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D L Page

Publications and source records attributed to D L Page.

At least 73 records · Page 4Linked to original sources

A cell-based immunobiosensor with engineered molecular recognition--Part II: Enzyme amplification systems.

Immune cells in vivo routinely perform highly selective immunosensing in blood and tissues as part of their normal immune surveillance functions. We have been investigating the potential of exploiting the immunosensing detection abilities of excitable immune cells (i.e. the mast cell) for the development of whole cell immunobiosensors. A key feature is that these immune cells can be selectively engineered to recognize specific antigens in vitro. In the presence of antigen, these cells undergo excitable activation responses which result in increased metabolism and the exocytosis of stored intracellular mediators. We have previously determined that mast cell metabolic responses can be thermally transduced in real time, thus indicating the possibility of whole cell thermoelectric immunobiosensing. In this work we investigated the use of enzyme amplification systems to enhance the direct transduction of immune cell responses to analyte. It was found that with appropriate enzymes, peak outputs occurred within approximately 5 min (4-20 times faster than without enzymes) and peak response magnitudes were up to nine-fold greater than without enzymes.

Amine Oxidase (Copper-Containing)↗

A cell-based immunobiosensor with engineered molecular recognition--Part III: Engineering molecular recognition.

We have been studying the feasibility of exploiting the recognition and amplification abilities of living immune cells for the development of hybrid immunosensors. Our group has previously reported that cell metabolic activation responses, induced by calcium ionophore A23187, can be directly transduced using calorimetric transducers, and that enzyme systems can be integrated to enhance sensing response time and output. In this study our goal was to determine the feasibility of transducing the thermal activation responses of mast cells molecularly engineered to a specific antigen. Rat peritoneal mast cells were sensitized to the model antigenic analyte dinitrophenylated-albumin (DNP-A), with monoclonal anti-DNP-A IgE, and challenged with antigen at final concentrations of 10 or 100 ng/ml. The addition of antigen resulted in the molecular triggering of cell activation, yielding thermal responses similar to those obtained previously with the ionophore model. A peak thermal response of 1.7 microW/5 x 10(5) cells was obtained within approximately 7 min of addition of antigen. The incorporation of selected amplification enzyme systems increased peak thermal outputs approximately three-fold, and reduced peak thermal response times to less than 3 min. A preliminary regression analysis of these data suggests a quantitative relationship exists between analyte concentration and peak thermal response (R = 0.988). These results support the feasibility and potential versatility of cell-based immunobiosensors for the selective detection and quantification of immunological analytes of interest.

Animals↗

Elevated levels of plasma triglycerides are associated with histologically defined premenopausal breast cancer risk.

Lipids and lipoproteins have been associated with breast cancer risk; however, published results have been inconsistent. To clarify these associations, we measured fasting lipids in women undergoing breast biopsies. A case-control study examined the association of fasting levels of lipids with histologically defined breast cancer risk. Four groups of premenopausal women were assembled on the basis of histological appearance of breast tissue: 1) no epithelial proliferation (n = 102), 2) proliferation without atypia (n = 53), 3) atypical hyperplasia or carcinoma in situ (n = 53), and 4) node-negative invasive cancer (n = 102). A postoperative fasting blood specimen was analyzed for cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Demographics, risk factors, diet, physical activity, fasting weight, and skin-fold thickness were measured. Triglyceride levels were significantly higher in women with node-negative invasive cancer (0.94 +/- 1.04 mg/ml) than in those with no epithelial proliferation (0.83 +/- 1.04 mg/ml, p = 0.03). This association persisted after adjustment for age, body size, lipids, reproductive and familial risk factors, and previous benign breast problems (p < 0.01), in keeping with an independent association of elevated triglycerides with breast cancer risk.

Adult↗

Pathology of preinvasive and excellent-prognosis breast cancer.

Our review of recent developments in breast cancer involving evaluation of cellular and tissue samples is targeted at indicators of elevated risk of sufficient magnitude to attain clinical significance; lesions unassociated with metastatic capacity but of sufficient risk to attain that capacity that formal treatment is necessary, ie, ductal carcinoma in situ; and indicators of good prognosis in invasive cancer. Ductal carcinoma in situ has been the subject of much recent discussion. We highlight particularly the area of stratification or classification within this group of lesions. The importance of the extensiveness of ductal carcinoma in situ in the prediction of local recurrence within the conserved breast is included. Also discussed are advances in diagnostic techniques, specifically core needle biopsies performed under mammographic and ultrasonographic guidance.

