Michele Menicagli

Inflammatory cells contribute to the generation of an angiogenic phenotype in pancreatic ductal adenocarcinoma

Background: Inflammatory cells contribute to the growth and spread of human malignancies by producing molecules that enhance tumour invasiveness. Aims: To characterise the inflammatory infiltrate in pancreatic ductal adenocarcinoma and to analyse its contribution to angiogenesis and its prognostic relevance. Methods: Immunohistochemistry was used to identify inflammatory cells and evaluate the expression of proangiogenic and prolymphangiogenic molecules (vascular endothelial growth factor A (VEGF-A), VEGF-C, and basic fibroblast growth factor (bFGF)) by inflammatory and cancer cells in 137 pancreatic cancers. Intratumorous microvessel density (IMD) was assessed using CD34 as an endothelial cell marker. Results: There were significantly more mast cells and macrophages in pancreatic cancers than in normal pancreas and the number of mast cells directly correlated with the presence of lymph node metastases. However, there was no relation between numbers of infiltrating inflammatory cells and the presence of chronic pancreatitis (CP)-like changes in the parenchyma surrounding the tumour. Double immunostaining revealed that both pancreatic mast cells and macrophages express VEGF-A, VEGF-C, and bFGF. These factors were also expressed in the tumour cells in many cases. The numbers of VEGF-A expressing tumour cells and bFGF expressing tumour and inflammatory cells significantly correlated with IMD. Moreover, tumours with higher IMD had higher numbers of infiltrating mast cells and macrophages. Conclusions: Mononuclear inflammatory cells of the non-specific immune response are recruited to pancreatic cancer tissues independent of the presence of CP-like changes, may influence the metastatic capacity of the cancer cells, and may contribute to the development of tumours with high angiogenic activity.

KLF4 is a Novel Candidate Tumor Suppressor Gene in Pancreatic Ductal Carcinoma

Ductal pancreatic carcinoma (DPC) is a deadly disease with an incidence of 9 cases in 100,000 people per year and a mortality rate close to 100%. Allelic losses in the long arm of chromosome 9 are commonly encountered in many human malignancies but no data are yet available about DPC. We screened 40 laser-microdissected DPC samples and 6 pre-invasive lesions for 9 microsatellite mapping markers of region 9q21.3 through 9q34.2. A small overlapping region of deletion, spanning 8 million base pairs, was identified between D9S127 and D9S105. Two genes, RSG3 and KLF4, mapped to 9q31.1 through 9q32, were further investigated. A highly significant association was found between KLF4 gene expression levels and genomic status. Similarly, absence of immunohistochemical expression of KLF4 protein was found in 86.8% cases of DPC (33/38). Overexpression of KLF4 in a human pancreatic carcinoma cell line induced a significant decrease in the proliferation associated with up-regulation of p21 and the down-regulation of cyclin D1. In conclusion, we identified a novel oncosuppressor region located at the 9q 31.1-3 locus that is lost in DPC at high frequency. Loss of KLF4 expression is closely related to the genomic loss, and its restoration inhibits cancer cell proliferation, suggesting a key suppressor role in pancreatic tumorigenesis.

Prognostic Role of Histological Necrosis for Nonmetastatic Clear Cell Renal Cell Carcinoma: Correlation With Pathological Features and Molecular Markers

PURPOSE We defined the prognostic role of tumor necrosis and its extent in nonmetastatic clear cell renal cell carcinoma. Also, we further investigated its pathogenesis by correlating this tumor feature with other pathological characteristics and molecular markers related to the von Hippel Lindau-hypoxia inducible factor pathway and to tumor proliferation. MATERIALS AND METHODS A total of 213 patients with nonmetastatic clear cell renal cell carcinoma were evaluated. Mean followup was 66 months. The presence and extent of histological necrosis were correlated with clinicopathological factors, Ki-67 antigen expression calculated by the MIB-1 (Ki-67 antibody) index, pVHL, HIF-1alpha, the tumor infiltrating lymphocyte subset and cancer specific survival. RESULTS Histological necrosis was present in 63.8% of clear cell renal cell carcinoma cases. Necrosis was significantly associated with grade and the degree of tumor infiltrating lymphocytes, while its extent correlated significantly with grade, the degree of tumor infiltrating lymphocytes and stage. Tumor necrosis was a significant prognostic factor, which was confirmed even when limiting analysis to patients with intracapsular renal cell carcinoma. On multivariate analysis histological necrosis was not an independent predictor of cancer specific survival. The extent of tumor necrosis was not a significant prognostic factor. The presence and extent of histological necrosis was not associated with high Ki-67 expression and it did not correlate with pVHL expression or with nuclear and cytoplasmic HIF-1alpha expression. CONCLUSIONS Based on our results we cannot support histological necrosis and its extent as prognostic factors for clear cell renal cell carcinoma. Efforts should be made to develop nomograms that use routinely available and objective predictor variables. The precise mechanism that causes tumor necrosis remains unknown but the host immune response might significantly contribute to its development.

