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Mortuza S, Chin-Yee B, James TE, Chin-Yee IH, Hedley BD, Ho JM, Saini L, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Keow J, Sangle N, Hsia CC. Myelodysplastic Neoplasms (MDS) with Ring Sideroblasts or SF3B1 Mutations: The Improved Clinical Utility of World Health Organization and International Consensus Classification 2022 Definitions, a Single-Centre Retrospective Chart Review. Curr Oncol 2024; 31:1762-1773. [PMID: 38668037 PMCID: PMC11049163 DOI: 10.3390/curroncol31040134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Myelodysplastic neoplasms (MDS) with ring sideroblasts (RS) are diagnosed via bone marrow aspiration in the presence of either (i) ≥15% RS or (ii) 5-14% RS and an SF3B1 mutation. In the MEDALIST trial and in an interim analysis of the COMMANDS trial, lower-risk MDS-RS patients had decreased transfusion dependency with luspatercept treatment. A total of 6817 patients with suspected hematologic malignancies underwent molecular testing using a next-generation-sequencing-based genetic assay and 395 MDS patients, seen at our centre from 1 January 2018 to 31 May 2023, were reviewed. Of these, we identified 39 evaluable patients as having lower-risk MDS with SF3B1 mutations: there were 20 (51.3%) males and 19 (48.7%) females, with a median age of 77 years (range of 57 to 92). Nineteen (48.7%) patients had an isolated SF3B1 mutation with a mean variant allele frequency of 35.2% +/- 8.1%, ranging from 7.4% to 46.0%. There were 29 (74.4%) patients with ≥15% RS, 6 (15.4%) with 5 to 14% RS, one (2.6%) with 1% RS, and 3 (7.7%) with no RS. Our study suggests that a quarter of patients would be missed based on the morphologic criterion of only using RS greater than 15% and supports the revised 2022 definitions of the World Health Organization (WHO) and International Consensus Classification (ICC), which shift toward molecularly defined subtypes of MDS and appropriate testing.
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Affiliation(s)
- Shamim Mortuza
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Benjamin Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Tyler E. James
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Ian H. Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jenny M. Ho
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Lalit Saini
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
| | - Laila Schenkel
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Pratibha Bhai
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Jonathan Keow
- Edmonton Base Lab, Alberta Precision Laboratories, Edmonton, AB T2N 1M7, Canada;
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada; (B.D.H.); (L.S.); (P.B.); (B.S.); (N.S.)
| | - Cyrus C. Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada; (S.M.); (B.C.-Y.); (I.H.C.-Y.); (J.M.H.); (L.S.); (A.L.-L.)
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Chin-Yee B, Suthakaran A, Hedley BD, Howlett C, Stuart A, Sadikovic B, Chin-Yee IH, Hsia CC. T-cell clonality testing for the diagnosis of T-cell large granular lymphocytic leukemia: Are we identifying pathology or incidental clones? Int J Lab Hematol 2022; 44:1115-1120. [PMID: 36380468 DOI: 10.1111/ijlh.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION T-cell clonality testing by T-cell receptor (TCR) gene rearrangement is key to the diagnosis of T-cell lymphoproliferative disorders such as T-cell large granular lymphocytic (T-LGL) leukemia. Benign clonal T-cell expansions, however, are commonly found in patients without identifiable disease, a condition referred to as T-cell clones of uncertain significance (T-CUS). In practice, T-cell clonality testing is performed for a range of reasons and results are often challenging to interpret given the overlap between benign and malignant clonal T-cell proliferations and uncertainties in the management of T-CUS. METHODS We conducted a 5-year retrospective cohort study of 211 consecutive patients who underwent PCR-based T-cell clonality testing for suspected T-LGL leukemia at our institution to characterize the use of T-cell clonality testing and its impact on patient management. RESULTS Overall, 46.4% (n = 98) of individuals tested had a clonal T-cell population identified. Patients with a monoclonal T-cell population were more likely to be older, have rheumatoid arthritis and have higher lymphocyte counts compared to patients with polyclonal populations. The majority of patients eventually diagnosed and treated for T-LGL leukemia had rheumatoid arthritis and lower neutrophil counts compared to untreated patients with monoclonal T-cell populations. A diagnosis of T-LGL leukemia was made in only a minority of patients (n = 48, 22.7%), and only a small proportion were treated (n = 17, 8.1%). CONCLUSION Our study suggests that T-cell clonality testing most commonly identifies incidental T-cell clones with only a minority of patients receiving a diagnosis of T-LGL leukemia and fewer requiring active treatment. These finding indicate an opportunity to improve utilization of T-cell clonality testing in clinical practice to better target patients where the results of testing would impact clinical management.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Abitha Suthakaran
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Beca BM, Radford MJ, Hedley BD, Chin-Yee IH, Lazo-Langner A, Hsia CC. Thrombolysis in the recovery of coagulated bone marrow aspirate samples. Int J Lab Hematol 2022; 44:e233-e235. [PMID: 35633199 DOI: 10.1111/ijlh.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Bogdan Mihai Beca
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael James Radford
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Bhai P, Hsia CC, Schenkel LC, Hedley BD, Levy MA, Kerkhof J, Santos S, Stuart A, Lin H, Broadbent R, Nan S, Yang P, Xenocostas A, Chin-Yee I, Sadikovic B. Clinical Utility of Implementing a Frontline NGS-Based DNA and RNA Fusion Panel Test for Patients with Suspected Myeloid Malignancies. Mol Diagn Ther 2022; 26:333-343. [PMID: 35381971 DOI: 10.1007/s40291-022-00581-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of molecular genetic biomarkers is rapidly advancing to aid diagnosis, prognosis, and clinical management of hematological disorders. We have implemented a next-generation sequencing (NGS) assay for detection of genetic variants and fusions as a frontline test for patients suspected with myeloid malignancy. In this study, we summarize the findings and assess the clinical impact in the first 1613 patients tested. METHODS All patients were assessed using NGS based Oncomine Myeloid Research Assay (ThermoFisher) including 40 genes (17 full genes and 23 genes with clinically relevant "hotspot" regions), along with a panel of 29 fusion driver genes (including over fusion 600 partners). RESULTS Among 1613 patients with suspected myeloid malignancy, 43% patients harbored at least one clinically relevant variant: 91% (90/100) in acute myeloid leukemia patients, 71.7% (160/223) in myelodysplastic syndrome (MDS), 77.5% (308/397) in myeloproliferative neoplasm (MPN), 83% (34/41) in MPN/MDS, and 100% (40/40) in chronic myeloid leukemia patients. Comparison of NGS and cytogenetics results revealed a high degree of concordance in gene fusion detection. CONCLUSIONS Our findings demonstrate clinical utility and feasibility of integrating a NGS-based gene mutation and fusion testing assay as a frontline diagnostic test in a large reported cohort of patients with suspected myeloid malignancy, in a clinical laboratory setting. Overlap with cytogenetic test results provides opportunity for testing reduction and streamlining.
