1
|
Novelli F, Yoshikawa Y, Vitto VAM, Modesti L, Minaai M, Pastorino S, Emi M, Kim JH, Kricek F, Bai F, Onuchic JN, Bononi A, Suarez JS, Tanji M, Favaron C, Zolondick AA, Xu R, Takanishi Y, Wang Z, Sakamoto G, Gaudino G, Grzymski J, Grosso F, Schrump DS, Pass HI, Atanesyan L, Smout J, Savola S, Sarin KY, Abolhassani H, Hammarström L, Pan-Hammarström Q, Giorgi C, Pinton P, Yang H, Carbone M. Germline BARD1 variants predispose to mesothelioma by impairing DNA repair and calcium signaling. Proc Natl Acad Sci U S A 2024; 121:e2405231121. [PMID: 38990952 PMCID: PMC11260134 DOI: 10.1073/pnas.2405231121] [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: 03/13/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
We report that ~1.8% of all mesothelioma patients and 4.9% of those younger than 55, carry rare germline variants of the BRCA1 associated RING domain 1 (BARD1) gene that were predicted to be damaging by computational analyses. We conducted functional assays, essential for accurate interpretation of missense variants, in primary fibroblasts that we established in tissue culture from a patient carrying the heterozygous BARD1V523A mutation. We found that these cells had genomic instability, reduced DNA repair, and impaired apoptosis. Investigating the underlying signaling pathways, we found that BARD1 forms a trimeric protein complex with p53 and SERCA2 that regulates calcium signaling and apoptosis. We validated these findings in BARD1-silenced primary human mesothelial cells exposed to asbestos. Our study elucidated mechanisms of BARD1 activity and revealed that heterozygous germline BARD1 mutations favor the development of mesothelioma and increase the susceptibility to asbestos carcinogenesis. These mesotheliomas are significantly less aggressive compared to mesotheliomas in asbestos workers.
Collapse
Affiliation(s)
- Flavia Novelli
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Yoshie Yoshikawa
- Department of Genetics, School of Medicine, Hyogo Medical University, Hyogo663-8501, Japan
| | - Veronica Angela Maria Vitto
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Lorenzo Modesti
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Michael Minaai
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Sandra Pastorino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Mitsuru Emi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Jin-Hee Kim
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Franz Kricek
- NBS-C Bioscience & Consulting GmbH, Vienna1230, Austria
| | - Fang Bai
- Shanghai Institute for Advanced Immunochemical Studies, Shanghai Tech University, Shanghai201210, China
| | - José N. Onuchic
- Center for Theoretical Biological Physics, Rice University, Houston, TX77005
| | - Angela Bononi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Joelle S. Suarez
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Mika Tanji
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Cristina Favaron
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Alicia A. Zolondick
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, HI96822
| | - Ronghui Xu
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Yasutaka Takanishi
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Zhanwei Wang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Greg Sakamoto
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Giovanni Gaudino
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | | | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera Santo Antonio and Santo Biagio (SS) Antonio e Biagio e Cesare Arrigo, Alessandria15121, Italy
| | - David S. Schrump
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD20892-1201
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University, New York, NY10016
| | - Lilit Atanesyan
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Jan Smout
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Suvi Savola
- Department of Oncogenetics, MRC Holland, Amsterdam 1057, the Netherlands
| | - Kavita Y. Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, CA94305
| | - Hassan Abolhassani
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Lennart Hammarström
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Qiang Pan-Hammarström
- Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm17165, Sweden
| | - Carlotta Giorgi
