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Liu S, Zheng Q, Zhang R, Li T, Zhan J. Construction of a combined random forest and artificial neural network diagnosis model to screening potential biomarker for hepatoblastoma. Pediatr Surg Int 2022; 38:2023-2034. [PMID: 36271952 DOI: 10.1007/s00383-022-05255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of our study is to identify potential biomarkers of hepatoblastoma (HB) and further explore the pathogenesis of it. METHODS Differentially expressed genes (DEGs) were incorporated into the combined random forest and artificial neural network diagnosis model to screen candidate genes for HB. Gene set enrichment analysis (GSEA) was used to analyze the ARHGEF2. Student's t test was performed to evaluate the difference of tumor-infiltrating immune cells (TIICs) between normal and HB samples. Spearson correlation analysis was used to calculate the correlation between ARHGEF2 and TIICs. RESULTS ARHGEF2, TCF3, TMED3, STMN1 and RAVER2 were screened by the new model. The GSEA of ARHGEF2 included cell cycle pathway and antigen processing presenting pathway. There were significant differences in the composition of partial TIICs between HB and normal samples (p < 0.05). ARHGEF2 was significantly correlated with memory B cells (Cor = 0.509, p < 0.05). CONCLUSION These 5 candidate genes contribute to the molecular diagnosis and targeted therapy of HB. And we found "ARHGEF2-RhoA-Cyclin D1/CDK4/CDK6-EF2" is a key mechanism regulating cell cycle pathway in HB. This will be helpful in the treatment of HB. The occurrence of HB is related to abnormal TIICs. We speculated that memory B cells play an important role in HB.
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Affiliation(s)
- Shaowen Liu
- Clinical School of Paediatrics, Tianjin Medical University, 238 Longyan Road, Beichen District, Tianjin, 300400, China
| | - Qipeng Zheng
- Clinical School of Paediatrics, Tianjin Medical University, 238 Longyan Road, Beichen District, Tianjin, 300400, China
| | - Ruifeng Zhang
- Clinical School of Paediatrics, Tianjin Medical University, 238 Longyan Road, Beichen District, Tianjin, 300400, China
| | - Tengfei Li
- Clinical School of Paediatrics, Tianjin Medical University, 238 Longyan Road, Beichen District, Tianjin, 300400, China
| | - Jianghua Zhan
- Clinical School of Paediatrics, Tianjin Medical University, 238 Longyan Road, Beichen District, Tianjin, 300400, China. .,Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin, 300400, China.
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Liu J, Wu X, Xu C, Ma M, Zhao J, Li M, Yu Q, Hao X, Wang G, Wei B, Xia N, Dong Q. A Novel Method for Observing Tumor Margin in Hepatoblastoma Based on Microstructure 3D Reconstruction. Fetal Pediatr Pathol 2022; 41:371-380. [PMID: 32969743 DOI: 10.1080/15513815.2020.1822965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: We investigated three-dimensional (3 D) reconstruction for the assessment of the tumor margin microstructure of hepatoblastoma (HB). Methods: Eleven surgical resections of childhood hepatoblastomas obtained between September 2018 and December 2019 were formalin-fixed, paraffin-embedded, serially sectioned at 4 μm, stained with hematoxylin and eosin (every 19th and 20th section stained with alpha-fetoprotein and glypican 3), and the digital images of all sections were acquired at 100× followed by image registration using the B-spline based method with modified residual complexity. Reconstruction was performed using 3 D Slicer software. Results: The reconstructed orthogonal 3 D images clearly presented the internal microstructure of the tumor margin. The rendered 3 D image could be rotated at any angle. Conclusions: Microstructure 3 D reconstruction is feasible for observing the pathological structure of the HB tumor margin.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China.,Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu 246400, China
| | - XiongWei Wu
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Chongzhi Xu
- College of Computer Science and Technology, Qingdao University, Qingdao 266000, China
| | - Mingdi Ma
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Jie Zhao
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Min Li
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - QiYue Yu
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - XiWei Hao
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - GuoDong Wang
- College of Computer Science and Technology, Qingdao University, Qingdao 266000, China
| | - Bin Wei
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Nan Xia
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Qian Dong
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
