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Mendes B, Domingues I, Santos J. Radiomic Pipelines for Prostate Cancer in External Beam Radiation Therapy: A Review of Methods and Future Directions. J Clin Med 2024; 13:3907. [PMID: 38999473 PMCID: PMC11242211 DOI: 10.3390/jcm13133907] [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: 05/26/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Prostate Cancer (PCa) is asymptomatic at an early stage and often painless, requiring only active surveillance. External Beam Radiotherapy (EBRT) is currently a curative option for localised and locally advanced diseases and a palliative option for metastatic low-volume disease. Although highly effective, especially in a hypofractionation scheme, 17.4% to 39.4% of all patients suffer from cancer recurrence after EBRT. But, radiographic findings also correlate with significant differences in protein expression patterns. In the PCa EBRT workflow, several imaging modalities are available for grading, staging and contouring. Using image data characterisation algorithms (radiomics), one can provide a quantitative analysis of prognostic and predictive treatment outcomes. Methods: This literature review searched for original studies in radiomics for PCa in the context of EBRT. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review includes 73 new studies and analyses datasets, imaging modality, segmentation technique, feature extraction, selection and model building methods. Results: Magnetic Resonance Imaging (MRI) is the preferred imaging modality for radiomic studies in PCa but Computed Tomography (CT), Positron Emission Tomography (PET) and Ultrasound (US) may offer valuable insights on tumour characterisation and treatment response prediction. Conclusions: Most radiomic studies used small, homogeneous and private datasets lacking external validation and variability. Future research should focus on collaborative efforts to create large, multicentric datasets and develop standardised methodologies, ensuring the full potential of radiomics in clinical practice.
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Affiliation(s)
- Bruno Mendes
- Research Center of the Portuguese Institute of Oncology of Porto (CI-IPOP), Medical Physics, Radiobiology and Radiological Protection Group, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (I.D.); (J.S.)
- Faculty of Engineering of the University of Porto (FEUP), R. Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Inês Domingues
- Research Center of the Portuguese Institute of Oncology of Porto (CI-IPOP), Medical Physics, Radiobiology and Radiological Protection Group, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (I.D.); (J.S.)
- Polytechnic Institute of Coimbra, Coimbra Institute of Engineering, Rua Pedro Nunes-Quinta da Nora, 3030-199 Coimbra, Portugal
| | - João Santos
- Research Center of the Portuguese Institute of Oncology of Porto (CI-IPOP), Medical Physics, Radiobiology and Radiological Protection Group, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; (I.D.); (J.S.)
- School of Medicine and Biomedical Sciences (ICBAS), R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
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Hammers J, Lindsay D, Narayanasamy G, Sud S, Tan X, Dooley J, Marks LB, Chen RC, Das SK, Mavroidis P. Evaluation of the clinical impact of the differences between planned and delivered dose in prostate cancer radiotherapy based on CT-on-rails IGRT and patient-reported outcome scores. J Appl Clin Med Phys 2022; 24:e13780. [PMID: 36087039 PMCID: PMC9859987 DOI: 10.1002/acm2.13780] [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: 03/15/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To estimate the clinical impact of differences between delivered and planned dose using dose metrics and normal tissue complication probability (NTCP) modeling. METHODS Forty-six consecutive patients with prostate adenocarcinoma between 2010 and 2015 treated with intensity-modulated radiation therapy (IMRT) and who had undergone computed tomography on rails imaging were included. Delivered doses to bladder and rectum were estimated using a contour-based deformable image registration method. The bladder and rectum NTCP were calculated using dose-response parameters applied to planned and delivered dose distributions. Seven urinary and gastrointestinal symptoms were prospectively collected using the validated prostate cancer symptom indices patient reported outcome (PRO) at pre-treatment, weekly treatment, and post-treatment follow-up visits. Correlations between planned and delivered doses against PRO were evaluated in this study. RESULTS Planned mean doses to bladder and rectum were 44.9 ± 13.6 Gy and 42.8 ± 7.3 Gy, while delivered doses were 46.1 ± 13.4 Gy and 41.3 ± 8.7 Gy, respectively. D10cc for rectum was 64.1 ± 7.6 Gy for planned and 60.1 ± 9.3 Gy for delivered doses. NTCP values of treatment plan were 22.3% ± 8.4% and 12.6% ± 5.9%, while those for delivered doses were 23.2% ± 8.4% and 9.9% ± 8.3% for bladder and rectum, respectively. Seven of 25 patients with follow-up data showed urinary complications (28%) and three had rectal complications (12%). Correlations of NTCP values of planned and delivered doses with PRO follow-up data were random for bladder and moderate for rectum (0.68 and 0.67, respectively). CONCLUSION Sensitivity of bladder to clinical variations of dose accumulation indicates that an automated solution based on a DIR that considers inter-fractional organ deformation could recommend intervention. This is intended to achieve additional rectum sparing in cases that indicate higher than expected dose accumulation early during patient treatment in order to prevent acute severity of bowel symptoms.
