Children with relapsed or refractory nephroblastoma: favorable long-term survival after high-dose chemotherapy and autologous stem cell transplantation

BACKGROUND

High-dose chemotherapy (HDC) with autologous stem-cell rescue (ASCR) is a treatment option for pediatric patients with relapsed nephroblastoma. We present long term results of 9 patients treated between 1993 and 2013 at our center.

PROCEDURE

Reinduction therapy was carried out according to GPOH and SIOP recommendations. The conditioning regimen consisted of carboplatin (1 200 mg/m²), etoposide (800 mg/m² or 40 mg/kg) and melphalan (180 mg/m²). Purging of the grafts with immunomagnetic CD34 positive selection was performed in 5 patients.

RESULTS

8 of 9 Patients (90%) are alive without evidence of disease after a median follow-up of 8.5 years. Leukocyte engraftment occurred after a median of 10 days (range 8-12). Median numbers of 667/µl CD3+, 329/µl CD4+, 369/µl CD8+T cells and 949/µl B cells were reached after 180 days. No negative impact of CD34 selection was observed. No transplantation-related death occurred. Acute toxicity comprised mucositis III°-IV° in all and veno-occlusive disease in one patient. Long term effects probably related to treatment occurred in 3/7 evaluable patients and comprised hearing impairment, reduced renal phosphate reabsorption, mild creatinine elevation and hypothyroidism (n=1, each).

CONCLUSION

Thus, in our experience HDC with ASCR is an effective treatment of recurrent or refractory nephroblastoma with acceptable side effects. However, a randomized trial proving its efficiency with a high level of evidence is needed.

Kidney transplant recipients treated with belatacept exhibit increased naïve and transitional B cells

Phase III clinical studies have shown that kidney transplant (KT) recipients treated with the costimulation blocker belatacept exhibited a better renal allograft function and lower donor-specific anti-HLA immunization when compared to recipients treated with calcineurin inhibitors (CNI). We analyzed B cell phenotype in KT recipients treated with belatacept and stable renal function (N = 13). Results were compared to those observed in stable patients treated with CNI (N = 12), or with chronic antibody-mediated rejection (N = 5). Both transcriptional profile and phenotypic characterization of peripheral B cells were performed by real-time polymerase chain reaction and flow cytometry, respectively. In belatacept group, the frequency and absolute number of transitional B cells as defined by both phenotypes: CD19(+) CD24(hi) CD38(hi) and CD19(+) IgD(hi) CD38(hi) CD27(-) , as well as naïve B cells were significantly higher compared with CNI group. B cell activating factor (BAFF) and BAFF receptor mRNA levels were significantly lower in belatacept group than in CNI group. These results show for the first time that belatacept influences B cell compartment by favoring the occurrence of transitional B cells with potential regulatory properties, as described in operational tolerant patients. This role may explain the lower alloimmunization rate observed in belatacept-treated patients.

[Influence of anterior cruciate reconstruction on postural stability: A pre- and postoperative comparison]

BACKGROUND

Ruptures of the anterior cruciate ligament (ACL) lead to an anteromedial rotational instability in the knee joint and, thus, to a deterioration of the patient's ability to stand (postural control). It still remains unclear whether postural control can be restored by ACL reconstruction. The aim of this study was to investigate the effect of a unilateral ACL graft on the ability to stably stand on the injured leg using computer-aided dynamic posturography (CDP); the stability indices on standing on one leg were compared pre- and postoperatively.

PATIENTS AND METHODS

A total of 25 patients were studied after unilateral ACL injury and subsequent ACL reconstruction using CDP. The average time of follow-up was 608 days (range 357-821 days). The ability to stably stand on the healthy and injured leg was compared and evaluated for significant differences.

