Franco Patrone | University of Genova (original) (raw)
Papers by Franco Patrone
PubMed, Dec 1, 2016
Here we report the clinical, pathological, and immunological features of a rare case of Waldenstr... more Here we report the clinical, pathological, and immunological features of a rare case of Waldenström macroglobulinemia (WM) with pleural infiltrations. An atypical chylothorax, successfully treated by videothoracoscopy, represented the main clinical feature of this case of low-grade lymphoplasmacytic lymphoma. Pleuropulmonary manifestations are rare (from 0 to 5% of cases) in WM, with chylothorax observed in just seven patients worldwide. In addition to describing this uncommon clinical presentation, we investigate hypothetical pathogenetic mechanisms causing chylothorax and through an up-todate review of available literature furnish helpful suggestions for diagnosis and management of chylothorax in WM patients.
Recent Results in Cancer Research, 1998
The first GROCTA trial compared 5-year tamoxifen treatment to ten chemotherapy cycles in a group ... more The first GROCTA trial compared 5-year tamoxifen treatment to ten chemotherapy cycles in a group of 504 pre-/post-menopausal, node-positive, ER-positive breast cancer patients. This study also included an arm combining tamoxifen with chemotherapy. Fifteen-year results showed no difference between tamoxifen and tamoxifen plus chemotherapy, while both treatments were significantly superior to chemotherapy alone. A confirmatory study (GROCTA 02) was performed in 244 pre-/perimenopausal patients by comparing 5 years of tamoxifen treatment (plus 2 years of goserelin) to six CMF cycles. No difference has emerged so far between the tamoxifen and CMF arms at a median follow-up time of 62 months. Post-menopausal women were scheduled to receive 3 years of tamoxifen treatment and then to be randomly allocated to further 2 years of tamoxifen or to 2 years of low-dose aminoglutethimide (GROCTA 04B). So far 662 patients have been entered, 375 of whom have been randomized to tamoxifen (n = 188) or aminoglutethimide (n = 187). Preliminary results (median follow-up time 32 months) show no major difference in patients' outcome. A new trial (ITA trial) with a similar design but employing anastrozole in place of aminoglutethimide has been activated in 1998. The GROCTA 03 study investigated the potential superiority of alternating adjuvant chemotherapy over standard CMF. This study, which included 107 node-positive ER-negative pre-menopausal women, was prematurely closed because more patients allocated to the triple alternated chemotherapy appeared to have relapsed and died at the first interim analysis. The use of high-dose chemotherapy (HDC) was explored by the GROCTA 06 trial which included 53 patients with ten or more involved nodes and a maximum age of 55 years. These patients were scheduled to receive three standard CEF cycles followed by one cycle of HDC (cyclophosphamide 5 g/m2; etoposide 1.5 g/m2; cisplatin 150 mg/m2) without any form of bone marrow rescue. This HDC program proved to be feasible but was not superior to CMF-based chemotherapy we had previously employed in a comparable group of patients in previous GROCTA trials. These findings prompted us to explore new HDC programmes with the use of peripheral stem cell support and in addition the possible value of new drugs such as Taxol and vinorelbine. New-generation trials will also explore the value of new prognostic indicators such as tumor proliferative activity, which are prospectively used to allocate patients to different treatment options.
PubMed, 1991
Peripheral blood neutrophil polymorphonuclear leukocytes (PMN) from healthy donors were found to ... more Peripheral blood neutrophil polymorphonuclear leukocytes (PMN) from healthy donors were found to inhibit the cytolytic efficiency of interleukin 2 (IL-2)-activated lymphocytes (LAK cells) in a dose-dependent manner. The inhibitory activity of PMN was not merely due to PMN acting as cold alternative targets, PMN ingestion of the label released by target cells or cell overcrowding in test wells. Heat-treated (50 degrees C, 30 min) lysates from PMN maintained their ability to inhibit LAK cell cytotoxicity, whereas PMN supernatants were completely ineffective. Oxidant scavengers (catalase, superoxide, dismutase) did not affect the PMN-mediated inhibition of LAK cell function. The results suggest that PMN contain heat-stable factor(s) able to suppress LAK cytotoxicity and potentially capable of limiting the therapeutic efficacy of IL-2 and/or LAK cells.
Blood, Nov 19, 2010
Abstract 4458 Acquired resistance to Imatinib in advanced phase of CML has been associated with m... more Abstract 4458 Acquired resistance to Imatinib in advanced phase of CML has been associated with mutations in the kinase domain (KD) of BCR-ABL. We have recently reviewed the status of the mutations in 52 patients with early CP-CML on the samples collected at diagnosis. Mutations were identified by direct sequency (DS) with BidDye Terminator V1.1. cycle sequencing kit and analyzed with a 3130 AB capillary electrophoresis system. Twenty-eight patients had low risk, 10 intermediate risk and 14 high risk, according to Sokal/Euro. Ten out of 14 high Sokal risk patients showed the following mutations: Y253C, S265R, E255K, F359Y, N374S, E255V, E255V, E255V, R332L, E334G. Three of these patients progressed during Imatinib and second-line TKIs and died of blastic phase CML at 23, 33 and 69 months. Curiously, S265R and N374S mutations disappeared during Imatinib treatment but were substituted during follow-up by other two mutations: E255L and H396R. The patient carrying E255L mutation died in blastic phase at 33 months and the one with mutation H396R was well controlled by Nilotinib and he is now alive in CMR 26 months after. Only one out of the 10 intermediate Sokal risk carried KD mutations at diagnosis (D363G). This patient is alive in MMR at 26 months after diagnosis under Imatinib. None of the 28 low Sokal risk patients carried KD mutations at diagnosis and no patients developed cytogenetic evolution while on treatment. In conclusion, the fact that KD mutations were more present in patients with high Sokal risk supports the hypothesis that the probability developing a mutation is related to the basic biology of the disease rather than being merely a random event. Disclosures: No relevant conflicts of interest to declare.
