Nucleolin expression has prognostic value in neuroblastoma patients

BACKGROUND

Neuroblastoma (NB) represents the most frequent form of extra-cranial solid tumour of infants, responsible for 15% of childhood cancer deaths. Nucleolin (NCL) prognostic value in NB was investigated.

METHODS

NCL protein expression was retrospectively evaluated in tumour samples of NB patients at diagnosis and after chemotherapy. NCL prognostic value at mRNA level was assessed in a cohort of 20 patients with stage 4 NB (qPCR20, n=20, discovery dataset) and in the MultiPlatform786 including 786 patients of all stages (validation dataset). Overall and event-free survival curves were plotted by Kaplan-Meier method and compared by log-rank test.

FINDINGS

NCL protein, down-modulated after chemotherapy in association with features of neuroblastic differentiation,resulted statistically significantly overexpressed in NB tumours and higher in stage 4 compared to stage 1,2,3 patients. In the stage 4 patients cohort qPCR20, patients with high NCLmRNA expression revealed a statisticallysignificant lower survival probability than those with low NCL expression (OS: HR 4.1 95%CI 1.2-13.8;p=0.0215[Log-rank test], EFS: HR 4.1 95%CI 1.2-14.0, p=0.0197[Log-rank test]). In the MultiPlatform786 (n=786), multivariate analysis suggested thatNCL expression has a statistically significant prognostic value even in the model adjusted for established prognostic markers. NCL expression significantly stratified also patients with >18 months and stage 4 tumour (OS: HR 1.8 95%CI 1.2-2.7, p=0.0009[Log-rank test]; EFS: HR 1.7 95%CI 1.1-2.5, p=0.002[Log-rank test]), patients with>18 months stage 4 with MYCN non amplified tumour[EFS: HR 2.3 95%CI 1.2-4.7, p=0.01[Log-rank test]), and patients with MYCN non amplified and MYC high [OS: HR 11.9 95%CI 2.3-62.4, p=0.003[Log-rank test]; EFS: HR 7.2 95%CI 1.6-33.4, p=0.01[Log-rank test]). A statistically significant correlation between NCL and MYCN, MYC, and TERT was found in independent datasets (MultiPlatform786 (n=786) and Agilent394 (n=394). Gene set enrichment analysis revealed a statisticallysignificant positive enrichment of MYC target genes and genes involved in telomerase maintenance.

INTERPRETATION

NCL is a novel and independent (adjusting for age, INSS stage, and MYCN status) prognostic marker for NB.

FUNDING

IMH-EuroNanoMed II-2015 and AIRC-IG.

Abstract 2194: Synergistic cytotoxicity of targeted liposomes containing doxorubicin and C6-ceramide against nucleolin-overexpressing ovarian cancer cells is supported by the downregulation of the Akt pathway

The acknowledgment that cancer stem cells (CSC) may originate from non-stem cancer cells, interconverting through an EMT-mediated process has turned these distinct cell subpopulations into two relevant therapeutic targets. Moreover, the PI3K/AKT/mTOR pathway is essential to CSC proliferation and survival and it is often over activated in ovarian cancer. One of the strategies to target these different tumor cell populations, relies on the combination of conventional chemotherapeutic drugs (as tumor debulking agents, targeting non-stem cancer cells) with sphingolipids targeting CSC (at the level of PI3K/Akt/mTOR). Nucleolin overexpression has been demonstrated on the surface of both breast CSC and non-stem breast cancer cells (Fonseca NA, Biomaterials 2015) and endothelial cells from tumor blood vessels. The pH-sensitive lipid-based nanoparticle, functionalized with the nucleolin-binding F3 peptide, was recently modified to encapsulate a synergistic combination of a sphingolipid (C6-ceramide) and doxorubicin (DXR). Following the promising results in breast cancer, the aim of this work was to assess the therapeutic potential of this strategy against nucleolin-overexpressing ovarian cancer cell lines, as well as the underlying mechanism of action at the molecular level. A 12.9-fold increase of association of fluorescently-labelled F3 peptide-targeted liposomes ([F3]L), relative to the non-targeted counterparts, into (bulk) ovarian cancer cell lines (SKOV-3, OVCAR-3 and TOV-112D) was observed by flow cytometry. Importantly, a similar pattern of association by putative CSC enriched population (CD44high/EpCAMhigh) was also observed. These results corroborated the marked increase of cytotoxicity (assessed by the resazurin reduction viability assay) enabled by the targeted drug combinations, relative to [F3]L containing only DXR. In fact, the targeted drug combination enabled a 90% death of SKOV-3 cancer cells, following an 8 h incubation, a level of cell killing not achieved by the counterpart containing only DXR. Against the OVCAR-3 and TOV-112D cell lines, the IC90 of the targeted drug combination, following 1 h of incubation, was 2-fold lower than the one resulting from the incubation with [F3]L containing only DXR. In addition, the effect of nucleolin-mediated intracellular delivery of C6-ceramide at the p-Akt protein levels was further discriminated by western blot analysis in SKOV-3 cells. The observed 3.2-fold downregulation of p-Akt levels supported the C6-ceramide-mediated improved cytotoxicity of the drug combination. Overall, these results pointed out the enhanced efficacy of targeted synergistic drug combinations against ovarian cancer, due to the capability to target nucleolin-overexpressing cancer cells and further inhibit the Akt pathway.

