Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents.

PURPOSE: The early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil). METHODS: Patients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri-COVID-19 and control cohorts were tested using Cohen's h test to assess the standardized differences between the two groups. RESULTS: Among 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98 v 197) versus a 12.5% reduction at PM (294 v 336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9% v 29.9%; P = .015) and an increase in treatment delay (61.9% v 9.7%; P < .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4% v 22.3%; P < .001) and a higher rate of discontinuation of radiotherapy (9.4% v 1.1%; P < .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9% v 2.6%; P < .001) and PM (10.5% v 3.6%; P < .01). CONCLUSION: The early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.

Chemopreventive effects of the dietary histone deacetylase inhibitor tributyrin alone or in combination with vitamin A during the promotion phase of rat hepatocarcinogenesis.

The chemopreventive effects of tributyrin (TB) and vitamin A (VA), alone or in combination, were investigated during the promotion phase of rat hepatocarcinogenesis. Compared to diethylnitrosamine control rats, TB and TB+VA-treated rats, but not VA-treated rats, presented a lower incidence and mean number of hepatocyte nodules and a smaller size of persistent preneoplastic lesions (pPNLs). In addition, TB and TB+VA-treated rats exhibited a higher apoptotic body index in pPNL and remodeling PNL, whereas VA-treated rats presented only a higher apoptotic body index in remodeling PNL. None of the treatments inhibited cell proliferation in PNL. TB and TB+VA-treated rats, but not VA-treated rats, exhibited higher levels of H3K9 acetylation and p21 protein expression. TB and VA-treated rats exhibited increased hepatic concentrations of butyric acid and retinoids, respectively. Compared to normal rats, diethylnitrosamine control animals exhibited lower retinyl palmitate hepatic concentrations. All groups had similar expression levels and exhibited similar unmethylated CRBP-I promoter region in microdissected pPNL, indicating that epigenetic silencing of this gene was not involved in alteration of retinol metabolism in early hepatocarcinogenesis. Data support the effectiveness of TB as a dietary histone deacetylase inhibitor during the promotion phase of hepatocarcinogenesis, which should be considered for chemoprevention combination strategies.

Caracterização funcional das isoformas de splicing do gene ADAM23 / Functional characterization of ADAM23 gene splicing isoforms

A ADAM23 é uma glicoproteína transmembrana pertencente à família ADAM (A Disintegrin and Metalloprotease) que apresenta a estrutura protéica típica dos membros desta família, mas não possui atividade de metaloprotease. O gene ADAM23 apresenta três isoformas de splicing, α, ß e γ, que codificam proteínas com porções C-terminais distintas. As isoformas α e ß codificam proteínas com domínios transmembranas diferentes, enquanto γ provavelmente consiste em uma isoforma secretada ou citoplasmática de ADAM23. Foi demonstrado que o gene ADAM23 está epigeneticamente silenciado em tumores de mama de estágios mais avançados e que seu silenciamento está associado a um maior risco de desenvolvimento de metástases e a um pior prognóstico. Recentemente, foi descrito que a proteína ADAM23 interage diretamente com a integrina αVß3 na linhagem tumoral de mama MDA-MB-435, sendo capaz de modular seu estado conformacional, controlando sua ativação. Utilizando RNAi, observou-se que o silenciamento completo do gene ADAM23 (i.e., as três isoformas) aumenta os níveis de αVß3 em conformação ativa na superfície das células MDA-MB-435, promovendo um incremento de sua capacidade migratória e adesiva. No presente trabalho, avaliamos por reações de amplificação em tempo real o perfil de expressão das três isoformas de splicing do gene ADAM23 em cinco tecidos normais (mama, cólon, cérebro, próstata e pâncreas) e em doze linhagens tumorais derivadas destes tecidos. Observamos diferenças nos níveis de expressão das isoformas em todas as amostras avaliadas, tanto dentro de uma determinada amostra, como quando comparamos tecidos normais entre si ou com linhagens tumorais. A isoforma γ é a mais expressa em todos os tecidos normais (exceto em cérebro) e em todas as linhagens tumorais. Em tecido normal de mama e de próstata e nas doze linhagens tumorais, ADAM23α é a segunda isoforma mais expressa, sendo ß a menos expressa. Constatamos também que a fração representada por cada isoforma, em relação à expressão total do gene ADAM23, está alterada nas linhagens tumorais, em comparação aos tecidos normais correspondentes. Com o intuito de elucidar a função das isoformas de ADAM23 separadamente, utilizamos shRNAs (short hairpin RNAs) para reduzir a expressão de cada isoforma de modo individual e específico na linhagem tumoral MDA-MB-435, e avaliamos seu efeito na proliferação, na morfologia, na adesão e no espraiamento celular. Verificamos que a redução da expressão da isoforma γ aumentou significativamente a taxa de proliferação das células MDA-MB-435 cultivadas em modelo tridimensional. Demonstramos também que ADAM23γ participa da regulação da morfologia e da capacidade de espraiamento das células MDA-MB-435 em condições padrão de cultivo (i.e., meio de cultura completo e placas não-sensibilizadas com substratos) e em componentes específicos da matriz extracelular, como fibronectina, colágeno I e matrigel. A isoforma α também está envolvida no controle da morfologia e do espraiamento da linhagem MDA-MB-435, porém, de modo distinto da isoforma γ. Já ADAM23ß não interfere na morfologia das células MDA-MB-435 e tem efeito marginal no espraiamento celular apenas em condições padrão de cultivo. Em conjunto, nossos resultados demonstram que as isoformas de ADAM23 são diferencialmente expressas em tecidos normais e tumorais, e exercem funções biológicas distintas

