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Li J, Long S, Zhang Y, Wei W, Yu S, Liu Q, Hui X, Li X, Wang Y. Molecular mechanisms and diagnostic model of glioma-related epilepsy. NPJ Precis Oncol 2024; 8:223. [PMID: 39363097 PMCID: PMC11450052 DOI: 10.1038/s41698-024-00721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 09/22/2024] [Indexed: 10/05/2024] Open
Abstract
Epilepsy is one of the most common symptoms in patients with gliomas; however, the mechanisms underlying its interaction are not yet clear. Moreover, epidemiological studies have not accurately identified patients with glioma-related epilepsy (GRE), and there is an urgent need to identify the molecular mechanisms and markers of its occurrence. We analyzed the demographics, transcriptome, whole-genome, and methylation sequences of 997 patients with glioma, to determine the genetic differences between glioma and GRE patients and to determine the upregulated molecular function, cellular composition, biological processes involved, signaling pathways, and immune cell infiltration. Twelve machine learning algorithms were refined into 113 combinatorial algorithms for building diagnostic recognition models. A total of 342 patients with GRE were identified with WHO grade 2 (174), grade 3 (107), and grade 4 (61). The mean age of the patients with GREs, with IDH mutations (n = 217 [63%]) and 1p19q non-codeletion (n = 169 [49%]), was 38 years old. GRE molecular functions were mainly passive transmembrane transporter protein activity, ion channel activity, and gated channel activity. Cellular components were enriched in the cation-channel and transmembrane transporter complexes. Cerebral cortical development regulates the membrane potential and synaptic organization as major biological processes. The signaling pathways mainly focused on cholinergic, GABAergic, and glutamatergic synapses. LASSO, combined with Random Forest, was the best diagnostic model and identified nine diagnostic genes. This study provides new insights and future perspectives for resolving the molecular mechanisms of GRE.
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Affiliation(s)
- Jinwei Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shengrong Long
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yang Zhang
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shuangqi Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Quan Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
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Lai B, Yi Y, Yang X, Li X, Xu L, Yan Z, Yang L, Han R, Hu H, Duan X. Dynamic contrast-enhanced and diffusion-weighted MRI of cervical carcinoma: Correlations with Ki-67 proliferation status. Magn Reson Imaging 2024; 112:136-143. [PMID: 39029603 DOI: 10.1016/j.mri.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/15/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To investigate the association of quantitative parameter (apparent diffusion coefficient [ADC]) from diffusion-weighted imaging (DWI) and various quantitative and semiquantitative parameters from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with Ki-67 proliferation index (PI) in cervical carcinoma (CC). METHODS A total of 102 individuals with CC who received 3.0 T MRI examination (DWI and DCE MRI) between October 2016 and December 2022 were enrolled in our investigation. Two radiologists separately assessed the ADC parameter and various quantitative and semiquantitative parameters including (volume transfer constant [Ktrans], rate constant [kep], extravascular extracellular space volume fraction [ve], volume fraction of plasma [vp], time to peak [TTP], maximum concentration [MaxCon], maximal slope [MaxSlope] and area under curve [AUC]) for each tumor. Their association with Ki-67 PI was analyzed by Spearman association analysis. The discrepancy between low-proliferation and high-proliferation groups was subsequently analyzed. The receiver operating characteristic (ROC) curve analysis utilized to identify optimal cut-off points for significant parameters. RESULTS Both ADC (ρ = -0.457, p < 0.001) and Ktrans (ρ = -0.467, p < 0.001) indicated a strong negative association with Ki-67 PI. Ki-67 PI showed positive correlations with TTP, MaxCon, MaxSlope and AUC (ρ = 0.202, 0.231, 0.309, 0.235, respectively; all p values<0.05). Compared with the low-proliferation group, high-Ki-67 group presented a significantly lower ADC (0.869 ± 0.125 × 10-3 mm2/s vs. 1.149 ± 0.318 × 10-3 mm2/s; p < 0.001) and Ktrans (1.314 ± 1.162 min-1vs. 0.391 ± 0.390 min-1; p < 0.001), also significantly higher MaxCon values (0.756 ± 0.959 vs. 0.422 ± 0.341; p < 0.05) and AUC values (2.373 ± 3.012 vs. 1.273 ± 1.000; p < 0.05). The cut-offs of ADC, Ktrans, MaxCon and AUC for discrimating low- and high-Ki-67 groups were 0.920 × 10-3 mm2/s, 0.304 min-1, 0.209 and 1.918, respectively. CONCLUSIONS ADC, Ktrans, TTP, MaxCon, MaxSlope and AUC are associated with Ki-67 PI. ADC and Ktrans exhibited high performance to discriminate low and high Ki-67 status of CC.
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Affiliation(s)
- Bingjia Lai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongju Yi
- Information Technology Department, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong, China
| | - Xiaojun Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Xiumei Li
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Longjiahui Xu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Zhuoheng Yan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Lu Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Riyu Han
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China.
