Mitral and tricuspid annular abnormalities in hypereosinophilic syndrome – a three-dimensional speckle-tracking echocardiographic study

Introduction

Peripheral eosinophilia with absolute eosinophil count more than 1.500 cells/uL and eosinophilic tissue and end-organ damage are typical features in hypereosinophilic syndrome. In the present study it was hypothesized that hypereosinophilic syndrome-related atrial and ventricular abnormalities are associated with changes in size and function of mitral and/or tricuspid annuli.

Methods

The study comprised 17 patients with hypereosinophilic syndrome who were recruited, prospectively, 2 patients had to be excluded due to suboptimal image quality (mean age: 61.7±11.2 years, 10 males). The control group consisted of 24 healthy volunteers (mean age: 55.2±7.9 years, 12 males). Complete two-dimensional Doppler echocardiography was performed, mitral and tricuspid annuli were measured by three-dimensional speckle-tracking echocardiography.

Results

Only interventricular septum proved to be significantly thickened in patients with hypereosinophilic syndrome, other parameters did not differ between the groups examined. Increased end-diastolic and end-systolic mitral annular diameter (2.6±0.3 cm vs. 2.4±0.3 cm, p<0.05 and 2.2±0.2 cm vs. 1.7±0.3 cm, p<0.05, respectively), area (9.5±2.3 cm2 vs. 7.5±1.9 cm2, p<0.05 and 6.7±2.0 cm2 vs. 3.8±1.1 cm2, p<0.05, respectively), and perimeter (11.6±1.7 cm vs. 10.4±1.3 cm, p<0.05 and 9.9±1.9 cm vs. 7.4±1.1 cm, p<0.05, respectively) together with reduced mitral annular fractional area change (29.6±13.0% vs. 47.7±15.8%, p<0.05) and fractional shortening (16.6±11.9% vs. 28.9±12.7%, p<0.05) could be detected in patients with hypereosinophilic syndrome as compared to that of matched controls. From tricuspid annular morphological parameters, only end-diastolic tricuspid annular area (9.1±2.4 cm2 vs. 7.5±1.9 cm2, p<0.05) and end-systolic tricuspid annular perimeter (9.9±1.2 cm vs. 9.3±1.4 cm, p<0.05) proved to be significantly increased in patients with hypereosinophilic syndrome as compared to controls with preserved tricuspid annular functional parameters.

Conclusion

Mitral annular dilation is more pronounced compared to that of tricuspid annulus in hypereosinophilic syndrome. Mitral annular functional impairment is present in hypereosinophilic syndrome.

Funding Acknowledgement

Type of funding sources: None.

The tricuspid annulus in cardiac amyloidosis – a three-dimensional speckle-tracking echocardiographic study

Introduction

Amyloidosis is a rare condition due to extracellular deposition of excessive amount of protein in parenchymal tissues including the heart. The present study aimed to test whether cardiac amyloidosis (CA) is associated with morphological and functional abnormalities of the tricuspid annulus (TA). For this aim, the results of patients having CA were compared to age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography (3DSTE). Moreover, differences in TA parameters between light-chain CA (AL-CA) and transthyretin CA (TTR-CA) were studied as well.

Methods

The study comprised 27 CA patients (mean age: 62.7±9.1 years, 21 males), their results were compared to those of 20 age- and gender-matched healthy volunteers (59.3±3.8 years, 13 males). Current consensus criteria were used for the definition of CA. Biopsy was carried out in all patients to confirm the diagnosis of CA. The first positive biopsy site was the myocardium in 7 cases, bone marrow in 6 cases, duodenum and rectum in 5 cases, salivary gland in 1 case, skin and subcutaneous tissue in 2 cases and kidney in 10 cases in the CA patients. In 5 CA patients, biopsy samples were collected from more than one organ. CA proved to be AL-CA in 21 subjects and TTR-CA in 6 patients. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all CA patients and controls.

