401
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MacKeigan JP, Krueger DA. Differentiating the mTOR inhibitors everolimus and sirolimus in the treatment of tuberous sclerosis complex. Neuro Oncol 2015; 17:1550-9. [PMID: 26289591 DOI: 10.1093/neuonc/nov152] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/11/2015] [Indexed: 02/06/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic autosomal dominant disorder characterized by benign tumor-like lesions, called hamartomas, in multiple organ systems, including the brain, skin, heart, kidneys, and lung. These hamartomas cause a diverse set of clinical problems based on their location and often result in epilepsy, learning difficulties, and behavioral problems. TSC is caused by mutations within the TSC1 or TSC2 genes that inactivate the genes' tumor-suppressive function and drive hamartomatous cell growth. In normal cells, TSC1 and TSC2 integrate growth signals and nutrient inputs to downregulate signaling to mammalian target of rapamycin (mTOR), an evolutionarily conserved serine-threonine kinase that controls cell growth and cell survival. The molecular connection between TSC and mTOR led to the clinical use of allosteric mTOR inhibitors (sirolimus and everolimus) for the treatment of TSC. Everolimus is approved for subependymal giant cell astrocytomas and renal angiomyolipomas in patients with TSC. Sirolimus, though not approved for TSC, has undergone considerable investigation to treat various aspects of the disease. Everolimus and sirolimus selectively inhibit mTOR signaling with similar molecular mechanisms, but with distinct clinical profiles. This review differentiates mTOR inhibitors in TSC while describing the molecular mechanisms, pathogenic mutations, and clinical trial outcomes for managing TSC.
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Affiliation(s)
- Jeffrey P MacKeigan
- Laboratory of Systems Biology, Van Andel Research Institute, Grand Rapids, Michigan (J.P.M.); Department of Pediatrics, Tuberous Sclerosis Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (D.A.K.)
| | - Darcy A Krueger
- Laboratory of Systems Biology, Van Andel Research Institute, Grand Rapids, Michigan (J.P.M.); Department of Pediatrics, Tuberous Sclerosis Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (D.A.K.)
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402
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Sasongko TH, Ismail NFD, Nik Abdul Malik NMA, Zabidi-Hussin ZAMH. Rapamycin and its analogues (rapalogs) for Tuberous Sclerosis Complex-associated tumors: a systematic review on non-randomized studies using meta-analysis. Orphanet J Rare Dis 2015; 10:95. [PMID: 26259610 PMCID: PMC4531483 DOI: 10.1186/s13023-015-0317-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/03/2015] [Indexed: 12/26/2022] Open
Abstract
Background Rapamycin has gained significant attention for its potential activity in reducing the size of TSC-associated tumors, thus providing alternative to surgery. This study aimed at determining the efficacy of rapamycin and rapalogs for reducing the size of TSC-associated solid tumors in patients with Tuberous Sclerosis Complex (TSC). Methods Our data sources included electronic searches of the PubMed. We included into our meta-analysis any type of non-randomized study that reported the use of rapamycin and rapalogs for reducing the size of TSC-associated solid tumors in patients with TSC. Data was entered into Cochrane Review Manager Version 5.3 and analyzed. Results Four case reports and 4 clinical trials were included. Five patients from the case reports (all with SEGA) and 91 patients from the clinical trials (41 with SEGA, 63 with kidney angiomyolipoma and 5 with liver angiomyolipoma) were included into the analysis. Volume and diameter of SEGAs were significantly reduced by mean difference of 1.23 cc (95 % CI −2.32 to −0.13; p = 0.03) and 7.91 mm (95 % CI −11.82 to −4.01; p < 0.0001), respectively. Volume and mean of sum of longest diameter of kidney angiomyolipomas were significantly reduced by mean difference of 39.5 cc (95 % CI −48.85 to −30.15; p <0.00001) and 69.03 mm (95 % CI −158.05 to 12.65; p = 0.008), respectively. In liver angiomyolipomas, however, reduction in tumor size was not evident. Sum of longest diameter of liver angiomyolipomas in 4 patients were enlarged by 2.7 mm (95 % CI 28.42 to −23.02) by the end of treatment, though not significant (p = 0.84). Conclusions Rapamycin and rapalogs showed efficacy towards reducing the size of SEGA and kidney angiomyolipoma but not liver angiomyolipomas. This finding is strengthening the conclusion of our Cochrane systematic review on the randomized trials.
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Affiliation(s)
- Teguh Haryo Sasongko
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia. .,Center for Neuroscience Services and Research, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Nur Farrah Dila Ismail
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Nik Mohamad Ariff Nik Abdul Malik
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Z A M H Zabidi-Hussin
- Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, USM Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
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403
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Wheless JW. Use of the mTOR inhibitor everolimus in a patient with multiple manifestations of tuberous sclerosis complex including epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 4:63-6. [PMID: 26543807 PMCID: PMC4543076 DOI: 10.1016/j.ebcr.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/25/2022]
Abstract
Tuberous sclerosis complex (TSC) is a genetic disease in which overactivation of mechanistic target of rapamycin (mTOR) signaling leads to the growth of benign hamartomas in multiple organs, including the brain, and is associated with a high rate of epilepsy and neurological deficits. The mTOR inhibitor everolimus has been used in the treatment of subependymal giant cell astrocytomas and renal angiomyolipomas in patients with TSC. This article describes the case of a 13-year-old girl with TSC-associated epilepsy with refractory generalized seizures who initiated treatment with everolimus and experienced subsequent improvement in several TSC manifestations, including a reduction in seizure frequency from clusters of two or three daily to one every 2 to 4 weeks after 1.5 years of treatment.
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Affiliation(s)
- James W Wheless
- Le Bonheur Children's Hospital and the University of Tennessee Health Science Center, Memphis, TN, USA
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404
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Effect of Chronic Administration of Low Dose Rapamycin on Development and Immunity in Young Rats. PLoS One 2015; 10:e0135256. [PMID: 26248290 PMCID: PMC4527665 DOI: 10.1371/journal.pone.0135256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/20/2015] [Indexed: 12/25/2022] Open
Abstract
Mammalian target of rapamycin (mTOR) regulates cell growth, cell differentiation and protein synthesis. Rapamycin, an inhibitor of mTOR, has been widely used as an immunosuppressant and anti-cancer drug. Recently, mTOR inhibitors have also been reported to be a potential anti-epileptic drug, which may be effective when used in young patients with genetic epilepsy. Thus, a suitable dose of rapamycin which can maintain the normal function of mTOR and has fewer side effects ideally should be identified. In the present study, we first detected changes in marker proteins of mTOR signaling pathway during development. Then we determined the dose of rapamycin by treating rats of 2 weeks of age with different doses of rapamycin for 3 days and detected its effect on mTOR pathway. Young rats were then treated with a suitable dose of rapamycin for 4 weeks and the effect of rapamycin on mTOR, development and immunity were investigated. We found that the expression of the marker proteins of mTOR pathway was changed during development in brain hippocampus and neocortex. After 3 days of treanent, 0.03 mg/kg rapamycin had no effect on phospho-S6, whereas 0.1, 0.3, 1.0 and 3.0 mg/kg rapamycin inhibited phospho-S6 in a dose-dependent manner. However, only 1.0 mg/kg and 3.0 mg/kg rapamycin inhibited phospho-S6 after 4 weeks treatment of rapamycin. Parallel to this result, rats treated with 0.1 and 0.3 mg/kg rapamycin had no obvious adverse effects, whereas rats treated with 1.0 and 3.0 mg/kg rapamycin showed significant decreases in body, spleen and thymus weight. Additionally, rats treated with 1.0 and 3.0 mg/kg rapamycin exhibited cognitive impairment and anxiety as evident by maze and open field experiments. Furthermore, the content of IL-1β, IL-2, IFN-γ, TNF-α in serum and cerebral cortex were significantly decreased in 1.0 and 3.0 mg/kg rapamycin-treated rats. The expression of DCX was also significantly decreased in 1.0 and 3.0 mg/kg rapamycin-treated rats. However, rats treated with 1.0 mg/ kg rapamycin exhibited fewer and milder side effects than those treated with 3.0 mg/kg. In summary, all these data suggest that there is not a rapamycin dose that can inhibit mTOR for epilepsy without causing any side effects, but 1 mg /kg may be the optimal dose for young rats for suppressing mTOR with relatively few side effects.
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405
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Fukumura S, Watanabe T, Takayama R, Minagawa K, Tsutsumi H. Everolimus Treatment for an Early Infantile Subependymal Giant Cell Astrocytoma With Tuberous Sclerosis Complex. J Child Neurol 2015; 30:1192-5. [PMID: 25143481 DOI: 10.1177/0883073814544703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
Subependymal giant cell astrocytomas are benign tumors often observed with tuberous sclerosis complex. These tumors are rarely diagnosed during fetal life or early infancy. Until recently, the only available treatment has been surgical resection. Current clinical research has demonstrated that everolimus can induce these tumors' regression. We report a 19-month-old boy with tuberous sclerosis complex. At 2 months of age, he presented with congenital subependymal giant cell astrocytoma that was complicated by refractory epilepsy and severe mental retardation. Treatment with everolimus was started when he was 10 months old. Three months after initiating everolimus, the tumor was significantly reduced in size, and the reduction was subsequently maintained. His seizures decreased and he showed cognitive and developmental improvement. No severe adverse events have been observed to date. Everolimus has promise as an effective alternative to surgery for subependymal giant cell astrocytomas during early infancy.
