Association between respiratory distress time and invasive mechanical ventilation in COVID-19 patients: A multicentre regional cohort study

AIM

To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.

MATERIALS AND METHODS

An observational multicentre cohort study of patients hospitalised in five COVID-19-designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.

MEASUREMENTS AND MAIN RESULTS

We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48-12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89-39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.

DISCUSSION

Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients' need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.

Non-invasive continuous arterial pressure monitoring during transcatheter atrial fibrillation ablation: a feasibility prospective study

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter atrial fibrillation (AF) ablation is still carried out with continuous invasive radial arterial blood pressure (BP) monitoring in many centers. Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a non invasive alternative method used in ICU. No data on CNBP reliability are available in the electrophysiology lab during AF ablation, where rhythm variations are common.

Purpose

The objective of the present study was to compare continuous noninvasive arterial pressure measured with the ClearSight device with invasive radial artery pressure, used as the reference method during AF ablation.

Methods

We prospectively enrolled 55 consecutive patients (age 62±11 years, 79% male) undergoing transcatheter AF ablation (62% paroxysmal, 38% persistent) at our center. Standard of care invasive BP monitoring via a radial cannula and a contro-lateral non-invasive finger volume-clamp continuous BP measurement device were positioned simultaneously in all patients for the entire procedure. Bland-Altman analysis was used to analyze agreement between the two techniques.

Results

A total of 1219 paired measurements for systolic, diastolic, and mean arterial pressure were obtained in 55 subjects, with a mean (SD) of 22 (9) measurements per patient. Mean bias (SD) was -12,97 (13,89) mmHg for systolic pressure (level of agreement -14,24–40,20; correlation coefficient 0,84), -1,85 (8,52) mmHg for diastolic pressure (level of agreement -18,54–14,84; correlation coefficient 0,77) and 2,31 (8,75) mmHg for mean pressure (level of agreement -14,84–19,46; correlation coefficient 0,85).

Conclusion

In patients undergoing AF ablation, non-invasive finger volume-clamp continuous BP monitoring with the ClearSight device showed acceptable agreement with standard of care invasive BP monitoring. Larger studies are needed to confirm potential clinical implications of a continuous non-invasive BP monitoring during AF ablation.

Computational Fluid Dynamics (CFD) Analysis of Subject-specific Bronchial Tree Models in Lung Cancer Patients

Lung resection is the only potentially curative treatment for lung cancer. The inevitable partial removal of functional lung tissue along with the tumoral mass requires a careful and structured pre-operative condition of patients. In particular, the postoperative residual functionality of the lung needs to be predicted. Clinically, this is assessed through algorithms based on pulmonary function tests (PFTs). However, these approaches neglect the local airway segment's functionality and provide a globally averaged evaluation. CFD was demonstrated to provide patient-specific, quantitative, and local information on flow dynamics and regional ventilation in the bronchial tree. This study aims to apply CFD to characterize the flow dynamics in 12 patients affected by lung cancer and evaluate the effects of the tumoral masses on flow parameters and lobar flow distribution. Patient-specific airway models were reconstructed from CT images, and the tumoral masses were manually segmented. Measurements of lungs and tumor volumes were collected. A peripherality index was defined to describe tumor distance from the parenchyma. CFD simulations were performed in Fluent^®, and the results were analyzed in terms of flow parameters and lobar volume flow rate (VFR). The predicted postoperative forced expiratory volume in 1s (ppoFEV1) was estimated and compared to the current clinical algorithm. The patients under analysis showed relatively small tumoral masses located close to the lung parenchyma. CFD results did not highlight lobar alterations of flow parameters, whereas the flow to the lung affected by the tumor was found to be significantly lower (p=0.026) than the contralateral lung. The estimation ppoFEV1 obtained through the results of the simulations showed a high correlation (ρ=0.993, p<0.001) with the clinical formula.Clinical Relevance- The proposed study establishes the efficacy and applicability of CFD for the pre-operative characterization of patients undergoing lobectomy surgery. This technique can provide additional information on local functionality and flow dynamics to support patients' operability.

Publisher Correction: Compartmentalized activities of the pyruvate dehydrogenase complex sustain lipogenesis in prostate cancer

In the HTML version of this article initially published, the name of author Diletta Di Mitri was miscoded in the XML such that Di was included as part of the given name instead of the family name. The error has been corrected in the HTML version of the article.

Compartmentalized activities of the pyruvate dehydrogenase complex sustain lipogenesis in prostate cancer

The mechanisms by which mitochondrial metabolism supports cancer anabolism are still unclear. Here, we unexpectedly find that genetic and pharmacological inactivation of Pyruvate Dehydrogenase A1 (PDHA1), a subunit of pyruvate dehydrogenase complex (PDC) inhibits prostate cancer development in different mouse and human xenograft tumour models by affecting lipid biosynthesis. Mechanistically, we show that in prostate cancer, PDC localizes in both mitochondria and nucleus. While nuclear PDC controls the expression of Sterol regulatory element-binding transcription factor (SREBF) target genes by mediating histone acetylation, mitochondrial PDC provides cytosolic citrate for lipid synthesis in a coordinated effort to sustain anabolism. In line with these evidence, we find that PDHA1 and the PDC activator, Pyruvate dehydrogenase phosphatase 1 (PDP1), are frequently amplified and overexpressed at both gene and protein level in prostate tumours. Taken together, these findings demonstrate that both mitochondrial and nuclear PDC sustain prostate tumourigenesis by controlling lipid biosynthesis thereby pointing at this complex as a novel target for cancer therapy.

Colonization by multidrug-resistant organisms in long-term care facilities in Italy: a point-prevalence study

OBJECTIVES

To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated.

METHODS

A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis.

RESULTS

A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals.

CONCLUSIONS

MDRO colonization is common among residents in Italian LTCFs.

Ultrasound screening for abdominal aortic aneurysms

QUESTIONS UNDER STUDY

This pilot study aimed to assess the feasibility, acceptance and costs of an ultrasound scan screening programme for abdominal aortic aneurysms (AAA) in the elderly male population resident in Canton Ticino, Switzerland.

METHODS

The target population were male patients aged 65-80 years who attended the outpatient clinics of the Lugano Regional Hospital in 2013. The patients showing interest were contacted by phone to verify their eligibility and fix the appointment for the ultrasound scan of the abdominal aorta. Patients with recent examinations suitable for AAA detection were excluded. Aneurysm was defined as an abdominal aorta with sagittal and/or axial diameter  30 mm. Patients' characteristics and study results were presented as descriptive statistics. The chi-squared test was used to compare categorical variables with p <0.05 as a statistical significance threshold.

RESULTS

1634 patients received the screening information leaflet and 745 (45.6%) underwent the ultrasound scan. Among the 1091 eligible patients, the acceptance rate was 68.3%. A previously unknown AAA was diagnosed in 31 patients (4.2%, 95% confidence interval 2.8-5.9%). Age and area of residence had a statistically significant impact on patient's acceptance rate (p <0.05). The mean cost per screened patient was CHF 88.

CONCLUSIONS

AAA screening of male patients aged 65-80 years is feasible with limited financial and organisational effort. Adherence might be improved by a larger community-based programme and involvement of general practitioners.

