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Si Y, Guan J, Xu Y, Chen K, Kim S, Zhou L, Jaskula-Sztul R, Liu XM. Dual-Targeted Extracellular Vesicles to Facilitate Combined Therapies for Neuroendocrine Cancer Treatment. Pharmaceutics 2020; 12:E1079. [PMID: 33187322 PMCID: PMC7696983 DOI: 10.3390/pharmaceutics12111079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022] Open
Abstract
Neuroendocrine (NE) cancers arise from cells within the neuroendocrine system. Chemotherapies and endoradiotherapy have been developed, but their clinical efficacy is limited. The objective of this study was to develop a dual-targeted extracellular vesicles (EV)-delivered combined therapies to treat NE cancer. Specifically, we produced EV in stirred-tank bioreactors and surface tagged both anti-somatostatin receptor 2 (SSTR 2) monoclonal antibody (mAb) and anti-C-X-C motif chemokine receptor 4 (CXCR4) mAb to generate mAbs-EV. Both live-cell confocal microscopy imaging and In Vivo Imaging System (IVIS) imaging confirmed that mAbs-EV specifically targeted and accumulated in NE cancer cells and NE tumor xenografts. Then the highly potent natural cytotoxic marine compound verrucarin A (Ver-A) with IC50 of 2.2-2.8 nM and microtubule polymerization inhibitor mertansine (DM1) with IC50 of 3.1-4.2 nM were packed into mAbs-EV. The in vivo maximum tolerated dose study performed in non-tumor-bearing mice indicated minimal systemic toxicity of mAbs-EV-Ver-A/DM1. Finally, the in vivo anticancer efficacy study demonstrated that the SSTR2/CXCR4 dual-targeted EV-Ver-A/DM1 is more effective to inhibit NE tumor growth than the single targeting and single drug. The results from this study could expand the application of EV to targeting deliver the combined potent chemotherapies for cancer treatment.
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Affiliation(s)
- Yingnan Si
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
| | - JiaShiung Guan
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
| | - Yuanxin Xu
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
| | - Kai Chen
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
| | - Seulhee Kim
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
| | - Lufang Zhou
- Department of Medicine, University of Alabama at Birmingham, 703 19th Street South, Birmingham, AL 35294, USA;
| | - Renata Jaskula-Sztul
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL 35294, USA;
| | - X. Margaret Liu
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL 35294, USA; (Y.S.); (J.G.); (Y.X.); (K.C.); (S.K.)
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Chouliaras K, Newman NA, Shukla M, Swett KR, Levine EA, Sham J, Mann GN, Shen P. Analysis of recurrence after the resection of pancreatic neuroendocrine tumors. J Surg Oncol 2018; 118:416-421. [PMID: 30259518 DOI: 10.1002/jso.25146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Outcomes after recurrence of resected pancreatic neuroendocrine tumors (PNETs) are not well described. We aim to assess the rate and sites of recurrence, and its effect on clinical outcomes. METHODS Retrospective chart review of patients (n = 83) who underwent surgical resection of PNETs at 2 institutions. Patients were treated from September 2002 to July 2010. RESULTS There were 13 (16%) recurrences. The most common site of recurrence was the liver (9 patients, 9.6%). The most common treatment of recurrences was chemotherapy (5 patients, 36%). The 1-, 3-, and 5-year disease-free survival was 90.9%, 82.7%, and 72.5%, respectively. Median recurrence-free survival was 127 months. The median follow-up for all PNET patients was 25.8 months (range, 1-140 months). The 3-year survival was 97%. The median follow-up of patients after the diagnosis of a recurrence was 13.8 months. The overall survival for those with and without recurrence was 96.3% and 100%, respectively (P = .36). The age ( P = .002) and lymph node ratio ( P < .001) were predictors of recurrence on multivariate analysis. CONCLUSIONS Age and lymph node ratio are significant predictors of recurrence after the resection of PNETs with hepatic metastases being the most common. Survival of patients with recurrence is not significantly different from patients without recurrence.
