the clinical departments
Transcription
the clinical departments
S C I E N T I F I C R E P O R T 2009 00intro 9 07 2010 16:43 Pagina II COVER IMAGES top left: Unpublished image by Vania Broccoli (see Stem cells and neurogenesis, page 39) Rosettes-like structures organized by neural progenitors derived by direct in vitro cell differentiation of human iPS cells. top middle: Hierarchical clustering of gene expression profiles in healthy tissues (rows, genes; columns, tissues) (Giorgio Casari, Head of Neurogenomics Unit, page 169) top right: Unpublished image by Gian Giacomo Consalez (see Developmental neurogenetics Unit, page 36) Progenitors tagged during early embryogenesis by a genetic inducible fate mapping approach develop into mature Purkinje neurons in the adult cerebellar cortex. bottom: Unpublished image by Enrico Gherlone (see Dento-facial histopathology Unit, page 162) The graft material particles (GM) appeared well-included and showed continuity with the new bone (NB) tissue and deposition of osteoid matrix. Some of the images in this book has been published in scientific papers: Fig. 1, p. 14: EMBO Reports Fig. 4, p. 42: Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders Fig. 5, p. 43: Neurobiology of Disease Fig. 10, p. 78: Radiology Fig. 16, p. 154: Science Fig. 17, p. 155: PLoS One Fig. 18, p. 156: Journal of Neuroscience Fig. 19, p. 157: Molecular and Cellular Proteomics Fig. 20, p. 159: Molecular and Cellular Biology Fig. 24, p. 172: Angewandte Chemie Fig. 25, p. 186, toke part in "GE Healthcare IN Cell World Image Competition Award" 2009 Edited by the San Raffaele Library Layout by Roberto Cremonesi Printed by Grafiche Parole Nuove, Brugherio INDEX - III INDEX INTRODUCTIONS VII Introduction by the President Introduzione del Presidente Introduction by the Scientific Director Introduction by the Chief Operating Officer VIII IX XIII XXII San Raffaele Scientific Retreat 2009 I ragazzi della via Olgettina Introduction by the General Director Clinical Area 2009 Seminars and lectures XXV XXIX XXXII XXXIV DIVISION OF MOLECULAR ONCOLOGY Introduction by the Directors Research Units Lymphoid malignancies Unit B-cell neoplasia Biology of multiple myeloma Cell activation and signalling Dynamic fluorescence spectroscopy in biomedicine Lymphoid organ development Preclinical models of cancer Tumour microenvironment Immuno-biotherapy of melanoma and solid tumors Unit Cancer gene therapy Functional genomics of cancer Unit Model genetics of membrane trafficking Unit Molecular histology and cell growth Unit Tumor biology and vascular targeting Unit Clinical Research Units 1 5 7 7 8 8 9 9 10 10 11 11 12 13 13 14 Digestive and pancreatico-biliary endoscopy Unit Endosonography: diagnostic and therapeutic endoscopic ultrasound Gastrointestinal surgical oncology Unit Head and neck oncology Unit Multidisciplinary group for thoracic surgical oncology Oncogenesis in liver neoplasms Unit Onco-hematology Unit Pancreatic cancer Unit: biology and new therapeutic approaches Pathology Unit Clinical lymphoid malignancies Gynecologic oncology Medical oncology Unit - Clinical trials Medical oncology Unit - Phase I and lung cancer clinical trials Urological Research Institute (URI) Selected publications 15 15 16 17 17 18 18 19 19 20 20 21 21 22 23 DIVISION OF NEUROSCIENCE 27 Introduction by the Directors Research Units 32 Neuropsychopharmacology Unit Cell adhesion Unit Cellular and molecular neurobiology Unit Cellular neurophysiology Unit Developmental neurogenetics Unit Neurobiology of learning Unit Proteomics of iron metabolism Unit Molecular genetics of mental retardation Unit Neural degeneration Unit Stem cells and neurogenesis 34 34 35 35 36 37 37 38 38 39 IV - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units Acute brain protection, Acute post-operative pain, Drugs and central nervous system Unit 40 Eye repair Unit 40 Cognitive neuroscience Unit 41 Experimental neurosurgery Unit 41 Functional neuroradiology Unit 42 In vivo Human molecular and structural neuroimaging Unit 43 Neuroothology Unit 43 Psychiatry and clinical psychobiology 44 Sleep medicine 44 Clinical psychology 45 Motor function rehabilitation 45 INSTITUTE OF EXPERIMENTAL NEUROLOGY (INSPE) 46 Introduction by the Director Research Units Experimental neuropathology Experimental neurophysiology Molecular genetics of behaviour Neuromuscular repair Neuroimmunology Unit Clinical neuroimmunology CNS repair Neuroimaging research Unit Neuroimaging of CNS white matter Human inherited neuropathies Unit Axo-glia interactions Unit 47 47 48 48 49 50 50 51 51 52 52 Clinical Research Units Inflammatory CNS disorders Unit Cerebrovascular disorders Memory disorders Movement disorders Neuromuscular disorders Paroxysmal events Selected publications DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES 53 54 54 55 55 56 57 63 Introduction Research Units 66 Amino acid and stable isotopes Unit Complications of diabetes Obesity and metabolic related diseases 67 67 68 Bone metabolism Unit Coagulation service & thrombosis research Unit Cardiodiabetes & core lab Pediatric endocrinology research 68 69 69 70 Clinical Research Units Diabetes and endocrinology Unit Cardio-metabolic and clinical trials Clinical pediatric endocrinology Diabetes and metabolic diseases in children and adolescents Neonatology Foetal-maternal medicine Infertility Cardiovascular interventions Unit Clinical cardiovascular biology Unit Ischaemic heart disease, heart failure and echocardiography Unit Organ protection in critically ill patients, advanced cardiac failure and mechanical supports Unit Structural heart disease Unit Study and treatment of aortic disease Unit Center for arrhythmia research Vision first Unit Selected publications 71 71 72 72 73 73 74 75 75 76 77 77 78 79 79 81 DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY 85 Introduction by the Directors Research Units 89 Skeletal muscle development and therapy Unit Functional genetics of muscle regeneration Gene expression and muscular dystrophy Unit Molecular and functional immunogenetics Neural stem cell biology Autoimmunity & vascular inflammation Unit Innate immunity and tissue remodelling Cellular pharmacology Unit Experimental hematology Unit Angiogenesis and tumor targeting 91 91 92 92 93 94 94 95 95 96 Clinical Research Units Hematology and hematopoietic stem cell transplantation Unit Immunohematology and transfusion medicine Unit PSIEP - Strategic Program of Pediatric Immunohematology 96 97 97 INDEX - V THE SAN RAFFAELE TELETHON INSTITUTE FOR GENE THERAPY (HSR-TIGET) 98 Introduction by the Director Research Units Gene transfer technologies and new gene therapy strategies Unit Gene/neural stem cell therapy for lysosomal storage diseases Hematopoietic stem cell based gene therapy for the treatment of lysosomal storage disorders Safety of gene therapy and insertional mutagenesis Gene transfer into stem cells Unit Immunological tolerance Unit From FOXP3 mutation to IPEX syndrome Tolerogenic dendritic cells Pathogenesis and therapy of ADA-SCID Unit Gene therapy FOR WASP/Omenn Tumor immunology Unit Viral evolution and transmission Unit Viral pathogens & biosafety Unit 126 127 127 Clinical Research Units 99 99 100 100 101 101 102 102 103 103 Clinical Research Units Pediatric Clinical Research Unit - Gene therapy for Wiskott-Aldrich Syndrome 104 Pediatric Clinical Research Unit - ADA gene transfer into hematopoietic stem cells for the treatment of ADA-SCID 105 Pediatric Clinical Research Unit - Clinical trial of gene therapy in metachromatic leukodystrophy 105 Selected publications 106 DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES 111 Introduction by the Directors Research Units 116 Leukocyte biology Unit Cellular and molecular allergology Human virology Infection and cystic fibrosis Protein engineering and therapeutics γδ T cells in innate and adaptive immunity Immunobiology of HIV AIDS immunopathogenesis Unit Biocrystallography Unit Cellular immunology Unit Emerging bacterial pathogens Unit Experimental immunology Unit Immunopathology Unit Lymphocyte activation Unit 118 118 119 120 120 121 122 122 123 123 124 125 125 126 Management and antiretroviral treatment of HIV infection 128 Neurovirology 128 Study and treatment of hepatotropic viruses related diseases 129 Vaccine and immunotherapy 129 Clinical immunopathology and advanced medical therapeutics Unit 130 Clinical transplant Unit 130 Gynecological cancers immunology 131 Immunology in liver neoplasms 131 Pancreatic tumors: immunotherapy and β cell function substitution 132 Clinical hepato-gastroenterology 132 Transplant surgery 133 DIABETES RESEARCH INSTITUTE (DRI) 134 Introduction by the Directors Research Units Immune tolerance Experimental diabetes β cell biology Cell imaging 135 135 136 137 Clinical Research Units Islet transplantation Prevention in type 1 diabetes Epidemiology & data management Childhood diabetes Islet processing activity Selected publications 137 138 138 139 139 141 DIVISION OF GENETICS AND CELL BIOLOGY 149 Introduction by the Directors Research Units 152 Protein transport and secretion Unit Age related diseases Molecular immunology Chromatin dynamics Unit In vivo Chromatin and transcription Biology of myelin Unit Biomolecular mass spectrometry Unit Gene expression Unit Genetics of common disorders Unit 153 153 154 154 155 156 157 157 158 00intro 9 07 2010 16:43 Pagina VI VI - SAN RAFFAELE SCIENTIFIC INSTITUTE Molecular basis of polycystic kidney disease Unit Molecular genetics Unit Molecular dynamics of the nucleus NeuroGlia Unit Regulation of iron metabolism Unit Molecular genetics of renal disorders Unit 158 159 159 160 160 161 Clinical Research Units Dento-facial histopathology Unit Genomics of renal diseases and hypertension Unit Tissue engineering and biomaterials Selected publications CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS 162 163 163 165 167 Introduction by the Director Research Units 168 Neurogenomics Unit Theoretical biology Organelle biogenesis and motility Unit Genomic Unit for the diagnosis of human pathologies Proteome biochemistry Unit Biomolecular NMR laboratory Selected publications 169 170 170 170 171 172 173 CFCM, Core Facility for Conditional Mutagenesis 187 FRACTAL, Flow cytometry Resource, Analytical Cytology Technical Applications Laboratory CERMAC, Centre of Excellence of High Field Magnetic Resonance 187 Mouse histopathology THE CLINICAL DEPARTMENTS 177 Introduction by the Directors Clinical Research Units 178 Clinical and experimental radiology Unit High technology in radiation therapy Unit Medical physics Unit Molecular imaging Unit Neuroradiology research group Selected publications 179 179 180 181 181 182 FACILITIES 185 ALEMBIC, Advanced Light and Electron Microscopy BioImaging Center 186 188 191 Department of arrhythmology 192 Cardio-thoracic-vascular Department 193 Department of general and specialistic surgery 196 Head and neck Department 199 Department of infectious diseases 202 Maternal and child health Department 204 Department of internal and specialistic medicine 206 Department of clinical neuroscience 208 Department of neurology 210 Department of oncology 211 Department of radiology 213 Department of urology 215 CLINICAL SERVICES CENTER FOR IMAGING 187 216 Pathology 218 Laboratory medicine 218 Immunohematology and Transfusion medicine service 218 Emergency medicine 219 General intensive care 220 Anaesthesia and neurointensive care Unit 220 AISPO - San Raffaele in the world 221 PUBLICATIONS 227 Best papers 2009 229 List of 2009 publications 230 INTRODUCTIONS - VII INTRODUCTIONS VIII - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the President I am particularly delighted to present this Annual Report of the scientific research work carried on by the numerous researchers operating in our University and Research Centers. I personally believe that it is impossible to choose a path of research while not following at the same time different others: a research is made out of different paths interweaved together. Thus, I cannot help but notice my satisfaction in observing such an important and great scientific platform as San Raffaele is. Such platform includes the basic research, the translational research and the clinic and applied researches into a joined unity. Dear Raffaelians, Physicians, Researchers, and all Personnel You all, who here in Italy and in our San Raffaele centres abroad form a true Army to fight illness and death, which were never sought after by God. (God, that is, who created man in a condition of full strength, apt for a perfectly healthy life.) You are in charge of searching for the adequate biological, environmental, and ethical conditions to carry man back to his original state of perfection, as a king-owner of the Generating Universe, with the duty of ruling it and mastering it [possidete eam]. Do not surrender to difficulties. Your self-awareness - which is to say, your awareness of the human value which resides in each one of us leads us to responsibility, prudence, and, at the same time, to the requisite resilience and audaciousness. You shall know that “Everything is possible to him who has faith”. Even I, poor man and penniless, have shown this to You, raising Your “City of Man - S. Raffaele” out of a swamp. Seek out and you shall find: “you will receive whatever you ask for in prayer.” I think about You and love You all. Yours, don Luigi Maria Verzè (Founder, President, Provost) INTRODUCTIONS - IX Introduzione del Presidente Sono particolarmente felice di presentare anche quest’anno il lavoro dei nostri eccellenti ricercatori. Sono convinto da sempre che non ci sia cura senza ricerca. È perciò che mi sento soddisfatto di vedere una piattaforma scientifica del San Raffaele di così vaste proporzioni. Una piattaforma che comprende in una unità strettamente organizzata e integrata la ricerca di base, la ricerca traslazionale, la ricerca clinica e applicata. Carissimi Raffaeliani Medici, Ricercatori di base e Clinici, Personale tutto, che costituite in Italia e nei nostri San Raffaele all’estero un vero esercito per battere la malattia e la morte mai volute da Dio. Lui, infatti, ha creato l’uomo in condizione eucrasica, atto a vivere in longevità perfettamente sano. Tocca a Voi ricercare le condizioni biologiche, ambientali, ed etico-equilibranti adeguate a far tornare l’uomo al suo stato perfetto originale, quale re-padrone dell’Universo Creatore con l’ordine di dominarlo “possidete eam”. Non arrendeteVi alle difficoltà. La consapevolezza del Vostro “io”, cioè del valore uomo che sta in ciascuno di noi, ci induce alla responsabilità, alla prudenza e, insieme, alla tenacia e all’audacia necessarie. Sappiate che “Tutto è possibile a chi crede”. Anch’io, pover-uomo e squattrinato, Ve ne ho dato l’esempio tirando fuori da una marcita la Vostra “Città dell’uomo S. Raffaele”. Cercate e troverete “pregate e vi sarà dato”. Vi penso e Vi amo tutti. Vostro don Luigi Maria Verzè (Fondatore, Presidente, Rettore) X - SAN RAFFAELE SCIENTIFIC INSTITUTE THE ETHICS COMMITTEE CHAIRMAN: Gianna Zoppei, Health Care Supervisor, San Raffaele Scientific Institute VICE CHAIRMAN: Guido Pozza, Physician, Professor Emeritus of Internal Medicine, Università Vita-Salute San Raffaele SECRETARY: Alfredo Anzani, Expert in Bioethics, San Raffaele Scientific Institute MEMBERS: Giliola Calori, Biostatistician, San Raffaele Scientific Institute Ilaria Carretta, Psychologist and Psychoterapist, San Raffaele Scientific Institute Francesco Caviezel, Physician, Professor Emeritus of Endocrinology, University of Milan Maurizio Chiodi, Theologian, Professor at the Theological Faculty of Northern Italy, Milan Francesco Clementi, Pharmacologist, Professor Emeritus of Pharmacology, University of Milan Cesarina Curti, Expert in Medical Devices, San Raffaele Scientific Institute Maria Grazia Fusi, Regional Area GPs, Milan Andrea Gentilomo, Medical Examiner, Professor of Legal Medicine, University of Milan Roberts Mazzuconi, Hospital Director, San Raffaele Scientific Institute Massimo Reichlin, Expert in Bioethics, Professor of Phylosophy, Università Vita-Salute San Raffaele Maria Grazia Roncarolo, Scientific Director, San Raffaele Scientific Institute Claudio Rugarli, Physician, Professor Emeritus of Internal Medicine, Università Vita-Salute San Raffaele Patrizia Tadini, Pharmacist, San Raffaele Scientific Institute Cesare Triberti, Expert in Legal Procedures Liliana Villa, Representative of the Fondazione Centro San Raffaele del Monte Tabor Ewa Wysocka, Representative of Nursing Area Maria Elisabetta Zanardelli, Volunteer association member, Associazione per l’Aiuto ai Giovani Diabetici (Onlus) CONSULTANT: Gianvincenzo Zuccotti, Head of Pediatrics Unit, Luigi Sacco Hospital, Milan The Ethics Committee complies with the legislative requirements of May 1998 as well as with the EU, national, and local rules concerning pharmacological trials. INTRODUCTIONS - XI SAN RAFFAELE SCIENTIFIC INSTITUTE BOARD OF DIRECTORS: Roberto Cusin, Ennio Doris, Carlo Salvatori, Laura Ziller, Gianna Zoppei PRESIDENT: professor don Luigi Maria Verzè VICE-PRESIDENT: Mario Cal HEAD OF HUMAN RESOURCES CORPORATE DEPARTMENT: Antonio Limardi HEAD OF ADMINISTRATION & FINANCE CORPORATE DEPARTMENT: Mario Valsecchi HEAD OF LEGAL & GENERAL AFFAIRS CORPORATE DEPARTMENT: Alessandro Cremaschi HEAD OF TECHNICAL DEPARTMENT: Andrea Roma HEAD OF PUBLIC RELATIONS DEPARTMENT: Cristina Poma HEAD OF COMMUNICATION: Paolo Klun GENERAL DIRECTOR OF CLINICAL AREA: Renato Botti SCIENTIFIC DIRECTOR: Maria Grazia Roncarolo CHIEF OPERATING OFFICER OF RESEARCH AREA: Maurizio Savi ORGANIZATION CHART BŽĂƌĚ Žf DŝƌĞĐƚŽƌƐ GĞIĞƌĂt SĞĐƌĞƚĂƌLJ Žf ƚŚĞ WƌĞƐŝĚĞIĐLJ WƌĞƐŝĚĞIƚ EmƉtŽLJĞƌ VŝĐĞWƌĞƐŝĚĞIƚ HĞĂtƚŚ &SĂfĞƚLJ SƵƉĞƌvŝƐŽƌLJ BŽĚLJ LĞŐŝƐt͘DĞĐƌĞĞ Ϯ3ϭ/ϮϬϬϭ IIƚĞƌIĂt SƵƉĞƌvŝƐŽƌLJ ŽmmŝƚƚĞĞ HƵmĂI RĞƐŽƵƌĐĞƐ ŽƌƉŽƌĂƚĞDĞƉĂƌƚmĞIƚ ŽmmƵIŝĐĂƚŝŽIƐ dĞĐŚIŝĐĂt DĞƉĂƌƚmĞIƚ AĚmŝIŝƐƚƌĂƚŝŽI &FŝIĂIĐĞ ŽƌƉŽƌĂƚĞDĞƉĂƌƚmĞIƚ WƵďtŝĐRĞtĂƚŝŽIƐ DĞƉĂƌƚmĞIƚ LĞŐĂt &GĞIĞƌĂt AffĂŝƌƐ ŽƌƉŽƌĂƚĞDĞƉĂƌƚmĞIƚ IIƚĞƌIĂt AƵĚŝƚ DĞƉĂƌƚmĞIƚ GĞIĞƌĂt DŝƌĞĐƚŽƌ ŚŝĞf OƉĞƌĂƚŝIŐ OffŝĐĞƌ tŝIŝĐĂt AƌĞĂ RĞƐĞĂƌĐŚ AƌĞĂ SƚĂff LINIAL DEWARdMENdS HŽƐƉŝƚĂt DŝƌĞĐƚŽƌ SĐŝĞIƚŝfŝĐ DŝƌĞĐƚŽƌ SƚĂff RESEARH DIVISIONSANDENdERS The San Raffaele Scientific Institute is a teaching hospital affiliated to the Università Vita-Salute San Raffaele (DGR .3 dicembre 1999, n. 6/46798) XII - SAN RAFFAELE SCIENTIFIC INSTITUTE Scientific Directorate SCIENTIFIC DIRECTOR: Maria Grazia Roncarolo CHIEF OPERATING OFFICER: Maurizio Savi SECRETARY: Titti Meroni PROGRAM MANAGER TO THE SCIENTIFIC DIRECTOR: Marina Castellano STUDIES, DEVELOPMENT & QUALITY OFFICE MANAGER: Vanda Parezanovic ASSISTANT TO THE SCIENTIFIC DIRECTOR: Laura Reiss HEAD OF SCIENTIFIC OFFICE: Giulio Negri Maria Grazia Roncarolo GRANT OFFICE: Stefano Apollonio, Riccarda Daneri, Michele Granetto, Paola Rebagliati HEAD OF CLINICAL TRIAL OFFICE: Elisabetta Riva CLINICAL TRIAL OFFICE: Raffaella Biagetti, Giovanna Bombelli, Anna Cantoni, Giliola Calori, Margherita Ianniello, Maria Rosa Mandelli, Veronica Savia HEAD OF BIOTECHNOLOGY TRANSFER OFFICE: Daniela Bellomo (as of January 2010 Lucia Faccio) BIOTECHNOLOGY TRANSFER OFFICE: Fabrizio Bacchi, Lucia Faccio, Simona Locatelli, Paola Pozzi, Roberto Santarella Maurizio Savi HEAD OF LIBRARY: Laura Tei LIBRARY: Diego Maria Bertini, Francesco Curci, Elena Ponzi, Maria Samarati HEAD OF ADMINISTRATIVE OFFICE: Maria Rosa Pedrazzi ADMINISTRATIVE OFFICE: Roberto Barchi*, Giovanna Bernardi, Francesca Dodero, Barbara Lapio, Massimiliano Meoni, Ornella Muraro, Marco Picariello, Patrizia Scotti, Miriam Togni HEADS OF MARKETING & FUNDRASING OFFICE: Luca Isotti, Lisa Orombelli MARKETING & FUNDRASING OFFICE: Federica Cattaneo, Patrizia Mogliani, Chiara Scolari, Cristiana Secchi HEAD OF HUMAN RESOURCE OFFICE: Giuseppe Defidio HUMAN RESOURCE OFFICE: Roberta Berno, Alberto Martoglio LOGISTICS & IT SERVICES: Marco Crespi, Giuseppe Miracoli * Università Vita-Salute San Raffaele INTRODUCTIONS - XIII Introduction by the Scientific Director THE MISSION AND THE VISION The mission of the San Raffaele Scientific Institute (SRSI) is to conduct innovative research to benefit the care and cure of our patients and also to provide state-of-the-art education and training for new generations of doctors, physician scientists and research scientists with a high level of social responsibility. To achieve this objective, we want to perform cutting-edge science and to advance the knowledge of human diseases resulting in the identification of novel therapies. Our vision is that Research is the backbone of the SRSI, intersecting and connecting with both the clinical and the teaching programs. Our objective is to further integrate research, teaching and clinical activities by aligning preclinical and clinical research with our clinical strengths. THE SCIENTIFIC INSTITUTE The SRSI comprises the clinical activities of the research hospital with more than 1400 beds and the research activities conducted in Di.Bi.T.1 and Di.Bi.T.2. The SRSI is part of the San Raffaele Biomedical Science Park, which also includes the Vita-Salute San Raffaele University that was established in 1996. The University hosts the faculties of medicine, psychology and philosophy and provides specialized post-graduate courses, resident programs in various medical specialties and international PhD programs in Cellular/Molecular Biology and Molecular Medicine. In addition, the San Raffaele Biomedical Science Park hosts several biotechnology companies, including MolMed, Telbios and Axxam, which interact with the SRSI. Established in 1971, the SRSI was one of Italy’s first private hospitals. In 1972 it was granted the status of “Research Hospital” (IRCCS: “Istituto di Ricovero e Cura a Carattere Scientifico”), focusing mainly on diabetes and metabolic diseases and consequently received dedicated funding from the Italian Ministry of Health. In 1992, a research building (about 40,000 sq m or 431,000 sq ft) was opened to accommodate the Department XIV - SAN RAFFAELE SCIENTIFIC INSTITUTE of Biotechnology (Di.Bi.T.1). The initial areas of research covered by Di.Bi.T.1 were genetics, cell biology and immunology, while in the late 90s gene therapy, stem cell biology and molecular mechanisms of diseases were added. In recognizing the SRSI as a center of excellence in the area of molecular medicine research, the Italian Ministry of Health granted it the status of Molecular Medicine Research Institute in 2001. This status was renewed in 2008, following an audit by the Ministery of Health. In 2009 the construction (Di.Bi.T.2), consisting of three new buildings, was completed. This allowed the much needed growth of the University and will create additional space for SRSI research groups, with dedicated space for new state-of-the-art technology platforms, and expansion of our translational research efforts in key disease areas such as regenerative medicine, neuroscience, immunology, inflammation, cardiovascular and oncology. In the last two years a new research strategy and research organization has been implemented, building on current strengths to invest in new strategic areas in order to further increase our competitiveness as a center of excellence in biomedical research and to create the best environment for the translation of fundamental research into clinical applications. Together with the implementation of this new research organization, the administrative and supporting research structure has also been extensively reorganized (see introduction by Maurizio Savi, the Chief Operating Officer for research). In this organizational model, preclinical and clinical research activities are consolidated in six Research Divisions and two Research Centers: RESEARCH DIVISIONS Molecular Oncology Neuroscience Metabolic and Cardiovascular Sciences Regenerative Medicine, Stem Cells and Gene Therapy Immunology, Transplantation and Infectious Diseases Genetics and Cell Biology RESEARCH CENTERS Imaging Genomics, Bioinformatics and Biostatistics At present, approximately 1402 people are working in these Research Divisions and Research Centers: 729 people, including scientists, technicians, service managers, as well as postdoctoral fellows, PhD students and undergraduate students, in Di.Bi.T 1 and Di.Bi.T 2 and 673 people, including physicians, research nurses, residents and clinical fellows, on clinical research projects in the hospital. Activities within the Research Divisions include genetics, cell biology, stem cell biology, gene therapy and immunology focusing on disease areas such as cancer, transplant rejection, autoimmune/inflammatory diseases, infections, neurodegenerative, cardiovascular and metabolic diseases. The research conducted in these areas has the common goal to increase knowledge on the molecular basis of diseases and to identify innovative therapies and new diagnostic options. The SRSI also hosts three Research Institutes, which are fully integrated within the Divisional organization, but have a high degree of scientific and administrative independence based on specific agreements and funding from external entities: - The San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), which is a joint venture with the Telethon Foundation, is pioneering cell and gene therapy strategies in genetic diseases - The Institute for Experimental Neurology (INSPE), supported by a research contract with Merck-Serono, INTRODUCTIONS - XV investigates the biological and molecular mechanisms underlying diseases of the nervous system and their clinical translation, with a strong focus on multiple sclerosis - The recently established Diabetes Research Institute (HSR-DRI), which is part of the international Diabetes Research Institutes Federation. The main objectives of HSR-DRI are to identify and apply novel treatments to prevent islet beta cell destruction and to restore sufficient insulin production in type-1 diabetes patients Furthermore, the SRSI hosts several scientists belonging to the Dulbecco-Telethon Institute (DTI), which sponsors research on the molecular and biological mechanisms of gene regulation and genetic diseases. Research activities within Research Divisions and Centers are at the intersection of clinical activities, which are organized in 12 Clinical Departments (see introduction by Renato Botti, General Director of the clinical area). In this classical matrix model the Research Divisions intersect with many Clinical Departments in which basic research units (BRU) and clinical research units (CRU) are fully integrated and aligned. Figure1. Matrix of research activities in the research Divisions and Centers integrated with the Clinical Departments. SCIENTIFIC ACTIVITIES IN 2009 2009 was an important year to make the new research organization operational and to reinforce the research activities in the six Research Divisions and the two Research Centers. The following five research divisions: Molecular Oncology; Neuroscience; Regenerative Medicine Stem Cells and Gene Therapy; Immunology Transplantation and Infectious Diseases; Genetics and Cell Biology became fully operational, whereas operational establishment of the Research Division in Metabolic and Cardiovascular Science is progressing well and will be completed by the end of 2010. The Research Center for Genomics, Bioinformatics and Biostatistics and the Research Center for Imaging were all started in 2009 with the aim to meet the increasing need for state-of-the-art imaging and functional genomic technologies. A new director for the Center for imaging was appointed. These two technology platforms will support all pathological and therapeutic areas and are expected to further favor integration between basic and clinical research and to provide strong impulses for translational research from bench to bed-side and back again. XVI - SAN RAFFAELE SCIENTIFIC INSTITUTE The Research Programs within the Research Divisions are also crucial for promoting integration between laboratory and clinical research. The Research Programs are aimed at creating synergies between groups with different expertise and defining common strategic investments, which will favor fast-track translational research. During 2009, eight Research Programs across Research Divisions and Clinical Departments were implemented: RESEARCH PROGRAMS Stem Cells: from basic research to clinical experimentation Brain Regeneration usIng medical Devices, Gene vectors and stEm cells (BRIDGE) Program in Immunology and Bio-immunotherapy of Cancer (PIBIC) Pancreatic Islet Transplantation Human Brain Invivo Mapping with neuroimaging (BRAINMAP) Bone Physiopathology Program (BoNetwork) Correlates of HIV-Associated Immune Response Modulation (CHARM) Microenvironment and Genes in Cancers of the Blood (MAGIC) During 2009, one of the major tasks for the Directors of the Research Divisions and Research Centers was to prepare a five-year research plan in which the vision and the mission, the goals with related implementation and the investments plan are clearly defined for each Research Division and Research Center. Currently, the overall five-year strategic plan has been completed and will be presented to our International Scientific Advisory Board. The Board is composed of four renowned scientists: • Professor Aaron Ciechanover (Director, Rappaport Institute for Research in the Medical Sciences, Technion-Israel Institute of Technology, Haifa, Israel), 2004 Nobel Prize in Chemistry; • Professor Paul Herrling (Head of Corporate Research, Novartis International; Member of the Board of Trustees of The Scripps Research institute; Vice-President of the Board of ETH - Swiss Federal Institutes of Technology); • Professor Jacques Banchereau (Director, Baylor Institute for Immunology Research, Dallas, USA), 2009 Award in Human Immunology Research - American Association of Immunologists - Dana Foundation; • Professor Irving Weissman (Director, Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, USA; member of the American Academy of Science). The Advisory Board was appointed by the Board of Directors of the San Raffaele Foundation and has the primary function to assist the Board in the evaluation of the quality of our research, our research strategies and implementation plans in keeping with the highest international research standards. Despite the worldwide financial and economical crisis of 2009, which also had an impact on our research organization, a number of initiatives were successfully carried out: - The first among the three new research buildings of Di.Bi.T 2 was equipped and is now fully occupied. It accommodates new research groups within the Institute of Experimental Neurology (INSPE) as well as a new research group, established in collaboration with the Cystic Fibrosis Foundation, which carries out research projects in the area of cystic fibrosis and host/pathogens relationship. In addition, the new space allowed the expansion of our cytofluorimetry and FACS sorting facility. - A new career path for physician scientists was implemented. We believe this is a key achievement in the integration of clinical, teaching and research activities as these professionals will be at the interface that allows optimal communication and interaction between the three areas. - We implemented a competitive international postdoctoral program, which will enable us to recruit from a highly skilled pool of researchers to further increase the international dimension of our institution. - We worked with the Human Resources Office to establish a new career path for scientists. The aim of this project is to define the career path for young investigators, allowing them more independence and recognition with more responsibility and accountability and to establish transparent and well-defined criteria for periodical evaluations of the performance of our scientists. - We have implemented a new series of weekly seminars, named San Raffaele Research Seminars. The speakers at these seminars are Unit Heads, both from Basic Research Units and from Clinical Research Units. The INTRODUCTIONS - XVII intention of these seminars is to allow the SRSI scientific community to learn about ongoing research in the Institute and to foster integration and cross-fertilization between clinical and basic scientists. 2009 was a very productive year for the SRSI in terms of scientific publications and clinical trials. The total number of scientific publications was 773, with a total Impact Factor of 4153. More than 10% of all SRSI publications are in top-level scientific journals (Impact Factor over 10). Based on these results, our Institution is the most highly ranked Italian IRCCS in terms of scientific level and scientific productivity (figures 2 and 3). Figure 2. Publications and total Impact Factor of SRSI in the past 3 years 4.153,262 3870,073 3561,234 740 693 2007 (average IF: 5,139) 2008 (average IF: 5,230) Total IF 2007-2009 773 2009 (average IF: 5,373) Publications 2007-2009 Figure 3. % of SRSI publications sorted according to Impact Factor ranges 100,0% 80,0% 62,8% 62,2% 63,4% 60,0% 40,0% 27,7% 30,0% 26,0% 20,0% 9,5% 7,8% 10,6% 0,0% < 5,000 5,000-9,999 Impact Factor ranges 2007 2008 2009 10,000 XVIII - SAN RAFFAELE SCIENTIFIC INSTITUTE The scientific productivity of the SRSI is also demonstrated by its ability to design and conduct clinical trials, which were in part enabled through support from pharmaceutical and biotechnology companies. In 2009, the Ethics Committee examined 234 protocols, 119 (51 %) of which were sponsored by Pharmaceutical Companies. Submission of these 234 clinical trial protocols were supported and guided by the Clinical Research Office. Figure 4. Clinical trials evaluated by the HSR Ethics Committee in 2009 Pharmaceutical companies sponsored trials No-profit groups sponsored trials HSR investigators initiated trials 30% 51% 19% 21% 27% Pharmacological protocols Observational protocols Basic research protocols Medical device protocols 2% 50% INTRODUCTIONS - XIX Figure 5. Clinical trials run by Clinical Departments and approved in 2009 Sponsored trials Department of infectious diseases Department of oncology Department of neurology Department of internal and specialistic medicine Cardio-thoracic-vascular Department Department of urology Head and neck Department Department of arrhythmology Department of general and specialistic surgery Maternal and child health Department Department of clinical neuroscience Department of radiology Other 1% 8% 1% 4%4% 3% 4% 8% 24% 4% 11% 13% 15% No-profit trials Department of infectious diseases Department of neurology Cardio-thoracic-vascular Department Head and neck Department Department of clinical neuroscience 12% 3% Department of oncology Department of internal and specialistic medicine Department of urology Maternal and child health Department Department of radiology 2% 7% 12% 5% 21% 9% 3% 26% As of December 2009, the Office of Biotechnology Transfer, which is in charge of the management of intellectual property, patents and know–how, and of the creation of spin–off companies, managed 295 sponsored research and industrial collaboration contracts, illustrating that SRSI is a preferential partner for scientific and clinical collaborators. The high level of innovative research in the SRSI is also reflected in the issue of 96 patents and 38 patent families, while 52 licenses were taken out by external parties. The competitiveness of the SRSI is shown by its ability to attract funding, not only from the public sector (Ministry of Health, Superior Institute of Health, Ministry of University and Research), but also from private XX - SAN RAFFAELE SCIENTIFIC INSTITUTE Italian sources (mainly Telethon, the Italian Association for Cancer Research and Bank Foundations) and from international sources (e.g. European Community, European Research Council, American National Institute of Health, World Health Organization, Association for International Cancer Research, Gates Foundation, Wellcome Trust, Juvenile Diabetes Research Foundation). The impressive critical mass and quality of our scientific community was highlighted during our yearly scientific retreat, which in 2009 was again organized in Stresa with three full days of scientific presentations given by basic and clinical scientists. During the San Raffaele Research retreat, the three top publications of 2008 were awarded with the SRSI innovation prize. Finally, in 2009 a number of important educational initiatives, scientific events and prestigious international meetings were organized and hosted by our basic and clinical scientists. A special mention should go to the scientific symposium organized in honour of Professor Guido Pozza who was the scientific director of the SRSI for 15 years and who continues to be a highly experienced mentor and advisor to our scientists. THE FUTURE We are very much looking forward to moving to the second and third new research buildings of Di.Bi.T 2. The new space will be used to further optimize current key research activities, such as stem cell and gene therapy, and to accommodate research groups working in new strategic areas, such as molecular oncology, translational genomics and preclinical imaging. The SRSI will continue to be a multidisciplinary Institute, but we will also pay particular attention to invest in research on those diseases with a high unmet medical need and in therapeutic areas of increasing medical demand, such as oncology and cardiovascular research. The main efforts in 2010 will be devoted to a new project aimed at integrating clinical, teaching and research activities in the area of oncology. This new initiative in cancer research and therapy will be built on all the know-how, expertise and resources already present at the SRSI. In addition, we plan to establish a strong and fully operational Metabolic and Cardiovascular Diseases Research Division. Investments in basic research in this latter increasingly important area, in which the SRSI has proven clinical excellence, will significantly increase our visibility and competitiveness. The SRSI will continue to support and strengthen its areas of excellence: genetics and cell biology, stem cell and gene therapy (with HSR-TIGET), immunology inflammation and infectious diseases (with DRI), and neuroscience (with INSPE). We will continue to strengthen our position as a leading center for translational medicine by giving rise to a Clinical Research Center. In this context, close collaboration between basic researchers, clinical investigators and physician scientists will be strongly supported with the ultimate goal to apply new therapeutic principles, invented at the laboratory benches, as efficiently as possible to our patients. In particular, we are aiming towards expertise in the fields of wide genomic analyses of complex diseases, stratification of patients by genotyping and phenotyping, pharmacokinetics and pharmacogenomics, besides becoming an active Center for the clinical proof of concept trials. I am confident that this research strategy and structure will further enhance the SRSI’s position as an Institute of excellence conducting innovative science in the field of Molecular Medicine, which in the end will benefit our patients. I am also convinced that it will make us attractive for young Italian scientists who currently work abroad, but are highly motivated to return home and contribute to the international competitiveness of Italian medical science. The worldwide financial and economical crisis is not yet over and 2010 will also be a year of constraints, which will be a challenge for the speed of implementation of our strategic research plan. However, nothing will stop us continuing with the integration of high quality basic and clinical research by devoting dedicated investments to new translational research units. The vision of our President, which can be summarized in three key elements: “there is no cure without research”, “research is the backbone of our Institution” and “basic research is the foundation of our knowledge and culture”, continues to inspire us and help us to overcome innumerable hurdles. We therefore wish to thank our President and Vice-President, as well as the Board of Directors, for their trust in our vision and their con- INTRODUCTIONS - XXI tinuous support. Many thanks also to our Research Directors and Associate Directors for their dedication and determination in designing the new organizational and strategic research plan, which will further strengthen the SRSI’s leading position in Italy and contribute to its position among the leading institutes in biomedical science internationally. I also would like to express my gratitude to the project and group leaders and all members of the scientific community for their continuous support and sense of responsibility in this difficult year. Finally, a special thank you goes to all scientists, physicians, staff, post-doctoral fellows and students who, through their work, efforts, enthusiasm and passion, contributed to the research progress illustrated in this 2009 scientific report and who make the SRSI such a wonderful place to work at. I hope you will find our report interesting and informative Maria Grazia Roncarolo Scientific director XXII - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Chief Operating Officer The San Raffaele Scientific Institute is one of the most important biomedical research centers in Italy and is in a leading position in the sector which has the highest potential impact on people’s health. This fact, together with its potential to attract grants for further growth at an international level, is confirmation that we need not only to finance and support our already excellent and high-quality research program, but also to aim to become the largest melting pot of top-level doctors and researchers of future generations through strategic planning over a medium/long-term period. With this in mind, the organizational-management structure of the Research Area has developed and implemented a shared and integrated governance and management system, both of the structures and processes of the core business (i.e. scientific production) and of the support areas, which are all part of the Research Management Staff, as shown in figure 1. Figure 1: The Research Area processes network Four fundamental areas have been identified, characterizing the operating-management processes which support the core business: economic-financial management, organizational development, human resources and infrastructures, and marketing and fundraising activities, meaning communication ‘with’ and ‘for’ our external stakeholders. (See figure 2) INTRODUCTIONS - XXIII Figure 2: Areas characterizing the operating-management processes We have therefore identified the following medium-long-term objectives for each of these areas: ª To guarantee the Research sustainability, while meeting the requirements of efficacy, efficiency and economy necessary for resources administration; ª To guarantee accurate and transparent financial reporting and administrative accounting; ª To develop organizational and governance mechanisms that are coherent with strategic objectives; ª To develop an organization that focuses on people, that is able to valorize professional skills and create a stimulating and gratifying work environment; ª To guarantee transparency in the raising and spending of funds, as well as the serious and rigorous transmission of scientific data. To reach these objectives, numerous initiatives at various structural and service levels were planned and implemented during 2009: PLANNING AND MANAGEMENT CONTROL The planning and monitoring criteria and conditions for the economic-financial management of the Research Divisions and Centers were identified through an improved definition of the budgets for each division together with the criteria for monitoring the results in order to reach a true system of performance-based accountability in the short-to-medium term. ORGANIZATIONAL DEVELOPMENT & MANAGEMENT SYSTEMS The organizational model and its implementation has further evolved through completion of the distribution of the various scientific activities in the Research Divisions & Centers, as well as through organizational structuring and the activation of governance mechanisms within each research division and center. In order to reach a coherent integration of the new organizational model of the Research Areas with other models and management systems and/or regulations of the San Raffaele Foundation, measures have been taken to revise the conditions and responsibilities linked to both the Security Management System and the Quality Management System. A method has been introduced to revise processes and responsibilities in order to render coherent the new organizational structure of research area with the ‘Model of Organization, Management & Control’ as well as with the ‘Ethics Code’ of the Foundation. XXIV - SAN RAFFAELE SCIENTIFIC INSTITUTE HUMAN RESOURCES A committee of professionals was appointed to define the new career paths of researchers with the aim to optimize the range of positions already available, to identify the most useful indicators, both from the point of view of staff career progression and in the interests of the Institution, to reward virtuous paths of complete scientific and managerial development. COMMUNICATION & MARKETING For San Raffaele, communication is becoming indispensable to promote its strategic position, to be competitive in the Italian Health and Research environment, and to diversify its financial sources. In order to promote its activities, results and projects, the Research Direction has strengthened its Marketing & Fundraising Office that, since 2009, has been committed to the promotion of specific fundraising projects and initiatives for various markets and reference targets: donations from individuals, companies, foundations & organizations, and institutions. Our priority for the future will be to define, according to the objectives highlighted in the Strategic Scientific Plan, a strategic-operational plan with which to steer all research area activities towards the same goals, and to control particularly critical development areas, such as fundraising, and creation of value for research and comunication. It is highly desirable for a mission-oriented non-profit Institution such as ours that this strategic-operational plan is on one hand oriented towards communication, and on the other, I would say above all, it aims to provide an efficient level of organizational governance, functional to the monitoring and strengthening of the relationships with our stakeholders, internal and external. If conceived in this way, this plan will be able to produce noticeable and beneficial effects on the research organization in terms of alignment with and valorization of its mission. With the transformation underway, the effects of which will unfold in 2010, it seems right to take this opportunity to modify the approach towards the financial report, considering it not only as a legal necessity, but also as a tool to measure the immeasurable – those activities with faded edges that make up the heart of San Raffaele’s ‘production of science’ and ‘production of value ’. Maurizio Savi Chief Operating Officer INTRODUCTIONS - XXV SAN RAFFAELE SCIENTIFIC RETREAT 2009 XXVI - SAN RAFFAELE SCIENTIFIC INSTITUTE BEST POSTER AWARD 1st – Erica Butti Cell fate analysis and selective killing of neural stem/precursor cells in the adult mouse: potential application to study the role of the endogenous CNS stem cell compartment in neurological diseases 2nd – Emanuela Porrello Csn5/Jab1 regulates Schwann cell-axon interaction and plays a role in peripheral nerve development and function INTRODUCTIONS - XXVII 3rd – Bruno Di Stefano New procedures for genetic reprogramming of healthy and Parkinson’s adult human cells and their differentiation into neural and dopaminergic progenitors BEST PAPER AWARD 1st – Giancarlo Comi Comi, G; Pulizzi, A; Rovaris, M; Abramsky, O; Arbizu, T; Boiko, A; Gold, R; Havrdova, E; Komoly, S; Selmaj, K; Sharrack, B; Filippi, M. Effect of laquinimod on MRI-monitored disease activity in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, doubleblind, placebo-controlled phase IIb study. Lancet: 2008; 371(9630): 2085-2092 XXVIII - SAN RAFFAELE SCIENTIFIC INSTITUTE 2nd – Michele De Palma De Palma, M; Mazzieri, R; Politi, LS; Pucci, F; Zonari, E; Sitia, G; Mazzoleni, S; Moi, D; Venneri, MA; Indraccolo, S; Falini, A; Guidotti, LG; Galli, R; Naldini, L. Tumor-targeted interferon-alpha delivery by Tie2-expressing monocytes inhibits tumor growth and metastasis. Cancer Cell: 2008; 14(4): 299-311 3rd – Stefano Biffo (in the photo: Valentina Gandin) Gandin, V; Miluzio, A; Barbieri, AM; Beugnet, A; Kiyokawa, H; Marchisio, PC; Biffo, S. Eukaryotic initiation factor 6 is rate-limiting in translation, growth and transformation. Nature: 2008; 455(7213): 684-688 INTRODUCTIONS - XXIX I RAGAZZI DELLA VIA OLGETTINA 30 anni della storia del diabete al San Raffaele October 31, 2009 Our President, don Luigi Maria Verzè, and Guido Pozza, Professor Emeritus of Internal medicine, Università Vita-Salute San Raffaele XXX - SAN RAFFAELE SCIENTIFIC INSTITUTE Guido Pozza and Emanuele Bosi, Head of the Department of internal and specialistic medicine and Associate director of the Diabetes Research Institute INTRODUCTIONS - XXXI Health Care Directorate HEALTH CARE SUPERVISOR: Gianna Zoppei GENERAL DIRECTOR: Renato Botti HOSPITAL DIRECTOR: Roberts Mazzuconi PLANNING & CONTROL DIRECTOR: Alessandro Longo INFORMATION SYSTEMS DIRECTOR: Carla Masperi PROCUREMENT & LOGISTIC DIRECTOR: Alberto Russo HEALTH AREA PROJECT DEVELOPMENT DIRECTOR: Maria Romano CUSTOMER SERVICE DIRECTOR: Riccardo Pizzo TECHNICAL SERVICE DIRECTOR: Andrea Roma E-SERVICES FOR LIFE AND HEALTH DIRECTOR: Alberto Sanna PROMOTION & DEVELOPMENT MANAGER: Alberto Galliani ORGANIZATION & DEVELOPMENT MANAGER: Margherita Gambaro LEGAL OFFICE MANAGER: Piergiorgio Sammartino Renato Botti XXXII - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by General Director Clinical Area San Raffaele Hospital is a private no-profit Foundation certified as Istituto di Ricovero e Cura a Carattere Scientifico (Research Hospital). It is relentlessly pursuing its three interrelated activities of clinical care, research and education since 1971, when it was established, and represented one of the first examples of a fully independent private hospital in Italy. In 1972 the Italian Ministry of Health granted to San Raffaele the status of IRCCS (Research Hospital), which favoured its development as a site for clinical research. Originally specialized in diabetes and metabolic diseases, the status of research hospital was confirmed for the area of Molecular Medicine in the years 2004 and 2008. San Raffaele IRCCS is a qualified hospital, well known in Italy for specific and relevant pathologies, as well as for a highly specialized Emergency Center. It is a teaching Hospital linked with the Faculties of Medicine and Surgery and Psychology of the San Raffaele Vita-Salute University. Its high quality medical assistance and the availability of an extensive area of about 300.000 square metres has led to a fast growth of the services provided by the Research Hospital. San Raffaele Hospital is part of the Italian National Health Service: it has 1.397 beds accredited with the National Health Service, 75 of them dedicated to day surgery and day hospital treatments. In 2009 the hSR activity counts 56.870 in-patients, 62.835 patients admitted to the Emergency Room, more than 8.000.000 out-patients and diagnostic tests. The Hospital counts about 3.740 employees. In January 2008, after the approval by the Board of Directors, the Hospital started to organize the medical areas in Clinical Departments. Due to the complexity of the Institution, this process required a great effort for the analysis and definition of aggregation area, operational procedures and for the definition of the activity indicators. The process is still ongoing, but almost completed. The introduction of this new working model was aimed to integrate and coordinate the resources and the processes of the different Clinical Units, to make them more flexible, efficient with regard to the structural and management costs, to improve their specific role in patients’ management and to increase the quality of their medical activity. From December 2009 to January 2010, Arrithmology Department has been absorbed by Cardio-ThoracicVascular Department, generating a total Departments reduction from 12 to 11. 1) CARDIO-THORACIC-VASCULAR DEPARTMENT 2) DEPARTMENT OF GENERAL AND SPECIALISTIC SURGERY 3) HEAD AND NECK DEPARTMENT 4) DEPARTMENT OF INFECTIOUS DISEASES 5) MATERNAL AND CHILD HEALTH DEPARTMENT 6) DEPARTMENT OF INTERNAL AND SPECIALISTIC MEDICINE 7) DEPARTMENT OF NEUROLOGY 8) DEPARTMENT OF CLINICAL NEUROSCIENCE 9) DEPARTMENT OF ONCOLOGY 10)DEPARTMENT OF RADIOLOGY 11)DEPARTMENT OF UROLOGY There are six Cross Department Areas: 1. Imaging’s Laboratory (Services of Immuno-hematology and Transfusion Medicine, Laboraf, Pathological Anatomy) 2. Imaging (Radiology, Neuroradiology, Nuclear Medicine) 3. Anaesthesia and Resuscitation (General Medicine, Cardiosurgery, Neurosurgery, Intensive Care Unit – ICU) 4. Rehabilitation (Neurological, Cardiovascular, Orthopaedic) 5. Emergency Such Areas, directly coordinated by the Health Direction, may enclose Units of different Clinical Departments and Units which do not belong to Departments (Emergency Medicine, Services of Transfusion Medicine, Pathological Anatomy). The objective of the creation of these areas is to promote standardization of activities, to realize common projects and synergies, to encourage the interexchange of the human and technological resources, to promote the communication between the Departments. The activation of the Clinical Departments was made possible thanks to the strict collaboration between the INTRODUCTIONS - XXXIII medical areas and the hSR management. All the procedures and processes were discussed and approved jointly, deriving from the common objective to increase the quality of the medical treatments and the efficiency of the Institute. The project management has been played and is played by the Health Direction, supported by the commitments of Board of Directors and General Direction. The Clinical Departments are led by the Directors, appointed for three years and nominated by the President of the Board of Directors, with the approval of the President of the Board of Director of the Università VitaSalute San Raffaele. Each Director has been assigned several measurable objectives included in the so-called Cruscotto Dipartimentale. The Cruscotto Dipartimentale is aimed to monitor yearly the reaching of the goals assigned and the proper enforcement of the Department processes. The Departmental Director is assisted by a Director Management Assistant (DMA), a person with management background, with the function to co-ordinate the Department as far as the administrative issues are concerned and to facilitate the relationships between the Department and the hSR Health Direction and the Institute management. The Departmental Director is also supported by a so- called Department Area Coordinator (DAC) that performs clinical activity and, in addition, is responsible for the coordination and the management of a specific Departmental Area of activity (i.e. Research, Information Technology, Quality…). The clinical activity and resources management of the departmental Units is attributed to the Clinical Unit Leader (CUL). The implementation Departmental Model of the San Raffaele hospital is progressively reaching its goals with regard to economic efficiency and clinical effectiveness maintaining the central role of the patient through the full integration and the co-sharing of the human, technologic and logistic resources. Renato Botti General Director Clinical Area XXXIV - SAN RAFFAELE SCIENTIFIC INSTITUTE 2009 SEMINARS AND LECTURES Division of molecular oncology Division of neuroscience Division of metabolic and cardiovascular sciences Division of regenerative medicine, stem cells, and gene therapy Division of immunology, transplantation, and infectious diseases Division of genetics and cell biology Center for genomics, bioinformatics, and biostatistics January 20, 2009 Gene therapy trial for childhood cerebral adrenoleukodystrophy Natalie Cartier, INSERM U745, Faculté de Pharmacie, Paris Guest: Luigi Naldini January 26, 2009 “Primo Levi Lectures”, nel giorno della memoria Medicina e mondo ebraico nella storia Giorgio Cosmacini, Università Vita-Salute San Raffaele Guest: Giorgio Parmiani February 2, 2009 Regulation of Cell Polarity Athar H. Chishti, Department of Pharmacology, University of Illinois College of Medicine Guest: Alessandra Bolino February 23, 2009 Local protein synthesis and spine dysmorphogenesis: learning from the Fragile X Syndrome Claudia Bagni, Dept. of Experimental Medicine and Biochemical Sciences, University of Rome “Tor Vergata”, Developmental and Molecular Genetics Section, Catholic University of Leuven Guest: Jacopo Meldolesi February 25, 2009 Flexibility and alternative conformations: clues to the operation of PDI as a protein folding catalyst Robert Freedman, Department of Biological Sciences, Warwick University, UK Guest: Roberto Sitia March 11, 2009 Functions of PI3K in inflammation and cancer Matthias Wymann, Inst. Biochemistry and Genetics, Dept. for Biomedicine, University of Basel Guest: Ruggero Pardi March 12, 2009 How to succeed in science without really trying Jonathan W. Yewdell, Cellular Biology Section, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, NIAID, Bethesda Guest: Roberto Sitia March 13, 2009 Cysteine oxidation in catalysis and regulation Leslie B. Poole, Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, USA Guest: Roberto Sitia March 16, 2009 The DNA damage response: a common pathway regulating the expression of different NK receptor activating ligands on diseased cells Angela Santoni, Università di Roma “La Sapienza”, Dipartimento di Medicina Sperimentale Guest: Angelo Manfredi March 18, 2009 Making and using phage antibody libraries Andrew Bradbury, Los Alamos National Laboratory, B division, Los Alamos Guest: Roberto Sitia INTRODUCTIONS - XXXV April 3, 2009 The control of nerve development, pathology and repair by c-Jun and Notch in Schwann cells Kristjan Jessen, Research Department of Cell and Developmental Biology, UCL, London Guest: Lawrence Wrabetz April 6, 2009 Functional Genomics of the Brain Stefano Gustincich, The Giovanni ArmeniseHarvard Foundation Laboratory, International School for Advanced Studies (ISAS)-SISSA Guest: Jacopo Meldolesi April 6, 2009 Manipulation of adaptive autoimmunity Salvatore Albani, Arizona Arthritis Center University of Arizona, Tucson Guest: Maria Grazia Roncarolo April 7, 2009 Polycomb repressors controlling stem cell fate: implications for cancer and development Maarten van Lohuizen, Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam Guest: Eugenio Montini April 9, 2009 The Pathosystems Resource Integration Center (PATRIC) at VBI: An Integrative Resource on Host-Pathogen Interactions Bruno Sobral, Virginia Bioinformatics Institute, Virginia Tech Blacksburg, Virginia, USA Guest: Elisa Vicenzi April 22, 2009 Molecular battles between HIV and macrophages Gianfranco Pancino, Research Director INSERM Regulation of Retroviral Infections Unit Institute Pasteur, Paris Guest: Lucia Lopalco April 22, 2009 Epigenetic regulation of stem cell differentiation Niall Dillon, MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College, London Guest: Marco E. Bianchi April 27, 2009 Gene regulatory code Alexander Kel, BIOBASE GmbH, Wolfenbuettel, Germany Guest: Angela Bachi April 28, 2009 Neuronal physiology in animal models of mental retardation Yann Humeau, INCI, UPR3212 CNRS, Université Louis Pasteur, Strasbourg Guest: Patrizia D’Adamo April 30, 2009 Death Receptors, Ubiquitin Editing & Inflammasome function Vishva Dixit, Early Discovery Research, Genentech Inc, San Francisco Guest: Marta Muzio May 4, 2009 Probing how, when and where CD4 and CD8 T cells influence antibody responses Ian McLennan, MRC Centre for Immune Regulation, University of Birmingham Guest: Paolo Dellabona May 11, 2009 SLAM-Family cell surface receptors also control bacterial killing in phagosomes Cox Terhorst, Professor of Medicine, Harvard Medical School, and Chief, Division of Immunology, Beth Israel Deaconess Medical Center, Boston Guest: Maria Grazia Roncarolo May 13, 2009 Expanding AAV capacity for in vivo gene therapy Alberto Auricchio, Dept. of Pediatrics, “Federico II” University, Napoli & TIGEM (Telethon Institute of Genetics and Medicine) Guest: Vania Broccoli XXXVI - SAN RAFFAELE SCIENTIFIC INSTITUTE May 18, 2009 The influence of T cell avidity on the differentiation of effector and memory T cells Rose Zamoyska, Institute of Immunology and Infection Research, University of Edinburgh Guest: Anna Mondino May 21, 2009 Studying monocyte functions in mouse and human Frederic Geissmann, Center for Inflammation Biology & Dept of Rheumatology, King’s College London School of Medicine Guest: Luigi Naldini May 25, 2009 Cellular and molecular mechanisms in lymphoid organ formation in health and disease Reina Mebius, Dept. Molecular Cell Biology and Immunology, VUMC, Amsterdam Guest: Andrea Brendolan May 25, 2009 Molecular Pathogenesis of Multiple Myeloma P. Leif Bergsagel, Mayo Clinic Cancer Center Scottsdale Guest: Giovanni Tonon May 29, 2009 ER stress signaling foci Eelco van Anken, Dept. Biochemistry & Biophysics, UCSF, San Francisco CA Guest: Roberto Sitia June 8, 2009 Mitochondrial Medicine: A Therapy for Muscular Dystrophies? Paolo Bernardi, Department of Biomedical Sciences, University of Padova Guest: Jacopo Meldolesi June 15, 2009 Charcot-Marie-Tooth disorder: from animal models to therapy Michel Fontés, Therapie des Maladies Génétiques.Faculté de Médecine de la Timone, Marseille Guest: Lawrence Wrabetz June 16, 2009 Modulation of inflammation by hepcidin Ivana De Domenico, Internal Medicine Department, Hematology Division, University of Utah Guest: Clara Camaschella June 22, 2009 Unravelling “good” and “bad” Protein Interactions Franca Fraternali, Randall Division of Cell and Molecular Biophysics, King’s College London UK Guest: Giovanna Musco June 22, 2009 Claw paw meets the Adams family; a novel signalling axis in nerve development Dies Meijer, Department of Cell Biology and Genetics, Erasmus University Medical Center, Rotterdam Guest: Alessandra Bolino June 29, 2009 CD14 regulates the dendritic cell life cycle through NFAT activation following LPS encounter Francesca Granucci, Department of Biotechnology and Bioscience, University of Milano-Bicocca Guest: Anna Villa July 3, 2009 What Targets ER Folding Enzymes to the Mitochondria-Associated Membrane (MAM)? Thomas Simmen, Department of Cell Biology, University of Alberta, Edmonton Guest: Roberto Sitia INTRODUCTIONS - XXXVII July 6, 2009 Zebrafish visual system development and function: imaging studies Filippo Del Bene, Dept. of Physiology, University of California, San Francisco Guest: Gian Giacomo Consalez October 15, 2009 Development of the Vertebrate Musculoskeletal System: the Role of Muscle and Connective Tissue Interactions Gabrielle Kardon, Department of Human Genetics, University of Utah Guest: Giulio Cossu July 15, 2009 Bacterial genomes as basis for the discovery of vaccine antigens and novel virulence factors: the MenB experience Mariagrazia Pizza, Novartis Vaccines, Siena Guest: Alessandra Bragonzi October 15, 2009 Is it possible to correct the anergy of human tumor-infiltrating lymphocytes? Pierre van der Bruggen, Ludwig Institute for Cancer Research, Belgium Guests: Vincenzo Russo & Catia Traversari September 8, 2009 Structural Roles of Laminins in Nerve and Muscle Peter Yurchenco, Department of Pathology and Laboratory Medicine, UMDNJ, Robert Wood Johnson Medical School, New Jersey Guest: Maria Laura Feltri September 21, 2009 Quantitative targeted proteomics for the analysis of cellular networks Paola Picotti, Institute of Molecular Systems Biology, ETH, Zurich, Switzerland Guest: Angela Bachi September 28, 2009 Bone density measurements: the limitations in pediatrics Vicente Gilsanz, Childrens Hospital Los Angeles, University of Southern California Guest: Stefano Mora October 12, 2009 The role of dendritic cell subsets in control tolerance to islet antigens Jonathan D. Katz, Diabetes Research Center, Cincinnati Children’s Hospital Research Foundation Guest: Paolo Dellabona October 19, 2009 Are we ready for next-generation, genome-driven systems bIology? Elia Stupka, UCL Cancer Institute, London Guest: Giorgio Casari October 23, 2009 Searching for genes that induce myocardial protection, myocardial repair or neoangiogenesis by in vivo gene transfer using AAV vectors Mauro Giacca, International Centre for Genetic Engineering and Biotechnology, (ICGEB), Trieste Guest: Guido Poli October 26, 2009 NK cells control of tumor progression Ennio Carbone, University of Catanzaro Magna Graecia and Department of Microbiology, Cell and Tumor Biology, Karolinska Institutet Guest: Giorgio Parmiani November 6, 2009 Dendritic cells in bacterial handling in the gut Maria Rescigno, Department of Experimental Oncology, European Institute of Oncology Guest: Marika Falcone November 27, 2009 How viruses enter their host cells Ari Helenius, ETH, Zurich, Switzerland Guest: Daniela Talarico XXXVIII - SAN RAFFAELE SCIENTIFIC INSTITUTE December 2, 2009 Sox2 is a mediator of FGF signaling that regulates bone development Claudio Basilico, Dept. of Microbiology, NYU School of Medicine Guest: Simone Cenci December 15, 2009 From form to function: a role of Wnt signalling at the synapse Patricia Salinas, Department of Cell and Developmental Biology, University College London, UK Guest: Ivan De Curtis December 14, 2009 Quiescent stem cells in intestinal homeostasis and cancer Riccardo Fodde, Department of Pathology, Erasmus Medical Center, Rotterdam Guest: Daniela Talarico December 21, 2009 Innate mechanisms in the regulation of human B cell physiology Elisabetta Traggiai, Dipartimento di Scienze Pediatriche, Laboratorio di Immunologia delle Malattie Reumatiche, Istituto G. Gaslini, Genova Guest: Marta Muzio 00intro 2 9 07 2010 16:45 Pagina XXXIX SCIENTIFIC REPORTS The Scientific Director, the Chief Operating Officer, the Directors and Associated Directors of the Research Divisions, and the Directors of the Institutes and the Scientific and Technical Committee DIVISIONS, CENTERS, INSTITUTES, AND RESEARCH PROGRAMMES Microenvironment and Genes in Cancers of the Blood (MAGIC Program) Division of molecular oncology Division of neuroscience INSPE Institute of experimental neurology Human Brain Invivo Mapping with neuroimaging (BRAINMAP Program) Brain Regeneration using medIcal Devices, Gene vectors and stEm cells (BRIDGE Program) Division of metabolic and cardiovascular sciences Stem Cells Program: from basic research to clinical experimentation Division of regenerative medicine, stem cells, and gene therapy HSR-TIGET The San Raffaele-Telethon Institute for gene therapy Division of immunology, transplantation, and infectious diseases DRI Diabetes research institute Division of genetics and cell biology Center for genomics, bioinformatics and biostatistics Center for imaging Program in Immunology and Bio-immunotherapy of Cancer (PIBIC) Islet Trasplantation Program (ITP) Correlates of HIV-Associated Immune Response Modulation program (CHARM) Bone Physiopathology Program (BoNetwork) DIVISION OF MOLECULAR ONCOLOGY - 1 DIVISION OF MOLECULAR ONCOLOGY Director: Federico Caligaris-Cappio* Associate Director: Giorgio Parmiani Research Units Lymphoid malignancies Unit HEAD OF UNIT: Federico Caligaris-Cappio*, POST-DOCTORAL FELLOWS: Maria Teresa Sabrina Bertilaccio, Carlo Calissano, Cristina Scielzo PHD STUDENT: Giorgia Simonetti FELLOW: Elisa ten Hacken B-Cells neoplasia GROUP LEADER: Paolo Ghia* POST-DOCTORAL FELLOWS: Claudia Fazi**, Agnieszka Janus** PHD STUDENT: Antonis Dagklis FELLOW: Lydia Scarfò Biology of multiple myeloma GROUP LEADER: Marina Ferrarini POST-DOCTORAL FELLOW: Daniela Belloni Cell activation and signalling GROUP LEADER: Marta Muzio PHD STUDENTS: Benedetta Apollonio**, Stavroula Ntoufa Dynamic fluorescence spectroscopy in biomedicine GROUP LEADER: Valeria R. Caiolfa POST DOCTORAL FELLOW: Christian Hellriegel FELLOW: Moreno Zamai Lymphoid organ development GROUP LEADER: Andrea Brendolan PHD STUDENT: Laura Castagnaro, Elisa Lenti Preclinical models of cancer GROUP LEADER: Rosa Bernardi POST-DOCTORAL FELLOWS: Nadia Coltella, Benedetta Pozzi PHD STUDENT: Ylenia Guarnerio** TECHNICIAN: Marco Perego Tumor microenvironment GROUP LEADER: Elisabetta Ferrero PHD STUDENT: Lorenzo Veschini 2 - SAN RAFFAELE SCIENTIFIC INSTITUTE Immuno-biotherapy of melanoma and solid tumors Unit HEAD OF UNIT: Giorgio Parmiani RESEARCHER: Cristina Maccalli PHYSICIAN: Lorenzo Pilla POST-DOCTORAL FELLOW: Tiziano Di Tomaso PHD STUDENT: Valeria Cambiaghi TECHNICIAN: Gloria Sovena Cancer gene therapy GROUP LEADER: Vincenzo Russo PHD STUDENTS: Raffaella Fontana**, Laura Raccosta FELLOWS: Andrea Leiva, Claudia Lanterna**, Sara Tezza** TECHNICIAN: Daniela Maggioni Functional genomics of cancer Unit HEAD OF UNIT: Giovanni Tonon PHD STUDENTS: Aurora Negro**, Beatrice Rondinelli** Model genetics of membrane trafficking Unit HEAD OF UNIT: Ottavio Cremona* POST-DOCTORAL FELLOWS: Simona Ferron, Karin Ferrari, Alessandra Zatti Molecular histology and cell growth Unit HEAD OF UNIT: Stefano Biffo FORMER HEAD OF UNIT: Pier Carlo Marchisio* POST-DOCTORAL FELLOWS: Daniela Brina, Stefano Grosso, Elia Ranzato, Viviana Volta PHD STUDENT: Elisa Pesce FELLOWS: Anne Beugnet, Marilena Mancino TECHNICIAN: Annarita Miluzio Tumor biology and vascular targeting Unit HEAD OF UNIT: Angelo Corti RESEARCHERS: Flavio Curnis PHD STUDENTS: Eleonora Dondossola** FELLOW: Luca Crippa TECHNICIANS: Barbara Colombo, Anna Gasparri, Angelina Sacchi DIVISION OF MOLECULAR ONCOLOGY - 3 Clinical Research Units Digestive and pancreatico-biliary endoscopy Unit HEAD OF UNIT: Pier Alberto Testoni* PHYSICIANS: Lorella Fanti, Antonella Giussani, Alberto Mariani, Edi Viale RESIDENTS: Milena Di Leo, Chiara Notaristefano, Cristian Vailati FELLOWS: Antonella Putignano, Gemma Rossi, Sabrina Testoni Endosonography: diagnostic and therapeutic endoscopic ultrasound CLINICAL GROUP LEADER: Paolo Giorgio Arcidiacono PHYSICIANS: Silvia Carrara, Gianni Mezzi, Maria Chiara Petrone RESIDENT: Cinzia Boemo Gastrointestinal surgical oncology Unit HEAD OF UNIT: Carlo Staudacher* PHYSICIANS: Paolo Aldo Raul Baccari, Paola De Nardi, Saverio Di Palo, Elena Orsenigo, Andrea Marco Tamburini, Andrea Vignali RESIDENTS: Maria Chiara Salandini, Ilaria Santagostino FELLOWS: Michele Carvello, Paolo Gazzetta, Luca Ghirardelli, Shigeki Kusamura, Francesco Luparini, Alessio Mocci, Jacopo Nifosi Head and neck oncology Unit HEAD OF UNIT: Mario Bussi* PHYSICIANS: Stefano Bondi, Leone Giordano, Francesca Lira Luce, Matteo Trimarchi RESIDENTS: Chiara Bellini, Beatrice Fabiano, Pietro Limardo, Paola Recanati TECHNICIANS: Daniela Gherner, Barbara Ramella Multidisciplinary group for thoracic surgical oncology HEAD OF UNIT: Piero Zannini* PHYSICIANS: Alessandro Bandiera, Angelo Carretta, Paola Ciriaco, Giulio Melloni, Giampiero Negri*, Armando Puglisi, Carlopietro Voci* RESIDENTS: Michele Giovanardi, Annamaria Gremmo, Piergiorgio Muriana, Stefano Sestini, Antonio Tuoro Oncogenesis in liver neoplasms Unit HEAD OF UNIT: Gianfranco Ferla* PHYSICIAN: Mvunde Mukenge RESIDENT: Francesca Ratti Onco-hematology Unit HEAD OF UNIT: Fabio Ciceri PHYSICIANS: Massimo Bernardi, Consuelo Corti, Elena Guggiari, Francesca Lunghi, Magda Marcatti RESIDENTS: Alessandro Crotta, Fabio Giglio, Simona Malato POST-DOCTORAL FELLOW: Michela Tassara TECHNICIAN: Roberta Mattarucchi Pancreatic cancer Unit: biology and new therapeutic approaches HEAD OF UNIT: Valerio Di Carlo* PHYSICIANS: Gianpaolo Balzano, Marco Braga*, Renato Castoldi, Walter Zuliani RESIDENTS: Federica Milani, Cristina Ridolfi FELLOW: Greta Grassini Clinical lymphoid malignancies HEAD OF UNIT: Federico Caligaris-Cappio* CLINICAL GROUP LEADER: Andrés Jose Maria Ferreri PHYSICIANS: Matteo Carrabba, Marco Foppoli, Silvia Govi, Silvia Mappa RESIDENTS: Marta Bruno Ventre, Giovanni Donadoni, Giada Licata, Emerenziana Marturano, Chiara Francesca Verona TECHNICIAN: Arianna Vino 4 - SAN RAFFAELE SCIENTIFIC INSTITUTE Gynecologic oncology HEAD OF UNIT: Massimo Candiani* CLINICAL GROUP LEADER: Giorgia Mangili PHYSICIANS: Patrizia De Marzi, Elisabetta Garavaglia, Micaela Petrone, Emanuela Rabaiotti, Riccardo Viganò RESIDENTS: Cinzia Gentile, Serena Montoli, Francesca Pella PHD STUDENTS: Jessica Ottolina, Cristina Sigismondi Medical oncology Unit HEAD OF UNIT: Eugenio Villa Clinical trials CLINICAL GROUP LEADER: Michele Reni PHYSICIANS: Daniela Aldrighetti, Stefano Cereda, Elena Mazza, Monica Ronzoni, Giordano Pietro Vitali, Patrizia Zucchinelli CONSULTANTS: Monica Giovannini, Alessia Rognone RESEARCH NURSE: Simona Longoni Phase I and lung cancer clinical trials CLINICAL GROUP LEADER: Vanesa Gregorc PHYSICIANS: Giovanni Citterio, Maria Grazia Viganò RESIDENTS: Luca Bergamaschi, Umberto Peretti, Cristina Sorlini, Paolo Strati PHD STUDENT: Anna Spreafico FELLOWS: Alessandra Bulotta, Chiara Lazzari, Gilda Rossoni URI, Urological Research Institute HEADS OF UNIT: Francesco Montorsi* and Petter Hedlund PHYSICIANS: Roberto Bertini, Alberto Briganti, Nicolò Maria Buffi, Andrea Cestari, Renzo Colombo, Andrea Gallina, Luciano Nava, Andrea Salonia, Vincenzo Scattoni, Nazareno Suardi, Antonino Saccà RESIDENTS: Firas Abdollah, Marco Bianchi, Umberto Capitanio, Dario Di Trapani, Matteo Ferrari, Giovanni Lughezzani, Carmen Maccagnano, Federico Pellucchi, Giovanni Petralia, Lorenzo Rocchini, Francesco Sozzi, Elena Strada, Manuela Tutolo * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele DIVISION OF MOLECULAR ONCOLOGY - 5 Introduction by the Directors Mission and vision - The Division’s aim is to develop translational research programmes and clinical research. The tenet of this aim is that any significant progress toward the cure of cancer can only be based on an improved understanding of its pathogenesis, which, in turn, will lead to the development of improved diagnostics and more rationale therapeutic interventions. This will be achieved by fostering extensive collaborations between basic scientists and clinicians. Organization - The Division of Research of Molecular Oncology entails 14 Federico Caligaris-Cappio Basic Research Units (URB) and 15 groups of Clinical Research (GRC) that are organizing themselves into Research Programs. The Personnel is close to 140 people. The Lab space allocated to the Division is about m2 2500. We are working to develop infrastructure facilities that favour the Division development (patient’s data base, bio-bank, mouse and cell lines registers). Goals - The main goal is to join efforts with the Clinical Department of Oncology to create an internationally competitive Integrated Cancer Center (HSR-ICC) which integrates cancer research, treatment and education with the aim of curing cancer. While providing “State-of-the-art” clinical care for all cancers, we intend to become “Second to None” in selected areas of excellence. The scientific aims of the Division are based on the approach “build on strength”. Two major areas of excellence have been identified: Cancer Microenvironment; and Cancer Immunology and Immunotherapy. The scientific aims within these areas have been funnelled into two specific Research Programs, Immunology and Bio-Immunotherapy of Cancer (PIBIC) and Microenvironment and Genes in Cancers of the Blood (MAGIC), which span from basic science to clinical application and focus on specific malignancies for which we are Giorgio Parmiani internationally renowned. We are exploring the possibility of developing additional scientific programs. One example is a program on Cancer Stem Cells in collaboration with the Division of Stem Cells and Regenerative Medicine. Further novel Disease-Oriented Programs, focusing each on specific cancer types, will be progressively developed following the main stream of Personalized Medicine, that is to tailor treatment on the basis of the specific molecular characteristics of each individual patient’s malignancy. The Disease-Oriented Programs will involve Lymphoid Malignancies, Pancreatic Cancer, Thoracic Cancers, Genitourinary Cancers, Neuro Oncology, Melanoma. Achievements - PIBIC represents the merging of two previous programs and is co-organized with the 6 - SAN RAFFAELE SCIENTIFIC INSTITUTE Division of Immunology. PIBIC’s scientific theme is a historical strength of the Institution. Its investigations exploit the role of the immune system and of its manipulation in specific cancers, especially melanoma and epithelial cancers. PIBIC aims at translating results of basic/pre-clinical studies into novel, proof of principle clinical trials. MAGIC is developing through the expertise, network organization and multidisciplinarity of the Lymphoid Tumor Unit, the Myeloma Unit and the Leukemia Unit which bridge the Division of Molecular Oncology with the Clinical Department of Oncology and also entails the participation of numerous Research Divisions. The program spans from genomic and epigenomic studies to the characterization of the interactions between genes and microenvironment in the development and progression of blood cancers. We expect to translate the findings into more comprehensive prognostic and predictive cards for the risk stratification of individual patients and to develop novel therapeutic strategies based upon new molecular targets. Training Opportunities - The Division hosts the Section of Biology and Biotherapy of Cancer which is part of the Institutional PhD Program in Molecular Medicine and offers numerous post-doc opportunities. It is also prepared to host, train and mentor Physician Scientists. DIVISION OF MOLECULAR ONCOLOGY - 7 Research Units LYMPHOID MALIGNANCIES UNIT The principal aim of our Unit is to to dissect the elements responsible for the clinical presentation and the natural history of Chronic Lymphocytic Leukemia (CLL). It is plausible to consider that both “causal genes” (including distinct microRNA, miR) and a number of other “influential genes” operate and that the products of all these genes interact with the microenvironment inducing proliferation, survival and clonal expansion of CLL cells within the tissues. The investigation of these elements will lead to the identification of molecules and mechanisms that could be exploited as potential therapeutic targets. This has been approached in the current year by analyzing different aspects in vitro and in vivo. We investigated the functional relationships between miR-221/222 cluster and p27, a key regulator of cell cycle, in CLL. The enforced expression of miR-221/222 in the CLL cell line MEC1 induced a significant downregulation of p27 protein and conferred a proliferative advantage to the transduced cells. Accordingly, the expression of miR-221/miR-222 and p27 was found to be inversely related in leukemic cells obtained from the peripheral blood of CLL patients. Interestingly, when miR-221/222 and p27 protein were evaluated in different anatomic compartments (lymph nodes or bone marrow) of the same patients, increased expression of the two miRNAs became apparent as compared to peripheral blood. This finding was paralleled by a low expression of p27. These data indicate that the miR-221/222 cluster modulates the expression of p27 protein in CLL cells and that miR-221/222 and p27 may represent a regulatory loop maintaining CLL cells in a resting condition. Easily reproducible animal models that allow for study of the biology of CLL have been very difficult to establish. We have developed a novel transplantable xenograft murine model of CLL by engrafting the CLL cell line MEC1 into Rag2-/-γc-/- mice. The result is a novel in vivo model that has systemic involvement, develops very rapidly, allows the measurement of tumor burden, and has 100% engraftment efficiency. This model closely resembles aggressive human CLL and could be very useful for evaluating both the biologic basis of CLL growth and dissemination as well as the efficacy of new therapeutic agents. Federico Caligaris-Cappio B-CELL NEOPLASIA The natural history of Monoclonal B Cell Lymphocytosis (MBL) Our main research interest is on chronic malignancies of mature B-cells that are virtually incurable. These diseases have a long natural history that may be preceded by a pre-malignant phase as in the case of Chronic Lymphocytic Leukemia (CLL). In the recent past, we and others have identified the presence of monoclonal B cells (MBL) resembling CLL cells and circulating in the peripheral blood of otherwise healthy individuals that may progress to CLL at a rate of 1.1%/year. During 2009, we aimed at dissecting the relationship between the two entities (CLL and MBL), as it remained yet unclear and, in particular, we tested, in a prospective cohort, if CLL is always preceded by MBL. Among 77,469 healthy adults who were enrolled in the US, Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, 45 subjects were identified in whom CLL was subsequently diagnosed up to 6.4 years later, and for whom viable frozen cells were available for analysis. Using six-color flow cytometry and RT-PCR assay for immunoglobulin heavy-chain gene rearrangement, we demonstrated that 44 of 45 patients with CLL (98%) had a prediagnostic MBL clone. We analyzed the presence of somatic mutations in the immunoglobulin heavy-chain variable (IGHV) genes in 35 of 45 prediagnostic clones (78%) and found that 27/35 of them (77%) had mutations. These results indicated that, in virtually all CLL (both mutated and unumutated) cases, the disease diagnosis was preceded by a prediagnostic MBL clone, up to 77 months earlier. In the same cohort, 109 persons developed CLL and had serially collected prediagnostic serum samples avail- 8 - SAN RAFFAELE SCIENTIFIC INSTITUTE able for analysis. We then studied the serum immune-related abnormalities preceding CLL diagnosis. We observed an abnormal κ/λ free light chains (FLCs) in 38% of the cases while immunoglobulins were diminished in 13% of them and a monoclonal (M)-protein could be detected in 3% of all cases. Interestingly, in a total of 48 persons (44%), an abnormal FLC ratio and an M-protein could be observed up to 9.8 years before CLL diagnosis. In contrast, hypogammaglobulinemia was not present until 3 years before the diagnosis of CLL. These findings support a role for chronic immune stimulation in CLL genesis. These studies may help to better define ways to understand the mechanisms responsible for the evolution from MBL to CLL. Paolo Ghia BIOLOGY OF MULTIPLE MYELOMA Role of hypoxia in bone marrow angiogenesis associated with Multiple Myeloma The main focus of our research is to dissect the role of bone marrow (BM) microenvironment in Multiple Myeloma (MM) pathogenesis. MM is a tumor of fully differentiated plasma cells (PC) growing almost exclusively within the BM, which delivers pro-survival signals and confers chemo-resistance to neoplastic cells. BM angiogenesis also deeply contributes to MM development and progression. The investigation of the mechanisms governing the interactions between the malignant PC and the milieu supporting its growth is expected to identify new therapeutic targets for the disease, which remains ultimately incurable with available treatments. We are currently investigating the mechanisms responsible for MM-associated BM angiogenesis. In solid tumors, hypoxia represents a major stimulus to angiogenesis. Exposure to a low-O2 environment triggers an evolutionary conserved hypoxic response in mammalian cells, based on the regulated expression of hypoxia-inducible- factor (HIF)-1α. HIF up-regulation results in the expression of genes that mediate glycolysis and angiogenesis, including VEGF and bFGF. BM is considered hypoxic by nature, but the role of hypoxia in supporting MM-associated, hypoxia-dependent angiogenesis has not been characterized so far. During 2009, we initially compared different BM cellular components, including MM PC, endothelial cells and BM stromal cells (BMSC), for their capability to release pro-angiogenic cytokines and chemokines. BMSC were obtained from BM aspirates of MM patients, propagated and characterized as CD105positive, CD73positive, CD31negative adherent cells. BMSC were found to represent a major source of pro-angiogenic factors, including IL-6, VEGF, IL-8 and SDF-1 α. Moreover, exposure of BMSC to hypoxic conditions (5% O2), obtained by culturing cells in a hypoxic chamber, lead to a significant increase in VEGF release. In collaboration with E. Ferrero, (Division of Molecular Oncology - HSR), we are currently assessing the function, in terms of angiogenesis induction in vitro, of BMSC supernatants generated both in normoxia and hypoxia, as well as the contribution of selected molecules. Final aim is to define biomarkers to be used to identify patients who can potentially benefit from anti-angiogenetic approaches, and to monitor the effect of therapy on angiogenesis. Marina Ferrarini CELL ACTIVATION AND SIGNALLING The principal aim of our Unit is to dissect the molecular events which regulate cell activation and signalling, in particular focussing our attention on the B-cell receptor (BCR) and Toll-like receptors (TLR) signalling pathways in normal and malignant B lymphocytes. The investigation of these elements is leading to the identification of molecules and mechanisms that could be exploited as potential therapeutic targets. Toll-like receptors (TLR) are key players in host defence from infection. They recognize a specific set of molecular patterns of microbial origin, immediately trigger an innate immune response, and bridge innate and adaptive immunity. TLR have also been shown to play a role in tumor development. In this context, chronic Bcell malignancies are an interesting example as clonal B lymphocytes remain responsive to and dependent on stimuli originating from the microenvironment which then become crucial for maintaining and propagating the disease. Emerging evidences suggest that, among other microenvironmental elements, TLR ligands may play a role in the pathogenesis of chronic B-cell lymphoid malignancies. DIVISION OF MOLECULAR ONCOLOGY - 9 In the current year, we studied fresh leukemic cells, freshly isolated from CLL patients, for the expression pattern of TLR1 to TLR10, NOD1, NOD2, RP105 (also known as CD180) and TIR8 (also known as SIGIRR). CLL cells were found to express, at different levels, distinct pattern recognition receptors including TLR1, TLR2, TLR6, TLR10, NOD1, NOD2 and RP105. The specific TLR expressed by CLL cells were functional. Leukemic cells, upon stimulation with TLR1/2/6 ligands, such as bacterial lipopeptides, activated several signalling pathways including the nuclear factor-κB cascade; cells stimulated with TLR ligands expressed more CD86 and CD25 activation molecules, and were protected from spontaneous apoptosis. These findings further support the hypothesis that CLL cells resemble antigen-activated B-cells and suggest a potential role of TLR in modulating CLL cell response in the context of specific antigen recognition. Conceivably, their manipulation may find a place in specific settings of treatment of these tumors. Marta Muzio DYNAMIC FLUORESCENCE SPECTROSCOPY IN BIOMEDICINE Molecular dynamics of cell membrane receptors beyond multiphoton fluorescence microscopy A crescent awareness of the need exists to replace static, “hard-wired” diagrams of receptor interactomes (i.e., a schematic representations of signaling pathways), with real time dynamics of multi-protein complexes, as they assembly, translocate and disassembly in living cells, governing the fundamental mechanisms of a cell. These are the most demanding challenges in quantitative live imaging. State-of-the-art confocal, multiphoton imaging technologies and even super-resolved fluorescence microscopies (STED, PALM) are far to fulfil these tasks. Our group has advanced in the development of molecular imaging tools that are sensitive and quantitative and have the potential to follow the dynamics of whole protein complexes, in real time, in live cells and more importantly with nanometric (i.e. molecular) resolution. They are based on time resolved fluorescence imaging, image correlation and fluorescence fluctuation spectroscopy rather than on “colors” (which is normally what microscopy does, in any fancy manner). We have chosen to focus on three target systems, the urokinase plasminogen activator and its receptor (uPA/uPAR), the epidermal growth factor and its receptor (EGF/EGFR) and the neural cell adhesion molecule and fibroblast growth factor receptor (NCAM/FGFR). These systems have a relevant role in the coordination of complex events leading to changes in cell growth, adhesion, movement and survival of the cell and their implication in cancer. Although they are structurally diverse, there are evidences of cross-talking between them. Applying the new N&B imaging, durning last year, we have been able to follow the interaction kinetics and stoichiometry of NCAM with FGFR and of ATF with uPAR, showing how binding leads to the receptor re-assembly on the cell membrane, internalization of the ligand-receptor complexes and recycling on the membrane surface. Valeria R. Caiolfa LYMPHOID ORGAN DEVELOPMENT The research in our laboratory focuses on identifying the molecular and cellular mechanisms underlying the development and function of secondary lymphoid organs. Our long-term goal is to understand how the stromal microenvironment regulates the function, survival and expansion of normal lymphoid and leukemia/lymphoma cells. Concomitantly, we are translating our knowledge on how secondary lymphoid organs develop to construct a functional artificial lymph node that could serve as a novel approach to enhance anti-tumor immunity. Over the past year, we have pursued the following research projects: 1. Elucidating the roles of oncogenic transcription factors in secondary lymphoid organ development. By using DNA-microarray and chromatin immunoprecipitation analyses we are identifying the molecular pathways controlled by oncogenic transcription factors during proliferation/differentiation of stromal progenitor cells. With this approach, we have recently uncovered several deregulated pathways associated with loss of Tlx1, an oncogene required for spleen cell fate specification and proliferation. We are currently validating some of these deregulated pathways. 10 - SAN RAFFAELE SCIENTIFIC INSTITUTE 2. Uncovering the differentiation pathways of stromal progenitors during lymphoid tissue development. We have exploited a genetic approach in mice to label stromal progenitors within developing lymphoid organs. We are currently fate mapping the differentiation pathways of spleen and lymph node mesenchymal progenitors, identifying their contribution to the adult stromal cell pool and establishing functional relationships with lymphoid cells. 3. Generating functional artificial lymphoid organs (aLOs). By exploiting mesenchymal cell lines as a new source of stromal cells, we have succeeded in constructing aLOs with features similar to normal lymphoid organs, including presence of T- and B-cell compartments as well as stromal-cell networks. Over the year, we have also generated aLOs by using primary mesenchymal progenitors and found that primary mesenchymal cells are equally efficient in supporting the formation of artificial lymphoid structures, thus opening to the possibility of using mesenchymal stem cells as a source of stromal progenitors. Andrea Brendolan PRECLINICAL MODELS OF CANCER The main objective of this unit is to understand the role of pro-angiogenic factors and the efficacy of their targeting in leukemogenesis by creating mouse models. Emerging data is suggesting that in addition to promoting growth and metastasis of solid tumors, angiogenesis may also promote leukemogenesis. Clinical studies indicate that leukemia patients express high levels of proangiogenic factors such as VEGF and have increased angiogenesis in their bone marrow. However, the molecular mechanisms leading to high VEGF production in leukemia have not been elucidated. Based on preliminary data, we hypothesized that upregulation of the transcription factor HIF-1α, the main positive regulator of VEGF expression in solid tumors, may cause high VEGF expression and may promote disease progression also in some forms of leukemia. Therefore, inhibiting HIF-1α activity may be a useful molecular approach to restrain leukemogenesis. In the past year we have: 1. Established lentiviral vectors to overexpress or silence HIF-1α and VEGF in primary mouse hematopoietic cells. We are currently co-transducing hematopoietic cells with leukemogenic fusion proteins and vectors overexpressing HIF-1α and VEGF in order to verify in vivo whether these factors accelerate leukemogenesis. 2. Analyzed the expression of HIF-1α in hematopoietic malignancies. 3. We have analyzed a number of established cell lines representative of hematopoietic neoplasms and found that the expression of HIF-1α is high prevalently in B cell malignancies. At the same time however, assays that evaluate HIF-1α activity reveal that even in the absence of high levels of expression, HIF-1α activity is high in certain myeloid leukemias. In collaboration with the Department of Pathology and the Hematology and Transplantation Unit of San Raffaele Hospital, we are now planning to analyze bone marrow samples of human leukemia for HIF-1α and VEGF expression. 4. Silenced HIF-1α and VEGF expression in cell lines and begun to investigate the outcome of inhibiting HIF-1α as a means to inhibit leukemogenesis both in vitro, through co-culture experiments, and in vivo upon injection into immunocompromised mice. Rosa Bernardi TUMOUR MICROENVIRONMENT Multiple Myeloma angiogenesis: identification of biomarkers and use of 3-D cultures in bioreactor to evaluate response to anti-angiogenic drugs Bone Marrow (BM) angiogenesis contributes to Multiple Myeloma (MM) pathogenesis and progression and BM microvessel density (MVD) has been associated with disease stage and response to therapy. Efficacy of an- DIVISION OF MOLECULAR ONCOLOGY - 11 ti-myeloma drugs, including the proteasome inhibitor Bortezomib and the immunomodulatory drugs (IMiD) could also depend on efficacy on MM vasculature. An emerging concept states that, besides the number of abnormal microvessels, their shape and structure may play a pivotal role in tumor growth and metastatization. Lack of validated biological markers of angiogenesis and of animal models spontaneously developing MM, are major biases to monitor angiogenesis in its multiple forms in the course of MM and to assess response to drugs, in particular to anti-VEGF (Bevacizumab, Avastin) drugs, approved for treatment of solid cancers, but not currently used for MM. In collaboration with M. Ferrarini (Division of Molecular Oncology), we are now measuring, in the medullar and peripheral sera of patients with MM and MGUS, the concentration of selected cytochemokines involved in angiogenesis and vessel normalization, including VEGF, and Angiopoietin-1 and -2; their relationship with MVD, presence of hypoxic areas and clinical data will be evaluated. The technology of 3-D culture model in bioreactor, by us validated for its ability to maintain viable and functional MM organotypic cultures, will be used to assess, through serial immunohistological examinations, MVD, vessel shape, presence of hypoxic areas and specific response to anti-angiogenic drugs, by means of a in-house developed, dedicated software. Elisabetta Ferrero IMMUNO-BIOTHERAPY OF MELANOMA AND SOLID TUMORS UNIT Pre-clinical work. During the year 2009 our Unit has made substantial progress in the study of human colorectal cancer (CRC) antigens deriving from somatically mutated cancer driving genes, i.e. those genes that are involved in the neoplastic transformation or in the maintenance of the neoplastic features like tumor progression and invasion. We have identified several of these genes by deep sequencing, then we have characterized the mutated proteins containing potential epitopes recognized by T lymphocytes of the patient. These entirely new and tumor specific antigens will then be tested functionally to assess their in vitro immunogenicity for peripheral blood T cells of colorectal cancer patients. We have also expanded our study of cancer stem cells by an immunological characterization of their profile in glioblastoma. A similar study has been initiated in colorectal cancer stem cells and we succeeded in generating new tissue culture lines of pairs of CSC and non-CSC tumor lines that will be then analyzed for stemness features and immunogenicity in in vitro assays. Also the analysis of the role of NKG2D+ T cells as anti-melanoma effectors has continued by acquiring new data on the association between release of soluble NKG2D ligands by melanoma cells and patients’ prognosis. During 2009, a new project has been also started to investigate biological mechanisms that may explain the worse prognosis in melanoma patients bearing ulcerated vs. non ulcerated primary tumors. The network of protein/cytokines that may be triggered by the ulceration (hypoxia, necrosis) will be studied in melanoma samples by immunohistochemistry and by in vitro assays. Genes that are activated by such process will be determined in comparison with melanoma cells obtained from non-ulcerated lesions and their gene products assessed functionally. Clinical trials. Over 100 patients with melanoma have been visited and some of them enrolled in ongoing clinical studies. Meanwhile, the first part of the RNA-based vaccination in prostate cancer patients has been concluded; patients’ immune response to the vaccine is under evaluation. The new protocol of combination of the anti-vascular agent NGR-hTNF and peptide-based vaccine has been approved by the Ethics Committee pending the approval of the Istituto Superiore di Sanità and it is planned to start shortly. Giorgio Parmiani CANCER GENE THERAPY Pre-clinical and clinical studies have demonstrated the key role of the immune system in controlling tumor growth. Nevertheless, the full clinical exploitation of these immune-based strategies is far from being successful, due to the limited clinical efficacy showed by current studies of immunotherapy. Among several reasons responsible for that, immune escape mechanisms perturbing the tumor microenvironment have recently been 12 - SAN RAFFAELE SCIENTIFIC INSTITUTE demonstrated to play a relevant role in affecting antitumor immune responses. In fact, in some circumstances the blockade of these mechanisms restores the antitumor immune response and induces an effective control of tumor growth. Based on this, avoidance of immune surveillance has been proposed as the 7th hallmark of cancer (extrinsic oncogenic factors), and it should integrate with the six established intrinsic oncogenic factors to fully explain tumor formation/establishment and metastasis. In recent years, several molecules and cells generating immune suppressive networks responsible for the inhibition of the antitumor immune response, have been extensively investigated and identified. The research of our group is focused on the investigation of cellular and molecular mechanisms increasing tumor antigen-presentation, and on the identification of new immune escape mechanisms, with the final goal to identify new strategies to improve the antitumor immune response. In particular, we have recently developed a novel strategy of active immunotherapy based on the in vivo loading of antigen presenting cells (i.e. dendritic cells) with tumor antigens (Russo et al. J Clin Invest, 2007). The clinical translation of this approach has led to the development of antitumor effectors correlating with a favorable clinical outcome in melanoma patients (Fontana et al. Blood, 2009). Moreover, we have recently identified a novel mechanism of tumor immune escape, which dampens the spontaneous immune-mediated control of tumor growth by impairing the functional expression of the lymphoid-organ homing receptor CCR7 on maturing dendritic cells. Of note, the use of drugs interfering with this pathway, restores the spontaneous antitumor immune response and the control of tumor growth in different mouse tumor models (Villablanca et al. Nat Med, 2010). Vincenzo Russo FUNCTIONAL GENOMICS OF CANCER UNIT Transcriptomic, genetic and epigenetic reprogramming of cancer cells Our laboratory is currently pursuing the following lines of research: 1. Role of histone methylation and demethylation in cancer development. In the nuclei of eukaryotic cells, DNA is packed into chromatin. The basic constituent of chromatin, the nucleosome, is comprised of 147 bp of DNA wound around an octamer of core histone proteins. Post-translational modifications of the N-terminal tails of these core histone proteins, modulate chromatin configuration, resulting in changes in transcriptional regulation. These epigenetic modifications are controlled by complex enzymatic machinery that, when deregulated, disrupt normal transcriptional programs. Indeed, genomic alterations of MLL, NSD1, CREBBP, WHSC1L1 and WHSC1, all encoding proteins involved in histone modification, have been implicated in several cancer types. Through genomic analysis and large-scale high-throughput sequencing, we have identified genetic lesions affecting histone methylases and demethylases and we are exploring the role of the genes implicated in these genomic rearrangements in the development of multiple myeloma, lung cancer and renal carcinoma. 2. Receptor tyrosine kinase receptors in the development of Multiple Myeloma. The protein kinase is the most commonly represented Pfam domain encoded by cancer genes. Many carcinogenic tyrosine kinases are receptors, which are often overexpressed and/or mutated in a variety of tumors. Therapeutic agents targeting this class of receptors have proven to be highly effective in the clinical setting. Multiple Myeloma (MM) is the second most frequent hematological cancer and remains incurable. Several RTKs are expressed in MM and there is mounting evidence of their pathogenetic importance in this disease. We have conducted a genomic and proteomic survey of primary MM samples and identified two RTKs that were overexpressed relative to levels present in plasma cells derived from normal donors. Strikingly, both RTKs tap into developmental pathways that are highly relevant in cancer biology and demonstrated robust transforming activity. The goal of this project is to elucidate the nature of the signaling mediated by these RTKs in MM, both in vitro and in vivo, with the final goal of identifying more effective drugs against MM. Giovanni Tonon DIVISION OF MOLECULAR ONCOLOGY - 13 MODEL GENETICS OF MEMBRANE TRAFFICKING UNIT Epsins are endocytic adaptors with putative functions in housekeeping forms of endocytosis as well as in actin dynamics, and neurotransmission. To test the role of the ubiquitously expressed Epn1 and 2 genes in vivo, we generated KO mice for those genes (Chen H. et al., 2009 PNAS, 106:13838). While single epn mutants do not show major phenotypic defects, Epn1/2 double KO (DKO) mutants are embryonic lethal at E9.5-E10, i.e., at the beginning of organogenesis. Developmental defects observed in Epn1/2 DKO embryos recapitulated those produced by a global impairment of Notch signaling. However, housekeeping forms of clathrin-mediated endocytosis were not impaired in cells derived from these embryos. Our findings support a role of epsin as a specialized endocytic adaptor of Notch ligands in mammals. In collaboration with the laboratory of Kohji Takei (Okayama University), we studied amphiphysin1 function in actin dynamics (Yamada H, 2009 J Biol Chem, 284:34244). We reported that amphiphysin1 interacts with NWASP and stimulates N-WASP- and Arp2/3-dependent actin polymerization. This association undergoes regulation and is enhanced by stimulating phosphatidylserine receptors on the cell surface that trigger ruffle formation. These results indicate that amphiphysin 1 is a key actin regulator and that such function cooperates with the endocytic adaptor role of the protein during the endocytic reaction. In collaboration with the laboratory of Pietro De Camilli (Yale University), we analyzed endocytic intermediates that accumulate in cells that lack dynamin expression (i.e. cells derived from dnm1/2 conditional DKO mice; Ferguson S. et al., 2009 Dev Cell, 17:811). In these cells, actin-nucleating proteins, actin, and BAR domain proteins accumulate at the base of arrested endocytic clathrin-coated pits, where they support the growth of dynamic long tubular necks. These results demonstrate a concerted action of these proteins prior to, and independent of, dynamin and emphasize similarities between clathrin-mediated endocytosis in yeast and higher eukaryotes. Our data also demonstrate that the relationship between dynamin and actin is intimately connected to dynamin’s endocytic role and that dynamin terminates a powerful actin- and BAR protein-dependent tubulating activity. Ottavio Cremona MOLECULAR HISTOLOGY AND CELL GROWTH UNIT Translational control in cancer Cancer cells are characterized by several metabolic anomalies. Among them, protein synthesis (translation) is highly deregulated. Translation is controlled by defined factors known as eukaryotic initiation factors (eIFs). Recent work has led to the identification of two initiation factors involved in tumorigenesis: eIF4E, and eIF6. Our laboratory focuses on the biology of eIF6. Evidence produced in our lab has shown that eukaryotic initiation factor 6 (eIF6) is important in transformation, downstream of growth factors and oncogenic mutations of ras. eIF6 is a rate-limiting factor in ribosome biogenesis and translation, and has the unique property to bridge these two processes. eIF6 is necessary for cell growth and synthesis of 60S ribosomal subunits. Converging genetic and biochemical evidence indicates that eIF6 is rate-limiting for 60S ribosome assembly, by acting in a multiprotein complex mostly composed of essential genes. eIF6 controls also translation. Briefly, eIF6 biochemical activity regulates 40S + 60S ribosomal joining in a mTORc1 independent fashion. Our lab has shown that eIF6 is controlled by growth factors/mitogens and positively regulates translation. In this context, cells with half levels of eIF6, compared to normal, have a normal basal level of translation, but insulin-stimulated translation is blunted. Related to cancer, eIF6 is significantly upregulated during colon carcinoma progression, and in other tumors. In the last year we have progressed on the characterization of the role of eIF6 in tumor biology, by demonstrating that several classes of tumors are affected by eIF6 expression. The analysis of the molecular mechanism by which eIF6 acts, is in progress. Stefano Biffo 14 - SAN RAFFAELE SCIENTIFIC INSTITUTE . Figure 1. eIF6 in ribosome biogenesis and translational control (from Miluzio et al., Embo Reports, 2009). In the nucleolus, eIF6 associates with immature large ribosomal subunits (pre-60S) and other regulatory proteins (trans-acting factors). eIF6 is found during pre-60S subunit maturation in the nucleoplasm and is exported to the cytosol. Here, eIF6 release allows the 60S to join the 40S subunit, and the active, translating 80S complex is formed. eIF6 shuttling between the nucleus and cytoplasm allows the proper formation of pre-60S. eIF6, eukaryotic initiation factor 6; PABP, polyA-binding protein. TUMOR BIOLOGY AND VASCULAR TARGETING UNIT Our studies focus on the development of new strategies for cancer therapy based on drugs that affect the tumor vasculature and microenvironment. For example, we have found that peptides containing the NGR, isoDGR and RGD sequences can be exploited for delivering Tumor Necrosis Factor α (TNF) and other cytokines to tumor vessels. These compounds can induce vascular damage, can alter endothelial permeability and can increase the penetration of various chemotherapeutic drugs in tumors. Because of these properties, one of these compounds, called NGR-TNF, is currently tested in several Phase II clinical studies, alone and in combination with chemotherapy, with evidence of activity. A Phase III study in patients with malignant pleural mesothelioma started recently. Other lines of research are focused on the role of proteins containing the NGR, RGD and isoDGR sequences in tumor vascular biology and angiogenesis. We have found that circulating CgA, an RGD-containing protein secreted by many neuroendocrine cells and granulocytes, is elevated in patients with cancer and other inflammatory diseases. This protein can regulate fibroblast and endothelial cell adhesion, can inhibit TNF-induced vascular leakage, can inhibit angiogenesis and can inhibit tumor growth and metastasis development in various animal models by affecting the tumor microenvironment. Regarding NGR (asparagineglycine-arginine) this sequence is present in many molecules of the extracellular matrix. We have demonstrated that it can undergo rapid deamidation reactions generating the isoAsp-Gly-Arg (isoDGR) sequence in fibronectin. Peptides and fibronectin fragments containing the isoDGR motif can bind αvβ3, an integrin expressed in the angiogenic vasculature, can affect endothelial cell functions and can inhibit tumor growth. We have hypothesized that the NGR-to-isoDGR switch in fibronectin and in other proteins of the ECM might work as a “molecular timer” for generating new binding sites for integrins. Finally, we have shown that peptides containing the isoDGR motif can be exploited for the delivery of TNF and nanoparticles to tumors. Angelo Corti DIVISION OF MOLECULAR ONCOLOGY - 15 Clinical Research Units DIGESTIVE AND PANCREATICO-BILIARY ENDOSCOPY UNIT The Unit is involved in the development and clinical application of advanced endoscopic imaging and endoluminal therapy for recognition and treatment of high-grade dysplasia and early cancer of the gastrointestinal tract (G.I.) and pancreatico-biliary system. Advanced endoscopic imaging. In the last years the research has been focused mainly on the use of Optical Coeherence Tomography (OCT) for detecting and characterizing mucosal and submucosal lesions of the G.I. tract and for differential diagnosis of structures of unknown aetiology of the main pancreatic and common bile duct. We first used OCT imaging to investigate the layers of the main pancreatic and common bile duct in ex-vivo studies and in humans, by ERCP. Using this technique, we were able to characterize the intraductal tissue structure and differentiate between neoplastic and inflammatory strictures, as documented by recent publications. At present, surface and contrast enhanced endoscopic imaging is used to investigate mucosal flat lesions (preneoplastic and neoplastic); the technique appeared particularly useful in Barrett’s esophagus, gastric dysplasia, and colonic flat adenomas. Confocal endomicroscopy is currently used in clinical practice since the beginning of 2010. It is a new advanced imaging technique which enables in vivo microscopy with subcellular resolution during ongoing endoscopy. The technique is very effective in detecting neoplastic lesions at a very early stage, identifies pre-neoplastic lesions, and gives information about living cells in human beings. Confocal endoscopy can be carried out also with probes that can be inserted into the pancreatico-biliary system, during ERCP procedures. Endoluminal therapy. Endoscopy is commonly used for treatment of neoplastic lesions of the G.I. tract confined within submucosa, because the technique permits to remove tissue by mucosal resection, submucosal dissection, and radiofrequency ablation. Radiofrequency can also be delivered into the pancreatico-biliary ductal system to treat neoplastic strictures. The Unit is involved in the development of new devices for tissue removal, including knife models and water jet probes for tissue lifting, and radiofrequency delivering devices for both G.I. tract and pancreatico-biliary ductal system. By using these devices, dysplastic epithelium and early cancer within Barrett’s esophagus, as well as in the stomach and colon, can be completely removed, and neoplastic ductal strictures can be treated. Pier Alberto Testoni ENDOSONOGRAPHY: DIAGNOSTIC AND THERAPEUTIC ENDOSCOPIC ULTRASOUND The focus of our Endosonography Unit is to develop research programmes in diagnosis and treatment of premalignant and malignant pancreatic lesions. The importance of diagnostic Endoscopic Ultrasound (EUS), the therapeutic and interventional applications of EUS are expanding and may become a major breakthrough in the management of pancreatic diseases. The diagnosis of premalignant lesions is necessary to avoid that most patients have advanced disease at the time of diagnosis. Screening and surveillance for pancreatic cancer and its precursors is a new indication for endoscopic ultrasound. We are cooperating with John Hopkins Medical Institutions (Baltimore) for an international program of screening of patients with a strong family history of pancreatic cancer screened on a periodic basis for pancreatic lesion. In the same way we are organizing a national screening program with the Italian Association for the study of the pancreas (AISP). 16 - SAN RAFFAELE SCIENTIFIC INSTITUTE We are cooperating with Mayo Clinic Jacksonville for an international registry for multi-center collaboration in Intraductal Papillary Mucinous Neoplasm (IPMN) research and clinical management, with the aim of identifying clinical and morphological predictors of cancer in patients with IPMN who undergo surgery, and to identify predictors of progression to cancer or high grade dysplasia among patients who are followed in surveillance programs. Patients with unresectable locally advanced pancreatic disease don’t have many chances and chemoradiation confers them only a minimal symptomatic improvement. Radiofrequency ablation is a local thermal therapy used for palliative treatment of solid tumours. We have developed a new flexible bipolar ablation probe combining radiofrequency and cryotechnology applied under EUS-guided and we have demonstrated the feasibility and efficacy of this new treatment, using it in a porcine model. We have also evaluated the efficacy of this new hybrid cryotherm probe (CTP) in destroying neoplastic tissue of explanted pancreas of patients with pancreatic adenocarcinoma, analyzing both the tissue histological changes and relationship between application time and long axis diameter of necrosis obtained. The application provokes selective necrosis in neoplastic tissue, and there was a statistical significant correlation between necrosis diameter and application time. Now we are designing a clinical protocol for the treatment of local advanced carcinomas just after the first line of chemotherapy to study the capability of the CTP to increase the number of patients to be resected. Paolo Giorgio Arcidiacono GASTROINTESTINAL SURGICAL ONCOLOGY UNIT Our Unit’s research activity has been focused on several different relevant topics in gastrointestinal oncology: 1. Role of the induction of innate and adaptive antitumor immunity in nonmetastatic rectal cancer patients treated with neoadjuvant CT-RT and its relationship with pCR and survival. The aim is to verify whether innate factors influence the outcome of antineoplastic treatment, and whether they may predict in selected patients the clinical response and survival. 2. Evaluation of the clinical significance of circulating Tumor Cells (CTCs) in blood from patients with gastrointestinal cancers. The aim is to determine and quantify CTCs in all patients with any stage of gastrointestinal malignancy, as well as correlate their presence with clinical and pathological factors. Our second goal is to test the prognostic value regarding disease free overall survival. 3. Evaluation of parameters for tumor response to neoadjuvant chemotherapy in advanced gastrointestinal cancers in an attempt to coin a new tumor regression grade system. 4. Evaluation of surrogate biological markers of oncological outcome in gastric cancer which includes the assessment of Cox-2 expression. 5. HIPEC in the treatment of locally advanced gastric cancer following preoperative chemotherapy and curative surgery. The purpose of the present protocol is to investigate the feasibility, morbidity, toxicity, mortality and oncological outcome of HIPEC in patients with locally advanced gastric cancer with a high risk for peritoneal dissemination. 6. Cytoreductive surgery and HIPEC in the treatment of peritoneal carcinomatosis from colon cancer. The purpose of the present pilot study is to investigate the feasibility, morbidity, toxicity, mortality and survival of the cytoreductive surgery and HIPEC in colon cancer patients with primary/relapsing peritoneal carcinomatosis or at a high risk for peritoneal dissemination. 7. Sentinel node mapping during laparoscopic gastrectomy for gastric cancer. Laparoscopic modified surgery based on sentinel node status would be the goal of a minimally invasive approach for pathologically node negative early gastric cancer. The aim is to evaluate the feasibility in gastric cancer patients who underwent laparoscopic detection of sentinel node. Carlo Staudacher DIVISION OF MOLECULAR ONCOLOGY - 17 HEAD AND NECK ONCOLOGY UNIT Our Unit’s main research focus is the investigation on functional problems and outcomes of advanced larynx cancer bearers. A new technique of subtotal laryngectomy has been performed, in cooperation with other Ear, Nose and Throat (ENT) oncological departments, to preserve the voice in advanced larynx cancers, extended to the subglottis. Phonatory and deglutition results have been studied, together with the satisfaction degree. As far as total laryngectomy concerns satisfaction and quality of life after voice prosthesis rehabilitation have been investigated. New functional surgical techniques and psychooncological studies will be carried on in the next period to guarantee the best social outcome in subjects undergoing organ sacrificing surgery for advanced larynx cancer. A series of 350 cases of parotidectomies performed in 7 years has been investigated from a clinical and statistical point of view. Attention was paid to correlation between Fine Needle Aspiration Citology (FNAC) and definitive histological examination, to facial palsy, Frey’s syndrome and relapses; statistical analysis was performed on the grouped data. Over past 20 years, high risk human papilloma virus (HPV) infections has been established as a risk factor for developing head and neck squamous cell carcinoma, independent of tobacco and alcohol use. Our unit is collaborating with the Laboratory of Tumor Immunology (M.D. Maria Pia Protti) with the aim of showing the presence of viral genoma (HPV 16) in tumour cells. Besides we are investigating a specific immune response in patients’ blood; in detail we are verifying the presence of CD4 + T cells with an immune response specific for peptide sequences corresponding to E6 and E7 of HPV. Further analysis and studies will be required to assess the feasibility and the efficacy of targeted HPV16 vaccination Mario Bussi MULTIDISCIPLINARY GROUP FOR THORACIC SURGICAL ONCOLOGY Multidisciplinary approach for patients affected by non-small cell lung cancer and colorectal and renal cancer lung metastases Surgery remains the best treatment for patients affected by non-small cell lung cancer (NSCLC). Advanced age, cardiorespiratory comorbidities and pathological mediastinal lymph nodes represent some contraindication to surgical resection. To extend possibility of surgical treatment, we undertook the following lines of research. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a potential alternative to mediastinoscopy to confirm or exclude lymph node metastases. Preliminary studies have demonstrated that it may lead to an improvement in the results of N-staging decreasing the morbidity correlated to mediastinoscopy. The aim of this study is to assess the effectiveness and safety of EBUS-TBNA in staging NSCLC patients. Advanced emphysema is frequently associated with lung cancer and can impede surgical treatment. New therapeutic strategies such as bronchoscopic lung volume reduction (BLVR) have been developed recently. The goal of BLVR is to obtain a functional improvement by endoscopically-positioning one-way endobronchial valves which divert ventilation from the emphysematous areas to more normal lung regions. The aim of this study is to assess the results of BLVR in terms of post-treatment morbidity and improvement of respiratory function aimed to perform surgery on patients affected by NSCLC. Advanced age and associated cardiac and pulmonary diseases may however be a contraindication to surgical treatment. The aim of the study is to assess the results of new treatment-strategies as percutaneous radiofrequency thermoablation and tomotherapy, a recently-developed radiotherapy technique, in patients with earlystage NSCLC with a contraindication to surgical treatment. Surgical resection both for colorectal and renal cancer lung metastases are well-accepted treatment modali- 18 - SAN RAFFAELE SCIENTIFIC INSTITUTE ties. Identification of new tumor markers to supplement clinical and pathological staging may allow to identify those patients with lung metastases from colorectal and renal cancer at highest risk of recurrence following surgery. The aim of this study is to evaluate the use of immunohistochemical analysis to assess the prognostic value of some tumor markers (microsatellite instability and S100a4 protein) in colorectal and renal cancer metastases. Piero Zannini ONCOGENESIS IN LIVER NEOPLASMS UNIT The Hepatobiliary Unit is a multidisciplinary clinical unit where the traditional gap between physicians and surgeons has been overcome to reach the optimal standards of patient care. Indeed, the medical staff includes hepatologists and hepatobiliary surgeons who share their specific competences to treat in an unique environment both “internal” and “surgical” patients. Clinical activities are mainly focused on hepatobiliary tumors and chronic liver diseases, including primary (hepatocellular carcinoma and cholangiocarcinoma) and metastastic liver tumors (mainly liver metastases from colorectal cancer), liver cirrhosis and related complications (portal hypertension, ascites, esophageal varices), benign and malignant diseases of the biliary tract, acute and chronic hepatitis. As far as concern liver tumors, the research activities are mainly focused on the outcome (in term of overall survival and disease-free survival) of patients affected by liver metastases from colorectal cancer and treated by surgery and adjuvant/neoadjuvant chemotherapy. Studies regarding the prognostic factors of survival after surgery and the impact of locoregional chemotherapy on the outcome after surgery have been published (World J Surg, Ann Surg Oncol, J Gastroint Surg, J HBS). Among the speculative studies about the liver metastases from colorectal cancer, the hepatobiliary unit have been involved in cooperative protocols of study with the Unit of Immuno-biotherapy of Melanoma and Solid Tumors (Prof. Parmiani). Surgical specimens have been collected after liver resection for colorectal liver metastases to characterize the expression of OX40 and 4-1BB on peripheral blood lymphocytes and in tumor and lymphoid tissue of oncological patients. The study has ended the phase of case collection and it is still ongoing as far as concern the final results. Further cooperative studies about carcinogenesis in patients affected by hepatocellular carcinoma and HCV infection are under evaluation at the present time. Gianfranco Ferla ONCO-HEMATOLOGY UNIT The San Raffaele Onco-Hematology Group of Clinical Research is active in clinical research for acute leukemias, myelodisplasia, mieloproliferative disorders, lymphomas and myelomas. Investigator-Initiated clinical trials are higly integrated in clinical care. To this purpose, the infrastructures comprise a clinical care facility with ISO-9001 accreditation comprising all the requirements for care of patients affected by acute and chronic leukemia, lymphoma and myeloma, a bone marrow transplantation unit and a dedicated Day Hospital Unit. We participate and contribute to national and international disease networks (NILG, Gimema, Leukemianet, GITIL, IIL). Clinical research is organized in Diseases Units: Leukemia Unit and Myeloma Unit and we contribute to the Lymphoma Unit. During 2009 the clinical research activity has been focused on several diseasespecific master trials: NILG-AML master trial of the cooperative group NILG in AML at diagnosis; NILGALL 10/07 master trial of the cooperative group NILG in ALL patients at diagnosis with a systematic application of an MRD-oriented strategy to post remission therapies (www.nilg.it); salvage chemotherapy with clofarabine in relapsed AML; WT1 monitoring in bone marrow and peripheral blood at diagnosis to establish the predictive significance of disease persistence or relapse (MRD) to tailor adoptive immunotherapy strategies post allogeneic bone marrow transplantation; metabolomics profiling in patients with acute leukemia at diagnosis and during treatment; metabolomics of MGUS and multiple myeloma. Several trials with new drugs (plerixafor, romiplostim, eltrombopag, clofarabine, treosulfan), are ongoing for leukemias, myelomas and MDS. Fabio Ciceri DIVISION OF MOLECULAR ONCOLOGY - 19 PANCREATIC CANCER UNIT: BIOLOGY AND NEW THERAPEUTIC APPROACHES The Unit of Pancreatic Surgery during 2009 performed 162 resections, a surgical volume among the highest in Europe. These cases are a great source of data and material for every type of research in this field. Pancreatic ductal adenocarcinoma was the cause of resection in 95 patients. Pancreatic cancer is the fourth leading cause of cancer mortality in the Western world and it has the worst prognosis among malignancies, with a 5-years survival < 5%. To improve discouraging present results, different new therapeutic strategies are under evaluation at our unit. We are presently investigating in prospective studies different schemes and modality of perioperative chemotherapy. A randomised study on adjuvant chemotherapy has been completed: comparing standard Gemcitabine with 4-drugs combination therapy we found a benefit in disease-free survival in favour of the new combination therapy (1-year disease-free survival 65% versus 46%). In the basic science setting, a study on pancreatic cancer stem cells (CSC) has been carried on. Putative CSC marker expression has been evaluated by flow cytometry in cell lines (n=17) and in primary tumor of patients with pancreatic cancer (n=29). Only CXCR4 expression correlated to in vitro chemoresistance (p=0.028) and in vivo clonogenicity (p=0.042). Further, CXCR4 positivity in primary tumor resulted a risk factor for recurrence (0.028; hazard ratio 1.31- CI 1.03-1.66; cox regression analysis). No correlation has been noticed with other stem cell markers previously described. Researches were focused also on pancreatic cancer neurotropism, that is a hallmark of this tumor and represents a major source of local tumor recurrence after surgery. Our study showed that the CX3CR1 receptor may be involved in perineural growth and is a relevant and independent risk factor to predict an early local tumor relapse in resected patients. We are presently investigating whether mutations in K-Ras, an early genetic lesion in pancreatic adenocarcinoma, can play a role in the upregulation of CX3CR1. Valerio Di Carlo PATHOLOGY UNIT Our research areas mainly focus on three major topics: hematopathology, pancreatic neoplasms and urologic malignancies. Our hematopathology group is actively involved in two major fields. The first regards the link between infectious agents, mainly bacteria, and lymphoproliferative disorders. Following the model of the etiopathogenetic relationship between gastric MALT lymphoma and Helicobacter pylori infection, we have discovered in collaboration with our Oncology Department and Aviano National Cancer Institute, the link between ocular adnexal lymphomas and Chalmydophila psittaci infection. This observation lead to an important change in treatment strategies for these lymphomas and international collaboration have been established both on clinical and pathobiological aspects. The second major field of investigation involves the relationship between neoplastic cells and microenvironment in hematologic neoplasms, including indolent forms (such as marginal zone lymphomas, chronic lymphocytic leukemia, follicular lymphomas, plasma cell dyscrasias, chronic myeloproliferative disordes and myelodysplastic syndromes) and aggressive hemopathies (such as high-grade lymphomas, mantle cell lymphomas and acute leukemias). In this context several line of investigation are currently active and in particular the role of accessory cells –T lymphocytes subclasses, monocyte-macrophages cells, dendritic and stromal cells-, in these heterogeneous malignancies. The other area of diagnostic and research interest are pancreatic neoplasms, deriving from the exocrine pancreas - the most frequent and lethal ductal adenocarcinoma- and from the endocrine component. San Raffaele Scientific Institute is a leader hospital in the treatment of pancreatic diseases. Present interest is to establish primary pancreatic adenocarcinoma in vitro cultures as a tool for research and for drug testing with the aim to develop a methodology able not only to validate novel candidate drug targets but also to select the best available treatment for every Patient. Another area of research involvement is in the field of urologic malignancies: active research projects are on the identification of prognostic and predictive markers in renal cell carcinoma and in prostatic adenocarcinoma. Claudio Doglioni 20 - SAN RAFFAELE SCIENTIFIC INSTITUTE CLINICAL LYMPHOID MALIGNANCIES In 2009 the Unit of Clinical Lymphoid Malignancies has continued the scientific activity with a specific interest in the extranodal lymphomas such as MALT lymphomas and primary and secondary central nervous system lymphomas. After studying the pathogenetic role of Chlamydia Psittaci and the effectiveness of eradicating antibiotic therapy with doxycicline in the treatment of ocular adnexal lymphomas (OAL), we have developed a phase II trial to analyse activity and safety of high dose of Clarithromycin in relapsed or refractory EMZL patients and a phase II trial about the use of intraocular rituximab in relapsed or refractory patients affected by lymphoma of the conjunctiva. Furthermore, we are currently interested in studying the connection between the presence of infection by other bacteria and the development of some forms of lymphomas such as OAL, mantle cell lymphoma and cutaneous lymphomas. High dose methotrexate (HD-MTX)-based chemotherapy is the conventional first line therapy for primary CNS lymphomas (PCNSL) and the addiction of HD-AraC to HD-MTX has recently demonstrated to improve the outcome with acceptable toxicity. We have further developed an international multicentric randomized phase II trial on PCNSL evaluating HD-MTX and HDAra-C with or without Thiothepa and with or without Rituximab followed by whole brain radiotherapy (WBRT) vs autologous stem cell transplantation (ASCT). CNS dissemination is often a lethal event in patients with aggressive lymphomas. In small retrospective series high-dose chemotherapy supported by ASCT produced encouraging results. We designed a multicentric phase II trial to evaluate a combination of methotrexate and cytarabine as induction therapy followed by R-HDS as consolidation and thiotepa-BCNU-based conditioning supported by ASCT in patients with secondary CNS Bcell lymphomas. An interim analysis conducted on the first 13 registered patients has showed 9 (69%) complete remissions and 3 partial remissions (OR rate 92%) with acceptable toxicity. At a median follow up of 15 months 4 patients experienced relapse/progression, with a 2-yr EFS of 46%; 9 patients are still alive with a 2-yr OS of 54%. This intensive approach shows encouraging preliminary results in this lymphoma, which has otherwise dismal prognosis. Andrés Jose Maria Ferreri GYNECOLOGIC ONCOLOGY In 2009 the gynecologic oncology unit has been involved in endometrial, ovarian and trophoblastic tumour research in order to improve the quality of clinical activity. We studied biological and clinical prognostic factors that may help the physician in decision making processes. Endometrial Cancer. We studied the role of FDG PET-TC examination in the management of high risk endometrial cancer. We also studied the surgical approach in the elderly patients with endometrial cancer. Finally we evaluated the adjuvant treatment with concomitant radiotherapy and chemotherapy in patients with high risk endometrial cancer. Ovarian Cancer. We took part in two clinical international multi-centric protocols: the first study involves the utilization of intraperitoneal (IP) catumaxumab with the primary objective to evaluate the safety of the three hour I.P. infusion of this drug with or without prednisolone. The second study evaluates the efficacy of pazopanib in the treatment of ovarian cancer. Much effort has been invested in order to preserve fertility in young patients submitted to gynaecologic surgery: we evaluated the role of the conservative treatment in patients with advanced ovarian serous borderline tumour. Trophoblastic tumour. We introduced the intensive use of transvaginal ultrasound in the managment of trophoblastic tumor. We are now able to riduce follow up period in patients with a desire of pregnancy. Giorgia Mangili DIVISION OF MOLECULAR ONCOLOGY - 21 MEDICAL ONCOLOGY UNIT - CLINICAL TRIALS The Unit is involved in clinical trials addressing the role of antineoplastic drugs and strategies in the therapeutic management of pancreatic, central nervous system (CNS), prostate, renal, colorectal, gastric, biliary tract, and breast cancer. Scientific activity regards also translational research and studies aimed at identifying new prognostic and predictive biological markers. Scientific activity on pancreatic cancer included: a) a phase II trial randomizing patients with stage IV disease to receive maintenance therapy with sunitinib or observation and exploring the role of potential surrogate biomarkers; b) a study to identify a proteomic profile predictive of the outcome of patients with advanced disease; c) a pharmacogenetic trial to assess the impact on the outcome of the SNPs involved in the metabolism of antiblastic drugs administered in advanced disease; d) a phase II-III trial randomizing patients with resectable disease to receive neoadjuvant or adjuvant chemotherapy. In the topic of CNS tumors, ongoing trials are aimed at: a) identifying a proteomic profile able to predict the outcome of newly diagnosed glioblastoma (GBM) treated with standard chemo-radiation (RT); b) assessing the role of temozolomide (TMZ) associated to RT in newly diagnosed GBM in elderly patients; c) assessing the role of TMZ concurrent to RT and adjuvant in non-1p/19q deleted anaplastic glioma; e) analyzing the role of primary chemotherapy with TMZ versus RT after stratification for 1p loss in low grade glioma; f) exploring the role of salvage therapy with TMZ in pituitary neoplasms; g) exploring the role of salvage therapy with hydroxyurea alone or in combination with imatinib in meningiomas; h) investigating activity and safety of adjuvant fotemustine and concomitant RT in anaplastic astrocytoma. Research activity in gastric cancer is focusing on: a) feasibility of a new first-line chemotherapy combination in metastatic disease; b) the role of laparoscopic hyperthermic intraperitoneal chemotherapy in advanced disease; c) clinical and pathological correlations of tumor regression grade and erb-B2 expression in resected disease after neoadjuvant chemotherapy; d) prognostic role of the expression of cyclooxigenase-2, Angiopoeitin2, VEGF in resected gastric cancer. Michele Reni MEDICAL ONCOLOGY UNIT - PHASE I AND LUNG CANCER CLINICAL TRIALS The research activity of lung cancer group is divided into two main areas: pathogenesis of NSCLC and phase I/II studies. In the first area, we are focusing on improving knowledge on molecular mechanisms of new and standard therapies, specific toxicities and pathways of drug resistance for defining personalized therapies. We developed and validated a proteomic algorithm, VeriStratTM, Biodesix Inc., that classifies NSCLC patients according to their outcome after EGFR-TKIs therapy in a good or a poor label. This algorithm may select those patients who do not benefit from EGFR TKIs suggesting that the molecular species generating VeriStratTM classifier may identify a primary resistance mechanism. In our study, four out of the 8 peaks composing VeriStratTM resulted to be the secreted form of Serum Amyloid A1 (SAA1) and its truncated forms. Moreover, in the poor classified patients different inflammatory proteins resulted up-regulated: SAA2, SAA4, haptoglobin, α1-antitrypsin and α1-antichimotrypsin, suggesting that inflammation may play a role in the EGFR-TKIs resistance. It is not still clear if SAA has a direct role in cancer pathogenesis and progression. SAA interacts with extracellular matrix adhesion molecules and it induces the activation of metalloproteinase, that release of tyrosine kinase family ligands (EGF, IGF, VEGF) and this mechanism may bypass EGFR pathway or it may be involved in metastatic development. Our experience with regards to Phase I studies started in 2003, with a new anti-vascular targeting agent (VTA), NGR-h-TNF which has been discovered and fully characterized at the San Raffaele Scientific Institute (Dr. A. Corti, Division of Molecular Oncology) and then tested in clinical trials at Department of Oncology. Since then four phase I/Ib studies have been conducted as single agent and in combination with chemotherapy. In 2009, one phase Ib study in combination with cisplatin and three phase II studies with NGR-hTNF single agent have been finished, one in hepatocellular carcinoma (HCC), one in colorectal carcinoma (CRC) and one in malignant pleural mesothelioma (MPM). NGR-hTNF have shown a good toxicity profile, with evidence of 22 - SAN RAFFAELE SCIENTIFIC INSTITUTE transient grade 1-2 constitutional symptoms (especially chills) during infusion. Promising results on antitumor activity were observed in three phase II studies. A phase III study in mesothelioma started very recently and it is currently ongoing. Vanesa Gregorc UROLOGICAL RESEARCH INSTITUTE (URI) The Department of Urology, Vita-Salute San Raffaele, Milan, headed by Professor Patrizio Rigatti, represents one of the most important international institutions for the diagnosis and the treatment of urological malignancies. The Department takes account weekly of 25 operating rooms, serving 110 beds for ordinary recovery. Every year, about 1000, 500 and 250 surgeries are performed for prostate, bladder and kidney cancer, respectively. The clinical investigations performed in the last years leaded to the publication of 623 scientific contributions for a overall citation index of 6872 with a significant boost in the last three years (citation index last three years: 3113; h-index 40) [Source SCOPUS April 2010]. Every year, the Department substantially contributes with a significant number of accepted abstracts to the most important international and national meetings. The main clinical research areas consist of prostate cancer, kidney cancer, bladder cancer, infertility and andrology, female sexual medicine, benign prostatic hyperplasia. Ongoing and new translational researches has been starting after the birth of the Urological Research Institute (URI), headed by Professor Petter Hedlund. The main basic research areas consist of prostate and bladder cancer, functional urology, reproductive and erectile dysfunction. Francesco Montorsi DIVISION OF MOLECULAR ONCOLOGY - 23 Selected publications 9 Arcidiacono, PG; Calori, G; Carrara, S; McNicol, ED; Testoni, PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev.: 2009; -1: CD007519 – Review. IF 2008: 5,182 9 Breda, A; Finelli, A; Janetschek, G; Porpiglia, F; Montorsi, F.Complications of Laparoscopic Surgery for Renal Masses: Prevention, Management, and Comparison with the Open Experience. Eur. Urol.: 2009; 55(4): 836850 – Review. IF 2008: 6,512 9 Burger, JA; Ghia, P; Rosenwald, A; Caligaris-Cappio, F. The microenvironment in mature B-cell malignancies: A target for new treatment strategies. Blood: 2009; 114(16): 3367-3375 – Review. IF 2008: 10,432 9 Capitanio, U; Karakiewicz, PI; Jeldres, C; Briganti, A; Salonia, A; Cestari, A; Guazzoni, G; Rigatti, P; Montorsi, F. Suspected Clinical T3 Prostate Cancer Is Associated with a High Rate of Negative Extended Biopsies: Clinical Implications. Eur. Urol.: 2009; 55(1): 253-254 – Letter. IF 2008: 6,512 9 Chen, H; Ko, G; Zatti, A; Di Giacomo, G; Liu, L; Raiteri, E; Perucco, E; Collesi, C; Min, W; Zeiss, C; De Camilli, P; Cremona, O. Embryonic arrest at midgestation and disruption of Notch signaling produced by the absence of both epsin 1 and epsin 2 in mice. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(33): 13838-13843 – Article. IF 2008: 9,380 9 Ciceri, F; Bonini, C; Lupo Stanghellini, MT; Bondanza, A; Traversari, C; Salomoni, M; Turchetto, L; Colombi, S; Bernardi, M; Peccatori, J; Pescarollo, A; Servida, P; Magnani, Z; Perna, SK; Valtolina, V; Crippa, F; Callegaro, L; Spoldi, E; Crocchiolo, R; Fleischhauer, K; Ponzoni, M; Vago, L; Santoro, A; Todisco, E; Apperley, J; Olavarria, E; Slavin, S; Weissinger, EM; Hertenstein, B; Stadler, M; Yannaki, E; Fassas, A; Anagnostopoulos, A; Bregni, M; Gallo Stampino, C; Bruzzi, P; Bordignon, C. Early and effective immunorecovery after family haploidentical hemopoietic transplantation for leukemia by gene-engineered lymphocytes: the TK007 study. Lancet Oncol.: 2009; 10(5): 489-500 – Article. IF 2008: 13,283 9 Dagklis, A; Fazi, C; Sala, C; Cantarelli, V; Scielzo, C; Massacane, R; Toniolo, D; Caligaris-Cappio, F; Stamatopoulos, K; Ghia, P. The immunoglobulin gene repertoire of low-count chronic lymphocytic leukemia (CLL)like monoclonal B lymphocytosis is different from CLL: diagnostic implications for clinical monitoring. Blood: 2009; 114(1): 26-32 – Article. IF 2008: 10,432 9 Fanti, L; Agostoni, M; Gemma, M; Gambino, G; Facciorusso, A; Guslandi, M; Torri, G; Testoni, PA. Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: A randomized double-blind trial. Am. J. Gastroenterol.: 2009; 104(5): 1119-1124 – Article. IF 2008: 6,444 9 Ferreri, AJ; Reni, M; Foppoli, M; Martelli, M; Pangalis, GA; Frezzato, M; Cabras, MG; Fabbri, A; Corazzelli, G; Ilariucci, F; Rossi, G; Soffietti, R; Stelitano, C; Vallisa, D; Zaja, F; Zoppegno, L; Aondio, GM; Avvisati, G; Balzarotti, M; Brandes, AA; Fajardo, J; Gomez, H; Guarini, A; Pinotti, G; Rigacci, L; Uhlmann, C; Picozzi, P; Vezzulli, P; Ponzoni, M; Zucca, E; Caligaris-Cappio, F; Cavalli, F. High-dose cytarabine plus highdose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet: 2009; 374(9700): 1512-1520 – Article. IF 2008: 28,409 9 Gregorc, V; Santoro, A; Bennicelli, E; Punt, CJA; Citterio, G; Timmer-Bonte, JNH; Caligaris-Cappio, F; Lambiase, A; Bordignon, C; Van Herpen, CML. Phase Ib study of NGR-hTNF, a selective vascular targeting agent, administered at low doses in combination with doxorubicin to patients with advanced solid tumours. Br. J. Cancer: 2009; 101(2): 219-224 – Article. IF 2008: 4,846 9 Miluzio, A; Beugnet, A; Volta, V; Biffo, S. Eukaryotic initiation factor 6 mediates a continuum between 60S ribosome biogenesis and translation. EMBO Rep.: 2009; 10(5): 459-465 – Review. IF 2008: 7,099 9 Ponzoni, M; Dolcetti, R; Doglioni, C; Ferreri, AJM. Bugs and marginal zone lymphoma of the ocular adnexae: Is the future already here? Blood: 2009; 114(16): 3499 – Letter. IF 2008: 10,432 9 Reni, M; Cereda, S; Balzano, G; Passoni, P; Rognone, A; Zerbi, A; Nicoletti, R; Mazza, E; Arcidiacono, PG; 24 - SAN RAFFAELE SCIENTIFIC INSTITUTE Di Carlo, V; Villa, E. Outcome of upfront combination chemotherapy followed by chemoradiation for locally advanced pancreatic adenocarcinoma. Cancer Chemother. Pharmacol.: 2009; 64(6): 1253-1259 – Article. IF 2008: 2,740 9 Vago, L; Perna, SK; Zanussi, M; Mazzi, B; Barlassina, C; Stanghellini, MTL; Perrelli, NF; Cosentino, C; Torri, F; Angius, A; Forno, B; Casucci, M; Bernardi, M; Peccatori, J; Corti, C; Bondanza, A; Ferrari, M; Rossini, S; Roncarolo, MG; Bordignon, C; Bonini, C; Ciceri, F; Fleischhauer, K. Loss of mismatched HLA in leukemia after stem-cell transplantation. N. Engl. J. Med.: 2009; 361(5): 478-488 – Article. IF 2008: 50,017 9 Villablanca, EJ; Raccosta, L; Zhou, D; Fontana, R; Maggioni, D; Negro, A; Sanvito, F; Ponzoni, M; Valentinis, B; Bregni, M; Prinetti, A; Steffensen, KR; Sonnino, S; Gustafsson, JA; Doglioni, C; Bordignon, C; Traversari, C; Russo, V. Tumor-mediated liver X receptor-alpha activation inhibits CC chemokine receptor-7 expression on dendritic cells and dampens antitumor responses. Nat. Med.: 2010; 16(1): 98-105 – Article. IF 2008: 27,553 DIVISION OF MOLECULAR ONCOLOGY - 25 Lymphoid organ development Immuno-biotherapy of melanoma and solid tumors Unit Tumor biology and vascular targeting Unit Pancreatic cancer Unit: biology and new therapeutic approaches DIVISION OF NEUROSCIENCE - 27 DIVISION OF NEUROSCIENCE Director: Gianvito Martino Associate Director: Flavia Valtorta * Research Units Neuropsychopharmacology Unit HEAD OF UNIT: Flavia Valtorta* POST-DOCTORAL FELLOW: Francesca Botti PHD STUDENTS: Serena Bellani**, Eugenio Fornasiero** FELLOW: Fabrizia Guarnieri TECHNICIAN: Elena Monzani Cell adhesion Unit HEAD OF UNIT: Ivan De Curtis* POST-DOCTORAL FELLOW: Roberta Pennucci PHD STUDENTS: Claudia Asperti**, Antonio Totaro** FELLOWS: Veronica Astro, Luisa Micheletti TECHNICIANS: Sara Corbetta, Diletta Tonoli Cellular and molecular neurobiology Unit HEAD OF UNIT: Jacopo Meldolesi* RESEARCHER: Paola Podini PHD STUDENT: Ilaria Prada** FELLOWS: Rosalba D’Alessandro, Joanna Mikulak, Sara Negrini TECHNICIANS: Anna Lorusso, Gabriella Racchetti Cellular neurophysiology Unit HEAD OF UNIT: Fabio Grohovaz* RESEARCHER: Daniele Zacchetti PHD STUDENTS: Barbara Bettegazzi**, Romina Macco**, Ilaria Pelizzoni** FELLOW: Alessandra Consonni** TECHNICIAN: Franca Codazzi Developmental neurogenetics Unit HEAD OF UNIT: Gian Giacomo Consalez PHD STUDENTS: Ilaria Albieri**, Valeria Barili** FELLOWS: Sara Dentali, Luca Massimino, Rosina Paterra TECHNICIANS: Aurora Badaloni, Laura Croci Neurobiology of learning Unit HEAD OF UNIT: Antonio Malgaroli* RESEARCHER: Vincenzo Zimarino PHD STUDENTS: Marcello Belfiore **, Mattia Ferro, Maddalena Ripamonti Proteomics of iron metabolism Unit HEAD OF UNIT: Sonia Levi* RESEARCHERS: Anna Cozzi, Paolo Santambrogio PHD STUDENT: Alessandro Campanella** FELLOW: Elisabetta Rovelli 28 - SAN RAFFAELE SCIENTIFIC INSTITUTE Molecular genetics of mental retardation Unit (Dulbecco Telethon Institute) GROUP LEADER: Patrizia D’Adamo POST-DOCTORAL FELLOW: Maila Giannandrea PHD STUDENT: Veronica Bianchi FELLOWS: Maria Lidia Mignogna, Elena Carlotta Vismara Neural degeneration Unit (Dulbecco Telethon Institute) GROUP LEADER: Manolis Fanto PHD STUDENTS: Piera Calamita**, Ilaria Nisoli**, Simona Occhi FELLOW: Francesco Napoletano Stem cells and neurogenesis GROUP LEADER: Vania Broccoli PHD STUDENTS: Gaia Colasante**, Serena Giannelli**, Sara Ricciardi**, Alessandro Sessa** FELLOWS: Giorgia Colciago, Bruno Di Stefano, Sara Lopalco, Federica Ungaro Clinical Research Units Acute brain protection, Acute post-operative pain, Drugs and central nervous system Unit HEAD OF UNIT: Luigi Beretta* PHYSICIANS: Massimo Agostoni, Maria Rosa Calvi, Assunta De Vitis, Marco Gemma, Davide Poli Eye repair Unit HEAD OF UNIT: Paolo Rama CONSULTANTS: Federica Ferrario, Chiara Insacco, Stanislav Matuska, Giorgio Paganoni, Maurizia Viganò Cognitive neuroscience Unit HEAD OF UNIT: Stefano F. Cappa* RESEARCHERS: Jubin Abutalebi*, Nicola Canessa, Andrea Moro* PHYSICIANS: Maria Cristina Giusti, Sandro Iannaccone, Marco Lacerenza, Alessandra Marcone, Michele Zamboni POST-DOCTORAL FELLOW: Pasquale Della Rosa, PHD STUDENTS: Federica Alemanno**, Eleonora Catricalà, Rosa Manenti** Experimental neurosurgery Unit HEAD OF UNIT: Pietro Mortini* PHYSICIANS: Stefania Acerno, Lina Raffaella Barzaghi, Nicola Boari, Camillo Ferrari da Passano, Alberto Franzin, Lorenzo Gioia, Marco Losa, Carlo Mandelli, Piero Picozzi, Micol Valle PHD STUDENT: Silvia Snider** RESIDENTS: Paola Castellazzi, Elena Colombo, Angelica Dipinto, Filippo Gagliardi, Lucio Aniello Mazzeo, Marzia Medone, Davide Milani, Alda Rocca, Carlo Serra Functional neuroradiology Unit HEAD OF UNIT: Andrea Falini* PHYSICIANS: Nicoletta Anzalone, Cristina Baldoli, Valeria Blasi, Silvia Pontesilli, Roberta Scotti, Paolo Vezzulli PHD STUDENT: Monia Cabinio** RESIDENTS: Antonella Castellano, Elisa Scola TECHNICIAN: Antonella Iadanza** In vivo Human molecular and structural neuroimaging Unit HEAD OF UNIT: Daniela Perani* RESEARCHER: Marco Tettamanti PHD STUDENT: Monica Consonni** POST-DOCTORAL FELLOW: Cristina Saccuman DIVISION OF NEUROSCIENCE - 29 FELLOWS: Elena Maria Andreolli, Danilo Spada Neuroothology Unit HEAD OF UNIT: Mario Bussi* PHYSICIAN: Lucia Oriella Piccioni CONSULTANTS: Fabrizio Ferrario, Annalisa Meli, Roberto Teggi Psychiatry and clinical neurosciences Unit HEAD OF UNIT: Francesco Benedetti Psychiatry and clinical psychobiology HEAD OF UNIT: Francesco Benedetti PHYSICIANS: Ilaria Aina, Sara Angelone, Cinzia Arancio, Barbara Barbini, Laura Bellodi*, Alessandro Bernasconi, Laura Bianchi, Marta Bosia, Stefania Cammino, Marco Catalano, Roberto Cavallaro, Maria Cristina Cavallini, Mara Cigala Fulgosi, Federica Cocchi, Cristina Colombo, Michele Cucchi, Sara Dallaspezia, Stefano Erzegovesi, Linda Franchini, Marta Henin, Laura Liperi, Marco Locatelli, Adelio Lucca, Fausto Panigada, Ernestina Politi, Adriana Pontiggia, Laura Sforzini, Enrico Smeraldi*, Raffaella Zanardi PHD STUDENTS: Elisa Galimberti, Sara Poletti POST DOCTORAL FELLOWS: Francesco Fresi, Daniele Radaelli. FELLOWS: Margherita Bechi, Vittoria Bottelli, Paola Canali, Ursula Catenazzi, Daniele Cavadini, Emma Fadda, Marcello Florita, Chiara Gavinelli, Stefania Ozino, Giulia Paredi, Adele Pirovano, Roberta Riccaboni, Tomaso Siccardi RESIDENTS: Giampiero Bottero, Dario Del Monte, Clara Locatelli, Alessia Malaguti, Chiara Ruffini, Irene Vanelli TECHNICIAN: Cristina Lorenzi Sleep medicine CLINICAL GROUP LEADER: Luigi Ferini-Strambi* RESEARCHERS: Vincenza Castronovo, Mauro Manconi, Alessandro Oldani, Marco Zucconi PHD STUDENT: Sara Marelli TECHNICIANS: Massimo Antonio, Daniele Bizzozero, Elisa Dallabà, Cristina Martinelli Clinical psychology CLINICAL GROUP LEADER: Cesare Maffei* RESEARCHERS: Marco Battaglia*, Andrea Fossati*, Mariagrazia Movalli, Anna Ogliari*, Laura Vanzulli, Raffaele Visintini RESIDENTS: Roberta Alesiani, Silvia Boccalon, Naima Coppolino, Maria Chiara Fiorin§, Gianluca Franciosi, Laura Giarolli, Valeria Parlatini, Paola Pesenti-Gritti§, Chiara Spatola§, Martina Testa. §EXTERNAL RESIDENTS Motor function rehabilitation CLINICAL GROUP LEADER: Roberto Gatti PHYSICAL THERAPIST: Andrea Tettamanti 30 - SAN RAFFAELE SCIENTIFIC INSTITUTE INSPE, Institute of Experimental Neurology Director: Giancarlo Comi* Research Units Experimental neurology Unit HEAD OF UNIT: Giancarlo Comi* Experimental neuropathology GROUP LEADER: Angelo Quattrini PHD STUDENTS: Federica Cerri, Nilo Riva** TECHNICIAN: Giorgia Dina Experimental neurophysiology GROUP LEADER: Letizia Leocani BIOENGINEER: Marco Cursi PHD STUDENTS: Ninfa Amato**, Marco Cambiaghi**, Alberto Inuggi, Sinem Kara, Svetla Velikova FELLOW: Javier Gonzalez-Rosa RESIDENTS: Mariangela Bianco, Raffaella Chieffo, Francesca Spagnolo, Laura Straffi TECHNICIAN: Samantha Guzzoni Molecular genetics of behaviour GROUP LEADER: Riccardo Brambilla* PHD STUDENTS: Raffaele D'Isa**, Daniel Orellana**, Alessandro Papale** FELLOW: Stefania Fasano TECHNICIAN: Marzia Indrigo Neuromuscular repair GROUP LEADER: Stefano Carlo Previtali POST-DOCTORAL FELLOW: Domi Teuta PHD STUDENT: Emanuela Porrello** RESIDENT: Ignazio Diego Lopez TECHNICIAN: Isabella Lorenzetti Neuroimmunology Unit HEAD OF UNIT: Gianvito Martino RESEARCHER: Luca Muzio POST-DOCTORAL FELLOW: Erica Butti PHD STUDENTS: Cecilia Laterza**, Cinzia Marinaro**, Annamaria Nigro** TECHNICIANS: Andrea Bergamaschi, Elena Brambilla Clinical neuroimmunology GROUP LEADER: Roberto Furlan PHD STUDENTS: Giuseppe De Santis, Livia Garzetti, Chiara Maiorino RESIDENT: Dacia Dallalibera TECHNICIANS: Alessandra Bergami CNS repair GROUP LEADER: Stefano Pluchino PHD STUDENTS: Chiara Cossetti, Melania Cusimano, Elena Giusto, Lucia Zanotti RESIDENTS: Marco Bacigaluppi, Luca Peruzzotti Jametti TECHNICIAN: Giuliana Salani DIVISION OF NEUROSCIENCE - 31 Neuroimaging research Unit HEAD OF UNIT: Massimo Filippi BIOENGINEERS: Elisabetta Pagani, Paola Valsasina RESIDENTS: Martina Absinta, Sebastiano Galantucci FELLOWS: Federica Agosta**, Elisa Canu**, Giulia Longoni**, Michela Pievani**, Paolo Preziosa**, Stefania Sala**, Lidia Sarro** TECHNICIANS: Luca Dall’Occhio, Alessandro Meani, Melissa Petrolini, Ilaria Taffi, Roberto Vuotto Neuroimaging of CNS white matter GROUP LEADER: Maria Assunta Rocca PHD STUDENT: Gianna Riccitelli** TECHNICIANS: Paolo Misci, Mauro Sibilia Human inherited neuropathies Unit (Dulbecco Telethon Institute) HEAD OF UNIT: Alessandra Bolino PHD STUDENTS: Annalisa Bolis, Silvia Coviello, Ilaria Vaccari FELLOWS: Patrizia Cassella, Enrico Fragasso, Lara Piantoni Axo-Glia interactions Unit (FISM) GROUP LEADER: Carla Taveggia POST-DOCTORAL FELLOW: Amelia Trimarco TECHNICIAN: Rosa La Marca Clinical Research Units Inflammatory CNS disorders Unit HEAD OF UNIT: Vittorio Martinelli RESEARCHERS: Filippo Martinelli-Boneschi, Lucia Moiola, Mariaemma Rodegher PHYSICIAN: Paolo Rossi PHD STUDENTS: Federica Esposito**, Marta Radaelli** RESIDENTS: Elda Judica, Elisabetta Stefania Perego Cerebrovascular disorders CLINICAL GROUP LEADER: Maria Sessa RESEARCHER: Francesco Corea PHYSICIANS: Silvia Mammi, Antonella Poggi, Luisa Roveri PHD STUDENT: Grazia Nuzzaco**, Maria Carmela Spinelli** RESIDENTS: Chiara Ghidinelli, Sara La Gioia Memory disorders CLINICAL GROUP LEADER: Giuseppe Magnani RESIDENTS: Francesca Caso, Elisabetta Coppi, Chiara Vismara Movements disorders CLINICAL GROUP LEADER: Ubaldo Del Carro PHYSICIANS: Stefano Amadio, Roberta Guerriero, Stefania Medaglini, Maria Grazia Natali Sora, Maria Antonietta Volontè RESIDENTS: Calogera Butera, Luisa De Toni Franceschini, Habtom Tesfaghebriel, Daniela Ungaro Neuromuscular disorders CLINICAL GROUP LEADER: Raffaella Fazio PHYSICIANS: Fabio Formaglio, Patrizia Dacci PHD STUDENT: Daniela Privitera** Paroxysmal events CLINICAL GROUP LEADER: Fabio Minicucci PHYSICIANS: Bruno Colombo, Giovanna Franca Fanelli, Fabio Formaglio, Paolo Marchettini RESIDENTS: Maria Grazia Deriu, Giulia Pavan * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 32 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Directors The brain is by far the most complex organ in our body, and, in addition, it is one of the least accessible. These two facts, together with the fact that neurons are post-mitotic cells and therefore cannot be expanded in vitro, have hampered neuroscience research, which for a long time has been lagging behind research in other fields. The mission of the Division of Neuroscience is to be able to integrate morphological with functional and biochemical aspects of the nervous system in Gianvito Martino healthy and pathological conditions, from the molecular to the clinical level. This integration, which requires a strong basic research, will also have important consequences for translational research, allowing the development of new therapies and new diagnostic markers. Integration among morphology, function and neurochemistry – in both healthy and diseased nervous system – will be first of all pursued in the following prioritized research areas: 1. evaluation of the physiological maturation and aging processes of the CNS and the assessment of the different pathological substrates (inflammation vs. degeneration) of the main neurological and psychiatric diseases; 2. combination of powerful new stem cell isolation and gene transfer approaches to state-of-the-art neuroimaging, immunological and neurophysiological readouts to test new therapeutic strategies in relevant animal model of neurodegenerative diseases; 3. understanding how a functional nervous system is generated during development to better understand the basis of neurological and psychiatric pathologies linked to developmental defects (e.g. mental retardation, schizophrenia, and bipolar disorders); 4. investigation of cellular and molecular mechanisms sustaining neurodeFlavia Valtorta generation to identify new therapeutic targets to be translated into new neuroprotective therapies. An important role in bridging the gap between advancements in our understanding of the mechanisms of brain functioning and our understanding of the pathogenesis of human neurological disorders (and the development of novel therapeutic strategies) will be played by the development of animal models which are amenable to studies ranging from the molecular to the neurophysiological and behavioural level. This will be coupled with efforts finalized at integrating neurophysiological and neuroimaging tools at both the micro- and macro-scopic levels, developing novel therapeutic tools, and performing phase I and phase II trials. The vision of the Division of Neuroscience is to achieve, within three-five years the followings aims: 1. to accomplish the cultural integration between basic and clinical research in the above-mentioned neuroscience areas; 2. to continue to support a gold standard educational program for graduate students in the field of neuroscience and experimental neurology; 3. to consolidate the current research areas of scientific excellence such as nervous system regeneration, brain imaging, cognitive neuroscience, cell biology of the neuron and glial cells, and neuroinflammation; 4. to build a competitive research in the fields of neurodegeneration and of developmental neurobiology; 5. to develop strong pre-clinical research in psychiatric and behavioural disorders. DIVISION OF NEUROSCIENCE - 33 To reach the ambitious aims we are proposing we plan to systematically assess the progress of existing staff and the achievement of the proposed milestones. Furthermore, we plan to recruit excellent investigators in selected key fields and the continuous implementation of technological platforms and facilities. 34 - SAN RAFFAELE SCIENTIFIC INSTITUTE Research Units NEUROPSYCHOPHARMACOLOGY UNIT Comprehensive goal of our research is the elucidation of the molecular mechanisms which underlie communication between cells of the brain, both in the adult and during development. The main form of communication between neurons is achieved through regulated secretion of neurotransmitter occurring at synapses. This process is therefore of paramount importance for information processing in the central nervous system and is known to be deranged in a number of pathological states. In the past year research in our group has focused on two main topics: Diseases of synaptic origin. 1) Synapsins are a family of brain phosphoproteins involved in neurotransmitter release through regulation of synaptic vesicle availability. Synapsin KO mice develop an epileptic phenotype, and a mutation in the human synapsin I gene has been recently associated with epilepsy. We have found that mutant synapsin I is subject to nonsense-mediated mRNA decay (NMD). However, the protein which escapes NMD exhibits neurotoxic properties. 2) α-synuclein is a cytosolic protein highly abundant in the brain whose overexpression or mutation participate in the pathogenesis of Parkinson’s disease. We have found that wild type and A30P mutated synuclein profoundly affect actin cytoskeleton dynamics in a differential manner. Since the actin cytoskeleton regulates several aspects of synaptic function, its disorganization may be responsible for the synaptic pathology which is an early hallmark of neurodegeneration. Membrane trafficking in neuronal development. The establishment of a polarized cellular organization is required from the earliest steps of neuronal growth to achieve proper differentiation. We have found that a number of dynamic membrane paths including directional traffic, high-capacity exocytosis and endocytosis are polarized already in morphologically undifferentiated neurons and their presence correlates with the emergence of the axon. Our data suggest that these membrane paths might regulate a set of adhesion molecules required for the polarized migration of neurons. Flavia Valtorta CELL ADHESION UNIT Molecular mechanisms for the regulation of cell migration, invasion, and neuronal development Rho GTPases are implicated in cell motility and neuronal differentiation. We have shown that two Rac genes are needed for neuronal and mammalian brain development. The analysis of the 3 lines of mice with mutation in the Rac3 gene (Rac3KO), conditional mutation of Rac1 in neurons (Rac1N), or mutation of both GTPases (Rac3KO/Rac1N) has shown that while single mutant mice develop normally, double KO mice are heavily impaired neurologically. Recent analysis of these mice has revealed alterations also in the interneuronal network, with strong decrease in the number of specific populations of cortical and hippocampal GABAergic cells, important for normal brain function. This defect may contribute to the epileptic phenotype observed in double KO mice, and supports the requirement of two Rac genes for neuronal development in mammals. The multi-molecular GIT complexes are involved in the regulation of cell migration. These complexes are assembled by the multi-domain GIT1 or GIT2 proteins, which interact functionally with Arf and Rac GTPases. We have analyzed the function of the GIT/PIX complexes in the early neuronal development. We observed a specific inhibition of neuritogenesis by depletion by RNA interference of either GIT2 or αPIX, while silencing of GIT1 or βPIX, respectively, did not induce an appreciable effect. Liprin-α1 belongs to a family of adaptor proteins involved in the assembly of neuronal synapses and in the or- DIVISION OF NEUROSCIENCE - 35 ganization of focal adhesions. We found that Liprin-α1 positively regulates motility, while its downregulation prevents spreading and formation of lamellipodia. Further analysis has shown the requirement of Liprin-α1 for the invasive behavior of breast cancer cells, and the high expression of this protein in human tumors. Interestingly, liprin-α1 affects the behavior of invasive cells not only by regulating their motility, but also by affecting the degradation of the extracellular matrix associated to invadopodia. The comprehensive molecular/cellular analysis performed by us is establishing Liprin-α as an essential regulator of migration and invasion, and as a novel candidate marker of tumor progression. Ivan De Curtis CELLULAR AND MOLECULAR NEUROBIOLOGY UNIT Role of REST in the physiology and pathology of nerve cells The interest of the Unit is focussed on the transcription factor REST and on its role in the functional cell biology of nerve cells. In previous studies we had demonstrated that REST governs the expression of neurosecretion since many genes coding for the proteins of the secretory vesicles and of their exocytosis are repressed as long as REST is high, a condition typical of non-nerve cells, and are expressed only when REST drops, as it occurs during nerve cell maturation. In the last year we have shown that, in addition, high REST governs positively the expression of another type of exocytic vesicle that we discovered years ago, the enlargesome, and that exocytosis of this vesicle sustains a new form of growth of neurites that occurs not only in neurosecretory cell lines, but also in neurons of the embryonal brain and in primary neuronal cultures shortly after their seeding. This result demonstrates that the membrane traffic processes that sustain neurite outgrowth are at least two, one (occurring at an early phase) sustained by the exocytosis of enlargesomes, the other (predominant later on) by the exocytosis of vesicles rich in VAMP7, as reported previously by others. The second line of research concerns the role of REST in the transformation of nerve cell tumors, in particular medullo and neuroblastomas. Here we have discovered that high REST induces a decrease of another important factor, TSC2. Interestingly, low TSC2 induces the increase of β-catenin and of its transcription (with TCF) of several genes, including REST. Therefore, the three factors are strictly linked to each other and their interaction seems to govern the transformation. Finally we have tackled the problem of astrocytes, a type of non-excitable cells that appear to be competent for neurosecretion. We have found that in those cells the levels of REST are variable, from low as in neurons to high as in non-nerve cells. Only the low REST astrocytes appear to be neurosecretory, as suggested also by the appearance of specific neurosecretory vesicles in cultured astrocytes transfected with a dominant negative construct of the repressor. These results explain mechanistically a problem that has been intensely investigated and discussed in the astrocyte field during the last 15 years. Jacopo Meldolesi CELLULAR NEUROPHYSIOLOGY UNIT Physiopathological mechanisms in neuroprotection and neurodegeneration The research of our unit is aimed to understand the molecular mechanisms of neurodegeneration and neuroprotection. We mainly focused on Alzheimer’s disease, the most frequent form of dementia, and on iron-mediated oxidative stress, a harmful condition observed during aging and shared by several diseases of the central nervous system, including stroke and Parkinson. Regarding Alzheimer’s disease, we investigated BACE1, the β-secretase responsible for the production of the neurotoxic amyloid-β peptides that accumulate in the brain of the patients. In particular, we studied how BACE1 expression is controlled in neurons and astrocytes, with special attention to the translational mechanisms. A parallel project on the effects of amyloid-β revealed that fibrillar amyloid targets microglial cells and that activation of these cells triggers the release of various molecules that might harm neurons. For this reason, we performed a characterization of the molecular mechanisms of glia activation by investigating: different pro- 36 - SAN RAFFAELE SCIENTIFIC INSTITUTE tocols of stimulation leading to specific phenotypes; the underlying intracellular pathways; the upregulation of proteins and the release of molecules in the extracellular milieu. As for iron-mediated oxidative stress, we studied the pathways of Fe2+ entry in neurons and the consequences of iron accumulation in terms of ROS accumulation, Ca2+ changes and cell death. We demonstrate that Fe2+ can enter neurons through both Voltage Operated Calcium Channels and, during strong synaptic activity, NMDA receptors. Our results show that neuronal death is due to iron-mediated ROS production and point to mitochondria as the main target of iron toxicity. In a related project we are also studying the effects mutations in the ferritin light chain (inherited in the hereditary neuroferritinopathy disease) have in iron control and overall neuronal survival (in collaboration with the Proteomics of iron metabolism Unit). Fabio Grohovaz DEVELOPMENTAL NEUROGENETICS UNIT The cerebellum as a model for the study of neurogenesis and CNS regeneration The cerebellum as a model for the study of neurogenesis and CNS regeneration. The cerebellum is a highly plastic system. Recent observations show that exogenous Purkinje cells (PCs) integrate productively and establish proper synaptic connections with their afferents and post-synaptic targets, when grafted to a host cerebellum. Several neurodegenerative cerebellar ataxias feature a selective, cell-autonomous loss of PCs, warranting the development of experimental cell replacement strategies in model organisms. Our laboratory, in collaboration with F. Rossi’s lab (U. of Turin) is setting up protocols for Purkinje cell transplantation in wild type mice and murine models of neurodegenerative ataxias (SCA2). In parallel, we are continuing our analysis of regulatory pathways involed in normal cerebellar development. Factors controlling early stages of cerebellar neurogenesis. The neurogenetic cascades controlling PC development are still poorly understood, partially hampering the design of rational protocols for cell replacement. Through the analysis of mutant mouse lines featuring genetic defects in cerebellar development, our group is contributing to the analysis of pathways regulating early and late stages of cerebellar neurogenesis. A study just completed has revealed that one gene, Zfp423, whose mutation causes a severe cerebellar malformation, works at the intersection of Notch and BMP signaling pathways, regulating their interaction in neural cells (Masserdotti, Badaloni et al., in revision). In a parallel study, taking advantage of a knock-in line generated in our lab, we are applying genetic inducible fate mapping to characterize the eventual fate of progenitors positive for neurogenin 2 (Neurog2), a proneural gene expressed in the cerebellar ventricular zone during developmental neurogenesis. These studies have revealed that Neurog2+ progenitors give rise to a specific subset of cerebellar GABA neurons (Leto et al., in preparation). Further functional studies will clarify the specific role of this transcription factor in cerebellar neurogenesis. These studies will permit the isolation of a highly enriched population of committed PC progenitors for use in experimental cell replacement. ➥ Figure 2. Progenitors tagged during early embryogenesis by a genetic inducible fate mapping approach develop into mature Purkinje neurons in the adult cerebellar cortex. DIVISION OF NEUROSCIENCE - 37 Factors controlling PC survival in development. Insulin-like growth factor 1 (IGF1) is an anabolic factor playing important roles in the context of neuronal development, physiology, survival and degeneration. Mice carrying a null mutation in the Ebf2 gene, encoding an helix-loop-helix transcription factor important for cerebellar development (Croci et al., 2006; Chung et al., 2008; Chung et al., 2009), lose IGF1 expression in PCs at birth. We have characterized the regulation of local IGF1 transcription and its role in antagonizing PC apoptosis, regulating their metabolism and signal transduction (Croci et al., accepted). At birth, PCs initiate a series of major changes in their morphology, connectivity and function, sharply upregulating their protein synthesis activity. The acute requirement for locally produced IGF1 by PCs in the transition between pre- and postnatal life warrants further studies of this factor’s specific role(s) in the regulation of PC homeostasis and survival. Gian Giacomo Consalez NEUROBIOLOGY OF LEARNING UNIT A novel family of indicators to monitor synaptic activity in vivo Every human behavior depends on an activity change in one or more brain areas, often with the contribution of very small subgroups of cells and synapses. Conversely, when a brain disease modifies a behavioral aspect, inevitably this effect arises from a change in neural activity. Hence, viewing the fine structure of the brain by the most advanced imaging techniques is certainly important but it would be more important to find some effective way to detect changes in neuronal and synaptic activity during both physiological and pathological processes. Unfortunately techniques available today to monitor brain function, such as E.E.G., fMRI, fNIRS, etc., either sample brain activity very indirectly, through changes in metabolism and blood flow, or do not have the resolution which is required to reveal changes in small networks of neuronal cells and synapses. For the above reasons, the demand for a methodology that could yield a more direct readout of in vivo neuronal and synaptic activity is extremely high. We have recently developed a methodology that provides a very direct and sensitive readout of brain activity. This is based on a family of recombinant molecules which were designed in our lab to detect synaptic activaton via the uptake of small exogenous markers. This methodology is capable of revealing the physiological activation of brain synaptic networks with very high sensitivity and resolution. In collaboration with the Unit of Developmental Neurogenetics directed by Gian Giacomo Consalez we are generating a series of transgenic animal models that will be used for the selective probing of specific subgroups of neuronal cells and pathways in the in-vivo brain. Antonio Malgaroli PROTEOMICS OF IRON METABOLISM UNIT Ferritins and iron in neurodegenerative disorders The brain expresses virtually all the proteins involved in the iron regulatory mechanisms, and it is characterized by limited iron exchanges. Excess iron is thought to catalyze the formation of reactive oxygen species and induce oxidative damage, to which the brain is particularly sensitive, and that is a common denominator in many neurodegenerative disorders. In these disorders, local alterations of levels of iron or of the proteins of iron metabolism (particularly ferritins) have been often reported, but it is unclear whether this is the cause or a consequence of the degeneration processes. Neuroferritinopathies, genetic defects connected with neurodegeneration and brain iron accumulation, is due to altered L-ferritin, a molecule that is central to the regulation of cellular iron homeostasis. We have developed cellular and animal models of this disease with the aim to study the relationship between brain iron misregulation and neurodegeneration The cellular models include HeLa and neuroblastoma cells lines that overexpress L-ferritin wild type (FTL-wt) and two different pathogenic variants (FTL460InsA and 498InsTC). They showed some characteristics found in the patients tissues, including the formation of ferritin aggregates. Characterization of these models suggested that the pathogenicity of the variants acts through iron imbalance and consequent oxidative damage, while the ferritin aggregates does not 38 - SAN RAFFAELE SCIENTIFIC INSTITUTE seem to be toxic. Transgenic mice expressing human wt-FTL and two mutants (460InsA and 498InsTC) were obtained and their preliminary characterization indicated that high levels of transgene expression were detected in brain and peripheral organs, suggesting that they may represent a model for the human disorder. We also continued the characterization of the physiological role of the mitochondrial ferritin (FtMt), demonstrating its protective effect against iron-mediated oxidative damage in Friedreich ataxia patient’s fibloblasts. Futhermore, analyzing human substantia nigra (SN) and putamen autoptic samples from Restless Legs Syndrome (RLS) cases and controls, we detected the increase of FtMt levels and number of mitochondria in the SN of RLS respects the controls samples, suggesting that it may be involved in the pathogenesis of RLS. Sonia Levi MOLECULAR GENETICS OF MENTAL RETARDATION UNIT Our research is focused on the understanding of the molecular mechanisms responsible for X-linked Mental Retardation (XLMR), a common cause of inherited intellectual disability in the human population, with a reported prevalence of about 0,9-1,4/1000 males. In the last years, we have showed that mutations in GDI1, one of the protein controlling the recycling of small RAB GTPases, are responsible for XLMR. The that lack of αGDI in animal models alters cognitive functions and the biogenesis and recycling of synaptic vesicles. We were able to reverse the specific short-term memory deficit of Gdi1 KO mice by using a “spaced” instead to “massed” cognitive training protocol, suggesting that the lack of Gdi1 alters steps controlling the formation and maintenance of the SV pools possibly through changes in the Rab cycle and interfering with the efficiency of mental processing (Bianchi et al., HMG 2009). The association of GDI1 mutations with XLMR led us to test the hypothesis that X-linked RAB genes highly expressed in brain could also be involved in XLMR. This was confirmed by the discovery of mutations in RAB39B in XLMR patients and of a novel role for this RAB GTPase of unknown function in normal neuronal development and synapses formation and maintenance (Giannadrea et al., AJHG 2010). Genetic, biochemical, functional and behavioural approaches will be used to unravel the pathogenetic role of RAB39B. From these studies we expect to gain novel insights into the molecular mechanisms regulating synapse formation and to link them to learning and memory processes. Patrizia D’Adamo NEURAL DEGENERATION UNIT Dentatorubropallidoluysian Atrophy (DRPLA) is a neurodegenerative disease caused by the expansion of a polyglutamine tract in the Atrophin-1 gene. As for the other diseases of the polyglutamine family the precise mechanisms through which neurodegeneration and the neurological manifestations arise are not clear. To address these issues we have generated several Drosophila models for DRPLA by expressing wt and mutated forms of human Atrophin-1 and Drosophila Atro. We have used the fly retinal neurons to analyse the cellular mechanism of neurodegeneration by polyglutamine Atrophins. We have reported (Nisoli et al. Cell Death Diff. 2010) that Atrophins interefere with the autophagic flux blocking digestion of the autophagic organells after fusion with the lysosomes. Thus in our models DRPLA shares toxic mechanisms proper of lysosomal storage disorders, which set it apart from other polyglutamine diseases like huntington. This has also important therapeutical consequences as it predicts that pharmacological therapies currently considered that woul stimulate further autophagy to rescue neurodegeneration would not be effective for DRPLA. We also continue our investigations on the role of Fat and its pathway in mediating neurodegeneration by polyglutamine Atrophin focusing on the role of cell size control as an event which precedes neurodegeneration. Finally in collaboration with Dr. Muzio at INSPE we are developing a model for Blood Brain Barrier (BBB) breakdown in Drosophila which would allow to use flies to identify critical components for BBB homeostasis. Manolis Fanto DIVISION OF NEUROSCIENCE - 39 STEM CELLS AND NEUROGENESIS Exploiting genetic reprogramming to generate human iPS cells for modeling genetic disorders and for therapeutic cell transplantations A formidable approach named genetic reprogramming has been recently devised to generate embryonic stem-like cells (iPS) from mouse and human fibroblasts cells by stable retroviral expression of a cocktail of ES specific genes. iPS cells offer remarkable promises as a new source of stem cells with the following features (a) autologous stem cells from donor patient fibroblasts, (b) extensive self-renewal in vitro, (c) ability to differentiate into a wide spectrum of functional cell types relevant for therapy, (d) generation of embryonic stem-like cells without using preimplantation embryos. Furthermore, iPS technology offers also an unprecedented opportunity to recapitulate both normal and pathologic human tissue formation in vitro, thereby facilitating disease investigation and drug development. Our group has established all the procedures for a reliable and efficient generation of mouse and human iPS cells starting from a variety of somatic mature cells. Various reprogramming vectors have been tested including a single vector containing three genes fused with 2A peptide sequences and flanked with loxP sites. This last vector has allowed to generating effectively factor-free human iPS cell lines after its removal trough Cre expression. We have generated iPS cell lines from somatic cells of a variety of genetic diseases including Parkinson and Rett Syndrome. In particular, we have established iPS cell lines from Rett syndrome patients with mutation in the Cdkl5 gene. Our lab has shown that Cdkl5 is influencing gene splicing rate as well as synapse establishment in mouse neurons. Thus, we are assessing whether similar impairments are notable in patient-specific iPS cells. Further, we showed that iPS cells can be efficiently differentiated into neural precursor cells, giving rise to neuronal and glial cell types in culture. Furthermore, iPS cells were induced to differentiate into dopamine neurons of midbrain character and were able to improve behavior in a rat model of Parkinson’s disease upon transplantation into the adult brain. These results offer the scientific ground for further exploring human iPS cells for transplantations in Parkinson’s disease. Vania Broccoli Figure 3. Rosettes-like structures organized by neural progenitors derived by direct in vitro cell differentiation of human iPS cells. ZO-1 immunofluorescence staining (purple) highlights the apical cellular domains where cell junctions are specifically localized lying on the most internal side of the rosettes. DAPI nuclear staining is in blue. 40 - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units ACUTE BRAIN PROTECTION, ACUTE POST-OPERATIVE PAIN, DRUGS AND CENTRAL NERVOUS SYSTEM UNIT Anesthesia and intensive care: head and neck Clinical research areas • Prognosis of diffuse axonal injury after trauma by MRI (prospective observational study). • Cerebral perfusion before and after cranioplasty in patients previously submitted to osteo-dural decompression to control high intracranial pressure (prospective observational study). • Troponine and BNP after major elective neurosurgery (prospective observational study). • Cerebral perfusion after major elective neurosurgery in patients submitted to normo- or hyper-ventilation during surgery (randomized controlled study). • Partecipation to the multicenter prospectic database “Neurolink” of patients admitted to neurosurgical Intensive Care Units after severe head injury. • Partecipation to the multicenter prospectic study “Neuromorfeo” (randomized comparison between total intravenous and inhalation anesthesia during major elective neurosurgery). • Effects of propofol on “functional MRI” in 4-8 ys old children submitted to sedation to accomplish neuroradiological examination (prospective observational study). • Effects of propofol and thiopental on “functional MRI” in 1-4 ys old children submitted to sedation to accomplish neuroradiological examination (randomized controlled study). • Physiopathology of mechanical ventilation during ENT surgery with laser-proof endotracheal tubes (prospective observational study). • Systemic complications during catharact surgery under local anesthesia (prospective observational study). Luigi Beretta EYE REPAIR UNIT Clinical and basic research in ophthalmology Analysis of neurogenic and regenerative potential of Müller Glial Cells in both the healthy and diseased mammalian retina Our Unit, in collaboration with the Stem Cell Research Department, has been extensively studying Müller Glial Cells in-vitro and in-vivo. We established procedures for isolation of Müller cells from murine and human retinas and for their promotion into neuronal and photoreceptor lineages. We plan to improve in-vitro growth of our cells in order to obtain lines of stably growing Müller Glia cells. On the other side, our methods for neuronal and photoreceptor differentiation will be further improved in order to obtain a higher percentage of photoreceptors for possible future cell therapies. Finally, a mouse model for Müller Glia genetic tracing has already been established and will be used for the study of in-vivo Müller Glia regenerative potential in scenarios of retinal damage or degeneration. Retrospective study to evaluate the efficacy and safety of autologous cultivated limbal stem cell transplantation for restoration of corneal epithelium in patients with limbal stem cell deficiency due to ocular burns. The primary objective of this observational study is to evaluate the success of transplantation based on stable corneal epithelium without significant recurrence of neo-vascularisation at 12 months post-intervention. Retrospective evaluation of the clinical management of patients affected by Acanthamoeba keratitis. The primary objective of this study is to retrospectively evaluate the clinical outcome in patients affected by Acanthamoeba keratitis treated with PHMB 0.02% alone or in combination with other anti-amoebal drugs. DIVISION OF NEUROSCIENCE - 41 Multicentric, randomised, double masked, controlled trial on the safety and efficacy of Cyclosporine A eye drop treatment on patients with ocular cicatricial pemphigoid. The primary aim of the study is to evaluate the efficacy of Cyclosporine A 0.05% eye drop treatment in controlling conjunctival inflammation in patients with ocular cicatrical pemphigoid, in addition to conventional immunosuppressive systemic therapy. The study compares patients using CyA 0.05% eyedrops versus placebo and evaluates the percentage of patients showing more than two relapses of conjunctival inflammation during the two years of treatment. Paolo Rama COGNITIVE NEUROSCIENCE UNIT The Unit applies a multi-disciplinary approach, combining expertises from many different areas (neurology and neuroscience, linguistics, cognitive psychology, philosophy, economics), with the general aim to investigate the neural basis of cognitive function in health and disease. The experimental approaches include behavioural studies in normal subjects and in neurological patients, brain imaging using magnetic resonance techniques and positron emission tomography, and neurophysiological investigations based on evoked responses, transcranial magnetic and electrical stimulation. The main lines of investigation are: • the neural basis of knowledge representation (semantic memory), with a special emphasis on the mechanisms underlying the acquisition and processing of abstract concepts • the neurological mechanisms of syntacitc processing, in terms of their specificity and relationship to other aspects of cognition • the representation of multiple languages in the polyglot brain and their impact on other cognitive functions • social cognitive neuroscience, with a special emphasis on decision making in conditions of uncertainty, and on the impact of social contexts on complex choices. These studies involve normal volunteers, and are applied also to populations with special levels of expertise. These areas of “basic” cognitive neuroscience research are fully integrated with a clinical research program, which focuses on model-based behavioural testing of patients affected by cognitive disorders due to acquired focal and degenerative brain damage. The main conditions investigated using this approach are Alzheimer Disease, the fronto-temporal dementia spectrum, movement disorders, such as Parkinson Disease, as well as the consequences of focal brain damage due to stroke or trauma. The patients are studied using innovative testing procedures, typically derived from experimental paradigms applied to normal subjects, and the results correlated with those derived from the application of functional and structural imaging methods, allowing the correlation of behavioural findings with their neural underpinnings at different levels (gray matter, white matter, neurotransmission), as well as with the results of genetic analyses. Stefano F. Cappa EXPERIMENTAL NEUROSURGERY UNIT • Results of Gamma Knife Radiosurgery in the treatment of pituitary adenomas. Collaboration with Prof. Comi, Dott. Martino, Dept. of Neurology, INSPE, Dott. Ciceri Dept. of Hematology HSR, in the design of clinical trial regarding cell therapy with blood monocytes in traumatic spinal cord injury. • Role of cancer stem cells in brain tumours biology (in collaboration with Dott. Galli, SCRI HSR). • Cerebral MRI perfusion study in the follow-up of patients treated with Gamma Knife Radiosurgery for brain metastases (in collaboration with Dott. Politi, Dep. of Neuroradiology). • Study of pathogenetic mechanisms involved in human pituitary adenomas (in collaboration with Prof. G.K. Stalla, Department of Endocrinology, Max Planck Institute of Psychiatry, Munich, Germany). • Molecular biology and genetics of chordomas (in collaboration with Prof. P. Riva, Department of Biology and Genetics, Medical Faculty, University of Milan). • Molecular biology and genetics of craniopharyngiomas (in collaboration with Prof. P. Riva, Department of Biology and Genetics, Medical Faculty, University of Milan). 42 - SAN RAFFAELE SCIENTIFIC INSTITUTE • Microanatomical studies for new skull base approaches and relative reconstructive techniques (in collaboration con Prof. AJ Caputy, Prof. F. Roberti, George Washington University Neurological Institute, Washington DC, USA). • Study of microcerebral blood flow (in collaboration with Prof. Agabiti Rosei, Prof. D. Rizzoni, Dott. G. Boari, Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia). Pietro Mortini FUNCTIONAL NEURORADIOLOGY UNIT The Unit is composed by different groups that apply conventional and advanced MR techniques to investigate brain structure and function during physiological and pathological development, during normal and pathological aging, in neuro-oncology and neurovascular diseases. The neuropediatric group focused on the process of myelination in normal and preterm neonates; diffusion techniques have been employed to follow the modification of white matter over time. Functional MR techniques have been used to test the possibility to investigate auditory and language areas in same subjects. Functional MRI has been used to investigate lateralization of the mirror neuron system in normal adult subjects and to verify the influence of experience on some specific motor functions, like digit skill, in musicians (in collaboration with Experimental Neurophysiology U). Volumetric techniques (VBM analysis) and diffusion based techniques have been employed to study subjects affected by neurodegenerative diseases like MCI, Alzheimer Disease and the Fronto-Temporal Dementia. Aim of the project was to identify functional MR markers for an early diagnosis of MCI and of those changes associated with the conversion of MCI to dementia. Similar techniques have been employed to characterize the selective involvement of different brain areas in fronto-temporal dementia (in collaboration with Cognitive Neuroscience U.). The neurodegenerative changes related to motor neuron disease have been studied in Patients with ALS and PLS. The vascular group applied new high resolution techniques to identify vulnerability characteristics in patients with severe carotid stenosis and their correlation with cerebral ischemia and to test new contrast media. Finally, the neuro-oncology group focused on the clinical validation and utility of tractography, a new diffusion based MR technique and on the development of new algorithm based on tensorial diffusion, potentially useful to better characterize the different cellular and extracellular components of brain tumors. Other topics like the study of inflammatory diseases or optic nerve degeneration have been performed in collaboration with Neuroimaging Research Unit, Neuroimaging of CNS White Matter Unit, Eye Repair Unit. Andrea Falini Figure 4. Spectroscopy shows reduction of N-Acetyl aspartate in the motor area (top left), normal spectra from the sensitive area (bottom left) and frontal area (top right) in patients with Amyotrophic Lateral Sclerosis DIVISION OF NEUROSCIENCE - 43 IN VIVO HUMAN MOLECULAR AND STRUCTURAL NEUROIMAGING UNIT Researches were aimed at investigating using PET and SPECT the brain functional parameters and neurotransmission systems in neurological and psychiatric diseases: 18F-FDG for the evaluation of glucose metabolism, 11C-Raclopride and 11C-Fe CIT for the dopaminergic system, 11C FMZ for the gabaergic system, 11CMP4 for AchE activity and 11C-PK for measuring neuroinflammation. These researches include Alzheimer’s disease and MCI, fronto-temporal dementia and its variants, early and late onset of Parkinson’s disease, both sporadic and genetically determined, primary dystonia (genetic and sporadic), and rare conditions such as Fatal Familial Insomnia, an inherited prion disease. Depending on the pathological condition, PET and specific radiotracers reveal functional and neurotransmission changes which are also correlated with clinical symptoms and their severity. Among the psychiatric disease, obsessive compulsive disorders (OCD) were studied with PET and 11C-Raclopride for the evaluation of dopaminergic system, and 11C- MDL for the evaluation of 5HT2 serotonin receptors. MRI structural studies were also used to address functional changes and morphometric changes (voxelbased-morphometry (VBM) and diffusion tensor imaging (DTI) techniques) in neurological and psychiatric diseases that showed anatomical changes related to the underlying neuropathology. In OCD morphometric DTI measurements showed fibre tracts changes that also correlated with clinical signs. We also addressed functional changes (fMRI), morphometric changes (VBM and DTI) in familial and in genetic association developmental dyslexia that were also correlated to reading disabilities and neuropsychological deficits. Researches on the neural basis of the cognitive functions addressed a) language processes in monolingual and bilingual individuals, showing the role of control mechanisms and critical variables such as exposure and proficiency in influencing dynamic changes in the neural substrates b) emotion processes, showing the functional connections between sensory and perceptual brain regions and emotional system, c) music related processing, in adult and infants, by using fMRI, MRI and EEG that allowed fundamental aspects of the related networking. Daniela Perani Figure 5. Single subject tractography and DTI fractional anysotrophy changes in Obsessive Compulsive Disorder NEUROOTHOLOGY UNIT Little is known regarding the cortical areas involved in human vocalization. The study aim is to investigate larynx cortical area involved in phonation. A 3 Tesla Magnetic Functional Resonance is performed in 6 healthy adults to evaluate voice production related brain activations, using 5 tasks involving laryngeal muscles motor control. We analyzed cerebral network modifications caused by a damage to the laryngeal structures. The fMRI is used to examine 12 patients underwent to laryngeal surgery from January 2007 to February 2008. The pts will be evaluated with the same fMRI tasks used in the healthy population and the results obtained about the two study groups (healthy and surgical group) will be compared in order to obtain informations about the neuronal plasticity following the laryngeal surgery. In a sample of 30 pts referring dizziness and migraine we found a higher prevalence of vestibular abnormalities than in a normal dizzy group. We found increased stabilometric parameters and visual dependence. We compared the rate of vestibular anomalies and the presence of definite migrainous vertigo in a sample of 52 pts with Panic Disorders and agoraphobia, 30 pts with Panic Disorders without agoraphobia and 20 pts with depression, all referring dizziness. Agoraphobic pts presented a higher rate of vestibular anomalies and definite 44 - SAN RAFFAELE SCIENTIFIC INSTITUTE migrainous vertigo. Vestibular anomalies may play a role in the arise of agoraphobic symptoms. We demonstrated an increased body sway during non foveal visual stimulation in agoraphobic pts compared with normal subjects. Establish a role of genetically determined alterations of ionic transporters in inner ear in predisposing to develop Meniére Syndrome (MS). We demonstrated a higher rate of Adducin mutation in a sample of 30 pts with definite MS than in 2 different normal control group. Pts with MS presented a lower serum levels of ouabaine, an hormone controlling ionic transporters activity. The results underline the possibility that an increased pump activity and a lack of feed-back mechanisms may change osmolarity of endolymph. Establish the efficacy of low level laser therapy in tinnitus treatment. Our results on a sample of 30 pts with tinnitus did not demonstrate any therapeutic results. Mario Bussi PSYCHIATRY AND CLINICAL PSYCHOBIOLOGY During the year 2009 we continued our research activities at the interface between neuroscience and behavioral disorders, with the aim of increasing scientific knowledge and developing effective diagnosis and treatment options in the broad field of Psychiatry and Clinical Psychobiology. In the field of psychiatric genetics, we discovered new influences of gene variants in the monoaminergic pathways and in the biological clock on core feature of illnesses and on response to treatments. In particular, we published the first reports on the influence of COMT variants on response to antidepressant drugs and on new influences of 5-HT2A and 5-HTTLPR. In the field of brain imaging we produced the first reports that changes in the levels of glutamate correlate with successful antidepressant chronotherapeutics and that changes in medial prefrontal cortex neural responses parallel successful antidepressant treatment. We developed new methods for the study of brain correlates of social cognition in schizophrenia, and defined functional and structural brain correlates of theory of mind and empathy deficits in schizophrenia. Moreover, we implemented computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation, and transcranial magnetic stimulation to improve OCD treatment options; continued the characterization of the psychopatological features of eating disorders and anxiety disorders; and published guidelines on the chonotherapeutic options for mood disorders. All these findings were obtained in the context of research activities that had been ongoing since 1988 and have continued thereon. Francesco Benedetti SLEEP MEDICINE Movement-related sleep disorders The main objective of our research program is the evaluation of movement-related sleep disorders, as the Restless Legs Syndrome and Periodic Limb Movements (PLMs) during sleep. RLS is characterized by disagreeable sensitive symptoms in the lower limbs occurring at rest and improving with movements. A genetic mutation and a dysfunction in the dopaminergic nervous system seem to contribute to the pathogenesis of the disease. We found a locus for RLS on chromosome 14q13-21 region in a large Italian family. We are extending the genetic investigation to other large families. We have conducted an epidemiological/MRI study on a group of patients affected by Multiple Sclerosis (MS) and we found a high prevalence of RLS in MS and a significant correlation between RLS and cervical spinal cord damage. Another large multicenter study that we have conducted in 861 MS patients and 649 controls confirmed the previous data. We are evaluating by polysomnography the effects of dopamine agonists with different receptor selectivity on RLS and PLMs. We are evaluating the periodicity/duration of PLMs in patients with RLS or other sleep disorders, as REM sleep behaviour disorder (RBD) and narcolepsy, in order to demonstrate a possible different etiopathogenesis. RBD is a parasomnia with intermittent loss of REM atonia and violent behaviour associated with dream mentation. RBD may precede neurodegenerative disorders. We found specific neuropsychological deficits, as well DIVISION OF NEUROSCIENCE - 45 as olfactory dsyfunctions, in idiopathic RBD patients: these abnormalities are similar to those described in the early stages of Lewy body disease. On-going projects are aimed at longitudinally assessing the neurocognitive functions, EEG and motor activity during sleep, in idiopathic RBD patients. Luigi Ferini-Strambi CLINICAL PSYCHOLOGY The Unit of Clinical Psychology developed research programs in different areas. The principal key words can be summarized according to the characteristics of each Sub-Unit: 1. Personality and Personality Disorders: the project on mentalized affectivity, emotion instability, disorders of the Self and aggression (Professor A. Fossati) aimed at assessing the role of deficits in mentalization and emotion dysregulation in aggressive behaviors. A major result was the deficits mentalized affectivity significantly mediated the effects of attachment styles on impulsive aggressiveness, at least in nonclinical participants. A second major findings was the evidence of a dissociability of proactive aggression –from reactive aggression based on measures of emotional instability. Interestingly, different manifestations of narcissistic personality were shown to have distinct patterns of associations with reactive and proactive dimensions of aggression. Finally, over narcissistic personality features were shown to mediate the relation between the edonistic style of prosocial moral reasoning and proactive aggression. 2. The project on emotional dysregulation in Borderline Personality Disorder (BPD) (Professor C. Maffei) aimed at studying the way Borderline subjects manage emotional activation raised by videoclips stimulating specific emotions and how emotional activation interferes with cognitive capacities, mainly mind-reading, that is the capacity to individuate behavioral intentionality. 3. The Development and Psychopathology Sub-Unit (Professor M. Battaglia) research programs aimed to explore the importance of gene and environment and their possible interplay in shaping individual differences in different problem behaviours, pertaining both to internalizing and externalizing areas. Different approaches and strategies have been employed to determine the extent to which individual differences could be due to genes and/or environment: general population approaches, family based approaches, and multivariate twin designs. These programs have been conducted in collaboration with foreign Institutes and Universities. 4. The research project on HIV infection (Doctor R. Visintini) was a part of a multicentric national study coordinated by the Health Ministry (National AIDS Center - Istituto Superiore di Sanità) concerning the vaccine for HIV infection (TAT). The psychological evaluation of all the voluntary subjects involved in this project was coordinated by the Clinical Psychology Unit of our hospital. Cesare Maffei MOTOR FUNCTION REHABILITATION The research activities of 2009 focused on: biomechanical analysis of coupled movements coordination, measure of cortical activation during execution of motor tasks performed with cognitive facilitations and anatomical localisation of painful muscles points. Literature report that the association of the same movement in the two body sides is easier when they are executed in a symmetrical modality (in-phase coordination). This aptitude is represented by a better performance both in speed of execution and coordination pattern. Moreover the symmetrical coupled movement association is spontaneously chosen by subjects. The hypothesis of research is that described motor behaviour permit an energy saving due to a mechanical stabilisation of body parts and centre of mass. We investigated whether the centre of pressure displacement, the torque exerted to the ground and the electromyographic activity of muscles involved with a postural role, are lower during in-phase coordination compared to anti-phase one. This study was realised in the Lab of movement analysis, where the gesture kinematics, the ground reaction forces and the surface electromyography were recorded. Moreover, a collaboration with the Functional Unit of Quantitative Neuroimaging of HSR, is allowing to 46 - SAN RAFFAELE SCIENTIFIC INSTITUTE study the effect of cognitive facilitations during the execution of motor tasks. The acquisitions regarded the study of cortical activations during a dual task involving both cognitive and motor performances. These acquisitions were executed prior to and after a cognitive training to analyze if a cognitive training could lead to a better motor performance during a motor-cognitive dual task. The idea of this study origins from described difficulty of some kind of patients with CNS disease (eg: Parkinson disease) to perform the dual task. The first part of this study has been conducted with healthy subjects. Finally, in collaboration with the Lab of neuromuscular system engineering of the Turin Polytechnic the muscles painful points were studied. Using the technology of the Turin Polytechnic is possible to localize the muscle innervations zone by surface electromyography executed with matrix of electrodes. The aim of the study is to establish if the muscle painful points coincide with the innervations zone. Roberto Gatti INSTITUTE OF EXPERIMENTAL NEUROLOGY (INSPE) Director: Giancarlo Comi* Introduction by the Director The Institute of Experimental Neurology (INSPE) constitutes one of the major European institutes primarily dedicated to translational research in the neuroscience field. The overall ambition is to conjugate high level of basic research with the specific competences in pre-clinical and clinical research. This is achievable considering that INSPE includes both research laboratories and the Neurological Department of the San Raffaele Scientific Institute. Multiple sclerosis, stroke, traumatic injuries of the central and peripheral nervous system, and neuromuscular diseases do represent the primary targets of the INSPE reGiancarlo Comi search although research in neurodegenerative disorders is also in the pipeline of the Institute. The primary goal is to better understand the molecular mechanisms that sustain inflammatory and degenerative pathogenic mechanisms underlying neurological disorders so to identify therapeutic targets, validate in co-operation with third parties new treatments, develop new disease biomarkers for both clinical trials and patients monitoring. The neurological department is deeply involved in the definition of new treatment algorithms for stroke, inflammatory and neurodegenerative diseases. The molecular and functional bases for central and peripheral nervous system recovery processes and the potential to modulate them by cellular and gene therapy and by specific rehabilitation interventions are another area of interest of INSPE. The INSPE laboratories spans on three different levels in a newly established building within the DIBIT2. One floor is dedicated to neuropathology, experimental neurophysiology, neurogenetics of monogenic and complex diseases. Another floor is dedicated to basic and clinical neuroimmunology, neurobiology, neural stem cell research and neuroembriology. The third floor is focused on neuroimaging of neuroinflammatory and neuro-degenerative disorders. Other laboratories involved in behavioral research and in signals that regulate myelination and in clinical neurophysiology are also part of the Institute. DIVISION OF NEUROSCIENCE - 47 Research Units EXPERIMENTAL NEUROPATHOLOGY Regenerating the peripheral nervous system. The role of HMGB1 in the repair of peripheral nervous system: an in vivo and in vitro study. Motor nerve biopsy: clinical usefulness and histopathological criteria Regeneration of the nervous system (PNS) is the primary target of nerve injuries. We have already demonstrated how collagen tubes (medical device, MD) enhance nerve regeneration in a model of peripheral nerve injury, restoring a normal nerve and performing better than other MD available in clinical practice. To evaluate whether the environment in the MD can influence nerve regeneration, we will perform gene expression analysis by Illumina platform. Thus, the main aim of this project is to evaluate the biological events underlying regeneration of the PNS. These informations will improve therapeutic strategies not only for traumatic injury of the PNS but for disorders of PNS such as peripheral neuropathy, condition that affect many people in our Country. We examined the role of HMGB1 in the nerve lesions of patients with neuropathies. We showed that HMGB1 was expressed in a wide range of nerve cells in patients compared to normal nerve: macrophages surrounding vasculitic lesions expressed high levels of HMGB1 in the damaged nerves. However, the extent of endoneurial HMGB1 expression level in Schwann cells was closely related to the degree of axonal degeneration and fiber loss in neuropathies. In addition, we will investigate in vitro the effect of HMGB1 on the proliferation, migration and apoptosis of SC. We showed, independently from pathogenesis, that HMGB1 expression correlate with the degree of pathological abnormalities, in particular with the extent of fibrosis. We can assume that, in addition to its role as a trigger of inflammation, HMGB1 could directly stimulate repair in the PNS rather than regeneration. Thus, HMGB1 may serve as one potential target for therapeutic intervention in nerve disorders. Early differential diagnosis of Motor Neuropathies (MN) and Lower Motor Neuron Diseases (LMND) is important, as prognosis and therapeutic approaches are different. We evaluated the diagnostic contribution of the biopsy of the motor branch of the obturator nerve in consecutive patients in which, after clinical and neurophysiological studies, the differential diagnosis was still open. At baseline, motor biopsy was performed; diagnostic confirmation was obtained by clinical follow-up. Our results support the usefulness of this procedure in MN and LMND. Angelo Quattrini EXPERIMENTAL NEUROPHYSIOLOGY We developed and validated neurophysiological methods for the functional-anatomical investigation of brain circuitries in physiological and pathological conditions. One application has been the study of circuitries involved in motor programming and execution using non-invasive methods like EEG source analysis, functional magnetic resonance imaging (fMRI) and focal transcranial magnetic stimulation (TMS). In a first validation study of EEG methods for localizing the primary motor cortex (M1), multimodal functional neuroimaging by combining fMRI and EEG in healthy subjects was studied to achieve high-resolution reconstruction of the spatiotemporal cortical current density (CCD) distribution of movement-related cortical potentials on EEG. We found fMRI activations, EEG sources and TMS mapping corresponding to the anatomical landmark of the hand area in all subjects with fMRI and TMS center-of-gravity and in almost all subjects using fMRI-CCD with moderate constraint. A significant improvement was found using fMRI-CCD compared to CCD alone. We also investigated the effects of healthy aging on the pattern of activation to self-paced movement using EEG CCD and a realistic volume conductor. Aging was associated with recruitment of a larger cortical neuronal population in the presence of a significantly longer movement, which more likely suggest their reduced selectivity in activating the motor cortex than a compensatory mechanism to produce an optimum performance. Movement duration resulted negatively correlated with pre-SMA activity, suggesting its involvement in movement termina- 48 - SAN RAFFAELE SCIENTIFIC INSTITUTE tion. We also examine the resting state brain rhythms in drug naïve obsessive-compulsive disorder (OCD) patients using power (coupling of EEG bands, low-resolution electromagnetic tomography-LORETA) and coherence. In OCD, increased frontal beta, hyperactivity of insular delta sources, together with rhythms decoupling and reduced interhemispheric alpha coherence, are consistent with previous evidence of frontal dysfunction and with additional involvement of cortico-subcortical functional connections. This approach may provide functional measures on different levels of involvement of cortico-subcortical circuits in neuropsychiatric disorders. Letizia Leocani MOLECULAR GENETICS OF BEHAVIOUR The role of Ras-ERK signalling in behavioural plasticity and brain diseases Our laboratory has focussed for a number of years on the role of the Ras-ERK intracellular cascade in neuronal cell signalling and behavioural plasticity. Once neurotransmitter receptors are activated, specific guanine exchange factors (GEFs) are able to catalyse the exchange of GDP for GTP on Ras proteins, thus activating this class of small GTPases. Activated Ras proteins then stimulate the core element of the signalling pathway, the Ras-MEK-ERK protein kinase cascade which is crucially involved in transducing signals to the nucleus, hence controlling chromatin remodelling and gene expression, key steps involved in synaptic plasticity and in the formation of long-term memories. In recent years, it has become clear that deregulation of this signalling pathway in the brain may lead to brain dysfunction. The work of our laboratory is focussing on three brain diseases associated to abnormally high RasERK activity: drug addiction, L-DOPA induced dyskinesia (LID) and the Ras-MAPK syndromes. The key brain structure implicated in both drug addiction and LID is the striatum. We have recently completed the analysis of several mouse strains bearing mutations affecting striatum-dependent behavioural plasticity. For instance, we showed that expression in the dorsal portion of the striatum of a potent inhibitor of the CREB family of transcription factors, which are nuclear substrates of the ERK pathway, results in significant alterations at the level of both cocaine and morphine dependent behaviour. In addition, mice deficient for RasGRF1, a neuronal specific activator of Ras proteins, show strongly attenuated cocaine-mediated cellular and behavioural responses. Importantly, Ras-GRF1 deficient mice also appear to be protected toward abnormal involuntary movements (AIM), the behavioural correlate of dyskinesia in rodents, in a neurotoxic model of LID. Finally, we showed that a conditional, forebrain specific gain of function mutation in K-Ras (K-RasG12V) largely recapitulates the cognitive impairments found in the Ras-MAPK syndromes, a recently identified class of gain of function genetic diseases which are characterised by mental retardation. Riccardo Brambilla NEUROMUSCULAR REPAIR We are currently interested in the mechanisms that sustain neuromuscular tissue repair. In particular, we are interested in the role of adhesion in such a mechanism, which relies on the interaction between extracellular matrix, cell surface adhesive receptors and cytoskeleton constituents. In 2009 we identified a role for vimentin, an intermediate filament that belongs to the cytoskeleton of neurons and Schwann cells, in peripheral nerve development, myelination, and nerve regeneration. Loss of vimentin results in painful peripheral neuropathy and distal motor denervation. Myelination is controlled with cell extrinsic mechanism, as is modulated by loss of vimentin in neurons and not in Schwann cells. Future studies will clarify how vimentin modulates myelination. Loss of function experiments in transgenic mice have been also performed to investigate the role of Jab-1, which is a signaling molecules likely downstream to the laminin pathway. Preliminary experiments show that loss of Jab-1 results in abnormal axon sorting and myelination, consistent with a defective laminin pathway. Finally, we are also investigating the efficacy of stem cell therapy to rescue muscle and nerve degeneration in Congenital Muscular Dystrophy (CMD) and related neuropathy. Mesoangioblasts engineered to deliver a crosslinker molecule that re-connect myocytes to the basal lamina have been delivered in mouse models of CMD. DIVISION OF NEUROSCIENCE - 49 Treated mice showed delayed deterioration of motor performances and the amelioration of muscle tissue. Stefano Carlo Previtali Figure 6. Denervated neuromuscular junctions in vimentin null mice NEUROIMMUNOLOGY UNIT Several recent data do indicate that an alteration of peculiar functions (e.g. proliferation, migration, differentiation) of sub-ventricular zone (SVZ)-derived neural stem/precursor cells (NPCs) might, over time, contribute to the failure of the central nervous system (CNS). To assess this, we have generated transgenic mice, using recombineering and lentiviral vector technologies, in which we are able to trace (from their origin in the SVZ to their final destination in the CNS) and/or to kill NPCs. Two founder lines have been generated by using two NPC-restricted genes such as AspM and Nestin: (i) a transgenic mouse line in which the ligand-dependent CRE-ERT2 gene was cloned under the control of AspM cis-acting regions, AspmCreERT2; (ii) a transgenic mouse line in which the killing gene (TK) was under the control of Nestin regulatory regions, NestfloxGFPfloxTK-IRES-LacZ. On one hand, AspmCreERT2 mice were crossed with the reporter mice Rosa26R-YFP (AspMCreERT2/Rosa26RYFP double transgenic mouse line) so to be able to trace and follow AspM descendants from early cortical development to post natal age. On the other hand, we crossed NestfloxGFPfloxTKIRES-LacZ mice with CMV-Cre mice to induce the activation of TK gene in SVZ cells (NestfloxGFPfloxTKIRES-LacZ/CMV-Cre mice). Beside, to assess the relevance of AspM precursor cells and to be able to selectively kill them a transgenic mouse line NestfloxGFPfloxTK-IRES-LacZ has been generated by crossing AspmCreERT2 line with the NestfloxGFPfloxTK-IRES-LacZ double transgenic mice. Tracing and killing experiments so far performed do indicate that the transgenic tools we generated can be considered solid and reproducible enough to trace NPCs from embryonic to adult life. This should led us to define the proliferative, differentiation and migratory, as well as reparative, capacities of SVZ-NPCs in inflammatory and degenerative conditions of the CNS. Gianvito Martino Figure 7. The SVZ is morphologically deranged during acute and the chronic CNS inflammation. The panel shows the SVZ from mice with experimental autoimmune encephalomyelitis (EAE), the animal model of MS. The vast majority of microglia (Iba-1+ cells in blue) show a ramified ‘quiescent’ morphology while many astrocyte-like cells (GFAP+ cells in green) remain associated to vessels (CD31+ cells in red) (arrows). Scale bar 200 micron. 50 - SAN RAFFAELE SCIENTIFIC INSTITUTE CLINICAL NEUROIMMUNOLOGY The Unit of Clinical Neuroimmunology is currently active in both experimental and clinical neuroimmunology with the aim to have a bi-directional transfer of scientific questions and experimental data between the two. Concerning our work on mice, during 2009 we have completed a study concerning therapeutic effectiveness of the interference with chemokine signaling, i.e. CCL2, in experimental neuroinflammation. Further, we have characterized in two distinct papers the kinetic of FoxP3+ T regulatory cells, and their role in disease suppression using rapamycin, during experimental autoimmune encephalomyelitis (EAE), a mouse model for multiple sclerosis (MS), posing a serious note of caution in the use of FoxP3 as tout court marker of T cells with suppressive functions. In two relevant collaborative efforts, we have contributed to elucidate a novel mechanism of intercellular communication used by glial cells to propagate pro-inflammatory signals in the brain, and we have characterized early damage, affecting glutamatergic synapses, already present in EAE mice during a pre-clinical stage of the disease. Both findings have lead to further, very relevant studies in both experimental and clinical settings, leading to the characterization of novel biomarkers, insight into pathogenesis of MS and especially in the relation between inflammation and neurodegeneration. Concerning clinical research, we have published a comparative study describing 5 different protocols to detect anti-aquaporin IV antibodies, typical of neuromyelitis optica (NMO) patients, posing a note of caution on currently used detection techniques, and on interpretation of data from the literature. Further, we have conducted a large study, that is still ongoing, determining immunological markers in patients affected by major psychoses, with the aim to determine the possible contribution of the immune system to pathogenesis. Finally, we contributed to a European consensus on how cerebrospinal fluid samples should be collected and stored for biomarker analysis in MS. Roberto Furlan CNS REPAIR Human neural stem cells ameliorate autoimmune encephalomyelitis in non-human primates The development of cell-based therapies aimed at promoting tissue repair in central nervous system (CNS) diseases, represents one of the most challenging areas of investigation in the field of regenerative medicine. Indeed, cells play a critical role in reparative regeneration, as regenerating structures depend on a) proliferation of cells surviving to the injury; b) de-differentiation of cells in the remaining tissue, or by c) influx of cells originating outside the damaged tissue. As such, the central role of stem cells and progenitors in regeneration has motivated a number of experimental approaches for CNS diseases with neural tissue repair being achieved after stem cell transplantation. Recent evidence from our own and other labs indicates that undifferentiated neural stem/precursor cells (NPCs) might very efficiently protect the CNS from chronic degeneration induced by inflammation, such as that occurring in experimental autoimmune encephalomyelitis (EAE) and stroke (Nature 2003, 422: 688-694; Nature 2005, 436: 266-271). Yet, a comprehensive understanding of the mechanisms by which NPCs exert their therapeutic impact is lacking. To address this, This study was designed as a preclinical test of the feasibility of human NPC transplantation in an outbreed non-human primate EAE model approximating the clinical and complex neuropathological situation of human multiple sclerosis (MS) more closely than EAE in the laboratory rodent. We examined the safety and efficacy of the intravenous (i.v.) and intrathecal (i.c.) administration of human NPCs in common marmosets affected by myelin oligodendrocyte glycoprotein-induced EAE. Treatment commenced at the occurrence of detectable brain lesions on a 4.7T spectrometer. NPC-injected EAE marmosets accumulated lower disability and displayed increased survival, as compared to controls. Transplanted NPCs persisted within the central nervous system (CNS), but also in draining lymph nodes, for up to three months after transplantation and exhibited remarkable immune regulatory capacity. Herein, we provide the first evidence that human CNS stem cells ameliorate EAE in non-human primates without overt side effects. Immune regulation is suggested as the major putative mechanism by which NPCs ameliorate EAE in vivo. Our findings represent a critical step towards the clinical use of human NPCs in MS. Stefano Pluchino DIVISION OF NEUROSCIENCE - 51 NEUROIMAGING RESEARCH UNIT Major results: Normal functioning of the human brain Cognitive and motor learning results in short-term structural GM changes of brain neuronal networks. Assessment of MS pathophysiology using structural and functional MRI In relapse-onset MS, cortical lesions accumulate over 3-year follow up and are associated with disability progression and cognitive impairment; a dysfunction of the anterior components of the default mode network may be among the factors responsible for the accumulation of cognitive deficits in progressive MS; tactile-associated cervical cord fMRI activity is increased in relapse-onset and PP MS, and is more prominent in patients with severe locomotor disability. Assessment of treatment efficacy in MS clinical trials 500 µg interferon β-1b was not more effective than the standard 250 µg dose, and both doses had similar clinical effects to glatiramer acetate; 1 g oral methylprednisolone (MP) x 5 days is not inferior to 1 g IV MP x 5 days in reducing the gadolinium-enhancing lesions over 1 week. MRI Assessment of CNS damage in migraine and optic neuropathies Abnormalities of the resting-state visual and motor networks occur in cluster headache patients outside the acute attack; brain damage in patients with Leber’s optic neuropathy is not limited to the anterior visual pathways, but extends posteriorly to the optic radiations and primary visual cortex. MRI Assessment of CNS damage with aging and neurodegenerative diseases Different patterns of microstructural and volumetric abnormalities occur with aging in WM tracts from healthy subjects; in MCI, the severity of microstructural damage within and beyond the medial temporal lobe was associated with an increased risk to develop AD; in ALS, more severe CST damage predicts greater disability progression rate and individual survival after 3.4 years; in depressed PD patients the pattern of brain atrophy overlaps with key regions involved in major depressive disorders, suggesting an increased vulnerability of this neural circuit in PD. Massimo Filippi NEUROIMAGING OF CNS WHITE MATTER In vivo assessment of pathophysiology of MS and other white matter diseases using MR-based techniques Using functional magnetic resonance imaging (fMRI) and quantitative MR-based techniques, we found that: 1) during the performance of a simple motor task, patients with primary progressive multiple sclerosis (PPMS) had more significant activations of several areas located in the fronto-parietal-occipital lobes. Compared with PPMS patients, controls had increased functional connectivity between the left primary SMC and the ipsilateral inferior frontal gyrus. Conversely, PPMS patients showed increased functional connectivity between the left primary SMC and the right cuneus. Moderate correlations were found between functional activations and damage to WM fiber bundles critical for motor network function; 2) during the performance of a cognitive task, cognitively preserved PPMS patients, compared to cognitively impaired patients had increased activations of the caudate nucleus, prefrontal cortex (PFC), and inferior parietal lobule. The opposite comparison showed increased activations of the SII, cerebellum, and insula in CI patients. In PPMS, a decreased composite cognitive score correlated with increased activity of the cerebellum, insula, and SII, as well as decreased PFC activity. T2 lesion volume correlated with decreased PFC recruitment and increased SII recruitment; 3) we investigated effective connectivity changes of the sensorimotor network in pediatric relapsing remitting (RR) MS patients in comparison with adult patients with clinically isolated syndromes (CIS) suggestive of MS or RRMS. Coefficients of effective connectivity of the sensorimotor network were similar in control subjects and pediatric MS patients. In adult patients with CIS and even more evidently in those with RR MS, an increase of intra- and in- 52 - SAN RAFFAELE SCIENTIFIC INSTITUTE terhemispheric strengths of coefficients of effective connectivity was found. The increases in such coefficients were correlated with corpus callosum and corticospinal tract damage; 4) we found that compared with healthy controls, patients with benign (B) and secondary progressive (SP) MS had increased activations of the left primary SMC. SPMS also showed increased activations of several areas in the fronto-temporo-occipital lobes and reduced activations of the supplementary motor area, putamen, and cerebellum. Maria Assunta Rocca HUMAN INHERITED NEUROPATHIES UNIT Impairment of endosomal dynamics in neurodegenerative disorders of the central and peripheral nervous system Polyphosphoinositides (PPIs) phospholipids represent important second messengers that govern a variety of cellular functions including endosomal sorting and membrane trafficking. PPIs have a restricted distribution within the cell, and their concentration is tightly regulated by the concerted action of specific kinases and phosphatases. In the nervous system, intracellular trafficking is a key event in basically all steps of development and differentiation of both neurons and glial cells. However, relatively little is known on the regulation of endosomal trafficking by phospholipids in these cells. The MTMR2 (Myotubularin-related protein 2) and FIG4 genes encode phospholipid phosphatases whose loss causes autosomal recessive demyelinating Charcot-Marie-Tooth neuropathies, CMT4B1 and CMT4J, respectively. Hallmark of CMT4B1 are myelin outfoldings, redundant folds of excessive myelin. We previously reported that CMT4B1 is caused by loss of MTMR2 in human and created a faithful mouse model of the disease. MTMR2 is a 3-phosphatase acting on PtdIns(3)P and PtdIns(3,5)P2, with a suggested role in intracellular trafficking. However, why altered phospholipid levels leads to CMT4B1 remains to be assessed. CMT4J is a severe demyelinating neuropathy due to loss of the FIG4 phosphatase. Loss of FIG4 in mice provokes the Plt phenotype, characterized by massive degeneration of the central and peripheral nervous system. In the Plt mouse, extensive vacuolization of neurons has been observed as a consequence of decreased levels of PtdIns(3,5)P2, which is the substrate of FIG4. To elucidate endosomal dynamics and its regulation by phospholipids in both neurons and Schwann cells, we took advantage of the Mtmr2-null and Plt mouse mutants. We already generated a double knock-out mouse which has been preliminarily characterized. We revealed for the first time a role of MTMR2 in neurons, since loss of MTMR2 exacerbates neuronal degeneration of Plt mouse. On the contrary, haploinsufficiency of FIG4 rescued myelin outfoldings in Mtmr2-null mice, suggesting that MTMR2 and FIG4 have opposite functions in Schwann cells. The preliminary analysis of this new model suggested strategies to rescue the disease phenotypes, aimed at restoring phospholipid levels and endosomal dynamics. Alessandra Bolino AXO-GLIA INTERACTIONS UNIT Myelin is a multilamellar structure deriving from the spiral wrapping around the axons of oligodendrocytes in the central nervous system (CNS) and Schwann cells in the peripheral nervous system (PNS). In the absence of glial cells neurons die, demonstrating that the survival of these two cell types in developing nerves is strictly linked. Similarly, axons promote the proliferation, survival and differentiation of myelinating glia. In addition, axons also determine the amount of myelin formed. Alteration in myelination can have dramatic consequences that can span from reduction of the conduction of the nerve impulses to neuronal cell death, with a significant impairment of normal functionality in patients affected by demyelinating disorders. Neuregulin1 (NRG1) is a key axonal signal that controls many aspects of PNS development, including glial cell survival and proliferation. We have previously demonstrated that NRG1 type III is an essential instructive signal for PNS myelination. We have also showed that in the CNS, type III NRG1 is not essential for OL myelination and the regulation of myelination in PNS and CNS is distinct. DIVISION OF NEUROSCIENCE - 53 We are now investigating how type III NRG1 is expressed on the axon and the regulation of the signal transduction pathway activated in glial cells during myelination. NRG1 are proteolytically cleaved in their extra and intracellular domains. Upon cleavage in the juxtamembrane region, type III NRG1 remains tethered on the axonal surface and acts as a juxtacrine signal. We are now investigating the identity of the secretases involved in NRG1 cleavage and their role in myelination. Our results suggest the ADAM 17 participates in type III NRG1 cleavage and, in vitro and in vivo studies, indicate that this cleavage inhibits myelination. Our results underscore the existence of several components controlling myelination and implicate secretases as key determinants in controlling type III NRG1 expression on the axon. The identification of the neuronal proteins regulating myelination are likely to provide important insights into the mechanisms required for its generation and maintenance and could be effective to develop therapies for demyelinating diseases in which disability is correlated to myelin and axonal loss. Carla Taveggia Clinical Research Units INFLAMMATORY CNS DISORDERS UNIT Our Clinical Unit was involved in many International RCTs (phase II, III or IV) to evaluate the safety and efficacy of newly-developed immunosuppressive or immunomodulatory (DM) drugs (Fingolimod, Laquinimod, Cladribine, Teriflunomide, Ocrelizumab and Alemtuzumab) and to asses the efficacy of symptomatic therapies (Sativex in refractory spasticity due to MS). We coordinated a multicentre RCT on the long term benefits of a sequential therapy with Mitoxantrone (MTX) followed by β-Interferon (IFN) on patients with bad prognostic factors in the early phase of the disease. We were the promoting centre of an Italian multicentre study to evaluate the safety and efficacy of Natalizumab in clinical practice. We published the data on a short-term MRI study comparing high dose oral versus iv Methylprednisolone (MP) in MS relapses: oral high dose MP resulted as effective as iv MP with a similar safety profile. Finally we were involved in 3 multicentre RCTs planned to asses the efficacy of conventional treatments in delaying the convertion to MS after a first demyelinating clinical event (CIS). The PRECISE’ results have been recently published, confirming the beneficial effects of the early use of Glatiramer Acetate. We collected and analyzed clinical and laboratory data on more than 3000 MS patients, treated with DM drugs, to identify the predictors of clinical efficacy or safety. In particular, we conducted a retrospective analysis on the efficacy of MTX treatment in patients with RR and SP MS and we were the promoting centre of a multicentre retrospective study to evaluate the incidence of Acute Leukaemia (AL) in patients treated with MTX. The risk of AL was 0.93 %, which represents a global risk of 1 AL every 107 MTX treated MS patients. We conducted a study with a whole-genome case-control approach using the Illumina platform, to identify allelic variants associated with the risk to develop MS and its variant “primary progressive”. Finally, we evaluated the efficacy of different aspects of intensive rehabilitation in MS patients with and without fatigue, and the clinical, immunological, and MRI characteristics of “atypical” forms of MS, to define an algorithm able to differentiate CNS demyelinating diseases from other primary CNS inflammatory diseases. Vittorio Martinelli 54 - SAN RAFFAELE SCIENTIFIC INSTITUTE CEREBROVASCULAR DISORDERS The cerebrovascular patient: from bedside to bench and vice versa The Stroke Team is involved in: a) Optimization of diagnostic/therapeutic management. Within a multicentric project aimed at the definition of outcomes of efficacy and efficiency in the management of cerebrovascular pts, we recruited 891 consecutive pts. Preliminary evaluation indicates that thrombolysis and vascular imaging correlate with better outcome. b) International clinical trials evaluating therapeutic strategies in primary and secondary prevention. c) Individuation and validation of diagnostic/prognostic markers: Biochemical markers – within a collaborative project funded by the Ministry of Health we are collecting samples from patients undergoing thrombolysis to study the prognostic role of markers of haemostasis and inflammation. Cognitive markers – all consecutive patients admitted to the Stroke Unit are evaluated in the acute phase and with repeated neuropsychological testings. Preliminary results indicate that executive dysfunctions are one of the most relevant consequences of stroke/TIA and that Frontal Assessment Battery is a good measure of these dysfunctions and a good predictor of long-term cognitive outcome. Markers of carotid plaque instability - in collaboration with the Cardiovascular Department, we studied 76 patients with asymptomatic and symptomatic carotid stenosis by Color/Power Ultrasonography (US) before thromboendoarterectomy. A correlation between diagnosis of instability by US and histology (McNemar test p=0,02) was found. d) Characterization of genetic determinants of ischemic stroke risk with a whole genome approach using Illumina® Bead Station 500. We have recruited 250 cerebrovascular pts and we plan to reach 500 pts by 2011: genetic characterization and association with phenotype will follow. We are involved in an international collaborative study on whole-genome genetic association with clinical characteristics of almost 1,000 patients affected by cervical arterial dissection. e) Evaluation of the physiopathological role of patent forame ovale in patients with migraine and/or stroke. 48 subjects were screened for the persistence of right-to-left shunt (RLS) with transcranial Doppler and for the presence of white matter lesions (WMLs) using a 3.0 Tesla MRI. Preliminary results indicate that RLS does not increase WMLs. Maria Sessa MEMORY DISORDERS The main task of our unit is the recruitment and proper diagnostic classification of patients with memory disorders and dementias respecting international diagnostic criteria: the correct identification of patients with dementia is the cornerstone of any type of study (neuroradiological, epidemiological, neurophysiological, genetics). Our Unit works in close collaboration with the Neuroimaging Research Unit (M. Filippi and F. Agosta) and Functional Neuroradiology Unit (A. Falini) to identify structural and functional MR markers for the early diagnosis of the mild cognitive impairment (MCI), to define the structural and functional CNS changes associated with the conversion of MCI to Alzheimer’s disease (AD) and to characterize the structural and functional substrates of the non-AD dementia (frontotemporal dementia). Additional approaches in close collaboration with the Experimental Neurophysiology Unit (L. Leocani) have been based on studies on programming of voluntary movement and motor control in aged normal subjects, MCI and AD patients. Our interest is also focused on the genetic components of AD. The Centre is engaged in the collection of blood samples to create a clinical database and biological bank of subjects suffering from dementia with the aim to identify genetic factors involved in the risk of developing dementia and in the individual response to drugs, for which a genomewide study has been recently completed on 183 AD patients treated with Acetylcholinesterase inhibitors (AChI) (F. Martinelli-Boneschi; Laboratory of neurological complex disorders). Recently we evaluated effectiveness of donepezil in 342 AD patients with a retrospective study during a follow-up of three years. We are also involved in clinical pharmacological trials to provide to AD patients innovative drugs (γ-secretase inhibitor, anti β-amyloid monoclonal antibody). Giuseppe Magnani DIVISION OF NEUROSCIENCE - 55 MOVEMENT DISORDERS The Movement Disorder Unit of San Raffaele Institute arises from two different experiences: the first that grows around the Parkinson and correlate diseases Clinical Center and, by now, long lasting practice in deep brain stimulation (DBS); the second one that developed inside the Clinical Neurophysiology Unit. In these years the group has been working on different fields of interest, like the clinical and neurophysiological study on safety and efficacy of botulinum toxin type A (BT-A) therapy in different muscular fiber hyperactivity disorders. Notably we are studying the functional recovery after BT-A therapy in patients with focal spasticity in multiple sclerosis (MS) as well as the identification of guidelines for the treatment with BT-A in MS patients with neurogenic bladder without urine retention. In progression are the transcranial magnetic stimulation (TMS) study of the exteroceptive suppression (“geste antagoniste”) in cervical dystonia, which started the last year; the research of new targets and optimization of the procedures of surgical neurostimulation in Parkinson disease and correlate disorders with particular focus on the mechanisms of action of the neurostimulation through functional studies of cerebral metabolism and on the neuropsychological and behavioral modifications; the adjustement of the interoperating monitoring (IOM). Still at the start is the protocol: ‘clinical and neurophysiological study of the efficacy and safety of the repetitive transcranial magnetic stimulation (rTMS) in chronic neurogenic pain (CNP)’. We are also keeping on our animal neurophysiological studies in several model of experimental peripheral neuropathy, like the nervous regeneration after crush, in the aim of verifying whether the association of classical neurophysiological tests and stimulated single fiber electromyography (SFEMG) may contribute to better describe axonal and muscle fibers regeneration. Ubaldo Del Carro NEUROMUSCULAR DISORDERS My group is working on two different topics: Neuromuscular diseases and Clinical Neuroimmunology. About clinical studies in Neuromuscular Diseases addressed to give the best medical supports to our patients: 1. we participated in validation of the Italian version of the neuropathic pain symptom inventory in peripheral nervous system diseases 2. we has been involved in a nationwide retrospective analysis on the effect of immune therapy in patients with chronic inflammatory demyelinating polyradiculoneuropathy 3. we completed multicentric clinical trial with talampanel in pts with ALS 4. we completed the study of brain fMRI in pts with acquired / familiar peripheral neuropathies in order to evaluate the origin of symptom “fatigue”. 5. we completed an open multicentric international study (phase III) about the efficacy of subcutaneous Ig in treatment of patients with MMN. We are working on: 1. evaluation of FKT long term efficacy in pt with peripheral ataxia 2. efficacy of long term therapy with IVIg versus corticosteroids 3. a clinical multicentric randomized double blind trial for the efficacy of lithium carbonate in ALS patients 4. a clinical multicentric randomized double blind trial for the efficacy of EPO in ALS About Clinical Neuroimmunology: 1. We critically evaluated the different techniques for the detections of AQP4 antibodies (involving in pathogenesis of Devic disease) in order to give to clinicians the more specific and sensitive technique and we are directly involved in the creation of a Italian network for the standardization of these immunological testes. 2. we are involved in collection of clinical and immunological data of paraneoplastic patients (PNSEuronetwork) We are working on: 1. detection of new antigens as target of immune-mediated neuropathies 2. detection of new antigens in movement disorders diseases 56 - SAN RAFFAELE SCIENTIFIC INSTITUTE 3. detection of new antigens in neuritis/retinitis of immune-mediated origin 4. implementation of immunological diagnostic testes for detection of CNS neuoromediated diseases Raffaella Fazio PAROXYSMAL EVENTS Our unit is principally involved in the evaluation of epileptic patterns during status epilepticus and single seizures. Status epilecticus is a medical emergency and the times for its identification and treatment influence the prognosis of the patient. The current limits are especially connected to the possibilities of access of instrumental diagnosis and to the lack of therapeutic protocols universally acknowledged. For a correct diagnosis of non convulsive status epilepticus and to verify the effects of the therapies is essential the contribution of neurophysiological diagnostic and, in particular, the electroencephalographic one. Long term EEG monitoring (LTM) is a well-established procedure in the evaluation of epilepsy patients. The analysis of EEG recordings is necessary to determine the seizure onset zone. LTM is also particularly useful in the evaluation of critically ill patients, in which seizures are frequently silent, and in the pre-surgical evaluation of patients with pharmacorefractory epilepsy. Main goal of our studies is related to the automatic analysis of seizures EEG pattern in order to obtain a 24 hours of monitoring of patiens. We are also involved in the neurophysiological evaluation of mechanisms mediating epileptogenesis in Tuberous Sclerosis Complex in mice and in the human evaluation of therapy with Rapamycin. This drugs has no documented properties as an anticonvulsant agent but it has strong efficacy for preventing epileptic encephalopathy in animal model of Tuberous Sclerosis. Before starting with a human trials we need some more information about the risks of withdrawal and we are actually involved in these part of the study. A multicentre study of efficacy of Rapamicyn in human may be plan for the next year. Fabio Minicucci DIVISION OF NEUROSCIENCE - 57 Selected publications 9 Arcidiacono, PG; Calori, G; Carrara, S; McNicol, ED; Testoni, PA. Celiac plexus block for pancreatic cancer Asperti, C; Astro, V; Totaro, A; Paris, S; de Curtis, I. Liprin-α1 promotes cell spreading on the extracellular matrix by affecting the distribution of activated integrins. J. Cell Sci.: 2009; 122(18): 3225-3232 - Article IF 2008: 6,247 9 Benedetti, F; Bernasconi, A; Bosia, M; Cavallaro, R; Dallaspezia, S; Falini, A; Poletti, S; Radaelli, D; Riccaboni, R; Scotti, G; Smeraldi, E. Functional and structural brain correlates of theory of mind and empathy deficits in schizophrenia. Schizophr Res: 2009; 114(1-3): 154-160 - Article IF 2008: 4,174 9 Bianchi, V; Farisello, P; Baldelli, P; Meskenaite, V; Milanese, M; Vecellio, M; Muhlemann, S; Lipp, HP; Bonanno, G; Benfenati, F; Toniolo, D; D’Adamo, P. Cognitive impairment in Gdi1-deficient mice is associated with altered synaptic vesicle pools and short-term synaptic plasticity, and can be corrected by appropriate learning training. Hum. Mol. Genet.: 2009; 18(1): 105-117 - Article IF 2008: 7,249 9 Castronovo, V; Canessa, N; Ferini-Strambi, L; Aloia, MS; Consonni, M; Marelli, S; Iadanza, A; Bruschi, A; Falini, A; Cappa, SF. Brain activation changes before and after PAP treatment in obstructive sleep apnea. Sleep: 2009; 32(9): 1161-1172 - Article IF 2008: 4,475 9 Centonze, D; Muzio, L; Rossi, S; Cavasinni, F; De Chiara, V; Bergami, A; Musella, A; D’Amelio, M; Cavallucci, V; Martorana, A; Bergamaschi, A; Cencioni, MT; Diamantini, A; Butti, E; Comi, G; Bernardi, G; Cecconi, F; Battistini, L; Furlan, R; Martino, G. Inflammation triggers synaptic alteration and degeneration in experimental autoimmune encephalomyelitis. J. Neurosci.: 2009; 29(11): 3442-3452 - Article IF 2008: 7,452 9 Chiappalone, M; Casagrande, S; Tedesco, M; Valtorta, F; Baldelli, P; Martinoia, S; Benfenati, F. Opposite changes in glutamatergic and GABAergic transmission underlie the diffuse hyperexcitability of synapsin i-deficient cortical networks. Cereb. Cortex: 2009; 19(6): 1422-1439 - Article IF 2008: 5,907 9 Colasante, G; Sessa, A; Crispi, S; Calogero, R; Mansouri, A; Collombat, P; Broccoli, V. Arx acts as a regional key selector gene in the ventral telencephalon mainly through its transcriptional repression activity. Dev. Biol.: 2009; 334(1): 59-71 - Article IF 2008: 4,416 9 Corbetta, S; Gualdoni, S; Ciceri, G; Monari, M; Zuccaro, E; Tybulewicz, VLJ; De Curtis, I. Essential role of Rac1 and Rac3 GTPases in neuronal development. FASEB J.: 2009; 23(5): 1347-1357 - Article IF 2008: 7,049 9 Cunha, C; Angelucci, A; D’Antoni, A; Dobrossy, MD; Dunnett, SB; Berardi, N; Brambilla, R. Brain-derived neurotrophic factor (BDNF) overexpression in the forebrain results in learning and memory impairments. Neurobiol. Dis.: 2009; 33(3): 358-368 - Article IF 2008: 4,852 9 Fornasiero, EF; Bonanomi, D; Benfenati, F; Valtorta, F. The role of synapsins in neuronal development. Cell. Mol. Life Sci.: 2009; 1-14 - Article in Press IF 2008: 5,511 9 Franzin, A; Snider, S; Picozzi, P; Bolognesi, A; Serra, C; Vimercati, A; Passarin, O; Mortini, P. Evaluation of Different Score Index for Predicting Prognosis in Gamma Knife Radiosurgical Treatment for Brain Metastasis. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 74(3): 707-713 - Article IF 2008: 4,639 9 Losa, M; Bianchi, R; Barzaghi, R; Giovanelli, M; Mortini, P. Persistent adrenocorticotropin response to desmopressin in the early postoperative period predicts recurrence of Cushing’s disease. J. Clin. Endocrinol. Metab.: 2009; 94(9): 3322-3328 - Article IF 2008: 6,325 9 Martinelli, V; Rocca, MA; Annovazzi, P; Pulizzi, A; Rodegher, M; Martinelli-Boneschi, F; Scotti, R; Falini, A; Sormani, MP; Comi, G; Filippi, M. A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. Neurology: 2009; 73(22): 1842-1848 - Article IF 2008: 7,043 9 Paulesu, E; Vallar, G; Berlingeri, M; Signorini, M; Vitali, P; Burani, C; Perani, D; Fazio, F. Supercalifragilisticexpialidocious: How the brain learns words never heard before. Neuroimage: 2009; 45(4): 1368-1377 - Article 58 - SAN RAFFAELE SCIENTIFIC INSTITUTE IF 2008: 5,694 9 Stefano, L; Racchetti, G; Bianco, F; Passini, N; Gupta, RS; Bordignon, PP; Meldolesi, J. The surface-exposed chaperone, Hsp60, is an agonist of the microglial TREM2 receptor. J. Neurochem.: 2009; 110(1): 284-294 - Article IF 2008: 4,500 Selected publications (INSPE) 9 Arcidiacono, PG; Calori, G; Carrara, S; McNicol, ED; Testoni, PA. Celiac plexus block for pancreatic cancer Bolis, A; Coviello, S; Visigalli, I; Taveggia, C; Bachi, A; Chishti, AH; Hanada, T; Quattrini, A; Previtali, SC; Biffi, A; Bolino, A. Dlg1, Sec8, and Mtmr2 regulate membrane homeostasis in Schwann cell myelination. J. Neurosci.: 2009; 29(27): 8858-8870 - Article IF 2008: 7,452 9 Cerri, F; Gavazzi, A; Previtali, SC; Franceschi, M; Lopez, ID; Scarlato, M; Podini, P; Comi, G; Quattrini, A. Diffuse intraneural leiomyoma in a case of sensorimotor neuropathy. Acta Neuropathol.: 2009; 117(5): 595597 - Article IF 2008: 5,310 9 Comi, G; Martinelli, V; Rodegher, M; Moiola, L; Bajenaru, O; Carra, A; Elovaara, I; Fazekas, F; Hartung, HP; Hillert, J; King, J; Komoly, S; Lubetzki, C; Montalban, X; Myhr, KM; Ravnborg, M; Rieckmann, P; Wynn, D; Young, C; Filippi, M. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet: 2009; 374(9700): 1503-1511 - Article IF 2008: 28,409 9 Inuggi, A; Amato, N; Magnani, G; Gonzalez-Rosa, JJ; Chieffo, R; Comi, G; Leocani, L. Cortical control of unilateral simple movement in healthy aging. Neurobiol. Aging: 2009; (): - Article in Press IF 2008: 5,959 9 Pluchino, S; Gritti, A; Blezer, E; Amadio, S; Brambilla, E; Borsellino, G; Cossetti, C; Del Carro, U; Comi, G; ‘T Hart, B; Vescovi, A; Martino, G. Human neural stem cells ameliorate autoimmune encephalomyelitis in non-human primates. Ann. Neurol.: 2009; 66(3): 343-354 - Article IF 2008: 9,935 DIVISION OF NEUROSCIENCE - 59 Neuropsychopharmacology Unit Cellular and molecular neurobiology Unit Cellular neurophysiology Unit 60 - SAN RAFFAELE SCIENTIFIC INSTITUTE Molecular genetics of mental retardation Unit Neural degeneration Unit Stem cells and neurogenesis DIVISION OF NEUROSCIENCE - 61 Cognitive neuroscience Unit Clinical neuroimmunology DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 63 DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES Research Units Amino acid and stable isotopes Unit HEAD OF UNIT: Livio Luzi RESEARCHERS: Andrea Caumo, Stefano Benedini, Roberto Codella, Ileana Terruzzi FELLOWS: Chiara Martinelli, Anna Montesano, Antonella Pagani, Pamela Senesi Complications of diabetes GROUP LEADER: Gianpaolo Zerbini RESEARCHERS: Mara Lorenzi, Anna Maestroni PHD STUDENT: Silvia Maestroni CONSULTANT: Gemma Tremolada TECHNICIAN: Daniela Gabellini Obesity and metabolic related diseases GROUP LEADER: Gianluca Perseghin FELLOW: Guido Lattuada TECHNICIAN: Francesca Ragogna Bone metabolism Unit HEAD OF UNIT: Alessandro Rubinacci RESEARCHER: Isabella Villa POST-DOCTORAL FELLOW: Emanuela Mrak FELLOW: Simona Bolamperti CONSULTANTS: Giovanna Mignogna, Gianluigi Moro, Marcella Sirtori TECHNICIAN: Ennio Leporati Coagulation service & thrombosis research Unit HEAD OF UNIT: Armando D’Angelo RESEARCHERS: Luciano Crippa, Patrizia Della Valle, Annalisa Fattorini, Silvana Viganò FELLOW: Giulia Pavani TECHNICIAN: Elisabetta Pattarini, Francesca Sampietro Cardiodiabetes & core Lab HEAD OF UNIT: Emanuele Bosi* GROUP LEADER: Lucilla D. Monti FELLOW: Elena Galluccio TECHNICIANS: Sabrina Costa, Barbara Fontana Pediatric endocrinology research HEAD OF UNIT: Giuseppe Chiumello* GROUP LEADER: Stefano Mora FELLOWS: Silvia Carlucci, Annalisa Donini, Silvia Genovese, Ilaria Zamproni TECHNICIAN: Maria Puzzovio 64 - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units Diabetes and endocrinologyUnit HEAD OF UNIT: Emanuele Bosi* PHYSICIANS: Alberto Davalli, Gabriella Galimberti, Roberto Lanzi, Marco Federico Manzoni, Alessandro Saibene RESIDENTS: Chiara Cappelletti, Valentina Crippa, Valentina Doria, Ilaria Formenti, Manuela Fortunato, Andrea Laurenzi, Sara Madaschi, Elena Peretti, Francesca Perticone, Cecilia Piani, Maria Grazia Radaelli, Alessandro Rossini, Annachiara Uccellatore, Valentina Villa TECHNICIAN NUTRITIONIST: Monica Marchi RESEARCH NURSE: Eleonora Bianconi TRIAL COORDINATOR: Pauline Grogan Cardio-metabolic and clinical trials CLINICAL GROUP LEADER: Piermarco Piatti FELLOWS: Pietro Lucotti, Emanuela Setola RESEARCH NURSE: Michela Stuccillo Pediatrics Unit HEAD OF UNIT: Giuseppe Chiumello* Clinical pediatric endocrinology CLINICAL GROUP LEADER: Giovanna Weber* RESEARCHERS: Stefania Di Candia, Gabriella Pozzobon, Gianni Russo, Maria Cristina Vigone Diabetes and metabolic diseases in children and adolescents CLINICAL GROUP LEADER: Franco Meschi RESEARCHERS: Karen Marenzi, Matteo Viscardi Neonatology CLINICAL GROUP LEADER: Graziano Barera RESEARCHERS: Antonella Poloniato, Rosanna Rovelli RESIDENT: Patrizia Corsin Gynecology and obstetrics Unit HEAD OF UNIT: Massimo Candiani* Fetal-maternal medicine CLINICAL GROUP LEADER: Maria Teresa Castiglioni RESEARCHERS: Susanna Rosa, Maddalena Smid, Luca Valsecchi PHD STUDENT: Paolo Cavoretto FELLOWS: Federica Pasi, Audrey Serafini Infertility CLINICAL GROUP LEADER: Enrico Papaleo RESEARCHERS: Ilaria Cino, Lucia De Santis, Michela Molgora, Nicoletta Panacci, Simone Rofena FELLOW: Elena Gismano Cardiovascular interventions Unit HEAD OF UNIT: Antonio Colombo PHYSICIANS: Mauro Carlino, Alfredo Castelli, Alaide Chieffo, Cosmo Godino, Azeem Mohamed Latib, Matteo Montorfano FELLOWS: Rasha Al-Lamee, Francesco Arioli, Economou Fotios, Alfonso Ielasi, Marco Mussardo, Kensuke Takagi RESIDENTS: Filippo Figini, Daniela Piraino, TRIAL COORDINATOR: Angela Ferrari Clinical cardiovascular biology Unit HEAD OF UNIT: Domenico Cianflone* PHYSICIANS: Enrico Ammirati, Nicole Cristell DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 65 POST-DOCTORAL FELLOW: Norma Maugeri RESIDENTS: Alessandro Durante, Anna Chiara Vermi TECHNICIAN: Michela Banfi RESEARCH NURSE: Barbara Pontiroli Ischaemic heart disease, heart failure and echocardiography Unit HEAD OF UNIT: Alberto Margonato PHYSICIANS: Eustachio Agricola, Alberto Capelletti, Gabriele Fragasso, Andrea Macchi, Michele Oppizzi RESIDENTS: Michela Cera, Irene Franzoni, Claudia Montanaro, Isabella Rosa, Anna Salerno, Massimo Slavich POST-DOCTORAL FELLOW: Fabio Buzzetti PHD STUDENTS: Francesco Maranta, Camilla Tarlasco Organ protection in critically ill patients, Advanced cardiac failure and mechanical supports Unit HEAD OF UNIT: Alberto Zangrillo* PHYSICIANS: Elena Bignami, Tiziana Bove, Luca Cabrini, Giuseppina Maria Casiraghi, Sergio Colombo, Remo Daniel Covello, Giovanni Landoni, Giovanni Marino, Melissa Messina, Federico Pappalardo, Davide Salaris, Paolo Silvani RESIDENTS: Laura Corno, Giulia Maj, Anna Maria Mizzi, Giacomo Monti, Laura Ruggeri, Stefano Turi POST-DOCTORAL FELLOWS: Luigi Barile, Luca Buratti, Elena Frati QUALITY ASSURANCE AND REGULATORY AFFAIRS: Simona Massani, Lara Sussani, Paola Zuppelli Structural heart disease Unit HEAD OF UNIT: Ottavio Alfieri* PHYSICIANS: Stefano Benussi, Michele De Bonis, Francesco Maisano FELLOWS: Andrea Guidotti, Ylenia Privitera, Davide Schiavi Study and treatment of aortic disease Unit HEAD OF UNIT: Roberto Chiesa* PHYSICIANS: Domenico Astore, Renata Clotilde Castellano, Efrem Civilini, Laura Dordoni, Gloria Esposito, Enrico Maria Marone, Massimiliano Marrocco-Trischitta, Germano Melissano, Yamume Tshomba RESIDENTS: Chiara Brioschi, Giovanni Coppi, Andrea Kahlberg, Davide Logaldo, Daniele Mascia, Daniele Psacharopulo, Sara Spelta, Gianbattista Tshiombo FELLOWS: Domenico Baccellieri, Luca Bertoglio, Barbara Catenaccio Center for arrhythmia research HEAD OF UNIT: Carlo Pappone CLINICAL GROUP LEADER: Vincenzo Santinelli POST-DOCTORAL FELLOWS: Giuseppe Augello, Alessia Pappone, Simone Sala, Nicoleta Sora, Pasquale Vergara RESIDENTS: Giuseppe Ciconte, Andrea Radinovic, Massimo Saviano TECHNICIAN: Giorgio Maida Vision first Unit HEAD OF UNIT: Francesco Bandello* PHYSICIANS: Maurizio Battaglia Parodi, Paolo Bettin, Stefania Bianchi Marzoli, Gianluigi Bolognesi, Marco Codenotti, Francesco Fasce, Antonio Giordano Resti, Ugo Introini, Rosangela Lattanzio, Francesco Loperfido, Gisella Maestranzi, Giulio Modorati, Luisa Pierro, Alessandra Tavola RESIDENTS: Maria Lucia Cascavilla, Umberto De Benedetto, Federico Di Matteo, Matteo Ghidoni, Silvia Giatsidis, Jacopo Milesi, Laura Regali, Ilaria Zucchiatti CONSULTANTS: Nicola Baccelli, Loredana Bonisolli, Elena Bruschi, Gabriella Cammarata, Carlo Ciampi, Paola Ciasca, Annalisa Colucci, Marina Fiori, Maddalena Forti, Marco Gagliardi, Silvia Gomarasca, Lauretta Guarisco, Francesca Legorini, Maria Pia Manitto, Angela Malegori, Elena Mantovani, Elisabetta Martina, Paolo Mauceri, Lisa Melzi, Elisabetta Miserocchi, Veronica Odazio, Matteo Prati, Andrea Ramoni, Carmen Rojo, Michela Rossi, Marco Setaccioli, Monica Stoppani, Fabrizio Scotti, Alessandra Spinelli TECHNICIANS: Giorgio Alto, Alessio Buzzotta * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 66 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction Mission and Vision - It is unquestionable that some of the most relevant diseases with high social, economic and clinical impact in developed societies link disorders of metabolism to chronic and acute alterations of cardiovascular function. Metabolic and cardiovascular diseases represent a major area of clinical care and research at San Raffaele Research Institute. Thus, the Division of Metabolic and Cardiovascular Sciences will be devoted to planning an integrated approach to treat patients and understand mechanisms based on a structured view of the pathophysiological connections between metabolic and cardiovascular alterations. Such a vision could set a strong example of how to tackle complex problems with beneficial outcomes. Aim of the Division is therefore not only to exploit the obvious possibility of synergy at the level of basic research, but also the creation of clinical programs in which experts in the study of altered metabolism are integrated in the team of cardiologists, cardiac surgeons, vascular surgeons and cardiac emergency physicians treating acute or chronic cardiovascular diseases. Conversely, cardiovascular specialists should be part of the clinical team evaluating and treating patients with metabolic disorders. Organization - At this stage, the Strategic Committee for Research is involved with drawing the guidelines for implementation of the Institutional Research Division of Metabolic and Cardiovascular Sciences. The efforts of this work-in-progress are focused on facilitating interactions that will lead to creating a common research space for the investigators of the Division. Goals - The biology of endothelium may be considered as a theme of unifying interest and particular relevance to research bridging the metabolic and cardiovascular disease areas. This could easily be expanded to include the biology of other cellular components of the vessel wall – smooth muscle cells, fibroblasts, inflammatory cells and adipocytes – which play a concerted and fundamental role in controlling all responses to acute and chronic vascular injuries. Along with this unifying theme, areas of interest span from the mechanisms of myocardial damage; thrombosis; hemostatic imbalance (post-surgery bleeding in emergency patients and patients with ventricular assisting devices); pathobiology of the atherosclerotic plaque; metabolic alterations leading to cardiovascular diseases, in particular insulin resistance and type 2 diabetes; material sciences and bioengineering with respect to developing new devices; and cell therapies. The outcomes of this integrated approach will lay new grounds for innovative treatments of established metabolic and cardiovascular diseases, personalized preventive medicine programs and new generations of clinical and nutritional studies. Achievements - Work performed in the Division is internationally recognized in several areas of excellence including arrhythmology, cardiac valve and aortic surgery, acute and chronic myocardial damage, coronary revascularization, vascular inflammation, insulin resistance, diabetic macro- and microangiopathy, intermediary and energy metabolism, bone pathophysiology. Training Opportunities - The Division, through the intertwined connections with several Clinical Care Departments, gives ample support to the Postgraduate Schools in Anesthesia and Intensive Care, Cardiovascular Diseases, Cardiac Surgery, Vascular Surgery, Endocrinology and Metabolic Diseases, Obstetrics and Gynecology, Pediatrics, and Ophthalmology. DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 67 Research Units AMINO ACID AND STABLE ISOTOPES UNIT The group is pursuing several major research areas. In details we are studying: the association among gene polymorphisms, DNA methylation and metabolism in diabetes, obesity and athletes. Diabetes and obesity are conditions often associated with altered levels of plasma homocysteine (Hcy) concentrations. Recently the interrelation between physical exercise and higher Hcy plasma levels have been studied in athletes. We are investigating the effect of in vitro DNA demethylation on MyoD, Myogenin, MHC, PPARγ and leptin expression to evaluate the effect of deficiency in DNA methylation by polymorphisms on cells myogenesis and adipogenesis promotion. Metabolic outcome of islet transplantation: using clamp techniques combined with tracer infusions glucose, lipid and amino acids metabolism are studied in type 1 diabetic individuals undergoing islet transplantation. Mathematical modelling of metabolic and endocrine systems. The simultaneous assessment of insulin sensitivity and insulin secretion is of paramount importance to evaluate the metabolic status of a subject at risk of becoming diabetic or to monitor the effect of therapies. Aim of our research is to develop methods to perform the simultaneous assessment of insulin secretion and insulin sensitivity. The increasing need to keep the experimental costs as low as possible has given remarkable impulse to the use of indices of derived from an oral glucose tolerance test (OGTT). We are developing a suitable mathematical model that will allow us to reliably estimate these parameters in different physiopathological states from a 3-sample OGTT. Lastly, a nutraceutical line of research was undertaken to discover metabolic effects of plant-derived proteins. Livio Luzi COMPLICATIONS OF DIABETES Prevention, cure and remission of the complications of diabetes Despite major efforts aimed to obtain the best possible control of glucose metabolism, microvascular complications of diabetes remain among the major causes of end stage renal disease and blindness in Europe. Whether the complications of diabetes may be the result, in predisposed individuals, of the persistent toxic effect of glucose on specific progenitor cells localized in target organs of diabetes such as the renal glomerulus or the retina, is presently unknown. To test this hypothesis we are presently involved in two major projects: 1. Identification of podocyte progenitor cells (PPCs). In case of diabetes the podocytes, i.e. the glomerular cells responsible for the filtering capacity of the kidney, tend to die and to detach from the basal membrane causing the onset of a progressive and irreversible proteinuria. Searching for progenitor cells, we identified inside the human visceral glomerulus, clusters of cells characterized by the expression of podocyte markers on one hand and of stem cell markers on the other, suggesting the presence of PPCs inside the adult human kidney. Experiments aimed to isolate and grow in culture PPCs are presently under way. The characterization of PPCs may allow to understand the cellular bases of diabetic nephropathy. 2. Endothelial progenitor cells (EPCs) and vascular disease in type 1 diabetes The final stage of diabetic retinopathy, so called proliferative retinopathy (PDR), is characterized by the active proliferation, inside the retina, of incompetent new capillaries causing hemorrhages and retinal detachment. Whether EPCs might be involved in the pathogenesis of PDR is presently unknown. In collaboration with the Vision First Unit of this Institute we have demonstrated that an increased activity of EPCs is found not only in type 1 diabetic patients with PDR, but also in patients with initial signs of diabetic retinopathy despite a 68 - SAN RAFFAELE SCIENTIFIC INSTITUTE short duration of diabetes. Conversely, EPCs activity is normal in patients without retinopathy despite a long duration of diabetes. Altogether these findings suggest that increased activity of EPCs is not only a marker of predisposition to develop PDR, but may also be directly involved in the pathogenesis of the complication. Gianpaolo Zerbini OBESITY AND METABOLIC RELATED DISEASES Insulin resistance is the common alteration leading to deleterious metabolic effects at the level of the skeletal muscle, liver, heart, adipose tissue and β-cells responsible of the pathogenesis of obesity and metabolic syndrome. The molecular mechanisms responsible of insulin resistance at the cellular level were largely identified in animal models. Despite that, the understanding of the pathogenic events leading to their activation remains unresolved, eluding the drug-related strategies of intervention. Our working hypothesis is that any perturbation (genetic or acquired) that leads to an increase in intracellular fatty acids concentrations such as 1) acquired or inherited defects in mitochondrial lipid oxidation, 2) defects in adipocyte fat metabolism 3) increased fat delivery to muscle/liver/heart/adipose tissue due to higher energy intake constitutes a detrimental factor predisposing to the onset of insulin resistance. With our research activity we were among the first to demonstrate that in humans increased fat accumulation within the skeletal muscle and the liver has systemic deleterious metabolic effects and that increased epicardial fat and intracardiac fat accumulation is a major factor involved in diabetesinduced heart alterations. At this stage, to identify the targets to be treated to reduce fat-induced insulin resistance is of paramount importance. The methodological approach that was developed to address this issue is based on Magnetic Resonance Spectroscopy techniques in vivo in humans to study non invasively the alteration of energy metabolism in single organs and tissues to assess the impact on the whole body system using 31PMRS. In particular the cardiac and hepatic applications are novel, promising and strategic tools in our field of investigation to identify targets for potential treatments. Gianluca Perseghin BONE METABOLISM UNIT Aging bone: gene expression and endocrine mileu The Unit is engaged in the effort to characterize the microstructural parameters, biomolecular signaling and endocrine milieu characterizing the bone undergoing to fragility fractures. To these purposes, three lines of research have been carried out. 1. A pQCT study of the femoral neck of the elderly undergoing to hip replacement for femoral fractures or primary arthrytis was performed. Results suggest that a bone mechanical adaptation mechanism to the age related loss of trabecular elements is preserved only in the arthrytis group that exibits an overall lower risk of fragility fractures. The lack of this protective mechanism in the osteoporotic cohort is consistent with the hypothesis that the aging process is accompanied by a disturbance of the mechanotransduction process. 2. Wnt signaling in bone samples of postmenopausal women have been evaluated. Results indicate that aging induces an altered balance between Wnt agonists and antagonists, constituting an age dependent insufficiency state of the Wnt signalling pathway with a subsequent impairment of osteoblastogenesis. The gene expression profile was consistent with the major features of aging bone. In order to investigate the cell targets potentially affected by the altered Wnt signalling, mesenchymal cell fraction availability has been evaluated by challenging their differentiation profile and markers expression in vitro. Preliminary results suggest that the mesenchymal cell pool is available despite age and might therefore constitute a direct potential pharmacological target. 3. The modulation of the GH intracellular signaling after the GH receptor activation exerted by estrogens has been evaluated in human osteoblast-like cells. 17β-estradiol is able to positively modulate GH signaling, by inducing an increase of STAT5 phosphorylation with consequent increase in the IGF2 gene transcription and protein production. Further studies are ongoing in order to characterize the molecular mechanisms involved in estrogen facilitatory action on GH signaling. DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 69 By collaborative efforts, the bone phenotypes of ADA deficiency, islets transplant recipients, MPS, adult GHdeficiency, genetic clusters, coronary calcification and Paget disease have been evaluated. Alessandro Rubinacci Figure 8. 3D reconstruction of human femural neck by an originally developed software. COAGULATION SERVICE & THROMBOSIS RESEARCH UNIT More about hyperhomocysteinemia and poor folate status Our group has been interested in the identification of thrombophilia markers since a long time. Moderate hyperhomocysteinemia, an indicator of poor vitamin status, is a risk factor for thrombosis, but its causative role has not been yet defined. In collaboration with the University La Sapienza of Rome, we evaluated tHcy levels in patients with chronic obstructive pulmonary disease (COPD), who are at increased atherothrombotic risk. Compared to controls, COPD patients had higher plasma tHcy (median: 13.9 micromol/l vs 11.5 micromol/l, p = 0.002) and lower circulating folate (median: 2.5 ng/ml vs 2.8 ng/ml, p = 0.03) also after adjusting for smoking, heart failure, renal function and C-reactive protein (OR 1.36, p = 0.01). Low levels of folate (p = 0.02), vitamin B12 (p = 0.04), and hypertriglyceridemia (p 2 = 0.52). Thus, COPD patients have a poor B vitamin status and increased tHcy, possibly resulting in increased atherothrombotic risk. Human chromosomes are capped by telomeres, which consist of tandem repeats of DNA and associated proteins. Telomere dysfunction has been associated with development of age-related pathologies (cancer, cardiovascular disease, Alzheimer’s disease, Parkinson’s disease). Folate provides precursors for nucleotide synthesis thus affecting DNA integrity; it also modulates DNA methylation, which in turn epigenetically regulates telomere length. In collaboration with the Tufts University of Boston, we determined whether folate status and the 677C > T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene are associated with the telomere length of peripheral blood mononuclear cells in healthy men. When plasma folate concentration was above the median, there was a positive relationship between folate and telomere length. In contrast, there was an inverse relationship between folate and telomere length when plasma folate concentration was below the median. The MTHFR 677C > T polymorphism was weakly associated with increased telomere length at belowmedian folate status. Folate status may thus affect DNA integrity and influence the epigenetic regulation of telomere length through DNA methylation. Armando D’Angelo CARDIODIABETES & CORE LAB Genetic characterization of different pathways in the induction of the Cardio-diabetes Syndrome Our previous clinical experience demonstrated a specific phenotype characterized by increased fasting nitric oxide levels but reduced response after an insulin stimulus in patients with cardiovascular disease and in type 2 diabetic patients and their first degree relatives. At genetic level we found a strong association between eNOS gene variants and type 2 diabetes and intra-stent restenosis. The polymorphism in intron 18 of eNOS gene affects the physiological mRNA splicing, with skipping of exons 19 and 20. As a result, the alternative transcript does not encode an enzymatically active protein and, when co-expressed, it inhibits enzymatic activity of the full-length, thus acting as dominant negative regulators of nitric oxide synthesis. This suggests that truncated 70 - SAN RAFFAELE SCIENTIFIC INSTITUTE NOS polypeptides have diminished enzymatic activity and it will explain the presence of dramatically increased presence of early restenosis in patients carrying the eNOS SNP in intron 18. Our project is aimed to evaluate eNOS gene function and the mechanisms of gene expression and regulation in the presence of gene variants and the impact at cellular levels both in arterial or platelet cells of patients carrying the polymorphism. The importance of metabolic factors, i.e. the presence of alterations of glucose or lipid metabolism will be taken into account. Recent data seems to demonstrate, in healthy subjects, that eNOS gene variants correlate with a reduced number of endothelial progenitor cells. The presence of eNOS gene variants also correlate with increased IMT values, an index of early atherosclerosis. In 2009, we started the evaluation of the presence of new candidate gene variants (ANP) in patients with mitral valve disease. Further, we will continue with the definition of the molecular mechanisms involved in early endothelial activation and inflammation in isolated endothelial cells and the evaluation of genes expression for inflammation and oxidative stress in endothelial progenitors cells and the search of new serological indices involved in the pathogenesis of Cardio-diabetes in strict collaboration with the Cardio-Metabolic and Clinical Trials Unit. The group also collaborate with the Neurogenomics Unit, the Cardio-Thoraco-Vascular and the Neurology Departments. Lucilla D. Monti PEDIATRIC ENDOCRINOLOGY RESEARCH Although osteoporosis is regarded as a condition of the elderly, it is now clear that it has its antecedents during childhood and adolescence. One of the key factors influencing the development of osteoporosis in adulthood is the bone mass gain occurring during growth. The concerted action of bone-forming cells (osteoblasts), and bone-resorbing cells (osteoclasts) is crucial for the development of a healthy and competent skeleton. Whenever bone metabolism is impaired during childhood and adolescence, bone mass accrual is deficient. The study of bone physiology is thus important to identify the factors influencing a correct metabolism. Our group is investigating these factors in healthy children and adolescents by the assessment of specific biochemical markers of bone metabolism and by measurements of bone mass using different techniques. We are also actively involved in the study of bone health in several pediatric disorders. In particular, we are investigating the role of antiretroviral treatment on bone mass in HIV-infected youths, in collaboration with Alessandra Viganò at Sacco Hospital in Milan. We are also studying bone mass and bone metabolism in young patients with congenital adrenal hyperplasia, a disease leading to disturbances of sexual differentiation. In collaboration with the Universities of Milan, Insubria, and Catania, our group is coordinating a research aimed to the identification of genetic markers of a rare disorder of glucose metabolism: Congenital Hyperinsulinism of Infancy (CHI). We established a National Registry for this disease, and we enrolled and studied 35 families with CHI. Molecular studies lead to the identification of several novel mutations responsible for the disease. Hypophosphatemic rickets is a rare condition leading to impaired bone mineralization, skeletal deformities, and metabolic disturbances. The cause of the disease have been described recently, but they remain unknown in some patients. Our group is involved in a collaborative study with the group of Maria Luisa Brandi, University of Florence, to identify the genetic causes of this type of rickets. Stefano Mora DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 71 Clinical Research Units DIABETES AND ENDOCRINOLOGY UNIT The research of our unit focused on relevant clinical questions, such as self-monitoring of blood glucose, lifestyle changes (diet and physical activity), disabling diabetic neuropathy: 1. Self-monitoring of blood glucose for the management of patients with type 2 diabetes is a controversial issue. We are conducting a Nationwide multicenter randomized clinical trial to study the impact of a program of lifestyle changes based on self-monitoring of blood glucose in patients with type 2 diabetes treated with diet alone or oral agents. The trial will recruit 1000 participants in over 30 diabetes outpatient clinics throughout Italy. 2. Physical activity is one of the cornerstone of diabetes treatment. However, only a small proportion of patients with type 2 diabetes walks at least 10,000 steps/day. Modern technology may help our patients achieve this goal. We are conducting a randomized clinical trial to assess whether providing patients with type 2 with a with a step counter with wireless connection to a cell phone helps achieving the walking goal of 10000 steps/day. 3. Patients with type 1 diabetes need to adjust their pre-meal insulin bolus according to the expected carbohydrate content of their meal. The method of carbohydrate counting has become very popular in Northern America and more recently in Europe. We are conducting a randomized clinical trial to study the impact of carbohydrate counting on glucose control in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion using an external insulin pump. 4. Peripheral neuropathy is a frequent and disabling microvascular complication of both type 1 and type 2 diabetes. Pharmacological treatment of diabetic neuropathy is purely symptomatic and largely unsatisfactory. As a novel and original non pharmacological treatment, a Frequency modulated Electro-Magnetic neural Stimulation (FREMS) method, characterized by sequences of modulated electrical stimuli which vary automatically in pulse frequency, duration and voltage amplitude, has recently been developed by our group. In a pilot trial FREMS proved to be safe and efficacious in the treatment of painful diabetic neuropathy, with the evidence of associated enhancement of local tissue microcirculation. Emanuele Bosi CARDIO-METABOLIC AND CLINICAL TRIALS New etiopathogenetic approaches and clinical trials in the prevention and cure of Cardio-diabetes Syndrome The main hypothesis of CARDIO-DIABETES Project is that type 2 diabetes mellitus and ischemic cardiomyopathy are the same disease. Furthermore, in our opinion, the heart is not only a passive player being affected by the negative effects of type 2 diabetes but is also an active player acting as an endocrine-metabolic organ able to induce type 2 diabetes. To screen populations at higher risk to develop DM2, we initiated the characterization of the metabolic and endothelial differences between coronary and carotid atherosclerosis. Preliminary data in a small group of patients suggested that coronary atherosclerosis is characterized by decreased adiponectin levels, insulin resistence and a more proatherogenetic profile than carotid atherosclerosis. Conversely, an increased prothrombotic state and higher platelet activation seem to be present in patients with carotid vasculopathy, suggesting the presence of a marked heterogeneity of coronary and carotid atherosclerosis. Further, in patients with heart valve disease we demonstrated a high prevalence of DM2 associated with increased ANP and FFA levels. In the light to evaluate innovative treatments to revert insulin resistance (IR) and endothelial dysfunction (ED), as part of a nutritional planning, two studies with L-arginine were performed in CAD and in obese type 2 diabetic patients. In both cases, we showed that chronic oral L-arginine therapy ameliorated IR, ED, glucose tolerance and inflammation. In a new protocol, in collaboration with GPs of Milan area, we aim to deepen insight in the the characterization of glucose tolerance and insulin resistance not only in CAD patients 72 - SAN RAFFAELE SCIENTIFIC INSTITUTE but also in first degree relatives (CAD-R). We also plan to cross-integrate a therapeutic intervention by changes in life style, diet and physical activity aimed to reduce the progression to type 2 diabetes with analytical research procedures based on the evaluation of eNOS variants both in CAD and CAD-R. The Unit works in strict collaboration with the Cardio-Diabetes and Core Lab. Unit. The group also collaborate with the Neurogenomics Unit, the Cardio-Thoraco-Vascular and the Neurology Departments. The group is also involved in the largest and major world-wide sponsored Clinical Trials for the prevention and cure of DM2 and CAD. Piermarco Piatti CLINICAL PEDIATRIC ENDOCRINOLOGY We evaluated the role of genetic alterations on etiopathogenesis of some paediatric endocrinopathies. Congenital Hypothyroidism (CH): we identified in cooperation with Milan University, 7 mutations on gene involved in iodine organification (DUOX2/ DUOXA2), and 3 mutations on TSH-receptor gene. We also performed genetic analysis in patients with CH and associated choreoathetosis, discovering two new mutations in TTF1 gene. We are performing studies to identify interaction between genetic, epigenetic environmental, factors of pathogenesis of CH. Congenital Hyperinsulinism: to date, 34 families have been recruited; we identified 13 mutations in ABCC8/ KCNJ11 genes (5 new mutations). Moreover one patient had a novel mutation of the HADH gene; two patients showed an homozygosity strand on chromosome 1, containing the MCAD gene. Finally we identified new possible loci associated to CHI in families (by genome-wide SNP mapping). In the next years we will continue to screen new patients. Hypogonadotrophic Hypogonadism: we are studying these patients from clinical and genetic perspective. In two patients a mutation in candidate genes has been found. Overweight and obesity are increasing dramatically in children. A timely diagnosis of impaired glucose tolerance (IGT) is desirable in obesity. We assessed whether one or more biochemical indexes measured in fasting conditions could be used to identify obese children at risk of IGT. In order to assess less-invasive and more accurate methods for the diagnosis and follow-up of various forms of Congenital Adrenal Hyperplasia (CAH), we determined salivary and urinary steroid profile through liquid chromatography-mass spectrometry. In CAH due to 21-hydroxylase deficiency, a good differentiation between heterozygotes and healthy subjects is obtained through urinary hormones 17-hydroxypregnanolone and pregnenediol. Small for gestational age (SGA) children are at risk for obesity and Metabolic Syndrome (MetS). We continued the analysis of the intrahepatic fat, measured using localized hepatic 1HMRS, whole body energy homeostasis, insulin sensitivity, and body composition in SGA and born appropriate for gestational age adolescents. Giovanna Weber DIABETES AND METABOLIC DISEASES IN CHILDREN AND ADOLESCENTS The aim of the unit is clinical research in children and adolescents with type 1 diabetes. We have a large outpatients clinic attended by 750 pediatric subjects with diabetes. We have 3 main lines of study: 1) technology in diabetes 2) prevention of micro and macrovascular complication of diabetes 3) obesity in diabetic children. We study the different application of technology in pediatric diabetology. More than 140 children treated with pump for continuous subcutaneous insulin infusion (CSII) are in follow-up for many years end monitoring long term results in term of HbA1c, acute complications, quality of life. We took part in a multicenter italian study named VIPKIDS in order to study results and quality of life in children with CSII. Moreover we use continuous glucose monitoring (GCMS) in children and adolescents and we follow in outpatients the first combined application of CSII and CGMS. We are comparing CSII and MDI in children < 6 yrs. DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 73 Regarding prevention of microvascular complication we have a database of patients with longlasting diabetes in order to perform periodic assessment monitoring the microvascular complications and related factors. Moreover we perform a study with Dr Zerbini on effect of EPC cells in retinopathy and on level of C peptide and microvascular complications. In order to study the prevalence of obesity in type 1 diabetic children we perform a study in a cohort of 7-14 year’s old children with diabetes compared with a cohort of normal children same age. We evaluate risk factors for macrovascular complications, physical examination and laboratory results. Moreover we try to study the effect of the introduction of carbohydrate counting in the metabolic control and BMI change in diabetic children. We are an active part of SIEDP’s group in pediatric diabetology and we participate in different multicenter studies. Our Unit is fully involved in research projects in cooperation with Childhood Diabetes Unit of Diabetes Research Institute in the following topics: secondary and tertiary prevention of type 1 diabetes, identification of rare cause of monogenic insulin dependent diabetes. Franco Meschi NEONATOLOGY Central nervous system and neuropsychological development in newborn The study of central nervous system maturation and of neuropsychological development in term and preterm newborn in different clinical conditions is one of the most important research area of our group. The collaboration with Neuroradiology Unit and Neuroscience Department is pivotal for such studies. • A longitudinal study is ongoing in order to evaluate myelinization and maturation of brain by serial MRI scan in preterm babies with gestational age less than 34 weeks at birth: different imaging tecniques, like diffusion technique imaging (DTI) and functional MRI are performed with high field MRI. Clinical and psychomotor follow up evaluations will be correlated to post-natal clinical data. Preliminary data are under evaluation and analisis. • We examine neuronal function understanding auditory development in the first week of life. We used functional MRI to study brain activity in melodic and language processing in a cohort of newborns. • The Unit is involved in a multicentre study, with other Italian Neonatology Units, on quality of life in “wellbeing” preterm infants: the aim of this study is to evaluate quality of care, its perception from the baby, effect and consequence on neuropsychological development up to the age of seven years. Graziano Barera FOETAL-MATERNAL MEDICINE Study of new predictors of pregnancy outcomes in women with high risk pregnancies 1. Study of markers of cellular and systemic inflammation We are planning a prospective study of women at high risk of complications during pregnancy (Anti Phospholipids Syndrome, recurrent miscarriages, second trimester abortion or intrauterine fetal death, even in the absence of detectable autoimmunity). The goal is to explore the markers of cellular activation, systemic inflammation and coagulation. The patients, all treated with low molecular weight heparins, will be matched with a control group, free from pregnancy complications. An additional group of women with type 1 diabetes, a disease of autoimmune etiopathogenesis, will also be studied. We project to start patient recruitment in early 2010, after Ethics Committee approval. 2. Study of early morphological markers of abnormal fetal development Despite optimal pre-natal care pregnant patients with type 1 diabetes have an increased risk of macrosomia and fetal distress compared to women without diabetes. Furthermore, the growth pattern of fetuses of diabetic 74 - SAN RAFFAELE SCIENTIFIC INSTITUTE mothers and the timing of growth changes are poorly understood. Recent evidences are highlighting the relevance of events in the first trimester of pregnancy for the development of complications in the later phase of pregnancy. We described a specific delay of early growth among diabetic pregnancies, and this finding may be a predictor of the pregnancy outcome. By conventional and 3D ultrasound we are continuing the study of fetal and placental volumes to document fetal and trophoblastic development during the first trimester and the correlation of these measurements both with levels of maternal serum hormones (eg f-BhCG and PAPP-A) and with pregnancy outcomes in women with type 1 diabetes and women at high risk of complication during pregnancy. 3. Study of feto- placentar nucleic acids in maternal plasma in preeclampsia and intrauterine growth restriction Our collaboration with the Genomic Unit for Diagnosis of Human Pathologies is ongoing and we are evaluating a panel of transcripts of fetal and placental genes potentially involved in the pathogenesis of preeclampsia and intrauterine growth restriction. At this purpose we are collecting blood from patient at risk to develop this pathologies at different gestational ages. The identification of early markers of these diseases is important for early diagnosis and prevention. 4. New therapeutic option for gestational diabetes We are designing a study of vitamin supplementation in pregnancies complicated by gestational diabetes mellitus (GDM). Myoinositol has been already been used for the treatment of Polycystic Ovarian Syndrome with an improvement of insulin-resistance. Our hypothesis is that myoinositol in patients with GDM will improve insulin resistance and decrease the proportion of women with GDM who will require insulin to control their blood glucose during pregnancy. We are planning to start recruitment for this study in July 2010 Maria Teresa Castiglioni INFERTILITY The department is primarily involved in both clinical and laboratory (applied) research with the final aim to increase pregnancy outcome in couples undergoing assisted reproductive technologies. Our team is testing the clinical efficacy of different novel molecules on the outcome of ovulation induction protocols. Two multicentre randomised control trials are on: the first on a novel method for subcutaneous progesterone administration, is renewing interest on the importance of the luteal phase support; the latter, is testing the role of co-treatment (rFSH + r-LH) in the approach to “poor prognosis patients” such as aged women or patients with a compromised ovarian reserve. Actually we are the first Italian IVF (In-vitro Fertilization) department undergoing trials on nutraceutical (i.e Inositol and Melatonin) in reproductive fields. Optimization of gametes is part of a project aimed to improve the clinical outcome of IVF. The study involves males undergoing ICSI (intra cytoplasmic sperm injection) for severe oligoastenozoospermia in the absence of chromosomal abnormalities. Patients are divided into two groups undergoing ICSI or IMSI (High Magnification Sperm Injection). The same samples are also analyzed for DNA integrity. SCSA (Sperm Chromatin Structure Assay) via flow cytometry has been developed in collaboration with Dr. A. Palini - Laboraf. The study try to determine if, independently from the rate of DNA damage, a severe oligozoospermic patient can benefit from IMSI. Cryoprotectants (CPAs) are essential for cryopreservation but potentially can cause disruption of cell function. Studies in the mouse suggest that exposure to CPAs can generate a transient increase in intracellular Ca2+, thus leading to a disturbance of cell cycle or activation. Therefore, the recording changes of intracellular Ca2+ in oocytes during exposure to CPAs could help to identify more appropriate conditions to minimize the disruption of cell cycle and, ultimately, improve the entire process of cryopreservation. Aim of our study is to evaluate the increase in the concentration of intracellular Ca2+ adding different types and concentration of cryoprotectants simulating conditions adopted for slow freezing or vitrification of human oocyte. Enrico Papaleo DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 75 CARDIOVASCULAR INTERVENTIONS UNIT Imaging/Intravascular Ultrasound (IVUS): New criteria for optimal DES were tested in the multicenter randomized AVIO study. APICE OCT is an ongoing multi-center, randomized trial evaluating the re-endothelization of 2 second generation (zotarolimus vs. everolimus) drug-eluting stents. Complex Coronary Lesions: Outcomes following drug eluting stent (DES) implantation vs. CABG in unprotected left main coronary artery lesions and anatomical features of restenosis following bare metal stent and DES implantation were reported from our center. Two randomized trials were conducted to assess the optimal revascularization therapy in diabetics with multivessel disease (FREEDOM) and in triple vessel disease and/or left main lesions (SYNTAX). RITMO, is an Italian registry evaluating prevalence, therapeutical choice and prognosis of patients with angiographic stenosis of unprotected left main disease. Paclitaxel-eluting balloons: two randomized studies evaluating drug-eluting balloons as compared to DES in de novo coronary lesions are ongoing: DILATATION and BELLO. Adjunctive therapy: The PARIS registry is a study evaluating dual antiplatelet therapy (DAT) after stent implantation. The duration of DAT is currently also being investigated in the SECURITY study. Adjunctive therapy trials are: AQUARIUS, evaluating the efficacy of aliskiren on the progression of atherosclerosis in patients with coronary artery disease when added to optimal background therapy; BINDARIT, a pilot study to evaluate the efficacy and safety of Bindarit dose in preventing bare-metal stent restenosis; and the SATURN trial, assessing the effects of high doses of atorvastatin vs. rosuvastatin. Neoangiogenesis: evaluated through intramyocardial injection of autologous stem cells in patients with refractory angina despite optimal medical therapy or not eligible for further revascularization. Structural Heart Disease/Transcatheter valve therapy: Two devices of our program received CE-mark approval: the balloon-expandable Edwards-Sapien valve, and the self-expanding CoreValve ReValving System. The multi-center SOURCE registry is testing Edwards Sapien. The outcomes of a percutaneous edge-to-edge repair approach for mitral valve regurgitation with the MitraClip system (Evalve) were reported. Antonio Colombo CLINICAL CARDIOVASCULAR BIOLOGY UNIT WP1: Circulating inflammatory markers in ACS Task 1 - The study of markers of activation of leukocytes during the very early phase (< 6 hours) of acute myocardial infarction (STEMI) has revealed the presence of fully degranulated neutrophils in circle. This observation allowed us show that platelets and leukocytes are activated and transiently express a pro-thrombotic and proinflammatory phenotype. We observed that neutrophils phagocyte activated platelets in the circulation, helping to eliminate circulating activated platelets and could help explain the transience of the phenomenon. Blood. 2009, 113 (21): 5254-65 Task 2 - Biological phenotype of 1099 STEMI and 878 controls in three ethnic groups (Italy, Scotland, China). We studied their metabolic and inflammatory profiles, the incremental value of inflammatory markers on top of risk factors and the cytokine profiles in samples upstream of active coronary lesion and downstream into the coronary sinus. [Young Investigator Award XV International Symposium On Atherosclerosis 2009 (Boston), Young Investigator Award Congress of the Italian Society for the Study of Atherosclerosis (Milan 2009)] Task 3 - Blood levels and function regulating lymphocytes (Treg) in acute and chronic coronary syndromes (ACS); identifying a possible differential role of Treg in different presentations of coronary artery disease. WP2: Gene Profiles in acute coronary syndromes We completed DNA extraction and quality control in our biobank of 1099 STEMI, 878 100 NSTEMI and 100 PVD. A first set of 48 SNPs for 100 STEMI, 100 NSTEMI and 100 controls was studiedand we have identified a subset of SNPs to be studied on the remaining patients and controls. WP3: Study of other mechanisms that could explain the transience of the cellular activation observed in AMI Task 1 - The role of pentraxin 3 an acute phase reactant produced by monocytes, macrophages and neutrophils. In vitro PTX3 modulates platelet adhesion and reduces the stimulating effect of activated platelets on neutrophils. 76 - SAN RAFFAELE SCIENTIFIC INSTITUTE Task 2 - Components of Coronary Thrombus. We showed that the neutrophil degranulation in ACS is not due to atherosclerosis or to ischemic damage while coronary thrombi show neutrophil extracellular traps (NETs) and that activated platelets induce NETs. Domenico Cianflone Figure 9. TEM imaging of the phagocytic clearance of an activated platelet ISCHAEMIC HEART DISEASE, HEART FAILURE AND ECHOCARDIOGRAPHY UNIT Our group is carrying out several lines of investigation in the 3 main fields of interest of the Unit: ischemic heart disease, heart failure and echocardiography. Heart failure • Myocardial mytochondrial ferritin determination in patients with dilated cardiomyopathy of different etiologies - This study aims to compare mytocondrial ferritin expression in biopsies obtained from “healthy” subjects and patients with heart failure; in 2009 we performed 9 myocardial biopsies in “healthy” subjects during heart surgery. • Metabolic modulation of left ventricular function and energy metabolism in patients with heart failure: role of insuline sensitizers and anti-oxidants - The aim of these two protocols is to study the profound metabolic modification occurring in heart failure, often enhanced by insuline resistance and increased xantine oxidase levels. • Effects of acute manipulation of serum non esterified fatty acids concentration on left ventricular energy metabolism and function in patients with heart failure - We have completed the first part of the study which tries out the hypothesis that acute variations of circulating metabolic substrates could negatively affect left ventricle energetic homeostasis in heart failure patients. • The role of essential aminoacid supplementation in chronic heart failure - This study evaluates the therapeutic effects of essential aminoacids supplementation in counteracting the metabolic derangements occurring in congestive heart failure. Ischeamic heart disease • Bone mass density, osteoprotegerin levels and severity of atherosclerotic coronary disease in unstable and stable patients - During the last year, we have studied osteoprotegerin levels in 33 patients with stable coronary artery disease and 21 patients with ST elevation myocardial infarction. • Assessment of Loxin Test in the evaluation of coronary risk - We have enrolled 100 patients with coronary artery disease and 100 healthy controls, in order to evaluate the usefulness of Loxin Test for the assessment of coronary artery disease risk; the results will be soon available. Echocardiography In the year 2009 the echolab was actively involved in many research fields. 3d echocardiography has been applied in particular to mitral valve disease, often in functional mitral regurgitation in patients with left ventricu- DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 77 lar disfunction; other areas of research include the clinical application of contrast echocardiography, basic research of animal experiments, and the clinical application of new generation of contrast molecular agents. Alberto Margonato ORGAN PROTECTION IN CRITICALLY ILL PATIENTS, ADVANCED CARDIAC FAILURE AND MECHANICAL SUPPORTS UNIT Perioperative organ failure is associated to high morbidity and mortality. We are coordinating large multicentre randomized controlled studies at the Italian level on numerous topics. These studies are supported by the two largest and most influential Italian scientific societies in the field of anesthesia and intensive care (SIAARTI and ITACTA). All the studies have been approved by the Ethical committee of San Raffaele Hospital, have been published on www.clinicaltrials.gov and include: • early treatment of low cardiac output syndrome and of advanced heart failure with mechanical supports (ECMO, VAD in scientific collaboration with the Berlin Hertz Centrum.) or with pharmacological support (levosimendan vs placebo: 30 centres, 1000 patients, double blind RCT). • prevention of dialysis dependent acute renal failure and mortality after cardiac surgery (20 centres, 1000 patients, fenoldopam vs placebo, double blind RCT) • optimization of perioperative cardiac protection (esmolol vs placebo and volatile agents versus total intravenous anesthesia). • safety and efficacy or recombinant activated factor VII, of desmopressin, factor XIII, protein C zymogen and protein C activated in patients experiencing excessive bleeding or with sepsis after surgery in large multicentre randomized studies or in patients with severe sepsis admitted in the intensive care unit. • anesthesiological challenges of the unfit patients, ideal candidate to transfemoral artery aortic valve implantation. • non-invasive ventilation outside intensive care unit and the role of the Medical Emergency Team for a timely treatment of critically ill patients in the hospital ward. • cardiac biomarkers (proBNP, cardiac troponin) and Renal biomarkers (ouabaine) We are also publishing numerous original papers and systematic review of the literature on the above described topics. With almost 40 papers published in pubmed indexed journals in 2009 we’re the most prolific Italian group publishing in anesthesia and intensive care journals. We are also editing an international journal “HSR proceedings in Intensive Care and Cardiovascular Anesthesia”, freely available on www.itacta.org Alberto Zangrillo STRUCTURAL HEART DISEASE UNIT Treatment of structural heart disease Heart failure Surgical strategies to treat patients with heart failure due to ischemic or idiopathic cardiomyopathies are investigated. Original procedures to correct secondary mitral and tricuspid regurgitation have been developed and extensively applied with a rigorous long-term follow-up. A multidisciplinary protocol for mechanical circulation assistance has been prepared and selection intense have been established. Cell therapy (myoblast) has been used in patients with post infarction left ventricular dysfunction, in the contest of a multicenter prospective monitorized placebo controlled study (MAGIC study). 78 - SAN RAFFAELE SCIENTIFIC INSTITUTE Heart valve disease Innovative techniques to repair mitral and aortic valve are systematically evaluated. New imaging modalities are applied and correlated to the operative findings. In repair the tricuspid valve, a new prosthetic ring has been developed and tested on the bench. Ischemic heart disease Active contribution has been given to the SYNTAX study and the FREEDOM study, both comparing PCI and CABG in multivessel disease. Atrial fibrillation New surgical methods to increase the effectiveness of the atrial fibrillation ablation procedures, during open heart surgery, have been developed. A program for the treatment of lone atrial fibrillation via a minimally invasive approach has been initiated, and new technologies have been introduced and meticulously tested. The left atrial remodeling has been studied non only structurally but also at molecular and biochemical level. Transcatheter valve therapy A multidisciplinary program for transcatheter aortic and mitral valve therapy has been developed using a wide spectrum of techniques and technologies. Guidelines have been prepared and extensive investigation in this new area are ongoing. Ottavio Alfieri STUDY AND TREATMENT OF AORTIC DISEASE UNIT Our group is conducting several clinical research studies regarding the treatment of aortic disease. In particular, endovascular repair has emerged as an extremely valuable alternative modality for the treatment of thoracic aortic diseases due to its reduced invasiveness as compared to open repair. We are studying technical and clinical outcomes of the thoracic endograft Zenith Cook TX2 for the treatment of the aneurysms of descending thoracic aorta participating at the pivotal multicentric (42 North American and European Centers) non-randomized trial Zenith TX2 Thoracic Endovascular graft Clinical Study Protocol #03-536 (enrolment 2006 – 2011). We also analysed the outcomes of endovascular treatment of thoracic aortic disease with the thoracic endograft Bolton Relay participating at the RESTORE registry. Regarding the outcomes of endovascular repair of aortic dissections we also participate at the multicentric (12 European Centers) non-randomized trial Zenith Dissection Endovascular System Clinical study Protocol # 07004 (enrolment 2008-2013) to evaluate the outcomes of the treatment of acute type B dissection with the thoracic endograft TX2 and the stent Zenith Cook TXD (Zenith Dissection Endovascular System). We also participate at the study SAFROS: Patient Safety in Robotic Surgery (2010-2013) in order to develop technologies for patient safety in robotic surgery. In particular the aim of the study is to demonstrate that a properly controlled robotic surgery can improve the level of patient safety currently achievable by traditional surgery. We also deepened specific strategies for virtual angioscopy (figure 10) and for the preoperative detection of the Adamkiewicz artery by multidetector computed tomography and post-processing with OsiriX software. In addition, we updated early and long-term results of endovascular repair of traumatic thoracic aortic rupture, and conducted and analysed the outcomes from a National survey on endovascular repair of aorto-oesophageal and aorto-bronchial fistulas. As a Nation referral Center, we are reviewing our large experience of open and hybrid repair of thoracoabdominal aortic aneurysms and dissections with the use of the more innovative technique of organ protection and specific graft material. Roberto Chiesa Figure 10. Virtual angioscopy enables an endoluminal view of the aorta and allows to navigate within the true (green box) and false lume (red box). Navigating through the lumens allow to study the origin of renal and visceral vessels and their relationship with the dissecting lamella. DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 79 CENTER FOR ARRHYTHMIA RESEARCH The research activity of the Arrhythmology group of San Raffaele University-Hospital is focused on atrial fibrillation ablation, particularly on remote ablation using tip-irrigated magnetic catheters in 2008. In our center catheter ablation of atrial fibrillation is safely performed in many patients with and without comorbidities. We are conducting a large study in the elderly to assess both efficacy and safety in this patient population. Another area of research is the pathophysiology of atrial fibrillation investigating the natural history of the arrhythmia with its progression from the first symptomatic episode. We are also assessing the effect of catheter ablation on atrial fibrillation progression by the APAF2 study which is a 3-year extension study of the previous 1-year APAF trial. It was designated to compare the long-term outcome of catheter ablation versus conventional antiarrhythmic drug therapy in a large number of patients randomized to both strategies. At 3 years (2008) the results demonstrate a striking superiority of catheter ablation over antiarrhythmic drugs in terms of efficacy, arrhythmia progression and late complications. The identification of asymptomatic subjects at risk of sudden death with either latent Brugada syndrome or Wolff-Parkinson-White syndrome represents another important area of research in our center. Finally, the last area of research is the development of new technologies for catheter design and 3D anatomical reconstruction of cardiac chambers for atrial fibrillation ablation. Vincenzo Santinelli VISION FIRST UNIT The Research Unit “Vision First “ was started in November 2009 under the direction of Prof. Francesco Bandello. The following Research Lines (CR: Clinical Research BR: Basic Research) are part of the Unit: Medical Retina CR: New therapeutic options with intravitreal compounds (anti-VEGF agents or steroids) for Age-Related Macular Degeneration (AMD), Diabetic Retinopathy (DR) and Retinal Vein Occlusion, are presently tested in several multicentre clinical trials. BR: Evaluation of the behaviour of Endothelial Progenitor Cells in DR and AMD in collaboration with the Diabetes Complication Unit. Surgical Retina CR: Evaluation of new therapeutic options: Enzymatic Vitreolysis with Autologous Plasmin and use of neuroenhancement agents in patients with previous Retinal Detachment. BR: Set up of a Vitreous Biobank. Pediatric Ophthalmology CR: Multicentre clinical trial to test efficacy and tolerance of Azytromicin vs Tobramicin in pediatric purulent bacterial conjunctivitis. Neuro-Ophthalmology CR: Evaluation of structural and functional brain damage and visual network plasticity in Leber’s Hereditary Optic Neuropathy, Hereditary Retinal Dystrophies and Ereditary Optic Neuropathies in collaboration with Neuroradiology and Neuroimaging Research Units. Evaluation of efficacy and safety of surgical decompression and Gamma Knife radiosurgery on Pituitary Tumors and Meningiomas compressing the anterior visual pathway in collaboration with Neurosurgery Unit. Orbital Surgery CR: Evaluation of new therapeutic strategies of ocular MALT lymphomas in collaboration with Pathology and Oncology Unit. Imaging CR: Evaluation of the inter/intra operatory reproducibility of nerve fiber layer thickness and topographic measurement of the optic nerve and cornea among different Spectral Domain OCT instruments. Ocular Immunology and Uveitis CR: Evaluation of new biologic agents for the treatment of intraocular inflammation. 80 - SAN RAFFAELE SCIENTIFIC INSTITUTE Ocular Oncology CR: Evaluation of treatment with Gamma Knife Radiosurgery of conjunctival and intraocular tumors in collaboration with Neurosurgery Unit. Glaucoma CR: Several clinical studies (multicentric and single center) to test new medical and surgical therapeutic options in glaucoma management are ongoing. Francesco Bandello DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 81 Selected publications 9 Benedini, S; Perseghin, G; Terruzzi, I; Scifo, P; Invernizzi, PL; Del Maschio, A; Lazzarin, A; Luzi, L. Effect of L-acetylcarnitine on body composition in HIV-related lipodystrophy. Horm. Metab. Res.: 2009; 41(11): 840845 - Article IF 2008: 2,715 9 Blasi, V; Longaretti, R; Giovanettoni, C; Baldoli, C; Pontesilli, S; Vigone, C; Saccuman, C; Nigro, F; Chiumello, G; Scotti, G; Weber, G. Decreased parietal cortex activity during mental rotation in children with congenital hypothyroidism. Neuroendocrinology: 2009; 89(1): 56-65 - Article IF 2008: 2,913 9 Castoldi, G; di Gioia, CRT; Bombardi, C; Perego, C; Perego, L; Mancini, M; Leopizzi, M; Gorradi, B; Perlini, S; Zerbini, G; Stella, A. Prevention of myocardial fibrosis by N-acetyl-seryl-aspartyl-lysyl-proline in diabetic rats. Clin. Sci.: 2010; 118(3): 211-220 - Article IF 2008: 4,187 9 De Cobelli, F; Esposito, A; Belloni, E; Pieroni, M; Perseghin, G; Chimenti, C; Frustaci, A; Del Maschio, A. Delayed-enhanced cardiac MRI for differentiation of fabry’s disease from symmetric hypertrophic cardiomyopathy. Am. J. Roentgenol.: 2009; 192(3): W97–W102 - Article IF 2008: 2,940 9 Del Rio, D; Valtuena, S; Pellegrini, N; Bianchi, MA; Ardigo, D; Franzini, L; Scazzina, F; Monti, L; Zavaroni, I; Brighenti, F. Intervention study with a high or low antioxidant capacity diet: Effects on circulating Î2carotene. Eur. J. Clin. Nutr.: 2009; 63(10): 1220-1225 - Article IF 2008: 2,686 9 Di Candia, S; Gessi, A; Pepe, G; Sogno Valin, P; Mangano, E; Chiumello, G; Gianolli, L; Proverbio, MC; Mora, S. Identification of a diffuse form of hyperinsulinemic hypoglycemia by 18-fluoro-L-3,4 dihydroxyphenylalanine positron emission tomography/CT in a patient carrying a novel mutation of the HADH gene. Eur. J. Endocrinol.: 2009; 160(6): 1019-1023 - Case report IF 2008: 3,791 9 Esposito, A; De Cobelli, F; Perseghin, G; Pieroni, M; Belloni, E; Mellone, R; Canu, T; Gentinetta, F; Scifo, P; Chimenti, C; Frustaci, A; Luzi, L; Maseri, A; Del Maschio, A. Impaired left ventricular energy metabolism in patients with hypertrophic cardiomyopathy is related to the extension of fibrosis at delayed gadolinium-enhanced magnetic resonance imaging. Heart: 2009; 95(3): 228-233 - Article IF 2008: 4,964 9 Lucotti, P; Monti, L; Setola, E; La Canna, G; Castiglioni, A; Rossodivita, A; Pala, MG; Formica, F; Paolini, G; Catapano, AL; Bosi, E; Alfieri, O; Piatti, P. Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass. Metab.-Clin. Exp.: 2009; 58(9): 1270-1276 - Article IF 2008: 2,920 9 Perseghin, G. Where does insulin resistance start? The liver. Diabetes Care: 2009; 32(Suppl2): S164-S167 Review IF 2008: 7,349 9 Perseghin, G; Caumo, A; Lattuada, G; De Cobelli, F; Ntali, G; Esposito, A; Belloni, E; Canu, T; Ragogna, F; Scifo, P; Del Maschio, A; Luzi, L. Elevated fasting plasma C-peptide occurs in non-diabetic individuals with fatty liver, irrespective of insulin resistance. Diabetic Med.: 2009; 26(9): 847-854 - Article IF 2008: 3,172 9 Perseghin, G; De Cobelli, F; Esposito, A; Belloni, E; Lattuada, G; Canu, T; Invernizzi, PL; Ragogna, F; La Torre, A; Scifo, P; Alberti, G; Del Maschio, A; Luzi, L. Left ventricular function and energy metabolism in middle-aged men undergoing long-lasting sustained aerobic oxidative training. Heart: 2009; 95(8): 630-635 Article IF 2008: 4,964 9 Perseghin, G; Lattuada, G; Ragogna, F; Alberti, G; La Torre, A; Luzi, L. Free leptin index and thyroid function in male highly trained athletes. Eur. J. Endocrinol.: 2009; 161(6): 871-876 - Article IF 2008: 3,791 82 - SAN RAFFAELE SCIENTIFIC INSTITUTE 9 Piemonti, L; Calori, G; Lattuada, G: Mercalli, A; Ragogna, F; Garancini, MP; Ruotolo, G; Luzi, L; Perseghin, G. Association between plasma monocyte chemoattractant protein-1 concentration and cardiovascular disease mortality in middle-aged diabetic and nondiabetic individuals. Diabetes Care: 2009; 32(11): 2105-2110 Article IF 2008: 7,349 9 Sauer, AV; Mrak, E; Hernandez, RJ; Zacchi, E; Cavani, F; Casiraghi, M; Grunebaum, E; Roifman, CM; Cervi, MC; Ambrosi, A; Carlucci, F; Roncarolo, MG; Villa, A; Rubinacci, A; Aiuti, A. ADA-deficient SCID is associated with a specific microenvironment and bone phenotype characterized by RANKL/OPG imbalance and osteoblast insufficiency. Blood: 2009; 114(15): 3216-3226 - Article IF 2008: 10,432 9 Setola, E; Monti, LD; Lucotti, P; Galluccio, E; Oldani, M; Bosi, E; Piatti, P. Fasting hyperinsulinemia associates with increased sub-clinical inflammation in first-degree relatives normal glucose tolerant women independently of the metabolic syndrome. Diabetes-Metab. Res. Rev.: 2009; 25(7): 639-646 - Article IF 2008: 3,149 DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES - 83 Bone metabolism Unit Clinical pediatric endocrinology Neonatology DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 85 DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY Director: Giulio Cossu Associate Directors: Fabio Ciceri, Luigi Naldini * Research Units Skeletal muscle development and therapy Unit HEAD OF UNIT: Giulio Cossu RESEARCHER: Graziella Messina POST-DOCTORAL FELLOWS: Arianna Dellavalle, Hoshia Hidetoshi, Anna Pistocchi, Gonzalo Ugarte PHD STUDENTS: Sara Benedetti, Ornella Cappellari, Simona Rolandi-Maciotta, Giuliana Rossi, Saverio Tedesco FELLOWS: Chiara Bonfanti, Giovanni Maroli. TECHNICIANS: Stefania Antonini, Diego Covarello, Anna Innocenzi, Stefania Monteverde, Laura Perani, Rossana Tonlorenzi Functional genetics of muscle regeneration GROUP LEADER: Silvia Brunelli POST-DOCTORAL FELLOWS: Stephanie François, Patrizia Pessina, Thierry Touvier, Paola Zordan PHD STUDENTS: Emanuele Azzoni, Valentina Conti FELLOW: Tiziana Fatone Gene expression and muscular dystrophy Unit (Dulbecco Telethon Institute) GROUP LEADER: Davide Gabellini POST-DOCTORAL FELLOWS: Sergia Bortolanza, Cristina Godio, Mariaelena Pistoni, Alexandros Xynos PHD STUDENTS: Daphne Cabianca, Valentina Casà, Claudia Huichalaf, Marie Victoire Neguembor Molecular and functional immunogenetics GROUP LEADER: Katharina Fleischhauer POST-DOCTORAL FELLOW: Federico Sizzano PHD STUDENT: Pietro Crivello, Cristina Toffalori FELLOW: Cinzia Pultrone (from April 2009) TECHNICIAN: Laura Zito Neural stem cell biology GROUP LEADER: Rossella Galli PHD STUDENTS: Daniela Corno**, Laura Magri**, Stefania Mazzoleni** FELLOWS: Sara Morosini, Mauro Pala TECHNICIAN: Vivian Deidda Vigoriti Autoimmunity & vascular inflammation Unit HEAD OF UNIT: Angelo A. Manfredi* PHD STUDENTS: Lidia Bosurgi**, Lucia Cottone TECHNICIANS: Annalisa Capobianco, Antonella Monno Innate immunity and tissue remodelling GROUP LEADER: Patrizia Rovere-Querini POST-DOCTORAL FELLOWS: Gianfranca Corna, Elena Rigamonti PHD STUDENTS: Lara Campana, Alessandra Castiglioni, Michela Vezzoli 86 - SAN RAFFAELE SCIENTIFIC INSTITUTE Cellular pharmacology Unit HEAD OF UNIT: Emilio Clementi POST-DOCTORAL FELLOWS: Clara De Palma, Sestina Falcone, Cristiana Perrotta PHD STUDENTS: Laura Bizzozero, Roberta Buono, Denise Cazzato FELLOW: Viviana Pisa TECHNICIAN: Clara Sciorati Experimental hematology Unit HEAD OF UNIT: Chiara Bonini RESEARCHER: Attilio Bondanza POST-DOCTORAL FELLOW: Luca Vago** PHD STUDENTS: Monica Casucci**, Maddalena Noviello**, Elena Provasi** FELLOW: Alessandra Forcina RESIDENT: Sara Mastaglio TECHNICIANS: Barbara Camisa, Zulma Magnani Angiogenesis and tumor targeting HEAD OF UNIT: Luigi Naldini* GROUP LEADER: Michele De Palma POST-DOCTORAL FELLOW: Roberta Mazzieri PHD STUDENTS: Daniela Biziato**, Ferdinando Pucci**, Mario Leonardo Squadrito TECHNICIANS: Davide Moi, Anna Ranghetti Clinical Research Units Hematology and hematopoietic stem cell transplantation Unit HEAD OF UNIT: Fabio Ciceri PHYSICIANS: Andrea Assanelli, Jacopo Peccatori RESIDENTS: Valeria Calbi, Daniela Clerici, Raffaella Greco POST-DOCTORAL FELLOWS: Maria Teresa Lupo Stanghellini, Annalisa Ruggeri TECHNICIANS: Roberta Mattarucchi Immunohematology and transfusion medicine Unit HEAD OF UNIT: Silvano Rossini RESEARCHERS: Laura Bellio, Oriana Perini FELLOW: Irene Cuppari PSIEP - Strategic Program of Pediatric Immunohematology HEAD OF UNIT: Maria Grazia Roncarolo* PHYSICIANS: Alessandro Aiuti, Rosa Bacchetta, Barbara Cappelli, Sarah Marktel RESIDENT: Sara Napolitano The San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET) Director: Luigi Naldini* Research Units Gene transfer technologies and new gene therapy strategies Unit HEAD OF UNIT: Luigi Naldini* POST-DOCTORAL FELLOWS: Mario Amendola, Bernhard Gentner** PHD STUDENTS: Francesco Boccalatte**, Alessio Cantore**, Pietro Genovese**, Alice Giustacchini**, Angelo Lombardo**, Erika Zonari TECHNICIANS: Giulia Schira, Lucia Sergi Sergi DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 87 Gene/Neural stem cell therapy for lysosomal storage diseases GROUP LEADER: Angela Gritti PHD STUDENTS: Chiara Cavazzin, Annalisa Lattanzi, Margherita Neri**, Sara Santambrogio** FELLOW: Beatriz Alcalà-Franco TECHNICIAN: Claudio Maderna Hematopoietic stem cell gene therapy for lysosomal storage disorders GROUP LEADER: Alessandra Biffi POST-DOCTORAL FELLOWS: Alessia Capotondo, Ilaria Visigalli PHD STUDENTS: Stefania Delai, Silvia Ungari** FELLOW: Rita Milazzo TECHNICIAN: Tiziana Plati Safety of gene therapy and insertional mutagenesis GROUP LEADER: Eugenio Montini PHD STUDENTS: Daniela Cesana**, Marco Ranzani** TECHNICIAN: Fabrizio Benedicenti Gene transfer into stem cells Unit HEAD OF UNIT: Giuliana Ferrari* POST-DOCTORAL FELLOW: Maria Rosa Lidonnici, Emanuela Anna Roselli PHD STUDENT: Rossella Ierardi TECHNICIANS: Giacomo Mandelli, Claudia Rossi, Francesca Tiboni Immunological tolerance Unit HEAD OF UNIT: Maria Grazia Roncarolo* POST-DOCTORAL FELLOWS: Andrea Annoni, Georgia Fousteri, Kevin Goudy PHD STUDENT: Maura Rossetti TECHNICIANS: Grazia Andolfi, Claudia Sartirana, Eleonora Tresoldi From FOXP3 mutation to IPEX syndrome GROUP LEADER: Rosa Bacchetta RESEARCHER: Barbarella Lucarelli POST-DOCTORAL FELLOWS: Didem Aydin, Laura Passerini PHD STUDENT: Sara Di Nunzio Tolerogenic dendritic cells GROUP LEADER: Silvia Gregori PHD STUDENT: Giada Amodio, Chiara Magnani TECHNICIAN: Daniela Tomasoni Pathogenesis and therapy of ADA-SCID Unit HEAD OF UNIT: Alessandro Aiuti PHD STUDENTS: Luca Biasco, Immacolata Brigida, Aisha Vanessa Sauer TECHNICIANS: Raisa Jofra Hernandez, Anna Ripamonti Gene therapy for WASP/Omenn GROUP LEADER: Anna Villa POST-DOCTORAL FELLOWS: Marita Bosticardo, Renata Ilde Mazzucchelli, Samantha Scaramuzza PHD STUDENTS: Marco Catucci, Michela Locci, Maria Carmina Castiello TECHNICIANS: Elena Caldana, Elena Draghici 88 - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units PCRU - Pediatric Clinical Research Unit HEAD OF UNIT: Maria Grazia Roncarolo* COORDINATOR: Alessandro Aiuti PROJECT LEADERS: Alessandro Aiuti (ADA-SCID), Maria Grazia Roncarolo* (WAS), Maria Sessa and Alessandra Biffi (MLD) RESIDENTS: Francesca Ferrua, Francesca Fumagalli QUALITY ASSURANCE AND REGULATORY AFFAIRS: Valentina Bergamante FELLOWS: Federica Barzaghi, Marta Frittoli, Laura Lorioli PHD STUDENT: Martina Cesani RESEARCH NURSES: Luciano Callegaro, Miriam Casiraghi * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 89 Introduction by the Directors Mission - The Division of Regenerative Medicine was established with the mission of exploiting results from basic and pre-clinical research to conduct a series of Phase I/II cell and gene therapy clinical trials for monogenic disorders of the hematopoietic system, skeletal muscle, and nervous system as well as to implement novel cell and gene therapy strategies for treating hematological malignancies. Vision - The Division will develop or maintain strong and competitive research activity in cell and developmental biology of these tissues; molecular pathogenesis of the diseases under investigation; gene transfer and cell transplantation strategies; role of the inflammatory and immune response in modulating engraftment of the transplanted cells and survival of the gene-modified cells. Bringing together researchers with complementary skills and expertise will enable an effective synergy between research projects that share common methodological approaches and face similar scientific/technological and regulatory hurdles, with the goal to ensure a robust pipeline of preclinical studies feeding the clinical trial units. Recruitments in areas such as hematopoietic stem cell biology and translational medicine will complement the existing plan and increase the chance of achieving the ambitious goals of this plan. Giulio Cossu Organization - The Division is mainly comprised of three major pillars, which represents the three major pre-existing structures that have now been merged. The first pillar is the San Raffaele-Telethon Institute for Gene Therapy (TIGET; www.sanraffaele.org/research/tiget), directed by Luigi Naldini. This Fabio Ciceri is a multi-disciplinary research Institute with strong emphasis on the development of gene transfer for the treatment of rare genetic disorders. The second pillar is the former SCRI (Stem Cell Research Institute), originally founded to study muscle and neural stem cells and to design novel cell therapies for these tissues, directed by Giulio Cossu. The third pillar is represented by the clinical HSC Transplantation (HSCT) Unit, directed by F. Ciceri, which has one of the largest HSC transplantation case records in EU The Division currently comprises 11 Unit heads and 12 Group leaders for a total of approximately 200 researchers, graduate students and technicians. The governance format is based upon one Director (G. Cossu) and two vice-directors (L. Naldini and F. Ciceri) and a Board also comprising four senior scientists (A. Aiuti, C. Bonini, G. Ferrari and A. Manfredi). Goals - Several genetic diseases will be targeted with cell and gene therapy approaches: these include congenital immune deficiencies, hematologic disorders such as b thalassemia and hemophilia B, muscular dystrophies, and several lysosomal storage disorders. Vector technology certainly represents one of the strengths of our Division and will benefit most of the other projects. Basic research in areas mentioned above will produce high quality results that in turn will support further developments in cell and gene therapy. Achievements - The Division is composed of several internationally recognized experts who contributed to: 2) the pioneering of successful gene therapy trials of hematopoietic stem cell (HSC) therapy and of adoptive cancer immunotherapy; 2) the development and validation of new gene transfer technologies; 3) the identification and characterization of new stem cells, innate effector and immune regula- 90 - SAN RAFFAELE SCIENTIFIC INSTITUTE tory cells; 4) a state-of-the-art clinical center for HSC transplantation in cancer and pediatric diseases; 5) cutting edge results in basic reaseach. This is documented by numerous articles published in top tier journals (New England Journal of Medicine, Cell, Nature, Science etc.) and is supported by funding from most competitive sources (NIH, ERC etc.). Many patents have been deposited securing the intellectual property of this research activity. Training opportunies - PhD programs, post-doctoral and resident fellowships. DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 91 Research Units SKELETAL MUSCLE DEVELOPMENT AND THERAPY UNIT The research activity of the unit focuses on the development and clinical translation of cell therapies for muscular dystrophies and on the study of skeletal muscle development. The first project aims at transplantation of mesoangioblasts (pericytes) in primary myopathies and is currently dedicated to donor cell intra-arterial transplantation in pediatric Duchenne patients: a phase I/II clinical trial is foreseen to start early in 2011, while a preliminary trial to validate outcome measures in these patients started on June 2009 and will be completed by July 2010. Future protocols foresee autologous cell correction by either lentiviral vectors or human artificial chromosomes (HAC) respectively expressing either α sarcoglycan (for limb girdle muscular dystrophy 2D) or the whole dystrophin locus for Duchenne, and have been tested in pre-clinical models. Specifically HAC-dystrophin have been transferred in mouse dystrophic mesoangioblasts and have been shown to ameliorate structure and function of mdx dystrophic mice (Tedesco et al. submitted). Moreover protocols to derive mesoangioblasts from patients’ iPS are being developed aiming to make it available in the future an unlimited source of autologous cells. The second project aims to understand the role of different cell populations in the histogenesis and regeneration of skeletal muscle, their origin, lineage relationship and the signals that control their differentiation. In particular we are focusing on the gene Nuclear Factor Ix that controls the transcriptional switch between embryonic and fetal skeletal muscle (Messina et al. Cell 2010). In addition, other experiments address the origin of mesoangioblasts during fetal muscle histogenesis, their lineage relationship with skeletal myoblasts and their fate using genetic lineage tracing. Giulio Cossu Figure 11. How can you mend a broken heart? The image shows an explant culture from a heart biopsy with outgrowing cells. Curiously, the explant has the shape of a heart. FUNCTIONAL GENETICS OF MUSCLE REGENERATION Molecular and cellular biology of muscle regeneration: role of necdin and of vascular endothelial precursors Regeneration of muscle fibers, lost during pathological muscle degeneration or after injuries, is sustained by generation of new myofibers. Necdin (Ndn) is a MAGE protein expressed in satellite cells derived myogenic precursors during perinatal growth. Following muscle injury necdin null mice showed a significant defect in muscle healing while mice over-expressing necdin showed significantly increased myofiber regeneration. We elucidated the role of necdin in muscle showing that it increases expression of myogenin, by cooperating with MyoD and accelerates differentiation (Deponti et al. JBC, 2007). We have also shown that necdin is selectively expressed in the atrophic muscles of cachectic mice (tumor induced cachexia) and proved that its expression is causally linked to a protective response of the tissue against tumor-induced wasting, inhibition of myogenic differentiation and fiber regeneration. Necdin plays this role mainly via interference with TNF-α signaling, including regulation of expression of TNFRI, of p53 and of the activity of caspase 3 and 9 (Sciorati et al., JCS, 2009). 92 - SAN RAFFAELE SCIENTIFIC INSTITUTE Furthermore we were able to isolate a novel protein that interacts with Necdin, CCAR1/CARP1: the complex Necdin/CCAR1/p53 appears to mediates the anti-apoptotic action of Necdin in myoblast precursor cells (Francois et al, submitted). These data prompted us to investigate whether Necdin could be exploited also to enhance myogenic differentiation and inhibit cell death of other types of stem cells, such as mesoangioblasts (MABs). Overexpression of Ndn in vitro increases the differentiation ability of MABs, and inhibit cell death. In addition muscles of αSarcoglycan dystrophic mice injected with Ndn-MABs showed a greater reconstitution of stem cell derived fibers respect to wt MABs (Pessina et al, submitted). To investigate in vivo the role of endothelial derived myogenesis, we have generated a transgenic mouse expressing an inducible Cre recombinase (CRE-ERT2) under the control of an endothelial specific promoter (Vascular Endothelial Cadherin). Lineage tracing experiments show that endothelial progenitors can give rise to cells of the skeletal muscle lineage at fetal and perinatal stages and contribute to muscle regeneration following acute damage in the adult. Silvia Brunelli GENE EXPRESSION AND MUSCULAR DYSTROPHY UNIT Our group is interested in elucidating the regulatory pathways controlling muscle-specific gene expression and delineate how they become subverted in muscular dystrophy using facioscapulohumeral muscular dystrophy (FSHD) as a paradigm. FSHD is the second most common muscular dystrophy in adults. FSHD is an autosomal dominant disorder that is not due to a mutation within a protein-coding gene. Instead, FSHD patients carry deletions of 3.3 kilobase macrosatellite, termed D4Z4, located at chromosome 4q35. D4Z4 appears to regulate chromatin structure and its partial deletion causes an epigenetic alteration leading to over-expression of the 4q35 gene FRG1. Importantly, transgenic mice over-expressing FRG1 display an FSHD phenotype and are the first animal model of the disease. The number of D4Z4 repeats is a critical determinant of the age of onset and clinical severity of FSHD. In general, fewer repeats are associated with a more severe phenotype that presents in childhood. Paradoxically, individuals completely devoid of D4Z4 are normal. This suggests that at least one copy of D4Z4 is required to cause FSHD, possibly through a gain-of-function mechanism. Our preliminary results indicate that an non-protein coding RNA (ncRNA) is generated starting from upstream of D4Z4 uniquely in FSHD patients. Interestingly, the ncRNA is nuclear because it remains associated to the 4q35 chromatin. Notably, knockdown of this transcript causes a significant reduction of 4q35 gene de-repression. Hence, it is tempting to speculate that production of this ncRNA activates the epigenetic cascade culminating with 4q35 gene de-repression in FSHD. An attractive hypothesis would be that transcription of the region proximal to D4Z4 may play a role in de-condensation of the 4q35 genomic region, setting the stage for activation of 4q35 genes and, most importantly, preventing re-repression of the region. We are characterizing the ncRNA to determine how it regulates 4q35 gene expression. These studies will provide a critical nexus for revealing the basis of ncRNAs in FSHD etiology and their possible use as therapeutic targets. Our analysis will generate novel insights into the biological role of DNA repeats and ncRNAs in regulating chromatin structure in higher eukaryotes. Davide Gabellini MOLECULAR AND FUNCTIONAL IMMUNOGENETICS The scientific activity of this Unit is aimed at characterizing new immunogenetic parameters relevant for the clinical outcome of allogeneic hematopoietic stem cell transplantation (HSCT). During the year 2009, the following main achievements were made: Characterization of the loss of mismatched HLA by leukemia as a major mechanism of immune escape from allore- DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 93 active donor T cells in after haploidentical HSCT. We characterized selective loss of the mismatched HLA haplotype through uniparental disomy (UPD) of the short arm of chromosome 6, in 5 out of 17 patients (29.4%) of patients with leukemia relapse after haploidentical HSCT. This phenomenon was identified through comparative analysis of patient chimerism follow-up posttransplantation by short tandem repeat (STR) and by HLA typing. UPD of chromosome 6 was observed only in leukemia at relapse and not in the same patient’s leukemia at diagnosis, showing that it was a de novo event. We also showed that this event led to complete evasion of the mutated leukemia from recognition by donor T cells alloreactive to the lost haplotype. These data underline the importance of an attentive cross-talk between the laboratory and the clinics, and set the basis for searching for additional targets of post-transplant leukemia immunoediting. Identification of non-permissive HLA-DPB1 disparities significantly associated with the clinical outcome of unrelated HSCT. We refined a previously developed algorithm for definition of non-permissive HLA-DPB1 disparities, and verified its predictivity in a collaborative study with the Italian Bone Marrow Donor Registry (IBMDR). In 537 consecutive transplants facilitated by the IBMDR from unrelated volunteer donors, we showed that the presence of non-permissive mismatches was significantly associated with the probability of overall survival, due to non-relapse mortality. This was true not only in the cohort overall, but in particular in transplants presenting 0 or 1 additional mismatch at other HLA loci. These data set the basis for refining the guidelines for unrelated stem cell donor selection. They are currently being tested in international collaborative studies, and functional evidence for the underlying immunological mechanisms is being sought in the laboratory. Katharina Fleischhauer NEURAL STEM CELL BIOLOGY Epidermal growth factor receptor (EGFR) is unevenly expressed in most of de novo glioblastoma multiforme (GBM) specimens, suggesting that it might specifically label subsets of GBM cells that behave as tumor-initiating cells (TICs). Indeed, we purified different cell fractions from GBM patient’s specimens by fluorescence activated cell sorting (FACS), based on their relative expression of EGFR and of the putative TIC marker CD133 and demonstrated that all these subpopulations were endowed with tumorigenic potential, although to different extent. When subjected to whole-transcript microarray profiling, EGFR-expression TICs were characterized by a specific molecular signature, clearly distinguishable from that of EGFR-negative TICs and closely associated with highly malignant GBM subclasses. ➥ Figure 12. Cancer stem cells isolated from human glioblastoma multiforme, stained for the Epidermal Growth Factor Receptor (EGFR, green) and the cytoskeleton protein F-actin (red). 94 - SAN RAFFAELE SCIENTIFIC INSTITUTE Medulloblastoma (MB) is the most common brain tumor in childhood. We isolated several cancer stem cell (CSC) lines from mouse MBs, aiming at the identification of CSC-specific genes by molecular comparison with normal cerebellar neural stem cells (NSCs). Transcriptome analysis pinpointed several genes differentially expressed between CSCs and NSCs. One of them is Ebf3, a transcription factor involved in cerebellum development and neuronal commitment. We have assessed Ebf3 expression in human MB specimens both in silico and by IHC and we observed that Ebf3 is highly expressed both at the mRNA and protein levels, thus suggesting a relevant role of Ebf3 in human MB biology. By targeting Tsc1 deletion to embryonic (e) and adult (a) NSCs, we generated Tsc1 mutant mice that display: 1) shortened life span; 2) alterations in cortical lamination and adult neurogenesis; and 3) spontaneous epileptic seizures. During the last year, we established in vitro several eNSC lines from wt and mutant mouse cortex at embryonic day 16.5. Mutant eNSCs are defective in their neurogenic potential, as they give rise to dramatically low number of neurons. Most interestingly, mutant eNSCs overexpress several genes, involved in neural patterning and regionalization as well as in cell adhesion and motility, that are also expressed in patient-derived cortical tubers (CTs) and subependymal giant cell astrocytomas (SEGAs). Rossella Galli AUTOIMMUNITY & VASCULAR INFLAMMATION UNIT Threats to tissue integrity, including sterile injuries and infection, cause inflammation. Inflammation may lead to eradication of invading pathogens and to the repair of damaged tissues. However, it may be deleterious,with persistent inflammatory damage and degeneration. The pattern of cell death in situ and the features of leukocytes and antigen presenting cells that actually dispose of cell death remnants influence the outcome of the inflammatory event. Defects in the initiation and execution steps of programmed cell death such as in the clearance of cell debris contribute to systemic autoimmune diseases, in which the deregulated response to cell death behaves both as an initiator and an amplifying circuit, contributing to the specific clinical features of each disease. Moreover, stem and precursor cells represent a potential target of the autoimmune response, which could thus jeopardize their differentiation in the injured tissue. During vascular inflammation a self-sustaining circuit attracts and activates inflammatory leukocytes in the wall of vessels of various size and anatomical characteristics. Vascular inflammation fulfils homeostatic roles and the activation of circulating leukocytes, platelets and endothelial cells is under the control of humoral innate immunity. We are directly addressing the molecular mechanisms underlying the vicious circle that maintains and amplifies vessel and tissue injury, with specific attention to the role of injury-associated signals (Damage-Associated Molecular Patterns, DAMPS, or Alarmins) and of acute phase proteins. Angelo A. Manfredi INNATE IMMUNITY AND TISSUE REMODELLING Macrophages play a dual role in damaged tissues: they enhance local injury, through their effectors functions, and they favour repair. Macrophage differentiate in polarized type I (classically activated) and type II (alternatively activated) macrophages in peripheral tissues, depending on environmental cues. The identification of the molecular code that control macrophage fate, which can be partially mimicked or tampered with, will provide novel strategies for the treatment of various immune-mediated diseases. The main goal of the group is to identify the events that determine the action of infiltrating polarized macrophages in in vivo models of acute (toxic) and chronic injury of skeletal muscle (muscular dystrophies and inflammatory myopathies) and of the peritoneum, as a consequence of benign (endometriosis) and malignant (ovary carcinoma) ectopic cellular growth. We specifically focus on the cross-talk between macrophages and stem/precursor cells in these models and are actively investigating the molecular pathways by which the two cell populations influence and reciprocally control migration, survival and differentiation. Patrizia Rovere-Querini DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 95 CELLULAR PHARMACOLOGY UNIT Role of nitric oxide in myogenesis: physiological and pathological aspects Mitochondrial dynamics in myogenesis: endogenous nitric oxide stimulates myogenic differentiation by inhibiting mitochondrial fission We elucidated the role of mitochondrial fission and fusion in skeletal muscle function. We found that inhibition of mitochondrial fission with formation of elongated mitochondria is required for myogenesis to occur and that this event depends on endogenous generation of nitric oxide (NO) by the differentiating myogenic cells. Blockade of NO synthesis enhanced activity, translocation and docking to mitochondria of the pro-fission GTPase dynamin related protein 1 (Drp1), inhibiting mitochondrial elongation and myogenic differentiation. A dominant-negative Drp1 reversed the effects due to NO synthesis blockade on fission and myogenesis, establishing a causal relationship between these processes. Under NO synthesis blockade, myogenic precursors displayed a latent mitochondrial dysfunction, compensated under basal conditions but that rendered cells more sensitive to apoptotic clearance. This indicates the existence of a quality control check for myogenesis, dependent on generation of NO and correct mitochondrial morphofunctional status. Nitric oxide combined with non steroidal antiinflammatory drugs and the therapy of Muscular Dystrophyies We developed a therapy of muscular dystrophies with clinical-grade drugs, without the severe side effect of corticosteroids combining the non steroidal anti-inflammatory drugs (NSAIDs) ibuprofen or paracetamol and the NO donor isosrbide dinitrate) Two murine models for muscular dystrophies (α-sarcoglycan null and mdx mice) treated for one year showed significant amelioration of the morphological, biochemical and functional phenotype in the absence of secondary effects. The mechanism of action of the treatment include cyclic GMPdependent enhancement of mitochondrial energy metabolism, and S nitrosylation of a specific type 2 histone deacetylase. The new therapeutic strategy we propose is not selective for a subset of mutations and provides ground for immediate clinical experimentation. Emilio Clementi EXPERIMENTAL HEMATOLOGY UNIT T cell-based gene therapy for cancer The immune system can be properly modified to eradicate cancer. Currently, effector molecules, such as monoclonal antibodies and cells such a tumor-reactive lymphocytes, able to selectively target and eliminate tumors, may be isolated and/or engineered. The potency of cellular adoptive immunotherapy for the treatment of cancer has been clearly revealed by the persistent and complete clinical responses observed in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) followed by the adoptive transfer of donor T lymphocytes. However, several hurdles remain to be overcome before adoptive immunotherapy can become a broadly applicable therapeutic approach to treat cancer. We exploited gene transfer technologies to overcome these hurdles thus enbling the development of safe and effective immunotherapeutic approaches for cancer. In allo-HSCT, most of the antileukemic potential resides in alloreactivity towards patient-specific antigens, such as minor and major histocompatibility antigens, by donor lymphocytes. Unfortunately, alloreactivity is also responsible for the most serious and frequent complication of allo-HSCT: the Graft-versus-Host-Disease (GvHD). In a phase I-II clinical trial enrolling 54 pts undergoing haploidentical HSCT, we showed that the transfer of a suicide gene into donor lymphocytes, allows to provide rapid and effective immune reconstitution, and control of GvHD. By taming the toxicity of allo-HSCT the suicide gene approach renders haploidentical HSCT a feasible, safe and more effective option for cancer patients of all ages. Gene transfer technologies allow not only to improve the safety profile of cancer immunotherapy, but also to increase its feasibility and efficacy: the transfer of autologous tumor specific cytotoxic T lymphocytes (CTLs) in cancer patients is highly effective for selected tumor. However, major hurdles such as the difficulty in expanding rare, high-avidity tumor-specific CTLs limit this approach. We set up protocols to efficiently transfer into T lymphocytes gene encoding for tumor-specific molecules such as T-cell receptors (TCRs) or chimeric antigen receptors (CARs), to confer to T cells tumor-specificity and activity. Chiara Bonini 96 - SAN RAFFAELE SCIENTIFIC INSTITUTE ANGIOGENESIS AND TUMOR TARGETING Macrophage heterogeneity in the tumor microenvironment: implications for angiogenesis and antiangiogenic therapy Macrophages infiltrate developing tumors, where they seem to support angiogenesis by releasing factors that stimulate the growth and expansion of new blood vessels from the pre-existing vasculature. However, tumor-associated macrophages (TAMs) may comprise functionally distinct subpopulations. Our recent studies suggest that, in mouse tumors, only a specific TAM subset displays a profound pro-angiogenic phenotype, the TIE2-expressing macrophages (TEMs). TEMs are characterized by the high expression of mannose receptor-1 (MRC1) and aptoglobin/hemoglobin scavenger receptor (CD163), and the low expression of several pro-inflammatory and anti-angiogenic molecules, such as IL-1β, COX2, iNOS and IL-12 (as compared to other TAMs). In contrast, a substantial fraction of the TIE2-negative TAMs express CD11c and produce higher amounts of pro-inflammatory molecules and lower amounts of pro-angiogenic factors. Our studies further indicate that different ratios of MRC1+ TEMs and CD11c+ TAMs are present in different tumor types, and that this may correlate with the angiogenic features of tumors. Little is known of the tumor-secreted factors that regulate TEM’s proangiogenic activity. Because TEMs express the angiopoietin (ANG) receptor TIE2 (ca. 20-50-fold more than CD11c+ TAMs) and respond to ANG2 stimulation in vitro, we speculated that ANG2, which is secreted by angiogenic blood vessels, could regulate the attraction and/or biological activity of TEMs in tumors. We found that blocking ANG2 using a novel, humanized monoclonal antibody, delays tumor progression in the MMTV-PyMT spontaneous breast cancer model and inhibits the growth of pulmonary metastases, both in early and late treatment trials. Furthermore, the specific knock-down of TIE2 in TEMs inhibits tumor angiogenesis and vessel perfusion in MMTV-PyMT mice. Together, these data support the notion that targeting the ANG2/TIE2 angiogenic axis in tumors may represent a dual-target strategy that impairs both vascular cells (i.e., angiogenic tumor blood vessels) and proangiogenic macrophages (TEMs) in the angiogenic process. Assessing the specific contribution of distinct TAM subpopulations to tumor angiogenesis and progression may thus have important implications for the design of improved anticancer therapies. Michele De Palma Clinical Research Units HEMATOLOGY AND HEMATOPOIETIC STEM CELL TRANSPLANTATION UNIT The San Raffaele Hematology and Bone Marrow Transplantation (BMT) Unit is highly integrated with dr Bonini, Fleischauer and Cossu Research Units in translational research. The stem cell transplantation activity is integrated with the Blood Bank Unit (Director Silvano Rossini) in a Stem Cell transplantation Program as member of European Group for Blood and Marrow Tranplantation, EBMT (www.ebmt.org), in the file for Jacie-EBMT accreditation. Overall, the Unit is the largest Italian Unit for allogeneic HSC transplantation, performing since 2006 around 100 allogeneic tranplants/year. The Unit has long-lasting experience in transplantation from family mismatched haploidentical donors, with programs of cell therapy with suicide-gene modified donor T lymphocytes and cell therapy with IL-10 induced T-regulatory cells for the control of Graft-versus-Host disease. Our aim is to develop new conditioning regimens based on treosulfan for allogeneic hematopoietic stem cells transplantation (HSCT) to reduce transplant related toxicity (Allo-treo trial, Eudract 2005-005182-11), and to increase antileukemia activity (cofarabine-treosulfan, Clo3o trial, Eudract 2008-006972-31). New modalities of immune suppression has been developed based on rapamycin (TrRaMM trial, Eudract 2007 005477-54) for Graft-versusHost disease prevention in the context of T-repleted haploidentical SCT. The unit is involved in development of mesoangiobalst cell-therapy treatment of Duchenne Muscle distrophy in collaboration with dr Cossu lab. Fabio Ciceri DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 97 IMMUNOHEMATOLOGY AND TRANSFUSION MEDICINE UNIT The Hospital San Raffaele (HSR) Immunohematology and Transfusion Medicine Service (ITMS) provides clinical services to support HSR patients in need of blood component therapy, cellular therapy, therapeutic apheresis, and specialized laboratory diagnostics. This ISO 9002 Certified unit collects and prepares the blood components and cellular therapy products used in patient care at the HSR, and provides education in the field of Transfusion Medicine. A Radio Frequency Identification (RFID) project is underway with the goal of increasing safety by implementing radiofrequency identification technology in the daily management of transfusions and transfusion products. This system is a model for process traceability from donor to patient, for automation in the identification of patients, blood units and/or cellular products. The ITMS is subdivided into three distinct sub-units The blood donation center sub-unit is responsible for the collection and testing of blood to be transfused into patients at the San Raffaele Hospital. The Therapeutic Apheresis and Cellular Therapy sub-unit is responsible for collecting and processing hematopoietic stem cells and performs the necessary diagnostic testing required for bone marrow transplantation procedures. The lab supplies hematopoietic stem cells and relevant cells in support of clinical trials for allogenic bone marrow and peripheral blood transplantation and offers a Stem Cell Cryo Banking service for autologous and allogeneic bone marrow products. Bone Marrow from qualified donors is collected in accordance and recognition of the Italian Bone Marrow Donor Registry (IBMDR). Therapeutic apheresis procedures to treat patients with neurologic and blood diseases, including photopheresis, red cell and plasma exchange procedures are also performed routinely. The Clinical Laboratory Diagnostics sub-unit includes the following specialized laboratories: Immunohematology, Hematology, Flow Cytometry, Hematological Molecular Biology and an EFI Certified and accredited HLA tissue typing laboratory. New technologies such as genetic red blood cell typing are being investigated. A special emphasis is given to oncohematologic malignancies. These pathologies are studied using a multi-disciplinary approach. Silvano Rossini PSIEP - STRATEGIC PROGRAM OF PEDIATRIC IMMUNOHEMATOLOGY The Strategic Program of Pediatric Immunohematology is a pediatric Unit dedicated to translational and clinical research in children with immunological, hematological, autoimmune and other genetic disorders. In this context children are offered in addition to the standard care also experimental therapeutic option, among these cellular therapy and gene therapy. Between 2005 and 2009 the Unit has performed more than pediatric 70 allogeneic stem cell transplantations for thalassemia, sickle cell anemia, immunodeficiencies and acute leukemias. The clinical performance of the Unit in was very high as demonstrated by an engraftment rate of 95% and a treatment related mortality of 5%. The Program is collaborating with HSR-TIGET on the study of pathogenesis and therapy for genetic diseases, with particular regards to primary immunodeficiencies and autoimmune diseases with known or unknown genetic defect. In synergy with the Pediatric clinical research Unit of HSR TIGET, clinical studies for gene therapy of Wiskott-Aldrich Syndrome and Metachromatic Leukodystrophy are ongoing and in preparation for gene therapy of thalassemia. Finally, the Program is implementing a cell therapy clinical study for Duchenne muscular dystrophy (project leader Prof Cossu). Maria Grazia Roncarolo 98 - SAN RAFFAELE SCIENTIFIC INSTITUTE THE SAN RAFFAELE TELETHON INSTITUTE FOR GENE THERAPY (HSR-TIGET) Director: Luigi Naldini* Introduction by the Director The San Raffaele Telethon Institute for Gene Therapy (TIGET, www.sanraffaele.org/research/tiget) is a multi-disciplinary research Institute with strong emphasis on the development of gene transfer technologies, cell and gene therapy strategies and their application to the treatment of rare genetic disorders. It hosts approximately 100 researchers (5 Heads of Unit and 7 Group/Project Leaders). HSR-TIGET was created in 1995 as a joint-venture between the San Raffaele Scientific Institute and the Telethon Foundation with the mission to perform cutting edge research in gene and cell therapy and to promote its translation into therapeutic advances for rare inborn diseases. The research projects span from basic to pre-clinical studies aiming to: a) identify the genetic bases and the patho-physiological processes of the inherited diseases under study, which include primary immunodeficiencies Luigi Naldini and autoimmune disorders, thalassemia and other blood disorders, leukodystrophies and other lysosomal storage disorders; b) develop new gene transfer technologies for more efficient and safe genetic modification of target cells, c) establish procedures for isolation, gene transfer and transplantation of stem cells; d) modulate immune response to gene and cell products to improve efficacy and stability of the therapy; e) test the new therapeutic strategies in pre-clinical disease models instrumental to design clinical trials. TIGET scientists, led by Luigi Naldini, have made essential contribution to the original development and continued improvements of lentiviral vectors, which have become one of the most widely used tool in biomedical research today and hold the promise of therapy for several human diseases. In parallel, TIGET scientists, led by Maria Grazia Roncarolo, have made significant advances in the field of immuno-tolerance mediated by regulatory T cells and the potential application of these cells as cell therapy of immune-mediated diseases. Furthermore, TIGET has established a Pediatric Clinical Research Unit (P-CRU) within the San Raffaele Hospital that focuses on the diagnosis, treatment and follow-up of patients with primary immunodeficiencies, hematologic and metabolic disorders, including those enrolled in the gene therapy trials. The TIGET clinical trial for a severe form of primary immunodeficiency (ADA-SCID) has provided the most successful demonstration today that gene transfer into human hematopoietic stem cells (HSC) can result in long-term correction of disease with an excellent safety record. Two new gene therapy trials for Metachromatic Leukodystrophy and Wiskott-Aldrich Syndrome are expected to start in the P-CRU in spring 2010. They will be among the first trials employing lentiviral vectors for HSC gene transfer. Towards this goal, TIGET has developed large-scale manufacturing of clinical grade lentiviral vectors in close collaboration with MolMed, a biotechnology company within the San Raffaele Biomedical Science Park, and has held several meetings on the subject with regulatory authorities in Italy (ISS) and Europe (EMEA). Overall, this research environment provides world-recognized leading scientific expertise in vector design and assays, genetic modification of HSC, pre-clinical models of HSC activity as well as in the translational, regulatory and clinical issues associated with testing novel therapies for immune and hematological diseases. It is clear that monogenic diseases that lack effective therapies offer the best setting to validate the therapeutic potential of gene therapy in an appropriate risk-benefit setting. DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 99 Research Units GENE TRANSFER TECHNOLOGIES AND NEW GENE THERAPY STRATEGIES UNIT We have long pursued the development of new gene transfer technologies and exploited them to gain insight into biological processes of high medical relevance, such as hematopoietic stem cell (HSC) activity and angiogenesis, and to provide proof-of-principle of new strategies for treating genetic disease and cancer. Throughout the years we have made major contributions to the development of lentiviral vectors for efficient and safe gene transfer. Today, lentiviral vectors represent one of the most broadly used tools in biomedical research and their successful first clinical testing in HSC was listed by the journal Science among the scientific breakthroughs of 2009. In 2010, we will launch two new clinical trials of lentiviral vector-based HSC gene therapy for Metachromatic Leukodystrophy and Wiskott-Aldrich Syndrome. We recently applied microRNA regulation to vector design and provided a new strategy to make transgenes and medically used viruses stringently responsive to cell type, activation and differentiation. Using this approach, we could overcome the immunological barrier to stable gene transfer, one of the major hurdles to successful gene therapy, and establish long-term correction of hemophilia in the mouse and dog models. We are now investigating the microRNA network regulating hematopoiesis and exploiting this knowledge to develop novel vectors with stringently controlled expression throughout the lineages. We have also pioneered the use of engineered Zinc-finger nucleases to target vector integration and edit the human genome. By this approach we can correct, rather than replace genes and insert the transgene with high efficiency and specificity downstream its own endogenous promoter or into a safe genomic harbor that allows for robust expression without interference on endogenous transcription. By combining all these strategies we can provide radically improved gene transfer platforms. Furthermore, we are exploiting these technologies for the generation and genetic correction of induced pluripotent stem cells, providing a potentially unlimited source of patient-derived vector free gene corrected multipotent cells for future applications of regenerative medicine. Luigi Naldini GENE/NEURAL STEM CELL THERAPY FOR LYSOSOMAL STORAGE DISEASES In lysosomal storage disorders (LSD) deficiency of specific lysosomal enzymes results in storage of undegraded macromolecules, functional impairment and cell death. Leukodystrophies (MLD, GLD) and GM2-gangliosidosis (Tay-Sachs and Sandhoff diseases) are “global” diseases affecting the central and peripheral nervous system and peripheral organs. Bone marrow transplant and enzyme replacement therapy cannot reverse the course of the disease and are unsatisfactory for treating the CNS. Our main goal is to develop novel gene- and neural stem cell (NSC)-based approaches to correct the metabolic defect and to restore the widespread CNS tissue damage in murine models of LSD. This is being addressed through different strategies: a) intracerebral injection of lentiviral vectors encoding for the missing genes (Lattanzi et al., Hum Mol. Genetics 2010); b) heterologous NSC transplantation (naïve or enzyme overexpressing NSC. Our studies allowed us to establish optimal experimental protocols for NSC neonatal transplantation. We are currently optimizing neonatal intracerebral direct gene delivery. These CNS-directed strategies will be combined with available approaches able to treat the PNS and visceral organs (i.e. hematopoietic stem cell transplantation), according to protocols that will take into consideration both the biological features of the donor cells and those of the pathologic environment. In order to better exploit the therapeutic potential of these strategies an important part of research activity is devoted to study: a) the biology of NSC during the onset and progression of the neurodegenerative condition (Martino et al., JNC, 2009) and b) the cell-autonomous and non-cell autonomous mechanisms regulating resident stem cell compartments and NSC migration and engraftment following transplantation. As a future project we aim to generate induced Pluripotent Stem Cells from skin fibroblasts of GLD and MLD patients, in or- 100 - SAN RAFFAELE SCIENTIFIC INSTITUTE der to have patient-specific pluripotent cell lines that could be differentiated into neural cells by means of previously described protocols. Given the absence of a source of neural cells from patients, these cell lines might constitute a valuable in vitro model to study the mechanisms underlying the pathogenesis of the diseases and to further confirm the safety and efficiency of gene transfer. Angela Gritti HEMATOPOIETIC STEM CELL BASED GENE THERAPY FOR THE TREATMENT OF LYSOSOMAL STORAGE DISORDERS In most Lysosomal Storage Disorders (LSD) hematopoietic stem cell (HSC) transplantation is not or poorly effective. HSC gene therapy could ameliorate the outcome of allogeneic transplant and thus provide an expectation of efficacious treatment for these LSD. HSC can be genetically modified to express supra-normal levels of the therapeutic enzyme, and become a quantitatively more effective source of functional enzyme than normal donor’s cells. Moreover, autologous HSC are immediately available, thus saving precious time in rapidly progressing forms, and, when employed in a transplant setting, significantly reduce transplant-related morbidity and mortality. We are thus implementing an innovative approach based on the transplantation of autologous, gene corrected HSC for the treatment of severe LSD lacking efficacious and safe therapeutic opportunities. To this goal, we exploit the unique features of lentiviral vectors (LV), which are prime candidates for HSC gene transfer. By using LV for HSC gene correction, we proved the therapeutic potential of HSC gene therapy in the murine model of metachromatic leukodystrophy (MLD), a severe dysmyelinating LSD. Based on the results obtained in the preclinical model and on an extensive safety study, a clinical trial of HSC gene therapy for MLD has recently been approved (patient’s recruitment open on March 15, 2010). The same approach has been applied with success to the murine model of type I Mucopolysaccharidosis (MPS I), a LSD characterized by visceral organ, skeleton and nervous system involvement. Thus, a clinical development plan for MPS I has recently started. In the case of globoid leukodystrophy (GLD), we recently demonstrated that the disease-causing enzyme (GALC) could not be over-expressed in HSC since it causes an unbalance in the content of bioactive sphingolipids tightly controlling HSC survival. Interestingly, when using a LV in which GALC expression is regulated by an HSC-specific microRNA we could obtain safe HSC transduction, GALC over-expression in the transduced HSC progeny, and significant phenotypic amelioration in mice transplanted with the transduced HSC. Therefore, an advanced LV design allows rendering HSC gene therapy a safe and efficacious approach to be further developed also for GLD. Alessandra Biffi SAFETY OF GENE THERAPY AND INSERTIONAL MUTAGENESIS In vivo models to assess the risk of insertional mutagenesis in the liver upon vector systemic delivery Efficient liver gene transfer by lentiviral vectors (LV) may allow the treatment of hepatic and systemic diseases. However, evaluation of the safety of liver gene transfer is required, as vector integration may occasionally lead to transformation of hepatocytes. We setup sensitive assays for liver genotoxicity in vivo exploiting 2 tumor-prone mouse models and wild type mice. LVs carrying in the LTRs ubiquitous (LV.SF.LTR) or hepatospecific enhancers (LV.ET.LTR) were systemically administered in newborn mice. LV.SF.LTR in Cdkn2a-/- mice induced early onset of histiocytic lymphomas with respect to uninjected mice (p<0.0001), showing that non-hepatocyte cells are the most susceptible target for transformation upon systemic injection of a genotoxic LV. LV.ET.LTR induced high grade hepatocellular carcinomas (HCC) in 30% of Cdkn2a-/- mice (0 HCCs in controls). Moreover, LV.ET.LTR induced HCCs in a mouse model of liver-specific Pten deficiency (incidence 25%, p<0.05), and in wild type mice in combination with a tumor promoting CCl4 treatment (incidence 75%, p=0.002). We exploited these validated mouse models to test the safety of SINLVs developed for the therapy of hemophilia B. A SINLV that express factor IX transcript under the control of hepatospecific enhancer with target se- DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 101 quences for microRNA 142.3p (SINLV.ET.FIX.142T) was administered in newborn mice at dose matched with LV.ET.LTR. Survival curves and HCC incidence readouts in Cdkn2a-/- mice injected with SINLV.ET.FIX.142T did not show evidence of genotoxicity. Evaluation of SINLV.ET.FIX.142T genotoxicity is also ongoing in wild type mice with CCl4 treatment. Our approach will be instrumental to establish vector designs with the best biosafety profile for liver gene therapy. Eugenio Montini GENE TRANSFER INTO STEM CELLS UNIT Gene therapy for β thalassemia Thalassemias are globally the most common monogenic disorders, affecting thousands of newborn annually. At present, the only definitive cure is allogeneic bone marrow (BM) transplantation, which is, however, available for a minority of patients. Gene therapy represents an attractive alternative for patients lacking a suitable donor. The development of lentiviral vectors (LV) and the optimization of hematopoietic stem cells (HSC) transduction have provided significant contributions to this field, leading to the application of LVs expressing the human ß-globin gene in preclinical models. Extensive preclinical studies of biology, efficacy and safety in human cells are mandatory to make a rigorous evaluation of a predictable successful trial. We achieved long-term correction of thalassemia in the murine model using the novel GLOBE vector (Miccio et al. PNAS, 2008). Following on from this successful result, the exploitation of the therapeutic efficacy of GLOBE was investigated in BM-CD34+ cells from a large cohort of pediatric patients. We have shown correction of hallmark features of the thalassemic phenotype, such as synthesis of HbA and ineffective erythropoiesis. We demonstrated that GLOBE efficiently transduces CD34+ cells, providing physiological levels of HbA in the erythroid progeny with a low number of integrants/cell. In order to assess the risk of genotoxicity related to GLOBE, we sequenced and mapped the GLOBE integration sites in thalassemic CD34+ cells. Analysis of integration events showed preference for intragenic regions, without hot spots in protoncogenes, tumor-supressor or cell cycle related genes. The potential of globin LV in perturbing gene expression over a distance of 200 kb from the integration site was tested in human erythroid cells transduced with GLOBE and with a derived vector carrying the cHS4 insulator in the LTR. We investigated changes in gene expression of 256 genes and generation of cellular aberrant transcripts originating by splicing events between cellular and vector sites. The analysis was performed at clonal level in transduced cells before and after induction to terminal differentiation. Overall, these results will provide evidence of efficacy and safety for the use of GLOBE in clinical gene therapy of thalassemia. Giuliana Ferrari IMMUNOLOGICAL TOLERANCE UNIT Ex vivo and in vivo induction of regulatory T cells to re-establish/induce tolerance in T-cell mediated diseases Regulatory T (Tr) cells represent specific T cell subsets that play a key role in inducing and maintaining tolerance. Most attention has been focused on the natural Tr (nTreg) cells and on the adaptive type 1 Tr (Tr1) cells, which are developmentally and functionally distinct, and cooperate in suppressing immune responses and in maintaining immunological homeostasis by inducing tolerance to self and foreign antigens. We are exploring and developing different strategies to promote/maintain tolerance via Tr cells: adoptive cell therapy with ex vivo expansion/induction of Tr cells and in vivo induction of Tr cells with tolerogenic compounds. We validated GMP protocols to selectively expand nTreg cells using rapamycin, and to generate Ag-specific Tr1 cells with exogenous IL-10 or IL-10-derived from tolerogenic dendritic cells. Clinical studies in hematopoietic stem cell transplantation using Tr-based cell therapy demonstrated that infusion of Tr1 cells is well-tolerated, safe, and does not result in severe GvHD. Alternatively to the use of ex vivo expanded/induced Tr cells, these cells can be induced directly in vivo. A 102 - SAN RAFFAELE SCIENTIFIC INSTITUTE combination therapy with depleting agents (i.e. anti-CD45 mAb) and rapamycin/IL-10 treatment is highly effective in inducing tolerance in pre-clinical models of transplantation and type 1 diabetes. (T1D). Alternatively, a small molecular weight (smw) compound that specifically activates the Aryl Hydrocarbon Receptor (AHR) is efficient for inducing transplantation tolerance via direct or DC-mediated effects on Tr cells. Preliminary data using a T1D mouse model show that this smw compound has distinct tolerogenic properties compared to other AHR agonists since it is capable of controlling autoimmunity. In a model of gene therapy, including in LV vectors target sequences for miR142, a microRNA exclusively expressed in hematopoietic lineage cells, results in suppression of transgene (tg) expression in professional APC. This strategy enabled stable delivery of tg (i.e. GFP and F.IX) in immuno-competent mice by inhibiting immune responses and de novo inducing tg-specific Tr cells. These approaches represent significant progress towards the definition of new therapeutic protocols aimed at suppressing pathology and restoring peripheral tolerance in immune-mediated diseases. Maria Grazia Roncarolo FROM FOXP3 MUTATION TO IPEX SYNDROME IPEX syndrome as a paradigm of monogenic autoimmune disease: genotype/phenotype correlation, immune pathogenic mechanisms and novel therapeutic options Immune dysregulation, Polyendocrinopathy, Enteropathy, X-linked (IPEX) syndrome is due to mutations of FOXP3 gene, the transcription factor driving the differentiation and function of regulatory T (Treg) cells. The disease is characterized by early onset refractory and life threatening enteropathy, eczema, elevated IgE levels and Type I diabetes. Genetic analysis of FOXP3 mutations should always be performed to ensure an accurate diagnosis and FOXP3 protein expression analysis should not be the only diagnostic tool for IPEX. Thanks to a wide collaborative network (www.ipexconsortium.org), we have collected data on the clinical presentation and immunological features of at least 20 unrelated affected males with different mutations. We have observed that FOXP3 mutated Treg cells in IPEX patients have normal FOXP3 demethylation but show impaired suppressive function. FOXP3 mutated T effector (Teff) cells also seem to contribute to the immune dysregulation, with an increased production of IL-17. However, we recently demonstrated that, in female carriers of the mutation, only the nTreg cells bearing the active wt allele of FOXP3 are selected to give rise to a normal Treg cell population, whereas the distribution of the two alleles was random in Teff cells. Differential gene expression profile analysis between FOXP3 null and FOXP3 wt cells of the same individuals are ongoing to clarify the role of FOXP3 in Teff cells. Since immunosuppressive drugs can only partially control the clinical manifestations of IPEX and haematopoietic stem cell transplantation (HSCT), although curative, is accessible to a limited number of patients, we are defining the most appropriate gene transfer approach for IPEX. Results of FOXP3 gene transfer into conventional Teff cells demonstrated that suppressive capacity is conferred to human T cells upon high and stable lentiviral mediated FOXP3 expression even in the presence of FOXP3 mutations. Therefore, gene transfer might represent a valid alternative to restore tolerance in IPEX patients. Results obtained from these studies will provide new insights into the biology of immune regulation, and will pave the way for expert diagnosis and more rationale therapeutic approaches not only for IPEX but also for other autoimmune pathologies. Rosa Bacchetta TOLEROGENIC DENDRITIC CELLS Requirements for the induction of Tr1-inducer monocyte-derived dendritic cells Dendritic cells (DC) are the most potent APC of the immune system able to promote immunity or tolerance based on their ability to secrete inflammatory or immunomodulatory cytokines, respectively. Several biological or pharmacological agents have been used to generate tolerogenic DC in vitro. We identified a new subset of tolerogenic DC, called DC-10, inducible in vitro in the presence of IL-10, which have a peculiar phenotype and cytokine-production profile, and are powerful inducers IL-10-producing T regulatory (Tr1) cells. The molecular mechanism underlying Tr1 cell induction via DC-10 is the IL-10-dependent Ig-like transcript(ILT)4/HLAG1 pathway. G-CSF is used in the clinic for the mobilization of bone marrow hematopoietic stem cells into the DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 103 bloodstream. G-CSF has pleiotropic effects on adaptive immune responses, it alters T cell functions and modulates DC. Monocytes from G-CSF-treated healthy donors differentiate into tolerogenic DC in vitro (post GDC) in the presence of autologous serum, containing high levels of IL-10 and IFN-α, and induce Tr1 cells. Based on these findings we postulated that G-SCF can replace IL-10 in promoting tolerogenic DC. Comparative analyses between monocytes differentiated with G-CSF (G-DC) and DC-10 demonstrated that both subsets are CD14+CD1a-, acquire a DC-like morphology, with mature myeloid phenotype. In contrast to DC-10, G-DC express significantly lower levels of ILT4 and HLA-G. G-DC spontaneously produce IL-10, although at lower levels compared to DC-10 and, in contrast to DC-10, secrete low levels of IL-12 upon stimulation. Both G-DC and DC-10 display low stimulatory capacity and induce anergy in naïve T cells. However, DC-10, but not G-DC, induce suppressor Tr1 cells. The inability of G-DC to promote Tr1 cell differentiation does not reside in their cytokine-production profile but rather in the low expression of ILT4 and HLA-G. These findings demonstrate that in vitro differentiation of DC with G-CSF can replicate some but not all features of post GDC. Moreover, potent Tr1-inducers DC should secrete high levels of IL-10 in the absence of IL-12 and express high levels of ILT4 and HLA-G. Silvia Gregori PATHOGENESIS AND THERAPY OF ADA-SCID UNIT Pathogenesis of ADA-SCID and its correction by gene therapy Genetic defects in the adenosine deaminase (ADA) gene are among the most common causes for SCID. Available therapeutic options for this otherwise fatal disorder include bone marrow transplantation (BMT), enzyme replacement therapy (PEG-ADA) or hematopoietic stem cell gene therapy (GT). Our aim is to acquire new information on the immune and organ alterations of this disease, and to investigate the ability of gene therapy cells to correct these manifestations. From detailed studies on the bone phenotype in ADA deficient mice, we obtained evidence for specific skeletal defects related to ADA-SCID. These alterations are the combined result of an imbalanced RANKL/OPG axis and an intrinsic defect of osteoblast function with subsequent low bone formation. Treatment of ADA-deficient neonatal mice with PEG-ADA, BMT, or GT resulted in full recovery of the altered bone parameters. Remarkably, untreated ADA-SCID patients showed a similar imbalance in RANKL/OPG levels alongside severe growth retardation. Retroviral gene therapy, but not PEG-ADA, improved serum RANKL levels and children’s growth, Autoimmune manifestations are frequently observed in patients with milder forms of the disease or patients on PEG-ADA. We found that untreated ADA-/- mice display alterations both in central and peripheral tolerance mechanisms. In PEG-ADA treated mice the percentage of nTregs significantly decreased and their suppressive function was completely abolished after long-term treatment. Subsequently, treated mice developed multiple autoimmune manifestations, indicating long-term PEG-ADA treatment interferes with nTreg functions. To assess if defects in peripheral tolerance may be the consequence of an impaired development or function of human nTregs, we analyzed their frequency, the FoxP3 methylation profile and the suppressive function of nTregs in ADA-SCID patients following ERT, GT or BMT as compared to controls. We found that the proportion and function of nTregs after GT mirrored that of controls, while nTreg from the ERT group showed a reduced frequency and impaired function. This study provides new insights into a possible predisposition to autoimmunity related to ADA-SCID and the underlying mechanisms causing immune dysregulation. Alessandro Aiuti GENE THERAPY FOR WASP/OMENN Lentiviral-mediated gene therapy leads to B and dendritic cell reconstitution in Wiskott-Aldrich Syndrome murine model Wiskott-Aldrich Syndrome (WAS) is an X-linked primary immunodeficiency characterized by thrombocytopenia, eczema, recurrent infections, autoimmunity and lymphomas. Transplantation of hematopoietic stem cells (HSC) from HLA-identical donors is curative, but not available to all patients. We have developed a protocol of gene therapy (GT) for WAS based on the transplant of genetically corrected autologous HSC using an 104 - SAN RAFFAELE SCIENTIFIC INSTITUTE HIV-based lentiviral vector encoding for WASp promoter/cDNA (w1.6W). We have previously demonstrated long-term restoration of WASp expression and functional correction of T cells upon GT in was-/- mice. However, B cell and DC phenotypic and functional reconstitution in GT treated mice was not fully evaluated. We then transplanted was-/- mice sublethally irradiated with Lin- BM cells wt, was-/- untransduced or transduced with w1.6W LV. B cells expressing WASp were present in all tissues isolated from GT treated mice (bone marrow, spleen, peripheral blood and peritoneal cavity). WASp positive DCs were detected in spleen, lymph nodes and thymus of GT treated mice. To test B cell functionality, we challenged mice with pneumococcal antigens (P23 vaccine). Mice were challenged 4 months after GT by injecting i.p. P23 vaccine. GT treated mice showed an improved antibody response, reaching levels comparable to mice transplanted with wt BM cells. Based on preliminary results showing autoantibodies against dsDNA in majority of was-/- mice, we evaluated the presence of autoantibodies in treated mice. GT partially corrected the phenotype of was-/- mice, by decreasing the frequency of mice positive for autoantibodies. To test the functionality of DCs from GT treated mice, we differentiated them in vitro from BM (BMDCs) or isolated DCs from spleen. We found that although only 20% of BMDCs