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Almeida Rodrigues AK, Silva PG, Nogueira C, Ferreira SS, Cordeiro J, Carneiro B, Tavora F. Expression of tumoral GSK3-β, PD-L1, and CD8 cell density in urothelial carcinomas, association with tumor grade and overall survival. Am J Clin Exp Immunol 2023; 12:87-97. [PMID: 38022872 PMCID: PMC10658161] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023]
Abstract
Bladder cancer is the most common malignancy in the urinary tract, and is biologically and clinically quite heterogeneous. Around 90% of diagnoses are made in the 6th decade, being more prevalent in males. The programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) axis play a putative role in immune checkpoint and as a means through which cancer evades the immune system. Inhibition of the glicogênio synthase kinase (GSK) 3 leads to the downregulation of PD-1 via upregulation of the transcription factor Tbet. The use of biomarkers PD-L1 and GSK-3β and evaluation of the immune infiltrate have very promising correlations with urothelial carcinoma prognosis and treatment prediction. OBJECTIVE To investigate the protein expression of PD-L1 and GSK-3β and the CD8-positive immune infiltrates in bladder carcinomas. MATERIALS AND METHODS This was a cross-sectional study of 140 samples of urothelial carcinomas from 2015 to 2018. Automated digitally assisted scoring and conventional analyses of the markers of GSK-3β (27C10), CD8 (7103β) and PDL-1 (22c3), were reviewed by two pathologists independently and a histologic score was calculated. The density of CD8 was also measured. RESULTS The immunoexpression of GSK-3β (91%) was presented in most samples, PD-L1 in 62.9% and CD8 cells present in 46.3% of cases. When analyzed in conjunction, the levels of GSK-3β and PD-L1 (P = 0.033), and CD8 and PD-L1 (P<0.002) showed significant correlations. No significant associations were observed between GSK-3β and CD8. The positivity of GSK-3β and PD-L1 was predominant in high-grade tumors. CONCLUSION Despite the tumor microenvironment heterogeneity, the expression of CD8, GSK-3β and PDL1 could be valuable and GSK-3β could be a potential target in advanced bladder cancer, especially in the context of immunotherapy.
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Affiliation(s)
| | - Paulo Goberlanio Silva
- ICC (Ceara Cancer Institute), Laboratory of Molecular Biology and GeneticsFortaleza, CE, Brazil
| | - Cleto Nogueira
- Argos LaboratoryFortaleza, CE, Brazil
- Department of Pathology and Legal Medicine, Federal University of CearaFortaleza, CE, Brazil
| | - Samuel S Ferreira
- Argos LaboratoryFortaleza, CE, Brazil
- Department of Pathology and Legal Medicine, Federal University of CearaFortaleza, CE, Brazil
| | - Juliana Cordeiro
- Argos LaboratoryFortaleza, CE, Brazil
- Department of Pathology and Legal Medicine, Federal University of CearaFortaleza, CE, Brazil
| | | | - Fabio Tavora
- Argos LaboratoryFortaleza, CE, Brazil
- Department of Pathology and Legal Medicine, Federal University of CearaFortaleza, CE, Brazil
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Tavora F, de Sousa JC. Tissue navigator, an important position in the Pathology laboratory in the Precision Medicine era. ESMO Open 2023; 8:101827. [PMID: 37757665 PMCID: PMC10534212 DOI: 10.1016/j.esmoop.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- F Tavora
- Argos Laboratory, Fortaleza, Brazil.
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Maleszewski JJ, Basso C, Burke A, Castonguay M, Leduc C, Tavora F, Sheppard M, Suri R, Judge M, Cooper WA. Dataset for the reporting of neoplasms of the heart, pericardium, and great vessels: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2023; 482:303-309. [PMID: 36512082 DOI: 10.1007/s00428-022-03473-7] [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: 10/31/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) was founded by major pathology organizations from around the world to produce internationally standardized and evidence-based datasets for pathologists' reporting of cancer. Its goal is to improve cancer patient outcomes worldwide and to advance international benchmarking in cancer management. The ICCR cancer dataset development schedule is aligned with revisions of the WHO Classification of Tumours ("Blue Book") series, and in 2015 ICCR developed an initial series of thoracic datasets including a dataset for neoplasms of the heart, pericardium, and great vessels. This edition has now been updated to align with the 2021 WHO Blue Book series. An expert panel was convened to review and revise the dataset. While the majority of ICCR datasets are focused on malignant tumors, the scope of this dataset includes a number of benign tumors and tumor-like entities because of the rarity of cardiac malignancies and the serious implications of even histologically benign lesions. Due to the rarity of cardiac tumors, evidence in support of reporting elements is limited.
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Affiliation(s)
- Joseph J Maleszewski
- ICCR Dataset for the Reporting of Neoplasms of the Heart, Pericardium, and Great Vessels Dataset Authoring Committee, Department of Laboratory Medicine & Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Allen Burke
- University of Maryland Medical Center, University of Maryland, Baltimore, MD, USA
| | - Mathieu Castonguay
- Department of Pathology, Faculty of Medicine, Dalhousie University Halifax, Halifax, NS, Canada
| | - Charles Leduc
- Department of Pathology, University of Montreal Health Center, Montreal, QC, Canada
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Mary Sheppard
- St. George's Medical School, University of London, London, UK
| | - Rakesh Suri
- Division of Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Meagan Judge
- Royal College of Pathologists of Australasia, Surry Hills, New South Wales, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.,Discipline of Pathology, School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Rodrigues A, Nogueira C, Marinho LC, Velozo G, Sousa J, Silva PG, Tavora F. Computer-assisted tumor grading, validation of PD-L1 scoring, and quantification of CD8-positive immune cell density in urothelial carcinoma, a visual guide for pathologists using QuPath. Surg Exp Pathol 2022. [DOI: 10.1186/s42047-022-00112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Advances in digital imaging in pathology and the new capacity to scan high-quality images have change the way to practice and research in surgical pathology. QuPath is an open-source pathology software that offers a reproducible way to analyze quantified variables. We aimed to present the functionality of biomarker scoring using QuPath and provide a guide for the validation of pathologic grading using a series of cases of urothelial carcinomas.
Methods
Tissue microarrays of urothelial carcinomas were constructed and scanned. The images stained with HE, CD8 and PD-L1 immunohistochemistry were imported into QuPath and dearrayed. Training images were used to build a grade classifier and applied to all cases. Quantification of CD8 and PD-L1 was undertaken for each core using cytoplasmic and membrane color segmentation and output measurement and compared with pathologists semi-quantitative assessments.
Results
There was a good correlation between tumor grade by the pathologist and by QuPath software (Kappa agreement 0.73). For low-grade carcinomas (by the report and pathologist), the concordance was not as high. Of the 32 low-grade tumors, 22 were correctly classified as low-grade, but 11 (34%) were diagnosed as high-grade, with the high-grade to the low-grade ratio in these misclassified cases ranging from 0.41 to 0.58. The median ratio for bona fide high-grade carcinomas was 0.59. Some of the reasons the authors list as potential mimickers for high-grade cases are fulguration artifact, nuclear hyperchromasia, folded tissues, and inconsistency in staining. The correlation analysis between the software and the pathologist showed that the CD8 marker showed a moderate (r = 0.595) and statistically significant (p < 0.001) correlation. The internal consistency of this parameter showed an index of 0.470. The correlation analysis between the software and the pathologist showed that the PDL1 marker showed a robust (r = 0.834) and significant (p < 0.001) correlation. The internal consistency of this parameter showed a CCI of 0.851.
Conclusions
We were able to demonstrate the utility of QuPath in identifying and scoring tumor cells and IHC quantification of two biomarkers. The protocol we present uses a free open-source platform to help researchers deal with imaging and data processing in the surgical pathology field.
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Maleszewski JJ, Basso C, Bois MC, Glass C, Klarich KW, Leduc C, Padera RF, Tavora F. The 2021 WHO Classification of Tumors of the Heart. J Thorac Oncol 2021; 17:510-518. [PMID: 34774791 DOI: 10.1016/j.jtho.2021.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Carolyn Glass
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charles Leduc
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fabio Tavora
- Department of Pathology, Argos Laboratory/Messejana Heart and Lung Hospital, Fortaleza, Brazil
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Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K. The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer. Arch Pathol Lab Med 2021; 145:461-493. [PMID: 32589068 DOI: 10.5858/arpa.2020-0015-ra] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Controversies and uncertainty persist in prostate cancer grading. OBJECTIVE.— To update grading recommendations. DATA SOURCES.— Critical review of the literature along with pathology and clinician surveys. CONCLUSIONS.— Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace "tertiary grade pattern" in radical prostatectomy (RP) with "minor tertiary pattern 5 (TP5)," and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)-targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) "atypical intraductal proliferation (AIP)" is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
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Affiliation(s)
- Jonathan I Epstein
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada.,Urology (Epstein), David Geffen School of Medicine at UCLA, Los Angeles, California (Huang).,and Oncology (Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis (Amin)
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Fine)
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain (Algaba)
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles (Aron)
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Koç University, İstanbul, Turkey (Baydar)
| | - Antonio Lopez Beltran
- Department of Pathology, Champalimaud Centre for the Unknown, Lisbon, Portugal (Beltran)
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center, Montréal, Quebec, Canada (Brimo)
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Maurizio Colecchia
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (Colecchia)
| | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France (Comperat)
| | | | | | - Angelo M DeMarzo
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Giovanna A Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Guo)
| | - Donna E Hansel
- Department of Pathology, Oregon Health and Science University, Portland (Hansel)
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Hirsch)
| | - Jiaoti Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Huang)
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Humphrey)
| | - Rafael E Jimenez
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Qingnuan Kong
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong, China (Kong).,Kong is currently located at Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (Kryvenko)
| | - L Priya Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Priti Lal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (Lal)
| | - Mathieu Latour
- Department of Pathology, CHUM, Université de Montréal, Montréal, Quebec, Canada (Latour)
| | - Tamara Lotan
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Fiona Maclean
- Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia (Maclean)
| | - Cristina Magi-Galluzzi
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India (Menon)
| | - Hiroshi Miyamoto
- Departments of Pathology and Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York (Miyamoto)
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy (Montironi)
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Nguyen)
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia (Osunkoya)
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Mark A Rubin
- Department for BioMedical Research, University of Bern, Bern, Switzerland (Rubin)
| | - Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Shah)
| | - Jeffrey S So
- Institute of Pathology, St Luke's Medical Center, Quezon City and Global City, Philippines (So)
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan (Takahashi)
| | - Fabio Tavora
- Argos Laboratory, Federal University of Ceara, Fortaleza, Brazil (Tavora)
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Lawrence True
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Sara E Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill (Wobker)
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Chicago, Illinois (Yang)
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, Massachusetts (Zhou)
| | - Debra L Zynger
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Kiril Trpkov
- and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (Trpkov)
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Alves M, Borges DDP, Kimberly A, Martins Neto F, Oliveira AC, de Sousa JC, Nogueira CD, Carneiro BA, Tavora F. Glycogen Synthase Kinase-3 Beta Expression Correlates With Worse Overall Survival in Non-Small Cell Lung Cancer-A Clinicopathological Series. Front Oncol 2021; 11:621050. [PMID: 33767989 PMCID: PMC7985549 DOI: 10.3389/fonc.2021.621050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Glycogen Synthase Kinase-3 beta (GSK-3β) regulates diverse cell functions including metabolic activity, signaling and structural proteins. GSK-3β phosphorylates target pro-oncogenes and regulates programmed cell death-ligand 1 (PD-L1). This study investigated the correlation between GSK-3β expression and clinically relevant molecular features of lung adenocarcinoma (PDL1 score, PTEN expression and driver mutations). Methods We evaluated 95 lung cancer specimens from biopsies and surgical resections. Immunohistochemistry was performed to analyze the expression of GSK-3β, PTEN, and PDL1. Epidemiological data, molecular characteristics and staging were evaluated from medical records. The histologic classification was performed by an experienced pulmonary pathologist. Results Most patients were female (52.6%) and the majority had a positive smoking history. The median age was 68.3 years, with individuals over 60 years accounting for 82.1%. The predominant histological subtype was adenocarcinoma (69.5%), followed by squamous cell carcinoma (20.0%). GSK-3β expression in tumors was cytoplasmic with a dotted pattern and perinuclear concentration, with associated membranous staining. Seven (7.3%) tumors had associated nuclear expression localization. Seventy-seven patients (81.1%) had advanced clinical-stage tumors. GSK-3β was positive in 75 tumors (78%) and GSK3-positive tumors tended to be diagnosed at advanced stages. Among stage III/IV tumors, 84% showed GSK3 positivity (p= 0.007). We identified a statistically significant association between GSK-3β and PTEN in the qualitative analysis (p 0.021); and when comparing PTEN to GSK-3β intensity 2+ (p 0.001) or 3+ expression (> 50%) – p 0.013. GSK-3β positive tumors with a high histological score had a worse overall survival. Conclusion We identified the histological patterns of GSK-3β expression and evaluated its potential as marker for overall survival, establishing a simple histological score to measure the evaluated status in resected tissues. The use of GSK-3β expression as an immune response biomarker remains a challenge. Future studies will seek to explain the role of its interaction with PTEN.