International Journal of Immunopathology and Pharmacology, 1989
Although neutrophils (neutrophilic polymorphonuclear leukocytes, PMNs) provide a principal means ... more Although neutrophils (neutrophilic polymorphonuclear leukocytes, PMNs) provide a principal means of host defense against bacteria and fungi, they can also promote host tissue injury in several non infectious diseases (1). The intervention of PMNs in the pathogenesis of gouty arthritis, rheumatoid arthritis, autoantibody -and immunecomplex-mediated glomerulo-nephritis has been well documented. Moreover, a relevant role of PMNs in tissue injury is now more than suggestive in an increasing number of disease states, including immune vasculitis, ulcerative colitis, chronic obstructive pulmonary disease, adult acute respiratory distress syndrome. At present, the same toxic potential of PMNs is generally thought to be equally responsible for both the microorganism killing and the tissue injury in the aforementioned disorders (1, 2, 3). This fact, coupled with the incomplete knowledge of the events underlying the PMN responses and the PMN-mediated tissue injury, makes rational therapeutic approaches untimely at least as far as the dangerous effects of PMNs are concerned.
Bone marrow transplantation, 1992
ANTMAN K.; CORRINGHAM R.; DE VRIES E.; ELFENBEIN G.; GIANNI AM; GISSELBRECHT C.; HERZIG R.; JUTTN... more ANTMAN K.; CORRINGHAM R.; DE VRIES E.; ELFENBEIN G.; GIANNI AM; GISSELBRECHT C.; HERZIG R.; JUTTNER C.; KAIZER H.; KENNEDY MJ; KESSINGER A.; KOTASEK D.; LAZARUS H.; LJUNGMAN P.; MARANINCHI D.; NOBHOLTZ J.; ...
Blood, Nov 16, 2006
Histone deacetylases (HDACs) modulate gene transcription and chromatin assembly by modifying hist... more Histone deacetylases (HDACs) modulate gene transcription and chromatin assembly by modifying histones at the post-transcriptional level. HDAC inhibitors have promising antitumor activity and are presently explored in clinical studies for malignancies of different histology. Preliminary evidence in animal models of immune disorders also suggests immunosuppressive properties for these small molecules, although the underlying mechanisms remain at present poorly understood. Here, we show that two HDAC inhibitors of clinical use, sodium valproate and MS-275, profoundly affect cytokine-induced differentiation of human monocytes to dendritic cells (DCs), and impair DC phenotypic maturation in response to the Toll-like receptor (TLR) ligand polyinosinic:polycytidylic acid (poly I:C) characterized by a reduced expression of HLA- and costimulatory molecules. HDAC inhibitors reduce cytokine secretion important for T-cell activation like IL-12 and immunostimulatory capacity in DCs and inhibit DC migratory capacity toward the chemoattractant CCL19/MIP-3β. The observed defects in DC function upon exposure to HDAC inhibitors were not due to an increased rate of apoptosis or production of IL-10. We finally investigated the effects of HDAC inhibition on intracellular signalling pathways that play a key role in controlling DC differentiation and function. HDAC inhibitors have been reported to cause a downregulation of the hematopoietic transcription factor PU.1, which contributes to the development of thymic and myeloid dendritic cells and of Langerhans cells in the mouse. We evaluated herein whether PU.1 expression was affected by VPA in monocyte-derived DCs, however, no significant reduction in protein levels could be detected. Therefore, our data rule out PU.1 shortening as a mechanism responsible for the functional defects observed in DCs that were exposed to HDAC inhibitors. Similarly, no significant effect of HDAC inhibitors was detected on Bcl-6, another known target of HDAC inhibitors that, besides its role in lymphomas, has also been linked to the regulation of cytokine and chemokine release in macrophages. In contrast, addition of VPA blocked RelB nuclear relocalization in response to poly I:C in a concentration-dependent manner. Interestingly, IRF-3 and IRF-8, which have been involved in DC differentiation, IL-12 production and DC migration, were also affected by HDAC inhibitors, since their nuclear levels were reduced by VPA in unstimulated as well as in poly I:C-activated DCs. On the other hand, IRAK-1 downregulation in response to poly I:C was not affected by VPA, suggesting that the effects of HDAC inhibition on RelB, IRF-3 and IRF-8 are probably mediated downstream of MyD88 and IRAK-1. In conclusion, HDAC inhibitors exhibit strong immunomodulatory properties on human DCs. Our results support the evaluation of HDAC inhibitors in inflammatory and autoimmune disorders.
European Journal of Cancer, 2011
Thrombosis and Haemostasis, 2014
Pharmacological treatments targeting CXC chemokines and the associated neutrophil activation and ... more Pharmacological treatments targeting CXC chemokines and the associated neutrophil activation and recruitment into atherosclerotic plaques hold promise for treating cardiovascular disorders. Therefore, we investigated whether FK866, a nicotinamide phosphoribosyltransferase (NAMPT) inhibitor with anti-inflammatory properties that we recently found to reduce neutrophil recruitment into the ischaemic myocardium, would exert beneficial effects in a mouse atherosclerosis model. Atherosclerotic plaque formation was induced by carotid cast implantation in ApoE-/-mice that were fed with a Western-type diet. FK866 or vehicle were administrated intraperitoneally from week 8 until week 11 of the diet. Treatment with FK866 reduced neutrophil infiltration and MMP-9 content and increased collagen levels in atherosclerotic plaques compared to vehicle. No effect on other histological parameters, including intraplaque lipids or macrophages, was observed. These findings were associated with a reduction in both systemic and intraplaque CXCL1 levels in FK866-treated mice. In vitro, FK866 did not affect MMP-9 release by neutrophils, but it strongly reduced CXCL1 production by endothelial cells which, in the in vivo model, were identified as a main CXCL1 source at the plaque level. CXCL1 synthesis inhibition by FK866 appears to reflect interference with nuclear factor-κB signalling as shown by reduced p65 nuclear levels in endothelial cells pre-treated with FK866. In conclusion, pharmacological inhibition of NAMPT activity mitigates inflammation in atherosclerotic plaques by reducing CXCL1-mediated activities on neutrophils. These results support further assessments of NAMPT inhibitors for the potential prevention of plaque vulnerability.
