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Pozzi V, Molinelli E, Campagna R, Serritelli EN, Cecati M, De Simoni E, Sartini D, Goteri G, Martin NI, van Haren MJ, Salvolini E, Simonetti O, Offidani A, Emanuelli M. Knockdown of nicotinamide N-methyltransferase suppresses proliferation, migration, and chemoresistance of Merkel cell carcinoma cells in vitro. Hum Cell 2024; 37:729-738. [PMID: 38504052 PMCID: PMC11016511 DOI: 10.1007/s13577-024-01047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer, with a propensity for early metastasis. Therefore, early diagnosis and the identification of novel targets become fundamental. The enzyme nicotinamide N-methyltransferase (NNMT) catalyzes the reaction of N-methylation of nicotinamide and other analogous compounds. Although NNMT overexpression was reported in many malignancies, the significance of its dysregulation in cancer cell phenotype was partly clarified. Several works demonstrated that NNMT promotes cancer cell proliferation, migration, and chemoresistance. In this study, we investigated the possible involvement of this enzyme in MCC. Preliminary immunohistochemical analyses were performed to evaluate NNMT expression in MCC tissue specimens. To explore the enzyme function in tumor cell metabolism, MCC cell lines have been transfected with plasmids encoding for short hairpin RNAs (shRNAs) targeting NNMT mRNA. Preliminary immunohistochemical analyses showed elevated NNMT expression in MCC tissue specimens. The effect of enzyme downregulation on cell proliferation, migration, and chemosensitivity was then evaluated through MTT, trypan blue, and wound healing assays. Data obtained clearly demonstrated that NNMT knockdown is associated with a decrease of cell proliferation, viability, and migration, as well as with enhanced sensitivity to treatment with chemotherapeutic drugs. Taken together, these results suggest that NNMT could represent an interesting MCC biomarker and a promising target for targeted anti-cancer therapy.
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Affiliation(s)
- Valentina Pozzi
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Elisa Molinelli
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Roberto Campagna
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy.
| | - Emma N Serritelli
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Monia Cecati
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Edoardo De Simoni
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Davide Sartini
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy.
| | - Gaia Goteri
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Nathaniel I Martin
- Biological Chemistry Group, Institute of Biology Leiden, Leiden University, Sylviusweg 72, 2333 BE, Leiden, The Netherlands
| | - Matthijs J van Haren
- Biological Chemistry Group, Institute of Biology Leiden, Leiden University, Sylviusweg 72, 2333 BE, Leiden, The Netherlands
| | - Eleonora Salvolini
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Oriana Simonetti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Annamaria Offidani
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
| | - Monica Emanuelli
- Department of Clinical Sciences, Polytechnic University of Marche, 60020, Ancona, Italy
- New York-Marche Structural Biology Center (NY-MaSBiC), Polytechnic University of Marche, 60131, Ancona, Italy
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2
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Alberti A, Gurizzan C, Baggi A, Bossi P. Where do we stand with immunotherapy for nonmelanoma skin cancers in the curative setting? Curr Opin Otolaryngol Head Neck Surg 2024; 32:89-95. [PMID: 37997885 DOI: 10.1097/moo.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW Nonmelanoma skin cancers (NMSC) represent a heterogeneous group of diseases that encompasses among the principal histologies basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC). Given the fact that high tumor mutational burden due to ultraviolet mutagenesis represents a common hallmark of NMSCs, immunotherapy has proved to be a promising therapeutic approach in recent years. The aim of this review is to shed light on immunotherapy applications in NMSCs in the curative setting. RECENT FINDINGS Immune checkpoint inhibitors represent the first-line treatment of choice for advanced cSCC and MCC, while in second line for BCC. Given this success, more and more trials are evaluating the use of immune checkpoint blockade in neoadjuvant setting for NMSCs. Clinical trials are still ongoing, with the most mature data being found in cSCC. Also, translational studies have identified promising biomarkers of response. SUMMARY Locoregional treatments of NMSCs can have non negligible functional and cosmetic impacts on patients, affecting their quality of life. As immunogenic diseases, neoadjuvant immunotherapy represents a promising treatment that could change the therapeutic path of these patients. Upcoming results from clinical trials will address these crucial issues.
