1
|
Moreno L, Weston R, Owens C, Valteau-Couanet D, Gambart M, Castel V, Zwaan CM, Nysom K, Gerber N, Castellano A, Laureys G, Ladenstein R, Rössler J, Makin G, Murphy D, Morland B, Vaidya S, Thebaud E, van Eijkelenburg N, Tweddle DA, Barone G, Tandonnet J, Corradini N, Chastagner P, Paillard C, Bautista FJ, Gallego Melcon S, De Wilde B, Marshall L, Gray J, Burchill SA, Schleiermacher G, Chesler L, Peet A, Leach MO, McHugh K, Hayes R, Jerome N, Caron H, Laidler J, Fenwick N, Holt G, Moroz V, Kearns P, Gates S, Pearson ADJ, Wheatley K. Bevacizumab, Irinotecan, or Topotecan Added to Temozolomide for Children With Relapsed and Refractory Neuroblastoma: Results of the ITCC-SIOPEN BEACON-Neuroblastoma Trial. J Clin Oncol 2024:JCO2300458. [PMID: 38190578 DOI: 10.1200/jco.23.00458] [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: 02/28/2023] [Revised: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE Outcomes for children with relapsed and refractory high-risk neuroblastoma (RR-HRNB) remain dismal. The BEACON Neuroblastoma trial (EudraCT 2012-000072-42) evaluated three backbone chemotherapy regimens and the addition of the antiangiogenic agent bevacizumab (B). MATERIALS AND METHODS Patients age 1-21 years with RR-HRNB with adequate organ function and performance status were randomly assigned in a 3 × 2 factorial design to temozolomide (T), irinotecan-temozolomide (IT), or topotecan-temozolomide (TTo) with or without B. The primary end point was best overall response (complete or partial) rate (ORR) during the first six courses, by RECIST or International Neuroblastoma Response Criteria for patients with measurable or evaluable disease, respectively. Safety, progression-free survival (PFS), and overall survival (OS) time were secondary end points. RESULTS One hundred sixty patients with RR-HRNB were included. For B random assignment (n = 160), the ORR was 26% (95% CI, 17 to 37) with B and 18% (95% CI, 10 to 28) without B (risk ratio [RR], 1.52 [95% CI, 0.83 to 2.77]; P = .17). Adjusted hazard ratio for PFS and OS were 0.89 (95% CI, 0.63 to 1.27) and 1.01 (95% CI, 0.70 to 1.45), respectively. For irinotecan ([I]; n = 121) and topotecan (n = 60) random assignments, RRs for ORR were 0.94 and 1.22, respectively. A potential interaction between I and B was identified. For patients in the bevacizumab-irinotecan-temozolomide (BIT) arm, the ORR was 23% (95% CI, 10 to 42), and the 1-year PFS estimate was 0.67 (95% CI, 0.47 to 0.80). CONCLUSION The addition of B met protocol-defined success criteria for ORR and appeared to improve PFS. Within this phase II trial, BIT showed signals of antitumor activity with acceptable tolerability. Future trials will confirm these results in the chemoimmunotherapy era.
Collapse
Affiliation(s)
- Lucas Moreno
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Makin
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | - Dermot Murphy
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Bruce Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sucheta Vaidya
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | - Deborah A Tweddle
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | | | | | | | | | | | | | | | | | - Lynley Marshall
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Juliet Gray
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Louis Chesler
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin O Leach
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | - Kieran McHugh
- Great Ormond Street Hospital, London, United Kingdom
| | | | - Neil Jerome
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | | | | | | - Grace Holt
- University of Birmingham, Birmingham, United Kingdom
| | | | - Pamela Kearns
- University of Birmingham, Birmingham, United Kingdom
| | - Simon Gates
- University of Birmingham, Birmingham, United Kingdom
| | - Andrew D J Pearson
- The Royal Marsden NHS Foundation Trust & Institute for Cancer Research, London, United Kingdom
| | | |
Collapse
|
2
|
Powell SJ, Withey SB, Sun Y, Grist JT, Novak J, MacPherson L, Abernethy L, Pizer B, Grundy R, Morgan PS, Jaspan T, Bailey S, Mitra D, Auer DP, Avula S, Arvanitis TN, Peet A. Applying machine learning classifiers to automate quality assessment of paediatric dynamic susceptibility contrast (DSC-) MRI data. Br J Radiol 2023; 96:20201465. [PMID: 36802769 PMCID: PMC10161906 DOI: 10.1259/bjr.20201465] [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: 02/22/2023] Open
Abstract
OBJECTIVE Investigate the performance of qualitative review (QR) for assessing dynamic susceptibility contrast (DSC-) MRI data quality in paediatric normal brain and develop an automated alternative to QR. METHODS 1027 signal-time courses were assessed by Reviewer 1 using QR. 243 were additionally assessed by Reviewer 2 and % disagreements and Cohen's κ (κ) were calculated. The signal drop-to-noise ratio (SDNR), root mean square error (RMSE), full width half maximum (FWHM) and percentage signal recovery (PSR) were calculated for the 1027 signal-time courses. Data quality thresholds for each measure were determined using QR results. The measures and QR results trained machine learning classifiers. Sensitivity, specificity, precision, classification error and area under the curve from a receiver operating characteristic curve were calculated for each threshold and classifier. RESULTS Comparing reviewers gave 7% disagreements and κ = 0.83. Data quality thresholds of: 7.6 for SDNR; 0.019 for RMSE; 3 s and 19 s for FWHM; and 42.9 and 130.4% for PSR were produced. SDNR gave the best sensitivity, specificity, precision, classification error and area under the curve values of 0.86, 0.86, 0.93, 14.2% and 0.83. Random forest was the best machine learning classifier, giving sensitivity, specificity, precision, classification error and area under the curve of 0.94, 0.83, 0.93, 9.3% and 0.89. CONCLUSION The reviewers showed good agreement. Machine learning classifiers trained on signal-time course measures and QR can assess quality. Combining multiple measures reduces misclassification. ADVANCES IN KNOWLEDGE A new automated quality control method was developed, which trained machine learning classifiers using QR results.
Collapse
Affiliation(s)
- Stephen J Powell
- Physical Sciences for Health CDT, University of Birmingham, Birmingham, United Kingdom.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie B Withey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Yu Sun
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - James T Grist
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,Department of Psychology, Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Paul S Morgan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Medical Physics, Nottingham University Hospitals, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Radiology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Dorothee P Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
3
|
Rodriguez D, Calmon R, Aliaga ES, Warren D, Warmuth-Metz M, Jones C, Mackay A, Varlet P, Le Deley MC, Hargrave D, Cañete A, Massimino M, Azizi AA, Saran F, Zahlmann G, Garcia J, Vassal G, Grill J, Peet A, Dineen RA, Morgan PS, Jaspan T. MRI and Molecular Characterization of Pediatric High-Grade Midline Thalamic Gliomas: The HERBY Phase II Trial. Radiology 2022; 304:174-182. [DOI: 10.1148/radiol.211464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
4
|
Rodrigues B, Adamski J, English M, Curry H, Solanki G, Peet A, Apps J. RARE-11. 60 years single centre experience of craniopharyngioma management. Neuro Oncol 2022. [PMCID: PMC9164632 DOI: 10.1093/neuonc/noac079.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Adamantinomatous craniopharyngiomas are challenging intracranial tumours associated with significant morbidity. Management includes surgery and radiotherapy, with a shift towards more conservative surgery in recent years, aimed at preserving hypothalamic function. The West Midlands Regional Children’s Tumour Registry collects detailed clinical, pathological and follow up information on patients treated within the region from 1957. 52 cases (26 male, 26 female) of craniopharyngioma treated at Birmingham Children’s Hospital 1957-2018, were identified, with further clinical details obtained from patient records, where available. Visual symptoms were the commonest presenting feature (63%), followed by headache (48%), vomiting (31%), neurological symptoms (31%) and features of endocrine disorders (21%) with a median symptom duration of 6 months (range <1-24). Initial management was with gross total resection (GTR) in 14 patients, subtotal resection in 22 patients and subtotal resection with adjuvant radiotherapy in seven patients. Two patients received radiotherapy without resection, and five patients underwent cystic drainage procedures alone. Two patients initially underwent shunt insertion alone, but received radiotherapy at progression. 30 (58%) patients underwent relapse/progression, with a median time to progression of 1.2 years (range 0.2-6.3). 15 had further surgery. Radiotherapy was used in 14/15 patients who had not previously received radiotherapy, with the other undergoing a GTR. To date 10 patients have died, nine from tumour related reasons and one from pulmonary embolism. Where data was available at follow up, all patients had at least one endocrinopathy, with 38/45 patients having diabetes insipidus. Hypothalamic obesity was identified in 14/36 (39%) patients with sufficient records, with this more common in those undergoing GTR (7/9 (78%)) compared to other surgical procedures (7/27)(26%)(p<0.05). Three patients have developed neurovascular complications and three fatty liver disease. This experience is consistent with the literature and supports the increasing usage of hypothalamic sparing surgical management.
Collapse
Affiliation(s)
- Beryl Rodrigues
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Jenny Adamski
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Helen Curry
- West Midlands Regional Children's Tumour Registry , Birmingham , United Kingdom
| | - Guirish Solanki
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
- University of Birmingham , Birmingham , United Kingdom
| | - John Apps
- Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham , United Kingdom
- University of Birmingham , Birmingham , United Kingdom
| |
Collapse
|
5
|
Murray M, Apps J, Lawson A, Kirton L, Peet A, Arvanitis T, Fern L, Mitra D, Coleman N, Ajithkumar T, Bison B, Veal G, Stark D, Morana G, Nicholson J, Billingham L. GCT-03. MonoGerm: A proposed phase II trial of carboplatin or vinblastine monotherapy induction prior to radiotherapy for intracranial germinoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.197] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Intracranial germinoma is chemosensitive but radiotherapy (RT) is needed for cure. In localised disease, three-drug standard-of-care (SOC) inpatient chemotherapy is used to reduce RT fields/dose. Concomitant diabetes insipidus is common, making chemotherapy delivery challenging. Small studies have demonstrated benefits from single-agent carboplatin or vinblastine in germinoma as an alternative to SOC. However, this needs prospective evaluation in a clinical trial. METHODS: We developed a trial, with a patient-public-involvement workstream, primarily evaluating whether single-agent chemotherapy (carboplatin or vinblastine) is non-inferior to SOC for inducing radiological complete response (CR) in localised disease, and is associated with reduced toxicity and improved quality-of-life (QoL), evaluated through patient-reported-outcome-measures (PROMs). RESULTS: The resultant proposed multi-centre, phase II proof-of-principle trial will investigate, in parallel, two single agents as monotherapy induction, in children/teenagers/adults with intracranial germinoma. Trial features include: a) Bayesian statistical design determining whether CR rate for either agent is sufficiently non-inferior to SOC; b) ‘Flip-flop’ design with alternating, continuous enrolment to the two single-agents, interim assessments after each recruited cohort, and early stopping rules for inferiority; c) Safety MRI, after 6-weeks of chemotherapy with real-time central-radiological-review; d) Proof-of-principle vinblastine monotherapy arm for metastatic patients awaiting definitive craniospinal-irradiation; e) State-of-the-art integrated imaging acquisition, QoL/PROM, pharmacokinetics and circulating microRNA studies to maximise information/learning; f) European and North American neuroradiological response criteria comparison and prospective evaluation of new consensus criteria. CONCLUSIONS: Trial results will: a) establish whether monotherapy is a treatment option in this setting, which may be practice-altering; b) use QoL/PROM data to inform on optimal treatment if results similar; c) use embedded radiological assessments to develop intracranial germinoma trials and facilitate European/US study comparisons; d) describe vinblastine pharmacokinetic data to inform future dosing schedules in this and other malignancies; and e) quantify circulating microRNAs, facilitating future non-invasive diagnosis/risk-stratification.
