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Denk CH, Kunzmann J, Maieron A, Wöhrer A, Quinot V, Oberndorfer S. Histopathological examination of characteristic brain MRI findings in acute hyperammonemic encephalopathy: A case report and review of the literature. Neuroradiol J 2023:19714009231212370. [PMID: 37915221 DOI: 10.1177/19714009231212370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Acute hyperammonemic encephalopathy is associated with distinct brain MRI findings, namely, hyperintensity in T2-weighted sequences as well as restricted diffusion in diffusion-weighted imaging with accentuation in the insular cortex and cingulate gyrus. The pathophysiology and the histopathological correlates of these characteristic MRI findings are largely unknown. CASE REPORT We present a 57-year-old male with a history of chronic alcohol abuse, liver cirrhosis and portal hypertension, and a clinical syndrome (variceal bleeding, depression of consciousness, seizures), elevated plasma ammonia levels, and characteristic brain MRI abnormalities suggestive of acute hyperammonemic encephalopathy. A postmortem histopathological examination revealed extensive hypoxic ischemic encephalopathy without evidence for metabolic encephalopathy. No episodes of prolonged cerebral hypoxemia were documented throughout the course of the disease. We conducted a review of the literature, which exhibited no reports of hyperammonemic encephalopathy in association with characteristic brain MRI findings and a consecutive histopathological examination. CONCLUSION This is the first report of a patient with acute hyperammonemic encephalopathy together with characteristic brain MRI findings and a histopathological correlation. Although characteristic MRI findings of acute hyperammonemic encephalopathy were present, a histopathological examination revealed only hypoxic pathology without signs of metabolic encephalopathy.
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Affiliation(s)
- C H Denk
- Department of Neurology, University Hospital St. Pölten, Karl Landsteiner Private University of Health Sciences (KLPU), Austria
| | - J Kunzmann
- Department of Radiology, University Hospital St. Pölten, Karl Landsteiner Private University of Health Sciences (KLPU), Austria
| | - A Maieron
- Department of Gastroenterology, University Hospital St. Pölten, Karl Landsteiner Private University of Health Sciences (KLPU), Austria
| | - A Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria
| | - V Quinot
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria
| | - S Oberndorfer
- Department of Neurology, University Hospital St. Pölten, Karl Landsteiner Private University of Health Sciences (KLPU), Austria
- Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, Austria
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2
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Lang A, Jeron RL, Lontzek B, Kiesel B, Mischkulnig M, Berghoff AS, Ricken G, Wöhrer A, Rössler K, Lötsch-Gojo D, Roetzer-Pejrimovsky T, Berger W, Hainfellner JA, Höftberger R, Widhalm G, Erhart F. Mapping high-grade glioma immune infiltration to 5-ALA fluorescence levels: TCGA data computation, classical histology, and digital image analysis. J Neurooncol 2023; 164:211-220. [PMID: 37543970 PMCID: PMC10462498 DOI: 10.1007/s11060-023-04406-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Resection of high-grade gliomas has been considerably improved by 5-aminolevulinic acid (5-ALA). However, not all neurobiological properties of 5-ALA are fully understood. Specifically, potential differences in immune infiltration have not been conclusively examined, despite recent reports that immune cells might play a role. Thus, we here provide a systematic mapping of immune infiltration of different 5-ALA fluorescence levels. METHODS Tumor-associated macrophages (CD68, CD163), cytotoxic T cells (CD8), and regulatory T cells (FoxP3) were quantified via three methods. First, data from The Cancer Genome Atlas (TCGA) of 172 patients was examined for correlations between 5-ALA fluorescence-related mRNA expression signatures and immune markers. Second, as classical histology, 508 stained slides from 39 high-grade glioma patients were analysed semi-quantitatively by two independent reviewers, generating 1016 data points. Third, digital image analysis was performed with automated scanning and algorithm-based cell quantification. RESULTS TCGA mRNA data from 172 patients showed a direct, significant correlation between 5-ALA signatures and immune markers (p < 0.001). However, we were not able to confirm this finding in the here studied initial set of 39 patient histologies where we found a comparable immune infiltration in different fluorescence levels. Digital image analysis correlated excellently with standard histology. CONCLUSION With mapping the immune infiltration pattern of different 5-ALA categories, we are adding fundamental basic insights to the field of 5-ALA and glioma biology. The observation that a significant correlation in TCGA data did not fully translate to detectable differences in immune infiltration in first histology data warrants further investigation in larger cohorts.
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Affiliation(s)
- Alexandra Lang
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Raphael L Jeron
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bastian Lontzek
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mario Mischkulnig
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniela Lötsch-Gojo
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer-Pejrimovsky
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Walter Berger
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Friedrich Erhart
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Central Nervous System Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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3
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Baumann B, Wöhrer A. Polarization-insensitive optical coherence tomography based on partly depolarized light. Opt Lett 2023; 48:3499-3502. [PMID: 37390165 DOI: 10.1364/ol.488143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/23/2023] [Indexed: 07/02/2023]
Abstract
Polarization-related image artifacts are frequently observed in optical coherence tomography (OCT) data. As most modern OCT layouts rely on polarized light sources, only the co-polarized component of the light scattered from within a sample can be detected after interference with the reference beam. Cross-polarized sample light does not interfere with the reference beam and thus produces artifacts ranging from a reduction to the full absence of OCT signals. Here we present a simple yet effective technique to prevent polarization artifacts. By partly depolarizing the light source at the interferometer entrance, we achieve OCT signals regardless of the sample polarization state. We demonstrate the performance of our approach in a defined retarder as well as in birefringent dura mater tissue. This simple and cost-effective technique can be applied to obviate cross-polarization artifacts in virtually any OCT layout.
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Wadiura LI, Kiesel B, Roetzer-Pejrimovsky T, Mischkulnig M, Vogel CC, Hainfellner JA, Matula C, Freudiger CW, Orringer DA, Wöhrer A, Roessler K, Widhalm G. Toward digital histopathological assessment in surgery for central nervous system tumors using stimulated Raman histology. Neurosurg Focus 2022; 53:E12. [PMID: 36455278 DOI: 10.3171/2022.9.focus22429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Intraoperative neuropathological assessment with conventional frozen sections supports the neurosurgeon in optimizing the surgical strategy. However, preparation and review of frozen sections can take as long as 45 minutes. Stimulated Raman histology (SRH) was introduced as a novel technique to provide rapid high-resolution digital images of unprocessed tissue samples directly in the operating room that are comparable to conventional histopathological images. Additionally, SRH images are simultaneously and easily accessible for neuropathological judgment. Recently, the first study showed promising results regarding the accuracy and feasibility of SRH compared with conventional histopathology. Thus, the aim of this study was to compare SRH with conventional H&E images and frozen sections in a large cohort of patients with different suspected central nervous system (CNS) tumors. METHODS The authors included patients who underwent resection or stereotactic biopsy of suspected CNS neoplasm, including brain and spinal tumors. Intraoperatively, tissue samples were safely collected and SRH analysis was performed directly in the operating room. To enable optimal comparison of SRH with H&E images and frozen sections, the authors created a digital databank that included images obtained with all 3 imaging modalities. Subsequently, 2 neuropathologists investigated the diagnostic accuracy, tumor cellularity, and presence of diagnostic histopathological characteristics (score 0 [not present] through 3 [excellent]) determined with SRH images and compared these data to those of H&E images and frozen sections, if available. RESULTS In total, 94 patients with various suspected CNS tumors were included, and the application of SRH directly in the operating room was feasible in all cases. The diagnostic accuracy based on SRH images was 99% when compared with the final histopathological diagnosis based on H&E images. Additionally, the same histopathological diagnosis was established in all SRH images (100%) when compared with that of the corresponding frozen sections. Moreover, the authors found a statistically significant correlation in tumor cellularity between SRH images and corresponding H&E images (p < 0.0005 and R = 0.867, Pearson correlation coefficient). Finally, excellent (score 3) or good (2) accordance between diagnostic histopathological characteristics and H&E images was present in 95% of cases. CONCLUSIONS The results of this retrospective analysis demonstrate the near-perfect diagnostic accuracy and capability of visualizing relevant histopathological characteristics with SRH compared with conventional H&E staining and frozen sections. Therefore, digital SRH histopathology seems especially useful for rapid intraoperative investigation to confirm the presence of diagnostic tumor tissue and the precise tumor entity, as well as to rapidly analyze multiple tissue biopsies from the suspected tumor margin. A real-time analysis comparing SRH images and conventional histological images at the time of surgery should be performed as the next step in future studies.
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Affiliation(s)
- Lisa I Wadiura
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Barbara Kiesel
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Thomas Roetzer-Pejrimovsky
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | | | - Clemens C Vogel
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Johannes A Hainfellner
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Christian Matula
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | | | - Daniel A Orringer
- 4Department of Neurosurgery, New York University, New York, New York
| | - Adelheid Wöhrer
- 2Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Karl Roessler
- 1Department of Neurosurgery, Medical University of Vienna, Austria
| | - Georg Widhalm
- 1Department of Neurosurgery, Medical University of Vienna, Austria
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5
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Mair MJ, Leibetseder A, Heller G, Puhr R, Tomasich E, Goldberger S, Hatziioannou T, Wöhrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Furtner J, Pichler J, Preusser M, Berghoff AS. Early Postoperative Treatment versus Initial Observation in CNS WHO Grade 2 and 3 Oligodendroglioma: Clinical Outcomes and DNA Methylation Patterns. Clin Cancer Res 2022; 28:4565-4573. [PMID: 35998208 DOI: 10.1158/1078-0432.ccr-22-1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The treatment of oligodendroglioma consists of tumor resection and radiochemotherapy. The timing of radiochemotherapy remains unclear, and predictive biomarkers are limited. EXPERIMENTAL DESIGN Adult patients diagnosed with isocitrate dehydrogenase (IDH)-mutated, 1p/19q-codeleted CNS WHO grade 2 and 3 oligodendroglioma at the Medical University of Vienna and the Kepler University Hospital Linz (Austria) in 1992 to 2019 were included. Progression-free (PFS) and overall survival (OS) between early postoperative treatment and initial observation were compared using propensity score-weighted Cox regression models. DNA methylation analysis of tumor tissue was performed using Illumina MethylationEPIC 850k microarrays. RESULTS One hundred thirty-one out of 201 (65.2%) patients with CNS WHO grade 2 and 70 of 201 (34.8%) with grade 3 oligodendroglioma were identified. Eighty-three of 201 (41.3%) patients underwent early postoperative treatment, of whom 56 of 83 (67.5%) received radiochemotherapy, 15 of 84 (18.1%) radiotherapy (RT) only and 12 of 83 (14.5%) chemotherapy only. Temozolomide-based treatment was administered to 64 of 68 (94.1%) patients, whereas RT + procarbazine, lomustine (CCNU), and vincristine (PCV) were applied in 2 of 69 (3.5%) patients. Early treatment was not associated with PFS [adjusted hazard ratio (HR) 0.74; 95% CI, 0.33-1.65, P = 0.459] or OS (adjusted HR: 2.07; 95% CI, 0.52-8.21, P = 0.302) improvement. Unsupervised clustering analysis of DNA methylation profiles from patients receiving early treatment revealed two methylation clusters correlating with PFS, whereas no association of clustering with O6-methylguanine methyltransferase (MGMT) promoter methylation, CNS WHO grade, extent of resection, and treating center could be observed. CONCLUSIONS In this retrospective study, early postoperative treatment was not associated with improved PFS/OS in oligodendroglioma. The potentially predictive value of whole-genome methylation profiling should be validated in prospective trials.
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Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Annette Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Gerwin Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rainer Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sebastian Goldberger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Martin Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Julia Furtner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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6
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Lang A, Jeron RL, Kiesel B, Mischkulnig M, Bergmeister-Berghoff AS, Ricken G, Wöhrer A, Rössler K, Lötsch-Gojo D, Rötzer-Pejrimovsky T, Hainfellner JA, Höftberger R, Widhalm G, Erhart F. P13.04.B Dissecting high-grade glioma immune infiltration in samples from fluorescence-guided surgery: digital pathology with automated image analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is a widely used technique to conduct maximum safe resection of high-grade gliomas (HGG). 5-ALA accumulates in malignant tumor tissue where it is metabolized to Protoporphyrin IX (PpIX), an agent with fluorescence properties. It helps neurosurgeons to distinguish between tumor-infiltrated tissue and healthy brain parenchyma. Even though fluorescence-guided surgery is clinically well established, the biological properties of different fluorescence levels are not comprehensively studied yet. A relevant current gap in that respect is the pattern of immune cell infiltration in fluorescent versus non-fluorescent tissue samples. In light of future research, reliable, standardized histopathology methods that allow high-throughput analysis are desirable and digital pathology with automated image analysis is an attractive option to explore.
Material and Methods
128 formalin-fixed paraffin-embedded (FFPE) tissue blocks of 39 patients who underwent fluorescence-guided surgery of a HGG were included. Samples were selected based on their documented 5-ALA fluorescence intensity status (strong, vague, negative). Microtome-cut sections of the tissue were stained with antibodies against CD8, CD68, CD163 and FOX P3, representing immune cell populations of specific interest (cytotoxic T cells, glioma-associated macrophages, regulatory T cells). A total of 512 stained slides were then available for assessment. In addition to a classical, semi-quantitative analysis by two independent human reviewers, the immune infiltration intensity was measured via automated image analysis with the digital pathology software QuPath Version 0.3.2.
Results
Across all stained FFPE samples CD68 showed the overall highest intensity, followed by CD163. CD8 and FoxP3 showed generally lower average intensities. In 5-ALA negative and positive high-grade glioma samples the immune cell infiltration pattern was the same. Quantitative automatic digital pathology correlated well with the classical human histopathological analysis for the majority of markers evaluated.
