Identificazione di profili di rischio cardiovascolare nel trapianto di rene: polimorfismi di geni coinvolti nei processi di infiammazione e di apoptosi

Introduction. Cardiovascular disease (CVD) represents the main cause of morbidity and mortality in kidney recipients. This study was undertaken to assess the impact of functional polymorphisms located in cytokine and apoptosis genes on CVD after kidney transplantation. Cytokine polymorphisms, generally located in gene regulatory regions, are associated with high and low cytokine production and are likely to modulate the magnitude of inflammatory responses following transplantation, depending on the balance between the levels of pro-inflammatory and antiinflammatory cytokines. The role of apoptosis in atherosclerosis has not been completely elucidated, and here we explored the hypothesis that the heterogeneity in cardiovascular risk in kidney recipients may also be linked to functional polymorphisms involved in apoptosis induction. Purpose. In the search for relevant genetic markers of predisposition to CVD after renal transplant, the present investigation was undertaken to identify the clinical impact of polymorphisms of cytokines TNF-��, TGF-��, IL-10, IL-6, IFN-�� and IL-8 and of apoptosis genes Fas and Caspase 9 in a population of kidney transplant recipients. Materials and methods. The study involved 167 patients who received cadaveric kidney transplantation at our centre between 1997 and 2005 (minimum follow-up of 12 months); 35 of them had experienced cardiovascular events (CVD group) and 132 had no cardiovascular complications (non-CVD group). Genotyping was performed using RFLP (Restriction Fragment Length Polymorphism) for RFLP per IL-8/T-251A, Fas/G-670A e Casp9/R221Q polymorphism and SSP (Sequence Specific Primer) for TNF-��/G-308A, TGF-��/L10P, TGF-��/R25P, IL-10/G-1082A, IL- 10/C-819T, IL-10/C-592A, IL-6/G-174C, IFN-��/T+874A polymorphisms.Results. We found a significant difference in TNF-�� and IL-10 genotype frequencies between the patients who had suffered cardiovascular events and those with no CVD history. The high producer genotype for proflogistic cytokine TNF-�� appeared to have a significantly superior prevalence in the CVD group compared to the non-CVD group (40.0% vs 21.2%) and it resulted in a 2.4-fold increased cardiovascular risk (OR=2.361; p=0.0289). On the other hand, the high producer genotype for the antiinflammatory cytokine IL-10 was found in 2.8% of the CVD group and in 16.7% of non-CVD group; logistic regression showed a 0.3-fold reduced risk of CVD associated with genetically determined high IL-10 production (OR=0.278; p<0.0001). The other polymorphisms did not prove to have any impact on CVD. Conclusions. TNF-�� and IL-10 gene polymorphisms might represent cardiovascular risk markers in renal transplant recipients.

Impatto di rifaximina sul microbiota intestinale: selezione di bifidobatteri antibiotico resistenti

