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The identification of direct nuclear hormone receptor gene targets provides clues to their contribution to both development and cancer progression. Until recently, the identification of such direct target genes has relied on a combination of expression analysis and in silico searches for consensus binding motifs in gene promoters. Consensus binding motifs for transcription factors are often defined using in vitro DNA binding strategies. Such in vitro strategies fail to account for the many factors that contribute significantly to target selection by transcription factors in cells beyond the recognition of these short consensus DNA sequences. These factors include DNA methylation, chromatin structure, posttranslational modifications of transcription factors, and the cooperative recruitment of transcription factor complexes. Chromatin immunoprecipitation (ChIP) provides a means of isolating transcription factor complexes in the context of endogenous chromatin, allowing the identification of direct transcription factor targets. ChIP can be combined with site-specific PCR for candidate binding sites or alternatively with cloning, genomic microarrays or more recently direct high throughput sequencing to identify novel genomic targets. The application of ChIP-based approaches has redefined consensus binding motifs for transcription factors and provided important insights into transcription factor biology.

A fluorescence in situ hybridisation (FISH) assay has been used to screen for ETV1 gene rearrangements in a cohort of 429 prostate cancers from patients who had been diagnosed by trans-urethral resection of the prostate. The presence of ETV1 gene alterations (found in 23 cases, 5.4%) was correlated with higher Gleason Score (P=0.001), PSA level at diagnosis (P=

Background The aberrant transcription in cancer of genes normally associated with embryonic tissue differentiation at various organ sites may be a hallmark of tumour progression. For example, neuroendocrine differentiation is found more commonly in cancers destined to progress, including prostate and lung. We sought to identify proteins which are involved in neuroendocrine differentiation and differentially expressed in aggressive/metastatic tumours. Results Expression arrays were used to identify up-regulated transcripts in a neuroendocrine (NE) transgenic mouse model of prostate cancer. Amongst these were several genes normally expressed in neural tissues, including the pro-neural transcription factors Ascl1 and Hes6. Using quantitative RT-PCR and immuno-histochemistry we showed that these same genes were highly expressed in castrate resistant, metastatic LNCaP cell-lines. Finally we performed a meta-analysis on expression array datasets from human clinical material. The expression of these pro-neural transcripts effectively segregates metastatic from localised prostate cancer and benign tissue as well as sub-clustering a variety of other human cancers. Conclusion By focussing on transcription factors known to drive normal tissue development and comparing expression signatures for normal and malignant mouse tissues we have identified two transcription factors, Ascl1 and Hes6, which appear effective markers for an aggressive phenotype in all prostate models and tissues examined. We suggest that the aberrant initiation of differentiation programs may confer a selective advantage on cells in all contexts and this approach to identify biomarkers therefore has the potential to uncover proteins equally applicable to pre-clinical and clinical cancer biology.

Dyspnoea is the most common presenting symptom amongst patients with acute heart failure syndromes (AHFS). It is distressing to patients and therefore an important target for treatment in clinical practice, clinical trials, and for regulatory approval of novel agents. Despite its importance as a treatment target, no consensus exists on how to assess dyspnoea in this setting. There is a considerable uncertainty about the reproducibility of the various instruments used to measure dyspnoea, their ability to reflect changes in symptoms and whether they accurately reflect the patient's experience. Little attempt has been made to ensure consistent implementation with respect to patients' posture during assessment or timing in relationship to therapy. There is also limited understanding of how rapidly and completely dyspnoea responds to standard therapy. A standardized method with which to assess dyspnoea is required for clinical trials of AHFS in order to ensure uniform collection of data on a key endpoint. We propose the Provocative Dyspnoea Assessment, a method of measurement that combines sequential dyspnoea provocation by positioning and walking with a dyspnoea self assessment using a five-point Likert scale, to yield a final Dyspnoea Severity Score. This proposed tool requires detailed validation but has face validity for the uniform assessment of dyspnoea. © The Author 2008.

