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Coni S.,Institute Of Biologie Valrose | Infante P.,Italian Institute of Technology | Gulino A.,Italian Institute of Technology | Gulino A.,University of Rome La Sapienza | Gulino A.,Neuromed Institute
Biochemical Pharmacology | Year: 2013

Hedgehog is a key morphogen regulating embryonic development and tissue repair. Remarkably, when misregulated, it leads to tumorigenesis. Hedgehog signaling is triggered by binding of ligands with transmembrane receptor Ptch and is subsequently mediated by transcriptional effectors belonging to the Gli family, whose functions is tuned by a number of molecular interactions and post-synthetic modifications. The complex of these regulatory circuitries provides a tight control of developmental processes, mainly involving the modulation of genes determining the fate of stem cells. Similarly, Hedgehog regulates cancer stem cells fostering tumorigenesis. To this regard, these processes represent promising targets for novel therapeutic strategies aiming at the control of stemness reactivation and maintenance in cancer. © 2012 Elsevier Inc.


Fasano A.,Catholic University of the Sacred Heart | Fasano A.,Neuromed Institute | Ricciardi L.,Messina University | Pettorruso M.,Catholic University of the Sacred Heart | Bentivoglio A.R.,Catholic University of the Sacred Heart
Journal of Neurology | Year: 2011

Punding, a peculiar stereotyped behavior characterized by intense fascination with complex, excessive, non-goal-oriented, repetitive activities, is a quite rare condition complicating Parkinson's disease (PD). It is triggered by dopaminergic therapy and could have a strong impact on patient quality of life. No study has specifically investigated medical management of this condition, and only a few anecdotal reports have provided therapeutic hints. Given the suggested similarities to drug-induced dyskinesias, we have previously suggested a multistep algorithm for management of punding. We conducted a prospective open-label study on ten PD punders aimed at testing its validity. In two cases, reduction of levodopa therapy was efficacious; amantadine was effective in controlling punding in four cases; in the remaining cases, quetiapine was employed, with mild efficacy in two cases. © 2010 Springer-Verlag.


De Smaele E.,University of Rome La Sapienza | Ferretti E.,University of Rome La Sapienza | Gulino A.,University of Rome La Sapienza | Gulino A.,Neuromed Institute
Brain Research | Year: 2010

The use of miRNAs as biomarkers has gained growing interest in the last few years. Their role in regulating a great variety of targets and, as a consequence, multiple pathways, makes their use in diagnostics a powerful tool to be exploited for early detection of disease, risk assessment and prognosis and for the design of innovative therapeutic strategies. While still not fully validated, profiling of blood cells, exosomes or body fluid miRNAs would represent a tremendous and promising advance in non-invasive diagnostics of CNS disorders. A major challenge is represented by technological aspects of miRNA detection and discovery aiming to genome-wide high throughput, sensitive and accurate analysis. Although there is much to be learned in the field, this review will highlight the potential role of miRNA as a new class of biomarkers in several CNS disorders, including neurodegenerative diseases such as Alzheimer, Huntington and Parkinson diseases, schizophrenia and autism as well as different types of cancer (e.g. gliomas and medulloblastomas). © 2010 Elsevier B.V. All rights reserved.


Lanzetta G.,Neuromed Institute | Minniti G.,Neuromed Institute | Minniti G.,University of Rome La Sapienza
Tumori | Year: 2010

Current treatment of glioblastoma in the elderly includes surgery, radiotherapy and chemotherapy, but the prognosis remains extremely poor, and its optimal management is still debated. Longer survival after extensive resection compared with biopsy only has been reported, although the survival advantage remains modest. Radiation in the form of standard (60 Gy in 30 fractions over 6 weeks) and abbreviated courses of radiotherapy (30-50 Gy in 6-20 fractions over 2-4 weeks) has been employed in elderly patients with glioblastoma, showing survival benefits compared with supportive care alone. Temozolomide is an alkylating agent recently employed in older patients with newly diagnosed glioblastoma. The addition of concomitant and/or adjuvant chemotherapy with temozolomide to radiotherapy, which is currently the standard treatment in adults with glioblastoma, is emerging as an effective therapeutic option for older patients with favorable prognostic factors. The potential benefits on survival, improvement in quality of life and toxicity of different schedules of radiotherapy plus temozolomide need to be addressed in future randomized studies.


