Abstract P5-05-08: Molecular cross-talk between retinoic acid and NOTCH1 signaling pathways: Role in triple negative breast cancer

Triple Negative Breast Cancer (TNBC) represents 10-20% of all breast cancers and it is characterized by poor prognosis and high recurrence rate. The heterogeneity of the disease and the absence of well-defined molecular targets have so far challenged successful therapeutic strategies. NOTCH1 has been found to act as a driver oncogene in a small subset of TNBC characterized by constitutive activation of the protein, acting as a transcription factor. Preclinical studies support an anti-tumor activity of All-Trans Retinoic Acid (ATRA) in specific subsets of breast cancer.

By screening a large panel of breast cancer cell lines recapitulating the heterogeneity of TNBC we identify a specific subset sensitive to the anti-proliferative activity of ATRA. These cell lines (N-TNBC cell lines) are characterized by a Notch1 intragenic fusion transcript conferring gain of function activity to the protein. Indeed, sequence analysis reveals that the cell lines harbor an interstitial deletion in the NOTCH1 gene encompassing the negative regulatory region (NRR) domain. These cell lines depend on Notch active signaling for their proliferation since their cell growth is impaired by Notch inhibitors (γ-secretase inhibitors, e.g. DAPT, PF-3084014). Proliferation assays reveal that ATRA and γ-secretase inhibitors act synergistically in inhibiting cancer cell growth in N-TNBC cell lines suggesting the existence of a cross talk between the molecular pathways engaged by retinoic acid and NOTCH1.

By using retinoic acid receptors (RARs) agonists and antagonists as well as RAR specific silencing experiments we identify RARα as the retinoic acid receptor responsible of the anti-proliferation activity of ATRA in N-TNBC cell lines. In particular N-TNBC cell lines respond to RARα activation by inducing high amounts of the onco-supressor protein RARβ. This feature is unique in ATRA sensitive TNBC cell lines and does not occur in ATRA sensitive luminal cell lines arguing for the existence of a retinoic acid specific mechanism of action in N-TNBC. Since RARs act as transcription factors inside the cells, to gain insights into the molecular pathway at the basis of the observed ATRA/NOTCH1 cross talk, we performed RNAseq analysis of ATRA and/or DAPT treated N-TNBC cells. Gene set enrichment analysis reveal that ATRA is able to directly affect NOTCH1 transduction pathway by modulating the expression of NOTCH1 target genes. In particular, in two out of three N-TNBC cell lines ATRA directly inhibits the NOTCH1 expression at a transcriptional level and its downregulation is increased by ATRA/DAPT combinations. Pathway analysis has allowed the identification of putative molecular hubs responsible for the synergistic effects observed and therefore likely at the basis of the crosstalk between ATRA/NOTCH pathways. These findings are of clinical interest since both the retinoid and NOTCH signaling display crucial physiologic activities and their pleiotropic effects could impinge on the success of therapeutic options based on their pathway modulation.

The newly discovered specificity of ATRA action in the context of NOTCH1 addicted TNBC provides new tools for the identification of patients candidates benefitting from strategies targeting the ATRA/NOTCH axis.

Citation Format: Paroni G, Zanetti A, Bolis M, Vallerga A, Troiani M, Fratelli M, Kurosaki M, Terao M, Garattini E. Molecular cross-talk between retinoic acid and NOTCH1 signaling pathways: Role in triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-08.

Abstract P2-02-15: All-trans retinoic acid perturbs the lipidomic profiles of luminal breast cancer cells characterized by sensitivity to the anti-proliferative activity of the retinoid

Background: All-trans retinoic acid (ATRA) is the active metabolite of vitamin A and a promising agent in the prevention and treatment of breast cancer. We recently demonstrated that approximately 70% of estrogen-receptor-positive (ER+) breast cancer cell lines and primary tumors are sensitive to the anti-proliferative effects of ATRA (1,2). In contrast only 10-20% of the HER2-positive and triple-negative counterparts respond to the retinoid. The significance of lipids in the growth, progression and drug sensitivity of specific types of solid tumors, including breast cancer, is largely overlooked. In particular the role, if any, of specific lipids in the anti-tumor action of ATRA in breast cancer has never been studied.

