Apoptosis is mediated by FeHV-1 through the intrinsic pathway and interacts with the autophagic process

BACKGROUND

Although FeHV-1 is a primary feline pathogen, little is known about its interactions with host cells. Its relationship with several cellular pathways has recently been described, whereas its interplay with the apoptotic process, unlike other herpesviruses, has not yet been clarified. The aim of this work was to evaluate whether FeHV-1 induces apoptosis in its permissive cells, as well as the pathway involved and the effects of induction and inhibition of apoptosis on viral replication.

METHODS

Monolayers of CRFK cells were infected at different times with different viral doses. A cytofluorimetric approach allowed the quantification of cells in early and late apoptosis. All infections and related controls were also subjected to Western blot analysis to assess the expression of apoptotic markers (caspase 3-8-9, Bcl-2, Bcl-xL, NF-κB). An inhibitor (Z-VAD-FMK) and an inducer (ionomycin) were used to evaluate the role of apoptosis in viral replication. Finally, the expression of autophagy markers during the apoptosis inhibition/induction and the expression of apoptosis markers during autophagy inhibition/induction were evaluated to highlight any crosstalk between the two pathways.

RESULTS

FeHV-1 triggered apoptosis in a time- and dose-dependent manner. Caspase 3 cleavage was evident 48 h after infection, indicating the completeness of the process at this stage. While caspase 8 was not involved, caspase 9 cleavage started 24 h post-infection. The expression of other mitochondrial damage markers also changed, suggesting that apoptosis was induced via the intrinsic pathway. NF- κB was up-regulated at 12 h, followed by a gradual decrease in levels up to 72 h. The effects of apoptosis inhibitors and inducers on viral replication and autophagy were also investigated. Inhibition of caspases resulted in an increase in viral glycoprotein expression, higher titers, and enhanced autophagy, whereas induction of apoptosis resulted in a decrease in viral protein expression, lower viral titer, and attenuated autophagy. On the other hand, the induction of autophagy reduced the cleavage of caspase 3.

CONCLUSIONS

In this study, we established how FeHV-1 induces the apoptotic process, contributing to the understanding of the relationship between FeHV-1 and this pathway.

Oxidative Status and Histological Evaluation of Wild Boars' Tissues Positive for Zearalenone Contamination in the Campania Region, Southern Italy

Zearalenone (ZEN) is a mycotoxin produced by fungi belonging to the genera Fusarium spp. and commonly found in feed and food. It is frequently related to reproductive disorders in farm animals and, occasionally, to hyperestrogenic syndromes in humans. Nowadays, knowledge about ZEN effects on wild boars (Sus scrofa) is extremely scarce, despite the fact that they represent one of the most hunted game species in Italy. The aim of this study was to investigate how ZEN affects the liver, kidney, and muscle oxidative status and morphology of wild boars hunted in various locations throughout the province of Avellino, Campania Region, Southern Italy, during the 2021-2022 hunting season. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities, as well as the malondialdehyde (MDA) levels, were assessed by colorimetric assays; tissue morphology was evaluated by hematoxylin-eosin and Masson's stains. Our data showed that ZEN contamination might result in oxidative stress (OS) and some histopathological alterations in wild boars' livers and kidneys rather than in muscles, emphasizing the importance of developing a wildlife monitoring and management strategy for dealing not only with the problem of ZEN but the surveillance of mycotoxins in general.

Autophagy up-regulation upon FeHV-1 infection on permissive cells

FeHV-1 is a member of the Herpesviridae family that is distributed worldwide and causes feline viral rhinotracheitis (FVR). Since its relationship with the autophagic process has not yet been elucidated, the aim of this work was to evaluate the autophagy mediated by FeHV-1 and to determine its proviral or antiviral role. Our data showed that autophagy is induced by FeHV-1 in a viral dose and time-dependent manner. Phenotypic changes in LC3/p62 axis (increase of LC3-II and degradation of p62) were detected from 12 h post infection using western blot and immuno-fluorescence assays. In a second step, by using late autophagy inhibitors and inducers, the possible proviral role of autophagy during FeHV-1 infection was investigating by assessing the effects of each chemical in terms of viral yield, cytotoxic effects, and expression of viral glycoproteins. Our findings suggest that late-stage autophagy inhibitors (bafilomycin and chloroquine) have a negative impact on viral replication. Interestingly, we observed an accumulation of gB, a viral protein, when cells were pretreated with bafilomycin, whereas the opposite effect was observed when an autophagy inducer was used. The importance of autophagy during FeHV-1 infection was further supported by the results obtained with ATG5 siRNA. In summary, this study demonstrates FeHV-1-mediated autophagy induction, its proviral role, and the negative impact of late autophagy inhibitors on viral replication.

