Managing the COVID-19 Pandemic: Experience of Managers in Healthcare: A Narrative Inquiry

The pandemic represented a challenge for hospital managers at different levels, required to reorganise services without compromising care. This study aimed to analyse the experiences of hospital managers during the COVID-19 pandemic. A narrative inquiry was conducted in a multisite acute hospital. Data were collected through narratives and open-ended questions. Direct and non-direct-care managers were invited to participate. Data were analyzed considering Clandinin & Connelly's (2000) framework and Braun & Clarke, (2006). Thirty-six narratives and open-ended question responses were analysed. Participants were nurses (n = 20), doctors, technicians, administrative and hospitality service managers. Themes were grouped into three narrative dimensions: (1) personal-"the emergency engulfed us", (2) practical/professional-"managing the pandemic", (3) social-"the strength of the team and people". Different narrative threads were identified between direct-care and non direct-care managers. Problems faced, factors helpful for management and suggestions for improvement were also reported. The pandemic had an important impact on managers and their roles, in terms of the need for clear concise information, staff support, and adequate professional and technical resources. A sense of unity and belonging facilitated management.

NETosis in Acute Thrombotic Disorders

The release of extracellular traps by neutrophils (NETs) represents a novel active mechanism of cell death that has been recently implicated in the pathogenesis of thrombotic disorders. The aim of this study was to investigate the generation of NETs in different groups of patients with acute thrombotic events (ATEs) and to establish whether NETs markers can predict the risk of new cardiovascular events. We performed a case-control study of patients with ATE, including acute coronary syndrome (n = 60), cerebrovascular accident (n = 50), and venous thromboembolism (n = 55). Control subjects (n = 70) were identified among patients admitted for acute chest pain and in which a diagnosis of ATE was excluded. Serum levels of NET markers and neutrophil activation, such as myeloperoxidase (MPO)-DNA complexes, neutrophil gelatinase-associated lipocalin, polymorphonuclear neutrophil elastase, lactoferrin, and MPO, were measured in each patient. We found that circulating levels of MPO-DNA complexes were significantly increased in patients with ATE (p < 0.001) compared with controls and that this association remained significant even after fully adjustment for traditional risk factors (p = 0.001). A receiver operating characteristics analysis of circulating MPO-DNA complexes in discriminating between controls and patients with ATE showed a significant area under the curve of 0.76 (95% confidence interval: 0.69-0.82). After a median follow-up of 40.7 (± 13.8) months, 24 out of the 165 patients with ATE presented a new cardiovascular event and 18 patients died. None of the markers under investigation influenced survival or the incidence of new cardiovascular events. In conclusion, we found that increase of markers of NETosis can be observed in acute thrombotic conditions, occurring both on the arterial and venous site. Nevertheless, the level of neutrophil markers measured during the ATE is not predictive of future risk of mortality and cardiovascular events.

Six Sigma can significantly reduce costs of poor quality of the surgical instruments sterilization process and improve surgeon and operating room personnel satisfaction

Operating room (OR) management is a complex multidimensional activity combining clinical and managerial aspects. This longitudinal observational study aimed to assess the impact of Six-Sigma methodology to optimize surgical instrument sterilization processes. The project was conducted at the operating theatre of our tertiary regional hospital during the period from July 2021 to December 2022. The project was based on the surgical instrument supply chain analysis. We applied the Six Sigma lean methodology by conducting workshops and practical exercises and by improving the surgical instrument process chain, as well as checking stakeholders' satisfaction. The primary outcome was the analysis of Sigma improvement. Through this supply chain passed 314,552 instruments in 2022 and 22 OR processes were regularly assessed. The initial Sigma value was 4.79 ± 1.02σ, and the final one was 5.04 ± 0.85σ (SMD 0.60, 95%CI 0.16-1.04, p = 0.010). The observed improvement was estimated in approximately $19,729 of cost savings. Regarding personnel satisfaction, 150 questionnaires were answered, and the overall score improved from 6.6 ± 2.2 pts to 7.0 ± 1.9 pts (p = 0.013). In our experience the application of the Lean Six Sigma methodology to the process of handling the surgical instruments from/to the OR was cost-effective, significantly decreased the costs of poor quality and increased internal stakeholder satisfaction.

Abstract 2849: The oral SERD Elacestrant in combination with the PI3K inhibitor MEN1611 inhibits tumor growth in ER+/HER2- breast cancer in vitro and in PDX models

In estrogen receptor (ER)+/HER2-breast cancer(BC), the addition of CDK4/6 inhibitors (CDK4/6i) to endocrine therapies (ET) leads to a significant increase in progression-free survival. Nevertheless, clinical resistance emerges. The upregulation of the PI3K/AKT/mTOR signaling pathway is one of the multiple acquired mechanisms of resistance to the CDK4/6i and ET combination. Thus, the extensive crosstalk between the PI3K/AKT/mTOR and ER pathways underlines the importance of targeting both pathways to overcome drug resistance in ER+/HER2- BC. Here we have evaluated the antitumor activity of Elacestrant, the oral selective estrogen receptor degrader (SERD) and antagonist, in combination with the σ-sparing PI3K inhibitor MEN1611, in vitro and in vivo in different clinically relevant BC Patient-Derived Xenograft (PDX) models, resistant to CDK4/6i and to ET, harboring mutations in PIK3CA and/or ESR1 genes. In cell-based proliferation assays, the combination of Elacestrant and MEN1611 showed a synergistic effect in inhibiting the growth of ER+ BC cell lines. In vivo data in MCF7- and patient-derived xenograft models showed compelling antitumor activity using the combination at tolerable and clinically relevant doses, compared to the single agents. In the PDX HBxC-3, wild-type for PIK3CA and ESR1 genes, the Tumor Volume-Inhibition (TVI) was 56.2%, 48.7% and 71.7% for MEN1611, Elacestrant and the combination group, respectively. In this model, the combination showed improved anti-tumor activity in comparison to the single agent treatments. In the PDX models HBxC-19 and CTG-2308, wild-type for ESR1 gene, but harboring a PIK3CA mutation, the TVI of the combination was 94.6% and 61.4%, respectively. In the latter model the combination was significantly superior to the single agents. In the PDX model CTG-1260, with PIK3CA and ESR1 mutations, MEN1611 and Elacestrant single agent treatment showed tumor growth inhibition with TVIs of 63.2% and 52.3%, while the combination showed a significant TVI of 86.9%. Overall, in all the tested in vivo models the combination of Elacestrant and MEN1611 was superior in comparison to the single agents by overcoming resistance to ER inhibition potentially driven by PI3K pathway activation in PIK3CA mutated tumors. The current data support the use of Elacestrant, the first oral SERD with positive phase III results in the EMERALD trial (Bidard et al.; JCO 2022), in combination with the PI3K inhibitor MEN1611, in ER+/HER2- mBC patients harboring PIK3CA mutations and who progressed to CDK4/6i plus ET.

Citation Format: Giuseppe Merlino, Alessio Fiascarelli, Simone Talucci, Patrizia Tunici, Mario Bigioni, Alessandro Bressan, Monica Binaschi. The oral SERD Elacestrant in combination with the PI3K inhibitor MEN1611 inhibits tumor growth in ER+/HER2- breast cancer in vitro and in PDX models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2849.

Antitumor activity of the PI3K δ-sparing inhibitor MEN1611 in PIK3CA mutated, trastuzumab-resistant HER2 + breast cancer

PURPOSE

Dysregulation of the PI3K pathway is one of the most common events in breast cancer. Here we investigate the activity of the PI3K inhibitor MEN1611 at both molecular and phenotypic levels by dissecting and comparing its profile and efficacy in HER2 + breast cancer models with other PI3K inhibitors.

METHODS

Models with different genetic backgrounds were used to investigate the pharmacological profile of MEN1611 against other PI3K inhibitors. In vitro studies evaluated cell viability, PI3K signaling, and cell death upon treatment with MEN1611. In vivo efficacy of the compound was investigated in cell line- and patient-derived xenografts models.

