1
|
Li H, Gao J, Gao Y, Lin N, Zheng M, Ye Z. Denosumab in Giant Cell Tumor of Bone: Current Status and Pitfalls. Front Oncol 2020; 10:580605. [PMID: 33123484 PMCID: PMC7567019 DOI: 10.3389/fonc.2020.580605] [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: 07/07/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Denosumab is a monoclonal antibody against RANK ligand for treatment of giant cell tumor of bone (GCTB). Clinical trials and case series have demonstrated that denosumab is relevant to beneficial tumor response and surgical down-staging in patients of GCTB. However, these trials or case series have limitations with a short follow-up. Recent increasing studies revealed that denosumab probably increased the local recurrence risk in patients treated with curettage. This may be caused by the thicken bone margin of tumor that trapped tumor cells from curettage. The direct bone formation by tumor cells in the margin after denosumab treatment also contributed to the local recurrence. in vitro studies showed denosumab resulted in a cytostatic instead of a true cytotoxic response on neoplastic stromal cells. More importantly, denosumab-treated GCTB exhibited morphologic overlap with malignancy, and a growing number of patients of malignant transformation of GCTB during denosumab treatment have been reported. The optimal duration, long term safety, maintenance dose, and optimum indications remain to be elucidated. With these concerns in mind, this review warns that the denosumab therapy of GCTB should be applied with caution.
Collapse
Affiliation(s)
- Hengyuan Li
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Junjie Gao
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Youshui Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Nong Lin
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Minghao Zheng
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Zhaoming Ye
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| |
Collapse
|
2
|
Mohtasham N, Saghravanian N, Fatemi B, Vahedi M, Afzal-Aghaee M, Kadeh H. A comparative study of osteopontin and MMP-2 protein expression in peripheral and central giant cell granuloma of the jaw. Braz J Otorhinolaryngol 2017; 85:150-156. [PMID: 29339027 PMCID: PMC9452220 DOI: 10.1016/j.bjorl.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/08/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction Oral peripheral and central giant cell granulomas are lesions with little-known etiology and pathogenesis. Objective The aim of this study was to compare matrix metalloproteinases-2 and osteopontin protein expression in the multinucleated giant cells and mononuclear cells of the peripheral and central giant cell granuloma lesions. Methods In this retrospective study, the presence of matrix metalloproteinases-2 and osteopontin in 37 cases of central giant cell granuloma and 37 cases of peripheral giant cell granuloma paraffin blocks were assessed by streptavidin-biotin immunohistochemistry. Independent sample t-test, Chi-square, Mann–Whitney tests and Spearman's rank correlation coefficient were used. Results The osteopontin was expressed in both multinucleated giant cells and mononuclear cells in all cases of peripheral and central giant cells granulomas. However, the matrix metalloproteinases-2 expression was positive in 86.5% of giant cells and it was positive in all of mononuclear cells in peripheral giant cells granuloma. In central giant cells granulomas, 91.8% of giant cells and all mononuclear cells were positive for matrix metalloproteinases-2 marker. Percentage and Intensity of staining were significantly higher in central than peripheral giant cells lesions, for both markers (p ˂ 0.05). Conclusion This study showed that the expression of osteopontin in giant cells supports the theory of osteolcastic nature of these cells. Also, the presence of osteopontin and matrix metalloproteinases-2 in mononuclear cells may indicate the monocyte-macrophage origin of these cells, as the differentiation of the precursors of the mononuclear stromal monocyte/macrophage to osteoclasts is possibly affected by the expression of osteolytic factors. Also, may be differences in biological behaviors of these lesions are associated with the level of osteopontin and matrix metalloproteinases-2 expression.
Collapse
Affiliation(s)
- Nooshin Mohtasham
- Oral and Maxillofacial Disease Research Center, Mashhad University of Medical Sciences, School of Dentistry, Department of Oral and Maxillofacial Pathology, Mashhad, Iran
| | - Nasrollah Saghravanian
- Oral and Maxillofacial Disease Research Center, Mashhad University of Medical Sciences, School of Dentistry, Department of Oral and Maxillofacial Pathology, Mashhad, Iran
| | - Bahareh Fatemi
- Kerman University of Medical Sciences, School of Dentistry, Department of Endodontics, Kerman, Iran
| | - Mehdi Vahedi
- Kerman University of Medical Sciences, School of Dentistry, Department of Periodontology, Kerman, Iran
| | - Monavar Afzal-Aghaee
- Mashhad University of Medical Sciences, Social Medicine Specialist, Mashhad, Iran
| | - Hamideh Kadeh
- Oral and Dental Disease Research Center, Zahedan University of Medical Science, School of Dentistry, Department of Oral & Maxillofacial Pathology, Zahedan, Iran.