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Paolo Pinton
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara44121, Italy
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| | - Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI96816
| |
Collapse
|
2
|
Yu Z, Zhang Z, Liu J, Wu X, Fan X, Pang J, Bao H, Yin J, Wu X, Shao Y, Liu Z, Liu F. Identification of pathogenic germline variants in a large Chinese lung cancer cohort by clinical sequencing. Mol Oncol 2024; 18:1301-1315. [PMID: 37885353 PMCID: PMC11076998 DOI: 10.1002/1878-0261.13548] [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: 06/01/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023] Open
Abstract
Genetic factors play significant roles in the tumorigenicity of lung cancer; however, there is lack of systematic and large-scale characterization of pathogenic germline variants for lung cancer. In this study, germline variants in 146 preselected cancer-susceptibility genes were detected in 17 904 Chinese lung cancer patients by clinical next-generation sequencing. Among 17 904 patients, 1738 patients (9.7%) carried 1840 pathogenic/likely pathogenic (P/LP) variants from 87 cancer-susceptibility genes. SBDS (SBDS ribosome maturation factor) (1.37%), TSHR (thyroid stimulating hormone receptor) (1.20%), BLM (BLM RecQ like helicase) (0.62%), BRCA2 (BRCA2 DNA repair associated) (0.62%), and ATM (ATM serine/threonine kinase) (0.45%) were the top five genes with the highest overall prevalence. The top mutated pathways were all involved in DNA damage repair (DDR). Case-control analysis showed SBDS c.184A>T(p.K62*), TSHR c.1574T>C(p.F525S), BRIP1 (BRCA1 interacting helicase 1) c.1018C>T(p.L340F), and MUTYH (mutY DNA glycosylase) c.55C>T(p.R19*) were significantly associated with increased lung cancer risk (q value < 0.05). P/LP variants in certain genes were associated with early onset of lung cancer. Our study indicates that Chinese lung cancer patients have a higher prevalence of P/LP variants than previously reported. P/LP variants are distributed in multiple pathways and dominated by DNA damage repair-associated pathways. The association between identified P/LP variants and lung cancer risk requires further studies for verification.
Collapse
Affiliation(s)
- Zhe Yu
- Department of Respiratory MedicineNingbo NO.2 HospitalChina
| | - Zirui Zhang
- Department of Cardiovascular and Thoracic SurgeryNanjing Drum Tower Hospital Affiliated to Nanjing University School of MedicineChina
| | - Jun Liu
- Department of ChemotherapyAffiliated Hospital of Nantong UniversityChina
| | | | | | | | - Hua Bao
- Nanjing Geneseeq Technology Inc.China
| | - Jiani Yin
- Nanjing Geneseeq Technology Inc.China
| | - Xue Wu
- Nanjing Geneseeq Technology Inc.China
| | - Yang Shao
- Nanjing Geneseeq Technology Inc.China
- School of Public HealthNanjing Medical UniversityChina
| | - Zhengcheng Liu
- Department of Cardiovascular and Thoracic SurgeryNanjing Drum Tower Hospital Affiliated to Nanjing University School of MedicineChina
| | - Fang Liu
- Senior Department of OncologyThe Fifth Medical Center of PLA General HospitalBeijingChina
| |
Collapse
|
3
|
Yun KM, Bazhenova L. Emerging New Targets in Systemic Therapy for Malignant Pleural Mesothelioma. Cancers (Basel) 2024; 16:1252. [PMID: 38610930 PMCID: PMC11011044 DOI: 10.3390/cancers16071252] [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: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) is a heterogeneous cancer composed of distinct molecular and pathologic subtypes. Unfortunately, MPM is aggressive, and current therapies for advanced, unresectable disease remain limited to cytotoxic chemotherapy and immunotherapy. Our understanding of the genomic landscape of MPM is steadily growing, while the discovery of effective targeted therapies in MPM has advanced more slowly than in other solid tumors. Given the prevalence of alterations in tumor suppressor genes in MPM, it has been challenging to identify actionable targets. However, efforts to characterize the genetic signatures in MPM over the last decade have led to a range of novel targeted therapeutics entering early-phase clinical trials. In this review, we discuss the advancements made thus far in targeted systemic therapies in MPM and the future direction of targeted strategies in patients with advanced MPM.
