A novel on-a-chip system with a 3D-bioinspired gut mucus suitable to investigate bacterial endotoxins dynamics

The possible pathogenic impact of pro-inflammatory molecules produced by the gut microbiota is one of the hypotheses considered at the basis of the biomolecular dialogue governing the microbiota-gut-brain axis. Among these molecules, lipopolysaccharides (LPS) produced by Gram-negative gut microbiota strains may have a potential key role due to their toxic effects in both the gut and the brain. In this work, we engineered a new dynamic fluidic system, the MINERVA device (MI-device), with the potential to advance the current knowledge of the biological mechanisms regulating the microbiota-gut molecular crosstalk. The MI-device supported the growth of bacteria that are part of the intestinal microbiota under dynamic conditions within a 3D moving mucus model, with features comparable to the physiological conditions (storage modulus of 80 ± 19 Pa, network mesh size of 41 ± 3 nm), without affecting their viability (∼ 109 bacteria/mL). The integration of a fluidically optimized and user-friendly design with a bioinspired microenvironment enabled the sterile extraction and quantification of the LPS produced within the mucus by bacteria (from 423 ± 34 ng/mL to 1785 ± 91 ng/mL). Compatibility with commercially available Transwell-like inserts allows the user to precisely control the transport phenomena that occur between the two chambers by selecting the pore density of the insert membrane without changing the design of the system. The MI-device is able to provide the flow of sterile medium enriched with LPS directly produced by bacteria, opening up the possibility of studying the effects of bacteria-derived molecules on cells in depth, as well as the assessment and characterization of their effects in a physiological or pathological scenario.

Cyberloafing: Investigating the Importance and Implications of New and Known Predictors

Cyberloafing occurs when employees use technology to loaf instead of work. Despite mounting organizational concern and psychological research on cyberloafing, research provides little actionable guidance to address cyberloafing. Therefore, the present study builds on previous cyberloafing investigations in three primary ways. First, we utilize a person-situation framework to compare personological and situational construct domains. Second, we extend the cyberloafing nomological network by investigating previously unexamined, yet powerful, predictors. Third, we employ a multivariate approach to identify the most important cyberloafing antecedents. From seven cyberloafing constructs, we found that boredom, logical reasoning, and interpersonal conflict were the most important correlates. Our results highlight novel, important predictors of cyberloafing and allow us to provide empirically-based recommendations for developing cyberloafing interventions.

PDGFRβ promotes oncogenic progression via STAT3/STAT5 hyperactivation in anaplastic large cell lymphoma

BACKGROUND

Anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin T cell lymphoma commonly driven by NPM-ALK. AP-1 transcription factors, cJUN and JUNb, act as downstream effectors of NPM-ALK and transcriptionally regulate PDGFRβ. Blocking PDGFRβ kinase activity with imatinib effectively reduces tumor burden and prolongs survival, although the downstream molecular mechanisms remain elusive.

METHODS AND RESULTS

In a transgenic mouse model that mimics PDGFRβ-driven human ALCL in vivo, we identify PDGFRβ as a driver of aggressive tumor growth. Mechanistically, PDGFRβ induces the pro-survival factor Bcl-xL and the growth-enhancing cytokine IL-10 via STAT5 activation. CRISPR/Cas9 deletion of both STAT5 gene products, STAT5A and STAT5B, results in the significant impairment of cell viability compared to deletion of STAT5A, STAT5B or STAT3 alone. Moreover, combined blockade of STAT3/5 activity with a selective SH2 domain inhibitor, AC-4-130, effectively obstructs tumor development in vivo.

CONCLUSIONS

We therefore propose PDGFRβ as a novel biomarker and introduce PDGFRβ-STAT3/5 signaling as an important axis in aggressive ALCL. Furthermore, we suggest that inhibition of PDGFRβ or STAT3/5 improve existing therapies for both previously untreated and relapsed/refractory ALK+ ALCL patients.

OP0236 JAK-STAT INHIBITION RESTORES EPITHELIAL CELLS’ HOMEOSTASIS IN PRIMARY SJOGREN’S SYNDROME

Background

Although salivary gland epithelial cells (SGECs) are key players in the pathogenesis of autoimmune epithelitis that characterizes primary Sjӧgren’s Syndrome (pSS), the mechanisms sustaining SGECs activation in pSS remain largely undetermined. Therefore, therapeutic strategies to counteract SGECs activation in pSS are also lacking. In previous studies, we revealed that maladaptive autophagy sustains survival and pro-inflammatory activation of SGECs in pSS (1).

Objectives

To determine the therapeutic potential of JAK/STAT inhibition with baricitinib to restore homeostatic regulation of SGECs in pSS, by reducing autophagy, survival, and expression of adhesion molecules.

Methods

Primary SGECs were isolated from minor salivary glands (SG) of large cohort of patients with pSS or sicca syndrome and subjected to mechanistic and functional studies including flow-cytometry, immunoblotting, and immunofluorescence to assess autophagy (autophagic-flux, LC3IIB, p62, LC3B+/LAMP1+ staining), apoptosis (annexin V/PI, Caspase-3) and activation (ICAM, VCAM). Focus score and germinal centers were determined in homologous SG biopsies to assess correlations of findings with histological disease severity. Primary SGECs of patients with pSS were treated with Baricitinib (1 mM) for 24 prior to assessment of autophagy, apoptosis and activation.

