ESMO Consensus conferences: guidelines on malignant lymphoma. part 2: marginal zone lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma

To complement the existing treatment guidelines for all tumour types, ESMO organizes consensus conferences to focus on specific issues in each type of tumour. In this setting, a consensus conference on the management of lymphoma was held on 18 June 2011 in Lugano, next to the 11th International Conference on Malignant Lymphoma. The conference convened ∼30 experts from all around Europe, and selected six lymphoma entities to be addressed; for each of them, three to five open questions were to be addressed by the experts. For each question, a recommendation should be given by the panel, referring to the strength of the recommendation based on the level of evidence. This consensus report focuses on the three less common lymphoproliferative malignancies: marginal zone lymphoma, mantle cell lymphoma, and peripheral T-cell lymphomas. A first report had focused on diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukaemia.

Using whole-exome sequencing to identify inherited causes of autism

Despite significant heritability of autism spectrum disorders (ASDs), their extreme genetic heterogeneity has proven challenging for gene discovery. Studies of primarily simplex families have implicated de novo copy number changes and point mutations, but are not optimally designed to identify inherited risk alleles. We apply whole-exome sequencing (WES) to ASD families enriched for inherited causes due to consanguinity and find familial ASD associated with biallelic mutations in disease genes (AMT, PEX7, SYNE1, VPS13B, PAH, and POMGNT1). At least some of these genes show biallelic mutations in nonconsanguineous families as well. These mutations are often only partially disabling or present atypically, with patients lacking diagnostic features of the Mendelian disorders with which these genes are classically associated. Our study shows the utility of WES for identifying specific genetic conditions not clinically suspected and the importance of partial loss of gene function in ASDs.

249 BIOPHYSICAL AND BIOCHEMICAL CHARACTERISTICS OF ALPACA SEMEN AFTER COLLECTION BY ELECTROEJACULATION

The collection of alpaca semen presents difficulties because of the characteristics of mounts and copulation time in addition to the high viscosity of semen. The biophysical and biochemical characteristics of alpaca semen were investigated. Semen samples from four adult males from 6 to 7 years of age were collected using an electroejaculation technique. The biophysical parameters measured in seminal plasma included volume, color, sperm concentration, motility, and viscosity, and the biochemical parameters included pH and glucose, calcium, triglyceride, cholesterol, high-density lipoprotein cholesterol, total protein, albumin, alanine transaminase, alkaline phosphatase, and γ-glutamyltranspeptidase concentrations. The mean time for semen collection was 10.3 ± 1.5 min; the volume varied from 1.2 to 3.8 and the colour from clear to milky, and pH was 7.4 ± 0.03. Mean concentration of spermatozoa was 69.3 ± 193 million mL–1, and motility was 52.4 ± 9.7%. Biochemical parameters were glucose (mg dL–1) 8.22 ± 0.77; cholesterol (mg dL–1) 79.78 ± 5.64; triglycerides (mg dL–1) 44.12 ± 7.38; high-density lipoprotein cholesterol (mg dL–1) 4.73 ± 0.30; total protein (g dL–1) 2.36 ± 0.15; albumin (g dL–1) 0.97 ± 0.33; calcium (mg dL–1) 11.77 ± 1.74; alanine transaminase (U L–1) 17.92 ± 9.09; alkaline phosphatase (U L–1) 288.76 ± 279.59; and γ-glutamyltranspeptidase (U L–1) 89.62 ± 39.09. These results provide information on the biophysical and biochemical characteristics of alpaca semen collected by electroejaculation, with variable results in the enzymatic components.

Soybean oil: a potentially new intravascular perfusate

BACKGROUND

Given that micelles of lipids are colloids, the hypothesis was generated that the rapid administration of large volumes of soybean oil micelles would be an effective perfusion fluid. We also hypothesized that oxygen loading would be enhanced due to the greater solubility of oxygen in lipids compared to water.

