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Hibbert PD, Runciman WB, Carson-Stevens A, Lachman P, Wheaton G, Hallahan AR, Jaffe A, White L, Muething S, Wiles LK, Molloy CJ, Deakin A, Braithwaite J. Characterising the types of paediatric adverse events detected by the global trigger tool – CareTrack Kids. Journal of Patient Safety and Risk Management 2020. [DOI: 10.1177/2516043520969329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionA common method of learning about adverse events (AEs) is by reviewing medical records using the global trigger tool (GTT). However, these studies generally report rates of harm. The aim of this study is to characterise paediatric AEs detected by the GTT using descriptive and qualitative approaches.MethodsMedical records of children aged 0–15 were reviewed for presence of harm using the GTT. Records from 2012–2013 were sampled from hospital inpatients, emergency departments, general practice and specialist paediatric practices in three Australian states. Nurses undertook a review of each record and if an AE was suspected a doctor performed a verification review of a summary created by the nurse. A qualitative content analysis was undertaken on the summary of verified AEs.ResultsA total of 232 AEs were detected from 6,689 records reviewed. Over four-fifths of the AEs (193/232, 83%) resulted in minor harm to the patient. Nearly half (112/232, 48%) related to medication/intravenous (IV) fluids. Of these, 83% (93/112) were adverse drug reactions. Problems with medical devices/equipment were the next most frequent with nearly two-thirds (32/51, 63%) of these related to intravenous devices. Problems associated with clinical processes/procedures comprise one in six AEs (38/232, 16%), of which diagnostic problems (12/38, 32%) and procedural complications (11/38, 29%) were the most frequent.ConclusionAdverse drug reactions and issues with IVs are frequently identified AEs reflecting their common use in paediatrics. The qualitative approach taken in this study allowed AE types to be characterised, which is a prerequisite for developing and prioritising improvements in practice.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - William B Runciman
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Lachman
- International Society for Quality in Health Care, Dublin, Ireland
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Hospital, North Adelaide, Australia
| | - Andrew R Hallahan
- Children’s Health Queensland Hospital and Health Service, Herston, Australia
| | - Adam Jaffe
- University of New South Wales, Sydney, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, Australia
| | - Les White
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
- University of New South Wales, Sydney, Australia
| | | | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Anita Deakin
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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2
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Wiles LK, Hooper TD, Hibbert PD, Molloy C, White L, Jaffe A, Cowell CT, Harris MF, Runciman WB, Schmiede A, Dalton C, Hallahan AR, Dalton S, Williams H, Wheaton G, Murphy E, Braithwaite J. Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study. PLoS One 2019; 14:e0209637. [PMID: 30625190 PMCID: PMC6326465 DOI: 10.1371/journal.pone.0209637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.
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Affiliation(s)
- Louise K. Wiles
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Tamara D. Hooper
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter D. Hibbert
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte Molloy
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Les White
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
| | - Christopher T. Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William B. Runciman
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Annette Schmiede
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Chris Dalton
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R. Hallahan
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Brisbane, Queensland, Australia
| | - Sarah Dalton
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
- New South Wales (NSW) Agency for Clinical Innovation (ACI), Chatswood, Sydney, New South Wales, Australia
| | - Helena Williams
- Russell Clinic, Blackwood, Adelaide, South Australia, Australia
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
- Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia
- Cancer Australia, Surry Hills, Sydney, New South Wales, Australia
- Adelaide Primary Health Network, Mile End, Adelaide, South Australia, Australia
- Country SA Primary Health Network, Nuriootpa, Adelaide, South Australia, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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3
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Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E, Molloy CJ, Wiles LK, Ramanathan S, Arnolda G, Ting HP, Hooper TD, Szabo N, Wakefield JG, Hughes CF, Schmiede A, Dalton C, Dalton S, Holt J, Donaldson L, Kelley E, Lilford R, Lachman P, Muething S. Quality of Health Care for Children in Australia, 2012-2013. JAMA 2018; 319:1113-1124. [PMID: 29558552 PMCID: PMC5885883 DOI: 10.1001/jama.2018.0162] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. OBJECTIVE To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. EXPOSURES Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. MAIN OUTCOMES AND MEASURES Quality of care for each clinical condition and overall. RESULTS Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. CONCLUSIONS AND RELEVANCE Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D. Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Adam Jaffe
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
| | - Les White
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
| | - Christopher T. Cowell
- Kids Research Institute, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William B. Runciman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Andrew R. Hallahan
- Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Helena M. Williams
- Russell Clinic, Blackwood, South Australia, Australia
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Charlotte J. Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Louise K. Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Shanthi Ramanathan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tamara D. Hooper
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Natalie Szabo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - John G. Wakefield
- Clinical Excellence Division, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Clifford F. Hughes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- International Society for Quality in Health Care, Dublin, Ireland
| | - Annette Schmiede
- Bupa Health Foundation Australia, Sydney, New South Wales, Australia
| | - Chris Dalton
- Bupa Health Foundation Australia, Sydney, New South Wales, Australia
| | - Sarah Dalton
- Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
- New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia
- Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Joanna Holt
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Liam Donaldson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organization, Geneva, Switzerland
| | - Ed Kelley
- World Health Organization, Geneva, Switzerland
| | | | - Peter Lachman
- International Society for Quality in Health Care, Dublin, Ireland
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4
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Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, Garzia L, Torchia J, Nor C, Morrissy AS, Agnihotri S, Thompson YY, Kuzan-Fischer CM, Farooq H, Isaev K, Daniels C, Cho BK, Kim SK, Wang KC, Lee JY, Grajkowska WA, Perek-Polnik M, Vasiljevic A, Faure-Conter C, Jouvet A, Giannini C, Nageswara Rao AA, Li KKW, Ng HK, Eberhart CG, Pollack IF, Hamilton RL, Gillespie GY, Olson JM, Leary S, Weiss WA, Lach B, Chambless LB, Thompson RC, Cooper MK, Vibhakar R, Hauser P, van Veelen MLC, Kros JM, French PJ, Ra YS, Kumabe T, López-Aguilar E, Zitterbart K, Sterba J, Finocchiaro G, Massimino M, Van Meir EG, Osuka S, Shofuda T, Klekner A, Zollo M, Leonard JR, Rubin JB, Jabado N, Albrecht S, Mora J, Van Meter TE, Jung S, Moore AS, Hallahan AR, Chan JA, Tirapelli DPC, Carlotti CG, Fouladi M, Pimentel J, Faria CC, Saad AG, Massimi L, Liau LM, Wheeler H, Nakamura H, Elbabaa SK, Perezpeña-Diazconti M, Chico Ponce de León F, Robinson S, Zapotocky M, Lassaletta A, Huang A, Hawkins CE, Tabori U, Bouffet E, Bartels U, Dirks PB, Rutka JT, Bader GD, Reimand J, Goldenberg A, Ramaswamy V, Taylor MD. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell 2017; 31:737-754.e6. [PMID: 28609654 PMCID: PMC6163053 DOI: 10.1016/j.ccell.2017.05.005] [Citation(s) in RCA: 720] [Impact Index Per Article: 102.9] [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: 09/23/2016] [Revised: 03/24/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023]
Abstract
While molecular subgrouping has revolutionized medulloblastoma classification, the extent of heterogeneity within subgroups is unknown. Similarity network fusion (SNF) applied to genome-wide DNA methylation and gene expression data across 763 primary samples identifies very homogeneous clusters of patients, supporting the presence of medulloblastoma subtypes. After integration of somatic copy-number alterations, and clinical features specific to each cluster, we identify 12 different subtypes of medulloblastoma. Integrative analysis using SNF further delineates group 3 from group 4 medulloblastoma, which is not as readily apparent through analyses of individual data types. Two clear subtypes of infants with Sonic Hedgehog medulloblastoma with disparate outcomes and biology are identified. Medulloblastoma subtypes identified through integrative clustering have important implications for stratification of future clinical trials.
