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Karna B, Pellegata NS, Mohr H. Animal and Cell Culture Models of PPGLs - Achievements and Limitations. Horm Metab Res 2024; 56:51-64. [PMID: 38171372 DOI: 10.1055/a-2204-4549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Research on rare tumors heavily relies on suitable models for basic and translational research. Paragangliomas (PPGL) are rare neuroendocrine tumors (NET), developing from adrenal (pheochromocytoma, PCC) or extra-adrenal (PGL) chromaffin cells, with an annual incidence of 2-8 cases per million. While most PPGL cases exhibit slow growth and are primarily treated with surgery, limited systemic treatment options are available for unresectable or metastatic tumors. Scarcity of appropriate models has hindered PPGL research, preventing the translation of omics knowledge into drug and therapy development. Human PPGL cell lines are not available, and few animal models accurately replicate the disease's genetic and phenotypic characteristics. This review provides an overview of laboratory models for PPGLs, spanning cellular, tissue, organ, and organism levels. We discuss their features, advantages, and potential contributions to diagnostics and therapeutics. Interestingly, it appears that in the PPGL field, disease models already successfully implemented in other cancers have not been fully explored.
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Affiliation(s)
- Bhargavi Karna
- Institute for Diabetes and Cancer, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
| | - Natalia Simona Pellegata
- Institute for Diabetes and Cancer, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Hermine Mohr
- Institute for Diabetes and Cancer, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany
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Mohr H, Foscarini A, Steiger K, Ballke S, Rischpler C, Schilling F, Pellegata NS. Imaging pheochromocytoma in small animals: preclinical models to improve diagnosis and treatment. EJNMMI Res 2021; 11:121. [PMID: 34894301 PMCID: PMC8665914 DOI: 10.1186/s13550-021-00855-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs), together referred to as PPGLs, are rare chromaffin cell-derived tumors. They require timely diagnosis as this is the only way to achieve a cure through surgery and because of the potentially serious cardiovascular complications and sometimes life-threatening comorbidities that can occur if left untreated. The biochemical diagnosis of PPGLs has improved over the last decades, and the knowledge of the underlying genetics has dramatically increased. In addition to conventional anatomical imaging by CT and MRI for PPGL detection, new functional imaging modalities have emerged as very useful for patient surveillance and stratification for therapy. The availability of validated and predictive animal models of cancer is essential for translating molecular, imaging and therapy response findings from the bench to the bedside. This is especially true for rare tumors, such as PPGLs, for which access to large cohorts of patients is limited. There are few animal models of PPGLs that have been instrumental in refining imaging modalities for early tumor detection, as well as in identifying and evaluating novel imaging tracers holding promise for the detection and/or treatment of human PPGLs. The in vivo PPGL models mainly include xenografts/allografts generated by engrafting rat or mouse cell lines, as no representative human cell line is available. In addition, there is a model of endogenous PCCs (i.e., MENX rats) that was characterized in our laboratory. In this review, we will summarize the contribution that various representative models of PPGL have given to the visualization of these tumors in vivo and we present an example of a tracer first evaluated in MENX rats, and then translated to the detection of these tumors in human patients. In addition, we will illustrate briefly the potential of ex vivo biological imaging of intact adrenal glands in MENX rats.
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Affiliation(s)
- Hermine Mohr
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany
| | - Alessia Foscarini
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Simone Ballke
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and Cancer, Helmholtz Zentrum München, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany. .,Joint Heidelberg-IDC Translational Diabetes Program, Heidelberg University Hospital, Heidelberg, Germany. .,Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy.
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Abstract
Animal models of cancer have been instrumental in advancing our understanding of the biology of tumor initiation and progression, in studying gene function and in performing preclinical studies aimed at testing novel therapies. Several animal models of the MEN1 syndrome have been generated in different organisms by introducing loss-of-function mutations in the orthologues of the human MEN1 gene. In this review, we will discuss MEN1 and MEN1-like models in Drosophila, mice and rats. These model systems with their specific advantages and limitations have contributed to elucidate the function of Menin in tumorigenesis, which turned out to be remarkably conserved from flies to mammals, as well as the biology of the disease. Mouse models of MEN1 closely resemble the human disease in terms of tumor spectrum and associated hormonal changes, although individual tumor frequencies are variable. Rats affected by the MENX (MEN1-like) syndrome share some features with MEN1 patients albeit they bear a germline mutation in Cdkn1b (p27) and not in Men1 Both Men1-knockout mice and MENX rats have been exploited for therapy-response studies testing novel drugs for efficacy against neuroendocrine tumors (NETs) and have provided promising leads for novel therapies. In addition to presenting well-established models of MEN1, we also discuss potential models which, if implemented, might broaden even further our knowledge of neuroendocrine tumorigenesis. In the future, patient-derived xenografts in zebrafish or mice might allow us to expand the tool-box currently available for preclinical studies of MEN1-associated tumors.
