait associee de maniere significative a une CVF Conclusion Cette cohorte est la premiere decrivant l’histoire naturelle de toutes les PID-FP autres que la FPI. Le chainage des donnees de la cohorte a celles du SNDS a permis d’obtenir une grande quantite d’informations visant a mieux caracteriser la prise en charge et l’evolution de ces maladies. L’histoire naturelle des PID-FP suit un schema caracterise par une aggravation des symptomes respiratoires, un declin progressif de la fonction pulmonaire et une mortalite precoce malgre une prise en charge appropriee.

Highlights • Molecular status determination following decalcification procedures is challenging. • The Idylla™ EGFR assay demonstrates good performance on decalcified bone samples. • The choice of EGFR assay should be adapted to patient and sample specificities., Detection of molecular alterations in lung cancer bone metastasis (LCBM) is particularly difficult when decalcification procedure is needed. The Idylla™ real-time (RT)-PCR is compared to the routine method used in our laboratory, which combines next generation and Sanger sequencing, for the detection of EGFR mutations in LCBM. LCBM subjected to EDTA or formic acid decalcification were analysed for EGFR mutational status using two methods: first, the Ion Torrent Ampliseq next generation sequencing (NGS) assay +/- Sanger sequencing was used prospectively; then, the fully-automated, RT-PCR based molecular testing system Idylla™ EGFR Mutation Test was applied retrospectively. Out of the 34 LCBM assayed, 14 (41.2%) were unsuitable for NGS analysis and five remained unsuitable after additional Sanger EGFR sequencing (5/34, 14.7%). Using Idylla™, valid results were observed for 33/34 samples (97.1%). The concordance between the NGS +/- Sanger sequencing method and the RT-PCR method was 89.7% (26/29), one false positive EGFR S768I mutation and two false negative results were observed using Idylla™; one of these false negative cases was diagnosed by Sanger sequencing with a rare exon 19 EGFR mutation not covered by the Idylla™ EGFR Mutation Test design. Detection of EGFR mutations in decalcified LCBM is challenging using NGS, more than half of samples showing invalid results. Alternative methods should thus be preferred to spare clinical samples and decrease delay. The Idylla™ EGFR Mutation Test shows a good performance on decalcified bone samples and could be used as a first step. In case of negative results, a sequencing approach is mandatory to check the presence of rare EGFR mutations sensitive to EGFR tyrosine kinase inhibitors.

Malignant peritoneal mesotheliomas (MPM) are rare, accounting for approximately 8% of cases of mesothelioma in France. We performed comparative genomic hybridization (CGH) on frozen MPM samples using the Agilent Human Genome CGH 180 K array. Samples were taken from a total of 33 French patients, comprising 20 men and 13 women with a mean (range) age of 58.4 (17-76) years. Asbestos exposure was reported in 8 patients (24.2%). Median (range) overall survival (OS) was 39 (0-119) months. CGH analysis demonstrated the presence of chromosomal instability in patients with MPM, with a genomic pattern that was similar to that described for pleural mesothelioma, including the loss of chromosomal regions 3p21, 9p21, and 22q12. In addition, novel genomic copy number alterations were identified, including the 15q26.2 region and the 8p11.22 region. Median OS was associated with a low peritoneal cancer index (P=.011), epithelioid subtype (P=.038), and a low number of genomic aberrations (P=.015), all of which constitute good prognostic factors for MPM. Our results provide new insights into the genetic and genomic background of MPM. Although pleural and peritoneal mesotheliomas have different risk factors, different therapeutics, and different prognosis; these data provide support to combine pleural and peritoneal mesothelioma in same clinical assays.

International audience; Glycogen storage disease type I (GSDI) is a rare metabolic disease due to glucose-6 phosphatase deficiency, characterized by fasting hypoglycemia. Patients also develop chronic kidney disease whose mechanisms are poorly understood. To decipher the process, we generated mice with a kidney-specific knockout of glucose-6 phosphatase (K.G6pc-/- mice) that exhibited the first signs of GSDI nephropathy after 6 months of G6pc deletion. We studied the natural course of renal deterioration in K.G6pc-/- mice for 18 months and observed the progressive deterioration of renal functions characterized by early tubular dysfunction and a later destruction of the glomerular filtration barrier. After 15 months, K.G6pc-/- mice developed tubular-glomerular fibrosis and podocyte injury, leading to the development of cysts and renal failure. On the basis of these findings, we were able to detect the development of cysts in 7 out of 32 GSDI patients, who developed advanced renal impairment. Of these 7 patients, 3 developed renal failure. In addition, no renal cysts were detected in six patients who showed early renal impairment. In conclusion, renal pathology in GSDI is characterized by progressive tubular dysfunction and the development of polycystic kidneys that probably leads to the development of irreversible renal failure in the late stages. Systematic observations of cyst development by kidney imaging should improve the evaluation of the disease's progression, independently of biochemical markers.