Interaction of CDCP1 with HER2 enhances HER2-driven tumorigenesis and promotes trastuzumab resistance in breast cancer

Understanding the molecular pathways that contribute to the aggressive behavior of HER2-positive breast cancers may aid in the development of novel therapeutic interventions. Here, we show that CDCP1 and HER2 are frequently co-overexpressed in metastatic breast tumors and associated with poor patient prognosis. HER2 and CDCP1 co-overexpression leads to increased transformation ability, cell migration, and tumor formation in vivo, and enhanced HER2 activation and downstream signaling in different breast cancer cell lines. Mechanistically, we demonstrate that CDCP1 binds to HER2 through its intracellular domain, thereby increasing HER2 interaction with the non-receptor tyrosine kinase c-SRC (SRC), leading to trastuzumab resistance. Taken together, our findings establish that CDCP1 is a modulator of HER2 signaling and a biomarker for the stratification of breast cancer patients with poor prognosis. Our results also provide a rationale for therapeutic targeting of CDCP1 in HER2-positive breast cancer patients.

Control of carbapenemase-producing Klebsiella pneumoniae: a region-wide intervention

Starting in 2010, there was a sharp increase in infections caused by Klebsiella pneumoniae resistant to carbapenems in the Emilia-Romagna region in Italy. A region-wide intervention to control the spread of carbapenemase-producing K. pneumoniae (CPKP) in Emilia-Romagna was carried out, based on a regional guideline issued in July 2011. The infection control measures recommended to the Health Trusts (HTs) were: phenotypic confirmation of carbapenemase production, active surveillance of asymptomatic carriers and contact isolation precautions for carriers. A specific surveillance system was activated and the implementation of control measures in HTs was followed up. A significant linear increase of incident CPKP cases over time (p<0.001) was observed at regional level in Emilia-Romagna in the pre-intervention period, while the number of cases remained stable after the launch of the intervention (p=0.48). Considering the patients hospitalised in five HTs that provided detailed data on incident cases, a downward trend was observed in incidence after the release of the regional guidelines (from 32 to 15 cases per 100,000 hospital patient days). The spread of CPKP in Emilia-Romagna was contained by a centrally-coordinated intervention. A further reduction in CPKP rates might be achieved by increased compliance with guidelines and specific activities of antibiotic stewardship.

Abstract 1451: MicroRNAs regulated by ESE3/EHF control important mediators of epithelial cell differentiation and stemness in prostate tumors

Deregulated expression of ETS transcription factors has emerged as an important event in prostate cancer pathogenesis. We found that loss of the ETS factor ESE3/EHF induced a broad dedifferentiation program associated with epithelial-to-mesenchymal transition (EMT) and induction of metastatic and cancer stem-like cell properties. To understand the mechanism by which ESE3/EHF controls differentiation of prostate epithelial cells, we examined microRNA (miRNA) expression in a cohort of primary prostate tumors and prostate epithelial normal and cancer cells using miRNA gene arrays. A distinct set of miRNAs was specifically deregulated in cancer cells and tumors with low ESE3/EHF expression. Bioinformatic analysis indicated that the deregulated miRNAs controlled many genes involved in EMT and cell stemness. Interestingly, we found that miR-424 was at the top list of the miRNAs up-regulated in ESE3 low expressing tumors and cell lines. This finding was confirmed by qRT-PCR both in cells and human tumors. Functional assays showed that ESE3/EHF controlled directly miR-424 by binding to the pre-miRNA promoter and repressing its transcription. Inhibition of miR-424 using an antimiR reduced anchorage-independent growth and cell migration in cancer cells with low ESE3 expression and high miR-424 level. On the contrary, stable expression of pre-miR-424 in cells with low endogenous miR-424 level increased anchorage-independent growth and cell migration. Furthermore, modulation of miR-424 expression affected in vitro prostatosphere formation, a phenotype associated with cancer stem-like cell properties. Consistently, inhibition of miR-424 in DU145 prostate cancer cells reduced growth of tumor xenografts in immunodeficient mice. Integrating bioinformatic analyses of the predicted targets and gene profiling of cells with miR-424 overexpression we found that miRNA-424 controlled several factors involved in protein degradation. Collectively, these results show for the first time that ESE3/EHF controls a distinct network of miRNAs with both oncogenic and tumor suppressor functions. Loss of ESE3/EHF resulted specifically in increased expression of miR-424, which has oncogenic properties in prostate epithelial cells. This represents a novel mechanism by which deregulation of ESE3/EHF impact on prostate tumorigenesis. Thus, targeting miR-424 could be a novel therapeutic strategy for prostate cancer.

Citation Format: Cecilia Dallavalle, Domenico Albino, Gianluca Civenni, Paola Ostano, Davide Genini, Ramon Garcia-Escudero, Laura Curti, Sandra Pinton, Manuela Sarti, Giovanna Chiorino, Carlo V. Catapano, Giuseppina M. R. Carbone. MicroRNAs regulated by ESE3/EHF control important mediators of epithelial cell differentiation and stemness in prostate tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1451. doi:10.1158/1538-7445.AM2014-1451

Abstract 953: Novel inhibitors of signal transducer and activator of transcription 3 (STAT3) show potent activity in cell cultures and tumor xenografts

The transcription factor (TF) STAT3 is an attractive target for development of anticancer drugs. STAT3 is over-expressed and activated in many human malignancies and has an important role in multiple oncogenic signaling pathways affecting proliferation, survival and metabolic adaptation of cancer cells. It has been difficult, however, to develop effective inhibitors of STAT3. In this study, we performed an in-depth analysis of the mechanism of action of two compounds, OPB-31121 and OPB-51602, which are currently undergoing clinical testing. We combined computational docking (CD), molecular dynamic simulation (MDS) and in vitro binding assays to study the compounds interaction with STAT3. CD predicted that OPB-31121 and OPB-51602 could bind to a common pocket in the STAT3 SH2 domain, which was not shared with other STAT3 inhibitors. MDS and in silico mutational analysis allowed refinement of the binding site predictions and an estimate of the relative binding affinities. Isotermal titration calorimetry (ITC) studies confirmed that OPB-31121 and OPB-51602 bound with high affinity (Kd, 5-10 nM) to recombinant STAT3 SH2 domain. Binding of the two compounds was disrupted by mutations of aminoacid residues in the predicted binding pocket and was mutually exclusive in competition assays. In contrast, OPB-31121 and OPB-51602 did not compete for binding with other STAT3 inhibitors, confirming that they occupied distinct pockets in the SH2 domain. In cell culture assays, OPB-31121 and OPB-51602 interfered with both Tyr705 and Ser727 phosphorylation, which are required for full transcriptional activity of STAT3. Proliferation of cancer cells was strongly affected in vitro by OPB-51602 and OPB-31121 in anchorage-dependent growth and soft-agar assays. In these assays OPB-51602 and OPB-31121 were active at low nanomolar concentrations (IC50, 5-10 nM). Interestingly, the compounds were more effective in metabolic stress conditions (e.g., nutrient and glucose depletion), suggesting that STAT3 inhibition interfered with relevant metabolic functions in cancer cells. In vivo treatment with OPB-51602 (PO, 20-40 mg/kg, 3-5 days) reduced Tyr705 and Ser727 phosphorylation in tumor xenografts. Growth of DU145 prostate tumor xenografts was almost completely arrested by daily treatment with OPB-51602 (PO, 20-40 mg/kg, 2 weeks). Interestingly, tumor growth did not resume after discontinuation of the 2-weeks treatment, indicating a persistent impairment of tumor-initiating capability. Altogether, this study demonstrates that STAT3 is the relevant intracellular target of OPB-51602 and OPB-31121. The two compounds bound with high affinity to a distinct pocket in the SH2 domain of STAT3 and interfered with STAT3 functions both in cells and tumor xenografts. These features resulted in distinctive biological activity and pharmacological properties of these novel compounds.