Conclusion
We successfully explored and established novel digital pathology technologies for the study of immune cell infiltration patterns in neurooncology, specifically in the context of fluorescence-guided resection. Leveraging this platform could allow parallelized and high-throughput analysis of immune cell infiltration also in other contexts.
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Affiliation(s)
- A Lang
- Medical University Vienna , Vienna , Austria
| | - R L Jeron
- Medical University Vienna , Vienna , Austria
| | - B Kiesel
- Medical University Vienna , Vienna , Austria
| | | | | | - G Ricken
- Medical University Vienna , Vienna , Austria
| | - A Wöhrer
- Medical University Vienna , Vienna , Austria
| | - K Rössler
- Medical University Vienna , Vienna , Austria
| | | | | | | | | | - G Widhalm
- Medical University Vienna , Vienna , Austria
| | - F Erhart
- Medical University Vienna , Vienna , Austria
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Mair M, Leitner J, Zvonek M, Windhager H, Häller K, Kührer G, Paiato C, Kiesel B, Wöhrer A, Widhalm G, Nenning KH, Langs G, Preusser M, Furtner J, Berghoff A. 286MO Radiomics-based prediction of lymphocyte infiltration in IDH-wildtype glioblastoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Klotz S, Ricken G, Preusser M, Dieckmann K, Widhalm G, Rössler K, Fischer P, Kalev O, Wöhrer A, Kovacs GG, Gelpi E. Enhanced expression of autophagy-related p62 without increased deposits of neurodegeneration-associated proteins in glioblastoma and surrounding tissue - An autopsy-based study. Brain Pathol 2022; 32:e13058. [PMID: 35229396 PMCID: PMC9425004 DOI: 10.1111/bpa.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/17/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022] Open
Abstract
Neurodegenerative diseases are a major health burden. The underlying causes are not yet fully understood, but different mechanisms such as cell stress and chronic inflammation have been described as contributing factors. Neurodegenerative changes have been observed in the vicinity of brain tumors, typically around slowly growing benign lesions. Moreover, in‐vitro data suggest a potential induction of pathological tau deposits also in glioblastoma, a highly malignant and proliferative brain cancer. The aim of this study was to evaluate neurodegeneration‐associated protein deposition and autophagy as well as microglial activation within and surrounding glioblastoma. Post‐mortem brain tissue of 22 patients with glioblastoma was evaluated immunohistochemically for phosphorylated tau, beta‐amyloid, alpha‐synuclein and phosphorylated TDP‐43. Additionally, the autophagy marker p62 and the microglial marker HLA‐DR were investigated. The data was compared to 22 control cases and ten cases with other space occupying brain lesions. An increase of p62‐immunoreactivity was observed within and adjacent to the glioblastoma tumor tissue. Moreover, dense microglial infiltration in the tumor tissue and the immediate surrounding brain tissue was a constant feature. Deposition of neurodegeneration‐associated proteins was found in the majority of cases (86.4%) but in distant sites. These findings suggested a preexisting neurodegenerative pathology, which followed a typical distributional pattern: ten cases with Alzheimer disease neuropathological changes, including two severe cases, eight cases with primary age‐related tauopathy, six cases with aging‐related tau astrogliopathy and one case with progressive supranuclear palsy. Collectively, our data suggests enhanced autophagy in glioblastoma tumor cells and the surrounding brain. The variety and distribution of distant neurodegeneration‐associated protein aggregates observed in the majority of cases, suggest a preexisting rather than a tumor‐induced neurodegenerative condition.
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Affiliation(s)
- Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Peter Fischer
- Medical Research Society Vienna D.C., Head of Department of Psychiatry, Danube Hospital, Vienna, Austria
| | - Ognian Kalev
- Department of Neuropathology, Kepler University Hospital, Linz, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Medical University of Vienna, Vienna, Austria
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9
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Wadiura LI, Reichert D, Sperl V, Lang A, Kiesel B, Erkkilae M, Wöhrer A, Furtner J, Roetzer T, Leitgeb R, Mischkulnig M, Widhalm G. Influence of dexamethasone on visible 5-ALA fluorescence and quantitative protoporphyrin IX accumulation measured by fluorescence lifetime imaging in glioblastomas: is pretreatment obligatory before fluorescence-guided surgery? J Neurosurg 2021:1-9. [PMID: 34678775 DOI: 10.3171/2021.6.jns21940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is nowadays widely applied for improved resection of glioblastomas (GBMs). Initially, pretreatment with dexamethasone was considered to be essential for optimal fluorescence effect. However, recent studies reported comparably high rates of visible fluorescence in GBMs despite absence of dexamethasone pretreatment. Recently, the authors proposed fluorescence lifetime imaging (FLIM) for the quantitative analysis of 5-ALA-induced protoporphyrin IX (PpIX) accumulation. The aim of this study was thus to investigate the influence of dexamethasone on visible fluorescence and quantitative PpIX accumulation. METHODS The authors prospectively analyzed the presence of visible fluorescence during surgery in a cohort of patients with GBMs. In this study, patients received dexamethasone preoperatively only if clinically indicated. One representative tumor sample was collected from each GBM, and PpIX accumulation was analyzed ex vivo by FLIM. The visible fluorescence status and mean FLIM values were correlated with preoperative intake of dexamethasone. RESULTS In total, two subgroups with (n = 27) and without (n = 20) pretreatment with dexamethasone were analyzed. All patients showed visible fluorescence independent from preoperative dexamethasone intake. Furthermore, the authors did not find a statistically significant difference in the mean FLIM values between patients with and without dexamethasone pretreatment (p = 0.097). CONCLUSIONS In this first study to date, the authors found no significant influence of dexamethasone pretreatment on either visible 5-ALA fluorescence during GBM surgery or PpIX accumulation based on FLIM. According to these preliminary data, the authors recommend administering dexamethasone prior to fluorescence-guided surgery of GBMs only when clinically indicated.
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Affiliation(s)
- Lisa I Wadiura
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - David Reichert
- 2Center for Medical Physics and Biomedical Engineering.,3Christian Doppler Laboratory OPTRAMED
| | - Veronika Sperl
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Alexandra Lang
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Barbara Kiesel
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | | | - Adelheid Wöhrer
- 4Department of Neurology-Division for Neuropathology and Neurochemistry.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Julia Furtner
- 5Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology; and.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Thomas Roetzer
- 4Department of Neurology-Division for Neuropathology and Neurochemistry.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Rainer Leitgeb
- 2Center for Medical Physics and Biomedical Engineering.,3Christian Doppler Laboratory OPTRAMED
| | - Mario Mischkulnig
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
| | - Georg Widhalm
- 1Department of Neurosurgery.,6Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, Austria
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Mair MJ, Leibetseder A, Wöhrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Pichler J, Preusser M, Berghoff AS. P14.14 Adjuvant treatment versus initial observation in newly diagnosed WHO grade II and grade III oligodendroglioma: real-life data from two academic, tertiary care centers in Austria. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Oligodendrogliomas are rare, slow-growing brain tumors with a survival prognosis of >10 years. Although adjuvant radio-chemotherapy has been shown to prolong survival, aggressive treatment comes at the cost of increased toxicity. Systematic data on the optimal timing of adjuvant treatment in oligodendroglioma are lacking.
MATERIAL AND METHODS
Patients treated for a newly diagnosed IDH-mutated, 1p/19q-codeleted oligodendroglioma (WHO grades II/III) in 2000 - 2018 at the Medical University of Vienna or the Kepler University Hospital Linz (Austria) were included in this retrospective study. Adjuvant treatment was defined as radiotherapy (RT), chemotherapy (CHT) or radio-chemotherapy (R-CHT) within 6 months after resection in the absence of progression. “Wait and see” was defined as regular follow up with magnetic resonance imaging and treatment at progression.
RESULTS
185 patients were identified, comprising 123/185 (66.5%) WHO grade II and 62/185 (33.5%) WHO grade III oligodendrogliomas. Median age at diagnosis was 42 years (range: 20–82). Gross total resection (GTR) could be achieved in 77/178 (42.3%) evaluable patients. Adjuvant treatment was applied in 63/185 (38.2%) patients, of whom 43/63 (68.3%) underwent R-CHT, 9/63 (14.3%) CHT only and 11/63 (17.5%) RT only. 43/52 (82.7%) received temozolomide-based treatment, 1/52 (1.9%) procarbazine, lomustine and vincristine (PCV), 1/52 dacarbazine/fotemustine and in 7/52 (13.5%) patients, no data on used regimens was available. Adjuvant treatment was more frequently applied in WHO grade 3 tumors (p<0.001), while there was no association of adjuvant treatment with extent of resection (p=0.24). Patients after GTR who underwent adjuvant therapy presented with longer progression-free survival (PFS) compared to patients initially managed with observation (median: 150 months, 95%CI: 100 - not reached (n.r.) vs. median: 101 months, 95%CI: 73.2–115; p=0.053). In non-GTR tumors, patients with adjuvant therapy presented with a significantly longer median PFS of 107.5 months (95%CI: 62.8-n.r.) as compared to patients initially managed with observation (45.3 months, 95%CI: 41.2–78.8; p=0.025).
CONCLUSION
The application of adjuvant therapy was associated with favorable PFS in patients who underwent resection of newly diagnosed oligodendroglioma in this retrospective study. Prospective clinical trials should investigate the risks and benefits of adjuvant treatment versus initial observation in patients with oligodendroglioma.
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Affiliation(s)
- M J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - A Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - M Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - S Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - T von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - J Pichler
- Department of Internal Medicine and Neurooncology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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11
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Mair M, Tomasich E, Heller G, Müller L, Wöhrer A, Kiesel B, Widhalm G, Dieckmann K, Hainfellner J, Preusser M, Berghoff A. 343MO Clinical features and DNA methylation patterns in long- and short-term survivors of WHO grade II-III glioma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Mair MJ, Ilhan-Mutlu A, Pajenda S, Kiesel B, Wöhrer A, Widhalm G, Dieckmann K, Marosi C, Wagner L, Preusser M, Berghoff AS. Circulating PD-L1 levels change during bevacizumab-based treatment in recurrent glioma. Cancer Immunol Immunother 2021; 70:3643-3650. [PMID: 33956203 PMCID: PMC8571215 DOI: 10.1007/s00262-021-02951-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2021] [Indexed: 01/09/2023]
Abstract
Purpose In primary brain tumors, the efficacy of immune-modulating therapies is still under investigation as inflammatory responses are restricted by tight immunoregulatory mechanisms in the central nervous system. Here, we measured soluble PD-L1 (sPD-L1) in the plasma of patients with recurrent glioblastoma (GBM) and recurrent WHO grade II–III glioma treated with bevacizumab-based salvage therapy. Methods Thirty patients with recurrent GBM and 10 patients with recurrent WHO grade II–III glioma were treated with bevacizumab-based salvage therapy at the Medical University of Vienna. Prior to each treatment cycle, EDTA plasma was drawn and sPD-L1 was measured applying a sandwich ELISA with a lower detection limit of 0.050 ng/ml. Leukocyte counts and C-reactive protein (CRP) levels were measured according to institutional practice. Results Median number of sPD-L1 measurements was 6 per patient (range: 2–24). At baseline, no significant difference in sPD-L1 concentrations was observed between WHO grade II–III glioma and GBM. Intra-patient variability of sPD-L1 concentrations was significantly higher in WHO grade II–III glioma than in GBM (p = 0.014) and tendentially higher in IDH-mutant than in IDH-wildtype glioma (p = 0.149) In WHO grade II–III glioma, sPD-L1 levels were significantly lower after one administration of bevacizumab than at baseline (median: 0.039 ng/ml vs. 0.4855 ng/ml, p = 0.036). In contrast, no significant change could be observed in patients with GBM. Conclusions Changes in systemic inflammation markers including sPD-L1 are observable in patients with recurrent glioma under bevacizumab-based treatment and differ between WHO grade II–III glioma and GBM. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02951-2.
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Affiliation(s)
- Maximilian J Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Ayseguel Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Sahra Pajenda
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ludwig Wagner
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria. .,Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria.
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13
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Hangel G, Cadrien C, Lazen P, Sharma S, Furtner J, Lipka A, Heckova E, Hingerl L, Motyka S, Gruber S, Strasser B, Kiesel B, Mischkulnig M, Preusser M, Roetzer T, Wöhrer A, Widhalm G, Rössler K, Trattnig S, Bogner W. BIMG-04. MAPPING HETEROGENEITY OF HIGH-GRADE GLIOMA METABOLISM USING HIGH RESOLUTION 7T MRSI. Neurooncol Adv 2021. [PMCID: PMC7992249 DOI: 10.1093/noajnl/vdab024.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Neurosurgical resection in gliomas depends on the precise preoperative definition of the tumor and its margins to realize a safe maximum resection that translates into a better patient outcome. New metabolic imaging techniques could improve this delineation as well as designate targets for biopsies. We validated the performance of our fast high-resolution whole-brain 3D-magnetic resonance spectroscopic imaging (MRSI) method at 7T in high-grade gliomas (HGGs) as first step to this regard. METHODS We measured 23 patients with HGGs at 7T with MRSI covering the whole cerebrum with 3.4mm isotropic resolution in 15 min. Quantification used a basis-set of 17 neurochemical components. They were evaluated for their reliability/quality and compared to neuroradiologically segmented tumor regions-of-interest (necrosis, contrast-enhanced, non-contrast-enhanced+edema, peritumoral) and histopathology (e.g., grade, IDH-status). RESULTS We found 18/23 measurements to be usable and ten neurochemicals quantified with acceptable quality. The most common denominators were increases of glutamine, glycine, and total choline as well as decreases of N-acetyl-aspartate and total creatine over most tumor regions. Other metabolites like taurine and serine showed mixed behavior. We further found that heterogeneity in the metabolic images often continued into the peritumoral region. While 2-hydroxy-glutarate could not be satisfyingly quantified, we found a tendency for a decrease of glutamate in IDH1-mutant HGGs. DISCUSSION Our findings corresponded well to clinical tumor segmentation but were more heterogeneous and often extended into the peritumoral region. Our results corresponded to previous knowledge, but with previously not feasible resolution. Apart from glycine/glutamine and their role in glioma progression, more research on the connection of glutamate and others to specific mutations is necessary. The addition of low-grade gliomas and statistical ROI analysis in a larger cohort will be the next important steps to define the benefits of our 7T MRSI approach for the definition of spatial metabolic tumor profiles.
