In-vitro-Rekonstitution des vesikulären Transportes zu Recycling-Endosomen und Analyse von sekretiertem Caveolin-1 aus humanen Prostatakrebszellen

Der Transferrin-Zyklus ist ein wichtiges Modell für denintrazellulären Transport, daher sollten in der vorliegendenArbeit einzelne, immer noch unverstandene Prozesse desvesikulären, intrazellulären Transportes durch dieCharakterisierung einen in vitro-Transportassay untersuchtwerden. Der Ansatz eines in vitro-Systems wurde deshalbgewählt, um mit Experimenten in denen einzelne Faktoren undbestimmte Konditionen untersucht werden sollten, diese unterdefinierten, reproduzierbaren Konditionen durchzuführen, diein einem in vivo-System kaum zu gewährleisten sind. Ohne denEinfluss von „störenden“, weil unkontrollierten Faktoren,wie es bei in vivo-Systemen der Fall ist, konnte imvorliegende Ansatz der Transport zu immunisoliertenRecycling-Endosomen (die Isolierung erfolgte hierbei mitanti-Rab11-Antikörpern, einem Marker fürRecycling-Endosomen) unter bestimmten Bedingungen untersuchtwerden. Dabei wurde als Marker Acridinium-markiertesTransferrin gewählt, welches in Zellen internalisiert wurde.Die Spezifität des Transportes in dem zellfreien System warhierbei sehr hoch, wie Kontrollexperimente inImmunisolierungsansätzen ohne Rab11-Antikörper zeigten. ImRahmen einer ersten Charakterisierung des Transportassayswurden essentielle, für den in vivo-Transport essentielleParameter auch in den in vitro-Experimenten untersucht.Hierbei wurde zum einen der Faktor Temperatur gewählt, daTransport in Zellen bei 4°C in der Regel zum Erliegen kommt.Dies konnte auch in dem vorgestellten System gezeigt werden.Ein weiterer, essentieller Faktor ist Energie in Form vonATP. ATP-Depletion wurde in den Experimenten durch Hinzugabeeines ATP-erschöpfenden Systems erzielt. Auch hier zeigteder Transport von Ac-Tfn zu Recycling-Endosomen eine starkeInhibierung. Mit Hilfe des so charakterisierten Assayskonnten anschließend weitere Experimente durchgeführtwerden, die den Einfluss von bestimmten Reagenzien undKonditionen auf den Transport untersuchten. So zeigte derTransport in Zeitverlaufsexperimenten einen Anstieg desTransportes bis 30 Minuten, bei 30 Minuten wurde ein Maximumerreicht. Nach Erreichen dieses Maximums war nachfolgendeine leichte Abnahme des Transfers von Ac-Tfn zu denRecycling-Endosomen zu beobachten. Da Rab-Proteine alsSchlüsselregulatoren für den intrazellulären, vesikulärenTransport gelten, und die Immunisolierungen mitanti-Rab11-Antikörpern durchgeführt wurden, wurde somit auchder Einfluss dieser GTPasen auf das Transportsystemuntersucht. Zugegebenes GDI, welches in der Lage istRab-Proteine in GDP-gebundener Form von spezifischenMembranen zu extrahieren, und daher ein gut untersuchterInhibitor von Rab-Funktionen ist, konnte auch in diesemTransportassay den Transport von Transferrin inhibieren. Einweiterer Aspekt war die Rolle des Cytoskelettes imintrazellulären Transport. Da in früheren Untersuchungen(Trischler et al., 1999) Aktin auf Recycling-Endosomengefunden wurde, erfolgte in diesen Arbeiten eineKonzentration auf die Rolle des Aktin in diesenTransportprozessen. Durch die Zugabe von Cytochalasin D, daseinen Aufbau von Aktingerüsten verhindert, wurde derTransport ebenfalls inhibiert. Durchaffinitätschromatographische Aufreinigungen konnte einestarke Interaktion von Aktin an immobilisiertes Rab11gezeigt werden. Die eluierten Fraktionen, die neben Aktinnoch weitere, jedoch unbekannte Proteine enthielten, konntenin dem in vitro-Fusionsassay eingesetzt werden und führtendort zu einer Stimulation des Transportes. Neben demgefundenen Aktin, könnten somit noch weitere, unbekannteProteine in dem Proteingemisch wichtige Funktionen imintrazellulären, vesikulären Transport übernehmen. EineIdentifizierung dieser Proteine ist dabei für weiterführendeArbeiten essentiell.Caveolin-1, Markerprotein für die Caveolae-Membrandomänewird überraschenderweise von verschiedenen Zellensekretiert. Da Caveolin-1 normalerweise ein integralesMembranprotein ist, wird von einer Sekretion alsLipoproteinpartikel ausgegangen. Die Rolle diesessekretierten Partikels ist unbekannt, wobei einige Autoreneine Funktion als autokrinen/ parakrinen Faktor vorschlagen(Tahir et al., 2001). In der vorliegenden Arbeit solltendiese Partikel daher aufgereinigt und erstmalscharakterisiert werden. Die Partikel wurden aus transienttransfizierten LNCaP-Zellen gewonnen, die Cav-1 in dasserumfreie Medium abgaben. In einer erstenGrößenuntersuchung durch FPLC konnte ein Molekulargewichtzwischen 2.000.000 Da und 660.000 Da bestimmt werden. DieseResultate konnten durch den Ansatz der nativenBlau-Gelelektrophorese bestätigt werden. In einem weiterenAnsatz, der die Dichte der Partikel charakterisieren sollte,wurde in zwei unterschiedlichen Ansätzen (CsCl-, sowieOptiprep Dichtezentrifuagtion) eine ähnliche Dichte desPartikels wie HDL ermittelt. Um eine stärkere Aufreinigungder Partikel zu erzielen, wurde eine Aufreinigung mit Hilfevon Ni-NTA-Agarose durchgeführt. Dies war möglich, denn diebei der Transfektion verwendete C-DNA trug einen His6-tag.Die so aufgereingten Partikel verloren auch nach derNi-NTA-Chromatographie nicht ihre biochemischenEigenschaften, wie in überprüfenden CsCl-Gradienten zu sehenwar. Die Partikel konnten anschließend zum ersten Mal inelektronenmikroskopischen Aufnahmen (Negativkontrastierung)visualisiert werden. Ein weiteres Ziel dieser Arbeit war es,zu untersuchen ob auf Cav-1 Lipoproteinpartikeln nochweitere Proteine zu finden waren. Durch eine kombinierteAufreinigung über Ni-NTA Chromatographie undCsCl-Dichtezentrifugation und im Vergleich mit demAusgangsmaterial konnten in der Silberfärbung Proteinbandenerkannt werden, die wie Cav-1 in den Fraktionen angereichertvorlagen. Eine massenspektroskopische Identifikation einerder Banden ergab, dass es sich hierbei um nm 23(Nukleosid-diphosphat-kinase) handelte, einem Protein dasebenfalls von verschiedenen Tumoren sekretiert wird.