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Affiliation(s)
- Marclesson Alves
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil
| | | | - Aline Kimberly
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil.,Argos Pathology Laboratory, Department of Investigative Pathology, Fortaleza, Brazil
| | - Francisco Martins Neto
- Departments of Patholoy, Oncology and Thoracic Surgery, Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Ana Claudia Oliveira
- Departments of Patholoy, Oncology and Thoracic Surgery, Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Juliana Cordeiro de Sousa
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil.,Argos Pathology Laboratory, Department of Investigative Pathology, Fortaleza, Brazil
| | - Cleto D Nogueira
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil.,Argos Pathology Laboratory, Department of Investigative Pathology, Fortaleza, Brazil
| | - Benedito A Carneiro
- Division of Hematology/Oncology, Lifespan Cancer Institute, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Fabio Tavora
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil.,Argos Pathology Laboratory, Department of Investigative Pathology, Fortaleza, Brazil.,Departments of Patholoy, Oncology and Thoracic Surgery, Messejana Heart and Lung Hospital, Fortaleza, Brazil
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8
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Souza PMMD, Gerson G, Soares CEL, Souza SGD, Dias JS, Melo DND, Ruiz EM, Tavora F, Cavalcanti LPDG. COVID-19 Home Deaths without Medical Assistance in Northeastern Brazil. Am J Trop Med Hyg 2021; 104:514-518. [PMID: 33308386 PMCID: PMC7866358 DOI: 10.4269/ajtmh.20-1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTSince its beginning in Wuhan, China, in December 2019, the disease caused by COVID-19 has reached more than 27 million confirmed cases and more than 880 thousand deaths worldwide by early September 2020. Although it is known that some of these deaths may have been influenced by the overload of health systems, the world medical literature lacks data on deaths due to COVID-19 in patients who have not received medical assistance. We conducted a retrospective transversal study to report the clinical and epidemiological profile of the first 200 consecutive cases of home deaths without medical assistance caused by COVID-19 diagnosed by verbal autopsy and real-time PCR in samples of postmortem nasopharyngeal swabs, in the state of Ceara, in Northeastern Brazil. The data show a slightly increased prevalence of cases in males (57%) and an average age of 76.8 years. Previous comorbidities were reported in 85.5% of cases, the most common being cardiovascular disease (45%), neurological disease (30%), and diabetes (29%). The main symptoms reported were dyspnea (79%), fever (75.5%), cough (69%), and fatigue (42.5%). The average time between the onset of illness and death was 7.3 days, being statistically shorter in patients who had previous comorbidities (P = 0.0215). This is the first study to evidence the clinical and epidemiological characteristics of COVID-19 home deaths without medical assistance, which may represent a considerable portion of the pandemic burden, especially in the context of health system overload.
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Affiliation(s)
| | - Gunter Gerson
- 1“Dr. Rocha Furtado” Death Verification Service, Fortaleza, Brazil
- 3Ceara Federal University, Fortaleza, Brazil
| | | | | | | | - Deborah Nunes de Melo
- 1“Dr. Rocha Furtado” Death Verification Service, Fortaleza, Brazil
- 3Ceara Federal University, Fortaleza, Brazil
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9
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Henrich SE, McMahon KM, Plebanek MP, Calvert AE, Feliciano TJ, Parrish S, Tavora F, Mega A, De Souza A, Carneiro BA, Thaxton CS. Prostate cancer extracellular vesicles mediate intercellular communication with bone marrow cells and promote metastasis in a cholesterol-dependent manner. J Extracell Vesicles 2020; 10:e12042. [PMID: 33408816 PMCID: PMC7775568 DOI: 10.1002/jev2.12042] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 06/10/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022] Open
Abstract
Primary tumours can establish long-range communication with distant organs to transform them into fertile soil for circulating tumour cells to implant and proliferate, a process called pre-metastatic niche (PMN) formation. Tumour-derived extracellular vesicles (EV) are potent mediators of PMN formation due to their diverse complement of pro-malignant molecular cargo and their propensity to target specific cell types (Costa-Silva et al., 2015; Hoshino et al., 2015; Peinado et al., 2012; Peinado et al., 2017). While significant progress has been made to understand the mechanisms by which pro-metastatic EVs create tumour-favouring microenvironments at pre-metastatic organ sites, comparatively little attention has been paid to the factors intrinsic to recipient cells that may modify the extent to which pro-metastatic EV signalling is received and transduced. Here, we investigated the role of recipient cell cholesterol homeostasis in prostate cancer (PCa) EV-mediated signalling and metastasis. Using a bone metastatic model of enzalutamide-resistant PCa, we first characterized an axis of EV-mediated communication between PCa cells and bone marrow that is marked by in vitro and in vivo PCa EV uptake by bone marrow myeloid cells, activation of NF-κB signalling, enhanced osteoclast differentiation, and reduced myeloid thrombospondin-1 expression. We then employed a targeted, biomimetic approach to reduce myeloid cell cholesterol in vitro and in vivo prior to conditioning with PCa EVs. Reducing myeloid cell cholesterol prevented the uptake of PCa EVs by recipient myeloid cells, abolished NF-κB activity and osteoclast differentiation, stabilized thrombospondin-1 expression, and reduced metastatic burden by 77%. These results demonstrate that cholesterol homeostasis in bone marrow myeloid cells regulates pro-metastatic EV signalling and metastasis by acting as a gatekeeper for EV signal transduction.
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Affiliation(s)
- Stephen E. Henrich
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
| | - Kaylin M. McMahon
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
| | - Michael P. Plebanek
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
| | - Andrea E. Calvert
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
| | - Timothy J. Feliciano
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
| | - Samuel Parrish
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Fabio Tavora
- Department of PathologyMessejana Heart and Lung HospitalFortalezaBrazil
| | - Anthony Mega
- Warren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
- Lifespan Cancer InstituteProvidenceRhode IslandUSA
| | - Andre De Souza
- Warren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
- Lifespan Cancer InstituteProvidenceRhode IslandUSA
| | - Benedito A. Carneiro
- Warren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
- Lifespan Cancer InstituteProvidenceRhode IslandUSA
| | - C. Shad Thaxton
- Department of UrologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Simpson Querrey Institute for BioNanotechnologyNorthwestern UniversityChicagoIllinoisUSA
- Robert H. Lurie Comprehensive Cancer CenterNorthwestern UniversityChicagoIllinoisUSA
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10
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Prabhu VV, Morrow S, Rahman Kawakibi A, Zhou L, Ralff M, Ray J, Jhaveri A, Ferrarini I, Lee Y, Parker C, Zhang Y, Borsuk R, Chang WI, Honeyman JN, Tavora F, Carneiro B, Raufi A, Huntington K, Carlsen L, Louie A, Safran H, Seyhan AA, Tarapore RS, Schalop L, Stogniew M, Allen JE, Oster W, El-Deiry WS. ONC201 and imipridones: Anti-cancer compounds with clinical efficacy. Neoplasia 2020; 22:725-744. [PMID: 33142238 PMCID: PMC7588802 DOI: 10.1016/j.neo.2020.09.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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: 08/10/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/20/2022]
Abstract
ONC201 was originally discovered as TNF-Related Apoptosis Inducing Ligand (TRAIL)-inducing compound TIC10. ONC201 appears to act as a selective antagonist of the G protein coupled receptor (GPCR) dopamine receptor D2 (DRD2), and as an allosteric agonist of mitochondrial protease caseinolytic protease P (ClpP). Downstream of target engagement, ONC201 activates the ATF4/CHOP-mediated integrated stress response leading to TRAIL/Death Receptor 5 (DR5) activation, inhibits oxidative phosphorylation via c-myc, and inactivates Akt/ERK signaling in tumor cells. This typically results in DR5/TRAIL-mediated apoptosis of tumor cells; however, DR5/TRAIL-independent apoptosis, cell cycle arrest, or antiproliferative effects also occur. The effects of ONC201 extend beyond bulk tumor cells to include cancer stem cells, cancer associated fibroblasts and immune cells within the tumor microenvironment that can contribute to its efficacy. ONC201 is orally administered, crosses the intact blood brain barrier, and is under evaluation in clinical trials in patients with advanced solid tumors and hematological malignancies. ONC201 has single agent clinical activity in tumor types that are enriched for DRD2 and/or ClpP expression including specific subtypes of high-grade glioma, endometrial cancer, prostate cancer, mantle cell lymphoma, and adrenal tumors. Synergy with radiation, chemotherapy, targeted therapy and immune-checkpoint agents has been identified in preclinical models and is being evaluated in clinical trials. Structure-activity relationships based on the core pharmacophore of ONC201, termed the imipridone scaffold, revealed novel potent compounds that are being developed. Imipridones represent a novel approach to therapeutically target previously undruggable GPCRs, ClpP, and innate immune pathways in oncology.