The ideal approach for the long term treatment of intestinal disorders, such as inflammatory bowel disease (IBD), is represented by a safe and well tolerated therapy able to reduce mucosal inflammation and maintain homeostasis of the intestinal microbiota. A combined therapy with antimicrobial agents, to reduce antigenic load, and immunomodulators, to ameliorate the dysregulated responses, followed by probiotic supplementation has been proposed. Because of the complementary mechanisms of action of antibiotics and probiotics, a combined therapeutic approach would give advantages in terms of enlargement of the antimicrobial spectrum, due to the barrier effect of probiotic bacteria, and limitation of some side effects of traditional chemiotherapy (i.e. indiscriminate decrease of aggressive and protective intestinal bacteria, altered absorption of nutrient elements, allergic and inflammatory reactions). Rifaximin (4-deoxy-4���-methylpyrido[1���,2���-1,2]imidazo[5,4-c]rifamycin SV) is a product of synthesis experiments designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a non systemic antibiotic with a broad spectrum of antibacterial action, covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually non absorbed, its bioavailability within the gastrointestinal tract is rather high with intraluminal and faecal drug concentrations that largely exceed the MIC values observed in vitro against a wide range of pathogenic microorganisms. The gastrointestinal tract represents therefore the primary therapeutic target and gastrointestinal infections the main indication. The little value of rifaximin outside the enteric area minimizes both antimicrobial resistance and systemic adverse events. Fermented dairy products enriched with probiotic bacteria have developed into one of the most successful categories of functional foods. Probiotics are defined as ���live microorganisms which, when administered in adequate amounts, confer a health benefit on the host��� (FAO/WHO, 2002), and mainly include Lactobacillus and Bifidobacterium species. Probiotic bacteria exert a direct effect on the intestinal microbiota of the host and contribute to organoleptic, rheological and nutritional properties of food. Administration of pharmaceutical probiotic formula has been associated with therapeutic effects in treatment of diarrhoea, constipation, flatulence, enteropathogens colonization, gastroenteritis, hypercholesterolemia, IBD, such as ulcerative colitis (UC), Crohn���s disease, pouchitis and irritable bowel syndrome. Prerequisites for probiotics are to be effective and safe. The characteristics of an effective probiotic for gastrointestinal tract disorders are tolerance to upper gastrointestinal environment (resistance to digestion by enteric or pancreatic enzymes, gastric acid and bile), adhesion on intestinal surface to lengthen the retention time, ability to prevent the adherence, establishment and/or replication of pathogens, production of antimicrobial substances, degradation of toxic catabolites by bacterial detoxifying enzymatic activities, and modulation of the host immune responses. This study was carried out using a validated three-stage fermentative continuous system and it is aimed to investigate the effect of rifaximin on the colonic microbial flora of a healthy individual, in terms of bacterial composition and production of fermentative metabolic end products. Moreover, this is the first study that investigates in vitro the impact of the simultaneous administration of the antibiotic rifaximin and the probiotic B. lactis BI07 on the intestinal microbiota. Bacterial groups of interest were evaluated using culture-based methods and molecular culture-independent techniques (FISH, PCR-DGGE). Metabolic outputs in terms of SCFA profiles were determined by HPLC analysis. Collected data demonstrated that rifaximin as well as antibiotic and probiotic treatment did not change drastically the intestinal microflora, whereas bacteria belonging to Bifidobacterium and Lactobacillus significantly increase over the course of the treatment, suggesting a spontaneous upsurge of rifaximin resistance. These results are in agreement with a previous study, in which it has been demonstrated that rifaximin administration in patients with UC, affects the host with minor variations of the intestinal microflora, and that the microbiota is restored over a wash-out period. In particular, several Bifidobacterium rifaximin resistant mutants could be isolated during the antibiotic treatment, but they disappeared after the antibiotic suspension. Furthermore, bacteria belonging to Atopobium spp. and E. rectale/Clostridium cluster XIVa increased significantly after rifaximin and probiotic treatment. Atopobium genus and E. rectale/Clostridium cluster XIVa are saccharolytic, butyrate-producing bacteria, and for these characteristics they are widely considered health-promoting microorganisms. The absence of major variations in the intestinal microflora of a healthy individual and the significant increase in probiotic and health-promoting bacteria concentrations support the rationale of the administration of rifaximin as efficacious and non-dysbiosis promoting therapy and suggest the efficacy of an antibiotic/probiotic combined treatment in several gut pathologies, such as IBD. To assess the use of an antibiotic/probiotic combination for clinical management of intestinal disorders, genetic, proteomic and physiologic approaches were employed to elucidate molecular mechanisms determining rifaximin resistance in Bifidobacterium, and the expected interactions occurring in the gut between these bacteria and the drug. The ability of an antimicrobial agent to select resistance is a relevant factor that affects its usefulness and may diminish its useful life. Rifaximin resistance phenotype was easily acquired by all bifidobacteria analyzed [type strains of the most representative intestinal bifidobacterial species (B. infantis, B. breve, B. longum, B. adolescentis and B. bifidum) and three bifidobacteria included in a pharmaceutical probiotic preparation (B. lactis BI07, B. breve BBSF and B. longum BL04)] and persisted for more than 400 bacterial generations in the absence of selective pressure. Exclusion of any reversion phenomenon suggested two hypotheses: (i) stable and immobile genetic elements encode resistance; (ii) the drug moiety does not act as an inducer of the resistance phenotype, but enables selection of resistant mutants. Since point mutations in rpoB have been indicated as representing the principal factor determining rifampicin resistance in E. coli and M. tuberculosis, whether a similar mechanism also occurs in Bifidobacterium was verified. The analysis of a 129 bp rpoB core region of several wild-type and resistant bifidobacteria revealed five different types of miss-sense mutations in codons 513, 516, 522 and 529. Position 529 was a novel mutation site, not previously described, and position 522 appeared interesting for both the double point substitutions and the heterogeneous