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Katsushima K, Joshi K, Yuan M, Romero B, Batish M, Stapleton S, Jallo G, Kolanthai E, Seal S, Saulnier O, Taylor MD, Wechsler-Reya RJ, Eberhart CG, Perera RJ. A therapeutically targetable positive feedback loop between lnc-HLX-2-7, HLX, and MYC that promotes group 3 medulloblastoma. Cell Rep 2024; 43:113938. [PMID: 38460130 DOI: 10.1016/j.celrep.2024.113938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/01/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024] Open
Abstract
Recent studies suggest that long non-coding RNAs (lncRNAs) contribute to medulloblastoma (MB) formation and progression. We have identified an lncRNA, lnc-HLX-2-7, as a potential therapeutic target in group 3 (G3) MBs. lnc-HLX-2-7 RNA specifically accumulates in the promoter region of HLX, a sense-overlapping gene of lnc-HLX-2-7, which activates HLX expression by recruiting multiple factors, including enhancer elements. RNA sequencing and chromatin immunoprecipitation reveal that HLX binds to and activates the promoters of several oncogenes, including TBX2, LIN9, HOXM1, and MYC. Intravenous treatment with cerium-oxide-nanoparticle-coated antisense oligonucleotides targeting lnc-HLX-2-7 (CNP-lnc-HLX-2-7) inhibits tumor growth by 40%-50% in an intracranial MB xenograft mouse model. Combining CNP-lnc-HLX-2-7 with standard-of-care cisplatin further inhibits tumor growth and significantly prolongs mouse survival compared with CNP-lnc-HLX-2-7 monotherapy. Thus, the lnc-HLX-2-7-HLX-MYC axis is important for regulating G3 MB progression, providing a strong rationale for using lnc-HLX-2-7 as a therapeutic target for G3 MBs.
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Affiliation(s)
- Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA; Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Kandarp Joshi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA; Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA; Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Brigette Romero
- Department of Medical and Molecular Sciences, University of Delaware, 15 Innovation Way, Newark, DE 19701, USA
| | - Mona Batish
- Department of Medical and Molecular Sciences, University of Delaware, 15 Innovation Way, Newark, DE 19701, USA
| | - Stacie Stapleton
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - George Jallo
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Elayaraja Kolanthai
- Advanced Materials Processing and Analysis Center, Nanoscience and Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Sudipta Seal
- Advanced Materials Processing and Analysis Center, Nanoscience and Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Olivier Saulnier
- Genomics and Development of Childhood Cancers, Institut Curie, PSL University, 75005 Paris, France; INSERM U830, Cancer Heterogeneity Instability and Plasticity, Institut Curie, PSL University, 75005 Paris, France; SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, 75005 Paris, France
| | - Michael D Taylor
- Texas Children's Cancer Center, Hematology-Oncology Section, Houston, TX 77004, USA; Department of Pediatrics - Hematology/Oncology and Neurosurgery, Baylor College of Medicine, Houston, TX 77004, USA
| | - Robert J Wechsler-Reya
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg. 558, Baltimore, MD 21205, USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA; Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA.
