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1.
Blood ; 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38996210

RESUMO

Clonal cytopenia of undetermined significance (CCUS) represents a distinct disease entity characterized by myeloid-related somatic mutations with a variant allele fraction of ≥2% in individuals with unexplained cytopenia(s) but without a myeloid neoplasm (MN). Notably, CCUS carries a risk of progressing to MN, particularly in cases featuring high-risk mutations. Understanding CCUS requires dedicated studies to elucidate its risk factors and natural history. Our analysis of 357 CCUS patients investigated the interplay between clonality, cytopenia, and prognosis. Multivariate analysis identified 3 key adverse prognostic factors: the presence of splicing mutation(s) (score = 2 points), platelet count <100×109/L (score = 2.5), and ≥2 mutations (score = 3). Variable scores were based on the coefficients from the Cox proportional hazards model. This led to the development of the Clonal Cytopenia Risk Score (CCRS), which stratified patients into low- (score <2.5 points), intermediate- (score 2.5-<5), and high-risk (score ≥5) groups. The CCRS effectively predicted 2-year cumulative incidence of MN for low- (6.4%), intermediate- (14.1%), and high- (37.2%) risk groups, respectively, by Gray's test (P <.0001). We further validated the CCRS by applying it to an independent CCUS cohort of 104 patients, demonstrating a c-index of 0.64 (P =.005) in stratifying the cumulative incidence of MN. Our study underscores the importance of integrating clinical and molecular data to assess the risk of CCUS progression, making the CCRS a valuable tool that is practical and easily calculable. These findings are clinically relevant, shaping the management strategies for CCUS and informing future clinical trial designs.

2.
Leuk Lymphoma ; 65(8): 1136-1144, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38648559

RESUMO

The FLT3 inhibitor quizartinib has been shown to improve overall survival when added to intensive induction chemotherapy ("7 + 3") in patients 18-75 years old with newly diagnosed AML harboring a FLT3-ITD mutation. However, the health economic implications of this approval are unknown. We evaluated the cost-effectiveness of quizartinib using a partitioned survival analysis model. One-way and probabilistic sensitivity analyses were conducted. In the base case scenario, the addition of quizartinib to 7 + 3 resulted in incremental costs of $289,932 compared with 7 + 3 alone. With an incremental gain of 0.84 quality-adjusted life years (QALYs) with quizartinib + 7 + 3 induction vs. 7 + 3 alone, the incremental cost-effectiveness ratio for the addition of quizartinib to standard 7 + 3 was $344,039/QALY. Only an 87% reduction in the average wholesale price of quizartinib or omitting quizartinib continuation therapy after completion of consolidation therapy and allogeneic hematopoietic cell transplant would make quizartinib a cost-effective option.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Benzotiazóis , Análise Custo-Benefício , Quimioterapia de Indução , Leucemia Mieloide Aguda , Mutação , Compostos de Fenilureia , Tirosina Quinase 3 Semelhante a fms , Humanos , Tirosina Quinase 3 Semelhante a fms/genética , Tirosina Quinase 3 Semelhante a fms/antagonistas & inibidores , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/economia , Leucemia Mieloide Aguda/mortalidade , Compostos de Fenilureia/uso terapêutico , Compostos de Fenilureia/economia , Quimioterapia de Indução/métodos , Quimioterapia de Indução/economia , Benzotiazóis/uso terapêutico , Benzotiazóis/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Pessoa de Meia-Idade , Adulto , Feminino , Idoso , Masculino , Adulto Jovem , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Adolescente , Inibidores de Proteínas Quinases/uso terapêutico , Inibidores de Proteínas Quinases/economia
3.
Cancer J ; 29(3): 130-137, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37195768

RESUMO

ABSTRACT: Clonal hematopoiesis (CH) confers a high risk of aging-related diseases and hematologic malignancy. There are still significant knowledge gaps in identifying high-risk patients with CH and managing such patients. In this review, we focus on 3 areas: (1) the natural history of CH; (2) the risks of progression of CH, including CH of indeterminate potential, clonal cytopenia of undetermined significance, and therapy-related CH, to myeloid malignancy; and (3) the challenges and unmet needs of CH management and research.


