1
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Barbui T, Vannucchi AM, De Stefano V, Carobbio A, Ghirardi A, Carioli G, Masciulli A, Rossi E, Ciceri F, Bonifacio M, Iurlo A, Palandri F, Benevolo G, Pane F, Ricco A, Carli G, Caramella M, Rapezzi D, Musolino C, Siragusa S, Rumi E, Patriarca A, Cascavilla N, Mora B, Cacciola E, Mannarelli C, Loscocco GG, Guglielmelli P, Gesullo F, Betti S, Lunghi F, Scaffidi L, Bucelli C, Vianelli N, Bellini M, Finazzi MC, Tognoni G, Rambaldi A. Ropeginterferon versus Standard Therapy for Low-Risk Patients with Polycythemia Vera. NEJM Evid 2023; 2:EVIDoa2200335. [PMID: 38320126 DOI: 10.1056/evidoa2200335] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Ropeginterferon for Patients with Polycythemia VeraPatients with low-risk polycythemia vera were randomly assigned to receive ropeginterferon alfa-2b and phlebotomy or phlebotomy alone. The trial met its end point of maintenance of a hematocrit target (≤45%) without thrombotic events, progression of leukocytosis, thrombocytosis, and worsening of splenomegaly in the ropeginterferon alfa-2b group.
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Affiliation(s)
- Tiziano Barbui
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Alessandro Maria Vannucchi
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Valerio De Stefano
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Alessandra Carobbio
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Arianna Ghirardi
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Greta Carioli
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Elena Rossi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Fabio Ciceri
- Unità Operativa di Ematologia e Trapianto Midollo Osseo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan
| | - Massimiliano Bonifacio
- Department of Medicine, Section of Hematology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandra Iurlo
- Unità Operativa Complessa di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda - Ospedale Maggiore Policlinico, Milan
| | - Francesca Palandri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Istituto di Ematologia "L. & A. Seragnoli", Bologna, Italy
| | - Giulia Benevolo
- Struttura Complessa di Ematologia Universitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio Pane
- Unità Operativa Complessa di Ematologia e Trapianti di Midollo, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Alessandra Ricco
- Unità Operativa di Ematologia con Trapianto, Azienda Ospedaliera Universitaria "Consorziale Policlinico" di Bari, Bari, Italy
| | - Giuseppe Carli
- Unità Operativa Complessa di Ematologia, Azienda Unità Sanitaria Locale Socio Sanitaria (ULSS) 8 Berica, Ospedale San Bortolo di Vicenza, Vicenza, Italy
| | - Marianna Caramella
- Divisione di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan
| | - Davide Rapezzi
- Divisione di Ematologia, Azienda Ospedaliera S. Croce e Carle di Cuneo, Cuneo, Italy
| | - Caterina Musolino
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy
| | - Sergio Siragusa
- Divisione di Ematologia, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Palermo, Italy
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Divisione di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo di Pavia, Pavia, Italy
| | - Andrea Patriarca
- Struttura Complessa a Direzione Universitaria (SCDU) di Ematologia, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Nicola Cascavilla
- Unità Operativa di Ematologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Barbara Mora
- Unità Operativa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Emma Cacciola
- Unità Operativa di Emostasi Centro Federato Federazione Centri per la Diagnosi della Trombosi e la Sorveglianza delle terapie Antitrombotiche (FCSA), Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G. F. Ingrassia", Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Carmela Mannarelli
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Giuseppe Gaetano Loscocco
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Paola Guglielmelli
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Francesca Gesullo
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Silvia Betti
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Francesca Lunghi
- Unità Operativa di Ematologia e Trapianto Midollo Osseo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristina Bucelli
- Unità Operativa Complessa di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda - Ospedale Maggiore Policlinico, Milan
| | - Nicola Vianelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Istituto di Ematologia "L. & A. Seragnoli", Bologna, Italy
| | - Marta Bellini
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Finazzi
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan
| | - Gianni Tognoni
- Centro di Coordinamento Nazionale dei Comitati Etici, Agenzia Italiana del Farmaco (AIFA), Rome
| | - Alessandro Rambaldi
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan
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2
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Mannelli F, Gesullo F, Mannarelli C, Vanderwert F, Lazzi S, Mungai F, Berti V, Santi R, Guglielmelli P, Vannucchi AM. Diagnostic and therapeutic challenges in mast cell sarcoma. Am J Hematol 2023; 98:529-532. [PMID: 36464921 DOI: 10.1002/ajh.26804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Fiorenza Vanderwert
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Stefano Lazzi
- Sezione di Patologia, Università degli Studi di Siena, Siena, Italy
| | - Francesco Mungai
- SOD Radiodiagnostica di Emergenza-Urgenza, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Valentina Berti
- SOD Medicina Nucleare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Raffaella Santi
- Sezione di Patologia, Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, SOD Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
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3
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Sordi B, Vanderwert F, Crupi F, Gesullo F, Zanotti R, Bonadonna P, Crosera L, Elena C, Fiorelli N, Ferrari J, Grifoni F, Sciumè M, Parente R, Triggiani M, Palterer B, Mecheri V, Almerigogna F, Santi R, Di Medio L, Brandi ML, Iorno ML, Ciardetti I, Bencini S, Annunziato F, Mannarelli C, Pieri L, Guglielmelli P, Mannelli F, Vannucchi AM. Disease correlates and clinical relevance of hereditary α-tryptasemia in patients with systemic mastocytosis. J Allergy Clin Immunol 2023; 151:485-493.e11. [PMID: 36309122 DOI: 10.1016/j.jaci.2022.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic mastocytosis (SM) encompasses a heterogeneous group of clonal disorders characterized by abnormal expansion of mast cells (MCs). Beyond KIT and other genes recurrently mutated in myeloid neoplasms, several genetic variants have been described as predisposing to the development of the disease and influencing its clinical phenotype. Increased copy number variants of the TPSAB1 gene were identified as a cause of nonclonal elevated tryptasemia and defined as hereditary α-tryptasemia (HαT). Moreover, HαT is enriched in patients with SM, where it can affect the incidence of mediator-related symptoms. OBJECTIVE In a multicenter data set of 444 patients with MC disorders, we aimed to investigate the clinical correlates of germline TPSAB1 copy number gains. METHODS Droplet digital PCR was performed in all cases to ascertain the presence of HαT. Clinical history along with blood values and bone marrow examination were analyzed. RESULTS We confirmed a higher incidence of HαT+ cases (n = 59, 13.3%) in patients diagnosed with mastocytosis with respect to the general population (approximately 5%). HαT+ patients were characterized by a lower MC-associated disease burden and higher levels of tryptase. Several disease variables were coherent with this pattern, from bone marrow MC infiltration to MC-related histopathologic traits, which also accounted for a significantly higher incidence of clonal MC activation syndrome in HαT+ (10.2%) compared to HαT- (3.4%, P = .029) patients. We also confirmed that HαT+ carriers had a significantly higher frequency of anaphylaxis, without relevant differences for other clinical manifestations. CONCLUSION These findings on a large patient series support and extend previous data, and suggest that knowledge of HαT status may be useful for personalized management of patients with SM.
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Affiliation(s)
- Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Fiorenza Vanderwert
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Crupi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberta Zanotti
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Patrizia Bonadonna
- UO Allergologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lara Crosera
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Elena
- Divisione di Ematologia, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Nicolas Fiorelli
- Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | | | - Federica Grifoni
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mariarita Sciumè
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Roberta Parente
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Massimo Triggiani
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Boaz Palterer
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Valentina Mecheri
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Fabio Almerigogna
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Raffaella Santi
- Sezione di Patologia, Dipartimento di Scienze della Salute, Università di Florence, Florence, Italy
| | - Lisa Di Medio
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Luisa Brandi
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; FirmoLab, Fondazione FIRMO, Florence, Italy
| | - Maria Loredana Iorno
- Allergologia e Immunologia Clinica Azienda Toscana Centro Ospedale S. Giovanni di Dio, Florence, Italy
| | - Isabella Ciardetti
- Dipartimento di Scienze della Salute, sezione Dermatologia, Università degli Studi di Florence, Florence, Italy
| | - Sara Bencini
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Francesco Annunziato
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy.