Malignant mesothelioma (MM) is a malignancy arising from the mesothelial cells lining the thoracic and abdominal serosal cavities. The pleural space is the most commonly affected site, accounting for about 80% of cases, while peritoneum makes up the majority of the remaining 20%. The different types of mesotheliomas are generally considered as distinct diseases with specific risk factors, therapeutic strategies and prognoses. Epidemiological and clinical differences between pleural and peritoneal MM raise questions about the involvement of different molecular mechanisms. Since the BAP1 gene is involved in the BAP1 cancer syndrome and seems to be a prognostic factor in MM, this review presents an overview of BAP1 alterations in mesothelioma comparing pleural and peritoneal localizations.

In patients with chronic fibrosing interstitial lung disease (ILD), a progressive fibrosing phenotype (PF-ILD) may develop, but information on the frequency and characteristics of this population outside clinical trials is lacking. We assessed the characteristics and outcomes of patients with PF-ILD other than idiopathic pulmonary fibrosis (IPF) in a real-world, single-centre clinical cohort. The files of all consecutive adult patients with fibrosing ILD (2010–2017) were examined retrospectively for pre-defined criteria of ≥10% fibrosis on high-resolution computed tomography and progressive disease during overlapping windows of 2 years. Baseline was defined as the date disease progression was identified. Patients receiving nintedanib or pirfenidone were censored from survival and progression analyses. In total, 1395 patients were screened; 617 had ILD other than IPF or combined pulmonary fibrosis and emphysema, and 168 had progressive fibrosing phenotypes. In 165 evaluable patients, median age was 61 years; 57% were female. Baseline mean forced vital capacity (FVC) was 74±22% predicted. Median duration of follow-up was 46.2 months. Annualised FVC decline during the first year was estimated at 136±328 mL using a linear mixed model. Overall survival was 83% at 3 years and 72% at 5 years. Using multivariate Cox regression analysis, mortality was significantly associated with relative FVC decline ≥10% in the previous 24 months (p, In a real-world clinical cohort (PROGRESS), progressive fibrosing interstitial lung disease was characterised by continued lung function decline. Lung function decline, age and underlying diagnosis subgroup predicted mortality. https://bit.ly/2EB3OpF