Nuclear Expression of Hypoxia-inducible Factor-1?? in Clear Cell Renal Cell Carcinoma is Involved in Tumor Progression

ObjectivesThe most frequent genomic abnormality in clear cell renal cell carcinoma (cc-RCC) is inactivation of Von Hippel-Lindau gene (VHL). pVHL19 is a ligase promoting proteosomal degradation of hypoxia-inducible factor-1alfa (HIF-1α); pVHL30 is associated with microtubules. VHL exert its oncogenetic action both directly and through HIF-1α activation. TNM classification is unable to define a correct prognostic evaluation of intracapsular cc-RCC. The nucleo-cytoplasmic trafficking in VHL/HIF-1α pathway could be relevant in understanding the molecular pathogenesis of renal carcinogenesis. This study analyzes VHL/HIF-1α proteins in a large series of intracapsular cc-RCCs, correlating their expression and cellular localization with prognosis. Materials and MethodsTwo anti-pVHL (clones Ig32 and Ig33) and 1 anti-HIF-1α were used on tissue microarrays from 136 intracapsular cc-RCCs (mean follow-up: 74 mo). Clone 32 recognizes both pVHLs, whereas clone 33 only pVHL30. Results were matched with clinicopathologic variables and tumor-specific survival (TSS). ResultsA strong cytoplasmic positivity was found for all antibodies in the largest part of cases, associated to a strong nuclear localization in the case of HIF-1α. All pVHL-negative cases were associated with high HIF-1α expression. pVHL negativity and HIF-1α nuclear positivity significantly correlated with shorter TSS. In multivariate analysis both pVHL negativity and HIF-1α nuclear expression were independent predictors of TSS. ConclusionsThe localization of the proteins well matches with their role and with the supposed tumor molecular pathways. The correlation with prognosis of VHL/HIF-1α alterations confirms the relevance of their molecular pathway and of the cellular trafficking of their products in the pathogenesis of renal cancer.

Granulocyte-macrophage colony-stimulating factor as an autocrine survival-growth factor in human gliomas.

We studied the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF) and its receptors (GM-CSF.R) in 20 human brain gliomas with different tumor gradings and demonstrated constitutive high levels of both mRNA gene expression and protein production exclusively in the highest-grade tumors (WHO, III-IV grade). Five astrocytic cell lines were isolated in vitro from glioma cells, which had selectively adhered to plates pre-coated with rhGM-CSF. These cells were tumorigenic when xenografted to athymic mice, and produced GM-CSF constitutively in culture. Two lines, particularly lines AS1 and PG1, each from a patient with glioblastoma multiforme, constitutively over-expressed both GM-CSF and GM-CSF.R genes and secreted into their culture media biologically active GM-CSF. Different clones of the AS1 line, isolated after subsequent passages in vitro and then transplanted to athymic mice, demonstrated higher tumorigenic capacity with increasing passages in vivo. Cell proliferation was stimulated by rhGM-CSF in late-stage malignant clones, whereas apoptosis occurred at high frequency in the presence of blocking anti-GM-CSF antibodies. In contrast, rhGM-CSF did not induce any apparent effect in early-stage clones expressing neither GM-CSF nor GM-CSF.R. The addition of rhGM-CSF or rhIL-1β, to cultures induced the overproduction of both GM-CSF and its receptors and increased gene activation for several functional proteins (e.g. NGF, VEGF, VEGF.R1, G-CSF, MHC-II), indicating that these cells may undergo dynamic changes in response to environmental stimuli. These findings thus revealed: (1) that the co-expression of both autocrine GM-CSF and GM-CSF.R correlates with the advanced tumor stage; (2) that an important contribution of GM-CSF in malignant glioma cells is the prevention of apoptosis. These results imply that GM-CSF has an effective role in the evolution and pathogenesis of gliomas.