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2
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Yuan M, Mahmud I, Katsushima K, Joshi K, Saulnier O, Pokhrel R, Lee B, Liyanage W, Kunhiraman H, Stapleton S, Gonzalez-Gomez I, Kannan RM, Eisemann T, Kolanthai E, Seal S, Garrett TJ, Abbasi S, Bockley K, Hanes J, Chapagain P, Jallo G, Wechsler-Reya RJ, Taylor MD, Eberhart CG, Ray A, Perera RJ. miRNA-211 maintains metabolic homeostasis in medulloblastoma through its target gene long-chain acyl-CoA synthetase 4. Acta Neuropathol Commun 2023; 11:203. [PMID: 38115140 PMCID: PMC10729563 DOI: 10.1186/s40478-023-01684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
The prognosis of childhood medulloblastoma (MB) is often poor, and it usually requires aggressive therapy that adversely affects quality of life. microRNA-211 (miR-211) was previously identified as an important regulator of cells that descend from neural cells. Since medulloblastomas primarily affect cells with similar ontogeny, we investigated the role and mechanism of miR-211 in MB. Here we showed that miR-211 expression was highly downregulated in cell lines, PDXs, and clinical samples of different MB subgroups (SHH, Group 3, and Group 4) compared to normal cerebellum. miR-211 gene was ectopically expressed in transgenic cells from MB subgroups, and they were subjected to molecular and phenotypic investigations. Monoclonal cells stably expressing miR-211 were injected into the mouse cerebellum. miR-211 forced expression acts as a tumor suppressor in MB both in vitro and in vivo, attenuating growth, promoting apoptosis, and inhibiting invasion. In support of emerging regulatory roles of metabolism in various forms of cancer, we identified the acyl-CoA synthetase long-chain family member (ACSL4) as a direct miR-211 target. Furthermore, lipid nanoparticle-coated, dendrimer-coated, and cerium oxide-coated miR-211 nanoparticles were applied to deliver synthetic miR-211 into MB cell lines and cellular responses were assayed. Synthesizing nanoparticle-miR-211 conjugates can suppress MB cell viability and invasion in vitro. Our findings reveal miR-211 as a tumor suppressor and a potential therapeutic agent in MB. This proof-of-concept paves the way for further pre-clinical and clinical development.
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Affiliation(s)
- Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Iqbal Mahmud
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Kandarp Joshi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Olivier Saulnier
- The Arthur and Sonia Labatt Brain Tumour Research Centre and the Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Wathsala Liyanage
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Haritha Kunhiraman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Stacie Stapleton
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Ignacio Gonzalez-Gomez
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Tanja Eisemann
- National Cancer Institute-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
| | - Elayaraja Kolanthai
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL, 32826, USA
| | - Sudipta Seal
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL, 32826, USA
| | - Timothy J Garrett
- Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Saed Abbasi
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Kimberly Bockley
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Justin Hanes
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Prem Chapagain
- Department of Physics, Florida International University, Miami, FL, 33199, USA
| | - George Jallo
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Robert J Wechsler-Reya
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre and the Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
- Texas Children's Cancer Center, Hematology-Oncology Section, Houston, TX, 77030, USA
- Department of Pediatrics-Hematology/Oncology and Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Animesh Ray
- Riggs School of Applied Life Sciences, Keck Graduate Institute, Claremont, CA, 91711, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA.
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Huisman TAGM, Patel R, Kralik S, Desai NK, Meoded A, Chen K, Weiner HL, Curry DJ, Lequin M, Kranendonk M, Orman G, Jallo G. Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors. Pediatr Neurosurg 2023; 58:240-258. [PMID: 37604135 DOI: 10.1159/000531998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Neuroimaging has evolved from anatomical imaging toward a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion-weighted imaging, permeability imaging, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI), tractography, metabolic imaging, connectomics, event-related functional imaging, resting state functional imaging, and much more is now being offered. SUMMARY Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed, taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR-guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. KEY MESSAGES In the current manuscript, we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility-weighted imaging, and 1H magnetic resonance spectroscopy, various perfusion weighted imaging approaches including arterial spin labeling, dynamic contrast enhanced imaging, and dynamic susceptibility contrast imaging. Pre-, intra, and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image-guided laser ablation and MR-guided high-intensity-focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.