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Affiliation(s)
- Shinobu Fukumura
- The Department of Child Neurology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-Ku, Sapporo, Japan Department of Pediatrics, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Toshihide Watanabe
- The Department of Child Neurology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-Ku, Sapporo, Japan Department of Pediatrics, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Rumiko Takayama
- The Department of Child Neurology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-Ku, Sapporo, Japan Department of Pediatrics, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Kimio Minagawa
- The Department of Child Neurology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-Ku, Sapporo, Japan Department of Pediatrics, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
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406
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Barker FG. Brain Tumor Clinical Trials. Neurosurgery 2015; 62 Suppl 1:141-5. [DOI: 10.1227/neu.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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407
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Hoshiai S, Oguma E, Sato Y, Konishi T, Minami M. Congenital focal lymphedema as a diagnostic clue to tuberous sclerosis complex: report of two cases diagnosed by ultrasound. Skeletal Radiol 2015; 44:1165-8. [PMID: 25616615 DOI: 10.1007/s00256-015-2094-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/30/2014] [Accepted: 01/02/2015] [Indexed: 02/02/2023]
Abstract
Tuberous sclerosis complex (TSC) is a familial disorder characterized by benign hamartomas in the brain and other organs. Generally, the diagnosis of TSC is relatively easy, based on a medical history, a physical examination, and imaging findings. However, it can be difficult to consider a possibility of TSC in neonates and infants when congenital lymphedema is the sole external manifestation, because lymphedema associated with TSC is extremely rare. Herein, we report two cases of TSC showing congenital lymphedema at the initial presentation. Both patients were girls, and their sole complaint was congenital lymphedema. We diagnosed TSC using ultrasound focusing on the kidney, heart, and brain in addition to the extremity showing lymphedema. Awareness of a potential association of congenital lymphedema with TSC may assist in the diagnosis of TSC by ultrasound.
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Affiliation(s)
- Sodai Hoshiai
- Department of Radiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama, Japan,
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408
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Soden SE, Saunders CJ, Willig LK, Farrow EG, Smith LD, Petrikin JE, LePichon JB, Miller NA, Thiffault I, Dinwiddie DL, Twist G, Noll A, Heese BA, Zellmer L, Atherton AM, Abdelmoity AT, Safina N, Nyp SS, Zuccarelli B, Larson IA, Modrcin A, Herd S, Creed M, Ye Z, Yuan X, Brodsky RA, Kingsmore SF. Effectiveness of exome and genome sequencing guided by acuity of illness for diagnosis of neurodevelopmental disorders. Sci Transl Med 2015; 6:265ra168. [PMID: 25473036 DOI: 10.1126/scitranslmed.3010076] [Citation(s) in RCA: 386] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Neurodevelopmental disorders (NDDs) affect more than 3% of children and are attributable to single-gene mutations at more than 1000 loci. Traditional methods yield molecular diagnoses in less than one-half of children with NDD. Whole-genome sequencing (WGS) and whole-exome sequencing (WES) can enable diagnosis of NDD, but their clinical and cost-effectiveness are unknown. One hundred families with 119 children affected by NDD received diagnostic WGS and/or WES of parent-child trios, wherein the sequencing approach was guided by acuity of illness. Forty-five percent received molecular diagnoses. An accelerated sequencing modality, rapid WGS, yielded diagnoses in 73% of families with acutely ill children (11 of 15). Forty percent of families with children with nonacute NDD, followed in ambulatory care clinics (34 of 85), received diagnoses: 33 by WES and 1 by staged WES then WGS. The cost of prior negative tests in the nonacute patients was $19,100 per family, suggesting sequencing to be cost-effective at up to $7640 per family. A change in clinical care or impression of the pathophysiology was reported in 49% of newly diagnosed families. If WES or WGS had been performed at symptom onset, genomic diagnoses may have been made 77 months earlier than occurred in this study. It is suggested that initial diagnostic evaluation of children with NDD should include trio WGS or WES, with extension of accelerated sequencing modalities to high-acuity patients.
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Affiliation(s)
- Sarah E Soden
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
| | - Carol J Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA. Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Laurel K Willig
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Emily G Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA. Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Laurie D Smith
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Josh E Petrikin
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Jean-Baptiste LePichon
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Neil A Miller
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA. Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Darrell L Dinwiddie
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Greyson Twist
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Aaron Noll
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Bryce A Heese
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Lee Zellmer
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Andrea M Atherton
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Ahmed T Abdelmoity
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Nicole Safina
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Sarah S Nyp
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Britton Zuccarelli
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Ingrid A Larson
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Ann Modrcin
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Suzanne Herd
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Mitchell Creed
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
| | - Zhaohui Ye
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Xuan Yuan
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Robert A Brodsky
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Stephen F Kingsmore
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO 64108, USA. School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA. Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO 64108, USA
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409
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Bissler JJ, Kingswood JC, Radzikowska E, Zonnenberg BA, Frost M, Belousova E, Sauter M, Nonomura N, Brakemeier S, de Vries PJ, Berkowitz N, Miao S, Segal S, Peyrard S, Budde K. Everolimus for renal angiomyolipoma in patients with tuberous sclerosis complex or sporadic lymphangioleiomyomatosis: extension of a randomized controlled trial. Nephrol Dial Transplant 2015; 31:111-9. [PMID: 26156073 DOI: 10.1093/ndt/gfv249] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/11/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mammalian target of rapamycin (mTOR) inhibitors are recommended as first-line treatment of renal angiomyolipoma associated with tuberous sclerosis complex (TSC) or sporadic lymphangioleiomyomatosis (sporadic LAM), but follow-up is limited. Longer term efficacy and tolerability data from a Phase 3, double-blind, placebo-controlled trial are presented. METHODS Following favorable results from the primary analysis (data cutoff 30 June 2011) of the EXIST-2 trial, patients still receiving study treatment were allowed to enter an open-label extension. Everolimus was initiated at 10 mg once daily and titrated based on tolerability. The primary outcome was angiomyolipoma response rate (≥ 50% reduction from baseline in target lesion volumes). Safety was a secondary endpoint. RESULTS As of the cutoff date (1 May 2013), 112 patients had received everolimus, and the response rate in 107 patients with angiomyolipoma (median duration of medication exposure of 28.9 months) was 54%. The proportion of patients achieving angiomyolipoma reductions of ≥ 30% and ≥ 50% increased over time, reaching 81.6% (62/76) and 64.5% (49/76), respectively, by Week 96. No everolimus-treated patients experienced renal bleeding. The long-term safety profile was consistent with previous reports; adverse events (AEs) were mostly Grade 1/2, and there were no new safety issues. The frequency of emerging AEs and severe AEs lessened over time. CONCLUSIONS Longer term everolimus treatment appeared safe and effective in patients with TSC- or sporadic LAM-associated renal angiomyolipoma not requiring surgical intervention. Continued reduction in angiomyolipoma volume was demonstrated, and there was no angiomyolipoma-related bleeding; AEs were predictable and generally manageable. TRIAL REGISTRATION clinicaltrialsgov identifier: NCT00790400 (http://clinicaltrials.gov/ct2/show/NCT00790400).
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Affiliation(s)
- John J Bissler
- St. Jude Children's Research Hospital and Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | | | | - Elena Belousova
- Moscow Research Institute of Pediatrics and Pediatric Surgery, Moscow, Russia
| | - Matthias Sauter
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität MüNchen, Munich, Germany
| | | | | | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Noah Berkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Sara Miao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Scott Segal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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410
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Abdel-Rahman O, Fouad M. Risk of oral and gastrointestinal mucosal injury in patients with solid tumors treated with everolimus, temsirolimus or ridaforolimus: a comparative systematic review and meta-analysis. Expert Rev Anticancer Ther 2015; 15:847-858. [DOI: 10.1586/14737140.2015.1047350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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411
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Bhat M, Watt KD. Mammalian target of rapamycin inhibition after solid organ transplantation: canit, and doesit, reduce cancer risk? Clin Transplant 2015; 29:654-663. [DOI: 10.1111/ctr.12559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Mamatha Bhat
- Division of Gastroenterology and Hepatology; McGill University Health Centre; Montreal QC Canada
| | - Kymberly D. Watt
- Division of Gastroenterology and Hepatology; Mayo Clinic; Rochester MN USA
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412
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Long-Term Everolimus Treatment in Individuals With Tuberous Sclerosis Complex: A Review of the Current Literature. Pediatr Neurol 2015; 53:23-30. [PMID: 26092412 DOI: 10.1016/j.pediatrneurol.2014.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/02/2014] [Accepted: 10/26/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tuberous sclerosis complex is a genetic disease usually caused by mutations to either TSC1 or TSC2, where its gene products are involved in the inhibition of the mammalian target of rapamycin pathway. Under normal cellular conditions, mammalian target of rapamycin (mTOR) regulates cell growth and proliferation in response to signals from nutrients or growth factors, but loss of TSC1 or TSC2 leads to overactivation of mTOR and uncontrolled cellular proliferation. Everolimus is an mTOR inhibitor approved for use in a number of indications where mTOR overactivation is implicated, including tuberous sclerosis complex. METHODS AND PATIENTS We conducted a literature search of PubMed to identify published articles about the long-term efficacy and safety of everolimus in patients with tuberous sclerosis complex. RESULTS The short-term efficacy and safety of everolimus in patients with tuberous sclerosis complex has been demonstrated in placebo-controlled trials, and open-label extension studies are ongoing to monitor long-term effects, including safety. Examples of regrowth following discontinuation of mTOR inhibitors suggest that everolimus needs to be given indefinitely to maintain suppression of subependymal giant cell astrocytoma and other tuberous sclerosis complex-associated disease manifestations. No additional safety concerns have been reported to date with long-term administration of everolimus, but published long-term data (>1 year treatment) are currently limited to a small open-label trial and case reports for this relatively rare condition. CONCLUSIONS From the limited data available, long-term administration of everolimus appears feasible with few safety concerns beyond those associated with short-term use. Further investigation is needed to determine the long-term efficacy and safety of everolimus in patients with tuberous sclerosis complex.
