Integrins regulate hERG1 dynamics by girdin-dependent Gαi3: signaling and modeling in cancer cells

The hERG1 potassium channel is aberrantly over expressed in tumors and regulates the cancer cell response to integrin-dependent adhesion. We unravel a novel signaling pathway by which integrin engagement by the ECM protein fibronectin promotes hERG1 translocation to the plasma membrane and its association with β1 integrins, by activating girdin-dependent Gαi3 proteins and protein kinase B (Akt). By sequestering hERG1, β1 integrins make it avoid Rab5-mediated endocytosis, where unbound channels are degraded. The cycle of hERG1 expression determines the resting potential (Vrest) oscillations and drives the cortical f-actin dynamics and thus cell motility. To interpret the slow biphasic kinetics of hERG1/β1 integrin interplay, we developed a mathematical model based on a generic balanced inactivation-like module. Integrin-mediated cell adhesion triggers two contrary responses: a rapid stimulation of hERG1/β1 complex formation, followed by a slow inhibition which restores the initial condition. The protracted hERG1/β1 integrin cycle determines the slow time course and cyclic behavior of cell migration in cancer cells.

Respiratory challenges and ventilatory management in different types of acute brain-injured patients

Acute brain injury (ABI) covers various clinical entities that may require invasive mechanical ventilation (MV) in the intensive care unit (ICU). The goal of MV, which is to protect the lung and the brain from further injury, may be difficult to achieve in the most severe forms of lung or brain injury. This narrative review aims to address the respiratory issues and ventilator management, specific to ABI patients in the ICU.

DNA supercoiling restricts the transcriptional bursting of neighboring eukaryotic genes

DNA supercoiling has emerged as a major contributor to gene regulation in bacteria, but how DNA supercoiling impacts transcription dynamics in eukaryotes is unclear. Here, using single-molecule dual-color nascent transcription imaging in budding yeast, we show that transcriptional bursting of divergent and tandem GAL genes is coupled. Temporal coupling of neighboring genes requires rapid release of DNA supercoils by topoisomerases. When DNA supercoils accumulate, transcription of one gene inhibits transcription at its adjacent genes. Transcription inhibition of the GAL genes results from destabilized binding of the transcription factor Gal4. Moreover, wild-type yeast minimizes supercoiling-mediated inhibition by maintaining sufficient levels of topoisomerases. Overall, we discover fundamental differences in transcriptional control by DNA supercoiling between bacteria and yeast and show that rapid supercoiling release in eukaryotes ensures proper gene expression of neighboring genes.

Combination Therapy with a Bispecific Antibody Targeting the hERG1/β1 Integrin Complex and Gemcitabine in Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) represents an unmet medical need. Difficult/late diagnosis as well as the poor efficacy and high toxicity of chemotherapeutic drugs result in dismal prognosis. With the aim of improving the treatment outcome of PDAC, we tested the effect of combining Gemcitabine with a novel single chain bispecific antibody (scDb) targeting the cancer-specific hERG1/β1 integrin complex. First, using the scDb (scDb-hERG1-β1) in immunohistochemistry (IHC), Western blot (WB) analysis and immunofluorescence (IF), we confirmed the presence of the hERG1/β1 integrin complex in primary PDAC samples and PDAC cell lines. Combining Gemcitabine with scDb-hERG1-β1 improved its cytotoxicity on all PDAC cells tested in vitro. We also tested the combination treatment in vivo, using an orthotopic xenograft mouse model involving ultrasound-guided injection of PDAC cells. We first demonstrated good penetration of the scDb-hERG1-β1 conjugated with indocyanine green (ICG) into tumour masses by photoacoustic (PA) imaging. Next, we tested the effects of the combination at either therapeutic or sub-optimal doses of Gemcitabine (25 or 5 mg/kg, respectively). The combination of scDb-hERG1-β1 and sub-optimal doses of Gemcitabine reduced the tumour masses to the same extent as the therapeutic doses of Gemcitabine administrated alone; yielded increased survival; and was accompanied by minimised side effects (toxicity). These data pave the way for a novel therapeutic approach to PDAC, based on the combination of low doses of a chemotherapeutic drug (to minimize adverse side effects and the onset of resistance) and the novel scDb-hERG1-β1 targeting the hERG1/β1 integrin complex as neoantigen.

Quantifying how post-transcriptional noise and gene copy number variation bias transcriptional parameter inference from mRNA distributions

Transcriptional rates are often estimated by fitting the distribution of mature mRNA numbers measured using smFISH (single molecule fluorescence in situ hybridization) with the distribution predicted by the telegraph model of gene expression, which defines two promoter states of activity and inactivity. However, fluctuations in mature mRNA numbers are strongly affected by processes downstream of transcription. In addition, the telegraph model assumes one gene copy, but in experiments cells may have two gene copies as cells replicate their genome during the cell cycle. Whilst it is often presumed that post-transcriptional noise and gene copy number variation affect transcriptional parameter estimation, the size of the error introduced remains unclear. To address this issue, here we measure both mature and nascent mRNA distributions of GAL10 in yeast cells using smFISH and classify each cell according to its cell cycle phase. We infer transcriptional parameters from mature and nascent mRNA distributions, with and without accounting for cell cycle phase and compare the results to live-cell transcription measurements of the same gene. We find that: (i) correcting for cell cycle dynamics decreases the promoter switching rates and the initiation rate, and increases the fraction of time spent in the active state, as well as the burst size; (ii) additional correction for post-transcriptional noise leads to further increases in the burst size and to a large reduction in the errors in parameter estimation. Furthermore, we outline how to correctly adjust for measurement noise in smFISH due to uncertainty in transcription site localisation when introns cannot be labelled. Simulations with parameters estimated from nascent smFISH data, which is corrected for cell cycle phases and measurement noise, leads to autocorrelation functions that agree with those obtained from live-cell imaging.

Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients

PURPOSE

Severe cases of coronavirus disease 2019 develop ARDS requiring admission to the ICU. This study aimed to investigate the ultrasound characteristics of respiratory and peripheral muscles of patients affected by COVID19 who require mechanical ventilation.

