MicroRNAs expression analysis in high grade gliomas

Several biomarkers had been proposed as useful parameters to better define the prognosis or to delineate new target therapy strategies for glioblastoma (GBM) patients. MicroRNAs could represent interesting molecules, for their role in tumorigenesis and cancer progression and for their specific tissue expression. Although many studies have tried to identify a specific microRNAs signature for glioblastoma, by now an exhaustive GBM microRNAs profile is far to be well defined. In this work we set up a real-time qPCR, based on LNA primers, to investigate the expression of 19 microRNAs in brain tumors, focusing our attention on GBMs. MiRNAs expression in 30 GBM paired FFPE-Fresh/Frozen samples was firstly analyzed. The good correlation obtained comparing miRNAs results confirmed the feasibility of performing miRNAs analysis starting from FFPE tissues. This leads to many advantages, as a good disposal of archival tumor and normal brain specimens and the possibility to verify the percentage of tumor cells in the analyzed sample. In the second part we compared 3 non-neoplastic brain references to use as control in miRNAs analysis. Normal adjacent the tumor, epileptic specimens and a commercial total RNA were analyzed for miRNAs expression and results showed that different non-neoplastic controls could lead to important discrepancies in GBM miRNAs profiles. Analyzing 50 FFPE GBMs using all 3 non-neoplastic references, we defined a putative GBM miRNAs signature: mir-10b, miR-21 and miR-27a resulted upregulated, while miR-7, miR-9, miR-26a, miR-31, miR-101, miR-137, miR-222 and miR-330 were downregulated. Comparing miRNAs expression among GBM group and gliomas of grade I, II and III, we obtained 3 miRNAs (miR-10b, mir-34a and miR-101) showing a different regulation status between high grade and low grade gliomas. Intriguingly, miR-10b was upregulated in high grade and significantly downregulated in low grade gliomas, suggesting that could be a candidate for a GBM target therapy.

Metamorfismo ercinico di bassa-pressione: evoluzione tettonico-metamorfica del complesso di mandatoriccio (massiccio della Sila - Calabria)