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Key Words
- 5-fu, 5-fluorouracil
- a2a, adenosine 2a receptor
- alcl, anaplastic large cell lymphoma
- all, acute lymphoblastic leukemia
- aml, acute myeloid leukemia
- ampk, amp kinase
- atrt, atypical teratoid rhabdoid tumor
- auc, area under the curve
- brd, bromodomain
- camp, cyclic amp
- cck18, caspase-cleaved cytokeratin 18
- ck18, cytokeratin 18
- cll, chronic lymphocytic leukemia
- clpp, caseinolytic protease p
- clpx, caseinolytic mitochondrial matrix peptidase chaperone subunit x
- cml, chronic myelogenous leukemia
- crc, colorectal cancer
- csc, cancer stem cell
- ctcl, cutaneous t-cell lymphoma
- dipg, diffuse intrinsic pontine glioma
- dlbcl, diffuse large b-cell lymphoma
- dna-pkcs, dna-activated protein kinase catalytic subunit
- dr5, death receptor 5
- drd1, dopamine receptor d1
- drd2, dopamine receptor d2
- drd3, dopamine receptor d3
- drd4, dopamine receptor d4
- drd5, dopamine receptor d5
- dsrct, desmoplastic small round cell tumor
- ec, endometrial cancer
- egfr, epidermal growth factor receptor
- flair, fluid-attenuated inversion recovery
- gbm, glioblastoma multiforme
- gdsc, genomics of drug sensitivity in cancer
- girk, g protein-coupled inwardly rectifying potassium channel
- gnrh, gonadotropin-releasing hormone receptor
- gpcr, g protein coupled receptor
- hcc, hepatocellular carcinoma
- ihc, immunohistochemistry
- hgg, high-grade glioma
- isr, integrated stress response
- mcl, mantle cell lymphoma
- mm, multiple myeloma
- mtd, maximum tolerated dose
- nhl, non-hodgkin’s lymphoma
- nk, natural killer
- noael, no-observed-adverse-event-level
- nsclc, non-small cell lung cancer
- os, overall survival
- oxphos, oxidative phosphorylation
- pc-pg, pheochromocytoma-paraganglioma
- pd, pharmacodynamic
- pdx, patient-derived xenograft
- pfs, progression-free survival
- pk, pharmacokinetic
- plc, phospholipase c
- rano, response assessment in neuro-oncology
- recist, response evaluation criteria in solid tumors
- rhtrail, recombinant human trail
- rp2d, recommended phase ii dose
- sar, structure–activity relationship
- sclc, small-cell lung cancer
- tic10, trail-inducing compound 10
- tmz, temozolomide
- tnbc, triple-negative breast cancer
- trail, tnf-associated apoptosis-inducing ligand
- tunel, terminal deoxynucleotidyl transferase dutp nick end labeling
- who, world health organization
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Affiliation(s)
- Varun Vijay Prabhu
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA
| | - Sara Morrow
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA
| | | | - Lanlan Zhou
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Marie Ralff
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Jocelyn Ray
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Aakash Jhaveri
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Isacco Ferrarini
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Young Lee
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Cassandra Parker
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Yiqun Zhang
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Robyn Borsuk
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Wen-I Chang
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Joshua N Honeyman
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Fabio Tavora
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Benedito Carneiro
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Alexander Raufi
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Kelsey Huntington
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Lindsey Carlsen
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Anna Louie
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Howard Safran
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | - Attila A Seyhan
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA
| | | | - Lee Schalop
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA
| | - Martin Stogniew
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA
| | - Joshua E Allen
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA.
| | - Wolfgang Oster
- Oncoceutics, Inc., 3675 Market St, Suite 200, Philadelphia, PA 19104, USA
| | - Wafik S El-Deiry
- Warren Alpert Medical School, Brown University, 70 Ship Street, Room 537, Providence, RI 02912, USA.
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11
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Borden BA, Baca Y, Xiu J, Tavora F, Winer I, Weinberg BA, Vanderwalde AM, Darabi S, Korn WM, Mazar AP, Giles FJ, Crawford L, Safran H, El-Deiry WS, Carneiro BA. The Landscape of Glycogen Synthase Kinase-3 Beta Genomic Alterations in Cancer. Mol Cancer Ther 2020; 20:183-190. [PMID: 33087512 DOI: 10.1158/1535-7163.mct-20-0497] [Citation(s) in RCA: 3] [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] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022]
Abstract
Glycogen synthase kinase-3β (GSK-3β), a serine/threonine kinase, has been implicated in the pathogenesis of many cancers, with involvement in cell-cycle regulation, apoptosis, and immune response. Small-molecule GSK-3β inhibitors are currently undergoing clinical investigation. Tumor sequencing has revealed genomic alterations in GSK-3β, yet an assessment of the genomic landscape in malignancies is lacking. This study assessed >100,000 tumors from two databases to analyze GSK-3β alterations. GSK-3β expression and immune cell infiltrate data were analyzed across cancer types, and programmed death-ligand 1 (PD-L1) expression was compared between GSK-3β-mutated and wild-type tumors. GSK-3β was mutated at a rate of 1%. The majority of mutated residues were in the kinase domain, with frequent mutations occurring in a GSK-3β substrate binding pocket. Uterine endometrioid carcinoma was the most commonly mutated (4%) tumor, and copy-number variations were most commonly observed in squamous histologies. Significant differences across cancer types for GSK-3β-mutated tumors were observed for B cells (P = 0.018), monocytes (P = 0.002), dendritic cells (P = 0.005), neutrophils (P = 0.0003), and endothelial cells (P = 0.014). GSK-3β mRNA expression was highest in melanoma. The frequency of PD-L1 expression was higher among GSK-3β-mutated tumors compared with wild type in colorectal cancer (P = 0.03), endometrial cancer (P = 0.05), melanoma (P = 0.02), ovarian carcinoma (P = 0.0001), and uterine sarcoma (P = 0.002). Overall, GSK-3β molecular alterations were detected in approximately 1% of solid tumors, tumors with GSK-3β mutations displayed a microenvironment with increased infiltration of B cells, and GSK-3β mutations were associated with increased PD-L1 expression in selected histologies. These results advance the understanding of GSK-3β complex signaling network interfacing with key pathways involved in carcinogenesis and immune response.
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Affiliation(s)
- Brittany A Borden
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Fabio Tavora
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, Rhode Island
| | - Ira Winer
- Wayne State School of Medicine, Karmanos Cancer Institute, Detroit, Michigan
| | | | | | - Sourat Darabi
- Hoag Family Cancer Institute, Newport Beach, California
| | | | | | | | - Lorin Crawford
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Howard Safran
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, Rhode Island.,Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, Rhode Island
| | - Wafik S El-Deiry
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, Rhode Island.,Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, Rhode Island.,Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Benedito A Carneiro
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island. .,Division of Hematology/Oncology, Lifespan Cancer Institute, Providence, Rhode Island.,Joint Program in Cancer Biology, Brown University and Lifespan Health System, Providence, Rhode Island
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12
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Fine SW, Trpkov K, Amin MB, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, Costello T, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong MX, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Pavlovich CP, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Epstein JI. Practice patterns related to prostate cancer grading: results of a 2019 Genitourinary Pathology Society clinician survey. Urol Oncol 2020; 39:295.e1-295.e8. [PMID: 32948433 DOI: 10.1016/j.urolonc.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To survey urologic clinicians regarding interpretation of and practice patterns in relation to emerging aspects of prostate cancer grading, including quantification of high-grade disease, cribriform/intraductal carcinoma, and impact of magnetic resonance imaging-targeted needle biopsy. MATERIALS AND METHODS The Genitourinary Pathology Society distributed a survey to urology and urologic oncology-focused societies and hospital departments. Eight hundred and thirty four responses were collected and analyzed using descriptive statistics. RESULTS Eighty percent of survey participants use quantity of Gleason pattern 4 on needle biopsy for clinical decisions, less frequently with higher Grade Groups. Fifty percent interpret "tertiary" grade as a minor/<5% component. Seventy percent of respondents would prefer per core grading as well as a global/overall score per set of biopsies, but 70% would consider highest Gleason score in any single core as the grade for management. Seventy five percent utilize Grade Group terminology in patient discussions. For 45%, cribriform pattern would affect management, while for 70% the presence of intraductal carcinoma would preclude active surveillance. CONCLUSION This survey of practice patterns in relationship to prostate cancer grading highlights similarities and differences between contemporary pathology reporting and its clinical application. As utilization of Gleason pattern 4 quantification, minor tertiary pattern, cribriform/intraductal carcinoma, and the incorporation of magnetic resonance imaging-based strategies evolve, these findings may serve as a basis for more nuanced communication and guide research efforts involving pathologists and clinicians.
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Affiliation(s)
- Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Kiril Trpkov
- Department of Pathology and Lab Medicine, University of Calgary and Alberta Precision Labs, Calgary, AB, Canada
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles, CA
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | | | - Fadi Brimo
- Department of Pathology, McGill University Health Center, Montréal, QC, Canada
| | | | - Maurizio Colecchia
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Tony Costello
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Angelo M DeMarzo
- Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Giovanna A Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donna E Hansel
- Department of Pathology, Oregon Health and Science University Portland OR, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | | | | | - Francesca Khani
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY
| | - Max X Kong
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, CA
| | - Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - L Priya Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Priti Lal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mathieu Latour
- Department of Pathology, CHUM, Université de Montréal, Montréal, QC, Canada
| | - Tamara Lotan
- Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Hiroshi Miyamoto
- Departments of Pathology and Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, NY
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus, OH
| | - Christian P Pavlovich
- Departments of Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY
| | - Mark A Rubin
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey S So
- Institute of Pathology, St Luke's Medical Center, Quezon City and Global City, Philippines
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fabio Tavora
- Argos Laboratory, Federal University of Ceara, Fortaleza, Brazil
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Lawrence True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Sara E Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill, NC
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Chicago, IL
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA
| | - Debra L Zynger
- Department of Pathology, Ohio State University, Columbus, OH
| | - Jonathan I Epstein
- Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD; Departments of Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
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13
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Borden BA, Xiu J, Baca Y, Ramos P, Giles FJ, Mazar A, Tavora F, Safran H, El-Deiry WS, Carneiro BA. Abstract 5292: Glycogen synthase kinase-3 beta (GSK-3b) genomic alterations and increased programmed death-ligand 1 (PD-L1) expression in advanced malignancies. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5292] [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
Background: GSK-3β, a serine/threonine kinase, has been implicated in the pathogenesis of many cancers. Aberrant expression of GSK-3β promotes tumor growth and chemotherapy resistance. GSK-3β phosphorylates target pro-oncogenes (C-Jun and C-myc), as well as non-glycosylated forms of PD-L1 leading to its proteasome degradation (Li CW Nat Commun 2016). GSK-3β tumor genomic alterations have been described, yet are not well-characterized. Characterizing alterations and functional impact can guide patient selection for treatment with GSK-3β inhibitors and related combinations in clinical development, including 9-ING-41, a first-in-class, selective small molecule GSK-3β inhibitor currently in phase 1/2 clinical trial (NCT03678883).
