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Ngo N, Blomain ES, Simiele E, Romero I, Hoppe RT, Hiniker SM, Kovalchuk N. Improved organ sparing using auto-planned Stanford volumetric modulated arc therapy for total body irradiation technique. Pediatr Blood Cancer 2023; 70:e30589. [PMID: 37486149 DOI: 10.1002/pbc.30589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE/OBJECTIVES To evaluate dosimetric differences between auto-planned volumetric modulated arc therapy (VMAT) total body irradiation (TBI) technique and two-dimensional radiotherapy using anterior-posterial/posterio-anterial beams (2D AP/PA) TBI technique. METHODS Ten pediatric patients treated with VMAT-TBI on Varian c-arm linac were included in this study. VMAT-TBI plans were generated using our in-house developed and publicly shared auto-planning scripts. For each VMAT-TBI plan, a 2D AP/PA plan was created replicating the institution's clinical setup with the patient positioned at extended source to skin distance (SSD) with a compensator to account for differences in patient thickness, 50% transmission daily lung blocks, and electron chest wall boosts prescribed to 50% of the photon prescription. Clinically relevant metrics were analyzed and compared between the VMAT and 2D plans. RESULTS All VMAT-TBI plans achieved planned target volume (PTV) D90% ≥ 100% of prescription. VMAT-TBI PTV D90% significantly increased (7.1% ± 2.9%, p < .001) compared to the 2D technique, whereas no differences were observed in global Dmax (p < .2) and PTV V110% (p < .4). Compared to the 2D plans, significant decreases in the Dmean to the lungs (-25.6% ± 11.5%, p < .001) and lungs-1 cm (-34.1% ± 10.1%, p < .001) were observed with the VMAT plans. The VMAT technique also enabled decrease of dose to other organs: kidneys Dmean (-32.5% ± 5.0%, p < .001) and lenses Dmax (-5.3% ± 8.1%, p = .03); and in addition, for 2 Gy prescription: testes/ovaries Dmean (-41.5% ± 11.5%, p < .001), brain Dmean (-22.6% ± 5.4%, p = .002), and thyroid Dmean (-18.2% ± 16.0%, p = .03). CONCLUSIONS Superior lung sparing with improved target coverage and similar global Dmax were observed with the VMAT plans as compared to 2D plans. In addition, VMAT-TBI plans provided greater dose reductions in gonads, kidneys, brain, thyroid, and lenses.
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Affiliation(s)
- Nicholas Ngo
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Erik S Blomain
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Eric Simiele
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Ignacio Romero
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Richard T Hoppe
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Susan M Hiniker
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
| | - Nataliya Kovalchuk
- Radiation Oncology Department, Stanford University Cancer Center, Palo Alto, California, USA
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Blomain ES, Somani A, Subramanian A, Soudi S, Oladipo E, New C, Kenney DE, Nemat-Gorgani N, Hiniker SM, Chin AL, Avedian RS, Steffner RJ, Mohler DG, van de Rijn M, Moding E. YIA23-002: Evolutionary Pressures Shape Soft Tissue Sarcoma Development and Response to Radiotherapy. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Kovalchuk N, Simiele E, Skinner L, Yang Y, Howell N, Lewis J, Hui C, Blomain ES, Hoppe RT, Hiniker SM. The Stanford VMAT TBI Technique. Pract Radiat Oncol 2022; 12:245-258. [PMID: 35182803 DOI: 10.1016/j.prro.2021.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE In this work, we describe the technical aspects of the XXX VMAT TBI technique, compare it to other VMAT TBI techniques, and share our initial experience. METHODS From September 2019 to August 2021, 35 patients were treated with VMAT TBI at our institution. Treatment planning was performed using in-house developed automated planning scripts. Organ sparing depended on the regimen: myeloablative (lungs, kidneys, and lenses); non-myeloablative with benign disease (lungs, kidneys, lenses, gonads, brain, and thyroid). Quality assurance was performed using EPID portal dosimetry and Mobius3D. Robustness was evaluated for the first ten patients by performing local and global isocenter shifts of 5 mm. Treatment was delivered using IGRT for every isocenter and every fraction. In-vivo measurements were performed on the matchline between the VMAT and AP/PA fields and on the testes for the first fraction. RESULTS The lungs, lungs-1cm, and kidneys Dmean were consistently spared to 57.6±4.4%, 40.7±5.5%, and 70.0±9.9% of the prescription dose, respectively. Gonadal sparing (Dmean=0.69±0.13 Gy) was performed for all patients with benign disease. The average PTV D1cc was 120.7±6.4% for all patients. The average Gamma passing rate for the VMAT plans was 98.1±1.6% (criteria of 3%/2mm). Minimal differences were observed between Mobius3D- and EclipseAAA-calculated PTV Dmean (0.0±0.3%) and lungs Dmean (-2.5±1.2%). Robustness evaluation showed that the PTV Dmax and lungs Dmean are insensitive to small positioning deviations between the VMAT isocenters (1.1±2.4% and 1.2±1.0%, respectively). The average matchline dose measurement indicated patient setup was reproducible (96.1±4.5% relative to prescription dose). Treatment time, including patient setup and beam-on, was 47.5±9.5 min. CONCLUSIONS The XXX VMAT TBI technique, from simulation to treatment delivery, was presented and compared to other VMAT TBI techniques. Together with publicly shared autoplanning scripts, our technique may provide the gateway for wider adaptation of this technology and the possibility of multi-institutional studies in the cooperative group setting.
