IMMUNOREACT 7: Regular aspirin use is associated with immune surveillance activation in colorectal cancer

BACKGROUND

Long-term daily use of aspirin reduces incidence and mortality due to colorectal cancer (CRC). This study aimed to analyze the effect of aspirin on the tumor microenvironment, systemic immunity, and on the healthy mucosa surrounding cancer.

METHODS

Patients with a diagnosis of CRC operated on from 2015 to 2019 were retrospectively analyzed (METACCRE cohort). Expression of mRNA of immune surveillance-related genes (PD-L1, CD80, CD86, HLA I, and HLA II) in CRC primary cells treated with aspirin were extracted from Gene Expression Omnibus-deposited public database (GSE76583). The experiment was replicated in cell lines. The mucosal immune microenvironment of a subgroup of patients participating in the IMMUNOREACT1 (ClinicalTrials.gov NCT04915326) project was analyzed with immunohistochemistry and flow cytometry.

RESULTS

In the METACCRE Cohort, 12% of 238 patients analyzed were aspirin users. Nodal metastasis was significantly less frequent (p = .008) and tumor-infiltrating lymphocyte infiltration was higher (p = .02) among aspirin users. In the CRC primary cells and selected cell lines, CD80 mRNA expression was increased following aspirin treatment (p = .001). In the healthy mucosa surrounding rectal cancer, the ratio of CD8/CD3 and epithelial cells expressing CD80 was higher in aspirin users (p = .027 and p = .034, respectively).

CONCLUSIONS

These data suggested that regular aspirin use may have an active role in enhancing immunosurveillance against CRC.

IMMUNOREACT 6: weak immune surveillance characterizes early-onset rectal cancer

BACKGROUND

Colon cancer in young patients is often associated with hereditary syndromes; however, in early-onset rectal cancer, mutations of these genes are rarely observed. The aim of this study was to analyse the features of the local immune microenvironment and the mutational pattern in early-onset rectal cancer.

METHODS

Commonly mutated genes were analysed within a rectal cancer series from the University Hospital of Padova. Mutation frequency and immune gene expression in a cohort from The Cancer Genome Atlas ('TCGA') were compared and immune-cell infiltration levels in the healthy rectal mucosa adjacent to rectal cancers were evaluated in the IMMUNOlogical microenvironment in REctal AdenoCarcinoma Treatment 1 and 2 ('IMMUNOREACT') series.

RESULTS

In the authors' series, the mutation frequency of BRAF, KRAS, and NRAS, as well as microsatellite instability frequency, were not different between early- and late-onset rectal cancer. In The Cancer Genome Atlas series, among the genes with the most considerable difference in mutation frequency between young and older patients, seven genes are involved in the immune response and CD69, CD3, and CD8β expression was lower in early-onset rectal cancer. In the IMMUNOlogical microenvironment in REctal AdenoCarcinoma Treatment 1 and 2 series, young patients had a lower rate of CD4+ T cells, but higher T regulator infiltration in the rectal mucosa.

CONCLUSION

Early-onset rectal cancer is rarely associated with common hereditary syndromes. The tumour microenvironment is characterized by a high frequency of mutations impairing the local immune surveillance mechanisms and low expression of immune editing-related genes. A constitutively low number of CD4 T cells associated with a high number of T regulators indicates an imbalance in the immune surveillance mechanisms.

IMMUNOREACT 5: female patients with rectal cancer have better immune editing mechanisms than male patients – a cohort study

BACKGROUND

Studies evaluating sex differences in colorectal cancer (CRC) tumor microenvironment are limited, and no previous study has focused on rectal cancer patients' constitutive immune surveillance mechanisms. The authors aimed to assess gender-related differences in the immune microenvironment of rectal cancer patients.

METHODS

A systematic review and meta-analysis were conducted up to 31 May 2021, including studies focusing on gender-related differences in the CRC tumor microenvironment. Data on the mutational profile of rectal cancer were extracted from the Cancer Genome Atlas (TCGA). A subanalysis of the two IMMUNOREACT trials (NCT04915326 and NCT04917263) was performed, aiming to detect gender-related differences in the immune microenvironment of the healthy mucosa in patients with early (IMMUNOREACT 1 cohort) and locally advanced rectal cancer following neoadjuvant therapy (IMMUNOREACT 2 cohort). In the retrospective IMMUNOREACT 1 cohort (therapy naive), the authors enrolled 442 patients (177 female and 265 male), while in the retrospective IMMUNOREACT 2 cohort (patients who had neoadjuvant therapy), we enrolled 264 patients (80 female and 184 male). In the prospective IMMUNOREACT 1 cohort (therapy naive), the authors enrolled 72 patients (26 female and 46 male), while in the prospective IMMUNOREACT 2 cohort (patients who had neoadjuvant therapy), the authors enrolled 105 patients (42 female and 63 male).

