1
|
Stein AP, Harder J, Holmes HR, Merz CNB, Pepine CJ, Keeley EC. Single Nucleotide Polymorphisms in Coronary Microvascular Dysfunction. J Am Heart Assoc 2024; 13:e032137. [PMID: 38348798 PMCID: PMC11010085 DOI: 10.1161/jaha.123.032137] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Coronary microvascular dysfunction is an underdiagnosed pathologic process that is associated with adverse clinical outcomes. There are data to suggest that coronary microvascular dysfunction, in some cases, may be genetically determined. We present an updated review of single nucleotide polymorphisms in coronary microvascular dysfunction.
Collapse
Affiliation(s)
- Andrew P Stein
- Department of Medicine University of Florida Gainesville FL USA
| | - Jonathan Harder
- Department of Medicine University of Florida Gainesville FL USA
| | - Henry R Holmes
- Department of Medicine University of Florida Gainesville FL USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA
| | - Carl J Pepine
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| | - Ellen C Keeley
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| |
Collapse
|
2
|
Stein AP, Matthia EL, Petty SA, Stewart B, Vilaro JR, Al-Ani MAZ, Ahmed MM, Aranda JM, Hiemenz JW, Parker AM. Transthyretin Cardiac Amyloidosis Disguised as Light Chain Amyloidosis or Multiple Myeloma? Am J Cardiol 2024; 210:85-92. [PMID: 37852567 DOI: 10.1016/j.amjcard.2023.10.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
We describe 2 challenging cases of cardiac transthyretin amyloidosis initially treated as cardiac amyloidosis light chain in the setting of active myeloma. Endomyocardial biopsy with mass spectrometry was essential to confirm the appropriate diagnosis to direct the treatment.
Collapse
Affiliation(s)
- Andrew P Stein
- Department of Medicine, University of Florida, Gainesville, Florida.
| | - Eldon L Matthia
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Stephen A Petty
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Brian Stewart
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Juan R Vilaro
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Mohammad A Z Al-Ani
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Mustafa M Ahmed
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Juan M Aranda
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - John W Hiemenz
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Hematology/Oncology Medicine, University of Florida, Gainesville, Florida
| | - Alex M Parker
- Department of Medicine, University of Florida, Gainesville, Florida; Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
3
|
Edwards ER, Fei-Zhang DJ, Stein AP, Lott DG, Chelius DC, Sheyn A, Rastatter J. The impact of digital inequities on laryngeal cancer disparities in the US. Am J Otolaryngol 2024; 45:104066. [PMID: 37820390 DOI: 10.1016/j.amjoto.2023.104066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. METHODS DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. RESULTS With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03-1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04-1.08), and radiation therapy (OR 1.02; 95 % CI 1.00-1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94-97). CONCLUSIONS Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.
Collapse
Affiliation(s)
- Evan R Edwards
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA
| | - Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Chicago, IL 60611, USA
| | - David G Lott
- Division of Laryngology, Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163-2242, USA
| | - Jeffrey Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Chicago, IL 60611, USA
| |
Collapse
|
4
|
Stein AP, Stewart BD, Patel DC, Al-Ani M, Vilaro J, Aranda JM, Ahmed MM, Parker AM. Recurrent Cardiac Sarcoidosis and Giant Cell Myocarditis After Heart Transplant: A Case Report and Systematic Literature Review. Am J Cardiol 2023; 207:271-279. [PMID: 37769570 DOI: 10.1016/j.amjcard.2023.08.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/03/2023]
Abstract
Recurrence of cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) after heart transplant is rare, with rates of 5% in CS and 8% in GCM. We aim to identify all reported cases of recurrence in the literature and to assess clinical course, treatments, and outcomes to improve understanding of the conditions. A systematic review, utilizing Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was conducted by searching MEDLINE/PubMed and Embase of all available literature describing post-transplant recurrent granulomatous myocarditis, CS, or GCM. Data on demographics, transplant, recurrence, management, and outcomes data were collected from each publication. Comparison between the 2 groups were made using standard statistical approaches. Post-transplant GM recurrence was identified in 39 patients in 33 total publications. Reported cases included 24 GCM, 12 CS, and 3 suspected cases. Case reports were the most frequent form of publication. Mean age of patients experiencing recurrence was 42 years for GCM and 48 years for CS and favored males (62%). Time to recurrence ranged from 2 weeks to 9 years post-transplant, occurring earlier in GCM (mean 1.8 vs 3.0 years). Endomyocardial biopsies (89%) were the most utilized diagnostic method over cardiac magnetic resonance and positron emission tomography. Recurrence treatment regimens involved only steroids in 40% of CS, whereas other immunomodulatory regimens were utilized in 70% of GCM. In conclusion, GCM and CS recurrence after cardiac transplantation holds associated risks including concurrent acute cellular rejection, a higher therapeutic demand for GCM recurrence compared with CS, and mortality. New noninvasive screening techniques may help modify post-transplant monitoring regimens to increase both early detection and treatment of recurrence.
Collapse
Affiliation(s)
| | | | - Divya C Patel
- Division of Pulmonary, Critical Care and Sleep Medicine
| | - Mohammad Al-Ani
- Division of Cardiology, Department of Medicine, University of Florida Gainesville, Florida
| | - Juan Vilaro
- Division of Cardiology, Department of Medicine, University of Florida Gainesville, Florida
| | - Juan M Aranda
- Division of Cardiology, Department of Medicine, University of Florida Gainesville, Florida
| | - Mustafa M Ahmed
- Division of Cardiology, Department of Medicine, University of Florida Gainesville, Florida
| | - Alex M Parker
- Division of Cardiology, Department of Medicine, University of Florida Gainesville, Florida
| |
Collapse
|
5
|
Edwards ER, Sachse S, Howard NS, Maronian NC, Morrison RJ, Stein AP. Endoscopic L-stent for suprastomal tracheal stenosis. Am J Otolaryngol 2023; 44:103949. [PMID: 37329695 DOI: 10.1016/j.amjoto.2023.103949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Evan R Edwards
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States of America
| | - Sydney Sachse
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, 675 N St Clair St, Chicago, IL 60611, United States of America
| | - N Scott Howard
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States of America
| | - Nicole C Maronian
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States of America
| | - Robert J Morrison
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States of America
| | - Andrew P Stein
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University, 675 N St Clair St, Chicago, IL 60611, United States of America.