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Affiliation(s)
- Nataliya Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Eric Simiele
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Nicole Howell
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Jonathan Lewis
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Erik S Blomain
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, United States.
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Blomain ES, Moding EJ. Liquid Biopsies for Molecular Biology-Based Radiotherapy. Int J Mol Sci 2021; 22:11267. [PMID: 34681925 PMCID: PMC8538046 DOI: 10.3390/ijms222011267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Molecular alterations drive cancer initiation and evolution during development and in response to therapy. Radiotherapy is one of the most commonly employed cancer treatment modalities, but radiobiologic approaches for personalizing therapy based on tumor biology and individual risks remain to be defined. In recent years, analysis of circulating nucleic acids has emerged as a non-invasive approach to leverage tumor molecular abnormalities as biomarkers of prognosis and treatment response. Here, we evaluate the roles of circulating tumor DNA and related analyses as powerful tools for precision radiotherapy. We highlight emerging work advancing liquid biopsies beyond biomarker studies into translational research investigating tumor clonal evolution and acquired resistance.
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Affiliation(s)
- Erik S. Blomain
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Everett J. Moding
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
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Simiele E, Skinner L, Yang Y, Blomain ES, Hoppe RT, Hiniker SM, Kovalchuk N. A Step Toward Making VMAT TBI More Prevalent: Automating the Treatment Planning Process. Pract Radiat Oncol 2021; 11:415-423. [PMID: 33711488 DOI: 10.1016/j.prro.2021.02.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Our purpose was to automate the treatment planning process for total body irradiation (TBI) with volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS Two scripts were developed to facilitate autoplanning: the binary plug-in script automating the creation of optimization structures, plan generation, beam placement, and setting of the optimization constraints and the stand-alone executable performing successive optimizations. Ten patients previously treated in our clinic with VMAT TBI were used to evaluate the efficacy of the proposed autoplanning process. Paired t tests were used to compare the dosimetric indices of the produced auto plans to the manually generated clinical plans. In addition, 3 physicians were asked to evaluate the manual and autoplans for each patient in a blinded retrospective review. RESULTS No significant differences were observed between the manual and autoplan global Dmax (P < .893), planning target volume V110% (P < .734), kidneys Dmean (P < .351), and bowel Dmax (P < .473). Significant decreases in the Dmean to the lungs and lungs-1cm (ie, lungs with 1-cm inner margin) volumes of 5.4% ± 6.4% (P < .024) and 6.8% ± 7.4% (P < .017), respectively, were obtained with the autoplans compared with the manual plans. The autoplans were selected 77% of the time by the reviewing physicians as equivalent or superior to the manual plans. The required time for treatment planning was estimated to be 2 to 3 days for the manual plans compared with approximately 3 to 5 hours for the autoplans. CONCLUSIONS Large reductions in planning time without sacrificing plan quality were obtained using the developed autoplanning process compared with manual planning, thus reducing the required effort of the treatment planning team. Superior lung sparing with the same target coverage and similar global Dmax were observed with the autoplans as compared with the manual treatment plans. The developed scripts have been made open-source to improve access to VMAT TBI at other institutions and clinics.
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Affiliation(s)
- E Simiele
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - L Skinner
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Y Yang
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - E S Blomain
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - R T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - S M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Blomain ES, Kovalchuk N, Neilsen BK, Skinner L, Hoppe RT, Hiniker SM. A Preliminary Report of Gonadal-Sparing TBI Using a VMAT Technique. Pract Radiat Oncol 2020; 11:e134-e138. [PMID: 32795616 DOI: 10.1016/j.prro.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 01/28/2023]
Abstract
Reproductive toxicity is common after total body irradiation (TBI) and has major quality of life implications for patients. In that context, this is the first report of gonadal-sparing volumetric-modulated arc therapy (VMAT) TBI, successfully delivered in a boy and a girl with aplastic anemia. Both patients' VMAT TBI plans demonstrated improved gonadal sparing versus simulated conventional 2-dimensional (2D) approach (mean testes dose, 0.45 Gy VMAT vs 0.72 Gy 2D; mean ovary dose, 0.64 Gy VMAT vs 1.47 Gy 2D). Planning target volume coverage was also improved for both cases with the VMAT plan versus conventional 2D plan (2 Gy D90% vs 1.9 Gy D90%, respectively). Given these dosimetric advantages, the present study can serve as a proof-of-concept for further prospective studies evaluating this technique for wider applications in populations receiving TBI.
