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Daly MB, Pal T, Maxwell KN, Churpek J, Kohlmann W, AlHilli Z, Arun B, Buys SS, Cheng H, Domchek SM, Friedman S, Giri V, Goggins M, Hagemann A, Hendrix A, Hutton ML, Karlan BY, Kassem N, Khan S, Khoury K, Kurian AW, Laronga C, Mak JS, Mansour J, McDonnell K, Menendez CS, Merajver SD, Norquist BS, Offit K, Rash D, Reiser G, Senter-Jamieson L, Shannon KM, Visvanathan K, Welborn J, Wick MJ, Wood M, Yurgelun MB, Dwyer MA, Darlow SD. NCCN Guidelines® Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2024. J Natl Compr Canc Netw 2023; 21:1000-1010. [PMID: 37856201 DOI: 10.6004/jnccn.2023.0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic/likely pathogenic (P/LP) variants associated with increased risk of breast, ovarian, pancreatic, and prostate cancer, including BRCA1, BRCA2, CDH1, PALB2, PTEN, and TP53, and recommended approaches to genetic counseling/testing and care strategies in individuals with these P/LP variants. These NCCN Guidelines Insights summarize important updates regarding: (1) a new section for transgender, nonbinary and gender diverse people who have a hereditary predisposition to cancer focused on risk reduction strategies for ovarian cancer, uterine cancer, prostate cancer, and breast cancer; and (2) testing criteria and management associated with TP53 P/LP variants and Li-Fraumeni syndrome.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Kara N Maxwell
- 3Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Zahraa AlHilli
- 6Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Banu Arun
- 7The University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Veda Giri
- 10Yale Cancer Center/Smilow Cancer Hospital
| | - Michael Goggins
- 11The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Andrea Hagemann
- 12Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Ashley Hendrix
- 13St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Nawal Kassem
- 16Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Seema Khan
- 17Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Julie S Mak
- 21UCSF Helen Diller Family Comprehensive Cancer Center
| | - John Mansour
- 22UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | | | | | - Leigha Senter-Jamieson
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Kala Visvanathan
- 11The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Valentine MC, Bruce S, Hagemann A, Thaker P, Fuh K. 20 Characterization of the mutational landscape of high-grade serous ovarian cancer pre- and post-neoadjuvant chemotherapy. Gynecol Oncol Rep 2022. [DOI: 10.1016/s2352-5789(22)00232-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wilson EM, Stock E, Kuroki L, Fuh K, Thaker P, Hagemann A. 25 Comparison of three testing strategies for germline genetic testing for homologous recombination deficiency mutations in women with epithelial ovarian cancer. Gynecol Oncol Rep 2022. [DOI: 10.1016/s2352-5789(22)00237-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wilson E, Stock E, Huang R, Buchanan T, Kotnik E, Mullen M, Khabele D, Kuroki L, Fuh K, McCourt C, Thaker P, Massad LS, Mutch D, Powell M, Hagemann A. Germline and somatic genetic testing trends among women with epithelial ovarian cancer (197). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01424-x] [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: 11/29/2022]
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Wilson E, Stock E, Huang R, Buchanan T, Kotnik E, Mullen M, Khabele D, Kuroki L, Fuh K, McCourt C, Thaker P, Massad LS, Mutch D, Powell M, Hagemann A. Comparison of three testing strategies for germline genetic testing for homologous recombination deficiency mutations in women with epithelial ovarian cancer (198). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01425-1] [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: 11/04/2022]
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Bruce S, Blachut B, Tunnage I, Mintz R, Liebendorfer A, Joshi T, Cummings M, Stasenko M, Shahin M, Hagemann I, Mullen M, Kuroki L, Hagemann A, Fuh K, McCourt C, Thaker P, Khabele D, Mutch D, Powell M. Effect of sentinel lymph node isolated tumor cells on recurrence free survival in patients with mismatch repair proficient vs. deficient stage I/II endometrioid endometrial adenocarcinoma (173). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01400-7] [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: 11/04/2022]
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Grither W, Baker B, Hagemann A, Khabele D, Kuroki L, McCourt C, Mutch D, Powell M, Thaker P, Fuh K, Longmore G. ROR2 can function independent of tyrosine kinase activity to promote ovarian cancer metastasis (264). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01485-8] [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: 11/04/2022]
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Stock E, Lomonosova E, Noia H, Bruce S, Grither W, Mullen M, Khabele D, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Patti G, Longmore G, Fuh K. Pharmacologic inhibition of discoidin domain Receptor 2 (DDR2) sensitizes homologous recombination proficient ovarian cancer models to treatment with olaparib (245). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01468-8] [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: 11/04/2022]
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Blachut B, Vanderlan J, Tippey A, Mazul A, Liebendorfer A, Qureshi R, Hagemann A, Thaker P, Fuh K, McCourt C, Massad LS, Mutch D, Powell M, Khabele D, Kuroki L. Socioeconomic disparities in distress and coping in gynecologic oncology patients (568). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01789-9] [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: 11/04/2022]
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Pachigolla S, Massad L, Thaker P, Mutch D, Powell M, Khabele D, McCourt C, Kuroki L, Hagemann A, Fuh K, Dehdashti F, Siegel B, Schwarz J, Markovina S, Grigsby P, Lin A. A Nomogram Predicting Early Cervical Cancer Distant Recurrence. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1649] [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: 11/28/2022]
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Henke LE, Stanley JA, Robinson C, Srivastava A, Contreras JA, Curcuru A, Green OL, Massad LS, Kuroki L, Fuh K, Hagemann A, Mutch D, McCourt C, Thaker P, Powell M, Markovina S, Grigsby PW, Schwarz JK, Chundury A. Phase I Trial of Stereotactic MRI-Guided Online Adaptive Radiation Therapy (SMART) for the Treatment of Oligometastatic Ovarian Cancer. Int J Radiat Oncol Biol Phys 2021; 112:379-389. [PMID: 34474109 DOI: 10.1016/j.ijrobp.2021.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/18/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy is increasingly used to treat a variety of oligometastatic histologies, but few data exist for ovarian cancer. Ablative stereotactic body radiation therapy dosing is challenging in sites like the abdomen, pelvis, and central thorax due to proximity and motion of organs at risk. A novel radiation delivery method, stereotactic magnetic-resonance-guided online-adaptive radiation therapy (SMART), may improve the therapeutic index of stereotactic body radiation therapy through enhanced soft-tissue visualization, real-time nonionizing imaging, and ability to adapt to the anatomy-of-the-day, with the goal of producing systemic-therapy-free intervals. This phase I trial assessed feasibility, safety, and dosimetric advantage of SMART to treat ovarian oligometastases. METHODS AND MATERIALS Ten patients with recurrent oligometastatic ovarian cancer underwent SMART for oligometastasis ablation. Initial plans prescribed 35 Gy/5 fractions with goal 95% planning target volume coverage by 95% of prescription, with dose escalation permitted, subject to strict organ-at-risk dose constraints. Daily adaptive planning was used to protect organs-at-risk and/or increase target dose. Feasibility (successful delivery of >80% of