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Zhang K, Zakeri A, Alban T, Dong J, Ta HM, Zalavadia AH, Branicky A, Zhao H, Juric I, Husich H, Parthasarathy PB, Rupani A, Drazba JA, Chakraborty AA, Ching-Cheng Huang S, Chan T, Avril S, Wang LL. VISTA promotes the metabolism and differentiation of myeloid-derived suppressor cells by STAT3 and polyamine-dependent mechanisms. Cell Rep 2024; 43:113661. [PMID: 38175754 PMCID: PMC10851928 DOI: 10.1016/j.celrep.2023.113661] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) impair antitumor immune responses. Identifying regulatory circuits during MDSC development may bring new opportunities for therapeutic interventions. We report that the V-domain suppressor of T cell activation (VISTA) functions as a key enabler of MDSC differentiation. VISTA deficiency reduced STAT3 activation and STAT3-dependent production of polyamines, which causally impaired mitochondrial respiration and MDSC expansion. In both mixed bone marrow (BM) chimera mice and myeloid-specific VISTA conditional knockout mice, VISTA deficiency significantly reduced tumor-associated MDSCs but expanded monocyte-derived dendritic cells (DCs) and enhanced T cell-mediated tumor control. Correlated expression of VISTA and arginase-1 (ARG1), a key enzyme supporting polyamine biosynthesis, was observed in multiple human cancer types. In human endometrial cancer, co-expression of VISTA and ARG1 on tumor-associated myeloid cells is associated with poor survival. Taken together, these findings unveil the VISTA/polyamine axis as a central regulator of MDSC differentiation and warrant therapeutically targeting this axis for cancer immunotherapy.
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Affiliation(s)
- Keman Zhang
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Amin Zakeri
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Tyler Alban
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Juan Dong
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Hieu M Ta
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Ajay H Zalavadia
- Imaging Core Facility, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Andrelie Branicky
- Imaging Core Facility, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Haoxin Zhao
- Imaging Core Facility, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Ivan Juric
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Hanna Husich
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Prerana B Parthasarathy
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Amit Rupani
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Judy A Drazba
- Imaging Core Facility, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Abhishek A Chakraborty
- Department of Cancer Biology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Stanley Ching-Cheng Huang
- Department of Pathology, University Hospitals Cleveland Medical Center, and Case Western Reserve University School of Medicine, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Timothy Chan
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Stefanie Avril
- Department of Pathology, University Hospitals Cleveland Medical Center, and Case Western Reserve University School of Medicine, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Li Lily Wang
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA.
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Wilkerson AD, Parthasarathy PB, Stabellini N, Mitchell C, Pavicic PG, Fu P, Rupani A, Husic H, Rayman PA, Swaidani S, Abraham J, Budd GT, Moore H, Al-Hilli Z, Ko JS, Baar J, Chan TA, Alban T, Diaz-Montero CM, Montero AJ. Phase II Clinical Trial of Pembrolizumab and Chemotherapy Reveals Distinct Transcriptomic Profiles by Radiologic Response in Metastatic Triple-Negative Breast Cancer. Clin Cancer Res 2024; 30:82-93. [PMID: 37882661 PMCID: PMC10767305 DOI: 10.1158/1078-0432.ccr-23-1349] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE A single arm, phase II trial of carboplatin, nab-paclitaxel, and pembrolizumab (CNP) in metastatic triple-negative breast cancer (mTNBC) was designed to evaluate overall response rate (ORR), progression-free survival (PFS), duration of response (DOR), safety/tolerability, overall survival (OS), and identify pathologic and transcriptomic correlates of response to therapy. PATIENTS AND METHODS Patients with ≤2 prior therapies for metastatic disease were treated with CNP regardless of tumor programmed cell death-ligand 1 status. Core tissue biopsies were obtained prior to treatment initiation. ORR was assessed using a binomial distribution. Survival was analyzed via the Kaplan-Meier method. Bulk RNA sequencing was employed for correlative studies. RESULTS Thirty patients were enrolled. The ORR was 48.0%: 2 (7%) complete responses (CR), 11 (41%) partial responses (PR), and 8 (30%) stable disease (SD). The median DOR for patients with CR or PR was 6.4 months [95% confidence interval (CI), 4-8.5 months]. For patients with CR, DOR was >24 months. Overall median PFS and OS were 5.8 (95% CI, 4.7-8.5 months) and 13.4 months (8.9-17.3 months), respectively. We identified unique transcriptomic landscapes associated with each RECIST category of radiographic treatment response. In CR and durable PR, IGHG1 expression was enriched. IGHG1high tumors were associated with improved OS (P = 0.045) and were concurrently enriched with B cells and follicular helper T cells, indicating IGHG1 as a promising marker for lymphocytic infiltration and robust response to chemo-immunotherapy. CONCLUSIONS Pretreatment tissue sampling in mTNBC treated with CNP reveals transcriptomic signatures that may predict radiographic responses to chemo-immunotherapy.