Breast Neoplasms↗

Pathology of mammographically discovered breast cancer. Clinical implications of size and histologic differentiation.

The management of breast cancer is becoming increasingly complex, almost year by year. Previous paradigms have held that issues were dichotomous (e.g., good versus bad). These are being challenged constantly by more complex models that demand more than a duality of choice in therapeutic decision making. Most importantly, the determinants of local failure after conservative treatment are quite different from the determinants of survival. While we develop enhanced chemotherapy for immediate life-threatening disease, we also accepting subtypes of breast cancer that are of little threat to life and need little treatment. With the establishment of the efficacy of systemic chemotherapy, the question of whether some patients may be helped with chemotherapy becomes extremely important. The list of possible clinically useful subcategories is growing and is under active development. However, the prognostic factors in use have been validated repeatedly. The two major elements of anatomic staging--size and lymph node status--interact powerfully with histologic categories of grade and special type. In the area of small tumors, these associations indicate lesions that have almost no likelihood of association with distant failure, at least within 5 years.

Axilla↗

Loss of heterozygosity and microsatellite instability in breast hyperplasia. No obligate correlation of these genetic alterations with subsequent malignancy.

Loss of heterozygosity and microsatellite instability have been often reported in breast cancer and seldom in proliferative breast disease (PBD). DNA samples from microdissected PBD lesions, including papillomas (25 lesions), from 8 women were analyzed by polymerase chain reaction for loss of heterozygosity and microsatellite instability at 10 loci including INT-2 oncogene locus, D17S796 (the p53 gene region), and D17S579 (in the region of the BRCA-1 gene). In a patient, five loci with microsatellite instability and two loci with loss of heterozygosity were identified in one papilloma with florid hyperplasia and atypia, and 10 other PBD lesions were negative for genetic alteration (GA) and atypia. Three loci with microsatellite instability were identified in another PBD lesion without atypia, whereas another lesion from this second patient had minimal atypia without GAs. These two patients have been well for more than 20 years. No other patient, including a woman developing cancer, had GAs. We detected GAs in PBD (25% of women, 8% of lesions). Incomplete correlation between GAs and anatomic atypia was suggested. It seems evident that several GAs in PBD lesions may not indicate clinically meaningful premalignancy for remaining breast.

Adolescent↗

Cytokeratins, CEA, and mucin histochemistry in the diagnosis and characterization of extramammary Paget's disease.

To identify a sensitive marker for extramammary Paget's disease and to identify histochemical and immunohistochemical features that suggest occult pelvic cancer in patients with extramammary Paget's disease, we retrieved all cases between 1983 and 1992 with a Standardized Nomenclature of Medicine code of extramammary Paget's disease in the Vanderbilt University Medical Center (Nashville, Tenn) surgical pathology archives. All were stained for alcian blue/dPAS (periodic acid-Schiff), mucicarmine, AE1/AE3, cytokeratin (CAM 5.2), cytokeratin (CK) 7, CK 20, carcinoembryonic antigen (CEA), orthokeratin, prostate-specific antigen, and S-100. Sixteen cases (2 men, 14 women) were retrieved. Two had pelvic malignancies: one rectal adenocarcinoma and one transitional carcinoma. Only CK7 marked all cases. Mucins were sensitive but focal, a potential problem in small biopsy specimens. The transitional tumor had a unique staining profile (CEA- and mucin-negative). CK20 strongly marked Paget cells associated with rectal cancer; its presence suggests a large bowel lesion but is not specific. No case expressed prostate-specific antigen; its presence in a man suggests prostatic carcinoma.

Adenocarcinoma↗

Prognostic indicators in breast cancer and who needs them.