profile of nucleotide changes. The sequence heterogeneity of codon 522 in Bifidobacterium leads to hypothesize an indirect role of its encoded amino acid in the binding with the rifaximin moiety. These results demonstrated the chromosomal nature of rifaximin resistance in Bifidobacterium, minimizing risk factors for horizontal transmission of resistance elements between intestinal microbial species. Further proteomic and physiologic investigations were carried out using B. lactis BI07, component of a pharmaceutical probiotic preparation, as a model strain. The choice of this strain was determined based on the following elements: (i) B. lactis BI07 is able to survive and persist in the gut; (ii) a proteomic overview of this strain has been recently reported. The involvement of metabolic changes associated with rifaximin resistance was investigated by proteomic analysis performed with two-dimensional electrophoresis and mass spectrometry. Comparative proteomic mapping of BI07-wt and BI07-res revealed that most differences in protein expression patterns were genetically encoded rather than induced by antibiotic exposure. In particular, rifaximin resistance phenotype was characterized by increased expression levels of stress proteins. Overexpression of stress proteins was expected, as they represent a common non specific response by bacteria when stimulated by different shock conditions, including exposure to toxic agents like heavy metals, oxidants, acids, bile salts and antibiotics. Also, positive transcription regulators were found to be overexpressed in BI07-res, suggesting that bacteria could activate compensatory mechanisms to assist the transcription process in the presence of RNA polymerase inhibitors. Other differences in expression profiles were related to proteins involved in central metabolism; these modifications suggest metabolic disadvantages of resistant mutants in comparison with sensitive bifidobacteria in the gut environment, without selective pressure, explaining their disappearance from faeces of patients with UC after interruption of antibiotic treatment. The differences observed between BI07-wt e BI07-res proteomic patterns, as well as the high frequency of silent mutations reported for resistant mutants of Bifidobacterium could be the consequences of an increased mutation rate, mechanism which may lead to persistence of resistant bacteria in the population. However, the in vivo disappearance of resistant mutants in absence of selective pressure, allows excluding the upsurge of compensatory mutations without loss of resistance. Furthermore, the proteomic characterization of the resistant phenotype suggests that rifaximin resistance is associated with a reduced bacterial fitness in B. lactis BI07-res, supporting the hypothesis of a biological cost of antibiotic resistance in Bifidobacterium. The hypothesis of rifaximin inactivation by bacterial enzymatic activities was verified by using liquid chromatography coupled with tandem mass spectrometry. Neither chemical modifications nor degradation derivatives of the rifaximin moiety were detected. The exclusion of a biodegradation pattern for the drug was further supported by the quantitative recovery in BI07-res culture fractions of the total rifaximin amount (100 ��g/ml) added to the culture medium. To confirm the main role of the mutation on the �� chain of RNA polymerase in rifaximin resistance acquisition, transcription activity of crude enzymatic extracts of BI07-res cells was evaluated. Although the inhibition effects of rifaximin on in vitro transcription were definitely higher for BI07-wt than for BI07-res, a partial resistance of the mutated RNA polymerase at rifaximin concentrations > 10 ��g/ml was supposed, on the basis of the calculated differences in inhibition percentages between BI07-wt and BI07-res. By considering the resistance of entire BI07-res cells to rifaximin concentrations > 100 ��g/ml, supplementary resistance mechanisms may take place in vivo. A barrier for the rifaximin uptake in BI07-res cells was suggested in this study, on the basis of the major portion of the antibiotic found to be bound to the cellular pellet respect to the portion recovered in the cellular lysate. Related to this finding, a resistance mechanism involving changes of membrane permeability was supposed. A previous study supports this hypothesis, demonstrating the involvement of surface properties and permeability in natural resistance to rifampicin in mycobacteria, isolated from cases of human infection, which possessed a rifampicin-susceptible RNA polymerase. To understand the mechanism of membrane barrier, variations in percentage of saturated and unsaturated FAs and their methylation products in BI07-wt and BI07-res membranes were investigated. While saturated FAs confer rigidity to membrane and resistance to stress agents, such as antibiotics, a high level of lipid unsaturation is associated with high fluidity and susceptibility to stresses. Thus, the higher percentage of saturated FAs during the stationary phase of BI07-res could represent a defence mechanism of mutant cells to prevent the antibiotic uptake. Furthermore, the increase of CFAs such as dihydrosterculic acid during the stationary phase of BI07-res suggests that this CFA could be more suitable than its isomer lactobacillic acid to interact with and prevent the penetration of exogenous molecules including rifaximin. Finally, the impact of rifaximin on immune regulatory functions of the gut was evaluated. It has been suggested a potential anti-inflammatory effect of rifaximin, with reduced secretion of IFN-�� in a rodent model of colitis. Analogously, it has been reported a significant decrease in IL-8, MCP-1, MCP-3 e IL-10 levels in patients affected by pouchitis, treated with a combined therapy of rifaximin and ciprofloxacin. Since rifaximin enables in vivo and in vitro selection of Bifidobacterium resistant mutants with high frequency, the immunomodulation activities of rifaximin associated with a B. lactis resistant mutant were also taken into account. Data obtained from PBMC stimulation experiments suggest the following conclusions: (i) rifaximin does not exert any effect on production of IL-1��, IL-6 and IL-10, whereas it weakly stimulates production of TNF-��; (ii) B. lactis appears as a good inducer of IL-1��, IL-6 and TNF-��; (iii) combination of BI07-res and rifaximin exhibits a lower stimulation effect than BI07-res alone, especially for IL-6. These results confirm the potential anti-inflammatory effect of rifaximin, and are in agreement with several studies that report a transient pro-inflammatory response associated with probiotic administration. The understanding of the molecular factors determining rifaximin resistance in the genus Bifidobacterium assumes an applicative significance at pharmaceutical and medical level, as it represents the scientific basis to justify the simultaneous use of the antibiotic rifaximin and probiotic bifidobacteria in the clinical treatment of intestinal disorders.