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Affiliation(s)
- Erik S Blomain
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Beth K Neilsen
- College of Medicine, University of Nebraska, Omaha, Nebraska
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Blomain ES, Rappaport JA, Pattison AM, Bashir B, Caparosa E, Stem J, Snook AE, Waldman SA. APC-β-catenin-TCF signaling silences the intestinal guanylin-GUCY2C tumor suppressor axis. Cancer Biol Ther 2020; 21:441-451. [PMID: 32037952 PMCID: PMC7515458 DOI: 10.1080/15384047.2020.1721262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sporadic colorectal cancer initiates with mutations in APC or its degradation target β-catenin, producing TCF-dependent nuclear transcription driving tumorigenesis. The intestinal epithelial receptor, GUCY2C, with its canonical paracrine hormone guanylin, regulates homeostatic signaling along the crypt-surface axis opposing tumorigenesis. Here, we reveal that expression of the guanylin hormone, but not the GUCY2C receptor, is lost at the earliest stages of transformation in APC-dependent tumors in humans and mice. Hormone loss, which silences GUCY2C signaling, reflects transcriptional repression mediated by mutant APC-β-catenin-TCF programs in the nucleus. These studies support a pathophysiological model of intestinal tumorigenesis in which mutant APC-β-catenin-TCF transcriptional regulation eliminates guanylin expression at tumor initiation, silencing GUCY2C signaling which, in turn, dysregulates intestinal homeostatic mechanisms contributing to tumor progression. They expand the mechanistic paradigm for colorectal cancer from a disease of irreversible mutations in APC and β-catenin to one of guanylin hormone loss whose replacement, and reconstitution of GUCY2C signaling, could prevent tumorigenesis
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Affiliation(s)
- Erik S Blomain
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rappaport
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda M Pattison
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Babar Bashir
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ellen Caparosa
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan Stem
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam E Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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Shi W, Blomain ES, Siglin J, Palmer JD, Dan T, Wang Y, Werner-Wasik M, Glass J, Kim L, Bar Ad V, Bhamidipati D, Evans JJ, Judy K, Farrell CJ, Andrews DW. Correction to: Salvage fractionated stereotactic re-irradiation (FSRT) for patients with recurrent high grade gliomas progressed after bevacizumab treatment. J Neurooncol 2018; 137:179. [PMID: 29313182 DOI: 10.1007/s11060-018-2744-5] [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: 11/24/2022]
Abstract
The fourth author's name was incorrect in the initial online publication. The original article has been corrected.
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Affiliation(s)
- Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Erik S Blomain
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua Siglin
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Altoona Cancer Center, Altoona, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Tu Dan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Yang Wang
- Cyberknife Center, Huashan Hospital Pudong, Fudan University, Shanghai, China
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jon Glass
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lyndon Kim
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Voichita Bar Ad
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Deepak Bhamidipati
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Judy
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David W Andrews
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Shi W, Blomain ES, Siglin J, Palmer JD, Dan T, Wang Y, Werner-Wasik M, Glass J, Kim L, Bar Ad V, Bhamidipati D, Evans JJ, Judy K, Farrell CJ, Andrews DW. Salvage fractionated stereotactic re-irradiation (FSRT) for patients with recurrent high grade gliomas progressed after bevacizumab treatment. J Neurooncol 2017; 137:171-177. [PMID: 29235052 DOI: 10.1007/s11060-017-2709-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/09/2017] [Accepted: 12/04/2017] [Indexed: 11/24/2022]
Abstract
Bevacizumab failure is a major clinical problem in the management of high grade gliomas (HGG), with a median overall survival (OS) of < 4 months. This study evaluated the feasibility and efficacy of fractionated stereotactic re-irradiation (FSRT) for patients progressed after Bevacizumab treatment. Retrospective review was conducted of 36 patients treated with FSRT after progression on bevacizumab. FSRT was most commonly delivered in 3.5 Gy fractions to a total dose of 35 Gy. Survival from initial diagnosis, as well as from recurrence and re-irradiation, were utilized as study endpoints. Univariate and multivariate analysis was performed. The median time from initial bevacizumab treatment to FSRT was 8.5 months. The median plan target volume for FSRT was 27.5 cc. The median OS from FSRT was 4.8 months. FSRT treatment was well tolerated with no grade 3 or higher toxicity. Favorable outcomes were observed in patients with recurrent HGG who received salvage FSRT after bevacizumab failure. The treatment was well tolerated. Prospective study is warranted to further evaluate the efficacy of salvage FSRT for selected patients with recurrent HGG amenable to FSRT, who had failed bevacizumab treatment.