Low-pressure/high-temperature (LP/HT) metamorphic belts are characterised by rocks that experienced abnormal heat flow in shallow crustal levels (T > 600 °C; P < 4 kbar) resulting in anomalous geothermal gradients (60-150 °C/km). The abnormal amount of heat has been related to crustal underplating of mantle-derived basic magmas or to thermal perturbation linked to intrusion of large volumes of granitoids in the intermediate crust. In particular, in this latter context, magmatic or aqueous fluids are able to transport relevant amounts of heat by advection, thus favouring regional LP/HT metamorphism. However, the thermal perturbation consequent to heat released by cooling magmas is responsible also for contact metamorphic effects. A first problem is that time and space relationships between regional LP/HT metamorphism and contact metamorphism are usually unclear. A second problem is related to the high temperature conditions reached at different crustal levels. These, in some cases, can completely erase the previous metamorphic history. Notwithstanding this problem is very marked in lower crustal levels, petrologic and geochronologic studies usually concentrate in these attractive portions of the crust. However, only in the intermediate/upper-crustal levels of a LP/HT metamorphic belt the tectono-metamorphic events preceding the temperature peak, usually not preserved in the lower crustal portions, can be readily unravelled. The Hercynian Orogen of Western Europe is a well-documented example of a continental collision zone with widespread LP/HT metamorphism, intense crustal anatexis and granite magmatism. Owing to the exposure of a nearly continuous cross-section of the Hercynian continental crust, the Sila massif (northern Calabria) represents a favourable area to understand large-scale relationships between granitoids and LP/HT metamorphic rocks, and to discriminate regional LP/HT metamorphic events from contact metamorphic effects. Granulite-facies rocks of the lower crust and greenschist- to amphibolite-facies rocks of the intermediate-upper crust are separated by granitoids emplaced into the intermediate level during the late stages of the Hercynian orogeny. Up to now, advanced petrologic studies have been focused mostly in understanding P-T evolution of deeper crustal levels and magmatic bodies, whereas the metamorphic history of the shallower crustal levels is poorly constrained. The Hercynian upper crust exposed in Sila has been subdivided in two different metamorphic complexes by previous authors: the low- to very low-grade Bocchigliero complex and the greenschist- to amphibolite-facies Mandatoriccio complex. The latter contains favourable mineral assemblages in order to unravel the tectono-metamorphic evolution of the Hercynian upper crust. The Mandatoriccio complex consists mainly of metapelites, meta-arenites, acid metavolcanites and metabasites with rare intercalations of marbles and orthogneisses. Siliciclastic metasediments show a static porphyroblastic growth mainly of biotite, garnet, andalusite, staurolite and muscovite, whereas cordierite and fibrolite are less common. U-Pb ages and internal features of zircons suggest that the protoliths of the Mandatoriccio complex formed in a sedimentary basin filled by Cambrian to Silurian magmatic products as well as by siliciclastic sediments derived from older igneous and metamorphic rocks. In some localities, metamorphic rocks are injected by numerous aplite/pegmatite veins. Small granite bodies are also present and are always associated to spotted schists with large porphyroblasts. They occur along a NW-SE trending transcurrent cataclastic fault zone, which represents the tectonic contact between the Bocchigliero and the Mandatoriccio complexes. This cataclastic fault zone shows evidence of activity at least from middle-Miocene to Recent, indicating that brittle deformation post-dated the Hercynian orogeny. P-T pseudosections show that micaschists and paragneisses of the Mandatoriccio complex followed a clockwise P-T path characterised by four main prograde phases: thickening, peak-pressure condition, decompression and peak-temperature condition. During the thickening phase, garnet blastesis started up with spessartine-rich syntectonic core developed within micaschists and paragneisses. Coevally (340 ± 9.6 Ma), mafic sills and dykes injected the upper crustal volcaniclastic sedimentary sequence of the Mandatoriccio complex. After reaching the peak-pressure condition (≈4 kbar), the upper crust experienced a period of deformation quiescence marked by the static overgrowths of S2 by Almandine-rich-garnet rims and by porphyroblasts of biotite and staurolite. Probably, this metamorphic phase is related to isotherms relaxation after the thickening episode recorder by the Rb/Sr isotopic system (326 ± 6 Ma isochron age). The post-collisional period was mainly characterised by decompression with increasing temperature. This stage is documented by the andalusite+biotite coronas overgrown on staurolite porphyroblasts and represents a critical point of the metamorphic history, since metamorphic rocks begin to record a significant thermal perturbation. Peak-temperature conditions (≈620 °C) were reached at the end of this stage. They are well constrained by some reaction textures and mineral assemblages observed almost exclusively within paragneisses. The later appearance of fibrolitic sillimanite documents a small excursion of the P-T path across the And-Sil boundary due to the heating. Stephanian U-Pb ages of monazite crystals from the paragneiss, can be related to this heating phase. Similar monazite U-Pb ages from the micaschist combined with the lack of fibrolitic sillimanite suggest that, during the same thermal perturbation, micaschists recorded temperatures slightly lower than those reached by paragneisses. The metamorphic history ended with the crystallisation of cordierite mainly at the expense of andalusite. Consequently, the Ms+Bt+St+And+Sill+Crd mineral assemblage observed in the paragneisses is the result of a polyphasic evolution and is characterised by the metastable persistence of the staurolite in the stability fields of the cordierite. Geologic, geochronologic and petrographic data suggest that the thermal peak recorded by the intermediate/upper crust could be strictly connected with the emplacement of large amounts of granitoid magmas in the middle crust. Probably, the lithospheric extension in the relatively heated crust favoured ascent and emplacement of granitoids and further exhumation of metamorphic rocks. After a comparison among the tectono-metamorphic evolutions of the different Hercynian crustal levels exposed in Sila, it is concluded that the intermediate/upper crustal level offers the possibility to reconstruct a more detailed tectono-metamorphic history. The P-T paths proposed for the lower crustal levels probably underestimate the amount of the decompression. Apart from these considerations, the comparative analysis indicates that P-T paths at various crustal levels in the Sila cross section are well compatible with a unique geologic scenario, characterized by post-collisional extensional tectonics and magmas ascent.

Biochemistry in healthy and neoplastic human tissues: metabolic alteration revealed by HR-MAS nuclear magnetic resonance spectroscopy

