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Thompson SM, Vella A, Thompson GB, Rumilla KM, Service FJ, Grant CS, Andrews JC. Selective Arterial Calcium Stimulation With Hepatic Venous Sampling Differentiates Insulinoma From Nesidioblastosis. J Clin Endocrinol Metab 2015; 100:4189-97. [PMID: 26312578 PMCID: PMC4702445 DOI: 10.1210/jc.2015-2404] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT In adult patients with endogenous hyperinsulinemic hypoglycemia and negative or inconclusive noninvasive imaging, insulinoma and non-insulinoma pancreatogenous hypoglycemic syndrome (NIPHS) resulting from diffuse nesidioblastosis must be considered in the differential diagnosis. It is not known whether the biochemical results of selective arterial calcium stimulation (SACST) with hepatic venous sampling can differentiate insulinoma from diffuse nesidioblastosis. OBJECTIVE To determine the specificity of SACST with hepatic venous sampling in differentiating insulinoma from diffuse nesidioblastosis. DESIGN Retrospective review (January 1996 to March 2014). SETTING Tertiary referral center. PATIENTS OR OTHER PARTICIPANTS A total of 116 patients with biochemical evidence of endogenous hyperinsulinemic hypoglycemia and negative or inconclusive noninvasive imaging who were subsequently shown at surgery to have insulinoma (n = 42) or nesidioblastosis (n = 74) after undergoing SACST with hepatic venous sampling. INTERVENTION(S) SACST with hepatic venous sampling before pancreatic exploration. MAIN OUTCOME MEASURE(S) Receiver operating characteristic curves were generated from the biochemical results of SACST to determine the specificity of the maximum hepatic venous insulin concentration (mHVI) and the relative-fold increase in hepatic venous insulin concentration (rHVI) over baseline after calcium injection from the dominant artery in differentiating insulinoma from nesidioblastosis. RESULTS The mHVI (21.5-fold; P < .001) and rHVI (3.9-fold; P < .001) were significantly higher in the insulinoma group compared to the nesidioblastosis group. The areas under the receiver operating characteristic curve for mHVI and rHVI were excellent (0.94; P < .0001) and good (0.83; P < .0001), respectively, for differentiating insulinoma from nesidioblastosis. mHVI cutoffs of > 91.5 and > 263.5 μIU/mL were 95 and 100% specific for insulinoma, respectively. A 19-fold increase in rHVI over baseline was 99% specific for insulinoma. CONCLUSIONS These data suggest that the mHVI and rHVI at SACST may be useful in differentiating insulinoma from nesidioblastosis with high specificity in patients with hyperinsulinemic hypoglycemia and negative or inconclusive noninvasive imaging.
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Affiliation(s)
- Scott M Thompson
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Adrian Vella
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Geoffrey B Thompson
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Kandelaria M Rumilla
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - F John Service
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Clive S Grant
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - James C Andrews
- Department of Radiology (S.M.T., J.C.A.), Department of Surgery (S.M.T., G.B.T., C.S.G.), Division of Endocrinology, Diabetes, and Metabolism (A.V., F.J.S.), and Department of Laboratory Medicine and Pathology (K.M.R.), College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
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Iglesias P, Lafuente C, Martín Almendra MÁ, López Guzmán A, Castro JC, Díez JJ. Insulinoma: a multicenter, retrospective analysis of three decades of experience (1983-2014). ACTA ACUST UNITED AC 2015; 62:306-13. [PMID: 26050581 DOI: 10.1016/j.endonu.2015.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983-2014 in four Spanish hospitals. METHODS All patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included. RESULTS Twenty-nine patients [23 women (79.3%); mean age 48.7±17.4 years (range, 16-74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n=18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3±6.5mg/dL) in the fasting test was 9.0±4.4h, with maximal insulin levels of 25.0±20.3μU/mL. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1,7±0,7cm]. Surgery achieved cure in the majority (n=24, 88.9%) of patients. CONCLUSION In our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45-50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.
