Rapid ECMO Training for Nurses in Response to the COVID-19 Pandemic

Purpose

From March 17^th to April 29^th, our ECMO Program placed 30 adult patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) for management of coronavirus disease 2019 (COVID-19). This acute increase in volume placed a strain on our available ECMO-competent nursing staff. Although perfusionists function as our ECMO specialists, our critical care nurses provide continuous circuit monitoring and respond to emergencies. Because of the need to increase the number of ECMO-competent nurses, on March 27^th a focused, two-hour COVID-ECMO training course was implemented.

Methods

We retrospectively reviewed the number of ECMO care hours provided by our nursing staff and separated the nursing staff into two cohorts. Group A consisted of nurses who had undergone ECMO training prior to the pandemic (n=126). Group B consisted of nurses whose initial ECMO training occurred during the pandemic (N=145). We then compared the number of nursing hours provided by each cohort before and after training.

Results

From March 27^th to May 4^th, 145 nurses completed training, increasing our total number of ECMO-competent nurses from 126 to 271 (115% increase). From March 17^th to June 30^th, 20,677 ECMO care hours were provided. Pre-training, all 634 care hours were 100% provided by Group A nurses. Post-training, 20,043 care hours were provided, consisting of 39% Group A nursing coverage and 61% Group B nursing coverage. There were no differences in nursing related ECMO-emergencies between the two groups. At the conclusion of the surge, 28 out of 30 (93%) patients survived ECMO and 26 out of 29 patients (90%) survived to hospital discharge. One patient has a pending hospital disposition.

Conclusion

Rapid implementation of an abbreviated ECMO education program for nurses is feasible. It met the time-sensitive needs of the COVID-19 pandemic and provided safe nursing coverage to patients requiring ECMO.

In vitro assessment of the cytotoxic effects of secondary metabolites from Spirulina platensis on hepatocellular carcinoma

Background

Spirulina platensis, an edible cyanobacterium, is considered as a valuable and natural resource of novel anticancer agents. This study aimed to investigate the anticancer potential of major bioactive metabolites from Spirulina platensis on hepatocellular carcinoma cells. The total phenolic and alkaloid content of S. platensis were determined using spectrophotometric procedures and thin-layer chromatography. ‍‍Cellular viability of HepG2 cancer cells and normal fibroblasts was evaluated using MTT assay after 24 h treatment with 0.02–2 mg/ml of alkaloids, phenolic compounds, aqueous, and methanol extracts from Spirulina platensis.

Results

Total phenolic and total alkaloid compounds were 150.5 ± 1.18 mg gallic acid equivalents/mg extract and 11.4 ± 0.05 mg atropine equivalents/mg extract, respectively. All tested extracts and compounds demonstrated the inhibitory effect on the viability of HepG2 cells in a dose-dependent manner without cytotoxicity on normal cells. The most potent anticancer activity was induced by alkaloids (2 ± 0.001 mg/ml) with 80% reduction in cell viability and an IC50 of 0.53 ± 0.08 mg/ml. IC50 values of the aqueous extract, the methanolic extract, and phenolic compounds were 1.7 ± 0.14, 1.28 ± 0.22, and 0.86 ± 0.14 mg/ml, respectively.

Conclusions

This is the first report to demonstrate anticancer effects of alkaloids and phenolic compounds of Spirulina platensis in relation to liver cancer.

Abstract 5105: A novel metabolite from an extremophile Streptomyces with apoptosis regulator function

Apoptosis or programmed cell death is essential for the normal functioning and survival of most multi-cellular organisms. The morphological and biochemical characteristics of apoptosis are highly conserved during the evolution. Therapeutic strategies based on exogenous delivery of the native form of superoxide dismutase (SOD), a free radical scavenger, are limited because of its short half-life (approximately 6 min) in vivo and poor permeability across the blood barrier and cell membrane. In this study, the spectrum of in vivo anti cancer activity of a Streptomyces SOD with a carrier protein designated Kavir-48by apoptotic function was assessed. Two xenograft models including LXFl 529 and LXFL H460 lung cancer cells were used. Purified protein complex was administrated through intra- peritoneal injection (ip) for 4 weeks. The results showed that treatment with 300 mg/kg of kavir-48 significantly reduced the growth of xenografted tumor with a tumor growth inhibition (TGI) of 70 % for LXFI 529 cell line. In addition, no adverse effects were observed based on general appearance, weight loss or reduction in weight gain. Finally, Kavir-48, demonstrated a highly anti-tumor efficacy in vivo and a tolerability profile amenable to intra peritoneal administration. It acts as a promising therapeutic target against cancer.Further analysis on this antitumor metabolite on gene expression profiles involved in regulation of apoptosis and oxidative stress pathways in different cancer cells in progress.

