Comparing efficacy and safety of P013, a proposed pertuzumab biosimilar, with the reference product in HER2-positive breast cancer patients: a randomized, phase III, equivalency clinical trial

BACKGROUND

Breast cancer is the most frequently diagnosed cancer and the leading reason for cancer-related death among women. Neoadjuvant treatment with dual-HER2 (human epidermal growth factor receptor 2) blockade has shown promising effects in this regard. The present study aimed to compare the efficacy and safety of a proposed pertuzumab biosimilar with the reference pertuzumab.

METHODS

This randomized, phase III, multicenter, equivalency clinical trial was conducted on chemotherapy-naive women with HER2-positive breast cancer. Patients were randomly assigned (1:1) to receive six cycles of either P013 (CinnaGen, Iran) or the originator product (Perjeta, Roche, Switzerland) along with trastuzumab, carboplatin, and docetaxel every 3 weeks. Patients were stratified by cancer type (operable, locally advanced, inflammatory) and hormone receptor status. The primary endpoint was breast pathologic complete response (bpCR). Secondary endpoints included comparisons of total pCR, overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity.

RESULTS

Two hundred fourteen patients were randomized to treatment groups. bpCR rate in the per-protocol population was 67.62% in the P013 and 71.57% in the reference drug groups. Based on bpCR, P013 was equivalent to the reference pertuzumab with a mean difference of - 0.04 (95% CI: - 0.16, 0.09). Secondary endpoints were also comparable between the two groups.

CONCLUSIONS

The proposed biosimilar P013 was equivalent to the reference product in terms of efficacy. The safety of both medications was also comparable.

In vitro elimination of EL4 cancer cells from spermatogonia stem cells by miRNA-143- and 206-loaded folic acid conjugated PLGA nanoparticles

Aim: MiRNA's-143 and -206 are powerful apoptotic regulators in cancer cells. This study aimed to use miRNA-143- and 206-loaded poly(lactic-co-glycolic) acid (PLGA) nanoparticles conjugated with folic acid to induce apoptosis in the EL4 cancer cells. Materials & methods: The therapy was conducted in six groups: Treatment with both miRNAs simultaneously (mixed miRNAs), miRNA-206 treatment, miRNA-143 treatment, blank PLGA, blank polyethylenimine (PEI) and complex PEI-miRNAs. Results: In terms of viability, in mixed miRNAs, no synergistic effect was observed on EL4 cell elimination. However, in the single miRNA-206 group, a stronger apoptotic effect was observed than the mixed miRNAs group and single miRNA-143 group alone. Conclusion: MiRNAs' apoptotic induction effects in cancer cells were found to be remarkable.

A Post-Marketing Surveillance Study to Evaluate the Safety Profile of AlvotereⓇ (Docetaxel) in Iranian Patients Diagnosed with Different Types of Cancers Receiving Chemotherapy

Background

Docetaxel is a clinically well established antimitotic chemotherapy medication. Labeled docetaxel indications are breast cancer, gastric cancer, head and neck cancer, non–small cell lung cancer, and prostate cancer.

Objective

This is a Phase IV study to evaluate the safety profile of docetaxel (Alvotere; NanoAlvand, Iran) in Iranian patients diagnosed with different types of cancers receiving chemotherapy regimens with docetaxel.

Methods

Patients who received Alvotere as a part of their chemotherapy regimen were enrolled in this Phase IV, observational, multicenter, open-label study. Alvotere was administrated as a single agent or in combination with other chemotherapy agents. Safety parameters in each cycle were assessed, and the related data were recorded in booklets.

Findings

A total of 411 patients with different types of cancers were enrolled from 25 centers in Iran. The most common malignancies among participants were breast cancer (49.88%), followed by gastric cancer (22.63%). Participants’ mean age was 53.33 years, and the mean total dose used in each cycle was 132 mg. According to the results, 341 patients experienced at least 1 adverse event, that the most common was alopecia (41.12%). In total, 92 (22.38%) patients had at least 1 adverse event of grade 3 or 4, and 25 (6.08%) patients showed 54 serious adverse events, which the causality assessment for all was possibly related to Alvotere. There was a significant difference between men and women in the incidence of skin and subcutaneous tissue disorders (55.63% in women vs 41.73% in men; P = 0.009). Also, the incidence of gastrointestinal disorders, nervous system disorders, skin and subcutaneous tissue disorders, hepatic enzymes increase, and fluid retention was significantly higher (P < 0.05) in patients receiving anthracyclines in their chemotherapy regimens.

Conclusions

The findings of this open-label, observational, multicenter, postmarketing surveillance showed that Alvotere appears to have an acceptable safety profile in Iranian cancer patients receiving chemotherapeutic regimens. (Curr Ther Res Clin Exp. 2022; 82:XXX–XXX) © 2022 Elsevier HS Journals, Inc.

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Totally 411 patients were enrolled from 25 centers in Iran.

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The most common adverse event was alopecia (41.12%).

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Only 25 (6.08%) patients experienced serious adverse events.

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Results of this study support the safety profile of Alvotere® in Iranian patients.

The Role of MicroRNA 143 and MicroRNA 206 in The Regulation of Apoptosis in Mouse Lukemia Cancer Cells and Spermatogonial Cells

OBJECTIVE

In cancer treatments, smart gene delivery via nanoparticles (NPs) can be targeted for cancer cells, while concurrently minimizing damage to healthy cells. This study assessed the efficiency of poly lactic-co-glycolic acid (PLGA)-miR 143/206 transfection on apoptosis in mouse leukemia cancer cells (El4) and spermatogonial stem cells (SSCs).

MATERIALS AND METHODS

In this experimental study, neonatal mouse spermatogonia cells and EL4 cancer cell lines were used. MicroRNA-PLGA NPs were prepared, characterized, and targeted with folate. Several doses were evaluated to obtain a suitable miR dose that can induce appropriate apoptosis in EL4 cells, while not harming SSCs. Cells were treated separately at 3 doses of each miR (for miR 143, doses of 25, 50 and 75 nmol and for miR 206, doses of 50, 100 and 150 nmol). The experiments were performed at 24, 48 and 72 hours. Viability and apoptosis were investigated by MTT and Annexin Kits.