Collapse
Affiliation(s)
- Karen M. Yun
- Division of Hematology-Oncology, Moores Cancer Center at UC San Diego Health, La Jolla, CA 92093, USA;
| | | |
Collapse
|
4
|
Cerbone L, Orecchia S, Bertino P, Delfanti S, de Angelis AM, Grosso F. Clinical Next Generation Sequencing Application in Mesothelioma: Finding a Golden Needle in the Haystack. Cancers (Basel) 2023; 15:5716. [PMID: 38136262 PMCID: PMC10741845 DOI: 10.3390/cancers15245716] [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: 09/27/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Mesothelioma comprises a group of rare cancers arising from the mesothelium of the pleura, peritoneum, tunica vaginalis testis and pericardium. Mesothelioma is generally associated with asbestos exposure and has a dismal prognosis, with few therapeutic options. Several next generation sequencing (NGS) experiments have been performed on mesothelioma arising at different sites. These studies highlight a genomic landscape mainly characterized by a high prevalence (>20%) of genomic aberrations leading to functional losses in oncosuppressor genes such as BAP1, CDKN2A, NF2, SETD2 and TP53. Nevertheless, to date, evidence of the effect of targeting these alterations with specific drugs is lacking. Conversely, 1-2% of mesothelioma might harbor activating mutations in oncogenes with specifically approved drugs. The goal of this review is to summarize NGS applications in mesothelioma and to provide insights into target therapy of mesothelioma guided by NGS.
Collapse
Affiliation(s)
- Luigi Cerbone
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Sara Orecchia
- Molecular Pathology Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy;
| | - Pietro Bertino
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Sara Delfanti
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Antonina Maria de Angelis
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Federica Grosso
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| |
Collapse
|
5
|
Farinea G, Crespi V, Listì A, Righi L, Bironzo P, Merlini A, Malapelle U, Novello S, Scagliotti GV, Passiglia F. The Role of Germline Mutations in Thoracic Malignancies: Between Myth and Reality. J Thorac Oncol 2023; 18:1146-1164. [PMID: 37331604 DOI: 10.1016/j.jtho.2023.05.028] [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: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
Considering the established contribution of environmental factors to the development of thoracic malignancies, the inherited susceptibility of these tumors has rarely been explored. However, the recent introduction of next-generation sequencing-based tumor molecular profiling in the real-word setting enabled us to deeply characterize the genomic background of patients with lung cancer with or without smoking-related history, increasing the likelihood of detecting germline mutations with potential prevention and treatment implications. Pathogenic germline variants have been detected in 2% to 3% of patients with NSCLC undergoing next-generation sequencing analysis, whereas the proportion of germline mutations associated with the development of pleural mesothelioma widely varies across different studies, ranging between 5% and 10%. This review provides an updated summary of emerging evidence about germline mutations in thoracic malignancies, focusing on pathogenetic mechanisms, clinical features, therapeutic implications, and screening recommendations for high-risk individuals.
Collapse
Affiliation(s)
- Giovanni Farinea
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Veronica Crespi
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Angela Listì
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| |
Collapse
|
6
|
Ganzinelli M, Guffanti F, Ianza A, Sobhani N, Crovella S, Zanconati F, Bottin C, Confalonieri M, Fumagalli S, Guglielmi A, Generali D, Damia G. Epithelioid Mesothelioma Patients with Very Long Survival Display Defects in DNA Repair. Cancers (Basel) 2023; 15:4309. [PMID: 37686585 PMCID: PMC10486625 DOI: 10.3390/cancers15174309] [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: 06/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
AIM DNA repair has an important role in malignant pleural mesothelioma (MPM) tumorigenesis and progression. Prognostic/predictive biomarkers for better management of MPM patients are needed. In the present manuscript, we analyzed the expression of more than 700 genes in a cohort of MPM patients to possibly find biomarkers correlated with survival. METHODS A total of 54 MPM patients, all with epithelioid histology, whose survival follow-up and formalin-fixed paraffin-embedded tumors were available, were included in the study. Gene expression profiles were evaluated using a Nanostring platform analyzing 760 genes involved in different cellular pathways. The percentages of proliferating tumor cells positive for RAD51 and BRCA1 foci were evaluated using an immunofluorescence assay, as a readout of homologous recombination repair status. RESULTS Patient median survival time was 16.9 months, and based on this value, they were classified as long and short survivors (LS/SS) with, respectively, an overall survival ≥ and <16.9 months as well as very long and very short survivors (VLS/VSS) with an overall survival ≥ than 33.8 and < than 8.45 months. A down-regulation in the DNA damage/repair expression score was observed in LS and VLS as compared to SS and VSS. These findings were validated by the lower number of both RAD51 and BRCA1-positive tumor cells in VLS as compared to VSS. CONCLUSIONS The down-regulation of DNA repair signature in VLS was functionally validated by a lower % of RAD51 and BRCA1-positive tumor cells. If these data can be corroborated in a prospective trial, an easy, cost-effective test could be routinely used to better manage treatment in MPM patients.
