Validated graft-specific biomarkers identify patients at risk for chronic graft-versus-host disease and death

BACKGROUNDChronic graft-versus-host disease (cGVHD) is a serious complication of allogeneic hematopoietic cell transplantation (HCT). More accurate information regarding the risk of developing cGVHD is required. Bone marrow (BM) grafts contribute to lower cGVHD, which creates a dispute over whether risk biomarker scores should be used for peripheral blood (PB) and BM.METHODSDay 90 plasma proteomics from PB and BM recipients developing cGVHD revealed 5 risk markers that were added to 8 previous cGVHD markers to screen 982 HCT samples of 2 multicenter Blood and Marrow Transplant Clinical Trials Network (BMTCTN) cohorts. Each marker was tested for its association with cause-specific hazard ratios (HRs) of cGVHD using Cox-proportional-hazards models. We paired these clinical studies with biomarker measurements in a mouse model of cGVHD.RESULTSSpearman correlations between DKK3 and MMP3 were significant in both cohorts. In BMTCTN 0201 multivariate analyses, PB recipients with 1-log increase in CXCL9 and DKK3 were 1.3 times (95% CI: 1.1-1.4, P = 0.001) and 1.9 times (95%CI: 1.1-3.2, P = 0.019) and BM recipients with 1-log increase in CXCL10 and MMP3 were 1.3 times (95%CI: 1.0-1.6, P = 0.018 and P = 0.023) more likely to develop cGVHD. In BMTCTN 1202, PB patients with high CXCL9 and MMP3 were 1.1 times (95%CI: 1.0-1.2, P = 0.037) and 1.2 times (95%CI: 1.0-1.3, P = 0.009) more likely to develop cGVHD. PB patients with high biomarkers had increased likelihood to develop cGVHD in both cohorts (22%-32% versus 8%-12%, P = 0.002 and P < 0.001, respectively). Mice showed elevated circulating biomarkers before the signs of cGVHD.CONCLUSIONBiomarker levels at 3 months after HCT identify patients at risk for cGVHD occurrence.FUNDINGNIH grants R01CA168814, R21HL139934, P01CA158505, T32AI007313, and R01CA264921.

BET-bromodomain and EZH2 inhibitor-treated chronic GVHD mice have blunted germinal centers with distinct transcriptomes

Despite advances in the field, chronic graft-versus-host-disease (cGVHD) remains a leading cause of morbidity and mortality following allogenic hematopoietic stem cell transplant. Because treatment options remain limited, we tested efficacy of anticancer, chromatin-modifying enzyme inhibitors in a clinically relevant murine model of cGVHD with bronchiolitis obliterans (BO). We observed that the novel enhancer of zeste homolog 2 (EZH2) inhibitor JQ5 and the BET-bromodomain inhibitor JQ1 each improved pulmonary function; impaired the germinal center (GC) reaction, a prerequisite in cGVHD/BO pathogenesis; and JQ5 reduced EZH2-mediated H3K27me3 in donor T cells. Using conditional EZH2 knockout donor cells, we demonstrated that EZH2 is obligatory for the initiation of cGVHD/BO. In a sclerodermatous cGVHD model, JQ5 reduced the severity of cutaneous lesions. To determine how the 2 drugs could lead to the same physiological improvements while targeting unique epigenetic processes, we analyzed the transcriptomes of splenic GCB cells (GCBs) from transplanted mice treated with either drug. Multiple inflammatory and signaling pathways enriched in cGVHD/BO GCBs were reduced by each drug. GCBs from JQ5- but not JQ1-treated mice were enriched for proproliferative pathways also seen in GCBs from bone marrow-only transplanted mice, likely reflecting their underlying biology in the unperturbed state. In conjunction with in vivo data, these insights led us to conclude that epigenetic targeting of the GC is a viable clinical approach for the treatment of cGVHD, and that the EZH2 inhibitor JQ5 and the BET-bromodomain inhibitor JQ1 demonstrated clinical potential for EZH2i and BETi in patients with cGVHD/BO.

Targeting temporal metabolic needs of T follicular helper cells to treat cGVHD utilizing a mitochondrial pyruvate carrier inhibitor