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Affiliation(s)
| | | | | | | | | | | | - Eva Heckova
- Medical University of Vienna, Vienna, Austria
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14
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Mair MJ, Kiesel B, Feldmann K, Widhalm G, Dieckmann K, Wöhrer A, Müllauer L, Preusser M, Berghoff AS. LAG-3 expression in the inflammatory microenvironment of glioma. J Neurooncol 2021; 152:533-539. [PMID: 33651248 PMCID: PMC8084780 DOI: 10.1007/s11060-021-03721-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 01/06/2023]
Abstract
Purpose Immune modulatory therapies including immune checkpoint inhibitors have so far failed to result in clinically meaningful efficacy in glioma. We aimed to investigate lymphocyte activation gene 3 (LAG-3), an inhibitory receptor on immune cells and target of second-generation immune checkpoint inhibitors, in glioma. Methods 97 patients with diffuse glioma (68 with glioblastoma, 29 with WHO grade II-III glioma) were identified from the Neuro-Biobank of the Medical University of Vienna. LAG-3 expression in the inflammatory microenvironment was assessed by immunohistochemistry (monoclonal anti-LAG-3 antibody, clone 17B4) and correlated to CD3+ , CD8+ , CD20+ and PD-1+ tumor-infiltrating lymphocytes (TILs) and PD-L1 expression on tumor cells. Results LAG-3+ TILs could be observed in 10/97 (10.3%) IDH-wildtype samples and in none of the included IDH-mutant glioma samples (p = 0.057). Further, LAG-3+ TILs were only observed in WHO grade IV glioblastoma, while none of the investigated WHO grade II–III glioma presented with LAG-3+ TILs (p = 0.03). No association of O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation and presence of LAG-3+ TILs was observed (p = 0.726). LAG-3 expression was associated with the presence of CD3+ (p = 0.029), CD8+ (p = 0.001), PD-1+ (p < 0.001) TILs and PD-L1+ tumor cells (p = 0.021), respectively. No association of overall survival with LAG-3+ TIL infiltration was evident (median OS 9.9 vs. 14.2 months, p = 0.95). Conclusions LAG-3 is only rarely expressed on TILs in IDH-wildtype glioma and associated with active inflammatory milieu as defined by higher TIL density. Immune microenvironment diversity should be considered in the design of future immunotherapy trials in glioma. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03721-x.
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Affiliation(s)
- Maximilian J Mair
- Division of Oncology and Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Katharina Feldmann
- Division of Oncology and Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology and Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology and Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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15
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Millesi M, Kiesel B, Mazanec V, Wadiura LI, Wöhrer A, Herta J, Wolfsberger S, Novak K, Furtner J, Rössler K, Knosp E, Widhalm G. 5-ALA fluorescence for intraoperative visualization of spinal ependymal tumors and identification of unexpected residual tumor tissue: experience in 31 patients. J Neurosurg Spine 2020:1-9. [PMID: 33276339 DOI: 10.3171/2020.6.spine20506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gross-total resection (GTR) is the treatment of choice in the majority of patients suffering from spinal ependymal tumors. In such tumors, the extent of resection (EOR) is considered the key factor for tumor recurrence and thus patient prognosis. However, incomplete resection is not uncommon and leads to increased risk of tumor recurrence. One important cause of incomplete resection is insufficient intraoperative visualization of tumor tissue as well as residual tumor tissue. Therefore, the authors investigated the value of 5-aminolevulinic acid (5-ALA)-induced fluorescence in a series of spinal ependymal tumors for improved tumor visualization. METHODS Adult patients who underwent preoperative 5-ALA administration and surgery for a spinal ependymal tumor were included in this study. For each tumor, a conventional white-light microsurgical resection was performed. Additionally, the fluorescence status (strong, vague, or no fluorescence) and fluorescence homogeneity (homogenous or inhomogeneous) of the spinal ependymal tumors were evaluated during surgery using a modified neurosurgical microscope. In intramedullary tumor cases with assumed GTR, the resection cavity was investigated for potential residual fluorescing foci under white-light microscopy. In cases with residual fluorescing foci, these areas were safely resected and the corresponding samples were histopathologically screened for the presence of tumor tissue. RESULTS In total, 31 spinal ependymal tumors, including 27 intramedullary tumors and 4 intradural extramedullary tumors, were included in this study. Visible fluorescence was observed in the majority of spinal ependymal tumors (n = 25, 81%). Of those, strong fluorescence was noted in 23 of these cases (92%), whereas vague fluorescence was present in 2 cases (8%). In contrast, no fluorescence was observed in the remaining 6 tumors (19%). Most ependymal tumors demonstrated an inhomogeneous fluorescence effect (17 of 25 cases, 68%). After assumed GTR in intramedullary tumors (n = 15), unexpected residual fluorescing foci within the resection cavity could be detected in 5 tumors (33%). These residual fluorescing foci histopathologically corresponded to residual tumor tissue in all cases. CONCLUSIONS This study indicates that 5-ALA fluorescence makes it possible to visualize the majority of spinal ependymal tumors during surgery. Unexpected residual tumor tissue could be detected with the assistance of 5-ALA fluorescence in approximately one-third of analyzed intramedullary tumors. Thus, 5-ALA fluorescence might be useful to increase the EOR, particularly in intramedullary ependymal tumors, in order to reduce the risk of tumor recurrence.
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Affiliation(s)
- Matthias Millesi
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Barbara Kiesel
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Vanessa Mazanec
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Lisa I Wadiura
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Adelheid Wöhrer
- 2Division of Neuropathology and Neurochemistry, Department of Neurology.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | | | - Stefan Wolfsberger
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | | | - Julia Furtner
- 3Department of Biomedical Imaging and Image-Guided Therapy; and.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Karl Rössler
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Engelbert Knosp
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
| | - Georg Widhalm
- 1Department of Neurosurgery.,4Comprehensive Cancer Center-Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Austria
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16
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Hangel G, Cadrien C, Lazen P, Furtner J, Lipka A, Hečková E, Hingerl L, Motyka S, Gruber S, Strasser B, Kiesel B, Mischkulnig M, Preusser M, Roetzer T, Wöhrer A, Widhalm G, Rössler K, Trattnig S, Bogner W. High-resolution metabolic imaging of high-grade gliomas using 7T-CRT-FID-MRSI. Neuroimage Clin 2020; 28:102433. [PMID: 32977210 PMCID: PMC7511769 DOI: 10.1016/j.nicl.2020.102433] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Successful neurosurgical intervention in gliomas depends on the precision of the preoperative definition of the tumor and its margins since a safe maximum resection translates into a better patient outcome. Metabolic high-resolution imaging might result in improved presurgical tumor characterization, and thus optimized glioma resection. To this end, we validated the performance of a fast high-resolution whole-brain 3D-magnetic resonance spectroscopic imaging (MRSI) method at 7T in a patient cohort of 23 high-grade gliomas (HGG). MATERIALS AND METHODS We preoperatively measured 23 patients with histologically verified HGGs (17 male, 8 female, age 53 ± 15) with an MRSI sequence based on concentric ring trajectories with a 64 × 64 × 39 measurement matrix, and a 3.4 × 3.4 × 3.4 mm3 nominal voxel volume in 15 min. Quantification used a basis-set of 17 components including N-acetyl-aspartate (NAA), total choline (tCho), total creatine (tCr), glutamate (Glu), glutamine (Gln), glycine (Gly) and 2-hydroxyglutarate (2HG). The resultant metabolic images were evaluated for their reliability as well as their quality and compared to spatially segmented tumor regions-of-interest (necrosis, contrast-enhanced, non-contrast enhanced + edema, peritumoral) based on clinical data and also compared to histopathology (e.g., grade, IDH-status). RESULTS Eighteen of the patient measurements were considered usable. In these patients, ten metabolites were quantified with acceptable quality. Gln, Gly, and tCho were increased and NAA and tCr decreased in nearly all tumor regions, with other metabolites such as serine, showing mixed trends. Overall, there was a reliable characterization of metabolic tumor areas. We also found heterogeneity in the metabolic images often continued into the peritumoral region. While 2HG could not be satisfyingly quantified, we found an increase of Glu in the contrast-enhancing region of IDH-wildtype HGGs and a decrease of Glu in IDH1-mutant HGGs. CONCLUSIONS We successfully demonstrated high-resolution 7T 3D-MRSI in HGG patients, showing metabolic differences between tumor regions and peritumoral tissue for multiple metabolites. Increases of tCho, Gln (related to tumor metabolism), Gly (related to tumor proliferation), as well as decreases in NAA, tCr, and others, corresponded very well to clinical tumor segmentation, but were more heterogeneous and often extended into the peritumoral region.
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Affiliation(s)
- Gilbert Hangel
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
| | - Cornelius Cadrien
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Lazen
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexandra Lipka
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
| | - Eva Hečková
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Hingerl
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stanislav Motyka
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Strasser
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Mario Mischkulnig
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Inner Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
| | - Wolfgang Bogner
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Millesi M, Kiesel B, Wöhrer A, Mercea PA, Bissolo M, Roetzer T, Wolfsberger S, Furtner J, Knosp E, Widhalm G. Is Intraoperative Pathology Needed if 5-Aminolevulinic-Acid-Induced Tissue Fluorescence Is Found in Stereotactic Brain Tumor Biopsy? Neurosurgery 2020; 86:366-373. [PMID: 31049574 DOI: 10.1093/neuros/nyz086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/05/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Intraoperative histopathology and acquisition of multiple tissue samples in stereotactic biopsies results in a prolonged length of surgery and potentially increased complication rate. OBJECTIVE To investigate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with the assistance of 5-aminolevulinic acid (5-ALA) induced fluorescence. METHODS Patients that received 5-ALA prior to stereotactic biopsy of a suspected brain tumor were included. According to our strategy, the procedure was terminated in the case of strong fluorescence of the biopsy samples. In contrast, intraoperative histology was demanded in the case of vague/no fluorescence. Length of surgery, number of biopsy samples, diagnostic rate, and periprocedural complications were compared between these 2 groups. RESULTS Altogether, 79 patients were included, and strong fluorescence was present in 62 cases (79%), vague fluorescence was in 4 cases (5%), and no fluorescence was in 13 cases (16%). The diagnostic rate was comparable in biopsies with strong fluorescence without intraoperative histopathology and cases with vague/no fluorescence with intraoperative histopathology (98% vs 100%; P = 1.000). A significantly shorter length of surgery (41 vs 77 min; P < .001) and reduced average number of biopsy samples (3.6 vs 4.9; P = .011) was found in patients with strong compared to vague/no fluorescence. However, no statically significant difference in periprocedural complications between cases with strong and vague/no fluorescence was found (7% vs 18%; P = .166). CONCLUSION Our data demonstrate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with assistance of 5-ALA. Thus, this biopsy strategy will increase the efficiency of this standard neurosurgical procedure in the future.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Petra A Mercea
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Marco Bissolo
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
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18
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Mair M, Häller K, Kührer G, Feldmann K, Kiesel B, Wöhrer A, Widhalm G, Furtner-Srajer J, Preusser M, Berghoff A. 362O Perifocal edema volume correlates with density of tumour-infiltrating cytotoxic T cells in newly diagnosed glioblastoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Başaran AE, Kiesel B, Frischer JM, Furtner J, Wöhrer A, Dieckmann K, Dorfer C. Intrameningioma Metastasis: A Wolf in Sheep's Clothing? Experience from a Series of 7 Cases. World Neurosurg 2019; 132:169-172. [PMID: 31491578 DOI: 10.1016/j.wneu.2019.08.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intrameningioma metastasis is a rare differential diagnosis. The clinical implications of these lesions are poorly understood. We screened our database to identify all patients who had been undergone surgery between January 2000 and December 2018 and had been diagnosed with intrameningioma metastasis. Medical charts and radiographic images were reviewed. Brain edema was related to tumor size on preoperative T2-weighted magnetic resonance imaging and classified as little (i.e., less than the tumor size), moderate (i.e., less than triple the size of the tumor), and extensive (i.e., more than triple the size of the tumor). CASE DESCRIPTIONS We identified 7 patients (3 men and 4 women) with a median age of 61 years (range, 33-63 years). A systemic cancer had been diagnosed preoperatively in all patients (lung adenocarcinoma, n = 5; breast adenocarcinoma, n = 1; pancreas adenocarcinoma, n = 1). Mean time interval between diagnosis of the systemic cancer and the intracranial dural mass was 32 months (SD 23.05). The preoperative working diagnosis was meningioma in 5 patients, and metastasis in 2 patients. All patients were symptomatic at the time of diagnosis with a short history of headache (n = 2), nausea (n = 1), and dizziness (n = 1), and 5 patients harbored neurologic deficits, including hemiparesis (n = 2), hemihypesthesia (n = 2), and paresthesia (n = 1). Preoperative images showed brain edema in all patients (extensive, n = 4; moderate, n = 3). CONCLUSIONS Intrameningioma metastases show an aggressive clinical behavior prompting early surgical intervention. Clinicians should be aware of this rare entity when counseling patients.