Role of caveolin-1 in the proliferation of solid tumours in vitro

Caveolin-1 (Cav-1), the essential structural constituent of caveolae, which are flask-shaped invaginations of the plasma membrane, has been found to play a key role in the modulation of cell proliferation and cancer development. It seems to act as an oncosuppressor or a promoter of growth, depending on the histotype, stage and grade of each tumour. The aim of this study was to analyze the effects of Caveolin-1 gene silencing on the proliferation of human lung cancer and osteosarcoma in vitro. Our data show that Cav-1 silencing blocks the growth in both metastatic lung cancer cell lines analyzed, suggesting a proliferation promoting action of the protein in these cells. A marked decrease of phospho-Akt, phospho-ERK, STAT3, cyclin D1, CDK4 and consequently of phospho-Rb expression was evident in the cells treated with Cav-1 siRNA. With regards to osteosarcoma, we demonstrated that the suppression of Cav-1 results in the blocking of MG-63 and in the slowing down of HOS proliferation, suggesting a role for Cav-1 as a promoter of tumour growth in these cell lines. A marked decrease of phospho-Akt, cyclin E, CDK2 and phospho-Rb and an increase of p21 expression levels were evident in the cells treated with Cav-1 siRNA. Our results suggest two new cell cycle inhibiting pathways, mediated by Cav-1 knock-down, and provide new insights into the molecular mechanisms underlying the tumour-promoting role of Cav-1 in lung cancer and osteosarcoma. In this work we also investigated the role of estrogens in lung cancer and the functional cross-talk between Cav-1 and estrogens/estrogen receptors in it. Our results show that 17β-estradiol induces proliferation either in RAL or in SCLC-R1 cells and that both cell lines are sensitive to 4-OHT antiproliferative effect. The sensitivity to estrogen stimulation seems to be gender- and/or histological type-independent in metastatic lung cancer in vitro.