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Affiliation(s)
- Pratibha Bhai
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Laila C Schenkel
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael A Levy
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Jennifer Kerkhof
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Stephanie Santos
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Alan Stuart
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada
| | - Robert Broadbent
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Shirley Nan
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ping Yang
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, Room E6-211, London, ON, N6A 5W9, Canada.
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON, Canada.
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Borowitz MJ, Wood BL, Keeney M, Hedley BD. Measurable Residual Disease Detection in B-Acute Lymphoblastic Leukemia: The Children's Oncology Group (COG) Method. Curr Protoc 2022; 2:e383. [PMID: 35263042 DOI: 10.1002/cpz1.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Measurable (minimal) residual disease (MRD) in B-acute lymphoblastic leukemia (B-ALL), as assessed by flow cytometry, is an established prognostic factor used to adjust treatment in most pediatric therapeutic protocols. MRD in B-ALL has been standardized by the Children's Oncology Group in North America and more recently in a multicenter Foundation for the National Institutes of Health-funded study. This article outlines the reagents, instrument setup, and analysis protocols required for the reproducible detection of residual leukemic cells in patients following induction therapy for B-ALL. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Staining and flow cytometry for B-acute lymphoblastic leukemia (B-ALL) measurable residual disease detection Support Protocol: Specimen collection, handling, storage, and shipping Basic Protocol 2: Analysis and interpretation of data for B-ALL measurable residual disease detection Basic Protocol 3: Analysis of samples lacking sufficient CD19+ events.
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Affiliation(s)
- Michael J Borowitz
- Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brent L Wood
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Michael Keeney
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
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Kawata E, Hedley BD, Chin-Yee B, Xenocostas A, Lazo-Langner A, Hsia CC, Howson-Jan K, Yang P, Levy MA, Santos S, Bhai P, Howlett C, Lin H, Kadour M, Sadikovic B, Chin-Yee I. Reducing cytogenetic testing in the era of next generation sequencing: Are we choosing wisely? Int J Lab Hematol 2021; 44:333-341. [PMID: 34713980 DOI: 10.1111/ijlh.13747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In most laboratories, next generation sequencing (NGS) has been added without consideration for redundancy compared to conventional cytogenetics (CG). We tested a streamlined approach to genomic testing in patients with suspected myeloid and plasma cell neoplasms using next generation sequencing ("NGS first") as the primary testing modality and limiting cytogenetics (CG) to samples with morphologic abnormalities in the marrow aspirate. METHODS Based on morphologic interpretation of bone marrow aspirate and flow cytometry, samples were triaged into four groups: (a) Samples with dysplasia or excess blasts had both NGS and karyotyping; (b) Samples without excess blasts or dysplasia had NGS only; (c) Repeat samples with previous NGS and/or CG studies were not retested; (d) Samples for suspected myeloma with less than 5% plasma cell had CG testing cancelled. RESULTS Seven hundred eleven adult bone marrow (BM) samples met the study criteria. The NGS first algorithm eliminated CG testing in 229/303 (75.6%) of patients, primarily by reducing repeat testing. Potential cost avoided was approximately $124 000 per annum. Hematologists overruled the triage comment in only 11/303 (3.6%) cases requesting CG testing for a specific indication. CONCLUSIONS Utilizing NGS as the primary genomic testing modality NGS was feasible and well accepted, reducing over three quarters of all CG requests and improving the financial case for adoption of NGS. Key factors for the success of this study were collaboration of clinical and genomic diagnostic teams in developing the algorithm, rapid turnaround time for BM interpretation for triage, and communication between laboratories.
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Affiliation(s)
- Eri Kawata
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Hematology, Panasonic Health Insurance Organization Matsushita Memorial Hospital, Moriguchi, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anargyros Xenocostas
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
| | - Kang Howson-Jan
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ping Yang
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Cytogenetics Laboratory, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Santos
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
| | - Mike Kadour
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada.,Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University, London, Ontario, Canada
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Voss C, Esmail S, Liu X, Knauer MJ, Ackloo S, Kaneko T, Lowes L, Stogios P, Seitova A, Hutchinson A, Yusifov F, Skarina T, Evdokimova E, Loppnau P, Ghiabi P, Haijan T, Zhong S, Abdoh H, Hedley BD, Bhayana V, Martin CM, Slessarev M, Chin-Yee B, Fraser DD, Chin-Yee I, Li SS. Epitope-specific antibody responses differentiate COVID-19 outcomes and variants of concern. JCI Insight 2021; 6:148855. [PMID: 34081630 PMCID: PMC8410046 DOI: 10.1172/jci.insight.148855] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUNDThe role of humoral immunity in COVID-19 is not fully understood, owing, in large part, to the complexity of antibodies produced in response to the SARS-CoV-2 infection. There is a pressing need for serology tests to assess patient-specific antibody response and predict clinical outcome.METHODSUsing SARS-CoV-2 proteome and peptide microarrays, we screened 146 COVID-19 patients' plasma samples to identify antigens and epitopes. This enabled us to develop a master epitope array and an epitope-specific agglutination assay to gauge antibody responses systematically and with high resolution.RESULTSWe identified linear epitopes from the spike (S) and nucleocapsid (N) proteins and showed that the epitopes enabled higher resolution antibody profiling than the S or N protein antigen. Specifically, we found that antibody responses to the S-811-825, S-881-895, and N-156-170 epitopes negatively or positively correlated with clinical severity or patient survival. Moreover, we found that the P681H and S235F mutations associated with the coronavirus variant of concern B.1.1.7 altered the specificity of the corresponding epitopes.CONCLUSIONEpitope-resolved antibody testing not only affords a high-resolution alternative to conventional immunoassays to delineate the complex humoral immunity to SARS-CoV-2 and differentiate between neutralizing and non-neutralizing antibodies, but it also may potentially be used to predict clinical outcome. The epitope peptides can be readily modified to detect antibodies against variants of concern in both the peptide array and latex agglutination formats.FUNDINGOntario Research Fund (ORF) COVID-19 Rapid Research Fund, Toronto COVID-19 Action Fund, Western University, Lawson Health Research Institute, London Health Sciences Foundation, and Academic Medical Organization of Southwestern Ontario (AMOSO) Innovation Fund.