Collapse
Affiliation(s)
- Monica Ganzinelli
- Unit of Thoracic Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Federica Guffanti
- Laboratory of Preclinical Gynecological Oncology, Department of Experimental Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Anna Ianza
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Navid Sobhani
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Sergio Crovella
- IRCCS Burlo Garofolo, Via dell’Istria 65/1, 34137 Trieste, Italy;
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Cristina Bottin
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Stefano Fumagalli
- Laboratory of Biology of Neurodegenerative Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Alessandra Guglielmi
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Daniele Generali
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Giovanna Damia
- Laboratory of Preclinical Gynecological Oncology, Department of Experimental Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| |
Collapse
|
7
|
Dietz MV, van Kooten JP, Paats MS, Aerts JGVJ, Verhoef C, Madsen EVE, Dubbink HJ, von der Thüsen JH. Molecular alterations and potential actionable mutations in peritoneal mesothelioma: a scoping review of high-throughput sequencing studies. ESMO Open 2023; 8:101600. [PMID: 37453150 PMCID: PMC10368826 DOI: 10.1016/j.esmoop.2023.101600] [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: 04/04/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Peritoneal mesothelioma (PeM) is a rare malignancy with a poor prognosis. Currently there is a lack of effective systemic therapies. Due to the rarity of PeM, it is challenging to study new treatment options. Off-label use of targeted drugs could be an effective approach. This scoping review aims to explore the genomic landscape of PeM to identify potential therapeutic targets. MATERIALS AND METHODS A systematic literature search of Embase, Medline, Web of Science, the Cochrane Library, and Google Scholar was carried out up to 1 November 2022. Studies that reported on molecular alterations in PeM detected by high-throughput sequencing techniques were included. Genes that were altered in ≥1% of PeMs were selected for the identification of potential targeted therapies. RESULTS Thirteen articles were included, comprising 824 PeM patients. In total, 142 genes were altered in ≥1% of patients, of which 7 genes were altered in ≥10%. BAP1 was the most commonly altered gene (50%). Other commonly altered genes were NF2 (25%), CDKN2A (23%), CDKN2B (17%), PBRM1 (15%), TP53 (14%), and SETD2 (13%). In total, 17% of PeM patients were carriers of a germline mutation, mainly in BAP1 (7%). CONCLUSIONS This scoping review provides an overview of the mutational landscape of PeM. Germline mutations might be a larger contributor to the incidence of PeM than previously thought. Currently available targeted therapy options are limited, but several targeted agents [such as poly (ADP-ribose) polymerase (PARP), enhancer of zeste homolog 2 (EZH2), and cyclin-dependent kinase 4/6 (CDK4/6) inhibitors] were identified that might provide new targeted therapy options in the future.