International audience; Yersina ruckeri is an enterobacteria responsible for Enteric redmouth disease (ERM), which causes significant economic losses in the aquaculture industry worldwide. Two biotypes have been described within Y. ruckeri: biotype 1 (BT1) and biotype 2 (BT2). Unlike BT1, BT2 is negative for motility and lipase secretion. The emergence of BT2 Y. ruckeri has been associated with disease outbreaks in vaccinated fish in several countries, notably France in the early 2000s. In this study, 15 BT2 strains (14 BT2 strains isolated in France and the BT2 reference strain EX5) were studied to compare the phenotypic characters of the BT1 and BT2 strains and to determine the genetic origin of the emergence of BT2 in France. BT1 bacteria are significantly longer in size than BT2 bacteria (a difference of 0.222 mu m). The loss of motility of some French BT2 strains could be due to the loss of their ability to produce flagella caused by three mutations within the fliG, flhC and flgA genes. In the light of these results, the emergence of BT2 Yersinia ruckeri in France is discussed.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus inflammatoire, diffus, et parfois fibrosant (PID) [1] . Certains patients atteints de PID fibrosante, peuvent developper un phenotype d’evolution progressive comparable a celui observe dans la fibrose pulmonaire idiopathique ; ces pathologies sont regroupees sous le terme de PID de phenotype ou de forme progressive (PID-FP) [2] . L’objectif est de decrire la frequence, les caracteristiques cliniques et l’evolution des patients PID-FP hors FPI. Methodes L’etude a porte sur tous les patients successifs hospitalises dans un centre de reference des maladies pulmonaires rares entre janvier 2010 et decembre 2017, âges de 18 ans et plus, et presentant une PID fibrosante diagnostiquee par scanner thoracique. Parmi eux, les patients presentant une PID-FP ont ete selectionnes sur les criteres de progression definis par une baisse de la CVF ≥ 10 % avec ou sans deterioration clinique, ou une baisse de la CVF entre 5 et 10 % associee a une aggravation des symptomes respiratoires, ou une baisse de la CVF entre 5 et 10 % associee a une etendue croissante de la fibrose au scanner en moins de 24 mois. Cette etude a ete approuvee par la CNIL le 09/2018 (918305). Resultats Actuellement 149 patients presentant une PID-FP ont ete inclus. La majorite des patients etaient des femmes (57 %) d’âge moyen 59 ± 14 ans. La CVF moyenne etait de 73,3 ± 21 % de la theorique et la DLco de 43,0 ± 17,5 %. Pour les 104 patients dont l’information est disponible, la duree entre le diagnostic de la PID et celui de la progression etait de 2,7 ± 3,8 ans. La repartition etiologique etait : 8 % de pneumopathie d’hypersensibilite, 6 % de pneumopathie interstitielle non specifique idiopathique, 24 % de PID inclassable, 48 % de PID auto-immune, et 14 % d’autres PID. Les criteres de progression etaient une baisse de la CVF ≥ 10 % (65 %), une baisse de la CVF de 5–10 % associee a une aggravation des symptomes (24 %), une baisse de la CVF de 5–10 % associee a une etendue croissante de la fibrose au scanner (2 %) ou une aggravation des symptomes et une etendue croissante de la fibrose au scanner (9 %) en moins de 24 mois. Conclusion Ces resultats preliminaires fournissent des elements sur l’epidemiologie des patients PID-FP pour lesquels un essai therapeutique avec le nintedanib est actuellement en cours.

International audience; SMARCA4-deficient thoracic sarcoma (SMARCA4-DTS) is a recently described entity with an aggressive clinical course and specific genetic alterations of the BAF chromatin remodeling complex. In the present study, we reviewed the clinical and pathologic features of 30 cases of SMARCA4-DTS, discussed its main differential diagnoses and the challenging diagnostic scenarios that the average pathologist may face. In addition, we tested the specificity of the "SMARCA4-DTS immunohistochemical signature" (co-loss of SMARCA4 and SMARCA2 with overexpression of SOX2) in a large cohort of intrathoracic malignancies. Patients ranged from 28 to 90 years of age (median: 48 y), with a marked male predominance (male:female=9:1) and they were usually smokers. Tumors were generally large compressive masses located in the mediastinum (n=13), pleura (n=5), lung (n=2) or in 2 or more of these topographies (n=10). Treatment strategies were varied, including 1 case treated with EZH2 inhibitors. Median overall survival was 6 months. Histologically, tumors were poorly differentiated frequently showing rhabdoid features. A subset of cases showed a focal myxoid stroma (7%, n=2/30) and rare cases displayed a previously unreported pattern simulating desmoplastic small round cell tumors (7%, n=2/30). Making a diagnosis was challenging when dealing with biopsy material from massively necrotic tumors and in this setting the expression of SOX2, CD34, and SALL4 proved useful. All tested cases displayed concomitant loss of SMARCA4 and SMARCA2 and most tumors expressed epithelial markers (Pan-keratin or EMA) (n=29/30), SOX2 (n=26/27), and CD34 (n=17/27). SMARCB1 expression was retained in all cases (23/23). SALL4 and Claudin-4 were expressed in a subset of cases (n=7/21 and 2/19, respectively). TTF-1 and P63 were focally expressed in 1 case each. P40 and NUT were not expressed (0/23 and 0/20, respectively) The SMARCA4-DTS immunohistochemical signature was both sensitive and specific, with only a subset of small cell carcinoma of the ovary hypercalcemic type showing overlapping phenotypes. Our study confirms and expands the specific features of SMARCA4-DTS, emphasizing the fact that they can be straightforwardly identified by pathologists.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus diffus inflammatoire et/ou fibrosant [1] . Certains patients atteints de pneumopathie interstitielle diffuse fibrosante, peuvent developper un phenotype a evolution progressive similaire a celui observe dans la fibrose pulmonaire idiopathique (FPI), ces pathologies etant regroupees sous le terme de pneumopathie interstitielle diffuse a forme progressive (PID-FP) [2] . L’objectif de cette etude est de developper des algorithmes pour identifier les patients avec PID-FP non-FPI afin de decrire l’epidemiologie, et le fardeau global de ces maladies en France. Methodes Un algorithme bases sur la CIM-10, et reposant sur des algorithmes americains, a ete developpe en France afin de selectionner entre le 01/01/2010 et le 31/12/2017 les cas prevalents et incidents de PID-FP non-FPI au sein du Systeme national des donnees de sante (SNDS). Un algorithme sera aussi developpe a partir de la cohorte clinique de patients avec PID-FP non-FPI suivis par le Centre national de reference des maladies pulmonaires rares de Lyon. Description des algorithmes Un premier algorithme a ete developpe pour extraire les sejours des patients atteints de PID-FP, base sur la selection de l’ensemble des sejours avec un code de diagnostic de fibrose pulmonaire puis l’exclusion des patients FPI. Les formes progressives seront enfin extraites a partir des donnees de demandes de remboursement pour des traitements specifiques, de consultations chez le pneumologue, d’actes d’imagerie, d’examens de la fonction pulmonaire et/ou d’hospitalisations. La seconde approche consistera a creer un algorithme via une approche par apprentissage automatique grâce au recoupement des donnees du SNDS et de la cohorte clinique. Conclusion Le developpement de ces deux algorithmes par des approches differentes permettra de comparer les resultats obtenus et de choisir l’approche la plus valide pour approfondir les connaissances sur ces pathologies. Cette etude permettra d’estimer le nombre de patients atteints de PID-FP non-FPI, de decrire leur parcours de soins et les couts associes, ainsi que d’explorer la correlation entre la capacite vitale forcee de ces patients et leur morbi-mortalite.