Tumor Infiltrating Lymphocytes But Not Serum Pituitary Antibodies Are Associated with Poor Clinical Outcome after Surgery in Patients with Pituitary Adenoma

CONTEXT Serum pituitary antibodies (Pit Abs) and tumor-infiltrating lymphocytes (TILs) have been described in pituitary adenomas, but their clinical significance remains unknown. OBJECTIVE The objective of the study was to assess Pit Abs and TILs prevalence in pituitary adenomas and their influence on clinical outcome. DESIGN This was a prevalence case-control study. PATIENTS AND SETTING Two hundred ninety-one pituitary adenoma cases (110 non-secreting, 30 ACTH-69 GH-71 prolactin- and 13 TSH-secreting adenoma; 177 operated and 114 untreated), 409 healthy controls, and 14 autoimmune hypophysitis were enrolled in a tertiary referral center. INTERVENTION Pit Abs were measured using immunofluorescence in all cases and controls (n = 714). The presence of TILs was evaluated using CD45 staining in a subset of adenomas surgically treated (n = 72). MAIN OUTCOME MEASURE Clinical response of pituitary adenoma after surgery was evaluated. RESULTS Pit Abs prevalence was higher in adenomas (5.1%) than healthy subjects (0.7%, P < 0.0001) and lower than in autoimmune hypophysitis patients (57%, P < 0.0001). Similarly, TILs prevalence was higher in adenomas than normal pituitary (P = 0.01) and lower than in autoimmune hypophysitis (P < 0.0001). No correlation between Pit Abs and TILs was found (P = 0.78). A poor clinical outcome was more common in adenoma patients with TILs (11 of 18, 61%) than in those without (17 of 54, 31%, P = 0.026). Multivariate regression analysis identified the presence of TILs as independent prognostic factor for persistence/recurrence of pituitary adenoma. CONCLUSIONS TILs and Pit Abs are present in a significant number of pituitary adenoma patients. Cell-mediated immunity appears to be predictive of a less favorable clinical outcome.

FISH Image Analysis Using a Modified Radial Basis Function Network

Fluorescent in situ hybridization (FISH) is a valuable method for determining Her-2/neu status in breast carcinoma samples, an important prognostic indicator. Visual evaluation of FISH images is a difficult task which involves manual counting of dots in multiple images, a procedure which is both time consuming and prone to human error. A number of algorithms have recently been developed dealing with (semi)-automated analysis of FISH images. These algorithms are quite promising but further improvement is required in improving their accuracy. Here, we present a novel method for analyzing FISH images based on the statistical properties of Radial Basis Functions. Our method was evaluated on a data set of 100 breast carcinoma cases provided by the Aristotle University of Thessaloniki and the University of Pisa, with promising results.

CXCL12α/SDF-1 from perisynaptic Schwann cells promotes regeneration of injured motor axon terminals

The neuromuscular junction has retained through evolution the capacity to regenerate after damage, but little is known on the inter‐cellular signals involved in its functional recovery from trauma, autoimmune attacks, or neurotoxins. We report here that CXCL12α, also abbreviated as stromal‐derived factor‐1 (SDF‐1), is produced specifically by perisynaptic Schwann cells following motor axon terminal degeneration induced by α‐latrotoxin. CXCL12α acts via binding to the neuronal CXCR4 receptor. A CXCL12α‐neutralizing antibody or a specific CXCR4 inhibitor strongly delays recovery from motor neuron degeneration in vivo. Recombinant CXCL12α in vivo accelerates neurotransmission rescue upon damage and very effectively stimulates the axon growth of spinal cord motor neurons in vitro. These findings indicate that the CXCL12α‐CXCR4 axis plays an important role in the regeneration of the neuromuscular junction after motor axon injury. The present results have important implications in the effort to find therapeutics and protocols to improve recovery of function after different forms of motor axon terminal damage.

Molecular portrait of a rare case of metastatic glioblastoma: somatic and germline mutations using whole-exome sequencing

