TTF-1 Research Articles

Analysis of molecular mechanisms of the development of experimental diabetes in Wistar rats under conditions of intermittent hypoxia

There is strong evidence that hypoxic training, within the context of diabetes, constitutes a specialized form of exercise performed under conditions of intermittent hypoxia. This approach holds promise for effectively managing and enhancing diabetes outcomes, as it has the potential to influence metabolism and physiological processes within the body significantly. The key elements of hypoxic training in diabetes encompass activities geared toward activating metabolic pathways, enhancing mitochondrial function, and regulating blood glucose levels. Such interventions can potentially lead to improvements in insulin resistance, a reduction in glycemia, and an overall enhancement of cardiorespiratory function. Hypoxic training achieves these benefits by heightening insulin sensitivity and reducing blood glucose levels, which can be particularly advantageous for individuals with diabetes. The aim of the work is to determine changes in the expression of genes associated with the course of diabetes under conditions of exposure to intermittent hypoxia in pancreatic tissue samples of Wistar rats. Materials and methods. Analysis of gene expression was used by the polymerase chain reaction method with reverse transcription in real-time using the RT2 Profiler™ PCR Array Rat Diabetes kit (QIAGEN, Germany), where the pancreas of experimental animals was studied. Results. According to the results of the PCR study of animals with experimental diabetes and the influence of hypoxic training on its course, the activity of the studied genes can be divided as follows: genes with low expression compared to the control group of animals, where ∆∆Cт <30 (Ace; Cd28; Ctla4; Dusp4 ; Enpp1; Foxp3; G6pc; Gcgr; Glp1r; Gpd1; Gsk3b; Hmox1; Ide; Ikbkb; Il10; Il6; Ins1; Nfkb1; Nkx2-1; Parp1; Pdx1; Pik3cd; Pik3r1; Ppargc1a; Ptpn1; Rab4a; Retn; Slc14a2 ; Snap25; Sod2; Stx4; Stxbp1; Stxbp2; Tnf; Tnfrsf1a; Tnfrsf1b; Ucp2; Vamp2; Vegfa); genes in which no significant changes were detected in the samples in relation to the control group (Acly; Adra1a; Adrb3; Agt; Akt2; Aqp2; Ccl5; Ccr2; Ceacam1; Cebpa; Dpp4; Fbp1; Foxc2; Foxg1; Gcg; Gck; Hnf1b; Hnf4a ; Icam1; Ifng; Igfbp5; Il12b; Il4r; Inppl1; Irs1; Irs2; Mapk14; Mapk8; Neurod1; Nos3; Nrf1; Nsf; Ppara; Pparg; Pygl; Sell; Serpine1; Slc2a4; Snap23; Srebf1; Stxbp4; Tgfb1; Trib3 ; Vamp3; Vapa); there are no genes with high expression compared to the control group. Conclusions. The Nkx2-1 genes, Pik3r1, and Slc14a2 in rats subjected to experimental diabetes displayed notably reduced protein expression activity. Hypoxic training demonstrated an impact on mitigating the expression of the Nkx2-1 protein, which suggests that it might affect the mitochondrial muscle respiratory chain, modulate insulin signaling, and potentially rectify molecular deficiencies associated with diabetic nephropathy. Expression of Dpp4 genes, Gck, Ifng, Mapk8, Nsf and Sell in rats with experimental diabetes and the effect of hypoxic training on it were reduced to the level of control (intact) rats. As a result of the normalization of Dpp4 gene expression, Gck, Ifng, Mapk8, Nsf and Sell may be the influence of the effects of hypoxic training on molecular mechanisms of regulation of hormones and signals related to metabolism and the endocrine system, effects on the immune system and inflammatory processes, as well as insulin resistance.

The lncRNA Sweetheart regulates compensatory cardiac hypertrophy after myocardial injury in murine males

After myocardial infarction in the adult heart the remaining, non-infarcted tissue adapts to compensate the loss of functional tissue. This adaptation requires changes in gene expression networks, which are mostly controlled by transcription regulating proteins. Long non-coding transcripts (lncRNAs) are taking part in fine-tuning such gene programs. We describe and characterize the cardiomyocyte specific lncRNA Sweetheart RNA (Swhtr), an approximately 10 kb long transcript divergently expressed from the cardiac core transcription factor coding gene Nkx2-5. We show that Swhtr is dispensable for normal heart development and function but becomes essential for the tissue adaptation process after myocardial infarction in murine males. Re-expressing Swhtr from an exogenous locus rescues the Swhtr null phenotype. Genes that depend on Swhtr after cardiac stress are significantly occupied and therefore most likely regulated by NKX2-5. The Swhtr transcript interacts with NKX2-5 and disperses upon hypoxic stress in cardiomyocytes, indicating an auxiliary role of Swhtr for NKX2-5 function in tissue adaptation after myocardial injury.

