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Li H, Bartke R, Zhao L, Verma Y, Horacek A, Rechav Ben-Natan A, Pangilinan GR, Krishnappa N, Nielsen R, Hockemeyer D. Functional annotation of variants of the BRCA2 gene via locally haploid human pluripotent stem cells. Nat Biomed Eng 2024; 8:165-176. [PMID: 37488236 PMCID: PMC10878975 DOI: 10.1038/s41551-023-01065-7] [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: 07/29/2021] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Abstract
Mutations in the BRCA2 gene are associated with sporadic and familial cancer, cause genomic instability and sensitize cancer cells to inhibition by the poly(ADP-ribose) polymerase (PARP). Here we show that human pluripotent stem cells (hPSCs) with one copy of BRCA2 deleted can be used to annotate variants of this gene and to test their sensitivities to PARP inhibition. By using Cas9 to edit the functional BRCA2 allele in the locally haploid hPSCs and in fibroblasts differentiated from them, we characterized essential regions in the gene to identify permissive and loss-of-function mutations. We also used Cas9 to directly test the function of individual amino acids, including amino acids encoded by clinical BRCA2 variants of uncertain significance, and identified alleles that are sensitive to PARP inhibitors used as a standard of care in BRCA2-deficient cancers. Locally haploid human pluripotent stem cells can facilitate detailed structure-function analyses of genes and the rapid functional evaluation of clinically observed mutations.
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Affiliation(s)
- Hanqin Li
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, CA, USA
| | - Rebecca Bartke
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Lei Zhao
- Section for GeoGenetics, Globe Institute, University of Copenhagen, Copenhagen, Denmark
| | - Yogendra Verma
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Anna Horacek
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Alma Rechav Ben-Natan
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Gabriella R Pangilinan
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | | | - Rasmus Nielsen
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
- Section for GeoGenetics, Globe Institute, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Hockemeyer
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA.
- Innovative Genomics Institute, University of California, Berkeley, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
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Tawil ME, Chryssikos T, Rechav Ben-Natan A, Ambati VS, Guney E, Shah V, Abla AA, Mummaneni PV. Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e174. [PMID: 37306964 PMCID: PMC10637418 DOI: 10.1227/ons.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Michael E. Tawil
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alma Rechav Ben-Natan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Vardhaan S. Ambati
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ekin Guney
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Vinil Shah
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Adib A. Abla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
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Shabani S, Agarwal N, Ben-Natan AR, Huang J, Le VP, Chou D, Mummaneni PV. Technical Note: Hinged Table for Single-Position Navigated Lateral Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e441. [PMID: 36827189 DOI: 10.1227/ons.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Affiliation(s)
- Saman Shabani
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Vargas E, Shabani S, Mummaneni PV, Park C, Rechav Ben-Natan A, Rivera JJ, Huang J, Berven S, Braunstein S, Chou D. Does surgery for metastatic spinal tumors improve functional outcomes in patients without spinal cord compression but with potentially unstable spines? J Neurosurg Spine 2023:1-8. [PMID: 37148234 DOI: 10.3171/2023.3.spine221120] [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: 10/06/2022] [Accepted: 03/21/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE In the absence of spinal cord compression, it is unclear if surgery is more effective than radiation treatment for improving functional outcomes in metastatic spinal tumor patients with potentially unstable spines. The authors compared functional status outcomes assessed with Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) scores after surgery or radiation in patients without spinal cord compression with Spine Instability Neoplastic Score (SINS) values of 7-12 indicating possible instability (SINS 7-12). METHODS A retrospective review was performed of patients with metastatic spinal tumor SINS values of 7-12 at a single institution between 2004 and 2014. Patients were divided into two different groups: 1) those treated with surgery and 2) those treated with radiation. Baseline clinical characteristics were measured, and KPS and ECOG scores were obtained pre- and postradiation or postsurgery. The paired, nonparametric Wilcoxon signed-rank test and ordinal logistic regression analysis were used for statistical analysis. RESULTS A total of 162 patients met inclusion criteria; 63 patients were treated operatively and 99 patients were treated with radiation. The mean follow-up was 1.9 years, with a median of 1.1 years for the surgical cohort (ranging from 2.5 months to 13.8 years) and a mean of 2 years with a median of 0.8 years for the radiation cohort (ranging from 2 months to 9.3 