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Affiliation(s)
- Alim Emre Başaran
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
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20
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Kerschbaumer J, Pinggera D, Steiger R, Rietzler A, Wöhrer A, Riedmann M, Grams AE, Thomé C, Freyschlag CF. Results of Phosphorus Magnetic Resonance Spectroscopy for Brain Metastases Correlate with Histopathologic Results. World Neurosurg 2019; 127:e172-e178. [PMID: 30878742 DOI: 10.1016/j.wneu.2019.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brain metastases (BMs) are classically well-circumscribed lesions. Still, the amount of edema in these neoplasms suggests either mechanisms of infiltration or defense. A better understanding of the mechanisms within the edema of BMs seems reasonable to preoperatively identify areas of potential infiltration and resect them. BMs represent tumors with high energy demand and cell turnover; therefore, they qualify for preoperative investigation with phosphorus-31 magnetic resonance spectroscopy (31PMRS), which reveals information about those characteristics. METHODS Ten patients with BMs were included in this trial. All underwent preoperative standard magnetic resonance imaging with additional 31PMRS. In all patients, 1 voxel within the contrast-enhancing tumor (CE+), 1 voxel at the border (including CE+ areas and surrounding T2-hyperintensive [T2+] areas), and 1 distant voxel purely including T2+ areas were determined by a neuroradiologist and a neurosurgeon. A frameless stereotactic biopsy was performed after craniotomy. Subsequently, the metabolites of the 31PMRS were analyzed and compared with the histopathologic results. RESULTS Ratios, reflecting resynthesis (CE+/border/T2+: 1.109 ± 0.192/1.112 ± 0.158/1.083 ± 0.097), hydrolysis (0.303 ± 0.089/0.360 ± 0.122/0.321 ± 0.089), energy demand (4.227 ± 2.35/3.453 ± 1.284/3.599 ± 0.833), and membrane turnover (1.239 ± 0.2611/3.453 ± 1.284/3.599 ± 0.283) were calculated and compared intraindividually with a voxel from the contralateral side (resynthesis/hydrolysis/energy demand/membrane turnover: 1.063 ± 0.085/0.335 ± 0.073/3.317 ± 0.7573/0.784 ± 0.186), respectively. Resynthesis showed a trend toward higher ratios in CE+ and border biopsies without reaching statistical significances. This trend was also seen concerning energy demand. Membrane turnover was significantly higher in CE+, border zone, and also in the T2+ areas compared with controls (P > 0.001). CONCLUSIONS 31PMRS in BMs provides information on metabolic changes in tumor and surrounding edema. There is proof of enhanced metabolism in tissue without histologic tumor manifestation.
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Affiliation(s)
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Rietzler
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Marina Riedmann
- Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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21
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Erhart F, Buchroithner J, Reitermaier R, Fischhuber K, Klingenbrunner S, Sloma I, Hibsh D, Kozol R, Efroni S, Ricken G, Wöhrer A, Haberler C, Hainfellner J, Krumpl G, Felzmann T, Dohnal AM, Marosi C, Visus C. Immunological analysis of phase II glioblastoma dendritic cell vaccine (Audencel) trial: immune system characteristics influence outcome and Audencel up-regulates Th1-related immunovariables. Acta Neuropathol Commun 2018; 6:135. [PMID: 30518425 PMCID: PMC6280511 DOI: 10.1186/s40478-018-0621-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023] Open
Abstract
Audencel is a dendritic cell (DC)-based cellular cancer immunotherapy against glioblastoma multiforme (GBM). It is characterized by loading of DCs with autologous whole tumor lysate and in vitro maturation via “danger signals”. The recent phase II “GBM-Vax” trial showed no clinical efficacy for Audencel as assessed with progression-free and overall survival in all patients. Here we present immunological research accompanying the trial with a focus on immune system factors related to outcome and Audencel’s effect on the immune system. Methodologically, peripheral blood samples (from apheresis before Audencel or venipuncture during Audencel) were subjected to functional characterization via enzyme-linked immunospot (ELISPOT) assays connected with cytokine bead assays (CBAs) as well as phenotypical characterization via flow cytometry and mRNA quantification. GBM tissue samples (from surgery) were subjected to T cell receptor sequencing and immunohistochemistry. As results we found: Patients with favorable pre-existing anti-tumor characteristics lived longer under Audencel than Audencel patients without them. Pre-vaccination blood CD8+ T cell count and ELISPOT Granzyme B production capacity in vitro upon tumor antigen exposure were significantly correlated with overall survival. Despite Audencel’s general failure to induce a significant clinical response, it nevertheless seemed to have an effect on the immune system. For instance, Audencel led to a significant up-regulation of the Th1-related immunovariables ELISPOT IFNγ, the transcription factor T-bet in the blood and ELISPOT IL-2 in a dose-dependent manner upon vaccination. Post-vaccination levels of ELISPOT IFNγ and CD8+ cells in the blood were indicative of a significantly better survival. In summary, Audencel failed to reach an improvement of survival in the recent phase II clinical trial. No clinical efficacy was registered. Our concomitant immunological work presented here indicates that outcome under Audencel was influenced by the state of the immune system. On the other hand, Audencel also seemed to have stimulated the immune system. Overall, these immunological considerations suggest that DC immunotherapy against glioblastoma should be studied further – with the goal of translating an apparent immunological response into a clinical response. Future research should concentrate on investigating augmentation of immune reactions through combination therapies or on developing meaningful biomarkers.
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22
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Bieńkowski M, Wöhrer A, Moser P, Kitzwögerer M, Ricken G, Ströbel T, Hainfellner JA. Molecular diagnostic testing of diffuse gliomas in the real-life setting: A practical approach. Clin Neuropathol 2018; 37:166-177. [PMID: 29923492 PMCID: PMC6102559 DOI: 10.5414/np301110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/21/2018] [Indexed: 12/21/2022] Open
Abstract
Typing of diffuse gliomas according to the WHO 2016 Classification of Tumors of the Central Nervous System is based on the integration of histology with molecular biomarkers. However, the choice of appropriate methods for molecular analysis and criteria for interpretation of test results is left to each diagnostic laboratory. In the present study, we tested the applicability of combined immunohistochemistry, direct sequencing, and multiplex ligation-dependent probe amplification (MLPA) for diagnostic assessment of IDH1/2 mutation status, chromosome 1p/19q status, and TERT promoter mutations. To this end, we analyzed a consecutive series of 165 patients with diffuse low- and high-grade gliomas (WHO grade II and III) from three Austrian centers in which tissue specimens were routinely processed. We could reliably detect IDH1/2 mutations by combining immunohistochemistry, direct sequencing, and MLPA analysis. MLPA analysis also allowed reliable detection of combined whole chromosomal arm 1p/19q codeletion when using carefully selected criteria providing an optimal balance between sensitivity and specificity. Direct sequencing proved to be suitable for identification of TERT promoter mutations, although its analytical performance remains to be assessed. To conclude, we propose a practicable combination of methods and criteria which allow reliable molecular diagnostic testing of diffuse gliomas in the real-life setting.
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Affiliation(s)
- Michał Bieńkowski
- Institute of Neurology, Medical University of Vienna, Austria
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Poland
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Austria
| | | | - Melitta Kitzwögerer
- Department of Pathology, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Austria
| | - Thomas Ströbel
- Institute of Neurology, Medical University of Vienna, Austria
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23
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Handisurya A, Rumpold T, Caucig-Lütgendorf C, Flechl B, Preusser M, Ilhan-Mutlu A, Dieckmann K, Widhalm G, Grisold A, Wöhrer A, Hainfellner J, Ristl R, Kurz C, Marosi C, Gessl A, Hassler M. Are hypothyroidism and hypogonadism clinically relevant in patients with malignant gliomas? A longitudinal trial in patients with glioma. Radiother Oncol 2018; 130:139-148. [PMID: 30389240 DOI: 10.1016/j.radonc.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND So far, the development and course of therapy-induced deficiencies in hypothalamic-pituitary hormones in adult patients with malignant gliomas has not received much attention. However, such deficiencies may impact patient's quality of life substantially. METHODS In this monocentric longitudinal trial, we examined hormonal levels of TSH, T3, T4, fT3, fT4, FSH, LH, testosterone, estradiol and prolactin in patients with malignant high grade gliomas before the start of radiochemotherapy (RCT), at the end of RCT and then every three months for newly diagnosed patients and every six months in patients diagnosed more than two years before study inclusion. Growth hormone was not measured in this trial. RESULTS 436 patients (198 female, 238 male) with high-grade gliomas, aged 19-83 years (median 50 years), were included in this study. Low levels of thyroid hormones were observed in around 10% of patients within the first six months of follow up and increasingly after 36 months. Half of premenopausal women at study entry developed premature menopause, 35% showed hyperprolactinemia. Low testosterone levels were measured in 37% of men aged less than 50 years and in 35/63 (55%) of men aged 50 years or older. DISCUSSION The results of this study show that a significant percentage of patients with malignant gliomas develop hormonal deficiencies mandating regular clinical follow up, state of the art counseling and if clinically necessary substitution therapy.
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Affiliation(s)
- Ammon Handisurya
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; Institute of Radiooncology, Kaiser Franz-Josef Spital SMZ-Süd, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Austria
| | | | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Christine Kurz
- Department of Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
| | - Alois Gessl
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Marco Hassler
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
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24
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Marosi C, Stacherl M, Flechl B, Dieckmann K, Wöhrer A, Hainfellner J, Widhalm G, Kiesel B, Preusser M. P01.010 Patterns of care in glioma patients surviving beyond ten years. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - B Flechl
- Medaustron, Wiener Neustadt, Austria
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25
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Berghoff AS, Kiesel B, Widhalm G, Wilhelm D, Rajky O, Kurscheid S, Kresl P, Wöhrer A, Marosi C, Hegi ME, Preusser M. Correlation of immune phenotype with IDH mutation in diffuse glioma. Neuro Oncol 2018; 19:1460-1468. [PMID: 28531337 DOI: 10.1093/neuonc/nox054] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Tumor infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) are targets of immune checkpoint inhibitors. Methods Forty-three World Health Organization (WHO) grade II/III gliomas (39 IDH-mutant [mut], 4 IDH-wildtype [wt]) and 14 IDH-mut glioblastomas (GBM) were analyzed for TIL (CD3+; PD1+) infiltration and PD-L1 expression. Results were compared with the data of a previously published series of 117 IDH-wt glioblastomas. PD-L1 gene expression levels were evaluated in 677 diffuse gliomas grades II-IV from The Cancer Genome Atlas (TCGA) database. Results TIL and PD-L1 expression were observed in approximately half of WHO grade II/III gliomas. IDH-wt status was associated with significantly higher TIL infiltration and PD-L1 expression among all (grades II-IV) cases (n = 174, P < 0.001) and within the cohort of glioblastomas (n = 131, P < 0.001). In low-grade glioma (LGG) and glioblastoma cohorts of TCGA, significantly higher PD-L1 gene expression levels were evident in IDH-wt compared with IDH-mut samples (LGG: N = 516; P = 1.933e-11, GBM: N = 161; P < 0.009). Lower PD-L1 gene expression was associated with increased promoter methylation (Spearman correlation coefficient -0.36; P < 0.01) in the LGG cohort of TCGA. IDH-mut gliomas had higher PD-L1 gene promoter methylation levels than IDH-wt gliomas (P < 0.01). Conclusions The immunological tumor microenvironment of diffuse gliomas differs in association with IDH mutation status. IDH-wt gliomas display a more prominent TIL infiltration and higher PD-L1 expression than IDH-mut cases. Mechanistically this may be at least in part due to differential PD-L1 gene promoter methylation levels. Our findings may be relevant for immune modulatory treatment strategies in glioma patients.
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Affiliation(s)
- Anna Sophie Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Barbara Kiesel
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Georg Widhalm
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dorothee Wilhelm
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Orsolya Rajky
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sebastian Kurscheid
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philip Kresl
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Christine Marosi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Monika E Hegi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthias Preusser
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Genome Science, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia; Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery & Neuroscience Research Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Abstract
PURPOSE Despite the established role of O6-methyl-guanine-DNA methyltransferase (MGMT) as a marker for temozolomide response, consensus of the most reliable method to assess MGMT expression in pituitary adenomas is still missing. Currently, immunohistochemistry (IHC) assessment of formaldehyde fixed tissue samples is most widely used in a semiquantitative description. As formaldehyde fails to completely preserve nucleic acids, RCL2, an alcohol-based formaldehyde-free fixative, has been proposed as a more reliable alternative in terms of cell stability. Furthermore, as the current method of IHC is semiquantitative and observer-dependent, pyrosequencing, an objective tool to evaluate the methylation status of the MGMT promoter, has emerged as a reliable and accurate alternative. The aim of this study was to validate the current IHC method for assessment of MGMT protein expression in pituitary adenomas. METHODS The tissue samples of 8 macroadenomas with positive IHC MGMT expression (> 50%) were investigated: first, we compared the time dependent stability of MGMT protein expression after pituitary adenoma removal between formaldehyde vs. RCL2. Then, we compared positive IHC MGMT expression with methylated promoter status using pyrosequencing. RESULTS In the first 12 h after adenoma removal, tissue samples remained MGMT positive in significantly more samples when fixated with formaldehyde than with RCL2, respectively (96 vs. 81%, p = 0.025). CONCLUSION Our data confirm that the current method using formaldehyde tissue fixation and IHC reveals stable and reliable results of MGMT assessment in pituitary adenomas.