METHODS

A 100% lethal mouse model of blood loss was used to compare the ability of soybean oil micelles to that of Ringer's lactate, blood and other fluids, with respect to raising and maintaining the blood pressure for one hour. Oxygen on- and off-loading of various concentrations of soybean oil micelles was determined using mass spectroscopy. Nitric oxide uptake by micelles was also determined in a similar fashion.

RESULTS

A 20% soybean oil emulsion was superior to Ringer's lactate in raising and maintaining blood pressure. A 20% soybean oil emulsion with 5% albumin added was superior to shed blood as well as solutions comprised of 5% albumin added to either normal saline or Ringer's lactate. There was a linear relationship between oxygen content and micelle concentration between 10% and 30%. Off-loading of oxygen from the micelles was nearly as fast as off-loading from water. Nitric oxide also loaded preferentially onto soybean oil micelles.

CONCLUSIONS

(1) Soybean oil emulsions were superior to other fluids in restoring and maintaining the blood pressure; (2) oxygen-carrying ability of soybean oil micelles exceeds that of water and follows Henry's law between 10% and 30% w/v oil content; (3) nitric oxide was carried by the micelles; (4) animals receiving soybean oil micelles did not exhibit fat embolization; (5) colloids comprised of soybean oil-containing micelles may be used to replace blood loss and may be used to deliver oxygen and other potentially therapeutic gases such as nitric oxide to tissues.

Cost analysis of real-time polymerase chain reaction microbiological diagnosis in patients with septic shock

Antibiotic treatment for septic shock is generally prescribed on an empirical basis using broad-spectrum antibiotics. Molecular diagnostic techniques can detect the presence of microbial DNA in blood within a few hours and facilitate early, targeted treatment. The aim of this study was to evaluate the economic impact of a real-time polymerase chain reaction technique, LightCycler SeptiFast (LSC), in patients with sepsis. A cost-minimisation study was carried out in patients admitted with a diagnosis of severe sepsis or septic shock to the intensive care unit of a university hospital. The stay in the intensive care unit, hospital admission, 28-day and six-month mortality, and the economic cost of the clinical process were also evaluated. The study involved 48 patients in the LSC group and 54 patients in the control group. The total cost was €42,198 in the control group versus €32,228 in the LCS group with statistically significant differences (P <0.05), giving rise to an average net saving of €9970 per patient. The mortality rate was similar in both groups. The main finding of this study was the significant economic saving afforded by the use of the LCS technique, due to the shortening of intensive care unit stay and the use of fewer antibiotics.

Electrosurgery in patients with implantable electronic cardiac devices (pacemakers and defibrillators)

The electrosurgical unit is a very useful tool widely used in dermatology to treat benign and malignant skin lesions and to achieve hemostasis during surgery. However, precautions are required when this technique is used in patients with implantable electronic cardiac devices (IECD), such as pacemakers and defibrillators, because electromagnetic interference produced by the tool may cause such devices to malfunction. Before using electrosurgery in patients with IECDs, it is essential to ascertain the type of implanted device and the patient's level of dependence on it. The location of the skin lesion to be treated with respect to the device should also be assessed. Bipolar pacemakers are more resistant to interference. Appropriate monitoring and the use of bipolar forceps are recommended.

Transcriptome profiling of UPF3B/NMD-deficient lymphoblastoid cells from patients with various forms of intellectual disability