This thesis is focused on the metabolomic study of human cancer tissues by ex vivo High Resolution-Magic Angle Spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy. This new technique allows for the acquisition of spectra directly on intact tissues (biopsy or surgery), and it has become very important for integrated metabonomics studies. The objective is to identify metabolites that can be used as markers for the discrimination of the different types of cancer, for the grading, and for the assessment of the evolution of the tumour. Furthermore, an attempt to recognize metabolites, that although involved in the metabolism of tumoral tissues in low concentration, can be important modulators of neoplastic proliferation, was performed. In addition, NMR data was integrated with statistical techniques in order to obtain semi-quantitative information about the metabolite markers. In the case of gliomas, the NMR study was correlated with gene expression of neoplastic tissues. Chapter 1 begins with a general description of a new “omics” study, the metabolomics. The study of metabolism can contribute significantly to biomedical research and, ultimately, to clinical medical practice. This rapidly developing discipline involves the study of the metabolome: the total repertoire of small molecules present in cells, tissues, organs, and biological fluids. Metabolomic approaches are becoming increasingly popular in disease diagnosis and will play an important role on improving our understanding of cancer mechanism. Chapter 2 addresses in more detail the basis of NMR Spectroscopy, presenting the new HR-MAS NMR tool, that is gaining importance in the examination of tumour tissues, and in the assessment of tumour grade. Some advanced chemometric methods were used in an attempt to enhance the interpretation and quantitative information of the HR-MAS NMR data are and presented in chapter 3. Chemometric methods seem to have a high potential in the study of human diseases, as it permits the extraction of new and relevant information from spectroscopic data, allowing a better interpretation of the results. Chapter 4 reports results obtained from HR-MAS NMR analyses performed on different brain tumours: medulloblastoma, meningioms and gliomas. The medulloblastoma study is a case report of primitive neuroectodermal tumor (PNET) localised in the cerebellar region by Magnetic Resonance Imaging (MRI) in a 3-year-old child. In vivo single voxel 1H MRS shows high specificity in detecting the main metabolic alterations in the primitive cerebellar lesion; which consist of very high amounts of the choline-containing compounds and of very low levels of creatine derivatives and N-acetylaspartate. Ex vivo HR-MAS NMR, performed at 9.4 Tesla on the neoplastic specimen collected during surgery, allows the unambiguous identification of several metabolites giving a more in-depth evaluation of the metabolic pattern of the lesion. The ex vivo HR-MAS NMR spectra show higher detail than that obtained in vivo. In addition, the spectroscopic data appear to correlate with some morphological features of the medulloblastoma. The present study shows that ex vivo HR-MAS 1H NMR is able to strongly improve the clinical possibility of in vivo MRS and can be used in conjunction with in vivo spectroscopy for clinical purposes. Three histological subtypes of meningiomas (meningothelial, fibrous and oncocytic) were analysed both by in vivo and ex vivo MRS experiments. The ex vivo HR-MAS investigations are very helpful for the assignment of the in vivo resonances of human meningiomas and for the validation of the quantification procedure of in vivo MR spectra. By using one- and two dimensional experiments, several metabolites in different histological subtypes of meningiomas, were identified. The spectroscopic data confirmed the presence of the typical metabolites of these benign neoplasms and, at the same time, that meningomas with different morphological characteristics have different metabolic profiles, particularly regarding macromolecules and lipids. The profile of total choline metabolites (tCho) and the expression of the Kennedy pathway genes in biopsies of human gliomas were also investigated using HR-MAS NMR, and microfluidic genomic cards. 1H HR-MAS spectra, allowed the resolution and relative quantification by LCModel of the resonances from choline (Cho), phosphorylcholine (PC) and glycerolphorylcholine (GPC), the three main components of the combined tCho peak observed in gliomas by in vivo 1H MRS spectroscopy. All glioma biopsies depicted an increase in tCho as calculated from the addition of Cho, PC and GPC HR-MAS resonances. However, the increase was constantly derived from augmented GPC in low grade NMR gliomas or increased PC content in the high grade gliomas, respectively. This circumstance allowed the unambiguous discrimination of high and low grade gliomas by 1H HR-MAS, which could not be achieved by calculating the tCho/Cr ratio commonly used by in vivo 1H MR spectroscopy. The expression of the genes involved in choline metabolism was investigated in the same biopsies. The present findings offer a convenient procedure to classify accurately glioma grade using 1H HR-MAS, providing in addition the genetic background for the alterations of choline metabolism observed in high and low gliomas grade. Chapter 5 reports the study on human gastrointestinal tract (stomach and colon) neoplasms. The human healthy gastric mucosa, and the characteristics of the biochemical profile of human gastric adenocarcinoma in comparison with that of healthy gastric mucosa were analyzed using ex vivo HR-MAS NMR. Healthy human mucosa is mainly characterized by the presence of small metabolites (more than 50 identified) and macromolecules. The adenocarcinoma spectra were dominated by the presence of signals due to triglycerides, that are usually very low in healthy gastric mucosa. The use of spin-echo experiments enable us to detect some metabolites in the unhealthy tissues and to determine their variation with respect to the healthy ones. Then, the ex vivo HR-MAS NMR analysis was applied to human gastric tissue, to obtain information on the molecular steps involved in the gastric carcinogenesis. A microscopic investigation was also carried out in order to identify and locate the lipids in the cellular and extra-cellular environments. Correlation of the morphological changes detected by transmission (TEM) and scanning (SEM) electron microscopy, with the metabolic profile of gastric mucosa in healthy, gastric atrophy autoimmune diseases (AAG), Helicobacter pylori-related gastritis and adenocarcinoma subjects, were obtained. These ultrastructural studies of AAG and gastric adenocarcinoma revealed lipid intra- and extra-cellularly accumulation associated with a severe prenecrotic hypoxia and mitochondrial degeneration. A deep insight into the metabolic profile of human healthy and neoplastic colon tissues was gained using ex vivo HR-MAS NMR spectroscopy in combination with multivariate methods: Principal Component Analysis (PCA) and Partial Least Squares Discriminant Analysis (PLS-DA). The NMR spectra of healthy tissues highlight different metabolic profiles with respect to those of neoplastic and microscopically normal colon specimens (these last obtained at least 15 cm far from the adenocarcinoma). Furthermore, metabolic variations are detected not only for neoplastic tissues with different histological diagnosis, but also for those classified identical by histological analysis. These findings suggest that the same subclass of colon carcinoma is characterized, at a certain degree, by metabolic heterogeneity. The statistical multivariate approach applied to the NMR data is crucial in order to find metabolic markers of the neoplastic state of colon tissues, and to correctly classify the samples. Significant different levels of choline containing compounds, taurine and myoinositol, were observed. Chapter 6 deals with the metabolic profile of normal and tumoral renal human tissues obtained by ex vivo HR-MAS NMR. The spectra of human normal cortex and medulla show the presence of differently distributed osmolytes as markers of physiological renal condition. The marked decrease or disappearance of these metabolites and the high lipid content (triglycerides and cholesteryl esters) is typical of clear cell renal carcinoma (RCC), while papillary RCC is characterized by the absence of lipids and very high amounts of taurine. This research is a contribution to the biochemical classification of renal neoplastic pathologies, especially for RCCs, which can be evaluated by in vivo MRS for clinical purposes. Moreover, these data help to gain a better knowledge of the molecular processes envolved in the onset of renal carcinogenesis.

