Novel epigenetic target therapy for prostate cancer: a preclinical study.

Epigenetic events are critical contributors to the pathogenesis of cancer, and targeting epigenetic mechanisms represents a novel strategy in anticancer therapy. Classic demethylating agents, such as 5-Aza-29-deoxycytidine (Decitabine), hold the potential for reprograming somatic cancer cells demonstrating high therapeutic efficacy in haematological malignancies. On the other hand, epigenetic treatment of solid tumours often gives rise to undesired cytotoxic side effects. Appropriate delivery systems able to enrich Decitabine at the site of action and improve its bioavailability would reduce the incidence of toxicity on healthy tissues. In this work we provide preclinical evidences of a safe, versatile and efficient targeted epigenetic therapy to treat hormone sensitive (LNCap) and hormone refractory (DU145) prostate cancers. A novel Decitabine formulation, based on the use of engineered erythrocyte (Erythro-Magneto-Hemagglutinin Virosomes, EMHVs) drug delivery system (DDS) carrying this drug, has been refined. Inside the EMHVs, the drug was shielded from the environment and phosphorylated in its active form. The novel magnetic EMHV DDS, endowed with fusogenic protein, improved the stability of the carried drug and exhibited a high efficiency in confining its delivery at the site of action in vivo by applying an external static magnetic field. Here we show that Decitabine loaded into EMHVs induces a significant tumour mass reduction in prostate cancer xenograft models at a concentration, which is seven hundred times lower than the therapeutic dose, suggesting an improved pharmacokinetics/pharmacodynamics of drug. These results are relevant for and discussed in light of developing personalised autologous therapies and innovative clinical approach for the treatment of solid tumours

Potential role of low kV ex vivo micro-CT for 3D morphometry of paraffin embedded coronary vessels before histology

Purpose: Micro CT is an established tool for non destructive 3D inspection of small specimens. Aim of the study was to demonstrate that despite its limitations in differentiation of soft materials, micro CT can reliably display coronary vessel structure and surrounding tissues after paraffin embedding. Data were obtained from coronary specimens of pig, physical phantoms and numerical simulations. Preliminary images with dual-energy techniques are also shown. Methods: A micro CT scanner built by our group was used for the experiments. The x-ray tube was set up in the range of 20-50 kV; the voxel size was set to 21 μm. A phantom composed of formalin fixed fat and myocardium of rat, dehydrated and paraffin embedded, was used to measure the contrast of different tissues with respect to background. Similar acquisitions were simulated numerically. Real samples of pig excised coronary arteries were processed in the same way and acquired with the same settings; resulting images were compared to those obtained by histology. Results: In phantom, the myocardium contrast vs. paraffin varied from 40% at 20 kV to 29% at 50 kV. The fat contrast vs. background was 2% at 20 kV, whereas it was indistinguishable from the background at 50 kV; all the contrasts in phantom appeared lower than those expected from simulations, probably because of tissue shrinkage. In the samples from pig (see Figure), the vessel wall contrast was 25% greater than the myocardium contrast; the pericardium and a balloon induced stenosis were clearly distinguished. All micro CT scans were shorter than 1 hour. Conclusion: Micro CT is a useful complementary tool for the 3D morphometry of coronary vessels after paraffin embedding, and it can help for the preliminary identification of features of interest for subsequent histological analysis

