High expression of peptide receptors as a novel target in gastrointestinal stromal tumours

Recent significant advances in understanding the biology of gastrointestinal stromal tumours (GIST) have led to the introduction of a new targeted therapy (imatinib mesylate, Glivec). Hopes of a new era of a specific cancer therapy, however, have been tempered by the recognition that a significant proportion of patients who initially respond to the drug eventually become resistant to it. Given the successful development of peptide receptor scintigraphy and radiotherapy for neuroendocrine tumours, we postulated that a similar approach could offer a valid alternative in the diagnosis and therapy of GIST. Using in vitro receptor autoradiography to measure peptide receptors, we found that 16/19 GIST expressed bombesin subtype 2 receptors, 16/19 expressed vasoactive intestinal peptide subtype 2 receptors (VPAC2) and 12/19 expressed cholecystokinin subtype 2 receptors, in most cases in extremely high densities. All GIST metastases were shown to express two or more of these peptide receptors in very high density. Receptors were also expressed in non-responders to Glivec or after chemo-embolisation. Conversely, somatostatin subtype 2, cholecystokinin subtype 1, bombesin subtype 1 and 3, and neuropeptide Y subtype Y1 and Y2 receptors were not or only rarely expressed. These data represent a strong molecular basis for the use of radiolabelled bombesin, vasoactive intestinal peptide and/or cholecystokinin analogues as targeting agents to localise GIST tumours in patients by in vivo scintigraphy and/or to perform targeted radiotherapy to destroy GIST primaries, metastases and recurrences, including those resistant to Glive

Selection of peptide ligands binding to the basolateral cell surface of proximal convoluted tubules

Selection of peptide ligands binding to the basolateral cell surface of proximal convoluted tubules.BackgroundRecently, we have reported a novel approach of screening phage-display peptide libraries on microdissected intact renal tubular segments and identified an RGD-containing peptide ligand that specifically binds to the basolateral membrane of cortical collecting ducts (CCD). However, screening phage libraries on proximal convoluted tubules (PCT) did not yield a tubule segment-specific ligand. Here, we describe the successful modification of our previously developed phage-display approach and the identification of two distinct ligands that bind specifically to receptors expressed at the basolateral membrane of PCT.MethodsEx vivo screening of phage-display peptide libraries for specific ligands was adapted for PCT. The previously developed method was significantly extended by applying it to a distinct tubular segment, varying the number of rounds of biopanning and incubating phage libraries with absorber cells prior to biopanning. Binding specificity and cellular localization of selected peptide-displaying phage or the corresponding synthetic peptide were analyzed using various epithelial cell lines as well as competition assays and confocal immunofluorescence microscopy.ResultsScreening phage-display peptide libraries, depleted of ligands binding to ubiquitously expressed receptors by preincubation with HEK-293 cells, led to the identification of two PCT-specific ligands. Phage expressing peptides with the consensus sequence GV(K/R)GX3(T/S) or RDXR mediated 15-fold and 13-fold higher binding to PCT than control phage, and binding to PCT was 13-fold and 21-fold higher than binding to CCD, respectively. Neither phage mediated significant binding to various epithelial cell lines, and binding of both ligands was abolished by the addition of the corresponding synthetic peptide. Immunofluorescence experiments revealed a submembrane localization of both ligands upon incubation with PCT.ConclusionsExploiting the versatility of phage-display and biopanning allowed the identification of two distinct peptide ligands that bind specifically to the basolateral membrane of PCT. Tubule segment-specific ligands, such as the described PCT ligands, may be useful for the analysis of cell-extracellular matrix interactions and may contribute to the development of new therapeutic strategies for renal diseases

Cruciate retaining and cruciate substituting ultra-congruent insert

The posterior cruciate ligament (PCL) conservation and the polyethylene insert constraint in total knee arthroplasty (TKA) are still debated. The PCL is one of the primary stabilizers of the joint, but cruciate retaining (CR) implants have the disadvantage of a difficult balancing of the PCL. Postero-stabilized (PS) implants were introduced to reduce this problem. However, also the PS implants have some disadvantages, due to the cam-mechanism, such as high risk of cam-mechanism polyethylene wear. To minimize the polyethylene wear of the cam-mechanism and the bone sacrifice due to the intercondylar box, different types of inserts were developed, trying to increase the implant conformity and to reduce stresses on the bone-implant interface. In this scenario ultra-congruent (UC) inserts were developed. Those inserts are characterized by a high anterior wall and a deep-dished plate. This conformation should guarantee a good stability without the posterior cam. Few studies on both kinematic and clinical outcomes of UC inserts are available. Clinical and radiological outcomes, as well as kinematic data are similar between UC mobile bearing (MB) and standard PS MB inserts at short to mid-term follow-up. In this manuscript biomechanics and clinical outcomes of UC inserts will be described, and they will be compared to standard PS or CR inserts

