Inhibition of intracellular dipeptidyl peptidases 8 and 9 enhances parthenolide's anti-leukemic activity.

Parthenolide is selectively toxic to leukemia cells; however, it also activates cell protective responses that may limit its clinical application. Therefore, we sought to identify agents that synergistically enhance parthenolide's cytotoxicity. Using a high-throughput combination drug screen, we identified the anti-hyperglycemic, vildagliptin, which synergized with parthenolide to induce death of the leukemia stem cell line, TEX (combination index (CI)=0.36 and 0.16, at effective concentration (EC) 50 and 80, respectively; where CI <1 denotes statistical synergy). The combination of parthenolide and vildagliptin reduced the viability and clonogenic growth of cells from acute myeloid leukemia patients and had limited effects on the viability of normal human peripheral blood stem cells. The basis for synergy was independent of vildagliptin's primary action as an inhibitor of dipeptidyl peptidase (DPP) IV. Rather, using chemical and genetic approaches we demonstrated that the synergy was due to inhibition of the related enzymes DPP8 and DPP9. In summary, these results highlight DPP8 and DPP9 inhibition as a novel chemosensitizing strategy in leukemia cells. Moreover, these results suggest that the combination of vildagliptin and parthenolide could be useful for the treatment of leukemia.

Assessment of the downstream portion of the mitochondrial pathway of caspase activation in patients with acute myeloid leukemia.

Most chemotherapeutic agents used in the treatment of acute myeloid leukemia (AML) induce apoptosis by triggering the mitochondrial pathway of caspase activation. To investigate the downstream portion of the mitochondrial pathway of caspase activation in patients with AML, cytosolic lysates were stimulated with cytochrome c and dATP and hydrolysis of Ac-DEVD-AFC by effector caspases was measured. Defects in the distal mitochondrial pathway were more common in samples from patients with AML that relapsed rapidly after induction chemotherapy compared to samples from treatment naïve patients. The incidence of blocked pathways did not differ based on response to induction chemotherapy, as even nonresponders generally had an intact pathway. When the distal mitochondrial pathway was blocked, defects were usually at the level of the effector caspases. Thus, functional defects in the distal portion of the mitochondrial pathway of caspase activation may help explain the nature of response and relapse after treatment.

Hematopoietic protein tyrosine phosphatase suppresses extracellular stimulus-regulated kinase activation.

The mitogen-activated protein kinases (MAPKs) are signaling molecules that become enzymatically activated through phosphorylation by diverse stimuli. Hematopoietic cytokines, growth factors, and stimulated lymphocyte antigen receptors may activate specific MAPKs by altering the balance of MAPK-activating protein kinases and the protein phosphatases that target their activation sites. Hematopoietic protein tyrosine phosphatase (HePTP) is a hematopoiesis-specific cytoplasmic protein tyrosine phosphatase whose expression is induced by mitogenic stimuli. To investigate the role of HePTP in hematopoietic development, we constructed mice deficient in this phosphatase using the technique of homologous recombination. Primary lymphocytes from HePTP(-/-) mice show enhanced activation of extracellular stimulus-regulated kinase (ERK) after both phorbol myristate acetate (PMA) and anti-CD3-mediated T-cell receptor (TCR) stimulation, suggesting a true physiological relationship between these two molecules. Activation of MEK, the physiological activator of ERK, by anti-CD3 or PMA is not affected by HePTP deletion. The distribution of hematopoietic lineages in bone marrow and peripheral blood samples and the in vitro proliferative capacity of bone marrow progenitors from HePTP deletion mice do not deviate from those of matched littermate controls. Similarly, lymphocyte activation and development are indistinguishable in HePTP(-/-) mice and controls. We conclude that HePTP is a physiological regulator of ERK on the basis of these studies and hypothesize that its deletion is well compensated for in the developing mouse through reduction of ERK targets or enhancement of physiologically opposed signaling pathways.

Accumulation of sestamibi in lymphoma cell lines in vitro.