fractions in the first on-table attempt) and safety of this approach was evaluated, in addition to efficacy, survival metrics, quality-of-life, prospective timing and dosimetric outcomes. RESULTS Ten women with seventeen ovarian oligometastases were treated with SMART, and 100% of treatment fractions were successfully delivered. Online adaptive plans were selected at time of treatment for 58% of fractions, due to initial plan violation of organs-at-risk constraints (84% of adapted fractions) or observed opportunity for planning target volume dose escalation (16% of adapted fractions), with a median on-table time of 64 minutes. A single Grade ≥3 acute (within 6 months of SMART) treatment-related toxicity (duodenal ulcer) was observed. Local control at 3 months was 94%; median progression-free survival was 10.9 months. Median Kaplan-Meier estimated systemic-therapy-free survival after radiation completion was 11.5 months, with concomitant quality-of-life improvements. CONCLUSIONS SMART is feasible and safe for high-dose radiation therapy ablation of ovarian oligometastases of the abdomen, pelvis, and central thorax with minimal toxicity, high rates of local control, and prolonged systemic-therapy-free survival translating into improved quality-of-life.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer A Stanley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
| | - Amar Srivastava
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jessika A Contreras
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Austen Curcuru
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Katherine Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Andrea Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Premal Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers University, New Brunswick, New Jersey
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Tankou J, Toboni M, Kuroki L, McCourt C, Hagemann A, Thaker P, Powell M, Khabele D, Mutch D, Fuh K. Inhibition of GAS6/AXL improves efficacy of HER2 inhibitor trastuzumab in uterine serous cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01008-8] [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: 11/15/2022]
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13
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Buckley E, Mullen M, Kuroki L, Nizamuddin R, Stein J, Fuh K, Hagemann A, McCourt C, Mutch D, Khabele D, Powell M, Ippolito J, Thaker P. High visceral fat to subcutaneous fat adiposity ratios portend a poor prognosis in patients with endometrial cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00965-3] [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]
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14
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Johns E, Kuroki L, Toboni M, Stanley J, Zhang F, Schwarz J, Hagemann A, Thaker P, Powell M, Mutch D, McCourt C, Khabele D. Radiation therapy for vaginal and perirectal lesions in recurrent ovarian cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01131-8] [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: 11/29/2022]
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15
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Fuh K, Lomonosova E, Hagemann A, McCourt C, Powell M, Fantl W, Thaker P. Multi-dimensional biomarker analyses identify pembrolizumab responders in advanced-stage, high-grade endometrial cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01048-9] [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]
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16
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Mullen M, Lomonosova E, Toboni M, Oplt A, Cybulla E, Blachut B, Noia H, Wilke D, Rankin E, Kuroki L, Hagemann A, Hagemann I, McCourt C, Thaker P, Mutch D, Powell M, Vindigni A, Fuh K. GAS6 inhibition induces platinum sensitivity through increased replication stress in ovarian cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00720-4] [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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17
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Stock E, Schab A, Oplt A, Noia H, Lomonosova E, Bruce S, Khabele D, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Fuh K. Increasing sensitivity to olaparib through inhibition of discoidin domain receptor 2 (DDR2) in homologous-recombination proficient ovarian cancer models. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00729-0] [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: 11/15/2022]
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18
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Grither W, Baker B, Hagemann A, Khabele D, Kuroki L, Mutch D, Powell M, Thaker P, Longmore G, Fuh K. Silencing ROR2 inhibits metastatic behavior of ovarian cancer cells. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01171-9] [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]
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Bruce S, Cho K, Lomonosova E, Noia H, Stock E, Khabele D, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Patti G, Fuh K. AVB-500, a selective inhibitor of GAS6-AXL, in combination with paclitaxel alters uterine serous cancer cell metabolism. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00826-x] [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]
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20
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Grither W, Morikis V, Baker B, Hagemann A, Khabele D, Kuroki L, Mutch D, Powell M, Thaker P, Fuh K, Longmore G. Wnt5a influences the directional displacement of ovarian cancer cells. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01289-0] [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: 11/16/2022]
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21
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Zamorano A, Wilson E, Liu J, Kuroki L, Thaker P, McCourt C, Fuh K, Powell M, Mutch D, Khabele D, Colditz G, Hagemann A. Low quality of life and activity levels persist in obese endometrial cancer survivors despite participation in a behavioral weight loss intervention. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01032-5] [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: 11/28/2022]
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Kuroki L, Morris D, Greenwade M, Landon M, Hagemann A, Thaker P, Massad LS, McCourt C, Fuh K, Powell M, Mutch D, Khabele D, Vanderlan J. Gynecologic oncology patients who are unemployed and underinsured face high distress that extends beyond financial toxicity. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00962-8] [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: 11/27/2022]
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Spitzner FP, Dehning J, Wilting J, Hagemann A, P. Neto J, Zierenberg J, Priesemann V. MR. Estimator, a toolbox to determine intrinsic timescales from subsampled spiking activity. PLoS One 2021; 16:e0249447. [PMID: 33914774 PMCID: PMC8084202 DOI: 10.1371/journal.pone.0249447] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Here we present our Python toolbox "MR. Estimator" to reliably estimate the intrinsic timescale from electrophysiologal recordings of heavily subsampled systems. Originally intended for the analysis of time series from neuronal spiking activity, our toolbox is applicable to a wide range of systems where subsampling-the difficulty to observe the whole system in full detail-limits our capability to record. Applications range from epidemic spreading to any system that can be represented by an autoregressive process. In the context of neuroscience, the intrinsic timescale can be thought of as the duration over which any perturbation reverberates within the network; it has been used as a key observable to investigate a functional hierarchy across the primate cortex and serves as a measure of working memory. It is also a proxy for the distance to criticality and quantifies a system's dynamic working point.
