The role of interleuchin 6 (IL-6) in the promotion of an aggressive and stem cell-like phenotype in human breast cancer cells and in stem/progenitor cells expanded in vitro as mammospheres

High serum levels of Interleukin-6 (IL-6) correlate with poor outcome in breast cancer patients. However no data are available on the relationship between IL-6 and stem/progenitor cells which may fuel the genesis of breast cancer in vivo. Herein, we address this issue in mammospheres (MS), multi-cellular structures enriched in stem/progenitor cells of the mammary gland, and also in MCF-7 breast cancer cells. We show that MS from node invasive breast carcinoma tissues express IL-6 mRNA at higher levels than MS from matched non-neoplastic mammary glands. We find that IL-6 mRNA is detectable only in basal-like breast carcinoma tissues, an aggressive variant showing stem cell features. Our results reveal that IL-6 triggers a Notch-3-dependent up-regulation of the Notch ligand Jagged-1, whose interaction with Notch-3 promotes the growth of MS and MCF-7 derived spheroids. Moreover, IL-6 induces a Notch-3-dependent up-regulation of the carbonic anhydrase IX gene, which promotes a hypoxia-resistant/invasive phenotype in MCF-7 cells and MS. Finally, an autocrine IL-6 loop relies upon Notch-3 activity to sustain the aggressive features of MCF-7-derived hypoxia-selected cells. In conclusion, our data support the hypothesis that IL-6 induces malignant features in Notch-3 expressing, stem/progenitor cells from human ductal breast carcinoma and normal mammary gland.

Stem cell pathways in the basal-like breast carcinoma: the role of beta-catenin and HIF-1alpha

Basal-like tumor is an aggressive breast carcinoma subtype that displays an expression signature similar to that of the basal/myoepithelial cells of the breast tissue. Basal-like carcinoma are characterized by over-expression of the Epidermal Growth Factor receptor (EGFR), high frequency of p53 mutations, cytoplasmic/nuclear localization of beta-catenin, overexpression of the Hypoxia inducible factor (HIF)-1alpha target Carbonic Anhydrase isoenzime 9 (CA9) and a gene expression pattern similar to that of normal and cancer stem cells, including the over-expression of the mammary stem cell markers CD44. In this study we investigated the role of p53, EGFR, beta-catenin and HIF-1alpha in the regulation of stem cell features and genes associated with the basal-like gene expression profile. The findings reported in this investigation indicate that p53 inactivation in ductal breast carcinoma cells leads to increased EGFR mRNA and protein levels. In our experimental model, EGFR overexpression induces beta-catenin cytoplasmatic stabilization and transcriptional activity and, by that, leads to increased aggressive features including mammosphere (MS) forming and growth capacity, invasive potential and overexpression of the mammary stem cell gene CD44. Moreover we found that EGFR/beta-catenin axis promotes hypoxia survival in breast carcinoma cells via increased CA9 expression. Indeed beta-catenin positively regulates CA9 expression upon hypoxia exposure. Interestingly we found that beta-catenin inhibits HIF-1alpha transcriptional activity. Looking for the mechanism, we found that CA9 expression is promoted by HIF-1alpha and cytoplasmatic beta-catenin further increased it post-transcriptionally, via direct mRNA binding and stabilization. These data reveal a functional beta-catenin/HIF-1alpha interplay among hallmarks of basal-like tumors and unveil a new functional role for cytoplasmic beta-catenin in the phenotype of such tumors. Therefore it can be proposed that the interplay here described among EGFR/beta-catenin and HIF-1alpha may play a role in breast cancer stem cell survival and function.

