(1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies

Invasive fungal infections (IFIs) are life-threatening complications of hematological malignancies that must be diagnosed early to allow effective treatment. Few data are available on the performance of serum (1–3)-β-D-glucan (BG) assays for diagnosing IFI in patients with hematological malignancies admitted to the intensive care unit (ICU). In this study, 737 consecutive patients with hematological malignancies admitted to 17 ICUs routinely underwent a BG assay at ICU admission. IFIs were diagnosed using standard criteria applied by three independent specialists. Among the 737 patients, 439 (60%) required mechanical ventilation and 273 (37%) died before hospital discharge. Factors known to alter BG concentrations were identified in most patients. IFIs were documented in 78 (10.6%) patients (invasive pulmonary aspergillosis, n = 54; Pneumocystis jirovecii pneumonia, n = 13; candidemia, n = 13; and fusarium infections, n = 3). BG concentrations (pg/mL) were higher in patients with than without IFI (144 (77–510) vs. 50 (30–125), < 0.0001). With 80 pg/mL as the cutoff, sensitivity was 72%, specificity 65%, and area-under-the-curve 0.74 (0.68–0.79). Assuming a prevalence of 10%, the negative and positive predictive values were 94% and 21%. By multivariable analysis, factors independently associated with BG > 80 pg/mL were IFI, admission SOFA score, autologous bone-marrow or hematopoietic stem-cell transplantation, and microbiologically documented bacterial infection. In conclusion, in unselected critically ill hematology patients with factors known to affect serum BG, this biomarker showed only moderate diagnostic performance and rarely detected IFI. However, the negative predictive value was high. Studies are needed to assess whether a negative BG test indicates that antifungal de-escalation is safe.

Red blood cell transfusion in the resuscitation of septic patients with hematological malignancies

BACKGROUND

Indications for red blood cell (RBC) transfusion in septic acute circulatory failure remain unclear. We addressed the practices and the prognostic impact of RBC transfusion in the early resuscitation of severe sepsis and septic shock in patients with hematological malignancies.

METHODS

We performed a retrospective analysis of a prospectively collected database of patients with hematological malignancies who required intensive care unit (ICU) admission in 2010-2011. Patients with a main admission diagnosis of severe sepsis or septic shock were included in the present study. We assessed RBC transfusion during the first two days as part of initial resuscitation.

RESULTS

Among the 1011 patients of the primary cohort, 631 (62.4%) were admitted to the ICU for severe sepsis (55%) or septic shock (45%). Among them, 210 (33.3%) patients received a median of 2 [interquartile 1-3] packed red cells during the first 48 h. Hemoglobin levels were lower in transfused patients at days 1 and 2 and became similar to those of non-transfused patients at day 3. Early RBC transfusion was more likely in patients with myeloid neoplasms and neutropenia. Transfused patients displayed more severe presentations as assessed by higher admission SOFA scores and blood lactate levels and the further requirements for organ failure supports. RBC transfusion within the first two days was associated with higher day 7 (20.5 vs. 13.3%, p = 0.02), in-ICU (39 vs. 25.2%, p < 0.001) and in-hospital (51 vs. 36.6%, p < 0.001) mortality rates. RBC transfusion remained independently associated with increased in-hospital mortality in multivariate logistic regression (OR 1.52 [1.03-2.26], p = 0.03) and propensity score-adjusted (OR 1.64 [1.05-2.57], p = 0.03) analysis.

CONCLUSIONS

RBC transfusion is commonly used in the early resuscitation of septic patients with hematological malignancies. Although it was preferentially provided to the most severe patients, we found it possibly associated with an increased risk of death.

[Pulmonary tumor thrombotic microangiopathy]

Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.

