PRENATAL EXPOSURE TO CB2 RECEPTORS AGONIST DIFFERENTIALLY IMPACTS MALE AND FEMALE GERM CELLS VIA HISTONE MODIFICATION

Cannabis use during pregnancy is increasing in the last few years potentially because of decreased perception of the risk of harm. Regardless, recent evidence demonstrated that prenatal cannabis exposure is associated with adverse outcomes. To date there is limited evidence of the impact of cannabis exposure during pregnancy on the reproductive health of the offspring. The biological effects of cannabis are mediated by two cannabinoid receptors, CB₁ and CB₂. We previously demonstrated that CB₂ is highly expressed in mouse male and female fetal germ cells. In this study, we investigated the effects of prenatal exposure to a selective CB₂ agonist, JWH-133, on the long-term reproductive health of male and female offspring and on the involved molecular epigenetic mechanisms. Notably, we focused on epigenetic histone modifications that can silence or activate gene expression, playing a pivotal role in cell differentiation. We reported that prenatal activation of CB₂ has a sex-specific impact on germ cell development of the offspring. In male it determines a delay of germ cell differentiation coinciding with an enrichment of H3K27me3, while in female it causes a reduction of the follicles number through an increased apoptotic process not linked to modified H3K27me3 level.

A minimal promoter region of Kit gene recapitulates mast cell differentiation in development, aging and inflammation

To follow mast cells (MCs) distribution during aging and inflammation, we characterized two transgenic mouse models in which the EGFP expression is controlled by 9kb or 12kb of Kit gene promoter, defined as p18 and p70, respectively. We detected EGFP-positive cells in the serosal surfaces of the peritoneum, pleuras and pericardium, mucosal cavities, and connective tissue of almost all organs including gonads of p70, but not of p18 mice. By FACS and immunofluorescence for FcεR1, Kit and β7-integrin, we found that these EGFP positive cells were MCs. In non-inflammatory conditions, a higher percentage of EGFP positive cells was found in juvenile with respect to adult serosal surfaces, but no differences between males and females at both developmental ages. We found, however, a striking difference in developing gonads, with low numbers of EGFP positive cells in foetal ovaries compared to age matched testes. Under inflammatory conditions caused by high fat diet (HFD), mice showed an increase in serosal EGFP positve cells. Altogether our results identify a regulatory region of the Kit gene, activated in MCs and that directing EGFP expression, can be employed to trace this immune cell type throughout the organism and in different animal conditions.

Impact of age and gender on glioblastoma onset, progression, and management

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, while its frequency in pediatric patients is 10-15%. For this reason, age is considered one of the major risk factors for the development of GBM, as it correlates with cellular aging phenomena involving glial cells and favoring the process of tumor transformation. Gender differences have been also identified, as the incidence of GBM is higher in males than in females, coupled with a worse outcome. In this review, we analyze age- and gender- dependent differences in GBM onset, mutational landscape, clinical manifestations, and survival, according to the literature of the last 20 years, focusing on the major risk factors involved in tumor development and on the mutations and gene alterations most frequently found in adults vs young patients and in males vs females. We then highlight the impact of age and gender on clinical manifestations and tumor localization and their involvement in the time of diagnosis and in determining the tumor prognostic value.

Immune-related Thyroid Dysfunction (irTD) in Non-small Cell Lung Cancer (NSCLC) Correlates With Response and Survival

BACKGROUND

There is no clear information on the proportion of patients who need therapy for immune-related thyroid dysfunction (irTD) or who need to delay, omit, or discontinue immunotherapy. Furthermore, it is not well known whether irTD correlates with better outcomes or not.

PATIENTS AND METHODS

We conducted a retrospective study in patients with metastatic non-small cell lung cancer (NSCLC) treated with anti-PD1 or anti-PD-L1.

RESULTS

Our study enrolled 75 patients, 25.3% of them developed immune-related thyroid dysfunction. Three patients delayed a course of immunotherapy due to irTD, 2 patients omitted a course and 1 patient permanently discontinued. In patients with irTD compared with those without irTD the ORR was 42.1% vs. 7.1% (p<0.001), DCR was 78.9% vs. 32.1% (p<0.001); mPFS was 15.7 vs. 3.6 months (p<0.001) and mOS was 18.6 months vs. 5.1 months (p<0.001).

CONCLUSION

Immune-related thyroid dysfunction has a mild impact on the immunotherapy treatment program. The occurrence of irTD correlates with more favorable response and survival.

