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Stojiljković D, Cvetković A, Jokić A, Mirčić D, Mihajlović S, Krivokuća A, Crnogorac MĐ, Glisic L. Li-Fraumeni Syndrome With Six Primary Tumors-Case Report. Case Rep Oncol Med 2024; 2024:6699698. [PMID: 38765733 PMCID: PMC11101246 DOI: 10.1155/2024/6699698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 05/22/2024] Open
Abstract
Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome associated with a high, lifetime risk of a broad spectrum of cancers caused by pathogenic germline TP53 mutations. Numerous different germline TP53 mutations have been associated with LFS, which has an exceptionally diverse clinical spectrum in terms of tumor type and age of onset. Our patient has developed six asynchronous tumors to date: a phyllode tumor of the breast, a pheochromocytoma, a rosette-forming glioneuronal tumor (RGNT), an adrenocortical carcinoma (ACC), a ductal carcinoma of the breast, and a thymoma. The occurrence of such a number of rare tumors is sporadic even among in the population of patients living with cancer predisposition syndromes. In this instance, the omission of pretest genetic counseling and thorough family tree analysis prior to selecting the test led to the oversight of an underlying TP53 likely pathogenic mutation (classified as Class 4). This emphasizes the necessity for such counseling to prevent overlooking crucial genetic information. Neglecting this step could have had profound implications on the patient's treatment, particularly considering the early onset and occurrence of multiple tumors, which typically raise suspicion of a hereditary component. The implications for family members must be considered.
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Affiliation(s)
- Dejan Stojiljković
- Department of Surgery, Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Cvetković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology With Reanimatology and Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Andrej Jokić
- Department of Anesthesiology With Reanimatology and Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Dijana Mirčić
- Department of Anesthesiology With Reanimatology and Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Sanja Mihajlović
- Department of Surgery, Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ana Krivokuća
- Department for Experimental Research and Genetics, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Marija Đorđić Crnogorac
- Department for Experimental Research and Genetics, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Lazar Glisic
- Department of Obstetrics and Gynecology, University Clinic Ulm, Faculty of Medicine, University of Ulm, Ulm, Germany
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Ghosh C, Hu J, Kebebew E. Advances in translational research of the rare cancer type adrenocortical carcinoma. Nat Rev Cancer 2023; 23:805-824. [PMID: 37857840 DOI: 10.1038/s41568-023-00623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/21/2023]
Abstract
Adrenocortical carcinoma is a rare malignancy with an annual worldwide incidence of 1-2 cases per 1 million and a 5-year survival rate of <60%. Although adrenocortical carcinoma is rare, such rare cancers account for approximately one third of patients diagnosed with cancer annually. In the past decade, there have been considerable advances in understanding the molecular basis of adrenocortical carcinoma. The genetic events associated with adrenocortical carcinoma in adults are distinct from those of paediatric cases, which are often associated with germline or somatic TP53 mutations and have a better prognosis. In adult primary adrenocortical carcinoma, the main somatic genetic alterations occur in genes that encode proteins involved in the WNT-β-catenin pathway, cell cycle and p53 apoptosis pathway, chromatin remodelling and telomere maintenance pathway, cAMP-protein kinase A (PKA) pathway or DNA transcription and RNA translation pathways. Recently, integrated molecular studies of adrenocortical carcinomas, which have characterized somatic mutations and the methylome as well as gene and microRNA expression profiles, have led to a molecular classification of these tumours that can predict prognosis and have helped to identify new therapeutic targets. In this Review, we summarize these recent translational research advances in adrenocortical carcinoma, which it is hoped could lead to improved patient diagnosis, treatment and outcome.
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Affiliation(s)
| | - Jiangnan Hu
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University, Stanford, CA, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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3
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Libé R, Haissaguerre M, Renaudin K, Faron M, Decaussin-Petrucci M, Deschamps F, Gimenez-Roqueplo AP, Mirallie E, Murez T, Pattou F, Rocher L, Taïeb D, Savoie PH, Tabarin A, Bertherat J, Baudin E, de la Fouchardière C. [Guidelines of the French National ENDOCAN-COMETE, Association of Endocrine Surgery, Society of Urology for the management of adrenocortical carcinoma]. Bull Cancer 2023; 110:707-730. [PMID: 37061367 DOI: 10.1016/j.bulcan.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/17/2023]
Abstract
The adrenocortical carcinoma (ACC) is a primary malignant tumor developed from the adrenal cortex, defined by a Weiss score≥3. Its prognosis is poor and depends mainly on the stage of the disease at diagnosis. Care is organized in France by the multidisciplinary expert centers of the national ENDOCAN-COMETE "Adrenal Cancers" network, certified by the National Cancer Institute. This document updates the guidelines for the management of ACC in adults based on the most robust data in the literature. It's divided into 11 chapters: (1) circumstances of discovery; (2) pre-therapeutic assessment; (3) diagnosis of ACC; (4) oncogenetics; (5) prognostic classifications; (6) treatment of hormonal hypersecretion; (7) treatment of localized forms; (8) treatment of relapses; (9) treatment of advanced forms; (10) follow-up; (11) the particular case of ACC and pregnancy. R0 resection of all localized ACC remains an unmet need and it must be performed in expert centers. Flow-charts for the therapeutic management of localized ACC, relapse or advanced ACC are provided. It was written by the experts from the national ENDOCAN-COMETE network and validated by all French Societies involved in the management of these patients (endocrinology, medical oncology, endocrine surgery, urology, pathology, genetics, nuclear medicine, radiology, interventional radiology).
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Affiliation(s)
- Rossella Libé
- CHU Paris Centre, hôpital Cochin, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Paris, France.
| | - Magalie Haissaguerre
- CHU de Bordeaux, hôpital Haut-Lévêque, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Pessac, France
| | - Karine Renaudin
- CHU de Nantes, hôpital Hôtel-Dieu, service d'anatomie pathologique, Nantes, France
| | - Matthieu Faron
- Gustave-Roussy Cancer Campus, service de chirurgie viscérale oncologique, Villejuif, France
| | | | - Fréderic Deschamps
- Gustave-Roussy Cancer Campus, département de radiologie interventionnelle, Villejuif, France
| | | | - Eric Mirallie
- CHU de Nantes, hôpital Hôtel-Dieu, institut des maladies de l'appareil digestif, chirurgie cancérologique, digestive et endocrinienne, Nantes, France
| | - Thibaut Murez
- CHU de Montpellier, département d'urologie et transplantation rénale, Montpellier, France
| | - François Pattou
- CHRU de Lille, département de chirurgie endocrinienne et métabolique, Lille, France
| | - Laurence Rocher
- Hôpitaux et université Paris Saclay, hôpital Antoine-Béclère, service de radiologie, Clamart, France
| | - David Taïeb
- La Timone University Hospital, Aix-Marseille University, CERIMED, département de médecine nucléaire, Marseille, France
| | - Pierre Henri Savoie
- Hôpital d'instruction des Armées Sainte-Anne, service d'urologie, Toulon, France
| | - Antoine Tabarin
- CHU de Bordeaux, hôpital Haut-Lévêque, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Pessac, France
| | - Jérôme Bertherat
- CHU Paris Centre, hôpital Cochin, centre coordonnateur ENDOCAN-COMETE, service d'endocrinologie, Paris, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus, centre coordonnateur ENDOCAN-COMETE, service de cancérologie endocrine, Villejuif, France
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Adrenocortical Carcinoma (ACC) Cells Rewire Their Metabolism to Overcome Curcumin Antitumoral Effects Opening a Window of Opportunity to Improve Treatment. Cancers (Basel) 2023; 15:cancers15041050. [PMID: 36831394 PMCID: PMC9954484 DOI: 10.3390/cancers15041050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Extensive research suggests that curcumin interferes with multiple cell signaling pathways involved in cancer development and progression. This study aimed to evaluate curcumin effects on adrenocortical carcinoma (ACC), a rare but very aggressive tumor. Curcumin reduced growth, migration and activated apoptosis in three different ACC cell lines, H295R, SW13, MUC-1. This event was related to a decrease in estrogen-related receptor-α (ERRα) expression and cholesterol synthesis. More importantly, curcumin changed ACC cell metabolism, increasing glycolytic gene expression. However, pyruvate from glycolysis was only minimally used for lactate production and the Krebs cycle (TCA). In fact, lactate dehydrogenase, extracellular acidification rate (ECAR), TCA genes and oxygen consumption rate (OCR) were reduced. We instead found an increase in Glutamic-Pyruvic Transaminase (GPT), glutamine antiport transporter SLC1A5 and glutaminase (GLS1), supporting a metabolic rewiring toward glutamine metabolism. Targeting this mechanism, curcumin effects were improved. In fact, in a low glutamine-containing medium, the growth inhibitory effects elicited by curcumin were observed at a concentration ineffective in default growth medium. Data from this study prove the efficacy of curcumin against ACC growth and progression and point to the concomitant use of inhibitors for glutamine metabolism to improve its effects.
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Puglisi S, Basile V, Sperone P, Terzolo M. Pregnancy in patients with adrenocortical carcinoma: a case-based discussion. Rev Endocr Metab Disord 2023; 24:85-96. [PMID: 36414840 DOI: 10.1007/s11154-022-09769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
Although adrenocortical carcinoma (ACC) during pregnancy is rare, a retrospective review of a case series at our hospital revealed that almost one third of our patients were women in childbearing age. Given that the age of maternity is increasing, dealing with a tumor diagnosis during pregnancy and the need for fertility planning in cancer survivors is likely to become more frequent.We thus carried out a case-based discussion regarding: i) diagnosing and treating an ACC during pregnancy; ii) patients conceiving while on mitotane; iii) ACC survivors with a maternal desire.In each of these cases, it is important to provide patients with sufficient information, to offer medical advice and psychological support, to personalize treatments in accordance with the wishes of the patient and her relatives, and to collaborate with other specialists since a multidisciplinary expert team is required to manage each case individually.
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Affiliation(s)
- Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy
| | - Paola Sperone
- Medical Oncology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy.