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Affiliation(s)
- Florence M G Cavalli
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf 40225, Germany; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Department of Pediatric Neuro-Oncogenomics, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Düsseldorf 40225, Germany
| | - Ladislav Rampasek
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - John Peacock
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - David J H Shih
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Livia Garzia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jonathon Torchia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Carolina Nor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - A Sorana Morrissy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sameer Agnihotri
- UPCI Brain Tumor Program, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Yuan Yao Thompson
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Claudia M Kuzan-Fischer
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Hamza Farooq
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Keren Isaev
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Craig Daniels
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Byung-Kyu Cho
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Wieslawa A Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron 69677, France; ONCOFLAM - Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon 69008, France
| | | | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Bron 69677, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Charles G Eberhart
- Departments of Pathology, Ophthalmology and Oncology, John Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - G Yancey Gillespie
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - James M Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA; Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - Sarah Leary
- Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - William A Weiss
- Departments of Pediatrics, Neurological Surgery and Neurology, University of California San Francisco, San Francisco, CA 94143-0112, USA
| | - Boleslaw Lach
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada; Department of Pathology and Laboratory Medicine, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Marie-Lise C van Veelen
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam 3015 CN, the Netherlands
| | - Pim J French
- Department of Neurology, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Young Shin Ra
- Department of Neurosurgery, University of Ulsan, Asan Medical Center, Seoul 05505, South Korea
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City 06720, Mexico
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Gaetano Finocchiaro
- Department of Neuro-Oncology, Istituto Neurologico Besta, Milan 20133, Italy
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan 20133, Italy
| | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka 540-0006, Japan
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Medical and Health Science Centre, Debrecen 4032, Hungary
| | - Massimo Zollo
- Dipartimento di Biochimica e Biotecnologie Mediche, University of Naples, Naples 80145, Italy
| | - Jeffrey R Leonard
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Nada Jabado
- Division of Hematology/Oncology, Department of Pediatrics, McGill University, Montreal, QC H4A 3J1, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada; Department of Pathology, Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona 08950, Spain
| | - Timothy E Van Meter
- Department of Pediatrics, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0646, USA
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun 519-763, Chonnam South Korea
| | - Andrew S Moore
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Andrew R Hallahan
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Daniela P C Tirapelli
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Carlos G Carlotti
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Maryam Fouladi
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Ali G Saad
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Luca Massimi
- Department of Pediatric Neurosurgery, Catholic University Medical School, Rome 00198, Italy
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Helen Wheeler
- Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW 2065, Australia
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto 860-8555, Japan
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | - Shenandoah Robinson
- Division of Pediatric Neurosurgery, Rainbow & Babies Children's Hospital, Case Western Reserve, Cleveland, OH 44106, USA
| | - Michal Zapotocky
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Alvaro Lassaletta
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Annie Huang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Pathology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Eric Bouffet
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Ute Bartels
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Peter B Dirks
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - James T Rutka
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Gary D Bader
- The Donnelly Centre, University of Toronto, Toronto, ON M5S 3E1, Canada; Banting and Best Department of Medical Research, University of Toronto, Toronto, ON M5G 1L6, Canada; McLaughlin Centre, University of Toronto, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada; Samuel Lunenfeld Research Institute at Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Jüri Reimand
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Program in Neuroscience and Mental Health and Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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5
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Staal JA, Lau LS, Zhang H, Ingram WJ, Hallahan AR, Northcott PA, Pfister SM, Wechsler-Reya RJ, Rusert JM, Taylor MD, Cho YJ, Packer RJ, Brown KJ, Rood BR. Proteomic profiling of high risk medulloblastoma reveals functional biology. Oncotarget 2016; 6:14584-95. [PMID: 25970789 PMCID: PMC4546489 DOI: 10.18632/oncotarget.3927] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022] Open
Abstract
Genomic characterization of medulloblastoma has improved molecular risk classification but struggles to define functional biological processes, particularly for the most aggressive subgroups. We present here a novel proteomic approach to this problem using a reference library of stable isotope labeled medulloblastoma-specific proteins as a spike-in standard for accurate quantification of the tumor proteome. Utilizing high-resolution mass spectrometry, we quantified the tumor proteome of group 3 medulloblastoma cells and demonstrate that high-risk MYC amplified tumors can be segregated based on protein expression patterns. We cross-validated the differentially expressed protein candidates using an independent transcriptomic data set and further confirmed them in a separate cohort of medulloblastoma tissue samples to identify the most robust proteogenomic differences. Interestingly, highly expressed proteins associated with MYC-amplified tumors were significantly related to glycolytic metabolic pathways via alternative splicing of pyruvate kinase (PKM) by heterogeneous ribonucleoproteins (HNRNPs). Furthermore, when maintained under hypoxic conditions, these MYC-amplified tumors demonstrated increased viability compared to non-amplified tumors within the same subgroup. Taken together, these findings highlight the power of proteomics as an integrative platform to help prioritize genetic and molecular drivers of cancer biology and behavior.
