The search for Multiple Myeloma Stem cells: molecular characterization and self-renewal mechanisms involved in the disease persistence

The existence of Multiple Myeloma Stem cells (MMSCs)is supposed to be one of the major causes of MM drug-resistance. However, very little is known about the molecular characteristics of MMSCs, even if some studies suggested that these cells resembles the memory B cells. In order to molecularly characterize MMSCs, we isolated the 138+138- population. For each cell fraction we performed a VDJ rearrangement analysis. The complete set of aberrations were performed by SNP Array 6.0 and HG-U133 Plus 2.0 microarray analyses (Affymetrix). The VDJ rearrangement analyses confirmed the clonal relationship between the 138+ clone and the immature clone. Both BM and PBL 138+ clones showed exactly the same genomic macroalterations. In the BM and PBL 138-19+27+ cell fractions several micro-alterations (range: 1-350 Kb) unique of the memory B cells clone were highlighted. Any micro-alterations detected were located out of any genomic variants region and are presumably associated to the MM pathogenesis, as confirmed by the presence of KRAS, WWOX and XIAP genes among the amplified regions. To get insight into the biology of the clonotypic B cell population, we compared the gene expression profile of 8 MM B cells samples 5 donor B cells vs, thus showing a differential expression of 11480 probes (p-value: <0,05). Among the self-renewal mechanisms, we observed the down-regulation of Hedgehog pathway and the iperactivation of Notch and Wnt signaling. Moreover, these immature cells showed a particular phenotype correlated to resistance to proteasome inhibitors (IRE1α-XBP1: -18.0; -19.96. P<0,05). Data suggested that the MM 138+ clone might resume the end of the complex process of myelomagenesis, whereas the memory B cells have some intriguing micro-alterations and a specific transcriptional program, supporting the idea that these post germinal center cells might be involved in the transforming event that originate and sustain the neoplastic clone.