Identifizierung von T-Zell-erkannten Nierenzellkarzinom-Antigenen

Eine Voraussetzung für die Entwicklung neuer immunmodulatorischer Therapieverfahren ist die Kenntnis immunogener Tumorantigene, die von tumorreaktiven T-Zellen erkannt werden. In der vorliegenden Arbeit wurden tumorreaktive CD8+ zytotoxische T-Lymphozyten (CTL, cytotoxic T-lymphocytes) aus dem Blut eines HLA (human leukocyte antigen)-kompatiblen Fremdspenders generiert. Methodisch wurden hierzu CD8-selektionierte periphere Blutlymphozyten repetitiv mit der klarzelligen Nierenzellkarzinomlinie MZ1851-RCC (RCC, renal cell carcinoma) in einer allogenen gemischten Lymphozyten-Tumorzell Kultur (MLTC, mixed lymphocyte tumor cell culture) stimuliert. Aus den Responderlymphozyten wurden mit Hilfe des Grenzverdünnungsverfahrens klonale zytotoxische T-Zellen generiert und expandiert. Die CTL-Klone wurden anschließend phänotypisch mittels Durchflußzytometrie sowie funktionell mittels HLA-Antikörper-Blockadeexperimenten und Kreuzreaktivitätstests detailliert charakterisiert. Dabei konnte gezeigt werden, daß aus dem Blut eines allogenen gesunden Spenders CD8+ T-Zellen isoliert werden können, welche Reaktivität gegen Nierenzellkarzinome (NZK) aufweisen und über verschiedene HLA-Klasse-I-Allele restringiert sind. Die von den einzelnen CTL-Klonen erkannten Zielstrukturen zeigten entweder ubiquitäre (z.B. HLA-Cw*0704-reaktiver CTL-Klon E77) oder eine tumorspezifische (z.B. HLA-B*0702-restringierter CTL-Klon A4) Gewebeexpression. Zur Identifizierung der natürlich prozessierten Peptidliganden wurden die HLA-B/C-Allele unter Verwendung des monoklonalen Antikörpers B123.2 aus einem zuvor hergestellten Detergenslysat der Nierenzellkarzinomlinie MZ1851-RCC immunchromatographisch aufgereinigt. Aus den so isolierten HLA-Peptid-Komplexen wurden die tumorassoziierten Peptidliganden nach Säureeluation und Filtration abgespalten und über eine „reverse phase“-HPLC (high performance liquid chromatography) fraktioniert. Die Überprüfung der einzelnen HPLC-Fraktionen auf Bioaktivität erfolgte mit den korrespondierenden CTL-Klonen in 51Cr-Zytotoxizitätstests. Dabei wurde eine HPLC-Fraktion identifiziert, die die lytische Funktion des HLA-B*0702-restringierten CTL-Klons A4 auslösen konnte. Die bioaktive HPLC-Fraktion wurde dazu durch eine zweite (second dimension) Kapillar-Flüssigkeitschromatographie (Cap-LC, capillar liquid chromatography) in Subfraktionen geringerer Komplexität aufgetrennt und die darin enthaltenen Peptidepitope durch das MALDI-TOF/TOF (matrix assisted laser desorption/ionization- time of flight/time of flight)-Analyseverfahren sequenziert. Innerhalb dieser HPLC-Fraktion wurden eine Vielzahl von HLA-B/C-assoziierten Peptidliganden erfolgreich sequenziert, was die Effektivität dieser Verfahrenstechnik zur Identifizierung natürlich prozessierter HLA-Klasse-I-bindender Peptide unter Beweis stellt. Leider war es mit dieser Methode bisher nicht möglich, das von CTL-Klon A4 detektierte Peptidepitop zu sequenzieren. Dies liegt möglicherweise in der unzureichenden Konzentration des Peptidepitops in der bioaktiven HPLC-Fraktion begründet. In Folgearbeiten soll nun mit erhöhter Probenmenge beziehungsweise verbesserter Analytik der erneute Versuch unternommen werden, das Zielantigen des CTL-Klons A4 zu identifizieren. Die Kenntnis von Antigenen, die tumorspezifisch exprimiert und von CD8+ CTL aus gesunden Spendern erkannt werden, eröffnet neue therapeutische Möglichkeiten, das spezifische Immunsystem des Stammzellspenders nach allogener Blutstammzelltransplantation gezielt zur Steigerung von Tumorabstoßungsreaktionen (z.B. durch Vakzinierung oder adoptivem T-Zelltransfer) zu nutzen.