Modifications of the PI3K/Akt/mTOR axis during FeHV-1 infection in permissive cells

FeHV-1 is the causative agent of infectious rhinotracheitis in cats. The relationship between viral infection and the PI3K/Akt/mTOR pathway, as well as its function in crucial physiological processes like as autophagy, apoptosis or the IFN induction cascade is known for other varicelloviruses. However, there is no information on whether autophagy is activated during FeHV-1 infection nor on how this infection modifies PI3K/Akt/mTOR pathway. In this work, we aim to elucidate the involvement of this pathway during cytolytic infection by FeHV-1 in permissive cell lines. Using a phenotypic approach, the expression of proteins involved in the PI3K/Akt/mTOR pathway was examined by Western blot analysis. The findings demonstrated the lack of modifications in relation to viral dose (except for phospho-mTOR), whereas there were changes in the expression of several markers in relation to time as well as a mismatch in the time of activation of this axis. These results suggest that FeHV-1 may interact independently with different autophagic signaling pathways. In addition, we found an early phosphorylation of Akt, approximately 3 h after infection, without a concomitant decrease in constitutive Akt. This result suggests a possible role for this axis in viral entry. In a second phase, the use of early autophagy inhibitors was examined for viral yield, cytotoxic effects, viral glycoprotein expression, and autophagy markers and resulted in inefficient inhibition of viral replication (12 h post-infection for LY294002 and 48 h post-infection for 3-methyladenine). The same markers were examined during Akt knockdown, and we observed no differences in viral replication. This result could be explained by the presence of a protein kinase in the FeHV-1 genome (encoded by the Us3 gene) that can phosphorylate various Akt substrates as an Akt surrogate, as has already been demonstrated in genetically related viruses (HSV-1, PRV, etc.). For the same reasons, the use of LY294002 at the beginning of infection did not affect FeHV-1-mediated Akt phosphorylation. Our findings highlight changes in the PI3K/Akt/mTOR pathway during FeHV-1 infection, although further research is needed to understand the importance of these changes and how they affect cellular processes and viral propagation.

The Microalga Skeletonema marinoi Induces Apoptosis and DNA Damage in K562 Cell Line by Modulating NADPH Oxidase

Chronic myeloid leukemia (CML) is a myeloproliferative disease that activates multiple signaling pathways, causing cells to produce higher levels of reactive oxygen species (ROS). Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (NOXs) are a major generator of ROS in leukemia, and marine natural products have shown promising activities for the treatment of hematopoietic malignancies. In the present study, we investigated the effect of the marine microalga Skeletonema marinoi (S.M.), a ubiquitous diatom that forms massive blooms in the oceans, on the human leukemia cell line K562. The effects of S.M. extract on cell viability, production of ROS, nitric oxide (NO), and apoptosis were examined. In this preliminary work, S.M. was able to decrease cell viability (p < 0.05) and increase apoptosis levels (p < 0.05) in K562 cells after 48 h of treatment. In addition, the levels of NOX, NO, and malondialdehyde (MDA) were reduced in K562-treated cells (p < 0.05), whereas the levels of SOD, CAT, and GPx increased during treatment (p < 0.05). Finally, analyzing Bax and Bcl-2 expression, we found a significant increase in the proapoptotic protein Bax and a sustained decrease in the antiapoptotic protein Bcl-2 (p < 0.05) in the K562-treated cells.

Ochratoxin A and Kidney Oxidative Stress: The Role of Nutraceuticals in Veterinary Medicine-A Review

The problem of residues of toxic contaminants in food products has assumed considerable importance in terms of food safety. Naturally occurring contaminants, such as mycotoxins, are monitored routinely in the agricultural and food industries. Unfortunately, the consequences of the presence of mycotoxins in foodstuffs are evident in livestock farms, where both subacute and chronic effects on animal health are observed and could have non-negligible effects on human health. Ochratoxin A (OTA) is a common mycotoxin that contaminates food and feeds. Due to its thermal stability, the eradication of OTA from the food chain is very difficult. Consequently, humans and animals are frequently exposed to OTA in daily life. In this review article, we will devote time to highlighting the redox-based nephrotoxicity that occurs during OTA intoxication. In the past few decades, the literature has improved on the main molecules and enzymes involved in the redox signaling pathway as well as on some new antioxidant compounds as therapeutic strategies to counteract oxidative stress. The knowledge shown in this work will address the use of nutraceutical substances as dietary supplements, which would in turn improve the prophylactic and pharmacological treatment of redox-associated kidney diseases during OTA exposure, and will attempt to promote animal feed supplementation.

Curcumin Supplementation Protects Broiler Chickens Against the Renal Oxidative Stress Induced by the Dietary Exposure to Low Levels of Aflatoxin B1

Aflatoxin B1 (AFB1) causes hepatotoxicity, immunotoxicity, and kidney damage, and it is included in group I of human carcinogens. The European Commission has established maximum limits of AFB1 in feed, ranging from 5 to 20 μg/kg. Chicken is moderately sensitive to AFB1, which results in reduced growth performance and economic losses. Oxidative stress triggered by AFB1 plays a crucial role in kidney damage and the antioxidant activity of Curcumin (CURC) could help in preventing such adverse effect. Twenty-days-old broilers were treated for 10 days with AFB1 (0.02 mg/kg feed), alone or in combination with CURC (400 mg/kg feed), to explore the effects on the renal tissue. Animals exposed to AFB1 alone displayed alterations of the oxidative stress parameters compared with controls: serum antioxidant capacity, and enzymatic activity of kidney superoxide dismutase, catalase and glutathione peroxidase were decreased, while renal malondialdehyde levels and NADPH oxidase complex expression were increased. The administration of CURC attenuates all the oxidative stress parameters modified by AFB1 in the chicken kidney, opening new perspectives in the management of aflatoxicosis.