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Chimento A, De Luca A, Avena P, De Amicis F, Casaburi I, Sirianni R, Pezzi V. Estrogen Receptors-Mediated Apoptosis in Hormone-Dependent Cancers. Int J Mol Sci 2022; 23:1242. [PMID: 35163166 PMCID: PMC8835409 DOI: 10.3390/ijms23031242] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
It is known that estrogen stimulates growth and inhibits apoptosis through estrogen receptor(ER)-mediated mechanisms in many cancer cell types. Interestingly, there is strong evidence that estrogens can also induce apoptosis, activating different ER isoforms in cancer cells. It has been observed that E2/ERα complex activates multiple pathways involved in both cell cycle progression and apoptotic cascade prevention, while E2/ERβ complex in many cases directs the cells to apoptosis. However, the exact mechanism of estrogen-induced tumor regression is not completely known. Nevertheless, ERs expression levels of specific splice variants and their cellular localization differentially affect outcome of estrogen-dependent tumors. The goal of this review is to provide a general overview of current knowledge on ERs-mediated apoptosis that occurs in main hormone dependent-cancers. Understanding the molecular mechanisms underlying the induction of ER-mediated cell death will be useful for the development of specific ligands capable of triggering apoptosis to counteract estrogen-dependent tumor growth.
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Affiliation(s)
- Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Francesca De Amicis
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via Pietro Bucci, Arcavacata di Rende, 87036 Cosenza, Italy
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Ilanchezhian M, Varghese DG, Glod JW, Reilly KM, Widemann BC, Pommier Y, Kaplan RN, Del Rivero J. Pediatric adrenocortical carcinoma. Front Endocrinol (Lausanne) 2022; 13:961650. [PMID: 36387865 PMCID: PMC9659577 DOI: 10.3389/fendo.2022.961650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy of the adrenal gland with an unfavorable prognosis. It is rare in the pediatric population, with an incidence of 0.2-0.3 patients per million in patients under 20 years old. It is primarily associated with Li-Fraumeni and Beckwith-Wiedemann tumor predisposition syndromes in children. The incidence of pediatric ACC is 10-15fold higher in southern Brazil due to a higher prevalence of TP53 mutation associated with Li-Fraumeni syndrome in that population. Current treatment protocols are derived from adult ACC and consist of surgery and/or chemotherapy with etoposide, doxorubicin, and cisplatin (EDP) with mitotane. Limited research has been reported on other treatment modalities for pediatric ACC, including mitotane, pembrolizumab, cabozantinib, and chimeric antigen receptor autologous cell (CAR-T) therapy.
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Affiliation(s)
- Maran Ilanchezhian
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Diana Grace Varghese
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - John W. Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Karlyne M. Reilly
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte C. Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Yves Pommier
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Rosandra N. Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
- *Correspondence: Jaydira Del Rivero,
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Shariq OA, McKenzie TJ. Adrenocortical carcinoma: current state of the art, ongoing controversies, and future directions in diagnosis and treatment. Ther Adv Chronic Dis 2021; 12:20406223211033103. [PMID: 34349894 PMCID: PMC8295938 DOI: 10.1177/20406223211033103] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 12/22/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with an annual incidence of ~1 case per million population. Differentiating between ACC and benign adrenocortical tumors can be challenging in patients who present with an incidentally discovered adrenal mass, due to the limited specificity of standard diagnostic imaging. Recently, urine steroid metabolite profiling has been prospectively validated as a novel diagnostic tool for the detection of malignancy with improved accuracy over current modalities. Surgery represents the only curative treatment for ACC, although local recurrence and metastases are common, even after a margin-negative resection is performed. Unlike other intra-abdominal cancers, the role of minimally invasive surgery and lymphadenectomy in ACC is controversial. Adjuvant therapy with the adrenolytic drug mitotane is used to reduce the risk of recurrence after surgery, although evidence supporting its efficacy is limited; it is also currently unclear whether all patients or a subset with the highest risk of recurrence should receive this treatment. Large-scale pan-genomic studies have yielded insights into the pathogenesis of ACC and have defined distinct molecular signatures associated with clinical outcomes that may be used to improve prognostication. For patients with advanced ACC, palliative combination chemotherapy with mitotane is the current standard of care; however, this is associated with poor response rates (RR). Knowledge from molecular profiling studies has been used to guide the development of novel targeted therapies; however, these have shown limited efficacy in early phase trials. As a result, there is an urgent unmet need for more effective therapies for patients with this devastating disease.
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Affiliation(s)
| | - Travis J McKenzie
- Department of Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
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Abstract
Resident progenitor and/or stem cell populations in the adult adrenal cortex enable cortical cells to undergo homeostatic renewal and regeneration after injury. Renewal occurs predominantly in the outer layers of the adrenal gland but newly formed cells undergo centripetal migration, differentiation and lineage conversion in the process of forming the different functional steroidogenic zones. Over the past 10 years, advances in the genetic characterization of adrenal diseases and studies of mouse models with altered adrenal phenotypes have helped to elucidate the molecular pathways that regulate adrenal tissue renewal, several of which are fine-tuned via complex paracrine and endocrine influences. Moreover, the adrenal gland is a sexually dimorphic organ, and testicular androgens have inhibitory effects on cell proliferation and progenitor cell recruitment in the adrenal cortex. This Review integrates these advances, including the emerging role of sex hormones, into existing knowledge on adrenocortical cell renewal. An in-depth understanding of these mechanisms is expected to contribute to the development of novel therapies for severe endocrine diseases, for which current treatments are unsatisfactory.
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Affiliation(s)
- Rodanthi Lyraki
- Université Côte d'Azur, INSERM, CNRS, Institut de Biologie Valrose, Nice, France
| | - Andreas Schedl
- Université Côte d'Azur, INSERM, CNRS, Institut de Biologie Valrose, Nice, France.
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10
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A Phenylacetamide Resveratrol Derivative Exerts Inhibitory Effects on Breast Cancer Cell Growth. Int J Mol Sci 2021; 22:ijms22105255. [PMID: 34067547 PMCID: PMC8157022 DOI: 10.3390/ijms22105255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Resveratrol (RSV) is a natural compound that displays several pharmacological properties, including anti-cancer actions. However, its clinical application is limited because of its low solubility and bioavailability. Here, the antiproliferative and anti-inflammatory activity of a series of phenylacetamide RSV derivatives has been evaluated in several cancer cell lines. These derivatives contain a monosubstituted aromatic ring that could mimic the RSV phenolic nucleus and a longer flexible chain that could confer a better stability and bioavailability than RSV. Using MTT assay, we demonstrated that most derivatives exerted antiproliferative effects in almost all of the cancer cell lines tested. Among them, derivative 2, that showed greater bioavailability than RSV, was the most active, particularly against estrogen receptor positive (ER+) MCF7 and estrogen receptor negative (ER-) MDA-MB231 breast cancer cell lines. Moreover, we demonstrated that these derivatives, particularly derivative 2, were able to inhibit NO and ROS synthesis and PGE2 secretion in lipopolysaccharide (LPS)-activated U937 human monocytic cells (derived from a histiocytoma). In order to define the molecular mechanisms underlying the antiproliferative effects of derivative 2, we found that it determined cell cycle arrest at the G1 phase, modified the expression of cell cycle regulatory proteins, and ultimately triggered apoptotic cell death in both breast cancer cell lines. Taken together, these results highlight the studied RSV derivatives, particularly derivative 2, as promising tools for the development of new and more bioavailable derivatives useful in the treatment of breast cancer.
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The Sexually Dimorphic Adrenal Cortex: Implications for Adrenal Disease. Int J Mol Sci 2021; 22:ijms22094889. [PMID: 34063067 PMCID: PMC8124132 DOI: 10.3390/ijms22094889] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
Many adrenocortical diseases are more prevalent in women than in men, but the reasons underlying this sex bias are still unknown. Recent studies involving gonadectomy and sex hormone replacement experiments in mice have shed some light onto the molecular basis of sexual dimorphism in the adrenal cortex. Indeed, it has been shown that gonadal hormones influence many aspects of adrenal physiology, ranging from stem cell-dependent tissue turnover to steroidogenesis and X-zone dynamics. This article reviews current knowledge on adrenal cortex sexual dimorphism and the potential mechanisms underlying sex hormone influence of adrenal homeostasis. Both topics are expected to contribute to personalized and novel therapeutic approaches in the future.
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Allegra S, Puglisi S, Brescia I, Chiara F, Basile V, Calabrese A, Reimondo G, De Francia S. Sex Differences on Mitotane Concentration and Treatment Outcome in Patients with Adrenocortical Carcinoma. Life (Basel) 2021; 11:life11030266. [PMID: 33807024 PMCID: PMC8004922 DOI: 10.3390/life11030266] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: In clinical settings, data regarding sex are rarely investigated. In women, factors such as body size and composition, hormonal variations, metabolism, and access to care systems and therapy could strongly influence the pharmacological management and the outcome of the therapy. To underline this sex-related difference, we retrospectively collected data from adrenocortical carcinoma patients treated with mitotane, and then evaluated sex-related pharmacokinetics parameters. (2) Methods: A fully validated chromatographic method was used to quantify mitotane concentration in plasma collected from adult patients, also considering the active metabolite ortho,para,dichlorodiphenylethene (o,p'-DDE). Statistical analyses were used to evaluate the sex influence on drugs pharmacokinetics. (3) Results: We found that sex resulted as predictive factor of plasma mitotane and o,p'-DDE concentrations and significantly influenced the attainment of the therapeutic target of mitotane, implying that female sex could be a risk factor of treatment failure. (4) Conclusions: These results suggest that mitotane therapy should be modulated according to patient sex. Furthermore, the proposed approach could contribute to facilitating and disseminating sex-specific pharmacology.
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Affiliation(s)
- Sarah Allegra
- Laboratory of Clinical Pharmacology “Franco Ghezzo”, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (I.B.); (F.C.); (S.D.F.)
- Correspondence: ; Tel.: +39-011-6705442
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (S.P.); (V.B.); (A.C.); (G.R.)
| | - Irene Brescia
- Laboratory of Clinical Pharmacology “Franco Ghezzo”, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (I.B.); (F.C.); (S.D.F.)
| | - Francesco Chiara
- Laboratory of Clinical Pharmacology “Franco Ghezzo”, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (I.B.); (F.C.); (S.D.F.)
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (S.P.); (V.B.); (A.C.); (G.R.)
| | - Anna Calabrese
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (S.P.); (V.B.); (A.C.); (G.R.)
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (S.P.); (V.B.); (A.C.); (G.R.)
| | - Silvia De Francia
- Laboratory of Clinical Pharmacology “Franco Ghezzo”, Department of Clinical and Biological Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, TO, Italy; (I.B.); (F.C.); (S.D.F.)