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.

The medical management after surgery for advanced heart failure

The aim of the Research of this Ph D Project is to improve the medical management after surgery for advanced heart failure, both after left ventricular assist devices (LVAD) implantation, and after heart transplantation in the long-term. Regarding heart transplantation (HTx), the Research Project is focused on diagnostics, classification, prevention and treatment of cardiac allograft vasculopathy (CAV), and on treatment of post-HTx cancers; the results are presented in the first part of this Thesis. In particular, the main aspect investigated are the prognostic role of information derived from coronary angiography, coronary tomography and intravascular ultrasound, and the different sensitivity of these techniques in predicting outcomes and in diagnosing CAV. Moreover, the role of mTOR inhibitors on CAV prevention or treatment is investigated, both alone and in combination with different anti-CMV prevention strategies, as well as the impact of mTOR inhibitors on clinical outcomes in the long term. Regarding LVAD, the main focus is on the role of transthoracic echocardiography in the management of patients with a continuous-flow, centrifugal, intrapericardial pump (HVAD, Heartware); this section is reported in the second part of this Thesis. The main aspects investigated are the use of echocardiography in patients with HVAD device and its interaction with the information derived from pump curves' analysis in predicting aortic valve opening status, a surrogate of the condition of support provided by the LVAD.

Funktionelle Analyse der Plasmamembran-Ca 2+-ATPase 2 -PMCA2- in Modellen der Neurodegeneration

Calcium (Ca2+) ist ein ubiquitär vorkommendes Signalmolekül, das an der Regulation zahlreicher zellulärer Prozesse, von der Proliferation bis zum programmierten Zelltod, beteiligt ist. Daher müssen die intrazellulären Ca2+-Spiegel streng kontrolliert werden. Veränderungen der Ca2+-Homöostase während der altersassoziierten Neurodegeneration können dazu beitragen, dass Neuronen vulnerabler sind. So wurden erhöhte Ca2+-Konzentrationen in gealterten Neuronen, begleitet von einer erhöhten Vulnerabilität, beobachtet (Hajieva et al., 2009a). Weiterhin wird angenommen, dass der selektive Untergang von dopaminergen Neuronen bei der Parkinson Erkrankung auf eine erhöhte Ca2+-Last zurückzuführen sein könnte, da diese Neuronen einem ständigen Ca2+-Influx,rnaufgrund einer besonderen Isoform (CaV 1.3) spannungsgesteuerter Ca2+-Kanäle des L-Typs, ausgesetzt sind (Chan et al., 2007). Bislang wurden die molekularen Mechanismen, die einem Ca2+-Anstieg zu Grunde liegen und dessen Auswirkung jedoch nicht vollständig aufgeklärt und daher in der vorliegenden Arbeit untersucht. Um Veränderungen der Ca2+-Homöostase während der altersassoziiertenrnNeurodegeneration zu analysieren wurden primäre Mittelhirnzellen aus Rattenembryonen und SH-SY5Y-Neuroblastomazellen mit dem Neurotoxin 1-Methyl-4-Phenyl-Pyridin (MPP+), das bei der Etablierung von Modellen der Parkinson-Erkrankung breite Anwendung findet, behandelt. Veränderungen der intrazellulären Ca2+-Konzentration wurden mit einem auf dem grün fluoreszierenden Protein (GFP)-basierten Ca2+-Indikator,rn„Cameleon cpYC 3.6“ (Nagai et al., 2004), ermittelt. Dabei wurde in dieser Arbeit gezeigt, dass MPP+ die Abregulation der neuronenspezifischen ATP-abhängigen Ca2+-Pumpe der Plasmamembran (PMCA2) induziert, die mit der Ca2+-ATPase des endoplasmatischen Retikulums (SERCA) und dem Na+/Ca2+-Austauscher (NCX) das zelluläre Ca2+-Effluxsystem bildet, was zu einer erhöhten zytosolischen Ca2+-Konzentration führt. Die PMCA2-Abnahme wurde sowohl auf Transkriptionsebene als auch auf Proteinebene demonstriert, während keine signifikanten Veränderungen der SERCA- und NCX-Proteinmengen festgestellt wurden. Als Ursache der Reduktion der PMCA2-Expression wurde eine Abnahme des Transkriptionsfaktors Phospho-CREB ermittelt, dessen Phosphorylierungsstatus abhängig von der Proteinkinase A (PKA) war. Dieser Mechanismus wurde einerseits unter MPP+-Einfluss und andererseits vermittelt durch endogene molekulare Modulatoren gezeigt. Interessanterweise konnten die durch MPP+ induzierte PMCA2-Abregulation und der zytosolische Ca2+-Anstieg durch die Aktivierung der PKA verhindert werden. Parallel dazu wurde eine MPP+-abhängige verringerte mitochondriale Ca2+-Konzentration nachgewiesen, welche mit einer Abnahme des mitochondrialen Membranpotentials korrelierte. Darüber hinaus kam es als Folge der PMCA2-Abnahme zu einem verminderten neuronalen Überleben.rnVeränderungen der Ca2+-Homöostase wurden auch während der normalen Alterung inrnprimären Fibroblasten und bei Mäusen nachgewiesen. Dabei wurden verringerte PMCA und SERCA-Proteinmengen in gealterten Fibroblasten, einhergehend mit einem Anstieg der zytosolischen Ca2+-Konzentration demonstriert. Weiterhin wurden verringerte PMCA2-Proteinmengen im Mittelhirn von gealterten Mäusen (C57B/6) detektiert.rnDer zelluläre Ca2+-Efflux ist somit sowohl im Zuge der physiologischen Alterung als auch in einem altersbezogenen Krankheitsmodell beeinträchtigt, was das neuronale Überleben beeinflussen kann. In zukünftige Studien soll aufgeklärt werden, welche Auswirkungen einer PMCA2-Reduktion genau zu dem Verlust von Neuronen führen bzw. ob durch eine PMCA2-Überexpression neurodegenerative Prozesse verhindert werden können.

