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Internò V, Massari F, Rudà R, Maiorano BA, Caffo O, Procopio G, Bracarda S, Atzori F, Passarelli A, Bersanelli M, Stellato M, Fornarini G, Galli L, Ortega C, Zanardi E, Incorvaia L, Facchini G, Giron Berrios JR, Ricotta R, Santoni M, Funaioli C, Trerotoli P, Porta C, Rizzo M. An Italian multicenter retrospective real-life analysis of patients with brain metastases from renal cell carcinoma: the BMRCC study. ESMO Open 2023; 8:101598. [PMID: 37467658 PMCID: PMC10485397 DOI: 10.1016/j.esmoop.2023.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/03/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The treatment of patients with brain-spread renal cell carcinoma (RCC) is an unmet clinical need, although more recent therapeutic strategies have significantly improved RCC patients' life expectancy. Our multicenter, retrospective, observational study investigated a real-world cohort of patients with brain metastases (BM) from RCC (BMRCC). PATIENTS AND METHODS A total of 226 patients with histological diagnosis of RCC and radiological evidence of BM from 22 Italian institutions were enrolled. Univariate and multivariate models were performed to investigate the impact of clinicopathological features and multimodal treatments on both overall survival (OS) from the BM diagnosis and intracranial progression-free survival (iPFS). RESULTS The median OS from the BM diagnosis was 18.8 months (interquartile range: 6.2-43 months). Multivariate analysis confirmed the following as positive independent prognostic factors: a Karnofsky Performance Status >70% [hazard ratio (HR) = 0.49, 95% confidence interval (CI) 0.26-0.92, P = 0.0026] and a single BM (HR = 0.51, 95% CI 0.31-0.86, P = 0. 0310); in contrast, the following were confirmed as worse prognosis factors: progressive extracranial disease (HR = 1.66, 95% CI 1.003-2.74, P = 0.00181) and only one line of systemic therapy after the BM occurrence (HR = 2.98, 95% CI 1.62-5.49, P = 0.029). Subgroup analyses showed no difference in iPFS according to the type of the first systemic treatment [immunotherapy (IT) or targeted therapy (TT)] carried out after the BM diagnosis (HR = 1.033, 95% CI 0.565-1.889, P = 0.16), and revealed that external radiation therapy (eRT) significantly prolonged iPFS when combined with IT (10.7 months, 95% CI 4.9-48 months, P = 0.0321) and not when combined with TT (9.01 months, 95% CI 2.7-21.2 months, P = 0.59). CONCLUSIONS Our results suggest a potential additive effect in terms of iPFS for eRT combined with IT and encourage a more intensive multimodal therapeutic strategy in a multidisciplinary context to improve the survival of BMRCC patients.
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Affiliation(s)
- V Internò
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Policlinico di Bari, Bari, Italy
| | - F Massari
- Medical Oncology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - R Rudà
- Division of Neuro-Oncology, Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Torino, Italy
| | - B A Maiorano
- Medical Oncology Unit, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - O Caffo
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari di Trento, Trento, Italy
| | - G Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - S Bracarda
- Medical and Translational Oncology Unit, Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - F Atzori
- Medical Oncology Unit, University Hospital of Cagliari, Cagliari, Italy
| | - A Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - M Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - M Stellato
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; Department of Medical Oncology, Fondazione Policlinico Campus Bio-Medico, Roma, Italy
