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Encinas-García T, Mendoza-Cano F, Muhlia-Almazán A, Vega-Peralta J, Sánchez-Paz A. Comparison of five commercial kits for isolation of total RNA in samples of WSSV-infected shrimp. DISEASES OF AQUATIC ORGANISMS 2023; 156:59-70. [PMID: 38032039 DOI: 10.3354/dao03762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Viral diseases are the most serious threat to the expansion and development of shrimp aquaculture. Rapid diagnosis of the white spot syndrome virus (WSSV), a lethal shrimp pathogen, is essential to restrict its spread and reduce the mortality of infected shrimp. This virus has globally affected the shrimp farming industry, with a devastating economic impact. Several studies have focused on the expression of WSSV transcripts to understand the molecular mechanisms governing the pathological development of the disease. Since gene expression studies and molecular diagnostics at the early stages of infection depend on the efficient isolation of high-quality RNA, the extraction methods should be carefully selected. However, previous comparisons of the performance of RNA isolation kits have yet to be systematically investigated. In this study, 5 commercial RNA extraction methods were compared in WSSV-infected shrimp. The highest total RNA yield (ng mg-1 tissue) was obtained using TRIzol. Even though the 260/280 nm absorption ratios showed significant differences, the methods showed good purity values (>2.0). RNA integrity was evaluated in a denaturing agarose gel electrophoresis, and degradation was observed after the total RNA samples were treated with DNase I. Finally, the method that allowed the earlier detection of WSSV transcripts by qRT-PCR was the Zymo Direct-zol RNA MiniPrep kit. This study shows that the amount of observed (or estimated) WSSV transcripts might be affected because of the RNA isolation method. In addition, these results may contribute to improve the accuracy of the results obtained in gene expression studies, for more sensitive and robust detection of WSSV.
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Affiliation(s)
- Trinidad Encinas-García
- Laboratorio de Virología, Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Campus Hermosillo, Hermosillo, Sonora, CP 83106, México
| | - Fernando Mendoza-Cano
- Laboratorio de Virología, Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Campus Hermosillo, Hermosillo, Sonora, CP 83106, México
| | - Adriana Muhlia-Almazán
- Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD) Unidad Hermosillo, Carretera Gustavo Enrique Astiazaran Rosas, No. 46, Col. La Victoria, Hermosillo, Sonora 83304, México
| | - Juan Vega-Peralta
- Laboratorio de Virología, Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Campus Hermosillo, Hermosillo, Sonora, CP 83106, México
| | - Arturo Sánchez-Paz
- Laboratorio de Virología, Centro de Investigaciones Biológicas del Noroeste (CIBNOR), Campus Hermosillo, Hermosillo, Sonora, CP 83106, México
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Decruyenaere P, Verniers K, Poma-Soto F, Van Dorpe J, Offner F, Vandesompele J. RNA Extraction Method Impacts Quality Metrics and Sequencing Results in Formalin-Fixed, Paraffin-Embedded Tissue Samples. J Transl Med 2023; 103:100027. [PMID: 37039153 DOI: 10.1016/j.labinv.2022.100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 01/11/2023] Open
Abstract
Archived formalin-fixed, paraffin-embedded (FFPE) tissue samples are being increasingly used in molecular cancer research. Compared with fresh-frozen tissue, the nucleic acid analysis of FFPE tissue is technically more challenging. This study aimed to compare the impact of 3 different RNA extraction methods on yield, quality, and sequencing-based gene expression results in FFPE samples. RNA extraction was performed in 16 FFPE tumor specimens from patients with diffuse large B-cell lymphoma and in reference FFPE material from microsatellite-stable and microsatellite-instable cell lines (3 replicates each) using 2 silica-based procedures (A, miRNeasy FFPE; C, iCatcher FFPE Tissue RNA) and 1 isotachophoresis-based procedure (B, Ionic FFPE to Pure RNA). The RNA yield; RNA integrity, as reflected by the distribution value 200; and RNA purity, as reflected by the 260/280 and the 260/230 nm absorbance ratios, were determined. The RNA was sequenced on the NovaSeq 6000 instrument using the TruSeq RNA Exome and SMARTer Stranded Total RNA-Seq Pico v3 library preparations kits. Our results highlight the impact of RNA extraction methodology on both preanalytical and sequencing-based gene expression results. Overall, methods B and C outperformed method A because these showed significantly higher fractions of uniquely mapped reads, an increased number of detectable genes, a lower fraction of duplicated reads, and better representation of the B-cell receptor repertoire. Differences among the extraction methods were generally more explicit for the total RNA sequencing method than for the exome-capture sequencing method. Importantly, the predicative value of quality metrics varies among extraction kits, and caution should be applied when comparing and interpreting results obtained using different methods.
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Lima VR, da Costa Aguiar Alves B, Fonseca FLA, Zveibil DK, Del Giglio A. Pre-analytical processing protocol of breast biopsies affects multigene panel results. Int J Exp Pathol 2022; 103:112-120. [PMID: 35569033 DOI: 10.1111/iep.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
The creation of multigene panels for prognostic and predictive purposes allows a more accurate indication of adjuvant chemotherapy for patients with breast cancer. In a previous study, we reproduced a multigene panel of 21 genes based on the commercial Oncotype-DX method. We submitted 183 embedded specimens obtained from breast surgery on patients with locoregional disease (stages I to III) between 2005 and 2010 performed at the Hospitals of the Medical School of the ABC Foundation. When we analysed the correlations between the score of the multigene panel and the progression-free interval (PFI) in all patients, we did not find a statistically significant association. However, when we selected only the 71 samples that had amplification of at least eight non-housekeeping genes, we observed that those with scores above the 75th percentile had a significantly lower PFI (p = .0054). Samples processed with nonbuffered formaldehyde were associated with a worse quality of extracted RNA (p = .004) and a significantly higher multigene panel score (p = .021). We conclude that variations in the pre-analytical processing of specimens destined for multigene panel amplification can significantly affect the results, with a potential impact on clinical management.
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Affiliation(s)
- Vanessa Reinaldo Lima
- Clinical Analysis Laboratory of the Medical School of the ABC (FMABC) University Center, Santo André, Brazil
| | | | - Fernando Luiz Affonso Fonseca
- Clinical Analysis Laboratory of the Medical School of the ABC (FMABC) University Center, Santo André, Brazil.,Institute of Pharmaceutical Sciences, Federal University of São Paulo (UNIFESP), Diadema, Brazil
| | - Debora Krutman Zveibil
- Department of Pathology, Medical School of the ABC (FMABC) University Center, Santo André, Brazil
| | - Auro Del Giglio
- Discipline of Oncology and Hematology, Medical School of the ABC (FMABC) University Center, Santo André, Brazil
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Belltall A, Mazzinari G, Garrido-Cano I, Giner F, Marí AM, Eroles P, Argente-Navarro MP, Cata JP, Diaz-Cambronero O. Opioid Receptor Expression in Colorectal Cancer: A Nested Matched Case-Control Study. Front Oncol 2022; 12:801714. [PMID: 35463331 PMCID: PMC9019344 DOI: 10.3389/fonc.2022.801714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is growing interest in the possible effect of perioperative anesthetic management on the growth and spread of cancer. The impact of perioperative use of opioids on cancer recurrence remains controversial and an assessment cannot yet be established based on current publications. This study aimed to assess the differential expression of opioid receptors between healthy and tumor tissues in patients with stage II and III colorectal cancer undergoing elective surgery by immunohistochemistry (IHC). Methods Propensity-score matched case-control study nested in a retrospective cohort of patients with stage II or III colorectal. The primary endpoint was the difference in µ-opioid receptor (MOR) expression measured by IHC between tumor and healthy tissue in subject with or without recurrence. Secondary endpoints were to evaluate the differences in Opioid Growth Factor Receptor (OGFR), cyclic adenosine monophosphate (cAMP) production and protein kinase A (PKA) in the matched sample and from a from samples of colorectal cancer stored in the Cancer Genome Atlas (TCGA) and Genotype Tissue Expression Project (GTEx). Results There was a significant difference in MOR receptor (median 3 [intequartile range IQR: 1-3] and 0 [IQR: 0-2], P<0.001) and OGFR receptor (median 6 [IQR: 5-6] and 2 [IQR: 1-2], P<0.001) in tumor and control tissue respectively. However, there were no significant differences in cAMP nor PKA expression between both types of tissues and in expression in any of the analyzed variables by recurrence status. The MOR and OGFR expression data from TCGA database were similar to our sample size data with lower expression of MOR and higher expression of OGFR in tumoural samples with a skewed distribution for MOR expression in tumor tissue both in patients with and without recurrence. Conclusion In patients with stage II and III colorectal cancer, overall expression of MOR and OGFR was significantly increased but was not different between previously matched patients with or without recurrence. No differences were found in the analyzed metabolic pathway of cAMP-PKA: These results were confirmed by an in silico analysis of samples from the TCGA-GTEx database.
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Affiliation(s)
- Amparo Belltall
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Guido Mazzinari
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Euro-Periscope, Onco-Anaesthesiology Research Group (RG) of European Society of Anaesthesiology and Intensive Care, Brussels, Belgium
| | - Iris Garrido-Cano
- Euro-Periscope, Onco-Anaesthesiology Research Group (RG) of European Society of Anaesthesiology and Intensive Care, Brussels, Belgium
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medical Oncology, University of Valencia INCLIVA-Hospital Clínico de Valencia-Centro de Investigación Biomédica en Red - Oncología (CIBERONC), Valencia, Spain
| | - Francisco Giner
- Department of Pathology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Anabel Marqués Marí
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Euro-Periscope, Onco-Anaesthesiology Research Group (RG) of European Society of Anaesthesiology and Intensive Care, Brussels, Belgium
| | - Pilar Eroles
- Euro-Periscope, Onco-Anaesthesiology Research Group (RG) of European Society of Anaesthesiology and Intensive Care, Brussels, Belgium
- INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medical Oncology, University of Valencia INCLIVA-Hospital Clínico de Valencia-Centro de Investigación Biomédica en Red - Oncología (CIBERONC), Valencia, Spain
| | - María Pilar Argente-Navarro
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Juan Pablo Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Anesthesia and Surgical Oncology Research Group, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oscar Diaz-Cambronero
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
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Saraji A, Offermann A, Stegmann-Frehse J, Hempel K, Kang D, Krupar R, Watermann C, Jonigk D, Kühnel MP, Kirfel J, Perner S, Sailer V. Cracking it - successful mRNA extraction for digital gene expression analysis from decalcified, formalin-fixed and paraffin-embedded bone tissue. PLoS One 2021; 16:e0257416. [PMID: 34529723 PMCID: PMC8445430 DOI: 10.1371/journal.pone.0257416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
With the advance of precision medicine, the availability of tumor tissue for molecular analysis has become a limiting factor. This is particularly the case for bone metastases which are frequently occurring in cancer types such as prostate cancer. Due to the necessary decalcification process it was long thought that transcriptome analysis will not be feasible from decalcified formalin-fixed, paraffin-embedded (DFFPE) in a large manner. Here we demonstrate that mRNA extraction from DFFPE is feasible, quick, robust and reproducible and that decalcification does not hamper subsequent gene expression analysis. This might assist in implementing transcriptome analysis from DFFPE into every day practice.
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Affiliation(s)
- Alireza Saraji
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Anne Offermann
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Janine Stegmann-Frehse
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Katharina Hempel
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Duan Kang
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Christian Watermann
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Mark Philipp Kühnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Jutta Kirfel
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Perner
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Verena Sailer
- Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- * E-mail:
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Schmidt M, Edlund K, Hengstler JG, Heimes AS, Almstedt K, Lebrecht A, Krajnak S, Battista MJ, Brenner W, Hasenburg A, Rahnenführer J, Gehrmann M, Kellokumpu-Lehtinen PL, Wirtz RM, Joensuu H. Prognostic Impact of Immunoglobulin Kappa C ( IGKC) in Early Breast Cancer. Cancers (Basel) 2021; 13:3626. [PMID: 34298839 PMCID: PMC8304855 DOI: 10.3390/cancers13143626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 01/12/2023] Open
Abstract
We studied the prognostic impact of tumor immunoglobulin kappa C (IGKC) mRNA expression as a marker of the humoral immune system in the FinHer trial patient population, where 1010 patients with early breast cancer were randomly allocated to either docetaxel-containing or vinorelbine-containing adjuvant chemotherapy. HER2-positive patients were additionally allocated to either trastuzumab or no trastuzumab. Hormone receptor-positive patients received tamoxifen. IGKC was evaluated in 909 tumors using quantitative real-time polymerase chain reaction, and the influence on distant disease-free survival (DDFS) was examined using univariable and multivariable Cox regression and Kaplan-Meier estimates. Interactions were analyzed using Cox regression. IGKC expression, included as continuous variable, was independently associated with DDFS in a multivariable analysis also including age, molecular subtype, grade, and pT and pN stage (HR 0.930, 95% CI 0.870-0.995, p = 0.034). An independent association with DDFS was also found in a subset analysis of triple-negative breast cancers (TNBC) (HR 0.843, 95% CI 0.724-0.983, p = 0.029), but not in luminal (HR 0.957, 95% CI 0.867-1.056, p = 0.383) or HER2-positive (HR 0.933, 95% CI 0.826-1.055, p = 0.271) cancers. No significant interaction between IGKC and chemotherapy or trastuzumab administration was detected (Pinteraction = 0.855 and 0.684, respectively). These results show that humoral immunity beneficially influences the DDFS of patients with early TNBC.
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Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at Dortmund TU, 44139 Dortmund, Germany; (K.E.); (J.G.H.)