Localized pleural mesothelioma in a dog

Malignant mesotheliomas with localized growth are extremely rare in dogs. A 9-year-old male dog presented with a localized tumour that originated from the parietal pleura and had polypoid growth in the thoracic cavity. Histological examination revealed that the tumour consisted of tubular formations with scattered cysts and minimal papillary growth pattern. Neoplastic cells were immunopositive for mesothelial markers (calretinin and Wilms' tumour gene 1) and negative for carcinoma markers (thyroid transcription factor 1 and tumour protein 63). The animal was alive with no recurrence or metastasis/dissemination 11 months after surgery. To the best of our knowledge, this is the first report of a localized mesothelioma in a dog without metastasis/dissemination and highlights the value of mesothelial markers for an accurate diagnosis.

Deep-learning-based cross-modality translation from Stokes image to bright-field contrast.

Mueller matrix (MM) microscopy has proven to be a powerful tool for probing microstructural characteristics of biological samples down to subwavelength scale. However, in clinical practice, doctors usually rely on bright-field microscopy images of stained tissue slides to identify characteristic features of specific diseases and make accurate diagnosis. Cross-modality translation based on polarization imaging helps to improve the efficiency and stability in analyzing sample properties from different modalities for pathologists. In this work, we propose a computational image translation technique based on deep learning to enable bright-field microscopy contrast using snapshot Stokes images of stained pathological tissue slides. Taking Stokes images as input instead of MM images allows the translated bright-field images to be unaffected by variations of light source and samples. We adopted CycleGAN as the translation model to avoid requirements on co-registered image pairs in the training. This method can generate images that are equivalent to the bright-field images with different staining styles on the same region. Pathological slices of liver and breast tissues with hematoxylin and eosin staining and lung tissues with two types of immunohistochemistry staining, i.e., thyroid transcription factor-1 and Ki-67, were used to demonstrate the effectiveness of our method. The output results were evaluated by four image quality assessment methods. By comparing the cross-modality translation performance with MM images, we found that the Stokes images, with the advantages of faster acquisition and independence from light intensity and image registration, can be well translated to bright-field images.

Perfluorooctanoic acid disrupts thyroid-specific genes expression and regulation via the TSH-TSHR signaling pathway in thyroid cells

Perfluorooctanoic acid (PFOA) is a highly persistent and widespread chemical in the environment with endocrine disruption effects. Although it has been reported that PFOA can affect multiple aspects of thyroid function, the exact mechanism by which it reduces thyroxine levels has not yet been elucidated. In this study, FRTL-5 rat thyroid follicular cells were used as a model to study the toxicity of PFOA to the genes related to thyroid hormone synthesis and their regulatory network. Our results reveal that PFOA interfered with the phosphorylation of the cyclic adenosine monophosphate (cAMP)-response element binding protein (CREB) induced by thyroid-stimulating hormone (TSH), as well as the transcription levels of paired box 8 (PAX8), thyroid transcription factor 1 (TTF1), sodium/iodide cotransporter (NIS), thyroglobulin (TG), and thyroid peroxidase (TPO). However, the above outcomes can be alleviated by enhancing cAMP production with forskolin treatment. Further investigations showed that PFOA reduced the mRNA level of TSH receptor (TSHR) and impaired its N-glycosylation, suggesting that PFOA has disrupting effects on both transcriptional regulation and post-translational regulation. In addition, PFOA increased endoplasmic reticulum (ER) stress and decreased ER mass in FRTL-5 cells. Based on these findings, it can be inferred that PFOA disrupts the TSH-activated cAMP signaling pathway by inhibiting TSHR expression and its N-glycosylation. We propose that this mechanism may contribute to the decrease in thyroid hormone levels caused by PFOA. Our study sheds light on the molecular mechanism by which PFOA can disrupt thyroid function and provides new insights and potential targets for interventions to counteract the disruptive effects of PFOA.

