Noisy Oncology: applications of bounded noise transitions in modelling tumor growth

I tumori macroscopici e microscopici, dopo la loro prima fase di crescita, sono composti da un numero medio elevato di cellule. Così, in assenza di perturbazioni esterne, la loro crescita e i punti di equilibrio possono essere descritti da equazioni differenziali. Tuttavia, il tumore interagisce fortemente col macroambiente che lo circonda e di conseguenza una descrizione del tutto deterministica risulta a volte inappropriata. In questo caso si può considerare l'interazione con fluttuazioni statistiche, causate da disturbi esterni, utilizzando le equazioni differenziali stocastiche (SDE). Questo è vero in modo particolare quando si cerca di modellizzare tumori altamente immunogenici che interagiscono con il sistema immunitario, in quanto la complessità di questa interazione risulta in fenomeni di multistabilità. Così, il rumore può provocare disturbi e indurre transizioni di stato (Noise-Induced-Transitions). E' importante notare che una NIT può avere implicazioni profonde sulla vita di un paziente, dal momento che una transizione da uno stato di equilibrio piccolo, nelle dimensioni del tumore, ad uno stato di equilibrio macroscopico, nella maggior parte dei casi significa il passaggio dalla vita alla morte. Generalmente l'approccio standard è quello di modellizzare le fluttuazioni stocastiche dei parametri per mezzo di rumore gaussiano bianco o colorato. In alcuni casi però questa procedura è altamente inadeguata, a causa della illimitatezza intrinseca dei rumori gaussiani che può portare a gravi incongruenze biologiche: pertanto devono essere utilizzati dei rumori "limitati", che, tuttavia, sono molto meno studiati di quelli gaussiani. Inoltre, l'insorgenza di NIT dipende dal tipo di rumore scelto, che rivela un nuovo livello di complessità in biologia. Lo scopo di questa tesi è quello di studiare le applicazioni di due tipi diversi di "rumori limitati" nelle transizioni indotte in due casi: interazione tra tumore e sistema immunitario e chemioterapia dei tumori. Nel primo caso, abbiamo anche introdotto un nuovo modello matematico di terapia, che estende, in modo nuovo, il noto modello di Norton-Simon.

Tolerance and immunity to human tumor-associated antigens

Tumor-assoziierte Antigene (TAA) repräsentieren wichtige Zielstrukturen in zytotoxischen T-Zell (ZTL)-basierten Immuntherapien zur Behandlung maligner Erkrankungen. Die Tatsache, dass TAA nicht spezifisch nur in Tumoren sondern auch in nicht-transformierten Zellen vorhanden sind, kann infolge verschiedener Toleranz-Mechanismen zur Eliminierung von ZTL führen, deren T-Zell-Rezeptoren eine hohe Affinität für TAA besitzen. Entsprechend erfordert die Entwicklung effektiver Immuntherapeutika die genaue Analyse des verfügbaren T-Zell-Repertoires mit Spezifität für ein gegebenes TAA.Die Arbeit fokusierte das Tyrosinase (369-377) ZTL-Epitop, das im Komplex mit HLA-A*0201 (A2.1) auf der Zell-Oberfläche von malignen Melanomen und verschiedenen nicht-transformierten Zellen präsentiert wird. Es wurde gefunden, dass sowohl das humane als auch das murine Tyrosinase (369-377)-spezifische ZTL-Repertoire durch Selbst-Toleranz kompromittiert ist und dass diese Toleranz weder durch Verwendung einer bestimmten Peptid-Variante noch durch Interferenz mit CD4+CD25+ regulatorischen T-Zellen oder CTLA-4 umgangen werden kann. Diese Ergebnisse wurden anschließend auf ein anderes Krankheitsmodell, das Multiple Myelom (MM), adaptiert. Unter Umgehung von Selbst-Toleranz in A2.1-transgenen Mäusen wurde gezeigt, dass Transkriptionsfaktoren, die die terminale Differenzierung von B-Zellen in maligne und nicht-maligne Plasmazellen diktieren, als MM-assoziierte ZTL-Epitope dienen können.Diese Arbeit bietet einen bedeutenden und innovativen Beitrag zur Gestaltung von Tyrosinase-basierten Melanom- und MM-reaktiven Immuntherapien.