The curative potential of allogeneic hematopoietic stem cell transplantation is limited by development of chronic graft versus host disease (cGVHD) and metabolic regulation of immune cells is a promising therapeutic target. During cGVHD, interactions between T follicular helper (TFH) and germinal center B (GCB) cells result in production of alloreactive class-switched antibodies that attack host tissues, causing multi-organ damage and tissue fibrosis. We show the metabolic dependencies of TFH change throughout cGVHD progression and targeting mitochondrial pyruvate transport is an effective strategy to mitigate disease. Pyruvate, the end product of glycolysis, is transported by the mitochondrial pyruvate carrier (MPC) for use in the tricarboxylic acid cycle and oxidative phosphorylation (OXPHOS). TFH require glycolysis in order to induce a GC reaction, both in an immunization model and in an in vivo systemic cGVHD model with bronchiolitis obliterans (BO). Furthermore, Seahorse data from TFH extracted early in disease development in the BO model demonstrate increased dependency on glycolysis. But Seahorse data also indicates TFH undergo a shift away from glycolysis and toward OXPHOS as cGVHD continues. Based on the central role of MPC in tying pyruvate to multiple metabolic pathways, we examined an inhibitor of MPC (7ACC1) in reducing TFH activity. Administration of 7ACC1 resulted in inhibition of GCB production of class switched antibody in an in vitro assay. These findings were additionally supported in vivo, whereby daily treatment after establishment of cGVHD resulted in a decrease in disease severity. These data provide evidence that inhibiting mitochondrial pyruvate transport is a viable therapeutic strategy for cGVHD.

This work was supported by grants from National Institutes of Health, National Institute of Allergy, and Infectious Diseases R37 AI34495, T32 AI007313; National Heart, Lung, and Blood Institute R01 HL56067, R01 HL11879, R01 HL115114 ; National Cancer Institute P01 CA065493

Targeting the Retinoid X Receptor Pathway Prevents and Ameliorates Murine Chronic Graft-Versus-Host Disease

Most allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients receive peripheral blood stem cell grafts resulting in a 30%-70% incidence of chronic graft-versus-host disease (cGVHD), a major cause of mortality and morbidity in long-term survivors. While systemic steroids remain the standard of care for first-line therapy, patients may require long-term administration, and those with steroid-resistant or refractory cGVHD have a worse prognosis. Although durable and deep responses with second-line therapies can be achieved in some patients, there remains an urgent need for new therapies. In this study, we evaluated the efficacy of IRX4204, a novel agonist that activates RXRs and is in clinical trials for cancer treatment to prevent and treat cGVHD in two complementary murine models. In a major histocompatibility complex mismatched, non-sclerodermatous multiorgan system model with bronchiolitis obliterans, IRX4204 prevented and reversed cGVHD including associated pulmonary dysfunction with restoration of germinal center T-follicular helper: T-follicular regulatory cell balance. In a minor histocompatibility antigen disparate sclerodermatous model, IRX4204 treatment significantly prevented and ameliorated skin cGVHD by reducing Th1 and Th17 differentiation due to anti-inflammatory properties. Together, these results indicate that IRX4204 is a promising therapeutic option to treat cGVHD with bronchiolitis obliterans or sclerodermatous manifestations.

Recent Metabolic Advances for Preventing and Treating Acute and Chronic Graft Versus Host Disease

The therapeutic efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited by the development of graft-versus-host disease (GVHD). In GVHD, rigorous pre-conditioning regimen resets the immune landscape and inflammatory milieu causing immune dysregulation, characterized by an expansion of alloreactive cells and a reduction in immune regulatory cells. In acute GVHD (aGVHD), the release of damage- and pathogen- associated molecular patterns from damaged tissue caused by the conditioning regimen sets the stage for T cell priming, activation and expansion further exacerbating tissue injury and organ damage, particularly in the gastrointestinal tract. Studies have shown that donor T cells utilize multiple energetic and biosynthetic pathways to mediate GVHD that can be distinct from the pathways used by regulatory T cells for their suppressive function. In chronic GVHD (cGVHD), donor T cells may differentiate into IL-21 producing T follicular helper cells or tissue resident T helper cells that cooperate with germinal center B cells or memory B cells, respectively, to produce allo- and auto-reactive antibodies with subsequent tissue fibrosis. Alternatively, donor T cells can become IFN- γ/IL-17 cytokine expressing T cells that mediate sclerodermatous skin injury. Patients refractory to the first line standard regimens for GVHD treatment have a poor prognosis indicating an urgent need for new therapies to restore the balance between effector and regulatory immune cells while preserving the beneficial graft-versus-tumor effect. Emerging data points toward a role for metabolism in regulating these allo- and auto-immune responses. Here, we will discuss the preclinical and clinical data available on the distinct metabolic demands of acute and chronic GVHD and recent efforts in identifying therapeutic targets using metabolomics. Another dimension of this review will examine the changing microbiome after allo-HSCT and the role of microbial metabolites such as short chain fatty acids and long chain fatty acids on regulating immune responses. Lastly, we will examine the metabolic implications of coinhibitory pathway blockade and cellular therapies in allo-HSCT. In conclusion, greater understanding of metabolic pathways involved in immune cell dysregulation during allo-HSCT may pave the way to provide novel therapies to prevent and treat GVHD.