| |
Collapse
|
6
|
Perry C, Budweg JB, Stein AP, Harder J, Gupta S, Nusbickel AJ, Smoot M, Patel K, Winchester DE. Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities. Am J Med 2023; 136:350-354. [PMID: 36566899 DOI: 10.1016/j.amjmed.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
Collapse
Affiliation(s)
| | | | | | | | - Shishir Gupta
- University of Florida College of Medicine, Gainesville
| | | | | | - Keval Patel
- University of Florida College of Medicine, Gainesville
| | - David E Winchester
- University of Florida College of Medicine, Gainesville; Cardiology Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla.
| |
Collapse
|
7
|
Affiliation(s)
- Iris S. Harrison
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Andrew P. Stein
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Lawangeen Zeb
- Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Nila S. Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
- Correspondence to: Nila S. Radhakrishnan, MD, Associative Professor of Medicine; Chief, Division of Hospital Medicine, University of Florida College of Medicine, PO Box 100238, Gainesville, FL 32610.
| |
Collapse
|
8
|
Brand TM, Iida M, Corrigan KL, Braverman CM, Coan JP, Flanigan BG, Stein AP, Salgia R, Rolff J, Kimple RJ, Wheeler DL. Retraction. Sci Signal 2021; 14:eabn0168. [PMID: 34752142 PMCID: PMC8787917 DOI: 10.1126/scisignal.abn0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Toni M Brand
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Mari Iida
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Kelsey L Corrigan
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Cara M Braverman
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - John P Coan
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Bailey G Flanigan
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Andrew P Stein
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research,
City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010,
USA
| | - Jana Rolff
- Experimental Pharmacology and Oncology Berlin-Buch GmbH,
Robert-Roessle-Str. 10, 13125 Berlin, Germany
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| | - Deric L Wheeler
- Department of Human Oncology, University of Wisconsin
School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705,
USA
| |
Collapse
|
9
|
Neevel AJ, Smith JD, Morrison RJ, Hogikyan ND, Kupfer RA, Stein AP. Postacute COVID-19 Laryngeal Injury and Dysfunction. OTO Open 2021; 5:2473974X211041040. [PMID: 34458661 PMCID: PMC8392819 DOI: 10.1177/2473974x211041040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 01/06/2023] Open
Abstract
Objective Patients with COVID-19 are at risk for laryngeal injury and dysfunction secondary to respiratory failure, prolonged intubation, and other unique facets of this illness. Our goal is to report clinical features and treatment for patients presenting with voice, airway, and/or swallowing concerns postacute COVID-19. Study Design Case series. Setting Academic tertiary care center. Methods Patients presenting with laryngeal issues following recovery from COVID-19 were included after evaluation by our laryngology team. Data were collected via retrospective chart review from March 1, 2020, to April 1, 2021. This included details of the patient’s COVID-19 course, initial presentation to laryngology, and subsequent treatment. Results Twenty-four patients met inclusion criteria. Twenty (83%) patients were hospitalized, and 18 required endotracheal intubation for a median (range) duration of 14 days (6-31). Ten patients underwent tracheostomy. Patients were evaluated at a median 107 days (32-215) after their positive SARS-CoV-2 test result. The most common presenting concerns were dysphonia (n = 19, 79%), dyspnea (n = 17, 71%), and dysphagia (n = 6, 25%). Vocal fold motion impairment (50%), early glottic injury (39%), subglottic/tracheal stenosis (22%), and posterior glottic stenosis (17%) were identified in patients who required endotracheal intubation. Patients who did not need intubation were most frequently treated for muscle tension dysphonia (67%). Conclusion Patients may develop significant voice, airway, and/or swallowing issues postacute COVID-19. These complications are not limited to patients requiring intubation or tracheostomy. Multidisciplinary laryngology clinics will continue to play an integral role in diagnosing and treating patients with COVID-19–related laryngeal sequelae.
Collapse
Affiliation(s)
- Andrew J Neevel
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
10
|
Cheng OT, Stein AP, Babajanian E, Hoppe KR, Li S, Jung H, Abrol A, Akkus A, Younesi M, Altawallbeh G, Ghannoum MA, Bonfield T, Akkus O, Zender CA. Heparin-mediated antibiotic delivery from an electrochemically-aligned collagen sheet. Biomed Mater Eng 2021; 32:159-170. [PMID: 33780355 DOI: 10.3233/bme-201133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Implantable medical devices and hardware are prolific in medicine, but hardware associated infections remain a major issue. OBJECTIVE To develop and evaluate a novel, biologic antimicrobial coating for medical implants. METHODS Electrochemically compacted collagen sheets with and without crosslinked heparin were synthesized per a protocol developed by our group. Sheets were incubated in antibiotic solution (gentamicin or moxifloxacin) overnight, and in vitro activity was assessed with five-day diffusion assays against Pseudomonas aeruginosa. Antibiotic release over time from gentamicin-infused sheets was determined using in vitro elution and high performance liquid chromatography (HPLC). RESULTS Collagen-heparin-antibiotic sheets demonstrated larger growth inhibition zones against P. aeruginosa compared to collagen-antibiotic alone sheets. This activity persisted for five days and was not impacted by rinsing sheets prior to evaluation. Rinsed collagen-antibiotic sheets did not produce any inhibition zones. Elution of gentamicin from collagen-heparin-gentamicin sheets was gradual and remained above the minimal inhibitory concentration for gentamicin-sensitive organisms for 29 days. Conversely, collagen-gentamicin sheets eluted their antibiotic load within 24 hours. Overall, heparin-associated sheets demonstrated larger inhibition zones against P. aeruginosa and prolonged elution profile via HPLC. CONCLUSION We developed a novel, local antibiotic delivery system that could be used to coat medical implants/hardware in the future and reduce post-operative infections.