Collapse
Affiliation(s)
| | | | - M S Paats
- Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam
| | - J G V J Aerts
- Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam
| | | | | | - H J Dubbink
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | | |
Collapse
|
8
|
Digifico E, Erreni M, Mannarino L, Marchini S, Ummarino A, Anfray C, Bertola L, Recordati C, Pistillo D, Roncalli M, Bossi P, Zucali PA, D’Incalci M, Belgiovine C, Allavena P. Important functional role of the protein osteopontin in the progression of malignant pleural mesothelioma. Front Immunol 2023; 14:1116430. [PMID: 37398648 PMCID: PMC10312076 DOI: 10.3389/fimmu.2023.1116430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Background Malignant Pleural Mesothelioma (MPM) is an aggressive cancer of the mesothelial lining associated with exposure to airborne non-degradable asbestos fibers. Its poor response to currently available treatments prompted us to explore the biological mechanisms involved in its progression. MPM is characterized by chronic non-resolving inflammation; in this study we investigated which inflammatory mediators are mostly expressed in biological tumor samples from MPM patients, with a focus on inflammatory cytokines, chemokines and matrix components. Methods Expression and quantification of Osteopontin (OPN) was detected in tumor and plasma samples of MPM patients by mRNA, immunohistochemistry and ELISA. The functional role of OPN was investigated in mouse MPM cell lines in vivo using an orthotopic syngeneic mouse model. Results In patients with MPM, the protein OPN was significantly more expressed in tumors than in normal pleural tissues and predominantly produced by mesothelioma cells; plasma levels were elevated in patients and associated with poor prognosis. However, modulation of OPN levels was not significantly different in a series of 18 MPM patients receiving immunotherapy with durvalumab alone or with pembrolizumab in combination with chemotherapy, some of whom achieved a partial clinical response. Two established murine mesothelioma cell lines: AB1 and AB22 of sarcomatoid and epithelioid histology, respectively, spontaneously produced high levels of OPN. Silencing of the OPN gene (Spp1) dramatically inhibited tumor growth in vivo in an orthotopic model, indicating that OPN has an important promoting role in the proliferation of MPM cells. Treatment of mice with anti-CD44 mAb, blocking a major OPN receptor, significantly reduced tumor growth in vivo. Conclusion These results demonstrate that OPN is an endogenous growth factor for mesothelial cells and inhibition of its signaling may be helpful to restrain tumor progression in vivo. These findings have translational potential to improve the therapeutic response of human MPM.
Collapse
Affiliation(s)
| | - Marco Erreni
- Unit of Advanced Optical Microscopy, IRCCS Humanitas Research Hospital, Milano, Italy
| | - Laura Mannarino
- Lab. Cancer Pharmacology, IRCCS Humanitas Research Hospital, Milano, Italy
- Department Biomedical Sciences, Humanitas University, Milano, Italy
| | - Sergio Marchini
- Lab. Cancer Pharmacology, IRCCS Humanitas Research Hospital, Milano, Italy
| | - Aldo Ummarino
- Department Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department Biomedical Sciences, Humanitas University, Milano, Italy
| | - Clément Anfray
- Department Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Bertola
- Mouse and Animal Pathology Lab., Fondazione Unimi, and Department of Veterinary Medicine and Animal Sciences, University of Milano, Lodi, Italy
| | - Camilla Recordati
- Mouse and Animal Pathology Lab., Fondazione Unimi, and Department of Veterinary Medicine and Animal Sciences, University of Milano, Lodi, Italy
| | - Daniela Pistillo
- Biobank, Humanitas IRCCS Humanitas Research Hospital, Milano, Italy
| | - Massimo Roncalli
- Department Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paola Bossi
- Department Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Andrea Zucali
- Department Biomedical Sciences, Humanitas University, Milano, Italy
- Department Oncology, IRCCS Humanitas Research Hospital, Milano, Italy
