P13.22 Menglia: an innovative approach to liquid biopsies in glioma patients

BACKGROUND

Gliomas are the second most frequent primary brain tumor. Since 2016 gliomas are classified according to histological, and molecular features such as IDH status and 1p19q codeletion. Recently oncological research has focused on liquid biopsies to reduce the need for invasive diagnostic tests. Cerebrospinal fluid (CSF) is the principal source of brain tumor biomarkers. Modern technologies currently allow us to analyze proteomic and metabolomic tumor profiles, in order to find new biomarkers without being constrained by a priori hypothesis. Several data from the literature also suggests that inflammatory cells and cytokines in tumors contribute to tumor growth, progression and immunosuppression. The possibility of simultaneously testing different inflammatory molecules on the biological fluids could lead to the identification of new biological markers with prognostic and predictive value for treatment response.

STUDY OBJECTIVES

- Identification of protein and/or lipid biomarkers specific to the glioma subgroup among those under analysis. - Identification of tumor group- and subgroup-specific CSF and/or serum inflammatory biomarkers among those tested. - Correlation of biomarkers with Progression Free Survival (PFS), Overall Survival (OS).

ELIGIBILITY CRITERIA

- Patients with a radiological suspected diagnosis of glioma eligible for surgery. - Age ≥ 18 years. - Availability of histological samples, CSF, blood and urine. - Patients with unconfirmed histological diagnosis of glioma will be excluded. - Patients who have never received any systemic or local treatment for CNS diseases.

STUDY DESIGN

This is a prospective monocentric study involving mass spectrometry analysis for characterization of proteins and metabolites and ELISA analysis for the characterization of different cytokines in parallel anonymized biological samples consisting of tumor tissue, CSF, blood and urine from glioma patients, divided into three different molecular subtypes: 1p19q codelet/IDH mutated, 1p19q non-codelet/IDH mutated and 1p19q non-codelet/IDH wt. Biological samples will be taken at surgery, at 24–48 h after surgery and every 3 months up to 1 year. The control group will include patients with subarachnoid hemorrhage or hydrocephalus, either undergoing external ventricular shunting or undergoing ventricular catheter placement/revision surgery.

STUDY ANALYSIS

Data interpretation will be based on a statistical analysis of the data, applying tools such as Principal Component Analysis (PCA) Weighted Correlation Network Analysis (WGNCA), Multiple Venn Diagram, T-Test, ANOVA, Clustering and Gene Ontology Enrichment, non-parametric Mann-Whitney test. For the assessment of clinical outcome, survival curves will be compared between different groups of patients who share a similar protein/metabolomic/inflammatory profile.

Zoledronic acid boosts γδ T-cell activity in children receiving αβ+ T and CD19+ cell-depleted grafts from an HLA-haplo-identical donor

We demonstrated that γδ T cells of patients given HLA-haploidentical HSCT after removal of αβ⁺ T cells and CD19⁺ B cells are endowed with the capacity of killing leukemia cells after ex vivo treatment with zoledronic acid (ZOL). Thus, we tested the hypothesis that infusion of ZOL in patients receiving this type of graft may enhance γδ T-cell cytotoxic activity against leukemia cells. ZOL was infused every 28 d in 43 patients; most were treated at least twice. γδ T cells before and after ZOL treatments were studied in 33 of these 43 patients, till at least 7 mo after HSCT by high-resolution mass spectrometry, flow-cytometry, and degranulation assay. An induction of Vδ2-cell differentiation, paralleled by increased cytotoxicity of both Vδ1 and Vδ2 cells against primary leukemia blasts was associated with ZOL treatment. Cytotoxic activity was further increased in Vδ2 cells, but not in Vδ1 lymphocytes in those patients given more than one treatment. Proteomic analysis of γδ T cells purified from patients showed upregulation of proteins involved in activation processes and immune response, paralleled by downregulation of proteins involved in proliferation. Moreover, a proteomic signature was identified for each ZOL treatment. Patients given three or more ZOL infusions had a better probability of survival in comparison to those given one or two treatments (86% vs. 54%, respectively, p = 0.008). Our data indicate that ZOL infusion in pediatric recipients of αβ T- and B-cell-depleted HLA-haploidentical HSCT promotes γδ T-cell differentiation and cytotoxicity and may influence the outcome of patients.