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Affiliation(s)
- Avia D. Wilkerson
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
- Cleveland Clinic Digestive Disease & Surgery Institute, Department of General Surgery, Cleveland, Ohio
| | | | - Nickolas Stabellini
- Graduate Education Office, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Carley Mitchell
- University Hospitals Cleveland Medical Center, Department of Internal Medicine, Cleveland, Ohio
| | - Paul G. Pavicic
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Pingfu Fu
- Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | - Amit Rupani
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Hana Husic
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Patricia A. Rayman
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Shadi Swaidani
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Jame Abraham
- Cleveland Clinic Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland, Ohio
| | - G. Thomas Budd
- Cleveland Clinic Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland, Ohio
| | - Halle Moore
- Cleveland Clinic Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland, Ohio
| | - Zahraa Al-Hilli
- Cleveland Clinic Digestive Disease & Surgery Institute, Department of General Surgery, Cleveland, Ohio
| | - Jennifer S. Ko
- Cleveland Clinic Pathology & Laboratory Medicine, Department of Anatomic Pathology, Cleveland, Ohio
| | - Joseph Baar
- University Hospitals/Seidman Cancer Center Case Western Reserve University, Cleveland, Ohio
| | - Timothy A. Chan
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Tyler Alban
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - C. Marcela Diaz-Montero
- Cleveland Clinic Lerner Research Institute, Center for Immunotherapy & Precision Immuno-Oncology, Cleveland, Ohio
| | - Alberto J. Montero
- University Hospitals/Seidman Cancer Center Case Western Reserve University, Cleveland, Ohio
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3
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Pavicic PG, Rayman PA, Swaidani S, Rupani A, Makarov V, Tannenbaum CS, Edwards RP, Vlad AM, Diaz-Montero CM, Mahdi H. Immunotherapy with IL12 and PD1/CTLA4 inhibition is effective in advanced ovarian cancer and associates with reversal of myeloid cell-induced immunosuppression. Oncoimmunology 2023; 12:2198185. [PMID: 37066116 PMCID: PMC10101660 DOI: 10.1080/2162402x.2023.2198185] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
The tumor microenvironment (TME) in ovarian cancer (OC) is characterized by immune suppression, due to an abundance of suppressive immune cells populations. To effectively enhance the activity of immune checkpoint inhibition (ICI), there is a need to identify agents that target these immunosuppressive networks while promoting the recruitment of effector T cells into the TME. To this end, we sought to investigate the effect of the immunomodulatory cytokine IL12 alone or in combination with dual-ICI (anti-PD1 + anti-CTLA4) on anti-tumor activity and survival, using the immunocompetent ID8-VEGF murine OC model. Detailed immunophenotyping of peripheral blood, ascites, and tumors revealed that durable treatment responses were associated with reversal of myeloid cell-induced immune suppression, which resulted in enhanced anti-tumor activity by T cells. Single cell transcriptomic analysis further demonstrated striking differences in the phenotype of myeloid cells from mice treated with IL12 in combination with dual-ICI. We also identified marked differences in treated mice that were in remission compared to those whose tumors progressed, further confirming a pivotal role for the modulation of myeloid cell function to allow for response to immunotherapy. These findings provide the scientific basis for the combination of IL12 and ICI to improve clinical response in OC.