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Affiliation(s)
- F. P. Spitzner
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - J. Dehning
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - J. Wilting
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - A. Hagemann
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - J. P. Neto
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - J. Zierenberg
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - V. Priesemann
- Max-Planck-Institute for Dynamics and Self-Organization, Göttingen, Germany
- Bernstein-Center for Computational Neuroscience (BCCN) Göttingen, Göttingen, Germany
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24
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Tankou J, Toboni M, Noia H, Oplt A, Wilke D, Khabele D, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Fuh K. Abstract PO045: Inhibition of GAS6/AXL improves efficacy of HER2 inhibitor trastuzumab in uterine serous cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.endomet20-po045] [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: 11/16/2022]
Abstract
Abstract
Objectives: To determine whether inhibition of GAS6/AXL can improve efficacy to the humanized anti-HER2 monoclonal antibody trastuzumab by decreasing uterine serous cancer cell invasion and cell survival in vitro and tumor burden in vivo. Methods: We treated AXL-expressing and HER2-expressing uterine serous cancer cell lines (ARK1, ARK2) with trastuzumab, AVB-500, or trastuzumab plus AVB-500. Clonogenic cell survival assays were performed. Matrigel invasion assays were used to assess the invasive capacity of ARK2 cells after 24 hours of treatment with vehicle, AVB-500, trastuzumab, or trastuzumab plus AVB-500. A proximity ligation assay was used to examine colocalization of HER2/neu and AXL. Western blots were performed to assess the effects of the individual drugs and combination on phosphorylation of HER2/neu and AXL. An intraperitoneal tumor model with 10 million ARK1 cells was treated with vehicle, AVB-500, trastuzumab, or trastuzumab plus AVB-500 for 35 days. The number, size, and volume of tumor nodules were measured. GraphPad Prism was used for statistical analysis. Results: We found decreased cell survival by clonogenic assays in ARK1 and ARK2 cells treated with trastuzumab plus AVB-500 compared to trastuzumab alone (relative absorbance 0.155 nm vs 0.202 nm, P=0.015). There was significantly less invasion from treatment with trastuzumab plus AVB-500 than with trastuzumab alone (3.2 vs 17.8 invading tumor cells/hpf, P=0.0004). Western blot showed that cells treated with trastuzumab plus AVB-500 had reduced phospho-AXL compared to cells treated with AVB-500 or trastuzumab alone. Furthermore, the proximity ligation assay demonstrated co-localization of the AXL and HER2 receptors in both ARK1 and ARK2 cells indicating a physical closeness that could account for this co-regulation. We found that mice treated with trastuzumab plus AVB-500 developed significantly less tumor burden than mice treated with trastuzumab alone (0.03205 g vs 0.08316 g, P= 0.024), AVB-500 alone (0.0320 g vs 0.1638 g, P<0.0001), and vehicle alone (0.03205 g vs 0.1154 g, P= 0.0395). Conclusions: The GAS6/AXL inhibitor AVB-500 potentiated the effect of trastuzumab to decrease uterine serous cancer cell proliferation and invasion in vitro and tumor burden in vivo likely through AXL and HER2 complexes.
Citation Format: Joan Tankou, Michael Toboni, Hollie Noia, Alyssa Oplt, Daniel Wilke, Dineo Khabele, Lindsay Kuroki, Andrea Hagemann, Carolyn McCourt, Premal Thaker, David Mutch, Matthew Powell, Katherine Fuh. Inhibition of GAS6/AXL improves efficacy of HER2 inhibitor trastuzumab in uterine serous cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO045.
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Affiliation(s)
- Joan Tankou
- Washington University School of Medicine, St. Louis, MO
| | | | - Hollie Noia
- Washington University School of Medicine, St. Louis, MO
| | - Alyssa Oplt
- Washington University School of Medicine, St. Louis, MO
| | - Daniel Wilke
- Washington University School of Medicine, St. Louis, MO
| | - Dineo Khabele
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Premal Thaker
- Washington University School of Medicine, St. Louis, MO
| | - David Mutch
- Washington University School of Medicine, St. Louis, MO
| | | | - Katherine Fuh
- Washington University School of Medicine, St. Louis, MO
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25
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Toboni MD, Mullen M, Tankou J, Noia H, Oplt A, Wilke D, Khabele D, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Fuh K. Abstract PO047: AVB-500, a receptor tyrosine kinase AXL inhibitor, improves response to olaparib in uterine serous cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.endomet20-po047] [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: 11/16/2022]
Abstract
Abstract
Objectives: We determined whether inhibition of GAS6/AXL with AVB-500 in combination with olaparib could improve response in HR-proficient (HRP) uterine serous cancer (USC). Methods: Two USC cell lines (ARK1 & ARK4) were radiated with 10Gy, and RAD51 foci were identified by immunofluorescence (IF). These were treated with AVB-500 (Aravive Biologics, Houston, TX) in combination with the poly ADP ribose polymerase (PARP) inhibitor, olaparib. Colony forming assays were assessed after 4 days of treatment with either AVB-500 alone, olaparib alone or combination treatment (olaparib + AVB-500). Colonies were stained and absorbance was obtained to calculate relative cell survival using Graph Pad Prism. In vivo studies were performed using NOD-SCID mice injected with 1 × 107 ARK1 cells intraperitoneally followed by treatment q3 days for 14-day treatment period. Treatment groups were vehicle control, AVB-500 alone, olaparib alone and olaparib with AVB-500. Results: ARK1 and ARK4 cells were found to have an increase in gamma-H2AX and RAD51 foci after radiation that was consistent with HRP. In clonogenic assays, colonies were stained and absorbance was obtained for each experimental arm. Olaparib + AVB-500 had significantly less absorbance than the olaparib only group for ARK1s (0.417nm vs 0.756nm, p=0.001) as well as in ARK4s (0.186nm vs 0.641nm, p=0.003). In an intraperitoneal model with ARK1 tumors, the olaparib + AVB-500 treated group had less tumor weight than those treated with olaparib alone (0.008g vs 0.138g, p=0.002) and AVB-500 alone (0.008g vs 0.145g, p=0.0006) after a 14-day treatment period. Conclusions: AVB-500 in combination with olaparib demonstrates an improved response than olaparib alone with a greater decrease in tumor burden. This was demonstrated in two HRP cell lines. Additional therapeutic and mechanistic experiments are ongoing.