RESULTS

Based on MTT assay results, the optimal dose of miR 143 was 75 nmol (59.87 ± 2.85 % SSC and 35.3 ± 0.78 % EL4) (P≤0.05), and for miR 206, the optimal dose was 150 nmol (54.82 ± 6.7 % SSC and 33.92 ± 3.01% EL4) (P≤0.05). The optimal time was 48 hours. At these doses, the survival rate of the EL4 cells was below the half maximal inhibitory concentration (IC₅₀) and SSC survival was above 50%. Annexin V staining also confirmed the selected doses (for miR 143 total apoptosis was 6.62% ± 1.8 SSC and 37.4% ± 4.2 EL4 (P≤0.05), and miR 206 was (10.98% ± 1.5 SSC and 36.4% ± 3.7 EL4, P≤0.05).

CONCLUSION

Using intelligent transfection by NPs, we were able to induce apoptosis on EL4 cells and maintain acceptable SSC survival rates.

Predictive Value of Risk Factors for Chronic Idiopathic Thrombocytopenic Purpura in Patients with Acute Type of Disease

BACKGROUND: Immune thrombocytopenic purpura (ITP) is an autoimmune disease in which autoantibodies react with platelet surface antigens and results in mild to severe thrombocytopenia due to decreased platelet count or inhibition of platelet production. Given the relatively high prevalence of ITP among children and the lack of standard diagnostic testing for the diagnosis of chronic disease, this study evaluated the predictive value of risk factors for chronic ITP in hospitalized patients. METHODS: This prospective cohort study was performed on 65 children with ITP who referred to Ali Asghar and Rasool Akram Hospitals in Tehran, Iran, during the years 2017 and 2018. Relationships between different risk factors, including age of diagnosis, gender, white cell count, primary platelet count, mean platelet volume (MPV), history and type of the previous patient infection, FCG gene mutation, and type of FCG mutation with a chronic disease incidence were investigated using multiple logistic regression model. RESULTS: Of 65 patients, 31 (47.69%) were male and 34 (52.31%) were female included in the study. Twenty-eight patients (43.08%) had acute ITP and 37 (56.92%) had chronic ITP. Frequency of FCG gene mutation in patients with chronic and acute type ITP was 16.36% and 7.27%, respectively (p = 0.51). No association was found between the history of the previous infection and its type with the chronic incidence of ITP. The multiple logistic regression model showed that three factors, including the absolute number of lymphocytes, age of diagnosis, and primary white blood cells (WBC) count were directly linked to chronic ITP. Furthermore, three factors of platelet, sex, and MPV were indirectly related to chronic ITP. In addition, the absolute number of lymphocytes, age of diagnosis and primary WBC count were significantly associated with chronic ITP. The receiver operating characteristic analysis showed that the cutoff rate of these factors was 0.31. Further analysis of these risk factors in comparison with the gold standard demonstrated that the diagnostic sensitivity and specificity of these risk factors for chronic ITP were 73.08% and their specificity was 88.57%, indicating the high importance and predictive power of these risk factors. CONCLUSIONS: According to the results of this study, for the first time in Iran, six risk factors, including the absolute number of lymphocytes, age at diagnosis, sex, MPV level, platelet level at time of diagnosis, and primary WBC count were considered as the most important risk factors affecting the incidence of chronic ITP. Of course, more comprehensive studies can definitely lead to more comprehensive models.

Protective effects of resveratrol against osteonecrosis at the extraction site in bisphosphonate-treated rats

Resveratrol (RSV) is a phytoestrogen with a wide range of therapeutic effects, including antioxidant and anti-inflammatory effects. This study was performed to evaluate the protective role of RSV against osteonecrosis after tooth extraction in rats treated with bisphosphonates. Thirty-nine male Wistar rats, weighing 300-350 g, were divided into three groups (n = 13) according to the planned drug regimen: alendronate + dexamethasone (AL/DEX), alendronate + dexamethasone + RSV (AL/DEX/RSV), and no drugs (control group). The first and second molars of each rat were extracted and the extraction sites were analysed histologically 14 days later. The data collected were subjected to statistical analysis by means of Kruskal-Wallis, Mann-Whitney, χ², and Fisher's exact tests using IBM SPSS software at a significance level of 0.05. The incidence of osteonecrosis was significantly lower in the AL/DEX/RSV group (P = 0.001) and control group (P = 0.041) than in the AL/DEX group, while the amount of new bone formation did not differ significantly between the AL/DEX/RSV and AL/DEX groups (P > 0.05). RSV showed a protective effect by significantly reducing osteonecrosis, which could be due to its antioxidant effects.

Anchored Fibromodulin as a Novel Target in Chronic Lymphocytic Leukemia: Diagnostic and Therapeutic Implications

BACKGROUND

We have previously reported the aberrant expression of Fibromodulin (FMOD) in patients with chronic lymphocytic leukemia (CLL). Although FMOD has been considered as a cytoplasmic or secretory protein, we discovered the cell surface expression of FMOD in leukemic B cells via anchoring with glycosylphosphatidylinositol (GPI).

OBJECTIVE

To evaluate FMOD as a new biomarker in CLL patients in comparison with healthy individuals.

METHODS

A monoclonal antibody was generated against human FMOD. The cell surface expression of FMOD in 52 CLL patients and 45 healthy individuals were compared by flow cytometry. A bacterial phosphatidylinositol-specific phospholipase C (PI-PLC) was used to determine the cell surface localization of FMOD using ELISA and flow cytometry techniques. Annexin V-FITC and propidium iodide (PI) was used to detect apoptosis induction in CLL PBMCs following in vitro incubation with anti-FMOD mAb.