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Affiliation(s)
- Paul G. Pavicic
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patricia A. Rayman
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shadi Swaidani
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Rupani
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vladimir Makarov
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles S. Tannenbaum
- Department of Inflammation and Immunity, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Robert P. Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences and Magee Women’s Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anda M. Vlad
- Department of Obstetrics, Gynecology and Reproductive Sciences and Magee Women’s Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C. Marcela Diaz-Montero
- Center for Immunotherapy & Precision Immuno-Oncology (CITI), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Haider Mahdi
- Department of Obstetrics, Gynecology and Reproductive Sciences and Magee Women’s Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of Gynecologic Oncology; Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
- Translational Hematology Oncology Research Department, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Noto FK, Sangodkar J, Adedeji BT, Moody S, McClain CB, Tong M, Ostertag E, Crawford J, Gao X, Hurst L, O’Connor CM, Hanson EN, Izadmehr S, Tohmé R, Narla J, LeSueur K, Bhattacharya K, Rupani A, Tayeh MK, Innis JW, Galsky MD, Evers BM, DiFeo A, Narla G, Jamling TY. The SRG rat, a Sprague-Dawley Rag2/Il2rg double-knockout validated for human tumor oncology studies. PLoS One 2020; 15:e0240169. [PMID: 33027304 PMCID: PMC7540894 DOI: 10.1371/journal.pone.0240169] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
We have created the immunodeficient SRG rat, a Sprague-Dawley Rag2/Il2rg double knockout that lacks mature B cells, T cells, and circulating NK cells. This model has been tested and validated for use in oncology (SRG OncoRat®). The SRG rat demonstrates efficient tumor take rates and growth kinetics with different human cancer cell lines and PDXs. Although multiple immunodeficient rodent strains are available, some important human cancer cell lines exhibit poor tumor growth and high variability in those models. The VCaP prostate cancer model is one such cell line that engrafts unreliably and grows irregularly in existing models but displays over 90% engraftment rate in the SRG rat with uniform growth kinetics. Since rats can support much larger tumors than mice, the SRG rat is an attractive host for PDX establishment. Surgically resected NSCLC tissue from nine patients were implanted in SRG rats, seven of which engrafted and grew for an overall success rate of 78%. These developed into a large tumor volume, over 20,000 mm3 in the first passage, which would provide an ample source of tissue for characterization and/or subsequent passage into NSG mice for drug efficacy studies. Molecular characterization and histological analyses were performed for three PDX lines and showed high concordance between passages 1, 2 and 3 (P1, P2, P3), and the original patient sample. Our data suggest the SRG OncoRat is a valuable tool for establishing PDX banks and thus serves as an alternative to current PDX mouse models hindered by low engraftment rates, slow tumor growth kinetics, and multiple passages to develop adequate tissue banks.
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Affiliation(s)
- Fallon K. Noto
- Hera BioLabs Inc., Lexington, Kentucky, United States of America
- * E-mail:
| | - Jaya Sangodkar
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Sam Moody
- Hera BioLabs Inc., Lexington, Kentucky, United States of America
| | | | - Ming Tong
- Poseida Therapeutics Inc., San Diego, California, United States of America
| | - Eric Ostertag
- Poseida Therapeutics Inc., San Diego, California, United States of America
| | - Jack Crawford
- Hera BioLabs Inc., Lexington, Kentucky, United States of America
| | - Xiaohua Gao
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Lauren Hurst
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Caitlin M. O’Connor
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Erika N. Hanson
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Rita Tohmé
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America
- Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jyothsna Narla
- Regional Medical Center, San Jose, California, United States of America
| | - Kristin LeSueur
- Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kajari Bhattacharya
- Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Amit Rupani
- Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Marwan K. Tayeh
- Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jeffrey W. Innis
- Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Human Genetics, The University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew D. Galsky
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - B. Mark Evers
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Analisa DiFeo
- Department of Obstetrics and Gynecology, The University of Michigan, Ann Arbor, Michigan, United States of America
| | - Goutham Narla
- Hera BioLabs Inc., Lexington, Kentucky, United States of America