Provenienza dei sedimenti arenitici nel bacino di Tracia (eo-oligocene, Turchia nord-occidentale e Grecia nord-orientale)

The Thrace Basin is the largest and thickest Tertiary sedimentary basin of the eastern Balkans region and constitutes an important hydrocarbon province. It is located between the Rhodope-Strandja Massif to the north and west, the Marmara Sea and Biga Peninsula to the south, and the Black Sea to the est. It consists of a complex system of depocenters and uplifts with very articulate paleotopography indicated by abrupt lateral facies variations. Its southeastern margin is widely deformed by the Ganos Fault, a segment of the North Anatolian strike-slip fault system . Most of the Thrace Basin fill ranges from the Eocene to the Late Oligocene. Maximum total thickness, including the Neogene-Quaternary succession, reaches 9.000 meters in a few narrow depocenters. This sedimentary succession consists mainly of basin plain turbiditic deposits with a significant volcaniclastic component which evolves upwards to shelf deposits and continental facies, with deltaic bodies prograding towards the basin center in the Oligocene. This work deals with the provenance of Eocene-Oligocene clastic sediments of the southern and western part of Thrace Basin in Turkey and Greece. Sandstone compositional data (78 gross composition analyses and 40 heavy minerals analyses) were used to understand the change in detrital modes which reflects the provenance and geodinamic evolution of the basin. Samples were collected at six localities, which are from west to est: Gökçeada, Gallipoli and South-Ganos (south of Ganos Fault), Alexandroupolis, Korudağ and North-Ganos (north of Ganos Fault). Petrologic (framework composition and heavy-mineral analyses) and stratigraphic-sedimentologic data, (analysis of sedimentologic facies associations along representative stratigraphic sections, paleocurrents) allowed discrimination of six petrofacies; for each petrofacies the sediment dispersal system was delineated. The Thrace Basin fill is made mainly of lithic arkoses and arkosic litharenites with variable amount of low-grade metamorphic lithics (also ophiolitic), neovolcanic lithics, and carbonate grains (mainly extrabasinal). Picotite is the most widespread heavy mineral in all petrofacies. Petrological data on analyzed successions show a complex sediment dispersal pattern and evolution of the basin, indicating one principal detrital input from a source area located to the south, along both the İzmir-Ankara and Intra-Pontide suture lines, and a possible secondary source area, represented by the Rhodope Massif to the west. A significant portion of the Thrace Basin sediments in the study area were derived from ophiolitic source rocks and from their oceanic cover, whereas epimetamorphic detrital components came from a low-grade crystalline basement. An important penecontemporaneous volcanic component is widespread in late Eocene-Oligocene times, indicating widespread post-collisional (collapse?) volcanism following the closure of the Vardar ocean. Large-scale sediment mass wasting from south to north along the southern margin of the Thrace Basin is indicated (i) in late Eocene time by large olistoliths of ophiolites and penecontemporaneous carbonates, and (ii) in the mid-Oligocene by large volcaniclastic olistoliths. The late Oligocene paleogeographic scenario was characterized by large deltaic bodies prograding northward (Osmancik Formation). This clearly indicates that the southern margin of the basin acted as a major sediment source area throughout its Eocene-Oligocene history. Another major sediment source area is represented by the Rhodope Massif, in particolar the Circum-Rhodopic belt, especially for plutonic and metamorphic rocks. Considering preexisting data on the petrologic composition of Thrace Basin, silicilastic sediments in Greece and Bulgaria (Caracciolo, 2009), a Rhodopian provenance could be considered mostly for areas of the Thrace Basin outside our study area, particularly in the northern-central portions of the basin. In summary, the most important source area for the sediment of Thrace Basin in the study area was represented by the exhumed subduction-accretion complex along the southern margin of the basin (Biga Peninsula and western-central Marmara Sea region). Most measured paleocurrent indicators show an eastward paleoflow but this is most likely the result of gravity flow deflection. This is possible considered a strong control due to the east-west-trending synsedimentary transcurrent faults which cuts the Thrace Basin, generating a series of depocenters and uplifts which deeply influenced sediment dispersal and the areal distribution of paleoenvironments. The Thrace Basin was long interpreted as a forearc basin between a magmatic arc to the north and a subduction-accretion complex to the south, developed in a context of northward subduction. This interpretation was challenged by more recent data emphasizing the lack of a coeval magmatic arc in the north and the interpretation of the chaotic deposit which outcrop south of Ganos Fault as olistoliths and large submarine slumps, derived from the erosion and sedimentary reworking of an older mélange unit located to the south (not as tectonic mélange formed in an accretionary prism). The present study corroborates instead the hypothesis of a post-collisional origin of the Thrace Basin, due to a phase of orogenic collapse, which generated a series of mid-Eocene depocenters all along the İzmir-Ankara suture (following closure of the Vardar-İzmir-Ankara ocean and the ensuing collision); then the slab roll-back of the remnant Pindos ocean played an important role in enhancing subsidence and creating additional accommodation space for sediment deposition.