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Affiliation(s)
- Alexander S G Micko
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
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27
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Abstract
PURPOSE Knowledge of biological behavior is crucial for clinical management of functioning pituitary macroadenomas. For recurrent cases unresponsive to standard treatment, temozolomide (TMZ) has been used as a therapeutic alternative. MGMT (O6-methyl-guanine-DNA methyltransferase) and MSH6 (mutS homolog 6) immunoexpression have been linked to the response to TMZ treatment and MGMT immunoexpression has been additionally linked to early recurrence of non-functioning pituitary adenomas. The aim of this study was to assess the prognostic value of MGMT and MSH6 immunoexpression for aggressive functioning pituitary adenomas. METHODS The study cohort comprised a single center series of 76 patients who underwent an operation for functioning pituitary macroadenoma. We retrospectively compared 38 patients with postoperative persistent or recurrent disease with another set of 38 patients who were in endocrine remission. RESULTS Low-to-moderate MGMT immunoexpression (<50%) was significantly more frequent in the group with persistent/recurrent disease than in cases of endocrine remission (66 vs. 21%, p < 0.001). Furthermore, adenomas with low-to-moderate MGMT immunoexpression were significantly more often recurrent (76 vs. 30%, p < 0.001) and invasive (64 vs. 28%, p = 0.002). CONCLUSION In our series, low-to-moderate MGMT immunoexpression was the only marker that significantly correlated with surgical invasiveness and recurrence in functioning pituitary macroadenomas. Therefore, in the future, MGMT status may be considered an additional marker for understanding the biological behavior of pituitary adenomas.
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Affiliation(s)
- Alexander S G Micko
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | | | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Christine Marosi
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
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28
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Hutter HP, Wöhrer A, Damm L, Wanek G, Leiss U, Weis S, Rieger R, Freyschlag C, Furtmüller B, Wallner P, Kundi M. Mobile phone use and brain tumors in young people: Austrian experience within the MOBI-KIDS study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- HP Hutter
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
| | - A Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - L Damm
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - G Wanek
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
| | - U Leiss
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - S Weis
- Wagner-Jauregg Provincial Neuropsychiatric Clinic, Linz, Austria
| | - R Rieger
- State Hospital Gmunden, Gmunden, Austria
| | - Ch Freyschlag
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - P Wallner
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
| | - M Kundi
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Vienna, Austria
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29
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Ströbel T, Madlener S, Tuna S, Vose S, Lagerweij T, Wurdinger T, Vierlinger K, Wöhrer A, Price BD, Demple B, Saydam O, Saydam N. Ape1 guides DNA repair pathway choice that is associated with drug tolerance in glioblastoma. Sci Rep 2017; 7:9674. [PMID: 28852018 PMCID: PMC5574897 DOI: 10.1038/s41598-017-10013-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/02/2017] [Indexed: 12/19/2022] Open
Abstract
Ape1 is the major apurinic/apyrimidinic (AP) endonuclease activity in mammalian cells, and a key factor in base-excision repair of DNA. High expression or aberrant subcellular distribution of Ape1 has been detected in many cancer types, correlated with drug response, tumor prognosis, or patient survival. Here we present evidence that Ape1 facilitates BRCA1-mediated homologous recombination repair (HR), while counteracting error-prone non-homologous end joining of DNA double-strand breaks. Furthermore, Ape1, coordinated with checkpoint kinase Chk2, regulates drug response of glioblastoma cells. Suppression of Ape1/Chk2 signaling in glioblastoma cells facilitates alternative means of damage site recruitment of HR proteins as part of a genomic defense system. Through targeting "HR-addicted" temozolomide-resistant glioblastoma cells via a chemical inhibitor of Rad51, we demonstrated that targeting HR is a promising strategy for glioblastoma therapy. Our study uncovers a critical role for Ape1 in DNA repair pathway choice, and provides a mechanistic understanding of DNA repair-supported chemoresistance in glioblastoma cells.
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Affiliation(s)
- Thomas Ströbel
- Institute of Neurology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Sibylle Madlener
- Molecular Neuro-Oncology Research Unit, Department of Pediatrics & Adolescent Medicine, Medical University of Vienna, A-1090, Vienna, Austria
| | - Serkan Tuna
- Molecular Neuro-Oncology Research Unit, Department of Pediatrics & Adolescent Medicine, Medical University of Vienna, A-1090, Vienna, Austria
| | - Sarah Vose
- Vermont Department of Public Health, 108 Cherry St., Burlington, VT, 05402, USA
| | - Tonny Lagerweij
- Neuro-Oncology Research Group, Department of Neurosurgery, VU University Medical Center, Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Thomas Wurdinger
- Neuro-Oncology Research Group, Department of Neurosurgery, VU University Medical Center, Amsterdam, 1081 HV, Amsterdam, The Netherlands.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Klemens Vierlinger
- Molecular Diagnostics, AIT - Austrian Institute of Technology, A-1190, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, A-1090, Vienna, Austria
| | - Brendan D Price
- Department of Radiation Oncology, Division of Genomic Instability and DNA Repair, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Bruce Demple
- Department of Pharmacological Sciences, Stony Brook University, School of Medicine, Stony Brook, NY, 11794-8651, USA
| | - Okay Saydam
- Molecular Neuro-Oncology Research Unit, Department of Pediatrics & Adolescent Medicine, Medical University of Vienna, A-1090, Vienna, Austria.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Nurten Saydam
- Molecular Neuro-Oncology Research Unit, Department of Pediatrics & Adolescent Medicine, Medical University of Vienna, A-1090, Vienna, Austria. .,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
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30
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Eichbichler K, Dorozinski J, Furtner J, Wöhrer A, Dieckmann K, Caucig-Lütgendorf C, Prayer D, Preusser M, Hainfellner J, Marosi C. P18.06 Quality of life and neurocognitive performance of patients with glioma surviving longer than five years after surgery and radiotherapy. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Mercea P, Kiesel B, Mischkulnig M, Millesi M, Berghoff A, Wöhrer A, Wolfsberger S, Ungersböck K, Knosp E, Preusser M, Marhold F, Widhalm G. Analysis of 5-ALA induced fluorescence in brain metastases and surrounding brain tissue. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Mischkulnig M, Widhalm G, Kiesel B, Wöhrer A, Mercea P, Wolfsberger S, Knosp E, Millesi M. 5-ALA induced fluorescence in spinal ependymomas: Data from 21 patients. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Kiesel B, Mischkulnig M, Wöhrer A, Millesi M, Preusser M, Wolfsberger S, Knosp E, Widhalm G. 5-ALA induced fluorescence for intraoperative visualization of specific intratumoral histopathological compartments in newly diagnosed glioblastoma. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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34
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Millesi M, Kiesel B, Mischkulnig M, Mercea P, Bissolo M, Wöhrer A, Wolfsberger S, Knosp E, Widhalm G. Value of 5-ALA in frameless stereotactic brain biopsies. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Millesi M, Kiesel B, Mischkulnig M, Martínez-Moreno M, Wöhrer A, Wolfsberger S, Knosp E, Widhalm G. Analysis of the surgical benefits of 5-ALA-induced fluorescence in intracranial meningiomas: experience in 204 meningiomas. J Neurosurg 2016; 125:1408-1419. [PMID: 27015401 DOI: 10.3171/2015.12.jns151513] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One of the most important causes for recurrence of intracranial meningiomas is residual tumor tissue that remains despite assumed complete resection. Recently, intraoperative visualization of meningioma tissue by 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence was reported. The aim of this study was to investigate the possible surgical benefits of PpIX fluorescence for detection of meningioma tissue. METHODS 5-ALA was administered preoperatively to 190 patients undergoing resection of 204 intracranial meningiomas. The meningiomas' PpIX fluorescence status, fluorescence quality (strong or vague), and intratumoral fluorescence homogeneity were investigated during surgery. Additionally, specific sites, including the dural tail, tumor-infiltrated bone flap, adjacent cortex, and potential satellite lesions, were analyzed for PpIX fluorescence in selected cases. RESULTS PpIX fluorescence was observed in 185 (91%) of 204 meningiomas. In the subgroup of sphenoorbital meningiomas (12 of 204 cases), the dural part showed visible PpIX fluorescence in 9 cases (75%), whereas the bony part did not show any PpIX fluorescence in 10 cases (83%). Of all fluorescing meningiomas, 168 (91%) showed strong PpIX fluorescence. Typically, most meningiomas demonstrated homogeneous fluorescence (75% of cases). No PpIX fluorescence was observed in any of the investigated 89 dural tails. In contrast, satellite lesions could be identified through PpIX fluorescence in 7 cases. Furthermore, tumor-infiltrated bone flaps could be visualized by PpIX fluorescence in all 13 cases. Notably, PpIX fluorescence was also present in the adjacent cortex in 20 (25%) of 80 analyzed cases. CONCLUSIONS The authors' data from this largest patient cohort to date indicate that PpIX fluorescence enables intraoperatively visualization of most intracranial meningiomas and allows identification of residual tumor tissue at specific sites. Thus, intraoperative detection of residual meningioma tissue by PpIX fluorescence might in future reduce the risk of recurrence.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
| | - Barbara Kiesel
- Department of Neurosurgery
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
| | | | | | - Adelheid Wöhrer
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
- Institute of Neurology, Medical University of Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
| | - Engelbert Knosp
- Department of Neurosurgery
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
| | - Georg Widhalm
- Department of Neurosurgery
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, and
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36
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Berghoff AS, Kiesel B, Widhalm G, Wilhelm D, Rajky O, Kurscheid S, Hegi M, Wöhrer A, Marosi C, Preusser M. P04.09 Tumor infiltrating lymphocytes and programmed death ligand 1 (PD-L1) expression in diffuse and anaplastic gliomas. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Grabner G, Kiesel B, Wöhrer A, Millesi M, Wurzer A, Göd S, Mallouhi A, Knosp E, Marosi C, Trattnig S, Wolfsberger S, Preusser M, Widhalm G. Local image variance of 7 Tesla SWI is a new technique for preoperative characterization of diffusely infiltrating gliomas: correlation with tumour grade and IDH1 mutational status. Eur Radiol 2016; 27:1556-1567. [PMID: 27300198 PMCID: PMC5334387 DOI: 10.1007/s00330-016-4451-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization. METHODS Adult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI. RESULTS In 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p < 0.0001), IDH1-R132H negative compared to IDH1-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001). CONCLUSIONS Our data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures. KEY POINTS • 7 Tesla local image variance helps to quantify hypointense susceptibility-weighted imaging structures. • SWI-LIV is significantly increased in high-grade and IDH1-R132H negative gliomas. • SWI-LIV is a promising technique for improved preoperative glioma characterization. • Preoperative management of diffusely infiltrating gliomas will be optimized.
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Affiliation(s)
- Günther Grabner
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, St. Veiterstraße 47, 9020, Klagenfurt am Wörthersee, Austria
| | - Barbara Kiesel
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Adelheid Wöhrer
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Matthias Millesi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Aygül Wurzer
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Sabine Göd
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Ammar Mallouhi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Engelbert Knosp
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Stefan Wolfsberger
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria. .,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
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38
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Mühlebner A, van Scheppingen J, Hulshof HM, Scholl T, Iyer AM, Anink JJ, van den Ouweland AMW, Nellist MD, Jansen FE, Spliet WGM, Krsek P, Benova B, Zamecnik J, Crino PB, Prayer D, Czech T, Wöhrer A, Rahimi J, Höftberger R, Hainfellner JA, Feucht M, Aronica E. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex. PLoS One 2016; 11:e0157396. [PMID: 27295297 PMCID: PMC4905625 DOI: 10.1371/journal.pone.0157396] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022] Open
Abstract
Tuberous Sclerosis Complex (TSC) is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers) contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1) activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC.