MATERIALS AND METHODS

This is a prospective observational study. We performed muscle ultrasound at the admission of ICU in 32 intubated patients with ARDS COVID19. The ultrasound was comprehensive of thickness and echogenicity of both parasternal intercostal and diaphragm muscles, and cross-sectional area and echogenicity of the rectus femoris.

RESULTS

Patients who survived showed a significantly lower echogenicity score as compared with those who did not survive for both parasternal intercostal muscles. Similarly, the diaphragmatic echogenicity was significantly different between alive or dead patients. There was a significant correlation between right parasternal intercostal or diaphragm echogenicity and the cumulative fluid balance and urine protein output. Similar results were detected for rectus femoris echogenicity.

CONCLUSIONS

The early changes detected by echogenicity ultrasound suggest a potential benefit of proactive early therapies designed to preserve respiratory and peripheral muscle architecture to reduce days on MV, although what constitutes a clinically significant change in muscle echogenicity remains unknown.

A validation study of a continuous automatic measurement of the mechanical power in ARDS patients

The mechanical power (MP) is the energy delivered into the respiratory system over time. It can be computed as a direct measurement of the inspiratory area of the airway pressure and volume loop during the respiratory cycle or calculated by "power equations". The absence of a bedside computation limited its widespread use. Recently, it has been developed an automatic monitoring system inside of a mechanical ventilator.

PURPOSE

Our aim was to investigate the repeatability and the accuracy of the measured MP at different PEEP values and tidal volume compared with the calculated MP.

MATERIAL AND METHODS

MP was measured and calculated in sedated and paralyzed ARDS patients at low and high tidal volume, at 5-10-15 cmH₂O of PEEP both in volume and pressure-controlled ventilation. The same measurements were performed twice.

RESULTS

Fifty ARDS patients were enrolled. MP was measured and calculated for a total of 300 measurements. The bias and limits of agreement were 0.38 from -1.31 to 2.0 J/min. The measured and calculated MP were similar in each ventilatory condition.

CONCLUSIONS

The mechanical power measured by a new automatic real time system implemented in a mechanical ventilator was repeatable and accurate compared with the computed one.

Applying deep neural networks and inertial measurement unit in recognizing irregular walking differences in the real world

Falling injuries pose serious health risks to people of all ages, and knowing the extent of exposure to irregular surfaces will increase the ability to measure fall risk. Current gait analysis methods require overly complicated instrumentation and have not been tested for external factors such as walking surfaces that are encountered in the real-world, thus the results are difficult to extrapolate to real-world situations. Artificial intelligence approaches (in particular deep learning networks of varied architectures) to analyze data collected from wearable sensors were used to identify irregular surface exposure in a real-world setting. Thirty young adults wore six Inertial Measurement Unit (IMU) sensors placed on their body (right wrist, trunks at the L5/S1 level, left and right thigh, left and right shank) while walking over eight different surfaces commonly encountered in the living community as well as occupational settings. Three variations of deep learning models were trained to solve this walking surface recognition problem: 1) convolution neural network (CNN); 2) long short term memory (LSTM) network and 3) LSTM structure with an extra global pooling layer (Global-LSTM) which learns the coordination between different data streams (e.g. different channels of the same sensor as well as different sensors). Results indicated that all three deep learning models can recognize walking surfaces with above 0.90 accuracy, with the Global-LSTM yielding the best performance at 0.92 accuracy. In terms of individual sensors, the right thigh based Global-LSTM model reported the highest accuracy (0.90 accuracy). Results from this study provide further evidence that deep learning and wearable sensors can be utilized to recognize irregular walking surfaces induced motion alteration and applied to prevent falling injuries.

Analysis of anaerobic digester mixing: comparison of long shafted paddle mixing vs gas mixing

The anaerobic digestion (AD) process is influenced by a variety of operation parameters, such as sludge rheology, mixing, temperature, solid retention time (SRT), hydraulic retention time (HRT) and solids concentration. The optimum in the mixing lies somewhere between no-mixing and continuous mixing, as the lack or excessive mixing can lead to poor AD performance instead. A three-dimensional computational fluid dynamics steady/unsteady model, incorporating the rheological properties of the sludge, was developed and applied to quantify mixing in a full-scale anaerobic digester. Mechanical and gas mixing solutions were taken into account, keeping constant the daily energy consumption. Results, consisting of velocity magnitude and patterns, dead zone formation and turbulence levels were discussed. Compared to the mechanical mixing, gas mixing had lower percentage of dead zones (about 5% against 50%), larger maximum velocity (about 3 m/s against 1 m/s) as well as larger turbulent kinetic energy levels (0.24 m²/s² against 0.001 m²/s²).

Hemidesmosomes modulate force generation via focal adhesions

Hemidesmosomes are specialized cell-matrix adhesion structures that are associated with the keratin cytoskeleton. Although the adhesion function of hemidesmosomes has been extensively studied, their role in mechanosignaling and transduction remains largely unexplored. Here, we show that keratinocytes lacking hemidesmosomal integrin α6β4 exhibit increased focal adhesion formation, cell spreading, and traction-force generation. Moreover, disruption of the interaction between α6β4 and intermediate filaments or laminin-332 results in similar phenotypical changes. We further demonstrate that integrin α6β4 regulates the activity of the mechanosensitive transcriptional regulator YAP through inhibition of Rho-ROCK-MLC- and FAK-PI3K-dependent signaling pathways. Additionally, increased tension caused by impaired hemidesmosome assembly leads to a redistribution of integrin αVβ5 from clathrin lattices to focal adhesions. Our results reveal a novel role for hemidesmosomes as regulators of cellular mechanical forces and establish the existence of a mechanical coupling between adhesion complexes.

Abstract 1216: Novel strategies in cancer immunotherapy: Harness the hERG1 β1 macromolecular complex via a new bispecific antibody and its bifunctional TRAIL

Introduction Among hindrances in cancer treatment, the lack of appropriate markers to be exploited for targeted therapy, and the need of new potential drugs are two big challenges.hERG1 potassium channels are a novel class of oncological targets and, in cancer, they are known to interact with integrins. It has been recently demonstrated that macromolecular complexes formed between hERG1 and β1 integrins selectively occurs in many types of cancer (Becchetti A et al., 2017). In this scenario, hERG1 could be exploited as a therapeutic target providing non cardiotoxic strategies aimed at blocking hERG1.