Sortilin limits EGFR signaling by promoting its internalization in lung cancer

Tyrosine kinase receptors such as the epidermal growth factor receptor (EGFR) transduce information from the microenvironment into the cell and activate homeostatic signaling pathways. Internalization and degradation of EGFR after ligand binding limits the intensity of proliferative signaling, thereby helping to maintain cell integrity. In cancer cells, deregulation of EGFR trafficking has a variety of effects on tumor progression. Here we report that sortilin is a key regulator of EGFR internalization. Loss of sortilin in tumor cells promoted cell proliferation by sustaining EGFR signaling at the cell surface, ultimately accelerating tumor growth. In lung cancer patients, sortilin expression decreased with increased pathologic grade, and expression of sortilin was strongly correlated with survival, especially in patients with high EGFR expression. Sortilin is therefore a regulator of EGFR intracellular trafficking that promotes receptor internalization and limits signaling, which in turn impacts tumor growth.

Determinants of 1-year survival in critically ill acute leukemia patients: a GRRR-OH study

Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs. Median age was 58 years and 70% had newly diagnosed leukemia. ICU mortality rate was 28.6 and 39.6% of the patients alive at 1 year. Admission for intensive monitoring was independently associated with better 1-year survival by multivariate analysis. Conversely, relapsed/refractory disease, secondary leukemia, mechanical ventilation and renal replacement therapy were independently associated with 1-year mortality. This study confirms the impact of organ dysfunction on long-term survival in ICU patients with AL. Follow-up studies to assess respiratory and renal recovery are warranted.

SCO-spondin oligopeptide inhibits angiogenesis in glioblastoma

Angiogenesis plays a critical role in glioblastoma growth and progression. We therefore aimed at evaluating the anti-angiogenic properties of an oligopeptide originating from SCO-spondin (NX) on a model of human glioblastoma. To this end, we studied the impact of NX treatment on human brain endothelial cells (HBMECs) alone or co-cultured with glioblastoma cells (U87-MG) on apoptosis, proliferation, migration and release of angiogenic factors. We further investigated the anti-angiogenic potential of NX on human glioblastoma cells grown on chorio-allantoic membrane (CAM) or in glioblastoma xenografts. The results of our experiments showed that NX treatment impaired the microvascular network and induced a decrease in cell proliferation, vascularization and tumor growth in the CAM model as well as in xenotransplants. Interestingly, our in vitro experiments showed that NX impairs HBMECs migration but also regulates the release of angiogenic factors from U87-MG. These results are confirmed by the profiling of NX-treated U87-MG grown on CAM that highlighted modifications of several genes involved in angiogenesis. In conclusion, NX inhibits tumorigenesis by impairing the ability of glioblastoma cells to induce angiogenesis and by inhibiting endothelial cell migration. This molecule might therefore be an interesting candidate for future cancer therapies.

Abstract 3327: Sortilin controls the EGFR nuclear translocation

The epidermal growth factor receptor (EGFR) deregulations play a central role in cancer progression. EGFR generates extra- and intracellular signals through various pathways, including its release in the tumor microenvironment through extracellular vesicles, as well as the nuclear EGFR signaling. That ultimately results in oncogenic signals promoting the tumor aggressiveness. Our previous report showed that sortilin, a member of the VPS10P sorting proteins, is associated with EGFR to allow its secretion through exosomes in non-small cell lung cancer (NSCLC) cells. Furthermore, sortilin is mainly present in the Golgi which is an essential compartment involved in the EGFR bypass towards the nucleus. Therefore, our aim is to investigate the potential role of sortilin in EGFR nuclear translocation.

EGFR and sortilin translocation into the nucleus has been validated by proximity ligation assay and confocal microscopy analysis. Moreover, to study the sortilin function in the EGFR nuclear translocation, we resorted to the NSCLC cell line A549 in which the sortilin expression was silenced using a shRNA delivery. Subcellular fractionations and nuclear protein extractions were performed to study the impact of the sortilin loss on the EGF-induced EGFR nuclear translocation.