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4
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Guglielmelli P, Maccari C, Sordi B, Balliu M, Atanasio A, Mannarelli C, Capecchi G, Sestini I, Coltro G, Loscocco GG, Rotunno G, Angori E, Borri FC, Tefferi A, Vannucchi AM. Phenotypic correlations of CALR mutation variant allele frequency in patients with myelofibrosis. Blood Cancer J 2023; 13:21. [PMID: 36710362 PMCID: PMC9884661 DOI: 10.1038/s41408-023-00786-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Paola Guglielmelli
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Chiara Maccari
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Benedetta Sordi
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Manjola Balliu
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Alessandro Atanasio
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Carmela Mannarelli
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Giulio Capecchi
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Ilaria Sestini
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Giacomo Coltro
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Giuseppe Gaetano Loscocco
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy ,grid.9024.f0000 0004 1757 4641Doctorate School GenOMec, University of Siena, Siena, Italy
| | - Giada Rotunno
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
| | - Eva Angori
- grid.8404.80000 0004 1757 2304University of Florence, Florence, Italy
| | - Filippo C. Borri
- grid.8404.80000 0004 1757 2304University of Florence, Florence, Italy
| | - Ayalew Tefferi
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Alessandro M. Vannucchi
- grid.24704.350000 0004 1759 9494CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy
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5
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Coltro G, Mannelli F, Loscocco GG, Mannarelli C, Rotunno G, Maccari C, Pancani F, Atanasio A, Vannucchi AM, Guglielmelli P. Differential prognostic impact of cytopenic phenotype in prefibrotic vs overt primary myelofibrosis. Blood Cancer J 2022; 12:116. [PMID: 35961958 PMCID: PMC9374751 DOI: 10.1038/s41408-022-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giacomo Coltro
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Mannelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Gaetano Loscocco
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Carmela Mannarelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giada Rotunno
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Maccari
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabiana Pancani
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Atanasio
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Maria Vannucchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy. .,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Paola Guglielmelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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6
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Loscocco GG, Guglielmelli P, Mannelli F, Mora B, Mannarelli C, Rotunno G, Pancani F, Maccari C, Bartalucci N, Romagnoli S, Coltro G, Passamonti F, Vannucchi AM. SF3B1 mutations in primary and secondary myelofibrosis: clinical, molecular and prognostic correlates. Am J Hematol 2022; 97:E347-E349. [PMID: 35796725 DOI: 10.1002/ajh.26648] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe G Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Doctorate School GenOMec, University of Siena, Siena, Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesco Mannelli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Barbara Mora
- Hematology Unit, Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi-Ospedale di Circolo, Italy
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giada Rotunno
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Fabiana Pancani
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Chiara Maccari
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Bartalucci
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Simone Romagnoli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giacomo Coltro
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesco Passamonti
- Hematology Unit, Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi-Ospedale di Circolo, Italy
| | - Alessandro M Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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7
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Mannelli F, Bencini S, Coltro G, Loscocco GG, Peruzzi B, Rotunno G, Maccari C, Gesullo F, Borella M, Paoli C, Caporale R, Mannarelli C, Annunziato F, Guglielmelli P, Vannucchi AM. Integration of multiparameter flow cytometry score improves prognostic stratification provided by standard models in primary myelofibrosis. Am J Hematol 2022; 97:846-855. [PMID: 35338671 DOI: 10.1002/ajh.26548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
Prognostic modeling in myelofibrosis (MF) has classically pursued the integration of informative clinical and hematological parameters to separate patients' categories with different outcomes. Modern stratification includes also genetic data from karyotype and mutations. However, some poorly standardized variables, as peripheral blood (PB) blast count by morphology, are still included. In this study, we used multiparameter flow cytometry (MFC) with the aim of improving performance of existing scores. We studied 363 MF patients with available MFC files for PB CD34+ cells count determination at diagnosis. We adapted Ogata score to MF context including 2 parameters: absolute CD34+ cells count (/μL) and granulocytes to lymphocytes SSC ratio. A score of 1 was attributed to above-threshold values of each parameter. Accordingly, patients were categorized as MFClow (score = 0, 62.0%), MFCint (score = 1, 29.5%), and MFChigh (score = 2, 8.5%). MFClow had significantly longer median OS (not reached) compared to MFCint (55 months) and MFChigh (19 months). We integrated MFC into established models as a substitute of morphological PB blasts count. Patients were reclassified according to MFC-enhanced scores, and concordance (C-) indexes were compared. As regards IPSS, C-indexes were 0.67 and 0.74 for standard and MFC-enhanced model, respectively (Z score - 3.82; p = 0.0001). MFC-enhanced MIPSS70+ model in PMF patients yielded a C-index of 0.78, outperforming its standard counterpart (C-index 0.73; Z score - 2.88, p = 0.004). Our data suggest that the incorporation of MFC-derived parameters, easily attainable from standard assay used for CD34+ cells determination, might help to refine the current prognostic stratification models in myelofibrosis.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Giacomo Coltro
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Giuseppe G Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
- Doctorate School GenOMec, University of Siena, Italy
| | - Benedetta Peruzzi
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Chiara Maccari
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Miriam Borella
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Chiara Paoli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberto Caporale
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
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Coltro G, Rotunno G, Mannelli F, Loscocco GG, Bartalucci N, Mannarelli C, Maccari C, Guglielmelli P, Vannucchi AM. P985: THE ALLELIC RATIO OF DRIVER AND ASXL1 MUTATIONS IS PROGNOSTICALLY RELEVANT IN PMF. Hemasphere 2022. [PMCID: PMC9430524 DOI: 10.1097/01.hs9.0000846808.30540.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Loscocco GG, Guglielmelli P, Gangat N, Rossi E, Mannarelli C, Betti S, Maccari C, Ramundo F, Jadoon Y, Gesullo F, Ceglie S, Paoli C, Pardanani A, De Stefano V, Tefferi A, Vannucchi AM. Clinical and molecular predictors of fibrotic progression in essential thrombocythemia: A multicenter study involving 1607 patients. Am J Hematol 2021; 96:1472-1480. [PMID: 34424575 PMCID: PMC9293196 DOI: 10.1002/ajh.26332] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022]
Abstract
The current retrospective study involving a total of 1607 patients was designed to identify clinical and molecular variables that were predictive of inferior myelofibrosis‐free survival (MFS) in WHO‐defined essential thrombocythemia (ET), utilizing three independent patient cohorts: University of Florence, Italy (n = 718); Mayo Clinic, USA (n = 479) and Policlinico Gemelli, Catholic University, Rome, Italy (n = 410). The Florence patient cohort was first examined to identify independent risk factors for MFS, which included age > 60 years (HR 2.5, 95% CI 1.3–4.9), male sex (2.1, 1.2–3.9), palpable splenomegaly (2.1, 1.2–3.9), CALR 1/1‐like or MPL mutation (3.4, 1.9–6.1) and JAK2V617F variant allele frequency > 35% (4.2, 1.6–10.8). Subsequently, an operational molecular risk category was developed and validated in the other two cohorts from Mayo Clinic and Rome: “high molecular risk” category included patients with JAK2V617F VAF >35%, CALR type 1/1‐like or MPL mutations; all other driver mutation profiles were assigned to “low molecular risk” category. The former, compared to the latter molecular risk category, displayed significantly higher risk of fibrotic transformation: Florence cohort with respective fibrotic transformation risk rates of 8% vs. 1.2% at 10 years and 33% vs. 8% at 20 years (p < 0.001; HR 6.1; 95% CI 3.2–11.7); Mayo Cohort, 16% vs. 7% at 10 years and 44% vs. 25% at 20 years (p < 0.001; HR 2.5; 95% CI 1.6–4.1); and Rome cohort 7.8% vs. 4.6% at 10 years and 31.2% vs. 7.1% at 20 years (p = 0.007, HR 2.7; 95% CI 1.3–5.8). The present study provides practically useful risk signals for fibrotic transformation in ET and facilitates identification of patients who require close monitoring and appropriate counseling.
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Affiliation(s)
- Giuseppe G. Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | - Naseema Gangat
- Divisions of Hematology Mayo Clinic Rochester Minnesota USA
| | - Elena Rossi
- Section of Hematology, Department of Radiological and Hematological Sciences Catholic University Rome Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | - Silvia Betti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Chiara Maccari
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | - Francesco Ramundo
- Section of Hematology, Department of Radiological and Hematological Sciences Catholic University Rome Italy
| | - Yamna Jadoon
- Divisions of Hematology Mayo Clinic Rochester Minnesota USA
| | - Francesca Gesullo
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | - Sara Ceglie
- Section of Hematology, Department of Radiological and Hematological Sciences Catholic University Rome Italy
| | - Chiara Paoli
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
| | | | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences Catholic University Rome Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Ayalew Tefferi
- Divisions of Hematology Mayo Clinic Rochester Minnesota USA
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero‐Universitaria Careggi University of Florence Florence Italy
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10
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Coltro G, Rotunno G, Mannelli L, Mannarelli C, Fiaccabrino S, Romagnoli S, Bartalucci N, Ravenda E, Gelli E, Sant'Antonio E, Patnaik MM, Tefferi A, Vannucchi AM, Guglielmelli P. RAS/CBL mutations predict resistance to JAK inhibitors in myelofibrosis and are associated with poor prognostic features. Blood Adv 2020. [PMID: 32777067 DOI: 10.1182/blood-advances.2020002175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
The dysregulation of the JAK/STAT pathway drives the pathogenesis of myelofibrosis (MF). Recently, several JAK inhibitors (JAKis) have been developed for treating MF. Select mutations (MTs) have been associated with impaired outcomes and are currently incorporated in molecularly annotated prognostic models. Mutations of RAS/MAPK pathway genes are frequently reported in cancer and at low frequencies in MF. In this study, we investigated the phenotypic, prognostic, and therapeutic implications of NRASMTs, KRASMTs, and CBLMTs (RAS/CBLMTs) in 464 consecutive MF patients. A total of 59 (12.7%) patients had RAS/CBLMTs: NRASMTs, n = 25 (5.4%); KRASMTs, n = 13 (2.8%); and CBLMTs, n = 26 (5.6%). Patients with RAS/CBLMTs were more likely to present with high-risk clinical and molecular features. RAS/CBLMTs were associated with inferior overall survival compared with patients without MTs and retained significance in a multivariate model, including the Mutation-Enhanced International Prognostic Score System (MIPSS70) risk factors and cytogenetics; however, inclusion of RAS/CBLMTs in molecularly annotated prognostic models did not improve the predictive power of the latter. The 5-year cumulative incidence of leukemic transformation was notably higher in the RAS/CBLMT cohort. Among 61 patients treated with JAKis and observed for a median time of 30 months, the rate of symptoms and spleen response at 6 months was significantly lower in the RAS/CBLMT cohort. Logistic regression analysis disclosed a significant inverse correlation between RAS/CBLMTs and the probability of achieving a symptom or spleen response that was retained in multivariate analysis. In summary, our study showed that RAS/CBLMTs are associated with adverse phenotypic features and survival outcomes and, more important, may predict reduced response to JAKis.