RESULTS

The results demonstrated the widespread cell surface expression of GPI-anchored FMOD in CLL patients (median: 79.9 %), although healthy individuals had low FMOD expression (median: 6.2 %) (p≤0.0001). The cut-off value of FMOD expression was estimated with high sensitivity and specificity at 17.9 %. Furthermore, in vitro apoptosis induction of leukemic cells following incubation with anti-FMOD mAb showed a direct apoptosis of CLL cells (27.9%) with very low effect on healthy PBMCs (6%).

CONCLUSION

The membrane-anchoring of FMOD by means of a GPI moiety in leukemic cells supports FMOD as a highly potential diagnostic and therapeutic target in CLL patients.

Monoclonal and Polyclonal Antibodies Specific to Human Fibromodulin

Background

The unique expression of fibromodulin (FMOD) in patients with chronic lymphocytic leukemia (CLL) has been previously reported. Detecting FMOD in CLL patients using specific anti-FMOD mAbs might provide a promising method in detection, monitoring, and prognosis of CLL.

Objectives

In this study, we aimed for producing specific antibodies against FMOD to facilitate further cohort study of CLL, thus addressing FMOD as a potential target of detection.

Materials and Methods

Human FMOD gene (1087 bp) was extracted from genome of the CLL patients, and was cloned into the expression vector of pET-22b (+). The recombinant FMOD protein (rFMOD) was expressed in Escherichia coli. The purified rFMOD protein was used as an immunogen in rabbit and mice. Hybridoma technology was used to develop the monoclonal antibodies (mAbs). Polyclonal antibody (pAb) was purified from the rabbit sera using affinity column. The reactivity of anti-FMOD antibodies was assessed in ELISA, immunocytochemistry (ICC) and Western blot.

Results

ICC results showed that the anti-FMOD antibodies specifically detected FMOD in CLL PBMCs and cell lines. The developed anti-FMOD pAb detected FMOD in CLL lysates, compared to healthy PBMCs, in Western blot and ELISA.

Conclusions

The developed anti-FMOD mAbs, and pAb specifically detect FMOD in CLL samples and might be used as research tools for further investigations in CLL.

Piriformospora indica inoculation alleviates the adverse effect of NaCl stress on growth, gas exchange and chlorophyll fluorescence in tomato (Solanum lycopersicum L.)

Salinity is now an increasingly serious environmental issue that affects the growth and yield of many plants. In the present work, the influence of inoculation with the symbiotic fungus, Piriformospora indica, on gas exchange, water potential, osmolyte content, Na/K ratio and chlorophyll fluorescence of tomato plants under three salinity levels (0, 50, 100 and 150 mm NaCl) and three time periods (5, 10 and 15 days after exposure to salt) was investigated. Results indicate that P. indica inoculation improved growth parameters of tomato under salinity stress. This symbiotic fungus significantly increased photosynthetic pigment content under salinity, and more proline and glycine betaine accumulated in inoculated roots than in non-inoculated roots. P. indica further significantly improved K⁺ content and reduced Na⁺ level under salinity treatment. After inoculation with the endophytic fungus, leaf physiological parameters, such as water potential, net photosynthesis, stomatal conductance and transpiration, were all higher under the salt concentrations and durations compared with controls without P. indica. With increasing salt level and salt treatment duration, values of F₀ and qP increased but F_m , F_v /F_m , F'_v /F'_m and NPQ declined in the controls, while inoculation with P. indica improved these values. The results indicate that the negative effects of NaCl on tomato plants were alleviated after P. indica inoculation, probably by improving physiological parameters such as water status and photosynthesis.

A Double-Blind, Randomized Comparison Study between Zytux™ vs MabThera® in Treatment of CLL with FCR Regimen: Non-Inferiority Clinical Trial

BACKGROUND

Chronic lymphocytic leukemia (CLL) is characterized by accumulation of B cells in blood, lymphoid tissues and bone marrow. Addition of rituximab to CLL chemotherapy regimens has been associated with improved survival. The aim of this study was to establish efficacy and safety of Zytux™ in comparison to MabThera^® in treatment of CLL.

MATERIALS AND METHODS

Seventy CLL patients who met the criteria for entering the study were randomized into two groups (35 patients in each group). Both groups received Fludarabine and Cyclophosphamide plus Rituximab as part of the FCR regimen. Group A was treated with Zytux™, and group B was treated with MabThera^®. A non-inferiority margin of 20% for the primary outcome was defined to examine the similarity between Zytux™ and MabThera^®.

RESULTS

Baseline demographic characteristics showed no statistically significant difference between the two groups. The two treatment groups were comparable in terms of laboratory and clinical findings, cellular index changes and CD (5, 19, 20 and 23) counts during therapy cycles and at the end of the treatment period. Regarding safety results, Zytux™ demonstrated a similar profile of adverse reactions in comparison to MabThera^®. Moreover, the overall response rate was 88% and 89% for Zytux™ and MabThera^®, respectively (CI -0.17, 0.18).

CONCLUSION

Results showed non-inferiority of Zytux™ in terms of efficacy and adverse events as a biosimilar version of MabThera^®.

Aberrant Methylation-Mediated Suppression of APAF1 in Myelodysplastic Syndrome

Background: Myelodysplastic syndromes (MDSs) include a diverse group of clonal bone marrow disorders characterized by ineffective hematopoiesis and pancytopenia. It was found that down regulation of APAF1, a putative tumor suppressor gene (TSG), leads to resistance to chemotherapy and disease development in some cancers. In this study, we investigated the relation of APAF1 methylation status with its expression and clinicopathological factors in myelodysplastic syndrome (MDS) patients. Materials andMethods: Methylation Sensitive-High Resolution Melting Curve Analysis (MS-HRM) was employed in studying the methylation of CpG islands in the APAF1promoter region in MDS. Gene expression was analyzed by using real time RT-PCR. Results: 42.6% of patient samples were methylated in promoter region of APAF1analyzed, while methylation of the gene was not seen in controls (P<0.05). Methylation of APAF1was significantly associated with the suppression of its mRNA expression (P=0.00). The methylation status of APAF1in advanced-stage MDS patients (80%) was significantly higher than that of the early-stage MDS patients (28.2%) (P=0.001). The difference in frequency of hypermethylatedAPAF1 gene was significant between good (37.5%) and poor (85.71%) cytogenetic risk groups (P=0.043). In addition, a higher frequency of APAF1hypermethylation was observed in higher-risk MDS group (69.2%) compared to lower-risk MDS group (34.14%) (P=0.026). Conclusion: Our study indicated that APAF1hypermethylation in MDS was associated to high-risk disease classified according to the IPSS, WHO and cytogenetic risk.

