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Kwan Z, Paulose Nadappuram B, Leung MM, Mohagaonkar S, Li A, Amaradasa KS, Chen J, Rothery S, Kibreab I, Fu J, Sanchez-Alonso JL, Mansfield CA, Subramanian H, Kondrashov A, Wright PT, Swiatlowska P, Nikolaev VO, Wojciak-Stothard B, Ivanov AP, Edel JB, Gorelik J. Microtubule-Mediated Regulation of β 2AR Translation and Function in Failing Hearts. Circ Res 2023; 133:944-958. [PMID: 37869877 PMCID: PMC10635332 DOI: 10.1161/circresaha.123.323174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND β1AR (beta-1 adrenergic receptor) and β2AR (beta-2 adrenergic receptor)-mediated cyclic adenosine monophosphate signaling has distinct effects on cardiac function and heart failure progression. However, the mechanism regulating spatial localization and functional compartmentation of cardiac β-ARs remains elusive. Emerging evidence suggests that microtubule-dependent trafficking of mRNP (messenger ribonucleoprotein) and localized protein translation modulates protein compartmentation in cardiomyocytes. We hypothesized that β-AR compartmentation in cardiomyocytes is accomplished by selective trafficking of its mRNAs and localized translation. METHODS The localization pattern of β-AR mRNA was investigated using single molecule fluorescence in situ hybridization and subcellular nanobiopsy in rat cardiomyocytes. The role of microtubule on β-AR mRNA localization was studied using vinblastine, and its effect on receptor localization and function was evaluated with immunofluorescent and high-throughput Förster resonance energy transfer microscopy. An mRNA protein co-detection assay identified plausible β-AR translation sites in cardiomyocytes. The mechanism by which β-AR mRNA is redistributed post-heart failure was elucidated by single molecule fluorescence in situ hybridization, nanobiopsy, and high-throughput Förster resonance energy transfer microscopy on 16 weeks post-myocardial infarction and detubulated cardiomyocytes. RESULTS β1AR and β2AR mRNAs show differential localization in cardiomyocytes, with β1AR found in the perinuclear region and β2AR showing diffuse distribution throughout the cell. Disruption of microtubules induces a shift of β2AR transcripts toward the perinuclear region. The close proximity between β2AR transcripts and translated proteins suggests that the translation process occurs in specialized, precisely defined cellular compartments. Redistribution of β2AR transcripts is microtubule-dependent, as microtubule depolymerization markedly reduces the number of functional receptors on the membrane. In failing hearts, both β1AR and β2AR mRNAs are redistributed toward the cell periphery, similar to what is seen in cardiomyocytes undergoing drug-induced detubulation. This suggests that t-tubule remodeling contributes to β-AR mRNA redistribution and impaired β2AR function in failing hearts. CONCLUSIONS Asymmetrical microtubule-dependent trafficking dictates differential β1AR and β2AR localization in healthy cardiomyocyte microtubules, underlying the distinctive compartmentation of the 2 β-ARs on the plasma membrane. The localization pattern is altered post-myocardial infarction, resulting from transverse tubule remodeling, leading to distorted β2AR-mediated cyclic adenosine monophosphate signaling.
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MESH Headings
- Rats
- Animals
- In Situ Hybridization, Fluorescence
- Heart Failure/metabolism
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Myocardial Infarction/metabolism
- Myocytes, Cardiac/metabolism
- Cyclic AMP/metabolism
- Receptors, Adrenergic, beta-1/metabolism
- Microtubules/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Adenosine Monophosphate/metabolism
- Adenosine Monophosphate/pharmacology
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Affiliation(s)
- Zoe Kwan
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
- Department of Chemistry (Z.K., B.P.N., A.P.I., J.B.E.), Imperial College London, United Kingdom
| | - Binoy Paulose Nadappuram
- Department of Chemistry (Z.K., B.P.N., A.P.I., J.B.E.), Imperial College London, United Kingdom
- Department of Pure and Applied Chemistry, University of Strathclyde, United Kingdom (B.P.N.)
| | - Manton M. Leung
- Sir William Dunn School of Pathology, University of Oxford, United Kingdom (M.M.L.)
| | - Sanika Mohagaonkar
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Ao Li
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Kumuthu S. Amaradasa
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Ji Chen
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Stephen Rothery
- FILM Facility, Imperial College London, United Kingdom (S.R.)
| | - Iyobel Kibreab
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Jiarong Fu
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Jose L. Sanchez-Alonso
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Catherine A. Mansfield
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | | | - Alexander Kondrashov
- Division of Cancer and Stem Cells, University of Nottingham Biodiscovery Institute, United Kingdom (A.K.)
| | - Peter T. Wright
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
- School of Life and Health Sciences, University of Roehampton, United Kingdom (P.T.W.)