THU540 Cribriform Morular Thyroid Carcinoma In A Young Female With Prior Exposure To Whole-Body Radiation For Metastatic Wilms’ Tumor

Abstract Disclosure: D. Caesario: None. M.S. Richardson: None. D. Carneiro-Pla: None. J.K. Fernandes: None. Introduction: Cribriform morular thyroid carcinoma (CMTC) is a rare thyroid cancer that is classically associated with familial adenomatous polyposis (FAP), but can also occur sporadically. We report a case of CMTC in a young female with history of whole-body radiation therapy (WBRT). Case Report: A 19-year-old female with past medical history of Wilms’ tumor (WT) with lung metastasis status post left nephrectomy and WBRT at the age of 6 was seen for newly diagnosed thyroid nodules. Physical exam was remarkable for thyromegaly. Thyroid function tests were normal. Thyroid ultrasound revealed 2 dominant TI-RADS 4 nodules measuring 1.9 x 1.7 x 2.1 cm on the left lobe and 0.9 x 0.8 x 0.8 cm on the right lobe. No suspicious lymphadenopathy. Fine needle aspiration biopsy on both nodules showed findings consistent with papillary thyroid carcinoma (PTC). No family history of thyroid disorders, malignancies, or FAP. She underwent total thyroidectomy with central neck node sampling. Thyroid gland surgical pathology result revealed CMTC positive for thyroid transcription factor-1 (TTF-1), β-catenin, and cytokeratins 5 and 6. It was negative for calcitonin. There was no evidence of invasion, extension, or lymph node metastasis. Genetic tests are currently pending. Discussion: CMTC was previously considered a variant of PTC, accounting for 0.2 to 6% of PTC cases. However, recent observations have challenged this view, and latest WHO update reclassified it as a distinct form of thyroid cancer. It is associated with an indolent clinical course and good prognosis. It almost exclusively affects young women. Both familial and sporadic cases are associated with mutations in the adenomatous polyposis coli (APC) gene. The APC protein is a negative regulator that controls β-catenin concentrations, which is involved in cell adhesion. Mutations in the APC gene may result in FAP and colorectal cancers. In cases associated with FAP, the tumors are usually multifocal and/or bilateral, while sporadic cases usually appear as single nodule. Tumor cells are always positive for TTF-1 and negative for calcitonin. They can also be positive for multiple cytokeratins, but strong nuclear and cytoplasmic staining for β-catenin is the hallmark of this tumor type. The case above occurred in a young female with no significant family history, but who underwent WBRT for WT as a child. Radiation is a known predisposing factor for thyroid cancer, and limited studies on early exposure to radiation revealed higher incidence of sporadic CMTC. However, even among FAP associated cases, CMTC diagnosis preceded that of FAP in up to 40% of the cases. Additionally, up to 20% of WT cases have mutations of the WT1 gene, and among these, at least half also carry acquired somatic mutations in CTNNB1, the gene encoding β-catenin. So far, there has been no reported case of CMTC in the background of WT. It will be interesting to see if she has these underlying mutations. Presentation: Thursday, June 15, 2023

SAT550 Warthin-like Variant of Papillary Thyroid Carcinoma: An Even Rarer Presentation

Abstract Disclosure: J. Kunadia: None. S. Chablani: None. Introduction: We present a rare case of Warthin-like variant of papillary thyroid carcinoma (WLPTC) with later development of a second primary malignancy. Clinical Case: A 56 year old female with hypertension, hyperlipidemia, ulcerative colitis, asthma, and a strong family history of cancer presented in 2017 for evaluation of an enlarged thyroid gland noted by her primary care provider. Patient was asymptomatic and denied prior thyroid disease and head or neck radiation. Labs demonstrated normal TSH and free T4 levels. TPO antibodies were elevated to 1,155 IU/mL (reference range 0.0 – 5.5 IU/mL). Thyroid US was notable for a diffusely enlarged thyroid gland containing a 1.4 x 0.6 x 1.0 cm solid, hypoechoic nodule without calcifications in the upper pole of the right lobe. Shared decision-making resulted in a plan for continued surveillance. Repeat thyroid US in 2018 demonstrated that this nodule had increased in volume by 56.25%, now measuring 1.4 x 0.75 x 1.25 cm. Fine needle aspiration (FNA) biopsy was performed and positive for papillary thyroid carcinoma (PTC). Patient underwent total thyroidectomy; pathology revealed a 1.2 x 1 x 0.9 cm WLPTC and 0.2 cm papillary thyroid microcarcinoma. There was no evidence of extrathyroidal extension, angioinvasion, or lymph node involvement. Follow-up neck US in 2020 demonstrated a 0.4 cm hypoechoic ovoid structure in the left thyroid bed and an enlarged but morphologically normal-appearing right level II lymph node. Repeat neck US in 2021 showed the appearance of a new 2.8 cm right level II lymph node; FNA was positive for malignancy with negative thyroid transcription factor-1 staining and undetectable thyroglobulin. Patient underwent an excision biopsy of the lymph node, and pathology was consistent with metastatic adenoid cystic carcinoma (ACC). A right submandibular gland lesion detected on subsequent MRI head and neck was resected and confirmed to be the primary source of ACC. Patient was treated with adjuvant radiation therapy with adequate response to therapy. Conclusion: WLPTC is a rare subtype of PTC that accounts for 0.2-1.9% of cases and carries a strong association with Hashimoto’s thyroiditis. It is histologically characterized by papillary architecture, oncocytic changes, nuclear features of PTC, and dense lymphoplasmacytic infiltration of the papillary cores. WLPTC is considered to have a favorable prognosis given its low frequency of lymphovascular invasion and low recurrence risk. This case also highlights the importance of keeping a broad differential when evaluating new findings on neck US in patients with a history of thyroid cancer. Metastases to cervical lymph nodes most commonly occur from head and neck tumors. However, to date, only one other case of PTC with second primary malignancy of salivary ACC has been reported. Presentation Date: Saturday, June 17, 2023