RESULTS

Consistent with its biochemical selectivity, MEN1611 demonstrated lower cytotoxic activity in a p110δ-driven cellular model when compared to taselisib, and higher cytotoxic activity in the p110β-driven cellular model when compared to alpelisib. Moreover, MEN1611 selectively decreased the p110α protein levels in PIK3CA mutated breast cancer cells in a concentration- and proteasome-dependent manner. In vivo, MEN1611 monotherapy showed significant and durable antitumor activity in several trastuzumab-resistant PIK3CA-mutant HER2 + PDX models. The combination of trastuzumab and MEN1611 significantly improved the efficacy compared to single agent treatment.

CONCLUSIONS

The profile of MEN1611 and its antitumoral activity suggest an improved profile as compared to pan-inhibitors, which are limited by a less than ideal safety profile, and isoform selective molecules, which may potentially promote development of resistance mechanisms. The compelling antitumor activity in combination with trastuzumab in HER2 + trastuzumab-resistant, PIK3CA mutated breast cancer models is at the basis of the ongoing B-Precise clinical trial (NCT03767335).

Biomarkers of Neutrophil Activation in Patients with Symptomatic Chronic Peripheral Artery Disease Predict Worse Cardiovascular Outcome

Neutrophils play a role in cardiovascular (CV) disease. However, relatively scant evidence exists in the setting of peripheral artery disease (PAD). The aims of this study were to measure biomarkers of neutrophil activation in patients with symptomatic chronic PAD compared with healthy controls, to assess their association with PAD severity, and to evaluate their prognostic value in patients with PAD. The following circulating markers of neutrophil degranulation were tested: polymorphonuclear neutrophil (PMN) elastase, neutrophil gelatinase-associated lipocalin (NGAL), and myeloperoxidase (MPO). Neutrophil extracellular traps (NETs) were quantified by measuring circulating MPO–DNA complexes. Patients with PAD underwent a comprehensive series of vascular tests. The occurrence of 6-month major adverse CV (MACE) and limb events (MALE) was assessed. Overall, 110 participants were included, 66 of which had PAD. After adjustment for conventional CV risk factors, PMN-elastase (adjusted odds ratio [OR]: 1.008; 95% confidence interval [CI]: 1.002–1.015; p = 0.006), NGAL (adjusted OR: 1.045; 95%CI: 1.024–1.066; p < 0.001), and MPO (adjusted OR: 1.013; 95%CI: 1.001–1.024; p = 0.028) were significantly associated with PAD presence. PMN-elastase (adjusted hazard ratio [HR]: 1.010; 95%CI: 1.000–1.020; p = 0.040) and MPO (adjusted HR: 1.027; 95%CI: 1.004–1.051; p = 0.019) were predictive of 6-month MACE and/or MALE. MPO displayed fair prognostic performance on receiver operating characteristic (ROC) curve analyses, with an area under the curve (AUC) of 0.74 (95%CI: 0.56–0.91) and a sensitivity and specificity of 0.80 and 0.65, respectively, for a cut-off of 108.37 ng/mL. MPO–DNA showed a weak inverse correlation with transcutaneous oximetry (TcPO2) on proximal foot (adjusted ρ −0.287; p = 0.032). In conclusion, in patients with symptomatic chronic PAD, enhanced neutrophil activity may be associated with an increased risk of acute CV events, rather than correlate with disease severity. Further research is needed to clarify the role of neutrophils in PAD natural history.

Business-community relations under COVID-19: A study of micro and small firms

In considering the premises of social capital and stakeholder theory, this study examines the extent to which firm-community relationships were affected during the COVID-19 crisis, and the significance of firms for their community during this unprecedented event. Responses from 107 Italian micro and small firms were gathered through an online questionnaire. The findings first reveal a strengthening of relations, particularly between firms and other businesses in their community; however, participants' comments also recognise no changes or even weakening relations. Second, three dimensions highlighting the significance of firms' survival during the crisis emerged: the community context, underlining firms' socioeconomic and symbolic contributions, the immediate stakeholders, emphasising contributions towards employment and support of local businesses, and the broader community-society context, underscoring firms' contribution towards consumer and societal needs. The study proposes a conceptual framework illustrating various relationships between the findings and the considered conceptual underpinnings and suggests various implications.

Enhanced neutrophil activity, but not neutrophil extracellular trap markers, is found in patients with symptomatic chronic peripheral arterial disease

Background/Introduction

Neutrophil degranulation and neutrophil extracellular traps (NETs) are suggested to play a role in cardiovascular (CV) disease development [1]. Human studies showed that markers of NETs, are increased in patients with severe coronary atherosclerosis and predict risk of cardiac events [2]. The role of NETs in peripheral artery disease (PAD) has not been investigated.

Purpose

To measure circulating markers of neutrophil activity in patients with symptomatic PAD compared with matched healthy controls, evaluate their association with disease severity, and assess their prognostic value.

Methods

Multicenter, prospective case-control study. Circulating levels of polymorphonuclear neutrophil (PMN)-elastase, neutrophil gelatinase-associated lipocalin (NGAL), myeloperoxidase (MPO), and NETs-associated MPO-DNA complexes were measured in patients with symptomatic PAD and heathy controls. The former underwent comprehensive vascular evaluation including ankle-brachial index (ABI) calculation, transcutaneous oximetry measurement, constant-load treadmill test, 6-minute walking test, pulse wave velocity, and flow-mediated dilatation of the brachial artery. Six-month outcomes were: occurrence of major adverse CV (MACE) and limb events (MALE), ABI reduction ≥0.15, and 6-minute walking distance reduction ≥20 m.

Results

Overall, 110 participants were included, 66 had symptomatic PAD. Levels of all but one biomarker (MPO-DNA) were significantly higher in patients with PAD compared with healthy controls (Fig. 1). No significant correlation was found between biomarkers and vascular tests in patients with PAD. Baseline PMN-elastase (adjusted hazard ratio [HR]: 1.010; 95% CI: 1.000–1.020; p=0.040) and MPO (adjusted HR: 1.027; 95% CI: 1.004–1.051; p=0.019) were predictive of MACE and/or MALE at 6-month follow-up in patients with symptomatic PAD (Table 1).

Conclusions

Present data show enhanced neutrophil activity, but not NETs levels, in patients with symptomatic PAD compared to controls. Baseline PMN-elastase and MPO levels were associated with worst CV outcome in patients with chronic PAD. These data suggest a role of neutrophils in PAD development and severity that needs to be further elucidated.

Funding Acknowledgement

Type of funding sources: None.

Overcoming the unprecedented: Micro, small and medium hospitality enterprises under COVID-19

The sudden irruption of COVID-19 has paralysed, even devastated, numerous industries. Academic and industry publications also convey the destructive impacts of this phenomenon on hospitality and tourism businesses. While business owners and managers are still constrained by unpredictability, restrictions, and ongoing uncertainty, those vying to continue will need to build their adaptive skill repertoire to cope with the crisis-related regime. This study is primarily concerned with businesses' adaptation phase from owners/managers' viewpoints, including how they manage and envision a future coexistence with COVID-19 threats. Drawing on an international sample of owners/managers of hospitality and tourism businesses, and considering the foundations of the dynamic capabilities framework, eight dimensions emerged from the findings. Five of these, persevering, dynamic, austere restrictions, business environment, and stakeholder, strongly suggest the relevance of reconfiguring, a cluster of dynamic capabilities. Together, the dimensions demonstrate participants' strong commitment to navigate through the threat while pursuing socioeconomic sustainability.

Reducing Changeover Time Between Surgeries Through Lean Thinking: An Action Research Project

Background

Maximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries.

Methods

Using an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite.

Results

Improved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources.

Conclusion

Lean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.

Impacts, lessons learnt and envisioning the future of firms under COVID-19 – implications for knowledge management

Purpose

The purpose of this study is to examine the significance of knowledge management as a tool for firms to adapt to an ongoing unprecedented crisis. Moreover, in considering the knowledge-based view of the firm, the study will ascertain the impacts, lessons learnt and how firms envisage their future under the current unpredictable regime from the viewpoints of firm owners/managers.