Use of isotope hydrology in groundwater conceptualization for modeling flow and contaminant transport at northwestern Sinai, Egypt

The study area extends along northwestern Sinai coastal plain, which is considered an integral part of the Mediterranean Sea. It depends mainly on the groundwater resource for different type of human activities such as agricultural and drinking. Many programs and policies should be implemented in this area to concurrently improve the sustainability of groundwater use and manage the risks of its degradation. Leakage from some factories in Bir El-Abd might be a contamination source that would threaten groundwater. In this paper, an attempt was made using an integrated approach of the hydrogeological setting and the conjugation of the hydrogeochemical data with the stable isotope hydrology for representation of the conceptual model of the study area. Those tools give more insights on the characterization of the groundwater system with all relevant boundaries and main recharge sources of the aquifer; which is considered to be the key components of a groundwater modeling. A particular focus is placed on modeling a hypothetical accident for contaminant transport in the groundwater system, using both lead and chromium as a typical contaminant component. Further predication of the concentration of those elements has been estimated, and the safety distances of their plume have been determined. This study would be helpful in dealing with water management issues related to contaminant hydrogeology. As well, it introduces some finding for reducing the environmental risk form the industrial development at the study area.

Hydrochemical and multivariate analysis of groundwater quality in the northwest of Sinai, Egypt

The northwestern coast of Sinai is home to many economic activities and development programs, thus evaluation of the potentiality and vulnerability of water resources is important. The present work has been conducted on the groundwater resources of this area for describing the major features of groundwater quality and the principal factors that control salinity evolution. The major ionic content of 39 groundwater samples collected from the Quaternary aquifer shows high coefficients of variation reflecting asymmetry of aquifer recharge. The groundwater samples have been classified into four clusters (using hierarchical cluster analysis), these match the variety of total dissolvable solids, water types and ionic orders. The principal component analysis combined the ionic parameters of the studied groundwater samples into two principal components. The first represents about 56% of the whole sample variance reflecting a salinization due to evaporation, leaching, dissolution of marine salts and/or seawater intrusion. The second represents about 15.8% reflecting dilution with rain water and the El-Salam Canal. Most groundwater samples were not suitable for human consumption and about 41% are suitable for irrigation. However, all groundwater samples are suitable for cattle, about 69% and 15% are suitable for horses and poultry, respectively.

Epidermal growth factor receptor in colorectal carcinoma: correlation with clinico-pathological prognostic factors

OBJECTIVE

This study was undertaken to determine the relationship between epidermal growth factor receptor (EGFR) status in primary colorectal cancer (CRC) to different clinico-pathological prognostic factors.

METHOD

Seventy-nine primary CRC were studied using four scoring systems: 1- EGFR pharmDx score, 2- score modified from the Hercept test [J Histo cytochem, 52 (2004) 893], 3- two additive scores with different cutoff points [Mod Pathol, 11 (1998) 155], 4- two multiplicative scores with different cutoff points [Ann Oncol, 16 (2005) 102].

RESULTS

More than 10% membranous EGFR reactivity was identified in 46.8% (37/79) of the tumours. The intensity was classified as mild, moderate and strong representing 8.9%, 20.3% and 17.7% respectively. Strong correlation was found between the EGFR pharmDx and the proposed scores, at different cutoff points (P < 0.01). A strong correlation was found between EGFR expression, advanced clinical stage (P < 0.01), nodal involvement (P < 0.01) and lympho-vascular invasion (LV) (P < 0.05) in category I factors, poorly differentiated tumours in IIA (P < 0.05), infiltrative border configuration in IIB (P < 0.01), perineural invasion (PN) in III (P < 0.01), and larger tumours in IV (P < 0.01). Heterogenous staining was present in 46.3% of tumours and was associated with an increased score, LV and PN invasion and advanced clinical stage (P < 0.05).

CONCLUSION

Using a cut-off point of 10%, similar results with different scoring systems were obtained, representing standardization for EGFR interpretation. EGFR expression is correlated with conventional clinico-pathological prognostic factors.

Differential scanning calorimetry to investigate the compatibility of ciprofloxacin hydrochloride with excipients

The compatibility between ciprofloxacin hydrochloride (CFX) and some excipients was evaluated using differential scanning calorimetry (DSC). Physical mixture, coground mixture, compressed mixture and kneaded mixture were prepared to study the effect of sample manipulation. In addition, the samples of physical mixture were also accelerated at 55 degrees C for three weeks to obtain more reliable conclusions. Different types of excipients currently used in tablet or capsule formulations namely, calcium phosphate dibasic dihydrate (Emcompress), magnesium stearate lactose, sorbitol, mannitol, croscarmellose sodium (Ac-Di-Sol), sodium carboxymethyl starch (Primojel), microcrystalline cellulose (Avicel PH 101, Emcocil) were examined. The DSC scan of CFX displayed two endothermic peaks probably as a result of a fusion process followed by a decomposition process. CFX appeared to interact with sorbitol, mannitol, Ac-Di-Sol, Primojel, Avicel PH 101 and Emcocil.