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at Dortmund TU, 44139 Dortmund, Germany; (K.E.); (J.G.H.)
| | - Anne-Sophie Heimes
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Antje Lebrecht
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Slavomir Krajnak
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Marco J. Battista
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Walburgis Brenner
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center Mainz, 55131 Mainz, Germany; (A.-S.H.); (K.A.); (A.L.); (S.K.); (M.J.B.); (W.B.); (A.H.)
| | - Jörg Rahnenführer
- Department of Statistics, TU Dortmund University, 44221 Dortmund, Germany;
| | | | | | | | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, 00290 Helsinki, Finland;
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D’Abbronzo G, Franco R. The changing role of the pathologist in the era of targeted therapy in personalized medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1923400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Giuseppe D’Abbronzo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Zhai M, Guo Y, Su A, Tian H, Sun G, Kang X, Li K, Yan F. Identification of genes related to dexamethasone-induced immunosuppression in chicken thymus using transcriptome analysis. Res Vet Sci 2020; 132:318-327. [PMID: 32726728 DOI: 10.1016/j.rvsc.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022]
Abstract
The molecular mechanism of stress-induced immunosuppression (SIS) in certain poultry immune organs is not completely clear. In this study, we constructed a stress immunosuppression model by selecting 180 healthy 7-day-old Gushi chickens and dividing them randomly into two groups: a D_T group and a B_T group. The D_T group was given dexamethasone, and the B_T group was given normal saline, according to the treatment method established and reported in our previous study. Thymus samples were subsequently taken from both groups. RNA-seq was used to sequence the transcriptomes of the thymus samples from both groups, and 1278 significant differentially expressed genes (DEGs) were obtained, of which 845 genes were up-regulated and 433 genes were down-regulated (padj<0.05, |FC| ≥ 2, FPKM>1). We identified immune-related gene ontology (GO) terms including immune system processes, immune system process regulation, and T cell activation. The results of KEGG (http: //www.kegg.jp) analysis showed that the DEGs are involved in a variety of immune-related pathways, such as cytokine-cytokine receptor interactions, Jak-STAT signaling pathways, and cell adhesion molecules (CAMs). The cytokine-cytokine receptor interaction pathway involves the DEGs CCR6, CCR5, CD40LG and FAS. The DEGs in the Jak-STAT signaling pathway were SPRY2, BCL2L1. These DEGS play an important role in cell apoptosis. CD40L, CD8, among other genes, are involved in the CAMs pathway. The results of this study add to existing data on the genomic study of stress affecting immune function, and provide a basis for further studies of the molecular mechanisms of stress-influenced immune function.
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Affiliation(s)
- Minxi Zhai
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China
| | - Yujie Guo
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China
| | - Aru Su
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China
| | - Huihui Tian
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China
| | - Guirong Sun
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; Henan Innovative Engineering Research Center of Poultry Germplasm Resource, Zhengzhou 450046, China
| | - Xiangtao Kang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; Henan Innovative Engineering Research Center of Poultry Germplasm Resource, Zhengzhou 450046, China.
| | - Kui Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China.
| | - Fengbin Yan
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; Henan Innovative Engineering Research Center of Poultry Germplasm Resource, Zhengzhou 450046, China.
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9
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Deschuymer S, Sørensen BS, Dok R, Laenen A, Hauben E, Overgaard J, Nuyts S. Prognostic value of a 15-gene hypoxia classifier in oropharyngeal cancer treated with accelerated chemoradiotherapy. Strahlenther Onkol 2020; 196:552-560. [PMID: 32080773 DOI: 10.1007/s00066-020-01595-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE A 15-gene hypoxia classifier has been developed and validated as a predictive factor for patients with head and neck squamous cell carcinoma treated with radiotherapy and nimorazole. This paper aimed to investigate the role of this hypoxia classifier as a prognostic factor for patients with oropharyngeal cancer (OPC) treated with accelerated chemoradiotherapy. METHODS P16 and 15-gene hypoxia classifier status, categorising tumours as more or less hypoxic, were determined for 136 OPC patients. Locoregional recurrence rate (LRR) and overall survival (OS) were estimated with cumulative incidence function and Kaplan-Meier method, respectively, stratified according to p16 and hypoxia status. RESULTS P16-positive patients (34.6%) had significantly better LRR and OS than p16-negative patients. The 5‑year LRR of patients with more hypoxic OPC was similar to those with less hypoxic OPC in the overall patient population (27.3% versus 25.1%; p = 0.98; HR = 1.01 [CI95% 0.47;2.17]) and in the p16-negative OPC (36.4% versus 30.1%; p = 0.70; HR = 1.17 [CI95% 0.53;2.56]). No significant OS differences could be observed in neither p16-negative nor p16-positive subgroup with a 5-year OS for p16-negative more hypoxic OPC of 44.2% versus 49.0% in the less hypoxic OPC (p = 0.92; HR 0.97 [CI95% 0.51;1.84]). CONCLUSION No significant outcome differences were observed between more or less hypoxic tumours, as determined by the 15-gene hypoxia classifier. These results suggest that the 15-gene hypoxia classifier may not have prognostic value in an OPC patient cohort treated with accelerated chemoradiotherapy.
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Affiliation(s)
- Sarah Deschuymer
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Rüveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Esther Hauben
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
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10
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Islam S, Uehara O, Matsuoka H, Kuramitsu Y, Adhikari BR, Hiraki D, Toraya S, Jayawardena A, Saito I, Muthumala M, Nagayasu H, Abiko Y, Chiba I. DNA hypermethylation of sirtuin 1 (SIRT1) caused by betel quid chewing-a possible predictive biomarker for malignant transformation. Clin Epigenetics 2020; 12:12. [PMID: 31931863 PMCID: PMC6958620 DOI: 10.1186/s13148-019-0806-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND DNA hypermethylation of tumor suppressor genes is observed in precancerous lesions and oral cancer of individuals with the habits of betel quid (BQ) chewing. SIRT1 has been identified as playing a role in the maintenance of epithelial integrity, and its alteration is often related to carcinogenesis. However, the methylation and transcription status of SIRT1 in patients with BQ chewing-related oral cancer has not been investigated. We examined the methylation status of SIRT1 in paraffin-embedded tissue samples of oral squamous cell carcinoma (OSCC) obtained from BQ chewing and non-chewing patients and in tissue samples from healthy control subjects. In addition, we examined whether the hypermethylation of SIRT1 followed by its transcriptional downregulation in the human gingival epithelial cells could be caused by arecoline, a major component of BQ. Furthermore, we investigated the methylation status of SIRT1 in smear samples of macroscopically healthy buccal mucosa from subjects with a habit of BQ chewing. RESULTS SIRT1 was significantly hypermethylated in tissue samples of OSCC from BQ chewers and non-chewers than in oral mucosa from healthy control subjects. Results also showed that the hypermethylation level of SIRT1 was significantly higher in OSCC of patients with BQ chewing habits than in those of non-chewing habits (p < 0.05). Our in vitro model showed that hypermethylation is followed by downregulation of the transcriptional level of SIRT1 (p < 0.05). The methylation levels of SIRT1 in the smear samples obtained from BQ chewing individuals were significantly higher than those in the samples obtained from individuals that did not chew BQ. The duration of BQ chewing habits was correlated positively to the frequency of SIRT1 hypermethylation (p < 0.05). CONCLUSIONS Our results suggest that DNA hypermethylation of SIRT1 is involved in the occurrence of oral cancer in BQ chewing patients and that hypermethylation in the oral mucosa of BQ chewers could be a predictive marker for the occurrence of malignant transformation. This is the first report that showed DNA hypermethylation in clinically healthy oral epithelium of BQ chewers. Our study shows evidence that DNA hypermethylation may be an early event of oral carcinogenesis prior to observable clinical changes.
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Affiliation(s)
- Shajedul Islam
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan.,Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Osamu Uehara
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan.,Research Institute of Cancer Prevention, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Hirofumi Matsuoka
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Yasuhiro Kuramitsu
- Research Institute of Cancer Prevention, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Bhoj Raj Adhikari
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Daichi Hiraki
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Seiko Toraya
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Asiri Jayawardena
- Department of General Education, School of Dental Medicine, Tsurumi University, Kanagawa, 230-8501, Japan
| | - Ichiro Saito
- Department of Pathology, School of Dental Medicine, Tsurumi University, Kanagawa, 230-8501, Japan
| | - Malsantha Muthumala
- Department of Oral and Maxillofacial Surgery, Army Hospital, Colombo, Sri Lanka
| | - Hiroki Nagayasu
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan.
| | - Itsuo Chiba
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, 061-0293, Japan
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11
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Bräutigam K, Lindner J, Budczies J, Pahl S, Kunitz A, Melcher I, Wust P, Nebrig M, Baur A, Denkert C, Pfitzner B. PARP-1 expression as a prognostic factor in Desmoid-type fibromatosis. Ann Diagn Pathol 2019; 44:151442. [PMID: 31855806 DOI: 10.1016/j.anndiagpath.2019.151442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/15/2022]
Abstract
Desmoid-type fibromatoses (or desmoid tumors) are entities of intermediate biological potential and are locally invasive. Radical surgery, as state of the art therapy, is frequently limited by incomplete resections. Hormone modifying therapies are promising but further research is required. Poly Adenosine Diphosphate Ribose Polymerase-1 (PARP-1), a DNA repairing enzyme, might be a pathogenetic factor and could become a potential target for therapy as shown by the successful treatment of selected carcinomas and sarcomas by PARP-inhibition. In this study, we investigated the expression of estrogen receptors (ER) α (1) and β (2), progesterone receptor (PR), androgen receptor (AR), as well as PARP-1 via immunohistochemistry and quantitative RT-PCR in 69 tissue samples of desmoid tumors. Immunohistochemistry was quantified using the Immunoreactivity Score (IRS). Overall expression patterns were correlated with clinical-pathologic parameters to determine their value as a prognostic factor. Among the investigated hormone receptors only ERβ showed partial cytoplasmic reactivity. PARP-1 revealed variable nuclear positivity with IRS ranging from 0 to 6. Univariate survival analysis showed that higher expression of estrogen receptor 1 was associated with shorter disease-free survival (p = 0.005). Uni- (p = 0.03) and multivariate (p = 0.003) analyses of mRNA data revealed that higher PARP-1 expression correlated with earlier recurrence. According to this study PARP-1 expression is associated with poorer prognosis, that is faster recurrence, highlighting the possibility of PARP-1-targeting agents as a therapeutic option. Hormone receptors were of minor prognostic relevance in this study.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Child
- Child, Preschool
- Disease-Free Survival
- Estrogen Receptor alpha/genetics
- Estrogen Receptor alpha/metabolism
- Female
- Fibromatosis, Aggressive/diagnosis
- Fibromatosis, Aggressive/metabolism
- Fibromatosis, Aggressive/pathology
- Humans
- Immunohistochemistry
- Infant
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Poly (ADP-Ribose) Polymerase-1/antagonists & inhibitors
- Poly (ADP-Ribose) Polymerase-1/genetics
- Poly (ADP-Ribose) Polymerase-1/metabolism
- Prognosis
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Receptors, Progesterone/genetics
- Receptors, Progesterone/metabolism
- Young Adult
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Affiliation(s)
- Konstantin Bräutigam
- Institute of Pathology, University of Bern, Murtenstrasse 31, 3008 Bern, Switzerland.
| | - Judith Lindner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany; DKTK, DKFZ Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Pahl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Annegret Kunitz
- Vivantes Klinikum Spandau, Department of Hematology, Oncology and Palliative Medicine, Neue Bergstraße 6, 13585 Berlin, Germany
| | - Ingo Melcher
- Vivantes Klinikum Spandau, Department of Orthopaedics and Trauma Surgery, Neue Bergstraße 6, 13585 Berlin, Germany
| | - Peter Wust
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology and Radiotherapy, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Maxim Nebrig
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Baur
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Denkert
- Department of Pathology, University Hospital Marburg, Philipps-Universität, Marburg, Germany
| | - Berit Pfitzner
- Institute of Pathology, DRK Kliniken Berlin Westend, Spandauer Damm 130, 14050 Berlin, Germany
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12
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Kovacs Z, Jung I, Csernak E, Szentirmay Z, Banias L, Rigmanyi G, Gurzu S. DNA extraction from paraffin embedded colorectal carcinoma samples: A comparison study of manual vs automated methods, using four commercially kits. World J Clin Oncol 2019; 10:307-317. [PMID: 31572667 PMCID: PMC6766462 DOI: 10.5306/wjco.v10.i9.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nucleic acid isolation from formalin-fixed, paraffin-embedded tissue (FFPET) samples is a daily routine in molecular pathology laboratories, but extraction from FFPET is not always easily achieved. Choosing the right extraction technique is key for further examinations.
AIM To compare the performance of four commercially available kits used for DNA extraction in routine practice.
METHODS DNA isolation was performed on 46 randomly selected formalin-fixed, paraffin-embedded (FFPE) colorectal adenocarcinoma (CRC) surgical specimens. Four commercially available extraction kits were used: two for manual DNA extraction (the PureLink Genomic DNA Mini Kit from Invitrogen and the High Pure FFPE DNA Isolation Kit from Roche) and two for automated DNA extraction (the iPrep Genomic DNA Kit from Invitrogen and the MagnaPure LC DNA Isolation Kit from Roche). The DNA concentration and quality (odds ratio) among the four systems were compared. The results were correlated with the clinicopathological aspects of CRC cases: age, gender, localization, macro- and microscopic features, lymph node metastases, and the lymph node ratio.