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Affiliation(s)
- Giacomo Coltro
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giada Rotunno
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lara Mannelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Medical Genetics, University of Siena, Siena, Italy
| | - Carmela Mannarelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sara Fiaccabrino
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simone Romagnoli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Niccolò Bartalucci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Enrica Ravenda
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Eleonora Gelli
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Faculty of Medicine and Surgery, University of Florence, Florence, Italy; and
| | - Emanuela Sant'Antonio
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | | | - Alessandro M Vannucchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paola Guglielmelli
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Center of Research and Innovation for Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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11
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Salati S, Genovese E, Carretta C, Zini R, Bartalucci N, Prudente Z, Pennucci V, Ruberti S, Rossi C, Rontauroli S, Enzo E, Calabresi L, Balliu M, Mannarelli C, Bianchi E, Guglielmelli P, Tagliafico E, Vannucchi AM, Manfredini R. Calreticulin Ins5 and Del52 mutations impair unfolded protein and oxidative stress responses in K562 cells expressing CALR mutants. Sci Rep 2019; 9:10558. [PMID: 31332222 PMCID: PMC6646313 DOI: 10.1038/s41598-019-46843-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 07/03/2019] [Indexed: 12/26/2022] Open
Abstract
Somatic mutations of calreticulin (CALR) have been described in approximately 60–80% of JAK2 and MPL unmutated Essential Thrombocythemia and Primary Myelofibrosis patients. CALR is an endoplasmic reticulum (ER) chaperone responsible for proper protein folding and calcium retention. Recent data demonstrated that the TPO receptor (MPL) is essential for the development of CALR mutant-driven Myeloproliferative Neoplasms (MPNs). However, the precise mechanism of action of CALR mutants haven’t been fully unraveled. In this study, we showed that CALR mutants impair the ability to respond to the ER stress and reduce the activation of the pro-apoptotic pathway of the unfolded protein response (UPR). Moreover, our data demonstrated that CALR mutations induce increased sensitivity to oxidative stress, leading to increase oxidative DNA damage. We finally demonstrated that the downmodulation of OXR1 in CALR-mutated cells could be one of the molecular mechanisms responsible for the increased sensitivity to oxidative stress mediated by mutant CALR. Altogether, our data identify novel mechanisms collaborating with MPL activation in CALR-mediated cellular transformation. CALR mutants negatively impact on the capability of cells to respond to oxidative stress leading to genomic instability and on the ability to react to ER stress, causing resistance to UPR-induced apoptosis.
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Affiliation(s)
- Simona Salati
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Genovese
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Carretta
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Zini
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bartalucci
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Zelia Prudente
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Pennucci
- Institute for Cell and Gene Therapy & Center for Chronic Immunodeficiency, University of Freiburg, Freiburg, Germany
| | - Samantha Ruberti
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Rossi
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sebastiano Rontauroli
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Enzo
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Calabresi
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Manjola Balliu
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Elisa Bianchi
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Guglielmelli
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Enrico Tagliafico
- Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro M Vannucchi
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Rossella Manfredini
- Centre for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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12
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Pacilli A, Rotunno G, Mannarelli C, Fanelli T, Pancrazzi A, Contini E, Mannelli F, Gesullo F, Bartalucci N, Fattori GC, Paoli C, Vannucchi AM, Guglielmelli P. Mutation landscape in patients with myelofibrosis receiving ruxolitinib or hydroxyurea. Blood Cancer J 2018; 8:122. [PMID: 30467377 PMCID: PMC6250726 DOI: 10.1038/s41408-018-0152-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/27/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
Abstract
Refractoriness to ruxolitinib in patients with myelofibrosis (MF) was associated with clonal evolution; however, whether genetic instability is promoted by ruxolitinib remains unsettled. We evaluated the mutation landscape in 71 MF patients receiving ruxolitinib (n = 46) and hydroxyurea (n = 25) and correlated with response. A spleen volume response (SVR) was obtained in 57% and 12%, respectively. Highly heterogenous patterns of mutation acquisition/loss and/or changes of variant allele frequency (VAF) were observed in the 2 patient groups without remarkable differences. In patients receiving ruxolitinib, driver mutation type and high-molecular risk profile (HMR) at baseline did not impact on response rate, while HMR and sole ASXL1 mutations predicted for SVR loss at 3 years. In patients with SVR, a decrease of ≥ 20% of JAK2V617F VAF predicted for SVR duration. VAF increase of non-driver mutations and clonal progression at follow-up correlated with SVR loss and treatment discontinuation, and clonal progression also predicted for shorter survival. These data indicate that (i) ruxolitinib does not appreciably promote clonal evolution compared with hydroxyurea, (ii) VAF increase of pre-existing and/or (ii) acquisition of new mutations while on treatment correlated with higher rate of discontinuation and/or death, and (iv) reduction of JAK2V617F VAF associated with SVR duration.
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Affiliation(s)
- Annalisa Pacilli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | | | - Alessandro Pancrazzi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Elisa Contini
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Niccolò Bartalucci
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | | | - Chiara Paoli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy.
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
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13
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Tefferi A, Lavu S, Mudireddy M, Lasho TL, Finke CM, Gangat N, Pardanani A, Hanson CA, Mannarelli C, Guglielmelli P, Vannucchi AM. JAK2 exon 12 mutated polycythemia vera: Mayo-Careggi MPN Alliance study of 33 consecutive cases and comparison with JAK2V617F mutated disease. Am J Hematol 2018; 93:E93-E96. [PMID: 29274140 DOI: 10.1002/ajh.25017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Ayalew Tefferi
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Sravanthi Lavu
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Mythri Mudireddy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Terra L. Lasho
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Christy M. Finke
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Naseema Gangat
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Animesh Pardanani
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Curtis A. Hanson
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Division of Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
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14
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Tefferi A, Nicolosi M, Mudireddy M, Szuber N, Finke CM, Lasho TL, Hanson CA, Ketterling RP, Pardanani A, Gangat N, Mannarelli C, Fanelli T, Guglielmelli P, Vannucchi AM. Driver mutations and prognosis in primary myelofibrosis: Mayo-Careggi MPN alliance study of 1,095 patients. Am J Hematol 2018; 93:348-355. [PMID: 29164670 DOI: 10.1002/ajh.24978] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 12/22/2022]
Abstract
The 2013 discovery of calreticulin (CALR) mutations in myeloproliferative neoplasms was attended by their association with longer survival in primary myelofibrosis (PMF). Subsequent studies have suggested prognostic distinction between type 1/like and type 2/like CALR mutations and detrimental effect from triple-negative mutational status. Among 709 Mayo Clinic patients with PMF, 467 (66%) harbored JAK2, 112 (16%) CALR type 1/like, 24 (3.4%) CALR type 2/like, 38 (5.4%) MPL mutations and 68 (10%) were triple-negative. Survival was longer with type 1/like CALR, compared to JAK2 (HR 2.6, 95% CI 1.9-3.5), type 2/like CALR (HR 2.5, 95% CI 1.4-4.5), MPL (HR 1.8, 95% CI 1.1-2.9) and triple-negative mutational status (HR 2.4, 95% CI 1.6-3.6), but otherwise similar between the non-type 1/like CALR mutational states (P = .41). In multivariable analysis, the absence of type 1/like CALR (P < .001; HR 2, 95% CI 1.4-2.7), presence of ASXL1/SRSF2 mutations (P < .001; HR 1.9, 95% CI 1.5-2.4) and DIPSS-plus (P < .001) were each predictive of inferior survival. Furthermore, among 210 patients with ASXL1/SRSF2 mutations, survival was significantly longer in the presence vs. absence of type 1/like CALR mutations (median 5.8 vs. 2.9 years; P < .001). Triple-negative status did not disclose additional prognostic information for overall or leukemia-free survival. The observations regarding the prognostic distinction between CALR mutation variants were validated in an external cohort of 386 patients from the University of Florence Careggi hospital. We conclude that type 1/like CALR mutations in PMF not only predict superior survival, but also partially amend the detrimental effect of high molecular risk mutations.