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MESH Headings
- Agglutination Tests/methods
- Amino Acid Sequence
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody Formation/immunology
- Antibody Specificity/immunology
- COVID-19/blood
- COVID-19/immunology
- COVID-19/mortality
- COVID-19 Serological Testing/methods
- Epitopes/immunology
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Humans
- Immunity, Humoral
- Microarray Analysis/methods
- Nucleocapsid/chemistry
- Nucleocapsid/genetics
- Nucleocapsid/immunology
- Peptides/immunology
- SARS-CoV-2/genetics
- SARS-CoV-2/immunology
- Severity of Illness Index
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
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Affiliation(s)
| | | | | | - Michael J. Knauer
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Lori Lowes
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Peter Stogios
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Tatiana Skarina
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Elena Evdokimova
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Loppnau
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Pegah Ghiabi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Taraneh Haijan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | | | - Husam Abdoh
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Claudio M. Martin
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Douglas D. Fraser
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Esmail S, Knauer MJ, Abdoh H, Voss C, Chin-Yee B, Stogios P, Seitova A, Hutchinson A, Yusifov F, Skarina T, Evdokimova E, Ackloo S, Lowes L, Hedley BD, Bhayana V, Chin-Yee I, Li SSC. Rapid and accurate agglutination-based testing for SARS-CoV-2 antibodies. Cell Rep Methods 2021; 1:100011. [PMID: 34235498 PMCID: PMC8114573 DOI: 10.1016/j.crmeth.2021.100011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
We have developed a rapid, accurate, and cost-effective serologic test for SARS-CoV-2 virus, which caused the COVID-19 pandemic, on the basis of antibody-dependent agglutination of antigen-coated latex particles. When validated using plasma samples that are positive or negative for SARS-CoV-2, the agglutination assay detected antibodies against the receptor-binding domain of the spike (S-RBD) or the nucleocapsid protein of SARS-CoV-2 with 100% specificity and ∼98% sensitivity. Furthermore, we found that the strength of the S-RBD antibody response measured by the agglutination assay correlated with the efficiency of the plasma in blocking RBD binding to the angiotensin-converting enzyme 2 in a surrogate neutralization assay, suggesting that the agglutination assay might be used to identify individuals with virus-neutralizing antibodies. Intriguingly, we found that >92% of patients had detectable antibodies on the day of a positive viral RNA test, suggesting that the agglutination antibody test might complement RNA testing for the diagnosis of SARS-CoV-2 infection.
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Affiliation(s)
- Sally Esmail
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
| | - Michael J. Knauer
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Husam Abdoh
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Courtney Voss
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
| | - Benjamin Chin-Yee
- Divison of Hematology, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Peter Stogios
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Almagul Seitova
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Ashley Hutchinson
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Farhad Yusifov
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Tatiana Skarina
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Elena Evdokimova
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - Suzanne Ackloo
- Structural Genomics Consortium, University of Toronto, 101 College Street, MaRS South Tower, Suite 700, Toronto, ON M5G 1L7, Canada
| | - Lori Lowes
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Benjamin D. Hedley
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Shawn S.-C. Li
- Departments of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6G 2V4, Canada
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Hedley BD, Cheng G, Keeney M, Kern W, Padurean A, Luider J, Chin‐Yee I, Lowes LE, Rohrbach J, Ortega R, Smit A, Lo K, Magari R, Tejidor L. A multicenter study evaluation of the ClearLLab 10C panels. Cytometry B Clin Cytom 2021; 100:225-234. [PMID: 32667744 PMCID: PMC8048967 DOI: 10.1002/cyto.b.21935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Multiparameter flow cytometry plays an important role in the diagnosis, staging, and monitoring of patients with a suspected hematological malignancy. The ClearLLab 10C Panels consist of four reagent panels (B-Lineage Tube, T-Lineage Tube, and 2 Myeloid Lineage Tubes), each consisting of 10 color/10 antibody conjugates utilizing Beckman Coulters proprietary dry format optimized for investigating patients with suspected leukemia or lymphoma. A multicenter study was conducted to evaluate the performance of the ClearLLab 10C Panels for qualitative assessment of normal versus abnormal phenotype in peripheral blood, bone marrow, and lymph node samples with suspected hematological malignancies. ClearLLab 10C was compared to laboratory developed tests (LDTs) and final clinical diagnosis. Four clinical sites were used to enroll patient's spent specimens (n = 453); three laboratories in North America and one in Europe. Of the 453 specimens, 198 had no malignancy and 255 contained an abnormal population. The diagnostic accuracy of the ClearLLab 10C Panels was achieved with sensitivity of 96% and specificity of 95% with respect to patient final clinical diagnosis. The agreement of phenotyping between ClearLLab10C Panels and LDTs was 98%. Any differences noted between ClearLLab 10C and LDT were due to either the presence of populations below the level of detection, the lack of clinical information provided to the evaluators, or marker(s) not present in these panels. Overall, the ClearLLab 10C demonstrated excellent agreement to LDTs and diagnosis. These four reagent panels can be adopted by individual laboratories to assess the presence or absence of malignancy.
