Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand?

Introduction

Diffuse intrinsic pontine glioma (DIPG) is a rare clinically, neuro-radiologically, and molecularly defined malignancy of the brainstem with a median overall survival of approximately 11 months. Our aim is to evaluate the current tendency for its treatment in Europe in order to develop (inter)national consensus guidelines.

Methods

Healthcare professionals specialized in DIPG were asked to fill in an online survey with questions regarding usual treatment strategies at diagnosis and at disease progression in their countries and/or their centers, respectively.

Results

Seventy-four healthcare professionals responded to the survey, of which 87.8% were pediatric oncologists. Only 13.5% of the respondents biopsy all of their patients, 41.9% biopsy their patients infrequently. More than half of the respondents (54.1%) treated their patients with radiotherapy only at diagnosis, whereas 44.6% preferred radiotherapy combined with chemotherapy. When the disease progresses, treatment strategies became even more diverse, and the tendency for no treatment increased from 1.4% at diagnosis to 77.0% after second progression. 36.5% of the healthcare professionals treat children younger than 3 years differently than older children at diagnosis. This percentage decreased, when the disease progresses. Most of the participants (51.4%) included less than 25% of their patients in clinical trials.

Conclusion

This survey demonstrates a large heterogeneity of treatment regimens, especially at disease progression. We emphasize the need for international consensus guidelines for the treatment of DIPG, possible by more collaborative clinical trials.

Electronic supplementary material

The online version of this article (10.1007/s11060-019-03287-9) contains supplementary material, which is available to authorized users.

Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening

Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors.

Preferential priming of alloreactive T cells with indirect reactivity

The relative contributions of the direct and indirect pathways in alloimmune responses have not been fully elucidated. We report a novel murine TCR transgenic system that can simultaneously track the CD4-direct (CD4-d), CD4-indirect (CD4-i) and CD8-direct (CD8-d) pathways after transplantation. Using this system, we have observed a profoundly greater proliferation of CD4-i T cells relative to CD4-d and CD8-d T cells after transplantation. Furthermore, a much larger proportion of CD4-i T cells attain an effector phenotype. We also analyzed endogenous, wild-type T cells using enzyme-linked immunospot analysis. In naïve mice, T cells with indirect reactivity were undetectable, but T cells with direct reactivity were abundant. However, 10 days after skin or heterotopic heart transplantation, CD4-i T cells comprised approximately 10% of the CD4+ response. Consistent with increased priming of the CD4-i pathway, we observed that the CD4-i T cells were further enriched in the effector cells migrating to the allograft and in memory-like T cells persisting after rejection. Thus, priming of the CD4-i pathway is favored after transplantation, allowing a rare population to rapidly become a major component of the CD4+ T-cell response in acute allograft rejection. The generalizability of this observation to other models remains to be determined.

Disruption of a host-parasite system following the introduction of an exotic host species

The potential of biological invasions to threaten native ecosystems is well recognized. Here we describe how an introduced species impacts on native host-parasite dynamics by acting as an alternative host. By sampling sites across an invasion front in Ireland, we quantified the influence of the introduced bank vole (Clethrionomys glareolus) on the epidemiology of infections caused by flea-transmitted haemoparasites of the genus Bartonella in native wood mice (Apodemus sylvaticus). Bartonella infections were detected on either side of the front but occurred exclusively in wood mice, despite being highly prevalent in both rodent species elsewhere in Europe. Bank vole introduction has, however, affected the wood mouse-Bartonella interaction, with the infection prevalence of both Bartonella birtlesii and Bartonella taylorii declining significantly with increasing bank vole density. Whilst flea prevalence in wood mice increases with wood mouse density in areas without bank voles, no such relationship is detected in invaded areas. The results are consistent with the dilution effect hypothesis. This predicts that for vector-transmitted parasites, the presence of less competent host species may reduce infection prevalence in the principal host. In addition we found a negative relationship between B. birtlesii and B. taylorii prevalences, indicating that these two microparasites may compete within hosts.

Improved convergence and speed for the distance geometry program APA to determine protein structure

The alternating projections algorithm (APA) is a program that is based on alternating projections and is designed to determine the three dimensional structure of proteins using distance geometry. The sampling and convergence properties of APA, as tested on bovine pancreatic trypsin inhibitor (BPTI) were previously reported in this journal. The results confirmed the program's earlier success with poly-L-alanine. However, the asymptotic convergence of the alternating projections was slow. We show that after good convergence is first obtained via alternating projections, that a weighted quadratic penalty function then produces the final conformation with better convergence in half the time required by the asymptotic convergence of alternating projections.

Naltrexone normalizes the suppression but not the surge of delta 5-3 beta-hydroxysteroid dehydrogenase activity in Leydig cells of stressed rat fetuses

Rat fetuses from mothers stressed chronically by immobilization and high intensity illumination beginning on day 14 of gestation have higher than normal levels of delta 5-3 beta-hydroxysteroid dehydrogenase (3 beta HSD) activity in Leydig cells on day 17 of gestation and lower than normal levels on days 18 and 19. Plasma testosterone titers in normal and stressed male fetuses closely parallel the activity of 3 beta HSD in fetal Leydig cells. In the present study quantitative cytochemistry was used to determine whether the stress-induced alterations in 3 beta HSD activity could be prevented by treating the mother with naltrexone, an opioid receptor blocker, before each stress session. Naltrexone normalized 3 beta HSD activity on days 18 and 19 of gestation, suggesting that the stress-induced suppression involves the endogenous opioid system. In contrast, naltrexone did not prevent the elevation in enzyme activity seen on day 17 in stressed fetuses. The persistence of a stress-induced surge on day 17, in spite of naltrexone therapy, suggests that some nonopioid mechanism is operational at that time.