Thermochronologic and geodynamic evolution of the Pontides: Sakarya terrane (Karakaya Complex) and Istanbul terrane, Turkey.

An integrated array of analytical methods -including clay mineralogy, vitrinite reflectance, Raman spectroscopy on carbonaceous material, and apatite fission-track analysis- was employed to constrain the thermal and thermochronological evolution of selected portions of the Pontides of northern Turkey. (1) A multimethod investigation was applied for the first time to characterise the thermal history of the Karakaya Complex, a Permo-Triassic subduction-accretion complex cropping out throughout the Sakarya Zone. The results indicate two different thermal regimes: the Lower Karakaya Complex (Nilüfer Unit) -mostly made of metabasite and marble- suffered peak temperatures of 300-500°C (greenschist facies); the Upper Karakaya Complex (Hodul and the Orhanlar Units) –mostly made of greywacke and arkose- yielded heterogeneous peak temperatures (125-376°C), possibly the result of different degree of involvement of the units in the complex dynamic processes of the accretionary wedge. Contrary to common belief, the results of this study indicate that the entire Karakaya Complex suffered metamorphic conditions. Moreover, a good degree of correlation among the results of these methods demonstrate that Raman spectroscopy on carbonaceous material can be applied successfully to temperature ranges of 200-330°C, thus extending the application of this method from higher grade metamorphic contexts to lower grade metamorphic conditions. (2) Apatite fission-track analysis was applied to the Sakarya and the İstanbul Zones in order to constrain the exhumation history and timing of amalgamation of these two exotic terranes. AFT ages from the İstanbul and Sakarya terranes recorded three distinct episodes of exhumation related to the complex tectonic evolution of the Pontides. (i) Paleocene - early Eocene ages (62.3-50.3 Ma) reflect the closure of the İzmir-Ankara ocean and the ensuing collision between the Sakarya terrane and the Anatolide-Tauride Block. (ii) Late Eocene - earliest Oligocene (43.5-32.3 Ma) ages reflect renewed tectonic activity along the İzmir-Ankara. (iii) Late Oligocene- Early Miocene ages reflect the onset and development of the northern Aegean extension. The consistency of AFT ages, both north and south of the tectonic contact between the İstanbul and Sakarya terranes, suggest that such terranes were amalgamated in pre-Cenozoic times. (3) Fission-track analysis was also applied to rock samples from the Marmara region, in an attempt to constrain the inception and development of the North Anatolian Fault system in the region. The results agree with those from the central Pontides. The youngest AFT ages (Late Oligocene - early Miocene) were recorded in the western portion of the Marmara Sea region and reflect the onset and development of northern Aegean extension. Fission-track data from the eastern Marmara Sea region indicate rapid Early Eocene exhumation induced by the development of the İzmir-Ankara orogenic wedge. Thermochronological data along the trace of the Ganos Fault –a segment of the North Anatolian Fault system- indicate the presence of a tectonic discontinuity active by Late Oligocene time, i.e. well before the arrival of the North Anatolian Fault system in the area. The integration of thermochronologic data with preexisting structural data point to the existence of a system of major E-W-trending structural discontinuities active at least from the Late Oligocene. In the Early Pliocene, inception of the present-day North Anatolian Fault system in the Marmara region occurred by reactivation of these older tectonic structures. 