from GT treated mice expressed WASp, in vitro phagocytosis, in vivo migratory capacity and T cell priming were ameliorated compared to was-/- BMDCs. In conclusion, our data demonstrate that lentiviral vector-mediated gene transfer in was-/- mice restores WASp expression and functionality in B and dendritic cells, providing further evidence of the efficacy of our GT approach. Anna Villa Clinical Research Units PEDIATRIC CLINICAL RESEARCH UNIT - GENE THERAPY FOR WISKOTT-ALDRICH SYNDROME WAS is an X-linked immunodeficiency characterized by thrombocytopenia, infections, autoimmunity and lymphomas. Transplantation of hematopoietic stem cell (HSC) from HLA-identical donors provides a complete cure for this disease but is not available for all patients and is still associated with risks of complications. Gene therapy with HSC could represent an alternative for patients lacking an HLA-identical donor. We previously demonstrated that a lentiviral vector encoding for human WAS gene under the control of endogenous 1.6 kb long promoter efficiently transduced and corrected human and mouse cells. We set up a transduction protocol for CD34+ cells from the bone marrow or mobilized peripheral blood of healthy donors, which were exposed once or twice to GMP grade lentiviral vector encoding WASp. qPCR performed on transduced cells showed a vector copy number per cell (VCN) of 0.4±0.1 (1 hit), and 0.6±0.2 (2 hits). The same protocol was used to transduce HSC from WAS patients resulting in a VCN of 0.7±0.1 (1 hit) and 1.4±0.3 (2 hits) and restoration of protein expression in differentiated cells. About 40% (1 hit) and 60% (2 hits) of CFC were positive for integrated vector. Transduced human HSC injected in sub-lethally irradiated Rag2/gc- deficient mice showed a normal biodistribution into hematopoietic organs, with normal differentiation capacity into myeloid and lymphoid cells (T and B) and no evidence of vector shedding or germline transmission. These data complete our previous preclinical studies performed in the mouse model demonstrating long-term safety and efficacy of gene therapy. A phase I/II gene therapy protocol based on infusion of transduced CD34+ cells combined with a reduced intensity conditioning has been approved by the Ethical Committee and regulatory authorities and will begin in 2010. The clinical trial is aimed at investigating: 1) the safety of the procedure and of the use of lentiviral vectors; 2) the in vivo long-term engraftment and expression of vector-derived WASP; 3) the ability of gene corrected cells to restore immune functions and increase platelet counts. If successful this study will provide key results on the safety and efficacy of gene therapy for WAS with lentiviral vectors. Maria Grazia Roncarolo DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 105 PEDIATRIC CLINICAL RESEARCH UNIT - ADA GENE TRANSFER INTO HEMATOPOIETIC STEM CELLS FOR THE TREATMENT OF ADA-SCID SCID due to adenosine deaminase (ADA)-deficiency is a fatal congenital disorder of the immune system associated with systemic toxicity. In the absence of an HLA-matched sibling donor, hematopoietic stem cell (HSC) transplant from alternative donors is still affected by high morbidity and mortality, while enzyme replacement therapy (PEG-ADA) fails often to sustain adequate immune reconstitution. Our approach is based on retroviral-mediated gene transfer into bone marrow CD34+ HSC combined to a nonmyeloablative chemotherapy prior to cell reinfusion. Fifteen ADA-SCID children have been treated according to this experimental protocol, enrolled in 3 different clinical trials. No toxicity or adverse events related to gene transfer have been observed after gene therapy. All patients are alive and 13 remain off PEG-ADA, with the longest follow up at >9 years after gene therapy. Molecular analysis showed the presence of multilineage engraftment of gene corrected HSC, confirmed by common vector insertions in lymphoid and myeloid cell subsets, derived from a common stem/progenitor cell. Comparison of vector integration analyses from HSC-gene therapy patients with those of ADA-SCID patients previously treated with infusions of mature lymphocytes revealed that MLV-vector insertions are cell-specific and linked to genetic-chromatin state of target cells in vitro. Immunological studies showed a progressive recovery in T-cell count and normalization of immune functions, leading to antigenspecific responses and effective protection from infections. Cell cycle and telomere length analyses showed that T-cell homeostatic expansion contributes substantially to immune reconstitution, especially in the early months after treatment, but this is not associated to senescence in the stem cell compartment. Finally, ADA expression persisted long-term, resulting in efficient systemic detoxification and amelioration of patients’ growth. In summary, these studies have provided evidence that HSC gene transfer is a safe and efficacious therapy for ADASCID, resulting in correction of both the immunological and metabolic defects. These results have opened a new perspective for the treatment of other life-threatening diseases of the hematopoietic system. Alessandro Aiuti PEDIATRIC CLINICAL RESEARCH UNIT - CLINICAL TRIAL OF GENE THERAPY IN METACHROMATIC LEUKODYSTROPHY Clinical trial of gene therapy in metachromatic leukodystrophy In the last six years we have studied the natural history of Metachromatic Leukodystrophy (MLD) on a cohort of 28 patients. We demonstrated a quite precise genotype-phenotype correlation, confirming that patients with 0/0 or 0/R genotype (late infantile and early juvenile) have a early onset disease and a rapid clinical progression, while patients with R/R genotype (late juvenile and adult) have a later onset and a more stable disease. Moreover, this study allowed us to validate clinical (Gross Motor Function Measure) and instrumental (brain Magnetic Resonance; ElectroNeuroGraphic recordings) tests to monitor disease progression. The study has been designed in the perspective of the clinical translation of a gene therapy approach based on autologous hematopoietic stem cells and lentiviral vectors. The clinical trial will be a Phase I/II study, in open, non-randomized, perspective, comparative with the non-contemporary population of MLD patients studied within a natural history study. To demonstrate efficacy, candidate patients should have an expected disease progression and survival time, which would allow evaluation of potential clinical benefits and safety of the proposed therapy. Therefore, either late infantile patients in pre-symptomatic phase, or early juvenile in pre- or early- symptomatic phase will be recruited. A myeloablative conditioning regimen based on IV Busulfan will be administered. Together with safety end-points, efficacy will be assessed as reduction in the progression of the clinical motor impairment in treated patients as compared to the progression in control patients, and as a significant increase of residual ARSA activity as compared to pre-treatment values. The clinical trial has been authorised by HSR Ethical Committee and Italian Superior Institute of Health (ISS). We plan to treat 8 patients, recruited internationally, in a period of 3 years, who will be followed for the safety and efficacy endpoint measures for a period of 3 years within the clinical trial and thereafter life-long for monitoring of safety, according to Italian legislation. Maria Sessa 106 - SAN RAFFAELE SCIENTIFIC INSTITUTE Selected publications 9 Battaglia, M; Roncarolo, MG. The Fate of Human Treg Cells. Immunity: 2009; 30(6): 763-765 - Short Survey IF 2008: 20,579 9 Bianchi, ME; Manfredi, AA. Dangers in and out. Science: 2009; 323(5922): 1683-1684 - Review IF 2008: 28,103 9 Bonini, C; Russo, V. The hidden (and lazy) TCR. Blood: 2009; 114(14): 2855-2856 - Comment IF 2008: 10,432 9 Bosticardo, M; Marangoni, F; Aiuti, A; Villa, A; Roncarolo, MG. Recent advances in understanding the pathophysiology of Wiskott-Aldrich syndrome. Blood: 2009; 113(25): 6288-6295 - Review IF 2008: 10,432 9 Brown, BD; Naldini, L. Exploiting and antagonizing microRNA regulation for therapeutic and experimental applications. Nat. Rev. Genet.: 2009; 10(8): 578-585 - Review IF 2008: 24,185 9 Cassani, B; Montini, E; Maruggi, G; Ambrosi, A; Mirolo, M; Selleri, S; Biral, E; Frugnoli, I; Hernandez-Trujillo, V; Di Serio, C; Roncarolo, MG; Naldini, L; Mavilio, F; Aiuti, A. Integration of retroviral vectors induces minor changes in the transcriptional activity of T cells from ADA-SCID patients treated with gene therapy. Blood: 2009; 114(17): 3546-3556 - Article IF 2008: 10,432 9 Ciceri, F; Bonini, C; Lupo Stanghellini, MT; Bondanza, A; Traversari, C; Salomoni, M; Turchetto, L; Colombi, S; Bernardi, M; Peccatori, J; Pescarollo, A; Servida, P; Magnani, Z; Perna, SK; Valtolina, V; Crippa, F; Callegaro, L; Spoldi, E; Crocchiolo, R; Fleischhauer, K; Ponzoni, M; Vago, L; Santoro, A; Todisco, E; Apperley, J; Olavarria, E; Slavin, S; Weissinger, EM; Hertenstein, B; Stadler, M; Yannaki, E; Fassas, A; Anagnostopoulos, A; Bregni, M; Gallo Stampino, C; Bruzzi, P; Bordignon, C. Early and effective immunorecovery after family haploidentical hemopoietic transplantation for leukemia by gene-engineered lymphocytes: the TK007 study. Lancet Oncol.: 2009; 10(5): 489-500 - Article IF 2008: 13,283 9 Crocchiolo, R; Zino, E; Vago, L; Oneto, R; Bruno, B; Pollichieni, S; Sacchi, N; Sormani, MP; Marcon, J; Lamparelli, T; Fanin, R; Garbarino, L; Miotti, V; Bandini, G; Bosi, A; Ciceri, F; Bacigalupo, A; Fleischhauer, K for the Gruppo Italiano Trapianto di Midollo Osseo, Cellule Staminale Ematopoietiche (CSE) e Terapia Cellulare, and the Italian Bone Marrow Donor Registry. Nonpermissive HLA-DPB1 disparity is a significant independent risk factor for mortality after unrelated hematopoietic stem cell transplantation. Blood: 2009; 114(7): 1437-1444 - Article IF 2008: 10,432 9 Di Nunzio, S; Cecconi, M; Passerini, L; McMurchy, AN; Baron, U; Turbachova, I; Vignola, S; Valencic, E; Tommasini, A; Junker, A; Cazzola, G; Olek, S; Levings, MK; Perroni, L; Roncarolo, MG; Bacchetta, R. Wild-type FOXP3 is selectively active in CD4+CD25(hi) regulatory T cells of healthy female carriers of different FOXP3 mutations. Blood: 2009; 114(19): 4138-4141 - Brief Report IF 2008: 10,432 9 Kaneko, S; Mastaglio, S; Bondanza, A; Ponzoni, M; Sanvito, F; Aldrighetti, L; Radrizzani, M; La Seta-Catamancio, S; Provasi, E; Mondino, A; Nagasawa, T; Fleischhauer, K; Russo, V; Traversari, C; Ciceri, F; Bordignon, C; Bonini, C. IL-7 and IL-15 allow the generation of suicide gene-modified alloreactive self-renewing central memory human T lymphocytes.. Blood: 2009; 113(5): 1006-1015 - Article IF 2008: 10,432 9 Locci, M; Draghici, E; Marangoni, F; Bosticardo, M; Catucci, M; Aiuti, A; Cancrini, C; Marodi, L; Espanol, T; Bredius, RGM; Thrasher, AJ; Schulz, A; Litzman, J; Roncarolo, MG; Casorati, G; Dellabona, P; Villa, A. The Wiskott-Aldrich syndrome protein is required for iNKT cell maturation and function. J. Exp. Med.: 2009; 206(4): 735-742 - Article IF 2008: 15,463 9 Maugeri, N; Rovere-Querini, P; Evangelista, V; Covino, C; Capobianco, A; Bertilaccio, MT; Piccoli, A; Totani, L; Cianflone, D; Maseri, A; Manfredi, AA. Neutrophils phagocytose activated platelets in vivo: a phosphatidylserine, P-selectin, and {beta}2 integrin-dependent cell clearance program. Blood: 2009; 113(21): 52545265 - Article IF 2008: 10,432 9 Messina, G; Cossu, G. The origin of embryonic and fetal myoblasts: a role of Pax3 and Pax7. Genes Dev.: 2009; 23(8): 902-905 - Review IF 2008: 13,623 DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 107 9 Naldini, L. A comeback for gene therapy. Science: 2009; 326(5954): 805-806 - Short Survey IF 2008: 28,103 9 Vago, L; Perna, SK; Zanussi, M; Mazzi, B; Barlassina, C; Stanghellini, MTL; Perrelli, NF; Cosentino, C; Torri, F; Angius, A; Forno, B; Casucci, M; Bernardi, M; Peccatori, J; Corti, C; Bondanza, A; Ferrari, M; Rossini, S; Roncarolo, MG; Bordignon, C; Bonini, C; Ciceri, F; Fleischhauer, K. Loss of mismatched HLA in leukemia after stem-cell transplantation. N. Engl. J. Med.: 2009; 361(5): 478-488 - Article IF 2008: 50,017 Selected publications (HSR-TIGET) 9 Aiuti, A; Cattaneo, F; Galimberti, S; Benninghoff, U; Cassani, B; Callegaro, L; Scaramuzza, S; Andolfi, G; Mirolo, M; Brigida, I; Tabucchi, A; Carlucci, F; Eibl, M; Aker, M; Slavin, S; Al-Mousa, H; Ghonaium, AA; Ferster, A; Duppenthaler, A; Notarangelo, L; Wintergerst, U; Buckley, RH; Bregni, M; Marktel, S; Valsecchi, MG; Rossi, P; Ciceri, F; Miniero, R; Bordignon, C; Roncarolo, MG. Gene therapy for immunodeficiency due to adenosine deaminase deficiency. N. Engl. J. Med.: 2009; 360(5): 447-458 - Article IF 2008: 50,017 9 Annoni, A; Brown, BD; Cantore, A; Sergi Sergi, L; Naldini, L; Roncarolo, MG. In vivo delivery of a microRNA-regulated transgene induces antigen-specific regulatory T cells and promotes immunologic tolerance. Blood: 2009; 114(25): 5152-5161 - Article IF 2008: 10,432 9 Gentner, B; Schira, G; Giustacchini, A; Amendola, M; Brown, BD; Ponzoni, M; Naldini, L. Stable knockdown of microRNA in vivo by lentiviral vectors. Nat. Methods: 2009; 6(1): 63-66 - Article IF 2008: 13,651 9 Montini, E; Cesana, D; Schmidt, M; Sanvito, F; Bartholomae, CC; Ranzani, M; Benedicenti, F; Sergi Sergi, L; Ambrosi, A; Ponzoni, M; Doglioni, C; Di Serio, C; von Kalle, C; Naldini, L. The genotoxic potential of retroviral vectors is strongly modulated by vector design and integration site selection in a mouse model of HSC gene therapy.. J. Clin. Invest.: 2009; 119(4): 964-975 - Article IF 2008: 16,559 9 Pucci, F; Venneri, MA; Biziato, D; Nonis, A; Moi, D; Sica, A; Di Serio, C; Naldini, L; De Palma, M. A distinguishing gene signature shared by tumor-infiltrating Tie2-expressing monocytes, blood “resident” monocytes, and embryonic macrophages suggests common functions and developmental relationships. Blood: 2009; 114(4): 901-914 - Article IF 2008: 10,432 108 - SAN RAFFAELE SCIENTIFIC INSTITUTE Skeletal muscle development and therapy Unit Functional genetics of muscle regeneration Gene expression and muscular dystrophy Unit DIVISION OF REGENERATIVE MEDICINE, STEM CELLS, AND GENE THERAPY - 109 Molecular and functional immunogenetics Experimental hematology Unit Gene transfer into stem cells Unit DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 111 DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES Director: Ruggero Pardi* Associate Director: Adriano Lazzarin* Research Units Leukocyte biology Unit HEAD OF UNIT: Ruggero Pardi* RESEARCHER: Monica Fabbri POST-DOCTORAL FELLOWS: Raffaella Molteni, Martina Panattoni** PHD STUDENTS: Carolina Lage Crespo**, Anna Lukacs**, Michela Palmisano, Michol Savio** TECHNICIAN: Barbara Clissi Cellular and molecular allergology GROUP LEADER: Samuele E. Burastero PHD STUDENT: Mona-Rita Yacoub** TECHNICIAN: Daniela Breda Human virology GROUP LEADER: Mauro S. Malnati RESEARCHER: Silvia Heltai PHD STUDENT: Lia Vassena** FELLOWS: Giulia Cassina, Emanuela De Martino TECHNICIAN: Francesca Sironi Infection and cystic fibrosis GROUP LEADER: Alessandra Bragonzi POST-DOCTORAL FELLOW: Cristina Cigana PHD STUDENTS: Irene Bianconi, Nicola Ivan Lorè, Moira Paroni FELLOW: Elisa Pedretti Protein engineering and therapeutics GROUP LEADER: Luca Vangelista POST-DOCTORAL FELLOW: Massimiliano Secchi γδ T cells in innate and adaptive immunity RESEARCHER: Maria Raffaella Zocchi FELLOWS: Paolo Canevali, Alessandra Musso Infectious diseases Unit HEAD OF UNIT: Adriano Lazzarin* Immunobiology of HIV GROUP LEADER: Lucia Lopalco PHD STUDENTS: Lorenzo Diomede, Maria Luisa Visciano** FELLOW: Valentina Merati TECHNICIAN: Claudia Pastori Immunological diagnostics of tuberculosis GROUP LEADER: Claudio Fortis 112 - SAN RAFFAELE SCIENTIFIC INSTITUTE AIDS immunopathogenesis Unit HEAD OF UNIT: Guido Poli* RESEARCHER: Massimo Alfano PHD STUDENTS: Luca Cassetta, Giulia Della Chiara, Samanta Mariani FELLOW: Livia Gobbo TECHNICIAN: Chiara Rizzi Biocrystallography Unit HEAD OF UNIT: Massimo Degano POST-DOCTORAL FELLOWS: Beatrice Alfieri, Fabrizio Gangemi, Claudia Minici PHD STUDENT: Stefano Vavassori** FELLOW: Francesca Giannese TECHNICIAN: Paola Tornaghi Cellular immunology Unit HEAD OF UNIT: Matteo Bellone PHD STUDENTS: Luca Generoso, Elena Jachetti**, Alessia Ricupito**, Nicolò Rigamonti** TECHNICIAN: Matteo Grioni Emerging bacterial pathogens Unit HEAD OF UNIT: Daniela Maria Cirillo PHD STUDENT: Paolo Miotto, Elisa Schena** FELLOWS: Emanuele Borroni, Lucinda Furci, Paola Mantegani, Antonella Tuscano, Diego Zallocco Experimental immunology Unit HEAD OF UNIT: Paolo Dellabona RESEARCHERS: Giulia Casorati, Claudia De Lalla PHD STUDENTS: Virginia Cecconi**, Maya Fedeli**, Nagabhooshan Hegde**, Marco Lepore, Anna Napoletano FELLOW: Michele Cosmo Romano TECHNICIANS: Marta Delogu, Claudio Garavaglia Immunopathology Unit HEAD OF UNIT: Luca G. Guidotti RESEARCHER: Giovanni Sitia POST-DOCTORAL FELLOW: Lara Ravanetti PHD STUDENT: Matteo Iannacone TECHNICIANS: Pietro Di Lucia, Marta Mainetti Lymphocyte activation Unit HEAD OF UNIT: Anna Mondino POST-DOCTORAL FELLOWS: Chaitanya Ekkirala, Rodrigo Hess-Michelini PHD STUDENTS: Teresa Manzo**, Romana Tomasoni** TECHNICIAN: Veronica Basso Tumor immunology Unit HEAD OF UNIT: Maria Pia Protti RESEARCHER: Lucia De Monte POST-DOCTORAL FELLOWS: Giulia Di Lullo, Diego Marescotti PHD STUDENTS: Donato Calabrese** TECHNICIAN: Giuseppe Consogno Viral evolution and transmission Unit HEAD OF UNIT: Gabriella Scarlatti POST-DOCTORAL FELLOW: Mariangela Cavarelli PHD STUDENTS: Stefania Dispinseri, Lara Mainetti FELLOWS: Priscilla Biswas, Chiara Foglieni TECHNICIAN: Monica Tolazzi DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 113 Viral pathogens and biosafety Unit HEAD OF UNIT: Elisa Vicenzi POST-DOCTORAL FELLOW: Anna Kajaste-Rudnitski PHD STUDENT: Tiziana Coradin FELLOW: Cinzia Pultrone (till March 2009) TECHNICIAN: Silvia Ghezzi Clinical Research Units Infectious diseases Unit HEAD OF UNIT: Adriano Lazzarin* Management and antiretroviral treatment of HIV infection CLINICAL GROUP LEADER: Antonella Castagna PHYSICIAN: Nicola Gianotti FELLOWS: Francesca Cossarini, Vincenzo Spagnuolo STATISTICIAN: Laura Galli TECHNICIAN: Andrea Galli Neurovirology CLINICAL GROUP LEADER: Paola Cinque PHYSICIANS: Simona Bossolasco, Francesca Ferretti POST-DOCTORAL FELLOW: Manuela Testa TECHNICIAN: Arabella Bestetti Study and treatment of hepatotropic viruses related diseases CLINICAL GROUP LEADER: Caterina Uberti-Foppa RESEARCHER: Giulia Morsica POST-DOCTORAL FELLOWS: Sabrina Bagaglio, Hamid Ibrahim Hasson FELLOWS: Alice Dadda, Camilla Granieri, Lucy Porrino Vaccine and immunotherapy CLINICAL GROUP LEADER: Giuseppe Tambussi PHYSICIAN: Silvia Nozza FELLOW: Manuela Pogliaghi RESEARCH NURSE: Liviana della Torre TECHNICIAN: Andrea Galli QUALITY ASSURANCE AND REGULATORY AFFAIRS: Vega Rusconi TRIAL COORDINATOR: Clara Ronchetti Clinical immunopathology and advanced medical therapeutics Unit HEAD OF UNIT: Maria Grazia Sabbadini* PHYSICIANS: Elena Baldissera, Enrica P. Bozzolo, Giselda Colombo, Massimo Memoli, Luisa Praderio, Moreno Tresoldi POST-DOCTORAL FELLOWS: Patrizia Aiello, Stefano Franchini FELLOWS: Mattia Baldini, Emmanuel Della Torre, Barbara Guglielmi, Francesca Motta, Fulvio Salvo, Mirta Tiraboschi CONSULTANT: Lorenzo Dagna** Clinical transplant Unit HEAD OF UNIT: Antonio Secchi* PHYSICIANS: Rossana Caldara, Chiara Gremizzi, Vera Paloschi POST-DOCTORAL FELLOWS: Gabriella Cicenia, Alessandra Petrelli, Andrea Vergani CONSULTANT: Paolo Fiorina 05immunology 9 07 2010 16:48 Pagina 114 114 - SAN RAFFAELE SCIENTIFIC INSTITUTE Gynecological cancers immunology HEAD OF UNIT: Massimo Candiani* CLINICAL GROUP LEADER: Massimo Origoni* PHYSICIANS: Luigi Caputo, Guia Carminati, Davide Ferrari RESIDENTS: Francesca Occhi**, Chiara Stefani** Immunology in liver neoplasms HEAD OF UNIT: Gianfranco Ferla* CLINICAL GROUP LEADER: Luca Aldrighetti PHYSICIANS: Marco Catena, Renato Finazzi RESIDENT: Federica Cipriani Obesity RESEARCHER: Michele Paganelli Pancreatic tumors: immunotherapy and β-cell function substitution HEAD OF UNIT: Valerio Di Carlo* CLINICAL GROUP LEADER: Alessandro Zerbi PHYSICIAN: Marco Stella RESIDENTS: Vanessa Capitanio, Giovanni Capretti, Federica Merlini Gastroenterology Unit HEAD OF UNIT: Pier Alberto Testoni* Clinical hepato-gastroenterology RESEARCHER: Mario Guslandi Digestive pathophysiology RESEARCHER: Sandro Passaretti Transplant surgery HEAD OF UNIT: Carlo Staudacher* RESEARCHER: Carlo Socci DRI, Diabetes Research Institute Director: Luca G. Guidotti Associate Director: Emanuele Bosi* Research Units Diabetes research Unit HEAD OF UNIT: Luca G. Guidotti Immune tolerance GROUP LEADER: Manuela Battaglia PHD STUDENTS: Alessandra Ferraro, Nicola Gagliani FELLOW: Andrea Valle TECHNICIANS: Tatiana Jofra, Angela Stabilini 05immunology 9 07 2010 16:48 Pagina 115 DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 115 Experimental diabetes GROUP LEADER: Marika Falcone POST-DOCTORAL FELLOW: Vera Usuelli PHD STUDENT: Caterina Di Pietro** FELLOW: Tamara Vorobjova TECHNICIAN: Alessandra Caputo β-cell biology GROUP LEADER: Lorenzo Piemonti POST-DOCTORAL FELLOW: Leda Racanicchi PHD STUDENTS: Elisa Cantarelli, Valeria Sordi FELLOWS: Antonio Citro, Erica Dugani Cell imaging HEAD OF UNIT: Alessandro Del Maschio* GROUP LEADER: Maria Luisa Malosio FELLOW: Cristina Brigatti** Clinical Research Units Islet transplantation HEAD OF UNIT: Antonio Secchi* CLINICAL GROUP LEADER: Paola Maffi BIOLOGIST: Paola Magistretti Prevention in Type 1 diabetes HEAD OF UNIT: Emanuele Bosi* CLINICAL GROUP LEADER: Luca Falqui PHYSICIANS: Matteo Rocco Pastore, Sabina Martinenghi RESIDENT: Laura Molteni RESEARCH NURSE: Pauline Grogan Epidemiology & data management RESEARCHER: Marina Scavini Childhood diabetes HEAD OF UNIT: Giuseppe Chiumello* RESEARCHER: Riccardo Bonfanti PHYSICIAN: Andrea Rigamonti RESIDENTS: Roseila Battaglino, Valentina Biffi, Giulio Frontino Islet processing activity SUPERVISOR: Lorenzo Piemonti RESEARCHER: Rita Nano FELLOWS: Raffaella Melzi, Alessia Mercalli * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 116 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Directors Mission and vision - Consistent with the Institutional mission of promoting a strong integration between pre-clinical, mechanistic research and its potential exploitation for the diagnosis and cure of human disease, the comprehensive goal and unifying mission of the DITID is to perform forefront mechanistic, translational and clinical research eventually enabling us to harness the immune response for the benefit of patients. To achieve its ambitious goals, the DITID will profit from its own potential, but will also aim at prospectively increasing such potential. This will be accomplished not only by systematically assessing progress of existing staff and estabRuggero Pardi lishing defined operational plans and milestones, but also through the recruitment of a few young, brilliant investigators, along with the implementation of shared technological platforms and facilities. It is only through such a blend of inspired excellence, recruitment plans and advanced technology that the above statements will become realistic and feasible in the medium to long term. Organization - As of January 2010, the DIDIT comprises 21 Basic Research Units, with a total of 120 investigators and technicians (including graduate students) who have a primary affiliation to the DITID, plus 11 Clinical Research Groups, which include 65 dedicated professionals. Future, coordinated research efforts will be focused on the existing Diabetes Research Institute, along with three interdivisional Research Programs: The interdepartmental program of immunology, immunobiotherapy and gene therapy of Cancer, copromoted with the Division of Molecular Oncology; the Islet TransAdriano Lazzarin plantation Program; CHARM: Correlates of HIV-Associated Immune Response Modulation, merging efforts and promoting synergistic interactions between the DITID and the Department of Infectious Diseases). The scientific and Institutional goals of the DITID research programs are meant to promote coordination and synergies in research and clinical groups working on interdependent areas, but will by no means deter DITID members from carrying out individual, curiosity-driven research and/or from generating spontaneous collaborative efforts both within the DITID and with outside investigators. Goals - DITID teams, comprised of immunologists, pathologists, microbiologists, infectious disease specialists, experimental surgeons, scientists, and clinicians, are tackling this formidable challenge from many different avenues, pooling their talents and pouring their energies into four interdependent and sequentially coordinated objectives: 1. To dissect sites, molecular networks and microenvironmental cues underlying antigen recognition, immune cell differentiation, immunological memory and the acquisition of tolerance to self and foreign antigen; 2. To develop models and tools to manipulate the above responses; 3. To translate the most effective tools into proof-of-concept designs for phase I/II clinical trials in cancer, infection and chronic inflammation; 4. To develop novel and sensitive approaches to assess the immune status and monitor antigenic responses in clinical settings and in healthy subjects. Achievements - Collectively, from 2007 to 2009 basic and clinical research groups or individual investigators affiliated with the DITID have published 421 papers in peer-reviewed journals, with an overall Impact Factor of 2,503.93. DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 117 Training Opportunities - Higher education, and particularly Graduate education, has traditionally been an asset of the DITID, which in the academic year 2002-2003 established a highly competitive basic and applied immunology PhD program under the auspices of San Raffaele University. Starting in 2004, the DITID has obtained funding exceeding 2 M€ to support the program. Furthermore, an interdepartmental post-doctoral program is currently being launched to host 3 to 5 young researchers, both national and international. 118 - SAN RAFFAELE SCIENTIFIC INSTITUTE Research Units LEUKOCYTE BIOLOGY UNIT Inflammatory cell migration in nonresolving inflammation: identification and validation of novel molecular targets Diseases underlying unresolving inflammation represent the greatest collective burden of suffering and economic cost in the developed world: collectively, one out of three individuals is estimated to be chronically affected at a certain time of her/his life span. In chronic inflammation, a variety of “inputs”, both exogenous and endogenous, ultimately affect the recruitment and activation of immune and inflammatory cells, thereby amplifying and perpetuating the inflammatory state. Based on these premises, the general assumption and comprehensive goal underlying our recent work is that a thorough understanding of the mechanisms involved in persistent leukocyte migration and homing to the site of lesions will be germane to the discovery of novel therapeutic targets and more selective anti-inflammatory drugs that interfere with selected steps in this process. In the last year we have unveiled a novel role of ubiquitous β arrestins in regulating the activation of signaling pathways underlying discrete integrin-mediated steps in chemokine-driven leukocyte extravasation. By combining in vivo approaches in β arrestin knockout mice with in vitro studies in engineered cellular models we have show that membrane-recruited β arrestin-2 is required for the onset and maintenance of shear stress-resistant leukocyte adhesion mediated by both β-1 and β-2 integrins. We have subsequently identified intermediates and effectors in the signaling cascade that qualify as “druggable” targets for the development of novel therapeutics that selectively prevent inflammatory cell migration to the site of lesions in nonresolving inflammation. Additionally, we showed that JAM-A has a cell-autonomous role in neutrophil chemotaxis both in vivo and in vitro, which is independent of the interaction of neutrophils with endothelial cells. On activated neutrophils, JAM-A concentrates in a polarized fashion at the leading edge and uropod. These data might explain why, in its absence, the directional migration of neutrophils towards an inflammatory stimulus is markedly impaired. We are currently testing the hypothesis that chemokines and integrins cooperatively control gene expression programs in extravasating and infiltrating leukocytes. Ruggero Pardi CELLULAR AND MOLECULAR ALLERGOLOGY Significant reduction of allergenicity by structurally-guided single point mutations Recombinant allergens are entering clinical practice as highly performing diagnostic tools and have demonstrated efficacy and safety in controlled clinical trials. One of the advantages of immunotherapy with recombinant allergens is the possibility to mutate them in order to loose allergenicity while fully maintaining T-cell stimulatory potential, which is mandatory for the success of immunotherapy itself. Conventional strategies to generate “allergoids” include extended deletions of B-cell epitopes and multiple mutations of the allergen molecule. Alternatively, we are investigating (in collaboration with the Department of Experimental Medicine of the University of Parma) the possibility to destroy crucial B cell epitopes with a single mutation approach. We are working on the model of the Mus m 1.0101 major mouse allergen, belonging to the lipocalin protein family. Preliminary data reveals that Tyr120 is particularly important for the overall stability of this protein. Mutations at the level of this residue appear primarily responsible for alterations in the H-bonds network that stabilizes this molecule and provide striking conformational modifications of the global protein architecture, as assessed by nuclear magnetic resonance. We propose to investigate whether and to what extent this approach is capable of significantly impairing allergen recognition by IgE from mouse-allergic patients, and its impact on T-cell epitopes. We are also interested to verify whether this strategy can be applied to recombinant panallergens. Panallergens, such as profilins, are promising tools to vaccinate a relevant proportion of allergic subjects who are presently orphans of a specific immunotherapy. Previous data generated in this laboratory suggest that profilins DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 119 may play a crucial role in the epitope spreading of the immune response in polysensitized individuals, who represent approximately one third of the population allergic to pollen allergens. In principle, a specific vaccination with immunogens clinically “easy to handle” due to low allergenicity could bring about a favorable interference in this process for a large proportion of allergic individuals. Samuele E. Burastero Figure 13. Slab view of MUP2 crystal structure (1JV4, displayed in topology cartoon): W19 is visible at the bottom of the hydrophobic cavity of the b-barrel. The tryptophan side chain is predicted to form a cation-p interaction, deemed energetically significant by the CaPTURE web server, with the atoms belonging to residue R122. The proximity of these interacting residues to Y120 is appreciable; the side chains of the cited residues are represented in sticks. HUMAN VIROLOGY The failure of anti HIV-1 vaccine strategy based on the induction of a broad T-cell response against structural antigens suggests that the most effective defence against HIV-1 transmission might require the combination of HIV-1-specific T-cell responses and anti-HIV-specific antibody (Ab) responses. Our unit is mainly involved on the development of an effective anti HIV-1 vaccine studying, on one side, the distinctive features of the Tcell mediated immune response towards structural and regulatory HIV-1 encoded antigens in particular cohorts of HIV-1 infected individuals who survive for long time without sign of immune deterioration (LTNP) and/or naturally control viral replication below the level of detection of the clinical lab tests (Elite controllers= EC). On the other side, we are conducting a deep characterization of the HIV-1 Envelope protein gp160 aiming to individuate structural modifications that render the gp160 a useful immunogen. Indeed, relevant epitopes of this oligomeric protein are shielded by “variable” loops that we are removing/modifying from the gp160 scaffolds of two selected HIV-1 strains: the CCR5 dependent strain BaL and the R5X4 strain US077. Results obtained in 2009 A strong response against the HIV-1 encoded antigen Tat is the hallmark of EC individuals being more frequent, higher and wider than in the other cohorts of HIV-1+ individuals. In addition, EC recognize selectively particular regions of the protein that are critical for the trans-activating function of Tat. Interestingly, in silico prediction of recognized epitopes matched with patients’ HLA, shows that targeted epitopes can be shared by multiple HLA alleles.The deletion of the V2 region as well as the disruption of potential N-glycosilation sites present in the V2 and in the V1-V2 stem-loop regions reduces fusion and modifies the recognition of mAbs directed against CD4-induced epitopes. Only the deletion of the V1 region is well tolerated by both gp160 proteins. Interestingly, the V1-deletion in the US077 gp160 increases the interaction with CD4/CCR5 complex allowing the binding of larger amounts of sCD4 and of the neutralizing CD4-binding site specific mAb B12, suggesting that this molecule might represent a potential candidate for vaccine development. Mauro S. Malnati 120 - SAN RAFFAELE SCIENTIFIC INSTITUTE INFECTION AND CYSTIC FIBROSIS Pseudomonas aeruginosa-host interactions in Cystic Fibrosis: implications for pathogenesis and therapy Persistent bacterial infections involving P. aeruginosa pose serious problems for human health including Cystic Fibrosis (CF) patients. After causing an initial acute disease state, which is kept in check by an immune response, P. aeruginosa establishes persistent infection and colonize the host by evading immune surveillance. The goal of our program is to elucidate cellular and molecular mechanisms that are involved in the hostpathogen interactions during persistent infection with the aim of devising new therapeutic approaches to treat respiratory infections. Cellular and molecular mechanisms involved in P. aeruginosa-host pathogen interactions. Life-long P. aeruginosa chronic infections in the airways of CF patients is established with patho-adaptive variants, which are clonal with the initially acquired strains. We have taken two approaches of functional genomics, through trascriptomics and insertion mutagenesis, to obtain a genome scale picture of P. aeruginosa expression and strategies adopted by P. aeruginosa in the persistent lifestyle. By using a PCR-based signaturetagged mutagenesis (Pos-STM) based on positive selection screening in a murine model of chronic airways infection, we disclosed novel patho-adaptive mutations. Of particular interest was the finding that P. aeruginosa virulence factors, relevant in the acute infection, were modified or selected against during chronic infection. In particular, changes in P. aeruginosa PAMPs lead to escape host innate immune system and endorse pathogenesis. Our findings emphasize studies to define novel virulence determinants in adapted P. aeruginosa population and novel targets which may lead to improved antimicrobial therapeutic strategies. Evaluation of novel molecules for treating respiratory infection and inflammation. Over the years, we have accumulated expertise on mouse model for acute infection, established a mouse model for airway chronic infection and collected unique reagents such as a selection of highly virulent CF-related pathogens. Based on this expertise, we have established the Cystic Fibrosis Animal Core Facility (CFaCore) to support investigations on candidate therapeutic molecules and to favor the translation of basic research projects into pre-clinical applications. Alessandra Bragonzi PROTEIN ENGINEERING AND THERAPEUTICS Three major research fields are being exploited in our laboratory. Main efforts are devoted to HIV-1 entry inhibitors based on engineered derivatives of RANTES and other CCR5-binding chemokines, in an attempt to create CCR5 antagonists with potent anti-HIV-1 activity. Both fulllength RANTES mutants and short peptides are presently being developed as CCR5-antagonist anti-HIV-1 mucosal microbicides. The ‘live microbicides’ field is a promising and innovative approach based on the engineering of human commensal bacteria, such as lactic acid bacteria (LAB), to produce anti-HIV-1 protein therapeutics, a field in which we are involved and committed. A further aspect of HIV-1 entry inhibitor development consists in the possible combination of different lead compounds. Both full-length and short peptide RANTES derivatives presented full additivity or even slight synergism when tested in vitro in combination with different HIV-1 inhibitors. In a second research area, structure-function knowledge on IgE and its receptors is applied to the benefit of human health. In this view, we devise IgE engineering in an attempt to combat both allergic manifestations as well as cancer. In a research program co-directed with Prof. Antonio Siccardi, we found that IgE is a potent adjuvant in anti-tumor vaccination and Fc epsilon RI, the high affinity receptor for IgE, has a key role in the IgE anti-tumor effect. The system has been evolved by engineering a recombinant modified vaccinia virus Ankara to express a truncated version of human membrane IgE, capable to bind and activate human Fc epsilon RI. This system, that includes the use of transgenic mice expressing the human receptor, has the advantage of being safe and close to the clinics. In addition, we have strong evidence that endogenous IgE, in a transgenic mouse engineered to produce high IgE levels, prevents tumor development in vivo. Finally, we are planning to expand the commensal LAB engineering as a system to be exploited: a) for the de- DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 121 velopment of several live therapeutic applications, including human cytomegalovirus and allergy prevention; b) for the use of LAB as a novel recombinant protein production system; and c) as a RANTES mutant screening platform. Luca Vangelista Figure 14. Engineering commensal Lactic Acid Bacteria (LAB) to screen new potent RANTES-based anti-HIV-1 CCR5 antagonists, a system prompted to provide live microbicide candidates γδ T CELLS IN INNATE AND ADAPTIVE IMMUNITY Role of γδ T cells in host defense against infections and lymphomas Circulating Vδ2 T cells respond to mycobacteria and certain viruses, while the Vδ1 subset is resident in the mucosal-associated lymphoid tissue and participate in the immunity against intracellular microrganisms. Vδ2 T lymphocytes recognize non-peptidic phosphorylated molecules expressed by mycobacteria, while Vδ1 T cells interact with stress-induced MHC-related antigens (MICA, MICB) and with the ULBPs, receptors for the UL16 protein produced by CMV-infected cells. We showed that Vδ1 T lymphocytes are increased in HIV1 infected patients, express cytoplasmic interferon (IFN)γ and interleukin (IL)17, proliferate and produce both cytokines in response to C. albicans, while Vδ2 T cells respond to mycobacterial phosphate antigens. The IFNγ/IL17 double producer γδ T cells express the Th17 RORC and the Th1 TXB21 transcription factors, bear the CD27 memory T cell marker, the CCR7 homing receptor, the chemokine receptors CCR4 and CCR6 and the CD161 marker of Th17 cells, that mediates transendothelial migration (Blood 2009, 113:6611-6618). We also found that circulating Vδ1 T lymphocytes are increased in patients with CLL and NHL, where they proliferate, produce TNFα,IFNγ or IL4 in response to autologous cells, provided they express MICA or ULBPs (Blood 2007, 109:2078-2085). These ligands can be upregulated in vivo by the use of all-trans-retinoic acid or sodium valproate (Leukemia 2009, 23:642-648). Of note, the number of circulating Vδ1 T cells in CLL and of IL4 producing Vδ1 T lymphocytes infiltrating the lymph nodes in NHL correlates with disease stage and progression. Moreover, they are more resistant to apoptosis due to activation, via NKG2D, of the alternative pathway of NF-κB, leading to transcription and production of Bcl-xL antiapoptotic protein (in preparation). Thus, specifically equipped circulating memory γδ T cells seem to be expanded in different pathological conditions, being preferentially Th1/Th17 or Th2, probably depending on the antigen(s) encountered in lymphoid tissues undergoing infections, chronic inflammation, or malignant transformation. We are investigating the microenvironmental factors driving γδ T cells towards one of these differentiating/effector pathway Maria Raffaella Zocchi 122 - SAN RAFFAELE SCIENTIFIC INSTITUTE IMMUNOBIOLOGY OF HIV Natural immune responses to generate new vaccinal strategies against HIV transmission HIV infection remains a major health burden worldwide and despite efforts and expectations, no effective preventive HIV vaccine is available yet. Our Unit focuses on the structure-immunogenicity applied to the hostvirus relationship. In details, we have analysed and characterized both mucosal and systemic humoral immunity involved in HIV resistance. The last few years have provided documentary evidence of the existence of subjects who, despite multiple exposures to HIV-1, remain seronegative (referred to as ESN). The possibility that some of these subjects may be “spontaneously vaccinated/cured” cannot be excluded, and so the study of their antiviral response may reveal as yet unknown resistance mechanisms that may be reproducible in others. The analyses the immune factors involved in immune controls could be extremely relevant to generate strategies able to prevent and control HIV transmission. CCR5 cellular protein is one the main coreceptors for HIV and CCR5 downregulating immunoglobulins were found in sera and mucosal samples in ESN suggesting a role for such antibodies in controlling viral replication in vivo. Our findings suggest that natural mucosal anti CCR5 antibodies, at mucosal sites, bind receptor and reach CCR5 intracellularly, thus preventing interaction with HIV and subsequent transcytosis. Thus, our research is aimed at creating such immune barrier by targeting the host rather than the virus establishing a durable elimination of CCR5. Proof of principle for this strategy has been provided by our team in mice. Our Unit also focuses to create an immune barrier by targeting the highly conserved regions of gp41, which could be an attractive target to prevent mucosal transmission. These regions are recognized by broad cross neutralizing antibodies which are rarely elicited potentially due to molecular mimicry o self-determinant and thus the immunization is designed to break tolerance and force the immune system in raising such antibodies. Of interest is that, natural HIV neutralizing IgA has been associated to gp41 but not to other viral proteins in ESN. Results from these studies are expected to provide novel direction for the development of durable HIV infection prevention measures not restricted to specific HIV isolates. Lucia Lopalco AIDS IMMUNOPATHOGENESIS UNIT Central theme of our Unit is the regulation of HIV replication by exogenous host factors, primarily of immunological nature. In this scenario, we have been focusing our research primarily on the 4 topics listed below. 1. Role of macrophage polarization in HIV infection. This project explores the potential role of M1 vs. M2 polarization of monocyte-derived macrophages (MDM) infected in vitro with R5 HIV-1 in terms of virus replication. We have observed that both M1 and M2 polarized MDM support less efficiently virus multiplication, although with differences in terms of potency (M1>M2), duration (M2>M1) of the effect and mechanism of action (M1: pre-integration; M2: post-integration). 2. Role of macrophage adhesion in controlling HIV replication. Based on our published papers on the inhibitory effect of urokinase-type plasminogen activator (uPA), we have addressed the role of static adhesion and of integrin-dependent signaling in impeding the release of mature virions from intra-cellular compartments from infected MDM and related cell lines. 3. Molecular pathogenesis of HIV infection, with specific regard to the role of the JAK/STAT signaling pathway, and of STAT5 in particular, in HIV replication. This project is the development of our paper published in 2007 (A. Crotti et al. Blood) in which we demonstrate a direct and functional binding of STAT5 and of its naturally C-terminus truncated variant STAT5∆ to the HIV-1 LTR. In addition, we are pursuing the characterization of a transcriptome derived from primary CD4+ T cells infected with either a CCR5-using (R5) vs. a CXCR4-dependent (X4) HIV infection. 4. Genetic studies in HIV long-term nonprogressors (LTNP). Within a EC-funded consortium (“GISHEAL”), headed by Guido Poli, we have performed a genome-wide association study (GWAS) using an ILLUMINA 550 HapMap platform to identify candidate alleles associated with the LTNP condition. We have indeed identified LTNP-associated regions in HLA Class I, II and III loci. Guido Poli DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 123 BIOCRYSTALLOGRAPHY UNIT Our unit is interested in the structure-function relationship of biological macromolecules, in particular within the processes of immune system recognition of pathogens and host-pathogen interactions. Our activities are primarily focused on three main areas: 1. Target identification and structure-based drug design. We demonstrated that enzymes with nucleoside hydrolase activity are essential for both Trypanosomes (causative agents of tropical neglected diseases) and Stahpylococcus aureus. We determined the crystal structure of both isozymes, and used them as templates for the design of novel compounds that inhibit the enzymatic activity. These compounds are effective in infection models of Trypanosoma brucei, and will be similarly tested against Staphylococcus. 2. Molecular mechanisms involved in T cell and B cell physiology. The APECED syndrome is a genetic autoimmune disease characterized by a loss of central tolerance to self proteins due to lack of their thymic expression, leading to the absence of antigen normally driving the clonal deletion of autoreactive T cells. The disease is caused by mutations in the AIRE gene, coding for a multidomain protein of ~600 amino acids of largely unknown function. We are studying the structure of AIRE using a combination of NMR spectroscopy and X-ray crystallography to shed light on its complex function. The overall goal of the project is to understand the molecular events underlying the expression of antigens in thymic selection, and to broaden our knowledge of the mechanisms of immunological tolerance. 3. Novel molecular tools in cancer suicide gene therapy. We engineered a synthetic fluorouridine-activating enzyme (FAE) that efficiently converts FUR to a cytotoxic metabolite. Expression of the gene in tumoral cells enhances their sensitivity to the prodrug, with EC50 reductions ranging from 50 to 98 % in different cell lines. Subcutaneous tumor models show a reduction in mass and an enhanced survival when subjected to the FAE/FUR treatment. We plan to develop adequate vectors for a tumor selective delivery of the FAE gene, and to demonstrate its efficacy in spontaneous models of neoplastic diseases. This treatment could represent an alternative, lytic approach to the treatment of solid cancers. Massimo Degano Figure 15. Surface representation of the IG-NH from Trypanosoma brucei brucei with the substrate inosine modeled in the active site. Potent, competitive inhibitors of the enzyme take advantage of aromatic stacking interactions with residue Trp80. CELLULAR IMMUNOLOGY UNIT Harnessing the immune system against cancer Our major goal is to achieve a deeper understanding of the molecular events regulating the interactions among transformed cells, their surrounding stroma and the immune system during the different phases of tumor development and progression. This knowledge is then implemented to identify means whereby induce in vivo a therapeutic tumor-specific immune response. Monitoring the immune response against a tumor associated antigen (TAA) in the transgenic adenocarcinoma 124 - SAN RAFFAELE SCIENTIFIC INSTITUTE of the mouse prostate (TRAMP) mice, a primary model of prostate cancer (PC), we have found that spontaneous tumor development and progression associates with the induction of a progressive state of selective immune tolerance. Indeed, tumor-bearing mice still harbor TAA-specific T lymphocytes that no longer respond to a specific vaccination. So far, none of the best-characterized mechanisms of tumor escape [i.e. regulatory T cells (Treg), myeloid derived suppressor cells (MDSC), and inhibitory enzymes] although existing in tumor-bearing TRAMP mice, appeared to be relevant for the induction of TAA-tolerance. Considering the profound state of TAA-specific immune tolerance that associates with PC progression in TRAMP mice, we have hypothesized that alternative therapeutic strategies would be either the combination of active or adoptive immunotherapy with tumor debulking approaches, or a “reload” of the immune system by allotransplantation. Hence, on the one hand we are designing novel strategies that increase synergy between tumor debulking chemotherapy and immunotherapy. On the other hand, we are implementing allogeneic hematopoietic stem cell transplantation and post-transplant tumor-specific vaccination in TRAMP mice. Preliminary data suggest that in both combined therapeutic approaches each single treatment act in synergy with the others. An additional complexity of the TRAMP model is the monitoring of tumor growth. Indeed, prostate masses are detectable by abdominal palpation only in advanced phases of disease. In collaboration with the Department of Nuclear Medicine, we havedeveloped and validated PET imaging as a reliable tool for in vivo assessment of disease biology and progression in TRAMP mice using radioligands routinely applied in clinical practice: [18F]FDG and [11C]choline. Matteo Bellone EMERGING BACTERIAL PATHOGENS UNIT Virulence and molecular epidemiology of drug resistant bacterial pathogens of community and nosocomial origin Tuberculosis (TB): from public health to basic and applied research We target some of the research priority areas in the TB field: new diagnostics for accurate and rapid DRTB diagnosis and biomarkers for vaccine and treatment follow up. We established a European consortium with extensive experience in basic and clinical research on MDR-TB, TB control and epidemiology. TBPANNET and TM-REST FP7grants sustain this project. We implemented the activities of our HSR-WHO TB Supranational laboratory and we are now collaborating with 9 middle-high burden TB Countries world wide. Host’s miRNAs and pathogen’s bacterial smallRNAs play a key role during host-pathogen interaction. We established an in vitro model for M. tuberculosis infection in human macrophages and monocytoid cell lines to characterize host’s miRNAs response during infection. miRNAs expression profile was studied with a Taqman medium-density arrays after infection with antigens and selected MTB strains. smallRNA fraction from the pathogenic Mtuberculosis H37Rv and the avirulent strain Mbovis BCG were sequenced to identify unknown sRNAs in mycobacteria. Validation of candidates by expression analysis and target prediction are in progress. Molecular epidemiology and virulence factors of nosocomial drug resistant pathogens. Global epidemiology of S. aureus methicillin-resistant (MRSA) is evolving and the community-acquired (CA) highly virulent US300-ST8 MRSA clone is the predominant clone in the US and is emerging in Europe. Studying 350 MRSA strains since 2005 we have identified: 1) a significant shift over time from clones bearing the scc mecI to clones with scc mec IV; 2) two predominant clones, ST22 (EMRSA15) and HSR1 (Italian); 3) toxigenic US300 related strains causing severe infections. We are studying the expression of virulence factors in those clones. C. difficile associated-colitis is increasing in nosocomial settings and highly virulent strains are spreading worldwide. C. difficile strains from symptomatic patients were fully characterized for virulence factors and we showed the presence of epidemic strains with mutation/deletion in the tcdC gene coding for the negative regulator of toxinA/B. We are now investigating the association of virulence to mutations conferring antibiotic resistance. Daniela Maria Cirillo DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 125 EXPERIMENTAL IMMUNOLOGY UNIT We aim at gaining mechanistic insights into three aspects of the immune response that have direct relevance to human health. 1. Development and function of CD1-restricted, lipid antigen-specific T cells. CD1d-restricted invariant (i)NKT cells are a unique subset of T lymphocytes with innate effector functions whose development relies on a distinct genetic program. We have shown that this program includes miRNAs and identified an iNKT cell-specific miRNA signature. We are characterizing the molecular pathways regulated by selected miRNAs. Following up our identification of the adjuvant function of iNKT cells for vaccine responses, we have defined a second mechanism by which iNKT cells can provide help to vaccine-specific B cells, which relies on direct cognate interactions. We have also gained further insights into the mechanisms by which mouse iNKT cells control prostate cancer in the TRAMP mouse transgenic model. A second type of CD1 restricted T cells recognizes endogenous lipid antigens presented by CD1a, b, c. We are testing the hypothesis that lipids synthesized by malignant cells may stimulate this T cell response. We have identified a self-lipid molecule extracted from leukemia cells that stimulate CD1-restricted T cells, and we are characterizing this T cell response in patients. 2. Tumor-specific CD4+ T cell responses. We are optimizing the use of HLA-DR1101 tetramers to investigate the CD4+ T cell response specific for natural promiscuous epitopes derived from the frequent shared tumor antigen MAGE-3. Our study reveals the critical importance of the epitope binding registers into HLA-DR groove to generate functional HLA-DR tetramers. 3. Immunogenicity of the mutated tumor antigenome. We are testing the hypothesis that somatic mutations in colorectal cancer genes (CRC CAN-genes) generate strongly immunogenic antigens and specific immune responses in patients. By next generation sequencing of the 40 most frequently mutated CAN-genes we are generating the atlas of unique or recurrent somatic mutations in 10 CRC samples. The immunogenicity of synthetic peptides encompassing the CAN-gene mutations is being investigated with T lymphocytes from patients or healthy HLA-matched controls. Paolo Dellabona IMMUNOPATHOLOGY UNIT Host-Virus interactions in the pathogenesis of viral hepatitis and viral hemorrhagic fevers The hepatitis B virus (HBV) and hepatitis C virus (HCV) are noncytopathic viruses causing acute and chronic hepatitis of variable duration and severity. Over 700 million people worldwide are chronically infected by these viruses and about 2 million of them die each year from the complications (i.e. cirrhosis and hepatocellular carcinoma, HCC) of these infections. The main objective of our research is to define the cellular and molecular mechanisms responsible for viral clearance and disease pathogenesis during HBV or HCV infection with the expectation that our results will help to devise new therapeutic approaches to prevent and cure these diseases. Our hepatitis program takes advantage of infected patients, unique mouse models of infection and new technological advances in the field of live imaging, tackling a number of unresolved issues that comprise the means by which virus-specific T cells traffic and recognize viral antigens within the liver and how such processes are affected by the anatomical and hemodynamical changes that characterize the complications of chronic HBV infection. Having recently described a novel role for platelets in the pathogenesis of viral hepatitis (i.e. activated platelets contribute promote the recruitment of virus-specific T cells into the liver), we are also currently dissecting the molecular basis of platelet/CTL interactions and the impact that pharmacologic inhibition of platelet activation may have on the severity of immune-mediated chronic liver injury and HCC development. In related studies aimed at testing the role of platelets in the pathogenesis of viral hemorrhagic fevers, we found that mice infected with different isolates of hemorrhagic arenaviruses develop a mild hemorrhagic anemia, which becomes severe and eventually lethal in animals depleted of platelets or lacking integrin β-3. Lethal hemorrhagic anemia is mediated by virus-induced interferon (IFN)- α/β that causes platelet dysfunction, mucocutaneous blood loss and suppression of erythropoiesis. Further, platelet-depleted mice fail to mount an efficient T cell response and do not clear the virus. These studies indicate that IFN- α/β is required and sufficient to cause the platelet dysfunction and the mechanism of this action is currently under investigation. Luca G. Guidotti 126 - SAN RAFFAELE SCIENTIFIC INSTITUTE LYMPHOCYTE ACTIVATION UNIT On the cellular and molecular mechanisms controlling adaptive T cell immunity Our goal is to gain a deeper understanding of the cellular and molecular mechanisms at the basis of adaptive immunity, with emphasis on the role of CD4+ T lymphocytes in the establishment of immunological memory and/or peripheral tolerance to tumors. We combine single cell-based in vivo analyses of T cell function with in vitro biochemical and molecular characterization of the cells. We have developed several mouse models allowing the tracing of antigen- and tumor-specific CD4 and CD8 T cells in lymphoid and non lymphoid tissues. At present we are focusing on: 1) the analysis of tumor-specific immune responses in mice with spontaneous and transplantable tumor diseases and in the contest of active and adoptive immunotherapy, and 2) the definition of the role of mTOR-dependent pathways in T cell tolerance and differentiation. Ongoing scientific activities include: • The study of the cooperation between minor histocompatibility antigen- and tumor-specific immunity in rejection of advanced prostate cancer in TRAMP mice. (R. Hess-Michelini, T. Manzo, M. Freschi, V. Basso, M. Bellone and A. Mondino, 2010). • The exploitation of transient TCR/CD28/IL-7 stimulation for the expansion of undifferentiated memory CD4+ T cells. This has implication for adoptive cell therapy optimization. (V. Basso and A. Mondino, in preparation) • The study of dendritic cell-based vaccine immunogenicity in the context of allotransplantation. We found that potent tumor-specific T cell priming can be induced in spite of concurrent potent minor histocompatibility antigen-specific responses. (T. Manzo, R. Hess-Michelini, V. Basso, J-G Chai, M. Bellone and A. Mondino, submitted) • This analysis of TSC-1 and mTOR in T cell biology. We find that TSC-1/mTOR-dependent signaling are central to T cell development and the acquisition of transcriptional competence at genes involved in lineage determination. (R. Tomasoni, V. Basso, S. Colombetti and A. Mondino, submitted) Anna Mondino TUMOR IMMUNOLOGY UNIT Role of tumor antigen specific CD4+ T cells in tumor regression or promotion Evidence for a role of CD4+ T cells in the antitumor immune response is established. However, along with pro-inflammatory (Th1) anti-tumor immunity, it is now clear that CD4+ T cells may also exert regulatory and anti-inflammatory (Th2) functions, eventually leading to tumor promotion through still not completely known mechanisms. We set a strategy to study the quantity and quality of naturally occurring tumor antigen (TAA)specific CD4+ T cells in patients with cervical and pancreatic cancer. Cervical lesions (CIN) are associated with infection by HPV. We focus on HPV-18 and found that low frequency of CD4+ T cells specific for the E6 and E7 proteins are present in the majority of HPV-18+ CIN patients. Surprisingly, we also found HPV-18-specific CD4+ T cells in 50% of patients tested, irrespective of the presence of HPV-18 in their lesions, suggesting that the HPV-18- responsive patients might have cleared the infection. In agreement with this hypothesis, we found that a robust Th1/Th2 immune response against E7 but not E6 was associated with the HPV-18- status. On the contrary, a robust Th1/Th2 immune response against E6 but not against E7 correlated with lack of relapse. Our data demonstrate a positive role for anti-HPV-18 E6 and E7 CD4+ T immunity in CIN patients. Pancreatic cancer (PC) is a very aggressive disease with dismal prognosis; peculiar is the tumor microenvironment characterized by an extensive fibrotic stroma, which is believed to favor tumor progression. We previously reported a TAA-specific CD4+ Th2 immune-deviation in PC patients that correlated at the tumor site with a predominant GATA-3+ over T-bet+ lymphoid infiltrate. We are currently testing the hypothesis that factor(s) present in the tumor microenvironment activate dendritic cells with Th2 polarizing capability that in the draining lymph nodes would prime TAA-specific CD4+ Th2 cells. These cells will then home to the tumor, under the influence of Th2 attractant chemokines, where they would exert effector functions on other immune cells with the activation of a cascade of events affecting immune and tumor cells and further contribute directly by Th2 cytokine secretion to fibrosis, which is a hallmark in pancreatic cancer. Maria Pia Protti DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 127 VIRAL EVOLUTION AND TRANSMISSION UNIT Antigenic and phenotypic characterisation of HIV-1 variants in transmission and disease progression as target for vaccine development The intestinal mucosa is the main portal of entry of HIV-1 via all routes of transmission, and the site of major immune subversion early after infection. HIV-1 was shown to transcytose through the epithelial intestinal mucosal layer but the pathways taken by the virus are still only mere speculation. Our results support the hypothesis that dendritic cells (DCs) mediate HIV-1 transmission from the lumen through the intestinal mucosa with a process similar to bacterial sampling via a virus envelope-mediated mechanism with preferential transmission of specific viral phenotypes to the underlying target cells. The cellular and molecular mechanisms driving the migration of HIV-1 through the intestinal epithelial barrier may be possible targets for mucosal vaccines. DCs mediating HIV-1 transmission may have important implications for inducing innate, non-specific defences and promote adaptive immune response though to different degree in different intestinal sites. Indeed, in our experimental set-up DCs conditioned with epithelial cell-released factors change phenotype, and in turn restrict viral replication. Understanding the cellular cross-talk and the type of immune responses promoted, will provide useful information on how to achieve an efficient anti-HIV immune responses in vivo. Production of an broad neutralizing antibody (Nab) against multiple HIV-1 variants is a desired characteristic for HIV vaccines. We showed that those individuals who do control the disease progression (Long-term non progressors) and/or control naturally the virus (Elite controllers) have mainly antibody against their own virus but not cross-reacting against heterologous viruses, and thus are not of major interest for vaccine research. Instead our recent results indicated that an antibody response can raise shortly after infection and does not need to follow the expected pattern of viral escape. The exquisite strong sensitivity of these viral variants to known cross-reactive monoclonal antibodies make them an excellent antigen for vaccine development Gabriella Scarlatti VIRAL PATHOGENS & BIOSAFETY UNIT Virus-host interactions: Human Immunodeficiency Virus (HIV), SARS Coronavirus (SARS-CoV) and Influenza viruses HIV. We have been studying HIV-infected individuals who naturally control HIV-1 infection maintaining a healthy clinical state without the use of antiretroviral drugs (defined as LTNP). Among the nine HIV genes, the integrity, variability and function of vif accessory gene have been analyzed in LTNP. Since most of HIV genes exploit and manipulate cell host proteins, we are currently concentrating on host cell factors that restrict HIV infection. In particular, we are interested in the role of the member 22 of the TRIparite Motif protein family (TRIM22) on HIV replication. Previous observations have shown that overexpression of TRIM22 restricts HIV infection. We have identified a model of U937 cell subclones in which TRIM22 endogenous expression correlates with poor HIV replication. Current studies are ongoing to define the precise mechanism of TRIM22 restriction. A CoV is the etiological agent of the Severe Acute Respiratory Syndrome (SARS). Although the virus primarily infects the lungs, however, SARS-CoV causes a systemic infection since the virus has been found in blood, urine and stool. We have been particularly interested in the kidney and intestinal tropism of the virus and identified human kidney cell lines that support SARS-CoV persistent infection. Such an infection leads to viral adaptation sustained by the emergence of a single point mutation in the viral membrane glycoprotein that increases SARS-CoV replication in vitro and contributes to enhance its cytopathicity in a mouse model of SARSCoV infection. We have also identified the intestinal cell lines that supports SARS-CoV productive infection. Influenza viruses. A currently believed dogma assesses that avian influenza viruses of H5, H7 and H9 subtypes have the potential to be passed from animals, whether domesticated or wild, to humans. In contrast, H1 and H3 subtypes are devoid of such danger since the human population is endowed with cross-neutralizing antibodies raised during seasonal infection and/or vaccination. By screening a panel of sera obtained from healthy volunteers who have responded to the seasonal influenza vaccine, we have demonstrated that humans do not have cross-reacting antibodies against contemporary avian viruses raising concerns on future pandemic influenza. Elisa Vicenzi 128 - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units MANAGEMENT AND ANTIRETROVIRAL TREATMENT OF HIV INFECTION The Clinical Trial Unit (CTU) is a clinical research unit within the Department of Infectious Diseases, San Raffaele Hospital, focused on addressing clinically relevant questions that may improve HIV patient care. The activities of this unit are mainly concentrated on two areas: cohort studies and clinical trials. As for the Cohort Studies, CTU participates to several national and international networks of HIV cohorts (ICONA, ARCA, NEAT, EuroSida, D:A:D, COHERE, EURO CHAVI) collecting large amount of data on HIV patients and addressing scientific questions (prognosis and outcome of adults HIV-infected subjects) that single cohorts cannot answer individually. To be part of these collaborations, our internal database (the Infectious Diseases Database (IDD-HSR)) is regularly updated by fully-dedicated resources. Moreover, CTU uses data from IDD-HSR for its own clinical studies mainly focused on long-term comorbidities associated with HIV infection and antiretroviral treatment such as diabetes, cancer, osteoporosis. As for the Clinical Trials area, CTU is involved in the conduction and coordination of national and international industry sponsored phase II-IV clinical trials contributing to the: • registration of new antiretroviral compounds, • organization of early access program of experimental drugs for patients with limited therapeutic options. CTU is also actively involved in proposing, coordinating and conducting investigator-driven independent, no-profit, randomised and non-randomised clinical studies and committed to develop spin-off projects on new strategies in salvage therapy. In 2009, CTU activities were concentrated on the conduction of clinical studies providing insights on: 1) salvage strategies in patients resistant to all the standard therapies; 2) holding regimens in failing patients without therapeutic options (T20 recycling, lamivudine monotherapy). Antonella Castagna NEUROVIROLOGY Viral infections of the Central Nervous System (CNS): HIV infection of the CNS and Progressive Multifocal Leukoencephalopathy (PML) The importance of HIV CNS infection in the current era of suppressive antiretroviral treatment relates to the role of the CNS as virus reservoir and the concern that persistent CNS immuneactivation may lead to neurocognitive impairment. We have observed a 42% frequency of neurocognitive impairment in treated and virologically suppressed patients with nadir CD4 cells PML is a progressive demyelinating disease caused by JCV infection of oligodendrocytes. The mechanisms of JCV reactivation leading to PML in patients with compromised immunity are mostly unknown. By sequencing the JCV non coding control region (NCCR), we have identified identically highly “rearranged” patient-specific sequences in CSF and plasma pairs, but not in urine, of PML patients. By sequencing the viral capsid protein-1 (VP1) coding gene we have identified mutations and deletions in both CSF and plasma of >90% of PML patients, but not in urine, corresponding to aminacid substitutions at critical sites for JCV binding to sialic acid residues of the cell receptor, suggesting that, during reactivation, the virus may acquire adaptive mutations within the patient that are associated with increased neurotropism. We have also characterized the CD8 T cell responses by IFN-γ Elispot in both healthy subjects and PML patients, and identified an immunodominant HLA-A*02-restricted JCV-VP1 epitope. By studying the IgG response against JCV-VP1, PML patients had low antibody titres compared to immunocompromised controls. Altogether, the combined study of T and B cell responses could thus provide a tool to recognize persons at risk to develop PML. Paola Cinque DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 129 STUDY AND TREATMENT OF HEPATOTROPIC VIRUSES RELATED DISEASES Treatment strategy against HCV in HIV/HCV coinfected individuals: HAART simplification, mechanism of viral resistance to anti-HCV treatment Current standard of treatment for hepatitis C virus infection (HCV) in HIV negative and positive individuals involves a combination of pegylated-interferon-α (Peg-IFN) and the nucleoside analogue ribavirin. The efficacy of this combination is limited especially for genotype 1 infection for which less than one half of subjects achieve sustained eradication of viremia. In HIV infected patients, chronic hepatitis C affects one third of HIV positive individuals. These patients are less prone to maintain a sustained virologic response to anti-HCV treatment respect to HCV monoinfected individuals. The frequency of adverse events during anti-HCV treatment is increased by concomitant highly active antiretroviral treatment (HAART). Additionally, HCV infection limits HAART treatment because liver toxicity is more frequent in this setting. On the basis of this multifaceted scenario, we decided to focus two important issues: to improve the response to anti-HCV treatment in an intent to treat fashion, to investigate the mechanism of viral resistance to antiviral treatment. We performed a prospective randomized study (KAMON 2) aimed to simplify HAART during standard anti HCV treatment. This study demonstrated that simplification of HAART (one drug arm vs. HAART arm) during 48 weeks anti-HCV treatment was effective as standard HAART treatment and response to anti-HCV treatment did not differ between patients included in the two arms. The anti-HCV treatment response in HIV/HCV infected patients is lower than in HCV monoinfected ones. This clinical evidence may be related to immune competence and unknown factors. To determine the temporal dynamics of HCV infecting genotype in HIV/HCV infected patients under anti-HCV treatment and their role in the treatment response was performed the molecular analysis of HCV viral strains in collected plasma samples of Kamon 2 study. A different virologic profile was shown between sustained virological responders (SR) and non responders (NR) to anti-HCV treatment: SR were infected by a single HCV genotype, while NR were infected with more than one genotype, suggesting that viral resistance in HIV/HCV coinfected patients is not only associated with infecting HCV genotype per se but also with the presence of a mixed HCV infection. Caterina Uberti-Foppa VACCINE AND IMMUNOTHERAPY Recombinant human interleukin-7 in HIV immunological non-responders to conventional antiretroviral therapy HIV infection is characterized by depletion of CD4 T cells and altered immune function, leading to severe immune deficiency. CD4 cell depletion is the hallmark of HIV infection and occurs as a consequence of direct viral replication and resulting cytolysis and apoptosis, but also as part of a general activation induced cell death. The CD4 count is, with the HIV viral load, the strongest predictor of subsequent disease progression and survival. An adequate CD4 response for most patients on therapy is defined as an increase in the range of 50–150 cells/µL per year with an accelerated response in the first 3 months of treatment. From 25% to 30% of HIV–infected patients who are receiving long term highly active antiretroviral therapy do not exhibit a marked increase in the CD4 T cell count leading to an absence of recovery in the CD4 count, despite achieving complete suppression of the HIV load. These patients are referred to as “immunological nonresponders.” Apart from antiviral therapy for the infection, immunotherapies such as interleukin-7 (IL-7) that influence Tcell homeostatic mechanisms are undergoing clinical evaluation. Because of its pleiotropic effects on developing and mature T cells, IL-7 may help to restore immune function during HIV infection. At least 2 potential indications of rhIL-7 should be explored. Both correspond to unmet medical needs: to rescue patients who experience immunological failure on HAART. First IL-7 will likely improve recovery of CD4 T-cells in patients who remain lymphopenic under HAART, while HIV replication is at least partly suppressed. Despite recent progress, morbidity and mortality of these patients remain higher than in patients who restore better their cell immunity. Second, this cytokine can be use to overcome the usual limitations of 130 - SAN RAFFAELE SCIENTIFIC INSTITUTE HAART, observed in nearly all treated patients (i.e. the persisting insufficiency of the anti HIV T-cell response, relatively toxic) The clinical research activity of Vaccine and Immunotherapy Research Center is currently focused on the conduction of multicentric, internantional phase I clinical trials employing IL-7 as immunotherapy on HIV positive patients with poor CD4 recovery under conventional antiretroviral therapy. GiuseppeTambussi CLINICAL IMMUNOPATHOLOGY AND ADVANCED MEDICAL THERAPEUTICS UNIT Our interest focuses on the immunological features of systemic inflammatory diseases, with specific attention to the identification of novel diagnostic and predictive markers of disease and disease activity, and to the dissection pathogenic mechanisms involved. We are specifically interested in: • the pathogenesis of the prototypic systemic autoimmune disease, Systemic Lupus Erythematosus, with particular regard to the processes leading to kidney damage and pregnancy complications; • the role of neuroendocrine mediators in vessel inflammation. In particular, we are carrying out a rather comprehensive analysis of the factors underlying the enhanced cardiovascular risk of patients with sustained systemic inflammation; • the immunopathogenesis of fibrosis and vascular damage in scleroderma and possible novel therapies; • novel approaches in diagnosing and treating systemic vasculitides; • the cytokine and chemokine network underlying the recruitment and activation of cells in systemic histiocytoses; • the mechanisms of actions of biological agents used for the treatment of immune-mediated diseases (cytokines & anti-cytokines, monoclonal antibodies). Maria Grazia Sabbadini CLINICAL TRANSPLANT UNIT Metabolic impact of portal venous drainage in pancreas transplantation The veins of a transplanted pancreas are usually anastomozed to the external iliac vein of the recipient, leading to peripheral insulin secretion, while in physiological setting insulin is secreted within the portal system. This leads to peripheral hyperinsulinization, a condition that was reported to be atherogenic. Pancreas transplantation can be performed with portal venous drainage, but requires a more complicated surgical procedure. Furthermore portal drainage of the transplanted pancreas was considered less immunogenic than systemic drainage. The aim of this study is to evaluate the endocrine-metabolic impact and rate of rejection of portal venous drainage in patients undergoing pancreas transplantation, compared to systemic venous drainage. Open-label single center study comparing the efficacy and safety of tacrolimus vs cyclosporin in simultaneous kidney-pancreas transplantation. The aim of the study is to evaluate the impact on patient survival, graft survival, rate of rejection, rate of complications and metabolic control of Cyclosporin vs Tacrolimus in kidney-pancreas transplantation. Transplant Immunology The transplant immunology activity is developed in collaboration with the Harvard Medical School in Boston, US, in the context of the Transplantation Research Center at Children’s Hospital and it is coordinated by Paolo Fiorina M.D. The Lab is focused on two major topics: 1. the regulation of anti pancreatic islet response both in term of autoimmunity versus self antigens in type 1 diabetes and in term of alloimmunity in allogeneic islet transplantation. DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 131 Potential clinical application guides the development of our protocols. In particular it has been analyzed: 2. a. B cell role and effect of depletion trough anti-CD22 immunotoxin on type 1 diabetes development and anti-islet response maintenance. b. Use of a combination treatment based on murine Thymoglobulin and CTLA4-Ig to modulate islet rejection in NOD mice and to promote diabetes reversal. c. Immunotherapy of diabetes trough the use of mesenchymal stem cells. Use of new strategies to prevent or halting the curse of chronic rejection. Starting from the new murine model available in our Lab (the bm12 into B6 minor mismatch model) we have developed new strategies with a high translational aim. Particularly, we are testing the effect of mobilizing endogenous hematopoietic stem cells by targeting CXCR4-CXCL12 axis. These progenitors are known for their regenerative and immunological properties. We will take advantage of these characteristics to abrogate the ongoing sub-acute alloimmune response evident in chronic rejection, as well as we will benefit from their regenerative ability to repair damaged kidney. Antonio Secchi GYNECOLOGICAL CANCERS IMMUNOLOGY Human PapillomaVirus (HPV) and cervical cancer Main field of investigation of the Clinical Research Group is the correlation between Human Papillomavirus (HPV) and the onset of cervical cancer. It is widely demonstrated that HPV infection is the causal factor for neoplastic transformation of cervical cells; throghout viral DNA integration into cellular nuclei and viral protein expression, preneoplastic lesions (CIN) progress to invasive cancer. In cooperation with the Tumor Immunology Unit we focused on HPV-18 and found that low frequency of CD4+ T cells specific for the E6 and E7 proteins are present in the majority of HPV-18+ CIN patients. We also found HPV-18-specific CD4+ T cells in 50% of patients tested, irrespective of the presence of HPV-18 in their lesions, suggesting that HPV-18- responsive patients might have cleared the infection. Consistent with this hypothesis, we found that a robust Th1/Th2 immune response against E7 but not E6 was associated with the HPV-18- status. On the contrary, a robust Th1/Th2 immune response against E6 but not against E7 correlated with lack of relapse. Our data demonstrate a positive role for anti-HPV-18 E6 and E7 CD4+ T immunity in CIN patients. In a recent study we found a significantly higher relapse rate of preneoplastic lesions (CIN2 - CIN3) after surgical treatment in cases with reduced CD4,CD8,CD11C,T-bet and GATA-3 in the cervix. On the other side, high levels of CD4+ and GATA-3+ in cervical tissues correlate with disease regression. These data strenghten the tight correlation between immune response and HPV-related carcinogenesis. Ongoing research projects deal with: • Morphological study of cervical immune cells populations (mucosal immunity); • Early biomolecular HPV 16-18 diagnosis and identification of “at risk” patients; • HPV DNA identification as screening tool for cervical “high grade” lesions; • Quantitative analysis of cervical immune sub-populations and correlation with HPV and HIV genital infection. Massimo Origoni IMMUNOLOGY IN LIVER NEOPLASMS Evaluation of stress response in hepatobiliary surgery for liver neoplasms The research programs of the Hepatobiliary Unit of the Department of Surgery are focused on the technical aspects as well as the biological effects of the hepatic resections for liver neoplasms. In this setting, several studies are ongoing to reach the goals of optimizing the surgical techniques to minimize the biological postoperative stress in terms of clinical outcome, inflammatory profile, and immunosuppression. A prospective study (case-matched analysis) has been performed to investigate the short term outcome in pa- 132 - SAN RAFFAELE SCIENTIFIC INSTITUTE tients undergoing laparoscopic and open liver resections, in terms of clinical outcome, inflammatory profile and coagulation homeostasis. Thirty-two (=32) patients undergoing elective hepatic resections have been enrolled in the study. Sixteen (=16) patients were non randomly assigned to the laparoscopic approach (LPS group), while the further 16 to the traditional open procedure (LPT group). The two groups were matched for the extent of resection, and then for further parameters such as age, gender, preoperative liver function, tumor histology and size, and ASA score. We collected information about several indicators of postoperative clinical outcome, such as operating time, intraoperative blood losses and blood transfusions, tumor exposure at the transection surface and minimal surgical margin, hospital stay and overall morbidity rate, postoperative analgesic therapy, mobilization recovery time and fasting duration.. We obtained plasmatic samples (collected preoperatively, in 1st, 2nd and 5th postoperative day) for the liver function assessment, measuring the Aspartate Aminotranspherase (AST), Alanina Aminotranspherase (ALT) and Total Bilirubin (BIL) levels. Moreover, we determined the serum levels of white blood cells count (WBC), C-reactive protein (CRP), Interleukin-6 (IL-6) and Tumor Necrosis Factor (TNF) as markers of the inflammatory surgical stress response. Finally, we evaluated the coagulation homeostasis measuring the serum levels of several parameters, such as prothrombin time (PT ratio), platelets count (PLT), fibrinogen (FG), antithrombin III (ATIII) and fibrin Ddimer (XDP).Postoperative plasma levels of AST, ALT, WBC, CRP, IL-6, PT and XDP, along with blood losses, blood transfusions rate, analgesic therapy amount, fasting duration, mobilization recovery time and overall morbidity showed a lower rise in LPS group compared to LPT group. The decrease of PLT, ATIII and FG levels was lower in LPS group than in LPT group. The laparoscopic technique for hepatic resections results in improved clinical outcome, lower inflammatory stress response and lower coagulation alterations. Luca Aldrighetti PANCREATIC TUMORS: IMMUNOTHERAPY AND ß CELL FUNCTION SUBSTITUTION During 2009 the Unit of Pancreatic and Endocrine Surgery has focused its clinical research on pancreatic tumors. Surgical procedures performed represent the source of data and material necessary for every type of investigation and research. Pancreatic cancer is a very aggressive disease with poor prognosis. Peculiar is the tumor microenvironment characterised by an extensive fibrotic stroma which favors rapid tumor progression. A key-point is the assessment whether the Th2 polarisation of CEA-specific CD4 T cells from pancreatic cancer is stable or can be reverted by immunomodulating cytokines. We found that only the combination of IL-12 and IL-27 modified the polarisation of Th2 effectors by both reduction of IL-5, GM-CSF and IL-13 and induction of IFN-γ production, which lasted after cytokine removal. Moreover, the combined treatment functionally modulated the Th2 polarization of CEA-specific CD4 T cells and enhanced pre-existing Th1 type immunity. The present results demonstrate that tumor antigen specific Th2 CEA-specific CD4 T cells in pancreatic cancer are endowed with functional plasticity. Hence, loco-regional cytokines delivery or targeted therapy based on antibodies or molecules directed to the tumor stroma might improve anti-tumor immunity and ameliorate fibrosis without systemic toxicity. Valerio Di Carlo CLINICAL HEPATO-GASTROENTEROLOGY Manipulation of the gut microbiota in the management of chronic intestinal disorders The role of the gut microbiota in promoting and maintaining intestinal inflammation is now well recognized. Antibiotics such as ciprofloxacin and metronidazole can be effectively employed in the treatment of inflammatory bowel disease, but side effects are common. Both non-adsorbable antibiotics such as rifaximin and probiotics can represent a safer alternative. Probiotics have been tested in the treatment of ulcerative colitis and Crohn’s disease (both in the acute phase and in the DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 133 maintenance of remission) with variable but promising results. The choice of the specific probiotic agent to is a critical point because the mechanism of action of the various Lactobacillus strains, Bifidobacteria or yeasts such as Saccharomyces boulardii is quite different. To further our previous published experience in this area, we are currently evaluating the precise role of single probiotic agents, probiotic mixtures and rifaximin in the short- and long-term treatment of chronic intestinal disorders both of overt inflammatory nature (ulcerative colitis and Crohn’s disease) and where microscopic inflammation may have a pathogenetic role (microscopic colitis, irritable bowel syndrome). Moreover, in co-operation with the recently established Probiotic Association (a multidisciplinary national society including gastroenterologists, paediatricians and microbiologists) we are endeavouring to identify and develop proper study protocols in order to evaluate the efficacy of probiotic agents in clinical trials carried out according to a correct methodology able to generate sound evidence-based data. Mario Guslandi TRANSPLANT SURGERY The Area of Transplant Surgery focused its clinical research on Simultaneous Pancreas and Kidney Transplantation and Pancreas Alone Transplantation in IDDM patients regarding the following three fields: a) effect of pancreatic transplantation with portal delivery of insulin secretion; b) effect of immunosuppressive protocols on pancreas alone transplantation; c) efficacy of pancreas from pediatric donors to cure diabetes. a) 25 patients underwent to pancreas transplantation with portal delivery of insulin secretion. Survival of the pancreas was 82% and 63% at 1 and 5 years, respectively. Homa B% values which represent insulin delivery and insulin sensitivity recipients was no significantly different between patients with portal drainage transplant and normal individuals. b) From 2004 38 Pancreas transplantation alone have been performed; all of them received the whole organ with enteric diversion of exocrine secretion, 8 with portal-venous and 20 with systemic-venous graft drainage. Two regimens of immunosuppressive therapy were used: in 2004 it was prednisone, mycophenolate mofetil, ATG (Anti-thymocyte globulin) and cyclosporine A, while from 2005 to 2009 was prednisone, mycophenolate mofetil, ATG and tacrolimus. Cyclosporine A group included nine patients while tacrolimus group included nineteen. 1 year graft survival was 55% in the cyclosporine A group while it was 80,7% in the tacrolimus group (p 0.12); after 5 years, graft survival was 33% in the cyclosporine A group and 72,7% in the tacrolimus group (p 0.062). c) Pediatric donors could represent a novel source available for pancreas transplantation. From 2006 13 IDDM patients received pancreas transplants from pediatric donors (age between 12 and 17 years). After 1 year, patients survival rate is 92%, while pancreas graft survival is 61,5%, 40% for portal and 75% for systemic drainage. 2 patients with portal drainage developed graft thrombosis and one interrupted immunosuppressive therapy because of the onset of Moskowitz syndrome. 1 year after the operation mean HgbA1 was 4,9 (range 4,6 to 5,4) %; during OGTT mean basal glucose was 81,9mg/dl and mean basal insulin was 9,1 µU/ml, at 120 minutes mean glucose was 88,3mg/dl and mean insulin was 42,4 µU/ml. Carlo Socci 134 - SAN RAFFAELE SCIENTIFIC INSTITUTE DIABETES RESEARCH INSTITUTE (DRI) Director: Luca G. Guidotti Associate Director: Emanuele Bosi* Introduction by the Directors Type 1 diabetes (T1D) afflicts nearly 150,000 people in Italy, most of them children or young adults. Untreated, T1D is a fatal disease. Exogenous insulin, administered by multiple injections or by a continuous subcutaneous infusion from an external pump, allows long-term survival in those who develop the disease, and most who are treated in this way will have a very good health-related quality of life. However, insulin therapy does not provide normal glycemic control, and long-term survivors commonly develop vascular complications such as diabetic retinopathy (the most common cause of adult blindness) and diabetic nephropathy (the most common indication for adult kidney transplantation). Luca G. Guidotti T1D results from the body’s inability to produce insulin, a hormone that is needed to convert glucose into energy and regulate metabolism. The cause of insulin deficiency is the immune-mediated destruction of insulin producing β-cells located within the islets of the pancreas. The cellular and molecular determinants mediating this autoimmune process are still largely unknown. Over the last 3 decades T1D has been one of the most relevant single areas of interest for patient care and research at the San Raffaele Scientific Institute. With the objective of reinforcing and expanding its commitment on diabetes research and care, in late 2007 a specialized and independent Research Institute entirely devoted to T1D, denominated Diabetes Research Institute (HSRDRI), was launched at San Raffaele. HSR-DRI is part of the International DRI federation (DRI-NET), which includes 12 other DRI’s around the world. HSR-DRI has an Executive Committee (Maria Grazia Roncarolo, Emanuele Bosi, Luca G. Guidotti, Alessandro Del Maschio, Antonio Secchi) and a Scientific Advisory Board (Guido Pozza, Camillo Ricordi, Giuseppe Chiumello, Massimo Trucco) and is composed of five Units of Basic Research and four Groups of Clinical Research. The Institute collaborates with nine groups of Basic Research (E. Bonifacio, Uni-Dresden; M. Von Herrath, Uni-San Diego; M. Atkinson, Uni-Gainesville; P. Fiorina, Harvard; S. Gregori, Tiget; R. Bacchetta, Tiget; G. Zerbini, M. Lorenzi, V. Lampasona, HSR), six external Units of Clinical Research (C. Ricordi, Miami; A. Ziegler, Uni-Munchen; F. Bertuzzi, Niguarda, Milan; PM. Piatti, G. Perseghin; M. Venturini HSR) and three external Cores (L. Monti, HSR; E. Bazzigaluppi, Laboraf; A. Sanna, LaboRaf), which closely interact with HSR-DRI scientists and actively contribute to the scientific progress of the Institute. The overall objective of HSR-DRI is to prevent and cure T1D. To achieve this objective, two specific programs are pursued, both of which take advantage of patients and animal models: • Prediction and prevention of T1D: this program aims to define mechanisms of Emanuele Bosi DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 135 induction and perpetuation of autoimmunity and at developing strategies for halting/reverting the progression to T1D. • β cell replacement and cell therapy in T1D: this program aims to develop novel immune tolerance-inducing, immunosuppression-lightening and islet-regeneration therapies to prolong the survival of native and/or transplanted β cells. Research Units IMMUNE TOLERANCE Immunological tolerance in autoimmune type 1 diabetes: from problems toward solutions Aims: Type-1 diabetes (T1D) is a chronic disorder mediated by self reactive cells that invade the pancreas and destroy the insulin-producing cells. Peripheral tolerance results from a fine tuned balance between pathogenic T cells and regulatory T cells (Tregs). Our goals are to: (1) characterize the immune responses occurring in the target organ of T1D patients; (2) define new clinical grade protocols for the ex vivo expansion of human Tregs; and (3) identify new therapies for re-establishing tolerance in pre-clinical animal models of T1D. Achievements: (a) Pancreatic lymph nodes (PLN) were collected from T1D patients who underwent pancreas transplantation and were characterized phenotypically and functionally. We observed that FOXP3+ Tregs of T1D patients are functional when they circulate in the peripheral blood but, within the site of auto-inflammatory drainage, they are environmentally modified towards a helper/effector phenotype despite being epigenetically imprinted to promote tolerance. (b) We previously demonstrated that rapamycin selectively expands ex vivo Tregs while impedes the expansion of effector T cells. New studies have now delineated a good manufacturing practice (GMP) protocol for rapamycin-based human Tregs expansion Finally, (c) we showed that cell therapy with Ag-specific Tr1 cells induced an IL-10–dependent tolerance in a stringent mouse model of islet transplant. The therapeutic advantage of donor-specific Tr1 cells was due to their antigen-specificity. Conclusions: (1) T1D patients do have Tregs in their target organ but they are unfit. It is still unknown whether this finding is a cause or a consequence of the autoimmune disease. However, even if Tregs are not a part of the problem they could still be part of the solution and treatments targeted at re-fitting Tregs may represent a solution for patients affected by T1D. (2) The definition of a GMP-grade protocol for the FOXP3+ Treg expansion provides an additional justification for their clinical use. (3) The antigen-specific requirements for Tr1 cells strongly point to the definition of clinical grade protocols for the generation of antigen-specific human Tr1 cells to be used as cell therapy in T-cell–mediated diseases. Manuela Battaglia EXPERIMENTAL DIABETES Pathogenetic mechanisms of autoimmune type 1 diabetes Our research is focused on characterizing pathogenic mechanisms responsible for breaking self-tolerance and generating autoimmune disease in animal models and patients with Type 1 Diabetes (T1D). The ultimate goal is to identify novel targets for therapeutic intervention in T1D. Our two main projects are: 136 - SAN RAFFAELE SCIENTIFIC INSTITUTE 1. Study of gut immune regulation in T1D patients. The gut is home of several immune regulatory cell subsets that contribute to maintain peripheral tolerance towards self-tissues. Specifically, tolerogenic dendritic cells (CD103+CD11c+ DCs) of the intestinal lamina propria are responsible for extrathymic differentiation of FoxP3+ Treg cells, a potent regulatory T cell subsets that is crucial for prevention of autoimmune diabetes. Recently, thanks to collaboration with Clinical Units we received duodenal biopsies and study immune regulatory cells in the gut of patients with T1D and controls. Our analysis revealed that T1D patients have a significant reduction of gut CD4+CD25+FoxP3+CD127- Treg cells (P = 0.03) due to defective function of lamina propria tolerogenic DCs. Our future objective is to understand whether the altered Treg cell differentiation in the gut of T1D patients is related to genetic or environmental factors, e.g., microbiota alterations. 2. Restoration of immune regulatory iNKT cell function in pre-clinical models of T1D. iNKT cells are immune regulatory cells crucial for prevention of autoimmune T1D. We recently demonstrated that iNKT cell inability to prevent autoimmune disease in T1D-prone NOD mice is due to lack of signals driving their peripheral differentiation towards a regulatory phenotype, i.e., defective SLAM-SLAM homotypic interaction with myeloid DCs (Baev et al. JI 2008). In 2009 we developed a gene therapy approach to restore SLAM expression on NOD myeloid DCs. We cloned the murine SLAM gene into the MIGR1 retroviral vector and used it to transfect myeloid NOD DCs of NOD mice and test their capacity to induce regulatory iNKT cell differentiation. Our next goal is to test whether restoration of SLAM expression in NOD DCs and regulatory iNKT cell differentiation prevents autoimmune diabetes. Moreover, we will assess whether a similar genetic defect of SLAM expression is present on DCs of T1D patients. Marika Falcone β CELL BIOLOGY β cell replacement in diabetes Background and unsolved issues. In principle, treatment for type-1 diabetes and many cases of type-2 diabetes, lies in the possibility of finding a β cell mass replacement capable of performing two essential functions: assessing blood sugar levels and secreting appropriate levels of insulin in the vascular bed. Our project focuses on creating conditions that favour β cell expansion and survival in transplanted and native environments Currently, the only available clinical therapy capable of restoring β cell mass in diabetic patients is the allogeneic/autologous transplantation of β cells. Despite advances in recent years the somatic cell therapy is still problematic. Starting hypothesis and main results. The somatic cell therapy for T1D is a great platform to address mechanistic questions regarding type-1 diabetes. In the last years we were able to study the impact of β cell challenge to the immune status of the patient and the efficacy of immunotherapeutics and their ability to control allogeneic and autoimmune responses. The results of these studies demonstrate (a) that survival of both syngeneic and allogeneic islet grafts in the liver is sub-optimal, (b) that inflammatory reaction play a relevant role for the survival and function of islets after transplantation, (c) that the actual immunosuppressive regimens do not control efficiently both allogeneic and autoimmune response. Conclusions and future plans. To obtain the long term replacement of β cells in patients with diabetes we are working on: (1) study bone marrow as site for islet transplantation, (2) develop novel islet survival strategies by modulating inflammation specifically inhibiting pathways involving CCL2 or IL-8, (3) Improve islet transplantation outcome by cotransplantation of islets and feeder cells using mesenchymal stem cells, (4) determine mechanisms of islet autoantigen immunization and destruction (5) to identify a renewable source of cells to be used to increase the transplantable β cell mass. Lorenzo Piemonti DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 137 CELL IMAGING Non-invasive in vivo magnetic resonance imaging of Endorem®-labeled pancreatic islets in the liver following transplantation in humans. Non-invasive magnetic resonance imaging (MRI) of pancreatic islets is an attractive option for the “real-time” monitoring of graft evolution in parallel to the measurement of metabolic parameters in T1diabetic patients. We have previously optimized a labeling procedure for human islets using a clinically approved contrast agent based on superparamagnetic iron oxide, Endorem®, assessing safety and in vivo MRI quality issues in a preclinical model (Malosio et al, AJT 2009). Since 2009 a clinical study has started in collaboration with the Islet Transplant Program and the Radiology Department, on T1diabetic patients, receiving intrahepatic transplantation of islet, of which the highly pure fraction is labeled with Endorem®. This allows to visualize by MRI (T2*-weighted imaging) over time the presence of hypointese spots associated with labeled islets within the liver. This study is aimed at assessing how the MRI read-out correlates with the clinical measurement of islet function (glycemia; C-peptide; insulin need; HbA1c) and its usefulness in terms of prediction of functional success or failure. Three patients have been transplanted so far and MRI monitoring over time (24h, 48h, 7d and once every month for one year) is ongoing in parallel to the metabolic follow-up. Identification of mechanisms underlying b cell functional failure. Pancreatic β cell failure leading to cell death is a common feature of both T1 and T2 diabetes. The mechanisms involved remain largely unknown, though Endoplasmatic Reticulum (ER) and oxidative stress, mitochondrial insufficiency and up-regulation of inflammatory pathways have been implicated. The characterization of a rat insulinoma, the RIN-5AH line, by cell biology and fluorescence microscopy imaging approaches, including the H2O2-sensing HyPervectors targeted to different intracellular compartments, is showing that these cells display spontaneously many of the above mentioned stress features. Our studies aim at understanding: 1. the relationship between ER stress and oxidative stress, 2. mechanisms contributing to β cell survival or death and their impact on β cell functional failure. Maria Luisa Malosio Clinical Research Units ISLET TRANSPLANTATION The clinical Islet Transplantation Program activity has focused on the continuation of ongoing clinical trials and the start up of new translational lines of research. Continuation of ongoing studies: 2) Study of the effect of exenatide on the dysfunction of transplanted islets. Two patients completed one year treatment. No remarkable advantages of this treatment option were observed: one patient resumed subcutaneous insulin treatment at low doses, the other is continuing with exenatide administration. 3) Pilot clinical trial (started in 2007) on a new immunosuppressive regimen without daclizumab and calcineurin inhibitors and with the potential of accomodating T regulatory cells expansion. This study was completed. Two patients became insulin independent (insulin independence duration as of December 2009: 13 and 3 months); four patients had achieved partial islet function; three patients had early islet failure, probably because of rejection. 4) Effect of islet transplantation alone on long-term diabetes complications(i.e., early retinopathy, neuropathy, carotid artery disease) data are being collected prospectively and will be analyzed after the completion of a 5 years follow-up. 138 - SAN RAFFAELE SCIENTIFIC INSTITUTE 5) 6) 7) Prospective study of kidney function and incidence of cancer in patients who had received islet transplant alone. Data entry in the Collaborative Islet Transplant Registry, supported by USA NIH and JDRF. Safety and efficacy study of pancreatic islet autotransplant with total pancreatectomy. Three patients received islet autotransplant and became insulin independent after one infusion of islet. New studies: 1) Pilot clinical trial on a new immunosuppressive regimen including ATG, MMF, tacrolimus during the first 3 months after islet transplantation and sirolimus thereafter. One patients received the first islet infusion (9,185 IEq/kg) using this immunosuppressive regimen and achieved partial islet function. 2) Safety study on intra bone marrow islet infusion in patients not eligible for islet infusion in the liver. Three transplants have been completed [one autotransplant and two allotransplants (1 islet alone; 1 islet after kidney)]. C-peptide secretion was observed after islet infusion and no adverse events were recorded. 3) Study on in vivo magnetic resonance imaging of the transplanted islet. Three patients received Endorem-labeled islet into the liver; labeled islets were clearly recognized as hypo-intense spots scattered into the liver. As for islet function, sustained C-peptide secretion was observed in two cases, early failure occurred in one case. Paola Maffi PREVENTION IN TYPE 1 DIABETES This research program encompasses all studies aiming at the definition of pathogenetic mechanisms of induction and perpetuation of autoimmunity in humans and the identification of strategies for halting or reverting the progression to clinically overt type 1 diabetes. In 2002, with the support of the Juvenile Diabetes Research Foundation (JDRF), a Clinical Center infrastructure has been created at San Raffaele to host a TrialNet Center. TrialNet is a NIH-supported network of clinical centres, investigators and core support facilities in the US and Canada, United Kingdom, Italy, Germany, Finland and Australia. The goals of TrialNet programs are to: further define epidemiology, natural history and risk factors of type 1 diabetes; support the development and implementation of clinical trials of agents to slow the progression of type 1 diabetes in new-onset patients, and delaying or preventing the emergence of type 1 diabetes in individuals found to be at risk of the disease. Recently completed studies at the San Raffaele Centre include: the metabolic assessment of residual insulin secretion in patients with type 1 diabetes and the Mycophenolate/Daclizumab clinical trial in recent onset patients; ongoing studies include: the natural history of development of type 1 diabetes; oral insulin for the prevention of diabetes in relatives at risk; studies under implementation include: s.q. GAD administration for the prevention of diabetes in relatives at risk. An additional focus of the Clinical centre is the creation and expansion of a wide network of affiliate and satellite centres throughout Italy to support the enrolment into all the TrialNet studies. Based on the same JDRF-funded infrastructure, other clinical trials, in addition to those performed within TrialNet, have been performed (e.g. anti-CD3 in new onset type 1 diabetes) or are expected to be developed in the future, possibly including also phase I/proof-of-concept studies. Emanuele Bosi EPIDEMIOLOGY & DATA MANAGEMENT The mission of the Epidemiology and Data Management Core is to provide methodological support to investigator-initiated clinical research and translational research projects within the Department of Immunology, Transplantation and Infectious Diseases with special regards to those within the Diabetes Research Institute (DRI). The Epidemiology and Data Management Core is currently providing support to the following major projects within the Diabetes Research Institute and the Islet Transplant Program: a) studies of regulatory T cells in pancreatic and peripheral lymphonodes and of gut biopsies of patients DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 139 b) c) d) e) with type 1 diabetes. This studies use unique biological material collected through the collaboration of clinicians and basic scientists. a clinical trial testing safety, feasibility and efficacy of an immunesuppressive regimen that is compatible with the use of T regulatory cells to induce immune tolerance. This study is part of a multicenter trial in collaboration with the European Consortium for Islet Transplantation (ECIT). a trial testing feasibility, safety and efficacy of the bone marrow as an alternative site for islet cell transplant in patients with type 1 diabetes in whom liver islet infusion is not feasible. a randomized clinical trial to assess whether total pancreatectomy with islet autotransplantation is a superior alternative to pancreaticoduodenectomy in patients at very high-risk of complications of the pancreatic anastomosis (soft pancreas and pancreatic duct diameter a longitudinal study to identify and characterize the organ donor “inflammatory signature” and its potential to predict graft outcome. The study is conducted in collaboration with the Nord Italian Transplant program (NITp) and will involve over 1,000 cadaveric organ donors and 2,000 organ recipients over the area served by NITp. Marina Scavini CHILDHOOD DIABETES The Unit is involved in clinical trial aimed to secondary and tertiary prevention of type 1 diabetes in childhood. We have access to one of the larger cohort of newly diagnosed type 1 diabetes in children and adolescents at italian level. During 2009 we collaborated with the Trialnet Center for the screening of family members of children with Type 1 diabetes. We screened together 100 family members and we are part of the secondary prevention trial with oral insulin. Morover for tertiary prevention we participated to the Diamyd Trial an international multicenter phase 3 trial with GAD vaccination. We screened 9 patients in the trial end we enrolled 7 patients. We are following these patients for 2 years. Also for tertiary prevention we are involved in an italian multicenter trial sponsored by AIFA testing Metformine in patients at onset of disease. We are actually screening patients at onset of diabetes in order to enrol in this trial. The Unit is studying the characteristic of patients at onset of type 1 diabetes without immunologic cause of type 1 diabetes: we try to identify unfrequent genetic mutation able to cause early onset diabetes (Mody, neonatal diabetes, insulin mutation, other rare mutation etc) in collaboration with Prof Barbetti in Rome. Moreover in order to study T cells at onset of type 1 diabetes we setup a study in collaboration with Battaglia’s Lab and Piemonti’s Lab, to study regulatory T cells and B cells at onset of diabetes and try to correlate phenothype and genotype of these patients. In collaborations with others italian centers of SIEDP we participated in different multicenter trial. In particularly we take part in a trial aimed to study concordance in italian twins for type 1 diabetes in collaboration with Istituto Superiore di Sanità aimed to discriminate between genetic and environmental factors in the pathogenesis of type 1 diabetes. We take part in a study aimed to clarify the history of potential celiac disease in diabetic patients. Riccardo Bonfanti ISLET PROCESSING ACTIVITY Islet Processing Facility activity is devoted to islet of Langerhans isolation from human pancreas. Allogenic transplant. IPF mission is to provide isolated human islets for transplantation in type 1 diabetic patients as stated on the Italian organ and tissues transplant regulation. Islets available for transplantation means that they have been determined to meet all release specifications and to be suitable for utilization. At this purpose, IPF organized management with the target of ensuring that human islets have the quality required for transplantation in humans. 140 - SAN RAFFAELE SCIENTIFIC INSTITUTE Autologous transplant. We recently introduced islets isolation from segmental pancreas, obtained in the management of uncontrolled fistula after Whipple resection. Islets re-infused in the same patient allow to reach a glycemic control also in patient with completion pancreatectomy. ECIT – Islet for Research. Human islet preparations not suitable for transplant in patients can be used as a mean to drive the isolation procedures improvement, engraftment and its outcome, according to the local ethical committee decisions. IPF, as a member of ECIT Consortium supported by JDRF, distributes islet preparation not suitable for transplant, with the aim to improve the research activities in diabetes. Different studies are currently in progress with the aim to increase the effectiveness of the islet transplant, to achieve the immunological tolerance, define the best culture condition in terms of recovery before the transplant, and improve the islet transplant program with the stem cell base therapy. Rita Nano DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 141 Selected publications 9 Abrams, D; Lévy, Y; Losso, MH; Babiker, A; Collins, G; Cooper, DA; Darbyshire, J; Emery, S; Fox, L; Gordin, F; Lane, HC; Lundgren, JD; Mitsuyasu, R; Neaton, JD; Phillips, A; Routy, JP; Tambussi, G; Wentworth, D; INSIGHT-ESPRIT Study Group; SILCAAT Scientific Committee. Interleukin-2 therapy in patients with HIV infection. New Engl. J. Med.: 2009; 361(16): 1548-1559 - Article IF 2008: 50,017 9 Alfano, M; Mariani, SA; Elia, C; Pardi, R; Blasi, F; Poli, G. Ligand-engaged urokinase-type plasminogen activator receptor and activation of the CD11b/CD18 integrin inhibit late events of HIV expression in monocytic cells. Blood: 2009; 113(8): 1699-1709 - Article IF 2008: 10,432 9 Baldan, R; Cavallerio, P; Tuscano, A; Parlato, C; Fossati, L; Moro, M; Serra, R; Cirillo, DM. First report of hypervirulent strains polymerase chain reaction ribotypes 027 and 078 causing severe Clostridium difficile infection in Italy. Clin. Infect. Dis.: 2010; 50(1): 126-127 - Letter IF 2008: 8,266 9 Bragonzi, A; Paroni, M; Nonis, A; Cramer, N; Montanari, S; Rejman, J; Di Serio, C; Doring, G; Tummler, B. Pseudomonas aeruginosa microevolution during cystic fibrosis lung infection establishes clones with adapted virulence. Am. J. Respir. Crit. Care Med. : 2009; 180(2): 138-145 - Article IF 2008: 9,792 9 Capua, I; Kajaste-Rudnitski, A; Bertoli, E; Vicenzi, E. Pandemic vaccine preparedness - Have we left something behind?. PLoS Pathog.: 2009; 5(6): art. no. e1000482 – Note IF 2008: 9,125 9 Cassol, E; Cassetta, L; Rizzi, C; Alfano, M; Poli, G. M1 and M2a polarization of human monocyte-derived macrophages inhibits HIV-1 replication by distinct mechanisms. J. Immunol.: 2009; 182(10): 6237-6246 - Article IF 2008: 6,000 9 Cinque, P; Koralnik, IJ; Gerevini, S; Miro, JM; Price, RW. Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect. Dis.: 2009; 9(10): 625-636 - Review IF 2008: 13,165 9 Fenoglio, D; Poggi, A; Catellani, S; Battaglia, F; Ferrera, A; Setti, M; Murdaca, G; Zocchi, MR. Vdelta1 T lymphocytes producing IFN-gamma and IL-17 are expanded in HIV-1-infected patients and respond to Candida albicans.. Blood: 2009; 113(26): 6611-6618 - Article IF 2008: 10,432 9 Lennox, JL; DeJesus, E; Lazzarin, A; Pollard, RB; Madruga, JVR; Berger, DS; Zhao, J; Xu, X; Williams-Diaz, A; Rodgers, AJ; Barnard, RJ; Miller, MD; DiNubile, MJ; Nguyen, BY; Leavitt, R; Sklar, P. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatment-naive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet: 2009; 374(9692): 796-806 - Article IF 2008: 28,409 9 Locci, M; Draghici, E; Marangoni, F; Bosticardo, M; Catucci, M; Aiuti, A; Cancrini, C; Marodi, L; Espanol, T; Bredius, RGM; Thrasher, AJ; Schulz, A; Litzman, J; Roncarolo, MG; Casorati, G; Dellabona, P; Villa, A. The Wiskott-Aldrich syndrome protein is required for iNKT cell maturation and function. J. Exp. Med.: 2009; 206(4): 735-742 - Article IF 2008: 15,463 9 Molteni, R; Crespo, CL; Feigelson, S; Moser, C; Fabbri, M; Grabovsky, V; Krombach, F; Laudanna, C; Alon, R; Pardi, R. Î?-Arrestin 2 is required for the induction and strengthening of integrin-mediated leukocyte adhesion during CXCR2-driven extravasation. Blood: 2009; 114(5): 1073-1082 - Article IF 2008: 10,432 9 Poggi, A; Catellani, S; Garuti, A; Pierri, I; Gobbi, M; Zocchi, MR. Effective in vivo induction of NKG2D ligands in acute myeloid leukaemias by all-trans-retinoic acid or sodium valproate. Leukemia: 2009; 23(4): 641648 - Article IF 2008: 8,634 9 Rusnati, M; Vicenzi, E; Donalisio, M; Oreste, P; Landolfo, S; Lembo, D. Sulfated K5 Escherichia coli polysaccharide derivatives: A novel class of candidate antiviral microbicides. Pharmacol. Ther.: 2009; 123(3): 310322 - Review IF 2008: 9,443 9 Tonti, E; Galli, G; Malzone, C; Abrignani, S; Casorati, G; Dellabona, P. NKT-cell help to B lymphocytes can occur independently of cognate interaction.. Blood: 2009; 113(2): 370-376 - Article IF 2008: 10,432 142 - SAN RAFFAELE SCIENTIFIC INSTITUTE 9 Urbinati, C; Nicoli, S; Giacca, M; David, G; Fiorentini, S; Caruso, A; Alfano, M; Cassetta, L; Presta, M; Rusnati, M. HIV-1 Tat and heparan sulfate proteoglycan interaction: a novel mechanism of lymphocyte adhesion and migration across the endothelium. Blood: 2009; 114(15): 3335-3342 - Article IF 2008: 10,432 Selected publications (DRI) 9 Cantarelli, E; Melzi, R; Mercalli, A; Sordi, V; Ferrari, G; Lederer, CW; Mrak, E; Rubinacci, A; Ponzoni, M; Sitia, G; Guidotti, LG; Bonifacio, E; Piemonti, L. Bone marrow as an alternative site for islet transplantation. Blood: 2009; 114(20): 4566-4574 - Article IF 2008: 10,432 9 Malosio, ML; Esposito, A; Poletti, A; Chiaretti, S; Piemonti, L; Melzi, R; Nano, R; Tedoldi, F; Canu, T; Santambrogio, P; Brigatti, C; De Cobelli, F; Maffi, P; Secchi, A; Del Maschio, A. Improving the procedure for detection of intrahepatic transplanted islets by magnetic resonance imaging. Am. J. Transplant. : 2009; 9(10): 2372-2382 - Article IF 2008: 6,559 9 Parker, MJ; Xue, S; Alexander, JJ; Wasserfall, CH; Campbell-Thompson, ML; Battaglia, M; Gregori, S; Mathews, CE; Song, S; Troutt, M; Eisenbeis, S; Williams, J; Schatz, DA; Haller, MJ; Atkinson, MA. Immune depletion with cellular mobilization imparts immunoregulation and reverses autoimmune diabetes in nonobese diabetic mice. Diabetes: 2009; 58(10): 2277-2284 - Article IF 2008: 8,398 9 Piemonti, L; Calori, G; Lattuada, G: Mercalli, A; Ragogna, F; Garancini, MP; Ruotolo, G; Luzi, L; Perseghin, G. Association between plasma monocyte chemoattractant protein-1 concentration and cardiovascular disease mortality in middle-aged diabetic and nondiabetic individuals. Diabetes Care: 2009; 32(11): 2105-2110 Article IF 2008: 7,349 9 Valle, A; Jofra, T; Stabilini, A; Atkinson, M; Roncarolo, MG; Battaglia, M. Rapamycin prevents and breaks the anti-CD3-induced tolerance in NOD mice. Diabetes: 2009; 58(4): 875-881 - Article IF 2008: 8,398 DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 143 Leukocyte biology Unit Cellular and molecular allergology Infection and cystic fibrosis Human virology Protein engineering and therapeutics AIDS immunopathogenesis Unit 144 - SAN RAFFAELE SCIENTIFIC INSTITUTE Biocrystallography Unit Cellular immunology Unit Emerging bacterial pathogens Unit Experimental immunology Unit Lymphocyte activation Unit DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 145 Viral pathogens & biosafety Unit Viral evolution and transmission Unit Management and antiretroviral treatment of HIV infection Study and treatment of hepatotropic viruses related diseases 146 - SAN RAFFAELE SCIENTIFIC INSTITUTE Vaccine and immunotherapy Clinical immunopathology and advanced medical therapeutics Unit Clinical transplant Unit DIVISION OF IMMUNOLOGY, TRANSPLANTATION, AND INFECTIOUS DISEASES - 147 Immune tolerance Experimental diabetes β cell biology Islet processing activity DIVISION OF GENETICS AND CELL BIOLOGY - 149 DIVISION OF GENETICS AND CELL BIOLOGY Director: Roberto Sitia* Associate Director: Marco E. Bianchi* Research Units Protein transport and secretion Unit HEAD OF UNIT: Roberto Sitia* RESEARCHER: Tiziana Anelli POST-DOCTORAL FELLOWS: Jose Garcia-Manteiga, Eva Margittai** PHD STUDENT: Margherita Cortini**, Francesca Fontana FELLOWS: Milena Bertolotti, Martina Brunati, Riccardo Ronzoni TECHNICIANS: Claudio Fagioli, Elena Pasqualetto Age related diseases GROUP LEADER: Simone Cenci POST-DOCTORAL FELLOW: Laura Oliva PHD STUDENTS: Elisa Benasciutti, Enrico Milan**, Niccolò Pengo FELLOW: Ugo Orfanelli TECHNICIAN: Elisabetta Mariani Molecular immunology GROUP LEADER: Antonio Siccardi FELLOWS: Rita Nunzia Fucci, Elisa Nigro TECHNICIAN: Elisa Soprana Chromatin dynamics Unit HEAD OF UNIT: Marco E. Bianchi* POST-DOCTORAL FELLOWS: Roberta Palumbo, Angela Raucci, Emilie Venereau PHD STUDENTS: Antonella Antonelli, Jaron Liu, Tobias Pusterla** FELLOWS: Lisa Trisciuoglio, Luca Sessa TECHNICIANS: Francesco De Marchis, Alessandro Catucci In vivo Chromatin and transcription GROUP LEADER: Alessandra Agresti PHD STUDENT: Barbara Celona** Biology of myelin Unit HEAD OF UNIT: Lawrence Wrabetz POST-DOCTORAL FELLOWS: Maurizio D’Antonio, Pietro Fratta, Francesca Florio, Ambra Zaghetto PHD STUDENTS: Nicolò Musner**, Francesca Ornaghi**, Elisa Tinelli**, Domenica Vizzuso** TECHNICIANS: Cinzia Ferri, Paola Saveri Biomolecular mass spectrometry Unit HEAD OF UNIT: Angela Bachi POST-DOCTORAL FELLOWS: Alfonsina D’Amato, Vittoria Matafora, Federico Torta PHD STUDENT: Umberto Restuccia FELLOW: Santosh Anand TECHNICIAN: Angela Cattaneo 150 - SAN RAFFAELE SCIENTIFIC INSTITUTE Gene expression Unit HEAD OF UNIT: Fulvio Mavilio RESEARCHERS: Maria Pannese, Alessandra Recchia POST-DOCTORAL FELLOW: Claudia Cattoglio PHD STUDENT: Valentina Poletti** FELLOW: Simona Capossela TECHNICIAN: Serenella Sartori Genetics of common disorder Unit HEAD OF UNIT: Daniela Toniolo RESEARCHER: Silvia Bione POST-DOCTORAL FELLOWS: Giorgio Pistis, Michela Traglia PHD STUDENT: Tanguy Corre ** FELLOWS: Ivan Buetti, Salvatore Carrabino, Massimiliano Cocca, Corrado Masciullo TECHNICIANS: Cinzia Sala, Fiammetta Viganò Molecular basis of polycystic kidney disease Unit (Dulbecco Telethon Institute) HEAD OF UNIT: Alessandra Boletta POST-DOCTORAL FELLOW: Isaline Rowe PHD STUDENTS: Maddalena Castelli**, Monika Pema TECHNICIANS: Marco Chiaravalli, Gianfranco Distefano Molecular genetics Unit HEAD OF UNIT: Francesco Blasi* RESEARCHER: Daniela Talarico POST-DOCTORAL FELLOW: Silvia D’Alessio PHD STUDENTS: Patrizia Marzorati, Silvia Mori FELLOWS: Ambra Crippa, Laura Gerasi TECHNICIAN: Massimo Resnati Molecular dynamics of the nucleus GROUP LEADER: Massimo Crippa POST-DOCTORAL FELLOW: Nicola Micali PHD STUDENT: Monika Wozinska** FELLOWS: Andrea Boni**, Matteo Marinelli** NeuroGlia Unit HEAD OF UNIT: Maria Laura Feltri POST-DOCTORAL FELLOWS: Silvia Bogni, Ernesto Pavoni, Yannick Poitelon PHD STUDENTS: Cristina Colombelli, Monica Ghidinelli**, Marta Pellegatta** FELLOW: Marilena Palmisano TECHNICIANS: Stefania Saccucci, Desirée Zambroni Regulation of iron metabolism Unit HEAD OF UNIT: Clara Camaschella* POST-DOCTORAL FELLOW: Laura Silvestri PHD STUDENTS: Antonella Nai, Alessia Pagani RESIDENT: Erika Poggiali Molecular genetics of renal disorders Unit (Dulbecco Telethon Institute) GROUP LEADER: Luca Rampoldi POST-DOCTORAL FELLOW: Céline Schaeffer PHD STUDENT: Ilenia Bernascone**, Martina Brunati FELLOWS: Simone Perucca, Matteo Trudu DIVISION OF GENETICS AND CELL BIOLOGY - 151 Clinical Research Units Dento-facial histopathology Unit HEAD OF UNIT: Enrico Gherlone* PHYSICIANS: Paolo Capparé, Carlo Alberto Cortella, Roberto Crespi, Massimo Pasi, Raffaele Vinci, Stefano Zandonella Necca Genomics of renal diseases and hypertension Unit HEAD OF UNIT: Paolo Manunta* CLINICAL GROUP LEADER: Donatella Spotti RESEARCHER: Laura Zagato PHYSICIANS: Teresa Arcidiacono, Chiara Lanzani, Luisa Persichini, Maria Teresa Sciarrone Alibrandi, Giuseppe Vezzoli RESIDENTS: Giovanna Bonavida, Irene Botticelli, Marialuisa Querques, Francesco Rainone, Marco Simonini FELLOWS: Lorena Citterio, Simona Delli Carpini, Elisabetta Messaggio TECHNICIAN: Nunzia Casamassima RESEARCH NURSES: Elena Brioni, Marie Jankaricova Tissue engineering and biomaterials HEAD OF UNIT: Gianfranco Fraschini* CLINICAL GROUP LEADER: Giuseppe M. Peretti PHYSICIAN: Corrado Sosio RESIDENTS: Laura Mangiavini, Alessandro Pozzi, Celeste Scotti POST-DOCTORAL FELLOW: Daniela Deponti FELLOW: Rosa Ballis * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 152 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Directors The Division of Genetics and Cell Biology (DGCB) consists of 14 basic and 3 clinical research groups, totaling over 140 staff. It occupies laboratory space in Dibit 1 and 2 buildings. Mission - DGCB aims at the mechanistic comprehension of biological phenomena to acquire basic knowledge and fuel translational and clinical research with novel concepts, tools and protocols. Understanding Physiology and Pathology in cellular and molecular terms is fundamental to cure disease and create novel bio-technologies. Scientific training is another DGCB priority. Roberto Sitia Organization - Scientists are free to engage in competitive research projects: they are encouraged to join forces, data and equipment so as to foster synergies. Areas of particular strength include bone and cartilage physiopathology, the physiopathology of stress responses and conformational diseases, chromatin dynamics and epigenetics, cell polarity, and the genetics of complex disorders. DGCB staff is engaged in inter-Divisional Research Programs and Institutional Facilities. Goals - Biology is becoming more and more a hard science. Surprising disMarco E. Bianchi coveries are still made of course, but there is little doubt that quantitative aspects are now essential. This is especially true for an Institute like ours, which expects basic and clinical research to synergistically flourish. In strict collaboration with the Center of Genomics, BioInformatics and BioStatistics, DGCB develops state of the art technological platforms for the scientific community. DGCB aims at providing clinical sciences with novel concepts and protocols and develops robust cellular and animal models for their testing. As important is reverse translation, where the detailed analysis of cohorts of patients can unravel physiological mechanisms. Identifying mutational hotspots in patients, for instance, sheds light on the structure and function of the normal product. The iterative process of translation is a key asset for DGCB. Main achievements - The numerous scientific achievements in 2009 are described in the sections devoted to the single laboratories and are testified by the publication of about 70 papers on international journals. Training opportunities - DGCB hosts both PhD and PostDoctoral training programs, where positions are offered on a competitive basis for a minimum of 3 and 2 years, respectively. DIVISION OF GENETICS AND CELL BIOLOGY - 153 Research Units PROTEIN TRANSPORT AND SECRETION UNIT Our Unit is exploring the processes of oxidative folding, quality control and degradation of proteins –antibodies in particular- in the early secretory compartment (ESC). Solving the structure of ERp44 revealed a novel mechanism that regulates the binding and release of this chaperone to its client proteins (Wang et al., 2008), likely governed by pH (Vavassori et al., in preparation). ERp44 interacts with ERGIC-53 and regulates the transport and/or polymerization of Ero1, IgM and SUMF1 (Cortini and Sitia, 2010 a, b; Fraldi et al., 2008). With Ero1, ERp44 also regulates IP3R1 channels (Bergamelli et al., submitted), thus integrating redox and calcium homeostasis/signaling (Anelli & Sitia, 2008; 2010). By manipulating the expression of key quality controllers in ESC, we could modify the fate of aggregation-prone mutant secretory proteins (Ronzoni et al., 2010). Identifying potential targets for the wide family of ER storage disorders, these findings have profound implications in the pathogenesis of these and other protein conformational diseases Anelli and Sitia, 2010). The lab analyses also the mechanisms that orchestrate the architectural (de novo biogenesis of the secretory apparatus) and functional (onset of Ig secretion and eventually apoptosis) changes during B lymphocyte-plasma cell differentiation. Our observation that proteasomal capacity declines in parallel to the massive increase in antibody production explains in part the exquisite sensitivity of normal and malignant plasma cells to proteasome inhibitors (Nerini et al., 2008; Cascio et al., 2008, Cenci et al., 2008). Indeed, the proteasomal load vs capacity ratio correlates with drug sensitivity and can hence provide a useful clinical indicator (Bianchi et al., 2009). The tight connections between disulfide bond formation, protein secretion and oxidative stress identify novel targets for manipulating maladaptive stress responses (Masciarelli & Sitia, 2008; Rubartelli & Sitia, 2009a, b). The possibility of modulating ER proteostasis, redox and stress could offer new therapeutic strategies not only in ER storage and conformational diseases, but also in myeloma and other types of cancer. Roberto Sitia AGE RELATED DISEASES We explore the basic cell biology of normal and malignant plasma cells, with implications for Ab responses and Multiple Myeloma (MM, 2% of all cancer deaths). Our discovery that differentiating plasma cells decrease proteasome activity and suffer from proteotoxic stress (Cenci et al, 2006) provided us with a unique biological model linking protein synthesis to death, with key immune and oncological implications, like the potential exploitation of proteasome inhibitors (PI) as humoral immunosuppressants in vivo (Cascio et al, 2008). Hence, our research activity aims at: understanding how plasma cells cope with stress and proteasomal overload, investigating the mysterious mechanisms regulating mammalian proteasome biogenesis; exploiting proteotoxicity to identify novel targets against plasma cell cancers. Along these lines, we found that plasma cells deploy autophagy with potent regulatory effects on lifespan and Ig secretion (Pengo et al, manuscript in preparation). In MM, proteasome expression and functional workload are key determinants of apoptotic sensitivity to PI, providing potential molecular targets and prognostic indicators (Bianchi et al, 2009). Moreover, we are demonstrating an adaptive role for autophagy in MM (Fontana et al, unpublished). Parallel in vivo studies on the molecular mechanisms driving the differentiation of osteoclasts, unique boneresorbing cells, are unveiling novel links between adaptive immunity and bone biology, of potential therapeutic interest against bone-wasting conditions (Cenci et al, 2003; Benasciutti et al, manuscript in preparation). Given the vicious connection between MM and bone cells, this model will be of use to better understand the MM environment. Simone Cenci 154 - SAN RAFFAELE SCIENTIFIC INSTITUTE MOLECULAR IMMUNOLOGY Two main projects are pursued. 