| | - Pamela Swiatlowska
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Viacheslav O. Nikolaev
- Institute of Experimental Cardiovascular Research, University Medical Center, Hamburg-Eppendorf, Germany (H.S., V.O.N.)
| | - Beata Wojciak-Stothard
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
| | - Aleksandar P. Ivanov
- Department of Chemistry (Z.K., B.P.N., A.P.I., J.B.E.), Imperial College London, United Kingdom
| | - Joshua B. Edel
- Department of Chemistry (Z.K., B.P.N., A.P.I., J.B.E.), Imperial College London, United Kingdom
| | - Julia Gorelik
- National Heart and Lung Institute (Z.K., S.M., A.L., K.S.A., J.C., I.K., J.F., J.L.S.-A., C.A.M., P.S., B.W.-S., P.T.W., J.G.), Imperial College London, United Kingdom
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Handa BS, Li X, Baxan N, Roney CH, Shchendrygina A, Mansfield CA, Jabbour RJ, Pitcher DS, Chowdhury RA, Peters NS, Ng FS. Ventricular fibrillation mechanism and global fibrillatory organization are determined by gap junction coupling and fibrosis pattern. Cardiovasc Res 2021; 117:1078-1090. [PMID: 32402067 PMCID: PMC7983010 DOI: 10.1093/cvr/cvaa141] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/25/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Conflicting data exist supporting differing mechanisms for sustaining ventricular fibrillation (VF), ranging from disorganized multiple-wavelet activation to organized rotational activities (RAs). Abnormal gap junction (GJ) coupling and fibrosis are important in initiation and maintenance of VF. We investigated whether differing ventricular fibrosis patterns and the degree of GJ coupling affected the underlying VF mechanism. METHODS AND RESULTS Optical mapping of 65 Langendorff-perfused rat hearts was performed to study VF mechanisms in control hearts with acute GJ modulation, and separately in three differing chronic ventricular fibrosis models; compact fibrosis (CF), diffuse fibrosis (DiF), and patchy fibrosis (PF). VF dynamics were quantified with phase mapping and frequency dominance index (FDI) analysis, a power ratio of the highest amplitude dominant frequency in the cardiac frequency spectrum. Enhanced GJ coupling with rotigaptide (n = 10) progressively organized fibrillation in a concentration-dependent manner; increasing FDI (0 nM: 0.53 ± 0.04, 80 nM: 0.78 ± 0.03, P < 0.001), increasing RA-sustained VF time (0 nM: 44 ± 6%, 80 nM: 94 ± 2%, P < 0.001), and stabilized RAs (maximum rotations for an RA; 0 nM: 5.4 ± 0.5, 80 nM: 48.2 ± 12.3, P < 0.001). GJ uncoupling with carbenoxolone progressively disorganized VF; the FDI decreased (0 µM: 0.60 ± 0.05, 50 µM: 0.17 ± 0.03, P < 0.001) and RA-sustained VF time decreased (0 µM: 61 ± 9%, 50 µM: 3 ± 2%, P < 0.001). In CF, VF activity was disorganized and the RA-sustained VF time was the lowest (CF: 27 ± 7% vs. PF: 75 ± 5%, P < 0.001). Global fibrillatory organization measured by FDI was highest in PF (PF: 0.67 ± 0.05 vs. CF: 0.33 ± 0.03, P < 0.001). PF harboured the longest duration and most spatially stable RAs (patchy: 1411 ± 266 ms vs. compact: 354 ± 38 ms, P < 0.001). DiF (n = 11) exhibited an intermediately organized VF pattern, sustained by a combination of multiple-wavelets and short-lived RAs. CONCLUSION The degree of GJ coupling and pattern of fibrosis influences the mechanism sustaining VF. There is a continuous spectrum of organization in VF, ranging between globally organized fibrillation sustained by stable RAs and disorganized, possibly multiple-wavelet driven fibrillation with no RAs.
