50 research outputs found
Trasplante de progenitores hemopoyéticos
In the second half of the XX century, the transplant
of hemopoietic progenitors ceased to be a desperate
treatment with a high incidence of complications
implying a high mortality, and became a
curative treatment for thousands of patients with
hematological neoplasias and other diseases. Since
then understanding of the hemopoietic stem cells
has increased, peripheral blood has replaced bone
marrow as a source of progenitors, cord blood has
been established as a viable source of progenitors
and the realisation of unrelated transplants is a reality
for many patients. The improvement of conditioning
regimes and the introduction of new non-myeloablative
treatments have reduced relapses. The
new diagnostic techniques and the new anti-microbial
treatments have reduced infectious complications
and their mortality. There has been an advance
in knowledge in determining minimal residual disease
and the anti-tumour effect of the lymphocytes of the
donor, which has made it possible to widen the indications.
Besides, new understanding of the immunobiology
of the transplant has, on the one hand,
improved the options for controlling one of the principal
complications, the graft-versus-host disease,
and, on the other, a better use is made of the
immunotherapeutic effect of the transplant
Measurement of prethrombotic markers in the assessment of acquired hypercoagulable states
Hypercoagulable states can be detected by measuring activation peptides, enzyme-inhibitor complexes, and fibrin/fibrinogen degradation products, which are markers of hemostatic activation. A series of these prethrombotic markers has been evaluated in the elderly, pregnancy, diabetes and acute myocardial infarction patients (n=30 in each group) as well as in hematologic malignancies (n=42). The parameters assayed were: prothrombin fragment 1+2 (F1+2), thrombin-antithrombin III complexes (TAT), fibrinopeptide A (FPA), plasmin-alpha2 antiplasmin complexes (PAP) and D-Dimer. Results were compared with those obtained in a group of 30 healthy subjects. We found a significant increase of F1+2, TAT and FPA in elderly (p<0.05), acute myocardial infarction (AMI) (p<0.01), hematologic malignancies (p<0.01), and pregnancy (p<0.0001), indicating a marked clotting activation. Diabetic patients under strict metabolic control only presented a moderate increase of TAT (p<0.05), suggesting a slight activation. We also observed a highly significant elevation of PAP and D-Dimer in elderly (p<0.001), AMI (p<0.0001), and malignancy (p<0.0001), indicating an activation of the fibrinolytic system. The combination of selected fibrinolytic and coagulation measurements is useful for the detection of a hypercoagulable state in conditions characterized by a risk of thrombosis
Trasplante de homoinjertos valvulares cardiacos y vasculares
The advances in the manipulation of human tissues,
the development of cryobiology, paediatric cardiac
surgery, the impossibility of obtaining an ideal
prosthetic cardiac valve and the surgical treatment of
cardiovascular infections have revived interest in the
use of homografts. The donors of these homografts
can be: a) Live donors: aortic and pulmonary valve of
the recipient of a heart transplant; b) Multiorgan
donors with a diagnosis of death according to neurological
criteria, whose heart is rejected for heart transplant;
c) Cadaver donors with asystolia of less than 8
hours.
Homograft cardiac valves are the substitute of
choice in aortic valve endocarditis, patients with
counter-indications for anticoagulation, reconstruction
of the outflow tract of the right ventricle, aortic
valve replacement in children and young adults
through the Ross operation, and an optional indication
is the aortic valve and/or rising aorta replacement
in patients over 60 years of age. Although there
are not sufficiently broad series of homogratfs with
arterial substitutes, with respect to the number of
patients and time of evolution, the results suggest
that this can benefit patients with vascular infection,
immunodepressed patients or complex patients
whose technique during the operation might require
a homograft
Emergence of Secondary Acute Leukemia in a Patient Treated for Osteosarcoma: Implications of Germline TP53 Mutations
Secondary leukemia and myelodysplastic syndromes have been reported
in patients following treatment for a wide range of neoplastic disorders. However
second malignancies after chemotherapy and/or irradiation for osteosarcoma are
unusual. PROCEDURE: We report the case of a 15-year-old girl who developed a
myelodysplastic syndrome with evolution to acute nonlymphocytic leukemia after
treatment for osteosarcoma. Therapy-related acute leukemia karyotype findings
such as abnormalities of chromosomes 5, 7, and 17 were found in the cytogenetic
analysis. Moreover, using denaturing gradient gel electrophoresis and DNA
sequencing, we detected the presence of a double germline mutation in exon 7 of
the TP53 gene. CONCLUSION: This observation supports the possibility of a causal
relationship between germline TP53 mutations and the development of secondary
leukemia and myelodysplasi
Clotting activation and impairment of fibrinolysis in malignancy
Different coagulation and fibrinolysis parameters were investigated in 149 patients with metastatic and non-metastatic tumours and results were compared with those obtained in a healthy population. Results showed a significant increase of thrombin-antithrombin complexes, fibrinopeptide A (FPA) and fibrin monomers in the group of patients (p less than 0.001). There was also a significant prolongation of euglobulin lysis time (p less than 0.005) and an increase of plasminogen activator inhibitor activity (p less than 0.0001), fibrinogen degradation products (p less than 0.001), and D-dimer (p less than 0.05) in the group of patients as compared to controls; FPA levels were also increased in patients with metastases (p less than 0.005). This study demonstrates clotting activation, at the level of fibrinogen to fibrin conversion, and impairment of fibrinolysis in patients with malignancy
Thrombopenic purpura induced by a monoclonal antibody directed to a 35-kilodalton surface protein (p35) expressed on murine platelets and endothelial cells
OBJECTIVE:
With the aim of obtaining monoclonal antibodies (mAbs) against mouse endothelial surface antigens, immunization of rats with a mouse-derived endothelial cell line (PY4.1) and subsequent hybridoma production were performed.