The nonsense-mediated mRNA decay (NMD) pathway was originally discovered by virtue of its ability to rapidly degrade aberrant mRNAs with premature termination codons. More recently, it was shown that NMD also directly regulates subsets of normal transcripts, suggesting that NMD has roles in normal biological processes. Indeed, several NMD factors have been shown to regulate neurological events (for example, neurogenesis and synaptic plasticity) in numerous vertebrate species. In man, mutations in the NMD factor gene UPF3B, which disrupts a branch of the NMD pathway, cause various forms of intellectual disability (ID). Using Epstein Barr virus-immortalized B cells, also known as lymphoblastoid cell lines (LCLs), from ID patients that have loss-of-function mutations in UPF3B, we investigated the genome-wide consequences of compromised NMD and the role of NMD in neuronal development and function. We found that ~5% of the human transcriptome is impacted in UPF3B patients. The UPF3B paralog, UPF3A, is stabilized in all UPF3B patients, and partially compensates for the loss of UPF3B function. Interestingly, UPF3A protein, but not mRNA, was stabilised in a quantitative manner that inversely correlated with the severity of patients' phenotype. This suggested that the ability to stabilize the UPF3A protein is a crucial modifier of the neurological symptoms due to loss of UPF3B. We also identified ARHGAP24, which encodes a GTPase-activating protein, as a canonical target of NMD, and we provide evidence that deregulation of this gene inhibits axon and dendrite outgrowth and branching. Our results demonstrate that the UPF3B-dependent NMD pathway is a major regulator of the transcriptome and that its targets have important roles in neuronal cells.

Identification of predictive circulating biomarkers of bevacizumab-containing regimen efficacy in pre-treated metastatic colorectal cancer patients

BACKGROUND

To identify whether circulating levels of angiogenesis-related factors may be predictive of bevacizumab efficacy in pre-treated metastatic colorectal cancer (mCRC) patients.

METHODS

Pre-treatment serum levels of 24 cytokines were measured using a multiplex bead assay (MBA) in 32 pre-treated mCRC patients treated with irinotecan plus bevacizumab-based salvage therapy. Macrophage-derived chemokine (MDC), interleukins (ILs) 8 and 6 levels were also validated by enzyme-linked immunosorbent assay (ELISA) at different time points during therapy.

RESULTS

Higher epidermal growth factor (EGF) and MDC baseline levels (2.2- and 1.4-fold, respectively) and lower IL-10, IL-6 and IL-8 levels (0.2-, 0.6-, and 0.6-fold, respectively, P<0.05) were observed in patients responding to therapy. Baseline levels of these five serum factors compose a risk signature that may define the subset of patients most likely to benefit from bevacizumab-based therapy in terms of response rate and survival times. A positive correlation was found between MBA and ELISA results (P<0.01). Treatment exposure increased MDC and had opposite effects on IL-8 levels, which were decreased (P<0.05).

CONCLUSION

This study suggests that a set of inflammatory and angiogenesis-related serum markers may be associated with the efficacy of bevacizumab-containing regimen.

Mechanical actuation of ion channels using a piezoelectric planar patch clamp system

High-throughput screening of ion channels is now possible with the advent of the planar patch clamp system. This system drastically increases the number of ion channels that can be studied, as multiple ion channel experiments can now be conducted in parallel. However, due to tedious, usually pressure-driven mechanotransduction techniques, there has been a slow integration of this technology into the field of mechanosensitive ion channels. By implementing a piezoelectric quartz substrate into a planar patch clamp system, we show that the patch clamp substrate itself can be used to mechanically actuate ion channels. The piezoelectric substrate transduces an external, applied electric field into a mechanical tension, so precise actuation of the membrane can be accomplished. By applying this electric field only to the outer edges of the substrate, no ulterior electric field is created in the vicinity of the membrane during actuation. Further, with resonant frequencies ranging from 1 kHz to 200 MHz, quartz substrates can be used to apply a wide range of time-varying tensions to cell membranes. This will allow for new and instructive investigations into the dynamic mechanotransductive properties of ion channels.

P3-07-45: Role of SPECT-CT in Detecting Sentinel Lymph Nodes in Patients with Ipsilateral Breast Cancer Recurrence and Previous Axillary Lymph Node Dissection

Background: Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence and a previous axillary lymph node dissection (ALND) is still controversial. Although previous reports have showed extra-axillary drainage in 40–60% of patients, the clinical significance of this drainage is unknown. SPECT-CT may help to localize aberrant sentinel nodes.