Collapse
Affiliation(s)
- Olivia T Cheng
- Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, USA
| | - Andrew P Stein
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eric Babajanian
- Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, USA
| | - Kathryn R Hoppe
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hyungjin Jung
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | - Anish Abrol
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anna Akkus
- Department of Macromolecular Science & Engineering, CWRU, Cleveland, OH, USA
| | - Mousa Younesi
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | | | - Mahmoud A Ghannoum
- Center for Medical Mycology, CWRU and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Ozan Akkus
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | - Chad A Zender
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
11
|
Smith JD, Correll JA, Stein JL, Kupfer RA, Hogikyan ND, Morrison RJ, Stein AP. Discordant SARS-CoV-2 Detection in the Nasopharynx Versus Trachea for Patients With Tracheostomies. Laryngoscope 2021; 131:E2634-E2638. [PMID: 33959969 PMCID: PMC8242790 DOI: 10.1002/lary.29617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES/HYPOTHESIS Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Our goal was to evaluate for discordance in SARS-CoV-2 detection in hospitalized patients with COVID-19 and tracheostomies based on the site analyzed. STUDY DESIGN Retrospective chart review METHODS: This single-institution study evaluated hospitalized patients with COVID-19 who had tracheostomies placed during their treatment. We analyzed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) results after tracheostomy. All included patients had nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period, allowing us to characterize rate of test concordance. RESULTS Forty-five patients met our inclusion criteria. Thirty-two (71.1%) patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive. There were no statistically significant differences in demographic or clinical variables, including time to tracheostomy and time to testing, among patients with concordant versus discordant SARS-CoV-2 results. CONCLUSION This represents the first study to examine SARS-CoV-2 RNA NAAT concordance between NP and TR sites in hospitalized patients with COVID-19 and tracheostomies. One-third of patients demonstrated discordant testing when NP and TR specimens were collected within a 48-hour time period. Thus, patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. We recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
Collapse
Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jason A Correll
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jennifer L Stein
- Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, U.S.A
| | - Robbi A Kupfer
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Robert J Morrison
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Andrew P Stein
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
12
|
Affiliation(s)
- Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
13
|
Weber MH, Stein AP, D'Anza BD. A Destructive Sinonasal Process Leading to Sudden Blindness. JAMA Otolaryngol Head Neck Surg 2019; 145:83-84. [PMID: 30383156 DOI: 10.1001/jamaoto.2018.2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael H Weber
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brian D D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| |
Collapse
|
14
|
Brand TM, Iida M, Stein AP, Corrigan KL, Braverman CM, Coan JP, Pearson HE, Bahrar H, Fowler TL, Bednarz BP, Saha S, Yang D, Gill PS, Lingen MW, Saloura V, Villaflor VM, Salgia R, Kimple RJ, Wheeler DL. Correction: AXL Is a Logical Molecular Target in Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2018; 24:6099. [PMID: 30510088 DOI: 10.1158/1078-0432.ccr-18-3194] [Citation(s) in RCA: 1] [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: 11/16/2022]
|
15
|
|
16
|
Redlich N, Robinson AM, Nickel KP, Stein AP, Wheeler DL, Adkins DR, Uppaluri R, Kimple RJ, Van Tine BA, Michel LS. Anti-Trop2 blockade enhances the therapeutic efficacy of ErbB3 inhibition in head and neck squamous cell carcinoma. Cell Death Dis 2018; 9:5. [PMID: 29305574 PMCID: PMC5849045 DOI: 10.1038/s41419-017-0029-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/02/2017] [Accepted: 09/20/2017] [Indexed: 12/22/2022]
Abstract
ErbB3 has been widely implicated in treatment resistance, but its role as a primary treatment target is less clear. Canonically ErbB3 requires EGFR or ErbB2 for activation, whereas these two established treatment targets are thought to signal independently of ErbB3. In this study, we show that ErbB3 is essential for tumor growth of treatment-naive HNSCC patient-derived xenografts. This ErbB3 dependency occurs via ErbB3-mediated control of EGFR activation and HIF1α stabilization, which require ErbB3 and its ligand neuregulin-1. Here, we show that ErbB3 antibody treatment selects for a population of ErbB3-persister cells that express high levels of the transmembrane protein Trop2 that we previously identified as an inhibitor of ErbB3. Co-treatment with anti-ErbB3 and anti-Trop2 antibodies is synergistic and produces a greater anti-tumor response than either antibody alone. Collectively, these data both compel a revision of ErbB-family signaling and delineate a strategy for its effective inhibition in HNSCC.
Collapse
Affiliation(s)
| | - Anthony M Robinson
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Kwangok P Nickel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Andrew P Stein
- School of Medicine, Department of Otolaryngology, Case Western Reserve University, Cleveland, OH, USA
| | - Deric L Wheeler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Douglas R Adkins
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Brian A Van Tine
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Loren S Michel
- Memorial Sloan-Kettering Cancer Center, Monmouth, NJ, USA
| |
Collapse
|
17
|
Brand TM, Iida M, Corrigan KL, Braverman CM, Coan JP, Flanigan BG, Stein AP, Salgia R, Rolff J, Kimple RJ, Wheeler DL. Abstract 3333: The receptor tyrosine kinase AXL mediates nuclear translocation of the epidermal growth factor receptor. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3333] [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
The epidermal growth factor receptor (EGFR) is an important therapeutic target in patients with various cancers. Unfortunately, resistance to anti-EGFR therapeutics is common. Previous studies in our laboratory identified two mechanisms of resistance to the EGFR monoclonal antibody cetuximab: First, the nuclear translocation of EGFR bypasses the inhibitory effects of cetuximab; and second, the receptor tyrosine kinase AXL mediates cetuximab resistance by maintaining EGFR activation and downstream signaling. On the basis of these findings, we hypothesized that AXL could mediate the nuclear translocation of EGFR in the setting of cetuximab resistance. We found that NSCLC cetuximab-resistant clones and patient-derived xenografts (PDXs) had increased abundance of nuclear EGFR (nEGFR) and AXL. Cellular fractionation techniques, super resolution microscopy, and electron microcopy revealed that genetic loss of AXL diminished the nuclear translocation and accumulation of EGFR. Building on previous studies indicating that SRC family kinases (SFKs) and HER family ligands mediate the nuclear translocation of EGFR, we found that AXL knockdown down-regulated the expression of the SFKs YES and LYN, and the ligand neuregulin-1 (NRG1). Furthermore, AXL knockdown decreased the interaction between EGFR and HER3 and the nuclear abundance of HER3. Nuclear localization of EGFR could be rescued only upon simultaneous overexpression of Lyn and NRG1 in cells depleted of AXL. Collectively, these data uncover a previously unrecognized role for AXL in regulating the nuclear translocation of EGFR and suggest that AXL-mediated SFK activation and NRG1 expression are necessary and sufficient to regulate this process.