RESULTS The highest DNA concentration was obtained using the manual kits: 157.24 ± 62.99 ng/µL for the PureLink Genomic DNA Mini Kit and 86.64 ng/µL ± 43.84 for the High Pure FFPE DNA Isolation Kit (P < 0.0001). Lower concentrations were obtained with automated systems: 20.39 ± 21.19 ng/µL for the MagnaPure LC DNA Isolation Kit and 8.722 ± 6.408 ng/µL for the iPrep Genomic DNA Kit, with differences between the systems used (P < 0.0001). The comparison between age, gender, tumor localization, pT or pN stage and the lymph node ratio indicated no statistically significant difference in DNA concentration using any of the nucleic acid isolation kits. DNA concentration was influenced by the macroscopic features and grade of differentiation. A higher DNA concentration was obtained for well-differentiated polypoid colorectal adenocarcinomas (CRCs), compared with undifferentiated ulcero-infiltrative carcinomas, irrespective of the kit used.
CONCLUSION For research or diagnosis that needs high DNA concentrations, manual methods of DNA isolation should be used. A higher amount of DNA can be obtained from polypoid-type differentiated CRCs. Automated systems confer comfort and a lower amount of DNA that is, however, sufficient for classic polymerase chain reaction (PCR) and real-time quantitative PCR molecular examinations. All four commercially available kits can be successfully used in daily practice.
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Affiliation(s)
- Zsolt Kovacs
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 530149, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 530149, Romania
| | | | | | - Laura Banias
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 530149, Romania
| | - Genoveva Rigmanyi
- Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 540139, Romania
| | - Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 530149, Romania
- Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures 540139, Romania
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13
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Schmeller J, Wessolly M, Mairinger E, Borchert S, Hager T, Mairinger T, Schmid KW, Wohlschlaeger J, Walter RFH, Mairinger FD. Setting out the frame conditions for feasible use of FFPE derived RNA. Pathol Res Pract 2018; 215:381-386. [PMID: 30606660 DOI: 10.1016/j.prp.2018.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/01/2018] [Accepted: 12/24/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The usage of formalin-fixed paraffin embedded (FFPE) tissue is characterized by its long shelf-life and simple handling. Therefore it is the most commonly available tissue specimen in routine diagnostics and histological studies. Formaldehyde fixation may result in RNA degradation and cross linking with proteins, while storage conditions also affect RNA integrity. The present study was designed to investigate the influence of these factors on RNA analysis. DESIGN FFPE-derived RNA from sections of 23 patients with spontaneous pneumothoraxes was used. Unstained sections of FFPE tissue were stored at various temperatures (-80 °C, -20 °C, 4 °C, 24 °C) prior to RNA extraction. The potential impact on RNA quality of semi-automatic and manual RNA isolation and three different deparaffinization agents (mineral oil, xylene and d-limonene) were compared. RESULTS The storage temperature of FFPE sections affects RNA concentration and fragmentation, with the optimal storage temperature below -20 °C. The RNA extracted with d-limonene shows equivalent quality to the RNA extracted using more toxic standard agents. The manual isolation provides a higher RNA yield compared to the semi-automatic isolation. However, no differences in the amount of longer RNA fragments were observed. Furthermore, the semi-automatic isolation showed an enhanced RNA quality. CONCLUSION FFPE sections not directly used for RNA extraction should be stored below -20 °C to increase quality and yield of the RNA. Usage of semi-automatic isolation produces superior results and simplifies routine processes by having less hands-on-time. Replacement of toxic xylene by d-limonene may contribute to improved occupational safety while not influencing analytical results.
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Affiliation(s)
- Jan Schmeller
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Michael Wessolly
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elena Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sabrina Borchert
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Hager
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Mairinger
- Department of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jeremias Wohlschlaeger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert F H Walter
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabian D Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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14
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Christodoulou C, Oikonomopoulos G, Koliou GA, Kostopoulos I, Kotoula V, Bobos M, Pentheroudakis G, Lazaridis G, Skondra M, Chrisafi S, Koutras A, Bafaloukos D, Razis E, Papadopoulou K, Papakostas P, Kalofonos HP, Pectasides D, Skarlos P, Kalogeras KT, Fountzilas G. Evaluation of the Insulin-like Growth Factor Receptor Pathway in Patients with Advanced Breast Cancer Treated with Trastuzumab. Cancer Genomics Proteomics 2018; 15:461-471. [PMID: 30343280 DOI: 10.21873/cgp.20105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Trastuzumab is a monoclonal antibody against HER2-positive breast cancer. Despite improving the natural history of the disease, there is a number of patients who are resistant to it, whereas all patients will eventually develop resistance and disease will progress. Inconsistent preclinical data show that the IGF-R pathway may contribute to either de novo or acquired resistance to trastuzumab. MATERIALS AND METHODS In total, 227 trastuzumab-treated metastatic breast cancer patients were evaluated for IGF-1, IGF-1R, GLP-1R, Akt1, Akt2 Akt3 mRNA expression, and IGF-1Rα, IGF-1Rβ, IGF-2R protein expression. RESULTS Only 139 patients were truly HER2-positive by central assessment. Among HER2-positive patients, high Akt2 and GLP-1R mRNA expression showed a trend towards higher and lower risk of progression, respectively (HR=1.83, 95%CI=0.90-3.72, p=0.094 and HR=0.62, 95%CI=0.36-1.06, p=0.079), while high Akt1 and GLP-1R mRNA expression presented a trend towards unfavorable survival (HR=1.67, 95%CI=0.93-2.99, p=0.086 and HR=1.67, 95%CI=0.94-2.96, p=0.080). Among HER2-negative patients, high GLP-1R mRNA expression and negative stromal IGF-1Rβ protein expression showed a trend towards worse survival (HR=2.31, 95%CI=0.87-6.13, p=0.094 and HR=2.03, 95%CI=0.94-4.35, p=0.071, respectively). In the multivariate analyses, HER2-positive patients with high Akt1 and GLP-1R mRNA expression had a worse survival (HR=1.86, 95%CI=1.01-3.43, p=0.045 and HR=1.83, 95%CI=0.99-3.41, p=0.055, respectively). CONCLUSION This study revealed a crosstalk between the IGF-R pathway and HER2. There was evidence that high Akt1 and GLP-1R mRNA expression might affect survival among HER2-positive metastatic breast cancer patients treated with trastuzumab.
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Affiliation(s)
| | | | | | - Ioannis Kostopoulos
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George Lazaridis
- Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Maria Skondra
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, Athens, Greece
| | - Sofia Chrisafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Koutras
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | | | - Evangelia Razis
- Third Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Haralambos P Kalofonos
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, Athens, Greece
| | - Pantelis Skarlos
- Department of Radiotherapy, Metropolitan Hospital, Piraeus, Greece
| | - Konstantine T Kalogeras
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Translational Research Section, Hellenic Cooperative Oncology Group, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Baur V, Papadopoulos T, Kazakov DV, Agaimy A, Hartmann A, Isbary G, Wirtz RM, Schultz ES. A case of multiple familial trichoepitheliomas responding to treatment with the Hedgehog signaling pathway inhibitor vismodegib. Virchows Arch 2018; 473:241-246. [DOI: 10.1007/s00428-018-2397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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16
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Mathieson W, Guljar N, Sanchez I, Sroya M, Thomas GA. Extracting DNA from FFPE Tissue Biospecimens Using User-Friendly Automated Technology: Is There an Impact on Yield or Quality? Biopreserv Biobank 2018; 16:191-199. [DOI: 10.1089/bio.2018.0009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Nafia Guljar
- Division of Surgery, Imperial College London, London, United Kingdom
| | | | - Manveer Sroya
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Gerry A. Thomas
- Division of Surgery, Imperial College London, London, United Kingdom
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17
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Pfitzner BM, Lederer B, Lindner J, Solbach C, Engels K, Rezai M, Dohnal K, Tesch H, Hansmann ML, Salat C, Beer M, Schneeweiss A, Sinn P, Bankfalvi A, Darb-Esfahani S, von Minckwitz G, Sinn BV, Kronenwett R, Weber K, Denkert C, Loibl S. Clinical relevance and concordance of HER2 status in local and central testing-an analysis of 1581 HER2-positive breast carcinomas over 12 years. Mod Pathol 2018; 31:607-615. [PMID: 29271415 DOI: 10.1038/modpathol.2017.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 01/07/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) is a central predictive biomarker in breast cancer. Inaccurate HER2 results in different laboratories could be as high as 20%. However, this statement is based on data generated more than 13 years ago and may not reflect the standards of modern diagnostic pathology. We compared central and local HER2 testing in a total of 1581 HER2-positive tumors from five clinical trials. We evaluated the clinical relevance for pathological complete response (pCR) and disease-free survival in a subgroup of 677 tumors, which received an anti-HER2 therapy. Over the period of 12 years, the discordance rate for HER2 decreased from 52.4 (GeparTrio) to 8.4% (GeparSepto). Discordance rates were significantly higher in hormone receptor (HR)-positive tumors (26.6%), compared to HR-negative tumors (16.3%, P<0.0001), which could be explained by a different distribution of HER2 mRNA levels in HR-positive and HR-negative tumors. pCR rates were significantly lower in discordant tumors (13.7%) compared to concordant tumors (32.2%, GeparQuattro and GeparQuinto, P<0.001). In survival analysis, tumors with discordant HER2 testing had a reduced overall survival (OS) in the HR-negative group (P=0.019) and a trend for improved OS in the HR-positive group (P=0.125). The performance of local HER2 testing was considerably improved over time and has reached a 92% concordance, which shows that quality initiatives in diagnostic pathology are working. Tumors with discordant HER2 testing had a reduced therapy response and different survival rates.
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Affiliation(s)
- Berit M Pfitzner
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Judith Lindner
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Knut Engels
- Center of Pathology, Cytology and Molecular Pathology Neuss, Neuss, Germany
| | - Mahdi Rezai
- European Breast Center, Luisen Hospital, Düsseldorf, Germany
| | - Karel Dohnal
- Center of Pathology and Cytology Düsseldorf, Düsseldorf, Germany
| | - Hans Tesch
- Oncology Bethanien, Frankfurt/Main, Germany
| | - Martin L Hansmann
- Institute of Pathology, University Hospital Frankfurt, Frankfurt/ Main, Germany
| | | | | | - Andreas Schneeweiss
- Division Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Agnes Bankfalvi
- Institute of Pathology Essen, University Hospital Essen, Essen, Germany
| | - Silvia Darb-Esfahani
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Pathology Spandau, Berlin, Germany
| | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, Germany.,University Women's Hospital Frankfurt, Frankfurt/ Main, Germany
| | - Bruno V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Gynecological Hospital Sana Klinikum Offenbach, Offenbach, Germany
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18
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Kriegmair MC, Wirtz RM, Worst TS, Breyer J, Ritter M, Keck B, Boehmer C, Otto W, Eckstein M, Weis CA, Hartmann A, Bolenz C, Erben P. Prognostic Value of Molecular Breast Cancer Subtypes based on Her2, ESR1, PGR and Ki67 mRNA-Expression in Muscle Invasive Bladder Cancer. Transl Oncol 2018; 11:467-476. [PMID: 29477637 PMCID: PMC5834659 DOI: 10.1016/j.tranon.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION: Gene expression analyses have identified similarities between bladder and breast cancer, where clinical risk stratification is based on Her2, ESR1, PGR and Ki67 expression. The aim of the study was to assess the respective marker gene expression in patients treated with radical cystectomy for muscle-invasive bladder cancer (MIBC) and to evaluate the applicability of breast cancer subtypes for MIBC risk stratification. MATERIALS & METHODS: 102 patients treated with radical cystectomy for MIBC were assessed. Using routine FFPE tissue and an IVD validated kit, mRNA expression was measured by single step RT-qPCR. Partition test were employed to define cut-off values for high or low marker gene expression. Association of expression with outcome was assessed using Kaplan-Meier analysis and multivariate cox regression analysis. Finally, we performed validation of our results in the MD-Anderson cohort (n = 57). RESULTS: Cancer specific survival (CSS) was impaired in patients with high gene expression of Her2 (P = 0.0009) and ESR1 (P = 0.04). In the multivariate regression model Her2 expression remained significant for the prediction of CSS (HR = 2.11, CI 1.11-4.21, P = 0.024). Furthermore, molecular stratification by breast cancer subgroups was significant (P = 0.023) for CSS prediction. Especially the differentiation between Her2-positive and Luminal A (HR = 4.41, CI 1.53-18.71, P = 0.004) and Luminal B (HR = 1.96, CI 0.99-4.08, P = 0.053) respectively was an independent prognostic parameter for CSS. External validation resulted in comparable risk stratification with differences in fractional subgroups distribution. CONCLUSION: Gene expression of Her2, ESR1, PGR, Ki67 and corresponding breast cancer subtypes allow a risk-stratification in MIBC, whereby Her2 overexpressing tumors reveal a particularly poor prognosis.