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Affiliation(s)
- Hermine Mohr
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
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Lee M, Minaskan N, Wiedemann T, Irmler M, Beckers J, Yousefi BH, Kaissis G, Braren R, Laitinen I, Pellegata NS. Targeting PI3K/mTOR signaling exerts potent antitumor activity in pheochromocytoma in vivo. Endocr Relat Cancer 2017; 24:1-15. [PMID: 27811202 DOI: 10.1530/erc-16-0324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/03/2016] [Indexed: 12/16/2022]
Abstract
Pheochromocytomas (PCCs) are mostly benign tumors, amenable to complete surgical resection. However, 10-17% of cases can become malignant, and once metastasized, there is no curative treatment for this disease. Given the need to identify the effective therapeutic approaches for PCC, we evaluated the antitumor potential of the dual-PI3K/mTOR inhibitor BEZ235 against these tumors. We employed an in vivo model of endogenous PCCs (MENX mutant rats), which closely recapitulate the human tumors. Mutant rats with PCCs were treated with 2 doses of BEZ235 (20 and 30 mg/kg), or with placebo, for 2 weeks. Treatment with BEZ235 induced cytostatic and cytotoxic effects on rat PCCs, which could be appreciated by both staining the tumors ex vivo with appropriate markers and non-invasively by functional imaging (diffusion-weighted magnetic resonance imaging) in vivo Transcriptomic analyses of tumors from rats treated with BEZ235 or placebo-identified potential mediators of therapy response were performed. Slc6a2, encoding the norepinephrine transporter (NET), was downregulated in a dose-dependent manner by BEZ235 in rat PCCs. Moreover, BEZ235 reduced Slc6a2/NET expression in PCC cell lines (MPC) also. Studies of a BEZ235-resistant derivative of the MPC cell line confirmed that the reduction of NET expression associates with the response to the drug. Reduction of NET expression after BEZ235 treatment in vivo could be monitored by positron emission tomography (PET) using a tracer targeting NET. Altogether, here we demonstrate the efficacy of BEZ235 against PCC in vivo, and show that functional imaging can be employed to monitor the response of PCC to PI3K/mTOR inhibition therapy.
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Affiliation(s)
- Misu Lee
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
| | - Ninelia Minaskan
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
| | - Tobias Wiedemann
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
| | - Martin Irmler
- Institute of Experimental GeneticsHelmholtz Zentrum München, Neuherberg, Germany
| | - Johannes Beckers
- Institute of Experimental GeneticsHelmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD)Neuherberg, Germany
- Technische Universität MünchenChair of Experimental Genetics, Freising, Germany
| | - Behrooz H Yousefi
- Department of Pharmaceutical RadiochemistryTechnische Universität München, Garching, Germany
| | - Georgios Kaissis
- Institute for Diagnostic and Interventional RadiologyKlinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional RadiologyKlinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Iina Laitinen
- Department of Nuclear MedicineKlinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and CancerHelmholtz Zentrum München, Neuherberg, Germany
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Leinhäuser I, Richter A, Lee M, Höfig I, Anastasov N, Fend F, Ercolino T, Mannelli M, Gimenez-Roqueplo AP, Robledo M, de Krijger R, Beuschlein F, Atkinson MJ, Pellegata NS. Oncogenic features of the bone morphogenic protein 7 (BMP7) in pheochromocytoma. Oncotarget 2016; 6:39111-26. [PMID: 26337467 PMCID: PMC4770760 DOI: 10.18632/oncotarget.4912] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/07/2015] [Indexed: 12/29/2022] Open
Abstract
BMP7 is a growth factor playing pro- or anti-oncogenic roles in cancer in a cell type-dependent manner. We previously reported that the BMP7 gene is overexpressed in pheochromocytomas (PCCs) developing in MENX-affected rats and human patients. Here, analyzing a large cohort of PCC patients, we found that 72% of cases showed elevated levels of the BMP7 protein. To elucidate the role of BMP7 in PCC, we modulated its levels in PCC cell lines (overexpression in PC12, knockdown in MPC and MTT cells) and conducted functional assays. Active BMP signaling promoted cell proliferation, migration, and invasion, and sustained survival of MENX rat primary PCC cells. In PCC, BMP7 signals through the PI3K/AKT/mTOR pathway and causes integrin β1 up-regulation. Silencing integrin β1 in PC12 cells suppressed BMP7-mediated oncogenic features. Treatment of MTT cells with DMH1, a novel BMP antagonist, suppressed proliferation and migration. To verify the clinical applicability of our findings, we evaluated a dual PI3K/mTOR inhibitor (NVP-BEZ235) in MENX-affected rats in vivo. PCCs treated with NVP-BEZ235 had decreased proliferation and integrin β1 levels, and higher apoptosis. Altogether, BMP7 activates pro-oncogenic pathways in PCC. Downstream effectors of BMP7-mediated signaling may represent novel targets for treating progressive/inoperable PCC, still orphan of effective therapy.