Potential Approaches Versus Approved or Developing Chronic Myeloid Leukemia Therapy

Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of patients with chronic myeloid leukemia (CML). However, continued use of these inhibitors has contributed to the increase in clinical resistance and the persistence of resistant leukemic stem cells (LSCs). So, there is an urgent need to introduce additional targeted and selective therapies to eradicate quiescent LSCs, and to avoid the relapse and disease progression. Here, we focused on emerging BCR-ABL targeted and non-BCR-ABL targeted drugs employed in clinical trials and on alternative CML treatments, including antioxidants, oncolytic virus, engineered exosomes, and natural products obtained from marine organisms that could pave the way for new therapeutic approaches for CML patients.

Prevalence and Co-Occurrence of Different Types of Body Dysmorphic Disorder Among Men Having Sex with Men

Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM). MSM have proven to be more inclined to develop body dissatisfaction and body image disorders compared to non-MSM. Our study investigates the prevalence of BDD and the prevalence and co-occurrence of muscle dysmorphia (MD) and penile dysmorphic disorder (PDD) in a sample of 261 Italian MSM recruited online. From our data, gathered through self-report measures, the prevalence of BDD, MD, and PDD in our populations was 5.4%, 8.8%, and 4.2%, respectively. Compared to their elders, younger adults (ages 18-34) appear to be at higher risk of BDD and especially of MD. Non-significant differences have been observed for the prevalence of PDD depending on the age range. Our study shows that the risk of body image disorders among MSM is quite common, especially among young adults, and higher than what is found among heterosexual men.

Aujeszky's Disease in South-Italian Wild Boars (Sus scrofa): A Serological Survey

Simple Summary

Aujeszky’s disease (AD, pseudorabies) is a viral disease of suids caused by Suid Herpesvirus 1 (SHV-1) also referred as Aujeszky’s disease virus (ADV) or Pseudorabies virus (PRV). The aim of our study was to evaluate seroprevalence of AD in wild boar hunted in the Campania Region, during the 2016–2017 hunting season. A total of 503 serum samples from wild boars hunted in the provinces of Campania Region were tested for antibody against ADV using an ELISA assay. A Seroprevalence of 23.85% (120/503, 95% Confidence Interval (CI 95%: 20.15–27.55) was found. Gender was not significantly associated with of ADV seropositivity (p > 0.05), while the presence of ADV antibodies was statistically associated with age (>36-month, p < 0.0001) and location (Avellino, p = 0.0161).

Abstract

Aujeszky’s disease (AD, pseudorabies) is a viral disease of suids caused by Suid Herpesvirus 1 (SHV-1) also referred as Aujeszky’s disease virus (ADV) or Pseudorabies virus (ADV). Domestic pig and Wild boar (Sus scrofa) are the natural host, but many species can be infected with ADV. The aim of our study was to evaluate seroprevalence of AD in wild boar hunted in the Campania Region, during the 2016–2017 hunting season. A total of 503 serum samples from wild boars hunted in the provinces of Campania Region (Southern Italy) were collected and were tested for antibody against ADV using an AD, blocking ELISA assay. A Seroprevalence of 23.85% (120/503, 95% Confidence Interval (CI): 20.15–27.55) was found. Gender was not significantly associated with of ADV seropositivity (p > 0.05), while the presence of ADV antibodies was statistically associated with age (>36-month, p < 0.0001) and location (Avellino, p = 0.0161). Our prevalence values are like those obtained in 2010 in our laboratory (30.7%), demonstrating a constant circulation of ADV in the area.

Curcumin Modulates Nitrosative Stress, Inflammation, and DNA Damage and Protects against Ochratoxin A-Induced Hepatotoxicity and Nephrotoxicity in Rats

Ochratoxin A (OTA) is a fungal toxin of critical concern for food safety both for human health and several animal species, also representing a cancer threat to humans. Curcumin (CURC) is a natural polyphenol that has anti-apoptotic, anti-inflammatory, and antioxidant effects. The aim of this study was to investigate the cytoprotective effect of CURC against OTA-induced nephrotoxicity and hepatotoxicity through the study of the nitrosative stress, pro-inflammatory cytokines, and deoxyribonucleic acid (DNA) damage. Sprague Dawley rats were daily treated with CURC (100 mg/kg b.w.), OTA (0.5 mg/kg b.w), or CURC with OTA by oral gavage for 14 days. Our results demonstrated that OTA exposure was associated with significant increase of pro-inflammatory and DNA oxidative-damage biomarkers. Moreover, OTA induced the inducible nitric oxide synthase, (iNOS) resulting in increased nitric oxide (NO) levels both in kidney and liver. The co-treatment OTA + CURC counteracted the harmful effects of chronic OTA treatment by regulating inflammation, reducing NO levels and oxidative DNA damage in kidney and liver tissues. Histology revealed that OTA + CURC treatment determinates mainly an Iba1+ macrophagic infiltration with fewer CD3+ T-lymphocytes in the tissues. In conclusion, we evidenced that CURC exerted cytoprotective and antioxidant activities against OTA-induced toxicity in rats.

