@article {335, title = {Clinical Significance and Molecular Annotation of Cellular Morphometric Subtypes in Lower Grade Gliomas discovered by Machine Learning.}, journal = {Neuro Oncol}, year = {2022}, month = {2022 Jun 18}, abstract = {

BACKGROUND: Lower grade gliomas (LGG) are heterogenous diseases by clinical, histological, and molecular criteria. We aimed to personalize the diagnosis and therapy of LGG patients by developing and validating robust cellular morphometric subtypes (CMS) and to uncover the molecular signatures underlying these subtypes.

METHODS: Cellular morphometric biomarkers (CMBs) were identified with artificial intelligence technique from TCGA-LGG cohort. Consensus clustering was used to define CMS. Survival analysis was performed to assess the clinical impact of CMBs and CMS. A nomogram was constructed to predict 3- and 5- year overall survival (OS) of LGG patients. Tumor mutational burden (TMB), and immune cell infiltration between subtypes were analyzed using the Mann-Whitney test. The double-blinded validation for important immunotherapy-related biomarkers were executed using immunohistochemistry (IHC).

RESULTS: We developed a machine learning pipeline to extract CMBs from whole slide images of tissue histology; identifying and externally validating robust CMS of LGGs in multi-center cohorts. The subtypes had independent predicted OS across all three independent cohorts. In the TCGA-LGG cohort, patients within the poor-prognosis subtype responded poorly to primary and follow-up therapies. LGGs within the poor-prognosis subtype were characterized by high mutational burden, high frequencies of copy number alterations, and high levels of tumor-infiltrating lymphocytes and immune checkpoint genes. Higher levels of PD-1/PD-L1/CTLA-4 were confirmed by immunohistochemical staining. In addition, the subtypes learned from LGG demonstrates translational impact on glioblastoma (GBM).

CONCLUSIONS: We developed and validated a framework (CMS-ML) for CMS discovery in LGG associated with specific molecular alterations, immune micro-environment, prognosis, and treatment response.

}, issn = {1523-5866}, doi = {10.1093/neuonc/noac154}, author = {Liu, Xiao-Ping and Jin, Xiaoqing and Ahmadian, Saman Seyed and Yang, Xu and Tian, Su-Fang and Cai, Yu-Xiang and Chawla, Kuldeep and Snijders, Antoine M and Xia, Yankai and van Diest, Paul J and Weiss, William A and Mao, Jian-Hua and Li, Zhi-Qiang and Vogel, Hannes and Chang, Hang} } @article {333, title = {Identification of a novel cancer microbiome signature for predicting prognosis of human breast cancer patients.}, journal = {Clin Transl Oncol}, volume = {24}, year = {2022}, month = {2022 Mar}, pages = {597-604}, abstract = {

BACKGROUND: Prognosis of breast cancer (BC) patients differs considerably and identifying reliable prognostic biomarker(s) is imperative. With evidence that the microbiome plays a critical role in the response to cancer therapies, we aimed to identify a cancer microbiome signature for predicting the prognosis of BC patients.

METHODS: The TCGA BC microbiome data (TCGA-BRCA-microbiome) was downloaded from cBioPortal. Univariate and multivariate Cox regression analyses were used to examine association of microbial abundance with overall survival (OS) and to identify a microbial signature for creating a prognostic scoring model. The performance of the scoring model was assessed by the area under the ROC curve (AUC). Nomograms using the microbial signature, clinical factors, and molecular subtypes were established to predict OS and progression-free survival (PFS).

RESULTS: Among 1406 genera, the abundances of 94 genera were significantly associated with BC patient OS in TCGA-BRCA-microbiome dataset. From that set we identified a 15-microbe prognostic signature and developed a 15-microbial abundance prognostic scoring (MAPS) model. Patients in low-risk group significantly prolong OS and PFS as compared to those in high-risk group. The time-dependent ROC curves with MAPS showed good predictive efficacy both in OS and PFS. Moreover, MAPS is an independent prognostic factor for OS and PFS over clinical factors and PAM50-based molecular subtypes and superior to the previously published 12-gene signature. The integration of MAPS into nomograms significantly improved prognosis prediction.

CONCLUSION: MAPS was successfully established to have independent prognostic value, and our study provides a new avenue for developing prognostic biomarkers by microbiome profiling.

}, keywords = {Breast Neoplasms, Female, Humans, Microbiota, Prognosis, Survival Rate}, issn = {1699-3055}, doi = {10.1007/s12094-021-02725-3}, author = {Mao, A W and Barck, H and Young, J and Paley, A and Mao, J -H and Chang, Hang} } @article {334, title = {NaroNet: Discovery of tumor microenvironment elements from highly multiplexed images.}, journal = {Med Image Anal}, volume = {78}, year = {2022}, month = {2022 May}, pages = {102384}, abstract = {

Understanding the spatial interactions between the elements of the tumor microenvironment -i.e. tumor cells. fibroblasts, immune cells- and how these interactions relate to the diagnosis or prognosis of a tumor is one of the goals of computational pathology. We present NaroNet, a deep learning framework that models the multi-scale tumor microenvironment from multiplex-stained cancer tissue images and provides patient-level interpretable predictions using a seamless end-to-end learning pipeline. Trained only with multiplex-stained tissue images and their corresponding patient-level clinical labels, NaroNet unsupervisedly learns which cell phenotypes, cell neighborhoods, and neighborhood interactions have the highest influence to predict the correct label. To this end, NaroNet incorporates several novel and state-of-the-art deep learning techniques, such as patch-level contrastive learning, multi-level graph embeddings, a novel max-sum pooling operation, or a metric that quantifies the relevance that each microenvironment element has in the individual predictions. We validate NaroNet using synthetic data simulating multiplex-immunostained images where a patient label is artificially associated to the -adjustable- probabilistic incidence of different microenvironment elements. We then apply our model to two sets of images of human cancer tissues: 336 seven-color multiplex-immunostained images from 12 high-grade endometrial cancer patients; and 382 35-plex mass cytometry images from 215 breast cancer patients. In both synthetic and real datasets, NaroNet provides outstanding predictions of relevant clinical information while associating those predictions to the presence of specific microenvironment elements.