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Affiliation(s)
- Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
| | - Christian Lafuente
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | | | - Antonio López Guzmán
- Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora de Sonsoles, Ávila, España
| | - José Carlos Castro
- Servicio de Endocrinología y Nutrición, Hospital General, Segovia, España
| | - Juan José Díez
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, España
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103
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Wenning AS, Kirchner P, Antwi K, Fani M, Wild D, Christ E, Gloor B. Preoperative Glucagon-like peptide-1 receptor imaging reduces surgical trauma and pancreatic tissue loss in insulinoma patients: a report of three cases. Patient Saf Surg 2015; 9:23. [PMID: 26034506 PMCID: PMC4450456 DOI: 10.1186/s13037-015-0064-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 11/21/2022] Open
Abstract
Background Insulinomas are rare tumors, in the majority of cases best treated by surgical resection. Preoperative localization of insulinoma is challenging. The more precise the preoperative localization the less invasive and safer is the resection. The purpose of the study is to check the impact of a new technique to localize insulinoma on the surgical strategy. Findings We present exact preoperative localization with Glucagon-like peptide-1 receptor (GLP-1R) imaging. This allows a more precise resection thereby reducing surgical access trauma, loss of healthy pancreatic tissue and increasing safety and quality of the surgical intervention. Conclusion With the help of precise preoperative localization of insulinoma with GLP-1R imaging the surgeon is able to minimize the amount of resected healthy pancreatic tissue. We hypothesize that GLP-1R imaging will become a preoperative diagnostic tool to be used for many patients scheduled for open or laparoscopic insulinoma resection.
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Affiliation(s)
- Anna Silvia Wenning
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital, CH-3010 Berne, Switzerland
| | - Paul Kirchner
- Division of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, University Hospital, Berne, Switzerland
| | - Kwadwo Antwi
- Department of Radiology, Division of Nuclear Medicine, University Hospital, Basel, Switzerland
| | - Melpomeni Fani
- Department of Radiology, Division of Nuclear Medicine, University Hospital, Basel, Switzerland
| | - Damian Wild
- Department of Radiology, Division of Nuclear Medicine, University Hospital, Basel, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, University Hospital, Berne, Switzerland
| | - Beat Gloor
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital, CH-3010 Berne, Switzerland
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104
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Antwi K, Fani M, Nicolas G, Rottenburger C, Heye T, Reubi JC, Gloor B, Christ E, Wild D. Localization of Hidden Insulinomas with ⁶⁸Ga-DOTA-Exendin-4 PET/CT: A Pilot Study. J Nucl Med 2015; 56:1075-8. [PMID: 25999434 DOI: 10.2967/jnumed.115.157768] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/15/2015] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED (111)In-DOTA-exendin-4 SPECT/CT has been shown to be highly efficient in the detection of insulinomas. We aimed at determining whether novel PET/CT imaging with [Nle(14),Lys(40)(Ahx-DOTA-(68)Ga)NH2]exendin-4 ((68)Ga-DOTA-exendin-4) is feasible and sensitive in detecting benign insulinomas. METHODS (68)Ga-DOTA-exendin-4 PET/CT and (111)In-DOTA-exendin-4 SPECT/CT were performed in a randomized cross-over order on 5 patients with endogenous hyperinsulinemic hypoglycemia. The gold standard for comparison was the histologic diagnosis after surgery. RESULTS In 4 patients histologic diagnosis confirmed a benign insulinoma, whereas one patient refused surgery despite a positive (68)Ga-DOTA-exendin-4 PET/CT scan. In 4 of 5 patients, previously performed conventional imaging (CT or MR imaging) was not able to localize the insulinoma. (68)Ga-DOTA-exendin-4 PET/CT correctly identified the insulinoma in 4 of 4 patients, whereas (111)In-DOTA-exendin-4 SPECT/CT correctly identified the insulinoma in only 2 of 4 patients. CONCLUSION These preliminary data suggest that the use of (68)Ga-DOTA-exendin-4 PET/CT in detecting hidden insulinomas is feasible.
