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Tufail M, Wan WD, Jiang C, Li N. Targeting PI3K/AKT/mTOR signaling to overcome drug resistance in cancer. Chem Biol Interact 2024; 396:111055. [PMID: 38763348 DOI: 10.1016/j.cbi.2024.111055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
This review comprehensively explores the challenge of drug resistance in cancer by focusing on the pivotal PI3K/AKT/mTOR pathway, elucidating its role in oncogenesis and resistance mechanisms across various cancer types. It meticulously examines the diverse mechanisms underlying resistance, including genetic mutations, feedback loops, and microenvironmental factors, while also discussing the associated resistance patterns. Evaluating current therapeutic strategies targeting this pathway, the article highlights the hurdles encountered in drug development and clinical trials. Innovative approaches to overcome resistance, such as combination therapies and precision medicine, are critically analyzed, alongside discussions on emerging therapies like immunotherapy and molecularly targeted agents. Overall, this comprehensive review not only sheds light on the complexities of resistance in cancer but also provides a roadmap for advancing cancer treatment.
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Affiliation(s)
- Muhammad Tufail
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Dong Wan
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China; Institute of Oral Precancerous Lesions, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Li
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China; Institute of Oral Precancerous Lesions, Central South University, Changsha, China; Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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2
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Cattrini C, Manfredi M, Barboro P, Ghirimoldi M, Mennitto A, Martini V, Battioni A, Le Van M, Gobbato S, Branni C, Ayed RB, Pinato DJ, Catalano F, Zanardi E, Boccardo F, Gennari A. Untargeted lipidomics reveal association of elevated plasma C18 ceramide levels with reduced survival in metastatic castration-resistant prostate cancer patients. Sci Rep 2023; 13:17791. [PMID: 37853018 PMCID: PMC10585001 DOI: 10.1038/s41598-023-44157-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023] Open
Abstract
Emerging evidence highlights the potential prognostic relevance of circulating lipids in metastatic castration-resistant prostate cancer (mCRPC), with a proposed 3-lipid signature. This study aims to analyze the lipidomic profiles of individuals with mCRPC to identify lipid species that could serve as predictive indicators of prognosis and therapeutic response. Plasma samples were collected from mCRPC patients initiating first-line treatment (1 L) (n = 29) and those previously treated with at least two lines of therapy (> 2 L) (n = 19), including an androgen-receptor signaling inhibitor and a taxane. Employing an untargeted lipidomic approach, lipids were extracted from the plasma samples and subjected to analysis. A comprehensive identification and quantification of 789 plasma lipids was achieved. Notably, 75 species displayed significant dysregulation in > 2 L patients in comparison to the 1 L group. Among these, 63 species exhibited elevated levels, while 12 were reduced. Patients included in > 2 L cohort showed elevated levels of acylcarnitines (CAR), diacylglycerols (DG), phosphatidylethanolamines (PE), triacylglycerols (TG), and ceramides (Cer). Notably, some upregulated lipids, including CAR 14:0, CAR 24:1, Cer d18:1/16:0, Cer d18:1/18:0 (C18 Cer), Cer d18:2/18:0, Cer d18:1/24:1, and Cer d20:1/24:1, showed significant associations with overall survival (OS) in univariate models. Specifically, increased levels of C18 Cer remained significantly associated with poorer OS in the multivariate model, even after adjusting for treatment line and PSA levels (Hazard Ratio: 3.59 [95% Confidence Interval 1.51-8.52], p = 0.004). Employing quantitative mass spectrometry, our findings underscore the independent prognostic significance of C18 Cer in individuals with mCRPC. This discovery opens avenues for further studies within this field.
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Affiliation(s)
- Carlo Cattrini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132, Genoa, Italy.