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Affiliation(s)
- Ines Leinhäuser
- Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Radiation Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Andrea Richter
- Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Misu Lee
- Institute of Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ines Höfig
- Institute of Radiation Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nataša Anastasov
- Institute of Radiation Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology Comprehensive Cancer Center Tübingen and University of Tübingen, Tübingen, Germany
| | - Tonino Ercolino
- Azienda Ospedaliero-Universitaria di Careggi, Endocrine Unit, Florence, Italy
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR U970, Paris Cardiovascular Research Center-PARCC, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Genetics, Paris, France
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Ronald de Krijger
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Beuschlein
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Michael J Atkinson
- Institute of Radiation Biology, Helmholtz Zentrum München, Neuherberg, Germany
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Wiedemann T, Peitzsch M, Qin N, Neff F, Ehrhart-Bornstein M, Eisenhofer G, Pellegata NS. Morphology, Biochemistry, and Pathophysiology of MENX-Related Pheochromocytoma Recapitulate the Clinical Features. Endocrinology 2016; 157:3157-66. [PMID: 27254000 DOI: 10.1210/en.2016-1108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pheochromocytomas (PCCs) are tumors arising from neural crest-derived chromaffin cells. There are currently few animal models of PCC that recapitulate the key features of human tumors. Because such models may be useful for investigations of molecular pathomechanisms and development of novel therapeutic interventions, we characterized a spontaneous animal model (multiple endocrine neoplasia [MENX] rats) that develops endogenous PCCs with complete penetrance. Urine was longitudinally collected from wild-type (wt) and MENX-affected (mutant) rats and outputs of catecholamines and their O-methylated metabolites determined by mass spectrometry. Adrenal catecholamine contents, cellular ultrastructure, and expression of phenylethanolamine N-methyltransferase, which converts norepinephrine to epinephrine, were also determined in wt and mutant rats. Blood pressure was longitudinally measured and end-organ pathology assessed. Compared with wt rats, mutant animals showed age-dependent increases in urinary outputs of norepinephrine (P = .0079) and normetanephrine (P = .0014) that correlated in time with development of tumor nodules, increases in blood pressure, and development of hypertension-related end-organ pathology. Development of tumor nodules, which lacked expression of N-methyltransferase, occurred on a background of adrenal medullary morphological and biochemical changes occurring as early as 1 month of age and involving increased adrenal medullary concentrations of dense cored vesicles, tissue contents of both norepinephrine and epinephrine, and urinary outputs of metanephrine, the metabolite of epinephrine. Taken together, MENX-affected rats share several biochemical and pathophysiological features with PCC patients. This model thus provides a suitable platform to study the pathogenesis of PCC for preclinical translational studies aimed at the development of novel therapies for aggressive forms of human tumors.