Studio di marcatori immunoistochimici, analisi FISH e ruolo dei microRNA nelle neoplasie gliali di basso e di alto grado

Gliomas are the most common primary brain tumours. Despite advances in surgical techniques, postoperative supportive care, radiation and adjuvant systemic therapy, the life expectancy of patients with high grade glioma has remained essentially poor. Furthermore differential diagnosis among astrocytomas, oligodendrogliomas and oligoastrocytomas is very challenging and subject to inter-observer variability. The purpose of the research was: 1) to investigate a series of high grade and low grade gliomas at gene and protein (immunohistochemistry) levels to disclose possible genetic portraits of malignancy; 2) to verify the utility of Nogo-A, Olig-2 and synaptophysin in providing a correct histological diagnosis of oligodendroglioma and to investigate a possible complementary role in selecting the best areas suitable for detecting 1p/19q codeletion using FISH analysis; 3) to study the role of microRNA in high grade gliomas. In order to obtain these goals large series of brain tumors were studied with DNA microarrays, immunohistochemistry and RT-PCR The results demonstrated that: - Overexpression of IGFBP-2 and CDC20 is highly related to glioblastomas and their immunopositivity can be useful for the identification of glioblastoma in small biopsies. - Nogo-A is the most useful and specific marker in differentiating oigodendrogliomas from other gliomas. Furthermore, using a Nogo-A driven FISH analysis, it is possible to identify a larger number of 1p19q codeletions in gliomas. - microRNAs can be studied in paraffin embedded tissues better than in fresh tissues. A series of six microRNA, significatively deregulated in glioblastomas, may represent a genetic signature with prognostic and predictive value and could constitute candidates for novel anti-cancer therapeutics.

Identificazione di fattori trascrizionali associati al differenziamento neurale in cellule di sarcoma di Ewing: ruolo di NF-kB

Il sarcoma di Ewing (ES) è un tumore maligno pediatrico dell’apparato scheletrico; è associato a una traslocazione specifica codificante la proteina di fusione EWS-FLI1 e all’alta espressione di CD99, una glicoproteina di membrana fisiologicamente coinvolta in diversi processi biologici. EWS-FLI1 e CD99, sono riportati avere ruoli divergenti nella modulazione della malignità e del differenziamento di ES. CD99 inoltre è riportato modulare il pathway di MAPK, il quale interagendo con molteplici fattori di trascrizione partecipa a processi di proliferazione e differenziamento. In questo studio abbiamo investigato in due linee cellulari di ES silenziate per CD99 (TC-71shCD99 e IOR/CARshCD99) l’attività basale di diversi fattori trascrizionali quali: NF-kBp65, AP1, Elk-1, E2F e CREB. L’unico fattore trascrizionale statisticamente significativo è risultato essere NF-kBp65 e abbiamo valutato il suo ruolo nel differenziamento neurale di cellule di ES e la relazione con EWS-FLI1 e CD99. L’attività trascrizionale di NF-kB è stata valutata attraverso gene reporter assay in linee cellulari di ES a diversa espressione di CD99, EWS-FLI1 e NF-kB stesso. Il differenziamento neurale è stato valutato come espressione di βIII-Tubulin in immunofluorescenza. Il silenziamento di CD99 induce una down-modulazione dell’attività trascrizionale di NF-kB, mentre il knockdown di EWS-FLI1 ne induce un’aumento. Inoltre, il silenziamento di EWS-FLI1 non è in grado di contrastare la riduzione dell’attività di NF-kB osservata dopo silenziamento di CD99, suggerendo un ruolo dominante del CD99 nel signaling di NF-kB. Cellule deprivate di CD99 ma non di EWS-FLI1, mostrano un fenotipo differenziato in senso neurale, fenotipo che viene perso quando le cellule sono indotte a sovraesprimere NF-kB. Inoltre, in cellule CD99 positive, il silenziamento di NF-kB induce un leggero differenziamento neurale. In conclusione, questi dati hanno evidenziato il ruolo di NF-kB nel differenziamento di cellule di ES e che potrebbe essere un potenziale target nel ridurre la progressione di questo tumore.

Valutazione dell’impiego dei test per la genotipizzazione di HPV e l’espressione degli oncogeni virali nel follow-up di donne conizzate per lesioni cervicali di alto grado nello screening del cervico-carcinoma della Regione Emilia-Romagna