ADAM23 is a transmembrane glycoprotein that belongs to the ADAM (A Disintegrin and Metalloprotease) family of proteins and exhibits the typical protein structure of the family members, but it doesn't have metalloprotease activity. The ADAM23 gene has three splicing isoforms, α, ß and γ, that code for proteins with different C-terminal regions. Isoforms α and ß code for proteins with different transmembrane domains, while γ probably constitute a secreted or cytoplasmatic isoform of ADAM23. It has been demonstrated that the ADAM23 gene is epigenetically silenced in advanced stage breast tumors and that its silencing is associated with a higher risk of developing metastases and with a worse prognosis. Recently, it was described that ADAM23 protein interacts directly with αVß3 integrin in the breast tumor cell line MDA-MB-435, modulating its conformational state and controlling its activation. Using RNAi, it was observed that the complete silencing of ADAM23 gene (the three isoforms) raises the levels of αVß3 in its active conformation in the surface of MDA-MB-435 cells, promoting an increase in its migratory and adhesive capacity. In the present work, we evaluated by real time PCR the expression pattern of the three splicing isoforms of ADAM23 gene in five normal tissues (breast, colon, brain, prostate and pancreas) and in twelve tumor cell lines derived from these tissues. We observed differences in the expression levels of the three isoforms in all samples, either within a specific sample or comparing normal tissues among them or with tumor cell lines. Isoform γ has the highest expression in all normal tissues (except for brain) and in all tumor cell lines evaluated. In breast and prostate normal tissues and in all tumor cell lines, ADAM23α is the second most expressed isoform, while ß is the less expressed. We also noticed that the ratio represented by each isoform, relative to the total expression of ADAM23 gene, is altered in the tumor cell lines, compared to the corresponding normal tissues. With the aim to elucidate the function of ADAM23 isoforms separately, we used shRNAs (short hairpin RNAs) to reduce the expression of each isoform specifically in the MDA-MB-435 tumor cell line, and studied its effects in proliferation, morphology, adhesion and cell spreading. We observed that the reduced expression of isoform γ significantly increased the proliferation rate of MDA-MB-435 cells cultivated in tridimensional system. Also, we demonstrated that ADAM23γ participates in the regulation of cell morphology and spreading of MDA-MB-435 cells, both in standard culture conditions (cell culture media with fetal serum and in plates not sensitized with substrates) and in specific components of extracellular matrix, such as fibronectin, collagen type I and matrigel. Isoform α is also involved in the control of morphology and spreading of MDA-MB-435 cell line, although in a distinct manner from isoform γ. ADAM23ß doesn't interfere in the morphology of MDA-MB-435 cells and plays a discrete role in cell spreading only under standard culture conditions. Together, our results demonstrate that ADAM23 isoforms are differently expressed in normal and tumoral tissue, and play distinct biological roles

ADAM23 negatively modulates alpha(v)beta(3) integrin activation during metastasis.

The ADAM23 gene is frequently silenced in different types of tumors, and, in breast tumors, silencing is correlated with tumor progression, suggesting that it might be associated with the acquisition of a metastatic phenotype. ADAM23 exerts its function mainly through the disintegrin domain, because its metalloprotease domain is inactive. Analysis of ADAM23 binding to integrins has revealed a specific interaction with alpha(v)beta(3) integrin mediated by the disintegrin domain. Altered expression of alpha(v)beta(3) integrin has been observed in different types of tumors, and expression of this integrin in the activated form has been shown to promote metastasis formation. Here, we investigated the possibility that interaction between ADAM23 and alpha(v)beta(3) integrin might negatively modulate alpha(v)beta(3) activation during metastatic progression. ADAM23 expression was knocked down using short hairpin RNA in the MDA-MB-435 cell line, which has been extensively used as a model for alpha(v)beta(3) integrin activation. Ablation of ADAM23 enhanced alpha(v)beta(3) integrin activation by at least 2- to 4-fold and ADAM23 knockdown cells showed enhanced migration and adhesion to classic alpha(v)beta(3) integrin ligands. Ablation of ADAM23 expression also enhanced pulmonary tumor cell arrest in immunodeficient mice. To complement our findings with clinical evidence, we showed that silencing of ADAM23 gene by DNA promoter hypermethylation in a collection of 94 primary breast tumors was significantly associated with lower distant metastases-free and disease-specific survivals and was an independent prognostic factor for poor disease outcome. Our results strongly support a functional role of ADAM23 during metastatic progression by negatively modulating alpha(v)beta(3) integrin activation.

SATR-1 hypomethylation is a common and early event in breast cancer.

Genome stability and normal gene expression are maintained by a fixed and predetermined DNA methylation pattern, which becomes abnormal in malignant cells. Hypomethylation of satellite DNA sequences is frequently found in tumors and has been associated with an increased frequency of DNA rearrangements and chromosome instability. In this work, we used methylation-sensitive arbitrarily primed polymerase chain reaction (MSAP-PCR) to identify differentially methylated DNA fragments in normal and tumor breast samples. We identified a novel differentially methylated fragment located on chromosome 5 with high similarity to a SATR-1 satellite sequence. This fragment was found to be hypomethylated in 63% of breast tumor cell lines and in 86% of breast tumors relative to normal breast tissue. We found that normal tissue adjacent to breast tumors displayed a variable decrease in methylation and that the decrease observed for most of these adjacent samples was higher than observed for normal breast tissue derived from reduction mammoplasty. The methylation decrease was, however, significantly higher in tumor samples than in adjacent tissue (chi2= 154, 1 df, P < 10(-4)), suggesting that SATR-1 hypomethylation frequently occurs in the early stages of tumor development. Our results highlight the importance of global DNA hypomethylation as a contributing factor in breast tumorigenesis.