To present the case of a collegiate tennis player with celiac disease symptoms.Celiac disease is a common intestinal disorder that is often confused with other conditions. It causes severe intestinal damage manifested by several uncomfortable signs and symptoms. Failure by the sports medicine staff to recognize symptoms consistent with celiac disease and treat them appropriately can have deleterious consequences for the athlete.Irritable bowel syndrome, Crohn disease, Addison disease, lupus erythematosus, juvenile rheumatoid arthritis, lactose intolerance, herpes zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain syndrome, hyperthyroidism, anemia, type I diabetes.The athlete underwent a series of blood and allergen tests to confirm or refute a diagnosis of celiac disease. When celiac disease was suspected, dietary modifications were made to eliminate all wheat-based and gluten-based products from the athlete's diet.The athlete was able to fully compete in a competitive National Collegiate Athletic Association Division I tennis program while experiencing the debilitating effects associated with celiac disease. The immediacy of symptom onset was notable because the athlete had no history of similar complaints.Celiac disease is a potentially life-threatening condition that affects more people than reported. A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life.

Microcell-mediated transfer of normal chromosome 11 (chr 11) to a clonal derivative of the ovarian cancer cell line, OVCAR3, was performed and generated independent hybrids with a common set of phenotypes: inhibition of cell growth and of cellular migration in vitro; and inhibition of tumor growth in vivo. Differential display reverse transcriptase-PCR (RT-PCR), cDNA-representational difference analysis, and hybridization of cDNA high-density filter arrays identified altered mRNAs associated with these phenotypic alterations. Quantitative RT-PCR-based validation of each altered mRNA eliminated false positives to identify a reduced set of expression differences. Twelve products were confirmed as up-regulated and 4 as down-regulated upon introduction of chr 11. Strikingly, 4 of the 12 up-regulated genes were located on chr 11. Expression analysis of selected products by quantitative RT-PCR in a series of 18 human primary ovarian tumors revealed several associations with clinicopathological features. Importantly, low expression of two products, the lysosomal protease CTSD and the lens crystallin CRYAB, was significantly associated with adverse patient survival. Immunohistochemical analysis of CTSD in a larger independent panel of 58 primary ovarian tumors confirmed that low CTSD was associated with poor survival. Furthermore, low CTSD was significantly associated with serous histology and advanced tumor stage. The combined approach of microcell-mediated chromosome transfer and expression difference analysis has identified several altered mRNAs in a model of chr 11-mediated ovarian tumor suppression. The detailed contextual characterization of these genes will determine the extent of their involvement in neoplastic development.

Epithelial ovarian cancer (EOC), the leading cause of death from gynecological malignancy, is a poorly understood disease. The typically advanced presentation of EOC with loco-regional dissemination in the peritoneal cavity and the rare incidence of visceral metastases are hallmarks of the disease. These features relate to the biology of the disease, which is a principal determinant of outcome1,2. EOC arises as a result of genetic alterations sustained by the ovarian surface epithelium (OSE; ref. 3). The causes of these changes are unknown but are manifest by activation of oncogenes and inactivation of tumor-suppressor genes (TSGs). Our analysis of loss of heterozygosity at 11q25 identified OPCML (also called OBCAM), a member of the IgLON family of immunoglobulin (Ig) domain–containing glycosylphosphatidylinositol (GPI)-anchored cell adhesion molecules, as a candidate TSG in EOC. OPCML is frequently somatically inactivated in EOC by allele loss and by CpG island methylation. OPCML has functional characteristics consistent with TSG properties both in vitro and in vivo. A somatic missense mutation from an individual with EOC shows clear evidence of loss of function. These findings suggest that OPCML is an excellent candidate for the 11q25 ovarian cancer TSG. This is the first description to our knowledge of the involvement of the IgLON family in cancer.