In vitro studies on the effect of some chemicals on the growth and sporification of Penicillium expansum and Botrytis cinerea

Penicillium expansum and Botrytis cinerea are among the pathogens most frequently affecting apples and grapes after harvest, respectively. We studied the behaviour of these moulds when subjected to different concentrations of methanol (MeOH) and dimethyl sulfoxide (DMSO) as a alternative method to fungicides in controlling postharvest decay of horticultural products. The experiments were performed with 5 cm Petri dishes containing PDA amended with 0, 5, 10, 20, 30, 40 or 50 microL/mL of the two tested chemicals. Freshly prepared conidia of B. cinerea and P. expansum were sown onto the media and then kept into an incubation chamber at 21 degrees C up to 3 and 6 days, respectively. Daily, the colony forming units (cfu), the colony diameter and the degree of sporification were monitored. Compared to the control, both chemicals affected the growth rate of the two pathogens. The P. expansum and B. cinerea cfu value was not significantly inhibited but the colony diameter and the sporification degree decreased when concentration was raised. B. cinerea cultured on DMSO showed a significant drop of sporification up to the tested concentration of 10 microL/mL, and a complete inhibition of cfu when the concentration was higher than 20 microL/mL.

In vitro studies on the effect of some chemicals on the growth and sporification of Penicillium digitatum and P. italicum

The behaviour of Penicillium digitatum and P. italicum was investigated when subjected to different concentrations of methanol (MeOH) and dimethyl sulfoxide (DMSO). The experiments were performed in 9 cm Petri dishes containing PDA amended with 0, 5, 10, 20, 30, 40 or 50 microL/mL of each of the single or combined chemicals. Daily, the formed colonies (cfu), the colony diameter and the degree of sporification were monitored during incubation at 20 degrees C for 5 day. Additionally, the pathogen development and its performance were studied by scanning electron microscopy (SEM). According to the chemical, the mycelium growth rate was affected differently and, compared to the control, only MeOH inhibited the expansion of the colony diameter. This effect was more pronounced for P. italicum. A nearly linear drop of cfu was observed as the concentration of the two chemicals was raised, and a complete inhibition of the two pathogens was attained with 50 microL/mL MeOH. With respect to the sporification degree the two pathogens were influenced similarly, but the tested compounds had opposite effects. Indeed, with MeOH, sporification took place earlier (24-36 h postinoculation) compared to the control (60 h), while during the whole experiment, DMSO at concentrations higher than 0.5 microL/mL, drastically inhibited the sporification. SEM observations of P. digitatum growth on DMSO amended media evidenced a marked increase of mycelium branching and alterations to the conidiophore, while MeOH reduced the mycelium length and fastened the conidiophore formation. The combination of the two compounds produced a synergistic interaction reducing by 40% the concentration required to inhibit completely the germination and growth of P. digitatum.

Synergic interactions between 2-deoxy-D-glucose and Candida saitoana enhances citrus green mould control

The activity of 2-deoxy-D-gLucose (2-DG) alone or in combination with a biocontrol yeast (Candida saitoana, strain 8C) was evaluated in vitro and in vivo against citrus green mould (Penicillium digitatum Sacc.). The in vitro assays were performed on amended potato dextrose agar (PDA) containing 0, 1.5, 3.0, 6.0, 15.0, 30.0 or 60.0 mM of 2-DG. P. digitatum conidia were sown on the amended media and growth inhibition occurred starting from 6.0 mM. A nearly total inhibition of the growth and spore germination occurred with 60.0 mM of 2-DG. The antagonist was not affected by any of the 2-DG concentrations employed and the amended plates resulted well colonized within 2 d post-treatment. In vivo assays were carried out with 'Hamlin' oranges, inoculated with P. digitatum 24 h before treating with: the antagonist; the above reported concentrations of 2-DG, or by combining the two treatments. Seven days post-treatment the inhibition activity exerted by 3.0, 6.0, 15.0, 30.0 and 60.0 mM of 2-DG combined with the yeast was 15, 37, 42, 63 and 84%, respectively. While that exerted by the antagonist was 22% and that by the different concentrations of 2-DG were 7, 11, 27, 42 and 57%, respectively. Compared to single treatments, the co-application significantly and in a synergic mode improved the control of decay. Alterations to the hyphae were observed by SEM when the pathogen was cultured on amended media and into the wounds of inoculated oranges.

Host involvement in the improved decay control following NaHCO3 co-application with imazalil

In order to improve the treatment efficiency of conventional synthetic fungicides we investigated the relationship between the decay control efficacy and the concentration of imazalil (IMZ) when the fungicide was co-applied with NaHCO3 (SBC) for 2 min. Experiments were carried out using lemon fruit (Citrus limon (L.) Burm .f. cv Verna), either wounded or not before the treatment with 0, 50, 100, 250 or 1000 microg mL(-1) IMZ or the co-application of 3% SBC with 0, 50, 100 and 250 microg mL(-1) IMZ. Wounded lemons were used to simulate and study, the host-fungicide interaction in a potential infection court as affected by the SBC-IMZ coapplication. The occurrence of natural decay was monitored after 7, 14 and 30 days of storage at 8 degrees C and after a 6 day simulated marketing period (SMP) at 20 degrees C and 75% RH. During storage and SMP a comparable efficacy to 1000 microg mL(-1) IMZ, in controlling natural decay development, was obtained with a ten times lesser amount of IMZ when co-applied with SBC. Studies performed following the SBC-IMZ co-application evidenced the induction of natural resistance along with structural changes and an increase of IMZ allocated in the potential infection courts.

