Evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines

The potential clinical utility of genetic markers associated with response to fluoropyrimidine treatment in colorectal cancer patients remains controversial despite extensive study. Our aim was to test the clinical validity of both novel and previously identified markers of adverse events in a broad clinical setting. We have conducted an observational pharmacogenetic study of early adverse events in a cohort study of 254 colorectal cancer patients treated with 5-fluorouracil or capecitabine. Sixteen variants of nine key folate (pharmacodynamic) and drug metabolising (pharmacokinetic) enzymes have been analysed as individual markers and/or signatures of markers. We found a significant association between TYMP S471L (rs11479) and early dose modifications and/or severe adverse events (adjusted OR = 2.02 [1.03; 4.00], p = 0.042, adjusted OR = 2.70 [1.23; 5.92], p = 0.01 respectively). There was also a significant association between these phenotypes and a signature of DPYD mutations (Adjusted OR = 3.96 [1.17; 13.33], p = 0.03, adjusted OR = 6.76 [1.99; 22.96], p = 0.002 respectively). We did not identify any significant associations between the individual candidate pharmacodynamic markers and toxicity. If a predictive test for early adverse events analysed the TYMP and DPYD variants as a signature, the sensitivity would be 45.5 %, with a positive predictive value of just 33.9 % and thus poor clinical validity. Most studies to date have been under-powered to consider multiple pharmacokinetic and pharmacodynamic variants simultaneously but this and similar individualised data sets could be pooled in meta-analyses to resolve uncertainties about the potential clinical utility of these markers

Model Checking CTL is Almost Always Inherently Sequential

The model checking problem for CTL is known to be P-complete (Clarke, Emerson, and Sistla (1986), see Schnoebelen (2002)). We consider fragments of CTL obtained by restricting the use of temporal modalities or the use of negations---restrictions already studied for LTL by Sistla and Clarke (1985) and Markey (2004). For all these fragments, except for the trivial case without any temporal operator, we systematically prove model checking to be either inherently sequential (P-complete) or very efficiently parallelizable (LOGCFL-complete). For most fragments, however, model checking for CTL is already P-complete. Hence our results indicate that, in cases where the combined complexity is of relevance, approaching CTL model checking by parallelism cannot be expected to result in any significant speedup. We also completely determine the complexity of the model checking problem for all fragments of the extensions ECTL, CTL+, and ECTL+

Diffusion Processes on Small-World Networks with Distance-Dependent Random-Links

We considered diffusion-driven processes on small-world networks with distance-dependent random links. The study of diffusion on such networks is motivated by transport on randomly folded polymer chains, synchronization problems in task-completion networks, and gradient driven transport on networks. Changing the parameters of the distance-dependence, we found a rich phase diagram, with different transient and recurrent phases in the context of random walks on networks. We performed the calculations in two limiting cases: in the annealed case, where the rearrangement of the random links is fast, and in the quenched case, where the link rearrangement is slow compared to the motion of the random walker or the surface. It has been well-established that in a large class of interacting systems, adding an arbitrarily small density of, possibly long-range, quenched random links to a regular lattice interaction topology, will give rise to mean-field (or annealed) like behavior. In some cases, however, mean-field scaling breaks down, such as in diffusion or in the Edwards-Wilkinson process in "low-dimensional" small-world networks. This break-down can be understood by treating the random links perturbatively, where the mean-field (or annealed) prediction appears as the lowest-order term of a naive perturbation expansion. The asymptotic analytic results are also confirmed numerically by employing exact numerical diagonalization of the network Laplacian. Further, we construct a finite-size scaling framework for the relevant observables, capturing the cross-over behaviors in finite networks. This work provides a detailed account of the self-consistent-perturbative and renormalization approaches briefly introduced in two earlier short reports.Comment: 36 pages, 27 figures. Minor revisions in response to the referee's comments. Furthermore, some typos were fixed and new references were adde

On Second-Order Monadic Monoidal and Groupoidal Quantifiers

We study logics defined in terms of second-order monadic monoidal and groupoidal quantifiers. These are generalized quantifiers defined by monoid and groupoid word-problems, equivalently, by regular and context-free languages. We give a computational classification of the expressive power of these logics over strings with varying built-in predicates. In particular, we show that ATIME(n) can be logically characterized in terms of second-order monadic monoidal quantifiers