Blood, Nov 20, 2009
Abstract 2733 Poster Board II-709 Introduction: APO866, a reversible inhibitor of nicotinamide ph... more Abstract 2733 Poster Board II-709 Introduction: APO866, a reversible inhibitor of nicotinamide phosphoribosyltransferase (Nampt), acts by severely depleting intracellular NAD+ content and thus eliciting mitochondrial dysfunction, ATP depletion, and autophagic cell death. TNF-Related Apoptosis Inducing Ligand (TRAIL) binds to plasma membrane receptors DR4 and DR5 and causes apoptosis through activation of caspase-8 and caspase-10. These, in turn, activate effector caspases either directly or via Bid cleavage and subsequent initiation of the mitochondrial apoptotic pathway. In the present work, we have explored the interaction between APO866 and TRAIL in cellular models of hematological malignancies. Materials and Methods: The lymphoma cell lines Jurkat, PEER, MOLT-4, H9, and Namalwa, primary B-cell chronic lymphocytic leukemia (B-CLL) cells, as well as normal peripheral blood mononuclear cells (PBMCs) were treated with increasing concentrations of APO866, TRAIL, or with 1:1, 1:3, or 1:10 combinations of both agents for 72 hours (48 h APO866 + 24 h TRAIL). Cell death was assessed by propidium iodide staining and flow cytometry (FC). Apoptosis was assessed by Annexin V-propidium iodide staining and FC. Combination indices were calculated according to the Chou and Talalay method. DR5 membrane expression was assessed with a FITC-conjugated anti-DR5 antibody and FC after 12, 24, and 48 h exposure to APO866. Mitochondrial transmembrane potential (Δψm) and cell cycle analysis after single agent or combination treatment were determined by tetramethylrhodamine (TMRE) and Nicoletti staining, respectively, and FC. Intracellular NAD+ and ATP contents were quantified by cyclic assays and HPLC, respectively. The role of autophagy and of caspase activity in the cytotoxic activity of APO866, TRAIL, and of their combination was assessed using the PI3K inhibitors 3-methyladenine, LY2940002, and wortmannin, and the caspase inhibitors Z-VAD-FMK (pan-caspase inhibitor), Z-LEHD-FMK (caspase-9 inhibitor), and Z-IETD-FMK (caspase-8 inhibitor), respectively. Results/Discussion: APO866 induced NAD+ depletion, Δψm dissipation, and ATP exhaustion in the absence of caspase activation as detected by caspase-3 cleavage. Accordingly, autophagy but not caspase inhibitors blocked APO866 activity. Vice versa, TRAIL-induced apoptosis was blocked by the caspase inhibitors and enhanced by the PI3K inhibitors. Remarkably, APO866 and TRAIL showed a potent synergistic interaction in lymphoma cell lines and in primary B-CLL cells, consistently exhibiting combination indices below 1 upon exposure to a wide range of drugs concentrations. On the other hand, the two drugs and their combinations were poorly active and failed to show any cooperation in healthy PBMCs, indicating a specific activity against malignant cells. As a metabolic correlate of their interaction, TRAIL enhanced APO866-induced NAD+ depletion and Δψm. dissipation. As a result, lymphoma cells underwent massive ATP depletion and autophagic cell death. No DR5 upregulation at the cell surface of lymphoma cells was observed in response to APO866. Conclusions: APO866 and TRAIL show potent synergistic interaction in preclinical cell models of Non…
Blood, Nov 20, 2009
Abstract 4251 Kinase domain (KD) mutations are associated with resistance to Imatinib in CP-CML b... more Abstract 4251 Kinase domain (KD) mutations are associated with resistance to Imatinib in CP-CML but their incidence and prognostic significance before any treatment are unclear. To assess if KD mutations at diagnosis may have prognostic significance, we have recently reviewed (before treatment with Imatinib) the mutation status of 45 patients,of whom low risk: 24 patients; intermediate risk: 8 patients; high risk: 13 patients, according to Sokal/Euro. We found that a) no patient with low and intermediate risk showed KD mutations at diagnosis; b) 4/13 high risk patients showed the following mutations at diagnosis: S265R, E255K, F359Y and E255V/E258V; other 5 patients developed mutations during Imatinib treatment (E255V, T315I, E255V/E258V, H396R and D248-274). All patients with low-intermediate risk are alive and well at a median of 44 months (range, 15-71 months). On the contrary, 3/4 high risk patients with KD mutations at diagnosis progressed and died of blastic evolution at 23, 33 and 69 months despite Nilotinib and Dasatinib therapy. Other 3/5 high risk patients who developed mutations under Imatinib, died of blastic evolution at 22, 23 and 43 months despite Nilotinib and Dasatinib treatment. Seven high risk patients are alive under Imatinib between 4 and 51 months. In conclusion, the KD mutations at diagnosis were frequent in high Sokal/Euro risk group supporting the concept that such mutations could be related to the basic biology of the disease. These data, if confirmed, could modify our approach to high risk patients with KD mutation at diagnosis, i.e. utilizing second/third TKI generation earlier during the disease and, in selected cases, reconsidering allografting earlier before leukemic evolution make such procedure useless. Disclosures: No relevant conflicts of interest to declare.
Blood, Nov 16, 2005
Background. It has been demonstrated that about 70% of patients with CML in chronic phase (CP) at... more Background. It has been demonstrated that about 70% of patients with CML in chronic phase (CP) at diagnosis co-expressed p210 and p190 BCR/ABL transcripts, although at a much lower level (Blood1996;87:5213–17). In previous studies, the co-expression of p210 and p190 BCR-ABL transcripts at diagnosis was considered as indicative of higher tumor burden. However, the clinical relevance of p190 BCR-ABL mRNA monitoring in CML pts under Imatinib on bone marrow (BM) samples is not known. Materials and Methods. BM samples were obtained from 83 pts with CP-CML treated with Imatinib at a daily oral dose ranging between 300–500mg. These included 192 samples from 43 pts with late CP-CML (post-IFN failure) and 140 samples from 40 pts with early CP-CML who received Imatinib as first line therapy. Median follow-up was 18 (3–58) and 39 (12–58) months for early and late CP-CML, respectively. As part of a diagnostic work-up, BM samples from each patient were assessed for expression of both p210 and p190 BCR/ABL levels by real-time quantitative reverse transcription PCR (QRT-PCR) using a TAQ-Man system (ABI Prism 7700 Perkin Elmer) for BCR-ABL and ABL genes. The median number of BM assessment was 3 (2–6) for early CP-CML and 4 (2–10) for late CP-CML. A major molecular response (MMR) was defined as BCR-ABL/ABL ratios less than 0.05%. A specific nested RT-PCR screening was assessed for detection of p210 (b2a2, b3a2) and p190 (e1a2) BCR-ABL transcripts to confirm the negative data of p210 and p190 in QRT-PCR. Results. A MMR was obtained in 20 pts (50%) and 20 pts (46%) in early and late CP-CML respectively. However, early CP-CML pts showed a significantly greater reduction in p210 BCR-ABL levels compared to late CP-CML after 12 months of Imatinib therapy (p=0.006), indicating a different kinetic of molecular response. Co-expression of p210 and p190 BCR-ABL transcripts at diagnosis was 73% for early CP-CML, whereas it was not available for late CP-CML. To test whether the persistence of p190 BCR-ABL transcript was predictive of MMR, we divided CML pts in 2 groups, those with 0 or 1 p190 BCR-ABL positive samples (group 1) and those with 2 or more positive samples (group 2) during the follow-up. We found that CP-CML pts of the group 2 showed a significant lower probability to obtain MMR molecular response compared to pts of group 1 both for late and early CML patients respectively [17/24 (71%) vs 5/19 (26%) with p=0.0039)], [15/21 (71%) vs 6/18 (33%) with p=0.017)]. This correlation holds also for complete cytogenetic response (data not shown). Conclusions. In this study, approximately 50% of pts reached a MMR; half of them had undetectable values of p210 BCR-ABL transcripts. However, in a proportion of pts with complete cytogenetic response and low level of p210 BCR-ABL transcript, the expression of p190 is still detectable. The persistence of p190 signal despite the 2–3log fall in p210 BCR-ABL levels, may be of prognostic significance and may disclose unfolded concepts of biological relevance.
