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Bioinformatics analysis quantifies neighborhood preferences of cancer cells in Hodgkin lymphoma
(2017)
Motivation Hodgkin lymphoma is a tumor of the lymphatic system and represents one of the most frequent lymphoma in the Western world. It is characterized by Hodgkin cells and Reed-Sternberg cells, which exhibit a broad morphological spectrum. The cells are visualized by immunohistochemical staining of tissue sections. In pathology, tissue images are mainly manually evaluated, relying on the expertise and experience of pathologists. Computational quantification methods become more and more essential to evaluate tissue images. In particular, the distribution of cancer cells is of great interest.
Results Here, we systematically quantified and investigated cancer cell properties and their spatial neighborhood relations by applying statistical analyses to whole slide images of Hodgkin lymphoma and lymphadenitis, which describes a non-cancerous inflammation of the lymph node. We differentiated cells by their morphology and studied the spatial neighborhood relation of more than 400,000 immunohistochemically stained cells. We found that, according to their morphological features, the cells exhibited significant preferences for and aversions to cells of specific profiles as nearest neighbor. We quantified differences between Hodgkin lymphoma and lymphadenitis concerning the neighborhood relations of cells and the sizes of cells. The approach can easily be applied to other cancer types.
In pathology, tissue images are evaluated using a light microscope, relying on the expertise and experience of pathologists. There is a great need for computational methods to quantify and standardize histological observations. Computational quantification methods become more and more essential to evaluate tissue images. In particular, the distribution of tumor cells and their microenvironment are of special interest. Here, we systematically investigated tumor cell properties and their spatial neighborhood relations by a new application of statistical analysis to whole slide images of Hodgkin lymphoma, a tumor arising in lymph nodes, and inflammation of lymph nodes called lymphadenitis. We considered properties of more than 400, 000 immunohistochemically stained, CD30-positive cells in 35 whole slide images of tissue sections from subtypes of the classical Hodgkin lymphoma, nodular sclerosis and mixed cellularity, as well as from lymphadenitis. We found that cells of specific morphology exhibited significant favored and unfavored spatial neighborhood relations of cells in dependence of their morphology. This information is important to evaluate differences between Hodgkin lymph nodes infiltrated by tumor cells (Hodgkin lymphoma) and inflamed lymph nodes, concerning the neighborhood relations of cells and the sizes of cells. The quantification of neighborhood relations revealed new insights of relations of CD30-positive cells in different diagnosis cases. The approach is general and can easily be applied to whole slide image analysis of other tumor types.
Hintergrund: Aphasien gehören nicht zu den typischen klinischen Manifestationen lakunärer Hirninfarkte, sind jedoch im Rahmen seltener atypischer lakunärer Syndrome beschrieben.
Ziel der Arbeit: Beschreibung von Aphasiemustern und betroffener Fasertrakte bei lakunären Infarkten.
Material und Methoden: Fallserie von drei Patienten mit in der Magnetresonanztomographie nachgewiesenen lakunären Hirninfarkten und Aphasie. Identifikation betroffener Faserbahnen mittels Fasertraktographie der koregistrierten Schädigungsorte in Gehirnen zweier gesunder Probanden.
Ergebnisse: Radiologisch waren die Lakunen, die Aphasien hervorriefen, weit lateral im Marklager der linken Hemisphäre gelegen und befanden sich im Vergleich zu der Lakune eines nichtaphasischen Kontrollpatienten weiter rostrodorsal. Klinisch fand sich trotz Aussparung des Kortex, Thalamus und weiter Teile der Basalganglien eine leichte bis moderate nichtflüssige Aphasie mit syntaktischen Defiziten. In der Fasertraktographie zeigten die aphasischen im Vergleich zum nichtaphasischen Patienten eine stärkere Affektion der Fasern des linken Fasciculus arcuatus sowie eine Beteiligung des frontostriatalen und frontalen Aslant-Trakts.
Diskussion: Links lateral gelegene lakunäre Infarkte können durch Beteiligung sprachrelevanter Fasertrakte eine klinisch relevante Aphasie hervorrufen.
Background: Inflammation is essential for the pathogenesis of multiple sclerosis (MS). While the immune system contribution to the development of neurological symptoms has been intensively studied, inflammatory biomarkers for mental symptoms such as depression are poorly understood in the context of MS. Here, we test if depression correlates with peripheral and central inflammation markers in MS patients as soon as the diagnosis is established. Methods: Forty-four patients were newly diagnosed with relapsing-remitting MS, primary progressive MS or clinically isolated syndrome. Age, gender, EDSS, C-reactive protein (CRP), albumin, white blood cells count in cerebrospinal fluid (CSF WBC), presence of gadolinium enhanced lesions (GE) on T1-weighted images and total number of typical MS lesion locations were included in linear regression models to predict Beck Depression Inventory (BDI) score and the depression dimension of the Symptoms Checklist 90-Revised (SCL90RD). Results: CRP elevation and GE predicted significantly BDI (CRP: p = 0.007; GE: p = 0.019) and SCL90RD (CRP: p = 0.004; GE: p = 0.049). The combination of both factors resulted in more pronounced depressive symptoms (p = 0.04). CSF WBC and EDSS as well as the other variables were not correlated with depressive symptoms. Conclusions: CRP elevation and GE are associated with depressive symptoms in newly diagnosed MS patients. These markers can be used to identify MS patients exhibiting a high risk for the development of depressive symptoms in early phases of the disease.