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Affiliation(s)
- Jerome A Staal
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Ling San Lau
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Huizhen Zhang
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
| | - Wendy J Ingram
- UQ Child Health Research Centre, The University of Queensland and Queensland Children's Medical Research Institute, Children's Health, Queensland, Australia
| | - Andrew R Hallahan
- UQ Child Health Research Centre, The University of Queensland and Queensland Children's Medical Research Institute, Children's Health, Queensland, Australia
| | - Paul A Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidleberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidleberg, Germany
| | | | - Jessica M Rusert
- Sanford-Burnham Medical Research Institute, La Jolla, California, USA
| | - Michael D Taylor
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington DC, USA
| | - Kristy J Brown
- Center for Genetic Medicine, Children's National Medical Center, Washington DC, USA
| | - Brian R Rood
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington DC, USA
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6
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Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, McLendon RE, Bigner DD, Lipp ES, Perreault S, Cho YJ, Grant G, Kim SK, Lee JY, Rao AAN, Giannini C, Li KKW, Ng HK, Yao Y, Kumabe T, Tominaga T, Grajkowska WA, Perek-Polnik M, Low DCY, Seow WT, Chang KTE, Mora J, Pollack IF, Hamilton RL, Leary S, Moore AS, Ingram WJ, Hallahan AR, Jouvet A, Fèvre-Montange M, Vasiljevic A, Faure-Conter C, Shofuda T, Kagawa N, Hashimoto N, Jabado N, Weil AG, Gayden T, Wataya T, Shalaby T, Grotzer M, Zitterbart K, Sterba J, Kren L, Hortobágyi T, Klekner A, László B, Pócza T, Hauser P, Schüller U, Jung S, Jang WY, French PJ, Kros JM, van Veelen MLC, Massimi L, Leonard JR, Rubin JB, Vibhakar R, Chambless LB, Cooper MK, Thompson RC, Faria CC, Carvalho A, Nunes S, Pimentel J, Fan X, Muraszko KM, López-Aguilar E, Lyden D, Garzia L, Shih DJH, Kijima N, Schneider C, Adamski J, Northcott PA, Kool M, Jones DTW, Chan JA, Nikolic A, Garre ML, Van Meir EG, Osuka S, Olson JJ, Jahangiri A, Castro BA, Gupta N, Weiss WA, Moxon-Emre I, Mabbott DJ, Lassaletta A, Hawkins CE, Tabori U, Drake J, Kulkarni A, Dirks P, Rutka JT, Korshunov A, Pfister SM, Packer RJ, Ramaswamy V, Taylor MD. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol 2016; 17:484-495. [PMID: 26976201 PMCID: PMC4907853 DOI: 10.1016/s1470-2045(15)00581-1] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 12/12/2022]
Abstract
Background Incomplete surgical resection of medulloblastoma is controversially considered a marker of high-risk disease; driving aggressive surgical resections, “second-look” surgeries, and/or intensified chemoradiotherapy. All prior publications evaluating the clinical importance of extent of resection (EOR) failed to account for molecular subgroup. We analysed the prognostic value of EOR across 787 medulloblastoma samples in a subgroup-specific manner. Methods We retrospectively identified patients from Medulloblastoma Advanced Genomics International Consortium (MAGIC) centres with a histological diagnosis of medulloblastoma and complete extent of resection and survival data. Specimens were collected from 35 international institutions. Medulloblastoma subgroup affiliation was determined using nanoString gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. Extent of resection (EOR) based on post-operative imaging was classified as gross total (GTR), near total (NTR, <1·5cm2), or subtotal (STR, ≥ 1·5cm2). Overall survival (OS) and progression-free survival (PFS) multivariable analyses including subgroup, age, metastatic status, geographical location of therapy (North America/Australia vs world), and adjuvant therapy regimen were performed. The primary endpoint was the impact of surgical EOR by molecular subgroup and other clinical variables on OS and PFS. Findings 787 medulloblastoma patients (86 WNT, 242 SHH, 163 Group 3, and 296 Group 4) were included in a multivariable Cox model of PFS and OS. The marked benefit of EOR in the overall cohort was greatly attenuated after including molecular subgroup in the multivariable analysis. There was an observed PFS benefit of GTR over STR (hazard ration [HR] 1·45, 95% CI; 1·07–1·96, p=0·02) but there was no observed PFS or OS benefit of GTR over NTR (HR 1·05, 0·71–1·53, p=0·82 and HR 1·14, 0·75–1·72, p=0.55). There was no statistically significant survival benefit to greater EOR for patients with WNT, SHH, or Group 3 patients (HR 1·03, 0·67–1·58, p=0·9 for STR vs. GTR). There was a PFS benefit for GTR over STR in patients with Group 4 medulloblastoma (HR1·97, 1·22–3·17, p=0·01), particularly those with metastatic disease (HR 2·22, 1–4·93, p=0·05). A nomogram based on this multivariable cox proportional hazards model shows the comparably smaller impact of EOR on relative risk for PFS and OS than subgroup affiliation, metastatic status, radiation dose, and adjuvant chemotherapy. Interpretation The prognostic benefit of EOR for patients with medulloblastoma is attenuated after accounting for molecular subgroup affiliation. Although maximal safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high as there is no definitive benefit to GTR over NTR. Our results suggest a re-evaluation of the long-term implications of intensified craniospinal irradiation (36 Gy) in children with small residual portions of medulloblastoma. Funding Funding Canadian Cancer Society Research Institute, Terry Fox Research Institute, Canadian Institutes of Health Research, National Institutes of Health, Pediatric Brain Tumor Foundation, Garron Family Chair in Childhood Cancer Research.
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Affiliation(s)
- Eric M Thompson
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Betty Luu
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Darell D Bigner
- Department of Pathology, Duke University, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
| | - Eric S Lipp
- Department of Pathology, Duke University, Durham, NC, USA
| | | | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford, CA, USA
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yu Yao
- Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology & Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew S Moore
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Wendy J Ingram
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Andrew R Hallahan
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Lyon, France
| | - Michelle Fèvre-Montange
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences, Université de Lyon, Lyon, France
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; ONCOFLAM, Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | | | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, QC, Canada
| | - Alexander G Weil
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Tenzin Gayden
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Takafumi Wataya
- Department of Pediatric Neurosurgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tarek Shalaby
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Michael Grotzer
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | - Tibor Hortobágyi
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Almos Klekner
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Bognár László
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Tímea Pócza
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Pim J French
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Luca Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Jeffrey R Leonard
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Alice Carvalho
- Departamento de Oncologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Sofia Nunes
- Unidade de Neuro-Oncologia Pediátrica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Xing Fan
- Department of Neurosurgery and Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City, Mexico
| | - David Lyden
- Department of Pediatrics and Cell and Developmental Biology, Weill Cornell Medical College, New York, NY, USA
| | - Livia Garzia
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - David J H Shih
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Noriyuki Kijima
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christian Schneider
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Adamski
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul A Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Ana Nikolic
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Arman Jahangiri
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brandyn A Castro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - William A Weiss
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Iska Moxon-Emre
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia E Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Abhaya Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Roger J Packer
- Department of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Vijay Ramaswamy
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Foresto SA, Youlden DR, Baade PD, Hallahan AR, Aitken JF, Moore AS. The outcomes and treatment burden of childhood acute myeloid leukaemia in Australia, 1997-2008: A report from the Australian Paediatric Cancer Registry. Pediatr Blood Cancer 2015; 62:1664-6. [PMID: 25855531 DOI: 10.1002/pbc.25517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 10/29/2014] [Accepted: 02/24/2015] [Indexed: 11/07/2022]
Abstract
Childhood acute myeloid leukaemia (AML) requires intensive therapy and is associated with survival rates that are substantially inferior to many other childhood malignancies. We undertook a retrospective analysis of Australian Paediatric Cancer Registry data from 1997 to 2008 together with a single-centre audit during the same period assessing burden on service delivery at a tertiary children's hospital (Royal Children's Hospital, Brisbane). Although survival improved from 54.3% (1997-2002) to 69.2% (2003-2008), childhood AML caused a disproportionate number of childhood cancer deaths, accounting for 5.5% of all childhood cancer diagnoses yet 7.9% of all childhood cancer mortality. Furthermore, treatment was associated with significant toxicity requiring intensive use of local health resources. Novel therapeutic strategies aimed at improving survival and reducing toxicity are urgently required.