Design/methodology/approach

A qualitative data collection approach was selected, with face-to-face and online interviews undertaken with owners/managers of 33 firms operating in Singapore.

Findings

The data analysis reveals as many as eight dimensions pertaining to impacts, lessons learnt and the envisioned future of the firms. The relevance of knowledge management emerged, for instance, in supporting firms and staff to overcome initial challenges after the crisis became apparent. Knowledge management was also an exemplar of lessons learnt, through new knowledge development, strengthening links with consumers, through operational skilfulness and awareness, as well as in explaining how firms envision their future. These findings also underscore key tenets of the knowledge-based view of the firm.

Originality/value

Conceptually, the proposed dimensions stemming from the three examined research questions, together with the propositions and theoretical framework, contribute to a deeper understanding of the links between knowledge management and how firms confront a severe crisis. Empirically, the findings’ highlighted associations with knowledge management elements to illuminate how firms address the impacts of the COVID-19 crisis, as well as the lessons learnt and the envisioned future of firms operating under severe crisis conditions.

Triangle Singularity as the Origin of the a_{1}(1420)

The COMPASS Collaboration experiment recently discovered a new isovector resonancelike signal with axial-vector quantum numbers, the a_{1}(1420), decaying to f_{0}(980)π. With a mass too close to and a width smaller than the axial-vector ground state a_{1}(1260), it was immediately interpreted as a new light exotic meson, similar to the X, Y, Z states in the hidden-charm sector. We show that a resonancelike signal fully matching the experimental data is produced by the decay of the a_{1}(1260) resonance into K^{*}(→Kπ)K[over ¯] and subsequent rescattering through a triangle singularity into the coupled f_{0}(980)π channel. The amplitude for this process is calculated using a new approach based on dispersion relations. The triangle-singularity model is fitted to the partial-wave data of the COMPASS experiment. Despite having fewer parameters, this fit shows a slightly better quality than the one using a resonance hypothesis and thus eliminates the need for an additional resonance in order to describe the data. We thereby demonstrate for the first time in the light-meson sector that a resonancelike structure in the experimental data can be described by rescattering through a triangle singularity, providing evidence for a genuine three-body effect.

Abstract 1376: Dosing frequency/PD/efficacy relationship of MEN1611 in HER2 amplified, PIK3CA mutated, and refractory to Trastuzumab xenograft model of breast cancer

The PI3K-AKT-mTOR pathway is one of the most dysregulated pathways in human cancers, with PIK3CA, the gene encoding the p110α catalytic isoform of PI3K, representing the most frequently mutated gene of this network. In breast tumors, PIK3CA mutations occur in about 20% to 40% of HER2-positive and HER2-negative respectively. The lack of driver oncogenic function, hypothesized for PIK3CA mutations, paralleled by the poor clinical benefit showed by monotherapy with PI3K inhibitors in solid tumors, suggests the use of rational combinations with optimized dosing to improve PI3K inhibitor efficacy. Here we investigate the activity of the PI3K α/β selective and δ-sparing inhibitor MEN1611 in once-daily (QD) at 3.2 mg/kg versus twice-daily (BID) dosing at 1.6 mg/kg, both as a single agent and in combination with trastuzumab, to examine the correlation between drug regimen, target effect, and tumor response. The in vivo studies were investigated with the HER2 amplified, PIK3CA mutated (p.C420R), and trastuzumab-resistant JIMT-1 breast cancer cell line. To compare the effect of QD versus BID MEN1611 treatment, we evaluated the magnitude of PI3K signaling at the tumor site, by measuring the levels of pAKT and pS6 at different time points, at the beginning and the end of treatment. Anti-tumor activity was evaluated in terms of tumor volume inhibition (TVI) and by the modified response evaluation criteria in solid tumors (mRECIST). In monotherapy, although QD dosing produced a slightly longer pathway inhibition (10 vs 8 hours) than the BID, the maximum magnitude achieved was comparable. The analysis of anti-tumor efficacy, showed non-significant differences between the two schedules in terms of tumor volume inhibition (52% versus 45% for the QD and the BID respectively), confirming the PD data. In combo, BID administration was able to keep the pathway efficiently downregulated, counteracting a rebound effect observed at the 24 hour time point in the QD group of animals. Moreover, efficacy evaluation showed significant tumor-regression activity in the BID group of animals compared to the QD (79% versus 43% respectively). Although further studies are needed to evaluate time-dependent drug exposure in tumor and plasma samples, these preliminary findings support the BID clinical schedule of MEN1611 in the B-PRECISE-01 clinical trial (NCT03767335).

Citation Format: Alessio Fiascarelli, Giuseppe Merlino, Stefania Capano, Alessandro Bressan, Mario Bigioni, Andrea Pellacani, Monica Binaschi, Massimiliano Salerno. Dosing frequency/PD/efficacy relationship of MEN1611 in HER2 amplified, PIK3CA mutated, and refractory to Trastuzumab xenograft model of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1376.

Abstract 1170: MEN1112/OBT357, a first-in-class humanized de-fucosylated monoclonal antibody targeting CD157 positive cells in acute myeloid leukemia and myelodysplastic syndrome

Bst1/CD157 is a GPI-anchored transmembrane protein encoded by a member of the CD38 NADase/ADP-ribosyl cyclase gene family, which is expressed on some blood cells of the myeloid lineage, such as monocytes and neutrophils. The antigen is found to be highly expressed, at diagnosis and relapse, in primary samples derived from Acute Myeloid Leukemia (AML) patients, showing the brightest expression in monocyte-oriented blasts. Moreover, CD157 is expressed in high and low-risk Myelodysplastic Syndrome (MDS) patients. MEN1112/OBT357, is a humanized de-fucosylated monoclonal antibody, in clinical development (clinicaltrials.gov identifier: NCT02353143), that is characterized by high affinity and specificity against CD157, inducing potent in vitro Antibody-Dependent Cell-mediated Cytotoxicity (ADCC). The de-fucosylation improved the binding of MEN1112/OBT357 to both high and low-affinity alleles of FcγRIIIa/CD16a, allowing stronger recognition by NK cells. Since no Complement-Dependent Cytotoxicity (CDC) activity was detected, the MEN1112/OBT357 mechanism of action should mainly rely on immune effector cells. Indeed, in an in vitro reporter assay, MEN1112/OBT357 significantly triggered ADCC activity against AML target cell lines with different expression of CD157. Since the ex vivo sensitivity assay is considered a pharmacologically and clinically relevant model to evaluate the preclinical efficacy of therapeutic antibodies in AML (1), MEN1112/OBT357 activity was tested in 38 AML primary samples, demonstrating promising efficacy in an autologous setting, both in peripheral blood and bone marrow samples, in comparison to healthy donor blood samples and independently from FcγRIIIa polymorphisms. A similar activity was also observed in CD157 positive MDS primary samples. Since Myeloid-Derived Suppressor Cells (MDSCs) have been described to be increased in the bone marrow of both AML and MDS patients and their presence to be associated with resistance to chemotherapy (2, 3), we investigated CD157 expression in MDSCs, demonstrating a high expression of the antigen in the bone marrow and peripheral blood of AML patients. Importantly, we confirmed in ex vivo experiments, the depletion of these immunosuppressive cells by MEN1112/OBT357. Overall, our data demonstrate that MEN1112/OBT357 is a novel antibody with potent ex vivo activity against blast cells in AML and MDS patients, suggesting a potential contribution of MEN1112/OBT357 in altering the immunosuppressive environment in the bone marrow niche. References 1. Swords RT et al. Leukemia Research 2018 2. Sun H. et al. Int J Hematology 2015 3. Kittang A.O. et al. Oncoimmunology 2016

Citation Format: Corrado Carrisi, Daniela Bellarosa, Diego Bisignano, Adriano Venditti, Francesco Buccisano, Giuseppe Sconocchia, Andrea Coppola, Anna Aureli, Alessio Fiascarelli, Alessandro Bressan, Simone Baldini, Andrea Pellacani, Monica Binaschi. MEN1112/OBT357, a first-in-class humanized de-fucosylated monoclonal antibody targeting CD157 positive cells in acute myeloid leukemia and myelodysplastic syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1170.