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413
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Davis PE, Peters JM, Krueger DA, Sahin M. Tuberous Sclerosis: A New Frontier in Targeted Treatment of Autism. Neurotherapeutics 2015; 12:572-83. [PMID: 25986747 PMCID: PMC4489948 DOI: 10.1007/s13311-015-0359-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder with a high prevalence of autism spectrum disorder (ASD). Tremendous progress in understanding the pathogenesis of TSC has been made in recent years, along with initial trials of medical treatment aimed specifically at the underlying mechanism of the disorder. At the cellular level, loss of TSC1 or TSC2 results in upregulation of the mechanistic target of rapamycin (mTOR) pathway. At the circuitry level, TSC and mTOR play crucial roles in axonal, dendritic, and synaptic development and function. In this review, we discuss the molecular mechanism underlying TSC, and how this disease results in aberrant neural connectivity at multiple levels in the central nervous system, leading to ASD symptoms. We then review recent advances in mechanism-based treatments of TSC, and the promise that these treatments provide for future mechanism-based treatment of ASD. Because of these recent advances, TSC represents an ideal model for how to make progress in understanding and treating the mechanisms that underlie ASD in general.
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Affiliation(s)
- Peter E. Davis
- />Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, 02115 MA USA
| | - Jurriaan M. Peters
- />Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, 02115 MA USA
| | - Darcy A. Krueger
- />Division of Neurology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Mustafa Sahin
- />Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, 02115 MA USA
- />F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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414
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Alentorn A, Duran-Peña A, Pingle SC, Piccioni DE, Idbaih A, Kesari S. Molecular profiling of gliomas: potential therapeutic implications. Expert Rev Anticancer Ther 2015; 15:955-62. [PMID: 26118895 DOI: 10.1586/14737140.2015.1062368] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gliomas are the most common primary malignant brain tumor. Over the last decade, significant advances have been made in the molecular characterization of this tumor group, identifying predictive biomarkers or molecular actionable targets, and paving the way to molecular-based targeted therapies. This personalized therapeutic approach is effective and illustrated in the present review. Among many molecular abnormalities, BRAF mutation and mTOR activation in pilocytic astrocytomas and subependymal giant cell astrocytomas are actionable targets sensitive to vemurafenib and everolimus, respectively. Chromosome arms 1p/19q co-deletion and IDH mutational status are pivotal in driving delivery of early procarbazine, lomustine and vincristine chemotherapy in anaplastic oligodendroglial tumors. Although consensus to assess MGMT promoter methylation is not reached yet, it may be useful in predicting resistance to temozolomide in elderly patients.
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Affiliation(s)
- Agusti Alentorn
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de neurologie 2-Mazarin, Paris, France
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415
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Goldberg HJ, Harari S, Cottin V, Rosas IO, Peters E, Biswal S, Cheng Y, Khindri S, Kovarik JM, Ma S, McCormack FX, Henske EP. Everolimus for the treatment of lymphangioleiomyomatosis: a phase II study. Eur Respir J 2015; 46:783-94. [DOI: 10.1183/09031936.00210714] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/04/2015] [Indexed: 11/05/2022]
Abstract
Lymphangioleiomyomatosis is a rare, progressive cystic lung disorder characterised by dysregulated activation of mammalian target of rapamycin (mTOR) signalling.This was a phase IIa, multicentre, open-label study of the mTOR inhibitor everolimus (2.5 mg·day−1 escalated to 10 mg·day−1) in 24 women with lymphangioleiomyomatosis. Primary endpoints were safety, pharmacokinetics and serum vascular endothelial growth factor-D (VEGF-D) levels; secondary endpoints were measures of lung function.Following 26 weeks of everolimus treatment, forced vital capacity exhibited stability, while forced expiration volume in 1 s improved from baseline, with mean changes (95% confidence interval) of 10 mL (−111–132) and 114 mL (11–217), respectively; 6-min walk distance improved by 47 m. Median VEGF-D and collagen IV levels decreased from baseline, from 1730 pg·mL−1 to 934.5 pg·mL−1, and 103 ng·mL−1 to 80.5 ng·mL−1, respectively. Adverse events were mostly grade 1−2; mouth ulceration, headache, nausea, stomatitis and fatigue were common. Serious adverse events suspected to be treatment related included peripheral oedema, pneumonia, cardiac failure and Pneumocystis jirovecii infection. Everolimus blood levels increased dose proportionally.In this study, everolimus improved some measures of lung function and exercise capacity and reduced serum VEGF-D and collagen IV. Side effects were generally consistent with known toxicities of mTOR inhibitors, although some were severe.
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416
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Ishii R, Wataya-Kaneda M, Canuet L, Nonomura N, Nakai Y, Takeda M. Everolimus improves behavioral deficits in a patient with autism associated with tuberous sclerosis: a case report. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40810-015-0004-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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417
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Overwater IE, Bindels-de Heus K, Rietman AB, ten Hoopen LW, Vergouwe Y, Moll HA, de Wit MCY. Epilepsy in children with tuberous sclerosis complex: Chance of remission and response to antiepileptic drugs. Epilepsia 2015; 56:1239-45. [DOI: 10.1111/epi.13050] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Iris E. Overwater
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Karen Bindels-de Heus
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - André B. Rietman
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Leontine W. ten Hoopen
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Yvonne Vergouwe
- Department of Public Health; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Marie-Claire Y. de Wit
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
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418
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Sarnat HB, Flores-Sarnat L. Infantile tauopathies: Hemimegalencephaly; tuberous sclerosis complex; focal cortical dysplasia 2; ganglioglioma. Brain Dev 2015; 37:553-62. [PMID: 25451314 DOI: 10.1016/j.braindev.2014.08.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 11/16/2022]
Abstract
Tau is a normal microtubule-associated protein; mutations to phosphorylated or acetylated forms are neurotoxic. In many dementias of adult life tauopathies cause neuronal degeneration. Four developmental disorders of the fetal and infant brain are presented, each of which exhibits up-regulation of tau. Microtubules are cytoskeletal structures that provide the strands of mitotic spindles and specify cellular polarity, growth, lineage, differentiation, migration and axonal transport of molecules. Phosphorylated tau is abnormal in immature as in mature neurons. Several malformations are demonstrated in which upregulated tau may be important in pathogenesis. All produce highly epileptogenic cortical foci. The prototype infantile tauopathy is (1) hemimegalencephaly (HME); normal tau is degraded by a mutant AKT3 or AKT1 gene as the aetiology of focal somatic mosaicism in the periventricular neuroepithelium. HME may be isolated or associated with neurocutaneous syndromes, particularly epidermal naevus syndromes, also due to somatic mutations. Other tauopathies of early life include: (2) tuberous sclerosis complex; (3) focal cortical dysplasia type 2b (FCD2b); and (4) ganglioglioma, a tumor with dysplastic neurons and neoplastic glial cells. Pathological tau in these infantile cases alters cellular growth and architecture, synaptic function and tissue organization, but does not cause neuronal loss. All infantile tauopathies are defined neuropathologically as a tetrad of (1) dysmorphic and megalocytic neurons; (2) activation of the mTOR signaling pathway; (3) post-zygotic somatic mosaicism; and (4) upregulation of phosphorylated tau. HME and FCD2b may be the same disorder with different timing of the somatic mutation in the mitotic cycles of the neuroepithelium. HME and FCD2b may be the same disorder with different timing of the somatic mutation in the mitotic cycles of the neuroepithelium. Tauopathies must be considered in infantile neurological disease and no longer restricted to adult dementias. The mTOR inhibitor everolimus, already demonstrated to be effective in TSC, also may be a potential treatment in other infantile tauopathies.
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Affiliation(s)
- Harvey B Sarnat
- Department of Paediatrics, University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Foundation, Calgary, Alberta, Canada; Department of Pathology (Neuropathology), University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Foundation, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Foundation, Calgary, Alberta, Canada.
| | - Laura Flores-Sarnat
- Department of Paediatrics, University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Foundation, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Foundation, Calgary, Alberta, Canada
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419
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Role of mTOR inhibitors in epilepsy treatment. Pharmacol Rep 2015; 67:636-46. [DOI: 10.1016/j.pharep.2014.12.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/24/2014] [Accepted: 12/30/2014] [Indexed: 01/16/2023]
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420
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Blackmon K. Structural MRI biomarkers of shared pathogenesis in autism spectrum disorder and epilepsy. Epilepsy Behav 2015; 47:172-82. [PMID: 25812936 DOI: 10.1016/j.yebeh.2015.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 01/28/2023]
Abstract
Etiological factors that contribute to a high comorbidity between autism spectrum disorder (ASD) and epilepsy are the subject of much debate. Does epilepsy cause ASD or are there common underlying brain abnormalities that increase the risk of developing both disorders? This review summarizes evidence from quantitative MRI studies to suggest that abnormalities of brain structure are not necessarily the consequence of ASD and epilepsy but are antecedent to disease expression. Abnormal gray and white matter volumes are present prior to onset of ASD and evident at the time of onset in pediatric epilepsy. Aberrant brain growth trajectories are also common in both disorders, as evidenced by blunted gray matter maturation and white matter maturation. Although the etiological factors that explain these abnormalities are unclear, high heritability estimates for gray matter volume and white matter microstructure demonstrate that genetic factors assert a strong influence on brain structure. In addition, histopathological studies of ASD and epilepsy brain tissue reveal elevated rates of malformations of cortical development (MCDs), such as focal cortical dysplasia and heterotopias, which supports disruption of neuronal migration as a contributing factor. Although MCDs are not always visible on MRI with conventional radiological analysis, quantitative MRI detection methods show high sensitivity to subtle malformations in epilepsy and can be potentially applied to MCD detection in ASD. Such an approach is critical for establishing quantitative neuroanatomic endophenotypes that can be used in genetic research. In the context of emerging drug treatments for seizures and autism symptoms, such as rapamycin and rapalogs, in vivo neuroimaging markers of subtle structural brain abnormalities could improve sample stratification in human clinical trials and potentially extend the range of patients that might benefit from treatment. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Affiliation(s)
- Karen Blackmon
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, NY 10016, USA; Center for Mind/Brain Sciences, University of Trento, Rovereto, Trento 38068, Italy.