Results

SGECs from pSS patients (n=29) exhibited increased autophagy (as determined by autophagic-flux p=0.001; LC3IIB p=0.02; p62 p=0.064; LC3IIB/LAMP1+ staining), increased expression of anti-apoptotic molecules (Bcl2 p=0.006), and reduced apoptosis (Annexin-V/PI p=0.002, Caspase-3 p=0.057) compared to sicca (n=16). Induction of autophagy in pSS SGECs correlated with histologic disease severity. Treatment of pSS SGECs with baricitinib ex vivo suppressed autophagy, increased apoptosis, and reduced expression of adhesion molecules.

Conclusion

SGECs in the inflammatory milieu of pSS are characterized by induction of autophagy and pro-survival mechanisms, and by expression of adhesion molecules. These changes correlate with SG infiltration with immune cells and with histologic disease severity. Among clinically available therapies, the JAK/STAT inhibitor baricitinib effectively reduced autophagy, countered the state of maladaptive activation of SGECs, and restored epithelial cell homeostasis. Transcriptomics and metabolomics studies are ongoing to dissect the specific mechanisms responsible for these beneficial effects.

References

[1]Colafrancesco S, et al. Maladaptive autophagy in the pathogenesis of autoimmune epithelitis in Sjӧgren’s Syndrome. Arthritis Rheumatol 2021.

Disclosure of Interests

Serena Colafrancesco Speakers bureau: Novartis

Sobi, Grant/research support from: Eli Lilly, cristiana barbati: None declared, Roberta Priori: None declared, Federico Giardina: None declared, angelica gattamelata: None declared, raffaella izzo: None declared, Bruna Cerbelli: None declared, Carla Giordano: None declared, Susanna Scarpa: None declared, Massimo Fusconi: None declared, Francesca Romana Spinelli Speakers bureau: Eli Lilly

Pfizer

Abbvie, Giulio Cavalli: None declared, cristiano alessandri: None declared, Fabrizio Conti: None declared

Gender-specific soluble α-klotho levels as marker of GH deficiency in children: a case-control study

PURPOSE

To evaluate circulating soluble α-klotho (sαKL) levels in GHD children before and after 12 months of GH treatment (GHT).

METHODS

Auxological and basal metabolic parameters, oral glucose tolerance test for glucose and insulin levels, insulin sensitivity indices and klotho levels were evaluated before and after 12 months of follow-up in 58 GHD children and 56 healthy controls.

RESULTS

At baseline, GHD children showed significantly lower growth velocity standard deviation score (SDS) (p < 0.001), bone/chronological age ratio (p < 0.001), GH peak and area under the curve (AUC) after arginine test (ARG) (both p < 0.001) and glucagon stimulation test (GST) (p < 0.001 and 0.048, respectively), IGF-1 (p < 0.001), with higher BMI (SDS) (p < 0.001), WC (SDS) (p = 0.003) and sαKL (p < 0.001) than controls. After 12 months of GHT, GHD children showed a significant increase in height (SDS) (p < 0.001), growth velocity (SDS) (p < 0.001), bone/chronological age ratio (p < 0.001) IGF-1 (p < 0.001), fasting insulin (p < 0.001), Homa-IR (p < 0.001) and sαKL (p < 0.001) with a concomitant decrease in BMI (SDS) (p = 0.002) and WC (SDS) (p = 0.038) than baseline. At ROC curve analysis, we identified a sαKL cut-off to discriminate controls and GHD children of 1764.4 pg/mL in females and 1339.4 pg/mL in males. At multivariate analysis, the independent variables significantly associated with sαKL levels after 12 months of GHT were the oral disposition index (p = 0.004, β = 0.327) and IGF-1 (p = 0.019, β = 0.313).

CONCLUSIONS

Gender-related sαKL may be used as a marker of GHD combined to GH and IGF-1. Insulin and IGF-1 are independently associated with sαKL values after 12 months of GHT.

Maladaptive autophagy in the pathogenesis of autoimmune epithelitis in Sjӧgren's Syndrome

OBJECTIVE

Salivary gland epithelial cells (SGECs) are key cellular drivers in the pathogenesis of primary Sjӧgren's Syndrome (pSS); however, the mechanisms sustaining SGECs activation in pSS remain undetermined. The aim of this study is to determine the role of autophagy in the survival and activation of SGECs in pSS.

METHODS

Primary SGECs isolated from minor salivary glands (SG) of patients with pSS or sicca syndrome were evaluated by flow-cytometry, immunoblotting, and immunofluorescence to assess autophagy (autophagic-flux, LC3IIB, p62, LC3B+/LAMP1+ staining), apoptosis (annexin V/PI, Caspase-3) and activation (ICAM, VCAM). Focus score and germinal centers presence was assessed in SG from the same patients to correlate with histological severity. Human salivary gland (HSG) cells were stimulated in vitro with PBMCs and serum from pSS patients in the presence or absence of autophagy inhibitors to determine changes in autophagy and epithelial cell activation.

RESULTS

SGECs from pSS patients (n=24) exhibited increased autophagy (autophagic-flux p=0.001; LC3IIB p=0.02; p62 p=0.064; LC3IIB/LAMP1+ staining), increased expression of anti-apoptotic molecules (Bcl2 p=0.006), and reduced apoptosis (Annexin-V/PI p=0.002, Caspase-3 p=0.057) compared to sicca (n=16). Autophagy correlated with histologic disease severity. In vitro experiments on HSG cells stimulated with serum and PBMCs from pSS patients confirmed activation of autophagy and expression of adhesion molecules, which was reverted upon pharmacologic inhibition of autophagy.