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Liu J, Xiu W, Duan G, Dong Q. Application of 3D Simulation Software in Chemotherapy and Hepatoblastoma Surgery in Children. Front Surg 2022; 9:908381. [PMID: 35722529 PMCID: PMC9200229 DOI: 10.3389/fsurg.2022.908381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aims to explore the clinical value of a computer-assisted surgery system (Hisense CAS) in hepatoblastoma (HB) surgery in children after neoadjuvant chemotherapy. Patients and Methods The clinical medical records of children with HB treated after neoadjuvant chemotherapy at the Affiliated Hospital of Qingdao University from January 2016 to January 2019 were analyzed retrospectively. Results A total of 21 children were enrolled in this study, including 13 boys and 8 girls. All cases successfully underwent three-dimensional (3D) reconstruction of the liver and tumor using Hisense CAS, simulated hepatectomy, and hepatectomy according to the preoperative operation plan. There were twelve cases of right hemihepatectomy, four cases of right trefoil hepatectomy, one case of left lobe hepatectomy, and three cases of middle lobe hepatectomy, and one case of V and VI segment hepatectomy. All children recovered well after the operation. The follow-up ranged from 5 months to 3 years. One child died of systemic metastasis 8 months after the operation. One child received one course of chemotherapy after the operation. Due to the serious reaction to the chemotherapy, the family refused further treatment and follow-up. The remaining 19 children had no complications or recurrence. Conclusion Hisense CAS can clearly and intuitively display the position and shape of the HB before and after chemotherapy and its relationship with the intrahepatic pipeline system and accurately evaluate the changes in tumor volume and the distance between important blood vessels, which is conducive to the operator selecting the best operation opportunity, timely formulating the best operation plan and implementing individualized and accurate liver tumor resection.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Wenli Xiu
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
- Correspondence: Qian Dong Guangqi Duan
| | - Qian Dong
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
- Correspondence: Qian Dong Guangqi Duan
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Yang X, Wang Q, Wang Y, Song T, Zheng Y, Wang W, Shi Y. LRH-1 high expression in the ovarian granulosa cells of PCOS patients. Endocrine 2021; 74:413-420. [PMID: 34129175 DOI: 10.1007/s12020-021-02774-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders with heterogeneity. There are also reports that liver receptor homolog 1 [LRH-1 or nuclear receptor subfamily 5 group A member 2] plays an important role in the reproductive system. But up to now, there are no reports related to the link with PCOS and LRH-1. In this study, we aimed to detect the LRH-1 expression in the ovarian granulosa cell (GC) of PCOS patients and explore the potential relationship between LRH-1 and PCOS. METHODS In all, 146 follicular fluid samples were collected in this study, including 72 from PCOS patients and 74 from control patients who underwent intracytoplasmic sperm injection or in vitro fertilization-embryo transfer. The ovarian GCs were extracted from the patient's follicular fluid by magnetic-activated cell sorting method, and real-time quantitative PCR was used to measure the expression of LRH-1 in ovarian GCs. Then we analyzed the correlation between the expression level of LRH-1 and the clinical characteristics of the patient by using Pearson Correlation analysis. RESULTS The expression of LRH-1 was significantly higher in PCOS patients ovarian GCs than that in the control patients [(1.38 ± 0.47) vs (1.03 ± 0.32), t = 5.327, p < 0.0001], and it was positively correlated with antral follicles counting (r = 0.3607, p < 0.0001) and the serum anti-Mullerian hormone (r = 0.2662, p = 0.0012), luteotropic hormone (r = 0.2518, p = 0.0022), testosterone (r = 0.2794, p = 0.0006) in all patients. No statistical significance between LRH-1 and body mass index, follicle-stimulating hormone, homeostasis model assessment of insulin resistance, dehydroepiandrosterone sulfate, progesterone. CONCLUSIONS Compared with the control group, we found that LRH-1 was highly expressed in the ovarian GCs of PCOS patients. Our study has revealed the relationship between the LRH-1 expression and PCOS, which suggested that LRH-1 may play an important role in ovulation disorders. While this finding provided new ideas for the study of pathogenesis, it also provided a theoretical basis for the clinical diagnosis and treatment for PCOS.
