Caracterización molecular de las neoplasias mieloides relacionadas con la terapia

Las neoplasias mieloides relacionadas con la terapia (NMRT) se definen como aquellas leucemias mieloblásticas agudas (LMA) ó síndromes mielodisplásicos (SMD) desarrollados en pacientes previamente tratados con quimioterapia, radioterapia ó la combinación de ambas por una patología previa. Constituyen una de las mayores complicaciones de los supervivientes de otras formas de cáncer, representando entre un 10-20% de las LMA en el momento actual. Además, se presupone una incidencia en aumento a medio plazo debido a la mejora en la supervivencia de los pacientes oncológicos. Por otro lado se considera un grupo de pacientes con mal pronóstico per se aunque se les aplican los mismos factores de riesgo que a los pacientes de novo. En el momento actual la estratificación pronóstica de los pacientes con LMA o SMD de novo se basa principalmente en su caracterización citogenética y molecular, especialmente en los últimos años tras el desarrollo de las nuevas técnicas de secuenciación. En el caso de las NMRT se ha descrito una mayor frecuencia de alteraciones en los cromosomas 5 y 7 en pacientes sometidos a tratamiento con agentes alquilantes y/ó radioterapia así como alteraciones cromosómicas balanceadas en los expuestos a inhibodores de topoisomerasa II. Desde el punto de vista molecular, la caracterización de estos pacientes no se ha realizado de forma tan exhaustiva como en los pacientes sin antecedentes de exposición previa a tóxicos y aunque se apunta por mayor frecuencia de mutaciones en genes como TP53 o RUNX1, la caracterización molecular de los mismos es incompleta. Por ello nos hemos planeado el análisis del perfil genético de estos pacientes, mediante el análisis de sus características citogenéticas y su perfil mutacional mediante el empleo de tecnología de secuenciación de nueva generación (NGS) mediante la aplicación de un panel customizado para cubrir las regiones exónicas de interés de genes con implicación en enfermedades mieloides. El análisis de una serie de 74 pacientes con diagnóstico de NMRT nos ha mostrado una alta frecuencia de alteraciones citogenéticas en el 72% de los pacientes, con especial relevancia de los pacientes con alteraciones de los cromosomas 5y/o 7, así como presencia de cariotipos complejos hasta en un 20% de los mismos. El análisis del perfil mutacional mostró alteraciones en el 95% de los pacientes, siendo TP53 el gen más frecuentemente afectado. No se encontraron diferencias en el perfil mutacional de los pacientes con LMA-t y SMD-t. La presencia de mutaciones en TP53 tuvo un impacto negativo en la supervivencia global, mientras que el diagnóstico previo de LPA-t se asoció a mejor supervivencia

Trombocitopenia inmune primaria en pacientes de edad avanzada : experiencia en un centro

Estudi descriptiu dels pacients majors de 60 anys amb diagnòstic de trombocitopènia immune primària en un centre. S'han revisat característiques bàsiques en el moment de l'inici de la malaltia, així com les diferents línies de tractament, resposta, evolució i complicacions sorgides en aquest grup d'edat, en què la literatura publicada sobre aquest tema és menor que en els pacients joves.Estudio descriptivo de los pacientes mayores de 60 años con diagnóstico de trombocitopenia inmune primaria en un centro. Se han revisado características básicas en el momento del inicio de la enfermedad, así como las diferentes líneas de tratamiento, respuesta, evolución y complicaciones surgidas en este grupo de edad, en el que la literatura publicada al respecto es menor que en los pacientes jóvenes

Impact of Region-of-Interest Delineation Methods, Reconstruction Algorithms, and Intra- and Inter-Operator Variability on Internal Dosimetry Estimates Using PET

Purpose: Human dosimetry studies play a central role in radioligand development for positron emission tomography (PET). Drawing regions of interest (ROIs) on the PET images is used to measure the dose in each organ. In the study aspects related to ROI delineation methods were evaluated for two radioligands of different biodistribution (intestinal vs urinary). Procedures: PET images were simulated from a human voxel-based phantom. Several ROI delineation methods were tested: antero-posterior projections (AP), 3D sub-samples of the organs (S), and a 3D volume covering the whole-organ (W). Inter- and intra-operator variability ROI drawing was evaluated by using human data. Results: The effective dose estimates using S and W methods were comparable to the true values. AP methods overestimated (49 %) the dose for the radioligand with intestinal biodistribution. Moreover, the AP method showed the highest inter-operator variability: 11 ± 1 %. Conclusions: The sub-sampled organ method showed the best balance between quantitative accuracy and inter- and intra-operator variability

Assessment of myocardial viscoelasticity with Brillouin spectroscopy in myocardial infarction and aortic stenosis models.