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Affiliation(s)
- Kwadwo Antwi
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Melpomeni Fani
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Guillaume Nicolas
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Christof Rottenburger
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Tobias Heye
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Jean Claude Reubi
- Division of Cell Biology and Experimental Cancer Research, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Beat Gloor
- Department of Visceral Surgery, University Hospital of Bern, Bern, Switzerland; and
| | - Emanuel Christ
- Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital of Bern, Bern Switzerland
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
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105
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Jodal A, Pape F, Becker-Pauly C, Maas O, Schibli R, Béhé M. Evaluation of ¹¹¹in-labelled exendin-4 derivatives containing different meprin β-specific cleavable linkers. PLoS One 2015; 10:e0123443. [PMID: 25855967 PMCID: PMC4391719 DOI: 10.1371/journal.pone.0123443] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/04/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cleavable linkers, which are specifically cleaved by defined conditions or enzymes, are powerful tools that can be used for various purposes. Amongst other things, they have been successfully used to deliver toxic payloads as prodrugs into target tissues. In this work novel linker sequences targeting meprin β, a metalloprotease expressed in the kidney brush-border membrane, were designed and included in the sequence of three radiolabelled exendin-4 derivatives. As radiolabelled exendin-4 derivatives strongly accumulate in the kidneys, we hypothesised that specific cleavage of the radiolabelled moiety at the kidney brush-border membrane would allow easier excretion of the activity into the urine and therefore improve the pharmacological properties of the peptide. RESULTS The insertion of a cleavable linker did not negatively influence the in vitro properties of the peptides. They showed a good affinity to the GLP-1 receptor expressed in CHL cells, a high internalisation and sufficiently high stability in fresh human blood plasma. In vitro digestion with recombinant meprin β rapidly metabolised the corresponding linker sequences. After 60 min the majority of the corresponding peptides were digested and at the same time the anticipated fragments were formed. The peptides were also quickly metabolised in CD1 nu/nu mouse kidney homogenates. Immunofluorescence staining of meprin β in kidney sections confirmed the expression of the protease in the kidney brush-border membrane. Biodistribution in GLP-1 receptor positive tumour-xenograft bearing mice revealed high specific uptake of the 111In-labelled tracers in receptor positive tissue. Accumulation in the kidneys, however, was still high and comparable to the lead compound 111In-Ex4NOD40. CONCLUSION In conclusion, we show that the concept of cleavable linkers specific for meprin β is feasible, as the peptides are rapidly cleaved by the enzyme while retaining their biological properties.
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Affiliation(s)
- Andreas Jodal
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen, Switzerland
| | - Fabienne Pape
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | | | - Ole Maas
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen, Switzerland
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Martin Béhé
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen, Switzerland
- * E-mail:
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106
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Glucagon-like-peptide-1 receptor expression in normal and diseased human thyroid and pancreas. Mod Pathol 2015; 28:391-402. [PMID: 25216224 DOI: 10.1038/modpathol.2014.113] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/04/2014] [Accepted: 07/04/2014] [Indexed: 12/18/2022]
Abstract
Glucagon-like-peptide-1 (GLP1) analogs may induce thyroid or pancreatic diseases in animals, raising questions about their use in diabetic patients. There is, however, controversy regarding expression of GLP1 receptors (GLP1R) in human normal and diseased thyroid and pancreas. Here, 221 human thyroid and pancreas samples were analyzed for GLP1R immunohistochemistry and compared with quantitative in vitro GLP1R autoradiography. Neither normal nor hyperplastic human thyroids containing parafollicular C cells express GLP1R with either method. Papillary thyroid cancer do not, and medullary thyroid carcinomas rarely express GLP1R. Insulin- and somatostatin-producing cells in the normal pancreas express a high density of GLP1R, whereas acinar cells express them in low amounts. Ductal epithelial cells do not express GLP1R. All benign insulinomas express high densities of GLP1R, whereas malignant insulinomas rarely express them. All ductal pancreatic carcinomas are GLP1R negative, whereas 6/20 PanIN 1/2 and 0/12 PanIN 3 express GLP1R. Therefore, normal thyroid, including normal and hyperplastic C cells, or papillary thyroid cancer are not targets for GLP1 analogs in humans. Conversely, all pancreatic insulin- and somatostatin-producing cells are physiological GLP1 targets, as well as most acini. As normal ductal epithelial cells or PanIN 3 or ductal pancreatic carcinomas do not express GLP1R, it seems unlikely that GLP1R is related to neoplastic transformation in pancreas. GLP1R-positive medullary thyroid carcinomas and all benign insulinomas are candidates for in vivo GLP1R targeting.