Assuntos
Neoplasias Hematológicas , Síndromes Mielodisplásicas , Humanos , Hematopoiese Clonal/genética , Hematopoese/genética , Síndromes Mielodisplásicas/genética , Neoplasias Hematológicas/genética , Neoplasias Hematológicas/terapia , Mutação
4.
Leuk Res ; 129: 107076, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37075557

RESUMO

The accrual of somatic mutations is a byproduct of aging. When a clone bearing a somatic genetic alteration, conferring comparative competitive advantage, displays sufficient outgrowth to become detectable amongst an otherwise polyclonal background in the hematopoietic system, this is called clonal hematopoiesis (CH). Somatic genetic alterations observed in CH include point mutations in cancer related genes, mosaic chromosomal alterations or a combination of these. Interestingly, clonal hematopoiesis (CH) can also occur with somatic variants in genes without a known role in cancer and in the absence of a somatic genetic alteration through a process that has been described as 'genetic drift'. Clonal hematopoiesis of indeterminate significance (CHIP), is age-related and defined by the presence of somatic point mutations in cancer related genes, in the absence of cytopenias or a diagnosis of hematologic neoplasm, with a variant allele fraction ≥ 2 %. Remarkably, the increased mortality associated with CHIP is largely due to cardiovascular disease. Subsequently, CHIP has been associated with a myriad of age-related conditions such as Alzheimer's Disease, osteoporosis, CVA and COPD. CHIP is associated with an increased risk of hematologic malignancies, particularly myeloid neoplasms, with the risk rising with increasing clone size and clonal complexity. Mechanisms regulating clonal evolution and progression to hematologic malignancies remain to be defined. However, observations on context specific CH arising in the setting of bone marrow failure states, or on exposure to chemotherapy and radiation therapy, suggest that CH reflects context specific selection pressures and constraint-escape mechanisms.


Assuntos
Neoplasias Hematológicas , Transtornos Mieloproliferativos , Pancitopenia , Humanos , Hematopoiese Clonal/genética , Hematopoese/genética , Neoplasias Hematológicas/patologia , Evolução Clonal/genética , Mutação
5.
Blood Adv ; 7(13): 3213-3224, 2023 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-36939371

RESUMO

Tyrosine kinase inhibitor (TKI) use is critical in the care of patients with chronic myeloid leukemia (CML). Quantitative polymerase chain reaction (qPCR) testing for BCR-ABL1 every 3 months during the first year of TKI treatment is recommended to assure achievement of milestone response goals. Real-world evidence for the patterns of qPCR monitoring and TKI adherence in the older patient population is lacking. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 1192 patients aged ≥66 years (median age, 74 years) with newly diagnosed CML who were followed up for ≥13 months from TKI initiation. In total, 965 patients (81.0%) had ≥1 test, with 425 (35.7%) and 540 (45.3%) of the patients tested during 1, 2, and ≥3 quarters (optimal monitoring) of the first year from TKI initiation, respectively. In multivariable analysis, diagnosis in later years and influenza vaccination before diagnosis, a proxy for health care access, were associated with optimal qPCR monitoring. Use of low-income subsidy and residing in census tracts with the lowest socioeconomic status were associated with less optimal monitoring. Patients with optimal monitoring were 60% more likely to be TKI adherent (odds ratio, 1.60; 95% CI, 1.11-2.31; P = .01) and had improved 5-year survival (hazard ratio, 0.66; 95% CI, 0.49-0.90; P < .01) than those without such monitoring. In this large, real-world study of CML management patterns, many older patients had suboptimal molecular monitoring, which was associated with decreased TKI adherence and worse survival.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva , Humanos , Idoso , Estados Unidos , Medicare , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Doença Crônica
6.
Hematol Rep ; 15(1): 73-87, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36810551