Citation Format: Toni M. Brand, Mari Iida, Kelsey L. Corrigan, Cara M. Braverman, John P. Coan, Bailey G. Flanigan, Andrew P. Stein, Ravi Salgia, Jana Rolff, Randall J. Kimple, Deric L. Wheeler. The receptor tyrosine kinase AXL mediates nuclear translocation of the epidermal growth factor receptor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3333. doi:10.1158/1538-7445.AM2017-3333
Collapse
Affiliation(s)
| | - Mari Iida
- 1Univ. of Wisconsin-Madison, Madison, WI
| | | | | | | | | | | | | | - Jana Rolff
- 3Experimental Pharmacology and Oncology Berlin-Buch GmbH, Berlin, Germany
| | | | | |
Collapse
|
18
|
Brand TM, Iida M, Corrigan KL, Braverman CM, Coan JP, Flanigan BG, Stein AP, Salgia R, Rolff J, Kimple RJ, Wheeler DL. RETRACTED: The receptor tyrosine kinase AXL mediates nuclear translocation of the epidermal growth factor receptor. Sci Signal 2017; 10:10/460/eaag1064. [PMID: 28049763 PMCID: PMC7094775 DOI: 10.1126/scisignal.aag1064] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The epidermal growth factor receptor (EGFR) is a therapeutic target in patients with various cancers. Unfortunately, resistance to EGFR-targeted therapeutics is common. Previous studies identified two mechanisms of resistance to the EGFR monoclonal antibody cetuximab. Nuclear translocation of EGFR bypasses the inhibitory effects of cetuximab, and the receptor tyrosine kinase AXL mediates cetuximab resistance by maintaining EGFR activation and downstream signaling. Thus, we hypothesized that AXL mediated the nuclear translocation of EGFR in the setting of cetuximab resistance. Cetuximab-resistant clones of non-small cell lung cancer in culture and patient-derived xenografts in mice had increased abundance of AXL and nuclear EGFR (nEGFR). Cellular fractionation analysis, super-resolution microscopy, and electron microscopy revealed that genetic loss of AXL reduced the accumulation of nEGFR. SRC family kinases (SFKs) and HER family ligands promote the nuclear translocation of EGFR. We found that AXL knockdown reduced the expression of the genes encoding the SFK family members YES and LYN and the ligand neuregulin-1 (NRG1). AXL knockdown also decreased the interaction between EGFR and the related receptor HER3 and accumulation of HER3 in the nucleus. Overexpression of LYN and NRG1 in cells depleted of AXL resulted in accumulation of nEGFR, rescuing the deficit induced by lack of AXL. Collectively, these data uncover a previously unrecognized role for AXL in regulating the nuclear translocation of EGFR and suggest that AXL-mediated SFK and NRG1 expression promote this process.
Collapse
Affiliation(s)
- Toni M. Brand
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Mari Iida
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Kelsey L. Corrigan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Cara M. Braverman
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - John P. Coan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Bailey G. Flanigan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Andrew P. Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Ravi Salgia
- Department of Medical Oncology & Therapeutics Research. City of Hope Comprehensive Cancer Center. 1500 East Duarte Road, Duarte, CA, 91010
| | - Jana Rolff
- Experimental Pharmacology and Oncology Berlin-Buch GmbH, Robert-Roessle-Str. 10, 13125 Berlin, Germany
| | - Randall J. Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA
| | - Deric L. Wheeler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, Wisconsin, 53705 USA,Corresponding author.
| |
Collapse
|
19
|
Swick AD, Stein AP, McCulloch TM, Hartig GK, Ong IM, Sampene E, Prabakaran PJ, Liu CZ, Kimple RJ. Defining the boundaries and expanding the utility of head and neck cancer patient derived xenografts. Oral Oncol 2016; 64:65-72. [PMID: 28024726 DOI: 10.1016/j.oraloncology.2016.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/11/2016] [Accepted: 11/27/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patient derived xenografts (PDXs) represent an essential tool in oncologic research, and we sought to further expand our repertoire of head and neck squamous cell carcinoma (HNSCC) while determining potential boundaries for this system. METHODS We consented new patients for PDX development and determined if a 24-h time delay from tumor excision to xenograft implantation affected PDX establishment. We developed a tissue microarray (TMA) from formalin fixed, paraffin embedded PDXs and their subsequent passages and carried out quantitative immunohistochemistry for EGFR, pEGFR, pAkt, pERK and ERCC1. First and last passaged PDXs were compared via a paired t-test to examine for the stability of protein expression across passages. We performed a similar comparison of the mutational profile of the patient tumor and resulting xenografts using a targeted sequencing approach. RESULTS No patient/tumor characteristics influenced PDX take rate and the 24-h time delay from tumor excision to xenograft implantation did not affect PDX establishment, growth or histology. There was no significant difference in biomarker expression between the first and last passaged PDXs for EGFR, pEGFR, pAkt, and ERCC1. For pERK there was a significant difference (p=0.002), but further analysis demonstrated this only arose in three of 15 PDXs. Targeted sequencing revealed striking stability of passenger and likely driver mutations from patient to xenograft. CONCLUSIONS The stability of protein expression across PDX passages will hopefully allow greater investigation of predictive biomarkers in order to identify ones for further pre-clinical and clinical investigation.
Collapse
Affiliation(s)
- Adam D Swick
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Andrew P Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Timothy M McCulloch
- Department of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Gregory K Hartig
- Department of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Irene M Ong
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Emmanuel Sampene
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Prashanth J Prabakaran
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Cheng Z Liu
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
| |
Collapse
|
20
|
Britt CJ, Stein AP, Gessert T, Pflum Z, Saha S, Hartig GK. Factors influencing sialocele or salivary fistula formation postparotidectomy. Head Neck 2016; 39:387-391. [PMID: 27550745 DOI: 10.1002/hed.24564] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/05/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Does the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele/salivary fistula formation? METHODS All patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013 were considered. Patients who developed a sialocele/salivary fistula were identified. Extent of dissection, age, sex, body mass index (BMI), volume of specimen, and rate of malignancy were examined. RESULTS Seventy of 771 patients (9.1%) developed a sialocele/salivary fistula. Sixty-seven fistulae (96%) developed within 1 month and all resolved by 6 months. Age, sex, pathology, and BMI were not increased in the sialocele group. Inferior and middle superficial parotidectomy had a significantly higher rate of sialocele than other extents of dissection. Volume of tissue removed was not significantly different between dissection groups. CONCLUSION Sialocele/salivary fistula is common postparotidectomy and is more likely with inferior and middle superficial parotidectomy. © 2016 Wiley Periodicals, Inc. Head Neck 39: 387-391, 2017.