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Affiliation(s)
- Jacob Hammers
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Daniel Lindsay
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ganesh Narayanasamy
- Department of Radiation OncologyUniversity of Arkansas for Medical SciencesArkansasUSA
| | - Shivani Sud
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Xianming Tan
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina HospitalsChapel HillNorth CarolinaUSA
| | - John Dooley
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Lawrence B. Marks
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ronald C. Chen
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Shiva K. Das
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Panayiotis Mavroidis
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
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3
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Redox-responsive nanoparticles enhance radiation therapy by altering multifaceted radio-resistance mechanisms in human castration-resistant prostate cancer cells and xenografts. Radiother Oncol 2022; 170:213-223. [DOI: 10.1016/j.radonc.2022.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/19/2022]
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Nakahara S, Ohguri T, Kakinouchi S, Itamura H, Morisaki T, Tani S, Yahara K, Fujimoto N. Intensity-Modulated Radiotherapy with Regional Hyperthermia for High-Risk Localized Prostate Carcinoma. Cancers (Basel) 2022; 14:cancers14020400. [PMID: 35053562 PMCID: PMC8774016 DOI: 10.3390/cancers14020400] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/25/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The purpose of this study was to evaluate the efficacy and toxicity of adding regional hyperthermia to intensity-modulated radiotherapy (IMRT) plus neoadjuvant androgen deprivation therapy (ADT) for high-risk localized prostate carcinoma. Methods: Data from 121 consecutive patients with high-risk prostate carcinoma who were treated with IMRT were retrospectively analyzed. The total planned dose of IMRT was 76 Gy in 38 fractions for all patients; hyperthermia was used in 70 of 121 patients. Intra-rectal temperatures at the prostate level were measured to evaluate thermal dose. Results: Median number of heating sessions was five and the median total thermal dose of CEM43T90 was 7.5 min. Median follow-up duration was 64 months. Addition of hyperthermia to IMRT predicted better clinical relapse-free survival. Higher thermal dose with CEM43T90 (>7 min) predicted improved biochemical disease-free survival. The occurrence of acute and delayed toxicity ≥Grade 2 was not significantly different between patients with or without hyperthermia. Conclusions: IMRT plus regional hyperthermia represents a promising approach with acceptable toxicity for high-risk localized prostate carcinoma. Further studies are needed to verify the efficacy of this combined treatment.
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Affiliation(s)
- Sota Nakahara
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
| | - Takayuki Ohguri
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
- Correspondence: ; Tel.: +81-93-691-7264; Fax: +81-93-692-0249
| | - Sho Kakinouchi
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
| | - Hirohide Itamura
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
| | - Takahiro Morisaki
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
| | - Subaru Tani
- Department of Therapeutic Radiology, University Hospital of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (S.N.); (S.K.); (H.I.); (T.M.); (S.T.)