Although some authors have suggested that sestamibi imaging is useful in evaluation of patients with lymphoma, others have obtained equivocal results. This discrepancy has been further investigated in vitro using two patient-derived non-Hodgkin's lymphoma cell lines, OCI-Ly3 and OCI-Ly18. Sestamibi (0.2 MBq/ml) was added to a suspension of OCI-Ly3 or OCI-Ly18 cells and aliquots were removed over 1 h and centrifuged to determine cell-associated radioactivity. Further experiments studied the effect of addition of a P-glycoprotein (Pgp) modulator or alteration in plasma and/or mitochondrial membrane potentials. Accumulation of sestamibi reached plateau values within 30 min, but these values were 6-fold higher in OCI-Ly3 than in OCI-Ly18. Inhibition of Pgp function with GG918 or PSC833 did not affect OCI-Ly3 cells but increased accumulation in OCI-Ly18 cells 3-fold, indicating a moderate level of Pgp. However, both cell lines responded similarly to membrane potential alterations: hyperpolarization of the mitochondrial membrane with nigericin had little effect on accumulation: in contrast, depolarization of the plasma membrane with an isotonic high potassium buffer reduced accumulation of sestamibi to 52% of control and additional depolarization of the mitochondrial membrane with valinomycin further reduced accumulation to 12% of control levels. These studies suggest that there can be wide differences in accumulation between cell lines, in part due to Pgp-mediated efflux, but that both of these cell lines have highly polarized mitochondria with little further capacity for hyperpolarization.

Nontargeted stable integration of recombinant adeno-associated virus into human leukemia and lymphoma cell lines as evaluated by fluorescence in situ hybridization.

A number of studies on human epithelial cells of varying origin have demonstrated integration of recombinant adeno-associated virus (AAV) vectors into a variety of chromosomes compared with the site-specific integration on chromosome 19 predominantly observed for wild-type (wt) AAV. We have constructed a recombinant AAV (rAAV) vector and tested the integration into hematopoietic cells, using the human acute myeloid leukemia cell line AML5 and the human non-Hodgkin's lymphoma cell line OCI-LY18 as targets. The integration sites were visualized by fluorescence in situ hybridization (FISH). Positive signals were observed for chromosomes 1, 2, 3, 8, 14, 15, 19, and Y. The majority of cells demonstrated integration into one specific site. A minority showed simultaneous integration into more than one chromosome. The frequency of observed integrations was not uniformly distributed among chromosomes; for instance, in AML5 chromosome 2 seemed to be favored. Colony-derived AML5 clones bore unique integration patterns indicating successful transduction of clonogenic progenitor cells with high proliferative potential. The integration was stable and observed for more than 12 months after transduction. FISH has been shown to be a powerful tool for detailed analyses of rAAV integration patterns and can be used to evaluate targets and transduction conditions.

[Large granular lymphocytic leukemia. Case report with scarce expression in peripheral blood]. / Leucemia de linfocitos grandes granulares. Presentación de un caso con escasa expresión en sangre periférica.

The case of a 33 year old woman with a large granular lymphocytic leukemia is presented. The main symptoms were neutropenia and recurrent respiratory bacterial infections. No enlargement of the liver, spleen or lymph nodes was noted. Circulating lymphocytes averaged 3000/microliter with 35% of large granular cells. The bone marrow biopsy showed lymphatic infiltration with both nodular and interstitial pattern. Lymphocytes bore the T suppressor phenotype (CD8+, CD45 RO+, CD20-, kappa-, lambda-). Cytogenetic studies revealed a low expression clone with 7q-: del (7)(q36). Gene rearrangements for immunoglobulins or T-cell receptors could not be demonstrated by Southern Blot. Bone marrow cultures grew normally while both normal and patient bone marrow showed marked inhibition when incubated with patients serum. Normalization of the peripheral granulocytic count was obtained with prednisone, while granulocytic-stimulating factors, chlorambucil, and cyclosporine A were partially active or inactive. We suggest that this case represents a form of the lymphoproliferative disease of granular lymphocytes. To our knowledge, the deletion of the long arm of chromosome 7 has not been described in this disease.

Effects of thrombolysis and atenolol or metoprolol on the signal-averaged electrocardiogram after acute myocardial infarction. Late Potentials Italian Study (LAPIS).

Late potentials (LPs) detected on the signal-averaged (SA) electrocardiogram (ECG) predict arrhythmic events after acute myocardial infarction (AMI). The effect of thrombolysis on the incidence of LPs after AMI is controversial and its impact on subsequent arrhythmic events is not known. Moreover, the effects of beta blockers on the SAECG have not been studied. Six hundred eighteen patients with AMI were studied; thrombolysis was given to 228 (37%). In comparison with patients treated conventionally, those receiving thrombolysis were significantly younger and more frequently male, had higher peak values of creatine kinase, a lower prevalence of non-Q-wave AMI, and a higher incidence of ventricular fibrillation in the acute phase, and more frequently received beta blockers. An SAECG obtained 6 to 8 days after AMI showed LPs in 24% of patients receiving and in 25% not receiving thrombolysis (p = NS). On admission, intravenous beta blockers were administered to 110 patients (18%); those receiving beta blockers were younger, had lower peak values of creatine kinase and more frequently received thrombolysis. LPs were less frequently found in patients treated than in those not treated with beta blockers (15 vs 27%; p = 0.007); however, this effect was found only in those with an ejection fraction > or = 40%. Independent predictors of LPs by multivariate analysis were an ejection fraction < 40% (p = 0.007), ventricular fibrillation in the acute phase (p = 0.02), and absence of beta-blocking therapy (p = 0.03). During a mean follow-up of 12 +/- 7 months, there were 39 cardiac deaths (6%), 13 of which were sudden (2%), and 9 sustained ventricular tachycardias.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hematopoiesis regulation]. / Regulación de la hematopoyesis.