Collapse
Affiliation(s)
- Christopher J Britt
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew P Stein
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Thomas Gessert
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Zach Pflum
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandeep Saha
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory K Hartig
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
21
|
Abstract
PURPOSE The global incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been increasing, and it has been proposed that a rising rate of human papillomavirus (HPV)-associated cancers is driving the observed changes in OPSCC incidence. We carried out this systematic review to further examine the prevalence of HPV in OPSCC over time worldwide. METHODS A systematic literature search was performed to identify all articles through January 31, 2014, which reported on the prevalence of HPV in OPSCC. Articles that met the inclusion criteria were divided into 4 time frames (pre-1995, 1995-1999, 2000-2004, and 2005 to present) based on the median year of the study's sample collection period. Using a weighted analysis of variance model, we examined the trends of HPV-positivity over time worldwide, in North America, and in Europe. RESULTS Our literature search identified 699 unique articles. One hundred seventy-five underwent review of the entire study, and 105 met the inclusion criteria. These 105 articles reported on the HPV prevalence in 9541 OPSCC specimens across 23 nations. We demonstrated significant increases in the percentage change of HPV-positive OPSCCs from pre-1995 to present: 20.6% worldwide (P for trend: P < 0.001), 21.6% in North America (P = 0.013), and 21.5% in Europe (P = 0.033). CONCLUSIONS Interestingly, whereas in Europe there was a steady increase in HPV prevalence across all time frames, reaching nearly 50% most recently, in North America HPV prevalence appears to have plateaued over the past decade at about 65%. These findings may have important implications regarding predictions for the future incidence of OPSCC.
Collapse
Affiliation(s)
- Andrew P Stein
- From the Departments of *Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI; †Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI; and ‡Biostatistics, University of Wisconsin, Madison, WI
| | | | | | | | | | | | | |
Collapse
|
22
|
Britt CJ, Stein AP, Patel PN, Harari PM, Hartig GK. Incidental Parotid Neoplasms. Otolaryngol Head Neck Surg 2015; 153:566-8. [DOI: 10.1177/0194599815586764] [Citation(s) in RCA: 6] [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] [Received: 02/06/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
Objective To better characterize parotid masses incidentally identified on imaging. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Medical records were reviewed for 771 patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients were stratified into 2 groups: those with tumors identified solely on imaging (parotid incidentalomas [PIs]) and those with palpable masses, pain, facial nerve dysfunction, or other reasons their mass was identified (nonincidentals [NIs]). A χ2 test was employed to compare the prevalence of malignancy in PIs compared with NIs. Trend analysis was performed to determine the prevalence of PIs over the 20-year period. Results Of the 771 patients, 67 (8.7%) had their mass discovered incidentally on imaging (PIs). There was a significant difference in the rate of malignancy in the NI (32.7%) compared with the PI group (6.0%) ( P < .01). During the 1994 to 2003 time period, 4.0% of all parotoidectomies performed were for PIs, while during the second decade (2004-2013), this proportion increased to 10.2%. This represents a 155.0% increase in the percentage of parotidectomies carried out for PIs between these 2 periods. Conclusion In this study, the rate of malignancy in PIs was significantly lower than the rate of malignancy in patients with NIs. The occurrence of PIs has increased over time and now represents greater than 10.0% of all parotidectomies performed at the University of Wisconsin. This information is important to consider when consenting a patient for resection of a PI.
Collapse
Affiliation(s)
- Christopher J. Britt
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew P. Stein
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Priyesh N. Patel
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gregory K. Hartig
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
23
|
Stein AP, Britt CJ, Saha S, McCulloch TM, Wieland AM, Harari PM, Hartig GK. Patient and tumor characteristics predictive of primary parotid gland malignancy: A 20-year experience at the University of Wisconsin. Am J Otolaryngol 2015; 36:429-34. [PMID: 25766621 DOI: 10.1016/j.amjoto.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify patient and tumor characteristics predictive of primary parotid malignancy. MATERIALS AND METHODS Records were reviewed for patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients with primary parotid neoplasms were separated into benign or malignant subgroups. A multivariate logistic regression model was employed to compare categorical (gender, lesion side, nature of presentation, recurrence) and numerical variables (age, tumor size) between the benign and malignant groups. Mean BMI was compared between the groups by univariate analysis. RESULTS 771 patients underwent parotidectomy from 1994 to 2013, and 474 had a primary parotid neoplasm. No relationship existed between malignancy and gender (p=0.610), lesion side (p=0.110), or BMI (p=0.196). Mean age (p=0.015) and tumor size (p=0.011) were significantly different between the benign and malignant groups. Patient presentation was classified into three categories: symptomatic (n=109), palpable and asymptomatic (n=303), and incidentally noted on imaging (n=57). From all patients with symptomatic, asymptomatic or incidentally noted masses, 41.3%, 10.6% and 5.3%, respectively, were diagnosed with malignant disease. There was a significant relationship between the patient's initial presentation and malignancy (p<0.001), and patients with facial nerve dysfunction or skin involvement had the greatest likelihood of malignancy. Finally, there was a significant association between malignancy and recurrence (p=0.001). CONCLUSIONS In this study, age, tumor size, and nature of presentation were all associated with primary parotid malignancy. Understanding the impact of these features on the probability of malignancy is valuable in decision making and counseling of patients presenting with a newly diagnosed parotid neoplasm.
Collapse
|
24
|
Brand TM, Iida M, Stein AP, Corrigan KL, Braverman CM, Coan JP, Pearson HE, Bahrar H, Fowler TL, Bednarz BP, Saha S, Yang D, Gill PS, Lingen MW, Saloura V, Villaflor VM, Salgia R, Kimple RJ, Wheeler DL. AXL Is a Logical Molecular Target in Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2015; 21:2601-12. [PMID: 25767293 DOI: 10.1158/1078-0432.ccr-14-2648] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/27/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) represents the eighth most common malignancy worldwide. Standard-of-care treatments for patients with HNSCC include surgery, radiation, and chemotherapy. In addition, the anti-EGFR monoclonal antibody cetuximab is often used in combination with these treatment modalities. Despite clinical success with these therapeutics, HNSCC remains a difficult malignancy to treat. Thus, identification of new molecular targets is critical. EXPERIMENTAL DESIGN In the current study, the receptor tyrosine kinase AXL was investigated as a molecular target in HNSCC using established cell lines, HNSCC patient-derived xenografts (PDX), and human tumors. HNSCC dependency on AXL was evaluated with both anti-AXL siRNAs and the small-molecule AXL inhibitor R428. Furthermore, AXL inhibition was evaluated with standard-of-care treatment regimens used in HNSCC. RESULTS AXL was found to be highly overexpressed in several models of HNSCC, where AXL was significantly associated with higher pathologic grade, presence of distant metastases, and shorter relapse-free survival in patients with HNSCC. Further investigations indicated that HNSCC cells were reliant on AXL for cellular proliferation, migration, and invasion. In addition, targeting AXL increased HNSCC cell line sensitivity to chemotherapy, cetuximab, and radiation. Moreover, radiation-resistant HNSCC cell line xenografts and PDXs expressed elevated levels of both total and activated AXL, indicating a role for AXL in radiation resistance. CONCLUSIONS This study provides evidence for the role of AXL in HNSCC pathogenesis and supports further preclinical and clinical evaluation of anti-AXL therapeutics for the treatment of patients with HNSCC.