Host-pathogen-biocontrol agent interaction as affected by sequential application of Na2CO3 and CaCl2

Among the alternatives to synthetic postharvest fungicides encouraging results have been reported with biocontrol agents, and on Citrus fruits, their efficacy was improved when co-applied with GRAS compounds or with physical means. Still, the reason for this increased efficacy has not been explained and therefore a study was performed using orange fruit (Citrus sinensis Osbec. cv 'Washington navel') as host, P. digitatum as the pathogen, a yeast (Pichia guiliermondii, isolate 5A) as the biocontrol agent, white 2% Na2CO3 (SC) and 1% CaCl2 were employed as GRAS compounds. When treatments were combined salts were applied sequentially, and SC preceded CaCl2 followed by the yeast. As a result of large scale trait with inoculated and un-inoculated fruit a clear beneficial interaction occurred when treatments were combined. SC exerted a direct fungistatic activity and an indirect one by inducing scoparone in host tissue. Also the isolate A5 induced the phytoalexin accumulation and when combined with SC a greater accumulation occurred within the first 7 days post-treatment. The application of CaCl2 alone had no effect on pathogenesis, while when combined with SC or with the yeast, decay was towered. The yeast growth on an amended medium was negatively affected by the addition of SC; while in vivo this effect was missing. The antagonist growth in vivo was enhanced when applied together with 1% CaCl2 also when applied with SC. The results reported improve our knowledge on the complex interactions among host, pathogen and the antagonist as affected by SC and CaCl2.

Treatments with acetic acid followed by curing reduce postharvest decay on Citrus fruit

Citrus fruit are susceptible to many postharvest diseases and disorders, but Penicillium digitatum and Penicillium italicum are the most common and serious pathogens during storage and marketing. The continuous employ in packing houses of synthetic fungicides such as imazalil (IMZ) or thiabendazote for the control of these pathogens is promoting the selection of resistant biotypes. These considerations together with an increased attention for human health and the environment have multiplied the studies on new ecological technologies. In recent years researchers studies focused on alternatives to the chemical control of post-harvest decay, such as the utilization of GRAS compounds as well as physical methods. In the present study is reported the sequential use of acetic acid (AAC) followed by curing. The lemon variety "Verna" and the orange variety "Jaffa", naturally inoculated, were treated with vapours of AAC performed at three different concentration (15, 25 and 50 microL/L) for 15 minutes, after an incubation period of 24 hours at 27 degrees C and 90% relative humidity (RH). After treatments fruits were cured at 36 degrees C for 36 hours with 90% RH and subsequently stored at 8 degrees C and 90% of RH for eight weeks. Both citrus varieties were also treated with IMZ at a concentration of 200 mL/HL. At the end of the experiment decay and weight loss were evaluated. After 8 weeks of storage, in the lemon variety, the lowest percentage of infected wounds was 1.5% for both the fruit treated with IMZ or with AAC at 25 microL/L. Fruit treated with 15 mciroL/L or untreated (control) showed similar results with 13.6% and 16.6% of rotted fruit respectively. Different results were obtained with the orange variety, in this case the synthetic fungicide was the most effective at the end of the storage period, with 18.0% of decay. AAC treatments were not a successful as on lemons, the best result was achieved even in this case with AAC performed at 25 pL/L, but with 39.9% of decay. In both species the weight loss was not affected by the treatments. These results show that a good control of postharvest decay could be achieved, on lemon fruit, by combining the effect of a GRAS compound such as AAC with curing. Conversely the results obtained, by applying this control method to the orange variety were not so promising. Further researches are needed to shed light on the different behaviour between the two species.

New approach for rapid detection of known hemoglobin variants using LC-MS/MS combined with a peptide database

The identification of hemoglobin (Hb) variants is usually performed by means of different analytical steps and methodologies. Phenotypic methods, such as gel electrophoresis and high performance liquid chromatography, are used to detect the different electrophoretic or chromatographic behaviors of hemoglobin variants in comparison to HbA0 used as a control. These data often need to be combined with mass spectrometry analyses of intact globins and their tryptic peptide mixtures. As an alternative to a 'step-by-step' procedure, we have developed a 'single step' approach for the identification of Hb variants present in biological samples. This is based on the microHPLC-ESI-MS/MS analysis of the peptide mixture generated by a tryptic digestion of diluted Hb samples and an in-house new database containing solely the variant tryptic peptide of known human Hb variants. The experimental results (full MS and MS/MS spectra) are correlated with theoretical mass spectra generated from our in-house-built variant peptide database (Hbp) using the SEQUEST algorithm. Simple preparation of samples and an automated identification of the variant peptide are the main characteristics of this approach, making it an attractive method for the detection of Hb variants at the routine clinical level. We have analyzed 16 different samples, each containing a different known variant of hemoglobin.