Positive and negative signals are crucial in the regulation of the hematopoietic system. In the last 30 years, more than 20 molecules (glycoproteins) with biological activity upon the hematopoietic progenitor cells and even on the mature blood cells have been purified. The best known of these biomolecules are the hematopoietic growth factors (colony stimulating factors and interleukins), which are able to stimulate bone marrow cells to give mature progeny. At present, not only the sequence of the majority of these glycoproteins and their codifying genes has been determined, but also their target cells and cellular receptors. Research studies of the interaction between the hematopoietic progenitor cells and their stimulating and inhibiting factors are very helpful in the development of clinical trials and have become important tools to explore the origin of a great number of hematological diseases. However, the mechanisms underlying growth/inhibitory factor production and progenitor cell proliferation remain poorly understood.

Regulación de la hematopoyesis. / [Hematopoiesis regulation]

Positive and negative signals are crucial in the regulation of the hematopoietic system. In the last 30 years, more than 20 molecules (glycoproteins) with biological activity upon the hematopoietic progenitor cells and even on the mature blood cells have been purified. The best known of these biomolecules are the hematopoietic growth factors (colony stimulating factors and interleukins), which are able to stimulate bone marrow cells to give mature progeny. At present, not only the sequence of the majority of these glycoproteins and their codifying genes has been determined, but also their target cells and cellular receptors. Research studies of the interaction between the hematopoietic progenitor cells and their stimulating and inhibiting factors are very helpful in the development of clinical trials and have become important tools to explore the origin of a great number of hematological diseases. However, the mechanisms underlying growth/inhibitory factor production and progenitor cell proliferation remain poorly understood.

The myelodysplastic syndrome: prognostic factors in relation to the "in vitro" clonogenic assay.

The object of this study was to determine whether the "in vitro" parameters of medullary and blood granulopoiesis in patients with MDS, furnish information of either prognostic or diagnostic value. This study covered 94 patients with MDS. All patients were studied at the onset of disease. In order to identify the factors related to patients' survival, Cox Multiple Regression analysis was performed by the BMD P2L program. When analyzing by means of actuarial curves the survival probability of patients with benign development versus those of malignant development (those who developed ANLL), the significance between both groups was p = 0.0001. Different variables of patients included in this study were analyzed and all showed great significances. Fab: p = 0.0022, disease evolution: p = 0.0001 and presence of blastic aggregates: p = 0.0011. Cox's regression analysis revealed that the only predictable survival variable is the presence of blastic colonies and/or clusters. Accordingly, two groups were constructed: favourable and unfavourable. In the favourable group, 40% of the patients belonged to the RA group, while in the unfavourable group, 55% belonged to the RAEB group. This study shows the validity of the elaboration of prognostic groups in MDS according to the presence of blastic colonies and/or clusters in CFUGM medullary and/or peripheral cultures. The "in vitro" myeloid progenitors culture techniques may therefore be advantageously applied in these disorders for formulating a diagnosis and predicting the patient's short term evolution.

Pure red cell aplasia in a patient with systemic lupus erythematosus.

Pure red cell aplasia developed in a female patient with systemic lupus erythematosus (SLE). Erythroid colony growth was assessed in semisolid medium culture of bone marrow obtained from a normal donor and cultured in the presence of normal and patient sera. Colony forming units of erythropoiesis and burst forming units of erythropoiesis obtained from a normal donor were inhibited in the presence of patient sera. Our findings support the concept that circulating inhibitors might influence the proliferation of erythroid progenitor cells and erythroid aplasia may be an immunologically mediated syndrome.

[Late potentials, myocardial kinetics and ventricular vulnerability as markers of sudden death after myocardial infarct]. / Potenziali "tardivi", cinetica miocardica e vulnerabilità ventricolare come "markers" di morte improvvisa dopo infarto miocardico.