Abstract PS18-26: Men1611 promotes immune activating myeloid cell polarization

MEN1611 is a PI3K inhibitor currently in clinical development targeting the p110 α, β and γ isoforms, while sparing the δ subunit. In preclinical models, MEN1611 has demonstrated a long lasting antitumor activity when combined with trastuzumab in HER2+/PiK3CA mutated breast cancer. Aim of this work is to characterize the effects of MEN1611 on the PI3Kγ isoform, highly expressed in tumor-associated macrophages (TAMs), in order to understand whether the anti-tumor activity of MEN1611 might be also mediated by the inflammatory microenvironment. Previous evidences have shown that selective targeting of PI3Kγ by IPI-549 can reshape the inflammatory cells infiltrating tumors towards a less immunosuppressive phenotype and promote cytotoxic T cell-mediated tumor regression. In order to evaluate the effect of MEN1611 on TAMs, we established an in vitro model by differentiating murine and human macrophages from bone marrow-derived monocytes or buffy coats-isolated monocytes respectively. Pro-inflammatory M1 macrophages have been differentiated by treatment with Lipopolysaccharide (LPS) and interferon γ (IFNγ), while pro-tumoral M2 macrophages by interleukin 4 (IL-4) stimulation. The cells, thus obtained, have been incubated with MEN1611 or IPI-549 (positive control) and the effects on their phenotype, gene and protein expression, evaluated through confocal microscopy, RNASeq and flow cytometry respectively. A syngeneic xenograft model of breast cancer based on 4T1 cells has been also established in order to investigate in vivo the activity of MEN1611 on the inflammatory environment (TAMs and T cells). In vitro data showed MEN1611 and IPI-549 ability to repolarize murine and human macrophages towards a pro-inflammatory phenotype. Confocal analysis revealed a shape remodeling from an elongated M2-like towards a round M1-like; gene and protein expression analysis revealed a significant increase of immuno-stimulating factors mRNA and M1 chemokines and cytokines secretion, respectively. A modulation of the inflammatory infiltrate was also observed in vivo where RNASeq and flow cytometry analysis on dissociated treated tumors highlighted an increase of pro-inflammatory markers. The in-silico ingenuity pathway analysis (IPA) performed on genes modulated by MEN1611 revealed the enhancement of some processes related to an immune activating switch, such as the recruitment of myeloid cells or the cytotoxicity of lymphocytes and natural killer cells. In conclusion, we demonstrated in a cellular context that MEN1611 activity on PI3Kγ isoform is responsible for macrophages reprogramming from an immune-suppressive to an immune-activating phenotype. Moreover, we observed that in 4T1 murine breast cancer model, tumor regression induced by MEN1611 was also sustained by a modulation of the inflammatory microenvironment, characterized by an increased recruitment and cytotoxicity of T cells.

Citation Format: Stefania Capano, Alessandro Paoli, Alessio Fiascarelli, Andrea Massimiliano Tomirotti, Mario Bigioni, Alessandro Bressan, Daniela Bellarosa, Massimiliano Salerno, Monica Binaschi. Men1611 promotes immune activating myeloid cell polarization [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-26.

Targeting CD205 with the antibody drug conjugate MEN1309/OBT076 is an active new therapeutic strategy in lymphoma models

Antibody drug conjugates represent an important class of anti-cancer drugs in both solid tumors and hematological cancers. Here, we report preclinical data on the anti-tumor activity of the first-in-class antibody drug conjugate MEN1309/OBT076 targeting CD205. The study included preclinical in vitro activity screening on a large panel of cell lines, both as single agent and in combination and validation experiments on in vivo models. CD205 was first shown frequently expressed in lymphomas, leukemias and multiple myeloma by immunohistochemistry on tissue microarrays. Anti-tumor activity of MEN1309/OBT076 as single agent was then shown across 42 B-cell lymphoma cell lines with a median IC50 of 200 pM and induction of apoptosis in 25/42 (59.5%) of the cases. The activity appeared highly correlated with its target expression. After in vivo validation as the single agent, the antibody drug conjugate synergized with the BCL2 inhibitor venetoclax, and the anti-CD20 monoclonal antibody rituximab. The first-in-class antibody drug targeting CD205, MEN1309/OBT076, demonstrated strong pre-clinical anti-tumor activity in lymphoma, warranting further investigations as a single agent and in combination.

COVID-19, aftermath, impacts, and hospitality firms: An international perspective

Drawing on the theory of resilience, and on an international sample of 45 predominantly small hospitality businesses, this exploratory study extends knowledge about the key concerns, ways of coping, and the changes and adjustments undertaken by these firms' owners and managers during the COVID-19 outbreak. The various emergent relationships between the findings and the considered conceptual underpinnings of the literature on resilience, revealed nine theoretical dimensions. These dimensions critically illuminate and extend understanding concerning the actions and alternatives owners-managers resorted to when confronted with an extreme context. For instance, with financial impacts and uncertainty being predominant issues among participants, over one-third indicated actioning alternative measures to create much-needed revenue streams, and preparing for a new post-COVID-19 operational regime, respectively. Furthermore, 60 percent recognised making changes to the day-to-day running of the business to respond to initial impacts, or biding time in anticipation of a changing business and legal environment.

In vitro activity of fosfomycin against mucoid and non-mucoid Pseudomonas aeruginosa strains

OBJECTIVES

Pseudomonas aeruginosa is the most frequent infectious agent in cystic fibrosis patients. P. aeruginosa resistance to first line antibiotics limits therapeutic options, but the therapeutic potential of older generation antibiotics, such as fosfomycin is under investigation. Fosfomycin does not belong to any other antibiotic class and acts by inhibiting the biosynthesis of the bacterial cell wall during the initial phases. A major problem for the use of fosfomycin against P. aeruginosa is the absence of a clinical breakpoint, the last one of 32 μg/mL was proposed in 2013 by the CA-SFM (Comité de l'Antibiogramme de la Société Française de Microbiologie).

METHODS

Sixty-one strains of P. aeruginosa (thirty mucoid and thirty-one non mucoid) were collected from respiratory samples of cystic fibrosis patients. All isolates were identified by MALDI-TOF (Bruker, Bremen, Germany). Fosfomycin MICs against P. aeruginosa were measured using an automated system and confirmed by the gold standard method.

RESULTS

There was no significant difference between mucoid and non-mucoid strains. MIC distribution and susceptibility rates were obtained by agar dilution method and from this data we measured MIC50 and MIC90 which were equal to 32 μg/mL and 64 μg/mL, respectively. From automated method results we measured a very major error (VME), major error (ME) and categorical agreement (CA) which were equal to 0%, 11% and 89%, respectively. Comparing automated and agar dilution methods, a Cohen's kappa equal to 73% (0.726) was measured.

CONCLUSIONS

Our data suggest that fosfomycin has good effect against mucoid and non-mucoid strains of P. aeruginosa and automated systems can be implemented in clinical microbiology laboratories to assess fosfomycin with rapid and reproducible results.

MEN1309/OBT076, a First-In-Class Antibody-Drug Conjugate Targeting CD205 in Solid Tumors

CD205 is a type I transmembrane glycoprotein and is a member of the C-type lectin receptor family. Analysis by mass spectrometry revealed that CD205 was robustly expressed and highly prevalent in a variety of solid malignancies from different histotypes. IHC confirmed the increased expression of CD205 in pancreatic, bladder, and triple-negative breast cancer (TNBC) compared with that in the corresponding normal tissues. Using immunofluorescence microscopy, rapid internalization of the CD205 antigen was observed. These results supported the development of MEN1309/OBT076, a fully humanized CD205-targeting mAb conjugated to DM4, a potent maytansinoid derivate, via a cleavable N-succinimidyl-4-(2-pyridyldithio) butanoate linker. MEN1309/OBT076 was characterized in vitro for target binding affinity, mechanism of action, and cytotoxic activity against a panel of cancer cell lines. MEN1309/OBT076 displayed selective and potent cytotoxic effects against tumor cells exhibiting strong and low to moderate CD205 expression. In vivo, MEN1309/OBT076 showed potent antitumor activity resulting in durable responses and complete tumor regressions in many TNBC, pancreatic, and bladder cancer cell line-derived and patient-derived xenograft models, independent of antigen expression levels. Finally, the pharmacokinetics and pharmacodynamic profile of MEN1309/OBT076 was characterized in pancreatic tumor-bearing mice, demonstrating that the serum level of antibody-drug conjugate (ADC) achieved through dosing was consistent with the kinetics of its antitumor activity. Overall, our data demonstrate that MEN1309/OBT076 is a novel and selective ADC with potent activity against CD205-positive tumors. These data supported the clinical development of MEN1309/OBT076, and further evaluation of this ADC is currently ongoing in the first-in-human SHUTTLE clinical trial.

Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease

AIM

The aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered.

METHOD

Patients' characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow-up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period.

RESULTS

Histological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4-575.5).

CONCLUSION

Anastomotic stenosis is a frequent, long-term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.

Abstract 2160: MEN1611, a novel α-selective PI3K inhibitor in solid tumors

The PI3K pathway regulates various cellular processes such as proliferation, growth, apoptosis and cytoskeletal rearrangement. This pathway is frequently de-regulated and considered an oncogenic driver in human cancer. In most solid tumors, the activation of the PI3K pathway is induced by mutations of the catalytic subunit PI3Kα, present in approximately 20% to 50% of breast cancer, 14% of colorectal cancer and in 5-10% of NSCLC. Besides being an actionable target, the PI3K pathway is implicated in de novo and acquired treatment resistant in various tumor types treated with targeted therapy. As a matter of fact, the most interesting antitumor activity with PI3K inhibitors has been observed in combination. Here, we present MEN1611 (previously PA799), a PI3-kinase inhibitor with a peculiar biochemical profile targeting with high inhibition potency the mutated forms of PI3Kα and PI3Kγ. In the current study we demonstrate the anticancer activity and the pharmacodynamic effects of MEN1611 as monotherapy or in combination with targeted therapies in both xenograft and PDX models of breast cancer and in colorectal cancer and in NSCLC models, all with defined genetic profiles. MEN1611, at a clinically relevant dose, showed good antitumor activity in combination with targeted therapy agents against breast cancer, colorectal cancer and NSCLC models bearing PI3Kα mutations. A reduced activity was instead observed when the tumor models were wild type for PI3Kα or had low levels of PTEN. The antitumor activity of MEN611 was supported by its pharmacodynamic activity. In all the models, both AKT and S6 phosphorylation, markers of PI3K inhibition, were significantly inhibited upon treatment. In agreement with the biochemical profile of the drug, in PTEN null xenograft models where the tumor driver is the PI3K β-isoform, we observed lower effects in term of antitumor activity and of molecular inhibition of the pathway. Last, MEN1611 induction of hyperglycemia and insulin release was studied in the tumor models at clinical relevant dose as a marker of class-effect toxicity. MEN1611 showed significant antitumor activity in combination with other targeted therapies in breast, colon and NSCL cancer PI3Kα mutant models. Our results support the evidence that MEN611 is a PI3Kα specific inhibitor and provided the basis for the planned phase IB/II.

Citation Format: Giuseppe Merlino, Alessio Fiascarelli, Mario Bigioni, Alessandro Bressan, Clelia Irrissuto, Andrea Pellacani, Maurizio Scaltriti, Monica Binaschi. MEN1611, a novel α-selective PI3K inhibitor in solid tumors [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 2160.

Abstract 2145: The role of MEN1611, a class I PI3-kinases (PI3Ks) inhibitor, in reprogramming the pro-tumoral inflammatory environment

MEN1611 (previously PA799) is a specific PI3Ks inhibitor with peculiar biochemical profile: it targets at the highest potency the mutated PI3Kα isoforms and the PI3Kγ isoform. PI3Kγ isoform is abundantly expressed in myeloid cells but not in cancer cells and promotes myeloid cell trafficking during inflammation and cancer. Previous studies have shown that selective inactivation of macrophage PI3Kγ is able to promote an immunostimulatory transcriptional program that restores CD8+ T cell activation and cytotoxicity. Based on these evidences, we sought to investigate whether the anti-tumoral activity of MEN1611, that has been demonstrated especially in tumors harboring PI3Kα mutations, should be mediated also by inflammatory cells. To this aim we have set up an in vitro model in order to study macrophages polarization: in the presence of colony stimulating factor, mouse bone marrow-derived monocytes were directed into M0 macrophages differentiation, followed by M1 (by lipopolysaccharides and interferon γ) or M2 stimulation (by interleukin 4). Potential changes in macrophage phenotype induced by MEN1611 were measured by quantitative RT-qPCR and mouse cytokine antibody array. Moreover in order to evaluate in vivo the immune modulatory capacity of MEN1611 two syngeneic tumor models were established: 4T1 breast tumor model and CT26.wt colorectal tumor model. M1 or M2 polarized macrophages displayed different cell morphologies: M2 cells exhibited an higher degree of elongation compared with M1 or unstimulated M0 cells. Their activation status was tracked and confirmed by gene expression analysis, enzymatic assays (iNOS and arginase activity) and cytokine array. MEN1611 treatment was able to revert M2 cell morphology towards an M1-like round cell shape. Analysis of gene expression in MEN1611-treated macrophages showed a significant increase of immunostimulating factors mRNAs, such as IL-1b, IL-12b and iNOS, in M2 macrophages. MEN1611 also enhanced the secretion of pro-inflammatory cytokines both in M1 and M2 macrophages. In syngeneic mouse models, immune cell subsets were characterized via flow cytometry: both 4T1 and CT26.wt tumors had a similar baseline relative amount of M1 and M2 macrophages and were characterized by CD4+ and CD8+ T cells infiltrates. The impact of MEN1611 treatment on macrophages and T lymphocytes subsets infiltrating tumors is currently studied. In conclusion, we have demonstrated the ability of MEN1611 to modulate macrophage polarization towards an immune-activating phenotype at clinically relevant doses. These findings might suggest the involvement of PI3Kγ as part of MEN1611 mechanism of action.

Citation Format: Stefania Capano, Alessio Fiascarelli, Andrea M Tomirotti, Mario Bigioni, Alessandro Bressan, Daniela Bellarosa, Andrea Pellacani, Monica Binaschi. The role of MEN1611, a class I PI3-kinases (PI3Ks) inhibitor, in reprogramming the pro-tumoral inflammatory environment [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 2145.

Status of COMPASS RICH-1 Upgrade with MPGD-based Photon Detectors

A Set of new MPGD-based Photon Detectors is being built for the upgrade of COMPASS RICH-1. The detectors cover a total active area of 1.4 m2 and are based on a hybrid architecture consisting of two THGEM layers and a Micromegas. A CsI film on one THGEM acts as a reflective photocathode. The characteristics of the detector, the production of the components and their validation tests are described in detail.

First Measurement of Transverse-Spin-Dependent Azimuthal Asymmetries in the Drell-Yan Process

The first measurement of transverse-spin-dependent azimuthal asymmetries in the pion-induced Drell-Yan (DY) process is reported. We use the CERN SPS 190  GeV/c π^{-} beam and a transversely polarized ammonia target. Three azimuthal asymmetries giving access to different transverse-momentum-dependent (TMD) parton distribution functions (PDFs) are extracted using dimuon events with invariant mass between 4.3  GeV/c^{2} and 8.5  GeV/c^{2}. Within the experimental uncertainties, the observed sign of the Sivers asymmetry is found to be consistent with the fundamental prediction of quantum chromodynamics (QCD) that the Sivers TMD PDFs extracted from DY have a sign opposite to the one extracted from semi-inclusive deep-inelastic scattering (SIDIS) data. We present two other asymmetries originating from the pion Boer-Mulders TMD PDFs convoluted with either the nucleon transversity or pretzelosity TMD PDFs. A recent COMPASS SIDIS measurement was obtained at a hard scale comparable to that of these DY results. This opens the way for possible tests of fundamental QCD universality predictions.