EGF stimulation highly increases the nuclear translocation of the EGFR and sortilin complex. Interestingly, sortilin depletion significantly decreases the EGF-induced EGFR nuclear translocation in the A549 cells. Strikingly, sortilin-depleted cells exhibit an overexpression of EGFR target genes (MYC, ABCG2, AURKA and CCND1) compared to the control cells. These results suggest that the overexpression of the EGFR target genes is independent of EGFR nuclear translocation in sortilin-depleted cells. Thus, we analyze the activation of the known transcription factors directly involved in the control of EGFR up-regulated genes to determine whether they are activated in sortilin-depleted cells. Moreover, to better understand the sortilin-dependent EGFR nuclear translocation, we compare functional properties (proliferation,

migration and angiogenesis assays) of sortilin-depleted and control cells.

Altogether, our findings suggest a key role of sortilin in the regulation of the EGFR nuclear transport, towards the control of target genes that are widely involved in cancer progression.

Citation Format: Hussein Al Akhrass, Thomas Naves, Marie-Odile Jauberteau, François Vincent, Fabrice Lalloué. Sortilin controls the EGFR nuclear translocation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3327. doi:10.1158/1538-7445.AM2017-3327

Towards single egg toxicity screening using microcoil NMR

Planar NMR microcoils are evaluated, their application to single eggs is demonstrated, and their potential for studying smaller single cells is discussed.

Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome

PURPOSE

The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure.

METHODS

Post hoc analysis of a multicenter database within 20 years was performed. All patients with malignancies and Berlin ARDS definition were included. Noninvasive ventilation use was defined as NIV lasting more than 1 hour, whereas failure was defined as a subsequent requirement of invasive ventilation. Conditional backward logistic regression analyses were conducted.

RESULTS

A total of 1004 met the Berlin definition of ARDS. Noninvasive ventilation was used in 387 patients (38.6%) and NIV failure occurred in 71%, with an in-hospital mortality of 62.7%. Severity of ARDS defined by the partial pressure arterial oxygen and fraction of inspired oxygen ratio (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.15-4.19), pulmonary infection (OR, 1.81; 95% CI, 1.08-3.03), and modified Sequential Organ Failure Assessment (SOFA) score (OR, 1.13; 95% CI, 1.06-1.21) were associated with NIV failure. Factors associated with hospital mortality were NIV failure (OR, 2.52; 95% CI, 1.56-4.07), severe ARDS as compared with mild ARDS (OR, 1.89; 95% CI, 1.05-1.19), and modified SOFA score (OR, 1.12; 95% CI, 1.05-1.19).

CONCLUSION

Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.

Ankle to brachial systolic pressure index at rest increases with age in asymptomatic physically active participants

BACKGROUND

It is commonly acknowledged that the ability to use the ankle-brachial index (ABI), a reliable way to diagnose atherosclerosis, decreases with age in the general population. The aim of this study was to determine the relationship between resting ABI and age in different populations.

METHODS

674 physically active participants with (active high risk, ACT_HR) or without (active low risk, ACT_LR) cardiovascular risk factors or/and sedentary (SED) subjects, aged 20-70 years. Systolic arterial pressure was recorded at rest and simultaneously with automatic sphygmomanometers at the arms and ankles. ABI was calculated as the ratio of the lowest, highest or mean ankle pressure to the highest arm pressure.

RESULTS

Proportion of ABI_min<0.90 was 10.3% in SED_HR subjects versus 0.5% and 1.2%, respectively, in ACT_HR and ACT_LR groups. The averaged ABI value of each group was in the normal range in all groups (ABI>0.90) but was significantly lower in SED_HR compared with all active participants (p<0.001). Regression lines from ABI_mean versus age could lead to approximately +0.05 every 15 years of age in apparently healthy active participants (ACT_LR).

CONCLUSION

ABI at rest increases with the increase in age in the groups of low-risk asymptomatic middle-aged trained adults. The previously reported decrease in ABI with age is found only in SED_HR subjects, and is very likely to rely on the increased prevalence of asymptomatic arterial disease in this group. The increase of ABI with age is consistent with the 'physiological' stiffness observed in ageing arteries even in the absence of 'pathological' atherosclerotic lesions.

TRIAL REGISTRATION NUMBER

NIH clinicaltrial.gov: NCT01812343.