| | - Katuya Yahara
- Department of Radiotherapy, Kurashiki Medical Center, Kurashiki 710-8522, Japan;
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan;
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Lee V, An Y, Park HS, Yu JB, Kim SP, Jairam V. Emergency department visits for radiation cystitis among patients with a prostate cancer history. BJU Int 2021; 130:208-216. [PMID: 34806813 DOI: 10.1111/bju.15650] [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: 03/05/2021] [Revised: 08/31/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy (RT) to the pelvic area, among patients with a prostate cancer history, and identify those who are at increased risk of requiring invasive measures. PATIENTS AND METHODS This study queried the Nationwide Emergency Department Sample for all ED visits from January 2006 to December 2015 with a primary diagnosis of RC and secondary diagnosis of prostate cancer. ED visits were characterised by demographic factors, socioeconomic factors, and hospital characteristics. Weighted frequencies were used to create national estimates for all data analysis. RESULTS A weighted total of 17 382 ED visits occurred for RC among patients with a prostate cancer history, of which 9655 (55.5%) were treated with an invasive procedure. Notable factors associated with undergoing an invasive procedure included having a prior prostatectomy (odds ratio [OR] 5.48, 95% confidence interval [CI] 2.62-11.46), urinary retention (OR 1.35, 95% CI 1.12-1.64), haematuria (OR 1.20, 95% CI 1.01-1.42), and undergoing a blood transfusion (OR 2.12, 95% CI 1.72-2.62). ED visits that were associated with invasive procedures had a higher median total charge ($34 707.53 vs $15 632.53) and an increased median length of stay (5 vs 3 days) compared to visits without an invasive procedure. CONCLUSIONS Among ED visits for RC in prostate cancer, approximately one half required an invasive procedure for treatment. While RT remains an effective modality for patients with prostate cancer, providers should be mindful of RC as a potential complication.
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Affiliation(s)
- Victor Lee
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
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Hammers JE, Pirozzi S, Lindsay D, Kaidar-Person O, Tan X, Chen RC, Das SK, Mavroidis P. Evaluation of a commercial DIR platform for contour propagation in prostate cancer patients treated with IMRT/VMAT. J Appl Clin Med Phys 2020; 21:14-25. [PMID: 32058663 PMCID: PMC7020979 DOI: 10.1002/acm2.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/08/2019] [Accepted: 08/06/2019] [Indexed: 11/12/2022] Open
Abstract
Purpose To assess the performance and limitations of contour propagation with three commercial deformable image registration (DIR) algorithms using fractional scans of CT‐on‐rails (CTOR) and Cone Beam CT (CBCT) in image guided prostate therapy patients treated with IMRT/VMAT. Methods Twenty prostate cancer patients treated with IMRT/VMAT were selected for analysis. A total of 453 fractions across those patients were analyzed. Image data were imported into MIM (MIM Software, Inc., Cleveland, OH) and three DIR algorithms (DIR Profile, normalized intensity‐based (NIB) and shadowed NIB DIR algorithms) were applied to deformably register each fraction with the planning CT. Manually drawn contours of bladder and rectum were utilized for comparison against the DIR propagated contours in each fraction. Four metrics were utilized in the evaluation of contour similarity, the Hausdorff Distance (HD), Mean Distance to Agreement (MDA), Dice Similarity Coefficient (DSC), and Jaccard indices. A subfactor analysis was performed per modality (CTOR vs. CBCT) and time (fraction). Point estimates and 95% confidence intervals were assessed via a Linear Mixed Effect model for the contour similarity metrics. Results No statistically significant differences were observed between the DIR Profile and NIB algorithms. However, statistically significant differences were observed between the shadowed NIB and NIB algorithms for some of the DIR evaluation metrics. The Hausdorff Distance calculation showed the NIB propagated contours vs. shadowed NIB propagated contours against the manual contours were 14.82 mm vs. 8.34 mm for bladder and 15.87 mm vs. 11 mm for rectum, respectively. Similarly, the Mean Distance to Agreement calculation comparing the NIB propagated contours vs. shadowed NIB propagated contours against the manual contours were 2.43 mm vs. 0.98 mm for bladder and 2.57 mm vs. 1.00 mm for rectum, respectively. The Dice Similarity Coefficients comparing the NIB propagated contours and shadowed NIB propagated contours against the manual contours were 0.844 against 0.936 for bladder and 0.772 against 0.907 for rectum, respectively. The Jaccard indices comparing the NIB propagated contours and shadowed NIB propagated contours against the manual contours were 0.749 against 0.884 for bladder and 0.637 against 0.831 for rectum, respectively. The shadowed NIB DIR, which showed the closest agreement with the manual contours performed significantly better than the DIR Profile in all the comparisons. The OAR with the greatest agreement varied substantially across patients and image guided radiation therapy (IGRT) modality. Intra‐patient variability of