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Affiliation(s)
- Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Erik S Blomain
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua Siglin
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Altoona Cancer Center, Altoona, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Tu Dan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Yang Wang
- Cyberknife Center, Huashan Hospital Pudong, Fudan University, Shanghai, China
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jon Glass
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lyndon Kim
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Voichita Bar Ad
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Deepak Bhamidipati
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Judy
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David W Andrews
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Todd Milne G, Sandner P, Lincoln KA, Harrison PC, Chen H, Wang H, Clifford H, Qian HS, Wong D, Sarko C, Fryer R, Richman J, Reinhart GA, Boustany CM, Pullen SS, Andresen H, Moltzau LR, Cataliotti A, Levy FO, Lukowski R, Frankenreiter S, Friebe A, Calamaras T, Baumgartner R, McLaughlin A, Aronovitz M, Baur W, Wang GR, Kapur N, Karas R, Blanton R, Hell S, Waldman SA, Lin JE, Colon-Gonzalez F, Kim GW, Blomain ES, Merlino D, Snook A, Erdmann J, Wobst J, Kessler T, Schunkert H, Walter U, Pagel O, Walter E, Gambaryan S, Smolenski A, Jurk K, Zahedi R, Klinger JR, Benza RL, Corris PA, Langleben D, Naeije R, Simonneau G, Meier C, Colorado P, Chang MK, Busse D, Hoeper MM, Masferrer JL, Jacobson S, Liu G, Sarno R, Bernier S, Zhang P, Todd Milne G, Flores-Costa R, Currie M, Hall K, Möhrle D, Reimann K, Wolter S, Wolters M, Mergia E, Eichert N, Geisler HS, Ruth P, Friebe A, Feil R, Zimmermann U, Koesling D, Knipper M, Rüttiger L, Tanaka Y, Okamoto A, Nojiri T, Kumazoe M, Tokudome T, Miura K, Hino J, Hosoda H, Miyazato M, Kangawa K, Kapil V, Ahluwalia A, Paolocci N, Eaton P, Campbell JC, Henning P, Franz E, Sankaran B, Herberg FW, Kim C, Wittwer M, Luo Q, Kaila V, Dames SA, Tobin A, Alam M, Rudyk O, Krasemann S, Hartmann K, Prysyazhna O, Zhang M, Zhao L, Weiss A, Schermuly R, Eaton P, Moyes AJ, Chu SM, Baliga RS, Hobbs AJ, Michalakis S, Mühlfriedel R, Schön C, Fischer DM, Wilhelm B, Zobor D, Kohl S, Peters T, Zrenner E, Bartz-Schmidt KU, Ueffing M, Wissinger B, Seeliger M, Biel M, Ranek MJ, Kokkonen KM, Lee DI, Holewinski RJ, Agrawal V, Virus C, Stevens DA, Sasaki M, Zhang H, Mannion MM, Rainer PP, Page RC, Schisler JC, Van Eyk JE, Willis MS, Kass DA, Zaccolo M, Russwurm M, Giesen J, Russwurm C, Füchtbauer EM, Koesling D, Bork NI, Nikolaev VO, Agulló L, Floor M, Villà-Freixa J, Manfra O, Calamera G, Surdo NC, Meier S, Froese A, Nikolaev VO, Zaccolo M, Levy FO, Andressen KW, Aue A, Schwiering F, Groneberg D, Friebe A, Bajraktari G, Burhenne J, Haefeli WE, Weiss J, Beck K, Voussen B, Vincent A, Parsons SP, Huizinga JD, Friebe A, Mónica FZ, Seto E, Murad F, Bian K, Burgoyne JR, Prysyazhna O, Richards D, Eaton P, Calamera G, Bjørnerem M, Ulsund AH, Kim JJ, Kim C, Levy FO, Andressen KW, Donzelli S, Goetz M, Schmidt K, Wolters M, Stathopoulou K, Prysyazhna O, Scotcher J, Dees C, Subramanian H, Butt E, Kamynina A, Bruce King S, Nikolaev VO, de Witt C, Leichert LI, Feil R, Eaton P, Cuello F, Dobrowinski H, Lehners M, Schmidt MPH, Feil R, Feil S, Wen L, Wolters M, Thunemann M, Schmidt K, Olbrich M, Langer H, Gawaz M, Friebe A, de Wit C, Feil R, Franz E, Kim JJ, Bertinetti D, Kim C, Herberg FW, Ghofrani HA, Grimminger F, Grünig E, Huang Y, Jansa P, Jing ZC, Kilpatrick D, Langleben D, Rosenkranz S, Menezes F, Fritsch A, Nikkho S, Frey R, Humbert M, Groneberg D, Aue A, Schwiering F, Friebe A, Harloff M, Reinders J, Schlossmann J, Jung J, Wales JA, Chen CY, Breci L, Weichsel A, Bernier SG, Solinga R, Sheppeck JE, Renhowe PA, Montfort WR, Qin L, Sung YJ, Casteel D, Kim C, Kollau A, Neubauer A, Schrammel A, Russwurm M, Koesling D, Mayer B, Kumazoe M, Takai M, Takeuchi C, Kadomatsu M, Hiroi S, Takamatsu K, Nojiri T, Kangawa K, Tachibana H, Opelt M, Eroglu E, Waldeck-Weiermair M, Russwurm M, Koesling D, Malli R, Graier WF, Fassett JT, Schrammel A, Mayer B, Sollie SJ, Moltzau LR, Hernandez-Valladares M, Berven F, Levy FO, Andressen KW, Nojiri T, Tokudome T, Kumazoe M, Arai M, Suzuki Y, Miura K, Hino J, Hosoda H, Miyazato M, Okumura M, Kawaoka S, Kangawa K, Peters S, Schmidt H, Selin Kenet B, Nies SH, Frank K, Wen L, Rathjen FG, Feil R, Petrova ON, Lamarre I, Négrerie M, Robinson JW, Egbert JR, Davydova J, Jaffe LA, Potter LR, Robinson JW, Blixt N, Shuhaibar LC, Warren GL, Mansky KC, Jaffe LA, Potter LR, Romoli S, Bauch T, Dröbner K, Eitner F, Ruppert M, Radovits T, Korkmaz-Icöz S, Li S, Hegedűs P, Loganathan S, Németh BT, Oláh A, Mátyás C, Benke K, Merkely B, Karck M, Szabó G, Scheib U, Broser M, Mukherjee S, Stehfest K, Gee CE, Körschen HG, Oertner TG, Hegemann P, Schmidt H, Dickey DM, Dumoulin A, Kühn R, Jaffe L, Potter LR, Rathjen FG, Schobesberger S, Wright P, Poulet C, Mansfield C, Friebe A, Harding SE, Nikolaev VO, Gorelik J, Kollau A, Opelt M, Wölkart G, Gorren ACF, Russwurm