Citation Format: Davide Genini, Lara Brambilla, Erik Laurini, Gianluca Civenni, Sandra Pinton, Manuela Sarti, Ramon Garcia-Escudero, Laurent Perez, Giuseppina M. Carbone, Sabrina Pricl, Carlo V. Catapano. Novel inhibitors of signal transducer and activator of transcription 3 (STAT3) show potent activity in cell cultures and tumor xenografts. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 953. doi:10.1158/1538-7445.AM2014-953

Abstract C180: Novel small molecule inhibitors of signal transducer and activator of transcription (STAT3) for cancer treatment

Transcription factors (TFs) represent attractive targets for cancer therapy. However, very few direct TF inhibitors are currently in the clinic. STAT3 is overexpressed and activated in many human cancers promoting proliferation, survival and metabolic adaptation of cancer cells. In this study we investigated the mechanism of action of two new anticancer compounds, OPB-31121 and OPB-51602, currently evaluated in phase I clinical trials. Computational docking and molecular dynamic simulation (MDS) showed that the two compounds bound to the SH2 domain of STAT3 with an estimated binding affinity 2-3 orders of magnitude lower than other known STAT3 inhibitors (STAT3i). Furthermore, the compounds shared a common binding pocket that did not overlap with that of the other STAT3i. Binding assays using isothermal titration calorimetry (ITC) confirmed that OPB-31121 and OPB-51602 bound to recombinant STAT3-SH2 with Kd in the nM range. Binding of the two compounds was disrupted by mutations of amino acids in the predicted binding pocket. Interestingly, competition assays demonstrated that OPB-31121 and OPB-51602 did not prevent binding of other STAT3i, in agreement with the MDS predictions. OPB-51602 and OPB-31121 blocked both Tyr705 and Ser727 phosphorylation, which are required for full STAT3 activation, and inhibited the activity of STAT3 dependent luciferase reporter in human cancer cells. Both compounds strongly reduced anchorage-dependent growth and colony formation in soft-agar. Intriguingly, both compounds were more effective in conditions of metabolic stress (e.g., nutrient and glucose depletion), suggesting that they affected STAT3 functions relevant for metabolic adaptation of cancer cells. In vivo OPB-51602 (20-40 mg/kg PO daily for 2 weeks) arrested growth of DU145 prostate tumor xenografts and concomitantly reduced Tyr705 and Ser727 phosphorylation in tumor tissues. Interestingly, growth inhibition persisted after discontinuation of the treatment, suggesting a stable impairment of tumor-initiating capability and tumor regrowth. Altogether, this study identifies STAT3 as a relevant target of these new compounds. We show that both drugs interact directly with STAT3 and interfere with STAT3 functions in cells and tumor xenografts. Notably, the two compounds bind with high affinity to a unique pocket in the STAT3-SH2 domain that is not shared by other known STAT3i. These features might be relevant for their ability to block specific STAT3 functions and protein interactions resulting in distinctive biological activity and pharmacological properties of these novel compounds.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C180.

Citation Format: Lara Brambilla, Davide Genini, Erik Laurini, Gianluca Civenni, Sandra Pinton, Manuela Sarti, Laurent Perez, Sabrina Pricl, Giuseppina M. Carbone, Carlo V. Catapano. Novel small molecule inhibitors of signal transducer and activator of transcription (STAT3) for cancer treatment. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C180.

RNAi-mediated silencing of Myc transcription inhibits stem-like cell maintenance and tumorigenicity in prostate cancer

Several studies link disease progression, recurrence, and treatment failures to the cancer stem-like cell (CSC) subpopulation within the heterogeneous tumor cell population. Myc is a transcription factor having a central function in stem cell biology and in human cancers. Hence, Myc represents an attractive target to develop CSC-specific therapies. Recent findings suggest that Myc transcription can be silenced using an RNA interference (RNAi)-based strategy that targets noncoding promoter-associated RNA (paRNA) overlapping the transcription start site. In this study, we investigated the effects of silencing Myc transcription on prostate CSC in cell culture and xenograft models of human prostate cancer. Treatment with an effective promoter-targeting siRNA reduced the fraction of CSCs, leading to reduced self-renewal, tumor-initiating, and metastatic capability. Combined analysis of stem-like cells and senescence markers indicated that Myc silencing triggered a phenotypic shift and senescence in the CSC subpopulation. Notably, systemic delivery of the promoter-targeting siRNA in the xenograft model produced a striking suppression in the development of prostate tumors. Our results support a pivotal role for Myc in CSC maintenance and show that Myc targeting via RNAi-based transcriptional silencing can trigger CSC senescence and loss of their tumor-initiating capability. More generally, our findings demonstrate the efficacy of RNAi-based transcriptional strategies and the potential to target regulatory noncoding paRNAs for therapeutic applications.

Differential expression of testin and survivin in breast cancer subtypes

Testin (TES) is a putative tumour-suppressor gene downregulated in various types of cancers. Survivin is a nodal protein involved in multiple signalling pathways, tumour maintenance and inhibition of apoptosis. Previous studies indicate that TES and survivin can functionally interact and modulate cell death and proliferation in breast cancer cells. The aim of the present study was to investigate the expression and prognostic relevance of TES and survivin in breast cancer subtypes examining a large cohort of breast cancer patients. We determined the expression of TES and survivin by immunohistochemistry (IHC) in tissue samples from 242 breast cancer patients diagnosed between 1981 and 2009. The expression of these proteins was compared with clinical and pathological data. There was a significant association of nuclear survivin overexpression and TES downregulation with triple-negative tumours [P=0.009; univariate odds ratio (OR), 3.20; 95% CI, 1.34-7.66] (P=0.018; multivariate OR, 2.90; 95% CI, 1.20‑6.97). A further significant correlation was observed between TES downregulation and the luminal B subtype (P=0.019, univariate OR: 2.90; 95% CI, 1.19‑7.06) (P=0.032, multivariate OR, 2.67; 95% CI, 1.09-6.65), independent of survivin expression. Our results demonstrated a statistically significant association between TES downregulation and highly aggressive breast tumour subtypes, such as triple-negative and luminal B tumours, along with the prognostic relevance of nuclear expression of survivin. To our knowledge, this is the first demonstration of such an association.

ETS transcription factor ESE1/ELF3 orchestrates a positive feedback loop that constitutively activates NF-κB and drives prostate cancer progression

Chromosomal translocations leading to deregulated expression of ETS transcription factors are frequent in prostate tumors. Here, we report a novel mechanism leading to oncogenic activation of the ETS factor ESE1/ELF3 in prostate tumors. ESE1/ELF3 was overexpressed in human primary and metastatic tumors. It mediated transforming phenotypes in vitro and in vivo and induced an inflammatory transcriptome with changes in relevant oncogenic pathways. ESE1/ELF3 was induced by interleukin (IL)-1β through NF-κB and was a crucial mediator of the phenotypic and transcriptional changes induced by IL-1β in prostate cancer cells. This linkage was mediated by interaction of ESE1/ELF3 with the NF-κB subunits p65 and p50, acting by enhancing their nuclear translocation and transcriptional activity and by inducing p50 transcription. Supporting these findings, gene expression profiling revealed an enrichment of NF-κB effector functions in prostate cancer cells or tumors expressing high levels of ESE1/ELF3. We observed concordant upregulation of ESE1/ELF3 and NF-κB in human prostate tumors that was associated with adverse prognosis. Collectively, our results define an important new mechanistic link between inflammatory signaling and the progression of prostate cancer.