Understanding The Physiological, Biochemical, and Molecular Mechanisms of Salinity Tolerance in Strawberry Cultivars and in HvTPK1-Overexpressed Barley

The research was carried out to investigate of main elements of salt stress response in two strawberry cultivars, Elsanta and Elsinore. Plants were grown under 0, 10, 20 and 40 mM NaCl for 80 days. Salinity dramatically affected growth in both cultivars, although Elsinore appeared to be more impaired than Elsanta. Moreover a significant reduction of leaf photosynthesis, evaporation, and stomatal conductance was recorded 24 hrs after the stress was applied in both cultivars, whereas physiological functions were differentially restored after acclimation. However, cv. Elsanta had more efficient leaf gas exchange and water status than cv. Elsinore. In general, Fruit yield reduced upon salinization, wheares fruit quality concerning fruit taste, aroma, appearance, total soluble solids and titratable acidity, did not change but rather was enhanced under moderate salinity. On the other hand fruit quality was impaired at severe salt stress. Fruit antioxidant content and antioxidant capacity were enhanced significantly by increasing salt concentration in both cultivars. The oxidative effects of the stress were defined by the measures of some enzymatic activities and lipid peroxidation. Consistently, an increase in superoxide dismutase (SOD), catalase (CAT), peroxide dismutase (POD) enzymes and higher content of proline and soluble proteins were observed in cv. Elsinore than in cv. Elsanta. The increase coincided with a decrease in lipid peroxidation. The research confirmed that although strawberry cultivars were sensitive to salinity, difference between cultivars exist; The experiment revealed that cv. Elsanta could stand severe salt stress, which was lethal to cv. Elsinore. The parameters measured in the previous experiment were proposed as early screening tools for the salt stress response in nine strawberry genotypes. The results showed that, wheares Elsanta and Elsinore cultivars had a lower dry weight reduction at 40 mM NaCl among cultivars, Naiad, Kamila, and Camarosa were the least salt-sensitive cultivars among the screened.

Risk appetite e risk tolerance: strumenti di supporto agli istituti di credito per l'assunzione di rischi in tempi di crisi

Negli ultimi anni l’attenzione di legislatori e degli Organi di Vigilanza, in base alle riforme regolamentari attivate in risposta alla crisi economica, si sono focalizzate sulle pratiche di risk management delle Banche, sottolineando l’importanza dei sistemi di controllo e gestione dei rischi. Il presente lavoro nasce con l’intento di analizzare e valutare le caratteristiche salienti del processo di assunzione e gestione dei rischi nel sistema economico finanziario attuale. Numerosi e autorevoli esperti, come gli operatori del Financial Stability Board , Institute of International Finance e Senior Supervisory Group, si sono espressi sulle cause della crisi finanziaria ed hanno sollevato dubbi circa la qualità delle azioni intraprese da alcuni manager, sulle loro politiche gestionali e sulla comprensione delle reali condizioni in cui versavano le loro Banche (in termini di esposizione ai rischi, report da aggregazione dati su performance aziendali e qualità dei dati aggregati) , si è ritenuto giusto dal punto di vista teorico approfondire in particolare i temi del Risk Appetite e Risk Tolerance, novità introdotte nelle diverse direttive e normative in risposta alle citate ed ambigue politiche di gestione ed assunzione rischi. I concetti, qui introdotti, di appetito e tolleranza al rischio conducono ad una ampia sfera di riferimento che guarda alla necessità di fissare degli obiettivi di rischio e loro limiti per poter meglio controllare e valutare la stabilità economica/finanziaria e stimare gli effetti di condizioni peggiorative (reali o soltanto teoriche, come gli stress test) sulla solvibilità e profittabilità delle Banche nazionali ed internazionali. Inoltre, ad integrazione di quanto precedentemente esposto sarà illustrata una survey sulla disclosure delle principali Banche europee in relazione alle informazioni sul Risk Appetite e sul Risk Tolerance.

Metodi operativi per la riduzione dell'impatto acustico delle operazioni aeroportuali: efficacia delle noise abatement procedures

Il rumore causato dagli aeromobili nelle varie operazioni aeroportuali è uno dei problemi più sentiti dalle popolazioni che risiedono nelle aree adiacenti gli aeroporti.Nonostante i progressi fatti dal punto di vista tecnologico, che hanno portato a una notevole riduzione del fenomeno, il continuo aumento della domanda di traffico aereo ha ridotto l’efficacia di queste migliorie tecniche, anche a causa di una scarsa pianificazione territoriale nel corso degli anni. Ci sono numerosi interventi possibili per ridurre l'inquinamento acustico, in questa tesi vengono analizzate in special modo le NAP e la loro applicazione al caso dell'aeroporto di Bologna.