Material and Methods: Between 2008 and 2011, SLN were performed in 25 patients with ipsilateral breast cancer recurrence and previous ALND. The day before surgery 99Tc nanocolloid was injected retroareolar in the affected breast and injected intratumorally when the recurrence was after a mastectomy. Linfoscintigraphy was obtained in all patients and a SPECT-CT was performed in all cases even when planar images showed no drainage. During surgery, the sentinel node was identified using a gamma probe. During the procedure the surgeon decided to remove the sentinel node if it was considered technically feasible. The project was IRB approved and all patients signed an informed consent.

Results: Records from the previous ALND showed 9 patients with positive axillary nodes with a mean of 19 (range 10–35) lymph nodes excised. Twenty four patients had undergone a lumpectomy and 1 patient a mastectomy. After the injection, the SPECT-CT showed at least one hot spot in 20 patients, with a mean of 1.8 hot spots (range 0–5). Hot spots on SPECT-CT were located as follows: in 10 patients axillary, 1 subclavicular, 7 internal mammary, 1 intramammary, 1 mediastinic and 7 patients had a contralateral axillary hot spot. In 4 patients we don't found any hot spot on SPECT-CT. After excising 2 axillary nodes and 1 intrammary node in 3 patients, the pathologist didn't identify any lymph node in the hot spot removed. This are considered as false positives (15%). In 4 patients although hot spots were identified, sentinel node dissection wasn't performed because it was arguable the benefit for the patients taking into account the location and number of hot spots.

Optimization of Conducting Polymer Synthesis for Battery Applications

The evolution of the capacity to store electrical charges of electrogenerated polypyrrole and polythiophene films, as a function of the parameters of synthesis (electrical potential, solvent, Monomer concentration and temperature) was analyzed. The polymer production was followed by “ex situ” ultramicrogravimetry. The stored charge in each film was controlled by voltammetry and chronoamperometry, in the background electrolyte (in absence of Monomer). The charge storage ability was calculated from the ratio between stored charge and polymer mass adhered to the electrode. The charge storage ability of an electrogenerated film decreases several times when one of the parameters of synthesis: potential of polymerization, temperature, concentration of monomer or donor number of the solvent, increase. The change on the polymer property when the conditions of synthesis shift, points to a mixed polymerization-degradation process during polymer growth. The knowledge of those variations allows to optimize the conditions of synthesis to generate conducting polymers for specific batteries applications.

Association of RRM1 -37A>C polymorphism with clinical outcome in colorectal cancer patients treated with gemcitabine-based chemotherapy

BACKGROUND

To investigate whether single nucleotide polymorphisms (SNPs) in gemcitabine (GMB) metabolism genes were associated with clinical outcome in pre-treated metastatic colorectal cancer (mCRC) patients.

PATIENTS AND METHODS

SNPs of hCNT1, hENT1, CDA, dCTD and RRM1 genes were evaluated in 95 mCRC patients and detected using TaqMan genotyping assays. Association of genotypes with overall response rate (ORR), time to progression (TTP) and overall survival (OS) was tested by univariate and multivariate analysis. RRM1 -37A>C polymorphism was correlated with GMB IC50 value and with the RRM1 gene expression level in CRC cell lines.

RESULTS

The ORR was 38.9%. The median TTP and OS were 4 and 14.3 months, respectively. By multivariate analysis, patients carrying the RRM1 -37CC genotype or the CDA A-76 C-containing allele had a significantly higher likelihood of achieving a tumour response. RRM1 -37A>C polymorphism remained associated with clinical efficacy (TTP). In vitro experiments, in CRC cell lines, showed that the RRM1 A-37C genotype was associated with the levels of RRM1 expression and with GMB IC50 values. Finally, the down-regulation of RRM1 with a specific siRNA strongly influenced GMB sensitivity.

CONCLUSION

RRM1 -37A>C polymorphism may represent a useful biomarker to select mCRC patients most likely to benefit from GMB-based salvage therapy.