}, keywords = {Breast Neoplasms, Female, Humans, Prognosis, Tumor Microenvironment}, issn = {1361-8423}, doi = {10.1016/j.media.2022.102384}, author = {Jim{\'e}nez-S{\'a}nchez, Daniel and Ariz, Mikel and Chang, Hang and Matias-Guiu, Xavier and de Andrea, Carlos E and Ortiz-de-Sol{\'o}rzano, Carlos} } @article {326, title = {A new platform for ultra-high dose rate radiobiological research using the BELLA PW laser proton beamline.}, journal = {Sci Rep}, volume = {12}, year = {2022}, month = {2022 01 27}, pages = {1484}, abstract = {

Radiotherapy is the current standard of care for more than 50\% of all cancer patients. Improvements in radiotherapy (RT) technology have increased tumor targeting and normal tissue sparing. Radiations at ultra-high dose rates required for FLASH-RT effects have sparked interest in potentially providing additional differential therapeutic benefits. We present a new experimental platform that is the first one to deliver petawatt laser-driven proton pulses of 2\ MeV energy at 0.2\ Hz repetition rate by means of a compact, tunable active plasma lens beamline to biological samples. Cell monolayers grown over a 10\ mm diameter field were exposed to clinically relevant proton doses ranging from 7 to 35\ Gy at ultra-high instantaneous dose rates of 10\ Gy/s. Dose-dependent cell survival measurements of human normal and tumor cells exposed to LD protons showed significantly higher cell survival of normal-cells compared to tumor-cells for total doses of 7\ Gy and higher, which was not observed to the same extent for X-ray reference irradiations at clinical dose rates. These findings provide preliminary evidence that compact LD proton sources enable a new and promising platform for investigating the physical, chemical and biological mechanisms underlying the FLASH effect.

}, keywords = {Cell Line, Humans, Lasers, Monte Carlo Method, Neoplasms, Proton Therapy, Radiation Oncology, Radiobiology, Radiometry, Radiotherapy Dosage, Synchrotrons}, issn = {2045-2322}, doi = {10.1038/s41598-022-05181-3}, author = {Bin, Jianhui and Obst-Huebl, Lieselotte and Mao, Jian-Hua and Nakamura, Kei and Geulig, Laura D and Chang, Hang and Ji, Qing and He, Li and De Chant, Jared and Kober, Zachary and Gonsalves, Anthony J and Bulanov, Stepan and Celniker, Susan E and Schroeder, Carl B and Geddes, Cameron G R and Esarey, Eric and Simmons, Blake A and Schenkel, Thomas and Blakely, Eleanor A and Steinke, Sven and Snijders, Antoine M} } @article {332, title = {Prospective Study Reveals Host Microbial Determinants of Clinical Response to Fecal Microbiota Transplant Therapy in Type 2 Diabetes Patients.}, journal = {Front Cell Infect Microbiol}, volume = {12}, year = {2022}, month = {2022}, pages = {820367}, abstract = {

Background: Increasing evidence shows that alterations in gut microbiome (GM) contribute to the development of type 2 diabetes mellitus (T2DM), and fecal microbiota transplantation (FMT) successfully treats various human diseases. However, the benefits of FMT therapy to T2DM patients remain unknown.

Methods: We enrolled 17 patients with T2DM for nonblinded, one-armed intervention trial of FMT. A total of 20 healthy individuals were recruited as the baseline control. HbA1c\% and metabolic parameter change were evaluated in 17 T2DM patients 12 weeks after they received FMT from healthy donors. The GM composition was characterized by 16S rRNA gene amplicon sequencing from fecal samples prior to and 12 weeks after FMT treatment.

Results: We found that the GM of T2DM patients was reconstituted by FMT. We observed a statistically significant decrease in HbA1c\% (from 7.565 {\textpm} 0.148 to 7.190 {\textpm} 0.210, p\<0.01), blood glucose (from 8.483 {\textpm} 0.497 to 7.286 {\textpm} 0.454 mmol/L, p\<0.01), and uric acid (from 309.4 {\textpm} 21.5 to 259.1 {\textpm} 15.8 {\textmu}mol/L, p\<0.01) while a significant increase in postprandial C-peptide (from 4.503 {\textpm} 0.600 to 5.471 {\textpm} 0.728 ng/ml, p\<0.01) at 12 weeks after FMT. Closely evaluating the changes in these assays, we found individual variability in response to FMT treatment. Out of 17 T2DM patients, 11 were found to significantly improve T2DM symptoms. The FMT responders have significantly higher levels of the family and the genus (family ) in their pretreated fecal in comparison to nonresponders, which could predict the clinical response with an area under the curve of 0.83.

Conclusion: Our findings suggest that certain T2DM patients can potentially benefit from FMT, and the pretreated abundance of and in the fecal of patients may serve as potential biomarkers for selecting T2DM patients to receive FMT.

}, keywords = {Diabetes Mellitus, Type 2, Fecal Microbiota Transplantation, Feces, Glycated Hemoglobin A, Humans, Prospective Studies, RNA, Ribosomal, 16S, Treatment Outcome}, issn = {2235-2988}, doi = {10.3389/fcimb.2022.820367}, author = {Ding, Dafa and Yong, Huijuan and You, Na and Lu, Wei and Yang, Xu and Ye, Xiaolong and Wang, Yayun and Cai, Tingting and Zheng, Xiaoling and Chen, Hui and Cui, Bota and Zhang, Faming and Liu, Xingyin and Mao, Jian-Hua and Lu, Yibing and Chang, Hang} } @article {330, title = {Contribution of trace element exposure to gestational diabetes mellitus through disturbing the gut microbiome.}, journal = {Environ Int}, volume = {153}, year = {2021}, month = {2021 08}, pages = {106520}, abstract = {

BACKGROUND: A healthy gut microbiome is critical for glucose metabolism during pregnancy. In vivo studies indicate that trace element affects the composition and function of the gut microbiome and potentially leads to metabolic disorders but their relationships are largely unknown. We aimed to investigate whether the gut microbiome plays a role in the relationship between trace element exposure and gestational diabetes mellitus (GDM).

METHODS: In a prospective cohort study, serum levels of 22 trace elements and the fecal gut microbiome composition were assessed in 837 pregnant women in the second trimester between 22 and 24\ weeks of pregnancy prior to GDM diagnosis. Regression and mediation analysis were used to explore the link between element exposure, the gut microbiome, and GDM.