Gas embolization of the liver in a rat model of rapid decompression

Occurrence of liver gas embolism after rapid decompression was assessed in 31 female rats that were decompressed in 12 min after 42 min of compression at 7 ATA (protocol A). Sixteen rats died after decompression (group I). Of the surviving rats, seven were killed at 3 h (group II), and eight at 24 h (group III). In group I, bubbles were visible in the right heart, aortic arch, liver, and mesenteric veins and on the intestinal surface. Histology showed perilobular microcavities in sinusoids, interstitial spaces, and hepatocytes. In group II, liver gas was visible in two rats. Perilobular vacuolization and significant plasma aminotransferase increase were present. In group III, liver edema was evident at gross examination in all cases. Histology showed perilobular cell swelling, vacuolization, or hydropic degeneration. Compared with basal, enzymatic markers of liver damage increased significantly. An additional 14 rats were decompressed twice (protocol B). Overall mortality was 93%. In addition to diffuse hydropic degeneration, centrilobular necrosis was frequently observed after the second decompression. Additionally, 10 rats were exposed to three decompression sessions (protocol C) with doubled decompression time. Their mortality rate decreased to 20%, but enzymatic markers still increased in surviving rats compared with predecompression, and perilobular cell swelling and vacuolization were present in five rats. Study challenges were 1) liver is not part of the pathophysiology of decompression in the existing paradigm, and 2) although significant cellular necrosis was observed in few animals, zonal or diffuse hepatocellular damage associated with liver dysfunction was frequently demonstrated. Liver participation in human decompression sickness should be looked for and clinically evaluated

Phenotype Changes of Circulating Monocytes in a Hypercholesterolemic Swine Model of Coronary Artery Disease

Objective: Inflammation and immunity activation play a key role in atherosclerosis (ATS) onset and progression. Aim of this study was to investigate the relationships between phenotype of circulating monocytes and coronary artery disease (CAD) development in a histologically well-characterized swine model of ATS. Methods: Blood samples were obtained from 6 animals at baseline and after 16 weeks high fat cholesterolenriched diet. Flow cytometry monocyte identification was performed (CD172a marker). Adhesion (CD18a, CD11a, CD11R3, CD49d, CD29), differentiation (CD14) and activation receptors (SLA-DR, CD16, CD163) were quantified as percentage of positivity (%) and Relative Fluorescence Intensity (RFI). Lipid parameters (LDL, oxLDL, HDL) and soluble endothelial ICAM-1 were measured and histologic quantitative assessment of coronary ATS was performed. Results: Flow cytometry analysis demonstrated a significant post-diet decrease of CD14 RFI and an increment of % SLA-DR. Pre-diet values of ICAM-1 and % SLA-DR correlated reciprocally (P=0.0191) and with several CAD severity indexes (P≤0.02). Positive correlations between RFI changes of CD29 (P=0.0213) and CD18a (P=0.0341) and morphometric indexes of coronary ATS were found. Post-diet RFI values of CD29, CD18a and CD16 were also closely related to morphometric parameters (P<0.03). A cumulative post-diet tendency to increase of CD14low/ CD163high monocyte fraction (45.07 ± 2.27 vs. 40.14 ± 3.16) and a tight correlation between changes of this monocyte subset and corresponding HDL variations (P=0.0100) were also observed. Conclusions: Blood monocyte orientation towards a macrophage-like phenotype, similar to a HDL-induced maturation, and a close association between markers changes and severity of diet induced coronary ATS could provide new insights into plaque growth and progression in CAD

Ex-vivo micro-CT for the assessment of the structure of paraffin embedded coronary vessels before histology

Purpose: Aim of the study was to demonstrate that absorption-based single low-energy micro-CT can reliably display coronary vessel structure and surrounding tissues after paraffin embedding. Methods and Materials: A micro-CT scanner built by our group was used for the experiments. The x-ray tube was set up in the range of 20-50 kV. A phantom composed of formalin fixed fat and myocardial tissues of rat, dehydrated and paraffin embedded, was used to measure the image contrast of relevant tissues with respect to the background. Similar acquisitions were simulated using standardized attenuation functions and simulated spectra. Real samples of pig excised coronary arteries were also processed in the same way and acquired with similar settings; resulting images were compared to those obtained by histology. The voxel size in the micro-CT images was 21 &#956;m. Results: In phantom, the myocardium contrast vs. paraffin varied from 40% at 20 kV to 29% at 50 kV. The fat contrast was 2% at 20 kV, whereas it was indistinguishable from the background at 50 kV. The pericardium and a balloon induced stenosis were clearly distinguished. A noncalcified fatty streak was also identified. All contrasts in phantom appeared lower than those expected from simulations, probably because of the sample processing. The image quality was sufficient for segmentation purposes, allowing quantitative morphometry within the selected Volume of Interest (VOI). Conclusion: Micro-CT is a useful complementary tool for the assessment of coronary vessels structure after sample embedding in paraffin prior to histological examination. This type of imaging can help for the identification of features for subsequent histological analysis in experimental models of restenosis and atherogenesis