Computational modelling of human stem cell-derived cardiomyocytes - Texture descriptors for biological image processing

This thesis investigates two distinct research topics. The main topic (Part I) is the computational modelling of cardiomyocytes derived from human stem cells, both embryonic (hESC-CM) and induced-pluripotent (hiPSC-CM). The aim of this research line lies in developing models of the electrophysiology of hESC-CM and hiPSC-CM in order to integrate the available experimental data and getting in-silico models to be used for studying/making new hypotheses/planning experiments on aspects not fully understood yet, such as the maturation process, the functionality of the Ca2+ hangling or why the hESC-CM/hiPSC-CM action potentials (APs) show some differences with respect to APs from adult cardiomyocytes. Chapter I.1 introduces the main concepts about hESC-CMs/hiPSC-CMs, the cardiac AP, and computational modelling. Chapter I.2 presents the hESC-CM AP model, able to simulate the maturation process through two developmental stages, Early and Late, based on experimental and literature data. Chapter I.3 describes the hiPSC-CM AP model, able to simulate the ventricular-like and atrial-like phenotypes. This model was used to assess which currents are responsible for the differences between the ventricular-like AP and the adult ventricular AP. The secondary topic (Part II) consists in the study of texture descriptors for biological image processing. Chapter II.1 provides an overview on important texture descriptors such as Local Binary Pattern or Local Phase Quantization. Moreover the non-binary coding and the multi-threshold approach are here introduced. Chapter II.2 shows that the non-binary coding and the multi-threshold approach improve the classification performance of cellular/sub-cellular part images, taken from six datasets. Chapter II.3 describes the case study of the classification of indirect immunofluorescence images of HEp2 cells, used for the antinuclear antibody clinical test. Finally the general conclusions are reported.

Die Identifizierung und Charakterisierung von HLA-Klasse-I-restringierten Minorhistokompatibilitätsantigenen und Leukämie-assoziierten Antigenen mittels cDNA-Expressionsklonierung

Die allogene hämatopoetische Stammzelltransplantation (allo-HSCT) bietet bei einem hohen Anteil akuter Leukämien die einzige kurative Behandlungsmöglichkeit. Um die mit ihr assoziierte Morbidität und Mortalität zu senken und ihre Effektivität zu steigern, soll die GvL (graft-versus-leukemia)-Reaktion als eigentliches Therapieziel gegenüber der unerwünschten GvHD (graft-versus-host disease) möglichst selektiv verstärkt werden. Wesentliche Mediatoren beider Effekte sind alloreaktive T-Zellen. Bei HLA-Übereinstimmung zwischen Spender und Empfänger sind so genannte Minorhistokompatibilitätsantigene (mHAgs) und Leukämie-assoziierte Antigene (LAA) die mutmaßlichen Zielstrukturen beider Reaktionen. Im Rahmen der vorliegenden Arbeit wurden in dem Leukämie-Modell der Patientin MZ201 [akute myeloische Leukämie (AML) vom Subtyp FAB M5] mittels T-Zell-basierter cDNA-Expressionsklonierung zwei neue Antigene identifiziert, die von allogenen, AML-reaktiven CD8+ T-Lymphozyten aus Blut eines HLA-passenden gesunden Spenders erkannt wurden. Es handelt sich zum einen um das HLA-B*5601-restringierte mHAg PLAUR-317P, das aus einem Polymorphismus des Gens PLAUR (plasminogen activator, urokinase receptor) resultiert. Das von den T-Zellen am Besten erkannte Peptid enthält die Aminosäuren 316 - 327. PLAUR wird in lymphohämatopoetischen Zellen und in verschiedenen Malignomen überexprimiert und ist dabei mit schlechterer Prognose und vermehrter Gewebeinvasivität assoziiert. Etwa 30% getesteter Individuen tragen das Allel PLAUR-317P. Zum anderen handelt es sich um ein Epitop aus der Signalregion des Chemokins CXCL3 [chemokine (C-X-C motif) ligand 3], das von CD8+ T-Zellen des gleichen Spenders auf Leukämiezellen der Patientin MZ201 in Assoziation mit HLA-A*0201 erkannt wurde. Auch CXCL3 wird vorwiegend in Zellen der Myelopoese exprimiert. Aufgrund ihres Expressionsmusters sind beide Antigene potentielle Zielstrukturen für die Elimination der Empfänger-Hämatopoese unter Einschluss der Leukämieblasten im Rahmen der allo-HSCT. Weiterführende Untersuchungen müssen zeigen, ob diese Antigene tatsächlich in vivo GvL-Reaktionen hervorrufen. Die Kenntnis eines repräsentativen Spektrums solcher Antigene würde verbesserte Spenderselektionen erlauben und neue Wege des adoptiven T-Zelltransfers erschließen helfen.