| |
Collapse
|
3
|
Zhou X, Liu XZ, Fan GT, Wu SJ, Zhao JN, Shi X. Expression of Matrix Metalloproteinase-9 and CD34 in Giant Cell Tumor of Bone. Orthop Surg 2017; 8:220-5. [PMID: 27384731 DOI: 10.1111/os.12250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/19/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Giant cell tumor of bone (GCTB) invades extensively and metastasizes, however, the pathological grade and imaging findings are not accurate predictors of its prognosis. Thus, the aim of this study was to explore the relationships between expression of cluster of differentiation (CD)34 and matrix metalloproteinase-9 (MMP-9) and the biological behavior of GCTB with the hope of identifying predictors of prognosis. METHODS Sixty-eight patients with GCTBs attending our institution from September 2008 to August 2013 were enrolled in this prospective study and grouped according to tumor location. Relevant patient characteristics were assessed. Additionally, the expression of CD34 and MMP-9 in these patients was assayed by an immunohistochemistry staining procedure and the relationships between CD34/MMP-9 and microvessel density (MVD) analyzed by Spearman correlation analysis. RESULTS It was found that CD34 factor localizes in the cytoplasm of the endothelial cells of small blood vessels in the tumor stroma and is strongly expressed in GCTBs. In addition, radiological grading showed that there was significantly more CD34 antibody-labeled MVD in invasive than in non-invasive tumors (P < 0.05) and significantly more CD34 antibody-labeled MVD in patients who developed recurrences than in those who did not (P < 0.05). Expression of MMP-9 was localized in the cytoplasm of tumor cells and the rate of MMP-9 positivity in GCTBs was significantly higher in active and invasive tumors than in non-invasive tumors (P < 0.01). Moreover, there were significantly more MVDs in MMP-9-positive than in MMP-9 negative tumors (P < 0.01). CD34 and MMP-9 are positively correlated with MVD values in GCTBs and closely correlated with their grade of malignancy. CONCLUSION Expression of CD34 and MMP-9 accurately predicts clinical behavior detection and prognosis of GCTBs.
Collapse
Affiliation(s)
- Xing Zhou
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xiao-Zhou Liu
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Gen-Tao Fan
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Su-Jia Wu
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jian-Ning Zhao
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xin Shi
- Department of Orthopaedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| |
Collapse
|
4
|
Mukaihara K, Suehara Y, Kohsaka S, Akaike K, Tanabe Y, Kubota D, Ishii M, Fujimura T, Kazuno S, Okubo T, Takagi T, Yao T, Kaneko K, Saito T. Protein Expression Profiling of Giant Cell Tumors of Bone Treated with Denosumab. PLoS One 2016; 11:e0148401. [PMID: 26863138 PMCID: PMC4749282 DOI: 10.1371/journal.pone.0148401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/18/2016] [Indexed: 11/30/2022] Open
Abstract
Giant cell tumors of bone (GCTB) are locally aggressive osteolytic bone tumors. Recently, some clinical trials have shown that denosumab is a novel and effective therapeutic option for aggressive and recurrent GCTB. This study was performed to investigate the molecular mechanism underlying the therapeutic effect of denosumab. Comparative proteomic analyses were performed using GCTB samples which were taken before and after denosumab treatment. Each expression profile was analyzed using the software program to further understand the affected biological network. One of identified proteins was further evaluated by gelatin zymography and an immunohistochemical analysis. We identified 13 consistently upregulated proteins and 19 consistently downregulated proteins in the pre- and post-denosumab samples. Using these profiles, the software program identified molecular interactions between the differentially expressed proteins that were indirectly involved in the RANK/RANKL pathway and in several non-canonical subpathways including the Matrix metalloproteinase pathway. The data analysis also suggested that the identified proteins play a critical functional role in the osteolytic process of GCTB. Among the most downregulated proteins, the activity of MMP-9 was significantly decreased in the denosumab-treated samples, although the residual stromal cells were found to express MMP-9 by an immunohistochemical analysis. The expression level of MMP-9 in the primary GCTB samples was not correlated with any clinicopathological factors, including patient outcomes. Although the replacement of tumors by fibro-osseous tissue or the diminishment of osteoclast-like giant cells have been shown as therapeutic effects of denosumab, the residual tumor after denosumab treatment, which is composed of only stromal cells, might be capable of causing bone destruction; thus the therapeutic application of denosumab would be still necessary for these lesions. We believe that the protein expression patterns and the results of the network analysis will provide a better understanding of the effects of denosumab administration in patients with GCTB.