Gulino A.,University of Rome La Sapienza | Gulino A.,Neuromed Institute | Di Marcotullio L.,University of Rome La Sapienza | Screpanti I.,University of Rome La Sapienza
Experimental Cell Research | Year: 2010

Numb is an evolutionary conserved protein that plays critical roles in cell fate determination. Mammalian Numb displays a higher degree of structural complexity compared to the Drosophila homolog based on the number of encoding genes (Numb and Numb-like) and of alternative spliced isoforms. Accordingly, Numb proteins display a complex pattern of functions such as the control of asymmetric cell division and cell fate choice, endocytosis, cell adhesion, cell migration, ubiquitination of specific substrates and a number of signaling pathways (i.e. Notch, Hedgehog, p53). Recent findings indicate that, besides controlling such physiologic developmental processes, subversion of the above Numb-dependent events plays a critical role in disease (e.g. cancer). We will review here the multiple functions of mNumb and their underlying molecular mechanisms in development and disease. © 2009 Elsevier Inc. All rights reserved.


Scaringi C.,University of Rome La Sapienza | Minniti G.,University of Rome La Sapienza | Caporello P.,Neuromed Institute | Enrici R.M.,University of Rome La Sapienza
Anticancer Research | Year: 2012

Glioblastoma is the most frequent primary malignant brain tumor in adults. Postoperative radiotherapy (RT) with concomitant and adjuvant chemotherapy with temozolomide is the standard treatment, however the prognosis remains poor with a median survival in the range of 12-15 months. In recent years, several targeted agents have been developed as potential inhibitors of molecular genetic and signal transduction pathways involved in gliomatogenesis, including those of vascular endothelial growth factor and its receptor, epidermal growth factor receptor, integrin, and mammalian target of rapamycin. The integrins are a family of transmembrane glycoprotein receptors that mediate cell matrix and cell-cell interactions, and are widely expressed in glioma cells and tumor vasculature. The critical role of integrins in angiogenesis, cell invasion and migration make them an attractive target for anticancer therapy. Inhibitory peptides and monoclonal antibodies to integrins are currently being investigated in clinical trials in patients with solid tumors, such as colorectal cancer, renal cell carcinoma, and melanoma. Cilengitide, a cyclized Arg-Gly-Glu(RGD)- containing pentapeptide that selectively blocks activation of the αvβ3 and αvβ5 integrins has shown encouraging activity in patients with glioblastoma as single agent, and in association with standard RT and temozolomide. In this review, we provide a brief overview of the preclinical experience and current clinical results of cilengitide therapy in patients with recurrent or newly diagnosed glioblastoma.


Minniti G.,Neuromed Institute | Minniti G.,University of Rome La Sapienza | Scaringi C.,University of Rome La Sapienza | Enrici R.M.,University of Rome La Sapienza
Radiation Oncology | Year: 2011

Radiotherapy (RT) remains an effective treatment in patients with acromegaly refractory to medical and/or surgical interventions, with durable tumor control and biochemical remission; however, there are still concerns about delayed biochemical effect and potential late toxicity of radiation treatment, especially high rates of hypopituitarism. Stereotactic radiotherapy has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. Radiation can be delivered in a single fraction by stereotactic radiosurgery (SRS) or as fractionated stereotactic radiotherapy (FSRT) in which smaller doses are delivered over 5-6 weeks in 25-30 treatments. A review of the recent literature suggests that pituitary irradiation is an effective treatment for acromegaly. Stereotactic techniques for GH-secreting pituitary tumors are discussed with the aim to define the efficacy and potential adverse effects of each of these techniques. © 2011 Minniti et al; licensee BioMed Central Ltd.