Heart diseases are associated with changes in the biomechanical properties of the myocardial wall. However, there is no modality available to assess myocardial stiffness directly. Brillouin microspectroscopy (mBS) is a consolidated mechanical characterization technique, applied to the study of the viscoelastic and elastic behavior of biological samples and may be a valuable tool for assessing the viscoelastic properties of the cardiac tissue. In this work, viscosity and elasticity were assessed using mBS in heart samples obtained from healthy and unhealthy mice (n = 6 per group). Speckle-tracking echocardiography (STE) was performed to evaluate heart deformation. We found that mBS was able to detect changes in stiffness in the ventricles in healthy myocardium. The right ventricle showed reduced stiffness, in agreement with its increased compliance. mBS measurements correlated strongly with STE data, highlighting the association between displacement and stiffness in myocardial regions. This correlation was lost in pathological conditions studied. The scar region in the infarcted heart presented changes in stiffness when compared to the rest of the heart, and the hypertrophied left ventricle showed increased stiffness following aortic stenosis, compared to the right ventricle. We demonstrate that mBS can be applied to determine myocardial stiffness, that measurements correlate with functional parameters and that they change with disease.post-print6652 K

Early preventive treatment with Enalapril improves cardiac function and delays mortality in mice with arrhythmogenic right ventricular cardiomyopathy type 5.

Background: Arrhythmogenic right ventricular cardiomyopathy type 5 (ARVC5) is an inherited cardiac disease with complete penetrance and an aggressive clinical course caused by mutations in TMEM43 (transmembrane protein 43). There is no cure for ARVC5 and palliative treatment is started once the phenotype is present. A transgenic mouse model of ARVC5 expressing human TMEM43-S358L (TMEM43mut) recapitulates the human disease, enabling the exploration of preventive treatments. The aim of this study is to determine whether preventive treatment with heart failure drugs (β-blockers, ACE [angiotensin-converting enzyme] inhibitors, mineralocorticoid-receptor antagonists) improves the disease course of ARVC5 in TMEM43mut mice. Methods: TMEM43mut male/female mice were treated with metoprolol (β-blockers), enalapril (ACE inhibitor), spironolactone (mineralocorticoid-receptor antagonist), ACE inhibitor + mineralocorticoid-receptor antagonist, ACE inhibitor + mineralocorticoid-receptor antagonist + β-blockers or left untreated. Drugs were initiated at 3 weeks of age, before ARVC5 phenotype, and serial ECG and echocardiograms were performed. Results: TMEM43mut mice treated with enalapril showed a significantly increased median survival compared with untreated mice (26 versus 21 weeks; P=0.003). Enalapril-treated mice also exhibited increased left ventricular ejection fraction at 4 months compared with controls (37.0% versus 24.9%; P=0.004), shorter QRS duration and reduced left ventricle fibrosis. Combined regimens including enalapril also showed positive effects. Metoprolol decreased QRS voltage prematurely and resulted in a nonsignificant decrease in left ventricular ejection fraction compared with untreated TMEM43mut mice. Conclusions: Preventive enalapril-based regimens reduced fibrosis, improved ECG, echocardiographic parameters and survival of ARVC5 mice. Early metoprolol did not show positive effects and caused premature ECG abnormalities. Our findings pave the way to consider prophylactic enalapril in asymptomatic ARVC5 genetic carriers.pre-print326 K

A Descriptive Analysis of ATTR Amyloidosis in Spain from the Transthyretin Amyloidosis Outcomes Survey.