Synchronous Bilateral Ovarian Mesonephric-like Adenocarcinomas with Separate Origins from High-Grade Mullerian Adenosarcoma and Endometriosis: Report of a Rare Case.

Mesonephric-like adenocarcinoma (MLA) of the ovary is a recently recognized, rare malignancy with aggressive clinical behavior, and is thought to originate from Mullerian epithelium with mesonephric transdifferentiation. Emerging evidence suggests that MLA may be classified as an endometriosis-associated neoplasm. The presence of a sarcomatous component within MLA is extremely rare, with common differential diagnoses including the spindle cell component of MLA, carcinosarcoma, as well as mixed Mullerian adenocarcinoma and adenosarcoma. Herein, we report a 58-year-old Chinese woman with bilateral ovarian solid-cystic masses. The left ovarian mass comprised a biphasic tumor with a predominantly high-grade sarcomatous component displaying heterologous mesenchymal differentiation, including liposarcoma, rhabdomyosarcoma and chondrosarcoma-like areas, with a null-type p53 expression. The epithelial component ranged from a bland appearance in areas diagnostic of adenosarcoma to a clearly invasive carcinoma, both with mesonephric-like phenotype, being negative for estrogen receptor, progesterone receptor, and Wilms' tumor 1, variably positive for paired box gene 8, GATA binding protein 3, and thyroid transcription factor 1, with a wild-type p53 expression. The differing p53 expression between the epithelial and sarcomatous elements mitigated against a diagnosis of carcinosarcoma. The right ovarian mass showed endometriosis with focal direct evidence of the development of malignancy within a benign endometriotic cyst, exhibiting the identical immunoprofile of MLA but originating as another malignancy. To the best of our knowledge, this case represents the first reported case of synchronous bilateral ovarian MLAs with separate origins, from high-grade Mullerian adenosarcoma and endometriosis respectively, which broadens the morphologic spectrum of MLA and provides further evidence supporting the Mullerian origin theory.

2225P FOX1 (rs965513), NKX2-1 (rs944289) and BRAF (V600E) gene mutations and their role in development of papillary thyroid cancer

2225P FOX1 (rs965513), NKX2-1 (rs944289) and BRAF (V600E) gene mutations and their role in development of papillary thyroid cancer

Thyroid transcription factor‐1 expression in lung neuroendocrine tumours: a gender-related biomarker?

PurposeThyroid transcription factor‐1 (TTF‐1) assessed by immunohistochemistry (IHC) is a specific biomarker for lung adenocarcinoma, and is commonly used to confirm the pulmonary origin of neuroendocrine tumours (NET). The majority of the available data suggest that TTF-1 is favourable prognostic biomarker for lung adenocarcinomas, whereas its role is more conflicting for lung NET. The main aim of this multicenter retrospective study was to investigate the potentially relevant associations between TTF-1 biomarker and clinical and pathological features of the study population, as well as determine TTF-1 prognostic effect on the clinical outcome of the patients.MethodsA multicentre retrospective study was conducted on 155 surgically-removed lung NET, with available IHC TTF-1 assessment.ResultsMedian age was 59.5 years (range 13–86), 97 patients (62.6%) were females, 31 cases (20%) were atypical carcinoids, 4 (2.6%) had TNM stage IV. Mitotic count ≥2 per 10 high-power field was found in 35 (22.6%) subjects, whereas necrosis was detected in 20 patients (12.9%). TTF-1 was positive in 78 cases (50.3%). The median overall survival was 46.9 months (range 0.6–323) and the median progression-free survival was 39.1 months (range 0.6–323). Statistically significant associations were found between (1) TTF-1 positivity and female sex (p = 0.007); and among (2) TTF-1 positivity and the absence of necrosis (p = 0.018).ConclusionsThis study highlights that TTF-1 positivity differs according to sex in lung NET, with a more common TTF-1 positive staining in female. Moreover, TTF-1 positivity correlated with the absence of necrosis. These data suggest that TTF-1 could potentially represent a gender-related biomarker for lung NET.