Abstract 3118: ESE1/ELF3 and constitutive activation of NF-kB in human prostate cancer: prognostic relevance and rationale for context-dependent therapeutic strategies

Activation of inflammatory circuits occurs frequently in human cancers. Here, we show that ESE1/ELF3 exerts oncogenic functions and is an important link between inflammatory signaling and prostate cancer progression. We found that ESE1/ELF3 is overexpressed in human primary and metastatic prostate tumors, mediates key transforming phenotypes in prostate cancer cells and induces transcriptional changes in relevant oncogenic pathways. Moreover, ESE1/ELF3 contributes to IL-1beta induced and constitutive activation of NF-kB by multiple transcriptional and post-transcriptional mechanisms. ESE1/ELF3 interacts with p65/RELA and p50/NFKB1, enhances nuclear localization and transcriptional activity of the NF-kB complex, and induces transcription of p50/NFKB1by binding to the gene promoter. This positive feedback loop leading to ESE1/ELF3 upregulation and NF-kB activation is also active in human prostate tumors. Bioinformatic analyses revealed that the ESE1/ELF3 transcriptional program converged with NF-kB and IL-1beta target genes in experimental models and human tumors. Furthermore, human prostate tumors with high ESE1/ELF3 expression were enriched of ESE1/ELF3 and NF-kB target genes. Evaluation of tumor tissue microarrays by immunohistochemistry and of multiple gene expression datasets revealed that combined upregulation of ESE1/ELF3 and p65/p50 was associated with significantly reduced overall survival and increased disease recurrence. Furthermore, we speculated that the positive feedback loop between ESE1/ELF3 and NF-kB could be selectively disrupted by NF-kB inhibitors. To test this hypothesis, we used BAY-117085, a known inhibitor of NF-kB, and a second compound, EC-70124, which was recently reported to potently inhibit NF-kB. Both compounds inhibited NF-kB reporter activity in prostate cancer cells and reduced phosphorylation of IkBα. Moreover, expression of genes induced by ESE1/ELF3, cell migration and proliferation were significantly reduced by NF-kB inhibitors selectively in ESE1/ELF3 expressing cells. Collectively, this study provides a mechanistic link between inflammation and prostate cancer progression and suggests new tools for patient stratification and design of context-dependent strategies for a subset of prostate cancer patients with clinically aggressive and high risk tumors marked by ESE1/ELF3 and NF-kB activation.

Citation Format: Nicole Longoni, Domenico Albino, Gianluca Civenni, Sandra Pinton, Maurizia Mello-Grand, Paola Ostano, Gioacchino D’ Ambrosio, Fausto Sessa, George N. Thalmann, Manuela Sarti, Ramon Garcia-Escudero, Francisco Morris, Giovanna Chiorino, Carlo V. Catapano, Giuseppina M. Carbone. ESE1/ELF3 and constitutive activation of NF-kB in human prostate cancer: prognostic relevance and rationale for context-dependent therapeutic strategies. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3118. doi:10.1158/1538-7445.AM2013-3118

Abstract 3307: Transcriptional silencing of c-Myc by promoter-directed siRNA efficiently target prostate cancer stem cells

Prostate cancer is the most frequent epithelial cancer in elderly men in Western countries. Depending on the stage, prostate cancer treatment requires surgery, hormone therapy, radio- and chemo-therapy. c-MYC is a transcription factor activated by mitogenic signaling pathways and playing a central function in stem cell biology. Over-activity of c-Myc plays a central role in tumorigenesis by affecting cell proliferation, metabolic adaptation and survival. Amplification of c-MYC is one of the most common genetic alterations occurring in cancer genomes. c-Myc expression is significantly elevated in invasive prostate adenocarcinomas compared to benign prostatic hyperplasia and normal prostate tissue. Particularly, c-Myc is highly expressed in prostate cancer cells having the CD44+/CD24- phenotype, which is described as a hallmark of cancer progenitor/stem cells (CSCs). Importantly, several studies link therapy resistance and disease progression to the CSC subpopulation within the highly heterogeneous cellular composition of the tumor. CSCs are likely the tumor initiating population that produces metastasis and disease recurrence. These lines of evidence suggest a central role of c-Myc in the maintenance of CSC compartment in human tumors and justify c-Myc as a therapeutic target.

Previously, we showed that the c-Myc gene could be silenced with small interfering RNAs (siRNA) targeting its promoter. Interestingly, single transfection with myc targeting siRNA (myc-siRNA) induced long lasting effects on cell proliferation and clonogenicity, indicative of a persistent loss of proliferative and clonogenic potential. In this study, we investigated the effects of transcriptional silencing of c-Myc on the CSC subpopulation in human prostate cancer cell lines in vitro and in vivo. We found that treatment with myc-siRNA significantly reduced the fraction of CSCs defined by expression of stem cell surface markers CD44 and CD24, in vitro sphere forming ability and self-renewal. Furthermore, combined analysis of senescence and cell surface markers showed that senescence occurred prevalently in the CD44+/CD24- cell subpopulation leading to its depletion, and reduced self renewal capability, in vivo tumorigenicity and metastatic potential. Moreover, repeated intraperitoneal administration of myc-siRNA over a 4-week period reduced tumor growth in a xenogeneic prostate cancer model. These results are consistent with the role of c-Myc in the maintenance of the CSC subpopulation in human prostate tumors and suggest that c-Myc downregulation induces an irreversible loss of clonogenic and tumor-initiating capability linked to the induction of cell senescence in CSCs. Our findings show also that an RNAi-based transcriptional therapy directed to genes directly involved in the maintenance of the cancer stem cells could be an efficient approach to block progression and relapse of prostate cancer.

Citation Format: Gianluca Civenni, Anastasia Malek, Domenico Albino, Manuela Sarti, Sandra Pinton, Stefano Di Marco, Giuseppina M. Carbone, Carlo V. Catapano. Transcriptional silencing of c-Myc by promoter-directed siRNA efficiently target prostate cancer stem cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3307. doi:10.1158/1538-7445.AM2013-3307

Correlation of UHRF1 expression in primary prostate cancer patients with adverse prognosis

4661

Background: Cancer of the prostate is a leading cause of cancer death in western countries. There is a great need to understand the clinical course of the disease and to distinguish the indolent tumors from those with aggressive behavior. Epigenetic mechanisms play an essential role in cancer initiation and progression. Our groups have recently provided evidence that over-expression of UHFR1 (ubiquitin-like with PHD and ring finger domain) leads to prostate cancer progression by activating a robust epigenetic switch involving silencing of a network of tumor suppressor genes. The purpose of this study was to evaluate in a clinical setting the prognostic impact of UHFR1 expression. Methods: In a series of 225 eligible patients (median age 63 years, range 44-75) with prostate cancer treated in a single institution with prostatectomy between 1990 and 1999 we evaluated the tumor nuclear expression of UHRF1 by immunohistochemistry (IHC). Clinical and histological data of the series were also reviewed. The UHFR1 expression (evaluated in tissue microarrays by immunohistochemistry) and prognostic factors were analyzed using univariate analyses and multivariate logistic regression analysis to identify association with overall survival (OS). Results: The median FU for the series was 137 months (range 1-229), eighty-one patients died (median FU 85 months). In Ninety-seven patients (43%) the UHRF1 expression was positive. In univariate analyses Gleason Score (<7 vs 7-9), Stage Risk Group (TNM Stage <III vs Stage III and/or N+) and UHFR1 expression (negative vs positive) were significant prognostic factors for OS with p-value <0.0001. In multivariate analyses Gleason Score, Stage Risk Group and UHFR1 expression were independent predictors for OS with respectively HRs of 2.77 (95% CI 1.72-4.46) p<0.0001, HRs of 1.96 (95% CI 1.14-3.37) p=0.014 and Hrs 1.35 (95% CI 1.02-1.78) p=0.030. Conclusions: Our results indicate that expression of UHFR1 protein, independently from historical prognostic factors, is linked with adverse prognosis for overall survival in a homogeneous primary prostate cancer treated group with long-term follow-up.