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Affiliation(s)
- Steven A Foresto
- Oncology Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | | | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Andrew R Hallahan
- Oncology Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Andrew S Moore
- Oncology Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
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8
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Wiles LK, Hooper TD, Hibbert PD, White L, Mealing N, Jaffe A, Cowell CT, Harris MF, Runciman WB, Goldstein S, Hallahan AR, Wakefield JG, Murphy E, Lau A, Wheaton G, Williams HM, Hughes C, Braithwaite J. CareTrack Kids-part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development. BMJ Open 2015; 5:e007748. [PMID: 25854976 PMCID: PMC4390723 DOI: 10.1136/bmjopen-2015-007748] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite the widespread availability of clinical guidelines, considerable gaps remain between the care that is recommended (appropriate care) and the care provided. This protocol describes a research methodology to develop clinical indicators for appropriate care for common paediatric conditions. METHODS AND ANALYSIS We will identify conditions amenable to population-level appropriateness of care research and develop clinical indicators for each condition. Candidate conditions have been identified from published research; burden of disease, prevalence and frequency of presentation data; and quality of care priority lists. Clinical indicators will be developed through searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts will review the indicators using a wiki-based approach and modified Delphi process. A formative evaluation of the wiki process will be undertaken. ETHICS AND DISSEMINATION Human Research Ethics Committee approvals have been received from Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Health Network (South Australia). Applications are under review with Macquarie University and the Royal Australian College of General Practitioners. We will submit the results of the study to relevant journals and offer national and international presentations.
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Affiliation(s)
- Louise K Wiles
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tamara D Hooper
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Les White
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- New South Wales Health, NSW Kids and Families, North Sydney, New South Wales, Australia
| | - Nicole Mealing
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Christopher T Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Mark F Harris
- Faculty of Medicine, Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - William B Runciman
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Stan Goldstein
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R Hallahan
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - John G Wakefield
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Elisabeth Murphy
- New South Wales Health, NSW Kids and Families, North Sydney, New South Wales, Australia
| | - Annie Lau
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women's and Children's Health Network, South Australia, Australia
| | | | - Clifford Hughes
- Clinical Excellence Commission, Sydney South, New South Wales, Australia
| | - Jeffrey Braithwaite
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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9
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Hibbert PD, Hallahan AR, Muething SE, Lachman P, Hooper TD, Wiles LK, Jaffe A, White L, Wheaton GR, Runciman WB, Dalton S, Williams HM, Braithwaite J. CareTrack Kids-part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review. BMJ Open 2015; 5:e007750. [PMID: 25854978 PMCID: PMC4390767 DOI: 10.1136/bmjopen-2015-007750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The aim of this study is to measure the frequency and types of adverse events encountered in Australian paediatric care in a range of healthcare settings. METHODS AND ANALYSIS A form of retrospective medical record review, the Institute of Healthcare Improvement's Global Trigger Tool, will be modified to collect data. Records of children aged <16 years managed during 2012 and 2013 will be reviewed. We aim to review 6000-8000 records from a sample of healthcare practices (hospitals, general practices and specialists). ETHICS AND DISSEMINATION Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Hospital Network in South Australia. An application is under review with the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers.
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Affiliation(s)
- Peter D Hibbert
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew R Hallahan
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | | | - Peter Lachman
- Great Ormond St Hospital, Great Ormond St, London, UK
| | - Tamara D Hooper
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
| | - Louise K Wiles
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
| | - Adam Jaffe
- Department of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney Children's Hospital Network, Randwick, New South Wales, Australia
| | - Les White
- Department of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of NSW Kids and Families, New South Wales Health, North Sydney, New South Wales, Australia
| | - Gavin R Wheaton
- Division of Paediatric Medicine, Women's and Children's Health Network, South Australia, Australia
| | - William B Runciman
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Sarah Dalton
- Emergency Department, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Clinical Excellence Commission, Sydney, New South Wales, Australia
| | | | - Jeffrey Braithwaite
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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10
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Hooper TD, Hibbert PD, Mealing N, Wiles LK, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Goldstein S, Hallahan AR, Wakefield JG, Murphy E, Lau A, Wheaton G, Williams HM, Hughes C, Braithwaite J. CareTrack Kids-part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review. BMJ Open 2015; 5:e007749. [PMID: 25854977 PMCID: PMC4390725 DOI: 10.1136/bmjopen-2015-007749] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. METHODS AND ANALYSIS A random sample of 6000-8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged <16 years who presented with at least one of the study conditions during 2012 and 2013 will be reviewed. ETHICS AND DISSEMINATION Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service and Women's and Children's Hospital Network (South Australia). An application is under review for the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and offer oral presentations to researchers, clinicians and policymakers at national and international conferences.
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Affiliation(s)
- Tamara D Hooper
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nicole Mealing
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Les White
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- New South Wales Health, NSW Kids and Families, Sydney, New South Wales, Australia
| | - Christopher T Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Mark F Harris
- Faculty of Medicine, Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - William B Runciman
- Division of Education, Arts and Social Sciences, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Stan Goldstein
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R Hallahan
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - John G Wakefield
- Patient Safety and Quality Unit, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Elisabeth Murphy
- New South Wales Health, NSW Kids and Families, Sydney, New South Wales, Australia
| | - Annie Lau
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women's and Children's Health Network, South Australia, Australia
| | | | - Clifford Hughes
- Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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11
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Youlden DR, Baade PD, Hallahan AR, Valery PC, Green AC, Aitken JF. Conditional survival estimates for childhood cancer in Australia, 2002-2011: A population-based study. Cancer Epidemiol 2015; 39:394-400. [PMID: 25769222 DOI: 10.1016/j.canep.2015.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Conditional survival estimates take into account the time that a patient has remained alive following diagnosis to provide a realistic perspective on the probability of longer term survival. Such estimates are scarce for childhood cancer, particularly by age at diagnosis or stage of cancer. METHODS De-identified population-based data were obtained from the Australian Paediatric Cancer Registry for children aged 0-14 years diagnosed with cancer between 1983 and 2010. Mortality status was followed up to the end of 2011. The hybrid period method was used to calculate relative survival estimates for those who were at risk during the period 2002-2011. Conditional survival stratified by diagnostic group or subgroup, age and stage at diagnosis was then obtained from the ratio of the relative survival estimates at different time points. RESULTS A total of 13,537 children were eligible for inclusion. Five-year survival for all childhood cancers combined improved from 82% at diagnosis (95% confidence interval=81-83%) to 89% (88-90%) conditional on surviving one year, and 97% (97-98%) conditional on surviving five years after diagnosis. Conditional survival reached 95% within five years of diagnosis for nearly all types of cancer, regardless of a child's age or stage at diagnosis. CONCLUSION Most children diagnosed with cancer who are alive five years after diagnosis can anticipate similar survival to children in the general population. This information may help alleviate some of the distress associated with childhood cancer, particularly for those with an initially poor prognosis.