RESUMO

OBJECTIVES: To investigate and characterize JAK2 mutations in myelodysplastic syndrome (MDS), we present three cases with diverse JAK2 mutations and review the literature. METHODS: The institutional SoftPath software was used to find MDS cases between January 2020 and April 2022. The cases with a diagnosis of a myelodysplastic/myeloproliferative overlap syndrome including MDS/MPN with ring sideroblasts and thrombocytosis were excluded. The cases with molecular data by next generation sequencing looking for gene aberrations commonly seen in myeloid neoplasms were reviewed for the detection of JAK2 mutations including variants. A literature review on the identification, characterization, and significance of JAK2 mutations in MDS was performed. RESULTS: Among 107 cases of the MDS reviewed, a JAK2 mutation was present in three cases, representing 2.8% of the overall cases. A JAK2 V617F mutation was found in one case representing slightly less than 1% of all the MDS cases. In addition, we found JAK2 R564L and JAK2 I670V point mutation variants to be associated with a myelodysplastic phenotype. CONCLUSIONS: JAK2 mutations in MDS are rare and represent less than 3% of cases. It appears that JAK2 variant mutations in MDS are diverse and further studies are needed to understand their role in the phenotype and prognosis of the disease.

7.
Curr Opin Hematol ; 30(2): 70-77, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36602939

RESUMO

PURPOSE OF REVIEW: The aim of this study was to provide insight into how novel next-generation sequencing (NGS) techniques are set to revolutionize clinical practice. RECENT FINDINGS: Advances in sequencing technologies have focused on improved capture of mutations and reads and cellular resolution. Both short and long read DNA sequencing technology are being refined and combined in novel ways with other multiomic approaches to gain unprecedented biological insight into disease. Single-cell (sc)DNA-seq and integrated scDNA-seq with immunophenotyping provide granular information on disease composition such as clonal hierarchy, co-mutation status, zygosity, clonal diversity and genotype phenotype correlations. These and other techniques can identify rare cell populations providing the opportunity for increased sensitivity in measurable residual disease monitoring and precise characterization of residual clones permitting distinction of leukemic from pre/nonmalignant clones. SUMMARY: Increasing genetics-based mechanistic insights and classification of myeloid diseases along with a decrease in the cost of high-throughput NGS mean novel sequencing technologies are closer to being a reality in standard clinical practice. These technologies are poised to improve diagnostics, our ability to monitor treatment response and minimal residual disease and allow the study of premalignant conditions such as clonal haematopoiesis.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Análise de Sequência de DNA/métodos , Mutação , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Estudos de Associação Genética
9.
Cancers (Basel) ; 13(17)2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34503213

RESUMO

SUMOylation is a dynamic and reversible post-translational modification, characterized more than 20 years ago, that regulates protein function at multiple levels. Key oncoproteins and tumor suppressors are SUMO substrates. In addition to alterations in SUMO pathway activity due to conditions typically present in cancer, such as hypoxia, the SUMO machinery components are deregulated at the genomic level in cancer. The delicate balance between SUMOylation and deSUMOylation is regulated by SENP enzymes possessing SUMO-deconjugation activity. Dysregulation of SUMO machinery components can disrupt the balance of SUMOylation, contributing to the tumorigenesis and drug resistance of various cancers in a context-dependent manner. Many molecular mechanisms relevant to the pathogenesis of specific cancers involve SUMO, highlighting the potential relevance of SUMO machinery components as therapeutic targets. Recent advances in the development of inhibitors targeting SUMOylation and deSUMOylation permit evaluation of the therapeutic potential of targeting the SUMO pathway in cancer. Finally, the first drug inhibiting SUMO pathway, TAK-981, is currently also being evaluated in clinical trials in cancer patients. Intriguingly, the inhibition of SUMOylation may also have the potential to activate the anti-tumor immune response. Here, we comprehensively and systematically review the recent developments in understanding the role of SUMOylation in cancer and specifically focus on elaborating the scientific rationale of targeting the SUMO pathway in different cancers.

