POST COVID-19 LUNG TRANSPLANTATION ITALIAN PIVOTAL PROTOCOL: SOME ETHICAL CONSIDERATIONS

SARS‑CoV‑2 mostly affects the respiratory system with clinical patterns ranging from the common cold to fatal pneumonia. During the first wave of the COVID-19 pandemic, owing to the high number of patients who were infected with SARS‑CoV‑2 and subsequently recovered, it has been shown that some patients with post–COVID-19 terminal respiratory failure need lung transplantation for survival. There is increasing evidence coming from worldwide observations that this procedure can be performed successfully in post–COVID-19 patients. However, owing to the scarcity of organs, there is a need to define the safety and efficacy of lung transplant for post–COVID-19 patients as compared to patients waiting for a lung transplant for other pre-existing conditions, in order to ensure that sound ethical criteria are applied in organ allocation. The Milan's Policlinic Lung Transplant Surgery Unit, with the revision of the National Second Opinion for Infectious Diseases and the contribution of the Italian Lung Transplant Centres and the Italian National Transplant Centre, set up a pivotal observational protocol for the lung transplant of patients infected and successively turned negative for SARS‑CoV‑2, albeit with lung consequences such as acute respiratory distress syndrome or some chronic interstitial lung disease.

The protocol was revised and approved by the Italian National Institute of Health Ethics Committee. Description of the protocol and some ethical considerations are reported in this article.

Availability of HLA-allele-matched unrelated donors and registry size: Estimation from haplotype frequency in the Italian population

In Italy, an HLA-matched unrelated donor is currently the primary donor when a HLA matched sibling is not found for allogeneic haematopoietic stem cell transplantation (HSCT). Better outcomes for transplantation require optimal matching between donor and recipient at least at the HLA-A, -B, -C, and -DRB1 loci; therefore, the availability of HLA-matched unrelated donors is important. The enormous HLA polymorphism has always necessitated registries with a large number of individuals in order to be able to provide well-matched donors to a substantial percentage of patients. In order to increase the efficiency of the Italian Bone Marrow Donor Registry (IBMDR) in providing Italian patients with a suitable donor, the probability of finding an HLA-A, -B, -C, and -DRB1 allele-matched (8/8) or a single mismatch unrelated donor (7/8) was estimated in this study according to IBMDR size. Using a biostatistical approach based on HLA haplotype frequencies of more than 100,000 Italian donors enrolled in the IBMDR and HLA-typed at high-resolution level, the probability of finding an 8/8 HLA-matched donor was 23.8%; 33.4%; and 41.4% in simulated registry sizes of 200,000; 500,000; and 1,000,000 donors; respectively. More than 2 million recruited donors are needed to increase the likelihood of identifying an HLA 8/8 matched donor for 50% of Italian patients. If one single mismatch at HLA I class loci was accepted, the probability of finding a 7/8 HLA-matched donor was 62.8%; 73.7%; and 80.3% in 200,000 donors; 500,000; and 1,000,000 donors; respectively. Using the regional haplotype frequencies of IBMDR donors, the probability of recruiting a donor with a new HLA phenotype, in the different Italian regions, was also calculated. Our findings are highly relevant in estimating the optimal size of the national registry, in planning a cost-effective strategy for donor recruitment in Italy, and determining the regional priority setting of recruitment activity in order to increase the phenotypic variability of IBMDR as well as its efficiency.

Manipulation, and cryopreservation of autologous peripheral blood stem cell products in Italy: A survey by GITMO, SIDEM and GIIMA societies

There is considerable heterogeneity in manipulation and cryopreservation of hematopoietic stem cells (HSC) for autologous HSC transplantation across Europe and Italy. To better address this point, three Italian Scientific Societies (GITMO- Gruppo Italiano per il Trapianto di Midollo Osseo; SIDEM- Società Italiana Emaferesi e Manipolazione Cellulare; and GIIMA- Gruppo Italiano Interdisciplinare Manipolazione e Aferesi per Terapie Cellulari), in collaboration with the Competent Authority "National Transplant Center" (CNT) sent to 85 Italian transplant centers (TC) a survey, which included 12 questions related to the most critical elements in graft processing. Fifty-nine centers (70 %) responded to the questionnaire. Overall, this survey demonstrates that the majority (>90 %) of responding TC used standardized procedures for HSC processing; however, an intercenter heterogeneity was clearly documented in several standard operating procedures adopted by different TC. These results seem to suggest that further standardization and efforts are needed to provide recommendations and guidelines on HSC manipulation, cryopreservation and functional assessment of cryopreserved material for autologous HSCT.