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Du Y, Li R, Fu D, Zhang B, Cui A, Shao Y, Lai Z, Chen R, Chen B, Wang Z, Zhang W, Chu L. Multi-omics technologies and molecular biomarkers in brain tumor-related epilepsy. CNS Neurosci Ther 2024; 30:e14717. [PMID: 38641945 PMCID: PMC11031674 DOI: 10.1111/cns.14717] [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: 11/17/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Brain tumors are one of the leading causes of epilepsy, and brain tumor-related epilepsy (BTRE) is recognized as the major cause of intractable epilepsy, resulting in huge treatment cost and burden to patients, their families, and society. Although optimal treatment regimens are available, the majority of patients with BTRE show poor resolution of symptoms. BTRE has a very complex and multifactorial etiology, which includes several influencing factors such as genetic and molecular biomarkers. Advances in multi-omics technologies have enabled to elucidate the pathophysiological mechanisms and related biomarkers of BTRE. Here, we reviewed multi-omics technology-based research studies on BTRE published in the last few decades and discussed the present status, development, opportunities, challenges, and prospects in treating BTRE. METHODS First, we provided a general review of epilepsy, BTRE, and multi-omics techniques. Next, we described the specific multi-omics (including genomics, transcriptomics, epigenomics, proteomics, and metabolomics) techniques and related molecular biomarkers for BTRE. We then presented the associated pathogenetic mechanisms of BTRE. Finally, we discussed the development and application of novel omics techniques for diagnosing and treating BTRE. RESULTS Genomics studies have shown that the BRAF gene plays a role in BTRE development. Furthermore, the BRAF V600E variant was found to induce epileptogenesis in the neuronal cell lineage and tumorigenesis in the glial cell lineage. Several genomics studies have linked IDH variants with glioma-related epilepsy, and the overproduction of D2HG is considered to play a role in neuronal excitation that leads to seizure occurrence. The high expression level of Forkhead Box O4 (FOXO4) was associated with a reduced risk of epilepsy occurrence. In transcriptomics studies, VLGR1 was noted as a biomarker of epileptic onset in patients. Several miRNAs such as miR-128 and miRNA-196b participate in BTRE development. miR-128 might be negatively associated with the possibility of tumor-related epilepsy development. The lncRNA UBE2R2-AS1 inhibits the growth and invasion of glioma cells and promotes apoptosis. Quantitative proteomics has been used to determine dynamic changes of protein acetylation in epileptic and non-epileptic gliomas. In another proteomics study, a high expression of AQP-4 was detected in the brain of GBM patients with seizures. By using quantitative RT-PCR and immunohistochemistry assay, a study revealed that patients with astrocytomas and oligoastrocytomas showed high BCL2A1 expression and poor seizure control. By performing immunohistochemistry, several studies have reported the relationship between D2HG overproduction and seizure occurrence. Ki-67 overexpression in WHO grade II gliomas was found to be associated with poor postoperative seizure control. According to metabolomics research, the PI3K/AKT/mTOR pathway is associated with the development of glioma-related epileptogenesis. Another metabolomics study found that SV2A, P-gb, and CAD65/67 have the potential to function as biomarkers for BTRE. CONCLUSIONS Based on the synthesized information, this review provided new research perspectives and insights into the early diagnosis, etiological factors, and personalized treatment of BTRE.
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Affiliation(s)
- Yaoqiang Du
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Rusong Li
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Danqing Fu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Biqin Zhang
- Cancer Center, Department of HematologyZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Ailin Cui
- Cancer Center, Department of Ultrasound MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Yutian Shao
- Zhejiang BioAsia Life Science InstitutePinghuChina
| | - Zeyu Lai
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Rongrong Chen
- School of Clinical MedicineHangzhou Normal UniversityHangzhouChina
| | - Bingyu Chen
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Zhen Wang
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Wei Zhang
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Lisheng Chu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
- Department of PhysiologyZhejiang Chinese Medical UniversityHangzhouChina
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Meyer HS, Wiestler B, Hönikl LS, Delbridge C, Ketterer C, Gempt J, Meyer B. Clinical, radiological and pathological features of temporomesial tumors in the adult. A single center experience from 15 years. Front Oncol 2023; 13:1236269. [PMID: 37700844 PMCID: PMC10493778 DOI: 10.3389/fonc.2023.1236269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction The mesial temporal lobe plays a distinct role in epileptogenesis, and tumors in this part of the brain potentially have specific clinical and radiological features. Differentiating high-grade from lower-grade tumors or non-neoplastic lesions can be challenging, preventing the decision for early resection that can be critical in high-grade tumors. Methods A brain tumor database was analyzed retrospectively to identify patients with temporomesial tumors. We determined clinical features (age, sex, symptoms leading to clinical presentation) as well as neuroradiological (tumor location and the presence of contrast enhancement on initial magnetic resonance imaging (MRI)) and neuropathological findings. Results We identified 324 temporal tumors. 39 involved the mesial temporal lobe. 77% of temporomesial tumors occured in males, and 77% presented with seizures, regardless of tumor type or grade. In patients 50 years or older, 90% were male and 80% had glioblastoma (GBM); there was no GBM in patients younger than 50 years. 50% of GBMs lacked contrast enhancement. Male sex was significantly associated with GBM. In both contrast-enhancing and non-enhancing tumors, age of 50 years or older was also significantly associated with GBM. Conclusion In middle-aged and older patients with a mesial temporal lobe tumor, GBM is the most likely diagnosis even when there is no MRI contrast enhancement. Prolonged diagnostic workup or surveillance strategies should be avoided and early resection may be justified in these patients.