Introduction Transthyretin amyloidosis (ATTR amyloidosis) is a clinically heterogeneous disease caused by mutations in the transthyretin (TTR) gene or aggregation of wild-type transthyretin (ATTRwt). In Spain, there are two large endemic foci of ATTR amyloidosis caused by the Val30Met variant, with additional cases across the country; however, these data may be incomplete, as there is no centralized patient registry. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations. This analysis aimed to gain a deeper understanding of the clinical profile of patients with ATTR amyloidosis in Spain. Methods This was a descriptive analysis of the demographic and clinical characteristics of symptomatic patients enrolled at six sites geographically dispersed throughout Spain (data cutoff: January 6, 2020). Patient data at enrollment, including genotype, demographics, and clinical presentation for symptomatic patients, were recorded. Patients were grouped by predominant phenotype based on clinical measures at enrollment: predominantly cardiac, predominantly neurologic, or mixed (cardiac and neurologic). Results There were 379 patients (58.0% male; 63.3% symptomatic) enrolled in the six THAOS sites in Spain. Predominant genotypes were the Val30Met mutation (69.1%) or ATTRwt (15.6%). Predominant phenotype distribution was neurologic (50.4%), mixed (35.8%), and cardiac (13.8%) for all symptomatic patients (n = 240); neurologic (67.8%), mixed (21.2%), and cardiac (11.0%) for symptomatic Val30Met (n = 146); and mixed (64.9%), cardiac (22.8%), and neurologic (12.3%) for symptomatic ATTRwt (n = 57). Symptomatic patients reported a range of ATTR amyloidosis signs and symptoms at enrollment, with autonomic neuropathy and sensory neuropathy common in all phenotypes. Conclusions These results from THAOS highlight the phenotypic heterogeneity associated with ATTR amyloidosis in Spain and the importance of comprehensive neurologic and cardiac evaluations in all patients with ATTR amyloidosis.post-print392 K

Outcomes and effect of somatic mutations after erythropoiesis stimulating agents in patients with lower-risk myelodysplastic syndromes

Background: Erythropoiesis stimulating agents (ESAs) are the first-line therapy in patients with lower-risk myelodysplastic syndromes (LR-MDS). Some predictive factors for ESAs response have been identified. Type and number of somatic mutations have been associated with prognosis and response to therapies in MDS patients.Objectives: The objective was to evaluate the outcomes after ESAs in patients with LR-MDS and to address the potential predictive value of somatic mutations in ESAs-treated patients.Design: Multi-center retrospective study of a cohort of 722 patients with LR-MDS included in the SPRESAS (Spanish Registry of Erythropoietic Stimulating Agents Study) study. Retrospective analysis of 65 patients with next generation sequencing (NGS) data from diagnosis.Methods: ESAs' efficacy and safety were evaluated in patients receiving ESAs and best supportive care (BSC). To assess the potential prognostic value of somatic mutations in erythroid response (ER) rate and outcome, NGS was performed in responders and non-responders.Results: ER rate for ESAs-treated patients was 65%. Serum erythropoietin (EPO) level = 3; p = 0.170). The presence of >= 3 mutated genes was also significantly associated with worse OS (hazard ratio, 2.8; p= 0.015), even in responders. A higher cumulative incidence of acute myeloid leukemia progression at 5 years was also observed in patients with >= 3 mutated genes versus<3 (33.3% and 10.7%, respectively; p< 0.001).Conclusion: This large study confirms the beneficial effect of ESAs and the adverse effect of somatic mutations in patients with LR-MDS

IGF-II treatment prevents the oxidative damage derived by MPP+/MPTP administration in a cellular and animal model of Parkinson’s disease.

El factor de crecimiento de la insulina-II (IGF-II) ha mostrado efectos antioxidantes y neuroprotectores en algunos trastornos neurodegenerativos, como es la Enfermedad de Parkinson (EP). Analizamos el efecto de IGF-II y la implicación de la esfingosina kinasa (SPHK), en la citoarquitectura/función mitocondrial tras provocar daño oxidativo con la administración de la neurotoxina MPTP y su metabolito activo. La línea celular SN4741 se trató con MPP+ solo/en presencia de IGF-II (2 h). Los tratamientos fueron reemplazados por medio/IGF-II (2h), respectivamente. Se estudió: morfología (microscopía electrónica, EM), tasa de consumo de oxígeno (OCR) y muerte celular (LDH). MPTP/probenecid(p) por vía parenteral (35d) indujo un daño progresivo en la vía nigroestriatal dopaminérgica (DA-NSP) de los animales. En los días 36-44, se inyectó vehículo. El grupo control recibió vehículo siguiendo el mismo régimen de administración (1-44d). Otro grupo se trató con IGF-II una vez inducido el daño por MPTP (22-44 días). Para investigar el papel de IGF-II en la alteración conductual inducida por MPTP/p, se evaluó el rendimiento motor. Se realizó inmunotinción para marcadores dopaminérgicos y astrogliosis. Las células tratadas con MPP+ mostraron menos mitocondrias (EM) y con pérdida parcial/total de crestas, alteraciones de membrana y forma hinchada. IGF-II mantuvo el número de mitocondrias con morfología similar al control. La disminución de OCR tras la administración de MPP+ (30%) se recuperó con IGF-II. SPHK está implicada en este mecanismo, como indica su inhibición (MPP++IGF-II+MPA-08 6 veces > LDH vs MPP++IGF-II). En animales, IGF-II recuperó el efecto de MPTP sobre los marcadores DA-NSP y sobre el rendimiento motor. IGF-II contrarresta el aumento del estrés oxidativo y la disfunción mitocondrial inducida por la neurotoxina, el deterioro conductual y la degeneración de DA-NSP. SPHK estaría involucrada en este mecanismo.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