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Affiliation(s)
- Benjamin D. Hedley
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Guoyan Cheng
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Michael Keeney
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Wolfgang Kern
- MLL Munich Leukemia LaboratoryDepartment of ImmunophenotypingMunichGermany
| | - Adrian Padurean
- Neogenomics Laboratory, Inc.Department of Flow CytometryFort MyersFloridaUSA
| | - Joanne Luider
- Calgary Laboratory ServicesFlow Cytometry CalgaryAlbertaCanada
| | - Ian Chin‐Yee
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Lori E. Lowes
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Justin Rohrbach
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Ortega
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Astrid Smit
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Ka‐Wai Lo
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Magari
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Liliana Tejidor
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
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Knauer MJ, Hedley BD, Bhayana V, Payne M, Chin-Yee I, Delport J. Interim analysis of the clinical performance of five SARS-Cov-2 serology assays. Clin Biochem 2020; 86:28-30. [PMID: 32905808 PMCID: PMC7474956 DOI: 10.1016/j.clinbiochem.2020.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Michael J Knauer
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada.
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada
| | - Michael Payne
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada
| | - Johan Delport
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada
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Lowes LE, Hedley BD, Sutherland DR, Keeney M. Evaluation of Versalyse as an alternative red blood cell lysing agent in the evaluation of CD34 stem and progenitor cells with the ISHAGE guidelines. Cytometry B Clin Cytom 2020; 100:402-405. [PMID: 33009886 DOI: 10.1002/cyto.b.21960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lori E Lowes
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin D Hedley
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - D Robert Sutherland
- Laboratory Medicine Program, The University Health Network, Toronto, Ontario, Canada
| | - Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
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Keeney M, Hedley BD, Chin-Yee IH. Flow cytometry-Recognizing unusual populations in leukemia and lymphoma diagnosis. Int J Lab Hematol 2017; 39 Suppl 1:86-92. [PMID: 28447408 DOI: 10.1111/ijlh.12666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/24/2017] [Indexed: 12/16/2022]
Abstract
Flow cytometry is an invaluable technology in the examination of blood, bone marrow, tissue and body fluids for the presence or absence of hematological disease. It is used in both diagnostic and follow-up testing, with an increasingly important role in the detection of very small residual disease populations (Minimal Residual Disease, MRD) However, flow cytometry immunophenotyping of leukemia and lymphoma is highly dependent on interpretation of results and with the increased complexity of 8-10 color instruments routinely used in clinical laboratories, knowledge of disease-defining populations is increasingly important as is recognizing normal and reactive patterns. This manuscript presents case studies with flow cytometric patterns encountered in routine screening of samples sent for leukemia and lymphoma immunophenotyping, focusing mainly on B-cell disorders which may be missed or incorrectly interpreted by the laboratory (including a hematopathologist) performing the test. Case studies are used to illustrate our laboratory's standardized approach to the interpretation of flow cytometric data. In addition to a standardized approach, these cases emphasize the importance of interpretative skills of technologist and hematopathologists in recognizing abnormal patterns in detecting hematological malignancies.
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Affiliation(s)
- M Keeney
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - B D Hedley
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - I H Chin-Yee
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada.,Department of Medicine, Schulich School of Medicine Western University, London, ON, Canada
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Keeney M, Wood BL, Hedley BD, DiGiuseppe JA, Stetler-Stevenson M, Paietta E, Lozanski G, Seegmiller AC, Greig BW, Shaver AC, Mukundan L, Higley HR, Sigman CC, Kelloff G, Jessup JM, Borowitz MJ. A QA Program for MRD Testing Demonstrates That Systematic Education Can Reduce Discordance Among Experienced Interpreters. Cytometry B Clin Cytom 2017; 94:239-249. [PMID: 28475275 DOI: 10.1002/cyto.b.21528] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Minimal residual disease (MRD) in B lymphoblastic leukemia (B-ALL) by flow cytometry is an established prognostic factor used to adjust treatment in most pediatric therapeutic protocols. MRD in B-ALL has been standardized by the Children's Oncology Group (COG) in North America, but not routine clinical labs. The Foundation for National Institutes of Health sought to harmonize MRD measurement among COG, oncology groups, academic, community and government, laboratories. METHODS Listmode data from post-induction marrows were distributed from a reference lab to seven different clinical FCM labs with variable experience in B-ALL MRD. Labs were provided with the COG protocol. Files from 15 cases were distributed to the seven labs. Educational sessions were implemented, and 10 more listmode file cases analyzed. RESULTS Among 105 initial challenges, the overall discordance rate was 26%. In the final round, performance improved considerably; out of 70 challenges, there were five false positives and one false negative (9% discordance), and no quantitative discordance. Four of six deviations occurred in a single lab. Three samples with hematogones were still misclassified as MRD. CONCLUSIONS Despite the provision of the COG standardized analysis protocol, even experienced laboratories require an educational component for B-ALL MRD analysis by FCM. Recognition of hematogones remains challenging for some labs when using the COG protocol. The results from this study suggest that dissemination of MRD testing to other North American laboratories as part of routine clinical management of B-ALL is possible but requires additional educational components to complement standardized methodology. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Brent L Wood
- Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Seattle, Washington
| | - Benjamin D Hedley
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Gerard Lozanski
- Department of Pathology, Ohio State University, Columbus, Ohio
| | - Adam C Seegmiller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bruce W Greig
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron C Shaver
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Gary Kelloff
- Cancer Imaging Program, National Cancer Institute, Bethesda, Maryland
| | | | - Michael J Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Hedley BD, Keeney M, Popma J, Chin-Yee I. Novel lymphocyte screening tube using dried monoclonal antibody reagents. Cytometry B Clin Cytom 2015; 88:361-70. [PMID: 25944189 DOI: 10.1002/cyto.b.21251] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/09/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022]
Abstract
We previously developed a 10-color 11-antibody combination including a viability dye, to screen T-, B-, and natural killer (NK)-cell populations in blood, bone marrow, tissue, and body fluids. Recently, Beckman Coulter has introduced a line of dried reagents that, unlike liquid reagents and cocktails, require no refrigeration, titration, or manipulation before using. We evaluated custom tubes based on our standard lymphocyte screening panel, focusing on comparative analysis, ease of use, and advantages compared with our liquid reagent set. We tested 42 samples from blood (n = 15), bone marrow (n = 17), and tissue (n = 10) with the combination CD4/CD8/KAPPA/LAMBDA/CD19/CD56/CD5/CD20/CD10/CD3/CD45 and a vital dye by both methods and compared positivity and staining intensity for each antigen. Of the 42 samples, 5 were normal samples, 3 were red cell disorders, 20 were B-cell malignancies, 5 T-cell malignancies, 4 myeloid malignancies, and the remaining 5 were other diagnoses. Dried reagents gave equivalent staining intensity results to our standard panel in a variety of sample types, with diagnoses including reactive lymphocytosis, chronic lymphocytic leukemia, and various lymphomas. Our standard panel for evaluation of mature lymphoid malignancies allows rapid assessment of any sample type while providing direct assessment of viability. The dried reagent tube reduces preanalytical work, with simple addition of sample and the viability dye to the tube, saving time, reducing potential errors, and obviating need to titrate and monitor individual antibodies. With a shelf life of at least 12 months, the reagents also offer potential savings in reagent costs by reducing wastage due to expiration or tandem breakdown in standard liquid formulation.
