L'associazione Tipifarnib-Bortezomib nel trattamento delle leucemie acute mieloidi: risultati di uno studio multicentrico di fase I/II e validazione di un profilo genico predittivo di risposta

Background. Outcome of elderly acute myeloid leukemia (AML) patients is dismal. Targeted-therapies might improve current results by overcoming drug-resistance and reducing toxicity. Aim. We conduced a phase II study aiming to assess efficacy and toxicity of Tipifarnib (Zarnestra®) and Bortezomib (Velcade®) association in AML patients >18 years, unfit for conventional therapy, or >60 years, in relapse. Furthermore, we aimed to evaluated the predictive value of the RASGRP1/APTX ratio, which was previously found to be associated to treatment sensitivity in patients receiving Zarnestra alone. Methods. Velcade (1.0 mg/m2) was administered as weekly infusion for 3 weeks (days 1, 8, 15). Zarnestra was administered at dose of 300-600 mg BID for 21 consecutive days. Real-time quantitative-PCR (q-PCR) was used for RASGRP1/APTX quantification. Results. 50 patients were enrolled. Median age was 71 years (56-89). 3 patients achieved complete remission (CR) and 1 partial response (PR). 2 patients obtained an hematological improvement (HI), and 3 died during marrow aplasia. 10 had progressive disease (PD) and the remaining showed stable disease (SD). RASGRP1/APTX was evaluated before treatment initiation on bone marrow (BM) and/or peripheral blood (PB). The median RASGRP/APTX value on BM was higher in responder (R) patients than in non responders (NR) ones, respectively (p=0.006). Interestingly, no marrow responses were recorded in patients with BM RASGRP1/APTX ratio <12, while the response rate was 50% in patients with ratio >12. Toxicity was overall mild, the most common being febrile neutropenia. Conclusion. We conclude that the clinical efficacy of the combination Zarnestra-Velcade was similar to what reported for Zarnestra alone. However we could confirm that the RASGPR1/APTX level is an effective predictor of response. Though higher RASGRP1/APTX is relatively rare (~10% of cases), Zarnestra (±Velcade) may represent an important option in a subset of high risk/frail AML patients.

Il Nilotinib nella terapia di prima linea della leucemia mieloide cronica

Background: Nilotinib is a potent and selective BCR-ABL inhibitor. The phase 3 ENESTnd trial demonstrated superior efficacy nilotinib vs imatinib, with higher and faster molecular responses. After 24 months, the rates of progression to accelerated-blastic phase (ABP) were 0.7% and 1.1% with nilotinib 300mg and 400mg BID, respectively, significantly lower compared to imatinib (4.2%). Nilotinib has been approved for the frontline treatment of Ph+ CML. With imatinib 400mg (IRIS trial), the rate of any event and of progression to ABP were higher during the first 3 years. Consequently, a confirmation of the durability of responses to nilotinib beyond 3 years is extremely important. Aims: To evaluate the response and the outcome of patients treated for 3 years with nilotinib 400mg BID as frontline therapy. Methods: A multicentre phase 2 trial was conducted by the GIMEMA CML WP (ClinicalTrials.gov.NCT00481052). Minimum 36-month follow-up data for all patients will be presented. Definitions: Major Molecular Response (MMR): BCR-ABL/ABL ratio <0,1%IS; Complete Molecular Response (CMR): undetectable transcript levels with ≥10,000 ABL transcripts; failures: according to the revised ELN recommendations; events: failures and treatment discontinuation for any reason. All the analysis has been made according to the intention-to-treat principle. Results: 73 patients enrolled: median age 51 years; 45% low, 41% intermediate and 14% high Sokal risk. The cumulative incidence of CCgR at 12 months was 100%. CCgR at each milestone: 78%, 96%, 96%, 95%, 92% at 3, 6, 12, 18 and 24 months, respectively. The overall estimated probability of MMR was 97%, while the rates of MMR at 3, 6, 12, 18 and 24 months were 52%, 66%, 85%, 81% and 82%, respectively. The overall estimated probability of CMR was 79%, while the rates of CMR at 12 and 24 months were 12% and 27%, respectively. No patient achieving a MMR progressed to AP. Only one patient progressed at 6 months to ABP and subsequently died (high Sokal risk, T315I mutation). Adverse events were mostly grade 1 or 2 and manageable with appropriate dose adaptations. During the first 12 months, the mean daily dose was 600-800mg in 74% of patients. The nilotinib last daily dose was as follows: 800mg in 46 (63%) patients, 600mg in 3 (4%) patients and 400mg in 18 (25%), 6 permanent discontinuations. Detail of discontinuation: 1 patient progressed to ABP; 3 patients had recurrent episodes of amylase and/or lipase increase (no pancreatitis); 1 patient had atrial fibrillation (unrelated to study drug) and 1 patient died after 32 months of mental deterioration and starvation (unrelated to study drug). Two patients are currently on imatinib second-line and 2 on dasatinib third-line. With a median follow-up of 39 months, the estimated probability of overall survival, progression-free survival and failure-free survival was 97%, the estimated probability of event-free survival was 91%. Conclusions: The rate of failures was very low during the first 3 years. Responses remain stable. The high rates of responses achieved during the first 12 months are being translated into optimal outcome for most of patients.