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Affiliation(s)
- Angelika Mühlebner
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Hanna M. Hulshof
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theresa Scholl
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Anand M. Iyer
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jasper J. Anink
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Mark D. Nellist
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Floor E. Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim G. M. Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pavel Krsek
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Barbora Benova
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Peter B. Crino
- Shriners Hospital Pediatric Research Center and Department of Neurology, Temple University, Philadelphia, United States of America
| | - Daniela Prayer
- Department of Radiology, Medical University Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Jasmin Rahimi
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | | | | | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Stichting voor Epilepsie in Nederland (SEIN), Hemstede, The Netherlands
- * E-mail:
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39
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Langsteger W, Rezaee A, Loidl W, Geinitz HS, Fitz F, Steinmair M, Broinger G, Pallwien-Prettner L, Beheshti M, Imamovic L, Beheshti M, Rendl G, Hackl D, Tsybrovsky O, Steinmair M, Emmanuel K, Moinfar F, Pirich C, Langsteger W, Bytyqi A, Karanikas G, Mayerhöfer M, Koperek O, Niederle B, Hartenbach M, Beyer T, Herrmann K, Czernin J, Rausch I, Rust P, DiFranco MD, Lassen M, Stadlbauer A, Mayerhöfer ME, Hartenbach M, Hacker M, Beyer T, Binzel K, Magnussen R, Wei W, Knopp MU, Flanigan DC, Kaeding C, Knopp MV, Leisser A, Nejabat M, Hartenbach M, Kramer G, Krainer M, Hacker M, Haug A, Lehnert W, Schmidt K, Kimiaei S, Bronzel M, Kluge A, Wright CL, Binzel K, Zhang J, Wuthrick E, Maniawski P, Knopp MV, Blaickner M, Rados E, Huber A, Dulovits M, Kulkarni H, Wiessalla S, Schuchardt C, Baum RP, Knäusl B, Georg D, Bauer M, Wulkersdorfer B, Wadsak W, Philippe C, Haslacher H, Zeitlinger M, Langer O, Bauer M, Feldmann M, Karch R, Wadsak W, Zeitlinger M, Koepp MJ, Asselin MC, Pataraia E, Langer O, Zeilinger M, Philippe C, Dumanic M, Pichler F, Pilz J, Hacker M, Wadsak W, Mitterhauser M, Nics L, Steiner B, Hacker M, Mitterhauser M, Wadsak W, Traxl A, Wanek T, Kryeziu K, Mairinger S, Stanek J, Berger W, Kuntner C, Langer O, Mairinger S, Wanek T, Traxl A, Krohn M, Stanek J, Filip T, Sauberer M, Kuntner C, Pahnke J, Langer O, Svatunek D, Denk C, Wilkovitsch M, Wanek T, Filip T, Kuntner-Hannes C, Fröhlich J, Mikula H, Denk C, Svatunek D, Wanek T, Mairinger S, Stanek J, Filip T, Fröhlich J, Mikula H, Kuntner-Hannes C, Balber T, Singer J, Fazekas J, Rami-Mark C, Berroterán-Infante N, Jensen-Jarolim E, Wadsak W, Hacker M, Viernstein H, Mitterhauser M, Denk C, Svatunek D, Sohr B, Mikula H, Fröhlich J, Wanek T, Kuntner-Hannes C, Filip T, Pfaff S, Philippe C, Mitterhauser M, Hartenbach M, Hacker M, Wadsak W, Wanek T, Halilbasic E, Visentin M, Mairinger S, Stieger B, Kuntner C, Trauner M, Langer O, Lam P, Aistleitner M, Eichinger R, Artner C, Eidherr H, Vraka C, Haug A, Mitterhauser M, Nics L, Hartenbach M, Hacker M, Wadsak W, Kvaternik H, Müller R, Hausberger D, Zink C, Aigner RM, Cossío U, Asensio M, Montes A, Akhtar S, Te Welscher Y, van Nostrum R, Gómez-Vallejo V, Llop J, VandeVyver F, Barclay T, Lippens N, Troch M, Hehenwarter L, Egger B, Holzmannhofer J, Rodrigues-Radischat M, Pirich C, Pötsch N, Rausch I, Wilhelm D, Weber M, Furtner J, Karanikas G, Wöhrer A, Mitterhauser M, Hacker M, Traub-Weidinger T, Cassou-Mounat T, Balogova S, Nataf V, Calzada M, Huchet V, Kerrou K, Devaux JY, Mohty M, Garderet L, Talbot JN, Stanzel S, Pregartner G, Schwarz T, Bjelic-Radisic V, Liegl-Atzwanger B, Aigner R, Stanzel S, Quehenberger F, Aigner RM, Marković AK, Janković M, Jerković VM, Paskaš M, Pupić G, Džodić R, Popović D, Fornito MC, Familiari D, Koranda P, Polzerová H, Metelková I, Henzlová L, Formánek R, Buriánková E, Kamínek M, Thomson WH, Lewis C, Thomson WH, O'Brien J, James G, Notghi A, Huber H, Stelzmüller I, Wunn R, Mandl M, Fellner F, Lamprecht B, Gabriel M, Fornito MC, Leonardi G, Thomson WH, O'Brien J, James G, Hudzietzová J, Sabol J, Fülöp M. 32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016. EJNMMI Res 2016; 6:32. [PMID: 27090254 PMCID: PMC4835428 DOI: 10.1186/s13550-016-0168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/22/2022] Open
Abstract
A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT W Langsteger, A Rezaee, W Loidl, HS Geinitz, F Fitz, M Steinmair, G Broinger, L Pallwien-Prettner, M Beheshti A2 F18 Choline PET – CT: an accurate diagnostic tool for the detection of parathyroid adenoma? L Imamovic, M Beheshti, G Rendl, D Hackl, O Tsybrovsky, M Steinmair, K Emmanuel, F Moinfar, C Pirich, W Langsteger A3 [18F]Fluoro-DOPA-PET/CT in the primary diagnosis of medullary thyroid carcinoma A Bytyqi, G Karanikas, M Mayerhöfer, O Koperek, B Niederle, M Hartenbach A4 Variations of clinical PET/MR operations: An international survey on the clinical utilization of PET/MRI T Beyer, K Herrmann, J Czernin A5 Standard Dixon-based attenuation correction in combined PET/MRI: Reproducibility and the possibility of Lean body mass estimation I Rausch, P Rust, MD DiFranco, M Lassen, A Stadlbauer, ME Mayerhöfer, M Hartenbach, M Hacker, T Beyer A6 High resolution digital FDG PET/MRI imaging for assessment of ACL graft viability K Binzel, R Magnussen, W Wei, MU Knopp, DC Flanigan, C Kaeding, MV Knopp A7 Using pre-existing hematotoxicity as predictor for severe side effects and number of treatment cycles of Xofigo therapy A Leisser, M Nejabat, M Hartenbach, G Kramer, M Krainer, M Hacker, A Haug A8 QDOSE – comprehensive software solution for internal dose assessment Wencke Lehnert, Karl Schmidt, Sharok Kimiaei, Marcus Bronzel, Andreas Kluge A9 Clinical impact of Time-of-Flight on next-generation digital PET imaging of Yttrium-90 radioactivity following liver radioembolization CL Wright, K Binzel, J Zhang, Evan Wuthrick, Piotr Maniawski, MV Knopp A10 Snakes in patients! Lessons learned from programming active contours for automated organ segmentation M Blaickner, E Rados, A Huber, M Dulovits, H Kulkarni, S Wiessalla, C Schuchardt, RP Baum, B Knäusl, D Georg A11 Influence of a genetic polymorphism on brain uptake of the dual ABCB1/ABCG2 substrate [11C]tariquidar M Bauer, B Wulkersdorfer, W Wadsak, C Philippe, H Haslacher, M Zeitlinger, O Langer A12 Outcome prediction of temporal lobe epilepsy surgery from P-glycoprotein activity. Pooled analysis of (R)-[11C]-verapamil PET data from two European centres M Bauer, M Feldmann, R Karch, W Wadsak, M Zeitlinger, MJ Koepp, M-C Asselin, E Pataraia, O Langer A13 In-vitro and in-vivo characterization of [18F]FE@SNAP and derivatives for the visualization of the melanin concentrating hormone receptor 1 M Zeilinger, C Philippe, M Dumanic, F Pichler, J Pilz, M Hacker, W Wadsak, M Mitterhauser A14 Reducing time in quality control leads to higher specific radioactivity of short-lived radiotracers L Nics, B Steiner, M Hacker, M Mitterhauser, W Wadsak A15 In vitro 11C-erlotinib binding experiments in cancer cell lines with epidermal growth factor receptor mutations A Traxl, Thomas Wanek, Kushtrim Kryeziu, Severin Mairinger, Johann Stanek, Walter Berger, Claudia Kuntner, Oliver Langer A16 7-[11C]methyl-6-bromopurine, a PET tracer to measure brain Mrp1 function: radiosynthesis and first PET evaluation in mice S Mairinger, T Wanek, A Traxl, M Krohn, J Stanek, T Filip, M Sauberer, C Kuntner, J Pahnke, O Langer A17 18F labeled azidoglucose derivatives as “click” agents for pretargeted PET imaging D Svatunek, C Denk, M Wilkovitsch, T Wanek, T Filip, C Kuntner-Hannes, J Fröhlich, H Mikula A18 Bioorthogonal tools for PET imaging: development of radiolabeled 1,2,4,5-Tetrazines C Denk, D Svatunek, T Wanek, S Mairinger, J Stanek, T Filip, J Fröhlich, H Mikula, C Kuntner-Hannes A19 Preclinical evaluation of [18F]FE@SUPPY- a new PET-tracer for oncology T Balber, J Singer, J Fazekas, C Rami-Mark, N Berroterán-Infante, E Jensen-Jarolim, W Wadsak, M Hacker, H Viernstein, M Mitterhauser A20 Investigation of Small [18F]-Fluoroalkylazides for Rapid Radiolabeling and In Vivo Click Chemistry C Denk, D Svatunek, B Sohr, H Mikula, J Fröhlich, T Wanek, C Kuntner-Hannes, T Filip A21 Microfluidic 68Ga-radiolabeling of PSMA-HBED-CC using a flow-through reactor S Pfaff, C Philippe, M Mitterhauser, M Hartenbach, M Hacker, W Wadsak A22 Influence of 24-nor-ursodeoxycholic acid on hepatic disposition of [18F]ciprofloxacin measured with positron emission tomography T Wanek, E Halilbasic, M Visentin, S Mairinger, B Stieger, C Kuntner, M Trauner, O Langer A23 Automated 18F-flumazenil production using chemically resistant disposable cassettes P Lam, M Aistleitner, R Eichinger, C Artner A24 Similarities and differences in the synthesis and quality control of 177Lu-DOTA-TATE, 177Lu -HA-DOTA-TATE and 177Lu-DOTA-PSMA (PSMA-617) H Eidherr, C Vraka, A Haug, M Mitterhauser, L Nics, M Hartenbach, M Hacker, W Wadsak A25 68Ga- and 177Lu-labelling of PSMA-617 H Kvaternik, R Müller, D Hausberger, C Zink, RM Aigner A26 Radiolabelling of liposomes with 67Ga and biodistribution studies after administration by an aerosol inhalation system U Cossío, M Asensio, A Montes, S Akhtar, Y te Welscher, R van Nostrum, V Gómez-Vallejo, J Llop A27 Fully automated quantification of DaTscan SPECT: Integration of age and gender differences F VandeVyver, T Barclay, N Lippens, M Troch A28 Lesion-to-background ratio in co-registered 18F-FET PET/MR imaging – is it a valuable tool to differentiate between low grade and high grade brain tumor? L Hehenwarter, B Egger, J Holzmannhofer, M Rodrigues-Radischat, C Pirich A29 [11C]-methionine PET in gliomas - a retrospective data analysis of 166 patients N Pötsch, I Rausch, D Wilhelm, M Weber, J Furtner, G Karanikas, A Wöhrer, M Mitterhauser, M Hacker, T Traub-Weidinger A30 18F-Fluorocholine versus 18F-Fluorodeoxyglucose for PET/CT imaging in patients with relapsed or progressive multiple myeloma: a pilot study T Cassou-Mounat, S Balogova, V Nataf, M Calzada, V Huchet, K Kerrou, J-Y Devaux, M Mohty, L Garderet, J-N Talbot A31 Prognostic benefit of additional SPECT/CT in sentinel lymph node mapping of breast cancer patients S Stanzel, G Pregartner, T Schwarz, V Bjelic-Radisic, B Liegl-Atzwanger, R Aigner A32 Evaluation of diagnostic value of TOF-18F-FDG PET/CT in patients with suspected pancreatic cancer S Stanzel, F Quehenberger, RM Aigner A33 New quantification method for diagnosis of primary hyperpatahyroidism lesions and differential diagnosis vs thyropid nodular disease in dynamic scintigraphy A Koljević Marković, Milica Janković, V Miler Jerković, M Paskaš, G Pupić, R Džodić, D Popović A34 A rare case of diffuse pancreatic involvement in patient with merkel cell carcinoma detected by 18F-FDG MC Fornito, D Familiari A35 TSH-stimulated 18F-FDG PET/CT in the diagnosis of recurrent/metastatic radioiodine-negative differentiated thyroid carcinomas in patients with various thyroglobuline levels P Koranda, H Polzerová, I Metelková, L Henzlová, R Formánek, E Buriánková, M Kamínek A36 Breast Dose from lactation following I131 treatment WH Thomson, C Lewis A37 A new concept for performing SeHCAT studies with the gamma camera WH Thomson, J O’Brien, G James, A Notghi A38 Whole body F-18-FDG-PET and tuberculosis: sensitivity compared to x-ray-CT H Huber, I Stelzmüller, R Wunn, M Mandl, F Fellner, B Lamprecht, M Gabriel A39 Emerging role 18F-FDG PET-CT in the diagnosis and follow-up of the infection in heartware ventricular assist system (HVAD) MC Fornito, G Leonardi A40 Validation of Poisson resampling software WH Thomson, J O’Brien, G James A41 Protection of PET nuclear medicine personnel: problems in satisfying dose limit requirements J Hudzietzová, J Sabol, M Fülöp
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Affiliation(s)
- W Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - A Rezaee
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - W Loidl
- Prostate Cancer Center Linz, Department of Urology, St Vincent's Hospital, Linz, Austria
| | - H S Geinitz
- Department of Radiation Oncology, St Vincent's Hospital, Linz, Austria
| | - F Fitz
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Steinmair
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Broinger
- Department of Radiology, St Vincent's Hospital, Linz, Austria
| | - L Pallwien-Prettner
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Beheshti
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - L Imamovic
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - M Beheshti
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Rendl
- Department of Nuclear Medicine and Endocrinology, Paracelsus Private Medical University Salzburg, St Vincent's Hospital, Linz, Austria
| | - D Hackl
- Department of Surgery, St Vincent's Hospital, Linz, Austria
| | - O Tsybrovsky
- Department of Pathology, St Vincent's Hospital, Linz, Austria
| | - M Steinmair
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - K Emmanuel
- Department of Surgery, St Vincent's Hospital, Linz, Austria
| | - F Moinfar
- Department of Pathology, St Vincent's Hospital, Linz, Austria
| | - C Pirich
- Department of Nuclear Medicine and Endocrinology, Paracelsus Private Medical University Salzburg, St Vincent's Hospital, Linz, Austria
| | - W Langsteger
- PET - CT Center Linz & Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - A Bytyqi
- PET-CT Center Linz, Department of Nuclear Medicine & Endocrinology, St Vincent's Hospital, Linz, Austria
| | - G Karanikas
- Medical University of Vienna, Division of Nuclear Medicine, Vienna, Austria
| | - M Mayerhöfer
- Medical University of Vienna, Division of General and Pediatric Radiology, Vienna, Austria
| | - O Koperek
- Medical University of Vienna, Institute of Pathology, Vienna, Austria
| | - B Niederle
- Medical University Vienna, Division of Surgical Endocrinology, Vienna, Austria
| | - M Hartenbach
- Medical University of Vienna, Division of Nuclear Medicine, Vienna, Austria
| | - T Beyer
- QIMP, CMPBME, Medical University of Vienna, ᅟ, Austria
| | - K Herrmann
- Department of Nuclear Medicine, University of Würzburg, ᅟ, Germany.,Department of Molecular and Medical Pharmacology, UCLA, ᅟ, USA
| | - J Czernin
- Department of Molecular and Medical Pharmacology, UCLA, ᅟ, USA
| | - I Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - P Rust
- Department of Nutritional Sciences, University of Vienna, ᅟ, Austria
| | - M D DiFranco
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - M Lassen
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - A Stadlbauer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M E Mayerhöfer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, ᅟ, Austria
| | - T Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, ᅟ, Austria
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - R Magnussen
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - W Wei
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - M U Knopp
- Sports Medicine, Pepperdine University, Malibu, CA, USA
| | - D C Flanigan
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - C Kaeding
- Sports Medicine, The Ohio State University, Columbus, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - A Leisser
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Nejabat
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - G Kramer
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Krainer
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - A Haug
- Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - Wencke Lehnert
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Karl Schmidt
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Sharok Kimiaei
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Marcus Bronzel
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - Andreas Kluge
- ABX-CRO advanced pharmaceutical services (Forschungsgesellschaft mbH), Dresden, Germany
| | - C L Wright
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - K Binzel
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - J Zhang
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - Evan Wuthrick
- Radiation Oncology, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Piotr Maniawski
- Clinical Science - Nuclear Medicine, Philips Healthcare, Cleveland, OH, USA
| | - M V Knopp
- Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - M Blaickner
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - E Rados
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - A Huber
- AIT Austrian Institute of Technology, Health & Environment Department -Biomedical Systems, Vienna, Austria
| | - M Dulovits
- Woogieworks Animation Studio, Perchtoldsdorf, Austria
| | - H Kulkarni
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - S Wiessalla
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - C Schuchardt
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - R P Baum
- THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT) ENETS Center of Excellence, Zentralklinik Bad Berka, ᅟ, Germany
| | - B Knäusl
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, ᅟ, Austria
| | - D Georg
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, ᅟ, Austria
| | - M Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - B Wulkersdorfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Health and Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - M Feldmann
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.,University College London, London, UK
| | - R Karch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M J Koepp
- University College London, London, UK
| | - M-C Asselin
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - E Pataraia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - M Zeilinger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Dumanic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - F Pichler