Accuracy of endoscopic ultrasonography for determination of tumor invasion depth in gastric cancer

BACKGROUND

Gastric cancer (GC) is one the common lethal cancers in Iran. Detection of GC in the early stages would assesses to improve the survival of patients. In this study, we attempt to evaluate the accuracy of EUS in detection depth of invasion of GC among Iranian Patients.

MATERIALS AND METHODS

This study is a retrospective study of patients with pathologically confirmed GC. They underwent EUS before initiating the treatment. The accuracy of EUS and agreement between the two methods was evaluated by comparing pre treatment EUS finding with post operative histopathological results.

RESULTS

The overall accuracy of EUS for T and N staging was 67.9% and 75.47, respectively. Underestimation and overestimation was seen in 22 (14.2%) and 40 (25.6%) respectively. The EUS was more accurate in large tumors and the tumors located in the middle and lower parts of the stomach. The EUS was more sensitive in T3 staging. The values of weighted Kappa from the T and N staging were 0.53 and 0.66, respectively.

CONCLUSIONS

EUS is a useful modality for evaluating the depth of invasion of GC. The accuracy of EUS was higher if the tumor was located in the lower parts of the stomach and the size of the tumor was more than 3 cm. Therefore, judgments made upon other criteria evaluated in this study need to be reconsidered.

Gene Expression and Methylation Pattern in HRK Apoptotic Gene in Myelodysplastic Syndrome

Myelodysplastic syndromes (MDSs) are a clonal bone marrow (BM) disease characterized by ineffective hematopoiesis, dysplastic maturation and progression to acute myeloid leukemia (AML). Methylation silencing of HRK has been found in several human malignancies. In this study, we explored the association of HRK methylation status with its expression, clinical parameters and MDS subtypes in MDS patients. To study the methylation status of HRK gene, we applied Methylation Sensitive-High Resolution Melting Curve Analysis (MS-HRM) in MDS patients, as well as healthy controls and EpiTect®PCR Control DNA. Real time RT-PCR was used for gene expression analysis. Methylation frequency in promoter region of HRK in patient samples was 20.37%. Methylation of HRK was significantly related to transcriptional downregulation (P=0.023). The difference in frequency of hypermethylated HRK gene was significant between good (10%) and poor (71.42%) cytogenetic risk groups (P= 0.001), advanced stage MDS patients (66.66%) in comparison with early stage MDS patients (2.56%) (P= 0.00), higher- risk MDS group (61.53%) and lower- risk MDS group (7.31%) (P= 0.00). HRK hypermethylation was associated with advanced- stage MDS and downregulation of HRK gene may play a role in the progression of MDS.

Uterine primitive neuroectodermal tumor

Primitive neuroectodermal tumors are fairly rare in uterus. A case of uterine body primitive neuroectodermal tumor in a 32-year-old Iranian woman is presented. The patient was admitted with abdominal pain and fever and underwent emergency exploratory surgery with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. Posterior wall of the uterus was necrotic and ruptured and a huge tumor disrupted the uterine body. The tumor was strongly positive for CD99, NSE, and chromogranin; No reaction was seen for CD10, CD45 and myogenin. To the best of our knowledge, this is the first report of an uterine body primitive neuroectodermal tumor and the second report of uterine primitive neuroectodermal tumor from Iran.

Chromogenic In Situ Hybridisation Test for Breast Cancer Patients with Equivocal IHC Results--a Study from Iran

BACKGROUND

HER2/neu overexpression on cell membranes of breast cancer cells is due to HER2/neu gene amplification and it is important to identify potential candidates for anti HER2 therapy with trastuzumab. IHC, FISH and CISH are standard FDA approved assays currently used to determine HER2 status in routine practice. The aim of this study was to determine HER2 gene amplification, using the CISH method in breast carcinoma samples which had IHC +2 reactions.

MATERIALS AND METHODS

This study was conducted from 2008- 2010 using 334 consecutive breast carcinoma samples referred from local laboratories to Mehr Hospital. CISH assays were performed for all cases, and IHC tests were also done for determining efficacy and accuracy of local labs. HER2 status in local IHC tests was compared with central IHC and CISH results.

RESULTS

Of 334 breast cancer patients, 16 were negative for HER2 IHC (0, +1), 201 cases were equivocal (+2), and 31 positive (+3). Of 334 referral cases, 88 were CISH positive (26.3%) and 246 were CISH negative (73.7%). Of 201 IHC +2 cases, HER2 gene amplification was observed in 42 cases (kappa: 0.42). A 29.9% concordance was found between local IHC and central IHC. Sensitivity and specificity of local IHC were 90% and 53.8%, respectively.

CONCLUSIONS

Low accuracy of IHC results in local labs was associated with the following factors: using former FDA-approved criteria for HER2 interpretation, utilizing non-validated kits, and lack of any quality assurance program. Therefore, following the new 2014 ASCO/CAP guideline and comprehensive quality assurance should be implemented to ensure accuracy of HER2 testing.

Spontaneous Immunity Against the Receptor Tyrosine Kinase ROR1 in Patients with Chronic Lymphocytic Leukemia

Background

ROR1 is a receptor tyrosine kinase expressed in chronic lymphocytic leukemia (CLL) and several other malignancies but absent in most adult normal tissues. ROR1 is considered an onco-fetal antigen. In the present study we analysed spontaneous humoral and cellular immunity against ROR1 in CLL patients.