contour metric evaluation was insignificant across all the DIR algorithms. Statistical significance at α = 0.05 was observed for manual vs. deformably propagated contours for bladder for all the metrics except Hausdorff Distance (P = 0.01 for MDA, P = 0.02 for DSC, P = 0.01 for Jaccard), whereas the corresponding values for rectum were: P = 0.03 for HD, P = 0.01 for MDA, P < 0.01 for DSC, P < 0.01 for Jaccard. The performance of the different metrics varied slightly across the fractions of each patient, which indicates that weekly contour propagation models provide a reasonable approximation of the daily contour propagation models. Conclusion The high variance of Hausdorff Distance across all automated methods for bladder indicates widely variable agreement across fractions for all patients. Lower variance across all modalities, methods, and metrics were observed for rectum. The shadowed NIB propagated contours were substantially more similar to the manual contours than the DIR Profile or NIB contours for both the CTOR and CBCT imaging modalities. The relationship of each algorithm to similarity with manual contours is consistent across all observed metrics and organs. Screening of image guidance for substantial differences in bladder and rectal filling compared with the planning CT reference could aid in identifying fractions for which automated DIR would prove insufficient.
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Affiliation(s)
- Jacob E Hammers
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
| | | | - Daniel Lindsay
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
| | - Orit Kaidar-Person
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
| | - Shiva K Das
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC
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7
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Stevic I, Buescher G, Ricklefs FL. Monitoring Therapy Efficiency in Cancer through Extracellular Vesicles. Cells 2020; 9:cells9010130. [PMID: 31935901 PMCID: PMC7017260 DOI: 10.3390/cells9010130] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/21/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023] Open
Abstract
Extracellular vesicles (EVs) are a heterogeneous group of membrane-enclosed vesicles made of a phospholipid bilayer and are secreted by all cell types. EVs are present in a variety of body fluids containing proteins, DNA, RNA species, and lipids, and play an important role in cell- to-cell communication and are worth being considered as biomarkers for both early diagnosis of cancer patients and real-time monitoring of treatment response. Recently, emerging evidence verified EVs to have crucial roles in cancer progression and metastasis and a great potential in therapeutic applications. In this review, we discuss the potential of EVs in monitoring the efficacy of cancer therapies.
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Affiliation(s)
- Ines Stevic
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Gustav Buescher
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Franz Lennard Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Correspondence: ; Tel.: +49-40-7410-53750
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Khusbu FY, Zhou X, Roy M, Chen FZ, Cao Q, Chen HC. Resveratrol induces depletion of TRAF6 and suppresses prostate cancer cell proliferation and migration. Int J Biochem Cell Biol 2019; 118:105644. [PMID: 31712163 DOI: 10.1016/j.biocel.2019.105644] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/08/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023]
Abstract
Although the early diagnosis of prostate cancer (PCa) enhances life expectancy with a 5-year survival rate of 100 %, metastasized-PCa is the fundamental reason for death by PCa, hence requires an advanced and target-directed treatment strategy. Metastasis is considered to be initiated with the epithelial-mesenchymal transition (EMT) event in which tumor cells change their epithelial characteristics into mesenchymal form and exacerbates the cancer progression. Herein, we investigated the effect and mechanism of resveratrol function in PCa cell proliferation and migration and reported that TNF-receptor associated factor 6 (TRAF6), an unconventional E3 ligase, is a key mediator of resveratrol function to inhibit PCa cell growth and proliferation and targeted for lysosomal degradation by resveratrol. MTT and cell counting demonstrated that resveratrol inhibited the viability and proliferation in DU145 and PC3 cells. Resveratrol (50 μM) mediated the degradation of TRAF6 which in turn facilitated repression of the NF-κB pathway. Also, wound healing and transwell migration assays and level of EMT-related proteins showed that resveratrol used TRAF6, at least in part to inhibit cell migration. Overexpression of TRAF6 augmented EMT in PCa by upregulating the expression of transcription factor SLUG. Moreover, TRAF6 overexpression was closely associated with EMT process through the NF-κB pathway. Our exploration exhibited that resveratrol may inhibit EMT through the TRAF6/NF-κB/SLUG axis. Altogether, this study represents that TRAF6 acts as an intermediary of resveratrol action to suppress PCa cell proliferation and migration, and concerns future attention to obtain as a therapeutic target for the treatment of PCa.
