RNA expression profiling of renal allografts in a nonhuman primate identifies variation in NK and endothelial gene expression

RNA transcript expression estimates are a promising method to study the mechanisms and classification of renal allograft rejections. Here we use the Nanostring platform to profile RNA expression in renal allografts in a nonhuman primate (NHP), the Cynomolgus monkey. We analyzed protocol and indication 278 archival renal allograft samples, both protocol and indication from 76 animals with diagnoses of chronic antibody-mediated rejection (CAMR), acute cellular rejection (TCMR), and MIXED (both CAMR and TCMR), plus normals and samples with no pathological rejection using a Cynomolgus-specific probe set of 67 genes. Analysis identified RNA expression heterogeneity of endothelial and NK genes within CAMR and TCMR, including the stages of CAMR. Three factors were partitioned into additional groups. One group with the longest allograft survival time is pure CAMR without NK or CD3. Three mixed groups show variation in NK and CD3. TCMR was split into 2 groups with variation in NK genes. Additional validation of the complete gene-set correlated many of the genes with diagnoses of CAMR, MIXED, and TCMR rejections and with Banff histologic criteria defined in human subjects. These NHP data demonstrate the utility of RNA expression profiling to identify additional heterogeneity of endothelial and NK RNA gene expressions.

TP53 Codon 72 Polymorphism does not Affect Risk of Cervical Cancer in Patients from the Gambia

Aims

A case-control study was performed to investigate the relationship between cervical cancer and TP53 polymorphism at codon 72 in young black African women from The Gambia.

Materials and Methods

The TP53 polymorphism at codon 72 was examined by PCR amplification and SSCP analysis in 40 patients with primary cervical cancer and in 20 healthy women of the same age and from the same geographical area. The occurrence of TP53 polymorphism in combination with the HPV-16 E6 genotype (assayed by PCR) was evaluated.

Results

The distribution of TP53 genotypes in cervical cancer patients and in the control group was not statistically different (p=0.45) and homozygosity for argine at residue 72 was not associated with cervical cancer (odds ratio: 1.24; 95% confidence interval 0.21-9.16). Similarly, a different genotype distribution, cervical cancer and presence of HPV-16 E6 were not observed.

Conclusions

These results cannot rule out an association between TP53 polymorphism at codon 72, HPV infection and the etiology of cervical cancer in this population sample.

Chronic Antibody-Mediated Rejection in Nonhuman Primate Renal Allografts: Validation of Human Histological and Molecular Phenotypes

Molecular testing represents a promising adjunct for the diagnosis of antibody-mediated rejection (AMR). Here, we apply a novel gene expression platform in sequential formalin-fixed paraffin-embedded samples from nonhuman primate (NHP) renal transplants. We analyzed 34 previously described gene transcripts related to AMR in humans in 197 archival NHP samples, including 102 from recipients that developed chronic AMR, 80 from recipients without AMR, and 15 normal native nephrectomies. Three endothelial genes (VWF, DARC, and CAV1), derived from 10-fold cross-validation receiver operating characteristic curve analysis, demonstrated excellent discrimination between AMR and non-AMR samples (area under the curve = 0.92). This three-gene set correlated with classic features of AMR, including glomerulitis, capillaritis, glomerulopathy, C4d deposition, and DSAs (r = 0.39-0.63, p < 0.001). Principal component analysis confirmed the association between three-gene set expression and AMR and highlighted the ambiguity of v lesions and ptc lesions between AMR and T cell-mediated rejection (TCMR). Elevated three-gene set expression corresponded with the development of immunopathological evidence of rejection and often preceded it. Many recipients demonstrated mixed AMR and TCMR, suggesting that this represents the natural pattern of rejection. These data provide NHP animal model validation of recent updates to the Banff classification including the assessment of molecular markers for diagnosing AMR.

