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  • American Society of Hematology  (2)
  • 1
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 5100-5100
    Abstract: The polymorphisms on chromosome 9p21 play a role in the risk for cardiovascular events in chronic myeloid leukemia patients? Chronic myeloid leukemia (CML) is an onco-haematological disease due to the aberrant expression of an onco-protein with constitutive tyrosine kinase activity. The average age of onset is 55-60 years. The treatment with tyrosine kinase inhibitors (TKIs) drastically changed the outcome of patients affected by chronic myeloid leukemia, allowing long-term improvement in overall survival and deep molecular responses. TKI treatment is also associated to an increased risk of cardiovascular event. The etiopathogenesis of this effects is not clear possibily due to a damage to the endothelial cell, the results of the interaction of genetical predisposition, risk factors and life style habit. The 9p21 region is the strongest genomic marker for cardiovascular disease that has been identified in multiple genome-wide association study. We retrospectively studied 182 patients affected by CML and treated with different TKIs for expression of polymorphism rs1333040C 〉 T and rs7865618A 〉 G of chromosome 9p21 in order to define the role of genetic cardiovascular risk profile to better tailor individualized treatment strategy and identify patients who require strict monitoring of additional risk factors during treatment. Patients and methods We analysed 182 CML patients in chronic phase. All patients were treated with either first, second or third generation TKIs. Patients were compared to a control group including 171 subjects. Genomic DNA was isolated from peripheral blood and the rs1333040C 〉 T and rs7865618A 〉 G polymorphisms were assessed by PCR-RFLP using the BsmI and MspI restriction endonucleases, respectively. Results Ninety-three out of 181 (51%) patients presented the C/T polymorphism, 82 (46%) presented T/T polymorphism and 6 (3%) patient presented wild type polymorphism C/C for rs1333040, test result was not evaluable in 1 patient. Eighty-five out of 181 (47%) patients presented the G/A polymorphism, 73 (40%) presented A/A polymorphism and 23 (13%) patient presented wild type polymorphism G/G for rs7875618 . Test result was not evaluable in 1 patient. The distribution of polymorphism C/C for rs1333040 and G/G for rs7875618 were statistically different compared to control group (p0.0004 and p0.0136 respectively) as showed in table 1. In a sub-analysis, including only 93 patients, a significantly higher incidence of cardiovascular events according to genotypes of SNP rs 1333040 was observed. In C/T group (54 patients) we retrospectively observed 3 cardiovascular events (5.55%) : 2 were transient ischemic attack (TIA) before the diagnosis of CML occurring in 2 female patients aged 69 and 73 respectively and a peripheral arterial obstructive disease (PAOD) in a female patient ,aged 74, with a baseline CAD score of 10, receiving nilotinib 800 mg/d as third line treatment. In T/T group (39 patients) we retrospectively observed 9 (23.1%) cardiovascular events at a median age of 60 years (range 44-82) and with a median estimated cardiovascular risk of 8 (range 0-20) Six patients developed a myocardial acute infarction (AMI) during treatment with TKIs, but 5 out of six had a previous history of AMI. One patient presented a TIA after history of previous of AMI. All patients with previous history of AMI were receving antiplatelets agents. One patient developed PAOD during first line treatment wih nilotinib and one developed an distal arteriopathy associated to an erectile dysfunction. The different incidence of cardiovascular events according to genotypes (T/T vs C/T ) was statistically significant by Fisher'sTest (p=0.0248). Discussion The role of 9p21 region , in particular the genes located in proximity of a noncoding RNA sequence named ANRIL, could be a useful guide for the prophylaxis of cardiovascular events during TKI therapy. Table 1 genotypes distribution between CML patients and controls rs1333040 rs7865618 Patients 82 93 6 23 85 73 46% 51% 3% 13% 47% 40% Controls 62 84 25 8 77 86 36% 49% 15% 5% 45% 50% p=0.0004 P=0.0136 Disclosures Bacigalupo: SANOFI: Speakers Bureau; PIERRE FABRE: Speakers Bureau.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 563-563