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Affiliation(s)
- Balvinder S Handa
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Xinyang Li
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London, UK
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King’s College London, London, UK
| | - Anastasia Shchendrygina
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Catherine A Mansfield
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Richard J Jabbour
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - David S Pitcher
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Rasheda A Chowdhury
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicholas S Peters
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
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3
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Medvedev RY, Sanchez-Alonso JL, Mansfield CA, Judina A, Francis AJ, Pagiatakis C, Trayanova N, Glukhov AV, Miragoli M, Faggian G, Gorelik J. Local hyperactivation of L-type Ca 2+ channels increases spontaneous Ca 2+ release activity and cellular hypertrophy in right ventricular myocytes from heart failure rats. Sci Rep 2021; 11:4840. [PMID: 33649357 PMCID: PMC7921450 DOI: 10.1038/s41598-021-84275-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/10/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Right ventricle (RV) dysfunction is an independent predictor of patient survival in heart failure (HF). However, the mechanisms of RV progression towards failing are not well understood. We studied cellular mechanisms of RV remodelling in a rat model of left ventricle myocardial infarction (MI)-caused HF. RV myocytes from HF rats show significant cellular hypertrophy accompanied with a disruption of transverse-axial tubular network and surface flattening. Functionally these cells exhibit higher contractility with lower Ca2+ transients. The structural changes in HF RV myocytes correlate with more frequent spontaneous Ca2+ release activity than in control RV myocytes. This is accompanied by hyperactivated L-type Ca2+ channels (LTCCs) located specifically in the T-tubules of HF RV myocytes. The increased open probability of tubular LTCCs and Ca2+ sparks activation is linked to protein kinase A-mediated channel phosphorylation that occurs locally in T-tubules. Thus, our approach revealed that alterations in RV myocytes in heart failure are specifically localized in microdomains. Our findings may indicate the development of compensatory, though potentially arrhythmogenic, RV remodelling in the setting of LV failure. These data will foster better understanding of mechanisms of heart failure and it could promote an optimized treatment of patients.
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Affiliation(s)
- Roman Y Medvedev
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy.,Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Jose L Sanchez-Alonso
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Catherine A Mansfield
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Aleksandra Judina
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Alice J Francis
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | | | - Natalia Trayanova
- Department of Biomedical Engineering and Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, USA
| | - Alexey V Glukhov
- Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Michele Miragoli
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.,Dipartimento Di Medicina E Chirurgia, Università Degli Studi di Parma, Via Gramsci 14, 43124, Parma, Italy
| | - Giuseppe Faggian
- Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy
| | - Julia Gorelik
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Handa BS, Li X, Mansfield CA, Jabbour RJ, Pitcher D, Chowdhury RA, Peters NS, Ng FS. P1594Ventricular fibrosis spatial distribution and quantity is a key mechanistic determinant of ventricular fibrillation mechanisms. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ventricular fibrosis is known to play a critical role in initiation and maintenance of ventricular fibrillation (VF). Post myocardial infarction the quantity of fibrosis negatively correlates with survival. There is a lack of data on how the quantity and degree of fibrosis influences the mechanisms of VF itself. VF mechanisms remain debated, there are data to support both critical areas sustaining rotational drivers (RDs) and the contrary hypothesis of disorganized myocardial activation driving VF.
Purpose
We hypothesized that the underlying mechanism of VF is influenced by the spatial distribution and quantity of ventricular fibrosis.
Methods
Thirty-five Sprague-Dawley rats underwent permanent left anterior descending (LAD) ligation (n=11), 20mins LAD territory ischaemia-reperfusion (n=13) or in-vivo angiotensin infusion (500ng/kg/min, n=11) to generate compact (CF), patchy (PF) and diffuse fibrosis (DF) models respectively. After a 4-week maturation period, the hearts were explanted, Langendorff perfused and VF induced with burst pacing and 30μM pinacidil. Fibrillation dynamics were quantified using phase analysis, phase singularity (PS) tracking and our novel method of global fibrillation organisation quantification, frequency dominance index (FDI), which is a power ratio of highest amplitude dominant frequency in the frequency spectrum.
Results
Ventricular fibrosis for each group was characterized and quantified (CF: 22.3±3.2%, PF: 18.4±4.2%, DF: 5.8±1.3%, p=0.046). VF was driven predominantly by disorganised activity in CF, PSs were detected 26±7% of time comparative to 51.2±4% in DF and 69.5±8% in PF group (p=0.001). PF stabilised RDs, average maximum rotations for a single RD in PF were 31.6±7.1 comparative to 12.5±1.7 in DF and 6.4±1.1 in CF, p<0.001. The average maximum duration for a single RDs was significantly longer in PF (PF: 1231±365ms, DF: 568±68ms, CF: 363±41ms, p=0.014). Similarly, average rotations per RD were greater in the PF group (PF: 4.5±0.7, DF: 3.3±0.2, CF: 2.41±0.3 rotations, p=0.013). Total number of RDs/second were much greater with PF (PF: 12.4±2.0, DF: 5.4±0.8, CF: 3.1±1.1, p<0.001). VF organisation measured by FDI was higher in PF (PF: 0.61±0.07, DF: 0.47±0.04, CF: 0.33±0.03, p=0.004). RDs in DF showed a greater degree of meander comparative to PF (DF: 12.6±1.4 vs PF: 9.3±0.8 pixels, p=0.024).
Conclusion
VF mechanisms occur along a spectrum between organised activity sustained by discrete drivers and disorganised myocardial activation. The underlying VF mechanism can differ significantly dependent on the quantity and pattern of fibrosis. Patchy fibrosis stabilises RDs with localization to discrete areas and sustains an organised form of VF comparative to CF where VF is largely disorganised. Characterising the degree and pattern of fibrosis in patient groups vulnerable to VF might be beneficial in identifying patients with suitable targets for ablation.