Minniti G.,University of Rome La Sapienza | Minniti G.,Neuromed Institute | Scaringi C.,University of Rome La Sapienza | Baldoni A.,University of Rome La Sapienza | And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose: To describe the quality of life (QOL) in elderly patients with glioblastoma (GBM) treated with an abbreviated course of radiation therapy (RT; 40 Gy in 15 fractions) plus concomitant and adjuvant temozolomide (TMZ). Methods and Materials: Health-related QOL (HRQOL) was assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30, version 3) and EORTC Quality of Life Questionnaire Brain Cancer Module (QLQ-BN20). Changes from baseline in the score of 9 preselected domains (global QLQ, social functioning, cognitive functioning, emotional functioning, physical functioning, motor dysfunction, communication deficit, fatigue, insomnia) were determined 4 weeks after RT and thereafter every 8 weeks during the treatment until disease progression. The proportion of patients with improved HRQOL scores, defined as a change of 10 points or more, and duration of changes were recorded. Results: Sixty-five patients completed the questionnaires at baseline. The treatment was consistently associated with improvement or stability in most of the preselected HRQOL domains. Global health improved over time; mean score differed by 9.6 points between baseline and 6-month follow-up (P=.03). For social functioning and cognitive functioning, mean scores improved over time, with a maximum difference of 10.4 points and 9.5 points between baseline and 6-month follow-up (P=.01 and P=.02), respectively. By contrast, fatigue worsened over time, with a difference in mean score of 5.6 points between baseline and 4-month follow-up (P=.02). Conclusions: A short course of RT in combination with TMZ in elderly patients with GBM was associated with survival benefit without a negative effect on HRQOL until the time of disease progression. © 2013 Elsevier Inc. All rights reserved.


Scaringi C.,University of Rome La Sapienza | Enrici R.M.,University of Rome La Sapienza | Minniti G.,University of Rome La Sapienza | Minniti G.,Neuromed Institute
OncoTargets and Therapy | Year: 2013

The expansion in understanding the molecular biology that characterizes cancer cells has led to the rapid development of new agents to target important molecular pathways associated with aberrant activation or suppression of cellular signal transduction pathways involved in gliomagenesis, including epidermal growth factor receptor, vascular endothelial growth factor receptor, mammalian target of rapamycin, and integrins signaling pathways. The use of antiangiogenic agent bevacizumab, epidermal growth factor receptor tyrosine kinase inhibitors gefitinib and erlotinib, mammalian target of rapamycin inhibitors temsirolimus and everolimus, and integrin inhibitor cilengitide, in combination with radiation therapy, has been supported by encouraging preclinical data, resulting in a rapid translation into clinical trials. Currently, the majority of published clinical studies on the use of these agents in combination with radiation and cytotoxic therapies have shown only modest survival benefits at best. Tumor heterogeneity and genetic instability may, at least in part, explain the poor results observed with a single-target approach. Much remains to be learned regarding the optimal combination of targeted agents with conventional chemoradiation, including the use of multipathways-targeted therapies, the selection of patients who may benefit from combined treatments based on molecular biomarkers, and the verification of effective blockade of signaling pathways. © 2013 Scaringi et al.


Suppa A.,Neuromed Institute | Marsili L.,University of Rome La Sapienza | Di Stasio F.,University of Rome La Sapienza | Latorre A.,University of Rome La Sapienza | And 4 more authors.
Movement Disorders | Year: 2014

In humans, intermittent and continuous theta-burst stimulation (iTBS and cTBS) elicit long-term changes in motor-evoked potentials (MEPs) reflecting long-term potentiation (LTP)- and depression (LTD)-like plasticity in the primary motor cortex (M1). In this study, we used TBS to investigate M1 plasticity in patients with MSA. We also assessed whether responses to TBS reflect M1 excitability as tested by short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), short-interval intracortical facilitation (SICF), and the input/output curves. We studied 20 patients with MSA and 20 healthy subjects (HS). Patients were clinically evaluated with the Unified Multiple System Atrophy Rating Scale. The left M1 was conditioned with TBS. Twenty MEPs were recorded from the right first dorsal interosseous muscle before TBS and 5, 15, and 30 minutes thereafter. In a subgroup of 10 patients, we also tested MEPs elicited by SICI, ICF, SICF, and input/output curves, before TBS. Between-group analysis of variance showed that at all time points after iTBS MEPs increased, whereas after cTBS they decreased only in HS. In both subgroups tested, patients with predominant parkinsonian and cerebellar features, iTBS and cTBS left MEPs unchanged. MSA patients had reduced SICI, but normal ICF, SICF, and input/output curves. No correlation was found between patients' clinical features and responses to TBS and M1 excitability variables. These findings suggest impaired M1 plasticity in MSA. © 2013 Movement Disorder Society.

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