| | - G Fornarini
- Department of Medical Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - L Galli
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - C Ortega
- Oncology Unit-ASL Cuneo 2-'Michele e Pietro Ferrero' Hospital, Verduno, Cuneo, Italy
| | - E Zanardi
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - G Facchini
- ASL Napoli 2 Nord, Oncology Operative Unit, 'S. Maria delle Grazie' Hospital-Pozzuoli, Napoli, Italy
| | - J R Giron Berrios
- Department of Medical Oncology, Belcolle Hospital of Viterbo, Viterbo, Italy
| | - R Ricotta
- Oncology Unit, IRCCS MultiMedica, Sesto San Giovanni, Milano, Italy
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata, Italy
| | - C Funaioli
- Medical Oncology Unit, ASST 'Santi Paolo e Carlo', Milano, Italy
| | - P Trerotoli
- Department of Interdisciplinary Medicine, University of Bari 'Aldo Moro', Bari, Italy
| | - C Porta
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Policlinico di Bari, Bari, Italy; Department of Interdisciplinary Medicine, University of Bari 'Aldo Moro', Bari, Italy
| | - M Rizzo
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Policlinico di Bari, Bari, Italy; Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
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Stellato M, Buti S, Maruzzo M, Bersanelli M, Ermacora P, Maiorano B, Prati V, De Giorgi U, Pierantoni F, Malgeri A, Mennitto A, Cavo A, Vitale M, Santoni M, Carella C, Procopio G, Verzoni E, Santini D. 1462P Clinical outcome of patients with non-clear metastatic renal cell carcinoma treated with pembrolizumab-axitinib combination: NEMESIA (non-clear metastatic renal cell carcinoma pembrolizumab axitinib) study, a subgroup analysis of I-RARE observational study (Meet-URO 23a). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Verzoni E, Todoerti K, Rivoltini L, Huber V, Rodolfo M, Agnelli L, Devecchi A, Busico A, Perrone F, Centonze G, De Cecco L, Claps M, Guadalupi V, Stellato M, Giannatempo P, De Braud F, Procopio G, Sepe P. 1470P Transcriptomic signature and immune infiltrate in metastatic collecting duct renal cell carcinoma patients treated with first-line cabozantinib: Results of exploratory endpoints from BONSAI trial (Meeturo 2). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Renoux F, Stellato M, Haftmann C, Vogetseder A, Huang R, Subramaniam A, Becker MO, Blyszczuk P, Becher B, Distler JHW, Kania G, Boyman O, Distler O. The AP1 Transcription Factor Fosl2 Promotes Systemic Autoimmunity and Inflammation by Repressing Treg Development. Cell Rep 2021; 31:107826. [PMID: 32610127 DOI: 10.1016/j.celrep.2020.107826] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/27/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
Regulatory T cells (Tregs) represent a major population in the control of immune homeostasis and autoimmunity. Here we show that Fos-like 2 (Fosl2), a TCR-induced AP1 transcription factor, represses Treg development and controls autoimmunity. Mice overexpressing Fosl2 (Fosl2tg) indeed show a systemic inflammatory phenotype, with immune infiltrates in multiple organs. This phenotype is absent in Fosl2tg × Rag2-/- mice lacking T and B cells, and Fosl2 induces T cell-intrinsic reduction of Treg development that is responsible for the inflammatory phenotype. Fosl2tg T cells can transfer inflammation, which is suppressed by the co-delivery of Tregs, while Fosl2 deficiency in T cells reduces the severity of autoimmunity in the EAE model. We find that Fosl2 could affect expression of FoxP3 and other Treg development genes. Our data highlight the importance of AP1 transcription factors, in particular Fosl2, during T cell development to determine Treg differentiation and control autoimmunity.