Low-dose IL-2 for In vivo expansion of CD4+ and CD8+ regulatory T cells in nonhuman primates

IL-2 is a known potent T cell growth factor that amplifies lymphocyte responses in vivo. This capacity has led to the use of high-dose IL-2 to enhance T cell immunity in patients with AIDS or cancer. However, more recent studies have indicated that IL-2 is also critical for the development and peripheral expansion of regulatory T cells (Tregs). In the current study, low-dose IL-2 (1 million IU/m(2) BSA/day) was administered to expand Tregs in vivo in naïve nonhuman primates. Our study demonstrated that low-dose IL-2 therapy significantly expanded peripheral blood CD4(+) and CD8(+) Tregs in vivo with limited expansion of non-Treg cells. These expanded Tregs are mainly CD45RA(-) Foxp3(high) activated Tregs and demonstrated potent immunosuppressive function in vitro. The results of this preclinical study can serve as a basis to develop Treg immunotherapy, which has significant therapeutic potential in organ/cellular transplantation.

Mechanisms of donor-specific tolerance in recipients of haploidentical combined bone marrow/kidney transplantation

We recently reported long-term organ allograft survival without ongoing immunosuppression in four of five patients receiving combined kidney and bone marrow transplantation from haploidentical donors following nonmyeloablative conditioning. In vitro assays up to 18 months revealed donor-specific unresponsiveness. We now demonstrate that T cell recovery is gradual and is characterized by memory-type cell predominance and an increased proportion of CD4⁺ CD25⁺ CD127⁻ FOXP3⁺ Treg during the lymphopenic period. Complete donor-specific unresponsiveness in proliferative and cytotoxic assays, and in limiting dilution analyses of IL-2-producing and cytotoxic cells, developed and persisted for the 3-year follow-up in all patients, and extended to donor renal tubular epithelial cells. Assays in two of four patients were consistent with a role for a suppressive tolerance mechanism at 6 months to 1 year, but later (≥ 18 months) studies on all four patients provided no evidence for a suppressive mechanism. Our studies demonstrate, for the first time, long-term, systemic donor-specific unresponsiveness in patients with HLA-mismatched allograft tolerance. While regulatory cells may play an early role, long-term tolerance appears to be maintained by a deletion or anergy mechanism.

[Italian Cystic Fibrosis Registry: 10 years of activity]

Cystic Fibrosis (CF) is a recessive autosomic genetic disease with an incidence in mediterranean countries of about 1:3500 born alive. In Italy the considerable genetic variability makes it difficult to identify all the homozygous subjects and, consequently, to estimate the incidence of the disease in healthy carriers. The disease is evolutive and affects various systems, most of all the respiratory and gastrointestinal systems. Not many years ago, when the clinical definition of CF was first introduced, average survival did not exceed the pediatric age. Nowadays with ever advancing diagnostic and therapeutical techniques many CF patients survive until an adult age. It is therefore necessary to plan adequate health service interventions so as to satisfy as much as possible the needs of both the patients and their families. To this end data collected since 1.1.1988 by the Italian registry for CF (year of birth, sex, region of birth and residence, diagnosis procedures, results of sweat test, pancreatic insufficiency, DNA analysis, status: alive, dead, lost to follow up) of all the patients, diagnosed in the 18 Reference Centres and the 3 local Centres for CF, have proved to be extremely useful. Since the birth of the Registry on 31.12.1997, data relating to 2458 patients alive on 1.1.1988 and 1159 born during the last ten years, for a total of 3617 subjects (1756 females and 1861 males), have been recorded. As already mentioned a considerable increase in life expectancy of CF patients (from 1988 to 1990 the average age of death was 14 years, from 1994 to 1997 it was 19) and a consequent increase in the percentage of adult patients have been observed.

Tumour necrosis factor enhances the therapeutic effect of mitoxantrone in human ovarian cancer xenograft

The combination of Tumour Necrosis Factor (TNF) and mitoxantrone was evaluated for potential chemotherapeutic effect against a human ovarian cancer cell line A2774 hetero-transplanted in female nude mice. Both antitumour efficacy (relative survival and reduction of ascites) and toxicity (weight loss and liver toxicity) of TNF alone, mitoxantrone alone or TNF + mitoxantrone were evaluated. A significant difference (P < 0.002) was observed only among animals bearing tumours treated with mitoxantrone (0.012 mg/Kg) + TNF (5 x 10(5) U/Kg) and controls. No cytotoxic effects were observed for this combination. These observations provide a rationale for further evaluation of TNF + mitoxantrone based regimes for the treatment of recurrent ovarian cancer.