Background Castration-resistant prostate cancer is a heterogeneous conditon that is poorly characterised. Although the androgen receptor (AR) is of particular importance, other factors such as c-Myc and the E2F family also have a role in later stage disease. Hes6 is a transcription cofactor associated with stem-cell characteristics in neural tissue, but its role in cancer remains uncertain. We aimed to assess the role of Hes6 in castration-resistant prostate cancer and to identify its prognostic and therapeutic relavance. Methods We transduced an androgen-sensitive cell line (LNCaP) to constitutively overexpress Hes6 and luciferase to permit xenografting in NOD-SCID gamma mice and bioluminescent monitoring of tumour growth. We used microarray genomics and chromatin immunoprecipitation-sequencing to study the molecular environment underpinning the cellular effects of Hes6. We generated a 61-patient hormone relapsed prostate cancer tissue microarray and assessed 285 publicly available human prostate cancers in a meta-analysis to profile Hes6 and its associated regulome in aggressive human disease. Findings We found that Hes6 was upregulated in aggressive human prostate cancer with its expression controlled by c-Myc and AR. Hes6 drove castration-resistant tumour growth by enhancing AR transcriptional activity in the absence of ligand binding. The AR was preferentially directed to a regulatory network enriched for other transcription factors including E2F1. We found a physical interaction between E2F1 and both Hes6 and AR, with increased occupancy of AR at E2F1 target sites in the presence of Hes6. In the clinical setting, we uncovered a Hes6-associated signature that predicts poor outcome in prostate cancer on longitudinal follow-up of men after prostatectomy. We found, in our model of castration resistance, that this process can be pharmacologically targeted by inhibition of PLK1, part of the Hes6 and E2F1 regulome, with restoration of sensitivity to castration. Interpretation We have shown for the first time, to our knowledge, the crucial role of Hes6 in development of castration-resistant prostate cancer and identified its potential in patient-specific therapeutic strategies. Funding Cambridge Biomedical Research Centre, GlaxoSmithKline, Raymond and Beverley Sackler Studentship.

BCR-ABL negative myeloproliferative neoplasms (MPNs), such as polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis (MF) are chronic myeloid malignancies characterized by overproduction of hematopoietic cells. JAK2 mutations are found in most patients with PV, and in only 50-60% of patients with ET and MF. JAK2 mutation testing has greatly simplified MPN diagnosis, but distinguishing JAK2-wildtype ET from reactive thrombocytosis remains a diagnostic challenge. Mutations in signalling pathways (MPL, LNK) and epigenetic regulators (TET2, DNMT3A, IDH1/2, EXH2, ASXL1) have been found in a minority of MPNs. However genome-wide data are lacking and the pathogenesis of MPNs that do not harbor JAK2 or MPLmutations remains obscure. Methods Exome sequencing was performed in 151 MPN patients on matched tumor and constitutional samples. CALR status was assessed in 3412 samples using Sanger sequencing and analysis of exome/genome sequencing data. Presence of CALR mutations in hematopoietic stem and progenitor cells was assessed by flow sorting and sequencing. Phylogenetic trees were established using hematopoietic colonies. Calreticulin cellular localisation was assessed in patient samples and cell lines expressing CALR variants by flow cytometry and immunofluorescence. Results Exome sequencing identified 1498 somatic mutations with a median of 6.5 mutations in PV and ET, and 13 in MF (MF vs ET, P=0.0002; MF vs PV, P=0.008). JAK2V617F was found in all cases of PV (n=48), 56% of ET (35/62), and 69% of MF (27/39), and MPL mutations in 7 ET and MF cases. Mutations in epigenetic regulators TET2, DNMT3A, ASXL1, EZH2, and IDH1/2 were identified in 22, 12, 12, 4, 3 patients respectively, and components of the splicing machinery (U2AF1, SF3B1 or SRSF2) were mutated in 9 patients. Mutations in rare genes reported to be mutated in MPNs were found in four patients (1 CBL; 2 NFE2; 1 SH2B3/LNK). We found novel somatic mutations in CHEK2 (1 PV, 1 ET and 1 MF) which have not been previously reported in MPNs. The mutation spectrum showed a predominance of C>T transitions. Pairwise associations between MPN genes demonstrated that ASXL1 and SRSF2 mutations were positively correlated with mutations in epigenetic modifiers. Novel somatic mutations in calreticulin (CALR) were identified by exome sequencing in the majority (26/31) of JAK2 or MPL unmutated patients. CALR and JAK2/MPL mutations were mutually exclusive, and 97% of patients harbored a mutation in 1 of these 3 genes. In an extended follow up screen of 1345 hematological malignancies, 1517 other cancers and 550 controls we found CALR mutations in 71% of ET (80/112), 56% of idiopathic MF (18/32), 86% of post ET-MF (12/14) and 8% of myelodysplasia (10/115), but not in other myeloid, lymphoid or solid cancers. Compared to JAK2-mutated MPNs, those with CALR mutations presented with higher platelet counts (Wilcoxon rank-sum, P=0.0003), lower hemoglobin levels (Student’s t test, P=0.02) and showed a higher incidence of transformation to MF (Fishers exact, P=0.03). All CALR mutations were insertions or deletions affecting exon 9, with 2 common variants L367fs*46 (52 bp deletion) and K385fs*47 (5 bp insertion). Loss of heterozygosity over CALR was seen in a minority of patients. Of 148 CALR mutations identified, there were 19 distinct variants. Remarkably, all generated a +1 basepair frameshift, which results in loss of most of the C-terminal acidic domain of the protein as well as the KDEL Golgi-to-endoplasmic reticulum (ER) retrieval signal, raising the possibility of compromised ER retention. Mutant proteins were readily detected in transfected cell lines and localised to the ER in the same manner as wildtype CALR, without Golgi or cell surface accumulation. These results are consistent with studies reporting KDEL-independent mechanisms of ER retention. Mutation of CALR was detected in highly purified hematopoietic stem/progenitor cells. Clonal analyses demonstrated CALR mutations in the earliest phylogenetic node in 5/5 patients, consistent with it being an initiating mutation in these individuals. Conclusions We describe the mutational landscape of BCR-ABL negative MPNs and demonstrate that somatic mutations in the endoplasmic reticulum chaperone CALR are found in the majority of patients with JAK2-unmutated MPNs. These results reveal a novel biological pathway as a target for tumorigenic mutations and will simplify diagnosis of MPN patients. Disclosures: Bowen: Celgene: Honoraria. Harrison:S Bio: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Shire: Speakers Bureau; Celgene: Honoraria; YM Bioscience: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Gilead: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Vannucchi:Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees.