MATERIALS AND METHODS:
One of the mAbs produced by hybridoma EOL5F5 was selected for its surface binding to endothelial cell lines, and identification of the mAb-recognized antigen was performed by immunoprecipitation. Experiments were performed to analyze the effects of EOL5F5 on systemic administration to mice.
RESULTS:
EOL5F5-recognized antigen was a single band of 35 kDa under reducing and nonreducing conditions, features that do not match other known differentiation antigens with comparable tissue distribution. In vivo administration of purified EOL5F5 mAb to mice (n = 20) induced intense cutaneous purpura as well as severe but transient thrombocytopenia. Expression of EOL5F5-recognized antigen was detected on platelets from which it immunoprecipitated a moiety of identical electrophoretic pattern in SDS-PAGE, as the one recognized on endothelial cells. Immunohistochemically, EOL5F5-recognized antigen (p35) also was expressed on dermal capillaries, suggesting that, in addition to thrombocytopenia, damaging effects of the antibody on endothelial cells also might cause the observed purpura.
CONCLUSIONS:
Our results show induction of thrombocytopenic purpura in mice with an mAb against a single antigenic determinant expressed on both platelets and endothelium. EOL5F5 mAb injection sets the stage for useful experimental models that resemble immune thrombocytopenic purpura
A single prior course of BCNU-cisplatin chemotherapy has a significant deleterious effect on mobilization kinetics of otherwise untreated patients
Extensive prior treatment with cytotoxic agents is
associated with impaired mobilization of hematopoietic
cells. To assess the effect of a single course of standarddose
chemotherapy (CT), we compared the results of
filgrastim-induced mobilization among two sequential
groups of grade III–IV malignant glioma patients
included in a hematopoietic transplantation program.
The first group (21 patients) had never been treated with
CT until 2 days after surgery, when they received a course
of 100 mg/m2 BCNU (IV) and 100 mg intracarotid
cisplatin for cytoreduction (not for mobilization). At 1
month after this CT, they were mobilized with 12 lg/kg
filgrastim. The second group (22 patients) was mobilized
with the same dose of filgrastim directly after the surgery,
without having ever received any prior CT. The blood level
of CD34þ cells was significantly lower in the CT-treated
patients, both on the fourth day of filgrastim (15 vs 36
cells 106/l; P¼0.01) and on the fifth (25 vs
58 cells 106/l; P¼0.003), as it was the number of
CD34þ cells collected per apheresis (1.3 vs 3.5 106/l;
Po0.0005). The toxic effect of a single course of BCNUcisplatin
CT led to significant impairment of the
filgrastim-induced mobilization response.
Bone Marrow Transplantation advance onlin
Frequent and simultaneous epigenetic inactivation of TP53 pathway genes in acute lymphoblastic leukemia
Aberrant DNA methylation is one of the most frequent alterations in patients with Acute Lymphoblastic Leukemia (ALL).
Using methylation bead arrays we analyzed the methylation status of 807 genes implicated in cancer in a group of ALL
samples at diagnosis (n = 48). We found that 154 genes were methylated in more than 10% of ALL samples. Interestingly,
the expression of 13 genes implicated in the TP53 pathway was downregulated by hypermethylation. Direct or indirect
activation of TP53 pathway with 5-aza-29-deoxycitidine, Curcumin or Nutlin-3 induced an increase in apoptosis of ALL cells.
The results obtained with the initial group of 48 patients was validated retrospectively in a second cohort of 200 newly
diagnosed ALL patients. Methylation of at least 1 of the 13 genes implicated in the TP53 pathway was observed in 78% of
the patients, which significantly correlated with a higher relapse (p = 0.001) and mortality (p,0.001) rate being an
independent prognostic factor for disease-free survival (DFS) (p = 0.006) and overall survival (OS) (p = 0.005) in the
multivariate analysis. All these findings indicate that TP53 pathway is altered by epigenetic mechanisms in the majority of
ALL patients and correlates with prognosis. Treatments with compounds that may reverse the epigenetic abnormalities or
activate directly the p53 pathway represent a new therapeutic alternative for patients with ALL
Utilización de células madre en terapia regenerativa cardíaca
One of the most important challenges in modern medicine is the use of stem cells for the treatment of human disease such as diabetes, Parkinson ́s disease or isquemic cardiomyopathy. A number of problems need to be solved before stem cells can be applied clinically. In this paper we will review some concepts related to the potential of stem cells, focusing on adult stem cells as they have recently been described by the group of Catherine Verfaillie. We will also present our initial clinical results using adult stem cells for cardiac regenerative therapy. In the studies mentioned above, autologous muscle stem cells (satelite cells) were infused directly in the periphery of the scar tissue of the infarct. We describe the technique for ex vivo expansion and purification of muscle stem cells.La posibilidad de utilizar células madre en el tratamiento de diversas enfermedades humanas como la diabetes, la enfermedad de Parkinson, la cardiopatía isquémica constituye uno de los retos mas importantes de la medicina moderna. Sin embargo, antes de que los resultados de los estudios con células madre se traduzcan clínicamente existen múltiples problemas que deben ser resueltos. A continuación trataremos de exponer algunos conceptos relacionados con las células madre y su potencial, centrándonos principalmente en las células madre adultas tal como han sido recientemente descritas por el grupo de Catherine Verfaillie. Además presentaremos resultados de alguno de los primeros estudios clínicos realizados con células madre adultas como forma de terapia regenerativa cardíaca. En dichos tra- bajos se han empleado células madre de músculo (células satélite) autólogas en pacientes con infarto de miocardio, inyectándose direc- tamente dichas células en la periferia de la cicatriz secundaria al infarto