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.

Evaluation der Leukämie-Reaktivität von PRAME- und p53-spezifischen T-Zellen bei lymphohämatopoetischen Neoplasien im Rahmen einer adoptiven Immuntherapie

Der Transplantat-gegen-Leukämie (GVL) Effekt als immuntherapeutisches Mittel bei der allogenen hämatopoetischen Stammzell Transplantation (HSZT) ist hauptsächlich durch Spender Lymphozyten vermittelt, welche hämatopoetische Minor-Histokompatibilitäts Antigene bzw. Leukämie-assoziierte Antigene (z. B.: PRAME, p53) erkennen. Der adoptive Transfer von Leukämie-spezifischen T-Zellen kann den GVL-Effekt, ohne ein Auftreten einer Transplantat-gegen-Wirt Erkrankung (GVHD), steigern. Unter Verwendung von HLA-A2 und human CD8 transgenen Mäusen (CD8yCyA2Kb) konnten in dieser Arbeit PRAME spezifische CD8+ zytotoxischen T-Zellen generiert werden. Diese zytotoxischen CD8+ T-Zellen zeigten in Chromfreisetzungsuntersuchungen lytische Aktivität gegen eine Vielzahl von Zelllinien, die PRAME endogen prozessieren sowie gegen das spezifische PRAME-Peptid. Des Weiteren wurden die hier generierten T-Zellen auf ihre zytotoxische Aktivität gegen akute myeloische Leukämie Blasten hin untersucht, und diese Untersuchungen zeigten AML-Reaktivität der PRAME-spezifischen sowie der als Vergleich genutzten p53- und HLA-A2-spezifischen T-Zellen. Das Potenzial der PRAME-spezifischen ZTL die GVL-Immunität in vivo zu erhöhen ohne das Vorkommen einer GVHD wurde in einem Tumor-Protektions-Model unter der Nutzung von NOD/SCIDgcnull Mäusen untersucht. Die PRA100- bzw. p53-ZTL wurden adoptiv in NOD/SCIDgcnull Rezipienten transferiert und gleichzeitig wurden die Tiere mit PRAME-, oder p53-exprimierende Tumorzelllinien inokuliert. Die Reduktion des Tumorwachstums bestätigte die Spezifität der T-Zellen auch in vivo. In weiteren in vivo Experimenten wurden NOD/SCIDgcnull Mäuse mit AML-Blasten rekonstituiert. Durch die Applikation von nur CD34 positiven Zellen aus einer AML-Probe, oder einer CD56 depletierten Probe, konnten Rekonstitutionen in 95 % aller Versuche erfolgreich beendet werden. Wurde eine Rekonstitution mittels PCR- und FACS-Analysen diagnostiziert, so folgten mehrere Applikationen der PRAME- oder p53-spezifischen ZTL. In diesen Untersuchungen konnten wir in einem therapeutischen AML-in vivo-Modell zeigen, dass die in diesen Untersuchungen generierten/verwandten ZTL in der Lage sind AML-Blasten in vivo zu bekämpfen und so die leukämische Last der Tiere im Blut sowie in der Milz auf unter 1 % zu regulieren. Der prozentuale Anteil humaner AML Zellen im Knochenmark konnte deutlich gesenkt werden (< 10 %). Zusammenfassend sind die von uns generierten PRAME-spezifischen T-Zellen in der Lage, in vitro und auch in vivo, endogen prozessiertes Protein auf Zelllinien und AML-Blasten zu erkennen und zu lysieren. Auch die p53-ZTL, welche als eine weitere Antigen-spezifische ZTL-Population in vivo getestet wurden, zeigten GVL-Effekte. Die Kenntnis von Tumor- bzw. Leukämie assoziierten Antigenen und die daraus erwachsene Möglichkeit der Generierung krankheitsspezifischer ZTL bietet die Grundlage für eine spezifische Immuntherapie maligner Erkrankungen.