Collapse
Affiliation(s)
- Toni M Brand
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mari Iida
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew P Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelsey L Corrigan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cara M Braverman
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John P Coan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hannah E Pearson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Harsh Bahrar
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler L Fowler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Bryan P Bednarz
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Sandeep Saha
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - David Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Parkash S Gill
- Departments of Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - Vassiliki Saloura
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Victoria M Villaflor
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ravi Salgia
- Division of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Deric L Wheeler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| |
Collapse
|
25
|
Stein AP, Swick AD, Smith MA, Blitzer GC, Yang RZ, Saha S, Harari PM, Lambert PF, Liu CZ, Kimple RJ. Xenograft assessment of predictive biomarkers for standard head and neck cancer therapies. Cancer Med 2015; 4:699-712. [PMID: 25619980 PMCID: PMC4430263 DOI: 10.1002/cam4.387] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 12/27/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) remains a challenging cancer to treat with overall 5-year survival on the order of 50–60%. Therefore, predictive biomarkers for this disease would be valuable to provide more effective and individualized therapeutic approaches for these patients. While prognostic biomarkers such as p16 expression correlate with outcome; to date, no predictive biomarkers have been clinically validated for HNSCC. We generated xenografts in immunocompromised mice from six established HNSCC cell lines and evaluated response to cisplatin, cetuximab, and radiation. Tissue microarrays were constructed from pre- and posttreatment tumor samples derived from each xenograft experiment. Quantitative immunohistochemistry was performed using a semiautomated imaging and analysis platform to determine the relative expression of five potential predictive biomarkers: epidermal growth factor receptor (EGFR), phospho-EGFR, phospho-Akt, phospho-ERK, and excision repair cross-complementation group 1 (ERCC1). Biomarker levels were compared between xenografts that were sensitive versus resistant to a specific therapy utilizing a two-sample t-test with equal standard deviations. Indeed the xenografts displayed heterogeneous responses to each treatment, and we linked a number of baseline biomarker levels to response. This included low ERCC1 being associated with cisplatin sensitivity, low phospho-Akt correlated with cetuximab sensitivity, and high total EGFR was related to radiation resistance. Overall, we developed a systematic approach to identifying predictive biomarkers and demonstrated several connections between biomarker levels and treatment response. Despite these promising initial results, this work requires additional preclinical validation, likely involving the use of patient-derived xenografts, prior to moving into the clinical realm for confirmation among patients with HNSCC.
Collapse
Affiliation(s)
- Andrew P Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Adam D Swick
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Molly A Smith
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Grace C Blitzer
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Robert Z Yang
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Sandeep Saha
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Paul F Lambert
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Cheng Z Liu
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53706
| |
Collapse
|
26
|
Britt CJ, Stein AP, Hartig GK. Factors Influencing Sialocele or Salivary Fistula Formation Post-parotidectomy. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Determine if the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele or salivary fistula formation after parotidectomy. Methods: A retrospective chart review was performed for all patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients who developed a sialocele or salivary fistula at any time postoperatively were identified. Age, sex, area and size of defect, body mass index (BMI), and rate of malignancy were evaluated to assess any relationship to these complications. Results: A total of 771 patients underwent parotidectomy at our institution from 1994 to 2013. Of these, 75 (9.7%) developed a sialocele or salivary fistula. Sialoceles or salivary fistulas developed in 96% (72/75) within 1 month post-parotidectomy, and none developed after 6 months. Age, sex, BMI, and histology were not associated with sialocele or salivary fistula formation. Extent of parotidectomy was quantified through assessment of surgical volume of tissue removed. The average volume of tissue removed was 37.8 cubic centimeters (cc) (range 0.2-277 cc; 95% confidence interval [28.4 cc, 47.2 cc]). Sixty-four patients (85.3%) underwent superficial parotidectomy, 7 (9.3%) underwent total parotidectomy, and extent of surgery was not documented in 4 patients (5.3%). 2 patients (2.7%) underwent revision surgery. Of patients who underwent superficial parotidectomy, 28 (43.8%) were complete superficial parotidectomy and 23 (35.9%) were partial inferior superficial parotidectomy. Conclusions: Sialocele is an uncommon complication post-parotidectomy. Contrary to other studies, we observed that sialocele formation does not depend on amount of parotid tissue removed, site of parotidectomy, gender, age, BMI, or rate of malignancy.
Collapse
|
27
|
Brand TM, Iida M, Stein AP, Corrigan KL, Braverman CM, Luthar N, Toulany M, Gill PS, Salgia R, Kimple RJ, Wheeler DL. AXL mediates resistance to cetuximab therapy. Cancer Res 2014; 74:5152-64. [PMID: 25136066 DOI: 10.1158/0008-5472.can-14-0294] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The EGFR antibody cetuximab is used to treat numerous cancers, but intrinsic and acquired resistance to this agent is a common clinical outcome. In this study, we show that overexpression of the oncogenic receptor tyrosine kinase AXL is sufficient to mediate acquired resistance to cetuximab in models of non-small cell lung cancer (NSCLC) and head and neck squamous cell carcinoma (HNSCC), where AXL was overexpressed, activated, and tightly associated with EGFR expression in cells resistant to cetuximab (Ctx(R) cells). Using RNAi methods and novel AXL-targeting agents, we found that AXL activation stimulated cell proliferation, EGFR activation, and MAPK signaling in Ctx(R) cells. Notably, EGFR directly regulated the expression of AXL mRNA through MAPK signaling and the transcription factor c-Jun in Ctx(R) cells, creating a positive feedback loop that maintained EGFR activation by AXL. Cetuximab-sensitive parental cells were rendered resistant to cetuximab by stable overexpression of AXL or stimulation with EGFR ligands, the latter of which increased AXL activity and association with the EGFR. In tumor xenograft models, the development of resistance following prolonged treatment with cetuximab was associated with AXL hyperactivation and EGFR association. Furthermore, in an examination of patient-derived xenografts established from surgically resected HNSCCs, AXL was overexpressed and activated in tumors that displayed intrinsic resistance to cetuximab. Collectively, our results identify AXL as a key mediator of cetuximab resistance, providing a rationale for clinical evaluation of AXL-targeting drugs to treat cetuximab-resistant cancers. Cancer Res; 74(18); 5152-64. ©2014 AACR.