Solving the controversy of healthier organic fruit: Leaf wounding triggers distant gene expression response of polyphenol biosynthesis in strawberry fruit (Fragaria x ananassa)

The claim that organic agriculture produces higher levels of phytochemicals has been controversial for decades. Using strawberries as a model crop in field conditions, a preharvest leaf wounding stress was applied to study the production of phytochemicals in fruits. As a result phenolic compounds (PCs) and total soluble sugars increased significantly, where specific phenylpropanoids showed increment up to 137% and several genes related to PCs biosynthesis and sugar transport were overexpressed. It was observed that the accumulation of PCs on fruits can be triggered by the application of wounding stress in a distant tissue and this accumulation is directly related to carbon partition and associated gene expression. This supports the idea that higher levels of healthy phytochemicals reported in organic fruits and vegetables could be due to the wounding component of the biotic stress attributed to insects to which the plant are exposed to.

Analysis of the Trend Over Time of High-Urgency Liver Transplantation Requests in Italy in the 4-Year Period 2014-2017

BACKGROUND

The national protocol for the handling of high-urgency (HU) liver organ procurement for transplant is administered by the Italian National Transplant Center. In recent years, we have witnessed a change in requests to access the program. We have therefore evaluated their temporal trend, the need to change the access criteria, the percentage of transplants performed, the time of request satisfaction, and the follow-up.

METHODS

We analyzed all the liver requests for the HU program received during the 4-year period of 2014 to 2017 for adult recipients (≥18 years of age): all the variables linked to the recipient or to the donor and the organ transplants are registered in the Informative Transplant System as established by the law 91/99. In addition, intention to treat (ITT) survival rates were compared among 4 different groups: (1) patients on standard waiting lists vs (2) patients on urgency waiting lists, and (3) patients with a history of transplant in urgency vs (4) patients with a history of transplant not in urgency.

RESULTS

Out of the 370 requests included in the study, 291 (78.7%) were satisfied with liver transplantation. Seventy-nine requests (21.3%) have not been processed, but if we consider only the real failures, this percentage falls to 13.1% and the percentage of satisfied requests rises to 86.9%. The average waiting period for liver transplantation (LT) is 1.7 days and most requests (74%) are met in less than 24 hours, if we consider the hours between the registration of the request and the donor reporting . The percentage of late retransplantations is 2.1%. The clinical indication for HU-LT that appears to improve over time is hepatic artery thrombosis (82.5%). The overall 1-year patient survival is 68.3%. The overall 1-year graft survival, performed on all the patients, is 89% and all the indications for HU-LT appear to go well over time with an average survival rate greater than 85%.

CONCLUSIONS

The indications for HU-LT are changing according to the changes in the hepatologic field in recent years. The centralized management of requests has proven to be successful in optimizing responses. Urgent LT is confirmed to be lifesaving in its timeliness.

Effects of foliar application of zinc sulfate and zinc nanoparticles in coffee (Coffea arabica L.) plants

A greenhouse study comparing the physiological responses and uptake of coffee (Coffea arabica L.) plants to foliar applications of zinc sulfate (ZnSO₄) and zinc nano-fertilizer (ZnO NPs) was conducted with the aim to understand their effects on plant physiology. One-year old coffee plants were grown in greenhouse conditions and treated with two foliar applications of 10 mg/L of Zn as either zinc sulfate monohydrate (ZnSO₄ ‧ H₂O) or zinc oxide nanoparticle (ZnO NPs 20% w/t) and compared to untreated control plants over the course of 45 days. ZnO NPs positively affected the fresh weight and dry weight (FW and DW) of roots and leaves, increasing the FW by 37% (root) and 95% (leaves) when compared to control. The DW increase was 28%, 85%, and 20% in roots, stems, and leaves, respectively. The net photosynthetic rate increased 55% in response to ZnO NPs treatment at the end of experiment when compared to control. ZnO NPs-treated leaves contained significantly higher amounts of Zn (1267.1 ± 367.2 mg/kg DW) when compared to ZnSO₄-treated plants (344.1 ± 106.2 mg/kg DW), while control plants had the lowest Zn content in the leaf tissue (53.6 ± 18.9 mg/kg DW). X-ray micro-analyses maps demonstrated the increased penetrance of ZnO NPs in coffee leaf tissue. Overall, ZnO NPs had a more positive impact on coffee growth and physiology than conventional Zn salts, which was most likely due to their increased ability to be absorbed by the leaf. These results indicate that the application of ZnO NPs could be considered for coffee systems to improve fruit set and quality, especially in areas where Zn deficiency is high.