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421
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Abstract
Tuberous sclerosis complex is an autosomal-dominant, neurocutaneous, multisystem disorder characterized by cellular hyperplasia and tissue dysplasia. The genetic cause is mutations in the TSC1 gene, found on chromosome 9q34, and TSC2 gene, found on chromosome 16p13. The clinical phenotypes resulting from mutations in either of the 2 genes are variable in each individual. Herein, advances in the understanding of molecular mechanisms in tuberous sclerosis complex are reviewed, and current guidelines for diagnosis, treatment, follow-up, and management are summarized.
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Affiliation(s)
- Francis J DiMario
- Department of Pediatrics, Neurogenetics-Tuberous Sclerosis Clinic, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06070, USA.
| | - Mustafa Sahin
- Multidisciplinary Tuberous Sclerosis Program, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Darius Ebrahimi-Fakhari
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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422
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Kuo JC, Gorddard N, Stuart-Harris R. Renal failure requiring hemodialysis in two patients with metastatic breast cancer treated with everolimus. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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423
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Prabhakar S, Zhang X, Goto J, Han S, Lai C, Bronson R, Sena-Esteves M, Ramesh V, Stemmer-Rachamimov A, Kwiatkowski DJ, Breakefield XO. Survival benefit and phenotypic improvement by hamartin gene therapy in a tuberous sclerosis mouse brain model. Neurobiol Dis 2015; 82:22-31. [PMID: 26019056 DOI: 10.1016/j.nbd.2015.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 12/12/2022] Open
Abstract
We examined the potential benefit of gene therapy in a mouse model of tuberous sclerosis complex (TSC) in which there is embryonic loss of Tsc1 (hamartin) in brain neurons. An adeno-associated virus (AAV) vector (serotype rh8) expressing a tagged form of hamartin was injected into the cerebral ventricles of newborn pups with the genotype Tsc1(cc) (homozygous for a conditional floxed Tsc1 allele) SynI-cre(+), in which Tsc1 is lost selectively in neurons starting at embryonic day 12. Vector-treated Tsc1(cc)SynIcre(+) mice showed a marked improvement in survival from a mean of 22 days in non-injected mice to 52 days in AAV hamartin vector-injected mice, with improved weight gain and motor behavior in the latter. Pathologic studies showed normalization of neuron size and a decrease in markers of mTOR activation in treated as compared to untreated mutant littermates. Hence, we show that gene replacement in the brain is an effective therapeutic approach in this mouse model of TSC1. Our strategy for gene therapy has the advantages that therapy can be achieved from a single application, as compared to repeated treatment with drugs, and that AAV vectors have been found to have minimal to no toxicity in clinical trials for other neurologic conditions. Although there are many additional issues to be addressed, our studies support gene therapy as a useful approach in TSC patients.
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Affiliation(s)
- Shilpa Prabhakar
- Molecular Neurogenetics Unit, Department of Neurology and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - Xuan Zhang
- Molecular Neurogenetics Unit, Department of Neurology and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - June Goto
- Translational Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sangyeul Han
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Lai
- Molecular Neurogenetics Unit, Department of Neurology and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - Roderick Bronson
- Rodent Histopathology Core Facility, Harvard Medical School, Boston, MA, USA
| | - Miguel Sena-Esteves
- Neurology Department, Gene Therapy Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vijaya Ramesh
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J Kwiatkowski
- Translational Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Xandra O Breakefield
- Molecular Neurogenetics Unit, Department of Neurology and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, and Program in Neuroscience, Harvard Medical School, Boston, MA, USA.
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424
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Zhang B, Zou J, Rensing NR, Yang M, Wong M. Inflammatory mechanisms contribute to the neurological manifestations of tuberous sclerosis complex. Neurobiol Dis 2015; 80:70-9. [PMID: 26003087 DOI: 10.1016/j.nbd.2015.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 02/06/2023] Open
Abstract
Epilepsy and other neurological deficits are common, disabling manifestations of the genetic disorder, tuberous sclerosis complex (TSC). Brain inflammation has been implicated in contributing to epileptogenesis in acquired epilepsy due to brain injury, but the potential role of inflammatory mechanisms in genetic epilepsies is relatively unexplored. In this study, we investigated activation of inflammatory mediators and tested the effects of anti-inflammatory treatment on epilepsy in the Tsc1-GFAP conditional knock-out mouse model of TSC (Tsc1(GFAP)CKO mice). Real-time quantitative RT-PCR, immunohistochemistry, and Western blotting demonstrated increased expression of specific cytokines and chemokines, particularly IL-1β and CXCL10, in the neocortex and hippocampus of Tsc1(GFAP)CKO mice, which was reversed by treatment with a mammalian target of rapamycin complex 1 (mTORC1) inhibitor. Double-labeling immunohistochemical studies indicated that the increased IL-1β was localized primarily to astrocytes. Importantly, the increase in inflammatory markers was also observed in astrocyte culture in vitro and at 2 weeks of age in Tsc1(GFAP)CKO mice before the onset of epilepsy in vivo, indicating that the inflammatory changes were not secondary to seizures. Epicatechin-3-gallate, an inhibitor of IL-1β and CXCL10, at least partially reversed the elevated cytokine and chemokine levels, reduced seizure frequency, and prolonged survival of Tsc1(GFAP)CKO mice. These findings suggest that mTOR-mediated inflammatory mechanisms may be involved in epileptogenesis in the genetic epilepsy, TSC.
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Affiliation(s)
- Bo Zhang
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Jia Zou
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas R Rensing
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Meihua Yang
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA.
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425
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Harter PN, Jennewein L, Baumgarten P, Ilina E, Burger MC, Thiepold AL, Tichy J, Zörnig M, Senft C, Steinbach JP, Mittelbronn M, Ronellenfitsch MW. Immunohistochemical Assessment of Phosphorylated mTORC1-Pathway Proteins in Human Brain Tumors. PLoS One 2015; 10:e0127123. [PMID: 25993328 PMCID: PMC4437987 DOI: 10.1371/journal.pone.0127123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/10/2015] [Indexed: 01/14/2023] Open
Abstract
Background Current pathological diagnostics include the analysis of (epi-)genetic alterations as well as oncogenic pathways. Deregulated mammalian target of rapamycin complex 1 (mTORC1) signaling has been implicated in a variety of cancers including malignant gliomas and is considered a promising target in cancer treatment. Monitoring of mTORC1 activity before and during inhibitor therapy is essential. The aim of our study is to provide a recommendation and report on pitfalls in the use of phospho-specific antibodies against mTORC1-targets phospho-RPS6 (Ser235/236; Ser240/244) and phospho-4EBP1 (Thr37/46) in formalin fixed, paraffin embedded material. Methods and Findings Primary, established cell lines and brain tumor tissue from routine diagnostics were assessed by immunocyto-, immunohistochemistry, immunofluorescent stainings and immunoblotting. For validation of results, immunoblotting experiments were performed. mTORC-pathway activation was pharmacologically inhibited by torin2 and rapamycin. Torin2 treatment led to a strong reduction of signal intensity and frequency of all tested antibodies. In contrast phospho-4EBP1 did not show considerable reduction in staining intensity after rapamycin treatment, while immunocytochemistry with both phospho-RPS6-specific antibodies showed a reduced signal compared to controls. Staining intensity of both phospho-RPS6-specific antibodies did not show considerable decrease in stability in a timeline from 0–230 minutes without tissue fixation, however we observed a strong decrease of staining intensity in phospho-4EBP1 after 30 minutes. Detection of phospho-signals was strongly dependent on tissue size and fixation gradient. mTORC1-signaling was significantly induced in glioblastomas although not restricted to cancer cells but also detectable in non-neoplastic cells. Conclusion Here we provide a recommendation for phospho-specific immunohistochemistry for patient-orientated therapy decisions and monitoring treatment response.
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Affiliation(s)
- Patrick N. Harter
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- * E-mail: (PNH); (MWR)
| | - Lukas Jennewein
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
- Department of Neurosurgery, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Elena Ilina
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Michael C. Burger
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Senckenberg Institute of Neurooncology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Anna-Luisa Thiepold
- Senckenberg Institute of Neurooncology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Julia Tichy
- Senckenberg Institute of Neurooncology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Martin Zörnig
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt am Main, Germany
| | - Christian Senft
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurosurgery, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Joachim P. Steinbach
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Senckenberg Institute of Neurooncology, University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael W. Ronellenfitsch
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Senckenberg Institute of Neurooncology, University of Frankfurt am Main, Frankfurt am Main, Germany
- * E-mail: (PNH); (MWR)
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426
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Lymphangioleiomyomatosis: New Treatment Perspectives. Lung 2015; 193:467-75. [PMID: 25980593 DOI: 10.1007/s00408-015-9742-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/04/2015] [Indexed: 12/21/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare multisystem disease, occurs in women, usually premenopausal, caused by the proliferation of neoplastic smooth muscle-derived cells. Mutations in the tuberous sclerosis complex genes, lead to the activation of mammalian target of rapamycin kinase (mTOR), results in proliferation of LAM cells, its increasing motility, and survival. Polycystic lung destruction, extensive involvement of lymphatic channels, chylothorax, chyloperitoneum, and renal angiomyolipomas can develop in LAM patients. The new, promising treatment strategies have been recently introduced due to discovery of the genetic and molecular mechanisms of LAM. Comprehension of the disease pathogenesis has resulted in the implementation of other therapeutic agents such as mTOR inhibitors, VEGF-D inhibitors, statins, interferon, chloroquine analogs, cyclin-dependent kinase inhibitors, matrix metalloproteinase inhibitors, aromatase inhibitors, and their combinations. The mTOR inhibitors appear to be the most important, and the efficacy of sirolimus in LAM treatment has been proved. The article discussed the new control studies with mTOR inhibitors, doxycycline, simvastatin, and combination of them in LAM patients.
