5 Years Experience in Collecting Tumor Specimen at Patient's Tumor Bank of Hope (PATH) – A Decentralized, Independent Biobank in Germany Controlled by Patients

Purpose: PATH was established by a German breast cancer advocacy group in 2002. While there are other tumor banks around the world, the immediate benefit for the donating patient is not always clear. With PATH, we set out to prove that patients, physicians and researchers can join forces to operate a tumor bank at the highest ethical standards while collecting tumor specimen at highest and standardized quality. In addition, PATH has developed data acquisition and management methods for disease and therapy process and follow-up.Design: PATH Foundation is a non-profit organization.Seven certified German „breast centers“ are currently our partners. PATH is presented to patients in pre-OP discussion in these centers and they are given the opportunity to take part, by agreeing to an informed consent. The informational documents and consent form we give to patients were developed in collaboration with Prof. Taupitz of Germany's National Board of Ethics. The whole PATH procedure causes no additional cost for the patient.PATH tissuebank contains tumor-, normal tissue- and blood serum-specimen in fresh frozen quality stored in -152°C freezers or liquid nitrogen tanks. The first aliquot of each specimen is stored exclusively for the patient, the rest of the material is donated to PATH for research purposes. All cooperation partners (OB/Gyns and pathologists) commit to working strictly according to PATH's SOPs. There are 4 SOPs (extraction of blood serum und tissue aliquots, labeling of the specimen and quality-check with RIN assay).Cooperation partners' compliance and the implementation of the SOPs is monitored in biannual visits and meetings.All important data regarding tumor biology and therapy as well as sample processing are collected in PATH's own centrally managed MySQL database. The process was approved by the Bavarian Commission of Data Protection.Furthermore, PATH collects necessary follow-up data directly from the patient as well as from local tumor registries.Results: We began the collection of specimen in 2004.Data acquisition and implementation of the data base started in 2005. Follow-up began in late 2008. As of 04/2009, we have 3255 sufficiently documented patient data sets correlating with patients taking part in the PATH procedure (median age is 56). The available PATH collection contains 2732 tumor research specimen from 1251 patients (according to the last analysis of a collective of 2020 patients in 12/2008). Other quantities of collected specimen incl. patients' aliquot (ps') tumor = 1578; ps' normal tissue = 1591; ps' serum = 1876; resarch aliquots (ra) normal tissue = 2667; ra serum = 6068. This means that in 78,1% it was possible to collect a patient's tumor aliquot and in 61,9% at least one research specimen, varying with tumor stage.Conclusion: Over the last 5 years, PATH has gained broad experience in tumorbanking that is allowing it to operate a biobank at the highest ethical and qualitative standards. With its follow-up efforts, PATH will be able to provide a great variety of research specimen with at least a mean follow-up time of 5 years in 2011!

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3074.

CD 1-reactive leukemic cells in bone marrow: Presence of Langerhans cell marker on leukemic monocytic cells

Langerhans cells originate in bone marrow and probably belong to the monocyte-macrophage lineage. CD1 is a specific marker of Langerhans cells. By immunofluorescence and immunoelectron microscopy, CD1a antigen and myeloid markers (CD11, CD13, CD14, CD15, CD33, HLA-DR) were studied in 53 cases of acute myeloid leukemias (AML) and 3 acute lymphoblastic leukemias (ALL). The 11 ANLL without monocytic component were CD1a negative. 2/5 of acute myelomonocytic leukemias (AML4) and 9/37 of acute monocytic leukemias (AML5) were positive. All 3 ALL were negative. No correlation was found between CD1a and myeloid markers. CD1a+ AML did not differ from CD1a- AML with regard to cytogenetics or response to therapy. The CD1a positive cells may originate from an abnormal proliferation of CD1a positive cells which are present in bone marrow and which may differentiate into Langerhans cell precursors.

[Mucopolysaccharidoses]

Mucopolysaccharidoses are a family of metabolic disorders characterized by a deficiency in the catabolic lysosomal pathways. They are rare, inherited diseases which lead to progressive cellular, tissue and organ damage across a broad spectrum of phenotypes. To prevent irreversible damage early diagnosis is essential. Typical signs and symptoms are the thoracolumbar gibbus, shortened and plumped metacarpal bones, hip dysplasia, deformed ribs and ovoid vertebral bodies. Due to the typical deformation of the pelvis hip dislocation occurs often in childhood. Bilateral carpal tunnel syndrome is frequent. Bone marrow transplantation and enzyme replacement therapy are available. Orthopaedic interventions are based on individual therapeutic decisions and indications.