Immunoreactivity of TTF-1, GATA-3, CEA, and p16/Ki67 cocktail in Cellprep®-processed control samples: Comparison of long-term storage in vials and slides.

Cellprep® (CP) is a novel liquid-based cytology (LBC) system. This study aimed to assess the immunoreactivity of control samples stored long-term under two storage conditions using CP. The immunoreactivity in control samples was evaluated under two sample storage conditions: CP vial storage at room temperature (RT: 20-25°C) and CP slide storage in a refrigerator (2-6°C). Clinical samples as controls (total: positive/negative) were immunostained using thyroid transcription factor-1 (TTF-1) (20: 14/6), GATA binding protein 3 (GATA-3) (13: 10/3), carcinoembryonic antigen (CEA) (23: 15/8), and the p16/Ki67 cocktail (20: 12/8) markers. The first immunocytochemistry (ICC) was performed within 1 month using CP vials stored at RT. Samples stored in CP vials and on CP slides were used for the second (within 3-6 months) and third (within 6-11 months) ICCs. Compared with the first ICC, the concordance of immunoreactivity for the second and third ICCs was evaluated using the weighted kappa coefficient. For TTF-1, CEA, and the p16/Ki67 cocktail markers, ICC controls had stable immunoreactivity for a minimum of 6 months when samples were stored in CP vials (kappa coefficients >0.8), whereas for GATA-3, they were for 3 months. On CP slides, only for the p16/Ki67 cocktail, ICC controls had stable immunoreactivity for at least 3 months (kappa coefficient >0.8). Clinical samples as ICC controls revealed consistently more stable immunoreactivity in CP vials than on CP slides for TTF-1, GATA-3, CEA, and the p16/Ki67 cocktail markers.

Intracranial dissemination in a primary small cell carcinoma of the brain: a case report and literature review.

Primary intracranial small cell carcinoma (SCC) is extremely rare with only 8 previously reported cases. We describe a case of primary intracranial SCC with intracranial metastasis. A 46-year-old man presented with decreased vision and a red and swollen left eye. Brain magnetic resonance imaging (MRI) revealed a heterogeneously enhanced tumor on the left frontal lobe. Preoperative systemic computed tomography (CT), MRI, and positron emission tomography (PET)-CT revealed no extracranial tumors. The tumor on the left frontal lobe was excised. Immunohistochemical staining on the excision showed positivity for CD56, synaptophysin (Syn), cytokeratin (CK), and Ki-67 (30%), and negativity for thyroid transcriptional factor-1 (TTF-1), glial fibrillary acidic protein (GFAP), B-cell lymphoma 6 (Bcl-6), multiple myeloma oncogene 1 (MUM-1), C-Myc, Vimentin, P40, P53, CK7, CD3, CD5, CD20, CD79a, CD10, and CD23. The pathological examination strongly suggested that the tumor was a primary intracranial SCC. One year after the surgery, the patient was readmitted with slurred speech and slow movements. Three well-defined tumors were found in the left upper frontal lobe by brain MRI. Tumor resection was then performed. Further immunohistochemical examination of the excised tissue displayed the same pattern as previously, indicating the recurrence of intracranial SCC in the left frontal lobe. The patient received adjuvant chemotherapy and radiotherapy after the tumor resection. At the 2-year follow-up, he remained asymptomatic.

Thyroid transcription factor-1 (TTF-1) expression and the efficacy of combination therapy with immune checkpoint inhibitors and cytotoxic chemotherapy in non-squamous non-small cell lung cancer.