Materials and Methods A scDb, a bifunctional single-chain diabody, directed against hERG1/β1 complex, was developed via SOE-PCR methodology. Such antibody was tested on HCT116 cells in lateral motility and western blotting experiments. Moreover immunohistochemistry (IHC) was performed on metastatic colorectal cancer (mCRC) paraffin embedded samples using the scDb, an anti-hERG1 and an anti-β1 integrin. Moreover, we improved the pro-apoptotic effects of the nude hERG1/β1-scDb, developing a trifunctional recombinant protein, in which the scDb-hERG1-β1 was linked to the tumour necrosis factor-related apoptosis-inducing ligand (TRAIL).

Results and Discussion Performing IHC on sequential sections of mCRC confirmed the specificity of the scDb for both hERG1 and β1 integrin. In vitro data provide evidences that the administering of the bispecific antibody has an impact on lateral motility. Moreover, signaling pathways are also affected by the antibody treatment, as AKT phosphorylation and HIF1α levels are decreased when the molecule is administered, suggesting a possible effect of the bispecific antibody on the VEGF-A signaling pathway, which are consistent with our previous hypothesis (Becchetti A et al., 2017) of a possible cross-talk leading to a deep impact on VEGF expression and, thus, on neoangiogenesis. Encouraging results were obtained when testing the scDb-hERG1-β1 -TRAIL fusion protein, which was capable to produce a strong induction of apoptosis in ALL cells (32.6 vs 11% at 24h; 62.4% vs 10% at 48h), with no effects on TRAIL- resistant (Panc1) tumour cells.

Conclusions scDb-hERG1/β1 could be used as a potential new therapeutic tool for cancer patients’ treatment as well as for early molecular diagnosis. In fact, the selective expression of hERG1/β1 complex in cancer cells and its role in angiogenesis and cancer progression suggests that a molecule selectively targeting the complex will be an invaluable tool for cancer treatment. In this view, we have recently licensed a patent which will be exploited with the final aim to undergo clinical trials. Becchetti A, et al. (2017) Science Signaling 10(473). Patent. Inventors: Arcangeli A, Duranti C. et al. Patent Ref: 102017000083637

Citation Format: Claudia Duranti, Jessica Iorio, Stefano Coppola, Giulia Petroni, Tiziano Lottini, Lara Magni, Elena Lastraioli, Annarosa Arcangeli. Novel strategies in cancer immunotherapy: Harness the hERG1 β1 macromolecular complex via a new bispecific antibody and its bifunctional TRAIL [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1216.

Role of c-MET Inhibitors in Overcoming Drug Resistance in Spheroid Models of Primary Human Pancreatic Cancer and Stellate Cells

Pancreatic stellate cells (PSCs) are a key component of tumor microenvironment in pancreatic ductal adenocarcinoma (PDAC) and contribute to drug resistance. c-MET receptor tyrosine kinase activation plays an important role in tumorigenesis in different cancers including PDAC. In this study, effects of PSC conditioned medium (PCM) on c-MET phosphorylation (by immunocytochemistry enzyme-linked immunosorbent assay (ELISA)) and drug response (by sulforhodamine B assay) were investigated in five primary PDAC cells. In novel 3D-spheroid co-cultures of cyan fluorescence protein (CFP)-firefly luciferase (Fluc)-expressing primary human PDAC cells and green fluorescence protein (GFP)-expressing immortalized PSCs, PDAC cell growth and chemosensitivity were examined by luciferase assay, while spheroids' architecture was evaluated by confocal microscopy. The highest phospho-c-MET expression was detected in PDAC5 and its subclone sorted for "stage specific embryonic antigen-4" (PDAC5 (SSEA4)). PCM of cells pre-incubated with PDAC conditioned medium, containing increased hepatocyte growth factor (HGF) levels, made PDAC cells significantly more resistant to gemcitabine, but not to c-MET inhibitors. Hetero-spheroids containing both PSCs and PDAC5 (SSEA4) cells were more resistant to gemcitabine compared to PDAC5 (SSEA4) homo-spheroids. However, c-MET inhibitors (tivantinib, PHA-665752 and crizotinib) were equally effective in both spheroid models. Experiments with primary human PSCs confirmed the main findings. In conclusion, we developed spheroid models to evaluate PSC-PDAC reciprocal interaction, unraveling c-MET inhibition as an important therapeutic option against drug resistant PDAC.

Quantifying cellular forces and biomechanical properties by correlative micropillar traction force and Brillouin microscopy

Cells sense and respond to external physical forces and substrate rigidity by regulating their cell shape, internal cytoskeletal tension, and stiffness. Here we show that the combination of micropillar traction force and noncontact Brillouin microscopy provides access to cell-generated forces and intracellular mechanical properties at optical resolution. Actin-rich cytoplasmic domains of 3T3 fibroblasts showed significantly higher Brillouin shifts, indicating a potential increase in stiffness when adhering on fibronectin-coated glass compared to soft PDMS micropillars. Our findings demonstrate the complementarity of micropillar traction force and Brillouin microscopy to better understand the relation between cell force generation and the intracellular mechanical properties.

The Activity of Kv 11.1 Potassium Channel Modulates F-Actin Organization During Cell Migration of Pancreatic Ductal Adenocarcinoma Cells

Cell migration exerts a pivotal role in tumor progression, underlying cell invasion and metastatic spread. The cell migratory program requires f-actin re-organization, generally coordinated with the assembly of focal adhesions. Ion channels are emerging actors in regulating cell migration, through different mechanisms. We studied the role of the voltage dependent potassium channel K_V 11.1 on cell migration of pancreatic ductal adenocarcinoma (PDAC) cells, focusing on its effects on f-actin organization and dynamics. Cells were cultured either on fibronectin (FN) or on a desmoplastic matrix (DM) with the addition of a conditioned medium produced by pancreatic stellate cells (PSC) maintained in hypoxia (Hypo-PSC-CM), to better mimic the PDAC microenvironment. K_V11.1 was essential to maintain stress fibers in a less organized arrangement in cells cultured on FN. When PDAC cells were cultured on DM plus Hypo-PSC-CM, K_V11.1 activity determined the organization of cortical f-actin into sparse and long filopodia, and allowed f-actin polymerization at a high speed. In both conditions, blocking K_V11.1 impaired PDAC cell migration, and, on cells cultured onto FN, the effect was accompanied by a decrease of basal intracellular Ca²⁺ concentration. We conclude that K_V11.1 is implicated in sustaining pro-metastatic signals in pancreatic cancer, through a reorganization of f-actin in stress fibers and a modulation of filopodia formation and dynamics.