| | - Maurizio D’Incalci
- Lab. Cancer Pharmacology, IRCCS Humanitas Research Hospital, Milano, Italy
- Department Biomedical Sciences, Humanitas University, Milano, Italy
| | | | - Paola Allavena
- Department Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department Biomedical Sciences, Humanitas University, Milano, Italy
| |
Collapse
|
9
|
Belcaid L, Bertelsen B, Wadt K, Tuxen I, Spanggaard I, Højgaard M, Benn Sørensen J, Ravn J, Lassen U, Cilius Nielsen F, Rohrberg K, Westmose Yde C. New pathogenic germline variants identified in mesothelioma. Lung Cancer 2023; 179:107172. [PMID: 36944283 DOI: 10.1016/j.lungcan.2023.03.008] [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: 11/15/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Mesothelioma (MM) is associated with asbestos exposure, tumor heterogeneity and aggressive clinical behavior. Identification of germline pathogenic variants (PVs) in mesothelioma is relevant for identifying potential actionable targets and genetic counseling. METHODS 44 patients underwent whole exome sequencing (WES) or whole genome sequencing (WGS). Germline variants were selected according to association with inherited cancer using a 168-gene in silico panel, and variants classified according to ACMG/AMP classification as pathogenic (class 5) or likely pathogenic (class 4). RESULTS In total, 16 patients (36%) were found to carry pathogenic or likely pathogenic variants in 13 cancer associated genes (ATM, BAP1, BRCA2, CDKN2A, FANCA, FANCC, FANCD2, FANCM, MUTYH, NBN, RAD51B, SDHA and XPC). The germline PVs occurred in DNA repair pathways, including homologous recombination repair (HRR) (75%), nucleotide excision repair (6%), cell cycle regulatory (7%), base excision repair (6%), and hypoxic pathway (6%). Five (31%) patients with a germline PV had a first or second degree relative with mesothelioma compared to none for patients without a germline PV. Previously undiagnosed BRCA2 germline PVs were identified in two patients. Potential actionable targets based on the germline PVs were found in four patients (9%). CONCLUSION This study revealed a high frequency of germline PVs in patients with mesothelioma. Furthermore, we identified germline PVs in two genes (NBN & RAD51B) not previously associated with mesothelioma. The data support germline testing in mesothelioma and provide a rationale for additional investigation of the HRR pathway as a potential actionable target.
Collapse
Affiliation(s)
- Laila Belcaid
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Birgitte Bertelsen
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karin Wadt
- Dept. of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ida Tuxen
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Iben Spanggaard
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Højgaard
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jens Benn Sørensen
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jesper Ravn
- Dept. of Thoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ulrik Lassen
- Dept. of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Finn Cilius Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | |
Collapse
|
10
|
The Genes-Stemness-Secretome Interplay in Malignant Pleural Mesothelioma: Molecular Dynamics and Clinical Hints. Int J Mol Sci 2023; 24:ijms24043496. [PMID: 36834912 PMCID: PMC9963101 DOI: 10.3390/ijms24043496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
MPM has a uniquely poor somatic mutational landscape, mainly driven by environmental selective pressure. This feature has dramatically limited the development of effective treatment. However, genomic events are known to be associated with MPM progression, and specific genetic signatures emerge from the exceptional crosstalk between neoplastic cells and matrix components, among which one main area of focus is hypoxia. Here we discuss the novel therapeutic strategies focused on the exploitation of MPM genetic asset and its interconnection with the surrounding hypoxic microenvironment as well as transcript products and microvesicles representing both an insight into the pathogenesis and promising actionable targets.