Journal of Clinical Oncology, Jun 20, 2006
16534 Background: Pegylated filgrastim is a new formulation of a granulocyte colony-stimulating f... more 16534 Background: Pegylated filgrastim is a new formulation of a granulocyte colony-stimulating factor that has a long circulating half-life, permitting a single dose of filgrastim per cycle of chemotherapy. Methods: To evaluate whether a single subcutaneous injection of pegfilgrastim (6 mg) is as safe and effective as daily filgrastim (5 mcg/kg/day), 40 consecutive autologous stem cell transplantations performed for breast cancer and lymphomas have been analysed. Median age was 47 yrs (20–61) and 48 yrs (30–63) in pegfilgrastim and filgrastim group, respectively. All patients had normal bone marrow biopsy. The first cohort of patients received 5 mcg/kg/day of filgrastim starting from day 5 post transplantation and the second cohort of patients received a single subcutaneous injection of 6 mg pegfilgrastim on day 5 after transplantation. Results: Median duration of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 7 (4–9) and 6 (5–9) days, respectively (P 0.29). Neutropenic fever incidence was significantly higher in filgrastim group, 9/20 vs 16/20 (P 0.048), the median duration was not significantly different, 1 (1–6) vs 3 (1–7) days. The grade 3–4 mucositis was higher in filgrastim patient group, 4/20 vs 13/20 in pegfilgrastim and filgrastim, respectively (P 0.009). The adverse events observed during post-transplant aplasia were attributable to complications arising from myelo-suppressive chemotherapy or the primary disease. The only occurring adverse event considered to be cytokine related was mild to moderate bone pain. The overall incidence of bone pain requiring non-narcotic analgesia was not statistically different, 20% (4/20) in pegfilgrastim patients and 40% (8/20) in filgrastim patients. The patients in filgrastim group received a mean of 9.8 daily injections. Conclusions: A single injection of pegfilgrastim administered at day 5 post transplant shows comparable safety and efficacy profiles to daily injections of filgrastim and may be cost-effective. No significant financial relationships to disclose.
Current Cancer Drug Targets, Apr 1, 2012
Blood, Nov 20, 2009
Abstract 4404 Cancer cells almost invariably exhibit aberrant histone deacetylase (HDAC) activity... more Abstract 4404 Cancer cells almost invariably exhibit aberrant histone deacetylase (HDAC) activity leading to changes in chromatine structure, altered gene expression, poor differentiation, impaired apoptosis and increased proliferation. Accordingly, virtually all the HDAC inhibitors currently available show some degree of antitumor activity in preclinical cancer models and several of these compounds are currently under investigation or already approved for the treatment of human malignancies. Such is the case of the hydroxamic acid derivative suberoylanilide hydroxamic acid (Vorinostat, Zolinza), approved for the treatment of cutaneous T cell lymphomas. Sirtuins are a large family of deacetylases characterized by a unique, NAD+-dependent enzymatic mechanism. In addition to their established role in metabolism and longevity, recent evidence points to an emerging role for sirtuins in carcinogenesis. In the attempt to identify drug combinations that would increase the activity of traditional HDAC inhibitors we have explored the combination of valproic acid (VA) and butyrate (BU) with the sirtuin inhibitors cambinol and sirtinol in primary B-cell chronic lymphocytic leukemia (B-CLL) cells (n=35), acute myelogenous leukemia (AML) cells (n=10) and leukemia cell lines. Cell viability was assessed by propidium iodide staining and flow cytometry. Combination indices were determined using the median-effect method. In leukemia cells, exposure to sirtuin inhibitors synergistically increased VA and BU mediated cytotoxicity. Conversely, these drugs were poorly active and failed to show any cooperation in healthy cells, including peripheral blood mononuclear cells and fibroblasts, suggesting a cancer-specific mode of action. Similar results were obtained by combining VA or BU with the Nampt inhibitor APO866, which reduces intracellular NAD+ levels and thereby prevents sirtuin activity. Remarkably, SIRT1 and SIRT6 inhibition per se did not seem to account for cell demise upon HDAC inhibition since expression of a dominant negative SIRT1 isoform or RNA interference-mediated SIRT6 silencing failed to increase VA and BU activity. Our data indicate a specific requirement by leukemia cells for sustained sirtuin activity when classical HDACs are inhibited. This feature is suitable to be therapeutically exploited by combining sirtuin inhibitors or APO866 with classical HDAC inhibitors especially for the treatment of hematological malignancies. Disclosures: No relevant conflicts of interest to declare.
Supplementary Figures legend
Journal of Clinical Oncology, May 20, 2014
e13511 Background: The ALK inhibitor crizotinib is the standard of care of patients with ALK+, ad... more e13511 Background: The ALK inhibitor crizotinib is the standard of care of patients with ALK+, advanced NSCLC. However, its clinical benefit is limited by the development of resistance. Cycles of f...