Myocardial interleukin-6 in the setting of left ventricular mechanical assistance: relation with outcome and C-reactive protein

Background: In left ventricular assist device (LVAD) recipients, plasma levels of interleukin (IL)-6 are associated with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles, reflecting postoperative risk. However, it is not clear how the cardiac. Conclusions: Cardiac IL-6 levels do not contribute to improve risk profile of LVAD recipients in relation to clinical inpatient post-implantation. Instead, plasma IL-6 and serum CRP concentrations are more effective in predicting the severity of the clinical course in the early phase of LVAD therapy. level of IL-6, detectable on the tissue samples at the time of implantation, can contribute to predict the post-operative outcome

Non-enhanced micro-CT of paraffin embedded coronary vessels: a tool for experimental atherosclerosis

Purpose. To assess and quantify morphometric parameters of full-length coronary arteries in three dimensions at high resolution by micro-CT (?CT), and to evaluate the possible integration with in vivo information by invasive coronary angiography (ICA) and and intravascular ultrasound (IVUS). Methods and Materials. Excised left coronary artery (LMCA and LAD) and underlying myocardium from pigs on a high-cholesterol diet were fixed in formalin, dehydrated and embedded in paraffin as a whole sample inside a Falcon-type test tube. In vivo information obtained by ICA and IVUS were also available for the same animals. After the ?CT scan, the samples were further processed in order to perform standard histological stains. Results. For each sample, we have obtained a reconstructed volume of 512x512x1400 isotropic voxels, with a voxel size of 57.4^3 ?m^3. The ?CT images provided good discrimination between fat, muscle and calcium, allowing a reliable segmentation of walls and lesions. The profiles of total area, wall area and calcium along the entire coronary artery allowed a comprehensive evaluation of the progress of atherosclerosis in terms of intimal thickening, plaque formation and calcification. Microcalcifications down to 0.2 nl (nanoliters) were localized and displayed in 3D. The integration with IVUS allowed also to recover the lumen area under in vivo physiological state. Conclusion. Micro-CT allows a comprehensive evaluation in 3D and at high resolution of plaque evolution in an experimental model of coronary artery disease in pigs. The integration with ICA and IVUS can lead to the full characterization of disease progression

Simulation of atherosclerotic plaque growth using computational biomechanics and patient-specific data

Atherosclerosis is the one of the major causes of mortality worldwide, urging the need for prevention strategies. In this work, a novel computational model is developed, which is used for simulation of plaque growth to 94 realistic 3D reconstructed coronary arteries. This model considers several factors of the atherosclerotic process even mechanical factors such as the effect of endothelial shear stress, responsible for the initiation of atherosclerosis, and biological factors such as the accumulation of low and high density lipoproteins (LDL and HDL), monocytes, macrophages, cytokines, nitric oxide and formation of foams cells or proliferation of contractile and synthetic smooth muscle cells (SMCs). The model is validated using the serial imaging of CTCA comparing the simulated geometries with the real follow-up arteries. Additionally, we examine the predictive capability of the model to identify regions prone of disease progression. The results presented good correlation between the simulated lumen area (P<0.0001), plaque area (P<0.0001) and plaque burden (P<0.0001) with the realistic ones. Finally, disease progression is achieved with 80% accuracy with many of the computational results being independent predictors

Predictive added value of selected plasma lipids to a re-estimated minimal risk tool