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Affiliation(s)
- Benjamin D Hedley
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Michael Keeney
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Janice Popma
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Ian Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, Schulich School of Medicine Western University of Ontario, London, Ontario, N6K 5W9, Canada
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Hedley BD, Llewellyn-Smith N, Lang S, Hsia CC, MacNamara N, Rosenfeld D, Keeney M. Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry. Cytometry 2015; 88:330-7. [DOI: 10.1002/cyto.b.21245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/21/2015] [Accepted: 04/03/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin D. Hedley
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
| | | | - Stephen Lang
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | - Cyrus C. Hsia
- Department of Medicine; Division of Hematology; London Health Sciences Centre, Victoria Hospital; London Ontario N6A 5W9 Canada
| | - Neil MacNamara
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | | | - Michael Keeney
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
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Lowes LE, Hedley BD, Keeney M, Allan AL. Adaptation of semiautomated circulating tumor cell (CTC) assays for clinical and preclinical research applications. J Vis Exp 2014:e51248. [PMID: 24637923 DOI: 10.3791/51248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The majority of cancer-related deaths occur subsequent to the development of metastatic disease. This highly lethal disease stage is associated with the presence of circulating tumor cells (CTCs). These rare cells have been demonstrated to be of clinical significance in metastatic breast, prostate, and colorectal cancers. The current gold standard in clinical CTC detection and enumeration is the FDA-cleared CellSearch system (CSS). This manuscript outlines the standard protocol utilized by this platform as well as two additional adapted protocols that describe the detailed process of user-defined marker optimization for protein characterization of patient CTCs and a comparable protocol for CTC capture in very low volumes of blood, using standard CSS reagents, for studying in vivo preclinical mouse models of metastasis. In addition, differences in CTC quality between healthy donor blood spiked with cells from tissue culture versus patient blood samples are highlighted. Finally, several commonly discrepant items that can lead to CTC misclassification errors are outlined. Taken together, these protocols will provide a useful resource for users of this platform interested in preclinical and clinical research pertaining to metastasis and CTCs.
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Affiliation(s)
- Lori E Lowes
- London Regional Cancer Program, London Health Sciences Centre; Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, Western University
| | | | - Michael Keeney
- Special Hematology/Flow Cytometry, London Health Sciences Centre; Lawson Health Research Institute
| | - Alison L Allan
- London Regional Cancer Program, London Health Sciences Centre; Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, Western University; Lawson Health Research Institute; Department of Oncology, Western University;
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Abstract
Flow cytometry has become an essential tool for identification and characterization of hematological cancers and now, due to technological improvements, allows the identification and rapid enumeration of small tumor populations that may be present after induction therapy (minimal residual disease, MRD). The quantitation of MRD has been shown to correlate with relapse and survival rates in numerous diseases and in certain cases, and evidence of MRD is used to alter treatment protocols. Recent improvements in hardware allow for high data rate collection. Improved fluorochromes take advantage of violet laser excitation and maximize signal-to-noise ratio allowing the population of interest to be isolated in multiparameter space. This isolation, together with a low background rate, permits for detection of residual tumor populations in a background of normal cells. When counting such rare events, the distribution is governed by Poisson statistics, with precision increasing with higher numbers of cells collected. In several hematological malignancies, identification of populations at frequencies of 0.01% and lower has been attained. The choice of antibodies used in MRD detection facilitates the definition of a fingerprint to identify abnormal populations throughout treatment. Tumor populations can change phenotype, and an approach that relies on 'different from normal' has proven useful, particularly in the acute leukemias. Flow cytometry can and is used for detection of MRD in many hematological diseases; however, standardized approaches for specific diseases must be developed to ensure precise identification and enumeration that may alter the course of patient treatment.
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Affiliation(s)
- B D Hedley
- Special Hematology, London Health Sciences Centre, London, ON, Canada
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Brown W, Keeney M, Hedley BD. Initial performance evaluation of the UniCel® DxH slide maker/stainer Coulter® cellular analysis system. Int J Lab Hematol 2013; 36:172-83. [PMID: 24028789 DOI: 10.1111/ijlh.12150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the advancements in instrumentation within hematology laboratories, there is still a need for review of a peripheral blood film (PBF). For a thorough PBF evaluation, it is critical that a well spread and stained film is available. METHODS In this study, we evaluated an automatic slide maker/stainer (DxH-SMS, Beckman Coulter) compared with manually prepared blood films on 124 normal and abnormal samples. The primary goal of the study was to determine whether or not the DxH-SMS was able to consistently and reproducibly prepare and stain blood films of exemplary quality, without carryover between specimens. Additionally, repeatability of white blood cell distribution, comparability of morphology to reference methodologies, and grading of acceptance criteria outlined in the CLSI document H20-A2 were assessed. RESULTS Carryover was not an issue and repeatability was within expected limits. There was excellent agreement of the 5-part differential between the automated blood films made by the DxH-SMS compared with the manually prepared reference blood film. There was no difference in identification and enumeration of blasts, variant lymphocytes, or nucleated red blood cells (P < 0.05). Red cell morphology showed excellent agreement. CONCLUSION Blood films prepared by the DxH-SMS are of excellent quality, reproducible, and compare well with manually prepared slides. Introduction to our laboratory has improved and standardized slide quality.