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Chimento A, De Luca A, Nocito MC, Sculco S, Avena P, La Padula D, Zavaglia L, Sirianni R, Casaburi I, Pezzi V. SIRT1 is involved in adrenocortical cancer growth and motility. J Cell Mol Med 2021; 25:3856-3869. [PMID: 33650791 PMCID: PMC8051751 DOI: 10.1111/jcmm.16317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
Adrenocortical cancer (ACC) is a rare tumour with unfavourable prognosis, lacking an effective treatment. This tumour is characterized by IGF‐II (insulin‐like growth factor II) overproduction, aromatase and ERα (oestrogen receptor alpha) up‐regulation. Previous reports suggest that ERα expression can be regulated by sirt1 (sirtuin 1), a nicotinamide adenine dinucleotide (NAD+)‐dependent class III histone deacetylases that modulates activity of several substrates involved in cellular stress, metabolism, proliferation, senescence, protein degradation and apoptosis. Nevertheless, sirt1 can act as a tumour suppressor or oncogenic protein. In this study, we found that in H295R and SW13 cell lines, sirt1 expression is inhibited by sirtinol, a potent inhibitor of sirt1 activity. In addition, sirtinol is able to decrease ACC cell proliferation, colony and spheroids formation and to activate the intrinsic apoptotic mechanism. Particularly, we observed that sirtinol interferes with E2/ERα and IGF1R (insulin growth factor 1 receptor) pathways by decreasing receptors expression. Sirt1 involvement was confirmed by using a specific sirt1 siRNA. More importantly, we observed that sirtinol can synergize with mitotane, a selective adrenolitic drug, in inhibiting adrenocortical cancer cell growth. Collectively, our data reveal an oncogenic role for sirt1 in ACC and its targeting could implement treatment options for this type of cancer.
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Affiliation(s)
- Adele Chimento
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Marta Claudia Nocito
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Sara Sculco
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Davide La Padula
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Lucia Zavaglia
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Ivan Casaburi
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Vincenzo Pezzi
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
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Kiseljak-Vassiliades K, Bancos I, Hamrahian A, Habra M, Vaidya A, Levine AC, Else T. American Association of Clinical Endocrinology Disease State Clinical Review on the Evaluation and Management of Adrenocortical Carcinoma in an Adult: a Practical Approach. Endocr Pract 2020; 26:1366-1383. [PMID: 33875173 DOI: 10.4158/dscr-2020-0567] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this Disease State Clinical Review is to provide a practical approach to patients with newly diagnosed adrenocortical carcinoma, as well as to follow-up and management of patients with persistent or recurrent disease. METHODS This is a case-based clinical review. The provided recommendations are based on evidence available from randomized prospective clinical studies, cohort studies, cross-sectional and case-based studies, and expert opinions. RESULTS Adrenocortical carcinoma is a rare malignancy, often with poor outcomes. For any patient with an adrenal mass suspicious for adrenocortical carcinoma, the approach should include prompt evaluation with detailed history and physical exam, imaging, and biochemical adrenal hormone assessment. In addition to adrenal-focused imaging, patients should be evaluated with chest-abdomen-pelvis cross-sectional imaging to define the initial therapy plan. Patients with potentially resectable disease limited to the adrenal gland should undergo en bloc open surgery by an expert surgeon. For patients presenting with advanced or recurrent disease, a multidisciplinary approach considering curative repeat surgery, local control with surgery, radiation therapy or radiofrequency ablation, or systemic therapy with mitotane and/or cytotoxic chemotherapy is recommended. CONCLUSION As most health care providers will rarely encounter a patient with adrenocortical carcinoma, we recommend that patients with suspected adrenocortical carcinoma be evaluated by an expert multidisciplinary team which includes clinicians with expertise in adrenal tumors, including endocrinologists, oncologists, surgeons, radiation oncologists, pathologists, geneticists, and radiologists. We recommend that patients in remote locations be followed by the local health care provider in collaboration with a multidisciplinary team at an expert adrenal tumor program. ABBREVIATIONS ACC = adrenocortical carcinoma; ACTH = adrenocorticotropic hormone; BRACC = borderline resectable adrenocortical carcinoma; CT = computed tomography; DHEAS = dehydroepiandrosterone sulfate; EDP = etoposide, doxorubicin, cisplatin; FDG = 18F-fluorodeoxyglucose; FNA = fine-needle aspiration; HU = Hounsfield units; IVC = inferior vena cava; LFS = Li-Fraumeni syndrome; MEN1 = multiple endocrine neoplasia type 1; MRI = magnetic resonance imaging; OAC = oncocytic adrenocortical carcinoma; PC = palliative care; PET = positron emission tomography.
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Affiliation(s)
- Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Amir Hamrahian
- Division of Endocrinology, Johns Hopkins Hospital, Baltimore, Maryland
| | - MouhammedAmir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alice C Levine
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
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15
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Estrogen receptor α plays an important role in Cushing’s syndrome during pregnancy. Med Hypotheses 2020; 143:109817. [DOI: 10.1016/j.mehy.2020.109817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
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16
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Trotta F, Avena P, Chimento A, Rago V, De Luca A, Sculco S, Nocito MC, Malivindi R, Fallo F, Pezzani R, Pilon C, Lasorsa FM, Barile SN, Palmieri L, Lerario AM, Pezzi V, Casaburi I, Sirianni R. Statins Reduce Intratumor Cholesterol Affecting Adrenocortical Cancer Growth. Mol Cancer Ther 2020; 19:1909-1921. [PMID: 32546662 DOI: 10.1158/1535-7163.mct-19-1063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/08/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Mitotane causes hypercholesterolemia in patients with adrenocortical carcinoma (ACC). We suppose that cholesterol increases within the tumor and can be used to activate proliferative pathways. In this study, we used statins to decrease intratumor cholesterol and investigated the effects on ACC growth related to estrogen receptor α (ERα) action at the nuclear and mitochondrial levels. We first used microarray to investigate mitotane effect on genes involved in cholesterol homeostasis and evaluated their relationship with patients' survival in ACC TCGA. We then blocked cholesterol synthesis with simvastatin and determined the effects on H295R cell proliferation, estradiol production, and ERα activity in vitro and in xenograft tumors. We found that mitotane increases intratumor cholesterol content and expression of genes involved in cholesterol homeostasis, among them INSIG, whose expression affects patients' survival. Treatment of H295R cells with simvastatin to block cholesterol synthesis decreased cellular cholesterol content, and this affected cell viability. Simvastatin reduced estradiol production and decreased nuclear and mitochondrial ERα function. A mitochondrial target of ERα, the respiratory complex IV (COXIV), was reduced after simvastatin treatment, which profoundly affected mitochondrial respiration activating apoptosis. Additionally, simvastatin reduced tumor volume and weight of grafted H295R cells, intratumor cholesterol content, Ki-67 and ERα, COXIV expression and activity and increase terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells. Collectively, these data demonstrate that a reduction in intratumor cholesterol content prevents estradiol production and inhibits mitochondrial respiratory chain-inducing apoptosis in ACC cells. Inhibition of mitochondrial respiration by simvastatin represents a novel strategy to counteract ACC growth.
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Affiliation(s)
- Francesca Trotta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Vittoria Rago
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Sara Sculco
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Marta C Nocito
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rocco Malivindi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Francesco Fallo
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Raffaele Pezzani
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Catia Pilon
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Francesco M Lasorsa
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, and CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, Bari, Italy
| | - Simona N Barile
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, and CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, Bari, Italy
| | - Luigi Palmieri
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, and CNR Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, Bari, Italy
| | - Antonio M Lerario
- Departments of Molecular and Integrative Physiology and Internal Medicine, University of Michigan, Medical School, Ann Arbor, Michigan
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy.
| | - Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy.
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17
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Rossi GP, Caroccia B, Seccia TM. Role of estrogen receptors in modulating aldosterone biosynthesis and blood pressure. Steroids 2019; 152:108486. [PMID: 31499072 DOI: 10.1016/j.steroids.2019.108486] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022]
Abstract
Blood pressure is lower in premenopausal women than in age-matched men; after menopause blood pressure values and the prevalence of hypertension show opposite trends indicating that estrogens contribute to maintaining normal blood pressure values in women. In experimental studies menopause increases aldosterone levels, an effect alleviated by estrogen treatment. We have recently discovered a role of estrogen receptors (ER) in controlling aldosterone biosynthesis in the human adrenocortical zona glomerulosa, which expresses both the classical ERα and β receptors and G protein-coupled estrogen receptor (GPER). We have also identified that GPER mediates an aldosterone-induced aldosterone response. We found that 17 β-estradiol exerts a dual effect: it blunts aldosterone production via ERβ, but displays a potent aldosterone secretagogue effect via GPER activation after ERβ blockade. Thus, in premenopausal women high estrogen levels might tonically blunt aldosterone synthesis via ERβ, thereby maintaining normal blood pressure; after menopause loss of this estrogen-mediated inhibition can contribute to increasing blood pressure via GPER-mediated aldosterone release. The additional findings that GPER mediates an aldosterone-induced stimulation of aldosterone biosynthesis and that GPER predominates in aldosterone-producing adenomas strongly involves this receptor in the pathophysiology of primary aldosteronism. Our purpose here was to provide an update on estrogen receptor function in the normal adrenal cortex and its relevance for the sex differences in blood pressure in light of the newly discovered role of GPER in regulating aldosterone synthesis. The implications of the novel knowledge for the treatment of estrogen-dependent malignancies with ER modulators are also discussed.
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18
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Sada A, Asaad M, Bews KA, Thompson GB, Young WF, Bancos I, Farley DR, Dy BM, Lyden ML, Habermann EB, McKenzie TJ. Comparison between functional and non-functional adrenocortical carcinoma. Surgery 2019; 167:216-223. [PMID: 31543320 DOI: 10.1016/j.surg.2019.04.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 04/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND While roughly half of adrenocortical carcinomas are functional, whether functional status impacts outcomes remains controversial. We compared presentation and survival for functional and nonfunctional neoplasms. METHODS Adult patients presented with adrenocortical carcinomas at the Mayo Clinic were included. Tumor characteristics and outcomes were analyzed. RESULTS The 266 identified patients presented with stage I (6%), II (33%), III (26%), and IV disease (32%); stage was unknown in 3%. Fifty-three percent of tumors were functional; patients with functional adrenocortical carcinomas were younger, more likely to be female, and more likely to present with metastatic disease. Surgical resection was undertaken in 84% of patients with 69% having R0 resection. While 30-day morbidity was similar between functional and nonfunctional adrenocortical carcinomas, median overall survival was better for nonfunctional adrenocortical carcinomas (median 66 vs 22 months, P = .01). Functional adrenocortical carcinomas was independently associated with shorter survival after adjusting for age, sex, grade, stage, and resection attempt: hazard ratio = 1.5 (95% confidence interval, 1.04-2.14, P = .03). CONCLUSION In our cohort, long term survival was worse for all patients with functional tumors. However, when analyzing patients with R0 resection, there was no survival difference between functional and nonfunctional adrenocortical carcinomas, signaling need for better understanding of adrenocortical carcinomas behavior to individualize and optimize treatment strategies.