CONCLUSIONS

In pSS SGECs, inflammation induces autophagy and pro-survival mechanisms, which promote SGEC activation and mirror histological severity. These findings indicate that autophagy is a central contributor to the pathogenesis of pSS and a new therapeutic target.

Autoimmune polyendocrine syndrome type 1: an Italian survey on 158 patients

BACKGROUND

Autoimmune Polyglandular Syndrome type 1 (APS-1) is a rare recessive inherited disease, caused by AutoImmune Regulator (AIRE) gene mutations and characterized by three major manifestations: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CH) and Addison's disease (AD).

METHODS

Autoimmune conditions and associated autoantibodies (Abs) were analyzed in 158 Italian patients (103 females and 55 males; F/M 1.9/1) at the onset and during a follow-up of 23.7 ± 15.1 years. AIRE mutations were determined.

RESULTS

The prevalence of APS-1 was 2.6 cases/million (range 0.5-17 in different regions). At the onset 93% of patients presented with one or more components of the classical triad and 7% with other components. At the end of follow-up, 86.1% had CH, 77.2% AD, 74.7% CMC, 49.5% premature menopause, 29.7% autoimmune intestinal dysfunction, 27.8% autoimmune thyroid diseases, 25.9% autoimmune gastritis/pernicious anemia, 25.3% ectodermal dystrophy, 24% alopecia, 21.5% autoimmune hepatitis, 17% vitiligo, 13.3% cholelithiasis, 5.7% connective diseases, 4.4% asplenia, 2.5% celiac disease and 13.9% cancer. Overall, 991 diseases (6.3 diseases/patient) were found. Interferon-ω Abs (IFNωAbs) were positive in 91.1% of patients. Overall mortality was 14.6%. The AIRE mutation R139X was found in 21.3% of tested alleles, R257X in 11.8%, W78R in 11.4%, C322fsX372 in 8.8%, T16M in 6.2%, R203X in 4%, and A21V in 2.9%. Less frequent mutations were present in 12.9%, very rare in 9.6% while no mutations in 11% of the cases.

CONCLUSIONS

In Italy, APS-1 is a rare disorder presenting with the three major manifestations and associated with different AIRE gene mutations. IFNωAbs are markers of APS-1 and other organ-specific autoantibodies are markers of clinical, subclinical or potential autoimmune conditions.

Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study

PURPOSE

To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively.

METHODS

Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH.

RESULTS

Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p < 0.001) and U/Kg (p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH. At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH.

CONCLUSION

Patients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.

PET/MRI for staging patients with Hodgkin lymphoma: equivalent results with PET/CT in a prospective trial

To compare FDG-PET/unenhanced MRI and FDG-PET/diagnostic CT in detecting infiltration in patients with newly diagnosed Hodgkin lymphoma (HL). The endpoint was equivalence between PET/MRI and PET/CT in correctly defining the revised Ann Arbor staging system. Seventy consecutive patients with classical-HL were prospectively investigated for nodal and extra-nodal involvement during pretreatment staging with same-day PET/CT and PET/MRI. Findings indicative of malignancy with the imaging procedures were regarded as lymphoma infiltration; in case of discrepancy, positive-biopsy and/or response to treatment were evidenced as lymphoma. Sixty of the 70 (86%) patients were evaluable having completed the staging program. Disease staging based on either PET/MRI or PET/CT was correct for 54 of the 60 patients (90% vs. 90%), with difference between proportions of 0.0 (95% CI, -9 to 9%; P=0.034 for the equivalence test). As compared with reference standard, invasion of lymph nodes was identified with PET/MRI in 100% and with PET/CT in 100%, of the spleen with PET/MRI in 66% and PET/CT in 55%, of the lung with PET/MRI in 60% and PET/CT in 100%, of the liver with PET/MRI in 67% and PET/CT in 100%, and of the bone with PET/MRI in 100% and PET/CT in 50%. The only statistically significant difference between PET/MRI and PET/CT was observed in bony infiltration detection rates. For PET/CT, iodinate contrast medium infusions' average was 86 mL, and exposure to ionizing radiation was estimated to be 4-fold higher than PET/MRI. PET/MRI is a promising safe new alternative in the care of patients with HL.

Using Mobile Sensors to Study Personality Dynamics

Abstract. Research interest in personality dynamics over time is rapidly growing. Passive personality assessment via mobile sensors offers an intriguing new approach for measuring a wide variety of personality dynamics. In this paper, we address the possibility of integrating sensor-based assessments to enhance personality dynamics research. We consider a variety of research designs that can incorporate sensor-based measures and address pitfalls and limitations in terms of psychometrics and practical implementation. We also consider analytic challenges related to data quality and model evaluation that researchers must address when applying machine learning methods to translate sensor data into composite personality assessments.

Protein requirement of patients on CAPD: A study on nitrogen balance

This work was presented in part at the 12th Annual Contractor's Conference of the National Institutes of Arthritis, Metabolism and Digestive Diseases, Bethesda, USA, January 15, 1979 and the Congress of the International Society for Artificial Internal Organs at the symposium on CAPD, New York Hilton, New York, April 19, 1979.

Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion

CONTEXT

Glucocorticoid (GC) replacement therapy in patients with adrenal insufficiency (AI) is life saving. After over 50 years of conventional GC treatment, novel formulations are now entering routine clinical practice.