Valutazione dell'efficacia dell'infusione intraepatica di cellule staminali (SC) autologhe CD133+ in pazienti affetti da cirrosi ed insufficienza epatica di grado avanzato

Numerose evidenze sperimentali hanno dimostrato il contributo delle cellule staminali (SC) di derivazione midollare nei processi di rigenerazione epatica dopo danno tissutale. E’ cresciuto pertanto l’interesse sul loro potenziale impiego in pazienti con cirrosi. Questo studio si proponeva di valutare la fattibilità e la sicurezza della reinfusione intraepatica di cellule staminali midollari autologhe CD133+ in 12 pazienti con insufficienza epatica terminale. Previa mobilizzazione nel sangue periferico mediante somministrazione di granulocyte-colony stimulating factor (G-CSF) alla dose di 7,5 mcg/Kg/b.i.d. e raccolta per leucoaferesi (solo se la concentrazione di CD133 + SC era > 8/μL), le cellule CD133+ altamente purificate sono state reinfuse in arteria epatica a partire da 5x104/Kg fino a 1x106/kg. Nei tre giorni successivi è stato somministrato G-CSF per favorire l’espansione e l’attecchimento delle cellule. Durante la fase della mobilizzazione e quella della reinfusione sono stati eseguiti saggi biologici quali: caratterizzazione fenotipica delle SC circolanti, saggi clonogenici, valutazione della concentrazione sierica del Hepatocyte Growth Factor (HGF), Stromal-Derived Factor-1 (SDF-1) ed il Vascular-Endotelial Growth Factor (VEGF) e caratterizzazione fenotipica delle CD133+SC purificate. Fino ad oggi sono stati reinfusi 12 pazienti. Questi dati preliminari suggeriscono che è possibile mobilizzare e reinfondere un numero considerevole di SC autologhe CD133+ altamente purificate in pazienti con ESLD . Gli studi biologici mostrano che: il numero di progenitori ematopoietici ed endoteliali circolanti è aumentato dopo il trattamento con G–CSF; le SCs CD133+ altamente purificato esprimono marcatori emopoietici ed endoteliali; la concentrazione sierica di HGF, SDF-1, VEGF e la capacità clonogenica di progenitori emopoietici sono aumentati durante la mobilitazione e nelle fasi di reinfusione; il potenziale clonogenico dei progenitori endoteliali mostra espressione variabile.