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107
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Reubi JC, Waser B. Triple-Peptide Receptor Targeting In Vitro Allows Detection of All Tested Gut and Bronchial NETs. J Nucl Med 2015; 56:613-5. [DOI: 10.2967/jnumed.114.153189] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/21/2015] [Indexed: 01/06/2023] Open
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108
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Kyrilli A, Igoillo-Esteve M, Féry F, Grieco FA, Eisendrath P, Blocklet D, Goldman S, Henquin JC, Gotthardt M, Cnop M. Insulinoma Localization by Glucagon-Like Peptide-1 Receptor Imaging After 18 Years of Hypoglycemia. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14427.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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109
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Meibom SK. Detection of a Small Insulinoma Using a Novel Glucagon-Like Peptide-1 Receptor Ligand. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14599.co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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110
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Sadowski SM, Neychev V, Cottle-Delisle C, Merkel R, Yang LA, Quezado MM, Chang R, Kebebew E. Detection of insulinoma using (68)Gallium-DOTATATE PET/CT: a case report. Gland Surg 2014; 3:E1-5. [PMID: 25493261 DOI: 10.3978/j.issn.2227-684x.2014.10.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/20/2014] [Indexed: 11/14/2022]
Abstract
Insulinomas are the most common cause of endogenous hyperinsulinemic hypoglycemia in non-diabetic adults. They are most often benign, small and difficult to localize with current imaging techniques. This is of high importance, as complete surgical resection is the only curative treatment. Anatomic imaging, (111)In-pentetreotide scan and (68)Gallium-DOTATATE positron emission tomography/computed tomography (PET/CT) were compared in a patient with insulinoma. (68)Gallium-DOTATATE PET/CT and selective arterial calcium stimulation localized the insulinoma. At surgery, a tumor in the anterior aspect of the pancreatic body was found which confirmed the preoperative localization, and a 2.1 cm tumor was enucleated, World Health Organization (WHO) grade I insulinoma. The patient remains euglycemic and free of symptoms at last follow up. In conclusion, (68)Gallium-DOTATATE PET/CT imaging may be a useful adjunct localizing study for insulinomas. It is a non-invasive preoperative localization study that could guide surgical exploration for successful therapy.
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Affiliation(s)
- Samira M Sadowski
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Vladimir Neychev
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Candice Cottle-Delisle
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Roxanne Merkel
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lily A Yang
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Martha M Quezado
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard Chang
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Electron Kebebew
- 1 Endocrine Oncology Branch, 2 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; 3 Radiology Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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Wild D. Role of molecular imaging in the detection of neuroendocrine tumour. Cancer Imaging 2014. [PMCID: PMC4242753 DOI: 10.1186/1470-7330-14-s1-o29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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112
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The rise, fall, and resurgence of immunotherapy in type 1 diabetes. Pharmacol Res 2014; 98:31-8. [PMID: 25107501 DOI: 10.1016/j.phrs.2014.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/11/2022]
Abstract
Despite considerable effort to halt or delay destruction of β-cells in autoimmune type 1 diabetes (T1D), success remains elusive. Over the last decade, we have seen a proliferation of knowledge on the pathogenesis of T1D that emerged from studies performed in non-obese diabetic (NOD) mice. However, while results of these preclinical studies appeared to hold great promise and boosted patients' hopes, none of these approaches, once tested in clinical settings, induced remission of autoimmune diabetes in individuals with T1D. The primary obstacles to translation reside in the differences between the human and murine autoimmune responses and in the contribution of many environmental factors associated with the onset of disease. Moreover, inaccurate dosing as well as inappropriate timing and uncertain length of drug exposure have played a central role in the negative outcomes of such therapeutic interventions. In this review, we summarize the most important approaches tested thus far in T1D, beginning with the most successful preclinical studies in NOD mice and ending with the latest disappointing clinical trials in humans. Finally, we highlight recent stem cell-based trials, for which expectations in the scientific community and among individuals with T1D are high.