The 1st myocardial infarction requires the identification of patients who are at high risk of malignant ventricular arrhythmias. Our study group included 55 consecutive patients (age less than 70): all had non-invasive "signal averaging" recording and 24 hour dynamic electrocardiogram at the post-acute phase of their 1st myocardial infarction (MI) and 3 months later. Wall motion abnormalities were evaluated in each patient but two. 24 randomized patients (without documented sustained ventricular tachycardia) underwent right programmed ventricular stimulation at the 3rd month after MI and pathological repetitive responses were evaluated (Table III); they were hemodynamically stable and without persistent ischemia. Late potentials have been compared to spontaneous and induced ventricular arrhythmias, wall motion abnormalities (Table II) and two-year follow-up (Table VI), in order to identify predictive markers of sudden death or malignant arrhythmias. Ventricular late potentials were identified in 28 patients (51%) 4-8 days after MI: mean duration was equal to 75 +/- 33 msec; they did not show any relationship to the site (Table I) and to the extension of necrosis (Table II). Ventricular late potentials had no significant association with myocardial dyskinesia (Table II) while their association with complex ventricular arrhythmias, detected on Holter monitoring within 8 days after MI, and with the induction of repetitive ventricular responses (greater than or equal to 2 complexes) showed significant correlations (respectively p = 0.02; p = 0.01). In regard of the recognition of spontaneous ventricular tachycardia (greater than or equal to 3 complexes) in the follow-up, the detection of late potentials showed 75% sensibility with predictive value equal to 32% (Table V); the combination of late potentials and ventricular dyskinesia exhibited the highest specificity (88%) and predictive value (54%). By the end of follow-up there had been 6 cardiac deaths (2 sudden, 4 from left ventricular failure): late potentials longer than 75 msec were recorded in all patients who had cardiac death; in the post acute phase of MI repetitive ventricular arrhythmias were detected in only 1 of the 2 case of sudden cardiac death and in none of the patients who developed sustained ventricular tachycardia in the follow-up (Table VI). Myocardial dyskinesia was present in each patient who developed non sudden cardiac death (Table VI).(ABSTRACT TRUNCATED AT 400 WORDS)

[Costs, benefits and hazards of electrophysiologic studies in sinoatrial and atrioventricular block]. / Costi, benefici e rischi dello studio elettrofisiologico nei blocchi seno-atriali ed atrio-ventricolari.

Time and costs involved in electrophysiologic study for sino-atrial and/or atrio-ventricular blocks were evaluated in 42 patients. Analysis of charge for staff, specific electrophysiologic equipment and disposable items reveals an operating cost of 540.000 lire per study. An electrophysiologic study is the only method of diagnosing with certainty the level of A-V block and of assessing the prognosis of patients with infranodal conduction disease. It also allows a careful choice of permanent pacing mode. The potential risk, although small involved in this procedure, its cost and the need of a high operating standard suggest however that the number of electrophysiology laboratories should not indiscriminately increase.

Electrophysiological study of atrio-ventricular block and ventricular conduction defects. Prognostic and therapeutical implications.

His bundle study with long term follow-up (mean 42 months) was performed in 155 patients (107 with previous syncope, 48 without or with few symptoms). The electrocardiogram showed various conduction abnormalities, but in some cases it was normal. Patients were excluded at the beginning of the study, if they showed sick sinus syndrome, recorded 3rd degree atrioventricular block, angina pectoris, recent myocardial infarction, congenital or surgical cardiac block. In previous studies the diagnostic sensibility and specificity of ajmaline (1 mg/kg/1' i.v.) and overdriving tests have been evaluated. In this study the prognostic meaning of these tests has been evaluated. During a mean 42 months follow-up, 17 patients (10.9%) developed advanced atrioventricular block. A higher risk of developing advanced atrioventricular block below the AV node was detected in patients who showed: basal HV greater than or equal to 65 ms (33% developed advanced atrioventricular block vs 4.7% of patients with basal HV less than 65 ms; p less than 0.001); HV value greater than or equal to 120 ms or 2nd-3rd degree atrioventricular block during ajmaline test (40% progressed to advanced atrio-ventricular block vs 0.85%; p less than 0.001); HV prolonged greater than 10 ms or 2nd-3rd degree atrioventricular block during atrial pacing (40% progressed to a atrioventricular block vs 3.4%; p less than 0.001) regardless of previous syncope.(ABSTRACT TRUNCATED AT 250 WORDS)