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Affiliation(s)
- Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Cristina Gurizzan
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Alice Baggi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Paolo Bossi
- Department of Biomedical Sciences - Humanitas University, Medical Oncology and Hematology Unit
- Humanitas Cancer Center - IRCCS Humanitas Research Hospital, Rozzano MI, Italy
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3
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Orfanoudaki M, Smith EA, Hill NT, Garman KA, Brownell I, Copp BR, Grkovic T, Henrich CJ. An Investigation of Structure-Activity Relationships and Cell Death Mechanisms of the Marine Alkaloids Discorhabdins in Merkel Cell Carcinoma Cells. Mar Drugs 2023; 21:474. [PMID: 37755087 PMCID: PMC10532587 DOI: 10.3390/md21090474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
A library of naturally occurring and semi-synthetic discorhabdins was assessed for their effects on Merkel cell carcinoma (MCC) cell viability. The set included five new natural products and semi-synthetic compounds whose structures were elucidated with NMR, HRMS, and ECD techniques. Several discorhabdins averaged sub-micromolar potency against the MCC cell lines tested and most of the active compounds showed selectivity towards virus-positive MCC cell lines. An investigation of structure-activity relationships resulted in an expanded understanding of the crucial structural features of the discorhabdin scaffold. Mechanistic cell death assays suggested that discorhabdins, unlike many other MCC-active small molecules, do not induce apoptosis, as shown by the lack of caspase activation, annexin V staining, and response to caspase inhibition. Similarly, discorhabdin treatment failed to increase MCC intracellular calcium and ROS levels. In contrast, the rapid loss of cellular reducing potential and mitochondrial membrane potential suggested that discorhabdins induce mitochondrial dysfunction leading to non-apoptotic cell death.
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Affiliation(s)
- Maria Orfanoudaki
- Molecular Targets Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA; (M.O.); (E.A.S.)
| | - Emily A. Smith
- Molecular Targets Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA; (M.O.); (E.A.S.)
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Natasha T. Hill
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20891, USA; (N.T.H.); (K.A.G.); (I.B.)
| | - Khalid A. Garman
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20891, USA; (N.T.H.); (K.A.G.); (I.B.)
| | - Isaac Brownell
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20891, USA; (N.T.H.); (K.A.G.); (I.B.)
| | - Brent R. Copp
- School of Chemical Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Tanja Grkovic
- Molecular Targets Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA; (M.O.); (E.A.S.)
- Natural Products Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Frederick, MD 21702, USA
| | - Curtis J. Henrich
- Molecular Targets Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA; (M.O.); (E.A.S.)
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
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4
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Duarte‐Bateman D, Shen A, Bullock T, Sadeghi P, Escandón JM, Dedkova E, Gastman BR. Best practices in surgical and nonsurgical management of head and neck Merkel cell carcinoma: An update. Mol Carcinog 2023; 62:101-112. [PMID: 36367533 PMCID: PMC10098483 DOI: 10.1002/mc.23483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous neuroendocrine carcinoma. Controversy exists regarding optimal management of MCC as high-quality randomized studies and clinical trials are limited, and physicians are bound to interpret highly heterogeneous, retrospective literature in their clinical practice. Furthermore, the rising incidence and notably poor prognosis of MCC urges the establishment of best practices for optimal management of the primary tumor and its metastases. Herein, we summarized the relevant evidence and provided an algorithm for decision-making in MCC management based on the latest 2021 National Comprehensive Cancer Network guidelines. Additionally, we report current active MCC clinical trials in the United States. The initial management of MCC is dependent upon the pathology of the primary tumor and presence of metastatic disease. Patients with no clinical evidence of regional lymph node involvement generally require sentinel node biopsy (SLNB) while clinically node-positive patients should undergo fine needle aspiration (FNA) or core biopsy and full imaging workup. If SLNB or FNA/core biopsy are positive, a multidisciplinary team should be assembled to discuss if additional node dissection or adjuvant therapy is necessary. Wide local excision is optimal for primary tumor management and SLNB remains the preferred staging and predictive tool in MCC. The management of MCC has progressively improved in the last decade, particularly due to the establishment of immunotherapy as a new treatment option in advanced MCC. Ongoing trials and prospective studies are needed to further establish the best practices for MCC management.