Methods: Publicly-available tumor genomic data from cBioPortal was curated and analyzed. For each tumor with a GSK-3β alteration, histology and GSK-3β protein change/copy number variation (CNV) were obtained. A second cohort of tumors obtained from Caris Life Sciences (n=73,324) was interrogated for GSK-3β genomic alterations and PD-L1 expression (assessed via SP-142 antibody on tumor cells, cutoff used was 5%). Chi-square test was used to assess significance between PD-L1 expression of GSK3β-mutated tumors and that of GSK3β-wild type (wt) tumors.
Results: Of 46,237 cBioPortal tumors, 430 (1%) tumors had a GSK3β mutation or CNV. Similarly, of 73,324 samples from Caris, 819 (1%) tumors had GSK3β mutations. When combining the data from both cohorts, the histologies with most frequent GSK3β mutations were uterine endometrioid carcinoma (4%), non-melanoma skin cancer (3%), uterine neoplasms (3%), and melanoma (2%). Overall, top protein changes included R396Q (n=44), H310Q (n=40), R418C (n=16), and S215L (n=15). Of the top mutated loci, R96 (n=14) and R180 (n=12) are located in a key binding pocket for phosphoprotein GSK3β substrates.
The association between PD-L1 expression and GSK3β mutations was evaluated in 55,138 cases. The frequency of PD-L1 expression was significantly higher among GSK3β-mutated tumors compared to wt in colorectal cancer (8% vs. 4%, p=0.02), endometrial cancer (11% vs. 7%, p=0.05), melanoma (42% vs. 23%, p=0.01), ovarian surface epithelial carcinoma (20% vs. 7%, p=0.001), and uterine sarcoma (40% vs. 8%, p=0.005). Among these five histologies, 49 tumors had GSK3β mutations and were positive for PD-L1, and the top mutated residues were H310Q (n=5) and S215L (n=3).
Conclusions: In an assessment of over 100,000 tumor samples, GSK3β mutations were most frequently detected in uterine endometrioid carcinoma, non-melanoma skin cancer, uterine neoplasms, and melanoma. GSK3β mutations were associated with a higher frequency of PD-L1 expression in selected tumors. These results may have implications in the selection of patients for treatment with novel targeted therapies such as GSK3β inhibitors and PD-L1 inhibitors.
Citation Format: Brittany A. Borden, Joanne Xiu, Yasmine Baca, Pilar Ramos, Francis J. Giles, Andrew Mazar, Fabio Tavora, Howard Safran, Wafik S. El-Deiry, Benedito A. Carneiro. Glycogen synthase kinase-3 beta (GSK-3b) genomic alterations and increased programmed death-ligand 1 (PD-L1) expression in advanced malignancies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5292.
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Affiliation(s)
| | | | | | | | | | | | - Fabio Tavora
- 1Warren Alpert Medical School of Brown University, Providence, RI
| | - Howard Safran
- 1Warren Alpert Medical School of Brown University, Providence, RI
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14
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Tavora F, Lotan T, Alves M, Zhou L, Amin A, Arunasalam N, De Souza A, Mega A, Golijanin D, Giles F, El-Deiry W, Carneiro B. Abstract 2959: Glycogen synthase kinase 3-β expression in prostate cancer (PCa) correlates with aggressive pathological features and its blockade with 9-ING-41 inhibits viability of PCa cell lines. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2959] [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
Castration-resistant prostate cancer (CRPC) represents a lethal stage of disease with limited treatment options beyond androgen receptor (AR) inhibitors and chemotherapy. GSK-3β is a serine/threonine kinase established as a therapeutic target in several solid tumors. GSK-3β inhibitors reduce prostate cancer cell growth and inhibit AR-V7 transcriptional activity in vitro (Rinnab L et al 2008; Schütz SV et al 2011; Nakata et al 2017). This study aimed to characterize the GSK-3β expression in molecular subtypes of PCa and the antitumor activity of 9-ING-41, a selective small molecule GSK-3β inhibitor currently in phase 1/2 clinical studies (NCT03678883). We hypothesized that GSK3-β expression may correlate with sensitivity to GSK3-β inhibition as well as suppression of anti-apoptotic pathways. We evaluated the expression of GSK-3β in a tissue microarray of 134 specimens of PCa tumors from radical prostatectomies (median age 69, serum PSA 10.5 ± 7.6 ng/ml; grade groups (GG): 18 - GG 1 (13.4%), 67 - GG 2 (48.5%), 29 - GG 3 (21.4%), 7 - GG 4 (5.2%), 13 - GG 5 (9.7%); 72 patients (54.9%) had pT2 tumors, and 52 (39,1%) were pT3. Seven patients (5.7%) had positive lymph node (pN1 disease). ERG expression and PTEN loss were observed in 52% (71/134) and 42%, respectively. The GSK-3β histologic score (% of positive tumor cells multiplied by intensity 0-3) correlated with higher Gleason grade (p<0.05), extraprostatic extension (pT3a, p<0.05), but not with serum PSA, tumor volume, margin status or size of index nodule. Cases with predominant nuclear localization of GSK-3β (5%; N=7) had higher Gleason score, pathologic stage, and all but one had PTEN loss. The antiproliferative effect of 9-ING-41 in four PCa human cell lines (PC3, DU145, LNCAP and 22rV1) was investigated using Cell-Titer-Glo (CTG) viability assay. 9-ING-41 demonstrated a dose-dependent decrease in proliferation of AR positive (IC50s 0.3 μM LNCAP; 0.8 μM 22rV1) and AR negative cell lines (IC50 0.6 μM PC3, 0.2 μM DU145). 9-ING-41 induced robust apoptosis (cleaved PARP) in LNCAP and PC3 cells, but not in DU145. All four cell lines expressed GSK-3β, the target of 9-ING-41 and its level were not altered by treatment. 9-ING-41 decreased the expression of phosphorylated NF-kβ (Ser536), anti-apoptotic proteins MCL-1 and BCL-2 by western immunoblotting. Interestingly, the most sensitive cell line, DU145, had lower levels of NF-kβ and suppressed both MCL-1 and BCL-2 after exposure to 9-ING-41. Our current work is evaluating the extent of apoptosis versus growth arrest, especially in the DU145 cell line, where PARP cleavage was not observed. We are also evaluating the effects of the 9-ING-41 on cellular targets of GSK-3β as potential markers of drug efficacy. 9-ING-41 has potent anti-proliferative activity against PCa cell lines. These data support the inclusion of patients with CRPC in clinical studies of 9-ING-41 and its further investigation for the treatment of CRPC.
Citation Format: Fabio Tavora, Tamara Lotan, Marclesson Alves, Lanlan Zhou, Ali Amin, Navaraj Arunasalam, Andre De Souza, Anthony Mega, Dragan Golijanin, Frank Giles, Wafik El-Deiry, Benedito Carneiro. Glycogen synthase kinase 3-β expression in prostate cancer (PCa) correlates with aggressive pathological features and its blockade with 9-ING-41 inhibits viability of PCa cell lines [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2959.
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Affiliation(s)
- Fabio Tavora
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | | | | | - Lanlan Zhou
- 4Joint Program in Cancer Biology, Brown University and Lifespan Cancer institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Ali Amin
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Navaraj Arunasalam
- 5Joint Program in Cancer Biology, Brown University and Lifespan Cancer Institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Andre De Souza
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Anthony Mega
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Dragan Golijanin
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Frank Giles
- 6Developmental Therapeutics Consortium, Chicago, IL
| | - Wafik El-Deiry
- 5Joint Program in Cancer Biology, Brown University and Lifespan Cancer Institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Benedito Carneiro
- 1The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
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Tavora F, Zhou L, Amin A, Howard S, Arunasalam N, de Souza A, Mega A, Golijanin D, El-Deiry W, Carneiro B. Abstract 1836: ONC201 shows synergistic effect with the androgen receptor AR-inhibitor darotulamide in prostate cancer models. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1836] [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
Prostate cancer (PC) is the most frequently diagnosed cancer among men in the United States and is the 3rd cause of cancer mortality. Despite advances in the treatment and understanding of pathogenesis, patients with metastatic PC invariably progress to a lethal stage of castration-resistant prostate cancer (CRPC). Inhibition of androgen signaling remains crucial for the treatment of CRPC, but novel treatment strategies are urgently needed. ONC201 is a first-in-class, selective inhibitor of dopamine receptor D2 that upregulates death-receptor 5 and induces apoptosis. ONC201 induced apoptosis in PC cell lines and showed synergy with enzalutamide, docetaxel and everolimus (Lev A Mol Cancer Res 2018). Darolutamide (DARO) is a novel androgen receptor (AR) antagonist approved for treatment of patients with non-metastatic CRPC. DARO has higher affinity to AR and preclinical activity against enzalutamide-resistant PC cell lines including AR variants associated with enzalutamide agonism (Borgmann H Eur Urol 2018). We treated human PC cell lines (LNCAP [castration sensitive, AR wild-type], 22Rv1 [castration-resistant cell line that expresses AR splice variant AR-V7], DU145 [AR negative], PC3 [AR negative]) with DARO alone and combined with ONC201. Single-agent DARO decreased PC cell viability in Cell-Titer-Glo assays (IC50s of 10 and 693 nM for LNCAP and DU145, respectively). ONC201 showed strong synergism with DARO in LNCAP cells (combination indices < 1 at concentrations of 156, 312, 625 nM, and 1.25 µM of DARO with 2.5 μM ONC201). ONC201 induced robust apoptosis in 22Rv1 as measured by PARP cleavage, which was partially amplified by DARO. PARP cleavage was also observed in LNCAP cells with less intensity and not potentiated by DARO. ONC201 reduced the expression of phospho-AR (p-AR) in both 22Rv1 and LNCAP. The combination of ONC201 and DARO had a significant additive effect in reducing p-AR in 22Rv1, but not in LNCAP. ONC201 reduced PSA protein levels in LNCAP cells while DARO alone did not cause any significant change in PSA. Immunofluorescence experiments showed that DARO caused significant reduction of AR nuclear translocation in both 22rV1 and LNCAP cells. The combination with ONC201 potentiated this inhibition of AR translocation in both cell lines. ONC201 showed strong antiproliferative activity against PC cells lines independent of AR status. Combination of ONC201 with DARO demonstrated synergy in enzalutamide resistant 22Rv1 cells expressing AR-V7 with marked reduction of nuclear localization of AR. Our studies provide preclinical rationale for combination of ONC201 with DARO as a novel therapy of PC.