RESULTS: 128 pregnant women (15.3\%) were diagnosed with GDM. No individual trace elements were found significantly associated with GDM. In contrast, the composition of the gut microbiome was dramatically altered in women later diagnosed with GDM and characterized by lower alpha diversity and lower abundance of co-abundance groups (CAGs) composed of genera belonging to Ruminococcaceae, Coriobacteriales, and Lachnospiraceae. Rubidium (Rb) was positively associated with alpha diversity indices while mercury (Hg) and vanadium (V) showed negative associations. Elements including rubidium (Rb), thallium (Tl), arsenic (As), and antimony (Sb) were significantly correlated with GDM-related CAGs and mediation analysis revealed that Rb and Sb were inversely related to GDM risk by altering abundance levels of CAGs enriched for Lachnospiraceae, Coriobacteriales, and Ruminococcaceae.

CONCLUSION: Our study indicates that trace element exposure is associated with specific gut microbiome features that may contribute to GDM development, which could provide a new avenue for intervening in environmental exposure-related GDM.

}, keywords = {Diabetes, Gestational, Feces, Female, Gastrointestinal Microbiome, Humans, Pregnancy, Prospective Studies, Trace Elements}, issn = {1873-6750}, doi = {10.1016/j.envint.2021.106520}, author = {Zhang, Yuqing and Chen, Ting and Zhang, Yiyun and Hu, Qi and Wang, Xu and Chang, Hang and Mao, Jian-Hua and Snijders, Antoine M and Xia, Yankai} } @article {327, title = {Development and Validation of an Unsupervised Feature Learning System for Leukocyte Characterization and Classification: A Multi-Hospital Study}, volume = {129}, year = {2021}, month = {2021/06/01}, pages = {1837 - 1856}, abstract = {

The characterization and classification of white blood cells (WBC) are critical for the diagnosis of anemia, leukemia, and many other hematologic diseases. We developed WBC-Profiler, an unsupervised feature learning system for quantitative analysis of leukocytes. We demonstrate, through independent validation, that WBC-Profiler enables automatic extraction of complex and robust signatures from microscopic images without human-intervention and, thereafter, effective construction of interpretable leukocyte profiles, which decouples large scale complex leukocyte characterization from limitations in both human-based feature engineering/optimization and the end-to-end solutions provided by many modern deep neural networks. Further evaluation in a real-world clinical setting confirms that, compared with 23 clinicians from 8 hospitals (class-average-sensitivity, 0.798; class-average-specificity, 0.963; cell-average-timecost: 3.158\  s), WBC-Profiler performs with significantly improved accuracy and speed (class-average-sensitivity, 0.890; class-average-specificity, 0.980; cell-average-timecost: 0.375\  s). Our findings suggest that WBC-Profiler has the potential clinical implications.

}, isbn = {1573-1405}, url = {https://doi.org/10.1007/s11263-021-01449-9}, author = {Yan, Hong and Mao, Xuanyu and Yang, Xu and Xia, Yongquan and Wang, Chengbin and Wang, Junjun and Xia, Rui and Xu, Xuejing and Wang, Zhiqiang and Li, Zhiyang and Zhao, Xie and Li, Yan and Liu, Guoye and He, Li and Wang, Zhongyu and Wang, Zhiqiong and Li, Zhiqiang and Cai, Weidong and Shen, Han and Chang, Hang} } @article {331, title = {Distinct Clinical Impact and Biological Function of Angiopoietin and Angiopoietin-like Proteins in Human Breast Cancer.}, journal = {Cells}, volume = {10}, year = {2021}, month = {2021 09 29}, abstract = {

Secreted angiopoietin/angiopoietin-like (/) proteins are involved in many biological processes. However, the role of these proteins in human breast cancers (BCs) remains largely unclear. Here, we conducted integrated omics analyses to evaluate the clinical impact of / proteins and to elucidate their biological functions. In BCs, we identified rare mutations in / genes, frequent gains of , , and , and frequent losses of , , and , but observed that , , and were robustly downregulated in multiple datasets. The expression levels of , , and were positively correlated with overall survival (OS), while the expression levels of were negatively correlated with OS. Additionally, the expression levels of and were positively correlated with distant metastasis-free survival (DMFS), while the expression levels of and were negatively correlated with DMFS. The prognostic impacts of / genes depended on the molecular subtypes and on clinical factors. We discovered that various / genes were co-expressed with various genes involved in different pathways. Finally, with the exception of , the remaining genes showed significant correlations with cancer-associated fibroblasts, endothelial cells, and microenvironment score, whereas only was significantly correlated with immune score. Our findings provide strong evidence for the distinct clinical impact and biological function of / proteins, but the question of whether some of them could be potential therapeutic targets still needs further investigation in BCs.

}, keywords = {Angiopoietin-like Proteins, Angiopoietins, Breast Neoplasms, Female, Humans, Prognosis}, issn = {2073-4409}, doi = {10.3390/cells10102590}, author = {Yang, Hui and Zhang, Melody and Mao, Xuan-Yu and Chang, Hang and Perez-Losada, Jesus and Mao, Jian-Hua} } @article {323, title = {From Mouse to Human: Cellular Morphometric Subtype Learned From Mouse Mammary Tumors Provides Prognostic Value in Human Breast Cancer.}, journal = {Front Oncol}, volume = {11}, year = {2021}, month = {2021}, pages = {819565}, abstract = {

Mouse models of cancer provide a powerful tool for investigating all aspects of cancer biology. In this study, we used our recently developed machine learning approach to identify the cellular morphometric biomarkers (CMB) from digital images of hematoxylin and eosin (H\&E) micrographs of orthotopic -null mammary tumors (n = 154) and to discover the corresponding cellular morphometric subtypes (CMS). Of the two CMS identified, CMS-2 was significantly associated with shorter survival (p = 0.0084). We then evaluated the learned CMB and corresponding CMS model in transgenic mouse mammary tumors (n = 53) in which CMS-2 was significantly correlated with the presence of metastasis (p = 0.004). We next evaluated the mouse CMB and CMS model on The Cancer Genome Atlas breast cancer (TCGA-BRCA) cohort (n = 1017). Kaplan-Meier analysis showed significantly shorter overall survival (OS) of CMS-2 patients compared to CMS-1 patients (p = 0.024) and added significant prognostic value in multi-variable analysis of clinical and molecular factors, namely, age, pathological stage, and PAM50 molecular subtype. Thus, application of CMS to digital images of routine workflow H\&E preparations can provide unbiased biological stratification to inform patient care.