Collapse
Affiliation(s)
- Toni M Brand
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mari Iida
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew P Stein
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelsey L Corrigan
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cara M Braverman
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Neha Luthar
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mahmoud Toulany
- Division of Radiobiology and Molecular Environmental Research, Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Parkash S Gill
- Departments of Medicine and Pathology, University of Southern California, Los Angeles, California
| | - Ravi Salgia
- Department of Medicine, Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Deric L Wheeler
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| |
Collapse
|
28
|
Stein AP, Saha S, Yu M, Kimple RJ, Lambert PF. Prevalence of human papillomavirus in oropharyngeal squamous cell carcinoma in the United States across time. Chem Res Toxicol 2014; 27:462-9. [PMID: 24641254 PMCID: PMC4002059 DOI: 10.1021/tx500034c] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
![]()
Human
papillomaviruses (HPVs) are involved in approximately 5%
of all human cancer. Although initially recognized for causing nearly
all cases of cervical carcinoma, much data has now emerged implicating
HPVs as a causal factor in other anogenital cancers as well as a subset
of head and neck squamous cell carcinomas (HNSCCs), most commonly
oropharyngeal cancers. Numerous clinical trials have demonstrated
that patients with HPV+ oropharyngeal squamous cell carcinoma (OPSCC)
have improved survival compared to patients with HPV– cancers.
Furthermore, epidemiological evidence shows the incidence of OPSCC
has been steadily rising over time in the United States. It has been
proposed that an increase in HPV-related OPSCCs is the driving force
behind the increasing rate of OPSCC. Although some studies have revealed
an increase in HPV+ head and neck malignancies over time in specific
regions of the United States, there has not been a comprehensive study
validating this trend across the entire country. Therefore, we undertook
this meta-analysis to assess all literature through August 2013 that
reported on the prevalence of HPV in OPSCC for patient populations
within the United States. The results show an increase in the prevalence
of HPV+ OPSCC from 20.9% in the pre-1990 time period to 51.4% in 1990–1999
and finally to 65.4% for 2000–present. In this manner, our
study provides further evidence to support the hypothesis that HPV-associated
OPSCCs are driving the increasing incidence of OPSCC over time in
the United States.
Collapse
Affiliation(s)
- Andrew P Stein
- Departments of †Oncology, ‡Human Oncology, and §Biostatistics, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin 53706, United States
| | | | | | | | | |
Collapse
|
29
|
Hematti P, Kim J, Stein AP, Kaufman D. Potential role of mesenchymal stromal cells in pancreatic islet transplantation. Transplant Rev (Orlando) 2013; 27:21-9. [PMID: 23290684 DOI: 10.1016/j.trre.2012.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/09/2012] [Indexed: 12/11/2022]
Abstract
Pancreatic islet transplantation is an attractive option for treatment of type 1 diabetes mellitus but maintaining long term islet function remains challenging. Mesenchymal stromal cells (MSCs), derived from bone marrow or other sources, are being extensively investigated in the clinical setting for their immunomodulatory and tissue regenerative properties. Indeed, MSCs have been already tested in some feasibility studies in the context of islet transplantation. MSCs could be utilized to improve engraftment of pancreatic islets by suppressing inflammatory damage and immune mediated rejection. In addition to their immunomodulatory effects, MSCs are known to provide a supportive microenvironmental niche by secreting paracrine factors and depositing extracellular matrix. These properties could be used for in vivo co-transplantation to improve islet engraftment, or for in vitro co-culture to prime freshly isolated islets prior to implantation. Further, tissue specific pancreatic islet derived MSCs may open new opportunities for its use in islet transplantation as those cells might be more physiological to pancreatic islets.
Collapse
Affiliation(s)
- Peiman Hematti
- Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
| | | | | | | |
Collapse
|
30
|
Kim J, Breunig MJ, Escalante LE, Bhatia N, Denu RA, Dollar BA, Stein AP, Hanson SE, Naderi N, Radek J, Haughy D, Bloom DD, Assadi-Porter FM, Hematti P. Biologic and immunomodulatory properties of mesenchymal stromal cells derived from human pancreatic islets. Cytotherapy 2012; 14:925-35. [PMID: 22571381 DOI: 10.3109/14653249.2012.684376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AIMS Mesenchymal stromal cells (MSC) have now been shown to reside in numerous tissues throughout the body, including the pancreas. Ex vivo culture-expanded MSC derived from many tissues display important interactions with different types of immune cells in vitro and potentially play a significant role in tissue homeostasis in vivo. In this study, we investigated the biologic and immunomodulatory properties of human pancreatic islet-derived MSC. METHODS We culture-expanded MSC from cadaveric human pancreatic islets and characterized them using flow cytometry, differentiation assays and nuclear magnetic resonance-based metabolomics. We also investigated the immunologic properties of pancreatic islet-derived MSC compared with bone marrow (BM) MSC. RESULTS Pancreatic islet and BM-derived MSC expressed the same cell-surface markers by flow cytometry, and both could differentiate into bone, fat and cartilage. Metabolomics analysis of MSC from BM and pancreatic islets also showed a similar set of metabolic markers but quantitative polymerase chain reactions showed that pancreatic islet MSC expressed more interleukin(IL)-1b, IL-6, STAT3 and FGF9 compared with BM MSC, and less IL-10. However, similar to BM MSC, pancreatic islet MSC were able to suppress proliferation of allogeneic T lymphocytes stimulated with anti-CD3 and anti-CD28 antibodies. CONCLUSIONS Our in vitro analysis shows pancreatic islet-derived MSC have phenotypic, biologic and immunomodulatory characteristics similar, but not identical, to BM-derived MSC. We propose that pancreatic islet-derived MSC could potentially play an important role in improving the outcome of pancreatic islet transplantation by promoting engraftment and creating a favorable immune environment for long-term survival of islet allografts.