The SRSF4–GAS5-Glucocorticoid Receptor Axis Regulates Ventricular Hypertrophy.

RATIONALE: RBPs (RNA-binding proteins) play critical roles in human biology and disease. Aberrant RBP expression affects various steps in RNA processing, altering the function of the target RNAs. The RBP SRSF4 (serine/arginine-rich splicing factor 4) has been linked to neuropathies and cancer. However, its role in the heart is completely unknown. OBJECTIVE: To investigate the role of SRSF4 in the heart. METHODS AND RESULTS: Echocardiography of mice specifically lacking SRSF4 in the heart (SRSF4 KO) revealed left ventricular hypertrophy and increased cardiomyocyte area, which led to progressive diastolic dysfunction with age. SRSF4 KO mice showed altered electrophysiological activity under isoproterenol-induced cardiac stress, with a post-QRS depression and a longer QT interval, indicating an elevated risk of sudden cardiac death. RNA-Seq analysis revealed expression changes in several long noncoding RNAs, including GAS5 (growth arrest-specific 5), which we identified as a direct SRSF4 target in cardiomyocytes by individual-nucleotideresolution cross-linking and immuno-precipitation. GAS5 is a repressor of the GR (glucocorticoid receptor) and was downregulated in SRSF4 KO hearts. This corresponded with elevated GR transcriptional activity in cardiomyocytes, leading to increases in hypertrophy markers and cell size. Furthermore, hypertrophy in SRSF4 KO cardiomyocytes was reduced by overexpressing GAS5. CONCLUSIONS: Loss of SRSF4 expression results in cardiac hypertrophy, diastolic dysfunction, and abnormal repolarization. The molecular mechanism underlying this effect involves GAS5 downregulation and consequent elevation of GR transcriptional activity. Our findings may help to develop new therapeutic tools for the treatment of cardiac hypertrophy and myocardial pathology in patients with Cushing syndrome.post-print2695 K

The SRSF4–GAS5-Glucocorticoid Receptor Axis Regulates Ventricular Hypertrophy.

RATIONALE: RBPs (RNA-binding proteins) play critical roles in human biology and disease. Aberrant RBP expression affects various steps in RNA processing, altering the function of the target RNAs. The RBP SRSF4 (serine/arginine-rich splicing factor 4) has been linked to neuropathies and cancer. However, its role in the heart is completely unknown. OBJECTIVE: To investigate the role of SRSF4 in the heart. METHODS AND RESULTS: Echocardiography of mice specifically lacking SRSF4 in the heart (SRSF4 KO) revealed left ventricular hypertrophy and increased cardiomyocyte area, which led to progressive diastolic dysfunction with age. SRSF4 KO mice showed altered electrophysiological activity under isoproterenol-induced cardiac stress, with a post-QRS depression and a longer QT interval, indicating an elevated risk of sudden cardiac death. RNA-Seq analysis revealed expression changes in several long noncoding RNAs, including GAS5 (growth arrest-specific 5), which we identified as a direct SRSF4 target in cardiomyocytes by individual-nucleotideresolution cross-linking and immuno-precipitation. GAS5 is a repressor of the GR (glucocorticoid receptor) and was downregulated in SRSF4 KO hearts. This corresponded with elevated GR transcriptional activity in cardiomyocytes, leading to increases in hypertrophy markers and cell size. Furthermore, hypertrophy in SRSF4 KO cardiomyocytes was reduced by overexpressing GAS5. CONCLUSIONS: Loss of SRSF4 expression results in cardiac hypertrophy, diastolic dysfunction, and abnormal repolarization. The molecular mechanism underlying this effect involves GAS5 downregulation and consequent elevation of GR transcriptional activity. Our findings may help to develop new therapeutic tools for the treatment of cardiac hypertrophy and myocardial pathology in patients with Cushing syndrome.post-print2695 K