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427
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Molecular Connections between Cancer Cell Metabolism and the Tumor Microenvironment. Int J Mol Sci 2015; 16:11055-86. [PMID: 25988385 PMCID: PMC4463690 DOI: 10.3390/ijms160511055] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/30/2015] [Accepted: 05/08/2015] [Indexed: 12/13/2022] Open
Abstract
Cancer cells preferentially utilize glycolysis, instead of oxidative phosphorylation, for metabolism even in the presence of oxygen. This phenomenon of aerobic glycolysis, referred to as the “Warburg effect”, commonly exists in a variety of tumors. Recent studies further demonstrate that both genetic factors such as oncogenes and tumor suppressors and microenvironmental factors such as spatial hypoxia and acidosis can regulate the glycolytic metabolism of cancer cells. Reciprocally, altered cancer cell metabolism can modulate the tumor microenvironment which plays important roles in cancer cell somatic evolution, metastasis, and therapeutic response. In this article, we review the progression of current understandings on the molecular interaction between cancer cell metabolism and the tumor microenvironment. In addition, we discuss the implications of these interactions in cancer therapy and chemoprevention.
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428
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Prados MD, Byron SA, Tran NL, Phillips JJ, Molinaro AM, Ligon KL, Wen PY, Kuhn JG, Mellinghoff IK, de Groot JF, Colman H, Cloughesy TF, Chang SM, Ryken TC, Tembe WD, Kiefer JA, Berens ME, Craig DW, Carpten JD, Trent JM. Toward precision medicine in glioblastoma: the promise and the challenges. Neuro Oncol 2015; 17:1051-63. [PMID: 25934816 DOI: 10.1093/neuonc/nov031] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/15/2015] [Indexed: 12/17/2022] Open
Abstract
Integrated sequencing strategies have provided a broader understanding of the genomic landscape and molecular classifications of multiple cancer types and have identified various therapeutic opportunities across cancer subsets. Despite pivotal advances in the characterization of genomic alterations in glioblastoma, targeted agents have shown minimal efficacy in clinical trials to date, and patient survival remains poor. In this review, we highlight potential reasons why targeting single alterations has yielded limited clinical efficacy in glioblastoma, focusing on issues of tumor heterogeneity and pharmacokinetic failure. We outline strategies to address these challenges in applying precision medicine to glioblastoma and the rationale for applying targeted combination therapy approaches that match genomic alterations with compounds accessible to the central nervous system.
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Affiliation(s)
- Michael D Prados
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Sara A Byron
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Nhan L Tran
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Joanna J Phillips
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Annette M Molinaro
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Keith L Ligon
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Patrick Y Wen
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - John G Kuhn
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Ingo K Mellinghoff
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - John F de Groot
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Howard Colman
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Timothy F Cloughesy
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Susan M Chang
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Timothy C Ryken
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Waibhav D Tembe
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Jeffrey A Kiefer
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Michael E Berens
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - David W Craig
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - John D Carpten
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
| | - Jeffrey M Trent
- University of California San Francisco, San Francisco, California (M.D.P, J.J.P., A.M.M., S.M.C.); Translational Genomics Research Institute, Phoenix, Arizona (S.A.B., N.L.T., W.D.T., J.A.K., M.E.B., D.W.C., J.D.C., J.M.T.); Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (K.L.L., P.Y.W.); University of Texas Health Science Center, San Antonio, Texas (J.G.K.); Memorial Sloan-Kettering Cancer Center, New York, New York (I.K.M.); The University of Texas M.D. Anderson Cancer Center, Houston, Texas (J.F.d.G.); University of Utah Huntsman Cancer Institute, Salt Lake City, Utah (H.C.); University of California Los Angeles, Los Angeles, California (T.F.C.); Iowa Spine and Brain Institute, Waterloo, Iowa (T.C.R.)
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Sun P, Liu Z, Krueger D, Kohrman M. Direct medical costs for patients with tuberous sclerosis complex and surgical resection of subependymal giant cell astrocytoma: a US national cohort study. J Med Econ 2015; 18:349-56. [PMID: 25525770 DOI: 10.3111/13696998.2014.1001513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate direct medical costs for patients with tuberous sclerosis complex (TSC) and surgical resection of subependymal giant-cell astrocytoma (SEGA). METHODS This retrospective cohort study selected patients who had SEGA surgery and TSC claims between 2000-2011 from three large US nationwide claims databases. Selected patients were age 35 or less and had continuous health insurance in the year before and the year after their first SEGA surgery claim. The study examined the patients' demographic and clinical characteristics and estimated inpatient, outpatient, medication, and total medical costs paid by insurance companies for the pre-surgery year, post-surgery year, and other study periods, respectively. Repeated measures analysis and bootstrapping technique were used to assess the impact of the surgery on the direct medical costs. RESULTS Select patients (n = 47) had a mean baseline age of 11.6 years and 66% were male. Many had seizures (91.0%), hydrocephalus (59.6%), vision disorders (38.3%), stroke and hemiparesis (36.2%), and shunt (34.0%) in the pre-surgery year. The mean direct medical costs were $8543 (inpatient: $3770; outpatient: $3473; medication: $1300) for the pre-surgery year, and $85,397 (inpatient: $71,562; outpatient: $11,497; medication: $2338) for the post-surgery year. With the exclusion of the costs during the surgery month, the inpatient, outpatient, medication, and total costs in the post-surgery year were 1.6-4.3 times as much as the costs in the pre-surgery year (inpatient: 4.3:1; outpatient: 2.5:1; medication: 1.6:1; total: 3.1:1, p < 0.05). Repeated measures analysis with bootstrapping confirmed a link between the surgery and increases in direct medical costs (p < 0.05). CONCLUSIONS SEGA surgery had a substantial impact on direct medical costs. TSC patients with the surgery experienced significant post-surgery increases in their inpatient, outpatient, and medication costs. Additional research should be conducted to examine the surgery's cost-impact in a longer duration, or to compare the cost-effectiveness of the surgery vs other treatments.
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Affiliation(s)
- Peter Sun
- Kailo Research Group , Indianapolis, IN , USA
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430
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Belum VR, Washington C, Pratilas CA, Sibaud V, Boralevi F, Lacouture ME. Dermatologic adverse events in pediatric patients receiving targeted anticancer therapies: a pooled analysis. Pediatr Blood Cancer 2015; 62:798-806. [PMID: 25683226 PMCID: PMC4376610 DOI: 10.1002/pbc.25429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The dermatologic adverse events (AEs) of various molecularly targeted therapies are well-described in adult cancer patients. Little has been reported on the incidence and clinical presentation of such AEs in pediatric patients with cancer. To address this gap, we analyzed the dermatologic AEs reported across clinical trials of targeted anticancer therapies in pediatric patients. PROCEDURES We conducted an electronic literature search (PubMed, American Society of Clinical Oncology annual meetings' abstracts, ClinicalTrials.gov, NCI's Pediatric Oncology Branch webpage) to identify clinical trials involving targeted anticancer therapies that reported dermatologic AEs in their safety data. Studies were limited to the pediatric population, monotherapy trials (oncology), and English language publications. RESULTS Pooled data from 19 clinical studies investigating 11 targeted anticancer agents (alemtuzumab, rituximab, imatinib, dasatinib, erlotinib, vandetanib, sorafenib, cabozantinib, pazopanib, everolimus, and temsirolimus) were analyzed. The most frequently encountered dermatologic AEs were rash (127/660; 19%), xerosis (18/100; 18%), mucositis (68/402; 17%), and pruritus (12/169; 7%). Other AEs included pigmentary abnormalities of the skin/hair (13%), hair disorders (trichomegaly, hypertrichosis, alopecia, and madarosis; 14%), urticaria (7%), palmoplantar erythrodysesthesia (7%), erythema, acne, purpura, skin fissures, other 'unknown skin changes', exanthem, infection, flushing, telangiectasia, and photosensitivity. CONCLUSION This study describes the dermatologic manifestations of targeted anticancer therapy-related AEs in the pediatric population. Since these AEs are often associated with significant morbidity, it is imperative that pediatric oncologists be familiar with their recognition and management, to avoid unnecessary dose modifications and/or termination, and to prevent impairments in patients' quality of life.
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Affiliation(s)
| | - Courtney Washington
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA
| | | | - Vincent Sibaud
- Department of Dermatology, Institut Claudius Regaud, Institut Universitaire Cancer Toulouse-oncopole, Toulouse, France
| | - Franck Boralevi
- Unité de Dermatologie Pédiatrique, Hôpital Pellegrin-enfants, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Mario E. Lacouture
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY USA
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431
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Jung TY, Kim YH, Jung S, Baek HJ, Lee KH. The clinical characteristics of subependymal giant cell astrocytoma: five cases. Brain Tumor Res Treat 2015; 3:44-7. [PMID: 25977907 PMCID: PMC4426277 DOI: 10.14791/btrt.2015.3.1.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/26/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022] Open
Abstract
In this study, we reviewed the clinical characteristics of five cases of subependymal giant cell astrocytoma (SEGA) at our hospital between May 1997 and July 2012. The median age was 18 years old (range, 8 to 26). The clinical symptoms were presented as seizure in two patients and headache in three patients. All the tumors were located near the foramen of Monro. The median size of the tumors was 2.5 cm (range, 1.9-4.0). Two patients showed the solitary lesion, and three had subependymal nodules and cortical tubers. The median follow-up duration was 7.4 years (range, 2.0-14.3). Three patients were associated with the tuberous sclerosis complex (TSC). Four patients showed the SEGA at the first presentation and one patient experienced the 1.9 cm-sized growing mass during 7.7 years follow-up after the diagnosis of the TSC. The mass was totally removed in four patients and subtotally in one. Postoperatively, one patient took the medication for the seizure, which was controllable. The subtotally removed mass showed the recurrence postoperative 4.1 years later, and the recurred mass was stable for 4.5 years after the recurrence. The clinical follow-up study of the SEGA showed an indolent behavior before and after the surgery.