The Role of Body Image Concerns in Online Sexual Victimization among Female Adolescents: The Mediating Effect of Risky Online Behaviors

Female adolescents are particularly at risk of body image concerns. These individuals tend to make greater use of Social Networks and this could lead adolescents into behaviors that increase the risk of online sexual victimization (OSV). This cross-sectional study seeks to investigate the relation between body image concerns and OSV in a sample of female adolescents (n = 229) and the mediating role of three types of risky online behaviors in this link. Body image concerns predict OSV both directly and indirectly. Two of the three risky online behaviors proved to be mediators of the indirect link, namely: indiscriminate expansion of online network of contacts; and willingness to have relationships with strangers met online. Surprisingly, the third behavior, Sexting and Exhibitionism, was not shown to be a mediating factor between body image concerns and OSV. From our results emerges that adolescent girls with a negative body perception have a higher risk of OSV, and the relation between the two variables can be mediated by some risky online behaviors. It is likely that female adolescents use SNs more and adopt risky online behaviors in order to receive gratification and reassurance about their negative body image.

Investigating the links between fear of missing out, social media addiction, and emotional symptoms in adolescence: The role of stress associated with neglect and negative reactions on social media

Fear of missing out (FoMO) is known to be associated with a decrease in emotional well-being in adolescents. However, few studies have investigated the possible mediating factors between FoMO and emotional symptoms. In this study, we studied the relationship between FoMO and emotional symptoms in a sample of 472 Italian adolescents aged 11-19. In particular, the study investigated the possible mediating role of perceived stress associated with experiences of neglect and negative reactions by other social media users, and social media addiction. Self-report measures were used. Results show that FoMO directly and indirectly predicts emotional symptoms. Additionally, FoMO is associated with increased sensitivity to stress associated with experiences of neglect and negative reactions by online peers, and social media addiction. Sensitivity to stress associated with neglect (but not to negative reactions) by online peers is found to mediate the relationship between FoMO and social media addiction, which, in turn, mediates the relationship with emotional symptoms. In general, the study shows that FoMO is a factor in experiencing higher sensitivity to stress associated with neglect by online peers, which in turn my act as a trigger for social media addiction, and ultimately showing a negative impact on emotional well-being of adolescents. Limits and future directions for research are discussed.

P0988THE PROTECTIVE EFFECT OF RED ORANGE AND LEMON EXTRACT (RLE) IN DIABETIC OBESE ZUCKER RATS IS RELATED TO ITS ACTION ON THE NADPH OXIDASE SUBUNIT

Background and Aims

Type 2 diabetes mellitus is a pathological and chronical condition that induce a rearrangement in carbohydrate metabolism (Kaneto H et al. Antioxid Redox Signal. 2007). Even if the pathological mechanism of DN is not yet clear, NADPH oxidase (NOX) has been demonstrated to be involved in kidney ROS (Reactive Oxygen Species) generation during diabetic state (Palicz A. et al. J Biol Chem. 2001). Therefore, NOX-4, whose p22-phox subunit have shown a pivotal role in diabetes development, has been considered a potential pharmacological target in DN (Gill PS and Wilcox CS. Antioxid Redox Signal. 2006). In previous experiments performed on diabetic rat animal model with DN, we have found a beneficial effect of an extract rich in anthocyanins (ANT), members of flavonoids group (Shih PH. J Agric Food Chem. 2007). The aim of the present work was to investigate the molecular mechanisms involved in the DN and the protective effects of the new extract particularly abundant in ANT, the Red orange and Lemon Extract (RLE).

Method

Zucker diabetic fatty rats were divided into three groups and treated by gavage daily until 30 weeks of age, as follows: control group (ZF rats) received 1 mL of normal saline; ZDF Group (ZDF rats) received 1mL of normal saline; ZDF + RLE group (ZDF rats) treated with 90 mg/ kg of RLE dissolved in 1mL of normal saline. We examined the gene and protein expression of NOX4 catalytic subunit and its regulatory subunit p22-phox through Real Time PCR and western blot analysis.

Results

The expression gene levels of NOX4 significantly increased in diabetic rats ZDF, compared to control ZF (***p&lt;0.001). Exposure of ZDF rats with RLE induces a decreased expression of NOX4 (Figure 1) compared to ZDF. On the contrary, there were not significant expression levels variations for regulatory subunit p22-phox. Western blot results are in agreement with Real Time PCR data, in fact an increase in NOX4 protein levels (*p&lt;0.05) is evident, but no significant increase in p22-phox subunit was observed.

Conclusion

In conclusion, we hypothesize that the protective effect of RLE on the development of DN is related to its ability to inhibit NADPH oxidase activity and opens new perspectives for the treatment of DN.

Effects of a Red Orange and Lemon Extract in Obese Diabetic Zucker Rats: Role of Nicotinamide Adenine Dinucleotide Phosphate Oxidase

Diabetic nephropathy (DN) is the primary cause of end-stage renal disease, worldwide, and oxidative stress has been recognized as a key factor in the pathogenesis and progression of DN. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase has the most important contribution to reactive oxygen species generation during the development of DN. Bioactive compound use has emerged as a potential approach to reduce chronic renal failure. Therefore, a red orange and lemon extract (RLE) rich in anthocyanins was chosen in our study, to reduce the toxic renal effects during the development of DN in Zucker diabetic fatty rat (ZDF). RLE effects were examined daily for 24 weeks, through gavage, in ZDF rats treated with RLE (90 mg/kg). At the end of the experiment, ZDF rats treated with RLE showed a reduction of the diabetes-associated up-regulation of both NOX4 and the p47-phox and p22-phox subunits, and restored the BAX/BCL-2 ratio respect to ZDF rats. Furthermore, RLE was able to reduce the oxidative DNA damage measured in urine samples in ZDF rats. This study showed that RLE could prevent the renal damage induced by DN through its capacity to inhibit NOX4 and apoptosis mechanisms.