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Affiliation(s)
- M C Kriegmair
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - R M Wirtz
- Stratifyer Molecular Pathology, Werthmannstraße 1, 50935, Köln, Germany
| | - T S Worst
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - J Breyer
- Department of Urology, University of Regensburg, Landshuter Str. 65, 93053 Regensburg, Germany
| | - M Ritter
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B Keck
- Department of Urology, University Hospital Erlangen, Krankenhausstraße 8-10, 91054 Erlangen, Germany
| | - C Boehmer
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - W Otto
- Department of Urology, University of Regensburg, Landshuter Str. 65, 93053 Regensburg, Germany
| | - M Eckstein
- Institute of Pathology, University Hospital Erlangen, Krankenhausstraße 8-10, 91054 Erlangen, Germany
| | - C A Weis
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Krankenhausstraße 8-10, 91054 Erlangen, Germany
| | - C Bolenz
- Department of Urology, University of Ulm, Prittwitzstraße 43, 89075 Ulm, Germany
| | - P Erben
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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García-Giménez JL, Seco-Cervera M, Tollefsbol TO, Romá-Mateo C, Peiró-Chova L, Lapunzina P, Pallardó FV. Epigenetic biomarkers: Current strategies and future challenges for their use in the clinical laboratory. Crit Rev Clin Lab Sci 2017; 54:529-550. [PMID: 29226748 DOI: 10.1080/10408363.2017.1410520] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epigenetic modifications and regulators represent potential molecular elements which control relevant physiological and pathological features, thereby contributing to the natural history of human disease. These epigenetic modulators can be employed as disease biomarkers, since they show several advantages and provide information about gene function, thus explaining differences among patient endophenotypes. In addition, epigenetic biomarkers can incorporate information regarding the effects of the environment and lifestyle on health and disease, and monitor the effect of applied therapies. Technologies used to analyze these epigenetic biomarkers are constantly improving, becoming much easier to use. Laboratory professionals can easily acquire experience and techniques are becoming more affordable. A high number of epigenetic biomarker candidates are being continuously proposed, making now the moment to adopt epigenetics in the clinical laboratory and convert epigenetic marks into reliable biomarkers. In this review, we describe some current promising epigenetic biomarkers and technologies being applied in clinical practice. Furthermore, we will discuss some laboratory strategies and kits to accelerate the adoption of epigenetic biomarkers into clinical routine. The likelihood is that over time, better markers will be identified and will likely be incorporated into future multi-target assays that might help to optimize its application in a clinical laboratory. This will improve cost-effectiveness, and consequently encourage the development of theragnosis and the application of precision medicine.
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Affiliation(s)
- José Luis García-Giménez
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain.,e EpiDisease S.L. Spin-Off of CIBERER (ISCIII) , Valencia , Spain
| | - Marta Seco-Cervera
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain
| | - Trygve O Tollefsbol
- f Department of Biology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Carlos Romá-Mateo
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain
| | - Lorena Peiró-Chova
- b INCLIVA Biomedical Research Institute , Valencia , Spain.,g INCLIVA Biobank , Valencia , Spain
| | - Pablo Lapunzina
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,h Institute of Medical and Molecular Genetics (INGEMM) , IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid , Madrid , Spain
| | - Federico V Pallardó
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain
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20
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Predictive value of PD-L1 based on mRNA level in the treatment of stage IV melanoma with ipilimumab. J Cancer Res Clin Oncol 2017; 143:1977-1984. [DOI: 10.1007/s00432-017-2450-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/01/2017] [Indexed: 01/29/2023]
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21
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Automated high throughput nucleic acid purification from formalin-fixed paraffin-embedded tissue samples for next generation sequence analysis. PLoS One 2017; 12:e0178706. [PMID: 28570594 PMCID: PMC5453589 DOI: 10.1371/journal.pone.0178706] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022] Open
Abstract
Curation and storage of formalin-fixed, paraffin-embedded (FFPE) samples are standard procedures in hospital pathology laboratories around the world. Many thousands of such samples exist and could be used for next generation sequencing analysis. Retrospective analyses of such samples are important for identifying molecular correlates of carcinogenesis, treatment history and disease outcomes. Two major hurdles in using FFPE material for sequencing are the damaged nature of the nucleic acids and the labor-intensive nature of nucleic acid purification. These limitations and a number of other issues that span multiple steps from nucleic acid purification to library construction are addressed here. We optimized and automated a 96-well magnetic bead-based extraction protocol that can be scaled to large cohorts and is compatible with automation. Using sets of 32 and 91 individual FFPE samples respectively, we generated libraries from 100 ng of total RNA and DNA starting amounts with 95–100% success rate. The use of the resulting RNA in micro-RNA sequencing was also demonstrated. In addition to offering the potential of scalability and rapid throughput, the yield obtained with lower input requirements makes these methods applicable to clinical samples where tissue abundance is limiting.
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22
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Sinn HP, Schneeweiss A, Keller M, Schlombs K, Laible M, Seitz J, Lakis S, Veltrup E, Altevogt P, Eidt S, Wirtz RM, Marmé F. Comparison of immunohistochemistry with PCR for assessment of ER, PR, and Ki-67 and prediction of pathological complete response in breast cancer. BMC Cancer 2017; 17:124. [PMID: 28193205 PMCID: PMC5307758 DOI: 10.1186/s12885-017-3111-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 02/04/2017] [Indexed: 12/23/2022] Open
Abstract
Background Proliferation may predict response to neoadjuvant therapy of breast cancer and is commonly assessed by manual scoring of slides stained by immunohistochemistry (IHC) for Ki-67 similar to ER and PgR. This method carries significant intra- and inter-observer variability. Automatic scoring of Ki-67 with digital image analysis (qIHC) or assessment of MKI67 gene expression with RT-qPCR may improve diagnostic accuracy. Methods Ki-67 IHC visual assessment was compared to the IHC nuclear tool (AperioTM) on core biopsies from a randomized neoadjuvant clinical trial. Expression of ESR1, PGR and MKI67 by RT-qPCR was performed on RNA extracted from the same formalin-fixed paraffin-embedded tissue. Concordance between the three methods (vIHC, qIHC and RT-qPCR) was assessed for all 3 markers. The potential of Ki-67 IHC and RT-qPCR to predict pathological complete response (pCR) was evaluated using ROC analysis and non-parametric Mann-Whitney Test. Results Correlation between methods (qIHC versus RT-qPCR) was high for ER and PgR (spearman´s r = 0.82, p < 0.0001 and r = 0.86, p < 0.0001, respectively) resulting in high levels of concordance using predefined cut-offs. When comparing qIHC of ER and PgR with RT-qPCR of ESR1 and PGR the overall agreement was 96.6 and 91.4%, respectively, while overall agreement of visual IHC with RT-qPCR was slightly lower for ER/ESR1 and PR/PGR (91.2 and 92.9%, respectively). In contrast, only a moderate correlation was observed between qIHC and RT-qPCR continuous data for Ki-67/MKI67 (Spearman’s r = 0.50, p = 0.0001). Up to now no predictive cut-off for Ki-67 assessment by IHC has been established to predict response to neoadjuvant chemotherapy. Setting the desired sensitivity at 100%, specificity for the prediction of pCR (ypT0ypN0) was significantly higher for mRNA than for protein (68.9% vs. 22.2%). Moreover, the proliferation levels in patients achieving a pCR versus not differed significantly using MKI67 RNA expression (Mann-Whitney p = 0.002), but not with qIHC of Ki-67 (Mann-Whitney p = 0.097) or vIHC of Ki-67 (p = 0.131). Conclusion Digital image analysis can successfully be implemented for assessing ER, PR and Ki-67. IHC for ER and PR reveals high concordance with RT-qPCR. However, RT-qPCR displays a broader dynamic range and higher sensitivity than IHC. Moreover, correlation between Ki-67 qIHC and RT-qPCR is only moderate and RT-qPCR with MammaTyper® outperforms qIHC in predicting pCR. Both methods yield improvements to error-prone manual scoring of Ki-67. However, RT-qPCR was significantly more specific. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3111-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hans-Peter Sinn
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220-221, 69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Marius Keller
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220-221, 69120, Heidelberg, Germany
| | | | - Mark Laible
- BioNTech Diagnostics GmbH, 55131, Mainz, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Sotirios Lakis
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany
| | - Peter Altevogt
- German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sebastian Eidt
- Department of Pathology, St. Elisabeth-Krankenhaus, Werthmannstr. 1c, 50935, Köln, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany.,Department of Pathology, St. Elisabeth-Krankenhaus, Werthmannstr. 1c, 50935, Köln, Germany
| | - Frederik Marmé
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
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23
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Chen L, Kurtyka CA, Welsh EA, Rivera JI, Engel BE, Muñoz-Antonia T, Yoder SJ, Eschrich SA, Creelan BC, Chiappori AA, Gray JE, Ramirez JL, Rosell R, Schabath MB, Haura EB, Chen DT, Cress DW. Early2 factor (E2F) deregulation is a prognostic and predictive biomarker in lung adenocarcinoma. Oncotarget 2016; 7:82254-82265. [PMID: 27756884 PMCID: PMC5347689 DOI: 10.18632/oncotarget.12672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/07/2016] [Indexed: 12/12/2022] Open
Abstract
Clinicians routinely prescribe adjuvant chemotherapy (ACT) for resected non-small cell lung cancer patients. However, ACT only improves five-year disease-free survival in stage I-III non-small cell lung cancer by 5-15%, with most patients deriving no benefit. Herein, deregulation of the E2F pathway was explored as a biomarker in lung adenocarcinoma patients. An E2F pathway scoring system, based on 74 E2F-regulated genes, was trained for RNA from two platforms: fresh-frozen (FF) or formalin-fixed paraffin-embedded (FFPE) tissues. The E2F score was tested as a prognostic biomarker in five FF-based cohorts and two FFPE-based cohorts. The E2F score was tested as a predictive biomarker in two randomized clinical trials; JBR10 and the NATCH (Neo-Adjuvant Taxol-Carboplatin Hope) trial. The E2F score was prognostic in untreated patients in all seven datasets examined (p < 0.05). Stage-specific analysis of combined cohorts demonstrated that the E2F score was prognostic in stage I patients (p = 0.0495 to <0.001; hazard ratio, HR, =2.04- 2.22) with a similar trend in other stages. The E2F score was strongly predictive in stage II patients from the two combined randomized clinical trials with a significant differential treatment effect (p = 0.015). Specifically, ACT improved survival in stage II patients with high E2F (p = 0.01; HR= 0.21). The 5-year survival increased from 18% to 81%. In contrast, in patients with low E2F, 5-year survival was 57% in untreated patients and 41% in ACT-treated patients with a HR of 1.55 (p = 0.47). In summary, the E2F score provides valuable prognostic information for Stage I and predictive information for Stage II lung adenocarcinoma patients and should be further explored as a decision support tool for their treatment.
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Affiliation(s)
- Lu Chen
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Courtney A Kurtyka
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Eric A Welsh
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jason I Rivera
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Brienne E Engel
- Cancer Biology and Evolution, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Sean J Yoder
- Molecular Genomics Core Facility, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Steven A Eschrich
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ben C Creelan
- Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Alberto A Chiappori
- Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jhanelle E Gray
- Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jose Luis Ramirez
- Cancer Biology & Precision Medicine Program, Catalan Institute of Oncology, Badalona, Barcelona, Spain
| | - Rafael Rosell
- Cancer Biology & Precision Medicine Program, Catalan Institute of Oncology, Badalona, Barcelona, Spain
| | - Matthew B Schabath
- Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Eric B Haura
- Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Dung-Tsa Chen
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Douglas W Cress
- Cancer Biology and Evolution, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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24
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Seiler C, Sharpe A, Barrett JC, Harrington EA, Jones EV, Marshall GB. Nucleic acid extraction from formalin-fixed paraffin-embedded cancer cell line samples: a trade off between quantity and quality? BMC Clin Pathol 2016. [PMID: 28649177 PMCID: PMC5477763 DOI: 10.1186/s12907-016-0039-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Advanced genomic techniques such as Next-Generation-Sequencing (NGS) and gene expression profiling, including NanoString, are vital for the development of personalised medicines, as they enable molecular disease classification. This has become increasingly important in the treatment of cancer, aiding patient selection. However, it requires efficient nucleic acid extraction often from formalin-fixed paraffin-embedded tissue (FFPE). METHODS Here we provide a comparison of several commercially available manual and automated methods for DNA and/or RNA extraction from FFPE cancer cell line samples from Qiagen, life Technologies and Promega. Differing extraction geometric mean yields were evaluated across each of the kits tested, assessing dual DNA/RNA extraction vs. specialised single extraction, manual silica column based extraction techniques vs. automated magnetic bead based methods along with a comparison of subsequent nucleic acid purity methods, providing a full evaluation of nucleic acids isolated. RESULTS Out of the four RNA extraction kits evaluated the RNeasy FFPE kit, from Qiagen, gave superior geometric mean yields, whilst the Maxwell 16 automated method, from Promega, yielded the highest quality RNA by quantitative real time RT-PCR. Of the DNA extraction kits evaluated the PicoPure DNA kit, from Life Technologies, isolated 2-14× more DNA. A miniaturised qPCR assay was developed for DNA quantification and quality assessment. CONCLUSIONS Careful consideration of an extraction kit is necessary dependent on quality or quantity of material required. Here we provide a flow diagram on the factors to consider when choosing an extraction kit as well as how to accurately quantify and QC the extracted material.