}, issn = {2234-943X}, doi = {10.3389/fonc.2021.819565}, author = {Chang, Hang and Yang, Xu and Moore, Jade and Liu, Xiao-Ping and Jen, Kuang-Yu and Snijders, Antoine M and Ma, Lin and Chou, William and Corchado-Cobos, Roberto and Garc{\'\i}a-Sancha, Natalia and Mendiburu-Eli{\c c}abe, Marina and Perez-Losada, Jesus and Barcellos-Hoff, Mary Helen and Mao, Jian-Hua} } @article {329, title = {Genetic background influences the effect of thirdhand smoke exposure on anxiety and memory in Collaborative Cross mice.}, journal = {Sci Rep}, volume = {11}, year = {2021}, month = {2021 06 24}, pages = {13285}, abstract = {

Growing evidence indicates that thirdhand smoke (THS) exposure induces many adverse health effects. However, it is unclear how THS exposure affects behavior and how host genetic background modulates phenotypic changes. Here we used the Collaborative Cross (CC) mouse population-based model to assess behavioral alterations immediately after THS exposure from 4 to 9\ weeks of age. We first measured anxiety-like behavior in six strains using light/dark box combined with a custom multivariate mouse tracking system. We developed an anxiety risk scoring system based on anxiety-related traits and then evaluated the THS impact on them. THS exposure significantly decreased anxiety risk in CC019 (P = 0.002) and CC051 (P = 0.009), but increased anxiety risk in CC036 (P \< 0.001), while the other three strains did not show significant changes in anxiety-related traits. Such differences were driven by female mice for the six measures of anxiety-like behavior. Memory potential was measured in the same cohort of mice using the passive avoidance assay. Both THS-exposed male and female CC019 mice displayed significant memory loss compared to controls while no significant changes were found in the other five strains. This study provides strong evidence that THS exposure leads to strain-dependent changes in anxiety-like behavior and memory, suggesting that host genetic variations play a critical role in individual susceptibility to THS-induced effects.

}, keywords = {Animals, Anxiety, Collaborative Cross Mice, Female, Humans, Male, Memory, Risk Factors, Tobacco Smoke Pollution}, issn = {2045-2322}, doi = {10.1038/s41598-021-92702-1}, author = {He, Li and Wang, Pin and Schick, Suzyann F and Huang, Abel and Jacob, Peyton and Yang, Xu and Xia, Yankai and Snijders, Antoine M and Mao, Jian-Hua and Chang, Hang and Hang, Bo} } @article {324, title = {Gut microbiome partially mediates and coordinates the effects of genetics on anxiety-like behavior in Collaborative Cross mice.}, journal = {Sci Rep}, volume = {11}, year = {2021}, month = {2021 01 11}, pages = {270}, abstract = {

Growing evidence suggests that the gut microbiome (GM) plays a critical role in health and disease. However, the contribution of GM to psychiatric disorders, especially anxiety, remains unclear. We used the Collaborative Cross (CC) mouse population-based model to identify anxiety associated host genetic and GM factors. Anxiety-like behavior of 445 mice across 30 CC strains was measured using the light/dark box assay and documented by video. A custom tracking system was developed to quantify seven anxiety-related phenotypes based on video. Mice were assigned to a low or high anxiety group by consensus clustering using seven anxiety-related phenotypes. Genome-wide association analysis (GWAS) identified 141 genes (264 SNPs) significantly enriched for anxiety and depression related functions. In the same CC cohort, we measured GM composition and identified five families that differ between high and low anxiety mice. Anxiety level was predicted with 79\% accuracy and an AUC of 0.81. Mediation analyses revealed that the genetic contribution to anxiety was partially mediated by the GM.\ Our findings indicate that GM partially mediates and coordinates the effects of genetics on anxiety.

}, keywords = {Animals, Anxiety, Behavior, Animal, Collaborative Cross Mice, Gastrointestinal Microbiome, Mice}, issn = {2045-2322}, doi = {10.1038/s41598-020-79538-x}, author = {Jin, X and Zhang, Y and Celniker, S E and Xia, Y and Mao, J-H and Snijders, A M and Chang, Hang} } @article {325, title = {Host genetics and gut microbiota cooperatively contribute to azoxymethane-induced acute toxicity in Collaborative Cross mice.}, journal = {Arch Toxicol}, volume = {95}, year = {2021}, month = {2021 03}, pages = {949-958}, abstract = {

Azoxymethane (AOM) is a widely used carcinogen to study chemical-induced colorectal carcinogenesis and is an agent for studying fulminant hepatic failure. The inter-strain susceptibility to acute toxicity by AOM has been reported, but its association with host genetics or gut microbiota remains largely unexplored. Here a cohort of genetically diverse Collaborative Cross (CC) mice was used to assess the contribution of host genetics and the gut microbiome to AOM-induced acute toxicity. We observed variation in AOM-induced acute liver failure across CC strains. Quantitative trait loci (QTL) analysis revealed three chromosome regions significantly associated with AOM toxicity. Genes located within these QTL, including peroxisome proliferator-activated receptor alpha (Ppara), were enriched for enzyme activator and nucleoside-triphosphatase regulator activity. We further demonstrated that the protein level of PPARα in liver tissues from sensitive strains was remarkably lower compared to levels in resistant strains, consistent with protective role of PPAR family in liver injury. We discovered that the abundance levels of gut microbial families Anaeroplasmataceae, Ruminococcaceae, Lactobacillaceae, Akkermansiaceae and Clostridiaceae were significantly higher in the sensitive strains\ compared to the resistant strains. Using a random forest classifier method, we determined that the relative abundance levels of these microbial families predicted AOM toxicity with the area under the receiver-operating curve (AUC) of 0.75. Combining the three genetic loci and five microbial families increased the predictive accuracy of AOM toxicity (AUC of 0.99). Moreover, we found that Ruminococcaceae and Lactobacillaceae acted as mediators between host genetics and AOM toxicity. In conclusion, this study shows that host genetics and specific microbiome members play a critical role in AOM-induced acute toxicity, which provides a framework for analysis of the health effects from environmental toxicants.