Virtual histology assessment of cardiac allograft vasculopathy following introduction of everolimus--results of a multicenter trial

In this 12-month multicenter Scandinavian study, 78 maintenance heart transplant (HTx) recipients randomized to everolimus with reduced calcineurin inhibitor (CNI) exposure or continued standard CNI-therapy underwent matched virtual histology (VH) examination to evaluate morphological progression of cardiac allograft vasculopathy (CAV). Parallel measurement of a range of inflammatory markers was also performed. A similar rate of quantitative CAV progression was observed in the everolimus (n = 30) and standard CNI group (n = 48) (plaque index 1.9 ± 3.8% and 1.6 ± 3.9%, respectively; p = 0.65). However, VH analysis revealed a significant increase in calcified (2.4 ± 4.0 vs. 0.3 ± 3.1%; p = 0.02) and necrotic component (6.5 ± 8.5 vs. 1.1 ± 8.6%; p = 0.01) among everolimus patients compared to controls. The increase in necrotic and calcified components was most prominent in everolimus patients with time since HTx >5.1 years and was accompanied by a significant increase in levels of von Willebrand (vWF) factor (p = 0.04) and vascular cell adhesion molecule (VCAM) (p = 0.03). Conversion to everolimus and reduced CNI is associated with a significant increase in calcified and necrotic intimal components and is more prominent in patients with a longer time since HTx. A significant increase in vWF and VCAM accompanied these qualitative changes and the prognostic implication of these findings requires further investigation.

Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now?

The efficacy of everolimus with reduced cyclosporine in de novo heart transplant patients has been demonstrated convincingly in randomized studies. Moreover, everolimus-based immunosuppression in de novo heart transplant recipients has been shown in two randomized trials to reduce the increase in maximal intimal thickness based on intravascular ultrasound, indicating attenuation of cardiac allograft vasculopathy (CAV). Randomized trials of everolimus in de novo heart transplantation have also consistently shown reduced cytomegalovirus infection versus antimetabolite therapy. In maintenance heart transplantation, conversion from calcineurin inhibitors to everolimus has demonstrated a sustained improvement in renal function. In de novo patients, a renal benefit may only be achieved if there is an adequate reduction in exposure to calcineurin inhibitor therapy. Delayed introduction of everolimus may be appropriate in patients at high risk of wound healing complications, e.g. diabetic patients or patients with ventricular assist device. The current evidence base suggests that the most convincing reasons for use of everolimus from the time of heart transplantation are to slow the progression of CAV and to lower the risk of cytomegalovirus infection. A regimen of everolimus with reduced-exposure calcineurin inhibitor and steroids in de novo heart transplant patients represents a welcome addition to the therapeutic armamentarium.