Citation Format: Michael D. Toboni, Mary Mullen, Jo'an Tankou, Hollie Noia, Alyssa Oplt, Daniel Wilke, Dineo Khabele, Lindsay Kuroki, Andrea Hagemann, Carolyn McCourt, Premal Thaker, David Mutch, Matthew Powell, Katherine Fuh. AVB-500, a receptor tyrosine kinase AXL inhibitor, improves response to olaparib in uterine serous cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO047.
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Affiliation(s)
| | - Mary Mullen
- Washington University, St. Louis, St. Louis, MO
| | | | - Hollie Noia
- Washington University, St. Louis, St. Louis, MO
| | - Alyssa Oplt
- Washington University, St. Louis, St. Louis, MO
| | | | | | | | | | | | | | - David Mutch
- Washington University, St. Louis, St. Louis, MO
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Fuh K, Lomonosova E, Pachynski R, Malkova O, Oh S, Hagemann A, McCourt C, Powell M, Fantl W, Thaker P. Abstract PR004: Multi-dimensional biomarker analyses identify pembrolizumab responders in advanced stage, high grade endometrial cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.endomet20-pr004] [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: 11/16/2022]
Abstract
Abstract
Objectives: The recent FDA approval of pembrolizumab for the treatment of recurrent, tissue agnostic cancers with Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient (dMMR) has led to the treatment of a selected cohort of endometrial cancer (EC) patients. Methods: We designed a study to ascertain tumor immune modulatory effects of pembrolizumab in the front-line setting for advanced stage III/IV surgically-resectable endometrial cancers regardless of MSI-H or dMMR status. The primary objectives were to determine the safety of treatment with pembrolizumab by radiographic imaging and to determine progression-free survival at 6 months. Exploratory objective was to compare the immune response before and after treatment. In an open label, single-arm Phase I trial, 8 EC patients were treated with 2 doses of preoperative pembrolizumab IV prior to surgery followed by carboplatin and paclitaxel and 4 doses of pembrolizumab 200mg/kg q3 weeks IV. Peripheral blood was collected from EC patients at baseline level before treatment and post 2 doses of pembrolizumab treatment. Blood from healthy controls (HC) was also collected. Both were processed for high-dimensional single-cell mass cytometry (CyTOF) using an optimized lymphoid and myeloid panel. Results: Patients who responded to therapy showed lower frequency of circulating CD8+ naïve T cells but higher frequency of CD8+ effector T cells after the treatment than the poor responders. We observed post-therapy expansion of populations of CD8+ and CD4+ T cells expressing co-stimulatory receptor ICOS in responders but not in poor responders. Granzyme+CD8+ and Granzyme+CD4+ T cell populations were expanded after pembrolizumab treatment in responders but were decreased in poor responders. Higher frequency of CD27+Fas- CD4+ T cells at baseline and increased frequency of CD27-Fas+CD4+ T cells post-treatment were observed in responders but not in the poor responders. Furthermore, we identified that circulating MDSCs were reduced after pembrolizumab treatment in responders. Conclusions: Our results suggest that peripheral blood analysis may provide valuable insights into responses to anti-PD-1-targeted therapies in patients with endometrial cancers.
Citation Format: Katherine Fuh, Elena Lomonosova, Russell Pachynski, Olga Malkova, Stephen Oh, Andrea Hagemann, Carolyn McCourt, Matthew Powell, Wendy Fantl, Premal Thaker. Multi-dimensional biomarker analyses identify pembrolizumab responders in advanced stage, high grade endometrial cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PR004.
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Affiliation(s)
- Katherine Fuh
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | - Olga Malkova
- 1Washington University School of Medicine, St. Louis, MO,
| | - Stephen Oh
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | - Matthew Powell
- 1Washington University School of Medicine, St. Louis, MO,
| | | | - Premal Thaker
- 1Washington University School of Medicine, St. Louis, MO,
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Mullen MM, Lomonosova E, Noia H, Wilke D, Oplt A, Guo L, Kuroki L, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Fuh K. Abstract A13: Therapeutic AXL inhibition with AVB-S6-500 improves response to chemotherapy and induces a homologous recombination deficiency in ovarian cancer. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.ovca19-a13] [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: 11/16/2022]
Abstract
Abstract
Background: Over 80% of patients with advanced ovarian cancer will develop chemoresistance and die within 5 years. Biomarkers to predict chemoresponse and novel therapies to target chemoresistance would be practice changing. We aim to establish serum and tissue GAS6 as predictive biomarkers of chemoresponse and to determine if AXL inhibition through sequestration of its ligand, GAS6, with AVB-S6-500 (AVB) can improve chemoresponse. Further, we desired to understand the affect AVB has on DNA damage response (DDR).
Methods: AVB was supplied by Aravive Biologics. High-grade serous ovarian cancer (HGSOC) tumor samples were obtained pre- and post-neoadjuvant chemotherapy. AXL and GAS6 expression were evaluated by immunohistochemistry and serum concentration. In vitro viability and clonogenic assays were performed on chemoresistant tumor cells (OVCAR8, OVCAR5, COV62, and POV71-hTERT) treated with chemotherapy +/- AVB. Mouse models (OVCAR8, PDX, OVCAR5) were used to determine if the combination of chemotherapy + AVB reduced tumor burden. Immunofluorescent (IF) assays targeting γH2AX were used to evaluate DNA damage and additional assays targeting 53BP1, RAD51, BRCA1, and BRCA2 were used to evaluate DNA damage response in cells treated with AVB, carboplatin, and/or AVB+carboplatin. Flow cytometry was used to evaluate RPA binding and cell cycle.
Results: Patients with high pretreatment tumor GAS6 expression (>85%, n=7) or serum GAS6 concentrations (>25ng/mL, n=13) were more likely to be resistant to neoadjuvant chemotherapy than those with low tumor GAS6 expression (<45%, n=4) (P=0.010) or low serum GAS6 concentrations (<15ng/mL, n=5) (P=0.002). Carboplatin plus AVB (2μM, 5μM) and paclitaxel plus AVB (1μM) resulted in decreased cell viability and clonogenic growth compared to chemotherapy alone (p<0.05) in all tumor cell lines. In vivo tumor mouse models treated with chemotherapy+AVB had significantly smaller subcutaneous and intraperitoneal (IP) tumors than those treated with chemotherapy alone (P<0.001). Increased DNA damage occurred in tumor cells treated with AVB than controls and in tumor cells treated with carboplatin+AVB than carboplatin alone (OVCAR8, COV362, CAOV3, OVCAR3-TPMES P<0.001). Cells treated with AVB either alone or in combination with carboplatin demonstrated decreased binding of protein involved in homologous recombination including RPA, RAD51, BRCA1, and BRCA2 (P<0.05). Conversely, these same cells demonstrated increased binding of the nonhomologous end joining protein 53BP1 (P<0.05). There were no differences in cell cycle among the treatment groups.