Aims and Approach: The principal aim of the present work was to evaluate the specific perturbations induced by ATRA on the homeostasis of lipids in breast cancer cells characterized by sensitivity to the anti-proliferative action of the retinoid. To this purpose, we took a high-throughput approach and defined the lipidomic profiles of 16 breast cancer cell lines in basal conditions and following challenge with ATRA (1 μM) for 48 hours. The panel consisted of eight cell lines characterized by a luminal phenotype and eight cell lines with a basal phenotype. Four ATRA-sensitive cell lines (SKBR3, HCC1500, CAMA1 and MDAMB361) and 4 ATRA-resistant counterparts (HCC202, MDAMB175VII, ZR75.1 and HCC1419) were included in the luminal group. Similarly, the basal group contained 4 ATRA-sensitive (HCC1599, MB157, MDAMB157 and Hs578T) and 4 ATRA-resistant (MDAMB231, CAL851, HCC1187 and MDAMB436) cell types.

Results: Using Lipostar, a unique and recently developed software for high-throughput LC-MS lipidomics analysis (3), we identified lipid species whose levels were modified by ATRA in each cell line. This resulted in the generation of a lipid fingerprint consisting of 530 elements. We observed that ATRA reduced the amounts of cardiolipins in luminal and ATRA-sensitive breast cancer cell lines specifically. Similar effects were not observed in luminal and ATRA-resistant cells. ATRA-dependent reduction in the amounts of cardiolipins were never observed in basal cells, regardless of their sensitivity to the retinoid. Given the role played by cardiolipins in the homeostasis of the mitochondria, we evaluated the action of ATRA on the functional activity of these organelles in the luminal and ATRA-sensitive or ATRA-resistant cell lines. In SKBR3 and the other sensitive cell lines, we observed that ATRA modulated mitochondria-dependent oxygen consumption and ATP production. These effects were accompanied by an increase in mitochondrial membrane fluidity, which is consistent with the effects exerted by ATRA on the cellular content of cardiolipins. ATRA-dependent action on cardiolipins and mitochondrial homeostasis precedes maximal growth inhibition. The results provide new insights on the mechanisms underlying the anti-tumor action of ATRA.

References : 1) Centritto F. et al. EMBO Mol Med. 2015 Jul;7(7):950-72. 2) Bolis M et al.. Ann Oncol. 2017 Mar 1;28(3):611-621. 3) Goracci, L. et al., Anal Chem 2017, 89 (11), 6258-6265.

Citation Format: Terao M, Celestini V, Kurosaki M, Vallerga A, Bolis M, Fratelli M, Paroni G, Di Veroli A, Cruciani G, Goracci L, Garattini E. All-trans retinoic acid perturbs the lipidomic profiles of luminal breast cancer cells characterized by sensitivity to the anti-proliferative activity of the retinoid [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-02-15.

Abstract P5-05-09: Systemic perturbations induced by all-trans retinoic acid in the gene-expression profiles of sixteen breast cancer cell lines characterized by sensitivity and resistance to the anti-proliferative effects of the retinoid

Background: All-trans retinoic acid (ATRA) is a promising agent in the treatment of breast cancer. In view of ATRA-based therapeutic strategies aimed at the personalized treatment of mammary tumors, we recently demonstrated that approximately 70% of estrogen-receptor-positive (ER+) breast cancer is sensitive to the anti-proliferative effects of ATRA (1). In contrast only 10-20% of the HER2-positive and triple-negative counterparts respond to the retinoid. On the basis of these data and the available basal gene-expression profiles of breast cancer cell lines and primary tumors, we developed a model consisting of 21 genes (ATRA-21) which correctly predicts ATRA-sensitivity in the context of breast cancer (2).

Aims and Approach: The present study is aimed at getting insights into the molecular mechanisms underlying the anti-tumor action of ATRA in the specific subsets of breast cancer identified. In addition, we intend to determine specific genes and gene-networks modulated by ATRA which may represent pharmacological targets for the design of rational combinations between the retinoid and unrelated therapeutic agents to be used in the personalized treatment of breast cancer. A final goal is the identification of potential bio-markers of the anti-tumor response to ATRA to be used in the clinics. To address all these points, we performed deep-sequencing experiments on a panel of sixteen cell lines recapitulating the heterogeneity of the breast cancer phenotype and characterized for their anti-proliferative response to ATRA.