Thyroid transcription factor-1 (TTF-1) is expressed in approximately 70% of lung adenocarcinomas and is one of the most reliable makers to distinguish primary lung adenocarcinoma from metastatic disease. TTF-1-negative status is a poor prognostic factor, and TTF-1-negative lung adenocarcinoma is associated with poor efficacy of immune checkpoint inhibitor (ICI) monotherapy. However, the relationship between TTF-1 expression and the efficacy of ICI plus chemotherapy is still unclear. We performed a retrospective analysis of 129 consecutive patients with advanced non-squamous non-small cell lung cancer (NS-NSCLC) treated with ICI monotherapy or ICI plus chemotherapy between January 2016 and December 2021. The expression of programmed death ligand-1 (PD-L1) and TTF-1 was also determined in cases for which no previous data were available. We then evaluated the association between TTF-1 expression status and treatment efficacy. Of the 129 cases, 33 were TTF-1-negative and 96 were positive. In the ICI monotherapy group (N=70), progression-free survival (PFS) was not significantly different between TTF-1-positive and negative patients (median 3.6 vs. 3.8 months, P=0.27); however, in patients with wild-type epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), a trend for worse PFS was observed in TTF-1-negative cases compared with those that were TTF-1-positive (median 3.8 vs. 4.5 months, P=0.088). Moreover, long-term efficacy of ICI monotherapy (>2 years) was not observed in the TTF-1-negative group. TTF-1-negative patients tended to have worse overall survival (OS) than TTF-1-positive patients (median 15.6 vs. 19.5 months, P=0.13). In the ICI plus chemotherapy group (N=59), TTF-1-negative patients tended to have better PFS and similar OS compared with TTF-1-positive patients (median 9.9 vs. 9.6 months, P=0.14; median 32.3 vs. 18.9 months, P=0.78). Long-term efficacy was generally observed in TTF-1-negative patients treated with atezolizumab plus bevacizumab plus carboplatin plus paclitaxel (ABCP) (median PFS 22.5 months, median OS not reached). ICI monotherapy is generally less efficacious in TTF-1-negative NS-NSCLC patients, and clinicians should consider ICI plus chemotherapy in these cases. Our study suggests that ABCP is an optimal regimen for TTF-1-negative NS-NSCLC.

Gastric Metastasis from Primary Lung Adenocarcinoma: A Case Report

<p>原發性肺癌是臨床上常見的癌症，目前研究對於肺癌的診斷、臨床及病理表現、治療等等日新月異。然而，原發性肺癌合併腸胃道轉移的個案則是相當罕見，因為其常以無症狀或非特異性症狀表現，在臨床上容易被忽略或誤診。原發性肺癌合併胃部轉移與原發性胃癌在組織學的表現十分相似，需要依靠免疫組織化學染色（包含腫瘤細胞角蛋白7 (CK7)、甲狀腺轉錄因子-1 (TTF-1)、腫瘤細胞角蛋白20 (CK20)）協助鑑別診斷。此篇病例報告呈現一位原發性肺癌合併胃部轉移的個案，臨床表現包含長久的消化不良以及體重減輕，在追蹤期間被診斷為化療造成的不適，最後經免疫組織化學染色確診為原發性肺癌合併胃部轉移。</p> <p> </p><p>Primary lung cancer is very common and fatal. However, cases of primary lung cancer with gastrointestinal metastases are relatively rare. We present a case of gastric metastasis from primary lung adenocarcinoma with clinical manifestations including dyspepsia and weight loss. The patient was initially thought to undergo chemotherapy-induced side effects but later diagnosed as gastric metastasis from primary lung cancer (GMLC) through special immunohistochemical staining of tissue for thyroid transcription factor-1 (TTF-1) and cytokeratin-7 (CK-7). Since the gastrointestinal (GI) tract remains a rare site of metastasis of primary lung cancer, GMLC is primarily described in case series. The incidence is considered underestimated, and the main reason is that it mostly presents with asymptomatic and nonspecific symptoms which sometimes may be regarded as the side effects of chemotherapy, hence misidentified as primary gastric cancer. Complications such as acute gastric bleeding and gastric perforation occur in patients with gastric metastasis and may result in death in severe cases. The presentation of gastric metastasis is difficult to differentiate from primary gastric cancer under endoscopy, leading to misdiagnosis and inadequate treatment. As the histological appearance of primary lung cancer with gastric metastasis is highly similar to that of primary gastric cancer, immunohistochemistry (IHC) staining is needed to assist in differential diagnosis.</p> <p> </p>

Modeling a variant of unknown significance in the Drosophila ortholog of the human cardiogenic gene NKX2.5.

Sequencing of human genome samples has unearthed genetic variants for which functional testing is necessary to validate their clinical significance. We used the Drosophila system to analyze a variant of unknown significance in the human congenital heart disease gene NKX2.5 (also known as NKX2-5). We generated an R321N allele of the NKX2.5 ortholog tinman (tin) to model a human K158N variant and tested its function in vitro and in vivo. The R321N Tin isoform bound poorly to DNA in vitro and was deficient in activating a Tin-dependent enhancer in tissue culture. Mutant Tin also showed a significantly reduced interaction with a Drosophila T-box cardiac factor named Dorsocross1. We generated a tinR321N allele using CRISPR/Cas9, for which homozygotes were viable and had normal heart specification, but showed defects in the differentiation of the adult heart that were exacerbated by further loss of tin function. We propose that the human K158N variant is pathogenic through causing a deficiency in DNA binding and a reduced ability to interact with a cardiac co-factor, and that cardiac defects might arise later in development or adult life.