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Affiliation(s)
- W Brown
- Special Hematology, London Health Sciences Centre, London, ON, Canada
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Davis BH, McLaren CE, Carcio AJ, Wong L, Hedley BD, Keeney M, Curtis A, Culp NB. Determination of optimal replicate number for validation of imprecision using fluorescence cell-based assays: Proposed practical method. Cytometry 2013; 84:329-37. [DOI: 10.1002/cyto.b.21116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 05/25/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - Christine E. McLaren
- Department of Epidemiology; University of California Irvine; Irvine; California; 92697-7550
| | | | - Linda Wong
- Trillium Diagnostics, LLC; Bangor; Maine; 04401
| | - Benjamin D. Hedley
- London Laboratory Services Group; London Health Sciences Centre; London; Ontario; N6A 5W9; Canada
| | - Mike Keeney
- London Laboratory Services Group; London Health Sciences Centre; London; Ontario; N6A 5W9; Canada
| | - Adam Curtis
- Trillium Diagnostics, LLC; Bangor; Maine; 04401
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20
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Davis BH, McLaren CE, Carcio AJ, Wong L, Hedley BD, Keeney M, Curtis A, Culp NB. Determination of optimal replicate number for validation of imprecision using fluorescence cell based assays: Proposed practical method. Cytometry B Clin Cytom 2013:n/a-n/a. [PMID: 23873644 DOI: 10.1002/cytob.21116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/25/2013] [Accepted: 07/10/2013] [Indexed: 11/08/2022]
Abstract
Background: Assay validation includes determination of inherent imprecision across the reportable range. However specific practical guidelines for determinations of precision for cell based fluorescence assays performed on flow cytometers are currently lacking. Methods: Replicates of 10 or 20 measurements were obtained for flow cytometric assays developed for clinical IVD use, including neutrophil CD64 expression for infection/sepsis detection, fetal red cell enumeration for fetomaternal hemorrhage detection, human equilibrative nucleoside transporter 1 (hENT1) quantitation in leukocytes for possible correlation with drug responsiveness, and CD34+ hematopoietic stem cell (HSC) enumeration of apheresis products, using up to three different instrument platforms for each assay. For each assay, the mean, 95% confidence intervals of the mean (95%CI), standard deviation and coefficient of variation (CV) of sequential replicates were determined. Results: For all assays and most instrument platforms <5 replicates were found adequate to validate assay imprecision levels below the 5-10% CV for repeatability claimed by the manufacturers of these assays. Results plotted as a novel parameter derived from the 95%CI and the cumulative mean for replicates, termed variance factor (VF), provide a data driven means for determining optimal replicate numbers. Conclusions: The novel VF can provide information to guide the practical selection of optimal replicate numbers for validation of imprecision in flow cytometric assays. The optimal number of replicates was assay and instrument platform dependent. Our findings indicate 3-4 replicates are sufficient for most flow cytometric assays and instrument combinations, rather than the higher numbers suggested by CLSI guidelines for soluble analytes. © 2013 Clinical Cytometry Society.
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Affiliation(s)
- Bruce H Davis
- Trillium Diagnostics, LLC, 4 Union Street, Bangor, Maine, 04401, USA
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Lowes LE, Hedley BD, Keeney M, Allan AL. Response to Rossi et al. Cytometry A 2013; 83:599-601. [PMID: 23788417 DOI: 10.1002/cyto.a.22298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/26/2013] [Indexed: 11/07/2022]
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Lowes LE, Hedley BD, Keeney M, Allan AL. User-defined protein marker assay development for characterization of circulating tumor cells using the CellSearch® system. Cytometry A 2012; 81:983-95. [DOI: 10.1002/cyto.a.22158] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 07/12/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022]
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23
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Abstract
The Beckman Coulter UniCel® DxH 800 is a hematology analyzer incorporating new electronic and mechanical design with advanced algorithm technology to perform CBC, white blood cell (WBC) differential, nucleated red blood cell (NRBC), and reticulocyte analysis. Evaluation of this instrument was performed in our 800-bed tertiary care hospital and specifically centered upon the correlation of WBC, NRBC, and platelet (PLT) enumeration when compared to a predicate analyzer, the Coulter® LH 780, and flow cytometry (FCM) reference methods. Of particular interest were those samples with morphologically confirmed interference and extreme leukocytosis (evaluated with respect to red blood cell parameter correction). The sample set (n=272) consisted of morphologically normal and hematologically abnormal patients. Correlation of the WBC, PLT, and NRBC showed r(2) values of 0.994, 0.985, and 0.910 for the DxH 800 vs. FCM, respectively. The presence of interfering particles did not affect the accuracy of the DxH 800 with respect to WBC counts. The DxH 800 showed accurate PLT and NRBC counts in the clinically significant low range when compared to FCM. Compared to the LH 780, flagging rates were significantly reduced (NRBC flag), or equivalent (WBC, PLT flag) on the DxH 800. The DxH 800 demonstrated higher sensitivity and specificity for PLTs and NRBCs and achieved a lower NRBC false negative rate compared to the LH 780. The UniCel® DxH 800 represents a significant improvement to previous impedance analyzers in accurately detecting the presence of NRBCs at counts >1/100 WBC. Furthermore, it provides accurate PLT and WBC counts in the presence of interference and improved NRBC flagging efficiency when compared to the LH 780. Correction of red blood cell parameters is appropriate and accurate in cases of extreme leukocytosis.