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Affiliation(s)
- Florian Renoux
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Mara Stellato
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Haftmann
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | | | - Riyun Huang
- Sanofi, Immunology and Inflammation Research TA, Cambridge, MA 02139, USA
| | - Arun Subramaniam
- Sanofi, Immunology and Inflammation Research TA, Cambridge, MA 02139, USA
| | - Mike O Becker
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Przemyslaw Blyszczuk
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland; Department of Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Gabriela Kania
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Onur Boyman
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Rudnik M, Rolski F, Jordan S, Mertelj T, Stellato M, Distler O, Blyszczuk P, Kania G. Regulation of Monocyte Adhesion and Type I Interferon Signaling by CD52 in Patients With Systemic Sclerosis. Arthritis Rheumatol 2021; 73:1720-1730. [PMID: 33760395 DOI: 10.1002/art.41737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/11/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is characterized by dysregulation of type I interferon (IFN) signaling. CD52 is known for its immunosuppressive functions in T cells. This study was undertaken to investigate the role of CD52 in monocyte adhesion and type I IFN signaling in patients with SSc. METHODS Transcriptome profiles of circulating CD14+ monocytes from patients with limited cutaneous SSc (lcSSc), patients with diffuse cutaneous SSc (dcSSs), and healthy controls were analyzed by RNA sequencing. Levels of CD52, CD11b/integrin αΜ, and CD18/integrin β2 in whole blood were assessed by flow cytometry. CD52 expression was analyzed in relation to disease phenotype (early, lcSSc, dcSSc) and autoantibody profiles. The impact of overexpression, knockdown, and antibody blocking of CD52 was analyzed by gene and protein expression assays and functional assays. RESULTS Pathway enrichment analysis indicated an increase in adhesion- and type I IFN-related genes in monocytes from SSc patients. These cells displayed up-regulated expression of CD11b/CD18, reduced expression of CD52, and enhanced adhesion to intercellular adhesion molecule 1 and endothelial cells. Changes in CD52 expression were consistent with the SSc subtypes, as well as with immunosuppressive treatments, autoantibody profiles, and monocyte adhesion properties in patients with SSc. Overexpression of CD52 led to decreased levels of CD18 and monocyte adhesion, while knockdown of CD52 increased monocyte adhesion. Experiments with the humanized anti-CD52 monoclonal antibody alemtuzumab in blood samples from healthy controls increased monocyte adhesion and CD11b/CD18 expression, and enhanced type I IFN responses. Monocytic CD52 expression was up-regulated by interleukin-4 (IL-4)/IL-13 via the STAT6 pathway, and was down-regulated by lipopolysaccharide and IFNs α, β, and γ in a JAK1 and histone deacetylase IIa (HDAC IIa)-dependent manner. CONCLUSION Down-regulation of the antiadhesion CD52 antigen in CD14+ monocytes represents a novel mechanism in the pathogenesis of SSc. Targeting of the IFN-HDAC-CD52 axis in monocytes might represent a new therapeutic option for patients with early SSc.
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Affiliation(s)
- Michał Rudnik
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Filip Rolski
- Jagiellonian University Medical College, Krakow, Poland
| | - Suzana Jordan
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tonja Mertelj
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mara Stellato
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Przemysław Blyszczuk
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Jagiellonian University Medical College, Krakow, Poland
| | - Gabriela Kania
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Pachera E, Assassi S, Salazar GA, Stellato M, Renoux F, Wunderlin A, Blyszczuk P, Lafyatis R, Kurreeman F, de Vries-Bouwstra J, Messemaker T, Feghali-Bostwick CA, Rogler G, van Haaften WT, Dijkstra G, Oakley F, Calcagni M, Schniering J, Maurer B, Distler JH, Kania G, Frank-Bertoncelj M, Distler O. Long noncoding RNA H19X is a key mediator of TGF-β-driven fibrosis. J Clin Invest 2021; 130:4888-4905. [PMID: 32603313 DOI: 10.1172/jci135439] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
TGF-β is a master regulator of fibrosis, driving the differentiation of fibroblasts into apoptosis-resistant myofibroblasts and sustaining the production of extracellular matrix (ECM) components. Here, we identified the nuclear long noncoding RNA (lncRNA) H19X as a master regulator of TGF-β-driven tissue fibrosis. H19X was consistently upregulated in a wide variety of human fibrotic tissues and diseases and was strongly induced by TGF-β, particularly in fibroblasts and fibroblast-related cells. Functional experiments following H19X silencing revealed that H19X was an obligatory factor for TGF-β-induced ECM synthesis as well as differentiation and survival of ECM-producing myofibroblasts. We showed that H19X regulates DDIT4L gene expression, specifically interacting with a region upstream of the DDIT4L gene and changing the chromatin accessibility of a DDIT4L enhancer. These events resulted in transcriptional repression of DDIT4L and, in turn, in increased collagen expression and fibrosis. Our results shed light on key effectors of TGF-β-induced ECM remodeling and fibrosis.