Citation Format: Fabio Tavora, Lanlan Zhou, Ali Amin, Safran Howard, Navaraj Arunasalam, Andre de Souza, Anthony Mega, Dragan Golijanin, Wafik El-Deiry, Benedito Carneiro. ONC201 shows synergistic effect with the androgen receptor AR-inhibitor darotulamide in prostate cancer models [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1836.
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Affiliation(s)
| | - Lanlan Zhou
- 2Joint Program in Cancer Biology, Brown University and Lifespan Cancer institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Ali Amin
- 1Brown University, Providence, RI
| | - Safran Howard
- 3The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Navaraj Arunasalam
- 2Joint Program in Cancer Biology, Brown University and Lifespan Cancer institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Andre de Souza
- 3The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Anthony Mega
- 3The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Dragan Golijanin
- 3The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
| | - Wafik El-Deiry
- 2Joint Program in Cancer Biology, Brown University and Lifespan Cancer institute; Department of Pathology and Laboratory Medicine, Brown University; Hematology/Oncology Division, Department of Medicine, Lifespan and Brown University, Providence, RI
| | - Benedito Carneiro
- 3The Warren Alpert Medical School, Brown University, Providence and Lifespan Cancer Institute, Providence, RI
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Morais CE, Gurgel DC, Teixeira AC, Mattos TVA, Silva AVAD, Tavora F. Prevalence of ERG expression and PTEN loss in a Brazilian prostate cancer cohort. ACTA ACUST UNITED AC 2019; 52:e8483. [PMID: 31826177 PMCID: PMC6903141 DOI: 10.1590/1414-431x20198483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/20/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
PTEN is the most commonly inactivated tumor suppressor gene in primary prostate cancer (PCa) and its loss is associated with poor clinical outcomes. ERG rearrangement is a genomic alteration frequently found in PCa and its prognostic significance has yielded mixed results. Although the association of PTEN and ERG biomarkers has potential impact on clinical outcomes, studies examining the two genes simultaneously are scarce in Brazilian populations. In this study, we retrospectively examined the relationship between ERG expression and PTEN loss in 119 surgically treated prostate cancer patients from Northeastern Brazil through immunohistochemical analysis. ERG expression was found in 41.0% (48/117) of cases and the loss of PTEN detected in 38.1% (40/105) of samples. ERG-positive cases were significantly associated with lower prostate weight; ERG negatively correlated with Gleason score above 6. The lack of associations for PTEN loss alone in this cohort is counter to the literature, which shows that PTEN loss is usually associated with more aggressive disease. The overlapping of the two biomarkers revealed that samples with positive ERG expression without PTEN loss were associated with lower Gleason and lower Grade group. This study contributes with the discussion about the development of the molecular profiling of prostate cancer. The further development of similar studies could help in stratifying specific risk groups, leading to a more personalized therapeutic decision for prostate cancer treatment.
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Affiliation(s)
- C E Morais
- Laboratório Argos Patologia, Fortaleza, CE, Brasil.,Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - D C Gurgel
- Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - A C Teixeira
- Laboratório Argos Patologia, Fortaleza, CE, Brasil
| | - T V Arruda Mattos
- Departamento de Anatomia Patológica, Santa Casa Misericórdia de São Paulo, São Paulo, SP, Brasil
| | | | - F Tavora
- Laboratório Argos Patologia, Fortaleza, CE, Brasil.,Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil.,Centro Universitário Christus (Unichristus), Fortaleza, CE, Brasil
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17
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Oliveira ACDSMD, Silva AVAD, Alves M, Cronemberger E, Carneiro BA, Melo JC, Martins Neto F, Tavora F. Molecular profile of non-small cell lung cancer in northeastern Brazil. ACTA ACUST UNITED AC 2019; 45:e20180181. [PMID: 31166373 PMCID: PMC6715033 DOI: 10.1590/1806-3713/e20180181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/19/2018] [Accepted: 12/07/2018] [Indexed: 01/17/2023]
Abstract
Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.
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Affiliation(s)
| | | | - Marclesson Alves
- Unidade de Oncologia, Pronutrir Oncologia e Nutrição, Fortaleza (CE) Brasil
| | | | | | - Juliana Carneiro Melo
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza -UNIFOR - Fortaleza (CE) Brasil
| | - Francisco Martins Neto
- Unidade de Cirurgia Torácica, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
| | - Fabio Tavora
- Programa de Pós-Graduação em Patologia, Universidade Federal do Ceará, Fortaleza (CE) Brasil.,Departamento de Patologia, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza (CE) Brasil
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18
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Sahin I, Eturi A, De Souza A, Pamarthy S, Tavora F, Giles FJ, Carneiro BA. Glycogen synthase kinase-3 beta inhibitors as novel cancer treatments and modulators of antitumor immune responses. Cancer Biol Ther 2019; 20:1047-1056. [PMID: 30975030 DOI: 10.1080/15384047.2019.1595283] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a kinase at the crossroads of numerous metabolic and cell growth signaling pathways, glycogen synthase kinase-3 beta (GSK-3β) is a highly desirable therapeutic target in cancer. Despite its involvement in pathways associated with the pathogenesis of several malignancies, no selective GSK-3β inhibitor has been approved for the treatment of cancer. The regulatory role of GSK-3β in apoptosis, cell cycle, DNA repair, tumor growth, invasion, and metastasis reflects the therapeutic relevance of this target and provides the rationale for drug combinations. Emerging data on GSK-3β as a mediator of anticancer immune response also highlight the potential clinical applications of novel selective GSK-3β inhibitors that are entering clinical studies. This manuscript reviews the preclinical and early clinical results with GSK-3β inhibitors and delineates the developmental therapeutics landscape for this potentially important target in cancer therapy.
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Affiliation(s)
- Ilyas Sahin
- a Lifespan Cancer Institute, Division of Hematology/Oncology , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Aditya Eturi
- b Department of Medicine , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Andre De Souza
- a Lifespan Cancer Institute, Division of Hematology/Oncology , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Sahithi Pamarthy
- c Atrin Pharmaceuticals , Pennsylvania Biotechnology Center , Doylestown , PA , USA
| | - Fabio Tavora
- d Argos Laboratory/Messejana Heart and Lung Hospital , Fortaleza , Brazil
| | - Francis J Giles
- e Developmental Therapeutics Consortium , Chicago , IL , USA
| | - Benedito A Carneiro
- a Lifespan Cancer Institute, Division of Hematology/Oncology , The Warren Alpert Medical School of Brown University , Providence , RI , USA
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Alves da Silva AV, Martins Neto F, de Oliveira ACDSM, Carneiro BA, Alves M, Nogueira CD, Tavora F. The frequency of high PD-L1 expression is low in lung adenocarcinoma patients from Northeast Brazil. Surg Exp Pathol 2019. [DOI: 10.1186/s42047-019-0031-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
As Immune checkpoint inhibitors (ICPIs) are changing the standard-care in lung cancer with good clinical activities and durable responses, its indication must be based on the appropriate patient selection once only a fraction of patients has a response to these costly drugs. In larger cohorts the expression of programmed cell death–ligand 1 (PD-L1) has been associated with good clinical response of ICPIs in lung adenocarcinoma where the rate of high PD-L1 expression (defined as PD-L1tumor proportion score ≥ 50%) is ~ 30%, but once rare studies are available addressing the frequency of PD-L1 in populations outside those cohorts, we aimed to report the prevalence of PD-L1 and the frequency of patients with high PD-L1 expression utilizing data from a major pathology laboratory in Northeastern Brazil.
Methods
We retrospectively evaluated the PD-L1 expression in 158 surgically resected primary lung adenocarcinoma including 158 with anaplastic lymphoma kinase (ALK) expression. PD-L1 and ALK expression were evaluated by immunohistochemical analysis with the SP263 and D5F3 assays, respectively.
Results
Of the 158 samples analyzed, 94 (59.5%) had a PD-L1 tumor proportion score (TPS) < 1%, 38 (24.0%) had a PD-L1 TPS of 1–49% and 26 (16.5%) had a PD-L1 TPS of ≥50%. ALK expression was detected in 21 (13.3%) of the 158 tumor samples and 5 (3.2%) of them had a PD-L1 TPS of ≥50%.
Conclusion
The frequency of strong PD-L1 expression was lower than that previously reported in the trials where PD-L1 expression was used as a biomarker for patient selection. Also, considering that a subset of patients with ALK positivity had a strong PD-L1 expression, further studies will be required to examine the efficacy of PD-1/PD-L1 inhibitors in such patients.
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Paulk A, Tavora F, Burke A. Pulmonary mucinous adenocarcinomas: a clinicopathologic series with emphasis on the prognostic significance of spread through alveolar spaces, and presence of solid growth component. Surg Exp Pathol 2018. [DOI: 10.1186/s42047-018-0013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. Pathologic parameters predicting poor outcome have not been extensively studied, including the presence of spread through alveolar spaces (STAS).
Methods
We retrospectively studied time to lung recurrence and time to distant metastasis in 30 mucinous lung tumors, in relationship to histologic parameters, including spread through alveolar spaces, tumor size, invasive size, % invasive size, growth pattern (solid or cribriform, acinar, papillary, micropapillary, and lepidic), type of mucin-producing cell, and TTF-1 positivity.
Results
Median follow-up was 40 months. There were 7 patients (23%) with lung recurrence (mean 22 months) and 7 (23%) with distant metastases (mean 3.7 months). Columnar / goblet cell type was inversely correlated with TTF-1 expression (p = 0.01). The only pathologic parameters associated with outcome were STAS for lung recurrence (p = .005) and solid/cribriform growth (≥ 20% of tumor) for distant metastasis (p = 0.003).