Collapse
|
11
|
Casalone E, Birolo G, Pardini B, Allione A, Russo A, Catalano C, Mencoboni M, Ferrante D, Magnani C, Sculco M, Dianzani I, Grosso F, Mirabelli D, Filiberti RA, Rena O, Sacerdote C, Rodriguez-Barranco M, Smith-Byrne K, Panico S, Agnoli C, Johnson T, Kaaks R, Tumino R, Huerta JM, Riboli E, Heath AK, Trobajo-Sanmartín C, Schulze MB, Saieva C, Amiano P, Agudo A, Weiderpass E, Vineis P, Matullo G. Serum Extracellular Vesicle-Derived microRNAs as Potential Biomarkers for Pleural Mesothelioma in a European Prospective Study. Cancers (Basel) 2022; 15:125. [PMID: 36612122 PMCID: PMC9817828 DOI: 10.3390/cancers15010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive cancer with a dismal prognosis. Early therapeutic interventions could improve patient outcomes. We aimed to identify a pattern of microRNAs (miRNAs) as potential early non-invasive markers of MPM. In a case-control study nested in the European Prospective Investigation into Cancer and Nutrition cohort, we screened the whole miRNome in serum extracellular vesicles (EVs) of preclinical MPM cases. In a subgroup of 20 preclinical samples collected five years prior MPM diagnosis, we observed an upregulation of miR-11400 (fold change (FC) = 2.6, adjusted p-value = 0.01), miR-148a-3p (FC = 1.5, p-value = 0.001), and miR-409-3p (FC = 1.5, p-value = 0.04) relative to matched controls. The 3-miRNA panel showed a good classification capacity with an area under the receiver operating characteristic curve (AUC) of 0.81 (specificity = 0.75, sensitivity = 0.70). The diagnostic ability of the model was also evaluated in an independent retrospective cohort, yielding a higher predictive power (AUC = 0.86). A signature of EV miRNA can be detected up to five years before MPM; moreover, the identified miRNAs could provide functional insights into the molecular changes related to the late carcinogenic process, preceding MPM development.
Collapse
Affiliation(s)
| | - Giovanni Birolo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Barbara Pardini
- Italian Institute for Genomic Medicine, IIGM, 10060 Candiolo, Italy
- Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
| | | | - Alessia Russo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Chiara Catalano
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Manlio Mencoboni
- Medical Oncology, ASL 3 Genovese, Villa Scassi Hospital, 16149 Genoa, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, 28100 Novara, Italy
| | - Corrado Magnani
- Unit of Medical Statistics, Department of Translational Medicine, University of Eastern Piedmont and Cancer Epidemiology, CPO Piemonte, 28100 Novara, Italy
| | - Marika Sculco
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy
| | - Irma Dianzani
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy
- Interdepartmental Center for Studies on Asbestos and other Toxic Particulates “G. Scansetti”, University of Turin, 10126 Turin, Italy
| | - Federica Grosso
- Mesothelioma Unit, AO SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Città della Salute e della Scienza, University-Hospital and Center for Cancer Prevention (CPO), 10126 Turin, Italy
| | | | - Ottavio Rena
- Unit of Thoracic Surgery, University of Novara, 28100 Novara, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza, University-Hospital and Center for Cancer Prevention (CPO), 10126 Turin, Italy
| | - Miguel Rodriguez-Barranco
- Escuela Andaluza de Salud Pública (EASP), 18012 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Karl Smith-Byrne
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Salvatore Panico
- EPIC Centre of Naples, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, 80100 Napoli, Italy
| | - Claudia Agnoli
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), 69120 Heidelberg, Germany
| | - Rosario Tumino
- Hyblean Association for Epidemiology Research AIRE ONLYS, 97100 Ragusa, Italy
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London W2 1PG, UK
| | - Camino Trobajo-Sanmartín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Navarra Public Health Institute, 31008 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Calogero Saieva
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, 20014 San Sebastian, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, 08908 L’Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute—IDIBELL, 08908 L’Hospitalet de Llobregat, Spain
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College, London W2 1PG, UK
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
- Interdepartmental Center for Studies on Asbestos and other Toxic Particulates “G. Scansetti”, University of Turin, 10126 Turin, Italy
- Medical Genetics Unit, Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Medical Sciences, Via Santena 19, 10126 Torino, Italy
| |