Quantitative myocardial contrast echocardiography: a new method for the non-invasive detection of chronic heart transplant rejection

Chronic heart transplant rejection, i.e. cardiac allograft vasculopathy (CAV) is a major adverse prognostic factor after heart transplantation (HTx). This study tested the hypothesis that the relative myocardial blood volume (rBV) as quantified by myocardial contrast echocardiography accurately detects severe CAV as defined by coronary intravascular ultrasound (IVUS).

Ubiquitin-specific protease USP2-45 acts as a molecular switch to promote α2δ-1-induced downregulation of Ca v1.2 channels

Availability of voltage-gated calcium channels (Cav) at the plasma membrane is paramount to maintaining the calcium homeostasis of the cell. It is proposed that the ubiquitylation/de-ubiquitylation balance regulates the density of ion channels at the cell surface. Voltage-gated calcium channels Cav1.2 have been found to be ubiquitylated under basal conditions both in vitro and in vivo. In a previous study, we have shown that Cav1.2 channels are ubiquitylated by neuronal precursor cell-expressed developmentally downregulated 4 (Nedd4-1) ubiquitin ligases, but the identity of the counterpart de-ubiquitylating enzyme remained to be elucidated. Regarding sodium and potassium channels, it has been reported that the action of the related isoform Nedd4-2 is counteracted by the ubiquitin-specific protease (USP) 2-45. In this study, we show that USP 2-45 also de-ubiquitylates Cav channels. We co-expressed USPs and Cav1.2 channels together with the accessory subunits β2 and α2δ-1, in tsA-201 and HEK-293 mammalian cell lines. Using whole-cell current recordings and surface biotinylation assays, we show that USP2-45 specifically decreases both the amplitude of Cav currents and the amount of Cav1.2 subunits inserted at the plasma membrane. Importantly, co-expression of the α2δ-1 accessory subunit is necessary to support the effect of USP2-45. We further show that USP2-45 promotes the de-ubiquitylation of both Cav1.2 and α2δ-1 subunits. Remarkably, α2δ-1, but not Cav1.2 nor β2, co-precipitated with USP2-45. These results suggest that USP2-45 binding to α2δ-1 promotes the de-ubiquitylation of both Cav1.2 and α2δ-1 subunits, in order to regulate the expression of Cav1.2 channels at the plasma membrane.

Cytomegalovirus infection and disease reduce 10-year cardiac allograft vasculopathy-free survival in heart transplant recipients.

BACKGROUND Cytomegalovirus (CMV) is associated with an increased risk of cardiac allograft vasculopathy (CAV), the major limiting factor for long-term survival after heart transplantation (HTx). The purpose of this study was to evaluate the impact of CMV infection during long-term follow-up after HTx. METHODS A retrospective, single-centre study analyzed 226 HTx recipients (mean age 45 ± 13 years, 78 % men) who underwent transplantation between January 1988 and December 2000. The incidence and risk factors for CMV infection during the first year after transplantation were studied. Risk factors for CAV were included in an analyses of CAV-free survival within 10 years post-transplant. The effect of CMV infection on the grade of CAV was analyzed. RESULTS Survival to 10 years post-transplant was higher in patients with no CMV infection (69 %) compared with patients with CMV disease (55 %; p = 0.018) or asymptomatic CMV infection (54 %; p = 0.053). CAV-free survival time was higher in patients with no CMV infection (6.7 years; 95 % CI, 6.0-7.4) compared with CMV disease (4.2 years; CI, 3.2-5.2; p < 0.001) or asymptomatic CMV infection (5.4 years; CI, 4.3-6.4; p = 0.013). In univariate analysis, recipient age, donor age, coronary artery disease (CAD), asymptomatic CMV infection and CMV disease were significantly associated with CAV-free survival. In multivariate regression analysis, CMV disease, asymptomatic CMV infection, CAD and donor age remained independent predictors of CAV-free survival at 10 years post-transplant. CONCLUSIONS CAV-free survival was significantly reduced in patients with CMV disease and asymptomatic CMV infection compared to patients without CMV infection. These findings highlight the importance of close monitoring of CMV viral load and appropriate therapeutic strategies for preventing asymptomatic CMV infection.

The Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on Cardiac Allograft Vasculopathy in De Novo Recipients: One-Year Results of a Scandinavian Randomized Trial.

Early initiation of everolimus with calcineurin inhibitor therapy has been shown to reduce the progression of cardiac allograft vasculopathy (CAV) in de novo heart transplant recipients. The effect of de novo everolimus therapy and early total elimination of calcineurin inhibitor therapy has, however, not been investigated and is relevant given the morbidity and lack of efficacy of current protocols in preventing CAV. This 12-month multicenter Scandinavian trial randomized 115 de novo heart transplant recipients to everolimus with complete calcineurin inhibitor elimination 7-11 weeks after HTx or standard cyclosporine immunosuppression. Ninety-five (83%) patients had matched intravascular ultrasound examinations at baseline and 12 months. Mean (± SD) recipient age was 49.9 ± 13.1 years. The everolimus group (n = 47) demonstrated significantly reduced CAV progression as compared to the calcineurin inhibitor group (n = 48) (ΔMaximal Intimal Thickness 0.03 ± 0.06 and 0.08 ± 0.12 mm, ΔPercent Atheroma Volume 1.3 ± 2.3 and 4.2 ± 5.0%, ΔTotal Atheroma Volume 1.1 ± 19.2 mm(3) and 13.8 ± 28.0 mm(3) [all p-values ≤ 0.01]). Everolimus patients also had a significantly greater decline in levels of soluble tumor necrosis factor receptor-1 as compared to the calcineurin inhibitor group (p = 0.02). These preliminary results suggest that an everolimus-based CNI-free can potentially be considered in suitable de novo HTx recipients.

Everolimus initiation and early calcineurin inhibitor withdrawal in heart transplant recipients: a randomized trial.

In a randomized, open-label trial, everolimus was compared to cyclosporine in 115 de novo heart transplant recipients. Patients were assigned within 5 days posttransplant to low-exposure everolimus (3–6 ng/mL) with reduced-exposure cyclosporine (n = 56), or standard-exposure cyclosporine (n = 59), with both mycophenolate mofetil and corticosteroids. In the everolimus group, cyclosporine was withdrawn after 7–11 weeks and everolimus exposure increased (6–10 ng/mL). The primary efficacy end point, measured GFR at 12 months posttransplant, was significantly higher with everolimus versus cyclosporine (mean ± SD: 79.8 ± 17.7 mL/min/1.73 m2 vs. 61.5 ± 19.6 mL/min/1.73 m2; p < 0.001). Coronary intravascular ultrasound showed that the mean increase in maximal intimal thickness was smaller (0.03 mm [95% CI 0.01, 0.05 mm] vs. 0.08 mm [95% CI 0.05, 0.12 mm], p = 0.03), and the incidence of cardiac allograft vasculopathy (CAV) was lower (50.0% vs. 64.6%, p = 0.003), with everolimus versus cyclosporine at month 12. Biopsy-proven acute rejection after weeks 7–11 was more frequent with everolimus (p = 0.03). Left ventricular function was not inferior with everolimus versus cyclosporine. Cytomegalovirus infection was less common with everolimus (5.4% vs. 30.5%, p < 0.001); the incidence of bacterial infection was similar. In conclusion, everolimus-based immunosuppression with early elimination of cyclosporine markedly improved renal function after heart transplantation. Since postoperative safety was not jeopardized and development of CAV was attenuated, this strategy may benefit long-term outcome.

Effect of everolimus introduction on cardiac allograft vasculopathy--results of a randomized, multicenter trial.