Sound velocities and single-crystal elasticity of hydrous Fo90 olivine to 12 GPa

Nominally anhydrous minerals (NAMs) may contain significant amounts of water and constitute an important reservoir for mantle hydrogen. The colloquial term ‘water’ in NAMs is related to the presence of hydroxyl-bearing (OH-) point defects in their crystal structure, where hydrogen is bonded to lattice oxygen and is charge-balanced by cation vacancies. This hydrous component may therefore have substantial effects on the thermoelastic parameters of NAMs, comparable to other major crystal-chemical substitutions (e.g., Fe, Al). Assessment of water concentrations in natural minerals from mantle xenoliths indicates that olivine commonly stores ~0 – 200 ppm of water. However, the lack of samples originating from depths exceeding ~250 km coupled with the rapid diffusion of hydrogen in olivine at magmatic temperatures makes the determination of the olivine water content in the upper mantle challenging. On the other hand, numerous experimental data show that, at pressures and temperatures corresponding to deep upper mantle conditions, the water storage capacity of olivine increases to 0.2 – 0.5 wt.%. Therefore, determining the elastic properties of olivine samples with more realistic water contents for deep upper mantle conditions may help in interpreting both seismic velocity anomalies in potentially hydrous regions of Earth's mantle as well as the observed seismic velocity and density contrasts across the 410-km discontinuity. Here, we report simultaneous single-crystal X-ray diffraction and Brillouin scattering experiments at room temperature up to 11.96(2) GPa on hydrous (0.20(3) wt.% H2O) Fo90 olivine to assess its full elastic tensor, and complement these results with a careful re-analysis of all the available single-crystal elasticity data from the literature for anhydrous Fo90 olivine. While the bulk (K) and shear (G) moduli of hydrous Fo90 olivine are virtually identical to those of the corresponding anhydrous phase, their pressure derivatives K´ and G´ are slightly larger, although consistent within mutual uncertainties. We then defined linear relations between the water concentration in Fo90 olivine, the elastic moduli and their pressure derivatives, which were then used to compute the sound velocities of Fo90 olivine with higher degrees of hydration. Even for water concentrations as high as 0.5 wt.%, the sound wave velocities of hydrous and anhydrous olivines were found to be identical within uncertainties at pressures corresponding to the base of the upper mantle. Contrary to previous claims, our data suggest that water in olivine is not seismically detectable, at least for contents consistent with deep upper mantle conditions. In addition to that, our data reveal that the hydration of olivine is unlikely to be a key factor in reconciling seismic velocity and density contrasts across the 410-km discontinuity with a pyrolitic mantle

What Is the Role of Nanotechnology in Diagnosis and Treatment of Metastatic Breast Cancer? Promising Scenarios for the Near Future

Metastatic breast cancer represents a diagnostic and therapeutic challenge due to tumor heterogeneity and to various physiological barriers that hinder drug delivery to the metastatic sites. To overcome these limitations, nanoformulated drugs have been developed and tested in preclinical studies, and few of them have been successfully translated into clinical practice. In particular, liposomal anthracyclines and nanoformulated albumin-bound paclitaxel have revealed an improved therapeutic index when compared to conventional chemotherapy, with significant reduction of drugs toxicity. Several strategies for nanoparticles engineering have more recently been explored to increase selectivity for tumor cells and to reach poorly accessible metastatic districts. Targeted nanoparticles, directed toward tumor markers and tissue-specific metastases, may provide effective devices in case of low-vascularized and small-sized metastases, thus paving the way for a real change in the natural history of metastatic disease. A number of targets have been identified and exploited for surface functionalization of different types of nanoparticles, which are currently undergoing preclinical studies. The aim of this review is to provide an overview of current nanotechnology applied to metastatic breast cancer diagnosis and treatment. Promising results encourage an upcoming translation of this research into clinical practice for an effective management of the disease in the near future

Re-evaluating Adjuvant Breast Cancer Trials: Assessing Hormone Receptor Status by Immunohistochemical Versus Extraction Assays