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113
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Jodal A, Lankat-Buttgereit B, Brom M, Schibli R, Béhé M. A comparison of three (67/68)Ga-labelled exendin-4 derivatives for β-cell imaging on the GLP-1 receptor: the influence of the conjugation site of NODAGA as chelator. EJNMMI Res 2014; 4:31. [PMID: 25006548 PMCID: PMC4078388 DOI: 10.1186/s13550-014-0031-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/03/2014] [Indexed: 11/26/2022] Open
Abstract
Background Various diseases derive from pathologically altered β-cells. Their function can be increased, leading to hyperinsulinism, or decreased, resulting in diabetes. Non-invasive imaging of the β-cell-specific glucagon-like peptide receptor-1 (GLP-1R) would allow the assessment of both β-cell mass and derived tumours, potentially improving the diagnosis of various conditions. We tested three new 67/68Ga-labelled derivatives of exendin-4, an agonist of GLP-1R, in vitro and in vivo. We determined the influence of the chelator NODAGA conjugated to resident lysines either at positions 12 and 27 or the C-terminally attached lysine at position 40 on the binding and kinetics of the peptide. Methods Binding and internalisation of 67Ga-labelled Ex4NOD12, Ex4NOD27 and Ex4NOD40 were tested on Chinese hamster lung (CHL) cells stably transfected to express the GLP-1 receptor (GLP-1R). In vivo biodistribution of 68Ga-labelled peptides was investigated in CD1 nu/nu mice with subcutaneous CHL-GLP-1R positive tumours; the specificity of the binding to GLP-1R was determined by pre-injecting excess peptide. Results All peptides showed good in vitro binding affinities to GLP-1R in the range of 29 to 54 nM. 67/68Ga-Ex4NOD40 and 67/68Ga-Ex4NOD12 show excellent internalisation (>30%) and high specific uptake in GLP-1R positive tissue, but high activity was also found in the kidneys. Conclusions We show that of the three peptides, Ga-Ex4NOD40 and Ga-Ex4NOD12 demonstrate the most favourable in vitro properties and in vivo binding to GLP-1R positive tissue. Therefore, we conclude that the lysines at positions 12 and 40 might preferentially be utilised for modifying exendin-4.
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Affiliation(s)
- Andreas Jodal
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, OIPA/103, Villigen 5232, Switzerland
| | - Brigitte Lankat-Buttgereit
- Faculty of Medicine, Department of Gastroenterology, Endocrinology and Metabolism, University of Marburg, Marburg 35037, Germany
| | - Maarten Brom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, OIPA/103, Villigen 5232, Switzerland ; Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich 8092, Switzerland
| | - Martin Béhé
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, OIPA/103, Villigen 5232, Switzerland
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114
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Brand C, Abdel-Atti D, Zhang Y, Carlin S, Clardy SM, Keliher EJ, Weber WA, Lewis JS, Reiner T. In vivo imaging of GLP-1R with a targeted bimodal PET/fluorescence imaging agent. Bioconjug Chem 2014; 25:1323-30. [PMID: 24856928 PMCID: PMC4215873 DOI: 10.1021/bc500178d] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Accurate visualization and quantification of β-cell mass is critical for the improved understanding, diagnosis, and treatment of both type 1 diabetes (T1D) and insulinoma. Here, we describe the synthesis of a bimodal imaging probe (PET/fluorescence) for imaging GLP-1R expression in the pancreas and in pancreatic islet cell tumors. The conjugation of a bimodal imaging tag containing a near-infrared fluorescent dye, and the copper chelator sarcophagine to the GLP-1R targeting peptide exendin-4 provided the basis for the bimodal imaging probe. Conjugation was performed via a novel sequential one-pot synthetic procedure including (64)Cu radiolabeling and copper-catalyzed click-conjugation. The bimodal imaging agent (64)Cu-E4-Fl was synthesized in good radiochemical yield and specific activity (RCY = 36%, specific activity: 141 μCi/μg, >98% radiochemical purity). The agent showed good performance in vivo and ex vivo, visualizing small xenografts (<2 mm) with PET and pancreatic β-cell mass by phosphor autoradiography. Using the fluorescent properties of the probe, we were able to detect individual pancreatic islets, confirming specific binding to GLP-1R and surpassing the sensitivity of the radioactive label. The use of bimodal PET/fluorescent imaging probes is promising for preoperative imaging and fluorescence-assisted analysis of patient tissues. We believe that our procedure could become relevant as a protocol for the development of bimodal imaging agents.