Panel of Breast cancer cell lines and characteristicsCell linePhenotypeClassATRA-scoreATRA-sensitivitySKBR3LUMINALHER2+1.0yesHCC1500LUMINALER+0.7yesCAMA1LUMINALER+0.7yesMDAMB361LUMINALHER2+0.6yesHCC202LUMINALHER2+0.2noMDAMB175VIILUMINALER+0.2noZR751LUMINALER+0.1noHCC1419LUMINALHER2+0.1noHCC1599BASALTN1.0yesMB157BASALTN0.3yesMDAMB157BASALTN0.2yesHS578TBASALTN0.2yesMDAMB231BASALTN0.0noCAL851BASALTN0.0noHCC1187BASALTN0.0noMDAMB436BASALTN0.0noATRA-score = ATRA sensitivity index, the higher the score the higher is the sensitivity to ATRA. ER+ = estrogen-receptor-positive cell line. HER2+ = Her2-positive cell line.

Results: We exposed each cell line to ATRA (1 μM) for 24 hours and extracted total RNA which was subjected to deep sequencing. The global gene-expression data were analyzed with a number of complementary bio-informatic tools which resulted in the identification of approximately 100 genes whose expression is up- or down-regulated specifically in ATRA-sensitive luminal and/or basal cell lines. Pathway and gene-network analysis indicate a strong enrichment in the up-regulation of genes involved in the pathways modulated by interferons. These last results are consistent with the idea that ATRA exerts a strong immuno-modulatory action in breast cancer cells and represents proof of principle for the evaluation of combinations between the retinoid and check-point inhibitors in the treatment of breast cancer.

References: 1) Centritto F. et al. EMBO Mol Med. 2015 Jul;7(7):950-7. 2) Bolis M et al.. Ann Oncol. 2017 Mar 1;28(3):611-621.

Citation Format: Garattini E, Bolis M, Vallerga A, Fratelli M, Paroni G, Zanetti A, Kurosaki M, Gianni' M, Celestini V, Terao M. Systemic perturbations induced by all-trans retinoic acid in the gene-expression profiles of sixteen breast cancer cell lines characterized by sensitivity and resistance to the anti-proliferative effects of the retinoid [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-09.

Network-guided modeling allows tumor-type independent prediction of sensitivity to all-trans-retinoic acid

Background

All-trans-retinoic acid (ATRA) is a differentiating agent used in the treatment of acute-promyelocytic-leukemia (APL) and it is under-exploited in other malignancies despite its low systemic toxicity. A rational/personalized use of ATRA requires the development of predictive tools allowing identification of sensitive cancer types and responsive individuals.

Materials and methods

RNA-sequencing data for 10 080 patients and 33 different tumor types were derived from the TCGA and Leucegene datasets and completely re-processed. The study was carried out using machine learning methods and network analysis.

Results

We profiled a large panel of breast-cancer cell-lines for in vitro sensitivity to ATRA and exploited the associated basal gene-expression data to initially generate a model predicting ATRA-sensitivity in this disease. Starting from these results and using a network-guided approach, we developed a generalized model (ATRA-21) whose validity extends to tumor types other than breast cancer. ATRA-21 predictions correlate with experimentally determined sensitivity in a large panel of cell-lines representative of numerous tumor types. In patients, ATRA-21 correctly identifies APL as the most sensitive acute-myelogenous-leukemia subtype and indicates that uveal-melanoma and low-grade glioma are top-ranking diseases as for average predicted responsiveness to ATRA. There is a consistent number of tumor types for which higher ATRA-21 predictions are associated with better outcomes.

Conclusions

In summary, we generated a tumor-type independent ATRA-sensitivity predictor which consists of a restricted number of genes and has the potential to be applied in the clinics. Identification of the tumor types that are likely to be generally sensitive to the action of ATRA paves the way to the design of clinical studies in the context of these diseases. In addition, ATRA-21 may represent an important diagnostic tool for the selection of individual patients who may benefit from ATRA-based therapeutic strategies also in tumors characterized by lower average sensitivity.