Despite the latest advances in surgery, radiological assessment, and radiotherapy treatment, the incidence of glioblastoma (GBM) is roughly comparable to that of mortality, and the prognosis is almost always related to intracranial progression after surgery or radio-chemotherapy. The incidence of extracranial metastases of GBM are rarely reported in the literature, –4 and there is still no explanation for this hematological dissemination. A 70-year-old man was referred to the Radiotherapy Department of Pisa University Hospital after partial excision of a WHO grade IV GBM. Microscopic examination showed pleomorphic astrocytic tumor cells with marked nuclear atypia, mitotic activity, microvascular proliferation, necrosis, and positive glial fibrillary acidic protein (GFAP) immunostaining. Shortly after the first visit, the patient reported lumbar spine pain. Radiological investigation revealed the presence of a lytic lumbar lesion. The total-body CT showed bone, lung, and liver tumor masses. In order to obtain a pathological diagnosis of extracranial disease, we decided to perform a biopsy of the sternal lesion (Fig. 1A). Histological examination showed pleomorphic cells, necrosis, and mitotic activity. Positive immunohistochemistry for GFAP and CD56 indicated a glial origin, while negative PanCk, LCA, and TTF1 results excluded epithelial, lymphoid, pulmonary, and thyroid origins. Cytological examination revealed GFAP-positive cells with hyperchromatic nuclei and poor cytoplasm (Fig. 1B). Whole-exome sequencing was performed on paired GBM primary tumor and blood germinal DNA using the Ion Proton System (Life Tech). Filtering the data by high quality score, read depth, absence in dbSNP, mammalian conservation, and allele frequency ,1%, we found that synonymous and missense gene mutations represented the most common types of variations in both GBM tumor and blood DNA. Mutations found in blood DNA were further filtered, looking for disease-associated mutations (OMIM database). We recovered 11 gene variations: FAM161A-R213C, TRMT10A-R61C, OTOG-V2191A, GALC-A349S, TRIP11-S1968G, PRPF8-I1662T, FECH-Y197C, LZTR1-R630Q, ARID1A-Q1142fs, LAMA4-E276Dfs, and HYDIN-D2570T. Additional filtering was performed to remove the entire mutational germinal load from the dataset to identify 70 GBM tumor-exclusive somatic mutations. We selected 8 of the most predominant mutations (higher allele count and read quality) that we assumed had emerged in an early stage of tumor progression: C8A-R30W, CRISP1-R162H, CTBP2-H788L, CTSK-V95L, DOCK9-M1635I, HSD17B7-S173N, PRSS1-Q209E, and TRIM29-V532I. All of these variations were confirmed in the GBM by Sanger sequencing. In order to confirm the metastatic origin of the sternal lesions, we looked for at least one shared mutation within the 8 selected somatic mutations between GBM and sternal biopsy because the amount of starting material was not sufficient for a whole-exome analysis. We microdissected 100 GFAP-positive cells, taken after cytological preparation of the sternal lesion, and extracted DNA. The tumor-somatic C8A-R30W mutation was confirmed in DNA from the sternal biopsy while being absent in blood DNA (Fig. 1C). Sharing of the C8A-R30W mutation between the primary tumor and the sternal lesion confirms the latter as having a GBM metastatic origin. The primary tumor data were also filtered for driver mutations. We found 4 variations in genes identified as tumor suppressors: RB1 deletion of 5 bases (Gln257fs), CREBBP stop mutation (Gln1027*), ARID1A1 one-base deletion (p.Val1867Alafs), and BRCA2 stop mutation (Gln2164*). We finally performed a copy number variation (CNV) analysis, obtaining a prevalence of deletions in TP53, PTEN, ERBB2, TERT, RTEL1, CDKN2A, and PHLDB1 as well as amplifications in BRCA2 using a log2 cutoff of 0.8. The only variation with significant variance, however, was the RTEL1 deletion. Although the reported incidence of extracranial GBM is 0.2%, this phenomenon may not be as rare as believed. The hypoxic and proliferative zone of the GBM has an angiogenesisrelated breakdown of the blood-brain barrier, and GBM cells could have direct communication with the circulatory system. Thus, low levels of circulating GBM cells may be present in the early disease process of susceptible patients and ultimately lead to metastases in extracranial organs. The aggressive

Role of circulating endothelial progenitor cells in the reparative mechanisms of stable ischemic myocardium

BACKGROUND Mobilization of endothelial progenitor cells (EPCs) into circulation from bone marrow in patients with acute myocardial infarction has strong scientific evidence; less is known about EPC mobilization in patients with stable coronary artery disease (CAD). The aim of this study was to investigate the association of stable ischemic heart disease with EPC levels in tissue and blood. METHODS Fifty-five consecutive patients admitted to a single treatment center for valve or coronary artery bypass grafting (CABG) surgeries were included in the study. Blood samples were collected in the morning before surgery and analyzed by flow-cytometry to determine peripheral EPC levels (EPC/ml). Tissue EPC (CD34+VEGFR2+) levels were assessed on a right atrial appendage segment. RESULTS Mean age was 76±5years, 48% were men, and 53% had CAD The number of CD34+ VEGFR2+ cells in the tissue of patients with CAD was significantly higher (p<0.005) and circulating EPC showed a tendency to be reduced by approximately 20% in peripheral blood of patients with CAD when compared to those without CAD. CONCLUSION Patients with stable CAD had higher EPC density values (EPC/mm2) and were more likely to have lower EPC blood levels when compare with normal controls.