Inhibitory activity of 2-deoxy-D-glucose and Candida saitoana against Penicillium digitatum

The toxic activity of 2-deoxy-D-glucose (2-DG) alone or combined with the biocontrol yeast Candida saitoana strain 8C was evaluated in vitro and in vivo against the postharvest fungal pathogen Penicillium digitatum. In order to assess the effect of the 2-DG on both the biocontrol yeast and fungal pathogen, in vitro tests were performed in Petri dishes containing potato dextrose agar amended with different concentrations (1.5, 3.0, 6.0, 15.0, 30.0, 60.0 mM) of the sugar. The plates were then seeded with 25 microl of a P. digitatum conidial suspension at 10(5) conidia/mL. Result of the assays showed an enhanced inhibitory activity as concentration increased from 15.0 to 60.0 mM. Corroborated by SEM observations showing a reduced growth and the appearance of damaged hyphae were found. At 60 mM of 2-DG, a total inhibition occurred while concentrations from 1.5 to 6.0 mM resulted ineffective. The same tests evidenced no adverse effects on the yeast 8C at all tested concentrations. In vivo assays were carried out on orange fruit cv 'Biondo comune', wounded in 5 sites around the calyx. Each wound (2.5 wide and 3.4 mm depth) was first filled with 25 microl of a 0, 3.0, 6.0, 15.0, 30.0 or 60.0 mM 2-DG-water solution alone or combined with the yeast 8C at 10(8) cells/mL and then a 25 microl of the P. digitatum conidial suspension was added. Each treatment consisted of 3 replicates of 8 fruit (5 wounds/fruit) for a total 120 wounds per treatment. Oranges were maintained at 20 degrees C and high RH (95-98%) for up to 5 days, during which infection was monitored and the inhibitory activity calculated. The tests in vitro evedenced a significant slowing of the pathogen growth with the highest concentrations of 2-DG (15.0, 30.0 and 60.0 mM) with respect to the control; while at lower concentrations (1.5, 3.0, 6.0 mM) the development of the fungi was not significantly reduced. C. saitoana was resistant to all the doses employed to the abovementioned compound. In vivo the yeast alone was more effective compared to the sugar alone up to 6.0 mM while, at higher concentrations an additive effect was founded.

Biological and physical approaches to improve induced resistance against green mold of stored citrus fruit

Health and environmental concerns have point out the need to improve or change several manufacturing steps in the food chain. In this context particular attention should be given to the technologies involved in fruits and vegetables production. Nearly all fresh fruit and vegetables are subjected to different periods of storage and/or shelf-life before of their consumption. This implies the need to protect the commodities from microbial spoilage. Some Citrus species (e.g. lemon and grapefruit) may be stored for several months before consumption and then post-harvest treatments are essential to contain green (Penicillium digitatum) and blue (P. italicum) moulds. Alternative approaches to chemicals usually have a lower efficacy in containing rots but fulfill the consumer's expectation. Among the alternative strategies, the improvement of host natural resistance is promising. In this regard, we report some results concerning the use of biotic (yeast) and abiotic agents as inducers of phytoalexin (i.e. scoparone and/or scopoletin) accumulation in Citrus rind and its importance in the control of fungal decay. In all experiments the inducers were applied on fruits before or 24 h after inoculation with P. digitatum and the rot severity was monitored 7 days later. The accumulation of phytoalexins was monitored according to a standard methodology by HPLC. In all experiments a positive correlation was found between increase of the phytoalexin scoparone in host tissue and reduction of decay.

Optimal social health insurance with supplementary private insurance

This paper investigates the structure of a National Health Service in which there is compulsory social insurance covering a package of essentials, a given part of individuals' health expenditure, and supplementary private policy topping up the remaining services. The latter insurance contract provides for a co-payment by patients, limiting the so-called "third-party payer" effect. Thus, an individual's health expenditure is divided into three parts: the first covered by social insurance, the second by a private policy and the third out-of-pocket. Such mixed system design has received increasing attention in recent years and has been adopted by several industrialized countries. The conditions for optimal rates of social insurance coverage and of private coinsurance are analysed and discussed. The optimality requirements refer to efficiency as well as equity concerns.