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Affiliation(s)
- Farjana Yeasmin Khusbu
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.
| | - Xi Zhou
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Mridul Roy
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China; Molecular Science and Biomedicine Laboratory, State Key Laboratory for Chemo/Biosensing and Chemometrics, College of Biology, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Fang-Zhi Chen
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Qian Cao
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
| | - Han-Chun Chen
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.
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Villaggi E, Hernandez V, Fusella M, Moretti E, Russo S, Vaccara EML, Nardiello B, Esposito M, Saez J, Cilla S, Marino C, Stasi M, Mancosu P. Plan quality improvement by DVH sharing and planner's experience: Results of a SBRT multicentric planning study on prostate. Phys Med 2019; 62:73-82. [PMID: 31153401 DOI: 10.1016/j.ejmp.2019.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate, in a multi-institutional context, the role of Dose Volume Histogram (DVH) sharing in order to achieve higher plan quality, to harmonize prostate Stereotactic Body Radiation Therapy (SBRT) plans and to assess if the planner's experience in SBRT could lead to lower dose at organs at risk (OARs). METHODS During the first phase five patients enrolled for prostate SBRT were planned by multiple physicists according to common protocol. The prescription dose was 35 Gy in 5 fractions. Dosimetric parameters, modulation index (MIt), plan parameters, and planner experience level (EL) were statistically analyzed. During the second phase median DVHs from all centers were shared and physicists replanned one patient of the five, aiming at inter-planner harmonization and further OARs sparing. Data were summarized by Spearman-correlogram (p < 0.05) and boxplots. The Kruskal-Wallis test was used to compare the re-plans to the original plans. RESULTS Seventy-eight SBRT plans from 13 centers were evaluated. EL correlated with modulation of plan parameters and reduction of OARs doses, such as volume receiving 28 Gy of rectum (rectum-V28Gy), rectum-V32Gy, and bladder-V30Gy. The re-plans showed significant reduced variability in rectum-V28Gy and increased PTV dose homogeneity. No significant difference in plan complexity metrics and plan parameters between plans and re-plans were obtained. CONCLUSIONS Planner's experience in prostate SBRT was correlated with dosimetric parameters. Sharing median DVHs reduced variability among centers whilst keeping the same level of plan complexity. SBRT planning skills can benefit from a replanning phase after sharing DVHs from multiple centers, improving plan quality and concordance among centers.
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Affiliation(s)
- Elena Villaggi
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Piacenza, Italy.