RESULTS

Seven studies reported PD-L1 expression in the CRC microenvironment, but no significant difference could be identified between the sexes. In the TGCA series, mutations of SYNE1 and RYR2 were significantly more frequent in male patients with rectal cancer. In the IMMUNOREACT 1 cohort, male patients had a higher expression of epithelial cells expressing HLA class I, while female patients had a higher number of activated CD4+Th1 cells. Female patients in the IMMUNOREACT 2 cohort showed a higher infiltration of epithelial cells expressing CD86 and activated cytotoxic T cells (P=0.01).

CONCLUSIONS

Male patients have more frequent oncogene mutations associated with a lower expression of T-cell activation genes. In the healthy mucosa of female patients, more Th1 cells and cytotoxic T cells suggest a potentially better immune response to the tumor. Sex should be considered when defining the treatment strategy for rectal cancer patients or designing prognostic scores.

RGD_PLGA Nanoparticles with Docetaxel: A Route for Improving Drug Efficiency and Reducing Toxicity in Breast Cancer Treatment

Breast cancer is the leading cause of cancer-related death in women. Although many therapeutic approaches are available, systemic chemotherapy remains the primary choice, especially for triple-negative and advanced breast cancers. Unfortunately, systemic chemotherapy causes serious side effects and requires high doses to achieve an effective concentration in the tumor. Thus, the use of nanosystems for drug delivery may overcome these limitations. Herein, we formulated Poly (lactic-co-glycolic acid) nanoparticles (PLGA-NPs) containing Docetaxel, a fluorescent probe, and a magnetic resonance imaging (MRI) probe. The cyclic RGD tripeptide was linked to the PLGA surface to actively target α_vβ₃ integrins, which are overexpressed in breast cancer. PLGA-NPs were characterized using dynamic light scattering, fast field-cycling ¹H-relaxometry, and ¹H-nuclear magnetic resonance. Their therapeutic effects were assessed both in vitro in triple-negative and HER2+ breast cancer cells, and in vivo in murine models. In vivo MRI and inductively coupled plasma mass spectrometry of excised tumors revealed a stronger accumulation of PLGA-NPs in the RGD_PLGA group. Targeted PLGAs have improved therapeutic efficacy and strongly reduced cardiac side effects compared to free Docetaxel. In conclusion, RGD-PLGA is a promising system for breast cancer treatment, with positive outcome in terms of therapeutic efficiency and reduction in side effects.

Laparoscopic adrenalectomy for Cushing's syndrome: a 12-year experience

AIM

The outcome after laparoscopic adrenalectomy in 51 patients with pre-Cushing's and Cushing's syndrome was evaluated at six months and one year of follow-up.

METHODS

In this retrospective analysis of 51 patients (35 females and 16 males) selected for laparoscopic adrenalectomy (28 left and 23 right adrenal glands), clinical presentation, endocrine and blood chemistry and hemodynamics, and pre- and postsurgical management were analyzed. Evaluations included, blood pressure, body-mass index (BMI), lipid profile, blood glucose (fasting insulin and oral glucose tolerance test [OGTT]), liver function and hormonal profile (17-hydroxyprogesterone, dehydroepiandrosterone sulfate and cortisol), and perioperative complications.

RESULTS

Follow-up assessment showed a significant reduction in systolic (12.34 mm Hg) and diastolic blood pressure (11.09 mm Hg), a statistically significant decrease in total (11.67 mg/dL) and a statistically significant increase in high-density lipoprotein (HDL) cholesterol (6.46 mg/dL), and a statistically significant decrease in blood glucose at 60 minutes and an increase in insulin at 120 minutes. No statistically significant changes in the hormone profile were observed. There was a statistically significant reduction in cortisol concentration in response to the dexamethasone test. Mortality was zero and the surgical complications rate was low.

CONCLUSION

Laparoscopic adrenalectomy has become the gold standard in the treatment of adrenal disease. It is a safe technique, with clinically effective results and an excellent perioperative course.

Transanal endoscopic microsurgery for rectal tumors: an option to radical surgery?