Conclusions
Mucinous adenocarcinomas of the lung are similar to non-mucinous prognostically, in that STAS and solid growth are poor prognosticators, for local and distant recurrence, respectively. The growth patterns of mucinous adenocarcinomas should be reported similar to reporting of non-mucinous adenocarcinomas.
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Alves Da Silva A, Tavora F, Martins Neto F, Oliveira A, Alves M, Carneiro B, Lima A. P3.17-01 PD-L1 Expression, EGFR Mutations and ALK Expression in Non-Small Cell Lung Cancer (NSCLC) Patients from Brazil. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Costa R, Carneiro BA, Tavora F, Pai SG, Kaplan JB, Chae YK, Chandra S, Kopp PA, Giles FJ. The challenge of developmental therapeutics for adrenocortical carcinoma. Oncotarget 2018; 7:46734-46749. [PMID: 27102148 PMCID: PMC5216833 DOI: 10.18632/oncotarget.8774] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/10/2016] [Indexed: 12/11/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare disease with an estimated incidence of only 0.7 new cases per million per year. Approximately 30-70% of the patients present with advanced disease with very poor prognosis and without effective therapeutic options. In the recent years, unprecedented progresses in cancer biology and genomics have fostered the development of numerous targeted therapies for various malignancies. Immunotherapy has also transformed the treatment landscape of malignancies such as melanoma, among others. However, these advances have not brought meaningful benefits for patients with ACC. Extensive genomic analyses of ACC have revealed numerous signal transduction pathway aberrations (e.g., insulin growth factor receptor and Wnt/β-catenin pathways) that play a central role in pathophysiology. These molecular alterations have been explored as potential therapeutic targets for drug development. This manuscript summarizes recent discoveries in ACC biology, reviews the results of early clinical studies with targeted therapies, and provides the rationale for emerging treatment strategies such as immunotherapy.
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Affiliation(s)
- Ricardo Costa
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benedito A Carneiro
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fabio Tavora
- Department of Pathology, Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Sachin G Pai
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Young Kwang Chae
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sunandana Chandra
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter A Kopp
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francis J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chuzi S, Tavora F, Cruz M, Costa R, Chae YK, Carneiro BA, Giles FJ. Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis. Cancer Manag Res 2017; 9:207-213. [PMID: 28652812 PMCID: PMC5476791 DOI: 10.2147/cmar.s136818] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) inhibitors, represent an effective treatment modality for multiple malignancies. Despite the exciting clinical benefits, checkpoint inhibition is associated with a series of immune-related adverse events (irAEs), many of which can be life-threatening and result in significant treatment delays. Pneumonitis is an adverse event of special interest as it led to treatment-related deaths in early clinical trials. This review summarizes the incidence of pneumonitis during treatment with the different checkpoint inhibitors and discusses the prognostic significance of tumor type. The wide range of clinical, radiographic, and histologic characteristics of checkpoint inhibitor-related pneumonitis is reviewed and followed by guidance on the different management strategies.
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Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fabio Tavora
- Argos Laboratory, Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Marcelo Cruz
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ricardo Costa
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Young Kwang Chae
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benedito A Carneiro
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francis J Giles
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Souza BSDF, Silva DN, Carvalho RH, Sampaio GLDA, Paredes BD, Aragão França L, Azevedo CM, Vasconcelos JF, Meira CS, Neto PC, Macambira SG, da Silva KN, Allahdadi KJ, Tavora F, de Souza Neto JD, Dos Santos RR, Soares MBP. Association of Cardiac Galectin-3 Expression, Myocarditis, and Fibrosis in Chronic Chagas Disease Cardiomyopathy. Am J Pathol 2017; 187:1134-1146. [PMID: 28322201 DOI: 10.1016/j.ajpath.2017.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 01/30/2023]
Abstract
Chronic Chagas disease cardiomyopathy, caused by Trypanosoma cruzi infection, is a major cause of heart failure in Latin America. Galectin-3 (Gal-3) has been linked to cardiac remodeling and poor prognosis in heart failure of different etiologies. Herein, we investigated the involvement of Gal-3 in the disease pathogenesis and its role as a target for disease intervention. Gal-3 expression in mouse hearts was evaluated during T. cruzi infection by confocal microscopy and flow cytometry analysis, showing a high expression in macrophages, T cells, and fibroblasts. In vitro studies using Gal-3 knockdown in cardiac fibroblasts demonstrated that Gal-3 regulates cell survival, proliferation, and type I collagen synthesis. In vivo blockade of Gal-3 with N-acetyl-d-lactosamine in T. cruzi-infected mice led to a significant reduction of cardiac fibrosis and inflammation in the heart. Moreover, a modulation in the expression of proinflammatory genes in the heart was observed. Finally, histological analysis in human heart samples obtained from subjects with Chagas disease who underwent heart transplantation showed the expression of Gal-3 in areas of inflammation, similar to the mouse model. Our results indicate that Gal-3 plays a role in the pathogenesis of experimental chronic Chagas disease, favoring inflammation and fibrogenesis. Moreover, by demonstrating Gal-3 expression in human hearts, our finding reinforces that this protein could be a novel target for drug development for Chagas cardiomyopathy.
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Affiliation(s)
- Bruno Solano de Freitas Souza
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | | | | | | | - Bruno Diaz Paredes
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | | | - Carine Machado Azevedo
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Juliana Fraga Vasconcelos
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Cassio Santana Meira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Paulo Chenaud Neto
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Simone Garcia Macambira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil; Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Kátia Nunes da Silva
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Kyan James Allahdadi
- Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | | | | | - Milena Botelho Pereira Soares
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil; Center for Biotechnology and Cell Therapy, São Rafael Hospital, Salvador, Brazil.
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Mendes A, Nogueira C, Cronenberger E, Alves M, Neto F, Torres A, Tavora F, Oliveira AC. P1.02-044 EGFR Status in a Previously Untested Population from Northeastern Brazil. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Burke A, Tavora F. The 2015 WHO Classification of Tumors of the Heart and Pericardium. J Thorac Oncol 2015; 11:441-52. [PMID: 26725181 DOI: 10.1016/j.jtho.2015.11.009] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [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: 04/12/2015] [Revised: 11/10/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
This article reviews the nomenclature of benign and malignant neoplasm of the heart and pericardium in the 4th edition of the World Health Organization's Classification, with emphasis on differences since the 3rd edition of 2004. The tumours are divided into benign, malignant, and intermediate tumors of uncertain behavior, with separate sections on germ cell tumours and tumors of the pericardium. There are important updates in the sarcoma classification, with emphasis on the most common site, the left atrium. The importance of the new genetic finding in cardiac myxomas, namely somatic mutations in the PRKAR1A gene underscores the importance of this alteration in the pathogenesis of these tumors. Challenges on the classification of each entity are discussed.
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Affiliation(s)
- Allen Burke
- University of Maryland Medical Center, University of Maryland, Baltimore, Maryland.
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
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Zhang M, Cresswell N, Tavora F, Mont E, Zhao Z, Burke A. In-stent restenosis is associated with neointimal angiogenesis and macrophage infiltrates. Pathol Res Pract 2014; 210:1026-30. [DOI: 10.1016/j.prp.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 08/26/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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Torres AF, Braga DN, Muniz F, Mendonça C, Oliveira DN, de Souza ET, Burke A, Tavora F. Lymphocytic myocarditis at autopsy in patients with dengue fever. Braz J Infect Dis 2013; 17:619-21. [PMID: 24055392 PMCID: PMC9425131 DOI: 10.1016/j.bjid.2013.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 11/29/2022] Open
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Tavora F, Zhang M, Cresswell N, Li L, Fowler D, Franco M, Burke A. Quantitative Immunohistochemistry of Desmosomal Proteins (Plakoglobin, Desmoplakin and Plakophilin), Connexin-43, and N-cadherin in Arrhythmogenic Cardiomyopathy: An Autopsy Study. Open Cardiovasc Med J 2013; 7:28-35. [PMID: 23802019 PMCID: PMC3680985 DOI: 10.2174/1874192401307010028] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/23/2013] [Accepted: 02/24/2013] [Indexed: 12/19/2022] Open
Abstract
Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder related to mutations in desmosomal proteins. The current study tests the hypothesis that immunohistochemical staining for desmosomal proteins is of diagnostic utility by studying autopsy-confirmed cases of ARVC. Methods and Results: We studied 23 hearts from patients dying suddenly with ARVC. Control subject tissues were 21 hearts from people dying from non-cardiac causes (n=15), dilated cardiomyopathy (n=3) and coronary artery disease (n=3). Areas free of fibrofatty change or scarring were assessed on 50 sections from ARVC (24 left ventricle, 26 right ventricle) and 28 sections from controls. Immunohistochemical stains against plakoglobin, plakophilin, desmoplakin, connexin-43, and N-cadherin were applied and area expression analyzed by computerized morphometry. Desmin was stained as a control for fixation and similarly analyzed. The mean area of desmin expression was similar in controls and ARVC (86% vs. 85%, p=0.6). Plakoglobin expression was 4.9% ± 0.3% in controls, vs. 4.6% ± 0.3% in ARVC (p=0.3). Plakophilin staining was 4.8% ± 0.3% in controls vs. 4.4% ± 03% in ARVC (p=0.3). Desmoplakin staining was 3.4% in controls vs. 3.2 ± 0.2% in ARVC (p=0.6). There were no significant differences when staining was compared between right and left ventricles (all p > 0.1). For non-desmosomal proteins, the mean area of connexin-43 staining showed no significant difference by presence of disease. Conclusions: The small and insignificant decrease in junction protein expression in ARVC suggests that immunohistochemistry is not a useful tool for the diagnosis.
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Affiliation(s)
- Fabio Tavora
- Escola Paulista de Medicina/UNIFESP, Sao Paulo, Brazil
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31
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Jeudy J, Kirsch J, Tavora F, Burke AP, Franks TJ, Mohammed TL, Frazier AA, Galvin JR. From the radiologic pathology archives: cardiac lymphoma: radiologic-pathologic correlation. Radiographics 2013; 32:1369-80. [PMID: 22977025 DOI: 10.1148/rg.325115126] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lymphoma of the heart and pericardium is usually present as one aspect of disseminated disease and rarely occurs as a primary malignancy. It accounts for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. Cardiac lymphomas are most commonly diffuse large cell lymphomas and frequently manifest as an ill-defined, infiltrative mass. Atrial location is typical; the right atrium is most often affected. Pericardial thickening or effusion is often a common early feature of disease. Infiltration of atrial or ventricular walls with extension along epicardial surfaces is also a notable feature. At computed tomography, the attenuation of cardiac lymphoma may be similar to or lower than that of normal myocardium. At magnetic resonance imaging, it has variable signal intensity and contrast enhancement. Clinical manifestations may include pericardial effusion, cardiac arrhythmias, and a variety of nonspecific electrocardiographic abnormalities, notably first- to third-degree atrioventricular block. Treatment most commonly includes anthracycline-based chemotherapy and anti-CD20 treatment. Chemotherapy has been used alone or combined with radiation therapy. Palliative surgery has been performed, mainly for tumor debulking. The prognosis for patients with either primary or secondary lymphomatous heart involvement is usually poor; late diagnosis is one of the major factors affecting outcome.
