Liver cancer in a dish: modelling hepatocellular carcinoma using patient-derived tumor organoids

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the second most frequent cause of cancer-related mortality worldwide. HCC predominantly arises in cirrhotic livers as a consequence of underlying chronic diseases including viral hepatitis, alcoholic liver disease and non-alcoholic steatohepatitis. Treatment options for advanced HCC are limited. Sorafenib (Nexavar®) has been the only approved drug for the management of advanced HCC for the past ten years. Recently, additional multikinase inhibitors entered the clinic, however, without significantly improving overall survival as compared to sorafenib. Major advancements are expected to be achieved with the introduction of immune checkpoint inhibitors such as nivolumab (Opdivo®), but biomarkers to identify patients who may benefit from the treatment are currently missing. Moreover, several additional drugs have failed to meet clinical end points in large phase III trials, indicating a need for new drug discovery for HCC. A major obstacle for the development of new therapies is the lack of suitable preclinical animal models or cell culture systems that allow a faithful translation of basic research findings into the clinical setting. This thesis describes the generation of organoids derived from needle biopsies of HCCs. The use of tumor biopsies instead of surgically resected HCC specimens is important because it allows to generate organoids from all tumor stages, whereas surgical resection of HCCs is limited to a minority of patients with small, early stage tumors. These tumors are typically not treated with systemic therapies, and material derived from them might have limited value for developing new treatments for advanced HCCs. Because of the very limited amount of tissue that can be obtained with a needle biopsy, generation of HCC organoids was technically challenging. A key to our success was the immediate sample processing. The biobank of tumor organoids described in this study encompasses different etiologies and, most importantly, all clinical tumor stages. Our study design also allowed to compare the organoids with the originating tumor biopsies. We found that HCC organoids preserve the morphological characteristics and tumor marker expression of their originating tumors. Moreover, a comprehensive analysis of the genetic landscape in both, primary tumors and corresponding organoids, revealed a high concordance of the molecular alterations and the genetic heterogeneity, confirming that the organoids are a genuine representation of the originating tumors. In addition, tumor organoids can be successfully transplanted and propagated in immunodeficient mice to generate xenografts. Finally, in a proof of concept study, we show that tumor organoids can be used to test sensitivities to clinically-relevant drugs and provide a promising novel tool for developing tailored therapies

Cultural Discourse Analysis of Russian Alcohol Consumption

The study uses cultural discourse analysis to explore alcohol consumption that is valued as normal and enjoyable, and to examine how alcohol consumption is viewed as a problem in both folk and official discourses in Russia. An event called “posidet’” (to sit) is deeply embedded in Russian cultural discourse in the form of a communication ritual with enjoyable alcohol consumption. The ritual has a structured sequence, commonly upheld norms, and a multilayered “sacred object” that provides access to cultural meanings of Russian personhood, relations, actions, emotions, and location in the nature of things. A ritualistic corrective sequence in case someone refuses a drink results in a clash between the face of the immediate group and the face of the individual refusing to drink. The success of communal motives over individual ones ensures achieving “understanding,” the ultimate goal of the “sitting” event. Russian folk discourse defines problem drinking through two key terms and their clusters: “to drink” (regular consumption driven by dependency) and “to get drunk” (one-time heavy intoxication). Russian government discourse addresses problem drinking mainly though a term cluster that presumes a drinking individual’s imminent move toward alcoholism, with irreversible harm done to health, personhood, relationships, career, and Russia as a country. A comparative analysis demonstrates that the official discourse largely ignores the practice conveyed by the folk term cluster “to get drunk,” and portrays most of the problematic consumption through a term cluster close in its meaning to the folk practice “to drink.

