Generation of human memory stem T cells after haploidentical T-replete hematopoietic stem cell transplantation

Memory stem T cells (TSCM) have been proposed as key determinants of immunologic memory. However, their exact contribution to a mounting immune response, as well as the mechanisms and timing of their in vivo generation, are poorly understood. We longitudinally tracked TSCM dynamics in patients undergoing haploidentical hematopoietic stem cell transplantation (HSCT), thereby providing novel hints on the contribution of this subset to posttransplant immune reconstitution in humans. We found that donor-derived TSCM are highly enriched early after HSCT. We showed at the antigen-specific and clonal level that TSCM lymphocytes can differentiate directly from naive precursors infused within the graft and that the extent of TSCM generation might correlate with interleukin 7 serum levels. In vivo fate mapping through T-cell receptor sequencing allowed defining the in vivo differentiation landscapes of human naive T cells, supporting the notion that progenies of single naive cells embrace disparate fates in vivo and highlighting TSCM as relevant novel players in the diversification of immunological memory after allogeneic HSCT

Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells.

Haploidentical hematopoietic stem cell transplantation (HSCT) performed using bone marrow (BM) grafts and post-transplantation cyclophosphamide (PTCy) has gained much interest for the excellent toxicity profile after both reduced-intensity and myeloablative conditioning. We investigated, in a cohort of 40 high-risk hematological patients, the feasibility of peripheral blood stem cells grafts after a treosulfan-melphalan myeloablative conditioning, followed by a PTCy and sirolimus-based graft-versus-host disease (GVHD) prophylaxis (Sir-PTCy). Donor engraftment occurred in all patients, with full donor chimerism achieved by day 30. Post-HSCT recovery of lymphocyte subsets was broad and fast, with a median time to CD4 > 200/mu L of 41 days. Cumulative incidences of grade II to IV and III-IV acute GVHD were 15% and 7.5%, respectively, and were associated with a significant early increase in circulating regulatory T cells at day 15 after HSCT, with values < 5% being predictive of subsequent GVHD occurrence. The 1-year cumulative incidence of chronic GVHD was 20%. Nonrelapse mortality (NRM) at 100 days and 1 year were 12% and 17%, respectively. With a median follow-up for living patients of 15 months, the estimated 1-year overall and disease-free survival (DFS) was 56% and 48%, respectively. Outcomes were more favorable in patients who underwent transplantation in complete remission (1-year DFS 71%) versus patients who underwent transplantation with active disease (DFS, 34%; P = .01). Overall, myeloablative haploidentical HSCT with peripheral blood stem cells (PBSC) and Sir-PTCy is a feasible treatment option: the low rates of GVHD and NRM as well as the favorable immune reconstitution profile pave the way for a prospective comparative trial comparing BM and PBSC in this specific transplantation setting. (C) 2015 American Society for Blood and Marrow Transplantation

Frailty, psychological well-being, and social isolation in older adults with cognitive impairment during the SARS-CoV-2 pandemic: data from the GeroCovid initiative

Background: The containment measures linked to the COVID-19 pandemic negatively affected the phyco-physical well-being of the population, especially older adults with neurocognitive disorders (NCDs). This study aims to evaluate whether the frailty of NCD patients was associated with different changes in multiple health domains, in particular in relation to loneliness and social isolation, pre- and post-lockdown. Materials and methods: Patients were recruited from 10 Italian Centers for Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period (T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL (IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were administered. Caregivers' burden was also tested. Patients were categorized as non-frail, pre-frail, and frail according to the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale. Results: The sample included 165 subjects (61.9% women, mean age 79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores significantly declined between T0 and T2. There were no significative variations in functional and cognitive domains between the frail groups. During lockdown we recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale scores in frail people. In multivariable logistic regression, frailty was associated with an increase in social isolation, and a loss of IADL. Conclusions: We observed a global deterioration in functional and neuro-psychiatric domains irrespective of the degree of frailty. Frailty was associated with the worsening of social isolation during lockdown. Frail patients and their caregivers seemed to experience more anxiety and stress disorders during SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cancer stem cells from epithelial ovarian cancer patients privilege oxidative phosphorylation, and resist glucose deprivation