Effects of Curcumin on the Renal Toxicity Induced by Ochratoxin A in Rats

Ochratoxin A (OTA) is a powerful nephrotoxin and the severity of its damage to kidneys depends on both the dose and duration of exposure. According to the scientific data currently available, the mechanism of action still is not completely clarified, but it is supposed that oxidative stress is responsible for OTA-induced nephrotoxicity. Bioactive compound use has emerged as a potential approach to reduce chronic renal failure. Therefore, curcumin (CURC), due to its therapeutic effects, has been chosen for our study to reduce the toxic renal effects induced by OTA. CURC effects are examined in Sprague Dawley rats treated with CURC (100 mg/kg), alone or in combination with OTA (0.5 mg/kg), by gavage daily for 14 days. The end result of the experiment finds rats treated with OTA show alterations in biochemical and oxidative stress parameters in the kidney, related to a decrease in the Glomerular Filtration Rate (GFR). Conversely, the administration of CURC attenuates oxidative stress and prevents glomerular hyperfiltration versus the OTA group. Furthermore, kidney histological tests show a reduction in glomerular and tubular damage, inflammation and tubulointerstitial fibrosis. This study shows that CURC can mitigate OTA-induced oxidative damage in the kidneys of rats.

Parent and peer attachment as predictors of facebook addiction symptoms in different developmental stages (early adolescents and adolescents)

Facebook Addiction (FA) is a problem that concerns minors all over the world. The attachment bond with peers and parents has been proven to be a risk factor for the onset of FA. However, the family and peer group can have a different importance depending on the developmental period of the minor. This study examined the influence of peer and parental attachment on the symptoms of FA in early adolescents and adolescents to verify whether attachment to peers and parents predicts FA symptoms in both categories respectively. The sample was composed of 598 participants (142 early adolescents) between the ages of 11 and 17 years (M age = 14.82, SD = 1.52) recruited in the school setting. Multivariate multiple regressions were performed. For early adolescents the relationships with their parents influenced the levels of FA the most (such as withdrawal, conflict, and relapse), whereas peer relationships (such as, peer alienation) were the most relevant for adolescents. Our study provides support to the role of attachment to peers and parents as a risk factor for symptoms of FA. In line with developmental theories, parents and peers acquire a different weight in predicting the relationship between attachment and FA for early adolescents and adolescents respectively. Clinical implications and future research directions are discussed.

Student-teacher relationships and bullying: The role of student social status

Student-teacher relationships have been shown to influence bullying-related behaviors in students. This study considered the moderating role of students' social statuses in the classroom. The study sample included 435 students (48.7% females) taken from 18 Italian middle-school classrooms (i.e., sixth to eighth grade). A multigroup path analysis approach was employed to examine whether the effects of the student-teacher relationships on bullying-related behaviors differed among social statuses. The results showed that perceived conflict with the teacher was shown to have a significant positive effect on students' engagement in active bullying for students from all the statuses, except for neglected students. In particular, this effect was more relevant for rejected students. The results showed that social status and student-teacher relationships integrate and shed light on which roles are taken by young adolescents in school bullying, highlighting that it is important for the teachers to recognize these students.

The impact of chemotherapy on overall survival and quality of life of patients with metastatic colorectal cancer: a review of phase III trials

The treatment aims for advanced colorectal cancer (ACRC) patients are to prolong overall survival and to improve or maintain quality of life. Phase III studies published between 1997 and 2006 comparing different first or subsequent lines of treatment regimens were collected in order to evaluate the impact of these regimens on the overall survival and quality of life of ACRC patients. Our review shows that a first-line polychemotherapy regimen including oxaliplatin or irinotecan, in comparison with monochemotherapy, can improve overall survival. Second-line therapy and/or a cross-over between the first-line treatment arms can further modify the disease course. Hence, from the very beginning the treatment of ACRC patients must embrace a strategic approach taking into account all new agents available. Quality of life (QoL) was assessed in 52.3% of the first-line studies, while this was done in the whole group of studies evaluating pre-treated patients. QoL appears to be unrelated to the toxicity profile.