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Affiliation(s)
- Daniela Duarte‐Bateman
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
| | - Alan Shen
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
| | - Taylor Bullock
- Department of DermatologyCleveland ClinicClevelandOhioUSA
| | - Payam Sadeghi
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
| | - Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial HospitalUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Eliska Dedkova
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
| | - Brian R. Gastman
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
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5
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Zaggana E, Konstantinou MP, Krasagakis GH, de Bree E, Kalpakis K, Mavroudis D, Krasagakis K. Merkel Cell Carcinoma-Update on Diagnosis, Management and Future Perspectives. Cancers (Basel) 2022; 15:cancers15010103. [PMID: 36612102 PMCID: PMC9817518 DOI: 10.3390/cancers15010103] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
MCC is a rare but highly aggressive skin cancer. The identification of the driving role of Merkel cell polyomavirus (MCPyV) and ultraviolet-induced DNA damage in the oncogenesis of MCC allowed a better understanding of its biological behavior. The presence of MCPyV-specific T cells and lymphocytes exhibiting an 'exhausted' phenotype in the tumor microenvironment along with the high prevalence of immunosuppression among affected patients are strong indicators of the immunogenic properties of MCC. The use of immunotherapy has revolutionized the management of patients with advanced MCC with anti-PD-1/PD L1 blockade, providing objective responses in as much as 50-70% of cases when used in first-line treatment. However, acquired resistance or contraindication to immune checkpoint inhibitors can be an issue for a non-negligible number of patients and novel therapeutic strategies are warranted. This review will focus on current management guidelines for MCC and future therapeutic perspectives for advanced disease with an emphasis on molecular pathways, targeted therapies, and immune-based strategies. These new therapies alone or in combination with anti-PD-1/PD-L1 inhibitors could enhance immune responses against tumor cells and overcome acquired resistance to immunotherapy.
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Affiliation(s)
- Eleni Zaggana
- Department of Dermatology, University General Hospital of Heraklion, 71500 Crete, Greece
| | - Maria Polina Konstantinou
- Department of Dermatology, University General Hospital of Heraklion, 71500 Crete, Greece
- Correspondence: ; Tel.: +30-2810-3925-82; Fax: +30-2810-5420-85
| | | | - Eelco de Bree
- Medical School, University of Crete, 71500 Crete, Greece
- Department of Surgical Oncology, University General Hospital of Heraklion, 71500 Crete, Greece
| | - Konstantinos Kalpakis
- Medical School, University of Crete, 71500 Crete, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, 71500 Crete, Greece
| | - Dimitrios Mavroudis
- Medical School, University of Crete, 71500 Crete, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, 71500 Crete, Greece
| | - Konstantinos Krasagakis
- Department of Dermatology, University General Hospital of Heraklion, 71500 Crete, Greece
- Medical School, University of Crete, 71500 Crete, Greece
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Gubbi S, Vijayvergia N, Yu JQ, Klubo-Gwiezdzinska J, Koch CA. Immune Checkpoint Inhibitor Therapy in Neuroendocrine Tumors. Horm Metab Res 2022; 54:795-812. [PMID: 35878617 PMCID: PMC9731788 DOI: 10.1055/a-1908-7790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuroendocrine tumors (NETs) occur in various regions of the body and present with complex clinical and biochemical phenotypes. The molecular underpinnings that give rise to such varied manifestations have not been completely deciphered. The management of neuroendocrine tumors (NETs) involves surgery, locoregional therapy, and/or systemic therapy. Several forms of systemic therapy, including platinum-based chemotherapy, temozolomide/capecitabine, tyrosine kinase inhibitors, mTOR inhibitors, and peptide receptor radionuclide therapy have been extensively studied and implemented in the treatment of NETs. However, the potential of immune checkpoint inhibitor (ICI) therapy as an option in the management of NETs has only recently garnered attention. Till date, it is not clear whether ICI therapy holds any distinctive advantage in terms of efficacy or safety when compared to other available systemic therapies for NETs. Identifying the characteristics of NETs that would make them (better) respond to ICIs has been challenging. This review provides a summary of the current evidence on the value of ICI therapy in the management of ICIs and discusses the potential areas for future research.