Mechanisms of cell senescence: p21 and DNA damage response in aging and longevity

Theory of aging postulates that aging is a remodeling process where the body of survivors progressively adapts to internal and external damaging agents they are exposed to during several decades. Thus , stress response and adaptation mechanisms play a fundamental role in the aging process where the capability of adaptating effects, certainly, also is related the lifespan of each individual. A key gene linking aging to stress response is indeed p21, an induction of cyclin-dependent kinase inhibitor which triggers cell growth arrest associated with senescence and damage response and notably is involved in the up-regulation of multiple genes that have been associated with senescence or implicated in age-related . This PhD thesis project that has been performed in collaboration with the Roninson Lab at Ordway Research Institute in Albany, NY had two main aims: -the testing the hypothesis that p21 polymorphisms are involved in longevity -Evaluating age-associated differences in gene expression and transcriptional response to p21 and DNA damage In the first project, trough PCR-sequencing and Sequenom strategies, we we found out that there are about 30 polymorphic variants in the p21 gene. In addition, we found an haplotpype located in -5kb region of the p21 promoter whose frequency is ~ 2 fold higher in centenarians than in the general population (Large-scale analysis of haplotype frequencies is currently in progress). Functional studies I carried out on the promoter highilighted that the ���centenarian��� haplotype doesn���t affect the basal p21 promoter activity or its response to p53. However, there are many other possible physiological conditions in which the centenarian allele of the p21 promoter may potentially show a different response (IL6, IFN,progesterone, vitamin E, Vitamin D etc). In the second part, project #2, trough Microarrays we seeked to evaluate the differences in gene expression between centenarians, elderly, young in dermal fibroblast cultures and their response to p21 and DNA damage. Microarray analysis of gene expression in dermal fibroblast cultures of individuals of different ages yielded a tentative "centenarian signature". A subset of genes that were up- or downregulated in centenarians showed the same response to ectopic expression of p21, yielding a putative "p21-centenarian" signature. Trough RQ-PCR (as well Microarrays studies whose analysis is in progress) we tested the DNA damage response of the p21-centenarian signature genes showing a correlation stress/aging in additional sets of young and old samples treated with p21-inducing drug doxorubicin thus finding for a subset of of them , a response to stress age-related.

I linfociti T regolatori nella patologia epatica da HCV: dall'epatite cronica al trapianto

La storia naturale dell���epatopatia HCV-relata passa dall���epatite cronica alla cirrosi ed eventualmente all���epatocarcinoma fino ad arrivare alla possibile necessit�� del trapianto di fegato. HCV non esercita citolisi diretta, pertanto i fattori immunologici giocano il duplice ruolo di determinare l���evoluzione dell���infezione e il danno epatico. All���interno del sistema immunitario esistono linfociti in grado di inibire l���attivazione delle cellule effettrici modulando la risposta immunitaria; la popolazione regolatoria meglio conosciuta �� costituita dai cosiddetti T-reg caratterizzati dal fenotipo CD4+CD35hiFoxp3+. Scopo di questo studio �� stato determinare fenotipo e funzione dei T-reg, valutandone le correlazioni con caratteristiche cliniche e parametri biochimici e virologici, nelle diverse fasi della malattia epatica da HCV, a partire dall���epatite cronica, passando per la cirrosi, l���epatocarcinoma e terminando con il follow-up post-trapianto di fegato. Sono stati reclutati 80 pazienti con infezione cronica da HCV non in trattamento antivirale, di cui 52 con epatite cronica, 12 con cirrosi e 16 con epatocarcinoma. Di questi, 11 sono andati incontro a trapianto di fegato e sono stati poi seguiti fino a 36 mesi di follow up. Ventinove soggetti avevano transaminasi persistentemente nella norma e 28 mostravano ALT costantemente oltre 2.5x i valori normali. Quaranta donatori di sangue sono stati utilizzati come controlli sani. Marcatori di superficie (CD4, CD25) ed intracellulari (Foxp3) sono stati valutati in citofluorimetria su sangue intero periferico per tutti i soggetti al basale ed ogni 2-4 settimane dopo trapianto. In una quota di pazienti i T-reg sono stati estratti dai linfociti del sangue periferico con metodi immunomagnetici e la loro funzione valutata come percentuale di inibizione di proliferazione e produzione di IFN-�� da parte delle cellule bersaglio CD4+CD25- in esperimenti di co-coltura effettuati al basale e dopo 24-36 settimane dal trapianto. La percentuale di T-reg e l���espressione del Foxp3 sono risultate aumentate nei soggetti con HCV rispetto ai controlli sani, in particolare in coloro con cirrosi, HCC e nei pazienti con transaminasi normali indipendentemente dallo stadio di malattia, correlando inversamente con i livelli di transaminasi e direttamente con il punteggio MELD. La produzione di IFN-�� �� incrementata in tutti i pazienti HCV ma efficacemente controllata solamente dai T-reg dei pazienti con transaminasi normali. Dopo il trapianto di fegato, si verifica una precoce e reversibile riduzione delle T-reg circolanti. Alla 24ma e 36ma settimana dal trapianto la percentuale dei T-reg circolanti �� sovrapponibile al basale e i loro effetti, sia in termini di proliferazione che di produzione di IFN-��, sulle cellule bersaglio, gi�� dotate di una ridotta attivit�� intrinseca, appaiono particolarmente incisivi. In conclusione, l���epatopatia cronica da HCV �� caratterizzata da una popolazione di T-reg espansa che per��, con l���eccezione dei soggetti con transaminasi normali, non appare in grado di limitare il danno epatico immuno-mediato e potrebbe favorire lo sviluppo e la crescita di lesioni tumorali nei pazienti con malattia avanzata. Il trapianto di fegato, probabilmente a causa della terapia immunosoppressiva, si associa ad un marcato e transitorio declino dei T-reg le cui numerosit�� e funzione vengono completamente recuperate a sei mesi dall���intervento. La migliore conoscenza dei meccanismi alla base delle cinetica e della funzione delle cellule regolatorie potr�� fornire utili strumenti per il loro utilizzo come adiuvanti nella terapia dell���epatopatia cronica HCV relata.