Materials and Methods

Antibodies against ROR1 were analysed in 23 patients and 20 healthy donors by ELISA and Western blot. Purified serum IgG from patients was tested for cytotoxicity against CLL cells using the MTT viability assay. A cellular immune response against ROR1 derived HLA-A2 restricted 9 aa and 16 aa long peptides were analysed using peptide loaded dendritic cells co-cultured with autologous T cells from CLL patients (n = 9) and healthy donors (n = 6). IFN-γ, IL-5 and IL-17A-secreting T cells were assessed by ELISPOT and a proliferative response using a H3-thymidine incorporation assay.

Results

The majority of CLL patients had antibodies against ROR1. Significantly higher titers of anti-ROR1 antibodies were noted in patients with non-progressive as compared to progressive disease. The extracellular membrane-close ROR1 KNG domain seemed to be an immunodominant epitope. Ten patients with high titers of anti-ROR1 binding antibodies were tested for cytotoxicity. Five of those had cytotoxic anti-ROR1 antibodies against CLL cells. ROR1-specific IFN-γ and IL-17A producing T cells could be detected in CLL patients, preferentially in non-progressive as compared to patients with progressive disease (p<0.05).

Conclusion

ROR1 seemed to spontaneously induce a humoral as well as a T cell response in CLL patients. The data support the notion that ROR1 might be a specific neo-antigen and may serve as a target for immunotherapy.

Medical oncology, history and its future in Iran

Systemic therapy is one of the cornerstones of cancer treatment. In 1972, following representations by American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine (ABIM) recognized medical oncology as a new subspecialty of internal medicine. Subspecialty of Hematology and Medical Oncology was emerged in Iran in 1983. In the past, modern medical treatments and education were started in Dar Al-fonun school and then in Tehran University; now six universities in Iran are training in Subspecialty of Hematology and Medical Oncology. There are also ten active hematopoietic stem cell transplantation centers, thirty-one provincial medical schools use their specialized services. Future goals for Hematology and Medical Oncology in Iran include expansion and reinforcement of multidisciplinary teams across the country, early detection and prevention of cancer, providing educational program and conducting cancer researches. To achieve these goals, it is necessary to establish Cancer Hospitals in each province that link together through a network.

All-trans-retinoic Acid differentially regulates proliferation of normal and leukemic B cells from different subsets of chronic lymphocytic leukemia

All-trans-retinoic acid (ATRA) has been shown to modulate cell growth and differentiation in a variety of tumor cell types, but little is known regarding its precise role in regulation of leukemic B cells from different subsets of chronic lymphocytic leukemia (CLL). Previously, we showed that IL-21 significantly inhibits the CpG-mediated proliferation of CLL B cells in progressive compared to nonprogressive patients. In the present study, the effect of ATRA (10(-7) mol/L) on in vitro proliferation and apoptosis of B cells was investigated in 24 CLL patients and 8 normal subjects. Our results showed that ATRA markedly enhanced CpG-mediated proliferation of normal B cells, but it slightly inhibited CpG-induced proliferation of CLL B cells [stimulation index (SI): 105.6 vs. 14.7, P = 0.0001]. Although addition of IL-21 counteracted the proliferative effect of ATRA in normal B cells, it significantly enhanced the growth of tumor B cells in presence of CpG and ATRA. This stimulatory effect was restricted to nonprogressive and unmutated patients compared to progressive and mutated groups, respectively. Our results suggest that ATRA acts differentially on normal and CLL B cells and might have therapeutic implication in patients with progressive disease.

Eimeria arloingi: further studies on the development of some endogenous stages

The present study investigated the ultrastructural characteristics of gamogony and oocyst wall formation of Eimeria arloingi in experimentally infected kids. The 18 newborn animals allocated to 3 equal groups. Two of groups, A, B were inoculated with a single dose of 1×10(3) and 1×10(5) sporulated oocysts of E. arloingi, respectively. At 7, 14, 21, 28, 35, and 42days postinoculation (DPI), 1 kid from each group was necropsied for ultrastructural studies. Transmission electron microscopy was used to screen for the presence of developmental stages of the parasite. All stages of microgametocyte and macrogametocyte developments and also oocyst wall formation were observed from 7 to 42DPI. Different stages of schizigony accompanied by marked proliferation of endoplasmic reticulum, mitochondria and several granular dividing nuclei were diagnosed in the affected epithelial cells. Young microgamonts were recognizable by an electron lucent parasitophorous vacuole and several dividing nuclei with prominent nucleolar and peripheral chromatin in the cytoplasm. At a later stage, the nuclei began to elongate and a single mitochondrion and two basal bodies were observed in close proximity nucleus. These bodies eventually protruded from the surface of the gametocyte and formed two flagellar structures. Up to 80-120 microgametes were produced per microgamont. Macrogamonts were recognized by the presence of wall-forming bodies of types 1 and 2. Electron lucent WFB2 appeared earlier than the electron denser WFB1 during the process of macrogametogenesis. The outer layer of the oocyst wall was formed by the release of the contents of WFB1 at the surface to form an electron dense layer. The WFB2 appeared, subsequently, to give rise to the electron lucent inner layer. WFB1 plays a major role in oocyst wall formation.

Increased frequency of CD8+ and CD4+ regulatory T cells in chronic lymphocytic leukemia: association with disease progression

Little is known regarding the immunobiology of regulatory T (Treg) cells in hematopoietic malignancies, particularly in chronic lymphocytic leukemia (CLL). In the present study, we showed that the frequencies of CD8(+) and CD4(+) Treg cells were significantly increased in progressive as compared with indolent CLL patients and normal subjects. Enriched CD4(+) Treg cells induced a similar level of inhibition in polyclonally activated B cells and effector T cells from CLL patients and normal subjects. Our results suggest that the increase in circulating Treg cells may result in downregulation of tumor-specific immune response, leading to tumor expansion and disease progression.