Collapse
Affiliation(s)
- Jaehyup Kim
- University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Cytochromes P450 1A1 and 1A2 are involved in the oxidation of a wide spectrum of endogenous compounds and xenobiotics. Although their presence has been repeatedly confirmed in brain tissue, reports regarding their distribution in the brain are often contradictory. In the present study the possibility was examined that CYP1A1 and CYP1A2 are localized and inducible in the brain-CSF barrier and regions with a leaky blood brain barrier, where they may serve as a protective metabolic barrier. CYP1A1 and CYP1A2 levels were determined in subcellular fractions of multiple brain regions, as well as tissue homogenates of circumventricular organs, and the meninges by Western blotting and catalytic activity in control male rats and rats treated with the inducer beta-naphthoflavone (BNF). In control animals CYP1A1 immunoreactive protein was undetectable in regional brain microsomes or whole tissue homogenates of the arachnoid, dura mater, choroid plexus, pineal gland, median eminence, and pituitary. However, low levels of ethoxyresorufin O-deethylase (EROD) activity were observed in homogenates of the arachnoid, dura mater, choroid plexus, pineal gland, and pituitary. Western blotting revealed only low levels of CYP1A2 immunoreactive protein in brain microsomes from the cortex, cerebellum, brainstem, thalamus, hippocampus, and striatum from control animals. Following BNF treatment, EROD activity was induced 12-42-fold in the arachnoid, choroid plexus, dura mater, pineal gland, pituitary, and median eminence. Western blot analysis revealed CYP1A1 to be induced in the arachnoid, dura mater, choroid plexus, pineal gland, and pituitary, while CYP1A2 was undetectable. No induction of CYP1A1 or CYP1A2 protein was observed in brain microsomes from the olfactory bulb, cortex, striatum, hippocampus, cerebellum, or brainstem following BNF treatment, providing that the arachnoid membranes and choroid plexus had been carefully removed prior to brain dissection. Neither CYP1A1, 1A2 protein, nor EROD activity were detected in purified brain mitochondria, regardless of treatment or region. In conclusion, catalytically active CYP1A1 is located in the meninges as well as certain circumventricular organs, is inducible by BNF, and appears to be absent or expressed constitutively at very low levels in the majority of the brain parenchyma. The localization of CYP1A1 in the blood-CSF barrier and circumventricular tissues likely plays a role in protecting the brain from xenobiotics.
Collapse
Affiliation(s)
- D C Morse
- Department of Pharmacology and Toxicology, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | | | | | | |
Collapse
|
32
|
Li Y, Wang EJ, Chen L, Stein AP, Reuhl KR, Yang CS. Effects of phenethyl isothiocyanate on acetaminophen metabolism and hepatotoxicity in mice. Toxicol Appl Pharmacol 1997; 144:306-14. [PMID: 9194414 DOI: 10.1006/taap.1997.8134] [Citation(s) in RCA: 26] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Phenethyl isothiocyanate (PEITC), a compound derived from cruciferous and other vegetables, is a potent inhibitor of cytochrome P450 2E1. This enzyme catalyzes the bioactivation of acetaminophen (APAP) and many other xenobiotics. The present study investigated the effects of PEITC on APAP metabolism and associated hepatotoxicity in Swiss-Webster mice. When PEITC (19-150 micromol/kg) was given to mice intragastrically 1 hr before or immediately prior to a toxic dose of APAP, the APAP-induced hepatotoxicity was significantly decreased or was completely prevented. The extent of toxicity was evaluated by mortality, serum levels of glutamic-pyruvic transaminase, lactate dehydrogenase, and liver histopathology. Pretreatment of mice with ethanol enhanced APAP hepatotoxicity; this enhanced toxicity could also be prevented by the administration of PEITC. PEITC treatment prevented the depletion of hepatic glutathione levels caused by oxidized APAP metabolites. PEITC treatment also significantly decreased the plasma levels of oxidized APAP metabolites (analyzed as APAP-glutathione, APAP-cysteine, and APAP-N-acetylcysteine) and reduced the urinary excretion of APAP-cysteine. In microsomal incubations, PEITC effectively inhibited the rate of APAP-glutathione formation from APAP as well as the P450 2E1-dependent N-nitrosodimethylamine demethylase and the P450 1A2-dependent ethoxyresorufin O-deethylase activities. The protective action of PEITC against APAP toxicity is attributed to the blocking of APAP activation through inhibition of P450 enzymes.
Collapse
Affiliation(s)
- Y Li
- Laboratory for Cancer Research, Rutgers University, Piscataway, New Jersey 08855-0789, USA
| | | | | | | | | | | |
Collapse
|
33
|
Wang EJ, Li Y, Lin M, Chen L, Stein AP, Reuhl KR, Yang CS. Protective effects of garlic and related organosulfur compounds on acetaminophen-induced hepatotoxicity in mice. Toxicol Appl Pharmacol 1996; 136:146-54. [PMID: 8560468 DOI: 10.1006/taap.1996.0018] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In previous studies, we have demonstrated that diallyl sulfide, a flavor component of garlic, protects against chemically induced hepatotoxicity. The present study examined the activities of fresh garlic homogenates (FGH) and related organosulfur compounds in the protection against acetaminophen (APAP)-induced hepatotoxicity and the possible mechanisms involved in this protection. When FGH (5 g/kg) was administered to Swiss-Webster mice 2 hr prior to, or immediately after, an APAP treatment (0.2 g/kg), APAP-induced hepatotoxicity was essentially prevented as indicated by serum levels of alanine aminotransferase and lactate dehydrogenase and by liver histopathology. Partial protection was observed with a lower dose of FGH (0.5 g/kg). FGH also prevented APAP-induced hepatic glutathione depletion in a dose-dependent manner. FGH significantly inhibited the formation of APAP-oxidized metabolites, as indicated by decreased plasma levels of oxidized APAP metabolites. The amount of APAP excreted as oxidized metabolites in the 24 hr urine samples was also significantly lower in the mice pretreated with FGH. FGH supernatant inhibited cytochrome P450-dependent APAP oxidation in microsomal incubations. The results suggest that the protection against APAP-induced hepatotoxicity by FGH is mainly due to its inhibition of P450-mediated APAP bioactivation. Several garlic-derived organosulfur compounds and structurally related compounds were examined for their abilities to protect against APAP-induced hepatotoxicity. An S-allyl structure appears to be a common feature for most sulfides to inhibit P450 2E1-dependent activity and to display good protective activities.
Collapse
Affiliation(s)
- E J Wang
- Laboratory for Cancer Research, College of Pharmacy, Rutgers University, Piscataway, New Jersey 08855-0789, USA
| | | | | | | | | | | | | |
Collapse
|
34
|
Stein AP, Deichman ES. Tips on outreach programs that involve and educate. Provider 1987; 13:37, 40. [PMID: 10284718] [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: 02/12/2023]
|
35
|
Stein AP. Developing the potentials of the elderly: a publishing dream. Nurs Homes Sr Citiz Care 1987; 36:30-2. [PMID: 10283558] [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: 02/12/2023]
|
36
|
|
37
|
Stein AP, Baughman DC. Nursing implication of toxic shock syndrome. Crit Care Update 1981; 8:17-9. [PMID: 6909066] [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: 01/22/2023]
|