Nuovi meccanismi di regolazione dell'autoimmunit�� nella piastrinopenia immune

La Piastinopenia Immune (PTI) �� una patologia autoimmune ad eziologia ignota caratterizzata da piastrinopenia. I linfociti T regolatori (Tregs) sono coinvolti nei meccanismi di tolleranza immunologica e agiscono regolando l���attivit�� delle cellule T autoreattive e delle cellule dendritiche (DCs). Viceversa, le DCs, che esprimono Indoleamine 2,3-dioxygenase (IDO), partecipano al mantenimento della tolleranza agli auto-antigeni attraverso l���espansione dei Tregs. Inoltre, recenti studi hanno dimostrato che i linfociti T helper 17 (Th17) sono coinvolti nell���autoimmunit�� e che l���espressione di Interleuchina (IL)-17 �� associata a numerose patologie autoimmuni. Il ruolo dell���interazione fra DCs e Tregs ed il ruolo dei Th17 nella patogenesi della PTI non sono mai stati studiati in maniera approfondita. Gli obiettivi principali di questa tesi sono stati: a) caratterizzare fenotipicamente e funzionalmente i linfociti Tregs e DCs; b) valutare il ruolo patogenetico dell���interazione tra Tregs e DCs; c) quantificare i Th17 circolanti. I risultati dimostrano che: 1) il numero dei Tregs circolanti dei pazienti, identificati tramite i marcatori Foxp3 e CD127, �� significativamente ridotto rispetto alla controparte normale; 2) la conversione in vitro delle cellule CD4+CD25- in linfociti Tregs (CD4+CD25+Foxp3+) dopo stimolazione con DCs mature �� significativamente ridotta nei pazienti rispetto ai controlli; 3) sia l���espressione dell���enzima IDO nelle DCs mature (mRNA) che i livelli di chinurenine prodotte (indice di attivit�� enzimatica) sono risultati significativamente ridotti nei pazienti rispetto alla controparte normale. Questi risultati suggeriscono quindi che il ridotto numero dei Tregs circolanti nei pazienti con PTI pu�� essere, almeno in parte, attribuito alla scarsa capacit�� di conversione delle DCs, in quanto tali cellule esprimono meno IDO. I risultati dimostrano inoltre che: 1) i Tregs dei pazienti con PTI hanno una capacit�� soppressoria che �� significativamente inferiore rispetto ai soggetti normali; tale dato �� stato confermato dal dosaggio di IFN-��� nel surnatante della coltura; 2) i Tregs di pazienti con PTI non sono in grado di inibire la maturazione delle DCs, a differenza di quanto avviene nei soggetti sani: infatti, l���espressione delle molecole costimolatorie CD80 e CD86 sulle DCs �� risultata invariata in seguito a cocoltura con DCs immature; 3) il dosaggio delle citochine nel surnatante delle cocolture dimostra che la concentrazione di IL-10 e IL-6 �� significativamente ridotta nei pazienti rispetto ai controlli. La scarsa abilit�� dei Tregs di inibire la maturazione delle DCs e l���alterato pattern di secrezione di citochine potrebbero quindi contribuire all��� insorgenza del fenotipo pi�� maturo delle DCs nei pazienti con PTI. I linfociti Th17 circolanti di pazienti e controlli sono stati identificati in citofluorimetria come cellule CD4+CD161+CD196+. Da tale analisi �� emerso che la frequenza dei Th17 circolanti non �� significativamente diversa nei due gruppi. Questi dati dimostrano quindi che nella PTI l���interazione bidirezionale tra Tregs e DCs risulta alterata e svolge un ruolo patogenetico, in quanto, da un lato, ci sono Tregs con un deficit numerico e funzionale e, dall���altro, DCs con maggiore capacit�� immunogenica. Il numero dei Th17 non risulta invece alterato.

Risposta Immunitaria Epatite B specifica in pazienti affetti da Epatocarcinoma

Hepatitis B x protein (HBx) is a non structural, multifunctional protein of hepatitis B virus (HBV) that modulates a variety of host processes.Due to its transcriptional activity,able to alter the expression of growth-control genes,it has been implicated in hepatocarcinogenesis.Increased expression of HBx has been reported on the liver tissue samples of hepatocellular carcinoma (HCC),and a specific anti-HBx immune response can be detected in the peripheral blood of patients with chronic HBV.However,its role and entity has not been yet clarified.Thus,we performed a cross-sectional analysis of anti-HBx specific T cell response in HBV-infected patients in different stage of disease.A total of 70 HBV-infected subjects were evaluated:15 affected by chronic hepatitis (CH-median age 45 yrs),14 by cirrhosis (median age 55 yrs),11 with dysplastic nodules (median age 64 yrs),15 with HCC (median age 60 yrs),15 with IC(median age 53 yrs).All patients were infected by virus genotype D with different levels of HBV viremia and most of them (91%) were HBeAb positive.The HBx-specific T cell response was evaluated by anti-Interferon (IFN)-gamma Elispot assay after in vitro stimulation of peripheral blood mononuclear cells,using 20 overlapping synthetic peptides covering all HBx protein sequence.HBx-specific IFN-gamma-secreting T cells were found in 6 out of 15 patients with chronic hepatitis (40%), 3 out of 14 cirrhosis (21%), in 5 out of 11 cirrhosis with macronodules (54%), and in 10 out of 15 HCC patients (67%). The number of responding patients resulted significantly higher in HCC than IC (p=0.02) and cirrhosis (p=0.02). Central specific region of the protein x was preferentially recognize,between 86-88 peptides. HBx response does not correlate with clinical feature disease(AFP,MELD).The HBx specific T-cell response seems to increase accordingly to progression of the disease, being increased in subjects with dysplastic or neoplastic lesions and can represent an additional tool to monitor the patients at high risk to develop HCC

