Venetoclax Shows Low Therapeutic Activity in BCL2-Positive Relapsed/Refractory Peripheral T-Cell Lymphoma: A Phase 2 Study of the Fondazione Italiana Linfomi

Patients with relapsed/refractory (R/R) peripheral T-cell lymphoma (PTCL) have a poor prognosis, with an expected survival of less than 1 year using standard salvage therapies. Recent advances in our understanding of the biology of PTCL have led to identifying B-Cell Lymphoma 2 (BCL2) protein as a potential therapeutic target. BLC2 inhibitor venetoclax was investigated in a prospective phase II trial in patients with BCL2-positive R/R PTCL after at least one previous standard line of treatment (NCT03552692). Venetoclax given alone at a dosage of 800 mg/day resulted in one complete response (CR) and two stable diseases (SDs) among 17 enrolled patients. The majority of patients (88.2%) interrupted the treatment due to disease progression. No relationship with BCL2 expression was documented. At a median follow-up of 8 months, two patients are currently still on treatment (one CR and one SD). No case of tumor lysis syndrome was registered. Therefore, venetoclax monotherapy shows activity in a minority of patients whose biological characteristics have not yet been identified.Clinical Trial Registrationwww.clinicaltrials.gov (NCT03552692, EudraCT number 2017-004630-29).

Alisma Shugan Decoction Attenuates Hepatic fibrosis and Endoplasmic Reticulum Stress in Mice with Carbon Tetrachloride-Induced fibrosis

Background: Over the years, Alisma Shugan Decoction (ASD), because of its potent anti-inflammation activity, has been used in traditional Chinese medicine (TCM) for treatment of many inflammation-associated disorders including those of the heart, blood vessel and brain. Methods: Herein, we examined the probable therapeutic effect of ASD in carbon tetrachloride (CCI4)-induced liver injury and fibrosis mice models. Results: Our results demonstrate that ASD dose-dependently reduced the fibrosis-related increased collagen deposition secondary to liver tissue exposure to CCI4. Data from our biochemical analyses showed significantly less liver damage biomarkers including ALT, AST and hydroxyproline in the ASD-treated samples, suggesting hepato-protective effect of ASD. Furthermore, we demonstrated that treatment with ASD significantly reversed CCI4-induced elevation of TNF-α, IL-6, IL-1β and MCP-1. Comparative immunohistochemical staining of liver samples revealed that ASD dose-dependently downregulated the expression of pro-apoptotic, Bax while upregulating anti-apoptotic Bcl2 protein. Interestingly, NF-κB signaling, a principal regulator of inflammation was markedly suppressed by ASD treatment. In addition, treatment with ASD deregulated stress signaling pathways by suppressing the expression of markers of unfolded protein response, such as ATF6, IRE and GRP78. Conclusion: In conclusion, the present study provides preclinical evidence for the use of ASD as an efficacious therapeutic option in cases of chemical-induced liver damage and/or fibrosis. Further large-cohort validation of these findings is warranted.

Nanonutraceuticals: Anti-Cancer Activity and Improved Safety of Chemotherapy by Costunolide and Its Nanoformulation against Colon and Breast Cancer

Costunolide (COS) is a sesquiterpene lactone with anticancer properties. The present study investigated the anticancer effects of COS against the human colon (HCT116) and breast (MDA-MB-231-Luc) cancer cell lines. Inhibition of cell lines viability and IC50 of COS were assessed via an MTT assay. Furthermore, the apoptotic rate was detected by assessment of Bcl2-associated X (Bax) and B-cell lymphoma 2 (Bcl2) protein levels by flow cytometry. Xenograft mice model of HCT116 and MDA-MB-231-Luc were carried out to determine the effect of COS and its nanoparticles (COS-NPs). The results demonstrated that COS inhibited the viability of HCT116 and MDA-MB-231-Luc cells, with a half maximal inhibitory concentration value (IC50) of 39.92 µM and 100.57 µM, respectively. COS significantly increased Bax and decreased Bcl2 levels in treated cells. COS and COS-NPs, in combination with doxorubicin (DOX), significantly decreased the tumor growth of HCT116 and MDA-MB-231-Luc implants in mice. Furthermore, oral administration of COS and COS-NPs significantly decreased the viable cells and increased necrotic/apoptotic cells of HCT116 and MDA-MB-231-Luc implants. Interestingly, both COS and COS-NPs protected the cardiac muscles against DOX’s cardiotoxicity. The current results indicated the promising anticancer and cardiac muscles protection of COS and COS-NPs when administered with chemotherapy.