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Affiliation(s)
- Danny R Youlden
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia.
| | - Peter D Baade
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia
| | - Andrew R Hallahan
- Oncology Service, Children's Health Queensland, Cnr Bramston Terrace & Herston Road, Herston, Queensland, Australia
| | - Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Level 1, 147 Wharf Street, Brisbane, Queensland, Australia
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghoffer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia
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12
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Ingram WJ, Crowther LM, Little EB, Freeman R, Harliwong I, Veleva D, Hassall TE, Remke M, Taylor MD, Hallahan AR. ABC transporter activity linked to radiation resistance and molecular subtype in pediatric medulloblastoma. Exp Hematol Oncol 2013; 2:26. [PMID: 24219920 PMCID: PMC3851566 DOI: 10.1186/2162-3619-2-26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 01/09/2023] Open
Abstract
Background Resistance to radiation treatment remains a major clinical problem for patients with brain cancer. Medulloblastoma is the most common malignant brain tumor of childhood, and occurs in the cerebellum. Though radiation treatment has been critical in increasing survival rates in recent decades, the presence of resistant cells in a substantial number of medulloblastoma patients leads to relapse and death. Methods Using the established medulloblastoma cell lines UW228 and Daoy, we developed a novel model system to enrich for and study radiation tolerant cells early after radiation exposure. Using fluorescence-activated cell sorting, dead cells and cells that had initiated apoptosis were removed, allowing surviving cells to be investigated before extensive proliferation took place. Results Isolated surviving cells were tumorigenic in vivo and displayed elevated levels of ABCG2, an ABC transporter linked to stem cell behavior and drug resistance. Further investigation showed another family member, ABCA1, was also elevated in surviving cells in these lines, as well as in early passage cultures from pediatric medulloblastoma patients. We discovered that the multi-ABC transporter inhibitors verapamil and reserpine sensitized cells from particular patients to radiation, suggesting that ABC transporters have a functional role in cellular radiation protection. Additionally, verapamil had an intrinsic anti-proliferative effect, with transient exposure in vitro slowing subsequent in vivo tumor formation. When expression of key ABC transporter genes was assessed in medulloblastoma tissue from 34 patients, levels were frequently elevated compared with normal cerebellum. Analysis of microarray data from independent cohorts (n = 428 patients) showed expression of a number of ABC transporters to be strongly correlated with certain medulloblastoma subtypes, which in turn are associated with clinical outcome. Conclusions ABC transporter inhibitors are already being trialed clinically, with the aim of decreasing chemotherapy resistance. Our findings suggest that the inhibition of ABC transporters could also increase the efficacy of radiation treatment for medulloblastoma patients. Additionally, the finding that certain family members are associated with particular molecular subtypes (most notably high ABCA8 and ABCB4 expression in Sonic Hedgehog pathway driven tumors), along with cell membrane location, suggests ABC transporters are worthy of consideration for the diagnostic classification of medulloblastoma.
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Keating J, Tsoli M, Hallahan AR, Ingram WJ, Haber M, Ziegler DS. Targeting the inhibitor of apoptosis proteins as a novel therapeutic strategy in medulloblastoma. Mol Cancer Ther 2012; 11:2654-63. [PMID: 23012247 DOI: 10.1158/1535-7163.mct-12-0352] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medulloblastoma is the most common malignant brain tumor of childhood. Novel therapeutic strategies are urgently needed to overcome cytotoxic resistance. We hypothesized that antiapoptotic signals contribute to resistance and that treatment with proapoptotic agents could increase the efficacy of conventional therapies. A PCR array was used to assess the status of the apoptotic signaling pathway in medulloblastoma cells after treatment with cytotoxic chemotherapy. Treatment with cisplatin led to the upregulation of antiapoptotic signals, including inhibitor of apoptosis proteins (IAP), in medulloblastoma cells. We subsequently investigated the synergistic effect of a small-molecule IAP inhibitor, LBW242, in combination with cisplatin and/or radiotherapy in three human medulloblastoma cell lines and 5 short term primary patient medulloblastoma cultures. The addition of LBW242 to chemotherapy resulted in significantly increased antitumor activity with a similar effect observed in combination with radiotherapy. Measurement of caspase-8 and -9 activity indicated that the synergy resulted from induction of both the intrinsic and extrinsic apoptotic pathways. Apoptosis was confirmed by Annexin V staining and activation of caspases 3/7. Xenograft models were used to evaluate the mechanism of action and efficacy in vivo. The combination therapy significantly reduced the tumor burden in a medulloblastoma xenograft model and TUNEL analysis in a medulloblastoma orthograft confirmed in vivo induction of apoptosis. These findings support the strategy of targeting IAPs in combination with cytotoxic therapy as a novel treatment strategy for patients with medulloblastoma.
