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Low‐flow vascular malformations are congenital overgrowths composed of abnormal blood vessels potentially causing pain, bleeding and obstruction of different organs. These diseases are caused by oncogenic mutations in the endothelium, which result in overactivation of the PI3K/AKT pathway. Lack of robust in vivo preclinical data has prevented the development and translation into clinical trials of specific molecular therapies for these diseases. Here, we demonstrate that the Pik3ca H1047R activating mutation in endothelial cells triggers a transcriptome rewiring that leads to enhanced cell proliferation. We describe a new reproducible preclinical in vivo model of PI3K‐driven vascular malformations using the postnatal mouse retina. We show that active angiogenesis is required for the pathogenesis of vascular malformations caused by activating Pik3ca mutations. Using this model, we demonstrate that the AKT inhibitor miransertib both prevents and induces the regression of PI3K‐driven vascular malformations. We confirmed the efficacy of miransertib in isolated human endothelial cells with genotypes spanning most of human low‐flow vascular malformations. SYNOPSIS This work describes a robust preclinical model of PI3K‐driven vascular malformations using the postnatal mouse retina. We show that AKT inhibition by miransertib is an effective therapeutic strategy for these diseases. Pik3ca H1047R mutation in endothelial cells leads to enhanced cell cycle progression. Active angiogenesis is required for the formation of PI3K‐driven vascular malformations. PI3K‐driven vascular malformations are prevented and regressed upon miransertib treatment. Graphical Abstract This work describes a robust preclinical model of PI3K‐driven vascular malformations using the postnatal mouse retina. We show that AKT inhibition by miransertib is an effective therapeutic strategy for these diseases.

Background The lack of dystrophin expression in Duchenne muscular dystrophy (DMD) induces muscle fibre and replacement by fibro‐adipose tissue. Although the role of some growth factors in the process of fibrogenesis has been studied, pathways activated by PDGF‐AA have not been described so far. Our aim was to study the molecular role of PDGF‐AA in the fibrotic process of DMD. Methods Skeletal muscle fibro‐adipogenic progenitor cells (FAPs) from three DMD treated with PDGF‐AA at 50 ng/mL were analysed by quantitative mass spectrometry‐based proteomics. Western‐blot, immunofluorescence, and G‐LISA were used to confirm the mass spectrometry results. We evaluated the effects of PDGF‐AA on the activation of RhoA pathway using two inhibitors, C3‐exoenzyme and fasudil. Cell proliferation and migration were determined by BrdU and migration assay. Actin reorganization and collagen synthesis were measured by phalloidin staining and Sircol assay, respectively. In an in vivo proof of concept study, we treated dba/2J‐mdx mice with fasudil for 6 weeks. Muscle strength was assessed with the grip strength. Immunofluorescence and flow cytometry analyses were used to study fibrotic and inflammatory markers in muscle tissue. Results Mass spectrometry revealed that RhoA pathway proteins were up‐regulated in treated compared with non‐treated DMD FAPs (n = 3, mean age = 8 ± 1.15 years old). Validation of proteomic data showed that Arhgef2 expression was significantly increased in DMD muscles compared with healthy controls by a 7.7‐fold increase (n = 2, mean age = 8 ± 1.14 years old). In vitro studies showed that RhoA/ROCK2 pathway was significantly activated by PDGF‐AA (n = 3, 1.88‐fold increase, P < 0.01) and both C3‐exoenzyme and fasudil blocked that activation (n = 3, P < 0.05 and P < 0.001, respectively). The activation of RhoA pathway by PDGF‐AA promoted a significant increase in proliferation and migration of FAPs (n = 3, P < 0.001), while C3‐exoenzyme and fasudil inhibited FAPs proliferation at 72 h and migration at 48 and 72 h (n = 3, P < 0.001). In vivo studies showed that fasudil improved muscle function (n = 5 non‐treated dba/2J‐mdx and n = 6 treated dba/2J‐mdx, 1.76‐fold increase, P < 0.013), and histological studies demonstrated a 23% reduction of collagen‐I expression area (n = 5 non‐treated dba/2J‐mdx and n = 6 treated dba/2J‐mdx, P < 0.01). Conclusions Our results suggest that PDGF‐AA promotes the activation of RhoA pathway in FAPs from DMD patients. This pathway could be involved in FAPs activation promoting its proliferation, migration, and actin reorganization, which represents the beginning of the fibrotic process. The inhibition of RhoA pathway could be considered as a potential therapeutic target for muscle fibrosis in patients with muscular dystrophies.