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Affiliation(s)
- B D Hedley
- Department of Hematology, London Health Sciences Centre, London, Ontario, Canada
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24
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Hedley BD, Chu JE, Ormond DG, Beausoleil MS, Boasie A, Allan AL, Xenocostas A. Recombinant Human Erythropoietin in Combination with Chemotherapy Increases Breast Cancer Metastasis in Preclinical Mouse Models. Clin Cancer Res 2011; 17:6151-62. [DOI: 10.1158/1078-0432.ccr-10-3298] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Abstract
Over the past few decades, understanding of the physiologic function of erythropoietin (EPO) has evolved significantly. EPO binds to erythropoietin receptors (EPOR), initiating signaling that stimulates growth, inhibits apoptosis, and induces the differentiation of erythroid progenitors to increase red blood cell mass. EPO has additionally been shown to exert tissue-protective effects on multiple tissues, suggesting a pleiotropic mechanism of action. Erythropoiesis-stimulating agents (ESA) are used clinically for treating cancer-related anemia [chemotherapy-induced anemia (CIA)]. Recent clinical trials have reported increased adverse events and/or reduced survival in ESA-treated cancer patients receiving chemotherapy, potentially related to EPO-induced cancer progression. Signaling pathways downstream of EPO/EPOR have been shown to influence numerous cellular functions in both normal and tumor cells, including proliferation, apoptosis, and drug resistance. Some studies have reported effects on proliferation, reduced chemotherapy efficacy, reduction of apoptosis, and resistance to selective therapies on cancer cell lines, whereas others have shown null effects. In addition, newer targeted cancer therapies that are directed toward specific signaling pathways may be antagonized by ESAs. This molecular interplay between anticancer agents and potential survival signals triggered by ESAs may have been underestimated and may contribute toward decreased survival seen in certain trials. As more targeted anticancer therapies become available, these types of interactions may mitigate therapeutic efficacy by allowing tumor cells to acquire drug resistance. Therefore, a more complete understanding of the complex pathways involved will allow for the rational use of ESAs for the safe treatment of CIA in oncology patients.
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Affiliation(s)
- Benjamin D Hedley
- Division of Hematology, London Health Sciences Centre, London, Ontario, Canada
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26
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Abstract
Metastasis--the spread of cancer to distant organs--is responsible for most cancer deaths. Current adjuvant therapy is based on prognostic indicators that stratify patients into defined risk groups. However, some patients believed to have a good prognosis nonetheless develop metastases, in some cases many years after apparently successful treatment of their primary cancer. This period of clinical dormancy leads to many questions about how best to manage patients, including how to better assign risk of late recurrence, how long to monitor patients, and whether some patients will benefit from extended therapy to prevent late recurrences. The development of targeted therapies with fewer side effects is leading to clinical trials aimed at determining the effectiveness of such long-term therapy. However, much remains to be learned about tumor dormancy. Experimental studies are shedding light on biological and molecular mechanisms potentially responsible for tumor dormancy. Emerging research into tumor initiating cells, immunotherapy, and metastasis suppressor genes, may lead to new approaches for targeted antimetastatic therapy to prolong tumor dormancy. An improved understanding of tumor dormancy is needed for better management of patients at risk for late-developing metastases.
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Affiliation(s)
- Benjamin D Hedley
- Division of Hematology, London Health Sciences Centre, London, Ontario, Canada
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27
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Croker AK, Goodale D, Chu J, Postenka C, Hedley BD, Hess DA, Allan AL. High aldehyde dehydrogenase and expression of cancer stem cell markers selects for breast cancer cells with enhanced malignant and metastatic ability. J Cell Mol Med 2008; 13:2236-2252. [PMID: 18681906 DOI: 10.1111/j.1582-4934.2008.00455.x] [Citation(s) in RCA: 365] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cancer stem cells (CSCs) have recently been identified in leukaemia and solid tumours; however, the role of CSCs in metastasis remains poorly understood. This dearth of knowledge about CSCs and metastasis is due largely to technical challenges associated with the use of primary human cancer cells in pre-clinical models of metastasis. Therefore, the objective of this study was to develop suitable pre-clinical model systems for studying stem-like cells in breast cancer metastasis, and to test the hypothesis that stem-like cells play a key role in metastatic behaviour. We assessed four different human breast cancer cell lines (MDA-MB-435, MDA-MB-231, MDA-MB-468, MCF-7) for expression of prospective CSC markers CD44/CD24 and CD133, and for functional activity of aldehyde dehydrogenase (ALDH), an enzyme involved in stem cell self-protection. We then used fluorescence-activated cell sorting and functional assays to characterize differences in malignant/metastatic behaviour in vitro (proliferation, colony-forming ability, adhesion, migration, invasion) and in vivo (tumorigenicity and metastasis). Sub-populations of cells demonstrating stem-cell-like characteristics (high expression of CSC markers and/or high ALDH) were identified in all cell lines except MCF-7. When isolated and compared to ALDH(low)CD44(low/-) cells, ALDH(hi)CD44(+)CD24(-) (MDA-MB-231) and ALDH(hi)CD44(+)CD133(+) (MDA-MB-468) cells demonstrated increased growth (P < 0.05), colony formation (P < 0.05), adhesion (P < 0.001), migration (P < 0.001) and invasion (P < 0.001). Furthermore, following tail vein or mammary fat pad injection of NOD/SCID/IL2gamma receptor null mice, ALDH(hi)CD44(+)CD24(-) and ALDH(hi)CD44(+)CD133(+) cells showed enhanced tumorigenicity and metastasis relative to ALDH(low)CD44(low/-) cells (P < 0.05). These novel results suggest that stem-like ALDH(hi)CD44(+)CD24(-) and ALDH(hi)CD44(+)CD133(+) cells may be important mediators of breast cancer metastasis.