The research leading to these results received funding from the Obra Social “la Caixa” (to ME), the Cellex Foundation (to ME), the European Union's Horizon 2020 research and innovation programme under grant agreement No 727264 Epipharm (to ME), the 2015 Endowment fund for Research into Respiratory Health (“Fonds de Dotation Recherche en Santé Respiratoire”; to MD), the “Fondation ARC pour la recherche sur le cancer - Aide individuelle” (to MD), the Spanish Association Against Cancer (to VD), the Pla Estratègic de Recerca i Innovació en Salut (to SM), the Fondo de Investigación Sanitaria-Fondo Europeo de Desarrollo Regional (PI16/01821 to LMM and PI15/02223, to IG-B), RETTICS grant (RD12/0036/0040 to IG-B), Fundación Merck Salud (to IG-B), Departamento de Salud, Gobierno de Navarra (074-2017, to IGB), the European Commission MSCA IMMUNOMARK-799818 (to IBara), the China Scholarship Council and Karolinska Institutet Fonder (to QX), and the Health and Science Departments of the Generalitat de Catalunya (to ME). We thank IGTP–HUGTP Biobank (PT13/0010/0009) University Hospital Ramon y Cajal-IRYCIS Biobank (PT13/0010/0002), members of the Spanish National Biobanks Network of the Instituto de Salud Carlos III, Andalusia Public Health System Biobank, the Biological Resource Center of the Hospices Civils de Lyon (Tissu-tumorothèque Est), and the Tumor Bank Network of Catalonia for their help with the collection of samples., Duruisseaux, M., Martínez-Cardús, A., Calleja-Cervantes, M.E., Moran, S., Castro de Moura, M. , Davalos, V., Piñeyro, D., Sanchez-Cespedes, M., Girard, N., Brevet, M.,Giroux-Leprieur, E., Dumenil, C. Pradotto, M., Bironzo, P., Capelletto, E., Novello, S., Cortot, A. , Copin, M.-C., Karachaliou, N.,Gonzalez-Cao, M. ,Peralta, S., Montuenga, L.M.,Gil-Bazo, I. ,Baraibar, I.,Lozano, M.D., Varela, M. ,Ruffinelli, J.C.,Palmero, R., Nadal, E.,Moran, T., Perez, L., Ramos, I., Xiao, Q.,Fernandez, A.F., Fraga, M.F.,Gut, M., Gut, I. ,Teixidó, C. , Vilariño, N., Prat, A., Reguart, N., Benito, A.,Garrido, P., Barragan, I., Emile, J.-F., Rosell, R., Brambilla, E., Esteller, M.