    Abstract: Abstract 563 Sonic hedgehog (Shh) is a morphogen regulating epithelial-mesenchymal interactions during embryogenesis. In post-natal life, Shh is a potent indirect angiogenic agent, able to upregulate different families of angiogenic growth factors. Furthermore, Shh gene transfer enhances the contribution of bone marrow (BM)-derived endothelial progenitor cells to myocardial neovascularization. In this study, we tested the beneficial potentials of Shh gene therapy in an experimental model of peripheral limb ischemia, a disease characterized by occlusion of vessels of the arterial circulation of the legs, often secondary to atherosclerosis, thrombosis, and/or inflammatory processes. Ischemia of the left hindlimb was induced by excising the femoral artery, from its proximal origin as a branch of the external iliac artery till the bifurcation into saphenous and popliteal arteries. Blood flow was measured in ischemic and contralateral hindlimbs by laser Doppler perfusion imaging at days 0, 7, 14, 21, and 28 after ischemia. At day 28, mice were sacrificed and adductor muscles were analyzed for capillary and arteriole density. An additional set of 1-year-old C57BL/6J mice and 8-weeks-old C57BL/6J mice were used to study the effects of Shh gene therapy on mobilization of BM-derived endothelial progenitors in the course of ischemia. Mice were treated with 200 μ g phShh or empty plasmid and hindlimb ischemia was induced 7 days after treatment. Peripheral blood samples were obtained at days 2, 4, and 7 after induction of ischemia. FACS analyses were used to detect cells Lin- and Sca-1+CD34+, Sca-1+CD133+, Sca-1+ Flk-1+, CD14+ Flk-1+, CD14+ CD34+. We also used a BM transplantation model to test the effects of Shh gene therapy on BM-derived cells in the setting of hindlimb ischemia. Wild-type recipient mice received 2×106 BM cells from nls-Ptc1-LacZ mice. Six weeks laster, mice received treatment with 200 μ g phShh or empty plasmid in the hindlimb muscles. Seven days after treatment, ischemia of the left hindlimb was induced. X-gal positive cells were counted on hindlimb muscles 10 days after ischemia. We also measured local expression levels of VEGF165, Ang-1, and SDF-1α proteins in mice treated with 200 μ g phShh or empty plasmid 7 days after ischemia. At day 28 after ischemia, blood perfusion ratio between the ischemic and the contralateral leg was 0.97 ± 0.01 in Shh-treated mice and 0.68 ± 0.03 in control animals (p=0.008) (Figure 1a, b). Capillary and arteriole density were significantly higher in the phShh–treated muscles compared to controls (p=0.02; p=0.03, respectively). In both young and middle-aged animals, phShh treatment resulted in significant increase of the number of circulating CD45-/Sca-1+/Flk-1+ and CD45-/Sca-1+/CD133+ cells (p 〈 0.05). In the BM transplantation model, the number of X-gal positive cells in the ischemic site was significantly higher in phShh-treated animals (p=0.000002). Double fluorescent staining for β-gal and BS-1 lectin demonstrated incorporation of these cells into vascular structures, demonstrating that Shh gene therapy increases the number of cells migrating from the BM to the site of ischemia and contributing to the process of neovascularization. Finally, the expression of VEGF, ang-1, and SDF-1α measured after ischemia was significantly higher in animals treated with phShh than in mice treated with control (p= 0.00001; p= 0.00054; p= 0.00003, respectively). The current standard of care for ischemic diseases of lower extremities relies on direct revascularization, either by endovascular techniques or open surgical approaches. Early preclinical studies and phase I clinical trials achieved promising results with growth factors administered as recombinant proteins or single-agent gene therapies. In this study, we demonstrate that intramuscular administration of a plasmid containing the human Shh gene induces simultaneous activation of angiogenic, arteriogenic, and vasculogenic mechanisms, with beneficial effects in a model of peripheral artery disease. In addition, we showed the ability of Shh gene therapy to increase the number of circulating BM-derived circulating progenitor cells, as well as their incorporation in vascular structures at the level of the ischemic site. Figure 1. (a) Laser Doppler perfusion imaging. (b) Mice treated with phShh displayed significant increase of the ischemic/contralateral leg perfusion ratio. Figure 1. (a) Laser Doppler perfusion imaging. (b) Mice treated with phShh displayed significant increase of the ischemic/contralateral leg perfusion ratio. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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