Abstract P6-04-09: Cellular and molecular determinants of breast cancer sensitivity to all-trans retinoic acid: Identification of a gene expression fingerprint predicting responsiveness

All-trans retinoic acid (ATRA) and derived natural as well as synthetic retinoids are promising agents in the treatment and chemoprevention of various types of neoplasia, including mammary tumors. ATRA is an important component of the therapeutic schemes used for the treatment of a rare form of Acute Myelogenous Leukemia known as Acute Promyelocytic Leukemia. A rational use of the paradigmatic retinoid, ATRA, in a heterogeneous disease, like breast cancer, requires the definition of the cellular and molecular determinants of sensitivity to the agent. The major aim of the study was the definition of a predictive gene expression fingerprint that can be used for the selection of patients who may benefit from treatment protocols containing ATRA. To this purpose, we selected 45 breast cancer cell lines characterized for the constitutive whole genome gene expression profiles. The sensitivity of 30 cell lines (training set) to the anti-proliferative action of ATRA was defined after challenge with increasing concentrations of the retinoid for 3, 6 and 9 days. This analysis established that Luminal and ER-positive cell lines are enriched within the ATRA sensitive group. In contrast, cell lines characterized by a Basal-like phenotype, according to the PAM50 gene expression signature, are generally refractory to the growth inhibitory action of ATRA. The sensitivity of Luminal-A and Luminal-B and the general refractoriness of Basal-like tumors to ATRA was validated in short-term tissue slice cultures of surgical breast cancer specimens. The training set was used to define a gene-expression fingerprint consisting of approximately 50 genes significantly associated with ATRA sensitivity. The fingerprint was generated by reprocessing the RNA sequencing data contained in the CCLE (Cancer Cell line Encyclopedia) of the Broad Institute and it was built from approximately 60,000 coding and non-coding loci. The approach involved the use of general linear models (machine learning algorithm). The identified gene-expression fingerprint was subsequently used to successfully predict ATRA sensitivity in a test set consisting of the remaining 15 cell lines. As a first step towards the use of the fingerprint for the stratification of patients, we evaluated the proportion of predicted ATRA sensitive breast tumors in the TCGA dataset. In accordance with the cell line and primary tumor data, approximately 30% of the Luminal tumors present with a high similarity score to the identified gene expression fingerprint associated with ATRA sensitivity. In contrast, only 5% of the Basal-like or Triple-negative mammary tumors are characterized by the same high similarity score. Curiously, the ATRA sensitivity signature seems to be tumor context independent, as it correctly identifies the 20 Acute Promyelocytic Leukemia patients present in the 198 Acute Myelogenous Leukemia patients present in the TCGA dataset.

Citation Format: Garattini E, Bolis M, Paroni G, Fratelli M, Zambelli A, Terao M. Cellular and molecular determinants of breast cancer sensitivity to all-trans retinoic acid: Identification of a gene expression fingerprint predicting responsiveness. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-04-09.

BRAVISSIMO: 12-month results from a large scale prospective trial

The BRAVISSIMO study is a prospective, non-randomized, multi-center, multi-national, monitored trial, conducted at 12 hospitals in Belgium and 11 hospitals in Italy. This manuscript reports the findings up to the 12-month follow-up time point for both the TASC A&B cohort and the TASC C&D cohort. The primary endpoint of the study is primary patency at 12 months, defined as a target lesion without a hemodynamically significant stenosis on Duplex ultrasound (>50%, systolic velocity ratio no greater than 2.0) and without target lesion revascularization (TLR) within 12 months. Between July 2009 and September 2010, 190 patients with TASC A or TASC B aortoiliac lesions and 135 patients with TASC C or TASC D aortoiliac lesions were included. The demographic data were comparable for the TASC A/B cohort and the TASC C/D cohort. The number of claudicants was significantly higher in the TASC A/B cohort, The TASC C/D cohort contains more CLI patients. The primary patency rate for the total patient population was 93.1%. The primary patency rates at 12 months for the TASC A, B, C and D lesions were 94.0%, 96.5%, 91.3% and 90.2% respectively. No statistical significant difference was shown when comparing these groups. Our findings confirm that endovascular therapy, and more specifically primary stenting, is the preferred treatment for patients with TASC A, B, C and D aortoiliac lesions. We notice similar endovascular results compared to surgery, however without the invasive character of surgery.

