The effect of extracellular microenvironment on stemness and differentiation of Mesenchymal Stem Cells (MSC)

Le cellule staminali mesenchimali (MSC) impiegate nelle strategie di medicina rigenerativa sono state isolate da vari tessuti, quali midollo osseo, tessuto adiposo e polpa dentale. Le MSC sono elementi peculiari che contribuiscono al processo di guarigione ossea, sia direttamente poichè precurcosi degli osteoblasti o indirettamente, producendo citochine, fattori di crescita e modulando la vascolarizzazione e l’infiammazione. Pertanto, l’infusione di MSC rappresenta un potenziale approccio terapeutico per favorire la guarigione ossea. Tuttavia, il successo delle strategie rigenerative può essere influenzato da un microambiente sfavorevole. Lo scopo di questo studio è stato studiare come le caratteristiche fisico-chimiche del microambiente extracellulare, in particolare la tensione di ossigeno e l’acidosi extracellulare, possono modulare la staminalità e il potenziale osteogenico delle MSC. Abbiamo esaminato se l’ipossia prolungata influenzava il differenziamento osteogencio delle cellule staminali mesenchimali derivate dal tessuto adiposo (ASC). L’effetto della tensione di ossigeno è stato valutato sulla proliferazione cellulare, sugli antigeni di superficie, sull’espressione dei geni di staminalità e dell’osteogenesi, sulla deposizione di matrice minerale e sul rilascio dei fattori di crescita. Abbiamo dimostrato che l’ipossia aveva un duplice ruolo, promuoveva la proliferazione delle ASC in assenza di stimoli osteogenici, ma favoriva il differenziamento in presenza di fattori pro-osteogenici. Successivamente abbiamo valutato l’effetto di differenti livelli di pH extracellulare (6.5, 6.6, 7.1 e 7.4) sulla staminalità e il differenziamento osteogenico delle cellule staminali derivate dalla polpa dentale (DPSC). Abbiamo evidenziato che il microambiente acido promuoveva il fenotipo staminale delle DPSC. Inoltre, l’acidosi extracellulare riduceva significativamente la crescita cellulare favorendo lo stato quiescente G0 del ciclo cellulare. Infine, abbiamo dimostrato l’effetto inibitorio del pH acido sul potenziale osteogenico delle DPSC. Pertanto la modulazione delle variazioni della tensione di ossigeno e del pH extracellulare devono essere considerate quando le MSC rappresentano uno strumento terapeutico in campo ortopedico.Mesenchymal stem cells (MSC) have been isolated from various tissues, including bone marrow, adipose tissue, and dental pulp for regenerative strategies in orthopaedics and dentistry. MSC are critical elements that may contribute to bone healing, either directly as osteoblast precursors or indirectly by producing cytokines and growth factors, and by modulating vascularization and inflammation. The infusion of MSC therefore represents a valuable therapeutic approach to enhance bone healing. However, the success of regenerative strategy may be hampered by an unfavourable microenvironment. The aim of this study was to investigate how physicochemical characteristics of extracellular microenvironment, including oxygen tension and extracellular acidity, can modulate the stemness and the osteogenic potential of MSC. We first examined whether a prolonged exposure to hypoxia affects the osteogenic differentiation of adipose derived mesenchymal stem cells (ASC). The effect of oxygen tension was evaluated on cell proliferation, surface antigens, stemness gene and bone-related genes expression, alkaline phosphatase activity, mineral matrix deposition, and growth factor release. We demonstrated that hypoxia acts dually, promoting ASC proliferation and stemness in the absence of osteogenic stimuli, but also inducing their differentiation in a bone-like milieu. We subsequently investigated the effect of different levels of extracellular pH (6.5, 6.8, 7.1 and 7.4) on stemness and osteogenic differentiation of mesenchymal stem cells from dental pulp (DPSC). We were able to provide consistent evidence that an acidic microenvironment promotes the stemness state of DPSC. Moreover, extracellular acidosis significantly reduces cells growth, and push cells to reside in the quiescent G0 phase of the cell cycle. Finally, we demonstrated the inhibitory effect of acidic pH on the osteogenic potential of DPSC. Modulation of oxygen tension and extracellular pH variations must be considered when MSC are included as a therapeutic tool in bone-related applications

Tumor-activated mesenchymal stromal cells promote osteosarcoma stemness and migratory potential via IL-6 secretion

Osteosarcoma (OS) is an aggressive bone malignancy with a high relapse rate despite combined treatment with surgery and multiagent chemotherapy. As for other cancers, OS-associated microenvironment may contribute to tumor initiation, growth, and metastasis. We consider mesenchymal stromal cells (MSC) as a relevant cellular component of OS microenvironment, and have previously found that the interaction between MSC and tumor cells is bidirectional: tumor cells can modulate their peripheral environment that in turn becomes more favorable to tumor growth through metabolic reprogramming. Here, we determined the effects of MSC on OS stemness and migration, two major features associated with recurrence and chemoresistance. The presence of stromal cells enhanced the number of floating spheres enriched in cancer stem cells (CSC) of the OS cell population. Furthermore, the co-culturing with MSC stimulated the migratory capacity of OS via TGF\u3b21 and IL-6 secretion, and the neutralizing antibody anti-IL-6 impaired this effect. Thus, stromal cells in combination with OS spheres exploit a vicious cycle where the presence of CSC stimulates mesenchymal cytokine secretion, which in turn increases stemness, proliferation, migration, and metastatic potential of CSC, also through the increase of expression of adhesion molecules like ICAM-1. Altogether, our data corroborate the concept that a comprehensive knowledge of the interplay between tumor and stroma that also includes the stem-like fraction of tumor cells is needed to develop novel and effective anti-cancer therapies