Lung recruitment: What has computed tomography taught us in the last decade?

Although chest X-ray remains a fundamental lung imaging technique, through the years, CT scan has significantly improved our knowledge of the pathophysiological process and currently is the reference lung imaging tool for both a visual and quantitative computer-based analysis. The application of lung CT in the early phase of ARDS has led to changes in the clinical management in up of thirty percent of the patients. Although CT requires the transportation of the patient to the radiological department and exposes the patient to high dose of radiation, given the several information that CT can offer, it should be applied at least one time, in the early phase in all ARDS patients. CT plays an irreplaceable role to describe and assess the lung recruitability and to help a more physiological setting of mechanical ventilation.

Repetitive switching between DNA binding modes enables target finding by the glucocorticoid receptor

Transcription factor mobility is a determining factor in the regulation of gene expression. Here, we have studied the intranuclear dynamics of the glucocorticoid receptor (GR) using fluorescence recovery after photobleaching and single-molecule microscopy. First we have described the dynamic states in which the GR occurs. Subsequently we have analyzed the transitions between these states using a continuous time Markov chain model, and functionally investigated these states by making specific mutations in the DNA-binding domain. This analysis revealed that the GR diffuses freely through the nucleus, and once it leaves this free diffusion state it most often enters a repetitive switching mode. In this mode it alternates between slow diffusion as a result of brief nonspecific DNA binding events, and a state of stable binding to specific DNA target sites. This repetitive switching mechanism results in a compact searching strategy which facilitates finding DNA target sites by the GR.

Abstract 175: Mechanical transduction mediated by Integrin-ILK dependent actin dynamics drives stem-plasticity leading experimental metastatic colonization of prostate cancer leading experimental metastatic colonization of prostate cancer

Incurable bone metastasis is a main cause of death in prostate cancer. Metastasis is believed to be initiated by a small subpopulation of cancer cells termed tumor initiating cells (TICs) or cancer stem-like cells (CSCs). One of the key steps of the metastatic cascade is metastatic colonization of circulating tumor cells/clusters (CTCs) in a distant niche from circulation. From clinical database analysis, a significant up regulation of genes related to cell-ECM interaction was observed in prostate cancer patients derived CSCs, implying that the enhanced focal adhesion ability and its correlated cytoskeleton remodeling of CSCs plays a critical role in regulating metastatic colonization. However, due to a lack of tools to visualize the low amount of disseminated CSCs at high imaging resolution, it remains unknown how those cells behave when they interact with the stromal compartment at the inception of metastatic colonization. Hereby, we intravenously injected osteotropic prostate cancer cells with fluorescently-labeled F-actin into transparent zebrafish embryos to monitor single cell dynamics during metastatic colonization. In this model we observed a highly dynamic actin-based cytoskeletal remodeling in ALDHhi CSCs that controls extravasation and metastatic colonization. Transcriptome analysis revealed that this cytoskeleton remodeling was regulated by the focal adhesion factors: Integrinβ1 and integrin linked kinase (ILK). Genetic targeting of Integrinβ1 and ILK significantly inhibited expression of pluripotency genes, ALDH activity, metastatic colonization and outgrowth, suggesting the Integrinβ1-ILK axis as a key metastatic regulator that drives stem-like properties of CSCs during metastasis. Further in vitro and in vivo analysis showed that the Integrinβ1-ILK axis controls prostate cancer stem plasticity by generating contractile force through small GTPase-CDC42 and invadopodia regulator-N-wasp when the cells physically interact with the ECM. This mechanical transduction further activates mechanical sensor YAP/TAZ in a hippo-independent manner and promotes the expression of pluripotency genes that support metastatic initiation. Interference with this process by blocking CDC42-N-wasp signaling significantly attenuated mechanical transduction, impaired YAP/TAZ nuclear translocation and eventually inhibited metastatic initiation. Taken together, this study indicates a fundamental role of the mechanical transduction between ECMs and CSCs mediated by integrin/ILK dependent cytoskeleton remodeling at metastatic onset and outgrowth. Pharmacological targeting of this process may be a potent approach to attenuate the formation of prostate cancer metastasis on clinic.

Citation Format: Lanpeng Chen, Stefano Coppola, Nick Landman, Arwin Groenewoud, Thomas Schmidt, B.Ewa Snaar-Jagalska. Mechanical transduction mediated by Integrin-ILK dependent actin dynamics drives stem-plasticity leading experimental metastatic colonization of prostate cancer leading experimental metastatic colonization of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 175.

Abstract 183: HERG1 potassium channels perturb the β1 integrins mediated force transduction machinery in pancreatic cancer

Ion channels regulate cell proliferation, differentiation, and migration in normal and neoplastic cells through cell-cell and cell-extracellular matrix (ECM) transmembrane receptors called integrins. K+ flux through the human ether-à-gogo-related gene 1 (hERG1) channel shapes action potential firing in excitable cells such as cardiomyocytes. Its abundance is often aberrantly high in human tumors, including the pancreatic ductal adenocarcinoma (PDAC). We recently demonstrated that the direct interaction of β1 integrins with hERG1 channels in cancer cells stimulated distinct signaling pathways that depended on the conformational state of hERG1 and affected different aspects of tumor progression [1].

We hypothesized that hERG1 channels compromise the PDAC mechano-reciprocity, the ability to dynamically respond to externally applied forces by exerting forces, which enhances invasion and compromises treatment.