An accelerated vaccine schedule with a poly-antigenic hepatitis C virus MVA-based candidate vaccine induces potent, long lasting and in vivo cross-reactive T cell responses

We designed and evaluated in HLA-class I transgenic mouse models a hepatitis C virus (HCV) T cell-based MVA vectored vaccine expressing three viral antigens known to be targets of potent CD8+- and CD4+-mediated responses. An accelerated (3 week-based) vaccination induced specific CD8+ T cells harboring two effector functions (cytolytic activity - both in vitro and in vivo- and production of IFNgamma) as well as specific CD4+ T cells recognizing all three vaccine antigens. Responses were long lasting (6 months), boostable by a fourth MVA vaccination and in vivo cross-reactive as demonstrated in a surrogate Listeria-based challenge assay. This candidate vaccine has now moved into clinical trials.

Toxoplasma gondii: Comparison of human CD34+ and monocyte-derived dendritic cells after parasite infection

Human dendritic cells (DC) obtained in vitro from CD34(+) progenitors (CD34-DC) or blood monocytes (mo-DC) are different DC which may be used in a model of T. gondii infection. We compared the survival, infection rate and cell surface receptor expression of both DC types after living T. gondii tachyzoite infection. CD34-DC appeared less resistant to the parasite than mo-DC. At 48h post-infection, chemokine receptors responsible for DC homing and migration were absent in mo-DC, while down regulation of CCR6 and up regulation of CCR7 was observed in CD34-DC. This result, suggesting migration ability of CD34-DC, was confirmed by in vitro migration experiments against different chemokines. Tachyzoite supernatant, used as chemokine, attracted immature CD34-DC as observed by MIP3alpha, while MIP3beta, as expected, attracted mature CD34-DC. Under similar conditions, no significant difference was noticed between mature or immature mo-DC. These data indicated that CD34-DC represent an alternative model that allows migration assay of infected DC by T. gondii.

Forelimb and hindlimb forces in walking and galloping primates

One trait that distinguishes the walking gaits of most primates from those of most mammalian nonprimates is the distribution of weight between the forelimbs and hindlimbs. Nonprimate mammals generally experience higher vertical peak substrate reaction forces on the forelimb than on the hindlimb. Primates, in contrast, generally experience higher vertical peak substrate reaction forces on the hindlimb than on the forelimb. It is currently unclear whether this unusual pattern of force distribution characterizes other primate gaits as well. The available kinetic data for galloping primates are limited and present an ambiguous picture about peak-force distribution among the limbs. The present study investigates whether the pattern of forelimb-to-hindlimb force distribution seen during walking in primates is also displayed during galloping. Six species of primates were video-recorded during walking and galloping across a runway or horizontal pole instrumented with a force-plate. The results show that while the force differences between forelimb and hindlimb are not significantly different from zero during galloping, the pattern of force distribution is generally the same during walking and galloping for most primate species. These patterns and statistical results are similar to data collected during walking on the ground. The pattern of limb differentiation exhibited by primates during walking and galloping stands in contrast to the pattern seen in most nonprimate mammals, in which forelimb forces are significantly higher. The data reported here and by Demes et al. ([1994] J. Hum. Evol. 26:353-374) suggest that a relative reduction of forelimb vertical peak forces is part of an overall difference in locomotor mechanics between most primates and most nonprimate mammals during both walking and galloping.

Toxoplasma gondii regulates recruitment and migration of human dendritic cells via different soluble secreted factors

We investigated in vitro the properties of soluble factors produced by Toxoplasma gondii on the recruitment, maturation and migration of human dendritic cells (DC) derived from CD34+ progenitor cells. We used soluble factors including excreted secreted antigens (ESA) produced under various conditions by the virulent type I RH strain (ESA-RH) and the less virulent PRU type II strain (ESA-PRU). Soluble factors of both T. gondii strains appeared to possess a chemokine-like activity that attracted immature DC. This recruitment activity required the presence of functional CCR5 molecules on the cell membrane. Incubation of DC for 24 h with ESA triggered the migration of a large percentage of these cells towards the chemokine MIP-3beta; ESA-PRU was more efficient than ESA-RH. ESA produced in absence of exogenous protein and crude extract did not induce DC migration but retained recruitment activity. These data indicate that recruitment activity and migration-inducing activity are not governed by the same factors. Moreover, incubation of DC for 48 h with ESA did not modify the expression of costimulation or maturation markers (CD83, CD40, CD80, CD86 or HLA-DR), but induced a decrease in CCR6 expression associated with an increased expression of CCR7. Taken together, these results suggest that T. gondii controls recruitment and migration of immature DC by different soluble factors and may induce a dysfunction in the host-specific immune response.