years). After covariates were accounted for, the average posttreatment changes in KPS scores in the surgical cohort were 7.46 ± 17.3 and in the radiation cohort were -2 ± 13.6 (p = 0.045). No significant difference was observed in ECOG scores. KPS scores improved postoperatively in 60.3% of patients in the surgical group and postradiation in 32.3% of patients in the radiation cohort (p < 0.001). Subanalysis within the radiation cohort revealed no differences in fracture rates or local control between patients treated with external-beam radiation therapy versus stereotactic body radiation therapy. In patients initially treated with radiation, 21.2% eventually developed compression fractures at a treated level. Five of the 99 patients in the radiation cohort-all of whom had a fracture-eventually underwent either methyl methacrylate augmentation or instrumented fusion. CONCLUSIONS Patients with SINS values of 7-12 who underwent surgery had greater improvement in KPS scores-but not in ECOG scores-than patients undergoing radiation alone. In patients treated with radiation, treatment was converted to a procedural intervention such as surgery only in patients who sustained fractures. Of the patients with fractures after radiation (21 of 99), 5 patients underwent an invasive procedure and 16 did not.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steve Braunstein
- 3Radiation Oncology, University of California, San Francisco, California; and
| | - Dean Chou
- Departments of1Neurological Surgery
- 4Department of Neurological Surgery, Columbia University, New York, New York
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Bharadwaj UU, Ben-Natan AR, Huang J, Pedoia V, Chou D, Majumdar S, Link TM, Chin CT. Evaluation of 2 Novel Ratio-Based Metrics for Lumbar Spinal Stenosis. AJNR Am J Neuroradiol 2022; 43:1530-1538. [PMID: 36109122 PMCID: PMC9575539 DOI: 10.3174/ajnr.a7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Quantitative metrics of the dural sac such as the cross-sectional area are commonly used to evaluate central canal stenosis. The aim of this study was to analyze 2 new metrics to measure spinal stenosis on the basis of the ratio between the dural sac and disc cross-sectional areas (DDRCA) and the dural sac and disc anterior-posterior diameters (DDRDIA) and compare them with established quantitative metrics of the dural sac. MATERIALS AND METHODS T2-weighted axial MR images (n = 260 patients) were retrospectively evaluated, graded for central canal stenosis as normal (no stenosis), mild, moderate, or severe from L1/L2 through L5/S1 with 1 grade per spinal level and annotated to measure the DDRCA and DDRDIA. Thresholds were obtained using a decision tree classifier on a subset of patients (n = 130) and evaluated on the remaining patients (n = 130) for accuracy and consistency across demographics, anatomic variation, and clinical outcomes. RESULTS DDRCA and DDRDIA had areas under the receiver operating characteristic curve of 98.6 (97.4-99.3) and 98.0 (96.7-98.9) compared with dural sac cross-sectional area at 96.5 (95.0-97.7) for binary classification. DDRDIA and DDRCA had κ scores of 0.75 (0.71-0.79) and 0.80 (0.75-0.83) compared with dural sac cross-sectional area at 0.62 (0.57-0.66) for multigrade classification. No significant differences (P > .1) in the area under the receiver operating characteristic curve were observed for the DDRDIA across variations in the body mass index. The DDRDIA also had the highest area under the receiver operating characteristic curve among symptomatic patients (visual analog scale ≥ 7) or patients who underwent surgery. CONCLUSIONS Ratio-based metrics (DDRDIA and DDRCA) are accurate and robust to anatomic and demographic variability compared with quantitative metrics of the dural sac and better correlated with symptomatology and surgical outcomes.
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Affiliation(s)
- U U Bharadwaj
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - A R Ben-Natan
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - J Huang
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - V Pedoia
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - D Chou
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - S Majumdar
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - T M Link
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - C T Chin
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
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Agarwal N, Shabani S, Huang J, Ben-Natan AR, Mummaneni PV. Intraoperative Monitoring for Spinal Surgery. Neurol Clin 2022; 40:269-281. [DOI: 10.1016/j.ncl.2021.11.006] [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: 10/18/2022]
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Rechav Ben-Natan A, Agarwal N, Shabani S, Chung J, Le V, Chou D, Mummaneni PV. Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity. Neurosurgical Focus: Video 2022; 6:V19. [PMID: 36284586 PMCID: PMC9555349 DOI: 10.3171/2021.10.focvid21190] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022]
Abstract
The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190
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Affiliation(s)
- Alma Rechav Ben-Natan
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Saman Shabani
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jason Chung
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vivian Le
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
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