An Integrated Transmission-Media Noise Calibration Software For Deep-Space Radio Science Experiments

The thesis describes the implementation of a calibration, format-translation and data conditioning software for radiometric tracking data of deep-space spacecraft. All of the available propagation-media noise rejection techniques available as features in the code are covered in their mathematical formulations, performance and software implementations. Some techniques are retrieved from literature and current state of the art, while other algorithms have been conceived ex novo. All of the three typical deep-space refractive environments (solar plasma, ionosphere, troposphere) are dealt with by employing specific subroutines. Specific attention has been reserved to the GNSS-based tropospheric path delay calibration subroutine, since it is the most bulky module of the software suite, in terms of both the sheer number of lines of code, and development time. The software is currently in its final stage of development and once completed will serve as a pre-processing stage for orbit determination codes. Calibration of transmission-media noise sources in radiometric observables proved to be an essential operation to be performed of radiometric data in order to meet the more and more demanding error budget requirements of modern deep-space missions. A completely autonomous and all-around propagation-media calibration software is a novelty in orbit determination, although standalone codes are currently employed by ESA and NASA. The described S/W is planned to be compatible with the current standards for tropospheric noise calibration used by both these agencies like the AMC, TSAC and ESA IFMS weather data, and it natively works with the Tracking Data Message file format (TDM) adopted by CCSDS as standard aimed to promote and simplify inter-agency collaboration.

Context-sensitive design in transportation infrastructure: relating tire/pavement noise with wearing course characteristics

A design can be defined as context-sensitive when it achieves effective technical and functional transportation solutions, while preserving and enhancing natural environments and minimizing impacts on local communities. Traffic noise is one of the most critical environmental impacts of transportation infrastructure and it affects both humans and ecosystems. Tire/pavement noise is caused by a set of interactions at the contact patch and it is the predominant source of road noise at the regular traffic speeds. Wearing course characteristics affect tire/pavement noise through various mechanisms. Furthermore, acoustic performance of road pavements varies over time and it is influenced by both aging and temperature. Three experimentations have been carried out to evaluate wearing course characteristics effects on tire/pavement noise. The first study involves the evaluation of skid resistance, surface texture and tire/pavement noise of an innovative application of multipurpose cold-laid microsurfacing. The second one involves the evaluation of the surface and acoustic characteristics of the different pavement sections of the test track of the Centre for Pavement and Transportation Technology (CPATT) at the University of Waterloo. In the third study, a set of highway sections have been selected in Southern Ontario with various types of pavements. Noise measurements were carried out by means of the Statistical Pass-by (SPB) method in the first case study, whereas in the second and in the third one, Close-proximity (CPX) and the On-Board Sound Intensity (OBSI) methods have been performed in parallel. Test results have contributed to understand the effects of pavement materials, temperature and aging on tire/pavement noise. Negligible correlation was found between surface texture and roughness with noise. As a general trend, aged and stiffer materials have shown to provide higher noise levels than newer and less stiff ones. Noise levels were also observed to be higher with temperature increase.

In vitro characterisation and expansion of human regulatory T cells for their in vivo application in the induction of tolerance in haematopoietic stem cell and solid organ transplantation

Solid organ transplantation (SOT) is considered the treatment of choice for many end-stage organ diseases. Thus far, short term results are excellent, with patient survival rates greater than 90% one year post-surgery, but there are several problems with the long term acceptance and use of immunosuppressive drugs. Hematopoietic Stem Cells Transplantation (HSCT) concerns the infusion of haematopoietic stem cells to re-establish acquired and congenital disorders of the hematopoietic system. The main side effect is the Graft versus Host Disease (GvHD) where donor T cells can cause pathology involving the damage of host tissues. Patients undergoing acute or chronic GvHD receive immunosuppressive regimen that is responsible for several side effects. The use of immunosuppressive drugs in the setting of SOT and GvHD has markedly reduced the incidence of acute rejection and the tissue damage in GvHD however, the numerous adverse side effects observed boost the development of alternative strategies to improve the long-term outcome. To this effect, the use of CD4+CD25+FOXP3+ regulatory T cells (Treg) as a cellular therapy is an attractive approach for autoimmunity disease, GvHD and limiting immune responses to allograft after transplantation. Treg have a pivotal role in maintaining peripheral immunological tolerance, by preventing autoimmunity and chronic inflammation. Results of my thesis provide the characterization and cell processing of Tregs from healthy controls and patients in waiting list for liver transplantation, followed by the development of an efficient expansion-protocol and the investigation of the impact of the main immunosuppressive drugs on viability, proliferative capacity and function of expanded cells after expansion. The conclusion is that ex vivo expansion is necessary to infuse a high Treg dose and although many other factors in vivo can contribute to the success of Treg therapy, the infusion of Tregs during the administration of the highest dose of immunosuppressants should be carefully considered.