La costruzione razionale della casa. Scritti e progetti di Giuseppe Pagano

The rational construction of the house. The writings and projects of Giuseppe Pagano Description, themes and research objectives The research aims at analysing the architecture of Giuseppe Pagano, which focuses on the theme of dwelling, through the reading of 3 of his house projects. On the one hand, these projects represent “minor” works not thoroughly known by Pagano’s contemporary critics; on the other they emphasise a particular methodological approach, which serves the author to explore a theme closely linked to his theoretical thought. The house project is a key to Pagano’s research, given its ties to the socio-cultural and political conditions in which the architect was working, so that it becomes a mirror of one of his specific and theoretical path, always in a state of becoming. Pagano understands architecture as a “servant of the human being”, subject to a “utilitarian slavery” since it is a clear, essential and “modest” answer to specific human needs, free from aprioristic aesthetic and formal choices. It is a rational architecture in sensu stricto; it constitutes a perfect synthesis between cause and effect and between function and form. The house needs to accommodate these principles because it is closely intertwined with human needs and intimately linked to a specific place, climatic conditions and technical and economical possibilities. Besides, differently from his public and common masterpieces such as the Palazzo Gualino, the Istituto di Fisica and the Università Commerciale Bocconi, the house projects are representative of a precise project will, which is expressed in a more authentic way, partially freed from political influences and dogmatic preoccupations and, therefore, far from the attempt to research a specific expressive language. I believe that the house project better represents that “ingenuity”, freshness and “sincerity” that Pagano identifies with the minor architecture, thereby revealing a more authentic expression of his understanding of a project. Therefore, the thesis, by tracing the theoretical research of Pagano through the analysis of some of his designed and built works, attempts to identify a specific methodological approach to Pagano’s project, which, developed through time, achieves a certain clarity in the 1930s. In fact, this methodological approach becomes more evident in his last projects, mainly regarding the house and the urban space. These reflect the attempt to respond to the new social needs and, at the same time, they also are an expression of a freer idea of built architecture, closely linked with the place and with the human being who dwells it. The three chosen projects (Villa Colli, La Casa a struttura d’acciaio and Villa Caraccio) make Pagano facing different places, different customers and different economic and technical conditions, which, given the author’s biography, correspond to important historical and political conditions. This is the reason why the projects become apparently distant works, both linguistically and conceptually, to the point that one can define them as ”eclectic”. However, I argue that this eclecticism is actually an added value to the architectural work of Pagano, steaming from the use of a method which, having as a basis the postulate of a rational architecture as essence and logic of building, finds specific variations depending on the multiple variables to be addressed by the project. This is the methodological heritage that Pagano learns from the tradition, especially that of the rural residential architecture, defined by Pagano as a “dictionary of the building logic of man”, as an “a-stylistic background”. For Pagano this traditional architecture is a clear expression of the relationships between a theme and its development, an architectural “fact” that is resolved with purely technical and utilitarian aims and with a spontaneous development far from any aprioristic theoretical principle. Architecture, therefore, cannot be an invention for Pagano and the personal contribution of each architect has to consider his/her close relationship with the specific historical context, place and new building methods. These are basic principles in the methodological approach that drives a great deal of his research and that also permits his thought to be modern. I argue that both ongoing and new collaborations with younger protagonists of the culture and architecture of the period are significant for the development of his methodology. These encounters represent the will to spread his own understanding of the “new architecture” as well as a way of self-renewal by confronting the self with new themes and realities and by learning from his collaborators. Thesis’ outline The thesis is divided in two principal parts, each articulated in four chapters attempting to offer a new reading of the theory and work of Pagano by emphasising the central themes of the research. The first chapter is an introduction to the thesis and to the theme of the rational house, as understood and developed in its typological and technical aspects by Pagano and by other protagonists of the Italian rationalism of the 1930s. Here the attention is on two different aspects defining, according to Pagano, the house project: on the one hand, the typological renewal, aimed at defining a “standard form” as a clear and essential answer to certain needs and variables of the project leading to different formal expressions. On the other, it focuses on the building, understood as a technique to “produce” architecture, where new technologies and new materials are not merely tools but also essential elements of the architectural work. In this way the villa becomes different from the theme of the common house or from that of the minimalist house, by using rules in the choice of material and in the techniques that are every time different depending on the theme under exploration and on the contingency of place. It is also visible the rigorous rationalism that distinguishes the author's appropriation of certain themes of rural architecture. The pages of “Casabella” and the events of the contemporary Triennali form the preliminary material for the writing of this chapter given that they are primary sources to individuate projects and writings produced by Pagano and contemporary architects on this theme. These writings and projects, when compared, reconstruct the evolution of the idea of the rational house and, specifically, of the personal research of Pagano. The second part regards the reading of three of Pagano’s projects of houses as a built verification of his theories. This section constitutes the central part of the thesis since it is aimed at detecting a specific methodological approach showing a theoretical and ideological evolution expressed in the vast edited literature. The three projects that have been chosen explore the theme of the house, looking at various research themes that the author proposes and that find continuity in the affirmation of a specific rationalism, focussed on concepts such as essentiality, utility, functionality and building honesty. These concepts guide the thought and the activities of Pagano, also reflecting a social and cultural period. The projects span from the theme of the villa moderna, Villa Colli, which, inspired by the architecture of North Europe, anticipates a specific rationalism of Pagano based on rigour, simplicity and essentiality, to the theme of the common house, Casa a struttura d’acciaio, la casa del domani, which ponders on the definition of new living spaces and, moreover, on new concepts of standardisation, economical efficiency and new materials responding to the changing needs of the modern society. Finally, the third project returns to the theme of the, Villa Caraccio, revisiting it with new perspectives. These perspectives find in the solution of the open plant, in the openness to nature and landscape and in the revisiting of materials and local building systems that idea of the freed house, which express clearly a new theoretical thought. Methodology It needs to be noted that due to the lack of an official Archive of Pagano’s work, the analysis of his work has been difficult and this explains the necessity to read the articles and the drawings published in the pages of «Casabella» and «Domus». As for the projects of Villa Colli and Casa a struttura d’acciaio, parts of the original drawings have been consulted. These drawings are not published and are kept in private archives of the collaborators of Pagano. The consultation of these documents has permitted the analysis of the cited works, which have been subject to a more complete reading following the different proposed solutions, which have permitted to understand the project path. The projects are analysed thought the method of comparison and critical reading which, specifically, means graphical elaborations and analytical schemes, mostly reconstructed on the basis of original projects but, where possible, also on a photographic investigation. The focus is on the project theme which, beginning with a specific living (dwelling) typology, finds variations because of the historico-political context in which Pagano is embedded and which partially shapes his research and theoretical thought, then translated in the built work. The analysis of the work follows, beginning, where possible, from a reconstruction of the evolution of the project as elaborated on the basis of the original documents and ending on an analysis of the constructive principles and composition. This second phase employs a methodology proposed by Pagano in his article Piante di ville, which, as expected, focuses on the plant as essential tool to identify the “true practical and poetic qualities of the construction”(Pagano, «Costruzioni-Casabella», 1940, p. 2). The reading of the project is integrated with the constructive analyses related to the technical aspects of the house which, in the case of Casa a struttura d’acciaio, play an important role in the project, while in Villa Colli and in Villa Caraccio are principally linked to the choice of materials for the construction of the different architectural elements. These are nonetheless key factors in the composition of the work. Future work could extend this reading to other house projects to deepen the research that could be completed with the consultation of Archival materials, which are missing at present. Finally, in the appendix I present a critical selection of the Pagano’s writings, which recall the themes discussed and embodied by the three projects. The texts have been selected among the articles published in Casabella and in other journals, completing the reading of the project work which cannot be detached from his theoretical thought. Moving from theory to project, we follow a path that brings us to define and deepen the central theme of the thesis: rational building as the principal feature of the architectural research of Pagano, which is paraphrased in multiple ways in his designed and built works.