Conclusions: High GAS6 is associated with poor neoadjuvant chemoresponse in HGSOC patients. The combination of chemotherapy with AVB decreases tumor cell viability and tumor growth. AVB imparts a homologous recombination deficiency through downregulation of homology-directed DNA repair with an associated upregulation of nonhomologous end joining.
Citation Format: Mary Margaret Mullen, Elena Lomonosova, Hollie Noia, Daniel Wilke, Alyssa Oplt, Lei Guo, Lindsay Kuroki, Andrea Hagemann, Carolyn McCourt, Premal Thaker, David Mutch, Matthew Powell, Katherine Fuh. Therapeutic AXL inhibition with AVB-S6-500 improves response to chemotherapy and induces a homologous recombination deficiency in ovarian cancer [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr A13.
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Affiliation(s)
| | | | - Hollie Noia
- Washington University School of Medicine, St. Louis, MO
| | - Daniel Wilke
- Washington University School of Medicine, St. Louis, MO
| | - Alyssa Oplt
- Washington University School of Medicine, St. Louis, MO
| | - Lei Guo
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Premal Thaker
- Washington University School of Medicine, St. Louis, MO
| | - David Mutch
- Washington University School of Medicine, St. Louis, MO
| | | | - Katherine Fuh
- Washington University School of Medicine, St. Louis, MO
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Palisoul M, Greenwade M, Massad LS, Hagemann A, Powell M, Mutch D, Woolfolk C, Kuroki L. Factors influencing residents’ interest in gynecologic oncology fellowship. Gynecol Oncol Rep 2019; 30:100504. [PMID: 31867429 PMCID: PMC6906714 DOI: 10.1016/j.gore.2019.100504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/16/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
OB/GYN residents at academic programs are more likely to express intent to pursue a fellowship in gynecologic oncology. Strong mentor-mentee relationships influence OB/GYN residents’ interest in gynecologic oncology fellowship. The perception of burnout in gynecologic oncology fellows and faculty negatively impacts resident interest in the field.
Objectives To identify the role of mentorship and other factors associated with obstetrics and gynecology (OB/GYN) resident interest in pursuing a fellowship in gynecologic oncology. Methods A survey link was emailed to U.S. OB/GYN residency program coordinators to disperse to current residents. The 80-item survey asked about plans to pursue fellowship and influencing factors. Participants were stratified based on decision to pursue a fellowship in gynecologic oncology. Student’s t-test and Mann-Whitney tests were applied. Results Among 236 surveyed residents, 32 (13.6%) were planning to pursue a fellowship in gynecologic oncology. There were no demographic differences favoring the choice of gynecologic oncology; however, trainees at academic programs were more likely to aspire to the subspecialty (p = 0.01). Residents interested in gynecologic oncology had marginally more mentors than others (p = 0.06), were more likely to have a gynecologic oncology mentor (p < 0.01), and were more likely to have cited mentorship as a reason for their career aspirations (p = 0.01). These residents were also less likely to report obvious burnout among faculty and fellows in their department (p < 0.01 and p = 0.01, respectively). Conclusions Strong mentor relationships and the display of job satisfaction and work-life balance influence OB/GYN residents’ interest in gynecologic oncology fellowships. Programs should consider formal mentorship programs for residents, with priority on matching by subspecialty. The value of fellow and faculty efforts in mentorship should be recognized, and appropriate time should be protected for these relationships, along with efforts to support fellows and faculty at risk for burnout.
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Affiliation(s)
- Marguerite Palisoul
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
- Corresponding author at: 85 Seymour St, Suite 705, Hartford, CT 06106, United States.
| | - Molly Greenwade
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - Leslie S. Massad
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - Andrea Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - Matthew Powell
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - Candice Woolfolk
- Division of Statistics, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
| | - Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Washington University, 660 S. Euclid Ave. Mail Stop 8064, St Louis, MO 63110, United States
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Quinn J, Palisoul M, Guo L, Hagemann A, Powell M, Mutch D, McCourt C, Thaker P, Fuh K. Abstract 4034: Inhibition of AXL improves response to platinum and taxane in chemotherapy-resistant uterine and ovarian cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4034] [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: 11/16/2022]
Abstract
Abstract
AXL expression has been associated with decreased survival in uterine serous cancer (USC) and high-grade ovarian serous cancer (HGSOC). We determined whether therapeutic inhibition of AXL with BGB324, which is in Phase I/II clinical trials for solid tumors, would improve chemotherapy response in chemotherapy resistant uterine and ovarian cancers.
Taxane and platinum resistant ovarian and uterine cancer cell lines were used for in vitro cell viability (XTT) assays. Selective small molecule inhibition of AXL was achieved using BGB324. Western blotting was used to detect protein expression and activation. Tritium-labeled paclitaxel was utilized to measure chemotherapy accumulation in cancer cells. In vivo subcutaneous models were performed with the USC cell line ARK1 and patient-derived HGSOC xenografts (PDX). Statistical significance (p<0.05) and IC50 determination was assessed using Prism7.
Upon AXL inhibition by BGB324, the HGSOC cell lines OVCAR5, OVCAR3TP, and OVCAR3TPMes demonstrated a dose-dependent sensitization to paclitaxel and carboplatin chemotherapy. BGB324 treatment of OVCAR3TPMes cells improved response to carboplatin from untreated (IC50 of 73uM) to IC50 of 66uM, 51uM and 31uM at 0.25uM, 0.5uM, and 1uM, respectively (p<0.01). Similarly, paclitaxel response improved from untreated (IC50 of 15.4nM) to IC50 of 13.0nM, 11.3nM and 9.8nM at 0.25uM, 0.5uM, and 1uM, respectively (p<0.05).