M, Koesling D, Schrammel A, Mayer B, Schwaerzer GK, Casteel DE, Dalton ND, Gu Y, Zhuang S, Milewicz DM, Peterson KL, Pilz R, Schwiering F, Aue A, Groneberg D, Friebe A, Argyriou AI, Makrynitsa G, Alexandropoulos II, Stamopoulou A, Bantzi M, Giannis A, Topouzis S, Papapetropoulos A, Spyroulias GA, Stuehr DJ, Ghosh A, Dai Y, Misra S, Tchernychev B, Jung J, Liu G, Silos-Santiago I, Hannig G, Dao VTV, Deile M, Nedvetsky PI, Güldner A, Ibarra-Alvarado C, Gödecke A, Schmidt HHHW, Vachaviolos A, Gerling A, Thunemann M, Lutz SZ, Häring HU, Krüger MA, Pichler BJ, Shipston MJ, Feil S, Feil R, Vandenwijngaert S, Ledsky CD, Agha O, Hu D, Domian IJ, Buys ES, Newton-Cheh C, Bloch DB, Voussen B, Beck K, Mauro N, Keppler J, Friebe A, Ferreira WA, Chweih H, Brito PL, Almeida CB, Penteado CFF, Saad SSO, Costa FF, Frenette PS, Brockschnieder D, Stasch JP, Sandner P, Conran N, Zimmer DP, Tobin J, Shea C, Sarno R, Long K, Jacobson S, Tang K, Germano P, Wakefield J, Banijamali A, Im GYJ, Sheppeck JE, Profy AT, Todd Milne G, Currie MG, Masferrer JL. Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications : Bamberg, Germany. 23-25 June, 2017. BMC Pharmacol Toxicol 2017; 18:64. [PMID: 29035170 PMCID: PMC5667593 DOI: 10.1186/s40360-017-0170-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pattison AM, Merlino DJ, Blomain ES, Waldman SA. Guanylyl cyclase C signaling axis and colon cancer prevention. World J Gastroenterol 2016; 22:8070-8077. [PMID: 27688649 PMCID: PMC5037076 DOI: 10.3748/wjg.v22.i36.8070] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/25/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a major cause of cancer-related mortality and morbidity worldwide. While improved treatments have enhanced overall patient outcome, disease burden encompassing quality of life, cost of care, and patient survival has seen little benefit. Consequently, additional advances in CRC treatments remain important, with an emphasis on preventative measures. Guanylyl cyclase C (GUCY2C), a transmembrane receptor expressed on intestinal epithelial cells, plays an important role in orchestrating intestinal homeostatic mechanisms. These effects are mediated by the endogenous hormones guanylin (GUCA2A) and uroguanylin (GUCA2B), which bind and activate GUCY2C to regulate proliferation, metabolism and barrier function in intestine. Recent studies have demonstrated a link between GUCY2C silencing and intestinal dysfunction, including tumorigenesis. Indeed, GUCY2C silencing by the near universal loss of its paracrine hormone ligands increases colon cancer susceptibility in animals and humans. GUCY2C’s role as a tumor suppressor has opened the door to a new paradigm for CRC prevention by hormone replacement therapy using synthetic hormone analogs, such as the FDA-approved oral GUCY2C ligand linaclotide (Linzess™). Here we review the known contributions of the GUCY2C signaling axis to CRC, and relate them to a novel clinical strategy targeting tumor chemoprevention.
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Kumar S, Singh J, Kedika R, Mendoza F, Jimenez SA, Blomain ES, DiMarino AJ, Cohen S, Rattan S. Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG. Am J Physiol Gastrointest Liver Physiol 2016; 310:G1052-60. [PMID: 27173508 PMCID: PMC4935481 DOI: 10.1152/ajpgi.00034.2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/31/2016] [Indexed: 01/31/2023]
Abstract
Gastrointestinal dysmotility in systemic sclerosis (SSc) is associated with autoantibodies against muscarinic-3 receptor (M3-R). We investigated the temporal course of the site of action of these autoantibodies at the myenteric neurons (MN) vs. the smooth muscle (SM) M3-R in relation to disease duration, and determined the role of intravenous immunoglobulin (IVIG) in reversing these changes. Immunoglobulins purified from SSc patients (SScIgG) were used to assess their differential binding to MN and SM (from rat colon) employing immunohistochemistry (IHC). Effect of SScIgG on neural and direct muscle contraction was determined by cholinergic nerve stimulation and bethanechol-induced SM contraction. Effects of IVIG and its antigen-binding fragment F(ab')2 on SScIgG binding were studied by enzyme-linked immunosorbent assay (ELISA) of rat colonic longitudinal SM myenteric plexus (LSMMP) lysate and to second extracellular loop peptide of M3-R (M3-RL2). SScIgG from all patients demonstrated significantly higher binding to MN than to SM. With progression of SSc duration, binding at MN and SM increased in a linear fashion with a correlation coefficient of 0.696 and 0.726, respectively (P < 0.05). SScIgG-mediated attenuation of neural and direct SM contraction also increased with disease duration. ELISA analysis revealed that IVIG and F(ab')2 significantly reduced SScIgG binding to LSMMP lysate and M3-RL2. Dysmotility in SSc occurs sequentially, beginning with SScIgG-induced blockage of cholinergic neurotransmission (neuropathy), which progresses to inhibition of acetylcholine action at the SM cell (myopathy). IVIG reverses this cholinergic dysfunction at the neural and myogenic receptors by anti-idiotypic neutralization of SScIgG.