Background: Tumor levels of steroid hormone receptors, a factor used to select adjuvant treatment for early-stage breast cancer, are currently determined with immunohistochemical assays. These assays have a discordance of 10%-30% with previously used extraction assays. We assessed the concordance and predictive value of hormone receptor status as determined by immunohistochemical and extraction assays on specimens from International Breast Cancer Study Group Trials VIII and IX. These trials predominantly used extraction assays and compared adjuvant chemoendocrine therapy with endocrine therapy alone among pre- and postmenopausal patients with lymph node-negative breast cancer. Trial conclusions were that combination therapy provided a benefit to pre- and postmenopausal patients with estrogen receptor (ER)-negative tumors but not to ER-positive postmenopausal patients. ER-positive premenopausal patients required further study. Methods: Tumor specimens from 571 premenopausal and 976 postmenopausal patients on which extraction assays had determined ER and progesterone receptor (PgR) levels before randomization from October 1, 1988, through October 1, 1999, were re-evaluated with an immunohistochemical assay in a central pathology laboratory. The endpoint was disease-free survival. Hazard ratios of recurrence or death for treatment comparisons were estimated with Cox proportional hazards regression models, and discriminatory ability was evaluated with the c index. All statistical tests were two-sided. Results: Concordance of hormone receptor status determined by both assays ranged from 74% (κ = 0.48) for PgR among postmenopausal patients to 88% (κ = 0.66) for ER in postmenopausal patients. Hazard ratio estimates were similar for the association between disease-free survival and ER status (among all patients) or PgR status (among postmenopausal patients) as determined by the two methods. However, among premenopausal patients treated with endocrine therapy alone, the discriminatory ability of PgR status as determined by immunohistochemical assay was statistically significantly better (c index = 0.60 versus 0.51; P = .003) than that determined by extraction assay, and so immunohistochemically determined PgR status could predict disease-free survival. Conclusions: Trial conclusions in which ER status (for all patients) or PgR status (for postmenopausal patients) was determined by immunohistochemical assay supported those determined by extraction assays. However, among premenopausal patients, trial conclusions drawn from PgR status differed—immunohistochemically determined PgR status could predict response to endocrine therapy, unlike that determined by the extraction assa

P1245 Polymorphic Variants of HSD3B1 Gene Confer Different Outcome in Specific Subgroups of Patients Infected With SARS-CoV-2

Introduction: Severe respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the androgen receptor (AR), through ACE2 receptor and TMPRSS2, to enter nasal and upper airways epithelial cells. Genetic analyses revealed that HSD3B1 P1245C polymorphic variant increases dihydrotestosterone production and upregulation of TMPRSS2 with respect to P1245A variant, thus possibly influencing SARS-CoV-2 infection. Our aim was to characterize the HSD3B1 polymorphism status and its potential association with clinical outcomes in hospitalized patients with COVID-19 in Southern Switzerland. Materials and Methods: The cohort included 400 patients hospitalized for COVID-19 during the first wave between February and May 2020 in two different hospitals of Canton Ticino. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue blocks, and HSD3B1 gene polymorphism was evaluated by Sanger sequencing. Statistical associations were verified using different test. Results: HSD3B1 polymorphic variants were not associated with a single classical factor related to worse clinical prognosis in hospitalized patients with SARS-CoV-2. However, in specific subgroups, HSD3B1 variants played a clinical role: intensive care unit admission was more probable in patients with P1245C diabetes compared with P1245A individuals without this comorbidity and death was more associated with hypertensive P1245A>C cases than patients with P1245A diabetes without hypertension. Discussion: This is the first study showing that HSD3B1 gene status may influence the severity of SARS-CoV-2 infection. If confirmed, our results could lead to the introduction of HSD3B1 gene status analysis in patients infected with SARS-CoV-2 to predict clinical outcome. Keywords: HSD3B1 gene polymorphism; Likelihood-ratio tests; SARS-CoV-2; androgen receptor; direct sequencing

Swiss digital pathology recommendations: results from a Delphi process conducted by the Swiss Digital Pathology Consortium of the Swiss Society of Pathology

Integration of digital pathology (DP) into clinical diagnostic workflows is increasingly receiving attention as new hardware and software become available. To facilitate the adoption of DP, the Swiss Digital Pathology Consortium (SDiPath) organized a Delphi process to produce a series of recommendations for DP integration within Swiss clinical environments. This process saw the creation of 4 working groups, focusing on the various components of a DP system (1) scanners, quality assurance and validation of scans, (2) integration of Whole Slide Image (WSI)-scanners and DP systems into the Pathology Laboratory Information System, (3) digital workflow-compliance with general quality guidelines, and (4) image analysis (IA)/artificial intelligence (AI), with topic experts for each recruited for discussion and statement generation. The work product of the Delphi process is 83 consensus statements presented here, forming the basis for "SDiPath Recommendations for Digital Pathology". They represent an up-to-date resource for national and international hospitals, researchers, device manufacturers, algorithm developers, and all supporting fields, with the intent of providing expectations and best practices to help ensure safe and efficient DP usage