10.
Clin Cancer Res ; 27(20): 5708-5717, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34400417

RESUMO

PURPOSE: Thromboembolic events (TE) are the most common complications of myeloproliferative neoplasms (MPN). Clinical parameters, including patient age and mutation status, are used to risk-stratify patients with MPN, but a true biomarker of TE risk is lacking. Protein disulfide isomerase (PDI), an endoplasmic reticulum protein vital for protein folding, also possesses essential extracellular functions, including regulation of thrombus formation. Pharmacologic PDI inhibition prevents thrombus formation, but whether pathologic increases in PDI increase TE risk remains unknown. EXPERIMENTAL DESIGN: We evaluated the association of plasma PDI levels and risk of TE in a cohort of patients with MPN with established diagnosis of polycythemia vera (PV) or essential thrombocythemia (ET), compared with healthy controls. Plasma PDI was measured at enrollment and subjects followed prospectively for development of TE. RESULTS: A subset of patients, primarily those with JAK2-mutated MPN, had significantly elevated plasma PDI levels as compared with controls. Plasma PDI was functionally active. There was no association between PDI levels and clinical parameters typically used to risk-stratify patients with MPN. The risk of TE was 8-fold greater in those with PDI levels above 2.5 ng/mL. Circulating endothelial cells from JAK2-mutated MPN patients, but not platelets, demonstrated augmented PDI release, suggesting endothelial activation as a source of increased plasma PDI in MPN. CONCLUSIONS: The observed association between plasma PDI levels and increased risk of TE in patients with JAK2-mutated MPN has both prognostic and therapeutic implications.


Assuntos
Janus Quinase 2/genética , Mutação , Policitemia Vera/sangue , Policitemia Vera/genética , Isomerases de Dissulfetos de Proteínas/sangue , Trombocitemia Essencial/sangue , Trombocitemia Essencial/genética , Trombose/sangue , Trombose/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Policitemia Vera/complicações , Estudos Prospectivos , Medição de Risco , Trombocitemia Essencial/complicações , Trombose/etiologia
11.
Lancet Haematol ; 7(2): e122-e133, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31837959

RESUMO

BACKGROUND: Increased aurora A kinase (AAK) expression occurs in acute myeloid leukaemia; AAK inhibition is a promising therapeutic target in this disease. We therefore aimed to assess the activity of alisertib combined with 7 + 3 induction chemotherapy in previously untreated patients with high-risk acute myeloid leukaemia. METHODS: We did a single-arm, phase 2 trial of patients recruited from the Dana-Farber/Harvard Cancer Center in the USA. Eligible patients had previously untreated acute myeloid leukaemia, an Eastern Cooperative Oncology Group performance status of 0-2, and were at high risk of disease as defined by the presence of an adverse-risk karyotype, the presence of secondary acute myeloid leukaemia arising from previous myelodysplastic syndrome or myeloproliferative neoplasm, the presence of therapy-related acute myeloid leukaemia, or being 65 years or older. Enrolled patients received 7 + 3 induction chemotherapy of continuous infusion of cytarabine (100 mg/m2 per day on days 1-7) and intravenous bolus of idarubicin (12 mg/m2 per day on days 1-3). Oral alisertib (30 mg) was given twice per day on days 8-15. Patients could receive up to four consolidation cycles with cytarabine and alisertib, and alisertib maintenance for 12 months. The primary endpoint was a composite including the proportion of patients achieving complete remission and those with a complete remission with incomplete neutrophil or platelet count recovery. Analyses were per-protocol. This study is registered with Clinicaltrials.gov, number NCT02560025, and has completed enrolment. FINDINGS: Between Dec 31, 2015, and Aug 1, 2017, we enrolled a total of 39 eligible patients. 19 (49%) of 39 patients had secondary acute myeloid leukaemia and three (8%) had therapy-related acute myeloid leukaemia. At mid-induction, 33 (85%) of 39 patients showed marrow aplasia, six (15%) received re-induction. The median follow-up was 13·7 months (IQR 12·7-14·4). Composite remission was 64% (two-stage 95% CI 48-79), with 20 (51%) of 39 patients achieving complete remission and five (13%) achieving complete remission with incomplete neutrophil or platelet count recovery. The most common grade 3 or 4 adverse events included febrile neutropenia (16 [41%] of 39), neutropenia (12 [31%]), thrombocytopenia (13 [33%]), anaemia (11 [28%]), anorexia (nine [23%]), and oral mucositis (four [10%]). No treatment-related deaths were observed. INTERPRETATION: These results suggest that alisertib combined with induction chemotherapy is active and safe in previously untreated patients with high-risk acute myeloid leukaemia. This study met criteria to move forward to a future randomised trial. FUNDING: Millennium Pharmaceuticals.