To assess the dynamics of this chemoresponse, ARK1 USC cells were pre-treated with 0.5uM BGB324 and 1.0uM BGB324 and demonstrated a 31% and 43% increase in intracellular 3H-paclitaxel accumulation, respectively, when compared to cells without AXL inhibition (p<0.05). RT-PCR was utilized to detect changes in multidrug resistance protein transcripts; mRNA levels of P-Glycoprotein (PGP) had a 6.3-fold reduction in OVCAR3TPMES cells treated with 1uM BGB324 (p<0.05). This suggests that inhibition of AXL contributes to chemoresistance by increasing exposure of paclitaxel in tumor cells. The combination of paclitaxel and BGB324 therapy decreased USC tumor volume by 51-67% when compared to treatment with paclitaxel, BGB324, or vehicle control alone (p<0.05). In PDX models, BGB324 therapy improved tumor response with combined carboplatin and paclitaxel therapy when compared to chemotherapy alone, inhibitor alone, or vehicle control (77%, 87%, and 88% decrease in tumor volume at day 11, respectively, p<0.0001).
AXL expression contributes to platinum and taxane chemoresistance, and therapeutic inhibition of AXL with BGB324 restores chemosensitivity in ovarian and uterine cancer cell lines and patient derived xenograft models. Based on this data, chemoresistant tumors with AXL expression could be considered for treatment with BGB324 to restore chemosensitivity to carboplatin and paclitaxel.
Citation Format: Jeanne Quinn, Marguerite Palisoul, Lei Guo, Andrea Hagemann, Matthew Powell, David Mutch, Carolyn McCourt, Premal Thaker, Katherine Fuh. Inhibition of AXL improves response to platinum and taxane in chemotherapy-resistant uterine and ovarian cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4034.
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Affiliation(s)
- Jeanne Quinn
- Washington University School of Medicine, St. Louis, MO
| | | | - Lei Guo
- Washington University School of Medicine, St. Louis, MO
| | | | | | - David Mutch
- Washington University School of Medicine, St. Louis, MO
| | | | - Premal Thaker
- Washington University School of Medicine, St. Louis, MO
| | - Katherine Fuh
- Washington University School of Medicine, St. Louis, MO
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Haggerty AF, Hagemann A, Barnett M, Thornquist M, Neuhouser ML, Horowitz N, Colditz GA, Sarwer DB, Ko EM, Allison KC. A Randomized, Controlled, Multicenter Study of Technology-Based Weight Loss Interventions among Endometrial Cancer Survivors. Obesity (Silver Spring) 2017; 25 Suppl 2:S102-S108. [PMID: 29086522 PMCID: PMC6743497 DOI: 10.1002/oby.22021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of technology-based weight loss interventions for endometrial cancer (EC) survivors with obesity. METHODS EC survivors with obesity (n = 196) from three medical centers completed assessments for knowledge of obesity as a risk for EC and interest in weight management. Forty-one women were randomized to a 6-month intervention: telemedicine with Wi-Fi scales, text messaging (texting), or enhanced usual care (EUC). Changes in anthropometrics and psychosocial measures were analyzed. RESULTS One-third of survey participants lacked awareness that obesity increased the risk of EC, and 40% misclassified their body mass. There were no significant differences in weight loss across interventions (mean = -4.4 kg, SD = 6.5 kg). Telemedicine showed improvements in physical health and cancer-related body image (Ps = 0.04) compared to texting and in sexual functioning compared to EUC (P = 0.03). Total physical activity was increased in EUC compared with telemedicine (P = 0.01), and vigorous physical activity was increased in EUC compared with both interventions (P = 0.01-0.03); walking significantly increased in texting compared with telemedicine (P = 0.02). CONCLUSIONS Technology-based lifestyle interventions in EC survivors with obesity were accessible and resulted in weight loss and improved quality of life. EUC also produced weight loss, demonstrating a potential for beginning weight management with information on specific diet and exercise goals.
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Affiliation(s)
- Ashley F. Haggerty
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Hagemann
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Barnett
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mark Thornquist
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Neil Horowitz
- Dana Farber Cancer Institute, Harvard University, Cambridge, Massachusetts, USA
| | - Graham A. Colditz
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David B. Sarwer
- College of Public Health and Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Emily M. Ko
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly C. Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rauh S, Hoechstenbach L, Schmitz C, Hagemann A, Denine I. Outpatient monitoring with an eTool: self managed or with pro active intervention? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.070] [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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Fuh K, Gibson A, Wilke D, Ilagan M, Hagemann A, McCourt C, Thaker P, Mutch D, Powell M, Longmore G. Abstract AP18: FUNCTIONAL GENOMIC SCREEN FOR ATTACHMENT AND INVASION IN METASTATIC OVARIAN CANCER. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-ap18] [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: 11/16/2022]
Abstract
Abstract
PURPOSE: To perform a biologically relevant functional genomic screen for genes involved in attachment and early invasion incorporating tumor microenvironment cells cultured from human omentum.
METHODS: Primary fibroblasts cultured from the human omentum were plated as one component to recapitulate the tumor microenvironment. An arrayed small interfering RNA (siRNA) panel targeting 719 genes encoding kinases was used. Each well contained 2 oligos per gene. Three ovarian cancer cells with known metastatic capabilities (OVCAR8, ES2, and A2780) were selected and stably labeled with GFP. Following exposure to siRNA, ovarian cancer cells are overlaid upon a mixed submesothelial matrix (NOFs, collagen I, and fibronectin). After 72 hours of attachment/early invasion, a wash step was performed, and the functional readout of the intensity of fluorescence was performed. Cell death due to the siRNA was evaluated by staining with resazurin. Data was analyzed by expressing the effect of increased or decreased attachment using the median average deviation (MAD).
RESULTS: MAD values were generated for each gene. A baseline MAD value of 0 was used and positive MAD values denoted genes that influenced an increase in adhesion when knocked down whereas negative values represented genes that had decreased adhesion when knocked down. Negative controls for adhesion/early invasion were used and found to have a MAD value of 0.52 for mock transfection reagent control and 2.45 for siNEG control. Positive controls for adhesion/early invasion had a MAD value of -6.13 for siB1- integrin and -8.91 for a known inhibitor of attachment – canthardin. The transfection efficiency control, siDEATH, had a MAD value of -8.8. Of the 719 genes encoding kinases, we found 17 genes with MAD values above +3 and 19 genes with MAD values below -3. Of these hits, JAK1 and Wee1 were identified. JAK1 has been found to contribute to ovarian cancer invasion, migration, and metastasis in preclinical models. Wee1 is involved in cell cycle progression, and a Wee1 inhibitor is currently in a Phase II trial in relapsed ovarian cancer. Both targets confirm that biologically-relevant genes can be identified through this screen by incorporating stromal cells cultured from human omentum. Additionally, across 3 cell lines, we identified kinases that overlapped in at least 2 cell lines with a MAD lower range of -1.85. There were 94 kinases identified: 9 with a role in adhesion, 7 in immune response, 17 in proliferation, 6 in apoptosis, 16 in metabolism, 33 in cell cycle, 2 in migration, 3 in ribosomal, 1 in autophagy, and 23 genes with overlapping functions.