Background: Lipidomics is emerging for biomarker discovery in cardiovascular disease, and circulating lipids are increasingly incorporated in risk models to predict cardiovascular events. Moreover, specific classes of lipids, such as sphingomyelins, ceramides, and triglycerides, have been related to coronary artery disease (CAD) severity and plaque characteristics. To avoid unnecessary testing, it is important to identify individuals at low CAD risk. The only pretest model available so far to rule out the presence of coronary atherosclerosis in patients with chest pain, but normal coronary arteries, is the minimal risk tool (MRT).Aim: Using state-of-the-art statistical methods, we aim to verify the additive predictive value of a set of lipids, derived from targeted plasma lipidomics of suspected CAD patients, to a re-estimated version of the MRT for ruling out the presence of coronary atherosclerosis assessed by coronary CT angiography (CCTA).Methods: Two hundred and fifty-six subjects with suspected stable CAD recruited from five European countries within H2020-SMARTool, undergoing CCTA and blood sampling for clinical biochemistry and lipidomics, were selected. The MRT was validated by regression methods and then re-estimated (reMRT). The reMRT was used as a baseline model in a likelihood ratio test approach to assess the added predictive value of each lipid from 13 among ceramides, triglycerides, and sphingomyelins. Except for one lipid, the analysis was carried out on more than 240 subjects for each lipid. A sensitivity analysis was carried out by considering two alternative models developed on the cohort as baseline models.Results: In 205 subjects, coronary atherosclerosis ranged from minimal lesions to overt obstructive CAD, while in 51 subjects (19.9%) the coronary arteries were intact. Four triglycerides and seven sphingomyelins were significantly (p < 0.05) and differentially expressed in the two groups and, at a lesser extent, one ceramide (p = 0.067). The probability of being at minimal risk was significantly better estimated by adding either Cer(d18:1/16:0) (p = 0.01), SM(40:2) (p = 0.04), or SM(41:1) at a lesser extent (p = 0.052) to reMRT than by applying the reMRT alone. The sensitivity analysis confirmed the relevance of these lipids. Furthermore, the addition of SM(34:1), SM(38:2), SM(41:2), and SM(42:4) improved the predictive performance of at least one of the other baseline models. None of the selected triglycerides was found to provide an added value.Conclusions: Plasma lipidomics can be a promising source of diagnostic and prognostic biomarkers in cardiovascular disease, exploitable not only to assess the risk of adverse events but also to identify subjects without coronary atherosclerosis, thus reducing unnecessary further testing in normal subjects.Cardiolog

Non-Invasive Prediction of Site-Specific Coronary Atherosclerotic Plaque Progression using Lipidomics, Blood Flow, and LDL Transport Modeling

Background: coronary computed tomography angiography (CCTA) is a first line non-invasive imaging modality for detection of coronary atherosclerosis. Computational modeling with lipidomics analysis can be used for prediction of coronary atherosclerotic plaque progression. Methods: 187 patients (480 vessels) with stable coronary artery disease (CAD) undergoing CCTA scan at baseline and after 6.2 +/- 1.4 years were selected from the SMARTool clinical study cohort (Clinicaltrial.gov Identifiers NCT04448691) according to a computed tomography (CT) scan image quality suitable for three-dimensional (3D) reconstruction of coronary arteries and the absence of implanted coronary stents. Clinical and biohumoral data were collected, and plasma lipidomics analysis was performed. Blood flow and low-density lipoprotein (LDL) transport were modeled using patient-specific data to estimate endothelial shear stress (ESS) and LDL accumulation based on a previously developed methodology. Additionally, non-invasive Fractional Flow Reserve (FFR) was calculated (SmartFFR). Plaque progression was defined as significant change of at least two of the morphological metrics: lumen area, plaque area, plaque burden. Results: a multi-parametric predictive model, including traditional risk factors, plasma lipids, 3D imaging parameters, and computational data demonstrated 88% accuracy to predict site-specific plaque progression, outperforming current computational models. Conclusions: Low ESS and LDL accumulation, estimated by computational modeling of CCTA imaging, can be used to predict site-specific progression of coronary atherosclerotic plaques.</div