Preferential induction of MLL (Mixed Lineage Leukemia) rearrangements in human lymphocyte cultures treated with etoposide

Topoisomerase II inhibitors are effective chemotherapeutic agents in the treatment of cancer, in spite of being associated with the development of secondary leukemia. Our purpose was to determine the effects of etoposide on different genomic regions, aiming at discovering whether there are preferential sites which can be targeted by this drug in peripheral lymphocytes from healthy individuals. The in vitro treatment with low doses of etoposide (0.25, 0.5, and 1 µg/mL, in 1 hour-pulse or continuous-48 h treatment) induced a significant increase in chromosomal aberrations, detected by conventional staining and FISH with specific probes for chromosomes 8 and 11, compared with untreated controls (p < 0.05). Additionally, the frequencies of alterations at 11q23, detected by MLL specific probes, were significantly higher (p < 0.005) in treated cells than in controls. In contrast, an analysis of rearrangements involving the IGH gene did not disclose differences between treatments. The present results demonstrated the potential of etoposide to interact with preferential chromosome sites in human lymphocytes, even at concentrations below the mean plasma levels measured in cancer patients. This greater susceptibility to etoposide-induced cleavage may explain the more frequent involvement of MLL in treatment-related leukemia.FAPESPCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)CNP

Cytogenetic Instability in Childhood Acute Lymphoblastic Leukemia Survivors

Contemporary anticancer therapies have largely improved the outcome for children with cancer, especially for Acute Lymphoblastic Leukemia (ALL). Actually, between 78% and 85% of patients achieve complete remission and are alive after 5 years of therapy completion. However, as cure rates increase, new concerns about the late effects of genotoxic treatment emerge, being the risk of developing secondary neoplasias, the most serious life-threatening rising problem. In the present paper, we describe and review the cytogenetic findings in peripheral lymphocytes from ALL survivors, and discuss aspects associated to the occurrence of increased chromosome rearrangements in this growing cohort

MLL leukemia-associated rearrangements in peripheral blood lymphocytes from healthy individuals

Chromosomal translocations are characteristic of hematopoietic neoplasias and can lead to unregulated oncogene expression or the fusion of genes to yield novel functions. In recent years, different lymphoma/leukemia-associated rearrangements have been detected in healthy individuals. In this study, we used inverse PCR to screen peripheral lymphocytes from 100 healthy individuals for the presence of MLL (Mixed Lineage Leukemia) translocations. Forty-nine percent of the probands showed MLL rearrangements. Sequence analysis showed that these rearrangements were specific for MLL translocations that corresponded to t(4;11)(q21;q23) (66%) and t(9;11) (20%). However, RT-PCR failed to detect any expression of t(4;11)(q21;q23) in our population. We suggest that 11q23 rearrangements in peripheral lymphocytes from normal individuals may result from exposure to endogenous or exogenous DNA-damaging agents. In practical terms, the high susceptibility of the MLL gene to chemically-induced damage suggests that monitoring the aberrations associated with this gene in peripheral lymphocytes may be a sensitive assay for assessing genomic instability in individuals exposed to genotoxic stress

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Assessment of cellular responses mediated by temozolomide combined with metoxiamina, an inhibitor of DNA repair, in glioblastoma cell lines.