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Affiliation(s)
- Konstantinos Chouliaras
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Naeem A Newman
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Mrinal Shukla
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Katrina R Swett
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Edward A Levine
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Jonathan Sham
- Department of Surgery, Section of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Gary N Mann
- Department of Surgery, Section of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Perry Shen
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
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Chen G, Jaskula-Sztul R, Esquibel CR, Lou I, Zheng Q, Dammalapati A, Harrison A, Eliceiri KW, Tang W, Chen H, Gong S. Neuroendocrine Tumor-Targeted Upconversion Nanoparticle-Based Micelles for Simultaneous NIR-Controlled Combination Chemotherapy and Photodynamic Therapy, and Fluorescence Imaging. ADVANCED FUNCTIONAL MATERIALS 2017; 27:1604671. [PMID: 28989337 PMCID: PMC5630134 DOI: 10.1002/adfm.201604671] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Although neuroendocrine tumors (NETs) are slow growing, they are frequently metastatic at the time of discovery and no longer amenable to curative surgery, emphasizing the need for the development of other treatments. In this study, multifunctional upconversion nanoparticle (UCNP)-based theranostic micelles are developed for NET-targeted and near-infrared (NIR)-controlled combination chemotherapy and photodynamic therapy (PDT), and bioimaging. The theranostic micelle is formed by individual UCNP functionalized with light-sensitive amphiphilic block copolymers poly(4,5-dimethoxy-2-nitrobenzyl methacrylate)-polyethylene glycol (PNBMA-PEG) and Rose Bengal (RB) photosensitizers. A hydrophobic anticancer drug, AB3, is loaded into the micelles. The NIR-activated UCNPs emit multiple luminescence bands, including UV, 540 nm, and 650 nm. The UV peaks overlap with the absorption peak of photocleavable hydrophobic PNBMA segments, triggering a rapid drug release due to the NIR-induced hydrophobic-to-hydrophilic transition of the micelle core and thus enabling NIR-controlled chemotherapy. RB molecules are activated via luminescence resonance energy transfer to generate 1O2 for NIR-induced PDT. Meanwhile, the 650 nm emission allows for efficient fluorescence imaging. KE108, a true pansomatostatin nonapeptide, as an NET-targeting ligand, drastically increases the tumoral uptake of the micelles. Intravenously injected AB3-loaded UCNP-based micelles conjugated with RB and KE108-enabling NET-targeted combination chemotherapy and PDT-induce the best antitumor efficacy.
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Affiliation(s)
- Guojun Chen
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53715, USA. Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Renata Jaskula-Sztul
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Corinne R Esquibel
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Irene Lou
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Qifeng Zheng
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53715, USA. Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Ajitha Dammalapati
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - April Harrison
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Kevin W Eliceiri
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, USA. Department of Biomedical Engineering University of Wisconsin-Madison, Madison, WI 53706, USA. Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Weiping Tang
- School of Pharmacy, University of Wisconsin-Madison, WI 53705, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Shaoqin Gong
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53715, USA. Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, USA. Department of Biomedical Engineering University of Wisconsin-Madison Madison, WI 53706, USA
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Flanders VL, Gervais DA. Ablation of Liver Metastases: Current Status. J Vasc Interv Radiol 2010; 21:S214-22. [DOI: 10.1016/j.jvir.2010.01.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/09/2009] [Accepted: 01/19/2010] [Indexed: 02/07/2023] Open
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Pitt SC, Chen H, Kunnimalaiyaan M. Inhibition of phosphatidylinositol 3-kinase/Akt signaling suppresses tumor cell proliferation and neuroendocrine marker expression in GI carcinoid tumors. Ann Surg Oncol 2009; 16:2936-42. [PMID: 19588205 DOI: 10.1245/s10434-009-0591-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 06/11/2009] [Accepted: 06/11/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Overactivation of PI3K/Akt signaling facilitates tumor proliferation in several cancers. We have shown that various signal transduction pathways promote tumorigenesis in carcinoid tumors, which exhibit endogenously high levels of active, phosphorylated Akt. Therefore, we hypothesized that inhibition of the PI3K/Akt pathway would suppress carcinoid tumor cell growth and neuroendocrine (NE) marker production. METHODS Human carcinoid BON cells were treated in vitro with LY294002, a PI3-kinase inhibitor, or transfected with Akt1 siRNA. Tumor cell proliferation was measured by MTT for 6 days. The effect of LY294002 or Akt1 siRNA treatment was assessed by Western analysis. We examined the levels of phosphorylated Akt, total Akt, Akt1, and the NE markers human achaete-scute homolog1 (ASCL1) and chromogranin A (CgA). RESULTS Treatment of BON cells with LY294002 reduced tumor cell proliferation (76%) in a dose-dependent manner. Growth also decreased in Akt1 siRNA transfected cells (26%). Levels of active, phosphorylated Akt and the NE tumor markers, ASCL1 and CgA, were diminished with both LY294002 and Akt1 siRNA treatments proportional to the degree of Akt inhibition. Total Akt, Akt2, and Akt3 levels were unaffected by these experiments. CONCLUSIONS These data indicate that PI3K/Akt signaling performs a critical role in human carcinoid tumor cell survival and NE hormone generation. Furthermore, the development of novel therapeutics targeting Akt1 or components of the PI3K/Akt pathway may enhance the management of carcinoid disease.