HLA class II mismatch alleles as targets of the alloreactive CD4 T-cell response

In allogeneic hematopoietic stem cell transplantation (allo-HSCT), alloreactive T lymphocytes of donor origin mediate the beneficial graft-versus-leukemia effect but also induce graft-versus-host disease (GvHD). Since human leukocyte antigens (HLA) mismatch alleles represent major targets of alloreactive T lymphocytes, patient and donor are usually matched for the class I molecules A, B, C, and for the class II molecules DRB1 and DQB1, in order do reduce the risk of GvHD. The HLA-DPB1 locus, however, is still ignored in donor selection. Interestingly, clinical studies have demonstrated that disparities at HLA-DQB1 alleles as well as distinct HLA DPB1 mismatch constellations do not adversely affect the outcome of allo-HSCT. It has also been shown that HLA class II is predominantly expressed on hematopoietic cells under non-inflammatory conditions. Therefore, this PhD thesis focused on the application of CD4 T cells in adoptive immunotherapy of leukemias.rnIn the first part of this thesis we developed a rapid screening approach to detect T-cell reactivity of donors to single HLA class II mismatch alleles. Allo-HLA reactivity was measured in naive, memory, and entire CD4 T cells isolated from PBMC of healthy donors by flow cytometric cell sorting according to expression of the differentiation markers CD45RA, CD45RO, CD62L, and CCR7. T-cell populations were defined by a single marker to facilitate translation into a clinical-grade allo-depletion procedure. Alloreactivity to single HLA-DR/-DQ mismatch alleles was analyzed in short-term mixed lymphocyte reactions (MLR) in vitro. As standard antigen-presenting cells, we used the HLA-deficient cell line K562 upon electroporation with single HLA-DR/-DQ allele mRNA. We observed in IFN-γ ELISpot assays that allo-HLA-reactivity preferentially derived from subsets enriched for naive compared to memory T cells in healthy donors, irrespective of the HLA mismatch allele. This separation was most efficient if CD62L (P=0.008) or CD45RA (P=0.011) were used as marker. Median numbers of allo-HLA-reactive effector cells were 3.5-fold and 16.6-fold lower in CD62Lneg and CD45RAneg memory CD4 T cells than in entire CD4 T cells, respectively. In allele-specific analysis, alloreactivity to single HLA-DR alleles clearly exceeded that to HLA-DQ alleles. In terms of alloproliferation no significant difference could be observed between individual CD4 T-cell subsets. rnThe second part of this thesis dealed with the generation of allo-HLA-DQ/-DP specific CD4 T cells. Naive CD45RApos CD4 T cells isolated from healthy donor PBMC by flow cytometric cell sorting were stimulated in MLR against single allo-HLA-DQ/-DP alleles transfected into autologous mature monocyte-derived dendritic cells by mRNA electroporation. Rapidly expanding HLA-DQ/-DP mismatch reactive T cells significantly recognized and cytolysed primary acute myeloid leukemia (AML) blasts, fibroblasts (FB) and keratinocytes (KC) in IFN-γ ELISpot and 51chromium release assays if the targets carried the HLA DQ/ DP allele used for T cell priming. While AML blasts were recognized independent of pre-incubating them with IFN-γ, recognition of FB and KC required IFN-γ pre treatment. We further investigated HLA class II expression on hematopoietic and non-hematopoietic cells by flow cytometry. HLA class II was not detected on primary FB, KC, and non-malignant kidney cells, but was expressed at significant levels on primary AML blasts and B-LCL. Up-regulation of HLA class II expression was observed on all cell types after pre-incubation with IFN-γ.rnIn summary, the novel K562-HLA based MLR approach revealed that naive-depleted CD4 T-cell subsets of healthy individuals contain decreased allo-HLA reactivity in vitro. We propose the application of CD45RAneg naive-depleted CD4 T cells as memory T cell therapy, which might be beneficial for HLA-mismatched patients at high-risk of GvHD and low-risk of leukemia relapse. Memory T cells might also provide important post-transplant immune functions against infectious agents. Additionally, the screening approach could be employed as test system to detect donors which have low risks for the emergence of GvHD after allo-HSCT. In the second part of this thesis we developed a protocol for the generation of allo-HLA-DQ/-DP specific CD4 T cell lines, which could be applied in situations in which patient and donor are matched in all HLA alleles but one HLA-DQ/-DP allele with low GvHD potential. These T cells showed lytic activity to leukemia cells while presumably sparing non-hematopoietic tissues under non-inflammatory conditions. Therefore, they might be advantageous for allo-HSCT patients with advanced stage AML after reduced-intensity conditioning and T-cell depletion for the replenishment of anti-leukemic reactivity if the risk for disease relapse is high. rn

Atypical expression and distribution of embryonic stem cell marker, OCT4, in human lung adenocarcinoma

Lung cancer is one of the leading causes of cancer-related deaths in the world. Although the origin still remains to be resolved, a prevailing hypothesis implies the involvement of cancer stem cells (CSCs) responsible for tumor initiation, maintenance, and progression. Embryonic stem cell marker, OCT4, encoding the spliced variants OCT4A and OCT4B, has recently been shown to have a dual role; as a potential adult stem cell marker and as a CSC marker in germline and somatic tumors.