ESE3/EHF controls epithelial cell differentiation and its loss leads to prostate tumors with mesenchymal and stem-like features

Cancer stem cells (CSC) play a significant role in tumor progression, disease recurrence, and treatment failure. Here, we show that the endogenously expressed ETS transcription factor ESE3/EHF controls prostate epithelial cell differentiation and stem-like potential. We found that loss of ESE3/EHF induced epithelial-to-mesenchymal transition (EMT), stem-like features, and tumor-initiating and metastatic properties in prostate epithelial cells, and reexpression of ESE3/EHF inhibited the stem-like properties and tumorigenic potential of prostate cancer cells. Mechanistically, ESE3/EHF repressed the expression of key EMT and CSC genes, including TWIST1, ZEB2, BMI1, and POU5F1. Analysis of human tissue microarrays showed that reduced ESE3/EHF expression is an early event in tumorigenesis, frequently occurring independently of other ETS gene alterations. Additional analyses linked loss of ESE3/EHF expression to a distinct group of prostate tumors with distinctive molecular and biologic characteristics, including increased expression of EMT and CSC genes. Low ESE3/EHF expression was also associated with increased biochemical recurrence of prostate cancer and reduced overall survival after prostatectomy. Collectively, our findings define a key role for ESE3/EHF in the development of a subset of prostate tumors and highlight the clinical importance of identifying molecularly defined tumor subgroups.

Abstract B24: Loss of expression of the endogenous ETS factor ESE3/EHF is associated with a distinct tumor subtype with stem-like and basal cell features

Gene fusions leading to ectopic expression of ETS transcription factors are frequent in prostate tumors. However, the impact of endogenously expressed ETS factors on prostate tumorigenesis has not been deeply investigated. A comprehensive analysis of the ETS transcriptional network in normal and prostate tumor samples revealed frequent deregulation of multiple ETS factors, including endogenously expressed ETS like ESE3/EHF. We found that ETS gene expression patterns could be used to classify prostate tumors in subgroups characterized by partially distinct transcriptional and biological features. To further explore this concept we analyzed in greater details the properties of the group of ETS fusion negative tumors characterized by exclusive loss of ESE3/EHF expression without other ETS gene alterations (ESE3low tumors). ESE3low tumors represented approximately 25% of all tumors in multiple patient cohorts. Loss of ESE3/EHF expression determined by IHC on tissue microarray (TMAs) was an early event occurring at the level of HGPINs and tumors. Furthermore, reduced or absent ESE3/EHF stain in TMAs was associated with significantly increased biochemical relapse and reduced 10-year survival following prostatectomy for primary prostate cancer, independently of ERG status. Consistent with a role in tumor initiation and progression, ESE3/EHF knockdown in immortalized prostate epithelial cells induced epithelial-to-mesenchymal transition (EMT), in vitro stem-like properties and in vivo tumour-initiating and metastatic capability. Conversely, re-expression of ESE3/EHF in prostate cancer cells reduced stem-like potential and tumorigenicity. Analysis of gene expression profiling (GEP) data from three independent studies showed that the ESE3low tumours shared unique characteristics and displayed transcriptional features strikingly similar to transformed ESE3/EHF-knockdown prostate epithelial cells. Functional annotation and gene set enrichment analysis (GSEA) showed that ESE3low tumors were enriched of EMT and stem cell features. Furthermore, GSEA and unsupervised clustering indicated that ESE3low tumors retained prevalently expression of basal cell markers over luminal markers and displayed significant attenuation of androgen-induced genes compared to all other tumors. Interestingly, most of the ERG expressing tumors displayed opposite characteristics with expression of luminal markers. MicroRNA and lincRNA expression profiling also showed distinctive patterns between ESE3low tumors and the other tumors, while confirming the similarity with ESE3/EHF-knockdown cells. Collectively, these findings support a direct role of loss of ESE3/EHF expression in the pathogenesis of a subset of prostate tumors. Moreover, these data imply that distinct tumor subtypes can be indentified based on the expression of specific molecular marker that could reflect intrinsic differences in tumour biology and clinical evolution.

Citation Format: Maurizia Mello-Grand, Manuela Sarti, Gioacchino D'Ambrosio, Fausto Sessa, George Thalmann, Giovanna Chiorino, Carlo V. Catapano, Giuseppina MR Carbone, Domenico Albino, Vijay Kumar Singh, Gianluca Civenni, Nicole Longoni, Chiara Ghimenti, Paola Ostano, Sandra Pinton. Loss of expression of the endogenous ETS factor ESE3/EHF is associated with a distinct tumor subtype with stem-like and basal cell features [abstract]. In: Proceedings of the AACR Special Conference on Advances in Prostate Cancer Research; 2012 Feb 6-9; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(4 Suppl):Abstract nr B24.

Abstract B25: The ETS transcription factor ESE1 promotes activation of the NFKB pathway in prostate tumors

ETS transcription factors are important elements in the pathogenesis of prostate cancer. Here, we report that the ETS factor ESE1, which is expressed in normal prostate epithelial cells, is frequently upregulated in prostate tumors and functionally linked to activation of the NFkB pathway and inflammation. Immunohistochemistry and QRT-PCR in normal prostate and primary prostate tumor samples showed increased expression of ESE1 in about 35% of tumors. Over-expression of ESE1 was observed both in the presence and absence of ERG over-expression, indicating that activation of ESE1 could have an independent role in a subset of prostate tumors. Furthermore, elevated levels of ESE1 were significantly associated with higher rates of biochemical relapses in patients with primary tumors treated with radical prostatectomy (Log Rank (Mantel-Cox)=0.018). Overexpression of ESE1 in prostate cancer cells, like LNCaP and 22RV1, promoted a more aggressive phenotype with increased growth in soft-agar, resistance to anoikis and cell migration. When injected in nude mice, ESE1 over-expressing prostate cancer cells exhibited greater ability to form lung metastasis compared to control cells. ESE1 affected transcription of many genes and ChIP showed binding of ESE1 to ETS binding sites in the promoter of key genes involved in cell adhesion, metastasis and inflammation. Relevantly, we observed that mRNA and protein level of the NFkB subunit NFKB1 (p50) was increased in stable ESE1 expressing cells. Analysis of NFKB1 promoter revealed the presence of a previously unknown ETS binding site and ChIP demonstrated binding of ESE1 to this site, consistent with transcriptional activation of the gene by ESE1. Immunofluorescence microscopy showed a marked intranuclear localization of the NFkB p50/p65 complex, indicating that ESE1 promoted also NFkB activation. Consistently, the activity of the NFkB-responsive luciferase reporter was increased in ESE1 expressing cells compared to control cells. Furthermore, we found that the pro-inflammatory cytokine IL-1beta increased ESE1 mRNA and protein level in LNCaP cells while promoting intranuclear localization of the NFkB complex. This was associated with the induction of anoikis resistance and cell migration. All these effects were rescued by siRNA mediated knockdown of ESE1 indicating that ESE1 had a key role in mediating the effects of IL-1beta in these cells. We propose that the production of pro-inflammatory cytokines like IL-1beta within the tumor microenvironment results in the upregulation of ESE1 and establishment of a feed-forward loop leading to the constitutive activation of the NFkB linked to the ability of ESE1 to induce p50 transcription and NFkB nuclear translocation. These data show an important oncogenic role of ESE1 in prostate tumors and reveal a previously unidentified link between this ETS factor and the NFkB pathway.

Citation Format: Nicole Longoni, Maurizia Mello-Grand, Manuela Sarti, Sandra Pinton, Cecilia Dallavalle, Giovanna Chiorino, Carlo V. Catapano, Giuseppina M. Carbone. The ETS transcription factor ESE1 promotes activation of the NFKB pathway in prostate tumors [abstract]. In: Proceedings of the AACR Special Conference on Advances in Prostate Cancer Research; 2012 Feb 6-9; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(4 Suppl):Abstract nr B25.