Entwicklung und Charakterisierung eines Drop-on-Demand-Aerosolgenerators für die Probenzuführung kleinster Flüssigkeitsmengen in der analytischen Atomspektroskopie

Die pneumatische Zerstäubung ist die häufigste Methode der Probenzuführung von Flüssigkeiten in der Plasmaspektrometrie. Trotz der bekannten Limitierungen dieser Systeme, wie die hohen Probenverluste, finden diese Zerstäuber aufgrund ihrer guten Robustheit eine breite Anwendung. Die flussratenabhängige Aerosolcharakteristik und pumpenbasierte Signalschwankungen limitieren bisher Weiterentwicklungen. Diese Probleme werden umso gravierender, je weiter die notwendige Miniaturisierung dieser Systeme fortschreitet. Der neuartige Ansatz dieser Arbeit basiert auf dem Einsatz modifizierter Inkjet-Druckerpatronen für die Dosierung von pL-Tropfen. Ein selbst entwickelter Mikrokontroller ermöglicht den Betrieb von matrixkodierten Patronen des Typs HP45 mit vollem Zugriff auf alle essentiellen Betriebsparameter. Durch die neuartige Aerosoltransportkammer gelang die effiziente Kopplung des Tropfenerzeugungssystems an ein ICP-MS. Das so aufgebaute drop-on-demand-System (DOD) zeigt im Vergleich zu herkömmlichen und miniaturisierten Zerstäubern eine deutlich gesteigerte Empfindlichkeit (8 - 18x, elementabhängig) bei leicht erhöhtem, aber im Grunde vergleichbarem Signalrauschen. Darüber hinaus ist die Flexibilität durch die große Zahl an Freiheitsgraden des Systems überragend. So ist die Flussrate über einen großen Bereich variabel (5 nL - 12,5 µL min-1), ohne dabei die primäre Aerosolcharakteristik zu beeinflussen, welche vom Nutzer durch Wahl der elektrischen Parameter bestimmt wird. Das entwickelte Probenzuführungssystem ist verglichen mit dem pneumatischen Referenzsystem weniger anfällig gegenüber Matrixeffekten beim Einsatz von realen Proben mit hohen Anteilen gelöster Substanzen. So gelingt die richtige Quantifizierung von fünf Metallen im Spurenkonzentrationsbereich (Li, Sr, Mo, Sb und Cs) in nur 12 µL Urin-Referenzmaterial mittels externer Kalibrierung ohne Matrixanpassung. Wohingegen beim pneumatischen Referenzsystem die aufwändigere Standardadditionsmethode sowie über 250 µL Probenvolumen für eine akkurate Bestimmung der Analyten nötig sind. Darüber hinaus wird basierend auf der Dosierfrequenz eines dualen DOD-Systems eine neuartige Kalibrierstrategie vorgestellt. Bei diesem Ansatz werden nur eine Standard- und eine Blindlösung anstelle einer Reihe unterschiedlich konzentrierter Standards benötigt, um eine lineare Kalibrierfunktion zu erzeugen. Zusätzlich wurde mittels selbst entwickelter, zeitlich aufgelöster ICP-MS umfangreiche Rauschspektren aufgenommen. Aus diesen gelang die Ermittlung der Ursache des erhöhten Signalrauschens des DOD, welches maßgeblich durch das zeitlich nicht äquidistante Eintreffen der Tropfen am Detektor verursacht wird. Diese Messtechnik erlaubt auch die Detektion einzeln zugeführter Tropfen, wodurch ein Vergleich der Volumenverteilung der mittels ICP-MS detektierten, gegenüber den generierten und auf optischem Wege charakterisierten Tropfen möglich wurde. Dieses Werkzeug ist für diagnostische Untersuchungen äußerst hilfreich. So konnte aus diesen Studien neben der Aufklärung von Aerosoltransportprozessen die Transporteffizienz des DOD ermittelt werden, welche bis zu 94 Vol.-% beträgt.