- Medical Oncology, "Maggiore Della Carità" University Hospital, 28100, Novara, Italy.
| | - Marcello Manfredi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale, 28100, Novara, Italy
| | - Paola Barboro
- UO Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico S. Martino, 16132, Genova, Italy
| | - Marco Ghirimoldi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale, 28100, Novara, Italy
| | - Alessia Mennitto
- Medical Oncology, "Maggiore Della Carità" University Hospital, 28100, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - Veronica Martini
- Medical Oncology, "Maggiore Della Carità" University Hospital, 28100, Novara, Italy
| | - Alessio Battioni
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - Marco Le Van
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - Simone Gobbato
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - Carmen Branni
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - Rahma Ben Ayed
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
| | - David James Pinato
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Fabio Catalano
- UO Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico S. Martino, 16132, Genova, Italy
| | - Elisa Zanardi
- UO Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico S. Martino, 16132, Genova, Italy
| | - Francesco Boccardo
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132, Genoa, Italy
| | - Alessandra Gennari
- Medical Oncology, "Maggiore Della Carità" University Hospital, 28100, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100, Novara, Italy
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Fang S, Zhe S, Lin HM, Azad AA, Fettke H, Kwan EM, Horvath L, Mak B, Zheng T, Du P, Jia S, Kirby RM, Kohli M. Multi-Omic Integration of Blood-Based Tumor-Associated Genomic and Lipidomic Profiles Using Machine Learning Models in Metastatic Prostate Cancer. JCO Clin Cancer Inform 2023; 7:e2300057. [PMID: 37490642 PMCID: PMC10569777 DOI: 10.1200/cci.23.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE To determine prognostic and predictive clinical outcomes in metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castrate-resistant prostate cancer (mCRPC) on the basis of a combination of plasma-derived genomic alterations and lipid features in a longitudinal cohort of patients with advanced prostate cancer. METHODS A multifeature classifier was constructed to predict clinical outcomes using plasma-based genomic alterations detected in 120 genes and 772 lipidomic species as informative features in a cohort of 71 patients with mHSPC and 144 patients with mCRPC. Outcomes of interest were collected over 11 years of follow-up. These included in mHSPC state early failure of androgen-deprivation therapy (ADT) and exceptional responders to ADT; early death (poor prognosis) and long-term survivors in mCRPC state. The approach was to build binary classification models that identified discriminative candidates with optimal weights to predict outcomes. To achieve this, we built multi-omic feature-based classifiers using traditional machine learning (ML) methods, including logistic regression with sparse regularization, multi-kernel Gaussian process regression, and support vector machines. RESULTS The levels of specific ceramides (d18:1/14:0 and d18:1/17:0), and the presence of CHEK2 mutations, AR amplification, and RB1 deletion were identified as the most crucial factors associated with clinical outcomes. Using ML models, the optimal multi-omics feature combination determined resulted in AUC scores of 0.751 for predicting mHSPC survival and 0.638 for predicting ADT failure; and in mCRPC state, 0.687 for prognostication and 0.727 for exceptional survival. The models were observed to be superior than using a limited candidate number of features for developing multi-omic prognostic and predictive signatures. CONCLUSION Using a ML approach that incorporates multiple omic features improves the prediction accuracy for metastatic prostate cancer outcomes significantly. Validation of these models will be needed in independent data sets in future.
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Affiliation(s)
- Shikai Fang
- University of Utah, The School of Computing, Scientific Computing and Imaging Institute, Salt Lake City, UT
| | - Shandian Zhe
- The School of Computing, University of Utah, Salt Lake City, UT
| | - Hui-Ming Lin
- Garvan Institute for Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- St Vincent's Clinical School, UNSW Sydney, New South Wales, Australia
| | - Arun A. Azad
- Sir Peter MacCallum Department of Oncology, Department of Medical Oncology, University of Melbourne, Melbourne, Australia
| | - Heidi Fettke
- Sir Peter MacCallum Department of Oncology, Department of Medical Oncology, University of Melbourne, Melbourne, Australia
| | - Edmond M. Kwan
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Lisa Horvath
- Garvan Institute for Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- St Vincent's Clinical School, UNSW Sydney, New South Wales, Australia
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Blossom Mak
- Garvan Institute for Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | | | - Pan Du
- Predicine Inc, Hayward, CA
| | | | - Robert M. Kirby
- The School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT
| | - Manish Kohli