Collapse
|
12
|
Lam SK, Mutsaers SE. Editorial: Novel agents and combinations for treatment of malignant pleural mesothelioma in pre-clinical models. Front Pharmacol 2022; 13:1015959. [PMID: 36147341 PMCID: PMC9486835 DOI: 10.3389/fphar.2022.1015959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sze-Kwan Lam
- Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Sze-Kwan Lam,
| | - Steven Eugene Mutsaers
- Institute for Respiratory Health, University of Western Australia, Nedlands, WA, Australia
| |
Collapse
|
13
|
Vimercati L, Cavone D, Fortarezza F, Delfino MC, Ficarella R, Gentile A, De Palma A, Marulli G, De Maria L, Caporusso C, Marzullo A, d’Amati A, Romano DE, Caputi A, Sponselli S, Serio G, Pezzuto F. Case report: Mesothelioma and BAP1 tumor predisposition syndrome: Implications for public health. Front Oncol 2022; 12:966063. [PMID: 35992853 PMCID: PMC9386481 DOI: 10.3389/fonc.2022.966063] [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] [Received: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
BRCA-1 associated protein 1 (BAP1) tumour predisposition syndrome (TPDS) is a hereditary condition characterised by germline mutation of the tumour suppressor BAP1. This disorder is associated with the development of various benign and malignant tumours, mainly involving the skin, eyes, kidneys, and mesothelium. In this article, we report the case of a man recruited through the Apulia (Southern Italy) Mesothelioma Regional Operational Centre of the National Register of Mesotheliomas, who suffered from uveal melanoma, renal cancer, and mesothelioma, and a familial cluster of BAP1 germline mutations demonstrated by molecular analyses. The family members of the proband developed multiple malignancies. As tumours arising in this context have specific peculiarities in terms of clinical behaviour, identification of this condition through appropriate genetic counselling should be considered for adequate primary, secondary, and tertiary prevention measures for offspring.
Collapse
Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Fortarezza
- Pathology Unit, Department of Medicine, School of Medicine and Surgery, University Hospital of Padova, University of Padova, Padova, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Romina Ficarella
- Medical Genetics Unit, Department of Human Reproductive Medicine, ASL Bari, Bari, Italy
| | - Angela Gentile
- Medical Genetics Unit, Department of Human Reproductive Medicine, ASL Bari, Bari, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Bari, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Concetta Caporusso
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Marzullo
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, Bari, Italy
| | - Antonio d’Amati
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Egidio Romano
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Sponselli
- Interdisciplinary Department of Medicine, Occupational Medicine Section Ramazzini, University of Bari Aldo Moro, Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, Bari, Italy
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health (DCTV), Pathology Unit, University of Padova, Padova, Italy
| |
Collapse
|
14
|
Diagnostics of BAP1-Tumor Predisposition Syndrome by a Multitesting Approach: A Ten-Year-Long Experience. Diagnostics (Basel) 2022; 12:diagnostics12071710. [PMID: 35885614 PMCID: PMC9317020 DOI: 10.3390/diagnostics12071710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Germline mutations in the tumor suppressor gene BRCA1-associated protein-1 (BAP1) lead to BAP1 tumor predisposition syndrome (BAP1-TPDS), characterized by high susceptibility to several tumor types, chiefly melanoma, mesothelioma, renal cell carcinoma, and basal cell carcinoma. Here, we present the results of our ten-year experience in the molecular diagnosis of BAP1-TPDS, along with a clinical update and cascade genetic testing of previously reported BAP1-TPDS patients and their relatives. Specifically, we sequenced germline DNA samples from 101 individuals with suspected BAP1-TPDS and validated pathogenic variants (PVs) by assessing BAP1 somatic loss in matching tumor specimens. Overall, we identified seven patients (7/101, 6.9%) carrying six different germline BAP1 PVs, including one novel variant. Consistently, cascade testing revealed a total of seven BAP1 PV carriers. In addition, we explored the mutational burden of BAP1-TPDS tumors by targeted next-generation sequencing. Lastly, we found that certain tumors present in PV carriers retain a wild-type BAP1 allele, suggesting a sporadic origin of these tumors or a functional role of heterozygous BAP1 in neoplastic development. Altogether, our findings have important clinical implications for therapeutic response of BAP1-TPDS patients.
Collapse
|