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Affiliation(s)
- Alysha K Croker
- London Regional Cancer Program, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada.,Department of Anatomy & Cell Biology, University of Western Ontario, London, Ontario, Canada
| | - David Goodale
- London Regional Cancer Program, London, Ontario, Canada
| | - Jenny Chu
- London Regional Cancer Program, London, Ontario, Canada
| | - Carl Postenka
- London Regional Cancer Program, London, Ontario, Canada
| | | | - David A Hess
- Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Alison L Allan
- London Regional Cancer Program, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada.,Department of Anatomy & Cell Biology, University of Western Ontario, London, Ontario, Canada
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28
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Hedley BD, Welch DR, Allan AL, Al-Katib W, Dales DW, Postenka CO, Casey G, Macdonald IC, Chambers AF. Downregulation of osteopontin contributes to metastasis suppression by breast cancer metastasis suppressor 1. Int J Cancer 2008; 123:526-34. [PMID: 18470911 DOI: 10.1002/ijc.23542] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Breast cancer metastasis suppressor 1 (BRMS1) inhibits the ability of multiple human and murine cancer cell lines to metastasize to lymph nodes, bones and lungs. Comparison of mRNA expression in metastatic MDA-MB-435 human carcinoma cells (435) and metastasis-suppressed BRMS1 transfectants (435/BRMS1) showed a marked (>90%) reduction of osteopontin (OPN) mRNA and protein expression in BRMS1-overexpressing cells. OPN expression is associated with disease progression in patients, with higher levels of OPN produced by cancer cells associated with poorer patient survival. Furthermore, OPN has been suggested to promote survival of cancer cells in response to stress, although the mechanisms by which this may occur remain poorly understood. This study tested the hypothesis that re-expression of OPN in metastasis-suppressed 435/BRMS1 cells would reverse metastasis suppression and confer protection from stress-induced apoptosis. A stable pooled population of OPN overexpressing 435/BRMS1 cells was created (435/BRMS1/OPN). OPN re-expression did not affect in vitro cell growth rates; however, increased anchorage independent growth/survival and protection from hypoxia-induced apoptosis was observed (p < 0.05). In vivo, OPN re-expression in BRMS1 transfected cells did not affect in vivo primary tumor growth but did increase the incidence of spontaneous metastasis to lymph nodes and lungs in mice. These novel findings suggest that OPN downregulation by BRMS1 may be responsible, at least in part, for BRMS1-mediated metastasis suppression by sensitizing cancer cells to stress induced apoptosis. These studies clarify one mechanism by which BRMS1 can suppress metastasis.
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Affiliation(s)
- Benjamin D Hedley
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
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29
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Schulze EB, Hedley BD, Goodale D, Postenka CO, Al-Katib W, Tuck AB, Chambers AF, Allan AL. The thrombin inhibitor Argatroban reduces breast cancer malignancy and metastasis via osteopontin-dependent and osteopontin-independent mechanisms. Breast Cancer Res Treat 2007; 112:243-54. [PMID: 18097747 DOI: 10.1007/s10549-007-9865-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 12/10/2007] [Indexed: 12/23/2022]
Abstract
Osteopontin (OPN) has been clinically and experimentally associated with breast cancer metastasis. Proteolytic cleavage of OPN by thrombin has been reported to increase its biologic activity. The purpose of this study was to determine if inhibition of thrombin could reduce the malignancy-promoting effects of OPN on breast cancer cell behavior in vitro and in vivo. MDA-MB-468 human breast cancer cells were stably transfected to overexpress OPN (468-OPN) or a control vector (468-CON) and compared for functional differences in malignant/metastatic behavior in response to treatment with the thrombin-specific inhibitor Argatroban. Western blot analysis revealed that both 468-CON and 468-OPN cells produce thrombin and the thrombin-related protein tissue factor, and express very low levels of thrombin receptor (PAR-1). In vitro assays demonstrated that Argatroban treatment (25 microg/ml) of 468-OPN cells resulted in decreased cell growth, colony-forming ability, adhesion, and migration relative to untreated controls (P < 0.05), but did not have a significant effect on 468-CON cells. Following mammary fat pad injection, treatment with Argatroban (9 mg/kg/day) increased the in vivo tumor latency of both 468-CON and 468-OPN cells, and reduced primary tumor growth of 468-OPN cells (relative to untreated controls; P < 0.05). Furthermore, Argatroban treatment significantly decreased lymphatic metastasis of both 468-CON (P < 0.04) and 468-OPN (P < 0.01) cells relative to untreated controls. These novel findings indicate that inhibition of thrombin can reduce malignant and metastatic behavior of MDA-MB-468 breast cancer cells using both OPN-dependent and OPN-independent mechanisms, and suggest that thrombin inhibitors such as Argatroban may hold potential as therapeutic agents to combat breast cancer progression.
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Affiliation(s)
- Erika B Schulze
- London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
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30
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Abstract
Metastasis, or tumor growth in an ectopic site, may occur several years after apparently successful treatment of the primary malignancy. Clinical dormancy is seen in a large number of cancer patients, but once growth in an ectopic site initiates, current adjuvant therapies are inadequate and the majority of patients with metastatic disease will die. Many genes may regulate ectopic growth in a secondary site, including a small subset, termed the metastasis suppressor genes. Investigation into this class of genes holds promise in terms of gaining a greater understanding of tumor dormancy and how the process of metastasis may be naturally inhibited. This review will focus on the role of metastasis suppressor genes in tumor dormancy. Insights into the metastatic process from studies of metastasis suppressor genes may lead to novel targets for antimetastatic therapy through drug-induced reactivation of one or more of these genes and/or their respective signaling pathways.
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Affiliation(s)
- Benjamin D Hedley
- University of Western Ontario, Schulich School of Medicine & Dentistry, London Regional Cancer Program, Department of Oncology, London, Ontario, Canada.
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31
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Abstract
Metastases are responsible for most cancer deaths. Despite dramatic advances in cancer therapy, the presence of metastases implies a significantly shortened survival and reduced quality of remaining life. Aside from prevention of cancer altogether, or significant improvements in early detection for most cancers, effective novel therapeutic strategies targeting metastasis should provide the greatest clinical benefit. Metastasis research has shown that many of the initial steps in metastasis are completed with a high degree of efficiency and may have occurred by the time of clinical diagnosis. Therefore, targeting the later stages of metastasis may offer a more promising therapeutic approach for the development of antimetastatic therapies. Appropriate clinical strategies include targeting dormant solitary cells, active preangiogenic metastases, or vascularised metastases. Dormancy of solitary single cells, seen clinically and experimentally, may be an explanation for cancer recurrence. Eradication or inactivation of these dormant cells could provide large benefit for patients. However, little is known about what makes cancer cells dormant and, therefore, a greater knowledge of the mechanisms of dormancy is needed. This review discusses potential biological targets, as defined by the steps in the metastatic process, for antimetastatic therapies and provides examples of clinical strategies for preventing or treating successful metastasis.
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Affiliation(s)
- Benjamin D Hedley
- Department of Medical Biophysics, University of Western Ontario, London Regional Cancer Program, London Health Sciences Centre, Ontario, N6A 4L6, Canada.
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