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Affiliation(s)
- Sriram Gubbi
- Endocrinology, National Institutes of Health Clinical Center, Bethesda,
United States
| | | | - Jian Q Yu
- Nuclear Medicine, Fox Chase Cancer Center, Philadelphia, United
States
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, United States
| | - Christian A. Koch
- Medicine/Endocrinology, The University of Tennessee Health
Science Center, Memphis, United States
- Medicine, Fox Chase Cancer Center, Philadelphia, United
States
- Correspondence Prof. Christian A. Koch, FACP,
MACE Fox Chase Cancer
CenterMedicine, 333 Cottman
AvePhiladelphia19111-2497United
States215 728 2713
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7
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Addiction of Merkel cell carcinoma to MUC1-C identifies a potential new target for treatment. Oncogene 2022; 41:3511-3523. [PMID: 35688945 PMCID: PMC9249628 DOI: 10.1038/s41388-022-02361-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 02/08/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive malignancy with neuroendocrine (NE) features, limited treatment options, and a lack of druggable targets. There is no reported involvement of the MUC1-C oncogenic protein in MCC progression. We show here that MUC1-C is broadly expressed in MCCs and at higher levels in Merkel cell polyomavirus (MCPyV)-positive (MCCP) relative to MCPyV-negative (MCCN) tumors. Our results further demonstrate that MUC1-C is expressed in MCCP, as well as MCCN, cell lines and regulates common sets of signaling pathways related to RNA synthesis, processing, and transport in both subtypes. Mechanistically, MUC1-C (i) interacts with MYCL, which drives MCC progression, (ii) is necessary for expression of the OCT4, SOX2, KLF4, MYC, and NANOG pluripotency factors, and (iii) induces the NEUROD1, BRN2 and ATOH1 NE lineage dictating transcription factors. We show that MUC1-C is also necessary for MCCP and MCCN cell survival by suppressing DNA replication stress, the p53 pathway, and apoptosis. In concert with these results, targeting MUC1-C genetically and pharmacologically inhibits MCC self-renewal capacity and tumorigenicity. These findings demonstrate that MCCP and MCCN cells are addicted to MUC1-C and identify MUC1-C as a potential target for MCC treatment.
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Liu KX, Milligan MG, Schoenfeld JD, Tishler RB, Ng AK, Devlin PM, Fite E, Rabinowits G, Hanna GJ, Silk AW, Yoon CH, Thakuria M, Margalit DN. Characterization of clinical outcomes after shorter course hypofractionated and standard-course radiotherapy for stage I-III curatively-treated Merkel cell carcinoma. Radiother Oncol 2022; 173:32-40. [PMID: 35595174 DOI: 10.1016/j.radonc.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Limited data exists regarding the efficacy of curative hypofractionated radiotherapy (hypo-RT) regimens compared to conventionally-fractionated radiotherapy (conv-RT) for Merkel cell carcinoma (MCC). METHODS A retrospective analysis of 241 patients diagnosed with non-metastatic MCC from 2005-2021 and who received RT at Dana-Farber/Brigham & Women's Cancer Center. The primary outcome was cumulative incidence of in-field locoregional relapse using Gray's test with competing risks of death and isolated out-of-field recurrence. Secondary outcomes included overall survival (OS) and MCC-specific survival using log-rank tests, and risk factors of recurrence using Cox-proportional hazards regression. RESULTS There were 50 (20.6%) and 193 (79.4%) courses of hypo-RT and conv-RT, respectively. The hypo-RT cohort was older (≥73 years at diagnosis: 78.0% vs. 41.5%, p<0.01), and received a lower equivalent total RT dose in 2 Gy per fraction (<50 Gy: 58.0% vs. 5.2%, p<0.01). Median follow-up was 65.1 months (range: 1.2-194.5) for conv-RT and 25.0 months (range: 1.6-131.3) for hypo-RT cohorts. Two-year cumulative incidence of in-field locoregional relapse was low in both groups (1.1% conv-RT vs. 4.1% hypo-RT, p=0.114). While two-year OS was lower for the hypo-RT group (62.6% vs. 84.4%, p=0.0008), two-year MCC-specific survival was similar (84.7 vs. 86.6%, p=0.743). On multivariable analysis, immunosuppression, clinical stage III disease, and lymphovascular invasion were associated with any-recurrence when controlling for sex, age, and hypo-RT. CONCLUSIONS AND RELEVANCE There was no difference in cumulative incidence of in-field locoregional relapse or MCC-specific survival between hypo-RT and conv-RT. Prospective studies are needed to confirm hypo-RT as an efficacious treatment option for MCC.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Michael G Milligan
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Elliott Fite
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Guilherme Rabinowits
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, United States
| | - Glenn J Hanna
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Charles H Yoon
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Division of Surgical Oncology, Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, United States
| | - Manisha Thakuria
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States; Department of Dermatology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, United States; Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts, United States.