PubMed, Dec 1, 2016
Here we report the clinical, pathological, and immunological features of a rare case of Waldenstr... more Here we report the clinical, pathological, and immunological features of a rare case of Waldenström macroglobulinemia (WM) with pleural infiltrations. An atypical chylothorax, successfully treated by videothoracoscopy, represented the main clinical feature of this case of low-grade lymphoplasmacytic lymphoma. Pleuropulmonary manifestations are rare (from 0 to 5% of cases) in WM, with chylothorax observed in just seven patients worldwide. In addition to describing this uncommon clinical presentation, we investigate hypothetical pathogenetic mechanisms causing chylothorax and through an up-todate review of available literature furnish helpful suggestions for diagnosis and management of chylothorax in WM patients.
Recent Results in Cancer Research, 1998
The first GROCTA trial compared 5-year tamoxifen treatment to ten chemotherapy cycles in a group ... more The first GROCTA trial compared 5-year tamoxifen treatment to ten chemotherapy cycles in a group of 504 pre-/post-menopausal, node-positive, ER-positive breast cancer patients. This study also included an arm combining tamoxifen with chemotherapy. Fifteen-year results showed no difference between tamoxifen and tamoxifen plus chemotherapy, while both treatments were significantly superior to chemotherapy alone. A confirmatory study (GROCTA 02) was performed in 244 pre-/perimenopausal patients by comparing 5 years of tamoxifen treatment (plus 2 years of goserelin) to six CMF cycles. No difference has emerged so far between the tamoxifen and CMF arms at a median follow-up time of 62 months. Post-menopausal women were scheduled to receive 3 years of tamoxifen treatment and then to be randomly allocated to further 2 years of tamoxifen or to 2 years of low-dose aminoglutethimide (GROCTA 04B). So far 662 patients have been entered, 375 of whom have been randomized to tamoxifen (n = 188) or aminoglutethimide (n = 187). Preliminary results (median follow-up time 32 months) show no major difference in patients' outcome. A new trial (ITA trial) with a similar design but employing anastrozole in place of aminoglutethimide has been activated in 1998. The GROCTA 03 study investigated the potential superiority of alternating adjuvant chemotherapy over standard CMF. This study, which included 107 node-positive ER-negative pre-menopausal women, was prematurely closed because more patients allocated to the triple alternated chemotherapy appeared to have relapsed and died at the first interim analysis. The use of high-dose chemotherapy (HDC) was explored by the GROCTA 06 trial which included 53 patients with ten or more involved nodes and a maximum age of 55 years. These patients were scheduled to receive three standard CEF cycles followed by one cycle of HDC (cyclophosphamide 5 g/m2; etoposide 1.5 g/m2; cisplatin 150 mg/m2) without any form of bone marrow rescue. This HDC program proved to be feasible but was not superior to CMF-based chemotherapy we had previously employed in a comparable group of patients in previous GROCTA trials. These findings prompted us to explore new HDC programmes with the use of peripheral stem cell support and in addition the possible value of new drugs such as Taxol and vinorelbine. New-generation trials will also explore the value of new prognostic indicators such as tumor proliferative activity, which are prospectively used to allocate patients to different treatment options.
PubMed, 1991
Peripheral blood neutrophil polymorphonuclear leukocytes (PMN) from healthy donors were found to ... more Peripheral blood neutrophil polymorphonuclear leukocytes (PMN) from healthy donors were found to inhibit the cytolytic efficiency of interleukin 2 (IL-2)-activated lymphocytes (LAK cells) in a dose-dependent manner. The inhibitory activity of PMN was not merely due to PMN acting as cold alternative targets, PMN ingestion of the label released by target cells or cell overcrowding in test wells. Heat-treated (50 degrees C, 30 min) lysates from PMN maintained their ability to inhibit LAK cell cytotoxicity, whereas PMN supernatants were completely ineffective. Oxidant scavengers (catalase, superoxide, dismutase) did not affect the PMN-mediated inhibition of LAK cell function. The results suggest that PMN contain heat-stable factor(s) able to suppress LAK cytotoxicity and potentially capable of limiting the therapeutic efficacy of IL-2 and/or LAK cells.
Blood, Nov 19, 2010
Abstract 4458 Acquired resistance to Imatinib in advanced phase of CML has been associated with m... more Abstract 4458 Acquired resistance to Imatinib in advanced phase of CML has been associated with mutations in the kinase domain (KD) of BCR-ABL. We have recently reviewed the status of the mutations in 52 patients with early CP-CML on the samples collected at diagnosis. Mutations were identified by direct sequency (DS) with BidDye Terminator V1.1. cycle sequencing kit and analyzed with a 3130 AB capillary electrophoresis system. Twenty-eight patients had low risk, 10 intermediate risk and 14 high risk, according to Sokal/Euro. Ten out of 14 high Sokal risk patients showed the following mutations: Y253C, S265R, E255K, F359Y, N374S, E255V, E255V, E255V, R332L, E334G. Three of these patients progressed during Imatinib and second-line TKIs and died of blastic phase CML at 23, 33 and 69 months. Curiously, S265R and N374S mutations disappeared during Imatinib treatment but were substituted during follow-up by other two mutations: E255L and H396R. The patient carrying E255L mutation died in blastic phase at 33 months and the one with mutation H396R was well controlled by Nilotinib and he is now alive in CMR 26 months after. Only one out of the 10 intermediate Sokal risk carried KD mutations at diagnosis (D363G). This patient is alive in MMR at 26 months after diagnosis under Imatinib. None of the 28 low Sokal risk patients carried KD mutations at diagnosis and no patients developed cytogenetic evolution while on treatment. In conclusion, the fact that KD mutations were more present in patients with high Sokal risk supports the hypothesis that the probability developing a mutation is related to the basic biology of the disease rather than being merely a random event. Disclosures: No relevant conflicts of interest to declare.
