Regulator of telomere length 1 (RTEL1) mutations are associated with heterogeneous pulmonary and extra-pulmonary phenotypes

Regulator of telomere length 1 (RTEL1) mutations have been evidenced in 5-9% of familial pulmonary fibrosis; however, the phenotype of patients with interstitial lung disease (ILD) and RTEL1 mutations is poorly understood.Whole exome sequencing was performed in 252 probands with ILD and we included all patients with ILD and RTEL1 mutation. RTEL1 expression was evaluated by immunochemistry in the lungs of controls, as well as in RTEL1 and telomerase reverse transcriptase (TERT) mutation carriers.We identified 35 subjects from 17 families. Median age at diagnosis of ILD was 53.1 years (range 28.0-80.6). The most frequent pulmonary diagnoses were idiopathic pulmonary fibrosis (n=20, 57%), secondary ILD (n=7, 20%) and unclassifiable fibrosis or interstitial pneumonia with autoimmune features (n=7, 20%). The median transplant-free and overall survival periods were 39.2 months and 45.3 months, respectively. Forced vital capacity at diagnosis was the only factor associated with decreased transplant-free survival. Extra-pulmonary manifestations were less frequent as compared to other telomere-related gene mutation carriers. A systematic analysis of the literature identified 110 patients with ILD and RTEL1 mutations (including this series) and confirmed the heterogeneity of the pulmonary phenotype, the prevalence of non-idiopathic diseases and the low prevalence of extra-pulmonary manifestations.Immunohistochemistry showed that RTEL1 was expressed by bronchial and alveolar epithelial cells, as well as by alveolar macrophages and lymphocytes, but not by fibroblasts.

Chromatin texture changes related to proliferation and maturation in erythrocytes

Erythroid cell types were quantitatively assessed on the basis of the analysis of their nuclear images after Feulgen and Heidenhain blue counterstaining. An original nonsupervised classification method, developed in our laboratory, was applied to cell cycle analysis. Results obtained suggest that, in the four proliferative generation cycles, which concur with the successive morphological stages, there is a sequential flow of cells from one morphological stage to the next by cell cycling. We show that the chromatin pattern alone made it possible to set up a metric of the whole differentiation process occurring in the normal human erythroblastic lineage in which proliferating events occur.

[Adjuvant chemotherapy of non-small cell lung cancer: Tolerance of combined cisplatin-pemetrexed therapy]

RATIONALE

Adjuvant chemotherapy is standard for non-small cell lung cancer (NSCLC) after surgical resection. In this context, the tolerance of the treatment is an essential criterion in the choice of chemotherapy. This exploratory study evaluated, in the situation of adjuvant chemotherapy, the tolerance of combined cisplatin-pemetrexed. The study analyzed a cohort of non-squamous NSCLC patients treated in an adjuvant setting by combined cisplatin (75 mg/m(2)) and pemetrexed (500 mg/m(2)), under vitamin B12 and folic acid cover, 4 cycles at 21-day intervals.

RESULTS

The analysis included 23 patients (age: 58.7 ± 5 years, men: 56%, average creatinin clearance (Clea): 94 ± 22 mL/min, average haemoglobin: 13.8 ± 1.6g/dL). Over 92 planned courses, 7.6% are postponed (neutropenia), 4.3% were not given (asthenia). We noted 7 episodes of vomiting (4 grade 3), with two hospitalizations in the same patient; 5 episodes of anaemia grade 1-2 not requiring EPO prescription or transfusion and no febrile neutropenia. At the end of the treatment, three patients had a Clea<50 mL/mn and 5 a haemoglobin between 9 and 11 g/dL.

CONCLUSION

Combined cisplatin-pemetrexed in an adjuvant situation has a satisfactory tolerance.

A quantitative analysis of the human bone marrow granulocytic cell lineage using the SAMBA 200 cell image processor. I. The normal maturation sequence

A quantitative image analysis of the human normal bone marrow granulocytic line was performed using the SAMBA 200 image analyzer. The steps of image acquisition, preprocessing, segmentation and parametrization are described. Forty-one parameters were computed on 941 cell images belonging to the various maturation stages. The automated classification of these cells based upon a stepwise linear discriminant analysis resulted in 77% correctly classified cells; the five most discriminating parameters were the nuclear area, the nuclear convexity degree, the average cytoplasmic hue, the regularity of the nuclear boundary and the average cytoplasmic luminance. The evolution of the parameters correlates well with the cytologic evolution and the biochemical and functional events during the maturation process. It can be inferred from our results that the maturation sequence can be subdivided into two phases according to the evolution of the cell profiles. The first phase, from myeloblast to myelocyte, is discontinuous and appears as the critical point with regard to the expression of genes. The second phase, from myelocyte to polymorphonuclear cell, is a continuous sequence of transformations leading to the functional granulocyte.

A quantitative analysis of the human bone marrow granulocytic cell lineage using the SAMBA 200 cell image processor. II. The blast cells in refractory anemia with an excess of blasts

A quantitative image analysis of bone marrow blast cells from eight patients with refractory anemia with an excess of blast cells was performed using the SAMBA 200 cell image analyzer. A total of 33 parameters was computed on 665 cells visually classified as B1 blasts (agranular cells), B2 blasts (cells containing a few azurophilic granules) and B3 blasts (cells with numerous granules). The continuum of variation of some cytoplasmic parameters (area, hue and standard deviation of the luminance, hue and saturation histograms) and some nuclear parameters (area and convexity degree) from the B1 cells to the B3 cells indicated a concomitant cytoplasmic and nuclear maturation, with the B1 cells being the most immature. An attempt to automatically classify these cells using a stepwise linear discriminant analysis resulted in an average of 68% correctly classified cells at the fifth step. Among the B1 and B2 blast cells considered together, an unsupervised classification method distinguished seven subgroups of blasts, which were principally different in cytoplasmic area, cytoplasmic color and nuclear texture. The percentages of cells belonging to two of these subgroups were highly discriminatory with respect to the prognosis. These two cell types had morphologic, textural and color features that put them very near the normal immature myeloidlike progenitor cells and normal myeloblasts, as demonstrated by means of canonical analysis. All patients having a very low percentage of these two cells among their blast cells died from overt leukemia less than one year after the first diagnosis of their disease.

A quantitative analysis of the human bone marrow erythroblastic cell lineage using the SAMBA 200 cell image processor. I. The normal maturation sequence

A quantitative image analysis of the normal maturation sequence for the human bone marrow erythroblastic lineage was performed using the SAMBA 200 cell image processor. The different image analysis steps (image acquisition, preprocessing, segmentation, parametrization and data analysis) are briefly described. Thirty-three parameters related to geometry, color, texture and densitometry were computed on 638 cell images belonging to the five erythroblastic maturation stages. The automated classification of these cells, based upon a stepwise linear discriminant analysis, resulted in 80% correctly classified cells. Acceptance of confusions between successive maturation stages enhanced the rate of correctly classified cells to 100%. Among the ten most discriminating parameters, the nuclear area showed the highest correlation with the changes throughout the maturation process. The projection of the maturation sequence onto the factorial plane resulting from the canonical analysis emphasizes the existence of three phases of the maturation process, a finding that correlates well with the cytologic evolution and the biochemical and functional events during the maturation. The trajectory of cells within this factorial plane is thus regarded as a differentiation path from which a measure of the maturation could be derived.