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Affiliation(s)
- Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Alexiev BA, Tavora F. Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems. Virchows Arch 2013; 462:193-201. [PMID: 23307189 DOI: 10.1007/s00428-012-1363-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/29/2012] [Accepted: 12/20/2012] [Indexed: 12/25/2022]
Abstract
Clear cell adenocarcinoma (CCAC) of the urethra is a rare neoplasm, morphologically identical to its homologue arising in the female genital tract. The histogenesis of this neoplasm is uncertain. We present clinical, histopathologic, and immunohistochemical findings of four CCAC of the urethra and discuss the histogenesis and difficulties in diagnosis and differential diagnosis. CCAC of the urethra occurred in females (4/4). Two neoplasms were identified in urethral diverticulum; one of the two cases, in close proximity to a nephrogenic adenoma. CCAC exhibited tubulocystic, papillary, and diffuse/solid growth patterns. The neoplastic cells were cuboidal or columnar with eosinophilic or clear cytoplasm, and nuclear pleomorphism of at least moderate degree. Hobnail features and tumor necrosis were also observed. CCAC expressed p53 (4/4), AMACR (3/4), vimentin (3/4), PAX8 (2/4), CK7 (2/4), cytokeratin 34betaE12 (2/4), RCC (1/4), and CK20 (1/4) and were negative for PSA, WT1, ER, CA 125, uroplakin III, p16, and p63. The immunohistochemical profile supports a possible renal tubular cell differentiation/mesonephric origin for some urethral CCAC. Nephrogenic adenoma and metastatic clear cell carcinoma are the most important differential diagnostic considerations. Multicenter studies on more cases may improve our understanding of this malignancy.
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Affiliation(s)
- Borislav A Alexiev
- Department of Pathology, NBW85, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD 21201, USA.
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Zhang M, Tavora F, Zhang Y, Ripple M, Fowler D, Li L, Zhao Z, Burke A. The role of focal myocardial inflammation in sudden unexpected cardiac and noncardiac deaths—A clinicopathological study. Int J Legal Med 2011; 127:131-8. [DOI: 10.1007/s00414-011-0634-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/07/2011] [Indexed: 11/29/2022]
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34
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Lima MVA, Nogueira C, Oliveira JAA, Muniz Neto FJ, Franco M, Tavora F. Prostatic carcinomas with neuroendocrine differentiation diagnosed in needle biopsies, a morphologic study of 7 cases among 465 sequential biopsies in a tertiary cancer center. Int Braz J Urol 2011; 37:598-604. [PMID: 22099271 DOI: 10.1590/s1677-55382011000500005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Neuroendocrine carcinomas (NEC) of the prostate are rare, with only a few series hitherto reported. The objective of this study was to assess in a single institution the clinical and morphologic characteristics of neuroendocrine carcinomas diagnosed in needle core biopsies. MATERIALS AND METHODS The current study analyses seven cases diagnosed in needle biopsies at a large tertiary regional cancer center from Northeastern Brazil. Two pathologists reviewed specimens retrospectively, and demographic and morphologic characteristics were compared to 458 acinar tumors diagnosed in the same period. RESULTS There were five small cell carcinomas and two low-grade neuroendocrine carcinomas (carcinoid). NEC were associated with an acinar component in 5/7 cases and the Gleason score of the acinar component was always > 6. The number of cores involved in prostates with NEC was greater (65% compared to 24% of acinar tumors, p < 0.05). The mean PSA at diagnosis was 417.7 (range 5.7-1593, SD 218.3), compared to 100.5 (p = 0.1) of acinar tumors (range 0.3-8545, SD 22.7). Prostates harboring NEC were bigger (p < 0.001, mean volume 240 mL vs. 53 mL of acinar tumors). Treatment of NEC included palliative surgery, chemotherapy, and hormonal therapy. CONCLUSIONS NEC of the prostate is rare and often associated with a high-grade acinar component. Prostates with NEC tend to be larger and involve a greater number of cores than acinar tumors. PSA at diagnosis does not seem to predict the presence of NE tumors in needle biopsy.
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Affiliation(s)
- M V A Lima
- Hospital do Cancer, Instituto do Cancer do Ceara, Fortaleza, Ceara, Brazil.
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Zhang M, Tavora F, Oliveira JB, Li L, Franco M, Fowler D, Zhao Z, Burke A. PKP2 mutations in sudden death from arrhythmogenic right ventricular cardiomyopathy (ARVC) and sudden unexpected death with negative autopsy (SUDNA). Circ J 2011; 76:189-94. [PMID: 22019812 DOI: 10.1253/circj.cj-11-0747] [Citation(s) in RCA: 31] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Plakophilin2 (PKP2) is a desmosome-related protein with numerous armadillo repeats and has been linked to arrhythmogenic right ventricular cardiomyopathy (ARVC). Fatal arrhythmias resulting in sudden death also occur in the absence of morphologic cardiac abnormalities at autopsy, and have been linked to ion channel mutations in a subset of cases, but so far not to PKP2. METHODS AND RESULTS We sequenced all 14 exons of PKP2 in DNA extracted from postmortem heart tissues of 25 patients dying from ARVC and 25 from sudden unexpected death with negative autopsy (SUDNA). The primers were designed using the Primer Express 3.0 software. Direct sequencing for both sense and antisense strands was performed with a BigDye Terminator DNA sequencing kit on a 3130XL Genetic Analyzer. Mutation damage prediction was made using Mutation Taster, Polyphen and SIFT software. In 6 of the 25 ARVC samples, 6 PKP2 mutations were identified, 4 of which were likely significant, and 3 of which were novel (p.N641del, p.L64PfsX22, p.G269R). In 6 of the 25 cases of SUDNA samples, 6 PKP2 mutations were identified, 3 of which were likely significant, and 4 of which were not previously described (p.P665S, p.Y217TfsX45, p.E540, p.S615T). CONCLUSIONS PKP2 mutations are not specific for ARVC and may result in SUDNA. The link between ARVC and desmosomal mutations may not be causal but related to an association between defective desmosomal proteins and arrhythmias.
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Affiliation(s)
- Mingchang Zhang
- Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, China
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Tavora F, Zhang M, Franco M, Oliveira JB, Li L, Fowler D, Zhao Z, Cresswell N, Burke A. Distribution of biventricular disease in arrhythmogenic cardiomyopathy: an autopsy study. Hum Pathol 2011; 43:592-6. [PMID: 21937076 DOI: 10.1016/j.humpath.2011.06.014] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/22/2022]
Abstract
Arrhythmogenic cardiomyopathy is a rare cardiomyopathy characterized by fibrofatty replacement primarily of the right ventricular myocardium. It is a major cause of sudden death in the young and in athletes. There are few autopsy studies of the ventricular distribution of the disease. Fifty cases of sudden cardiac death with fibrofatty replacement in either ventricle from a single medical examiner's office were studied. Distribution of disease as determined grossly and microscopically was correlated with activity at time of death, race, and presence of inflammation. Extent of disease was right ventricular in 6 cases (12%; age, 25 ± 5 years), biventricular in 25 (50%; age, 36 ± 3 years), and left ventricular in 19 (38%; age, 37 ± 3 years) (P = .13). Inflammation was present in 44% of biventricular arrhythmogenic cardiomyopathy versus 74% of left ventricular arrhythmogenic cardiomyopathy and 83% of right ventricular arrhythmogenic cardiomyopathy (P = .06). Arrhythmogenic cardiomyopathy, when presenting with sudden death, is usually biventricular. There is a trend that univentricular involvement occurs at an earlier age and that right ventricular involvement shows more inflammation, suggesting different stages of disease.
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Affiliation(s)
- Fabio Tavora
- Department of Pathology, Escola Paulista de Medicina, UNIFESP, Sao Paulo 04023-900, Brazil
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Burke A, Zhang R, Tavora F, Li L, Fowler D, Oliveira JB. NOVEL PKP2 MUTATIONS IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY AND SUDDEN ARRHYTHMIC DEATHS IN MORPHOLOGICALLY NORMAL HEARTS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60227-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tavora F, Munivenkatappa R, Papadimitriou J, Drachenberg C, Sailey C, Mehra M, Burke A. Endothelitis in cardiac allograft biopsy specimens: Possible relationship to antibody-mediated rejection. J Heart Lung Transplant 2011; 30:435-44. [DOI: 10.1016/j.healun.2010.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 09/08/2010] [Accepted: 10/17/2010] [Indexed: 11/29/2022] Open
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Tavora F, Burke A, Oliveira JB. Re: Inherited cardiomyopathies mimicking arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2010; 20:387-8. [PMID: 21185745 DOI: 10.1016/j.carpath.2010.11.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 11/05/2010] [Indexed: 11/27/2022] Open
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Tavora F, Cresswell N, Li L, Fowler D, Burke A. [Frequency of acute plaque ruptures and thin cap atheromas at sites of maximal stenosis]. Arq Bras Cardiol 2010; 94:143-9, 153-9, 145-51. [PMID: 20428607 DOI: 10.1590/s0066-782x2010000200003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/20/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There have been few autopsy studies relating sites of thin cap atheroma (TCFA) to sites of acute plaque rupture in culprit arteries, and sites of maximal narrowing in non-culprit arteries. OBJECTIVE We aimed to quantify and locate the frequency of TCFA related to the sites of maximal stenosis in atherosclerotic plaques. METHODS We studied 88 hearts in victims of sudden death dying with coronary thrombus overlying acute plaque rupture. Thin cap atheromas were defined as fibrous cap < 65 microns overlying a necrotic core. Percent luminal narrowing was determined at the sites of plaque rupture and thin cap atheromas. RESULTS There were 81 men and 7 women, mean age 50 years +/- 9 SD. The plaque rupture was the site of maximal luminal narrowing in 47% of culprit arteries. TCFAs were present in 67 hearts (83%). Of these, 49 (73%) demonstrated TCFAs in the culprit artery; 17 (25%) in the culprit artery only, 32 (48%) in the culprit artery and in a non-culprit artery, and 18 (27%) only in a non-culprit artery. In non-culprit arteries, TCFAs represented the maximal site of stenosis in 44% of arteries. The acute rupture site is the site of maximal luminal narrowing in the involved vessel in 47% of hearts from patients dying with acute plaque rupture. CONCLUSION These data may suggest that luminal narrowing is not a reliable marker for TCFA.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, University of Maryland, USA.