Nitrous oxide (N₂O), nitric oxide (NO), denitrification losses and $NO_3^ - $ leaching from an irrigated sward were quantified under Mediterranean conditions. The effect of injected pig slurry (IPS) with and without the nitrification inhibitor dicyandiamide (DCD) was evaluated and also compared with that of a surface pig slurry application (SPS) and a control treatment (Control) without fertiliser. After application, fluxes of NO and N₂O peaked from SPS (3.06 mg NO-N m⁻² d⁻¹ and 108 mg N₂O-N m⁻² d⁻¹) and IPS (3.50 mg NO-N m⁻² d⁻¹ and 105 mg N₂O-N m⁻² d⁻¹). However, when irrigation was applied, N₂O and NO emissions declined. The total N₂O and denitrification losses were slightly large from IPS than from SPS, although the differences were not significant (P < 0.05). Emission of NO was not affected by the method of pig slurry application. DCD inhibited nitrification during the first 20-30 days and reduced N₂O and NO emissions from pig slurry by at least 46% and 37%, respectively. Considering the 215 days following pig slurry application, the emission factor of N₂O based on N fertiliser was 1.60% (SPS), 2.95% (IPS), and 0.50% (IPS + DCD). The emission factor for NO was 0.14% (SPS), 0.12% (IPS), and 0.02% (IPS + DCD). Environmental conditions of the crop favoured the denitrification process as the most important source of N₂O during the experimental period. The differences in the denitrification rate between treatments could be explained by the pattern of water soluble carbon (WSC), that was the highest value in injected pig slurry (with and without DCD). Due to low drainage (5% of water applied), leaching losses of $NO_3^ - $ were lower than those of denitrification from the upper soil layer (0-10 cm) in all treatments and especially with IPS + DCD, where the nitrification inhibitor was very efficient in reducing leaching losses.

Understanding the cell functionality during disease progression or drugs' mechanism are major challenges for precision medicine. Predictive models describing biological phenotypes can be challenging to obtain, particularly in scenarios where sample availability is limited, such as in the case of rare diseases. Here we propose a new method that reproduces the fibroadipogenic expansion that occurs in muscle wasting. We used immortalized fibroadipogenic progenitor cells (FAPs) and differentiated them into fibroblasts or adipocytes. The method successfully identified FAPs cell differentiation fate using accurate measurements of changes in specific proteins, which ultimately constitute a valid cellular platform for drug screening. Results were confirmed using primary FAPs differentiation as well as comparison with omics data from proteomics and genomic studies. Our method allowed us to screen 508 different drugs from 2 compounds libraries. Out of these 508, we identified 4 compounds that reduced fibrogenesis and adipogenesis of ≥30% of fibrogenesis and adipogenesis using immortalized cells. After selecting the optimal dose of each compound, the inhibitory effect on FAP differentiation was confirmed by using primary FAPs from healthy subjects (n = 3) and DMD patients (n = 3). The final 4 selected hits reduced fibrogenic differentiation in healthy and DMD samples. The inhibition of adipogenesis was more evident in DMD samples than healthy samples. After creating an inhibitory map of the tested drugs, we validated the signalling pathways more involved in FAPs differentiation analysing data from proteomic and genomic studies. We present a map of molecular targets of approved drugs that helps in predicting which therapeutic option may affect FAP differentiation. This method allows to study the potential effect of signalling circuits on FAP differentiation after drug treatment providing insights into molecular mechanism of action of muscle degeneration. The accuracy of the method is demonstrated by comparing the signal pathway activity obtained after drug treatment with proteomic and genomic data from patient-derived cells.