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Affiliation(s)
- Ayalew Tefferi
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Maura Nicolosi
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Mythri Mudireddy
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Natasha Szuber
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Christy M. Finke
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Terra L. Lasho
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Curtis A. Hanson
- Divisions of Hematopathology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Rhett P. Ketterling
- Divisions of Cytogenetics, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Animesh Pardanani
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Naseema Gangat
- Divisions of Hematology, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms; Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Tiziana Fanelli
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms; Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms; Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms; Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
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15
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Salati S, Prudente Z, Genovese E, Pennucci V, Rontauroli S, Bartalucci N, Mannarelli C, Ruberti S, Zini R, Rossi C, Bianchi E, Guglielmelli P, Tagliafico E, Vannucchi AM, Manfredini R. Calreticulin Affects Hematopoietic Stem/Progenitor Cell Fate by Impacting Erythroid and Megakaryocytic Differentiation. Stem Cells Dev 2018; 27:225-236. [PMID: 29258411 DOI: 10.1089/scd.2017.0137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Calreticulin (CALR) is a chaperone protein that localizes primarily to the endoplasmic reticulum (ER) lumen where it is responsible for the control of proper folding of neo-synthesized glycoproteins and the retention of calcium. Recently, mutations affecting exon 9 of the CALR gene have been described in approximately 40% of patients with myeloproliferative neoplasms (MPNs). Although the role of mutated CALR in the development of MPNs has begun to be clarified, there are still no data available on the function of wild-type (WT) CALR during physiological hematopoiesis. To shed light on the role of WT CALR during normal hematopoiesis, we performed gene silencing and overexpression experiments in hematopoietic stem progenitor cells (HSPCs). Our results showed that CALR overexpression is able to affect physiological hematopoiesis by enhancing both erythroid and megakaryocytic (MK) differentiation. In agreement with overexpression data, CALR silencing caused a significant decrease in both erythroid and MK differentiation of human HSPCs. Gene expression profiling (GEP) analysis showed that CALR is able to affect the expression of several genes involved in HSPC differentiation toward both the erythroid and MK lineages. Moreover, GEP data also highlighted the modulation of several genes involved in ER stress response, unfolded protein response (UPR), and DNA repair, and of several genes already described to play a role in MPN development, such as proinflammatory cytokines and hematological neoplasm-related markers. Altogether, our data unraveled a new and unexpected role for CALR in the regulation of normal hematopoietic differentiation. Moreover, by showing the impact of CALR on the expression of genes involved in several biological processes already described in cellular transformation, our data strongly suggest a more complex role for CALR in MPN development that goes beyond the activation of the THPO receptor and involves ER stress response, UPR, and DNA repair.
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Affiliation(s)
- Simona Salati
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Zelia Prudente
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Genovese
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Pennucci
- Institute for Cell and Gene Therapy & Center for Chronic Immunodeficiency, University of Freiburg, Freiburg, Germany
| | - Sebastiano Rontauroli
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bartalucci
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Samantha Ruberti
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Zini
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Rossi
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Bianchi
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Guglielmelli
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Enrico Tagliafico
- Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro M Vannucchi
- CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Rossella Manfredini
- Centre for Regenerative Medicine "Stefano Ferrari," University of Modena and Reggio Emilia, Modena, Italy
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16
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Guglielmelli P, Lasho TL, Rotunno G, Mudireddy M, Mannarelli C, Nicolosi M, Pacilli A, Pardanani A, Rumi E, Rosti V, Hanson CA, Mannelli F, Ketterling RP, Gangat N, Rambaldi A, Passamonti F, Barosi G, Barbui T, Cazzola M, Vannucchi AM, Tefferi A. MIPSS70: Mutation-Enhanced International Prognostic Score System for Transplantation-Age Patients With Primary Myelofibrosis. J Clin Oncol 2017; 36:310-318. [PMID: 29226763 DOI: 10.1200/jco.2017.76.4886] [Citation(s) in RCA: 305] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose To develop a prognostic system for transplantation-age patients with primary myelofibrosis (PMF) that integrates clinical, cytogenetic, and mutation data. Patients and Methods The study included 805 patients with PMF age ≤ 70 years recruited from multiple Italian centers and the Mayo Clinic (Rochester, MN), forming two independent learning and validation cohorts. A Cox multivariable model was used to select from among a list of 22 variables those that were predictive of overall survival (OS). Integrated clinical and genetic prognostic models with (MIPSS70-plus) or without (MIPSS70) cytogenetic information were developed. Results Multivariable analysis identified the following as significant risk factors for OS: hemoglobin < 100 g/L, leukocytes > 25 × 109/L, platelets < 100 × 109/L, circulating blasts ≥ 2%, bone marrow fibrosis grade ≥ 2, constitutional symptoms, absence of CALR type-1 mutation, presence of high-molecular risk mutation (ie, ASXL1, EZH2, SRSF2, IDH1/ 2), and presence of two or more high-molecular risk mutations. By assigning hazard ratio (HR)-weighted points to these variables, three risk categories were delineated for the MIPSS70 model; 5-year OS was 95% in low-risk, 70% in intermediate-risk, and 29% in high-risk categories, corresponding to median OS of 27.7 years (95% CI, 22 to 34 years), 7.1 years (95% CI, 6.2 to 8.1 years), and 2.3 years (95% CI, 1.9 to 2.7 years), respectively. In the MIPSS70-plus model, which included cytogenetic information, four risk categories were delineated, with 5-year OS of 91% in low-risk, 66% in intermediate-risk (HR, 3.2; 95% CI, 1.9 to 5.2), 42% in high-risk (HR, 6.4; 95% CI, 4.1 to 10.0), and 7% very high-risk categories (HR, 17.0; 95% CI, 9.8 to 29.2). Both models remained effective after inclusion of older patients in the analysis. Conclusion MIPSS70 and MIPSS70-plus provide complementary systems of risk stratification for transplantation-age patients with PMF and integrate prognostically relevant clinical, cytogenetic, and mutation data.
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Affiliation(s)
- Paola Guglielmelli
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Terra L Lasho
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Giada Rotunno
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Mythri Mudireddy
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Carmela Mannarelli
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Maura Nicolosi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Annalisa Pacilli
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Animesh Pardanani
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Elisa Rumi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Vittorio Rosti
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Curtis A Hanson
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Francesco Mannelli
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Alessandro Rambaldi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Francesco Passamonti
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Giovanni Barosi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Tiziano Barbui
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Mario Cazzola
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Alessandro M Vannucchi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
| | - Ayalew Tefferi
- Paola Guglielmelli, Giada Rotunno, Carmela Mannarelli, Annalisa Pacilli, Francesco Mannelli, and Alessandro M. Vannucchi, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence; Elisa Rumi, Vittorio Rosti, Giovanni Barosi, and Mario Cazzola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Elisa Rumi and Mario Cazzola, University of Pavia, Pavia; Alessandro Rambaldi, University of Milan, Milan; Alessandro Rambaldi and Tiziano Barbui, Azienda Socio sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Francesco Passamonti, University of Insubria, Varese, Italy; and Terra L. Lasho, Mythri Mudireddy, Maura Nicolosi, Animesh Pardanani, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, and Ayalew Tefferi, Mayo Clinic, Rochester, MN
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17
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Ruberti S, Bianchi E, Guglielmelli P, Rontauroli S, Barbieri G, Tavernari L, Fanelli T, Norfo R, Pennucci V, Fattori GC, Mannarelli C, Bartalucci N, Mora B, Elli L, Avanzini MA, Rossi C, Salmoiraghi S, Zini R, Salati S, Prudente Z, Rosti V, Passamonti F, Rambaldi A, Ferrari S, Tagliafico E, Vannucchi AM, Manfredini R. Involvement of MAF/SPP1 axis in the development of bone marrow fibrosis in PMF patients. Leukemia 2017; 32:438-449. [PMID: 28745329 PMCID: PMC5808097 DOI: 10.1038/leu.2017.220] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 01/13/2023]
Abstract
Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by hyperplastic megakaryopoiesis and myelofibrosis. We recently described the upregulation of MAF (v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog) in PMF CD34+ hematopoietic progenitor cells (HPCs) compared to healthy donor. Here we demonstrated that MAF is also upregulated in PMF compared with the essential thrombocytemia (ET) and polycytemia vera (PV) HPCs. MAF overexpression and knockdown experiments shed some light into the role of MAF in PMF pathogenesis, by demonstrating that MAF favors the megakaryocyte and monocyte/macrophage commitment of HPCs and leads to the increased expression of proinflammatory and profibrotic mediators. Among them, we focused our further studies on SPP1 and LGALS3. We assessed SPP1 and LGALS3 protein levels in 115 PMF, 47 ET and 24 PV patients plasma samples and we found that SPP1 plasma levels are significantly higher in PMF compared with ET and PV patients. Furthermore, in vitro assays demonstrated that SPP1 promotes fibroblasts and mesenchymal stromal cells proliferation and collagen production. Strikingly, clinical correlation analyses uncovered that higher SPP1 plasma levels in PMF patients correlate with a more severe fibrosis degree and a shorter overall survival. Collectively our data unveil that MAF overexpression contributes to PMF pathogenesis by driving the deranged production of the profibrotic mediator SPP1.