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Affiliation(s)
- Caroline Seiler
- AstraZeneca Oncology Innovative Medicines, Alderley Park, Macclesfield, UK.,Leeds University-AZ Sandwich Placement, Leeds, UK
| | - Alan Sharpe
- AstraZeneca Oncology Innovative Medicines, Alderley Park, Macclesfield, UK
| | | | | | | | - Gayle B Marshall
- AstraZeneca Oncology Innovative Medicines, Alderley Park, Macclesfield, UK.,AstraZeneca, 8AF6, Mereside, Alderley Park, Alderley Edge, Cheshire SK10 4TG UK
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25
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A prognostic profile of hypoxia-induced genes for localised high-grade soft tissue sarcoma. Br J Cancer 2016; 115:1096-1104. [PMID: 27701385 PMCID: PMC5117798 DOI: 10.1038/bjc.2016.310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/22/2016] [Accepted: 09/05/2016] [Indexed: 12/16/2022] Open
Abstract
Background: For decades, tumour hypoxia has been pursued as a cancer treatment target. However, prognostic and predictive biomarkers are essential for the use of this target in the clinic. This study investigates the prognostic value of a hypoxia-induced gene profile in localised soft tissue sarcoma (STS). Methods: The hypoxia-induced gene quantification was performed by real-time quantitative PCR (RT-qPCR) of formalin-fixed, paraffin-embedded tissue samples. The gene expression cut-points were determined in a test cohort of 55 STS patients and used to allocate each patient into a more or a less hypoxic group. The cut-points found in the test cohort were applied to a cohort of 77 STS patients for validation. Results: For patients with localised high-grade STS treated with surgery with or without postoperative radiation therapy, the prognostic value of the hypoxia-induced gene profile was proved in the test cohort and confirmed in the validation cohort. After adjustment for confounders, the hazard ratio (HR) was 3.2 (95% CI: 1.5; 7.0) for patients with more hypoxic tumours compared with patients with less hypoxic tumours regarding disease-specific survival. Moreover, for the development of metastatic disease, the HR was 2.61 (95% CI: 1.27; 5.33). Conclusions: The hypoxia-induced gene profile is a validated independent prognostic marker that may help identify STS patients needing more aggressive or different adjuvant treatment.
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26
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Prognostic Impact of mRNA Expression Levels of HER1-4 (ERBB1-4) in Patients with Locally Advanced Rectal Cancer. Gastroenterol Res Pract 2016; 2016:3481578. [PMID: 27610130 PMCID: PMC5004041 DOI: 10.1155/2016/3481578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022] Open
Abstract
Background. No predictive or prognostic biomarker is available for patients with locally advanced rectal cancer (LARC) undergoing perioperative chemoradiotherapy (CRT). Members of the human epidermal growth factor receptor (HER) family of receptor tyrosine kinases EGFR (HER1, ERBB1), HER2 (ERBB2), HER3 (ERBB3), and HER4 (ERBB4) are therapeutic targets in several cancers. The analysis was performed to assess expression levels and study the potential prognostic impact for disease-free and overall survival in patients with LARC. Patients and Methods. ERBB1–4 mRNA expression and tumor proliferation using Ki-67 (MKI67) mRNA were evaluated using RT-quantitative PCR in paraffin-embedded tumor samples from 86 patients (median age: 63) treated with capecitabine or 5-fluorouracil-based CRT within a phase 3 clinical trial. Results. A positive correlation of HER4 and HER2, HER3 and HER2, and HER4 and HER3 with each other was observed. Patients with high mRNA expression of ERBB1 (EGFR, HER1) had significantly increased risk for recurrence and death. Patients with high mRNA expression of MKI67 had reduced risk for relapse. Conclusion. This analysis suggests a prognostic impact of both ERBB1 and MKi67 mRNA expression in LARC patients treated with capecitabine or fluorouracil-based chemoradiotherapy.
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27
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Kaemmerer D, Reimann C, Specht E, Wirtz RM, Sayeg M, Baum RP, Schulz S, Lupp A. Differential expression and prognostic value of the chemokine receptor CXCR4 in bronchopulmonary neuroendocrine neoplasms. Oncotarget 2016; 6:3346-58. [PMID: 25671300 PMCID: PMC4413658 DOI: 10.18632/oncotarget.3242] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/24/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction For many tumors, the overexpression of the chemokine receptor CXCR4 is associated with increased malignancy and poor patient outcomes. However, comprehensive data for neuroendocrine neoplasms of the lung are still lacking. Methods CXCR4 expression was evaluated in a panel of bronchopulmonary neuroendocrine neoplasms (BP-NEN) comprising typical carcinoids (n = 26), atypical carcinoids (n = 30), and small cell lung cancers (SCLC, n = 34). Samples were analyzed by immunohistochemistry using the novel monoclonal rabbit anti-human CXCR4 antibody UMB-2 and by qRT-PCR. The expression was correlated with clinical data and overall patient survival. Results CXCR4 was predominantly localized at the plasma membrane of the tumor cells. CXCR4 was expressed with a high intensity in almost all of the 30 SCLC samples. In contrast, it was detected infrequently and with low intensity in the typical carcinoid and atypical carcinoid samples. There was a significant correlation between the immunohistochemistry and qRT-PCR data. Additionally, there was a significant negative relationship between CXCR4 expression and overall survival. Conclusions With increasing malignancy, BP-NEN clearly differ in the extent of CXCR4 expression. As in other tumor entities, CXCR4 overexpression significantly correlates with negative patient outcome. Due to its particular high expression rate in SCLC, CXCR4 may serve as a promising new target for diagnostic and pharmacological intervention as well as for peptide receptor-based radionuclide therapy.
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Affiliation(s)
- Daniel Kaemmerer
- Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Christiane Reimann
- Department of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Elisa Specht
- Department of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
| | - Manal Sayeg
- Department of Internal Medicine, Gastroenterology and Endocrinology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Richard P Baum
- Department of Molecular Radiotherapy and Molecular Imaging, Center for PET/CT, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Stefan Schulz
- Department of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Amelie Lupp
- Department of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
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28
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Mittal D, Caramia F, Michiels S, Joensuu H, Kellokumpu-Lehtinen PL, Sotiriou C, Loi S, Smyth MJ. Improved Treatment of Breast Cancer with Anti-HER2 Therapy Requires Interleukin-21 Signaling in CD8+ T Cells. Cancer Res 2016; 76:264-74. [PMID: 26744522 DOI: 10.1158/0008-5472.can-15-1567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
The HER2/ErbB2 monoclonal antibody (mAb) trastuzumab is combined with chemotherapy as a standard-of-care for newly diagnosed HER2(+) breast cancer patients, but some patients treated with this combination therapy experience early relapse. Our analysis of data from a clinical trial evaluating the efficacy of chemotherapy plus/minus trastuzumab suggested that the magnitude of trastuzumab benefit on distant disease-free survival was higher for increasing expression of the IL21 receptor (IL21R). Therefore, we investigated a possible role for IL21 signaling in promoting HER2 mAb therapeutic efficacy. We found that IL21R-deficient mice and wild-type mice treated with a neutralizing anti-IL21 mAb were less susceptible to trastuzumab-like anti-ErbB2 therapy. Furthermore, IL21R expression on CD8(+) T cells, but not on natural killer cells, was required for optimal anti-ErbB2 mAb efficacy, and IL21 expression was enhanced in tumor-infiltrating CD4(+) T lymphocytes after anti-ErbB2 therapy. Finally, we found that administering recombinant IL21 in combination with anti-ErbB2 therapy was therapeutic against primary tumors and experimental metastases in mice. Collectively, our findings suggest that elevating IL21 signaling may enhance trastuzumab efficacy, thus constituting a novel candidate strategy to overcome trastuzumab resistance and improve patient survival. Cancer
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Affiliation(s)
- Deepak Mittal
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia. School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Franco Caramia
- Peter MacCallum Cancer Centre, University of Melbourne, East Melbourne, Victoria, Australia
| | - Stefan Michiels
- Service de Biostatistique et d'Epidemiologie, Gustave Roussy, Villejuif, France. INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland
| | | | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, East Melbourne, Victoria, Australia
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia. School of Medicine, University of Queensland, Herston, Queensland, Australia.
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Cohen SA, Wu C, Yu M, Gourgioti G, Wirtz R, Raptou G, Gkakou C, Kotoula V, Pentheroudakis G, Papaxoinis G, Karavasilis V, Pectasides D, Kalogeras KT, Fountzilas G, Grady WM. Evaluation of CpG Island Methylator Phenotype as a Biomarker in Colorectal Cancer Treated With Adjuvant Oxaliplatin. Clin Colorectal Cancer 2015; 15:164-9. [PMID: 26702772 DOI: 10.1016/j.clcc.2015.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/21/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND The CpG island methylator phenotype (CIMP) is a promising biomarker for irinotecan/5-fluorouracil/leucovorin chemotherapy for stage III colon cancer. In the present study, we evaluated whether CIMP is a prognostic biomarker for standard-of-care oxaliplatin-based adjuvant therapy. MATERIALS AND METHODS The HE6C/05 trial randomized 441 patients with stage II-III colorectal adenocarcinoma to adjuvant XELOX (capecitabine, oxaliplatin) or modified FOLFOX6 (5-fluorouracil, leucovorin, oxaliplatin). The primary and secondary objectives were disease-free and overall survival, respectively. CIMP status was determined using the DNA methylation status of CACNA1G, IGF2, NEUROG1, RUNX3, and SOCS1. Cox models were used to assess the association of CIMP with survival. RESULTS Of the 293 available tumors, 28 (9.6%) were CIMP(+). On univariate Cox regression analysis, no significant differences in survival were observed between individuals with CIMP(+) versus CIMP(-) tumors. CIMP(+) tumors were more likely to be right-sided and BRAF mutant (χ(2), P < .001). In the multivariate model, TNM stage II (vs. stage III) was associated with a reduced risk of relapse (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.11-0.55; Wald's P < .001), and a colon primary located on the left side and earlier TNM stage were associated with a reduced risk of death (HR, 0.48; 95% CI, 0.28-0.81; P = .006; and HR, 0.22; 95% CI, 0.10-0.49; P < .001, respectively). CONCLUSION In the present exploratory analysis, CIMP did not appear to be a prognostic biomarker in oxaliplatin-treated patients with resected colorectal cancer.
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Affiliation(s)
- Stacey A Cohen
- Division of Oncology, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Chen Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; College of Life Sciences, Hebei University, Baoding, Hebei, People's Republic of China
| | - Ming Yu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Georgia Gourgioti
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - Ralph Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
| | - Georgia Raptou
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Chryssa Gkakou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - George Papaxoinis
- Oncology Section, Second Department of Internal Medicine, "Hippokration" Hospital, Athens, Greece
| | - Vasilios Karavasilis
- Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, "Hippokration" Hospital, Athens, Greece
| | - Konstantine T Kalogeras
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; Translational Research Section, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - William M Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Gastroenterology, University of Washington, Seattle, WA
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Kalmár A, Wichmann B, Galamb O, Spisák S, Tóth K, Leiszter K, Nielsen BS, Barták BK, Tulassay Z, Molnár B. Gene-expression analysis of a colorectal cancer-specific discriminatory transcript set on formalin-fixed, paraffin-embedded (FFPE) tissue samples. Diagn Pathol 2015. [PMID: 26208990 PMCID: PMC4515026 DOI: 10.1186/s13000-015-0363-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A recently published transcript set is suitable for gene expression-based discrimination of normal colonic and colorectal cancer (CRC) biopsy samples. Our aim was to test the discriminatory power of the CRC-specific transcript set on independent biopsies and on formalin-fixed, paraffin-embedded (FFPE) tissue samples. METHODS Total RNA isolations were performed with the automated MagNA Pure 96 Cellular RNA Large Volume Kit (Roche) from fresh frozen biopsies stored in RNALater (CRC (n = 15) and healthy colonic (n = 15)), furthermore from FFPE specimens including CRC (n = 15) and normal adjacent tissue (NAT) (n = 15) specimens next to the tumor. After quality and quantity measurements, gene expression analysis of a colorectal cancer-specific marker set with 11 genes (CA7, COL12A1, CXCL1, CXCL2, CHI3L1, GREM1, IL1B, IL1RN, IL8, MMP3, SLC5A7) was performed with array real-time PCR using Transcriptor First Strand cDNA Synthesis Kit (Roche) and RealTime ready assays on LightCycler480 System (Roche). In situ hybridization for two selected transcripts (CA7, CXCL1) was performed on NAT (n = 3), adenoma (n = 3) and CRC (n = 3) FFPE samples. RESULTS Although analytical parameters of automatically isolated RNA samples showed differences between fresh frozen biopsy and FFPE samples, both quantity and the quality enabled their application in gene expression analyses. CRC and normal fresh frozen biopsy samples could be distinguished with 93.3% sensitivity and 86.7% specificity and FFPE samples with 96.7 and 70.0%, respectively. In situ hybridization could confirm the upregulation of CXCL1 and downregulation of CA7 in colorectal adenomas and tumors compared to healthy controls. CONCLUSION According to our results, gene expression analysis of the analyzed colorectal cancer-specific marker set can also be performed from FFPE tissue material. With the addition of an automated workflow, this marker set may enhance the objective classification of colorectal neoplasias in the routine procedure in the future.
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Affiliation(s)
- Alexandra Kalmár
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary. .,Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary. .,2nd Department of Medicine Semmelweis University, Szentkirályi str. 46., 1088, Budapest, Hungary.
| | - Barnabás Wichmann
- Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary.
| | - Orsolya Galamb
- Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary.
| | - Sándor Spisák
- Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary.
| | - Kinga Tóth
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Katalin Leiszter
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | | | | | - Zsolt Tulassay
- Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary.
| | - Béla Molnár
- Molecular Medicine Research Unit, Hungarian Academy of Sciences, Budapest, Hungary.