CONCLUSIONS: By incorporating the tumor microenvironment into a functional genomic screen, biologically relevant genes for ovarian cancer cell attachment and early invasion can be identified and will be validated as potential novel therapeutic targets.
Citation Format: Katherine Fuh, Anne Gibson, Daniel Wilke, Maxene Ilagan, Andrea Hagemann, Carolyn McCourt, Premal Thaker, David Mutch, Matthew Powell, and Gregory Longmore. FUNCTIONAL GENOMIC SCREEN FOR ATTACHMENT AND INVASION IN METASTATIC OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr AP18.
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Affiliation(s)
- Katherine Fuh
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Anne Gibson
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Daniel Wilke
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Maxene Ilagan
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Andrea Hagemann
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Carolyn McCourt
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Premal Thaker
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - David Mutch
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Matthew Powell
- 1Washington University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
| | - Gregory Longmore
- 2Department of Medicine, Division of Medical Oncology, St. Louis, MO
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Kedor C, Hagemann A, Zernicke J, Mattat K, Callhoff J, Feist E. THU0399 Effectiveness and Safety of Low-Dose Cyclosporine a in Patients with Primary Sjögren's Syndrome (PSS) with Articular Involvement – Results of a Pilot Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2806] [Citation(s) in RCA: 3] [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: 11/04/2022]
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Corr B, Winter A, Sammel M, Chu C, Gage B, Hagemann A. Abstract number 4: Efficacy and safety of perioperative venous thromboembolism (VTE) prophylaxis in gynecologic oncology patients. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.04.022] [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: 10/25/2022]
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Ioffe Y, Foster K, Erickson B, Mutch D, Powell M, Thaker P, Hagemann A, Conner M, Huh W, Massad L. Low yield of residual vulvar carcinoma and dysplasia upon re-excision for close or positive margins. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.456] [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: 10/26/2022]
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Novetsky A, Smith K, Babb S, Jeffe D, Hagemann A, Thaker P, Powell M, Mutch D, Massad L, Zighelboim I. Timing of genetic counselling in patients with ovarian, fallopian tube, or primary peritoneal carcinoma. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.293] [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: 10/26/2022]
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Grabowski NT, Ahlfeld B, Brix A, Hagemann A, von Münchhausen C, Klein G. Similarities and differences among fluid milk products: traditionally produced, extended shelf life and ultrahigh-temperature processed. FOOD SCI TECHNOL INT 2013; 19:235-41. [DOI: 10.1177/1082013212442200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extended shelf life milk is a relatively new kind of fluid milk, generally manufactured by high-temperature treatment and/or micro-filtration. Being advertised as ‘pasteurized milk with an extended shelf life’, its flavour, compositional quality and labelling was questioned. Extended shelf life (high-temperature treatment), pasteurized (‘traditionally produced’) and ultrahigh-temperature milk were, therefore, compared at the beginning and end of shelf life. In triangle tests, panellists distinguished clearly between all products. High-temperature treatment milk’s flavour was closer to ultrahigh-temperature and traditionally produced milk in the beginning and at the end of shelf life, respectively. Physicochemically and bacteriologically, all three types could be distinguished. Since ‘extended shelf life’ comprises many process varieties (each affecting flavour differently), consumer information and appropriate package labelling beyond ‘long-lasting’ is necessary, e.g. by mentioning the heat treatment applied.
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Affiliation(s)
- NT Grabowski
- Institute for Food Quality and Food Safety, Hannover University of Veterinary Medicine, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - B Ahlfeld
- Institute for Food Quality and Food Safety, Hannover University of Veterinary Medicine, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - A Brix
- Veterinary Institute of the Lower Saxony Office for Consumer Protection and Food Safety, Eintrachtweg 17, D-30173 Hannover, Germany
| | - A Hagemann
- Institute for Food Quality and Food Safety, Hannover University of Veterinary Medicine, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - C von Münchhausen
- Institute for Food Quality and Food Safety, Hannover University of Veterinary Medicine, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - G Klein
- Institute for Food Quality and Food Safety, Hannover University of Veterinary Medicine, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
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Hagemann A, Øie G, Attramadal Y, Veiseth R, Evjemo JO. Content of essential fatty acids in cultivated Acartia tonsa nauplii fed a DHA-deficient Tetraselmis sp. concentrate. Commun Agric Appl Biol Sci 2013; 78:169-172. [PMID: 25141657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ioffe Y, Hillen T, Zhou G, Schwarz J, Mutch D, Powell M, Rader J, Zighelboim I, Hagemann A, Thaker P. Post-radiation damage to the pelvic girdle in cervical cancer patients: Is intensity modulated radiation therapy safer than conventional radiation? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.028] [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: 10/28/2022]
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40
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Garg G, Mutch D, Hagemann A, Gao F, Wright J, Morris R, Kizer N, Powell M. Positive peritoneal cytology is an independent risk-factor among women diagnosed with endometrial cancer confined to the uterus. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Schöttler J, Hagemann A, Grothusen C, Stohn S, Pleger D, von der Brelie M, Cremer J, Haake N. [Mid-term outcome of cardiac surgery patients with prolonged postoperative intensive care treatment]. Med Klin Intensivmed Notfmed 2011; 106:41-7. [PMID: 21975841 DOI: 10.1007/s00063-011-0025-6] [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: 07/13/2010] [Revised: 11/27/2010] [Accepted: 11/30/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of patients of advanced age and with severe comorbidities undergoing cardiac surgery is rising. Therefore, in addition to the cardiac surgery procedure itself, postoperative intensive care treatment plays an increasingly important role. The mid-term outcome of patients with postoperative long-term stays in intensive care and perioperative risk factors for an adverse outcome have not been sufficiently evaluated. MATERIAL AND METHODS All patients who underwent cardiac surgery in our institution between 2000 and 2004 and who required intensive care treatment on our cardiac surgery intensive care unit for at least 1 week were analyzed. Patients who received heart or lung transplantation or surgery for congenital heart failure were excluded. A total of 31 perioperative variables were evaluated for 230 patients. Follow-up was performed 1 year postoperatively. RESULTS In all, 4.3% of our patients required a prolonged stay in intensive care following cardiac surgery. Overall 1-year mortality among patients with a long-term stay in intensive care was 26.9%. The logistic regression identified postoperative renal failure requiring dialysis (OR 4.98) as the strongest predictor for mortality within the first year after surgery, followed by postoperative tracheotomy and preoperatively known atrial fibrillation. CONCLUSION Mid-term survival among patients who underwent cardiac surgery followed by a complicated postoperative course is encouragingly high. The risk factors identified for an adverse prognosis may be helpful in improving therapy strategies and general therapy decision-making.