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Affiliation(s)
- Susan C Pitt
- Endocrine Surgery Research Laboratory, Department of Surgery, University of Wisconsin, Madison, WI, USA
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Ellison EC, Johnson JA. The Zollinger-Ellison syndrome: a comprehensive review of historical, scientific, and clinical considerations. Curr Probl Surg 2009; 46:13-106. [PMID: 19059523 DOI: 10.1067/j.cpsurg.2008.09.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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7
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Pereira PL. Actual role of radiofrequency ablation of liver metastases. Eur Radiol 2007; 17:2062-70. [PMID: 17429644 DOI: 10.1007/s00330-007-0587-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Revised: 12/18/2006] [Accepted: 01/09/2007] [Indexed: 01/12/2023]
Abstract
The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour. More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20% of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective (versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement in patients with liver metastases.
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Affiliation(s)
- Philippe L Pereira
- Department of Diagnostic Radiology, Eberhard-Karls-University of Tübingen, Hoppe-Seyler-Str.3, 72076 Tuebingen, Germany.
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Abstract
The physiologic sequelae of a gastrinoma can be well controlled with medical therapy. The role of surgery has shifted from managing acid hyper-secretion and ulcer complications to preventing metastatic disease and managing symptomatic metastases. With improved methods of imaging for the detection of occult gastrinomas, the prospective evaluation of the role for surgery in altering the natural history of these tumors is now possible.
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Affiliation(s)
- Steven K Libutti
- Tumor Angiogenesis Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, CRC 4-5940, 10 Center Drive, Bethesda, MD 20892, USA.
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Blonski WC, Reddy KR, Shaked A, Siegelman E, Metz DC. Liver transplantation for metastatic neuroendocrine tumor: a case report and review of the literature. World J Gastroenterol 2006; 11:7676-83. [PMID: 16437698 PMCID: PMC4727220 DOI: 10.3748/wjg.v11.i48.7676] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine tumors are divided into gastrointestinal carcinoids and pancreatic neuroendocrine tumors. The WHO has updated the classification of these lesions and has abandoned the term "carcinoid". Both types of tumors are divided into functional and non-functional tumors. They are characterized by slow growth and frequent metastasis to the liver and may be limited to the liver for long periods. The therapeutic approach to hepatic metastases should consider the number and distribution of the liver metastases as well as the severity of symptoms related to hormone production and tumor bulk. Surgery is generally considered as the first line therapy. In patients with unresectable liver metastases, alternative treatments are dependent on the type and the growth rate. Initial treatments consist of long acting somatostatin analogs and/or interferon. Streptozocin-based chemotherapy is usually reserved for symptomatic patients with rapidly advancing disease, but generally the therapy is poorly tolerated and its effects are short-lived. Locoregional therapy directed such as hepatic-artery embolization and chemoembolization, radiofrequency thermal ablation and cryosurgery, is often used instead of systemic therapy, if the disease is limited to the liver. However, liver transplantation should be considered in patients with neuroendocrine metastases to the liver that are not accessible to curative or cytoreductive surgery and if medical or locoregional treatment has failed and if there are life threatening hormonal symptoms. We report a case of liver transplantation for metastatic neuroendocrine tumor of unknown primary source and provide a detailed review of the world literature on this controversial topic.
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Affiliation(s)
- Wojciech C Blonski
- Gastroenterology Division, University of Pennsylvania Health System, 3400 Spruce Street, 3 Ravdin Building, Philadelphia, PA 19104, USA
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Kunnimalaiyaan M, Chen H. The Raf-1 pathway: a molecular target for treatment of select neuroendocrine tumors? Anticancer Drugs 2006; 17:139-42. [PMID: 16428931 DOI: 10.1097/00001813-200602000-00004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuroendocrine (NE) tumors such as medullary thyroid cancer, carcinoid, small cell lung cancer and pheochromocytoma are metastatic in nature, and secrete biogenic amines and hormones. In this review, we will discuss the possibility that activation of the Ras/Raf signaling pathway may be a therapeutic target for patients with select NE tumors. In-vitro activation of Raf-1 in NE tumors either by expression of the ectopic catalytic domain of Raf-1 or by a pharmacologic drug, ZM336372, resulted in growth inhibition. In addition, activation of the Ras/Raf pathway led to a significant reduction in NE markers such as serotonin, chromogranin A and calcitonin. These data support development of Raf-1-activating compounds for treatment of patients with NE tumors of selective subtypes.