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Affiliation(s)
- Hanno S. Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa S. Hönikl
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carl Ketterer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Neumann B, Onken J, König N, Stetefeld H, Luger S, Luger AL, Schlachetzki F, Linker R, Hau P, Bumes E. Outcome of glioblastoma patients after intensive care unit admission with invasive mechanical ventilation: a multicenter analysis. J Neurooncol 2023; 164:249-256. [PMID: 37530945 PMCID: PMC10462561 DOI: 10.1007/s11060-023-04403-6] [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: 06/06/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Patients with glioblastoma are exposed to severe symptoms and organs failures (e.g., coma or acute respiratory failure), that may require intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). However, only limited data are available concerning the prognosis of patients with glioblastoma receiving IMV. We sought to describe the reasons for ICU admission, and outcomes of patients with glioblastoma requiring IMV for unplanned critical complications. METHODS In this retrospective analysis, four certified interdisciplinary brain tumor centers performed a retrospective review of their electronic data systems. All patients with glioblastoma admitted to an in-house ICU and receiving IMV between January 2015 and December 2019 were included. Clinical and prognostic factors as well as relevant outcome parameters were evaluated by group comparisons and Kaplan Meier survival curves. RESULTS We identified 33 glioblastoma patients with a duration of IMV of 9.2 ± 9.4 days. Main reasons for ICU admission were infection (n = 12; 34.3%) including 3 cases of Pneumocystis jirovecii pneumonia, status epilepticus (31.4%) and elevated intracranial pressure (22.9%). In-hospital mortality reached 60.6%. Younger age, low number of IMV days, better Karnofsky Performance Status Scale before admission and elevated intracranial pressure as cause of ICU admission were associated with positive prognostic outcome. CONCLUSION We conclude that less than 50% of patients with glioblastoma have a favorable short-term outcome when unplanned ICU treatment with IMV is required. Our data mandate a careful therapy guidance and frequent reassessment of goals during ICU stay.
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Affiliation(s)
- Bernhard Neumann
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
- Department of Neurology, Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Nicole König
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Henning Stetefeld
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sebastian Luger
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Anna-Luisa Luger
- Department of Neurology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), Goethe University Frankfurt, Frankfurt am Main, Germany
- University Cancer Center (UCT), Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, Germany
| | - Felix Schlachetzki
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Ralf Linker
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Peter Hau
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
- Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Elisabeth Bumes
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany.
- Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany.
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Lukas RV, Mrugala MM, Lesniak MS, Chandler JP. Challenging Cases in Neuro-Oncology. Semin Neurol 2022; 42:752-757. [PMID: 36417993 DOI: 10.1055/a-1985-7157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuro-oncology encompasses a broad field focusing on an array of neoplasms, many of which can mimic several diseases. Neurologists will often be involved in the initial diagnostic evaluation and management of these patients. Their insight is central to optimizing the diagnostic yield and providing high-level clinical care. Several neuro-oncologic cases are reviewed with a goal of increasing the understanding of these diseases in a clinically relevant manner and providing updates on the contemporary thinking in the subspecialty.
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Affiliation(s)
- Rimas V Lukas
- Department of Neurology, Northwestern University, Chicago, Illinois.,Lou and Jean Malnati Brain Tumor Institute, Chicago, Illinois
| | - Maciej M Mrugala
- Department of Neurology, Mayo Clinic-Scottsdale, Scottsdale, Arizona
| | - Maciej S Lesniak
- Lou and Jean Malnati Brain Tumor Institute, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - James P Chandler
- Lou and Jean Malnati Brain Tumor Institute, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
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Epileptogenesis and Tumorigenesis in Glioblastoma: Which Relationship? Medicina (B Aires) 2022; 58:medicina58101349. [PMID: 36295510 PMCID: PMC9606940 DOI: 10.3390/medicina58101349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is reported in 29–52% of patients with glioblastoma (GBM) and has an important role in the natural history of this tumor and patients’ life quality. Although GBM is less epileptogenic than lower-grade gliomas, seizures are usually more difficult to control with common antiseizure medications; drug resistance is found in 20% of cases. Recent studies suggest that seizures at the onset of GBM could be a possible favorable independent prognostic factor in patients. Moreover, a growing body of evidence shows that many molecular mechanisms that influence epileptogenesis often regulate GBM growth and invasiveness, sometimes favoring or counteracting the tumor, respectively. The better-characterized players include glutamate, γ-aminobutyric acid, aquaporin-4, and hypoxia-activated molecules. However, currently available data on the molecular basis of epileptogenesis, tumorigenesis, and their relationship is incomplete or discordant and further research is urgently needed on this topic.
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Knapp B, Roedig J, Roedig H, Krzysko J, Horn N, Güler BE, Kusuluri DK, Yildirim A, Boldt K, Ueffing M, Liebscher I, Wolfrum U. Affinity Proteomics Identifies Interaction Partners and Defines Novel Insights into the Function of the Adhesion GPCR VLGR1/ADGRV1. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27103108. [PMID: 35630584 PMCID: PMC9146371 DOI: 10.3390/molecules27103108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/20/2022]
Abstract
The very large G-protein-coupled receptor 1 (VLGR1/ADGRV1) is the largest member of the adhesion G-protein-coupled receptor (ADGR) family. Mutations in VLGR1/ADGRV1 cause human Usher syndrome (USH), a form of hereditary deaf-blindness, and have been additionally linked to epilepsy. In the absence of tangible knowledge of the molecular function and signaling of VLGR1, the pathomechanisms underlying the development of these diseases are still unknown. Our study aimed to identify novel, previously unknown protein networks associated with VLGR1 in order to describe new functional cellular modules of this receptor. Using affinity proteomics, we have identified numerous new potential binding partners and ligands of VLGR1. Tandem affinity purification hits were functionally grouped based on their Gene Ontology terms and associated with functional cellular modules indicative of functions of VLGR1 in transcriptional regulation, splicing, cell cycle regulation, ciliogenesis, cell adhesion, neuronal development, and retinal maintenance. In addition, we validated the identified protein interactions and pathways in vitro and in situ. Our data provided new insights into possible functions of VLGR1, related to the development of USH and epilepsy, and also suggest a possible role in the development of other neuronal diseases such as Alzheimer’s disease.