Assuntos
Azepinas/administração & dosagem , Quimioterapia de Indução , Leucemia Mieloide Aguda/tratamento farmacológico , Pirimidinas/administração & dosagem , Idoso , Azepinas/efeitos adversos , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Feminino , Seguimentos , Humanos , Idarubicina/administração & dosagem , Idarubicina/efeitos adversos , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Pirimidinas/efeitos adversos , Fatores de Risco
12.
Front Oncol ; 9: 1162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781488

RESUMO

AML holds a unique place in the history of immunotherapy by virtue of being among the first malignancies in which durable remissions were achieved with "adoptive immunotherapy," now known as allogeneic stem cell transplantation. The successful deployment of unselected adoptive cell therapy established AML as a disease responsive to immunomodulation. Classification systems for AML have been refined and expanded over the years in an effort to capture the variability of this heterogeneous disease and risk-stratify patients. Current systems increasingly incorporate information about cytogenetic alterations and genetic mutations. The advent of next generation sequencing technology has enabled the comprehensive identification of recurrent genetic mutations, many with predictive power. Recurrent genetic mutations found in AML have been intensely studied from a cell intrinsic perspective leading to the genesis of multiple, recently approved targeted therapies including IDH1/2-mutant inhibitors and FLT3-ITD/-TKD inhibitors. However, there is a paucity of data on the effects of these targeted agents on the leukemia microenvironment, including the immune system. Recently, the phenomenal success of checkpoint inhibitors and CAR-T cells has re-ignited interest in understanding the mechanisms leading to immune dysregulation and suppression in leukemia, with the objective of harnessing the power of the immune system via novel immunotherapeutics. A paradigm has emerged that places crosstalk with the immune system at the crux of any effective therapy. Ongoing research will reveal how AML genetics inform the composition of the immune microenvironment paving the way for personalized immunotherapy.

13.
Nat Genet ; 51(10): 1518-1529, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31570891

RESUMO

RNA modifications are emerging as key determinants of gene expression. However, compelling genetic demonstrations of their relevance to human disease are lacking. Here, we link ribosomal RNA 2'-O-methylation (2'-O-Me) to the etiology of dyskeratosis congenita. We identify nucleophosmin (NPM1) as an essential regulator of 2'-O-Me on rRNA by directly binding C/D box small nucleolar RNAs, thereby modulating translation. We demonstrate the importance of 2'-O-Me-regulated translation for cellular growth, differentiation and hematopoietic stem cell maintenance, and show that Npm1 inactivation in adult hematopoietic stem cells results in bone marrow failure. We identify NPM1 germline mutations in patients with dyskeratosis congenita presenting with bone marrow failure and demonstrate that they are deficient in small nucleolar RNA binding. Mice harboring a dyskeratosis congenita germline Npm1 mutation recapitulate both hematological and nonhematological features of dyskeratosis congenita. Thus, our findings indicate that impaired 2'-O-Me can be etiological to human disease.


Assuntos
Disceratose Congênita/genética , Epigenômica/métodos , Mutação em Linhagem Germinativa , Proteínas Nucleares/genética , Processamento Pós-Transcricional do RNA , RNA Mensageiro/genética , RNA Ribossômico/genética , Animais , Disceratose Congênita/patologia , Perfilação da Expressão Gênica , Células-Tronco Hematopoéticas , Masculino , Metilação , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Proteínas Nucleares/química , Nucleofosmina , RNA Nucleolar Pequeno , Transcriptoma
14.
Cell Res ; 29(6): 446-459, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31024166

RESUMO

Although targeted therapies have proven effective and even curative in human leukaemia, resistance often ensues. IDH enzymes are mutated in ~20% of human AML, with targeted therapies under clinical evaluation. We here characterize leukaemia evolution from mutant IDH2 (mIDH2)-dependence to independence identifying key targetable vulnerabilities of mIDH2 leukaemia that are retained during evolution and progression from early to late stages. Mechanistically, we find that mIDH2 leukaemia are metastable and vulnerable at two distinct levels. On the one hand, they are characterized by oxidative and genotoxic stress, in spite of increased 1-carbon metabolism and glutathione levels. On the other hand, mIDH2 leukaemia display inhibition of LSD1 and a resulting transcriptional signature of all-trans retinoic acid (ATRA) sensitization, in spite of a state of suppressed ATRA signalling due to increased levels of PIN1. We further identify GSH/ROS and PIN1/LSD1 as critical nodes for leukaemia maintenance and the combination of ATRA and arsenic trioxide (ATO) as a key therapeutic modality to target these vulnerabilities. Strikingly, we demonstrate that the combination of ATRA and ATO proves to be a powerfully synergistic and effective therapy in a number of mouse and human mIDH1/2 leukemic models. Thus, our findings pave the way towards the treatment of a sizable fraction of human AMLs through targeted APL-like combinatorial therapies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Trióxido de Arsênio/farmacologia , Isocitrato Desidrogenase/antagonistas & inibidores , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/tratamento farmacológico , Tretinoína/farmacologia , Animais , Modelos Animais de Doenças , Humanos , Isocitrato Desidrogenase/genética , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/patologia , Leucemia Promielocítica Aguda/genética , Leucemia Promielocítica Aguda/patologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Mutação , Neoplasias Experimentais/tratamento farmacológico , Neoplasias Experimentais/genética , Neoplasias Experimentais/patologia , Células Tumorais Cultivadas , Células U937
15.
Ocotal, Nueva Segovia; s.n; mar. 2019. 53 p. ilus, tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1015428

