Alterazioni dell'immunità umorale nei pazienti con sarcoma di Kaposi classico: caratterizzazione dei linfociti B circolanti e delle loro sottopopolazioni

Objectives: Human Herpesvirus 8 (HHV-8) is the etiological agent of Kaposi’s Sarcoma (KS) and it is also associated with two B cell lymphoproliferative diseases: primary effusion lymphoma (PEL), and the plasmablastic form of multicentric Castelman’s disease (MCD). HHV-8 establishes persistent infection in the host with tropism for multiple cell types. In KS patients, the virus is found in tumor-spindle cells, peripheral blood monocytes, endothelial progenitor circulating cells, T and B lymphocytes. Peripheral B cells represent one of the major virus reservoir, but the consequences of HHV-8 infection of these cells have been poorly characterized. Therefore, in this study the frequency, the immunophenotypic profile and the functional activity of different peripheral B cell subsets in patients with classic KS (cKS) was analysed in order to identify potential alterations of these cells. The classic variant of KS is ideal to perform such studies, as it lacks confounding factors such as HIV or EBV infection and immunosuppression. Methods: Whole-blood samples from patients with the classical form of KS (cKS) (n=62) and healthy age and sex-matched seronegative controls (HSN) (n=43) were analyzed by multiparametric flow-cytometry to determine the frequency of B cells and their subpopulations, as well as their surface expression of immunoglobulins and activation markers. Results: The frequency of circulating B cells was significantly higher in cKS patients than in controls. In particular, the analysis of the B cell subsets revealed a higher frequency of naïve B cells (CD19+CD27-), among which transitional CD19+CD38highCD5+ and pre-naïve (CD27-CD38intCD5+ ) B cells demonstrated an expansion. Memory B cells (CD19+CD27+) did not differ between the two study groups, except from a higher frequency of CD19+CD27+IgM+IgD+ B cells, the typical phenotype of marginal zone (MZ) B cells, in cKS patients. The characterization of membrane surface activation markers showed lower levels of the activation marker HLA-DR only on CD27- B cells, while CD80 and CD86 were less represented in all the the B cells from cKS patients. Moreover, B cells from cKS patients were smaller and with less granules than the ones from controls. Conclusion: Taken together, these results clearly indicate that circulating B cells are altered in patients with cKS, showing an expansion of the immature phenotypes. These B cell alterations may be due to an indirect viral effect rather than to a direct one: the cytokines expressed in the microenvironment typical of cKS may cause a faster release of immature cells from the bone marrow and a lower grade of peripheral differentiation, as already suggested for other chronic viral infections such as HIV and HCV. Further studies will be necessary to understand how these alterations contribute to the pathogenesis of KS and, eventually, to the different clinical evolution of the disease.

Role of SP-A gene polymorphism in lung transplantation

Lung transplantation is a widely accepted therapeutic option for end stage lung disease. Clinical outcome is yet challenged by primary graft failure responsible for the majority of the early mortality, by chronic allograft dysfunction and chronic rejection accounting for more than 30% of deaths after the third postoperative year. Pulmonary surfactant proteins (SP) A, B, C and D are one of the first host defense mechanisms the lung can mount. SP-A in particular, produced by the type II pneumocytes, is active in the innate and adaptive immune system being an opsonin, but also regulating the macrophage and lymphocyte response. The main hypothesis for this project is that pulmonary surfactant protein A polymorphism may determine the early and long term lung allograft survival. Of note SP-A biologic activity seems to be genetically determined and SP-A polymorphisms have been associated to various lung disease. The two SP-A genes SP-A1 and SP-A2 have several polymorphisms within the coding region, SP-A1 (6A, 6A2-20), and SP-A2(1A, 1A0-13). The SP-A gene expression is regulated by cAMP, TTF-1 and glucocorticoids. In vitro studies have indicated that SP-A1 and SP-A2 gene variants may have a variable response to glucocorticoids. We proposed to determine if SP-A gene polymorphism predicts primary graft dysfunction and/or chronic lung allograft dysfunction and if SP-A may serve as a biomarker of lung allograft dysfunction. We also proposed to study the interaction between immunosuppressive drugs and SP-A expression and determine whether this is dependent on SP-A polymorphisms. This study will generate novel information improving our understanding of lung allograft dysfunction. It is conceivable that the information will stimulate the interest for a multi centre study to investigate if SP-A polymorphism may be integrated in the donor lung selection criteria and/or to implement post transplant tailored immunosuppression.

Efficacia e sicurezza della profilassi anti-citomegalovirus rispetto alla strategia pre-sintomatica con valganciclovir in pazienti con trapianto di cuore trattati con everolimus o micofenolato

Il CMV è l’agente patogeno più frequente dopo trapianto (Tx) di cuore determinando sia sindromi cliniche organo specifiche sia un danno immunomediato che può determinare rigetto acuto o malattia coronarica cronica (CAV). I farmaci antivirali in profilassi appaiono superiori all’approccio pre-sintomatico nel ridurre gli eventi da CMV, ma l’effetto anti-CMV dell’everolimus (EVE) in aggiunta alla profilassi antivirale non è stato ancora analizzato. SCOPO DELLO STUDIO: analizzare l’interazione tra le strategie di profilassi antivirale e l’uso di EVE o MMF nell’incidenza di eventi CMV correlati (infezione, necessità di trattamento, malattia/sindrome) nel Tx cardiaco. MATERIALI E METODI: sono stati inclusi pazienti sottoposti a Tx cardiaco e trattati con EVE o MMF e trattamento antivirale di profilassi o pre-sintomatico. L’infezione da CMV è stata monitorata con antigenemia pp65 e PCR DNA. La malattia/sindrome da CMV è stato considerato l’endpoint principale. RISULTATI: 193 pazienti (di cui 10% D+/R-) sono stati inclusi nello studio (42 in EVE e 149 in MMF). Nel complesso, l’infezione da CMV (45% vs. 79%), la necessità di trattamento antivirale (20% vs. 53%), e la malattia/sindrome da CMV (2% vs. 15%) sono risultati significativamente più bassi nel gruppo EVE che nel gruppo MMF (tutte le P<0.01). La profilassi è più efficace nel prevenire tutti gli outcomes rispetto alla strategia pre-sintomatica nei pazienti in MMF (P 0.03), ma non nei pazienti in EVE. In particolare, i pazienti in EVE e strategia pre-sintomatica hanno meno infezioni da CMV (48 vs 70%; P=0.05), e meno malattia/sindrome da CMV (0 vs. 8%; P=0.05) rispetto ai pazienti in MMF e profilassi. CONCLUSIONI: EVE riduce significamene gli eventi correlati al CMV rispetto al MMF. Il beneficio della profilassi risulta conservato solo nei pazienti trattati con MMF mentre l’EVE sembra fornire un ulteriore protezione nel ridurre gli eventi da CMV senza necessità di un estensivo trattamento antivirale.