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Hoff AO, Hauache OM. [Multiple endocrine neoplasia type 1 (MEN 1): clinical, biochemical and molecular diagnosis and treatment of the associated disturbances]. ACTA ACUST UNITED AC 2006; 49:735-46. [PMID: 16444356 DOI: 10.1590/s0004-27302005000500014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple endocrine neoplasia (MEN) syndromes include types 1 (MEN 1) and 2 (MEN 2), von Hippel-Lindau syndrome, neurofibromatosis type 1 and Carney complex. These are complex genetic syndromes caused by activation or inactivation of different types of genes known to be involved in the regulation of cell proliferation. In this review we will discuss the clinical manifestations and management of the MEN 1 syndrome as well as the genetic screening of potential MEN 1 gene carriers. MEN 1 is a hereditary syndrome, transmitted in an autosomic dominant fashion and caused by an inactivating mutation of the MEN 1 gene, characterized by the development of primary hyperparathyroidism, islet cell tumors and pituitary adenomas. In addition, these patients can present with cutaneous manifestations such as angiofibromas and collagenomas, and can develop other neoplastic manifestations including carcinoids, thyroid tumors, adrenal adenomas, lipomas, pheochromocytomas and meningiomas. The MEN 1 gene encodes a peptide which is a tumor suppressor gene called menin. Several studies have demonstrated its importance in regulation of cell proliferation and have confirmed its role in the pathogenesis of the MEN 1 syndrome. The discovery of the MEN 1 gene and the genetic analysis of MEN 1 patients have resulted in earlier diagnosis and treatment of asymptomatic carriers which can potentially result in a longer survival of these patients. Further investigation of the function and signaling pathways of the menin protein will hopefully offer therapeutic alternatives to patients with malignant progression of MEN 1-related tumors and also result in improved survival.
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Kianmanesh R, O'Toole D, Sauvanet A, Ruszniewski P, Belghiti J. [Surgical treatment of gastric, enteric pancreatic endocrine tumors. Part 2. treatment of hepatic metastases]. ACTA ACUST UNITED AC 2006; 142:208-19. [PMID: 16335893 DOI: 10.1016/s0021-7697(05)80906-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of hepatic metastases (HM) marks a turning point in the evolutionand prognosis of well-differentiated endocrine tumors (ET). Management is usually multicisciplinary (chemotherapy, arterial chemo-embolization, percutaneous ablation, somatostatin analogs, biotherapy, and surgery). A thorough pre-operative work-up is neecessary to exclude extrahepatic disease and to detect tiny HM's. Complete resection (RO) is the only curative treatment for well-differentiated ET with HM. The type of resection is specific to each case and may range from wedge resection of a metastasis to complex hepatectomy with simultaneous resection of the primary ET. Cytoreductive surgery may be indicated for palliation when medical therapy fails to control endocrine symptoms. Operative mortality is low (0-6%) and global survival is 60-70% afterafter R) resection of HM of well-differentiated ET's. After resection of HM involving only one hepatic lobe, 5 year survival is better than 90%. When HM are multiple, bilobar and synchronous, the prognosis is very poor--only 10% of such patients can have a complete resection and this often requires a long prologue of ancillary procedures (chemotherapy, chemoembolization, portal vein ligation, percutaneous ablation). Hepatic transplantation (HT) has only a limited rôle in the treatment of HM for ET; mortality is high when HT is associated with large and complex resections, i.e. pancreaticoduodenectomy. Although there is no consensus in the literature, HT should be limited to the most optimal cases (young, good general health, well-differentiated tumor, slow evolution, complete resection of the primary rumor, and unresectable liver metastases). Global survival for HT in patients with ET is 60% at 2 years, 47% at 5 years; tumor-free survival at 5 years is 24%. HT for HM has better survival results for ET's of intestinal origin (carcinoids) than for duodenopancreatic ET's.