International Journal of Immunopathology and Pharmacology, 1989
Although neutrophils (neutrophilic polymorphonuclear leukocytes, PMNs) provide a principal means ... more Although neutrophils (neutrophilic polymorphonuclear leukocytes, PMNs) provide a principal means of host defense against bacteria and fungi, they can also promote host tissue injury in several non infectious diseases (1). The intervention of PMNs in the pathogenesis of gouty arthritis, rheumatoid arthritis, autoantibody -and immunecomplex-mediated glomerulo-nephritis has been well documented. Moreover, a relevant role of PMNs in tissue injury is now more than suggestive in an increasing number of disease states, including immune vasculitis, ulcerative colitis, chronic obstructive pulmonary disease, adult acute respiratory distress syndrome. At present, the same toxic potential of PMNs is generally thought to be equally responsible for both the microorganism killing and the tissue injury in the aforementioned disorders (1, 2, 3). This fact, coupled with the incomplete knowledge of the events underlying the PMN responses and the PMN-mediated tissue injury, makes rational therapeutic approaches untimely at least as far as the dangerous effects of PMNs are concerned.
Bone marrow transplantation, 1992
ANTMAN K.; CORRINGHAM R.; DE VRIES E.; ELFENBEIN G.; GIANNI AM; GISSELBRECHT C.; HERZIG R.; JUTTN... more ANTMAN K.; CORRINGHAM R.; DE VRIES E.; ELFENBEIN G.; GIANNI AM; GISSELBRECHT C.; HERZIG R.; JUTTNER C.; KAIZER H.; KENNEDY MJ; KESSINGER A.; KOTASEK D.; LAZARUS H.; LJUNGMAN P.; MARANINCHI D.; NOBHOLTZ J.; ...
Blood, Nov 16, 2006
Histone deacetylases (HDACs) modulate gene transcription and chromatin assembly by modifying hist... more Histone deacetylases (HDACs) modulate gene transcription and chromatin assembly by modifying histones at the post-transcriptional level. HDAC inhibitors have promising antitumor activity and are presently explored in clinical studies for malignancies of different histology. Preliminary evidence in animal models of immune disorders also suggests immunosuppressive properties for these small molecules, although the underlying mechanisms remain at present poorly understood. Here, we show that two HDAC inhibitors of clinical use, sodium valproate and MS-275, profoundly affect cytokine-induced differentiation of human monocytes to dendritic cells (DCs), and impair DC phenotypic maturation in response to the Toll-like receptor (TLR) ligand polyinosinic:polycytidylic acid (poly I:C) characterized by a reduced expression of HLA- and costimulatory molecules. HDAC inhibitors reduce cytokine secretion important for T-cell activation like IL-12 and immunostimulatory capacity in DCs and inhibit DC migratory capacity toward the chemoattractant CCL19/MIP-3β. The observed defects in DC function upon exposure to HDAC inhibitors were not due to an increased rate of apoptosis or production of IL-10. We finally investigated the effects of HDAC inhibition on intracellular signalling pathways that play a key role in controlling DC differentiation and function. HDAC inhibitors have been reported to cause a downregulation of the hematopoietic transcription factor PU.1, which contributes to the development of thymic and myeloid dendritic cells and of Langerhans cells in the mouse. We evaluated herein whether PU.1 expression was affected by VPA in monocyte-derived DCs, however, no significant reduction in protein levels could be detected. Therefore, our data rule out PU.1 shortening as a mechanism responsible for the functional defects observed in DCs that were exposed to HDAC inhibitors. Similarly, no significant effect of HDAC inhibitors was detected on Bcl-6, another known target of HDAC inhibitors that, besides its role in lymphomas, has also been linked to the regulation of cytokine and chemokine release in macrophages. In contrast, addition of VPA blocked RelB nuclear relocalization in response to poly I:C in a concentration-dependent manner. Interestingly, IRF-3 and IRF-8, which have been involved in DC differentiation, IL-12 production and DC migration, were also affected by HDAC inhibitors, since their nuclear levels were reduced by VPA in unstimulated as well as in poly I:C-activated DCs. On the other hand, IRAK-1 downregulation in response to poly I:C was not affected by VPA, suggesting that the effects of HDAC inhibition on RelB, IRF-3 and IRF-8 are probably mediated downstream of MyD88 and IRAK-1. In conclusion, HDAC inhibitors exhibit strong immunomodulatory properties on human DCs. Our results support the evaluation of HDAC inhibitors in inflammatory and autoimmune disorders.
European Journal of Cancer, 2011
Thrombosis and Haemostasis, 2014
Pharmacological treatments targeting CXC chemokines and the associated neutrophil activation and ... more Pharmacological treatments targeting CXC chemokines and the associated neutrophil activation and recruitment into atherosclerotic plaques hold promise for treating cardiovascular disorders. Therefore, we investigated whether FK866, a nicotinamide phosphoribosyltransferase (NAMPT) inhibitor with anti-inflammatory properties that we recently found to reduce neutrophil recruitment into the ischaemic myocardium, would exert beneficial effects in a mouse atherosclerosis model. Atherosclerotic plaque formation was induced by carotid cast implantation in ApoE-/-mice that were fed with a Western-type diet. FK866 or vehicle were administrated intraperitoneally from week 8 until week 11 of the diet. Treatment with FK866 reduced neutrophil infiltration and MMP-9 content and increased collagen levels in atherosclerotic plaques compared to vehicle. No effect on other histological parameters, including intraplaque lipids or macrophages, was observed. These findings were associated with a reduction in both systemic and intraplaque CXCL1 levels in FK866-treated mice. In vitro, FK866 did not affect MMP-9 release by neutrophils, but it strongly reduced CXCL1 production by endothelial cells which, in the in vivo model, were identified as a main CXCL1 source at the plaque level. CXCL1 synthesis inhibition by FK866 appears to reflect interference with nuclear factor-κB signalling as shown by reduced p65 nuclear levels in endothelial cells pre-treated with FK866. In conclusion, pharmacological inhibition of NAMPT activity mitigates inflammation in atherosclerotic plaques by reducing CXCL1-mediated activities on neutrophils. These results support further assessments of NAMPT inhibitors for the potential prevention of plaque vulnerability.