Using elastic micropillar arrays of varying stiffness (20-150 kPa) [2], we quantified the β1-integrin mediated forces exerted by PANC-1 cells. Micropillars coating with collagen and/or fibronectin derived peptides allowed us to direct cell surface receptor binding specificity (i.e. α2β1 and α5β1 integrins). Independently of the substrate coating, PANC-1 cells exerted higher forces as a function of substrate stiffness, as already demonstrated for other cell types. Remarkably, the disruption of the β1/hERG1 interaction through E4031 inhibition of hERG1 channels resulted in a significant increase in the detected cellular forces by ~20%, accompanied by an increase of focal adhesion areas as demonstrated by staining with vinculin.

Our results suggest that, in addition to alter distinct signaling pathways and tumor progression [1], the direct interaction of β1 integrins and hERG1 channels perturbs the force transduction machinery. These findings encouraged us to develop bispecific antibodies (scDb, single-chain diabody) binding to the β1/hERG1 complex that are now being validated in PDAC cell lines. In particular, we have developed a bispecific antibody (scDb-β1/hERG1) [3], which is composed by the variable domains (VH and VL chains) of monoclonal antibodies binding two different antigens, hERG1 and β1 integrin. Data obtained from in vitro studies demonstrates that the scDb antibody impacts cell viability and migratory behavior in Mia PaCa-2 cell lines, holding promises for translational impact after a further validation in vivo as a novel candidate in cancer therapeutics.

[1] Becchetti et al. Science Signaling (2017), 10 (473), eaaf3236.

[2] van Hoorn et al. Nano Lett (2014), 14, 4257-4262.

[3] Patent: “Novel antibodies”. Inventors: Annarosa Arcangeli, Claudia Duranti, Silvia Crescioli, Laura Carraresi. Patent Deposit: July 2017. Patent Ref: 102017000083637 (University of Florence).

Citation Format: Stefano Coppola, Claudia Duranti, Annarosa Arcangeli, Thomas Schmidt. HERG1 potassium channels perturb the β1 integrins mediated force transduction machinery in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 183.

Abstract 4040: α2β1 integrins are potential regulators of chemoresistance through modulation of biomechanical cues in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor characterized by intrinsic or rapidly acquired chemoresistance. The remarkable desmoplastic response has been reported as a major contributor to chemoresistance, suggesting that PDAC progression could be highly influenced by mechanical factors (1). A recent study showed a key role of epithelial tension and matricellular fibrosis in the aggressiveness of SMAD4 mutant PDAC (2). Here we aimed at evaluating new mechanopharmacology approaches to overcome chemoresistance. PDAC cells attached to collagen and fibronectin showed a decreased sensitivity to chemotherapy, while the malignant phenotype was highly correlated to α2β1 integrin(ITGA2)-mediated adhesion to type I collagen (3). We hence hypothesized that this integrin might modulate chemoresistance. In two cohorts of 50 radically resected patients treated with gemcitabine, high expression of ITGA2 (assessed by immunohistochemistry in tissue-microarrays with 4 cores for each tumor) correlated to significantly shorter progression and overall free survival. Our hypothesis was further investigated in a gemcitabine-resistant clone (PANC1-R). In this clone, ITGA2 was among the top 10 most differentially upregulated genes at next-generation sequencing analysis. Using migration assays, we found that PANC1-R were more invasive than PANC1 cells, and a specific siRNA for ITGA2 caused a significant reduction of invasiveness while enhancing both gemcitabine antiproliferative effects and apoptosis induction. Using elastic micropillar arrays of varying stiffness (20-150kPa) (4), we observed delayed spreading of PANC1-R compared to PANC1 while a 24-hour treatment with a non-cytotoxic dose of gemcitabine activated traction forces in both lines, albeit to a lesser extent in PANC1-R. Remarkably, these cells showed also a significant increase of CXCR4 and MMP2 expression when growing in spheroids embedded in stiff collagen, as well as a different trend in modulation of E2F1 after exposure to gemcitabine, when growing as 2D collagen monolayers on soft and stiff flat PDMS, suggesting that aggressive/invasive behavior and response to gemcitabine are altered by both collagen and stiffness. These results define ITGA2 as a new prognostic factor, exerting its function through the promotion of metastatic behavior and altered drug response of PDAC cells under differential biomechanical conditions, which holds a potential as a novel therapeutic target to overcome PDAC resistance.

References:

1. Coppola et al. Drug Resist Updates 2017;31:43.

2. Laklai et al. Nat Med 2016;22:497.

3. Grzesiak, Bouvet. Br J Cancer 2016;94:1311.

4. van Hoorn et al. Nano Lett 2014;14:4257.

Citation Format: Ilaria Carnevale, Stefano Coppola, Niccola Funel, Erik H. Danen, Thomas Schmidt, Elisa Giovannetti. α2β1 integrins are potential regulators of chemoresistance through modulation of biomechanical cues in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4040.

Easy Printing of High Viscous Microdots by Spontaneous Breakup of Thin Fibers

Electrohydrodynamic jetting is emerging as a successful technique for printing inks with resolutions well beyond those offered by conventional inkjet printers. However, the variety of printable inks is still limited to those with relatively low viscosities (typically <20 mPa s) due to nozzle clogging problems. Here, we show the possibility of printing ordered microdots of high viscous inks such as poly(lactic-co-glycolic acid) (PLGA) by exploiting the spontaneous breakup of a thin fiber generated through nozzle-free pyro-electrospinning. The PLGA fiber is deposited onto a partially wetting surface, and the breakup is achieved simply by applying an appropriate thermal stimulation, which is able to induce polymer melting and hence a mechanism of surface area minimization due to the Plateau-Rayleigh instability. The results show that this technique is a good candidate for extending the printability at the microscale to high viscous inks, thus extending their applicability to additional applications, such as cell behavior under controlled morphological constraints.