In the prognosis of breast cancer, pathologists are facing a time of consolidation. Widely accepted guidelines have been gained only recently, with expectations that further developments are soon to come. Prognostic data influence systemic treatment decisions that are largely dependent on stage criteria of lymph nodes and tumor size as well as menopausal status. Some researchers propose that lymph node removal has no therapeutic consequences and may not be necessary if the majority of women are to be treated by chemotherapy. Some pathologists take this information as gospel for simplifying the management of a complex disease, whereas others take information available at different levels of certainty and set treatment threshold probabilities on an individual patient basis. With regard to invasive carcinoma and systemic therapy, I believe that combined histologic grade, including an emphasis on mitotic counts and other proliferation indicators, provides information at either end of the staging spectrum. Thus, high-grade, small tumors are likely to recur and low-grade, large tumors are unlikely to recur, at least within a 2- to 5-year period. Whether use of this information can be extended and verified for use in therapeutic decision making for neoadjuvant chemotherapy or various escalated chemotherapy regimens remains to be established. However, this use of prognostic indicators or predictors to indicate therapeutic responsiveness represents the field's immediate future. There are separate and important indicators of local treatment failure in the breast following conservation. It is likely that the extensiveness of DCIS is the major determinant of local recurrence and that its interaction with extensiveness, type of carcinoma in situ, and the branching ductal anatomy of the breast are of primary importance. Finally, the groups of conditions recognized as DCIS continue to provide a fertile field of questioning and discovery. Unassailable at the present time is the evidence that small, low-grade lesions may be treated effectively by planned wide local excision. Precise guidelines and further information are necessary from planned trials stratified by size and histologic criteria. Prognostic considerations have only become important in guiding treatment decisions in the past few decades. The escalating importance of prognostic categories derives from the availability of more varied treatment options, which have applications in the different clinical settings discussed in this chapter.

Breast↗

Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma.

BACKGROUND: Risk of breast cancer after biopsy demonstrating a papilloma has long been variously interpreted on the basis of histologic pattern of multiplicity of papillomas. METHODS: A nested case control study was performed on women with surgical breast biopsies evidencing papillomas; cases who subsequently developed invasive carcinoma were compared with controls who did not. Presence of atypical hyperplasia (AH) within the papilloma as well as areas of AH in the surrounding parenchyma were evaluated in both cases and controls. The entire cohort (not tested) was separately evaluated for all variables except for atypia within papillomas. RESULTS: The relative risk of invasive carcinoma for women with papillomas containing AH was > 4x that of papillomas without AH within or surrounding the papilloma. This risk may be greater with added atypical hyperplasia outside the papilloma and most strikingly, most of the subsequent invasive carcinomas developed in the same breast and probably near the site of the original papilloma. However, ordinary patterns of epithelial hyperplasia lacking specific features of AH within the papilloma do not add to the risk of subsequent carcinoma development over papillomas without hyperplasia. CONCLUSIONS: This study indicates that women having papillomas with AH have a similar or greater cancer risk than others with specifically defined patterns of atypical hyperplasia within the breast parenchyma (4-5x relative risk). Most importantly, this risk is largely local in the region of the original papilloma.

Adult↗

Hereditary breast cancer: pathobiology, prognosis, and BRCA1 and BRCA2 gene linkage.

BACKGROUND: The purpose of this investigation was to determine if there are pathobiologic differences between BRCA1-related and BRCA2-related hereditary breast cancer (HBC) and non-HBC. METHODS: On the basis of linkage to chromosomes 17q or 13q and/or the presence of ovarian and male breast cancer, HBC families were classified as either "BRCA1-related" (26 families, 90 breast cancer pathology cases) or "Other" (26 families, 85 cases), in which most BRCA2 cases were likely to reside. Cases were compared with 187 predominantly non-HBC cases. Tumors were assessed for histologic type, grade, and ploidy and S-phase fraction by quantitative DNA flow cytometry. Clinical presentation and available follow-up data were obtained. RESULTS: BRCA1-related and Other HBC patients each presented at lower stage (P = 0.003) and earlier age than non-HBC patients (mean, 42.8 years and 47.1 years vs. 62.9 years, P = 0.0001). Compared with non-HBC, invasive BRCA1-related HBC had a lower diploidy rate (13% vs. 35%; P = 0.002), lower mean aneuploid DNA index (1.53 vs. 1.73; P= 0.002), and strikingly higher proliferation rates (mitotic grade 3; odds ratio [OR]= 4.42; P= 0.001; aneuploid mean S-phase fraction 16.5% vs. 9.3%, P < 0.0001). Other HBC patients, including patients in two BRCA2- linked families, had more tubular-lobular group (TLG) carcinomas (OR = 2.56, P = 0.007). All trends were independent of age. A nonsignificant trend toward better crude survival in both HBC groups was age- and stage-dependent. Compared with Other HBC, BRCA1-related HBC patients had fewer recurrences (P = 0.013), a trend toward lower specific death rates, and fared no worse than breast cancer patients at large. Other HBC patients, despite neutral prognostic indicators, fared worse. CONCLUSIONS: BRCA1-related HBCs are more frequently aneuploid and have higher tumor cell proliferation rates compared with Other HBC. Despite these adverse prognostic features, BRCA1-related HBC patients have paradoxically lower recurrence rates than Other HBC patients. The excess of TLG cancers in the "Other" HBC group may be associated with BRCA2 linkage.