Human lymph nodes play a central part of immune defense against infection agents and tumor cells. Lymphoid follicles are compartments of the lymph node which are spherical, mainly filled with B cells. B cells are cellular components of the adaptive immune systems. In the course of a specific immune response, lymphoid follicles pass different morphological differentiation stages. The morphology and the spatial distribution of lymphoid follicles can be sometimes associated to a particular causative agent and development stage of a disease. We report our new approach for the automatic detection of follicular regions in histological whole slide images of tissue sections immuno-stained with actin. The method is divided in two phases: (1) shock filter-based detection of transition points and (2) segmentation of follicular regions. Follicular regions in 10 whole slide images were manually annotated by visual inspection, and sample surveys were conducted by an expert pathologist. The results of our method were validated by comparing with the manual annotation. On average, we could achieve a Zijbendos similarity index of 0.71, with a standard deviation of 0.07.
Die digitale Pathologie ist ein neues, aber stetig wachsendes, Feld in der Medizin. Die kontinuierliche Entwicklung von verbesserten digitalen Scannern erlaubt heute das Abscannen von kompletten Gewebeschnitten und Whole Slide Images gewinnen an Bedeutung. Ziel dieser Arbeit ist die Methodenentwicklung zur Analyse von Whole Slide Images des klassischen Hodgkin Lymphoms. Das Hodgkin-Lymphom, oder Morbus Hodgkin, ist eine Tumorerkrankung des Lymphsystems, bei der die monoklonalen Tumorzellen in der Regel von B-Lymphozyten im Vorläuferstadium abstammen.
Etwas mehr als 9.000 Hodgkin-Lymphom-Fälle werden jährlich in den USA diagnostiziert. Zwar ist die 5-Jahre-Überlebensrate für Hodgkin-Lymphome mit 85,3 % vergleichsweise hoch, dennoch werden etwa 1.100 Todesfälle pro Jahr in den USA registriert. Auf mikroskopischer Ebene sind die Hodgkin-Reed-Sternberg Zellen (HRS-Zellen) typisch für das klassische Hodgkin Lymphom. HRS-Zellen haben einen oder mehrere Zellkerne, die stark vergrößert sind und eine grobe Chromatinstruktur aufweisen. Immunhistologisch gibt es für HRS-Zellen charakterisierende Marker, so sind HRS-Zellen positiv für den Aktivierungsmarker CD30.
Neben der konventionellen Mikroskopie, ermöglichen Scanner das Digitalisieren von ganzen Objektträgern (Whole Slide Image). Whole Slide Images werden bisher wenig in der Routinediagnostik eingesetzt. Ein großer Vorteil von digitalisierten Gewebeschnitten bietet sich bei der computergestützten Analyse. Automatisierte Bildanalyseverfahren wie Zellerkennung können Pathologen bei der Diagnose unterstützen, indem sie umfassende Statistiken zur Anzahl und Verteilung von immungefärbten Zellen bereitstellen.
Die untersuchten immunohistologischen Bilder wurden vom Dr. Senckenbergisches Institut für Pathologie des Universitätsklinikums Frankfurt bereit gestellt. Die betrachteten Gewebeschnitte sind gegen CD30 immungefärbt, einem Membranrezeptor, welcher in HRS-Zellen und aktivierten Lymphozyten exprimiert wird. Die Gewebeschnitte wurden mit einem Aperio ScanScope slide scanner digitalisiert und liegen mit einer hohen Auflösung von 0,25 μm pro Pixel vor. Bei den vorliegenden Gewebeschnittgrößen ergeben sich Bilder mit bis zu 90.000 x 90.000 Pixeln.
Der untersuchte Bilddatensatz umfasst 35 Bilder von Lymphknotengewebeschnitten der drei Krankheitsbilder: Gemischtzelliges klassisches Hodgkinlymphom, noduläres klassisches Hodgkinlymphom und Lymphadenitis. Die Bildverarbeitungspipeline wurden teils neu implementiert, teils von etablierten Bilderkennungssoftware und -bibliotheken wie CellProfiler und Java Advanced Imaging verwendet. CD30-positive Zellobjekte werden in den Gewebeschnitten automatisiert erkannt und neben der globalen Position im Whole Slide Image weitere Morphologiedeskriptoren berechnet, wie Fläche, Feret-Durchmesser, Exzentrität und Solidität. Die Zellerkennung zeigt mit 84 % eine hohe Präzision und mit 95 % eine sehr gute Sensitivität.