Tecniche di fault tolerance in swarm robotics

Questa tesi presenta e discute le sfide per ottenere sistemi di swarm robotis affidabili e tolleranti ai guasti e quindi anche alcuni metodi per rilevare anomalie in essi, in modo tale che ipotetiche procedure per il recupero possano essere affrontate, viene sottolineata inoltre l’ importanza di un’ analisi qualitativa dei guasti.

Damage tolerance analysis for Blackshape BS 115 programme, EASA CS VLA & CS-23

The thesis project has been developed in partnership with the Design Department of Blackshape Spa, a carbon – fiber ultra – light airplane company in Monopoli (Bari, Italy). The main goal is the assessment of a starting point for a damage tolerant concept during the design and certification phases of the Blackshape BS 115 airplane, with respect to EASA CS VLA & CS 23 Regulations. This approach has been carried out starting from an initial literary review as far as the way of modeling composites fractures is concerned. Further on, three finite element models have been generated and implemented in order to simulate defects occurring during manufacturing and service phases. At last, the procedures of non - destructive inspections have been taken into account, in order to establish how to investigate primary structures defects and delaminations during maintenance.

Noise mapping of highly trafficked roads of the province of Bologna according to D.Lgs. 194/2005

The European Community has stressed the importance of achieving a common understanding to deal with the environmental noise through community actions of the Member States. This implies the use of harmonized indicators and specific information regarding the values of indicators, the exceedance of limits and the number of people and dwellings exposed to noise. The D.Lgs. 149/2005 in compliance with the European Directive 2002/49/EC defines methodologies, noise indicators and types of outputs required. In this dissertation the work done for the noise mapping of highly trafficked roads of the Province of Bologna will be reported. The study accounts for the environmental noise generated by the road infrastructure outside the urban agglomeration of Bologna. Roads characterized by an annual traffic greater than three millions of vehicles will be considered. The process of data collection and validation will be reported, as long as the implementation of the calculation method in the software and the procedure to create and calibrate the calculation model. Results will be provided as required by the legislation, in forms of maps and tables. Moreover results regarding each road section accounted will be combined to gain a general understanding of the situation of the overall studied area. Although the understanding of the noise levels and the number of people exposed is paramount, it is not sufficient to develop strategies of noise abatement interventions. Thus a further step will be addressed: the creation of priority maps as the basis of action plans for organizing and prioritizing solutions for noise reduction and abatement. Noise reduction measures are reported in a qualitative way in the annex and constitute a preliminary research.

Dynamic distance analysis : new geometric data structures and algorithms for the real-time calculation of tolerance violating regions in the digital mockup process