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Affiliation(s)
- Alaa Sada
- Department of Surgery, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Malke Asaad
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Katherine A Bews
- Department of Health Services Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | - Benzon M Dy
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Elizabeth B Habermann
- Department of Health Services Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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19
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Fassnacht M, Dekkers O, Else T, Baudin E, Berruti A, de Krijger R, Haak H, Mihai R, Assie G, Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2018; 179:G1-G46. [PMID: 30299884 DOI: 10.1530/eje-18-0608] [Citation(s) in RCA: 492] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare and in most cases steroid hormone-producing tumor with variable prognosis. The purpose of these guidelines is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with ACC based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions, which we judged as particularly important for the management of ACC patients and performed systematic literature searches: (A) What is needed to diagnose an ACC by histopathology? (B) Which are the best prognostic markers in ACC? (C) Is adjuvant therapy able to prevent recurrent disease or reduce mortality after radical resection? (D) What is the best treatment option for macroscopically incompletely resected, recurrent or metastatic disease? Other relevant questions were discussed within the group. Selected Recommendations: (i) We recommend that all patients with suspected and proven ACC are discussed in a multidisciplinary expert team meeting. (ii) We recommend that every patient with (suspected) ACC should undergo careful clinical assessment, detailed endocrine work-up to identify autonomous hormone excess and adrenal-focused imaging. (iii) We recommend that adrenal surgery for (suspected) ACC should be performed only by surgeons experienced in adrenal and oncological surgery aiming at a complete en bloc resection (including resection of oligo-metastatic disease). (iv) We suggest that all suspected ACC should be reviewed by an expert adrenal pathologist using the Weiss score and providing Ki67 index. (v) We suggest adjuvant mitotane treatment in patients after radical surgery that have a perceived high risk of recurrence (ENSAT stage III, or R1 resection, or Ki67 >10%). (vi) For advanced ACC not amenable to complete surgical resection, local therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed recommendations about the management of mitotane treatment and other supportive therapies. Finally, we suggest directions for future research.
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Affiliation(s)
- Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Olaf Dekkers
- Department of Clinical Epidemiology
- Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Baudin
- Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
- INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Ronald de Krijger
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Harm Haak
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Guillaume Assie
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Reference Center dor Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, Internal Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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20
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Pacwa A, Gorowska-Wojtowicz E, Ptak A, Pawlicki P, Milon A, Sekula M, Lesniak K, Bilinska B, Hejmej A, Kotula-Balak M. Interplay between estrogen-related receptors and steroidogenesis-controlling molecules in adrenals. In vivo and in vitro study. Acta Histochem 2018; 120:456-467. [PMID: 29778238 DOI: 10.1016/j.acthis.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
Estrogen-related receptors (ERRs) α, β and γ appear to be novel molecules implicated in estrogen signaling. We blocked and activated ERRs in mouse (C57BL/6) adrenals and adrenocortical cells (H295R) using pharmacological agents XCT 790 (ERRα antagonist) and DY131 (ERRβ/γ agonist), respectively. Mice were injected with XCT 790 or DY131 (5 μg/kg bw) while cells were exposed to XCT 790 or DY131 (0.5 μg/L). Irrespectively of the agent used, changes in adrenocortical cell morphology along with changes in lutropin, cholesterol levels and estrogen production were found. Diverse and complex ERRs regulation of multilevel-acting steroidogenic proteins (perilipin; PLIN, cytochrome P450 side-chain cleavage; P450scc, translocator protein; TSPO, steroidogenic acute regulatory protein; StAR, hormone sensitive lipase; HSL and HMG-CoA reductase; HMGCR) was revealed. Blockage of ERRα decreased P450scc, StAR and TSPO expressions. Activation of ERRβ/γ increased P450scc, StAR and HMGCR while decreased HSL expressions. PLIN expression increased either after XCT 790 or DY131 treatment. Additionally, treatment with both XCT 790 or DY131 decreased activity of Ras/Raf, Erk and Akt indicating their involvement in control of morphology and steroidogenic function of cortex cells. ERRs are important in maintaining morpho-function of cortex cells through action in specific, opposite, or common manner on steroidogenic molecules.
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Affiliation(s)
- A Pacwa
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - E Gorowska-Wojtowicz
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - A Ptak
- Department of Physiology and Toxicology of Reproduction, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - P Pawlicki
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - A Milon
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - M Sekula
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - K Lesniak
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - B Bilinska
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - A Hejmej
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - M Kotula-Balak
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland.
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21
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Angelousi A, Kyriakopoulos G, Nasiri-Ansari N, Karageorgou M, Kassi E. The role of epithelial growth factors and insulin growth factors in the adrenal neoplasms. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:253. [PMID: 30069455 DOI: 10.21037/atm.2018.05.52] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human fetal and adult adrenal gland express both insulin growth factor-1 (IGF-1) and IGF-2, their receptors (IGF-Rs) and a variety of specific IGF binding proteins suggesting their potential role in the regulation of adrenal growth and function. IGF-2 overexpression is essential for the growth of monoclonal lesions, such as large benign adenomas (ACA) and adrenocortical carcinomas (ACC) and has been found to contribute to tumorigenesis in Beckwith-Wiedemann syndrome. IGF-2 is the most highly expressed gene observed in more than 85% of ACCs. However, no significant differences in clinical, biological and transcriptomic traits were found between tumors with high and low expression of IGF-2. On the contrary, the expression of IGF-1R, mediating the IGF-2 effects in vivo, was more discriminant between malignant (overexpression) and benign tumors. Data on the role of epithelial growth factor (EGF) and its receptor (EGF-R) in adrenocortical tumorigenesis are controversial. Several studies have shown EGF-R overexpression in ACCs but not in benign ACAs, suggesting that EGF-R could potentially be used as a marker for the differential diagnosis of ACAs and ACCs. Although, in vitro and animal studies provide promising results in the therapeutic role of IGF and EGF pathway inhibitors, the available data in humans are still not encouraging. Herein, we aim to present recent data on the role of IGF and EGF pathways in adrenal development and tumorigenesis and their potential implication in the treatment of the ACC, a rare malignancy with very poor prognosis.
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Affiliation(s)
- Anna Angelousi
- 1st Department of Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,1st Department of Propaedeutic Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Kyriakopoulos
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - Narjes Nasiri-Ansari
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Margarita Karageorgou
- 2nd Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Eva Kassi
- 1st Department of Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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22
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Caroccia B, Seccia TM, Barton M, Rossi GP. Estrogen Signaling in the Adrenal Cortex: Implications for Blood Pressure Sex Differences. Hypertension 2018; 68:840-8. [PMID: 27600178 DOI: 10.1161/hypertensionaha.116.07660] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brasilina Caroccia
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Teresa M Seccia
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Matthias Barton
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Gian Paolo Rossi
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.).
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Chimento A, Casaburi I, Avena P, Trotta F, De Luca A, Rago V, Pezzi V, Sirianni R. Cholesterol and Its Metabolites in Tumor Growth: Therapeutic Potential of Statins in Cancer Treatment. Front Endocrinol (Lausanne) 2018; 9:807. [PMID: 30719023 PMCID: PMC6348274 DOI: 10.3389/fendo.2018.00807] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022] Open
Abstract
Cholesterol is essential for cell function and viability. It is a component of the plasma membrane and lipid rafts and is a precursor for bile acids, steroid hormones, and Vitamin D. As a ligand for estrogen-related receptor alpha (ESRRA), cholesterol becomes a signaling molecule. Furthermore, cholesterol-derived oxysterols activate liver X receptors (LXRs) or estrogen receptors (ERs). Several studies performed in cancer cells reveal that cholesterol synthesis is enhanced compared to normal cells. Additionally, high serum cholesterol levels are associated with increased risk for many cancers, but thus far, clinical trials with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have had mixed results. Statins inhibit cholesterol synthesis within cells through the inhibition of HMG-CoA reductase, the rate-limiting enzyme in the mevalonate and cholesterol synthetic pathway. Many downstream products of mevalonate have a role in cell proliferation, since they are required for maintenance of membrane integrity; signaling, as some proteins to be active must undergo prenylation; protein synthesis, as isopentenyladenine is an essential substrate for the modification of certain tRNAs; and cell-cycle progression. In this review starting from recent acquired findings on the role that cholesterol and its metabolites fulfill in the contest of cancer cells, we discuss the results of studies focused to investigate the use of statins in order to prevent cancer growth and metastasis.
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Casaburi I, Chimento A, De Luca A, Nocito M, Sculco S, Avena P, Trotta F, Rago V, Sirianni R, Pezzi V. Cholesterol as an Endogenous ERRα Agonist: A New Perspective to Cancer Treatment. Front Endocrinol (Lausanne) 2018; 9:525. [PMID: 30254608 PMCID: PMC6141749 DOI: 10.3389/fendo.2018.00525] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/21/2018] [Indexed: 01/01/2023] Open
Abstract
The estrogen-related receptors (ERRs) are important members of nuclear receptors which contain three isoforms (α, β, and γ). ERRα is the best-characterized isoform expressed mainly in high-energy demanding tissues where it preferentially works in association with the peroxisome proliferator-activated receptor-γ co-activator 1α (PGC-1α) and PGC-1β. ERRα together with its cofactors modulates cellular metabolism, supports the growth of rapidly dividing cells, directs metabolic programs required for cell differentiation and maintains cellular energy homeostasis in differentiated cells. In cancer cells, the functional association between ERRα and PGC-1s is further influenced by oncogenic signals and induces metabolic programs favoring cell growth and proliferation as well as tumor progression. Recently, cholesterol has been identified as a natural ERRα ligand using a combined biochemical strategy. This new finding highlighted some important physiological aspects related to the use of cholesterol-lowering drugs such as statins and bisphosphonates. Even more meaningful is the link between increased cholesterol levels and certain cancer phenotypes characterized by an overexpressed ERRα such as mammary, prostatic, and colorectal cancers, where the metabolic adaptation affects many cancer processes. Moreover, high-energy demanding cancer-related processes are strictly related to the cross-talk between tumor cells and some key players of tumor microenvironment, such as tumor-associated macrophage that fuels cancer progression. Some evidence suggests that high cholesterol content and ERRα activity favor the inflammatory environment by the production of different cytokines. In this review, starting from the most recent observations on the physiological role of the new signaling activated by the natural ligand of ERRα, we propose a new hypothesis on the suitability to control cholesterol levels as a chance in modulating ERRα activity in those tumors in which its expression and activity are increased.