Pre-clinical and clinical development of leukemia stem cell inhibitors in acute leukemias

In Leukemias, recent developments have demonstrated that the Hedgehog pathway plays a key-role in the peculiar ability of self renewal of leukemia stem cells. The aim of this research activity was to investigate, through a first in man, Phase I, open label, clinical trial, the role and the impact, mainly in terms of safety profile, adverse events and pharmacokinetics, of a Sonic Hedgehog inhibitor compound on a population of heavely pretreated patients affected by AML, CML, MF, or MDS, resistant or refractory to standard chemotherapy. Thirty-five patients have been enrolled. The drug was administered orally, in 28 days cycles, without rest periods. The compound showed a good safety profile. The half life was of 17-35 hours, justifying the daily administration. Significant signs of activity, in terms of reduction of bone marrow blast cell amount were seen in most of the patients enrolled. Interestingly, correlative biological studies demonstrated that, comparing the gene expression profyiling signature of separated CD34+ cells before and after one cycle of treatment, the most variably expressed genes were involved in the Hh pathway. Moreover, we observed that many genes involved in MDR (multidrug resistance)were significantly down regulated after treatment. These data might lead to future clinical trials based on combinatory approaches, including, for instance, Hh inhibitors and conventional chemotherapy.

A SMO inhibitor drug reduces the progenitor cell's maintenance in the Drosophila hematopoietic organ: a novel model to study Chronic Myelogenous Leukemia relapse

The chronic myeloid leukemia complexity and the difficulties of disease eradication have recently led to the development of drugs which, together with the inhibitors of TK, could eliminate leukemia stem cells preventing the occurrence of relapses in patients undergoing transplantation. The Hedgehog (Hh) signaling pathway positively regulates the self-renewal and the maintenance of leukemic stem cells and not, and this function is evolutionarily conserved. Using Drosophila as a model, we studied the efficacy of the SMO inhibitor drug that inhibit the human protein Smoothened (SMO). SMO is a crucial component in the signal transduction of Hh and its blockade in mammals leads to a reduction in the disease induction. Here we show that administration of the SMO inhibitor to animals has a specific effect directed against the Drosophila ortholog protein, causing loss of quiescence and hematopoietic precursors mobilization. The SMO inhibitor induces in L3 larvae the appearance of melanotic nodules generated as response by Drosophila immune system to the increase of its hemocytes. The same phenotype is induced even by the dsRNA:SMO specific expression in hematopoietic precursors of the lymph gland. The drug action is also confirmed at cellular level. The study of molecular markers has allowed us to demonstrate that SMO inhibitor leads to a reduction of the quiescent precursors and to an increase of the differentiated cells. Moreover administering the inhibitor to heterozygous for a null allele of Smo, we observe a significant increase in the phenotype penetrance compared to administration to wild type animals. This helps to confirm the specific effect of the drug itself. These data taken together indicate that the study of inhibitors of Smo in Drosophila can represent a useful way to dissect their action mechanism at the molecular-genetic level in order to collect information applicable to the studies of the disease in humans.

Identification of novel genetic alterations in pediatric cytogenetically normal acute myeloid leukemia by next-generation sequencing

Pediatric acute myeloid leukemia (AML) is a molecularly heterogeneous disease that arises from genetic alterations in pathways that regulate self-renewal and myeloid differentiation. While the majority of patients carry recurrent chromosomal translocations, almost 20% of childhood AML do not show any recognizable cytogenetic alteration and are defined as cytogenetically normal (CN)-AML. CN-AML patients have always showed a great variability in response to therapy and overall outcome, underlining the presence of unknown genetic changes, not detectable by conventional analyses, but relevant for pathogenesis, and outcome of AML. The development of novel genome-wide techniques such as next-generation sequencing, have tremendously improved our ability to interrogate the cancer genome. Based on this background, the aim of this research study was to investigate the mutational landscape of pediatric CN-AML patients negative for all the currently known somatic mutations reported in AML through whole-transcriptome sequencing (RNA-seq). RNA-seq performed on diagnostic leukemic blasts from 19 pediatric CN-AML cases revealed a considerable incidence of cryptic chromosomal rearrangements, with the identification of 21 putative fusion genes. Several of the fusion genes that were identified in this study are recurrent and might have a prognostic and/or therapeutic relevance. A paradigm of that is the CBFA2T3-GLIS2 fusion, which has been demonstrated to be a common alteration in pediatric CN-AML, predicting poor outcome. Important findings have been also obtained in the identification of novel therapeutic targets. On one side, the identification of NUP98-JARID1A fusion suggests the use of disulfiram; on the other, here we describe alteration-activating tyrosine kinases, providing functional data supporting the use of tyrosine kinase inhibitors to specifically inhibit leukemia cells. This study provides new insights in the knowledge of genetic alterations underlying pediatric AML, defines novel prognostic markers and putative therapeutic targets, and prospectively ensures a correct risk stratification and risk-adapted therapy also for the “all-neg” AML subgroup.