Siena EVAR Score

AIM

Although several randomized trial and monocentric study reported good results EVAR of abdominal aortic aneurysm (AAA), the long-term results of EVAR is still debated for the incidence of complication and the necessity of reintervention and or surgical conversion. The aim of the present study was to generate a score to grade the risk of reintervention/conversion after EVAR.

METHODS

We present a five-year prospective study. All patients with AAA and treated by EVAR were inserted in the study. Patients with ruptured AAA or treated with fenestrated-graft or chimney technique were excluded from the analysis. The rates of reintervention, surgical conversion and aneurysm-related death were recorded at 6 months after the procedure. Complication predictors were analyzed and was generated a numeric score for all the variables to predict the patient individual risk.

RESULTS

During the study period 976 EVAR procedures were successfully performed. No patients were lost during follow-up. We report 23 reinterventions (2.35%), the majority were performed electively. In six cases (0.61%) was performed conversion to surgical repair (1 graft infection, 3 for continuous growing of the aneurysmal sac and 2 cases for a ruptured AAA). In our experience, we report 4 deaths (0.4%) due to aneurysm rupture (1 case), acute myocardial infarction (2 cases) and colon cancer (1 case). The procedures were defined at low, moderate or high risk, respectively, according to whether the Siena EVAR Score was defined as EVAR1 (score <3), EVAR2 (3-6) or EVAR3 (>6).

CONCLUSION

Our Score could be an useful tool to predict patients individual risk after EVAR but, to be validated, needs to be analyzed in independents cohorts in different Center.

Circulating high molecular weight adiponectin isoform is heritable and shares a common genetic background with insulin resistance in nondiabetic White Caucasians from Italy: evidence from a family-based study

OBJECTIVE

Reduced circulating adiponectin levels contribute to the aetiology of insulin resistance. Adiponectin circulates in three different isoforms: high molecular weight (HMW), medium molecular weight (MMW) and low molecular weight (LMW) isoforms. The genetics of adiponectin isoforms is mostly unknown. Our aim was to investigate whether and to which extent circulating adiponectin isoforms are heritable and whether they share common genetic backgrounds with insulin resistance-related traits.

METHODS

In a family-based sample of 640 nondiabetic White Caucasians from Italy, serum adiponectin isoforms concentrations were measured by ELISA. Three single nucleotide polymorphisms (SNPs) in the ADIPOQ gene previously reported to affect total adiponectin levels (rs17300539, rs1501299 and rs677395) were genotyped. The heritability of adiponectin isoform levels was assessed by variance component analysis. A linear mixed effects model was used to test the association between SNPs and adiponectin isoforms. Bivariate analyses were conducted to study genetic correlations between adiponectin isoforms levels and other insulin resistance-related traits.

RESULTS

All isoforms were highly heritable (h(2) = 0.60-0.80, P = 1.0 x 10(-13)-1.0 x 10(-23)). SNPs rs17300539, rs1501299 and rs6773957 explained a significant proportion of HMW variance (2-9%, P = 1.0 x 10(-3)-1.0 x 10(-5)). In a multiple-SNP model, only rs17300539 and rs1501299 remained associated with HMW adiponectin (P = 3.0 x 10(-4) and 2.0 x 10(-2)). Significant genetic correlations (P = 1.0 x 10(-2)-1.0 x 10(-5)) were observed between HMW adiponectin and fasting insulin, homeostasis model assessment of insulin resistance, HDL cholesterol and the metabolic syndrome score. Only rs1501299 partly accounted for these genetic correlations.

CONCLUSION

Circulating levels of adiponectin isoforms are highly heritable. The genetic control of HMW adiponectin is shared in part with insulin resistance-related traits and involves, but is not limited to, the ADIPOQ locus.