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - J Pilz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Radiopharmacy and Experimental Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - L Nics
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - B Steiner
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - A Traxl
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Thomas Wanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Kushtrim Kryeziu
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Severin Mairinger
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Johann Stanek
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Kuntner
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - Oliver Langer
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - S Mairinger
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Wanek
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - A Traxl
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Krohn
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - J Stanek
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - T Filip
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Sauberer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - C Kuntner
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - J Pahnke
- Department of Neuro-/Pathology, University of Oslo (UiO) and Oslo University Hospital (OUS), Oslo, Norway
| | - O Langer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - M Wilkovitsch
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Vienna, Austria
| | | | - J Fröhlich
- Austrian Institute of Technology, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - S Mairinger
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - J Stanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - J Fröhlich
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - C Kuntner-Hannes
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Balber
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - J Singer
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - J Fazekas
- Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - C Rami-Mark
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - N Berroterán-Infante
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - E Jensen-Jarolim
- Department of Immunology and Oncology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, ᅟ, Austria.,Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, ᅟ, Austria
| | - W Wadsak
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - H Viernstein
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Denk
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - D Svatunek
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - B Sohr
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - H Mikula
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - J Fröhlich
- Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria
| | - T Wanek
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - C Kuntner-Hannes
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - T Filip
- Austrian Institute of Technology, Biomedical Systems, Vienna, Austria
| | - S Pfaff
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Inorganic Chemistry, University of Vienna, ᅟ, Austria
| | - C Philippe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,LBI for Applied Diagnostics, Vienna, Austria
| | - M Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Inorganic Chemistry, University of Vienna, ᅟ, Austria
| | - T Wanek
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - E Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - M Visentin
- Department of Clinical Pharmacology and Toxicology, University Hospital, Zurich, Switzerland
| | - S Mairinger
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - B Stieger
- Department of Clinical Pharmacology and Toxicology, University Hospital, Zurich, Switzerland
| | - C Kuntner
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria
| | - M Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - O Langer
- Health and Environment Department, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, ᅟ, Austria
| | - P Lam
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - M Aistleitner
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - R Eichinger
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - C Artner
- IASON GmbH, Feldkirchnerstraße 4, A-8054, Graz-Seiersberg, Austria
| | - H Eidherr
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - C Vraka
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - A Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,LBI for Applied Diagnostics, Vienna, Austria
| | - L Nics
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, ᅟ, Austria
| | - M Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - W Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, ᅟ, Austria
| | - H Kvaternik
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - R Müller
- Seibersdorf Labor GmbH, ᅟ, Austria
| | - D Hausberger
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - C Zink
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - R M Aigner
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, ᅟ, Austria
| | - U Cossío
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | - M Asensio
- Engineering Department, Ingeniatrics Tecnologies, P.I. Parque Plata, Camino Mozárabe 41, 41900, Camas-Sevilla, Spain
| | - A Montes
- Engineering Department, Ingeniatrics Tecnologies, P.I. Parque Plata, Camino Mozárabe 41, 41900, Camas-Sevilla, Spain
| | - S Akhtar
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - Y Te Welscher
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - R van Nostrum
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands
| | - V Gómez-Vallejo
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | - J Llop
- CIC biomaGUNE, Edificio Empresarial "C", Paseo de Miramón 182, 20009, Donostia, Spain
| | | | | | | | - M Troch
- AZ St-Lucas Gent, ᅟ, Belgium
| | - L Hehenwarter
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - B Egger
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - J Holzmannhofer
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - M Rodrigues-Radischat
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - C Pirich
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Private Medical University Salzburg, ᅟ, Germany
| | - N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - I Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - D Wilhelm
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - G Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - T Traub-Weidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - T Cassou-Mounat
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France.,Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - S Balogova
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France.,Department of Nuclear Medicine, Comenius university & St. Elisabeth Oncology Institute, Bratislava, Slovakia
| | - V Nataf
- Radiopharmacy, Hôpital Tenon, AP-HP, Paris, France
| | - M Calzada
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France
| | - V Huchet
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - K Kerrou
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - J-Y Devaux
- Department of Nuclear Medicine, Hôpital Saint Antoine, AP-HP et Université Pierre et Marie Curie (UPMC), Paris, France
| | - M Mohty
- Hematology, Université Pierre et Marie Curie, Paris, France.,Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs U938, Paris, France
| | - L Garderet
- Hematology, Université Pierre et Marie Curie, Paris, France
| | - J-N Talbot
- Department of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie (UPMC), Paris, France
| | - S Stanzel
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - G Pregartner
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, ᅟ, Austria
| | - T Schwarz
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - V Bjelic-Radisic
- Medical University of Graz, Department of Gynecology and Obstetrics, ᅟ, Austria
| | | | - R Aigner
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - S Stanzel
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics, and Documentation, ᅟ, Austria
| | - R M Aigner
- Medical University of Graz, Department of Radiology, Division of Nuclear Medicine, ᅟ, Austria
| | - A Koljević Marković
- Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia
| | - Milica Janković
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - V Miler Jerković
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - M Paskaš
- National Cancer Research Center Serbia, Innovation Center, University of Belgrade - Faculty of Electrical Engineering, ᅟ, Serbia
| | - G Pupić
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - R Džodić
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - D Popović
- National Cancer Research Center Serbia, University of Belgrade- School of Electrical Engineering, ᅟ, Serbia
| | - M C Fornito
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - D Familiari
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - P Koranda
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - H Polzerová
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - I Metelková
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - L Henzlová
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - R Formánek
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - E Buriánková
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Kamínek
- Department of Nuclear Medicine, Palacky University and University Hospital, Olomouc, Czech Republic
| | - W H Thomson
- Physics and Nuclear Medicine Department City Hospital, Birmingham, UK
| | - C Lewis
- Maternity Department City Hospital, Birmingham, UK
| | - W H Thomson
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J O'Brien
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - G James
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - A Notghi
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - H Huber
- Institut für Nuklearmedizin und Endokrinologie, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - I Stelzmüller
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - R Wunn
- Zentrales Radiologie-Institut, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M Mandl
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - F Fellner
- Zentrales Radiologie-Institut, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - B Lamprecht
- Abteilung für Lungenkrankheiten, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M Gabriel
- Institut für Nuklearmedizin und Endokrinologie, AKH Linz/Kepler Universitätsklinikum, ᅟ, Austria
| | - M C Fornito
- Nuclear Medicine Department and PET/CT center - A.R.N.A.S " Garibaldi - Nesima", Via Palermo 636, 95122, Catania, Italy
| | - G Leonardi
- Heart-Failure Department - Azienda Ospedaliera Universitaria "Policlinico- Vittorio Emanuele", Catania, Italy
| | - W H Thomson
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J O'Brien
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - G James
- Physics and Nuclear Medicine Department, City Hospital, Birmingham, UK
| | - J Hudzietzová
- Faculty of Biomedical Engineering, CTU, Prague, Czech Republic
| | - J Sabol
- Faculty of Safety Management, PACR, Prague, Czech Republic
| | - M Fülöp
- Faculty of Public Health, SMU, Bratislava, Slovak Republic
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40
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Cetin H, Wöhrer A, Rittelmeyer I, Gencik M, Zulehner G, Zimprich F, Ströbel T, Zimprich A. The c.65-2A>G splice site mutation is associated with a mild phenotype in Danon disease due to the transcription of normal LAMP2 mRNA. Clin Genet 2016; 90:366-71. [DOI: 10.1111/cge.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- H. Cetin
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Wöhrer
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | | | - M. Gencik
- Center for Human Genetics; Vienna Austria
| | - G. Zulehner
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - F. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - T. Ströbel
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | - A. Zimprich
- Department of Neurology; Medical University of Vienna; Vienna Austria
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41
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Mert A, Kiesel B, Wöhrer A, Martínez-Moreno M, Minchev G, Furtner J, Knosp E, Wolfsberger S, Widhalm G. Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas. Neurosurg Focus 2015; 38:E4. [PMID: 25552284 DOI: 10.3171/2014.10.focus14597] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgery of suspected low-grade gliomas (LGGs) poses a special challenge for neurosurgeons due to their diffusely infiltrative growth and histopathological heterogeneity. Consequently, neuronavigation with multimodality imaging data, such as structural and metabolic data, fiber tracking, and 3D brain visualization, has been proposed to optimize surgery. However, currently no standardized protocol has been established for multimodality imaging data in modern glioma surgery. The aim of this study was therefore to define a specific protocol for multimodality imaging and navigation for suspected LGG. METHODS Fifty-one patients who underwent surgery for a diffusely infiltrating glioma with nonsignificant contrast enhancement on MRI and available multimodality imaging data were included. In the first 40 patients with glioma, the authors retrospectively reviewed the imaging data, including structural MRI (contrast-enhanced T1-weighted, T2-weighted, and FLAIR sequences), metabolic images derived from PET, or MR spectroscopy chemical shift imaging, fiber tracking, and 3D brain surface/vessel visualization, to define standardized image settings and specific indications for each imaging modality. The feasibility and surgical relevance of this new protocol was subsequently prospectively investigated during surgery with the assistance of an advanced electromagnetic navigation system in the remaining 11 patients. Furthermore, specific surgical outcome parameters, including the extent of resection, histological analysis of the metabolic hotspot, presence of a new postoperative neurological deficit, and intraoperative accuracy of 3D brain visualization models, were assessed in each of these patients. RESULTS After reviewing these first 40 cases of glioma, the authors defined a specific protocol with standardized image settings and specific indications that allows for optimal and simultaneous visualization of structural and metabolic data, fiber tracking, and 3D brain visualization. This new protocol was feasible and was estimated to be surgically relevant during navigation-guided surgery in all 11 patients. According to the authors' predefined surgical outcome parameters, they observed a complete resection in all resectable gliomas (n = 5) by using contour visualization with T2-weighted or FLAIR images. Additionally, tumor tissue derived from the metabolic hotspot showed the presence of malignant tissue in all WHO Grade III or IV gliomas (n = 5). Moreover, no permanent postoperative neurological deficits occurred in any of these patients, and fiber tracking and/or intraoperative monitoring were applied during surgery in the vast majority of cases (n = 10). Furthermore, the authors found a significant intraoperative topographical correlation of 3D brain surface and vessel models with gyral anatomy and superficial vessels. Finally, real-time navigation with multimodality imaging data using the advanced electromagnetic navigation system was found to be useful for precise guidance to surgical targets, such as the tumor margin or the metabolic hotspot. CONCLUSIONS In this study, the authors defined a specific protocol for multimodality imaging data in suspected LGGs, and they propose the application of this new protocol for advanced navigation-guided procedures optimally in conjunction with continuous electromagnetic instrument tracking to optimize glioma surgery.
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Berghoff A, Kiesel B, Widhalm G, Rajky O, Ricken G, Wöhrer A, Dieckmann K, Zielinski C, Marosi C, Preusser M. 2927 Programmed death ligand 1 (PD-L1) expression and tumor infiltrating lymphocytes in diffuse and anaplastic gliomas. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31642-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Bienkowski M, Berghoff AS, Marosi C, Wöhrer A, Heinzl H, Hainfellner JA, Preusser M. Clinical Neuropathology practice guide 5-2015: MGMT methylation pyrosequencing in glioblastoma: unresolved issues and open questions. Clin Neuropathol 2015; 34:250-7. [PMID: 26295302 PMCID: PMC4542181 DOI: 10.5414/np300904] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 01/01/2023] Open
Abstract
O6-methylguanine-methyltransferase (MGMT) promoter methylation status has prognostic and, in the subpopulation of elderly patients, predictive value in newly diagnosed glioblastoma. Therefore, knowledge of the MGMT promoter methylation status is important for clinical decision-making. So far, MGMT testing has been limited by the lack of a robust test with sufficiently high analytical performance. Recently, one of several available pyrosequencing protocols has been shown to be an accurate and robust method for MGMT testing in an intra- and interlaboratory ring trial. However, some uncertainties remain with regard to methodological issues, cut-off definitions, and optimal use in the clinical setting. In this article, we highlight and discuss several of these open questions. The main unresolved issues are the definition of the most relevant CpG sites to analyze for clinical purposes and the determination of a cut-off value for dichotomization of quantitative MGMT pyrosequencing results into "MGMT methylated" and "MGMT unmethylated" patient subgroups as a basis for further treatment decisions.