Prognostic significance of pathological biomarkers in patients with stage II-III colorectal cancer

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Background: Biopathological colorectal cancer (CRC) studies have provided information on pathogenesis, but it is unclear how important biomarkers actually are in predicting prognosis. The aim of our study was to define the prognostic significance of biomarkers and a biopathological profile that could predict an increase in the disease relapse risk in stage II-III CRC patients (pts). Methods: The primary tumor of the CRC pts treated with surgery was immunohistochemically evaluated on the Ki67, p53, bcl-2, TS, EGFR, MLH1 and MSH2 expressions. All 7 markers were measured using standard immunohistochemical techniques. The biomarker evaluations were scored by just one pathologist. Results: Between March 2001 and October 2006 the primary tumor of 242 consecutive pts was investigated. Pt characteristics were: males 141(58.3%), females 101(41.7%); median age 68.5 (24–88); primary tumor site: right colon 94(38.8%), left colon 148(61.2%); stage II 102(42.1%), stage III 81(33.5%), stage IV 59(24.4%). 5-fluorouracil based adjuvant chemotherapy was performed in 121 (66.1%) pts. After a median follow up of 30 months (1–80), 34 pts (10 pts stage II, 24 pts stage III) of 183 stage II-III pts (18.6%) had a disease recurrence. In a univariate analysis of stage II-III pts, a higher expression of Ki67 (= 50% positive cells) was significantly associated with an improved DFS (p= 0.014) and overall survival (OS) (p=0.010). Expression of p53, bcl-2, TS, EGFR, MLH1 and MSH2 were not significantly associated with DFS and OS. In a multivariate analysis adjusted for the impact of the disease stage and adjuvant chemotherapy, a higher expression of Ki67 was significantly associated with diminished risk of recurrence (HR: 0.395; 95% CI: 0.183–0.855, p=0.018) and death (HR: 0.179; 95% CI: 0.046–0.696, p=0.013). The evaluation of DNA mismatch repair status (MLH1, MSH2) demonstrated that the lack of MLH1 is more frequent in non-relapsed II-III stage pts than in IV stage pts (p= 0.024). Conclusions: This analysis showed a significant correlation between higher Ki67 expression and better DFS and OS in pts with stage II-III CRC. An higher frequency of MLH1 deficiency was observed in non-relapsed pts with stage II-III than in advanced disease.

No significant financial relationships to disclose.

Prognostic markers in stage II/III rectal cancer after neoadjuvant 5-fluorouracil-based chemoradiotherapy

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Background: The aim of this study was to evaluate the prognostic value of histologic tumor regression grade (TRG) and pathological biomarkers after neoadjuvant chemoradiotherapy (CT/RT) in rectal cancer pts. Methods: Pts entering the study had rectal adenocarcinoma and stage uT3-T4 N-/+ with location <12 cm from the anal margin. CT consisted of 5-fluorouracil (5FU) 225 mg/m2/die continuous infusion IV d1–38 with/without oxaliplatin (OXA) 60 mg/m2 weekly infusion IV for 6 times. RT was delivered up to a dose of 50.4 Gy in daily fractions of 1.8 Gy. Rectal surgery with TME was performed 6–8 weeks after neoadjuvant therapy. Eight courses of adjuvant CT (LV5FU2) were given after surgery. Immunohistochemical determination of Ki67, p53, bcl2, TS, EGFR, MLH1, MSH2 was performed in pre-treatment biopsy and operative specimen; TRG (Dworak) response (0=none, 1=low, 2–3= intermediate, 4=complete) and circumferential resection margin (CRM) were evaluated on surgical specimens. Results: Between March 2002 and December 2006, 56 pts had completed the integrated treatment. Pt characteristics were: 39M/17F; stage uT3N- 32(57.1%), uT3N+ 15(26.8%), uT3Nx 4(7.1%), uT4N+ 4(7.1%), uT4Nx 1(1.8%). CT was 5FU in 15(26.8%) pts, 5FU/OXA in 41(73.2%) pts. Pathological downstaging was achieved in 31(55.4%) pts, including 9(16.1%) pCR. After a median follow-up of 28.5(6–58) months, 7(12.5%) pts had disease recurrence. TRG evaluation was: no TRG0, 9(16.1%) TRG1, 21(37.5%) TRG2, 17(30.4%) TRG3, 9(16.1%) TRG4. CRM was negative in 91% of pts. By means of univariate analysis, TRG was found to be significantly correlated with DFS (estimated median DFS was 23 months in TRG1 pts, not achieved in TRG2–4 pts; p<0.0001). Other factors correlating significantly with a better DFS by univariate analysis included ypT0–2 (p=0.013) and pN- (p=0.002) categories, CRM- (p=0.024) and lower Ki67 expression post-CT/RT (p=0.012). Using multivariate analysis, we found that TRG2–4 was the strongest DFS prognostic factor (HR=0.0312; 95% CI: 0.003–0.40, p=0.008). Conclusions: In this analysis complete (TRG4) and intermediate (TRG2+3) pathological response produced improved DFS. Significant favorable prognostic factors were the ypT0–2/pN- categories, CRM- status and lower Ki67 expression after CT/RT.

No significant financial relationships to disclose.

Phase II study of cetuximab in combination with FOLFIRI in patients with untreated advanced gastric or gastroesophageal junction adenocarcinoma (FOLCETUX study)

BACKGROUND

The purpose of this phase II study was to evaluate the efficacy and safety of cetuximab combined with FOLFIRI as a first-line treatment of advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma.