Downregulation of IL-17-producing T cells is associated with regulatory T cell expansion and disease progression in chronic lymphocytic leukemia

Little is known about the immunobiology of interleukin-17 (IL-17)-producing T cells and regulatory T cells (Treg) in chronic lymphocytic leukemia (CLL). In this study, the frequencies of Th17, Tc17, and CD39(+) Treg cells were enumerated in peripheral T cells isolated from 40 CLL patients and 15 normal subjects by flow cytometry. Our results showed a lower frequency of Th17 and Tc17 cells in progressive (0.99 ± 0.12 % of total CD3(+)CD4(+) cells; 0.44 ± 0.09 % of total CD8(+) cells) compared to indolent patients (1.57 ± 0.24 %, p = 0.042; 0.82 ± 0.2 %, p = 0.09) and normal subjects (1.78 ± 0.2 %, p = 0.003; 0.71 ± 0.09 %, p = 0.04). Decrease in IL-17-producing T cells was associated with CD39(+) Treg cells expansion. Variation of IL-17-producing cells and Treg cells in indolent and progressive patients was neither associated to the expression levels of Th1- and Th2-specific transcription factors T-bet and GATA-3 nor to the frequencies of IFN-γ and IL-4-producing CD4(+) T cells in a selected number of samples. Additionally, suppressive potential of CD4(+) Treg was similar in CLL patients and normal subjects. Our data indicate that progression of CLL is associated with downregulation of IL-17-producing T cells and expansion of Treg cells, implying contribution of these subsets of T cells in the progression of CLL.

Reduced frequency of NKT-like cells in patients with progressive chronic lymphocytic leukemia

Natural killer T (NKT) cells are a subset of innate immune cells displaying a limited repertoire of antigen specificities and CD1d restriction. Little is known about contribution of NKT cells in cancer initiation and progression. In this study, the frequencies of NKT-like cells, B cells expressing CD1d molecule and CD4(+) regulatory (Treg) cells were analyzed in 40 patients with chronic lymphocytic leukemia (CLL) and 15 healthy subjects by flow cytometry. Our results showed that the frequency of CD3(+)CD56(+) NKT-like cells is significantly decreased in progressive (4.9 ± 0.8 % of total CD3(+) T cells) compared with indolent (8.1 ± 1.2 %, p = 0.036) patients and healthy subjects (10.6 ± 1.7 %, p = 0.003). However, no association was found between NKT-like cell frequency and immunoglobulin heavy chain variable region gene (IGHV) mutation or CD38 and ZAP70 expression. On the other hand, expression of CD1d molecule was significantly higher in leukemic B cells of patients with CLL (75 ± 1.5 % of total CD19(+) B cells) compared to B cells from healthy subjects (59.6 ± 2.2 %, p < 0.001), with no significant difference between progressive and indolent patients. Interestingly, the frequency of Treg cells was inversely correlated with that of NKT-like cells in patients with CLL (r = -0.4, p = 0.002). Our results suggest a protective role for NKT-like cells in patients with CLL, which seems to be downregulated presumably by Treg cells.

Novel nanocomposite coating for dental implant applications in vitro and in vivo evaluation

This study aimed at preparation and in vitro and in vivo evaluation of novel bioactive, biodegradable, and antibacterial nanocomposite coating for the improvement of stem cells attachment and antibacterial activity as a candidate for dental implant applications. Poly (lactide-co-glycolide)/bioactive glass/hydroxyapatite (PBGHA) nanocomposite coating was prepared via solvent casting process. The nanoparticle amounts of 10, 15, and 20 weight percent (wt%) were chosen in order to determine the optimum amount of nanoparticles suitable for preparing an uniform coating. Bioactivity and degradation of the coating with an optimum amount of nanoparticles were evaluated by immersing the prepared samples in simulated body fluid and phosphate buffer saline (PBS), respectively. The effect of nanocomposite coating on the attachment and viability of human adipose-derived stem cells (hASCs) was investigated. Kirschner wires (K-wires) of stainless steel were coated with the PBGHA nanocomposite coating, and mechanical stability of the coating was studied during intramedullary implantation into rabbit tibiae. The results showed that using 10 wt% nanoparticles (5 wt% HA and 5 wt% BG) in the nanocomposite could provide the desired uniform coating. The study of in vitro bioactivity showed rapid formation of bone-like apatite on the PBGHA coating. It was degraded considerably after about 60 days of immersion in PBS. The hASCs showed excellent attachment and viability on the coating. PBGHA coating remained stable on the K-wires with a minimum of 96% of the original coating mass. It was concluded that PBGHA nanocomposite coating provides an ideal surface for the stem cells attachment and viability. In addition, it could induce antibacterial activity, simultaneously.

Demographic and prognostic factors of 455 patients with acute leukemia admitted to two referral hospitals in tehran-iran during ten years (2001-2011)

BACKGROUND

Global death toll of Acute Leukemia (AL), as a heterogeneous group of hematopoietic malignancies, is rather high, i.e. almost 74% of 300,000 new cases die every year. This reflects a poor prognosis of this malignancy in most parts of the world, where contemporary and rather complex remedies are not available. There are a few well documented reports about the epidemiologic features of AL at national level in Iran. This retrospective study demonstrates demographic and laboratory features of Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) patients admitted to the main referral oncology hospitals in the ex-Iran University of Medical Sciences in Tehran (Firoozgar and Rasoul-Akram hospitals) during the last decade (2001-2011).

METHODS

Medical records of all patients admitted to the both hospitals diagnosed with AML and ALL were reviewed during the study period for demographic, biological and clinical characteristics at diagnosis.

RESULTS

Four-hundred fifty five patients were diagnosed with AML and ALL, who admitted to the both hospitals during ten years, of whom 59.6 % (271 patients) were male. Fifty five percent of patients had AML and 44.6 % had ALL, both significantly dominated in men (p<0.001). AML patients died more significantly (p<0.05) and the most deaths occurred in older patients (p<0.001). Initial WBC count was significantly related to death (p= 0.001), where the least death (13%) occurred in the group with initial WBC between 5-10×10(3)/μL and most of deceased had an initial WBC more than 10×10(3)/μL. Logistic regression showed that age, fever and WBC were significant prognostic factors.