A mechanopharmacology approach to overcome chemoresistance in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is a highly chemoresistant malignancy. This chemoresistant phenotype has been historically associated with genetic factors. Major biomedical research efforts were concentrated that resulted in the identification of subtypes characterized by specific genetic lesions and gene expression signatures that suggest important biological differences. However, to date, these distinct differences could not be exploited for therapeutic interventions. Apart from these genetic factors, desmoplasia and tumor microenvironment have been recognized as key contributors to PDAC chemoresistance. However, while several strategies targeting tumor-stroma have been explored including drugs against members of the Hedgehog family, they failed to meet the expectations in the clinical setting. These unsatisfactory clinical results suggest that, an important link between genetics and the influence of tumor microenvironment on PDAC chemoresistance remains to be elucidated. In this respect, mechanobiology is an emerging multidisciplinary field that encompasses cell and developmental biology as well as biophysics and bioengineering. Herein we provide a comprehensive overview of the key players in pancreatic cancer chemoresistance from the perspective of mechanobiology, and discuss novel experimental avenues such as elastic micropillar arrays that could provide fresh insights for the development of mechanobiology-targeted therapeutic approaches (know as mechanopharmacology) to overcome anticancer drug resistance in pancreatic cancer.

The conformational state of hERG1 channels determines integrin association, downstream signaling, and cancer progression

Ion channels regulate cell proliferation, differentiation, and migration in normal and neoplastic cells through cell-cell and cell-extracellular matrix (ECM) transmembrane receptors called integrins. K⁺ flux through the human ether-à-go-go-related gene 1 (hERG1) channel shapes action potential firing in excitable cells such as cardiomyocytes. Its abundance is often aberrantly high in tumors, where it modulates integrin-mediated signaling. We found that hERG1 interacted with the β₁ integrin subunit at the plasma membrane of human cancer cells. This interaction was not detected in cardiomyocytes because of the presence of the hERG1 auxiliary subunit KCNE1 (potassium voltage-gated channel subfamily E regulatory subunit 1), which blocked the β₁ integrin-hERG1 interaction. Although open hERG1 channels did not interact as strongly with β₁ integrins as did closed channels, current flow through hERG1 channels was necessary to activate the integrin-dependent phosphorylation of Tyr³⁹⁷ in focal adhesion kinase (FAK) in both normal and cancer cells. In immunodeficient mice, proliferation was inhibited in breast cancer cells expressing forms of hERG1 with impaired K⁺ flow, whereas metastasis of breast cancer cells was reduced when the hERG1/β₁ integrin interaction was disrupted. We conclude that the interaction of β₁ integrins with hERG1 channels in cancer cells stimulated distinct signaling pathways that depended on the conformational state of hERG1 and affected different aspects of tumor progression.

SIRT1-SIRT3 Axis Regulates Cellular Response to Oxidative Stress and Etoposide

Sirtuins are conserved NAD⁺ -dependent deacylases. SIRT1 is a nuclear and cytoplasmic sirtuin involved in the control of histones a transcription factors function. SIRT3 is a mitochondrial protein, which regulates mitochondrial function. Although, both SIRT1 and SIRT3 have been implicated in resistance to cellular stress, the link between these two sirtuins has not been studied so far. Here we aimed to unravel: i) the role of SIRT1-SIRT3 axis for cellular response to oxidative stress and DNA damage; ii) how mammalian cells modulate such SIRT1-SIRT3 axis and which mechanisms are involved. Therefore, we analyzed the response to different stress stimuli in WT or SIRT1-silenced cell lines. Our results demonstrate that SIRT1-silenced cells are more resistant to H₂ O₂ and etoposide treatment showing decreased ROS accumulation, γ-H2AX phosphorylation, caspase-3 activation and PARP cleavage. Interestingly, we observed that SIRT1-silenced cells show an increased SIRT3 expression. To explore such a connection, we carried out luciferase assays on SIRT3 promoter demonstrating that SIRT1-silencing increases SIRT3 promoter activity and that such an effect depends on the presence of SP1 and ZF5 recognition sequences on SIRT3 promoter. Afterwards, we performed co-immunoprecipitation assays demonstrating that SIRT1 binds and deacetylates the transcription inhibitor ZF5 and that there is a decreased interaction between SP1 and ZF5 in SIRT1-silenced cells. Therefore, we speculate that acetylated ZF5 cannot bind and sequester SP1 that is free, then, to increase SIRT3 transcription. In conclusion, we demonstrate that cells with low SIRT1 levels can maintain their resistance and survival by increasing SIRT3 expression. J. Cell. Physiol. 232: 1835-1844, 2017. © 2016 Wiley Periodicals, Inc.

Forward electrohydrodynamic inkjet printing of optical microlenses on microfluidic devices

We report a novel method for direct printing of viscous polymers based on a pyro-electrohydrodynamic repulsion system capable of overcoming limitations on the material type, geometry and thickness of the receiving substrate. In fact, the results demonstrate that high viscosity polymers can be easily manipulated for optical functionalizing of lab-on-a-chip devices through demonstration of direct printing of polymer microlenses onto microfluidic chips and optical fibre terminations. The present system has great potential for applications from biomolecules to nano-electronics. Moreover, in order to prove the effectiveness of the system, the optical performance of such microlenses has been characterized by testing their imaging capabilities when the fibroblast cells were allowed to flow inside the microfluidic channel, showing one of their possible applications on-board a LoC platform.

Maxillofacial trauma in the emergency department: pearls and pitfalls in airway management

Maxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the American College of Surgeons Advance Trauma Life Support (ATLS®) protocol. However, clinical dilemmas may arise about the best way to manage a potentially life-threatening injury. There are no recommendations about the best time to intubate, the warning signs for deciding to intubate, or which device should be used when difficulty is expected. In this context the ATLS® approach is important but not sufficient. It is also necessary to recognize and be able to manage specific problems in this scenario where clinical priorities may be conflicting, may suddenly change or may be hidden. This clinical review discusses the complexity of this scenario, providing an overview of the conditions at greatest risk for airway obstruction and the options for airway management, on the basis of the recent literature. Clinicians must recognize the milestones and pitfalls of this topic in order to adopt a systematic approach for airway management, to identify specific characteristics associated with it, and to establish the utility of different instruments for airway management.

Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse

BACKGROUND

Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio-circulatory collapse.