In a recent genome-wide study to identify androgen receptor target genes we found that the AR promotes tumor growth by enhancing the expression and activity of enzymes required for metabolic biosynthesis. This raises the possibility for effective therapeutic approaches directed towards AR target genes. Kinases are well-established drug targets. In this study we identify androgen regulated kinome and show that an important androgen regulated metabolic kinase is a drug target in prostate cancer. Our proteome study shows that this kinase interacts with the androgen receptor and regulates AR stability. Inhibition of this kinase significantly reduces AR protein levels and suppresses prostate cancer growth in cell-lines and ex vivo cultures. In clinical prostate cancer this kinase is highly over-expressed in metastatic prostate cancers and inhibition represses metastatic potential of prostate cancer cells. Our study therefore establishes this kinase for the first time as an AR target gene that regualtes AR itself as part of feedback loop and makes a case for further investigation of its inhibitors as novel AR antagonists in both localised and advanced disease. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B133. Citation Format: Mohammad asim, Charlie Massie, Heather Zecchini, Ajoeb Baridi, Nelma Gomes, Hisham Mohammed, Vincent Zecchini, Basetti Madhu, Arham Qureshi, Roslin Russell, Wiebke Hessenkemper, Rouchelle Sriranjan, Carrie Yang, Andy Lynch, Elena Gregorengko, Rory Stark, Paul Rennie, John Griffiths, Aria Baniahmad, Jasol Carroll, Ian Mills, David Neal. Regulation of the androgen receptor function by a metabolic kinase in prostate cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B133.