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9
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Fennig S, Landman Y, Brenner R, Billan S, Fenig E. Merkel cell carcinoma in lymph nodes with and without primary origin. Cancer Med 2022; 11:1484-1489. [PMID: 35128847 PMCID: PMC8921907 DOI: 10.1002/cam4.4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shlomit Fennig
- Institute of Oncology, Edith Wolfson Medical CenterHolonIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yosef Landman
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | - Ronen Brenner
- Institute of Oncology, Edith Wolfson Medical CenterHolonIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Salem Billan
- Division of OncologyRambam Health Care CampusHaifaIsrael
- Ruth & Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Eyal Fenig
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
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10
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Beyond Nicotinamide Metabolism: Potential Role of Nicotinamide N-Methyltransferase as a Biomarker in Skin Cancers. Cancers (Basel) 2021; 13:cancers13194943. [PMID: 34638427 PMCID: PMC8508019 DOI: 10.3390/cancers13194943] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 02/01/2023] Open
Abstract
Skin cancers (SC) collectively represent the most common type of malignancy in white populations. SC includes two main forms: malignant melanoma and non-melanoma skin cancer (NMSC). NMSC includes different subtypes, namely, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and keratoacanthoma (KA), together with the two pre-neoplastic conditions Bowen disease (BD) and actinic keratosis (AK). Both malignant melanoma and NMSC are showing an increasing incidence rate worldwide, thus representing an important challenge for health care systems, also because, with some exceptions, SC are generally characterized by an aggressive behavior and are often diagnosed late. Thus, identifying new biomarkers suitable for diagnosis, as well as for prognosis and targeted therapy is mandatory. Nicotinamide N-methyltransferase (NNMT) is an enzyme that is emerging as a crucial player in the progression of several malignancies, while its substrate, nicotinamide, is known to exert chemopreventive effects. Since there is increasing evidence regarding the involvement of this enzyme in the malignant behavior of SC, the current review aims to summarize the state of the art as concerns NNMT role in SC and to support future studies focused on exploring the diagnostic and prognostic potential of NNMT in skin malignancies and its suitability for targeted therapy.
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11
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Vayntraub A, Tayeb N, Squires B, Mehnert JM, Hassan Ii Q, Sebastian NT, Deryaniyagala R, Quinn TJ. The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis. Cureus 2021; 13:e18276. [PMID: 34722054 PMCID: PMC8545516 DOI: 10.7759/cureus.18276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/objective(s) Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neoplasm traditionally managed with surgical resection followed by radiotherapy (RT). With the recent approval of checkpoint inhibitors, chemotherapy is less commonly utilized. We analyzed the impact of RT and chemotherapy on overall survival (OS) in patients with MCC using Surveillance, Epidemiology, and End Results (SEER), a population-level database. Materials and methods We performed retrospective analyses on SEER 18 Custom Data registries for MCC (ICD-0-3 8247). Data from 1980 to 2016 was queried for analysis, and an initial list of 9,792 patients was populated (ICD: C00, C07.9, C44, C80.9). Selection for cases with chemotherapy and RT status, single primary tumor, primary tumor location and surgery treatment type yielded 5,002 cases for analysis. Baseline characteristics were compared with Chi-square or Mann-Whitney U test. Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was used to account for indication bias. Results Median follow-up time was 178 months (68 to 217 months). Independent prognostic factors positively correlated with increased OS, for both unadjusted Multivariate analysis and IPTW adjusted MVA were age, male sex, year of diagnosis, stage, RT status, and chemotherapy status. On adjusted MVA, use of chemotherapy was associated with worse OS (hazard ratio: 1.22 [95% CI 1.1-1.35], p<0.001), whereas RT was associated with improved OS (HR:0.9 [95% CI, 0.83-0.97], p=0.008). Conclusions The current study demonstrates that RT is associated with improved survival for patients with MCC. Chemotherapy was associated with worse OS. This supports the recent clinical shift towards immune checkpoints inhibitors as standard of care in the metastatic setting, and promising trials in the adjuvant and advanced settings.