Background Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. Patients and methods POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS . Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. Results Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0–1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10–2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01–1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10–7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40–6.27]; p = .005). Conclusions In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.

Introduction Les anti-PD-1 permettent un gain de survie dans les cancers bronchiques non a petites cellules (CBNPC) metastatiques. Cependant, la majorite des patients ne tire pas de benefice de ces traitements. Nous avons evalue l’interet de l’analyse a haut debit du methylome de CBNPC dans la prediction de l’efficacite des anti-PD-1. Methodes Etude multicentrique (15 centres) internationale (France, Espagne, Italie) retrospective. Criteres d’inclusion : CBNPC metastatique traite par anti-PD-1et prelevement tumoral disponible. Une cohorte decouverte (n = 34) a permis d’evaluer la correlation entre caracteristiques epigenetiques des tumeurs evaluees par methylome a haut debit (Illumina 850 K array beadchip) et efficacite des anti-PD-1. Une signature epigenetique (EPIMMUNE) predictive de l’efficacite des anti-PD-1 a ete elaboree et confirmee dans une cohorte de validation (n = 47). Nous avons isole un site specifique de methylation associe au benefice clinique et confirme son interet predictif par une technique de pyrosequencage dans une troisieme cohorte independante (n = 61). La methode de Kaplan–Meier a ete utilisee pour estimer la survie sans progression (SSP) et la survie globale (SG), le test de log-rank pour comparer les groupes de patients. Un modele de COX multivarie a ete construit pour identifier les variables independamment associees avec la SSP et la SG. Resultats La signature EPIMMUNE+ etait associee a une SSP allongee (HR 0,010, IC95 % 3,29 × 10–0,0282 ; p = 0,0067) et une SG allongee (HR 0,080, IC95 % 0,017–0,373 ; p = 0,0012) avec les anti-PD-1 dans la cohorte decouverte ( Fig. 1 ). Ces resultats etaient confirmes en SSP dans la cohorte validation. EPIMMUNE+ n’etait pas associee a l’expression de PD-L1, a l’infiltrat CD8 ou a la charge mutationnelle. Les tumeurs EPIMMUNE–etaient enrichies en macrophages, en polynucleaires neutrophiles, en fibroblastes et en cellules endotheliales senescentes. Le status demethyle du gene FOXP1 etait associe a une SSP allongee (p = 0,0063) et une SG allongee (p = 0,0094) dans la cohorte decouverte et dans une deuxieme cohorte de validation. EPIMMUNE+ et la demethylation de FOXP1 n’avait pas de valeur pronostique dans le TCGA. Conclusion Les caracteristiques epigenetique des cellules tumorales et du microenvironnement conditionnent l’efficacite des anti-PD-1 dans les CBNPC. La demethylation de FOXP1 pourrait etre un biomarqueur predictif de l’efficacite des anti-PD1 utilisable en clinique, complementaire de PD-L1 ou de la charge mutationnelle. Etude soutenue par le FRSR.