1. Construction of recombinant poxviruses. We developed novel methods that allow an extremely rapid production of recombinant poxviruses (MVA and FPV). An interesting side product was the description of the sequence of homologous recombination events that lead to the formation of markerless recombinants (Di Lullo et al., 2009; Di Lullo et al., 2010). Moreover, we developed a novel method for the parallel construction of MVA and FPV recombinants (Soprana et al., submitted). MVA and FPV are immunologically not cross-reactive and can be employed for efficient prime/boost strategies. Some of our influenza recombinant vaccine (M1, M2, Np, HA, of various H1 and H5 subtypes) are used in vaccination trials at the Robert Koch Institut in Berlin and at IZPS, Padova (Siccardi et al., in preparation). 2. Exploiting the adjuvant role of membrane IgE in cell vaccines. Owing to interactions between membrane IgE with specific receptors located on effector cells in a form of intercellular synapsis (Vangelista et al., 2005), tumor cells bearing membrane IgE are better vaccines than control cells (Reali et al., 2001). The adjuvanticity is dependent upon the interaction with Fc-epsilion RI receptor bearing cell (as demonstrated in knock-out mice). The adjuvant effect of human membrane IgE is demostrable also in mice which express only the human receptor (Nigro et al., 2009). A further demonstration of the IgE role in tumor control in mice is that transplanted tumors grow much less in hyper IgE transgenic mice (Nigro et al., in preparation). Antonio Siccardi CHROMATIN DYNAMICS UNIT Our group studies chromatin organization and function, and in particular the role of one protein, High Mobility Group Box 1 (HMGB1). The state of chromatin determines how specific genes are expressed by different cells in the same organism (that contain the same genome). Moreover, differentiated cells maintain their identity over time, and stem cells maintain their plasticity. When they fail in this, they can become tumors, or simply start performing erratically (degenerative diseases of various kinds). We are also very interested in a remarkable property of HMGB1. This nuclear protein can be leaked out of necrotic cells and signal traumatic tissue damage, triggering inflammation, cell proliferation and migration, innate and adaptive immune responses, angiogenesis and eventually tissue repair. The connection between chromatin status in apoptosis and tissue repair is a particular focus of our group. During 2009, we have been able to convince the “HMGB1-as-cytokine” field that by itself HMGB1 only acts as a chemoattractant (essentially for all cells that can migrate), and can act as a cytokine (inducing the synthesis of other cytokines, chemokines or immunological effector molecules) only when associated with other partner molecules, via the receptor for the partner molecule. We have also shown that extracellular HMGB2 is functionally very similar to extracellular HMGB1. ➥ Figure 16. HMGB1 as a DAMP. Inflammatory and immune responses are activated by Pathogen Associated Molecular Patterns (parts of bacteria, viruses etc) but also by endogenous distress signals, or Damage Associated Molecular Patterns, such as HMGB1. DIVISION OF GENETICS AND CELL BIOLOGY - 155 We have also shown that the signal transduction pathways activated by extracellular HMGB1 include Srcfamily kinases and the non-classical NF-κB pathway, in addition to the already known MAPK and classical NFκB pathways. Moreover, in collaboration with the group of Tadatsagu Taniguchi in Tokyo, we have shown that cytoplasmic HMGB1 binds nucleic acids that happen to be outside of the nucleus, and therefore may represent viral genomes. On doing so, HMGB1 presents the suspected viral genomes to specialized cytoplasmic virus detectors, and activates the antiviral responses of the cell. Marco E. Bianchi IN VIVO CHROMATIN AND TRANSCRIPTION Our focus is on the quantitative analysis of NF-κB transcriptional dynamics in living cells, at single cell level. Single cell analysis provides a sharper description of dynamic events and bypass the inherent limitation of kinetic studies in cell populations due to averaged results from standard biochemical approaches. In resting cells, NF-κB is mainly cytoplasmic and translocates to the nucleus upon inflammatory stimuli. Activated gene transcription leads to the resynthesis of several negative feedback genes that cause the inactivation of NF-κB and its re-localization to the cytoplasm. In the past, NF-κB nuclear cytoplasmic translocation has been reported to have a biphasic pattern with a sharp first nuclear translocation peak followed by a prolonged nuclear persistence with minor fluctuations. We demonstrated multiple consistent peaks of p65 nuclear localization (Sung et al, 2009) in single living fibroblasts from GFP-p65 knock-in mice that allow the detection of physiological levels of endogenous p65. Fourier analysis demonstrated that oscillations are sustained in the majority of the cells (79%) with 2.2 hours period (median value). Furthermore, p65 in late translocations is capable of diffusing on and interacting with the genome as effectively as the first p65 molecules activated after TNFα by FRAP. ➥ Figure 17. Fine-tuning transcriptional output by NF-κB oscillations. (A) When there are little or no NF-κB oscillations, immediately accessible target genes are continuously induced. Gene-specific mechanisms attenuate the transcription of these genes over time, while a different group of genes become responsive. In this model, overall gene expression kinetics does not critically depend on κB dynamics. (B) Sustained NF-κB oscillations allow only pulses of expression for the immediate early genes, as the transcription factor interacts transiently with the chromatin at discrete times. In later signaling cycles, NF-κB returns with characteristic genome-scanning competency and acts on late-accessible genes, without having accumulated early transcripts at a high level. Therefore, NF-κB oscillations, which are strongly coupled with upstream signaling kinetics, ensure balanced gene expression programs. 156 - SAN RAFFAELE SCIENTIFIC INSTITUTE Mathematical modeling and computational simulations predicted that two different system perturbations would abolish oscillations, constrain p65 in the nucleus and result in opposite functional consequences of p65 transcriptional activity. Leptomicyn and Cycloheximide (LMB and CHX) used to mimic high IKK inactivation rate and low IkBα synthesis rate, respectively showed constitutive nuclear localization while p65 mobility increased with LMB and decreased with CHX suggesting different transcriptional activities. Indeed, expression of NF-κB target genes was either inhibited (LMB) or profoundly enhanced (CHX) suggesting that NF-κB oscillations encode specific cellular signaling information. These results suggest that the oscillatory mode of NF-κB action may be a cellular trade-off between efficient pulses of expression and the need for NF-κB to monitor the signaling status for several hours to tune optimal transcriptional responses (figure 17). Alessandra Agresti BIOLOGY OF MYELIN UNIT Genesis and maintenance of myelin We have a long-standing interest in myelin, the sheath that enwraps larger axons in the nervous system to permit rapid conduction of impulses and guarantee axonal health. We have explored the role of axonal signals, adhesion and transcriptional regulation in myelination. In particular, we have exploited inherited neuropathies, which reveal important determinants of myelin formation. Recently, we have produced/studied seven mouse models of Myelin Protein Zero (MPZ) neuropathies that cause widely varying neuropathy phenotypes in patients. Mice overexpressing wildtype P0 develop congenital hypomyelination; mice expressing P0 with a myc-epitope tag at the amino terminus unexpectedly model two more severe subtypes of CMT1B neuropathy; and mice expressing P0 with any of five known human MPZ mutations model CMT1B or Congenital Hypomyelination Neuropathy. We validated these preclinical models (figure 18 shows onion bulbs and demyelination in peripheral nerve of MpzS63del mice), confirmed that the mutations operate through gain of function, and showed that the mutant proteins have their ‘toxic’ effect from various locations in the Schwann cell, many times away from myelin itself. For example, in MpzS63del mice, mutant P0 is retained in the endoplasmic reticulum and activates protein quality control pathways in myelinating Schwann cells of peripheral nerve. Our recent data suggest that protein quality control unintentionally alters translation of myelin proteins or impairs proteasome degradation of myelin proteins, thereby impairing myelin stability in CMT nerves. More recently, we have strong evidence that endoplasmic reticulum stress activates inappropriate dedifferentiation of myelinating Schwann cells—this could explain the developmental defect seen in S63del nerves. Another mutant P0 protein, P0Q215X, may be mistrafficked to the surface of Schwann cells where it may interfere with appropriate signals from its extracellular matrix. Finally, P0S63C may form disulfide bonded dimers in trans in the myelin sheath, altering the fluidity of the myelin sheath. These continuing studies reveal both the pathogenesis of neuropathy, and biological clues about the normal genesis and maintenance of myelin. Lawrence Wrabetz Figure 18. Onion bulbs and demyelination in peripheral nerve of MpzS63del mice DIVISION OF GENETICS AND CELL BIOLOGY - 157 BIOMOLECULAR MASS SPECTROMETRY UNIT Technological innovations have driven research in proteomics from single protein characterization to global approaches, aiming to achieve a comprehensive qualitative and quantitative description of complex molecular mechanisms. In this frame, we are developing novel approaches that can be applied to proteome analysis of cells under physiological and pathological states. During 2009 we investigated how post-translational modifications affect protein function. In particular, to gain insights into the interconnection of the SUMO and the ubiquitin-proteasome pathway, we have studied, by a SILAC based quantitative approach, the effect of proteasome inhibition on SUMO-conjugated proteins. 193 potential SUMO-1 substrates were identified, 78 of which are upregulated upon proteasome inhibition. Among these, Histone H1, Histone H3 and p160 myb binding protein 1A have been further characterized as novel SUMO-1 substrates. Moreover, the analysis of the nature of the SUMO-1 targets identified strongly indicates that sumoylation regulates the maintenance of nucleolar integrity acting in coordination with the ubiquitin-proteasome system (Matafora V. et al 2009). One of the major challenges in the proteomic study of phosphorylation is the enrichment of substoichiometric phosphorylated peptides from complex mixtures. We have developed a novel TiO2 coated matrix assisted laser desorption ionization plate that enables an efficient purification of phosphopeptides from complex mixtures (Torta F. et al 2009). This new active surface is able to bind and enrich phosphopeptides from complex mixtures and make them detectable for a standard MALDI-MS or MALDI-MS/MS analysis. The compatibility with a MALDITOF/TOF instrument could open the perspective of using it for the identification of phosphosites in complex biological samples while its ability to retain also other kind of phosphorylated biomolecules could open a new way of studying phospholipids. Angela Bachi Figure 19. SUMO-1 relocalization after MG132 treatment GENE EXPRESSION UNIT The rapidly expanding information on the structural and functional characteristics of the human genome allows the development of genome-wide approaches to the understanding of the molecular circuitry wiring stem cell genetic and epigenetic programs. Transcription factors regulate gene expression and shape the epigenetic state of chromatin by recruiting DNA methylation and histone modification complexes, playing essential roles during commitment and fate determination. Most genome-wide studies on gene expression programs and epigenetic chromatin modifications come from easy accessible, homogeneous cell lines. Little is known on rare stem cells that are defined only retrospectively by the nature of their progeny in culture or transplantation assays. We recently provided proof of principle for the use of retroviruses as genome “scanners” for active genes and regulatory sequences, by deep sequencing analysis “integromes” in CD34+ human stem-progenitor cells. We showed that retroviral vectors integrate in promoters, enhancers and other regions enriched in cell-type specific subsets of transcription factor binding sites, and proposed that the viral integrase tethers pre-integration complexes to transcriptionally active regulatory regions by binding to general components of the Pol II complex. We are currently applying retroviral scanning to the analysis of the genetic programs of human hematopoietic, neural and epithelial stem cells. Control of translation plays a critical role in development, growth, and differentiation. In eukaryotes, translation is mainly regulated at the level of initiation. The Wbscr1 gene encodes the eIF4H initiation factor. The human homolog of Wbscr1 is on chromosome 7, in a region commonly deleted in patients affected by the 158 - SAN RAFFAELE SCIENTIFIC INSTITUTE Williams-Beuren Syndrome (WBS). We have generated knock-out mutant mice for Wbscr1, which are characterized by dwarfism, reduced fertility and impairment of sensorimotor coordination and cognitive functions, as in WBS patients. To identify genes regulated at translational level by Wbscr1 we are performing micro array profiling on total and polysomal mRNAs from embryonic fibroblasts and liver of wild-type and null mice, a starting point to clarify the functions of this gene in human physiology and pathology. Fulvio Mavilio GENETICS OF COMMON DISORDERS UNIT The large number of recently published GWAS has shown that only few common variants are implicated in determining the risk for complex disorder and that they only explain a small fraction of the genetic risk. Among the cohorts used, the isolated populations appear particularly useful also in view of future approaches aimed at the search for less common variants, expected to increase the risk in carriers at a substantially higher rate. We have completed the first data collection of the isolated population of Val Borbera in North West Italy, including clinical data, with information on most common disorders and more than 60 serum and urine traits, genealogical and genotyping data. This has allowed a large set of association and linkage analysis and identified a number of new loci that have been replicated in different populations, in Italy, within the Italian Network of Genetic Isolates (INGI) and in Europe, confirming the power of the special genetics of the population isolates. The availability of genotyping data has also allowed the group to participate to several large consortia for meta analysis of blood cells traits and iron, reproductive traits, urine and uric acid, blood pressure, thyroid disorders and others. The genetics of premature ovarian failure (POF) is the second main topic of the unit. The association of the DIAPH2 gene variants to POF was confirmed. A major role for the DIAPH2 gene in follicular maturation was demonstrated by the finding that DIAPH2 is the main determinant of the cytoskeleton rearrangements induced by FSH, The study of the POF in Val Borbera has highlighted new loci, including one in the Major Histocompatibility Complex on chromosome 6 that would very well explain the common finding of association of POF and autoimmunity. Replicas of the results are ongoing using the other INGI populations as well as our large Italian POF case-control cohort. Daniela Toniolo MOLECULAR BASIS OF POLYCYSTIC KIDNEY DISEASE UNIT Unraveling the function of polycystin-1, the protein most commonly altered in Polycystic Kidney Diseases The nephron is the filtering unit of the kidney and is formed by the glomerulus and the renal tubule. The diameter of the tubule needs to be tightly controlled for its proper function. Polycystic Kidney Diseases (PKD), is a class of pathologies characterized by abnormally enlarged tubules eventually causing renal failure. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common form of PKD and a very frequent genetic disease affecting 1:1000. ADPKD is caused by mutations in either the PKD1 (in 85% of cases) or the PKD2 genes (in 15%) encoding for Polycystin-1 (PC-1), a large plasma membrane receptor, and Polycystin-2 (PC-2), a calcium channel, respectively. Our major interest is on studying the normal function of PC-1. In the past we had found that PC-1 is a multi-tasking receptor involved in regulating several signaling cascades. PC-1 induces cell-cycle arrest in the G0/G1 phase of the cell cycle and concomitantly resistance to apoptosis. We have identified a novel domain in the PC-1 C-terminal tail, a polyproline motif mediating an interaction with Src homology domain 3 (SH3). A screen for interactions using the PC-1 C-terminal tail identified the SH3 domain of nephrocystin-1 (NPHP1) as a potential binding partner of PC-1. NPHP1 is the product of a gene that is mutated in a different form of renal cystic disease, nephronophthisis (NPHP). We performed in vitro pull-down assays and NMR structural studies to confirm the interaction between the PC-1 polyproline motif and the NPHP1 SH3 domain. Furthermore, the two full-length proteins interact through these domains; using a novel model system allowing us to track endogenous PC-1, we have confirmed the interaction between the endogenous proteins. Finally, we have fund that NPHP1 trafficking to cilia does not require PC-1 and that PC- DIVISION OF GENETICS AND CELL BIOLOGY - 159 1 requires NPHP1 to regulate resistance to apoptosis, but not to regulate cell cycle progression. Our data uncover a link between two different ciliopathies, ADPKD and NPHP, supporting the notion that common pathogenetic defects underlie renal cyst formation. Alessandra Boletta MOLECULAR GENETICS UNIT Characterization of the Prep1 gene. We have characterized the apoptotic phenotype of Prep1. In the hypomorphic mice, apoptosis is due to the absence of the anti-apoptotic gene Bcl-Xl, whereas under Prep1 overexpression apoptosis depends on the increase of p53, which is a direct target of Prep1. We have demonstrated that Prep1 is a novel tumor suppressor. Indeed, Prep1 hypomorphic mice develop spontaneous tumors and the haploinsufficiency of the Prep1 allele increases the death rate of EmuMyc transgenic myce. This appears to be true also in man, since over 30% of the over thousand tumors do not express Prep1 (unlike the normal tissue) whereas 40% expressed it at very low level. Characterization of the uPAR function. We have demonstrated that uPAR KO mice have an hematopoietic phenotype. In particular, they are unable to mobilize hamatopoietic stem cells upon treatment with 5-FU or with GCSF. This phenotype is linked to a retention function of uPAR in the bone marrow that is released upon activation of plasmin and solubilization of uPAR. Retention is affected by uPAR through the interaction with the α4β1 integrin (VLA-1). In virtue of this deficiency, mice treated with 5-FU succumb rapidly, unlike wild type. uPAR is also involved in the formation of primary tumors, since uPAR Ko mice are protected in a skin carcinogenesis protocol. In this protocol, formation of primary papillomas, degeneration into squamous cells carcinoma and formation of metastasis is strongly and independently reduced. Therefore, uPAR is required for the formation of tumors, the malignant conversion and for their metastatic activity. An important basis for this phenotype is the inability of the uPAR Ko skin stem cells to maintain the skin homeostasis under stress conditions. Indeed the hair follicles stem cells are unable to respond to proliferative stimuli. The molecular mechanisms involved are now under investigation. Francesco Blasi Figure 20. Apoptosis in E9.5 wt embryos (left) and Prep1i/i embryos (right), TUNEL reaction, whole mount. MOLECULAR DYNAMICS OF THE NUCLEUS As members of the Molecular Genetics unit we have characterized the apoptotic phenotype linked to the depletion of Prep-1 (an homeobox-containing transcription factor), using mouse embryo fibroblasts from Prep-1 hypomorphic mutant mice as a model system. We found that the Bcl-x gene is a direct transcriptional target of Prep-1 and its downregulation affecs mitochondrial hoemeostasis and the apoptotic phenotyps of cells.As Mol- 160 - SAN RAFFAELE SCIENTIFIC INSTITUTE ecular dynamics of the nucleus group we have characterized the effect of the overexpression of Prep1 in human cells. The Prep-1 gene is located on chromosome 21 and cells from Down Syndrome patients “naturally” overexpress it. In parallel, we have also used a murine experimental model of Prep-1 overexpression. We found that p53 is a direct transcriptional target of Prep-1 in overexpressing cells, which, in turn, are more sensitive to apoptosis-inducing treatments (i.e. genotoxic stress) in both experimental systems. Finally, we have identified novel nuclear structures called “poised transcription factories”, characterized by the presence of transcriptionally competent, but inactive, genes and by the presence of the initiating form of RNA polymerase II, typically phosphorylated at serine 5 of the C-terminal domain. Such structures allow the “hosted” genes to rapidly respond to transcription-triggering stimuli. Interestingly, our results also show that transcription occurs independently of the position of the active gene relative to the chromosome territory to which it belongs and contribute to elucidate the functional organization of the nucleus. Massimo Crippa NEUROGLIA UNIT Schwann cells myelinate peripheral nerves, and contribute to neuronal development, differentiation, integrity and regeneration. Laminins, their receptors and the signals that they activate are required for many of these functions. Indeed mutations in genes coding for laminins or components of laminin receptor complexes cause hereditary neuropathies such as Merosin Deficient Congenital Muscular Dystrophy 1A, CMD1A, α dystroglycanopathies and Charcot-Marie-Tooth 4F. One of the processes affected in the absence of laminins is axonal sorting, the process by which large axons to be myelinated are segregated by a single Schwann cell. Using the Cre/LoxP system we have identified two α/β1 integrins and dystroglycan as the receptors important for radial sorting. All these are laminin receptors, so experiments are underway to determine if they bind to different laminins present in the Schwann cell basal lamina, and if they activate different signaling pathways. One signaling pathways that we had identified is the small RhoGTPase Rac1. We are using primary co-coltures of sensory neurons and Schwann cells and proteomics to identify Rac1 effectors relevant to myelination. It is known that neuropathies due to laminin deficiency also have abnormal folding of myelin and short myelin segments (internodes). This in turn leads to myelin instability and reduced nerve conduction velocity. We have shown that this is due to lack of adhesion to α6β4 integrin and dystroglycan. In addition, regulated proteolysis of dystroglycan by gelatinases (metalloproteinases 2 and 9) has a physiological role in organizing polarized compartments in the myelin segment. In hereditary and acquired neuropathies, metalloproteinases 2 and 9 are up-regulated, dystroglycan cleavage is augmented, and we showed that this can contribute to the formation of impaired myelin segments. Interestingly, this can be corrected by inhibiting cleavage of dystroglycan in vitro. We are now exploring if inhibition of this activity in vivo can be beneficial in animal models of neuropathies. Thus, laminin receptors have important and diverse function in peripheral nerves, which are relevant to the pathogenesis of neuromuscular diseases. Maria Laura Feltri REGULATION OF IRON METABOLISM UNIT The aim of our research is to unravel the systemic iron regulation in mammals and the molecular pathogenesis of genetic iron disorders leading to both iron deficiency and overload. The key iron hormone hepcidin is upregulated in iron overload by a bone morphogenetic protein (BMP6)-SMAD-dependent pathway that uses as co-receptor the hemochromatosis protein hemojuvelin. Hepcidin expression is also increased by an IL-6STAT3-dependent pathway in inflammation. Hepcidin expression is suppressed in iron deficiency/hypoxia by multiple and partially understood mechanisms. The liver serine protease matriptase-2, encoded by TMPRSS6, is a powerful hepcidin inhibitor, since TMPRSS6 inactivation leads to iron deficiency because of high hepcidin levels both in mice and in humans. We have shown that matriptase-2 cleaves membrane hemojuvelin into proteolytic fragments and that this cleavage is suppressed in TMPRSS6 mutants lacking or mutated in the serine DIVISION OF GENETICS AND CELL BIOLOGY - 161 protease domain. Matriptase-2 knock down by morpholino oligos in zebrafish causes anemia with high hepcidin levels, whereas the expression of matriptase-2 mutants results in a small anemic embryo, confirming the matriptase-2 role in iron metabolism and indirectly its interaction with hemojuvelin. Matriptase-2 physically interacts with hemojuvelin through its ectodomain and the interaction is preserved in mutants devoid of the serine protease domain. We have defined the molecular mechanisms of mutants TMPRSS6 that occur outside the serine protease domain, showing in in vitro systems that they are either unable to reach the cell surface and retained into the ER or unable to undergo auto-activation, as measured by the ability to release the serine protease domain in the culture media. In a Tmprss6-deficient mouse model we have shown that Tmprss6-haploinsufficiency confers susceptibility to iron deficiency in conditions of increased iron requests or following restriction of dietary iron, suggesting that heterozygous TMPRSS6 mutations may predispose patients to iron deficiency. Our results are relevant to understand the molecular pathogenesis and to implement innovative treatments of the two opposite disorders of iron metabolism: hemochromatosis and iron refractory iron deficiency anemia (IRIDA). Clara Camaschella MOLECULAR GENETICS OF RENAL DISORDERS UNIT Our interest is to understand the role of uromodulin in renal function and in chronic diseases of the kidney. Uromodulin is the most abundant protein found in urine. It is exclusively expressed by epithelial cells lining the thick ascending limb of Henle’s loop segment of the kidney nephrons and it plays a protective role against urinary tract infections (Bates et al., 2004) and calcium oxalate crystals-induced urothelial damage (Mo et al., 2004). We have been studying the molecular mechanisms that regulate uromodulin shedding and polymerization. We demonstrated that uromodulin is released in the urine through a conserved proteolytic cleavage (Santambrogio et al., 2008). Additionally, we recently demonstrated a functional link between protein cleavage and polymerization. Indeed, we identified two conserved motifs that play an inhibitory role of protein assembly. Proteolytic cleavage separating one of the two motifs from the mature monomer is needed to allow protein polymerisation into filaments (Schaeffer et al., 2009). Mutations in uromodulin lead to Medullary Cystic Kidney Disease/Familial Juvenile Hyperuricemic Nephropathy (MCKD/FJHN), that are autosomal dominant kidney diseases characterized by alteration of urinary concentrating ability, frequent hyperuricemia, tubulo-interstitial fibrosis, cysts at the cortico-medullary junction and renal failure. Through studies in transfected cells we demonstrated that mutations in uromodulin lead to ER retention of mutant protein (Rampoldi et al., 2003; Bernascone et al., 2006). This is consistent with the presence of uromodulin aggregates within the cytoplasm of tubular cells in kidney biopsies of MCKD/FJHN patients (Dahan et al., 2003; Rampoldi et al., 2003) and the dramatic reduction of protein levels in patient urine (Dahan et al., 2003). Luca Rampoldi 162 - SAN RAFFAELE SCIENTIFIC INSTITUTE Clinical Research Units DENTO-FACIAL HISTOPATHOLOGY UNIT Our activity focused on biological features and clinical applications of bone substitutes in grafting procedures and dental implants to allow implant-proshtodontics oral rehabilitations in edentulous patients. The integration of grafted materials with the host tissue can initiate regenerative, inflammatory and apoptotic response. Since molecular mechanisms exist at the basis of such response, we studied, by immunohistochemical analyses, the expression of proteins involved in the graft integration process, in parallel to clinical and histological modifications, occurring on sites treated with extraoral autologous bone graft deriving from the parietal region of the calvaria (eAB), intraoral autologous bone graft deriving from mandibular ramus (iAB) and heterologous bone graft from swine (hB) in human patients. In our study, the immunohistochemical expression of BSP, VEGF, eNOS in eAB samples was significantly higher (p < 0.05) compared to values recorded in iAB and hB samples. The inflammatory response, investigated by iNOS expression, was found lower in all autologous samples (eAB and iAB) compared to hB, at statistically significant values. Moreover, the expression of the proapoptotic molecule, Bax, resulted significantly lower (p < 0.05) in eAB than in iAB and hB samples. These values, together with the low number of apoptotic cells detected in autologous samples, suggest a good regenerative response when extraoral autologous bone graft is used in comparison to the response from the other grafts, and also suggest the use of calvaria graft as a predictable therapeutic procedure for repairing severe bone defects in oral and maxillofacial surgery, not only by clinical and biomechanical criteria, but also from a biomolecular aspect. Moreover, we studied bone substitutes, in particular magnesium-enriched hydroxyapatite (MHA) and calcium sulfate (CS): they could allow bone grafting procedures with minimally invasive procedures. In clinical studies by radiological, histological and histomorphometric examinations (percentages of mean vital bone, connective tissue and residual grafting material), both biomaterials, in particular MHA, demonstrated bone regeneration features to allow predictable implant positioning and oral rehabilitations (figure 21). Furthermore, we studied MHA biological features in bone regeneration by ex vivo osteoblast expansion and highly sensitive gene expression profiling by real-time reverse transcriptase polymerase chain reaction (RT-PCR). In 25 bone specimens obtained from 15 patients, we demonstrated that gene expression profiling of an array of osteoblast specific genes is effective in certifying osteoblast identity and function. Thus, we applied these findings in testing dental implants with innovative protocols: ‘platform switching’ implants, immediate loading in postextraction infected sites, implants in regenerated bone. In these studies, from January to December 2009, we totally placed 444 implants in 147 patients, with a cumulative survival rate of 98,4%. Enrico Gherlone Figure 21. The graft material particles (GM) appeared wellincluded and showed continuity with the new bone (NB) tissue and deposition of osteoid matrix DIVISION OF GENETICS AND CELL BIOLOGY - 163 GENOMICS OF RENAL DISEASES AND HYPERTENSION UNIT Genomics and pharmacogenomics of complex renal diseases Hypertension. Further analysis of our GWAS on salt-sensitive hypertension allowed to detect Myosin XVI, a non conventional myosin, significantly associated (p= 5.20E-06) to both systolic and diastolic blood pressure. Evaluating the effects of a low sodium diet, we discovered the determinant role of NEDD4L and CYP11B2 genotypic combinations. Pharmacogenomics. A new anti-hypertensive drug, rostafuroxin, selectively inhibits the effect of Endogenous Ouabain (EO) and 460Trp mutated α-adducin (ADD1). The anti-hypertensive effect was markedly influenced by an allele combination (profile) of genes previously selected. The fall in SBP with rostafuroxin was -18.5; -23; -17 mmHg in three different profiles, in placebo group was -2.0; -1.1 and -2.8 mmHg respectively. 23, 26 and 45% of total hypertensive population is included in the profiles. No profile effect was detected on the BP fall after losartan or diuretic treatment. Chronic Kidney Disease. CKD progression displays great individual variability. Patients can be slow or rapid progressors. Genes involved in hypertension have been evaluated in patients with CKD. ADD1 and ADD2 play a role in the natural history of ADPKD toward end stage disease by influencing the cyst formation. ACE and ADD2 affect proteinuria in chronic kidney disease and IgA nephropathy and, interacting with NCX1, display protective effects. ADD1 and ADD2 variants have a predictive role on time to re-stenosis in renal artery stenosis. Acute Renal Failure. ARF is a frequent postoperative complication of major surgery and an independent risk factor of perioperative mortality. A correlation between EO and GFR was observed identifying EO as a new biomarker of renal damage. Does plasma EO level increase precede or cause ARF? Since catecholamines and NT-proBNP have a delayed increase compared to that of EO, we conclude that EO levels could be influenced by acute circulating volume expansion. Calcium kidney stone disease. Polymorphisms of the calcium sensing receptor (CASR) gene located in the regulatory region were associated to stones in idiopathic stone formers and in patients with primary hyperparathyroidism. Kidneys of normal subjects carrying variant alleles of these SNPs had lower CASR mRNA content suggesting a predisposition to stone production. Paolo Manunta TISSUE ENGINEERING AND BIOMATERIALS Tissue engineering and analysis for osteo-cartilaginous, meniscal and tendon tissue One of the main goals of our group is the development of an engineered osteochondral composite for the repair of the cartilage lesion. In our studies, we focused on engineering in vitro a biphasic composite made of cellular cartilage scaffold and an osteo-bio-compatible material. Our studies have demonstrated the potential of a gross integration between the two components and a cartilage-like quality of the newly formed matrix. In collaboration with other laboratories, we are testing different biomaterials as scaffold for the reparative cells. One important aim of our research is also the importance of the in vivo maturation of the engineered cartilage. In fact, the effect of the passage from in vitro to in vivo and the in vitro prolongation of the culture time before the implantation represent important issues in the tissue engineering field. A series of studies are on their way for the analysis of the effects of using fresh or expanded cells or the addition of growth factors in the culture medium. We are also started a series of experiments with the attempt of characterizing the meniscal cells having the ultimate goal of developing an engineered meniscal substitute. We have demonstrated the presence of at least three cell lines within the meniscus tissue and a different biochemical composition in the young and adult 164 - SAN RAFFAELE SCIENTIFIC INSTITUTE meniscus. We have also started a series of experiments with the goal of create a tissue engineered tendon. Tendons do not repair spontaneously in the acute or chronic ruptures. We believe that a tendon engineered in vitro with a biological scaffold seeded with autologous fibroblasts could represent an important solution. As possible cell source we have tested tendon, ligament, and derma. We have also started a series of tests for the creation a lesion model in the rabbit patellar tendon. This would allow to test in vivo the efficacy of the engineered tendon for repairing lesion defect in vivo. Giuseppe M. Peretti DIVISION OF GENETICS AND CELL BIOLOGY - 165 Selected publications 9 Bianchi, G; Oliva, L; Cascio, P; Pengo, N; Fontana, F; Cerruti, F; Orsi, A; Pasqualetto, E; Mezghrani, A; Calbi, V; Palladini, G; Giuliani, N; Anderson, KC; Sitia, R; Cenci, S. The proteasome load versus capacity balance determines apoptotic sensitivity of multiple myeloma cells to proteasome inhibition. Blood: 2009; 113(13): 3040-3049 - Article IF 2008: 10,432 9 Bianchi, ME; Manfredi, AA. Dangers in and out. Science: 2009; 323(5922): 1683-1684 - Review IF 2008: 28,103 9 Camaschella, C. BMP6 orchestrates iron metabolism. Nature Genet.: 2009; 41(4): 386-388 - Review IF 2008: 30,259 9 Distefano, G; Boca, M; Rowe, I; Wodarczyk, C; Ma, L; Piontek, KB; Germino, GG; Pandolfi, PP; Boletta, A. Polycystin-1 regulates extracellular signal-regulated kinase-dependent phosphorylation of tuberin to control cell size through mTOR and its downstream effectors S6K and 4EBP1.. Mol. Cell. Biol.: 2009; 29(9): 23592371 - Article IF 2008: 5,942 9 Gow, A; Wrabetz, L. CHOP and the endoplasmic reticulum stress response in myelinating glia. Curr. Opin. Neurobiol. : 2009; 19(5): 505-510 - Article IF 2008: 8,102 9 Manunta, P; Ferrandi, M; Bianchi, G; Hamlyn, JM. Endogenous ouabain in cardiovascular function and disease.. J. Hypertens.: 2009; 27(1): 9-18 - Review IF 2008: 5,132 9 Matafora, V; D’Amato, A; Mori, S; Blasi, F; Bachi, A. Proteomics analysis of nucleolar SUMO-1 target proteins upon proteasome inhibition.. Mol. Cell Proteomics: 2009; 8(10): 2243-2255 - Article IF 2008: 8,834 9 Micali, N; Ferrai, C; Fernandez-Diaz, LC; Blasi, F; Crippa, MP. Prep1 directly regulates the intrinsic apoptotic pathway by controlling Bcl-XL levels. Mol. Cell. Biol.: 2009; 29(5): 1143-1151 - Article IF 2008: 5,942 9 Nigro, EA; Brini, AT; Soprana, E; Ambrosi, A; Dombrowicz, D; Siccardi, AG; Vangelista, L. Antitumor IgE adjuvanticity: key role of Fc epsilon RI. J. Immunol.: 2009; 183: 4530-4536 - Article IF 2008: 6,000 9 Rubartelli, A; Sitia, R. Chemo-metabolic regulation of immune responses by Tregs. Nat. Chem. Biol.: 2009; 5(10): 709-710 - Short Survey IF 2008: 14,612 9 Schaeffer, C; Santambrogio, S; Perucca, S; Casari, G; Rampoldi, L. Analysis of uromodulin polymerization provides new insights into the mechanisms regulating ZP domain-mediated protein assembly. Mol. Biol. Cell: 2009; 20(2): 589-599 - Article IF 2008: 5,558 9 Silvestri, L; Guillem, F; Pagani, A; Nai, A; Oudin, C; Silva, M; Toutain, F; Kannengiesser, C; Beaumont, C; Camaschella, C; Grandchamp, B. Molecular mechanisms of the defective hepcidin inhibition in TMPRSS6 mutations associated with iron-refractory iron deficiency anemia. Blood: 2009; 113(22): 5605-5608 - Article IF 2008: 10,432 9 Sung, MH; Salvatore, L; De Lorenzi, R; Indrawan, A; Pasparakis, M; Hager, GL; Bianchi, ME; Agresti, A. Sustained oscillations of NF-κB produce distinct genome scanning and gene expression profiles. PLoS ONE: 2009; 4(9): e7163 - Article IF 2008: No Impact Factor 9 Traglia, M; Sala, C; Masciullo, C; Cverhova, V; Lori, F; Pistis, G; Bione, S; Gasparini, P; Ulivi, S; Ciullo, M; Nutile, T; Bosi, E; Sirtori, M; Mignogna, G; Rubinacci, A; Buetti, I; Camaschella, C; Petretto, E; Toniolo, D. Heritability and demographic analyses in the large isolated population of val borbera suggest advantages in mapping complex traits genes. PLoS ONE: 2009; 4(10): art. no. e7554 - Article IF 2008: No Impact Factor 9 Yanai, H; Ban, T; Wang, Z; Choi, MK; Kawamura, T; Negishi, H; Nakasato, M; Lu, Y; Hangai, S; Koshiba, R; Savitsky, D; Ronfani, L; Akira, S; Bianchi, ME; Honda, K; Tamura, T; Kodama, T; Taniguchi, T. HMGB proteins function as universal sentinels for nucleic-acid-mediated innate immune responses. Nature: 2009; 462(7269): 99-103 - Article IF 2008: 31,434 166 - SAN RAFFAELE SCIENTIFIC INSTITUTE Biology of myelin Unit Biomolecular mass spectrometry Unit Molecular basis of polycystic kidney disease Unit NeuroGlia Unit Molecular genetics of renal disorders Unit Tissue engineering and biomaterials CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS - 167 CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS Director: Giorgio Casari * Research Units Neurogenomics Unit HEAD OF UNIT: Giorgio Casari* RESEARCHER: Giovanni Lavorgna POST-DOCTORAL FELLOWS: Laura Cassina**, Francesca Maltecca**, Michela Riba, Riccardo Vago** PHD STUDENT: Loredana Leo** FELLOWS: Laura Corti, Sara Cottonaro TECHNICIANS: Maurizio De Fusco, Celia Pardini Theoretical biology GROUP LEADER: Riccardo Fesce Organelle biogenesis and motility Unit HEAD OF UNIT: Maria Vittoria Schiaffino POST-DOCTORAL FELLOWS: Rosa Lucia D’Ambrosio, Tiziana Daniele, Ilaria Palmisano PHD STUDENT: Angela Palmigiano** Genomic Unit for the diagnosis of human pathologies HEAD OF UNIT: Maurizio Ferrari* RESEARCHERS: Annapaola Andolfo, Sara Benedetti, Paola Carrera, Laura Cremonesi, Isabella Fermo, Vito Lampasona PHD STUDENT: Angela Brisci** FELLOWS: Viviana Bornaghi, Francesca Bruno, Emanuela Castiglioni, Vincenza Causarano, Chiara Di Resta, Alessandra Foglio, Silvia Galbiati, Carlo Lombardoni, Chiara Redaelli, Francesca Rigo**, Elena Sommariva, Stefania Stenirri, Daniele Zeni TECHNICIANS: Rose Mary Carletti, Cinzia Magagnotti, Nadia Soriani Proteome biochemistry Unit HEAD OF UNIT: Massimo Alessio POST-DOCTORAL FELLOWS: Barbara Comuzzi, Valeria Corti PHD STUDENTS: Carlo Vittorio Cannistraci, Stefano Olivieri** FELLOWS: Sara D’Annibale, Cristina Sensi TECHNICIAN: Antonio Conti Biomolecular NMR laboratory (Dulbecco Telethon Institute) GROUP LEADER: Giovanna Musco POST-DOCTORAL FELLOWS: Massimiliano Gaetani, Michela Ghitti, Silvia Mari, Luca Mollica, Andrea Spitaleri PHD STUDENTS: Francesca Chignola, Valeria Mannella, Dmitrios Spiliotoupulos, Chiara Zucchelli FELLOWS: Giacomo Quilici, Maria Elena Sana * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 168 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Director Mission and vision - We want to become an internationally recognized center in genomics, bioinformatics and biostatistics that, by taking advantage of the excellent clinical environment coupled to outstanding basic science, will allow the Institute as a whole to advance towards integrative translational research. The Center will act as a catalyst for innovative research projects by complementing existing research lines across the Institute with high throughput technologies, quantitative methods, and powerful data mining approaches. Organization - At present five research units are included in the CGBB. All units focus on the molecular pathogenesis of diseases from different and Giorgio Casari original points of view: from organelle perspectives (Neurogenomics and Organelle Biogenesis and Motility Units), intimate protein-ligand interaction and metabolomics (Biomolecular NMR spectroscopy Unit), proteome (Proteome biochemistry Unit), molecular diagnosis of diseases (Genomic Unit for the Diagnosis of Human Pathologies). Common to all the units affiliated to the Center is the interest and involvement in developing bioinformatics and -omics approaches as an inherent approach within their fields of investigation. Goals - The overall goal of the center will be to provide HSR the skills and capacity to deliver high quality genomics, bioinformatics and biostatistics research and support. This will be achieved by aggregating research groups already operating in these fields as well as investing in the technologies required. In this light the main objectives of the Center for Genomics, Bioinformatics and Biostatistics are: • To create synergies across and beyond HSR allowing research groups at HSR to integrate -omics approaches in current and future research. • To produce original, high-impact research. • To enhance research conducted at HSR by providing support to research groups through a genomics/bioinformatics/biostatistics core facility. Achievements - CGBB Research Units have developed projects and expertise to deal with specific computational biological problems. The Neurogenomics Unit is involved in the parallel analysis of the mitochondrial transcriptome and proteome, as well as the systematic analysis of large non-coding RNAs, and the next generation sequencing of whole critical regions of Mendelian forms of disease. The Biomolecular NMR Spectroscopy Unit is tackling the need for fast, robust, and reliable methods for sampling molecular 3D conformations by developing an innovative computational application to sample conformations of flexible ligands. Also, this Unit is working on the characterization of receptor-ligand molecular interactions in their natural membrane environment using a ligand based NMR method. High resolution 2D and 3D electrophoretic systems are routinely used for the identification of proteins differentially expressed in different pathological and physiological conditions by the Proteome Biochemistry Unit, which developed a computational method for complex protein systems analysis. The Genomic Unit for the Diagnosis of Human Pathologies is involved in the development of a labon-chip platform integrating a PCR amplification microreactor with a customable microarray for the detection of DNA sequence variations. Mapping and dynamics of organelle movements are the main focus of the Organelle Biogenesis and Motility Unit that is applying bimolecular fluorescence complementation to enlighten protein interactions and combine this approach with correlative light-electron microscopy. Training Opportunities - The Coordinator of the Bioinformatics Core Facility will direct training and dissemination activities aimed at showcasing to the HSR community the possibilities provided by the new center. Examples of activities include: Bioinformatics Seminars, with local and invited speakers; one day workshops on specific aspects, e.g. next-generation sequencing; regular training courses. CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS - 169 Research Units NEUROGENOMICS UNIT SCA28: a disease caused by inefficient mitochondrial calcium buffering? The mitochondrial protease AFG3L2 forms homo-oligomeric and hetero-oligomeric complexes with its partner paraplegin (m-AAA proteases), which are in charge of protein quality control in the inner membrane. Mutations in AFG3L2 have been recently associated to a form of spinocerebellar ataxia (SCA28). We demonstrated that Afg3l2 haploinsufficient mouse recapitulates SCA28 phenotype, showing progressive ataxia due to dark degeneration and loss of Purkinje cells (PCs), mediated by mitochondrial dysfunction. Our hypothesis for SCA28 pathogenesis involves dysfunction of mitochondrial metabolism and inefficient Ca2+ internalization as the starting events leading to aberrant accumulation of calcium in PCs, thus mimicking excitotoxic-mediated dark degeneration. PINK1, the mitochondrial kinase associated to Parkinson’s disease Mutations of PINK1, a serine/threonine mitochondrial kinase, are responsible for a juvenile recessive form of Parkinson’s disease. The project is focusing on the characterization of the PINK1 pathways through the identification of novel specific interactors and substrates. Preliminary data arose from yeast two-hybrid screening and proteomic analysis resulted in a panel of candidates, belonging to microtubules-associated proteins, autophagic factors and proteins involved in ubiquitin degradation pathway. These potential interactions are being confirmed by different and complementary experimental strategies. Na,K ATPase and familial hemiplegic migraine Familial hemiplegic migraine (FHM) is Mendelian severe form of migraine with aura caused by mutations of the [alfa]2 subunit of the Na+/K+ pump, encoded by the ATP1A2 gene. In vitro models suggest a loss of function of FHM2 mutations. The project focuses on the characterization of two mouse models, a ATP1A2 knockin and a conditional mutants. At present, we demonstrate that cortical spreading depression (CSD), the molecular correlate of migraine aura, is facilitated in mutant mice. The astrocyte-specific expression of the [alfa]2 subunit of adult mice and the intense neuronal communication during CSD will be investigated by means of the astrocyte conditional mutant. Giorgio Casari Figure 22. Aberrant mitochondria at Afg3l2 mutant synapse 170 - SAN RAFFAELE SCIENTIFIC INSTITUTE THEORETICAL BIOLOGY 1. Characterization of the effects of microgravity (simulated absence of gravity in a random positioning machine) on the hair cell and cytoneural junction at the frog labyrinth. Potassium and calcium conductances have been dissected in dissociated ampullar hair cells and relevant changes have been observed following microgravity conditioning; then these changes have been correlated with functional changes produced by the same treatment in junctional transmission in the intact labyrinth 2. Investigation of the ionic selectivity of the nicotinic acetylcholine receptor (nAChR) at the rat sympathetic ganglion Having observed that the relative selectivity for potassium vs sudium ions was reduced by denervation, we set out to examine les drastic treatments and were able to show that simple procedures such as changing membrane potential or chloride concentrations are able to produce similar effects. This suggests that ionic selectivity may be dynamically modulated at the nAChR, with possible relevant functional consequences for synaptic efficacy Riccardo Fesce ORGANELLE BIOGENESIS AND MOTILITY UNIT The ocular albinism type 1 protein (OA1), an intracellular G protein-coupled receptor, regulates organelle biogenesis and motility in pigment cells We are focused into the study of secretory organelle biogenesis and transport in mammalian cells as alteration of these processes represents an important cause of human disease. Our experimental model is ocular albinism type 1, an X-linked disorder characterized by severe reduction of visual acuity, nystagmus, strabismus, photophobia, retinal hypopigmentation, foveal hypoplasia and misrouting of the optic tracts. The protein product of the ocular albinism gene, named OA1, is a pigment cell-specific membrane glycoprotein, displaying structural and functional features of G protein-coupled receptors (GPCRs), yet exclusively localized to intracellular organelles, i. e. lysosomes and melanosomes. Although the precise signaling pathway activated by OA1 remains unknown, examination of the skin and eyes of patients with ocular albinism reveals the presence of giant melanosomes (macromelanosomes); moreover, the analysis of Oa1-KO mouse melanocytes showed abnormal number, size and distribution of melanosomes, which are less numerous, bigger and displaced toward the cell periphery compared to wild-type melanocytes. These findings suggest that, as a resident intracellular GPCR, OA1 might be activated by an intra-luminal ligand, regulating melanosome maturation and movement by interacting with downstream effectors on the organelle membrane. Consistently, L-DOPA has been recently found to function as a ligand for OA1; however, this melanin by-product was found to activate OA1 when missorted to the plasma membrane in a heterologous overexpression system, and to bind the receptor with low affinity. Therefore, we set up an alternative assay to test for putative ligands, by taking advantage of protein-fragment complementation assays, including bimolecular fluorescence and luciferase complementation, which lead to the formation of fluorescent or enzymatic complexes, following specific interaction between two proteins under study. This method will allow to test the interaction between OA1 and the most typical effectors common to most GPCRs, G proteins and arrestins, in the physiological receptor context on intracellular organelles. Maria Vittoria Schiaffino GENOMIC UNIT FOR THE DIAGNOSIS OF HUMAN PATHOLOGIES The Unit applied advanced methodologies to molecular analysis of genes involved in several pathologies, including neurologic and neuromuscular disorders, arhythmogenic disorders, pediatric surfactant deficiency, macular degeneration, neurodegeneration, iron metabolism disorders, polycystic kidney disease, and myeloproliferative disorders. We developed high throughput SNP genotyping automated protocols and performed casecontrol association studies to correlate genome variation to disease predisposition. CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS - 171 Our approaches led to the identification of a variety of known and new sequence variations and made possible a genotype-phenotype correlation with particular respect in the field of both monogenic and multifactorial traits. We also applied new genotyping devices and methodologies, such as pyrosequencing-based assays for the identification of sequence variations in the CFTR gene and high-sensitive microarray substrates specifically designed to improve sensitivity for the identification of fetal paternally inherited sequences in maternal plasma. In the frame of the International Human Variome Project we are involved in creation and maintenance of Locus Specific Data Bases and Clinical-Molecular Data Bases aimed to realize an accurate documentation of genome variation related to disease. Our Clinical Proteomics group is working out strategies for biomarker discovery in different pathologies: prostate cancer, laminopathies, type-1 diabetes-related nephropathy, bronchopulmonary dysplasia. Our approach consists of identification of differentially expressed proteins in biological samples derived from patients. We essentially use 2D-electrophoresis, image analysis and mass spectrometry, in order to clarify molecular mechanisms of pathogenesis, indicate diagnostic tools or therapeutic targets to develop. A further area of research is aimed at the development of novel assays for detection of autoantibodies associated with autoimmune diseases. Recently new assays were developed, based on expression of recombinant autoantigens, and applied to the diagnostics of type 1 diabetes and neuromyelitis optica. In particular these allowed the study and characterization of the immune responses respectively to the Zinc Transporter 8 and Aquaporin 4 autoantigens. Maurizio Ferrari Figure 23. HRM analysis of normal (WT) and mutated samples in the FGFR3 gene. PROTEOME BIOCHEMISTRY UNIT Onco-proteomics: serological proteome analysis of colorectal carcinoma Immunologic tolerance to self-components is broken in pathologic conditions such as cancer. We performed a screening of the colorectal tumor proteoma by exploiting auto-antibodies contained in the sera of patients to identify colon specific tumoral antigens. Tumour-specific immunoreactive proteins have been found, the analysis demonstrated a modification in antigen recognition by patients B cells as a function of colon cancer progression. Autoantibodies directed against a surface metallo-protease have been found in patients, with higher frequency in patients with advanced disease. Neuro-proteomics: Protein pattern changes in cerebrospinal fluid (CSF) of neurodegenerative diseases CSF being in contact with the brain contains proteins released directly from the central nervous system following pathological conditions, thus CSF analysis is very important to understand the pathological processes and for diagnostic purpose. Differential expression proteomics analysis applied to CSF of patients with Amyotrophic Lateral Sclerosis compared to healthy subjects showed that ceruloplasmin protein expression was increased in ALS patients, in particular the asialo-ceruloplasmin isoforms. We are working on CSF from patients affected by Parkinson’s Disease. Proteins involved in the regulation of redox balance that might be a target of oxidative stress damage have been found differentially expressed showing different post-translational modifica- 172 - SAN RAFFAELE SCIENTIFIC INSTITUTE tions. Interestingly a control group of Alzheimer disease patients showed similar, but significantly less extent, modifications. Also the enzymatic function of one of the target proteins has been found impaired. Computational biology: development of computational methods for complex systems analysis We developed tools based on linear and non-linear dimensional reduction approaches followed by automatic clustering evaluation for the analysis of 2DE images aimed at the patients clustering and classification. This approach allowed us to discriminate patients affected by peripheral neuropathies with or without pain. We also developed a new filter the Median-modified Wiener filter that provides efficient denoising, preserving spot edge and morphology in 2-DE image processing. Massimo Alessio BIOMOLECULAR NMR LABORATORY We study the structure and dynamics of biomolecular complexes in solution by NMR spectroscopy in combination with a wide range of biochemical, biophysical and computational techniques.Our activity is focused on two main projects: 1) Structural characterization of the interaction of small drugs with extracellular cellular receptors; and 2) Structural and dynamic characterization of novel chromatin-interacting modules. 1. Integrin aVb3 is involved in many biological processes such as angiogenesis, inflammation, and cancer. aVb3 exerts its role interacting with proteins containing an RGD motif. Recent drug design research has therefore focused on the development of RGD-containing ligands for medical applications. A. Corti has recently shown that the isoDGR motif can compete with RGD in the binding to aVb3. By means of docking and metadynamics simulations we have characterized the interaction isoDGR-aVb3. Using ligand-based NMR techniques we have characterized the interactions isoDGR ligands with surface-receptors localized on living cells (in collaboration with Molmed) 2. Methylation of lysine residues on histone H3 tails regulates transcription. A recent addition to known methylated histone binding modules is the PHD finger. AIRE protein contains two PHD fingers and mutations in AIRE gene cause autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. AIRE promotes the expression of tissue-specific antigens in the thymus. The mechanism by which AIRE controls gene expression is currently unknown and the function of its PHD fingers is still elusive. We have characterized the three-dimensional structure of AIRE-PHD1 in complex with H3K4me0 (collaboration with P.Peterson tartu-University) providing a new link between the status of histone modifications and the regulation of tissue-specific antigen expression in thymus. We are currently characterizing PHD fingers from other transcriptional activators. The group collaborates to other projects aiming to characterize at molecular levels a) the interactions of the protein HMGB1 with CpG rich oligonucleotides (M. Bianchi) and b) the interaction of the intracellular part of PKD1 and the SH3 domain of NPHP1, two protein involved in renal genetic diseases (A. Boletta). Giovanna Musco Figure 24. Various ligand’s receptor interactions in different human cancer cell lines were probed directly by twodimensional transferred-NOE spectroscopy to prove recognition specificity and determine an affinity ranking of several ligands. CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS - 173 Selected publications 9 Bruno, F; Damin, F; Causarano, V; Galbiati, S; Di Carlo, G; Seia, M; Porcaro, L; Ferrari, M; Chiari, M; Cremonesi, L. High-sensitive microarray substrates specifically designed to improve sensitivity for the identification of fetal paternally inherited sequences in maternal plasma. Clin. Chem. Lab. Med.: 2009; 47(7): 818-823 Article IF 2008: 1,888 9 Cannistraci, CV; Montevecchi, FM; Alessio, M. Median-modified Wiener filter provides efficient denoising, preserving spot edge and morphology in 2-DE image processing. PROTEOMICS: 2009; 9(21): 4908-4919 - Article IF 2008: 4,586 9 Chignola, F; Gaetani, M; Rebane, A; Org, T; Mollica, L; Zucchelli, C; Spitaleri, A; Mannella, V; Peterson, P; Musco, G. The solution structure of the first PHD finger of autoimmune regulator in complex with non-modified histone H3 tail reveals the antagonistic role of H3R2 methylation. Nucleic Acids Res.: 2009; 37(9): 29512961 - Article IF 2008: 6,878 9 De Grandi, A; Volpato, CB; Bedin, E; Pattaro, C; Marroni, F; Pichler, I; Hicks, AA; Casari, G; Pramstaller, PP. ParkScreen: A Low-Cost Rapid Linkage Marker Panel for Parkinson’s Disease. J. Mol. Neurosci.: 2009; 39(1-2): 235-241 - Article IF 2008: 2,061 9 Innamorati, G; Giannone, F; Guzzi, F; Rovati, GE; Accomazzo, MR; Chini, B; Bianchi, E; Schiaffino, MV; Tridente, G; Parenti, M. Heterotrimeric G proteins demonstrate differential sensitivity to ß-arrestin dependent desensitization. Cell. Signal.: 2009; 21(7): 1135-1142 - Article IF 2008: 4,305 9 Maltecca, F; Magnoni, R; Cerri, F; Cox, GA; Quattrini, A; Casari, G. Haploinsufficiency of AFG3L2, the gene responsible for spinocerebellar ataxia type 28, causes mitochondria-mediated Purkinje cell dark degeneration. J. Neurosci.: 2009; 29(29): 9244-9254 - Article IF 2008: 7,452 9 Manfredi, I; Zani, AD; Rampoldi, L; Pegorini, S; Bernascone, I; Moretti, M; Gotti, C; Croci, L; Consalez, GG; Ferini-Strambi, L; Sala, M; Pattini, L; Casari, G. Expression of mutant ß2 nicotinic receptors during development is crucial for epileptogenesis. Hum. Mol. Genet.: 2009; 18(6): 1075-1088 - Article IF 2008: 7,249 9 Martinelli, P; La Mattina, V; Bernacchia, A; Magnoni, R; Cerri, F; Cox, G; Quattrini, A; Casari, G; Rugarli, EI. Genetic interaction between the m-AAA protease isoenzymes reveals novel roles in cerebellar degeneration. Hum. Mol. Genet.: 2009; 18(11): 2001-2013 - Article IF 2008: 7,249 9 Monti, L; Cinquetti, R; Guffanti, A; Nicassio, F; Cremona, M; Lavorgna, G; Bianchi, F; Vignati, F; Cittaro, D; Taramelli, R; Acquati, F. In silico prediction and experimental validation of natural antisense transcripts in two cancer-associated regions of human chromosome 6. Int. J. Oncol.: 2009; 34(4): 1099-1108 - Article IF 2008: 2,234 9 Myocardial Infarction Genetics Consortium; Kathiresan, S; Voight, BF; Purcell, S; Musunuru, K; Ardissino, D; Mannucci, PM; Anand, S; Engert, JC; Samani, NJ; Schunkert, H; Erdmann, J; Reilly, MP; Rader, DJ; Morgan, T; Spertus, JA; Stoll, M; Girelli, D; McKeown, PP; Patterson, CC; Siscovick, DS; O’Donnell, CJ; Elosua, R; Peltonen, L; Salomaa, V; Schwartz, SM; Melander, O; Altshuler, D; Ardissino, D; Merlini, PA; Berzuini, C; Bernardinelli, L; Peyvandi, F; Tubaro, M; Celli, P; Ferrario, M; Fetiveau, R; Marziliano, N; Casari, G; Galli, M; Ribichini, F; Rossi, M; Bernardi, F; Zonzin, P; Piazza, A; Mannucci, PM; Schwartz, SM; Siscovick, DS; Yee, J; Friedlander, Y; Elosua, R; Marrugat, J; Lucas, G; Subirana, I; Sala, J; Ramos, R; Kathiresan, S; Meigs, JB; Williams, G; Nathan, DM; MacRae, CA; O’Donnell, CJ; Salomaa, V; Havulinna, AS; Peltonen, L; Melander, O; Berglund, G; Voight, BF; Kathiresan, S; Hirschhorn, JN; Asselta, R; Duga, S; Spreafico, M; Musunuru, K; Daly, MJ; Purcell, S; Voight, BF; Purcell, S; Nemesh, J; Korn, JM; McCarroll, SA; Schwartz, SM; Yee, J; Kathiresan, S; Lucas, G; Subirana, I; Elosua, R; Surti, A; Guiducci, C; Gianniny, L; Mirel, D; Parkin, M; Burtt, N; Gabriel, SB; Samani, NJ; Thompson, JR; Braund, PS; Wright, BJ; Balmforth, AJ; Ball, SG; Hall, AS; Schunkert, H; Erdmann, J; Linsel-Nitschke, P; Lieb, W; Ziegler, A; Konig, IR; Hengstenberg, C; Fischer, M; Stark, K; Grosshennig, A; Preuss, M; Wichmann, HE; Schreiber, S; Schunkert, H; Samani, NJ; Erdmann, J; Ouwehand, W; Hengstenberg, C; Deloukas, P; Scholz, M; Cambien, F; Reilly, MP; Li, M; Chen, Z; Wilensky, R; Matthai, W; Qasim, A; Hakonarson, HH; Devaney, J; Burnett, MS; Pichard, AD; Kent, KM; Satler, L; Lindsay, JM; Waksman, R; Epstein, SE; Rader, DJ; Scheffold, T; Berger, 174 - SAN RAFFAELE SCIENTIFIC INSTITUTE K; Stoll, M; Huge, A; Girelli, D; Martinelli, N; Olivieri, O; Corrocher, R; Morgan, T; Spertus, JA; McKeown, PP; Patterson, CC; Schunkert, H; Erdmann, J; Linsel-Nitschke, P; Lieb, W; Ziegler, A; Konig, IR; Hengstenberg, C; Fischer, M; Stark, K; Grosshennig, A; Preuss, M; Wichmann, HE; Schreiber, S; Holm, H; Thorleifsson, G; Thorsteinsdottir, U; Stefansson, K; Engert, JC; Do, R; Xie, C; Anand, S; Kathiresan, S; Ardissino, D; Mannucci, PM; Siscovick, D; O’Donnell, CJ; Samani, NJ; Melander, O; Elosua, R; Peltonen, L; Salomaa, V; Schwartz, SM; Altshuler, D. Genome-wide association of early-onset myocardial infarction with single nucleotide polymorphisms and copy number variants. Nature Genetics: 2009; 41(3): 334-341 - Article IF 2008: 30,259 9 Sitaram, A; Piccirillo, R; Palmisano, I; Harper, DC; Dell’Angelica, EC; Schiaffino, MV; Marks, MS. Localization to mature melanosomes by virtue of cytoplasmic dileucine motifs is required for human OCA2 function. Mol. Biol. Cell: 2009; 20(5): 1464-1477 - Article IF 2008: 5,558 9 Vago, L; Perna, SK; Zanussi, M; Mazzi, B; Barlassina, C; Stanghellini, MTL; Perrelli, NF; Cosentino, C; Torri, F; Angius, A; Forno, B; Casucci, M; Bernardi, M; Peccatori, J; Corti, C; Bondanza, A; Ferrari, M; Rossini, S; Roncarolo, MG; Bordignon, C; Bonini, C; Ciceri, F; Fleischhauer, K. Loss of mismatched HLA in leukemia after stem-cell transplantation. N. Engl. J. Med.: 2009; 361(5): 478-488 - Article IF 2008: 50,017 CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS - 175 Neurogenomics Unit Genomic Unit for the diagnosis of human pathologies Proteome biochemistry Unit Biomolecular NMR laboratory CENTER FOR IMAGING - 177 CENTER FOR IMAGING Director: Carlo Tacchetti Associate Director: Alessandro Del Maschio* Clinical Research Units Clinical and experimental radiology Unit HEAD OF UNIT: Alessandro Del Maschio* PHYSICIANS: Francesco De Cobelli*, Antonio Esposito, Pietro Panizza, Massimo Venturini CONSULTANT: Claudio Losio TECHNICIAN: Tamara Canu High technology in radiation therapy Unit HEAD OF UNIT: Nadia Di Muzio PHYSICIANS: Genoveffa Berardi, Anna Chiara, Cesare Cozzarini, Aniko Maria Deli, Italo Dell’Oca, Andrei Fodor, Micaela Motta, Marcella Pasetti, Paolo Passoni, Najla Slim RESIDENT: Brigida Pappalardi TECHNICIANS: Laura Longoni, Giovannella Salvadori, Simone Selli Medical physics Unit HEAD OF UNIT: Riccardo Calandrino PHYSICISTS: Sara Broggi, Giovanni Mauro Cattaneo, Antonella Del Vecchio, Claudio Fiorino, Barbara Longobardi, Paola Mangili, Lucia Perna, Patrizia Signorotto RESEARCHERS: Veronica Ardu, Antonello Spinelli Molecular imaging Unit HEAD OF UNIT: Luigi Gianolli PHYSICIANS: Elena Busnardo, Carla Canevari, Federico Fallanca, Claudio Landoni, Patrizia Magnani, Maria Cristina Messa, Andrea Panzacchi, Maria Picchio, Ana Maria Samanes Gajate, Pietro Spagnolo, Paola Todeschini RESEARCHERS: Sara Belloli, Valentino Bettinardi, Assunta Carpinelli, Isabella Castiglioni, Maria Carla Gilardi, Mario Matarrese, Maria Grazia Minotti, Rosa Maria Moresco, Marco Rigamonti, Paola Scifo, Sergio Todde POST-DOCTORAL FELLOWS: Ioana Florea, Manuela Giglio, Valeria Masiello PHD STUDENTS: Francesca Gallivanone, Cristina Monterisi, Eugenio Rapisarda TECHNICIANS: Antonia Compierchio, Andrea Fabro, Paola Lanzoni, Carlo Pizzamiglio, Pasquale Simonelli, Francesco Sudati, Mauro Vaghi Neuroradiology research group HEAD OF UNIT: Giuseppe Scotti* GROUP LEADER: Letterio Salvatore Politi PHYSICIANS: Simonetta Gerevini, Claudio Righi, Francesco Scomazzoni, Franco Simionato FELLOW: Sara Pizzi * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 178 - SAN RAFFAELE SCIENTIFIC INSTITUTE Introduction by the Directors Mission - The mission of the Experimental Imaging Center (CIS, Centro di Imaging Sperimentale) is stratified into four different levels of intervention: • Added value to HSR campus: to harness existing imaging expertise and capabilities in the San Raffaele Scientific Institute, and develop them into a facility platform able to support the growth of multi-disciplinary research activities and speed the development of biomedical research discoveries in the campus. • Technology development: to promote and create an integrated platform for multidisCarlo Tacchetti ciplinary activity in R&D, involving biologists, chemists, physicists, computer scientists and clinician scientists, to develop tools and technologies in biomedical imaging. • Competitive biomedical research: to support independent clinical and pre-clinical research and to foster translational research. • Partnerships with private research institutions: to provide a focal point of interaction with pharmaceutical and biotechnology industries to explore Alessandro Del Maschio joint research collaborations or business ventures. Vision - CIS aims at establishing an internationally recognized leading integrated center in biomedical imaging. The goal is to foster the proper background to integrate facility, biomedical research and technology development. CENTER FOR IMAGING - 179 Clinical Research Units CLINICAL AND EXPERIMENTAL RADIOLOGY UNIT The main research projects encompass: 1) Breast Imaging. Screening and secondary oncologic prevention program of breast cancer in women of 4049 years old tailored and based on the personal risk factors. 2) Clinical trials with new contrast agents. Clinical trials on different contrast media have been conducted in evaluation of breast lesions, cardiac, coronary and vascular diseases. 3) Cardiac magnetic resonance (CMR) Imaging and Spectroscopy and cardiac Computed Tomography (CT). Understanding of pathophysiology and characterization of cardiomyopathies with gadolinium delayed-enhanced technique; evaluation of ventricular function and energy metabolism in different conditions such as different type of exercise training, obesity and fatty liver or insulin-resistance; accuracy of CT in the evaluation of coronary artery stenosis and stents with a new low dose radiation exposure technique. 4) Diffusion-weighted Magnetic Resonance Imaging. DWI provides quantitative and qualitative evaluation of gastric-esophageal, pancreatic and breast lesions, helping to differentiate between malignant and non-malignant lesions; moreover, DWI allows early information about response to chemotherapy also in patients with Gastric Esophageal Neoplasms. 5) Cellular and molecular imaging. A non-invasive MR based method for in-vivo cellular tracking has been developed and applied to cells labeling and imaging in order to follow the pancreatic islets fate, after their transplantation in mouse model of type 1 diabetes. 6) Imaging of islet transplantation in Humans. Non-invasive visualization of pancreatic islet transplantation is a major challenge. We developed new imaging techniques able to visualize labelled cells with MR and liverfocal-fatty changes with ultrasound as an early sign of altered graft function. 7) Implementation of radiotherapy planning by new imaging-techniques. Our aim has been to use different techniques such as MRI, diffusion weighted MR and 4D-CT to improve target volume definition in prostate cancer, rectal cancer and in pancreatic ductal adenocarcinoma. 8) Gastric Esophageal Tumors (GET) imaging. In the last year we focused our research on GET performing a prospective study using MR, Endoscopic-ultrasound and MDCT in evaluation of wall and nodes invasion. Alessandro Del Maschio HIGH TECHNOLOGY IN RADIATION THERAPY UNIT Prostate cancer After a median follow-up of 4 years, the incidence of biochemical relapses in the first 150 patients (pts) submitted to hypofractionated Helical Tomotherapy (HTT) with both radical and early adjuvant intent is < 5%. The gastroenteric toxicity profile is excellent, owing to the disappearance of Grade 3-4 rectal toxicity, while only < 5% patients experienced Grade 3 acute urinary toxicity. The feasibility of dose escalation up to 100-120 Gy by means of HTT to tumoral subvolumes (Dominant Intraprostatic Lesions, DILs) identified with MRI was investigated: a theoretical model indicates that is possible to escalate the dose to one or more DILs within the prostatic gland up to 100 Gy, with a risk of Grade 2-3 acute and late rectal sequelae < 5%. A multicentric, prospective, observational study investigating clinical and physico-dosimetric factors predictive of RT-induced urinary toxicity and erectile disfunction was designed and promoted by our group. The study, supported by the AIRC Grant 8784, will be conducted in the next 5 years in 20 Italian and foreign Radiotherapy Centers. Lung cancer A Phase I-II study evaluating the feasibility of PET guided hypofractionated HTT for the treatment of inop- 180 - SAN RAFFAELE SCIENTIFIC INSTITUTE erable locally advanced NSCLC delivering 52 Gy in 13 fractions (4 Gy/day) to the PET positive volume was completed, indicating that this approach is feasible and shortens the overall treatment time; moreover, HTT produces excellent toxicity profile and local control rate. Rectal cancer The feasibility of adaptive RT concomitant to CT as preoperative treatment was investigated: a precise estimate of rectal volume variations permits to better “guide” irradiation, allowing a significant tumour volume reduction and dose escalation in the second half of treatment.. Pancreatic cancer A dose-escalation study with hypofractionated HTT on CT pretreatd pts showed that the delivery of 44.25 Gy/15 fractions + CT is associated with a low rate of G3 acute toxicity and provides stabilization/improvement of local disease. CNS A thorough analysis on 373 patients treated with gamma-knife for SNC metastases from NSCLC indicated a dose > 22 Gy (single fraction) as the covariates most predictive of longer overall survival in pts decesed for cerebral progression. Nadia Di Muzio MEDICAL PHYSICS UNIT The main areas of interest of the Medical Physics Department (MPD) are the following: 1. Radiotherapy Physics The backbone of the department is the knowledge of advanced methodologies for the optimization of the radiotherapy treatments. Sophisticated treatment units such as tomotherapy and rapid-arc are continuously monitored and tuned by the senior staff of the Department. Novel treatment protocols and modalities for different cancer localization have been defined, in collaboration with the medical staff. Results have been presented at international meetings and published on peer review journals. The outcomes were monitored during patients follow up over several years. Multi-modal images were acquired before and during the treatment in order to obtain: 1) a more accurate definition of the real extension of neoplastic disease; 2) a better visualization of healthy tissues; 3) the evaluation of breathing related tumor/organ mobility (4D technology); 4) the definition of adaptive strategies to modify treatment plans. A number of investigations have been conducted evaluating the impact of multi-modal approach in treatment planning optimization for malignancies of different anatomical regions. 2. Physics for Imaging The use of monochromatic x-rays will lead to a significant dose reduction and an improvement of the image intrinsic contrast. In the next 3 years a compact inverse Compton scattering source (ICS) will be developed by INFN and HSR. The ICS will be capable to generate monochromatic x-rays beam for research and diagnostic imaging. A second research topic is the CT dose reduction and image quality optimization by using iterative image denoising and recovery algorithms. The MPD has recently to design and develop and optical imaging instrument in order to detect Cerenkov radiation (CR). The CR is a well-known phenomenon and is generated when charged particles travel through an optical transparent material with a velocity greater than light velocity in the material. We realised that a similar approach could also be applied in vivo in order to obtain small animal optical images. 3. Physics applied to Radioprotection, Laser and NMR Safety At HSR is present one of the largest Italian Nuclear Medicine Department (NMD) with two Cyclotrons for the preparation of PET radio-pharmaceuticals. The radiation protection of the NMD is carried out by the MPD staff and requires the use of the most advanced methodologies for ionizing radiation monitoring. Since the beginning of the 80s the MPD staff is also enrolled in the safety and quality assurance of Laser and NMR equipments installed at HSR. Riccardo Calandrino CENTER FOR IMAGING - 181 MOLECULAR IMAGING UNIT The main research activities are focused on: 1) Radiolabeling of ligands for in vivo PET imaging: a) activated microglia linked Translocator Protein ligand 19F-VC701; b) β amyloid complex ligand 11C-PIB and c) marker for cardiac sympathetic nervous system 11C-HED. The development of new tools for in vivo detection of angiogenesis and hypoxia and of an automatic system for the production of radiolabeled metals, such as 64/60 Cupper and 110 Indium are still ongoing. 2) Development of a) a new fully 3D iterative (OSEM) reconstruction algorithm which accounts for the Point Spread Function of PET and b) a computer-based method for Partial Volume Correction and Standard Uptake Value quantification in PET/CT oncological studies 3) Preclinical imaging activities for: a) characterization of preclinical cancer models using 18F-FDG and tracer for the in vivo imaging of hypoxia; b) 18F-FDG evaluation of a mouse model of lung cancer based on the subcutaneous implants of post surgery specimen from patients; c) in vivo characterization in rats of the effect of acute stress on the regional cerebral uptake of 18F-FDG. 4) Assessment of the role of PET/CT in staging and re-staging of different cancers, by 18F-FDG and 11CCholine, also including cost analysis evaluations. In particular, 18F-FDG PET/CT has been shown as an accurate diagnostic tool in the pre-surgical evaluation of pelvic nodes metastases in high risk endometrial cancer patients. In addition, it has been established the role of 11C-Choline PET/CT in the treatment planning of prostate cancer patients. 5) Clinical Imaging in Neuropharmacology and mathematical model were dedicated to the development of a new voxel based methods for the in vivo quantification of the activity of acetylcholine esterase in patients with dementia. 6) Prognostic value of SPECT/CTA in patients with an intermediate probability of CAD. Evaluation of a new sequential scan protocol for CTA on image quality and radiation dose with a randomized trial. Initial experience with a ultra-low-dose iodinate CM using a new high flow injection protocol in CTA. Luigi Gianolli NEURORADIOLOGY RESEARCH GROUP The Neuroradiology Research Group is committed to applying innovative imaging technologies toward more comprehensive understanding of pathologies of the central and peripheral nervous systems at both preclinical and clinical levels, and to developing new neuro-interventional procedures and protocols for minimally-invasive treatment of neurovascular diseases. During 2009 the research activity of the Group was focused on 3 main areas: preclinical studies, clinical diagnostic research activity and neuro-interventional trials. In the first area, the Group has a well-established expertise in conventional and advanced MR-based imaging techniques of brain tumors and of inflammatory, demyelinating and dysmyelinating murine models of central nervous system diseases. Using a human-grade 3 Tesla Magnetic Resonance Imaging (MRI) apparatus equipped with a mouse-dedicated coil we evaluated and quantified structural changes in the brains of murine models of several neurological pathologies, such as inherited or acquired demyelinating disorders and brain tumors. Further, innovative cellular and molecular imaging techniques were developed for monitoring stem cell transplantation in neurological diseases and for tracking the recruitment of hematopoietic and stromal cells inside the tumors. We explored several cell labelling strategies based on superparamagnetic iron oxides particles and on different MR reporter genes, allowing iron accumulation within cells. Trangenic mice expressing a mutated form of the human L-ferritin chain were also analyzed. In the field of clinical research, the Group worked on the vivo assessment of structural and functional aspects of brain and orbital inflammatory, infectious and tumoral disorders. Specific fields of interest were HIV-related infections and lymphomas. Additionally, MR-based imaging techniques were been applied also for studying peripheral nervous system disorders and neuromuscular diseases. The research in the neuro-interventional area was focused at the optimization of new endovascular techniques and at the validation of new angiographic devices for treatment of intracranial aneurysms, vascular stenosis/occlusions and artero-venous malformations or shunts. A clinical trial was carried out for the treatment of acute stroke patients. Letterio Salvatore Politi 182 - SAN RAFFAELE SCIENTIFIC INSTITUTE Selected publications 9 Belloli, S; Jachetti, E; Moresco, RM; Picchio, M; Lecchi, M; Valtorta, S; Freschi, M; Hess-Michelini, R; Bellone, M; Fazio, F. Characterization of preclinical models of prostate cancer using PET-based molecular imaging. Eur. J. Nucl. Med. Mol. Imaging: 2009; 36(8): 1245-1255 - Article IF 2008: 4,532 9 Benedetti, F; Bernasconi, A; Bosia, M; Cavallaro, R; Dallaspezia, S; Falini, A; Poletti, S; Radaelli, D; Riccaboni, R; Scotti, G; Smeraldi, E. Functional and structural brain correlates of theory of mind and empathy deficits in schizophrenia. SCHIZOPHR RES: 2009; 114(1-3): 154-160 - Article IF 2008: 4,174 9 Boschi, F; Spinelli, AE; D’Ambrosio, D; Calderan, L; Marengo, M; Sbarbati, A. Combined optical and single photon emission imaging: preliminary results. Phys. Med. Biol.: 2009; 54(23): L57-62 - Letter IF 2008: 2,784 9 Broggi, S; Cozzarini, C; Fiorino, C; Maggiulli, E; Alongi, F; Cattaneo, GM; Di Muzio, N; Calandrino, R. Modeling set-up error by daily MVCT for prostate adjuvant treatment delivered in 20 fractions: Implications for the assessment of the optimal correction strategies. Radiother. Oncol.: 2009; 93(2): 246-252 - Article IF 2008: 3,990 9 Castiglioni, I; Canesi, B; Schenone, A; Perani, D; Gilardi, MC. A Grid-based SPM service (GriSPM) for SPECT and PET neurological studies. Eur. J. Nucl. Med. Mol. Imaging: 2009; 36(7): 1193-1195 - Letter IF 2008: 4,532 9 Cinque, P; Koralnik, IJ; Gerevini, S; Miro, JM; Price, RW. Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect. Dis.: 2009; 9(10): 625-636 - Review IF 2008: 13,165 9 De Cobelli, F; Esposito, A; Belloni, E; Pieroni, M; Perseghin, G; Chimenti, C; Frustaci, A; Del Maschio, A. Delayed-enhanced cardiac MRI for differentiation of fabry’s disease from symmetric hypertrophic cardiomyopathy. Am. J. Roentgenol.: 2009; 192(3): W97–W102 - Article IF 2008: 2,940 9 Esposito, A; De Cobelli, F; Perseghin, G; Pieroni, M; Belloni, E; Mellone, R; Canu, T; Gentinetta, F; Scifo, P; Chimenti, C; Frustaci, A; Luzi, L; Maseri, A; Del Maschio, A. Impaired left ventricular energy metabolism in patients with hypertrophic cardiomyopathy is related to the extension of fibrosis at delayed gadolinium-enhanced magnetic resonance imaging. Heart: 2009; 95(3): 228-233 - Article IF 2008: 4,964 9 Giovacchini, G; Fallanca, F; Landoni, C; Gianolli, L; Picozzi, P; Attuati, L; Terreni, M; Picchio, M; Messa, C; Fazio, F. C-11 choline versus F-18 fluorodeoxyglucose for imaging meningiomas: an initial experience. Clin. Nucl. Med.: 2009; 34(1): 7-10 - Article IF 2008: 3,181 9 Marano, R; De Cobelli, F; Floriani, I; Becker, C; Herzog, C; Centonze, M; Morana, G; Gualdi, GF; Ligabue, G; Pontone, G; Catalano, C; Chiappino, D; Midiri, M; Simonetti, G; Marchisio, F; Olivetti, L; Fattori, R; Bonomo, L; Del Maschio, A. Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease). Eur. Radiol.: 2009; 19(5): 1114-1123 - Article IF 2008: 3,651 9 Pastorino, U; Landoni, C; Marchianò, A; Calabrò, E; Sozzi, G; Miceli, R; Picchio, M; Mariani, L; Messa, C; Fazio, F. Fluorodeoxyglucose uptake measured by positron emission tomography and standardized uptake value predicts long-term survival of CT screening detected lung cancer in heavy smokers. J. Thorac. Oncol.: 2009; 4(11): 1352-1356 - Article IF 2008: 3,508 9 Perna, L; Fiorino, C; Cozzarini, C; Broggi, S; Cattaneo, GM; De Cobelli, F; Mangili, P; Di Muzio, N; Calandrino, R. Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma: A comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy. Radiother. Oncol.: 2009; 93(1): 57-63 - Article IF 2008: 3,990 9 Perseghin, G; De Cobelli, F; Esposito, A; Belloni, E; Lattuada, G; Canu, T; Invernizzi, PL; Ragogna, F; La Torre, A; Scifo, P; Alberti, G; Del Maschio, A; Luzi, L. Left ventricular function and energy metabolism in middle-aged men undergoing long-lasting sustained aerobic oxidative training. Heart: 2009; 95(8): 630-635 Article IF 2008: 4,964 CENTER FOR IMAGING - 183 9 Signorelli, M; Guerra, L; Buda, A; Picchio, M; Mangili, G; Dell’Anna, T; Sironi, S; Messa, C. Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: Detection of pelvic nodal metastases. Gynecol. Oncol.: 2009; 115(2): 231-235 - Article IF 2008: 2,919 9 Visigalli, I; Moresco, RM; Belloli, S; Politi, LS; Gritti, A; Ungaro, D; Matarrese, M; Turolla, E; Falini, A; Scotti, G; Naldini, L; Fazio, F; Biffi, A. Monitoring disease evolution and treatment response in lysosomal disorders by the peripheral benzodiazepine receptor ligand PK11195. Neurobiol. Dis.: 2009; 34(1): 51-62 - Article IF 2008: 4,852 184 - SAN RAFFAELE SCIENTIFIC INSTITUTE High technology in radiation therapy Unit FACILITIES - 185 FACILITIES ALEMBIC, Advanced Light and Electron Microscopy Bioimaging Center HEAD OF UNIT: Fabio Grohovaz* RESEARCHER: Maria Carla Panzeri FELLOW: Miriam Ascagni TECHNICIANS: Cesare Covino, Andrea Menegon CFCM, San Raffaele-Telethon Core Facility for Conditional Mutagenesis HEAD OF UNIT: Marco E. Bianchi* RESEARCHER: Lorenza Ronfani FELLOWS: Ivana Benzoni, Rosanna Rinaldi TECHNICIAN: Maria Luisa Pintonello FRACTAL, Flow cytometry Resource, Analytical Cytology Technical Applications Laboratory Research Cytometry Support Team HEAD OF UNIT: Alessio Palini BIOLOGIST: Chiara Villa TECHNICIAN: Emanuele Canonico CERMAC, Centre of Excellence of High Field Magnetic Resonance HEAD OF UNIT: Giuseppe Scotti* PHYSICIAN: Valeria Blasi RESIDENTS: Antonella Castellano, Elisa Scola POST-DOCTORAL FELLOWS: Monia Cabinio, Sara Cirillo, Roberta Longaretti, Silvia Polverigiani PHD STUDENT: Paolo Vezzulli FELLOW: Paola Scifo TECHNICIAN: Antonella Iadanza Mouse histopathology HEAD OF UNIT: Claudio Doglioni* GROUP LEADER: Francesca Sanvito TECHNICIAN: Martina Rocchi * Professor at: Università Vita-Salute San Raffaele ** Università Vita-Salute San Raffaele 186 - SAN RAFFAELE SCIENTIFIC INSTITUTE ALEMBIC, Advanced Light and Electron Microscopy BioImaging Center Alembic is a resource for the scientific community by providing both access to sophisticated imaging techniques and innovation through the efforts of a small staff. The facility is designed to accommodate researchers by providing instrumentation and instructing them in the most effective use of it, so that they may perform experiments independently. This is particularly true for access to optical microscopes for which those interested are required to attend a course taught by the Alembic staff before being authorized to use the instrumentation. The research activity of the staff also promotes technical updates on a regular basis to keep the local facility on the forefront of available technology. In the course of the years, several new technologies have been integrated into Alembic and new ones are being developed. There is also an area in which the staff develops new methodologies and conducts research on techniques with significant potential to enhance bioimaging research. This R&D activity has mainly converged around the use of voltage sensitive dyes along two main directions: • integration of optical recordings with a multi electrode system to monitor membrane potential changes in complex neuronal networks (in collaboration with Politecnico di Milano and San Raffaele Units); • use in drug discovery screening (patent application n. EP09165872 “Method for optical measuring variations of cell membrane conductance”, filed in collaboration with Optotec on July 20, 2009). Main intrumentation at Alembic are: LIGHT MICROSCOPY • Leica TCS SP2 Laser Scanning Confocal • BioRad MRC 1024 Laser Scanning Confocal • Perkin Elmer UltraVIEW ERS Spinning Disk Confocal • Widefield Imaging Setup for time-lapse imaging • AIS2 automatic Microinjection/Imaging setup • DeltaVision RT Deconvolution System • Zeiss Axioplan2 with AxioCam MRc • GElifesciences IN Cell Analyzer 1000 for high throughput/high content screening ELECTRON MICROSCOPY • TEM LEO 912AB with energy filter for microanalysis • TEM Zeiss EM900 Our numbers in 2009 are: 607 registered users (411 active), 112 persons attending theorical/practical courses; 4560 hours of independent microscopes use. Web resources: www.sanraffaele.org/research/alembic Fabio Grohovaz Figure 25. Neurons and astrocytes isolated from rat hippocampus stained for DNA (blue), neuronal-specific βIIItubulin (green) and astrocyte-specific GFAP (red). Credits: Franca Codazzi, Cellular Neurophysiology Unit. Image acquired by GE Healthcare IN Cell 1000 - Miriam Ascagni, ALEMBIC. FACILITIES - 187 CFCM, Core Facility for Conditional Mutagenesis Transgenic and knock-out mice are widely used in the research because of their high impact in the understanding of the proteins functional role and because constitute models to study genetic diseases. The San Raffaele-Telethon Core Facility for Conditional Mutagenesis (CFCM) is operative from 1999. During this time CFCM provided to the Scientific Community more than 300 murine models. CFCM performs pronuclear injections and lentiviral infections to generate transgenic mice, offers the electroporation of Embryonic Stem cell (ES cells) and the blastocysts injection of recombinant clones. Moreover, CFCM carries out rederivation of mice via embryo transfer. In addition, CFCM helps Researchers to plan experiments, to manipulate and genotype mice. Other services provided by CFCM are the screening of resistant clones by Southern Blotting to identify gene targeted clones and the production of lentiviral vectors to generate transgenic mice via oocytes infections. Very important, CFCM is offering now the Embryo Cryopreservation. This is a basic service because Researchers spent time and moneys to maintain murine lines not necessary for their current studies. Moreover, these murine lines occupy precious space in the Animal House. CFCM is setting up the isolation of ES cells from wild type and mutant bastocysts. ES cells derived from transgenic mice represent important tools for the analysis of mutant mice. More information can be found at the site http://www.sanraffaele.org/CFCMn.html Marco E. Bianchi FRACTAL, Flow cytometry Resource, Analytical Cytology Technical Applications Laboratory The Flow cytometry Resource and Analytical Cytology Technical Applications Laboratory is a core facility that offers state-of-the-art instrumentation and analysis techniques to the scientific community. Flow cytometry is an evolving field; it is continually being re-discovered by young scientists who approach this technology to answer a multitude of questions in their discovery work. Cytometrists continue to find and develop new applications. So wide ranging is the applicability of this technology that practitioners may include, in addition to biologists, physicians, microbiologists, marine biologists, veterinarians and research chemists to name a few. Verifiable results can easily be obtained for such applications as Immunophenotyping, Cell division and Apoptosis, Cell activation, Intracellular pH shifts, Phagocytosis, Oxidative burst and many more. In addition to the analytical capabilities of this technique, the core facility offers assisted cell Sorting services for characterizing, separating and purifying populations of particles as diverse as beads, bacteria, micro-particles, cells and chromosomes. In 2009 the facility supported over 380 Researchers, performed more than 1450 cell sorts and logged over 9500 hours of analytical instrument time. Alessio Palini CERMAC, Centre of Excellence of High Field Magnetic Resonance CERMAC is a Centre of Excellence financed by an original grant of the ministry of Education and Ministry of health. Different research groups have access to the centre and perform studies independently financed. The core facility available is a 3Tesla magnet with post processing hardware and software facilities for advanced morphological and functional studies of the Central Nervous System. The following research groups have access and develop their projects within the centre; Neuroradiology, Nuclear Medicine, Neurology, Psychiatry, Radiology, Cognitive neurosciences. In 2008, 20 papers have been published in indexed journals. The main fields of research are devoted to: • Development and validation of MR advanced techniques and dedicated post-processing programs 188 - SAN RAFFAELE SCIENTIFIC INSTITUTE • Application of conventional and advanced techniques in the study of the normal brain: • Brain maturation in premature and terms neonates • Aging • Brain functions in paediatric and adult population (perception of music and sounds, language, memory and other cognitive functions) • Motor system function including mirror neurons system • Application of conventional and advanced techniques in the study of the diseased brain: • Brain inflammatory deseases, with a special focus on Multiple Sclerosis • Mood disorders and other psychiatric deseases like schizophrenia • Neuro-oncology (diffusion tensor imaging and tractography in brain tumors) • Vascular diseases • Degenerative diseases Giuseppe Scotti MOUSE HISTOPATHOLOGY The principal aim of the Mouse Histopathology Unit is to support, complement and favour the advancement of scientific projects, by providing conventional morphological analysis and immunophenotyping. The facility is located in the Department of Pathology and offers the technical and the intepretative experience for the analysis of tissues from animal models, evaluating the best histological or immunocytochemical procedures, based on the expected results. The services provided include: 1. macroscopic examination including perfusion and necroscopy 2. microscopic analysis • paraffin embedding and inclusion • microtome sectioning and standard HE staining • special histochemical staining (Perls, PAS, Masson, Gomori stain…) • frozen tissues and cryostatic section preparation • immunohistochemistry (commercial antibody and • cytospin and paraffin cytoblock • final report 3. image analysis The role of pathology in the field of experimental studies on laboratory animal is of interest for: • indentification and evaluation of experimentally induced lesions • setting of animal models of human diseases • efficacy and safety studies • phenotyping of transgenic mice To date multiple collaborations within our Institute have been settled in order to analyze the morphological and immunophenotipical patterns of murine models of diseases, treated with different therapeutic approaches and to analyze the efficacy of genic therapy and safety of the use of viral vectors. Francesca Sanvito FACILITIES - 189 ALEMBIC, Advanced Light and Electron Microscopy BioImaging Center CFCM, Core Facility for Conditional Mutagenesis CLINICAL DEPARTMENTS - 191 THE CLINICAL DEPARTMENTS 192 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF ARRHYTHMOLOGY Head of Department: Carlo Pappone DEPARTMENT AREA COORDINATOR: Vincenzo Santinelli Electrophysiology and cardiac pacing HEAD OF UNIT: Carlo Pappone§ RESEARCHER:Vincenzo Santinelli PHYSICIANS: Giuseppe Augello, Cristiano Ciaccio, Simone Gulletta, Patrizio Mazzone, Gabriele Paglino, Alessia Pappone, Simone Sala, Andreina Santagostino, Nicoleta Sora, Pasquale Vergara, Gabriele Vicedomini RESIDENTS: Francesco Arioli, Maria Avitabile, Giuseppe Ciconte, Amarild Cuko, Enrico Frigoli, Emma Gelera, Alessandra Marzi, Rita Naio, Andrea Radinovic, Stefania Sacchi, Massimo Saviano, Roberto Spoladore BIO ENGINEERS: Simonetta Crisà, Giorgio Maida FELLOWS: Ombretta Osnago, Francesca Zuffada § in 2010 the Cardio-Thoracic-Vascular Department will include Arrhythmology, which will be directed by Prof. Della Bella from January 15th, 2010. CLINICAL DEPARTMENTS - 193 CARDIO-THORACIC-VASCULAR DEPARTMENT Head of Department: Ottavio Alfieri* DEPARTMENT AREA COORDINATORS: Stefano Benussi, Renata Clotilde Castellano, Domenico Cianflone*, Guglielmo Cornero, Stefano Gerosa, Giovanni La Canna, Silvio Magrin, Giovanni Marino, Enrico Maria Marone, Germano Melissano, Stefano Moriggia, Carlopietro Voci* Cardiac surgery HEAD OF UNIT: Ottavio Alfieri* CLINICAL UNIT LEADERS: Michele De Bonis, Francesco Maisano, Alessandra Rossodivita CLINICAL UNIT COORDINATOR: Alessandro Castiglioni PHYSICIANS: Irina Arendar, Stefano Benussi, Andrea Blasio, David Ferrara, Andrea Fumero, Andrea Galanti, Antonio Grimaldi, Giuseppe Iaci, Giovanni Laino, Elisabetta Lapenna, Stefano Moriggia, Simona Nascimbene, Maria Grazia Pala, Alessandro Verzini RESIDENTS: Maria Chiara Calabrese, Micaela Cioni, Egidio Collu, Paolo Denti, Enrica Dorigo, Andrea Giacomini, Mario Manca, Maurizio Taramasso, Giorgio Viganò FELLOWS: Andrea Guidotti, Ylenia Privitera, Davide Schiavi Cardiac ultrasound imaging HEAD OF UNIT: Giovanni La Canna Cardiovascular rehabilitation and prevention HEAD OF UNIT: Domenico Cianflone* CLINICAL UNIT LEADER: Carlo Meloni PHYSICIANS: Alice Calabrese, Nicole Cristell Cath Lab HEAD OF UNIT: Antonio Colombo CLINICAL UNIT LEADERS: Mauro Carlino, Alaide Chieffo, Matteo Montorfano PHYSICIANS: Alfredo Castelli, Cosmo Godino, Azeem Mohamed Latib RESIDENTS: Filippo Figini, Daniela Piraino FELLOWS: Rasha Al-Lamee, Francesco Arioli, Economou Fotios, Alfonso Ielasi, Marco Mussardo, Kensuke Takagi TECHNICIANS: Gianfranco Accarino, Raimondo Bellanca, Salvatore Cannavale, Andrea Di Marco, Fanny Lavazza, Matteo Longoni, Davide Maccagni, Massimo Angelo Messa, Marcello Murino, Vittorio Romano, Mario Squilla Clinical cardiology HEAD OF UNIT: Alberto Margonato CLINICAL UNIT LEADERS: Fabrizio Bonetti, Alberto Cappelletti, Andrea Conversano, Gabriele Fragasso, Andrea Macchi, Michele Oppizzi PHYSICIANS: Eustachio Agricola, Fabio Buzzetti, Chiara Camesasca, Cristina Canciani, Barbara Demarchi, Stefano Gerosa, Alessandra Mailhac, Cinzia Nitti, Alessandra Pancaldi, Marco Papa, Cristina Pedrigi, Patrizia Puccetti, Carmen Silipigni Coronary Care Unit (CCU) HEAD OF UNIT: Alberto Margonato CLINICAL UNIT LEADERS: Carlo Ballarotto, Giuseppe Pizzetti PHYSICIANS: Giorgio Bassanelli, Roberto Spoladore Functional Rehabilitation HEAD OF UNIT: Alessandra Raschi 194 - SAN RAFFAELE SCIENTIFIC INSTITUTE Intensive Care Unit (ICU) and Post Operatory Care Unit (POCU) HEAD OF UNIT: Alberto Zangrillo* CLINICAL UNIT LEADER: Giovanni Landoni, Giovanni Marino CLINICAL UNIT COORDINATORS: Jaques N’Zepa Batonga, Andrea Carozzo, Guglielmo Cornero, Antonella Crescenti, Rossana Fiori, Silvio Magrin PHYSICIANS: Valeria Aldovrandi, Elena Bignami, Tiziana Bove, Maria Grazia Calabrò, Francesco Cama, Giuseppina Maria Casiraghi, Domenica Carrieri, Francesca Cavenago, Remo Daniel Covello, Monica De Luca, Greta Fano, Annalisa Franco, Giovanna Frau, Chiara Gerli, Giulio Melisurgo, Roberta Mennella, Melissa Messina, Fabrizio Monaco, Massimiliano Nuzzi, Federico Pappalardo, Tiziana Giuseppa Quattrocchi, Anna Mara Scandroglio, Ornella Sottocorna, Massimo Zambon Thoracic surgery HEAD OF UNIT: Piero Zannini* CLINICAL UNIT LEADERS: Giulio Melloni, Giampiero Negri* Carlopietro Voci* CLINICAL UNIT COORDINATOR: Angelo Carretta PHYSICIANS: Alessandro Bandiera, Paola Ciriaco, Armando Puglisi RESIDENTS: Michele Giovanardi, Annamaria Gremmo, Piergiorgio Muriana, Stefano Sestini, Antonio Tuoro Vascular surgery HEAD OF UNIT: Roberto Chiesa* CLINICAL UNIT LEADERS: Efrem Civilini, Enrico Maria Marone, Germano Melissano, Yamume Tshomba CLINICAL UNIT COORDINATOR: Renata Clotilde Castellano PHYSICIANS: Domenico Astore, Laura Dordoni, Gloria Esposito, Massimiliano Marrocco-Trischitta RESIDENTS: Chiara Brioschi, Giovanni Coppi, Andrea Kahlberg, Davide Logaldo, Daniele Mascia, Daniele Psacharopulo, Sara Spelta, Gianbattista Tshiombo FELLOWS: Domenico Baccellieri, Luca Bertoglio, Barbara Catenaccio * Professor at: Università Vita-Salute San Raffaele The clinical activity of the Department is devoted to the diagnosis and treatment of cardiac, thoracic and vascular disease. New techniques and technologies have been introduced to offer to the patients the entire spectrum of the therapy options in a multidisciplinary environment. Patients-centered care is the philosophy behind the daily clinical practice. The interaction among different specialists (anesthesiologists, cardiovascular and thoracic surgeons, interventional and clinical cardiologists) is favored by the contiguity of the areas devoted to surgery, cath lab procedures and intensive care. Patients with acute disease coming on emergency basis as well as patients with chronic diseases admitted electively are submit Ottavio Alfieri ted to diagnostic investigation, treatment, an then rehabilitation if needed. A well structured rehabilitation program is available providing complete recovery even for the sickest patients. An active outpatient clinic is functioning for new referrals and follow-up. Clinical activity and Areas of excellence - In regard to cardiac diseases, the main pathologies are ischemic and valvular heart diseases, which are treated either with catheter based interventions or minimally invasive procedures or conventional surgery. Grown-up patients with congenital heart disease have been increasing recently. A large number of patients with major aortic and vascular pathologies are CLINICAL DEPARTMENTS - 195 also increasingly referred as well as patients with complex oncological problems of the thoracic organs. Transcatheter aortic valve implantation has been widely carried out to treat inoperable or high risk patients with severe aortic stenosis and today the largest experience in Italy has been accumulated in this field by our multidisciplinary team. The percutaneous treatment of mitral insufficiency is performed in patients with heart failure and our series represents one of the very first in Europe. Innovative modalities of medical treatment for patients with congestive heart failure have been recently introduced, particularly in the field of improvement of cardiac metabolism, achieving a significant increase of survival/quality of life as compared to figures reported in the literature. A structurized program for the treatment of patients with end-stage heart failure has been developed. Aim of the program is to provide a comprehensive treatment for the failing heart, including mechanical circulatory support (short and long term) in different clinical settings: post cardiotomy cardiogenic shock, acute myocardial infarction, bridge to transplant, destination therapy. Also treatment of acute hypoxia and ARDS by ECMO is now offered as a life-saving procedure. A wide spectrum of aortic pathologies, including aneurysms, dissection, traumatic injuries, coarctation etc., are treated using both conventional and endovascular approaches. For high risk patients with complex aortic arch and thoracoabdominal pathology, hybrid open and endovascular strategies are selectively performed, and endovascular branch-technology is currently under evaluation. Both open and endovascular procedures are also used for carotid and lower limb revascularization. A great recent achievement in thoracic surgery has been the treatment of lung cancer in patients with emphysema. The respiratory impairment due to this disease used to be a surgical contraindication in the past. Today different strategies have been introduced in our Department to extend surgical indication in lung cancer including parenchyma-sparing bronchoplasty techniques, lung volume reduction surgery and bronchoscopic lung volume reduction. Finally, 3-D echocardiography has been introduced as a routine imaging modality to assess patients with structural heart disease, with considerable enhancement of diagnostic capabilities. Fields of research - Research is related to the clinical activity, as presented above. Ottavio Alfieri 196 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF GENERAL AND SPECIALISTIC SURGERY Head of Department: Carlo Staudacher* DEPARTMENT AREA COORDINATORS: Marco Braga*, Carlo Castoldi, Francesco Deni, Renato Finazzi, Emiliano Giorgi, Gilberto Mari, Michele Paganelli, Danilo Parolini, Sandro Passaretti, Carlo Socci, Marco Stella, Walter Zuliani Gastroenterologic surgery HEAD OF UNIT: Carlo Staudacher* CLINICAL UNIT LEADERS: Saverio Di Palo, Elena Orsenigo CLINICAL UNIT COORDINATORS: Paolo Aldo Raul Baccari, Paola De Nardi PHYSICIANS: Andrea Marco Tamburini, Andrea Vignali RESIDENTS: Michele Carvello, Tiziana Casiraghi, Carmen Forestieri, Francesco Luparini, Alessio Mocci, Danilo Parolini, Carlo Socci,Valentina Tomajer, Roberta Varale General and pancreatic surgery HEAD OF UNIT: Valerio Di Carlo* CLINICAL UNIT LEADERS: Marco Braga*, Marco Cristallo PHYSICIANS: Gianpaolo Balzano, Renato Castoldi, Walter Zuliani RESEARCHER: Lorenzo Piemonti RESIDENTS: Massimiliano Bissolati, Vanessa Capitanio, Giovanni Capretti, Cristina Gilardini, Federica Merlini, Federica Milani, Gregorio Stratta FELLOWS: Alessia Mercalli, Cristina Ridolfi, Valeria Sordi Hepatobiliary and week surgery HEAD OF UNIT: Gianfranco Ferla* CLINICAL UNIT LEADERS: Luca Aldrighetti, Edoardo Beretta, Alberto Marassi PHYSICIANS: Marco Catena, Enrico Fiacco, Renato Finazzi, Gilberto Mari, Mvunde Mukenge, Michele Paganelli CONSULTANT: Veronica Zuber RESIDENTS: Federica Cipriani, Ines Mulas, Carlo Pulitanò, Francesca Ratti Orthopaedics HEAD OF UNIT: Gianfranco Fraschini* CLINICAL UNIT LEADERS: Francesco Camnasio, Maurizio De Pellegrin, Giuseppe Gioia, Crispino Grispigni, Eliseo Mainetti RESEARCHER: Giuseppe M. Peretti* PHYSICIANS: Arianna Banfi, Carlo Castoldi, Pietro Ciampi, Alessandro De Ponti, Dario Fracassetti, Davide Mandelli, Umberto Mezzadri, Gianluigi Moro, Paola Rivoltini, Paolo Sirtori, Corrado Sosio, Matteo Vitali RESIDENTS: Niky Mancini, Laura Mangiavini, Alessandro Pozzi, Celeste Scotti POST-DOCTORAL FELLOW: Daniela Deponti Gastroenterology-Endoscopy HEAD OF UNIT: Pier Alberto Testoni* CLINICAL UNIT LEADERS: Paolo Giorgio Arcidiacono, Mario Guslandi, Sandro Passaretti PHYSICIANS: Silvia Carrara, Lorella Fanti, Alberto Mariani, Edi Viale FELLOWS: Cinzia Boemo, Milena Di Leo, Chiara Notaristefano, Cristian Vailati CONSULTANTS: Maura Corsetti, Antonella Giussani, Gianni Mezzi, Maria Chiara Petrone Anaesthesiology HEAD OF UNIT: Luigi Beretta* CLINICAL UNIT COORDINATORS: Massimo Agostoni, Massimo Caldi, Eleonora Colnaghi, Laura Comotti, Francesco Deni, Emiliano Giorgi, Daniela Giudici, Carla Martani, Valeria Perotti, Roberto Valeri, Giovanna Valentini PHYSICIANS: Barbara Airaghi, Felicia Adalgisa Antonino, Tania Capocasa, Mariela Decembrino, Daniela Larato, Renato Meani, Francesca Presti, Lorenzo Quario, Raffaella Reineke, Monica Scarioni CLINICAL DEPARTMENTS - 197 General intensive care HEAD OF UNIT: Alberto Zangrillo* CLINICAL UNIT LEADER: Sergio Colombo PHYSICIANS: Paolo Federico Beccaria, Pier Carlo Bergonzi, Luca Cabrini, Carlo Leggieri, Daniela Mamo, Elena Moizo, Silvia Marolina Morero, Milena Mucci, Davide Salaris, Federico Vinciguerra *Professor at: Università Vita-Salute San Raffaele The Department of Surgery and Specialized Units encompasses Upper Gastrointestinal Surgery, Colorectal Surgery, Pancreas Surgery, Breast Unit, Hepatobiliary Unit, Bariatric Surgery, Lymphatic Surgery, Endocrine Surgery, General Surgery, Transplantation, Gastroenterology & Endoscopy, Orthopedic Surgery, Anesthesiology, and Intensive Care Unit. The Department has three core missions: excellent clinical care, outstanding research productivity and the delivery of state of the art educational programs. The Upper Gastrointestinal Surgery Unit has a dedicated program in treating cancers and benign diseases of the upper gastrointestinal tract. Patients are treated by a multidisciplinary team of experts. A research program is ongoing to improve the pre operative workup of tumors of esophagus and stomach with the inclusion of Magnetic resonance imaging, sentinel node identification in early cancer stage and neoadjuvant chemotherapy and HIPEC in the advanced Carlo Staudacher ones. The high volume Colorectal Surgery Unit offers the most advanced surgical and minimally invasive options not only to eradicate the disease, but also to preserve patients’ ability to normal function. Among various programs there are the sentinel node mapping in colorectal and cancer of the anal canal and the perioperative evaluation of anorectal function a pelvic floor biofeedback rehabilitation method. The Pancreatic Surgery Unit has one of the highest pancreatic surgery volume in Europe with more than 160 pancreatic resections performed/ year. In order to treat the post-surgical diabetes secondary to total pancreatectomy there is an active program of islet autotransplantation. The Breast Unit applies the International Standard of excellence stated by EUSOMA (European Society of Mastology). In the Hepatobiliary Surgery Unit the activities are mainly focused on hepatobiliary tumors and chronic liver diseases, including primary and metastastic liver tumors, benign and malignant diseases of the biliary tract, acute and chronic hepatitis. Concerning the hepatic surgery the Unit is a high-volume unit for liver resections, performing 150-170 liver resection/year. A clinical program of laparoscopic liver surgery has been started on January 2007. Data regarding the Bariatric Surgery Unit included a successful activity in the past years. The current program foresees an activity increase, with special interest to the obese diabetic patient and metabolic surgery. Lymphatic Surgery: the primary and secondary lymphoedema surgical therapy finds in the lympho-venous anastomosis, as well as in the lymphatic grafting the more reliable procedures. The Section of Endocrine Surgery treats endocrine tumors in children and adults. Surgeons working in this section apply the state-of-the-art technology, including minimally invasive parathyroid surgery with intraoperative parathormone (PTH) assay determination , and laparoscopic adrenalectomy. The clinical activity of Transplant Surgery area includes the following programs: Simultaneous Pancreas and Kidney Transplantation and Pancreas Alone Transplantation in IDDM patients; double kidney from marginal donors; laparoscopic living donor nephrectomy; islet transplantation. The clinical activity of the Division of Gastroenterology and Gastrointestinal Endoscopy includes four main sections: clinical gastroenterology and 198 - SAN RAFFAELE SCIENTIFIC INSTITUTE hepatology, gastrointestinal and pancreatico-biliary endoscopy, ultrasound endoscopy, and digestive motility. The division is a tertiary referral center for therapeutic pancreatico-biliary and G.I. tract endoscopy, as well as for endoscopic ultrasound, diagnosis and treatment of motility disorders (mainly esophagus and rectum), and pancreatic diseases. Advanced endoscopic procedures, as ERCP, endoscopic ultrasound, and therapeutic G.I. tract procedures are carried out under deep sedation and anaesthesiologist assistance; two anaesthesiologists are involved daily in two operatory rooms.The Division of Orthopedic Surgery cares for all injuries and diseases of the musculoskeletal system. The Division provides subspecialty clinics in the specific areas of major joint reconstruction, sports medicine, pediatric orthopedics, foot, hand, spine, trauma, oncology, reconstructive microsurgery, and rehabilitation. The clinical activity of the Orthopaedics and Traumatology Unit aims to cover all the needs related to traumatic, degenerative, oncologic, infectious and metabolic aspects of the musculo-skeletal system. The spine surgery, the shoulder and elbow surgery, the treatment of the degenerative disease of the joints, the pelvis surgery, the diagnosis and treatment of the pathologies of the bone metabolism represent areas of distinction of the Orthopaedics and Traumatology Unit. The Orthopaedics and Traumatology Unit has also an intense basic research activity with the Laboratory for Tissue Engineering and Biomaterials. The Anesthesiology and Intensive Care Unit reflects the comprehensive effort of a team of anesthesia physicians, nurses, and staff to advanced patient care. Pre-admission diagnosis and staging program is ongoing in order to decrease hospital stay. The main fields of research are: Medical Emergency Team; Non-invasive Ventilation in innovative fields; Percutaneous Tracheostomy in difficult cases; Activated or Zymogen Protein C in sepsis; Use of Simulation in medical training; Extracorporeal support in ARDS patients (in particular in influenza A H1N1-related ARDS). The team are editing an international journal “HSR proceedings in Intensive Care and Cardiovascular Anesthesia”, freely available on www.itacta.org. Carlo Staudacher CLINICAL DEPARTMENTS - 199 HEAD AND NECK DEPARTMENT Head of Department: Giuseppe Scotti* DEPARTMENT AREA COORDINATORS: Antonio Dell'Acqua, Andrea Falini*, Marco Gemma, Susanna Piccoli, Sandra Pieralli, Claudio Righi, Francesco Scomazzoni Neuroradiology HEAD OF UNIT: Giuseppe Scotti* CLINICAL UNIT LEADERS: Nicoletta Anzalone, Cristina Baldoli, Andrea Falini*, Franco Simionato PHYSICIANS: Simonetta Gerevini, Sandra Pieralli, Letterio Salvatore Politi, Silvia Pontesilli, Claudio Righi, Francesco Scomazzoni, Roberta Scotti, Paolo Vezzulli Head and neck anaesthesia and neurointensive care HEAD OF UNIT: Luigi Beretta* CLINICAL UNIT LEADERS: Silvano Cozzi, Cristina Mattioli CLINICAL UNIT COORDINATORS: Antonio Dell’Acqua, Marco Gemma, Susanna Piccoli PHYSICIANS: Fabio Bernasconi, Maria Rosa Calvi, Marco Cerri, Antonella Cipriani, Assunta De Vitis, Cristina Frascoli, Luigi Gioia, Elisabetta Grandi, Maurizio Mungo, Davide Poli, Alfredo Ravizza, Luisa Sacchi Ophthalmology HEAD OF UNIT: Francesco Bandello* CLINICAL UNIT LEADER: Francesco Fasce CLINICAL UNIT COORDINATORS: Gianluigi Bolognesi, Luisa Pierro PHYSICIANS: Nicola Baccelli, Maurizio Battaglia Parodi, Paolo Bettin, Stefania Bianchi Marzoli, Elena Bruschi, Gabriella Cammarata, Maria Lucia Cascavilla, Carlo Ciampi, Paola Ciasca, Marco Codenotti, Annalisa Colucci, Umberto De Benedetto, Federico Di Matteo, Marina Fiori, Maddalena Forti, Marco Gagliardi, Matteo Ghidoni, Silvia Giatsidis, Antonio Giordano Resti, Lauretta Guarisco, Ugo Introini, Rosangela Lattanzio, Francesca Legorini, Francesco Loperfido, Gisella Maestranzi, Angela Malegori, Maria Pia Manitto, Elena Mantovani, Elisabetta Martina, Paolo Mauceri, Lisa Melzi, Jacopo Milesi, Elisabetta Miserocchi, Giulio Modorati, Veronica Odazio, Matteo Prati, Andrea Ramoni, Laura Regali, Carmen Rojo, Michela Rossi, Fabrizio Scotti, Marco Setaccioli, Alessandra Spinelli, Monica Stoppani, Gemma Tremolada, Ilaria Zucchiatti TECHNICIANS: Giorgio Alto, Adriana Angiolini, Alessio Buzzotta, Chiara Manclossi, Antonella Ribecca Cornea and ocular surface Unit HEAD OF UNIT: Paolo Rama CONSULTANTS: Federica Ferrario, Chiara Insacco, Stanislav Matuska, Giorgio Paganoni, Elena Scandola, Maurizia Viganò Otorhinolaryngology HEAD OF UNIT: Mario Bussi* PHYSICIANS: Stefano Bondi, Leone Giordano, Francesca Lira Luce, Lucia Oriella Piccioni, Matteo Trimarchi CONSULTANTS: Chiara Bellini, Beatrice Fabiano, Fabrizio Ferrario, Annalisa Meli, Andrea Muzza, Francesca Palonta, Rosaria Taverna, Roberto Teggi RESIDENTS: Pietro Limardo, Paola Recanati, Daniela Sarandria SPEECH THERAPISTS: Daniela Gherner, Barbara Ramella TECHNICIAN: Federica Mores Neurosurgery HEAD OF UNIT: Pietro Mortini* CLINICAL UNIT LEADERS: Stefania Acerno, Camillo Ferrari Da Passano, Alberto Franzin, Marco Losa, Carlo Mandelli, Piero Picozzi PHYSICIANS: Lina Raffaella Barzaghi, Nicola Boari, Paola Castellazzi, Lorenzo Gioia, Silvia Snider, Micol Valle CONSULTANT: Marzia Medone *Professor at: Università Vita-Salute San Raffaele 200 - SAN RAFFAELE SCIENTIFIC INSTITUTE The “head and neck department” develops, within a very busy and differentiated clinical practice, multiple fields of research, frequently integrated with other clinical departments or research divisions. Six clinical units are integrated within the Department: • Neurosurgery • Otolaryngology • Ophthalmology • Cornea and Ocular surface • Neuro intensive care • Neuroradiology Giuseppe Scotti Fields of research Neurosurgery Neurosurgery: surgery of brain tumors and base of the skull tumors is one of the fields of excellence of the unit. Surgery of the spine and peripheral nervous system is developed. The neurosurgery unit is involved in research studies regarding brain gliomas, peripheral nerves regeneration, role of radiotherapy in treatment of vascular malformations. Neurointensive Care • Prognosis of diffuse axonal injury after trauma by MRI • Cerebral perfusion before and after cranioplasty • Troponine and BNP after major elective neurosurgery • Cerebral perfusion after major elective neurosurgery in patients submitted to normo- or hyper-ventilation during surgery • Database “Neurolink” of patients admitted to neurosurgical Intensive Care Units after severe head injury. • Multicenter study “Neuromorfeo” (randomized comparison between total intravenous and inhalation anesthesia during major elective neurosurgery) • Effects of propofol on “functional MRI” in 14 and 4-8 ys old children submitted to sedation to accomplish neuroradiological examination • Physiopathology of mechanical ventilation during ENT surgery with laser-proof endotracheal tubes • Systemic complications during catharact surgery under local anesthesia Ophthalmology Retina New therapeutic options with intravitreal compounds for Age-Related Macular Degeneration (AMD), Diabetic Retinopathy (DR) and Retinal Vein Occlusion Evaluation of the behaviour of Endothelial Progenitor Cells in DR and AMD Evaluation of new therapeutic options: Enzymatic Vitreolysis with Autologous Plasmin and use of neuro-enhancement agents in patients with previous Retinal Detachment. Set up of a Vitreous Biobank. Pediatric Ophthalmology Multicentre clinical trial to test efficacy and tolerance of Azytromicin vs Tobramicin in purulent bacterial conjunctivitis. Neuro-Ophthalmology Evaluation of structural and functional brain damage and visual network plasticity in Leber’s Hereditary Optic Neuropathy, Hereditary Retinal Dystrophies and Ereditary Optic Neuropathies. Evaluation of efficacy and safety of surgical decompression and Gamma Knife radiosurgery on Tumors compressing the anterior visual pathway Orbital Surgery Evaluation of new therapeutic strategies of ocular MALT lymphomas CLINICAL DEPARTMENTS - 201 Imaging Evaluation of the inter /intra operator reproducibility of nerve fiber layer thickness and topographic measurement of the optic nerve and cornea among different Spectral Domain OCT instruments. Ocular Immunology and Uveitis Evaluation of new biologic agents for the treatment of intraocular inflammation. Ocular Oncology Evaluation of treatment with Gamma Knife Radiosurgery of conjunctival and intraocular tumors Glaucoma Studies on new medical and surgical therapeutic options in glaucoma management are ongoing. Otolaryngology • In collaboration with Neuroradiology fMRI studies are performed to evaluate plasticity and brain cortical reorganization in patient submitted to major surgery of the larynx for neoplastic lesions. • Research studies are performer to evaluate immune response in chronic rhinosinusitis and nasal polips. The unit is part of an international research network that is involved in developing a worldwide database of tumors of paranasal sinuses. • In collaboration with the Division of kidney diseases, studies are under way to evaluate genetically determined anomalies of ion transportation in the inner ear responsible for Menière syndrome. • In collaboration with the neeroscience division studies are performer on EEG anomalies in migraine patients with auditory problems. Neurophysiological studies are performed in patients submitted to laryngectomy fro head and neck cancer; evaluation of functional aspects and quality of life in laryngectomised patients with artificial prosthesis is under way. A new study regarding the role of viral genoma of HPV virus in the pathogenesis of head and neck tumors has been initiated. Cornea and ocular surface • Evaluation of the efficacy and safety of autologous cultivated limbal stem cell transplantation for restoration of corneal epithelium in patients with limbal stem cell deficiency due to ocular burns. • Clinical outcome in patients affected by Acanthamoeba keratitis treated with polyhexamethylene biguanide (PHMB) 0.02% alone or in combination with other anti-amoebal drugs . • A multicentric, randomized, double masked, controlled trial on the safety and efficacy of Cyclosporine A (CyA) eye drop treatment on patients with ocular cicatricial pemphigoid. • Research in different fields such as retinal pathology, in collaboration with the Stem Cell Research Department. Müller Glial Cells are extensively studied. A mouse model for Müller Glia genetic tracing has already been established and will be used for the study of in-vivo Müller Glia regenerative potential in scenarios of retinal damage or degeneration. Neuroradiology • Research in Neuroradiology addresses different fields with different research modalities. • Studies of brain maturation and functional activity of the pediatric brain are performed with MRI, functional MRI and brain activation techniques, both with 1.5T or 3.0 T magnets. • Functional activation in brain tumors, studies of disruption of associative and projective tracts and fibres are performed with diffusion tensor imaging techniques and tractography. Degenerative and inflammatory diseases are studied in cooperation with the neuroscience research division. • Ocular degenerative diseases and orbital lymphomas are studied in collaboration with ophthalmology and neuropathology units. • Experimental and animal research projects are under development in the field of stem cells targeting with MRI. Peripheral nervous system regeneration, and development of endovascular devices are other fields of research. Evaluation of new contrast media for MR angiography and coordination of multicenter international studies. Giuseppe Scotti 202 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF INFECTIOUS DISEASES Head of Department: Adriano Lazzarin* DEPARTMENT AREA COORDINATORS: Nicola Gianotti, Paolo Scarpellini Infectious diseases HEAD OF UNIT: Adriano Lazzarin* CLINICAL UNIT LEADERS: Antonella Castagna, Massimo Cernuschi, Paolo Scarpellini, Giuseppe Tambussi, Caterina Uberti-Foppa PHYSICIANS: Paola Cinque, Anna Danise, Luca Fumagalli, Nicola Gianotti, Monica Guffanti, Myriam