RESUMO

OBJETIVO: Caracterizar epidemiológicamente la tuberculosis en pacientes ingresados en el Hospital Escuela Universitario, Tegucigalpa Honduras 2017. METODOLOGÍA: Estudio descriptivo de corte transversal desarrollado en el Hospital Escuela Universitario, con una muestra de 158 pacientes con tuberculosis. Se revisaron los expedientes clínicos y los indicadores reportados por el Hospital. RESULTADOS: El 51% procedían de Francisco Morazán, el 9% de Choluteca y 6% de Comayagua y El Paraíso y 24% de otros departamentos. El 61% eran hombres y 39% mujeres. 28% de los pacientes se encontraban en una edad de 65 años y más. Con una edad promedio de 48 años. el de menor edad de 2 años y el de mayor edad 92 años.; el 77% de los pacientes eran nuevos y siguientes, con una reactivación y recaída del 1%. El 56% de los pacientes se clasificaron con tuberculosis pulmonar y 41% tuberculosis extra. Al 46% de los pacientes se le realizó serología por VIH; El 40 % de los pacientes con tuberculosis presentaron comorbilidad, siendo la más frecuente el VIH 62%. Un 24% de pacientes fallecieron. En el año 2017 y 2018 se observó un aumento en la prevalencia de tuberculosis de 1.84y 2.07, en comparación con años anteriores. CONCLUSIONES: La mayoría de los pacientes eran hombres, con predominio de edad de mayores de 65 años y en su mayoría procedían del distrito central. Se observó que la mayoría eran pacientes nuevos, más de la mitad de los casos se clasificaron como tuberculosis pulmonar, con predominio de comorbilidad VIH. En el último año aumentó la prevalencia y letalidad por TB en el Hospital


Assuntos
Humanos , Tuberculose , Sumários de Alta do Paciente Hospitalar , Epidemiologia , Epidemiologia Descritiva , Estudos Transversais
16.
Nat Commun ; 9(1): 159, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-29335436

RESUMO

The mitogen-activated protein kinase (MAPK) pathway is frequently aberrantly activated in advanced cancers, including metastatic prostate cancer (CaP). However, activating mutations or gene rearrangements among MAPK signaling components, such as Ras and Raf, are not always observed in cancers with hyperactivated MAPK. The mechanisms underlying MAPK activation in these cancers remain largely elusive. Here we discover that genomic amplification of the PPP1CA gene is highly enriched in metastatic human CaP. We further identify an S6K/PP1α/B-Raf signaling pathway leading to activation of MAPK signaling that is antagonized by the PML tumor suppressor. Mechanistically, we find that PP1α acts as a B-Raf activating phosphatase and that PML suppresses MAPK activation by sequestering PP1α into PML nuclear bodies, hence repressing S6K-dependent PP1α phosphorylation, 14-3-3 binding and cytoplasmic accumulation. Our findings therefore reveal a PP1α/PML molecular network that is genetically altered in human cancer towards aberrant MAPK activation, with important therapeutic implications.