The impact of cerium oxide nanoparticles on the physiology of soybean (Glycine max (L.) Merr.) under different soil moisture conditions

The ongoing global climate change raises concerns over the decreasing moisture content in agricultural soils. Our research investigated the physiological impact of two types of cerium oxide nanoparticles (CeO2NPs) on soybean at different moisture content levels. One CeO2NP was positively charged on the surface and the other negatively charged due to the polyvinylpyrrolidone (PVP) coating. The results suggest that the effect of CeO2NPs on plant photosynthesis and water use efficiency (WUE) was dependent upon the soil moisture content. Both types of CeO2NPs exhibited consistently positive impacts on plant photosynthesis at the moisture content above 70% of field capacity (θfc). Similar positive impact of CeO2NPs was not observed at 55% θfc, suggesting that the physiological impact of CeO2NPs was dependent upon the soil moisture content. The results also revealed that V Cmax (maximum carboxylation rate) was affected by CeO2NPs, indicating that CeO2NPs affected the Rubisco activity which governs carbon assimilation in photosynthesis. In conclusion, CeO2NPs demonstrated significant impacts on the photosynthesis and WUE of soybeans and such impacts were affected by the soil moisture content. Graphical abstract Soil moisture content affects plant cerium oxide nanoparticle interactions.

Physiological effects of cerium oxide nanoparticles on the photosynthesis and water use efficiency of soybean (Glycine max (L.) Merr.)

CeO₂NPs displayed concentration and coating property dependent effects on soybean photosynthesis and water use efficiency.

The impact of cerium oxide nanoparticles on the salt stress responses of Brassica napus L

Dwindling high quality water resources and growing population are forcing growers to irrigate crops with water of high salinity. It is well recognized that salinity negatively affects plant physiology and biochemistry, and represents one of the most serious threats to crop production and food security. Meanwhile, engineered nanoparticles (ENPs) are increasingly detected in irrigation water and agricultural soils due to the rapid advancement of nanotechnology. Previous research has demonstrated that ENPs such as cerium oxide nanoparticles (CeO₂-NPs) exert significant impact on plant growth and production. However, almost all previous studies were conducted in well controlled environment. Knowledge on how ENPs affect plant development in a stressed condition is almost empty. The goal of the present study was to understand the physiological and biochemical changes in Brassica napus L. (canola) cv. 'Dwarf Essex' under synergistic salt stress and CeO₂-NPs effects. Two salinity levels: 0 (control) and 100 mM NaCl, and three CeO₂-NPs concentrations: 0 (control), 200 and 1000 mg kg^-1 dry sand and clay mixture, were employed. As expected, 100 mM of NaCl significantly hindered plant growth and negatively affected the physiological processes of canola. Plants treated with CeO₂-NPs had higher plant biomass, exhibited higher efficiency of the photosynthetic apparatus and less stress in both fresh water and saline water irrigation conditions Overall, our results demonstrated that CeO₂-NPs led to changes in canola growth and physiology which improved the plant salt stress response but did not completely alleviate the salt stress of canola.

Zinc deficiency in field-grown pecan trees: changes in leaf nutrient concentrations and structure

BACKGROUND

Zinc (Zn) deficiency is a typical nutritional disorder in pecan trees [Carya illinoinensis (Wangenh.) C. Koch] grown under field conditions in calcareous soils in North America, including northern Mexico and south-western United States. The aim of this study was to assess the morphological and nutritional changes in pecan leaves affected by Zn deficiency as well as the Zn distribution within leaves.

RESULTS

Zinc deficiency led to decreases in leaf chlorophyll concentrations, leaf area and trunk cross-sectional area. Zinc deficiency increased significantly the leaf concentrations of K and Ca, and decreased the leaf concentrations of Zn, Fe, Mn and Cu. All nutrient values found in Zn-deficient leaves were within the sufficiency ranges, with the only exception of Zn, which was approximately 44, 11 and 9 µg g(-1) dry weight in Zn-sufficient, moderately and markedly Zn-deficient leaves, respectively. Zinc deficiency led to decreases in leaf thickness, mainly due to a reduction in the thickness of the palisade parenchyma, as well as to increases in stomatal density and size. The localisation of Zn was determined using the fluorophore Zinpyr-1 and ratio-imaging technique. Zinc was mainly localised in the palisade mesophyll area in Zn-sufficient leaves, whereas no signal could be obtained in Zn-deficient leaves.

CONCLUSION

The effects of Zn deficiency on the leaf characteristics of pecan trees include not only decreases in leaf chlorophyll and Zn concentrations, but also a reduction in the thickness of the palisade parenchyma, an increase in stomatal density and pore size and the practical disappearance of Zn leaf pools. These characteristics must be taken into account to design strategies to correct Zn deficiency in pecan tree in the field.