Acknowledgement/Funding
BHF Programme Grant PG/16/17/32069
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Affiliation(s)
- B S Handa
- Imperial College London, London, United Kingdom
| | - X Li
- Imperial College London, London, United Kingdom
| | | | - R J Jabbour
- Imperial College London, London, United Kingdom
| | - D Pitcher
- Imperial College London, London, United Kingdom
| | | | - N S Peters
- Imperial College London, London, United Kingdom
| | - F S Ng
- Imperial College London, London, United Kingdom
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Liede A, Evans G, Metcalfe KA, Price M, Snyder C, Lynch HT, Friedman S, Amelio J, Posner J, Lindeman G, Mansfield CA. Abstract P3-08-08: Preferences for breast cancer risk reduction among BRCA1 and BRCA2 mutation carriers: A discrete choice experiment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- A Liede
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - G Evans
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - KA Metcalfe
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - M Price
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - C Snyder
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - HT Lynch
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - S Friedman
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - J Amelio
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - J Posner
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - G Lindeman
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
| | - CA Mansfield
- Amgen Inc.; University of Manchester, United Kingdom; University of Toronto, Canada; University of Sydney, Australia; Creighton University; Facing Our Risk of Cancer Empowered (FORCE); Amgen Ltd, United Kingdom; RTI Health Solutions; Royal Melbourne Hospital and Walter & Eliza Hall Institute of Medical Research, Australia
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Liede A, Fairchild A, Friedman S, Amelio J, Hallett DC, Mansfield CA, Metcalfe KA. Abstract P2-09-09: Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Distress levels among female BRCA1 and BRCA2 mutation carriers can be similar to levels reported among breast cancer patients. However, there is a lack of data on long-term psychosocial functioning, and it is not known if uptake of risk-reducing surgery influences long-term cancer related distress in women with a BRCA mutation who are unaffected with cancer. The objective of this study was to evaluate long-term cancer-related distress in women with a BRCA mutation, and to evaluate predictors of distress, including uptake of cancer risk reducing surgery.
Methods: Female BRCA1 or BRCA2 mutation carriers, ages 25-55, and without cancer were eligible to complete the survey online. A validated instrument, Impact of Events Scale (IES)-Revised (Horowitz 1979, Weis & Marmar 1995; 0-80 overall scale), was used to assess current levels of cancer risk-related psychological distress. Respondents were recruited through the Facing Our Risk of Cancer Empowered (FORCE) advocacy organization, which includes women at high risk of breast cancer. This interim analysis is part of a larger multi-center patient preference study of BRCA mutation carriers designed to assess women's willingness to adopt hypothetical treatments to prevent breast cancer. Linear regression was used to evaluate predictors of IES distress levels.
Results: Between January and April 2015, 259 women completed the survey. The mean age of the participants was 41 years, and the mean time since receipt of genetic test results was 3.5 years (range 0-16; median 2 years). One hundred thirty-six (52%) women elected for prophylactic bilateral mastectomy (PBM), 139 (54%) elected for bilateral salpingo oophorectomy (BSO) (93 [36%] women had both surgeries), and 77 (30%) had not undergone risk-reducing surgery. The mean total IES score was 15.1 (range 0-72; median 11). Overall, 54 (21%) women reported moderate or severe cancer-related distress, and those who had undergone risk-reducing surgery reported lower perceived risk of developing breast cancer. Results to date indicate that shorter time since notification of mutation status, not having PBM (with or without BSO) (table), and not completing post-secondary education were independent predictors of higher IES distress scores.
IES severityNo prophylactic surgeryPBM onlyBSO onlyPBM and BSOn (%)77434693Subclinical27 (35)23 (54)16 (35)44 (47)Mild26 (34)13 (30)21 (46)35 (38)Moderate18 (23)5 (12)6 (13)11 (12)Severe6 (8)2 (5)3 (6)3 (3)
Conclusions: This study measured cancer-related distress in a large population of women with BRCA mutations who participate in the FORCE online support community. Higher levels of distress were associated with not having PBM and more recent genetic test disclosure. These findings are specific to a more informed community of women with high levels of understanding of cancer risk than may be seen in the clinical setting.
Citation Format: Liede A, Fairchild A, Friedman S, Amelio J, Hallett DC, Mansfield CA, Metcalfe KA. Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-09.
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Affiliation(s)
- A Liede
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - A Fairchild
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - S Friedman
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - J Amelio
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - DC Hallett
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - CA Mansfield
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
| | - KA Metcalfe
- Amgen Inc., CA; Facing Our Risk of Cancer Empowered (FORCE), Tampa, FL; University of Toronto, Toronto, ON, Canada; RTI Health Solutions, Research Triangle Park, NC
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