METHODS

Given the spectrum of medications currently available and new insights into the understanding of AI, the authors reviewed relevant medical literature with emphasis on original studies, prospective observational data and randomized controlled trials performed in the past 35 years. The Expert Opinion of a panel of selected endocrinologists was sought to answer specific clinical questions. The objective was to provide an evidence-supported guide, for the use of GC in various settings from university hospitals to outpatient clinics, that offers specific advice tailored to the individual patient.

RESULTS

The Panel reviewed available GC replacement therapies, comprising short-acting, intermediate and long-acting oral formulations, subcutaneous formulations and the novel modified-release hydrocortisone. Advantages and disadvantages of these formulations were reviewed.

CONCLUSIONS

In the Panel's opinion, achieving the optimal GC timing and dosing is needed to improve the outcome of AI. No-single formulation offers the best option for every patients. Recent data suggest that more emphasis should be given to the timing of intake. Tailoring of GS should be attempted in all patients-by experts-on a case-by-case basis. The Panel identified specific subgroups of AI patients that could be help by this process. Long-term studies are needed to confirm the short-term benefits associated with the modified-release GCs. The impact of GC tailoring has yet to be proven in terms of hospitalization rate, morbidity and mortality.

2-deoxy-2[F-18] fluoro-D-glucose positron emission tomography Deauville scale and core-needle biopsy to determine successful management after six doxorubicin, bleomycin, vinblastine and dacarbazine cycles in advanced-stage Hodgkin lymphoma

BACKGROUND

The clinical impact of the positivity of the Deauville scale (DS) of positron emission tomography (PET) performed at the end of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) in patients with advanced Hodgkin lymphoma (HL), in terms of providing rationale to shift poor responders onto a more intensive regimen, remain to be validated by histopathology.

PATIENTS AND METHODS

This prospective trial involved patients with stage IIB/IV HL who after six ABVD cycles underwent PET (PET6) and core-needle cutting biopsy (CNCB) of 2-deoxy-2[F-18] fluoro-d-glucose (FDG)-avid lymph nodes. Patients received high-dose chemotherapy/autologous haematopoietic stem cell rescue (HDCT/AHSCR) if CNCB was positive for HL, alternatively, if CNCB or PET was negative, received observation or consolidation radiotherapy (cRT) on residual nodal masses, as initially planned. The end-point was 5-year progression-free survival (PFS).

RESULTS

In all, 43 of the 169 (25%) evaluable patients were PET6 positive (DS 4, 32; DS 5, 11). Among them, histology showed malignancy (HL) in 100% of DS 5 scores and in 12.5% of DS 4 scores. Fifteen patients with positive biopsy received HDCT/AHSCR, whereas 28 patients with negative biopsy, as well as 126 patients with negative PET6, continued the original plan (cRT, 78 patients; observation, 76 patients). The 5-year PFS in the negative PET6 group, negative biopsy group and positive biopsy group was 95.4%, 100% and 52.5%, respectively.

CONCLUSION

DS positivity of end-of-ABVD PET in advanced HL carried a certain number of CNCB-proven non-malignant FDG-uptakes. The DS 4 scores which were found to have negative histology appeared to benefit from continuing the original non-intensive therapeutic plane as indicated by the successful outcome in more than 95% of them by obtaining similar 5-year PFS to the PET6-negative group. By contrast, the DS 5 score had consistently positive histology and was associated with unsuccessful conventional therapy, promptly requiring treatment intensification or innovative therapeutic approaches.

Recovering bifactor models: A comparison of seven methods

The last decade has witnessed a resurgence of interest in exploratory bifactor analysis models and the concomitant development of new methods to estimate these models. Understandably, due to the rapid pace of developments in this area, existing Monte Carlo comparisons of bifactor analysis have not included the newest methods. To address this issue, we compared the model recovery capabilities of 5 existing methods and 2 newer methods (Waller, 2018a) for exploratory bifactor analysis. Our study expands upon previous work in this area by comparing (a) a greater number of estimation algorithms and (b) by including both nonhierarchical and hierarchical bifactor models in our study design. In aggregate, we conducted almost 3 million exploratory bifactor analyses to identify the most accurate methods. Our results showed that, when compared with the alternatives, the rank-deficient Schmid-Leiman and Direct Schmid-Leiman methods were better able to recover both nonhierarchical and hierarchical bifactor structures. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Silver nanoparticles enter the tree stem faster through leaves than through roots

A major environmental pollution problem is the release into the atmosphere of particulate matter, including nanoparticles (NPs), which causes serious hazards to human and ecosystem health, particularly in urban areas. However, knowledge about the uptake, translocation and accumulation of NPs in plant tissues is almost completely lacking. The uptake of silver nanoparticles (Ag-NPs) and their transport and accumulation in the leaves, stems and roots of three different tree species, downy oak (Quercus pubescens Willd.), Scots pine (Pinus sylvestris L.) and black poplar (Populus nigra L.), were assessed. In the experiment, Ag-NPs were supplied separately to the leaves (via spraying, the foliar treatment) and roots (via watering, the root treatment) of the three species. Uptake, transport and accumulation of Ag were investigated through spectroscopy. The concentration of Ag in the stem was higher in the foliar than in the root treatment, and in poplar more than in oak and pine. Foliar treatment with Ag-NPs reduced aboveground biomass and stem length in poplars, but not in oaks or pines. Species-specific signals of oxidative stress were observed; foliar treatment of oak caused the accumulation of H2O2 in leaves, and both foliar and root treatments of poplar led to increased O2- in leaves. Ag-NPs affected leaf and root bacteria and fungi; in the case of leaves, foliar treatment reduced bacterial populations in oak and poplar and fungi populations in pine, and in the case of roots, root treatment reduced bacteria and increased fungi in poplar. Species-specific mechanisms of interaction, transport, allocation and storage of NPs in trees were found. We demonstrated definitively that NPs enter into the tree stem through leaves faster than through roots in all of the investigated tree species.

Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency

BACKGROUND

Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation.

METHODS

We selected 27 patients on hydrocortisone (mean dose 17.5 ± 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 ± 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 ± 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained.

RESULTS

After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed.

CONCLUSIONS

DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used.

Abstract P1-05-04: Leptin modulates exosome biogenesis in breast cancer cells through an enhanced Hsp90/Tsg101 interaction

Exosomes, small membrane vesicles secreted by both normal and malignant cells upon fusion of endosomal multivesicular bodies (MVBs) with the plasma membrane,play an important role in cell-to-cell communication. Several reports have highlighted the involvement of exosomes in many aspects of breast cancer (BC) development and progression, thus mounting interest in the potential exploitation of these vesicles and their cargoes as cancer biomarkers, drug delivery systems, and for the development of novel therapies. It has been extensively demonstrated the involvement of the obesity hormone leptin in all steps of breast tumorigenesis, but up to now its role in modulating breast cancer exosome generation has not been investigated. Here, we studied the effect of leptin on exosome biogenesis and secretion in estrogen receptor a (ERa)-positive MCF-7 and triple negative MDA-MB-231 BC cells. First, we revealed by Transmission Electron Microscopy (TEM) that the number of MVBs in the cytoplasm of leptin-treated MCF-7 and MDA-MB-231 BC cells was significantly increased compared to control untreated cells. Next, we characterized size distribution, particle number and protein cargo of exosomes, isolated by ultracentrifugation method, from conditioned media (CM) of cells treated or not with leptin. Nanoparticle Tracking Analysis revealed that the concentration of exosomes in the leptin treated MCF-7- and MDA-MB-231-CM was significantly higher compared to untreated samples. Furthermore, exosomes quantification by Acetylcholinesterase activity showed that the full leptin receptor antagonist, peptide LDFI, abrogated leptin-induced exosome secretion. Exosomes from leptin treated cells showedan increased expression of the leptin target gene Heat shock protein 90 (Hsp90) and its client protein HER2, along with activated leptin signaling effectors (pJAK2, pSTAT3, and pMAPK42/44) compared to exosomes from untreated cells. Mechanistically, our results demonstrated that, among proteins involved in exosome biogenesis, leptin significantly increased protein expression of the well-known exosomal luminal marker Tumor susceptibility gene 101 (Tsg101), without affecting its mRNA levels. Thus, we aimed to analyse specific Tsg101 protein-protein interaction as a possible mechanism able to modulate its stability or half-life within the cells. To answer to this question, we performed, in MCF-7 BC cells, co-immunoprecipitation studies combined with mass spectrometry. Analysis of the spectra identified Hsp90 as a specific Tsg101 interacting protein, and concomitantly immunoblotting assays revealed a specific interaction between HSP90 and Tsg101 in basal condition that was further increased upon leptin exposure. Accordingly, leptin-induced Tsg101 protein levels were completely abrogated in the presence of specific Hsp90 inhibitor, 17-allylamino-17-demethoxygeldanamicin.

In conclusion, our results demonstrate for the first time that leptin was able to increase exosomes release in BC cells, through an up-regulation of Tsg101 expression at posttranslational level. These findings, providing additional insights into the molecular mechanism governing exosome generation in BC cells, might open new avenues for therapeutic intervention in BC.

Citation Format: Gelsomino L, Giordano C, Barone I, Panza S, Augimeri G, Bonofiglio D, Catalano S, Andò S. Leptin modulates exosome biogenesis in breast cancer cells through an enhanced Hsp90/Tsg101 interaction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-05-04.

Insulin sensitivity and secretion and adipokine profile in patients with Cushing's disease treated with pasireotide

PURPOSE

To evaluate the effect of pasireotide on β-cell and adipose function in patients with Cushing's disease (CD).

METHODS

Clinical and hormonal parameters, insulin secretion evaluated by HOMA-β and by the area under the curve (AUC_2h) of C-peptide during a mixed meal tolerance test and insulin sensitivity, evaluated by the euglycaemic hyperinsulinaemic clamp, were evaluated in 12 patients with active CD, before and after 6 and 12 months of pasireotide. In addition, a panel of adipokines including leptin (Ob), leptin/leptin receptor ratio (Ob/Ob-R ratio), adiponectin, resistin, visfatin, adipocyte fatty acid binding protein (AFABP) and non-esterified fatty acids (NEFAs) was evaluated at baseline and after 12 months of pasireotide.

RESULTS

During 12 months of pasireotide treatment, a significant decrease in weight (p = 0.004), BMI (p = 0.008), waist circumference (p = 0.009), urinary free cortisol (p = 0.007), fasting insulinaemia (p = 0.007), HOMA-β (p = 0.015) and AUC_{2h c-peptide} (p = 0.017), concomitance with an increase in fasting glycaemia (p = 0.015) and HbA1c (p = 0.030), was found. With regard to adipokines, a significant decrease in Ob (p = 0.039), Ob/Ob-R ratio (p = 0.017) and AFABP (p = 0.036) was observed concomitant with a significant increase in Ob-R (p = 0.028) after 12 months of pasireotide.