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Affiliation(s)
- Sumit Kumar
- 1Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Jagmohan Singh
- 1Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Ramalinga Kedika
- 1Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Fabian Mendoza
- 2Division of Rheumatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Sergio A. Jimenez
- 3Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Erik S. Blomain
- 4Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Anthony J. DiMarino
- 1Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Sidney Cohen
- 1Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Satish Rattan
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
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Blomain ES, Merlino DJ, Pattison AM, Snook AE, Waldman SA. Guanylyl Cyclase C Hormone Axis at the Intersection of Obesity and Colorectal Cancer. Mol Pharmacol 2016; 90:199-204. [PMID: 27251363 DOI: 10.1124/mol.115.103192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/25/2016] [Indexed: 12/12/2022] Open
Abstract
Obesity has emerged as a principal cause of mortality worldwide, reflecting comorbidities including cancer risk, particularly in colorectum. Although this relationship is established epidemiologically, molecular mechanisms linking colorectal cancer and obesity continue to be refined. Guanylyl cyclase C (GUCY2C), a membrane-bound guanylyl cyclase expressed in intestinal epithelial cells, binds the paracrine hormones guanylin and uroguanylin, inducing cGMP signaling in colorectum and small intestine, respectively. Guanylin is the most commonly lost gene product in sporadic colorectal cancer, and its universal loss early in transformation silences GUCY2C, a tumor suppressor, disrupting epithelial homeostasis underlying tumorigenesis. In small intestine, eating induces endocrine secretion of uroguanylin, the afferent limb of a novel gut-brain axis that activates hypothalamic GUCY2C-cGMP signaling mediating satiety opposing obesity. Recent studies revealed that diet-induced obesity suppressed guanylin and uroguanylin expression in mice and humans. Hormone loss reflects reversible calorie-induced endoplasmic reticulum stress and the associated unfolded protein response, rather than the endocrine, adipokine, or inflammatory milieu of obesity. Loss of intestinal uroguanylin secretion silences the hypothalamic GUCY2C endocrine axis, creating a feed-forward loop contributing to hyperphagia in obesity. Importantly, calorie-induced guanylin loss silences the GUCY2C-cGMP paracrine axis underlying obesity-induced epithelial dysfunction and colorectal tumorigenesis. Indeed, genetically enforced guanylin replacement eliminated diet-induced intestinal tumorigenesis in mice. Taken together, these observations suggest that GUCY2C hormone axes are at the intersection of obesity and colorectal cancer. Moreover, they suggest that hormone replacement that restores GUCY2C signaling may be a novel therapeutic paradigm to prevent both hyperphagia and intestinal tumorigenesis in obesity.
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Affiliation(s)
- Erik S Blomain
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dante J Merlino
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda M Pattison
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam E Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
Despite advances in screening and prevention strategies, colorectal cancer (CRC) remains the second-leading cause of cancer-related death in the United States. Given this continued public health burden of CRC, there is a clear need for improved disease prevention. CRC initiates and progresses over decades, canonically proceeding via a series of stepwise molecular events that turn a normal epithelium into a dysfunctional epithelium, then subsequently into an adenoma, and finally an invasive adenocarcinoma. An emerging paradigm suggests that guanylyl cyclase C (GUCY2C) functions as a tumor suppressor in the intestine, and that the loss of hormone ligands for this receptor causes epithelial dysfunction and represents an important step in the disease process. In that context, GUCY2C ligand replacement therapy has been proposed as a strategy to prevent colorectal cancer, a translational opportunity that is underscored by the recent regulatory approval of the oral GUCY2C ligand linaclotide (Linzess™, Forest Laboratories and Ironwood Pharmaceuticals, Inc.).
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Affiliation(s)
- Erik S Blomain
- a Department of Pharmacology and Experimental Therapeutics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Amanda M Pattison
- a Department of Pharmacology and Experimental Therapeutics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Scott A Waldman
- a Department of Pharmacology and Experimental Therapeutics , Thomas Jefferson University , Philadelphia , PA , USA
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Affiliation(s)
- Erik S Blomain
- a Department of Pharmacology and Experimental Therapeutics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Scott A Waldman
- a Department of Pharmacology and Experimental Therapeutics , Thomas Jefferson University , Philadelphia , PA , USA
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Witek ME, Snook AE, Lin JE, Blomain ES, Xiang B, Magee M, Waldman SA. A novel CDX2 isoform regulates alternative splicing. PLoS One 2014; 9:e104293. [PMID: 25101906 PMCID: PMC4125279 DOI: 10.1371/journal.pone.0104293] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/11/2014] [Indexed: 12/27/2022] Open
Abstract
Gene expression is a dynamic and coordinated process coupling transcription with pre-mRNA processing. This regulation enables tissue-specific transcription factors to induce expression of specific transcripts that are subsequently amplified by alternative splicing allowing for increased proteome complexity and functional diversity. The intestine-specific transcription factor CDX2 regulates development and maintenance of the intestinal epithelium by inducing expression of genes characteristic of the mature enterocyte phenotype. Here, sequence analysis of CDX2 mRNA from colonic mucosa-derived tissues revealed an alternatively spliced transcript (CDX2/AS) that encodes a protein with a truncated homeodomain and a novel carboxy-terminal domain enriched in serine and arginine residues (RS domain). CDX2 and CDX2/AS exhibited distinct nuclear expression patterns with minimal areas of co-localization. CDX2/AS did not activate the CDX2-dependent promoter of guanylyl cyclase C nor inhibit transcriptional activity of CDX2. Unlike CDX2, CDX2/AS co-localized with the putative splicing factors ASF/SF2 and SC35. CDX2/AS altered splicing patterns of CD44v5 and Tra2-β1 minigenes in Lovo colon cancer cells independent of CDX2 expression. These data demonstrate unique dual functions of the CDX2 gene enabling it to regulate gene expression through both transcription (CDX2) and pre-mRNA processing (CDX2/AS).