BACKGROUND Everolimus reduces the progression of cardiac allograft vasculopathy (CAV) in de novo heart transplant (HTx) recipients, but the influence on established CAV is unknown. METHODS In this Nordic Certican Trial in Heart and lung Transplantation substudy, 111 maintenance HTx recipients (time post-HTx 5.8 ± 4.3 years) randomized to everolimus+reduced calcineurin inhibitor (CNI) or standard CNI had matching (intravascular ultrasound) examinations at baseline and 12 months allowing accurate assessment of CAV progression. RESULTS No significant difference in CAV progression was evident between the treatment groups (P = 0.30). When considering patients receiving concomitant azathioprine (AZA) therapy (n = 39), CAV progression was attenuated with everolimus versus standard CNI (Δmaximal intimal thickness 0.00 ± 0.04 and 0.04 ± 0.04 mm, Δpercent atheroma volume 0.2% ± 3.0% and 2.6% ± 2.5%, and Δtotal atheroma volume 0.25 ± 14.1 and 19.8 ± 20.4 mm(3), respectively [P < 0.05]). When considering patients receiving mycophenolate mofetil (MMF), accelerated CAV progression occurred with everolimus versus standard CNI (Δmaximal intimal thickness 0.06 ± 0.12 vs. 0.02 ± 0.06 mm and Δpercent atheroma volume 4.0% ± 6.3% vs. 1.4% ± 3.1%, respectively; P < 0.05). The levels of C-reactive protein and vascular cell adhesion molecule-1 declined significantly with AZA+everolimus, whereas MMF+everolimus patients demonstrated a significant increase in levels of C-reactive protein, vascular cell adhesion molecule-1, and von Willebrand factor. CONCLUSIONS Conversion to everolimus and reduced CNI does not influence CAV progression among maintenance HTx recipients. However, background immunosuppressive therapy is important as AZA+everolimus patients demonstrated attenuated CAV progression and a decline in inflammatory markers, whereas the opposite pattern was seen with everolimus+MMF. The different effect of everolimus when combined with AZA versus MMF could potentially reflect hitherto unknown interactions.

Everolimus-Eluting Bioresorbable Vascular Scaffold System in the Treatment of Cardiac Allograft Vasculopathy: the CART (Cardiac Allograft Reparative Therapy) Prospective Multicenter Pilot Study.

Cardiac allograft vasculopathy (CAV) is a form of accelerated atherosclerosis, which represents the leading cause of late morbidity and mortality after heart transplantation. The recent bioresorbable vascular scaffold (BVS) technology represents a potential novel therapeutic tool, in the context of CAV, by allowing transient scaffolding and concomitant vessel healing. Eligible subjects will be treated by using the Absorb Everolimus-Eluting BVS (Abbott Vascular, Santa Clara, CA, USA), and evaluated at pre-determined time points, up to 3 years since the index procedure. Both clinical and imaging data will be collected in dedicated case report forms (CRF). All imaging data will be analyzed in an independent core laboratory. The primary aim of the study is to evaluate the angiographic performance at 1 year of second-generation Absorb BVS, in heart transplant recipients affected by CAV.

The role and mechanism of supressor of cytokine signaling 1 in brain metastasis

Brain metastasis, which occurs in 40%-60% of patients with advanced melanoma, has led directly to death in the majority of cases. Unfortunately, little is known about the biological and molecular basis of melanoma brain metastases. In our previous study, we developed a model to study human melanoma brain metastasis and found that Stat3 activity was increased in human brain metastatic melanoma cells when compared with that in cutaneous melanoma cells. The increased activation of Stat3 is also responsible for affecting melanoma angiogenesis in vivo and melanoma cell invasion in vitro and significantly affecting the expression of bFGF, VEGF, and MMP-2 in vivo and in vitro. Interestingly, a member of a new family of cytokine-inducible inhibitors of signal transduction, termed suppressors of cytokine signaling 1 (SOCS1) was found to negatively regulate the Janus kinase signal transducer and activator of transcription (Jak/STAT) signaling cascade. Here we report that restoration of SOCS1 expression by transfecting of SOCS1-expressing vector effectively inhibited melanoma brain metastasis through inhibiting Stat3 activation and further affecting melanoma angiogenesis and melanoma cell invasion in vitro, and significantly affected the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) in vitro and in vivo. In addition, we used cDNA array to compare mRNA expression in the SOCS1-transfected and vector-transfected cell lines and found some genes are tightly correlated to the restoration of SOCS1. One of them is Caveolin-1 (Cav-1). Cav-1 was reported to function as a tumor suppressor gene by several groups. Finally, the Cav-1 expression is up-regulated in SOCS1-overexpressing cell line. Further study found the regulation of Cav-1 by SOCS1 occurs through inhibiting Stat3 activation. Activated Stat3 binds directly to Cav-1 promoter and the Cav-1 promoter within -575bp is essential for active Stat3 binding. My studies reveal that Stat3 activation and SOCS1 expression play important roles in melanoma metastases. Moreover, the expression between SOCS1, Stat3 and Cav-1 forms a feedback regulation loop. ^