Maillard, Roberto Novati, Silvia Nozza RESEARCHERS: Claudio Fortis, Laura Galli, Lucia Lopalco, Giulia Morsica, Claudia Pastori CONSULTANTS: Simona Bossolasco, Giovanni Gaiera, Andrea Galli, Giulia Gallotta, Hamid Ibrahim Hasson, Annamaria Pazzi, Cecilia Pizzocolo, Deborah Ratti, Clara Ronchetti, Vega Rusconi, Flavia Salmaso, Stefania Salpietro FELLOWS: Laura Alagna, Sabrina Bagaglio, Francesca Cossarini, Manuela Pogliaghi, Lucy Porrino, Vincenzo Spagnuolo, Chiara Tassan Din, Simon Tiberi, Giovanna Travi TECHNICIAN: Arabella Bestetti *Professor at: Università Vita-Salute San Raffaele The aim of the Department of Infectious Diseases is to maintain and improve excellence in the management of infectious diseases. In particular, the Department aims at optimizing treatment of HIV infection by clinical trials and data analyses, infectious diseases other than HIV, including tropical diseases, central nervous system infections and hepatitis, hospital-acquired infections, and opportunistic infections in the immune deficient host. The activity is organized in six Functional Units (ordinary admission, HIV-infected outpatient ambulatory, infectivology service at San Raffaele main building, experimental therapies, day-hospital plus gastroenterological fibroscopy and tropical diseases) and two Coordination Areas (quality and information technology). The Department includes three ordinary Admission Units, with 34 beds cumulatively (26 of which currently active), one day-hospital unit with six beds, and nine ambulatory rooms. About 4000 outpatients with HIV infection (80% on treatment with antiretroviral drugs) and 1000 with hepatitis B or C infection are currently followed-up, each of them attending about four visits per year. Adriano Lazzarin Two Clinical Trial Units have been set up and a clinical database (now containing information from more than 7000 HIV-infected patients) has been implemented, which allows patients’ clinical data gathered during everyday activity to be used for clinical research and to be timely available for matching laboratory with clinical findings. During 2008, 41 clinical trials were ongoing at the Department, including phase I, II and III clinical trials on new antiretroviral drugs, vaccines and immune-based therapies for HIV infection. Research collaborations with European and NIH academic initiatives are also well established, particularly in the field of HIV infection: the Department is member of the following study groups: Italian Cohort of Antiretroviral Naïve patients (ICONA), EUROSIDA (both of them taking part in the intercontinental Data Collection on Adverse events of Anti-HIV Drugs - D:A:D: study group), European AIDS Treatment Network (NEAT), and COHERE. The Department is also collaborating with Regione Lombardia to investigate treatment strategies for HIV infection aiming to reduce CLINICAL DEPARTMENTS - 203 health costs without jeopardizing treatment efficacy. In addition to clinical trials, the ongoing clinical research lines include: the pathogenesis and management of HIV drug-resistance, HIV encephalopathy, metabolic disorders and cardiovascular complications of HIV disease, co-infection with hepatitis viruses, HIV-associated tumors. The Department is also involved in the research of new diagnostic and management tools for the management of viral diseases different from HIV, particularly those affecting the central nervous system. The Department also tightly collaborates with the Comitato per le Infezioni Ospedaliere in order to survey, lower the incidence and improve the management of hospital-acquired infections, as well as with the transplantations units for the prevention and treatment of opportunistic infections in patients with treatment-related immune deficiencies. In this context, it is committed to the development and implementation of guidelines to assist other Departments in the management of infectious diseases. Furthermore, the Department participates to national initiatives aiming at studying and preventing the widespread of emerging and re-emerging diseases, such as tropical diseases and tuberculosis. In this context it is also involved in projects aiming at improving the cures in low-income countries, in collaboration with AISPO. Due to its high ranking in the management of HIV infection, the Department organizes residential stages in this field for doctors coming from all over Italy. Adriano Lazzarin 204 - SAN RAFFAELE SCIENTIFIC INSTITUTE MATERNAL AND CHILD HEALTH DEPARTMENT Head of Department: Giuseppe Chiumello* DEPARTMENT AREA COORDINATORS: Alessandro Aiuti, Ferdinando Bombelli, Riccardo Bonfanti, Guido Candotti, Moreno Dindelli, Stefano Ferrari, Maria Pia Guarneri, Stefania Luchini, Massimo Origoni* Pediatrics and neonatology HEAD OF UNIT: Giuseppe Chiumello* CLINICAL UNIT LEADERS: Graziano Barera, Franco Meschi, Gianni Russo, Giovanna Weber* PHYSICIANS: Riccardo Bonfanti, Stefania Di Candia, Margherita Franco, Gisella Garbetta, Maria Pia Guarneri, Karen Marenzi, Antonella Poloniato, Gabriella Pozzobon, Rosanna Rovelli, Paola Sgaramella, Maria Cristina Vigone, Matteo Viscardi RESEARCHER: Stefano Mora RESIDENTS: Valentina Biffi, Maddalena Bove, Bruna Cammarata, Giuseppe Cannalire, Ilaria Colombo, Francesca Cortinovis, Valentina Donghi , Matilde Ferrario, Giulio Frontino, Alessandra Giardelli, Barbara Parma, Arianna Passoni, Alessandra Perduca, Maria Antonietta Piscopo, Marco Pitea, Andrea Rigamonti, Elisa Rizzato, Paola Sogno Valin FELLOWS: Maria Puzzovio, Ilaria Zamproni Gynaecology and obstetrics HEAD OF UNIT: Massimo Candiani* CLINICAL UNIT LEADERS: Ferdinando Bombelli, Claudio Brigante, Maria Teresa Castiglioni, Enrico Conti, Giorgia Mangili, Daniele Spagnolo, Luca Valsecchi, Riccardo Viganò CLINICAL UNIT COORDINATORS: Guido Candotti, Gabriella Colombo, Moreno Dindelli, Stefano Ferrari, Francesco Fusi, Stefania Luchini PHYSICIANS: Anna Cardani, Davide Ferrari, Luca Gandini, Elisabetta Garavaglia, Guido Marelli, Elena Marsiglio, Micaela Petrone, Maria Teresa Potenza, Emanuela Rabaiotti, Susanna Rosa, Maddalena Smid RESEARCHER: Massimo Origoni* CONSULTANTS: Giada Almirante, Luigi Caputo, Paolo Cavoretto, Patrizia De Marzi, Rossana Favia, Susanna Filippis, Paolo Giardina, Fabio Mauro, Michela Molgora, Nicoletta Panacci, Enrico Papaleo, Simone Rofena RESIDENTS: Lara Di Piazza, Francesca Di Puppo, Cinzia Gentile, Serena Montoli, Francesca Occhi, Federica Pasi, Francesca Pella, Paola Persico, Serena Pirola, Anna Redaelli, Audrey Serafini, Chiara Stefani Pediatric immuno-hematology Unit HEAD OF UNIT: Maria Grazia Roncarolo* CLINICAL UNIT LEADER: Sarah Marktel PHYSICIANS: Alessandro Aiuti, Rosa Bacchetta, Alessandra Biffi, Barbara Cappelli RESIDENTS: Costanza Evangelio, Francesca Ferrua, Valentina Finizio, Marco Fossati, Sara Napolitano, Anna Noè CHARGE NURSE: Clara Soliman RESEARCH NURSES: Luciano Callegaro, Miriam Casiraghi *Professor at: Università Vita-Salute San Raffaele Giuseppe Chiumello The obstetrical outpatient management focuses on the clinical control of physiological and pathological pregnancies, with particular attention to gestational and pre-gestational diabetes, hypertension, autoimmune diseases, thrombophilia and recurrent abortion. In 2008, 3300 outpatient evaluations have been performed. A complementary first and second level ultrasound service and prenatal diagnosis is available, with nearly 3600 examinations performed in 2008. The obstetrical inpatient activities are mostly dedicated to delivery assistance (in 2008, 1910 deliveries) of which 66% are vaginal deliveries and 34% caesarean sections. The obstetrical admissions for medical complications of pregnancy represent less than 10% of total admissions underlining the predominant outpatient management of high risk pregnancies. CLINICAL DEPARTMENTS - 205 Other activities include Day surgery procedures, conservative and demolitive laparotomy, laparoscopy, vaginal surgery, and surgical treatment of urogenital prolapse and stress incontinence. Diagnosis, radical surgery, and chemotherapy for genital tumors, treatment for trophoblastic diseases, and diagnostic/operative hysteroscopy are also performed. Pilot center for the diagnosis and treatment of endometriosis with a multidisciplinary approach and the use of the most advanced minimally invasive surgical techniques. Infertile couples are managed with the most advanced treatments and assisted reproduction techniques such as intra uterine insemination (IUI), in vitro fertilization & embryo transfer (IVF), and intra cytoplasmic sperm Injection (ICSI) with fresh or frozen-thawed ejaculated semen or spermatozoa from surgically retrieved testicles. The activities of pediatric unit include involve general pediatric diseases, neonatology ,endocrinopaties and diabetes. Nearly 750 children are admitted yearly in the emergency room. Neonatal care is inspired by the most modern criteria of assistance for healthy newborns, and particular importance is given to the relationship between the mother and the newborn. Specialized assistance is provided to both premature and unhealthy newborns. Approximately 700 patients with congenital hypothyroidism are followed by an integrated multidisciplinary approach involving the pediatric endocrinologist and neuropsychologist. In these patients genetic studies have demonstrated 7 mutations on gene involved in iodine organification (DUOX2/ DUOXA2), and 3 mutations on TSH-receptor gene More than 750 cases of Type 1 Diabetes Mellitus are currently followed and 80 patients are newly diagnosed each year, representing one of the broadest case records in Italy and Europe. Particular focus is given to new technologies for continuous insulin infusion and glucose monitoring. Three trials are ongoing for secondary and tertiary prevention. The Unit is studying unfrequent genetic mutations able to cause early onset diabetes The management of Willi-Prader Syndrome involves a medical-psychological evaluation, close relationship with the family and motor-skills intervention, all of which have determined improvements in the prognosis of this disease. The case records of children with genital ambiguity is the greatest in Italy, and its management includes a collaboration with surgeons and psychologists. In order to assess less-invasive and more accurate methods for the diagnosis and follow-up of various forms of Congenital Adrenal Hyperplasia (CAH), we determined salivary and urinary steroid profile through liquid chromatography-mass spectrometry.The number of patients with GH disorders under growth hormone treatment is one of the greatest in Italy. Small for gestational age (SGA) children are at risk for obesity and Metabolic Syndrome (MetS); we are performing the analysis of the intrahepatic fat, measured using localized hepatic 1HMRS, whole body energy homeostasis, insulin sensitivity, and body composition in SGA and born appropriate for gestational age adolescents.Other main fields are bone diseases and hyperinsulinemic hypoglicemia. The field of pediatric hematology and immunology is dedicated to research, diagnosis and cure of children with genetic disorders of the blood. In this context children are offered in addition to standard care also experimental therapeutic options, among these cellular therapy and gene therapy. Our Institute has an ongoing clinical program for hemoglobinopaties, immunodeficiencies, autoimmune diseases with known or unknown genetic defects, metabolic disorders and muscular dystrophies. Concerning hemoglobinopaties, between 2005 and 2009, 68 bone marrow transplantation procedures were performed in patients with thalassemias or sickle cell anemias. In parallel, a research project of gene therapy in thalassemia is going and in 2012 a clinical trial will hopefully start. Regarding immunodeficiencies and autoimmune diseases with known or unknown genetic defects, our Institute regularly performs allogeneic stem cell transplantation and gene therapy of ADA-SCID and Wiskott-Aldrich Syndrome. Concerning metabolic disorders, a clinical trial of gene therapy in Metachromatic Leukodystrophy is ongoing. Finally, a cell therapy clinical study for Duchenne muscular dystrophy will start in 2011. Giuseppe Chiumello 206 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF INTERNAL AND SPECIALISTIC MEDICINE Head of Department: Emanuele Bosi* DEPARTMENT AREA COORDINATORS: Giselda Colombo, Matteo Rocco Pastore, Moreno Tresoldi General medicine, diabetes, endocrinology and metabolic diseases HEAD OF UNIT: Emanuele Bosi* CLINICAL UNIT LEADERS: Luca Falqui, Gabriella Galimberti, Roberto Lanzi, Matteo Rocco Pastore, Piermarco Piatti CLINICAL UNIT COORDINATOR: Marco Federico Manzoni PHYSICIANS: Alberto Davalli, Alessandro Saibene, Maurizio Storti RESIDENTS: Chiara Cappelletti, Valentina Crippa, Valentina Doria, Ilaria Formenti, Manuela Fortunato, Andrea Laurenzi, Sara Madaschi, Laura Molteni, Francesca Perticone, Cecilia Piani, Elena Peretti, Maria Grazia Radaelli, Alessandro Rossini, Annachiara Uccellatore NUTRITIONIST: Monica Marchi Clinical transplantation HEAD OF UNIT: Antonio Secchi* CLINICAL UNIT LEADERS: Rossana Caldara, Paola Maffi PHYSICIAN: Sabina Martinenghi CONSULTANTS: Chiara Gremizzi, Vera Paloschi RESIDENTS: Gabriella Cicenia, Andrea Vergani General medicine, clinical immunology and rheumatology HEAD OF UNIT: Maria Grazia Sabbadini* CLINICAL UNIT LEADERS: Giselda Colombo, Luisa Praderio, Moreno Tresoldi PHYSICIANS: Enrica P. Bozzolo, Massimo Memoli, Chiara Salmaggi, Nicoletta Saporiti, Raffaella Scotti, Magda Vecellio CONSULTANTS: Elena Baldissera, Lorenzo Dagna, Teresa D’Aliberti, Stefano Franchini, Mona-Rita Yacoub, Patrizia Aiello RESIDENTS: Mattia Baldini, Emmanuel della Torre, Barbara Guglielmi, Alessandro Marinosci, Francesca Motta, Fulvio Salvo, Mirta Tiraboschi Nephrology and dialysis HEAD OF UNIT: Donatella Spotti CLINICAL UNIT LEADERS: Paolo Manunta*, Giorgio Slaviero, Giuseppe Vezzoli PHYSICIANS: Teresa Arcidiacono, Chiara Lanzani, Marco Melandri, Luisa Persichini, Rita Quartagno, Maria Teresa Sciarrone Alibrandi, Paola Stella RESIDENTS: Irene Botticelli, Lino Merlino, Marialuisa Querques, Francesco Rainone, Marco Simonini *Professor at: Università Vita-Salute San Raffaele CLINICAL DEPARTMENTS - 207 Emanuele Bosi The Department of Internal Medicine incorporates all the areas and clinical activities of General and Specialized Medicine of the San Raffaele Hospital and Scientific Institute. Within the Department, physicians, nurses, technicians, students and volunteers are dedicated to the compassionate practice of medicine, with a continuum of care encompassing preventive medicine, acute care, palliative therapies and rehabilitation. The objective of the Department is to integrate clinical care, research and education with the aim of assisting patients at the best of current medical knowledge and technological expertise. Clinical activity and Areas of excellence - The Department of Internal Medicine is composed of four inpatient Clinical Units and many Outpatient Clinics and Services covering General Medicine and the medical specialties of Allergology, Clinical Immunology, Clinical Transplantation, Diabetes, Dialysis, Endocrinology, Hypertension, Metabolic Diseases, Nephrology, Nutrition and Rheumatology. Moreover, the Department of Internal Medicine works in close interaction with the Emergency Department, representing the main structure for hospitalization of patients presenting at the Emergency Medicine. The Department of Internal Medicine offers a complete range of teaching for students at the Medical School and hosts the Post Graduate Medical Schools of Allergology and Clinical Immunology, Endocrinology, Nephrology and Emergency Medicine, being also recognized as a centre of excellence in these specific fields. Fields of research - Integration between clinical care and research is a general theme across the Department. Relevant activities include: phase II/III clinical trials on novel pharmacological treatments and diagnostic tools in the fields of diabetes, rheumatoid arthritis, metabolism, hypertension, cardiovascular and immune-mediated diseases; and some important projects of translational medicine in the fields of islet transplantation and immunotherapies of type 1 diabetes and other autoimmune diseases. The Department is embedded in a remarkable clinical and scientific environment at San Raffaele, which offers unique opportunities for interdisciplinary collaboration and translational research. The scientific production by physicians and clinical investigators from the Department is remarkable, with internationally recognized areas of excellence in diabetes and metabolism, clinical immunology, hypertension, islet and pancreas transplantation. Emanuele Bosi 208 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF CLINICAL NEUROSCIENCE Head of Department: Enrico Smeraldi* DEPARTMENT AREA COORDINATORS: Barbara Barbini, Francesco Benedetti, Maria Cristina Cavallini, Andrea Fossati*, Ernestina Politi, Paolo Ronchi General psychiatry HEAD OF UNIT: Enrico Smeraldi* CLINICAL UNIT LEADERS: Roberto Cavallaro, Marco Locatelli PHYSICIANS: Ilaria Aina, Sara Angelone, Laura Bianchi, Marta Bosia, Federica Cocchi, Michele Cucchi, Daniela Di Molfetta, Marta Henin, Laura Liperi, Fausto Panigada, Ernestina Politi, Adriana Pontiggia, Paolo Ronchi, Laura Sforzini, Francesca Siliprandi RESIDENTS: Giampiero Bottero, Eugenia Fauci, Chiara Ruffini TECHNICIANS: Margherita Bechi, Vittoria Bottelli, Daniele Cavadini, Francesco Fresi, Alessia Santoro, Tomaso Siccardi Clinical health psychology HEAD OF UNIT: Lucio Sarno* PSYCHOLOGISTS: Valentina Di Mattei, Claudia Finocchiaro, Serena Giuliani, Carola Iris Ferrari, Rita Milesi, Chiara Motta, Liliana Novella, Valeria Pezzani, Alessandra Pradella, Maria Monica Ratti, Eleonora Sasso, Laura Tirloni RESIDENT: Stefano Clerici Clinical psychology and psychotherapy HEAD OF UNIT: Cesare Maffei* CLINICAL UNIT LEADERS: Mariagrazia Movalli, Laura Vanzulli CLINICAL UNIT COORDINATOR: Raffaele Visintini PHYSICIANS: Marco Battaglia*, Andrea Fossati* Anna Ogliari* CONSULTANTS: Francesca Biondini, Serena Borroni, Valentina Bregani, Paola Broggi, Elena Campanini, Ilaria Carretta, Paolo Casati, Elisabetta Cattaneo, Rosaria Devoti, Michela Donini, Cinzia Facchi, Marina Fiore, Sara Gaietta, Nicolò Gaj, Roberta Gallese, Salvatore La Viola, Gema Moelia Moreno Granados, Alessandro Pieri, Sergio Premoli, Erica Rossi, Roberto Vanni, Daniele Villa, Annalisa Zanoni RESIDENTS: Roberta Alesiani, Silvia Boccalon, Naima Coppolino, Maria Chiara Fiorin§, Gianluca Franciosi, Laura Giarolli, Valeria Parlatini, Paola Pesenti-Gritti§, Chiara Spatola§, Martina Testa §external residents Eating disorders HEAD OF UNIT: Laura Bellodi* CLINICAL UNIT LEADERS: Stefano Erzegovesi CLINICAL UNIT COORDINATORS: Giuseppina Diaferia, Maria Cristina Cavallini PHYSICIANS: Cinzia Arancio, Alessandro Bernasconi, Silvia Cocchi, Angela Gabriele FELLOWS: Ursula Catenazzi, Emma Fadda, Elisa Galimberti Mood disorders HEAD OF UNIT: Cristina Colombo CLINICAL UNIT LEADERS: Linda Franchini, Adelio Lucca, Raffaella Zanardi PHYSICIANS: Barbara Barbini, Francesco Benedetti, Euridice Campori, Mara Cigala Fulgosi, Sara Dallaspezia, David Rossini RESIDENTS: Dario Delmonte, Clara Locatelli, Alessia Malaguti Neurology HEAD OF UNIT: Stefano F. Cappa* CLINICAL UNIT LEADER: Sandro Iannaccone PHYSICIANS: Luca Bernasconi, Maria Cristina Giusti, Valeria Golzi, Alessandra Marcone, Barbara Sferrazza, Michele Zamboni RESEARCHERS: Jubin Abutalebi*, Nicola Canessa, Eleonora Catricalà, Pasquale Della Rosa PSYCHOLOGISTS: Valentina Esposito, Elena Farina, Paola Frasson, Valeria Ginex CLINICAL DEPARTMENTS - 209 Sleep disorders HEAD OF UNIT: Luigi Ferini-Strambi* PHYSICIANS: Mauro Manconi, Marco Zucconi *Professor at: Università Vita-Salute San Raffaele The first and main committment of the Department is to define and to develop a common guideline for the clinical approach to the different aspects of behavioural disorders, according to the funding principles of our Institution, in order to overcome the strict meaning of each symptom and to adequately consider the nature and the whole of the individual suffering. Enrico Smeraldi The public psychiatric structure is based on the model of Mental Health Department (DSM). Our department, in its psychiatric and psychological component, is based on long term therapeutical assistance, hence resembling DSM and their mode of function, but it differs from DSM in its objectives. In DSM, the main aim is to take care of the mental health of a community (differently defined) and it must be addressed in terms of prevention too. Treating patients in SPDC and CPS is a newly introduced option which can be considered also as a therapy in social environment (= territory, in the language of social psychiatry), that will be useful and produce mental health. On the other hand, the activity of our Department is mainly focused on the individual suffering and is addressed to the patient: the possible interest for the environment in which he lives or for his relationships is only aimed at improving assistance and therapeutical approach to the patient, who freely chooses our structure instead of the public one, even if located in his territory. The relationship between these two types of Psychiatric Departments has not yet been established and we are trying to find a different model of assistance according to the psychopathological “quality” of each disease. Another innovative feature is to put together in the same Department cognitive neurology and psychiatry, since behavioural disorders are frequent and common and the same therapeutical principles can be applied. Enrico Smeraldi 210 - SAN RAFFAELE SCIENTIFIC INSTITUTE DEPARTMENT OF NEUROLOGY Head of Department: Giancarlo Comi* CLINICAL UNIT LEADERS: Mauro Comola, Ubaldo Del Carro, Vittorio Martinelli, Fabio Minicucci DISEASE UNIT COORDINATORS: Bruno Colombo, Raffaella Fazio, Letizia Leocani, Giuseppe Magnani, Paolo Marchettini, Vittorio Martinelli, Maria Sessa, Giulio Truci, Maria Antonietta Volontè PHYSICIANS: Stefano Amadio, Giovanna Franca Fanelli, Fabio Formaglio, Roberta Guerriero, Silvia Mammi, Filippo Martinelli-Boneschi, Stefania Medaglini, Lucia Moiola, Antonella Poggi, Mariaemma Rodegher, Paolo Rossi, Luisa Roveri, Marina Scarlato RESIDENTS: Martina Absinta, Valeria Barcella, Mariangela Bianco, Calogera Butera, Francesca Caso, Daniela Ceppi, Raffaella Chieffo, Elisabetta Coppi, Dacia Dalla Libera, Donatella De Feo, Luisa De Toni Franceschini, Sebastiano Galantucci, Chiara Ghidinelli, Giacomo Giacalone, Elda Judica, Sara La Gioia, Emanuela Leopizzi, Giuseppe Liberatore, Giulia Longoni, Ignazio Diego Lopez, Maria Merello, Giulia Pavan, Elisabetta Stefania Perego, Luca Peruzzotti Jametti, Francesca Spagnolo, Laura Straffi, Habtom Tesfaghebriel, Daniela Ungaro, Chiara Vismara *Professor at: Università Vita-Salute San Raffaele The Department of Neurology consists of the Neurology Unit (45 beds), the Neurorehabilitation Unit (42 beds), the laboratory of Clinical Neurophysiology and the Neuropsychology Service. The out patient area, day hospital service and the Centres for Epilepsy, Multiple Sclerosis, Headache, Pain, ALS and Multiple Sclerosis are the other activity characterising the Department. Clinical activities are organized in disease units in order to provide patients an integrated assistance going from the diagnostic aspects to the advanced therapeutic interventions, including rehabilitaGiancarlo Comi tion. The Department of Neurology is mostly qualified for advanced treatment strategies in inflammatory diseases of the Central and Peripheral Nervous System, stroke, neurodegenerative disorders, acting in strict interaction with the Institute of Experimental Neurology. A large number of phase I-IV clinical trials performed in cooperation with pharmaceutical industries and generated by the Department itself make it possible to provide patients with more advanced therapeutic strategies. Points of excellence of the clinical research are etiologic and symptomatic treatment of multiple sclerosis, epidemiological studies on multiple sclerosis, and the evaluation of the disease pathogenesis and pathophysiology. Ischemic stroke researches are focused on the risk factors for the occurrence in young adults and on the organisational aspect of the early intervention. Studies on dementia are conducted in co-operation with Imaging and clinical neurophysiology laboratories and aims to define biomarkers specific for dementia subtypes and to assess the risk for evolution to Alzheimer Disease in patients with minimal cognitive impairment. In Amyotrophic Lateral Sclerosis the contribution of instrumental test to the early diagnosis, the characterisation of cognitive dysfunction, the assessment of the value of new treatments are the key research activities. The recovery medicine is one of the more recent area of research activated in the Department, because of the possibility to follow neurological dysfunctions due to acute central nervous system lesions, from the onset to the recovery phase. The impact of various therapeutic strategies to enhance recovery, the functional and molecular bases underlying brain plasticity after acute damage with imaging and neurophysiological examinations are deeply investigated. Giancarlo Comi CLINICAL DEPARTMENTS - 211 DEPARTMENT OF ONCOLOGY Head of Department: Federico Caligaris-Cappio* DEPARTMENT AREA COORDINATORS: Gianni Bordogna, Gianfranco Ciboddo, Consuelo Corti, Andrés Jose Maria Ferreri, Michele Reni Internal medicine HEAD OF UNIT: Federico Caligaris-Cappio* CLINICAL UNIT LEADERS: Marco Foppoli, Giovanna Petrella CLINICAL UNIT COORDINATOR: Aurelio Vicari PHYSICIANS: Gianfranco Ciboddo, Giovanni Citterio, Giovanni Donadoni, Giada Licata, Manuela Pacchioni RESIDENTS: Chiara Miggiano, Federica Pozzi, Carlo Rossi, Gilda Rossoni, Paolo Strati, Irene Vandoni, Chiara Francesca Verona, Angela Zanoni Haematology and bone marrow transplantation HEAD OF UNIT: Fabio Ciceri CLINICAL UNIT LEADERS: Massimo Bernardi, Consuelo Corti, Jacopo Peccatori PHYSICIANS: Andrea Assanelli, Lionello Camba, Matteo Carrabba, Elena Guggiari, Francesca Lunghi, Magda Marcatti, Maria Teresa Lupo Stanghellini Medical oncology HEAD OF UNIT: Eugenio Villa CLINICAL UNIT LEADERS: Daniela Aldrighetti, Monica Ronzoni PHYSICIANS: Gianni Bordogna, Stefano Cereda, Andrés Jose Maria Ferreri, Vanesa Gregorc, Elena Mazza, Michele Reni, Giordano Pietro Vitali, Patrizia Zucchinelli CONSULTANTS: Carmen Belli, Alessandra Bulotta, Monica Giovannini, Vincenzo Ricci, Alessia Rognone, Luca Tondulli, Maria Grazia Viganò Nuclear Medicine HEAD OF UNIT: Luigi Gianolli CLINICAL UNIT COORDINATOR: Daniela Perani* RESEARCHERS: Sara Belloli, Valentino Bettinardi, Assunta Carpinelli, Isabella Castiglioni, Maria Carla Gilardi, Adelmo Grimaldi, Mario Matarrese, Maria Grazia Minotti, Rosa Maria Moresco, Maria Picchio, Marco Rigamonti, Annarita Savi, Paola Scifo, Marco Tettamanti, Sergio Todde PHYSICIANS: Carla Canevari, Flaviano Dosio, Federico Fallanca, Claudio Landoni, Patrizia Magnani, Ursola Pajoro, Andrea Panzacchi, Gino Pepe, Ana Maria Samanes Gajate, Paola Todeschini, Giovanna Vanoli CONSULTANTS: Elena Busnardo, Elisabetta Giovannini, Eleonora Manca, Alberto Monello, Pietro Spagnolo RESIDENTS: Elena Greco, Paola Mapelli, Elena Spinapolice, Ignazio Vilardi FELLOWS: Emilia Buriova, Elisa Galli, Manuela Giglio, Claudia Francesca Maddé, Claudio Mannu, Valeria Masiello, Eugenio Rapisarda PHD STUDENTS: Francesca Gallivanone, Cristina Monterisi, Silvia Valtorta TECHNICIANS: Luca Brioschi, Patrizia Cerè, Antonia Compierchio, Paola Cordisco, Valeria Crippa, Silvia Debbia, Andrea Fabro, Davide Gatti, Paola Lanzoni, Stefania Longari, Raffaele Menichini, Giacomo Orlandi, Jacopo Perego, Riccardo Rigamonti, Silvana Romano, Lucia Rozza, Pasquale Simonelli, Stefano Stucchi, Francesco Sudati, Mauro Vaghi, Raffaele Vannulli Radiotherapy HEAD OF UNIT: Nadia Di Muzio CLINICAL UNIT LEADER: Angelo Bolognesi PHYSICIANS: Fodor Andrei, Saverio Beatrice, Genoveffa Berardi, Anna Chiara, Cesare Cozzarini, Aniko Maria Deli, Italo Dell’Oca, Micaela Motta, Marcella Pasetti, Paolo Passoni, Najla Slim RESIDENTS: Filippo Alongi, Brigida Pappalardi TECHNICIANS: Fabio Baratto, Nietta Barricella, Roberta Bin, Rita Calaciura, Alessandro Capelli, Alberta De Leonardis, Letizia Erre, Caterina Fiordelisi, Laura Longoni, Marilena Martulano, Lidio Palumbo, Diana Parutto, Vincenzo Sacco, Giovannella Salvadori, Andrea Sbalchiero, Simone Selli, Antonella Soccio, Marco Spagnuolo, Alessandro Tavilla *Professor at: Università Vita-Salute San Raffaele 212 - SAN RAFFAELE SCIENTIFIC INSTITUTE Federico Caligaris-Cappio The Department of Oncology is transforming everyday practice into protocol-based clinical activity to achieve optimization of care and acceleration of cure. The specific aims are: 1) to maintain/reach “state of the art” clinical care for all types of cancer; 2) to improve logistic and organization ameliorating patient care; 3) to strengthen research with the instruments of Translational Research and an interdisciplinary approach: this aim foresees the establishment of a Clinical Trial Unit essentially devoted to Phase I and Phase II clinical trials; 4) to join efforts with the Division of Molecular Oncology to establish an internationally competitive Integrated Cancer Center (HSR-ICC). Clinical activity and Areas of excellence - The Department includes the Divisions of Medicine 1Q and of Hematology and Bone Marrow Transplantation, the Units of Medical Oncology, Radiotherapy and Nuclear Medicine. The number of beds is 63, the personnel amounts to over 190 people; there are a management coordinator and a nurse coordinator. The cultural organization of the Department follows the Disease Unit model and is based upon a fruitful interaction with other Clinical Departments involved in the diagnosis and treatment of cancer and with several Research Divisions as well. The active Disease Units are Lymphoid, Lung, Pancreas, Breast, Head and Neck, GastroIntestinal, Melanoma, NeuroOncology, Genito-Urinary and Gynecological Oncology. In 2008 the Department has taken care of about 4500 cancer patients, furthermore a) the Departmental Area of Lymphoid Tumors has been established with 25 ongoing clinical trials (HSR is the coordinating center of 11), b) the Bone Marrow Transplantation Unit has ranked among the firsts in Italy as for the number of allogeneic transplantations performed and c) 43 clinical trials have been approved by the Ethical Committee including numerous Phase I and Phase II trials. Blood, thoracic, pancreas and brain tumors are Areas where the Department is especially active, not to mention the urological cancers in collaboration with the Department of Urology. The collaboration with the Division of Molecular Oncology is strengthened by the clinical experience in applying new therapies to patients and is favouring the development of new potential therapeutic tools that are systematically analysed in preclinical settings. The Department has become member of the European Organization of Cancer Centers (OECI), the Southern Europe for New Drugs Organization (SENDO), the Swiss Group for Clinical Cancer Research (SAKK), the CLL US/Europe Alliance Organization (driven by the MD Anderson Cancer Center) and is also member of the Network Italiano BioImmunoterapia dei Tumori (NIBIT) and of the Italian Melanoma Intergroup. Fields of research - Innovative strategies are urgently needed in the areas of diagnosis, patient risk stratification and treatment. We are building up teams of laboratory-based and clinical investigators with the aim of defining molecular endpoints in clinical material and use them to develop studies on the pathobiology of specific tumors and to organize pilot studies and investigator-driven clinical trials. The currently ongoing projects can be summarized under three main headings: 1) Molecular mechanisms of disease, one example being the association of infectious agents with the development of specific types of lymphoid malignancies; 2) New diagnostic and prognostic approaches to define biologically-based prognostic and predictive tools, one example being the validation of a number of new markers with proteomic technologies; 3) New treatment strategies developed by increasing Phase I and I-II studies and by clinically translating the results of preclinical investigations, examples being immunotherapy, anti-angiogenesis-based treatments and the use of tomotherapy in specific types of cancer. Federico Caligaris-Cappio CLINICAL DEPARTMENTS - 213 DEPARTMENT OF RADIOLOGY Head of Department: Alessandro Del Maschio* DEPARTMENT AREA COORDINATORS: Francesco De Cobelli*, Maurizia Del Maschio, Roberto Nicoletti, Pierluigi Paesano Radiology HSR HEAD OF UNIT: Alessandro Del Maschio* CLINICAL UNIT LEADERS: Francesco De Cobelli*, Maurizia Del Maschio, Roberto Nicoletti, Pierluigi Paesano, Pietro Panizza, Massimo Venturini PHYSICIANS: Laura Brasca, Stefano Cappio, Giulia Maria Crespi, Angela De Gaspari, Antonio Esposito, Elda Garuti, Domenico Ghio, Simone Gusmini, Carlo Martinenghi, Renata Mellone, Maria Grazia Rodighiero, Marco Salvioni, Simona Irma Tacchini, Roberto Varagona CONSULTANTS: Marina Benveniste, Roberta Carpanelli, Elena Contrino, Claudio Losio Radiology HSRT HEAD OF UNIT: Giuseppe Balconi CLINICAL UNIT LEADER: Gianpiero Cardone PHYSICIANS: Elena Capitelli, Francesca Di Sebastiano, Rossana Favia, Cristiana Iabichino, Roberto Lanzi, Massimo Mandelli TECHNICIANS: Cecilia Bertocchi, Enza Galvano, Caterina Parolo, Alessandra Poggi, Maria Pia Rapallo, Stefano Rovani *Professor at: Università Vita-Salute San Raffaele Alessandro Del Maschio The Global Activity of the Clinical Department of radiology includes more than 165000 diagnostic and interventional procedures (including emergency) per year. The Department of Radiology is composed of many inpatienst and outpatients Services covering all the main fields of general Radiology except of neuroradiology. The Department of Radiology is devided into two groups, the main at San Raffaele Hospital and the second at Ville Turro buildings. Moreover, the Department of Radiology works in close interaction with the Emergency Department, for the evaluation of the main acute diagnostic problems. The objective of the Department is to integrate clinical activity, research and education with the aim of helping patients at the best of current medical knowledge and technological expertise. Clinical activity and Areas of excellence - The Department includes six sections of clinical activity and areas of excellence: 1. Conventional and Digital Radiology 2. Breast Imaging 3. Ultrasound 4. Computed Tomography 5. Magnetic Resonance Imaging and Spectroscopy 6. Diagnostic and Interventional Radiology/Angiography 214 - SAN RAFFAELE SCIENTIFIC INSTITUTE Fields of research - The main fields of research are represented by: • Cardiac magnetic resonance (CMR) Imaging and Spectroscopy and cardiac Computed Tomography (CT). • Diffusion-weighted Magnetic Resonance Imaging in cancer patients • Development of clinical trials with new contrast agents especially in Magnetic Resonance Imaging • Cellular and molecular imaging with a new 7T magnet dedicated to animal studies • Pancreatic cancer imaging • Breast cancer imaging and screening. Moreover we developed many collaborations with internal and external groups, in particular: • with the Section of Nutrition/Metabolism and the Faculty of Exercise Sciences, Università degli Studi di Milano with Prof. Perseghin and Prof. Luzi it has been developed a tight cooperation on Magneticresonance spectroscopy of the heart and of the liver in order to evaluate the functional and metaboliceffects of physical exercise and pathological conditions such as diabetes, obesity or cardiomyopathies; • with the group of Prof. Manfredi, a non-invasive MR based method for in-vivo cellular tracking has • been developed and applied to follow the dendritic cells (DCs) in tumor bearing mice, allowing to investigate the critical aspects of DCs migration to establish an immune mediated cancer therapy;Alessandro Del Maschio • with the Unit of Radiation Therapy and Medical Physics of Dr. Di Muzio and Dr. Calandrino we • sought to implement the radiotherapy planning by new imaging-techniques. We have use different imagingtechnique as MRI and contrast enhanced 4D-CT to improve target volume definition in prostate cancer and in pancreatic ductal adenocarcinoma; • with the Transplant Unit of Prof. Secchi and Dr. Maffi we studied the metabolic effects in type 1 diabeticpatients who have undergone kidney or combined kidney-pancreas transplantation or islettransplantation with different imaging or spectroscopic approaches; moreover, with the same group in the setting of the DRI, a similar approach for cells labelling and imaging was also used to follow the pancreatic islets fate, after their transplantation in mouse model of type 1 diabetes; • with the Department of Mechanics, Politecnico di Torino, with the Department of Bioengineering, Politecnico di Milano, with the Istituto di Bioimmagini e Fisiologia Molecolare, Research National Council, Milan in order to develop a method for quantifying helical flow in vivo employing time-resolved cine phase contrast magnetic resonance imaging to obtain the complete spatio-temporal description of the three-dimensional pulsatile blood flow patterns in aorta. Alessandro Del Maschio CLINICAL DEPARTMENTS - 215 DEPARTMENT OF UROLOGY Head of Department: Patrizio Rigatti* DEPARTMENT AREA COORDINATORS: Roberto Bertini, Luigi Broglia, Andrea Cestari, Valerio Di Girolamo, Francesco Montorsi*, Luciano Nava, Vincenzo Scattoni Urology HSR HEAD OF UNIT: Patrizio Rigatti* CLINICAL UNIT COORDINATORS: Roberto Bertini, Renzo Colombo, Francesco Montorsi*, Andrea Salonia PHYSICIANS: Diego Angiolilli, Alberto Briganti, Lina Bua, Andrea Gallina, Massimo Ghezzi, Caterina Lania, Arianna Lesma, Marco Raber, Antonino Saccà, Vincenzo Scattoni, Nazareno Suardi, Giuseppe Zanni RESIDENTS: Firas Abdollah, Marco Bianchi, Tommaso Camerota, Umberto Capitanio, Dario Di Trapani, Matteo Ferrari, Salvatore Grimaldi, Carmen Maccagnano, Federico Pellucchi, Giovanni Petralia, Lorenzo Rocchini, Francesco Sozzi, Elena Strada, Manuela Tutolo Urological endoscopy service and day surgery HEAD OF UNIT: Valerio Di Girolamo Strategic Program for uro- andrological research HEAD OF UNIT: Francesco Montorsi* Urology HSRT HEAD OF UNIT: Giorgio Guazzoni* CLINICAL UNIT LEADERS: Piera Bellinzoni, Luigi Broglia, Luciano Nava PHYSICIANS: Antonia Centemero, Andrea Cestari, Andrea Losa, Tommaso Maga, Lorenzo Rigatti CONSULTANTS: Nicolò Maria Buffi, Fabio Fabbri, Mattia Sangalli, Emanuele Scapaticci, Matteo Zanoni RESIDENT: Giovanni Lughezzani *Professor at: Università Vita-Salute San Raffaele The Department of Urology at Vita-Salute San Raffaele University, Milan, chaired by Professor Patrizio Rigatti, is one of the most important institutions in the field both in terms of clinical and research activity. The Department was founded in 1985 and it is currently directed by Professor Patrizio Rigatti. Clinical activity - The surgical activity is based on 25 operating theatre sessions and it is serving 110 beds for ordinary recovery. Every year, about 1000, 500 and 250 surgical procedures are performed for prostate, bladder and kidney cancer, respectively. Specific interest is directed to robotic surgery which is currently used to perform radical prostatectomy, partial nephrectomy for cancer and reconstructive. Patrizio Rigatti Fields of research - The clinical investigations performed in the most recent years leaded to the publication of 623 scientific contributions for a overall citation index of 6872 (citation index last three years: 3113; h-index: 40) [Source SCOPUS April 2010]. During the last 3 years the Department of Urology ranked first in terms of abstracts presented at the official annual meetings of the European Association of Urology and American Urological Association. The main clinical research areas consist of prostate cancer, kidney cancer, bladder cancer, infertility and andrology, female sexual medicine, benign prostatic hyperplasia. Ongoing and new translational researches has been starting after the foundation of the Urological Research Institute (URI), headed by Professors Francesco Montorsi and Petter Hedlund. The main basic research areas consist of prostate and bladder cancer, functional urology, reproductive and erectile dysfunction. Patrizio Rigatti 216 - SAN RAFFAELE SCIENTIFIC INSTITUTE CLINICAL SERVICES Pathology HEAD OF UNIT: Claudio Doglioni* CLINICAL UNIT COORDINATORS: Gianluigi Arrigoni, Massimo Freschi, Maurilio Ponzoni, Isabella Sassi, Gianluca Taccagni, Maria Rosa Terreni PHYSICIANS: Luca Albarello, Giacomo Dell’Antonio, Nathalie Rizzo RESEARCHER: Francesca Sanvito CONSULTANTS: Anna Cremonini, Graziana Famoso BIOLOGISTS: Maria Giulia Cangi, Lorenza Pecciarini POST-DOCTORAL FELLOWS: Daniela Clavenna, Greta Grassini, Ilenia Papa TECHNICIANS: Mara Bertolazzi, Marina Brambilla, Roberta Brambilla, Roberto Cairella, Diana Ciscato, Elena Dal Cin, Stefania Demasi, Barbara Di Ruvo, Patrizia Ferrari, Marilena Flore, Franco Galli, Stefano Grassi, Laura Labbate, Camilla Lambiente, Anna Mauri, Martina Rocchi, Graziella Santambrogio, Carlo Silva, Anna Talarico CYTOTECHNOLOGISTS: Teresa Carbone, Miriam Cosciotti, Grazia Lamonaca, Giulio Legnani, Franca Toffolo Laboratory medicine HEAD OF DIVISION: Fernanda Dorigatti HEADS OF UNIT: Ferruccio Ceriotti, Massimo Clementi*, Maurizio Ferrari*(*), Massimo Locatelli CLINICAL UNIT LEADERS: Paola Cichero, Stefania Del Rosso, Fulvio Ferrara, Anna Maria Girardi, Cristina Ossi, Marina Pontillo, Sara Racca, Armando Soldarini, Laura Soldini, Silvana Viganò PHYSICIANS: Enzo Boeri, Luciano Crippa, Rita Daverio, Annalisa Fattorini, Nicasio Mancini, Andrea Motta, Maria Grazia Patricelli, Serena Rolla, Loredana Tomassini, Mladen Trbos BIOLOGISTS: Elena Bazzigaluppi, Sara Benedetti, Silvia Carletti, Anna Carobene, Arianna Crepaldi, Carlo Alberto Ferrero, Rossella Ieri, Rosanna Latino, Marcello Marinelli, Gabriella Passerini, Elisabetta Pattarini, Flavia Piccini, Barbara Maria Pirola, Laura Seghezzi, Barbara Sioli, Ivana Spiga, Annunziata Spina, Monica Zanussi BIOENGINEER: Davide Alessio CONSULTANTS: Emanuele Bosi*(#), Roberto Burioni*, Armando D’Angelo(#),Silvano Rossini, Orsetta Zuffardi(*) FELLOWS: Angela Brisci, Francesca Bruno, Filippo Canducci, Maria Rosaria Carbone(*), Emanuela Castiglioni, Vincenza Causarano, Donata De Marco, Roberta Diotti, Chiara Di Resta, Alessandra Foglio(*), Silvia Galbiati, Nadia Ghidoli, Carlo Lombardoni(*), Nicola Maganetti, Maria Chiara Marinozzi, Francesca Rigo(*), Monica Sassi, Elena Sommariva(*), Stefania Stenirri TECHNICIANS: Rose Mary Carletti, Cinzia Magagnotti(*), Michela Sanpaolo, Francesca Sampietro(#), Nadia Soriani(*) (*) reporting to the CENTER FOR GENOMICS, BIOINFORMATICS AND BIOSTATISTICS (#) reporting to the DIVISION OF METABOLIC AND CARDIOVASCULAR SCIENCES Immunohematology and transfusion medicine service HEAD OF UNIT: Silvano Rossini CLINICAL UNIT LEADERS: Lorena Barzizza, Laura Bellio PHYSICIANS: Cinzia Bargiggia, Alketa Bolentini, Katharina Fleischhauer, Salvatore Gattillo, Lucia Malabarba, Lilian Romero, Paola Ronchi BIOLOGISTS: Lia Parma, Oriana Perini, Cristina Tresoldi, Elisabetta Zino CHEMIST: Benedetta Mazzi TECHNICIANS: Daniela Ceresa, Silvia Corno, Luigi D’Amato, Stefania Dell’Orco, Giuseppe Di Leo, Dina Di Sciacca, Alessandra Galli, Emanuela Grioni, Maria Antonia Introini, Giuseppina Marabelli, Ilaria Mazzi, Gabriella Salomoni, Massimo Sacconi, Elisabetta Sironi, Serenesse Tomasi, Gabriele Torriani, Federica Valtorta, Matilde Zambelli, Paola Zappalalio Emergency medicine HEAD OF UNIT: Michele Carlucci DIRECTOR OF EMERGENCY MEDICINE PROGRAM: Marzia Spessot CLINICAL UNIT COORDINATORS: Pietro Bisagni, Anna Borri, Roberto Faccincani, Maria Vittoria Lavorato, Federica Mariani PHYSICIANS: Aldo Beneduce, Giuseppe Capasso, Laura Ferrario, Federico Furlan, Giulia Gallotta, Elisa Gatti, Simona Mauri, Enrico Ortolano, Simona Rocchetti, Maria Vittoria Taglietti, Luca Tomaello, Valentina Tomajer RESIDENTS: Vanessa Capitanio, Carmen Forestieri, Manuela Fortunato, Shigeki Kusamura, Andrea Laurenzi, Francesco Luparini, Alessandro Marinosci, Federica Merlini, Federica Milani, Alessio Mocci, Annamaria Pazzi, Elena Peretti, Alessandro Rossini, Roberta Varale CLINICAL SERVICES - 217 General intensive care HEAD OF UNIT: Alberto Zangrillo* CLINICAL UNIT COORDINATORS: Gabriele Cornaggia, Paolo Silvani Anesthesia HEAD OF UNIT: Luigi Beretta* CLINICAL UNIT COORDINATORS: Massimo Caldi, Daniela Giudici *Professor at: Università Vita-Salute San Raffaele 218 - SAN RAFFAELE SCIENTIFIC INSTITUTE PATHOLOGY The Unit of Anatomy Pathology is a Clinical Service that provides surgical pathology and cytopathology activity, intraoperative consultations, post-mortem examination to the San Raffaele Hospital, performing gross and microscopic examination and interpretation of tissue specimens that include biopsies and surgical excisions. Activity Our Unit evaluated more than 25.000 surgical and 24.000 cytologic specimens in 2009, encompassing most of the wide variety of pathology scenario. The diversity of the specimen material is reflected in the specialized medical and surgical practice at San Raffaele Hospital where Pathologists with particular interest and expertise in different specialty areas (e.g., hematopathology, uropathology, neuropathology, gynecologic pathology, etc.) interpret and signout these cases. This approach ensures excellent diagnostic interpretations, enhancing collaboration with the specialized clinical services present in San Raffaele Hospital. A broad, continuously expanding and updated array of specialized techniques is available to complement routine morphologic examination, including a wide menu of immunohistochemical and immunofluorescence reagents, molecular pathology analyses, cell cultures, karyotyping of solid tumors and molecular cytogenetic techniques. Claudio Doglioni LABORATORY MEDICINE Standardization in clinical chemistry. Two types of activities: 1. a multicenter study for the definition of reference intervals for aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase involving collaboration with Turkey and China and 2. the development and implementation of reference methods for enzyme catalytic activities to be applied to set target values to control materials for external quality assessment schemes and to validate and certify other field methods and routine laboratories. Microbiology and Virology. 1. Microbiology. Resistance and susceptibility to antibiotics and antifungal of bacteria and fungi; molecular diagnosis of sepsis. 2. Virology. Molecular biology of viral agents of acute respiratory diseases (coronaviruses, respiratory syncytial virus and viruses identified recently in infants with acute respiratory diseases); molecular monitoring of antiviral therapies and of therapies targeting virus fitness; in vitro characterization of anti-HCV neutralizing human monoclonal antibodies; cross-reacting and neutralizing human monoclonal antibody directed against the HCV\E2 protein; Hepatitis C virus (HCV)-driven stimulation of subfamily-restricted natural IgM antibodies in mixed cryoglobulinemia; anti- viral Response Elicited by Anti-Idiotype Monoclonal Antibodies. Laboraf collaborates with the research Center for genomics, bioinformatics and biostatistics, with the research Division of metabolic and cardiovascular sciences and with the Department of Internal and specialistic medicine. Fernanda Dorigatti IMMUNOHEMATOLOGY AND TRANSFUSION MEDICINE SERVICE The Hospital San Raffaele (HSR) Immunohematology and Transfusion Medicine Service (ITMS) provides clinical services to support HSR patients in need of blood component therapy, cellular therapy, therapeutic apheresis, and specialized laboratory diagnostics. This ISO 9002 Certified unit collects and prepares the blood components and cellular therapy products used in patient care at the HSR, maintain an accredited Immunohematology Reference Lab and provides education in the field of Transfusion Medicine. CLINICAL SERVICES - 219 The ITMS is subdivided into three distinct sub-units, each responsible for a particular process: Blood Donation Center The blood donation center sub-unit is responsible for the collection and testing of blood to be transfused into patients at the San Raffaele Hospital. It is responsible for handling all aspects of donor recruitment for whole blood products, apheresis products, the auto-transfusion program and therapeutic phlebotomy. Therapeutic Apheresis and Cellular Therapy The Therapeutic Apheresis and Cellular Therapy sub-unit is responsible for collecting and processing hematopoietic stem cells and performs the necessary diagnostic testing required for bone marrow transplantation procedures. The lab supplies hematopoietic stem cells and relevant cells in support of clinical trials for allogenic bone marrow and peripheral blood transplantation and offers a Stem Cell Cryo Banking service for autologous and allogeneic bone marrow products. Bone Marrow from qualified donors is collected in accordance and recognition of the Italian Bone Marrow Donor Registry (IBMDR). Therapeutic apheresis procedures to treat patients with neurologic and blood diseases, including photopheresis, red cell and plasma exchange procedures are also performed routinely. Clinical Laboratory Diagnostics The Clinical Laboratory Diagnostics sub-unit includes the following specialized laboratories: Immunohematology, Hematology, Flow Cytometry, Hematological Molecular Biology and an EFI Certified and accredited HLA tissue typing laboratory. New technologies such as genetic red blood cell typing are being investigated. A special emphasis is given to onco-hmatologic malignancies. These pathologies are studied using a multi-disciplinary approach. In 2008, the ITMS distributed over 18,000 RBC Units and 4000 Platelet units, performed over 220 Stem Cell collections and 660,000 clinical tests. Silvano Rossini EMERGENCY MEDICINE In 2009 the Emergency Department of San Raffaele Hospital provided care for 62.849 patients. Of the patients triaged 780 were given red code (that is, to be seen immediately in the resuscitation area). 9413 cases were given yellow code (that is, to be seen within 30 minutes of arrival). The largest amount of them (49634) were given lower priority (green code, that means to be seen within 1 hour of arrival). Only 3022 were given a white code (that is, patients whose conditions are not true emergencies). In 2009 we have seen 20848 patients with medical problems, 14853 with surgical problems and 11872 with minor trauma.7850 children have been treated in the pediatric area. In the dedicated area for obstetrics 5187 women received treatment. 9857 patients, after initial evaluation, were admitted to different wards for further investigations and treatments. In 2009 630 patients received surgery in the Emergency room. Major trauma (patient with multiple injuries) is treated by a trauma team who has been trained using the principles taught in the internationally recognized Advanced Trauma Life Support course. Medical emergencies are treated as taught in the Advanced Life Support and Trauma Advanced Life Support courses. Some members of the Emergency Room staff are ALS and ATLS instructors and such courses are regularly held in our Hospital every year. Staff members receive Emergency Medicine Up-to-date meetings every two weeks. Medical students from Università Vita e Salute are trained on application of classical emergency medicine principals in a humanistic and supportive patient environment. In 2009 physicians attended the following meetings and courses: Il laboratorio d’Urgenza: problematiche organizzative e novità diagnostiche (Cremona, November); Le urgenze neurologiche: dalla diagnosi alla terapia (Milan, November); International Meeting on Simulation in Healthcare-( Orlando, January); Trauma: Update and organization (Bologna: February; Rome: October; Parma: September; Milan: December); ESTES Antalya, May; Congresso SIMEU Lombardia (Milan, June); Medical Response to Major Incidents (Spalato, November). Michele Carlucci 220 - SAN RAFFAELE SCIENTIFIC INSTITUTE GENERAL INTENSIVE CARE In 2008 our General ICU admitted 491 patients. Nearly half of these patients required an intensive treatment, the others were subjects who needed a postoperative monitoring after major elective surgery. The occupational rate during last year was around 95%. Actually we’re changing our strategy to optimize ICU admissions, improving an early postoperative care in recovery room for the postoperative patients, in order to guarantee the care for hospital and territorial emergencies. In 2008 the principal critical illnesses admitted to our unit included: • Trauma patients (20% of intensive treatments). As front line of a 2nd level hospital in Milan county, general ICU accept a significant number of subject involved in traffic and work accident. • Respiratory failure (40% of intensive treatments). Primary and secondary ARDS (acute respiratory distress syndrome) are frequent and undesirable evolutions of pneumonia or systemic sepsis, especially in immunecompromised patients like in autoimmune pathology or after transplantation. • Cardiovascular failure or multiple organ dysfunctions (20% of intensive treatments). Patients rescued from cardiac arrest or with strong cardiac congestive failure. • Septic shock (10% of intensive treatments). Severe evolution of sepsis, complication in patients submitted to major surgery or transplantation. In our general ICU we can provide a wide range of therapeutic options and protocols for these specific pathologies, updated to the last international guidelines: the newest strategies in mechanical ventilation including extracorporeal life support, updated antibiotic therapy, hypothermic therapy post cardiac arrest and developments in continuous renal replacement therapy. An important first step has been done in training the staff to the use of echography in ICU. The general ICU physicians also provide a medical emergency team (MET) 24 hours a day, which is involved in hospital emergencies and consulting. This kind of organization allows MET to perform safely a non invasive ventilation treatment for mild or chronic respiratory failure in non intensive areas. The same ICU staff provides all the non-cardiosurgery emergency surgical procedures. Alberto Zangrillo ANAESTHESIA AND NEUROINTENSIVE CARE UNIT Neurointensive Care is a 6 beds unit. 300 patients are admitted every year, 50% from the Casualty Department (severe head injury, stroke and subarachnoid haemorrhage) and 50% from the Neurosurgery Unit (tumor, vascular). 20 patients with brain death are treated and 12 of them become organ donors. The Head and Neck Anaesthesia Staff provides general anaesthesia in neurosurgical, interventional neuroradiology, ENT and ophthalmic surgery for approximately 3000 cases per year and for conscious sedations in children and adults (1000 cases per year) submitted to diagnostic or therapeutic procedures in Neuroradiology. The General Anaesthesia Staff provides anaesthesia in the Surgical Department (Gastroenterology, Haepatology, Endocrine, Pancreatic), Orthopaedics, Obstetrics and Gynaecology, Plastic Surgery (approximately 20.000 cases/per year). Outside the O.R. sedation and anaesthesia are performed for diagnostic and therapeutic interventions in Gastroenterology. A staff is dedicated to the treatment of the postoperative acute pain and chronical neoplastic pain (“Hospital without Pain” Committee). Luigi Beretta 10finale 9 07 2010 16:50 Pagina 221 SAN RAFFAELE IN THE WORLD - 221 AISPO - SAN RAFFAELE IN THE WORLD HEALTH CARE SUPERVISOR: Gianna Zoppei GENERAL DIRECTOR: Renato Corrado PUBLIC RELATIONS: Laura Sincinelli DESK OFFICERS: Elena Balducci, Giuliano Brumat, Federico Chiodi-Daelli JUNIOR DESK OFFICERS: Sara Lenzi, Federico Porro HEALTH ECONOMY ADVISOR: Marco Borgognoni Gianna Zoppei CLINICAL AND RESEARCH STAFF: Ricardo Riberio, Hospital São Rafael, Salvador, Brazil Milena Soares, Hospital São Rafael, Salvador, Brazil Paul G. D’Arbela, St. Raphael of St. Francis Hospital Nsambya, Kampala, Uganda Klaus Reither, Swiss tropical and Public health institute, Bagamyo research and training center, Tanzania Martin Ogwang, Vice Operational Director, Lacor Hospital, Gulu, Uganda Daniela Maria Cirillo, Head, Emerging bacterial pathogens Unit Diego Zallocco, Project manager, Emerging bacterial pathogens Unit Emanuele Borroni, Biologist, Emerging bacterial pathogens Unit Gabriella Scarlatti, Head, Viral evolution and transmission Unit Mariangela Cavarelli, Researcher, Viral evolution and transmission Unit Stefania Dispinseri, Researcher, Viral evolution and transmission Unit Adriano Lazzarin, Head, Department of infectious diseases Massimo Cernuschi, Medical Doctor, Department of infectious diseases Massimo Clementi, Director, Microbiology Service Laboraf Flavia Lillo, Researcher, Microbiology Service Laboraf Fabio Ciceri, Head, Hematology and bone marrow transplant Unit Consuelo Corti, Consultant, Hematology and bone marrow transplant Unit Valeria Calbi, Hematologist Cooperant, Hematology and bone marrow transplant Unit Giacomo Dell’Antonio, Medical Doctor, Pathology Unit Ottavio Alfieri, Head, Cardiovascular and thoracic surgery department Antonio Grimaldi, senior cardiologist, Cardiovascular and thoracic surgery department Francesco Arioli, cardiologist, Cardiovascular and thoracic surgery department Enrico Ammirati, cardiologist, Cardiovascular and thoracic surgery department Filippo Figini, fellow cardiologist, Cardiovascular and thoracic surgery department 222 - SAN RAFFAELE SCIENTIFIC INSTITUTE AISPO - SAN RAFFAELE IN THE WORLD AISPO is the non-governmental organization born in 1984 under the aegis of the San Raffaele Foundation to respond to its mandate “andate, insegnate, guarite” (go, teach and heal). ANDATE. One of the first actions was the support and implementation of a reference hospital center in Salvador de Bahia, Brazil. Since, it has operated in cooperation projects mainly in the heath area devoted to the support of public and private institutions. AISPO is now present in 15 countries in South America, Africa, Asia, Mediterranean area and East Europe. For example in Sri Lanka after the Tsunami AISPO has trained local personnel and is now involved in the reconstruction of a 100-bed large hospital. In Uganda it has almost finalized a new laboratory with special emphasis on histopathology as to support the project for the diagnosis of human papilloma virus infection cause of cervical cancer in women, started together with the Department of Pathology of the San Raffaele. In Vietnam the University of Huè, University Vita-Salute San Raffaele and University of Cagliari have initiated a center for the control of respiratory diseases. INSEGNATE. Teaching is key to hand over knowledge. Courses, exchange programs, and ad personam training were organized to increase clinical, technical or administrative expertise in Africa, Asia and South America also in collaboration with the academics and other organizations (Ministry of Foreign Affairs, EC, WHO, UNAIDS, Gates Foundation). In addition clinical, technical, and administrative personnel of the San Raffaele Foundation travel to these sites in the world for short or long-term interventions. GUARITE. Research is the basis for understanding the pathogenesis, diagnosis and cure of a disease. Here we mention only a few examples of the ongoing projects which are representative of the bridging activity between cooperation and research. Laboratory training in Democratic Republic of Congo. ONCO – HEMATOLOGY: REDUCTION OF CHILD MORTALITY BY CANCER IN AFRICA The San Raffaele Hematology and Bone Marrow Transplant Unit is involved in projects of integrated clinical, epidemiological and basic cancer research in Uganda. Cancer is an increasingly important cause of premature mortality in the developing countries. Approximately 60% of global cancer occurs in developing countries with nearly 10 million new cases per year at present. Unless the increasing incidence rate of cancer can be slowed, it is likely to double by 2020, mostly in developing countries. Endemic Burkitt lymphoma is confined to areas of the world where malaria and other infectious diseases are endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a pathogenic co-factor. In order to cure these increasing diseases more hospitals and specialised centres are needed. We developed a collaboration with St. Mary’s Hospital - Lacor Gulu (Uganda) with main goals: the reduction of child mortality by cancer, the improvement of diagnostic capacity and the control of non communicable diseases like lymphomas. Essential Partners of the project are AISPO, the NGO “Patologioltrefrontiera” (implementation of a pathology service), and the INCTR (International Network Clinical Trial Research, www.inctr.org). A multicenter protocol for epidemiology, diagnosis and treatment of Burkitt lymphoma and other aggressive lym- SAN RAFFAELE IN THE WORLD - 223 phoma is running in paediatric and adult patients. INCTR coordinates centres in Tanzania, Kenya, Nigeria and Uganda joining this protocol, and providing a cancer registry, biological samples for molecular studies and infectious-related investigations, a centralized validation of diagnosis and a database for clinical outcome of treated patients. The San Raffaele hematologist is giving educational training to local staff for improving diagnosis from blood and bone-marrow smear and for cytofluorimetric analysis of blood cancers. St. Mary’s Hospital, Lacor Gulu, Uganda. CARDIOLOGY: ECHOCARDIOGRAPHIC SURVEY FOR PREVENTION AND CURE OF RHEUMATIC HEART DISEASE A group of cardiologists from San Raffaele Hospital has established a cooperational programme together with AISPO and the St. Raphael of St. Francis Hospital Nsambya in Kampala, Uganda. The main ongoing project is addressed to rheumatic heart disease (RHD), which still accounts for high morbidity and mortality in developing countries. The cardiologists are carrying out a survey of the prevalence of RHD at the Hospital in pupils attending a nearby school. Beyond interview and physical examination, enrolled subjects undergo echocardiographic study, useful to detect RHD’s valve lesions. So far, approximately 200 asymptomatic children have been screened and a high prevalence of subclinical rheumatic lesions has been observed. Careful echocardiographic evaluation, focused on early morphological markers by echo-Doppler standard approach, significantly enhanced the detection of subclinical disease, with high impact on the clinical decision making. Affected children enter a secondary prophylaxis (by penicillin) and follow-up programme. Moreover, every patient examined by the cardiologists is recorded in a detailed Register, thus allowing to collect the epidemiological data on the prevalence of heart pathology in the local population. Up to now, more than 150 individuals have been evaluated. Major causes of cardiac morbidity and mortality, such as RHD and hypertensive heart failure, appear preventable both by primary and secondary interventions; a large proportion of patients requires surgical treatment. Since this is not yet regularly available in Uganda, an international network (currently involving San Raffaele and Ancona Hospital in Italy, Wolfson Hospital in Israel, The Salam Centre for Cardiac Surgery in Sudan) is under development in order to allow patients with advanced valve disease – either diagnosed within the screening protocol or during daily clinical activity - to be operated on. So far, the first two young patients of the project have received heart surgery. 224 - SAN RAFFAELE SCIENTIFIC INSTITUTE UGANDA AND TANZANIA – EVALUATION OF NEW AND EMERGING DIAGNOSTICS FOR CHILDHOOD TUBERCULOSIS AISPO-Uganda (Nsambya Hospital, Kampala) and the San Raffaele Scientific Institute (Emerging Bacterial Pathogens Unit – IUATLD/WHO Supranational TB Reference Laboratory, Milan) are partners in a multicentre clinical trial that will be carried out in Uganda and Tanzania from August 2010 to July 2013, funded by the “European and Developing Countries Clinical Trials Partnership” (EDCTP). The overall objectives of the project “Evaluation of new and emerging diagnostics for childhood tuberculosis in high burden countries (TB CHILD)” focus on developing sustainable, cross-linked research capacities for the diagnosis of childhood tuberculosis (TB) and on the effective, efficient conduct of clinical evaluation trials on new or improved diagnostics for paediatric TB. Diagnosis and control of paediatric TB is often a low priority in tuberculosis-endemic regions, as children often develop sputum smear-negative disease and seldom contribute to transmission of TB. However, infants and children carry a large (15-25%) and increasing proportion of the overall burden of disease. Furthermore, young and HIV-infected children have an increased risk of severe, rapidly progressive forms of TB, such as disseminated disease and meningitis. The study, coordinated by the Ifakara Health Institute - Bagamoyo Research and Training Centre, Dar es Salaam, Tanzania represents a unique opportunity to build new research capacity in the field of diagnosis and management of paediatric TB in sub-Saharan Africa by exchanging knowledge and expertise between the European and African partners, improving laboratory and clinical infrastructure, providing short-term training and MSc/PhD scholarships for young scientists. Nsambya Hospital, Kampala, Uganda DEMOCRATIC REPUBLIC OF CONGO – SUPPORT TO FIGHT THE LARGE ENDEMIC DISEASES HIV/AIDS, TB AND MALARIA Since 2007 AISPO and the San Raffaele Scientific Institute (Viral Evolution and Transmission Unit and Department of Infectious Diseases) are collaborating with CESVI (NGO with headquarters in Bergamo) and the Ministry of Health of the Democratic Republic of Congo within a project funded by the Italian Ministry of Foreign Affairs to implement diagnosis, screening and cure of the major endemic diseases, HIV/AIDS, TB and malaria. The group operates in the urban area of the capital Kinshasa and in two smaller cities of the region Bas-Congo. Courses were organized for technician, health care workers, nurses and medical doctors to provide the background and knowledge on the three large endemics, to support the work of the four newly established health units and the adjunct laboratories. At the beginning of 2010 more than 10,000 persons were tested for HIV and finally precise figures of prevalence could be estimated. According to the area the prevalence ranges from 10 to 15% in the adult population, whereas it shows lower figures (3-5%) in the young aged 15 to 24 years. Approximately 1,000 HIV infected person are today regularly followed, data collected on informatic support, and given antiretroviral therapy SAN RAFFAELE IN THE WORLD - 225 according to their CD4+ T lymphocyte counts. We have started anonymous blood sampling on filter paper to respond to two important question for drug treatment and vaccine development: 1) do circulating viruses display drug resistant mutations, which would urge for changes in the drug regimen used? and 2) which of the more than 30 known subtypes of HIV-1 evolved during these years in the Democratic Republic of Congo? UGANDA – PREVENTION AND STUDY OF INVASIVE CERVICAL CANCER AND MANAGEMENT OF GYNECOLOGIC DISORDERS AMONG HIV-POSITIVE WOMEN Reproductive health care has not been prioritized in care and support. In the setting of HIV infection 30.6% of Pap smears exhibit cytologic abnormalities and 15.4% have evidence of dysplasia; these rates are 10 times greater than those observed among HIV-negative women. In Uganda, almost 2/3 of cancers among HIV positives are in women of child bearing age with an overall incidence rate of Invasive Cervical Cancer increasing from 44 cases per 100,000 in the general population to 70 in HIV positives, with a peak of 200 per 100,000 in the age range of 35-44 years. The project organized at Nsambya national referral hospital with the Unit of Pathology of the San Raffaele has a broad and comprehensive approach. The final goal is to integrate an epidemiologic survey as to determine incidence and prevalence of Human Papilloma Virus (HPV) infection and invasive cancer of the cervix in the general population and among HIV-positive women. Thus, it includes: Community mobilization and increased awareness of cervical cancer in the community. Training of health workers in cervical cancer screening through PAP smears, Visualization in acetic Acid (VIA). Establishment of a referral system between lower health facilities and secondary and tertiary care for samples and patient referrals. A laboratory will be established as support for HPV diagnosis, and the activities include: • Infrastructure renovation and equipment of the Pathology laboratory at Nsambya national referral hospital • Development and set up of a molecular biology section for the identification and typing of HPV infection • Set up of a telemedicine program in connection with the Reference Laboratory in Milan for the transfer of images of the cytological and histological slides both for training, quality control and diagnostic second opinion, in collaboration with Patologi Oltre Frontiera (POF) • Set up of External Quality Assurance (EQA) programs for cytology, histology and molecular biology • Carry out outreaches for sample collection and feedback • Setting up of a data bank • Analysis of the epidemiological data collected, both on the HPV type circulation in the specific geographical area and on its distribution by age group and by severity of disease. Immunohistostaining with CK AE1-3. 226 - SAN RAFFAELE SCIENTIFIC INSTITUTE BRAZIL – HOSPITAL SÃO RAFAEL, SALVADOR: A SUCCESS STORY FROM DEVELOPMENT COOPERATION TO RESEARCH The Hospital São Rafael in Brazil was founded in 1990 and is headquartered in Salvador de Bahia. With 302 beds the hospital is equipped with all the main specialties. In 2009 the Center of Biotechnology and Cell Therapy (CBTC) was initiated: it is one of the 8 centers selected in Brazil by the Health Ministry for development of cell therapies of high complexity, and the only one in the northern region of Brazil. It is integrated to the Brazilian Stem Cell Network. Phase I/II study of bone marrow mesenchymal stem cells for patients with spinal cord injury as well as Phase III study of bone marrow cell therapy in patients with chronic Chagas disease have been started. Studies of drug development against the major infectious disease, for example Leishmaniasis, Chagas, and malaria, are frontline. Hospital São Rafael, Salvador, Brazil “Not to strive for changes in the world is humiliating. Our commitment, as God’s children, is to contribute to its improvement. We must offer the best of what we are and the best of what we have.” D. Luigi Verzè PUBLICATIONS - 227 PUBLICATIONS PUBLICATIONS - 229 BEST PAPERS 2009 1. Aiuti, A; Cattaneo, F; Galimberti, S; Benninghoff, U; Cassani, B; Callegaro, L; Scaramuzza, S; Andolfi, G; Mirolo, M; Brigida, I; Tabucchi, A; Carlucci, F; Eibl, M; Aker, M; Slavin, S; Al-Mousa, H; Ghonaium, AA; Ferster, A; Duppenthaler, A; Notarangelo, L; Wintergerst, U; Buckley, RH; Bregni, M; Marktel, S; Valsecchi, MG; Rossi, P; Ciceri, F; Miniero, R; Bordignon, C; Roncarolo, MG. Gene therapy for immunodeficiency due to adenosine deaminase deficiency. N. Engl. J. Med.: 2009; 360(5): 447-458 - Article IF 2008: 50,017 2. INSIGHT- ESPIRIT Study Group and SILCAAT Scientific Committee; Abrams, D; Lévy, Y; Losso, MH; Babiker, A; Collins, G; Cooper, DA; Darbyshire, J; Emery, S; Fox, L; Gordin, F; Lane, HC; Lundgren, JD; Mitsuyasu, R; Neaton, JD; Phillips, A; Routy, JP; Tambussi, G; Wentworth, D. Interleukin-2 therapy in patients with HIV infection. New Engl. J. Med.: 2009; 361(16): 1548-1559 Article IF 2008: 50,017 3. Vago, L; Perna, SK; Zanussi, M; Mazzi, B; Barlassina, C; Lupo Stanghellini, MT; Perrelli, NF; Cosentino, C; Torri, F; Angius, A; Forno, B; Casucci, M; Bernardi, M; Peccatori, J; Corti, C; Bondanza, A; Ferrari, M; Rossini, S; Roncarolo, MG; Bordignon, C; Bonini, C; Ciceri, F; Fleischhauer, K. Loss of mismatched HLA in leukemia after stem-cell transplantation. N. Engl. J. Med.: 2009; 361(5): 478-488 - Article IF 2008: 50,017 4. Colombo, A; Sharp, AS. The bioabsorbable stent as a virtual prosthesis. Lancet: 2009; 373(9667): 869-870 - Article IF 2008: 28,409 5. Comi, G; Martinelli, V; Rodegher, M; Moiola, L; Bajenaru, O; Carra, A; Elovaara, I; Fazekas, F; Hartung, HP; Hillert, J; King, J; Komoly, S; Lubetzki, C; Montalban, X; Myhr, KM; Ravnborg, M; Rieckmann, P; Wynn, D; Young, C; Filippi, M. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet: 2009; 374(9700): 1503-1511 - Article IF 2008: 28,409 6. Ferreri, AJ; Reni, M; Foppoli, M; Martelli, M; Pangalis, GA; Frezzato, M; Cabras, MG; Fabbri, A; Corazzelli, G; Ilariucci, F; Rossi, G; Soffietti, R; Stelitano, C; Vallisa, D; Zaja, F; Zoppegno, L; Aondio, GM; Avvisati, G; Balzarotti, M; Brandes, AA; Fajardo, J; Gomez, H; Guarini, A; Pinotti, G; Rigacci, L; Uhlmann, C; Picozzi, P; Vezzulli, P; Ponzoni, M; Zucca, E; Caligaris-Cappio, F; Cavalli, F. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet: 2009; 374(9700): 1512-1520 - Article IF 2008: 28,409 7. Villablanca, EJ; Raccosta, L; Zhou, D; Fontana, R; Maggioni, D; Negro, A; Sanvito, F; Ponzoni, M; Valentinis, B; Bregni, M; Prinetti, A; Steffensen, KR; Sonnino, S; Gustafsson, JA; Doglioni, C; Bordignon, C; Traversari, C; Russo, V. Tumor-mediated liver X receptor-alpha activation inhibits CC chemokine receptor-7 expression on dendritic cells and dampens antitumor responses. Nat. Med.: 2009; 16(1): 98-105 - Article IF 2008: 27,553 8. Montini, E; Cesana, D; Schmidt, M; Sanvito, F; Bartholomae, CC; Ranzani, M; Benedicenti, F; Sergi Sergi, L; Ambrosi, A; Ponzoni, M; Doglioni, C; Di Serio, C; von Kalle, C; Naldini, L. The genotoxic potential of retroviral vectors is strongly modulated by vector design and integration site selection in a mouse model of HSC gene therapy.. J. Clin. Invest.: 2009; 119(4): 964-975 - Article IF 2008: 16,559 9. Locci, M; Draghici, E; Marangoni, F; Bosticardo, M; Catucci, M; Aiuti, A; Cancrini, C; Marodi, L; Espanol, T; Bredius, RGM; Thrasher, AJ; Schulz, A; Litzman, J; Roncarolo, MG; Casorati, G; Dellabona, P; Villa, A. The Wiskott-Aldrich syndrome protein is required for iNKT cell maturation and function. J. Exp. Med.: 2009; 206(4): 735-742 - Article IF 2008: 15,463 10. Battaglia, M; Pesenti-Gritti, P; Medland, SE; Ogliari, A; Tambs, K; Spatola, CAM. A genetically informed study of the association between childhood separation anxiety, sensitivity to CO2, panic disorder, and the effect of childhood parental loss. Arch. Gen. Psychiatry: 2009; 66(1): 64-71 - Article IF 2008: 14,273 11. Gentner, B; Schira, G; Giustacchini, A; Amendola, M; Brown, BD; Ponzoni, M; Naldini, L. Stable knockdown of microRNA in vivo by lentiviral vectors. Nat. Methods: 2009; 6(1): 63-66 - Article IF 2008: 13,651 12. Ciceri, F; Bonini, C; Lupo Stanghellini, MT; Bondanza, A; Traversari, C; Salomoni, M; Turchetto, L; Colombi, S; Bernardi, M; Peccatori, J; Pescarollo, A; Servida, P; Magnani, Z; Perna, SK; Valtolina, V; Crippa, F; Callegaro, L; Spoldi, E; Crocchiolo, R; Fleischhauer, K; Ponzoni, M; Vago, L; Santoro, A; Todisco, E; Apperley, J; Olavarria, E; Slavin, S; Weissinger, EM; Hertenstein, B; Stadler, M; Yannaki, E; Fassas, A; Anagnostopoulos, A; Bregni, M; Gallo Stampino, C; Bruzzi, P; Bordignon, C. Early and effective immunorecovery after family haploidentical hemopoietic transplantation for leukemia by gene-engineered lymphocytes: the TK007 study. Lancet Oncol.: 2009; 10(5): 489-500 - Article IF 2008: 13,283 13. Cantarelli, E; Melzi, R; Mercalli, A; Sordi, V; Ferrari, G; Lederer, CW; Mrak, E; Rubinacci, A; Ponzoni, M; Sitia, G; Guidotti, LG; Bonifacio, E; Piemonti, L. Bone marrow as an alternative site for islet transplantation. Blood: 2009; 114(20): 4566-4574 - Article IF 2008: 10,432 14. Valle, A; Jofra, T; Stabilini, A; Atkinson, M; Roncarolo, MG; Battaglia, M. Rapamycin prevents and breaks the anti-CD3-induced tolerance in NOD mice. Diabetes: 2009; 58(4): 875-881 - Article IF 2008: 8,398 15. Piemonti, L; Calori, G; Lattuada, G: Mercalli, A; Ragogna, F; Garancini, MP; Ruotolo, G; Luzi, L; Perseghin, G. Association between plasma monocyte chemoattractant protein-1 concentration and cardiovascular disease mortality in middle-aged diabetic and nondiabetic individuals. Diabetes Care: 2009; 32(11): 2105-2110 - Article IF 2008: 7,349 230 - SAN RAFFAELE SCIENTIFIC INSTITUTE P.1. Abbadessa, G; Accolla, R; Aiuti, F; Albini, A; Aldovini, A; Alfano, M; Antonelli, G; Bartholomew, C; Bentwich, Z; Bertazzoni, U; Berzofsky, JA; Biberfeld, P; Boeri, E; Buonaguro, L; Buonaguro, FM; Bukrinsky, M; Burny, A; Caruso, A; Cassol, S; Chandra, P; Ceccherini-Nelli, L; Chieco-Bianchi, L; Clerici, M; Colombini-Hatch, S; Morghen, CDG; De Maria, A; De Rossi, A; Dierich, M; Della-Favera, R; Dolei, A; Douek, D; Erfle, V; Felber, B; Fiorentini, S; Franchini, G; Gershoni, JM; Gotch, F; Green, P; Greene, WC; Hall, W; Haseltine, W; Jacobson, S; Kallings, LO; Kalyanaraman, VS; Katinger, H; Khalili, K; Klein, G; Klein, E; Klotman, M; Klotman, P; Kotler, M; Kurth, R; Lafeuillade, A; La Placa, M; Lewis, J; Lillo, F; Lisziewicz, J; Lomonico, A; Lopalco, L; Lori, F; Lusso, P; Macchi, B; Malim, M; Margolis, L; Markham, PD; Mcclure, M; Miller, N; Mingari, MC; Moretta, L; Noonan, D; O’Brien, S; Okamoto, T; Pal, R; Palese, P; Panet, A; Pantaleo, G; Pavlakis, G; Pistello, M; Plotkin, S; Poli, G; Pomerantz, R; Radaelli, A; Robert-Guroff, M; Roederer, M; Sarngadharan, MG; Schols, D; Secchiero, P; Shearer, G; Siccardi, A; Stevenson, M; Svoboda, J; Tartaglia, J; Torelli, G; Tornesello, ML; Tschachler, E; Vaccarezza, M; Vallbracht, A; Van Lunzen, J; Varnier, O; Vicenzi, E; Von Melchner, H; Witz, I; Zagury, D; Zagury, JF; Zauli, G; Zipeto, D. Unsung hero Robert C Gallo. Science: 2009; 323(5911): 206-207 - Letter P.2. Abrams, D; Lévy, Y; Losso, MH; Babiker, A; Collins, G; Cooper, DA; Darbyshire, J; Emery, S; Fox, L; Gordin, F; Lane, HC; Lundgren, JD; Mitsuyasu, R; Neaton, JD; Phillips, A; Routy, JP; Tambussi, G; Wentworth, D; INSIGHT- ESPIRIT Study Group and SILCAAT Scientific Committee. Interleukin2 therapy in patients with HIV infection. New Engl. J. Med.: 2009; 361(16): 1548-1559 - Article IF 2008: 50,017 P.3. Abutalebi, J; Della Rosa, PA; Tettamanti, M; Green, DW; Cappa, SF. Bilingual aphasia and language control: a follow-up fMRI and intrinsic connectivity study. Brain Lang. : 2009; 109(23): 141-156 - Article IF 2008: 2,929 P.4. Abutalebi, J; Tettamanti, M; Perani, D. The bilingual brain: Linguistic and non-linguistic skills. Brain Lang.: 2009; 109(2-3): 51-54 - Editorial IF 2008: 2,929 P.5. Achenbach, P; Lampasona, V; Landherr, U; Koczwara, K; Krause, S; Grallert, H; Winkler, C; Pfluger, M; Illig, T; Bonifacio, E; Ziegler, AG. Autoantibodies to zinc transporter 8 and SLC30A8 genotype stratify type 1 diabetes risk. Diabetologia: 2009; 52(9): 1881-1888 - Article IF 2008: 6,418 P.6. Acquaviva, PA; Cerutti, F; Adami, G; Gagliani, M; Ferrari, M; Gherlone, E; Cerutti, A. Degree of conversion of three composite materials employed in the adhesive cementation of indirect restorations: A micro-Raman analysis. J. Dent.: 2009; 37(8): 610615 - Article IF 2008: 2,033 P.7. Agosta, F; Gorno-Tempini, ML; Pagani, E; Sala, S; Caputo, D; Perini, M; Bartolomei, I; Fruguglietti, ME; Filippi, M. Longitudinal assessment of grey matter contraction in amyotrophic lateral sclerosis: A tensor based morphometry study. Amyotroph. Lateral. Scler.: 2009; 10(3): 168-174 - Article IF 2008: 1,815 P.8. Agosta, F; Rocca, MA; Valsasina, P; Sala, S; Caputo, D; Perini, M; Salvi, F; Prelle, A; Filippi, M. A longitudinal diffusion tensor MRI study of the cervical cord and brain in amyotrophic lateral sclerosis patients. J. Neurol. Neurosurg. Psychiatry: 2009; 80(1): 53-55 - Article IF 2008: 4,622 P.9. Agosta, F; Valsasina, P; Absinta, M; Sala, S; Caputo, D; Filippi, M. Primary progressive multiple sclerosis: tactile-associated functional MR activity in the cervical spinal cord. Radiology: 2009; 253(1): 209-215 - Article IF 2008: 9,380 P.10. Agosta, F; Valsasina, P; Caputo, D; Rocca, MA; Filippi, M. Tactile-associated fMRI recruitment of the cervical cord in healthy subjects. Hum. Brain Mapp.: 2009; 30(1): 340-345 - Article IF 2008: 5,996 P.11. Agosta, F; Vossel, KA; Miller, BL; Migliaccio, R; Bonasera, SJ; Filippi, M; Boxer, AL; Karydas, A; Possin, KL; GornoTempini, ML. Apolipoprotein E ?4 is associated with disease-specific effects on brain atrophy in Alzheimer’s disease and frontotemporal dementia. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(6): 2018-2022 - Article IF 2008: 5,395 P.12. Agricola, E; Ielasi, A; Oppizzi, M; Faggiano, P; Ferri, L; Calabrese, A; Vizzardi, E; Alfieri, O; Margonato, A. Long-term prognosis of medically treated patients with functional mitral regurgitation and left ventricular dysfunction. Eur. J. Heart Fail.: 2009; 11(6): 581-587 - Article IF 2008: 3,398 P.13. Aiuti, A; Brigida, I; Ferrua, F; Cappelli, B; Chiesa, R; Marktel, S; Roncarolo, MG. Hematopoietic stem cell gene therapy for adenosine deaminase deficient-SCID. Immunol. Res.: 2009; 44(1-3): 150-159 - Review IF 2008: 2,649 P.14. Aiuti, A; Cattaneo, F; Galimberti, S; Benninghoff, U; Cassani, B; Callegaro, L; Scaramuzza, S; Andolfi, G; Mirolo, M; Brigida, I; Tabucchi, A; Carlucci, F; Eibl, M; Aker, M; Slavin, S; Al-Mousa, H; Ghonaium, AA; Ferster, A; Duppenthaler, A; Notarangelo, L; Wintergerst, U; Buckley, RH; Bregni, M; Marktel, S; Valsecchi, MG; Rossi, P; Ciceri, F; Miniero, R; Bordignon, C; Roncarolo, MG. Gene therapy for immunodeficiency due to adenosine deaminase deficiency. N. Engl. J. Med.: 2009; 360(5): 447-458 - Article IF 2008: 50,017 P.15. Akcali, A; Ferini-Strambi, L; Kaynak, H; Karadeniz, D; Akcali, C. Genital restlessness (vulvodynia) events accompanying restless legs syndrome. Sleep Med.: 2009; 10(3): 395-396 - Letter IF 2008: 3,163 P.16. Akselrod-Ballin, A; Galun, M; Gomori, JM; Filippi, M; Valsasina, P; Basri, R; Brandt, A. Automatic segmentation and classification of multiple sclerosis in multichannel MRI. IEEE Trans. Biomed. Eng.: 2009; 56(10): 2461-2469 - Article IF 2008: 2,496 P.17. Aldrighetti, L; Pulitano, C; Catena, M; Arru, M; Guzzetti, E; Halliday, J; Ferla, G. Liver Resection with Portal Vein Thrombectomy for Hepatocellular Carcinoma With Vascular Invasion. Ann. Surg. Oncol.: 2009; 16(5): 1254 - Article IF 2008: 3,898 P.18. Alfano, M; Mariani, SA; Elia, C; Pardi, R; Blasi, F; Poli, G. Ligand-engaged urokinase-type plasminogen activator receptor and activation of the CD11b/CD18 integrin inhibit late events of HIV expression in monocytic cells. Blood: 2009; 113(8): 16991709 - Article IF 2008: 10,432 P.19. Alongi, F; Fiorino, C; Cozzarini, C; Broggi, S; Perna, L; Cattaneo, GM; Calandrino, R; Di Muzio, N. IMRT significantly reduces acute toxicity of whole-pelvis irradiation in patients treated with post-operative adjuvant or salvage radiotherapy after radical prostatectomy. Radiother. Oncol.: 2009; 93(2): 207-212 Article IF 2008: 3,990 P.20. Alpi, E; Landi, E; Barilari, M; Serresi, M; Salvadori, P; Bachi, A; Dente, L. Channel-interacting PDZ protein, ‘CIPP’, interacts with proteins involved in cytoskeletal dynamics. Biochem. J.: 2009; 419(2): 289-300 - Article IF 2008: 4,371 P.21. Altmann, DR; Jasperse, B; Barkhof, F; Beckmann, K; Filippi, M; Kappos, LD; Molyneux, P; Polman, CH; Pozzilli, C; Thompson, AJ; Wagner, K; Yousry, TA; Miller, DH. Sample PUBLICATIONS - 231 sizes for brain atrophy outcomes in trials for secondary progressive multiple sclerosis. Neurology: 2009; 73(7): 595-601 - Article IF 2008: 7,043 P.22. Altomare, DF; Binda, G; Ganio, E; De Nardi, P; Giamundo, P; Pescatori, M. Long-term outcome of Altemeiers procedure for rectal prolapse. Dis. Colon Rectum: 2009; 52(4): 698-703 - Article IF 2008: 2,615 P.23. Amendola, M; Passerini, L; Pucci, F; Gentner, B; Bacchetta, R; Naldini, L. Regulated and Multiple miRNA and siRNA Delivery Into Primary Cells by a Lentiviral Platform. Mol. Ther.: 2009; 17(6): 1039-1052 - Article IF 2008: 5,970 P.24. Andralojc, KM; Mercalli, A; Nowak, KW; Albarello, L; Calcagno, R; Luzi, L; Bonifacio, E; Doglioni, C; Piemonti, L. Ghrelin-producing epsilon cells in the developing and adult human pancreas. Diabetologia: 2009; 52(3): 486-493 - Article IF 2008: 6,418 P.25. Angiero, F; Farronato, G; Benedicenti, S; Vinci, R; Farronato, D; Magistro, S; Stefani, M. Mandibular condylar hyperplasia: Clinical, histopathological, and treatment considerations. CranioJ. Craniomandib. Pract.: 2009; 27(1): 24-32 - Article IF 2008: 0,556 P.26. Annoni, A; Brown, BD; Cantore, A; Sergi Sergi, L; Naldini, L; Roncarolo, MG. In vivo delivery of a microRNA-regulated transgene induces antigen-specific regulatory T cells and promotes immunologic tolerance. Blood: 2009; 114(25): 5152-5161 - Article IF 2008: 10,432 P.27. Anselmetti, S; Bechi, M; Bosia, M; Quarticelli, C; Ermoli, E; Smeraldi, E; Cavallaro, R. ‘Theory’ of mind impairment in patients affected by schizophrenia and in their parents.. Schizophr. Res.: 2009; 115(2-3): 278-285 - Article IF 2008: 4,174 P.28. Antinori, A; Ammassari, A; Torti, C; Marconi, P; Andreoni, M; Angarano, G; Bonora, S; Castagna, A; Cauda, R; Clerici, M; d’Arminio Monforte, A; De Luca, A; Di Perri, G; Galli, M; Girardi, E; Gori, A; Lazzarin, A; Lo Caputo, S; Mazzotta, F; Montella, F; Mussini, C; Perno, CF; Puoti, M; Rizzardini, G; Rusconi, S; Vullo, V; Carosi, G. Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy. Infection: 2009; 37(3): 270-282 - Article IF 2008: 1,831 P.29. Antiretroviral Therapy Cohort Collaboration, (ART-CC); Mocroft, A; Sterne, JA; Egger, M; May, M; Grabar, S; Furrer, H; Sabin, C; Fatkenheuer, G; Justice, A; Reiss, P; d’Arminio Monforte, A; Gill, J; Hogg, R; Bonnet, F; Kitahata, M; Staszewski, S; Casabona, J; Harris, R; Saag, M. Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal. Clin. Infect. Dis.: 2009; 48(8): 1138-1151 - Article IF 2008: 8,266 P.30. Antonelli, M; Acerno, S; Baldoli, C; Terreni, MR; Giangaspero, F. A case of melanotic desmoplastic ganglioglioma: Case Report. Neuropathology: 2009; 29(5): 597-601 - Article IF 2008: 1,727 P.31. Antonioli, P; Bachi, A; Fasoli, E; Righetti, PG. Efficient removal of DNA from proteomic samples prior to two-dimensional map analysis. J. Chromatogr. A: 2009; 1216(17): 3606-3612 Article IF 2008: 3,756 P.32. Anzalone, N; Gerevini, S; Scotti, R; Vezzulli, P; Picozzi, P. Detection of cerebral metastases on magnetic resonance imaging: Intraindividual comparison of gadobutrol with gadopentetate dimeglumine. Acta Radiol.: 2009; 50(8): 933-940 - Article IF 2008: 1,091 P.33. Arcidiacono, PG; Calori, G; Carrara, S; McNicol, ED; Testoni, PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev.: 2009; -1(CD007519) - Review IF 2008: 5,182 P.34. Arcidiacono, T; Paloschi, V; Rainone, F; Terranegra, A; Dogliotti, E; Aloia, A; Soldati, L; Vezzoli, G. Renal osteodystrophy and vascular calcification. J. Endocrinol. Invest. : 2009; 32(4 Suppl): 21-26 - Article IF 2008: 1,888 P.35. Asperti, C; Astro, V; Totaro, A; Paris, S; de Curtis, I. Liprinα1 promotes cell spreading on the extracellular matrix by affecting the distribution of activated integrins. J. Cell Sci.: 2009; 122(18): 3225-3232 - Article IF 2008: 6,247 P.36. Baccari, P; Civilini, E; Dordoni, L; Melissano, G; Nicoletti, R; Chiesa, R. Celiac artery compression syndrome managed by laparoscopy. J. Vasc. Surg.: 2009; 50(1): 134-139 - Article IF 2008: 3,770 P.37. Baccari, P; Nifosi, J; Ghirardelli, L; Staudacher, C. Laparoscopic incisional and ventral hernia repair without sutures: A single-center experience with 200 cases. J. Laparoendosc. Adv. Surg. Tech. A: 2009; 19(2): 175-179 - Article IF 2008: 0,912 P.38. Bacci, M; Capobianco, A; Monno, A; Cottone, L; Di Puppo, F; Camisa, B; Mariani, M; Brignole, C; Ponzoni, M; Ferrari, S; Panina-Bordignon, P; Manfredi, AA; Rovere-Querini, P. Macrophages are alternatively activated in patients with endometriosis and required for growth and vascularization of lesions in a mouse model of disease. Am. J. Pathol.: 2009; 175(2): 547-556 - Article IF 2008: 5,697 P.39. Bacigaluppi, M; Pluchino, S; Peruzzotti Jametti, L; Kilic, E; Kilic, U; Salani, G; Brambilla, E; West, MJ; Comi, G; Martino, G; Hermann, DM. Delayed post-ischaemic neuroprotection following systemic neural stem cell transplantation involves multiple mechanisms. Brain: 2009; 132(8): 2239-2251 - Article IF 2008: 9,603 P.40. Baldan, R; Tassan Din, C; Semeraro, G; Costa, C; Cichero, P; Scarpellini, P; Moro, M; Cirillo, DM. Severe community-onset infections in healthy individuals caused by community-acquired MRSA in an Italian teaching hospital, 2006-2008. J. Hosp. Infect.: 2009; 72(3): 271-273 - Letter IF 2008: 2,956 P.41. Ballabio, C; Fiocchi, A; Martelli, A; Pecora, S; Burastero, SE; Restani, P. A method for the analysis of milk and egg allergens for the atopy patch test. Exp. Dermatol.: 2009; 18(10): 886888 - Letter IF 2008: 3,259 P.42. Bandiera, A; Melloni, G; Freschi, M; Giovanardi, M; Carretta, A; Borri, A; Ciriaco, P; Zannini, P. Prognostic Factors and Analysis of S100a4 Protein in Resected Pulmonary Metastases from Renal Cell Carcinoma. World J.Surg.: 2009; 33(7): 14141420 - Article IF 2008: 2,641 P.43. Barbisan, F; Mazzucchelli, R; Santinelli, A; Lopez-Beltran, A; Cheng, L; Scarpelli, M; Montorsi, F; Montironi, R. Overexpression of ELAV-like Protein HuR is Associated with Increased COX-2 Expression in Atrophy, High-grade Prostatic Intraepithelial Neoplasia, and Incidental Prostate Cancer in Cystoprostatectomies. Eur. Urol.: 2009; 56(1): 105-112 - Article IF 2008: 6,512 P.44. Barkhof, F; Filippi, M. Multiple sclerosis: MRI-the perfect surrogate marker for multiple sclerosis?. Nat. Rev. Neurol.: 2009; 5(4): 182-183 - Article IF 2008: 6,979 P.45. Barkin, J; Roehrborn, CG; Siami, P; Haillot, O; Morrill, B; Black, L; Montorsi, F. Effect of dutasteride, tamsulosin and the combination on patient-reported quality of life and treatment sat- 232 - SAN RAFFAELE SCIENTIFIC INSTITUTE isfaction in men with moderate-to-severe benign prostatic hyperplasia: 2-year data from the CombAT trial. BJU Int.: 2009; 103(7): 919-926 - Article IF 2008: 2,704 P.46. Barone, L; Del Giudice, M; Fossati, A; Manaresi, F; Actis Perinetti, B; Colle, L; Veglia, F. Methods and Measures: Psychometric properties of the Manchester Child Attachment Story Task: An Italian multicentre study. Int. J. Behav. Dev.: 2009; 33(2): 185-190 - Article IF 2008: 0,983 P.47. Bastian, PJ; Carter, BH; Bjartell, A; Seitz, M; Stanislaus, P; Montorsi, F; Stief, CG; Schroder, F. Insignificant Prostate Cancer and Active Surveillance: From Definition to Clinical Implications. Eur. Urol.: 2009; 55(6): 1321-1332 - Review IF 2008: 6,512 P.48. Battaglia, M; Pesenti-Gritti, P; Medland, SE; Ogliari, A; Tambs, K; Spatola, CAM. A genetically informed study of the association between childhood separation anxiety, sensitivity to CO2, panic disorder, and the effect of childhood parental loss. Arch. Gen. Psychiatry: 2009; 66(1): 64-71 - Article IF 2008: 14,273 P.49. Battaglia, M; Roncarolo, MG. The Fate of Human Treg Cells. Immunity: 2009; 30(6): 763-765 - Short Survey IF 2008: 20,579 P.50. Battaglia, M; Strauss, L; Roncarolo, MG. Comment on M. Guillot-Delost et al. (2008;10:834-846): Clinical-grade preparation of human natural regulatory T cells encoding the thymidine kinase suicide gene as a safety gene. J. Gene Med.: 2009; 11(2): 180-181 - Note P.51. Battezzati, A; Benedini, S; Sereni, LP; DeTaddeo, F; Maffi, P; Secchi, A; Luzi, L. Protein and glutamine kinetics during counter-regulatory failure in type 1 diabetes. Nutr. Metab. Carbiovasc. Dis.: 2009; 19(5): 352-357 - Article IF 2008: 3,565 P.52. Becher, E; Roehrborn, CG; Siami, P; Gagnier, RP; Wilson, TH; Montorsi, F. The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study. Prostate Cancer Prostatic Dis.: 2009; 12(4): 369-374 - Article IF 2008: 2,062 P.53. Becker, F; Van Poppel, H; Hakenberg, OW; Stief, C; Gill, I; Guazzoni, G; Montorsi, F; Russo, P; Stockle, M. Assessing the Impact of Ischaemia Time During Partial Nephrectomy. Eur. Urol.: 2009; 56(4): 625-635 - Review IF 2008: 6,512 P.54. Begnozzi, L; Benassi, M; Bertanelli, M; Bonini, A; Cionini, L; Conte, L; Fiorino, C; Gabriele, P; Gardani, G; Giani, A; Magri, S; Morelli, M; Morrica, B; Olmi, P; Orecchia, R; Penduzzu, G; Raffaele, L; Rosi, A; Tabocchini, MA; Valdagni, R; Viti, V. Quality assurance of 3D-CRT: Indications and difficulties in their applications. Crit. Rev. Oncol./Hematol.: 2009; 70(1): 24-38 Review IF 2008: 4,589 P.55. Belli, C; Fennell, D; Giovannini, M; Gaudino, G; Mutti, L. Malignant pleural mesothelioma: Current treatments and emerging drugs. Expert Opin Emerg. Drugs: 2009; 14(3): 423-437 Review IF 2008: 3,080 P.56. Belloli, S; Jachetti, E; Moresco, RM; Picchio, M; Lecchi, M; Valtorta, S; Freschi, M; Hess-Michelini, R; Bellone, M; Fazio, F. Characterization of preclinical models of prostate cancer using PET-based molecular imaging. Eur. J. Nucl. Med. Mol. Imaging: 2009; 36(8): 1245-1255 - Article IF 2008: 4,532 P.57. Benedetti, B; Rovaris, M; Rocca, MA; Caputo, D; Zaffaroni, M; Capra, R; Bertolotto, A; Martinelli, V; Comi, G; Filippi, M. In-vivo evidence for stable neuroaxonal damage in the brain of patients with benign multiple sclerosis. Mult. Scler.: 2009; 15(7): 789-794 - Article IF 2008: 3,312 P.58. Benedetti, F; Bernasconi, A; Bosia, M; Cavallaro, R; Dallaspezia, S; Falini, A; Poletti, S; Radaelli, D; Riccaboni, R; Scotti, G; Smeraldi, E. Functional and structural brain correlates of theory of mind and empathy deficits in schizophrenia. Schizophr. Res.: 2009; 114(1-3): 154-160 - Article IF 2008: 4,174 P.59. Benedetti, F; Calabrese, G; Bernasconi, A; Cadioli, M; Colombo, C; Dallaspezia, S; Falini, A; Radaelli, D; Scotti, G; Smeraldi, E. Spectroscopic correlates of antidepressant response to sleep deprivation and light therapy: A 30 Tesla study of bipolar depression. Psychiatry Res. Neuroimaging: 2009; 173(3): 238242 - Article IF 2008: 2,638 P.60. Benedetti, F; Colombo, C; Pirovano, A; Marino, E; Smeraldi, E. The catechol-O-methyltransferase Val(108/158)Met polymorphism affects antidepressant response to paroxetine in a naturalistic setting. Psychopharmacology: 2009; 203(1): 155-160 Article IF 2008: 3,676 P.61. Benedetti, F; Radaelli, D; Bernasconi, A; Dallaspezia, S; Colombo, C; Smeraldi, E. Changes in medial prefrontal cortex neural responses parallel successful antidepressant combination of venlafaxine and light therapy. Arch. Ital. Biol.: 2009; 147(3): 8393 - Article IF 2008: 0,917 P.62. Benedetti, F; Smeraldi, E. Neuroimaging and genetics of antidepressant response to sleep deprivation: Implications for drug development. Curr. Pharm. Design: 2009; 15(22): 2637-2649 - Review IF 2008: 4,399 P.63. Benedini, S; Perseghin, G; Terruzzi, I; Scifo, P; Invernizzi, PL; Del Maschio, A; Lazzarin, A; Luzi, L. Effect of L-acetylcarnitine on body composition in HIV-related lipodystrophy. Horm. Metab. Res.: 2009; 41(11): 840-845 - Article IF 2008: 2,715 P.64. Benetti, E; Caridi, G; Vella, MD; Rampoldi, L; Ghiggeri, GM; Artifoni, L; Murer, L. Immature Renal Structures Associated With a Novel UMOD Sequence Variant. Am. J. Kidney Dis.: 2009; 53(2): 327-331 - Article IF 2008: 4,822 P.65. Benussi, S; Galanti, A; Nascimbene, S; Fumero, A; Dorigo, E; Zerbi, V; Alfieri, O. Complete Right Atrial Ablation With Bipolar Radiofrequency. Ann. Thorac. Surg.: 2009; 87(5): 15731576 - Article IF 2008: 2,689 P.66. Benvegnù, S; Franciotta, D; Sussman,J; Bachi, A; Zardini, E; Torreri, P; Govaerts, C; Pizzo, S; Legname, G. Prion protein paralog doppel protein interacts with alpha-2-macroglobulin: a plausible mechanism for doppel-mediated neurodegeneration. PLoS One: 2009; 4(6): e5968 - Article P.67. Bernardini, FP; Croxatto, JO; Orcioni, GF; Bianchi Marzoli, S. Visual loss secondary to orbital apex invasion as the first manifestation of recurrent nasopharyngeal carcinoma. Ophthalmic Plast. Reconstr. Surg.: 2009; 25(3): 248-250 - Article IF 2008: 0,670 P.68. Berney, T; Secchi, A. Rapamycin in islet transplantation: Friend or foe?. Transpl. Int.: 2009; 22(2): 153-161 - Review IF 2008: 3,115 P.69. Bertelloni, S; Balsamo, A; Giordani, L; Fischetto, R; Russo, G; Delvecchio, M; Gennari, M; Nicoletti, A; Maggio, MC; Concolino, D; Cavallo, L; Cicognani, A; Chiumello, G; Hiort, O; Baroncelli, GI; Faienza, MF. 17?-Hydroxysteroid dehydrogenase-3 deficiency: From pregnancy to adolescence. J. Endocrinol. Invest.: 2009; 32(8): 666-670 - Article IF 2008: 1,888 PUBLICATIONS - 233 P.70. Bertini, R; Roscigno, M; Freschi, M; Strada, E; Petralia, G; Pasta, A; Matloob, R; Sozzi, F; Da Pozzo, L; Colombo, R; Guazzoni, G; Doglioni, C; Montorsi, F; Rigatti, P. Renal Sinus Fat Invasion in pT3a Clear Cell Renal Cell Carcinoma Affects Outcomes of Patients Without Nodal Involvement or Distant Metastases. J. Urol.: 2009; 181(5): 2027-2032 - Article IF 2008: 3,952 P.71. Bertuzzi, F; Cainarca, S; Marzorati, S; Bachi, A; Antonioli, B; Nano, R; Verzaro, R; Ricordi, C. Collagenase isoforms for pancreas digestion. Cell Transplant.: 2009; 18(2): 203-206 - Article IF 2008: 5,251 P.72. Bettinardi, V; Rapisarda, E; Gilardi, MC. Number of partitions (gates) needed to obtain motion-free images in a respiratory gated 4D-PET/CT study as a function of the lesion size and motion displacement. Med. Phys.: 2009; 36(12): 5547-5558 - Article IF 2008: 3,871 P.73. Bhojani, N; Ahyai, S; Graefen, M; Capitanio, U; Suardi, N; Shariat, SF; Jeldres, C; Erbersdobler, A; Schlomm, T; Haese, A; Steuber, T; Heinzer, H; Montorsi, F; Huland, H; Karakiewicz, PI. Partin Tables cannot accurately predict the pathological stage at radical prostatectomy. Eur J Surg Oncol: 2009; 35(2): 123-128 - Article IF 2008: 2,491 P.74. Bhojani, N; Salomon, L; Capitanio, U; Suardi, N; Shariat, SF; Jeldres, C; Zini, L; Pharand, D; Peloquin, F; Arjane, P; Abbou, CC; De La Taille, A; Montorsi, F; Karakiewicz, PI. External Validation of the Updated Partin Tables in a Cohort of French and Italian Men. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 73(2): 347-352 - Article IF 2008: 4,639 P.75. Bianchi, G; Manunta, P; Glorioso, N. Clinical impact of adducin polymorphism. J. Hypertens.: 2009; 27(6): 1325-1327 Letter IF 2008: 5,132 P.76. Bianchi, G; Oliva, L; Cascio, P; Pengo, N; Fontana, F; Cerruti, F; Orsi, A; Pasqualetto, E; Mezghrani, A; Calbi, V; Palladini, G; Giuliani, N; Anderson, KC; Sitia, R; Cenci, S. The proteasome load versus capacity balance determines apoptotic sensitivity of multiple myeloma cells to proteasome inhibition. Blood: 2009; 113(13): 3040-3049 - Article IF 2008: 10,432 P.77. Bianchi, ME. Editorial: A recipe for inflammation. J. Leukoc. Biol.: 2009; 86(3): 471-472 - Editorial IF 2008: 4,605 P.78. Bianchi, ME. HMGB1 loves company. J. Leukoc. Biol.: 2009; 86(3): 573-576 - Short Survey IF 2008: 4,605 P.79. Bianchi, ME; Manfredi, AA. Dangers in and out. Science: 2009; 323(5922): 1683-1684 - Review IF 2008: 28,103 P.80. Bianchi, V; Farisello, P; Baldelli, P; Meskenaite, V; Milanese, M; Vecellio, M; Muhlemann, S; Lipp, HP; Bonanno, G; Benfenati, F; Toniolo, D; D’Adamo, P. Cognitive impairment in Gdi1deficient mice is associated with altered synaptic vesicle pools and short-term synaptic plasticity, and can be corrected by appropriate learning training. Hum. Mol. Genet.: 2009; 18(1): 105-117 - Article IF 2008: 7,249 P.81. Bianco, F; Perrotta, C; Novellino, L; Francolini, M; Riganti, L; Menna, E; Saglietti, L; Schuchman, EH; Furlan, R; Clementi, E; Matteoli, M; Verderio, C. Acid sphingomyelinase activity triggers microparticle release from glial cells. EMBO J.: 2009; 28(8): 1043-1054 - Article IF 2008: 8,295 P.82. Biancotto, A; Grivel, JC; Lisco, A; Vanpouille, C; Markham, PD; Gallo, RC; Margolis, LB; Lusso, P. Evolution of SIV to- ward RANTES resistance in macaques rapidly progressing to AIDS upon coinfection with HHV-6A. Retrovirology: 2009; 6: 61 - Article IF 2008: 4,042 P.83. Bignami, E; Biondi-Zoccai, G; Landoni, G; Fochi, O; Testa, V; Sheiban, I; Giunta, F; Zangrillo, A. Volatile Anesthetics Reduce Mortality in Cardiac Surgery. J. Cardiothorac. Vasc. Anesth.: 2009; 23(5): 594-599 - Article IF 2008: 0,994 P.84. Binda, P; Cicchini, GM; Burr, DC; Morrone, MC. Spatiotemporal distortions of visual perception at the time of saccades. J. Neurosci.: 2009; 29(42): 13147-13157 - Article IF 2008: 7,452 P.85. Blasi, V; Longaretti, R; Giovanettoni, C; Baldoli, C; Pontesilli, S; Vigone, C; Saccuman, C; Nigro, F; Chiumello, G; Scotti, G; Weber, G. Decreased parietal cortex activity during mental rotation in children with congenital hypothyroidism. Neuroendocrinology: 2009; 89(1): 56-65 - Article IF 2008: 2,913 P.86. Bobisse, S; Rondina, M; Merlo, A; Tisato, V; Mandruzzato, S; Amendola, M; Naldini, L; Willemsen, RA; Debets, R; Zanovello, P; Rosato, A. Reprogramming T lymphocytes for melanoma adoptive immunotherapy by T-cell receptor gene transfer with lentiviral vectors. Cancer Res.: 2009; 69(24): 9385-9394 - Article IF 2008: 7,514 P.87. Boffa, MC; Boinot, C; De Carolis, S; Rovere-Querini, P; Aurousseau, MH; Allegri, F; Nicaise-Roland, P; Barra, A; Botta, A; Ambrozic, A; Avcin, T; Tincani, A. Laboratory criteria of the obstetrical antiphospholipid syndrome: Data from a multicentric prospective European women cohort. Thromb. Haemost.: 2009; 102(1): 25-28 - Article IF 2008: 3,803 P.88. Boffa, MC; Lachassinne, E; Boinot, C; De Carolis, S; Rovere-Querini, P; Avcin, T; Biasini-Rebaioli, C; Le Toumelin, P; Aurousseau, MH; Tincani, A. European registry of babies born to mothers with antiphospholipid syndrome: A result update. Lupus: 2009; 18(10): 900-904 - Article IF 2008: 2,244 P.89. Boin, F; Franchini, S; Colantuoni, E; Rosen, A; Wigley, FM; Casciola-Rosen, L. Independent association of anti-?2-glycoprotein I antibodies with macrovascular disease and mortality in scleroderma patients. Arthritis Rheum.: 2009; 60(8): 2480-2489 Article IF 2008: 6,787 P.90. Bolenz, C; Shariat, SF; Fernandez, MI; Margulis, V; Lotan, Y; Karakiewicz, P; Remzi, M; Kikuchi, E; Zigeuner, R; Weizer, A; Montorsi, F; Bensalah, K; Wood, CG; Roscigno, M; Langner, C; Koppie, TM; Raman, JD; Mikami, S; Michel, MS; Strobel, P. Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: Value of lymph-node density. BJU Int.: 2009; 103(3): 302-306 - Article IF 2008: 2,704 P.91. Bolis, A; Coviello, S; Visigalli, I; Taveggia, C; Bachi, A; Chishti, AH; Hanada, T; Quattrini, A; Previtali, SC; Biffi, A; Bolino, A. Dlg1, Sec8, and Mtmr2 regulate membrane homeostasis in Schwann cell myelination. J. Neurosci.: 2009; 29(27): 8858-8870 - Article IF 2008: 7,452 P.92. Bonfanti, R; Colombo, C; Nocerino, V; Massa, O; Lampasona, V; Iafusco, D; Viscardi, M; Chiumello, G; Meschi, F; Barbetti, F. Insulin gene mutations as cause of diabetes in children negative for five type 1 diabetes autoantibodies. Diabetes Care: 2009; 32(1): 123-125 - Article IF 2008: 7,349 P.93. Bonini, C; Russo, V. The hidden (and lazy) TCR. Blood: 2009; 114(14): 2855-2856 - Comment IF 2008: 10,432 P.94. Borroni, B; Grassi, M; Agosti, C; Premi, E; Alberici, A; 234 - SAN RAFFAELE SCIENTIFIC INSTITUTE Paghera, B; Lucchini, S; Luca, MD; Perani, D; Padovani, A. Survival in frontotemporal lobar degeneration and related disorders: Latent class predictors and brain functional correlates. Rejuv. Res.: 2009; 12(1): 33-43 - Article IF 2008: 5,008 P.95. Borroni, B; Premi, E; Agosti, C; Alberici, A; Garibotto, V; Bellelli, G; Paghera, B; Lucchini, S; Giubbini, R; Perani, D; Padovani, A. Revisiting brain reserve hypothesis in frontotemporal dementia: evidence from a brain perfusion study. Dement. Geriatr. Cogn. Disord. : 2009; 28(2): 130-135 - Article IF 2008: 3,142 P.96. Boschi, F; Spinelli, AE; D’Ambrosio, D; Calderan, L; Marengo, M; Sbarbati, A. Combined optical and single photon emission imaging: preliminary results. Phys. Med. Biol.: 2009; 54(23): L57-62 - Letter IF 2008: 2,784 P.97. Bosi, E. Metformin - The gold standard in type 2 diabetes: What does the evidence tell us?. Diabetes Obes. Metab.: 2009; 11(SUPPL. 2): 3-8 - Review IF 2008: 4,259 P.98. Bosi, E; Dotta, F; Jia, Y; Goodman, M. Vildagliptin plus metformin combination therapy provides superior glycaemic control to individual monotherapy in treatment-naive patients with type 2 diabetes mellitus. Diabetes Obes. Metab.: 2009; 11(5): 506515 - Article IF 2008: 4,259 P.99. Bosticardo, M; Marangoni, F; Aiuti, A; Villa, A; Roncarolo, MG. Recent advances in understanding the pathophysiology of Wiskott-Aldrich syndrome. Blood: 2009; 113(25): 6288-6295 Review IF 2008: 10,432 P.100. Bousser, MG; Amarenco, P; Chamorro, A; Fisher, M; Ford, I; Fox, K; Hennerici, MG; Mattle, HP; Rothwell, PM; PERFORM Study Investigators. Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study.. Cerebrovasc. Dis.: 2009; 27(5): 509-518 - Article IF 2008: 3,041 P.101. Boy, J; Schmidt, T; Wolburg, H; Mack, A; Nuber, S; Bottcher, M; Schmitt, I; Holzmann, C; Zimmermann, F; Servadio, A; Riess, O. Reversibility of symptoms in a conditional mouse model of spinocerebellar ataxia type 3. Hum. Mol. Genet.: 2009; 18(22): 4282-4295 - Article IF 2008: 7,249 P.102. Bracciale, L; Colafigli, M; Zazzi, M; Corsi, P; Meraviglia, P; Micheli, V; Maserati, R; Gianotti, N; Penco, G; Setti, M; Di Giambenedetto, S; Butini, L; Vivarelli, A; Trezzi, M; De Luca, A. Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: Evolution over 12 years and predictors. J. Antimicrob. Chemother.: 2009; 64(3): 607-615 - Article IF 2008: 4,328 P.103. Bradford, BM; Tuzi, NL; Feltri, ML; McCorquodale, C; Cancellotti, E; Manson, JC. Dramatic reduction of PrPC level and glycosylation in peripheral nerves following PrP knock-out from Schwann cells does not prevent transmissible spongiform encephalopathy neuroinvasion. J. Neurosci.: 2009; 29(49): 15445-15454 - Article IF 2008: 7,452 P.104. Braga, M; Ljungqvist, O; Soeters, P; Fearon, K; Weimann, A; Bozzetti, F. ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin. Nutr.: 2009; 28(4): 378-386 - Article IF 2008: 3,203 P.105. Bragonzi, A; Paroni, M; Nonis, A; Cramer, N; Montanari, S; Rejman, J; Di Serio, C; Doring, G; Tummler, B. Pseudomonas aeruginosa microevolution during cystic fibrosis lung infection es- tablishes clones with adapted virulence. Am. J. Respir. Crit. Care Med. : 2009; 180(2): 138-145 - Article IF 2008: 9,792 P.106. Brambati, SM; Rankin, KP; Narvid, J; Seeley, WW; Dean, D; Rosen, HJ; Miller, BL; Ashburner, J; Gorno-Tempini, ML. Atrophy progression in semantic dementia with asymmetric temporal involvement: A tensor-based morphometry study. Neurobiol. Aging: 2009; 30(1): 103-111 - Article IF 2008: 5,959 P.107. Brandes, AA; Franceschi, E; Tosoni, A; Reni, M; Gatta, G; Vecht, C; Kortmann, RD. Adult neuroectodermal tumors of posterior fossa (medulloblastoma) and of supratentorial sites (stPNET). Crit. Rev. Oncol./Hematol.: 2009; 71(2): 165-179 - Review IF 2008: 4,589 P.108. Brandes, AA; Tosoni, A; Franceschi, E; Blatt, V; Santoro, A; Faedi, M; Amista, P; Gardiman, M; Labianca, R; Bianchini, C; Ermani, M; Reni, M. Fotemustine as second-line treatment for recurrent or progressive glioblastoma after concomitant and/or adjuvant temozolomide: a phase II trial of Gruppo Italiano Cooperativo di Neuro-Oncologia (GICNO). Cancer Chemother. Pharmacol.: 2009; 64(4): 769-775 - Article IF 2008: 2,740 P.109. Breda, A; Finelli, A; Janetschek, G; Porpiglia, F; Montorsi, F. Complications of Laparoscopic Surgery for Renal Masses: Prevention, Management, and Comparison with the Open Experience. Eur. Urol.: 2009; 55(4): 836-850 - Review IF 2008: 6,512 P.110. Bregni, M; Bernardi, M; Servida, P; Pescarollo, A; Crocchiolo, R; Treppiedi, E; Corradini, P; Ciceri, F; Peccatori, J. Long-term follow-up of metastatic renal cancer patients undergoing reduced-intensity allografting. Bone Marrow Transplant.: 2009; 44(4): 237-242 - Article IF 2008: 3,400 P.111. Briani, C; Lucchetta, M; Ghirardello, A; Toffanin, E; Zampieri, S; Ruggero, S; Scarlato, M; Quattrini, A; Bassi, N; Ermani, M; Battistin, L; Doria, A. Neurolupus is associated with anti-ribosomal P protein antibodies: An inception cohort study. J. Autoimmun.: 2009; 32(2): 79-84 - Article IF 2008: 7,881 P.112. Briganti, A. How to Improve the Ability to Detect Pelvic Lymph Node Metastases of Urologic Malignancies. Eur. Urol.: 2009; 55(4): 770-772 - Editorial IF 2008: 6,512 P.113. Briganti, A. Oestrogens and Prostate Cancer: Novel Concepts about an Old Issue. Eur. Urol.: 2009; 55(3): 543-545 - Editorial IF 2008: 6,512 P.114. Briganti, A. Rebuttal from Author re: George N Thalmann Positive Lymph Nodes at Lymphadenectomy for Prostate Cancer: Where Do We Set the Tiller? Eur Urol 2009;55:271-2. Eur. Urol.: 2009; 55(2): 273-274 - Editorial IF 2008: 6,512 P.115. Briganti, A; Blute, ML; Eastham, JH; Graefen, M; Heidenreich, A; Karnes, JR; Montorsi, F; Studer, UE. Pelvic Lymph Node Dissection in Prostate Cancer. Eur. Urol.: 2009; 55(6): 1251-1265 - Review IF 2008: 6,512 P.116. Briganti, A; Capitanio, U; Chun, FK; Karakiewicz, PI; Salonia, A; Bianchi, M; Cestari, A; Guazzoni, G; Rigatti, P; Montorsi, F. Prediction of sexual function after radical prostatectomy. Cancer: 2009; 115(13 Suppl): 3150-3159 - Article IF 2008: 5,238 P.117. Briganti, A; Capitanio, U; Suardi, N; Gallina, A; Salonia, A; Bianchi, M; Tutolo, M; Di Girolamo, V; Guazzoni, G; Rigatti, P; Montorsi, F. Benign Prostatic Hyperplasia and Its Aetiologies. Eur. Urol. Suppl.: 2009; 8(13): 865-871 - Review IF 2008: 1,711 PUBLICATIONS - 235 P.118. Briganti, A; Karakiewicz, PI; Chun, FKH; Suardi, N; Gallina, A; Abdollah, F; Freschi, M; Doglioni, C; Rigatti, P; Montorsi, F. Obesity does not increase the risk of lymph node metastases in patients with clinically localized prostate cancer undergoing radical prostatectomy and extended pelvic lymph node dissection. Int. J. Urol.: 2009; 16(8): 676-681 - Article IF 2008: 0,982 P.119. Briganti, A; Karakiewicz, PI; Joniau, S; Van Poppel, H. The Motion: Nomograms Should Become a Routine Tool in Determining Prostate Cancer Prognosis. Eur. Urol.: 2009; 55(3): 743-747 - Article IF 2008: 6,512 P.120. Briganti, A; Karnes, JR; Da Pozzo, LF; Cozzarini, C; Gallina, A; Suardi, N; Bianchi, M; Freschi, M; Doglioni, C; Fazio, F; Rigatti, P; Montorsi, F; Blute, ML. Two Positive Nodes Represent a Significant Cut-off Value for Cancer Specific Survival in Patients with Node Positive Prostate Cancer A New Proposal Based on a Two-Institution Experience on 703 Consecutive N+ Patients Treated with Radical Prostatectomy, Extended Pelvic Lymph Node Dissection and Adjuvant Therapy. Eur. Urol.: 2009; 55(2): 261-270 - Article IF 2008: 6,512 P.121. Brignole, C; Marimpietri, D; Pastorino, F; Di Paolo, D; Pagnan, G; Loi, M; Piccardi, F; Cilli, M; Tradori-Cappai, A; Arrigoni, G; Pistoia, V; Ponzoni, M. Anti-IL-10R antibody improves the therapeutic efficacy of targeted liposomal oligonucleotides. J. Control. Release: 2009; 138(2): 122-127 - Article IF 2008: 5,690 P.122. Briguori, C; Aranzulla, TC; Airoldi, F; Cosgrave, J; Tavano, D; Michev, I; Montorfano, M; Carlino, M; Castelli, A; Sangiorgi, MG; Colombo, A. Stent implantation in patients with severe left ventricular systolic dysfunction. Int. J. Cardiol.: 2009; 135(3): 376-384 - Article IF 2008: 3,121 P.123. Bril, V; Katzberg, H; Donofrio, P; Banach, M; Dalakas, MC; Deng, C; Hanna, K; Hartung, HP; Hughes, RA; Latov, N; Merkies, IS; van Doorn PA, on behalf of the ICE Study Group. Electrophysiology in chronic inflammatory demyelinating polyneuropathy with IGIV. Muscle Nerve: 2009; 39(4): 448-455 - Article IF 2008: 2,594 P.124. Brini, E; Ruffini, F; Bergami, A; Brambilla, E; Dati, G; Greco, B; Cirillo, R; Proudfoot, AEI; Comi, G; Furlan, R; Zaratin, P; Martino, G. Administration of a monomeric CCL2 variant to EAE mice inhibits inflammatory cell recruitment and protects from demyelination and axonal loss. J. Neuroimmunol.: 2009; 209(1-2): 33-39 - Article IF 2008: 3,159 P.125. Broccolo, F; Drago, F; Paolino, S; Cassina, G; Gatto, F; Fusetti, L; Matteoli, B; Zaccaria, E; Parodi, A; Lusso, P; Ceccherini-Nelli, L; Malnati, MS. Reactivation of human herpesvirus 6 (HHV-6) infection in patients with connective tissue diseases. J. Clin. Virol.: 2009; 46(1): 43-46 - Article IF 2008: 3,320 P.126. Broggi, S; Cozzarini, C; Fiorino, C; Maggiulli, E; Alongi, F; Cattaneo, GM; Di Muzio, N; Calandrino, R. Modeling set-up error by daily MVCT for prostate adjuvant treatment delivered in 20 fractions: Implications for the assessment of the optimal correction strategies. Radiother. Oncol.: 2009; 93(2): 246-252 - Article IF 2008: 3,990 P.127. Brown, BD; Naldini, L. Exploiting and antagonizing microRNA regulation for therapeutic and experimental applications. Nat. Rev. Genet.: 2009; 10(8): 578-585 - Review IF 2008: 24,185 P.128. Bruno, F; Damin, F; Causarano, V; Galbiati, S; Di Carlo, G; Seia, M; Porcaro, L; Ferrari, M; Chiari, M; Cremonesi, L. High-sensitive microarray substrates specifically designed to im- prove sensitivity for the identification of fetal paternally inherited sequences in maternal plasma. Clin. Chem. Lab. Med.: 2009; 47(7): 818-823 - Article IF 2008: 1,888 P.129. Brusati, R; Carota, F; Mortini, P; Chiapasco, M; Biglioli, F. A peculiar case of midface reconstruction with four free flaps in a cocaine-addicted patient. J. Plast. Reconstr. Aesthet. Surg.: 2009; 62(2): e33-e40 - Article IF 2008: 1,235 P.130. Buffi, N; Mottrie, A; Lughezzani, G; Koliakos, N; Schatteman, P; Carpentier, P; Fonteyne, E. Surgery Illustrated - Surgical Atlas Robotic radical cystectomy in the male. BJU Int.: 2009; 104(5): 726-745 - Article IF 2008: 2,704 P.131. Burastero, SE; Figini, M; Frigerio, B; Lusso, P; Mollica, L; Lopalco, L. Protective versus pathogenic anti-CD4 immunity: Insights from the study of natural resistance to HIV infection. J. Transl. Med.: 2009; 7: 101 - Review IF 2008: 2,917 P.132. Burastero, SE; Mistrello, G; Paolucci, C; Breda, D; Roncarolo, D; Zanotta, S; Falagiani, P. Clinical and immunological correlates of pre-co-seasonal sublingual immunotherapy with birch monomeric allergoid in patients with allergic rhinoconjunctivitis. Int. J. Immunopathol. Pharmacol.: 2009; 22(2): 343-352 - Article IF 2008: 2,793 P.133. Burastero, SE; Paolucci, C; Fabbri, M. Ambient pollutants as adjuvant for allergic sensitization: the emerging role of platinum group elements. J. Biol. Regul. Homeost. Agents: 2009; 23(4): 207-215 - Review IF 2008: 2,957 P.134. Burger, JA; Ghia, P; Rosenwald, A; Caligaris-Cappio, F. The microenvironment in mature B-cell malignancies: A target for new treatment strategies. Blood: 2009; 114(16): 3367-3375 Review IF 2008: 10,432 P.135. Burioni, R; Canducci, F; Mancini, N; Clementi, N; Sassi, M; De Marco, D; Saita, D; Diotti, RA; Sautto, G; Sampaolo, M; Clementi, M. Molecular cloning of the first human monoclonal antibodies neutralizing with high potency Swine-origin Influenza A pandemic virus (S-OIV). New Microbiol.: 2009; 32(4): 319-324 - Article IF 2008: 0,912 P.136. Burioni, R; Canducci, F; Saita, D; Perotti, M; Mancini, N; De Marco, D; Clementi, N; Chieffo, A; Denaro, M; Cianflone, D; Manfredi, AA; Colombo, A; Maseri, A; Clementi, M. Antigen-driven evolution of B lymphocytes in coronary atherosclerotic plaques. J. Immunol.: 2009; 183(4): 2537-2544 - Article IF 2008: 6,000 P.137. Burr, D; Silva, O; Cicchini, GM; Banks, MS; Morrone, MC. Temporal mechanisms of multimodal binding. Proc. R. Soc. BBiol. Sci.: 2009; 276(1663): 1761-1769 - Article IF 2008: 4,248 P.138. Cabrini, L; Idone, C; Colombo, S; Monti, G; Bergonzi, PC; Landoni, G; Salaris, D; Leggieri, C; Torri, G. Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure. Intensive Care Med.: 2009; 35(2): 339343 - Article IF 2008: 5,055 P.139. Cabrini, L; Levati, A. Risk management in anesthesia. Minerva Anestesiol: 2009; 75(11): 638-643 - Note IF 2008: 1,627 P.140. Cabrini, L; Monti, G; Villa, M; Pischedda, A; Masini, L; Dedola, E; Whelan, L; Marazzi, M; Colombo, S. Non-invasive ventilation outside the Intensive Care Unit for acute respiratory failure: The perspective of the general ward nurses. Minerva Anestesiol: 2009; 75(7-8): 427-433 - Article IF 2008: 1,627 236 - SAN RAFFAELE SCIENTIFIC INSTITUTE P.141. Calabrese, M; Agosta, F; Rinaldi, F; Mattisi, I; Grossi, P; Favaretto, A; Atzori, M; Bernardi, V; Barachino, L; Rinaldi, L; Perini, P; Gallo, P; Filippi, M. Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis. Arch. Neurol.: 2009; 66(9): 1144-1150 - Article IF 2008: 5,874 P.142. Calabrese, M; Filippi, M; Rovaris, M; Bernardi, V; Atzori, M; Mattisi, I; Favaretto, A; Grossi, P; Barachino, L; Rinaldi, L; Romualdi, C; Perini, P; Gallo, P. Evidence for relative cortical sparing in benign multiple sclerosis: A longitudinal magnetic resonance imaging study. Mult. Scler.: 2009; 15(1): 36-41 - Article IF 2008: 3,312 P.143. Calabrese, M; Rocca, MA; Atzori, M; Mattisi, I; Bernardi, V; Favaretto, A; Barachino, L; Romualdi, C; Rinaldi, L; Perini, P; Gallo, P; Filippi, M. Cortical lesions in primary progressive multiple sclerosis: a 2-year longitudinal MR study. Neurology: 2009; 72(15): 1330-1336 - Article IF 2008: 7,043 P.144. Calandrino, R; Del Maschio, A; Cattaneo, GM; Castiglioni, I. Imaging in radiotherapy. Nucl. Instrum. Methods Phys. Res. Sect. A-Accel. Spectrom. Dect. Assoc. Equip.: 2009; 608(1 SUPPL.): S11-S14 - Article IF 2008: 1,019 P.145. Calandrino, R; del Vecchio, A; Savi, A; Todde, S; Belloli, S. Intake risk and dose evaluation methods for workers in radiochemistry labs of a medical cyclotron facility. Health Phys.: 2009; 97(4): 315-321 - Article IF 2008: 0,869 P.146. Caligaris-Cappio, F. Chronic lymphocytic leukemia: “Cinderella” is becoming a star. Mol. Med.: 2009; 15(3-4): 67-69 - Article IF 2008: 3,411 P.147. Caligaris-Cappio, F. IG genes and hairy cell leukemia. Blood: 2009; 114(21): 4610-4611 - Comment IF 2008: 10,432 P.148. Caligaris-Cappio, F. ROMA illuminates CLL genomic lesions. Blood: 2009; 113(6): 1209-1210 - Note IF 2008: 10,432 P.149. Camaschella, C. Hereditary Sideroblastic Anemias: Pathophysiology, Diagnosis, and Treatment. Semin. Hematol.: 2009; 46(4): 371-377 - Article IF 2008: 3,070 P.150. Camaschella, C. BMP6 orchestrates iron metabolism. Nature Genet.: 2009; 41(4): 386-388 - Review IF 2008: 30,259 P.151. Camaschella, C; Poggiali, E. Towards explaining “unexplained hyperferrltlnemla”. Haematol-Hematol. J.: 2009; 94(3): 307-309 - Review IF 2008: 5,978 P.152. Campana, L; Bosurgi, L; Bianchi, ME; Manfredi, AA; Rovere-Querini, P. Requirement of HMGB1 for stromal cell-derived factor-1/CXCL12-dependent migration of macrophages and dendritic cells. J. Leukoc. Biol.: 2009; 86(3): 609-615 - Article IF 2008: 4,605 P.153. Campanella, A; Rovelli, E; Santambrogio, P; Cozzi, A; Taroni, F; Levi, S. Mitochondrial ferritin limits oxidative damage regulating mitochondrial iron availability: Hypothesis for a protective role in Friedreich ataxia. Hum. Mol. Genet.: 2009; 18(1): 1-11 - Article IF 2008: 7,249 P.154. Canducci, F; Marinozzi, MC; Sampaolo, M; Berre, S; Bagnarelli, P; Degano, M; Gallotta, G; Mazzi, B; Lemey, P; Burioni, R; Clementi, M. Dynamic features of the selective pressure on the human immunodeficiency virus type 1 (HIV-1) gp120 CD4-binding site in a group of long term non progressor (LTNP) subjects. Retrovirology: 2009; 6: 4 - Article IF 2008: 4,042 P.155. Canducci, F; Sampaolo, M; Marinozzi, MC; Boeri, E; Spagnuolo, V; Galli, A; Castagna, A; Lazzarin, A; Clementi, M; Gianotti, N. Dynamic patterns of human immunodeficiency virus type 1 integrase gene evolution in patients failing raltegravirbased salvage therapies. AIDS: 2009; 23(4): 455-460 - Article IF 2008: 5,460 P.156. Canessa, N; Motterlini, M; Di Dio, C; Perani, D; Scifo, P; Cappa, SF; Rizzolatti, G. Understanding others’ regret: a FMRI study. PLoS One: 2009; 4(10): e7402 - Article P.157. Cannistraci, CV; Montevecchi, FM; Alessio, M. Medianmodified Wiener filter provides efficient denoising, preserving spot edge and morphology in 2-DE image processing. Proteomics: 2009; 9(21): 4908-4919 - Article IF 2008: 4,586 P.158. Cantarelli, E; Melzi, R; Mercalli, A; Sordi, V; Ferrari, G; Lederer, CW; Mrak, E; Rubinacci, A; Ponzoni, M; Sitia, G; Guidotti, LG; Bonifacio, E; Piemonti, L. Bone marrow as an alternative site for islet transplantation. Blood: 2009; 114(20): 4566-4574 - Article IF 2008: 10,432 P.159. Capitanio, U; Cloutier, V; Zini, L; Isbarn, H; Jeldres, C; Shariat, SF; Perrotte, P; Antebi, E; Patard, JJ; Montorsi, F; Karakiewicz, PI. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU international: 2009; 103(11): 1496-1500 - Article IF 2008: 2,704 P.160. Capitanio, U; Isbarn, H; Shariat, SF; Jeldres, C; Zini, L; Saad, F; Graefen, M; Montorsi, F; Perrotte, P; Karakiewicz, PI. Partial Cystectomy Does Not Undermine Cancer Control in Appropriately Selected Patients With Urothelial Carcinoma of the Bladder: A Population-based Matched Analysist. Urology: 2009; 74(4): 858-864 - Article IF 2008: 2,242 P.161. Capitanio, U; Jeldres, C; Perrotte, P; Isbarn, H; Crepel, M; Cloutier, V; Baillargeon-Gagne, S; Shariat, SF; Duclos, A; Arjane, P; Widmer, H; Saad, F; Montorsi, F; Karakiewicz, PI. Population-based Study of Perioperative Mortality After Retroperitoneal Lymphadenectomy for Nonseminomatous Testicular Germ Cell Tumors. Urology: 2009; 74(2): 373-377 - Article IF 2008: 2,242 P.162. Capitanio, U; Karakiewicz, PI; Jeldres, C; Briganti, A; Gallina, A; Suardi, N; Cestari, A; Guazzoni, G; Salonia, A; Montorsi, F. The probability of Gleason score upgrading between biopsy and radical prostatectomy can be accurately predicted. Int. J. Urol.: 2009; 16(5): 526-529 - Article IF 2008: 0,982 P.163. Capitanio, U; Karakiewicz, PI; Jeldres, C; Briganti, A; Salonia, A; Cestari, A; Guazzoni, G; Rigatti, P; Montorsi, F. Suspected Clinical T3 Prostate Cancer Is Associated with a High Rate of Negative Extended Biopsies: Clinical Implications. Eur. Urol.: 2009; 55(1): 253-254 - Letter IF 2008: 6,512 P.164. Capitanio, U; Karakiewicz, PI; Valiquette, L; Perrotte, P; Jeldres, C; Briganti, A; Gallina, A; Suardi, N; Cestari, A; Guazzoni, G; Salonia, A; Montorsi, F. Biopsy Core Number Represents One of Foremost Predictors of Clinically Significant Gleason Sum Upgrading in Patients With Low-risk Prostate Cancer. Urology: 2009; 73(5): 1087-1091 - Article IF 2008: 2,242 P.165. Capitanio, U; Perrotte, P; Hutterer, GC; Suardi, N; Jeldres, C; Shariat, SF; Duclos, A; Arjane, P; Montorsi, F; Karakiewicz, PI. Effect of body mass index on prostate-specific antigen and percentage free prostate-specific antigen: Results from a prostate cancer screening cohort of 1490 men. Int. J. Urol.: 2009; 16(1): 9195 - Article IF 2008: 0,982 P.166. Capitanio, U; Perrotte, P; Zini, L; Jeldres, C; Shariat, SF; Isbarn, H; Arjane, P; Peloquin, F; Pharand, D; Montorsi, F; PUBLICATIONS - 237 Karakiewicz, PI. Nephrectomy improves survival in patients with invasion of adjacent viscera and absence of nodal metastases (stage T4N0 renal cell carcinoma). BJU Int.: 2009; 104(6): 795799 - Article IF 2008: 2,704 P.167. Capitanio, U; Perrotte, P; Zini, L; Suardi, N; Antebi, E; Cloutier, V; Jeldres, C; Shariat, SF; Duclos, A; Arjane, P; Saad, F; Montorsi, F; Karakiewicz, PI. Population-based Analysis of Normal Total PSA and Percentage of Free/Total PSA Values: Results From Screening Cohort. Urology: 2009; 73(6): 1323-1327 Article IF 2008: 2,242 P.168. Capitanio, U; Shariat, SF; Isbarn, H; Weizer, A; Remzi, M; Roscigno, M; Kikuchi, E; Raman, JD; Bolenz, C; Bensalah, K; Koppie, TM; Kassouf, W; Fernandez, MI; Strobel, P; Wheat, J; Zigeuner, R; Langner, C; Waldert, M; Oya, M; Guo, CC; Ng, C; Montorsi, F; Wood, CG; Margulis, V; Karakiewicz, PI. Comparison of Oncologic Outcomes for Open and Laparoscopic Nephroureterectomy: A Multi-Institutional Analysis of 1249 Cases. Eur. Urol.: 2009; 56(1): 1-9 - Article IF 2008: 6,512 P.169. Capitanio, U; Suardi, N; Shariat, SF; Lotan, Y; Palapattu, GS; Bastian, PJ; Gupta, A; Vazina, A; Schoenberg, M; Lerner, SP; Sagalowsky, AI; Karakiewicz, PI. Assessing the minimum number of lymph nodes needed at radical cystectomy in patients with bladder cancer. BJU international: 2009; 127(1): 1359-1362 - Article IF 2008: 2,704 P.170. Cappelleri, G; Ghisi, D; Fanelli, A; Aldegheri, G; La Colla, L; Albertin, A. Posterior psoas vs 3-in-1 approach for lateral femoral cutaneous and obturator nerve block for anterior cruciate ligament repair. Minerva Anestesiol: 2009; 75(10): 568-573 - Article IF 2008: 1,627 P.171. Cappelli, B; Chiesa, R; Evangelio, C; Biffi, A; Roccia, T; Frugnoli, I; Biral, E; Noe, A; Fossati, M; Finizio, V; Miniero, R; Napolitano, S; Ferrua, F; Soliman, C; Ciceri, F; Roncarolo, MG; Marktel, S. Absence of VOD in paediatric thalassaemic HSCT recipients using defibrotide prophylaxis and intravenous Busulphan. Br. J. Haematol.: 2009; 147(4): 554-560 - Article IF 2008: 4,478 P.172. Capuano, G; Rigamonti, N; Grioni, M; Freschi, M; Bellone, M. Modulators of arginine metabolism support cancer immunosurveillance. BMC immunol.: 2009; 10(): - Article IF 2008: 2,661 P.173. Carlen, M; Meletis, K; Goritz, C; Darsalia, V; Evergren, E; Tanigaki, K; Amendola, M; Barnabe-Heider, F; Yeung, MSY; Naldini, L; Honjo, T; Kokaia, Z; Shupliakov, O; Cassidy, RM; Lindvall, O; Frisen, J. Forebrain ependymal cells are Notch-dependent and generate neuroblasts and astrocytes after stroke. Nat. Neurosci.: 2009; 12(3): 259-267 - Article IF 2008: 14,164 P.174. Carpi, F; Pappone, C. Magnetic maneuvering of endoscopic capsules by means of a robotic navigation system. IEEE Trans. Biomed. Eng.: 2009; 56(5;4760277): 1482-1490 - Article IF 2008: 2,496 P.175. Carrara, S; Arcidiacono, PG; Giussani, A; Testoni, PA. Acute hemorrhage with retroperitoneal hematoma after endoscopic ultrasound-guided fine-needle aspiration of an intraductal papillary mucinous neoplasm of the pancreas. Am. J. Gastroenterol.: 2009; 104(6): 1610-1611 - Letter IF 2008: 6,444 P.176. Carretta, A; Casiraghi, M; Melloni, G; Bandiera, A; Ciriaco, P; Ferla, L; Puglisi, A; Zannini, P. Montgomery T-tube placement in the treatment of benign tracheal lesions. Eur. J. CardioThorac. Surg.: 2009; 36(2): 352-356 - Article IF 2008: 2,181 P.177. Carretta, A; Ciriaco, P; Melloni, G; Bandiera, A; Libretti, L; Puglisi, A; Giovanardi, M; Zannini, P. Surgical treatment of multiple primary adenocarcinomas of the lung. Thorac. Cardiovasc. Surg.: 2009; 57(1): 30-34 - Article IF 2008: 0,770 P.178. Cassani, B; Montini, E; Maruggi, G; Ambrosi, A; Mirolo, M; Selleri, S; Biral, E; Frugnoli, I; Hernandez-Trujillo, V; Di Serio, C; Roncarolo, MG; Naldini, L; Mavilio, F; Aiuti, A. Integration of retroviral vectors induces minor changes in the transcriptional activity of T cells from ADA-SCID patients treated with gene therapy. Blood: 2009; 114(17): 3546-3556 - Article IF 2008: 10,432 P.179. Cassetta, L; Fortunato, O; Adduce, L; Rizzi, C; Hering, J; Rovere-Querini, P; Bianchi, ME; Alfano, M; Poli, G. Extracellular high mobility group box-1 inhibits R5 and X4 HIV-1 strains replication in mononuclear phagocytes without induction of chemokines and cytokines. AIDS: 2009; 23(5): 567-577 - Article IF 2008: 5,460 P.180. Castella, A; Argentero, PA; Farina, EC; Anselmo, E; Djiomo, A; Zotti, CM; Piemonte Nosocomial Infection Study Group. Surgical site infections surveillance in northern Italy.. Infection: 2009; 37(1): 70-74 - Correspondence IF 2008: 1,831 P.181. Castelli, R; Bergamaschini, L; Sailis, P; Pantaleo, G; Porro, F. The impact of an aging population on the diagnosis of pulmonary embolism: Comparison of young and elderly patients. Clin. Appl. Thromb. Hemost.: 2009; 15(1): 65-72 - Article IF 2008: 1,421 P.182. Castiglioni, I; Canesi, B; Schenone, A; Perani, D; Gilardi, MC. A Grid-based SPM service (GriSPM) for SPECT and PET neurological studies. Eur. J. Nucl. Med. Mol. Imaging: 2009; 36(7): 1193-1195 - Letter IF 2008: 4,532 P.183. Castiglioni, MT; Scavini, M; Cavallin, R; Pasi, F; Rosa, S; Sabbadini, MG; Rovere-Querini, P. Elevation of plasma levels of the long pentraxin 3 precedes preeclampsia in pregnant patients with type 1 diabetes. Autoimmunity: 2009; 42(4): 296-298 - Article IF 2008: 2,525 P.184. Castronovo, V; Canessa, N; Ferini-Strambi, L; Aloia, MS; Consonni, M; Marelli, S; Iadanza, A; Bruschi, A; Falini, A; Cappa, SF. Brain activation changes before and after PAP treatment in obstructive sleep apnea. Sleep: 2009; 32(9): 1161-1172 Article IF 2008: 4,475 P.185. Cavallaro, R; Anselmetti, S; Poletti, S; Bechi, M; Ermoli, E; Cocchi, F; Stratta, P; Vita, A; Rossi, A; Smeraldi, E. Computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation. Psychiatry Res: 2009; 169(3): 191196 - Article IF 2008: 2,666 P.186. Cavarelli, M; Scarlatti, G. Phenotype variation in human immunodeficiency virus type 1 transmission and disease progression. Dis. Markers: 2009; 27(3): 121-136 - Article IF 2008: 2,303 P.187. Cavoretto, P; Serafini, A; Valsecchi, L; Lanna, M; Rustico, MA. Early diagnosis, follow-up, and prenatal treatment of a case of TRAP sequence occurring in a dichorionic triamniotic triplet pregnancy. J. Clin. Ultrasound: 2009; 37(6): 350-353 - Article IF 2008: 0,843 P.188. Cazzaniga, S; Sassi, F; Mercuri, SR; Naldi, L. Prediction of clinical response to excimer laser treatment in vitiligo by using neural network models. Dermatology: 2009; 219(2): 133-137 Article IF 2008: 2,227 P.189. Ceccarelli, A; Filippi, M; Neema, M; Arora, A; Valsasina, P; Rocca, MA; Healy, BC; Bakshi, R. T2 hypointensity in the deep gray matter of patients with benign multiple sclerosis. Mult. Scler.: 2009; 15(6): 678-686 - Article 238 - SAN RAFFAELE SCIENTIFIC INSTITUTE IF 2008: 3,312 P.190. Ceccarelli, A; Rocca, MA; Pagani, E; Falini, A; Comi, G; Filippi, M. Cognitive learning is associated with gray matter changes in healthy human individuals: A tensor-based morphometry study. Neuroimage: 2009; 48(3): 585-589 - Article IF 2008: 5,694 P.191. Ceccarelli, A; Rocca, MA; Valsasina, P; Rodegher, M; Pagani, E; Falini, A; Comi, G; Filippi, M. A multiparametric evaluation of regional brain damage in patients with primary progressive multiple sclerosis. Hum. Brain Mapp.: 2009; 30(9): 30093019 - Article IF 2008: 5,395 P.192. Centonze, D; Muzio, L; Rossi, S; Cavasinni, F; De Chiara, V; Bergami, A; Musella, A; D’Amelio, M; Cavallucci, V; Martorana, A; Bergamaschi, A; Cencioni, MT; Diamantini, A; Butti, E; Comi, G; Bernardi, G; Cecconi, F; Battistini, L; Furlan, R; Martino, G. Inflammation triggers synaptic alteration and degeneration in experimental autoimmune encephalomyelitis. J. Neurosci.: 2009; 29(11): 3442-3452 - Article IF 2008: 7,452 P.193. Ceriotti, F. Quantity quotient reporting Counterpoint. Clin. Chem. Lab. Med.: 2009; 47(10): 1207-1208 - Review IF 2008: 1,888 P.194. Ceriotti, F. Common reference intervals: The IFCC position. Clin. Biochem.: 2009; 42(4-5): 297 - Article IF 2008: 1,926 P.195. Ceriotti, F. Laboratory quality regulations and accreditation standards in Italy. Clin. Biochem.: 2009; 42(4-5): 317 - Article IF 2008: 1,926 P.196. Ceriotti, F; Hinzmann, R; Panteghini, M. Reference intervals: The way forward. Ann. Clin. Biochem.: 2009; 46(1): 8-17 Review IF 2008: 1,788 P.197. Cerri, F; Gavazzi, A; Previtali, SC; Franceschi, M; Lopez, ID; Scarlato, M; Podini, P; Comi, G; Quattrini, A. Diffuse intraneural leiomyoma in a case of sensorimotor neuropathy. Acta Neuropathol.: 2009; 117(5): 595-597 - Article IF 2008: 5,310 P.198. Cesani, M; Capotondo, A; Plati, T; Sergi Sergi, L; Fumagalli, F; Roncarolo, MG; Naldini, L; Comi, G; Sessa, M; Biffi, A. Characterization of new arylsulfatase A gene mutations reinforces genotype-phenotype correlation in metachromatic leukodystrophy. Hum. Mutat: 2009; 30(10): E936-E945 - Article IF 2008: 7,033 P.199. Charil, A; Corbo, M; Filippi, M; Kesavadas, C; Agosta, F; Munerati, E; Gambini, A; Comi, G; Scotti, G; Falini, A. Structural and metabolic changes in the brain of patients with upper motor neuron disorders: A multiparametric MRI study. Amyotrophic Lateral Scler.: 2009; 10(5-6): 269-279 - Article IF 2008: 1,815 P.200. Chaturvedi, S; Zivin, J; Breazna, A; Amarenco, P; Callahan, A; Goldstein, LB; Hennerici, M; Sillesen, H; Rudolph, A; Welch, MA; SPARCL Investigators. Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack. Neurology: 2009; 72(8): 688-694 - Article IF 2008: 7,043 P.201. Chen, H; Ko, G; Zatti, A; Di Giacomo, G; Liu, L; Raiteri, E; Perucco, E; Collesi, C; Min, W; Zeiss, C; De Camilli, P; Cremona, O. Embryonic arrest at midgestation and disruption of Notch signaling produced by the absence of both epsin 1 and epsin 2 in mice. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(33): 13838-13843 - Article IF 2008: 9,380 P.202. Chiappalone, M; Casagrande, S; Tedesco, M; Valtorta, F; Baldelli, P; Martinoia, S; Benfenati, F. Opposite changes in glutamatergic and GABAergic transmission underlie the diffuse hyperexcitability of synapsin i-deficient cortical networks. Cereb. Cortex: 2009; 19(6): 1422-1439 - Article IF 2008: 5,907 P.203. Chieffo, A; Foglieni, C; Nodari, RL; Briguori, C; Sangiorgi, G; Latib, A; Montorfano, M; Airoldi, F; Michev, I; Carlino, M; Colombo, A; Maseri, A. Histopathology of Clinical Coronary Restenosis in Drug-Eluting Versus Bare Metal Stents. Am. J. Cardiol.: 2009; 104(12): 1660-1667 - Article IF 2008: 3,905 P.204. Chiesa, R; Marone, EM; Tshomba, Y; Logaldo, D; Castellano, R; Melissano, G. Aortobifemoral bypass grafting using expanded polytetrafluoroethylene stretch grafts in patients with occlusive atherosclerotic disease. Ann. Vasc. Surg.: 2009; 23(6): 764-769 - Article IF 2008: 1,262 P.205. Chiesa, R; Tshomba, Y; Melissano, G; Logaldo, D. Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm?. Eur. J. Vasc. Endovasc. Surg.: 2009; 38(1): 26-34 - Article IF 2008: 3,007 P.206. Chignola, F; Gaetani, M; Rebane, A; Org, T; Mollica, L; Zucchelli, C; Spitaleri, A; Mannella, V; Peterson, P; Musco, G. The solution structure of the first PHD finger of autoimmune regulator in complex with non-modified histone H3 tail reveals the antagonistic role of H3R2 methylation. Nucleic Acids Res.: 2009; 37(9): 2951-2961 - Article IF 2008: 6,878 P.207. Chio, A; Schymick, JC; Restagno, G; Scholz, SW; Lombardo, F; Lai, SL; Mora, G; Fung, HC; Britton, A; Arepalli, S; Gibbs, JR; Nalls, M; Berger, S; Kwee, LC; Oddone, EZ; Ding, J; Crews, C; Rafferty, I; Washecka, N; Hernandez, D; Ferrucci, L; Bandinelli, S; Guralnik, J; Macciardi, F; Torri, F; Lupoli, S; Chanock, SJ; Thomas, G; Hunter, DJ; Gieger, C; Wichmann, HE; Calvo, A; Mutani, R; Battistini, S; Giannini, F; Caponnetto, C; Mancardi, GL; La Bella, V; Valentino, F; Monsurro, MR; Tedeschi, G; Marinou, K; Sabatelli, M; Conte, A; Mandrioli, J; Sola, P; Salvi, F; Bartolomei, I; Siciliano, G; Carlesi, C; Orrell, RW; Talbot, K; Simmons, Z; Connor, J; Pioro, EP; Dunkley, T; Stephan, DA; Kasperaviciute, D; Fisher, EM; Jabonka, S; Sendtner, M; Beck, M; Bruijn, L; Rothstein, J; Schmidt, S; Singleton, A; Hardy, J; Traynor, BJ. A two-stage genome-wide association study of sporadic amyotrophic lateral sclerosis. Hum. Mol. Genet.: 2009; 18(8): 1524-1532 - Article IF 2008: 7,249 P.208. Chiocca, E; Dati, E; Baroncelli, GI; Mora, S; Parrini, D; Erba, P; Bertelloni, S. Body mass index and body composition in adolescents treated with gonadotropin-releasing hormone analogue triptorelin depot for central precocious puberty: data at near final height. Neuroendocrinology: 2009; 89(4): 441-447 - Article IF 2008: 2,913 P.209. Chun, FKH; Suardi, N; Capitanio, U; Jeldres, C; Ahyai, S; Graefen, M; Haese, A; Steuber, T; Erbersdobler, A; Montorsi, F; Huland, H; Karakiewicz, PI. Assessment of Pathological Prostate Cancer Characteristics in Men with Favorable Biopsy Features on Predominantly Sextant Biopsy. Eur. Urol.: 2009; 55(3): 617-628 - Article IF 2008: 6,512 P.210. Chung, BH; Roehrborn, CG; Siami, P; Major-Walker, K; Morrill, BB; Wilson, TH; Montorsi, F. Efficacy and safety of dutasteride, tamsulosin and their combination in a subpopulation of the CombAT study: 2-year results in Asian men with moderateto-severe BPH. Prostate Cancer Prostatic Dis.: 2009; 12(2): 152159 - Article IF 2008: 2,062 P.211. Chung, SH; Sillitoe, RV; Croci, L; Badaloni, A; Consalez, G; Hawkes, R. Purkinje cell phenotype restricts the distribution of unipolar brush cells. Neuroscience: 2009; 164(4): 1496-1508 Article IF 2008: 3,556 PUBLICATIONS - 239 P.212. Cicchini, GM; Morrone, MC. Shifts in spatial attention affect the perceived duration of events. J. Vision: 2009; 9(1): 1-13 Article IF 2008: 2,950 P.213. Ciceri, F; Bonini, C; Lupo Stanghellini, MT; Bondanza, A; Traversari, C; Salomoni, M; Turchetto, L; Colombi, S; Bernardi, M; Peccatori, J; Pescarollo, A; Servida, P; Magnani, Z; Perna, SK; Valtolina, V; Crippa, F; Callegaro, L; Spoldi, E; Crocchiolo, R; Fleischhauer, K; Ponzoni, M; Vago, L; Santoro, A; Todisco, E; Apperley, J; Olavarria, E; Slavin, S; Weissinger, EM; Hertenstein, B; Stadler, M; Yannaki, E; Fassas, A; Anagnostopoulos, A; Bregni, M; Gallo Stampino, C; Bruzzi, P; Bordignon, C. Early and effective immunorecovery after family haploidentical hemopoietic transplantation for leukemia by gene-engineered lymphocytes: the TK007 study. Lancet Oncol.: 2009; 10(5): 489-500 - Article IF 2008: 13,283 P.214. Cighetti, G; Fermo, I; Aman, CS; Ferraroni, M; Secchi, A; Fiorina, P; Paroni, R. Dimethylarginines in complicated type 1 diabetes: Roles of insulin, glucose, and oxidative stress. Free Radic. Biol. Med.: 2009; 47(3): 307-311 - Article IF 2008: 5,399 P.215. Cinque, P; Koralnik, IJ; Gerevini, S; Miro, JM; Price, RW. Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect. Dis.: 2009; 9(10): 625-636 - Review IF 2008: 13,165 P.216. Ciriaco, P; Casiraghi, M; Negri, G; Gioia, G; Carretta, A; Melloni, G; Zannini, P. Early surgical repair of isolated traumatic sternal fractures using a cervical plate system. J.Trauma-Injury Infect.Crit.Care: 2009; 66(2): 462-464 - Article IF 2008: 2,342 P.217. Cloutier, V; Capitanio, U; Zini, L; Perrotte, P; Jeldres, C; Shariat, SF; Arjane, P; Patard, JJ; Montorsi, F; Karakiewicz, PI. Thirty-Day Mortality After Nephrectomy: Clinical Implications for Informed Consent. Eur. Urol.: 2009; 56(6): 998-1005 - Article IF 2008: 6,512 P.218. Cocucci, E; Racchetti, G; Meldolesi, J. Shedding microvesicles: artefacts no more. Trends Cell Biol.: 2009; 19(2): 43-51 Review IF 2008: 13,385 P.219. Colasante, G; Sessa, A; Crispi, S; Calogero, R; Mansouri, A; Collombat, P; Broccoli, V. Arx acts as a regional key selector gene in the ventral telencephalon mainly through its transcriptional repression activity. Dev. Biol.: 2009; 334(1): 59-71 - Article IF 2008: 4,416 P.220. Colombo, A; Bramucci, E; Sacca, S; Violini, R; Lettieri, C; Zanini, R; Sheiban, I; Paloscia, L; Grube, E; Schofer, J; Bolognese, L; Orlandi, M; Niccoli, G; Latib, A; Airoldi, F. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: The CACTUS (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents) study. Circulation: 2009; 119(1): 71-78 - Article IF 2008: 14,595 P.221. Colombo, A; Latib, A. Surgeons and Interventional Cardiologists in a Collaborative Environment. J. Am. Coll. Cardiol.: 2009; 53(3): 242-243 - Editorial IF 2008: 11,438 P.222. Colombo, A; Sharp, AS. The bioabsorbable stent as a virtual prosthesis. Lancet: 2009; 373(9667): 869-870 - Article IF 2008: 28,409 P.223. Colombo, G; Rusconi, F; Rubino, T; Cattaneo, A; Martegani, E; Parolaro, D; Bachi, A; Zippel, R. Transcriptomic and Proteomic Analyses of Mouse Cerebellum Reveals Alterations in RasGRF1 Expression Following In Vivo Chronic Treatment with Delta 9-Tetrahydrocannabinol. J. Mol. Neurosci.: 2009; 37(2): 111-122 - Article IF 2008: 2,061 P.224. Colucci, A; Modorati, G; Miserocchi, E; Di Matteo, F; Rama, P. Anterior uveitis complicating zoledronic acid infusion. Ocul. Immunol. Inflamm.: 2009; 17(4): 267-268 - Article IF 2008: 0,919 P.225. Combi, R; Ferini-Strambi, L; Tenchini, ML. CHRNA2 mutations are rare in the NFLE population: Evaluation of a large cohort of Italian patients. Sleep Med.: 2009; 10(1): 139-142 - Article IF 2008: 3,163 P.226. Comi, G. Treatment of multiple sclerosis: role of natalizumab. Neurol. Sci.: 2009; (Suppl 2): S155-S158 - Short Survey IF 2008: 1,435 P.227. Comi, G. Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta. Clin. Ther.: 2009; 31(6): 1142-1157 - Review IF 2008: 3,064 P.228. Comi, G; Martinelli, V; Rodegher, M; Moiola, L; Bajenaru, O; Carra, A; Elovaara, I; Fazekas, F; Hartung, HP; Hillert, J; King, J; Komoly, S; Lubetzki, C; Montalban, X; Myhr, KM; Ravnborg, M; Rieckmann, P; Wynn, D; Young, C; Filippi, M. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet: 2009; 374(9700): 1503-1511 - Article IF 2008: 28,409 P.229. Compagno, M; Lim, WK; Grunn, A; Nandula, SV; Brahmachary, M; Shen, Q; Bertoni, F; Ponzoni, M; Scandurra, M; Califano, A; Bhagat, G; Chadburn, A; Dalla-Favera, R; Pasqualucci, L. Mutations of multiple genes cause deregulation of NF-?B in diffuse large B-cell lymphoma. Nature: 2009; 459(7247): 717-721 - Article IF 2008: 31,434 P.230. Conti, M; Peretti, E; Cazzetta, G; Galimberti, G; Vermigli, C; Pola, R; Scionti, L; Bosi, E. Frequency-modulated electromagnetic neural stimulation enhances cutaneous microvascular flow in patients with diabetic neuropathy. J. Diabetes Complications: 2009; 23(1): 46-48 - Article IF 2008: 2,008 P.231. Copreni, E; Nicolis, E; Tamanini, A; Bezzerri, V; Castellani, S; Palmieri, L; Giri, MG; Vella, A; Colombatti, M; Rizzotti, P; Conese, M; Cabrini, G. Late generation lentiviral vectors: Evaluation of inflammatory potential in human airway epithelial cells. Virus Res.: 2009; 144(1-2): 8-17 - Article IF 2008: 2,429 P.232. Corbetta, C; Weber, G; Cortinovis, F; Calebiro, D; Passoni, A; Vigone, MC; Beck-Peccoz, P; Chiumello, G; Persani, L. A 7-year experience with low blood TSH cutoff levels for neonatal screening reveals an unsuspected frequency of congenital hypothyroidism (CH). Clin. Endocrinol.: 2009; 71(5): 739-745 Article IF 2008: 3,398 P.233. Corbetta, S; Gualdoni, S; Ciceri, G; Monari, M; Zuccaro, E; Tybulewicz, VLJ; De Curtis, I. Essential role of Rac1 and Rac3 GTPases in neuronal development. FASEB J.: 2009; 23(5): 1347-1357 - Article IF 2008: 7,049 P.234. Corre, T; Schuettler, J; Bione, S; Marozzi, A; Persani, L; Rossetti, R; Torricelli, F; Giotti, I; Vogt, P; Toniolo, D. A largescale association study to assess the impact of known variants of the human INHA gene on premature ovarian failure. Hum. Reprod.: 2009; 24(8): 2023-2028 - Article IF 2008: 3,773 P.235. Corsetti, M; De Nardi, P; Di Pietro, S; Passaretti, S; Testoni, PA; Staudacher, C. Rectal Distensibility and Symptoms 240 - SAN RAFFAELE SCIENTIFIC INSTITUTE After Stapled and Milligan-Morgan Operation for Hemorrhoids. J. Gastrointest. Surg.: 2009; 13(12): 2245-2251 - Article IF 2008: 2,311 P.236. Cossarini, F; Galli, L; Sagnelli, C; Gianotti, N; Hasson, H; Clementi, M; Soria, A; Salpietro, S; Lazzarin, A; Castagna, A. Survival of HIV-1 infected multidrug-resistant patients recycling enfuvirtide after a previous failure. J. Acquired Immune Defic. Syndr.: 2009; 51(2): 179-184 - Article IF 2008: 4,570 P.237. Cotton, RG; Al Aqeel, AI; Al-Mulla, F; Carrera, P; Claustres, M; Ekong, R; Hyland, VJ; Macrae, FA; Marafie, MJ; Paalman, MH; Patrinos, GP; Qi, M; Ramesar, RS; Scott, RJ; Sijmons, RH; Sobrido, MJ; Vihinen, M; Members of the Human Variome Project Data Collection from Clinics, Data Collection from Laboratories and Publication, Credit and Incentives Working Groups.. Capturing all disease-causing mutations for clinical and research use: Toward an effortless system for the Human Variome Project. Genet. Med.: 2009; 11(12): 843-849 Note IF 2008: 3,716 P.238. Court, FA; Hewitt, JE; Davies, K; Patton, BL; Uncini, A; Wrabetz, L; Feltri, ML. A laminin-2, dystroglycan, utrophin axis is required for compartmentalization and elongation of myelin segments. J. Neurosci.: 2009; 29(12): 3908-3919 - Article IF 2008: 7,452 P.239. Covello, RD; Maj, G; Landoni, G; Maisano, F; Michev, I; Guarracino, F; Alfieri, O; Colombo, A; Zangrillo, A. Anesthetic Management of Percutaneous Aortic Valve Implantation: Focus on Challenges Encountered and Proposed Solutions. J. Cardiothorac. Vasc. Anesth.: 2009; 23(3): 280-285 - Article IF 2008: 0,994 P.240. Cozzarini, C; Montorsi, F; Fiorino, C; Alongi, F; Bolognesi, A; Da Pozzo, LF; Guazzoni, G; Freschi, M; Roscigno, M; Scattoni, V; Rigatti, P; Di Muzio, N. Need for high radiation dose (>or=70 gy) in early postoperative irradiation after radical prostatectomy: a single-institution analysis of 334 high-risk, nodenegative patients. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 75(4): 966-974 - Article IF 2008: 4,639 P.241. Cozzi-Lepri, A; Phillips, AN; Martinez-Picado, J; Monforte, A; Katlama, C; Eg Hansen, AB; Horban, A; Bruun, J; Clotet, B; Lundgren, JD; EuroSIDA Study Group. Rate of accumulation of thymidine analogue mutations in patients continuing to receive virologically failing regimens containing zidovudine or stavudine: implications for antiretroviral therapy programs in resource-limited settings.. J. Infect. Dis.: 2009; 200(5): 687-697 Article IF 2008: 5,682 P.242. Cremasco, V; Mantelli, B; Lazzarin, A; Biswas, P. Improvement of CXCR3 ligand CXCL11/I-TAC measurement in human plasma and serum. New Microbiol.: 2009; 32(1): 125-128 - Article IF 2008: 0,912 P.243. Crepel, M; Isbarn, H; Capitanio, U; Liberman, D; Jeldres, C; Sun, M; Shariat, SF; Widmer, H; Arjane, P; Graefen, M; Montorsi, F; Patard, JJ; Perrotte, P; Karakiewicz, PI. Does Histologic Subtype Affect Oncologic Outcomes After Nephron-sparing Surgery?. Urology: 2009; 74(4): 842-845 - Article IF 2008: 2,242 P.244. Crescenzi, G; Landoni, G; Bignami, E; Belloni, I; Biselli, C; Rosica, C; Guarracino, F; Marino, G; Zangrillo, A. N-Terminal B-Natriuretic Peptide After Coronary Artery Bypass Graft Surgery. J. Cardiothorac. Vasc. Anesth.: 2009; 23(2): 147-150 Article IF 2008: 0,994 P.245. Crescenzi, G; Landoni, G; Monaco, F; Bignami, E; De Luca, M; Frau, G; Rosica, C; Zangrillo, A. Epidural Anesthesia in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery. J. Cardiothorac. Vasc. Anesth.: 2009; 23(6) - 807-812 Article IF 2008: 0,994 P.246. Crescenzi, G; Landoni, G; Zangrillo, A; Guarracino, F; Rosica, C; La Canna, G; Alfieri, O. Management and decisionmaking strategy for systolic anterior motion after mitral valve repair. J. Thorac. Cardiovasc. Surg.: 2009; 137(2): 320-325 - Article IF 2008: 3,037 P.247. Crespi, R; Cappare, P; Gherlone, E. Magnesium-enriched hydroxyapatite compared to calcium sulfate in the healing of human extraction sockets: Radiographic and histomorphometric evaluation at 3 months. J. Periodont.: 2009; 80(2): 210-218 - Article IF 2008: 1,961 P.248. Crespi, R; Cappare, P; Gherlone, E. Dental implants placed in extraction sites grafted with different bone substitutes: Radiographic evaluation at 24 months. J. Periodont.: 2009; 80(10): 1616-1621 - Article IF 2008: 1,961 P.249. Crespi, R; Capparè, P; Gherlone, E. Radiographic evaluation of marginal bone levels around platform-switched and nonplatform-switched implants used in an immediate loading protocol. Int. J. Oral Maxillofac. Implants: 2009; 24(5): 920-926 - Article IF 2008: 1,972 P.250. Crespi, R; Mariani, E; Benasciutti, E; Capparè, P; Cenci, S; Gherlone, E. Magnesium - enriched hydroxyapatite versus autologous bone in maxillary sinus grafting: Combining histomorphometry with osteoblast gene expression profiles in vivo. J. Periodont.: 2009; 80(4): 586-593 - Article IF 2008: 1,961 P.251. Crimella, C; Arnoldi, A; Crippa, F; Mostacciuolo, ML; Boaretto, F; Sironi, M; D’Angelo, MG; Manzoni, S; Piccinini, L; Turconi, AC; Toscano, A; Musumeci, O; Benedetti, S; Fazio, R; Bresolin, N; Daga, A; Martinuzzi, A; Bassi, MT. Point mutations and a large intragenic deletion in SPG11 in complicated spastic paraplegia without thin corpus callosum. J. Med. Genet.: 2009; 46(5): 345-351 - Article IF 2008: 5,713 P.252. Crinò, A; Di Giorgio, G; Livieri, C; Grugni, G; Beccaria, L; Bosio, L; Corrias, A; Chiumello, G; Trifiro, G; Salvatoni, A; Tonini, G; Gargantini, L; De Toni, T; Valerio, G; Ragusa, L; Franzese, A; Rinaldi, MM; Spera, S; Castelli Gattinara, G; Villani, S; Iughetti, L. A survey on prader-willi syndrome in the italian population: Prevalence of historical and clinical signs. J. Pediatr. Endocrinol. Metab.: 2009; 22(10): 883-893 - Review IF 2008: 0,938 P.253. Crivellari, M; Della Valle, P; Landoni, G; Pappalardo, F; Gerli, C; Bignami, E; Marino, G; Zangrillo, A; D’Angelo, A. Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery. Intensive Care Med.: 2009; 35(11): 1959-1963 - Article IF 2008: 5,055 P.254. Crocchiolo, R; Ciceri, F; Fleischhauer, K; Oneto, R; Bruno, B; Pollichieni, S; Sacchi, N; Sormani, MP; Fanin, R; Bandini, G; Bonifazi, F; Bosi, A; Rambaldi, A; Alessandrino, PE; Falda, M; Bacigalupo, A. HLA matching affects clinical outcome of adult patients undergoing haematopoietic SCT from unrelated donors: a study from the Gruppo Italiano Trapianto di Midollo Osseo and Italian Bone Marrow Donor Registry. Bone Marrow Transplant.: 2009; 44(9): 571-577 - Article IF 2008: 3,400 P.255. Crocchiolo, R; Fallanca, F; Giovacchini, G; Ferreri, AJM; Assanelli, A; Verona, C; Pescarollo, A; Bregni, M; Ponzoni, M; Gianolli, L; Fazio, F; Ciceri, F. Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma. Ann. Hematol: 2009; 88(12): 1229-1236 - Article PUBLICATIONS - 241 IF 2008: 2,454 P.256. Crocchiolo, R; Zino, E; Vago, L; Oneto, R; Bruno, B; Pollichieni, S; Sacchi, N; Sormani, MP; Marcon, J; Lamparelli, T; Fanin, R; Garbarino, L; Miotti, V; Bandini, G; Bosi, A; Ciceri, F; Bacigalupo, A; Fleischhauer, K; for the Gruppo Italiano Trapianto di Midollo Osseo, Cellule Staminale Ematopoietiche (CSE) e Terapia Cellulare, and the Italian Bone Marrow Donor Registry. Nonpermissive HLA-DPB1 disparity is a significant independent risk factor for mortality after unrelated hematopoietic stem cell transplantation. Blood: 2009; 114(7): 1437-1444 - Article IF 2008: 10,432 P.257. Croccolo, F; Quintini, A; Barni, R; Ripamonti, M; Malgaroli, A; Riccardi, C. H-mode inductive coupling plasma for PVC surface treatment. Eur. Phys. J. D: 2009; 54(2): 477-480 - Article IF 2008: 1,397 P.258. Cunha, C; Angelucci, A; D’Antoni, A; Dobrossy, MD; Dunnett, SB; Berardi, N; Brambilla, R. Brain-derived neurotrophic factor (BDNF) overexpression in the forebrain results in learning and memory impairments. Neurobiol. Dis.: 2009; 33(3): 358-368 - Article IF 2008: 4,852 P.259. Da Pozzo, LF; Cozzarini, C; Briganti, A; Suardi, N; Salonia, A; Bertini, R; Gallina, A; Bianchi, M; Fantini, GV; Bolognesi, A; Fazio, F; Montorsi, F; Rigatti, P. Long-Term Follow-up of Patients with Prostate Cancer and Nodal Metastases Treated by Pelvic Lymphadenectomy and Radical Prostatectomy: The Positive Impact of Adjuvant Radiotherapy. Eur. Urol.: 2009; 55(5): 1003-1011 - Article IF 2008: 6,512 P.260. Dagklis, A; Fazi, C; Sala, C; Cantarelli, V; Scielzo, C; Massacane, R; Toniolo, D; Caligaris-Cappio, F; Stamatopoulos, K; Ghia, P. The immunoglobulin gene repertoire of low-count chronic lymphocytic leukemia (CLL)-like monoclonal B lymphocytosis is different from CLL: Diagnostic implications for clinical monitoring. Blood: 2009; 114(1): 26-32 - Article IF 2008: 10,432 P.261. Dagklis, A; Fazi, C; Scarfò, L; Apollonio, B; Ghia, P. Monoclonal B lymphocytosis in the general population. Leuk. Lymphoma: 2009; 50(3): 490-492 - Article IF 2008: 1,939 P.262. D’Alessandro, R; Klajn, A; Meldolesi, J. Expression of dense-core vesicles and of their exocytosis are governed by the repressive transcription factor NRSF/REST. Ann.NY Acad.Sci.: 2009; 1152(): 194-200 - Conference Paper IF 2008: 2,303 P.263. D’Alessio, S; Blasi, F. The urokinase receptor as an entertainer of signal transduction. Front. Biosci.: 2009; 14(): 45754587 - Review IF 2008: 3,308 P.264. Dall’Asta, C; Vedani, P; Manunta, P; Pizzocri, P; Marchi, M; Paganelli, M; Folli, F; Pontiroli, AE. Effect of weight loss through laparoscopic gastric banding on blood pressure, plasma renin activity and aldosterone levels in morbid obesity. Nutr. Metab. Carbiovasc. Dis.: 2009; 19(2): 110-114 - Article IF 2008: 3,565 P.265. D’Amato, A; Bachi, A; Fasoli, E; Boschetti, E; Peltre, G; Senechal, H; Righetti, PG. In-depth exploration of cow’s whey proteome via combinatorial peptide ligand libraries. J. Proteome Res.: 2009; 8(8): 3925-3936 - Article IF 2008: 5,684 P.266. D’Angelo, A; Fattorini, A; Crippa, L. Thrombotic microangiopathy in pregnancy. Thromb. Res.: 2009; 123 (Suppl 2): S56S62 - Article IF 2008: 2,449 P.267. D’Antonio, M; Feltri, ML; Wrabetz, L. Myelin under stress. J. Neurosci. Res. : 2009; 87(15): 3241-3249 - Article IF 2008: 3,086 P.268. Dati, E; Baroncelli, GI; Mora, S; Russo, G; Baldinotti, F; Parrini, D; Erba, P; Simi, P; Bertelloni, S. Body composition and metabolic profile in women with complete androgen insensitivity syndrome. Sex. Dev.: 2009; 3(4): 188-193 - Article IF 2008: 1,000 P.269. De Cobelli, F; Esposito, A; Belloni, E; Pieroni, M; Perseghin, G; Chimenti, C; Frustaci, A; Del Maschio, A. Delayed-enhanced cardiac MRI for differentiation of fabry’s disease from symmetric hypertrophic cardiomyopathy. Am. J. Roentgenol.: 2009; 192(3): W97–W102 - Article IF 2008: 2,940 P.270. De Grandi, A; Volpato, CB; Bedin, E; Pattaro, C; Marroni, F; Pichler, I; Hicks, AA; Casari, G; Pramstaller, PP. ParkScreen: A Low-Cost Rapid Linkage Marker Panel for Parkinson’s Disease. J. Mol. Neurosci.: 2009; 39(1-2): 235-241 - Article IF 2008: 2,061 P.271. De Jager, PL; Chibnik, LB; Cui, J; Reischl, J; Lehr, S; Simon, KC; Aubin, C; Bauer, D; Heubach, JF; Sandbrink, R; Tyblova, M; Lelkova, P; Steering committee of the BENEFIT study; Steering committee of the BEYOND study; Steering committee of the LTF study; Steering committee of the CCR1 study; Havrdova, E; Pohl; C; Horakova, D; Ascherio, A; Hafler, DA; Karlson, EW. Integration of genetic risk factors into a clinical algorithm for multiple sclerosis susceptibility: a weighted genetic risk score. Lancet Neurol. : 2009; 8(12): 1111-1119 - Article IF 2008: 14,270 P.272. de Jong, MC; Mayo, SC; Pulitano, C; Lanella, S; Ribero, D; Strub, J; Hubert, C; Gigot, JF; Schulick, RD; Choti, MA; Aldrighetti, L; Mentha, G; Capussotti, L; Pawlik, TM. Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multiinstitutional Analysis. J. Gastrointest. Surg.: 2009; 13(12): 21412151 - Article IF 2008: 2,311 P.273. De Jong, MC; Pulitano, C; Ribero, D; Strub, J; Mentha, G; Schulick, RD; Choti, MA; Aldrighetti, L; Capussotti, L; Pawlik, TM. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: An international multi-institutional analysis of 1669 patients. Ann. Surg.: 2009; 250(3): 440-447 - Article IF 2008: 8,460 P.274. De Nardi, P; Osman, N; Ferrari, S; Carlucci, M; Persico, P; Staudacher, C. Laparoscopic treatment of deep pelvic endometriosis with rectal involvement. Dis. Colon Rectum: 2009; 52(3): 419-424 - Article IF 2008: 2,615 P.275. De Palma, M; Naldini, L. Tie2-expressing monocytes (TEMs): Novel targets and vehicles of anticancer therapy?. Biochim. Biophys. Acta-Rev. Cancer: 2009; 1796(1): 5-10 - Review IF 2008: 10,283 P.276. De Stefano, N; Filippi, M; Confavreux, C; Vermersch, P; Simu, M; Sindic, C; Hupperts, R; Bajenaru, O; Edan, G; Grimaldi, L; Marginean, I; Medaer, R; Orefice, G; Pascu, I; Pelletier, J; Sanders, E; Scarpini, E; Mancardi, GL. The results of two multicenter, open-label studies assessing efficacy, tolerability and safety of protiramer, a high molecular weight synthetic copolymeric mixture, in patients with relapsing-remitting multiple sclerosis. Mult. Scler.: 2009; 15(2): 238-243 - Article IF 2008: 3,312 P.277. Debette, S; Metso, TM; Pezzini, A; Engelter, ST; Leys, D; Lyrer, P; Metso, AJ; Brandt, T; Kloss, M; Lichy, C; Hausser, I; Touze, E; Markus, HS; Abboud, S; Caso, V; Bersano, A; Grau, A; Altintas, A; Amouyel, P; Tatlisumak, T; Dallongeville, J; Grond-Ginsbach, C; Pandolfo, M; Thijs, V; Metso, T; Metso, A; Metso, M; Tatlisumak, T; Bodenant, M; Debette, S; Leys, D; Ossou, P; Louillet, F; Mas, JL; Touze, E; Leder, S; Leger, A; 242 - SAN RAFFAELE SCIENTIFIC INSTITUTE Deltour, S; Crozier, S; Meresse, I; Samson, Y; Canaple, S; Godefroy, O; Lamy, C; Bejot, Y; Giroud, M; Decavel, P; Medeiros, E; Montiel, P; Moulin, T; Vuillier, F; Amouyel, P; Dallongeville, J; Debette, S; Fievet, N; Bellengier, L; Deplanque, D; Libersa, C; Schilling, S; Montel, S; Remy, C; Grond-Ginsbach, C; Kloss, M; Lichy, C; Wiest, T; Werner, I; Arnold, ML; Dos Santos, M; Grau, A; Dichgans, M; Hausser, I; Brandt, T; Thomas-Feles, C; Weber, R; Del Zotto, E; Giossi, A; Padovani, A; Pezzini, A; Caso, V; Ballabio, E; Bersano, A; Beretta, S; Ferrarese, C; Sessa, M; Paolucci, S; Engelter, S; Fluri, F; Hatz, F; Gisler, D; Tiemessen, A; Lyrer, P; Markus, H; Altintas, A; Martin, JJ. CADISP-genetics: An International project searching for genetic risk factors of cervical artery dissections. Int. J. Stroke: 2009; 4(3): 224-230 - Article IF 2008: 2,000 P.278. Dehò, F; Salonia, A; Briganti, A; Zanni, G; Gallina, A; Rokkas, K; Guazzoni, G; Rigatti, P; Montorsi, F. Anatomical radical retropubic prostatectomy in patients with a Preexisting three-piece inflatable prosthesis: A series of case reports. J. Sex. Med.: 2009; 6(2): 578-583 - Article IF 2008: 5,393 P.279. Del Rio, D; Valtuena, S; Pellegrini, N; Bianchi, MA; Ardigo, D; Franzini, L; Scazzina, F; Monti, L; Zavaroni, I; Brighenti, F. Intervention study with a high or low antioxidant capacity diet: Effects on circulating Î?-carotene. Eur. J. Clin. Nutr.: 2009; 63(10): 1220-1225 - Article IF 2008: 2,686 P.280. Delaugerre, C; Flandre, P; Chaix, ML; Ghosn, J; Raffi, F; Dellamonica, P; Jaeger, H; Shurmann, D; Cohen-Codar, I; Van, PN; Norton, M; Taburet, AM; Delfraissy, JF; Rouzioux, C; MONARK Study Group. Protease inhibitor resistance analysis in the MONARK trial comparing first-line lopinavir-ritonavir monotherapy to lopinavir-ritonavir plus zidovudine and lamivudine triple therapy. Antimicrob. Agents Chemother. : 2009; 53(7): 2934-2939 - Article IF 2008: 4,716 P.281. Denard, J; Rundwasser, S; Laroudie, N; Gonnet, F; Naldini, L; Radrizzani, M; Galy, A; Merten, OW; Danos, O; Svinartchouk, F. Quantitative proteomic analysis of lentiviral vectors using 2-DE. Proteomics: 2009; 9(14): 3666-3676 - Article IF 2008: 4,586 P.282. Deponti, D; Buono, R; Catanzaro, G; De Palma, C; Longhi, R; Meneveri, R; Bresolin, N; Bassi, MT; Cossu, G; Clementi, E; Brunelli, S. The low-affinity receptor for neurotrophins p75NTR plays a key role for satellite cell function in muscle repair acting via RhoA. Mol. Biol. Cell: 2009; 20(16): 3620-3627 - Article IF 2008: 5,558 P.283. Devuyst, O; Meij, I; Jeunemaitre, X; Ronco, P; Antignac, C; Christensen, EI; Knoers, NV; Levtchenko, EN; Deen, PM; Müller, D; Wagner, CA; Rampoldi, L; van’t Hoff, WG; EUNEFRON consortium. EUNEFRON, the European Network for the Study of Orphan Nephropathies. Nephrol. Dial. Transplant.: 2009; 24(7): 2011-2015 - Article IF 2008: 3,568 P.284. Di Candia, S; Gessi, A; Pepe, G; Sogno Valin, P; Mangano, E; Chiumello, G; Gianolli, L; Proverbio, MC; Mora, S. Identification of a diffuse form of hyperinsulinemic hypoglycemia by 18fluoro-L-3,4 dihydroxyphenylalanine positron emission tomography/CT in a patient carrying a novel mutation of the HADH gene. Eur. J. Endocrinol.: 2009; 160(6): 1019-1023 - Case report IF 2008: 3,791 P.285. Di Caro, S; Franceschi, F; Mariani, A; Thompson, F; Raimondo, D; Masci, E; Testoni, A; La Rocca, E; Gasbarrini, A. Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication. Dig. Liver Dis.: 2009; 41(7): 480-485 - Article IF 2008: 2,577 P.286. Di Comite, G; Previtali, P; Rossi, CM; Dell’Antonio, G; Rovere-Querini, P; Praderio, L; Dagna, L; Corti, A; Doglioni, C; Maseri, A; Sabbadini, MG; Manfredi, AA. High blood levels of chromogranin A in giant cell arteritis identify patients refractory to corticosteroid treatment. Ann. Rheum. Dis.: 2009; 68(2): 293-295 - Letter IF 2008: 7,188 P.287. Di Comite, G; Rossi, CM; Marinosci, A; Lolmede, K; Baldissera, E; Aiello, P; Mueller, RB; Herrmann, M; Voll, RE; Rovere-Querini, P; Sabbadini, MG; Corti, A; Manfredi, AA. Circulating chromogranin a reveals extra-articular involvement in patients with rheumatoid arthritis and curbs TNF-?-elicited endothelial activation. J. Leukoc. Biol.: 2009; 85(1): 81-87 - Article IF 2008: 4,605 P.288. Di Giambenedetto, S; Zazzi, M; Corsi, P; Gonnelli, A; Di Pietro, M; Giacometti, A; Almi, P; Trezzi, M; Boeri, E; Gianotti, N; Menzo, S; Del Gobbo, R; Francisci, D; Nerli, A; Galli, L; De Luca, A. Evolution and predictors of HIV types-1 drug resistance in patients failing combinatin antiretroviral therapy in Italy. Antivir. Ther.: 2009; 14(3): 359-369 - Article IF 2008: 4,105 P.289. Di Girolamo, F; Campanella, L; Samperi, R; Bachi, A. Mass spectrometric identification of hemoglobin modifications induced by nitrosobenzene. Ecotox. Environ. Safe.: 2009; 72(5): 1601-1608 - Article IF 2008: 2,590 P.290. Di Lullo, G; Soprana, E; Panigada, M; Palini, A; Erfle, V; Staib, C; Sutter, G; Siccardi, AG. Marker gene swapping facilitates recombinant Modified Vaccinia Virus Ankara production by host-range selection. J. Virol. Methods: 2009; 156(01-02): 37-43 - Article IF 2008: 2,077 P.291. Di Muzio, N; Fiorino, C; Cozzarini, C; Alongi, F; Broggi, S; Mangili, P; Guazzoni, G; Valdagni, R; Calandrino, R; Fazio, F. Phase I-II Study of Hypofractionated Simultaneous Integrated Boost with Tomotherapy for Prostate Cancer. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 74(2): 392-398 - Article IF 2008: 4,639 P.292. Di Nunzio, S; Cecconi, M; Passerini, L; McMurchy, AN; Baron, U; Turbachova, I; Vignola, S; Valencic, E; Tommasini, A; Junker, A; Cazzola, G; Olek, S; Levings, MK; Perroni, L; Roncarolo, MG; Bacchetta, R. Wild-type FOXP3 is selectively active in CD4+CD25(hi) regulatory T cells of healthy female carriers of different FOXP3 mutations. Blood: 2009; 114(19): 41384141 - Brief Report IF 2008: 10,432 P.293. Di Paolo, D; Loi, M; Pastorino, F; Brignole, C; Marimpietri, D; Becherini, P; Caffa, I; Zorzoli, A; Longhi, R; Gagliani, C; Tacchetti, C; Corti, A; Allen, TM; Ponzoni, M; Pagnan, G. Chapter 12 Liposome-Mediated Therapy of Neuroblastoma. Methods Enzymol.: 2009; 465(C): 225-249 - Review IF 2008: 2,312 P.294. Di Stefano, B; Prigione, A; Broccoli, V. Efficient genetic reprogramming of unmodified somatic neural progenitors uncovers the essential requirement of Oct4 and Klf4. Stem Cells Dev.: 2009; 18(5): 707-715 - Article IF 2008: 3,273 P.295. Distefano, G; Boca, M; Rowe, I; Wodarczyk, C; Ma, L; Piontek, KB; Germino, GG; Pandolfi, PP; Boletta, A. Polycystin1 regulates extracellular signal-regulated kinase-dependent phosphorylation of tuberin to control cell size through mTOR and its downstream effectors S6K and 4EBP1. Mol. Cell. Biol.: 2009; 29(9): 2359-2371 - Article IF 2008: 5,942 P.296. Donati, C; Cencetti, F; De Palma, C; Rapizzi, E; Brunelli, S; Cossu, G; Clementi, E; Bruni, P. TGF? protects mesoangioblasts from apoptosis via sphingosine kinase-1 regulation. Cell. Signal.: 2009; 21(2): 228-236 - Article IF 2008: 4,305 PUBLICATIONS - 243 P.297. Donida, BM; Mrak, E; Gravaghi, C; Villa, I; Cosentino, S; Zacchi, E; Perego, S; Rubinacci, A; Fiorilli, A; Tettamanti, G; Ferraretto, A. Case in phosphopeptides promote calcium uptake and modulate the differentiation pathway in human primary osteoblast-like cells. Peptides: 2009; 30(12): 2233-2241 - Article IF 2008: 2,565 P.298. Durum, SK; Mazzucchelli, RI. Live from the Liver: Hepatocyte IL-7. Immunity: 2009; 30(3): 320-321 - Short Survey IF 2008: 20,579 P.299. Eastell, R; Black, DM; Boonen, S; Adami, S; Felsenberg, D; Lippuner, K; Cummings, SR; Delmas, PD; Palermo, L; Mesenbrink, P; Cauley, JA; HORIZON Pivotal Fracture Trial. Effect of once-yearly zoledronic acid five milligrams on fracture risk and change in femoral neck bone mineral density. J. Clin. Endocrinol. Metab.: 2009; 94(9): 3215-3225 - Article IF 2008: 6,325 P.300. Eichler, F; Grodd, W; Grant, E; Sessa, M; Biffi, A; Bley, A; Kohlschuetter, A; Loes, DJ; Kraegeloh-Mann, I. Metachromatic leukodystrophy: A scoring system for brain MR imaging observations. Am. J. Neuroradiol.: 2009; 30(10): 1893-1897 - Article IF 2008: 2,745 P.301. Elsheikh, A; Ross, S; Alhasso, D; Rama, P. Numerical study of the effect of corneal layered structure on ocular biomechanics. Curr. Eye Res.: 2009; 34(1): 26-35 - Article IF 2008: 1,519 P.302. Ensoli, B; Fiorelli, V; Ensoli, F; Lazzarin, A; Visintini, R; Narciso, P; Di Carlo, A; Tripiciano, A; Longo, O; Bellino, S; Francavilla, V; Paniccia, G; Arancio, A; Scoglio, A; Collacchi, B; Ruiz Alvarez, MJ; Tambussi, G; Tassan Din, C; Palamara, G; Latini, A; Antinori, A; D’Offizi, G; Giuliani, M; Giulianelli, M; Carta, M; Monini, P; Magnani, M; Garaci, E. The preventive phase I trial with the HIV-1 Tat-based vaccine. Vaccine: 2009; 28(2): 371-378 - Article IF 2008: 3,298 P.303. Esposito, A; De Cobelli, F; Perseghin, G; Pieroni, M; Belloni, E; Mellone, R; Canu, T; Gentinetta, F; Scifo, P; Chimenti, C; Frustaci, A; Luzi, L; Maseri, A; Del Maschio, A. Impaired left ventricular energy metabolism in patients with hypertrophic cardiomyopathy is related to the extension of fibrosis at delayed gadolinium-enhanced magnetic resonance imaging. Heart: 2009; 95(3): 228-233 - Article IF 2008: 4,964 P.304. Fallanca, F; Giovacchini, G; Picchio, M; Bettinardi, V; Messa, C; Fazio, F. Incidental detection by [11C]choline PET/CT of meningiomas in prostate cancer patients. Q. J. Nucl. Med. Mol. Imag.: 2009; 53(4): 417-421 - Article IF 2008: 2,640 P.305. Famoso, G; Ponzoni, M; Terreni, MR; Assanelli, A; Mortini, P; Doglioni, C; Ferreri, AJM. Primary intracranial meningeal marginal zone B cell lymphoma of malt type (PMML) with osseous infiltration. Ann. Hematol.: 2009; 88(6): 599-601 Letter IF 2008: 2,454 P.306. Fanos, V; Scarcella, A; Puddu, M; Gallini, F; Tuminelli, F; Bragetti, P; Gallina, MR; Quartulli, L; Benincori, N; Citro, G; Dalla Via, L; Barera, G; Di Luzio Paparatti, U; Merolla, R; Romano, GV; Guida, G; Silvestri, M; Rossi, GA. Respiratory disorders and hospitalization rates during the second RSV season in preterm infants who received palivizumab prophylaxis during their first RSV season. J. Chemother.: 2009; 21(3): 302-310 - Article IF 2008: 0,843 P.307. Fanti, L; Agostoni, M; Gemma, M; Gambino, G; Facciorusso, A; Guslandi, M; Torri, G; Testoni, PA. Remifentanil vs Meperidine for Patient-Controlled Analgesia During Colonoscopy: A Randomized Double-Blind Trial. Am. J. Gastroenterol.: 2009; 104(5): 1119-1124 - Article IF 2008: 6,444 P.308. Farinazzo, A; Restuccia, U; Bachi, A; Guerrier, L; Fortis, F; Boschetti, E; Fasoli, E; Citterio, A; Righetti, PG. Chicken egg yolk cytoplasmic proteome, mined via combinatorial peptide ligand libraries. J. Chromatogr. A: 2009; 1216(8): 1241-1252 - Article IF 2008: 3,756 P.309. Fazio, R; Malosio, ML; Lampasona, V; De Feo, D; Privitera, D; Marnetto, F; Centonze, D; Ghezzi, A; Comi, G; Furlan, R; Martino, G. Antiacquaporin 4 antibodies detection by different techniques in neuromyelitis optica patients. Mult. Scler.: 2009; 15(10): 1153-1163 - Article IF 2008: 3,312 P.310. Fedeli, M; Napolitano, A; Wong, MP; Marcais, A; de Lalla, C; Colucci, F; Merkenschlager, M; Dellabona, P; Casorati, G. Dicer-dependent microRNA pathway controls invariant NKT cell development. J. Immunol.: 2009; 183(4): 2506-2512 - Article IF 2008: 6,000 P.311. Felice, B; Cattoglio, C; Cittaro, D; Testa, A; Miccios, A; Ferrari, G; Luzi, L; Recchia, A; Mavilio, F. Transcription factor binding sites are genetic determinants of retroviral integration in the human genome. PLoS ONE: 2009; 4(2): e4571 - Article P.312. Fellay, J; Ge, D; Shianna, KV; Colombo, S; Ledergerber, B; Cirulli, ET; Urban, TJ; Zhang, K; Gumbs, CE; Smith, JP; Castagna, A; Cozzi-Lepri, A; De Luca, A; Easterbrook, P; Gunthard, HF; Mallal, S; Mussini, C; Dalmau, J; Martinez-Picado, J; Miro, JM; Obel, N; Wolinsky, SM; Martinson, JJ; Detels, R; Margolick, JB; Jacobson, LP; Descombes, P; Antonarakis, SE; Beckmann, JS; O’Brien, SJ; Letvin, NL; McMichael, AJ; Haynes, BF; Carrington, M; Feng, S; Telenti, A; Goldstein, DB; NIAID Center for HIV/AIDS Vaccine Immunology (CHAVI). Common genetic variation and the control of HIV-1 in humans. PLoS Genet.: 2009; 5(12): e1000791 - Article IF 2008: 8,883 P.313. Fellin, G; Fiorino, C; Rancati, T; Vavassori, V; Baccolini, M; Bianchi, C; Cagna, E; Gabriele, P; Mauro, F; Menegotti, L; Monti, AF; Stasi, M; Valdagni, R. Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: Results of a large multicenter observational study. Radiother. Oncol.: 2009; 93(2): 197-202 - Article IF 2008: 3,990 P.314. Fellstroem, BC; Jardine, AG; Schmieder, RE; Holdaas, H; Bannister, K; Beutler, J; Chae, DW; Chevaile, A; Cobbe, SM; Granhagen-Riska, C; De Lima, JJ; Lins,R; Mayer, G; McMahon, AW; Parving, HH; Remuzzi, G; Samuelsson, O; Sonkodi, S; Sci, D; Saleymanlar, G; Tsakiris, D; Tesar, V; Todorov, V; Wiecek, A; Wuthrich, RP; Gottlow, M; Johnsson, E; Zannad, F; AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.. N. Engl. J. Med.: 2009; 360(14): 1395-1407 - Article IF 2008: 50,017 P.315. Fenoglio, D; Poggi, A; Catellani, S; Battaglia, F; Ferrera, A; Setti, M; Murdaca, G; Zocchi, MR. Vdelta1 T lymphocytes producing IFN-gamma and IL-17 are expanded in HIV-1-infected patients and respond to Candida albicans. Blood: 2009; 113(26): 6611-6618 - Article IF 2008: 10,432 P.316. Fenyo, EM; Heath, A; Dispinseri, S; Holmes, H; Lusso, P; Zolla-Pazner, S; Donners, H; Heyndrickx, L; Alcami, J; Bongertz, V; Jassoy, C; Malnati, M; Montefiori, D; Moog, C; Morris, L; Osmanov, S; Polonis, V; Sattentau, Q; Schuitemaker, H; Sutthent, R; Wrin, T; Scarlatti, G . International network for comparison of HIV neutralization assays: The NeutNet report. PLoS ONE: 2009; 4(2): e4505 - Article P.317. Ferguson, S; Raimondi, A; Paradise, S; Shen, H; Mesaki, K; Ferguson, A; Destaing, O; Ko, G; Takasaki, J; Cremona, O; O Toole, E; De Camilli, P. Coordinated Actions of Actin and BAR Proteins Upstream of Dynamin at Endocytic Clathrin-Coated Pits. Dev. Cell: 2009; 17(6): 811-822 - Article 244 - SAN RAFFAELE SCIENTIFIC INSTITUTE IF 2008: 12,882 P.318. Fernandez, MI; Shariat, SF; Margulis, V; Bolenz, C; Montorsi, F; Suardi, N; Remzi, M; Wood, CG; Roscigno, M; Kikuchi, E; Oya, M; Zigeuner, R; Langner, C; Weizer, A; Lotan, Y; Koppie, TM; Raman, JD; Karakiewizc, P; Bensalah, K; Schultz, M; Bernier, P. Evidence-based Sex-related Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Results of Large Multicenter Study. Urology: 2009; 73(1): 142-146 - Article IF 2008: 2,242 P.319. Ferrai, C; Naum-Ongania, G; Longobardi, E; Palazzolo, M; Disanza, A; Diaz, VM; Crippa, MP; Scita, G; Blasi, F. Induction of HoxB transcription by retinoic acid requires actin polymerization. Mol. Biol. Cell: 2009; 20(15): 3543-3551 - Article IF 2008: 5,558 P.320. Ferrario, F; Barone, MT; Landoni, G; Genderini, A; Heidemperger, M; Trezzi, M; Piccaluga, E; Danna, P; Scorza, D. Acetylcysteine and non-ionic isosmolar contrast-induced nephropathy - A randomized controlled study. Nephrol. Dial. Transplant.: 2009; 24(10): 3103-3107 - Article IF 2008: 3,568 P.321. Ferreri, AJ; Reni, M; Foppoli, M; Martelli, M; Pangalis, GA; Frezzato, M; Cabras, MG; Fabbri, A; Corazzelli, G; Ilariucci, F; Rossi, G; Soffietti, R; Stelitano, C; Vallisa, D; Zaja, F; Zoppegno, L; Aondio, GM; Avvisati, G; Balzarotti, M; Brandes, AA; Fajardo, J; Gomez, H; Guarini, A; Pinotti, G; Rigacci, L; Uhlmann, C; Picozzi, P; Vezzulli, P; Ponzoni, M; Zucca, E; Caligaris-Cappio, F; Cavalli, F. High-dose cytarabine plus highdose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet: 2009; 374(9700): 1512-1520 - Article IF 2008: 28,409 P.322. Ferreri, AJM; Assanelli, A; Crocchiolo, R; Ciceri, F. Central nervous system dissemination in immunocompetent patients with aggressive lymphomas: Incidence, risk factors and therapeutic options. Hematol. Oncol.: 2009; 27(2): 61-70 - Review IF 2008: 2,333 P.323. Ferreri, AJM; Dolcetti, R; Magnino, S; Doglioni, C; Ponzoni, M. Chlamydial infection: The link with ocular adnexal lymphomas. Nat. Clin. Pract. Oncol.: 2009; 6(11): 658-669 - Review IF 2008: 9,113 P.324. Ferreri, AJM; Ernberg, I; Copie-Bergman, C. Infectious agents and lymphoma development: Molecular and clinical aspects. J. Intern. Med.: 2009; 265(4): 421-438 - Review IF 2008: 5,412 P.325. Ferri, LA; Maugeri, N; Rovere-Querini, P; Calabrese, A; Ammirati, E; Cianflone, D; Maseri, A; Manfredi, AA. Anti-inflammatory action of apoptotic cells in patients with acute coronary syndromes. Atherosclerosis: 2009; 205(2): 391-395 - Article IF 2008: 4,601 P.326. Ficarra, V; Novara, G; Artibani, W; Cestari, A; Galfano, A; Graefen, M; Guazzoni, G; Guillonneau, B; Menon, M; Montorsi, F; Patel, V; Rassweiler, J; Van Poppel, H. Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies. Eur. Urol.: 2009; 55(5): 1037-1063 - Review IF 2008: 6,512 P.327. Filippi, M; Agosta, F. Closing the clinical-imaging gap in multiple sclerosis? Imaging iron deposition in deep gray matter. J. Neuroimaging: 2009; 19(1): 1-2 - Editorial IF 2008: 1,811 P.328. Filippi, M; Agosta, F. Magnetic resonance techniques to quantify tissue damage, tissue repair, and functional cortical reorganization in multiple sclerosis. Prog. Brain Res.: 2009; 175: 465-482 - Review IF 2008: 3,253 P.329. Filippi, M; Rocca, MA. Functional MR Imaging in Multiple Sclerosis. Neuroimaging Clin. N. Am.: 2009; 19(1): 59-70 - Review IF 2008: 1,532 P.330. Fimognari, FL; Loffredo, L; Di Simone, S; Sampietro, F; Pastorelli, R; Monaldo, M; Violi, F; D’Angelo, A. Hyperhomocysteinaemia and poor vitamin B status in chronic obstructive pulmonary disease. Nutr. Metab. Carbiovasc. Dis.: 2009; 19(9): 654-659 - Article IF 2008: 3,565 P.331. Fiorino, C; Alongi, F; Perna, L; Broggi, S; Cattaneo, GM; Cozzarini, C; Di Muzio, N; Fazio, F; Calandrino, R. Dose-Volume Relationships for Acute Bowel Toxicity in Patients Treated With Pelvic Nodal Irradiation for Prostate Cancer. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 75(1): 29-35 - Article IF 2008: 4,639 P.332. Fiorino, C; Valdagni, R; Rancati, T; Sanguineti, G. Dosevolume effects for normal tissues in external radiotherapy: Pelvis. Radiother. Oncol.: 2009; 93(2): 153-167 - Review IF 2008: 3,990 P.333. Fontana, R; Bregni, M; Cipponi, A; Raccosta, L; Rainelli, C; Maggioni, D; Lunghi, F; Ciceri, F; Mukenge, S; Doglioni, C; Colau, D; Coulie, PG; Bordignon, C; Traversari, C; Russo, V. Peripheral blood lymphocytes genetically modified to express the self/tumor antigen MAGE-A3 induce antitumor immune responses in cancer patients. Blood: 2009; 113(8): 1651-1660 - Article IF 2008: 10,432 P.334. Fossati, A; Acquarini, E; Feeney, JA; Borroni, S; Grazioli, F; Giarolli, LE; Franciosi, G; Maffei, C. Alexithymia and attachment insecurities in impulsive aggression. Attach. Hum. Dev.: 2009; 11(2): 165-182 - Article IF 2008: 1,510 P.335. Fossati, A; Borroni, S; Eisenberg, N; Maffei, C. Relations of proactive and reactive dimensions of aggression to overt and covert narcissism in nonclinical adolescents. Aggressive Behav.: 2009; 35: 1-7 - Article IF 2008: 2,056 P.336. Fossati, A; Raine, A; Borroni, S; Bizzozero, A; Volpi, E; Santalucia, I; Maffei, C. A Cross-Cultural Study of the Psychometric Properties of the Reactive-Proactive Aggression Questionnaire Among Italian Nonclinical Adolescents. Psychol. Assess.: 2009; 21(1): 131-135 - Article IF 2008: 2,773 P.337. Fragasso, G; Chierchia, SL; Arioli, F; Carandente, O; Gerosa, S; Carlino, M; Palloshi, A; Gianolli, L; Calori, G; Fazio, F; Margonato, A. Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: Long-term clinical and functional prognosis. Int. J. Cardiol.: 2009; 137(2): 137-144 - Article IF 2008: 3,121 P.338. Fragasso, G; Salerno, A; Spoladore, R; Cera, M; Montanaro, C; Margonato, A. Effects of metabolic approach in diabetic patients with coronary artery disease. Curr. Pharm. Design: 2009; 15(8): 857-862 - Article IF 2008: 4,399 P.339. Fragasso, G; Sanvito, F; Baratto, F; Martinenghi, S; Doglioni, C; Margonato, A. Cardiotoxicity after low-dose chloroquine antimalarial therapy. Heart Vessels: 2009; 24(5): 385-387 Article IF 2008: 1,351 P.340. Franceschetti, M; Pievani, A; Borleri, G; Vago, L; Fleischhauer, K; Golay, J; Introna, M. Cytokine-induced killer cells are terminallydifferentiated activated CD8 cytotoxic T-EMRA lymphocytes. Exp. Hematol.: 2009; 37(5): 616-628.e2 - Article IF 2008: 3,203 P.341. Franchi, GM; Villa, VV; Carrera, P; Sartorio, SM; Maffi, P; Bosi, E; Manzoni, MF. A new mutation in the MEN1 gene. Cancer Genet. Cytogenet.: 2009; 192(2): 99-101 - Letter PUBLICATIONS - 245 IF 2008: 1,482 P.342. Franzin, A; Snider, S; Picozzi, P; Bolognesi, A; Serra, C; Vimercati, A; Passarin, O; Mortini, P. Evaluation of Different Score Index for Predicting Prognosis in Gamma Knife Radiosurgical Treatment for Brain Metastasis. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 74(3): 707-713 - Article IF 2008: 4,639 P.343. Frasson, E; Graziottin, A; Priori, A; Dall’Ora, E; Didone, G; Garbin, EL; Vicentini, S; Bertolasi, L. Central nervous system abnormalities in vaginismus. Clin. Neurophysiol.: 2009; 120(1): 117-122 - Article IF 2008: 2,972 P.344. Frige’, F; Laneri, M; Veronelli, A; Folli, F; Paganelli, M; Vedani, P; Marchi, M; Noe’, D; Ventura, P; Opocher, E; Pontiroli, AE. Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass. Nutr. Metab. Carbiovasc. Dis.: 2009; 19(3): 198-204 - Article IF 2008: 3,565 P.345. Frova, G; Sorbello, M. Algorithms for difficult airway management: A review. Minerva Anestesiol: 2009; 75(4): 201-209 Review IF 2008: 1,627 P.346. Frulloni, L; Gabbrielli, A; Pezzilli, R; Zerbi, A; Cavestro, GM; Marotta, F; Falconi, M; Gaia, E; Uomo, G; Maringhini, A; Mutignani, M; Maisonneuve, P; Di Carlo, V; Cavallini, G. Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig. Liver Dis.: 2009; 41(4): 311-317 - Article IF 2008: 2,577 P.347. Fumagalli, LL; Lazzarin, A. Influenza A (H1N1) virus infection in Intensive Care Unit: The point of view of the infectious diseases consultant. Minerva Anestesiol: 2009; 75(11): 599-601 Editorial IF 2008: 1,627 P.348. Fumagalli, S; Di Cara, A; Neb-Gulati, A; Natt, F; Schwemberger, S; Hall, J; Babcock, GF; Bernardi, R; Pandolfi, PP; Thomas, G. Absence of nucleolar disruption after impairment of 40S ribosome biogenesis reveals an rpL11-translationdependent mechanism of p53 induction. Nat. Cell Biol.: 2009; 11(4): 501508 - Article IF 2008: 17,774 P.349. Fusar-Poli, P; Placentino, A; Carletti, F; Landi, P; Allen, P; Surguladze, S; Benedetti, F; Abbamonte, M; Gasparotti, R; Barale, F; Perez, J; McGuire, P; Politi, P. Functional atlas of emotional faces processing: a voxel-based meta-analysis of 105 functional magnetic resonance imaging studies. J. Psychiatry Neurosci. : 2009; 34(6): 418-432 - Review IF 2008: 4,123 P.350. Gabriel, R; Eckenberg, R; Paruzynski, A; Bartholomae, CC; Nowrouzi, A; Arens, A; Howe, SJ; Recchia, A; Cattoglio, C; Wang, W; Faber, K; Schwarzwaelder, K; Kirsten, R; Deichmann, A; Ball, CR; Balaggan, KS; Yañez-Muñoz, RJ; Ali, RR; Gaspar, HB; Biasco, L; Aiuti, A; Cesana, D; Montini, E; Naldini, L; Cohen-Haguenauer, O; Mavilio, F; Thrasher, AJ; Glimm, H; von Kalle, C; Saurin, W; Schmidt, M. Comprehensive genomic access to vector integration in clinical gene therapy. Nat. Med.: 2009; 15(12): 1431-1436 - Article IF 2008: 27,553 P.351. Gagliani, N; Ferraro, A; Roncarolo, MG; Battaglia, M. Autoimmune diabetic patients undergoing allogeneic islet transplantation: are we ready for a regulatory T-cell therapy?. Immunol. Lett.: 2009; 127(1): 1-7 - Review IF 2008: 2,858 P.352. Gagliardi, L; Bellù, R; Zanini, R; Dammann, O; Network Neonatale Lombardo Study Group. Bronchopulmonary dysplasia and brain white matter damage in the preterm infant: a complex relationship. Paediatr Perinat Epidemiol: 2009; 23(6): 582590 - Article IF 2008: 3,172 P.353. Galbiati, F; Givogri, MI; Cantuti, L; Lopez Rosas, A; Cao, H; van Breemen, R; Bongarzone, ER. Combined hematopoietic and lentiviral gene-transfer therapies in newborn twitcher mice reveal contemporaneous neurodegeneration and demyelination in Krabbe disease. J. Neurosci. Res.: 2009; 87(8): 1748-1759 - Article IF 2008: 3,086 P.354. Galimberti, D; Venturelli, E; Villa, C; Fenoglio, C; Clerici, F; Marcone, A; Benussi, L; Cortini, F; Scalabrini, D; Perini, L; Restelli, I; Binetti, G; Cappa, S; Mariani, C; Bresolin, N; Scarpini, E. MCP-1 A-2518G polymorphism: effect on susceptibility for frontotemporal lobar degeneration and on cerebrospinal fluid MCP-1 levels. J. Alzheimers Dis.: 2009; 17(1): 125-133 - Article IF 2008: 5,101 P.355. Gallina, A; Salonia, A; Briganti, A; Suardi, N; Dehò, F; Zanni, G; Sacca, A; Abdollah, F; Cestari, A; Guazzoni, G; Rigatti, P; Montorsi, F. Prevention and Management of Postprostatectomy Erectile Dysfunction. Eur. Urol. Suppl.: 2009; 8(2): 80-87 - Review IF 2008: 1,711 P.356. Garavaglia, E; Gentile, C; Cavoretto, P; Spagnolo, D; Valsecchi, L; Mangili, G. Ultrasound imaging after evacuation as an adjunct to ?-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia. Am. J. Obstet. Gynecol.: 2009; 200(4): 417.e1-5 - Article IF 2008: 3,453 P.357. Gaspar, HB; Aiuti, A; Porta, F; Candotti, F; Hershfield, MS; Notarangelo, LD. How I treat ADA deficiency. Blood: 2009; 114(17): 3524-3532 - Review IF 2008: 10,432 P.358. Gastaldelli, A; Perego, L; Paganelli, M; Sesti, G; Hribal, M; Chavez, AO; DeFronzo, RA; Pontiroli, A; Folli, F. Elevated concentrations of liver enzymes and ferritin identify a new phenotype of insulin resistance: Effect of weight loss after gastric banding. Obes. Surg.: 2009; 19(1): 80-86 - Article IF 2008: 2,913 P.359. Gemma, M; De Vitis, A; Baldoli, C; Calvi, MR; Blasi, V; Scola, E; Nobile, L; Iadanza, A; Scotti, G; Beretta, L. Functional magnetic resonance imaging (fMRI) in children sedated with propofol or midazolam. J. Neurosurg. Anesthesiol.: 2009; 21(3): 253-258 - Article IF 2008: 2,329 P.360. Gemma, M; Piccioni, LO; Gioia, L; Beretta, L; Bussi, M. Ropivacaine peritonsillar infiltration for analgesia after adenotonsillectomy in children: A randomized, double-blind, placebocontrolled Study. Ann. Otol. Rhinol. Laryngol.: 2009; 118(3): 227-231 - Article IF 2008: 1,339 P.361. Gentner, B; Schira, G; Giustacchini, A; Amendola, M; Brown, BD; Ponzoni, M; Naldini, L. Stable knockdown of microRNA in vivo by lentiviral vectors. Nat. Methods: 2009; 6(1): 63-66 - Article IF 2008: 13,651 P.362. Gentner, B; Wein, A; Croner, RS; Zeittraeger, I; Wirtz, RM; Roedel, F; Dimmler, A; Dorlaque, L; Hohenberger, W; Hahn, EG; Brueckl, WM. Differences In the Gene Expression Profile of Matrix Metalloproteinases (MMPs) and their inhibitors (TIMPs) in primary colorectal tumors and their synchronous liver metastases. Anticancer Res.: 2009; 29(1): 67-74 - Article IF 2008: 1,390 P.363. Gerber, RT; Latib, A; Ielasi, A; Cosgrave, J; Qasim, A; Airoldi, F; Chieffo, A; Montorfano, M; Carlino, M; Michev, I; Tobis, J; Colombo, A. Defining a new standard for IVUS optimized drug eluting stent implantation: The PRAVIO study. Catheter. Cardiovasc. Interv.: 2009; 74(2): 348-356 - Article IF 2008: 2,248 P.364. Gerola, S; Battistini, S; Stenirri, S; Nicolodi, M; Arnetoli, 246 - SAN RAFFAELE SCIENTIFIC INSTITUTE G; Canova, S; Binelli, G; Bernardi, A; Balan, S; Ferrari, M; Carrera, P. CACNA1A gene non-synonymous single nucleotide polymorphisms and common migraine in Italy: a case-control association study with a micro-array technology. Clin. Chem. Lab. Med.: 2009; 47(6): 783-785 - Letter IF 2008: 1,888 P.365. Ghezzi, A; Amato, MP; Annovazzi, P; Capobianco, M; Gallo, P; La Mantia, L; Marrosu, MG; Martinelli, V; Milani, N; Moiola, L; Patti, F; Pozzilli, C; Trojano, M; Zaffaroni, M; Comi, G; ITEMS (Immunomodulatory Treatment of Early-onset MS) Group. Long-term results of immunomodulatory treatment in children and adolescents with multiple sclerosis: the Italian experience. Neurol. Sci.: 2009; 30(3): 193-199 - Article IF 2008: 1,435 P.366. Giorgi, C; De Stefani, D; Bononi, A; Rizzuto, R; Pinton, P. Structural and functional link between the mitochondrial network and the endoplasmic reticulum. Int. J. Biochem. Cell Biol.: 2009; 41(10): 1817-1827 - Review IF 2008: 4,178 P.367. Giovacchini, G; Fallanca, F; Landoni, C; Gianolli, L; Picozzi, P; Attuati, L; Terreni, M; Picchio, M; Messa, C; Fazio, F. C-11 choline versus F-18 fluorodeoxyglucose for imaging meningiomas: an initial experience. Clin. Nucl. Med.: 2009; 34(1): 710 - Article IF 2008: 3,181 P.368. Giovacchini, G; Picchio, M; Schipani, S; Landoni, C; Gianolli, L; Bettinardi, V; Di Muzio, N; Gilardi, MC; Fazio, F; Messa, C. Changes in glucose metabolism during and after radiotherapy in non-small cell lung cancer. Tumori: 2009; 95(2): 177184 - Article IF 2008: 0,791 P.369. Godino, C; Sharp, ASP; Carlino, M; Colombo, A. Crossing CTOs - The tips, tricks, and specialist kit that can mean the difference between success and failure. Catheter. Cardiovasc. Interventions: 2009; 74(7): 1019-1046 - Review IF 2008: 2,248 P.370. Gonzalez Galvez, B; Covarello, D; Tonlorenzi, R; Brunelli, S; Dellavalle, A; Crippa, S; Mohammed, SAA; Scialla, L; Cuccovillo, I; Molla, F; Staszewsky, L; Maisano, F; Sampaolesi, M; Latini, R; Cossu, G. Human cardiac mesoangioblasts isolated from hypertrophic cardiomyopathies are greatly reduced in proliferation and differentiation potency. Cardiovasc. Res.: 2009; 83(4): 707-716 - Article IF 2008: 5,947 P.371. Gow, A; Wrabetz, L. CHOP and the endoplasmic reticulum stress response in myelinating glia. Curr. Opin. Neurobiol. : 2009; 19(5): 505-510 - Article IF 2008: 8,102 P.372. Graziottin, A; Koochaki, PE; Rodenberg, CA; Dennerstein, L. The prevalence of hypoactive sexual desire disorder in surgically menopausal women: An epidemiological study of women in four European countries. J. Sex. Med.: 2009; 6(8): 2143-2153 - Article IF 2008: 5,393 P.373. Graziottin, A; Serafini, A. HPV infection in women: Psychosexual impact of genital warts and intraepithelial lesions. J. Sex. Med.: 2009; 6(3): 633-645 - Review IF 2008: 5,393 P.374. Graziottin, A; Serafini, A; Palacios, S. Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction. Maturitas: 2009; 63(2): 128-134 - Review IF 2008: 2,032 P.375. Gregorc, V; Santoro, A; Bennicelli, E; Punt, CJA; Citterio, G; Timmer-Bonte, JNH; Caligaris-Cappio, F; Lambiase, A; Bordignon, C; Van Herpen, CML. Phase Ib study of NGR-hTNF, a selective vascular targeting agent, administered at low doses in combination with doxorubicin to patients with advanced solid tumours. Br. J. Cancer: 2009; 101(2): 219-224 - Article IF 2008: 4,846 P.376. Gregori, S; Magnani, CF; Roncarolo, MG. Role of human leukocyte antigen-G in the induction of adaptive type 1 regulatory T cells. Hum. Immunol.: 2009; 70(12): 966-969 - Article IF 2008: 3,061 P.377. Gritti, A; Molin, MD; Foroni, C; Bonfanti, L. Effects of developmental age, brain region, and time in culture on long-term proliferation and multipotency of neural stem cell populations. J. Comp. Neurol.: 2009; 517(3): 333-349 - Article IF 2008: 3,743 P.378. Guardado-Mendoza, R; Davalli, AM; Chavez, AO; Hubbard, GB; Dick, EJ; Majluf-Cruz, A; Tene-Perez, CE; Goldschmidt, L; Hart, J; Perego, C; Comuzzie, AG; Tejero, ME; Finzi, G; Placidi, C; La Rosa, S; Capella, C; Halff, G; Gastaldelli, A; DeFronzo, RA; Folli, F. Pancreatic islet amyloidosis, ?-cell apoptosis, and ?-cell proliferation are determinants of islet remodeling in type-2 diabetic baboons. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(33): 13992-13997 - Article IF 2008: 9,380 P.379. Guerini, FR; Calabrese, E; Agliardi, C; Zanzottera, M; Franceschi, M; Grimaldi, LME; Nemni, R; Ferrante, P. Association study of the HLA-A2 allele in Italian Alzheimer disease patients. Neurobiol. Aging: 2009; 30(12): 2082-2083 - Article IF 2008: 5,959 P.380. Gupta, A; Lotan, Y; Ashfaq, R; Roehrborn, CG; Raj, GV; Aragaki, CC; Montorsi, F; Shariat, SF. Predictive Value of the Differential Expression of the Urokinase Plasminogen Activation Axis in Radical Prostatectomy Patients. Eur. Urol.: 2009; 55(5): 1124-1134 - Article IF 2008: 6,512 P.381. Gusmini, S; Nicoletti, R; Martinenghi, C; Del Maschio, A. Vascular involvement in periampullary tumors: MDCT, EUS, and CDU. Abdom. Imaging: 2009; 34(4): 514-522 - Article IF 2008: 1,485 P.382. Hadzidimitriou, A; Darzentas, N; Murray, F; Smilevska, T; Arvaniti, E; Tresoldi, C; Tsaftaris, A; Laoutaris, N; Anagnostopoulos, A; Davi, F; Ghia, P; Rosenquist, R; Stamatopoulos, K; Belessi, C. Evidence for the significant role of immunoglobulin light chains in antigen recognition and selection in chronic lymphocytic leukemia. Blood: 2009; 113(2): 403-411 - Article IF 2008: 10,432 P.383. Hancock, BW; Qian, W; Linch, D; Delchier, JC; Smith, P; Jakupovic, I; Burton, C; Souhami, R; Wotherspoon, A; CopieBergman, C; Capella, C; Traulle, C; Levy, M; Cortelazzo, S; Ferreri, AJM; Ambrosetti, A; Pinotti, G; Martinelli, G; Vitolo, U; Cavalli, F; Gisselbrecht, C; Zucca, E. Chlorambucil versus observation after anti-Helicobacter therapy in gastric MALT lymphomas: Results of the international randomised LY03 trial. Br. J. Haematol.: 2009; 144(3): 367-375 - Article IF 2008: 4,478 P.384. Hanke, T; Misfeld, M; Heringlake, M; Schreuder, JJ; Wiegand, UKH; Eberhardt, F. The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function: A pressure-volume loop analysis. J. Thorac. Cardiovasc. Surg.: 2009; 138(1): 148156 - Article IF 2008: 3,037 P.385. Harvey, PD; Cavallaro, R. Meeting report: The Emory University-San Raffaele cognition satellite meeting. Schizophr. Res.: 2009; 113(2-3): 347-350 - Article IF 2008: 4,174 P.386. Hatzimouratidis, K; Burnett, AL; Hatzichristou, D; McCullough, AR; Montorsi, F; Mulhall, JP. Phosphodiesterase Type 5 Inhibitors in Postprostatectomy Erectile Dysfunction: A Critical Analysis of the Basic Science Rationale and Clinical Application. Eur. Urol.: 2009; 55(2): 334-347 - Review IF 2008: 6,512 P.387. Healy, B; Valsasina, P; Filippi, M; Bakshi, R. Sample size re- PUBLICATIONS - 247 quirements for treatment effects using gray matter, white matter and whole brain volume in relapsing-remitting multiple sclerosis. J. Neurol. Neurosurg. Psychiatry: 2009; 80(11): 1218-1223 - Article IF 2008: 4,622 P.388. Hellenthal, NJ; Shariat, SF; Margulis, V; Karakiewicz, PI; Roscigno, M; Bolenz, C; Remzi, M; Weizer, A; Zigeuner, R; Bensalah, K; Ng, CK; Raman, JD; Kikuchi, E; Montorsi, F; Oya, M; Wood, CG; Fernandez, M; Evans, CP; Koppie, TM. Adjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma: Results From the Upper Tract Urothelial Carcinoma Collaboration. J. Urol.: 2009; 182(3): 900-906 - Article IF 2008: 3,952 P.389. Iero, M; Filipazzi, P; Castelli, C; Belli, F; Valdagni, R; Parmiani, G; Patuzzo, R; Santinami, M; Rivoltini, L. Modified peptides in anti-cancer vaccines: are we eventually improving anti-tumour immunity?. Cancer Immunol. Immunother.: 2009; 58(7): 1159-1167 - Conference Paper IF 2008: 3,804 P.390. Indraccolo, S; Minuzzo, S; Masiero, M; Pusceddu, I; Persano, L; Moserle, L; Reboldi, A; Favaro, E; Mecarozzi, M; Di Mario, G; Screpanti, I; Ponzoni, M; Doglioni, C; Amadori, A. Cross-talk between tumor and endothelial cells involving the Notch3-DII4 interaction marks escape from tumor dormancy. Cancer Res.: 2009; 69(4): 1314-1323 - Article IF 2008: 7,514 P.391. Infusino, F; Lanza, GA; Sestito, A; Sgueglia, GA; Crea, F; Maseri, A. Combination of variant and microvascular angina. Clin. Cardiol.: 2009; 32(8): E40-E45 - Article IF 2008: 1,211 P.392. Innamorati, G; Giannone, F; Guzzi, F; Rovati, GE; Accomazzo, MR; Chini, B; Bianchi, E; Schiaffino, MV; Tridente, G; Parenti, M. Heterotrimeric G proteins demonstrate differential sensitivity to ?-arrestin dependent desensitization. Cell. Signal.: 2009; 21(7): 1135-1142 - Article IF 2008: 4,305 P.393. Isbarn, H; Boccon-Gibod, L; Carroll, PR; Montorsi, F; Schulman, C; Smith, MR; Sternberg, CN; Studer, UE. Androgen Deprivation Therapy for the Treatment of Prostate Cancer: Consider Both Benefits and Risks. Eur. Urol.: 2009; 55(1): 62-75 - Review IF 2008: 6,512 P.394. Isbarn, H; Jeldres, C; Budaus, L; Salomon, G; Schlomm, T; Steuber, T; Chun, FKH; Ahyai, S; Capitanio, U; Haese, A; Heinzer, H; Huland, H; Graefen, M; Karakiewicz, P. Effect of Body Mass Index on Histopathologic Parameters: Results of Large European Contemporary Consecutive Open Radical Prostatectomy Series. Urology: 2009; 73(3): 615-619 - Article IF 2008: 2,242 P.395. Isbarn, H; Jeldres, C; Capitanio, U; Zini, L; Shariat, SF; Lughezzani, G; Sun, M; Ahyai, SA; Duclos, A; Jolivet-Tremblay, M; Lattouf, JB; Valiquette, L; Perrotte, P; Montorsi, F; Graefen, M; Karakiewicz, PI. Thirty-day mortality after transurethral resection of the prostate in patients treated with androgen deprivation therapy. J. Endourol.: 2009; 23(8): 13471352 - Article IF 2008: 1,930 P.396. Isbarn, H; Jeldres, C; Zini, L; Perrotte, P; BaillargeonGagne, S; Capitanio, U; Shariat, SF; Arjane, P; Saad, F; McCormack, M; Valiquette, L; Peloquin, F; Duclos, A; Montorsi, F; Graefen, M; Karakiewicz, PI. A Population Based Assessment of Perioperative Mortality After Cystectomy for Bladder Cancer. J. Urol.: 2009; 182(1): 70-77 - Article IF 2008: 3,952 P.397. Isbarn, H; Pinthus, JH; Marks, LS; Montorsi, F; Morales, A; Morgentaler, A; Schulman, C. Testosterone and Prostate Cancer: Revisiting Old Paradigms. Eur. Urol.: 2009; 56(1): 48-56 Review IF 2008: 6,512 P.398. Ito, K; Bernardi, R; Pandolfi, PP. A novel signaling network as a critical rheostat for the biology and maintenance of the normal stem cell and the cancer-initiating cell. Curr. Opin. Genet. Dev.: 2009; 19(1): 51-59 - Review IF 2008: 9,677 P.399. Jeldres, C; Baillargeon-Gagne, S; Liberman, D; Isbarn, H; Capitanio, U; Shariat, SF; Sun, M; Lughezzani, G; Perrotte, P; Montorsi, F; Graefen, M; Karakiewicz, PI. A Population-based Analysis of the Rate of Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma in the United States. Urology: 2009; 74(4): 837-841 - Article IF 2008: 2,242 P.400. Jeldres, C; Isbarn, H; Capitanio, U; Zini, L; Bhojani, N; Shariat, SF; Cloutier, V; Lattouf, JB; Duclos, A; Jolivet-Tremblay, M; Valiquette, L; Saad, F; Graefen, M; Montorsi, F; Perrotte, P; Karakiewicz, PI. Development and External Validation of a Highly Accurate Nomogram for the Prediction of Perioperative Mortality After Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia. J. Urol.: 2009; 182(2): 626-632 Article IF 2008: 3,952 P.401. Jonikaitis, D; Deubel, H; de’Sperati, C. Time gaps in mental imagery introduced by competing saccadic tasks. Vis. Res.: 2009; 49(17): 2164-2175 - Article IF 2008: 2,051 P.402. Kahlberg, A; Marrocco-Trischitta, MM; Marone, EM; Amato, ACM; Melissano, G; Chiesa, R. An unusual case of dysphagia after endovascular exclusion of thoracoabdominal aortic aneurysm. J. Endovasc. Ther.: 2009; 16(2): 238-242 - Article IF 2008: 2,682 P.403. Kandzari, DE; Colombo, A; Park, SJ; Tommaso, CL; Ellis, SG; Guzman, LA; Teirstein, PS; Tamburino, C; Ormiston, J; Stone, GW; Dangas, GD; Popma, JJ; Bass, TA. Revascularization for Unprotected Left Main Disease Evolution of the Evidence Basis to Redefine Treatment Standards. J. Am. Coll. Cardiol.: 2009; 54(17): 1576-1588 - Review IF 2008: 11,438 P.404. Kaneko, S; Mastaglio, S; Bondanza, A; Ponzoni, M; Sanvito, F; Aldrighetti, L; Radrizzani, M; La Seta-Catamancio, S; Provasi, E; Mondino, A; Nagasawa, T; Fleischhauer, K; Russo, V; Traversari, C; Ciceri, F; Bordignon, C; Bonini, C. IL-7 and IL-15 allow the generation of suicide gene-modified alloreactive self-renewing central memory human T lymphocytes. Blood: 2009; 113(5): 1006-1015 - Article IF 2008: 10,432 P.405. Kappos, L; Freedman, MS; Polman, CH; Edan, G; Hartung, HP; Miller, DH; Montalbán, X; Barkhof, F; Radu, EW; Metzig, C; Bauer, L; Lanius, V; Sandbrink, R; Pohl, C; BENEFIT Study Group. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol.: 2009; 8(11): 987-997 - Article IF 2008: 14,270 P.406. Kaput, J; Cotton, RGH; Hardman, L; Watson, M; Aqeel, AIA; Al-Aama, JY; Al-Mulla, F; Alonso, S; Aretz, S; Auerbach, AD; Bapat, B; Bernstein, IT; Bhak, J; Bleoo, SL; Blocer, H; Brenner, SE; Burn, J; Bustamante, M; Calzone, R; CambonThomsen, A; Cargill, M; Carrera, P; Cavedon, L; Cho, YS; Chung, YJ; Claustres, M; Cutting, G; Dalgleish, R; Dunnen, JTD; Diaz, C; Dobrowolski, S; Santos, MRND; Ekong, R; Flanagan, SB; Flicek, P; Furukawa, Y; Genuardi, M; Ghang, H; Golubenko, MV; Greenblatt, MS; Hamosh, A; Hancock, JM; Hardison, R; Harrison, TM; Hoffmann, R; Horaitis, R; Howard, HJ; Barash, CI; Izagirre, N; Jung, J; Kojima, T; Laradi, S; Lee, YS; Lee, JY; Gil-da-Silva-Lopes, VL; Macrae, FA; Maglott, D; Marafie, MJ; Marsh, SGE; Matsubara, Y; Messiaen, LM; Moslein, G; Netea, MG; Norton, ML; Oefner, PJ; Oetting, 248 - SAN RAFFAELE SCIENTIFIC INSTITUTE WS; O’Leary, JC; De Ramirez, AMO; Paalman, MH; Parboosingh, J; Patrinos, GP; Perozzi, G;, RPhillips I; Povey, S; Prasad, S; Qi, M; Quin, DJ; Ramesar, RS; Richards, CS; Savige, J; Scheible, DG; Scott, RJ; Seminara, D; Shephard, EA; Sijmons, RH; Smith, TD; Sobrido, MJ; Tanaka, T; Tavtigian, SV; Taylor, GR; Teague, J; Topel, T; Ullman-Cullere, M; Utsunomiya, J; Van Kranen, HJ; Vihinen, M; Webb, E; Weber, TK; Yeager, M; Yeom, YI; Yim, SH; Yoo, HS. Planning the human variome project: The Spain report. Hum. Mutat.: 2009; 30(4): 496-510 Review IF 2008: 7,033 P.407. Karakiewicz, PI; Suardi, N; Capitanio, U; Isbarn, H; Jeldres, C; Perrotte, P; Sun, M; Ficarra, V; Zigeuner, R; Tostain, J; Mejean, A; Cindolo, L; Pantuck, AJ; Belldegrun, AS; Zini, L, de la Taille, A; Chautard, D; Descotes, JL; Shariat, SF; Valeri, A; Mulders, PF; Lang, H; Lechevallier, E; Patard, JJ. Conditional survival predictions after nephrectomy for renal cell carcinoma. J. Urol.: 2009; 182(6): 2607-2612 - Article IF 2008: 3,952 P.408. Karakiewicz, PI; Suardi, N; Capitanio, U; Jeldres, C; Ficarra, V; Cindolo, L; de la Taille, A; Tostain, J; Mulders, PFA; Bensalah, K; Artibani, W; Salomon, L; Zigeuner, R; Valeri, A; Descotes, JL; Rambeaud, JJ; Mejean, A; Montorsi, F; Bertini, R; Patard, JJ. A Preoperative Prognostic Model for Patients Treated with Nephrectomy for Renal Cell Carcinoma. Eur. Urol.: 2009; 55(2): 287-295 - Article IF 2008: 6,512 P.409. Karl, A; Carroll, PR; Gschwend, JE; Knuchel, R; Montorsi, F; Stief, CG; Studer, UE. The Impact of Lymphadenectomy and Lymph Node Metastasis on the Outcomes of Radical Cystectomy for Bladder Cancer. Eur. Urol.: 2009; 55(4): 826-835 - Review IF 2008: 6,512 P.410. Kathiresan, S; Voight, BF; Purcell, S; Musunuru, K; Ardissino, D; Mannucci, PM; Anand, S; Engert, JC; Samani, NJ; Schunkert, H; Erdmann, J; Reilly, MP; Rader, DJ; Morgan, T; Spertus, JA; Stoll, M; Girelli, D; McKeown, PP; Patterson, CC; Siscovick, DS; O’Donnell, CJ; Elosua, R; Peltonen, L; Salomaa, V; Schwartz, SM; Melander, O; Altshuler, D; Ardissino, D; Merlini, PA; Berzuini, C; Bernardinelli, L; Peyvandi, F; Tubaro, M; Celli, P; Ferrario, M; Fetiveau, R; Marziliano, N; Casari, G; Galli, M; Ribichini, F; Rossi, M; Bernardi, F; Zonzin, P; Piazza, A; Mannucci, PM; Schwartz, SM; Siscovick, DS; Yee, J; Friedlander, Y; Elosua, R; Marrugat, J; Lucas, G; Subirana, I; Sala, J; Ramos, R; Kathiresan, S; Meigs, JB; Williams, G; Nathan, DM; MacRae, CA; O’Donnell, CJ; Salomaa, V; Havulinna, AS; Peltonen, L; Melander, O; Berglund, G; Voight, BF; Kathiresan, S; Hirschhorn, JN; Asselta, R; Duga, S; Spreafico, M; Musunuru, K; Daly, MJ; Purcell, S; Voight, BF; Purcell, S; Nemesh, J; Korn, JM; McCarroll, SA; Schwartz, SM; Yee, J; Kathiresan, S; Lucas, G; Subirana, I; Elosua, R; Surti, A; Guiducci, C; Gianniny, L; Mirel, D; Parkin, M; Burtt, N; Gabriel, SB; Samani, NJ; Thompson, JR; Braund, PS; Wright, BJ; Balmforth, AJ; Ball, SG; Hall, AS; Schunkert, H; Erdmann, J; Linsel-Nitschke, P; Lieb, W; Ziegler, A; Konig, IR; Hengstenberg, C; Fischer, M; Stark, K; Grosshennig, A; Preuss, M; Wichmann, HE; Schreiber, S; Schunkert, H; Samani, NJ; Erdmann, J; Ouwehand, W; Hengstenberg, C; Deloukas, P; Scholz, M; Cambien, F; Reilly, MP; Li, M; Chen, Z; Wilensky, R; Matthai, W; Qasim, A; Hakonarson, HH; Devaney, J; Burnett, MS; Pichard, AD; Kent, KM; Satler, L; Lindsay, JM; Waksman, R; Epstein, SE; Rader, DJ; Scheffold, T; Berger, K; Stoll, M; Huge, A; Girelli, D; Martinelli, N; Olivieri, O; Corrocher, R; Morgan, T; Spertus, JA; McKeown, PP; Patterson, CC; Schunkert, H; Erdmann, J; Linsel-Nitschke, P; Lieb, W; Ziegler, A; Konig, IR; Hengstenberg, C; Fischer, M; Stark, K; Grosshennig, A; Preuss, M; Wichmann, HE; Schreiber, S; Holm, H; Thorleifsson, G; Thorsteinsdottir, U; Stefansson, K; Engert, JC; Do, R; Xie, C; Anand, S; Kathiresan, S; Ardissino, D; Mannucci, PM; Siscov- ick, D; O’Donnell, CJ; Samani, NJ; Melander, O; Elosua, R; Peltonen, L; Salomaa, V; Schwartz, SM; Altshuler, D; Myocardial Infarction Genetics Consortium. Genome-wide association of early-onset myocardial infarction with single nucleotide polymorphisms and copy number variants. Nature Genetics: 2009; 41(3): 334-341 - Article IF 2008: 30,259 P.411. Katlama, C; Haubrich, R; Lalezari, J; Lazzarin, A; Madruga, JV; Molina, JM; Schechter, M; Peeters, M; Picchio, G; Vingerhoets, J; Woodfall, B; De Smedt, G; DUET-1 DUET-2 study groups. Efficacy and safety of etravirine in treatment-experienced, HIV-1 patients: pooled 48 week analysis of two randomized, controlled trials. Aids: 2009; 23(17): 2289-2300 - Article IF 2008: 5,460 P.412. Kato, M; Zanardi, R; Rossini, D; De Ronchi, D; Okugawa, G; Kinoshita, T; Colombo, C; Serretti, A. 5-HT2A gene variants influence specific and different aspects of antidepressant response in Japanese and Italian mood disorder patients. Psychiatry Res.: 2009; 167(1-2): 97-105 - Article IF 2008: 2,666 P.413. Kesselring, AM; Wit, FW; Sabin, CA; Lundgren, JD; Gill, MJ; Gatell, JM; Rauch, A; Montaner, JS; de Wolf, F; Reiss, P; Mocroft, A; Nevirapine Toxicity Multicohort Collaboration. Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy. Aids: 2009; 23(13): 1689-1699 - Article IF 2008: 5,460 P.414. Klajn, A; Ferrai, C; Stucchi, L; Prada, I; Podini, P; Baba, T; Rocchi, M; Meldolesi, J; D’Alessandro, R. The rest repression of the neurosecretory phenotype is negatively modulated by BHC80, a protein of the BRAF/HDAC complex. J. Neurosci.: 2009; 29(19): 6296-6307 - Article IF 2008: 7,452 P.415. Korteweg, T; Rovaris, M; Neacsu, V; Filippi, M; Comi, G; Uitdehaag, BM; Knol, DL; Polman, CH; Barkhof, F; Vrenken, H; Polman, C; Montalban, X; Rovira, A; Miller, D; Thompson, A; Yousry, T; Fazekas, F; Frederiksen, J; Kappos, L; Palace, J; de Stefano, N. Can rate of brain atrophy in multiple sclerosis be explained by clinical and MRI characteristics?. Mult. Scler.: 2009; 15(4): 465-471 - Article IF 2008: 3,312 P.416. Korteweg, T; Tintore, M; Uitdehaag, BMJ; Knol, DL; Vrenken, H; Rovira, A; Frederiksen, J; Miller, DH; Fernando, K; Filippi, M; Agosta, F; Rocca, MA; Fazekas, F; Enzinger, C; Parry, A; Polman, CH; Montalban, X; Barkhof, F. A search for new MRI criteria for dissemination in space in subjects with a clinically isolated syndrome. Eur. Radiol.: 2009; 19(9): 22442248 - Article IF 2008: 3,651 P.417. Krug, I; Treasure, J; Anderluh, M; Bellodi, L; Cellini, E; Collier, D; di Bernardo, M; Granero, R; Karwautz, A; Nacmias, B; Penelo, E; Ricca, V; Sorbi, S; Tchanturia, K; Wagner, G; Fernandez-Aranda, F. Associations of individual and family eating patterns during childhood and early adolescence: A multicentre European study of associated eating disorder factors. Br. J. Nutr.: 2009; 101(6): 909-918 - Article IF 2008: 2,764 P.418. Kukreja, N; Serruys, PW; De Bruyne, B; Colombo, A; Macaya, C; Richardt, G; Fajadet, J; Hamm, C; Goedhart, D; Macours, N; Stoll, HP. Sirolimus-eluting stents, bare metal stents or coronary artery bypass grafting for patients with multivessel disease including involvement of the proximal left anterior descending artery: Analysis of the Arterial Revascularization Therapies study part 2 (. Heart: 2009; 95(13): 1061-1066 - Article IF 2008: 4,964 P.419. Kuznetsova, T; Manunta, P; Casamassima, N; Messaggio, E; Jin, Y; Thijs, L; Richart, T; Fagard, RH; Bianchi, G; Staessen, PUBLICATIONS - 249 JA. Left ventricular geometry and endogenous ouabain in a Flemish population. J. Hypertens.: 2009; 27(9): 1884-1891 - Article IF 2008: 5,132 P.420. La Canna, G; Maisano, F; De Michele, L; Grimaldi, A; Grassi, F; Capritti, E; De Bonis, M; Alfieri, O. Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm Transoesophageal doppler echocardiography study. Heart: 2009; 95(2): 130-136 - Article IF 2008: 4,964 P.421. La Colla, L; Albertin, A; La Colla, G. Pharmacokinetic model-driven remifentanil administration in the morbidly obese: The ‘critical weight’ and the ‘fictitious height’, a possible solution to an unsolved problem?. Clin. Pharmacokinet.: 2009; 48(6): 397-398 - Note IF 2008: 4,206 P.422. La Colla, L; Albertin, A; La Colla, G; Ceriani, V; Lodi, T; Porta, A; Aldegheri, G; Mangano, A; Khairallah, I; Fermo, I. No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. Eur. J. Anaesth.: 2009; 26(5): 362-369 - Article IF 2008: 1,550 P.423. La Rosa, S; Klersy, C; Uccella, S; Dainese, L; Albarello, L; Sonzogni, A; Doglioni, C; Capella, C; Solcia, E. Improved histologic and clinicopathologic criteria for prognostic evaluation of pancreatic endocrine tumors. Hum. Pathol.: 2009; 40(1): 30-40 Article IF 2008: 3,322 P.424. Lagha, M; Brunelli, S; Messina, G; Cumano, A; Kume, T; Relaix, F; Buckingham, ME. Pax3:Foxc2 Reciprocal Repression in the Somite Modulates Muscular versus Vascular Cell Fate Choice in Multipotent Progenitors. Dev. Cell: 2009; 17(6): 892899 - Article IF 2008: 12,882 P.425. Lambiase, A; Micera, A; Pellegrini, G; Merlo, D; Rama, P; De Luca, M; Bonini, S; Bonini, S. In vitro evidence of nerve growth factor effects on human conjunctival epithelial cell differentiation and mucin gene expression. Invest. Ophthalmol. Vis. Sci.: 2009; 50(10): 4622 - 4630 - Article IF 2008: 3,582 P.426. Landgren, O; Albitar, M; Ma, W; Abbasi, F; Hayes, RB; Ghia, P; Marti, GE; Caporaso, NE. B-cell clones as early markers for chronic lymphocytic leukemia. N. Engl. J. Med.: 2009; 360(7): 659-667 - Article IF 2008: 50,017 P.427. Landoni, G; Fochi, O; Tritapepe, L; Guarracino, F; Belloni, I; Bignami, E; Zangrillo, A. Cardiac protection by volatile anesthetics. A review. Minerva Anestesiol.: 2009; 75(5): 269-273 - Article IF 2008: 1,627 P.428. Landoni, G; Zambon, M; Zangrillo, A. Reducing perioperative myocardial infarction with anesthetic drugs and techniques. Curr. Drug Targets: 2009; 10(9): 858-862 - Article IF 2008: 4,187 P.429. Lanza, GA; Sgueglia, GA; Angeloni, G; Valsecchi, S; Sestito, A; Rebuzzi, AG; Crea, F; Maseri, A; Cianflone, D. Prognostic Value of Heart Rate Turbulence and Its Relation to Inflammation in Patients With Unstable Angina Pectoris. Am. J. Cardiol.: 2009; 103(8): 1066-1072 - Article IF 2008: 3,905 P.430. Latib, A; Chieffo, A; Colombo, A. Impact of optimal medical therapy and percutaneous coronary intervention on patients with stable angina. Nat. Clin. Pract. Cardiovasc. Med.: 2009; 6(2): 92-93 - Note IF 2008: 5,972 P.431. Latib, A; Colombo, A; Sangiorgi, GM. Bifurcation stenting: Current strategies and new devices. Heart: 2009; 95(6): 495-504 - Review IF 2008: 4,964 P.432. Latib, A; Cosgrave, J; Colombo, A. Bimodal distribution of angiographic measures of restenosis: What does it mean?. Heart: 2009; 95(19): 1556-1558 - Editorial IF 2008: 4,964 P.433. Lecchi, M; Belloli, S; Moresco, RM; Lui, R; Del Sole, A; Fazio, F; Lucignani, G. Technical and methodological issues in preclinical imaging with PET and SPECT. Minerva Biotechnol.: 2009; 21(2): 123-134 - Review IF 2008: 0,100 P.434. Lee, MS; Sillano, D; Latib, A; Chieffo, A; Zoccai, GB; Bhatia, R; Sheiban, I; Colombo, A; Tobis, J. Multicenter international registry of unprotected left main coronary artery percutaneous coronary intervention with drug-eluting stents in patients with myocardial infarction. Catheter. Cardiovasc. Interv.: 2009; 73(1): 15-21 - Article IF 2008: 2,248 P.435. Lehmann, HC; Kohne, A; Bernal, F; Jangouk, P; Meyer Zu Hörste, G; Dehmel, T; Hartung, HP; Previtali, SC; Kieseier, BC. Matrix metalloproteinase-2 is involved in myelination of dorsal root ganglia neurons. Glia: 2009; 57(5): 479-489 - Article IF 2008: 5,599 P.436. Lennox, JL; DeJesus, E; Lazzarin, A; Pollard, RB; Madruga, JVR; Berger, DS; Zhao, J; Xu, X; Williams-Diaz, A; Rodgers, AJ; Barnard, RJ; Miller, MD; DiNubile, MJ; Nguyen, BY; Leavitt, R; Sklar, P. Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatment-naive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trial. Lancet: 2009; 374(9692): 796-806 - Article IF 2008: 28,409 P.437. Lettieri, C; Savonitto, S; De Servi, S; Guagliumi, G; Belli, G; Repetto, A; Piccaluga, E; Politi, A; Ettori, F; Castiglioni, B; Fabbiocchi, F; De Cesare, N; Sangiorgi, G; Musumeci, G; Onofri, M; D’Urbano, M; Pirelli, S; Zanini, R; Klugmann, S. Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: Early and medium-term outcome. Am. Heart J.: 2009; 157(3): 569-575.e1 - Article IF 2008: 4,285 P.438. Levi, S; Rovida, E. The role of iron in mitochondrial function. Biochim. Biophys. Acta-Gen. Subj.: 2009; 1790(7): 629636 - Review IF 2008: 2,713 P.439. Lippi, G; Blanckaert, N; Bonini, P; Green, S; Kitchen, S; Palicka, V; Vassault, AJ; Mattiuzzi, C; Plebani, M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Clin. Chem. Lab. Med.: 2009; 47(2): 143153 - Conference Paper IF 2008: 1,888 P.440. Lira Luce, F; Sarandria, D; Pozzobon, G; Chiumello, G; Bussi, M. Pediatric otorhinolaryngologic manifestations of endocrinological pathologies. Int. J. Pediatr. Otorhinolaryngol.: 2009; 73(SUPPL.1): S49-S55 - Article IF 2008: 1,118 P.441. Lobsiger, CS; Boillee, S; McAlonis-Downes, M; Khan, AM; Feltri, ML; Yamanaka, K; Cleveland, DW. Schwann cells expressing dismutase active mutant SOD1 unexpectedly slow disease progression in ALS mice. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(11): 4465-4470 - Article IF 2008: 9,380 P.442. Locci, M; Draghici, E; Marangoni, F; Bosticardo, M; Catucci, M; Aiuti, A; Cancrini, C; Marodi, L; Espanol, T; Bredius, RGM; Thrasher, AJ; Schulz, A; Litzman, J; Roncarolo, MG; Casorati, G; Dellabona, P; Villa, A. The Wiskott-Aldrich syndrome protein is required for iNKT cell maturation and function. J. Exp. Med.: 2009; 206(4): 735-742 - Article IF 2008: 15,463 P.443. Lolmede, K; Campana, L; Vezzoli, M; Bosurgi, L; Ton- 250 - SAN RAFFAELE SCIENTIFIC INSTITUTE lorenzi, R; Clementi, E; Bianchi, ME; Cossu, G; Manfredi, AA; Brunelli, S; Rovere-Querini, P. Inflammatory and alternatively activated human macrophages attract vessel-associated stem cells, relying on separate HMGB1- and MMP-9-dependent pathways. J. Leukoc. Biol.: 2009; 85(5): 779-787 - Article IF 2008: 4,605 P.444. Lolmede, K; Rovere-Querini, P. Role of HMGB1 in the induction of immune responses against dying cells [Rôle du facteur high mobility group box 1 (HMGB1) dans l’induction des réponses immunitaires dirigées contre les cellules mortes]. Pathol. Biol.: 2009; 57(3): 217-218 - Editorial IF 2008: 0,960 P.445. Longo, O; Tripiciano, A; Fiorelli, V; Bellino, S; Scoglio, A; Collacchi, B; Alvarez, MJR; Francavilla, V; Arancio, A; Paniccia, G; Lazzarin, A; Tambussi, G; Tassan Din, C; Visintini, R; Narciso, P; Antinori, A; D’Offizi, G; Giulianelli, M; Carta, M; Di Carlo, A; Palamara, G; Giuliani, M; Laguardia, ME; Monini, P; Magnani, M; Ensoli, F; Ensoli, B. Phase I therapeutic trial of the HIV-1 Tat protein and long term follow-up. Vaccine: 2009; 27(25-26): 3306-3312 - Article IF 2008: 3,298 P.446. Lopes, FL; Azevedo, TM; Imbiriba, LA; Freire, RC; Valenca, AM; Caldirola, D; Perna, G; Volchan, E; Nardi, AE. Freezing reaction in panic disorder patients associated with anticipatory anxiety. Depress. Anxiety: 2009; 26(10): 917-921 - Article IF 2008: 2,526 P.447. Lorini, R; Klersy, C; D’Annunzio, G; Massa, O; Minuto, N; Iafusco, D; Bellanne-Chantelot, C; Frongia, AP; Toni, S; Meschi, F; Cerutti, F; Barbetti, F; Banin, P; Cadario, F; Calisti, L; Cappa, M; Crino, A; Cherubini, V; Chiari, G; Vanelli, M; Cotellessa, M; D’Amato, E; Cauvin, V; Franzese, A; Guazzarotti, L; Iughetti, L; Mancabitti, ML; Meossi, C; Pinelli, L; Pocecco, M; Scaramuzza, A; Sulli, N; Visentin, A. Maturity-onset diabetes of the young in children with incidental hyperglycemia: A multicenter Italian study of 172 families. Diabetes Care: 2009; 32(10): 1864-1866 - Article IF 2008: 7,349 P.448. Losa, M; Bianchi, R; Barzaghi, R; Giovanelli, M; Mortini, P. Persistent adrenocorticotropin response to desmopressin in the early postoperative period predicts recurrence of Cushing’s disease. J. Clin. Endocrinol. Metab.: 2009; 94(9): 3322-3328 - Article IF 2008: 6,325 P.449. Loupakis, F; Ruzzo, A; Cremolini, C; Vincenzi, B; Salvatore, L; Santini, D; Masi, G; Stasi, I; Canestrari, E; Rulli, E; Floriani, I; Bencardino, K; Galluccio, N; Catalano, V; Tonini, G; Magnani, M; Fontanini, G; Basolo, F; Falcone, A; Graziano, F. KRAS codon 61, 146 and BRAF mutations predict resistance to cetuximab plus irinotecan in KRAS codon 12 and 13 wild-type metastatic colorectal cancer. Br. J. Cancer: 2009; 101(4): 715-721 - Article IF 2008: 4,846 P.450. Lucotti, P; Monti, L; Setola, E; La Canna, G; Castiglioni, A; Rossodivita, A; Pala, MG; Formica, F; Paolini, G; Catapano, AL; Bosi, E; Alfieri, O; Piatti, P. Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass. Metab.-Clin. Exp.: 2009; 58(9): 1270-1276 - Article IF 2008: 2,920 P.451. Lughezzani, G; Capitanio, U; Jeldres, C; Isbarn, H; Shariat, SF; Arjane, P; Widmer, H; Perrotte, P; Montorsi, F; Karakiewicz, PI. Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma: a populationbased perspective. Cancer: 2009; 115(24): 5680-5687 - Article IF 2008: 5,238 P.452. Lughezzani, G; Jeldres, C; Isbarn, H; Perrotte, P; Shariat, SF; Sun, M; Widmer, H; Arjane, P; Peloquin, F; Pharand, D; Patard, JJ; Graefen, M; Montorsi, F; Karakiewicz, PI. Tumor Size is a Determinant of the Rate of Stage T1 Renal Cell Cancer Synchronous Metastasis. J. Urol.: 2009; 182(4 SUPPL.): 12871293 - Article IF 2008: 3,952 P.453. Lussana, F; Dentali, F; Abbate, R; d’Aloja, E; D’Angelo, A; De Stefano, V; Faioni, EM; Grandone, E; Legnani, C; Martinelli, I; Simioni, P; Tormene, D. Screening for thrombophilia and antithrombotic prophylaxis in pregnancy: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb. Res.: 2009; 124(5): e19–e25 - Article IF 2008: 2,449 P.454. Maccalli, C; Scaramuzza, S; Parmiani, G. TNK cells (NKG2D+ CD8+ or CD4+ T lymphocytes) in the control of human tumors. Cancer Immunol. Immunother.: 2009; 58(5): 801808 - Review IF 2008: 3,804 P.455. Mack, U; Migliori, GB; Sester, M; Rieder, HL; Ehlers, S; Goletti, D; Bossink, A; Magdorf, K; Holscher, C; Kampmann, B; Arend, SM; Detjen, A; Bothamley, G; Zellweger, JP; Milburn, H; Diel, R; Ravn, P; Cobelens, F; Cardona, PJ; Kan, B; Solovic, I; Duarte, R; Cirillo, DM; Lange, C. LTBI: Latent tuberculosis infection or lasting immune responses to M tuberculosis? A TBNET consensus statement. Eur. Resp. J.: 2009; 33(5): 956-973 - Conference Paper IF 2008: 5,545 P.456. MacManus, M; Nestle, U; Rosenzweig, KE; Carrio, I; Messa, C; Belohlavek, O; Danna, M; Inoue, T; Deniaud-Alexandre, E; Schipani, S; Watanabe, N; Dondi, M; Jeremic, B. Use of PET and PET/CT for Radiation Therapy Planning: IAEA expert report 2006-2007. Radiother. Oncol.: 2009; 91(1): 85-94 - Review IF 2008: 3,990 P.457. Magnoni, M; Coli, S; Marrocco-Trischitta, MM; Melisurgo, G; De Dominicis, D; Cianflone, D; Chiesa, R; Feinstein, SB; Maseri, A. Contrast-enhanced ultrasound imaging of periadventitial vasa vasorum in human carotid arteries. Eur. J. Echocardiogr.: 2009; 10(2): 260-264 - Article IF 2008: 1,917 P.458. Maher, VMG; Kitano, Y; Neuwirth, C; Davies, GJ; Maseri, A; Thompson, GR; Andreotti, F. Plasminogen activator inhibitor-1 removal using dextran sulphate columns Evidence of PAI-1 homeostasis. J. Thromb. Trombolysis: 2009; 28(2): 166172 - Article IF 2008: 2,266 P.459. Maisano, F; Kjaergard, HK; Bauernschmitt, R; Pavie, A; Rabago, G; Laskar, M; Marstein, JP; Falk, V. TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial. Eur. J. Cardio-Thorac. Surg.: 2009; 36(4): 708-714 - Article IF 2008: 2,181 P.460. Maisano, F; Michev, I; Rowe, S; Addis, A; Campagnol, M; Guidotti, A; Colombo, A; Alfieri, O. Transapical endovascular implantation of neochordae using a suction and suture device. Eur. J. Cardio-Thorac. Surg.: 2009; 36(1): 118-123 - Article IF 2008: 2,181 P.461. Maisano, F; Vigano, G; Calabrese, C; Taramasso, M; Denti, P; Blasio, A; Guidotti, A; Alfieri, O. Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation. Eur. J. Cardio-Thorac. Surg.: 2009; 36(2): 261-266 Article IF 2008: 2,181 P.462. Malcovati, L; Della Porta, MG; Pietra, D; Boveri, E; Pellagatti, A; Gallì, A; Travaglino, E; Brisci, A; Rumi, E; Passamonti, F; Invernizzi, R; Cremonesi, L; Boultwood, J; Wainscoat, JS; Hellström-Lindberg, E; Cazzola, M. Molecular and clinical features of refractory anemia with ringed sideroblasts associated with marked thrombocytosis. Blood: 2009; 114(17): 3538-3545 Article PUBLICATIONS - 251 IF 2008: 10,432 P.463. Mallamaci, F; Leonardis, D; Tripepi, R; Parlongo, G; Catalano, C; Tripepi, G; Castronovo, V; Ferini-Strambi, L; Zoccali, C. Sleep disordered breathing in renal transplant patients. Am. J. Transplant.: 2009; 9(6): 1373-1381 - Article IF 2008: 6,559 P.464. Malosio, ML; Esposito, A; Poletti, A; Chiaretti, S; Piemonti, L; Melzi, R; Nano, R; Tedoldi, F; Canu, T; Santambrogio, P; Brigatti, C; De Cobelli, F; Maffi, P; Secchi, A; Del Maschio, A. Improving the procedure for detection of intrahepatic transplanted islets by magnetic resonance imaging.. Am. J. Transplant. : 2009; 9(10): 2372-2382 - Article IF 2008: 6,559 P.465. Maltecca, F; Magnoni, R; Cerri, F; Cox, GA; Quattrini, A; Casari, G. Haploinsufficiency of AFG3L2, the gene responsible for spinocerebellar ataxia type 28, causes mitochondria-mediated Purkinje cell dark degeneration. J. Neurosci.: 2009; 29(29): 9244-9254 - Article IF 2008: 7,452 P.466. Mancini, L; Ciccarelli, O; Manfredonia, F; Thornton, JS; Agosta, F; Barkhof, F; Beckmann, C; De Stefano, N; Enzinger, C; Fazekas, F; Filippi, M; Gass, A; Hirsch, JG; Johansen-Berg, H; Kappos, L; Korteweg, T; Manson, SC; Marino, S; Matthews, PM; Montalban, X; Palace, J; Polman, C; Rocca, M; Ropele, S; Rovira, A; Wegner, C; Friston, K; Thompson, A; Yousry, T. Short-term adaptation to a simple motor task: A physiological process preserved in multiple sclerosis. Neuroimage: 2009; 45(2): 500-511 - Article IF 2008: 5,694 P.467. Mancini, N; Carletti, S; Ghidoli, N; Cichero, P; Ossi, CM; Ieri, R; Poli, E; Burioni, R; Clementi, M. Letters to the editor: molecular diagnosis of polymicrobial sepsis. J. Clin. Microbiol.: 2009; 47(4): 1274-1275 - Letter IF 2008: 3,945 P.468. Mancosu, P; Sghedoni, R; Bettinardi, V; Fioroni, F; Aquilina, MA; Grassi, E; Fazio, F; Borasi, G; Gilardi, MC. 4D-PET data sorting into different number of phases: a NEMA IQ phantom study. J. Appl. Clin. Med. Phys: 2009; 10(4): 220-231 - Article IF 2008: 1,225 P.469. Mandelli, C; Baiguini, M. Ulnar nerve entrapment neuropathy at the elbow: Decisional algorithm and surgical considerations. Neurocirugia: 2009; 20(1): 31-38 - Article IF 2008: 0,277 P.470. Mandelli, L; Marino, E; Pirovano, A; Calati, R; Zanardi, R; Colombo, C; Serretti, A. Interaction between SERTPR and stressful life events on response to antidepressant treatment. Eur. Neuropsychopharmacol.: 2009; 19(1): 64-67 - Article IF 2008: 3,661 P.471. Manfredi, AA; Capobianco, A; Bianchi, ME; RovereQuerini, P. Regulation of dendritic- and T-cell fate by injury-associated endogenous signals. Crit. Rev. Immunol.: 2009; 29(1): 6986 IF 2008: 3,241 P.472. Manfredi, I; Zani, AD; Rampoldi, L; Pegorini, S; Bernascone, I; Moretti, M; Gotti, C; Croci, L; Consalez, GG; Ferini-Strambi, L; Sala, M; Pattini, L; Casari, G. Expression of mutant ?2 nicotinic receptors during development is crucial for epileptogenesis. Hum. Mol. Genet.: 2009; 18(6): 1075-1088 Article IF 2008: 7,249 P.473. Mangano, C; Piattelli, A; Mangano, A; Mangano, F; Mangano, A; Iezzi, G; Borges, FL; D’Avila, S; Shibli, JA. Combining scaffolds and osteogenic cells in regenerative bone surgery: A preliminary histological report in human maxillary sinus augmentation. Clin. Implant Dent. Relat. Res.: 2009; 11(SUPPL. 1): e92-e102 - Article IF 2008: 1,782 P.474. Mansueto, M; Grimaldi, A; Mangili, G; Picchio, M; Giovacchini, G; Vigano, R; Messa, C; Fazio, F. Positron emission tomography/computed tomography introduction in the clinical management of patients with suspected recurrence of ovarian cancer: A cost-effectiveness analysis. Eur. J. Cancer Care: 2009; 18(6): 612-619 - Article IF 2008: 0,985 P.475. Manunta, P; Ferrandi, M; Bianchi, G; Hamlyn, JM. Endogenous ouabain in cardiovascular function and disease. J. Hypertens.: 2009; 27(1): 9-18 - Review IF 2008: 5,132 P.476. Marangoni, F; Bosticardo, M; Charrier, S; Draghici, E; Locci, M; Scaramuzza, S; Panaroni, C; Ponzoni, M; Sanvito, F; Doglioni, C; Liabeuf, M; Gjata, B; Montus, M; Siminovitch, K; Aiuti, A; Naldini, L; Dupre, L; Roncarolo, MG; Galy, A; Villa, A. Evidence for Long-term Efficacy and Safety of Gene Therapy for Wiskott-Aldrich Syndrome in Preclinical Models. Mol. Ther.: 2009; 17(6): 1073-1082 - Article IF 2008: 5,970 P.477. Marano, R; De Cobelli, F; Floriani, I; Becker, C; Herzog, C; Centonze, M; Morana, G; Gualdi, GF; Ligabue, G; Pontone, G; Catalano, C; Chiappino, D; Midiri, M; Simonetti, G; Marchisio, F; Olivetti, L; Fattori, R; Bonomo, L; Del Maschio, A. Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease). Eur. Radiol.: 2009; 19(5): 1114-1123 - Article IF 2008: 3,651 P.478. Margulis, V; Lotan, Y; Karakiewicz, PI; Fradet, Y; Ashfaq, R; Capitanio, U; Montorsi, F; Bastian, PJ; Nielsen, ME; Muller, SC; Rigaud, J; Heukamp, LC; Netto, G; Lerner, SP; Sagalowsky, AI; Shariat, SF. Multi-institutional validation of the predictive value of ki-67 labeling index in patients with urinary bladder cancer. J. Natl. Cancer Inst.: 2009; 101(2): 114-119 - Article IF 2008: 14,933 P.479. Mari, C; Bruno, F; Galbiati, S; Torri, A; Lombardo, F; Seia, M; Ferrari, M; Restagno, G; Cremonesi, L. Application of pyrosequencing to the identification of sequence variations in the cystic fibrosis transmembrane conductance regulator gene. Clin. Chem. Lab. Med.: 2009; 47(9): 1051-1054 - Article IF 2008: 1,888 P.480. Mariani, A; Arcidiacono, PG; Curioni, S; Giussani, A; Testoni, PA. Diagnostic yield of secretin-enhanced MRCP and EUS, and ERCP in patients with acute recurrent pancreatitis of unknown aetiology. Dig. Liver Dis.: 2009; 41(10): 753-758 - Article IF 2008: 2,577 P.481. Marino, E; Benedetti, F; Colombo, C; Pirovano, A; Smeraldi, E. P.1.21 The COMT Val(108/158)Met polymorphism affects antidepressant response to paroxetine in a naturalistic setting. Eur. Neuropsychopharmacol.: 2009; 19(SUPPL. 1): S19S20 - Article IF 2008: 3,661 P.482. Mariotti, M; Castiglioni, S; Garcia-Manteiga, JM; Beguinot, L; Maier, JAM. HD-PTP inhibits endothelial migration through its interaction with Src. Int. J. Biochem. Cell Biol.: 2009; 41(3): 687-693 - Article IF 2008: 4,178 P.483. Marone, EM; Volonte, M; Limoni, C; Petrini, O; Chiesa, R. Therapeutic Options and Patterns of Prescription in Chronic Venous Disorders: Results of a 3-Year Survey in Italy. Eur. J. Vasc. Endovasc. Surg.: 2009; 38(4): 511-517 - Article IF 2008: 3,007 P.484. Maroni, P; Citterio, L; Piccoletti, R; Bendinelli, P. Sam68 and ERKs regulate leptin-induced expression of OB-Rb mRNA in C2C12 myotubes. Mol. Cell. Endocrinol.: 2009; 309(1-2): 26-31 - Article 252 - SAN RAFFAELE SCIENTIFIC INSTITUTE IF 2008: 3,611 P.485. Marques, JF; Canessa, N; Cappa, S. Neural differences in the processing of true and false sentences: Insights into the nature of ‘truth’ in language comprehension. Cortex: 2009; 45(6): 759768 - Article IF 2008: 2,749 P.486. Marrocco-Trischitta, MM; Melissano, G; Castellano, R; Coppi, G; Chiesa, R. Endovascular abdominal aortic aneurysm repair in a patient with severe hemophilia B. J. Endovasc. Ther.: 2009; 16(1): 120-123 - Article IF 2008: 2,682 P.487. Marrocco-Trischitta, MM; Melissano, G; Kahlberg, A; Calori, G; Setacci, F; Chiesa, R. Chronic kidney disease classification stratifies mortality risk after elective stent graft repair of the thoracic aorta. J. Vasc. Surg.: 2009; 49(2): 296-301 - Article IF 2008: 3,770 P.488. Marrocco-Trischitta, MM; Melissano, G; Kahlberg, A; Vezzoli, G; Calori, G; Chiesa, R. The impact of aortic clamping site on glomerular filtration rate after juxtarenal aneurysm repair. Ann. Vasc. Surg.: 2009; 23(6): 770-777 - Article IF 2008: 1,262 P.489. Martignoni, G; Pea, M; Gobbo, S; Brunelli, M; Bonetti, F; Segala, D; Pan, CC; Netto, G; Doglioni, C; Hes, O; Argani, P; Chilosi, M. Cathepsin-K immunoreactivity distinguishes MiTF/TFE family renal translocation carcinomas from other renal carcinomas. Mod. Pathol.: 2009; 22(8): 1016-1022 - Article IF 2008: 4,678 P.490. Martin, JL; Ellis, SG; Colombo, A; Grube, E; Maloney, T; Friedman, MI; Baim, DS; Dawkins, K; Caputo, R; Stone, GW. Frequency of Coronary Artery Bypass Grafting Following Implantation of a Paclitaxel-Eluting or a Bare-Metal Stent Into a Single Coronary Artery. Am. J. Cardiol.: 2009; 103(1): 11-16 Article IF 2008: 3,905 P.491. Martinelli, P; La Mattina, V; Bernacchia, A; Magnoni, R; Cerri, F; Cox, G; Quattrini, A; Casari, G; Rugarli, EI. Genetic interaction between the m-AAA protease isoenzymes reveals novel roles in cerebellar degeneration. Hum. Mol. Genet.: 2009; 18(11): 2001-2013 - Article IF 2008: 7,249 P.492. Martinelli, V; Radaelli, M; Straffi, L; Rodegher, M; Comi, G. Mitoxantrone: benefits and risks in multiple sclerosis patients. Neurol. Sci.: 2009; (Suppl 2): S167-S170 - Article IF 2008: 1,435 P.493. Martinelli, V; Rocca, MA; Annovazzi, P; Pulizzi, A; Rodegher, M; Martinelli-Boneschi, F; Scotti, R; Falini, A; Sormani, MP; Comi, G; Filippi, M. A short-term randomized MRI study of high-dose oral vs intravenous methylprednisolone in MS. Neurology: 2009; 73(22): 1842-1848 - Article IF 2008: 7,043 P.494. Martino, S; Di Girolamo, I; Cavazzin, C; Tiribuzi, R; Galli, R; Rivaroli, A; Valsecchi, M; Sandhoff, K; Sonnino, S; Vescovi, A; Gritti, A; Orlacchio, A. Neural precursor cell cultures from GM2 gangliosidosis animal models recapitulate the biochemical and molecular hallmarks of the brain pathology. J. Neurochem.: 2009; 109(1): 135-147 - Article IF 2008: 4,500 P.495. Martino, S; Tiribuzi, R; Tortori, A; Conti, D; Visigalli, I; Lattanzi, A; Biffi, A; Gritti, A; Orlacchio, A. Specific determination of beta-galactocerebrosidase activity via competitive inhibition of beta-galactosidase.. Clin. Chem.: 2009; 55(3): 541-548 Article IF 2008: 5,579 P.496. Maruggi, G; Porcellini, S; Facchini, G; Perna, SK; Cattoglio, C; Sartori, D; Ambrosi, A; Schambach, A; Baum, C; Bonini, C; Bovolenta, C; Mavilio, F; Recchia, A. Transcriptional Enhancers Induce Insertional Gene Deregulation Independently From the Vector Type and Design. Mol. Ther.: 2009; 17(5): 851856 - Article IF 2008: 5,970 P.497. Masci, E; Mangiavillano, B; Barera, G; Parma, B; Albarello, L; Mariani, A; Doglioni, C; Testoni, PA. Optical coherence tomography in pediatric patients: A feasible technique for diagnosing celiac disease in children with villous atrophy. Dig. Liver Dis.: 2009; 41(9): 639-643 - Article IF 2008: 2,577 P.498. Masci, E; Rossi, M; Minoli, G; Mangiavillano, B; Bianchi, G; Colombo, E; Comin, U; Fesce, E; Perego, M; Ravelli, P; Lella, F; Buffoli, F; Zambelli, A; Lomazzi, A; Fasoli, R; Prada, A; Testoni, PA. Patient satisfaction after endoscopic retrograde cholangiopancreatography for biliary stones: A prospective multicenter study in Lombardy. J. Gastroenterol. Hepatol.: 2009; 24(9): 1510-1515 - Article IF 2008: 2,275 P.499. Massimino, M; Gandola, L; Spreafico, F; Biassoni, V; Luksch, R; Collini, P; Solero, CN; Simonetti, F; Pignoli, E; Cefalo, G; Poggi, G; Modena, P; Mariani, L; Potepan, P; Podda, M; Casanova, M; Pecori, E; Acerno, S; Ferrari, A; Terenziani, M; Meazza, C; Polastri, D; Ravagnani, F; Fossati-Bellani, F. No Salvage Using High-Dose Chemotherapy Plus/Minus Reirradiation for Relapsing Previously Irradiated Medulloblastoma. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 73(5): 1358-1363 - Article IF 2008: 4,639 P.500. Matafora, V; D’Amato, A; Mori, S; Blasi, F; Bachi, A. Proteomics analysis of nucleolar SUMO-1 target proteins upon proteasome inhibition. Mol. Cell Proteomics: 2009; 8(10): 22432255 - Article IF 2008: 8,834 P.501. Maugeri, N; Baldini, M; Rovere-Querini, P; Maseri, A; Sabbadini, MG; Manfredi, AA. Leukocyte and platelet activation in patients with giant cell arteritis and polymyalgia rheumatica: a clue to thromboembolic risks?. Autoimmunity: 2009; 42(4): 386-388 - Article IF 2008: 2,525 P.502. Maugeri, N; Rovere-Querini, P; Baldini, M; Sabbadini, MG; Manfredi, AA. Translational Mini-Review Series on Immunology of Vascular Disease: Mechanisms of vascular inflammation and remodelling in systemic vasculitis. Clin. Exp. Immunol.: 2009; 156(3): 395-404 - Review IF 2008: 2,853 P.503. Maugeri, N; Rovere-Querini, P; Evangelista, V; Covino, C; Capobianco, A; Bertilaccio, MT; Piccoli, A; Totani, L; Cianflone, D; Maseri, A; Manfredi, AA. Neutrophils phagocytose activated platelets in vivo: a phosphatidylserine, P-selectin, and {beta}2 integrin-dependent cell clearance program. Blood: 2009; 113(21): 5254-5265 - Article IF 2008: 10,432 P.504. Maziade, M; Rouleau, N; Gingras, N; Boutin, P; Paradis, ME; Jomphe, V; Boutin, J; Letourneau, K; Gilbert, E; Lefebvre, AA; Dore, MC; Marino, C; Battaglia, M; Merette, C; Roy, MA. Shared neurocognitive dysfunctions in young offspring at extreme risk for schizophrenia or bipolar disorder in eastern quebec multigenerational families. Schizophr. Bull.: 2009; 35(5): 919-930 Article IF 2008: 6,592 P.505. McQuaid, SJ; Lambrou, T; Cunningham, VJ; Bettinardi, V; Gilardi, MC; Hutton, BF. The Application of a Statistical Shape Model to Diaphragm Tracking in Respiratory-Gated Cardiac PET Images. Proc. IEEE: 2009; 97(12): 2039-2052 - Article IF 2008: 4,613 P.506. Mehran, R; Pocock, SJ; Stone, GW; Clayton, TC; Dangas, GD; Feit, F; Manoukian, SV; Nikolsky, E; Lansky, AJ; Kirtane, A; White, HD; Colombo, A; Ware, JH; Moses, JW; Ohman, EM. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting PUBLICATIONS - 253 with non-ST-elevation acute coronary syndromes: A risk model from the ACUITY trial. Eur. Heart J.: 2009; 30(12): 1457-1466 Article IF 2008: 8,917 P.507. Meliga, E; Garcia-Garcia, HM; Valgimigli, M; Chieffo, A; Biondi-Zoccai, G; Maree, AO; Gonzalo, N; Cook, S; Marra, S; Moretti, C; De Servi, S; Palacios, IF; Windecker, S; van Domburg, R; Colombo, A; Sheiban, I; Serruys, PW. Impact of drugeluting stent selection on long-term clinical outcomes in patients treated for unprotected left main coronary artery disease: The sirolimus vs paclitaxel drug-eluting stent for left main registry (SP-DELFT). Int. J. Cardiol.: 2009; 137(1): 16-21 - Article IF 2008: 3,121 P.508. Melissano, G; Bertoglio, L; Civelli, V; Moraes Amato, AC; Coppi, G; Civilini, E; Calori, G; De Cobelli, F; Del Maschio, A; Chiesa, R. Demonstration of the Adamkiewicz Artery by Multidetector Computed Tomography Angiography Analysed with the Open-Source Software OsiriX. Eur. J. Vasc. Endovasc. Surg.: 2009; 37(4): 395-400 - Article IF 2008: 3,007 P.509. Melissano, G; Chiesa, R. Hybrid procedures for thoracoabdominal aneurysms. J. Endovasc. Ther.: 2009; 16(4): 451-453 Note IF 2008: 2,682 P.510. Melissano, G; Chiesa, R. Advances in imaging of the spinal cord vascular supply and its relationship with paraplegia after aortic interventions. A review. Eur. J. Vasc. Endovasc. Surg.: 2009; 38(5): 567-577 - Review IF 2008: 3,007 P.511. Melissano, G; Chiesa, R. The “Other Revolution” in Stroke Prevention. Eur. J. Vasc. Endovasc. Surg.: 2009; 38(2): 141-142 - Editorial IF 2008: 3,007 P.512. Melloni, G; Casiraghi, M; Bandiera, A; Ciriaco, P; Carretta, A; Libretti, L; Zannini, P. Transbronchial Needle Aspiration in Lung Cancer Patients Suitable for Operation With Positive Mediastinal Positron Emission Tomography. Ann. Thorac. Surg.: 2009; 87(2): 373-378 - Article IF 2008: 2,689 P.513. Merkies, IS; Bril, V; Dalakas, MC; Deng, C; Donofrio P; Hanna, K; Hartung, HP; Hughes, RA; Latov, N; van Doorn, PA; ICE Study Group. Health-related quality-of-life improvements in CIDP with immune globulin IV 10%: the ICE Study. Neurology: 2009; 72(15): 1337-1344 - Article IF 2008: 7,043 P.514. Mesaros, S; Rocca, MA; Riccitelli, G; Pagani, E; Rovaris, M; Caputo, D; Ghezzi, A; Capra, R; Bertolotto, A; Comi, G; Filippi, M. Corpus callosum damage and cognitive dysfunction in benign MS. Hum. Brain Mapp.: 2009; 30(8): 2656-2666 - Article IF 2008: 5,395 P.515. Messina, G; Cossu, G. The origin of embryonic and fetal myoblasts: a role of Pax3 and Pax7. Genes Dev.: 2009; 23(8): 902-905 - Review IF 2008: 13,623 P.516. Messina, G; Sirabella, D; Monteverde, S; Gonzalez Galvez, B; Tonlorenzi, R; Schnapp, E; De Angelis, L; Brunelli, S; Relaix, F; Buckingham, M; Cossu, G. Skeletal muscle differentiation of embryonic mesoangioblasts requires Pax3 activity. Stem Cells: 2009; 27(1): 157-164 - Article IF 2008: 7,741 P.517. Messina, M; Boroli, F; Landoni, G; Bignami, E; Dedola, E; Batonga, JN; Magrin, S; Zangrillo, A. A comparison of epidural vs paravertebral blockade in thoracic surgery. Minerva Anestesiol: 2009; 75(11): 616-621 - Article IF 2008: 1,627 P.518. Messina, M; Magrin, S; Bignami, E; Maj, G; Carozzo, A; Mennella, R; Landoni, G; Zangrillo, A. Prospective randomized, blind comparison of ropivacaine and levobupivacaine for superficial plexus anesthesia in carotid endoarterectomy. Minerva Anestesiol.: 2009; 75(1-2): 7-12 - Article IF 2008: 1,627 P.519. Mezzi, G; Arcidiacono, PG; Carrara, S; Perri, F; Petrone, MC; De Cobelli, F; Gusmini, S; Staudacher, C; Del Maschio, A; Testoni, PA. Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy. World J. Gastroenterol.: 2009; 15(44): 5563-5567 - Article IF 2008: 2,081 P.520. Micali, N; Ferrai, C; Fernandez-Diaz, LC; Blasi, F; Crippa, MP. Prep1 directly regulates the intrinsic apoptotic pathway by controlling Bcl-XL levels. Mol. Cell. Biol.: 2009; 29(5): 11431151 - Article IF 2008: 5,942 P.521. Migliaccio, R; Agosta, F; Rascovsky, K; Karydas, A; Bonasera, S; Rabinovici, GD; Miller, BL; Gorno-Tempini, ML. Clinical syndromes associated with posterior atrophy: Early age at onset AD spectrum. Neurology: 2009; 73(19): 1571-1578 - Article IF 2008: 7,043 P.522. Migliori, GB; Sotgiu, G; Richardson, MD; Centis, R; Guenther, G; Hoffmann, H; Cirillo, DM; Toungossova, O; Kliiman, K; De Lorenzo, S; Spanevello, A; Lange, C. Consensus not yet reached on key drugs for extensively drug-resistant tuberculosis treatment. Clin. Infect. Dis.: 2009; 49(2): 315-316 - Letter IF 2008: 8,266 P.523. Mikulak, J; Gianolini, M; Versmisse, P; Pancino, G; Lusso, P; Verani, A. Biological and physical characterization of the X4 HIV-1 suppressive factor secreted by LPS-stimulated human macrophages. Virology: 2009; 390(1): 37-44 - Article IF 2008: 3,539 P.524. Miluzio, A; Beugnet, A; Volta, V; Biffo, S. Eukaryotic initiation factor 6 mediates a continuum between 60S ribosome biogenesis and translation. EMBO Rep.: 2009; 10(5): 459-465 - Review IF 2008: 7,099 P.525. Miotto, P; Saleri, N; Dembele, M; Ouedraogo, M; Badoum, G; Pinsi, G; Migliori, GB; Matteelli, A; Cirillo, DM. Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso. BMC Infect. Dis.: 2009; 9(1471): 142 - Article IF 2008: 2,536 P.526. Mirone, V; Fusco, F; Rossi, A; Sicuteri, R; Montorsi, F. Tadalafil and vardenafil vs sildenafil: A review of patient-preference studies. BJU Int.: 2009; 103(9): 1212-1217 - Review IF 2008: 2,704 P.527. Miserocchi, E; Modorati, G; Rama, P. Atypical toxoplasmosis masquerading late occurrence of typical findings. Eur. J. Ophthalmol. : 2009; 19(6): 1091-1093 - Article IF 2008: 1,010 P.528. Miyazawa, M; Lopalco, L; Mazzotta, F; Caputo, SL; Veas, F; Clerici, M. The?immunologic advantage? of HIV-exposed seronegative individuals. AIDS: 2009; 23(2): 161-175 - Editorial IF 2008: 5,460 P.529. Moch, H; Artibani, W; Delahunt, B; Ficarra, V; Knuechel, R; Montorsi, F; Patard, JJ; Stief, CG; Sulser, T; Wild, PJ. Reassessing the Current UICC/AJCC TNM Staging for Renal Cell Carcinoma. Eur. Urol.: 2009; 56(4): 636-643 - Review IF 2008: 6,512 P.530. Modorati, G; Miserocchi, E; Galli, L; Picozzi, P; Rama, P. Gamma knife radiosurgery for uveal melanoma: 12 years of experience. Br. J. Ophthalmol.: 2009; 93(1): 40-44 - Article IF 2008: 2,859 P.531. Molteni, R; Lage Crespo, C; Feigelson, S; Moser, C; Fabbri, M; Grabovsky, V; Krombach, F; Laudanna, C; Alon, R; Pardi, R. ?-Arrestin 2 is required for the induction and strength- 254 - SAN RAFFAELE SCIENTIFIC INSTITUTE ening of integrin-mediated leukocyte adhesion during CXCR2driven extravasation. Blood: 2009; 114(5): 1073-1082 - Article IF 2008: 10,432 P.532. Monforte, AD; Cozzi-Lepri, A; Castagna, A; Antinori, A; De Luca, A; Mussini, C; Caputo, SL; Arlotti, M; Magnani, G; Pellizzer, G; Maggiolo, F; Puoti, M; Icona Foundation Study Group. Risk of developing specific aids-defining illnesses in patients coinfected with HIV and hepatitis c virus with or without liver cirrhosis. Clin. Infect. Dis.: 2009; 49(4): 612-622 - Article IF 2008: 8,266 P.533. Montalban, X; Sastre-Garriga, J; Filippi, M; Khaleeli, Z; Téllez, N; Vellinga, M; Tur, C; Brochet, B; Barkhof, F; Rovaris, M; Miller, DH; Polman, CH; Rovira, A; Thompson, AJ. Primary progressive multiple sclerosis diagnostic criteria: A reappraisal. Mult. Scler.: 2009; 15(12): 1459-1465 - Article IF 2008: 3,312 P.534. Monti, L; Cinquetti, R; Guffanti, A; Nicassio, F; Cremona, M; Lavorgna, G; Bianchi, F; Vignati, F; Cittaro, D; Taramelli, R; Acquati, F. In silico prediction and experimental validation of natural antisense transcripts in two cancer-associated regions of human chromosome 6. Int. J. Oncol.: 2009; 34(4): 1099-1108 Article IF 2008: 2,234 P.535. Monti, P; Brigatti, C; Heninger, AK; Scirpoli, M; Bonifacio, E. Disengaging the IL-2 receptor with daclizumab enhances IL-7-mediated proliferation of CD4+ and CD8+ T Cells. Am. J. Transplant.: 2009; 9(12): 2727-2735 - Article IF 2008: 6,559 P.536. Montini, E; Cesana, D; Schmidt, M; Sanvito, F; Bartholomae, CC; Ranzani, M; Benedicenti, F; Sergi Sergi, L; Ambrosi, A; Ponzoni, M; Doglioni, C; Di Serio, C; von Kalle, C; Naldini, L. The genotoxic potential of retroviral vectors is strongly modulated by vector design and integration site selection in a mouse model of HSC gene therapy. J. Clin. Invest.: 2009; 119(4): 964975 - Article IF 2008: 16,559 P.537. Montironi, R; Cheng, L; Lopez-Beltran, A; Mazzucchelli, R; Scarpelli, M; Kirkali, Z; Montorsi, F. Joint Appraisal of the Radical Prostatectomy Specimen by the Urologist and the Uropathologist: Together, We Can Do It Better. Eur. Urol.: 2009; 56(6): 951-955 - Editorial IF 2008: 6,512 P.538. Montironi, R; Cheng, L; Lopez-Beltran, A; Scarpelli, M; Mazzucchelli, R; Mikuz, G; Kirkali, Z; Montorsi, F. Stage pT0 in Radical Prostatectomy with No Residual Carcinoma and with a Previous Positive Biopsy Conveys a Wrong Message to Clinicians and Patients: Why Is Cancer Not Present in the Radical Prostatectomy Specimen?. Eur. Urol.: 2009; 56(2): 272-274 - Editorial IF 2008: 6,512 P.539. Montironi, R; Cheng, L; Mazzucchelli, R; Scarpelli, M; Kirkali, Z; Montorsi, F; Lopez-Beltran, A. Critical Evaluation of the Prostate from Cystoprostatectomies for Bladder Cancer: Insights from a Complete Sampling with the Whole Mount Technique. Eur. Urol.: 2009; 55(6): 1305-1309 - Editorial IF 2008: 6,512 P.540. Montorsi, P; Ravagnani, PM; Galli, S; Ali, SG; Briganti, A; Salonia, A; Montorsi, F. The Triad of Endothelial Dysfunction, Cardiovascular Disease, and Erectile Dysfunction: Clinical Implications. Eur. Urol. Suppl.: 2009; 8(2): 58-66 - Review IF 2008: 1,711 P.541. Mora, S; Cafarelli, L; Erba, P; Puzzovio, M; Zamproni, I; Giacomet, V; Vigano, A. Differential effect of age, gender and puberty on bone formation rate assessed by measurement of bonespecific alkaline phosphatase in healthy Italian children and adolescents. J. Bone Miner. Metab.: 2009; 27(6): 721-726 - Article IF 2008: 2,100 P.542. Mora, S; Vigano, A; Cafarelli, L; Pattarino, G; Giacomet, V; Gabiano, C; Mignone, F; Zuccotti, G. Applicability of quantitative ultrasonography of the radius and tibia in HIV-infected children and adolescents. J. Acquir. Immune Defic. Syndr. : 2009; 51(5): 588-592 - Article IF 2008: 4,570 P.543. Morbiducci, U; Ponzini, R; Rizzo, G; Cadioli, M; Esposito, A; De Cobelli, F; Del Maschio, A; Montevecchi, FM; Redaelli, A. In vivo quantification of helical blood flow in human aorta by time-Resolved three-dimensional cine phase contrast magnetic resonance imaging. Ann. Biomed. Eng.: 2009; 37(3): 516-531 Article IF 2008: 2,605 P.544. Morichetti, D; Mazzucchelli, R; Lopez-Beltran, A; Cheng, L; Scarpelli, M; Kirkali, Z; Montorsi, F; Montironi, R. Secondary neoplasms of the urinary system and male genital organs. BJU Int.: 2009; 104(6): 770-776 - Short Survey IF 2008: 2,704 P.545. Morsica, G; Ancarani, F; Bagaglio, S; Maracci, M; Cicconi, P; Cozzi Lepri, A; Antonucci, G; Bruno, R; Santantonio, T; Tacconi, L; Baldelli, F; Piscopo, R; Santoro, D; Lazzarin, A; D’Arminio Monforte, A HepaICONA and the ICONA Study Groups. Occult Hepatitis B Virus Infection in a Cohort of HIVPositive Patients: Correlation with Hepatitis C Virus Coinfection, Virological and Immunological Features. Infection: 2009; 37(5): 445-449 - Article IF 2008: 1,831 P.546. Morsica, G; Bagaglio, S; Cicconi, P; Capobianchi, MR; Pellizzer, G; Caramello, P; Orani, A; Moioli, C; Rizzardini, G; Uberti-Foppa, C; Puoti, M; D’Arminio Monforte, A. Viral interference between hepatitis B, C, and D viruses in dual and triple infections in HIV-positive patients. J. Acquir. Immune Defic. Syndr. : 2009; 51(5): 574-581 - Article IF 2008: 4,570 P.547. Morsica, G; Bagaglio, S; Uberti-Foppa, C; Galli, L; Lazzarin, A. Detection of hepatitis c mutants with natural resistance to ns3/4a protease inhibitors in hiv/hcv-coinfected individuals treated with antiretroviral therapy. J. Acquir. Immune Defic. Syndr.: 2009; 51(1): 106-108 - Letter IF 2008: 4,570 P.548. Motta, M; Alongi, F; De martin, E; Fiorno, C; Maggiulli, E; Rigoni, L; Landoni, C; Broggi, S; Deli, AM; Calandrino, R; Di Muzio, N. Helical tomotherapy for scalp recurrence of primary eccrine mucinous adenocarcinoma. Tumori: 2009; 95: 832835 - Article IF 2008: 0,791 P.549. Mottrie, A; Buffi, N; Lughezzani, G; Denaeyer, G; Schatteman, P; Carpentier, P; Fonteyne, E. Surgery Illustrated - Surgical Atlas: Female robotic radical cystectomy. BJU Int.: 2009; 104(7): 1024-1035 - Article IF 2008: 2,704 P.550. Mottrie, A; Cestari, A; Buffi, N; Guazzoni, G; Irwin, BH; Aron, M; Gill, IS. The Motion: A Robot is Necessary for Laparoscopic Enucleation of Renal Masses. Eur. Urol.: 2009; 55(5): 1229-1232 - Article IF 2008: 6,512 P.551. Murphy, RL; Autran, B; Katlama, C; Brucker, G; Debre, P; Calvez, V; Clotet, B; Clumeck, N; Costagliola, D; Deeks, SG; Dorrell, L; Gatell, J; Haase, A; Klein, M; Lazzarin, A; McMichael, AJ; Papagno, L; Schacker, T; Wain-Hobson, S; Walker, BD; Youle, M. A step ahead on the HIV collaboratory. Science: 2009; 324(5932): 1264-1265 - Letter P.552. Mussini, C; Touloumi, G; Bakoyannis, G; Sabin, C; Castagna, A; Sighinolfi, L; Erikson, LE; Bratt, G; Borghi, V; Lazzarin, A; Cossarizza, A; Esposito, R. Magnitude and determinants of CD4 recovery after HAART resumption after 1 cycle of treatment interruption. J. Acquir. Immune Defic. Syndr.: 2009; 52(5): 588-594 - Article IF 2008: 4,570 PUBLICATIONS - 255 P.553. Muzio, M; Bertilaccio, MTS; Simonetti, G; Frenquelli, M; Caligaris-Cappio, F. The role of Toll-like receptors in chronic B cell malignancies. Leuk. Lymphoma: 2009; 50(10): 1573-1580 Review IF 2008: 1,939 P.554. Muzio, M; Scielzo, C; Bertilaccio, MTS; Frenquelli, M; Ghia, P; Caligaris-Cappio, F. Expression and function of toll like receptors in chronic lymphocytic leukaemia cells. Br. J. Haematol.: 2009; 144(4): 507-516 - Article IF 2008: 4,478 P.555. Nagpal, AD; Torracca, L; Fumero, A; Denti, P; Cioni, M; Alfieri, O. Concurrent prophylactic left atrial appendage exclusion: results from a randomized controlled trial pilot study. Eur. J. Cardio-Thorac. Surg.: 2009; 36(3): 553-557 - Article IF 2008: 2,181 P.556. Naldini, L. A comeback for gene therapy. Science: 2009; 326(5954): 805-806 - Short Survey IF 2008: 28,103 P.557. Naspro, R; Bachmann, A; Gilling, P; Kuntz, R; Madersbacher, S; Montorsi, F; Reich, O; Stief, C; Vavassori, I. A Review of the Recent Evidence (2006-2008) for 532-nm Photoselective Laser Vaporisation and Holmium Laser Enucleation of the Prostate. Eur. Urol.: 2009; 55(6): 1345-1357 - Review IF 2008: 6,512 P.558. Nativ, O; Witjes, JA; Hendricksen, K; Cohen, M; Kedar, D; Sidi, A; Colombo, R; Leibovitch, I. Combined ThermoChemotherapy for Recurrent Bladder Cancer After Bacillus Calmette-Guerin. J. Urol.: 2009; 182(4 SUPPL.): 1313-1317 - Article IF 2008: 3,952 P.559. Nebuloni, M; Cinque, P; Sidenius, N; Ferri, A; Lauri, E; Omodeo-Zorini, E; Zerbi, P; Vago, L. Expression of the urokinase plasminogen activator receptor (uPAR) and its ligand (uPA) in brain tissues of human immunodeficiency virus patients with opportunistic cerebral diseases. J. Neurovirol.: 2009; 15(1): 99107 - Article IF 2008: 1,858 P.560. Nigro, EA; Brini, AT; Soprana, E; Ambrosi, A; Dombrowicz, D; Siccardi, AG; Vangelista, L. Antitumor IgE adjuvanticity: key role of Fc epsilon RI. J. Immunol.: 2009; 183: 4530-4536 Article IF 2008: 6,000 P.561. Nobile, M; Rusconi, M; Bellina, M; Marino, C; Giorda, R; Carlet, O; Vanzin, L; Molteni, M; Battaglia, M. The influence of family structure, the TPH2 G-703T and the 5-HTTLPR serotonergic genes upon affective problems in children aged 10-14 years. J. Child Psychol. Psychiatry : 2009; 50(3): 317-325 - Article IF 2008: 4,854 P.562. Nocerino, V; Colombo, C; Bonfanti, R; Iafusco, D; Barbetti, F. Mutations in IAPP and NEUROG3 genes are not a common cause of permanent neonatal/infancy/childhood-onset diabetes. Diabetic Med.: 2009; 26(6): 660-661 - Letter IF 2008: 3,172 P.563. O’Connor, P; Filippi, M; Arnason, B; Comi, G; Cook, S; Goodin, D; Hartung, HP; Jeffery, D; Kappos, L; Boateng, F; Filippov, V; Groth, M; Knappertz, V; Kraus, C; Sandbrink, R; Pohl, C; Bogumil, T. 250 ?g or 500 ?g interferon beta-1b versus 20 mg glatiramer acetate in relapsing-remitting multiple sclerosis: a prospective, randomised, multicentre study. Lancet Neurol.: 2009; 8(10): 889-897 - Article IF 2008: 14,270 P.564. Olgiati, P; Mandelli, L; Lorenzi, C; Marino, E; Adele, P; Ferrari, B; De Ronchi, D; Serretti, A. Schizophrenia: Genetics, prevention and rehabilitation: Review article. Acta Neuropsychiatr.: 2009; 21(3): 109-120 - Review IF 2008: 1,380 P.565. Origoni, M; Cavoretto, P; Conti, E; Ferrari, A. Isolated tubal torsion in pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol.: 2009; 146(2): 116-120 - Review IF 2008: 1,565 P.566. Orru, V; Tsai, SJ; Rueda, B; Fiorillo, E; Stanford, SM; Dasgupta, J; Hartiala, J; Zhao, L; Ortego-Centeno, N; D’Alfonso, S; Arnett, FC; Wu, H; Gonzalez - Gay, MA; Tsao, BP; Pons Estel, B; Alarcon - Riquelme, ME; He, Y; Zhang, ZY; Allayee, H; Chen, XS; Martin, J; Bottini, N; Danieli, G; Galeazzi, M; Sabbadini, MG; Migliaresi, S; Domenico, G. A loss-of-function variant of PTPN22 is associated with reduced risk of systemic lupus erythematosus. Hum. Mol. Genet.: 2009; 18(3): 569-579 Article IF 2008: 7,249 P.567. Paciaroni, M; Agnelli, G; Caso, V; Corea, F; Ageno, W; Alberti, A; Lanari, A; Micheli, S; Bertolani, L; Venti, M; Palmerini, F; Billeci, AM; Comi, G; Previdi, P; Silvestrelli, G. Acute hyperglycemia and early hemorrhagic transformation in ischemic stroke.. Cerebrovasc. Dis.: 2009; 28(2): 119-123 - Article IF 2008: 3,041 P.568. Padeletti, L; Pappone, C; Curnis, A; Zanotto, G; Calo, L; Ricciardi, G; Pieragnoli, P; Dondina, C; Raciti, G; Michelucci, A. Product-experience reporting on endocardial defibrillation leads: A 4-year national perspective. Expert Rev. Med. Devices: 2009; 6(4): 383-388 - Article IF 2008: 2,071 P.569. Padua, L; Briani, C; Jann, S; Nobile-Orazio, E; Pazzaglia, C; Morini, A; Mondelli, M; Ciaramitaro, P; Cavaletti, G; Cocito, D; Fazio, R; Santoro, L; Galeotti, F; Carpo, M; Plasmati, R; Benedetti, L; Schenone, A; Marchettini, P; Cruccu, G. Validation of the Italian version of the Neuropathic Pain Symptom Inventory in peripheral nervous system diseases. Neurol. Sci.: 2009; 30(2): 99-106 - Article IF 2008: 1,435 P.570. Pagano, L; Valentini, CG; Posteraro, B; Girmenia, C; Ossi, C; Pan, A; Candoni, A; Nosari, A; Riva, M; Cattaneo, C; Rossini, F; Fianchi, L; Caira, M; Sanguinetti, M; Gesu, GP; Lombardi, G; Vianelli, N; Stanzani, M; Mirone, E; Pinsi, G; Facchetti, F; Manca, N; Savi, L; Mettimano, M; Selva, V; Caserta, I; Scarpellini, P; Morace, G; D’Arminio Monforte, A; Grossi, P; Giudici, D; Tortorano, AM; Bonini, A; Ricci, L; Picardi, M; Rossano, F; Fanci, R; Pecile, P; Fumagalli, L; Ferrari, L; Capecchi, PL; Romano, C; Busca, A; Barbui, A; Garzia, M; Minniti, RR; Farina, G; Montagna, MT; Bruno, F; Morelli, O; Chierichini, A; Placanica, PM; Castagnola, E; Bandettini, R; Giordano, S; Monastero, R; Tosti, ME; Rossi, MR; Spedini, P; Piane, R; Nucci, M; Pallavicini, F; Bassetti, M; Cristini, F; La Sorda, M; Viviani, M. Zygomycosis in Italy: A survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology). J. Chemother.: 2009; 21(3): 322-329 - Article IF 2008: 0,843 P.571. Palacios, S; Castano, R; Graziottin, A. Epidemiology of female sexual dysfunction. Maturitas: 2009; 63(2): 119-123 - Review IF 2008: 2,032 P.572. Palacios, S; Graziottin, A. Patient scenario: A 53-year-old woman with hypoactive sexual desire disorder. Maturitas: 2009; 63(2): 164-168 - Review IF 2008: 2,032 P.573. Palumbo, R; De Marchis, F; Pusterla, T; Conti, A; Alessio, M; Bianchi, ME. Src family kinases are necessary for cell migration induced by extracellular HMGB1. J. Leukoc. Biol.: 2009; 86(3): 617-623 - Article IF 2008: 4,605 P.574. Panaroni, C; Gioia, R; Lupi, A; Besio, R; Goldstein, SA; Kreider, J; Leikin, S; Vera, JC; Mertz, EL; Perilli, E; Baruffaldi, F; Villa, I; Farina, A; Casasco, M; Cetta, G; Rossi, A; Frattini, A; Marini, JC; Vezzoni, P; Forlino, A. In utero transplantation of 256 - SAN RAFFAELE SCIENTIFIC INSTITUTE adult bone marrow decreases perinatal lethality and rescues the bone phenotype in the knockin murine model for classical, dominant osteogenesis imperfecta. Blood: 2009; 114(2): 459-468 - Article IF 2008: 10,432 P.575. Panfoli, I; Calzia, D; Bianchini, P; Ravera, S; Diaspro, A; Candiano, G; Bachi, A; Monticone, M; Aluigi, MG; Barabino, S; Calabria, G; Rolando, M; Tacchetti, C; Morelli, A; Pepe, IM. Evidence for aerobic metabolism in retinal rod outer segment disks. Int. J. Biochem. Cell Biol.: 2009; 41(12): 2555-2565 - Article IF 2008: 4,178 P.576. Papa, M; Gaspardone, A; Fragasso, G; Ajello, S; Gioffre, G; Iamele, M; Iani, C; Margonato, A. Usefulness of Transcatheter Patent Foramen Ovale Closure in Migraineurs With Moderate to Large Right-to-Left Shunt and Instrumental Evidence of Cerebrovascular Damage. Am. J. Cardiol.: 2009; 104(3): 434-439 - Article IF 2008: 3,905 P.577. Papagno, C; Fogliata, A; Catricala, E; Miniussi, C. The lexical processing of abstract and concrete nouns. Brain Res.: 2009; 1263(C): 78-86 - Article IF 2008: 2,494 P.578. Papale, A; Cerovic, M; Brambilla, R. Viral vector approaches to modify gene expression in the brain. J. Neurosci. Methods: 2009; 185(1): 1-14 - Review IF 2008: 2,092 P.579. Papaleo, E; Unfer, V; Baillargeon, JP; Chiu, TT. Contribution of myo-inositol to reproduction. Eur. J. Obstet. Gynecol. Reprod. Biol.: 2009; 147(2): 120-123 - Review IF 2008: 1,565 P.580. Papaleo, E; Unfer, V; Baillargeon, JP; Fusi, F; Occhi, F; De Santis, L. Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles A prospective, controlled, randomized trial. Fertil. Steril.: 2009; 91(5): 1750-1754 - Article IF 2008: 4,167 P.581. Pappalardo, F; Maj, G; Scandroglio, A; Sampietro, F; Zangrillo, A; Koster, A. Bioline® heparin-coated ECMO with bivalirudin anticoagulation in a patient with acute heparin-induced thrombocytopenia: The immune reaction appeared to continue unabated. PERFUSION-UK: 2009; 24(2): 135-137 - Article IF 2008: 0,667 P.582. Pappone, C; Radinovic, A; Manguso, F; Vicedomini, G; Sala, S; Sacco, FM; Ciconte, G; Saviano, M; Ferrari, M; Sommariva, E; Sacchi, S; Ciaccio, C; Kallergis, EM; Santinelli, V. New-onset atrial fibrillation as first clinical manifestation of latent Brugada syndrome: Prevalence and clinical significance. Eur. Heart J.: 2009; 30(24): 2985-2992 - Article IF 2008: 8,917 P.583. Pappone, C; Santinelli, V. Where are we with atrial fibrillation ablation?. Rev. Esp. Cardiol.: 2009; 62(10): 1087-1091 Editorial IF 2008: 2,880 P.584. Paradiso, A; Mangia, A; Orlando, C; Verderio, P; Belfiglio, M; Marchetti, A; Bertario, L; Chiappetta, G; Gion, M; Tonini, GP; Podo, F; Vocaturo, A; Silvestrini, R; Romani, M; Belloni, E; Cavallo, D; Ulivi, P; Tommasi, S; Steffan, A; Russo, A; Alessio, M; Calistri, D; Zancan, M; Parrela, P; Broggini, M; Giuseppe, A; Buttitta, F; Finocchiaro, G; Mazzocco, K; Veronesi, G; Landuzzi, L; Benevolo, M; Mariani, L; De Marco, F; Venuti, A; Giannelli, G; Quaranta, M; Trojano, V. The Integrated Oncology Program of the Italian Ministry of Health. Analytical and clinical validation of new biomarkers for early diagnosis: network, resources, methodology, quality control, and data analysis. Int. J. Biol. Markers: 2009; 24(3): 119-129 - Article IF 2008: 1,265 P.585. Paraskevis, D; Pybus, O; Magiorkinis, G; Hatzakis, A; Wensing, AMJ; van de Vijver, DA; Albert, J; Angarano, G; Asjo, B; Balotta, C; Boeri, E; Camacho, R; Chaix, ML; Coughlan, S; Costagliola, D; De Luca, A; de Mendoza, C; Derdelinckx, I; Grossman, Z; Hamouda, O; Hoepelman, IM; Horban, A; Korn, K; Kucherer, C; Leitner, T; Loveday, C; MacRae, E; Maljovic-Berry, I; Meyer, L; Nielsen, C; Op de Coul, ELM; Ormaasen, V; Perrin, L; Puchhammer-Stockl, E; Ruiz, L; Salminen, MO; Schmit, JC; Schuurman, R; Soriano, V; Stanczak, J; Stanojevic, M; Struck, D; Van Laethem, K; Violin, M; Yerly, S; Zazzi, M; Boucher, CA; Vandamme, AM. Tracing the HIV-1 subtype B mobility in Europe: A phylogeographic approach. Retrovirology: 2009; 6: 49 - Article IF 2008: 4,042 P.586. Parisi, MR; Soldini, L; Di Perri, G; Tiberi, S; Lazzarin, A; Lillo, FB. Offer of rapid testing and alternative biological samples as practical tools to implement HIV screening programs. New Microbiol.: 2009; 32(4): 391-396 - Article IF 2008: 0,912 P.587. Parker, MJ; Xue, S; Alexander, JJ; Wasserfall, CH; Campbell-Thompson, ML; Battaglia, M; Gregori, S; Mathews, CE; Song, S; Troutt, M; Eisenbeis, S; Williams, J; Schatz, DA; Haller, MJ; Atkinson, MA. Immune depletion with cellular mobilization imparts immunoregulation and reverses autoimmune diabetes in nonobese diabetic mice. Diabetes: 2009; 58(10): 2277-2284 - Article IF 2008: 8,398 P.588. Pastorino, U; Landoni, C; Marchianò, A; Calabrò, E; Sozzi, G; Miceli, R; Picchio, M; Mariani, L; Messa, C; Fazio, F. Fluorodeoxyglucose uptake measured by positron emission tomography and standardized uptake value predicts long-term survival of CT screening detected lung cancer in heavy smokers. J. Thorac. Oncol.: 2009; 4(11): 1352-1356 - Article IF 2008: 3,508 P.589. Paul, L; Cattaneo, M; D’Angelo, A; Sampietro, F; Fermo, I; Razzari, C; Fontana, G; Eugene, N; Jacques, PF; Selhub, J. Telomere length in peripheral blood mononuclear cells is associated with folate status in men. J. Nutr.: 2009; 139(7): 1273-1278 Article IF 2008: 3,647 P.590. Paulesu, E; Vallar, G; Berlingeri, M; Signorini, M; Vitali, P; Burani, C; Perani, D; Fazio, F. Supercalifragilisticexpialidocious: How the brain learns words never heard before. Neuroimage: 2009; 45(4): 1368-1377 - Article IF 2008: 5,694 P.591. Pellegrini, G; Rama, P; Mavilio, F; De Luca, M. Epithelial stem cells in corneal regeneration and epidermal gene therapy. J.Pathol.: 2009; 217(2): 217-228 - Review IF 2008: 5,121 P.592. Penzo, M; Massa, PE; Olivotto, E; Bianchi, F; Borzi, RM; Hanidu, A; Xiang, LI; Jun, LI; Marcu, KB. Sustained NF-kB activation produces a short-term cell proliferation block in conjunction with repressing effectors of cell cycle progression controlled by E2F or FoxM1. J. Cell. Physiol.: 2009; 218(1): 215-227 - Article IF 2008: 4,313 P.593. Perna, L; Fiorino, C; Cozzarini, C; Broggi, S; Cattaneo, GM; De Cobelli, F; Mangili, P; Di Muzio, N; Calandrino, R. Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma: A comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy. Radiother. Oncol.: 2009; 93(1): 57-63 - Article IF 2008: 3,990 P.594. Perseghin, G. Viewpoints on the way to a consensus session: where does insulin resistance start? The liver. Diabetes Care: 2009; 32(Suppl2): S164-S167 - Review IF 2008: 7,349 P.595. Perseghin, G; Caumo, A; Lattuada, G; De Cobelli, F; Ntali, G; Esposito, A; Belloni, E; Canu, T; Ragogna, F; Scifo, P; Del Maschio, A; Luzi, L. Elevated fasting plasma C-peptide PUBLICATIONS - 257 occurs in non-diabetic individuals with fatty liver, irrespective of insulin resistance. Diabetic Med.: 2009; 26(9): 847-854 - Article IF 2008: 3,172 P.596. Perseghin, G; De Cobelli, F; Esposito, A; Belloni, E; Lattuada, G; Canu, T; Invernizzi, PL; Ragogna, F; La Torre, A; Scifo, P; Alberti, G; Del Maschio, A; Luzi, L. Left ventricular function and energy metabolism in middle-age men undergoing long lasting sustained aerobic oxidative training. Heart: 2009; 95(8): 630-635 - Article IF 2008: 4,964 P.597. Perseghin, G; Lattuada, G; Ragogna, F; Alberti, G; La Torre, A; Luzi, L. Free leptin index and thyroid function in male highly trained athletes. Eur. J. Endocrinol.: 2009; 161(6): 871876 - Article IF 2008: 3,791 P.598. Peters, L; Mocroft, A; Soriano, V; Rockstroh, JK; Losso, M; Valerio, L; Aldins, P; Reiss, P; Ledergerber, B; Lundgren, JD; EuroSIDA Study Group. Hepatitis C virus coinfection does not influence the CD4 cell recovery in HIV-1-infected patients with maximum virologic suppression. JAIDS: 2009; 50(5): 457-463 Article IF 2008: 4,570 P.599. Picchio, M; Crivellaro, C; Giovacchini, G; Gianolli, L; Messa, C. PET-CT for treatment planning in prostate cancer. Q J Nucl Med Mol Imaging: 2009; 53(2): 245-268 - Review IF 2008: 2,640 P.600. Picozzi, P; Wang, F; Cronk, K; Ryan, K. Eomesodermin requires transforming growth factor-?/activin signaling and binds Smad2 to activate mesodermal genes. J. Biol. Chem.: 2009; 284(4): 2397-2408 - Article IF 2008: 5,520 P.601. Piemonti, L; Calori, G; Lattuada, G: Mercalli, A; Ragogna, F; Garancini, MP; Ruotolo, G; Luzi, L; Perseghin, G. Association between plasma monocyte chemoattractant protein-1 concentration and cardiovascular disease mortality in middle-aged diabetic and nondiabetic individuals. Diabetes Care: 2009; 32(11): 2105-2110 - Article IF 2008: 7,349 P.602. Pievani, M; Rasser, PE; Galluzzi, S; Benussi, L; Ghidoni, R; Sabattoli, F; Bonetti, M; Binetti, G; Thompson, PM; Frisoni, GB. Mapping the effect of APOE ?4 on gray matter loss in Alzheimer’s disease in vivo. Neuroimage: 2009; 45(4): 10901098 - Article IF 2008: 5,694 P.603. Pizzi, RMR; Rossetti, D; Cino, G; Marino, D; Vescovi, AL; Baer, W. A cultured human neural network operates a robotic actuator. BioSystems: 2009; 95(2): 137-144 - Article IF 2008: 1,477 P.604. Plati, T; Visigalli, I; Capotondo, A; Buono, M; Naldini, L; Cosma, MP; Biffi, A. Development and maturation of invariant NKT cells in the presence of lysosomal engulfment. Eur. J. Immunol.: 2009; 39(10): 2748-2754 - Article IF 2008: 4,865 P.605. Pluchino, S; Gritti, A; Blezer, E; Amadio, S; Brambilla, E; Borsellino, G; Cossetti, C; Del Carro, U; Comi, G; ‘T Hart, B; Vescovi, A; Martino, G. Human neural stem cells ameliorate autoimmune encephalomyelitis in non-human primates. Ann. Neurol.: 2009; 66(3): 343-354 - Article IF 2008: 9,935 P.606. Pluchino, S; Zanotti, L; Brambilla, E; Rovere-Querini, P; Capobianco, A; Alfaro-Cervello, C; Salani, G; Cossetti, C; Borsellino, G; Battistini, L; Ponzoni, M; Doglioni, C; GarciaVerdugo, JM; Comi, G; Manfredi, AA; Martino, G. Immune regulatory neural stem/precursor cells protect from central nervous system autoimmunity by restraining dendritic cell function. PLoS One: 2009; 4(6): e5959 - Article P.607. Pluchino, S; Zanotti, L; Brini, E; Ferrari, S; Martino, G. Regeneration and repair in multiple sclerosis: The role of cell transplantation. Neurosci. Lett.: 2009; 456(3): 101-106 - Review IF 2008: 2,200 P.608. Poggi, A; Catellani, S; Garuti, A; Pierri, I; Gobbi, M; Zocchi, MR. Effective in vivo induction of NKG2D ligands in acute myeloid leukaemias by all-trans-retinoic acid or sodium valproate. Leukemia: 2009; 23(4): 641-648 - Article IF 2008: 8,634 P.609. Poggi, A; Catellani, S; Musso, A; Zocchi, MR. Gammadelta T lymphocytes producing IFN? and IL-17 in response to Candida albicans or mycobacterial antigens: Possible implications for acute and chronic inflammation. Curr. Med. Chem.: 2009; 16(35): 4743-4749 - Review IF 2008: 4,823 P.610. Pontiroli, AE; Frige, F; Paganelli, M; Folli, F. In morbid obesity, metabolic abnormalities and adhesion molecules correlate with visceral fat, not with subcutaneous fat: Effect of weight loss through surgery. Obes. Surg.: 2009; 19(6): 745-750 - Article IF 2008: 2,913 P.611. Ponzoni, D; Dolcetti, R; Doglioni, C; Ferreri, AJM. Bugs and marginal zone lymphoma of the ocular adnexae: Is the future already here?. Blood: 2009; 114(16): 3499 - Letter IF 2008: 10,432 P.612. Porcelli, S; Bosia, M; Marino, E; Angelone, SM; Smeraldi, E; Cavallaro, R. P.3.14 Association study of COMT Val108/158Met polymorphism and treatment response to haloperidol, risperidone and clozapine. Eur. Neuropsychopharmacol.: 2009; 19(SUPPL. 1): S73-S74 - Article IF 2008: 3,661 P.613. Porst, H; McVary, KT; Montorsi, F; Sutherland, P; ElionMboussa, A; Wolka, AM; Viktrup, L. Effects of Once-Daily Tadalafil on Erectile Function in Men with Erectile Dysfunction and Signs and Symptoms of Benign Prostatic Hyperplasia. Eur. Urol.: 2009; 56(4): 727-736 - Article IF 2008: 6,512 P.614. Portaccio, E; Goretti, B; Lori, S; Zipoli, V; Centorrino, S; Ghezzi, A; Patti, F; Bianchi, V; Comi, G; Trojano, M; Amato, MP; Falcini, M; Moiola, L; Falautano, M; De Caro, MF; Lopez, M; Vecchio, R; Grossi, P; Bertolotto, A; Giampaolo, S; Pozzilli, C; Bianchi, V; Manca, I; Masia, C; Bergamaschi, R; Veggiotti, P; Roscio, M; Contri, V; Gallo, P. The brief neuropsychological battery for children: A screening tool for cognitive impairment in childhood and juvenile multiple sclerosis. Mult. Scler.: 2009; 15(5): 620-626 - Article IF 2008: 3,312 P.615. Potkin, SG; Guffanti, G; Lakatos, A; Turner, JA; Kruggel, F; Fallon, JH; Saykin, AJ; Orro, A; Lupoli, S; Salvi, E; Weiner, M; Macciardi, F. Hippocampal atrophy as a quantitative trait in a genome-wide association study identifying novel susceptibility genes for Alzheimer’s Disease. PLoS ONE: 2009; 4(8): e6501 Article P.616. Price, AJ; Marzetta, F; Lammers, M; Ylinen, LMJ; Schaller, T; Wilson, SJ; Towers, GJ; James, LC. Active site remodeling switches HIV specificity of antiretroviral TRIMCyp. Nat. Struct. Mol. Biol.: 2009; 16(10): 1036-1042 - Article IF 2008: 10,987 P.617. Prosper, L; Redaelli, S; Pasi, M; Zarone, F; Radaelli, G; Gherlone, EF. A randomized prospective multicenter trial evaluating the platform-switching technique for the prevention of postrestorative crestal bone loss. Int. J. Oral Maxillofac. Implants: 2009; 24(2): 299-308 - Article IF 2008: 1,972 P.618. Pucci, F; Venneri, MA; Biziato, D; Nonis, A; Moi, D; Sica, A; Di Serio, C; Naldini, L; De Palma, M. A distinguishing gene signature shared by tumor-infiltrating Tie2-expressing monocytes, blood “resident” monocytes, and embryonic macrophages suggests common functions and developmental relationships. Blood: 2009; 114(4): 901-914 - Article 258 - SAN RAFFAELE SCIENTIFIC INSTITUTE IF 2008: 10,432 P.619. Pusterla, T; De Marchis, F; Palumbo, R; Bianchi, ME. High mobility group B2 is secreted by myeloid cells and has mitogenic and chemoattractant activities similar to high mobility group B1. Autoimmunity: 2009; 42(4): 308-310 - Article IF 2008: 2,525 P.620. Quill, JL; Hill, AJ; Laske, TG; Alfieri, O; Iaizzo, PA. Mitral leaflet anatomy revisited. J. Thorac. Cardiovasc. Surg.: 2009; 137(5): 1077-1081 - Article IF 2008: 3,037 P.621. Rabbone, I; Scaramuzza, A; Bobbio, A; Bonfanti, R; Iafusco, D; Lombardo, F, Toni, S; Tumini, S; Cerutti, F. Insulin pump therapy management in very young children with type 1 diabetes using continuous subcutaneous insulin infusion. Diabetes Technol. Ther. : 2009; 11(11): 707-709 - Article IF 2008: 2,127 P.622. Raggi, A; Perani, D; Giaccone, G; Iannaccone, S; Manconi, M; Zucconi, M; Garibotto, V; Marcone, A; Zamboni, M; Limido, L; Tagliavini, F; Ferini-Strambi, L; Cappa, SF. The behavioural features of fatal familial insomnia: A new Italian case with pathological verification. Sleep Med.: 2009; 10(5): 581-585 - Article IF 2008: 3,163 P.623. Rama, P; Di Matteo, F; Matuska, S; Paganoni, G; Spinelli, A. Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use. J. Cataract. Refract. Surg.: 2009; 35(4): 788-791 - Article IF 2008: 2,508 P.624. Raman, JD; Ng, CK; Shariat, SF; Margulis, V; Montorsi, F; Karakiewicz, P. Outcomes for patients with pTO disease after radical nephroureterectomy for upper-tract urothelial carcinoma. BJU Int.: 2009; 103(1): 3-4 - Note IF 2008: 2,704 P.625. Rancati, T; Fiorino, C; Sanguineti, G. NTCP Modeling of Subacute/Late Laryngeal Edema Scored by Fiberoptic Examination. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 75(3): 915-923 Article IF 2008: 4,639 P.626. Ranzato, E; Grosso, S; Patrone, M; Betta, PG; Viarengo, A; Biffo, S. Spreading of mesothelioma cells is rapamycin-sensitive and requires continuing translation. J.Cell.Biochem.: 2009; 108(4): 867-876 - Article IF 2008: 3,540 P.627. Rejman, J; Colombo, C; Conese, M. Engraftment of Bone Marrow-derived Stem Cells to the Lung in a Model of Acute Respiratory Infection by Pseudomonas aeruginosa. Molecular Therapy: 2009; 17(7): 1257-1265 - Article IF 2008: 5,970 P.628. Remzi, M; Haitel, A; Margulis, V; Karakiewizc, P; Montorsi, F; Kikuchi, E; Zigeuner, R; Weizer, A; Bolenz, C; Bensalah, K; Suardi, N; Raman, JD; Lotan, Y; Waldert, M; Ng, CK; Fernandez, M; Koppie, TM; Strobel, P; Kabbani, W; Murai, M; Langner, C; Roscigno, M; Wheat, J; Guo, CC; Wood, CG; Shariat, SF. Tumour architecture is an independent predictor of outcomes after nephroureterectomy: A multi-institutional analysis of 1363 patients. BJU Int.: 2009; 103(3): 307-311 - Article IF 2008: 2,704 P.629. Reni, M; Cereda, S; Balzano, G; Passoni, P; Rognone, A; Fugazza, C; Mazza, E; Zerbi, A; Di Carlo, V; Villa, E. Carbohydrate antigen 19-9 change during chemotherapy for advanced pancreatic adenocarcinoma. Cancer: 2009; 115(12): 2630-2639 Article IF 2008: 5,238 P.630. Reni, M; Cereda, S; Balzano, G; Passoni, P; Rognone, A; Zerbi, A; Nicoletti, R; Mazza, E; Arcidiacono, PG; Di Carlo, V; Villa, E. Outcome of upfront combination chemotherapy followed by chemoradiation for locally advanced pancreatic adeno- carcinoma. Cancer Chemother. Pharmacol.: 2009; 64(6): 12531259 - Article IF 2008: 2,740 P.631. Rizzolio, F; Pramparo, T; Sala, C; Zuffardi, O; De Santis, L; Rabellotti, E; Calzi, F; Fusi, F; Bellazzi, R; Toniolo, D. Epigenetic analysis of the critical region I for premature ovarian failure: Demonstration of a highly heterochromatic domain on the long arm of the mammalian X chromosome. J. Med. Genet.: 2009; 46(9): 585-592 - Article IF 2008: 5,713 P.632. Rizzoni, D; De Ciuceis, C; Porteri, E; Paiardi, S; Boari, GEM; Mortini, P; Cornali, C; Cenzato, M; Rodella, LF; Borsani, E; Rizzardi, N; Platto, C; Rezzani, R; Rosei, EA. Altered structure of small cerebral arteries in patients with essential hypertension. J. Hypertens.: 2009; 27(4): 838-845 - Article IF 2008: 5,132 P.633. Rizzuto, R; Marchi, S; Bonora, M; Aguiari, P; Bononi, A; De Stefani, D; Giorgi, C; Leo, S; Rimessi, A; Siviero, R; Zecchini, E; Pinton, P. Ca2+ transfer from the ER to mitochondria: When, how and why. Biochim. Biophys. Acta-Bioenerg.: 2009; 1787(11): 1342-1351 - Review IF 2008: 4,447 P.634. Robach, P; Recalcati, S; Girelli, D; Gelfi, C; Aachmann-Andersen, NJ; Thomsen, JJ; Norgaard, AM; Alberghini, A; Campostrini, N; Castagna, A; Viganò, A; Santambrogio, P; Kempf, T; Wollert, KC; Moutereau, S; Lundby, C; Cairo, G. Alterations of systemic and muscle iron metabolism in human subjects treated with low-dose recombinant erythropoietin. Blood: 2009; 113(26): 6707-6715 - Article IF 2008: 10,432 P.635. Rocca, MA; Absinta, M; Ghezzi, A; Moiola, L; Comi, G; Filippi, M. Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?. Hum. Brain Mapp.: 2009; 30(9): 2844-2851 - Article IF 2008: 5,395 P.636. Rocca, MA; Absinta, M; Valsasina, P; Ciccarelli, O; Marino, S; Rovira, A; Gass, A; Wegner, C; Enzinger, C; Korteweg, T; Sormani, MP; Mancini, L; Thompson, AJ; De Stefano, N; Montalban, X; Hirsch, J; Kappos, L; Ropele, S; Palace, J; Barkhof, F; Matthews, PM; Filippi, M. Abnormal connectivity of the sensorimotor network in patients with MS: A multicenter fMRI study. Hum. Brain Mapp.: 2009; 30(8): 2412-2425 - Article IF 2008: 5,395 P.637. Rocca, MA; Gatti, R; Agosta, F; Broglia, P; Rossi, P; Riboldi, E; Corti, M; Comi, G; Filippi, M. Influence of task complexity during coordinated hand and foot movements in MS patients with and without fatigue - A kinematic and functional MRI study. J. Neurol.: 2009; 256(3): 470-482 - Article IF 2008: 2,536 P.638. Rocca, MA; Valsasina, P; Ceccarelli, A; Absinta, M; Ghezzi, A; Riccitelli, G; Pagani, E; Falini, A; Comi, G; Scotti, G; Filippi, M. Structural and functional MRI correlates of stroop control in benign MS. Hum. Brain Mapp.: 2009; 30(1): 276-290 - Article IF 2008: 5,395 P.639. Roehrborn, CG; Siami, P; Barkin, J; Damiao, R; Becher, E; Minana, B; Mirone, V; Castro, R; Wilson, T; Montorsi, F. The Influence of Baseline Parameters on Changes in International Prostate Symptom Score with Dutasteride, Tamsulosin, and Combination Therapy among Men with Symptomatic Benign Prostatic Hyperplasia and an Enlarged Prostate: 2-Year Data from the CombAT Study. Eur. Urol.: 2009; 55(2): 461-471 - Article IF 2008: 6,512 P.640. Romanos, GE; Gutknecht, N; Dieter, S; Schwarz, F; Crespi, R; Sculean, A. Laser wavelengths and oral implantology. Lasers Med. Sci.: 2009; 24(6): 961-970 - Review IF 2008: 1,675 P.641. Roscigno, M; Shariat, SF; Freschi, M; Margulis, V; PUBLICATIONS - 259 Karakiewizc, P; Suardi, N; Remzi, M; Zigeuner, R; Bolenz, C; Kikuchi, E; Weizer, A; Bensalah, K; Sagalowsky, A; Koppie, TM; Raman, J; Fernandez, M; Strobel, P; Kabbani, W; Langner, C; Wheat, J; Guo, CC; Kassouf, W; Haitel, A; Wood, CG; Montorsi, F. Assessment of the Minimum Number of Lymph Nodes Needed to Detect Lymph Node Invasion at Radical Nephroureterectomy in Patients With Upper Tract Urothelial Cancer. Urology: 2009; 74(5): 1070-1074 - Article IF 2008: 2,242 P.642. Roscigno, M; Shariat, SF; Margulis, V; Karakiewicz, P; Remzi, M; Kikuchi, E; Langner, C; Lotan, Y; Weizer, A; Bensalah, K; Raman, JD; Bolenz, C; Guo, CC; Wood, CG; Zigeuner, R; Wheat, J; Kabbani, W; Koppie, TM; Ng, CK; Suardi, N; Bertini, R; Fernandez, MI; Mikami, S; Isida, M; Michel, MS; Montorsi, F. Impact of Lymph Node Dissection on Cancer Specific Survival in Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy. J. Urol.: 2009; 181(6): 2482-2489 - Article IF 2008: 3,952 P.643. Roscigno, M; Shariat, SF; Margulis, V; Karakiewicz, P; Remzi, M; Kikuchi, E; Zigeuner, R; Weizer, A; Sagalowsky, A; Bensalah, K; Raman, JD; Bolenz, C; Kassou, W; Koppie, TM; Wood, CG; Wheat, J; Langner, C; Ng, CK; Capitanio, U; Bertini, R; Fernàndez, MI; Mikami, S; Isida, M; Ströbel, P; Montorsi, F. The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed?. Eur. Urol.: 2009; 56(3): 512-519 - Article IF 2008: 6,512 P.644. Rossetti, R; Pasquale, ED; Marozzi, A; Bione, S; Toniolo, D; Grammatico, P; Nelson, LM; Beck-Peccoz, P; Persani, L. BMP15 mutations associated with primary ovarian insufficiency cause a defective production of bioactive protein. Hum. Mutat.: 2009; 30(5): 804-810 - Article IF 2008: 7,033 P.645. Rossi, CM; Di Comite, G. The clinical spectrum of the neurological involvement in vasculitides. J. Neurol. Sci.: 2009; 285(1-2): 13-21 - Review IF 2008: 2,359 P.646. Rossi, S; Furlan, R; De Chiara, V; Musella, A; Lo Giudice, T; Mataluni, G; Cavasinni, F; Cantarella, C; Bernardi, G; Muzio, L; Martorana, A; Martino, G; Centonze, D. Exercise attenuates the clinical, synaptic and dendritic abnormalities of experimental autoimmune encephalomyelitis. Neurobiol. Dis.: 2009; 36(1): 51-59 - Article IF 2008: 4,852 P.647. Rovaris, M; Agosta, F; Pagani, E; Filippi, M. Diffusion Tensor MR Imaging. Neuroimaging Clin. N. Am.: 2009; 19(1): 37-43 - Review IF 2008: 1,532 P.648. Rovaris, M; Barkhof, F; Calabrese, M; De Stefano, N; Fazekas, F; Miller, DH; Montalban, X; Polman, C; Rocca, MA; Thompson, AJ; Yousry, TA; Filippi, M. MRI features of benign multiple sclerosis Toward a new definition of this disease phenotype. Neurology: 2009; 72(19): 1693-1701 - Review IF 2008: 7,043 P.649. Rovira, A; Swanton, J; Tintore, M; Huerga, E; Barkhof, F; Filippi, M; Frederiksen, JL; Langkilde, A; Miszkiel, K; Polman, C; Rovaris, M; Sastre-Garriga, J; Miller, D; Montalban, X. A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Arch. Neurol.: 2009; 66(5): 587-592 - Article IF 2008: 5,874 P.650. Rubartelli, A; Sitia, R. Chemo-metabolic regulation of immune responses by Tregs. Nat. Chem. Biol.: 2009; 5(10): 709-710 - Short Survey IF 2008: 14,612 P.651. Rubinacci, A. Expanding the functional spectrum of vitamin K in bone. Focus on: “Vitamin K promotes mineralization, os- teoblast to osteocyte transition, and an anti-catabolic phenotype by Î?-carboxylation-dependent and -independent mechanisms”. Am. J. Physiol.-Cell Physiol.: 2009; 297(6): C1336-C1338 - Editorial IF 2008: 4,230 P.652. Ruddell, RG; Hoang-Le, D; Barwood, JM; Rutherford, PS; Piva, TJ; Watters, DJ; Santambrogio, P; Arosio, P; Ramm, GA. Ferritin functions as a proinflammatory cytokine via iron-independent protein kinase C zeta/nuclear factor kappaB-regulated signaling in rat hepatic stellate cells. Hepatology: 2009; 49(3): 887-900 - Article IF 2008: 11,355 P.653. Rusnati, M; Vicenzi, E; Donalisio, M; Oreste, P; Landolfo, S; Lembo, D. Sulfated K5 Escherichia coli polysaccharide derivatives: A novel class of candidate antiviral microbicides. Pharmacol. Ther.: 2009; 123(3): 310-322 - Review IF 2008: 9,443 P.654. Saccuman, MC; Scifo, P. Using MRI to characterize the anatomy and function of the auditory cortex in infancy. Ann.NY Acad.Sci.: 2009; 1169(): 297-307 - Conference Paper IF 2008: 2,303 P.655. Salmon, E; Kerrouche, N; Perani, D; Lekeu, F; Holthoff, V; Beuthien-Baumann, B; Sorbi, S; Lemaire, C; Collette, F; Herholz, K. On the multivariate nature of brain metabolic impairment in Alzheimer’s disease. Neurobiol. Aging: 2009; 30(2): 186-197 - Article IF 2008: 5,959 P.656. Salomon, G; Isbarn, H; Budaeus, L; Schlomm, T; Briganti, A; Steuber, T; Heinzer, H; Haese, A; Graefen, M; Karakiewicz, PI; Huland, H; Chun, F. Importance of baseline potency rate assessment of men diagnosed with clinically localized prostate cancer prior to radical prostatectomy. J. Sex. Med.: 2009; 6(2): 498504 - Article IF 2008: 5,393 P.657. Salomoni, G; Grassi, M; Mosini, P; Riva, P; Cavedini, P; Bellodi, L. Artificial neural network model for the prediction of obsessive-compulsive disorder treatment response. J. Clin. Psychopharmacol.: 2009; 29(4): 343-349 - Article IF 2008: 4,371 P.658. Salonia, A. Is ED Still Only Equal to ED?. Eur. Urol.: 2009; 55(4): 794-797 - Editorial IF 2008: 6,512 P.659. Salonia, A; Briganti, A; Gallina, A; Karakiewicz, P; Shariat, S; Freschi, M; Zanni, G; Capitanio, U; Bosi, E; Rigatti, P; Montorsi, F. Sex Hormone-binding Globulin: A Novel Marker for Nodal Metastases Prediction in Prostate Cancer Patients Undergoing Extended Pelvic Lymph Node Dissection. Urology: 2009; 73(4): 850-855 - Article IF 2008: 2,242 P.660. Salonia, A; Gallina, A; Matloob, R; Rocchini, L; Sacca, A; Abdollah, F; Colombo, R; Suardi, N; Briganti, A; Guazzoni, G; Rigatti, P; Montorsi, F. Is Sperm Banking of Interest to Patients With Nongerm Cell Urological Cancer Before Potentially Fertility Damaging Treatments?. J. Urol.: 2009; 182(3): 1101-1107 Article IF 2008: 3,952 P.661. Salonia, A; Matloob, R; Gallina, A; Abdollah, F; Sacca, A; Briganti, A; Suardi, N; Colombo, R; Rocchini, L; Guazzoni, G; Rigatti, P; Montorsi, F. Are Infertile Men Less Healthy than Fertile Men? Results of a Prospective Case-Control Survey. Eur. Urol.: 2009; 56(6): 1025-1032 - Article IF 2008: 6,512 P.662. Salonia, A; Sacca, A; Briganti, A; Del Carro, U; Dehò, F; Zanni, G; Rocchini, L; Raber, M; Guazzoni, G; Rigatti, P; Montorsi, F. Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: A case-controlled study. J. Sex. Med.: 2009; 6(6): 1755-1762 - Article IF 2008: 5,393 260 - SAN RAFFAELE SCIENTIFIC INSTITUTE P.663. Salvatoni, A; Veronelli; E; Nosetti, L; Berini, J; de Simone, S; Iughetti, L; Bosio, L; Chiumello, G; Grugni, G; Delù, G; Castelnuovo, P; Trifirò, G; Nespoli, L. Short-term effects of growth hormone treatment on the upper airways of non severely obese children with Prader-Willi syndrome. J. Endocrinol. Invest.: 2009; 32(7): 601-605 - Article IF 2008: 1,888 P.664. Santambrogio, R; Aldrighetti, L; Barabino, M; Pulitano, C; Costa, M; Montorsi, M; Ferla, G; Opocher, E. Laparoscopic liver resections for hepatocellular carcinoma Is it a feasible option for patients with liver cirrhosis?. Langenbecks Arch. Surg.: 2009; 394(2): 255-264 - Article IF 2008: 1,577 P.665. Santinelli, V; Radinovic, A; Manguso, F; Vicedomini, G; Gulletta, S; Paglino, G; Mazzone, P; Ciconte, G; Sacchi, S; Sala, S; Pappone, C. The Natural History of Asymptomatic Ventricular Pre-Excitation A Long-Term Prospective Follow-Up Study of 184 Asymptomatic Children. J. Am. Coll. Cardiol.: 2009; 53(3): 275-280 - Article IF 2008: 11,438 P.666. Santoro, MM; Bertoli, A; Lorenzini, P; Ceccherini-Silberstein, F; Gianotti, N; Mussini, C; Torti, C; Di Perri, G; Barbarini, G; Bini, T; Melzi, S; Caramello, P; Maserati, R; Narciso, P; Micheli, V; Antinori, A; Perno, CF. Two Different Patterns of Mutations are Involved in the Genotypic Resistance Score for Atazanavir Boosted Versus Unboosted by Ritonavir in Multiple Failing Patients. Infection: 2009; 37(3): 233-243 - Article IF 2008: 1,831 P.667. Sauer, AV; Aiuti, A. New insights into the pathogenesis of adenosine deaminase-severe combined immunodeficiency and progress in gene therapy. Curr Opin Allergy Clin Immunol.: 2009; 9(6): 496-502 - Review IF 2008: 3,497 P.668. Sauer, AV; Mrak, E; Jofra Hernandez, R; Zacchi, E; Cavani, F; Casiraghi, M; Grunebaum, E; Roifman, CM; Cervi, MC; Ambrosi, A; Carlucci, F; Roncarolo, MG; Villa, A; Rubinacci, A; Aiuti, A. ADA-deficient SCID is associated with a specific microenvironment and bone phenotype characterized by RANKL/OPG imbalance and osteoblast insufficiency. Blood: 2009; 114(15): 3216-3226 - Article IF 2008: 10,432 P.669. Sberna, MT; Rizzo, G; Zacchi, E; Cappare, P; Rubinacci, A. A preliminary study of the use of peripheral quantitative computed tomography for investigating root canal anatomy. Int. Endod. J.: 2009; 42(1): 66-75 - Article IF 2008: 2,465 P.670. Schaaf, C; Shan, B; Buchfelder, M; Losa, M; Kreutzer, J; Rachinger, W; Stalla, GK; Schilling, T; Arzt, E; Perone, MJ; Renner, U. Curcumin acts as anti-tumorigenic and hormone-suppressive agent in murine and human pituitary tumour cells in vitro and in vivo. Endocr.-Relat. Cancer: 2009; 16(4): 1339-1350 Article IF 2008: 5,236 P.671. Schaeffer, C; Santambrogio, S; Perucca, S; Casari, G; Rampoldi, L. Analysis of uromodulin polymerization provides new insights into the mechanisms regulating ZP domain-mediated protein assembly. Mol. Biol. Cell: 2009; 20(2): 589-599 - Article IF 2008: 5,558 P.672. Schnapp, E; Pistocchi, AS; Karampetsou, E; Foglia, E; Lamia, CL; Cotelli, F; Cossu, G. Induced early expression of mrf4 but not myog rescues myogenesis in the myod/myf5 doublemorphant zebrafish embryo. J. Cell Sci.: 2009; 122(Pt 4): 481488 - Article IF 2008: 6,247 P.673. Schweizer, A; Dejager, S; Bosi, E. Comparison of vildagliptin and metformin monotherapy in elderly patients with type 2 diabetes: A 24-week, double-blind, randomized trial. Diabetes Obes. Metab.: 2009; 11(8): 804-812 - Article IF 2008: 4,259 P.674. Scocchia, L; Grosso, RA; de’Sperati, C; Stucchi, N; BaudBovy, G. Observer’s control of the moving stimulus increases the flash-lag effect. Vis. Res.: 2009; 49(19): 2363-2370 - Article IF 2008: 2,051 P.675. Scotti, C; Pozzi, A; Mangiavini, L; Vitari, F; Boschetti, F; Domeneghini, C; Fraschini, G; Peretti, GM. Healing of meniscal tissue by cellular fibrin glue: an in vivo study. Knee Surg. Sports Traumatol. Arthrosc.: 2009; 17(6): 645-651 - Article IF 2008: 1,696 P.676. Secchi, M; Xu, Q; Lusso, P; Vangelista, L. The superior folding of a RANTES analogue expressed in lactobacilli as compared to mammalian cells reveals a promising system to screen new RANTES mutants. Protein Expr. Purif.: 2009; 68(1): 34-41 - Article IF 2008: 1,621 P.677. Seidlerova, J; Staessen, JA; Bochud, M; Nawrot, T; Casamassima, N; Citterio, L; Kuznetsova, T; Jin, Y; Manunta, P; Richart, T; Struijker-Boudier, HA; Fagard, R; Filipovsky, J; Bianchi, G. Arterial properties in relation to genetic variations in the adducin subunits in a white population. Am. J. Hypertens.: 2009; 22(1): 21-26 - Article IF 2008: 3,122 P.678. Seidlerova, J; Staessen, JA; Nawrot, T; Brand, E; BrandHerrmann, SM; Casamassima, N; Citterio, L; Hasenkamp, S; Kuznetsova, T; Li, Y; Manunta, P; Richart, T; Struijker-Boudier, HA; Fagard, R; Filipovsky, J. Arterial properties in relation to genetic variation in ?-adducin and the renin-angiotensin system in a White population. J. Hum. Hypertens.: 2009; 23(1): 55-64 - Article IF 2008: 2,637 P.679. Serafini, G; Andreani, M; Testi, M; Battarra, M; Bontadini, A; Biral, E; Fleischhauer, K; Marktel, S; Lucarelli, G; Roncarolo, MG; Bacchetta, R. Type 1 regulatory T cells are associated with persistent split erythroid/lymphoid chimerism after allogeneic hematopoietic stem cell transplantation for thalassemia. Haematol-Hematol. J.: 2009; 94(10): 1415-1426 - Article IF 2008: 5,978 P.680. Serretti, A; Chiesa, A; Calati, R; Perna, G; Bellodi, L; De Ronchi, D. Common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders. Int. Clin. Psychopharmacol.: 2009; 24(1): 1-18 Article IF 2008: 2,928 P.681. Setola, E; Monti, LD; Lucotti, P; Galluccio, E; Oldani, M; Bosi, E; Piatti, P. Fasting hyperinsulinemia associates with increased sub-clinical inflammation in first-degree relatives normal glucose tolerant women independently of the metabolic syndrome. Diabetes-Metab. Res. Rev.: 2009; 25(7): 639-646 - Article IF 2008: 3,149 P.682. Shariat, SF; Capitanio, U; Jeldres, C; Karakiewicz, PI. Can nomograms be superior to other prediction tools?. BJU Int.: 2009; 103(4): 492-495 - Review IF 2008: 2,704 P.683. Shariat, SF; Karakiewicz, PI; Godoy, G; Karam, JA; Ashfaq, R; Fradet, Y; Isbarn, H; Montorsi, F; Jeldres, C; Bastian, PJ; Nielsen, ME; Muller, SC; Sagalowsky, AI; Lotan, Y. Survivin as a prognostic marker for urothelial carcinoma of the bladder: A multicenter external validation study. Clin. Cancer Res.: 2009; 15(22): 7012-7019 - Article IF 2008: 6,488 P.684. Shariat, SF; Lotan, Y; Karakiewicz, PI; Ashfaq, R; Isbarn, H; Fradet, Y; Bastian, PJ; Nielsen, ME; Capitanio, U; Jeldres, C; Montorsi, F; Muller, SC; Karam, JA; Heukamp, LC; Netto, G; Lerner, SP; Sagalowsky, AI; Cote, RJ. p53 Predictive Value for pT1-2 N0 Disease at Radical Cystectomy. J. Urol.: 2009; 182(3): 907-913 - Article PUBLICATIONS - 261 IF 2008: 3,952 P.685. Sharp, ASP; Colombo, A. An innocent bystander in the coronary tree. Eur. Heart J.: 2009; 30(15): 1893 - Article IF 2008: 8,917 P.686. Shechter, R; London, A; Varol, C; Raposo, C; Cusimano, M; Yovel, G; Rolls, A; Mack, M; Pluchino, S; Martino, G; Jung, S; Schwartz, M. Infiltrating blood-derived macrophages are vital cells playing an anti-inflammatory role in recovery from spinal cord injury in mice. PLos Med.: 2009; 6(7): e1000113 - Article IF 2008: 12,185 P.687. Sheiban, I; Sillano, D; Biondi-Zoccai, G; Chieffo, A; Colombo, A; Vecchio, S; Margheri, M; Gunn, JP; Raina, T; Liistro, F; Bolognese, L; Lee, MS; Tobis, J; Moretti, C. Incidence and Management of Restenosis After Treatment of Unprotected Left Main Disease With Drug-Eluting Stents 70 Restenotic Cases From a Cohort of 718 Patients: FAILS (Failure in Left Main Study). J. Am. Coll. Cardiol.: 2009; 54(13): 1131-1136 - Article IF 2008: 11,438 P.688. Signorelli, M; Guerra, L; Buda, A; Picchio, M; Mangili, G; Dell’Anna, T; Sironi, S; Messa, C. Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: Detection of pelvic nodal metastases. Gynecol. Oncol.: 2009; 115(2): 231-235 - Article IF 2008: 2,919 P.689. Silber, S; Colombo, A; Banning, AP; Hauptmann, K; Drzewiecki, J; Grube, E; Dudek, D; Baim, DS. Final 5-year results of the TAXUS II trial: A randomized study to assess the effectiveness of slow-and moderate-release polymer-based paclitaxel-eluting stents for de novo coronary artery lesions. Circulation: 2009; 120(15): 1498-1504 - Article IF 2008: 14,595 P.690. Silvestri, L; Guillem, F; Pagani, A; Nai, A; Oudin, C; Silva, M; Toutain, F; Kannengiesser, C; Beaumont, C; Camaschella, C; Grandchamp, B. Molecular mechanisms of the defective hepcidin inhibition in TMPRSS6 mutations associated with iron-refractory iron deficiency anemia. Blood: 2009; 113(22): 56055608 - Article IF 2008: 10,432 P.691. Sironi, C; Teesalu, T; Muggia, A; Fontana, G; Marino, F; Savaresi, S; Talarico, D. EFA6A encodes two isoforms with distinct biological activities in neuronal cells. J. Cell Sci.: 2009; 122(12): 2108-2118 - Article IF 2008: 6,247 P.692. Sitaram, A; Piccirillo, R; Palmisano, I; Harper, DC; Dell’Angelica, EC; Schiaffino, MV; Marks, MS. Localization to mature melanosomes by virtue of cytoplasmic dileucine motifs is required for human OCA2 function. Mol. Biol. Cell: 2009; 20(5): 1464-1477 - Article IF 2008: 5,558 P.693. Snyder, AM; Wang, X; Patton, SM; Arosio, P; Levi, S; Earley, CJ; Allen, RP; Connor, JR. Mitochondrial ferritin in the substantia nigra in restless legs syndrome. J. Neuropathol. Exp. Neurol.: 2009; 68(11): 1193-1199 - Article IF 2008: 5,140 P.694. Soria, A; Porten, K; Fampou-Toundji, JC; Galli, L; Mougnutou, R; Buard, V; Kfutwah, A; Vessiere, A; Roussert, D; Teck, R; Calmy, A; Ciaffi, L; Lazzarin, A; Gianotti, N. Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-1infected patients. Antivir. Ther.: 2009; 14(3): 339-347 - Article IF 2008: 4,105 P.695. Sormani, MP; Rovaris, M; Comi, G; Filippi, M. A reassessment of the plateauing relationship between T2 lesion load and disability in MS. Neurology: 2009; 73(19): 1538-1542 - Article IF 2008: 7,043 P.696. Sorrentino, R; Apicella, D; Riccio, C; Gherlone, E; Zarone, F; Aversa, R; Garcia-Godoy, F; Ferrari, M; Apicella, A. Nonlinear visco-elastic finite element analysis of different porcelain ve- neers configuration. J. Biomed. Mater. Res. B Appl. Biomater.: 2009; 91(2): 727-736 - Article IF 2008: 2,030 P.697. Sotgiu, G; Ferrara, G; Matteelli, A; Richardson, MD; Centis, R; Ruesch-Gerdes, S; Toungoussova, O; Zellweger, JP; Spanevello, A; Cirillo, D; Lange, C; Migliori, GB. Epidemiology and clinical management of XDR-TB: A systematic review by TBNET. Eur. Resp. J.: 2009; 33(4): 871-881 - Review IF 2008: 5,545 P.698. Sousa, VL; Bellani, S; Giannandrea, M; Yousuf, M; Valtorta, F; Meldolesi, J; Chieregatti, E. ?-Synuclein and its A30P mutant affect actin cytoskeletal structure and dynamics. Mol. Biol. Cell: 2009; 20(16): 3725-3739 - Article IF 2008: 5,558 P.699. Soza, S; Leva, V; Vago, R; Ferrari, G; Mazzini, G; Biamonti, G; Montecucco, A. DNA ligase I deficiency leads to replication-dependent DNA damage and impacts cell morphology without blocking cell cycle progression. Mol. Cell. Biol.: 2009; 29(8): 2032-2041 - Article IF 2008: 5,942 P.700. Spagnuolo, V; Gianotti, N; Seminari, E; Galli, L; Fusetti, G; Salpietro, S; Lazzarin, A; Castagna, A. Changes in darunavir/r resistance score after previous failure to tipranavir/r in HIV-1-infected multidrug-resistant patients. J. Acquir. Immune Defic. Syndr. : 2009; 50(2): 192-195 - Article IF 2008: 4,570 P.701. Spoladore, R; Roccaforte, R; Fragasso, G; Gardini, C; Palloshi, A; Cuko, A; Arioli, F; Salerno, A; Margonato, A. Safety and efficacy of doxazosin as an “add-on” antihypertensive therapy in mild to moderate heart failure patients. Acta Cardiol.: 2009; 64(4): 485-491 - Article IF 2008: 0,581 P.702. Srivastava, PK; Callahan, MK; Mauri, MM. Treating human cancers with heat shock protein-peptide complexes: The road ahead. Expert Opin. Biol. Ther.: 2009; 9(2): 179-186 - Review IF 2008: 3,475 P.703. Stefano, L; Racchetti, G; Bianco, F; Passini, N; Gupta, RS; Panina Bordignon, P; Meldolesi, J. The surface-exposed chaperone, Hsp60, is an agonist of the microglial TREM2 receptor. J. Neurochem.: 2009; 110(1): 284-294 - Article IF 2008: 4,500 P.704. Stenstrom, K; Takemori, H; Bianchi, G; Katz, AI; Bertorello, AM. Blocking the salt-inducible kinase 1 network prevents the increases in cell sodium transport caused by a hypertension-linked mutation in human alpha-adducin. J. Hypertens.: 2009; 27(12): 2452-2457 - Article IF 2008: 5,132 P.705. Suardi, N; Gallina, A; Salonia, A; Briganti, A; Deho, F; Zanni, G; Abdollah, F; Naspro, R; Cestari, A; Guazzoni, G; Rigatti, P; Montorsi, F. Holmium laser enucleation of the prostate and holmium laser ablation of the prostate: Indications and outcome. Curr. Opin. Urol.: 2009; 19(1): 38-43 - Review IF 2008: 2,619 P.706. Suardi, N; Strada, E; Colombo, R; Freschi, M; Salonia, A; Lania, C; Cestari, A; Carmignani, L; Guazzoni, G; Rigatti, P; Montorsi, F. Leydig cell tumour of the testis: Presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience. BJU Int.: 2009; 103(2): 197-200 Article IF 2008: 2,704 P.707. Sung, MH; Salvatore, L; De Lorenzi, R; Indrawan, A; Pasparakis, M; Hager, GL; Bianchi, ME; Agresti, A. Sustained oscillations of NF-?B produce distinct genome scanning and gene expression profiles. PLoS ONE: 2009; 4; (9): e7163 - Article P.708. Tai, YT; Soydan, E; Song, W; Fulciniti, M; Kim, K; Hong, F; Li, XF; Burger, P; Rumizen, MJ; Nahar, S; Podar, K; Hideshima, T; Munshi, NC; Tonon, G; Carrasco, RD; Afar, DE; Anderson, KC. CS1 promotes multiple myeloma cell adhesion, 262 - SAN RAFFAELE SCIENTIFIC INSTITUTE clonogenic growth, and tumorigenicity via c-maf-mediated interactions with bone marrow stromal cells. Blood: 2009; 113(18): 4309-4318 - Article IF 2008: 10,432 P.709. Taniguchi, N; Carames, B; Ronfani, L; Ulmer, U; Komiya, S; Bianchi, ME; Lotz, M. Aging-related loss of the chromatin protein HMGB2 in articular cartilage is linked to reduced cellularity and osteoarthritis. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(4): 1181-1186 - Article IF 2008: 9,380 P.710. Taramasso, M; De Bonis, M; Lapenna, E; Verzini, A; La Canna, G; Grimaldi, A; Alfieri, O. Reverse Remodeling Effect of the CorCap Despite the Presence of Severe Mitral Regurgitation. Ann. Thorac. Surg.: 2009; 87(3): e23-e24 - Article IF 2008: 2,689 P.711. Tassi, E; Braga, M; Longhi, R; Gavazzi, F; Parmiani, G; Di Carlo, V; Protti, MP. Non-redundant role for IL-12 and IL-27 in modulating Th2 polarization of carcinoembryonic antigen specific CD4 T cells from pancreatic cancer patients. PLoS ONE: 2009; 4; (10): e7234 - Article P.712. Tedeschi, G; Amato, MP; D’Alessandro, R; Drago, F; Milanese, C; Popoli, P; Rossi, P; Savettieri, G; Tola, MR; Vanacore, N; Covezzoli, A; De Rosa, M; Comi, G; Pozzilli, C; Bertolotto, A; Marrosu, MG; Grimaldi, LM; Piccinni, C; Montanaro, N; Periotto, L; Iommelli, R; Addis, A; Martini, N; Provinciali, L; Mancardi, GL. The pharmacovigilance program on natalizumab in Italy: 2 years of experience. Neurol. Sci.: 2009; (Suppl 2): S163-S165 - Article IF 2008: 1,435 P.713. Teggi, R; Bellini, C; Piccioni, LO; Palonta, F; Bussi, M. Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction. Audiol. Neurootol.: 2009; 14(2): 115-120 Article IF 2008: 2,424 P.714. Teggi, R; Caldirola, D; Fabiano, B; Recanati, P; Bussi, M. Rehabilitation after acute vestibular disorders. J. Laryngol. Otol.: 2009; 123(4): 397-402 - Article IF 2008: 0,796 P.715. Teggi, R; Colombo, B; Bernasconi, L; Bellini, C; Comi, G; Bussi, M. Migrainous vertigo: Results of caloric testing and stabilometric findings. Headache: 2009; 49(3): 435-444 - Article IF 2008: 3,081 P.716. Testoni, PA; Mangiavillano, B; Mariani, A; Carrara, S; Notaristefano, C; Arcidiacono, PG. Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction: A pilot in vivo study. Dig. Liver Dis.: 2009; 41(12): 907-912 - Article IF 2008: 2,577 P.717. Tetè, S; Vinci, R; Zizzari, V; Cingano, L; Bollero, R; D’Apolito, G; Benzo, L; Dolci, A; Mortellaro, C; Gherlone, E. Evaluation of effects on bone tissue of different osteotomy techniques. J Craniofac Surg: 2009; 20(5): 1424-1429 - Article IF 2008: 0,716 P.718. Tetè, S; Zara, S; Vinci, R; Zizzari, V; Di Tore, U; Mastrangelo, F; Cataldi, A and Gherlone, E. Vascular endothelial growth factor and e-nitric oxide synthase-mediated regenerative response occurring upon autologous and heterologous bone grafts. Int. J. Immunopathol. Pharmacol.: 2009; 22(4): 1105-1116 - Article IF 2008: 2,793 P.719. Tettamanti, M; Rotondi, I; Perani, D; Scotti, G; Fazio, F; Cappa, SF; Moro, A. Syntax without language: Neurobiological evidence for cross-domain syntactic computations. Cortex: 2009; 45(7): 825-838 - Article IF 2008: 2,749 P.720. Teunissen, CE; Petzold, A; Bennett, JL; Berven, FS; Brundin, L; Comabella, M; Franciotta, D; Frederiksen, JL; Fleming, JO; Furlan, R; Hintzen, RQ; Hughes, SG; Johnson, MH; Krasulova, E; Kuhle, J; Magnone, MC; Rajda, C; Rejdak, K; Schmidt, HK; van Pesch, V; Waubant, E; Wolf, C; Giovannoni, G; Hemmer, B; Tumani, H; Deisenhammer, F. A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking. Neurology: 2009; 73(22): 1914-1922 - Review IF 2008: 7,043 P.721. Tibiletti, MG; Martin, V; Bernasconi, B; Del Curto, B; Pecciarini, L; Uccella, S; Pruneri, G; Ponzoni, M; Mazzucchelli, L; Martinelli, G; Ferreri, AJ; Pinotti, G; Assanelli, A; Scandurra, M; Doglioni, C; Zucca, E; Capella, C; Bertoni, F. BCL2, BCL6, MYC, MALT 1, and BCL10 rearrangements in nodal diffuse large B-cell lymphomas: a multicenter evaluation of a new set of fluorescent in situ hybridization probes and correlation with clinical outcome. Hum. Pathol.: 2009; 40(5): 645-652 - Article IF 2008: 3,322 P.722. Tjwa, M; Sidenius, N; Moura, R; Jansen, S; Theunissen, K; Andolfo, A; De Mol, M; Dewerchin, M; Moons, L; Blasi, F; Verfaillie, C; Carmeliet, P. Membrane-anchored uPAR regulates the proliferation, marrow pool size, engraftment, and mobilization of mouse hematopoietic stem/progenitor cells. J. Clin. Invest.: 2009; 119(4): 1008-1018 - Article IF 2008: 16,559 P.723. Tonti, E; Galli, G; Malzone, C; Abrignani, S; Casorati, G; Dellabona, P. NKT-cell help to B lymphocytes can occur independently of cognate interaction. Blood: 2009; 113(2): 370-376 Article IF 2008: 10,432 P.724. Torta, F; Fusi, M; Casari, CS; Bottani, CE; Bachi, A. Titanium dioxide coated MALDI plate for on target analysis of phosphopeptides. J. Proteome Res.: 2009; 8(4): 1932-1942 - Article IF 2008: 5,684 P.725. Torti, C; Lapadula, G; Antinori, A; Quirino, T; Maserati, R; Castelnuovo, F; Maggiolo, F; De Luca, A; Paraninfo, G; Antonucci, F; Migliorino, G; Lazzarin, A; Di Perri, G; Rizzardini, G; Esposito, R; Carosi, G. Hyperbilirubinemia during Atazanavir Treatment in 2,404 Patients in the Italian Atazanavir Expanded Access Program and MASTER Cohorts. Infection: 2009; 37(3): 244-249 - Article IF 2008: 1,831 P.726. Tortorano, AM; Posteraro, B; Viviani, MA; Prigitano, A; Girmenia, C; Lombardi, G; Ossi, C; Pozzi, C; Mirone, E; Sanguinetti, M; Pagano, L. Molecular identification and in vitro antifungal susceptibilities of 28 zygomycetes isolates: FIMUAECMM survey of Zygomycosis in Italy. J. Chemother.: 2009; 21(3): 363-364 - Letter IF 2008: 0,843 P.727. Tosetto, E; Ceol, M; Mezzabotta, F; Ammenti, A; Peruzzi, L; Caruso, MR; Barbano, G; Vezzoli, G; Colussi, G; Vergine, G; Giordano, M; Glorioso, N; Degortes, S; Soldati, L; Sayer, J; D’Angelo, A; Anglani, F. Novel mutations of the CLCN5 gene including a complex allele and A 5’ UTR mutation in dent disease 1. Clin. Genet.: 2009; 76(4): 413-416 - Letter IF 2008: 3,206 P.728. Traglia, M; Sala, C; Masciullo, C; Cverhova, V; Lori, F; Pistis, G; Bione, S; Gasparini, P; Ulivi, S; Ciullo, M; Nutile, T; Bosi, E; Sirtori, M; Mignogna, G; Rubinacci, A; Buetti, I; Camaschella, C; Petretto, E; Toniolo, D. Heritability and demographic analyses in the large isolated population of val borbera suggest advantages in mapping complex traits genes. PLoS ONE: 2009; 4(10): art. no. e7554 - Article P.729. Tranasi, M; Sberna, MT; Zizzari, V; D’Apolito, G; Mastrangelo, F; Salini, L; Stuppia, L; Tete, S. Microarray Evaluation of Age-related Changes in Human Dental Pulp. J. Endod.: 2009; 35(9): 1211-1217 - Article IF 2008: 2,727 P.730. Travi, G; Pergam, SA; Xie, H; Carpenter, P; Kiem, HP; Corey, L; Boeckh, MJ. The effect of imatinib on cytomegalovirus PUBLICATIONS - 263 reactivation in hematopoietic cell transplantation. Clin. Infect. Dis.: 2009; 49(11): e120–e123 - Article IF 2008: 8,266 P.731. Trimarchi, M; Giordano Resti, A; Bellini, C; Forti, M; Bussi, M. Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy. Eur. Arch. Oto-RhinoLaryn.: 2009; 266(11): 1747-1752 - Article IF 2008: 0,843 P.732. Tripodi, G; Citterio, L; Kouznetsova, T; Lanzani, C; Florio, M; Modica, R; Messaggio, E; Hamlyn, JM; Zagato, L; Bianchi, G; Staessen, JA; Manunta, P. Steroid Biosynthesis and Renal Excretion in Human Essential Hypertension: Association With Blood Pressure and Endogenous Ouabain. Am. J. Hypertens.: 2009; 22(4): 357-363 - Article IF 2008: 3,122 P.733. Trisciuoglio, L; Bianchi, ME. Several nuclear events during apoptosis depend on caspase-3 activation but do not constitute a common pathway. PLoS ONE: 2009; 4(7): e6234 - Article P.734. Trojano, M; Pellegrini, F; Paolicelli, D; Fuiani, A; Zimatore, GB; Tortorella, C; Simone, IL; Patti, F; Ghezzi, A; Portaccio, E; Rossi, P; Pozzilli, C; Salemi, G; Lugaresi, A; Bergamaschi, R; Millefiorini, E; Clerico, M; Lus, G; Vianello, M; Avolio, C; Cavalla, P; Iaffaldano, P; Direnzo, V; D’Onghia, M; Lepore, V; Livrea, P; Comi, G; Amato, MP. Post-marketing of disease modifying drugs in multiple sclerosis: An exploratory analysis of gender effect in interferon beta treatment. J. Neurol. Sci.: 2009; 286(1-2): 109-113 - Article IF 2008: 2,359 P.735. Trojano, M; Pellegrini, F; Paolicelli, D; Fuiani, A; Zimatore, GB; Tortorella, C; Simone, IL; Patti, F; Ghezzi, A; Zipoli, V; Rossi, P; Pozzilli, C; Salemi, G; Lugaresi, A; Bergamaschi, R; Millefiorini, E; Clerico, M; Lus, G; Vianello, M; Avolio, C; Cavalla, P; Lepore, V; Livrea, P; Comi, G; Amato, MP; Italian Multiple Sclerosis Database Network (MSDN) Group. Real-life impact of early interferon beta therapy in relapsing multiple sclerosis. Ann. Neurol.: 2009; 66(4): 513-520 - Article IF 2008: 9,935 P.736. Tsai, HT; Caporaso, NE; Kyle, RA; Katzmann, JA; Dispenzieri, A; Hayes, RB; Marti, GE; Albitar, M; Ghia, P; Rajkumar, SV; Landgren, O. Evidence of serum immunoglobulin abnormalities up to 9.8 years before diagnosis of chronic lymphocytic leukemia: a prospective study. Blood: 2009; 114(24): 4928-4932 Article IF 2008: 10,432 P.737. Tudor, D; Derrien, M; Diomede, L; Drillet, AS; Houimel, M; Moog, C; Reynes, JM; Lopalco, L; Bomsel, M. HIV-1 gp41specific monoclonal mucosal IgAs derived from highly exposed but IgG-seronegative individuals block HIV-1 epithelial transcytosis and neutralize CD4+ cell infection: An IgA gene and functional analysis. Mucosal Immunol.: 2009; 2(5): 412-426 - Article IF 2008: 0,000 P.738. Tumani, H; Hartung, HP; Hemmer, B; Teunissen, C; Deisenhammer, F; Giovannoni, G; Zettl, UK; BioMS Study Group. Cerebrospinal fluid biomarkers in multiple sclerosis.. Neurobiol. Dis.: 2009; 35(2): 117-127 - Review IF 2008: 4,852 P.739. Turturici, G; Geraci, F; Candela, ME; Cossu, G; Giudice, G; Sconzo, G. Hsp70 is required for optimal cell proliferation in mouse A6 mesoangioblast stem cells. Biochem. J.: 2009; 421(2): 193-200 - Article IF 2008: 4,371 P.740. Urbinati, C; Nicoli, S; Giacca, M; David, G; Fiorentini, S; Caruso, A; Alfano, M; Cassetta, L; Presta, M; Rusnati, M. HIV1 Tat and heparan sulfate proteoglycan interaction: a novel mechanism of lymphocyte adhesion and migration across the endothelium. Blood: 2009; 114(15): 3335-3342 - Article IF 2008: 10,432 P.741. Vago, L; Perna, SK; Zanussi, M; Mazzi, B; Barlassina, C; Lupo Stanghellini, MT; Perrelli, NF; Cosentino, C; Torri, F; Angius, A; Forno, B; Casucci, M; Bernardi, M; Peccatori, J; Corti, C; Bondanza, A; Ferrari, M; Rossini, S; Roncarolo, MG; Bordignon, C; Bonini, C; Ciceri, F; Fleischhauer, K. Loss of mismatched HLA in leukemia after stem-cell transplantation. N. Engl. J. Med.: 2009; 361(5): 478-488 - Article IF 2008: 50,017 P.742. Vago, R; Leva, V; Biamonti, G; Montecucco, A. DNA ligase I and Nbs1 proteins associate in a complex and colocalize at replication factories. Cell Cycle: 2009; 8(16): 2600-2607 - Article IF 2008: 4,120 P.743. Valdagni, R; Rancati, T; Ghilotti, M; Cozzarini, C; Vavassori, V; Fellin, G; Fiorino, C; Girelli, G; Barra, S; Zaffaroni, N; Pierotti, MA; Gariboldi, M. To Bleed or Not to Bleed A Prediction Based on Individual Gene Profiling Combined With DoseVolume Histogram Shapes in Prostate Cancer Patients Undergoing Three-Dimensional Conformal Radiation Therapy. Int. J. Radiat. Oncol. Biol. Phys.: 2009; 74(5): 1431-1440 - Article IF 2008: 4,639 P.744. Valenti, L; Guido, M; Dongiovanni, P; Cremonesi, L; Fracanzani, AL; Fargion, S. Ferroportin-1 in the recurrence of hepatic iron overload after liver transplantation. Dig. Liver Dis.: 2009; 41(7): e17-e20 - Article IF 2008: 2,577 P.745. Valentini, V; Calvo, F; Reni, M; Krempien, R; Sedlmayer, F; Buchler, MW; Di Carlo, V; Doglietto, GB; Fastner, G; GarciaSabrido, JL; Mattiucci, G; Morganti, AG; Passoni, P; Roeder, F; D’Agostino, GR. Intra-operative radiotherapy (IORT) in pancreatic cancer: Joint analysis of the ISIORT-Europe experience. Radiother. Oncol.: 2009; 91(1): 54-59 - Article IF 2008: 3,990 P.746. Valle, A; Jofra, T; Stabilini, A; Atkinson, M; Roncarolo, MG; Battaglia, M. Rapamycin prevents and breaks the anti-CD3induced tolerance in NOD mice. Diabetes: 2009; 58(4): 875-881 - Article IF 2008: 8,398 P.747. Valsecchi, L; Cavoretto P, Di; Piazza, L; Smid, M; Pontesilli, S; Scotti, R; Spagnolo, D; Baldoli, C. Prenatal diagnosis by 3D ultrasound and MRI of an unusual malformation of cortical development with brain-in-brain appearance. J. Clin. Ultrasound : 2009; 37(6): 354-359 - Article IF 2008: 0,843 P.748. Van Haaften, G; Dalgliesh, GL; Davies, H; Chen, L; Bignell, G; Greenman, C; Edkins, S; Hardy, C; O’Meara, S; Teague, J; Butler, A; Hinton, J; Latimer, C; Andrews, J; Barthorpe, S; Beare, D; Buck, G; Campbell, PJ; Cole, J; Forbes, S; Jia, M; Jones, D; Kok, CY; Leroy, C; Lin, ML; McBride, DJ; Maddison, M; Maquire, S; McLay, K; Menzies, A; Mironenko, T; Mulderrig, L; Mudie, L; Pleasance, E; Shepherd, R; Smith, R; Stebbings, L; Stephens, P; Tang, G; Tarpey, PS; Turner, R; Turrell, K; Varian, J; West, S; Widaa, S; Wray, P; Collins, VP; Ichimura, K; Law, S; Wong, J; Yuen, ST; Leung, SY; Tonon, G; Depinho, RA; Tai, YT; Anderson, KC; Kahnoski, RJ; Massie, A; Khoo, SK; Teh, BT; Stratton, MR; Futreal, PA. Somatic mutations of the histone H3K27 demethylase gene UTX in human cancer. Nature Genet.: 2009; 41(5): 521-523 - Article IF 2008: 30,259 P.749. van Luin, M; Bannister, WP; Mocroft, A; Reiss, P; Di Perri, G; Peytavin, G; Molto, J; Karlson, A; Castagna, A; Beniowski, M; Lundgren, JD. Absence of a relation between efavirenz plasma concentrations and toxicity-driven evafirenz discontinuations in the EuroSIDA study. Antivir. Ther.: 2009; 14(1): 75-83 - Article IF 2008: 4,105 P.750. Venditti, M; Falcone, M; Corrao, S; Licata, G; Serra, P; Salerno, F; Filetti, S; D’Erasmo, E; Fanelli, FR; Fiorentini, A; Cricco, L; Gasbarrone, L; Serafini, C; Ghio, R; Zoppoli, G; Cortellaro, M; Magenta, M; Nuti, R; Valenti, R; Milano, V; 264 - SAN RAFFAELE SCIENTIFIC INSTITUTE Brandimarte, C; Carfagna, P; Di Sciacca, R; Tuttolomondo, A; Serra, MG; Bernardi, M; Li Bassi, S; Stanghellini, V; Boschi, E; Antonaci, S; Vella, F; Catalano, A; Zeneroli, ML; Ascari, E; Veggetti, A; Manfredini, R; Gamberoni, S; Guarnieri, G; Fioretto, A; Di Michele, D; Parisi, D; Liberato, NL; Ronchi, E; Sturbini, S; Canafoglia, P; Gallerani, M; Boari, B; Nielsen, I; Annoni, G; Rossetti, A; Bernasconi, M; Giannatempo, C; Turconi, R; Colombo, M; Tedeschi, A; Rossi, R; Cappelli, R; Guidi, V; Tassara, R; De Melis, D; Cosentini, R; Arioli, M; Gobbo, G; Presotto, F; Gallana, S; Balduini, C; Bertolino, G; Fera, G; Corazza, GR; Capriglione, I; Pilerio, G; Cappellini, MD; Fabio, G; Carrabba, M; Sheng, CW; Secchi, MB; Leone, M; De Feudis, L; Gunelli, M; Ferri, O; Doroldi, C; Pistis, R; Sabbadini, MG; Tresoldi, M; Lambelet, P; Fascetti, S; Vanoli, M; Casella, G; Rosei, EA; Salvi, A; Noto, A; Perciaccante, A; Santini, C; Galie, M; Gasbarrini, G; Grieco, A; Nardi, B; Baritussio, AG; Vannuccini, R; Cappelletti, M; Gentiloni-Silveri, N; Lechi, A; Montesi, G. Outcomes of Patients Hospitalized with Community-Acquired, Health Care-Associated, and Hospital-Acquired Pneumonia. Ann. Intern. Med.: 2009; 150(1): 19-26 - Article IF 2008: 17,457 P.751. Veneziano, L; Guida, S; Mantuano, E; Bernard, P; Tarantino, P; Boccone, L; Hisama, FM; Carrera, P; Jodice, C; Frontali, M. Newly characterised 5? and 3? regions of CACNA1A gene harbour mutations associated with Familial Hemiplegic Migraine and Episodic Ataxia. J. Neurol. Sci.: 2009; 276(1-2): 31-37 - Article IF 2008: 2,359 P.752. Venturelli, E; Villa, C; Fenoglio, C; Clerici, F; Marcone, A; Ghidoni, R; Cortini, F; Scalabrini, D; Gallone, S; Rainero, I; Mandelli, A; Restelli, I; Binetti, G; Cappa, S; Mariani, C; Giordana, MT; Bresolin, N; Scarpini, E; Galimberti, D. The NOS3 G894T (Glu298Asp) polymorphism is a risk factor for frontotemporal lobar degeneration. Eur. J. Neurol.: 2009; 16(1): 37-42 Article IF 2008: 2,732 P.753. Vergani, A; Clissi, B; Sanvito, F; Doglioni, C; Fiorina, P; Pardi, R. Laser capture microdissection as a new tool to assess graft-infiltrating lymphocytes gene profile in islet transplantation. Cell Transplant.: 2009; 18(8): 827-832 - Article IF 2008: 5,251 P.754. Verheijen, MH; Camargo, N; Verdier, V; Nadra, K; de Preux Charles, AS; Medard, JJ; Luoma, A; Crowther, M; Inouye, H; Shimano, H; Chen, S; Brouwers, JF; Helms, JB; Feltri, ML; Wrabetz, L; Kirschner, D; Chrast, R; Smit, AB. SCAP is required for timely and proper myelin membrane synthesis. Proc. Natl. Acad. Sci. U. S. A.: 2009; 106(50): 21383-21388 - Article IF 2008: 9,380 P.755. Vezzoli, G; Soldati, L; Gambaro, G. Roles of calcium-sensing receptor (CaSR) in renal mineral ion transport. Curr. Pharm. Biotechnol.: 2009; 10(3): 302-310 - Review IF 2008: 2,649 P.756. Vignali, A; Di Palo, S; Orsenigo, E; Ghirardelli, L; Radaelli, G; Staudacher, C. Effect of prednisolone on local and systemic response in laparoscopic vs open colon surgery: A randomized, double-blind, placebo-controlled trial. Dis. Colon Rectum: 2009; 52(6): 1080-1088 - Article IF 2008: 2,615 P.757. Villa, C; Venturelli, E; Fenoglio, C; Clerici, F; Marcone, A; Benussi, L; Gallone, S; Scalabrini, D; Cortini, F; Serpente, M; Martinelli-Boneschi, F; Cappa, S; Binetti, G; Mariani, C; Rainero, I; Giordana, MT; Bresolin, N; Scarpini, E; Galimberti, D. DCUN1D1 is a risk factor for frontotemporal lobar degeneration. Eur. J. Neurol.: 2009; 16(7): 870-873 - Article IF 2008: 2,732 P.758. Villa, C; Venturelli, E; Fenoglio, C; Clerici, F; Marcone, A; Benussi, L; Ghidoni, R; Gallone, S; Cortini, F; Scalabrini, D; Serpente, M; Binetti, G; Cappa, S; Mariani, C; Rainero, I; Bresolin, N; Scarpini, E; Galimberti, D. CCL8/MCP-2 association analysis in patients with Alzheimer’s disease and frontotemporal lobar degeneration. J. Neurol.: 2009; 256(8): 1379-1381 Article IF 2008: 2,536 P.759. Villablanca, EJ; Raccosta, L; Zhou, D; Fontana, R; Maggioni, D; Negro, A; Sanvito, F; Ponzoni, M; Valentinis, B; Bregni, M; Prinetti, A; Steffensen, KR; Sonnino, S; Gustafsson, JA; Doglioni, C; Bordignon, C; Traversari, C; Russo, V. Tumormediated liver X receptor-alpha activation inhibits CC chemokine receptor-7 expression on dendritic cells and dampens antitumor responses. Nat. Med.: 2009; 16(1): 98-105 - Article IF 2008: 27,553 P.760. Villaescusa, JC; Buratti, C; Penkov, D; Mathiasen, L; Planaguma, J; Ferretti, E; Blasi, F. Cytoplasmic Prep1 interacts with 4EHP inhibiting Hoxb4 translation. PLoS ONE: 2009; 4(4): e5213 - Article P.761. Visigalli, I; Moresco, RM; Belloli, S; Politi, LS; Gritti, A; Ungaro, D; Matarrese, M; Turolla, E; Falini, A; Scotti, G; Naldini, L; Fazio, F; Biffi, A. Monitoring disease evolution and treatment response in lysosomal disorders by the peripheral benzodiazepine receptor ligand PK11195. Neurobiol. Dis.: 2009; 34(1): 51-62 - Article IF 2008: 4,852 P.762. Walenski, M; Sosta, K; Cappa, S; Ullman, MT. Deficits on irregular verbal morphology in Italian-speaking Alzheimer’s disease patients. Neuropsychologia: 2009; 47(5): 1245-1255 - Article IF 2008: 4,074 P.763. Weinand, C; Jian, WX; Peretti, GM; Bonassar, LJ; Gill, TJ. Conditions affecting cell seeding onto three-dimensional scaffolds for cellular-based biodegradable implants. J. Biomed. Mater. Res. Part B: 2009; 91(1): 80-87 - Article IF 2008: 2,030 P.764. Wieckowski, MR; Mariusz R; Giorgi, C; Lebiedzinska, M; Duszynski, J; Pinton, P. Isolation of mitochondria-associated membranes and mitochondria from animal tissues and cells. Nat. Protoc.: 2009; 4(11): 1582-1590 - Article IF 2008: 4,170 P.765. Wodarczyk, C; Rowe, I; Chiaravalli, M; Pema, M; Qian, F; Boletta, A. A novel mouse model reveals that polycystin-1 deficiency in ependyma and choroid plexus results in dysfunctional cilia and hydrocephalus. PLoS ONE: 2009; 4; (9): e7137 - Article P.766. Woodhoo, A; Alonso, MB; Droggiti, A; Turmaine, M; D’Antonio, M; Parkinson, DB; Wilton, DK; Al-Shawi, R; Simons, P; Shen, J; Guillemot, F; Radtke, F; Meijer, D; Feltri, ML; Wrabetz, L; Mirsky, R; Jessen, KR. Notch controls embryonic Schwann cell differentiation, postnatal myelination and adult plasticity. Nat. Neurosci.: 2009; 12(7): 839-847 - Article IF 2008: 14,164 P.767. Yamada, H; Padilla-Parra, S; Park, S J; Itoh, T; Chaineau, M; Monaldi, I; Cremona, O; Benfenati, F; De Camilli, P; Coppey-Moisan, M; Tramier, M; Galli, T; Takei, K. Dynamic interaction of amphiphysin with N-WASP regulates actin assembly. J. Biol. Chem.: 2009; 284(49): 34244-34256 - Article IF 2008: 5,520 P.768. Yanai, H; Ban, T; Wang, Z; Choi, MK; Kawamura, T; Negishi, H; Nakasato, M; Lu, Y; Hangai, S; Koshiba, R; Savitsky, D; Ronfani, L; Akira, S; Bianchi, ME; Honda, K; Tamura, T; Kodama, T; Taniguchi, T. HMGB proteins function as universal sentinels for nucleic-acid-mediated innate immune responses. Nature: 2009; 462(7269): 99-103 - Article IF 2008: 31,434 P.769. Yeni, P; Lamarca, A; Berger, D; Cimoch, P; Lazzarin, A; Salvato, P; Smaill, FM; Teofilo, E; Madison, SJ; Nichols, WG; Adkison, KK; Bonny, T; Millard, J; Mccarty, D. Antiviral activity and safety of aplaviroc, a CCR5 antagonist, in combination PUBLICATIONS - 265 with lopinavir/ritonavir in HIV-infected, therapy-naïve patients: Results of the EPIC study (CCR100136). HIV Med.: 2009; 10(2): 116-124 - Article IF 2008: 3,103 P.770. Yossepowitch, O; Bjartell, A; Eastham, JA; Graefen, M; Guillonneau, BD; Karakiewicz, PI; Montironi, R; Montorsi, F. Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences. Eur. Urol.: 2009; 55(1): 87-99 - Review IF 2008: 6,512 P.771. Zacche, MM; Caputo, L; Filippis, S; Zacche, G; Dindelli, M; Ferrari, A. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Gynecol. Endocrinol.: 2009; 25(8): 508-513 - Article IF 2008: 1,359 P.772. Zangrillo, A; Bignami, E; Biondi-Zoccai, GG; Covello, RD; Monti, G; D’Arpa, MC; Messina, M; Turi, S; Landoni, G. Spinal analgesia in cardiac surgery: a meta-analysis of randomized controlled trials. J. Cardiothorac. Vasc. Anesth. : 2009; 23(6): 813-821 - Article IF 2008: 0,994 P.773. Zangrillo, A; Biondi-Zoccai, G; Mizzi, A; Bruno, G; Bignami, E; Gerli, C; De Santis, V; Tritapepe, L; Landoni, G. Levosimendan Reduces Cardiac Troponin Release After Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies. Journal of Cardiothoracic and Vascular Anesthesia: 2009; 23(4): 474-478 - Article IF 2008: 0,994 P.774. Zangrillo, A; Mizzi, A; Biondi-Zoccai, G; Bignami, E; Calabrò, MG; Pappalardo, F; Dedola, E; Tritapepe, L; Marino, G; Landoni, G. Recombinant Activated Factor VII in Cardiac Surgery: A Meta-analysis. J. Cardiothorac. Vasc. Anesth.: 2009; 23(1): 34-40 - Article IF 2008: 0,994 P.775. Zangrillo, A; Turi, S; Crescenzi, G; Oriani, A; Distaso, F; Monaco, F; Bignami, E; Landoni, G. Esmolol Reduces Perioperative Ischemia in Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies. J. Cardiothorac. Vasc. Anesth.: 2009; 23(5): 625-632 - Article IF 2008: 0,994 P.776. Zazzi, M; Prosperi, M; Vicenti, I; Di Giambenedetto, S; Callegaro, A; Bruzzone, B; Baldanti, F; Gonnelli, A; Boeri, E; Paolini, E; Rusconi, S; Giacometti, A; Maggiolo, F; Menzo, S; De Luca, A. Rules-based HIV-1 genotypic resistance interpretation systems predict 8 week and 24 week virological antiretroviral treatment outcome and benefit from drug potency weighting. J. Antimicrob. Chemother.: 2009; 64(3): 616-624 - Article IF 2008: 4,328 P.777. Zhang, J; Sattler, M; Tonon, G; Grabher, C; Lababidi, S; Zimmerhackl, A; Raab, MS; Vallet, S; Zhou, Y; Cartron, MA; Hideshima, T; Tai, YT; Chauhan, D; Anderson, KC; Podar, K. Targeting angiogenesis via a c-Myc/hypoxia-inducible factor-1?dependent pathway in multiple myeloma. Cancer Res.: 2009; 69(12): 5082-5090 - Article IF 2008: 7,514 P.778. Zhang, L; Qiao, Q; Tuomilehto, J; Hammar, N; Ruotolo, G; Stehouwer, CDA; Heine, RJ; Eliasson, M; Zethelius, B. The impact of dyslipidaemia on cardiovascular mortality in individuals without a prior history of diabetes in the DECODE Study. Atherosclerosis: 2009; 206(1): 298-302 - Article IF 2008: 4,601 P.779. Zini, L; Capitanio, U; Jeldres, C; Lughezzani, G; Sun, M; Shariat, SF; Isbarn, H; Arjane, P; Widmer, H; Perrotte, P; Graefen, M; Montorsi, F; Karakiewicz, PI. External validation of a nomogram predicting mortality in patients with adrenocortical carcinoma. BJU Int.: 2009; 104(11): 1661-1667 - Article IF 2008: 2,704 P.780. Zini, L; Capitanio, U; Perrotte, P; Jeldres, C; Shariat, SF; Arjane, P; Widmer, H; Montorsi, F; Patard, JJ; Karakiewicz, PI. Population-based Assessment of Survival After Cytoreductive Nephrectomy Versus No Surgery in Patients With Metastatic Renal Cell Carcinoma. Urology: 2009; 73(2): 342-346 - Article IF 2008: 2,242 P.781. Zini, L; Cloutier, V; Isbarn, H; Perrotte, P; Capitanio, U; Jeldres, C; Shariat, SF; Saad, F; Arjane, P; Duclos, A; Lattouf, JB; Montorsi, F; Karakiewicz, PI. A simple and accurate model for prediction of cancer-specific mortality in patients treated with surgery for primary penile squamous cell carcinoma. Clin. Cancer Res.: 2009; 15(3): 1013-1018 - Article IF 2008: 6,488 P.782. Zini, L; Patard, JJ; Capitanio, U; Crepel, M; De La Taille, A; Tostain, J; Ficarra, V; Bernhard, JC; Ferriere, JM; Pfister, C; Villers, A; Montorsi, F; Karakiewicz, PI. Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma. BJU Int.: 2009; 103(7): 894-898 Article IF 2008: 2,704 P.783. Zini, L; Patard, JJ; Capitanio, U; Mejean, A; Villers, A; de La Taille, A; Ficarra, V; Crepel, M; Bertini, R; Salomon, L; Verhoest, G; Perrotte, P; Bensalah, K; Arjane, P; Biserte, J; Montorsi, F; Karakiewicz, P. The use of partial nephrectomy in European tertiary care centers. Eur J Surg Oncol: 2009; 35(6): 636642 - Article IF 2008: 2,491 P.784. Zini, L; Perrotte, P; Capitanio, U; Jeldres, C; Duclos, A; Arjane, P; Villers, A; Montorsi, F; Patard, JJ; Karakiewicz, PI. Race affects access to nephrectomy but not survival in renal cell carcinoma. BJU Int.: 2009; 103(7): 889-893 - Article IF 2008: 2,704 P.785. Zini, L; Perrotte, P; Capitanio, U; Jeldres, C; Shariat, SF; Antebi, E; Saad, F; Patard, JJ; Montorsi, F; Karakiewicz, PI. Radical versus partial nephrectomy: Effect on overall and noncancer mortality. Cancer: 2009; 115(7): 1465-1471 - Article IF 2008: 5,238 P.786. Zini, L; Perrotte, P; Jeldres, C; Capitanio, U; Duclos, A; Jolivet-Tremblay, M; Arjane, P; Peloquin, F; Pharand, D; Villers, A; Montorsi, F; Patard, JJ; Karakiewicz, PI. A population-based comparison of survival after nephrectomy vs nonsurgical management for small renal masses. BJU Int.: 2009; 103(7): 899-904 Article IF 2008: 2,704 AUTHOR INDEX - 267 AUTHOR INDEX A Abdollah, Firas 4, 215 P118, P355, P660, P661, P705 Absinta, Martina 31, 210 P9, P635, P636, P638 Abutalebi, Jubin 28, 208 P3, P4 Accarino, Gianfranco 193 Acerno, Stefania 28, 199 P30, P499 Agosta, Federica 31 P7, P8, P9, P10, P11, P141, P199, P327, P328, P416, P466, P521, P637, P647 Agostoni, Massimo 28, 196 P307 Agresti, Alessandra 149, 156 P707 Agricola, Eustachio 65, 193 P12 Aiello, Patrizia 113, 206 P287 Aina, Ilaria 29, 208 Airaghi, Barbara 196 Aiuti, Alessandro 86, 87, 88, 103, 105, 204 P13, P14, P99, P178, P350, P357, P442, P476, P667, P668 Alagna, Laura 202 Albarello, Luca 216 P24, P423, P497 Albieri, Ilaria 27 Alcalà-Franco, Beatriz 87 Aldovrandi, Valeria 194 Aldrighetti, Daniela 4, 211 Aldrighetti, Luca 114, 132, 196 P17, P272, P273, P404, P664 Alemanno, Federica 28 Alesiani, Roberta 29, 208 Alessio, Davide 216 Alessio, Massimo 167, 172 P157, P573, P584 Alfano, Massimo 112 P1, P18, P179, P740 Alfieri, Beatrice 112 Alfieri, Ottavio 65, 78, 193, 195, 221 P12, P65, P239, P246, P420, P450, P460, P461, P555, P620, P710 Al-Lamee, Rasha 64, 193 Almirante, Giada Alongi, Filippo 204 211 P19, P126, P240, P291, P331, P548 Alto, Giorgio 65, 199 Amadio, Stefano 31, 210 P605 Amato, Ninfa 30 Amendola, Mario 86 P23, P86, P173, P361 Ammirati, Enrico 64, 221 P325 Amodio, Giada 87 Anand, Santosh 149 P410 Andolfi, Grazia 87 P14 Andolfo, Annapaola 167 P722 Andrei, Fodor 211 Andreolli, Elena Maria 29 Anelli, Tiziana 149 Angelone, Sara 29, 208 P612 Angiolilli, Diego 215 Angiolini, Adriana 199 Annoni, Andrea 87 P26 Antonelli, Antonella 149 Antonini, Stefania 85 Antonino, Felicia 196 Adalgisa Antonio, Massimo 29 Anzalone, Nicoletta 28, 199 P32 Anzani, Alfredo X Apollonio, Benedetta 1 P261 Apollonio, Stefano XII Arancio, Cinzia 29, 208 Arcidiacono, Paolo 3, 16, 196 Giorgio P33, P175, P480, P519, P630, P716 Arcidiacono, Teresa 151, 206 P34 Ardu, Veronica 177 Arendar, Irina 193 Arioli, Francesco 64, 192, 193, 221 P337, P701 Arrigoni, Gianluigi 216 P121 268 - SAN RAFFAELE SCIENTIFIC INSTITUTE Ascagni, Miriam Asperti, Claudia Assanelli, Andrea Astore, Domenico Astro, Veronica Augello, Giuseppe Avitabile, Maria Aydin, Didem Azzoni, Emanuele 185 27 P35 86, 211 P255, P305, P322, P721 65, 194 27 P35 65, 192 192 87 85 B Baccari, Paolo Aldo Raul Baccelli, Nicola Baccellieri, Domenico Bacchetta, Rosa 3, 196 P36, P37 65, 199 65, 194 86, 87, 102, 204 P23, P292, P679 Bacchi, Fabrizio XII Bachi, Angela 149, 157 P20, P31, P71, P91, P223, P265, P289, P308, P500, P575, P724 Bacigaluppi, Marco 30 P39 Badaloni, Aurora 27 P211 Bagaglio, Sabrina 113, 202 P545, P546, P547 Balconi, Giuseppe 213 Baldini, Mattia 113, 206 P501, P502 Baldissera, Elena 113, 206 P287 Baldoli, Cristina 28, 199 P30, P85, P359, P747 Balducci, Elena 221 Ballarotto, Carlo 193 Ballis, Rosa 151 Balzano, Gianpaolo 3, 196 P629, P630 Bandello, Francesco 65, 80, 199 Bandiera, Alessandro 3, 194 P42, P176, P177, P512 Banfi, Arianna 196 Banfi, Michela 65 Baratto, Fabio 211 P339 Barbini, Barbara 29, 208 Barcella, Valeria 210 Barchi, Roberto XII Barera, Graziano 64, 73, 204 P306, P497 Bargiggia, Cinzia 216 Barile, Luigi Barili, Valeria Barricella, Nietta Barzaghi, Federica Barzaghi, Lina Raffaella Barzizza, Lorena Bassanelli, Giorgio Basso, Veronica Batonga, Jaques N’zepa Battaglia Parodi, Maurizio Battaglia, Manuela Battaglia, Marco Battaglino, Roseila Bazzigaluppi, Elena Beatrice, Saverio Beccaria, Paolo Federico Bechi, Margherita 65 27 211 88 28, 199 P448 216 193 112 194 P517 65, 199 114, 135 P49, P50, P351, P587, P746 29, 208 P48, P504, P561 115 216 211 197 29, 208 P27, P185 Belfiore, Marcello 27 Bellanca, Raimondo 193 Bellani, Serena 27 P698 Belli, Carmen 211 P55 Bellini, Chiara 3, 199 P713, P715, P731 Bellinzoni, Piera 215 Bellio, Laura 86, 216 Bellodi, Laura 29, 208 P417, P657, P680 Belloli, Sara 177, 211 P56, P145, P433, P761 Bellomo, Daniela XII Bellone, Matteo 112, 124 P56, P172 Belloni, Daniela 1 Benasciutti, Elisa 149 P250 Benedetti, Francesco 29, 44, 208 P58, P59, P60, P61, P62, P349, P481 Benedetti, Sara 167, 216 P251 Benedetti, Sara 85 Benedicenti, Fabrizio 87 P536 Benedini, Stefano 63 P51, P63 Beneduce, Aldo 216 Benussi, Stefano 65, 193 P65 Benveniste, Marina 213 AUTHOR INDEX - 269 Benzoni, Ivana Berardi, Genoveffa Beretta, Edoardo Beretta, Luigi 185 177, 211 196 28, 40, 196, 199, 217, 220 P359, P360 Bergamante, Valentina 88 Bergamaschi, Andrea 30 P192 Bergamaschi, Luca 4 Bergami, Alessandra 30 P124, P192 Bergonzi, Pier Carlo 197 P138 Bernardi, Giovanna XII Bernardi, Massimo 3, 211 P110, P213, P741, P750 Bernardi, Rosa 1, 10 P348, P398 Bernascone, Ilenia 150 P472 Bernasconi, 29, 208 Alessandro P58, P59, P61 Bernasconi, Fabio 199 Bernasconi, Luca 208 P715 Berno, Roberta XII Bertilaccio, Maria 1 Teresa Sabrina P503, P553, P554 Bertini, Diego Maria XII Bertini, Roberto 4, 215 P70, P259, P408, P642, P643, P783 Bertocchi, Cecilia 213 Bertoglio, Luca 65, 194 P508 Bertolazzi, Mara 216 Bertolotti, Milena 149 Bestetti, Arabella 113, 202 Bettegazzi, Barbara 27 Bettin, Paolo 65, 199 Bettinardi, Valentino 177, 211 P72, P304, P368, P468, P505 Beugnet, Anne 2 P524 Biagetti, Raffaella XII Bianchi Marzoli, 65, 199 Stefania P67 Bianchi, Laura 29, 208 Bianchi, Marco 4, 215 P116, P117, P120, P259, P279 Bianchi, Marco E. 149, 155, 185, 187 P77, P78, P79, P152, P179, P443, P471, P573, P619, P707, P709, P733, P768 Bianchi, Veronica 28 P80 Bianco, Mariangela 30, 210 Bianconi, Eleonora Bianconi, Irene Biasco, Luca 64 111 87 P350 Biffi, Alessandra 87, 88, 100, 204 P91, P171, P198, P300, P495, P604, P761 Biffi, Valentina 115, 204 Biffo, Stefano XXVIII, 2, 13 P524, P626 Bignami, Elena 65, 194 P83, P244, P245, P253, P427, P517, P518, P772, P773, P774, P775 Bin, Roberta 211 Biondini, Francesca 208 Bione, Silvia 150 P234, P644, P728 Bisagni, Pietro 216 Bissolati, Massimiliano 196 Biswas, Priscilla 112 P242 Biziato, Daniela 86 P618 Bizzozero, Daniele 29 Bizzozero, Laura 86 Blasi, Francesco 150, 159 P18, P263, P319, P500, P520, P722, P760 Blasi, Valeria 28, 185 P85, P359 Blasio, Andrea 193 P461 Boari, Nicola 28, 199 Boccalatte, Francesco 86 Boccalon, Silvia 29, 208 Boemo, Cinzia 3, 196 Boeri, Enzo 216 P1, P155, P288, P585, P776 Bogni, Silvia 150 Bolamperti, Simona 63 Bolentini, Alketa 216 Boletta, Alessandra 150, 159 P295, P765 Bolino, Alessandra 31, 52 P91 Bolis, Annalisa 31 P91 Bolognesi, Angelo 211 P240, P259, P342 Bolognesi, Gianluigi 65, 199 Bombelli, Ferdinando 204 Bombelli, Giovanna XII Bonavida, Giovanna 151 Bondanza, Attilio 86 P213, P404, P741 Bondi, Stefano 3, 199 Bonetti, Fabrizio 193 270 - SAN RAFFAELE SCIENTIFIC INSTITUTE Bonfanti, Chiara Bonfanti, Riccardo 85 115, 139, 204 P92, P562, P621 Boni, Andrea 150 Bonini, Chiara 86, 95 P93, P213, P404, P496, P741 Bonisolli, Loredana 65 Bordogna, Gianni 211 Borgognoni, Marco 221 Bornaghi, Viviana 167 Borri, Anna 216 P42 Borroni, Emanuele 112, 221 Borroni, Serena 208 P334, P335, P336 Bortolanza, Sergia 85 Bosi, Emanuele 64, 71, 114, 115, 134, 138, 206, 207, 216 P97, P98, P230, P341, P450, P659, P673, P681, P728 Bosia, Marta 29, 208 P27, P58, P612 Bossolasco, Simona 113, 202 Bosticardo, Marita 87 P99, P442, P476 Bosurgi, Lidia 85 P152, P443 Bottelli, Vittoria 29, 208 Bottero, Giampiero 29, 208 Botti, Francesca 27 Botti, Renato XXXI, XXXIII Botticelli, Irene 151, 206 Bove, Maddalena 204 Bove, Tiziana 65, 194 Bozzolo, Enrica P. 113, 206 Braga, Marco 3, 196 P104, P711 Bragonzi, Alessandra 111, 120 P105 Brambilla, Elena 30 P39, P124, P605, P606 Brambilla, Marina 216 Brambilla, Riccardo 30, 48 P258, P578 Brambilla, Roberta 216 Brasca, Laura 213 Breda, Daniela 111 P132 Bregani, Valentina 208 Brendolan, Andrea 1, 10 Brigante, Claudio 204 Briganti, Alberto 4, 215 P112, P113, P114, P115, P116, P117, P118, P119, P120, P162, P163, P164, P259, P278, P355, P540, P656, P659, P660, P661, P662, P705 Brigatti, Cristina 115 P464, P535 Brigida, Immacolata 87 P13, P14 Brina, Daniela 2 Brioni, Elena 151 Brioschi, Chiara 65, 194 Brioschi, Luca 211 Brisci, Angela 167, 216 P462 Broccoli, Vania 28, 39 P219, P294 Broggi, Paola 208 Broggi, Sara 177 P19, P126, P291, P331, P548, P593 Broglia, Luigi 215 Brumat, Giuliano 221 Brunati, Martina 149, 150 Brunelli, Silvia 85, 92 P282, P296, P370, P424, P443, P516 Bruno Ventre, Marta 3 Bruno, Francesca 167, 216 P128, P479 Bruschi, Elena 65, 199 Bua, Lina 215 Buetti, Ivan 150 P728 Buffi, Nicolò Maria 4, 215 P130, P549, P550 Bulotta, Alessandra 4, 211 Buono, Roberta 86 P282 Burastero, Samuele E. 111, 119 P41, P131, P132, P133 Buratti, Luca 65 Burioni, Roberto 216 P135, P136, P154, P467 Buriova, Emilia 211 Busnardo, Elena 177, 211 Bussi, Mario 3, 17, 29, 44, 199 P360, P440, P713, P714, P715, P731 Butera, Calogera 31, 210 Butti, Erica XXVI, 30 P192 Buzzetti, Fabio 65, 193 Buzzotta, Alessio 65, 199 C Cabianca, Daphne Cabinio, Monia Cabrini, Luca Caiolfa, Valeria R. Cairella, Roberto 85 28, 185 65, 197 P138, P139, P140 1, 9 216 AUTHOR INDEX - 271 Calabrese, Alice Calabrese, Donato Calabrese, Maria Chiara Calabrò, Maria Grazia Calaciura, Rita Calamita, Piera Calandrino, Riccardo Calbi, Valeria Caldana, Elena Caldara, Rossana Caldi, Massimo Caligaris-Cappio, Federico Calissano, Carlo Callegaro, Luciano Calori, Giliola Calvi, Maria Rosa Cama, Francesco Camaschella, Clara Camba, Lionello Cambiaghi, Marco Cambiaghi, Valeria Camerota, Tommaso Camesasca, Chiara Camisa, Barbara Cammarata, Bruna Cammarata, Gabriella Cammino, Stefania Camnasio, Francesco Campana, Lara Campanella, Alessandro Campanini, Elena Campori, Euridice Canali, Paola Canciani, Cristina Candiani, Massimo Candotti, Guido Canducci, Filippo Canessa, Nicola Canevali, Paolo Canevari, Carla Cangi, Maria Giulia 193 P12, P325 112 193 P461 194 211 28 177, 180 P19, P126, P144, P145, P291, P331, P548, P593 86, 221 P76 87 113, 206 196, 217 1, 3, 7, 211, 212 P134, P146, P147, P148, P260, P321, P375, P553, P554 1 88, 204 P14, P213 X, XII P33, P337, P487, P488, P508, P601 28, 199 P359 194 150, 161 P149, P150, P151, P690, P728 211 30 2 215 193 86 P38 204 65, 199 29 196 85 P152, P443 27 P153 208 208 29 193 4, 64, 114, 204 204 216 P135, P136, P154, P155 28, 208 P156, P184, P485 111 177, 211 216 Cannalire, Giuseppe Cannavale, Salvatore Cannistraci, Carlo Vittorio Canonico, Emanuele Cantarelli, Elisa 204 193 167 P157 185 115 P158 Cantoni, Anna XII Cantore, Alessio 86 P26 Canu, Elisa 31 Canu, Tamara 177 P303, P464, P595, P596 Capasso, Giuseppe 216 Capelletti, Alberto 65 Capelli, Alessandro 211 Capitanio, Umberto 4, 215 P73, P74, P116, P117, P159, P160, P161, P162, P163, P164, P165, P166, P167, P168, P169, P209, P217, P243, P394, P395, P396, P399, P400, P407, P408, P451, P478, P643, P659, P682, P684, P779, P780, P781, P782, P783, P784, P785, P786 Capitanio, Vanessa 114, 196, 216 Capitelli, Elena 213 Capobianco, Annalisa 85 P38, P471, P503, P606 Capocasa, Tania 196 Capossela, Simona 150 Capotondo, Alessia 87 P198, P604 Cappa, Stefano F. 28, 41, 208 P3, P156, P184, P354, P622, P719, P752, P757, P758, P762 Capparé, Paolo 151 P247, P248, P669 Cappellari, Ornella 85 Cappelletti, Alberto 193 Cappelletti, Chiara 64, 206 Cappelli, Barbara 86, 204 P13, P171 Cappio, Stefano 213 Capretti, Giovanni 114, 196 Caputo, Alessandra 115 Caputo, Luigi 114, 204 P771 Carbone, Maria 216 Rosaria Carbone, Teresa 216 Cardani, Anna 204 Cardone, Gianpiero 213 Carletti, Rose Mary 167, 216 Carletti, Silvia 216 P467 Carlino, Mauro 64, 193 P122, P203, P337, P363, P369 272 - SAN RAFFAELE SCIENTIFIC INSTITUTE Carlucci, Michele 216, 219 P274 Carlucci, Silvia 63 Carminati, Guia 114 Carobene, Anna 216 Carozzo, Andrea 194 P518 Carpanelli, Roberta 213 Carpinelli, Assunta 177, 211 Carrabba, Matteo 3, 211 P750 Carrabino, Salvatore 150 Carrara, Silvia 3, 196 P33, P175, P519, P716 Carrera, Paola 167 P237, P341, P364, P406, P751 Carretta, Angelo 3, 194 P42, P176, P177, P216, P512 Carretta, Ilaria X, 208 Carrieri, Domenica 194 Carvello, Michele 3, 196 Casà, Valentina 85 Casamassima, Nunzia 151 P419, P677, P678 Casari, Giorgio 167, 169 P270, P410, P465, P472, P491, P671 Casati, Paolo 208 Cascavilla, Maria 65, 199 Lucia Casiraghi, Giuseppina 65, 194 Maria Casiraghi, Miriam 88, 204 P668 Casiraghi, Tiziana 196 Caso, Francesca 31, 210 Casorati, Giulia 112 P310, P442, P723 Cassella, Patrizia 31 Cassetta, Luca 112 P179, P740 Cassina, Giulia 111 P125 Cassina, Laura 167 Castagna, Antonella 113, 128, 202 P28, P155, P236, P312, P532, P552, P700, P749 Castagnaro, Laura 1 Castellano, Antonella 28, 185 Castellano, Marina XII Castellano, Renata 65, 193, 194 Clotilde P204, P486 Castellazzi, Paola 28, 199 Castelli, Alfredo 64, 193 P122 Castelli, Maddalena 150 Castiello, Maria 87 Carmina Castiglioni, Alessandra 3, 85 Castiglioni, Alessandro 193 P450 Castiglioni, Emanuela 167, 216 Castiglioni, Isabella 177, 211 P144, P182 Castiglioni, Maria 64, 74, 204 Teresa P183 Castoldi, Carlo 196 Castoldi, Renato 3, 196 Castronovo, Vincenza 29 P184, P463 Casucci, Monica 86 P741 Catalano, Marco 29 Catena, Marco 114, 196 P17 Catenaccio, Barbara 65, 194 Catenazzi, Ursula 29, 208 Catricalà, Eleonora 28, 208 P577 Cattaneo, Angela 149 P223 Cattaneo, Elisabetta 208 Cattaneo, Federica XII Cattaneo, Giovanni 177 Mauro P19, P126, P144, P331, P593 Cattoglio, Claudia 150 P311, P350, P496 Catucci, Alessandro 149 Catucci, Marco 87 P442 Caumo, Andrea 63 P595 Causarano, Vincenza 167, 216 P128 Cavadini, Daniele 29, 208 Cavallaro, Roberto 29, 208 P27, P58, P185, P385, P612 Cavallini, Maria 29, 208 Cristina Cavarelli, Mariangela 112, 221 P186 Cavazzin, Chiara 87 P494 Cavenago, Francesca 194 Caviezel, Francesco X Cavoretto, Paolo 64, 204 P187, P356, P565 Cazzato, Denise 86 Cecconi, Virginia 112 Celona, Barbara 149 Cenci, Simone 149, 153 P76, P250 Centemero, Antonia 215 Ceppi, Daniela 210 AUTHOR INDEX - 273 Cera, Michela Cerè, Patrizia Cereda, Stefano Ceresa, Daniela Ceriotti, Ferruccio Cernuschi, Massimo Cerri, Federica Cerri, Marco Cesana, Daniela Cesani, Martina Cestari, Andrea Chiara, Anna Chiaravalli, Marco Chieffo, Alaide Chieffo, Raffaella Chiesa, Roberto Chignola, Francesca 65 P338 211 4, 211 P629, P630 216 216 P193, P194, P195, P196 202, 221 30 P197, P465, P491 199 87 P350, P536 88 P198 4, 215 P116, P162, P163, P164, P326, P355, P550, P705, P706 177, 211 150 P765 64, 193 P136, P203, P363, P430, P434, P507, P687 30, 210 65, 78, 194 P13, P36, P171, P204, P205, P402, P457, P483, P486, P487, P488, P508, P509, P510, P511 167 P206 X 221 Chiodi, Maurizio Chiodi-Daelli, Federico Chiumello, Giuseppe 63, 64, 115, 204, 205 P69, P85, P92, P232, P252, P284, P440, P663 Ciaccio, Cristiano 192 P582 Ciampi, Carlo 65, 199 Ciampi, Pietro 196 Cianflone, Domenico 64, 76, 193 P136, P325, P429, P457, P503 Ciasca, Paola 65, 199 Ciboddo, Gianfranco 211 Cicenia, Gabriella 113, 206 Ciceri, Fabio 3, 18, 85, 86, 96, 211, 221 P14, P110, P171, P213, P254, P255, P256, P322, P333, P404, P741 Cichero, Paola 216 P40, P467 Ciconte, Giuseppe 65, 192 P582, P665 Cigala Fulgosi, Mara 29, 208 Cigana, Cristina 111 Cino, Ilaria 64 Cinque, Paola 113, 128, 202 P215, P559 Cioni, Micaela 193 P555 Cipriani, Antonella 199 Cipriani, Federica 114, 196 Ciriaco, Paola 3, 194 P42, P176, P177, P216, P512 Cirillo, Daniela Maria 112, 124, 221 P40, P455, P522, P525, P697 Cirillo, Sara 185 Ciscato, Diana 216 Citro, Antonio 115 Citterio, Giovanni 4, 211 P375 Citterio, Lorena 151 P484, P677, P678, P732 Civilini, Efrem 65, 194 P36, P508 Clavenna, Daniela 216 Clementi, Emilio 86, 95 P81, P282, P296, P443 Clementi, Francesco X Clementi, Massimo 216, 221 P135, P136, P154, P155, P236, P467 Clerici, Daniela 86 Clerici, Stefano 208 Clissi, Barbara 111 P753 Cocca, Massimiliano 150 Cocchi, Federica 29, 208 P185 Cocchi, Silvia 208 Codazzi, Franca 27 Codella, Roberto 63 Codenotti, Marco 65, 199 Colasante, Gaia 28 P219 Colciago, Giorgia 28 Collu, Egidio 193 Colnaghi, Eleonora 196 Colombelli, Cristina 150 Colombo, Antonio 64, 75, 193 P122, P136, P203, P220, P221, P222, P239, P363, P369, P403, P418, P430, P431, P432, P434, P460, P490, P506, P507, P685, P687, P689 Colombo, Barbara 2 Colombo, Bruno 31, 210 P715 Colombo, Cristina 29, 208 P59, P60, P61, P412, P470, P481 Colombo, Elena 28 P498 Colombo, Gabriella 204 Colombo, Giselda 113, 206 Colombo, Ilaria 204 274 - SAN RAFFAELE SCIENTIFIC INSTITUTE Colombo, Renzo Colombo, Sergio Coltella, Nadia Colucci, Annalisa Comi, Giancarlo Comola, Mauro Comotti, Laura Compierchio, Antonia Comuzzi, Barbara Consalez, Gian Giacomo Consogno, Giuseppe Consonni, Alessandra Consonni, Monica Conti, Antonio Conti, Enrico Conti, Valentina Contrino, Elena Conversano, Andrea Coppi, Elisabetta Coppi, Giovanni Coppolino, Naima Coradin, Tiziana Corbetta, Sara Cordisco, Paola Corea, Francesco Corna, Gianfranca Cornaggia, Gabriele Cornero, Guglielmo Corno, Daniela Corno, Laura Corno, Silvia Corrado, Renato Corre, Tanguy Corsetti, Maura Corsin, Patrizia Cortella, Carlo Alberto Corti, Angelo 4, 215 P70, P558, P660, P661, P706 65, 197 P138, P140 1 65, 199 P224 XXVII, 30, 46, 210 P39, P57, P124, P190, P191, P192, P197, P198, P199, P226, P227, P228, P309, P365, P415, P492, P493, P514, P563, P567, P605, P606, P614, P635, P637, P638, P695, P712, P715, P734, P735 210 196 177, 211 167 27, 37 P211, P472 112 27 28 P184 167 P573 204 P565 85 213 193 31, 210 65, 194 P486, P508 29, 208 113 27 P233 211 31 P567 85 217 193, 194 85 65 216 221 150 P234 196 P235 64 151 2, 14 P286, P287, P293 Corti, Consuelo 3, 211, 221 P741 Corti, Laura 167 Corti, Valeria 167 Cortini, Margherita 149 Cortinovis, Francesca 204 P232 Cosciotti, Miriam 216 Cossarini, Francesca 113, 202 P236 Cossetti, Chiara 30 P605, P606 Cossu, Giulio 85, 91 P282, P296, P370, P443, P515, P516, P672, P739 Costa, Sabrina 63 Cottonaro, Sara 167 Cottone, Lucia 85 P38 Covarello, Diego 85 P370 Covello, Remo Daniel 65, 194 P239, P772 Coviello, Silvia 31 P91 Covino, Cesare 185 P503 Cozzarini, Cesare 177, 211 P19, P120, P126, P240, P259, P291, P331, P593, P743 Cozzi, Anna 27 P153 Cozzi, Silvano 199 Cremona, Ottavio 2, 13 P201, P317, P767 Cremonesi, Laura 167 P128, P462, P479, P744 Cremonini, Anna 216 Crepaldi, Arianna 216 Crescenti, Antonella 194 Crespi, Giulia Maria 213 Crespi, Marco XII Crespi, Roberto 151 P247, P248, P249, P250, P640 Crippa, Ambra 150 Crippa, Luca 2 Crippa, Luciano 63, 216 P266 Crippa, Massimo 150, 160 P319, P520 Crippa, Valentina 64, 206 Crippa, Valeria 211 Crisà, Simonetta 192 Cristallo, Marco 196 Cristell, Nicole 64, 193 Crivello, Pietro 85 AUTHOR INDEX - 275 Croci, Laura Crotta, Alessandro Cucchi, Michele Cuko, Amarild Cuppari, Irene Curci, Francesco Curnis, Flavio Cursi, Marco Curti, Cesarina Cusimano, Melania 27 P211, P472 3 29, 208 192 P701 86 XII 2 30 X 30 P686 D D’Adamo, Patrizia 28, 38 P80 D’Alessandro, Rosalba 27 P262, P415, P713 D’Alessio, Silvia 150 P263 D’Aliberti, Teresa 206 D’Amato, Alfonsina 149 P265, P501 D’Amato, Luigi 216 D’Ambrosio, Rosa 167 Lucia D’Angelo, Armando 63, 69, 216 P253, P266, P330, P454, P590, P728 D’Annibale, Sara 167 D’Antonio, Maurizio 149 P267, P767 D’Isa, Raffaele 30 Dacci, Patrizia 31 Dadda, Alice 113 Dagklis, Antonis 1 P260, P261 Dagna, Lorenzo 113, 206 P286 Dal Cin, Elena 216 Dall’Occhio, Luca 31 Dalla Libera, Dacia 210 Dallabà, Elisa 29 Dallalibera, Dacia 30 Dallaspezia, Sara 29, 208 P58, P59, P61 Daneri, Riccarda XII Daniele, Tiziana 167 Danise, Anna 202 D’Arbela, Paul G. 221 Davalli, Alberto 64, 206 P378 Daverio, Rita 216 De Benedetto, 65, 199 Umberto De Bonis, Michele De Cobelli, Francesco De Curtis, Ivan De Feo, Donatella De Fusco, Maurizio De Gaspari, Angela De Lalla, Claudia De Leonardis, Alberta De Luca, Monica De Marchis, Francesco De Marco, Donata De Martino, Emanuela De Marzi, Patrizia De Monte, Lucia De Nardi, Paola De Palma, Clara De Palma, Michele De Pellegrin, Maurizio De Ponti, Alessandro De Santis, Giuseppe De Santis, Lucia 65, 193 P420, P710 177, 213 P269, P303, P464, P477, P508, P519, P543, P593, P595, P596 27, 35 P35, P233 210 P309 167 213 112 P310 211 194 P245 149 P573, P619 216 P135, P136 111 4, 204 112 3, 196 P22, P235, P274 86 P282, P296 XXVIII, 86, 96 P275, P618 196 196 30 64 P580, P631 31, 210 De Toni Franceschini, Luisa De Vitis, Assunta 28, 199 P359 Debbia, Silvia 211 Decembrino, Mariela 196 Defidio, Giuseppe XII Degano, Massimo 112, 123 P154 Deidda Vigoriti, Vivian 85 Del Carro, Ubaldo 31, 55, 210 P605, P662 Del Maschio, 115, 177, 179, 213, 214 Alessandro P63, P144, P269, P303, P381, P464, P477, P508, P519, P543, P595, P596 Del Maschio, Maurizia 213 Del Monte, Dario 29 Del Rosso, Stefania 216 Del Vecchio, Antonella 177 P145 Delai, Stefania 87 Deli, Aniko Maria 177, 211 P548 276 - SAN RAFFAELE SCIENTIFIC INSTITUTE Dell’Acqua, Antonio Dell’Antonio, Giacomo Dell’Oca, Italo Dell’Orco, Stefania Della Chiara, Giulia Della Rosa, Pasquale 199 216, 221 P286 177, 211 216 112 28, 208 P3 Della Torre, Emmanuel113, 206 Della Torre, Liviana 113 Della Valle, Patrizia 63 P253 Dellabona, Paolo 112, 125 P310, P442, P723 Dellavalle, Arianna 85 P370 Delli Carpini, Simona 151 Delmonte, Dario 208 Delogu, Marta 112 Demarchi, Barbara 193 Demasi, Stefania 216 Deni, Francesco 196 Dentali, Sara 27 Denti, Paolo 193 P461, P555 Deponti, Daniela 151, 196 Deriu, Maria Grazia 31 Devoti, Rosaria 208 Di Candia, Stefania 64, 204 P284 Di Carlo, Valerio 3, 19, 114, 132, 196 P346, P629, P630, P711, P745 Di Girolamo, Valerio 215 P117 Di Leo, Giuseppe 216 Di Leo, Milena 3, 196 Di Lucia, Pietro 112 Di Lullo, Giulia 112 P290 Di Marco, Andrea 193 Di Mattei, Valentina 208 Di Matteo, Federico 65, 199 P224, P623 Di Molfetta, Daniela 208 Di Muzio, Nadia 177, 180, 211 P19, P126, P240, P291, P331, P368, P548, P593 Di Nunzio, Sara 87 P292 Di Palo, Saverio 3, 196 P756 Di Piazza, Lara 204 Di Pietro, Caterina 115 Di Puppo, Francesca 204 P38 Di Resta, Chiara 167, 216 Di Ruvo, Barbara 216 Di Sciacca, Dina Di Sebastiano, Francesca Di Stefano, Bruno 216 213 XXVII, 28 P294 Di Tomaso, Tiziano 2 Di Trapani, Dario 4, 215 Diaferia, Giuseppina 208 Dina, Giorgia 30 Dindelli, Moreno 204 P771 Diomede, Lorenzo 111 P737 Diotti, Roberta 216 P135 Dipinto, Angelica 28 Dispinseri, Stefania 112, 221 P316 Distefano, Gianfranco 150 P295 Dodero, Francesca XII Doglioni, Claudio 19, 185, 216, 218 P24, P70, P118, P120, P286, P305, P323, P333, P339, P390, P423, P476, P489, P497, P536, P606, P611, P721, P753, P759 Donadoni, Giovanni 3, 211 Dondossola, Eleonora 2 Donghi, Valentina 204 Donini, Annalisa 63 Donini, Michela 208 Dordoni, Laura 65, 194 P36 Doria, Valentina 64, 206 Dorigatti, Fernanda 216, 218 Dorigo, Enrica 193 P65 Dosio, Flaviano 211 Draghici, Elena 87 P442, P476 Dugani, Erica 115 Durante, Alessandro 65 E Ekkirala, Chaitanya Ramesh Erre, Letizia Erzegovesi, Stefano Esposito, Antonio Esposito, Federica Esposito, Gloria Esposito, Valentina Evangelio, Costanza 112 211 29, 208 177, 213 P269, P303, P464, P543, P595, P596 31 65, 194 208 204 P171 AUTHOR INDEX - 277 F Fabbri, Fabio Fabbri, Monica Fabiano, Beatrice Fabro, Andrea Facchi, Cinzia Faccincani, Roberto Faccio, Lucia Fadda, Emma Fagioli, Claudio Falcone, Marika Falcone, Sestina Falini, Andrea Fallanca, Federico Falqui, Luca Famoso, Graziana Fanelli, Giovanna Franca Fano, Greta Fanti, Lorella 215 111 P133, P531 3, 199 P714 177, 211 208 216 XII 29, 208 149 115, 136 P750 86 28, 42, 199 P58, P59, P184, P190, P191, P199, P493, P638, P761 177, 211 P255, P304, P367 115, 206 216 P305 31, 210 194 3, 196 P307 Fanto, Manolis 28, 38 Farina, Elena 208 Fasano, Stefania 30 Fasce, Francesco 65, 199 Fatone, Tiziana 85 Fattorini, Annalisa 63, 216 P266 Fauci, Eugenia 208 Favia, Rossana 204, 213 Fazi, Claudia 1 P260, P261 Fazio, Raffaella 31, 56, 210 P251, P309, P569 Fedeli, Maya 112 P310 Feltri, Maria Laura 150, 160 P103, P238, P267, P441, P754, P766 Ferini-Strambi, Luigi 29, 45, 209 P15, P184, P225, P463, P472, P622 Ferla, Gianfranco 3, 18, 114, 196 P17, P664 Fermo, Isabella 167 P214, P422, P589 Ferrara, David 193 Ferrara, Fulvio 216 Ferrari Da Passano, 28, 199 Camillo Ferrari, Angela 64 Ferrari, Carola Iris Ferrari, Davide Ferrari, Giuliana 208 114, 204 87, 101 P158, P311, P699 Ferrari, Karin 2 Ferrari, Matteo 4, 215 P479 Ferrari, Maurizio 167, 171, 216 P128, P364, P582, P741 Ferrari, Patrizia 216 Ferrari, Stefano 204 P38, P274 Ferrarini, Marina 1, 8 Ferrario, Fabrizio 29, 199 Ferrario, Federica 28, 199 Ferrario, Laura 216 Ferrario, Matilde 204 Ferraro, Alessandra 114 P351 Ferreri, Andrés Jose 3, 20, 211 Maria P255, P305, P321, P322, P323, P324, P383, P611, P721 Ferrero, Carlo Alberto 216 Ferrero, Elisabetta 1, 11 Ferretti, Francesca 113 Ferri, Cinzia 149 Ferro, Mattia 27 Ferron, Simona 2 Ferrua, Francesca 88, 204 P13, P171 Fesce, Riccardo 167, 170 Fiacco, Enrico 196 Figini, Filippo 64, 193, 221 Filippi, Massimo 31, 51 P7, P8, P9, P10, P11, P16, P21, P44, P57, P141, P142, P143, P189, P190, P191, P199, P228, P276, P327, P328, P329, P387, P415, P416, P466, P493, P514, P533, P563, P635, P636, P637, P638, P647, P648, P649, P695 Filippis, Susanna 204 P771 Finazzi, Renato 114, 196 Finizio, Valentina 204 P171 Finocchiaro, Claudia 208 Fiordelisi, Caterina 211 Fiore, Marina 208 Fiori, Marina 65, 199 Fiori, Rossana 194 Fiorin, Maria Chiara 29, 208 Fiorina, Paolo 113 P214, P753 Fiorino, Claudio 177 P19, P54, P126, P240, P291, P313, P331, P332, P593, P625, P743 278 - SAN RAFFAELE SCIENTIFIC INSTITUTE Fleischhauer, Katharina 85, 93, 216 P213, P254, P256, P340, P404, P679, P741 Flore, Marilena 216 Florea, Ioana 177 Florio, Francesca 149 Florita, Marcello 29 Fodor, Andrei 177 Foglieni, Chiara 112 P203 Foglio, Alessandra 167, 216 Fontana, Barbara 63 Fontana, Francesca 149 P76 Fontana, Raffaella 2 P333, P759 Foppoli, Marco 3, 211 P321 Forcina, Alessandra 86 Forestieri, Carmen 196, 216 Formaglio, Fabio 31, 210 Formenti, Ilaria 64, 206 Fornasiero, Eugenio 27 Forti, Maddalena 65, 199 P731 Fortis, Claudio 111, 202 Fortunato, Manuela 64, 206, 216 Fossati, Andrea 29, 208 P46, P334, P335, P336 Fossati, Marco 204 P171 Fotios, Economou 64, 193 Fousteri, Georgia 87 Fracassetti, Dario 196 Fragasso, Enrico 31 Fragasso, Gabriele 65, 193 P337, P338, P339, P576, P701 Franchini, Linda 29, 208 Franchini, Stefano 113, 206 P89 Franciosi, Gianluca 29, 208 P334 Franco, Annalisa 194 Franco, Margherita 204 François, Stephanie 85 Franzin, Alberto 28, 199 P342 Franzoni, Irene 65 Fraschini, Gianfranco 151, 196 P675 Frascoli, Cristina 199 Frasson, Paola 208 Frati, Elena 65 Fratta, Pietro 149 Frau, Giovanna 194 P245 Freschi, Massimo 216 P42, P56, P70, P118, P120, P172, P240, P641, P659, P706 Fresi, Francesco 29, 208 Frigoli, Enrico 192 Frittoli, Marta 88 Frontino, Giulio 115, 204 Fucci, Rita Nunzia 149 Fumagalli, Francesca 88 P198 Fumagalli, Luca 202 P347, P570 Fumero, Andrea 193 P65, P555 Furci, Lucinda 112 Furlan, Federico 216 Furlan, Roberto 30, 50 P81, P124, P192, P309, P646, P720 Fusi, Francesco 204 P580, P631 Fusi, Maria Grazia X G Gabellini, Daniela Gabellini, Davide Gabriele, Angela Gaetani, Massimiliano 63 85, 92 208 167 P206 Gagliani, Nicola 114 P351 Gagliardi, Filippo 28 Gagliardi, Marco 65, 199 Gaiera, Giovanni 202 Gaietta, Sara 208 Gaj, Nicolò 208 Galanti, Andrea 193 P65 Galantucci, Sebastiano 31, 210 Galbiati, Silvia 167, 216 P128, P479 Galimberti, Elisa 29, 208 Galimberti, Gabriella 64, 206 P230 Gallese, Roberta 208 Galli, Alessandra 216 Galli, Andrea 113, 202 P155 Galli, Elisa 211 Galli, Franco 216 Galli, Laura 113, 202 P236, P530, P547, P694, P700 Galli, Rossella 85, 94 P494 Galliani, Alberto XXXI AUTHOR INDEX - 279 Gallina, Andrea 4, 215 P117, P118, P120, P162, P164, P259, P278, P355, P659, P660, P661, P705 Gallivanone, Francesca 177, 211 Gallotta, Giulia 202, 216 P154 Galluccio, Elena 63 P681 Galvano, Enza 213 Gambaro, Margherita XXXI Gandini, Luca 204 Gangemi, Fabrizio 112 Garavaglia, Claudio 112 Garavaglia, Elisabetta 4, 204 P356 Garbetta, Gisella 204 Garcia-Manteiga, Jose 149 P482 Garuti, Elda 213 Garzetti, Livia 30 Gasparri, Anna 2 Gatti, Davide 211 Gatti, Elisa 216 Gatti, Roberto 29, 46 P637 Gattillo, Salvatore 216 Gavinelli, Chiara 29 Gazzetta, Paolo 3 Gelera, Emma 192 Gemma, Marco 28, 199 P307, P359, P360 Generoso, Luca 112 Genovese, Pietro 86 Genovese, Silvia 63 Gentile, Cinzia 4, 204 P356 Gentilomo, Andrea X Gentner, Bernhard 86 P23, P361, P362 Gerasi, Laura 150 Gerevini, Simonetta 177, 199 P32, P215 Gerli, Chiara 194 P253, P773 Gerosa, Stefano 193 P337 Gherlone, Enrico 151, 162 P6, P247, P248, P249, P250, P617, P696, P717 Gherner, Daniela 3, 199 Ghezzi, Massimo 215 Ghezzi, Silvia 113 Ghia, Paolo 1, 8 P134, P260, P261, P382, P426, P554, P736 Ghidinelli, Chiara 31, 210 Ghidinelli, Monica 150 Ghidoli, Nadia 216 P467 Ghidoni, Matteo 65, 199 Ghio, Domenico 213 Ghirardelli, Luca 3 P37, P756 Ghitti, Michela 167 Giacalone, Giacomo 210 Giacomini, Andrea 193 Giannandrea, Maila 28 P698 Giannelli, Serena 28 Giannese, Francesca 112 Gianolli, Luigi 177, 181, 211 P255, P284, P337, P367, P368, P599 Gianotti, Nicola 113, 202 P102, P155, P236, P288, P666, P694, P700 Giardelli, Alessandra 204 Giardina, Paolo 204 Giarolli, Laura 29, 208 P334 Giatsidis, Silvia 65, 199 Giglio, Fabio 3 Giglio, Manuela 177, 211 Gilardi, Maria Carla 177, 211 P72, P182, P368, P468, P505 Gilardini, Cristina 196 Ginex, Valeria 208 Gioia, Giuseppe 196 P216 Gioia, Lorenzo 28, 199 Gioia, Luigi 199 P360 Giordano Resti, 65, 199 Antonio P731 Giordano, Leone 3, 199 Giorgi, Emiliano 196 Giovanardi, Michele 3, 194 P42, P177 Giovannini, Elisabetta 211 Giovannini, Monica 4, 211 P55 Girardi, Anna Maria 216 Gismano, Elena 64 Giudici, Daniela 196, 217 P570 Giuliani, Serena 208 Giussani, Antonella 3, 196 P175, P480 Giustacchini, Alice 86 P361 Giusti, Maria Cristina 28, 208 Giusto, Elena 30 Gobbo, Livia 112 Godino, Cosmo 64, 193 P369 280 - SAN RAFFAELE SCIENTIFIC INSTITUTE Godio, Cristina Golzi, Valeria Gomarasca, Silvia Gonzalez-Rosa, Javier Goudy, Kevin Govi, Silvia Grandi, Elisabetta Granetto, Michele Granieri, Camilla Grassi, Stefano Grassini, Greta Greco, Elena Greco, Raffaella Gregorc, Vanesa 85 208 65 30 87 3 199 XII 113 216 3, 216 211 86 4, 22, 211 P375 Gregori, Silvia 87, 103 P376, P587 Gremizzi, Chiara 113, 206 Gremmo, Annamaria 3, 194 Grimaldi, Adelmo 211 P474 Grimaldi, Antonio 193, 221 P420, P710 Grimaldi, Salvatore 215 Grioni, Emanuela 216 Grioni, Matteo 112 P172 Grispigni, Crispino 196 Gritti, Angela 87, 100 P377, P494, P495, P605, P761 Grogan, Pauline 64, 115 Grohovaz, Fabio 27, 36, 185, 186 Grosso, Stefano 2 P626 Guarisco, Lauretta 65, 199 Guarneri, Maria Pia 204 Guarnerio, Ylenia 1 Guarnieri, Fabrizia 27 Guazzoni, Giorgio 215 P53, P70, P116, P117, P162, P163, P164, P240, P278, P291, P326, P355, P550, P660, P661, P662, P705, P706 Guerriero, Roberta 31, 210 Guffanti, Monica 202 Guggiari, Elena 3, 211 Guglielmi, Barbara 113, 206 Guidotti, Andrea 65, 193 P460, P461 Guidotti, Luca G. 112, 114, 125, 134 P158 Gulletta, Simone 192 P665 Guslandi, Mario 114, 133, 196 P307 Gusmini, Simone 213 P381, P519 Guzzoni, Samantha 30 H Hasson, Hamid Ibrahim Hedlund, Petter Hegde, Nagabhooshan Hellriegel, Christian Heltai, Silvia Henin, Marta Hess-Michelini, Rodrigo Hidetoshi, Hoshia Huichalaf, Claudia 113, 202 P236 4 112 1 111 29, 208 112 P56 85 85 I Iabichino, Cristiana Iaci, Giuseppe Iadanza, Antonella 213 193 28, 185 P184, P359 Iannaccone, Sandro 28, 208 P622 Iannacone, Matteo 112 Ianniello, Margherita XII Ielasi, Alfonso 64, 193 P12, P363 Ierardi, Rossella 87 Ieri, Rossella 216 P467 Indrigo, Marzia 30 Innocenzi, Anna 85 Insacco, Chiara 28, 199 Introini, Maria Antonia 216 Introini, Ugo 65, 199 Inuggi, Alberto 30 Isotti, Luca XII J Jachetti, Elena 112 P56 Jankaricova, Marie 151 Janus, Agnieszka 1 Jofra Hernandez, Raisa 87 P668 Jofra, Tatiana 114 P746 Judica, Elda 31, 210 K Kahlberg, Andrea Kajaste-Rudnitski, Anna 65, 194 P402, P487, P488 113 AUTHOR INDEX - 281 Kara, Sinem Kusamura, Shigeki 30 3, 216 Lazzarin, Adriano L La Canna, Giovanni 193 P246, P420, P450, P710 La Gioia, Sara 31, 210 La Marca, Rosa 31 La Viola, Salvatore 208 Labbate, Laura 216 Lacerenza, Marco 28 Lage Crespo, Carolina 111 P531 Laino, Giovanni 193 Lambiente, Camilla 216 Lamonaca, Grazia 216 Lampasona, Vito 167 P5, P92, P309 Landoni, Claudio 177, 211 P367, P368, P548, P588 Landoni, Giovanni 65, 194 P83, P138, P239, P244, P245, P246, P253, P320, P427, P428, P517, P518, P772, P773, P774, P775 Lania, Caterina 215 P706 Lanterna, Claudia 2 Lanzani, Chiara 151, 206 P732 Lanzi, Roberto 213 Lanzi, Roberto 64, 206 Lanzoni, Paola 177, 211 Lapenna, Elisabetta 193 P710 Lapio, Barbara XII Larato, Daniela 196 Laterza, Cecilia 30 Latib, Azeem 64, 193 Mohamed P203, P220, P363, P430, P431, P432, P434 Latino, Rosanna 216 Lattanzi, Annalisa 87 P495 Lattanzio, Rosangela 65, 199 Lattuada, Guido 63 P595, P596, P597, P601 Laurenzi, Andrea 64, 206, 216 Lavazza, Fanny 193 Lavorato, Maria 216 Vittoria Lavorgna, Giovanni 167 P534 Lazzari, Chiara 4 Leggieri, Carlo Legnani, Giulio Legorini, Francesca Leiva, Andrea Lenti, Elisa Lenzi, Sara Leo, Loredana Leocani, Letizia Leopizzi, Emanuela Leporati, Ennio Lepore, Marco Lesma, Arianna Levi, Sonia Liberatore, Giuseppe Licata, Giada Lidonnici, Maria Rosa Lillo, Flavia Limardo, Pietro Liperi, Laura Lira Luce, Francesca Liu, Jaron Locatelli, Clara Locatelli, Marco Locatelli, Massimo Locatelli, Simona Locci, Michela Logaldo, Davide Lombardo, Angelo Lombardoni, Carlo Longaretti, Roberta Longari, Stefania Longo, Alessandro Longobardi, Barbara Longoni, Giulia Longoni, Laura Longoni, Matteo Longoni, Simona Lopalco, Lucia Lopalco, Sara Loperfido, Francesco Lopez, Ignazio Diego Lorè, Nicola Ivan Lorenzetti, Isabella 111, 113, 202, 203, 221 P28, P63, P155, P236, P242, P302, P347, P411, P436, P445, P545, P547, P551, P552, P586, P694, P700, P725, P769 197 P138 216 65, 199 2 1 221 167 30, 48, 210 210 63 112 215 27, 38 P153, P438, P693 210 3, 211 87 221 P1, P586 3, 199 29, 208 3, 199 P440 149 29, 208 29, 208 216 XII 87 P442, P476 65, 194 P204, P205 86 167, 216 185 P85 211 XXXI 177 31, 210 177, 211 193 4 111, 122, 202 P1, P131, P528, P737 28 65, 199 30, 210 P197 111 30 282 - SAN RAFFAELE SCIENTIFIC INSTITUTE Lorenzi, Cristina 29 P564 Lorenzi, Mara 63 Lorioli, Laura 88 Lorusso, Anna 27 Losa, Andrea 215 Losa, Marco 28, 199 P448, P670 Losio, Claudio 177, 213 Lucarelli, Barbarella 87 Lucca, Adelio 29, 208 Luchini, Stefania 204 Lucotti, Pietro 64 P450, P681 Lughezzani, Giovanni 4, 215 P130, P395, P399, P451, P452, P549, P779 Lukacs, Anna 111 Lunghi, Francesca 3, 211 P333 Luparini, Francesco 3, 196, 216 Lupo Stanghellini, Maria Teresa 86, 211 P213, P741 Luzi, Livio 63, 67 P24, P51, P63, P303, P311, P595, P596, P597, P601 M Maccagnano, Carmen 4, 215 Maccagni, Davide 193 Maccalli, Cristina 2 P454 Macchi, Andrea 65, 193 Macco, Romina 27 Madaschi, Sara 64, 206 Maddé, Claudia 211 Francesca Maderna, Claudio 87 Maestranzi, Gisella 65, 199 Maestroni, Anna 63 Maestroni, Silvia 63 Maffei, Cesare 29, 45, 208 P334, P335, P336 Maffi, Paola 115, 138, 206 P51, P341, P464 Maga, Tommaso 215 Magagnotti, Cinzia 167, 216 Maganetti, Nicola 216 Maggioni, Daniela 2 P333, P759 Magistretti, Paola 115 Magnani, Chiara 87 P376 Magnani, Giuseppe 31, 54, 210 Magnani, Patrizia 177, 211 Magnani, Zulma 86 P213 Magri, Laura 85 Magrin, Silvio 193, 194 P517, P518 Maida, Giorgio 65, 192 Mailhac, Alessandra 193 Maillard, Myriam 202 Mainetti, Eliseo 196 Mainetti, Lara 112 Mainetti, Marta 112 Maiorino, Chiara 30 Maisano, Francesco 65, 193 P239, P370, P420, P459, P460, P461 Maj, Giulia 65 P239, P518, P581 Malabarba, Lucia 216 Malaguti, Alessia 29, 208 Malato, Simona 3 Malegori, Angela 65, 199 Malgaroli, Antonio 27, 37 P257 Malnati, Mauro S. 111, 119 P125, P316 Malosio, Maria Luisa 115, 137 P309, P464 Maltecca, Francesca 167 P465 Mammi, Silvia 31, 210 Mamo, Daniela 197 Manca, Eleonora 211 Manca, Mario 193 Mancini, Nicasio 216 P135, P136, P467 Mancini, Niky 196 Mancino, Marilena 2 Manclossi, Chiara 199 Manconi, Mauro 29, 209 P622 Mandelli, Carlo 28, 199 P469 Mandelli, Davide 196 Mandelli, Giacomo 87 Mandelli, Maria Rosa XII Mandelli, Massimo 213 Manenti, Rosa 28 Manfredi, Angelo A. 85, 94 P38, P79, P136, P152, P286, P287, P325, P443, P471, P501, P502, P503, P606 Mangiavini, Laura 151, 196 P675 Mangili, Giorgia 4, 20, 204 P356, P474, P688 Mangili, Paola 177 P291, P593 Manitto, Maria Pia 65, 199 AUTHOR INDEX - 283 Mannella, Valeria Mannu, Claudio Mantegani, Paola Mantovani, Elena Manunta, Paolo Manzo, Teresa Manzoni, Marco Federico Mapelli, Paola Mappa, Silvia Marabelli, Giuseppina Maranta, Francesco Marassi, Alberto Marcatti, Magda Marchettini, Paolo Marchi, Monica Marchisio, Pier Carlo Marcone, Alessandra Marelli, Guido Marelli, Sara Marenzi, Karen Marescotti, Diego Margittai, Eva Margonato, Alberto Mari, Gilberto Mari, Silvia Mariani, Alberto Mariani, Elisabetta Mariani, Federica Mariani, Samanta Marinaro, Cinzia Marinelli, Marcello Marinelli, Matteo Marino, Giovanni Marinosci, Alessandro Marinozzi, Maria Chiara Marktel, Sarah Maroli, Giovanni Marone, Enrico Maria Marrocco-Trischitta, Massimiliano 167 P206 211 112 65, 199 151, 163, 206 P75, P264, P419, P475, P677, P678, P732 112 64, 206 P341 211 3 216 65 196 3, 211 31, 210 P569 64, 206 P264, P344 2 28, 208 P354, P622, P752, P757, P758 204 29 P184 64, 204 112 149 65, 77, 193 P12, P337, P338, P339, P576, P701 196 167 3, 196 P285, P480, P497, P716 149 P250 216 112 P18 30 216 150 65, 193, 194 P244, P253, P774 206, 216 P287 216 P154, P155 86, 204 P13, P14, P171, P679 85 65, 193, 194 P204, P402, P483 65, 194 P402, P457, P486, P487, P488 Marsiglio, Elena Martani, Carla Martina, Elisabetta Martinelli, Chiara Martinelli, Cristina Martinelli, Vittorio Martinelli-Boneschi, Filippo Martinenghi, Carlo Martinenghi, Sabina Martino, Gianvito Martoglio, Alberto Martulano, Marilena Marturano, Emerenziana Marzi, Alessandra Marzorati, Patrizia Mascia, Daniele Masciullo, Corrado 204 196 65, 199 63 29 31, 53, 210 P57, P228, P365, P492, P493 31, 210 P493, P757 213 P381 115, 206 P339 27, 30, 49 P39, P124, P192, P309, P605, P606, P607, P646, P686 XII 211 3 192 150 65, 194 150 P728 Masiello, Valeria 177, 211 Masperi, Carla XXXI Massani, Simona 65 Massimino, Luca 27 Mastaglio, Sara 86 P404 Matafora, Vittoria 149 P500 Matarrese, Mario 177, 211 P761 Mattarucchi, Roberta 3, 86 Mattioli, Cristina 199 Matuska, Stanislav 28, 199 P623 Mauceri, Paolo 65, 199 Maugeri, Norma 65 P325, P501, P502, P503 Mauri, Anna 216 Mauri, Simona 216 Mauro, Fabio 204 Mavilio, Fulvio 150, 158 P178, P311, P350, P496, P591 Mazza, Elena 4, 211 P629, P630 Mazzeo, Lucio Aniello 28 Mazzi, Benedetta 216 P154, P741 Mazzi, Ilaria 216 Mazzieri, Roberta 86 Mazzoleni, Stefania 85 Mazzone, Patrizio 192 P665 284 - SAN RAFFAELE SCIENTIFIC INSTITUTE Mazzucchelli, Renata Ilde Mazzuconi, Roberts Meani, Alessandro Meani, Renato Medaglini, Stefania Medone, Marzia Melandri, Marco Meldolesi, Jacopo 87 P298 X, XXXI 31 196 31, 210 28, 199 206 27, 35 P218, P262, P414, P698, P703 Meli, Annalisa 29, 199 Melissano, Germano 65, 193, 194 P36, P204, P205, P402, P486, P487, P488, P508, P509, P510, P511 Melisurgo, Giulio 194 P457 Mellone, Renata 213 P303 Melloni, Giulio 3, 194 P42, P176, P177, P216, P512 Meloni, Carlo 193 Melzi, Lisa 65, 199 Melzi, Raffaella 115 P158, P464 Memoli, Massimo 113, 206 Menegon, Andrea 185 Menichini, Raffaele 211 Mennella, Roberta 194 P518 Meoni, Massimiliano XII Merati, Valentina 111 Mercalli, Alessia 115, 196 P24, P158 Merello, Maria 210 Merlini, Federica 114, 196, 216 Merlino, Lino 206 Meroni, Titti XII Meschi, Franco 64, 73, 204 P92, P447 Messa, Maria Cristina 177 P304, P367, P456, P474, P588 Messa, Massimo 193 Angelo Messaggio, Elisabetta 151 P419, P732 Messina, Graziella 85 P424, P515, P516 Messina, Melissa 65, 194 P517, P518, P772 Mezzadri, Umberto 196 Mezzi, Gianni 3, 196 P519 Micali, Nicola 150 P520 Micheletti, Luisa 27 Miggiano, Chiara 211 Mignogna, Giovanna 63 P728 Mignogna, Maria Lidia 28 Mikulak, Joanna 27 P523 Milan, Enrico 149 Milani, Davide 28 Milani, Federica 3, 196, 216 Milazzo, Rita 87 Milesi, Jacopo 65, 199 Milesi, Rita 208 Miluzio, Annarita 2 P524 Minici, Claudia 112 Minicucci, Fabio 31, 56, 210 Minotti, Maria Grazia 177, 211 Miotto, Paolo 112 P525 Miracoli, Giuseppe XII Misci, Paolo 31 Miserocchi, Elisabetta 65, 199 P224, P527, P530 Mizzi, Anna Maria 65 P773, P774 Mocci, Alessio 3, 196, 216 Modorati, Giulio 65, 199 P224, P527, P530 Mogliani, Patrizia XII Moi, Davide 86 P618 Moiola, Lucia 31, 210 P228, P365, P614, P635 Moizo, Elena 197 Molgora, Michela 64, 204 Mollica, Luca 167 P131, P206 Molteni, Laura 115, 206 Molteni, Raffaella 111 P531 Monaco, Fabrizio 194 P245, P775 Mondino, Anna 112, 126 P404 Monello, Alberto 211 Monno, Antonella 85 P38 Montanaro, Claudia 65 P338 Monterisi, Cristina 177, 211 Montesano, Anna 63 Monteverde, Stefania 85 P516 Monti, Giacomo 65 P138, P140, P772 Monti, Lucilla D. 63, 70 P279, P450, P534, P681 AUTHOR INDEX - 285 Montini, Eugenio Montoli, Serena Montorfano, Matteo Montorsi, Francesco Monzani, Elena Mora, Stefano 87, 101 P178, P350, P536 4, 204 64, 193 P122, P203, P363 4, 22, 215 P43, P45, P47, P52, P53, P70, P73, P74, P90, P109, P115, P116, P117, P118, P120, P159, P160, P161, P162, P163, P164, P165, P166, P167, P168, P209, P210, P217, P240, P243, P259, P278, P318, P326, P355, P380, P386, P388, P393, P395, P396, P397, P399, P400, P408, P409, P451, P452, P478, P526, P529, P537, P538, P539, P540, P544, P557, P613, P624, P628, P639, P641, P642, P643, P659, P660, P661, P662, P683, P684, P705, P706, P770, P779, P780, P781, P782, P783, P784, P785, P786 27 63, 70, 204 P208, P268, P284, P541, P542 208 Moreno Granados, Gema Moelia Morero, Silvia 197 Marolina Mores, Federica 199 Moresco, Rosa Maria 177, 211 P56, P433, P761 Mori, Silvia 150 P500 Moriggia, Stefano 193 Moro, Andrea 28 P719 Moro, Gianluigi 63, 196 Morosini, Sara 85 Morsica, Giulia 113, 202 P545, P546, P547 Mortini, Pietro 28, 42, 199 P129, P305, P342, P448, P632 Motta, Andrea 216 Motta, Chiara 208 Motta, Francesca 113, 206 Motta, Micaela 177, 211 P548 Movalli, Mariagrazia 29, 208 Mrak, Emanuela 63 P158, P297, P668 Mucci, Milena 197 Mukenge, Mvunde 3, 196 Mulas, Ines 196 Mungo, Maurizio 199 Muraro, Ornella XII Muriana, Piergiorgio 3, 194 Murino, Marcello 193 Musco, Giovanna Musner, Nicolò Mussardo, Marco Musso, Alessandra Muzio, Luca Muzio, Marta Muzza, Andrea 167, 172 P206 149 64, 193 111 P609 30 P192, P646 1, 9 P553, P554 199 N Nai, Antonella 150 P690 Naio, Rita 192 Naldini, Luigi 85, 86, 98, 99 P23, P26, P86, P127, P173, P178, P198, P275, P281, P350, P361, P476, P536, P556, P604, P618, P761 Nano, Rita 115, 140 P71, P464 Napoletano, Anna 112 Napoletano, Francesco 28 Napolitano, Sara 86, 204 P171 Nascimbene, Simona 193 P65 Natali Sora, Maria 31 Grazia Nava, Luciano 4, 215 Negri, Giampiero 3, 194 P216 Negri, Giulio XII Negrini, Sara 27 Negro, Aurora 2 P759 Neguembor, 85 Marie Victoire Neri, Margherita 87 Nicoletti, Roberto 213 P36, P381, P630 Nifosi, Jacopo 3 P37 Nigro, Annamaria 30 Nigro, Elisa 149 P560 Nisoli, Ilaria 28 Nitti, Cinzia 193 Noè, Anna 204 P171 Notaristefano, Chiara 3, 196 P716 Novati, Roberto 202 Novella, Liliana 208 286 - SAN RAFFAELE SCIENTIFIC INSTITUTE Noviello, Maddalena Nozza, Silvia Ntoufa, Stavroula Nuzzaco, Grazia Nuzzi, Massimiliano 86 113, 202 1 31 194 O Occhi, Francesca Occhi, Simona Odazio, Veronica Ogliari, Anna Ogwang, Martin Oldani, Alessandro Oliva, Laura Olivieri, Stefano Oppizzi, Michele Orellana, Daniel Orfanelli, Ugo Origoni, Massimo Orlandi, Giacomo Ornaghi, Francesca Orombelli, Lisa Orsenigo, Elena Ortolano, Enrico Osnago, Ombretta Ossi, Cristina Ottolina, Jessica Ozino, Stefania 114, 204 P580 28 65, 199 29, 208 P48 221 29 149 P76 167 65, 193 P12 30 149 114, 131, 204 P565 211 149 XII 3, 196 P756 216 192 216 P467, P570, P726 4 29 P Pacchioni, Manuela Paesano, Pierluigi Paganelli, Michele Pagani, Alessia Pagani, Antonella Pagani, Elisabetta Paganoni, Giorgio Paglino, Gabriele Pajoro, Ursola Pala, Maria Grazia 211 213 114, 196 P264, P344, P358, P610 150 P690 63 P690 31 P7, P190, P191, P514, P638, P647 28, 199 P623 192 P665 211 193 P450 Pala, Mauro Palini, Alessio Palmigiano, Angela Palmisano, Ilaria 85 185, 187 167 167 P692 Palmisano, Marilena 150 Palmisano, Michela 111 Palonta, Francesca 199 P713 Paloschi, Vera 113, 206 P34 Palumbo, Lidio 211 Palumbo, Roberta 149 P573, P619 Panacci, Nicoletta 64, 204 Panattoni, Martina 111 Pancaldi, Alessandra 193 Panigada, Fausto 29, 208 Panizza, Pietro 177, 213 Pannese, Maria 150 Panzacchi, Andrea 177, 211 Panzeri, Maria Carla 185 Papa, Ilenia 216 Papa, Marco 193 P576 Papale, Alessandro 30 P578 Papaleo, Enrico 64, 74, 204 P579, P580 Pappalardi, Brigida 177, 211 Pappalardo, Federico 65, 194 P253, P581, P774 Pappone, Alessia 65, 192 Pappone, Carlo 65, 192 P174, P568, P582, P583, P665 Pardi, Ruggero 111, 118 P18, P531, P753 Pardini, Celia 167 Paredi, Giulia 29 Parezanovic, Vanda XII Parlatini, Valeria 29, 208 Parma, Barbara 204 P497 Parma, Lia 216 Parmiani, Giorgio 1, 2, 11 P389, P454, P711 Parolini, Danilo 196 Parolo, Caterina 213 Paroni, Moira 111 P105 Parutto, Diana 211 Pasetti, Marcella 177, 211 Pasi, Federica 64, 204 P183 Pasi, Massimo 151 P617 AUTHOR INDEX - 287 Pasqualetto, Elena 149 P76 Passaretti, Sandro 114, 196 P235 Passerini, Gabriella 216 Passerini, Laura 87 P23, P292 Passoni, Arianna 204 P232 Passoni, Paolo 177, 211 P629, P630, P745 Pastore, Matteo Rocco 115, 206 Pastori, Claudia 111, 202 Paterra, Rosina 27 Patricelli, Maria 216 Grazia Pattarini, Elisabetta 63, 216 Pavan, Giulia 31, 210 Pavani, Giulia 63 Pavoni, Ernesto 150 Pazzi, Annamaria 202, 216 Peccatori, Jacopo 86, 211 P110, P213, P741 Pecciarini, Lorenza 216 P721 Pedrazzi, Maria Rosa XII Pedretti, Elisa 111 Pedrigi, Cristina 193 Pelizzoni, Ilaria 27 Pella, Francesca 4, 204 Pellegatta, Marta 150 Pellucchi, Federico 4, 215 Pema, Monika 150 P765 Pengo, Niccolò 149 P76 Pennucci, Roberta 27 Pepe, Gino 211 P284 Perani, Daniela 28, 43, 211 P4, P94, P95, P156, P182, P590, P622, P655, P719 Perani, Laura 85 Perduca, Alessandra 204 Perego, Elisabetta 31, 210 Stefania Perego, Jacopo 211 Perego, Marco 1 Peretti, Elena 64, 206, 216 P230 Peretti, Giuseppe M. 151, 164, 196 P675, P763 Peretti, Umberto 4 Perini, Oriana 86, 216 Perna, Lucia 177 P19, P331, P593 Perotti, Valeria 196 Perrotta, Cristiana 86 P81 Perseghin, Gianluca 63, 68 P63, P269, P303, P594, P595, P596, P597, P601 Persichini, Luisa 151, 206 Persico, Paola 204 P274 Perticone, Francesca 64, 206 Perucca, Simone 150 P671 Peruzzotti Jametti, 30, 210 Luca P39 Pesce, Elisa 2 Pesenti-Gritti, Paola 29, 208 P48 Pessina, Patrizia 85 Petralia, Giovanni 4, 215 P70 Petrella, Giovanna 211 Petrelli, Alessandra 113 Petrolini, Melissa 31 Petrone, Maria Chiara 3, 196 P519 Petrone, Micaela 4, 204 Pezzani, Valeria 208 Piani, Cecilia 64, 206 Piantoni, Lara 31 Piatti, Piermarco 64, 72, 206 P450, P681 Picariello, Marco XII Picchio, Maria 177, 211 P56, P304, P367, P368, P474, P588, P599, P688 Piccini, Flavia 216 Piccioni, Lucia Oriella 29, 199 P360, P713 Piccoli, Susanna 199 Picozzi, Piero 28, 199 P32, P321, P342, P367, P530, P600 Piemonti, Lorenzo 115, 136, 196 P24, P158, P464, P601 Pieralli, Sandra 199 Pieri, Alessandro 208 Pierro, Luisa 65, 199 Pievani, Michela 31 P602 Pilla, Lorenzo 2 Pintonello, 185 Maria Luisa Piraino, Daniela 64, 193 Pirola, Barbara Maria 216 Pirola, Serena 204 Pirovano, Adele 29 P60, P470, P481 Pisa, Viviana 86 288 - SAN RAFFAELE SCIENTIFIC INSTITUTE Piscopo, Maria Antonietta Pistis, Giorgio 204 150 P728 Pistocchi, Anna 85 P672 Pistoni, Mariaelena 85 Pitea, Marco 204 Pizzamiglio, Carlo 177 Pizzetti, Giuseppe 193 Pizzi, Sara 177 Pizzo, Riccardo XXXI Pizzocolo, Cecilia 202 Plati, Tiziana 87 P198, P604 Pluchino, Stefano 30, 50 P39, P605, P606, P607, P686 Podini, Paola 27 P197, P414 Poggi, Alessandra 213 Poggi, Antonella 31, 210 Poggiali, Erika 150 P151 Pogliaghi, Manuela 113, 202 Poitelon, Yannick 150 Poletti, Sara 29 P58, P185 Poletti, Valentina 150 Poli, Davide 28, 199 Poli, Guido 112, 122 P1, P18, P179 Politi, Ernestina 29, 208 Politi, Letterio 177, 181, 199 Salvatore P761 Poloniato, Antonella 64, 204 Polverigiani, Silvia 185 Pontesilli, Silvia 28, 199 P85, P747 Pontiggia, Adriana 29, 208 Pontillo, Marina 216 Pontiroli, Barbara 65 Ponzi, Elena XII Ponzoni, Maurilio 216 P158, P213, P229, P255, P305, P321, P323, P361, P390, P404, P476, P536, P606, P721, P759 Porrello, Emanuela XXVI, 30 Porrino, Lucy 113, 202 Porro, Federico 221 Potenza, Maria Teresa 204 Pozza, Guido X Pozzi, Alessandro 151, 196 P675 Pozzi, Benedetta 1 Pozzi, Federica 211 Pozzi, Paola XII Pozzobon, Gabriella 64, 204 P440 Prada, Ilaria 27 P414 Pradella, Alessandra 208 Praderio, Luisa 113, 206 P286 Prati, Matteo 65, 199 Premoli, Sergio 208 Presti, Francesca 196 Previtali, Stefano 30, 49 Carlo P91, P197, P435 Preziosa, Paolo 31 Privitera, Daniela 31 P309 Privitera, Ylenia 65, 193 Protti, Maria Pia 112, 126 P711 Provasi, Elena 86 P404 Psacharopulo, Daniele 65, 194 Puccetti, Patrizia 193 Pucci, Ferdinando 86 P23, P618 Puglisi, Armando 3, 194 P176, P177 Pulitanò, Carlo 196 P17, P272, P273, P664 Pultrone, Cinzia 85, 113 Pusterla, Tobias 149 P573, P619 Putignano, Antonella 3 Puzzovio, Maria 63, 204 P541 Q Quario, Lorenzo Quartagno, Rita Quattrini, Angelo 196 206 30, 47 P91, P111, P197, P465, P491 194 Quattrocchi, Tiziana Giuseppa Querques, Marialuisa 151, 206 Quilici, Giacomo 167 R Rabaiotti, Emanuela Raber, Marco Racanicchi, Leda Racca, Sara Racchetti, Gabriella 4, 204 215 P662 115 216 27 P218, P703 AUTHOR INDEX - 289 Raccosta, Laura 2 P333, P759 Radaelli, Daniele 29 P58, P59, P61 Radaelli, Maria Grazia 64, 206 Radaelli, Marta 31 P492 Radinovic, Andrea 65, 192 P582, P665 Ragogna, Francesca 63 P595, P596, P597, P601 Rainone, Francesco 151, 206 P34 Rama, Paolo 28, 41, 199 P224, P301, P425, P527, P530, P591, P623 Ramella, Barbara 3, 199 Ramoni, Andrea 65, 199 Rampoldi, Luca 150, 161 P64, P283, P472, P671 Ranghetti, Anna 86 Ranzani, Marco 87 P536 Ranzato, Elia 2 P626 Rapallo, Maria Pia 213 Rapisarda, Eugenio 177, 211 P72 Raschi, Alessandra 193 Ratti, Deborah 202 Ratti, Francesca 3, 196 Ratti, Maria Monica 208 Raucci, Angela 149 Ravanetti, Lara 112 Ravizza, Alfredo 199 Rebagliati, Paola XII Recanati, Paola 3, 199 P714 Recchia, Alessandra 150 P311, P350, P496 Redaelli, Anna 204 Redaelli, Chiara 167 Regali, Laura 65, 199 Reichlin, Massimo X Reineke, Raffaella 196 Reiss, Laura XII Reither, Klaus 221 Reni, Michele 4, 21, 211 P107, P108, P321, P629, P630, P745 Resnati, Massimo 150 Restuccia, Umberto 149 P308 Riba, Michela 167 Ribecca, Antonella 199 Riberio, Ricardo 221 Riccaboni, Roberta 29 P58 Ricci, Vincenzo Ricciardi, Sara Riccitelli, Gianna 211 28 31 P514, P638 Ricupito, Alessia 112 Ridolfi, Cristina 3, 196 Rigamonti, Andrea 115, 204 Rigamonti, Elena 85 Rigamonti, Marco 177, 211 Rigamonti, Nicolò 112 P172 Rigamonti, Riccardo 211 Rigatti, Lorenzo 215 Rigatti, Patrizio 215 P70, P116, P117, P118, P120, P163, P240, P259, P278, P355, P659, P660, P661, P662, P705, P706 Righi, Claudio 177, 199 Rigo, Francesca 167, 216 Rinaldi, Rosanna 185 Ripamonti, Anna 87 Ripamonti, Maddalena 27 P257 Riva, Elisabetta XII Riva, Nilo 30 Rivoltini, Paola 196 Rizzato, Elisa 204 Rizzi, Chiara 112 P179 Rizzo, Nathalie 216 Rocca, Alda 28 Rocca, Maria Assunta 31, 52 P8, P10, P57, P143, P189, P190, P191, P329, P416, P466, P493, P514, P635, P636, P637, P638, P648 Rocchetti, Simona 216 Rocchi, Martina 185, 216 Rocchini, Lorenzo 4, 215 P660, P661, P662 Rodegher, Mariaemma 31, 210 P191, P228, P492, P493 Rodighiero, Maria 213 Grazia Rofena, Simone 64, 204 Rognone, Alessia 4, 211 P629, P630 Rojo, Carmen 65, 199 Rolandi-Maciotta, 85 Simona Rolla, Serena 216 Roma, Andrea XXXI Romano, Maria XXXI Romano, Michele 112 Cosmo Romano, Silvana 211 Romano, Vittorio 193 Romero, Lilian 216 290 - SAN RAFFAELE SCIENTIFIC INSTITUTE Roncarolo, Maria Grazia Ronchetti, Clara Ronchi, Paola Ronchi, Paolo Rondinelli, Beatrice Ronfani, Lorenza Ronzoni, Monica Ronzoni, Riccardo Rosa, Isabella Rosa, Susanna Roselli, Emanuela Anna Rossetti, Maura Rossi, Carlo X, XII, XXI, 86, 87, 88, 97, 102, 104, 204 P13, P14, P26, P49, P50, P99, P171, P178, P198, P292, P351, P376, P442, P476, P668, P679, P741, P746 113, 202 216 208 2 185 P709, P768 4, 211 149 65 64, 204 P183 87 87 211 P286, P287, P645 Rossi, Claudia 87 Rossi, Erica 208 Rossi, Gemma 3 Rossi, Giuliana 85 Rossi, Michela 65, 199 Rossi, Paolo 31, 210 P637, P734, P735 Rossini, Alessandro 64, 206, 216 Rossini, David 208 P412 Rossini, Silvano 86, 97, 216, 219 P741 Rossodivita, 193 Alessandra P450 Rossoni, Gilda 4, 211 Rovani, Stefano 213 Rovelli, Elisabetta 27 P153 Rovelli, Rosanna 64, 204 Rovere-Querini, 85, 94 Patrizia P38, P87, P88, P152, P179, P183, P286, P287, P325, P443, P444, P471, P501, P502, P503, P606 Roveri, Luisa 31, 210 Rowe, Isaline 150 P295, P765 Rozza, Lucia 211 Rubinacci, Alessandro 63, 69 P158, P297, P651, P668, P669, P728 Ruffini, Chiara 29, 208 Rugarli, Claudio X Ruggeri, Annalisa 86 Ruggeri, Laura 65 Rusconi, Vega 113, 202 Russo, Alberto XXXI Russo, Gianni Russo, Vincenzo 64, 204 P69, P268 2, 12 P93, P333, P404, P759 S Sabbadini, Maria Grazia Saccà, Antonino Sacchi, Angelina Sacchi, Luisa Sacchi, Stefania Sacco, Vincenzo Sacconi, Massimo Saccucci, Stefania Saccuman, Cristina Saibene, Alessandro Sala, Cinzia Sala, Simone Sala, Stefania Salandini, Maria Chiara Salani, Giuliana 113, 130, 206 P183, P286, P287, P501, P502, P566, P750 4, 215 P355, P660, P661, P662 2 199 192 P582, P665 211 216 150 28 P85 64, 206 150 P260, P631, P728 65, 192 P582, P665 31 P7, P8, P9 3 30 P39, P606 Salaris, Davide 65, 197 P138 Salerno, Anna 65 P338, P701 Salmaggi, Chiara 206 Salmaso, Flavia 202 Salomoni, Gabriella 216 Salonia, Andrea 4, 215 P116, P117, P162, P163, P164, P259, P278, P355, P540, P658, P659, P660, P661, P662, P705, P706 Salpietro, Stefania 202 P236, P700 Salvadori, Giovannella 177, 211 Salvioni, Marco 213 Salvo, Fulvio 113, 206 Samanes Gajate, 177, 211 Ana Maria Samarati, Maria XII Sammartino, XXXI Piergiorgio Sampietro, Francesca 63, 216 P330, P581, P589 Sana, Maria Elena 167 AUTHOR INDEX - 291 Sangalli, Mattia Sanna, Alberto Sanpaolo, Michela Santagostino, Andreina Santagostino, Ilaria Santambrogio, Graziella Santambrogio, Paolo 215 XXXI 216 192 3 216 27 P153, P464, P634, P652 Santambrogio, Sara 87 P671 Santarella, Roberto XII Santinelli, Vincenzo 65, 79, 192 P582, P583, P665 Santoro, Alessia 208 Sanvito, Francesca 185, 188, 216 P339, P404, P476, P536, P753, P759 Saporiti, Nicoletta 206 Sarandria, Daniela 199 P440 Sarno, Lucio 208 Sarro, Lidia 31 Sartirana, Claudia 87 Sartori, Serenella 150 Sassi, Isabella 216 Sassi, Monica 216 P135 Sasso, Eleonora 208 Sauer, Aisha Vanessa 87 P667, P668 Saveri, Paola 149 Savi, Annarita 211 P145 Savi, Maurizio XII, XXIV Savia, Veronica XII Saviano, Massimo 65, 192 P582 Savio, Michol 111 Sbalchiero, Andrea 211 Scandola, Elena 199 Scandroglio, 194 Anna Mara P581 Scapaticci, Emanuele 215 Scaramuzza, Samantha 87 P14, P454, P476 Scarfò, Lydia 1 Scarioni, Monica 196 Scarlato, Marina 210 P111, P197 Scarlatti, Gabriella 112, 127, 221 P186, P316 Scarpellini, Paolo 202 P40, P570 Scattoni, Vincenzo 4, 215 P240 Scavini, Marina Schaeffer, Céline Schena, Elisa Schiaffino, Maria Vittoria Schiavi, Davide Schira, Giulia Sciarrone Alibrandi, Maria Teresa Scielzo, Cristina 115, 139 P183 150 P671 112 167, 170 P392, P692 65, 193 86 P361 151, 206 1 P260, P554 Scifo, Paola 177, 185, 211 P63, P156, P303, P595, P596, P654 Sciorati, Clara 86 Scola, Elisa 28, 185 P359 Scolari, Chiara XII Scomazzoni, Francesco 177, 199 Scotti, Celeste 151, 196 P675 Scotti, Fabrizio 65, 199 Scotti, Giuseppe 177, 185, 188, 199, 201 P58, P59, P85, P199, P359, P638, P719, P761 Scotti, Patrizia XII Scotti, Raffaella 206 Scotti, Roberta 28, 199 P32, P493, P747 Secchi, Antonio 113, 115, 131, 206 P51, P68, P214, P464 Secchi, Cristiana XII Secchi, Massimiliano 111 P676 Seghezzi, Laura 216 Selli, Simone 177, 211 Senesi, Pamela 63 Sensi, Cristina 167 Serafini, Audrey 64, 204 P187, P373, P374 Sergi Sergi, Lucia 86 P26, P198, P536 Serra, Carlo 28 P342 Sessa, Alessandro 28 P219 Sessa, Luca 149 Sessa, Maria 31, 54, 88, 105, 210 P198, P277, P300 Sestini, Stefano 3, 194 Setaccioli, Marco 65, 199 Setola, Emanuela 64 P450, P681 Sferrazza, Barbara 208 Sforzini, Laura 29, 208 292 - SAN RAFFAELE SCIENTIFIC INSTITUTE Sgaramella, Paola Sibilia, Mauro Siccardi, Antonio 204 31 149, 154 P1, P290, P560 Siccardi, Tomaso 29, 208 Sigismondi, Cristina 4 Signorotto, Patrizia 177 Silipigni, Carmen 193 Siliprandi, Francesca 208 Silva, Carlo 216 Silvani, Paolo 65, 217 Silvestri, Laura 150 P690 Simionato, Franco 177, 199 Simonelli, Pasquale 177, 211 Simonetti, Giorgia 1 P553 Simonini, Marco 151, 206 Sincinelli, Laura 221 Sioli, Barbara 216 Sironi, Elisabetta 216 Sironi, Francesca 111 Sirtori, Marcella 63 P728 Sirtori, Paolo 196 Sitia, Giovanni 112 P158 Sitia, Roberto 149, 153 P76, P650 Sizzano, Federico 85 Slavich, Massimo 65 Slaviero, Giorgio 206 Slim, Najla 177, 211 Smeraldi, Enrico 29, 208, 209 P27, P58, P59, P60, P61, P62, P185, P481, P612 Smid, Maddalena 64, 204 P747 Snider, Silvia 28, 199 P342 Soares, Milena 221 Socci, Carlo 114, 133, 196 Soccio, Antonella 211 Sogno Valin, Paola 204 P284 Soldarini, Armando 216 Soldini, Laura 216 P586 Soliman, Clara 204 P171 Sommariva, Elena 167, 216 P582 Soprana, Elisa 149 P290, P560 Sora, Nicoleta 65, 192 Sordi, Valeria 115, 196 P158 Soriani, Nadia Sorlini, Cristina Sosio, Corrado Sottocorna, Ornella Sovena, Gloria Sozzi, Francesco 167, 216 4 151, 196 194 2 4, 215 P70 Spada, Danilo 29 Spagnolo, Daniele 204 P356, P747 Spagnolo, Francesca 30, 210 Spagnolo, Pietro 177, 211 Spagnuolo, Marco 211 Spagnuolo, Vincenzo 113, 202 P155, P700 Spatola, Chiara 29, 208 P48 Spelta, Sara 65, 194 Spessot, Marzia 216 Spiga, Ivana 216 Spiliotoupulos, 167 Dmitrios Spina, Annunziata 216 Spinapolice, Elena 211 Spinelli, Alessandra 65, 199 P96, P623 Spinelli, Antonello 177 Spinelli, Maria 31 Carmela Spitaleri, Andrea 167 P206 Spoladore, Roberto 192, 193 P338, P701 Spotti, Donatella 151, 206 Spreafico, Anna 4 Squadrito, Mario 86 Leonardo Squilla, Mario 193 Stabilini, Angela 114 P746 Staudacher, Carlo 3, 16, 114, 196, 198 P37, P235, P274, P519, P756 Stefani, Chiara 114, 204 Stella, Marco 114, 196 Stella, Paola 206 Stenirri, Stefania 167, 216 P364 Stoppani, Monica 65, 199 Storti, Maurizio 206 Strada, Elena 4, 215 P70, P706 Straffi, Laura 30, 210 P492 Strati, Paolo 4, 211 Stratta, Gregorio 196 Stucchi, Stefano 211 Stuccillo, Michela 64 AUTHOR INDEX - 293 Suardi, Nazareno Sudati, Francesco Sussani, Lara 4, 215 P73, P74, P117, P118, P120, P162, P164, P165, P167, P169, P209, P259, P318, P355, P407, P408, P628, P641, P642, P660, P661, P705, P706 177, 211 65 T Taccagni, Gianluca Tacchetti, Carlo Tacchini, Simona Irma Tadini, Patrizia Taffi, Ilaria Taglietti, Maria Vittoria Takagi, Kensuke Talarico, Anna Talarico, Daniela Tamburini, Andrea Marco Tambussi, Giuseppe 216 177 213 X 31 216 64, 193 216 150 P691 3, 196 113, 130, 202 P2, P302, P445 Taramasso, Maurizio 193 P461, P710 Tarlasco, Camilla 65 Tassan Din, Chiara 202 P40, P302, P445 Tassara, Michela 3 Taveggia, Carla 31, 53 P91 Taverna, Rosaria 199 Tavilla, Alessandro 211 Tavola, Alessandra 65 Tedesco, Saverio 85 Teggi, Roberto 29, 199 P713, P714, P715 Tei, Laura XII ten Hacken, Elisa 1 Terreni, Maria Rosa 216 P30, P305, P367 Terruzzi, Ileana 63 P63 Tesfaghebriel, Habtom 31, 210 Testa, Manuela 113 Testa, Martina 29, 208 Testoni, Pier Alberto 3, 15, 114, 196 P33, P175, P235, P285, P307, P480, P497, P498, P519, P716 Testoni, Sabrina 3 Tettamanti, Andrea 29 Tettamanti, Marco 28, 211 P3, P4, P719 Teuta, Domi 30 Tezza, Sara Tiberi, Simon Tiboni, Francesca Tinelli, Elisa Tiraboschi, Mirta Tirloni, Laura Todde, Sergio Todeschini, Paola Toffalori, Cristina Toffolo, Franca Togni, Miriam Tolazzi, Monica Tomaello, Luca Tomajer, Valentina Tomasi, Serenesse Tomasoni, Daniela Tomasoni, Romana Tomassini, Loredana Tondulli, Luca Toniolo, Daniela Tonlorenzi, Rossana Tonoli, Diletta Tonon, Giovanni Tornaghi, Paola Torriani, Gabriele Torta, Federico Totaro, Antonio Touvier, Thierry Traglia, Michela Travi, Giovanna Trbos, Mladen Tremolada, Gemma Tresoldi, Cristina Tresoldi, Eleonora Tresoldi, Moreno Triberti, Cesare Trimarchi, Matteo Trimarco, Amelia Trisciuoglio, Lisa Truci, Giulio Trudu, Matteo Tshiombo, Gianbattista 2 202 P586 87 149 113, 206 208 177, 211 P145 177, 211 85 216 XII 112 216 196, 216 216 87 112 216 211 150, 158 P80, P234, P260, P631, P644, P728 85 P370, P443, P516 27 2, 12 P708, P748, P777 112 216 149 P724 27 P35 85 150 P728 202 P730 216 63, 199 216 P382 87 113, 206 P750 X 3, 199 P731 31 149 P733 210 150 65, 194 294 - SAN RAFFAELE SCIENTIFIC INSTITUTE Tshomba, Yamume Tuoro, Antonio Turi, Stefano Tuscano, Antonella Tutolo, Manuela 65, 194 P204, P205 3, 194 65 P772, P775 112 4, 215 P117 U Uberti-Foppa, Caterina Uccellatore, Annachiara Ugarte, Gonzalo Ungari, Silvia Ungaro, Daniela Ungaro, Federica Usuelli, Vera 113, 129, 202 P546, P547 64, 206 85 87 31, 210 P761 28 115 V Vaccari, Ilaria Vaghi, Mauro Vago, Luca Vago, Riccardo Vailati, Cristian Valentini, Giovanna Valeri, Roberto Valle, Andrea Valle, Micol Valsasina, Paola Valsecchi, Luca Valtorta, Federica Valtorta, Flavia Valtorta, Silvia Vandoni, Irene Vanelli, Irene Vangelista, Luca Vanni, Roberto Vannulli, Raffaele Vanoli, Giovanna Vanzulli, Laura Varagona, Roberto Varale, Roberta 31 177, 211 86 P213, P256, P340, P741 167 P699, P742 3, 196 196 196 114 P746 28, 199 31 P8, P9, P10, P16, P189, P191, P387, P636, P638 64, 204 P187, P356, P747 216 27, 34 P202, P698 211 P56 211 29 111, 121 P560, P676 208 211 211 29, 208 213 196, 216 Vassena, Lia Vavassori, Stefano Vecellio, Magda Velikova, Svetla Venereau, Emilie Venturini, Massimo Vergani, Andrea Vergara, Pasquale Vermi, Anna Chiara Verona, Chiara Francesca Verzini, Alessandro Veschini, Lorenzo Vezzoli, Giuseppe Vezzoli, Michela Vezzulli, Paolo Viale, Edi Vicari, Aurelio Vicedomini, Gabriele Vicenzi, Elisa Viganò, Fiammetta Viganò, Giorgio Viganò, Maria Grazia Viganò, Maurizia Viganò, Riccardo Viganò, Silvana Vignali, Andrea Vigone, Maria Cristina Vilardi, Ignazio Villa, Anna Villa, Chiara Villa, Daniele Villa, Eugenio Villa, Isabella Villa, Liliana Villa, Valentina Vinci, Raffaele Vinciguerra, Federico Vino, Arianna 111 112 206 P80 30 149 177, 213 113, 206 P753 65, 192 65 3, 211 P255 193 P710 1 151, 206 P34, P488, P727, P755 85 P443 28, 185, 199 P32, P321 3, 196 211 192 P582, P665 113, 127 P1, P653 150 193 P461 4, 211 28, 199 4, 204 P474 63, 216 3, 196 P756 64, 204 P85, P232 211 87, 104 P99, P442, P476, P668 185 208 4, 211 P629, P630 63 P297, P574 X 64 P341 151 P25, P717, P718 197 3 AUTHOR INDEX - 295 Viscardi, Matteo 64, 204 P92 Visciano, Maria Luisa 111 Visigalli, Ilaria 87 P91, P495, P604, P761 Visintini, Raffaele 29, 208 P302, P445 Vismara, Chiara 31, 210 Vismara, Elena 28 Carlotta Vitali, Giordano Pietro 4, 211 Vitali, Matteo 196 Vizzuso, Domenica 149 Voci, Carlopietro 3, 193, 194 Volontè, Maria 31, 210 Antonietta Volta, Viviana 2 P524 Vorobjova, Tamara 115 Vuotto, Roberto 31 W Weber, Giovanna Wozinska, Monika Wrabetz, Lawrence Wysocka, Ewa 64, 72, 204 P85, P232 150 149, 156 P238, P267, P371, P754, P766 X X Xynos, Alexandros 85 Y Yacoub, Mona-Rita 111, 206 Z Zacchetti, Daniele Zagato, Laura Zaghetto, Ambra Zallocco, Diego Zamai, Moreno Zambelli, Matilde Zambon, Massimo Zamboni, Michele 27 151 P732 149 112, 221 1 216 194 P428 28, 208 P622 Zambroni, Desirée Zamproni, Ilaria Zanardelli, Maria Elisabetta Zanardi, Raffaella Zandonella Necca, Stefano Zangrillo, Alberto 150 63, 204 P541 X 29, 208 P412, P470 151 65, 77, 194, 197, 217, 220 P83, P239, P244, P245, P246, P253, P427, P428, P517, P518, P581, P772, P773, P774, P775 Zanni, Giuseppe 215 P278, P355, P659, P662, P705 Zannini, Piero 3, 18, 194 P42, P176, P177, P216, P512 Zanoni, Angela 211 Zanoni, Annalisa 208 Zanoni, Matteo 215 Zanotti, Lucia 30 P606, P607 Zanussi, Monica 216 P741 Zappalalio, Paola 216 Zatti, Alessandra 2 P201 Zeni, Daniele 167 Zerbi, Alessandro 114 P346, P629, P630 Zerbini, Gianpaolo 63, 68 Zimarino, Vincenzo 27 Zino, Elisabetta 216 P256 Zito, Laura 85 Zocchi, Maria Raffaella 111, 121 P315, P608, P609 Zonari, Erika 86 Zoppei, Gianna X, XXXI, 221 Zordan, Paola 85 Zuber, Veronica 196 Zucchelli, Chiara 167 P206 Zucchiatti, Ilaria 65, 199 Zucchinelli, Patrizia 4, 211 Zucconi, Marco 29, 209 P622 Zuccotti, GianvincenzoX Zuffada, Francesca 192 Zuffardi, Orsetta 216 P631 Zuliani, Walter 3, 196 Zuppelli, Paola 65 San Raffaele Scientific Institute Via Olgettina, 60 20132 Milano Tel. 02 26431 www.sanraffaele.org