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Affiliation(s)
- Tobias Wiedemann
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mirko Peitzsch
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nan Qin
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Frauke Neff
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Monika Ehrhart-Bornstein
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Graeme Eisenhofer
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
| | - Natalia S Pellegata
- Institute for Diabetes and Cancer (T.W., N.S.P.) and Institute of Experimental Genetics (F.N.), Helmholtz Zentrum München, 85764 Neuherberg, Germany; Institute of Clinical Chemistry and Laboratory Medicine (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, and Department of Internal Medicine III (M.P., N.Q., G.E.), University Hospital Carl Gustav Carus, and Division of Molecular Endocrinology (M.E.-B., G.E.), Medical Clinic III, Technische Universität Dresden, 01307 Dresden, Germany
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Wiedemann T, Pellegata NS. Animal models of multiple endocrine neoplasia. Mol Cell Endocrinol 2016; 421:49-59. [PMID: 26184857 DOI: 10.1016/j.mce.2015.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/23/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
Multiple endocrine neoplasia (MEN) syndromes are autosomal dominant diseases with high penetrance characterized by proliferative lesions (usually hyperplasia or adenoma) arising in at least two endocrine tissues. Four different MEN syndromes have been so far identified: MEN type 1 (MEN1), MEN2A (also referred to as MEN2), MEN2B (or MEN3) and MEN4, which have slightly varying tumor spectra and are caused by mutations in different genes. MEN1 associates with loss-of-function mutations in the MEN1 gene encoding the tumor suppressor menin. The MEN2A and MEN2B syndromes are due to activating mutations in the proto-oncogene RET (Rearranged in Transfection) and are characterized by different phenotypic features of the affected patients. MEN4 was the most recent addition to the family of the MEN syndromes. It was discovered less than 10 years ago thanks to studies of a rat strain that spontaneously develops multiple endocrine tumors (named MENX). These studies identified an inactivating mutation in the Cdkn1b gene, encoding the putative tumor suppressor p27, as the causative mutation of the rat syndrome. Subsequently, germline mutations in the human ortholog CDKN1B were also found in a subset of patients with a MEN-like phenotype and this led to the identification of MEN4. Small animal models have been instrumental in understanding important biochemical, physiological and pathological processes of cancer onset and spread in intact living organisms. Moreover, they have provided us with insight into gene function(s) and molecular mechanisms of disease progression. We here review the currently available animal models of MEN syndromes and their impact on the elucidation of the pathophysiology of these diseases, with a special focus on the rat MENX syndrome that we have been characterizing.
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Affiliation(s)
- Tobias Wiedemann
- Institute of Pathology, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Natalia S Pellegata
- Institute of Pathology, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany.
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Accuracy of 68Ga DOTANOC PET/CT Imaging in Patients With Multiple Endocrine Neoplasia Syndromes. Clin Nucl Med 2016; 40:e351-6. [PMID: 25783509 DOI: 10.1097/rlu.0000000000000775] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the role of ⁶⁸Ga DOTANOC PET/CT imaging in patients with multiple endocrine neoplasia (MEN) syndromes. PATIENTS AND METHODS Data of 33 patients (age, 33.5 [13.8] years; male 14/female 19) with MEN syndromes (MEN 1, 9; MEN 2A, 19; MEN 2B, 5) who underwent 41 ⁶⁸Ga DOTANOC PET/CT studies were retrospectively analyzed. Twenty PET/CTs were done for staging and 21 for restating. PET/CT images were evaluated in consensus by 2 nuclear medicine physicians, qualitatively and semiquantitatively (SUV(max)). A combination of histopathology, clinical, and biomarker follow-up was taken as reference standard. RESULTS Of the total 41 ⁶⁸Ga DOTANOC PET/CTs, 34 were interpreted as positive for neuroendocrine tumors (NETs) and 7 as negative. The patientwise sensitivity of PET/CT was 94% (95% confidence interval [CI], 80-99), specificity was 71% (95% CI, 29-96), positive predictive value was 94% (95% CI, 80-99), negative predictive value was 71% (95% CI, 29-96), and accuracy was 90%. A total of 74 disease sites were demonstrated on PET/CT, including 41 primary NETs (pancreas, 10; stomach, 2; pheochromocytoma, 10; medullary thyroid carcinoma, 19), 31 metastatic sites (lymph node, 15; liver, 10; bone, 4; lung, 1; breast, 1), and 2 parathyroid adenomas. Lesionwise sensitivity, positive predictive value, and accuracy of PET/CT were 93%, 96%, and 90% overall, 89%, 95%, and 85% for primary tumors, and 100%, 97%, and 97% for metastasis, respectively. Among primary tumors, the SUV(max) of medullary thyroid carcinoma was significantly lower than gastro pancreatic NETs (P = 0.003) and pheochromocytomas (P = 0.003). No site-specific difference was seen in SUV(max) of metastatic lesions. CONCLUSIONS ⁶⁸Ga DOTANOC PET/CT shows high diagnostic accuracy in MEN syndrome and can demonstrate both primary and metastatic NETs in these patients.