Es konnte gezeigt werden, dass in Lymphadenitisfällen im Schnitt deutlich weniger CD30- positive Zellen präsent sind als in klassisches Hodgkinlymphom. Während hier im Schnitt nur rund 3.000 Zellen gefunden wurden, lag der Durchschnitt für das Mischtyp klassisches Hodgkinlymphom bei rund 19.000 CD30 positiven Zellen. Während die CD30-positiven Zellen in Lymphadenitisfällen relativ gleichmäßig verteilt sind, bilden diese in klassischen Hodgkinlymphom-Fällen Zellcluster höherer Dichte.
Die berechneten Morphologiedeskriptoren bieten die Möglichkeit die Gewebeschnitte und den Krankheitsverlauf näher zu beschreiben. Zudem sind bisher Größe und Erscheinungsbild der HRS-Zellen hauptsächlich anhand manuell ausgewählter Zellen bestimmt worden. Ein Maß für die Ausdehnung der Zellen ist der maximale Feret-Durchmesser. Bei CD30-Zellen im klassischen Hodgkinlymphom liegt dieser im Durchschnitt bei 20 μm und ist somit deutlich größer als die durchschnittlich gemessenen 15 μm in Lymphadenitis.
Es wurde ein graphentheoretischer Ansatz gewählt, um die CD30 positiven Zellen und ihre räumliche Nachbarschaft zu modellieren. In CD30-Zellgraphen von klassischen Hodgkinlymphom-Gewebeschnitten ist der durchschnittliche Knotengrad gegenüber den von Lymphadenitis-Bildern stark erhöht. Der Vergleich mit Zufallsgraphen zeigt, dass die beobachteten Knotengradverteilungen nicht für eine zufällige Verteilung der Zellen im Gewebeschnitt sprechen. Eigenschaften und Verteilung von Communities in CD30-Zellgraphen können hinzugenommen werden, um klassisches Hodgkinlymphom Gewebeschnitte näher zu charakterisieren.
Diese Arbeit zeigt, dass die Auswertung von Whole Slide Image unterstützend zur Verbesserung der Diagnose möglich ist. Die mehr als 400.000 automatisch erkannten CD30-positiven Zellobjekte wurden morphologisch beschrieben, und zusammen mit ihrer Position im Gewebeschnitt ist die Betrachtung wichtiger Eigenschaften des klassischen Hodgkinlymphoms realisierbar. Zellgraphen können durch weitere Zelltypen erweitert werden und auf andere Krankheitsbilder angewendet werden.
Introduction: Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) occurs approximately 1 in 3.500 live births representing the most common malformation of the upper digestive tract. Only half a century ago, EA/TEF was fatal among affected newborns suggesting that the steady birth prevalence might in parts be due to mutational de novo events in genes involved in foregut development.
Methods: To identify mutational de novo events in EA/TEF patients, we surveyed the exome of 30 case-parent trios. Identified and confirmed de novo variants were prioritized using in silico prediction tools. To investigate the embryonic role of genes harboring prioritized de novo variants we performed targeted analysis of mouse transcriptome data of esophageal tissue obtained at the embryonic day (E) E8.5, E12.5, and postnatal.
Results: In total we prioritized 14 novel de novo variants in 14 different genes (APOL2, EEF1D, CHD7, FANCB, GGT6, KIAA0556, NFX1, NPR2, PIGC, SLC5A2, TANC2, TRPS1, UBA3, and ZFHX3) and eight rare de novo variants in eight additional genes (CELSR1, CLP1, GPR133, HPS3, MTA3, PLEC, STAB1, and PPIP5K2). Through personal communication during the project, we identified an additional EA/TEF case-parent trio with a rare de novo variant in ZFHX3. In silico prediction analysis of the identified variants and comparative analysis of mouse transcriptome data of esophageal tissue obtained at E8.5, E12.5, and postnatal prioritized CHD7, TRPS1, and ZFHX3 as EA/TEF candidate genes. Re-sequencing of ZFHX3 in additional 192 EA/TEF patients did not identify further putative EA/TEF-associated variants.
Conclusion: Our study suggests that rare mutational de novo events in genes involved in foregut development contribute to the development of EA/TEF.
Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines.
Background: Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement.
Methods: The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement.
Results: We identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10).Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).
Conclusions: For multimorbidity research, the knowledge of diseases with high disagreement levels between the patients' perceived illnesses and their physicians' reports is important. The analysis shows that different patient characteristics have an impact on the agreement. Findings from this study should be included in the development of clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more reasons for disagreement and their consequences in health care.
Background: Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.
Methods: The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.
Results: Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.
Conclusions: Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.