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Affiliation(s)
- Joanna Keating
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, University ofNewSouth Wales, Australia
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Julian E, Hallahan AR, Wainwright BJ. RBP-J is not required for granule neuron progenitor development and medulloblastoma initiated by Hedgehog pathway activation in the external germinal layer. Neural Dev 2010; 5:27. [PMID: 20950430 PMCID: PMC2972267 DOI: 10.1186/1749-8104-5-27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 03/18/2010] [Accepted: 10/15/2010] [Indexed: 11/25/2022] Open
Abstract
Background The Notch signalling pathway plays crucial roles in neural development, functioning by preventing premature differentiation and promotion of glial cell fates. In the developing cerebellum Notch pathway components are expressed in granule neuron progenitors of the external germinal layer (EGL) but the precise function of Notch in these cells is unclear. The Hedgehog pathway is also crucial in cerebellar development, mainly via control of the cell cycle, and persistent activation of the pathways leads to the cerebellar tumour medulloblastoma. Interactions between Hedgehog and Notch have been reported in normal brain development as well as in Hedgehog pathway induced medulloblastoma but the molecular details of this interaction are not known and we investigate here the role of Notch signalling in the development of the EGL and the intersection between the two pathways in cerebellar granule neuron progenitors and in medulloblastoma. Results RBP-J is the major downstream effector of all four mammalian Notch receptors and the RBP-J conditional mouse facilitates inactivation of canonical Notch signals. Patched1 is a negative regulator of Hedgehog signalling and the Patched1 conditional mouse is widely used to activate Hedgehog signalling via Patched1 deletion in specific cell types. The conditional mouse lines were crossed with a Math1-Cre line to delete the two genes in granule neuron progenitors from embryonic day 10.5. While deletion of only Patched1 as well as Patched1 together with RBP-J leads to formation of medulloblastoma concomitant with disorganisation of cell layers, loss of RBP-J from granule neuron progenitors has no obvious effect on overall cerebellar morphology or differentiation and maturation of the different cerebellar cell types. Conclusions Our results suggest that even though Notch signalling has been shown to play important roles in cerebellar development, signalling via RBP-J is surprisingly not required in granule neuron progenitors. Furthermore, RBP-J inactivation in these cells does not influence the formation of medulloblastoma initiated by Hedgehog pathway activation. This may suggest a requirement of Notch in cerebellar development at a different developmental stage or in a different cell type than examined here - for example, in the neural stem cells of the ventricular zone. In addition, it remains a possibility that, in granule neuron progenitors, Notch may signal via an alternative pathway without the requirement for RBP-J.
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Affiliation(s)
- Elaine Julian
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
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15
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Julian E, Dave RK, Robson JP, Hallahan AR, Wainwright BJ. Canonical Notch signaling is not required for the growth of Hedgehog pathway-induced medulloblastoma. Oncogene 2010; 29:3465-76. [DOI: 10.1038/onc.2010.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bensink ME, Armfield NR, Pinkerton R, Irving H, Hallahan AR, Theodoros DG, Russell T, Barnett AG, Scuffham PA, Wootton R. Using videotelephony to support paediatric oncology-related palliative care in the home: from abandoned RCT to acceptability study. Palliat Med 2009; 23:228-37. [PMID: 19073783 DOI: 10.1177/0269216308100251] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours 'on-call' service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550.
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Affiliation(s)
- M E Bensink
- The University of Queensland Centre for Online Health, Royal Children's Hospital, Herston, QLD 4029, Australia.
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17
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Moore AS, Shaw PJ, Hallahan AR, Carter TL, Kilo T, Nivison‐Smith I, O’Brien TA, Tapp H, Teague L, Wilson SR, Tiedemann K. Haemopoietic stem cell transplantation for children in Australia and New Zealand, 1998–2006: a report on behalf of the Australasian Bone Marrow Transplant Recipient Registry and the Australian and New Zealand Children's Haematology Oncology Group. Med J Aust 2009; 190:121-5. [DOI: 10.5694/j.1326-5377.2009.tb02309.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/31/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew S Moore
- Oncology/Haematology Service, Royal Children's Hospital, Brisbane, QLD
| | - Peter J Shaw
- Oncology Unit, The Children's Hospital at Westmead, Sydney, NSW
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW
| | - Andrew R Hallahan
- Oncology/Haematology Service, Royal Children's Hospital, Brisbane, QLD
| | - Tina L Carter
- Bone Marrow Transplant Program, Department of Haematology/Oncology, Princess Margaret Hospital for Children, Perth, WA
| | - Tatjana Kilo
- Oncology Unit, The Children's Hospital at Westmead, Sydney, NSW
| | | | - Tracey A O’Brien
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Sydney, NSW
| | | | | | - Shaun R Wilson
- Oncology Unit, The Children's Hospital at Westmead, Sydney, NSW
| | - Karin Tiedemann
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC
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18
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Ingram WJ, McCue KI, Tran TH, Hallahan AR, Wainwright BJ. Sonic Hedgehog regulates Hes1 through a novel mechanism that is independent of canonical Notch pathway signalling. Oncogene 2007; 27:1489-500. [PMID: 17873912 DOI: 10.1038/sj.onc.1210767] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aberrant regulation of signalling mechanisms that normally orchestrate embryonic development, such as the Hedgehog, Wnt and Notch pathways, is a common feature of tumorigenesis. In order to better understand the neoplastic events mediated by Hedgehog signalling, we identified over 200 genes regulated by Sonic Hedgehog in multipotent mesodermal cells. Widespread crosstalk with other developmental signalling pathways is evident, suggesting a complex network of interactions that challenges the often over-simplistic representation of these pathways as simple linear entities. Hes1, a principal effector of the Notch pathway, was found to be a target of Sonic Hedgehog in both C3H/10T1/2 mesodermal and MNS70 neural cells. Desert Hedgehog also elicited a strong Hes1 response. While Smoothened function was found necessary for upregulation of Hes1 in response to Sonic Hedgehog, the mechanism does not require gamma-secretase-mediated cleavage of Notch receptors, and appears to involve transcription factors other than RBP-Jkappa. Thus, we have defined a novel mechanism for Hes1 regulation in stem-like cells that is independent of canonical Notch signalling.
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Affiliation(s)
- W J Ingram
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
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19
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Fan W, Khalid N, Hallahan AR, Olson JM, Zhao LP. A statistical method for predicting splice variants between two groups of samples using GeneChip expression array data. Theor Biol Med Model 2006; 3:19. [PMID: 16603076 PMCID: PMC1502129 DOI: 10.1186/1742-4682-3-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 04/07/2006] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Alternative splicing of pre-messenger RNA results in RNA variants with combinations of selected exons. It is one of the essential biological functions and regulatory components in higher eukaryotic cells. Some of these variants are detectable with the Affymetrix GeneChip that uses multiple oligonucleotide probes (i.e. probe set), since the target sequences for the multiple probes are adjacent within each gene. Hybridization intensity from a probe correlates with abundance of the corresponding transcript. Although the multiple-probe feature in the current GeneChip was designed to assess expression values of individual genes, it also measures transcriptional abundance for a sub-region of a gene sequence. This additional capacity motivated us to develop a method to predict alternative splicing, taking advance of extensive repositories of GeneChip gene expression array data. RESULTS We developed a two-step approach to predict alternative splicing from GeneChip data. First, we clustered the probes from a probe set into pseudo-exons based on similarity of probe intensities and physical adjacency. A pseudo-exon is defined as a sequence in the gene within which multiple probes have comparable probe intensity values. Second, for each pseudo-exon, we assessed the statistical significance of the difference in probe intensity between two groups of samples. Differentially expressed pseudo-exons are predicted to be alternatively spliced. We applied our method to empirical data generated from GeneChip Hu6800 arrays, which include 7129 probe sets and twenty probes per probe set. The dataset consists of sixty-nine medulloblastoma (27 metastatic and 42 non-metastatic) samples and four cerebellum samples as normal controls. We predicted that 577 genes would be alternatively spliced when we compared normal cerebellum samples to medulloblastomas, and predicted that thirteen genes would be alternatively spliced when we compared metastatic medulloblastomas to non-metastatic ones. We checked the consistency of some of our findings with information in UCSC Human Genome Browser. CONCLUSION The two-step approach described in this paper is capable of predicting some alternative splicing from multiple oligonucleotide-based gene expression array data with GeneChip technology. Our method employs the extensive repositories of gene expression array data available and generates alternative splicing hypotheses, which can be further validated by experimental studies.