Introduction Les metastases cerebrales (MC) dans les cancers bronchiques non a petites cellules (CBNPC) sont associees a un mauvais pronostic et a une resistance au traitement systemique. La caracterisation du micro-environnement immunitaire des MC permettrait de fournir un rationnel a l’utilisation de l’immunotherapie et d’aider a l’identification de nouvelles cibles therapeutiques. Methodes Quatre-vingt-cinq MC de CBNPC avances naifs de tout traitement et 14 tumeurs primaires pulmonaires appariees ont ete collectees. L’expression de 770 genes impliques dans la reponse immunitaire etait evaluee par le panel PanCancer IO360 (NanoString Technologies, Inc). Les donnees etaient comparees entre MC et tumeurs primitives. La reponse objective aux anti-PD1 etait evaluee selon les criteres RECIST 1.1. Resultats L’environnement immunitaire tumoral des MC etait plus « froid » comparativement aux CBNPC primitifs, avec 92 % des MC dans le cluster « froid » et 58 % des tumeurs primaires dans le cluster « chaud ». L’expression de genes caracterisant les differents types de cellules immunitaires etaient reprimes dans les MC par rapport aux tumeurs primitives, notamment pour les lymphocytes B (−1,7 log2 FC, p Conclusion Le micro-environnement immunitaire est moins favorable a l’efficacite des anti-PD1 dans les MC que dans les tumeurs primitives. La chimiokine CCL21 pourrait etre une nouvelle cible therapeutique dans les MC des CBNPC.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus diffus inflammatoire et/ou fibrosant [1] . Certains patients atteints de PID fibrosante, peuvent developper un phenotype a evolution progressive similaire a celui observe dans la fibrose pulmonaire idiopathique (FPI), ces pathologies etant regroupees sous le terme de PID a forme progressive (PID-FP) [2] . L’objectif de cette etude est de developper des algorithmes pour identifier les patients avec PID-FP non-FPI afin de decrire l’epidemiologie, et le fardeau global de ces maladies en France. Methodes Un algorithme base sur la CIM-10, et reposant sur des algorithmes americains, a ete developpe en France afin de selectionner entre le 01/01/2010 et le 31/12/2017 les cas prevalents et incidents de PID-FP non-FPI au sein du Systeme national des donnees de sante (SNDS). Un algorithme sera aussi developpe a partir de la cohorte clinique de patients avec PID-FP non-FPI suivis par le Centre national de reference des maladies pulmonaires rares de Lyon. Resultats Un premier algorithme a ete developpe pour extraire les sejours des patients atteints de PID-FP, base sur la selection de l’ensemble des sejours avec un code de diagnostic de fibrose pulmonaire puis l’exclusion des patients FPI. Les formes progressives seront enfin extraites a partir des donnees de demandes de remboursement pour des traitements specifiques, de consultations chez le pneumologue, d’actes d’imagerie, d’examens de la fonction pulmonaire et/ou d’hospitalisations. La seconde approche consistera a creer un algorithme via une approche par apprentissage automatique grâce au recoupement des donnees du SNDS et de la cohorte clinique. Conclusion Le developpement de ces deux algorithmes par des approches differentes permettra de comparer les resultats obtenus et de choisir l’approche la plus valide pour approfondir les connaissances sur ces pathologies. Cette etude permettra d’estimer le nombre de patients atteints de PID-FP non-FPI, de decrire leur parcours de soins et les couts associes, ainsi que d’explorer la correlation entre la capacite vitale forcee de ces patients et leur morbi-mortalite.

Introduction Les mutations activatrices du gene human epidermal growth factor receptor-2 (HER2) concerne 1,6 a 4,2 % des adenocarcinomes pulmonaires et sont majoritairement des insertions de l’exon 20. L’objectif de cette etude etait d’evaluer le microenvironnement immun et l’efficacite des anti-PD-1, mal connus dans ce sous-groupe moleculaire. Methodes Tous les cancers bronchiques non a petites cellules mutes HER2 (CBNPC HER2 +) diagnostiques par la plateforme de biologie moleculaire des Hospices Civils de Lyon (HCL) entre 2010 et 2019 ont ete inclus. Les donnees cliniques, histologiques, moleculaires et l’efficacite des anti-PD-1 ont ete collectees retrospectivement. Des immunomarquages PD-L1 ont ete realises sur les prelevements disponibles. Une cohorte controle de 225 patients CBNPC HER2 - traites par anti-PD-1 aux HCL de 2015 a 2019 apres echec d’une chimiotherapie a ete constituee. Les taux de reponses objectives aux anti-PD-1 selon RECIST 1.1 (test de Fisher), la survie sans progression (SSP) et globale (SG) (log rank) avec les anti-PD-1 etaient compares entre CBNPC HER2 + et − . Resultats Cinquante-trois CBNPC HER2 + etaient inclus : 55 % de femmes, 57 % de non-fumeurs, âge median 66 ans (45-88), 70 % de stade IV. Tous etaient des adenocarcinomes. Une expression de PD-L131 % des cellules tumorales etaient retrouvees dans 40 % des cas (16/40), 350 % dans 10 % (4/40). 11 CBNPC HER2 + ont recus un anti-PD-1 en deuxieme ligne et plus avec pour meilleure reponse une reponse partielle (RP) dans 9 % (1/11) des cas, une stabilite (ST) dans 46 % (5/11), une progression (PR) dans 45 % (5/11). La SSP mediane sous anti-PD-1 etait de 3,6 mois, la SG mediane de 5,8 mois. Dans la cohorte controle, la meilleure reponse aux anti-PD-1 etait une RP dans 7,5 % des cas, une ST dans 31 %, une PR dans 61 %, pour une SSP mediane de 2 mois et une SG mediane de 7,1 mois. Les taux de reponse (p = 0,22), la SSP (p = 0,59) et la SG (p = 0,66) n’etaient pas statistiquement differents entre les deux cohortes. Les taux de reponses, la SSP et la SG n’etaient pas statistiquement differents en comparant les CBNPC HER2 + et les CBNPC KRAS + ou pan-sauvage de la cohorte controle. 2 CBNPC HER2 + ont recu un anti-PD-1 en premiere ligne (PD-L1350 %) avec 2 RP, PFS a 7,75 mois et RP toujours en cours apres 9,5 mois de traitement, respectivement. Conclusion L’expression de PD-L1 est faible dans les CBNPC HER2+. Cependant, l’efficacite des anti-PD-1 semble comparable entre CBNPC HER2+ et CBNPC HER2−.