| | - Victor Hernandez
- Hospital Universitari Sant Joan de Reus, Department of Medical Physics, Tarragona, Spain
| | - Marco Fusella
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Eugenia Moretti
- Department of Medical Physics, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | | | | | - Marco Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | - Jordi Saez
- Hospital Clinic de Barcelona, Department of Radiation Oncology, Barcelona, Spain
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso, Italy
| | | | - Michele Stasi
- Department of Medical Physics, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiation Oncology Dept., Humanitas Research Hospital, Milano, Italy
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Scaggion A, Fusella M, Roggio A, Bacco S, Pivato N, Rossato MA, Peña LMA, Paiusco M. Reducing inter- and intra-planner variability in radiotherapy plan output with a commercial knowledge-based planning solution. Phys Med 2018; 53:86-93. [PMID: 30241759 DOI: 10.1016/j.ejmp.2018.08.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 02/02/2023] Open
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11
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Malla B, Aebersold DM, Dal Pra A. Protocol for serum exosomal miRNAs analysis in prostate cancer patients treated with radiotherapy. J Transl Med 2018; 16:223. [PMID: 30103771 PMCID: PMC6090775 DOI: 10.1186/s12967-018-1592-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Circulating exosomes from prostate cancer (PCa) patients undergoing radiotherapy are attractive candidate biomarkers for monitoring treatment response. Multiple workflows for isolation and content characterization of exosomes in biofluids have been attempted. We report a protocol to isolate and characterize exosomal miRNAs content and assess radiation-induced changes. METHODS In this pilot study, we performed targeted exosomal miRNA profiling of 25 serum samples obtained from PCa patients with intermediate- and high-risk disease treated with curative radiotherapy (RT), and controls. Post-treatment blood samples were collected at least 28 days after radiation therapy as a paired follow-up sample. The complete workflow consisted of two phases: I) filtration and polyethylene glycol salt precipitation phase which enriched particles below 200 nm in size followed by characterization using electron microscopy, and II) flow cytometry. Finally, miRNA expression analysis between untreated and treated patient samples was performed using RNA extraction kit, and qRT-PCR. RESULTS In our preliminary data, 1 ml of serum from PCa patients showed higher exosomal concentration (3.68E+10) compared to controls (6.07E+08). The overall expression of exosomes after RT was found to be higher compared to untreated samples; the median value changed from 3.68E+10 to 5.40E+10; p = 0.52. Using electron microscopy, we were able to visualize cup-shaped vesicles with morphology and size compatible with exosomes. The bead-based flow cytometry showed positivity for exosomal tetraspanins surface markers CD63 and CD9. All five miRNAs (hsa-let-7a-5p, hsa-miR-141-3p, hsa-miR-145-5p, hsa-miR-21-5p, hsa-miR-99b-5p) have been identified in exosomes. Despite overall changes in hsa-let-7a-5p expression after radiation, the difference was significant only in the high-risk group (p = 0.037). In addition, the radiation response to hsa-miR-21-5p was elevated in the high-risk group compared to the intermediate group (p = 0.036). CONCLUSIONS Herewith, we demonstrated a protocol for isolation of serum exosomes and exosomal miRNA amplification. The recovery of exosomal miRNAs and their differential expression after radiation treatment suggests promising biomarker potential that requires further investigation in larger patient cohorts.
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Affiliation(s)
- Bijaya Malla
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL USA
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Hayama Y, Doi H, Hasegawa T, Minami Y, Ichimura N, Koike M, Shiomi H, Oh RJ, Oishi F. Lower urinary tract symptoms in patients with prostate cancer under and after intensity-modulated radiation therapy. Low Urin Tract Symptoms 2018; 11:O127-O134. [PMID: 30010254 DOI: 10.1111/luts.12230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/09/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present study was to collect data on the characteristics, degree, and natural course of urinary complications, as well as self-care for such complications, in patients during and after prostate intensity-modulated radiation therapy (IMRT). METHODS Quality of life data were collected retrospectively for all eligible patients who underwent IMRT. In all eligible patients, urinary symptoms were evaluated using questionnaires and face-to-face interview. Participants were asked to respond to a self-administered questionnaire concerning the core lower urinary tract symptom score during the course of IMRT and up to 12 months after the completion of IMRT. RESULTS In all, 29 eligible patients were included in the study. The frequency of urinary symptoms increased over of the course of IMRT, decreased at ≥3 months after completion of IMRT, and disappeared 6 months after IMRT. Responses to the questionnaire revealed a variety of approaches to self-care and adaptations by patients to manage urinary symptoms. CONCLUSIONS During and after IMRT for localized prostate cancer, patients often developed more frequent urination and urgency than at the start of IMRT, and recovered 3-6 months after the completion of IMRT. Based on the present study, clinicians and nurses could help convey this information to patients and thus offer better support.