Early-type galaxies as probes of galaxy formation and cosmology

The goal of this thesis is to analyze the possibility of using early-type galaxies to place evolutionary and cosmological constraints, by both disentangling what is the main driver of ETGs evolution between mass and environment, and developing a technique to constrain H(z) and the cosmological parameters studying the ETGs age-redshift relation. The (U-V) rest-frame color distribution is studied as a function of mass and environment for two sample of ETGs up to z=1, extracted from the zCOSMOS survey with a new selection criterion. The color distributions and the slopes of the color-mass and color-environment relations are studied, finding a strong dependence on mass and a minor dependence on environment. The spectral analysis performed on the D4000 and Hδ features gives results validating the previous analysis. The main driver of galaxy evolution is found to be the galaxy mass, the environment playing a subdominant but non negligible role. The age distribution of ETGs is also analyzed as a function of mass, providing strong evidences supporting a downsizing scenario. The possibility of setting cosmological constraints studying the age-redshift relation is studied, discussing the relative degeneracies and model dependencies. A new approach is developed, aiming to minimize the impact of systematics on the “cosmic chronometer” method. Analyzing theoretical models, it is demonstrated that the D4000 is a feature correlated almost linearly with age at fixed metallicity, depending only minorly on the models assumed or on the SFH chosen. The analysis of a SDSS sample of ETGs shows that it is possible to use the differential D4000 evolution of the galaxies to set constraints to cosmological parameters in an almost model-independent way. Values of the Hubble constant and of the dark energy EoS parameter are found, which are not only fully compatible, but also with a comparable error budget with the latest results.

Multiscale fabrication of functional materials for life sciences

Regenerative medicine claims for a better understanding of the cause-effect relation between cell behaviour and environment signals. The latter encompasses topographical, chemical and mechanical stimuli, electromagnetic fields, gradients of chemo-attractants and haptotaxis. In this perspective, a spatial control of the structures composing the environment is required. In this thesis I describe a novel approach for the multiscale patterning of biocompatible functional materials in order to provide systems able to accurately control cell adhesion and proliferation. The behaviour of different neural cell lines in response to several stimuli, specifically chemical, topographical and electrical gradients is presented. For each of the three kind of signals, I chose properly tailored materials and fabrication and characterization techniques. After a brief introduction on the state of art of nanotechnology, nanofabrication techniques and regenerative medicine in Chapter 1 and a detailed description of the main fabrication and characterization techniques employed in this work in Chapter 2, in Chapter 3 an easy route to obtain accurate control over cell proliferation close to 100% is described (chemical control). In Chapter 4 (topographical control) it is shown how the multiscale patterning of a well-established biocompatible material as titanium dioxide provides a versatile and robust method to study the effect of local topography on cell adhesion and growth. The third signal, viz. electric field, is investigated in Chapter 5 (electrical control), where the very early stages of neural cell adhesion are studied in the presence of modest steady electric fields. In Chapter 6 (appendix) a new patterning technique, called Lithographically Controlled Etching (LCE), is proposed. It is shown how LCE can provide at the same time the micro/nanostructuring and functionalization of a surface with nanosized objects, thus being suitable for applications both in regenerative medicine in biosensing.

Nuovi processi catalitici per la sintesi di prodotti ad attività farmacologica

The transition metal-catalyzed allylic alkylation (Tsuji-Trost type reaction) is a powerful tool for C-C, C-N, and C-O bond formation, which has been widely applied to organic chemistry over the last decades. Typical substrates for this transformation are activated allylic compounds such as halides, esters, carbonates, carbamates, phosphates, and so on. However, use of these substrates is associated with the disadvantage of generating a stoichiometric amount of chemical waste. Furthermore, these starting materials have to be prepared in an extra step from the corresponding allylic alcohol. Thus, ideal substrates would be the allylic alcohols themselves, with water being the only byproduct in this case. However, the scarse propensity of the hydroxyl moiety to act as good leaving group has significantly limited their use so far. During the last decade significant efforts have been made in order to develop more atom-economical and environmentally-friendly allylic alkylation protocols by employing allylic alcohols directly. In this PhD dissertation two main projects addressing this topic are presented. “Project 1” deals with the development of new metal-catalyzed intramolecular Friedel-Crafts (FC) allylic alkylations of electron-rich (PAPER A), as well as challenging electron-poor arenes (PAPER B) with alcohols. In “Project 2”, gold(I)-catalyzed intramolecular and stereoselective allylic alkylation reactions are reported. In particular, a FC alkylation of indole-containing allylic alcohols is presented in PAPER C. While, an O-alkylation of aminol-containing allylic alcohols is reported in PAPER D. To the best of knowledge, these reports represent the first example of gold(I)-catalyzed stereoselective alkylations with alcohols.