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Affiliation(s)
- Barbara Knapp
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Jens Roedig
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Heiko Roedig
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Jacek Krzysko
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Nicola Horn
- Core Facility for Medical Bioanalytics, Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (N.H.); (K.B.); (M.U.)
| | - Baran E. Güler
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Deva Krupakar Kusuluri
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Adem Yildirim
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
| | - Karsten Boldt
- Core Facility for Medical Bioanalytics, Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (N.H.); (K.B.); (M.U.)
| | - Marius Ueffing
- Core Facility for Medical Bioanalytics, Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany; (N.H.); (K.B.); (M.U.)
| | - Ines Liebscher
- Rudolf Schönheimer Institute of Biochemistry, Faculty of Medicine, Leipzig University, 04103 Leipzig, Germany;
| | - Uwe Wolfrum
- Institute of Molecular Physiology (ImP), Molecular Cell Biology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany; (B.K.); (J.R.); (H.R.); (J.K.); (B.E.G.); (D.K.K.); (A.Y.)
- Correspondence:
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Wang Y, Deng K, Sun Y, Huang X, Dai Y, Chen W, Hu X, Jiang R. Preserved microstructural integrity of the corticospinal tract in patients with glioma-induced motor epilepsy: a study using mean apparent propagator magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:1415-1427. [PMID: 35111635 DOI: 10.21037/qims-21-679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND To compare the microstructural integrity of the corticospinal tract (CST) between glioma patients with motor epilepsy and without epilepsy using mean apparent propagator magnetic resonance imaging (MAP-MRI). METHODS A total of 26 patients with glioma adjacent to the CST pathway (10 with motor epilepsy and 16 without epilepsy) and 13 matched healthy controls underwent brain structural and diffusion MRI. The morphological characteristics of the CST (tract volume, tract number, and average length) were extracted, and diffusion parameter values including mean squared displacement (MSD), q-space inverse variance (QIV), return-to-origin probability (RTOP), return-to-axis probabilities (RTAP), return-to-plane probabilities (RTPP), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) along the CST were evaluated. The CST features were compared between healthy and affected sides and the relative CST features were compared across the three groups of participants. A receiver operating characteristic (ROC) curve was plotted to assess the performance of each relative CST characteristic for glioma-induced CST changes. RESULTS For patients without epilepsy, the tract number, tract volume, FA, RD, MSD, QIV, and RTAP changed significantly on the affected CST side compared with those on the healthy CST side (P=0.002, 0.002, 0.030 0.017, 0.039, 0.044, and 0.002, respectively). In contrast, for patients with motor epilepsy, no significant difference was found between the affected and healthy side in almost all CST features except RTPP (P=0.028). Compared with patients with motor epilepsy, the relative tract number, tract volume, AD, and RTAP were significantly lower (P=0.027, 0.018, 0.040, and 0.027, respectively) in patients without epilepsy, and their areas under the curve (AUCs) were 0.763, 0.781, 0.744, and 0.763, respectively. No significant difference was found between patients with motor epilepsy and matched healthy controls. CONCLUSIONS The MAP-MRI is a promising approach for evaluating CST changes. It provides additional information reflecting the microstructural complexity of the CST and demonstrates the preserved microstructural integrity of the CST in glioma patients with motor epilepsy.
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Affiliation(s)
- Yuhui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Kaiji Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yihai Dai
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weitao Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaomei Hu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
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10
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Knudsen-Baas KM, Storstein AM, Zarabla A, Maialetti A, Giannarelli D, Beghi E, Maschio M. Antiseizure medication in patients with Glioblastoma- a collaborative cohort study. Seizure 2021; 87:107-113. [PMID: 33761391 DOI: 10.1016/j.seizure.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We investigated, whether epileptic seizures (ES) as presenting symptom in adult patients with GBM are associated with better Overall Survival (OS) compared to ES presenting later during the course of GBM, and efficacy and safety of different antiseizure medications (ASMs). METHODS Retrospective consecutive cohort study of adults with GBM: 50 from Norway and 50 from Italy. We compared the time to changing ASM treatments. OS was investigated with a Cox regression model adjusted for time dependency. RESULTS Median follow-up was 17 months from GBM diagnosis. ES were the presenting symptom in 49 patients. All patients received ASM treatment. LEV was the first ASM in the majority of patients and the most effective at one year from the first prescription, (p = 0.004). Occurrence of adverse events (AEs) was similar between LEV and other ASMs (p = 0.47). Poorer OS correlated with older age at GBM diagnosis, country and ASM therapy. A negative impact of ASMs on OS was observed for LEV in a univariate and multivariate analysis, and for VPA (only in multivariate analysis), even when adjusted for O6-methylguanine-DNA-methyltransferase (MGMT) methylation status. Patients with ES as the onset symptom of GBM and patients who had first ES later had similar OS (p = 0.87). CONCLUSION ES as the GBM debut symptom did not lead to a longer OS. LEV was a more effective ASM compared to other treatments with no differences regarding AEs between LEV and other ASMs. Surprisingly, in our patients LEV and VPA were associated with worse OS than other ASMs. This result should be interpreted with caution due to the retrospective nature of this study along with the many variables which may affect the outcome in this population.