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Affiliation(s)
- Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Hwasun, Korea
| | - Young-Hee Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Hwasun, Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Hwasun, Korea
| | - Hee-Jo Baek
- Department of Pediatrics, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Hwasun, Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Hwasun, Korea
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432
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Wong M, Roper SN. Genetic animal models of malformations of cortical development and epilepsy. J Neurosci Methods 2015; 260:73-82. [PMID: 25911067 DOI: 10.1016/j.jneumeth.2015.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 12/31/2022]
Abstract
Malformations of cortical development constitute a variety of pathological brain abnormalities that commonly cause severe, medically-refractory epilepsy, including focal lesions, such as focal cortical dysplasia, heterotopias, and tubers of tuberous sclerosis complex, and diffuse malformations, such as lissencephaly. Although some cortical malformations result from environmental insults during cortical development in utero, genetic factors are increasingly recognized as primary pathogenic factors across the entire spectrum of malformations. Genes implicated in causing different cortical malformations are involved in a variety of physiological functions, but many are focused on regulation of cell proliferation, differentiation, and neuronal migration. Advances in molecular genetic methods have allowed the engineering of increasingly sophisticated animal models of cortical malformations and associated epilepsy. These animal models have identified some common mechanistic themes shared by a number of different cortical malformations, but also revealed the diversity and complexity of cellular and molecular mechanisms that lead to the development of the pathological lesions and resulting epileptogenesis.
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Affiliation(s)
- Michael Wong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Steven N Roper
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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433
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Rheb activation disrupts spine synapse formation through accumulation of syntenin in tuberous sclerosis complex. Nat Commun 2015; 6:6842. [PMID: 25880340 DOI: 10.1038/ncomms7842] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/03/2015] [Indexed: 01/14/2023] Open
Abstract
Rheb is a small GTP-binding protein and its GTPase activity is activated by the complex of Tsc1 and Tsc2 whose mutations cause tuberous sclerosis complex (TSC). We previously reported that cultured TSC neurons showed impaired spine synapse morphogenesis in an mTORC1-independent manner. Here we show that the PDZ protein syntenin preferentially binds to the GDP-bound form of Rheb. The levels of syntenin are significantly higher in TSC neurons than in wild-type neurons because the Rheb-GDP-syntenin complex is prone to proteasomal degradation. Accumulated syntenin in TSC neurons disrupts spine synapse formation through inhibition of the association between syndecan-2 and calcium/calmodulin-dependent serine protein kinase. Instead, syntenin enhances excitatory shaft synapse formation on dendrites by interacting with ephrinB3. Downregulation of syntenin in TSC neurons restores both spine and shaft synapse densities. These findings suggest that Rheb-syntenin signalling may be a novel therapeutic target for abnormalities in spine and shaft synapses in TSC neurons.
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434
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Samueli S, Abraham K, Dressler A, Groeppel G, Jonak C, Muehlebner A, Prayer D, Reitner A, Feucht M. Tuberous Sclerosis Complex: new criteria for diagnostic work-up and management. Wien Klin Wochenschr 2015; 127:619-30. [PMID: 25860851 DOI: 10.1007/s00508-015-0758-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/27/2015] [Indexed: 12/24/2022]
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic multisystem disorder, characterized by predominantly benign tumors in potentially all organ systems. System involvement, severity of clinical symptoms and the response to treatment are age-dependent and heterogeneous. Consequently, the disorder is still not recognized in a considerable number of patients. The diagnostic criteria and the guidelines for surveillance and management of patients with TSC were revised, and the establishment of specialized TSC-centers was strongly recommended during an International Consensus Conference in 2012. TOSCA (TuberOus SClerosis registry to increase disease Awareness), an international patient registry, was started to allow new insights into the causes of different courses. Finally, there are-since the approval of the mTOR inhibitor Everolimus-promising new therapeutic approaches.This review focuses on the various TSC related symptoms occurring at different ages, the novel recommendations for diagnosis and treatment as well as the need for multidisciplinary follow-up.
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Affiliation(s)
- Sharon Samueli
- Universitätsklinik für Kinder- und Jugendheilkunde, AKH Wien, Wien, Österreich
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435
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Abdel-Rahman O, Fouad M. Risk of fatigue in patients with solid tumors treated with everolimus, temsirolimus or ridaforolimus: a comparative meta-analysis. Expert Rev Anticancer Ther 2015; 15:477-486. [DOI: 10.1586/14737140.2015.1014342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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436
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Trelinska J, Dachowska I, Kotulska K, Baranska D, Fendler W, Jozwiak S, Mlynarski W. Factors affecting response to everolimus therapy for subependymal giant cell astrocytomas associated with tuberous sclerosis. Pediatr Blood Cancer 2015; 62:616-21. [PMID: 25557360 DOI: 10.1002/pbc.25368] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/29/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of the study was to investigate factors affecting response to everolimus, a mammalian-target-of-rapamycin (mTOR) inhibitor, of subependymal giant cell astrocytomas (SEGA) in patients with tuberous sclerosis complex (TSC). METHODS The study group consisted of 15 children with a diagnosis of TSC-related SEGA. Median therapy duration was 13 months. Age, sex, previous neurosurgical or mTOR inhibitor treatment, everolimus blood concentration and anticonvulsant therapy were analyzed as potential factors affecting reduction of SEGA tumor volume. RESULTS Significant reductions in SEGA volumes were noted at 3 and 6 months (median tumor volume 0.97 cm(3) and 0.70 cm(3) , respectively, versus 2.70 cm(3) at baseline, P = 0.001). Responses were observed in 11/15 (73.3%) and 10/12 (83.3%) patients at 3 and 6 months, respectively. The most rapid reduction of SEGA volume (58.6%) was found during the initial 3 months of treatment. There was no statistical difference in the extent of SEGA volume reduction between patients with everolimus trough levels <5 ng/ml and ≥5 ng/ml. Patients treated with ≤1 anticonvulsant had greater tumor reduction after 6 months of treatment. CONCLUSIONS Everolimus is an effective and safe treatment option for TSC-related SEGA. Drug dose titration according to blood concentration did not appear to be crucial to achieve clinical efficacy; however, concomitant anticonvulsant therapy may affect response to mTOR inhibitors.
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Affiliation(s)
- Joanna Trelinska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
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437
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Goyer I, Dahdah N, Major P. Use of mTOR inhibitor everolimus in three neonates for treatment of tumors associated with tuberous sclerosis complex. Pediatr Neurol 2015; 52:450-3. [PMID: 25682485 DOI: 10.1016/j.pediatrneurol.2015.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tuberous sclerosis complex is characterized by the growth of benign tumors in multiple organs, caused by the disinhibition of the mammalian target of rapamycin (mTOR) protein. mTOR inhibitors, such as everolimus, are used in patients with tuberous sclerosis complex, mainly to reduce the size of renal angiomyolipomas and subependymal giant cell astrocytomas. There are minimal data available regarding its use during the neonatal period. METHODS We report clinical and pharmacological data of three neonates treated with the mTOR inhibitor everolimus (two hemodynamically significant cardiac rhabdomyomas and one voluminous subependymal giant cell astrocytoma). RESULTS Beneficial clinical responses were observed in all three patients and the medication was generally well-tolerated. Optimal dose was 0.1 mg orally once daily and was confirmed with therapeutic drug monitoring. CONCLUSION Everolimus is a promising pharmacological approach to treat clinically significant inoperable cardiac rhabdomyomas or subependymal giant cell astrocytoma associated with tuberous sclerosis complex during the neonatal period.
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Affiliation(s)
- Isabelle Goyer
- Department of Pharmacy, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Philippe Major
- Department of Neurosciences, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
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438
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Complications of mammalian target of rapamycin inhibitor anticancer treatment among patients with tuberous sclerosis complex are common and occasionally life-threatening. Anticancer Drugs 2015; 26:437-42. [DOI: 10.1097/cad.0000000000000207] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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439
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Rodriguez FJ, Raabe EH. mTOR: a new therapeutic target for pediatric low-grade glioma? CNS Oncol 2015; 3:89-91. [PMID: 25055011 DOI: 10.2217/cns.14.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fausto J Rodriguez
- Division of Neuropathology, Johns Hopkins University, Baltimore, MD, USA
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440
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Kwiatkowski DJ, Palmer MR, Jozwiak S, Bissler J, Franz D, Segal S, Chen D, Sampson JR. Response to everolimus is seen in TSC-associated SEGAs and angiomyolipomas independent of mutation type and site in TSC1 and TSC2. Eur J Hum Genet 2015; 23:1665-72. [PMID: 25782670 PMCID: PMC4795200 DOI: 10.1038/ejhg.2015.47] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/17/2015] [Accepted: 01/27/2015] [Indexed: 12/18/2022] Open
Abstract
Tuberous sclerosis complex is an autosomal dominant disorder that occurs owing to inactivating mutations in either TSC1 or TSC2. Tuberous sclerosis complex-related tumors in the brain, such as subependymal giant cell astrocytoma, and in the kidney, such as angiomyolipoma, can cause significant morbidity and mortality. Recently, randomized clinical trials (EXIST-1 and EXIST-2) of everolimus for each of these tuberous sclerosis complex-associated tumors demonstrated the benefit of this drug, which blocks activated mammalian target of rapamycin complex 1. Here we report on the spectrum of mutations seen in patients treated during these trials and the association between mutation and response. TSC2 mutations were predominant among patients in both trials and were present in nearly all subjects with angiomyolipoma in whom a mutation was identified (97%), whereas TSC1 mutations were rare in those subjects (3%). The spectrum of mutations seen in each gene was similar to those previously reported. In both trials, there was no apparent association between mutation type or location within each gene and response to everolimus. Everolimus responses were also seen at a similar frequency for the 16–18% of patients in each trial in whom no mutation in either gene was identified. These observations confirm the strong association between TSC2 mutation and angiomyolipoma burden seen in previous studies, and they indicate that everolimus response occurs regardless of mutation type or location or when no mutation in TSC1 or TSC2 has been identified.