Ovarian cancer is the fourth leading cause of cancer-related death in women and the leading cause of gynecologic cancer death. Moreover, it is regarded as a therapy resistant tumor, because it shows the formation of more aggressive recurrence of the primary tumor as a result of chemotherapy. This chemo-resistance is thought to be related to the presence of the Cancer Stem Cells (CSC). Tumor cells are characterized by a high glycolytic metabolism even in the presence of oxygen, the so-called Warburg effect; however, it is unclear whether this condition is also shared by CSC. We identified ovarian CSC, according to their co-expression of CD44 and CD117 markers, in 40 samples of ascitic effusions from ovarian cancer-bearing patients. We have analyzed phenotipic characteristics by investigating stemness marker expression by flow-cytometry, spheroid formation assay, tumorigenicity in vivo and gene expression in RT-PCR. For the analysis of metabolic characteristics, ovarian cancer cells were FACS-sorted in to CD44+CD117+ and CD44+CD117- cell populations and analyzed through specific metabolic gene-cards. Results were confirmed also through Western Blot for specific metabolic enzymes and functional assay of mitochondrial activity. We have demonstrated that CD44+CD117+ EOC cells presented high tumorigenicity and expressed stemness-associated markers and multidrug resistance pumps. Moreover, the CD44+CD117+ cell population overexpressed genes associated with glucose uptake, oxidative phosphorylation (OXPHOS), and fatty acid -oxidation, indicating higher ability to direct pyruvate towards the Krebs cycle. Consistent with a metabolic profile dominated by OXPHOS, the CD44+CD117+ cells showed higher mitochondrial reactive oxygen species (ROS) production and elevated membrane potential, and underwent apoptosis upon inhibition of the mitochondrial respiratory chain. The CSC also had a high rate of pentose phosphate pathway (PPP) activity, which is not typical of cells privileging OXPHOS over glycolysis, and may rather reflect the PPP role in recharging scavenging enzymes. Furthermore, CSC resisted in vitro and in vivo glucose deprivation, while maintaining their CSC phenotype and OXPHOS profile. In this study, we show that a subpopulation of CD44+CD117+ EOC cells fulfilling the canonical properties of CSC does not preferentially exploit a glycolytic metabolism, privileging instead the mitochondrial respiratory pathway. These observations could explain the CSC resistance to anti-angiogenic therapies, and indicate this peculiar metabolic profile as a possible target of novel treatment strategies.Il cancro all’ovaio viene considerato un tumore resistente alla terapia e questa farmaco-resistenza si pensa sia correlata alla presenza delle cellule staminali tumorali (CSC). Le cellule staminali tumorali sono una rara e piccola popolazione cellulare responsabile dell’insorgenza del tumore, del mantenimento della sua crescita, dei casi di recidive e metastasi, in seguito alla loro proprietà di farmaco-resistenza. Considerando queste premesse, è indispensabile caratterizzare queste cellule in modo da trovare un possibile bersaglio terapeutico e migliorare i risultati delle terapie attuali. Le cellule tumorali sono caratterizzate da un metabolismo altamente glicolitico anche in presenza di ossigeno, denominato “Effetto Warburg”. Poco si conosce riguardo al metabolismo delle cellule staminali tumorali, e soprattutto non è noto se l’effetto Warburg è una condizione condivisa. Questo progetto di ricerca si prefigge di: - caratterizzare le CSC nel campioni primari di liquido ascitico di cancro all’ovaio; - studiare il profilo metabolico delle CSC isolate, per identificare eventuali differenze con la controparte differenziata. RISULTATI: Inizialmente abbiamo identificato le CSC, secondo la co-espressione dei marcatori CD44 (il recettore dell’acido ialuronico), e CD117 [c-kit, recettore della citochina SCF (Stem Cell Factor)] in 40 campioni di liquido ascitico di cancro all’ovaio di pazienti in cura all’ospedale di Padova. Questa rara popolazione cellulare CD44+CD117+ è in grado di formare strutture sferoidali; è altamente tumorigenica in topi immunodeficienti; presenta farmaco-resistenza, dimostrata con trattamenti in vitro con farmaci solitamente utilizzati in clinica; ed è caratterizzata da un’alta espressione di geni codificanti: pathway di staminalità (Nanog, Oct4, Sox2), pompe o enzimi detossificanti, coinvolti nei fenomeni di farmaco-resistenza (ABCG2, MRP1, MRP2 e ALDH1A) e enzimi coinvolti nel fenomeno della transizione epitelio-mesenchimale, importante nei processi di metastasi (SNAIL1, SNAIL2, ZEB1, ZEB2, TWIST1). Complessivamente, questi risultati dimostrano che le cellule CD44+CD117+ rappresentano una popolazione con caratteristiche di staminalità. A seguito di questa