In vielen Industriezweigen, zum Beispiel in der Automobilindustrie, werden Digitale Versuchsmodelle (Digital MockUps) eingesetzt, um die Konstruktion und die Funktion eines Produkts am virtuellen Prototypen zu überprüfen. Ein Anwendungsfall ist dabei die Überprüfung von Sicherheitsabständen einzelner Bauteile, die sogenannte Abstandsanalyse. Ingenieure ermitteln dabei für bestimmte Bauteile, ob diese in ihrer Ruhelage sowie während einer Bewegung einen vorgegeben Sicherheitsabstand zu den umgebenden Bauteilen einhalten. Unterschreiten Bauteile den Sicherheitsabstand, so muss deren Form oder Lage verändert werden. Dazu ist es wichtig, die Bereiche der Bauteile, welche den Sicherhabstand verletzen, genau zu kennen. rnrnIn dieser Arbeit präsentieren wir eine Lösung zur Echtzeitberechnung aller den Sicherheitsabstand unterschreitenden Bereiche zwischen zwei geometrischen Objekten. Die Objekte sind dabei jeweils als Menge von Primitiven (z.B. Dreiecken) gegeben. Für jeden Zeitpunkt, in dem eine Transformation auf eines der Objekte angewendet wird, berechnen wir die Menge aller den Sicherheitsabstand unterschreitenden Primitive und bezeichnen diese als die Menge aller toleranzverletzenden Primitive. Wir präsentieren in dieser Arbeit eine ganzheitliche Lösung, welche sich in die folgenden drei großen Themengebiete unterteilen lässt.rnrnIm ersten Teil dieser Arbeit untersuchen wir Algorithmen, die für zwei Dreiecke überprüfen, ob diese toleranzverletzend sind. Hierfür präsentieren wir verschiedene Ansätze für Dreiecks-Dreiecks Toleranztests und zeigen, dass spezielle Toleranztests deutlich performanter sind als bisher verwendete Abstandsberechnungen. Im Fokus unserer Arbeit steht dabei die Entwicklung eines neuartigen Toleranztests, welcher im Dualraum arbeitet. In all unseren Benchmarks zur Berechnung aller toleranzverletzenden Primitive beweist sich unser Ansatz im dualen Raum immer als der Performanteste.rnrnDer zweite Teil dieser Arbeit befasst sich mit Datenstrukturen und Algorithmen zur Echtzeitberechnung aller toleranzverletzenden Primitive zwischen zwei geometrischen Objekten. Wir entwickeln eine kombinierte Datenstruktur, die sich aus einer flachen hierarchischen Datenstruktur und mehreren Uniform Grids zusammensetzt. Um effiziente Laufzeiten zu gewährleisten ist es vor allem wichtig, den geforderten Sicherheitsabstand sinnvoll im Design der Datenstrukturen und der Anfragealgorithmen zu beachten. Wir präsentieren hierzu Lösungen, die die Menge der zu testenden Paare von Primitiven schnell bestimmen. Darüber hinaus entwickeln wir Strategien, wie Primitive als toleranzverletzend erkannt werden können, ohne einen aufwändigen Primitiv-Primitiv Toleranztest zu berechnen. In unseren Benchmarks zeigen wir, dass wir mit unseren Lösungen in der Lage sind, in Echtzeit alle toleranzverletzenden Primitive zwischen zwei komplexen geometrischen Objekten, bestehend aus jeweils vielen hunderttausend Primitiven, zu berechnen. rnrnIm dritten Teil präsentieren wir eine neuartige, speicheroptimierte Datenstruktur zur Verwaltung der Zellinhalte der zuvor verwendeten Uniform Grids. Wir bezeichnen diese Datenstruktur als Shrubs. Bisherige Ansätze zur Speicheroptimierung von Uniform Grids beziehen sich vor allem auf Hashing Methoden. Diese reduzieren aber nicht den Speicherverbrauch der Zellinhalte. In unserem Anwendungsfall haben benachbarte Zellen oft ähnliche Inhalte. Unser Ansatz ist in der Lage, den Speicherbedarf der Zellinhalte eines Uniform Grids, basierend auf den redundanten Zellinhalten, verlustlos auf ein fünftel der bisherigen Größe zu komprimieren und zur Laufzeit zu dekomprimieren.rnrnAbschießend zeigen wir, wie unsere Lösung zur Berechnung aller toleranzverletzenden Primitive Anwendung in der Praxis finden kann. Neben der reinen Abstandsanalyse zeigen wir Anwendungen für verschiedene Problemstellungen der Pfadplanung.

The role of DNA damage in the pathogenesis of nitrate tolerance - nitrosative versus oxidative DNA damage

6. Summary Despite the lack of direct evidence from large clinical trials for mutagenic and genotoxic effects of GTN therapy, the present study show s the induction of pre-mutagenic lesions, such as 8- oxo - G and O 6 - me - G by GTN t reatment as well as increased formation of DNA strand breaks. These results were obtained in an in vitro (EA.hy 926 – human endothelial cell line) and in vivo (Wistar rats and C57BL/6 mice) setting. However, GTN - induced DNA damage had no effect on the degr ee of nitrate tolerance but only on other pathological side effects such as oxidative stress, as confirmed by studies in MGMT knockout mice. Of clinical importance , this study establishes potent apoptotic properties of organic nitrates, which has been demo nstrated by the levels of the novel apoptotic marker and caspase - 3 substrate, fractin, as well as levels of cleaved caspase - 3 , the activated form of this pro - apoptotic enzyme . The p rotein analy tical data ha ve been confirmed by an independent assay for the apoptosis , Cell death detection assay (TUNEL) . First, these GTN - mediated apoptotic effects may account for the previously reported anti - cancer effects of GTN therapy (probably based on induction of apoptosis in tumor cells). Second, these GTN - mediated apop totic effects may account for the increased mortality rates observed in the group of organic nitrate - treated patients as reported by two independent meta - analysis (probably due to induction of apoptosis in highly beneficial endothelial progenitor cells as well as in cardiomyocytes during wound healing and cardiac remodeling) . Summary of the current investigations can be seen in Figure 18.