Prove accelerate per la verifica strutturale di trattrici agricole

The needs of customers to improve machinery in recent years have driven tractor manufacturers to reduce product life and development costs. The most significant efforts have concentrated on the attempt to decrease the costs of the experimental testing sector. The validation of the tractor prototypes are presently performed with a replication of a particularly unfavourable condition a defined number of times. These laboratory tests do not always faithfully reproduce the real use of the tractor. Therefore, field tests are also carried out to evaluate the prototype during real use, but it is difficult to perform such tests for a period of time long enough to reproduce tractor life usage. In this context, accelerated tests have been introduced in the automotive sector, producing a certain damage to the structure in a reduced amount of time. The goal of this paper is to define a methodology for the realization of accelerated structural tests on a tractor, through the reproduction of real customer tractor usage. A market analysis was performed on a 80 kW power tractor and a series of measures were then taken to simulate the real use of the tractor. Subsequently, the rainflow matrixes of the signals were extrapolated and used to estimate the tractor loadings for 10 years of tractor life. Finally these loadings were reproduced on testing grounds with special road pavements. The results obtained highlight the possibility of reproducing field loadings during road driving on proving grounds (PGs), but the use of two field operations is also necessary. The global acceleration factor obtained in this first step of the methodology is equal to three.

Espressione dell'Enzima ad Azione Immunoregolatoria Indoleamina 2,3-Diossigenasi nella Leucemia Mieloide Acuta dell'Adulto: correlazioni Clinico-Biologiche

L’enzima IDO interviene nella via di degradazione del triptofano, essenziale per la vita cellulare; l’iperespressione di IDO favorisce la creazione di un microambiente immunotollerante. Nelle LAM IDO è funzionalmente attivo nelle cellule blastiche e determina l’acquisizione di un fenotipo regolatorio da parte delle cellule T alloreattive; l’espressione della proteina aumenta in modo consensuale con l’evoluzione clinica della patologia. Scopo della Tesi è indagare l’esistenza di una correlazione tra l’iperespressione di IDO da parte delle cellule leucemiche, le caratteristiche di rischio alla diagnosi e l’outcome dei pazienti. Sono stati esaminati 45 pazienti adulti affetti da LAM afferiti all’Istituto di Ematologia di Bologna. I pazienti sono stati stratificati a seconda di: età di insorgenza della leucemia, secondarietà a Mielodisplasia o radio chemioterapia, iperleucocitosi, citogenetica, biologia molecolare (sono state valutate le alterazioni a carico dei geni FLT3 ed NPM). I pazienti sono stati analizzati per l’espressione del gene IDO mediante RT-PCR, seguita da Western Blot, allo scopo di stabilire la presenza di una proteina attiva; successivamente si è proceduto a verificare l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi per identificare una relazione tra l’espressione del gene ed un subset di pazienti a prognosi favorevole o sfavorevole. Dei 45 pazienti adulti affetti da LAM il 28,9% è risultato negativo per l’espressione di IDO, mentre il rimanente 71,1% è risultato positivo ed è stato suddiviso in tre ulteriori categorie, in base ai livelli di espressione. I dati non sembrano al momento suggerire l’esistenza di una correlazione tra l’espressione di IDO e le caratteristiche di rischio alla diagnosi. Nel gruppo di pazienti ad elevata espressione di IDO si riscontra un rate di resistenza alla chemioterapia di induzione più elevato, con una quota di pazienti resistenti pari al 71,4%, contro il 23,1% nel gruppo di pazienti IDO-negativi.

L'area dei Lungarni di Pisa nel tardo Medioevo (XIV-XV secolo). un tentativo di ricostruzione in 3D.