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Affiliation(s)
- Thierry A G M Huisman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Rajan Patel
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Kralik
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Desai
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Avner Meoded
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Karen Chen
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maarten Lequin
- Department of Radiology, Wilhelmina Children's Hospital and Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariette Kranendonk
- Department of Pathobiology, Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gunes Orman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA,
| | - George Jallo
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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Hersh AM, Lubelski D, Theodore N, Sciubba DM, Jallo G, Shimony N. Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population. Pediatr Neurosurg 2023; 58:367-378. [PMID: 36948181 DOI: 10.1159/000530286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Incidental intradural tumors of the spine in the pediatric population are rare lesions whose management remains unclear. Surgeons must balance the risks of iatrogenic deficits and complications after surgical resection against the risks from progressive growth of the tumor. Moreover, the natural history of an incidental finding can be difficult to predict. Here, we review the literature on incidental intradural tumors of the spine and present considerations for their management. SUMMARY Growth of the tumor or changes in radiographic features are usually indications for resection. Asymptomatic lesions can be found in patients with genetic syndromes that predispose to tumor formation, such as neurofibromatosis type 1 and 2, schwannomatosis, and Von-Hippel-Lindau syndrome, and careful workup of a genetic cause is warranted in any patient presenting with multiple tumors and/or cutaneous features. Close follow-up is generally favored given the heavy tumor burden; however, some recommend pre-emptive resection to prevent permanent neurological deficits. Incidental intradural tumors can also occur in association with hydrocephalus, significant syringomyelia, and cord compression, and surgical treatment is usually warranted. Tumors may also be discovered as part of the workup for scoliosis, where they are not truly incidental to the scoliosis but rather are contributing to curve deformation. KEY MESSAGES Thorough workup of patients for associated genetic syndromes or comorbidities should be undertaken in pediatric patients with incidental intradural tumors. Further research is needed into the natural history of these incidental lesions. Incidental tumors can often be managed conservatively with close follow-up, with surgical intervention warranted for expanding tumors or new-onset symptoms.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Manhasset, New York, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes-Murphey clinic, Memphis, Tennessee, USA
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Conti A, Magnani M, Zoli M, Kockro RA, Tuleasca C, Peschillo S, Umana GE, Tew SW, Jallo G, Garg K, Spetzler RF, Lafuente J, Chaurasia B. Social Media for Global Neurosurgery. Benefits and limitations of a groundbreaking approach to communication and education. Brain Spine 2023; 3:101728. [PMID: 37383446 PMCID: PMC10293234 DOI: 10.1016/j.bas.2023.101728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction Social media have become ubiquitous and their role in medicine is quickly growing. They provide an open platform by which members share educational material, clinical experiences, and collaborate with educational equity. Research question To characterize the role of social media in neurosurgery, we analyzed metrics of the largest neurosurgical group (Neurosurgery Cocktail), collected relevant data about activities, impact and risks of this groundbreaking technology. Material and methods We extracted Facebook metrics from 60-day time sample, including users demographics and other platform-specific values such as active members and number of posts within 60 days. A quality assessment of the posted material (clinical case reports and second opinions) was obtained establishing four main quality-criteria: privacy violation; quality of imaging; clinical and follow up data. Results By December 2022, the group included 29.524 members (79.8% male), most (29%) between 35 and 44 years of age. Over 100 countries were represented. A total of 787 posts were published in 60 days with an average of 12.7 per day. In 173 clinical cases presented through the platform, some issue with privacy was recorded in 50.9%. The imaging was considered insufficient in 39.3%, clinical data in 53.8%; follow up data were missing in 60.7%. Discussion and conclusion The study provided a quantitative evaluation of impact, flaws and limitations of social medial for healthcare. Flaws were mostly data breach and insufficient quality of case reports. There are actions to correct these flaws that can be easily taken to provide a greater credibility and efficacy to the system.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Marcello Magnani
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Matteo Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Ralf A. Kockro
- Centre for Microneurosurgery, Hirslanden Hospital, Zurich, Switzerland
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
| | - Simone Peschillo
- Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Centre, Gamma Knife Centre, Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Seow Wan Tew
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - George Jallo
- Institute of Brain protection sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Kanwaljeet Garg
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jesus Lafuente
- Department of Neurosurgery, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Katsushima K, Pokhrel R, Mahmud I, Yuan M, Murad R, Baral P, Zhou R, Chapagain P, Garrett T, Stapleton S, Jallo G, Bettegowda C, Raabe E, Wechsler-Reya RJ, Eberhart CG, Perera RJ. The oncogenic circular RNA circ_63706 is a potential therapeutic target in sonic hedgehog-subtype childhood medulloblastomas. Acta Neuropathol Commun 2023; 11:38. [PMID: 36899402 PMCID: PMC10007801 DOI: 10.1186/s40478-023-01521-0] [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: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/12/2023] Open
Abstract
Medulloblastoma (MB) develops through various genetic, epigenetic, and non-coding (nc) RNA-related mechanisms, but the roles played by ncRNAs, particularly circular RNAs (circRNAs), remain poorly defined. CircRNAs are increasingly recognized as stable non-coding RNA therapeutic targets in many cancers, but little is known about their function in MBs. To determine medulloblastoma subgroup-specific circRNAs, publicly available RNA sequencing (RNA-seq) data from 175 MB patients were interrogated to identify circRNAs that differentiate between MB subgroups. circ_63706 was identified as sonic hedgehog (SHH) group-specific, with its expression confirmed by RNA-FISH analysis in clinical tissue samples. The oncogenic function of circ_63706 was characterized in vitro and in vivo. Further, circ_63706-depleted cells were subjected to RNA-seq and lipid profiling to identify its molecular function. Finally, we mapped the circ_63706 secondary structure using an advanced random forest classification model and modeled a 3D structure to identify its interacting miRNA partner molecules. Circ_63706 regulates independently of the host coding gene pericentrin (PCNT), and its expression is specific to the SHH subgroup. circ_63706-deleted cells implanted into mice produced smaller tumors, and mice lived longer than parental cell implants. At the molecular level, circ_63706-deleted cells elevated total ceramide and oxidized lipids and reduced total triglyceride. Our study implicates a novel oncogenic circular RNA in the SHH medulloblastoma subgroup and establishes its molecular function and potential as a future therapeutic target.
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Affiliation(s)
- Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Iqbal Mahmud
- Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, USA.,Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Rabi Murad
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, USA
| | - Prabin Baral
- Department of Physics, Florida International University, Miami, USA
| | - Rui Zhou
- Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Prem Chapagain
- Department of Physics, Florida International University, Miami, USA.,Biomolecular Sciences Institute, Florida International University, Miami, USA
| | - Timothy Garrett
- Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, USA
| | | | - George Jallo
- Johns Hopkins All Children's Hospital, St. Petersburg, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chetan Bettegowda
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Raabe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA. .,Johns Hopkins All Children's Hospital, St. Petersburg, USA. .,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA.
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7
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Sellers A, Gatti J, Shimony N, Sun LR, Jallo G, Felling RJ, Goldenberg N, Meoded A. Abstract TMP63: Structural Network Changes In Children With Moyamoya Disease Prior To Surgical Intervention. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp63] [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: 02/05/2023]
Abstract
Purpose:
Moyamoya disease/syndrome (MMD) is a progressive steno-occlusive disease involving the intracranial arterial circulation. Long term stenosis/hypoperfusion can lead to intellectual disability and cognitive impairment even in the absence of documented infarct. We aim investigate any underlying network abnormalities in MMD patients with no apparent ischemic injury.
Materials and Methods:
We retrospectively reviewed children with MMD with normal appearing parenchyma on conventional MRI. Control patients were selected from our existing database. Clinical, surgical and demographic data, including degree of stenosis as measured semi-quantitatively on MRA, were collected. Patients with documented infarcts, low quality DTI, and NF1 were excluded from the analysis. Group and correlational connectometry with degree of stenosis were performed.
Results:
A total of 28 patients were reviewed with 16 patients included in the study. Median (and interquartile range) age was 10.5 (8.5 - 13.5). Between group connectometry analysis identified infratentorial and supratentorial decreased connectivity in patients compared to controls, specifically in: middle cerebellar peduncle, corpus callosum, right parietopontine tract, superior cerebellar peduncle, left inferior fronto-occipital fasciculus. (Figure 1) In addition, we found negative correlation between the degree of stenosis and structural connectivity of multiple white matter pathways.