CONCLUSIONS

12 months of treatment with pasireotide in CD is associated with an impairment of insulin secretion and an improvement of adipose function without any interference in insulin sensitivity.

Pasireotide treatment reduces cardiometabolic risk in Cushing's disease patients: an Italian, multicenter study

PURPOSE

Patients with Cushing's disease (CD) experience metabolic alterations leading to increased cardiovascular mortality. Recently, the visceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue dysfunction (ATD) and of the related cardiometabolic risk. We aimed to evaluate the impact of 12-month pasireotide treatment on cardiometabolic risk in CD patients.

METHODS

This is a multicentre, prospective, and observational study. Sixteen CD patients, referred to the Endocrine Units of the University Hospitals of Messina, Napoli, Padova, and Palermo (Italy), successfully treated with pasireotide for 12 month have been enrolled. In all patients, we assessed anthropometric, clinical, and biochemical parameters and calculated VAI, ATD severity, Framingham, and atherosclerotic cardiovascular disease (ASCVD) risk scores, before and after 6 and 12 months of treatment with pasireotide (1200-1800 mcg/daily).

RESULTS

Before starting pasireotide treatment, ATD was present in 7/16 patients (mild in 2/16, moderate in 3/16, and severe 2/16). After 12 months of treatment: (i) 24h-urinary free cortisol levels (p = 0.003), BMI (p < 0.001), waist circumference (p = 0.001), LDL-cholesterol (p = 0.033), total-cholesterol (p = 0.032), triglycerides (p = 0.030), VAI (p = 0.015), and ATD severity (p = 0.026) were significantly decreased as compared to baseline; (ii) ATD was present in only 1/16 patients; (iii) prevalence of diabetes mellitus (p = 0.015) and HbA1c levels (p = 0.001) were significantly increased as compared to baseline; (iv) Framingham and ASCVD risk scores were not significantly different from pre-treatment values.

CONCLUSIONS

Twelve-month pasireotide treatment significantly reduces VAI and ATD in CD patients. These positive effects on cardiometabolic risk occur despite no change in Framingham and ASCVD risk scores and the increase in the prevalence of diabetes mellitus.

One-hour post-load plasma glucose level is associated with a worse metabolic profile in children with GH deficiency

PURPOSE

In children, the plasma glucose value at 1 h (1hPG) during OGTT higher than 132.5 mg/dl is a predictor of alterations in glucose metabolism. We aimed to metabolically characterize GHD children according to 1hPG levels.

METHODS

Fifty-one GHD children (35 M, 16 F; mean age 8.6 years), grouped according to 1hPG, were evaluated at diagnosis and after 12 months of GH treatment (GHT) and compared with 50 matched controls at baseline. Auxological parameters, insulin-like growth factor-1 (IGF-1), glucose and insulin during OGTT, lipid profile, the oral disposition index (DIo), the homeostasis model assessment estimate of insulin resistance (Homa-IR), and the insulin sensitivity index (ISI) were evaluated.

RESULTS

At baseline, 31.4% of GHD children and 12% of controls (p = 0.016) showed 1hPG ≥ 132.5 mg/dl. The first ones showed higher mean 1hPG (p = 0.025) and LDL cholesterol (p = 0.029) and lower HDL cholesterol (p = 0.014) than controls. GHD with higher 1hPG showed a significant decrease in DIo (p < 0.001) without improvement in lipid profile after GHT, compared with children with lower 1hPG. After 12 months, the higher 1hPG group showed lower ISI Matsuda (p = 0.047) and DIo (p < 0.001) than the lower 1hPG group. 1hPG levels proved to be positively correlated with Homa-IR (p = 0.010) and LDL cholesterol (p = 0.032) and negatively with ISI Matsuda (p = 0.001) and DIo (p = 0.019). The 1hPG value at baseline was the only independent variable significantly associated with DIo at 12 months (p = 0.041).

CONCLUSIONS

1hPG level at baseline may be a useful tool to identify and properly follow up children with enhanced metabolic risk who probably need more surveillance during GHT.

LOCAL LEVELS OF PATIENT RADIATION EXPOSURE IN A UROLOGY OPERATING ROOM IN ITALY

The data analysed came from 545 patients and were related to five types of procedures performed in the urology operating room: percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureteropyeloscopy (UPS), ureteral catheterisation and nephrostomy. Local reference levels (75th percentiles) were determined for the various procedures. The peak entrance skin dose for a patient 20 cm thick was highest for PCNL, being 82 mGy, followed by 43 mGy for nephrostomy, 23 mGy for RIRS, 23 mGy for UPS and 17 mGy for stenting. Even taking into account the maximum values measured (296 mGy for UPS), the doses reached at the skin were not such as to cause deterministic effects. However, the threshold dose for male temporary sterility could be reached (150 mGy).