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Affiliation(s)
- Kristin M Knudsen-Baas
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; The National Center for Epilepsy, Norway.
| | | | - Alessia Zarabla
- Center for Tumor-related Epilepsy, UOSD Neuroncology, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
| | - Andrea Maialetti
- Center for Tumor-related Epilepsy, UOSD Neuroncology, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
| | - Ettore Beghi
- Laboratorio Malattie Neurologiche, IRCCS - Istituto "Mario Negri", Milano, Italy.
| | - Marta Maschio
- Center for Tumor-related Epilepsy, UOSD Neuroncology, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
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11
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Scalise M, Console L, Rovella F, Galluccio M, Pochini L, Indiveri C. Membrane Transporters for Amino Acids as Players of Cancer Metabolic Rewiring. Cells 2020; 9:cells9092028. [PMID: 32899180 PMCID: PMC7565710 DOI: 10.3390/cells9092028] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer cells perform a metabolic rewiring to sustain an increased growth rate and compensate for the redox stress caused by augmented energy metabolism. The metabolic changes are not the same in all cancers. Some features, however, are considered hallmarks of this disease. As an example, all cancer cells rewire the amino acid metabolism for fulfilling both the energy demand and the changed signaling routes. In these altered conditions, some amino acids are more frequently used than others. In any case, the prerequisite for amino acid utilization is the presence of specific transporters in the cell membrane that can guarantee the absorption and the traffic of amino acids among tissues. Tumor cells preferentially use some of these transporters for satisfying their needs. The evidence for this phenomenon is the over-expression of selected transporters, associated with specific cancer types. The knowledge of the link between the over-expression and the metabolic rewiring is crucial for understanding the molecular mechanism of reprogramming in cancer cells. The continuous growth of information on structure-function relationships and the regulation of transporters will open novel perspectives in the fight against human cancers.
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Affiliation(s)
- Mariafrancesca Scalise
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
| | - Lara Console
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
| | - Filomena Rovella
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
| | - Michele Galluccio
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
| | - Lorena Pochini
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
| | - Cesare Indiveri
- Unit of Biochemistry and Molecular Biotechnology, Department DiBEST (Biologia, Ecologia, Scienze della Terra), University of Calabria, Via Bucci 4C, 87036 Arcavacata di Rende, Italy; (M.S.); (L.C.); (F.R.); (M.G.); (L.P.)
- CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies (IBIOM) via Amendola 122/O, 70126 Bari, Italy
- Correspondence: ; Tel.: +39-09-8449-2939
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12
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Sun K, Liu Z, Li Y, Wang L, Tang Z, Wang S, Zhou X, Shao L, Sun C, Liu X, Jiang T, Wang Y, Tian J. Radiomics Analysis of Postoperative Epilepsy Seizures in Low-Grade Gliomas Using Preoperative MR Images. Front Oncol 2020; 10:1096. [PMID: 32733804 PMCID: PMC7360821 DOI: 10.3389/fonc.2020.01096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/02/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: The present study aimed to evaluate the performance of radiomics features in the preoperative prediction of epileptic seizure following surgery in patients with LGG. Methods: This retrospective study collected 130 patients with LGG. Radiomics features were extracted from the T2-weighted MR images obtained before surgery. Multivariable Cox-regression with two nested leave-one-out cross validation (LOOCV) loops was applied to predict the prognosis, and elastic net was used in each LOOCV loop to select the predictive features. Logistic models were then built with the selected features to predict epileptic seizures at two time points. Student's t-tests were then used to compare the logistic model predicted probabilities of developing epilepsy in the epilepsy and non-epilepsy groups. The t-test was used to identify features that differentiated patients with early-onset epilepsy from their late-onset counterparts. Results: Seventeen features were selected with the two nested LOOCV loops. The index of concordance (C-index) of the Cox model was 0.683, and the logistic model predicted probabilities of seizure were significantly different between the epilepsy and non-epilepsy groups at each time point. Moreover, one feature was found to be significantly different between the patients with early- or late-onset epilepsy. Conclusion: A total of 17 radiomics features were correlated with postoperative epileptic seizures in patients with LGG and one feature was a significant predictor of the time of epilepsy onset.
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Affiliation(s)
- Kai Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Yiming Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenchao Tang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Xuezhi Zhou
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Lizhi Shao
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Caixia Sun
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis of Guizhou Province, School of Computer Science and Technology, Guizhou University, Guiyang, China
| | - Xing Liu
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.,University of Chinese Academy of Science, Beijing, China
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13
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Giovannini G, Pasini F, Orlandi N, Mirandola L, Meletti S. Tumor-associated status epilepticus in patients with glioma: Clinical characteristics and outcomes. Epilepsy Behav 2019; 101:106370. [PMID: 31300386 DOI: 10.1016/j.yebeh.2019.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
Between 3 and 12% of all adult status epilepticus (SE) are caused by a brain tumor. Gliomas, and in particular, high-grade gliomas (HGGs), are at high risk of SE development. In this study, we aimed to describe the clinical characteristic and outcomes of tumor-associated SE (TASE) in a population of adult patients with glioma prospectively collected between 2013 and 2019. In the aforementioned period, we observed 26 TASE (median age: 68 years). Overall, 22 patients (85%) presented a HGG (one anaplastic astrocytoma and 21 a glioblastoma) while 4 had a LGG (two diffuse astrocytoma and two ganglioglioma). All the lesions were supratentorial, and the temporal lobe was the most frequently involved (20 patients). Fourteen patients (54%) had the SE episode as the first manifestation of the tumor; in the remaining 12 (all patients with a HGG), the development of SE heralded tumor progression or reappearance. When TASE outcomes were compared with the ones observed in the general population of SE (SEGP), the response to treatment was not different between the two populations (refractory SE (RSE)/super-refractory SE (SRSE) 12% versus 13%, p = 0.75). In the short-term, group with TASE had a significantly lower global disability (modified Rankin scale (mRS) < 3 at discharge: 60% versus 32%, p < 0.001; at 30 days follow-up: 62% versus 30%, p < 0.001) and mortality (30 days mortality: 4% versus 27%, p = 0.008). Six months and 1 year mortality did not show any difference between the two groups (6 months: 46% and 45%, respectively, p = 0.9; 1 year: 68% and 52%, respectively, p = 0.22). The appearance of TASE often heralds tumor grow and progression. Even in this context, it appears to be as treatment-responsive as SEGP and the short-term disability and mortality related to SE episode are lower than those observed in the SEGP. Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