Collapse
Affiliation(s)
- Matthew Murray
- University of Cambridge , Cambridge , United Kingdom
- Cambridge University Hospitals NHS Foundation Trust , Cambridge , United Kingdom
| | - John Apps
- Cancer Research UK Clinical Trials Unit, University of Birmingham , Birmingham , United Kingdom
| | - Anna Lawson
- Cancer Research UK Clinical Trials Unit, University of Birmingham , Birmingham , United Kingdom
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham , Birmingham , United Kingdom
| | - Andrew Peet
- University of Birmingham , Birmingham , United Kingdom
| | - Theodoros Arvanitis
- Institute of Digital Healthcare, University of Warwick , Warwick , United Kingdom
| | - Lorna Fern
- University College London Hospitals , London , United Kingdom
| | - Dipayan Mitra
- Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | | | - Thankamma Ajithkumar
- Cambridge University Hospitals NHS Foundation Trust , Cambridge , United Kingdom
| | - Brigitte Bison
- University Hospital Augsburg , Augsburg , United Kingdom
| | - Gareth Veal
- Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | - James Nicholson
- Cambridge University Hospitals NHS Foundation Trust , Cambridge , United Kingdom
- University of Cambridge , Cambridge , United Kingdom
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham , Birmingham , United Kingdom
| |
Collapse
|
6
|
Rose H, Ahmed A, Babourina-Brooks B, Khan O, MacPherson L, Manias K, Peake A, Ali S, Withey S, Worthington L, Novak J, Zarinabad N, Grundy R, Arvanitis T, Peet A. IMG-11. A COMPUTERISED CLINICAL DECISION SUPPORT SYSTEM FOR DIAGNOSING CHILDREN’S BRAIN TUMOURS USING FUNCTIONAL IMAGING AND MACHINE LEARNING. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION: Magnetic resonance imaging is a key investigation in the diagnosis of childhood solid tumours. Advanced techniques such as diffusion weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and perfusion imaging probe the underlying cellular, chemical and vascular nature of the disease. Coupled with machine learning these scanning methods show improvement in diagnostic accuracy compared with conventional imaging. Advanced image analysis is not routinely available in hospitals. We present a clinical decision support system (CDSS) developed for advanced MR analysis and interpretation. METHOD: The CDSS was developed in house. The Children’s Cancer and Leukaemia Group Functional Imaging Group (CCLGFIG) Database, a national resource, was used to provide a repository of cases together with their advanced imaging and machine learning diagnostic classifiers. A new case is displayed alongside cases in the repository with known diagnoses, including summary statistics for relevant diagnostic categories. The CDSS was made available to radiologists, in their clinical environment for technical and clinical evaluation. Structured interviews were undertaken. The CDSS was developed as a computer app for multi-centre distribution. RESULTS: 436 MRS, 240 DWI and 85 perfusion cases were available for building repositories. Machine learning classifiers showed diagnostic accuracies for the major childhood brain tumour types of 85-95%. Comparison of MRS with a data repository was found to improve non-invasive diagnosis. Results from the CDSS can be uploaded to the CCLGFIG to support multicentre research. Positive feedback on the CDSS from clinicians included: ready access to advanced analysis; simple and efficient integration into clinical workflow; and assisted interpretation of advanced analysis. DISCUSSION: Advanced MR analysis techniques provide improved non-invasive diagnostic accuracy but are difficult to implement on clinical systems due to technical, infrastructure and training limitations. CONCLUSION: We have successfully released a CDSS for paediatric cancer within the hospital environment and assessed its suitability for clinical use.
Collapse
Affiliation(s)
- Heather Rose
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Arfan Ahmed
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Ben Babourina-Brooks
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Omar Khan
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry , West Midlands , United Kingdom
| | - Lesley MacPherson
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Karen Manias
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Ashley Peake
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry , West Midlands , United Kingdom
| | - Sana Ali
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Stephanie Withey
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- RRPPS, University Hospital Birmingham NHS Foundation Trust, Bimingham , West Midlands , United Kingdom
| | - Lara Worthington
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- RRPPS, University Hospital Birmingham NHS Foundation Trust, Bimingham , West Midlands , United Kingdom
| | - Jan Novak
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
- Institute of Health and Neurodevelopment, Aston University, Birmingham , West Midlands , United Kingdom
| | - Nilou Zarinabad
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham , East Midlands , United Kingdom
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry , West Midlands , United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic sciences, The University of Birmingham, Birmingham , West Midlands , United Kingdom
- Birmingham Children’s Hospital, Birmingham , West Midlands , United Kingdom
| |
Collapse
|
7
|
Adiamah M, Lindsey JC, Burté F, Kohe S, Morcavallo A, Blair H, Hill RM, Singh M, Crosier S, Zhang T, Maddocks O, Peet A, Chesler L, Hickson I, Maxwell R, Clifford SC. MEDB-79. MYC-driven upregulation of the de novo serine and glycine pathway is a novel therapeutic target for Group 3 MYC-amplified Medulloblastoma. Neuro Oncol 2022. [PMCID: PMC9164881 DOI: 10.1093/neuonc/noac079.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite advances in the molecular sub-classification and risk-stratification of medulloblastoma (MB), a subset of tumours remain refractory to current multimodal therapies. Group 3 (MBGroup3) patients represent around 25% of MBs, and amplification and elevated expression of MYC in this group correlates with dismal clinical outcomes. Since direct targeting of MYC remains elusive, understanding and exploiting metabolic dependencies in MYC-amplified MBGroup3 may reveal novel therapeutic opportunities. We engineered three independent regulable MYC-amplified MBGroup3 cell-based models, each harbouring doxycycline-inducible anti-MYC shRNAs (two independent species) or a non-silencing shRNA control. In all three models, MYC knockdown (KD) revealed persistent MYC-dependent cancer phenotypes, reduction in proliferation and cell cycle progression. We utilised 1H high-resolution magic angle spectroscopy (HRMAS) and stable isotope-resolved metabolomics to assess changes in intracellular metabolites and pathway dynamics when MYC expression was modulated. Profiling revealed consistent MYC-dependent changes in metabolite concentrations across models. Notably, glycine was consistently accumulated following MYC KD suggesting altered pathway dynamics. 13C-glucose tracing further revealed a reduction in glucose-derived serine and glycine (de novo synthesis) following MYC KD which was attributable to lower expression of PHGDH, the rate-limiting enzyme of this pathway. Furthermore, in human primary tumours, elevated expression of PHGDH was associated with MYC amplification and poorer survival outcomes. MYC expressing cells showed greater sensitivity to pharmacological inhibition of PHGDH compared to MYC KD (MBGroup3) and MBSHH subgroup cell lines in vitro. Critically, targeting PHGDH in vivo, using MYC-dependent xenografts and genetically engineered mouse models, consistently slowed tumour progression and increased survival. In summary, metabolic profiling has uncovered MYC-dependent metabolic alterations and revealed the de novo serine/glycine synthesis pathway as a novel and clinically relevant therapeutic target in MYC-amplified MBGroup3. Together, these findings reveal metabolic vulnerabilities of MYC-amplified MBGroup3 which represent novel therapeutic opportunities for this poor-prognosis disease group.
Collapse
Affiliation(s)
- Magretta Adiamah
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Janet C Lindsey
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Florence Burté
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Sarah Kohe
- Institute of Cancer and Genomic Sciences, University of Birmingham , Birmingham , United Kingdom
| | - Alaide Morcavallo
- Division of Clinical Studies, Institute of Cancer Research , London , United Kingdom
| | - Helen Blair
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Rebecca M Hill
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Mankaran Singh
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Stephen Crosier
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Tong Zhang
- Institute of Cancer Sciences, University of Glasgow , Glasgow , United Kingdom
| | - Oliver Maddocks
- Institute of Cancer Sciences, University of Glasgow , Glasgow , United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham , Birmingham , United Kingdom
| | - Louis Chesler
- Division of Clinical Studies, Institute of Cancer Research , London , United Kingdom
| | - Ian Hickson
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Ross Maxwell
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| | - Steven C Clifford
- Newcastle University Centre for Cancer, Newcastle University , Newcastle , United Kingdom
| |
Collapse
|
8
|
Yang M, Sun Y, Wang S, Wang G, Zhang W, He J, Sun W, Yang M, Sun Y, Peet A. MRI-based Whole-Tumor Radiomics to Classify the Types of Pediatric Posterior Fossa Brain Tumor. Neurochirurgie 2022; 68:601-607. [PMID: 35667473 DOI: 10.1016/j.neuchi.2022.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Differential diagnosis between medulloblastoma (MB), ependymoma (EP) and astrocytoma (PA) is important due to differing medical treatment strategies and predicted survival. The aim of this study was to investigate non-invasive MRI-based radiomic analysis of whole tumors to classify the histologic tumor types of pediatric posterior fossa brain tumor and improve the accuracy of discrimination, using a random forest classifier. METHODS MRI images of 99 patients, with 59 MBs, 13 EPs and 27 PAs histologically confirmed by surgery and pathology before treatment, were included in this retrospective study. Registration was performed between the three sequences, and high- throughput features were extracted from manually segmented tumors on MR images of each case. The forest-based feature selection method was adopted to select the top ten significant features. Finally, the results were compared and analyzed according to the classification. RESULTS The top ten contributions according to the classifier of wavelet features all came from the ADC sequence. The random forest classifier achieved 100% accuracy on the training data and validated the best accuracy (0.938): sensitivity = 1.000, 0.948 and 0.808, specificity = 0.952, 0.926 and 1.000 for EP, MB and PA, respectively. CONCLUSION A random forest classifier based on the ADC sequence of the whole tumor provides more quantitative information than TIWI and T2WI in differentiating pediatric posterior fossa brain tumors. In particular, the histogram percentile value showed great superiority, which added diagnostic value in pediatric neuro-oncology.