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Affiliation(s)
- Elena Pachera
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Shervin Assassi
- Division of Rheumatology, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Gloria A Salazar
- Division of Rheumatology, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Mara Stellato
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Renoux
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Adam Wunderlin
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Przemyslaw Blyszczuk
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fina Kurreeman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Tobias Messemaker
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Wouter T van Haaften
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
| | - Fiona Oakley
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Janine Schniering
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Hw Distler
- Department of Internal Medicine 3, University of Erlangen, Erlangen, Germany
| | - Gabriela Kania
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Mojca Frank-Bertoncelj
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Błyszczuk P, Zuppinger C, Costa A, Nurzynska D, Di Meglio F, Stellato M, Agarkova I, Smith GL, Distler O, Kania G. Activated Cardiac Fibroblasts Control Contraction of Human Fibrotic Cardiac Microtissues by a β-Adrenoreceptor-Dependent Mechanism. Cells 2020; 9:cells9051270. [PMID: 32443848 PMCID: PMC7290967 DOI: 10.3390/cells9051270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Cardiac fibrosis represents a serious clinical problem. Development of novel treatment strategies is currently restricted by the lack of the relevant experimental models in a human genetic context. In this study, we fabricated self-aggregating, scaffold-free, 3D cardiac microtissues using human inducible pluripotent stem cell (iPSC)-derived cardiomyocytes and human cardiac fibroblasts. Fibrotic condition was obtained by treatment of cardiac microtissues with profibrotic cytokine transforming growth factor β1 (TGF-β1), preactivation of foetal cardiac fibroblasts with TGF-β1, or by the use of cardiac fibroblasts obtained from heart failure patients. In our model, TGF-β1 effectively induced profibrotic changes in cardiac fibroblasts and in cardiac microtissues. Fibrotic phenotype of cardiac microtissues was inhibited by treatment with TGF-β-receptor type 1 inhibitor SD208 in a dose-dependent manner. We observed that fibrotic cardiac microtissues substantially increased the spontaneous beating rate by shortening the relaxation phase and showed a lower contraction amplitude. Instead, no changes in action potential profile were detected. Furthermore, we demonstrated that contraction of human cardiac microtissues could be modulated by direct electrical stimulation or treatment with the β-adrenergic receptor agonist isoproterenol. However, in the absence of exogenous agonists, the β-adrenoreceptor blocker nadolol decreased beating rate of fibrotic cardiac microtissues by prolonging relaxation time. Thus, our data suggest that in fibrosis, activated cardiac fibroblasts could promote cardiac contraction rate by a direct stimulation of β-adrenoreceptor signalling. In conclusion, a model of fibrotic cardiac microtissues can be used as a high-throughput model for drug testing and to study cellular and molecular mechanisms of cardiac fibrosis.
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Affiliation(s)
- Przemysław Błyszczuk
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Wagistr. 14, 8952 Schlieren, Switzerland; (M.S.); (O.D.)
- Department of Clinical Immunology, Jagiellonian University Medical College, 30-663 Cracow, Poland
- Correspondence: (P.B.); (G.K.)
| | - Christian Zuppinger
- Department for BioMedical Research, Department of Cardiology, University Hospital Bern, 3008 Bern, Switzerland;
| | - Ana Costa
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK; (A.C.); (G.S.)
| | - Daria Nurzynska
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (D.N.); (F.D.M.)
| | - Franca Di Meglio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (D.N.); (F.D.M.)
| | - Mara Stellato
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Wagistr. 14, 8952 Schlieren, Switzerland; (M.S.); (O.D.)
| | | | - Godfrey L. Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK; (A.C.); (G.S.)
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Wagistr. 14, 8952 Schlieren, Switzerland; (M.S.); (O.D.)
| | - Gabriela Kania
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Wagistr. 14, 8952 Schlieren, Switzerland; (M.S.); (O.D.)
- Correspondence: (P.B.); (G.K.)