Monophasic Synovial Sarcoma of the Left Ventricle of the Heart: An Extremely Rare Case and Literature Review

BACKGROUND: Cardiac sarcomas account for <25% of all cardiac tumors. Of these, angiosarcomas are the most frequent. Synovial sarcomas (SS) are exceedingly rare. We present a case of primary left ventricle (LV) SS, a form of sarcoma particularly rare in the heart. CASE DESCRIPTION: A 19-year-old male was referred for further investigation of a LV tumor, presented with a 3-month history of exertional dyspnea and palpitations. He also experienced several syncopal episodes. The radiologic examination confirmed a mass in the LV, suspected for myxoma of the LV. Histopathologic examination revealed a malignant tumor with spindle cell components, suggesting leiomyosarcoma with differential diagnosis of monophasic SS. Immunohistochemistry demonstrated reactivity of the spindle cell component with the mesenchymal marker vimentin and BCL2 protein, while the smooth muscle marker, desmin, was negative, confirming the diagnosis of monophasic SS. CONCLUSIONS: Monophasic SS in the heart is diagnostically challenging since it shares the broad list of differential diagnoses of spindle cell tumors. Immunostaining is helpful to differentiate those entities to obtain a definitive diagnosis and proper treatment.

The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis

MYC/BCL2 protein co-expression (i.e., double expressor) has been shown to be a negative predictor of outcome in diffuse large B-cell lymphoma (DLBCL). We aimed to establish the incidence of double expressor status in patients with de novo DLBCL and identify the predictive value of this biomarker on treatment response through systematic review and meta-analysis. PubMed and Embase were searched for studies published through December 2019 that reported proportions of double expressor DLBCL. The pooled proportions of MYC and BCL2 expression, both alone and in combination, were computed using the inverse variance method for calculating weights and by the DerSimonian–Laird method. The pooled odds ratios (ORs) of complete remission (CR) rate were calculated, and meta-regression analysis was conducted to explore heterogeneity. Forty-one studies (7054 patients) were included. The pooled incidence of double expressor status in DLBCL was 23% (95% confidence interval [CI], 20–26%), with an adjusted estimate of 31% (95% CI, 27–36%). Neither MYC/BCL2 protein cutoff values, race, mean, or median age of included patients, or overall study quality was a significant factor of heterogeneity (p ≥ 0.20). Cases without double expressor status demonstrated a higher probability of CR to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone treatment (OR, 2.69; 95% CI, 1.55–4.67). Our results reaffirm the predictive power of this important biomarker.

Loss-of-function of Fbxo10, encoding a post-translational regulator of BCL2 in lymphomas, has no discernible effect on BCL2 or B lymphocyte accumulation in mice