«Ad unum velle et unum nolle». La Grande Congiura attraverso la diplomazia ribelle (1485-87)

Il progetto ReDiAr - Reti Diplomatiche Aragonesi (https://sites.google.com/unibas.it/rediar/home) offre un inventario digitale ad accesso aperto delle cartelle 246 e 247 (agosto 1485 - dicembre 1489) dell’Archivio di Stato di Milano, fondo Sforzesco Potenze Estere, risalenti al periodo della Grande Congiura ordita nel 1485-1487 da alcuni dei più importanti baroni e funzionari del Regno di Napoli contro re Ferrante I d’Aragona. La Congiura dei Baroni fu contrassegnata da diverse e numerose pratiche di ambasceria svolte per iniziativa degli stessi congiurati e del loro alleato più influente, papa Innocenzo VIII. Tra queste missioni sono annoverate quelle intrattenute con diverse potenze estere tra cui, appunto, quella pontificia, grazie alla quale fu possibile anche organizzare la ribellione de L’Aquila e dell’Abruzzo. Non vanno, inoltre, tralasciati i vari tentativi degli aristocratici di coinvolgere nel conflitto la Serenissima Repubblica di Venezia e il duca di Lorena Renato II, “vecchi” nemici della dinastia aragonese di Napoli. Senza contare, infine, il caso particolare rappresentato dal “Turco”, vero e proprio deterrente adoperato dalle varie parti in causa durante tutto il conflitto. In questo contesto, significativi sono anche gli scambi diplomatici tra i ribelli e la corte, che si manifestavano attraverso simulazioni e inganni, in cui la due parti ingaggiavano una vera e propria guerra diplomatica, fingendo un’apertura che in realtà, soprattutto da parte del sovrano, era necessaria per smascherare le intenzioni del nemico

Contrasting roles of SPARC-related granuloma in bacterial containment and in the induction of anti–Salmonella typhimurium immunity

The role of matricellular proteins in bacterial containment and in the induction of pathogen-specific adaptive immune responses is unknown. We studied the function of the matricellular protein secreted protein, acidic and rich in cysteine (SPARC/osteonectin) in the dissemination of locally injected Salmonella typhimurium and in the subsequent immune response. We show that SPARC was required for the development of organized acute inflammatory reactions with granuloma-like (GL) features and for the control of bacterial spreading to draining lymph nodes (DLNs). However, SPARC-related GL also inhibited dendritic cell (DC) migration to the DLNs and limited the development of adaptive immune response, thus conferring increased susceptibility to the pathogen. In SPARC-deficient mice, both DC migration and antigen-specific responses were restored against bacteria, leading to protective anti–S. typhimurium immunity. This highlights a new function of matricellular proteins in bacterial infection and suggests that initial containment of bacteria can have drawbacks

Prognostic and Predictive Value of Immune-Related Gene Expression Signatures vs Tumor-Infiltrating Lymphocytes in Early-Stage ERBB2/HER2-Positive Breast Cancer: A Correlative Analysis of the CALGB 40601 and PAMELA Trials

Càncer de mama; Expressió gènicaCáncer de mama; Expresión génicaBreast cancer; Gene ExpressionImportance Both tumor-infiltrating lymphocytes (TILs) assessment and immune-related gene expression signatures by RNA profiling predict higher pathologic complete response (pCR) and improved event-free survival (EFS) in patients with early-stage ERBB2/HER2-positive breast cancer. However, whether these 2 measures of immune activation provide similar or additive prognostic value is not known. Objective To examine the prognostic ability of TILs and immune-related gene expression signatures, alone and in combination, to predict pCR and EFS in patients with early-stage ERBB2/HER2-positive breast cancer treated in 2 clinical trials. Design, Setting, and Participants In this prognostic study, a correlative analysis was performed on the Cancer and Leukemia Group B (CALGB) 40601 trial and the PAMELA trial. In the CALGB 40601 trial, 305 patients were randomly assigned to weekly paclitaxel with trastuzumab, lapatinib, or both for 16 weeks. The primary end point was pCR, with a secondary end point of EFS. In the PAMELA trial, 151 patients received neoadjuvant treatment with trastuzumab and lapatinib for 18 weeks. The primary end point was the ability of the HER2-enriched subtype to predict pCR. The studies were conducted from October 2013 to November 2015 (PAMELA) and from December 2008 to February 2012 (CALGB 40601). Data analyses were performed from June 1, 2020, to January 1, 2022. Main Outcomes and Measures Immune-related gene expression profiling by RNA sequencing and TILs were assessed on 230 CALGB 40601 trial pretreatment tumors and 138 PAMELA trial pretreatment tumors. The association of these biomarkers with pCR (CALGB 40601 and PAMELA) and EFS (CALGB 40601) was studied by logistic regression and Cox analyses. Results The median age of the patients was 50 years (IQR, 42-50 years), and 305 (100%) were women. Of 202 immune signatures tested, 166 (82.2%) were significantly correlated with TILs. In both trials combined, TILs were significantly associated with pCR (odds ratio, 1.01; 95% CI, 1.01-1.02; P = .02). In addition to TILs, 36 immune signatures were significantly associated with higher pCR rates. Seven of these signatures outperformed TILs for predicting pCR, 6 of which were B-cell related. In a multivariable Cox model adjusted for clinicopathologic factors, including PAM50 intrinsic tumor subtype, the immunoglobulin G signature, but not TILs, was independently associated with EFS (immunoglobulin G signature–adjusted hazard ratio, 0.63; 95% CI, 0.42-0.93; P = .02; TIL-adjusted hazard ratio, 1.00; 95% CI, 0.98-1.02; P = .99). Conclusions and Relevance Results of this study suggest that multiple B-cell–related signatures were more strongly associated with pCR and EFS than TILs, which largely represent T cells. When both TILs and gene expression are available, the prognostic value of immune-related signatures appears to be superior