Citation Format: Ana Filipa Cruz, Nuno André Fonseca, Susana F. Sampaio, Vera Moura, Ramiro D. Almeida, Sérgio Simões, João Nuno Moreira. Synergistic cytotoxicity of targeted liposomes containing doxorubicin and C6-ceramide against nucleolin-overexpressing ovarian cancer cells is supported by the downregulation of the Akt pathway [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2194. doi:10.1158/1538-7445.AM2017-2194

Abstract 5155: Targeting nucleolin with doxorubicin-containing nanoparticle induces a significant tumor growth inhibition in an orthotopic animal model of standard of care-resistant mesothelioma

Mesothelioma is a malignant tumor of the mesothelium, the thin lining of the surface of the body cavities and the organs within, and is often associated with asbestos exposure. It has a poor prognosis, with a mean overall survival of 8.8 months. Chemotherapy has been used for malignant pleural mesothelioma as an adjuvant treatment after surgical resection (often palliative) or in patients who have inoperable disease. A combination of cisplatin and pemetrexed remains as the current standard of care, with only a 9% 5-year survival rate. Herein, a novel targeted treatment for mesothelioma, based on a doxorubicin (DXR)-containing nanoparticle functionalized with the nucleolin-binding F3 peptide (named PEGASEMP), is proposed. It relies on nucleolin deregulated overexpression in cancer cells and the tumor microenvironment (endothelial cells from tumor blood vessels). Studies were performed in an orthotopic model of human mesothelioma. Mesothelioma cells harvested from a patient with disease progression who undergone chemotherapy, were stably transduced with luciferase-reporter gene, and orthotopically injected intrapleurally into female immunocompromised mice. Animals were randomly allocated to different treatment groups: vehicle, peptide-targeted DXR-containing nanoparticle (PEGASEMP) at 5.6 or 7 mg of DXR/kg alone (q7dx5w); cisplatin at 4.0 mg/kg alone or combined with PEGASEMP at 5.6 mg of DXR/kg (q7dx5w). A control group administered with the standard of care, a combination of cisplatin at 4.0 mg/kg (q7dx5w) plus pemetrexed at 100.0 mg/kg (q2dx3x5w) was also included. Bioluminescence was monitored weekly with live imaging using IVIS Spectrum In Vivo Imaging system. Peptide-targeted DXR-containing nanoparticle at 7.0 mg/kg enabled a tumor growth inhibition, by the end of the treatment, that was 183-fold higher than the standard of care. Moreover, treatment with DXR-containing nanoparticle targeting nucleolin, either at 5.6 or 7.0 mg/kg, enabled a 10- or 66-fold reduction of tumor burden, respectively, relative to non-treated mice. Conversely, treatment with the standard of care did not show any effect on tumor growth inhibition (being similar to the group injected with vehicle) nor on tumor burden. Importantly, DXR-containing nanoparticle targeting nucleolin, at the highest tested dose, enabled a marked decreased of the incidence of tumor infiltration into the chest cavity, as well as of the presence of severe lung lesions, as compared with the standard of care (57.1% versus 100% and 14.3% versus 50%, respectively). Overall, the novel mechanism of action associated with DXR-containing nanoparticle targeting nucleolin, enables a significant benefit in terms of efficacy (and safety) in the treatment of mesothelioma, as compared with the current standard of care, thus supporting future clinical evaluation.