Collapse
Affiliation(s)
- Kenta Mukaihara
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Suehara
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Shinji Kohsaka
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Keisuke Akaike
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yu Tanabe
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Daisuke Kubota
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Midori Ishii
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tsutomu Fujimura
- Laboratory of Biochemical Analysis, Central Laboratory of Medical Sciences, Juntendo University School of Medicine, Tokyo, Japan
| | - Saiko Kazuno
- Laboratory of Biochemical Analysis, Central Laboratory of Medical Sciences, Juntendo University School of Medicine, Tokyo, Japan
| | - Taketo Okubo
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tatsuya Takagi
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Power PF, Mak IWY, Singh S, Popovic S, Gladdy R, Ghert M. ETV5 as a regulator of matrix metalloproteinase 2 in human chondrosarcoma. J Orthop Res 2013; 31:493-501. [PMID: 22968857 DOI: 10.1002/jor.22227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/15/2012] [Indexed: 02/04/2023]
Abstract
Chondrosarcoma is a unique type of bone cancer in that it does not respond to chemotherapy or radiation therapy, and therefore many affected patients die from metastatic disease. Metastasis has been correlated with the upregulation of the matrix metalloproteinase (MMP) family of proteases, which can degrade extracellular components. ETV5 is a transcription factor which has shown to be overexpressed in various types of invasive tumors. We hypothesized that ETV5 regulates MMP2 in human chondrosarcoma with the protease acting as a downstream effector. Gene knock-down of ETV5 in human chondrosarcoma cells reduces MMP2 mRNA expression as well as decreased protein production and significantly decreased MMP2 activity. With plasmid transfected ETV5 upregulation, MMP2 expression is similarly upregulated at the gene expression and protein levels. Data from our bone resorption studies revealed that when a matrix metalloproteinase-2 inhibitor is added to the growth media of chondrosarcoma cells, collagen released from bone chips incubated with the cells decreased by 27%. This data suggests that ETV5 has a significant role in regulating MMP2 expression and therefore matrix resorption in human chondrosarcoma, and thus may be a targetable upstream effector of the metastatic cascade in this cancer.
Collapse
Affiliation(s)
- Patricia F Power
- Department of Health Science Graduate Studies, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
6
|
Singh S, Singh M, Mak IWY, Turcotte R, Ghert M. Investigation of FGFR2-IIIC signaling via FGF-2 ligand for advancing GCT stromal cell differentiation. PLoS One 2012; 7:e46769. [PMID: 23071632 PMCID: PMC3469652 DOI: 10.1371/journal.pone.0046769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/07/2012] [Indexed: 02/06/2023] Open
Abstract
Giant cell tumor of bone (GCT) is an aggressive bone tumor consisting of multinucleated osteoclast-like giant cells and proliferating osteoblast-like stromal cells. The signaling mechanism involved in GCT stromal cell osteoblastic differentiation is not fully understood. Previous work in our lab reported that GCT stromal cells express high levels of TWIST1, a master transcription factor in skeletal development, which in turn down-regulates Runx2 expression and prevents terminal osteoblastic differentiation in these cells. The purpose of this study was to determine the upstream regulation of TWIST1 in GCT cells. Using GCT stromal cells obtained from patient specimens, we demonstrated that fibroblast growth factor receptor (FGFR)-2 signaling plays an essential role in bone development and promotes differentiation of immature osteoblastic cells. Fibroblast growth factor (FGF)-2 stimulates FGFR-2 expression, resulting in decreased TWIST1 expression and increased Runx2, alkaline phosphastase (ALP) and osteopontin (OPN) expression. Inhibition of FGFR-2 through siRNA decreased the expression of ALP, Runx2 and OPN in GCT stromal cells. Our study also confirmed that FGF-2 ligand activates downstream ERK1/2 signaling and pharmacological inhibition of the ERK1/2 signaling pathway suppresses FGF-2 stimulated osteogenic differentiation in these cells. Our results indicate a significant role of FGFR-2 signaling in osteoblastic differentiation in GCT stromal cells.
Collapse
Affiliation(s)
- Shalini Singh
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohini Singh
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Robert Turcotte
- Department of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Quebec, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| |
Collapse
|