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Affiliation(s)
- Michal Bienkowski
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Anna S. Berghoff
- Department of Medicine I
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
| | - Christine Marosi
- Department of Medicine I
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
| | - Harald Heinzl
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Johannes A. Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
| | - Matthias Preusser
- Department of Medicine I
- Comprehensive Cancer Center-CNS Tumours Unit (CCC-CNS), and
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Bojic M, Berghoff AS, Troch M, Agis H, Sperr WR, Widhalm G, Wöhrer A, Kalhs P, Preusser M, Rabitsch W. Haematopoietic stem cell transplantation for treatment of primary CNS lymphoma: single-centre experience and literature review. Eur J Haematol 2015; 95:75-82. [DOI: 10.1111/ejh.12482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Marija Bojic
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Anna S. Berghoff
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Marlene Troch
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Hermine Agis
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Wolfgang R. Sperr
- Department of Medicine I; Clinical Division of Haematology and Hemostaseology; Medical University of Vienna; Vienna Austria
| | - Georg Widhalm
- Department of Neurosurgery; Medical University of Vienna; Vienna Austria
| | - Adelheid Wöhrer
- Institute of Neurology; Medical University of Vienna; Vienna Austria
| | - Peter Kalhs
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - Matthias Preusser
- Department of Medicine I; Clinical Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Werner Rabitsch
- Unit for Bone Marrow and Stem Cell Transplantation; Department of Medicine I; Medical University of Vienna; Vienna Austria
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Micko ASG, Wöhrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 2015; 122:803-11. [PMID: 25658782 DOI: 10.3171/2014.12.jns141083] [Citation(s) in RCA: 294] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT An important prognostic factor for the surgical outcome and recurrence of a pituitary adenoma is its invasiveness into parasellar tissue, particularly into the space of the cavernous sinus (CS). The aims of this study were to reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. METHODS The authors investigated 137 pituitary macroadenomas classified radiologically at least on one side as Grade 1 or higher (parasellar extension) and correlated the surgical findings using an endoscopic technique, with special reference to the invasiveness of the tumor into the CS. In each case, postoperative MRI was performed to evaluate the gross-total resection (GTR) rate and the rate of endocrinological remission (ER) in functioning adenomas. RESULTS The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. CONCLUSIONS The proposed classification proved that with increasing grades, the likelihood of surgically observed invasion rises and the chance of GTR and ER decreases. The direct endoscopic view confirmed the low rate of invasion of Grade 1 adenomas but showed significantly lower rates of invasion in Grade 2 and 3 adenomas than those previously found using the microscopic technique. In cases in which the intracavernous internal carotid artery was encased (Grade 4), all the adenomas were invasive and the GTR/ER rate was 0%/0%. The authors suggest the addition of Grades 3A and 3B to distinguish the strikingly different outcomes of adenomas invading the superior CS compartments and those invading the inferior CS compartments.
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Berghoff AS, Bartsch R, Wöhrer A, Streubel B, Birner P, Kros JM, Brastianos PK, von Deimling A, Preusser M. Predictive molecular markers in metastases to the central nervous system: recent advances and future avenues. Acta Neuropathol 2014; 128:879-91. [PMID: 25287912 DOI: 10.1007/s00401-014-1350-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/26/2014] [Accepted: 09/28/2014] [Indexed: 12/14/2022]
Abstract
Metastases to the central nervous system (CNS) are common in several cancer types. For most primary tumors that commonly metastasize to the CNS, molecular biomarker analyses are recommended in the clinical setting for selection of appropriate targeted therapies. Therapeutic efficacy of some of these agents has been documented in patients with brain metastases, and molecular testing of CNS metastases should be considered in the clinical setting. Here, we summarize the clinically relevant biomarker tests that should be considered in neurosurgical specimens based on the current recommendations of the European Society of Medical Oncology (ESMO) or the National Comprehensive Cancer Network (NCCN) for the most relevant primary tumor types: lung cancer (EGFR mutations, ALK rearrangement, BRAF mutations), breast cancer (HER2 amplification, steroid receptor overexpression), melanoma (BRAF mutations), and colorectal cancer (RAS mutations). Furthermore, we discuss emerging therapeutic targets including novel oncogenic alterations (ROS1 rearrangements, FGFR1 amplifications, CMET amplifications, and others) and molecular features of the tumor microenvironment (including immune-checkpoint molecules such as CTLA4 and PD-1/PD-L1). We also discuss the potential role of advanced biomarker tests such as next-generation sequencing and "liquid biopsies" for patients with CNS metastases.
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Berghoff AS, Kiesel B, Widhalm G, Rajky O, Ricken G, Wöhrer A, Dieckmann K, Filipits M, Brandstetter A, Weller M, Kurscheid S, Hegi ME, Zielinski CC, Marosi C, Hainfellner JA, Preusser M, Wick W. Programmed death ligand 1 expression and tumor-infiltrating lymphocytes in glioblastoma. Neuro Oncol 2014; 17:1064-75. [PMID: 25355681 DOI: 10.1093/neuonc/nou307] [Citation(s) in RCA: 418] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/04/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors targeting programmed cell death 1 (PD1) or its ligand (PD-L1) showed activity in several cancer types. METHODS We performed immunohistochemistry for CD3, CD8, CD20, HLA-DR, phosphatase and tensin homolog (PTEN), PD-1, and PD-L1 and pyrosequencing for assessment of the O6-methylguanine-methyltransferase (MGMT) promoter methylation status in 135 glioblastoma specimens (117 initial resection, 18 first local recurrence). PD-L1 gene expression was analyzed in 446 cases from The Cancer Genome Atlas. RESULTS Diffuse/fibrillary PD-L1 expression of variable extent, with or without interspersed epithelioid tumor cells with membranous PD-L1 expression, was observed in 103 of 117 (88.0%) newly diagnosed and 13 of 18 (72.2%) recurrent glioblastoma specimens. Sparse-to-moderate density of tumor-infiltrating lymphocytes (TILs) was found in 85 of 117 (72.6%) specimens (CD3+ 78/117, 66.7%; CD8+ 52/117, 44.4%; CD20+ 27/117, 23.1%; PD1+ 34/117, 29.1%). PD1+ TIL density correlated positively with CD3+ (P < .001), CD8+ (P < .001), CD20+ TIL density (P < .001), and PTEN expression (P = .035). Enrichment of specimens with low PD-L1 gene expression levels was observed in the proneural and G-CIMP glioblastoma subtypes and in specimens with high PD-L1 gene expression in the mesenchymal subtype (P = 5.966e-10). No significant differences in PD-L1 expression or TIL density between initial and recurrent glioblastoma specimens or correlation of PD-L1 expression or TIL density with patient age or outcome were evident. CONCLUSION TILs and PD-L1 expression are detectable in the majority of glioblastoma samples but are not related to outcome. Because the target is present, a clinical study with specific immune checkpoint inhibitors seems to be warranted in glioblastoma.
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Affiliation(s)
- Anna Sophie Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Barbara Kiesel
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Georg Widhalm
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Orsolya Rajky
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Karin Dieckmann
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Martin Filipits
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Anita Brandstetter
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Michael Weller
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Sebastian Kurscheid
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Monika E Hegi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Christoph C Zielinski
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Christine Marosi
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Johannes A Hainfellner
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Matthias Preusser
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- Institute of Neurology, Medical University of Vienna, Vienna, Austria (A.S.B., G.R., A.W., J.A.H.); Department of Medicine I, Medical University of Vienna, Vienna, Austria (A.S.B., O.R., M.F., A.B., C.C.Z., C.M., M.P.); Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (A.S.B., B.K., G.W., O.R., G.R., A.W., K.D., M.F., A.B., C.C.Z., C.M., J.A.H., M.P.); Department of Neurosurgery, Medical University of Vienna, Vienna, Austria (B.K., G.W.); Department of Radiotherapy, Medical University of Vienna, Vienna, Austria (K.D.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Laboratory of Brain Tumor Biology and Genetics, Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Lausanne, Switzerland (S.K., M.E.H.); Neurology Clinic and National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany (W.W.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W.)
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Preusser M, Streubel B, Berghoff AS, Hainfellner JA, von Deimling A, Widhalm G, Dieckmann K, Wöhrer A, Hackl M, Zielinski C, Birner P. Amplification and overexpression of CMET is a common event in brain metastases of non-small cell lung cancer. Histopathology 2014; 65:684-92. [PMID: 25039982 DOI: 10.1111/his.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND CMET represents an emerging therapy target for monoclonal antibodies and tyrosine kinase inhibitors in non-small cell lung cancer (NSCLC). METHODS We investigated CMET gene amplification status by fluorescence in-situ hybridization (FISH) and CMET protein expression by immunohistochemistry in a large series of 209 NSCLC brain metastases (BM; 165 adenocarcinoma, 20 squamous cell carcinoma, 11 adenosquamous carcinomas, 11 large cell carcinomas and two large cell neuroendocrine carcinomas) and correlated our results to clinic-pathological parameters and molecular data from previous studies. RESULTS We found CMET gene amplification in 36/167 (21.6%) and CMET protein expression in 87/196 (44.4%) of evaluable BM. There was a strong correlation between the presence of CMET gene amplification and CMET protein expression (P < 0.001, chi-square test). Furthermore, presence of CMET amplification correlated positively with presence of ALK amplifications (P = 0.039, chi-square test) and high HIF1 alpha index (P = 0.013, Mann-Whitney U-test). Neither CMET expression nor CMET gene amplification status correlated with patient outcome parameters or known prognostic factors. CONCLUSIONS CMET overexpression and CMET amplification are commonly found in NSCLC BM and may represent a promising therapeutic target.
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Affiliation(s)
- Matthias Preusser
- Department of Internal Medicine 1, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, CNS Unit, Medical University of Vienna, Vienna, Austria
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Pieringer H, Parzer I, Wöhrer A, Reis P, Oppl B, Zwerina J. IgG4- related disease: an orphan disease with many faces. Orphanet J Rare Dis 2014; 9:110. [PMID: 25026959 PMCID: PMC4223520 DOI: 10.1186/s13023-014-0110-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/03/2014] [Indexed: 02/07/2023] Open
Abstract
Immunoglobulin G4- related disease (IgG4-RD) is a rare systemic fibro-inflammatory disorder (ORPHA284264). Although patients have been described more than 100 years ago, the systemic nature of this disease has been recognized in the 21st century only. Type 1 autoimmune pancreatitis is the most frequent manifestation of IgG4-RD. However, IgG4-RD can affect any organ such as salivary glands, orbits, retroperitoneum and many others. Recent research enabled a clear clinical and histopathological description of IgG4-RD. Typically, lymphoplasmacellular inflammation, storiform fibrosis and obliterative phlebitis are found in IgG4-RD biopsies and the tissue invading plasma cells largely produce IgG4. Elevated serum IgG4 levels are found in many but not all patients. Consequently, diagnostic criteria for IgG4-RD have been proposed recently. Treatment is largely based on clinical experience and retrospective case series. Glucocorticoids are the mainstay of therapy, although adjunctive immunosuppressive agents are used in relapsing patients. This review summarizes current knowledge on clinical manifestations, pathophysiology and treatment of IgG4-RD.
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Berghoff AS, Ilhan-Mutlu A, Wöhrer A, Hackl M, Widhalm G, Hainfellner JA, Dieckmann K, Melchardt T, Dome B, Heinzl H, Birner P, Preusser M. Prognostic significance of Ki67 proliferation index, HIF1 alpha index and microvascular density in patients with non-small cell lung cancer brain metastases. Strahlenther Onkol 2014; 190:676-85. [PMID: 24577133 DOI: 10.1007/s00066-014-0639-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/25/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Survival upon diagnosis of brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) is highly variable and established prognostic scores do not include tissue-based parameters. METHODS Patients who underwent neurosurgical resection as first-line therapy for newly diagnosed NSCLC BM were included. Microvascular density (MVD), Ki67 tumor cell proliferation index and hypoxia-inducible factor 1 alpha (HIF-1 alpha) index were determined by immunohistochemistry. RESULTS NSCLC BM specimens from 230 patients (151 male, 79 female; median age 56 years; 199 nonsquamous histology) and 53/230 (23.0%) matched primary tumor samples were available. Adjuvant whole-brain radiation therapy (WBRT) was given to 153/230 (66.5%) patients after neurosurgical resection. MVD and HIF-1 alpha indices were significantly higher in BM than in matched primary tumors. In patients treated with adjuvant WBRT, low BM HIF-1 alpha expression was associated with favorable overall survival (OS), while among patients not treated with adjuvant WBRT, BM HIF-1 alpha expression did not correlate with OS. Low diagnosis-specific graded prognostic assessment score (DS-GPA), low Ki67 index, high MVD, low HIF-1 alpha index and administration of adjuvant WBRT were independently associated with favorable OS. Incorporation of tissue-based parameters into the commonly used DS-GPA allowed refined discrimination of prognostic subgroups. CONCLUSION Ki67 index, MVD and HIF-1 alpha index have promising prognostic value in BM and should be validated in further studies.
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Affiliation(s)
- A S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
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