AIM

We present our experience in the treatment of rectal adenomas and selected cases of distal rectal cancer without evidence of nodal or distant metastasis (N0-M0) managed by transanal endoscopic microsurgery (TEM). This study examines our experience evaluating surgical morbidity, mortality and oncological outcome.

METHODS

Eight hundred ten patients with rectal lesions (462 adenomas, 115 T1, 130 T2 and 103 T3) were enrolled. All patients staged preoperatively as T2 and T3 underwent preoperative high dose radiotherapy and since 1997 patients with less than 70 year old and good general conditions also preoperative chemotherapy.

RESULTS

Minor complications were observed in 69 patients (8.5%) whereas major complications only in 5 patients (0.6%). Definitive histology confirmed adenomas in 431 cases (93%), while in 310 malignant lesions we had: 51 pT0 (14.7%), 127 pT1 (36.5%), 139 pT2 (39.9%) and 31 pT3 (8.9%). Sixteen (4.6%) patients (9 pT2 and 7 pT3) developed local recurrence whereas 6 (1.7%) patients distant metastasis. The survival rate at the end of follow-up was 100% for pT1 and 90% and 77% for pT2 and pT3 patients.

CONCLUSION

TEM is safe and effective for rectal adenomas not removable endoscopically. T1 cancer may undergo local excision alone, while T2 and T3 lesions require preoperative radiochemotherapy. The results reported seems to be not very different in terms of local recurrence and survival rate to those after conventional surgery.

Laparoscopic colectomy is a reliable option for colon cancer treatment

AIMS

To report oncological results in a remarkable single institution series of laparoscopic colectomy for cancer.

METHODS

340 not selected patients with adenocarcinoma of colon underwent laparoscopic colonic resection in a five years period (2004-2008). Of the 340 patients, there were 185 male and 155 female. The mean age was 68 years (31-92). Of the 340 procedures, 175 were laparoscopic right colectomy and 165 laparoscopic left colectomy. No tumor touch technique, ligation at vascular origin, adequate lymphadenectomy and minilaparotomy protection against cells implant was the main landmarks of all cases.

RESULTS

There was no intraoperative mortality. Twenty patients (5.8%) were converted to open surgery. Two patients (0,58%) died in the postoperative period. Five major complications occurred (1,5%) in the postoperative period. The average hospital stay for patients who underwent right colectomy was 6.7 days (4-27) and 6.9 for patients underwent left hemicolectomy (4-23). The average number of lymph nodes removed was 15.6. In a mean 38 months follow-up (25-78) there were 16 incisional hernias, 12 after right colectomy and 4 after left. Eight patients (4,5%) who underwent laparoscopic right colectomy and ten (6%) of the left colectomy group developed a metastatic disease. The overall mortality rate was 10.8%; 14.3% for patients who underwent resection of the right colon and 7.2% for the left colectomy series.

CONCLUSIONS

Laparoscopic colectomy for cancer is feasible, safe and not encumbered by an higher complications rate compared to open colectomy. If the oncological criteria are respected, the results are at least noniferior to the open access.

Laparoscopic adrenalectomy approaches: a 15-year experience in the search for a tailored procedure

AIM

This study reports single-institution experience with anterior, flank lateral and submesocolic approaches in laparoscopic adrenalectomy (LA).

METHODS

The study population was 267 patients who underwent LA from 1994 to 2008 at our institution. The choice of surgical route (anterior, anterior submesocolic or flank lateral) was based on patient characteristics (body-mass index, previous abdominal surgery) and lesion features (size, side, secreting mass, pheochromocytoma, suspected malignancy). The submesocolic approach, as described in 2005, was used for left-sided lesions ≤7-8 cm and in non-obese patients; the flank lateral approach was used in obese or previously operated patients. Of a total of 267 patients, 116 underwent right LA by the anterior and 4 by the flank lateral approach; 88 underwent left LA by the anterior, 37 by the submesocolic, and 22 by the flank lateral approach.

RESULTS

The mean operating time was: 80.1 min (range, 65-125) for right anterior and 93 min (range, 96-145) for right flank lateral LA; 108 min (range, 80-305) for left anterior, 56.2 min (range, 38-105) for submesocolic, and 80.5 min (range, 54-125) for flank lateral LA. Major intraoperative complications requiring conversion to open surgery occurred in 7 patients: bleeding (5); splenic colonic flexure tear (1); and hypertension with severe arrhythmia in pheochromocytoma removal (1). There were no significant statistically differences in length of hospital stay or analgesic medications after anterior, flank lateral or submesocolic LA; the mean operating time was significantly shorter with use of the anterior and submesocolic approaches.