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Affiliation(s)
- Christian Brand
- Radiochemistry and Imaging Sciences Service and §Molecular Imaging and Therapy Service, Department of Radiology, ∥Molecular Pharmacology and Chemistry Program, and ⊥Center for Molecular Imaging and Nanotechnology, Memorial Sloan Kettering Cancer Center , New York, New York 10065, United States
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Eriksson O, Velikyan I, Selvaraju RK, Kandeel F, Johansson L, Antoni G, Eriksson B, Sörensen J, Korsgren O. Detection of metastatic insulinoma by positron emission tomography with [(68)ga]exendin-4-a case report. J Clin Endocrinol Metab 2014; 99:1519-24. [PMID: 24512490 PMCID: PMC4010711 DOI: 10.1210/jc.2013-3541] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/27/2014] [Indexed: 12/22/2022]
Abstract
CONTEXT Insulinomas are the most common cause of endogenous hyperinsulinemic hypoglycemia in nondiabetic adult patients. They are usually benign, and curative surgery is the "gold standard" treatment if they can be localized. Malignant insulinomas are seen in less than 10% of patients, and their prognosis is poor. The glucagon like peptide-1 receptor (GLP-1R) is markedly up-regulated in insulinomas-especially benign lesions, which are difficult to localize with current imaging techniques. OBJECTIVE The aim of the study was to assess the possibility of the detection of primary and metastatic insulinoma by positron emission tomography (PET) using [(68)Ga]Ga-DO3A-VS-Cys(40)-Exendin-4 ([(68)Ga]Exendin-4) in a patient with severe hypoglycemia. DESIGN AND SETTING Dynamic and static PET/computed tomography (CT) examination of a patient was performed using [(68)Ga]Exendin-4 at Uppsala University Hospital, Uppsala, Sweden. PATIENTS A patient presented with hypoglycemia requiring continuous iv glucose infusions. A pancreatic insulinoma was suspected, and an exploratory laparotomy was urgently performed. At surgery, a tumor in the pancreatic tail with an adjacent metastasis was found, and a distal pancreatic resection (plus splenectomy) and removal of lymph node were performed. Histopathology showed a World Health Organization classification grade II insulinoma. Postoperatively, hypoglycemia persisted, but a PET/CT examination using the neuroendocrine marker [(11)C]-5-hydroxy-L-tryptophan was negative. INTERVENTIONS The patient was administered [(68)Ga]Exendin-4 and was examined by dynamic PET over the liver and pancreas. RESULTS The stable GLP-1 analog Exendin-4 was labeled with (68)Ga for PET imaging of GLP-1R-expressing tumors. The patient was examined by [(68)Ga]Exendin-4-PET/CT, which confirmed several small GLP-1R-positive lesions in the liver and a lymph node that could not be conclusively identified by other imaging techniques. The results obtained from the [(68)Ga]Exendin-4-PET/CT examination provided the basis for continued systemic treatment. CONCLUSION The results of the [(68)Ga]Exendin-4-PET/CT examination governed the treatment strategy of this particular patient and demonstrated the potential of this technique for future management of patients with this rare but potentially fatal disease.