Expression of mRNA for gelatinase A and TIMP-2 in cell cultures and tissue samples derived from breast and lung carcinomas

The aim of this study was to determine how closely expression of MMP-2 and TIMP-2 is associated with poor patient prognosis in breast and lung cancer. mRNA levels of MMP-2 and TIMP-2 were examined on dot blots in 34 cases of human breast carcinoma and in 13 cases of lung carcinoma. In breast carcinomas we found that high MMP-2 and/or low TIMP-2 expression did not consistently correspond to a poor clinical situation, while high MMP-2/TIMP-2 ratios were also found in subjects whose clinical status was relatively favorable. Statistical analysis did not show any significant association between MMP-2/TIMP-2 and the tumor markers examined. Regarding lung carcinomas, we did not find a correlation between the ratio and poor prognosis, whereas in lung carcinoma cells in vitro we found an enhancement in MMP-2 production. A possible explanation for these results is that in vivo, as opposed to in vitro, it appears that the stromal cells of the tumor and not the tumor cell itself, produce MMP-2.

Effect of granulocyte-macrophage colony-stimulating factor on growth of a xenotransplanted human ovarian cancer cell line IGROV-1 in nude mice

The clonal growth of cell lines derived from human ovarian tumours can be stimulated by GM-CSF in vitro. Among these cell lines one of the most responsive is the IGROV-1 cell line. This report describes the influence of GM-CSF on the in vivo growth of IGROV-1 cell xenografts in nude mice. Beginning one day after transplantation of the tumour, the cytokine was administered daily for 31 consecutive days as i.m. injections distant from the tumour lesion at doses of 0.1 microgram/kg and 1 microgram/kg. GM-CSF caused no significant effects on the growth modulation of the ovarian cancer cells in vivo.

[Multiorgan damage in exertion heatstroke]

The paper reports a fatal case of exertion heat stroke. The etiopathogenetic, clinical and therapeutic aspects of the case are described; although rarely observed, this pathology must be taken into account by the intensive care unit in order to ensure rapid aid and treatment in an attempt to modify the severe prognosis due to multiorgan damage which increases with the intensity and duration of hyperthermia.

[The role of directional atherectomy in the study of postangioplasty restenosis]

Restenosis is the major limit of arterial recanalization devices. Directional atherectomy has allowed for the first to remove atheroma samples by a percutaneous approach. A group of patients affected by superficial femoral artery disease who underwent directional atherectomy were studied. The patients were treated for primitive stenosis, restenosis after balloon angioplasty and thermal laser angioplasty. Intimal hyperplasia was the distinctive feature of restenosis and the cells were identified by immunohistochemistry and transmission electron microscopy as smooth muscle cells in an active synthetic phenotype. No differences were found in the restenosis process after balloon angioplasty and laser thermal angioplasty. Directional atherectomy is a useful tool to ameliorate our knowledge in the restenosis process after invasive procedure of recanalization.

A non-hormonal therapeutic alternative in cervico-vaginal dystrophies

The pharmaco therapeutic effect of polydeoxyribonucleotide vaginal suppositories in two dosages (PDRN 1,65 mg and PDRN 5 mg)* on vaginal dystrophy was studied. 40 women, aged more than forty, in surgical or physiological climacteric with cervico-vaginal dystrophy were examined. The study was carried out according to the double-blind method, randomized, between groups. Both treatments produced important ameliorations of subjective symptomatology and objective signs. No significant difference emerged between the two preparations. PDRN was proved to be a valid alternative to local hormonal therapies.

[Diverticulitis of the right colon. Description of our experience]

Two cases of diverticultis of the right colon are described which received surgical treatment. These lesions often simulate acute appendicitis and thus represent a intraoperative surprise Differential diagnosis using a neoblastic mass is often impossible. The paper stresses the importance of surgical treatment which in general terms is the same as the treatment of the diverticular mass of the left colon. In cases where it is difficult to decide between a phlogostic and neoblastic pathology, it is advised that a right hemicolectomy should be performed in line with criteria for oncological requirements.