Caspase activation and apoptosis in response to proteasome inhibitors

Several studies have indicated that proteasome inhibitors (PIs) are promising anticancer agents. We have discovered that PIs have the unique ability to activate effector caspases through a mitochondrial Bcl-2 inhibitable but caspase-9 independent pathway. Stabilization of released Smac induced by blockade of the proteasome could explain the apoptosome-independent cell death induced by PIs. In fact, Smac/DIABLO critically supports this PIs-dependent caspase activation. By using a new assay, we confirm that at a single cell level both Smac and PIs can activate caspases in the absence of the apoptosome. Moreover, we have observed two PIs-induced kinetics of caspase activation, with caspase-9 being still required for the rapid caspase activation in response to mitochondrial depolarization, but dispensable for the slow DEVDase activation. In summary, our data indicate that PIs can activate downstream caspases at least in part through Smac/DIABLO stabilization.

Caspase-2-induced apoptosis is dependent on caspase-9, but its processing during UV- or tumor necrosis factor-dependent cell death requires caspase-3

Mammalian caspases are a family of cysteine proteases that plays a critical role in apoptosis. We have analyzed caspase-2 processing in human cell lines containing defined mutations in caspase-3 and caspase-9. Here we demonstrate that caspase-2 processing, during cell death induced by UV irradiation, depends both on caspase-9 and caspase-3 activity, while, during TNF-alpha-dependent apoptosis, capase-2 processing is independent of caspase-9 but still requires caspase-3. In vitro procaspase-2 is the preferred caspase cleaved by caspase-3, while caspase-7 cleaves procaspase-2 with reduced efficiency. We have also demonstrated that caspase-2-mediated apoptosis requires caspase-9 and that cells co-expressing caspase-2 and a dominant negative form of caspase-9 are impaired in activating a normal apoptotic response and release cytochrome c into the cytoplasm. Our findings suggest a role played by caspase-2 as a regulator of the mitochondrial integrity and open questions on the mechanisms responsible for its activation during cell death.

[The carotid chemodectoma. Presentation of 4 clinical cases and review of the literature]

After a brief introduction about carotid body tumor's etiopathogenesis and clinical presentation, four clinical cases observed between January 1996 and December 1998 are described. Three of them have been classified as I and the last as III type according to Shamblin's classification. The diagnostic trial and surgical option needed by each patient are presented. The surgical treatment and the possibility of alternative or complementary techniques such as endovascular embolization and/or irradiation are discussed. The conclusion is drawn that surgical option for carotid body tumor is the best choice. Embolization, some hours before surgical treatment, can be a very useful procedure in order to reduce intraoperative risks and bleeding. Nevertheless surgery of carotid body tumor must be performed by surgical teams experienced in supra-aortic vessel treatment.

Reduction of mdr1 gene amplification in human multidrug-resistant LoVo DX cell line is promoted by triple helix-forming oligonucleotides

We have demonstrated previously that the GT triplex-forming oligodeoxyribonucleotide (TFO) d(TGTGTTTTTGTTTTGTTGGTTTTGTTT), named TFO ID, targeted to a polypyrimidine-polypurine coding sequence located within human multidrug-resistance mdrl gene, specifically and significantly reduced mdrl mRNA levels in the drug-resistant T-leukemic CEM-VLB100 cell line. In this article, we demonstrate that TFO 1D is effective at inhibiting not only transcription but also replication of mdrl genes, leading to a loss of amplified gene copies in the drug-resistant colon adenocarcinoma LoVo DX cell line. In contrast, TFO ID does not alter replication of the constitutive mdrl gene copy in the corresponding parental sensitive LoVo 109 cell line. A specific reduction in mdrl gene amplification levels was also obtained with the pyrimidine TFO d(CTTTTTCTTTTCTTCCTTTTCTTT), named TFO 24TC, directed against the same polypyrimidine-polypurine sequence of the mdrl gene. We suggest that triple helix-forming oligonucleotides might affect the replication of unstable chromosomal elements as amplicons in actively replicating cells by causing a local impairment of DNA polymerase activity. This study lends support to the notion that TFO may be used to reduce gene amplification aiming to control neoplastic progression in cancer cells bearing amplified oncogenes.