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Casaburi I, Avena P, De Luca A, Sirianni R, Rago V, Chimento A, Trotta F, Campana C, Rainey WE, Pezzi V. GPER-independent inhibition of adrenocortical cancer growth by G-1 involves ROS/Egr-1/BAX pathway. Oncotarget 2017; 8:115609-115619. [PMID: 29383185 PMCID: PMC5777797 DOI: 10.18632/oncotarget.23314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Abstract
We previously demonstrated that treatment of the H295R adrenocortical cancer cell line with the non-steroidal, high-affinity GPER (G protein-coupled estrogen receptor 1) agonist G-1 reduced tumor growth in vitro and in vivo through a GPER independent action. Moreover, we observed that G-1 treatment induces cell-cycle arrest and apoptosis following a sustained ERK1/2 activation. However, the precise mechanisms causing these effects were not clarified. Starting from our preliminary published results, we performed a microarray study that clearly evidenced a strong and significative up-regulation of EGR-1 gene in H295R cells treated for 24h with micromolar concentration of G-1. The microarray findings were confirmed by RT-PCR and Western-blot analysis as well as by immunofluorescence that revealed a strong nuclear staining for EGR-1 after G-1 treatment. EGR-1 is a point of convergence of many intracellular signaling cascades that control tumor cell growth and proliferation as well as others that relate to cell death machinery. Here we found that the increased Egr-1 expression was a consequence of G-1-mediated ROS-dependent ERK activation that were promptly reversed by the presence of the antioxidant n-acetyl-cysteine. Finally, we observed that silencing EGR-1 gene expression reversed the main effects induced by G-1 in ACC cells, including upregulation of the negative regulator of cell cycle, p21Waf1/Cip1 and the positive regulator of mitochondrial apoptotic pathway, BAX, as well as the cell growth inhibition. The identified ROS/MAPK/Egr-1/BAX pathway as a potential off-target effect of the G-1 could be useful in implementing the pharmacological approach for ACC therapy.
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Affiliation(s)
- Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Vittoria Rago
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Francesca Trotta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Carmela Campana
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - William E Rainey
- Departments of Molecular & Integrative Physiology and Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
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Role of Scaffold Protein Proline-, Glutamic Acid-, and Leucine-Rich Protein 1 (PELP1) in the Modulation of Adrenocortical Cancer Cell Growth. Cells 2017; 6:cells6040042. [PMID: 29112114 PMCID: PMC5755500 DOI: 10.3390/cells6040042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
PELP1 acts as an estrogen receptor (ER) coactivator that exerts an essential role in the ER's functions. ER coregulators have a critical role in the progression and response to hormonal treatment of estrogen-dependent tumors. We previously demonstrated that, in adrenocortical carcinoma (ACC), ERα is upregulated and that estradiol activates the IGF-II/IGF1R signaling pathways defining the role of this functional cross-talk in H295R ACC cell proliferation. The aim of this study was to determine if PELP1 is expressed in ACC and may play a role in promoting the interaction between ERα and IGF1R allowing the activation of pathways important for ACC cell growth. The expression of PELP1 was detected by Western blot analysis in ACC tissues and in H295R cells. H295R cell proliferation decrease was assessed by A3-(4,5-Dimethylthiaoly)-2,5-diphenyltetrazolium bromide (MTT) assay and [3H] thymidine incorporation. PELP1 is expressed in ACC tissues and in H295R cells. Moreover, treatment of H295R with E2 or IGF-II induced a multiprotein complex formation consisting of PELP1, IGF1R, ERα, and Src that is involved in ERK1/2 rapid activation. PELP1/ER/IGF1R/c-Src complex identification as part of E2- and IGF-II-dependent signaling in ACC suggests PELP1 is a novel and more efficient potential target to reduce ACC growth.
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Innocenti F, Cerquetti L, Pezzilli S, Bucci B, Toscano V, Canipari R, Stigliano A. Effect of mitotane on mouse ovarian follicle development and fertility. J Endocrinol 2017; 234:29-39. [PMID: 28450646 DOI: 10.1530/joe-17-0203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 11/08/2022]
Abstract
Mitotane (MTT) is an adrenolytic drug used in advanced and adjuvant treatment of adrenocortical carcinoma, in Cushing's disease and in ectopic syndrome. However, knowledge about its effects on the ovary is still scarce. The purpose of this study is to investigate the effect of MTT on the ovary using in vivo and in vitro models. The study was performed in CD1 mice and in the COV-434 human ovarian granulosa cell line. We examined ovarian morphology, follicle development, steroidogenesis and procreative function in mice and the effect of MTT on cell growth in vitro Our results revealed that treatment of CD1 mice with MTT induces a decrease in early antral follicles with a subsequent increase in the secondary follicles, measured by the increased levels of anti-Mullerian Hormone (P < 0.05) and decreased levels of FSH receptor (P < 0.05). Moreover, we observed a significant decrease in Cyp11a1 (P < 0.01) and Cyp17a1 (P < 0.001) mRNA level in MTT-treated animals. Ovulation, induced by PMSG/hCG stimulation, was also significantly impaired, with a reduction in the number of ovulated oocytes (P < 0.01) and fewer corpora lutea in treated animals. Likewise, the mating experiment demonstrated a delay in the time of conception as well as fewer pups per litter in MTT-treated mice (P < 0.05). Experiments performed on the COV-434 cell line showed a significant inhibition of growth followed by apoptosis (P < 0.01). In conclusion, our study highlights the key points of ovarian folliculogenesis affected by MTT and demonstrates impairment of the ovulation process with a negative impact on conception, which is nevertheless preserved.
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Affiliation(s)
- Federica Innocenti
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Lidia Cerquetti
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Serena Pezzilli
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Toscano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Canipari
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Antonio Stigliano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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28
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Stigliano A, Cerquetti L, Lardo P, Petrangeli E, Toscano V. New insights and future perspectives in the therapeutic strategy of adrenocortical carcinoma (Review). Oncol Rep 2017; 37:1301-1311. [PMID: 28184938 DOI: 10.3892/or.2017.5427] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/20/2016] [Indexed: 11/06/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an incidence ranging from 0.7 to 2.0 cases/million people per year. Hypercortisolism represents the most common clinical presentation in many patients although, less frequently, some ACC secreting androgens and estrogens are even more pathognomonic compared to cortisol secretion. Currently, radical surgery, when feasible, is still the only curative therapy. Mitotane, an adrenolytic drug, is used in the adjuvant setting and in combination with chemotherapy drugs in metastatic disease. The use of radiotherapy remains controversial, being indicated only in selected cases. New targeted therapies, such as insulin growth factor-1 (IGF-1), mammalian-target of rapamycin (m-TOR), vascular endothelial growth factor (VEGF) inhibitors and others, have recently been investigated with disappointing clinical results. The partial effectiveness of current treatments mandates the need for new therapeutic strategies against this tumor.
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Affiliation(s)
- Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Lidia Cerquetti
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Elisa Petrangeli
- CNR, Institute of Molecular Biology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Vincenzo Toscano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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29
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Wang Z, Monteiro CD, Jagodnik KM, Fernandez NF, Gundersen GW, Rouillard AD, Jenkins SL, Feldmann AS, Hu KS, McDermott MG, Duan Q, Clark NR, Jones MR, Kou Y, Goff T, Woodland H, Amaral FMR, Szeto GL, Fuchs O, Schüssler-Fiorenza Rose SM, Sharma S, Schwartz U, Bausela XB, Szymkiewicz M, Maroulis V, Salykin A, Barra CM, Kruth CD, Bongio NJ, Mathur V, Todoric RD, Rubin UE, Malatras A, Fulp CT, Galindo JA, Motiejunaite R, Jüschke C, Dishuck PC, Lahl K, Jafari M, Aibar S, Zaravinos A, Steenhuizen LH, Allison LR, Gamallo P, de Andres Segura F, Dae Devlin T, Pérez-García V, Ma'ayan A. Extraction and analysis of signatures from the Gene Expression Omnibus by the crowd. Nat Commun 2016; 7:12846. [PMID: 27667448 PMCID: PMC5052684 DOI: 10.1038/ncomms12846] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 08/05/2016] [Indexed: 12/14/2022] Open
Abstract
Gene expression data are accumulating exponentially in public repositories. Reanalysis and integration of themed collections from these studies may provide new insights, but requires further human curation. Here we report a crowdsourcing project to annotate and reanalyse a large number of gene expression profiles from Gene Expression Omnibus (GEO). Through a massive open online course on Coursera, over 70 participants from over 25 countries identify and annotate 2,460 single-gene perturbation signatures, 839 disease versus normal signatures, and 906 drug perturbation signatures. All these signatures are unique and are manually validated for quality. Global analysis of these signatures confirms known associations and identifies novel associations between genes, diseases and drugs. The manually curated signatures are used as a training set to develop classifiers for extracting similar signatures from the entire GEO repository. We develop a web portal to serve these signatures for query, download and visualization.