TGFβ Inhibits CD1d Expression on Dendritic Cells

The CD1 family of cell surface glycoprotein has been demonstrated to be a third lineage of antigen-presenting molecules for specific T cell responses. They present lipidic, glycolipidic antigen and hydrophobic peptide to T cells. CD1d restricted T cells play a role in autoimmune disease and in tumor immunity. Transforming growth factor beta (TGFbeta), a member of the family of polypeptide growth factors synthetized by human keratinocytes, has inhibitory effects on proliferation and differentiation of immune cells, especially on CD1d-restricted natural killer T cells. These properties led us to investigate the role of TGFbeta in CD1d expression on dendritic cells (DC), which are known to play a key role in initiation of the immune response. Here, we observed CD1d molecules on DC developed from PBMC with GM-CSF and IL4 but not with GM-CSF, IL4 and TGFbeta for 7 d. RT-PCR and FACS analysis (mAb 42.1) performed at various stages of differentiation on CD34+ HPC show that CD1d mRNA levels and CD1d molecule expression at the cell surface decreased progressively during the differentiation process. Thus, while committing DC-precursors differentiation toward the Langerhans cell (LC) pathway, TGFbeta likely inhibits CD1d transcription. Therefore, LC freshly recovered from epidermal sheet were evaluated by flow cytometry. In accordance with in vitro observation, they did not expressed measurable levels of CD1d molecules at the cell membrane. Thus, TGFbeta produced by keratinocytes contribute to selectively downregulate CD1d expression on intraepidermal-resident LC.

Interoperability and HealthGRID

OBJECTIVES

GRID technology, with initiatives like the GGF, will have the potential to allow both competition and interoperability not only among applications and toolkits, but also among implementations of key services. The pyramid of eHealth interoperability should be achieved from standards in communication and data security, storage and processing, to the policy initiatives, including organizational protocols, financing procedures, and legal framework. The open challenges for GRID use in clinical fields illustrate the potential of the combination of grid technologies with medical routine into a wider interoperable framework.

METHODS

The Telemedicine Alliance is a consortium (ESA, WHO and ITU), initiated in 2002, in building a vision for the provision of eHealth to European citizens by 2010. After a survey with more that 50 interviews of experts, interoperability was identified as the main showstopper to eHealth implementation.

RESULTS

There are already several groups and organizations contributing to standardization. TM-Alliance is supporting the "e-Health Standardization Coordination Group" (eHSCG).

CONCLUSIONS

It is now, in the design and development phase of GRID technology in Health, the right moment to act with the aim of achieving an interoperable and open framework. The Health area should benefit from the initiatives started at the GGF in terms of global architecture and services definitions, as well as from the security and other web services applications developed under the Internet umbrella. There is a risk that existing important results of the standardization efforts in this area are not taken up simply because they are not always known.

Calcium triggers beta-defensin (hBD-2 and hBD-3) and chemokine macrophage inflammatory protein-3 alpha (MIP-3alpha/CCL20) expression in monolayers of activated human keratinocytes

The inducible epidermal beta-defensins and the chemokine macrophage inflammatory protein-3alpha (MIP-3alpha/CCL20) are important mediators involved in innate and adaptive immunity and in the recruitment of immune cells. The aim of our study was to determine whether calcium could trigger the induction of beta-defensins (hBD-2 and hBD-3) mRNA and the release of MIP-3alpha by normal human keratinocyte monolayers. Epidermal cells derived from foreskin were cultured in defined medium supplemented with different calcium levels (0.09, 0.8 and 1.7 mM) and were stimulated or not with the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-alpha 1-500 ng/ml) or interferon-gamma (INF-gamma 1-100 ng/ml). A high calcium concentration (1.7 mM) alone applied in culture medium for 4 days was sufficient to induce hBD-2 and hBD-3 mRNA expression. Whatever interindividual variability in the expression of hBD-2 and hBD-3 mRNA and MIP-3alpha secretion, the addition of TNF-alpha for a short duration (26h), initiated a dose-dependent and coordinated up-regulation of hBD-2 and hBD-3 mRNA and MIP-3alpha release in keratinocyte cultures. Unlike hBD-2 and hBD-3 mRNA was preferentially stimulated by IFN-gamma rather than TNF-alpha. In our experimental conditions, L-isoleucine, described to stimulate beta-defensin in bovine epithelial cells, did not exert any effect either on hBD-2 and hBD-3 transcripts or MIP-3alpha protein. Taken together, these results confirm the major role of the maturation/differentiation process of normal human keratinocytes in the induction of inducible beta-defensins and MIP-3alpha chemokine, which contribute in vivo to the immunosurveillance of the skin barrier function.