Results

CA patients had significantly higher left atrial diameter, left ventricular (LV) end-diastolic diameter, thicker interventricular septum and LV posterior wall and increased E/A ratio compared to the results of healthy controls. None of the 27 CA patients and their matched controls had atrial fibrillation in their medical history. Dilated 3DSTE-derived end-diastolic and end-systolic TA diameter (3.0±0.6 cm vs. 2.1±0.2 cm, p<0.05 and 2.6±0.6 cm vs. 1.6±0.2 cm, p<0.05, respectively), area (10.7±3.5 cm2 vs. 6.1±1.1 cm2, p<0.05 and 8.0±3.2 cm2 vs. 4.1±1.0 cm2, p<0.05, respectively) and perimeter (12.5±2.0 cm vs. 9.8±1.0 cm, p<0.05 and 10.6±2.1 cm vs. 8.0±1.0 cm, p<0.05, respectively) could be detected in all CA patients and in the AL-CA and TTR-CA subgroups, as well. Although only a few TTR-CA patients were involved, morphologic TA parameters proved to be tendentiously higher as compared to those of AL-CA patients. Functional parameters of TA represented by TA fractional area change (TAFAC, 26.1±11.2% vs. 32.0±11.1%, p=0.07) and TA fractional shortening (TAFS, 12.8±10.3% vs. 21.6±7.4%, p<0.05) were found to be reduced in CA patients, which were more enhanced in TTR-CA patients (TAFAC for TTR-CA: 27.1±14.3% vs. TAFAC for AL-CA:25.7±10.5%, p=ns; TAFS for TTR-CA: 16.0±9.8% vs. TAFS for AL-CA: 11.9±10.4%, p=ns).

Conclusions

Dilated TA is associated with its functional deterioration in CA. Patients with TTR-CA have tendentiously more dilated TA with more enhanced TA functional parameters.

Funding Acknowledgement

Type of funding sources: None.

P333 Left ventricular rotational abnormalities in hypereosinophilic syndrome as assessed by three-dimensional speckle-tracking echocardiography

Introduction

Hypereosinophilic syndrome (HES) is a very heterogeneous group of disorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end-organ damage. In the present study, the ability of a novel non-invasive clinical tool, three-dimensional speckle-tracking echocardiography (3DSTE) was investigated to reveal any change in left ventricular (LV) rotational mechanics in clinically asymptomatic HES patients without manifest organ damage as determined by conventional diagnostic methods.

Methods

The present study comprised 13 patients established diagnosis of HES. However, one patient with idiopathic HES has been excluded due to insufficient image quality. The remaining patient population contained 11 cases with idiopathic HES and one patient with acute T-lymphoma associated HES (mean age: 59.7 ± 13.7 years, 8 males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). All HES patients and controls underwent complete two-dimensional Doppler echocardiography and 3DSTE.

Results

Both LV apical rotation (4.86 ± 1.92 degree vs. 10.07 ± 3.92 degree, p < 0.0001) and LV twist (8.52 ± 2.79 degree vs. 14.41 ± 4.26 degree, p < 0.0001) showed significant deteriotations in most of HES patients. In 2 subjects absence of LV twist called as LV „rigid body rotation’ (RBR) was detected. One patient had 1.77 degree counterclockwise (abnormally directed) LV basal rotation and 14.29 degree counterclockwise (normally directed) LV apical rotation resulting in 12.59 degree LV apico-basal gradient. The other patient had normally directed -2.09 degree LV basal rotation and almost zero (-0.27 degree) LV apical rotation resulting in 1.82 degree LV apico-basal gradient.

Conclusions

Reduced LV apical rotation and twist could be demonstrated in HES. LV-RBR could be detected in some HES patients.

A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts

Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m². More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.

Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long term follow-up results

Determining the viability of residual tumor masses is a great challenge after primary treatment of Hodgkin lymphoma. FDG-PET may play a crucial role in this procedure. In this study, files of 128 Hodgkin lymphoma patients were reviewed, who were treated in three Hungarian hematology centers between January 1995 and February 2005. CT scan showed residual tumor mass by all of them. Their median follow-up was 75.5 months from PET examination. The number of true-positive, true-negative, false-positive, false-negative subjects were 29, 83, 10, 6, respectively. Sensitivity of post-treatment FDG-PET was 83 %, specificity 93 %, positive predictive value 74 %, negative predictive value 93 %, and accuracy 88 %. The difference between the event free survival of PET positive and negative cases is highly significant (p=0.0000), according to the Mantel-Cox test. Our results in the largest cohort of patients, in accordance with literature, clearly indicates that patients with negative FDG-PET results are unlikely to progress or relapse during the longest follow-up.