CONCLUSION

Demographic characteristics of AL patients were almost the same as other global reports. Most deaths occurred in older patients, those who had fever, and patients with higher WBC count at first admission, which warrants more investigations accurately and also improvements in hospital records.

Trends in Prevalent Injuries among Iranian Pilgrims in Hajj

BACKGROUND

Annually millions of Muslims depart to Saudi Arabia for performing a religious pilgrimage called "Hajj". In this ceremony, pilgrims face numerous health hazards and injuries such as pressing in overcrowding, sliding, burning, falling down, traffic accidents etc. The main purpose of this study was to determine the prevalence of injuries in Hajj period across 2004 to 2008.

METHODS

This study was conducted on 253808 Iranian pilgrims on five consecutive years of Hajj ceremonies, from 2004 to 2008. We used a report sheet with 13 types of injuries and 13 mechanisms of these injuries. SPSS V13.5 soft ware was used for analyzing the data. ANOVA and independent sample t - test was conducted, and relationships were considered significant at P< 0.05.

RESULTS

The most common injuries was "tissue contusions and ruptures "(about 76/10000), and "tendon lesions" (about 62/10000). In addition, the most common mechanism of injuries was "ankle sprain" (69/10000) during the five consecutive years. The prevalence of all fractures was about 49/10000 and the proportion of burning with hot water or fire was about 40/10000. Changes of all causes of the injuries were significant in this study (P< 0.05).

CONCLUSIONS

We have suggested some directions for preventing of injuries and related Injuries in Hajj, in this study.

Eimeria species in wild rabbits (Oryctolagus cuniculus) in Fars province, Iran

This investigation was accomplished during February to November 2008. A total of 71 wild rabbits (Oryctolagus cuniculus) of about 5 to 12 months age were collected alive from different parts of Fars province, south of Iran. Faecal sampling was carried out directly from recti and the oocysts were isolated using sedimentation and floatation techniques and the sporulated oocyst were identified based on morphological and biological characteristics. All the rabbits were apparently healthy and showed no clinical symptoms. Twenty two rabbits (31.0%) were positive for infection with Eimeria and six species including Eimeria perforans (18.3%), Eimeria magna (16.9%), Eimeria media (14.1), Eimeria irresidua (11.2%), Eimeria flavescens (4.2%), and Eimeria coecicola (2.8%) were identified. Eighty six percent of the infected rabbits showed mixed infections with two or three Eimeria species. Lack of clinical signs could be due to the agro ecological and environmental conditions of rabbit habitats specifically dry and hot climatic features in recent years. In addition, immunity induced by long term exposure to low doses of oocysts shedded by the carrier animals probably have pivotal role in impairing parasitic developmental cycles and preventing acute coccidiosis.

Occurrence and biology of goat warble fly infestation by Przhevalskiana silenus (Diptera, Oestridae) in Iran

Goat warble fly infestation (GWFI) by the larvae of Przhevalskiana silenus is endemic in goats of semi-hilly and mountainous regions of Iran. This myiasis has severe economic impact on tanning industries, and it is responsible for impaired milk and meat production, growth retardation and carcass depreciation. To estimate the prevalence of GWFI in the southern areas of Iran, from October 2006 to December 2008, the carcasses of 8000 goats at a Shiraz slaughterhouse and 1000 each at Marvdasht and Darab cities were examined weekly for the presence of P. silenus larvae. In addition, appropriate sections from the skin and subcutaneous tissues were processed for histopathological investigation. The prevalence rate of infestation in different cities varied from 7.0% to 18.9% and the minimum and maximum infestation rate was 3 and 78, with an average rate of infestation of 26.2 warbles per animal. Significant differences were observed in the prevalence among different age groups with no significant difference between male and female animals. First instar larvae (L(1)) were found on infected animals from early August to end of September, second larval stage (L(2)) from early October to end of November and third-stage larvae (L(3)) from early December to mid-March. No larvae were found on skin or subcutaneous tissues from end of March to late July. Live L(1) initiated mild lymphocyte, macrophage and eosinophil infiltration while dead L(1) initiated granulomatous or pyogranulomatous reactions. Live L(2) induced severe inflammatory reaction and massive tissue necrosis, which continued for L(3) and until the end of infestation phase. The subcutaneous tissues, dermis and epidermis became necrotic and fragmented, and L(3) penetrated the necrotic area to start its aerobic life cycle.

Analysis of the immunoglobulin heavy chain variable region gene expression in Iranian patients with chronic lymphocytic leukemia

B-cell chronic lymphocytic leukemia (B-CLL) results from clonal expansion of phenotypically mature but functionally immature B-lymphocytes. The incidence of this type of leukemia is low in Asian countries, whereas it is the most frequent type of leukemia in the West. Previous investigations mainly conducted in Western populations have demonstrated non-random rearrangement of certain immunoglobulin variable region heavy (VH) and/or light (VL) chain genes in different groups of B-CLL patients. Little is known about the profile of VH gene expression in Asian patients. In the present study, we determined the frequency of VH gene family usage in 59 Iranian patients with B-CLL. VH gene family of patients was determined by reverse transcriptase-polymerase chain reaction using VH1-VH7 family specific primers. The most frequently expressed VH gene family was found to be VH3 (45.8%) followed by VH4 (32.2%), VH1 (18.6%), VH5 (1.7%) and VH6 (1.7%), with no expression of VH2 and VH7 gene families. The results indicate a lower representation of the VH1 and VH2 gene families and a higher representation of the VH4 gene family in Iranian B-CLL patients compared to Western patients, suggesting involvement of ethnic and/or environmental factors in B-CLL disease initiation.