Cytogenetic observations in human peripheral blood leukocytes following in vitro exposure to THz radiation: a pilot study

Emerging technologies are considering the possible use of Terahertz radiation in different fields ranging from telecommunications to biology and biomedicine. The study of the potential effects of Terahertz radiation on biological systems is therefore an important issue in order to safely develop a variety of applications. This paper describes a pilot study devoted to determine if Terahertz radiation could induce genotoxic effects in human peripheral blood leukocytes. For this purpose, human whole blood samples from healthy donors were exposed for 20 min to Terahertz radiation. Since, to our knowledge, this is the first study devoted to the evaluation of possible genotoxic effects of such radiation, different electromagnetic conditions were considered. In particular, the frequencies of 120 and 130 GHz were chosen: the first one was tested at a specific absorption rate (SAR) of 0.4 mW g-1, while the second one was tested at SAR levels of 0.24, 1.4, and 2 mW g-1. Chromosomal damage was evaluated by means of the cytokinesis block micronucleus technique, which also gives information on cell cycle kinetics. Moreover, human whole blood samples exposed to 130 GHz at SAR levels of 1.4 and 2 mW g-1 were also tested for primary DNA damage by applying the alkaline comet assay immediately after exposure. The results obtained indicate that THz exposure, in the explored electromagnetic conditions, is not able to induce either genotoxicity or alteration of cell cycle kinetics in human blood cells from healthy subjects.

Effects on apoptosis and reactive oxygen species formation by Jurkat cells exposed to 50 Hz electromagnetic fields

The effect of exposure to 50 Hz electromagnetic field on a human T-leukaemia cell line (Jurkat) was investigated by evaluating the reactive oxygen species (ROS) production and apoptosis, both spontaneous and induced by a specific anti Fas/CD95 monoclonal antibody (anti-Fas). Our results suggest that 1 h intermittent (5 min field on/10 min field off) exposure does not affect ROS formation, while a slight but statistically significant decrease of both spontaneous and anti-Fas-induced apoptosis was observed.

Short- and long-term effects of a dietary yeast beta-glucan (Macrogard) and alginic acid (Ergosan) preparation on immune response in sea bass (Dicentrarchus labrax)

The present study investigated the immunomodulatory activity of Ergosan, an algal extract containing alginic acid, and Macrogard, a yeast extract containing beta-glucans, on innate and specific immunity in sea bass (Dicentrarchus labrax). Four cycles of experimental feeding using normal fish feed formulation (control group) supplemented with Ergosan (0.5%) or Macrogard (0.1%) were performed at 60-day intervals (15 days of treatment+45 days of suspension). Serum complement, lysozyme, total proteins and heat shock protein (HSP) concentrations were measured at 15, 30 and 45 days from the end of the first 15-day feeding cycle (short term) and 45 days after the end of each feeding cycle over a 35-week period (long term). The percentage of B- and T-lymphocytes in peripheral blood leucocytes and gut were measured over long-term trial. Significant elevation (P < 0.05) in serum complement activity occurred in sea bass fed with alginic acid and glucans, at 15 days from the end of first cycle of treatment. Significant elevation (P < 0.05) in serum lysozyme, gill and liver HSP concentration were observed in the same experimental groups at 30 days from the end of treatment, whereas a significant increase (P < 0.05) of complement activity was only observed in fish that received an Ergosan diet. At 45 days from the end of treatment, complement, lysozyme and HSP concentration did not differ among groups. Over the long-term period, no significant differences were observed in innate and specific immune parameters, survival, growth performances and conversion index in treated and control fish. A dramatic decrease of both innate and acquired immune parameters was observed during the winter season in all groups, followed by a partial recovery when water temperature increased. Reduction in complement and lysozyme activities was significatively correlated (p < 0.01) to water temperature variation. The results suggested the potential of alginic acid and beta-glucans to activate some innate immune responses in sea bass, and particularly under conditions of immunodepression related to environmental stress.

Therapy of human pancreatic carcinoma based on suppression of HMGA1 protein synthesis in preclinical models

Pancreatic carcinoma is one of the most aggressive tumors, and, being refractory to conventional therapies, is an excellent target for new therapeutic approaches. Based on our previous finding of high HMGA1 expression in pancreatic cancer cells compared to normal pancreatic tissue, we evaluated whether suppression of HMGA1 protein expression could be a treatment option for patients affected by pancreatic cancer. Here we report that HMGA1 proteins are overexpressed in pancreatic carcinoma cell lines, and their downregulation through an adenovirus carrying the HMGA1 gene in an antisense orientation (Ad Yas-GFP) results in the death of three human pancreatic carcinoma cell lines (PANC1, Hs766T and PSN1). Pretreatment of PANC1 and PSN1 cells with Ad Yas-GFP suppressed and reduced, respectively, their ability to form xenograft tumors in nude mice. To further verify the role of HMGA1 in pancreatic tumorigenesis, we used a HMGA1 antisense phosphorothioate oligodeoxynucleotide (ODN); its addition induced a decrease in HMGA1 protein levels and a significant reduction of the proliferation rate of PANC1-, Hs766T- and PSN1-treated cells. Therefore, suppression of HMGA1 protein synthesis by an HMGA1 antisense approach seems to be a feasible treatment strategy in pancreatic carcinomas.

Adenoviral transduction of TESTIN gene into breast and uterine cancer cell lines promotes apoptosis and tumor reduction in vivo

PURPOSE

The human TESTIN (TES) gene is a putative tumor suppressor gene in the fragile chromosomal region FRA7G at 7q31.1/2 that was reported to be altered in leukemia and lymphoma cell lines. In this report, we investigated the effect of TES gene expression in vivo to evaluate a possible role of TES gene in human cancer.

EXPERIMENTAL DESIGN

We have analyzed the expression of TES gene in a panel of 25 breast tumors and 17 cell lines of breast, colon, and uterine cancers. Furthermore, to evaluate the potential of TES gene therapy, we studied the effects of adenoviral TES transduction (Ad-TES) in cell lines with undetectable TES expression (T47D and MES-SA) as well as in MCF-7 cell line where TES expression is normal.

RESULTS

Twenty-five percent of primary breast tumor samples as well as the breast cancer cell line T47D and the uterine sarcoma cell line MES-SA were negative or displayed low levels of TES. After TES restoration by Ad-TES transduction, T47D and MES-SA cell lines underwent apoptosis. Furthermore, TES expression significantly reduced the tumorigenic potential of both T47D and MES-SA in nude mice, whereas the untreated cells and Ad-GFP-infected cells showed tumor growth in vivo. The TES-positive cell line control (MCF-7) was not affected by TES expression and did not show a reduction of tumorigenicity in nude mice after infection with Ad-TES.

CONCLUSIONS

Ad-TES expression inhibit the growth of breast and uterine cancer cells lacking of TES expression through caspase-dependent and caspase-independent apoptosis, respectively, suggesting that Ad-TES infection should be explored as a therapeutic strategy.

Adenoviral Transduction of TESTIN Gene into Breast and Uterine Cancer Cell Lines Promotes Apoptosis and Tumor Reduction In vivo

Purpose: The human TESTIN (TES) gene is a putative tumor suppressor gene in the fragile chromosomal region FRA7G at 7q31.1/2 that was reported to be altered in leukemia and lymphoma cell lines. In this report, we investigated the effect of TES gene expression in vivo to evaluate a possible role of TES gene in human cancer.

Experimental Design: We have analyzed the expression of TES gene in a panel of 25 breast tumors and 17 cell lines of breast, colon, and uterine cancers. Furthermore, to evaluate the potential of TES gene therapy, we studied the effects of adenoviral TES transduction (Ad-TES) in cell lines with undetectable TES expression (T47D and MES-SA) as well as in MCF-7 cell line where TES expression is normal.