PATIENTS AND METHODS

Untreated patients with confirmed advanced gastric or gastroesophageal adenocarcinoma received cetuximab at an initial dose of 400 mg/m(2) intravenously (i.v.) followed by weekly doses of 250 mg/m(2), CPT 11 180 mg/m(2) i.v. on day 1, LFA 100 mg/m(2) i.v. followed by 5-FU 400 mg/m(2) i.v. bolus, and 600 mg/m(2) i.v. 22-h continuous infusion on days 1 and 2 (FOLFIRI) every 2 weeks, for a maximum of 24 weeks, then cetuximab alone was allowed in patients with a complete response, partial response, or stable disease. Antitumor activity was assessed by computed tomography (CT) and positron emission tomography (PET) at baseline and after 6 weeks, and further by CT alone or CT and PET every 6 weeks.

RESULTS

Thirty-eight patients were enrolled (median age 63.5 years, range 39-83; median Karnofsky performance status 90, range 70-100; stomach 89.5% and GEJ 10.5%; locally advanced disease 13.2% and metastatic disease 86.8%). All 38 patients were assessed for safety and survival, and 34 patients were assessed for overall response rates (ORR). The ORR was 44.1% [95% confidence interval (CI) 27.5% to 60.9%]. The median time-to-progression was 8 months (95% CI 7-9). At the median follow-up time of 11 months, 55.3% of patients were alive, with a median expected survival time of 16 months (95% CI 9-23). Grade 3-4 toxicity included neutropenia (42.1%), acne-like rash (21.1%), diarrhea (7.9%), asthenia (5.3%), stomatitis (5.3%), and hypertransaminasemia (5.3%). There was one (2.6%) treatment-related death.

CONCLUSIONS

The combination of cetuximab and FOLFIRI is active in gastric and GEJ adenocarcinoma. The higher toxicity appears to be limited to neutropenia.

Impact of biomarker dynamic profile and pathological response induced by neoadjuvant chemoradiotherapy in rectal cancer

3614

Background: The aim of this study was to evaluate the correlation among biomarkers, pathological response and clinical outcomes in patients (pts) with rectal cancer submitted to neoadjuvant chemoradiotherapy. Methods: Pts entering the study had rectal adenocarcinoma, uT3/4N-/+ or uT2N-/+ with inferior location. Chemotherapy consisted of oxaliplatin 60 mg/m2 weekly infusion IV for 6 times and 5-fluorouracil 225 mg/m2/die continuous infusion IV d 1–38. Radiotherapy was delivered up to a dose of 50.4 Gy in daily fractions of 1.8 Gy d 1–38. Rectal surgery with TME was performed 6–8 weeks after neoadjuvant treatment. Immunohistochemical determination of Ki67, p53, bcl2, TS, EGFR, MLH1 and MSH2 was performed in pretreatment biopsy and operative specimen. Results: Between March 2002 and May 2005, 32 pts had completed neoadjuvant therapy and surgery. Pt characteristics: 24 (75%) men and 8 (25%) women; median age 64 (33–80) years; stage uT2N-M0 3 (9.4%) pts, uT3N-M0 14 (43.8%), uT3N+M0 10 (31.2%), uT3NXM0 2 (6.2%), uT4N+M0 3 (9.4%). Surgery consisted of abdominal-perineal amputation in 12 (37.5%) and low-anterior resection in 17 (53.1%) pts, with negative circumferential resection margins in 86.2%. Laparoscopic local excision was performed in 3 (9.4%) pts. Pathological down-staging occurred in 18 (56.2%) pts, including 7 (21.9%) pT0N0, with sphincter preservation in 40%. Tumor Regression Grade (TRG) (according to Mandard) evaluation of operative specimen was: 7 TRG1, 11 TRG2, 11 TRG3 and 3 TRG4. Expression mean value in pretreatment biopsy and operative specimen was: Ki67 88.8% and 31.7%; p53 49.7% and 40.7%; TS 12.6% and 10.0%; MLH1 89.7% and 76.4%; MSH2 84.3% and 72.2%. The evaluation of biomarker profile in operative specimen of TRG2 pts vs TRG3–4 showed: Ki67 16.6% vs 46.2% (p=0.03); TS 4.5% vs 12.9% (ns); MSH2 82.3% vs 65.6% (ns); p53 52.3% vs 34.8% (ns). Median DFS was 19 (3–35) months. At a median follow-up of 22 (5–41) months, 100.0% of TRG1 pts, 90.9% of TRG2, 73.3% of TRG3–4 had no-evidence of disease relapse. Conclusions: These preliminary results suggest a correlation between Ki67 and pathological response in rectal cancer pts treated with neoadjuvant therapy. Moreover, DFS appears to be related to TRG.

No significant financial relationships to disclose.

18FDG-PET in targeted therapy with cetuximab in gastric or gastroesophageal junction (GEJ) adenocarcinoma: First results of the Italian FOLCETUX Study