Collapse
Affiliation(s)
- Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China.
| | - Yu Sun
- International Laboratory for Children's Medical Imaging Research, School of Biology Science and Medical Engineering, Southeast University, 210096 Nanjing, China.
| | - Shujie Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China
| | - Gang Wang
- Department of Neurosurgery, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China
| | - Wei Zhang
- Department of Radiology, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China
| | - Junping He
- Department of Neurosurgery, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China
| | - Weihang Sun
- International Laboratory for Children's Medical Imaging Research, School of Biology Science and Medical Engineering, Southeast University, 210096 Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, 210008 Nanjing, China
| | - Yu Sun
- Institute of Cancer & Genomic Science, University of Birmingham, B152TT, Birmingham, United Kingdom; International Laboratory for Children's Medical Imaging Research, School of Biology Science and Medical Engineering, Southeast University, 210096 Nanjing, China
| | - Andrew Peet
- Institute of Cancer & Genomic Science, University of Birmingham, B152TT, Birmingham, United Kingdom
| |
Collapse
|
9
|
Apps J, Peet A, English M, Adamski J. OTHR-20. Precision neuro-oncology in the real world. Opportunity and challenges from a UK Oncology Centre. Neuro Oncol 2022. [PMCID: PMC9164987 DOI: 10.1093/neuonc/noac079.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The last five years has shown advances in the molecular classification of brain tumour, molecular profiling techniques and an increased use of targeted therapies. We reviewed the molecular analysis pathways and use of targeted agents at Birmingham Children’s Hospital (BCH), a large (~55 new cases/year) neuro-oncology centre, between 2016-2021. Having previously been analysed locally by limited directed immuno-histochemical stains and referral for specific genetic tests, tissue is now referred for a range of second histopathological opinions and in depth molecular classification, via methylation array, panel sequencing, RNA fusion analysis, and whole genome sequencing. These are accessed through different evolving pathways and consent processes, including referral to other centres, national reference laboratories, clinical studies, and local genetics laboratories with links to national sequencing infrastructures. Different routes result in different reporting structures, timescales and with varying levels of interpretation, often without adequate access to clinical information and context. 21 patients were treated on five targeted agent clinical trials (Afatanib (n=6), Biomede (n=3), eSmart(n=1), PARC (n=7), Vinilo (n=5)), with one patient on both Afatanib and PARC trials. A further two patients visited other centres for trials. Eight patients received MAPK pathway inhibitors through compassionate access pathways, with benefit, including radiological response, in four. Cardiac toxicity was observed in three and retinal oedema in one. Two patients received immune checkpoint inhibition, with rapid fatal enlargement, either progression or pseudo-progression, in one case. These rapid changes in diagnostic and management options offer new opportunities for patients, but bring challenges to the delivery of neuro-oncology services, including the logistics of sample, report, clinical trial, compassionate access management and the increased multi-specialist support required for monitoring and management of toxicities. Integration of targeted agents into the appropriate part of a patient’s treatment strategy requires skilled interpretation of the benefits compared to conventional therapies.
Collapse
Affiliation(s)
- John Apps
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
- University of Birmingham , Bimingham , United Kingdom
| | - Andrew Peet
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
- University of Birmingham , Bimingham , United Kingdom
| | - Martin English
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
| | - Jenny Adamski
- Birmingham Women's and Children's Hospital , Birmingham , United Kingdom
| |
Collapse
|
10
|
Patel M, Zhan J, Natarajan K, Flintham R, Davies N, Sanghera P, Grist J, Duddalwar V, Peet A, Sawlani V. Artificial intelligence for early prediction of treatment response in glioblastoma. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Treatment response assessment in glioblastoma is challenging. Patients routinely undergo conventional magnetic resonance imaging (MRI), but it has a low diagnostic accuracy for distinguishing between true progression (tPD) and pseudoprogression (psPD) in the early post-chemoradiotherapy time period due to similar imaging appearances. The aim of this study was to use artificial intelligence (AI) on imaging data, clinical characteristics and molecular information within machine learning models, to distinguish between and predict early tPD from psPD in patients with glioblastoma.
Method
The study involved retrospective analysis of patients with newly-diagnosed glioblastoma over a 3.5 year period (n=340), undergoing surgery and standard chemoradiotherapy treatment, with an increase in contrast-enhancing disease on the baseline MRI study 4-6 weeks post-chemoradiotherapy. Studies had contrast-enhanced T1-weighted imaging (CE-T1WI), T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) sequences, acquired at 1.5 Tesla with 6-months follow-up to determine the reference standard outcome. 76 patients (mean age 55 years, range 18-76 years, 39% female, 46 tPD, 30 psPD) were included. Machine learning models utilised information from clinical characteristics (age, gender, resection extent, performance status), O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status and 307 quantitative imaging features; extracted from baseline study CE-T1WI/ADC and T2WI sequences using semi-automatically segmented enhancing disease and perilesional oedema masks respectively. Feature selection was performed within bootstrapped cross-validated recursive feature elimination with a random forest algorithm and Naïve Bayes five-fold cross-validation to validate the final model.
Results
Treatment response assessment based on the standard-of-care reports by clinical neuroradiologists showed an accuracy of 33% (sensitivity/specificity 52%/3%) to distinguish between tPD and psPD from the early post-treatment MRI study at 4-6 weeks. Machine learning-based models based on clinical and molecular features alone demonstrated an AUC of 0.66 and models using radiomic features alone from the early post-treatment MRI demonstrated an AUC of 0.46-0.69 depending on the feature and mask subset. A combined clinico-radiomic model utilising top common features demonstrated an AUC of 0.80 and an accuracy of 74% (sensitivity/specificity 78%/67%). The features in the final model were age, MGMT promoter methylation status, two shape-based features from the enhancing disease mask (elongation and sphericity), three radiomic features from the enhancing disease mask on ADC (kurtosis, correlation, contrast) and one radiomic feature from the perilesional oedema mask on T2WI (dependence entropy).
Conclusion
Current standard-of-care glioblastoma treatment response assessment imaging has limitations. In this study, the use of AI through a machine learning-based approach incorporating clinical characteristics and MGMT promoter methylation status with quantitative radiomic features from standard MRI sequences at early 4-6 weeks post-treatment imaging showed the best model performance and a higher accuracy to distinguish between tPD and psPD for early prediction of glioblastoma treatment response.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham
| | | |
Collapse
|
11
|
Rose H, Li H, Bennett CD, Novak J, Sun Y, MacPherson L, Avula S, Arvanitis T, Clark C, Bailey S, Mitra D, Auer D, Grundy R, Peet A. The role of diffusion tensor imaging metrics in machine learning-based characterisation of paediatric brain tumors and their practicality for multicentre clinical assessment. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Magnetic resonance imaging (MRI) is a valuable tool for non-invasive diagnosis of paediatric brain tumours. The rarity of the disease dictates multi-centre studies and imaging biomarkers that are robust to protocol variability. We investigated diffusion tensor MRI (DT-MRI), combined with machine learning, as an aid to diagnosis and evaluated the robustness of the imaging metrics.
Method
A multi-centre cohort of 52 clinical DT-MRI scans (20 medulloblastomas (MB), 21 pilocytic astrocytomas (PA), 11 ependymomas (EP)) were analysed retrospectively. Histograms for regions of solid tumour for fractional anisotropy (FA), mean diffusivity (MD), pure anisotropic diffusion (q) and pure isotropic diffusion (p) were compared to assess diagnostic capability. Linear discriminate analysis (LDA) was used for classification and validated using leave-one-out-cross-validation (LOOCV).
Results
Histogram medians for FA, MD, q and p were all different between tumor groups (P<.0001, Kruskal Wallis test). Median MD, p and q values were highest in PA, then EP and lowest in MB (P<.0001, Pairwise Wilcox test). FA median was higher for EP than PA (P=.004) with no significant difference between EP and MB (P=.591). ROC analysis showed that median MD, q and p perform best as a diagnostic marker (AUC= 0.92 to 0.99). LOOCV showed an overall accuracy of the LDA classification, ranging between 67% - 87%. FA values were highly dependent on protocol parameters, whereas pure anisotropic diffusion, q, was not.
Conclusion
DT-MRI metrics from multi-centre acquisitions can classify paediatric brain tumours. FA is the least robust metric to protocol variability and q provides the most robust quantification of anisotropic behaviour.
Collapse
Affiliation(s)
- Heather Rose
- Institute of Cancer and Genomic sciences, The University of Birmingham
| | - Huijun Li
- Birmingham Children’s Hospital
- Children’s Hospital of Nanjing Medical University, Nanjing
| | | | - Jan Novak
- Birmingham Children’s Hospital
- School of Life and Health Sciences, Aston University
| | - Yu Sun
- Institute of Cancer and Genomic sciences, The University of Birmingham
- Birmingham Children’s Hospital
| | | | | | | | | | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary
| | - Dipayan Mitra
- Neuroradiology Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham
| | - Andrew Peet
- Institute of Cancer and Genomic sciences, The University of Birmingham
| |
Collapse
|
12
|
Tyldesley-Marshall N, Greenfield S, Neilson SJ, English M, Adamski J, Peet A. The role of Magnetic Resonance Images (MRIs) in coping for patients with brain tumours and their parents: a qualitative study. BMC Cancer 2021; 21:1013. [PMID: 34507545 PMCID: PMC8431927 DOI: 10.1186/s12885-021-08673-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND When children and young people (CYP) are diagnosed with a brain tumour, Magnetic Resonance Imaging (MRI) is key to the clinical management of this condition. This can produce hundreds, and often thousands, of Magnetic Resonance Images (MRIs). METHODS Semi-structured interviews were undertaken with 14 families (15 parents and 8 patients), and analysed using Grounded Theory. Analysis was supported by the Framework Method. RESULTS Although the focus of the research was whether paediatric patients and their families find viewing MRIs beneficial, all patients and parents discussed difficult times during the illness and using various strategies to cope. This article explores the identified coping strategies that involved MRIs, and the role that MRIs can play in coping. Coping strategies were classified under the aim of the strategy when used: 'Normalising'; 'Maintaining hope and a sense of the future'; 'Dealing with an uncertain future'; and 'Seeking Support'. CONCLUSIONS Coping and finding ways to cope are clearly used by patients and their families and are something that they wish to discuss, as they were raised in conversations that were not necessarily about coping. This suggests clinicians should always allow time and space (in appointments, consultations, or impromptu conversations on the ward) for patient families to discuss ways of coping. MRIs were found to be used in various ways: to maintain or adapt normal; maintain hope and a sense of the future; deal with an uncertain future; and seek support from others. Clinicians should recognise the potential for MRIs to aid coping and if appropriate, suggest that families take copies of scans (MRIs) home. Professional coaches or counsellors may also find MRIs beneficial as a way to remind families that the child is in a more stable or 'better' place than they have been previously.
Collapse
Affiliation(s)
- Natalie Tyldesley-Marshall
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, B15 2TT UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Susan J. Neilson
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Martin English
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Jenny Adamski
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Andrew Peet
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, B15 2TT UK
- Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UK
| |
Collapse
|
13
|
Avula S, Peet A, Morana G, Morgan P, Warmuth-Metz M, Jaspan T, Group ESFPOSBTI. Correction to: European Society for Paediatric Oncology (SIOPE) MRI guidelines for imaging patients with central nervous system tumours. Childs Nerv Syst 2021; 37:2509-2510. [PMID: 34282475 DOI: 10.1007/s00381-021-05274-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L14 5AB, UK.