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Affiliation(s)
| | | | - Ram K. Selvaraju
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Fouad Kandeel
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Lars Johansson
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Gunnar Antoni
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Barbro Eriksson
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Jens Sörensen
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
| | - Olle Korsgren
- Preclinical PET Platform (O.E., I.V., R.K.S.), Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden; Department of Radiology, Oncology, and Radiation Sciences (I.V., L.J., G.A., J.S.), Uppsala University, SE-751 83 Uppsala, Sweden; PET Centre (I.V., G.A., J.S.), Centre for Medical Imaging, Uppsala University Hospital, Uppsala, SE-751 83 Sweden; Beckman Research Institute of the City of Hope (F.K.), Duarte, California 91010; AstraZeneca R&D (L.J.), SE-431 50 Mölndal, Sweden; Department of Medical Sciences (B.E.), Uppsala University, SE-751 83 Uppsala, Sweden; and Department of Immunology, Genetics, and Pathology (O.K.), Uppsala University SE-751 83, Uppsala, Sweden
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de Herder WW. GEP-NETS update: functional localisation and scintigraphy in neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP-NETs). Eur J Endocrinol 2014; 170:R173-83. [PMID: 24723670 DOI: 10.1530/eje-14-0077] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For patients with neuroendocrine tumours (NETs) of the gastrointestinal tract and pancreas (GEP) (GEP-NETs), excellent care should ideally be provided by a multidisciplinary team of skilled health care professionals. In these patients, a combination of nuclear medicine imaging and conventional radiological imaging techniques is usually mandatory for primary tumour visualisation, tumour staging and evaluation of treatment. In specific cases, as in patients with occult insulinomas, sampling procedures can provide a clue as to where to localise the insulin-hypersecreting pancreatic NETs. Recent developments in these fields have led to an increase in the detection rate of primary GEP-NETs and their metastatic deposits. Radiopharmaceuticals targeted at specific tumour cell properties and processes can be used to provide sensitive and specific whole-body imaging. Functional imaging also allows for patient selection for receptor-based therapies and prediction of the efficacy of such therapies. Positron emission tomography/computed tomography (CT) and single-photon emission CT/CT are used to map functional images with anatomical localisations. As a result, tumour imaging and tumour follow-up strategies can be optimised for every individual GEP-NET patient. In some cases, functional imaging might give indications with regard to future tumour behaviour and prognosis.
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Affiliation(s)
- Wouter W de Herder
- Section of Endocrinology, Department of Internal Medicine, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Waser B, Reubi JC. Radiolabelled GLP-1 receptor antagonist binds to GLP-1 receptor-expressing human tissues. Eur J Nucl Med Mol Imaging 2014; 41:1166-71. [PMID: 24519555 DOI: 10.1007/s00259-013-2684-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/20/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE Radiolabelled glucagon-like peptide 1 (GLP-1) receptor agonists have recently been shown to successfully image benign insulinomas in patients. For the somatostatin receptor targeting of tumours, however, it was recently reported that antagonist tracers were superior to agonist tracers. The present study therefore evaluated various forms of the (125)iodinated-Bolton-Hunter (BH)-exendin(9-39) antagonist tracer for the in vitro visualization of GLP-1 receptor-expressing tissues in rats and humans and compared it with the agonist tracer (125)I-GLP-1(7-36)amide. METHODS Receptor autoradiography studies with (125)I-GLP-1(7-36)amide agonist or (125)I-BH-exendin(9-39) antagonist radioligands were performed in human and rat tissues. RESULTS The antagonist (125)I-BH-exendin(9-39) labelled at lysine 19 identifies all human and rat GLP-1 target tissues and GLP-1 receptor-expressing tumours. Binding is of high affinity and is comparable in all tested tissues in its binding properties with the agonist tracer (125)I-GLP-1(7-36)amide. For comparison, (125)I-BH-exendin(9-39) with the BH labelled at lysine 4 did identify the GLP-1 receptor in rat tissues but not in human tissues. CONCLUSION The GLP-1 receptor antagonist exendin(9-39) labelled with (125)I-BH at lysine 19 is an excellent GLP-1 radioligand that identifies human and rat GLP-1 receptors in normal and tumoural tissues. It may therefore be the molecular basis to develop suitable GLP-1 receptor antagonist radioligands for in vivo imaging of GLP-1 receptor-expressing tissues in patients.
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Affiliation(s)
- Beatrice Waser
- Division of Cell Biology and Experimental Cancer Research, Institute of Pathology, University of Berne, PO Box 62, Murtenstrasse 31, 3010, Berne, Switzerland
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Affiliation(s)
- Ashley Grossman
- Churchill Hospital, University of Oxford, Oxford OX3 7LE, UK.
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