4061

Background: The aim of the study was to evaluate 18FDG-PET impact in gastric or GEJ cancer patients (pts) treated with cetuximab plus chemotherapy. Methods: Pts with stomach or GEJ unresectable/metastatic adenocarcinoma, not yet treated, EGFR+, were enrolled in the FOLCETUX study. Pts received cetuximab weekly at 400 mg/m2 iv loading dose, and then at 250 mg/m2 iv maintenance dose, weekly at 400 mg/m2 iv loading dose, and then at 250 mg/m2 iv maintenance dose, CPT11 180 mg/m2 iv d1, LFA 100 mg/m2 iv followed by 5FU 400 mg/m2 iv bolus and 600 mg/m2 iv continuous infusion 22h d1–2 (FOLFIRI) every 2 weeks, for a maximum of 24 weeks, then cetuximab alone was allowed in pts with CR/PR/SD. Anti-tumor activity was assessed by CT and PET scan at baseline and then every 6 weeks. A decrease in tumor FDG-uptake (metabolic response) was evaluated according to EORTC recommendations; objective response (OR) was evaluated with CT scan according to the RECIST criteria. Results: From November 2004 to December 2005, 22 pts (16M, 6F) performed at least 2 consecutive PET scans (at baseline and after 6 weeks), with a total of 91 PET scans (median per pts 4; range 2–8). PET was positive in 20 pts (90.9%); no FDG uptake was seen in 2 pts (9.1%) with signet ring cell carcinoma. A metabolic response correctly predicted: CR/PR in 10/12 pts (83%) after 6 weeks of therapy and in 11/12 (91.7%) after 12 weeks; SD in 4/8 pts (50%) after both 6 and 12 weeks. On the whole, response to therapy was predicted by PET after 6 weeks in 14/20 pts (70%). No correlation was demonstrated between median Standardized Uptake Value (SUV) at baseline PET and OR: 10.9 (3–29) in CR/PR pts and 9.6 (6.4–29.8) in SD pts. In the PET scan after 6, 12 and 18 weeks, the median SUV value respectively decreased to 4.4, 2.6 and <2.0 in CR/PR pts and to 7.5, 7.4 and 3.6 in SD pts. The percentage of SUV reduction after 6 weeks was 54.2 in CR/PR pts vs 30.3 in SD pts (p = 0.36); no difference was observed between intestina (55%) and non-intestinal (45%) subtypes. No significant correlation was observed between the Ki-67 and SUV value. Conclusions: These preliminary results suggest that PET can make an early prediction of the response to cetuximab plus FOLFIRI therapy.

No significant financial relationships to disclose.

A comparative study on capecitabine (Cape) pharmacokinetics (PK) in elderly or younger patients with metastatic breast (MBC) or colo-rectal cancer (CRC)

12003

Background: Cape is an efficient oral prodrug of 5FU in MBC and CRC. Unexpected severe toxicity in older patients (pts) was reported after standard dose of 2500mg/sm/day. About 70% of drug and metabolites are excreted with the urine and a 25% reduction of the dose is recommended if the pt has a creatinine clearance (CrCl) <50ml/min. However no prospective study has been done on Cape PK in the elderly pts. Methods: Between Oct 2004 and Nov 2005, 21 pts with MBC or CRC and age ≥70yrs or ≤60yrs who received Cape (1000 mg/sm bid for 14 days every 21 days) entered the study after giving signed informed consent. CrCl was calculated according to the Cockcroft-Gault method. Patient characteristics: 15 elderly pts (median 78 range71–84yrs), 6 younger pts (median 50.5 range 43–57yrs); 9 (42.9%) males and 12 (57.1%) females; median KPS 90 (range 70–100); 8 MBC pts (38%), 13 CRC pts (62%). Blood samples were taken on the first day of treatment at time 0 and at 0.25,0.5,1,2,3,4,5,6,8 hrs after the first drug administration and on 4th, 8th, 12th and 14th days in the morning. Plasma levels of Cape, 5DFUR, 5DFCR and 5FU were determined by a validated HPLC method and UV detection. Results: At present PK data after the first administration of Cape are available for 13 pts (9 elderly; 4 younger). The mean Cape and 5DFCR AUC0–8hr are higher in older patients (Cape 6653±2564.8 vs. 4427±2714.5; P=0.09; 5DFCR 8635±5197.1 vs. 6292±3813.6; P=0.26), while no evident differences are present for 5DFUR and 5FU. The same results are obtained both in pts with CrCl < and ≥ 50 ml/min. The ratios of DFUR_AUC to Cape_AUC and 5FU_AUC to Cape_AUC are conversely higher in younger than in older pts (mean: 2.2 vs 1.62). A large interindividual variability in the concentration/time curves is present for Cape and metabolites. Cape dose reduction because of G3 toxicity (2 hand-foot syndrome, 1 stomatitis) was performed in 3 elderly pts. Drug systemic exposure was higher in 2 of these pts independently of CrCl. Conclusions: The preliminary results of this PK study suggest that elderly patients treated with Cape at 1000 mg/sm/bid are more drug-exposed than younger patients, independently of renal function. PK analysis is ongoing for the remaining patients.

No significant financial relationships to disclose.

[Etiopathogenetic aspects of central diabetes insipidus. Report of a clinical case]

The manifold etiopathogenetic conditions responsible for central diabetes insipidus are minutely examined. On the ground of these introductory remarks, the Authors report a case of diabetes insipidus following from pituitary metastasis in a patient with cancer of the lung. Some relations between diabetes insipidus and cancer are discussed. The uncommon remark of a metastatic lesion in the etiopathogenesis of the central diabetes insipidus and its early display in the patient at issue support this description.

Molecular studies on DNA sequences coding for factor VII and factor XII of human coagulation

In this paper are described the immunological and molecular procedures that have allowed the identification and the nucleotide sequence characterization of recombinant cDNA coding for factor XII of human coagulation and have suggested the possible identification of other cDNA clones as coding for factor VII of human coagulation.