RESULTS

There was a significant improvement of postural control after ACL reconstruction. The Overall Stability Index (OSI) for the leg with ACL rupture was 3.7° ± 1.6° preoperatively and 3.0° ± 1.1° postoperatively (p < 0.05). In the postoperative comparison with the healthy leg, the value in the operated leg was 3.0° ± 1.1° and the healthy leg was 3.0° ± 1.4° (p = 0.99).

CONCLUSIONS

ACL replacement can be improve stability compared to the preoperative value by about 21% and even the stability level of the contralateral healthy knee can be achieved.

Long-range ordered nanodomains of grafted electroactive molecules

We demonstrate the capability to build zero and one-dimensional electroactive molecular nanostructures ordered over a macroscopic scale and stable under ambient conditions. To realize these arrays, we use the selective grafting of functionalized thiols (juglon and terthiophene based) on a self-organized metallic template. The nanoscale patterning of the molecular conductance is demonstrated and analyzed by scanning tunneling spectroscopy. Finally, the influence of the nanostructuring on electro-chemical properties is measured, paving the way to an all-bottom-up fabrication of nanostructured templates for nanosciences.

Adoptive T-cell transfer for refractory viral infections with cytomegalovirus, Epstein-Barr virus or adenovirus after allogeneic stem cell transplantation

Viral infections after allogeneic stem cell transplantation (SCT) are an important cause of morbidity and mortality as SCT can expose patients to a transient state of combined immunodeficieny. Most viral infections after SCT are caused by the endogenous reactivation of persistent pathogens such as adenovirus (ADV), cytomegalovirus (CMV), and Epstein-Barr-virus (EBV). The control of these infections will ultimately depend on the restoration of adequate T-cell immunity.

Ultrafast photoinduced dynamics of halogenated cyclopentadienes: observation of geminate charge-transfer complexes in solution

The photoinduced dynamics of the fully halogenated cyclopentadienes C5Cl6 and C5Br6 have been investigated in solution and gas phase by femtosecond time-resolved spectroscopy. Both in solution and in gas phase, homolytic dissociation into a halogen radical and a C5X5 (X = Cl, Br) radical was observed. In liquid phase, solvent-dependent formation of charge transfer complexes between geminate radicals was observed for the first time. These complexes were found to be surprisingly stable and offered the opportunity to follow the dynamics of specific radical pairs. In the case of C5Cl6 in trichloroethanol, a reaction of the chlorine radical with molecules from the solvent cage was observed.

[Kidney involvement in sarcoidosis]

Sarcoidosis is a chronic multisystemic inflammatory disorder of unknown etiology, characterized by the presence of non-necrotizing epithelioid and giant cell granulomas. Various renal manifestations have been reported in patients with sarcoidosis. Disorders of bone and mineral metabolism related to the overexpression of 25-hydroxyvitamin-D1α-hydroxylase by alveolar and granuloma macrophages are frequently associated with sarcoidosis. Hypercalcemia and hypercalciuria are a major cause of renal injury predisposing to pre renal azotemia, acute tubular necrosis, nephrolithiasis and nephrocalcinosis. Therapeutic management of hypercalcemia includes preventive measures (limited sunlight exposure, limited vitamin D and calcium intakes, and adequate hydration) and specific treatment in cases of severe hypercalcemia (corticosteroid therapy, chloroquine or ketoconazole). Granulomatous tubulointerstitial nephritis is the most common renal lesion associated with sarcoidosis leading to end stage renal disease in some patients. In these cases, interstitial fibrosis seems to appear early in the course of sarcoidosis and is a major prognostic factor requiring rapid corticosteroid therapy to reduce the risk of severe renal impairment. Membranous nephropathy seems to be the most frequent glomerular disease that may occur in association with sarcoidosis. Among kidney allograft recipients, the risk of recurrence of granulomatous tubulointerstitial nephritis is high and may have a negative impact on the graft survival.