Os gliomas compreendem mais de 70% de todos os tumores cerebrais primários. Mesmo com tratamento agressivo, a média de sobrevivência relatada para estes tumores é geralmente menor do que 1 ano após o diagnóstico. A quimioterapia baseada em agentes alquilantes, como a temozolomida (TMZ), tem mostrado, em média, uma modesta resposta e pequeno aumento da sobrevida. As principais lesões causadas pela TMZ são os aductos N7-metil-G e N3-metil-A, que são processados pelo reparo por excisão de base (BER), compreendendo mais de 80% das lesões induzidas no DNA pela TMZ. Há evidência de que a resistência a este quimioterápico pode ser causada em parte por um eficiente processo de reparo via BER, mas poucos estudos têm focalizado essa abordagem. Metoxiamina (MX) é um inibidor do reparo via BER que tem sido atualmente investigado como um possível aliado no combate a vários tipos de tumores, aumentando os efeitos citotóxicos de drogas, tais como a TMZ. No presente trabalho, foram avaliadas as respostas celulares de células de glioblastoma (GBM) ao tratamento com a TMZ, associada ou não à MX. Foram analisados parâmetros como citotoxicidade (24 h, Kit XTT), sobrevivência celular (120 h, Kit XTT) e clonogênica (10 dias após o tratamento), danos no DNA pelo Ensaio Cometa (2, 6, 12 e 24 h), a indução de apoptose (24, 48 e 72 h) e alterações na expressão gênica e transcricional (24, 48 e 72h) de genes envolvidos na via de reparo por BER. Sob tratamento das linhagens de GBM (U87, U343, U251, U138 e T98G) a diferentes concentrações de TMZ (100 a 1000 M), o efeito citotóxico foi observado em células analisadas após 120 h, sendo que a linhagem T98G foi a mais resistente ao tratamento com TMZ e foi a única a apresentar diferenças significativas entre o tratamento sozinho e combinado (p 0,05). Assim, foi selecionada a linhagem T98G para os demais experimentos e estudar as possíveis vias implicadas na resistência a essa droga. A sobrevivência clonogênica das células T98G foi reduzida, sob tratamento com a TMZ (100 a 800 M), com diferença significativas para as concentrações superiores a 400 M. Observou-se que o efeito da TMZ foi acentuado quando associada ao inibidor, com diferenças significativas para todas as concentrações testadas. A droga induziu uma maior porcentagem de danos no DNA (Ensaio Cometa) para ambos os tratamentos (400 e 600 M) e nos tempos de 2 e 6 h, com diferenças significativas entre os tratamentos (TMZ e TMZ+MX), somente na concentração de 600 M/2 h. Entretanto esses danos se equipararam nos tempos seguintes. A indução de apoptose analisada nas células T98G mostrou a freqüência máxima de 24,2% no tempo de 72h, na concentração de 600 M de TMZ, enquanto que uma maior indução de apoptose (47,7%) foi observada para a mesma concentração no tratamento combinado (TMZ + MX), resultando em diferenças significativas. A análise de expressão gênica realizada para os genes APE1, FEN1 e XRCC1, mostraram que houve uma menor indução dos genes APE1 e FEN1 no tratamento combinado. A expressão da proteína APE1 (analisada por Western blot) foi menos intensa em todos os tempos de tratamento combinado (TMZ + MX), possivelmente pelo bloqueio dos sítios AP causado pelo inibidor MX. A proteína FEN1 mostrou-se menos expressa na comparação dos tratamentos, nos tempos de 48 e 72 h, indicando uma inibição de proteínas da via BER downstream à remoção de sítios AP por APE1, possivelmente pela ligação de MX. PCNA teve sua expressão protéica aumentada no tratamento combinado, nos tempos de 24 h, e principalmente em 48 h, sugerindo uma indução devida a um aumento de danos no DNA. Portanto, os resultados dos ensaios realizados com a associação da TMZ à MX demonstraram a influência do tratamento combinado sobre a expressão de proteínas envolvidas no reparo via BER, o que contribuiu para uma redução da capacidade proliferativa das células T98G em decorrência da maior indução de danos por aductos DNA-MX não reparados, resultando também em aumento de morte celular apoptótica. Esses dados mostram que a modulação do reparo via BER pode constituir uma estratégia promissora para aumentar a eficácia do tratamento com a TMZ, o que poderá futuramente embasar a escolha de procedimentos terapêuticos que resultem numa maior eficácia do tratamento de gliomas com agentes alquilantes.Gliomas represent more than 70% of primary brain tumors. Even following an aggressive therapies, the mean survival rate of patients with these tumors is less than one year after diagnosis. Chemotherapy based on alkyklating agents, such as temozolomide (TMZ) has been reported to increase the survival rate. N7-metyl-G and N3-metyl-A adducts comprise more than 80% of the DNA lesions induced by TMZ and are processed by the base excision repair process (BER). There is evidence in the literature suggesting that the resistance to TMZ could be caused, in part, by an efficient repair by BER pathway, although few studies have focused on this subject. Metoxiamine (MX) is an effective BER inhibitor, which has been investigated as a conceivable treatment for different kinds of tumor, due to its synergistic effect with antitumoral drugs, such as TMZ. In the present study, the cellular responses to TMZ treatment associated or not with MX were evaluated in giloblastoma (GBM) cell lines. Several parameters were analyzed, such as cytotoxicity (24 h), cellular survival (120 h) and clonogenic efficiency (10 days after treatment), DNA damage and repair kinetics (after 2, 6, 12 and 24 h of recovery time), apoptosis induction (24, 48 and 72 h) and alterations in gene expression (24, 48 e 72h) for genes playing role in BER pathway. The treatment with TMZ 100 -1000 M (during 24 h) was cytotoxic for all GBM cell lines tested (U87, U343, U251, U138 and T98G), as analyzed after 120 h, with the T98G cell line being be the most resistant to TMZ; besides, T98G was the only one to present significant differences (p 0,05) in survival rates measured between TMZ treatment and TMZ combined with MX. Thus, T98G cells were selected for the subsequent experiments and for the study of the pathways implicated in TMZ resistance. The clonogenic efficiency of T98G cells was reduced under TMZ treatment (100 - 800 M) with significant differences for treatments above 400 M. In addition, the combined treatment TMZ plus MX significantly increased the cytotoxic effects, even for the lowest concentration. The comet assay showed higher percentage of DNA damage for both treatment modalities (TMZ and TMZ+MX) at 2 and 6 h of recovery, with significant differences between treatments for 2 h. Following 12 and 24 h of recovery, the amount of DNA damage reached the control levels, indicating the repair of DNA breaks. Apoptosis induction in T98G cells showed the highest frequency (24.2%) at 72h for 600 M TMZ, while the highest apoptosis induction (47.7%) was observed for the same concentration combined to MX. Quantitative gene expression analysis performed for three genes, APE1, FEN1 and XRCC1, showed a reduced expression of APE1 and FEN1 for the combined treatment. Western blot analysis demonstrated that APE1 was less expressed for all kind of treatments, probably due to AP-sites blockade caused by the inhibitor MX. In addition, FEN1 showed low levels of expression at 48h and 72h, indicating the inhibition of BER pathway downstream to the AP removal by APE1. On the other hand, PCNA expression was higher for the combined treatment (24h and mainly 48h), suggesting its induction probably due to increased DNA damage. Therefore, the present results demonstrated that the association of TMZ with MX interfered with the expression of proteins involved in BER, thus, reducing the clonogenic efficiency of T98G cells, probably as a consequence of the high production of unrepaired DNA-MX adducts, leading to cell death, including apoptosis. These data show that the modulation of BER is a promising strategy for magnifying the therapeutic impact of TMZ, and in the next future, this strategy may embrace the option to establish novel and efficient therapy protocols for the treatment of gliomas with alkylating agents