Obiettivi: Valutare la prevalenza dei diversi genotipi di HPV in pazienti con diagnosi di CIN2/3 nella Regione Emilia-Romagna, la persistenza genotipo-specifica di HPV e l’espressione degli oncogeni virali E6/E7 nel follow-up post-trattamento come fattori di rischio di recidiva/persistenza o progressione di malattia; verificare l’applicabilità di nuovi test diagnostici biomolecolari nello screening del cervicocarcinoma. Metodi: Sono state incluse pazienti con citologia di screening anormale, sottoposte a trattamento escissionale (T0) per diagnosi di CIN2/3 su biopsia mirata. Al T0 e durante il follow-up a 6, 12, 18 e 24 mesi, oltre al Pap test e alla colposcopia, sono state effettuate la ricerca e la genotipizzazione dell'HPV DNA di 28 genotipi. In caso di positività al DNA dei 5 genotipi 16, 18, 31, 33 e/o 45, si è proceduto alla ricerca dell'HPV mRNA di E6/E7. Risultati preliminari: Il 95.8% delle 168 pazienti selezionate è risultato HPV DNA positivo al T0. Nel 60.9% dei casi le infezioni erano singole (prevalentemente da HPV 16 e 31), nel 39.1% erano multiple. L'HPV 16 è stato il genotipo maggiormente rilevato (57%). Il 94.3% (117/124) delle pazienti positive per i 5 genotipi di HPV DNA sono risultate mRNA positive. Abbiamo avuto un drop-out di 38/168 pazienti. A 18 mesi (95% delle pazienti) la persistenza dell'HPV DNA di qualsiasi genotipo era del 46%, quella dell'HPV DNA dei 5 genotipi era del 39%, con espressione di mRNA nel 21%. Abbiamo avuto recidiva di malattia (CIN2+) nel 10.8% (14/130) a 18 mesi. Il pap test era negativo in 4/14 casi, l'HPV DNA test era positivo in tutti i casi, l'mRNA test in 11/12 casi. Conclusioni: L'HR-HPV DNA test è più sensibile della citologia, l'mRNA test è più specifico nell'individuare una recidiva. I dati definitivi saranno disponibili al termine del follow-up programmato.

Valutazione del coinvolgimento dell'oncogene c-myc e dei trasportatori abc nella farmacoresistenza dell'osteosarcoma ad alto grado

L’insorgenza di fenomeni coinvolti nello sviluppo della farmacoresistenza costituisce al momento la principale causa di mancata risposta al trattamento chemioterapico nell’osteosarcoma. Questo è in parte dovuto ad una sovraespressione di diversi trasportatori ABC nelle cellule tumorali che causano un aumento dell’efflusso extracellulare del chemioterapico e pertanto una ridotta risposta al trattamento farmacologico. L'oncogene C-MYC è coinvolto nella resistenza al metothrexate, alla doxorubicina e al cisplatino ed è un fattore prognostico avverso, se sovraespresso al momento della diagnosi, in pazienti affetti da osteosarcoma. C-MYC è in grado di regolare l'espressione di diversi trasportatori ABC, probabilmente coinvolti nella resistenza ai farmaci nell’osteosarcoma, e questo potrebbe spiegare l’impatto prognostico avverso dell’oncogene in questo tumore. L’espressione genica di C-MYC e di 16 trasportatori ABC, regolati da C-MYC e / o responsabili dell'efflusso di diversi chemioterapici, è stata valutata su due diverse casistiche cliniche e su un pannello di linee cellulari di osteosarcoma umano mediante real-time PCR. L'espressione della proteina è stata valutata per i 9 trasportatori ABC risultati più rilevanti.Infine l'efficacia in vitro di un inibitore, specifico per ABCB1 e ABCC1, è stata valutata su linee cellulari di osteosarcoma. ABCB1 e ABCC1 sono i trasportatori più espressi nelle linee cellulari di osteosarcoma. ABCB1 è sovraespresso al momento della diagnosi in circa il 40-45% dei pazienti affetti da osteosarcoma e si conferma essere un fattore prognostico avverso se sovraespresso al momento della diagnosi. Pertanto ABCB1 diventa il bersaglio di elezione per lo sviluppo di strategie terapeutiche alternative, nel trattamento dell’osteosarcoma, atte al superamento della farmacoresistenza. L’inibizione dell'attività di tale trasportatore causa un aumento della sensibilità al trattamento chemioterapico nelle linee cellulari di osteosarcoma farmacoresistenti, indicando questo approccio come una possibile strategia per superare il problema della mancata risposta al trattamento farmacologico nei pazienti con osteosarcoma che sovraesprimono ABCB1.

The "Orthoplastic" combined surgical approach to open tibia fractures: a multicentric prospective outcome study

Introduction: Open fractures of the leg represent a severe trauma. The combined approach, shared between plastic and orthopaedic surgeons, is considered to be important, although this multidisciplinary treatment is not routinely performed. Aim of this study was to verify whether the orthoplastic treatment is of any advantage over the traditional simply orthopedic treatment, through a multicentric inclusion of these unfrequent injuries into a prospective study. Material and methods: The following trauma centres were involved: Rizzoli Orthopaedic Institute/University of Bologna (leading centre) and Maggiore Hospital (Bologna, Italy), Frenchay Hospital (Bristol, United Kingdom), Jinnah Hospital (Lahore, Pakistan). All patients consecutively hospitalized in the mentioned centres between January 2012 and December 2013 due to tibial open fractures were included in the study and prospectively followed up to December 2014. Demographics and other clinical features were recorded, including the type of treatment (orthopaedic or orthoplastic). The considered outcome measures included duration of hospitalization, time for bone union and soft tissue closure, Enneking score at 3, 6 and 12 months, the incidence of osteomyelitis and other complications. Results: A total of 164 patients were included in the study. Out of them 68% were treated with an orthoplastic approach, whereas 32% received a purely orthopedic treatment. All considered outcome measures showed to be improved by the orthoplastic approach, compared to the orthopaedic one: time for soft tissue closure (2 versus 25 weeks), duration of hospital stay (22 versus 55 days), time for bone union (6 versus 8.5 months) , number of additional operations (0.6 versus 1.2) and functional recovery of the limb at 12 months (27 versus 19, Enneking’s score). All results were statistically significant. Conclusion: The combined orthoplastic approach to the treatment of open tibia fractures, in particular for high grade injuries (Gustilo 3B), is proven to improve the outcome of these severe injuries.