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Paul Morgan
- Department of Medical Physics, Nottingham University Hospitals, Nottingham, UK
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals, Nottingham, UK
| | | |
Collapse
|
14
|
Avula S, Peet A, Morana G, Morgan P, Warmuth-Metz M, Jaspan T. European Society for Paediatric Oncology (SIOPE) MRI guidelines for imaging patients with central nervous system tumours. Childs Nerv Syst 2021; 37:2497-2508. [PMID: 33973057 DOI: 10.1007/s00381-021-05199-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/05/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Standardisation of imaging acquisition is essential in facilitating multicentre studies related to childhood CNS tumours. It is important to ensure that the imaging protocol can be adopted by centres with varying imaging capabilities without compromising image quality. MATERIALS AND METHOD An imaging protocol has been developed by the Brain Tumour Imaging Working Group of the European Society for Paediatric Oncology (SIOPE) based on consensus among its members, which consists of neuroradiologists, imaging scientists and paediatric neuro-oncologists. This protocol has been developed to facilitate SIOPE led studies and regularly reviewed by the imaging working group. RESULTS The protocol consists of essential MRI sequences with imaging parameters for 1.5 and 3 Tesla MRI scanners and a set of optional sequences that can be used in appropriate clinical settings. The protocol also provides guidelines for early post-operative imaging and surveillance imaging. The complementary use of multimodal advanced MRI including diffusion tensor imaging (DTI), MR spectroscopy and perfusion imaging is encouraged, and optional guidance is provided in this publication. CONCLUSION The SIOPE brain tumour imaging protocol will enable consistent imaging across multiple centres involved in paediatric CNS tumour studies.
Collapse
Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L14 5AB, UK.
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Paul Morgan
- Department of Medical Physics, Nottingham University Hospitals, Nottingham, UK
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals, Nottingham, UK
| | | |
Collapse
|
15
|
Nadaf J, de Kock L, Chong AS, Korbonits M, Thorner P, Benlimame N, Fu L, Peet A, Warner J, Ploner O, Shuangshoti S, Albrecht S, Hamel N, Priest JR, Rivera B, Ragoussis J, Foulkes WD. Molecular characterization of DICER1-mutated pituitary blastoma. Acta Neuropathol 2021; 141:929-944. [PMID: 33644822 DOI: 10.1007/s00401-021-02283-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
Pituitary blastoma (PitB) has recently been identified as a rare and potentially lethal pediatric intracranial tumor. All cases that have been studied molecularly possess at least one DICER1 pathogenic variant. Here, we characterized nine pituitary samples, including three fresh frozen PitBs, three normal fetal pituitary glands and three normal postnatal pituitary glands using small-RNA-Seq, RNA-Seq, methylation profiling, whole genome sequencing and Nanostring® miRNA analyses; an extended series of 21 pituitary samples was used for validation purposes. These analyses demonstrated that DICER1 RNase IIIb hotspot mutations in PitBs induced improper processing of miRNA precursors, resulting in aberrant 5p-derived miRNA products and a skewed distribution of miRNAs favoring mature 3p over 5p miRNAs. This led to dysregulation of hundreds of 5p and 3p miRNAs and concomitant dysregulation of numerous mRNA targets. Gene expression analysis revealed PRAME as the most significantly upregulated gene (500-fold increase). PRAME is a member of the Retinoic Acid Receptor (RAR) signaling pathway and in PitBs, the RAR, WNT and NOTCH pathways are dysregulated. Cancer Hallmarks analysis showed that PI3K pathway is activated in the tumors. Whole genome sequencing demonstrated a quiet genome with very few somatic alterations. The comparison of methylation profiles to publicly available data from ~ 3000 other central nervous system tumors revealed that PitBs have a distinct methylation profile compared to all other tumors, including pituitary adenomas. In conclusion, this comprehensive characterization of DICER1-related PitB revealed key molecular underpinnings of PitB and identified pathways that could potentially be exploited in the treatment of this tumor.
Collapse
Affiliation(s)
- Javad Nadaf
- Department of Medical Genetics, The Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- McGill University Genome Centre, Montreal, QC, Canada
| | - Leanne de Kock
- Department of Medical Genetics, The Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Anne-Sophie Chong
- Department of Medical Genetics, The Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Paul Thorner
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Naciba Benlimame
- Research Pathology Facility, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Lili Fu
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Andrew Peet
- Birmingham Children's NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Justin Warner
- Department of Child Health, University Hospital of Wales, Heath Park, Cardiff, UK
| | | | - Shanop Shuangshoti
- Department of Pathology and Chulalongkorn GenePRO Center, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Steffen Albrecht
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Nancy Hamel
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Barbara Rivera
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Jiannis Ragoussis
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- McGill University Genome Centre, Montreal, QC, Canada
| | - William D Foulkes
- Department of Medical Genetics, The Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada.
- Department of Human Genetics, McGill University, Montreal, QC, Canada.
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada.
| |
Collapse
|
16
|
Badodi S, Pomella N, Zhang X, Morrison G, Pollard SM, Bennett CD, Clifford SC, Peet A, Marino S. EMBR-10. INOSITOL TREATMENT INHIBITS MEDULLOBLASTOMA THROUGH SUPPRESSION OF EPIGENETIC-DRIVEN METABOLIC ADAPTATION. Neuro Oncol 2021. [PMCID: PMC8168266 DOI: 10.1093/neuonc/noab090.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Medulloblastoma (MB) is the most common paediatric malignant brain tumour and is classified into four distinct molecular subgroups (WNT, SHH, G3 and G4), each of them further subdivided into subtypes with different prognosis and responses to therapy. Deregulation of chromatin modifier genes plays an essential role in MB, particularly in the G4 subgroup, the least understood of all subgroups, despite being the most common and associated with poor prognosis. A BMI1High; CHD7Low molecular signature identifies patients with poor survival within this subgroup. We show that BMI1High; CHD7Low mediates a novel epigenetic regulation of inositol metabolism in both G4 MB cells and patients. These tumours display hyperactivation of the AKT/mTOR pathway which leads to energetic rewiring characterized by enhanced glycolytic capacity and reduced mitochondrial function. We demonstrate that inositol administration counteracts this metabolic alteration, impairs MB proliferation in vitro and significantly extends survival in an in vivo pre-clinical model. Moreover, inositol synergises with cisplatin, a chemotherapy agent currently used in MB treatment, enhancing its therapeutic effect in vivo. Importantly, cerebellar neural stem cells bearing the BMI1High; CHD7Low signature do not show metabolic adaptation and are thus resistant to inositol treatment, highlighting a fundamental difference between normal and neoplastic metabolism in the developing cerebellum. In summary, we have identified an actionable vulnerability in a pre-clinical setting modelling a molecularly defined group of MB patients, the translational value of which can now be explored in signature-matched clinical trials in MB.
Collapse
Affiliation(s)
- Sara Badodi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicola Pomella
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Xinyu Zhang
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gillian Morrison
- Centre for Regenerative Medicine & Cancer Research UK Edinburgh Centre, The University of Edinburgh, Edinburgh, UK
| | - Steve M Pollard
- Centre for Regenerative Medicine & Cancer Research UK Edinburgh Centre, The University of Edinburgh, Edinburgh, UK
| | - Christopher D Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Steven C Clifford
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Silvia Marino
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
17
|
Patel M, Zhan J, Natarajan K, Flintham R, Davies N, Sanghera P, Grist J, Duddalwar V, Peet A, Sawlani V. Machine learning-based radiomic evaluation of treatment response prediction in glioblastoma. Clin Radiol 2021; 76:628.e17-628.e27. [PMID: 33941364 DOI: 10.1016/j.crad.2021.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
AIM To investigate machine learning based models combining clinical, radiomic, and molecular information to distinguish between early true progression (tPD) and pseudoprogression (psPD) in patients with glioblastoma. MATERIALS AND METHODS A retrospective analysis was undertaken of 76 patients (46 tPD, 30 psPD) with early enhancing disease following chemoradiotherapy for glioblastoma. Outcome was determined on follow-up until 6 months post-chemoradiotherapy. Models comprised clinical characteristics, O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, and 307 quantitative imaging features extracted from enhancing disease and perilesional oedema masks on early post-chemoradiotherapy contrast-enhanced T1-weighted imaging, T2-weighted imaging (T2WI), and apparent diffusion coefficient (ADC) maps. Feature selection was performed within bootstrapped cross-validated recursive feature elimination with a random forest algorithm. Naive Bayes five-fold cross-validation was used to validate the final model. RESULTS Top selected features included age, MGMT promoter methylation status, two shape-based features from the enhancing disease mask, three radiomic features from the enhancing disease mask on ADC, and one radiomic feature from the perilesional oedema mask on T2WI. The final model had an area under the receiver operating characteristics curve (AUC) of 0.80, sensitivity 78.2%, specificity 66.7%, and accuracy of 73.7%. CONCLUSION Incorporating a machine learning-based approach using quantitative radiomic features from standard-of-care magnetic resonance imaging (MRI), in combination with clinical characteristics and MGMT promoter methylation status has a complementary effect and improves model performance for early prediction of glioblastoma treatment response.
Collapse
Affiliation(s)
- M Patel
- University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Zhan
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Affiliated Hospital of Qingdao University, Qingdao Shi, Shandong Sheng, China
| | - K Natarajan
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Flintham
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Davies
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Sanghera
- University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Grist
- University of Birmingham, Birmingham, UK
| | - V Duddalwar
- Departments of Radiology, Urology and Biomedical Engineering, University of Southern California, USA
| | - A Peet
- University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - V Sawlani
- University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| |
Collapse
|
18
|
Badodi S, Pomella N, Zhang X, Rosser G, Whittingham J, Niklison-Chirou MV, Lim YM, Brandner S, Morrison G, Pollard SM, Bennett CD, Clifford SC, Peet A, Basson MA, Marino S. Inositol treatment inhibits medulloblastoma through suppression of epigenetic-driven metabolic adaptation. Nat Commun 2021; 12:2148. [PMID: 33846320 PMCID: PMC8042111 DOI: 10.1038/s41467-021-22379-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/12/2021] [Indexed: 12/11/2022] Open
Abstract
Deregulation of chromatin modifiers plays an essential role in the pathogenesis of medulloblastoma, the most common paediatric malignant brain tumour. Here, we identify a BMI1-dependent sensitivity to deregulation of inositol metabolism in a proportion of medulloblastoma. We demonstrate mTOR pathway activation and metabolic adaptation specifically in medulloblastoma of the molecular subgroup G4 characterised by a BMI1High;CHD7Low signature and show this can be counteracted by IP6 treatment. Finally, we demonstrate that IP6 synergises with cisplatin to enhance its cytotoxicity in vitro and extends survival in a pre-clinical BMI1High;CHD7Low xenograft model.
Collapse
Affiliation(s)
- Sara Badodi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicola Pomella
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Xinyu Zhang
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gabriel Rosser
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Whittingham
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - Maria Victoria Niklison-Chirou
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Therapeutic Innovation (CTI-Bath), Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Yau Mun Lim
- UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sebastian Brandner
- UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gillian Morrison
- Centre for Regenerative Medicine & Cancer Research UK Edinburgh Centre, The University of Edinburgh, Edinburgh, UK
| | - Steven M Pollard
- Centre for Regenerative Medicine & Cancer Research UK Edinburgh Centre, The University of Edinburgh, Edinburgh, UK
| | - Christopher D Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women and Children's Hospital, Birmingham, UK
| | - Steven C Clifford
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women and Children's Hospital, Birmingham, UK
| | - M Albert Basson
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Silvia Marino
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| |
Collapse
|
19
|
Novak J, Zarinabad N, Rose H, Arvanitis T, MacPherson L, Pinkey B, Oates A, Hales P, Grundy R, Auer D, Gutierrez DR, Jaspan T, Avula S, Abernethy L, Kaur R, Hargrave D, Mitra D, Bailey S, Davies N, Clark C, Peet A. Classification of paediatric brain tumours by diffusion weighted imaging and machine learning. Sci Rep 2021; 11:2987. [PMID: 33542327 PMCID: PMC7862387 DOI: 10.1038/s41598-021-82214-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/12/2021] [Indexed: 01/23/2023] Open
Abstract
To determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10−3 mm2 s−1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis.