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Cursano MC, Iuliani M, Casadei C, Stellato M, Tonini G, Paganelli G, Santini D, De Giorgi U. Combination radium-223 therapies in patients with bone metastases from castration-resistant prostate cancer: A review. Crit Rev Oncol Hematol 2020; 146:102864. [PMID: 31986318 DOI: 10.1016/j.critrevonc.2020.102864] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/27/2019] [Accepted: 01/04/2020] [Indexed: 01/26/2023] Open
Abstract
Chemotherapeutic agents (docetaxel, cabazitaxel), hormonal therapies (abiraterone, enzalutamide) and radium-223 improve survival in patients with bone metastatic castration-resistant prostate cancer (mCRPC). Combinations of radium-223 with these agents or novel drugs have been investigated in order to improve survival and decrease bone-related morbidity. In mCRPC, clinical and preclinical data indicate that radium-223, abiraterone and enzalutamide have a direct effect on prostate cancer cells and bone microenvironment when administered as single agents. Initial results from studies of radium-223 and abiraterone, enzalutamide or docetaxel demonstrated efficacy without any safety concern in pre-treated mCRPC; however, this safety profile changed when radium-based combination therapies were administered in un-pretreated mCRPC. This review underline the biological rationale for combining radium strategies, investigating their effects on bone in terms of control of skeletal-related events and bone disease progression. The aim is to understand the possible reasons why different radium-based combination treatments can led to different clinical outcomes.
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Affiliation(s)
- M C Cursano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128, Rome, Italy.
| | - M Iuliani
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128, Rome, Italy
| | - C Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola, Italy
| | - M Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128, Rome, Italy
| | - G Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128, Rome, Italy
| | - G Paganelli
- Department of Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola, Italy
| | - D Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128, Rome, Italy
| | - U De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola, Italy
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9
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Dell'Aquila E, Cremolini C, Zeppola T, Lonardi S, Bergamo F, Masi G, Stellato M, Marmorino F, Schirripa M, Urbano F, Ronzoni M, Tomasello G, Zaniboni A, Racca P, Buonadonna A, Allegrini G, Fea E, Di Donato S, Chiara S, Tonini G, Tomcikova D, Boni L, Falcone A, Santini D. Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO. Ann Oncol 2019; 29:924-930. [PMID: 29324972 DOI: 10.1093/annonc/mdy004] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Neutrophil/lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytes count, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available about unresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic and predictive role of NLR in the TRIBE trial. Patients and methods Pts enrolled in TRIBE trial were included. TRIBE is a multicentre phase III trial randomizing unresectable and previously untreated mCRC pts to receive FOLFOXIRI or FOLFIRI plus bevacizumab. A cut-off value of 3 was adopted to discriminate pts with low (NLR < 3) versus high (NLR ≥ 3) NLR, as primary analysis. As secondary analysis, NLR was treated as an ordinal variable with three levels based on terciles distribution. Results NLR at baseline was available for 413 patients. After multiple imputation at univariate analysis, patients with high NLR had significantly shorter progression-free survival (PFS) [hazard ratio (HR) 1.27 (95% CI 1.05-1.55), P = 0.017] and overall survival (OS) [HR 1.56 (95% CI 1.25-1.95), P < 0.001] than patients with low NLR. In the multivariable model, NLR retained a significant association with OS [HR 1.44 (95% CI 1.14-1.82), P = 0.014] but not with PFS [HR 1.18 (95% CI 0.95-1.46), P = 0.375]. No interaction effect between treatment arm and NLR was evident in terms of PFS (P for interaction = 0.536) or OS (P for interaction = 0.831). Patients with low [HR 0.84 (95% CI 0.64-1.08)] and high [HR 0.73 (95% CI 0.54-0.97)] NLR achieved similar PFS benefit from the triplet and consistent results were obtained in terms of OS [HR 0.83 (95% CI 0.62-1.12) for low NLR; HR 0.82 (95% CI 0.59-1.12) for high NLR]. Conclusion This study confirmed the prognostic role of NLR in mCRC pts treated with bevacizumab plus chemotherapy in the first line, showing the worse prognosis of pts with high NLR. The advantage of the triplet is independent of NLR at baseline.