Current State and Perspectives of Dendritic Cell Vaccination in Cancer Immunotherapy

Recent progress in the approach towards immunotherapy of cancer consists in molecular definition of tumor antigens, new tools for phenotypical and functional characterization of tumor-specific effector cells and clinical use of novel adjuvants for optimal stimulation of a cancer-specific immune response such as dendritic cells. In spite of these advances and immunological as well as clinical responses in selected patients, mechanisms involved in dendritic-cell-based cancer immunotherapy are still poorly understood. Therefore, a standardized study design and small pilot trials are needed to explore open scientific questions in future clinical trials. This review focuses on the different parameters of dendritic cell biology relevant to cancer immunotherapy and on innovative approaches to hopefully enhance the efficacy of dendritic cell vaccination.

Interleukin 4 down-regulates expression of c-kit and autocrine stem cell factor in human colorectal carcinoma cells

Stem cell factor (SCF) is a cytokine which plays an important role in the development of precursor cells. We have investigated the expression of SCF and its receptor, the c-kit proto-oncogene, in human colorectal carcinoma cell lines. Using reverse transcription-PCR, we confirmed the expression of c-kit in two lines (LS174T and LS1034) and of SCF in 9 of 11 cell lines tested. In a Northern blot, a single transcript of 6.6 kb was detected for SCF mRNA. In addition, two lines (LS174T and HT29) synthesized SCF protein, as detected by Western blot analysis. SCF stimulated proliferation and colony formation of LS174T in a dose-dependent manner up to 160%. A half-maximal effect was obtained with about 5.5 ng/ml of SCF under both growth conditions. LS174T cells expressed the M(r) 145,000 c-kit protein on the cell surface and a neutralizing anti-c-kit mAb inhibited colony formation of LS174T by 40%. Interleukin 4 (IL-4) completely inhibited SCF-induced proliferation of LS174T cells. Interestingly, IL-4 induced an almost complete down-regulation of both c-kit and SCF expression in LS174T. Our findings suggest that in LS174T cells, an SCF-mediated autocrine loop is functional and that IL-4 down-regulates the expression of both the receptor and the ligand of this circuit.

Growth inhibition of human colorectal-carcinoma cells by interleukin-4 and expression of functional interleukin-4 receptors

The growth-inhibitory effect of interleukin-4 (IL-4) was investigated in a panel of 7 human colorectal-carcinoma cell lines. In 5 cell lines (HT29, WiDr, LS411N, LS513, LS1034) a dose-dependent reduction of proliferation was documented. At 100 U/ml, IL-4 inhibited thymidine incorporation between 45 and 75% and MTT conversion (26 to 41%). The ability of LS513 and WiDr cells to form colonies after IL-4 treatment was reduced by 85 and 62% respectively. LS513 was the most sensitive cell line, with IL-4 inducing half-maximal inhibition at 5 to 6 U/ml. The inhibitory effect of IL-4 was completely neutralized by anti-IL-4 antibodies. Northern-blot analysis revealed the presence of IL-4-receptor (IL-4R) mRNA in all cell lines. The membrane expression of the 130-kDa IL-4R was assessed by FACS, utilizing an anti-IL-4R monoclonal antibody and was confirmed by biotinylated IL-4 binding. Our results attribute an important role for IL-4 as a negative regulator of colorectal-carcinoma cell growth, thus indicating a possible avenue for intervention in this disease.

Malignant progression of SV40-immortalised human milk epithelial cells

A human breast epithelial cell line (Hu-MI), established by microinjecting SV40 DNA into human milk epithelial cells, exhibits the phenotype of luminal epithelial cells and is neither clonogenic nor tumorigenic. From this cell line we have selected two sublines, HuMI-T and HuMI-TTul, reflecting different stages of spontaneous transformation. HuMI-T cells grow anchorage-independently, but do not induce tumours in nude mice. HuMI-TTul cells are clonogenic as well as tumorigenic. Cells from both lines exhibit polymorphic structural and numerical chromosome aberrations. Immortalisation of normal luminal epithelial cells from human mammary gland with SV40 DNA alone may thus cause random genetic changes eventually resulting in tumorigenic cell lines. Since Hu-MI, HuMI-T and HuMI-TTul represent some of the consecutive stages taking place during cellular transformation, they are particularly suited as a novel in vitro model system to study progression of human breast cancer.