Nuovi protocolli chemioterapici per i sarcomi dei tessuti molli ad alto grado di malignita' negli adulti: Risultati clinici, radiologici e istologici comparando chemioterapia standard e orientata sull'isotopo

I sarcomi dei tessuti molli sono un gruppo eterogeneo di tumori maligni di origine mesenchimale che si sviluppa nel tessuto connettivo. Il controllo locale mediante escissione chirurgica con margini ampi associato alla radioterapia e chemioterapia è il trattamento di scelta. Negli ultimi anni le nuove scoperte in campo biologico e clinico hanno sottolineato che i diversi istotipi posso essere considerati come entità distinte con differente sensibilità alla chemioterapia pertanto questa deve essere somministrata come trattamento specifico basato sull’istologia. Tra Ottobre 2011 e Settembre 2014 sono stati inclusi nel protocollo di studio 49 pazienti con sarcomi dei tessuti molli di età media alla diagnosi 48 anni (range: 20 - 68 anni). I tumori primitivi più frequenti sono: liposarcoma mixoide, sarcoma pleomorfo indifferenziato, sarcoma sinoviale. Le sedi di insorgenza del tumore erano più frequentemente la coscia, il braccio e la gamba. 35 pazienti sono stati arruolati nel Braccio A e trattati con chemioterapia standard con epirubicina+ifosfamide, 14 sono stati arruolati nel Braccio B e trattati con chemioterapia basata sull’istotipo. I dati emersi da questo studio suggeriscono che le recidive locali sembrano essere correlate favorevolmente alla radioterapia ed ai margini chirurgici adeguati mentre la chemioterapia non sembra avere un ruolo sul controllo locale della malattia. Anche se l'uso di terapie mirate, che hanno profili di tossicità più favorevoli e sono quindi meglio tollerate rispetto ai farmaci citotossici è promettente, tali farmaci hanno prodotto finora risultati limitati. Apparentemente l’insieme delle terapie mirate non sembra funzionare meglio delle terapie standard, tuttavia esse devono essere esaminate per singolo istotipo e confrontate con il braccio di controllo. Sono necessari studi randomizzati controllati su ampie casistiche per valutare l’efficacia delle terapie mirate sui differenti istotipi di sarcomi dei tessuti molli. Inoltre, nuovi farmaci, nuove combinazioni e nuovi schemi posologici dovranno essere esaminati per ottimizzare la terapia.

A 300 million year-long history. The metamorphic evolution of the Northern Apennine Variscan basement

The Variscan basement of Northern Apennines (Northern Italy) is a polymetamorphic portion of continental crust. This thesis investigated the metamorphic history of this basement occurring in the Cerreto Pass, in the Pontremoli well, and in the Pisani Mountains. The study comprised fieldwork, petrography and microstructural analysis, determination of the bulk rock and mineral composition, thermodynamic modelling, conventional geothermobarometry, monazite chemical dating and Ar/Ar dating of muscovite. The reconstructed metamorphic evolution of the selected samples allowed to define a long-lasting metamorphic history straddling the Variscan and Alpine orogenesis. Some general petrological issues generally found in low- to medium-grade metapelites were also tackled: (i) With middle-grade micaschist it is possible to reconstruct a complete P-T-D path by combining microstructural analysis and thermodynamic modelling. Prekinematic white mica may preserve Mg-rich cores related to the pre-peak stage. Mn-poor garnet rim records the peak metamorphism. Na-rich mylonitic white mica, the XFe of chlorite and the late paragenesis may constrain the retrograde stage. (ii) Metapelites may contain coronitic microstructures of apatite + Th-silicate, allanite and epidote around unstable monazite grains. Chemistry and microstructure of Th-rich monazite relics surrounded by this coronitic microstructure may suggest that monazite mineral was inherited and underwent partial dissolution and fluid-aided replacement by REE-accessory minerals at 500-600°C and 5-7 kbar. (iii) Fish-shaped white mica is not always a (prekinematic) mica-fish. Observed at high-magnification BSE images it may consist of several white mica formed during a mylonitic stage. Hence, the asymmetric foliation boudin is a suitable microstructure to obtain geochronological information about the shearing stage. (iv) Thermodynamic modelling of a hematite-rich metasedimentary rock fails to reproduce the observed mineral compositions when the bulk Fe2O3 is neglected or determined through titration. The mismatch between observed and computed mineral compositions and assemblage is resolved by tuning the effective ferric iron content by P-XFe2O3 diagrams.