Conclusion:
Our findings reveal abnormal structural connectivity in children with MMD in the absence of infarcts on conventional MRI. Connectomics offers a unique opportunity to study the effect of long-term stenosis/hypoperfusion on cerebellar-cerebral networks and provide new insights into the mechanism of the structural plasticity/reorganization in these patients before bypass surgery. Future research is needed to determine longitudinal network changes before and after surgery.
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Affiliation(s)
| | | | | | - Lisa R Sun
- Johns Hopkins Sch of Medicine, Baltimore, MD
| | - George Jallo
- Johns Hopkins All Children's Hosp, St Petersburg, FL
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Pokhrel R, Katsushima K, Stapleton S, Jallo G, Raabe E, Eberhart C, Perera R. BIOM-50. THE IDENTIFICATION AND FUNCTIONAL CHARACTERIZATION OF CIRCULAR RNA CIRC_63706 IN SONIC HEDGEHOG MEDULLOBLASTOMAS. Neuro Oncol 2022. [PMCID: PMC9660901 DOI: 10.1093/neuonc/noac209.060] [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] Open
Abstract
Abstract
Medulloblastoma is a central nervous system tumor that develops through various genetic, epigenetic, and non-coding (nc) RNA-related mechanisms, but the roles played by ncRNAs, particularly circular RNAs (circRNAs), remain poorly defined. CircRNAs are increasingly recognized as stable noncoding RNA therapeutic targets in many cancers, but little is known about their function, subtype specificity, and therapeutic potential in medulloblastomas. To determine medulloblastoma subgroup-specific circRNAs, we subjected RNA-seq data from 175 clinical medulloblastoma samples in four subgroups (SSH, WNT, G3, and G4) to a statistical and machine learning (random forest) pipeline and identified a group of medulloblastoma specific circular RNAs. CircRNA, circ_63706 was identified as sonic hedgehog (SHH) group specific and confirmed its expression by RNA-FISH analysis in clinical tissue samples (tissue microarrays). To identify the molecular function of circ_63706, we depleted circ_63706 in DAOY and ONS76 cells and subjected them to global RNA sequencing and lipid profiling. Circ_63706 resides in the coding gene Pericentrin (PCNT), which is known to be involved in congenital disorders. When Circ_63706 gets depleted by shRNA, it shows a significant decrease in cell proliferation and invasion in SSH cells, and mice implanted with circ_63706-deleted cells showed reduced tumor growth and extended survival compared to parental cells implant. At the molecular level, we identified circ_63706-deleted cells elevated total ceramide and oxidized lipids and reduced total triglyceride (TG). Our study implicates an identification of a novel oncogenic circular RNA in the medulloblastoma subgroup SSH and establishes its potential as a future therapeutic target.