Collapse
Affiliation(s)
- Jan Novak
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.,Aston Neuroscience Institute, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Heather Rose
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Lesley MacPherson
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Benjamin Pinkey
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Patrick Hales
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Daniel Rodriguez Gutierrez
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Ramneek Kaur
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Darren Hargrave
- Haematology and Oncology Department, Great Ormond Street Children's Hospital, London, UK
| | - Dipayan Mitra
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nigel Davies
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Radiation Protection Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Clark
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
| |
Collapse
|
20
|
Liu APY, Kelsey MM, Sabbaghian N, Park SH, Deal CL, Esbenshade AJ, Ploner O, Peet A, Traunecker H, Ahmed YHE, Zacharin M, Tiulpakov A, Lapshina AM, Walter AW, Dutta P, Rai A, Korbonits M, de Kock L, Nichols KE, Foulkes WD, Priest JR. Clinical Outcomes and Complications of Pituitary Blastoma. J Clin Endocrinol Metab 2021; 106:351-363. [PMID: 33236116 PMCID: PMC7823240 DOI: 10.1210/clinem/dgaa857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/03/2020] [Indexed: 12/22/2022]
Abstract
CONTEXT Pituitary blastoma is a rare, dysontogenetic hypophyseal tumor of infancy first described in 2008, strongly suggestive of DICER1 syndrome. OBJECTIVE This work aims to describe genetic alterations, clinical courses, outcomes, and complications in all known pituitary blastoma cases. DESIGN AND SETTING A multi-institutional case series is presented from tertiary pediatric oncology centers. PATIENTS Patients included children with pituitary blastoma. INTERVENTIONS Genetic testing, surgery, oncologic therapy, endocrine support are reported. OUTCOME MEASURES Outcome measures included survival, long-term morbidities, and germline and tumor DICER1 genotypes. RESULTS Seventeen pituitary blastoma cases were studied (10 girls and 7 boys); median age at diagnosis was 11 months (range, 2-24 months). Cushing syndrome was the most frequent presentation (n = 10). Cushingoid stigmata were absent in 7 children (2 with increased adrenocorticotropin [ACTH]; 5 with normal/unmeasured ACTH). Ophthalmoplegia and increased intracranial pressure were also observed. Surgical procedures included gross/near-total resection (n = 7), subtotal resection (n = 9), and biopsy (n = 1). Six children received adjuvant therapy. At a median follow-up of 6.7 years, 9 patients were alive; 8 patients died of the following causes: early medical/surgical complications (n = 3), sepsis (n = 1), catheter-related complication (n = 1), aneurysmal bleeding (n = 1), second brain tumor (n = 1), and progression (n = 1). Surgery was the only intervention for 5 of 9 survivors. Extent of resection, but neither Ki67 labeling index nor adjuvant therapy, was significantly associated with survival. Chronic complications included neuroendocrine (n = 8), visual (n = 4), and neurodevelopmental (n = 3) deficits. Sixteen pituitary blastomas were attributed to DICER1 abnormalities. CONCLUSIONS Pituitary blastoma is a locally destructive tumor associated with high mortality. Surgical resection alone provides long-term disease control for some patients. Quality survival is possible with long-term neuroendocrine management.
Collapse
Affiliation(s)
- Anthony P Y Liu
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Correspondence and Reprint Requests: Anthony P.Y. Liu, MBBS, MMedSc; MS 260, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA. E-mail:
| | - Megan M Kelsey
- Department of Pediatrics, Section of Pediatric Endocrinology, Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nelly Sabbaghian
- Department of Medical Genetics, The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sung-Hye Park
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Cheri L Deal
- Endocrinology and Diabetes Service, CHU-Sainte Justine and Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Adam J Esbenshade
- Department of Pediatrics, Monroe Carell Jr. Children’s Hospital, Nashville, Tennessee, USA
| | | | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | - Margaret Zacharin
- Department of Endocrinology and Diabetes, Royal Children’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Anatoly Tiulpakov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russia
| | - Anastasia M Lapshina
- Department of Fundamental Pathomorphology, Endocrinology Research Centre, Moscow, Russia
| | | | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Rai
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Márta Korbonits
- Department of Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Leanne de Kock
- Harry Perkins Institute of Medical Research, QEII Medical Centre and UWA Centre for Medical Research, the University of Western Australia, Perth, Australia
| | - Kim E Nichols
- Division of Cancer Predisposition, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - William D Foulkes
- Department of Medical Genetics, The Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Medical Genetics and Cancer Research Program, Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | | |
Collapse
|
21
|
Pavon-Mengual M, Curry H, Saraff V, Mohamed Z, Benghiat H, Ford D, Peet A, Adamski J, English M. MBCL-52. ENDOCRINE PROFILE AFTER MEDULLOBLASTOMA TREATMENT. Neuro Oncol 2020. [PMCID: PMC7715513 DOI: 10.1093/neuonc/noaa222.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of medulloblastoma has evolved substantially with more chemotherapy, risk-adapted dosing of radiotherapy (RT) and new RT techniques. We present the endocrine profile for our patients treated over a 20-year period. METHODS The charts of patients treated for medulloblastoma between 1/1/00 and 31/12/19 were reviewed. 105 were available. Group 1 received chemotherapy alone, Group 2 received 23.4 Gy whole CNS RT with a posterior fossa (PF) boost to 54 Gy, Group 3 received > 35 Gy whole CNS RT with PF boost to 54–59 Gy, Group 4 received PF RT to 54 Gy. All received chemotherapy according to national guidelines or clinical trials relevant at the time. RESULTS Group 1 (M:F 11:6, 7 survivors mean age 2 years range 1–7) had no endocrinopathies. At 5 years from diagnosis Group 2 (M:F 15:13) and Group 3 (M:F 35:14) had the following % RESULTS Survival 77:61; Growth Hormone deficiency 92:100; Thyroid deficiency 75:81; ACTH deficiency 42:33. Girls were more likely to need sex hormone replacement than boys. Group 4 (M:F 7:5 mean age 2) were all treated in the first decade. 3 survivors, one GH deficiency, one thyroxine deficiency, one both. CONCLUSIONS There is a trend to earlier endocrinopathies in the group 3 vs group 2 patients, but it does not reach statistical significance. Girls are more likely to need sex hormone replacement than boys. This investigation provides a contemporary profile of endocrinopathy after treatment for medulloblastoma that can be used for future comparisons.
Collapse
Affiliation(s)
- Miriam Pavon-Mengual
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Curry
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Vrinda Saraff
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Zainaba Mohamed
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Benghiat
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Daniel Ford
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Peet
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Jenny Adamski
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin English
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
22
|
Bennett C, Kohe S, Burte F, Rose H, Hicks D, Schwalbe E, Crosier S, Storer L, Lourdusamy A, Wilson M, Avula S, Mitra D, Dineen R, Bailey S, Williamson D, Grundy R, Clifford S, Peet A. MBRS-69. METABOLITE PROFILING OF SHH MEDULLOBLASTOMA IDENTIFIES A SUBSET OF CHILDHOOD TUMOURS ENRICHED FOR HIGH-RISK MOLECULAR BIOMARKERS AND CLINICAL FEATURES. Neuro Oncol 2020. [PMCID: PMC7715738 DOI: 10.1093/neuonc/noaa222.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
SHH medulloblastoma patients have a variable prognosis. Infants (<3–5 years at diagnosis) are associated with a good prognosis, while disease-course in childhood is associated with specific prognostic biomarkers (MYCN amplification, TP53 mutation, LCA histology; all high-risk). There is an unmet need to identify prognostic subgroups of SHH tumours rapidly in the clinical setting, to aid in real-time risk stratification and disease management. Metabolite profiling is a powerful technique for characterising tumours. High resolution magic angle spinning NMR spectroscopy (HR-MAS) can be performed on frozen tissue samples and provides high quality metabolite information. We therefore assessed whether metabolite profiles could identify subsets of SHH tumours with prognostic potential. Metabolite concentrations of 22 SHH tumours were acquired by HR-MAS and analysed using unsupervised hierarchical clustering. Methylation profiling assigned the infant and childhood SHH subtypes, and clinical and molecular features were compared between clusters. Two clusters were observed. A significantly higher concentration of lipids was observed in Cluster 1 (t-test, p=0.012). Cluster 1 consisted entirely of childhood-SHH whilst Cluster 2 included both childhood-SHH and infant-SHH subtypes. Cluster 1 was enriched for high-risk markers - LCA histology (3/7 v. 0/5), MYCN amplification (2/7 v. 0/5), TP53 mutations (3/7 v. 1/5) and metastatic disease - whilst having a lower proportion of TERT mutations (0/7 v. 2/5) than Cluster 2. These pilot results suggest that (i) it is possible to identify childhood-SHH patients linked to high-risk clinical and molecular biomarkers using metabolite profiles and (ii) these may be detected non-invasively in vivo using magnetic-resonance spectroscopy.
Collapse
Affiliation(s)
- Christopher Bennett
- University of Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Sarah Kohe
- University of Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Florence Burte
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Heather Rose
- University of Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Debbie Hicks
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Ed Schwalbe
- Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Stephen Crosier
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Lisa Storer
- University of Nottingham, Nottingham, United Kingdom
| | | | - Martin Wilson
- University of Birmingham, Birmingham, United Kingdom
| | - Shivaram Avula
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Dipayan Mitra
- Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Robert Dineen
- University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Daniel Williamson
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | | | - Steven Clifford
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Andrew Peet
- University of Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| |
Collapse
|
23
|
Hong J, Feng Z, Wang SH, Peet A, Zhang YD, Sun Y, Yang M. Brain Age Prediction of Children Using Routine Brain MR Images via Deep Learning. Front Neurol 2020; 11:584682. [PMID: 33193046 PMCID: PMC7604456 DOI: 10.3389/fneur.2020.584682] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/04/2020] [Indexed: 01/26/2023] Open
Abstract
Predicting brain age of children accurately and quantitatively can give help in brain development analysis and brain disease diagnosis. Traditional methods to estimate brain age based on 3D magnetic resonance (MR), T1 weighted imaging (T1WI), and diffusion tensor imaging (DTI) need complex preprocessing and extra scanning time, decreasing clinical practice, especially in children. This research aims at proposing an end-to-end AI system based on deep learning to predict the brain age based on routine brain MR imaging. We spent over 5 years enrolling 220 stacked 2D routine clinical brain MR T1-weighted images of healthy children aged 0 to 5 years old and randomly divided those images into training data including 176 subjects and test data including 44 subjects. Data augmentation technology, which includes scaling, image rotation, translation, and gamma correction, was employed to extend the training data. A 10-layer 3D convolutional neural network (CNN) was designed for predicting the brain age of children and it achieved reliable and accurate results on test data with a mean absolute deviation (MAE) of 67.6 days, a root mean squared error (RMSE) of 96.1 days, a mean relative error (MRE) of 8.2%, a correlation coefficient (R) of 0.985, and a coefficient of determination (R 2) of 0.971. Specially, the performance on predicting the age of children under 2 years old with a MAE of 28.9 days, a RMSE of 37.0 days, a MRE of 7.8%, a R of 0.983, and a R 2 of 0.967 is much better than that over 2 with a MAE of 110.0 days, a RMSE of 133.5 days, a MRE of 8.2%, a R of 0.883, and a R 2 of 0.780.