Background and Aims.Chemotherapy of colorectal liver metastases can induce hepatotoxicity in noncancerous liver. We describe these lesions and assess risk factors and impacts on postresection morbidity and mortality in naive patients to chemotherapy before the era of bevacizumab.Methods.Noncancerous liver tissue lesions were analysed according to tumour, chemotherapy, surgery, and patient characteristics.Results.Fifty patients aged 62 ± 9.3 years were included between 2003 and 2007. Thirty-three (66%) received chemotherapy, with Folfox (58%), Folfiri (21%), LV5FU2 (12%), or Xelox (9%) regimens. Hepatotoxicity consisted of 18 (36%) cases of severe sinusoidal dilatation (SD), 13 (26%) portal fibrosis, 7 (14%) perisinusoidal fibrosis (PSF), 6 (12%) nodular regenerative hyperplasia (NRH), 2 (4%) steatosis >30%, zero steatohepatitis, and 16 (32%) surgical hepatitis. PSF was more frequent after chemotherapy (21% versus 0%, ), especially LV5FU2 (). SD was associated with oxaliplatin (54.5% versus 23.5%, ) and low body mass index (). NRH was associated with oxaliplatin () and extensive resection (). No impact on mortality and morbidity was observed, apart postoperative elevation of bilirubin levels in case of PSF (), longer hospitalization in case of surgical hepatitis (), and greater blood loss in case of portal fibrosis ().Conclusions.Chemotherapy of colorectal liver metastases induces sinusoidal dilatation related to oxaliplatin and perisinusoidal fibrosis related to 5FU, without any impact on postoperative mortality.

Non invasive somatic detection assays are suitable for repetitive tumor characterization or for detecting the appearance of somatic resistance during lung cancer. Molecular diagnosis based on circulating free DNA (cfDNA) offers the opportunity to track the genomic evolution of the tumor, and was chosen to assess the molecular profile of several EGFR alterations, including deletions in exon 19 (delEX19), the L858R substitution on exon 21 and the EGFR resistance mutation T790M on exon 20. Our study aimed at determining optimal pre-analytical conditions and EGFR mutation detection assays for analyzing cfDNA using the picoliter-droplet digital polymerase chain reaction (ddPCR) assay. Within the framework of the CIRCAN project set-up at the Lyon University Hospital, plasma samples were collected to establish a pre-analytical and analytical workflow of cfDNA analysis. We evaluated all of the steps from blood sampling to mutation detection output, including shipping conditions (4H versus 24H in EDTA tubes), the reproducibility of cfDNA extraction, the specificity/sensitivity of ddPCR (using external controls), and the comparison of different PCR assays for the detection of the three most important EGFR hotspots, which highlighted the increased sensitivity of our in-house primers/probes. Hence, we have described a new protocol facilitating the molecular detection of somatic mutations in cancer patients from liquid biopsies, improving their diagnosis and introducing a less traumatic monitoring system during tumor progression.