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Affiliation(s)
- E Dell'Aquila
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - C Cremolini
- Department of Translational Research and New Technologies in Medicine and Surge, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy.
| | - T Zeppola
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - S Lonardi
- Department of Clinical and Experimental Oncolog, Medical Oncology Unit 1, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - F Bergamo
- Department of Clinical and Experimental Oncolog, Medical Oncology Unit 1, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - G Masi
- Department of Translational Research and New Technologies in Medicine and Surge, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - M Stellato
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Marmorino
- Department of Translational Research and New Technologies in Medicine and Surge, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - M Schirripa
- Department of Clinical and Experimental Oncolog, Medical Oncology Unit 1, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - F Urbano
- Department of Radiologica, Oncological and Pathological Sciences, Umberto I Policlinico di Roma, Rome, Italy
| | - M Ronzoni
- Medical Oncology, IRCCS San Raffaele, Milan, Italy
| | - G Tomasello
- S. C. Oncologia, ASST Ospedale di Cremona, Cremona, Italy
| | - A Zaniboni
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - P Racca
- SSD ColoRectal Cancer Unit-A.O.U. Department of Oncology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - A Buonadonna
- Division of Medical Oncology B, Centro di Riferimento Oncologico, Aviano, Italy
| | - G Allegrini
- Department of Oncology, Ospedale F. Lotti, Pontedera, Italy
| | - E Fea
- Department of Medical Oncology, Azienda Ospedaliera S Croce e Carle, Cuneo, Italy
| | - S Di Donato
- Department of Oncology, AUSL 4 Prato, Prato, Italy
| | - S Chiara
- Medical Oncology 2, Policlinico San Martino Hospital IRCCS per l'Oncologia, Genoa, Italy
| | - G Tonini
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - D Tomcikova
- Clinical Trials Coordinating Cente, Istituto Toscano Tumori, University Hospital Careggi, Florence, Italy
| | - L Boni
- Clinical Trials Coordinating Cente, Istituto Toscano Tumori, University Hospital Careggi, Florence, Italy
| | - A Falcone
- Department of Translational Research and New Technologies in Medicine and Surge, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - D Santini
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
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Dell’Aquila E, Rossini D, Stellato M, Bergamo F, Aprile G, Morano F, Intini R, Fea E, Ronzoni M, Libertini M, Buonadonna A, Fanchini L, Marcucci L, Maiello E, Marmorino F, Boccaccino A, Cordio S, Masi G, Falcone A, Santini D. Prognostic and predictive role of body mass index (BMI) in metastatic colorectal cancer (mCRC): A pooled analisys of TRIBE and TRIBE-2 studies by GONO. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stellato M, Czepiel M, Distler O, Błyszczuk P, Kania G. Identification and Isolation of Cardiac Fibroblasts From the Adult Mouse Heart Using Two-Color Flow Cytometry. Front Cardiovasc Med 2019; 6:105. [PMID: 31417912 PMCID: PMC6686717 DOI: 10.3389/fcvm.2019.00105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cardiac fibroblasts represent a main stromal cell type in the healthy myocardium. Activation of cardiac fibroblasts has been implicated in the pathogenesis of many heart diseases. Profibrotic stimuli activate fibroblasts, which proliferate and differentiate into pathogenic myofibroblasts causing a fibrotic phenotype in the heart. Cardiac fibroblasts are characterized by production of type I collagen, but non-transgenic methods allowing their identification and isolation require further improvements. Herein, we present a new and simple flow cytometry-based method to identify and isolate cardiac fibroblasts from the murine heart. Methods and Results: Wild-type and reporter mice expressing enhanced green fluorescent protein (EGFP) under the murine alpha1(I) collagen promoter (Col1a1-EGFP) were used in this study. Hearts were harvested and dissociated into single cell suspensions using enzymatic digestion. Cardiac cells were stained with the erythrocyte marker Ter119, the pan-leukocyte marker CD45, the endothelial cell marker CD31 and gp38 (known also as podoplanin). Fibroblasts were defined in a two-color flow cytometry analysis as a lineage-negative (Lin: Ter119-CD45-CD31-) and gp38-positive (gp38+) population. Analysis of hearts isolated from Col1a1-EGFP reporter mice showed that cardiac Lin-gp38+ cells corresponded to type I collagen-producing cells. Lin-gp38+ cells were partially positive for the mesenchymal markers CD44, CD140a, Sca-1 and CD90.2. Sorted Lin-gp38+ cells were successfully expanded in vitro for up to four passages. Lin-gp38+ cells activated by Transforming Growth Factor Beta 1 (TGF-β1) upregulated myofibroblast-specific genes and proteins, developed stress fibers positive for alpha smooth muscle actin (αSMA) and showed increased contractility in the collagen gel contraction assay. Conclusions: Two-color flow cytometry analysis using the selected cell surface antigens allows for the identification of collagen-producing fibroblasts in unaffected mouse hearts without using specific reporter constructs. This strategy opens new perspectives to study the physiology and pathophysiology of cardiac fibroblasts in mouse models.