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Affiliation(s)
- S Ruberti
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - E Bianchi
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - P Guglielmelli
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - S Rontauroli
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - G Barbieri
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - L Tavernari
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - T Fanelli
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - R Norfo
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy.,Haematopoietic Stem Cell Biology Laboratory, MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - V Pennucci
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - G Corbizi Fattori
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy.,GenOMec, University of Siena, Siena, Italy
| | - C Mannarelli
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy.,GenOMec, University of Siena, Siena, Italy
| | - N Bartalucci
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - B Mora
- Division of Hematology, Ospedale ASST Sette Laghi, Universita degli Studi dell'Insubria, Varese, Italy
| | - L Elli
- Division of Hematology, Ospedale ASST Sette Laghi, Universita degli Studi dell'Insubria, Varese, Italy
| | - M A Avanzini
- Department of Pediatric Onco-Hematology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Rossi
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - S Salmoiraghi
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - R Zini
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - S Salati
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - Z Prudente
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - V Rosti
- Center for the Study of Myelofibrosis, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Passamonti
- Division of Hematology, Ospedale ASST Sette Laghi, Universita degli Studi dell'Insubria, Varese, Italy
| | - A Rambaldi
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - S Ferrari
- Department of Life Sciences, Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
| | - E Tagliafico
- Department of Life Sciences, Center for Genome Research, University of Modena and Reggio Emilia, Modena, Italy
| | - A M Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - R Manfredini
- Department of Life Sciences, Centre for Regenerative Medicine 'Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
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18
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Pacilli A, Fanelli T, Mannarelli C, Rotunno G, Pancrazzi A, Vannucchi AM, Guglielmelli P. Clonal architecture of JAK2V617F mutated cells during treatment with ruxolitinib. Hematol Oncol 2017; 36:357-359. [PMID: 28474777 DOI: 10.1002/hon.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Annalisa Pacilli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
| | - Tiziana Fanelli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy.,GenOMec, University of Siena, Siena, Italy
| | - Carmela Mannarelli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
| | - Giada Rotunno
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
| | - Alessandro Pancrazzi
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
| | - Alessandro Maria Vannucchi
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
| | - Paola Guglielmelli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical medicine, University of Florence, Florence, Italy
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19
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Pieri L, Paoli C, Arena U, Marra F, Mori F, Zucchini M, Colagrande S, Castellani A, Masciulli A, Rosti V, De Stefano V, Betti S, Finazzi G, Ferrari ML, Rumi E, Ruggeri M, Nichele I, Guglielmelli P, Fjerza R, Mannarelli C, Fanelli T, Merli L, Corbizi Fattori G, Massa M, Cimino G, Rambaldi A, Barosi G, Cazzola M, Barbui T, Vannucchi AM. Safety and efficacy of ruxolitinib in splanchnic vein thrombosis associated with myeloproliferative neoplasms. Am J Hematol 2017; 92:187-195. [PMID: 27880982 DOI: 10.1002/ajh.24614] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients diagnosed with myelofibrosis (12 cases), polycythemia vera (5 cases) and essential thrombocythemia (4 cases) received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis. Nineteen patients carried JAK2V617F, one had MPLW515L, and one CALRL367fs*46 mutation. Eighteen patients had spleno-portal-mesenteric thrombosis, two had Budd-Chiari syndrome, and one had both sites involved; 16 patients had esophageal varices. Ruxolitinib was well tolerated with hematological toxicities consistent with those of patients without SVT and no hemorrhagic adverse events were recorded. After 24 weeks of treatment, spleen volume reduction ≥35% by MRI was achieved by 6/21 (29%) patients, and a ≥50% spleen length reduction by palpation at any time up to week 24 was obtained by 13/21 (62%) patients. At week 72, 8 of the 13 (62%) patients maintained the spleen response by palpation. No significant effect of treatment on esophageal varices or in splanchnic circulation was observed. MPN-related symptoms, evaluated by MPN-symptom assessment form (SAF) TSS questionnaire, improved significantly during the first 4 weeks and remained stable up to week 24. In conclusion, this trial shows that ruxolitinib is safe in patients with MPN-associated SVT, and effective in reducing spleen size and disease-related symptoms.
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Affiliation(s)
- Lisa Pieri
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Chiara Paoli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Umberto Arena
- Internal Medicine and Hepatology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Fabio Mori
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Mery Zucchini
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Arianna Masciulli
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - Vittorio Rosti
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | | | - Silvia Betti
- Institute of Hematology, Catholic University; Rome Italy
| | - Guido Finazzi
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | | | - Elisa Rumi
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Marco Ruggeri
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Ilaria Nichele
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Rajmonda Fjerza
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Carmela Mannarelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Tiziana Fanelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Lucia Merli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Giuditta Corbizi Fattori
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Margherita Massa
- IRCCS Policlinico San Matteo Foundation; Biotechnology Research Area; Pavia Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology; University “La Sapienza”; Rome Italy
| | | | - Giovanni Barosi
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | - Mario Cazzola
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Tiziano Barbui
- Hospital Papa Giovanni XXIII and Research Foundation; Bergamo Italy
| | - Alessandro M. Vannucchi
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
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Loscocco GG, Mannarelli C, Pacilli A, Fanelli T, Rotunno G, Gesullo F, Corbizi-Fattori G, Vannucchi AM, Guglielmelli P. Germline transmission of LNKE208Q variant in a family with myeloproliferative neoplasms. Am J Hematol 2016; 91:E356. [PMID: 27237057 DOI: 10.1002/ajh.24437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Giuseppe Gaetano Loscocco
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Carmela Mannarelli
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Annalisa Pacilli
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Tiziana Fanelli
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
- University of Siena
| | - Giada Rotunno
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Francesca Gesullo
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Giuditta Corbizi-Fattori
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
- University of Siena
| | - Alessandro Maria Vannucchi
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
| | - Paola Guglielmelli
- CRIMM, Centro Di Ricerca E Innovazione per Le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi, Firenze, DENOTHE Excellence Center; Italy
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Salati S, Zini R, Nuzzo S, Guglielmelli P, Pennucci V, Prudente Z, Ruberti S, Rontauroli S, Norfo R, Bianchi E, Bogani C, Rotunno G, Fanelli T, Mannarelli C, Rosti V, Salmoiraghi S, Pietra D, Ferrari S, Barosi G, Rambaldi A, Cazzola M, Bicciato S, Tagliafico E, Vannucchi AM, Manfredini R. Integrative analysis of copy number and gene expression data suggests novel pathogenetic mechanisms in primary myelofibrosis. Int J Cancer 2016; 138:1657-69. [PMID: 26547506 DOI: 10.1002/ijc.29920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/15/2015] [Accepted: 10/23/2015] [Indexed: 12/27/2022]
Abstract
Primary myelofibrosis (PMF) is a Myeloproliferative Neoplasm (MPN) characterized by megakaryocyte hyperplasia, progressive bone marrow fibrosis, extramedullary hematopoiesis and transformation to Acute Myeloid Leukemia (AML). A number of phenotypic driver (JAK2, CALR, MPL) and additional subclonal mutations have been described in PMF, pointing to a complex genomic landscape. To discover novel genomic lesions that can contribute to disease phenotype and/or development, gene expression and copy number signals were integrated and several genomic abnormalities leading to a concordant alteration in gene expression levels were identified. In particular, copy number gain in the polyamine oxidase (PAOX) gene locus was accompanied by a coordinated transcriptional up-regulation in PMF patients. PAOX inhibition resulted in rapid cell death of PMF progenitor cells, while sparing normal cells, suggesting that PAOX inhibition could represent a therapeutic strategy to selectively target PMF cells without affecting normal hematopoietic cells' survival. Moreover, copy number loss in the chromatin modifier HMGXB4 gene correlates with a concomitant transcriptional down-regulation in PMF patients. Interestingly, silencing of HMGXB4 induces megakaryocyte differentiation, while inhibiting erythroid development, in human hematopoietic stem/progenitor cells. These results highlight a previously un-reported, yet potentially interesting role of HMGXB4 in the hematopoietic system and suggest that genomic and transcriptional imbalances of HMGXB4 could contribute to the aberrant expansion of the megakaryocytic lineage that characterizes PMF patients.
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Affiliation(s)
- Simona Salati
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Roberta Zini
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Simona Nuzzo
- Center for Genome Research, University of Modena and Reggio Emilia, via Campi N.287, Modena, 41125, Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Valentina Pennucci
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Zelia Prudente
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Samantha Ruberti
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Sebastiano Rontauroli
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Ruggiero Norfo
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Elisa Bianchi
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
| | - Costanza Bogani
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Giada Rotunno
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Tiziana Fanelli
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Vittorio Rosti
- IRCCS Policlinico S.Matteo Foundation, Center for the Study of Myelofibrosis, Pavia, Italy
| | | | - Daniela Pietra
- Department of Hematology Oncology, IRCCS Policlinico San Matteo Foundation & University of Pavia, Pavia, Italy
| | - Sergio Ferrari
- Center for Genome Research, University of Modena and Reggio Emilia, via Campi N.287, Modena, 41125, Italy
| | - Giovanni Barosi
- IRCCS Policlinico S.Matteo Foundation, Center for the Study of Myelofibrosis, Pavia, Italy
| | | | - Mario Cazzola
- Department of Hematology Oncology, IRCCS Policlinico San Matteo Foundation & University of Pavia, Pavia, Italy
| | - Silvio Bicciato
- Center for Genome Research, University of Modena and Reggio Emilia, via Campi N.287, Modena, 41125, Italy
| | - Enrico Tagliafico
- Center for Genome Research, University of Modena and Reggio Emilia, via Campi N.287, Modena, 41125, Italy
| | - Alessandro M Vannucchi
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Rossella Manfredini
- Life Sciences Department University of Modena and Reggio Emilia, Centre for Regenerative Medicine, via Gottardi N.100, Modena, 41125, Italy
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22
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Guglielmelli P, Bisognin A, Saccoman C, Mannarelli C, Coppe A, Vannucchi AM, Bortoluzzi S. Small RNA Sequencing Uncovers New miRNAs and moRNAs Differentially Expressed in Normal and Primary Myelofibrosis CD34+ Cells. PLoS One 2015; 10:e0140445. [PMID: 26468945 PMCID: PMC4607157 DOI: 10.1371/journal.pone.0140445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/25/2015] [Indexed: 12/20/2022] Open
Abstract
Myeloproliferative neoplasms (MPN) are chronic myeloid cancers thought to arise at the level of CD34+ hematopoietic stem/progenitor cells. They include essential thrombocythemia (ET), polycythemia vera (PV) and primary myelofibrosis (PMF). All can progress to acute leukemia, but PMF carries the worst prognosis. Increasing evidences indicate that deregulation of microRNAs (miRNAs) might plays an important role in hematologic malignancies, including MPN. To attain deeper knowledge of short RNAs (sRNAs) expression pattern in CD34+ cells and of their possible role in mediating post-transcriptional regulation in PMF, we sequenced with Illumina HiSeq2000 technology CD34+ cells from healthy subjects and PMF patients. We detected the expression of 784 known miRNAs, with a prevalence of miRNA up-regulation in PMF samples, and discovered 34 new miRNAs and 99 new miRNA-offset RNAs (moRNAs), in CD34+ cells. Thirty-seven small RNAs were differentially expressed in PMF patients compared with healthy subjects, according to microRNA sequencing data. Five miRNAs (miR-10b-5p, miR-19b-3p, miR-29a-3p, miR-379-5p, and miR-543) were deregulated also in PMF granulocytes. Moreover, 3’-moR-128-2 resulted consistently downregulated in PMF according to RNA-seq and qRT-PCR data both in CD34+ cells and granulocytes. Target predictions of these validated small RNAs de-regulated in PMF and functional enrichment analyses highlighted many interesting pathways involved in tumor development and progression, such as signaling by FGFR and DAP12 and Oncogene Induced Senescence. As a whole, data obtained in this study deepened the knowledge of miRNAs and moRNAs altered expression in PMF CD34+ cells and allowed to identify and validate a specific small RNA profile that distinguishes PMF granulocytes from those of normal subjects. We thus provided new information regarding the possible role of miRNAs and, specifically, of new moRNAs in this disease.