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Affiliation(s)
| | | | | | - John Bissler
- St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Franz
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott Segal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - David Chen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Julian R Sampson
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
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441
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Taveira-DaSilva AM, Jones AM, Julien-Williams PA, Stylianou M, Moss J. Retrospective review of combined sirolimus and simvastatin therapy in lymphangioleiomyomatosis. Chest 2015; 147:180-187. [PMID: 25167325 DOI: 10.1378/chest.14-0758] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Combined simvastatin and sirolimus therapy reduces tuberous sclerosis complex 2-null lesions and alveolar destruction in a mouse model of lymphangioleiomyomatosis (LAM), suggesting that therapy with both drugs may benefit patients with LAM. METHODS To determine whether simvastatin changed the prevalence of adverse events or altered the therapeutic effects of sirolimus, we recorded adverse events and changes in lung function in patients with LAM treated with simvastatin plus sirolimus (n = 14), sirolimus alone (n = 44), or simvastatin alone (n = 20). RESULTS Sirolimus-related adverse events in the simvastatin plus sirolimus and sirolimus-only groups were 64% and 66% for stomatitis, 50% and 52% for diarrhea, 50% and 45% for peripheral edema, 36% and 61% for acne, 36% and 30% for hypertension, 29% and 27% for proteinuria, 29% and 27% for leukopenia, and 21% and 27% for hypercholesterolemia. The frequency of simvastatin-related adverse events in the simvastatin-only and simvastatin plus sirolimus groups were 60% and 50% for arthralgias and 35% and 36% for myopathy. Before simvastatin plus sirolimus therapy, FEV1 and diffusing capacity of the lung for carbon monoxide (Dlco) yearly rates of change were, respectively, -1.4 ± 0.2 and -1.8 ± 0.2% predicted. After simvastatin plus sirolimus therapy, these rates changed to +1.2 ± 0.5 (P = .635) and +0.3 ± 0.4% predicted (P = .412), respectively. In 44 patients treated with sirolimus alone, FEV1 and Dlco rates of change were -1.7 ± 0.1 and -2.2 ± 0.1% predicted before treatment and +1.7 ± 0.3 and +0.7 ± 0.3% predicted after treatment (P < .001). CONCLUSIONS Therapy with sirolimus and simvastatin does not increase the prevalence of drug adverse events or alter the therapeutic effects of sirolimus.
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Affiliation(s)
- Angelo M Taveira-DaSilva
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD..
| | - Amanda M Jones
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Patricia A Julien-Williams
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mario Stylianou
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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442
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Ito Y, Kawano H, Kanai F, Nakamura E, Tada N, Takai S, Horie S, Arai H, Kobayashi T, Hino O. Establishment of Tsc2‑deficient rat embryonic stem cells. Int J Oncol 2015; 46:1944-52. [PMID: 25738543 DOI: 10.3892/ijo.2015.2913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/09/2015] [Indexed: 11/05/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by TSC1 or TSC2 mutations. TSC causes the development of tumors in various organs such as the brain, skin, kidney, lung, and heart. The protein complex TSC1/2 has been reported to have an inhibitory function on mammalian target of rapamycin complex 1 (mTORC1). Treatment with mammalian target of rapamycin (mTOR) inhibitors has demonstrated tumor‑reducing effects in patients with TSC but is also associated with various adverse effects. In recent years, experiments involving in vivo differentiation of pluripotent stem cells have been reported as useful in elucidating mechanisms of pathogenesis and discovering new therapeutic targets for several diseases. To reveal the molecular basis of the pathogenesis caused by the Tsc2 mutation, we derived embryonic stem cells (ESCs) from Eker rats, which have the Tsc2 mutation and develop brain lesions and renal tumors. Although several studies have reported the necessity of Tsc1 and Tsc2 regulation to maintain ESCs and hematopoietic stem cells, we successfully established not only Tsc2+/+ and Tsc2+/- ESCs but also Tsc2-/- ESCs. We confirmed that these cells express pluripotency markers and retain the ability to differentiate into all three germ layers. Comprehensive gene expression analysis of Tsc2+/+ and Tsc2+/- ESCs revealed similar profiles, whereas the profile of Tsc2-/- ESCs was distinct from these two. In vitro differentiation experiments using these ESCs combined with in vivo experiments may reveal the mechanism of the tissue‑specific pathogenesis caused by the Tsc2 mutation and identify specific new therapeutic targets.
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Affiliation(s)
- Yoshitaka Ito
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruna Kawano
- Department of Molecular Pathogenesis, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fumio Kanai
- Laboratory of Genome Research, Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eri Nakamura
- Laboratory of Genome Research, Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Tada
- Laboratory of Genome Research, Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Setsuo Takai
- Department of Clinical Radiology, Faculty of Health Sciences, Hiroshima International University, Hiroshima, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Kobayashi
- Department of Molecular Pathogenesis, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Okio Hino
- Department of Molecular Pathogenesis, Juntendo University Graduate School of Medicine, Tokyo, Japan
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443
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Uno T, Ito S, Nakazawa A, Miyazaki O, Mori T, Terashima K. Successful treatment of Kaposiform hemangioendothelioma with everolimus. Pediatr Blood Cancer 2015; 62:536-8. [PMID: 25306933 DOI: 10.1002/pbc.25241] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/08/2014] [Indexed: 11/06/2022]
Abstract
There is currently no consensus on the second-line management of Kaposiform hemangioendothelioma (KHE) that was resistant to prednisolone and vincristine. We described an eight-year-old male with KHE in the right femur that was resistant to prednisolone, vincristine and propranolol. Everolimus, an inhibitor of mammalian target of rapamycin (mTOR) at the dosage of 0.1 mg/kg/day, successfully decreased the tumor size and controlled the symptoms. Everolimus should be further studied as an alternative agent to sirolimus in the management of KHE.
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Affiliation(s)
- Teruaki Uno
- Children's Cancer Center, National Center for Child Health and Development, Setagaya, Tokyo, Japan
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444
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Curatolo P. Mechanistic target of rapamycin (mTOR) in tuberous sclerosis complex-associated epilepsy. Pediatr Neurol 2015; 52:281-9. [PMID: 25591831 DOI: 10.1016/j.pediatrneurol.2014.10.028] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/29/2014] [Accepted: 10/29/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Tuberous sclerosis complex is a multiorgan disease resulting from a mutation of one of two TSC genes. The two gene products form a functional complex that regulates the mTOR signaling pathway (mTOR initially represented mammalian target of rapamycin, but increasingly the term mechanistic target of rapamycin is used to reflect the ubiquitous occurrence of mTOR). Epilepsy is the most common neurological symptom of tuberous sclerosis complex, occurring in 80% to 90% of affected individuals over the course of their lifetimes and causing significant morbidity and mortality. The mechanistic target of rapamycin (mTOR) signaling pathway is intricately involved in multiple cellular functions--including protein synthesis, cell growth and proliferation, and synaptic plasticity--which may influence neuronal excitability and precipitate epileptogenesis. Recent preclinical and clinical studies have increased interest in the potential role of mTOR inhibitors for the treatment of tuberous sclerosis complex-related epilepsy. METHODS Medline and PubMed database searches were used to identify relevant studies and other information on tuberous sclerosis complex-related epilepsies, the mTOR pathway, and current advances in treatment approaches. RESULTS Although current management strategies that provide symptomatic relief are effective at reducing the frequency of seizures in individuals with tuberous sclerosis complex, there is further room for the exploration of therapies that directly address hyperactive mTOR signaling--the underlying etiology of the disease. The role of the antiepileptic effect of mTOR inhibition was first demonstrated in knockout TSC1 mouse models. Additionally, several case studies demonstrated a positive effect on seizure frequency and severity in patients with pharmacoresistant epilepsy. In a phase 1/2 clinical trial with 28 patients, clinically relevant reduction in overall seizure frequency was documented in individuals treated with the mTOR inhibitor everolimus. In a phase 3 trial evaluating the role of everolimus in subependymal giant cell astrocytoma, seizures were a secondary end point. Because the median seizure frequency was zero in this study, the analysis was inconclusive. CONCLUSION Various preclinical models provide substantial evidence for the role of mTOR inhibition in the treatment of epilepsy in individuals with tuberous sclerosis complex. Preliminary clinical studies provide supportive evidence for a role of mTOR inhibition in the management of tuberous sclerosis complex-associated epilepsy and pave the way for new randomized placebo-controlled studies. This article reviews current treatment recommendations for the management of tuberous sclerosis complex-associated epilepsy as well as the rationale and evidence to support the use of mTOR inhibitors.
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Affiliation(s)
- Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Rome, Italy.
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445
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Abstract
PURPOSE OF REVIEW Tuberous sclerosis complex (TSC) is a multisystem genetic disorder with physical and neuropsychiatric manifestations and significant research progress has been made in recent years. Here, we focus on the key advances over the last 18 months. RECENT FINDINGS Three main themes were identified in the literature. Firstly, the diagnostic criteria and surveillance guidelines for TSC were revised, incorporating a genetic criterion alongside clinical criteria, and making a positive step towards evidence-based treatment of TSC. Secondly, a new term - TSC-associated neuropsychiatric disorders (TAND) - was introduced as an umbrella term for all possible neuropsychiatric difficulties seen in TSC, and a TAND Checklist was developed as a screening tool. Thirdly, the risks and benefits of molecularly targeted treatments of the neuropsychiatric manifestations of TSC are being debated. SUMMARY The updated diagnostic criteria and management guidelines, the new concept of TAND and the TAND Checklist should lead to significant improvements in the quality of care for individuals with TSC. The promise of mammalian target of rapamycin inhibitors and other molecular treatments are still to be confirmed. We suggest that great care should be taken to identify 'optimal mammalian target of rapamycin signalling' in the therapeutic approach to the neuropsychiatric features of the disorder.