Cisplatin, Epirubicin and 5-Fluorouracil Combination Chemotherapy for Recurrent Carcinoma of the Salivary Gland

Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies of major (7 cases) and minor (2 cases) salivary gland origin (4 adenoid cystic carcinomas, 2 adenocarcinomas, 2 poorly differentiated carcinomas, 1 mixed malignant tumor) were treated with cisplatin (60 mg/m2), epirubicin (50 mg/m2) and 5-fluorouracil (600 mg/m2) (CEF) by intravenous injections on the first day of a 21-day regimen. Previous therapy included surgery (1 case), radiotherapy (1 case), and surgery+radiotherapy (7 cases). There was 1, complete response (11.1%), 3 partial responses (33.3%), 2 unchanged lesions (22.2%) and 3 progressions (33.3%). Patients with local recurrence had a better response. Median remission duration was 7.5 months in CR + PR patients. Median overall survival was 8+ months; 14+ months for responders and 4 months for nonresponders. The major toxic effects were nausea/vomiting and alopecia; myelosuppression was less frequent and usually not severe.

Toxicity in Uremia 2. Correlation between PTH Levels and Impaired Aspecific Immunity

The role of PTH in depressing polynuclear leucocyte (PMN) phagocytosis in uremia was investigated. The hydrophobicity and phagocytic activity of normal PMN was tested in presence of uremic patients’ serum with low (Group A) or high (Group B) levels of plasma PTH.

The PMN phagocytic index was lowered by serum of both groups, but more in presence of Group B serum (p A vs B < 0.002). Similarly, the contact angle of cells was affected more in presence of serum of patients with high PTH levels (p B vs A < 0.003; p B vs C < 0.002).

CAPD + Hemoperfusion Once a Week in the Management of Children with End-stage Renal Disease

With hemoperfusion there is a sharp decline in the solute concentration of the blood compartment, but immediately after HP the concentration of these substances rises to the original level (post-Hp rebound). It may be inferred that the result would be better and the rebound phenomenon less marked if hemoperfusion could be combined with a continuous dialysis system such as CAPD.

The study was performed in 3 children of our CAPD programm. All patients were dialysed with 5 daily exchange each of one liter.

The patients underwent at 2-hours hemoperfusion with a charcoal column (Gambro Adsorba 150 c) once a week.

The data obtained with this form of treatment are indicative for a: significant increase of weekly clearance for uric acid and creatinine. low urea generation rate far 1–3 days after HP. low post-Hp rebound and reduced platelet count but not platelet activation.

Toxicity in Uremia 1. Correlation between PTH Levels and Depressed Cell Proliferation

Cell proliferation is significantly depressed in uremia; to assess the influence of PTH on it, normal lymphocytes were cultured in presence of uremic patients’ serum with low or high plasma PTH levels (Group A; PTH < 2.5 ng/ml; Group B: PTH > 12 ng/ml), and serum of normal subjects (Group C).

Cell proliferation was lowered by serum from both groups (p A vs C < 0.004; p B vs C < 0.001). However, the depressing effect was more evident when group B serum was employed (p A vs B< 0.002).

Artificial Gut for Total Parenteral Nutrition through the Peritoneal Cavity

Total parenteral nutrition was attempted by using the peritoneal route. In this way it was possible to convey to the patients all elemental nutrients used in hyperalimentation. Three patients were studied while treated for an episode of catabolic stress in the course of acute or chronic uremia. Adequacy of treatment was controlled by measuring urea generation rates, plasma concentrations of 3-methyl-histidine, glucose disappearance from dialysate and kinetics of lipid particles removal from plasma. The data collected demonstrate that peritoneal hyperalimentation is feasible and adequate for clinical purposes.

L-Glutaminase and L-Asparaginase by Extracorporeal Route in Acute Lymphoblastic Leukemia Therapy

Use of L-asparaginase by the extracorporeal route in the therapy of acute lymphoblastic leukemia (ALL) has been proposed.

Results, however, are not so satisfactory as i.v. administration of this enzyme, because the levels of L-asparagine do not fall for a sufficient length of time due to the antagonistic action of the L-asparagine-synthetase.

To avoid the L-asparagine rebound we have utilized, by extracorporeal route, L-glutaminase together with L-asparaginase, in order to reduce L-asparagine and L-glutamine levels.

We have therefore performed a series of experiments in vitro and in vivo either using L-asparaginase alone or together with L-glutaminase.

Results show that, contrary to what happens when L-asparaginase is used alone, L-asparagine levels decrease and remain low even after 24 hours from the treatment, when L-glutaminase is added to the system. Thus a lowering of L-glutamine levels, which seems to play an important role in the therapy of ALL, is obtained.

Thyroid Status and Nephron Loss - A study in Patients with Chronic Renal Failure, End Stage Renal Disease and/or on Hemodialysis

Thyroid function was measured in 30 healthy subjects and 84 patients with various degrees of nephron loss (GRF: 70 ± 15 m/min, 30 ± 16 ml/min, 10 ± 7 ml/min and 2.1 ± 1.3 ml/min).

A low T3 and T4 syndrome is evident when GRF is reduced to 30 ± 16 ml/min while a blunted TSH response is detected earlier in the course of nephron loss. T3 response to TRH was normal and FT4 was not affected by renal dysfunction. The data indicate that in nephron loss hypothalamic-pituitary abnormalities occur.

Studies on Amino Acids in Diabetic Patients Undergoing Capd

Studies in patients with uremia due to diabetes mellitus treated with CAPD show that the kinetics of amino acid equilibration between dialysate and plasma behave differently from those in patients with uremia of different etiology. Diabetics also have larger amino acid losses in dialysate.