The AR signalling axis is central to Prostate Cancer (PrCa) biology, shown by its use in both screening (PSA) and treatment of the disease (androgen deprivation therapy). Identifying direct target genes of the AR will provide a better understanding the key signalling pathways controlled by the AR in PrCa and could lead to improved biomarkers and future therapeutic targets for the disease. To this end we have performed fine mapping of androgen responsive gene expression in prostate cancer cell lines using Illumina bead-arrays, coupled with AR chromatin-immunoprecipitation and Solexa sequencing technology (ChIP-seq). This approach generated over ten thousand candidate AR target genes. We have then undertaken large scale, cross-platform validation using BioTrove Realtime PCR panels which allow the measurement of >600 transcripts simultaneously. Using this combination of approaches we have identified and validated several hundred AR regulated genes. We found that metabolic enzymes and kinases were significantly enriched in the set of direct AR regulated genes. In nine independent clinical gene expression studies we found that the most consistently up-regulated AR target gene was a calcium regulated kinase. At the protein level this kinase showed increased expression in two independent patient cohorts. A small molecule inhibitor of this kinase reduced the growth of a panel of PrCa cell lines in vitro and tumour growth in xenograft models. Interestingly, we found that the levels of this AR regulated kinase were reduced in clinical PrCa following androgen deprivation therapy, but were raised in Castrate Resistant disease. Therefore, we have identified an AR regulate kinase which contributes to tumour growth and is a potential marker and therapeutic target in both hormone naïve and anti-androgen resistant disease. In summary, these data show that combining expression analysis, ChIP-seq and high through-put validation has identified a framework to understand the oncogenic functions of the AR in prostate cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1714.

The missions specified for highperformance military aircraft have continually increased the relay switching requirements. Concurrently, the environmental and operational parameters tax the maximum capability of the state of the art. In addition, these relays must have increased reliability since their purpose is to provide simultaneous multiple functions, and also controls beyond the capability of the human operator.

We have become increasingly aware of sexual abuse in our society, and yet the majority of teens who were sexually abused as children enter adolescence carrying the secret of their abuse. Such hidden abuse may have devastating effects on the development of personal identity, self-esteem, attitudes, behaviors, and interpersonal relationships that may persist and set a pattern for a troubled adulthood. This article details how children cope with a sexually abusive situation, the long-term effects of unresolved sexual abuse, and diagnostic criteria to differentiate a hidden history of sexual abuse from other trauma and conditions. Focus is on recognizing and assessing "legitimate" symptoms that may be conscious or unconscious cries for help by victims of previous sexual abuse. Correct diagnosis is essential to appropriate intervention to lessen possible further psychologic damage during adolescence.

Made available in DSpace on 2015-12-07T15:37:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-28. Added 1 bitstream(s) on 2015-12-07T15:54:25Z : No. of bitstreams: 1 PM26035357.pdf: 1990010 bytes, checksum: b326791a0e5f08cda8b85785cf7dbabf (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Monocarboxylate Transporter 2 (MCT2) is a major pyruvate transporter encoded by the SLC16A7 gene. Recent studies pointed to a consistent overexpression of MCT2 in prostate cancer (PCa) suggesting MCT2 as a putative biomarker and molecular target. Despite the importance of this observation the mechanisms involved in MCT2 regulation are unknown. Through an integrative analysis we have discovered that selective demethylation of an internal SLC16A7/MCT2 promoter is a recurrent event in independent PCa cohorts. This demethylation is associated with expression of isoforms differing only in 5'-UTR translational control motifs, providing one contributing mechanism for MCT2 protein overexpression in PCa. Genes co-expressed with SLC16A7/MCT2 also clustered in oncogenic-related pathways and effectors of these signalling pathways were found to bind at the SLC16A7/MCT2 gene locus. Finally, MCT2 knock-down attenuated the growth of PCa cells. The present study unveils an unexpected epigenetic regulation of SLC16A7/MCT2 isoforms and identifies a link between SLC16A7/MCT2, Androgen Receptor (AR), ETS-related gene (ERG) and other oncogenic pathways in PCa. These results underscore the importance of combining data from epigenetic, transcriptomic and protein level changes to allow more comprehensive insights into the mechanisms underlying protein expression, that in our case provide additional weight to MCT2 as a candidate biomarker and molecular target in PCa. Uro-oncology Research Group, CRUK Cambridge Institute, Cambridge, UK Department of Pathology, Centro Hospitalar do Porto, Porto, Portugal Department of Morphology, Institute of Biosciences, Sao Paulo State University (UNESP), Sao Paulo, Brazil Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Molecular Diagnostics and Therapeutics Group, University College London, London, UK Statistics and Computational Biology Group, CRUK Cambridge Institute, Cambridge, UK Department of Urology, University of Cambridge, Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK. Department of Morphology, Institute of Biosciences, São Paulo State University (UNESP), São Paulo, Brazil. FAPESP: 2013/08830-2 FAPESP: 2013/06802-1