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Abstract
Coronary disease is an uncommon cause of severe morbidity and death in the young. The great majority of lesions are congenital, and anomalous origins and courses of the coronary arteries are the most common groups of diseases in the age group. Intimal proliferation and coronary arteritis are even less common causes of death in this age population. For this review, we retrospectively studied cases of coronary cardiac death in children and adolescents, from 2004 to 2007, from a statewide medical examiner's office. There were 197 natural deaths in children ages ≤16 years and 58 deaths from sudden infant death syndrome. Of these, the largest group of deaths showed no morphologic abnormalities and was attributed to arrhythmias. The next largest group of deaths comprised complex congenital heart disease (n=13; 20%), followed by myocarditis (n=11; 17%), coronary disease (n=9; 14%), cardiomyopathy (n=8; 12%), valve disease (n=4; 6%), and cardiac fibroma (n=1). Nine coronary deaths occurred in seven boys and two girls, ranging from 14 days to 16 years of age (mean, 8 years). An anomalous course of the coronaries was seen in seven of the nine coronary deaths, and the other two casualties were examples of intimal proliferations involving the coronaries. The rare examples of coronary lesions in the young are discussed in this article.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, Washington, DC, USA
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Cresswell NB, Tavora F, Chu WS, Mont E, Franco M, Burke A. IMMUNOHISTOCHEMICAL EXPRESSION OF N-CADHERIN IS DECREASED IN AUTOPSY TISSUES WITH ARVC. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60335-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tavora F, Cresswell N, Li L, Ripple M, Burke A. Immunolocalisation of fibrin in coronary atherosclerosis: implications for necrotic core development. Pathology 2010; 42:15-22. [PMID: 20025475 DOI: 10.3109/00313020903434348] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intraplaque haemorrhage has been shown to be important in necrotic core enlargement. Immunolocalisation of fibrin within progressive stages of plaque progression has not been extensively studied. METHODS Histological sections (n = 74) of human coronary arteries were stained immunohistochemically for fibrin II, red blood cell antigen (glycophorin A), and CD31. Plaques were chosen to represent a range of lesions [6 adaptive intimal thickening, AIT (AHA grade I); 4 intimal xanthomas (AHA grade II), 19 pathologic intimal thickening, PIT (AHA grade III, or pre-atheroma); 34 fibroatheromas, FA (AHA grade IV and V); and 11 thin cap fibroatheromas (TCFA, AHA grade IV)]. RESULTS Fibrin was generally absent in the intima of AIT and PIT, with moderate staining in cores of early FA (2.6 +/- 0.3). All late FA and TCFA demonstrated intracore fibrin, with mean scores of 2.9 +/- 0.3 and 3.0 +/- 0.3, respectively. Intimal vasa vasorum counts increased with intimal fibrin score (p < 0.0001); in 68% of cores with fibrin staining, there was minimal or no evidence of red cell breakdown. CONCLUSIONS Fibrin in necrotic cores is present proportional to intraplaque vasa vasorum and before red cells, suggesting leakage of vessels before frank intraplaque haemorrhage. Fibrin may play a role in the bridge between pre-atheroma and atheroma.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, Washington, DC, USA
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Tavora F, Cresswell N, Li L, Ripple M, Fowler D, Burke A. Morphologic features of exertional versus nonexertional sudden death in patients with hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:532-7. [PMID: 20152250 DOI: 10.1016/j.amjcard.2009.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/11/2009] [Accepted: 10/11/2009] [Indexed: 11/30/2022]
Abstract
Pathologic features that characterize hypertrophic cardiomyopathy (HC) in exertional versus nonexertional sudden deaths have not been extensively studied. We performed gross measurements and histologic analysis on 103 autopsy cases of HC and correlated these with clinical findings. Pathologic features of the 71 sudden deaths were compared between exertional and nonexertional deaths. Age at death was significantly younger in exertional (27 +/- 13 years) versus nonexertional sudden deaths (40 +/- 16 years, p = 0.0003). Exertional deaths were more likely in women (35 of 37) versus sudden deaths at rest (21 of 34, p = 0.0002). There was no significant difference in the incidence of syncope in the exertional sudden deaths (14%) compared to the nonexertional sudden deaths (9%, p = 0.5) or in the rate of a previous diagnosis of HC (21% vs 21%, respectively). Mean heart weight was significantly decreased in exertional sudden deaths versus nonexertional sudden deaths. There was no difference in the frequency of left ventricular outflow tract plaque (54% exertional vs 46% nonexertional, p = 0.06). By multivariate analysis, including all categories of HC, only decreased heart weight (p = 0.02) and male gender (p = 0.002) were significantly associated with exertional sudden death. In conclusion, there are no pathologic features that would identify patients with HC at risk for exertional death. Because relatively decreased heart weight is strongly associated with exertional death, and because a large proportion of exertional deaths with HC are not associated with significant asymmetry, cardiologists should be careful in excluding the diagnosis of HC in athletes with even mild degrees of cardiomegaly, especially young men.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, Washington, DC, USA
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Tavora F, Cresswell N, Li L, Ripple M, Fowler D, Burke A. Sudden coronary death caused by pathologic intimal thickening without atheromatous plaque formation. Cardiovasc Pathol 2009; 20:51-7. [PMID: 19913444 DOI: 10.1016/j.carpath.2009.08.004] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/11/2009] [Accepted: 08/20/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Atherosclerotic plaques progress from early lesions with little free cholesterol and lipid to late fibroatheromas with necrotic cores that may rupture. The frequency of severe coronary atherosclerosis without core formation in any artery in sudden coronary death is not known. METHODS We studied 314 hearts from 253 men and 61 women who died suddenly from severe coronary stenosis (≥ 1 epicardial artery with ≥ 75% luminal area narrowing) and with no other cause of death. If no section demonstrated any necrotic core, the designation was nonatheromatous atherosclerosis; if there was ≥ 1 necrotic core, the designation was atheromatous atherosclerosis. Plaques were scored for the presence of calcification, intimal inflammation, and neovasculature on a 5-point scale. Plaque burden was estimated semiquantitatively. RESULTS In 22 men (9%) and 14 women (23%), there were no necrotic cores in any plaque (nonatheromatous atherosclerosis). Fourteen of these 36 nonatheromatous atherosclerosis cases had focal acute thrombus due to erosion (39%). Of the remaining 278 cases (atheromatous atherosclerosis), acute erosions were present in 25 (9%; P<.0001). Sudden death due to nonatheromatous atherosclerosis occurred more frequently in women (P<.001), in Blacks (20%; P=.003), and at a younger age (44± 12 years) than atheromatous atherosclerosis (52 ± 12 years; P=.0003). On multivariate analysis, nonatheromatous atherosclerosis was associated with younger age (P=.001), female gender (P=.004), and Black race (P=.006). CONCLUSIONS Nonatheromatous atherosclerosis constitutes slightly >10% of sudden coronary deaths and is more frequent in young Black women. Nonatheromatous atherosclerosis is a relatively infrequent pathway for coronary plaque progression, leading to severe disease and sudden death that may involve plaque erosion.
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Affiliation(s)
- Fabio Tavora
- Armed Forces Institute of Pathology, Washington, DC, USA
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Tavora F, Li L, Ripple M, Fowler D, Burke A. Morphologic characteristic of coronary artery disease, with emphasis on thromboses, in patients younger than 40 years of age. Patholog Res Int 2009; 2010:628247. [PMID: 21151510 PMCID: PMC2989747 DOI: 10.4061/2010/628247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 08/18/2009] [Indexed: 11/30/2022]
Abstract
There are few pathologic descriptions of fatal coronary artery disease in the young. The morphologic characteristics of sudden coronary deaths in 47 hearts from patients younger than 40 years were studied. Numbers of plaques with necrotic cores were quantitated in each heart. Compared to 194 sudden coronary deaths >40 years, heart weight was lower, acute plaque erosions more frequent, and extent of disease less in the ≤40 years group. Plaque burden was less in hearts with erosions, and healed infarcts more common in hearts with stable plaque. The numbers of fibroatheromas increased with age until the 6th decade (P < .0001) as well as the proportion of total plaques that were atheromatous. Plaques in younger patients have fewer lipid-rich cores. Most thrombi show areas of organization, with layering frequent in erosions, suggesting a possible method of plaque enlargement in the absence of necrotic core formation.
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Affiliation(s)
- Fabio Tavora
- Deparment of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Building 54, Washington, DC 20306, USA
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Wang W, Tavora F, Sharma R, Eisenberger M, Netto GJ. PSMA expression in Schwannoma: A potential clinical mimicker of metastatic prostate carcinoma. Urol Oncol 2009; 27:525-8. [DOI: 10.1016/j.urolonc.2008.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/01/2008] [Accepted: 04/02/2008] [Indexed: 11/26/2022]
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Tavora F, Cresswell N, Li L, Ripple M, Solomon C, Burke A. Comparison of necropsy findings in patients with sarcoidosis dying suddenly from cardiac sarcoidosis versus dying suddenly from other causes. Am J Cardiol 2009; 104:571-7. [PMID: 19660614 DOI: 10.1016/j.amjcard.2009.03.068] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/29/2009] [Accepted: 03/29/2009] [Indexed: 11/26/2022]
Abstract
The clinical diagnosis of cardiac sarcoidosis can be difficult and is largely dependent on newer imaging modalities. A retrospective search of sudden cardiac deaths was performed from a reference laboratory and statewide medical examiner system for a 12-year period. Planimetry was performed on gross photographs of transverse short-axis sections, and the phase of the lesion and the portion of myocardium extent was estimated histologically. Lesions were classified histologically as early (primarily lymphocytic), intermediate (primarily granulomatous), and late (primarily scar). A total of 41 cases were found, including 25 in which the death was ascribed to sarcoidosis of the heart (group 1) and 16 in which sudden death was due to other findings (group 2). No significant differences were found in age or activity at death, although gross scars and epicardial nodules were more frequent in group 1 (p <0.0001). In the hearts with gross scars, the ventricular septum had the largest percentage of involvement (32%) followed by the posterior wall (25%). Histologically, the intermediate phase predominated in group 1, and the late phase predominated in group 2. Approximately 50% of the cases in group 1 had involvement in the right ventricular apex and septum, suggesting a positive yield by biopsy. In conclusion, cardiac sarcoidosis causing sudden death is characterized by extensive active granulomas with a predilection for the subepicardium and ventricular septum.
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