What if the future of HER2-positive breast cancer patients was written in miRNAs? An exploratory analysis from NeoALTTO study

HER2; MicroRNA; TrastuzumabHER2; MicroARN; TrastuzumabHER2; MicroARN; TrastuzumabBackground Neoadjuvant therapy with dual HER2 blockade improved pathological complete response (pCR) rate in HER2-positive breast cancer patients. Nevertheless, it would be desirable to identify patients exquisitely responsive to single agent trastuzumab to minimize or avoid overtreatment. Herein, we evaluated the predictive and prognostic value of basal primary tumor miRNA expression profile within the trastuzumab arm of NeoALTTO study (ClinicalTrials.gov Identifier: NCT00553358). Methods RNA samples from baseline biopsies were randomized into training (n = 45) and testing (n = 47) sets. After normalization, miRNAs associated with Event-free survival (EFS) and pCR were identified by univariate analysis. Multivariate models were implemented to generate specific signatures which were first confirmed, and then analyzed together with other clinical and pathological variables. Results We identified a prognostic signature including hsa-miR-153-3p (HR 1.831, 95% CI: 1.34–2.50) and hsa-miR-219a-5p (HR 0.629, 95% CI: 0.50–0.78). For two additional miRNAs (miR-215-5p and miR-30c-2-3p), we found a statistically significant interaction term with pCR (p.interaction: 0.017 and 0.038, respectively). Besides, a two-miRNA signature was predictive of pCR (hsa-miR-31-3p, OR 0.70, 95% CI: 0.53–0.92, and hsa-miR-382-3p, OR: 1.39, 95% CI: 1.01–1.91). Notably, the performance of this predictive miRNA signature resembled that of the genomic classifiers PAM50 and TRAR, and did not improve when the extended models were fitted. Conclusion Analyses of primary tumor tissue miRNAs hold the potential of a parsimonious tool to identify patients with differential clinical outcomes after trastuzumab based neoadjuvant therapy.This work was supported by a Young Investigator Grant (Ricerca Finalizzata Giovani Ricercatori) from the Italian Ministry of Health to M.V. Iorio (grant no. GR-2016-02361750)

Predictive Role of CD36 Expression in HER2-Positive Breast Cancer Patients Receiving Neoadjuvant Trastuzumab