}, keywords = {Animals, Azoxymethane, Carcinogens, Chemical and Drug Induced Liver Injury, Collaborative Cross Mice, Gastrointestinal Microbiome, Liver Failure, Acute, Male, Mice, Quantitative Trait Loci, Species Specificity}, issn = {1432-0738}, doi = {10.1007/s00204-021-02972-x}, author = {Zhong, Chenhan and He, Li and Lee, Sun-Young and Chang, Hang and Zhang, Yuqing and Threadgill, David W and Yuan, Ying and Zhou, Fuling and Celniker, Susan E and Xia, Yankai and Snijders, Antoine M and Mao, Jian-Hua} } @article {328, title = {Thirdhand cigarette smoke leads to age-dependent and persistent alterations in the cecal microbiome of mice.}, journal = {Microbiologyopen}, volume = {10}, year = {2021}, month = {2021 06}, pages = {e1198}, abstract = {

The gut microbiome composition is influenced by many factors including environmental exposures. Here, we investigated the effect of thirdhand cigarette smoke (THS) and exposure age on gut microbiome diversity. C57BL/6 mice were exposed to THS at human exposure relevant levels for three weeks during three different life stages: postnatal (0-3\ weeks of age), pubescent (4-7\ weeks of age), and adult (9-12\ weeks of age), respectively. Cecal microbiome profiles were assessed at 17\ weeks of age by 16S rRNA gene sequencing. We found that age at THS exposure strongly influenced the cecal microbiome composition. Although postnatal THS exposure significantly influenced the microbial composition, pubescent and adulthood exposures only had minor effects. The microbiome of postnatally THS-exposed mice significantly increased several degradation pathways that regulate glycolysis and pyruvate decarboxylation, and significantly decreased coenzyme A biosynthesis and pyrimidine deoxyribonucleoside salvage. Our results indicate that mouse postnatal development is particularly susceptible to persistent THS exposure effects on the gut microbiome.

}, keywords = {Age Factors, Animals, Bacteria, Cecum, Environmental Exposure, Female, Gastrointestinal Microbiome, Humans, Male, Mice, Mice, Inbred C57BL, Smoke, Tobacco, Tobacco Smoke Pollution}, issn = {2045-8827}, doi = {10.1002/mbo3.1198}, author = {He, Li and Zhou, Yan-Xia and Zhang, Yuqing and Hang, Bo and Chang, Hang and Schick, Suzaynn F and Celniker, Susan E and Xia, Yankai and Snijders, Antoine M and Mao, Jian-Hua} } @article {309, title = {Genetic and metabolic links between the murine microbiome and memory.}, journal = {Microbiome}, volume = {8}, year = {2020}, month = {2020 04 17}, pages = {53}, abstract = {

BACKGROUND: Recent evidence has linked the gut microbiome to host behavior via the gut-brain axis [1-3]; however, the underlying mechanisms remain unexplored. Here, we determined the links between host genetics, the gut microbiome and memory using the genetically defined Collaborative Cross (CC) mouse cohort, complemented with microbiome and metabolomic analyses in conventional and germ-free (GF) mice.

RESULTS: A genome-wide association analysis (GWAS) identified 715 of 76,080 single-nucleotide polymorphisms (SNPs) that were significantly associated with short-term memory using the passive avoidance model. The identified SNPs were enriched in genes known to be involved in learning and memory functions. By 16S rRNA gene sequencing of the gut microbial community in the same CC cohort, we identified specific microorganisms that were significantly correlated with longer latencies in our retention test, including a positive correlation with Lactobacillus. Inoculation of GF mice with individual species of Lactobacillus (L. reuteri F275, L. plantarum BDGP2 or L. brevis BDGP6) resulted in significantly improved memory compared to uninoculated or E. coli DH10B inoculated controls. Untargeted metabolomics analysis revealed significantly higher levels of several metabolites, including lactate, in the stools of Lactobacillus-colonized mice, when compared to GF control mice. Moreover, we demonstrate that dietary lactate treatment alone boosted memory in conventional mice. Mechanistically, we show that both inoculation with Lactobacillus or lactate treatment significantly increased the levels of the neurotransmitter, gamma-aminobutyric acid (GABA), in the hippocampus of the mice.

CONCLUSION: Together, this study provides new evidence for a link between Lactobacillus and memory and our results open possible new avenues for treating memory impairment disorders using specific gut microbial inoculants and/or metabolites. Video Abstract.

}, issn = {2049-2618}, doi = {10.1186/s40168-020-00817-w}, author = {Mao, Jian-Hua and Kim, Young-Mo and Zhou, Yan-Xia and Hu, Dehong and Zhong, Chenhan and Hang Chang and Brislawn, Colin J and Fansler, Sarah and Langley, Sasha and Wang, Yunshan and Peisl, B Y Loulou and Celniker, Susan E and Threadgill, David W and Wilmes, Paul and Orr, Galya and Metz, Thomas O and Jansson, Janet K and Snijders, Antoine M} } @article {322, title = {Identification of a novel 15-gene expression signature predicting overall survival of human colorectal cancer.}, journal = {Clin Transl Med}, volume = {10}, year = {2020}, month = {2020 Dec}, pages = {e258}, issn = {2001-1326}, doi = {10.1002/ctm2.258}, author = {Jiang, Chengfei and Zhao, Yue and Yuan, Binbin and Chang, Hang and Hang, Bo and Snijders, Antoine M and Mao, Jian-Hua and Zou, Xiaoping and Wang, Pin} } @article {307, title = {Systematic Analysis of Impact of Sampling Regions and Storage Methods on Fecal Gut Microbiome and Metabolome Profiles.}, journal = {mSphere}, volume = {5}, year = {2020}, month = {2020 01 08}, abstract = {

The contribution of human gastrointestinal (GI) microbiota and metabolites to host health has recently become much clearer. However, many confounding factors can influence the accuracy of gut microbiome and metabolome studies, resulting in inconsistencies in published results. In this study, we systematically investigated the effects of fecal sampling regions and storage and retrieval conditions on gut microbiome and metabolite profiles from three healthy children. Our analysis indicated that compared to homogenized and snap-frozen samples (standard control [SC]), different sampling regions did not affect microbial community alpha diversity, while a total of 22 of 176 identified metabolites varied significantly across different sampling regions. In contrast, storage conditions significantly influenced the microbiome and metabolome. Short-term room temperature storage had a minimal effect on the microbiome and metabolome profiles. Sample storage in RNALater showed a significant level of variation in both microbiome and metabolome profiles, independent of the storage or retrieval conditions. The effect of RNALater on the metabolome was stronger than the effect on the microbiome, and individual variability between study participants outweighed the effect of RNALater on the microbiome. We conclude that homogenizing stool samples was critical for metabolomic analysis but not necessary for microbiome analysis. Short-term room temperature storage had a minimal effect on the microbiome and metabolome profiles and is recommended for short-term fecal sample storage. In addition, our study indicates that the use of RNALater as a storage medium of stool samples for microbial and metabolomic analyses is not recommended. The gastrointestinal microbiome and metabolome can provide a new angle to understand the development of health and disease. Stool samples are most frequently used for large-scale cohort studies. Standardized procedures for stool sample handling and storage can be a determining factor for performing microbiome or metabolome studies. In this study, we focused on the effects of stool sampling regions and stool sample storage conditions on variations in the gut microbiome composition and metabolome profile.