The Warthin-like variant of papillary thyroid carcinomas: a clinicopathologic analysis report of two cases

Abstract Obejectives Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma, comparising various subtypes including classical PTC (accounting for approximately 55–65 % of cases) and several variants. The identified variants include papillary microcarcinoma, encapsulated variant, follicular variant, diffuse sclerosing variant, tall cell variant, columnar cell variant, cribriform-morular variant, and Warthin-like variant (WLV-PTC). WLV-PTC is a rare malignant neoplasm. Case presentation The present study introduced two cases of WLV-PTC from Affiliated Hospital of Chengde Medical College in retrospect. The macroscopic characteristics, histological feature, immunophenotyping, gene mutations, local invasion, and distant metastasis of the tumors were observed, and the relevant literature on WLV-PTC was reviewed. The tumor cells exhibited nuclear the characteristics similar to those of classic papillary thyroid carcinoma. Immunohistochemical analysis showed strong positivity for thyroid transcription factor 1, cytokeratin 19, Galectin-3, and CK, weak positivity for thyroglobulin, and the Ki-67 proliferation index ranging from 5 to 10 %. Gene mutation analysis revealed that Case 1 had a BRAF V600E mutation, whereas Case 2 had a wild-type mutation. WLV-PTC has histological features similar to those of Warthin tumor originating from salivary gland. Conclusions The prognosis of WLV-PTC is similar to that of conventional PTC of comparable size and stage.

Multifunctional Silk Fibroin/Carbon Nanofiber Scaffolds for In Vitro Cardiomyogenic Differentiation of Induced Pluripotent Stem Cells and Energy Harvesting from Simulated Cardiac Motion.

In this proof-of-concept study, cardiomyogenic differentiation of induced pluripotent stem cells (iPSCs) is combined with energy harvesting from simulated cardiac motion in vitro. To achieve this, silk fibroin (SF)-based porous scaffolds are designed to mimic the mechanical and physical properties of cardiac tissue and used as triboelectric nanogenerator (TENG) electrodes. The load-carrying mechanism, β-sheet content, degradation characteristics, and iPSC interactions of the scaffolds are observed to be interrelated and regulated by their pore architecture. The SF scaffolds with a pore size of 379 ± 34 μm, a porosity of 79 ± 1%, and a pore interconnectivity of 67 ± 1% upregulated the expression of cardiac-specific gene markers TNNT2 and NKX2.5 from iPSCs. Incorporating carbon nanofibers (CNFs) enhances the elastic modulus of the scaffolds to 45 ± 3 kPa and results in an electrical conductivity of 0.021 ± 0.006 S/cm. The SF and SF/CNF scaffolds are used as conjugate TENG electrodes and generate a maximum power output of 0.37 × 10-3 mW/m2, with an open-circuit voltage and a short circuit current of 0.46 V and 4.5 nA, respectively, under simulated cardiac motion. A novel approach is demonstrated for fabricating scaffold-based cardiac patches that can serve as tissue scaffolds and simultaneously allow energy harvesting.

Knockout of the Cardiac Transcription Factor NKX2-5 Results in Stem Cell-Derived Cardiac Cells with Typical Purkinje Cell-like Signal Transduction and Extracellular Matrix Formation.