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Affiliation(s)
- Paola Guglielmelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Bisognin
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Coppe
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Stefania Bortoluzzi
- Department of Molecular Medicine, University of Padova, Padova, Italy
- * E-mail:
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23
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Guglielmelli P, Rotunno G, Bogani C, Mannarelli C, Giunti L, Provenzano A, Giglio S, Squires M, Stalbovskaya V, Gopalakrishna P, Vannucchi AM. Ruxolitinib is an effective treatment for CALR-positive patients with myelofibrosis. Br J Haematol 2015; 173:938-40. [PMID: 26303809 DOI: 10.1111/bjh.13644] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paola Guglielmelli
- Laboratorio Congiunto per le Malattie Mieloproliferative, Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | - Giada Rotunno
- Laboratorio Congiunto per le Malattie Mieloproliferative, Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Costanza Bogani
- Laboratorio Congiunto per le Malattie Mieloproliferative, Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carmela Mannarelli
- Laboratorio Congiunto per le Malattie Mieloproliferative, Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Laura Giunti
- Department of Clinical and Experimental Biomedical Sciences, Medical Genetics Unit, Meyer University Hospital, Florence, Italy
| | - Aldesia Provenzano
- Department of Clinical and Experimental Biomedical Sciences, Medical Genetics Unit, Meyer University Hospital, Florence, Italy
| | - Sabrina Giglio
- Department of Clinical and Experimental Biomedical Sciences, Medical Genetics Unit, Meyer University Hospital, Florence, Italy
| | | | | | | | - Alessandro M Vannucchi
- Laboratorio Congiunto per le Malattie Mieloproliferative, Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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24
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Tapper W, Jones AV, Kralovics R, Harutyunyan AS, Zoi K, Leung W, Godfrey AL, Guglielmelli P, Callaway A, Ward D, Aranaz P, White HE, Waghorn K, Lin F, Chase A, Joanna Baxter E, Maclean C, Nangalia J, Chen E, Evans P, Short M, Jack A, Wallis L, Oscier D, Duncombe AS, Schuh A, Mead AJ, Griffiths M, Ewing J, Gale RE, Schnittger S, Haferlach T, Stegelmann F, Döhner K, Grallert H, Strauch K, Tanaka T, Bandinelli S, Giannopoulos A, Pieri L, Mannarelli C, Gisslinger H, Barosi G, Cazzola M, Reiter A, Harrison C, Campbell P, Green AR, Vannucchi A, Cross NC. Genetic variation at MECOM, TERT, JAK2 and HBS1L-MYB predisposes to myeloproliferative neoplasms. Nat Commun 2015; 6:6691. [PMID: 25849990 PMCID: PMC4396373 DOI: 10.1038/ncomms7691] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/20/2015] [Indexed: 12/21/2022] Open
Abstract
Clonal proliferation in myeloproliferative neoplasms (MPN) is driven by somatic mutations in JAK2, CALR or MPL, but the contribution of inherited factors is poorly characterized. Using a three-stage genome-wide association study of 3,437 MPN cases and 10,083 controls, we identify two SNPs with genome-wide significance in JAK2(V617F)-negative MPN: rs12339666 (JAK2; meta-analysis P=1.27 × 10(-10)) and rs2201862 (MECOM; meta-analysis P=1.96 × 10(-9)). Two additional SNPs, rs2736100 (TERT) and rs9376092 (HBS1L/MYB), achieve genome-wide significance when including JAK2(V617F)-positive cases. rs9376092 has a stronger effect in JAK2(V617F)-negative cases with CALR and/or MPL mutations (Breslow-Day P=4.5 × 10(-7)), whereas in JAK2(V617F)-positive cases rs9376092 associates with essential thrombocythemia (ET) rather than polycythemia vera (allelic χ(2) P=7.3 × 10(-7)). Reduced MYB expression, previously linked to development of an ET-like disease in model systems, associates with rs9376092 in normal myeloid cells. These findings demonstrate that multiple germline variants predispose to MPN and link constitutional differences in MYB expression to disease phenotype.
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Affiliation(s)
- William Tapper
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Amy V. Jones
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Ashot S. Harutyunyan
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Katerina Zoi
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens 11527, Greece
| | - William Leung
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Anna L. Godfrey
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Paola Guglielmelli
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Alison Callaway
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Daniel Ward
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Paula Aranaz
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Helen E. White
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Katherine Waghorn
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Feng Lin
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Andrew Chase
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - E. Joanna Baxter
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Cathy Maclean
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Jyoti Nangalia
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Edwin Chen
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Paul Evans
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Michael Short
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Louise Wallis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
| | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
| | - Andrew S. Duncombe
- Department of Haematology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Anna Schuh
- Oxford Biomedical Research Centre, Molecular Diagnostic Laboratory, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK
| | - Adam J. Mead
- Haematopoietic Stem Cell Biology Laboratory, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - Michael Griffiths
- School of Cancer Sciences, University of Birmingham,, Birmingham B15 2TT, UK
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Joanne Ewing
- Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - Rosemary E. Gale
- Department of Haematology, UCL Cancer Institute, London WC1 E6BT, UK
| | | | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Ulm 89081, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm 89081, Germany
| | - Harald Grallert
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg 85764, Germany
- German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Konstantin Strauch
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg 85764, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, 80539 Munich, Germany
| | - Toshiko Tanaka
- Longitudinal Study Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland 21224-6825, USA
| | | | - Andreas Giannopoulos
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens 11527, Greece
| | - Lisa Pieri
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Carmela Mannarelli
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Heinz Gisslinger
- Medical University of Vienna, Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Vienna 1090, Austria
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Mario Cazzola
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Andreas Reiter
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim 68167, Germany
| | - Claire Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, UK
| | - Peter Campbell
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
| | - Anthony R. Green
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Alessandro Vannucchi
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Nicholas C.P. Cross
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
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Mirigliani A, De Lucia M, Mannarelli C, Mannarelli D, Locuratolo N, Buzzanca A, Squarcione C, Torti M, Di Fabio F, Fattapposta F, Biondi M. Digeorge Syndrome: Psychotic Risk and ERPS Correlates. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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26
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Pennucci V, Zini R, Norfo R, Guglielmelli P, Bianchi E, Salati S, Sacchi G, Prudente Z, Tenedini E, Ruberti S, Paoli C, Fanelli T, Mannarelli C, Tagliafico E, Ferrari S, Vannucchi AM, Manfredini R. Abnormal expression patterns of WT1-as, MEG3 and ANRIL long non-coding RNAs in CD34+ cells from patients with primary myelofibrosis and their clinical correlations. Leuk Lymphoma 2014; 56:492-6. [PMID: 24707949 DOI: 10.3109/10428194.2014.910661] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Valentina Pennucci
- Center for Regenerative Medicine "Stefano Ferrari", University of Modena and Reggio Emilia , Modena , Italy
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27
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Vannucchi AM, Rotunno G, Bartalucci N, Raugei G, Carrai V, Balliu M, Mannarelli C, Pacilli A, Calabresi L, Fjerza R, Pieri L, Bosi A, Manfredini R, Guglielmelli P. Calreticulin mutation-specific immunostaining in myeloproliferative neoplasms: pathogenetic insight and diagnostic value. Leukemia 2014; 28:1811-8. [PMID: 24618731 PMCID: PMC4158831 DOI: 10.1038/leu.2014.100] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/20/2014] [Accepted: 02/28/2014] [Indexed: 01/01/2023]
Abstract
Mutations in the gene calreticulin (CALR) occur in the majority of JAK2- and MPL-unmutated patients with essential thrombocythemia (ET) and primary myelofibrosis (PMF); identifying CALR mutations contributes to the diagnostic pathway of ET and PMF. CALR mutations are heterogeneous spanning over the exon 9, but all result in a novel common protein C terminus. We developed a polyclonal antibody against a 17-amino-acid peptide derived from mutated calreticulin that was used for immunostaining of bone marrow biopsies. We show that this antibody specifically recognized patients harboring different types of CALR mutation with no staining in healthy controls and JAK2- or MPL-mutated ET and PMF. The labeling was mostly localized in megakaryocytes, whereas myeloid and erythroid cells showed faint staining, suggesting a preferential expression of calreticulin in megakaryocytes. Megakaryocytic-restricted expression of calreticulin was also demonstrated using an antibody against wild-type calreticulin and by measuring the levels of calreticulin RNA by gene expression analysis. Immunostaining using an antibody specific for mutated calreticulin may become a rapid, simple and cost-effective method for identifying CALR-mutated patients complementing molecular analysis; furthermore, the labeling pattern supports the preferential expansion of megakaryocytic cell lineage as a result of CALR mutation in an immature hematopoietic stem cell.