Study on acute phase proteins (haptoglobin, serum amyloid A, fibrinogen, and ceruloplasmin) changes and their diagnostic values in bovine tropical theileriosis

This study was conducted to assess the pattern of changes and the relative value of acute phase proteins (haptoglobin (Hp), serum amyloid A (SAA), ceruloplasmin and fibrinogen) in bovine tropical theileriosis. The diseased group comprised 50 dairy Holstein cattle, 2-3 years old, naturally infected with Theileria annulata. Infected animals were divided into four subgroups with different parasitemia rates (<1%, 1-3%, 3-5%, >5%). As a control group, 20 uninfected cattle were also sampled. Blood samples were collected and all measurements were done using validated methods. There were significant differences in red blood cells (RBCs), packed cell volume (PCV), hemoglobin (Hb) and concentrations of Hp, SAA, ceruloplasmin and fibrinogen between healthy cattle and those infected with T. annulata with different parasitemia rates (P < 0.05). As the parasitemia rate increased in infected cattle, a significant decrease was observed in RBCs, PCV, and Hb. In contrast, with increase in the parasitemia rate, a significant increase in the mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), Hp, SAA, ceruloplasmin, and fibrinogen was evident. The optimal cut-off point was set by the receiver operating characteristics (ROC) method to >5.68 microg/ml for SAA, >0.16 g/l for Hp, >0.064 g/l for ceruloplasmin and >4.00 g/l for fibrinogen with corresponding 84% sensitivity and 100% specificity for SAA, 76% sensitivity and 100% specificity for Hp, 84% sensitivity and 80% specificity for ceruloplasmin and 40% sensitivity and 100% specificity for fibrinogen. SAA had the highest sensitivity and specificity and was diagnosed to be a suitable indicator of APPs changes in bovine theileriosis.

Human leukocyte antigen class II allele association to disease progression in Iranian patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most frequent type of leukemia in Western countries, but its incidence is low in Asian populations. In the present study we determined the frequency of DRB1 and DQB1 alleles in 87 Iranian CLL patients and 100 healthy controls using a polymerase chain reaction (PCR) technique. An increased frequency of DRB1*07 (p = 0.04), DQB1*06 (p = 0.01) alleles, and DRB1*13/DQB1*03 haplotype (p = 0.01) and decreased frequency of the DQB1*03 (p = 0.01) allele were observed in our patients compared with healthy controls. Comparison between patients with indolent (n = 42) and progressive (n = 38) disease revealed a significant increase in DRB1*04 and DRB5 alleles in progressive patients. Similarly, a higher frequency of DRB5 (p = 0.01) allele was observed in CD38(+) compared with CD38(-) patients. Classification of the patients into immunoglobulin variable region heavy-chain genes mutated and unmutated subtypes did not reveal significant differences for the expression of any of the HLA alleles or haplotypes between these two subtypes. Our findings observed in an Iranian population indicate that CLL could be associated with distinct HLA class II alleles and haplotypes of which the DQB1*06 allele and DRB1*13/DQB1*03 haplotype have not already been reported in CLL patients from other ethnic backgrounds. Some HLA class II alleles may contribute to disease progression in CLL.

The relationship between serum level of thyroid hormones, trace elements and antioxidant enzymes in dromedary camel (Camelus dromedarius)

Thyroid hormones might be able to regulate the activities of superoxide dismutase (SOD), catalase and glutathione peroxidase (GPX). The role of thyroid hormones in metabolic pathways and antioxidant enzyme activities are well known in many species. Nevertheless, there is no report describing probable relationship between thyroid hormones status, erythrocyte antioxidant enzymes and serum profiles of trace elements. This study was undertaken to investigate the relationship between these parameters in Iranian dromedary camels. Blood samples were taken from the jugular vein of 30 clinically healthy Iranian dromedary camels under aseptic conditions during 6 consecutive days of summer. The serum was analyzed for serum profile of thyroid hormones, trace elements, SOD and GPX activity. There were no significant differences in serum thyroid hormones, serum level of zinc (Zn), copper (Cu), manganese (Mn), iron (Fe), selenium and antioxidant enzymes in different days (P > 0.05). There was a significant negative correlation between SOD and Fe (P < 0.01, r = -493). There was no significant correlation between other parameters. In case of copper deficiency likewise the present study, the copper was used to produce more SOD, so there was a decrease in Fe transportation, and it might be a cause of decrease in Fe amount. On the other hand, a relatively small quantity of Fe is present in tissue myoglobin, catalase, peroxidases, and cytochromes. So it might be another cause of decrease in Fe amount. The explanation for these finding is not possible at this moment and further investigations are needed to interpret these changes.

Immunophenotypic characterization of the leukemic B-cells from Iranian patients with chronic lymphocytic leukemia: association between CD38 expression and disease progression

BACKGROUND

Patients with B-cell chronic lymphocytic leukemia (B-CLL) have heterogeneous clinical courses, thus several biological parameters need to be added to the current clinical staging systems to predict disease outcome. Recent immunophenotypic studies performed mainly in Western populations have demonstrated the prognostic value of CD38 and ZAP-70 expression in B-CLL.

OBJECTIVES

To investigate the expression pattern of a variety of membrane antigens on leukemic cells from Iranian patients with CLL and to find out if there are any differences in the expression of these markers between indolent and progressive groups.

METHODS

In the present study, peripheral blood samples from 87 Iranian patients with B-CLL were analysed by flow cytometry.

RESULTS

In all cases, the neoplastic cells displayed B-CLL phenotype (CD5+/CD19+/sIg+). The vast majority of the cases expressed CD23, but failed to stain for CD3 or CD14. The leukemic cells of most patients expressed CD27 (84/87, 95.4%) and CD45RO (74/87, 83.9%) molecules, suggesting a memory B-cell phenotype. Comparison between the indolent (n=42) and progressive (n=37) patients revealed significantly higher frequency and intensity of CD38 expression in progressive group (40.5%) compared to indolent (11.9%) patients (p<0.05). None of the other membrane antigens were differentially expressed in these two groups of patients.

CONCLUSION

Our results obtained in an Asian ethnic population confirm and extend previous findings obtained from Western populations regarding the association of CD38 expression and disease progression in B-CLL.