Results: Twenty-five percent of primary breast tumor samples as well as the breast cancer cell line T47D and the uterine sarcoma cell line MES-SA were negative or displayed low levels of TES. After TES restoration by Ad-TES transduction, T47D and MES-SA cell lines underwent apoptosis. Furthermore, TES expression significantly reduced the tumorigenic potential of both T47D and MES-SA in nude mice, whereas the untreated cells and Ad-GFP-infected cells showed tumor growth in vivo. The TES-positive cell line control (MCF-7) was not affected by TES expression and did not show a reduction of tumorigenicity in nude mice after infection with Ad-TES.

Conclusions: Ad-TES expression inhibit the growth of breast and uterine cancer cells lacking of TES expression through caspase-dependent and caspase-independent apoptosis, respectively, suggesting that Ad-TES infection should be explored as a therapeutic strategy.

Alterations of the tumor suppressor gene Parkin in non-small cell lung cancer

PURPOSE

Parkin, a gene mutated in autosomal recessive juvenile Parkinsonism and mapped to the common fragile site FRA6E on human chromosome 6q25-q27, is associated with a frequent loss of heterozygosity and altered expression in breast and ovarian carcinomas. In addition, homozygous deletions of exon 2 creating deleterious truncations of the Parkin transcript were observed in the lung adenocarcinoma cell lines Calu-3 and H-1573, suggesting that the loss of this locus and the resulting changes in its expression are involved in the development of these tumors.

EXPERIMENTAL DESIGN

We examined 20 paired normal and non-small cell lung cancer samples for the presence of Parkin alterations in the coding sequence and changes in gene expression. We also restored gene expression in the Parkin-deficient lung carcinoma cell line H460 by use of a recombinant lentivirus containing the wild-type Parkin cDNA.

RESULTS

Loss of heterozygosity analysis identified a common region of loss in the Parkin/FRA6E locus with the highest frequency for the intragenic marker D6S1599 (45%), and semi-quantitative reverse transcription-PCR revealed reduced expression in 3 of 9 (33%) lung tumors. Although we did not observe any in vitro changes in cell proliferation or cell cycle, ectopic Parkin expression had the ability to reduce in vivo tumorigenicity in nude mice.

CONCLUSION

These data suggest that Parkin is a tumor suppressor gene whose inactivation may play an important role in non-small cell lung cancer tumorigenesis.

Hepatitis C virus infection: prevalence, predictor variables and prevention opportunities among drug users in Italy

The study assessed rates and predictor variables of hepatitis C virus (HCV) infection among drug users receiving pharmacological treatment for opiates addiction. There was a large cohort study in 16 public centres for drug users in north-eastern Italy, with data collected by standardized face-to-face interviews between February 2001 and August 2001. Of 1095 participants, 74.2% were HCV seropositive. Anti-HCV status was independently associated with duration of drug use of over 10 years, injecting as a route of drug administration, and hepatitis B virus (HBV) and human immunodeficiency virus (HIV) seropositivity. Further statistical analysis was conducted by dividing the subjects on the basis of the duration of heroin use: more or <10 years. In the multivariate analyses, route of drug administration and HBV status were associated with HCV seropositivity among both groups. Less education was associated with HCV among the shorter term drug users. HIV status and having a sexual partner with a history of drug use were associated with HCV seropositivity among the longer term drug users. Half of the short-term heroin users were still HCV seronegative when starting treatment, suggesting opportunities for reducing new HCV infections. Remarkable was the relationship between vaccination for hepatitis B and HCV serostatus. Being HBV seropositive was strongly associated with being HCV seropositive. But heroin users who had been vaccinated for HBV were not significantly more likely to be HCV seropositive than heroin users who were HBV seronegative. HBV vaccination does not provide biological protection against HCV; however, vaccinating heroin users against HBV may help to create a stronger pro-health attitude among heroin users, leading to a reduction in HCV risk behaviour.

Regression of upper gastric cancer in mice by FHIT gene delivery

Fhit expression is reduced in most cancers, and Fhit replacement by FHIT expression viruses in lung, esophageal, pancreatic, and cervical cancers induces apoptosis in the cancer cells. Mice carrying one or two inactivated Fhit alleles are hypersensitive to development of N-nitrosomethylbenzylamine (NMBA)-induced forestomach tumors. In the present study, we investigated the kinetics and mechanism of tumor reversal and intervention by oral delivery of FHIT expression viruses. Tumor analysis showed that: a) by 37 days post-NMBA, control mice showed approximately 7 tumors and by 84 days approximately 10 tumors/forestomach; b) mice receiving FHIT virus at 2 or 42 days post-NMBA showed significantly reduced tumor burdens; c) Fhit was still expressed at 82 days postinfection; d) control viral infection had no effect on tumor development; and e) reduced Bcl2, increased Bax expression, and increased TUNEL-positive apoptotic nuclei characterized the restored epithelia of FHIT transduced forestomachs. Thus, FHIT viral gene delivery prevents or retards development of carcinogen-induced forestomach tumors and reverses development of established tumors by 60-70% through an apoptotic pathway. This dramatic reduction in tumor burden emphasizes the efficacy of targeting the FHIT apoptotic pathway for tumor eradication.

Restoration of fragile histidine triad (FHIT) expression induces apoptosis and suppresses tumorigenicity in breast cancer cell lines

The fragile histidine triad (FHIT) gene at chromosome 3p14.2 is a tumor suppressor gene that is altered mainly by deletion in a large fraction of human tumors, including breast cancers. To evaluate the potential of FHIT gene therapy in this type of cancer, we have studied the biological effects of adenoviral FHIT transduction (Ad-FHIT) in breast cancer cell lines. The results showed that, after FHIT restoration in BT-549, MDA-MB-436, and HCC1806 cells, they underwent apoptosis by activation of the intrinsic pathway. In all three cell lines infected with Ad-FHIT, we have found activation of caspase-2, which is required for permeabilization of mitochondria, release of cytochrome c, and apoptosis. Furthermore, Fhit overexpression produces alteration in cell cycling properties, as well as reduction of the tumorigenic potential in nude mice.

Simultaneous paired analysis of numerical chromosomal aberrations and DNA content in osteosarcoma

Relatively little is known about the biologic relevance of numerical chromosomal changes in relation to DNA content in osteosarcoma. In this study, by using a series of human osteosarcoma cell lines, we standardized a method for the assessment, on the same nuclei specimen, of both specific chromosome copy numbers by fluorescence in situ hybridization (FISH) and the DNA content by static cytofluorometry or image cytometry. On the same cell lines, we also evaluated the DNA content by using flow cytometry and the chromosome number distribution by metaphase analysis. Comparison between these different methods showed that DNA ploidy level as determined by FISH or metaphase analysis is frequently lower than the ploidy pattern as defined by cytometric methods. By using comparative genomic hybridization, we were able to demonstrate that these discrepancies were due to the presence of several unbalanced chromosome aberrations, specifically gains and high-level amplifications, which affect the total DNA content with less effect on the total chromosome number. Thus, evaluation of DNA ploidy in osteosarcoma cells is needed for a correct interpretation of FISH or cytogenetic data concerning numerical chromosomal changes. Evaluation of tumor ploidy in a series of clinical samples demonstrated that in high-grade osteosarcoma, flow cytometry sometimes may give false results because of the presence of high proportions of contaminating, nonneoplastic cells that cannot be excluded from the flow cytometric assessment but that do not interfere with the evaluation of DNA ploidy by static cytofluorometry or image cytometry, in which only tumor cells are selected for the analysis. The possibility of using this method to evaluate, on the same nuclei sample, both specific chromosomal aberrations and DNA ploidy may allow a better determination of numerical chromosomal changes that may be relevant for the biologic behavior of osteosarcoma.