Blood, Nov 20, 2009
Abstract 2733 Poster Board II-709 Introduction: APO866, a reversible inhibitor of nicotinamide ph... more Abstract 2733 Poster Board II-709 Introduction: APO866, a reversible inhibitor of nicotinamide phosphoribosyltransferase (Nampt), acts by severely depleting intracellular NAD+ content and thus eliciting mitochondrial dysfunction, ATP depletion, and autophagic cell death. TNF-Related Apoptosis Inducing Ligand (TRAIL) binds to plasma membrane receptors DR4 and DR5 and causes apoptosis through activation of caspase-8 and caspase-10. These, in turn, activate effector caspases either directly or via Bid cleavage and subsequent initiation of the mitochondrial apoptotic pathway. In the present work, we have explored the interaction between APO866 and TRAIL in cellular models of hematological malignancies. Materials and Methods: The lymphoma cell lines Jurkat, PEER, MOLT-4, H9, and Namalwa, primary B-cell chronic lymphocytic leukemia (B-CLL) cells, as well as normal peripheral blood mononuclear cells (PBMCs) were treated with increasing concentrations of APO866, TRAIL, or with 1:1, 1:3, or 1:10 combinations of both agents for 72 hours (48 h APO866 + 24 h TRAIL). Cell death was assessed by propidium iodide staining and flow cytometry (FC). Apoptosis was assessed by Annexin V-propidium iodide staining and FC. Combination indices were calculated according to the Chou and Talalay method. DR5 membrane expression was assessed with a FITC-conjugated anti-DR5 antibody and FC after 12, 24, and 48 h exposure to APO866. Mitochondrial transmembrane potential (Δψm) and cell cycle analysis after single agent or combination treatment were determined by tetramethylrhodamine (TMRE) and Nicoletti staining, respectively, and FC. Intracellular NAD+ and ATP contents were quantified by cyclic assays and HPLC, respectively. The role of autophagy and of caspase activity in the cytotoxic activity of APO866, TRAIL, and of their combination was assessed using the PI3K inhibitors 3-methyladenine, LY2940002, and wortmannin, and the caspase inhibitors Z-VAD-FMK (pan-caspase inhibitor), Z-LEHD-FMK (caspase-9 inhibitor), and Z-IETD-FMK (caspase-8 inhibitor), respectively. Results/Discussion: APO866 induced NAD+ depletion, Δψm dissipation, and ATP exhaustion in the absence of caspase activation as detected by caspase-3 cleavage. Accordingly, autophagy but not caspase inhibitors blocked APO866 activity. Vice versa, TRAIL-induced apoptosis was blocked by the caspase inhibitors and enhanced by the PI3K inhibitors. Remarkably, APO866 and TRAIL showed a potent synergistic interaction in lymphoma cell lines and in primary B-CLL cells, consistently exhibiting combination indices below 1 upon exposure to a wide range of drugs concentrations. On the other hand, the two drugs and their combinations were poorly active and failed to show any cooperation in healthy PBMCs, indicating a specific activity against malignant cells. As a metabolic correlate of their interaction, TRAIL enhanced APO866-induced NAD+ depletion and Δψm. dissipation. As a result, lymphoma cells underwent massive ATP depletion and autophagic cell death. No DR5 upregulation at the cell surface of lymphoma cells was observed in response to APO866. Conclusions: APO866 and TRAIL show potent synergistic interaction in preclinical cell models of Non…
Blood, Nov 20, 2009
Abstract 4251 Kinase domain (KD) mutations are associated with resistance to Imatinib in CP-CML b... more Abstract 4251 Kinase domain (KD) mutations are associated with resistance to Imatinib in CP-CML but their incidence and prognostic significance before any treatment are unclear. To assess if KD mutations at diagnosis may have prognostic significance, we have recently reviewed (before treatment with Imatinib) the mutation status of 45 patients,of whom low risk: 24 patients; intermediate risk: 8 patients; high risk: 13 patients, according to Sokal/Euro. We found that a) no patient with low and intermediate risk showed KD mutations at diagnosis; b) 4/13 high risk patients showed the following mutations at diagnosis: S265R, E255K, F359Y and E255V/E258V; other 5 patients developed mutations during Imatinib treatment (E255V, T315I, E255V/E258V, H396R and D248-274). All patients with low-intermediate risk are alive and well at a median of 44 months (range, 15-71 months). On the contrary, 3/4 high risk patients with KD mutations at diagnosis progressed and died of blastic evolution at 23, 33 and 69 months despite Nilotinib and Dasatinib therapy. Other 3/5 high risk patients who developed mutations under Imatinib, died of blastic evolution at 22, 23 and 43 months despite Nilotinib and Dasatinib treatment. Seven high risk patients are alive under Imatinib between 4 and 51 months. In conclusion, the KD mutations at diagnosis were frequent in high Sokal/Euro risk group supporting the concept that such mutations could be related to the basic biology of the disease. These data, if confirmed, could modify our approach to high risk patients with KD mutation at diagnosis, i.e. utilizing second/third TKI generation earlier during the disease and, in selected cases, reconsidering allografting earlier before leukemic evolution make such procedure useless. Disclosures: No relevant conflicts of interest to declare.
Blood, Nov 16, 2005
Background. It has been demonstrated that about 70% of patients with CML in chronic phase (CP) at... more Background. It has been demonstrated that about 70% of patients with CML in chronic phase (CP) at diagnosis co-expressed p210 and p190 BCR/ABL transcripts, although at a much lower level (Blood1996;87:5213–17). In previous studies, the co-expression of p210 and p190 BCR-ABL transcripts at diagnosis was considered as indicative of higher tumor burden. However, the clinical relevance of p190 BCR-ABL mRNA monitoring in CML pts under Imatinib on bone marrow (BM) samples is not known. Materials and Methods. BM samples were obtained from 83 pts with CP-CML treated with Imatinib at a daily oral dose ranging between 300–500mg. These included 192 samples from 43 pts with late CP-CML (post-IFN failure) and 140 samples from 40 pts with early CP-CML who received Imatinib as first line therapy. Median follow-up was 18 (3–58) and 39 (12–58) months for early and late CP-CML, respectively. As part of a diagnostic work-up, BM samples from each patient were assessed for expression of both p210 and p190 BCR/ABL levels by real-time quantitative reverse transcription PCR (QRT-PCR) using a TAQ-Man system (ABI Prism 7700 Perkin Elmer) for BCR-ABL and ABL genes. The median number of BM assessment was 3 (2–6) for early CP-CML and 4 (2–10) for late CP-CML. A major molecular response (MMR) was defined as BCR-ABL/ABL ratios less than 0.05%. A specific nested RT-PCR screening was assessed for detection of p210 (b2a2, b3a2) and p190 (e1a2) BCR-ABL transcripts to confirm the negative data of p210 and p190 in QRT-PCR. Results. A MMR was obtained in 20 pts (50%) and 20 pts (46%) in early and late CP-CML respectively. However, early CP-CML pts showed a significantly greater reduction in p210 BCR-ABL levels compared to late CP-CML after 12 months of Imatinib therapy (p=0.006), indicating a different kinetic of molecular response. Co-expression of p210 and p190 BCR-ABL transcripts at diagnosis was 73% for early CP-CML, whereas it was not available for late CP-CML. To test whether the persistence of p190 BCR-ABL transcript was predictive of MMR, we divided CML pts in 2 groups, those with 0 or 1 p190 BCR-ABL positive samples (group 1) and those with 2 or more positive samples (group 2) during the follow-up. We found that CP-CML pts of the group 2 showed a significant lower probability to obtain MMR molecular response compared to pts of group 1 both for late and early CML patients respectively [17/24 (71%) vs 5/19 (26%) with p=0.0039)], [15/21 (71%) vs 6/18 (33%) with p=0.017)]. This correlation holds also for complete cytogenetic response (data not shown). Conclusions. In this study, approximately 50% of pts reached a MMR; half of them had undetectable values of p210 BCR-ABL transcripts. However, in a proportion of pts with complete cytogenetic response and low level of p210 BCR-ABL transcript, the expression of p190 is still detectable. The persistence of p190 signal despite the 2–3log fall in p210 BCR-ABL levels, may be of prognostic significance and may disclose unfolded concepts of biological relevance.