Note: This abstract was not presented at the meeting.

Citation Format: Nasrin Moazami, Fatoulah Hakami, Hamideh Ofoghi, Massoud Ghaffarpour. A novel metabolite from an extremophile Streptomyces with apoptosis regulator function. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5105. doi:10.1158/1538-7445.AM2014-5105

The mitochondrial ATPase6 gene is more susceptible to mutation than the ATPase8 gene in breast cancer patients

Background

Breast cancer is the most common malignancy in women throughout the world. Mitochondria play important roles in cellular energy production, free radical generation and apoptosis. Identification of mitochondrial DNA mutations and/or polymorphisms as cancer biomarkers is rapidly developing in molecular oncology research.

Methods

In this study, the DNA alterations of the mitochondrial ATPase 6 and 8 genes were investigated in 49 breast cancer patients using PCR amplification and direct DNA sequencing on mtDNA. A possible association between these variants and tumorigenesis was assessed. Furthermore, the impact of non-synonymous substitutions on the amino acid sequence was evaluated using the PolyPhen-2 software.

Results

Twenty eight distinct somatic mitochondrial DNA variants were detected in tumor tissues but not in the corresponding adjacent non-tumor tissues. Among these variants, 9 were observed for the first time in breast cancer patients. The mtDNA variants of A8384 (T7A), T8567C (I14T), G8572A (G16S), A9041G (H172R) and G9055A (A177T) showed the most significant effects probably due to damaging changes to the resulting protein. Furthermore, non-synonymous amino acid changing variants were more frequent in the ATPase6 gene compared to the ATPase8 gene.

Conclusion

Our results showed that the ATPase6 gene is more susceptible to variations in breast cancer and may play an important role in tumorigenesis by changing the energy metabolism level in cancer cells.

Abstract 1116: Evaluation of mitochondrial DNA G10398A polymorphism in Iranian breast cancer patients

Introduction: The role of mtDNA alteration is already recognized as being in carcinogenesis, tumor progression and prognosis in all type of cancers. mtDNA alteration in complex I have been reported in different cancers. An A to G polymorphism at nucleotide position 10398 caused a nonconservative amino acid substitution from threonine to alanine within the NADH dehydrogenase (ND3) subunit of Complex I. The mitochondrial DNA 10398 polymorphism G10398A within ND3 subunit of Complex I has been suggested to alter the mitochondrial subunit of electron transfer chain and has been associated with several neurodegenerative disorders and cancers. It has been also shown that mtDNA alteration G10398A within ND3 subunit of Complex I in breast cancer patients correlated with increased breast cancer risks in the Indian and African-American populations however, the 10398A allele was not increase breast cancer risk for Caucasian women. Interestingly, G10398A in Chinese population were shown correlated with breast cancer metastasis. The aim of this study was on the association of mtDNA G10398 A polymorphism in Iranian breast cancer patients. Materials and Methods: Patients and tissue specimens: 27 paired Fresh tumor and adjacent normal samples were obtained from consecutive patients with BC (age range, 33-74years; with median age of 49.16 years) who underwent surgery for a partial and or whole mama mastroctomy between October 2007 and Nov 2009 from IRANIAN National Tumor Bank, National Cancer Institute, Imam Khomeini Hospital Complexes, Medical Tehran University, Tehran, Iran. Histopathological examinations were performed by two expert's pathologists. Mutational analysis of mtDNA G10398A in tumor samples: fresh tumors and their adjacent were extracted for genomic DNA using the QIAamp Mini Kit (Qiagen in accordance with the manufactures instructions. We searched for 10398 Polymorphism in within ND3 subunit of Complex I by means of PCR sequencing. Result and conclusion:patient had histopathological grade I, II, and III with 66.6%, 25.9% and 7.4% respectively. The frequency of mtDNA G10398A polymorphism 44.440%(12 of 27).The Iranian women with G10398A variant showed a significantly increased risk of breast cancer (p< 0.05). Derived from these findings, mtDNA G10398A polymorphism may be a potential risk marker of breast cancerk in Iranian population.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1116. doi:1538-7445.AM2012-1116