TSH Response to TRH in Hemodialysis and CAPD Patients

The thyroid status was studied in 19 uremic patients (11 on HD and 8 on CAPD) and in a group of 17 healthy adult patients. In uremic patients T3 and T4 were significantly reduced (p < 0.001) and rT3 was increased (p < 0.001). The time course TSH response to TRH showed a lower peak response (in 5 patients it did not exceed 5 μU/ml) which on turn was also delayed (the peak was observed at 60 minutes in 63% of them). TSH concentrations in uremics were increased at 0 time (p < 0.02), lower at 20 minutes (p < 0.01) and increased at 120 minutes (p < 0.02). No difference existed between HD and CAPD. The thyroid response to TSH was normal as showed by a normal percent increase over basal values of T3 concentrations at 120 minutes. Uremic patients also showed a peak GH response at 20 minutes which was not observed in controls. The data exclude the existence on a primary form of hypothyroidism and point to the existence of hypothalamic-pituitary abnormalities, which should not be taken as indicative of secondary and/or tertiary hypothyroidism since FT4 values were normal in HD and increased in patients undergoing CAPD (p < 0.05) who on turn showed lower plasma albumin concentrations (p < 0.05).

Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

PURPOSE

Patients with growth hormone deficiency (GHD) demonstrate an increased cortisol/cortisone ratio which could potentially explain the metabolic features of GHD, while GH treatment (GHT) could increase the cortisol metabolism.

METHODS

In 35 children (27 M, mean age 10.1 years) with idiopathic GHD at baseline and after 12 months of GHT and in 25 controls, in addition to metabolic parameters, we assessed adrenal function by morning serum cortisol, its peak, and its area under the curve (AUC_COR) during insulin tolerance test (ITT).

RESULTS

A cortisol peak <18 µg/dl was shown in 22 and 31% of GHD children at baseline and after GHT, respectively. At baseline, GHD children had lower fasting glucose (p < 0.001) and ISI-Matsuda (p = 0.042), with concomitant higher Homa-IR (p = 0.006) and morning cortisol (p = 0.012) than controls. Morning cortisol was negatively correlated with GH (p < 0.001), fasting glucose (p < 0.001) and ISI-Matsuda (p < 0.001) and positively with Homa-IR (p = 0.010). Both cortisol peak and AUC_COR were negatively correlated with GH (all p < 0.001) and ISI-Matsuda (p = 0.016 and p = 0.001, respectively). After 12 months of GHT, a significant increase in fasting glucose (p < 0.001), and Homa-IR (p = 0.011) was documented, with a concomitant decrease in morning cortisol (p = 0.002), AUC_COR (p = 0.038), total (p = 0.003) and LDL-cholesterol (p = 0.016). No significant correlations were found among cortisol levels and all parameters were investigated.

CONCLUSIONS

Cortisol levels correlate with GH secretion and with many metabolic parameters in GHD children, while the metabolic effects during GHT are mainly due to GHT per se and less to cortisol reduction.

A New Chemical Etching Process to Improve Endosseous Implant Osseointegration: In Vitro Evaluation on Human Osteoblast-Like Cells

The development of novel mechanical and chemical surface modification treatments to improve the osteointegration properties of osseointegrated dental implants is nowadays a topic of great applicative interest. The aim of the present study was to analyse the role of surface topography and chemistry of four different surface treatments on titanium by an in vitro human osteosarcoma immortalised cell line model (MG63). The surface treatments considered were (a) machined titanium, (b) chemical etched on machined titanium, (c) sandblasted titanium and (d) chemical etching on sandblasted titanium.

Chemical and physical surface properties were investigated by Scanning Electron Microscopy, Thin Film-X ray Diffraction and by Laser Profilometry. The in vitro biological response was characterised using the MG63 cell line by elution cytotoxicity tests, cell morphology, adhesion, proliferation activity, alkaline phosphatase activity and total DNA content in order to show a relationship between osteoblast response and surface features.

Chemical and physical characterisation showed that the considered treatments differently modify the surface morphology in the micro and sub-micrometric scale. Although some differences in alkaline phosphatase activity were observed in the biological characterisation, depending on the specific material's surface finishing, the results showed that cells were well responsive on all the tested materials and grew and differentiated with similar proliferation rate.

Efficacy of combined treatment with pasireotide, pegvisomant and cabergoline in an acromegalic patient resistant to other treatments: a case report

BACKGROUND

The approach to acromegalic patients with persistent acromegaly after surgery and inadequate response to first-generation somatostatin receptor ligands (SRLs) should be strictly tailored. Current options include new pituitary surgery and/or radiosurgery, or alternative medical treatment with SRLs high dose regimens, pegvisomant (PEG) as monotherapy, or combined therapy with the addition of PEG or cabergoline to SRLs. A new pharmacological approach includes pasireotide, a second-generation SRL approved for patients who do not adequately respond to surgery and/or for whom surgery is not an option. No reports on efficacy and safety of combined therapy with pasireotide and pegvisomant (PEG) in acromegaly are available.

CASE PRESENTATION

Here we report the case of a 41-year-old acromegalic man with a mixed GH/PRL pituitary adenoma post-surgical resistant to first-generation SRLs both alone and in combination with cabergoline and PEG who achieved biochemical and tumor control with the combined triple treatment with pasireotide, PEG and cabergoline without adverse events and with a good compliance to treatment.

CONCLUSIONS

Twelve months of therapy with pasireotide, PEG and cabergoline proved to be safe and effective in this particular patient and the clinical improvement of disease resulted in an improved compliance to treatment.