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Rushworth LK, Loveridge C, Salji M, MacLeod M, Mui E, Sumpton D, Neilson M, Hedley A, Alexander L, McCartney E, Patel R, Wallace J, Delles C, Jones R, Leung HY. Phase II proof-of-concept study of atorvastatin in castration-resistant prostate cancer. BJU Int 2023; 131:236-243. [PMID: 35844167 PMCID: PMC10087532 DOI: 10.1111/bju.15851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test for evidence of statin-mediated effects in patients with castration-resistant prostate cancer (CRPC) as post-diagnosis use of statins in patients with prostate cancer is associated with favourable survival outcome. PATIENTS AND METHODS The SPECTRE trial was a 6-weeks-long proof-of-concept single-arm Phase II treatment trial, combining atorvastatin and androgen deprivation therapy in patients with CRPC (regardless of metastatic status), designed to test for evidence of statin-mediated effects in patients with CRPC. The primary study endpoint was the proportion of patients achieving a ≥50% drop from baseline in prostate-specific antigen (PSA) levels at any time over the 6-week period of atorvastatin medication (PSA response). Exploratory endpoints include PSA velocity and serum metabolites identified by mass spectrometry . RESULTS At the scheduled interim analysis, one of 12 patients experienced a ≥50% drop in PSA levels (primary endpoint), with ≥2 patients satisfying the primary endpoint required for further recruitment. All 12 patients experienced substantial falls in serum cholesterol levels following statin treatment. While all patients had comparable pre-study PSA velocities, six of 12 patients showed decreased PSA velocities after statin treatment, suggestive of disease stabilization. Unbiased metabolomics analysis on serial weekly blood samples identified tryptophan to be the dominant metabolite associated with patient response to statin. CONCLUSIONS Data from the SPECTRE study provide the first evidence of statin-mediated effects on CRPC and early sign of disease stabilization. Our data also highlight the possibility of altered tryptophan metabolism being associated with tumour response.
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Affiliation(s)
- Linda K. Rushworth
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Carolyn Loveridge
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Mark Salji
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Martin MacLeod
- Beatson West of Scotland Cancer CentreGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Ernest Mui
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | | | | | | | - Laura Alexander
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Elaine McCartney
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | | | - Jan Wallace
- Beatson West of Scotland Cancer CentreGlasgowUK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Rob Jones
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Hing Y. Leung
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
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Scheinberg T, Mak B, Butler L, Selth L, Horvath LG. Targeting lipid metabolism in metastatic prostate cancer. Ther Adv Med Oncol 2023; 15:17588359231152839. [PMID: 36743527 PMCID: PMC9893394 DOI: 10.1177/17588359231152839] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Despite key advances in the treatment of prostate cancer (PCa), a proportion of men have de novo resistance, and all will develop resistance to current therapeutics over time. Aberrant lipid metabolism has long been associated with prostate carcinogenesis and progression, but more recently there has been an explosion of preclinical and clinical data which is informing new clinical trials. This review explores the epidemiological links between obesity and metabolic syndrome and PCa, the evidence for altered circulating lipids in PCa and their potential role as biomarkers, as well as novel therapeutic strategies for targeting lipids in men with PCa, including therapies widely used in cardiovascular disease such as statins, metformin and lifestyle modification, as well as novel targeted agents such as sphingosine kinase inhibitors, DES1 inhibitors and agents targeting FASN and beta oxidation.
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Affiliation(s)
- Tahlia Scheinberg
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Blossom Mak
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Lisa Butler
- Prostate Cancer Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia,South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia
| | - Luke Selth
- South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia,Dame Roma Mitchell Cancer Research Labs, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia,Flinders Health and Medical Research Institute, Flinders University, College of Medicine and Public Health, Bedford Park, Australia
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6
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Raith F, O’Donovan DH, Lemos C, Politz O, Haendler B. Addressing the Reciprocal Crosstalk between the AR and the PI3K/AKT/mTOR Signaling Pathways for Prostate Cancer Treatment. Int J Mol Sci 2023; 24:ijms24032289. [PMID: 36768610 PMCID: PMC9917236 DOI: 10.3390/ijms24032289] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
The reduction in androgen synthesis and the blockade of the androgen receptor (AR) function by chemical castration and AR signaling inhibitors represent the main treatment lines for the initial stages of prostate cancer. Unfortunately, resistance mechanisms ultimately develop due to alterations in the AR pathway, such as gene amplification or mutations, and also the emergence of alternative pathways that render the tumor less or, more rarely, completely independent of androgen activation. An essential oncogenic axis activated in prostate cancer is the phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway, as evidenced by the frequent alterations of the negative regulator phosphatase and tensin homolog (PTEN) and by the activating mutations in PI3K subunits. Additionally, crosstalk and reciprocal feedback loops between androgen signaling and the PI3K/AKT/mTOR signaling cascade that activate pro-survival signals and play an essential role in disease recurrence and progression have been evidenced. Inhibitors addressing different players of the PI3K/AKT/mTOR pathway have been evaluated in the clinic. Only a limited benefit has been reported in prostate cancer up to now due to the associated side effects, so novel combination approaches and biomarkers predictive of patient response are urgently needed. Here, we reviewed recent data on the crosstalk between AR signaling and the PI3K/AKT/mTOR pathway, the selective inhibitors identified, and the most advanced clinical studies, with a focus on combination treatments. A deeper understanding of the complex molecular mechanisms involved in disease progression and treatment resistance is essential to further guide therapeutic approaches with improved outcomes.