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Affiliation(s)
- Xiao Yang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Qiumin Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Ying Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Tian Song
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Yanjun Zheng
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Wenqi Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China.
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A flexible microfluidic system for single-cell transcriptome profiling elucidates phased transcriptional regulators of cell cycle. Sci Rep 2021; 11:7918. [PMID: 33846365 PMCID: PMC8041752 DOI: 10.1038/s41598-021-86070-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/07/2021] [Indexed: 02/06/2023] Open
Abstract
Single cell transcriptome profiling has emerged as a breakthrough technology for the high-resolution understanding of complex cellular systems. Here we report a flexible, cost-effective and user-friendly droplet-based microfluidics system, called the Nadia Instrument, that can allow 3' mRNA capture of ~ 50,000 single cells or individual nuclei in a single run. The precise pressure-based system demonstrates highly reproducible droplet size, low doublet rates and high mRNA capture efficiencies that compare favorably in the field. Moreover, when combined with the Nadia Innovate, the system can be transformed into an adaptable setup that enables use of different buffers and barcoded bead configurations to facilitate diverse applications. Finally, by 3' mRNA profiling asynchronous human and mouse cells at different phases of the cell cycle, we demonstrate the system's ability to readily distinguish distinct cell populations and infer underlying transcriptional regulatory networks. Notably this provided supportive evidence for multiple transcription factors that had little or no known link to the cell cycle (e.g. DRAP1, ZKSCAN1 and CEBPZ). In summary, the Nadia platform represents a promising and flexible technology for future transcriptomic studies, and other related applications, at cell resolution.
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Sun W, Shi Q, Li J, Li J, Yu L. LRH1 Promotes Tumor Cell Proliferation and Migration and Is Correlated With Poor Prognosis in Ovarian Cancer. Front Oncol 2020; 10:583566. [PMID: 33194722 PMCID: PMC7641615 DOI: 10.3389/fonc.2020.583566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 01/11/2023] Open
Abstract
Background Liver receptor homolog 1 (LRH1) plays a vital role in several human cancers, but its role in ovarian cancer (OC) remains unclear. We aimed to explore the functions of LRH1 and its clinical relevance. Methods LRH1 expression was evaluated by immunohistochemistry and reverse transcription quantitative polymerase chain reaction (RT-qPCR). The effects of LRH1 on tumor cell proliferation, migration and epithelial–mesenchymal transition (EMT) were evaluated in vitro. Furthermore, bioinformatics analysis was applied to predict the functions of LRH1. Results RT-qPCR showed that LRH1 mRNA expression was higher in the invasive lesions (P < 0.05). LRH1 overexpression was extremely related with elevated International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.001), lymph node metastasis (P = 0.011), peritoneal metastasis (P = 0.001), and platinum resistance (P = 0.037). Furthermore, LRH1 expression was an independent prognostic index for disease-free survival in patients with OC (P = 0.041). LRH1 overexpression (P = 0.011), FIGO stage (P < 0.001), and ascites (P = 0.015) independently affected peritoneal metastasis in patients with OC. LRH1 knockdown significantly inhibited the proliferation, migration, and EMT of human OC cells (P < 0.05); however, it reversed cisplatin resistance. Bioinformatics analysis indicated that the functions of LRH1 were associated with the PRC1 complex, nuclear ubiquitin ligase complex, and Polycomb-group (PcG) proteins. Conclusions This study provides evidence of the predictive value of LRH1 on peritoneal metastasis and poor outcome and highlights the potential role of LRH1 as a biomarker for the targeted therapy of OC. Furthermore, LRH1 promotes OC cell proliferation, migration, and EMT in vitro, and its functions may be associated with PRC1 complex, nuclear ubiquitin ligase complex, and PcG proteins.