Human papillomavirus (HPV) and associated diseases: between applied diagnostic and basic research

Human Papillomavirus (HPV) is the cause of cervical cancers (among these, adenocarcinoma, AdCa) and is associated to a subgroup of oropharyngeal carcinomas (OPSCCs). Even if the risk for cancer development is linked to the infection by some viral genotypes, mainly HPV16 and 18, viral DNA alone seems not to be sufficient for diagnosis. Moreover, the role of the virus in OPSCCs has not been totally clarified yet. In the first part of the thesis, the performances concerning viral genotyping in clinical cervical samples of a new pyrosequencing-based test and a well-known hybridization-based assay have been compared. Similar results between the methods have been obtained. However, the former showed advantages in detecting intratype variants, higher specificity and a broader spectrum of detectable HPV types. The second part deals with the evaluation of virological markers (genotyping, viral oncoproteins expression, viral load, physical state and CpG methylation of HPV16 genome) in the diagnosis/prognosis of cervical AdCa and HPV-associated OPSCCs. HPV16 has been confirmed the most prevalent genotype in both the populations. Interestingly, the mean methylation frequency of viral DNA at the early promoter showed the tendency to be associated to invasion for cervical AdCa and to a worse prognosis for OPSCCs, suggesting a promising role as diagnostic/prognostic biomarker. The experiments of the third part were performed at the DKFZ in Heidelberg (Germany) and dealt with the analysis of the response to IFN-k transfection in HPV16-positive cervical cancer and head&neck carcinoma cell lines to evaluate its potential role as new treatment. After 24h, we observed increased IFN-b expression which lead to the up-regulation of genes involved in the antigens presentation pathway (MHC class I and immunoproteasome) and antiviral response as well, in particular in cervical cancer cell lines. This fact suggested also the presence of different HPV-mediated carcinogenic pathways between the two anatomical districts.

Studio della via di segnale PI3K/Akt/mTOR nelle Cellule Dendritiche

Il trapianto allogenico di cellule staminali emopoietiche �� spesso l���unica soluzione per la cura di diverse malattie ematologiche. La aGVHD �� la complicanza pi�� importante che si pu�� avere a seguito del trapianto allogenico ed �� causata dai linfociti T del donatore che riconoscono gli antigeni del ricevente presentati dalle APC. Eliminare o inattivare la APC del ricevente prima del trapianto potrebbe prevenire la aGVHD. Ad oggi non esistono farmaci specifici diretti contro le APC, sono per�� noti i meccanismi molecolari coinvolti nella sopravvivenza cellulare come la via di segnale di PI3K. In questo lavoro abbiamo testato l���attivit�� di due farmaci, che colpiscono target molecolari della via di PI3K, la rapamicina e la perifosina, sul differenziamento dei monociti a differenti popolazioni di cellule dendritiche (DC), in vitro. La rapamicina riduceva il recupero cellulare delle DC derivate da monociti coltivate in presenza di IL-4 aumentando l���apoptosi, mentre i monociti coltivati in presenza di GM-CSF con o senza IFN-�� risultavano resistenti alla rapamicina. Inoltre la rapamicina riduceva l���espressione della molecola costimolatoria CD86 e incrementava l���espressione della molecola CD1a solo nei monociti coltivati con GM-CSF e IL-4. Nelle DC derivate dai monociti in presenza di IL-4 la rapamicina bloccava la produzione di IL-12 e TNF-�� e ne alterava la capacit�� allostimolatoria. La rapamicina non alterava la sopravvivenza e la funzione delle DC circolanti. Il trattamento con perifosina provocava un incremento di apoptosi nei monociti coltivati sia con GM-CSF che con GM-CSF e IL-4. La perifosina bloccava la produzione di TNF-�� nelle DC derivate da monociti coltivati nelle diverse condizioni. Questi risultati dimostrano che l���azione della rapamicina �� strettamente dipendente dalla presenza dell���IL-4 nel terreno di coltura, in vitro, rispetto alla perifosina e suggeriscono un possibile ruolo della perifosina nella prevenzione della GVHD prima del trapianto allogenico di cellule staminali.