Citation Format: Nuno André Fonseca, Vera Moura, Fabiana Colelli, Daniela Pesce, Francesco Cardile, Claudio Pisano, Sérgio Simões, João Nuno Moreira. Targeting nucleolin with doxorubicin-containing nanoparticle induces a significant tumor growth inhibition in an orthotopic animal model of standard of care-resistant mesothelioma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5155. doi:10.1158/1538-7445.AM2017-5155

Depression, anxiety and adjustment in renal replacement therapy: a quality of life assessment

OBJECTIVES

To measure the quality of life (QOL) of patients on RRT with regard to depression, anxiety, and adjustment to illness.

MATERIAL

The study was conducted between 1996 and 1998 at a teaching hospital in Porto Alegre, Brazil. The study population included 125 patients (transplant n = 64, hemodialysis n = 42 and continuous ambulatory peritoneal dialysis [CAPD] n = 19).

METHODS

The Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and the Psychosocial Adjustment to Illness Scale (PAIS) were used for patient assessment. Results were analyzed using the Kruskall-Wallis, Mann-Whitney and ANOVA tests.

RESULTS

Depression scores were higher for hemodialysis patients compared with transplant patients (H = 15.22; p < 0.005). CAPD patients had intermediate scores (no statistical difference). As far as anxiety was concerned, no statistical difference was observed when the groups were compared. In terms of adjustment to illness, hemodialysis patients were significantly less well adjusted than transplant patients (H = 23.34; p < 0.001). Patients on CAPD had intermediate scores, with no significant difference compared with the other two groups.

CONCLUSION

The overall quality of life of transplant patients is higher than that of hemodialysis patients.

The effect of temperature on mobility of Angiostrongylus costaricensis third stage larvae

Third stage larvae (L3) from Angiostrongylus costaricensis were incubated in water at room temperature and at 5 degrees C and their mobility was assessed daily for 17 days. Viability was associated with the mobility and position of the L3, and it was confirmed by inoculation per os in albino mice. The number of actively moving L3 sharply decreased within 3 to 4 days, but there were some infective L3 at end of observation. A mathematical model estimated 80 days as the time required to reduce the probability of infective larvae to zero. This data does not support the proposition of refrigerating vegetables and raw food as an isolated procedure for prophylaxis of human abdominal angiostrongylosis infection.

Trends in asthma mortality in young people in southern Brazil

BACKGROUND

Mortality from asthma increased and is now declining in some countries, but little is known about these trends in South America.

OBJECTIVE

We aimed to assess trends in mortality from asthma in southern Brazil in children and young adults.

METHODS

Death certificates of 425 people in the state of Rio Grande do Sul aged between 5 and 39 years in whom asthma was reported to be the underlying cause of death during the period 1970 to 1992 were reviewed. Population data were available in 10-year age groups. Testing for trends in mortality rates was conducted using linear and log-linear regression procedures.

RESULTS

Asthma mortality rates in the age groups 5 to 19 and 20 to 39 years ranged between 0.04 and 0.39/100,000 and 0.28 to 0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in rate in 5- to 19-year olds was +0.01 (95% CI 0.003 to 0.016), an average annual percentage increase of +6.8% (95% CI 3% to 11%), with a total increase of 352% between 1970 and 1992. This increase was not due to a shift in labeling from bronchitis to asthma. In the 20 to 39-year age group, asthma and bronchitis mortality rates showed no trend to increase or decrease.

CONCLUSIONS

Asthma mortality in southern Brazil is low, but rose significantly between 1970 and 1992 in the 5 to 19-year age group. This trend differs from that found in other states of Brazil and several other Latin American countries. Reasons for this difference remain unclear.