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Sharma P, Dhull VS, Arora S, Gupta P, Kumar R, Durgapal P, Malhotra A, Chumber S, Ammini AC, Kumar R, Bal C. Diagnostic accuracy of (68)Ga-DOTANOC PET/CT imaging in pheochromocytoma. Eur J Nucl Med Mol Imaging 2013; 41:494-504. [PMID: 24158184 DOI: 10.1007/s00259-013-2598-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 10/01/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the diagnostic accuracy of (68)Ga-DOTANOC positron emission tomography (PET)/CT in patients with suspicion of pheochromocytoma. METHODS Data of 62 patients [age 34.3 ± 16.1 years, 14 with multiple endocrine neoplasia type 2 (MEN2)] with clinical/biochemical suspicion of pheochromocytoma and suspicious adrenal lesion on contrast CT (n = 70), who had undergone (68)Ga-DOTANOC PET/CT, were retrospectively analyzed. PET/CT images were analyzed visually as well as semiquantitatively, with measurement of maximum standardized uptake value (SUVmax), SUVmean, SUVmax/SUVliver, and SUVmean/SUVliver. Results of PET/CT were compared with (131)I-metaiodobenzylguanidine (MIBG) imaging, which was available in 40 patients (45 lesions). Histopathology and/or imaging/clinical/biochemical follow-up (minimum 6 months) was used as reference standard. RESULTS The sensitivity, specificity, and accuracy of (68)Ga-DOTANOC PET/CT was 90.4, 85, and 88.7%, respectively, on patient-based analysis and 92, 85, and 90%, respectively, on lesion-based analysis. (68)Ga-DOTANOC PET/CT showed 100% accuracy in patients with MEN2 syndrome and malignant pheochromocytoma. On direct comparison, lesion-based accuracy of (68)Ga-DOTANOC PET/CT for pheochromocytoma was significantly higher than (131)I-MIBG imaging (91.1 vs 66.6%, p = 0.035). SUVmax was higher for pheochromocytomas than other adrenal lesions (p = 0.005), MEN2-associated vs sporadic pheochromocytoma (p = 0.012), but no difference was seen between benign vs malignant pheochromocytoma (p = 0.269). CONCLUSION (68)Ga-DOTANOC PET/CT shows high diagnostic accuracy in patients with suspicion of pheochromocytoma and is superior to (131)I-MIBG imaging for this purpose. Best results of (68)Ga-DOTANOC PET/CT are seen in patients with MEN2-associated and malignant pheochromocytoma.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Gaertner FC, Wiedemann T, Yousefi BH, Lee M, Repokis I, Higuchi T, Nekolla SG, Yu M, Robinson S, Schwaiger M, Pellegata NS. Preclinical Evaluation of 18F-LMI1195 for In Vivo Imaging of Pheochromocytoma in the MENX Tumor Model. J Nucl Med 2013; 54:2111-7. [DOI: 10.2967/jnumed.113.119966] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Naji M, AL-Nahhas A. ⁶⁸Ga-labelled peptides in the management of neuroectodermal tumours. Eur J Nucl Med Mol Imaging 2012; 39 Suppl 1:S61-7. [PMID: 22388623 DOI: 10.1007/s00259-011-1990-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neuroectodermal tumours arise from chromaffin cells and possess the ability to secrete catecholamines. They are generally rare and may occur in association with a variety of hereditary syndromes such as MEN-2A and 2B, neurofibromatosis type 1 and von Hippel-Lindau disease. The most common types are phaeochromocytoma arising from the adrenal medulla and paraganglioma of extra-adrenal origin. Phaeochromocytomas tend to be benign and are often associated with a gene mutation if the disease is bilateral, while paragangliomas are often malignant, have a more aggressive nature and tend to metastasize. There are no specific histological or immunohistochemical features that indicate the malignant potential and the diagnosis of malignancy can only be established by the presence of distant metastases. Therefore, imaging can play a vital role in the diagnosis, localization, staging and assessment of spread. Traditionally, this is achieved with a combination of cross-sectional (CT and MRI) and functional ((123)I-MIBG or (111)In-octreotide) imaging. However, these modalities are not adequate and achieve moderate sensitivity. The introduction of (68)Ga-DOTA peptide in PET/CT imaging has led to improved receptor targeting and superb PET resolution, as well as accurate localization of lesions. The use of this technique in neuroectodermal tumours has been shown to be superior to all available modalities, but the available data are limited and larger studies are awaited to establish its role in the management of these tumours.
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Affiliation(s)
- Meeran Naji
- Departments of Nuclear Medicine and Radiology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
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