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Affiliation(s)
- A M Vannucchi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G Rotunno
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - N Bartalucci
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G Raugei
- Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - V Carrai
- Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - M Balliu
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - C Mannarelli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - A Pacilli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Calabresi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - R Fjerza
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Pieri
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - A Bosi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - R Manfredini
- Centre for Regenerative Medicine 'Stefano Ferrari', Department of Life Science, University of Modena and Reggio Emilia, Modena, Italy
| | - P Guglielmelli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Tefferi A, Guglielmelli P, Lasho TL, Rotunno G, Finke C, Mannarelli C, Belachew AA, Pancrazzi A, Wassie EA, Ketterling RP, Hanson CA, Pardanani A, Vannucchi AM. CALR and ASXL1 mutations-based molecular prognostication in primary myelofibrosis: an international study of 570 patients. Leukemia 2014; 28:1494-500. [DOI: 10.1038/leu.2014.57] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/30/2014] [Indexed: 12/14/2022]
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Susini MC, Guglielmelli P, Spolverini A, Biamonte F, Mannarelli C, Barosi G, Zoi K, Reiter A, Duncombe A, Cervantes F, Cazzola M, Cross N, Vannucchi AM. TheERCC2Gln/Gln polymorphism at codon 751 is not associated with leukaemic transformation in primary myelofibrosis. Br J Haematol 2013; 162:424-7. [DOI: 10.1111/bjh.12376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Maria C. Susini
- Department of Experimental and Clinical Medicine; University of Florence; Florence; Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine; University of Florence; Florence; Italy
| | - Ambra Spolverini
- Department of Experimental and Clinical Medicine; University of Florence; Florence; Italy
| | - Flavia Biamonte
- Department of Experimental and Clinical Medicine; University of Florence; Florence; Italy
| | - Carmela Mannarelli
- Department of Experimental and Clinical Medicine; University of Florence; Florence; Italy
| | - Giovanni Barosi
- Centro per la Mielofibrosi; Fondazione Policlinico San matteo; IRCCS; Pavia; Italy
| | - Katerina Zoi
- Haematology Research Laboratory; Academy of Athens; Athens; Greece
| | - Andreas Reiter
- III Medizinische Klinik; University of Mannheim; Mannheim; Germany
| | - Andrew Duncombe
- Department of Haematology; Southampton University Hospitals Trust; Southampton; UK
| | - Francisco Cervantes
- Haematology Department; Hospital Clinic; University of Barcelona; Barcelona; Spain
| | - Mario Cazzola
- Division of Hematology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia; Italy
| | - Nick Cross
- Wessex Regional Genetics Laboratory; Salisbury District Hospital; University of Southampton; Salisbury; UK
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Vannucchi AM, Lasho TL, Guglielmelli P, Biamonte F, Pardanani A, Pereira A, Finke C, Score J, Gangat N, Mannarelli C, Ketterling RP, Rotunno G, Knudson RA, Susini MC, Laborde RR, Spolverini A, Pancrazzi A, Pieri L, Manfredini R, Tagliafico E, Zini R, Jones A, Zoi K, Reiter A, Duncombe A, Pietra D, Rumi E, Cervantes F, Barosi G, Cazzola M, Cross NCP, Tefferi A. Mutations and prognosis in primary myelofibrosis. Leukemia 2013; 27:1861-9. [PMID: 23619563 DOI: 10.1038/leu.2013.119] [Citation(s) in RCA: 559] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 11/09/2022]
Abstract
Patient outcome in primary myelofibrosis (PMF) is significantly influenced by karyotype. We studied 879 PMF patients to determine the individual and combinatorial prognostic relevance of somatic mutations. Analysis was performed in 483 European patients and the seminal observations were validated in 396 Mayo Clinic patients. Samples from the European cohort, collected at time of diagnosis, were analyzed for mutations in ASXL1, SRSF2, EZH2, TET2, DNMT3A, CBL, IDH1, IDH2, MPL and JAK2. Of these, ASXL1, SRSF2 and EZH2 mutations inter-independently predicted shortened survival. However, only ASXL1 mutations (HR: 2.02; P<0.001) remained significant in the context of the International Prognostic Scoring System (IPSS). These observations were validated in the Mayo Clinic cohort where mutation and survival analyses were performed from time of referral. ASXL1, SRSF2 and EZH2 mutations were independently associated with poor survival, but only ASXL1 mutations held their prognostic relevance (HR: 1.4; P=0.04) independent of the Dynamic IPSS (DIPSS)-plus model, which incorporates cytogenetic risk. In the European cohort, leukemia-free survival was negatively affected by IDH1/2, SRSF2 and ASXL1 mutations and in the Mayo cohort by IDH1 and SRSF2 mutations. Mutational profiling for ASXL1, EZH2, SRSF2 and IDH identifies PMF patients who are at risk for premature death or leukemic transformation.
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Affiliation(s)
- A M Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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31
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Giannessi D, Lazzerini G, Filipponi P, Mannarelli C, Vaiani G, Grossi E, De Caterina R. Effects of nabumetone, a new non-steroidal anti-inflammatory drug, on urinary prostaglandin excretion in man. Pharmacol Res 1993; 28:229-41. [PMID: 8108313 DOI: 10.1006/phrs.1993.1126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nabumetone is a non-acidic pro-drug which, after absorption, is transformed by the liver into 6-methoxy-2-naphthylacetic acid (6-MNA), the active metabolite responsible for its anti-inflammatory activity. The urinary concentrations of 6-MNA are very low and its urinary metabolites are weak inhibitors of cyclo-oxygenase. For these reasons we hypothesized that nabumetone could spare renal cyclo-oxygenase products and, consequently, better preserve renal function unlike most other non-steroidal anti-inflammatory drugs (NSAIDs) which are known to cause an impairment of renal function, mostly related to inhibition of renal prostaglandin synthesis. We measured serum creatinine, creatinine clearance and the urinary excretion of stable prostaglandins (PG)E2 and 6-keto-PGF1 alpha, as a reflection of the renal production of PGE2 and PGI2, respectively, in 12 arthritic patients (5 males, 7 females) with normal creatinine clearance. Measurements were performed before and after a 2-week treatment with nabumetone (1 g day-1). 6-keto-PGF1 alpha and PGE2 were measured by specific radioimmunoassays (RIA) after organic solvent extraction and silicic acid column chromatography. The assay sensitivity to detect renal cyclo-oxygenase inhibition was independently verified by measuring urinary 6-keto-PGF1 alpha in normal subjects before and after aspirin and ibuprofen, known inhibitors of renal prostaglandins. At the end of treatment, serum levels of 6-MNA ranged between 24.5 and 122.4 mg 1-1, within the described therapeutic range for the drug. After nabumetone, no significant differences in the urinary excretion of the two prostaglandins with respect to baseline values were observed (for 6-keto-PGF1 alpha from 12.3 +/- 6.0 to 12.1 +/- 8.7 ng h-1, mean +/- S.D.; for PGE2 from 12.3 +/- 13.6 to 11.3 +/- 15.3 ng h-1). Also no changes in serum creatinine or creatinine clearance were observed. These results suggest that nabumetone does not significantly impair renal prostaglandin synthesis in patients with osteoarthritis.
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Affiliation(s)
- D Giannessi
- CNR Institute of Clinical Physiology, Pisa, Italy
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De Caterina R, Giannessi D, Lazzerini G, Filipponi P, Mannarelli C, Vaiani G, Grossi E. Effect of nabumetone on metabolism of renal arachidonate in humans. J Rheumatol Suppl 1992; 36:80. [PMID: 1474540 DOI: pmid/1474540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Filipponi P, Gregorio F, Cristallini S, Mannarelli C, Blass A, Scarponi AM, Vespasiani G. Partial gastrectomy and mineral metabolism: effects on gastrin-calcitonin release. Bone Miner 1990; 11:199-208. [PMID: 2268747 DOI: 10.1016/0169-6009(90)90059-o] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bone mineral metabolism was studied in 20 male patients, between 8 and 18 years, after surgical treatment for peptic ulcer (ten Billroth 1 and ten Billroth 2 gastrectomies) and in 16 sex- and aged-matched healthy controls. The bone mineral content was statistically reduced only in the Billroth 2 group. Serum 25(OH)D was lower in all patients, but fractional calcium absorption was similar to the control value. This may be due to increases in 1,25(OH)2D and parathyroid activity (particularly in Billroth 2). Serum osteocalcin levels and hydroxyproline excretion were higher than in the controls. A positive linear correlation emerged not only between serum 1,25(OH)2D and PTH levels but also between each of these and serum osteocalcin and urine hydroxyproline. Both PTH and calcitriol were inversely correlated with the bone mineral mass in Billroth 2, confirming a trend observed in Billroth 1. Although calcitonin values were normal, basal gastrin levels were severely impaired in all patients. In response to a mixed meal, increases in gastrin and calcitonin were significantly lower than in the controls. The calcitonin response to intravenous calcium and pentagastrin infusion was not significantly different to the controls. The percentage increase in gastrin and calcitonin responses to oral calcium correlated positively with the reduction in bone mineral content only in the Billroth 2 group, suggesting a reduction in calcitonin release may contribute to gastric surgery osteopenia in these patients.