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Affiliation(s)
- Wenzhou Sun
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Qingtao Shi
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Jiaxin Li
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Jinmeng Li
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
| | - Libo Yu
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China
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Shen G, Shen H, Zhang J, Yan Q, Liu H. DNA methylation in Hepatoblastoma-a literature review. Ital J Pediatr 2020; 46:113. [PMID: 32758256 PMCID: PMC7409486 DOI: 10.1186/s13052-020-00877-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor in children. Abnormal activation of the Wnt/β-catenin signaling pathway plays an important role in the formation and development of HB. Genes in HB show a global hypomethylation change, accompanied by hypermethylation of specific tumor suppressor genes (TSGs). This article reviews the hypermethylation changes in several TSGs, such as RASSF1A, SOCS1, APC, HHIP, and P16, and analyzes the pathways and mechanisms of TSGs regulating gene expression. The role of the methylation-regulating enzymes DNA methyltransferases (DNMTs) and ten-eleven translocation (TET) family members enzymes in the methylation changes of HB was analyzed, and it was speculated that the occurrence of HB is partly due to the obstruction of liver differentiation in the early stage of differentiation. The origin cells may be incompletely differentiated hepatocytes remaining in the liver of children after birth. Therefore, further studying the role of methylation regulating enzymes in methylation changes in HB is a promising future research direction.
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Affiliation(s)
- Gang Shen
- Pediatric Surgery Department, Weifang Peoples' Hospital, Weifang, China
| | - Hongyu Shen
- Ultrasound Department, Weifang Haifushan Hospital, Weifang, China
| | - Jing Zhang
- Pediatric Surgery Department, Weifang Peoples' Hospital, Weifang, China
| | - Qingtao Yan
- Pediatric Surgery Department, Weifang Peoples' Hospital, Weifang, China
| | - Huixian Liu
- Dermatology Department, Weifang Peoples' Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang, 261041, China.
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Volasertib preclinical activity in high-risk hepatoblastoma. Oncotarget 2019; 10:6403-6417. [PMID: 31741706 PMCID: PMC6849653 DOI: 10.18632/oncotarget.27237] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Relapsed and metastatic hepatoblastoma represents an unmet clinical need with limited chemotherapy treatment options. In a chemical screen, we identified volasertib as an agent with in vitro activity, inhibiting hepatoblastoma cell growth while sparing normal hepatocytes. Volasertib targets PLK1 and prevents the progression of mitosis, resulting in eventual cell death. PLK1 is overexpressed in hepatoblastoma biopsies relative to normal liver tissue. As a potential therapeutic strategy, we tested the combination of volasertib and the relapse-related hepatoblastoma chemotherapeutic irinotecan. We found both in vitro and in vivo efficacy of this combination, which may merit further preclinical investigation and exploration for a clinical trial concept.
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Mechanisms of Anticancer Drug Resistance in Hepatoblastoma. Cancers (Basel) 2019; 11:cancers11030407. [PMID: 30909445 PMCID: PMC6468761 DOI: 10.3390/cancers11030407] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 12/25/2022] Open
Abstract
The most frequent liver tumor in children is hepatoblastoma (HB), which derives from embryonic parenchymal liver cells or hepatoblasts. Hepatocellular carcinoma (HCC), which rarely affects young people, causes one fourth of deaths due to cancer in adults. In contrast, HB usually has better prognosis, but this is still poor in 20% of cases. Although more responsive to chemotherapy than HCC, the failure of pharmacological treatment used before and/or after surgical resection is an important limitation in the management of patients with HB. To advance in the implementation of personalized medicine it is important to select the best combination among available anti-HB drugs, such as platinum derivatives, anthracyclines, etoposide, tyrosine-kinase inhibitors, Vinca alkaloids, 5-fluorouracil, monoclonal antibodies, irinotecan and nitrogen mustards. This requires predicting the sensitivity to these drugs of each tumor at each time because, it should be kept in mind, that cancer chemoresistance is a dynamic process of Darwinian nature. For this goal it is necessary to improve our understanding of the mechanisms of chemoresistance involved in the refractoriness of HB against the pharmacological challenge and how they evolve during treatment. In this review we have summarized the current knowledge on the multifactorial and complex factors responsible for the lack of response of HB to chemotherapy.
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