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Affiliation(s)
- Zichen Wang
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Caroline D. Monteiro
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Kathleen M. Jagodnik
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
- Fluid Physics and Transport Processes Branch, NASA Glenn Research Center, 21000 Brookpark Rd, Cleveland, Ohio 44135, USA
- Center for Space Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030, USA
| | - Nicolas F. Fernandez
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Gregory W. Gundersen
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Andrew D. Rouillard
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Sherry L. Jenkins
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Axel S. Feldmann
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Kevin S. Hu
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Michael G. McDermott
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Qiaonan Duan
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Neil R. Clark
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Matthew R. Jones
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Yan Kou
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | - Troy Goff
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
| | | | - Fabio M R. Amaral
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire LE12 5RD, UK
| | - Gregory L. Szeto
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Materials Science & Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- The Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, Massachusetts 02139, USA
| | - Oliver Fuchs
- Paediatric Allergology and Pulmonology, Dr von Hauner University Children's Hospital, Ludwig-Maximilians-University of Munich, Member of the German Centre for Lung Research (DZL), Lindwurmstrasse 4, Munich 80337, Germany
| | - Sophia M. Schüssler-Fiorenza Rose
- Spinal Cord Injury Service, Veteran Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA
- Department of Neurosurgery, Stanford School of Medicine, Stanford, California 94304, USA
| | - Shvetank Sharma
- Department of Research, Institute of Liver & Biliary Sciences, D1, Vasant Kunj, New Delhi 110070, India
| | - Uwe Schwartz
- Department of Biochemistry III, University of Regensburg, Universitätsstrasse 31, Regensburg 93053, Germany
| | - Xabier Bengoetxea Bausela
- Department of Pharmacology and Toxicology, University of Navarra, Pamplona, Irunlarrea 1, Pamplona 31008, Spain
| | - Maciej Szymkiewicz
- Warsaw School of Information Technology under the auspices of the Polish Academy of Sciences, 6 Newelska St, Warsaw 01–447, Poland
| | | | - Anton Salykin
- Department of Biology, Faculty of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Carolina M. Barra
- IMIM-Hospital Del Mar, PRBB Barcelona, Dr Aiguader, Barcelona 88.08003, Spain
| | | | - Nicholas J. Bongio
- Department of Biology, Shenandoah University, 1460 University Dr Winchester, Winchester, Virginia 22601, USA
| | | | | | - Udi E. Rubin
- Department of Biological Sciences, 600 Fairchild Center, Mail Code 2402, Columbia University, New York, New York 10032, USA
| | - Apostolos Malatras
- Center for Research in Myology, Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS975, CNRS FRE3617, 47 Boulevard de l'hôpital, Paris 75013, France
| | - Carl T. Fulp
- 13-1, Higashi 4-chome Shibuya-ku, Tokyo 150-0011, Japan
| | - John A. Galindo
- Department of Biology and Institute of Genetics, Universidad Nacional de Colombia, Bogota, Cr. 30 # 45-08, Colombia
| | - Ruta Motiejunaite
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, 3 Blackfan Circle, Boston, Massachusetts 02115, USA
| | - Christoph Jüschke
- Department of Human Genetics, Faculty of Medicine and Health Sciences, University of Oldenburg, Ammerländer Heerstrasse 114-118, Oldenburg 26129, Germany
| | | | - Katharina Lahl
- Technical University of Denmark, National Veterinary Institute, Bülowsvej 27 Building 2-3, Frederiksberg C 1870, Denmark
| | - Mohieddin Jafari
- Protein Chemistry and Proteomics Unit, Biotechnology Research Center, Pasteur Institute of Iran, No. 358, 12th Farwardin Ave, Jomhhoori St, Tehran 13164, Iran
- School of Biological Sciences, Institute for Researches in Fundamental Sciences, Niavaran Square, P.O.Box, Tehran 19395-5746, Iran
| | - Sara Aibar
- University of Salamanca, Salamanca, Madrid 37008, Spain
| | - Apostolos Zaravinos
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute, Alfred Nobels Allé 8, level 7, Stockholm SE141 86, Sweden
- Department of Life Sciences, School of Sciences, European University Cyprus, 6 Diogenes Str. Engomi, P.O.Box 22006, Nicosia 1516, Cyprus
| | | | | | | | - Fernando de Andres Segura
- CICAB, Clinical Research Centre, Extremadura University Hospital, Elvas Av., s/n. 06006 Badajoz 06006, Spain
| | | | - Vicente Pérez-García
- Consejo Superior de Investigaciones Científicas, Centro Nacional de Biotecnología, Department of Immunology and Oncology, c/Darwin, 3 Madrid 28049, Spain
| | - Avi Ma'ayan
- Department of Pharmacological Sciences, BD2K-LINCS Data Coordination and Integration Center, Illuminating the Druggable Genome Knowledge Management Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1215, New York, New York 10029, USA
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30
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Scollo C, Russo M, Trovato MA, Sambataro D, Giuffrida D, Manusia M, Sapuppo G, Malandrino P, Vigneri R, Pellegriti G. Prognostic Factors for Adrenocortical Carcinoma Outcomes. Front Endocrinol (Lausanne) 2016; 7:99. [PMID: 27504106 PMCID: PMC4958635 DOI: 10.3389/fendo.2016.00099] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/07/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is an aggressive tumor characterized by a high recurrence rate and poor response to treatment. This study analyzes a consecutive series of ACC patients to evaluate the prognostic value of various clinical and pathological characteristics. METHODS We retrospectively evaluated 32 ACC patients followed at our Medical Center from 1997 to 2015 and evaluated the prognostic value of age at diagnosis, gender, tumor functional status, stage, and type of treatment with respect to overall survival (OS) and disease-free survival (DFS), as determined by Kaplan-Meier curves. RESULTS ACC was associated with hormonal overproduction in 50% of cases, and patients with isolated hyperandrogenism had a better prognosis. Recurrence was observed in 12/26 (46.2%) patients with no evidence of disease after surgery. Tumor size [hazard ratio (HR) 1.32, 95% confidential intervals (CI) 1.12-1.64; p = 0.007], ki-67 (HR 1.06, 95% CI 1.02-1.11; p = 0.009) and advanced stage at diagnosis (III-IV) (HR 6.51, 95% CI 1.65-24.68; p = 0.006) were associated with recurrence in the 26 R0 patients in the univariate analysis. Advanced stage was an independent risk factor for recurrence in the multivariate analysis (HR 8.10, 95% CI 1.55-41.35; p = 0.01). Five-year survival was 40.0%. Positive resection margins (HR 10.61, 95% CI 3.02-38.31; p = < 0.001), ki-67 (HR 1.04, 95% CI 1.01-1.07; p = 0.01) and advanced stage (HR 11.31, 95% CI 1.45-87.76; p = 0.02) were associated with poor survival in all 32 patients, but only positive resection margins were an independent predictor of mortality in the multivariate analysis (HR 6.22, 95% CI 1.44-26.05; p = 0.01). CONCLUSION ACC has a poor prognosis with a high recurrence rate. Tumor stage at diagnosis and the completeness of surgical excision are the most relevant prognostic factors.
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Affiliation(s)
- Claudia Scollo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marco Russo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Dario Giuffrida
- Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - Mario Manusia
- Pathology, Garibaldi-Nesima Hospital, Catania, Italy
| | - Giulia Sapuppo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasqualino Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Humanitas, Catania Oncology Center, Catania, Italy
- Institute of Biostructures and Bioimaging, CNR, Catania, Italy
| | - Gabriella Pellegriti
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- *Correspondence: Gabriella Pellegriti,
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Angelousi A, Zilbermint M, Berthon A, Espiard S, Stratakis CA. Diagnosis and Management of Hereditary Adrenal Cancer. Recent Results Cancer Res 2016; 205:125-47. [PMID: 27075352 DOI: 10.1007/978-3-319-29998-3_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Benign adrenocortical tumours (ACT) are relatively frequent lesions; on the contrary, adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with unfavourable prognosis. Recent advances in the molecular understanding of adrenal cancer offer promise for better therapies in the future. Many of these advances stem from the molecular elucidation of genetic conditions predisposing to the development of ACC. Six main clinical syndromes have been described to be associated with hereditary adrenal cancer. In these conditions, genetic counselling plays an important role for the early detection and follow-up of the patients and the affected family members.
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Affiliation(s)
- Anna Angelousi
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Mihail Zilbermint
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Annabel Berthon
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stéphanie Espiard
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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de Corbière P, Ritzel K, Cazabat L, Ropers J, Schott M, Libé R, Koschker AC, Leboulleux S, Deutschbein T, Do Cao C, Hahner S, Drui D, Miehle K, Caron P, Waldmann J, Chabre O, Quinkler M, Touraine P, Villares Fragoso MC, Bertherat J, Bertagna X, Fassnacht M, Raffin-Sanson ML. Pregnancy in Women Previously Treated for an Adrenocortical Carcinoma. J Clin Endocrinol Metab 2015; 100:4604-11. [PMID: 26461265 DOI: 10.1210/jc.2015-2341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Adrenocortical carcinomas (ACCs) are rare, aggressive tumors, of which some express receptors for estradiol, progesterone, and/or human chorionic gonadotoropin. Because this disease is encountered frequently in young women, pregnancy is a relevant issue. OBJECTIVE to evaluate the impact of pregnancy on outcome of patients previously treated for ACC. DESIGN/SETTING retrospective observational multicenter study of the European Network for the Study of Adrenal Tumors. PATIENTS Seventeen ACC patients (21 pregnancies), becoming pregnant at least 3 months after the initial treatment, were compared with 247 nonpregnant ACC patients less than 47 years old. A control group of 34 patients matched for age, sex, and tumor stage was used for survival analysis. MAIN OUTCOME MEASURE(S) Overall survival, tumors characteristics at diagnosis, pregnancy outcome. RESULTS All 17 patients with pregnancies had localized ACC. The median time between surgery and conception was 4 years (0.3-12 y). Two pregnancies were terminated at 8 weeks. Sixteen women gave birth to 19 live infants. With exception of 1 (presumably unrelated) cardiac malformation, no severe fetal or maternal complication was observed. After a median follow-up time of 8.36 years and 5.26 years after the first conception, 1 of the 17 patients had died and 5 had experienced a recurrence, among whom 3 occurred before conception. Overall survival was not significantly different between the "pregnancy group" and the matched controls. CONCLUSION Pregnancy in patients previously treated for ACC seems to not be associated with worse clinical outcome, although a "healthy mother effect" cannot be excluded.
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Affiliation(s)
- Pauline de Corbière
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Katrin Ritzel
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Laure Cazabat
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Jacques Ropers
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Matthias Schott
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Rosella Libé
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Ann-Cathrin Koschker
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Sophie Leboulleux
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Timo Deutschbein
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Christine Do Cao
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Stefanie Hahner
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Delphine Drui
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Konstanze Miehle
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Philippe Caron
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Jens Waldmann
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Olivier Chabre
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Marcus Quinkler
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Philippe Touraine
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Maria C Villares Fragoso
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Jérôme Bertherat
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Xavier Bertagna
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Martin Fassnacht
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
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Chimento A, Saturnino C, Iacopetta D, Mazzotta R, Caruso A, Plutino MR, Mariconda A, Ramunno A, Sinicropi MS, Pezzi V, Longo P. Inhibition of human topoisomerase I and II and anti-proliferative effects on MCF-7 cells by new titanocene complexes. Bioorg Med Chem 2015; 23:7302-12. [PMID: 26526741 DOI: 10.1016/j.bmc.2015.10.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 12/14/2022]
Abstract
The antitumor activity shown by many platinum complexes has produced a strong interest in research of new organometallic compounds having anticancer action. Among the many metal compounds synthesized and tested, those based on titanium have received considerable attention because of their cytotoxic activity against solid tumors. Particularly, new titanocene compounds containing aromatic groups linked to the Cp (cyclopentadienyl ring, C5H5) have been synthetized, such as the titanocene Y (bis-[(p-methoxybenzyl)cyclopentadienyl]titanium dichloride) that displayed promising medium-high cytotoxic activity on breast cancer cell lines. Other titanocene complexes recently synthesized, obtained by replacing the substituent methoxy-aryl of cyclopentadienes of titanocene Y with ethenyl-methoxide or ethenyl-phenoxide, showed increased cytotoxic activity on breast cancer cell lines being more stable compounds. In this paper, we report that new titanocene complexes holding lipophilic groups, for instance a methyl group on benzyl carbon, exhibit improved antiproliferative effect on breast cancer cell line MCF-7. Similar results have been obtained introducing a 5-methoxy naphthyl group to further stabilize the titanocene complexes. These inhibitory effects on breast cancer cells have been ascribed to human topoisomerase I and II inhibition as demonstrated by specific enzymatic assays.