Collapse
Affiliation(s)
- Jin Hong
- School of Informatics, University of Leicester, Leicester, United Kingdom
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhangzhi Feng
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shui-Hua Wang
- School of Architecture Building and Civil Engineering, Loughborough University, Loughborough, United Kingdom
- School of Mathematics and Actuarial Science, University of Leicester, Leicester, United Kingdom
| | - Andrew Peet
- Institute of Cancer & Genomic Science, University of Birmingham, Birmingham, United Kingdom
| | - Yu-Dong Zhang
- School of Informatics, University of Leicester, Leicester, United Kingdom
- Department of Information Systems, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yu Sun
- Institute of Cancer & Genomic Science, University of Birmingham, Birmingham, United Kingdom
- International Laboratory for Children's Medical Imaging Research, School of Biology Science and Medical Engineering, Southeast University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
24
|
Tyldesley-Marshall N, Greenfield S, Neilson S, English M, Adamski J, Peet A. Qualitative study: patients' and parents' views on brain tumour MRIs. Arch Dis Child 2020; 105:166-172. [PMID: 31391153 DOI: 10.1136/archdischild-2019-317306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/29/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND MRI is essential to the clinical management of children and young people with brain tumours. Advances in technology have made images more complicated to interpret, yet more easily available digitally. It is common practice to show these to patients and families, but how they emotionally respond to, understand and value, seeing brain tumour MRIs has not been formally studied. METHODS Qualitative semi-structured interviews were undertaken with 14 families (8 patients, 15 parents) purposively sampled from paediatric patients (0 to 18 years) attending a large UK children's hospital for treatment or monitoring of a brain tumour. Transcripts were analysed thematically using the Framework Method. RESULTS Four themes were identified: Receiving results (waiting for results, getting results back, preferences to see images), Emotional responses to MRIs, Understanding of images (what they can show, what they cannot show, confusion) and Value of MRIs (aesthetics, aiding understanding, contextualised knowledge/emotional benefits, enhanced control, enhanced working relationships, no value). All families found value in seeing MRIs, including reassurance, hope, improved understanding and enhanced feeling of control over the condition. However emotional responses varied enormously. CONCLUSIONS Clinical teams should always explain MRIs after 'framing' the information. This should minimise participant confusion around meaning, periodically evident even after many years. Patient and parent preferences for being shown MRIs varied, and often changed over time, therefore clinicians should identify, record and update these preferences. Time between scanning and receiving the result was stressful causing 'scanxiety', but most prioritised accuracy over speed of receiving results.
Collapse
Affiliation(s)
- Natalie Tyldesley-Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Institute of Clinical Sciences, University of Birmingham, UK
| | - Martin English
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Jenny Adamski
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| |
Collapse
|
25
|
Grist J, Withey S, MacPherson L, Oates A, Stephen Powell M, Novak J, Abernethy L, Pizer B, Grundy R, Bailey S, Mitra D, Arvantis T, Auer D, Avula S, Peet A. Utilising functional imaging to predict survival in paediatric brain tumours. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Brain tumours are a common cause of death in the paediatric population. We have previously shown that MR imaging and spectroscopy can be used to non-invasively differentiate between tumour types. Here, we demonstrate that functional imaging can be highly predictive of survival and grade in a paediatric cohort.
Methods
Perfusion (PWI) and diffusion weighted imaging (DWI) were performed in a multi-site (Birmingham Children’s Hospital, Royal Victoria Infirmary, Alder Hey, Nottingham) cohort ([grade, 5-year survival alive:dead number] = [I,15:1],[II, 5:1],[III,2:3],[IV,8:11]). ROIs were drawn on T2 imaging and functional imaging features (mean, standard deviation, skewness, and kurtosis) were derived. Supervised machine learning was used to predict 5-year survival and tumour grade from features. ANOVA and post-hoc tests were used to assess differences in features between grade and 5-year survival status.
Results
5-year survival was predicted with 89%, 85%, and 87% accuracy with all imaging, perfusion, or diffusion features, respectively.
A significant difference in perfusion was found between surviving and diseased participants (1.71 ± 0.82 vs 2.62 ± 1 mL/100g/min, respectively, p < 0.05). A significant difference in ADC (mm2 s-1) between tumour grades was found (1 vs 4 (1533 ± 458 vs 857 ± 239), 4 vs 3 (857 ± 239 vs 1197 ± 137), 4 vs 2 (857 ± 239 vs 1440 ± 557), corrected p < 0.05).
Conclusion
We have shown that perfusion and diffusion imaging features can be used to non-invasively assess tumour grade and estimate 5-year survival status in a cohort of paediatric brain tumours.
Collapse
Affiliation(s)
- James Grist
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie Withey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- RRPPS, University Hospitals Birmingham NHS foundation trust, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
| | - Adam Oates
- Radiology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
| | - Mr Stephen Powell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan Novak
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- Department of Psychology, School of Life and Health sciences, Aston University, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Theodoros Arvantis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS foundation trust, Birmingham, United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children’s NHS foundation trust, Liverpool, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
26
|
Withey S, MacPherson L, Oates A, Powell S, Novak J, Abernethy L, Pizer B, Grundy R, Bailey S, Mitra D, Arvanitis T, Auer D, Avula S, Peet A. Multicentre study of perfusion magnetic resonance imaging in paediatric brain tumours. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Studies in adults have shown that brain tumour perfusion correlates with grade. These studies are dominated by gliomas grade II to IV which are rare in children. The standard method, Dynamic Susceptibility Contrast MRI, provides estimates of relative cerebral blood volume (rCBV) but contrast agent leakage affects rCBV accuracy. The majority of perfusion studies have been conducted at single centres and variation in acquisition protocols makes the generalizability of results questionable. The aim of this study was to compare leakage-corrected rCBV with grade in paediatric brain tumours at multiple centres. Scans were analysed from 85 patients at 4 centres on 6 scanners prior to treatment. MRI protocols varied between centres. Histological diagnoses including grade were obtained. Whole-tumour median rCBV was significantly higher in the 45 high grade than the 40 low grade tumours (2.54 ± 1.63 ml/100ml vs 1.68 ± 1.36 ml/100ml, p=0.010). Low grade tumours, particularly pilocytic astrocytomas (grade I), displayed more contrast agent leakage consistent with their appearance on contrast enhanced images and required more leakage correction than high grade tumours. This finding differs from that in adults where contrast agent uptake is usually associated with higher grade. A cut-off of 1.70 ml/100ml for rCBV gave sensitivity and specificity of 76% and 65% respectively for discriminating grade. In summary, perfusion MRI can be used to help distinguish between low and high grade paediatric brain tumours. This finding is robust across multiple centres and acquisition protocols but correction should be made for leakage of contrast agent from the vessels.
Collapse
Affiliation(s)
- Stephanie Withey
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Lesley MacPherson
- Radiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Adam Oates
- Radiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Stephen Powell
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Jan Novak
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Laurence Abernethy
- Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Barry Pizer
- Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Dipayan Mitra
- Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Shivaram Avula
- Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, Birmingham, United Kingdom
- Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
27
|
Oras A, Peet A, Giese T, Tillmann V, Uibo R. A study of 51 subtypes of peripheral blood immune cells in newly diagnosed young type 1 diabetes patients. Clin Exp Immunol 2019; 198:57-70. [PMID: 31116879 DOI: 10.1111/cei.13332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Type 1 diabetes (T1D) results from autoimmune destruction of insulin-producing beta cells in pancreatic islets. Various immune cell populations are involved in disease development and natural course. However, to our knowledge, so far there are no comprehensive comparative investigations of all main immune cell populations and their most important subsets at the onset of disease. Therefore, in the current study, we analyzed 51 peripheral blood immune cell populations in 22 young T1D patients and in 25 age-matched controls using a comprehensive polychromatic flow cytometry panel developed for whole blood by the COST Action no. BM0907 ENTIRE (European Network for Translational Immunology Research and Education: From Immunomonitoring to Personalized Immunotherapy) consortium. We found that in T1D patients, frequencies and absolute counts of natural killer (NK) cells, dendritic cells (DC) and T cells, as well as their respective subsets, were significantly altered compared to controls. Further, we observed that changes in several cell populations (e.g. CD14+ CD16+ non-classical monocytes, plasmablasts) were dependent on the age of the patient. In addition to age-related changes, we also found that alterations in immune cell patterns were associated with parameters such as the presence of ketoacidosis and C-peptide serum levels. Our study provides a foundation for future studies investigating different cell lineages and their role in T1D and illustrates the value of polychromatic flow cytometry for evaluating all main peripheral immune cells and their subsets in whole blood samples.
Collapse
Affiliation(s)
- A Oras
- Instititute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - A Peet
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - T Giese
- Institut für Immunologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - V Tillmann
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - R Uibo
- Instititute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
28
|
Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips B, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high-grade central nervous system tumors: a systematic review. Pediatr Blood Cancer 2019; 66:e27509. [PMID: 30408313 DOI: 10.1002/pbc.27509] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/14/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in children with high-grade central nervous system (CNS) tumors, although no consensus has been reached regarding its effectiveness and whether earlier detection is associated with improved patient outcomes. This review aimed to evaluate this practice and any associated benefits and harms. METHODS Systematic searches for relevant studies were undertaken in a number of databases, including MEDLINE and EMBASE, from 1985 to August 2018. Study selection and data extraction was undertaken independently by two reviewers. Due to heterogeneity between studies, no pooling of data was undertaken. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS No comparative studies were identified. Three retrospective observational studies involving 306 patients were reviewed. All had high risk of bias by virtue of study design. Two studies reported outcomes by symptomatic status-both recurrence rates and overall survival for asymptomatic patients were comparable with those for clinically symptomatic patients. No quality-of-life outcomes were reported. CONCLUSION There is a paucity of evidence to guide clinical practice as to the effectiveness of MRI surveillance in pediatric patients with high-grade CNS tumors. These studies do not clearly demonstrate benefit or harm for the practice. With more research needed, there is a role for researchers to build into future trials data collection on surveillance imaging to give more information for the assessment of imaging frequency and duration in asymptomatic patients. This is an important question not only to clinicians and patients and their families but also from a health service resource perspective.