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Affiliation(s)
| | | | | | - George Jallo
- Johns Hopkins All Children's Hospital , St. Peterburg, FL , USA
| | - Eric Raabe
- Johns Hopkins University , Baltimore , USA
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9
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Katsushima K, Yuan M, Lee B, Stapleton S, Jallo G, Seal S, Eberhart C, Perera R. DDDR-31. THE THERAPEUTIC POTENTIAL OF THE LONG NON-CODING RNA LNC-HLX-2-7 IN GROUP 3 MEDULLOBLASTOMAS IN CHILDREN. Neuro Oncol 2022. [PMCID: PMC9660337 DOI: 10.1093/neuonc/noac209.396] [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] Open
Abstract
Abstract
Medulloblastoma (MB) is an aggressive brain tumor that predominantly affects children. Recent high-throughput sequencing studies suggest that the non-coding RNA genome, in particular long non-coding RNAs (lncRNAs), contributes to MB formation and tumor progression. Here we report the identification of a novel lncRNA, lnc-HLX-2-7, as a potential therapeutic target in group 3 MBs. In this study, we report that lnc-HLX-2-7 RNA specifically accumulates in the HLX (host gene of lnc-HLX-2-7) promoter region and activates HLX expression by recruiting multiple factors including enhancer elements. RNA sequencing and chromatin immunoprecipitation revealed that HLX directly binds to the promoters of several tumor-promoting genes, including MYC, and activates their expression. Furthermore, intravenous treatment with antisense oligonucleotides targeting lnc-HLX-2-7 coated with cerium-oxide nanoparticle (CNP-lnc-HLX-2-7) reduced tumor growth (40-50%) in intracranial MB xenograft mouse model (n = 10, p < 0.01, t-test). We found that the combinatorial therapy of CNP-lnc-HLX-2-7 and cisplatin further inhibits tumor growth and significantly prolongs mouse survival compared to CNP-lnc-HLX-2-7 monotherapy (n = 10, p < 0.01, t-test) only. We report here the importance of the lnc-HLX-2-7-HLX-MYC axis in regulating group 3 MB progression and provide a strong rationale for using lnc-HLX-2-7 as a specific and potent therapeutic target for the group 3 MBs in children.
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Affiliation(s)
| | | | | | | | - George Jallo
- Johns Hopkins All Children’s Hospital , St. Petersburg , USA
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10
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Yuan M, Katsushima K, Pokhrel R, Lee B, Stapleton S, Jallo G, Raabe E, Eberhart C, Perera R. EXTH-80. THE MOLECULAR FUNCTION AND THE THERAPEUTIC POTENTIAL OF MICRORNA-211 IN GROUP 3 MEDULLOBLASTOMAS IN CHILDREN. Neuro Oncol 2022. [PMCID: PMC9660672 DOI: 10.1093/neuonc/noac209.878] [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] Open
Abstract
Abstract
Medulloblastoma is a central nervous system tumor that primarily affects children and requires aggressive therapy. Patients often suffer from treatment-related side effects, and treatment-resistant recurrences are common, with high mortality rates. There are four major molecular MB subgroups (Wnt- and Shh-activated MBs G3 and G4 MBs). G3 MB is the most aggressive subtype, and the diagnosis and management remain challenging. Medulloblastomas develop through various genetic, epigenetic, and noncoding (nc) RNA-related mechanisms. However, the roles played by ncRNAs, (microRNAs, long noncoding RNAs, circular RNAs, etc.) in MB development remain poorly defined. Here we address this knowledge gap with an exemplar microRNA, microRNA 211 (miR-211) implicated in G3 MB development and progression. Our preliminary results support that miR-211 is an attractive therapeutic agent to treat this aggressive MB subtype. miR-211 is significantly downregulated in medulloblastoma cell lines compared to normal cerebellum, underscoring its important role as a therapeutic agent and a biomarker. miR-211 ectopic expression in G3 MB cells significantly reduced cell proliferation and 3D colony formation and induced apoptosis. In vivo, miR-211force-expression in G3 MB cells injected into mouse cerebellum produce smaller tumors than those derived from parental cells. We identified that Long-chain-fatty-acid—CoA ligase 4 (ACSL4), and the oncogene Ras-related protein Rab22A are miR-211 targets genes for G3 medulloblastomas. The preliminary results of this study are encouraging and will provide a pre-clinical foundation for further therapeutic testing.