Progress in restorative neurosurgery: human fetal striatal transplantation in Huntington's disease. Review

The purpose of this paper was to offer a review of the rationale, methods, biological and clinical results of human fetal striatal transplantation (HFST) in the treatment of Huntington's disease (HD). HD is a heritable neurodegenerative disease in which degeneration of neurons in the striatum leads to motor, psychiatric and cognitive deficits. The disease is progressive and inexorably lethal. At present there are no curative treatments for HD. A restorative therapy based on the intrastriatal transplantation of striatal neuroblasts taken from human fetus is currently being explored as potential treatment in selected HD patients. Pilot clinical trials of HFST have been started in few neurosurgery restorative centres. Results demonstrated that HFST is feasible and safe without relevant adverse effects; grafted neuroblasts survive, grow without evidence of neoplasia or teratoma, build new tissue with striatal-like imaging features, and move into the host brain towards short and long-distance cortical and sub-cortical targets. HFST delays disease progression and provides a period of improvement and stability. Even though larger-scale studies are still necessary to establish the true value of such a treatment, at this time, HFST represents a promising experimental therapy for patients with HD and one of the most interesting clinical application of restorative neurosurgery.

West Nile virus: the Italian national transplant network reaction to an alert in the north-eastern region, Italy 2011

We report four cases of West Nile virus (WNV) transmission following a single multiorgan donation in north-eastern Italy. The transmissions were promptly detected by local transplant centres. The donor had been tested for WNV by nucleic acid amplification test (NAT) prior to transplantation and was negative. There were no detected errors in the nationally implemented WNV safety protocols.

West Nile virus: the Italian national transplant network reaction to an alert in the north-eastern region, Italy 2011

We report four cases of West Nile virus (WNV) transmission following a single multiorgan donation in north-eastern Italy. The transmissions were promptly detected by local transplant centres. The donor had been tested for WNV by nucleic acid amplification test (NAT) prior to transplantation and was negative. There were no detected errors in the nationally implemented WNV safety protocols.

Electron-beam irradiation effects on phytochemical constituents and antioxidant capacity of pecan kernels [ Carya illinoinensis (Wangenh.) K. Koch] during storage

Pecans kernels (Kanza and Desirable cultivars) were irradiated with 0, 1.5, and 3.0 kGy using electron-beam (E-beam) irradiation and stored under accelerated conditions [40 degrees C and 55-60% relative humidity (RH)] for 134 days. Antioxidant capacity (AC) using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and oxygen radical absorbance capacity (ORAC) assays, phenolic (TP) and condensed tannin (CT) content, high-performance liquid chromatography (HPLC) phenolic profile, tocopherol content, peroxide value (PV), and fatty acid profiles were determined during storage. Irradiation decreased TP and CT with no major detrimental effects in AC. Phenolic profiles after hydrolysis were similar among treatments (e.g., gallic and ellagic acid, catechin, and epicatechin). Tocopherol content decreased with irradiation (>21 days), and PV increased at later stages (>55 days), with no change in fatty acid composition among treatments. Color lightness decreased, and a reddish brown hue developed during storage. A proposed mechanism of kernel oxidation is presented, describing the events taking place. In general, E-beam irradiation had slight effects on phytochemical constituents and could be considered a potential tool for pecan kernel decontamination.

Use of CFDA-SE for evaluating the in vitro proliferation pattern of human mesenchymal stem cells

BACKGROUND

Mesenchymal stem cells (MSC) are multipotent progenitors retaining the capability to undergo multilineage differentiation, mostly towards all the mesodermal cellular lineages. MSC growing under standard conditions are composed of two main subpopulations with a characteristic distribution in the morphologic flow cytometric scatter: RS (recycling stem) cells (small, agranular) and m (mature) MSC (large, moderately granular cells).

METHODS

MSC obtained from BM of healthy donors and expanded in culture were characterized by evaluating both the expression of conventional markers and differentiation potential. We used CFSE, a lipophilic dye that is taken up by cell membranes, to investigate separately the proliferative activity of RS cells and mMSC subsets.

RESULTS

With flow cytometric analysis, RS cells and mMSC showed nearly the same immunophenotypic pattern, even if a significantly smaller percentage of RS cells expressed some of the classic mesenchymal Ag. The RS cell fraction was confirmed to have a higher proliferative potential and such a feature was particularly evident under certain culture conditions.

DISCUSSION

CFSE has been shown as a reliable method for studying the proliferative activity of MSC subpopulations identified by flow cytometric analysis. The acquisition parameter strategy is crucial for the accuracy of the analysis.