The human heart controls blood flow, and therewith enables the adequate supply of oxygen and nutrients to the body. The correct function of the heart is coordinated by the interplay of different cardiac cell types. Thereby, one can distinguish between cells of the working myocardium, the pace-making cells in the sinoatrial node (SAN) and the conduction system cells in the AV-node, the His-bundle or the Purkinje fibres. Tissue-engineering approaches aim to generate hiPSC-derived cardiac tissues for disease modelling and therapeutic usage with a significant improvement in the differentiation quality of myocardium and pace-making cells. The differentiation of cells with cardiac conduction system properties is still challenging, and the produced cell mass and quality is poor. Here, we describe the generation of cardiac cells with properties of the cardiac conduction system, called conduction system-like cells (CSLC). As a primary approach, we introduced a CrispR-Cas9-directed knockout of the NKX2-5 gene in hiPSC. NKX2-5-deficient hiPSC showed altered connexin expression patterns characteristic for the cardiac conduction system with strong connexin 40 and connexin 43 expression and suppressed connexin 45 expression. Application of differentiation protocols for ventricular- or SAN-like cells could not reverse this connexin expression pattern, indicating a stable regulation by NKX2-5 on connexin expression. The contraction behaviour of the hiPSC-derived CSLCs was compared to hiPSC-derived ventricular- and SAN-like cells. We found that the contraction speed of CSLCs resembled the expected contraction rate of human conduction system cells. Overall contraction was reduced in differentiated cells derived from NKX2-5 knockout hiPSC. Comparative transcriptomic data suggest a specification of the cardiac subtype of CSLC that is distinctly different from ventricular or pacemaker-like cells with reduced myocardial gene expression and enhanced extracellular matrix formation for improved electrical insulation. In summary, knockout of NKX2-5 in hiPSC leads to enhanced differentiation of cells with cardiac conduction system features, including connexin expression and contraction behaviour.

Histological and immunohistochemical features of carcinomas with pulmonary involvement in cattle.

Primary pulmonary neoplasms in cattle are rare. There are few studies on the pathological findings of these neoplasms in this species. This study aimed to describe the histological and immunohistochemical findings of primary and metastatic pulmonary carcinomas in cattle. We conducted a retrospective study of 19 cases of epithelial neoplasms with pulmonary involvement. Histologically, most of the neoplasms were classified as primary pulmonary neoplasms, including different adenocarcinoma subtypes (4/19, 21%) and adenosquamous carcinomas (3/19, 16%), followed by squamous cell carcinoma (6/19, 32%), metastatic uterine adenocarcinoma (4/19, 21%), metastatic hepatocellular carcinoma (1/19, 5%), and metastatic cholangiocarcinoma (1/19, 5%). By immunohistochemistry, all neoplasms were positive for pancytokeratin, and 4/19 (21%) were positive for vimentin. Primary pulmonary neoplasms had immunoreactivity for thyroid transcription factor-1 (6/7), while only 2 of these cases were positive for napsin A. All cases with squamous differentiation (9/9) had immunoreactivity for cytokeratin (CK) 5/6, while only 7 of these cases were positive for p40. CK20, CK7, and CK8/18 showed varied immunoreactivity in the primary and metastatic pulmonary carcinomas but were important markers to confirm the diagnosis of primary mucinous adenocarcinoma and metastatic cholangiocarcinoma. HepPar-1 was only positive in the metastatic hepatocellular carcinoma. The limited number of cases of metastatic uterine adenocarcinomas in this study precluded identification of a specific immunophenotype for this tumor. Immunohistochemistry proved to be an important tool to confirm the proper classification of these neoplasms.

Thyroid transcription factor 1 (TTF-1) negativity as a predictor of unfavorable response to EGFR-TKI therapy in advanced lung adenocarcinoma patients with EGFR mutations.

The absence of thyroid transcription factor 1 (TTF-1) is associated with a lower frequency of epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma (LUAD). The aim of this study was to assess the impact of TTF-1 expression on the clinical response to EGFR-tyrosine kinase inhibitor (TKI) treatment in patients with advanced LUAD. The data of patients with advanced LUAD who were admitted to the Beijing Tiantan Hospital and Peking University Cancer Hospital (China) between April 2009 and May 2023 was retrospectively analyzed. A total of 227 patients diagnosed with advanced LUAD were included, of which 28.2% (64/227) had TTF-1-negative adenocarcinoma, while 54.6% (124/227) harbored EGFR mutations. Negative TTF-1 expression significantly correlated with male sex (68.8% vs. 42.3%, p < 0.001), history of heavy smoking (57.8% vs. 36.2%, p = 0.003), poorly differentiated tumors (86.5% vs. 43.2%, p < 0.001), and lower frequency of EGFR mutations (26.6% vs. 65.6%, p < 0.001) compared with TTF-1 positivity. Multivariable logistic regression showed that low prevalence of EGFR mutations (p < 0.001) and male sex (p = 0.006) were independent predictive factors for the negative expression of TTF-1. Patients lacking TTF-1 also exhibited worse overall response rate (ORR; 23.5% vs. 54.2%, p = 0.019), disease control rate (DCR; 58.8% vs. 89.7%, p = 0.003), and median progression-free survival (PFS; 2.9 vs. 11.6 months, p < 0.001) following treatment with EGFR-TKIs compared to the TTF-1-positive patients with EGFR mutations. Patients with TTF-1-negative and EGFR-mutant LUAD show a diminished response to EGFR-TKIs.