Lo scopo di questa ricerca è la ricostruzione dei Lungarni di Pisa nel Tardo Medioevo (XIV-XV secolo); lo studio intende sottolineare le trasformazioni urbanistiche che hanno cambiato il volto di Pisa nel corso del tempo e ricordare che l’area fluviale ebbe un ruolo di primo piano come baricentro commerciale ed economico della città, vocazione che si è in gran parte persa con l’età moderna e contemporanea. La metodologia seguita, affinata e perfezionata durante la partecipazione al progetto Nu.M.E. (Nuovo Museo Elettronico della Città di Bologna), si basa sull’analisi e il confronto di fonti eterogenee ma complementari, che includono precedenti studi di storia dell’urbanistica, un corpus di documentazione di epoca medievale (provvedimenti amministrativi come gli Statuti del Comune di Pisa, ma anche descrizioni di cronisti e viaggiatori), fonti iconografiche, tra cui vedute e mappe cinquecentesche o successive, e fonti materiali, come le persistenze medievali ancora osservabili all’interno degli edifici ed i reperti rinvenuti durante alcune campagne di scavo archeologiche. Il modello 3D non è concepito come statico e “chiuso”, ma è liberamente esplorabile all’interno di un engine tridimensionale; tale prodotto può essere destinato a livelli di utenza diversi, che includono sia studiosi e specialisti interessati a conoscere un maggior numero di informazioni e ad approfondire la ricerca, sia semplici cittadini appassionati di storia o utenti più giovani, come studenti di scuole medie superiori e inferiori.

Modulation of hypoxia-inducible factors as a therapeutic target for multiple myeloma

Hypoxia-inducible factor-1 alpha (HIF-1α) plays a critical role in survival and is associated with poor prognosis in solid tumors. The role of HIF-1α in multiple myeloma is not completely known. In the present study, we explored the effect of EZN2968, an locked nucleic acid antisense oligonucleotide against HIF-1α, as a molecular target in MM. A panel of MM cell lines and primary samples from MM patients were cultured in vitro in the presence of EZN2968 . Under normoxia culture condition, HIF-1α mRNA and protein expression was detectable in all MM cell lines and in CD138+ cells from newly diagnosed MM patients samples. Significant up-regulation of HIF-1α protein expression was observed after incubation with IL6 or IGF-I, confirming that HIF-1α can be further induced by biological stimuli. EZN2968 efficiently induces a selective and stable down-modulation of HIF-1α and decreased the secretion of VEGF released by MM cell. Treatment with EZN2968 gave rise to a progressive accumulation of cells in the S and subG0 phase. The analysis of p21, a cyclin-dependent kinase inhibitors controlling cell cycle check point, shows upregulation of protein levels. These results suggest that HIF-1α inhibition is sufficient for cell cycle arrest in normoxia, and for inducing an apoptotic pathways.. In the presence of bone marrow microenvironment, HIF-1α inhibition blocks MAPK kinase pathway and secretion of pro-surviaval cytokines ( IL6,VEGF,IL8) In this study we provide evidence that HIF-1α, even in the absence of hypoxia signal, is expressed in MM plasma cells and further inducible by bone marrow milieu stimuli; moreover its inhibition is sufficient to induce a permanent cell cycle arrest. Our data support the hypothesis that HIF-1α inhibition may suppress tumor growth by preventing proliferation of plasma cells through p21 activation and blocking pro-survival stimuli from bone marrow microenvironment.

Ricerca sulle Caratteristiche di Filtrabilità della Birra e Ottimizzazione del Processo di Filtrazione

Il presente lavoro ha avuto lo scopo di identificare le caratteristiche di filtrabilità della birra attraverso lo svolgimento di prove tecnologiche di filtrazione in scala di laboratorio e su scala pilota, utilizzando diverse tipologie di sistemi filtranti e sperimentando diversi materiali di membrana. La fase preliminare della caratterizzazione della filtrabilità della birra è stata condotta presso i laboratori del Campden-BRI – The Brewing Research International, Inghilterra, mentre le prove tecnologiche su scala pilota si sono svolte presso il CERB – Centro di Eccellenza per la Ricerca sulla Birra. Le prove di filtrazione e le analisi sui campioni hanno permesso di verificare le performance delle diverse membrane utilizzate in risposta alla variazione dei principali parametri del processo di filtrazione tangenziale. Sono stati analizzati diversi parametri di qualità della birra filtrata attraverso il monitoraggio del processo e lo svolgimento di prove analitiche sul prodotto volte ad evidenziare gli effetti delle differenti tecnologie adottate. Per quanto riguarda le prove di laboratorio per la caratterizzazione della filtrabilità della birra, l’analisi della PCS (Photon Correlation Spectroscopy) è stata utilizzata per verificare l’influenza di diversi trattamenti enzimatici sulla efficienza del processo di filtrazione e la loro influenza sulla stabilità colloidale della birra filtrata. Dai risultati ottenuti è emerso che il PCS è un valido strumento per determinare la distribuzione in classi di diametro e il diametro medio effettivo delle particelle solide in sospensione nella birra e può essere utilizzato sia per predire la stabilità della birra filtrata, sia per monitorare il processo di filtrazione in tempo reale.