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Affiliation(s)
| | - Francesco Pasini
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolo' Orlandi
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Laura Mirandola
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
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14
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Liang S, Fan X, Zhao M, Shan X, Li W, Ding P, You G, Hong Z, Yang X, Luan G, Ma W, Yang H, You Y, Yang T, Li L, Liao W, Wang L, Wu X, Yu X, Zhang J, Mao Q, Wang Y, Li W, Wang X, Jiang C, Liu X, Qi S, Liu X, Qu Y, Xu J, Wang W, Song Z, Wu J, Liu Z, Chen L, Lin Y, Zhou J, Liu X, Zhang W, Li S, Jiang T. Clinical practice guidelines for the diagnosis and treatment of adult diffuse glioma-related epilepsy. Cancer Med 2019; 8:4527-4535. [PMID: 31240876 PMCID: PMC6712518 DOI: 10.1002/cam4.2362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/05/2019] [Accepted: 05/25/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Glioma-related epilepsy (GRE) is defined as symptomatic epileptic seizures secondary to gliomas, it brings both heavy financial and psychosocial burdens to patients with diffuse glioma and significantly decreases their quality of life. To date, there have been no clinical guidelines that provide recommendations for the optimal diagnostic and therapeutic procedures for GRE patients. METHODS In March 2017, the Joint Task Force for GRE of China Association Against Epilepsy and Society for Neuro-Oncology of China launched the guideline committee for the diagnosis and treatment of GRE. The guideline committee conducted a comprehensive review of relevant domestic and international literatures that were evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and then held three consensus meetings to discuss relevant recommendations. The recommendations were eventually given according to those relevant literatures, together with the experiences in the diagnosis and treatment of over 3000 GRE cases from 24 tertiary level hospitals that specialize in clinical research of epilepsy, glioma, and GRE in China. RESULTS The manuscript presented the current standard recommendations for the diagnostic and therapeutic procedures of GRE. CONCLUSIONS The current work will provide a framework and assurance for the diagnosis and treatment strategy of GRE to reduce complications and costs caused by unnecessary treatment. Additionally, it can serve as a reference for all professionals involved in the management of patients with GRE.
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Affiliation(s)
- Shuli Liang
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China.,Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Zhao
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Xia Shan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Wenling Li
- Department of Neurosurgery, Second Affiliated Hospital, Hebei Medical University, Shijiazhuang, China
| | - Ping Ding
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Hong
- Department of Neurology, Shanghai Huashan Hospital, Fudan University, Shaihai, China
| | - Xuejun Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoming Luan
- Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Yang
- Department of Neurosurgery, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yongpin You
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tianming Yang
- Department of Neurosurgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Li
- Department of Neurosurgery, First Affiliated Hospital, Beijing University, Beijing, China
| | - Weiping Liao
- Department of Neurology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Wu
- Department of Neurology, First Affiliated Hospital, Beijing University, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qing Mao
- Department of Neurosurgery, Huaxi Hospital, Sichuan University, Chengdu, China
| | - Yuping Wang
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuefeng Wang
- Department of Neurology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chuanlu Jiang
- Department of Neurosurgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoyan Liu
- Pediatric Department, First Affiliated Hospital, Beijing University, Beijing, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Xingzhou Liu
- Epilepsy Center, Shanghai Deji Hospital, Shanghai, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jiwen Xu
- Department of Functional Neurosurgery, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Wang
- Department of Neurosurgery, Guangzhou Military General Hospital, Guangzhou, China
| | - Zhi Song
- Department of Neurology, Xiangya Third Hospital, Center South University, Changsha, China
| | - Jinsong Wu
- Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University, Shanghai, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China
| | - Ling Chen
- Department of Neurosurgery, Chinese PLA General Hospital and PLA Medical College, Beijing, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Zhou
- Department of Neurosurgery, Beijing Sanbo Hospital, Capital Medical University, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Shichuo Li
- China Association Against Epilepsy (CAAE), Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
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15