}, issn = {2379-5042}, doi = {10.1128/mSphere.00763-19}, author = {Liang, Yali and Dong, Tianyu and Chen, Minjian and He, Lianping and Wang, Tingzhang and Liu, Xingyin and Hang Chang and Mao, Jian-Hua and Hang, Bo and Snijders, Antoine M and Xia, Yankai} } @article {308, title = {Thirdhand smoke: Genotoxicity and carcinogenic potential.}, journal = {Chronic Dis Transl Med}, volume = {6}, year = {2020}, month = {2020 Mar}, pages = {27-34}, abstract = {

Thirdhand smoke (THS), the residual tobacco smoke remaining in the environment after tobacco has been smoked, represents a hidden and underestimated public health hazard. Evidence supports its widespread presence in indoor environments. Exposure to secondhand smoke (SHS), a precursor of THS, has been well documented as a risk factor for human cancers, especially lung cancer. However, the concept of THS as a distinct entity that poses health risks for small children has developed only recently and the associations of THS with cancer risk and other chronic diseases are poorly understood due to limited numbers of studies to date. In this perspective, we mainly summarize all published studies on the genotoxicity and carcinogenic potential of THS exposure. These studies begin to fill the knowledge gap in our understanding of cancer risk of THS. Accumulating data from existing and future studies will help reduce the tobacco-related cancer incidence through changes in lifestyle and tobacco control policies.

}, issn = {2589-0514}, doi = {10.1016/j.cdtm.2019.08.002}, author = {Hang, Bo and Wang, Pin and Zhao, Yue and Hang Chang and Mao, Jian-Hua and Snijders, Antoine M} } @article {302, title = {Unsupervised Transfer Learning via Multi-Scale Convolutional Sparse Coding for Biomedical Applications.}, journal = {IEEE Trans Pattern Anal Mach Intell}, volume = {40}, year = {2018}, month = {2018 May}, pages = {1182-1194}, abstract = {

The capabilities of (I) learning transferable knowledge across domains; and (II) fine-tuning the pre-learned base knowledge towards tasks with considerably smaller data scale are extremely important. Many of the existing transfer learning techniques are supervised approaches, among which deep learning has the demonstrated power of learning domain transferrable knowledge with large scale network trained on massive amounts of labeled data. However, in many biomedical tasks, both the data and the corresponding label can be very limited, where the unsupervised transfer learning capability is urgently needed. In this paper, we proposed a novel multi-scale convolutional sparse coding (MSCSC) method, that (I) automatically learns filter banks at different scales in a joint fashion with enforced scale-specificity of learned patterns; and (II) provides an unsupervised solution for learning transferable base knowledge and fine-tuning it towards target tasks. Extensive experimental evaluation of MSCSC demonstrates the effectiveness of the proposed MSCSC in both regular and transfer learning tasks in various biomedical domains.

}, issn = {1939-3539}, doi = {10.1109/TPAMI.2017.2656884}, author = {Hang Chang and Han, Ju and Zhong, Cheng and Snijders, Antoine M and Mao, Jian-Hua} } @article {102, title = {Phenotypic Characterization of Breast Invasive Carcinoma via Transferable Tissue Morphometric Patterns learned from Glioblastoma Multiforme.}, journal = {Proc IEEE Int Symp Biomed Imaging}, volume = {2016}, year = {2016}, month = {2016 Apr}, pages = {1025-1028}, abstract = {

Quantitative analysis of whole slide images (WSIs) in a large cohort may provide predictive models of clinical outcome. However, the performance of the existing techniques is hindered as a result of large technical variations (e.g., fixation, staining) and biological heterogeneities (e.g., cell type, cell state) that are always present in a large cohort. Although unsupervised feature learning provides a promising way in learning pertinent features without human intervention, its capability can be greatly limited due to the lack of well-curated examples. In this paper, we explored the transferability of knowledge acquired from a well-curated Glioblastoma Multiforme (GBM) dataset through its application to the representation and characterization of tissue histology from the Cancer Genome Atlas (TCGA) Breast Invasive Carcinoma (BRCA) cohort. Our experimental results reveals two major phenotypic subtypes with statistically significantly different survival curves. Further differential expression analysis of these two subtypes indicates enrichment of genes regulated by NF-kB in response to TNF and genes up-regulated in response to IFNG.

}, issn = {1945-7928}, doi = {10.1109/ISBI.2016.7493440}, author = {Han, Ju and Fontenay, Gerald V and Wang, Yunfu and Jiang-Hua Mao and Hang Chang} } @article {81, title = {Breast fibroblasts modulate early dissemination, tumorigenesis, and metastasis through alteration of extracellular matrix characteristics}, journal = {Neoplasia}, volume = {15}, year = {2013}, month = {2013 Mar}, pages = {249-62}, abstract = {

A wealth of evidence has now demonstrated that the microenvironment in which a tumorigenic cell evolves is as critical to its evolution as the genetic mutations it accrues. However, there is still relatively little known about how signals from the microenvironment contribute to the early events in the progression to malignancy. To address this question, we used a premalignant mammary model to examine how fibroblasts, and the extracellular matrix (ECM) proteins they secrete, influence progression to malignancy. Their effect on metastatic malignant cells was also assessed for comparison. We found that carcinoma-associated fibroblasts, and the distinct aligned ECM they deposit, can cause both premalignant and malignant mammary epithelial cells to assume a mesenchymal morphology that is associated with increased dissemination and metastasis, while benign reduction mammoplasty fibroblasts favor the maintenance of an epithelial morphology and constrain early dissemination, tumor growth, and metastasis. Our results suggest that normalizing the organization of the ECM could be effective in limiting systemic dissemination and tumor growth.