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Pentheroudakis G, Raptou G, Kotoula V, Wirtz RM, Vrettou E, Karavasilis V, Gourgioti G, Gakou C, Syrigos KN, Bournakis E, Rallis G, Varthalitis I, Galani E, Lazaridis G, Papaxoinis G, Pectasides D, Aravantinos G, Makatsoris T, Kalogeras KT, Fountzilas G. Immune response gene expression in colorectal cancer carries distinct prognostic implications according to tissue, stage and site: a prospective retrospective translational study in the context of a hellenic cooperative oncology group randomised trial. PLoS One 2015; 10:e0124612. [PMID: 25970543 PMCID: PMC4430485 DOI: 10.1371/journal.pone.0124612] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/01/2015] [Indexed: 02/06/2023] Open
Abstract
Background Although host immune response is an emerging prognostic factor for colorectal cancer, there is no consensus on the optimal methodology, surrogate markers or tissue for study. Patients and Methods Tumour blocks were prospectively collected from 344 patients with stage II/III colorectal cancer (CRC) treated with adjuvant chemotherapy. Whole section lymphocytic infiltration was studied along with mRNA expression of CD3Z, CD8, CD4, CXCL9, CXCL13, IGHM, FOXP3, SNAI2 and ESR1 by qRT-qPCR in tissue microarray (TMA) cores from the centre of tumour, invasive margin and adjacent normal mucosa. Results Lymphocytic infiltration, deficient MMR (10.9%), KRAS (40.7%) and BRAF (4.9%) mutations or single mRNA gene expression were not prognostic. Tumour ESR1 gene expression (Hazard Ratio [HR] for relapse 2.33, 95% CI 1.35-4.02; HR for death 1.74, 95% CI 1.02-2.97) and absence of necrosis (HR for relapse 1.71, 95% CI 1.05-2.71; HR for death 1.98, 95% CI 1.14-3.43) were adverse prognostic features. We used CD3Z and CD8 expression in order to devise the mRNA-based Immune Score (mIS) and proceeded to partitioning analysis in 267 patients, with age, stage, tumour site (Right vs Left CRC), KRAS mutation and tumour mIS as input factors. Only in patients with stage III right-sided colon cancer, a low immune response was associated with inferior disease-free survival (mIS-low, HR for relapse 2.28, 95% CI 1.05-8.02). No prognostic significance was seen for tumour mIS in any other stage or site of CRC, or for a similar mIS score derived from adjacent normal mucosa. Independent adverse prognostic significance was retained in multivariable analysis for absence of necrosis, tumour ESR1 expression in all patients and low tumour mIS in stage III right-sided CRC. Conclusions In localised CRC, mRNA-based CD3Z/CD8 profiling of tumour immune response may have stage, site and tissue-specific prognostic significance, along with ESR1 expression. Trial Registration ANZCTR.org.au ACTRN12610000509066
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Affiliation(s)
- George Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece
- * E-mail:
| | - Georgia Raptou
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - Eleni Vrettou
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Vasilios Karavasilis
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Georgia Gourgioti
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - Chryssa Gakou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - Evangelos Bournakis
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens School of Medicine, Athens, Greece
| | - Grigorios Rallis
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - Eleni Galani
- Second Department of Medical Oncology, “Metropolitan” Hospital, Piraeus, Greece
| | - Georgios Lazaridis
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - George Papaxoinis
- Oncology Section, Second Department of Internal Medicine, “Hippokration” Hospital, Athens, Greece
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, “Hippokration” Hospital, Athens, Greece
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, “Agii Anargiri” Cancer Hospital, Athens, Greece
| | - Thomas Makatsoris
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - Konstantine T. Kalogeras
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- Translational Research Section, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Analysis of somatostatin receptor 2A immunohistochemistry, RT-qPCR, and in vivo PET/CT data in patients with pancreatic neuroendocrine neoplasm. Pancreas 2015; 44:648-54. [PMID: 25872131 DOI: 10.1097/mpa.0000000000000316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Gallium 68 somatostatin receptor (SSTR) positron emission tomography/computed tomography (PET/CT) is one of the most sensitive imaging methods for pancreatic neuroendocrine tumors. The aim of the study was to correlate the receptor density generated from the static PET/CT (maximum standard uptake values [SUVmax], mean standard uptake values [SUVmean]) with subtype 2A SSTR (SSTR2A) immunohistochemistry and reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) gene-expression data. METHODS Thirty-nine tumor specimens (17 primary pancreatic tumors [PTs], 22 metastases [MTS]) of 19 patients with PET/CT scans preoperatively were evaluated. Subtype 2A SSTR expression was quantified immunohistochemically (immunoreactive score [IRS]) and on messenger RNA (mRNA) level by RT-qPCR. RESULTS The PT and MTS did not differ significantly in their SUVmax (P = 0.07) but displayed a dissimilarity with respect to their SSTR2A expression (mean [SD] IRS PT, 8.8 [3.6] vs mean [SD] IRS MTS, 5.1 [4.5]; P = 0.02).The SUVmean was highly significantly correlated to SSTR2A mRNA expression (C = 0.85, P < 0.001) and moderately to SSTR2A protein expression (C = 0.53, P = 0.05). Moreover, the SUVmax correlated moderately with SSTR2A protein expression (C = 0.44, P = 0.03) and mRNA expression (C = 0.64, P = 0.042). CONCLUSIONS The SUVmax and SUVmean are reliable ex vivo parameters for in vivo quantification of SSTR expression in pancreatic neuroendocrine tumors. Both immunohistochemistry and RT-qPCR are comparable methods for SSTR2A quantification. The PT and MTS differ significantly in their SSTR2A expression. This fact should be taken into account when treating patients with somatostatin analogs or peptide receptor radionuclide therapy.
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Atmaca A, Wirtz RW, Werner D, Steinmetz K, Claas S, Brueckl WM, Jäger E, Al-Batran SE. SNAI2/SLUG and estrogen receptor mRNA expression are inversely correlated and prognostic of patient outcome in metastatic non-small cell lung cancer. BMC Cancer 2015; 15:300. [PMID: 25928859 PMCID: PMC4404179 DOI: 10.1186/s12885-015-1310-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/01/2015] [Indexed: 12/26/2022] Open
Abstract
Background Epithelial-mesenchymal transition (EMT) is involved in important malignant features of cancer cells, like invasion, metastatic potential, anti-apoptotic and stem-cell like phenotypes. Among several transcription factors, SNAI2/SLUG is supposed to play an essential role for EMT. Methods Paraffin embedded tumor samples from 63 patients with metastatic non-small cell lung cancer, enrolled in a randomized phase II trial, were prospectively collected, 53 samples qualified for further analysis. Automated RNA extraction from paraffin and RT-quantitative PCR was used for evaluation of SNAI2/SLUG, estrogen receptor 1 (ESR1) and matrix-metalloproteinases (MMP) mRNA expression. Results Clinical features like age, gender, performance status, histological subtype and stage were similarly distributed among SNAI2/SLUG positive and negative patients. SNAI2/SLUG was significantly, inversely correlated with ESR1 mRNA expression (p < 0.0001). In contrast, MMP2 (p = 0.387), MMP7 (p = 0.396) and MMP9 mRNA expression (p = 0.366) did not correlate with SNAI2/SLUG. Patients with high SNAI2/SLUG expression (grouped by median expression) had a worse outcome. Median overall survival in patients with high SNAI2/SLUG expression was 5.7 months versus 11.6 months with low SNAI2/SLUG expression (p = .038). Inversely, patients with high ESR1 expression (grouped by median expression) had an improved median OS with 10.9 months vs. 5.0 months in the low expression group (p = .032). In multivariate analysis, SNAI2/SLUG2 (p = .022) and ESR1 (p = .017) separately were independent prognostic factors for survival. Conclusion SNAI2/SLUG is prognostic of patients’ outcome. The strong inverse correlation with ESR1 indicates a significant impact of estrogen receptor pathway regarding these malignant features.
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Affiliation(s)
- Akin Atmaca
- Department of Hematology and Oncology, Krankenhaus Nordwest, UCT-University Cancer Center, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Ralph W Wirtz
- STRATIFYER Molecular Pathology GmbH, Werthmannstraße 1, 50935, Cologne, Germany.
| | - Dominique Werner
- Institute of clinical research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Kristina Steinmetz
- Institute of clinical research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Silke Claas
- STRATIFYER Molecular Pathology GmbH, Werthmannstraße 1, 50935, Cologne, Germany.
| | - Wolfgang M Brueckl
- Department of Internal Medicine 3, Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nuermberg, Germany.
| | - Elke Jäger
- Department of Hematology and Oncology, Krankenhaus Nordwest, UCT-University Cancer Center, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
| | - Salah-Eddin Al-Batran
- Institute of clinical research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
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Bruns H, Büttner M, Fabri M, Mougiakakos D, Bittenbring JT, Hoffmann MH, Beier F, Pasemann S, Jitschin R, Hofmann AD, Neumann F, Daniel C, Maurberger A, Kempkes B, Amann K, Mackensen A, Gerbitz A. Vitamin D–dependent induction of cathelicidin in human macrophages results in cytotoxicity against high-grade B cell lymphoma. Sci Transl Med 2015; 7:282ra47. [DOI: 10.1126/scitranslmed.aaa3230] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bass BP, Engel KB, Greytak SR, Moore HM. A review of preanalytical factors affecting molecular, protein, and morphological analysis of formalin-fixed, paraffin-embedded (FFPE) tissue: how well do you know your FFPE specimen? Arch Pathol Lab Med 2015; 138:1520-30. [PMID: 25357115 DOI: 10.5858/arpa.2013-0691-ra] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Formalin fixation and paraffin embedding is a timeless, cost-efficient, and widely adopted method of preserving human tissue biospecimens that has resulted in a substantial reservoir of formalin-fixed, paraffin-embedded blocks that represent both the pathology and preanalytical handling of the biospecimen. This reservoir of specimens is increasingly being used for DNA, RNA, and proteomic analyses. OBJECTIVE To evaluate the impact of preanalytical factors associated with the formalin fixation and paraffin embedding process on downstream morphological and molecular endpoints. DATA SOURCES We surveyed the existing literature using the National Cancer Institute's Biospecimen Research Database for published reports investigating the potential influence of preanalytical factors associated with the formalin fixation and paraffin embedding process on DNA, RNA, protein, and morphological endpoints. CONCLUSIONS Based on the literature evidence, the molecular, proteomic, and morphological endpoints can be altered in formalin-fixed, paraffin-embedded specimens by suboptimal processing conditions. While the direction and magnitude of effects associated with a given preanalytical factor were dependent on the analyte (DNA, RNA, protein, and morphology) and analytical platform, acceptable conditions are highlighted, and a summary of conditions that could preclude analysis is provided.
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Affiliation(s)
- B Paige Bass
- From the Kelly Government Solutions Program, Kelly Services, Rockville (Drs Bass and Greytak), and the Biorepositories and Biospecimen Research Branch, Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda (Dr Moore), Maryland; and the Preferred Solutions Group, Arlington, Virginia (Dr Engel)
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Ierardi E, Amoruso A, Giorgio F, Principi M, Losurdo G, Piscitelli D, Buffelli F, Fiore MG, Mongelli A, Castellaneta NM, Giangaspero A, De Francesco V, Montenegro L, Di Leo A. Mucosal molecular pattern of tissue transglutaminase and interferon gamma in suspected seronegative celiac disease at marsh 1 and 0 stages. Saudi J Gastroenterol 2015; 21:379-85. [PMID: 26655133 PMCID: PMC4707806 DOI: 10.4103/1319-3767.167189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIM In celiac disease (CD), there is increased mRNA coding for tissue transglutaminase (tTG) and interferon gamma (IFNα). In seronegative celiac patients, the mucosal immune complexes anti-tTG IgA/tTG are found. We assayed tTG- and IFNα-mRNA in the mucosa of patients with a clinical suspicion of seronegative CD and correlated the values with intraepithelial CD3 lymphocytes (IELs). MATERIALS AND METHODS Distal duodenum specimens from 67 patients were retrieved and re-evaluated for immunohistochemically proven CD3 IELs. Five 10 μm sections were used for the extraction and assay of tTG and IFNα coding mRNA levels using reverse transcriptase real-time polymerase chain reaction (RT-PCR). Samples from 15 seropositive CD patients and 15 healthy subjects were used as positive and negative controls. Results were expressed as fold-change. RESULTS Our series was divided into three groups based on IEL count: >25 (14 patients: group A), 15-25 (26 patients: group B), and 0-15 (27 patients: Group C). tTG-mRNA levels were (mean ± SD): CD = 9.8 ± 2.6; group A = 10.04 ± 4.7; group B = 4.99 ± 2.3; group C = 2.26 ± 0.8, controls = 1.04 ± 0.2 (CD = group A > group B > group C = controls). IFNα-mRNA levels were: CD = 13.4 ± 3.6; group A = 7.28 ± 3.6; group B = 4.45 ± 2.9; group C = 2.06 ± 1.21, controls = 1.04 ± 0.4. CONCLUSIONS Our results suggest that tTG- and IFNγmRNA levels are increased in both seropositive and potential seronegative patients with CD, showing a strong correlation with the CD3 IEL count at stage Marsh 1. An increase in both molecules is found even when IELs are in the range 15-25 (Marsh 0), suggesting the possibility of a "gray zone" inhabited by patients which should be closely followed up in gluten-related disorders.