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Affiliation(s)
- Adele Chimento
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Carmela Saturnino
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, Fisciano (SA), Italy.
| | - Domenico Iacopetta
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy.
| | - Rosaria Mazzotta
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Anna Caruso
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Maria Rosaria Plutino
- Department of Chemistry, University of Messina and Consorzio Interuniversitario di Ricerca in Chimica dei Metalli nei Sistemi Biologici (CIRCMSB), Vill. S. Agata, Messina, Italy
| | - Annaluisa Mariconda
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, Fisciano (SA), Italy
| | - Anna Ramunno
- Department of Pharmaceutical and Biomedical Sciences, University of Salerno, Fisciano (SA), Italy
| | - Maria Stefania Sinicropi
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy.
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Pasquale Longo
- Department of Chemistry and Biology, University of Salerno, Fisciano (SA), Italy
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Casaburi I, Avena P, De Luca A, Chimento A, Sirianni R, Malivindi R, Rago V, Fiorillo M, Domanico F, Campana C, Cappello AR, Sotgia F, Lisanti MP, Pezzi V. Estrogen related receptor α (ERRα) a promising target for the therapy of adrenocortical carcinoma (ACC). Oncotarget 2015; 6:25135-48. [PMID: 26312764 PMCID: PMC4694820 DOI: 10.18632/oncotarget.4722] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022] Open
Abstract
The pathogenesis of the adrenocortical cancer (ACC) involves integration of molecular signals and the interplay of different downstream pathways (i.e. IGFII/IGF1R, β-catenin, Wnt, ESR1). This tumor is characterized by limited therapeutic options and unsuccessful treatments. A useful strategy to develop an effective therapy for ACC is to identify a common downstream target of these multiple pathways. A good candidate could be the transcription factor estrogen-related receptor alpha (ERRα) because of its ability to regulate energy metabolism, mitochondrial biogenesis and signalings related to cancer progression. In this study we tested the effect of ERRα inverse agonist, XCT790, on the proliferation of H295R adrenocortical cancer cell line. Results from in vitro and in vivo experiments showed that XCT790 reduced H295R cell growth. The inhibitory effect was associated with impaired cell cycle progression which was not followed by any apoptotic event. Instead, incomplete autophagy and cell death by a necrotic processes, as a consequence of the cell energy failure, induced by pharmacological reduction of ERRα was evidenced. Our results indicate that therapeutic strategies targeting key factors such as ERRα that control the activity and signaling of bioenergetics processes in high-energy demanding tumors could represent an innovative/alternative therapy for the treatment of ACC.
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Affiliation(s)
- Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Rocco Malivindi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Vittoria Rago
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Marco Fiorillo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Francesco Domanico
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Carmela Campana
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Anna Rita Cappello
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
| | - Federica Sotgia
- The Breakthrough Breast Cancer Research Unit and the Manchester Centre for Cellular Metabolism, Institute of Cancer Sciences, University of Manchester, UK
| | - Michael P. Lisanti
- The Breakthrough Breast Cancer Research Unit and the Manchester Centre for Cellular Metabolism, Institute of Cancer Sciences, University of Manchester, UK
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Italy
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Chimento A, Sirianni R, Casaburi I, Zolea F, Rizza P, Avena P, Malivindi R, De Luca A, Campana C, Martire E, Domanico F, Fallo F, Carpinelli G, Cerquetti L, Amendola D, Stigliano A, Pezzi V. GPER agonist G-1 decreases adrenocortical carcinoma (ACC) cell growth in vitro and in vivo. Oncotarget 2015; 6:19190-203. [PMID: 26131713 PMCID: PMC4662484 DOI: 10.18632/oncotarget.4241] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/23/2015] [Indexed: 12/26/2022] Open
Abstract
We have previously demonstrated that estrogen receptor (ER) alpha (ESR1) increases proliferation of adrenocortical carcinoma (ACC) through both an estrogen-dependent and -independent (induced by IGF-II/IGF1R pathways) manner. Then, the use of tamoxifen, a selective estrogen receptor modulator (SERM), appears effective in reducing ACC growth in vitro and in vivo. However, tamoxifen not only exerts antiestrogenic activity, but also acts as full agonist on the G protein-coupled estrogen receptor (GPER). Aim of this study was to investigate the effect of a non-steroidal GPER agonist G-1 in modulating ACC cell growth. We found that G-1 is able to exert a growth inhibitory effect on H295R cells both in vitro and, as xenograft model, in vivo. Treatment of H295R cells with G-1 induced cell cycle arrest, DNA damage and cell death by the activation of the intrinsic apoptotic mechanism. These events required sustained extracellular regulated kinase (ERK) 1/2 activation. Silencing of GPER by a specific shRNA partially reversed G-1-mediated cell growth inhibition without affecting ERK activation. These data suggest the existence of G-1 activated but GPER-independent effects that remain to be clarified. In conclusion, this study provides a rational to further study G-1 mechanism of action in order to include this drug as a treatment option to the limited therapy of ACC.
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Affiliation(s)
- Adele Chimento
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Ivan Casaburi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Fabiana Zolea
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Pietro Rizza
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Paola Avena
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Rocco Malivindi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Arianna De Luca
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Carmela Campana
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Emilia Martire
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Francesco Domanico
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
| | - Francesco Fallo
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Giulia Carpinelli
- Department of Cell Biology and Neurosciences, National Institute of Health, Rome, Italy
| | - Lidia Cerquetti
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Rome, Italy
| | | | - Antonio Stigliano
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Rome, Italy
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy
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Pilon C, Rebellato A, Urbanet R, Guzzardo V, Cappellesso R, Sasano H, Fassina A, Fallo F. Methylation Status of Vitamin D Receptor Gene Promoter in Benign and Malignant Adrenal Tumors. Int J Endocrinol 2015; 2015:375349. [PMID: 26843863 PMCID: PMC4710947 DOI: 10.1155/2015/375349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/10/2015] [Indexed: 01/04/2023] Open
Abstract
We previously showed a decreased expression of vitamin D receptor (VDR) mRNA/protein in a small group of adrenocortical carcinoma (ACC) tissues, suggesting the loss of a protective role of VDR against malignant cell growth in this cancer type. Downregulation of VDR gene expression may result from epigenetics events, that is, methylation of cytosine nucleotide of CpG islands in VDR gene promoter. We analyzed methylation of CpG sites in the VDR gene promoter in normal adrenals and adrenocortical tumor samples. Methylation of CpG-rich 5' regions was assessed by bisulfite sequencing PCR using bisulfite-treated DNA from archival microdissected paraffin-embedded adrenocortical tissues. Three normal adrenals and 23 various adrenocortical tumor samples (15 adenomas and 8 carcinomas) were studied. Methylation in the promoter region of VDR gene was found in 3/8 ACCs, while no VDR gene methylation was observed in normal adrenals and adrenocortical adenomas. VDR mRNA and protein levels were lower in ACCs than in benign tumors, and VDR immunostaining was weak or negative in ACCs, including all 3 methylated tissue samples. The association between VDR gene promoter methylation and reduced VDR gene expression is not a rare event in ACC, suggesting that VDR epigenetic inactivation may have a role in adrenocortical carcinogenesis.
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Affiliation(s)
- Catia Pilon
- Clinica Medica 3, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Andrea Rebellato
- Clinica Medica 3, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Riccardo Urbanet
- Clinica Medica 3, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Vincenza Guzzardo
- Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Rocco Cappellesso
- Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Ambrogio Fassina
- Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Francesco Fallo
- Clinica Medica 3, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
- *Francesco Fallo:
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Aufforth RD, Nilubol N. Emerging therapy for adrenocortical carcinoma. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014; 1:173-182. [PMID: 25635221 DOI: 10.2217/ije.14.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adrenocortical carcinoma (ACC) is a very rare and aggressive tumor with dismal outcomes. Best current treatments include complete surgical resection for localized resectable disease and systemic therapy with mitotane alone or in combination for advanced ACC. Advances in molecular genetic profiling of ACC have created multiple new targets for potential treatment options in ACC. This article reviews the current treatment options available for ACC and discusses the potential new targets identified through molecular profiling.
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Affiliation(s)
- Rachel D Aufforth
- Endocrine Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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38
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Adrenocortical carcinoma: the management of metastatic disease. Crit Rev Oncol Hematol 2014; 92:123-32. [PMID: 24958272 DOI: 10.1016/j.critrevonc.2014.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/30/2014] [Accepted: 05/16/2014] [Indexed: 12/13/2022] Open
Abstract
Adrenocortical cancer is a rare malignancy. While surgery is the cornerstone of the management of localized disease, metastatic disease is hard to treat. Cytotoxic chemotherapy and mitotane have been utilized with a variable degree of benefit and few long-term responses. A growing understanding of the molecular pathogenesis of this malignancy as well as multidisciplinary and multi-institutional collaborative efforts will result in better defined targets and subsequently, effective novel therapies.
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Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, Jolly S, Miller BS, Giordano TJ, Hammer GD. Adrenocortical carcinoma. Endocr Rev 2014; 35:282-326. [PMID: 24423978 PMCID: PMC3963263 DOI: 10.1210/er.2013-1029] [Citation(s) in RCA: 564] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy, often with an unfavorable prognosis. Here we summarize the knowledge about diagnosis, epidemiology, pathophysiology, and therapy of ACC. Over recent years, multidisciplinary clinics have formed and the first international treatment trials have been conducted. This review focuses on evidence gained from recent basic science and clinical research and provides perspectives from the experience of a large multidisciplinary clinic dedicated to the care of patients with ACC.