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Affiliation(s)
- Fabio Raith
- Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany
| | - Daniel H. O’Donovan
- Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany
| | - Clara Lemos
- Bayer Research and Innovation Center, Bayer US LLC, 238 Main Street, Cambridge, MA 02142, USA
| | - Oliver Politz
- Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany
| | - Bernard Haendler
- Research & Development, Pharmaceuticals, Bayer AG, Müllerstr. 178, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-30-2215-41198
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Mak B, Lin HM, Duong T, Mahon KL, Joshua AM, Stockler MR, Gurney H, Parnis F, Zhang A, Scheinberg T, Wittert G, Butler LM, Sullivan D, Hoy AJ, Meikle PJ, Horvath LG. Modulation of Plasma Lipidomic Profiles in Metastatic Castration-Resistant Prostate Cancer by Simvastatin. Cancers (Basel) 2022; 14:cancers14194792. [PMID: 36230715 PMCID: PMC9563053 DOI: 10.3390/cancers14194792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Elevated circulating sphingolipids are associated with shorter overall survival and therapeutic resistance in metastatic castration-resistant prostate cancer (mCRPC), suggesting that perturbations in sphingolipid metabolism promotes prostate cancer growth. This study assessed whether addition of simvastatin to standard treatment for mCRPC can modify a poor prognostic circulating lipidomic profile represented by a validated 3-lipid signature (3LS). Men with mCRPC (n = 27) who were not on a lipid-lowering agent, were given simvastatin for 12 weeks (40 mg orally, once daily) with commencement of standard treatment. Lipidomic profiling was performed on their plasma sampled at baseline and after 12 weeks of treatment. Only 11 men had the poor prognostic 3LS at baseline, of whom five (45%) did not retain the 3LS after simvastatin treatment (expected conversion rate with standard treatment = 19%). At baseline, the plasma profiles of men with the 3LS displayed higher levels (p < 0.05) of sphingolipids (ceramides, hexosylceramides and sphingomyelins) than those of men without the 3LS. These plasma sphingolipids were reduced after statin treatment in men who lost the 3LS (mean decrease: 23−52%, p < 0.05), but not in men with persistent 3LS, and were independent of changes to plasma cholesterol, LDL-C or triacylglycerol. In conclusion, simvastatin in addition to standard treatment can modify the poor prognostic circulating lipidomic profile in mCRPC into a more favourable profile at twice the expected conversion rate.
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Affiliation(s)
- Blossom Mak
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Hui-Ming Lin
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- St Vincent’s Clinical School, UNSW Sydney, Darlinghurst, NSW 2010, Australia
| | - Thy Duong
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Kate L. Mahon
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Anthony M. Joshua
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- St Vincent’s Clinical School, UNSW Sydney, Darlinghurst, NSW 2010, Australia
- Kinghorn Cancer Centre, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
| | - Martin R. Stockler
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Francis Parnis
- Adelaide Cancer Centre, Kurralta Park, SA 5037, Australia
| | - Alison Zhang
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Tahlia Scheinberg
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Gary Wittert
- South Australian Immunogenomics Cancer Institute and Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA 5005, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Lisa M. Butler
- South Australian Immunogenomics Cancer Institute and Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA 5005, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - David Sullivan
- Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- NSW Health Pathology, Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Andrew J. Hoy
- School of Medical Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - Peter J. Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Department of Cardiovascular Research Translation and Implementation, La Trobe University, Bundoora, VIC 3086, Australia
| | - Lisa G. Horvath
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- St Vincent’s Clinical School, UNSW Sydney, Darlinghurst, NSW 2010, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Correspondence: ; Tel.: +61-2-8514-0142
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