Genetic and environmental factors associated with cardiovascular diseases and acute myocardial infarction

Acute myocardial infarction (AMI) is a multifactorial disease with a complex pathogenesis where lifestyle, individual genetic background and environmental risk factors are involved. Altered inflammatory responses seems to be implicated in the pathogenesis of atherosclerosis. To understand which genes may predispose to increased risk of cardiovascular disease gene polymorphism of immune regulatory genes, and clinical events from the Offs of parents with an early AMI were investigated. Genetics data from Offs were compared with those obtained from healthy subjects and an independent cohort of patients with clinical sporadic AMI. Rates of clinical events during a 24 years follow up from Offs and from an independent Italian population survey were also evaluated. This study showed that a genetic signature consisting of the concomitant presence of the CC genotype of VEGF, the A allele of IL-10 and the A allele of IFN-�� was indeed present in the Offs population. During the 24-year follow-up, Offs with a positive familiarity in spite of a relatively young age showed an increased prevalence of diabetes, ischemic heart disease and stroke. In these patients with the genetic signature the EBV and HHV-6 herpes virus were also investigated and founded. These findings reinforce the notion that subjects with a familial history of AMI are at risk of an accelerated aging of cardiovascular system resulting in cardiovascular events. These data suggest that selected genes with immune regulatory functions and envoronmental factors are part of the complex genetic background contributing to familiarity for cardiovascular diseases.N

Molecular characterization of human CD4+ IL-10-producing regulatory cells

Previous studies in the group led to the identification of CD4+FOXP3- cells with regulatory functions in human blood that coproduce IL-10 and IFN-gamma. These cells do not belong to the Treg cell lineage since they are Foxp3- but they show some similarities with Th1 cells since they express CCR5, T-bet and produce high levels of IFN-gamma. Thus, they share relevant characteristics with both T regulatory type I cells (Tr1) and Th1 cells and we called them Th1-10 cells. In this study we presented a molecular characterization of Th1-10 cells that includes a gene expression and a microRNA profiling and performed functional studies to assess Th1-10 cells regulatory properties. We demonstrated that Th1-10 cells have a high regulatory potential being able to block the proliferation of activated CD4 na��ve T cells to a similar extent as conventional Treg cells, and that this suppression capacity is at least partially mediated by secreted IL10. We showed also that Th1-10 cells are closely related to Th1 effector memory cells and express genes involved in cytotoxicity. In particular, they express the transcription factor EOMES and the cytotoxic effector molecules GZMA and GZMK, and they release cytotoxic granules upon stimulation. Moreover, we found that Eomes regulates cytotoxic functions in CD4+ T cells. We demonstrated that miR-92a, selectively downregulated in Th1-10 cells, directly targets the 3���UTR of EOMES.and this finding identifies miR-92a as a possible mediator of Th1-10 cytotoxicity. Th1-10 cells retain some proliferative capacity when sorted ex vivo and activated in vitro via their TCR, and this effect is markedly enhanced by IL-15, which also had a pro-survival effect on Th-10 cells. Thus, in contrast to conventional cytotoxic T cells, Th1-10 cells have cytotoxic and regulatory functions and are not terminally differentiated, since they retain proliferative capacity.

Accuracy of liver stiffness measurement using fibroscan �� to predict the response to antiviral therapy in patients with chronic hepatitis c viral infection

Introduction: Antiviral therapy can prevent disease progression in patients with chronic hepatitis C . Transient Elastografy (TE; Fibroscan) is an accurate surrogate marker to liver fibrosis, by measuring liver stiffness (LS). LS decrease has been associated with sustained virologic response (SVR). Aim: to assess the changes of LS measurments in CHC patients during and one year after Interferon (IFN)-based antiviral therapy (IFN/ribavirin) or (telaprevir+IFN/ribavirin). Methods: consecutive 69 CHC patients (53.6% females, mean age 57.9 �� 11.4) who underwent antiviral therapy for at least 20 weeks were enrolled. LS was measured using FibroScan at baseline, after three months, at the end of treatment and one year after treatment discontinuation. Fibrosis was graded using METAVIR score. Results: twenty patients treated with triple therapy and 49 with IFN/ribavirin. Fifty patients had SVR and 19 were non-responders. SVR patients: F0-F1, F2 and F3 patients (39.1%, 7.2% and 17.4%; respectively) showed no significant LS decrease (P= 0.186, 0.068 and 0.075; respectively). Conversely, in F4 patients (36.2%) LS was significantly decreased (P=0.015) after one year of treatment completion. In all patients with no SVR, no significant decrease in LS was observed. Interestingly, all Patients with F4 fibrosis (even non-responders) showed an initial significant decrease in LS (P=0.024) at 3 months after the start of treatment. However, this decrease was not predictive of SVR; area under the ROC curve 0.369 (CI %: 0.145-0.592) P= 0.265. Conclusion: Our study showed that initial decrease in LSM, especially in patients with higher baseline fibrosis score is unlikely to predict an SVR. In addition no significant association was found between clinical or virological parameters and fibrosis improvement. Further studies are needed to delineate the most appropriate clinical scenarios for the LSM by Fibroscan in chronic hepatitis C and its role in monitoring the response to antiviral treatment.

Lo sviluppo di disturbi psichiatrici in pazienti hcv+ sottoposti a terapia antivirale: L'impatto dei nuovi farmaci