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Affiliation(s)
- Tobias Else
- MEND/Division of Metabolism, Endocrinology, and Diabetes (T.E., T.J.G., G.D.H.), Division of Molecular Medicine and Genetics (V.M.R.), Department of Internal Medicine; Departments of Radiation Oncology (A.S., J.S.), Pathology (T.J.G.), and Radiology (A.K., E.M.C.); and Division of Endocrine Surgery (B.S.M.), Section of General Surgery, (A.C.K.), Department of Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 48109
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Pilon C, Urbanet R, Williams TA, Maekawa T, Vettore S, Sirianni R, Pezzi V, Mulatero P, Fassina A, Sasano H, Fallo F. 1α,25-Dihydroxyvitamin D₃ inhibits the human H295R cell proliferation by cell cycle arrest: a model for a protective role of vitamin D receptor against adrenocortical cancer. J Steroid Biochem Mol Biol 2014; 140:26-33. [PMID: 24269839 DOI: 10.1016/j.jsbmb.2013.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/28/2013] [Accepted: 11/07/2013] [Indexed: 01/07/2023]
Abstract
UNLABELLED Using the human H295R adrenocortical carcinoma cell line as a model, we analyzed the role of 1α,25-dihydroxyvitamin D₃ [1α,25(OH)₂D₃)]--vitamin D receptor (VDR) axis in the growth of adrenocortical cancer (ACC). The presence of VDR in various adrenocortical tissues, including ACC, was also investigated. DNA synthesis was evaluated by [³H]thymidine cell incorporation after treatment with 1α,25(OH)₂D₃ at increasing doses. The effect of 1α,25(OH)₂D₃ on cell cycle and apoptosis was analyzed with a flow cytometer. Cyclin-dependent kinase 4 (CDK4) expression, a molecular marker of G1-S cell cycle transition phase, was evaluated in cells treated with 1α,25(OH)₂D₃ before and after VDR gene silencing. 1α,25(OH)₂D₃ treatment inhibited cell proliferation by 20% at a dose of 1 nM, in parallel with steroid secretion decrease. A cell cycle arrest in G1, with no change in apoptotic cell proportion, was observed after 10 nM 1α,25(OH)₂D₃ cell exposure. CDK4 activation was reduced by 10 nM 1α,25(OH)₂D₃ but was not affected by 1α,25(OH)₂D₃ after VDR gene silencing. Expression of VDR mRNA was lower in ACC than in benign adrenocortical tumors. VDR immunostaining was evident in benign tumors but it was weak in ACC tissues. CONCLUSIONS Slightly supra-physiological concentrations of 1α,25(OH)₂D₃ have a moderate anti-proliferative effect on H295R cells. Anti-proliferative effect was due to cell cycle arrest in G1 phase, without inducing apoptosis. The low mRNA expression levels at qRT-PCR as well as the weak immunohistochemical expression of VDR in ACC, suggests a protective role of VDR against malignant adrenocortical growth.
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Affiliation(s)
- Catia Pilon
- Department of Medicine-DIMED, Clinica Medica 3 and Cythopathology Unit, University of Padova, Padova, Italy
| | - Riccardo Urbanet
- Department of Medicine-DIMED, Clinica Medica 3 and Cythopathology Unit, University of Padova, Padova, Italy
| | - Tracy A Williams
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Takashi Maekawa
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Silvia Vettore
- Department of Medicine-DIMED, Clinica Medica 3 and Cythopathology Unit, University of Padova, Padova, Italy
| | - Rosa Sirianni
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende (CS), Italy
| | - Vincenzo Pezzi
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende (CS), Italy
| | - Paolo Mulatero
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Ambrogio Fassina
- Department of Medicine-DIMED, Clinica Medica 3 and Cythopathology Unit, University of Padova, Padova, Italy
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Francesco Fallo
- Department of Medicine-DIMED, Clinica Medica 3 and Cythopathology Unit, University of Padova, Padova, Italy.
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Biological activity of 3-chloro-azetidin-2-one derivatives having interesting antiproliferative activity on human breast cancer cell lines. Bioorg Med Chem Lett 2013; 23:6401-5. [PMID: 24119558 DOI: 10.1016/j.bmcl.2013.09.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 12/21/2022]
Abstract
Resveratrol (3,4',5 tri-hydroxystilbene), a natural plant polyphenol, has gained interest as a non-toxic agent capable of inducing tumor cell death in a variety of cancer types. However, therapeutic application of these beneficial effects remains very limited due to its short biological half-life, labile properties, rapid metabolism and elimination. Different studies were undertaken to obtain synthetic analogs of resveratrol with major bioavailability and anticancer activity. We have synthesized a series 3-chloro-azetidin-2-one derivatives, in which an azetidinone nucleus connects two aromatic rings. Aim of the present study was to investigate the effects of these new 3-chloro-azetidin-2-one resveratrol derivatives on human breast cancer cell lines proliferation. Our results indicate that some azetidin-based resveratrol derivatives may become new potent alternative tools for the treatment of human breast cancer.
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Chimento A, Casaburi I, Rosano C, Avena P, De Luca A, Campana C, Martire E, Santolla MF, Maggiolini M, Pezzi V, Sirianni R. Oleuropein and hydroxytyrosol activate GPER/ GPR30-dependent pathways leading to apoptosis of ER-negative SKBR3 breast cancer cells. Mol Nutr Food Res 2013; 58:478-89. [PMID: 24019118 DOI: 10.1002/mnfr.201300323] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/03/2013] [Accepted: 07/30/2013] [Indexed: 12/23/2022]
Abstract
SCOPE We have previously demonstrated that oleuropein (OL) and hydroxytyrosol (HT) reduce 17β-estradiol-mediated proliferation in MCF-7 breast cancer (BC) cells without affecting the classical genomic action of estrogen receptor (ER), but activating instead the ERK1/2 pathway. Here, we hypothesized that this inhibition could be mediated by a G-protein-coupled receptor named GPER/GPR30. Using the ER-negative and GPER-positive SKBR3 BC cells as experimental model, we investigated the effects of OL and HT on GPER-mediated activation of downstream pathways. METHODS AND RESULTS Docking simulations and ligand-binding studies evidenced that OL and HT are able to bind GPER. MTT cell proliferation assays revealed that both phenols reduced SKBR3 cell growth; this effect was abolished silencing GPER. Focusing on OL and HT GPER-mediated pathways, using Western blot analysis we showed a sustained ERK1/2 activation triggering an intrinsic apoptotic pathway. CONCLUSION Showing that OL and HT work as GPER inverse agonists in ER-negative and GPER-positive SKBR3 BC cells, we provide novel insights into the potential of these two molecules as tools in the therapy of this subtype of BC.
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Affiliation(s)
- Adele Chimento
- Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Cosenza, Italy
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Selective GPER activation decreases proliferation and activates apoptosis in tumor Leydig cells. Cell Death Dis 2013; 4:e747. [PMID: 23907461 PMCID: PMC3763437 DOI: 10.1038/cddis.2013.275] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 12/19/2022]
Abstract
We have previously shown that estrogens binding to estrogen receptor (ER) α increase proliferation of Leydig tumor cells. Estrogens can also bind to G protein-coupled ER (GPER) and activation of this receptor can either increase or decrease cell proliferation of several tumor types. The aim of this study was to investigate GPER expression in R2C rat tumor Leydig cells, evaluate effects of its activation on Leydig tumor cell proliferation and define the molecular mechanisms triggered in response to its activation. R2C cells express GPER and its activation, using the specific ligand G-1, is associated with decreased cell proliferation and initiation of apoptosis. Apoptosis after G-1 treatment was asserted by appearance of DNA condensation and fragmentation, decrease in Bcl-2 and increase in Bax expression, cytochrome c release, caspase and poly (ADP-ribose) polymerase-1 (PARP-1) activation. These effects were dependent on GPER activation because after silencing of the gene, using a specific small interfering RNA, cyt c release, PARP-1 activation and decrease in cell proliferation were abrogated. These events required a rapid, however, sustained extracellular regulated kinase 1/2 activation. G-1 was able to decrease the growth of R2C xenograft tumors in CD1 nude mice while increasing the number of apoptotic cells. In addition, in vivo administration of G-1 to male CD1 mice did not cause any alteration in testicular morphology, while cisplatin, the cytotoxic drug currently used for the therapy of Leydig tumors, severely damaged testicular structure, an event associated with infertility in cisplatin-treated patients. These observations indicate that GPER targeting for the therapy of Leydig cell tumor may represent a good alternative to cisplatin to preserve fertility in Leydig tumor patients.
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Sala M, Chimento A, Saturnino C, Gomez-Monterrey IM, Musella S, Bertamino A, Milite C, Sinicropi MS, Caruso A, Sirianni R, Tortorella P, Novellino E, Campiglia P, Pezzi V. Synthesis and cytotoxic activity evaluation of 2,3-thiazolidin-4-one derivatives on human breast cancer cell lines. Bioorg Med Chem Lett 2013; 23:4990-5. [PMID: 23860590 DOI: 10.1016/j.bmcl.2013.06.051] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 11/17/2022]
Abstract
It is well known that resveratrol (RSV) displayed cancer-preventing and anticancer properties but its clinical application is limited because of a low bioavailability and a rapid clearance from the circulation. Aim of this work was to synthesize pharmacologically active resveratrol analogs with an enhanced structural rigidity and bioavailability. In particular, we have synthesized a library of 2,3-thiazolidin-4-one derivatives in which a thiazolidinone nucleus connects two aromatic rings. Some of these compounds showed strong inhibitory effects on breast cancer cell growth. Our results indicate that some of thiazolidin-based resveratrol derivatives may become a new potent alternative tool for the treatment of human breast cancer.
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Affiliation(s)
- Marina Sala
- Department of Pharmaceutical Science, Division of Biomedicine, University of Salerno, Fisciano, SA 84084, Italy
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Current and emerging therapeutic options in adrenocortical cancer treatment. JOURNAL OF ONCOLOGY 2012; 2012:408131. [PMID: 22934112 PMCID: PMC3425859 DOI: 10.1155/2012/408131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 12/14/2022]
Abstract
Adrenocortical carcinoma (ACC) is a very rare endocrine tumour, with variable prognosis, depending on tumour stage and time of diagnosis. The overall survival is five years from detection. Radical surgery is considered the therapy of choice in the first stages of ACC. However postoperative disease-free survival at 5 years is only around 30% and recurrence rates are frequent. o,p'DDD (ortho-, para'-, dichloro-, diphenyl-, dichloroethane, or mitotane), an adrenolytic drug with significant toxicity and unpredictable therapeutic response, is used in the treatment of ACC. Unfortunately, treatment for this aggressive cancer is still ineffective. Over the past years, the growing interest in ACC has contributed to the development of therapeutic strategies in order to contrast the neoplastic spread. In this paper we discuss the most promising therapies which can be used in this endocrine neoplasia.
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