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Affiliation(s)
| | | | | | | | | | - George Jallo
- Johns Hopkins All Children’s Hospital , St. Petersburg , USA
| | - Eric Raabe
- Johns Hopkins University , Baltimore , USA
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11
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Pokhrel R, Katsushima K, Stapleton S, Jallo G, Raabe E, Eberhart CG, Perera RJ. MEDB-02. The identification and functional characterization of circular RNA Circ_63706 in sonic hedgehog medulloblastomas. Neuro Oncol 2022. [PMCID: PMC9165035 DOI: 10.1093/neuonc/noac079.377] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Circular RNAs (circRNAs) are increasingly recognized as stable and specific biomarkers and therapeutic targets in many cancers, but little is known about their function, subtype specificity, and biomarker potential in medulloblastomas. Medulloblastoma is a central nervous system tumor that predominantly affects children and always requires aggressive therapy. Understanding and identifying novel disease-related molecular mechanisms and pathways are essential for developing optimal and novel therapies. To identify medulloblastoma subgroup-specific circRNAs, we subjected RNA-seq data from 175 clinical medulloblastoma samples representing the four subgroups to a statistical and machine learning (random forest classification) pipeline. Circular RNA circ_63706 expression was specific to the sonic hedgehog (SSH) group, which was confirmed through in situ hybridization analysis of clinical tissue samples. Functional characterization of circ_63706 by siRNAs and shRNAs demonstrated that cell proliferation, invasion, and apoptosis are perturbed in circ_63706 cells and inhibited in vivo tumor growth. These novel medulloblastoma-specific circular RNAs are emerging as important oncogenes that not only provide valuable mechanistic insights into how medulloblastomas develop but also how they can be used as biomarkers and therapeutic targets. These results pave the way for the specific identification and personalized treatment of different medulloblastoma subgroups.
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Affiliation(s)
- Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children's Hospital, St. Petersburg , FL , USA
| | - Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children's Hospital, St. Petersburg , FL , USA
| | - Stacie Stapleton
- Johns Hopkins All Children's Hospital, St. Petersburg , FL , USA
| | - George Jallo
- Johns Hopkins All Children's Hospital, St. Petersburg , FL , USA
| | - Eric Raabe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Department of Pathology, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Department of Pathology, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children's Hospital, St. Petersburg , FL , USA
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12
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Lee B, Mohamad I, Pokhrel R, Murad R, Yuan M, Stapleton S, Bettegowda C, Jallo G, Eberhart CG, Garrett T, Perera RJ. MEDB-03. Medulloblastoma cerebrospinal fluid reveals hypoxic indicators (metabolites and lipids) and cancer-specific RNAs. Neuro Oncol 2022. [PMCID: PMC9165113 DOI: 10.1093/neuonc/noac079.378] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in children. There remains an unmet need for diagnostics to sensitively detect the disease, particularly recurrences. Cerebrospinal fluid (CSF) provides a window into the central nervous system, and liquid biopsy of CSF could provide a relatively non-invasive means for disease diagnosis. There has yet to be an integrated analysis of the transcriptomic, metabolomic, and lipidomic changes occurring in the CSF of children with MB. CSF samples from patients with (n=40) or without (n=11; no cancer) MB were subjected to RNA-sequencing and high-resolution mass spectrometry to identify RNA, metabolite, and lipid profiles. Differentially expressed transcripts, metabolites, and lipids were identified and their biological significance assessed by pathway analysis. Multivariate analysis method DIABLO (R package mixOmics) was used to integrate the molecular changes characterizing the CSF of MB patients. Differentially expressed transcripts, metabolites, and lipids in CSF were discriminatory for the presence of MB but not the exact molecular subtype. One hundred ten genes and ten circular RNAs were differentially expressed in MB CSF compared to normal representing TGF-β signaling, TNF-a signaling via NF-kB, and adipogenesis pathways. Tricarboxylic acid cycle and other metabolites (malate, fumarate, succinate, α-ketoglutarate, hydroxypyruvate, N-acetyl-aspartate) and total triacylglycerols were significantly upregulated in MB CSF compared to normal CSF. Although the transcriptomic, metabolomic, and lipid signatures in CSF to differentiate MB subgroup separation was challenging, we were able to identify a group of omics signatures that could separate cancer from normal CSF. Metabolic and lipidomic profiles both contained indicators of tumor hypoxia. Our approach provides several candidate signatures that deserve further validation, including the novel circular RNA circ_463, and insights into the impact of MB on the CSF microenvironment.