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Affiliation(s)
- Mara Stellato
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marcin Czepiel
- Department of Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Przemysław Błyszczuk
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland.,Department of Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Gabriela Kania
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Parisi A, Cortellini A, Roberto M, Venditti O, Santini D, Dell’Aquila E, Stellato M, Marchetti P, Occhipinti M, Zoratto F, Mazzuca F, Tinari N, De Tursi M, Iezzi L, Natoli C, Ratti M, Pizzo C, Ghidini M, Ficorella C, Cannita K. A real-life multicenter study on body weight loss and body mass index in advanced Gastric Cancer patients treated with Ramucirumab-based second-line therapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dell'Aquila E, Pantano F, Rossini D, Stellato M, Lonardi S, Masi G, Schirripa M, Marmorino F, Antoniotti C, Murgioni S, Tomasello G, Ronzoni M, Racca P, Vincenzi B, Allegrini G, Urbano F, Buonadonna A, Banzi M, Tonini G, Cremolini C, Falcone A, Santini D. Development of a new clinical nomogram including velocity rate of disease progression to predict outcome in metastatic colorectal cancer patients treated with bevacizumab beyond progression: A subanalysis from tribe trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vincenzi B, Nannini M, Grignani G, Fumagalli E, Gasperoni S, D'Ambrosio L, Badalamenti G, Dei Tos A, Incorvaia L, Casali P, Santini D, Tonini G, Stellato M, Catania G, Spalato Ceruso M, Pantaleo M. Rechallenge in GIST progressing to imatinib, sunitinib and regorafenib: An Italian survey. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stellato M, Rudnik M, Renoux F, Pachera E, Sotlar K, Klingel K, Henes J, Blyszczuk P, Distler O, Kania G. OP0049 Myocardial Fibrogenesis in Systemic Sclerosis: Involvement of A Novel Stromal Sub-Population. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rudnik M, Stellato M, Blyszczuk P, Pachera E, Dobrota R, Maurer B, Klingel K, Henes J, Sotlar K, Distler O, Kania G. OP0289 Micrornas as Potential Regulators of Monocyte Differentiation and Function in Heart Fibrosis in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Renoux F, Stellato M, Pachera E, Impellizzieri D, Dees C, Distler J, Kania G, Boyman O, Distler O. OP0206 Fra2 Is Playing A Key Role in The Control of Treg Development and Autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Blyszczuk P, Müller-Edenborn B, Valenta T, Osto E, Stellato M, Behnke S, Glatz K, Basler K, Lüscher TF, Distler O, Eriksson U, Kania G. Transforming growth factor-β-dependent Wnt secretion controls myofibroblast formation and myocardial fibrosis progression in experimental autoimmune myocarditis. Eur Heart J 2016; 38:1413-1425. [DOI: 10.1093/eurheartj/ehw116] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/02/2016] [Indexed: 12/23/2022] Open
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