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Affiliation(s)
- R Kianmanesh
- Fédération Médico-Chirurgicale d'Hépato-Gastroentérologie, Hôpital Beaujon, Clichy.
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Kouvaraki MA, Solorzano CC, Shapiro SE, Yao JC, Perrier ND, Lee JE, Evans DB. Surgical treatment of non-functioning pancreatic islet cell tumors. J Surg Oncol 2005; 89:170-85. [PMID: 15719379 DOI: 10.1002/jso.20178] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pancreatic endocrine tumors (PETs) are rare neoplasms originating from the amine precursor uptake and decarboxylation (APUD) stem cells. Although the majority of PETs are sporadic, they frequently occur in familial syndromes. PETs may cause a variety of functional syndromes or symptoms of local progression if they are non-functional. General neuroendocrine tumor markers are highly sensitive in the diagnostic assessment of a PET. Imaging studies for tumor localization and staging include computer tomography (CT) scan, magnetic resonance imaging (MRI), In(111)-octreotide scan, MIBG, and endoscopic ultrasonography (EUS). Treatment of PETs often requires a multi-modality approach; however, surgical resection remains the only curative therapy for localized (non-metastatic) disease. Treatment of metastatic disease includes biologic agents, cytotoxic chemotherapy, and liver-directed therapies.
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Affiliation(s)
- Maria A Kouvaraki
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Van Gompel JJ, Chen H. Insulin-like growth factor 1 signaling in human gastrointestinal carcinoid tumor cells. Surgery 2005; 136:1297-302. [PMID: 15657590 DOI: 10.1016/j.surg.2004.06.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Insulin-like growth factor 1 (IGF-1) is an autocrine regulator of carcinoid tumors. Blockade of IGF-1 signaling has been proposed as a therapeutic target in the treatment of patients with carcinoid syndrome. We hypothesized that the induction of parallel raf-1/MEK1 pathways will block IGF-1-mediated chromogranin A (CgA) maintenance. Methods Human gastrointestinal carcinoid tumor cells (BON) were treated with IGF-1 (0-500 ng/mL). Raf-1/MEK1 activation was achieved with an estrogen-inducible raf-1 vector that was transduced into BON cells. Activation of IGF-1/raf-1 pathways was determined by phosphorylation of downstream targets p70s6 and ERK1/2. The secreted and intercellular levels of CgA were measured in conditioned media and whole cell extracts by Western and enzyme-linked immunosorbent assay analysis. Results IGF-1 and raf-1 pathways were activated successfully in BON cells, as shown by high levels of phosphorylated p70s6 and phosphorylated ERK1/2, respectively. Treatment of BON cells with IGF-1 stimulated the release of CgA, while high intracellular CgA levels were maintained. The activation of raf-1/MEK1 reversed the effect of IGF-1 treatment by the depletion of intracellular CgA. Conclusions The induction of the raf-1/MEK1 pathway blocks IGF-1-mediated intracellular neuroendocrine hormone regulation. Therefore, raf-1/MEK1 activation may be a viable method to block IGF-1-mediated cellular effects and serve as a therapeutic target in gastrointestinal carcinoid tumors.
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Affiliation(s)
- Jamie Joseph Van Gompel
- Department of Surgery, University of Wisconsin Comprehensive Cancer Center, 600 Highland Avenue, Madison, WI 53792, USA
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Sippel RS, Carpenter JE, Kunnimalaiyaan M, Lagerholm S, Chen H. Raf-1 activation suppresses neuroendocrine marker and hormone levels in human gastrointestinal carcinoid cells. Am J Physiol Gastrointest Liver Physiol 2003; 285:G245-54. [PMID: 12851216 DOI: 10.1152/ajpgi.00420.2002] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastrointestinal carcinoid cells secrete multiple neuroendocrine markers and hormones including 5-HT and chromogranin A. The intracellular signaling pathways that regulate production of bioactive molecules are not completely understood. Our aim was to determine whether activation of the raf-1/MEK/MAPK signal transduction pathway in carcinoid cells could modulate production of neuroendocrine markers and hormones. Human pancreatic carcinoid cells (BON) were stably transduced with an estrogen-inducible raf-1 construct creating BON-raf cells. Activation of raf-1 in BON-raf cells led to a marked induction of phosphorylated MEK and ERK1/2 within 48 h. Importantly, raf-1 activation resulted in morphological changes accompanied by a marked decrease in neuroendocrine secretory granules by electronmicroscopy. Moreover, induction of raf-1 in BON-raf cells led to significant reductions in 5-HT, chromogranin A, and synaptophysin levels. Furthermore, treatment of BON-raf cells with MEK inhibitors PD-98059 and U-0126 blocked raf-1-mediated morphological changes and hormone suppression but not ERK1/2 phosphorylation. These results show that raf-1 induction suppresses neuroendocrine marker and hormone production in human gastrointestinal carcinoid cells via a pathway dependent on MEK activation.