Antineoplastic treatment class modulates COVID-19 mRNA-BNT162b2 vaccine immunogenicity in cancer patients: a secondary analysis of the prospective Vax-On study

BACKGROUND

Preliminary analysis from the Vax-On study did not find a correlation between cancer treatment type and antibody response to COVID-19 vaccination. We carried out a secondary subgroup analysis to verify the effects of comprehensive cancer treatment classification on vaccine immunogenicity.

METHODS

The Vax-On study prospectively enrolled patients who started a two-dose messenger RNA-BNT162b2 vaccine schedule from 9 March 2021 to 12 April 2021 (timepoint-1). Those on active treatment within the previous 28 days accounted for the exposed cases. Patients who had discontinued such treatment by at least 28 days or received intravesical therapy represented the control cases. Quantification of immunoglobulin G (IgG) antibodies against the receptor binding domain of the S1 subunit of the SARS-CoV-2 spike protein was carried out before the second dose (timepoint-2) and 8 weeks thereafter (timepoint-3). Seroconversion response was defined at ≥50 arbitrary units/ml IgG titer. Classification of antineoplastic agents was based on their pharmacodynamic properties.

RESULTS

Three hundred and sixty-six patients were enrolled (86 and 260 as control and exposed cases, respectively). Univariate analysis revealed a significantly lower IgG titer after both doses of vaccine in subgroups treated with tyrosine kinase inhibitors (TKIs), multiple cytotoxic agents, alkylating agents, and topoisomerase inhibitors. At timepoint-3, seroconversion response was significantly impaired in the topoisomerase inhibitors and mechanistic target of rapamycin (mTOR) inhibitors subgroups. After multivariate testing, treatment with alkylating agents and TKIs was significantly associated with a reduced change in IgG titer at timepoint-2. Treatment with mTOR inhibitors resulted in a similar interaction at each timepoint. Cyclin-dependent kinase 4/6 inhibitor treatment was independently correlated with an incremental variation in IgG titer at timepoint-3. Specific subgroups (TKIs, antimetabolites, alkylating agents, and multiple-agent chemotherapy) predicted lack of seroconversion at timepoint-2, but their effect was not retained at timepoint-3. Eastern Cooperative Oncology Group performance status 2, immunosuppressive corticosteroid dosing, and granulocyte colony-stimulating factor use were independently linked to lower IgG titer after either dose of vaccine.

CONCLUSIONS

Drugs interfering with DNA synthesis, multiple-agent cytotoxic chemotherapy, TKIs, mTOR and cyclin-dependent kinase 4/6 inhibitors differentially modulate humoral response to messenger RNA-BNT162b2 vaccine.

S-Adenosylmethionine Supplementation May Reduce Cancer-Related Fatigue: A Prospective Evaluation Using the FACIT-F Questionnaire in Colon Cancer Patients Undergoing Oxaliplatin-Based Chemotherapy Regimens

BACKGROUND

Fatigue is a common distressing symptom for patients living with chronic or acute diseases, including liver disorders and cancer (Cancer-Related Fatigue, CRF). Its etiology is multifactorial, and some hypotheses regarding the pathogenesis are summarized, with possible shared mechanisms both in cancer and in chronic liver diseases. A deal of work has investigated the role of a multifunctional molecule in improving symptoms and outcomes in different liver dysfunctions and associated symptoms, including chronic fatigue: S-adenosylmethionine (SAM; AdoMet). The aim of this work is actually to consider its role also in oncologic settings.

PATIENTS AND METHODS

Between January 2006 and December 2009, at the University Campus Bio-Medico of Rome, 145 patients affected by colorectal cancer in adjuvant (n = 91) or metastatic (n = 54; n = 40 with liver metastases) setting and treated with oxaliplatin-based regimen (FOLFOX for adjuvant and bevacizumab + XELOX for metastatic ones), 76 of which with the supplementation of S-adenosylmethionine (AdoMet; 400 mg b.i.d.) (57% of adjuvant patients and 44% of metastatic ones) and 69 without AdoMet supplementation, were evaluated for fatigue prevalence using the Functional Assessment of Chronic Illnesses Therapy-Fatigue (FACIT-F) questionnaire, at 3 and 6 months after the beginning of oncologic treatment. Notably, the number of patients with liver metastases was well balanced between the group of patients treated with AdoMet and those who were not.

RESULTS

Among patients receiving oxaliplatin-based chemotherapy, both in adjuvant and in metastatic settings, after just 3 months from the beginning of chemotherapy, mean scores from questionnaire domains like FACIT-F subscale (7.9 vs. 3.1, p = 0.006), FACIT physical (6.25 vs. 3.32, p = 0.020), FACIT emotional (4.65 vs. 2.19, p = 0.045), and FACIT-F total score (16.5 vs. 8.27, p = 0.021) were higher in those receiving supplementation of AdoMet, resulting in reduced fatigue; a significant difference was maintained even after 6 months of treatment.