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Affiliation(s)
- Wenhong Fan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA
| | - Najma Khalid
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA
| | - Andrew R Hallahan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA
- Department of Paediatrics and Child Health, University of Queensland, QLD, 4029, Australia
| | - James M Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA
| | - Lue Ping Zhao
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA
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20
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Abstract
Recent studies show that activation of p38 mitogen-activated protein kinase (MAPK) results in cancer cell apoptosis initiated by retinoids, cisplatin and other chemotherapeutic agents. The observation that divergent therapies act through a common signal transduction pathway raises the possibility of developing new anti-cancer agents that lack the side-effects caused by events upstream of p38 MAPK. Here, we review p38-MAPK-mediated tumor cell apoptosis and implications for cancer therapeutics.
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Affiliation(s)
- James M Olson
- Fred Hutchinson Cancer Research Center, and Department of Pediatrics, University of Washington, Seattle, WA, USA.
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21
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Hallahan AR, Pritchard JI, Hansen S, Benson M, Stoeck J, Hatton BA, Russell TL, Ellenbogen RG, Bernstein ID, Beachy PA, Olson JM. The SmoA1 Mouse Model Reveals That Notch Signaling Is Critical for the Growth and Survival of Sonic Hedgehog-Induced Medulloblastomas. Cancer Res 2004; 64:7794-800. [PMID: 15520185 DOI: 10.1158/0008-5472.can-04-1813] [Citation(s) in RCA: 327] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To develop a genetically faithful model of medulloblastoma with increased tumor incidence compared with the current best model we activated the Sonic Hedgehog (Shh) pathway by transgenically expressing a constitutively active form of Smoothened in mouse cerebellar granule neuron precursors (ND2:SmoA1 mice). This resulted in early cerebellar granule cell hyper-proliferation and a 48% incidence of medulloblastoma formation. Gene expression studies showed an increase in the known Shh targets Gli1 and Nmyc that correlated with increasing hyperplasia and tumor formation. Notch2 and the Notch target gene, HES5, were also significantly elevated in Smoothened-induced tumors showing that Shh pathway activation is sufficient to induce Notch pathway signaling. In human medulloblastomas reverse transcription-PCR for Shh and Notch targets revealed activation of both of these pathways in most tumors when compared with normal cerebellum. Notch pathway inhibition with soluble Delta ligand or gamma secretase inhibitors resulted in a marked reduction of viable cell numbers in medulloblastoma cell lines and primary tumor cultures. Treatment of mice with D283 medulloblastoma xenografts with a gamma secretase inhibitor resulted in decreased proliferation and increased apoptosis, confirming that Notch signaling contributes to human medulloblastoma proliferation and survival. Medulloblastomas in ND2:SmoA1 mice and humans have concomitant increase in Shh and Notch pathway activities, both of which contribute to tumor survival.
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Affiliation(s)
- Andrew R Hallahan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
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Hallahan AR, Pritchard JI, Chandraratna RAS, Ellenbogen RG, Geyer JR, Overland RP, Strand AD, Tapscott SJ, Olson JM. BMP-2 mediates retinoid-induced apoptosis in medulloblastoma cells through a paracrine effect. Nat Med 2003; 9:1033-8. [PMID: 12872164 DOI: 10.1038/nm904] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Accepted: 06/30/2003] [Indexed: 11/09/2022]
Abstract
The mechanisms of retinoid activity in tumors remain largely unknown. Here we establish that retinoids cause extensive apoptosis of medulloblastoma cells. In a xenograft model, retinoids largely abrogated tumor growth. Using receptor-specific retinoid agonists, we defined a subset of mRNAs that were induced by all active retinoids in retinoid-sensitive cell lines. We also identified bone morphogenetic protein-2 (BMP-2) as a candidate mediator of retinoid activity. BMP-2 protein induced medulloblastoma cell apoptosis, whereas the BMP-2 antagonist noggin blocked both retinoid and BMP-2-induced apoptosis. BMP-2 also induced p38 mitogen-activated protein kinase (MAPK), which is necessary for BMP-2- and retinoid-induced apoptosis. Retinoid-resistant medulloblastoma cells underwent apoptosis when treated with BMP-2 or when cultured with retinoid-sensitive medulloblastoma cells. Retinoid-induced expression of BMP-2 is thus necessary and sufficient for apoptosis of retinoid-responsive cells, and expression of BMP-2 by retinoid-sensitive cells is sufficient to induce apoptosis in surrounding retinoid-resistant cells.
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Affiliation(s)
- Andrew R Hallahan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
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23
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Berman DM, Karhadkar SS, Hallahan AR, Pritchard JI, Eberhart CG, Watkins DN, Chen JK, Cooper MK, Taipale J, Olson JM, Beachy PA. Medulloblastoma growth inhibition by hedgehog pathway blockade. Science 2002; 297:1559-61. [PMID: 12202832 DOI: 10.1126/science.1073733] [Citation(s) in RCA: 650] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Constitutive Hedgehog (Hh) pathway activity is associated with initiation of neoplasia, but its role in the continued growth of established tumors is unclear. Here, we investigate the therapeutic efficacy of the Hh pathway antagonist cyclopamine in preclinical models of medulloblastoma, the most common malignant brain tumor in children. Cyclopamine treatment of murine medulloblastoma cells blocked proliferation in vitro and induced changes in gene expression consistent with initiation of neuronal differentiation and loss of neuronal stem cell-like character. This compound also caused regression of murine tumor allografts in vivo and induced rapid death of cells from freshly resected human medulloblastomas, but not from other brain tumors, thus establishing a specific role for Hh pathway activity in medulloblastoma growth.
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Affiliation(s)
- David M Berman
- Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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24
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Hallahan AR, Shaw PJ, Rowell G, O'Connell A, Schell D, Gillis J. Improved outcomes of children with malignancy admitted to a pediatric intensive care unit. Crit Care Med 2000; 28:3718-21. [PMID: 11098979 DOI: 10.1097/00003246-200011000-00030] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the acute and long-term outcomes of children admitted to the intensive care unit with cancer or complications after bone marrow transplantation. DESIGN Retrospective analysis of databases from a prospective pediatric intensive care unit (PICU) database supplemented by case notes review. SETTING A PICU in a tertiary pediatric hospital. PATIENTS All children with malignancy admitted to the PICU between May 1, 1987, and April 30, 1996. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 206 admissions to the PICU during a 9-yr study period of 150 children with malignancies or complications after bone marrow transplantation. Forty patents died in the PICU (27% mortality rate). The most frequent indications for PICU admission were shock and respiratory disease. Of 56 children admitted with shock, there were 16 deaths (29% mortality rate). In 24 episodes of sepsis, inotropic and ventilatory support were required and 13 patients (54%) survived. Analysis of long-term survival gave estimates of 50% survival for all oncology patients admitted to the PICU and 42% for those admitted for shock. CONCLUSIONS A high proportion of oncology patients admitted to the PICU requiring intensive intervention survive and go on to be cured of their malignancy. Our study suggests the PICU outcome for these patients has improved.