- Division of Genetic Medicine, Department of Medicine, The University of Michigan, Ann Arbor, Michigan, United States of America
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5
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Sahinoz M, Khairi S, Cuttitta A, Brady GF, Rupani A, Meral R, Tayeh MK, Thomas P, Riebschleger M, Camelo-Piragua S, Innis JW, Bishr Omary M, Michele DE, Oral EA. Potential association of LMNA-associated generalized lipodystrophy with juvenile dermatomyositis. Clin Diabetes Endocrinol 2018; 4:6. [PMID: 29610677 PMCID: PMC5870259 DOI: 10.1186/s40842-018-0058-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is an auto-immune muscle disease which presents with skin manifestations and muscle weakness. At least 10% of the patients with JDM present with acquired lipodystrophy. Laminopathies are caused by mutations in the lamin genes and cover a wide spectrum of diseases including muscular dystrophies and lipodystrophy. The p.T10I LMNA variant is associated with a phenotype of generalized lipodystrophy that has also been called atypical progeroid syndrome. Case presentation A previously healthy female presented with bilateral proximal lower extremity muscle weakness at age 4. She was diagnosed with JDM based on her clinical presentation, laboratory tests and magnetic resonance imaging (MRI). She had subcutaneous fat loss which started in her extremities and progressed to her whole body. At age 7, she had diabetes, hypertriglyceridemia, low leptin levels and low body fat on dual energy X-ray absorptiometry (DEXA) scan, and was diagnosed with acquired generalized lipodystrophy (AGL). Whole exome sequencing (WES) revealed a heterozygous c.29C > T; p.T10I missense pathogenic variant in LMNA, which encodes lamins A and C. Muscle biopsy confirmed JDM rather than muscular dystrophy, showing perifascicular atrophy and perivascular mononuclear cell infiltration. Immunofluroscence of skin fibroblasts confirmed nuclear atypia and fragmentation. Conclusions This is a unique case with p.T10I LMNA variant displaying concurrent JDM and AGL. This co-occurrence raises the intriguing possibility that LMNA, and possibly p.T10I, may have a pathogenic role in not only the occurrence of generalized lipodystrophy, but also juvenile dermatomyositis. Careful phenotypic characterization of additional patients with laminopathies as well as individuals with JDM is warranted.
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Affiliation(s)
- Melis Sahinoz
- 1Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Shafaq Khairi
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
| | - Ashley Cuttitta
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Graham F Brady
- 4Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Amit Rupani
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Rasimcan Meral
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
| | - Marwan K Tayeh
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Peedikayil Thomas
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Meredith Riebschleger
- 6Division of Pediatric Rheumatology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | | | - Jeffrey W Innis
- 5Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA.,8Department of Human Genetics, University of Michigan, Ann Arbor, MI USA
| | - M Bishr Omary
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Daniel E Michele
- 3Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Elif A Oral
- 2Metabolism Endocrinology and Diabetes Division, Department of Internal Medicine, University of Michigan and Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI MI48105 USA
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Dasari T, Pavlovic-Surjancev B, Patel N, Williams A, Ezidinma P, Rupani A, Sinacore J, Heroux A. 290: Atrial Fibrillation and Atrial Flutter in Heart Transplant Patients: Incidence, Risk Factors and Clinical Outcomes. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.297] [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: 10/21/2022] Open
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7
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Rupani A, Modi C, Desai S, Rege J. Primary anaplastic large cell lymphoma of central nervous system--a case report. J Postgrad Med 2005; 51:326-7. [PMID: 16388180] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Central nervous system (CNS) involvement is extremely rare in anaplastic large cell lymphoma (ALCL). Primary ALCL of CNS on radiology is often misdiagnosed as tuberculosis. We report a fatal case of primary ALCL of CNS in a 17 year old male. He came with history of headache and left partial seizures. MRI showed a well- circumscribed lesion in the right fronto-parietal lobe eroding the skull bone. Biopsy showed large pleomorphic cells. Immunohistochemical stains showed positivity for CD30, CD43, EMA and ALK-1. In spite of radiotherapy and steroids, patient expired. Hence a high level of suspicion is essential for early diagnosis and for instituting appropriate treatment.
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Affiliation(s)
- A Rupani
- Department of Pathology, T. N. Medical College, B. Y. L. Nair Charitable Hospital, Mumbai, India.
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