CONCLUSION

In the authors' experience, tailoring the LA approach according to patient and lesion characteristics is both safe and effective. In selected cases, the operating time is shorter by the submesocolic appraoch. .

S-thanatin enhances the efficacy of tigecycline in an experimental rat model of polymicrobial peritonitis

We investigated the efficacy of the peptide s-thanatin alone and in combination with tigecycline in an animal model of sepsis induced by cecal ligation and puncture. Adult male Wistar rats were randomized to receive intravenously isotonic sodium chloride solution, 5mg/kg s-thanatin, 2mg/kg tigecycline, 5mg/kg s-thanatin combined with 2mg/kg tigecycline. The experiment was also performed with administration of the drugs 360 min after the surgical procedure to better investigate the clinical situation where there is an interval between the onset of sepsis and the initiation of therapy. Lethality, bacterial growth in blood, peritoneum, spleen and liver, and NO indices were evaluated. All compounds reduced the lethality when compared to control. In all experiments, the compounds reduced significantly bacterial growth and lethality compared with saline treatment. Treatment with s-thanatin resulted in significant decrease in plasma NO levels compared to tigecycline and control group. The combination between s-thanatin and tigecycline proved to be the most effective treatment in reducing all variables measured. S-thanatin may have potential therapeutic usefulness alone and when associated to tigecycline in polymicrobial peritonitis.

Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluation

BACKGROUND

Because the most suitable management of subclinical Cushing syndrome (SCS, which involves hypersecretion of cortisol without clinically evident disease) still is undefined, the current study aimed to compare retrospectively the outcome for a cohort of patients treated by medical therapy or laparoscopic adrenalectomy (LA).

METHODS

Over a 12-year period, 47 patients with SCS have been treated by means of LA (19 patients, group A) or medical therapy (28 patients, group B). Group A consisted of 15 women and 4 men with a mean age of 54.8 years. Eight patients had a left adrenal mass, whereas nine had a right adrenal mass, and one patient had bilateral lesion. Group B was composed of 18 women and 10 men with a mean age of 57.8 years. Of these patients, 14 had a left adrenal lesion, 12 had a right adrenal lesion, and 1 had bilateral lesion. The patients were followed up for a mean 4 years (range, 1-11 years) by both an endocrinologist and a surgeon.

RESULTS

In group A, hypertension improved for 66.3% of the patients; body mass index (BMI) decreased for 47.4%; and hyperlipidemia based on high-density lypoproteins (HDL) cholesterol, total cholesterol ratio, and triglyceridemic concentration improved for 63.2% of the patients. No changes in bone parameters were seen after surgery in SCS patients with osteoporosis. Some patients in group B, during their long-term medical therapy, experienced worsening hypertension (14.2%), hyperlipidemia (17.8%), and diabetes mellitus (8%).

CONCLUSIONS

This retrospective study focused on a cohort of patients with SCS. Their medium long-term follow-up evaluation showed that LA is better than medical therapy for treating this condition, especially by reducing the cardiovascular risk (hypertension-hyperlipidemia).

Coevolutionary toxicity as suggested by differential coniferyl alcohol inhibition of ceratocystis species growth

Coevolution has been shown to lower the toxicity of predator venoms to usual preys, in contrast to higher toxicity to non-prey similar species (Heatwole and Powell, 1998. Resistance of eels (Gymnothorax) to the venom of sea kraits (Laticauda colubrina): a test of coevolution. Toxicon 36, 619-625). In an attempt to examine whether such coevolutionary discrepancies also occur in plant host-parasite interactions, two strains of Ceratocystis grown on artificial medium, C. fimbriata, parasite of the plane tree, and C. bruneociliata, parasite of the Scots pine (Pinus sylvestris), were compared for growth parameters, in controls and in presence of various concentrations of coniferyl alcohol (a phenolic derivative previously found to be released following inoculation of pine trees with C. bruneociliata). Coniferyl alcohol differently inhibited the growth of both fungi. In the case of the conifer-specific fungus, inhibition rate was less marked at low doses (<2.5 mM) but it rose more steeply at higher doses (10 mM) after a sigmoidal transition at around 3.2 mM, indicating a physiological threshold. These results support the hypothesis of a specific action of coniferyl alcohol against C. Bruneociliata, as a coevolutionary adaptative characteristics of the fungus.