Regulation of the anti-apoptotic BCL2 protein determines cell survival and is frequently abnormal in B cell lymphomas. An evolutionarily conserved post-translational mechanism for over-expression of BCL2 in human B cell lymphomas and the BCL2 paralogue CED-9 in Caenorhabditis elegans results from loss-of-function mutations in human FBXO10 and its C.elegans paralogue DRE-1, a BCL2/CED-9-binding subunit of the SKP-CULLIN-FBOX (SCF) ubiquitin ligase. Here, we tested the role of FBXO10 in BCL2 regulation by producing mice with two different CRISPR/Cas9-engineered Fbxo10 mutations: an Asp54Lys (E54K) missense mutation in the FBOX domain and a Cys55SerfsTer55 frameshift (fs) truncating mutation. Mice homozygous for either mutant allele were born at the expected Mendelian frequency and appeared normal in body weight and appearance as adults. Spleen B cells from homozygous mutant mice did not have increased BCL2 protein, nor were the numbers of mature B cells or germinal centre B cells increased as would be expected if BCL2 was increased. Other lymphocyte subsets that are also regulated by BCL2 levels also displayed no difference in frequency in homozygous Fbxo10 mutant mice. These results support one of two conclusions: either FBXO10 does not regulate BCL2 in mice, or it does so redundantly with other ubiquitin ligase complexes. Possible candidates for the latter include FBXO11 or ARTS-XIAP. The difference between the role of FBXO10 in regulating BCL2 protein levels in C. elegans and in human DLBCL, relative to single-gene deficient mouse leukocytes, should be further investigated.

One Patient Diagnosed With Primary Refractory Diffuse Large B Cell Lymphoma Successfully Salvaged With BCL2 Inhibitor Followed by anti-CD19 CAR-T Suffered From a Secondary Onset of Severely CRS

Background Treatment of relapsed/refractory diffuse large B cell lymphoma (DLBCL) eligible for transplantation is limited by the efficacy of salvage therapy. Chimeric antigen receptor modified T cell (CAR-T) therapy has achieved the highest response rate of salvage therapy for relapsed/refractory aggressive B cell lymphoma. Cytokine release syndrome (CRS) and cytopenia are main side effects of CAR-T therapy. Case presentation A 61 years old Chinese male diagnosed as DLBCL was treated with rituximab combined with chemotherapy, unfortunately, he was resistant to first-line chemotherapy and other regimens. Due to high expression of BCL2 protein and amplification of BCL2 by next sequence generation, BCL2 inhibitor combined with low intensity chemotherapy was given to him as a bridge to anti-19 CAR-T therapy. Although escalation of dose from 100mg per day to 400mg in one week, he had no tumor lysis syndrome and achieved partial response. He suffered persist pancytopenia after CAR T-cells infusion, moreover, a severely secondary CRS on 54th day was observed and responded well to steroid.Discussion and conclusions BCL2 inhibitor may have a role in frontline or salvage therapy of DLBCL, especially for those with high BCL2 protein expression, mechanism of which should be still investigated. CAR-T therapy revolutionized the salvage of primary refractory DLBCL, but we should focus on persist cytopenia and severe CRS, and we reported the latest secondary CRS till now.

Synthesis, molecular docking studies, anticancer and antibacterial activities of some novel Dinuclear Nickel (II) Complexes 2, 4-Dihydroxy acetyl-4-Hydroxybenzoic Hydrazone

Substituted 2, 4-Dihydroxyacetyl-4-Hydroxybenzoic Hydrazone, which is known for their versatile biological activities, have been reported to show significant anti lung cancer activities. In the present study, a novel series of some 2, 4-Dihydroxyacetyl-4-Hydroxybenzoic Hydrazone ligands were complexed with Nickle and synthesized to develop more potent anti-cancer activities. The Ni complexes were synthesized in good to excellent yields, and equimolar solutions of 2, 4-dihydroxyacetophenone in methanol and 4-hydroxy benzoic hydrazide in hot aqueous ethanol were refluxed for two hours on a water bath and cooled. I.R., NMR and HRMS spectral analysis characterized the structures of all newly synthesized compounds. The title compounds were tested against a panel of Gram-positive and Gram-negative bacteria for in vitro antibacterial activity. The compounds were docked to BCL2 protein, an expressed protein of lung cancer for anti-cancer studies. All the title compounds were screened for anti-cancer activity using BCL2 lung protein based on insilico molecular docking studies, and the results showed IC50 value ranging between 40-45μg.