CD36 expression; Breast cancer; Neoadjuvant trastuzumabExpresión CD36; Cáncer de mama; Trastuzumab neoadyuvanteExpressió CD36; Càncer de mama; Trastuzumab neoadjuvantBackground Despite huge efforts to identify biomarkers associated with long-term clinical outcomes in patients with early-stage HER2-positive breast cancer (HER2+ BC) treated with (neo)adjuvant anti-HER2 therapy, no reliable predictors have been identified so far. Fatty acid uptake, a process mediated by the transmembrane transporter CD36, has recently emerged as a potential determinant of resistance to anti-HER2 treatments in preclinical HER2+ BC models. Methods Here, we investigated the association between baseline intratumor CD36 gene expression and event-free survival in 180 patients enrolled in the phase III trial Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization (NeoALTTO), which randomly assigned stage II-III HER2+ BC patients to receive neoadjuvant lapatinib, trastuzumab, or lapatinib-trastuzumab in combination with chemotherapy. To this aim, we selected NeoALTTO trial patients for whom pretreatment whole transcriptomic data were available. The main study results were validated in an independent cohort of patients enrolled in the neoadjuvant phase II trial NeoSphere. Results In 180 NeoALTTO patients, high intratumor CD36 expression was independently associated with worse event-free survival in patients treated with trastuzumab-based therapy (hazard ratio [HR] = 1.72, 95% confidence interval [CI] = 1.20 to 2.46), but not with lapatinib-based (HR = 1.02, 95% CI = 0.68 to 1.53) or trastuzumab-lapatinib–based (HR = 1.08, 95% CI = 0.60 to 1.94) therapy. Among 331 NeoSphere patients evaluated, high CD36 expression was independently associated with worse patient disease-free survival in both the whole study cohort (HR = 1.197, 95% CI = 1.002 to 1.428) and patients receiving trastuzumab-based neoadjuvant therapy (HR = 1.282, 95% CI = 1.049 to 1.568). Conclusions High CD36 expression predicts worse clinical outcomes in early-stage HER2+ BC treated with trastuzumab-based neoadjuvant therapy.The NeoALTTO trial was sponsored by GlaxoSmithKline; the NeoSphere trial was sponsored by F. Hoffmann-La Roche. Our subanalysis of the NeoALTTO and NeoSphere trials received no funding by pharmaceutical companies

End-of-neoadjuvant treatment circulating microRNAs and HER2-positive breast cancer patient prognosis: An exploratory analysis from NeoALTTO

Cáncer de mama HER2 positivo; MicroARN circulante; Tratamiento neoadyuvanteCàncer de mama HER2-positiu; MicroARN circulant; Tractament neoadjuvantHER2-positive breast cancer; Circulating microRNA; Neoadjuvant treatmentBackground: The absence of breast cancer cells in surgical specimens, i.e., pathological complete response (pCR), is widely recognized as a favorable prognostic factor after neoadjuvant therapy. In contrast, the presence of disease at surgery characterizes a prognostically heterogeneous group of patients. Here, we challenged circulating microRNAs (miRNAs) at the end of neoadjuvant therapy as potential prognostic biomarkers in the NeoALTTO study. Methods: Patients treated within the trastuzumab arm (i.e., pre-operative weekly trastuzumab for 6 weeks followed by the addition of weekly paclitaxel for 12 weeks; post-operative FEC for 3 cycles followed by trastuzumab up to complete 1 year of treatment) were randomized into a training (n= 54) and testing (n= 72) set. RT-PCR-based high-throughput miRNA profile was performed on plasma samples collected at the end of neoadjuvant treatment of both sets. After normalization, circulating miRNAs associated with event free survival (EFS) were identified by univariate and multivariate Cox regression model. Results: Starting from 23 circulating miRNAs associated with EFS in the training set, we generated a 3-circulating miRNA prognostic signature consisting of miR-185-5p, miR-146a-5p, miR-22-3p, which was confirmed in the testing set. The 3-circulating miRNA signature showed a C-statistic of 0.62 (95% confidence interval [95%CI] 0.53-0.71) in the entire study cohort. By resorting to a multivariate Cox regression model we found a statistical significant interaction between the expression values of miR-194-5p and pCR status (p.interaction =0.005) with an estimate Hazard Ratio (HR) of 1.83 (95%CI 1.14- 2.95) in patients with pCR, and 0.87 (95%CI 0.69-1.10) in those without pCR. Notably, the model including this interaction along with the abovementioned 3-circulating miRNA signature provided the highest discriminatory capability with a C-statistic of 0.67 (95%CI 0.58-0.76). Conclusions: Circulating miRNAs are informative to identify patients with different prognosis among those with heterogeneous response after trastuzumab-based neoadjuvant treatment, and may be an exploitable tool to select candidates for salvage adjuvant therapy.The NeoALTTO study was sponsored by GlaxoSmithKline; Lapatinib is an asset of Novartis AG as of March 2, 2015. This sub-study was supported by the Italian Ministry of Health to SC. No grant number is applicable, funds were obtained through a law that allows tax-payers to allocate the 5 × 1000 share of their payments to research