Collapse
Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
29
|
Sawlani V, Davies N, Patel M, Flintham R, Fong C, Heyes G, Cruickshank G, Steven N, Peet A, Hartley A, Benghiat H, Meade S, Sanghera P. Evaluation of Response to Stereotactic Radiosurgery in Brain Metastases Using Multiparametric Magnetic Resonance Imaging and a Review of the Literature. Clin Oncol (R Coll Radiol) 2018; 31:41-49. [PMID: 30274767 DOI: 10.1016/j.clon.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/27/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
AIMS Following stereotactic radiosurgery (SRS), brain metastases initially increase in size in up to a third of cases, suggesting treatment failure. Current imaging using structural magnetic resonance imaging (MRI) cannot differentiate between tumour recurrence and SRS-induced changes, creating difficulties with patient management. Combining multiparametric MRI techniques, which assess tissue physiological and metabolic information, has shown promise in answering this clinical question. MATERIALS AND METHODS Multiparametric MRI techniques, including spectroscopy, diffusion and perfusion imaging, were used for the differentiation of radiation-related changes and tumour recurrence after SRS for intracranial metastases in six cases. All patients presented with enlargement of the treated lesion, an increase in perilesional brain oedema and aggravation or appearance of neurological signs and symptoms from 7 to 29 weeks after primary treatment. RESULTS Multiparametric imaging helped to differentiate features of tumour progression (n = 4) from radiation-related changes (n = 2). A low apparent diffusion coefficient (ADC) <1000 × 10-6 mm2/s, high relative cerebral blood volume (rCBV) ratio > 2.1, high choline:creatine (Cho:Cr) ratio > 1.8 suggested tumour recurrence. A high ADC > 1000 × 10-6 mm2/s, low rCBV ratio < 2.1, Cho:Cr ratio < 1.8 suggested SRS-induced radiation changes. Multiparametric MRI diagnosis was confirmed by histology or radiological and clinical follow-up. CONCLUSION Multiparametric MRI was helpful in the early identification of radiation-related changes and tumour recurrence and may be useful for monitoring treatment changes in intracranial neoplasms after SRS treatment.
Collapse
Affiliation(s)
- V Sawlani
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - N Davies
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Patel
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Flintham
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Fong
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Heyes
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Cruickshank
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Steven
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Peet
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - A Hartley
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Benghiat
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Meade
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Sanghera
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
30
|
Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips R, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with low-grade central nervous system (CNS) tumours: a systematic review. J Neurooncol 2018; 139:507-522. [PMID: 29948767 PMCID: PMC6132973 DOI: 10.1007/s11060-018-2901-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is routinely used as a surveillance tool to detect early asymptomatic tumour recurrence with a view to improving patient outcomes. This systematic review aimed to assess its utility in children with low-grade CNS tumours. METHODS Using standard systematic review methods, twelve databases were searched up to January 2017. RESULTS Seven retrospective case series studies (n = 370 patients) were included, with average follow-up ranging from 5.6 to 7 years. No randomised controlled trials (RCTs) were identified. Due to study heterogeneity only a descriptive synthesis could be undertaken. Imaging was most frequent in the first year post-surgery (with 2-4 scans) reducing to around half this frequency in year two and annually thereafter for the duration of follow-up. Diagnostic yield ranged from 0.25 to 2%. Recurrence rates ranged from 5 to 41%, with most recurrences asymptomatic (range 65-100%). Collectively, 56% of recurrences had occurred within the first year post-treatment (46% in the first 6-months), 68% by year two and 90% by year five. Following recurrence, 90% of patients underwent treatment changes, mainly repeat surgery (72%). Five-year OS ranged from 96 to 100%, while five-year recurrence-free survival ranged from 67 to 100%. None of the studies reported quality of life measures. CONCLUSION This systematic review highlights the paucity of evidence currently available to assess the utility of MRI surveillance despite it being routine clinical practice and costly to patients, their families and healthcare systems. This needs to be evaluated within the context of an RCT.
Collapse
Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| |
Collapse
|
31
|
Abstract
1H-Magnetic Resonance Spectroscopy (MRS) is a novel advanced imaging technique used as an adjunct to MRI to reveal complementary non-invasive information about the biochemical composition of imaged tissue. Clinical uses in paediatrics include aiding diagnosis of brain tumours, neonatal disorders such as hypoxic-ischaemic encephalopathy, inherited metabolic diseases, traumatic brain injury, demyelinating conditions and infectious brain lesions. MRS has potential to improve diagnosis and treatment monitoring of childhood brain tumours and other CNS diseases, facilitate biopsy and surgical planning, and provide prognostic biomarkers. MRS is employed as a research tool outside the brain in liver disease and disorders of muscle metabolism. The range of clinical uses is likely to increase with growing evidence for added value. Multicentre trials are needed to definitively establish the benefits of MRS in specific clinical scenarios and integrate this promising new technique into routine practice to improve patient care. This article gives a brief overview of MRS and its potential clinical applications, and addresses challenges surrounding translation into practice.
Collapse
Affiliation(s)
- Karen Angela Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| |
Collapse
|
32
|
Bennett C, Kohe S, Gill S, Davies N, Storer L, Ritzmann T, Dunn W, Tennant D, Grundy R, Peet A. TBIO-19. MASS SPECTROMETRY OF COMMON CEREBELLAR TUMOURS IDENTIFIES DIFFERENCES IN METABOLISM. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Sarah Kohe
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Simrandip Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Nigel Davies
- Birmingham Children’s Hospital, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lisa Storer
- Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy Ritzmann
- Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Warwick Dunn
- Phenome Centre Birmingham, School of Biosciences, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Daniel Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Richard Grundy
- Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| |
Collapse
|
33
|
Manias K, Gill S, MacPherson L, Oates A, Pinkey B, Davies P, Zarinabad N, Davies N, Babourina-Brooks B, Wilson M, Peet A. RADI-01. DIAGNOSTIC ACCURACY AND ADDED VALUE OF QUALITATIVE RADIOLOGICAL REVIEW OF 1H-MRS IN EVALUATION OF CHILDHOOD BRAIN TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Simrandeep Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Adam Oates
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Benjamin Pinkey
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Davies
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Nigel Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ben Babourina-Brooks
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin Wilson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
34
|
Ghosh N, Manias K, Bennett CD, Oates A, English M, Peet A, Adamski J. LGG-29. RESIDUAL TUMOUR SIZE AS A PREDICTOR OF PROGRESSION FOR PAEDIATRIC LOW-GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Adam Oates
- Birmingham Children’s Hospital, Birmingham, UK
| | | | - Andrew Peet
- Birmingham Children’s Hospital, Birmingham, UK
| | | |
Collapse
|
35
|
Bennett C, Kohe S, Gill S, Ghosh N, Manias K, Oates A, English M, Adamski J, Tennant D, Peet A. LGG-40. EX VIVO TISSUE METABOLITE PROFILES PREDICT PROGRESSION-FREE SURVIVAL IN PAEDIATRIC CEREBELLAR PILOCYTIC ASTROCYTOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christopher Bennett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Sarah Kohe
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Simrandip Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Neelakshi Ghosh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Karen Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| | - Adam Oates
- Birmingham Children’s Hospital, Birmingham, UK
| | | | | | - Daniel Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital, Birmingham, UK
| |
Collapse
|
36
|
Zarinabad N, Meeus EM, Manias K, Foster K, Peet A. Automated Modular Magnetic Resonance Imaging Clinical Decision Support System (MIROR): An Application in Pediatric Cancer Diagnosis. JMIR Med Inform 2018; 6:e30. [PMID: 29720361 PMCID: PMC5956158 DOI: 10.2196/medinform.9171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/10/2018] [Accepted: 01/26/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Advances in magnetic resonance imaging and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyze relevant information from magnetic resonance imaging data to aid decision making, prevent errors, and enhance health care. OBJECTIVE The aim of this study was to design and develop a modular medical image region of interest analysis tool and repository (MIROR) for automatic processing, classification, evaluation, and representation of advanced magnetic resonance imaging data. METHODS The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumors in children (cohort of 48 children, with 37 malignant and 11 benign tumors). Mevislab software and Python have been used for the development of MIROR. Regions of interests were drawn around benign and malignant body tumors on different diffusion parametric maps, and extracted information was used to discriminate the malignant tumors from benign tumors. RESULTS Using MIROR, the various histogram parameters derived for each tumor case when compared with the information in the repository provided additional information for tumor characterization and facilitated the discrimination between benign and malignant tumors. Clinical decision support system cross-validation showed high sensitivity and specificity in discriminating between these tumor groups using histogram parameters. CONCLUSIONS MIROR, as a diagnostic tool and repository, allowed the interpretation and analysis of magnetic resonance imaging images to be more accessible and comprehensive for clinicians. It aims to increase clinicians' skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision making. The modular-based format of the tool allows integration of analyses that are not readily available clinically and streamlines the future developments.
Collapse
Affiliation(s)
- Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children Hospital NHS Trust, Birmingham, United Kingdom
| | - Emma M Meeus
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children Hospital NHS Trust, Birmingham, United Kingdom.,Physical Sciences of Imaging in Biomedical Sciences Doctoral Training Centre, University of Birmingham, Birmingham, United Kingdom
| | - Karen Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children Hospital NHS Trust, Birmingham, United Kingdom
| | - Katharine Foster
- Birmingham Children Hospital NHS Trust, Birmingham, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children Hospital NHS Trust, Birmingham, United Kingdom
| |
Collapse
|
37
|
Mustonen N, Siljander H, Peet A, Tillmann V, Härkönen T, Ilonen J, Hyöty H, Knip M. Early childhood infections precede development of beta-cell autoimmunity and type 1 diabetes in children with HLA-conferred disease risk. Pediatr Diabetes 2018; 19:293-299. [PMID: 28597957 DOI: 10.1111/pedi.12547] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 12/13/2016] [Revised: 04/13/2017] [Accepted: 05/09/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The etiology of type 1 diabetes (T1D) is largely unknown. Infections and microbial exposures are believed to play a role in the pathogenesis and in the development of islet autoimmunity in genetically susceptible individuals. OBJECTIVE To assess the relationships between early childhood infections, islet autoimmunity, and progression to T1D in genetically predisposed children. METHODS Children with human leukocyte antigen (HLA)-conferred disease susceptibility (N=790; 51.5% males) from Finland (n = 386), Estonia (n = 322), and Russian Karelia (n = 82) were observed from birth up to the age of 3 years. Children attended clinical visits at the age of 3, 6, 12, 18, 24, and 36 months. Serum samples for analyzing T1D-associated autoimmune markers were collected and health data recorded during the visits. RESULTS Children developing islet autoimmunity (n = 46, 5.8%) had more infections during the first year of life (3.0 vs 3.0, mean rank 439.1 vs 336.2; P = .001) and their first infection occurred earlier (3.6 vs 5.0 months; P = .005) than children with no islet autoimmunity. By May 2016, 7 children (0.9%) had developed T1D (progressors). Compared with non-diabetic children, T1D progressors were younger at first infection (2.2 vs 4.9 months; P = .004) and had more infections during the first 2 years of life (during each year 6.0 vs 3.0; P = .001 and P = .027, respectively). By 3 years of age, the T1D progressors had twice as many infections as the other children (17.5 vs 9.0; P = .006). CONCLUSIONS Early childhood infections may play an important role in the pathogenesis of T1D. Current findings may reflect either differences in microbial exposures or early immunological aberrations making diabetes-prone children more susceptible to infections.