Efficacy of rituximab and cladribine in patients with chronic lymphocytic leukemia and feasibility of stem cell mobilization: a prospective multicenter phase II trial (protocol SAKK 34/02)

This phase II trial investigated rituximab and cladribine in chronic lymphocytic leukemia. Four induction cycles, comprising cladribine (0.1 mg/kg/day days 1-5, cycles 1-4) and rituximab (375 mg/m(2) day 1, cycles 2-4), were given every 28 days. Stem cell mobilization (rituximab 375 mg/m(2) days 1 and 8; cyclophosphamide 4 g/m(2) day 2; and granulocyte colony-stimulating factor 10 microg/kg/day, from day 4) was performed in responders. Of 42 patients, nine achieved complete remission (CR), 15 very good partial remission, and two nodular partial remission (overall response rate 62%). Stem cell mobilization and harvesting (> or = 2 x 10(6) stem cells/kg body weight) were successful in 12 of 20 patients. Rituximab infusion-related adverse events were moderate. The main grade 3/4 adverse events during induction were neutropenia and lymphocytopenia. Rituximab plus cladribine was effective; however, the CR rate was modest and stem cell harvest was impaired in a large number of responding patients.

The stem cell gene "inhibitor of differentiation 1" (ID1) is frequently expressed in non-small cell lung cancer

Inhibitor of differentiation 1 (ID1) plays a role in cellular differentiation, proliferation, angiogenesis and tumor invasion. As shown recently, ID1 is positively regulated by the tyrosine kinase SRC in lung carcinoma cell lines and with that appears as a potential new therapeutic target in non-small cell carcinoma (NSCLC). To substantiate this hypothesis we examined ID1, SRC and matrix metalloproteinase-9 (MMP-9) immunohistochemically in human NSCLC specimens.

Preponderance of cells with stem cell characteristics in metastasising mouse mammary tumours induced by deregulated EphB4 and ephrin-B2 expression

We have previously shown that EphB4 and ephrin-B2 are differentially expressed in the mammary gland and that their deregulated expression in the mammary epithelium of transgenic mice leads to perturbations of the mammary parenchyma and vasculature. In addition, overexpression of EphB4 and expression of a truncated ephrin-B2 mutant, capable of receptor stimulation but incapable of reverse signalling, confers a metastasising phenotype on NeuT initiated mouse mammary tumours. We have taken advantage of this transgenic tumour model to compare stem cell characteristics between the non-metastasising and metastasising mammary tumours. We analysed the expression of the proliferation attenuating p21(waf) gene, which was significantly increased in the metastasising tumours. Moreover, we compared the expression of CK-19, Sca-1, CD24 and CD49f as markers for progenitor cells exhibiting a decreasing differentiation grade. Sca-1 expressing cells were the earliest progenitors detected in the non-metastasising NeuT induced tumours. The metastasising NeuT/EphB4 tumours were enriched in CD24 expressing cells, whereas the metastasising NeuT/truncated ephrin-B2 tumours contained in addition significant amounts of CD49f expressing cells. The same cell populations were also enriched in mammary glands of single transgenic MMTV-EphB4 and MMTV-truncated ephrin-B2 females indicating that deregulated EphB4-ephrin-B2 signalling interferes with the homeostasis of the stem/progenitor cell pool before tumour formation is initiated. Since the same cell populations are enriched in the normal tissue, primary mammary tumours and metastases we conclude that these progenitor cells were the origin of tumour formation and that this change in the tumour origin has led to the acquisition of the metastatic tumour phenotype.