Durvalumab plus tremelimumab for the treatment of advanced neuroendocrine neoplasms of gastroenteropancreatic and lung origin

Cancer immunotherapy; Neuroendocrine cancer; Tumour immunologyImmunoteràpia del càncer; Càncer neuroendocrí; Immunologia tumoralInmunoterapia del cáncer; Cáncer neuroendocrino; Inmunología tumoralSingle immune checkpoint blockade in advanced neuroendocrine neoplasms (NENs) shows limited efficacy; dual checkpoint blockade may improve treatment activity. Dune (NCT03095274) is a non-randomized controlled multicohort phase II clinical trial evaluating durvalumab plus tremelimumab activity and safety in advanced NENs. This study included 123 patients presenting between 2017 and 2019 with typical/atypical lung carcinoids (Cohort 1), G1/2 gastrointestinal (Cohort 2), G1/2 pancreatic (Cohort 3) and G3 gastroenteropancreatic (GEP) (Cohort 4) NENs; who progressed to standard therapies. Patients received 1500 mg durvalumab and 75 mg tremelimumab for up to 13 and 4 cycles (every 4 weeks), respectively. The primary objective was the 9-month clinical benefit rate (CBR) for cohorts 1-3 and 9-month overall survival (OS) rate for Cohort 4. Secondary endpoints included objective response rate, duration of response, progression-free survival according to irRECIST, overall survival, and safety. Correlation of PD-L1 expression with efficacy was exploratory. The 9-month CBR was 25.9%/35.5%/25% for Cohorts 1, 2, and 3 respectively. The 9-month OS rate for Cohort 4 was 36.1%, surpassing the futility threshold. Benefit in Cohort 4 was observed regardless of differentiation and Ki67 levels. PD-L1 combined scores did not correlate with treatment activity. Safety profile was consistent with that of prior studies. In conclusion, durvalumab plus tremelimumab is safe in NENs and shows modest survival benefit in G3 GEP-NENs; with one-third of these patients experiencing a prolonged OS.This work was supported by the Grupo Español de Tumores Neuroendocrinos y Endocrinos (GETNE). AstraZeneca provided durvalumab and tremelimumab and awarded a grant to GETNE to pay the costs of the study. The funder did not have a role in designing or conducting the study. The authors thank all patients and families, investigators and study staff involved in the DUNE trial; the MFAR Clinical Research team for regulatory, monitoring, and quality assurance activities; Pau Doñate PhD for manuscript and language editing; and Jordi Curto M.Sc. and Arturo Alvarez PhD for statistical support

Tumor-Associated Microbiome: Where Do We Stand?

Dysbiosis; Gut microbiome; TumorDisbiosis; Microbioma intestinal; TumorDisbiosi; Microbioma intestinal; TumorThe study of the human microbiome in oncology is a growing and rapidly evolving field. In the past few years, there has been an exponential increase in the number of studies investigating associations of microbiome and cancer, from oncogenesis and cancer progression to resistance or sensitivity to specific anticancer therapies. The gut microbiome is now known to play a significant role in antitumor immune responses and in predicting the efficacy of immune-checkpoint inhibitors in cancer patients. Beyond the gut, the tumor-associated microbiome-microbe communities located either in the tumor or within its body compartment-seems to interact with the local microenvironment and the tumor immune contexture, ultimately impacting cancer progression and treatment outcome. However, pre-clinical research focusing on causality and mechanistic pathways as well as proof-of-concept studies are still needed to fully understand the potential clinical utility of microbiome in cancer patients. Moreover, there is a need for the standardization of methodology and the implementation of quality control across microbiome studies to allow for a better interpretation and greater comparability of the results reported between them. This review summarizes the accumulating evidence in the field and discusses the current and upcoming challenges of microbiome studies