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Affiliation(s)
- P Filipponi
- Istituto di Clinica Medica I, Cattedra di Malattie del Ricambio, Perugia, Italy
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Filipponi P, Mannarelli C, Pacifici R, Grossi E, Moretti I, Tini S, Carloni C, Blass A, Morucci P, Hruska KA. Evidence for a prostaglandin-mediated bone resorptive mechanism in subjects with fasting hypercalciuria. Calcif Tissue Int 1988; 43:61-6. [PMID: 3142668 DOI: 10.1007/bf02555148] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study was performed to assess whether treatment with prostaglandin synthesis inhibitors decreases calcium excretion in patients with idiopathic hypercalciuria. Nineteen hypercalciuric (12 with fasting hypercalciuria (FH), 7 with nonfasting hypercalciuria (NFH) and 8 control non-hypercalciuric stone formers were treated with sodium diclofenac, 50 mg t.i.d. for 2 weeks. After a washout phase, 7 FH patients received 200 mg/day of sulindac (a nonsteroidal antiinflammatory agent (NSAID) inactive on renal prostaglandin synthetase) for 14 more days. Diclofenac reduced urine calcium excretion in subjects with idiopathic hypercalciuria with either normal or elevated fasting urinary calcium (from 387 +/- 26 to 240 +/- 23 mg/day, P less than 0.001; and from 370 +/- 39 to 246 +/- 40 mg/day, P less than 0.05, respectively), whereas it was ineffective in normocalciuric stone formers. Similar antihypercalciuric effectiveness was exerted by sulindac in the seven FH patients. The antihypercalciuric action exerted by diclofenac in subjects with FH was associated with a significant increment in serum PTH (48 +/- 4 vs, 70 +/- 9 pmol/liter, P less than 0.05), whereas in NFH subjects, the antihypercalciuric effect of diclofenac on NFH was not associated with a change in parathyroid activity. Since the major effect of NSAIDs is to decrease prostaglandin synthesis, these data suggest that prostaglandins may play a pathogenetic role in idiopathic hypercalciuria. Furthermore, they suggest that PTH is suppressed in patients with FH, possibly due to stimulation of prostaglandin-mediated bone resorption process.
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Affiliation(s)
- P Filipponi
- Institute of Clinica Medica I, University of Perugia, Italy
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Filipponi P, Mannarelli C, Gubbiotti G, Blass A, Moretti I, Tini S, Giuseppetti N, Ballanti S, Morucci P. The effects of calcitonin on idiopathic nephrolithiasis. Evidence of bone involvement in fasting hypercalciuria. J Endocrinol Invest 1988; 11:509-13. [PMID: 3171110 DOI: 10.1007/bf03350171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study was performed to evaluate the antihypercalciuric effect of calcitonin (CT), a potent inhibitor of bone osteoclastic activity, on idiopathic hypercalciuria (IH). Forty-two stone formers were studied: 18 suffered from fasting hypercalciuria (FH), 12 from nonfasting hypercalciuria (NFH) and 12 were normocalciuric stone formers (NSF). All patients received CT, 25 U/day sc for a period of 15 days. CT caused a statistically significant drop in urine calcium, phosphorus and hydroxyproline (OH-proline) excretion in FH patients and a concomitant increase in serum PTH levels. In this group the percentage variation (D%) of urine calcium decrease was linearly correlated with D% decrease in urine OH-proline. These results support the hypothesis that pathological bone reabsorption might be involved in the genesis of FH.
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Affiliation(s)
- P Filipponi
- Istituto di Clinica Medica I, University of Perugia, Italy
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Filipponi P, Gregorio F, Ferrandina C, Nicoletti I, Mannarelli C, Pippi R, Santeusanio F. Alpha-adrenergic system in the modulation of pancreatic A and B cell function in normal rats. Diabetes Res Clin Pract 1986; 2:325-36. [PMID: 2880701 DOI: 10.1016/s0168-8227(86)80069-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The role of the alpha-adrenergic system in the control of pancreatic A and B cell function was investigated in an isolated perfused rat pancreas model. Two experimental procedures were performed. In the first one we evaluated the effects of two distinct concentrations (10(-8) M and 10(-7) M) of five adrenergic substances, with varying degrees of potency on the alpha-adrenergic presynaptic receptor, on insulin (IRI) and glucagon (IRG) release induced by arginine (20 mM) plus glucose (6.6 mM). In the second procedure we studied the effects of the two alpha-blocking agents yohimbine (alpha 2-blocker) and prazosin (alpha 1-blocker) at 10(-7) M on epinephrine-modulated IRI and IRG response to the same combined metabolic stimulus. The inhibitory activity on basal and metabolically induced IRI secretion of the agonists was superimposable on their potency on the presynaptic alpha 2-adrenergic receptors. Similarly, the alpha 1-blocking agent prazosin was less effective than the alpha 2-blocker yohimbine in counteracting the inhibitory effects of epinephrine on basal and arginine plus glucose-induced insulin release. The alpha-cell activity was clearly stimulated by epinephrine, whereas selective alpha-adrenergic drugs showed no significant action on IRG secretion. Both alpha-blockers were ineffective on basal IRG release, while they had some potentiating effect on the epinephrine-induced glucagon release in basal state and during the metabolic stimulus, without a significant difference between the two drugs. We conclude that, at least in the isolated perfused rat pancreas, alpha 2-adrenergic receptors are involved in the inhibition of IRI release induced by catecholamines. On the contrary, the alpha-adrenergic system does not seem to play an essential role in the regulation of IRG secretion; the potentiation of the epinephrine-induced stimulation of A cell function by the alpha-adrenergic blockade could be accounted for by a greater availability of the catecholamine at the beta-receptor binding sites.
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Nicoletti I, Ambrosi F, Giammartino C, Fedeli L, Mannarelli C, Filipponi P. Catecholamines and pituitary-function. V. Effect of low-dose dopamine infusion on basal and gonadotropin-releasing hormone stimulated gonadotropin release in normal cycling women and patients with hyperprolactinemic amenorrhea. Horm Metab Res 1986; 18:479-84. [PMID: 3091473 DOI: 10.1055/s-2007-1012351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To verify the role of dopaminergic mechanisms in the control of gonadotropin secretion in normal and hyperprolactinemic women, we examined the gonadotropin response to GnRH (100 micrograms i.v.) administration in both basal conditions and during low-dose dopamine (DA, 0.1 microgram/kg/min) infusion. Hyperprolactinemic women, either with microadenoma or without radiological signs of pituitary tumor, showed significantly enhanced LH and FSH responses to GnRH in comparison with normal cycling women. 0.1 microgram/kg/min DA infusion did not result in any appreciable suppression of serum gonadotropin levels but significantly reduced the LH and FSH responses to GnRH in both normal and amenorrheic hyperprolactinemic women. Although both LH and FSH levels remained higher in hyperprolactinemic patients than in normal women after GnRH, the gonadotroph's sensitivity to DA inhibition was normal in the hyperprolactinemic group, as both control subjects and patients with hyperprolactinemic showed similar per cent suppression of GnRH-stimulated gonadotropin release during DA. These data confirm that hypothalamic DA modulates the gonadotroph's responsiveness to GnRH. The increased LH and FSH responses to GnRH in hyperprolactinemic patients and their reduction during low-dose DA infusion seem to indicate that endogenous DA inhibition of pituitary gonadotropin release is reduced rather than enhanced in women with pathological hyperprolactinemia.
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Moretti I, Mannarelli C, Tini S, Carloni C, Gregorio F, Boldrini P, Filipponi P. Effetto Di Una Terapia Idropinica Con Acqua Oligominerale Sulle Anomalie Metaboliche Di Pazienti Con Nefrolitiasi Idiopatica. Urologia 1986. [DOI: 10.1177/039156038605300202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pacifici R, Filipponi P, Mannarelli C, Vespasiani G, Porena M, Fedeli L, Morucci V, Avioli LV. Classification of idiopathic hypercalciuric patients by isotopic calcium absorption: a comparison with oral calcium tolerance test. Calcif Tissue Int 1985; 37:467-73. [PMID: 2998573 DOI: 10.1007/bf02557828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To test the accuracy of calcium tolerance test in estimating calcium absorption, we have measured the radioactive calcium absorption (expressed as Fx) in 27 patients with IH and renal calcium stones. The results of this test were compared with those of a standard oral calcium tolerance test. Although only seven of nine AH patients displayed normal fasting calcium excretion, they all displayed Fx values above normal and a normal parathyroid activity. Conversely, only 5 of our 18 RH patients demonstrated a hyperabsorption of radioactive calcium and an elevation in iPTH and cAMP above normal limits, yet all of them showed an increased calciuric response to an oral calcium challenge. Calcium absorption was inversely related to iPTH (r = -082; P less than 0.001) and cAMP (r = -064 P less than 0.05) in AH, but directly proportional to these parameters (r = 0.62 P less than 0.001 and r = 0.46 P less than 0.05, respectively) in RH patients. In view of these results, two ratios, iPTH/Fx and cAMP/Fx were used to discriminate between the two groups of patients. Both ratios were over normal limits in all RH patients and within normal range in all but one AH patient. Furthermore, no overlap was found between the two groups. Conversely, we were unable to completely separate AH from RH subjects on the basis of the oral calcium tolerance test, since in both groups the fasting and the absolute (or percentage) changes in urinary calcium, cAMP and blood iPTH levels following oral calcium loading, overlapped in each instance.(ABSTRACT TRUNCATED AT 250 WORDS)
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