Adult↗

Acute inflammatory changes in subcutaneous microtumors in the ears of mice induced by intravenous CM101 (GBS toxin).

CM101, a bacterial polysaccharide derived from group B streptococcus, induces pronounced inflammatory changes in and around tumor blood vessels 60 min after i.v. injection. A technique has been developed for implanting small numbers of tumor cells in the ear skin of mice. This allows macroscopic examination of the tumor and its supporting blood vessels as it reaches the 10000 cell size and greater. Treatments can be monitored in this model for effects on small "metastatic-like" tumor nodules by direct observation and by histological examination. Inflammatory changes were indicated by increased numbers of polymorphonuclear leukocytes (PMN) adjacent to and marginating within thin-walled blood vessels and within the tumor tissue. PMN were seen in the process of migrating through venules and enlarged capillaries, each with prominent endothelial cells. Tumor morphology was variable with evidence of occasional single necrotic cells. This contrasted with tumors in ears of dextran-treated or untreated mice, which had uniform tumor morphology, and acute inflammatory cells were rarely present.

Acute Disease↗

Correlation of histomorphology of ovarian masses with color Doppler sonography.

This study correlates the color Doppler sonography (CDS) findings in ovarian masses according to histomorphologic groups. Sixty-two surgically excised ovarian masses (31 benign and 31 malignant) in patients who underwent CDS were retrospectively reviewed. Lowest pulsatility index (PI) was used in benign and malignant unilocular cysts, septated cysts, predominantly cystic masses with solid components, predominantly solid masses with cystic areas and solid masses. The mean of the lowest PIs of benign lesions (1.7 +/- 0.7) were statistically significantly different (p < 0.05) from malignancies (0.7 +/- 0.3). The group of septated cysts (1.8 +/- 0.5 vs. 0.61 +/- 0.3) and predominantly cystic masses with solid areas (1.1 +/- 0.1 vs. 0.6 +/- 0.2) achieved statistical significance for benign vs. malignant masses. Predominantly solid masses with cystic areas (1.8 +/- 0.5 vs. 0.8 +/- 0.2) and solid masses (1.4 +/- 1.0 vs. 0.7 +/- 0.3) were not statistically significantly different. Because of a limited number of cases, statistically significant differences in the mean of the lowest PIs of benign vs. malignant unilocular cysts (2.1 +/- 0.5 vs. 1.9) could not be determined. When analyzed according to histomorphology, CDS findings were of predictive value in certain morphologies and not as much in others. This fact should be taken into account when evaluating an ovarian mass for malignancy with CDS.

Adolescent↗

The woman at high risk for breast cancer. Importance of hyperplasia.

In summary, some histopathologically identifiable lesions within the human breast indicate later development of invasive breast cancer at an increased incidence over that of the general population. Many of these may be regarded as markers of increased risk because they are indicative of cancers presenting anywhere in either breast, whereas the noncomedo DCIS lesions are unique in indicating a high likelihood of invasive disease at the same site of detection of the initial high-risk lesion (Table 2).

Breast↗

BRCA1 is secreted and exhibits properties of a granin.

Germline mutations in BRCA1 are responsible for most cases of inherited breast and ovarian cancer. However, the function of the BRCA1 protein has remained elusive. We now show that BRCA1 encodes a 190-kD protein with sequence homology and biochemical analogy to the granin protein family. Interestingly, BRCA2 also includes a motif similar to the granin consensus at the C terminus of the protein. Both BRCA1 and the granins localize to secretory vesicles, are secreted by a regulated pathway, are post-translationally glycosylated and are responsive to hormones. As a regulated secretory protein, BRCA1 appears to function by a mechanism not previously described for tumour suppressor gene products.

Amino Acid Sequence↗