Introduction: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. Methods: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. Results: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. Conclusions: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

The lack of dystrophin expression in Duchenne muscular dystrophy (DMD) leads to muscle necrosis and replacement of muscle tissue by fibro-adipose tissue. Although the role of some growth factors in the process of fibrogenesis has been previously studied, the pathways that are activated by PDGF-AA in muscular dystrophies have not been described so far. Herein we report the effects of PDGF-AA on the fibrotic process in muscular dystrophies by performing a quantitative proteomic study in DMD isolated fibro-adipogenic precursor cells (FAPs) treated with PDGF-AA. In vitro studies showed that RhoA/ROCK2 pathway is activated by PDGF-AA and induces the activation of FAPs. The inhibition of RhoA/ROCK signalling pathway by C3-exoenzyme or fasudil attenuated the effects of PDGF-AA. The blocking effects of RhoA/ROCK pathway were analysed in the dba/2J-mdx murine model with fasudil. Grip strength test showed an improvement in the muscle function and histological studies demonstrated reduction of the fibrotic area. Our results suggest that blockade of RhoA/ROCK could attenuate the activation of FAPs and could be considered a potential therapeutic approach for muscular dystrophies.

Low-flow vascular malformations are congenital overgrowths composed by abnormal blood vessels potentially causing pain, bleeding, and obstruction of different organs. These diseases are caused by oncogenic mutations in the endothelium which result in overactivation of the PI3K/AKT pathway. Lack of robust in vivo preclinical data has prevented the development and translation into clinical trials of specific molecular therapies for these diseases. Here, we describe a new reproducible preclinical in vivo model of PI3K-driven vascular malformations using the postnatal mouse retina. This model reproduces human disease with Pik3ca activating mutations expressed in a mosaic pattern and vascular malformations formed in veins and capillaries. We show that active angiogenesis is required for the pathogenesis of vascular malformations caused by activating Pik3ca mutations. Using this model, we demonstrate that low doses of the AKT inhibitor miransertib both prevents and induces the regression of PI3K-driven vascular malformations. We confirmed miransertib efficacy in isolated human endothelial cells with genotypes spanning most of human low-flow vascular malformations. Competing Interest Statement M.G. has a research agreement with ArQule, Inc., a wholly-owned subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and Venthera. E.B. is founder and CAB of Venthera. PI and Advisor for Pierre Fabre; PI clinical trial NCT04589650 (Novartis).

The HIPRA-HH-2 was a multicentre, randomized, active-controlled, double-blind, non-inferiority phase IIb clinical trial comparing the immunogenicity and safety of the PHH-1V adjuvanted recombinant vaccine as a heterologous booster against homologous booster with BNT162b2. Interim results demonstrated strong humoral and cellular immune response against the SARS-CoV-2 Wuhan-Hu-1 strain and the Beta, Delta, and Omicron BA.1 variants up to day 98 post-dosing. Here we report that these responses with PHH-1V are sustained up to 6 months, including in participants over 65 years, despite their smaller sample size. The PHH-1V booster was non-inferior in eliciting neutralizing antibodies for SARS-CoV-2 Omicron XBB.1.5 variant compared to BNT162b2 after 6 months. No severe COVID-19 cases occurred in any group, and mild cases were similar (50.4 % for PHH-1V vs. 47.8 % for BNT162b2). While both groups may have reached comparable immunity levels, these findings suggest that the PHH-1V vaccine provides long-lasting immunity against various of SARS-CoV-2 variants. ClinicalTrials.gov Identifier: NCT05142553