PML as a potential predictive factor of oxaliplatin/fluoropyrimidine-based first line chemotherapy efficacy in colorectal cancer patients

PML regulates a wide range of pathways involved in tumorigenesis, such as apoptosis, which is also one of the main mechanisms through which oxaliplatin and fluoropyrimidine exert their antineoplastic activity. The present study aims to investigate PML expression as a predictive factor of oxaliplatin/fluoropyrimidine therapy efficacy. EXPERIMENTAL DESIGN: 74 metastatic colorectal cancer patients who received oxaliplatin/floropyrimidine-based first line therapy have been included in this retrospective study. PML expression was assessed by immunohistochemistry. RESULTS: PML down-regulation was detected in 39 (52.7%) patients (14 complete and 25 partial PML loss). RR was significantly lower (25.6%) in patients with PML down-regulation than in patients with preserved PML expression (60%) (P\u2009=\u20090.006). Median TTP was 5.5 months when PML was down-regulated versus 11.9 months in case of preserved PML expression (P\u2009<\u20090.0001). A statistical significant difference was also detected in OS (15.6 and 24.5 months respectively, P\u2009=\u20090.003). The impact of PML down-regulation on TTP and OS was statistically significant also in a multivariate model. CONCLUSIONS: This study represents the first evidence of a possible correlation between PML protein expression and outcome of metastatic colorectal cancer patients treated with oxaliplatin/fluoropyrimidine-based first line therapy

High concordance of KRAS status between primary colorectal tumors and related metastatic sites: implications for clinical practice.

Purpose. Several studies have suggested that KRAS somatic mutations may predict resistance to cetuximab- and panitumumab-based treatments in metastatic colorectal cancer (CRC) patients. Nevertheless, most experiences were conducted on samples from primaries. The aim of this study was to evaluate the grade of concordance in terms of KRAS status between primaries and related metastases. Patients and Methods. We analyzed KRAS codon 12 and 13 mutations from formalin-fixed sections of 107 CRC primaries and related metastases. Eight pairs were excluded from the analysis because of the low amount of tumor tissue in the available samples. The main characteristics were: 50 men, 49 women; median age at diagnosis, 71 years (range, 41-84). The metastatic sites analyzed were the liver in 80 patients (80.8%), lung in seven patients (7.1%), and other sites in 12 patients (12.1%). Results. A KRAS mutation was found in 38 (38.4%) primary tumors and in 36 (36.4%) related metastases. The rate of concordance was 96.0% (95% confidence interval, 90.0%-98.9%). Discordance was observed in only four (4%) patients. Conclusions. Our results indicate that the detection of KRAS mutations in either primary or metastatic tumors from patients with CRC is concordant and this assessment could be used to predict response to targeted therapies such as cetuximab and panitumumab

Whole-exome sequencing in undiagnosed genetic diseases: interpreting 119 trios

Purpose: Despite the recognized clinical value of exome-based diagnostics, methods for comprehensive genomic interpretation remain immature. Diagnoses are based on known or presumed pathogenic variants in genes already associated with a similar phenotype. Here, we extend this paradigm by evaluating novel bioinformatics approaches to aid identification of new gene–disease associations. Methods: We analyzed 119 trios to identify both diagnostic genotypes in known genes and candidate genotypes in novel genes. We considered qualifying genotypes based on their population frequency and in silico predicted effects we also characterized the patterns of genotypes enriched among this collection of patients. Results: We obtained a genetic diagnosis for 29 (24%) of our patients. We showed that patients carried an excess of damaging de novo mutations in intolerant genes, particularly those shown to be essential in mice (P = 3.4 × 10−8). This enrichment is only partially explained by mutations found in known disease-causing genes. Conclusion: This work indicates that the application of appropriate bioinformatics analyses to clinical sequence data can also help implicate novel disease genes and suggest expanded phenotypes for known disease genes. These analyses further suggest that some cases resolved by whole-exome sequencing will have direct therapeutic implications

Colorado Native Plant Society Newsletter, Vol. 3 No. 4, July-August 1979

The Colorado Native Plant Society Newsletter will be published on a bimonthly basis. The contents will consist primarily of a calendar of events, notes of interest, editorials, listings of new members and conservation news. Until there is a Society journal, the Newsletter will include short articles also. The deadline for the Newsletter is one month prior to its release.https://epublications.regis.edu/aquilegia/1015/thumbnail.jp