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Affiliation(s)
- Yuka Hayama
- Department of Nursing, Faculty of Nursing, Doshisha Women's College of Liberal Arts, Kyoto, Japan.,Miyakojima IGRT Clinic, Osaka, Japan
| | - Hiroshi Doi
- Miyakojima IGRT Clinic, Osaka, Japan.,Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Yumi Minami
- Department of Nursing, Faculty of Nursing and Rehabilitation, Mukogawa Women's University, Nishinomiya, Japan
| | | | | | | | | | - Fumiko Oishi
- Department of Nursing, Faculty of Nursing, Seirei Christopher University, Shizuoka, Japan
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13
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Malla B, Zaugg K, Vassella E, Aebersold DM, Dal Pra A. Exosomes and Exosomal MicroRNAs in Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 98:982-995. [PMID: 28721912 DOI: 10.1016/j.ijrobp.2017.03.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
Despite current risk stratification systems using traditional clinicopathologic factors, many localized and locally advanced prostate cancers fail radical treatment (ie, radical prostatectomy, radiation therapy with or without androgen deprivation therapy). Therefore, a pressing need exists for enhanced methods of disease stratification through novel prognostic and predictive tools that can reliably be applied in clinical practice. Exosomes are 50- to 150-nm small vesicles released by cancer cells that reflect the genetic and nongenetic materials of parent cancer cells. Cancer cells can contain distinct sets of microRNA profiles, the expression of which can change owing to stress such as radiation therapy. These alterations or distinctions in contents allow exosomes to be used as prognostic and/or predictive biomarkers and to monitor the treatment response. Additionally, microRNAs have been shown to influence multiple processes in prostate tumorigenesis, including cell proliferation, induction of apoptosis, migration, oncogene inhibition, and radioresistance. Thus, comparative exosomal microRNA profiling at different levels could help portray tumor aggressiveness and response to radiation therapy. Although technical challenges persist in exosome isolation and characterization, recent improvements in microRNA profiling have evolved toward in-depth analyses of the exosomal cargo and its functions. We have reviewed the role of exosomes and exosomal microRNAs in biologic processes of prostate cancer progression and radiation therapy response, with a particular focus on the development of clinical assays for treatment personalization.
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Affiliation(s)
- Bijaya Malla
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Erik Vassella
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Bern University Hospital, Inselspital, Bern, Switzerland.
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Cagni E, Botti A, Micera R, Galeandro M, Sghedoni R, Orlandi M, Iotti C, Cozzi L, Iori M. Knowledge-based treatment planning: An inter-technique and inter-system feasibility study for prostate cancer. Phys Med 2017; 36:38-45. [PMID: 28410684 DOI: 10.1016/j.ejmp.2017.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Helical Tomotherapy (HT) plans were used to create two RapidPlan knowledge-based (KB) models to generate plans with different techniques and to guide the optimization in a different treatment planning system for prostate plans. Feasibility and performance of these models were evaluated. MATERIAL AND METHODS two sets of 35 low risk (LR) and 30 intermediate risk (IR) prostate cancer cases who underwent HT treatments were selected to train RapidPlan models. The KB predicted constraints were used to perform new 20KB plans using RapidArc technique (KB-RA) (inter-technique validation), and to optimise 20 new HT (KB-HT) plans in the Tomoplan (inter-system validation). For each validation modality, KB plans were benchmarked with the manual plans created by an expert planner (EP). RESULTS RapidPlan was successfully configured using HT plans. The KB-RA plans fulfilled the clinical dose-volume requirements in 100% and 92% of cases for planning target volumes (PTVs) and organs at risk (OARs), respectively. For KB-HT plans these percentages were found to be a bit lower: 90% for PTVs and 86% for OARs. In comparison to EP plans, the KB-RA plans produced higher bladder doses for both LR and IR, and higher rectum doses for LR. KB-HT and EP plans produced similar results. CONCLUSION RapidPlan can be trained to create models by using plans of a different treatment modality. These models were suitable for generating clinically acceptable plans for inter-technique and inter-system applications. The use of KB models based on plans of consolidated technique could be useful with a new treatment modality.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Andrea Botti
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Renato Micera
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Maria Galeandro
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Roberto Sghedoni
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Matteo Orlandi
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Cinzia Iotti
- Radiotherapy Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
| | - Mauro Iori
- Medical Physics Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
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Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know? BIOMED RESEARCH INTERNATIONAL 2016; 2016:6829875. [PMID: 28116302 PMCID: PMC5225325 DOI: 10.1155/2016/6829875] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
Radiotherapy (RT) for prostate cancer (PC) has steadily evolved over the last decades, with improving biochemical disease-free survival. Recently population based research also revealed an association between overall survival and doses ≥ 75.6 Gray (Gy) in men with intermediate- and high-risk PC. Examples of improved RT techniques are image-guided RT, intensity-modulated RT, volumetric modulated arc therapy, and stereotactic ablative body RT, which could facilitate further dose escalation. Brachytherapy is an internal form of RT that also developed substantially. New devices such as rectum spacers and balloons have been developed to spare rectal structures. Newer techniques like protons and carbon ions have the intrinsic characteristics maximising the dose on the tumour while minimising the effect on the surrounding healthy tissue, but clinical data are needed for confirmation in randomised phase III trials. Furthermore, it provides an overview of an important discussion issue in PC treatment between urologists and radiation oncologists: the comparison between radical prostatectomy and RT. Current literature reveals that all possible treatment modalities have the same cure rate, but a different toxicity pattern. We recommend proposing the possible different treatment modalities with their own advantages and side-effects to the individual patient. Clinicians and patients should make treatment decisions together (shared decision-making) while using patient decision aids.