caratterizzazione fenotipica, abbiamo studiato il profilo metabolico delle cellule CD44+CD117+, confrontandolo con quello della controparte non-staminale (CD44+CD117-). In primo luogo, abbiamo esaminato l’espressione di geni coinvolti in diverse importanti vie metaboliche, tra cui: il metabolismo del glucosio, il ciclo dell'acido tricarbossilico (TCA), la catena di trasporto degli elettroni (ETC) nel processo della respirazione mitocondriale, la via dei pentoso fosfati (PPP), e la β-ossidazione degli acidi grassi. Le cellule CD44+CD117+ mostrano alti livelli di espressione dei geni associati alla glicolisi, e sono caratterizzate da una forte dipendenza dalla via dei pentoso fosfati e della β-ossidazione degli acidi grassi, dimostrata da una significativa diminuzione della loro vitalità in seguito a trattamento in vitro con due inibitori specifici delle due vie metaboliche (DHEA e Etomoxir rispettivamente). Inoltre le cellule CD44+CD117+ sono caratterizzate da un'alta espressione dei geni codificati enzimi coinvolti nel ciclo di Krebs e nella fosforilazione ossidativa (OXPHOS). Questo risultato ci ha permesso di analizzare l'espressione di un enzima chiave del ciclo di Krebs, la piruvato deidrogenasi (PDH), fondamentale nel trasporto del piruvato dalla glicolisi alla respirazione cellulare. Abbiamo verificato livelli di espressione comparabili dell’enzima PDH nelle due popolazioni cellulari CD44+CD117+ e CD44+CD117-, mentre l’enzima PDHK1, che inattiva la piruvato deidrogenasi tramite fosforilazione, risulta meno espressa nella popolazione CD44+CD117+. Questi dati suggeriscono che nelle cellule staminali tumorali venga privilegiato il trasporto del piruvato verso i mitocondri, per catalizzare il metabolismo della respirazione mitocondriale. Alla luce di questi risultati, abbiamo studiato l’attività mitocondriale nella popolazione staminale e nella controparte non staminale. In particolare le cellule CD44+CD117+ sono caratterizzate da bassi livelli di ROS (specie reattive dell’ossigeno) totali, da alti livelli di ROS mitocondriali, da una iper-polarizzazione del potenziale di membrana mitocondriale in seguito a trattamento con oligomicina (inibitore dell’ATP-sintasi) e da una drammatica diminuzione della vitalità cellulare in seguito a trattamento con inibitori specifici della catena di trasporto degli elettroni (ETC) (oligomicina inibitore dell’ATP-sintasi; rotenone inibitore del complesso I e antimicina inibitore del complesso III). Complessivamente, questi risultati ci hanno suggerito un modello sperimentale del profilo metabolico delle cellule staminali tumorali CD44+CD117+, le quali privilegiano la via della respirazione mitocondriale, a discapito della via glicolitica. Inoltre, abbiamo dimostrato che un trattamento in vitro e in vivo (2DG) di deprivazione di glucosio o blocco della via glicolitica seleziona una popolazione di cellule con caratteristiche di staminalità: incremento dell’espressione dei marcatori CD44 e CD117, farmaco-resistenza, tumorigenicità in vivo, formazion dii sferoidi in vitro ed espressione di geni convolti in pathway tipici delle cellule staminali. Questa popolazione cellulare ha mostrato una down-regolazione della maggior parte delle vie metaboliche, entrando in uno stato di quiescenza pur mantenendo livelli di espressione significativi dei geni codificanti enzimi del metabolismo ossidativo e iper-polarizzazione del potenziale di membrana mitocondriale, nonché dell’attività dei mitocondri. A conclusione del progetto e come ulteriore dimostrazione del profilo metabolico ossidativo delle cellule staminali tumorali, contrario all’effetto Warburg sfruttato dalle cellule tumorali, abbiamo eseguito degli esperimenti in vitro con due farmaci che colpiscono le vie metaboliche della respirazione cellulare: Metformina e CPI-613. Metformina inibisce il complesso I della catena di trasporto degli elettroni ed è attualmente in uso in studi clinici come farmaco antitumorale promettente; CPI-613 è un farmaco innovativo che inibisce due enzimi chiave del ciclo degli acidi tricarbossilici, PDH e α-KGH. Trattamenti in vitro con questi farmaci hanno dimostrato una significativa diminuzione della vitalità delle cellule CD44+CD117+, fondamentale verifica della loro dipendenza da questo profilo metabolico. CONCLUSIONI: In questo studio abbiamo investigato il profilo metabolico delle cellule staminali tumorali, isolate ex-vivo da campioni di liquidi ascitici di pazienti con carcinoma ovarico, dimostrando che le CSC ovariche, a differenza delle cellule differenziate neoplastiche, sfuggono all’effetto Warburg, utilizzando preferibilmente una respirazione ossidativa. Questa osservazione può indicare nuove strade e nuove strategie per approcci di terapie mirate nei confronti delle CSC, alla luce delle peculiari caratteristiche del loro metabolismo