Evaluation of breast tumour cell contamination in the bone marrow and leukapheresis collections by RT-PCR for cytokeratin-19 mRNA

There is considerable interest in an autologous transplantation (AT) programme for patients with high-risk breast cancer; however, the issue of the incidence of occult bone marrow (BM) micrometastasis at diagnosis, and the cancer contamination of peripheral blood stem cell (PBSC) collections used for haematological rescue, is still debated. The presence of BM micrometastasis was evaluated in bilateral BM biopsies obtained at diagnosis of 33 patients with stage II/IIIA breast cancer using: (i) a 'nested' reverse transcriptase-polymerase chain reaction (RT-PCR) assay for cytokeratin 19 (K19) mRNA, (ii) histology, and (iii) immunohistochemistry (IHC) analysis with a panel of three monoclonal antibodies. The RT-PCR assay only was used to determine contamination of PBSC collections obtained after priming with recombinant human granulocyte-colony stimulating factor (rhG-CSF). K19 transcripts in one or both BM samples were detected in 48% of patients at diagnosis, with an overall 85% concordance with the results of IHC analysis. On the other hand, 56% of PCR- and IHC-positive BM samples were diagnosed as 'normal' on histological analysis. 57% of patients showed K19 mRNA in at least one PBSC collection; the possibility to have contaminated PBSC collections was significantly higher in patients with K19 positivity in BM at diagnosis. In four patients who had shown K19 positivity in BM and in PBSC collections, immunoselected CD34+ cells used for haematological rescue were K19-negative. There was a trend towards longer relapse free survival (RFS) in patients transplanted with K19-negative PBSC collections as compared to the others. In conclusion, a substantial proportion of patients with high-risk non-metastatic breast cancer present occult BM micrometastasis at diagnosis and also show cancer contamination of PBSC collections used for AT. These might represent a category of patients with poorer prognosis after AT, and possible candidates for more intensive and/or alternative therapeutic regimens, including AT with purged PBSCs.

Fatal herpesvirus 6 encephalitis after unrelated bone marrow transplant

A complex pattern of neurological dysfunctions with generalized seizures and visual allucinations, but without focal signs, suddenly arose 20 days after an unrelated bone marrow transplant for chronic myelogenous leukemia (CML) in a 13-year-old girl, accompanied by signs of acute skin graft-versus-host disease (GVHD). Magnetic resonance imaging (MRI) revealed multiple bilateral foci of signal abnormalities, which were exclusively localized in the grey matter, sparing the white. Extensive microbiological and virological assays of cerebrospinal fluid (CSF) allowed the identification of HHV-6, variant A, DNA. Further progression of both neurological alterations and of skin and gut GVHD led to a fatal outcome 2 weeks later. A retrospective analysis of both the recipient and donor mononuclear cell suspensions supported the hypothesis that HHV-6 had been acquired from the donor with the bone marrow graft. This report suggests a pathogenetic role of HHV-6 in viral encephalitis in immunocompromised bone marrow transplant (BMT) recipients, and its possible association with GVHD.

Pretransplant factor XII levels correlate with prognosis in patients undergoing autologous graft for hematological malignancies

A retrospective analysis of data collected in a previous study suggested that pre-conditioning levels of factor XII might have prognostic value in autologous graft recipients. In order to confirm whether pre-transplant factor XII (pFXII) levels could be correlated with outcome, seventy-six (35 autologous and 41 allogeneic) transplant recipients were prospectively evaluated. A significant direct relationship was found between pFXII levels and both overall and disease-free survival in the autologous grafts, but not in the allogeneic ones. Although the molecular mechanisms of this relationship still need to be clarified, these data seem to justify larger efforts to confirm whether factor XII (FXII) assay should be used in pre-transplant evaluation of patients.

High doses of recombinant human erythropoietin fail to accelerate platelet reconstitution in allogeneic bone marrow transplantation. Results of a pilot study

BACKGROUND AND OBJECTIVE

The effectiveness of recombinant human erythropoietin (rhEpo) in accelerating erythroid engraftment in patients undergoing allogeneic bone marrow transplantation (BMT) has been demonstrated in previous studies. On the other hand, there are experimental data suggesting that high doses of rhEpo might also exert a stimulatory effect on thrombopoiesis.

METHODS

We carried out a pilot study on the use of high doses of rhEpo (500 U/kg/day for 30 days after transplant) in ten patients (HD-Epo group) receiving BMT to evaluate the effects on both erythroid and platelet (Plt) engrafment. This group was compared to ten BMT patients who had not received the hormone (Placebo group).

RESULTS

The HD-Epo group patients showed signs of accelerated erythropoietic recovery; in fact, the time required to reach a reticulocyte count higher than 30 x 10(9)/L was significantly shorter than in the Placebo group, while the number of high RNA content reticulocytes (HFR) was about three times greater. Circulating transferrin receptor (TfR) levels 30 days after BMT were also significantly higher in the HD-Epo group than in the other. Finally, the number of red blood cell (RBC) transfusions in the first 30 days following BMT was about twofold lower in the HD-Epo group; moreover, 4/10 patients who were treated with HD-Epo did not require any RBC units. No significant effects on the engraftment of platelets or on the number of Plt transfusions were observed in the HD-Epo as compared to the Placebo group. No adverse effect was noted on granulocytopoiesis, nor were any adverse clinical experiences found in patients who had been treated with erythropoietin at high dosages.