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Improta I, Palorini F, Cozzarini C, Rancati T, Avuzzi B, Franco P, Degli Esposti C, Del Mastro E, Girelli G, Iotti C, Vavassori V, Valdagni R, Fiorino C. Bladder spatial-dose descriptors correlate with acute urinary toxicity after radiation therapy for prostate cancer. Phys Med 2016; 32:1681-1689. [DOI: 10.1016/j.ejmp.2016.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022] Open
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The role of medical physics in prostate cancer radiation therapy. Phys Med 2016; 32:435-7. [PMID: 27095755 DOI: 10.1016/j.ejmp.2016.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 01/20/2023] Open
Abstract
Medical physics, both as a scientific discipline and clinical service, hugely contributed and still contributes to the advances in the radiotherapy of prostate cancer. The traditional translational role in developing and safely implementing new technology and methods for better optimizing, delivering and monitoring the treatment is rapidly expanding to include new fields such as quantitative morphological and functional imaging and the possibility of individually predicting outcome and toxicity. The pivotal position of medical physicists in treatment personalization probably represents the main challenge of current and next years and needs a gradual change of vision and training, without losing the traditional and fundamental role of physicists to guarantee a high quality of the treatment. The current focus issue is intended to cover traditional and new fields of investigation in prostate cancer radiation therapy with the aim to provide up-to-date reference material to medical physicists daily working to cure prostate cancer patients. The papers presented in this focus issue touch upon present and upcoming challenges that need to be met in order to further advance prostate cancer radiation therapy. We suggest that there is a smart future for medical physicists willing to perform research and innovate, while they continue to provide high-quality clinical service. However, physicists are increasingly expected to actively integrate their implicitly translational, flexible and high-level skills within multi-disciplinary teams including many clinical figures (first of all radiation oncologists) as well as scientists from other disciplines.
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Mencia G, del Olmo NS, Muñoz-Moreno L, Maroto-Diaz M, Gomez R, Ortega P, José Carmena M, Javier de la Mata F. Polyphenolic carbosilane dendrimers as anticancer agents against prostate cancer. NEW J CHEM 2016. [DOI: 10.1039/c6nj02545e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Polyphenolic carbosilane dendrimers improved the antioxidant and anticancer properties of free vanillin.
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Affiliation(s)
- Gabriel Mencia
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
| | - Natalia Sanz del Olmo
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
| | - Laura Muñoz-Moreno
- Departamento de Biología de Sistemas, Universidad de Alcalá
- Campus Universitario
- E-28871 Alcalá de Henares
- Spain
| | - Marta Maroto-Diaz
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
| | - Rafael Gomez
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
| | - Paula Ortega
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
| | - Ma José Carmena
- Departamento de Biología de Sistemas, Universidad de Alcalá
- Campus Universitario
- E-28871 Alcalá de Henares
- Spain
| | - F. Javier de la Mata
- Departamento de Química Orgánica y Química Inorgánica, Universidad de Alcalá
- Campus Universitario
- Edificio de Farmacia
- E-28871 Alcalá de Henares
- Spain
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