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Affiliation(s)
- Matthew E. Witek
- Department of Radiation Oncology, Kimmel Cancer Center & Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Adam E. Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Jieru E. Lin
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Erik S. Blomain
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Bo Xiang
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Michael Magee
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Scott A. Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Merlino DJ, Blomain ES, Aing AS, Waldman SA. Gut-Brain Endocrine Axes in Weight Regulation and Obesity Pharmacotherapy. J Clin Med 2014; 3:763-94. [PMID: 26237477 PMCID: PMC4449653 DOI: 10.3390/jcm3030763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/29/2014] [Accepted: 06/16/2014] [Indexed: 12/21/2022] Open
Abstract
In recent years, the obesity epidemic has developed into a major health crisis both in the United States as well as throughout the developed world. With current treatments limited to expensive, high-risk surgery and minimally efficacious pharmacotherapy, new therapeutic options are urgently needed to combat this alarming trend. This review focuses on the endogenous gut-brain signaling axes that regulate appetite under physiological conditions, and discusses their clinical relevance by summarizing the clinical and preclinical studies that have investigated manipulation of these pathways to treat obesity.
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Affiliation(s)
- Dante J Merlino
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1020 Locust Street, JAH 368, Philadelphia, PA 19107, USA.
| | - Erik S Blomain
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1020 Locust Street, JAH 368, Philadelphia, PA 19107, USA.
| | - Amanda S Aing
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1020 Locust Street, JAH 368, Philadelphia, PA 19107, USA.
| | - Scott A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1020 Locust Street, JAH 368, Philadelphia, PA 19107, USA.
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Kim GW, Lin JE, Blomain ES, Waldman SA. Antiobesity pharmacotherapy: new drugs and emerging targets. Clin Pharmacol Ther 2013; 95:53-66. [PMID: 24105257 DOI: 10.1038/clpt.2013.204] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/18/2013] [Indexed: 02/07/2023]
Abstract
Obesity is a growing pandemic, and related health and economic costs are staggering. Pharmacotherapy, partnered with lifestyle modifications, forms the core of current strategies to reduce the burden of this disease and its sequelae. However, therapies targeting weight loss have a significant history of safety risks, including cardiovascular and psychiatric events. Here, evolving strategies for developing antiobesity therapies, including targets, mechanisms, and developmental status, are highlighted. Progress in this field is underscored by Belviq (lorcaserin) and Qsymia (phentermine/topiramate), the first agents in more than 10 years to achieve regulatory approval for chronic weight management in obese patients. On the horizon, novel insights into metabolism and energy homeostasis reveal guanosine 3',5'-cyclic monophosphate (cGMP) signaling circuits as emerging targets for antiobesity pharmacotherapy. These innovations in molecular discovery may elegantly align with practical off-the-shelf approaches, leveraging existing approved drugs that modulate cGMP levels for the management of obesity.
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Affiliation(s)
- G W Kim
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J E Lin
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - E S Blomain
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - S A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Gibbons AV, Lin JE, Kim GW, Marszalowicz GP, Li P, Stoecker BA, Blomain ES, Rattan S, Snook AE, Schulz S, Waldman SA. Intestinal GUCY2C prevents TGF-β secretion coordinating desmoplasia and hyperproliferation in colorectal cancer. Cancer Res 2013; 73:6654-66. [PMID: 24085786 DOI: 10.1158/0008-5472.can-13-0887] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tumorigenesis is a multistep process that reflects intimate reciprocal interactions between epithelia and underlying stroma. However, tumor-initiating mechanisms coordinating transformation of both epithelial and stromal components are not defined. In humans and mice, initiation of colorectal cancer is universally associated with loss of guanylin and uroguanylin, the endogenous ligands for the tumor suppressor guanylyl cyclase C (GUCY2C), disrupting a network of homeostatic mechanisms along the crypt-surface axis. Here, we reveal that silencing GUCY2C in human colon cancer cells increases Akt-dependent TGF-β secretion, activating fibroblasts through TGF-β type I receptors and Smad3 phosphorylation. In turn, activating TGF-β signaling induces fibroblasts to secrete hepatocyte growth factor (HGF), reciprocally driving colon cancer cell proliferation through cMET-dependent signaling. Elimination of GUCY2C signaling in mice (Gucy2c(-/-)) produces intestinal desmoplasia, with increased reactive myofibroblasts, which is suppressed by anti-TGF-β antibodies or genetic silencing of Akt. Thus, GUCY2C coordinates intestinal epithelial-mesenchymal homeostasis through reciprocal paracrine circuits mediated by TGF-β and HGF. In that context, GUCY2C signaling constitutes a direct link between the initiation of colorectal cancer and the induction of its associated desmoplastic stromal niche. The recent regulatory approval of oral GUCY2C ligands to treat chronic gastrointestinal disorders underscores the potential therapeutic opportunity for oral GUCY2C hormone replacement to prevent remodeling of the microenvironment essential for colorectal tumorigenesis.