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Affiliation(s)
- J Schöttler
- Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
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Schöttler J, Jussli-Melchers J, Stracke L, Stohn S, Schoeneich F, Rahimi A, Hagemann A, Lutter G, Cremer J. Support of saphenous vein grafts externally with a Nitinol mesh (eSVS™, Kips Bay Medical, Minneapolis, USA) during coronary artery bypass grafting. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269362] [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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Schöttler J, Cremer J, Hagemann A, Pleger D, Haake N. Long-term survival after cardiac surgery with complicated postoperative course. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246811] [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]
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Lutter G, Iino K, de Buhr W, Hagemann A, Edwards NM, Metzner A, Cremer J, Lozonschi L. Early survival after transapical implantation of a novel mitral valved stent. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246621] [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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Hagemann A, Schöttler J, Bräsen JH, Cheng HF, Lutter G, Cremer J. Effect of anakinra and erythropoietin on infarct size in an ischemia-reperfused rat heart model – first results. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246787] [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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Abstract
Breast and ovarian cancer continue to be a significant source of morbidity and mortality. Improved understanding of signalling pathways related to growth and apoptosis has led to targeted treatments and modest improvement in long term outcomes. However, it has become increasingly clear that tumor factors alone are not the sole determinants of outcome in patients with breast and ovarian cancer. The tumor microenvironment and other immunologic host processes play an integral role in the overall interactions between disease, host and treatment. Cytokines play a major role in the immune response to tumors. Single nucleotide polymorphisms (SNPs) in the regulatory or coding regions of many cytokine genes lead to functional alterations in the transcriptional regulation of these genes or the proteins they encode. This review examines the current literature linking functional variants in cytokine and other immune genes to outcomes in breast and ovarian cancer. We have focused on those involved in the proinflammatory response (IL-6, TNF-alpha), apoptosis (TGF-beta, Fas, FasL, C1QA), angiogenesis (IL-8) and autoimmunity (IL-10). While much remains to be learned about the mechanisms underlying these variants and their impact on tumor behavior, this area holds promise for future development of prognostic profiles and therapeutics exploiting the immune response.
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Affiliation(s)
- Sarah Kim
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Abstract
The expression of angiotensin (Ang) II receptors, active renin and prorenin in porcine and bovine ovarian follicles and corpora lutea was investigated and compared. In the wall tissue of porcine follicles, the Ang II receptor density was 47 (range 19-97; n = 13) fmol/mg membrane protein. The active renin concentration was 1.32 (0.40-3.43; n = 23) GU/kg wet tissue. These values were about 35-fold and 15-fold lower, respectively, than previously found in bovine follicles. No prorenin could be detected in the porcine follicular wall tissue. Ang II receptors of subtype 2 (AT2 receptors) with a dissociation constant (Kd) of 1.01 (0.64-1.79; n = 8) nmol/l for [Sar1-Ile5-Ile8]-Ang II were demonstrated in the bovine corpus luteum. The receptor density was 22.7 (1.9-93; n = 26) fmol/mg membrane protein, which was about 10-fold higher than in porcine corpora lutea. The active renin concentration was 20.7 (2.2-60.0; n = 26) GU/kg tissue in bovine and 0.40 (0.16-1.09; n = 17) GU/kg tissue in porcine corpora lutea. No prorenin could be detected in corpora lutea from both species. The variation between species in expression of the ovarian renin-angiotensin system indicates the existence of species differences in the physiological role.
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Affiliation(s)
- A H Nielsen
- Department of Anatomy and Physiology, Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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Abstract
Evidence has accumulated for the existence of local tissue renin-angiotensin systems in the reproductive tissues. In the ovary the local renin-angiotensin system (RAS) has been shown to influence ovulation and steroidogenesis. In this review we focus on aspects of a local RAS in the uteroplacental unit. High renin concentrations have been found in all tissues of the uteroplacental unit. The presence of renin mRNA in the endometrium, choriodecidua and the fetal part of the placenta indicates local renin synthesis. Angiotensin (Ang) II, formed by the enzymatic action of tissue renin and Ang I converting enzyme, acts by interaction with its receptors. These receptors have been demonstrated in high densities in the placenta and uterus, indicating an autocrine or paracrine action of Ang II. Several probable effects of the uteroplacental RAS can be defined. It is very likely that the uteroplacental RAS plays an important role during implantation and placentation by stimulation of decidualization and angiogenesis. Furthermore, Ang II may regulate synthesis and secretion of other hormones formed locally in the uteroplacental unit. During labour the action of Ang II may be important for contraction of the uterine musculature, Ang II is also involved in the complex regulation of the uteroplacental blood flow. Species difference in the expression of the uteroplacental RAS exists, and one may speculate that the physiological and pathophysiological roles vary between species.
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Affiliation(s)
- A Hagemann
- Department of Anatomy and Physiology, Royal Veterinary and Agricultural University, Copenhagen, Denmark
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Hanke T, Misfeld M, Karluss A, Charitos EI, Neumeier I, Hagemann A, Graf B, Stierle U, Sievers HH. New insights into surgical atrial fibrillation ablation therapy: Initial experience with a novel permanently implantable heart rhythm monitor device. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191709] [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]
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50
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Lutter G, Metzner A, Jahnke T, Boldt J, Hagemann A, Abdelhadi M, Cremer J, Stock U. Percutaneous tissue engineered pulmonary valved stent implantation. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191554] [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]
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