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Feyissa AM, Worrell GA, Tatum WO, Chaichana KL, Jentoft ME, Guerrero Cazares H, Ertekin-Taner N, Rosenfeld SS, ReFaey K, Quinones-Hinojosa A. Potential influence of IDH1 mutation and MGMT gene promoter methylation on glioma-related preoperative seizures and postoperative seizure control. Seizure 2019; 69:283-289. [PMID: 31141785 DOI: 10.1016/j.seizure.2019.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/21/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To examine the occurrence of glioma-related preoperative seizures (GPS) and post-operative seizure control (PSC) with respect to patients characteristics including five commonly tested tumor molecular markers (TMMs). METHODS A single-center retrospective cohort study of patients with glioma evaluated at the Mayo Clinic, Florida between 2016 and 2018. RESULTS 68 adult patients (mean age = 51-years, 45-males) were included. 46 patients had GPS. 57 patients underwent intra-operative electrocorticography during awake craniotomy-assisted glioma resection. All patients underwent glioma resection (53, gross-total resection) with histologies of pilocytic astrocytoma (n = 2), diffuse astrocytoma (n = 4), oligodendroglioma (n = 14), anaplastic astrocytoma (n = 16), anaplastic oligodendroglioma (n = 1), and glioblastoma (n = 31). 31 (67%) patients had PSC (median follow-up = 14.5 months; IQR = 7-16.5 months). IDH1 mutation (IDH1mut) was present in 32, ARTX retention in 53, MGMT gene promotor methylation in 15, 1p/19q co-deletion in 15, and over-expression of p53 in 19 patients. Patients with IDH1mut were more likely to have GPS (p = 0.037) and PSC (p = 0.035) compared to patients with IDH1 wild-type. Patients with MGMT gene promoter methylation were also likely to have PSC (p = 0.032). GPS or PSC did not differ by age, sex, extent of surgery, glioma grade, location, and histopathological subtype, p53 expression, ARTX retention, or 1p/19q co-deletion status. CONCLUSIONS GPS and PSC may be associated with IDH1 mutation and MGMT gene promoter methylation status but not other glioma characteristics including tumor grade, location, or histopathology. Prospective studies with larger sample size are needed to clarify the exact mechanisms of GPS and PSC by the various TMMs to identify new treatment targets.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Kaisorn L Chaichana
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Mark E Jentoft
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Hugo Guerrero Cazares
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Nileufer Ertekin-Taner
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Steven S Rosenfeld
- Department of Hematology/Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Karim ReFaey
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
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16
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Pregnolato S, Chakkarapani E, Isles AR, Luyt K. Glutamate Transport and Preterm Brain Injury. Front Physiol 2019; 10:417. [PMID: 31068830 PMCID: PMC6491644 DOI: 10.3389/fphys.2019.00417] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Preterm birth complications are the leading cause of child death worldwide and a top global health priority. Among the survivors, the risk of life-long disabilities is high, including cerebral palsy and impairment of movement, cognition, and behavior. Understanding the molecular mechanisms of preterm brain injuries is at the core of future healthcare improvements. Glutamate excitotoxicity is a key mechanism in preterm brain injury, whereby the accumulation of extracellular glutamate damages the delicate immature oligodendrocytes and neurons, leading to the typical patterns of injury seen in the periventricular white matter. Glutamate excitotoxicity is thought to be induced by an interaction between environmental triggers of injury in the perinatal period, particularly cerebral hypoxia-ischemia and infection/inflammation, and developmental and genetic vulnerabilities. To avoid extracellular build-up of glutamate, the brain relies on rapid uptake by sodium-dependent glutamate transporters. Astrocytic excitatory amino acid transporter 2 (EAAT2) is responsible for up to 95% of glutamate clearance, and several lines of evidence suggest that it is essential for brain functioning. While in the adult EAAT2 is predominantly expressed by astrocytes, EAAT2 is transiently upregulated in the immature oligodendrocytes and selected neuronal populations during mid-late gestation, at the peak time for preterm brain injury. This developmental upregulation may interact with perinatal hypoxia-ischemia and infection/inflammation and contribute to the selective vulnerability of the immature oligodendrocytes and neurons in the preterm brain. Disruption of EAAT2 may involve not only altered expression but also impaired function with reversal of transport direction. Importantly, elevated EAAT2 levels have been found in the reactive astrocytes and macrophages of human infant post-mortem brains with severe white matter injury (cystic periventricular leukomalacia), potentially suggesting an adaptive mechanism against excitotoxicity. Interestingly, EAAT2 is suppressed in animal models of acute hypoxic-ischemic brain injury at term, pointing to an important and complex role in newborn brain injuries. Enhancement of EAAT2 expression and transport function is gathering attention as a potential therapeutic approach for a variety of adult disorders and awaits exploration in the context of the preterm brain injuries.
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Affiliation(s)
- Silvia Pregnolato
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elavazhagan Chakkarapani
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anthony R Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Karen Luyt
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Yu Z, Zhang N, Hameed NUF, Qiu T, Zhuang D, Lu J, Wu J. The Analysis of Risk Factors and Survival Outcome for Chinese Patients with Epilepsy with High-Grade Glioma. World Neurosurg 2019; 125:e947-e957. [PMID: 30763739 DOI: 10.1016/j.wneu.2019.01.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the risk factors of tumor-related epilepsy (TRE) and the relationship between TRE and functional/survival outcomes in patients with high-grade glioma (HGG). METHODS The clinical data of 587 patients with HGG were retrospectively analyzed. A χ2 test and logistic multiple-regression analysis were used to analyze factors associated with TRE. Logistic and Cox regression were used to analyze factors that may influence functional and survival outcomes. RESULTS Glioma location in temporal (odds ratio [OR], 0.439; P = 0.04) and parietal lobes (OR, 0.092; P = 0.02) were independent protective factors of preoperative epilepsy, compared with gliomas of frontal lobe. Preoperative epilepsy (OR, 9.290; P < 0.001) and dominant hemispheric location (OR, 2.616; P = 0.04) were independent risk factors of postoperative epilepsy. On univariate analysis, patients with preoperative epilepsy had longer progression-free survival (PFS) (P = 0.001) and overall survival (OS) (P < 0.001). Multivariate analysis further confirmed that preoperative epilepsy was an independent protective factor of OS (hazard ratio, 0.587; P = 0.008). CONCLUSIONS In patients with HGG, preoperative epilepsy is significantly associated with tumor involvement of the frontal lobe, whereas postoperative epilepsy is associated with preoperative epilepsy and dominant hemispheric location. Also, patients with HGG with preoperative epilepsy have better PFS and OS.
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Affiliation(s)
- Zhengda Yu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Zhang
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - N U Farrukh Hameed
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Tianming Qiu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Dongxiao Zhuang
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Jinsong Wu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China.