}, keywords = {Animals, Breast, Cell Line, Cell Transformation, Coculture Techniques, Epithelial Cells, Experimental, Extracellular Matrix, Extracellular Signal-Regulated MAP Kinases, Female, Fibroblasts, Humans, Lung Neoplasms, Mammary Neoplasms, Neoplasm Metastasis, Neoplastic, Phenotype, Proto-Oncogene Proteins c-jun, rho GTP-Binding Proteins, Signal Transduction, Transforming Growth Factor beta, Tumor}, issn = {1476-5586}, author = {Dumont, Nancy and Liu, Bob and DeFilippis, Rosa Anna and Hang Chang and Rabban, Joseph T and Karnezis, Anthony N and Tjoe, Judy A and Marx, James and Parvin, Bahram and Tlsty, Thea D} } @article {205, title = {FAM83D promotes cell proliferation and motility by downregulating tumor suppressor gene FBXW7.}, journal = {Oncotarget}, volume = {4}, year = {2013}, month = {2013 Dec}, pages = {2476-86}, abstract = {

Amplification of chromosome 20q is frequently found in various types of human cancers, including breast cancer. The list of candidate oncogenes in 20q has expanded over the past decade. Here, we investigate whether FAM83D (family with sequence similarity 83, member D) on chromosome 20q plays any role in breast cancer development. The expression level of FAM83D is significantly elevated in breast cancer cell lines and primary human breast cancers. High expression levels of FAM83D are significantly associated with poor clinical outcome and distant metastasis in breast cancer patients. We show that ectopic expression of FAM83D in human mammary epithelial cells promotes cell proliferation, migration and invasion along with epithelial-mesenchymal transition (EMT). Ablation of FAM83D in breast cancer cells induces apoptosis and consequently inhibits cell proliferation and colony formation. Mechanistic studies reveal that overexpression of FAM83D downregulates FBXW7 expression levels through a physical interaction, which results in elevated protein levels of oncogenic substrates downstream to FBXW7, such as mTOR, whose inhibition by rapamycin can suppress FAM83D-induced cell migration and invasion. The results demonstrate that FAM83D has prognostic value for breast cancer patients and is a novel oncogene in breast cancer development that at least in part acts through mTOR hyper-activation by inhibiting FBXW7.

}, keywords = {Apoptosis, Breast Neoplasms, Cell Cycle Proteins, Cell Growth Processes, Cell Line, Chromosomal Proteins, Down-Regulation, Epithelial-Mesenchymal Transition, F-Box Proteins, Genes, Humans, Microtubule-Associated Proteins, Non-Histone, Prognosis, Transfection, Tumor, Tumor Suppressor, Ubiquitin-Protein Ligases}, issn = {1949-2553}, doi = {10.18632/oncotarget.1581}, author = {Wang, Zeran and Liu, Yueyong and Zhang, Pengju and Zhang, Weiguo and Wang, Weijing and Curr, Kenneth and Wei, Guangwei and Jiang-Hua Mao} } @article {204, title = {Hematein, a casein kinase II inhibitor, inhibits lung cancer tumor growth in a murine xenograft model.}, journal = {Int J Oncol}, volume = {43}, year = {2013}, month = {2013 Nov}, pages = {1517-22}, abstract = {

Casein kinase II (CK2) inhibitors suppress cancer cell growth. In this study, we examined the inhibitory effects of a novel CK2 inhibitor, hematein, on tumor growth in a murine xenograft model. We found that in lung cancer cells, hematein inhibited cancer cell growth, Akt/PKB Ser129 phosphorylation, the Wnt/TCF pathway and increased apoptosis. In a murine xenograft model of lung cancer, hematein inhibited tumor growth without significant toxicity to the mice tested. Molecular docking showed that hematein binds to CK2α in durable binding sites. Collectively, our results suggest that hematein is an allosteric inhibitor of protein kinase CK2 and has antitumor activity to lung cancer.

}, keywords = {Animals, Apoptosis, Blotting, Casein Kinase II, Cultured, Enzyme Inhibitors, Female, Hematoxylin, Humans, Immunoenzyme Techniques, Inbred BALB C, Lung Neoplasms, Mice, Phosphorylation, Proto-Oncogene Proteins c-akt, T Cell Transcription Factor 1, Tumor Cells, Western, Wnt Proteins, Xenograft Model Antitumor Assays}, issn = {1791-2423}, doi = {10.3892/ijo.2013.2087}, author = {Hung, Ming-Szu and Xu, Zhidong and Chen, Yu and Smith, Emmanuel and Jiang-Hua Mao and Hsieh, David and Lin, Yu-Ching and Yang, Cheng-Ta and Jablons, David M and You, Liang} } @article {194, title = {Mass spectrometry imaging for in situ kinetic histochemistry.}, journal = {Sci Rep}, volume = {3}, year = {2013}, month = {2013}, pages = {1656}, abstract = {

Tissues are composed of diverse cell subpopulations each with distinct metabolic characteristics that influence overall behavior. Unfortunately, traditional histopathology imaging techniques are {\textquoteright}blind{\textquoteright} to the spatially ordered metabolic dynamics within tissue. While mass spectrometry imaging enables spatial mapping of molecular composition, resulting images are only a static snapshot in time of molecules involved in highly dynamic processes; kinetic information of flux through metabolic pathways is lacking. To address this limitation, we developed kinetic mass spectrometry imaging (kMSI), a novel technique integrating soft desorption/ionization mass spectrometry with clinically accepted in vivo metabolic labeling of tissue with deuterium to generate images of kinetic information of biological processes. Applied to a tumor, kMSI revealed heterogeneous spatial distributions of newly synthesized versus pre-existing lipids, with altered lipid synthesis patterns distinguishing region-specific intratumor subpopulations. Images also enabled identification and correlation of metabolic activity of specific lipids found in tumor regions of varying grade.