Influence of APE1/REF-1 Gene on Cellular Responses of Glioblastoma Cells to Chemotherapeutic Temozolomide

A proteína APE1 (do inglêsApurinic/Apyrimidinicendonuclease 1/ Redox Factor-1 - APE1/REF-1) é uma enzima multifuncional, cuja expressão encontra-se frequentemente aumentada em gliomas. Além de apresentar atividade no reparo por excisão de base (BER), o gene APE1 também atua como fator de redução, mantendo fatores de transcrição (FTs) em um estado reduzido ativo. A via BER de reparo do DNA tem sido apontada como um possível fator de resistência a terapias baseadas no uso de agentes alquilantes, tais como temozolomida (TMZ). No presente trabalho, utilizou-se a estratégia de inibição da transcrição do gene APE1 pelo método de RNA interferente(siRNA) e tratamento com a droga TMZ nas células de glioblastoma (GBM), T98G (resistente à TMZ) e U87MG (sensível à TMZ), a fim de verificar a influência do silenciamento do gene APE1 sobre as respostas celulares à droga avaliadas por vários ensaios, bem como os efeitos sobre a expressão transcricional dos genes alvos dos FTs regulados por APE1. O silenciamento de APE1 e o tratamento das células T98G com a TMZ foram eficazes no sentido de reduzir a proliferação e a capacidade clonogênica, além de intervir na progressão do ciclo celular com bloqueio na fase S. Tais efeitos foram acompanhados pelo aumento da indução de danos no DNA e da expressão de H2AX fosforilada (H2AX), o que justifica a queda na sobrevivência celular. O mesmo efeito não foi observado nas células U87MG silenciadas para APE1 e tratadas com a TMZ, havendo o predomínio dos efeitos causados pela TMZ, exceto por uma leve indução de danos no DNA e de H2AX. Adicionalmente, nas células T98G silenciadas e tratadas, verificou-se uma moderada indução de apoptose, que foi observada ao longo dos tempos avaliados (1 a 10 dias), com uma leve indução de caspase-3 (5 dias); nessas células, observou-se também a indução (3,8 vezes) de morte celular autofágica (5 dias). Entretanto, nas células U87MG,a indução de apoptose foi baixa e não houve indução de morte por autofagia, sugerindo outros mecanismos de morte envolvidos na eliminação dessas células em resposta ao tratamento com a TMZ. O silenciamento de APE1 causou uma redução acentuada na invasão das células T98G, de forma similar à observada nas células somente tratadas com a TMZ, sendo que a combinação (silenciamento de APE1 e tratamento com a droga) resultou em um efeito aditivo, enquanto que nas células U87MG a combinação foi eficaz no sentido de reduzir a proporção de células invasivas, fato não observado nas condições isoladas. Os genes COX2 e VEGF, alvos dos FT NFB e HIF-1 (regulados por APE1) foram reprimidos nas células T98G enquanto que o gene VEGF foi induzido nas células U87MG, entretanto, tais alterações no padrão de expressão transcricional foram observadas somente em resposta ao tratamento com a TMZ, independentemente do silenciamento de APE1, indicando nenhuma mudança na atividade redox de APE1, possivelmente pela existência de proteínas APE1 remanescentes na célula. Além disso, a expressão proteica de NFBp65(ser563) foi aumentada em ambas as linhagens silenciadas e tratadas com a TMZ, provavelmente devido à inibição da proliferação celular. Em geral, os resultados do presente trabalho demonstraram que a estratégia de inibição do gene APE1 (participante da via BER) mostrou-se potencialmente viável, suportando a contribuição do BER na resistência à TMZ, visto que nas condições testadas, observou-se uma sensibilização das células de GBM, com efeito restrito às células de GBM resistentes (linhagem T98G), sendo pouco eficaz no sentido de sensibilizar as células sensíveis (linhagem U87MG) a esse agente. Assim, há que considerar as características genéticas de cada linhagem de GBM, visto que estas são cruciais para as respostas apresentadas pelas células aos tratamentos empregados.APE1 (Apurinic/Apyrimidinic endonuclease 1/ Redox Factor-1 - APE1/REF-1) protein is a multifunctional enzyme whose expression is often increased in gliomas. Besides presenting activity in base excision repair (BER), APE1 also acts as a reduction factor, maintaining transcription factors (TFs) in an active reduced state. The BER pathway has been implicated as a possible factor of resistance to therapies based