Antitumoral effects of attenuated Listeria monocytogenes in a genetically engineered mouse model of melanoma

Attenuated Listeria monocytogenes (Lmat-LLO) represents a valuable anticancer vaccine and drug delivery platform. Here we show that in vitro Lmat-LLO causes ROS production and, in turn, apoptotic killing of a wide variety of melanoma cells, irrespectively of their stage, mutational status, sensitivity to BRAF inhibitors or degree of stemness. We also show that, when administered in the therapeutic setting to Braf/Pten genetically engineered mice, Lmat-LLO causes a strong decrease in the size and volume of primary melanoma tumors, as well as a reduction of the metastatic burden. At the molecular level, we confirm that the anti-melanoma activity exerted in vivo by Lmat-LLO depends also on its ability to potentiate the immune response of the organism against the infected tumor. Our data pave the way to the preclinical testing of listeria-based immunotherapeutic strategies against metastatic melanoma, using a genetically engineered mouse rather than xenograft models

Integrated Antitumor Activities of Cellular Immunotherapy with CIK Lymphocytes and Interferons against KIT/PDGFRA Wild Type GIST

: Gastrointestinal stromal tumors (GISTs) are rare, mesenchymal tumors of the gastrointestinal tract, characterized by either KIT or PDGFRA mutation in about 85% of cases. KIT/PDGFRA wild type gastrointestinal stromal tumors (wtGIST) account for the remaining 15% of GIST and represent an unmet medical need: their prevalence and potential medical vulnerabilities are not completely defined, and effective therapeutic strategies are still lacking. In this study we set a patient-derived preclinical model of wtGIST to investigate their phenotypic features, along with their susceptibility to cellular immunotherapy with cytokine-induced killer lymphocytes (CIK) and interferons (IFN). We generated 11 wtGIST primary cell lines (wtGISTc). The main CIK ligands (MIC A/B; ULBPs), along with PD-L1/2, were expressed by wtGISTc and the expression of HLA-I molecules was preserved. Patient-derived CIK were capable of intense killing in vitro against wtGISTc resistant to both imatinib and sunitinib. We found that CIK produce a high level of granzyme B, IFNα and IFNγ. CIK-conditioned supernatant was responsible for part of the observed tumoricidal effect, along with positive bystander modulatory activities enhancing the expression of PD-L1/2 and HLA-I molecules. IFNα, but not In, had direct antitumor effects on 50% (4/8) of TKI-resistant wtGISTc, positively correlated with the tumor expression of IFN receptors. wtGIST cells that survived IFNα were still sensitive to CIK immunotherapy. Our data support the exploration of CIK immunotherapy in clinical studies for TKI-resistant wtGIST, proposing reevaluation for IFNα within this challenging setting

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study

The relationship involving acid-base imbalance, mineral metabolism and bone health status has previously been reported but the efficacy of the alkalizing supplementation in targeting acid overload and preventing bone loss has not yet been fully elucidated. In this randomized, double-blind, placebo-controlled study, the hypothesis that potassium citrate (K citrate) modifies bone turnover in women with postmenopausal osteopenia was tested. Three hundred and ten women were screened; 40 women met the inclusion criteria and were randomly assigned to the treatment or the placebo group. They were treated with K citrate (30 mEq day−1) or a placebo in addition to calcium carbonate (500 mg day−1) and vitamin D (400 IU day−1). At baseline and time points of 3 and 6 months, serum indicators of renal function, electrolytes, calciotropic hormones, serum bone turnover markers (BTMs) (tartrate-resistant acid phosphatase 5b (TRACP5b), carboxy-terminal telopeptide of type I collagen (CTX), bone alkaline phosphatase (BAP), procollagen type 1 N terminal propeptide (PINP)), and urine pH, electrolytes, and citrate were measured. The follow-up was completed by 17/20 patients in the “K citrate” group and 18/20 patients in the “placebo” group. At baseline, 90% of the patients exhibited low potassium excretion in 24 h urine samples, and 85% of cases had at least one urine parameter associated with low-grade acidosis (low pH, low citrate excretion). After treatment, CTX and BAP decreased significantly in both groups, but subjects with evidence of low-grade acidosis gained significant benefits from the treatment compared to the placebo. In patients with low 24h-citrate excretion at baseline, a 30% mean decrease in BAP and CTX was observed at 6 months. A significant reduction was also evident when low citrate (BAP: −25%; CTX: −35%) and a low pH (BAP: −25%; CTX: −30%) were found in fasting-morning urine. In conclusion, our results suggested that K citrate supplementation improved the beneficial effects of calcium and vitamin D in osteopenic women with a documented potassium and citrate deficit, and a metabolic profile consistent with low-grade acidosis

Il concetto di missed nursing care: una revisione narrativa della letteratura

Descrivere il concetto e le conseguenze delle cure infermieristiche perse. Metodi. È stata condotta una revisione della letteratura su Medline, Trip Database, Cinahl, Cochrane, attraverso una prima ricerca con i termini Missed care, Missed Nursing care. Risultati. Le missed care sono qualsiasi intervento infermieristico necessario al paziente ma omesso completamente, parzialmente o rimandato. Le cause delle cure perse sono la carenza di risorse umane, di presidi/materiali e di comunicazione ma dipendono anche da come gli infermieri individuano le priorità e dai rapporti con gli operatori di supporto. Le cure perse possono essere misurate con il Misscare: quelle perse con maggiore frequenza sono la deambulazione, la mobilizzazione passiva, l’igiene e la cura del cavo orale. Conclusioni. Sarebbe utile verificare quanto questi interventi vengono omessi o solo posticipati e confrontare il fenomeno a livello internazionale, la sua variabilità in base al numero di infermieri e la relazione tra cure perse ed esiti sui pazienti