Abstract 3646: Characterization of the novel antibody drug conjugate MEN1309 and its target antigen Ly75

Ly75 (CD205, DEC-205) is a type I transmembrane glycoprotein and a C-type lectin receptor involved in antigen uptake and processing, mainly expressed by antigen presenting cells (APC). The short cytoplasmic tail contains motifs for amino acid-based endocytosis, making this receptor an ideal target antigen for an antibody drug conjugate (ADC)-based antitumoral therapy. MEN1309 is a novel fully humanized ADC which binds to Ly75 with high affinity as shown by ELISA and FACS analysis. The antibody is conjugated to a maytansinoid DM4, a potent tubulin inhibitor, through a cleavable linker.The ability of Ly75 to internalize the antibody after binding was determined using an immunoflourescence assay that showed a rapid, efficient, and near complete internalization over a one hour time course.The expression of Ly75 mRNA and protein was investigated in human cancer cell lines derived from different histotypes and revealed high expression in pancreas, bladder, triple negative breast cancer (TNBC) cells and in diffuse large B-cell lymphoma (DLBCL). Indeed, MEN1309 shows a powerful (pM range) in vitro cytotoxic activity on different cancer cell lines expressing Ly75, whereas it exerts a weaker effect on antigen-negative cells. Besides the mechanism of action (MoA) of MEN1309 as an ADC, the putative efficacy of the antibody to drive an ADCC response was investigated through in vitro binding and functional assays. In spite of a high binding affinity of MEN1309 to FcγRIIIa, no ADCC response was observed, suggesting that the high internalization rate of the antigen could hamper the triggering of NK responses.Moreover, in order to characterize the functional role of Ly75 in cancer cell lines, its expression was downregulated by siRNA demonstrating an inhibition of the proliferation rate in cells from different histotypes.Finally, we investigated if some cancer cell lines could show a higher expression of two intergenically spliced forms derived from Ly75 and DCL-1 genes recently reported in literature. We found that the intergenically spliced forms were expressed on average 30 fold less than CD205 mRNA in all the cancer cell lines analyzed, suggesting that these variants derive just from an intergenic readthrough without a specific transcriptional regulation.

Citation Format: Alessandro Bressan, Alessio Fiascarelli, Giuseppe Merlino, Corrado Carrisi, Daniela Bellarosa, Rachel Dusek, Rahel Awdew, Sudha Swaminathan, Arnima Bisht, To Uyen T. Do, San Lin Lou, Dee Aud, Jonathan Terrett, Keith Wilson, Christian Rohlff, Monica Binaschi. Characterization of the novel antibody drug conjugate MEN1309 and its target antigen Ly75 [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 3646. doi:10.1158/1538-7445.AM2017-3646

Potential role of bioavailable curcumin in weight loss and omental adipose tissue decrease: preliminary data of a randomized, controlled trial in overweight people with metabolic syndrome. Preliminary study

OBJECTIVE

This randomized, controlled study aims to evaluate the tolerability and the efficacy of curcumin in overweight subjects affected from metabolic syndrome, with a focus on impaired glucose intolerance and android-type fat accumulation.

PATIENTS AND METHODS

Forty-four subjects, selected among those who after 30 days of diet and intervention lifestyle have shown a weight loss < 2%, have been treated for further 30 days either with curcumin complexed with phosphatidylserine in phytosome form or with pure phosphatidylserine. Outcomes concerning anthropometric measurements and body composition were analyzed at enrollment and after 30 and 60 days.

RESULTS

Curcumin administration increased weight loss from 1.88 to 4.91%, enhanced percentage reduction of body fat (from 0.70 to 8.43%), increased waistline reduction (from 2.36 to 4.14%), improved hip circumference reduction from 0.74 to 2.51% and enhanced reduction of BMI (from 2.10 to 6.43%) (p < 0.01 for all comparisons). Phosphatidylserine did not show any statistical significant effect. Tolerability was very good for both treatments, and no drop-out was reported.

CONCLUSIONS

Although preliminary, our findings suggest that a bioavailable form of curcumin is well-tolerated and can positively influence weight management in overweight people.

Observation of a New Narrow Axial-Vector Meson a1(1420)

The COMPASS Collaboration at CERN has measured diffractive dissociation of 190  GeV/c pions into the π(-)π(-)π(+) final state using a stationary hydrogen target. A partial-wave analysis (PWA) was performed in bins of 3π mass and four-momentum transfer using the isobar model and the so far largest PWA model consisting of 88 waves. A narrow peak is observed in the f0(980)π channel with spin, parity and C-parity quantum numbers J(PC)=1(++). We present a resonance-model study of a subset of the spin-density matrix selecting 3π states with J(PC)=2(++) and 4(++) decaying into ρ(770)π and with J(PC)=1(++) decaying into f0(980)π. We identify a new a1 meson with mass (1414(-13)(+15))  MeV/c2 and width (153(-23)(+8))  MeV/c2. Within the final states investigated in our analysis, we observe the new a1(1420) decaying only into f0(980)π, suggesting its exotic nature.

Pattern of association between endemic Hawaiian fruit flies (Diptera, Tephritidae) and their symbiotic bacteria: Evidence of cospeciation events and proposal of "Candidatus Stammerula trupaneae"

Several insect lineages have evolved mutualistic association with symbiotic bacteria. This is the case of some species of mealybugs, whiteflies, weevils, tsetse flies, cockroaches, termites, carpenter ants, aphids and fruit flies. Some species of Tephritinae, the most specialized subfamily of fruit flies (Diptera: Tephritidae), harbour co-evolved vertically transmitted, bacterial symbionts in their midgut, known as "Candidatus Stammerula spp.". The 25 described endemic species of Hawaiian tephritids, plus at least three undescribed species, are taxonomically distributed among three genera: the cosmopolitan genus Trupanea (21 described spp.), the endemic genus Phaeogramma (2 spp.) and the Nearctic genus Neotephritis (2 spp.). We examined the presence of symbiotic bacteria in the endemic tephritids of the Hawaiian Islands, which represent a spectacular example of adaptive radiation, and tested the concordant evolution between host and symbiont phylogenies. We detected through PCR assays the presence of specific symbiotic bacteria, designated as "Candidatus Stammerula trupaneae", from 35 individuals of 15 species. The phylogeny of the insect host was reconstructed based on two regions of the mitochondrial DNA (16S rDNA and COI-tRNALeu-COII), while the bacterial 16S rRNA was used for the symbiont analysis. Host and symbiont phylogenies were then compared and evaluated for patterns of cophylogeny and strict cospeciation. Topological congruence between Hawaiian Tephritinae and their symbiotic bacteria phylogenies suggests a limited, but significant degree of host-symbiont cospeciation. We also explored the character reconstruction of three host traits, as island location, host lineage, and host tissue attacked, based on the symbiont phylogenies under the hypothesis of cospeciation.

Measurement of the charged-pion polarizability

The COMPASS collaboration at CERN has investigated pion Compton scattering, π(-)γ→π(-)γ, at center-of-mass energy below 3.5 pion masses. The process is embedded in the reaction π(-)Ni→π(-)γNi, which is initiated by 190 GeV pions impinging on a nickel target. The exchange of quasireal photons is selected by isolating the sharp Coulomb peak observed at smallest momentum transfers, Q(2)<0.0015  (GeV/c)(2). From a sample of 63,000 events, the pion electric polarizability is determined to be α(π)=(2.0±0.6(stat)±0.7(syst))×10(-4)  fm(3) under the assumption α(π)=-β(π), which relates the electric and magnetic dipole polarizabilities. It is the most precise measurement of this fundamental low-energy parameter of strong interaction that has been addressed since long by various methods with conflicting outcomes. While this result is in tension with previous dedicated measurements, it is found in agreement with the expectation from chiral perturbation theory. An additional measurement replacing pions by muons, for which the cross-section behavior is unambiguously known, was performed for an independent estimate of the systematic uncertainty.