Assuntos
Ativação Enzimática/genética , Sistema de Sinalização das MAP Quinases/genética , Neoplasias da Próstata/genética , Proteína Fosfatase 1/genética , Proteínas Proto-Oncogênicas B-raf/metabolismo , Proteínas Quinases S6 Ribossômicas 70-kDa/metabolismo , Linhagem Celular Tumoral , Amplificação de Genes , Humanos , Masculino , Metástase Neoplásica , Células PC-3 , Fosfatidilinositol 3-Quinases/metabolismo , Proteína da Leucemia Promielocítica/metabolismo , Neoplasias da Próstata/patologia , Proteína Fosfatase 1/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais
17.
Nat Genet ; 50(2): 206-218, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29335545

RESUMO

Lipids, either endogenously synthesized or exogenous, have been linked to human cancer. Here we found that PML is frequently co-deleted with PTEN in metastatic human prostate cancer (CaP). We demonstrated that conditional inactivation of Pml in the mouse prostate morphs indolent Pten-null tumors into lethal metastatic disease. We identified MAPK reactivation, subsequent hyperactivation of an aberrant SREBP prometastatic lipogenic program, and a distinctive lipidomic profile as key characteristic features of metastatic Pml and Pten double-null CaP. Furthermore, targeting SREBP in vivo by fatostatin blocked both tumor growth and distant metastasis. Importantly, a high-fat diet (HFD) induced lipid accumulation in prostate tumors and was sufficient to drive metastasis in a nonmetastatic Pten-null mouse model of CaP, and an SREBP signature was highly enriched in metastatic human CaP. Thus, our findings uncover a prometastatic lipogenic program and lend direct genetic and experimental support to the notion that a Western HFD can promote metastasis.


Assuntos
Lipogênese/genética , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Proteínas de Ligação a Elemento Regulador de Esterol/fisiologia , Animais , Linhagem Celular Tumoral , Proliferação de Células/genética , Transformação Celular Neoplásica/genética , Transformação Celular Neoplásica/metabolismo , Humanos , Masculino , Redes e Vias Metabólicas/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Metástase Neoplásica , Células PC-3 , PTEN Fosfo-Hidrolase/genética , Neoplasias da Próstata/metabolismo , Proteínas de Ligação a Elemento Regulador de Esterol/genética
18.
Nat Commun ; 9(1): 66, 2018 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-29302031

RESUMO

Disease recurrence after therapy, due to the persistence of resistant leukemic cells, represents a fundamental problem in the treatment of leukemia. Elucidating the mechanisms responsible for the maintenance of leukemic cells, before and after treatment, is therefore critical to identify curative modalities. It has become increasingly clear that cell-autonomous mechanisms are not solely responsible for leukemia maintenance. Here, we report a role for Pml in mesenchymal stem cells (MSCs) in supporting leukemic cells of both CML and AML. Mechanistically, we show that Pml regulates pro-inflammatory cytokines within MSCs, and that this function is critical in sustaining CML-KLS and AML ckit+ leukemic cells non-cell autonomously.


Assuntos
Leucemia/metabolismo , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Neoplásicas/metabolismo , Proteína da Leucemia Promielocítica/metabolismo , Nicho de Células-Tronco , Doença Aguda , Animais , Proliferação de Células/genética , Células Cultivadas , Citocinas/metabolismo , Leucemia/genética , Leucemia/patologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/metabolismo , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mieloide/genética , Leucemia Mieloide/metabolismo , Leucemia Mieloide/patologia , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Proteína da Leucemia Promielocítica/genética
19.
Blood ; 129(13): 1791-1801, 2017 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-28126925

RESUMO

Myeloid-derived suppressor cells (MDSCs) play a critical role in promoting immune tolerance and disease growth. The mechanism by which tumor cells evoke the expansion of MDSCs in acute myeloid leukemia (AML) has not been well described. We have demonstrated that patients with AML exhibit increased presence of MDSCs in their peripheral blood, in comparison with normal controls. Cytogenetic studies demonstrated that MDSCs in patients with AML may be derived from leukemic or apparently normal progenitors. Engraftment of C57BL/6 mice with TIB-49 AML led to an expansion of CD11b+ Gr1+ MDSCs in bone marrow and spleen. Coculture of the AML cell lines MOLM-4, THP-1 or primary AML cells with donor peripheral blood mononuclear cells elicited a cell contact-dependent expansion of MDSCs. MDSCs were suppressive of autologous T-cell responses as evidenced by reduced T-cell proliferation and a switch from a Th1 to a Th2 phenotype. We hypothesized that the expansion of MDSCs in AML is accomplished by tumor-derived extracellular vesicles (EVs). Using tracking studies, we demonstrated that AML EVs are taken-up myeloid progenitor cells, resulting in the selective proliferation of MDSCs in comparison with functionally competent antigen-presenting cells. The MUC1 oncoprotein was subsequently identified as the critical driver of EV-mediated MDSC expansion. MUC1 induces increased expression of c-myc in EVs that induces proliferation in the target MDSC population via downstream effects on cell cycle proteins. Moreover, we demonstrate that the microRNA miR34a acts as the regulatory mechanism by which MUC1 drives c-myc expression in AML cells and EVs.