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Affiliation(s)
| | - Nadine Tayeb
- Department of Radiation Oncology, Michigan State University College of Human Medicine, East Lansing, USA
| | - Bryan Squires
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Janice M Mehnert
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, USA
| | - Quais Hassan Ii
- Medical Scientist Training Program, The Ohio State University College of Medicine, Columbus, USA
| | - Nikhil T Sebastian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | | | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
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T-Cell Responses in Merkel Cell Carcinoma: Implications for Improved Immune Checkpoint Blockade and Other Therapeutic Options. Int J Mol Sci 2021; 22:ijms22168679. [PMID: 34445385 PMCID: PMC8395396 DOI: 10.3390/ijms22168679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with rising incidence and high mortality. Approximately 80% of the cases are caused by the human Merkel cell polyomavirus, while the remaining 20% are induced by UV light leading to mutations. The standard treatment of metastatic MCC is the use of anti-PD-1/-PD-L1-immune checkpoint inhibitors (ICI) such as Pembrolizumab or Avelumab, which in comparison with conventional chemotherapy show better overall response rates and longer duration of responses in patients. Nevertheless, 50% of the patients do not respond or develop ICI-induced, immune-related adverse events (irAEs), due to diverse mechanisms, such as down-regulation of MHC complexes or the induction of anti-inflammatory cytokines. Other immunotherapeutic options such as cytokines and pro-inflammatory agents or the use of therapeutic vaccination offer great ameliorations to ICI. Cytotoxic T-cells play a major role in the effectiveness of ICI, and tumour-infiltrating CD8+ T-cells and their phenotype contribute to the clinical outcome. This literature review presents a summary of current and future checkpoint inhibitor therapies in MCC and demonstrates alternative therapeutic options. Moreover, the importance of T-cell responses and their beneficial role in MCC treatment is discussed.
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Heydari P, Kharaziha M, Varshosaz J, Javanmard SH. Current knowledge of immunomodulation strategies for chronic skin wound repair. J Biomed Mater Res B Appl Biomater 2021; 110:265-288. [PMID: 34318595 DOI: 10.1002/jbm.b.34921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/11/2022]
Abstract
In orchestrating the wound healing process, the immune system plays a critical role. Hence, controlling the immune system to repair skin defects is an attractive approach. The highly complex immune system includes the coordinated actions of several immune cells, which can produce various inflammatory and antiinflammatory cytokines and affect the healing of skin wounds. This process can be optimized using biomaterials, bioactive molecules, and cell delivery. The present review discusses various immunomodulation strategies for supporting the healing of chronic wounds. In this regard, following the evolution of the immune system and its role in the wound healing mechanism, the interaction between the extracellular mechanism and immune cells for acceleration wound healing will be firstly investigated. Consequently, the immune-based chronic wounds will be briefly examined and the mechanism of progression, and conventional methods of their treatment are evaluated. In the following, various biomaterials-based immunomodulation strategies are introduced to stimulate and control the immune system to treat and regenerate skin defects. Other effective methods of controlling the immune system in wound healing which is the release of bioactive agents (such as antiinflammatory, antigens, and immunomodulators) and stem cell therapy at the site of injury are reviewed.
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Affiliation(s)
- Parisa Heydari
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Mahshid Kharaziha
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Jaleh Varshosaz
- School of Pharmacy and Pharmaceutical Science, Isfahan University of Medical Science, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Dellambra E, Carbone ML, Ricci F, Ricci F, Di Pietro FR, Moretta G, Verkoskaia S, Feudi E, Failla CM, Abeni D, Fania L. Merkel Cell Carcinoma. Biomedicines 2021; 9:718. [PMID: 34201709 PMCID: PMC8301416 DOI: 10.3390/biomedicines9070718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and extremely aggressive neuroendocrine carcinoma of the skin, with increasing incidence worldwide. This review intends to propose a comprehensive evaluation of MCC epidemiology, clinical features, pathogenetic mechanisms, diagnosis, and therapies. A section is dedicated to immunological aspects and another to the involvement of angiogenesis and angiogenic growth factors in MCC progression, proposing novel diagnostic and therapeutic approaches. Advanced MCC tumors have been treated with immune checkpoint inhibitors with effective results. Therefore, the state of art of this immunotherapy is also examined, reporting on the most recent clinical trials in the field. We conclude by underlining the achievements in the understanding of MCC pathology and indicating the present needs for effective diagnosis and therapeutic management of the disease.