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Affiliation(s)
- Enzo Ierardi
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy,Address for correspondence: Prof. Enzo Ierardi, Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Piazza G, Cesare, Bari - 70124, Italy. E-mail:
| | - Annacinzia Amoruso
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Floriana Giorgio
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Mariabeatrice Principi
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Giuseppe Losurdo
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | | | | | - Maria G. Fiore
- Department of Pathology Section, University of Bari, Bari, Italy
| | - Antonio Mongelli
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Nicola M. Castellaneta
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Antonio Giangaspero
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Vincenzo De Francesco
- Department of Gastroenterology Department of Medical Sciences Unit, Ospedali Riuniti, Foggia, Italy
| | - Lucia Montenegro
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
| | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Gastroenterology Section, University of Bari, Bari, Italy
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Denkert C, von Minckwitz G, Brase JC, Sinn BV, Gade S, Kronenwett R, Pfitzner BM, Salat C, Loi S, Schmitt WD, Schem C, Fisch K, Darb-Esfahani S, Mehta K, Sotiriou C, Wienert S, Klare P, André F, Klauschen F, Blohmer JU, Krappmann K, Schmidt M, Tesch H, Kümmel S, Sinn P, Jackisch C, Dietel M, Reimer T, Untch M, Loibl S. Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy with or without carboplatin in human epidermal growth factor receptor 2-positive and triple-negative primary breast cancers. J Clin Oncol 2014; 33:983-91. [PMID: 25534375 DOI: 10.1200/jco.2014.58.1967] [Citation(s) in RCA: 749] [Impact Index Per Article: 74.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Modulation of immunologic interactions in cancer tissue is a promising therapeutic strategy. To investigate the immunogenicity of human epidermal growth factor receptor 2 (HER2) -positive and triple-negative (TN) breast cancers (BCs), we evaluated tumor-infiltrating lymphocytes (TILs) and immunologically relevant genes in the neoadjuvant GeparSixto trial. PATIENTS AND METHODS GeparSixto investigated the effect of adding carboplatin (Cb) to an anthracycline-plus-taxane combination (PM) on pathologic complete response (pCR). A total of 580 tumors were evaluated before random assignment for stromal TILs and lymphocyte-predominant BC (LPBC). mRNA expression of immune-activating (CXCL9, CCL5, CD8A, CD80, CXCL13, IGKC, CD21) as well as immunosuppressive factors (IDO1, PD-1, PD-L1, CTLA4, FOXP3) was measured in 481 tumors. RESULTS Increased levels of stromal TILs predicted pCR in univariable (P < .001) and multivariable analyses (P < .001). pCR rate was 59.9% in LPBC and 33.8% for non-LPBC (P < .001). pCR rates ≥ 75% were observed in patients with LPBC tumors treated with PMCb, with a significant test for interaction with therapy in the complete (P = .002) and HER2-positive (P = .006), but not the TNBC, cohorts. Hierarchic clustering of mRNA markers revealed three immune subtypes with different pCR rates (P < .001). All 12 immune mRNA markers were predictive for increased pCR. The highest odds ratios (ORs) were observed for PD-L1 (OR, 1.57; 95% CI, 1.34 to 1.86; P < .001) and CCL5 (OR, 1.41; 95% CI, 1.23 to 1.62; P < .001). CONCLUSION Immunologic factors were highly significant predictors of therapy response in the GeparSixto trial, particularly in patients treated with Cb. After further standardization, they could be included in histopathologic assessment of BC.
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Affiliation(s)
- Carsten Denkert
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France.
| | - Gunter von Minckwitz
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Jan C Brase
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Bruno V Sinn
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Stephan Gade
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Ralf Kronenwett
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Berit M Pfitzner
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Christoph Salat
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Sherene Loi
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Wolfgang D Schmitt
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Christian Schem
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Karin Fisch
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Silvia Darb-Esfahani
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Keyur Mehta
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Christos Sotiriou
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Stephan Wienert
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Peter Klare
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Fabrice André
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Frederick Klauschen
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Jens-Uwe Blohmer
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Kristin Krappmann
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Marcus Schmidt
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Hans Tesch
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Sherko Kümmel
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Peter Sinn
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Christian Jackisch
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Manfred Dietel
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Toralf Reimer
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Michael Untch
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
| | - Sibylle Loibl
- Carsten Denkert, Bruno V. Sinn, Berit M. Pfitzner, Wolfgang D. Schmitt, Silvia Darb-Esfahan, Stephan Wienert, Frederick Klauschen, and Manfred Dietel, Charité Universitätsmedizin Berlin; Carsten Denkert, German Cancer Consortium (DKTK); Peter Klare, Praxisklinik and Breast Center; Jens-Uwe Blohmer, St Gertrauden Krankenhaus and Charité Universitätsmedizin; Micheal Untch, Helios Klinikum Berlin-Buch, Berlin; Gunter von Minckwitz, Stephan Gade, Keyur Mehta, and Sibylle Loibl, German Breast Group, Neu-Isenburg; Gunter von Minckwitz, Women's Hospital, University of Frankfurt; Hans Tesch, Bethanien Hospital, Frankfurt; Jan C. Brase, Ralf Kronenwett, Karin Fisch, and Kristin Krappmann, Sividon Diagnostics, Cologne; Ralf Kronenwett, Heinrich-Heine University Düsseldorf, Düsseldorf; Christian Schem, Christian-Albrechts Universität zu Kiel, Kiel; Christoph Salat, Onkologische Schwerpunktpraxis, Munich; Marcus Schmidt, Johannes-Gutenberg Universität Mainz, Mainz; Sherko Kümmel, Kliniken Essen-Mitte, Essen; Peter Sinn, University of Heidelberg, Heidelberg; Christian Jakisch and Sibylle Loibl, Sana Klinikum Offenbach, Offenbach; Toralf Reimer, Klinikum Südstadt, Rostock, Germany; Sherene Loi, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sherene Loi and Christos Sotiriou, Institute Jules Bordet, Brussels, Belgium; and Fabrice André, Institute Gustave Roussy, Villejuif, France
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Aggerholm-Pedersen N, Safwat A, Bærentzen S, Nordsmark M, Nielsen OS, Alsner J, Sørensen BS. The importance of reference gene analysis of formalin-fixed, paraffin-embedded samples from sarcoma patients - an often underestimated problem. Transl Oncol 2014; 7:687-93. [PMID: 25500077 PMCID: PMC4311021 DOI: 10.1016/j.tranon.2014.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Reverse transcription quantitative real-time polymerase chain reaction is efficient for quantification of gene expression, but the choice of reference genes is of paramount importance as it is essential for correct interpretation of data. This is complicated by the fact that the materials often available are routinely collected formalin-fixed, paraffin-embedded (FFPE) samples in which the mRNA is known to be highly degraded. The purpose of this study was to investigate 22 potential reference genes in sarcoma FFPE samples and to study the variation in expression level within different samples taken from the same tumor and between different histologic types. METHODS Twenty-nine patients treated for sarcoma were enrolled. The samples encompassed 82 (FFPE) specimens. Extraction of total RNA from 7-μm FFPE sections was performed using a fully automated, bead-base RNA isolation procedure, and 22 potential reference genes were analyzed by reverse transcription quantitative real-time polymerase chain reaction. The stability of the genes was analyzed by RealTime Statminer. The intrasamples variation and the interclass correlation coefficients were calculated. The linear regression model was used to calculate the degradation of the mRNA over time. RESULTS The quality of RNA was sufficient for analysis in 84% of the samples. Recommended reference genes differed with histologic types. However, PPIA, SF3A1, and MRPL19 were stably expressed regardless of the histologic type included. The variation in ∆Cq value for samples from the same patients was similar to the variation between patients. It was possible to compensate for the time-dependent degradation of the mRNA when normalization was made using the selected reference genes. CONCLUSION PPIA, SF3A1, and MRPL19 are suitable reference genes for normalization in gene expression studies of FFPE samples from sarcoma regardless of the histology.
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Affiliation(s)
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Bærentzen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita S Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Macrophages and dendritic cells as actors in the immune reaction of classical Hodgkin lymphoma. PLoS One 2014; 9:e114345. [PMID: 25470820 PMCID: PMC4255018 DOI: 10.1371/journal.pone.0114345] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The inflammatory infiltrate plays a pivotal role in classical Hodgkin lymphoma (cHL). Here, we focussed on the role of macrophages (MΦ) and dendritic cells (DC). METHODS MΦ and DC infiltration was investigated in 106 cHL specimens using immunohistochemistry and cytokine expression was analyzed in a subset by real-time PCR. Human peripheral blood-derived monocytes, DC, MΦ stimulated with GM-CSF (MΦGM-CSF, pro-inflammatory MΦ-1-model) or M-CSF (MΦM-CSF, immunomodulatory MΦ-2-model) were incubated with cHL cell line (L1236, HDLM2) supernatants (SN). DC maturation or MΦ polarization were investigated by flow cytometry. Furthermore, the impact of DC or MΦ on cHL cell proliferation was analyzed by BrdU/CFSE assay. RESULTS In cHL tissues mature myeloid (m)DC and MΦ predominated. High numbers of CD83+ mDC and low numbers of CD163+ MΦ were associated with improved disease specific survival. In numerous cHL specimens increased levels of both pro- and anti-inflammatory cytokines and of IL13 and GM-CSF were observed compared to reactive lymphadenopathies. Maturation of DC and induction and maintenance of an immunomodulatory MΦ phenotype were promoted by SN derived from cHL cell lines. TNFα neutralization in SN resulted in a significant inhibition of mDC maturation. DC and pro-inflammatory MΦ inhibited the proliferation of cHL cells. CONCLUSION Adopting an immunomodulatory phenotype is a potential mechanism for how MΦ promote immune evasion in cHL. Mature DC, in contrast, might participate in antitumoral immunity.
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Preanalytical variables and performance of diagnostic RNA-based gene expression analysis in breast cancer. Virchows Arch 2014; 465:409-17. [PMID: 25218890 PMCID: PMC4180906 DOI: 10.1007/s00428-014-1652-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/28/2014] [Accepted: 08/26/2014] [Indexed: 01/22/2023]
Abstract
Prognostic multigene expression assays have become widely available to provide additional information to standard clinical parameters and to support clinicians in treatment decisions. In this study, we analyzed the impact of variations in tissue handling on the diagnostic EndoPredict test results. EndoPredict is a quantitative reverse transcription PCR assay conducted on RNA from formalin-fixed, paraffin-embedded (FFPE) tissue that predicts the likelihood of distant recurrence in patients with ER-positive/HER2-negative breast cancer. In this study, we performed a total of 138 EndoPredict assays to study the effects of preanalytical variables such as time to fixation, fixation time, tumor cell content, and section storage time on the EndoPredict test results. A time to fixation of up to 12 h and fixation of up to 5 days did not affect the results of the gene expression test. Paired samples of FFPE sections with tumor cell content ranging from 15 to 95 % and tumor-enriched samples showed a correlation coefficient of 0.97. Test results of tissue sections that have been stored for 12 months at +4 or +20 °C showed a correlation of 0.99 when compared to results of nonstored sections. In conclusion, preanalytical tissue handling is not a critical factor for diagnostic gene expression analysis with the EndoPredict assay. The test can therefore be easily integrated into the standard workflow of molecular pathology.
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Søes S, Daugaard IL, Sørensen BS, Carus A, Mattheisen M, Alsner J, Overgaard J, Hager H, Hansen LL, Kristensen LS. Hypomethylation and increased expression of the putative oncogene ELMO3 are associated with lung cancer development and metastases formation. Oncoscience 2014; 1:367-74. [PMID: 25594031 PMCID: PMC4278312 DOI: 10.18632/oncoscience.42] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/23/2014] [Indexed: 01/05/2023] Open
Abstract
Numerous genetic and epigenetic events driving tumorigenesis have been characterized. However, knowledge is lacking on the particular events required for the metastatic spread of cancer cells. The engulfment and cell motility 3 (ELMO3) gene plays an important role for the migratory potential of cells, but have not previously been studied in primary samples from cancer patients. We collected material from primary non-small cell lung cancer (NSCLC) tumors and paired brain or adrenal gland metastases from 26 patients and from 26 primary tumor samples from metastasis-free patients matched for age, gender, histology, T-stage, smoking status, and proportion of tumor cells. Using reverse transcriptase–quantitative PCR (RT-qPCR) ELMO3 was shown to be overexpressed in primary tumors from patients with distant metastases compared to normal lung tissue (p<0.001), and compared to primary tumors from metastasis-free patients (p<0.001). The increased expression coincided with decreased methylation levels of the ELMO3 promoter region. High expression and hypomethylation of ELMO3 were also observed when studying the paired brain and adrenal gland metastases. In conclusion, the putative oncogene, ELMO3, is overexpressed in NSCLC in combination with hypomethylation of its promoter and these cancer-specific events are associated with the formation of metastases.
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Affiliation(s)
- Signe Søes
- Department of Biomedicine, University of Aarhus, Aarhus C, Denmark
| | | | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Andreas Carus
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Hager
- Department of Pathology, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Lasse Sommer Kristensen
- Department of Biomedicine, University of Aarhus, Aarhus C, Denmark ; Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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Martin M, Brase JC, Calvo L, Krappmann K, Ruiz-Borrego M, Fisch K, Ruiz A, Weber KE, Munarriz B, Petry C, Rodriguez CA, Kronenwett R, Crespo C, Alba E, Carrasco E, Casas M, Caballero R, Rodriguez-Lescure A. Clinical validation of the EndoPredict test in node-positive, chemotherapy-treated ER+/HER2- breast cancer patients: results from the GEICAM 9906 trial. Breast Cancer Res 2014; 16:R38. [PMID: 24725534 PMCID: PMC4076639 DOI: 10.1186/bcr3642] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 03/25/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction EndoPredict (EP) is an RNA-based multigene test that predicts the likelihood of distant recurrence in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2–negative (HER2−) breast cancer (BC) who are being treated with adjuvant endocrine therapy. Herein we report the prospective-retrospective clinical validation of EP in the node-positive, chemotherapy-treated, ER+/HER2− BC patients in the GEICAM 9906 trial. Methods The patients (N = 1,246) were treated either with six cycles of fluorouracil, epirubicin and cyclophosphamide (FEC) or with four cycles of FEC followed by eight weekly courses of paclitaxel (FEC-P), as well as with endocrine therapy if they had hormone receptor–positive disease. The patients were assigned to EP risk categories (low or high) according to prespecified cutoff levels. The primary endpoint in the clinical validation of EP was distant metastasis-free survival (MFS). Metastasis rates were estimated using the Kaplan-Meier method, and multivariate analysis was performed using Cox regression. Results The molecular EP score and the combined molecular and clinical EPclin score were successfully determined in 555 ER+/HER2− tumors from the 800 available samples in the GEICAM 9906 trial. On the basis of the EP, 25% of patients (n = 141) were classified as low risk. MFS was 93% in the low-risk group and 70% in the high-risk group (absolute risk reduction = 23%, hazard ratio (HR) = 4.8, 95% confidence interval (CI) = 2.5 to 9.5; P < 0.0001). Multivariate analysis showed that, in this ER+/HER2− cohort, EP results are an independent prognostic parameter after adjustment for age, grade, lymph node status, tumor size, treatment arm, ER and progesterone receptor (PR) status and proliferation index (Ki67). Using the predefined EPclin score, 13% of patients (n = 74) were assigned to the low-risk group, who had excellent outcomes and no distant recurrence events (absolute risk reduction vs high-risk group = 28%; P < 0.0001). Furthermore, EP was prognostic in premenopausal patients (HR = 6.7, 95% CI = 2.4 to 18.3; P = 0.0002) and postmenopausal patients (HR = 3.3, 95% CI = 1.3 to 8.5; P = 0.0109). There were no statistically significant differences in MFS between treatment arms (FEC vs FEC-P) in either the high- or low-risk groups. The interaction test results between the chemotherapy arm and the EP score were not significant. Conclusions EP is an independent prognostic parameter in node-positive, ER+/HER2− BC patients treated with adjuvant chemotherapy followed by hormone therapy. EP did not predict a greater efficacy of FEC-P compared to FEC alone.