Collapse
Affiliation(s)
- N Mustonen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - H Siljander
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - A Peet
- Department of Pediatrics, University of Tartu and Tartu University Hospital, Tartu, Estonia
| | - V Tillmann
- Department of Pediatrics, University of Tartu and Tartu University Hospital, Tartu, Estonia
| | - T Härkönen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - J Ilonen
- Immunogenetics Laboratory, University of Turku and Turku University Hospital, Turku, Finland
| | - H Hyöty
- Department of Virology, School of Medicine, University of Tampere, Tampere, Finland.,Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - M Knip
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | | |
Collapse
|
38
|
Sawlani V, Flintham R, Davies N, Fong C, Meade S, Peet A, Cruickshank G, Benghiat H, Sanghera P. Evaluation of Response to Stereotactic Radiosurgery in Brain Metastases Using Multi parametric. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.070] [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: 11/12/2022] Open
|
39
|
Abstract
Tracing the fate of stable isotopically-enriched nutrients is a sophisticated method of describing and quantifying the activity of metabolic pathways. Nuclear Magnetic Resonance (NMR) offers high resolution data, yet is under-utilised due to length of time required to collect the data, quantification requiring multiple samples and complicated analysis. Here we present two techniques, quantitative spectral filters and enhancement of the splitting due to J-coupling in 1H,13C-HSQC NMR spectra, which allow the rapid collection of NMR data in a quantitative manner on a single sample. The reduced duration of HSQC spectra data acquisition opens up the possibility of real-time tracing of metabolism including the study of metabolic pathways in vivo. We show how these novel techniques can be used to trace the fate of labelled nutrients in a whole organ model of kidney preservation prior to transplantation using a porcine kidney as a model organ, and also show how the use of multiple nutrients, differentially labelled with 13C and 15N, can be used to provide additional information with which to profile metabolic pathways.
Collapse
|
40
|
Abstract
Tracing the fate of stable isotopically-enriched nutrients is a sophisticated method of describing and quantifying the activity of metabolic pathways. Nuclear Magnetic Resonance (NMR) spectroscopy offers high resolution data in terms of resolving metabolic pathway utilisation. Despite this, NMR spectroscopy is under-utilised due to length of time required to collect the data, quantification requiring multiple samples and complicated analysis. Here we present two techniques, quantitative spectral filters and enhancement of the splitting of
13C signals due to homonuclear
13C,
13C or heteronuclear
13C,
15N J-coupling in
1H,
13C-HSQC NMR spectra. Together, these allow the rapid collection of NMR spectroscopy data in a quantitative manner on a single sample. The reduced duration of HSQC spectra data acquisition opens up the possibility of real-time tracing of metabolism including the study of metabolic pathways
in vivo. We show how these techniques can be used to trace the fate of labelled nutrients in a whole organ model of kidney preservation prior to transplantation using a porcine kidney as a model organ. In addition, we show how the use of multiple nutrients, differentially labelled with
13C and
15N, can be used to provide additional information with which to profile metabolic pathways.
Collapse
Affiliation(s)
- Thomas Brendan Smith
- Institute of Metabolism and Systems Research, University of Birmingham, West Midlands, UK
| | - Kamlesh Patel
- Institute of Metabolism and Systems Research, University of Birmingham, West Midlands, UK
| | - Haydn Munford
- Institute of Metabolism and Systems Research, University of Birmingham, West Midlands, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, West Midlands, UK.,Birmingham Children's Hospital NHS Foundation Trust, West Midlands, UK
| | - Daniel A Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, West Midlands, UK
| | - Mark Jeeves
- Institute of Cancer and Genomic Sciences, University of Birmingham, West Midlands, UK
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, University of Birmingham, West Midlands, UK
| |
Collapse
|
41
|
Zarinabad N, Abernethy LJ, Avula S, Davies NP, Rodriguez Gutierrez D, Jaspan T, MacPherson L, Mitra D, Rose HEL, Wilson M, Morgan PS, Bailey S, Pizer B, Arvanitis TN, Grundy RG, Auer DP, Peet A. Application of pattern recognition techniques for classification of pediatric brain tumors by in vivo 3T 1 H-MR spectroscopy-A multi-center study. Magn Reson Med 2017; 79:2359-2366. [PMID: 28786132 PMCID: PMC5850456 DOI: 10.1002/mrm.26837] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/30/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
Purpose 3T magnetic resonance scanners have boosted clinical application of 1H‐MR spectroscopy (MRS) by offering an improved signal‐to‐noise ratio and increased spectral resolution, thereby identifying more metabolites and extending the range of metabolic information. Spectroscopic data from clinical 1.5T MR scanners has been shown to discriminate between pediatric brain tumors by applying machine learning techniques to further aid diagnosis. The purpose of this multi‐center study was to investigate the discriminative potential of metabolite profiles obtained from 3T scanners in classifying pediatric brain tumors. Methods A total of 41 pediatric patients with brain tumors (17 medulloblastomas, 20 pilocytic astrocytomas, and 4 ependymomas) were scanned across four different hospitals. Raw spectroscopy data were processed using TARQUIN. Borderline synthetic minority oversampling technique was used to correct for the data skewness. Different classifiers were trained using linear discriminative analysis, support vector machine, and random forest techniques. Results Support vector machine had the highest balanced accuracy for discriminating the three tumor types. The balanced accuracy achieved was higher than the balanced accuracy previously reported for similar multi‐center dataset from 1.5T magnets with echo time 20 to 32 ms alone. Conclusion This study showed that 3T MRS can detect key differences in metabolite profiles for the main types of childhood tumors. Magn Reson Med 79:2359–2366, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Collapse
Affiliation(s)
- Niloufar Zarinabad
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Laurence J Abernethy
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Nigel P Davies
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children's Hospital, Birmingham, United Kingdom.,Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Daniel Rodriguez Gutierrez
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, United Kingdom
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Dipayan Mitra
- Neuroradiology Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Heather E L Rose
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Martin Wilson
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Paul S Morgan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, United Kingdom.,Radiological Sciences, Department of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Simon Bailey
- Paediatric Oncology Department, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Theodoros N Arvanitis
- Birmingham Children's Hospital, Birmingham, United Kingdom.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Richard G Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Dorothee P Auer
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom.,Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, United Kingdom.,Radiological Sciences, Department of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Peet
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
42
|
Kohe S, Colmenero I, McConville C, Peet A. Immunohistochemical staining of lipid droplets with adipophilin in paraffin-embedded glioma tissue identifies an association between lipid droplets and tumour grade. ACTA ACUST UNITED AC 2017. [DOI: 10.7243/2055-091x-4-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
Affiliation(s)
| | | | - Andrew Peet
- University of Birmingham, Edgbaston, Birmingham, UK
| | | | | |
Collapse
|
44
|
Babourina-Brooks B, Kohe S, Davies N, Peet A. MB-85NON-INVASIVE TEMPERATURE MEASUREMENTS BY MRI AS A PREDICTOR OF THE SURVIVAL OF MEDULLOBLASTOMA PATIENTS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.81] [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] Open
|
45
|
Woodman H, Ford D, Sangha G, Bode C, Webster G, Cashmore J, English M, Peet A, Benghiat H. RO-16EXPERIENCE OF CRANIOSPINAL TOMOTHERAPY ®IN CHILDREN AND YOUNG ADULTS: DELIVERABILITY AND ACUTE TOXICITY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.16] [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
|
46
|
Murren R, Tennant D, Peet A. HG-100THE ROLE OF HYPOXIA ON LIPID DROPLET PRODUCTION IN GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.96] [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
|
47
|
Novak J, Withey S, MacPherson L, Avula S, Abernethy L, Peet A. RA-15PERFUSION INCREASES WITH GRADE IN PAEDIATRIC BRAIN TUMOURS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Manias K, English M, Ford D, Gill S, MacPherson L, Nicklaus-Wollenteit I, Rodrigues D, Peet A. RA-11ADDED VALUE OF 1-H MAGNETIC RESONANCE SPECTROSCOPY FOR THE DIAGNOSIS OF PAEDIATRIC BRAIN LESIONS IN CLINICAL PRACTICE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.10] [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
|
49
|
Wood J, Kim DH, Tooth D, Wilson M, Ward J, Bennett C, Lourdusamy A, Peet A, Layfield R, Barrett D, Smith S, Rahman R. METB-10DELINEATING INTRA-TUMOUR METABOLOMIC AND PHOSPHO-PROTEOMIC HETEROGENEITY IN PATIENT GLIOBLASTOMAS THROUGH ADVANCED ANALYTICAL METHODS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov221.10] [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
|
50
|
Pruul K, Kisand K, Alnek K, Metsküla K, Reimand K, Heilman K, Peet A, Varik K, Peetsalu M, Einberg Ü, Tillmann V, Uibo R. Differences in B7 and CD28 family gene expression in the peripheral blood between newly diagnosed young-onset and adult-onset type 1 diabetes patients. Mol Cell Endocrinol 2015; 412:265-71. [PMID: 25980680 DOI: 10.1016/j.mce.2015.05.012] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 12/21/2022]
Abstract
Type-1 diabetes (T1D) is a heterogeneous autoimmune disease, and there are pathogenetic differences between young- and adult-onset T1D patients. We hypothesized that the expressions of genes involved in costimulatory immune system pathways in peripheral blood are differently regulated in young- and adult-onset T1D. Study group I consisted of 80 children, adolescents, and young adults (age range 1.4-21.4 y; 31 controls and 49 T1D patients). Study group II consisted of 48 adults (age range 22.0-78.4 y; 30 controls and 18 T1D patients). The mRNA expression levels of CD86, CD28, CD25, CD226, CD40, BTLA, GITR, PDCD1, FoxP3, TGF-β, ICOS, sCTLA4, flCTLA4, and CD80 were measured in peripheral blood. Genetic polymorphisms (HLA haplotypes; rs231806, rs231775, and rs3087243 in CTLA4; rs763361 in CD226; and rs706778 in CD25) and T1D-associated autoantibodies were analyzed. In group I, there was significantly lower expression of CD226 in T1D patients than in the controls. In group II, there were significantly higher expression levels of CD86 and TGF-β in T1D patients than in the controls. In the T1D patients in group I, the upregulated CD80 expression correlated with the expression of both CTLA4 splice variants (sCTLA4 and flCTLA4). In contrast, in group II, upregulated CD86 correlated with TGF-β and CD25. In group I, the inhibitory CD80-CTLA4 pathway was activated, whereas, in group II, the activation CD86-CD28 pathway and TGF-β production were activated. These results emphasize the differences between young-onset and adult-onset T1D in the regulation of costimulatory pathways. These differences should be considered when developing novel treatments for T1D.
Collapse
Affiliation(s)
- K Pruul
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Kisand
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Alnek
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Metsküla
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Reimand
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Heilman
- Children's Clinic of Tartu University Hospital, N. Lunini 6, Tartu 51014, Estonia; Tallinn Children's Hospital, Tervise 28, Tallinn 13419, Estonia
| | - A Peet
- Children's Clinic of Tartu University Hospital, N. Lunini 6, Tartu 51014, Estonia; Department of Paediatrics, University of Tartu, N. Lunini 6, Tartu 51014, Estonia
| | - K Varik
- Surgery Clinic, Tartu University Hospital, L. Puusepa 8A, Tartu 51014, Estonia
| | - M Peetsalu
- Surgery Clinic, Tartu University Hospital, L. Puusepa 8A, Tartu 51014, Estonia
| | - Ü Einberg
- Tallinn Children's Hospital, Tervise 28, Tallinn 13419, Estonia
| | - V Tillmann
- Children's Clinic of Tartu University Hospital, N. Lunini 6, Tartu 51014, Estonia; Department of Paediatrics, University of Tartu, N. Lunini 6, Tartu 51014, Estonia
| | - R Uibo
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Centre for Translational Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia; Estonian Academy of Sciences, Kohtu 6, Tallinn 10130, Estonia.
| |
Collapse
|