on the use of alkylating agents such as temozolomide (TMZ). In the present study, we have been using a strategy of small interference RNA (siRNA) to down-regulate the APE1 gene under conditions of treatment with TMZ in T98G (resistant to TMZ) and U87MG (sensitive to TMZ), glioblastoma (GBM), in order to determine the effects of APE1 gene silencing on cellular responses to this drug, evaluated by several assays, as well as the effects on the transcriptional expression of target genes of TFs regulated by APE1. APE1 silencing and TMZ treatment was effective to reduce the cell proliferation and clonogenic capacity of T98G cells, in addition to interfering in the cell cycle progression (S-phase arrest). These effects were accompanied by induction of DNA damage and phosphorylation of H2AX (H2AX), which may explain the decrease in cell survival. The same effect was not observed in silenced U87MG and TMZ-treated cells, being observed a predominance of the effects caused by TMZ itself, except for a slight induction of DNA damage and H2AX. Additionally, in silenced T98G and TMZ-treated cells, there was a moderate induction of apoptosis, as observed over time (1 to 10 days), with a slight induction of caspase-3 (on day 5); for those cells, we also observed autophagic induction (3.8 fold) at day 5. However, the induction of apoptosis and autophagy in U87MG cells was very low, suggesting that other mechanisms of cell death might be involved in the elimination of GBM cells under TMZ treatment. APE1 silencing caused a marked reduction on the invasiveness of T98G cells, similarly to that observed in TMZ treated cells, while the combination (APE1 silencing and drug treatment) led to an additive effect. For U87MG, the treatment combination was effective in reducing the proportion of invasive cells, in spite of an absence of any effect produced by each isolated condition tested. Regarding to the expression profile of target genes of TFs regulated by the APE1 redox activity, it was observed that COX2 and VEGF genes, targets of FTs NFB and HIF-1, were down-regulated in T98G while VEGF gene showed induced in U87MG cells; however, such alterations in the transcriptional expression pattern were observed only in response to TMZ treatment, independently of APE1 gene silencing, indicating no change in the APE1 redox activity, possibly due to the presence of APE1 remaining proteins inside cells. In addition, NFBp65(ser563) protein expression was increased in both cell lines (silenced and treated with TMZ), probably due to the reduced cell proliferation rates. In general, the present results show that the strategy of APE1 gene knockdown was potentially viable, supporting the BER contribution of the mechanism of TMZ resistance, since under the conditions tested, there was a sensitization of GBM cells. However, this effect was restricted to the resistant cell line (T98G cells). Thus, it should be considered the genetic characteristics of each GBM cell line, since these are crucial to the cellular responses to the conditions tested in the present work

In Vitro PLK1 Inhibition by BI 2536 Decreases Proliferation and Induces Cell-Cycle Arrest in Melanoma Cells

Melanoma is one of the most treatment-resistant malignancies and regardless of new therapeutic tactics the outcome remains dismal. Polo-like kinase 1 (PLK1) has been shown to be over-expressed in a variety of tumors, becoming an attractive target for cancer management. In the present study we tested the in vitro antitumor activities of BI 2536, a selective inhibitor of PLK1, against two melanoma cell lines. Our results showed that nanomolar concentrations (10-150 nmol/L) of the drug significantly decreased cell proliferation and clonogenicity, promoting cell cycle arrest in G2/M. Targeting the cell cycle offers an attractive potential cancer-treatment option. Herein we show that PLK1 inhibition may be a feasible approach for the impairment of tumor progression and dissemination. This in vitro profile of melanoma cell growth inhibition by PLK1 modulation may be an interesting model to be tested in association with first-line antineoplasic agents in melanomas.CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico-Brazil) [471952/2011-7]CNPq (Conselho Nacional de Desenvolvimento Cientifico e TecnologicoBrazil