INTERPRETATION AND CONCLUSIONS

These data confirm that rhEpo may stimulate erythroid reconstitution after BMT, while its effects on Plt engraftment and on Plt transfusion requirements are minimal.

Analysis of leaf water relations in leaves of two olive (Olea europaea) cultivars differing in tolerance to salinity

One-year-old rooted cuttings of olive (Olea europaea L. cvs. Frantoio and Leccino) were grown either hydroponically or in soil in a greenhouse. Plants were exposed to NaCl treatments (0, 100, and 200 mM) for 35 days, followed by 30 to 34 days of relief from salt stress to determine whether previously demonstrated genotypic differences in tolerance to salinity were related to water relations parameters. Exposure to high salt concentrations resulted in reductions in predawn water potential (Psi(w)), osmotic potential at full turgor (Psi(piFT)), osmotic potential at turgor loss point (Psi(piTLP)), and relative water content (RWC) in both cultivars, regardless of the growth substrate. Leaf Psi(w) and RWC returned to values similar to those of controls by the end of the relief period. The effect of salinity on Psi(pi) appeared earlier in Leccino than in Frantoio. Values for Psi(piFT) were -2.50, -2.87, and -3.16 MPa for the 0, 100, and 200 mM salt-treated Frantoio plants, respectively, and -2.23, -2.87, and -3.37 MPa for the corresponding Leccino plants. Recovery of Psi(pi) was complete for plants in the 100 mM salt treatment, but not for plants in the 200 mM salt treatment, which maintained an increased pressure potential (Psi(pi)) compared to control plants. Net solute accumulation was higher in Leccino, the salt-sensitive cultivar, than in Frantoio. In controls of both cultivars, cations contributed 39.9 to 42.0% of the total Psi(piFT), mannitol and glucose contributed 27.1 to 30.8%, and other soluble carbohydrates contributed 3.1 to 3.6%. The osmotic contribution of Na(+) increased from 0.1-2.1% for non-treated plants to 8.6-15.5% and 15.6-20.0% for the 100 mM and 200 mM salt-treated plants, respectively. The mannitol contribution to Psi(piFT) reached a maximum of 9.1% at the end of the salinization period. We conclude that differences between the two cultivars in leaf water relations reflect differences in the exclusion capacities for Na(+) and Cl(-) ions.

Combination therapy with G-CSF and erythropoietin after autologous bone marrow transplantation for lymphoid malignancies: a randomized trial

Previous studies have shown that, unlike in patients submitted to allogeneic BMT, administration of recombinant erythropoietin (Epo) after autologous BMT (ABMT) had no significant effect on erythroid recovery and transfusional requirements. On the other hand, it has also been shown that combining Epo with recombinant granulocyte colony-stimulating factor (G-CSF) in patients with the acquired immunodeficiency syndrome (AIDS) and with myelodysplastic syndromes resulted in additive effects on erythropoiesis. To test the effects of combined G-CSF + Epo therapy on erythroid recovery after autologous bone marrow transplantation a pilot randomized, three-arm trial was designed. Thirty patients suffering from lymphoid malignancies submitted to ABMT were randomly assigned to receive G-CSF alone (5 micrograms/kg, from day + 1 up to reaching an ANC > or = 10(9)/1), G-CSF + Epo (150 U/kg, from day +1 to +21), or neither of these (controls). Patients receiving G-CSF + Epo had significantly more reticulocytes on day +21 and reached 30 x 10(9)/1 reticulocytes earlier when compared to both G-CSF and control patients; however, the number of red blood cell (RBC) transfusions was not modified by the addition of Epo to G-CSF, although both groups had significantly fewer units transfused than controls. No effect on platelet recovery or platelet transfusional requirements was observed. Myeloid recovery was comparable in the G-CSF and G-CSF+Epo groups, and significantly accelerated as compared to controls. We conclude that the addition of Epo to G-CSF causes a slight acceleration of erythroid recovery after ABMT, but is not associated with transfusional benefits. Therefore, the present data do not support the use of Epo in association with G-CSF to hasten erythroid recovery after ABMT.