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446
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Duvoux C, Toso C. mTOR inhibitor therapy: Does it prevent HCC recurrence after liver transplantation? Transplant Rev (Orlando) 2015; 29:168-74. [PMID: 26071984 DOI: 10.1016/j.trre.2015.02.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 02/07/2023]
Abstract
Prevention of hepatocellular carcinoma (HCC) recurrence after liver transplantation is a clinical priority. The importance of the mammalian target of rapamycin (mTOR) pathway in cell growth and survival makes it a logical target for antitumor strategies, as borne out by clinical data in various types of malignancy. A number of studies have indicated that the mTOR inhibitors everolimus and sirolimus suppress cell proliferation and tumor growth in animal models of HCC. Coadministration of an mTOR inhibitor could permit lower dosing of chemotherapeutic agents in HCC management, and trials in non-transplant HCC population are exploring combined used with various agents including sorafenib, the vascular endothelial growth factor inhibitor bevacizumab and conventional agents. In terms of a preventive effect after liver transplantation for HCC, data from retrospective studies and non-randomized prospective analyses in which patients received an mTOR inhibitor with concomitant calcineurin inhibitor therapy have indicated that HCC recurrence rates and overall survival may be improved compared to a standard calcineurin inhibitor regimen. Meta-analyses have supported these findings, but controlled trials are required before any firm conclusions can be drawn. In two of the three randomized trials which have assessed de novo mTOR inhibitor therapy after liver transplantation, there was a numerically lower rate of HCC recurrence by one year post-transplant in patients given an mTOR inhibitor versus the control arm, but absolute numbers were low. Overall, based on the available data from retrospective studies, meta-analyses, and post-hoc assessments of randomized trials, it appears advisable to consider mTOR inhibition-based immunosuppression after transplantation for HCC, particularly in patients who exceed the Milan criteria. Prospective data are awaited.
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Affiliation(s)
- Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit Henri Mondor Hospital, Paris Est University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Division of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland.
| | - Christian Toso
- Department of Hepatology and Liver Transplant Unit Henri Mondor Hospital, Paris Est University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Division of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
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447
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Nellist M, Brouwer RWW, Kockx CEM, van Veghel-Plandsoen M, Withagen-Hermans C, Prins-Bakker L, Hoogeveen-Westerveld M, Mrsic A, van den Berg MMP, Koopmans AE, de Wit MC, Jansen FE, Maat-Kievit AJA, van den Ouweland A, Halley D, de Klein A, van IJcken WFJ. Targeted Next Generation Sequencing reveals previously unidentified TSC1 and TSC2 mutations. BMC MEDICAL GENETICS 2015; 16:10. [PMID: 25927202 PMCID: PMC4422413 DOI: 10.1186/s12881-015-0155-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 02/16/2015] [Indexed: 12/24/2022]
Abstract
Background Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by mutations in TSC1 and TSC2. Conventional DNA diagnostic screens identify a TSC1 or TSC2 mutation in 75 - 90% of individuals categorised with definite TSC. The remaining individuals either have a mutation that is undetectable using conventional methods, or possibly a mutation in another as yet unidentified gene. Methods Here we apply a targeted Next Generation Sequencing (NGS) approach to screen the complete TSC1 and TSC2 genomic loci in 7 individuals fulfilling the clinical diagnostic criteria for definite TSC in whom no TSC1 or TSC2 mutations were identified using conventional screening methods. Results We identified and confirmed pathogenic mutations in 3 individuals. In the remaining individuals we identified variants of uncertain clinical significance. The identified variants included mosaic changes, changes located deep in intronic sequences and changes affecting promoter regions that would not have been identified using exon-only based analyses. Conclusions Targeted NGS of the TSC1 and TSC2 loci is a suitable method to increase the yield of mutations identified in the TSC patient population. Electronic supplementary material The online version of this article (doi:10.1186/s12881-015-0155-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Nellist
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Rutger W W Brouwer
- Center for Biomics, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Christel E M Kockx
- Center for Biomics, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Monique van Veghel-Plandsoen
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Caroline Withagen-Hermans
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Lida Prins-Bakker
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Marianne Hoogeveen-Westerveld
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Alan Mrsic
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Mike M P van den Berg
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands. .,Department of Ophthalmology, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Anna E Koopmans
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands. .,Department of Ophthalmology, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Marie-Claire de Wit
- Department of Neurology, Sophia Children's Hospital, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, 3508, Utrecht, EA, The Netherlands.
| | - Anneke J A Maat-Kievit
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Ans van den Ouweland
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Dicky Halley
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Annelies de Klein
- Department of Clinical Genetics, Ee-2426, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Wilfred F J van IJcken
- Center for Biomics, Erasmus Medical Center, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
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448
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Dill PE, Liang N, Pende M. New insights into the pathophysiology of the tuberous sclerosis complex: Crosstalk of mTOR- and hippo-YAP pathways in cell growth. Rare Dis 2015; 3:e1016701. [PMID: 26459669 PMCID: PMC4588522 DOI: 10.1080/21675511.2015.1016701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/21/2015] [Accepted: 02/03/2015] [Indexed: 12/22/2022] Open
Abstract
Tuberous Sclerosis Complex (TSC) is a genetic disease causing uncontrolled growth of hamartomas involving different organ systems. In the last decade, dysregulation of the mTORC1 pathway was shown to be a main driver of tumor growth in TSC. Recently, a new crosstalk was detected between the mTORC1 and the Hippo-YAP pathway, another major cell signaling cascade controlling cell growth and organ size. Elucidating this connection is an important step in understanding the complexity of TSC, enabling new pharmacological targets and therapeutical options.
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Affiliation(s)
- Patricia E Dill
- Institut Necker-Enfants Malades ; Paris, France ; Inserm ; Paris, France ; Université Paris Descartes; Sorbonne Paris Cité ; Paris, France ; Department of Pediatric Neurology and Developmental Medicine; University Children's Hospital Basel ; University of Basel ; Basel, Switzerland
| | - Ning Liang
- Institut Necker-Enfants Malades ; Paris, France ; Inserm ; Paris, France ; Université Paris Descartes; Sorbonne Paris Cité ; Paris, France
| | - Mario Pende
- Institut Necker-Enfants Malades ; Paris, France ; Inserm ; Paris, France ; Université Paris Descartes; Sorbonne Paris Cité ; Paris, France
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449
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Günther A, Baumann P, Burger R, Kellner C, Klapper W, Schmidmaier R, Gramatzki M. Activity of everolimus (RAD001) in relapsed and/or refractory multiple myeloma: a phase I study. Haematologica 2015; 100:541-7. [PMID: 25682600 DOI: 10.3324/haematol.2014.116269] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The mammalian target of rapamycin plays an important role in multiple myeloma. The allosteric mammalian target of rapamycin inhibitor everolimus has long been approved for immunosuppression and has shown activity in certain cancers. This investigator-initiated phase I trial explored the use of everolimus in relapsed and/or refractory multiple myeloma patients who had received two or more lines of prior treatment. Following a dose-escalation design, it called for a fixed dose of oral everolimus. Blood drug levels were monitored and the biological activity of everolimus was evaluated in bone marrow. Seventeen patients were enrolled (age range, 52 to 76 years). All had been previously treated with stem cell transplantation and proteasome inhibitors and almost all with immunomodulatory drugs. No dose-limiting toxicity was observed and the intended final daily dose of 10 mg was reached. Only one severe adverse event was assessed as possibly related to the study drug, namely atypical pneumonia. Remarkably few infections were observed. Although the trial was mainly designed to evaluate feasibility, anti-myeloma activity, defined as clinical benefit, was documented in ten of 15 evaluable patients at every dose level including eight patients with stable disease, one patient with minor remission and one with partial remission. However, the median time to progression was 90 days (range, 13 to 278 days). The biomarker study documented on-target activity of everolimus in malignant plasma cells as well as the microenvironment. The observed responses are promising and allow further studies to be considered, including those testing combination strategies addressing escape pathways. This trial is registered with EudraCT number 2006-002675-41.
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Affiliation(s)
- Andreas Günther
- Division of Stem Cell Transplantation and Immunotherapy, 2 Department of Medicine, University of Kiel, Germany
| | - Philipp Baumann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximillians-Universität München (LMU), Germany
| | - Renate Burger
- Division of Stem Cell Transplantation and Immunotherapy, 2 Department of Medicine, University of Kiel, Germany
| | - Christian Kellner
- Division of Stem Cell Transplantation and Immunotherapy, 2 Department of Medicine, University of Kiel, Germany
| | - Wolfram Klapper
- Division of Hematopathology, Institute of Pathology, University of Kiel, Germany
| | - Ralf Schmidmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximillians-Universität München (LMU), Germany
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, 2 Department of Medicine, University of Kiel, Germany
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450
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Subbiah V. Prospects and pitfalls of personalizing therapies for sarcomas: from children, adolescents, and young adults to the elderly. Curr Oncol Rep 2015; 16:401. [PMID: 25030655 DOI: 10.1007/s11912-014-0401-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sarcomas are a heterogeneous class of tumors that affect all ages, from children, adolescents, and young adults to the elderly. Within this panoply of tumor subtypes lies the opportunity to bring to bear a vision of personalized medicine in which the fast-paced evolution from the "one gene, one test, one drug" approach to a comprehensive "panomic," multiplex, multianalyte method coupled with advances in bioinformatics platforms can unravel the biology of this disease. The increasingly enlarging repertoire of novel agents provides innumerable prospects in precision medicine. Personalized therapy covers the entire spectrum of cancer care, from risk factor assessment through prevention, risk reduction, therapy, follow-up after therapy, and survivorship care. Challenges remain in implementing the science of precision medicine in the clinic, including providing comprehensive multidisciplinary care and overcoming regulatory and economic hurdles, which must be facilitated within the collaborative framework of academia, industry, federal regulators, and third-party payers.
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Affiliation(s)
- Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine and Division of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA,
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