}, keywords = {Cell Line, Equipment Design, Equipment Failure Analysis, Experimental, Humans, Lipids, Mass Spectrometry, Molecular Imaging, Neoplasms, Tumor}, issn = {2045-2322}, doi = {10.1038/srep01656}, author = {Louie, Katherine B and Bowen, Benjamin P and McAlhany, Stephanie and Huang, Yurong and Price, John C and Jiang-Hua Mao and Hellerstein, Marc and Northen, Trent R} } @article {82, title = {CD36 repression activates a multicellular stromal program shared by high mammographic density and tumor tissues}, journal = {Cancer Discov}, volume = {2}, year = {2012}, month = {2012 Sep}, pages = {826-39}, abstract = {

UNLABELLED: Although high mammographic density is considered one of the strongest risk factors for invasive breast cancer, the genes involved in modulating this clinical feature are unknown. Tissues of high mammographic density share key histologic features with stromal components within malignant lesions of tumor tissues, specifically low adipocyte and high extracellular matrix (ECM) content. We show that CD36, a transmembrane receptor that coordinately modulates multiple protumorigenic phenotypes, including adipocyte differentiation, angiogenesis, cell-ECM interactions, and immune signaling, is greatly repressed in multiple cell types of disease-free stroma associated with high mammographic density and tumor stroma. Using both in vitro and in vivo assays, we show that CD36 repression is necessary and sufficient to recapitulate the above-mentioned phenotypes observed in high mammographic density and tumor tissues. Consistent with a functional role for this coordinated program in tumorigenesis, we observe that clinical outcomes are strongly associated with CD36 expression.

SIGNIFICANCE: CD36 simultaneously controls adipocyte content and matrix accumulation and is coordinately repressed in multiple cell types within tumor and high mammographic density stroma, suggesting that activation of this stromal program is an early event in tumorigenesis. Levels of CD36 and extent of mammographic density are both modifiable factors that provide potential for intervention.

}, keywords = {Adipocytes, Animals, Antigens, Breast Neoplasms, CD36, Cell Differentiation, Female, Humans, Knockout, Mammography, Mice, Risk Factors, Signal Transduction, Stromal Cells}, issn = {2159-8290}, doi = {10.1158/2159-8290.CD-12-0107}, author = {DeFilippis, Rosa Anna and Hang Chang and Dumont, Nancy and Rabban, Joseph T and Chen, Yunn-Yi and Fontenay, Gerald V and Berman, Hal K and Gauthier, Mona L and Zhao, Jianxin and Hu, Donglei and Marx, James J and Tjoe, Judy A and Ziv, Elad and Febbraio, Maria and Kerlikowske, Karla and Parvin, Bahram and Tlsty, Thea D} } @article {179, title = {Progressive genomic instability in the FVB/Kras(LA2) mouse model of lung cancer.}, journal = {Mol Cancer Res}, volume = {9}, year = {2011}, month = {2011 Oct}, pages = {1339-45}, abstract = {

Alterations in DNA copy number contribute to the development and progression of cancers and are common in epithelial tumors. We have used array Comparative Genomic Hybridization (aCGH) to visualize DNA copy number alterations across the genomes of lung tumors in the Kras(LA2) model of lung cancer. Copy number gain involving the Kras locus, as focal amplification or whole chromosome gain, is the most common alteration in these tumors and with a prevalence that increased significantly with increasing tumor size. Furthermore, Kras amplification was the only major genomic event among the smallest lung tumors, suggesting that this alteration occurs early during the development of mutant Kras-driven lung cancers. Recurring gains and deletions of other chromosomes occur progressively more frequently among larger tumors. These results are in contrast to a previous aCGH analysis of lung tumors from Kras(LA2) mice on a mixed genetic background, in which relatively few DNA copy number alterations were observed regardless of tumor size. Our model features the Kras(LA2) allele on the inbred FVB/N mouse strain, and in this genetic background, there is a highly statistically significant increase in level of genomic instability with increasing tumor size. These data suggest that recurring DNA copy alterations are important for tumor progression in the Kras(LA2) model of lung cancer and that the requirement for these alterations may be dependent on the genetic background of the mouse strain.

}, keywords = {Animal, Animals, Cell Line, Chromosome Aberrations, Disease Models, Disease Progression, DNA, DNA Copy Number Variations, Gene Dosage, Gene Expression Regulation, Genes, Genomic Instability, Inbred C57BL, Lung Neoplasms, Mice, Neoplasm, Neoplastic, Proto-Oncogene Proteins p21(ras), ras, Tumor}, issn = {1557-3125}, doi = {10.1158/1541-7786.MCR-11-0219}, author = {To, Minh D and Quigley, David A and Jiang-Hua Mao and Del Rosario, Reyno and Hsu, Jeff and Hodgson, Graeme and Jacks, Tyler and Balmain, Allan} } @article {177, title = {Radiation acts on the microenvironment to affect breast carcinogenesis by distinct mechanisms that decrease cancer latency and affect tumor type.}, journal = {Cancer Cell}, volume = {19}, year = {2011}, month = {2011 May 17}, pages = {640-51}, abstract = {

Tissue microenvironment is an important determinant of carcinogenesis. We demonstrate that ionizing radiation, a known carcinogen, affects cancer frequency and characteristics by acting on the microenvironment. Using a mammary chimera model in which an irradiated host is transplanted with oncogenic Trp53 null epithelium, we show accelerated development of aggressive tumors whose molecular signatures were distinct from tumors arising in nonirradiated hosts. Molecular and genetic approaches show that TGFβ mediated tumor acceleration. Tumor molecular signatures implicated TGFβ, and genetically reducing TGFβ abrogated the effect on latency. Surprisingly, tumors from irradiated hosts were predominantly estrogen receptor negative. This effect was TGFβ independent and linked to mammary stem cell activity. Thus, the irradiated microenvironment affects latency and clinically relevant features of cancer through distinct and unexpected mechanisms.

}, keywords = {Animal, Animals, Breast Neoplasms, Cell Transformation, Dose-Response Relationship, Epithelial Cells, Estrogen, Female, Gene Expression Profiling, Gene Expression Regulation, Gene Regulatory Networks, Inbred BALB C, Knockout, Mammary Glands, Mice, Neoplasms, Neoplastic, Radiation, Radiation Chimera, Radiation-Induced, Reaction Time, Receptors, Time Factors, Transforming Growth Factor beta1, Tumor Burden, Tumor Microenvironment, Tumor Suppressor Protein p53, Whole-Body Irradiation}, issn = {1878-3686}, doi = {10.1016/j.ccr.2011.03.011}, author = {Nguyen, David H and Oketch-Rabah, Hellen A and Illa-Bochaca, Irineu and Geyer, Felipe C and Reis-Filho, Jorge S and Jiang-Hua Mao and Ravani, Shraddha A and Zavadil, Jiri and Borowsky, Alexander D and Jerry, D Joseph and Dunphy, Karen A and Seo, Jae Hong and Haslam, Sandra and Medina, Daniel and Barcellos-Hoff, Mary Helen} }