Assuntos
Proliferação de Células , Leucemia Mieloide Aguda/patologia , Mucina-1/fisiologia , Células Supressoras Mieloides/patologia , Animais , Comunicação Celular , Linhagem Celular Tumoral , Técnicas de Cocultura , Vesículas Extracelulares/patologia , Xenoenxertos , Humanos , Leucócitos Mononucleares , Camundongos , MicroRNAs/fisiologia , Proteínas Proto-Oncogênicas c-myc/biossíntese
20.
Edumecentro ; 6(3): 95-110, sep.-dic. 2014. ilus
Artigo em Espanhol | LILACS | ID: lil-721257

RESUMO

Fundamento: la evaluación periódica de una publicación seriada a través de indicadores bibliométricos permite obtener resultados objetivos y observar sus tendencias. Objetivo: describir la producción científica de la revista EDUMECENTRO. Métodos: se realizó un estudio bibliométrico, descriptivo, longitudinal y retrospectivo, se tomaron como muestra los 255 artículos publicados en el período 2009-2013. De la estadística descriptiva se utilizaron las frecuencias absolutas, el porcentaje y el promedio; los resultados obtenidos se presentaron en tablas y gráficos para su mejor interpretación. Resultados: se incrementa considerablemente la cantidad de artículos publicados en la revista en el quinquenio, la mayoría de los autores residen en Santa Clara, Villa Clara. Se observan como tendencias el incremento del número de artículos originales y la disminución de las comunicaciones breves. La mayoría de los primeros autores ostentan la categoría docente de profesor auxiliar y el título académico de másteres en ciencias. El diseño curricular y su perfeccionamiento en las carreras de las ciencias de la salud y la educación de postgrado y sus transformaciones, resultaron los temas que se abordan con una frecuencia mayor. Se encontraron discretos resultados en cuanto al porciento de actualización de las referencias bibliográficas y un buen número de publicaciones seriadas cubanas consultadas por los autores. Conclusiones: luego de analizar el comportamiento de algunos indicadores bibliométricos en los primeros cinco años de existencia de EDUMECENTRO, puede considerarse que los resultados son satisfactorios. Las recomendaciones que de ellos se derivan permitirán mejorar la gestión y la visibilidad de los artículos de este espacio divulgativo.


Background: the periodic evaluation of a serial publication through bibliometric indicators allows to obtain objective results and to observe its trends. Objective: to describe the scientific production of the journal EDUMECENTRO. Methods: a bibliometric, descriptive, longitudinal and retrospective study was done. The sample taken were the 255 articles published in the period 2009-2013. From the descriptive statistics, the absolute frequencies, the percentage and the average were used. The results obtained were presented in tables and graphs for their better interpretation. Results: the amount of articles published in the quinquennium was increased considerably, and most authors were residents in Santa Clara, Villa Clara. The trends observed were the increase in the number of original articles and the decrease in the brief communications. Most of the first authors had the teaching rank of Associate Professor, and the academic degree of Masters of Science. The curriculum design and its perfecting in the studies of medical sciences, and the postgraduate education and its development, were the themes that appeared with the highest frequency. Discreet results were found regarding the percentage of updating of the bibliographic references, and a considerable number of Cuban serial publications were consulted by the authors. Conclusions: after analyzing some bibliometric indicators in the first five years of existence of EDUMECENTRO, it may be considered that the results are satisfactory. The recommendations derived from these results will allow to improve the management and the visibility of the articles from this communication space.


Assuntos
Publicações Seriadas , Bibliometria , Indicadores de Produção Científica
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