Circulating CFU-E during hematopoietic recovery after allogeneic bone marrow transplantation: relationship to erythroid engraftment

The more mature erythroid progenitor assayable in vitro, the colony-forming unit-erythroid (CFU-E), is normally found in the bone marrow (BM) but is virtually absent from peripheral blood (PB), unlike the more immature progenitor, the burst-forming unit-erythroid (BFU-E). We report on the detection of CFU-E in the PB of six of 18 patients during hematopoietic recovery following allogeneic bone marrow transplantation (BMT); three of six patients with PB CFU-E were under treatment with recombinant human erythropoietin (rhEpo) as well as six of 12 who did not present with PB CFU-E. PB CFU-E were found as early as day 14 following BMT, reached a peak on day 28, and were still detectable on day 60. The presence of PB CFU-E was associated with signs of stimulated erythroid engraftment--an accelerated reticulocyte recovery, an increased number of reticulocytes, higher levels of serum transferrin receptor, and a reduction in transfusional requirements were found in these patients compared to those without PB CFU-E. The numbers of PB and BM BFU-E were similar in the two groups, as well as the numbers of PB and BM CFU-granulocyte/macrophage (CFU-GM) and multipotential CFU (CFU-GEMM); on the other hand, the percentage of BM BFU-E in S phase of the cell cycle was higher in the group of patients with PB CFU-E. While there was no difference between the two groups in serum Epo levels assayed on days 14 and 28 after BMT, patients with PB CFU-E had higher Epo levels in serum samples collected before starting the BMT procedure. These data suggest that the appearance of circulating CFU-E early after BMT is characteristic of a group of patients with an accelerated erythroid engraftment, although the mechanisms leading to the circulation of CFU-E after BMT remain unclear.

Prostaglandin E2 bladder instillation for the treatment of hemorrhagic cystitis after allogeneic bone marrow transplantation

BACKGROUND

Hemorrhagic cystitis (HC) is a major complication of high-dose cyclophosphamide therapy used in the preparative regimen for allogeneic or autologous bone marrow transplantation. Several viruses (adenovirus, cytomegalovirus and polyomavirus BK) have also been implicated in the etiology of HC. No one established method of treatment is as yet available.

MATERIALS AND METHODS

HC developed in 10 patients after allogeneic bone marrow transplantation and was BK viruria-associated in all cases. All patients were treated with instillations of prostaglandin E2 (PGE2) directly into the bladder.

RESULTS

A complete resolution of hematuria within a short time (5 +/- 1 days) was observed in all cases; in 4/10 patients urine cleared within 24 hours of the initial treatment. Intravesical PGE2 therapy caused no systemic circulatory or respiratory problems, although bladder spasms occurred in all patients.

CONCLUSIONS

Intravesical prostaglandin E2 instillation appears to be an effective treatment for hemorrhagic cystitis in bone marrow transplant patients; further studies are required to assess the actual role of BK virus in the pathogenesis of HC in bone marrow transplant patients.

The use of erythropoietin in the treatment of post-bone marrow transplantation anemia

The issue of the role of erythropoietin (Epo) in the erythroid reconstitution after bone marrow transplantation (BMT) has been addressed in several recent studies. A defective Epo production in response to anemia has been shown to occur in patients undergoing allogeneic BMT unlike in most of those subjected to an autologous rescue. The factors involved in the inadequate Epo production in BMT are discussed, with particular attention to the role of the immunosuppressive drug cyclosporin-A, which has been shown to inhibit Epo production in both in vivo and in vitro models. The observation of defective Epo production eventually led to the development of clinical trials of recombinant human Epo (rhEpo) administration in BMT patients; the aims of these studies were to stimulate erythroid engraftment, hence reducing blood transfusion exposure. Although the number of patients studied up to now is relatively small, a benefit from rhEpo administration in terms of accelerated erythroid engraftment seems very likely, and it may also be associated with decreased transfusional needs in most treated patients. However, further studies are needed to better define indications, dosages and schedules of rhEpo in BMT patients.

Ondansetron versus chlorpromazine for preventing emesis in bone marrow transplant recipients: a double-blind randomized study

Ondansetron, a selective 5-HT3 antagonist, is known to be effective for preventing emesis induced by cisplatin and other antineoplastic agents. We undertook a randomized double-blind study in a series of bone marrow transplantation (BMT) recipients to assess the antiemetic efficacy and the safety of ondansetron in comparison with chlorpromazine, which was being used at our institution, as the standard antiemetic agent for the conditioning regimen. Forty patients submitted to BMT (21 autologous, 19 allogeneic) were included in the study. Patients were randomly assigned to receive ondansetron (as a loading dose of 8 mg iv one hour before the beginning of the conditioning regimen followed by a continuous infusion of 1 mg per hour for the whole treatment period) or chlorpromazine 60 mg/m2/day given by continuous infusion for the same period (maximum 8 days). Twenty patients were assigned to ondansetron, while 20 were assigned to chlorpromazine. The response rate in terms of antiemetic efficacy and in nausea control was similar between the two treatment groups. On the contrary the two groups differed significantly in regard to side-effects: patients receiving ondansetron experienced significantly less sedation (p = 0.002), the absence of extrapyramidal reactions (p < 0.001) and no need for dose reduction (p < 0.001) as compared with patients treated with chlorpromazine.