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Affiliation(s)
- Elena Dellambra
- Molecular and Cell Biology Laboratory, IDI-IRCCS, 00167 Rome, Italy;
| | - Maria Luigia Carbone
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | | | - Francesco Ricci
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
| | | | - Gaia Moretta
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
| | - Sofia Verkoskaia
- Oncology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.D.P.); (S.V.)
| | - Elisa Feudi
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | - Cristina M. Failla
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, 00167 Rome, Italy;
| | - Luca Fania
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
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Gambichler T, Abu Rached N, Tannapfel A, Becker JC, Vogt M, Skrygan M, Wieland U, Silling S, Susok L, Stücker M, Meyer T, Stockfleth E, Junker K, Käfferlein HU, Brüning T, Lang K. Expression of Mismatch Repair Proteins in Merkel Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13112524. [PMID: 34063983 PMCID: PMC8196722 DOI: 10.3390/cancers13112524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Merkel cell carcinoma (MCC) is a rare and highly malignant skin cancer with neuroendocrine differentiation. About 80% are Merkel cell polyomavirus (MCPyV) positive. The aim of this work was to immunohistochemically investigate the expression of mismatch repair proteins (MSH2, MSH6, MLH1, and PMS2) in MCC (n = 56). In a second step, tumors with a low expression were tested for microsatellite instability. Microsatellite instability in MCC could have an impact on immune checkpoint inhibitor therapy (ICI) outcome. This study showed a significant association between low expression of mismatch repair proteins and a negative MCPyV status. Microsatellite instability was detected in only one case. Future studies will establish whether this subset of MCC patients respond better to ICI. Abstract We aimed to assess for the first time the mismatch repair (MMR) protein expression in Merkel cell carcinoma (MCC). Immunohistochemistry was performed for MLH1, MSH2, MSH6, and PMS2 on patients’ tumor tissue (n = 56), including neighbored healthy control tissue. In cases with low-level MMR expression (<10th percentile), we performed multiplex PCR in combination with high-resolution capillary electrophoresis in order to confirm microsatellite instability (MSI). Microscopic evaluation revealed a high median expression for all MMR proteins studied (91.6–96.3%). However, six patients (56/10.7%) had low-level MLH1 expression, six (55/10.9%) had low-level MSH2 expression, five (56/8.9%) had low-level MSH6 expression, and six (54/11.1%) had low-level PMS2 expression. Together, we observed nine (56/16.1%) patients who had low-level MMR expression of at least one protein. Of the patients with low-level MMR expression, MSI evaluation was possible in five cases, revealing one case with high-level MSI. In all MMR proteins assessed, low-level expression was significantly (p = 0.0004 to p < 0.0001) associated with a negative Merkel cell polyomavirus (MCPyV) status. However, the expression profiles of the MMR proteins did not correlate with clinical outcome measures such as disease relapse or death (p > 0.05). MCC appears to be a malignancy characterized by low-level MMR rather than completely deficient MMR in a subset of cases, predominantly affecting MCPyV-negative tumors. Future studies will establish whether this subset of MCC patients respond better to immune checkpoint inhibitor therapy.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
- Correspondence: (T.G.); (N.A.R.); Tel.: +49-234-509-6073 (N.A.R.)
| | - Nessr Abu Rached
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
- Correspondence: (T.G.); (N.A.R.); Tel.: +49-234-509-6073 (N.A.R.)
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, 44789 Bochum, Germany; (A.T.); (M.V.)
| | - Jürgen C. Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, 45147 Essen, Germany;
- Deutsches Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany
| | - Markus Vogt
- Institute of Pathology, Ruhr-University Bochum, 44789 Bochum, Germany; (A.T.); (M.V.)
| | - Marina Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Ulrike Wieland
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, 50935 Cologne, Germany; (U.W.); (S.S.)
| | - Steffi Silling
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, 50935 Cologne, Germany; (U.W.); (S.S.)
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Markus Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Thomas Meyer
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Klaus Junker
- Department of Pathology, Klinikum Bremen-Mitte, 28205 Bremen, Germany;
| | - Heiko U. Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
| | - Kerstin Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
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