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Maschio M, Pauletto G, Zarabla A, Maialetti A, Ius T, Villani V, Fabi A, Koudriavtseva T, Giannarelli D. Perampanel in patients with brain tumor-related epilepsy in real-life clinical practice: a retrospective analysis. Int J Neurosci 2018; 129:593-597. [PMID: 30507318 DOI: 10.1080/00207454.2018.1555160] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Epilepsy occurs in 35-70% of patients with gliomas; glutamate plays a central role via AMPA-receptor activation, which is involved both in seizure activity and tumor growth. We conducted a retrospective study on brain tumor-related epilepsy patients (BTRE) treated with perampanel in add-on (PER) for 12 months, to evaluate efficacy and tollerability, according to real-life clinical practice. MATERIALS AND METHODS Medical records of eleven patients (9 males, mean age 54 years) with glioma and epilepsy treated with PER in add-on, for inadequate seizure control or adverse events (AEs) from previous antiepileptic drugs (AEDs) therapy, were reviewed. Data collected included: tumor history, molecular factors, systemic therapy, type and number of seizures and concomitant AEDs, and AEs. RESULTS After 12 months of PER therapy, five patients were seizure-free, 4 had a seizure reduction ≥50% and the seizure frequency was unchanged in 2 patients. Responder rate was 81.8%. Two patients reported AEs; PER dose was reduced only in the one case. The final median dose of PER was 7.3 mg/day. We didn't find statistically significant differences in the comparison between mean values pre, mean values post and the average of decreasing number of seizures related to: histology, presence/absence of chemotherapy, radiotherapy, progression disease, KPS, IDH1, MGMT. DISCUSSION Despite the limitations due to small number of patients in a retrospective study, the high rate of responder and seizure-free patients suggest that PER could be a therapeutic option in BTRE. Prospective controlled studies are needed to confirm our data.
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Affiliation(s)
- Marta Maschio
- a Center for Tumor-related Epilepsy, UOSD Neurology , Regina Elena National Cancer Institute , Rome , Italy
| | - Giada Pauletto
- b Neurology Unit, Department of Neurosciences , S. Maria della Misericordia University Hospital , Udine , Italy
| | - Alessia Zarabla
- a Center for Tumor-related Epilepsy, UOSD Neurology , Regina Elena National Cancer Institute , Rome , Italy
| | - Andrea Maialetti
- a Center for Tumor-related Epilepsy, UOSD Neurology , Regina Elena National Cancer Institute , Rome , Italy
| | - Tamara Ius
- b Neurology Unit, Department of Neurosciences , S. Maria della Misericordia University Hospital , Udine , Italy
| | - Veronica Villani
- c UOSD Neurology , Regina Elena National Cancer Institute , Rome , Italy
| | - Alessandra Fabi
- d Oncology Unit , Regina Elena National Cancer Institute , Rome , Italy
| | | | - Diana Giannarelli
- e Biostatistic Unit , Regina Elena National Cancer Institute , Rome , Italy
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Stone TJ, Rowell R, Jayasekera BAP, Cunningham MO, Jacques TS. Review: Molecular characteristics of long-term epilepsy-associated tumours (LEATs) and mechanisms for tumour-related epilepsy (TRE). Neuropathol Appl Neurobiol 2018; 44:56-69. [DOI: 10.1111/nan.12459] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/22/2017] [Indexed: 12/14/2022]
Affiliation(s)
- T. J. Stone
- Developmental Biology and Cancer Programme; UCL Great Ormond Street Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - R. Rowell
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - B. A. P. Jayasekera
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - M. O. Cunningham
- Institute of Neuroscience; Newcastle University; Newcastle Upon Tyne UK
- Department of Neurosurgery; Royal Victoria Hospital; Newcastle Upon Tyne UK
| | - T. S. Jacques
- Developmental Biology and Cancer Programme; UCL Great Ormond Street Institute of Child Health; London UK
- Department of Histopathology; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Zhao J, Zhang L, Zheng L, Hong Y, Zhao L. LncRNATCF7 promotes the growth and self-renewal of glioma cells via suppressing the miR-200c-EpCAM axis. Biomed Pharmacother 2018; 97:203-208. [DOI: 10.1016/j.biopha.2017.10.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022] Open
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Wang Y, Jiang M, Yao Y, Cai Z. WWC3 Inhibits Glioma Cell Proliferation Through Suppressing the Wnt/β-Catenin Signaling Pathway. DNA Cell Biol 2017; 37:31-37. [PMID: 29115863 DOI: 10.1089/dna.2017.3931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The scaffolding protein WW and C2 domain-containing protein 3 (WWC3) belonging to the WWC protein family plays important roles in regulating cell proliferation, cell migration, and synaptic signaling. The critical role of WWC3 in tumorigenesis has emerged recently; however, the expression and function of WWC3 in glioma remain largely unknown. Here, we found that WWC3 was significantly downregulated in glioma tissues and cell lines. Overexpression of WWC3 inhibited the glioma cell proliferation, migration, and invasion. Depletion of WWC3 promoted the proliferation of glioma cells. Mechanistically, we found that overexpression of WWC3 suppressed the activity of β-catenin, the signaling that tightly associates with cell proliferation and growth. Depletion of WWC3 enhanced the activity of β-catenin/Wnt signaling. Further investigation demonstrated that WWC3 interacted with T cell factor 4 (TCF4), an identified associated binding partner of β-catenin. The interaction between WWC3 and TCF4 might inhibit the transcriptional activation of β-catenin. Our results provide novel insights into the aberrant expression and molecular mechanism of WWC3 in glioma, which indicated WWC3 as a potential target for clinical intervention in glioma.
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Affiliation(s)
- Yanni Wang
- 1 Department of Pediatrics, The First College of Clinical Medical Science, China Three Gorges University , Yi Chang City, China
| | - Man Jiang
- 2 Department of Emergency, The First College of Clinical Medical Science, China Three Gorges University , Yi Chang City, China
| | - Yongshan Yao
- 3 Department of Emergency and Traumatic Surgery, The First College of Clinical Medical Science, China Three Gorges University , Yi Chang City, China
| | - Zhengwei Cai
- 1 Department of Pediatrics, The First College of Clinical Medical Science, China Three Gorges University , Yi Chang City, China
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