The Use of Erythropoietin in the Treatment of Post-bone Marrow Transplatation Anemia

The issue of the role of erythropoietin (Epo) in the erythroid reconstitution after bone marrow transplantation (BMT) has been addressed in several recent studies. A defective Epo production in response to anemia has been shown to occur in patients undergoing allogeneic BMT unlike in most of those subjected to an autologous rescue. The factors involved in the inadeguate Epo production in BMT are discussed, with particular attention to the role of the immunosuppressive drug cyclosporin-A, which has been shown to inhibit Epo production in both in vivo and in vitro models. The observation of defective Epo production eventually led to the development of clinical trials of recombinant human Epo (rhEpo) administration in BMT patients; the aims of these studies were to stimulate erythroid engraftment, hence reducing blood transfusion exposure. Although the number of patients studied up to now is relatively small, a benefit from rhEpo administration in terms of accelerated erythroid engraftment seems very likely, and it may also be associated with decreased transfusional needs in most treated patients. However, further studies are needed to better define indications, dosages and schedules of rhEpo in BMT patients.

Stimulation of erythroid engraftment by recombinant human erythropoietin in ABO-compatible, HLA-identical, allogeneic bone marrow transplant patients

Recombinant human erythropoietin (rhEpo) was given i.v. at a dose of 50 U/kg/tid to eight patients undergoing an HLA-matched, ABO-compatible bone marrow transplantation (BMT), from day +1 up to day +30. Compared to the data recorded in 13 similar BMT patients who had not received the hormone, the administration of rhEpo resulted in a faster erythroid engraftment: in fact, the time required to reach a stable hematocrit value greater than or equal to 35% decreased from 123.0 to 58.0 days after BMT. Moreover, the number of blood reticulocytes on day +21 was about fourfold greater in the rhEpo group than in the controls, while the number of the most immature, high RNA content reticulocytes (HFR), as determined by a flow cytometric technique, was more than sixfold greater; finally, the recovery time of both total and HFR reticulocytes was significantly reduced by rhEpo. The stimulation of erythroid progenitors also resulted in a reduction in red blood cell (RBC) transfusion requirements: the number of RBC units delivered in the first 30 days following BMT decreased from 8.1 in the controls to 4.0, while the total number of RBC units before transfusion independence was about threefold lower than in the control. Finally, the time of transfusion dependence was significantly shortened by rhEpo. No clinically significant adverse effect directly attributable to rhEpo was recorded. These data suggest that the administration of rhEpo may be beneficial in hastening erythroid engraftment, and possibly in reducing RBC transfusion requirements following BMT.

Daunorubicin impairs 1-beta-D-arabinofuranosylcytosine uptake

Daunorubicin (DNR) and 1-beta-D-arabinofuranosylcytosine (Ara-C) act in a schedule-dependent fashion on leukemic cells. The present study was undertaken to determine whether the inhibition exerted by DNR on Ara-C cytotoxicity on HL 60 cells could be accounted for by an impairment of its uptake. After 250 ng/ml DNR treatment for 30 min, the time course of Ara-C uptake was measured, up to 128 min of incubation at 37 degrees C and at 4 degrees C, compared with controls. We found that DNR inhibits Ara-C uptake both at 37 and 4 degrees C, mostly acting on passive diffusion.

[Australia antigen and liver diseases. Report on personal cases and review of the literature]

The AA. relate the results of HBsAg and homologous antibody research by count-electrophoresis obtained in 274 patients with several chronic and acute liver-diseases. Moreover, the most important data of literature are discussed trying to relate the different results of the various AA. to the different sensitivity of the detection techniques and to the difficulties of classifying some disease (chronic hepatitis) and also to the factors related to the geographic distribution of Australia antigen. On the basis of this discussion the AA. make some general consideration on the meaning of HBsAg in the liver disease especially in the chronic diseases and in the primary liver cell carcinoma.

[Urinary infections due to Serratia marcescens: clinico-statistical pictures of patients hospitalized in the S. Maria della Scala Hospital in Siena during 1971, 1972, and 1973]

The Authors have carried out a clinical-statistical research into cases of urinary tract infection by Serratia marcescens isolated in 42 of 2500 urine-cultures effected during the period 1971-1973 by patients hospitalized in "S. Maria della Scala" Hospital of Siena. The Authors point out the high incidence of isolation of Serratia marcescens in urological patients and show some control measures to prevent the diffusion of such infections in hospital.