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Affiliation(s)
- Rebecca S Sippel
- Dept. of Surgery, Univ. of Wisconsin Medical School, University of Wisconsin Comprehensive Cancer Center, Madison 53792, USA
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Sippel RS, Chen H. Activation of the ras/raf-1 signal transduction pathway in carcinoid tumor cells results in morphologic transdifferentiation. Surgery 2002; 132:1035-9; discussion 1039. [PMID: 12490852 DOI: 10.1067/msy.2002.128877] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies of neuroendocrine tumor cell lines suggest that ras/raf-1 activation could be detrimental to tumorigenesis. The mechanism by which it alters neuroendocrine tumor cells is unclear. We hypothesize that activation of the ras/raf signal transduction pathway may alter gastrointestinal carcinoid cells by inducing morphologic transdifferentiation. METHODS Pancreatic carcinoid (BON) cells were transduced in a stable manner with an estrogen inducible raf-1 fusion protein (creating "BON-raf cells"). BON and BON-raf cells were then treated with either control or 1 micromol/L estradiol (E2). Western blots were used to confirm the phosphorylation of extracellular signal-regulated kinase 1/2. Morphologic changes were evaluated using light and electron microscopy. RESULTS Western blots using antibodies against phosphorylated and unphosphorylated extracellular signal-regulated kinase 1/2. confirmed that phosphorylation was only present in the BON-raf E2 cells. BON cells treated with control and E2 and BON-raf cells treated with control all looked identical in culture. After treatment with E2 to induce raf-1, the BON-raf cells underwent dramatic morphologic changes. Under light and electron microscopy the cells became flatter and developed much sharper cellular borders mimicking cellular differentiation. CONCLUSIONS Activation of the ras/raf-1 signal transduction pathway leads to prominent phenotypic changes that resemble differentiation of gastrointestinal carcinoid cells in vitro.
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Affiliation(s)
- Rebecca S Sippel
- Department of Surgery, The University of Wisconsin Medical School, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
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17
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Affiliation(s)
- Jerome Seidenfeld
- Technology Evaluation Center, Blue Cross and Blue Shield Association, Chicago, IL 60601-7680, USA
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18
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Solorzano CC, Lee JE, Pisters PW, Vauthey JN, Ayers GD, Jean ME, Gagel RF, Ajani JA, Wolff RA, Evans DB. Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients. Surgery 2001; 130:1078-85. [PMID: 11742342 DOI: 10.1067/msy.2001.118367] [Citation(s) in RCA: 214] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The natural history of nonfunctioning islet cell carcinoma of the pancreas is poorly defined. We therefore reviewed our institutional experience during a period of 12 years to define more clearly the natural history of this disease as a basis for individual therapeutic recommendations. METHODS The records of all patients who had histologically or cytologically confirmed nonfunctioning islet cell carcinoma of the pancreas were retrospectively reviewed. Patients were grouped by extent of disease at diagnosis and by initial treatment. Survival distributions were estimated by Kaplan-Meier analysis. RESULTS One hundred sixty-three patients with nonfunctioning islet cell carcinoma of the pancreas were identified. The overall median survival duration was 3.2 years. The median survival was 7.1 years in patients with localized disease who underwent a potentially curative resection and 5.2 years in those with locally advanced, unresectable, nonmetastatic disease (P = .04). Patients with metastatic disease that could not be resected had a median survival of 2.1 years. CONCLUSIONS Patients with completely resected localized disease had a long median survival. Patients with nonmetastatic but unresectable locally advanced disease also had a surprisingly long median survival; major treatment-related morbidity may be hard to justify in this subgroup. The short median survival in patients with metastatic disease suggests that the frequent practice of observation in this patient subgroup needs to be reexamined and that continued investigation of regional and systemic therapies with novel agents is warranted.
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Affiliation(s)
- C C Solorzano
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex. 77030, USA
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19
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Affiliation(s)
- M D McCarter
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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