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Affiliation(s)
- Ahmara V Gibbons
- Authors' Affiliations: Departments of Pharmacology and Experimental Therapeutics, and Medicine, Thomas Jefferson University; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia; Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Pathology, University of Utah, University Hospital, Salt Lake City, Utah
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Abstract
INTRODUCTION Obesity is a worldwide pandemic. Obesity-related health and economic costs are staggering. Existing strategies to combat obesity through lifestyle improvements and medical intervention have had limited success. Pharmacotherapy, in combination with lifestyle modification, may play a vital role in reversing the disease burden. However, past and current weight-loss medications have had serious safety risks, notably cardiovascular and psychiatric events. AREAS COVERED The authors review the strategies for designing new anti-obesity drugs by describing those currently in development. They describe their target, mechanism of action and developmental or regulatory status. Furthermore, they discuss the problem of weight regain following weight loss, and its relevance to the long-term success of anti-obesity pharmacotherapy. EXPERT OPINION For weight management drugs to achieve the safety and efficacy required to be impactful, current studies are uncovering and characterizing new targets, including new signaling circuits and hormones regulating appetite and metabolism, and re-evaluating the role of pharmacotherapy in weight management. To avoid the safety failures of many past weight-loss drugs, the models and strategies covered in this article incorporate recent advances in knowledge and technology. We discuss the emergence of cGMP signaling as a potentially transformative target in weight management. Modulating cGMP signaling may represent an ideal goal for an anti-obesity pharmacotherapy, reflecting some of the major themes described in the present review: targeting pathways that are newly realized as relevant for weight management; promoting safety by re-purposing drugs that are safe, proven, and approved for clinical use; and having a synergistic effect on multiple, reinforcing pathways.
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Affiliation(s)
- Gilbert W Kim
- Thomas Jefferson University, Department of Pharmacology and Experimental Therapeutics, Philadelphia, PA 19107, USA
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Le K, Blomain ES, Rodeck U, Aplin AE. Selective RAF inhibitor impairs ERK1/2 phosphorylation and growth in mutant NRAS, vemurafenib-resistant melanoma cells. Pigment Cell Melanoma Res 2013; 26:509-17. [PMID: 23490205 DOI: 10.1111/pcmr.12092] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/04/2013] [Indexed: 12/18/2022]
Abstract
The RAF inhibitor vemurafenib achieves remarkable clinical responses in mutant BRAF melanoma patients. However, vemurafenib is burdened by acquired drug resistance and by the side effects associated with its paradoxical activation of the ERK1/2 pathway in wild-type BRAF cells. This paradoxical effect has driven the development of a new class of RAF inhibitors. Here, we tested one of these selective, non-paradox-inducing RAF inhibitors termed paradox-breaker-04 (PB04) or PLX7904. Consistent with its design, PB04 is able to efficiently inhibit activation of ERK1/2 in mutant BRAF melanoma cells but does not hyperactivate ERK1/2 in mutant RAS-expressing cells. Importantly, PB04 inhibited ERK1/2 phosphorylation in mutant BRAF melanoma cells with acquired resistance to vemurafenib/PLX4720 that is mediated by a secondary mutation in NRAS. Consistent with ERK1/2 reactivation driving the re-acquisition of malignant properties, PB04 promoted apoptosis and inhibited entry into S phase and anchorage-independent growth in mutant N-RAS-mediated vemurafenib-resistant cells. These data indicate that paradox-breaker RAF inhibitors may be clinically effective as a second-line option in a cohort of acquired vemurafenib-resistant patients.
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Affiliation(s)
- Kaitlyn Le
- Department of Cancer Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
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Blomain ES, McMahon SB. Dynamic regulation of mitochondrial transcription as a mechanism of cellular adaptation. Biochim Biophys Acta 2012; 1819:1075-9. [PMID: 22766037 DOI: 10.1016/j.bbagrm.2012.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 12/12/2022]
Abstract
Eukaryotes control nearly every cellular process in part by modulating the transcription of genes encoded by their nuclear genome. However, these cells are faced with the added complexity of possessing a second genome, within the mitochondria, which encodes critical components of several essential processes, including energy metabolism and macromolecule biosynthesis. As these cellular processes require gene products encoded by both genomes, cells have adopted strategies for linking mitochondrial gene expression to nuclear gene expression and other dynamic cellular events. Here we discuss examples of several mechanisms that have been identified, by which eukaryotic cells link extramitochondrial signals to dynamic alterations in mitochondrial transcription. This article is part of a Special Issue entitled: Mitochondrial Gene Expression.
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Affiliation(s)
- Erik S Blomain
- Department of Cancer Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19104, USA
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