DISCUSSION AND CONCLUSIONS

Mechanisms and strategies for managing CRF are not fully understood. This work aimed at investigating the possible role of S-adenosylmethionine supplementation in improving fatigue scores in a specific setting of cancer patients, using a FACIT-F questionnaire, a well-validated quality of life instrument widely used for the assessment of CRF in clinical trials.

Breakthrough Cancer Pain Clinical Features and Differential Opioids Response: A Machine Learning Approach in Patients With Cancer From the IOPS-MS Study

PURPOSE

A large proportion of patients with cancer suffer from breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, such as optimal opioid dosages, are being investigated. In this analysis the hypothesis, we explore with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice.

METHODS

Partitioning around a k-medoids algorithm on a large data set of patients with BTcP, previously collected by the Italian Oncologic Pain Survey group, was used to identify possible subgroups of BTcP. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features, and use of basal pain and rapid-onset opioids. Opioid dosages were converted to a unique scale and the BTcP opioids-to-basal pain opioids ratio was calculated for each patient. We used polynomial logistic regression to catch nonlinear relationships between therapy satisfaction and opioid use.

RESULTS

Our algorithm identified 12 distinct BTcP clusters. Optimal BTcP opioids-to-basal pain opioids ratios differed across the clusters, ranging from 15% to 50%. The majority of clusters were linked to a peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients’ cluster computation to validate these clusters in future studies and provide handy indications for personalized BTcP therapy.

CONCLUSION

This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values that are possibly useful for future trials. These results will allow us to target BTcP therapy on the basis of patient characteristics and to define a precision medicine strategy also for supportive care.

Current Treatment Options for HCC: From Pharmacokinetics to Efficacy and Adverse Events in Liver Cirrhosis

BACKGROUND

Hepatocellular carcinoma (HCC) is among the world's most common cancers. For over ten years, the only medical treatment for it has been the multikinase inhibitor Sorafenib. Currently, however, other first or second-line therapeutic options have also shown efficacy against HCC, such as multikinase inhibitors (Regorafenib, Lenvatinib, and Cabozantinib), a monoclonal antibody against the vascular endothelial growth factor receptor 2 (Ramucirumab), and immune-checkpoint inhibitors (Nivolumab, Pembrolizumab, Ipilimumab).

AIM

The aim of this paper is to review the metabolic pathways of drugs that have been tested for the treatment of HCC and the potential influence of liver failure over those pathways.

METHODS

The Food and Drug Administration (FDA)'s and European Medicines Agency (EMA)'s datasheets, results from clinical trials and observational studies have been reviewed.

RESULTS

This review summarizes the current knowledge regarding targets, metabolic pathways, drug interactions, and adverse events of medical treatments for HCC in cirrhotic patients.

CONCLUSION

The new scenario of systemic HCC therapy includes more active drugs with different metabolic pathways and different liver adverse events. Clinical and pharmacological studies providing more data on the safety of these molecules are urgently needed.

Breakthrough cancer pain clinical features and differential opioids response: A machine learning approach in 4,016 cancer patients of IOPS-MS study

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Background: A large proportion of patients with cancer suffer from Breakthrough cancer pain (BTcP). Several unmet clinical needs concerning BTcP treatment, like optimal opioids dosage, are being investigated. We explored with an unsupervised learning algorithm whether distinct subtypes of BTcP exist and whether they can provide new insights into clinical practice. Methods: We used partitioning around medoids algorithm on a large dataset of patients with BTcP previously collected by the IOPS group in order to identify possible subgroups of BTcP; the input of the algorithm consisted of different BTcP features, like its duration or its intensity. Silhouette statistics was used to pick an optimal number of clusters. Resulting clusters were analyzed in terms of BTcP therapy satisfaction, clinical features and usage of basal pain and rapid onset opioids. Opioids dosages were converted to a unique scale and BTcP-opioids-to-basal-pain-opioids ratio (OpR) was calculated for each patient. Polynomial logistic regression was used to catch non-linear relationships between therapy satisfaction and opioids usage. Results: The cohort comprised 4016 patients with controlled basal pain and suffering from BTcP. Our algorithm identified 12 distinct BTcP clusters. Optimal OpRs differed across the clusters, ranging from 15% to 50%. In the whole cohort, OpR was more clearly associated with therapy satisfaction compared with BTcP opioids or basal pain opioids alone. The majority of the clusters were linked to peculiar association of certain drugs with therapy satisfaction or dissatisfaction. A free online tool was created for new patients cluster computation ( https://mancapaolo.shinyapps.io/UCBM_BTcPclusters/ ) in order to validate these clusters in future studies and to provide a possible, handy indications for personalized BTcP therapy. Conclusions: This work proposes a classification for BTcP and identifies subgroups of patients with unique efficacy of different pain medications. This work supports the theory that the optimal dose of BTcP opioids depends on the dose of basal opioids and identifies novel values, possibly useful for future trials.

Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report

A case of bilateral interdigital (Morton's) neuroma treated with steroid injection therapy developed plantar fat pad atrophy, shown on magnetic resonance imaging. Some pathologic changes at the site of injection (such as subcutaneous fat atrophy, depigmentation of the skin, and telangiectasias) are well known disadvantages of local steroid injection for the treatment of the Morton's neuroma. Scientific literature reports these problems (mainly as an aesthetic problem) in the dorsal aspect of the foot. In this work, the authors describe a case in which the steroid injection therapy has caused some changes in the plantar aspect of the feet, with serious functional problems. Fat pad atrophy is a serious problem in the foot and can cause a painful metatarsal syndrome with some important effects on the gait.

[Postoperative morbidity/mortality in gastric cancer according to the rules of the Japanese Society: preliminary report]

With the purpose of evaluate the Morbi-mortality related with the kind of surgery recommended by the Japanese Research Society for Gastric Cancer (JRSGC), 13 patients treated surgically by the Rules of that Society were reviewed. Eleven patients were males and 2 females, with ages between 24 and 72 years old. Twelve of them were operated at the Hospital "Dr. Luis Gómez López" (MSAS) and one in a private clinic, both centers located in Barquisimeto, Lara State. Twelve (92.3%) of the patients had advanced Gastric Cancer and only one case was an Early Gastric Cancer. Nine patients received a Distal Gastrectomy (69.23%) and 4 a Total Gastrectomy. Eight among the 13 also underwent a combined resection of another organ(s) (Spleen; 4: Transverse Colon: 1; some kind of Pancreatic resection: 3; Gallbladder: 2). Considering the kind of Radicality (= D2: lymph Node Level Dissection, based on the JRSGC), 10 patients (76.9%) received a D2 type (the Radicality recommended by the JRSGC), being also disected another Lymph Groups (ALFA), and the Paraortics one in 6 of them. The Post-operative Stages founded were: Ia: one case; II:2 cases; IIIb: 3 cases; IV a:2 cases and IVb: 5 cases (38.46%). In relation with the Post-operative Morbidity, directly related with this kind of surgery, only one patient with a severe Desnutrion developed a Fistula, but it healed spontaneously, after a conservative treatment. Two patients received a second surgery; one during the immediate Post-operative period because a Mesentery Rotation, and the other at the 20th. Post-operative day due to an eventration plus an abdominal wall abscess. Both patients were discharge in good conditions. None of the 13 cases stayed in an Intensive or Intermediate Care Unit. There was no case of Post-operative Mortality. It is important to reassure the low risk of Post-operative Complications with this kind of Radical surgery, for Gastric Cancer patients, even in those with nutrional deficit and with a minimal hospital conditions.

A rare case of splenic hematoma following chronic pancreatitis--the diagnostic and therapeutic procedures

We describe herein a clinical case in which a subcapsular splenic hematoma complicated chronic relapsing pancreatitis. A pathogenetic mechanism is postulated that explains the subacute insorgence of the liquid collection with the diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical therapy, consisting of exeresis of the cystic formation, splenectomy and caudal pancreatectomy, is recommended for this extremely rare complication.

Subcapsular splenic hematoma complicating chronic relapsing pancreatitis. Case report

A case of subcapsular splenic hematoma complicating chronic relapsing pancreatitis is described. A pathogenetic mechanism is postulated to explain the subacute evolution of fluid collection with diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical treatment comprised exercsis of the cystic structure, splenectomy and caudal pancreatectomy.

[Digestive physiopathology of the pancreatectomized patient. Comparison of the results of total pancreatectomy and pancreaticoduodenectomy with preservation of the pylorus]

The authors analyze their experience with pancreatectomy, pointing out the digestive pathophysiologic sequelae of the operated patients. A follow-up protocol based on upper digestive endoscopy, laboratory tests, scintigraphic and pH-metric tests compares the results achieved after total pancreatectomy with the results of pancreaticoduodenectomy. Total pancreatectomy is complicated by peptic ulcer, stump gastritis and gastroenteric dyskinesia. The preservation of the pylorus and the separation of the gastric anastomosis from the biliary one avoid the pathologic biliary reflux and minimize the functional and organic sequelae of the operation.