Directed growth of mixed self-assembled monolayers on a nanostructured template: a step toward the patterning of functional molecular domains

We report on the elaboration of networks of SAM domains. More precisely, we show the feasibility in making arrays of functionalized alkylthiol nanodomains bordered with an alkylthiol matrix. The several step process relies on the replication of a self-organized cobalt array grown on Au(111). The SAM process takes place in solution. The chemical affinity of thiol for gold leads to the selective grafting of molecules on the surface. After having removed the inorganic array, alkylthiol functionalized with a terthiophene unit is grafted in free gold areas. The efficiency of the replication of the initial template depends on the stability of the first SAM. We also investigate electronic tunnel transport through oligothiophene islands with the STM. The variation of the molecular contrast with bias voltage between the two molecular species indicates a potential resonant tunneling mechanism through the orbitals of the aromatic compound.

Mutation and expression of the p53 tumor suppressor gene in tumor samples and cancer cell-lines - comparison of nonisotopic direct DNA-sequencing, immunoblotting and immunohistochemistry

Mutations in the nuclear phosphoprotein p53 are the most frequent genetic alterations in human solid tumors detected so far. These mutations are clustered in highly conserved domains spanning from exon 4 to 9 of the gene. A very precise method of detecting p53 mutations is to sequence these domains. However, 2 to 3 overlapping PCR-amplifications were needed to span the whole mutation-prone region. We used a very rapid non radioactive solid-phase DNA sequencing method starting from mRNA to sequence the p53 domains in both directions with T7 DNA-polymerase allowing detection of the heterozygous state, where one allele shows the wild-type sequence, the other a mutated one. First we sequenced four colon carcinoma cell lines with known p53 mutations and one T-cell-leukemia cell line with a heterozygous situation to validate our method. Using this method we sequenced the p53 gene (exons four to nine) from 16 primary colon carcinomas. Seven of these 16 (44%) carcinomas showed mutations in the p53 gene resulting in amino acid exchanges. One showed a silent mutation, another one showed two point mutations in the highly conserved domain of the p53 gene. These colorectal carcinomas have been examined for overexpression of the p53 protein using a panel of monoclonal antibodies directed against p53 (PAb1801, PAb240, PAb421, PAb1620) by immunohistochemical analysis and immunoblotting. Furthermore, four colorectal cancer cell lines were examined by indirect immunofluorescence technique with the same mAb PAb1801 as used in histological staining. Analysis of 6 out of 15 (40%) tumor specimens revealed markedly positive p53 nuclear staining patterns using monoclonal antibody PAb1801. These data suggest that there is quite a good correlation between point mutation of the p53 gene and nuclear staining with monoclonal antibody PAb1801 detecting overexpressed p53 protein. Moreover, there is no convincing evidence that wild-type protein can be detected using the monoclonal antibodies PAb 1801 and PAb 1620.

Nucleoside transport across the plasma membrane mediated by equilibrative nucleoside transporter 3 influences metabolism of Arabidopsis seedlings

The metabolism of nitrogen-rich nucleosides in Arabidopsis seedlings was investigated at the level of import and subsequent salvage or degradation. Uptake and fate of nucleosides imported by equilibrative nucleoside transporter 3 (ENT3) was analysed and, furthermore, a comprehensive analysis of the effect of exogenously fed nucleosides at the level of metabolic as well as transcriptomic alterations was performed. Expression of nucleoside transporters ENT1 and ENT3, together with nucleoside import, was increased upon nitrogen limitation. Thereby a role for ENT3, which is expressed mainly in the vasculature of roots and leaves, as a major import route for nucleosides was supported. Exogenously fed nucleosides were able to attenuate nitrogen starvation effects such as chlorophyll breakdown, anthocyanin accumulation, RNA breakdown and reduced levels of amino acids. In response to nucleoside supply, up-regulation of genes involved in nitrogen distribution in plants was observed. In addition, genes involved in nucleoside metabolism were identified as regulated upon nitrogen limitation. In summary, an overall beneficial effect of nucleoside supply to Arabidopsis seedlings, especially under limiting nitrogen conditions, was observed.