Effect of oligomer length and base substitutions on the cytotoxic activity and specific nuclear protein recognition of GTn oligonucleotides in the human leukemic CCRF-CEM cell line

We have identified phosphodiester oligonucleotides composed of G and T bases, named GTn, which are able to inhibit the cellular growth of human cancer cell lines by recognising specific nuclear proteins. We demonstrated that GTn oligonucleotides require a length of at least 20 nucleotides in order to exert a significant cytotoxic effect and to retain the specific protein binding ability. In addition, we found that GTn cytotoxicity was lost when A or C bases were introduced at either 3' and 5' end or within the GTn sequences.

[Surgical treatment of post-mastectomy lymphedema of the upper limb]

The authors analyze their experience of surgical treatment of post-mastectomy lympho-edemas of the upper arm. They have performed 14 operations, each upon patients with praecox or later oedema, following Cariati's classification, and with median age of 56.5 years. Seven patients were present at the follow-up in 6 has been performed microsurgical lympho-venous anastomosis, in 1 a fasciotomy of the forearm and in 1 patient some silastic tubes were positioned in her subcutaneous tissue. An improvement of the subjective symptoms has been recorded in 57.14% of the patients, while the objective ones have improved in 50% of the patients. The authors think that the microsurgical treatment of the lymphedema post-mastectomy of the upper arm is the first choice nowadays.

Measuring left ventricular dimensions by conductance catheter in the rabbit

A miniaturized (3.5 F), six-electrode conductance catheter was tested in 18 anaesthetized adult rabbits (weight 3.8-4.6 kg, ethylurethane 2.5 g kg-1). In eight animals, the reference stroke volume (ref-SV) was obtained by an electromagnetic flow probe, while reference end-diastolic volume (ref-LVEDV) was computed by dividing ref-SV by undamped thermal dilution ejection fraction (ref-EF) estimates. Comparisons with conductance indexes (z-SV, z-LVEDV and z-EF) were made at baseline, subsequent levels of graded haemorrhage and reinfusion state. In 10 animals intraventricular segmental conductance was compared with echocardiographic left ventricular cross-section (5 MHz short-focus probe), in the basal state and during acute left ventricular volume changes generated by inferior vena cava balloon occlusion. In each experiment, parallel conductance due to the tissues surrounding the left ventricle (Gp) was determined by infusing a 5M NaCl solution bolus into the right ventricle. Linear regression analysis showed fairly good correlations between z-SV, z-LVEDV and z-EF and reference indexes (r = 0.84, r = 0.83, and r = 0.72, respectively; P less than 0.001 in all cases). A linear regression analysis from 17 interventions (inferior vena cava balloon occlusion) showed a good correlation between left ventricular echocardiographic cross-sectional area and conductance, and higher correlation coefficients, r ranging from 0.870 to 0.986 were obtained from continuously sampled conductance and echographic measurements. Parallel conductance Gp was correlated (r = 0.807, P less than 0.01) with the intercept of the regression line of echographic vs conductance data. The determination of Gp thus improved the accuracy of the left ventricular dimension estimate. These results add further evidence for the possibility of continuous monitoring of left ventricular dimension by means of a conductance catheter, and demonstrate the feasibility of such studies on small experimental animals.

Quantitative lymphoscintigraphy

A radioisotopic method was used to evaluate the state and dynamics of the lymphatic system in 92 patients affected by chronic oedema of the limbs and in 12 control subjects. After interstitial injections of 99mTc-sulphur microcolloid, scans were obtained using a LFOV camera linked to a data processor. The quantitative indices of clearance and lymph node uptake obtained showed good correlation with lymphoedema etiology, controls and ostensibly healthy limbs of patients affected by monolateral disease. In conclusion, quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.

[Lymphoscintigraphy in the study of lymphedema of the arms]

The aim of this work has been the study of the mechanism of lymph formation and drainage in the upper limb in patients with monolateral lymphoedema (15 limbs, L) in comparison with the apparently healthy limb (S) as well as with a control group (8 limbs, C). After interstitial injection of 99mTc sulphur micro-colloid, scans were obtained employing a LFOV camera linked to a data processor. Results were expressed as percentage of the id removed from the injection site 1 and 6 hr pi, mean T6%/h it is (T6-T1)/5 and percentage lymph nodes uptake at the same times. Mean T6%/h is significantly different between C and L, but not between L and S, while lymph node uptake at 6 hr shows a significant difference even between C and S. Quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.