Introduzione:l���interferone (IFN) usato per l���eradicazione del virus dell���Epatite C, induce effetti collaterali anche riferibili alla sfera psichica. I dati sugli eventi avversi di tipo psichiatrico dei nuovi farmaci antivirali (DAA) sono limitati. Lo scopo di questo studio �� di valutare lo sviluppo di effetti collaterali di tipo psichiatrico in corso di due distinti schemi di trattamento: IFN-peghilato e ribavirina [terapia duplice (standard o SOC)]; DAA in associazione a IFN-peghilato e ribavirina (terapia triplice). Metodi: pazienti HCV+ consecutivi seguiti presso l���Ambulatorio delle Epatiti Croniche della Semeiotica Medica del Dipartimento di Scienze Mediche e Chirurgiche dell���Universit�� di Bologna in procinto di intraprendere un trattamento antivirale a base di IFN, sottoposti ad esame psicodiagnostico composto da intervista clinica semistrutturata e test autosomministrati: BDI, STAXI-2, Hamilton Anxiety Scale, MMPI ��� 2. Risultati: Sono stati arruolati 84 pazienti, 57/84 (67.9%) nel gruppo in triplice e 27/84 nel gruppo SOC. Quasi tutti i pazienti arruolati hanno eseguito l���intervista clinica iniziale (82/84; 97.6%), mentre scarsa �� stata l���aderenza ai test (valori missing>50%). Ad eccezione dell���ansia, la prevalenza di tutti gli altri disturbi (irritabilit��, astenia, disfunzioni neurocognitive, dissonnia) aumentava in corso di trattamento. In corso di terapia antivirale 43/84 (51.2%) hanno avuto bisogno di usufruire del servizio di consulenza psichiatrica e 48/84 (57.1%) hanno ricevuto una psicofarmacoterapia di supporto, senza differenze significative fra i due gruppi di trattamento. Conclusioni : uno degli elementi pi�� salienti dello studio �� stata la scarsa aderenza ai test psicodiagnostici, nonostante l���elevata prevalenza di sintomi psichiatrici. I risultati di questo studio oltre ad evidenziare l���importanza dei sintomi psichiatrici in corso di trattamento e la rilevanza della consulenza psicologica e psichiatrica per consentire di portare a termine il ciclo terapeutico previsto (migliorandone l���efficacia), ha anche dimostrato che occorre ripensare gli strumenti diagnostici adattandoli probabilmente a questo specifico target.

Characterization of West Nile virus strains isolated in Italy

West Nile virus (WNV) is a neurotropic flavivirus that is maintained in an enzootic cycle between mosquitoes and birds, but can also infect and cause disease in humans and other vertebrate species. Most of WNV infections in humans are asymptomatic, but approximately 20% of infected people develop clinical symptoms, although severe neurological diseases are observed in less than 1% of them. WNV is the most widely distributed arbovirus in the world and has been recently associated with outbreaks of meningo-encephalitis in Europe, including Italy, caused by different viral strains belonging to distinct lineages 1 and 2. The hypothesis is that genetic divergence among viral strains currently circulating in Italy might reflect on their pathogenic potential and that the rapid spread of WNV with increased pathogenicity within na��ve population suggest that epidemic forms of the virus may encode mechanisms to evade host immunity. Infection with WNV triggers a delayed host response that includes a delay in the production of interferon-�� (IFN-��). IFNs are a family of immuno-modulatory cytokines that are produced in response to virus infection and serve as integral signal initiators of host intracellular defenses. The increased number of human cases and the lack of data about virulence of European WNV isolates highlight the importance to achieve a better knowledge on this emerging viral infection. In the present study, we investigate the phenotypic and IFN-��-regulatory properties of different WNV lineage 1 and 2 strains that are circulating in Europe/Italy in two cell lines: Vero and 1321N1. We demonstrate that: Vero and 1321N1 cells are capable of supporting WNV replication where different WNV strains show similar growth kinetics; WNV lineage 2 strain replicated in Vero and 1321N1 cells as efficiently as WNV lineage 1 strains; and both lineages 1 and 2 were highly susceptible to the antiviral actions of IFN-��.

Serum anti-interferon alpha antibodies in chronic hepatitis C patients treated with pegylated interferon alpha containing therapy

The development of anti-IFN�� antibodies is an occurrence described in chronic hepatitis C patients during treatment with Interferon��/PEG-Interferon��. However, its relevance, especially in difficult-to treat patients, has not been defined. Methods: We retrospectively measured the serum levels of anti-IFN�� antibodies (baseline and week 12) and IFN�� levels (week 12) by ELISA in 76 previous non-responders, and in 14 naive patients treated with Pegylated-IFN�� and Ribavirin. A group of 57 healthy donors (HD) was also assessed as control. Positivity to anti-IFN�� antibodies was established on the values of HD. Results: Baseline anti-IFN�� antibodies were detected in 15.5% of patients and in 7% of HD, with significantly higher concentrations in patients than HD (181.5��389.9 vs 95.9��143.0 ng mL���1, p=0.0023). All positive patients were IFN��-experienced. At week 12, the prevalence of positivity increased to 22.3 and 28.5% in experienced and na��ve patients, respectively, and the levels of anti-IFN�� antibodies did not differ between the two groups (391��792.3 vs 384.7��662.6 ng mL���1, respectively). IFN�� concentrations were significantly lower in antibody-positive patients than in antibody-negatives (988.2��1402 vs 3462��830.8 pg mL���1, p���0.0001) and the levels of antibodies and IFN�� were inversely correlated (r=-0.405, p=0.0001). The antibody-positive population clustered in null responders (67%) and 19/21 patients (90%) did not achieve SVR. Conclusions: The development of anti-IFN�� antibodies is a non-negligible occurrence in patients treated with PEG-IFN��, is stable over time, and has a relevant clinical impact when associated with low levels of circulating PEG-IFN��. It should be considered in patients undergoing treatments including PEG-IFN��.