Journal of Clinical Oncology, Jun 20, 2006
16534 Background: Pegylated filgrastim is a new formulation of a granulocyte colony-stimulating f... more 16534 Background: Pegylated filgrastim is a new formulation of a granulocyte colony-stimulating factor that has a long circulating half-life, permitting a single dose of filgrastim per cycle of chemotherapy. Methods: To evaluate whether a single subcutaneous injection of pegfilgrastim (6 mg) is as safe and effective as daily filgrastim (5 mcg/kg/day), 40 consecutive autologous stem cell transplantations performed for breast cancer and lymphomas have been analysed. Median age was 47 yrs (20–61) and 48 yrs (30–63) in pegfilgrastim and filgrastim group, respectively. All patients had normal bone marrow biopsy. The first cohort of patients received 5 mcg/kg/day of filgrastim starting from day 5 post transplantation and the second cohort of patients received a single subcutaneous injection of 6 mg pegfilgrastim on day 5 after transplantation. Results: Median duration of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 7 (4–9) and 6 (5–9) days, respectively (P 0.29). Neutropenic fever incidence was significantly higher in filgrastim group, 9/20 vs 16/20 (P 0.048), the median duration was not significantly different, 1 (1–6) vs 3 (1–7) days. The grade 3–4 mucositis was higher in filgrastim patient group, 4/20 vs 13/20 in pegfilgrastim and filgrastim, respectively (P 0.009). The adverse events observed during post-transplant aplasia were attributable to complications arising from myelo-suppressive chemotherapy or the primary disease. The only occurring adverse event considered to be cytokine related was mild to moderate bone pain. The overall incidence of bone pain requiring non-narcotic analgesia was not statistically different, 20% (4/20) in pegfilgrastim patients and 40% (8/20) in filgrastim patients. The patients in filgrastim group received a mean of 9.8 daily injections. Conclusions: A single injection of pegfilgrastim administered at day 5 post transplant shows comparable safety and efficacy profiles to daily injections of filgrastim and may be cost-effective. No significant financial relationships to disclose.
Current Cancer Drug Targets, Apr 1, 2012
Blood, Nov 20, 2009
Abstract 4404 Cancer cells almost invariably exhibit aberrant histone deacetylase (HDAC) activity... more Abstract 4404 Cancer cells almost invariably exhibit aberrant histone deacetylase (HDAC) activity leading to changes in chromatine structure, altered gene expression, poor differentiation, impaired apoptosis and increased proliferation. Accordingly, virtually all the HDAC inhibitors currently available show some degree of antitumor activity in preclinical cancer models and several of these compounds are currently under investigation or already approved for the treatment of human malignancies. Such is the case of the hydroxamic acid derivative suberoylanilide hydroxamic acid (Vorinostat, Zolinza), approved for the treatment of cutaneous T cell lymphomas. Sirtuins are a large family of deacetylases characterized by a unique, NAD+-dependent enzymatic mechanism. In addition to their established role in metabolism and longevity, recent evidence points to an emerging role for sirtuins in carcinogenesis. In the attempt to identify drug combinations that would increase the activity of traditional HDAC inhibitors we have explored the combination of valproic acid (VA) and butyrate (BU) with the sirtuin inhibitors cambinol and sirtinol in primary B-cell chronic lymphocytic leukemia (B-CLL) cells (n=35), acute myelogenous leukemia (AML) cells (n=10) and leukemia cell lines. Cell viability was assessed by propidium iodide staining and flow cytometry. Combination indices were determined using the median-effect method. In leukemia cells, exposure to sirtuin inhibitors synergistically increased VA and BU mediated cytotoxicity. Conversely, these drugs were poorly active and failed to show any cooperation in healthy cells, including peripheral blood mononuclear cells and fibroblasts, suggesting a cancer-specific mode of action. Similar results were obtained by combining VA or BU with the Nampt inhibitor APO866, which reduces intracellular NAD+ levels and thereby prevents sirtuin activity. Remarkably, SIRT1 and SIRT6 inhibition per se did not seem to account for cell demise upon HDAC inhibition since expression of a dominant negative SIRT1 isoform or RNA interference-mediated SIRT6 silencing failed to increase VA and BU activity. Our data indicate a specific requirement by leukemia cells for sustained sirtuin activity when classical HDACs are inhibited. This feature is suitable to be therapeutically exploited by combining sirtuin inhibitors or APO866 with classical HDAC inhibitors especially for the treatment of hematological malignancies. Disclosures: No relevant conflicts of interest to declare.
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Journal of Clinical Oncology, May 20, 2014
e13511 Background: The ALK inhibitor crizotinib is the standard of care of patients with ALK+, ad... more e13511 Background: The ALK inhibitor crizotinib is the standard of care of patients with ALK+, advanced NSCLC. However, its clinical benefit is limited by the development of resistance. Cycles of f...