A comparative study of blood retinol and selenium in minor lower urinary lesions. A case control study

A case control study was done at Ain Shams University Hospital. Eligibility criteria were put to select cases from the clinics of urosurgery department and a control group from the clinics of surgery departments. The study was conducted in the period form 1st of February till 1st of June 1992. Both cases and control groups were subjected to an interview questionnaire, clinical examination and laboratory investigation to estimate the serum levels of retinol and selenium. Serum retinol and selenium were significantly lower among cases than among control group (p < 0.05 and p < 0.0001 respectively). Moreover, it was found that cases who lived in lower Egypt, belonged to lower socioeconomic class, smoked cigarettes and with current urinary tract infections had mean value of serum retinol significantly lower than the control group (p < 0.05). There was a significant difference in the mean blood selenium between cases and control groups who lived in Cairo (p < 0.001).

Spectrophotometric determination of some catecholamine drugs using metaperiodate

A rapid spectrophotometric procedure for the determination of isoprenaline salts, levodopa, dopamine hydrochloride, and dobutamine hydrochloride, either in the drug substances or in pharmaceutical formulations, is described. The method is based on the development of orange, red, or violet products with sodium metaperiodate in an aqueous alcoholic medium. The reaction is suggested to proceed via oxidative cyclization of the catecholamine to form an aminochrome. The wavelengths of maximum absorption range from 465 to 520 nm. The structure of the cyclization product was confirmed by ultraviolet, infrared, and nuclear magnetic resonance spectroscopy and microanalysis data.

Short communication

A simple and rapid calorimetric method for the determination of 10 sulphonamides as single entities and sulphamethoxazole in combination with trimethoprim without prior separation was developed. The method is based on the reaction of sulphonamide with phenothiazine and N-bromosuccinimide at pH 6 to produce a blue coloured product after acidification. The chromogen for all the sulphonamides was measured at 605 nm. The effect of several variables on colour development (concentration of phenothiazine and N-bromosuccinimide, time, pH) were established. Beer's Law was obeyed for all the drugs. The method was successfully applied to the analysis of single component sulphonamide tablets and ophthalmic solutions, with average results of labelled claim of 96.7 +/- 0.95 to 100.67 +/- 1.2. A good correlation was observed between molar absorptivities and pK(a) values of the sulphonamides (r = 0.9005).

Colorimetric determination of C-2 unsubstituted phenothiazines, using morpholine and N-bromosuccinimide

A colorimetric method for quantitative determination of 6 C-2 unsubstituted phenothiazine derivatives is described. The method is based on reaction of phenothiazine derivative with morpholine and N-bromosuccinimide reagents in aqueous methanol at 60 degrees C to produce a blue color. Beer's law is obeyed in a wide range of concentrations for all 6 compounds at 660 nm. Optimum analytical conditions were determined and the produced color is stable for at least 24 h. Analytical data for determination of the pure compounds are presented together with the application of the proposed method to analysis of some pharmaceutical preparations. The results compare favorably with those of official methods. Furthermore, the method is specific for intact drug in the presence of oxidative decomposition products. The reaction product has been isolated and identified and a possible reaction mechanism is suggested.

Colorimetric determination of certain phenothiazine drugs by using morpholine and iodine-potassium iodide reagents

A colorimetric method was developed for the quantitative estimation of 11 phenothiazine drugs. The method is based on the interaction of unsulfoxidized drug with morpholine and iodine-potassium iodide reagents. The interaction for all studied phenothiazine drugs yields a blue product with 2 absorption maxima: one in the range of 620-640 nm with lower molar absorptivity and the other in the range of 662-690 nm with higher molar absorptivity. The color was stable for at least 10 h. The reproducibility and recovery of the method were excellent. The method was applied successfully to the analysis of various commercially available phenothiazines in different dosage forms. The results were comparable to those obtained by official procedures. The suitability of the method for detection and estimation of promethazine excreted in urine has been suggested by preliminary experiments. Reaction products have been isolated and identified.

Fibrinolytic activity in haemophiliacs

The fibrinolytic activity was studied in 7 haemophiliacs, in comparison with 5 normals and 7 patients with disseminated intravascular coagulopathy, by determining the level of the fibrin(ogen) degradation products (FDP) in samples obtained as sera, clotting occurring naturally, and samples obtained as plasma and converted into serum by addition of thrombin-EACA. It was found that in haemophiliacs serum samples had normal FDP levels while plasma converted to serum showed high levels. This was explained by the fibrinolytic action of thrombin. Fibrinolysis was not prevented by EACA present due to the fact that it is an inhibitor of the plasminogen system but not of thrombin.