Infection rates and comparative population dynamics of Peregrinus maidis (Hemiptera: Delphacidae) on corn plants with and without symptoms of maize mosaic virus (Rhabdoviridae: Nucleorhabdovirus) infection

We examined the population dynamics of the corn planthopper Peregrinus maidis (Ashmead) (Hemiptera: Delphacidae) throughout a cycle of corn (Zea mays L.) production on plants with or without symptoms of maize mosaic virus (MMV) (Rhabdoviridae: Nucleorhabdovirus) infection. Our results indicate that the timing of MMV plant infection greatly influenced the planthopper's host plant colonization patterns. Corn plants that expressed symptoms of MMV infection early in the crop cycle (28 d after planting) harbored, on average, 40 and 48% fewer planthoppers than plants that expressed symptoms of MMV infection later in the crop cycle (49 d after planting) and asymptomatic plants, respectively. We also observed a change in the number of brachypterous (short-wing type) and macropterous (long-wing type) winged forms produced; plants expressing early symptoms of MMV infection harbored, on average, 41 and 47% more of the brachypterous form than plants with late infections of MMV and plants with no symptoms of MMV, respectively. Furthermore, we determined the rates of MMV-infected planthoppers relative to their wing morphology (macropterous or brachypterous) and gender. MMV infection was 5 and 12% higher in females than in males in field and greenhouse experiments, respectively; however, these differences were not significantly different. This research provides evidence that MMV similarly infects P. maidis planthoppers regardless of the gender and wing morphotype. These results also suggest that the timing of symptom development greatly affects the population dynamics of the planthopper vector, and likely has important consequences for the dynamics of the disease in the field.

OC125, M11 and OV197 epitopes are not uniformly distributed in the tandem-repeat region of CA125 and require the entire SEA domain

The human cancer antigen 125 (CA125) is over-expressed in epithelial ovarian cancer cells and it plays a role in the pathogenesis of ovarian cancer. This protein presents a repeat region containing up to sixty tandem repeat units. The anti-CA125 monoclonal antibodies have been previously classified into three groups: two major families, the OC125-like antibodies and M11-like antibodies, and a third group, the OV197-like antibodies. A model in which a single repeat unit contains all the epitopes for these antibodies has been also proposed, even if their exact position is still undetermined. In the present work, the affinities of the monoclonal antibodies, representative of the three families, have been investigated for different CA125-recombinant repeats through Western blot analysis. Different patterns of antibody recognition for the recombinant repeats show that CA125 epitopes are not uniformly distributed in the tandem repeat region of the protein. The minimal region for the recognition of these antibodies has been also individuated in the SEA domain through the subcloning of deleted sequences of the highly recognized repeat-25 (R-25), their expression as recombinant fragments in E. coli and Western blot analysis. Obtained data have been further confirmed by ELISA using the entire R-25 as coating antigen.

Influence of the corn resistance gene Mv on the fitness of Peregrinus maidis (Hemiptera: Delphacidae) and on the transmission of maize mosaic virus (Rhabdoviridae: Nucleorhabdovirus)

Crops that are resistant to pests and pathogens are cost-effective for the management of pests and diseases. A corn (Zea mays L.) breeding program conducted in Hawaii has identified a source of heritable resistance to maize mosaic virus (MMV) (Rhabdoviridae: Nucleorhabdovirus). This resistance is controlled by the gene Mv, which has been shown to have a codominant action. To date, no studies have examined whether the resistance associated with this gene affects only MMV or whether it also affects the insect vector, the corn planthopper Peregrinus maidis (Ashmead) (Hemiptera: Delphacidae). Here, we examined the life history of the corn planthopper and its ability to transmit MMV on near isogenic lines that were homozygous dominant (Mv/Mv), homozygous recessive (mv/mv), or heterozygous (Mv/mv) for the gene. A field trial was also conducted to study the colonization of the corn plants with different genotypes by the planthopper. Although field observations revealed slightly lower densities ofplanthoppers on corn with the genotype Mv/Mv than on the inbreds with the genotype mv/mv and their hybrids with the genotype Mv/mv, laboratory assays showed no effects of the gene on planthopper development, longevity, or fecundity. In the field, the corn lines Mv/Mv had a lower incidence of MMV-infected plants. However, in the greenhouse, the transmission of MMV to corn seedlings did not differ across the near isogenic lines, although the corn lines Mv/Mv showed a delayed onset of symptoms compared with the corn lines mv/mv and Mv/mv. The acquisition of MMV by corn planthoppers on the corn genotypes Mv/Mv and Mv/mv averaged 0.2, whereas the acquisition on the corn genotypes mv/mv averaged > 0.3. Our results show that the Mv gene does not influence the fitness of the planthopper vector, suggesting that it may confer resistance by other means, possibly by limiting virus replication or movement within the host plant.

Dissecting the mode of maize chlorotic mottle virus transmission (Tombusviridae: Machlomovirus) by Frankliniella williamsi (Thysanoptera: Thripidae)

Maize chlorotic mottle virus (MCMV) (Tombusviridae: Machlomovirus) has been recorded in Hawaii (Kauai Island) since the early 1990s and has since become one of the most widespread corn viruses in the Hawaiian Islands. In the United States Mainland, MCMV has been reported to be transmitted by six different species of chrysomelid beetles, including the western corn rootworm, Diabrotica virgifera virgifera LeConte. However, none of these beetle species have been reported in Hawaii where the corn thrips, Frankliniella williamsi Hood (Thysanoptera: Thripidae) has been identified to be the main vector. In this study, we developed leaf disk transmission assays and real time reverse transcription-polymerase chain reaction to examine the mode of MCMV transmission by the corn thrips. We showed that thrips transmitted the virus with no evidence for latent periods. Both larvae and adults transmitted the virus for up to 6 d after acquisition, with decreasing rates of transmission as time progressed. There was no evidence that adult thrips that acquired the virus as larvae were competent vectors. Real time reverse-transcription polomerase chain reaction assays showed that viral load was depleted from the vector's body after thrips had access to healthy plant tissue. Depletion of viral load was also observed when thrips matured from larvae to adults. Thrips were able to transmit MCMV after acquisition and inoculation access periods of 3 h. However, transmission efficiency increased with longer acquisition and inoculation access periods. Taken altogether our data suggests that corn thrips transmit MCMV in a semipersistent manner. To our knowledge, this is the first work reporting evidence of a plant virus transmitted semipersistently by thrips.

SAHA/Vorinostat induces the expression of the CD137 receptor/ligand system and enhances apoptosis mediated by soluble CD137 receptor in a human breast cancer cell line

HDAC inhibitors (HDACis) represent a class of anticancer agents including suberoylanilide hydroxamic acid (SAHA, Vorinostat), which has shown a strong antitumor effect, both in vitro and in vivo. Induction of apoptotic genes is an important pathway of SAHA cytotoxic mechanism of action and it has been largely described that SAHA induces sensitization of cell death receptor-resistant breast cancer cells to apoptosis. In this study, we investigated the activation of some apoptotic genes which could be responsible for the in vivo antitumor potency of SAHA in a model of human breast cancer. We found that the apoptotic gene pattern induced by SAHA in the MDA-MB-231 cell line involves the upregulation of some molecules belonging to the TNF superfamily. In particular, we demonstrated that the upregulation of the CD137 receptor/ligand system correlates with a synergistic cytotoxic effect when MDA-MB-231 cells are treated with the combination of SAHA and soluble CD137 receptor. To our knowledge, this is the first study to indicate that this member of the TNF superfamily, CD137, is modulated by SAHA treatment in breast cancer cells, suggesting that the combination of SAHA with this TNF-related receptor could be a new therapeutic approach for the treatment of tumors.

First measurement of chiral dynamics in π- γ → π- π- π+

The COMPASS Collaboration at CERN has investigated the π- γ → π- π- π+ reaction at center-of-momentum energy below five pion masses, sqrt[s]<5m(π), embedded in the Primakoff reaction of 190 GeV pions impinging on a lead target. Exchange of quasireal photons is selected by isolating the sharp Coulomb peak observed at smallest momentum transfers, t'<0.001  GeV2/c2. Using partial-wave analysis techniques, the scattering intensity of Coulomb production described in terms of chiral dynamics and its dependence on the 3π-invariant mass m(3π)=sqrt[s] were extracted. The absolute cross section was determined in seven bins of sqrt[s] with an overall precision of 20%. At leading order, the result is found to be in good agreement with the prediction of chiral perturbation theory over the whole energy range investigated.

Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?

AIM

The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated.

METHOD

Patient characteristics, indications for surgery, surgical technique and postoperative complications were prospectively recorded. Stenosis was evaluated by rectoscopy at regular intervals, and patients were treated only if symptomatic. After at least 6 months following surgery, patients were asked to respond to the Short Form 36-item quality-of-life questionnaire during a telephone interview.

RESULTS

Of the original 211 patients considered, 195 underwent a follow-up rectoscopy and were included in the study. Benign stenosis were found in 26 (13%), and 19 (73%) symptomatic patients were treated successfully (15 with endoscopic dilatation and four with radial diathermic surgical incisions). Risk factors for anastomotic stenosis according to univariate analysis were female sex, diverticulitis, mechanical anastomosis, and anastomosis located between 8 and 12 cm from the anal verge. The significant risk factors identified by multivariate analysis were diverticulitis (OR 5, P=0.002) and mechanical anastomosis (OR 9, P=0.04). The self-perceived quality of life of patients with stenosis was significantly worse compared with controls.

CONCLUSION

Since diverticulitis and mechanical anastomosis are risk factors for anastomotic stenosis, surgeons should take this into account when they are considering what type of anastomotic technique to utilize.

The prevalence of 'Candidatus Arsenophonus phytopathogenicus' infecting the planthopper Pentastiridius leporinus (Hemiptera: Cixiidae) increase nonlinearly with the population abundance in sugar beet fields

The planthopper Pentastiridius leporinus (L.) (Hemiptera: Cixiidae) has been identified as the main vector of 'Candidatus Arsenophonus phytopathogenicus', a plant pathogenic bacterium associated to a sugar beet disease in eastern France called syndrome 'basses richesses'. In a 2-yr survey (2006-07), we quantified the abundance of P. leporinus populations migrating into 29 sugar beet fields in eastern France. Sticky traps posted in these fields were monitored on a twice-weekly (2006) or weekly (2007) basis. Subsets of the captured planthoppers were tested for the presence of Ca. A. phytopathogenicus through polymerase chain reaction (PCR). Our results showed that planthoppers colonized sugar beet fields in June and July of each year, following temporal patterns of migration that were fitted to logistic functions. The number of planthoppers migrating into sugar beet fields greatly varied among the fields and the years surveyed, averaging from a few (2-10) to over 400 planthoppers per trap. Interestingly, the prevalence of planthoppers infected by Ca. A. phytopathogenicus increased nonlinearly with the abundance of planthoppers captured on the traps. The proportion of infection for Ca. A. phytopathogenicus ranged from ≍0.07-1 (total infection) in small (2-10 planthoppers per trap) and large (400 planthoppers per trap) populations, respectively. We hypothesize that the outbreaks of P. leporinus in sugar beet fields, and the consequent increased rates of planthoppers infected by the Ca. A. phytopathogenicus, are key factors leading to the emergence of the sugar beet disease in eastern France.

Induction of a less aggressive phenotype in human colon carcinoma HCT116 cells by chronic exposure to HDAC inhibitor SAHA

Histone deacetylase inhibitors (HDACis) are anticancer molecules that epigenetically modulate cell functions. Chronic exposure of HCT116 colon cancer cells to SAHA has been investigated for a better understanding of resistance mechanisms but, surprisingly, a less aggressive tumor phenotype both in vitro and in vivo was obtained after exposure to increasing concentrations of SAHA. Indeed, HCT116/SAHA cells when injected into nude mice showed a reduced engraftment and growth with respect to HCT116 cells. This difference was not observed inoculating the cells into NOD/SCID mice that, differently from nude mice, lack NK activity, thus suggesting the involvement of the native immune response in impairment of HCT116/SAHA cell growth. In agreement with this result, a growing induction of NKG2D ligand expression, MICA and MICB, that are molecular mediators of NK cell killing, was confirmed in HCT116/SAHA chronically exposed to SAHA. A reduced clonogenic efficiency was also observed in HCT116/SAHA with respect to HCT116 cells. Interestingly, even after chronic exposure to SAHA, HCT116/SAHA cells developed only a moderate resistance to SAHA both in vitro and in vivo and they acquired a collateral sensitivity to anthracyclines. These results are of note and probably rely on the fact that, having simultaneously many different targets, HDACis would require many different mutations to display high resistance index. Moreover, to understand the molecular basis of HCT116/SAHA cell phenotype a gene expression profile of cancer genes was evaluated in HCT116 incubated with SAHA for 24 h and in HCT116/SAHA cells to identify selectively regulated genes.

Observation of a J(PC)=1-+ exotic resonance in diffractive dissociation of 190 GeV/c π- into π- π- π+

The COMPASS experiment at the CERN SPS has studied the diffractive dissociation of negative pions into the π- π- π+ final state using a 190  GeV/c pion beam hitting a lead target. A partial wave analysis has been performed on a sample of 420,000 events taken at values of the squared 4-momentum transfer t' between 0.1 and 1  GeV2/c2. The well-known resonances a1(1260), a2(1320), and π2(1670) are clearly observed. In addition, the data show a significant natural-parity exchange production of a resonance with spin-exotic quantum numbers J(PC)=1-+ at 1.66  GeV/c2 decaying to ρπ. The resonant nature of this wave is evident from the mass-dependent phase differences to the J(PC)=2-+ and 1++ waves. From a mass-dependent fit a resonance mass of (1660±10(-64)(+0))  MeV/c2 and a width of (269±21(-64)(+42))  MeV/c2 are deduced, with an intensity of (1.7±0.2)% of the total intensity.

Antitumor activity of delimotecan against human metastatic melanoma: pharmacokinetics and molecular determinants

Delimotecan (MEN 4901/T-0128) is a new cytotoxic prodrug constituted by a camptothecin analog (T-2513) bound to carboxymethyl dextran through a triglycine linker. A significant antitumor activity of delimotecan against human metastatic melanoma xenograft model Me15392 is reported. Dacarbazine, the drug approved for the treatment of metastatic melanoma, was ineffective in this melanoma model. Pharmacokinetic studies, together with the expression analysis of mRNA for enzymes involved in delimotecan metabolism, showed that T-2513 and other cytotoxic metabolites of delimotecan (SN 38 and T-0055) are generated in greater quantities in the tumor tissue than in toxicity target tissues, such as liver, thus accounting for the antitumoral activity. Moreover, we demonstrated that human metastatic melanoma cells are able to phagocytose delimotecan and cleave it to release the cytotoxic moieties T-2513 in the tumoral environment. Further flow cytometric analysis showed a higher recruitment of macrophages in xenografted human metastatic melanoma, when compared with other human tumors. Thus, the antitumoral activity of delimotecan exerted on metastatic melanoma is due to several factors: (i) the ability of melanoma cells to phagocytose and metabolise delimotecan; (ii) the accumulation of delimotecan in tumoral mass; (iii) the recruitment of macrophage cells to the melanoma nodule and (iv) the expression in melanoma cells of a pattern of enzymes that converts delimotecan into cytotoxic metabolites. Based on these results, delimotecan might be exploited as a new anticancer agent for the therapy of metastatic melanoma because of its high efficacy and good selectivity, and therefore clinical trials for this indication are warranted.

[Tuberculosis risk assessment in Italian healthcare centres]

BACKGROUND

Tuberculosis transmission is a significant hazard in healthcare settings.

METHODS

Risk factors suggested by CDC guidelines in 1994, which were adopted by the Italian Ministry of Health, were assessed in 29 centres via questionnaires in 2005.

RESULTS

Few centers were equipped with negative pressure, respiratory isolation rooms. Half of the centres had high or ongoing risk.

CONCLUSIONS

The hazard is underestimated mostly because of a high number of initially undiagnosed TB patients.