METHODS

We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio-circulatory arrest before organ procurement (RCA); those who experienced sustained cardio-circulatory collapse, treated with extra-corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non-Function (PNF), and complications during the first 30 days were analysed.

RESULTS

102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor's death was post-anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17-43], 54 [34-92], 716 [190-962] respectively, SGPT 17 [12-34], 46 [27-73], 84 [51-175] UI/L respectively, both P<0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End-Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar.

CONCLUSION

The use of livers procured from donors after brain death that experienced transient or sustained cardio-circulatory collapse was associated with early graft function comparable to that of standard donors.

Active accumulation of very diluted biomolecules by nano-dispensing for easy detection below the femtomolar range

Highly sensitive detection of biomolecules is of paramount interest in many fields including biomedicine, safety and eco-pollution. Conventional analyses use well-established techniques with detection limits ~1 pM. Here we propose a pyro-concentrator able to accumulate biomolecules directly onto a conventional binding surface. The operation principle is relatively simple but very effective. Tiny droplets are drawn pyro-electro-dynamically and released onto a specific site, thus increasing the sensitivity. The reliability of the technique is demonstrated in case of labelled oligonucleotides diluted serially. The results show the possibility to detect very diluted oligonucleotides, down to a few hundreds of attomoles. Excellent results are shown also in case of a sample of clinical interest, the gliadin, where a 60-fold improved detection limit is reached, compared with standard ELISA. This method could open the way to a mass-based technology for sensing molecules at very low concentrations, in environmental as well as in diagnostics applications.

Spontaneous assembly of carbon-based chains in polymer matrixes through surface charge templates

Stable chains of carbon-based nanoparticles were formed directly in polymer matrixes through an electrode-free approach. Spontaneous surface charges were generated pyroelectrically onto functionalized ferroelectric crystals, enabling the formation of electric field gradients that triggered the dipole-dipole interactions responsible for the alignment of the particles, while embedded in the polymer solution. The phenomenon is similar to the dielectrophoretic alignment of carbon nanotubes reported in the literature. However, here the electric fields are generated spontaneously by a simple heat treatment that, simultaneously, aligns the particles and provides the energy necessary for curing the host polymer. The result is a polymer sheet reinforced with well-aligned chains of carbon-based particles, avoiding the invasive implementation of appropriate electrodes and circuits. Because polymers with anisotropic features are of great interest for enhancing the thermal and/or the electrical conductivity, the electrode-free nature of this technique would improve the scaling down and the versatility of those interconnections that find applications in many fields, such as electronics, sensors, and biomedicine. Theoretical simulations of the interactions between the particles and the charge templates were implemented and appear in good agreement with the experimental results. The chain formation was characterized by controlling different parameters, including surface charge configuration, particle concentration, and polymer viscosity, thus demonstrating the reliability of the technique. Moreover, micro-Raman spectroscopy and scanning electron microscopy were used for a thorough inspection of the assembled chains.

Mechanistic evaluation of the transfection barriers involved in lipid-mediated gene delivery: interplay between nanostructure and composition

Here we present a quantitative mechanism-based investigation aimed at comparing the cell uptake, intracellular trafficking, endosomal escape and final fate of lipoplexes and lipid-protamine/deoxyribonucleic acid (DNA) (LPD) nanoparticles (NPs) in living Chinese hamster ovary (CHO) cells. As a model, two lipid formulations were used for comparison. The first formulation is made of the cationic lipid 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP) and the zwitterionic lipid dioleoylphosphocholine (DOPC), while the second mixture is made of the cationic 3β-[N-(N,N-dimethylaminoethane)-carbamoyl] cholesterol (DC-Chol) and the zwitterionic helper lipid dioleoylphosphatidylethanolamine (DOPE). Our findings indicate that lipoplexes are efficiently taken up through fluid-phase macropinocytosis, while a less efficient uptake of LPD NPs occurs through a combination of both macropinocytosis and clathrin-dependent pathways. Inside the cell, both lipoplexes and LPD NPs are actively transported towards the cell nucleus, as quantitatively addressed by spatio-temporal image correlation spectroscopy (STICS). For each lipid formulation, LPD NPs escape from endosomes more efficiently than lipoplexes. When cells were treated with DOTAP-DOPC-containing systems the majority of the DNA was trapped in the lysosome compartment, suggesting that extensive lysosomal degradation was the rate-limiting factors in DOTAP-DOPC-mediated transfection. On the other side, escape from endosomes is large for DC-Chol-DOPE-containing systems most likely due to DOPE and cholesterol-like molecules, which are able to destabilize the endosomal membrane. The lipid-dependent and structure-dependent enhancement of transfection activity suggests that DNA is delivered to the nucleus synergistically: the process requires both the membrane-fusogenic activity of the nanocarrier envelope and the employment of lipid species with intrinsic endosomal rupture ability.

Graded-size microlens array by the pyro-electrohydrodynamic continuous printing method

In the present work, the pyro-electrohydrodynamic technique was used for the realization of tunable-size microlens arrays. Poly(methyl methacrylate) dissolved in different solvent mixtures was used as the polymeric material for the realization of the microstructures. By controlling the experimental parameters and in particular, the volume of the drop reservoir, graded-size square arrays of tens of microlenses with focal length in the range 1.5-3 mm were produced. Moreover, the optical quality and geometrical features were investigated by profilometric and interferometric analysis.

Noninvasive ventilation in chest trauma: systematic review and meta-analysis

PURPOSE

Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy.

METHODS

We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis.

RESULTS

Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09-0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections.

CONCLUSIONS

These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma.

Preoperative changes of forced vital capacity due to body position do not correlate with postoperative respiratory function in obese subjects

BACKGROUND

Obese patients are at risk of developing postoperative pulmonary complications. We hypothesized that preoperative changes in dynamic spirometry due to body posture would correlate with the drop of forced vital capacity (FVC) measured early after surgery.

METHODS

Thirty consecutive morbidly obese patients undergoing gastric banding were investigated. All subjects were studied the day before surgery (T0) and on postoperative day one (T1). Forced Vital Capacity (FVC) was measured, together with heart rate, mean arterial pressure and respiratory rate. At T0 measurements were taken in a random fashion with subjects in upright and in supine position. Subjects were then investigated after surgery in the supine position (T1). Postoperative pain was assessed at T1 using visual analogue scale. Intraoperative variables were also collected.