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Affiliation(s)
- A R Hallahan
- Pediatric Intensive Care Unit, The Royal Alexandra Hospital for Children, The New Children's Hospital, Sydney, Australia
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25
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Abstract
OBJECTIVE To evaluate the clinical and diagnostic features of children presenting with haemophagocytic lymphohistiocytosis (HLH), evolution of the disease and outcomes in response to treatment. METHODOLOGY The medical records of 12 children, aged 5 weeks to 13 years at diagnosis, with HLH managed at a single institution were reviewed. RESULTS Presenting features were fever, hepatosplenomegaly, pancytopenia and hypertriglyceridemia or hypofibrinogenemia. Nine patients (75%) developed central nervous system (CNS) disease. Only one child with CNS disease survived. Five children had complete responses to therapy (42%), but all relapsed at a median of 1.5 months after starting treatment (range 2 weeks to 5 months). Two of the children treated are long-term survivors (17%), both after allogeneic bone marrow transplantation. All deaths occurred in the context of active disease. CONCLUSIONS Haemophagocytic lymphohistiocytosis is a disease with a poor prognosis. Central nervous system complications are common and response to treatment usually is transient. This study provides support for the use of immunomodulatory therapy for remission introduction followed by consideration of allogeneic bone marrow transplantation.
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Affiliation(s)
- A R Hallahan
- Department of Haematology and Oncology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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26
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Hallahan AR, Armour CL, Black JL. Products of neutrophils and eosinophils increase the responsiveness of human isolated bronchial tissue. Eur Respir J 1990; 3:554-8. [PMID: 2376251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study examines the possibility that products of neutrophils and eosinophils could increase the responsiveness of human isolated bronchial tissue. Neutrophils and eosinophils were isolated from the peripheral blood of healthy volunteers. The cells were incubated with 1 microM calcium ionophore A23187 for 10-15 min then centrifuged, the supernatant collected and stored at -70 degrees C. Human bronchial rings (2-3 mm diameter, 3-4 mm long) were prepared from specimens resected at thoracotomy. The tissues were suspended in organ baths under a 1 g load and changes in tension measured isometrically. Stable contractions to bolus doses of histamine (0.1-10 microM) or to electrical field stimulation (40-100 V, 4-16 Hz, 1 ms for 20 s) were established. Supernatant from 106 neutrophils or 105 eosinophils was then added and tissue responsiveness reassessed. Neutrophil supernatant increased tissue responsiveness to histamine and electrical field stimulation by 54 +/- 17% (n = 5, p less than 0.05) and 18 +/- 7% (n = 6, p less than 0.05), respectively. Eosinophil supernatant increased the histamine response by 60 +/- 23% (n = 8, p less than 0.05) while tissue responsiveness to electrical field stimulation was unchanged (n = 3). Thus, as neutrophils and eosinophils can change the responsiveness of human bronchus in vitro it is possible that they do this in vivo and may not simply be temporally related to the development of bronchial hyperresponsiveness.
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Affiliation(s)
- A R Hallahan
- Dept of Pharmacology, University of Sydney, New South Wales, Australia
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27
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Hallahan AR, Armour CL, Black JL. Products of neutrophils and eosinophils increase the responsiveness of human isolated bronchial tissue. Eur Respir J 1990. [DOI: 10.1183/09031936.93.03050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examines the possibility that products of neutrophils and eosinophils could increase the responsiveness of human isolated bronchial tissue. Neutrophils and eosinophils were isolated from the peripheral blood of healthy volunteers. The cells were incubated with 1 microM calcium ionophore A23187 for 10-15 min then centrifuged, the supernatant collected and stored at -70 degrees C. Human bronchial rings (2-3 mm diameter, 3-4 mm long) were prepared from specimens resected at thoracotomy. The tissues were suspended in organ baths under a 1 g load and changes in tension measured isometrically. Stable contractions to bolus doses of histamine (0.1-10 microM) or to electrical field stimulation (40-100 V, 4-16 Hz, 1 ms for 20 s) were established. Supernatant from 106 neutrophils or 105 eosinophils was then added and tissue responsiveness reassessed. Neutrophil supernatant increased tissue responsiveness to histamine and electrical field stimulation by 54 +/- 17% (n = 5, p less than 0.05) and 18 +/- 7% (n = 6, p less than 0.05), respectively. Eosinophil supernatant increased the histamine response by 60 +/- 23% (n = 8, p less than 0.05) while tissue responsiveness to electrical field stimulation was unchanged (n = 3). Thus, as neutrophils and eosinophils can change the responsiveness of human bronchus in vitro it is possible that they do this in vivo and may not simply be temporally related to the development of bronchial hyperresponsiveness.
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28
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Abstract
Rice et al. (1986) have described a flow cytometric method where the non-fluorescent probe monochlorobimane (mBCl) forms a fluorescent adduct with cellular glutathione (GSH) under the action of glutathione-S-transferase. We show here that for EMT6 carcinosarcoma cells there is a close correlation between mean cell fluorescence, expressed as a ratio to that of fluorescence calibration beads, and biochemically determined GSH content over the range 0.2-2.0 fmol cell-1. Single cell suspensions from 14 human cancers were prepared by 23-gauge needle aspiration or mechanical disaggregation of surgical specimens, stained using mBCl and examined by flow cytometry. There was a wide range in individual cell fluorescence, which in contrast to EMT6 cells was not strongly correlated with Coulter volume. By comparing tumour cell fluorescence to that of calibration beads, and assuming that the relationship with GSH content for EMT6 holds for other cells, a mean GSH content of 0.95 fmol cell-1 was derived for nine carcinomas, and 0.21 fmol cell-1 for five non-Hodgkin's lymphomas. Although this semi-quantitation needs further validation, the method used here is rapid, gives an indication of heterogeneity of tumour cell GSH content, and can be applied to fine needle biopsy samples. It therefore shows promise as a means for studying prospectively the relationship of GSH content to clinical drug and radiation sensitivity, and for monitoring the effects of agents such as buthionine sulphoximine which are intended to improve treatment results through tumour cell GSH depletion.
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Affiliation(s)
- D W Hedley
- Ludwig Institute for Cancer Research, University of Sydney, NSW, Australia
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