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Lippi G, Becan-McBride K, Behúlová D, Bowen RA, Church S, Delanghe J, Grankvist K, Kitchen S, Nybo M, Nauck M, Nikolac N, Palicka V, Plebani M, Sandberg S, Simundic AM. Preanalytical quality improvement: in quality we trust. Clin Chem Lab Med 2014; 51:229-41. [PMID: 23072858 DOI: 10.1515/cclm-2012-0597] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 11/15/2022]
Abstract
Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and quality assurance methods have also assured a valuable contribution for reducing diagnostic errors. Nevertheless, several lines of evidence still suggest that most errors in laboratory diagnostics fall outside the analytical phase, and the pre- and postanalytical steps have been found to be much more vulnerable. This collective paper, which is the logical continuum of the former already published in this journal 2 years ago, provides additional contribution to risk management in the preanalytical phase and is a synopsis of the lectures of the 2nd European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled "Preanalytical quality improvement: in quality we trust" (Zagreb, Croatia, 1-2 March 2013). The leading topics that will be discussed include quality indicators for preanalytical phase, phlebotomy practices for collection of blood gas analysis and pediatric samples, lipemia and blood collection tube interferences, preanalytical requirements of urinalysis, molecular biology hemostasis and platelet testing, as well as indications on best practices for safe blood collection. Auditing of the preanalytical phase by ISO assessors and external quality assessment for preanalytical phase are also discussed.
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Affiliation(s)
- Giuseppe Lippi
- U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Bonin S, Stanta G. Nucleic acid extraction methods from fixed and paraffin-embedded tissues in cancer diagnostics. Expert Rev Mol Diagn 2014; 13:271-82. [DOI: 10.1586/erm.13.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Westerman LJ, Schipper ME, Stel HV, Bonten MJ, Kusters JG. Appendiceal spirochaetosis in children. Gut Pathog 2013; 5:40. [PMID: 24330703 PMCID: PMC4029455 DOI: 10.1186/1757-4749-5-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/02/2013] [Indexed: 12/19/2022] Open
Abstract
Background Acute appendicitis is a surgical emergency in which the appendix is surgically removed to prevent peritonitis due to perforation of the appendix. Depending on age and gender, up to 17% of removed appendices do not show the histopathological changes pathognomonic for acute appendicitis and are called ‘pseudo-appendicitis’. Intestinal spirochaetes have been reported in up to 12.3% of these non-inflamed appendices obtained from adults. Although children carry the highest risk for acute appendicitis, not much is known on the prevalence of intestinal spirochaetes in children. The aim of this study was to determine whether there is an association between pseudo-appendicitis and appendiceal spirochaetosis in children. Methods Archival appendix specimens from paediatric patients (less than 18 years old) were obtained from two Dutch hospitals (acute appendicitis, n = 63; pseudo-appendicitis, n = 55; control appendices, n = 33) and microscopically analysed by H&E staining and spirochaete-specific immunohistochemistry and Brachyspira species specific real-time PCR. Results Five out of 142 appendices were found to be positive, all in male patients: one in the acute appendicitis group, two in the pseudo-appendicitis group and two in the control group. Conclusion The results obtained do not provide evidence for a role of Brachyspira species infection in the aetiology of acute appendicitis in children.
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Affiliation(s)
| | | | | | | | - Johannes G Kusters
- Department of Medical Microbiology, University Medical Centre Utrecht, PO-box 85500, 3508 GA, Utrecht, The Netherlands.
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Atmaca A, Al-Batran SE, Wirtz RM, Werner D, Zirlik S, Wiest G, Eschbach C, Claas S, Hartmann A, Ficker JH, Jäger E, Brueckl WM. The validation of estrogen receptor 1 mRNA expression as a predictor of outcome in patients with metastatic non-small cell lung cancer. Int J Cancer 2013; 134:2314-21. [PMID: 24174373 DOI: 10.1002/ijc.28571] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/10/2013] [Accepted: 10/07/2013] [Indexed: 12/23/2022]
Abstract
The prognostic role of estrogen receptors in lung cancer is not validated. Results from patients with early stage non-small lung cancer patients indicate a prognostic role of estrogen receptor 1 (ESR1) mRNA expression in these patients. Automated RNA extraction from paraffin and RT-quantitative PCR was used for evaluation of tumoral ESR1 and progesterone receptor (PGR) mRNA expression. The test cohort consisted of 31 patients with advanced or metastatic non-small cell lung cancer (NSCLC) patients, treated in a first-line registry trial. For validation, 53 patients from a randomized multicentre first-line study with eligible tumor samples were evaluated. There was no significant correlation of ESR1 expression with clinical characteristics. ESR1 high expression was of significant positive prognostic value in the training set with a median overall survival (OS) of 15.9 versus 6.2 months for high versus low ESR1 expression patients (p = 0.0498, HR 0.39). This could be confirmed in the validation cohort with a median OS of 10.9 versus 5.0 months in ESR1 high versus low patients, respectively (p = 0.0321, HR 0.51). In the multivariate analysis adjusted for histological subtype, gender, age and performance status, ESR1 expression remained an independent prognostic parameter for survival in both cohorts. In contrast to ESR1, PGR expression was not able to separate prognostic groups or to predict outcome significantly (for OS; p = 0.94). Our study shows that ESR1 mRNA as assessed by qPCR represents a reliable method for detecting ESR1 expression in NSCLC and that ESR1 expression is an independent prognostic factor in metastatic NSCLC.
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Affiliation(s)
- Akin Atmaca
- Department of Hematology and Oncology, Krankenhaus Nordwest, Frankfurt am Main, Germany
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Schaal U, Grenz S, Merkel S, Rau TT, Hadjihannas MV, Kremmer E, Chudasama P, Croner RS, Behrens J, Stürzl M, Naschberger E. Expression and localization of axin 2 in colorectal carcinoma and its clinical implication. Int J Colorectal Dis 2013; 28:1469-78. [PMID: 23702820 DOI: 10.1007/s00384-013-1709-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Aberrant activation of the Wnt/β-catenin pathway plays a major role in the development of colorectal carcinoma (CRC). Axin 2 is a key protein of this pathway and is upregulated in CRC. Here, we investigated RNA- and protein expression of axin 2 in CRC tissues at the single cell level. Moreover, the association of axin 2 with prognosis and survival was investigated in a large cohort of CRC patients (n = 280). METHODS Localization and expression of axin 2 and β-catenin was investigated using in situ hybridization and immunohistochemical staining. The quantitative expression levels of axin 2 were determined using RT-qPCR. The association of axin 2 expression with prognosis and survival of the patients was determined by statistical analysis (logrank test, Kaplan-Meier). RESULTS Our results confirmed the upregulation of axin 2 in CRC and showed that it is broadly expressed in the cytoplasm of the tumor epithelial cells both, in the tumor center and at the invasion front. Axin 2 was rarely expressed by tumor stromal cells and only weakly by normal colonic epithelial cells. Staining of β-catenin and axin 2 in consecutive CRC tissue sections revealed that nuclear translocation of β-catenin in the tumor front was not associated with changes in the cytoplasmic localization of axin 2. Axin 2 did not show any association with proven prognostic factors or survival of the CRC patients. CONCLUSION The generally increased expression of axin 2 in all tumor stages as compared to normal tissue suggests an initiating pathogenic function in the development of CRC.
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Affiliation(s)
- Ute Schaal
- Division of Molecular and Experimental Surgery, University Medical Center Erlangen, Erlangen, Germany
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Reliable PCR quantitation of estrogen, progesterone and ERBB2 receptor mRNA from formalin-fixed, paraffin-embedded tissue is independent of prior macro-dissection. Virchows Arch 2013; 463:775-86. [DOI: 10.1007/s00428-013-1486-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 01/04/2023]
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Ho YK, Xu WT, Too HP. Direct quantification of mRNA and miRNA from cell lysates using reverse transcription real time PCR: a multidimensional analysis of the performance of reagents and workflows. PLoS One 2013; 8:e72463. [PMID: 24039771 PMCID: PMC3764000 DOI: 10.1371/journal.pone.0072463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/17/2013] [Indexed: 01/19/2023] Open
Abstract
Substantial efforts have been devoted to in vitro testing of candidate chemotherapeutics by profiling transcriptional changes across the collection of NCI-60 cell-lines. A work-flow with reagents that enable the direct quantification of RNA of different molecular sizes simultaneously in the same sample without laborious total RNA isolation will invariably increase the throughput and accuracy of the study. MicroRNAs (miRNAs) are known to regulate most cellular functions, acting post-transcriptionally by repressing numerous eukaryotic mRNAs. Recent findings on the remarkable stability of miRNA prompted us to investigate the feasibility of quantifying the expression levels of both mRNA and miRNA directly from cell lysates (cell-to-Ct). Multidimensional analyses of the expressions of mRNA and miRNA across seven NCI-60 cell lines and multiple reagents were conducted to assess the performances of these reagents and workflows for cell-to-Ct measurements using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Quantification of RNA species using lysates prepared from an in-house and one of the commercial reagents demonstrated comparable performance to those prepared by the more laborious and conventional method of using guanidinium-phenol-chloroform. Additionally, miRNA was found to be highly stable in the cell lysates when incubated at room temperature for prolonged period of time and subjected to multiple freeze-thaw cycles. In summary, this study demonstrated significant differences in pre-analytical performance of a variety of commercially available reagents and described a cost-effective reagent useful for rapid, scalable, and high-throughput workflow for the detection of mRNA and miRNA from the same biological sample.
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Affiliation(s)
- Yoon Khei Ho
- Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Wen Ting Xu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Heng Phon Too
- Department of Biochemistry, National University of Singapore, Singapore, Singapore
- Molecular Engineering of Biological and Chemical System/Chemical Pharmaceutical Engineering, Singapore–Massachusetts Institute of Technology Alliance, Singapore, Singapore
- Bioprocessing Technology Institute, A*STAR (Agency for Science, Technology and Research), Singapore, Singapore
- * E-mail:
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Brase JC, Kronenwett R, Petry C, Denkert C, Schmidt M. From High-Throughput Microarray-Based Screening to Clinical Application: The Development of a Second Generation Multigene Test for Breast Cancer Prognosis. MICROARRAYS 2013; 2:243-64. [PMID: 27605191 PMCID: PMC5003465 DOI: 10.3390/microarrays2030243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/12/2013] [Accepted: 08/22/2013] [Indexed: 12/15/2022]
Abstract
Several multigene tests have been developed for breast cancer patients to predict the individual risk of recurrence. Most of the first generation tests rely on proliferation-associated genes and are commonly carried out in central reference laboratories. Here, we describe the development of a second generation multigene assay, the EndoPredict test, a prognostic multigene expression test for estrogen receptor (ER) positive, human epidermal growth factor receptor (HER2) negative (ER+/HER2−) breast cancer patients. The EndoPredict gene signature was initially established in a large high-throughput microarray-based screening study. The key steps for biomarker identification are discussed in detail, in comparison to the establishment of other multigene signatures. After biomarker selection, genes and algorithms were transferred to a diagnostic platform (reverse transcription quantitative PCR (RT-qPCR)) to allow for assaying formalin-fixed, paraffin-embedded (FFPE) samples. A comprehensive analytical validation was performed and a prospective proficiency testing study with seven pathological laboratories finally proved that EndoPredict can be reliably used in the decentralized setting. Three independent large clinical validation studies (n = 2,257) demonstrated that EndoPredict offers independent prognostic information beyond current clinicopathological parameters and clinical guidelines. The review article summarizes several important steps that should be considered for the development process of a second generation multigene test and offers a means for transferring a microarray signature from the research laboratory to clinical practice.
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Affiliation(s)
- Jan C Brase
- Sividon Diagnostics GmbH, Nattermannallee 1, 50829, Cologne, Germany.
| | - Ralf Kronenwett
- Sividon Diagnostics GmbH, Nattermannallee 1, 50829, Cologne, Germany.
| | - Christoph Petry
- Sividon Diagnostics GmbH, Nattermannallee 1, 50829, Cologne, Germany.
| | - Carsten Denkert
- Institute of Pathology, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
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