Hitting the brakes on autophagy for overcoming acquired resistance in triple negative breast cancer

Càncer de mama triple negatiu; Autofàgia; Resistència terapèuticaCáncer de mama triple negativo; Autofagia; Resistencia terapéuticaTriple negative breast cancer; Autophagy; Therapeutic resistanceComment on: Wang RX, Xu XE, Huang L, et al. eEF2 kinase mediated autophagy as a potential therapeutic target for paclitaxel-resistant triplenegative breast cancer. Ann Transl Med 2019;7:783.None

Effects of two mTOR inhibitors on in-vitro models of GH-secreting pituitary adenomas

Background: Gigantism and acromegaly are the main consequences of GH excess, mainly due to a pituitary adenoma. Surgery is the first therapeutic option, but also medical therapy is employed, being represented mostly by somatostatin analogues (SSA), that reduce both tumour mass and GH hypersecretion. However about 10% of patients is resistant to SSA. PI3K/Akt/mTOR pathway, activated by growth-factors such as IGF1, is important in regulating many cellular processes (viability, apoptosis and cell cycle), and it is deregulated in several neoplasms including GH-secreting pituitary tumours. Aim of the study: To understand how PI3K/Akt/mTOR pathway can influence viability and GH secretion in pituitary adenomas, we employed two inhibitors (Everolimus, mTOR inhibitor, and NVP-BEZ235, mTOR and PI3K inhibitor), evaluating their effects in presence or in absence of IGF1. Material and methods: We employed two GH-secreting pituitary adenoma rat cell lines and we assessed cell viability. Culture medium was collected to evaluate GH secretion by ELISA. Results: Both compounds (10–500 nM) caused a significant reduction in cell viability up to 60% in the two cell lines. On the other hand, IGF-1 induced cell viability by 60% as compared to control cells in GH3 cells and by 40% in GH4C1 cells. This effect was efficiently counteracted in both lines by Everolimus and NVP-BEZ235, indicating that these compounds could act, at least in part, on IGF-1 activated pathways. GH secretion was reduced by IGF1 in both cell lines; this effect was enhanced by Everolimus, but not by NVP-BEZ235 in both cell lines. Conclusions: Our results suggest that both compounds interfere with IGF1 signalling in GH-secreting rat cell lines, that could be used as a model to identify alternative pharmacological targets for GH-secreting pituitary adenomas resistant to SSA therapy