RESULTS

Body Mass Index (BMI) of the investigated subjects was 43.9 ± 5.7 Kg/m2 (range 33.8-60); their age was 40 ± 8 years. All dynamic spirometric data decreased significantly from upright to supine position (P<0.05) and after surgery from 3.07 L (2.77-3.71) to 1.50 (1.15-2.12) (FVC T0 supine vs. T1, P<0.05). Changes of FVC due to body position did not correlate with changes of FVC occurring after surgery (R2=0.105, P=0.081). When subjects were stratified by the median postoperative drop of FVC (45.74%), preoperative (anthropometric and spirometric data), intraoperative (ventilatory settings and hemodynamics) and postoperative (FVC and pain) parameters were similar between groups. The duration of pneumoperitoneum was correlated with the drop of FVC (R2=0.551, P<0.05).

CONCLUSION

The derangement of FVC that occurs in obese subjects after gastric banding is not predictable before surgery from anthropometric or spirometric data. The duration of pneumoperitoneum significantly contributes to postoperative impairment of respiratory function.

Quantitative measurement of intracellular transport of nanocarriers by spatio-temporal image correlation spectroscopy

Spatio-temporal image correlation spectroscopy (STICS) is a powerful technique for assessing the nature of particle motion in complex systems although it has been rarely used to investigate the intracellular dynamics of nanocarriers so far. Here we introduce a method to characterize the mode of motion of nanocarriers and to quantify their transport parameters on different length scales from single-cell to subcellular level. Using this strategy we were able to study the mechanisms responsible for the intracellular transport of DOTAP-DOPC/DNA and DC-Chol-DOPE/DNA lipoplexes in CHO-K1 live cells. Measurement of both diffusion coefficients and velocity vectors (magnitude and direction) averaged over regions of the cell revealed the presence of distinct modes of motion. Lipoplexes diffused slowly on the cell surface (diffusion coefficient, D ≈ 0.003 µm²/s). In the cytosol, the lipoplexes' motion was characterized by active transport with average velocity ν ≈ 0.03 µm/s and random motion. The method permitted us to generate intracellular transport map showing several regions of concerted motion of lipoplexes.

[Epidemiology and treatment of cryptorchidism and retractile testis: retrospective study in the area of Naples]

AIM

The authors report the results of a retrospective study carried out with family pediatricians (PDF) in the area of Naples to verify the epidemiology of cryptorchidism and retractile testis, the therapeutic strategy adopted and to assess whether they were in agreement with the data of the scientific literature.

METHODS

The study enrolled 6880 children, aged between 0-14 years, till March 2007; among those were recruited the patients with a diagnosis of cryptorchid and/or retractile testis. A patient schedule was completed with the affected side or bilaterality, age at diagnosis, type of treatment and the number of ascent retractile testis.

RESULTS

A purely descriptive analysis of the data was carried out: 81 patients were diagnosed with cryptorchid patients (1.18%) and 116 with retractile testis (1.68%). In 11 cases an ascent testicle was detected (9.48%). Forty-nine of the 81 cryptorchid patients (60.49%) were diagnosed in the age group of 0-2 years, 25 (30.86%) between 2-4 years and 7 (8.64 %) between 4-8 years. The hormonal therapy associated with surgery was mainly adopted in cryptorchid patients (35 patients).

CONCLUSION

The incidence of cryptorchidism in the area of Naples (1.18%) has not changed significantly. Only 60.49% of patients have been treated in an appropriate age group (0-2 years). The survey confirms the need to follow up the retractile testes for the possibility of definitive ascent in the inguinal canal. The study highlights the need for early diagnosis and treatment of this disease.

Extracorporeal lung perfusion and ventilation to improve donor lung function and increase the number of organs available for transplantation

INTRODUCTION

Ex vivo lung perfusion (EVLP) has been validated as a valuable technique to increase the pool of organs available for lung transplantation.

MATERIAL AND METHODS

After a preclinical experience, we obtained permission from the Ethics Committee of our institution to transplant lungs after EVLP reconditioning. ABO compatibility, size match, and donor arterial oxygen pressure (PaO(2))/fraction of inspired oxygen (FiO(2)) ≤ 300 mm Hg were considered to be inclusion criteria, whereas the presence of chest trauma and lung contusion, evidence of gastric content aspiration, pneumonia, sepsis, or systemic disease were exclusion criteria. We only considered subjects on an extra corporeal membrane oxygenation (ECMO) bridge to transplantation with rapid functional deterioration. Using Steen solution with packed red blood cells oxygenated with 21% O(2), 5% to 7% CO(2) was delivered, targeted with a blood flow of approximately 40% predicted cardiac output. Once normothermic, the lungs were ventilated with a tidal volume of 7 mL/kg a PEEP of 5 cmH(2)O and a respiratory rate of 7 bpm. Lungs were considered to be suitable for transplantation if well oxygenated [P(v-a) O(2) > 350 mm Hg on FiO(2) 100%], in the absence of deterioration of pulmonary vascular resistance and lung mechanics over the perfusion time.

RESULTS

From March to September 2011, six lung transplantations were performed, including two with EVLP. The functional outcomes were similar between groups: at T72 posttransplantation, the median PaO(2)/FiO(2) were 306 mm Hg (range, 282 to 331 mm Hg) and 323 mm Hg (range, 270 to 396 mm Hg) (P = 1, EVLP versus conventional). Intensive care unit ICU and hospital length of stay were similar (P = .533 and P = .663, respectively) with no mortality at 60 days in both groups. EVLP donors were older (49 ± 6 y versus 21 ± 7 y, P < .05), less well oxygenated (184 ± 6 mm Hg versus 570 ± 30, P < .05), displaying higher Oto scores (9.5 ± 0.7 versus 1.7 ± 1.5, P < .05).

CONCLUSIONS

The first 6 months of the EVLP program allowed us to increase the number of organs available for transplantation with short-term outcomes comparable to conventional transplantations.