Biomarker prediction of clinical outcome in operable breast cancer patients treated with tamoxifen

The predictivity of tumour size, oestrogen (ER) and progesterone (PgR) receptors, 3H-thymidine labelling index (TLI), c-erbB-2 and p27kip1 expression on clinical outcome was analysed on a consecutive series of 118 postmenopausal patients with ER-positive, node-positive tumours. All patients were treated with surgery +/- radiotherapy and adjuvant tamoxifen (30 mg/day) for at least 2 years. TLI, ER, c-erbB-2 and p27kip1 were generally unrelated to each other. PgR was directly related to ER and inversely to c-erbB-2. Tumour size was inversely related to both c-erbB-2 and p27kip1 expression. At a median follow-up of 75 months, 5-year relapse-free survival was significantly lower for patients with very rapidly proliferating (HR = 2.61, 95% CI = 1.34-5.08), PgR negative (HR = 2.76, 95% CI = 1.43-5.33) or relatively low ER content (HR = 2.20, 95% CI = 1.14-4.25) tumours than for patients with tumours expressing the opposite biological profiles. Overall survival was also significantly different as a function of TLI (HR = 3.47, 95% CI = 1.52-7.93) and PgR (HR = 2.27, 95% CI = 1.00-5.15). TLI and PgR maintained an independent relevance in multivariate analysis and together were capable of identifying subgroups of patients at significantly different risk of relapse and death.

The receptor-associated protein (RAP) interacts with several resident proteins of the endoplasmic reticulum including a glycoprotein related to actin

The receptor-associated protein (RAP) is a chaperone found primarily in the endoplasmic reticulum (ER) that plays a necessary role in the folding and exocytic trafficking of members of the LDL receptor gene family including megalin and the LDL receptor-related protein (LRP). Recently, RAP has been shown to interact with a growing number of proteins including several that are unrelated to the LDL receptor family as well as new members of this rapidly expanding family. Based on these observations, we have applied chemical crosslinking procedures to identify additional novel RAP-interacting proteins, and thereby better characterize the scope of RAP's ER-related function. In this study, we have identified eight proteins with molecular weights of 32, 35, 46, 55, 70, 95, 170, and 200 kDa that interact with endogenous RAP. These proteins were found to associate with RAP in multiple cell types from different species, suggesting that their expression and interactions with RAP are ubiquitous. Results of pulse-chase experiments show that most of the proteins remain sensitive to endoglycosidase-H digestion, and also remain stably associated with RAP over an extended period, suggesting that they are ER resident proteins. All of the RAP-associated proteins appear to be largely soluble as they partition into the aqueous phase following TX-114 detergent extraction. Sequence analysis and immunoblotting of the 46-kDa RAP-associated glycoprotein (gp46) shows that it is structurally and immunologically related to actin. If gp46 is also functionally related to actin as an intracellular structural protein, it may represent a novel component of the putative ER matrix.

Long-term follow-up for patients with Ewing's sarcoma of bone treated with adjuvant and neoadjuvant chemotherapy

The long-term results obtained in 252 patients with non-metastatic Ewing's sarcoma of bone treated between March 1972 and June 1988 according to three sequential protocols of treatment were evaluated. Primary tumor was treated with radiotherapy in 125 cases, with surgery in 52 and with surgical resection followed by radiotherapy in 75. In the first protocol (REA 1; 1972-78) chemotherapy was performed with a 3-drug regimen (VCR, CPM, ADM), whereas in the REA 2 protocol (1979-82) and in the REN 1 protocol (1983-88) a 4-drug regimen was used (VCR, CPM, ADM, ACTD). Chemotherapy was delivered as adjuvant treatment in REA 1 and 2, and as neoadjuvant in the last study. At a mean follow-up of 14.8 years, with the 95% of patients with a minimum FU of 10 years, 101 pts (40%) remained continuously free of disease, 144 patients relapsed, two patients died of adriamycin cardiotoxicity and 5 patients developed a second neoplasm. 6% of the patients relapsed 5 or more years after the diagnosis with the latest recurrence registered at the tenth year. Type of local treatment, LDH serum level, chemotherapy protocol and sex were predictive factors of DFS after a multivariate analysis. The possibility of late relapse in Ewing's sarcoma has been confirmed by our retrospective study and for patients with Ewing's sarcoma, a 10-year follow up should be recommended.

Insulin-like growth factor I receptor-mediated circuit in Ewing's sarcoma/peripheral neuroectodermal tumor: a possible therapeutic target

The disappointingly low survival rate observed in Ewing's sarcoma (ES)/peripheral neuroectodermal tumor (PNET) despite the adoption of aggressive multimodal treatments prompted us to study the existence of autocrine circuits to be used as innovative therapeutic targets. Of the several circuits analyzed, only the insulin-like growth factor receptor (IGF-IR)-mediated loop was found to be constantly present both in cell lines and clinical samples, suggesting a role for this autocrine circuit in the pathogenesis of ES/PNET. The in vitro inhibition of the IGF-IR-mediated circuit by the specific IGF-IR binding antibody alphaIR3 suppressed the growth of ES/PNET cells by decreasing the proliferative rate and increasing apoptosis. alphaIR3 also significantly inhibited the ability of ES/PNET cells to grow in soft agar and to migrate following a chemotactic stimulus. Inactivation of the IGF-IR signaling pathway may therefore be considered as an effective therapeutic modality for patients with ES/PNET.

[Quality assurance in radiology: quality control of radiographic cassettes]

A "quality team" in radiology, whose members are the authors of this paper, has implemented a quality control program to test the cassettes with intensifying screen systems used in radiology departments. 149 systems-124 of them for general purpose radiology and 25 for mammography-were submitted to the following tests: visual inspection of radiographic cassettes and intensifying screens, screen-film contact, intensifying screen cleanliness and relative sensitivity of the intensifying screens. The results of each type of test are reported in detail in the paper, on a 3-point scale: good, sufficient and poor. The overall results of the quality control tests show 78% of general purpose radiology cassettes to qualify as good (69%) or sufficient (9%), while 22% were of poor quality. 88% of the mammographic cassettes qualified as good (76%) or sufficient (12%), while 12% were of poor quality. All tests were easy to perform and required limited resources. The necessary procedures to keep quality high over time are also reported. To conclude, the results obtained with our quality control program could be used as an effective tool to address and plan the turnover of the cassettes with intensifying screens which are usually used in diagnostic radiology practice.

Value of immunohistochemical detection of noncollagenous proteins of bone for the diagnosis of bone tumours

The expression of osteonectin, osteopontin, bone sialoprotein, and osteocalcin was evaluated by immunohistochemistry in 57 cases of osteoid-forming and non-osteoid-forming bone tumours using specific polyclonal antibodies and the avidin-biotin peroxidase complex method. A positive immunostaining was found in all of the osteoid-forming rumours (osteoblastoma and osteosarcoma), both in the cells and in the extracellular matrix. Among non-osteoid-forming tumours, immunoreactivity to noncollagenous proteins was present in the cells but not in the matrix of chondrosarcoma, malignant fibrous histiocytoma, and fibrosarcoma, as well as in the mononuclear component of giant-cell rumours. Contrary to small-cell osteosarcoma, Ewing's sarcoma was always negative for all of the noncollagenous proteins considered. These results suggest that the immunohistochemical evaluation of noncollagenous proteins of bone may be a useful tool for the differential diagnosis of bone neoplasms, particularly among the heterogeneous group of small round cell tumours.