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Affiliation(s)
- Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
| | - Iqbal Mohamad
- Department Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine , Gainesville, FL , USA
| | - Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
| | - Rabi Murad
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla , CA , USA
| | - Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
| | - Stacie Stapleton
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
| | - Chetan Bettegowda
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Timothy Garrett
- Department Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine , Gainesville, FL , USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University , Baltimore, MD , USA
- Johns Hopkins All Children’s Hospital, St. Petersburg , FL , USA
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13
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Lee B, Mahmud I, Pokhrel R, Murad R, Yuan M, Stapleton S, Bettegowda C, Jallo G, Eberhart CG, Garrett T, Perera RJ. Correction to: Medulloblastoma cerebrospinal fluid reveals metabolites and lipids indicative of hypoxia and cancer-specific RNAs. Acta Neuropathol Commun 2022; 10:58. [PMID: 35459192 PMCID: PMC9027522 DOI: 10.1186/s40478-022-01368-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Hersh AM, Patel J, Pennington Z, Porras JL, Goldsborough E, Antar A, Elsamadicy AA, Lubelski D, Wolinsky JP, Jallo G, Gokaslan ZL, Lo SFL, Sciubba DM. Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. J Neurosurg Spine 2022; 37:1-11. [PMID: 35213831 DOI: 10.3171/2022.1.spine211235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose treatment is often technically challenging. Given the low volume seen at most centers, perioperative outcomes have been reported infrequently. Here, the authors present the largest single-institution series of IMSCTs, focusing on the clinical presentation, histological makeup, perioperative outcomes, and long-term survival of surgically treated patients. METHODS A cohort of patients operated on for primary IMSCTs at a comprehensive cancer center between June 2002 and May 2020 was retrospectively identified. Data on patient demographics, tumor histology, neuraxial location, baseline neurological status, functional deficits, and operative characteristics were collected. Perioperative outcomes of interest included length of stay, postoperative complications, readmission, reoperation, and discharge disposition. Data were compared across tumor histologies using the Kruskal-Wallis H test, chi-square test, and Fisher exact test. Pairwise comparisons were conducted using Tukey's honest significant difference test, chi-square test, and Fisher exact test. Long-term survival was assessed across tumor categories and histological subtype using the log-rank test. RESULTS Three hundred two patients were included in the study (mean age 34.9 ± 19 years, 77% white, 57% male). The most common tumors were ependymomas (47%), astrocytomas (31%), and hemangioblastomas (11%). Ependymomas and hemangioblastomas disproportionately localized to the cervical cord (54% and 59%, respectively), whereas astrocytomas were distributed almost equally between the cervical cord (36%) and thoracic cord (38%). Clinical presentation, extent of functional dependence, and postoperative 30-day outcomes were largely independent of underlying tumor pathology, although tumors of the thoracic cord had worse American Spinal Injury Association (ASIA) grades than cervical tumors. Rates of gross-total resection were lower for astrocytomas than for ependymomas (54% vs 84%, p < 0.01) and hemangioblastomas (54% vs 100%, p < 0.01). Additionally, 30-day readmission rates were significantly higher for astrocytomas than ependymomas (14% vs 6%, p = 0.02). Overall survival was significantly affected by the underlying pathology, with astrocytomas having poorer associated prognoses (40% at 15 years) than ependymomas (81%) and hemangioblastomas (66%; p < 0.01) and patients with high-grade ependymomas and astrocytomas having poorer long-term survival than those with low-grade lesions (p < 0.01). CONCLUSIONS The neuraxial location of IMSCTs, extent of resection, and postoperative survival differed significantly across tumor pathologies. However, perioperative outcomes did not vary significantly across tumor cohorts, suggesting that operative details, rather than pathology, may have a stronger influence on the short-term clinical course, whereas pathology appears to have a stronger impact on long-term survival.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaimin Patel
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Jose L Porras
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Earl Goldsborough
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Antar
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- 4Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island; and
| | - Sheng-Fu Larry Lo
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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15
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Lee B, Mohamad I, Pokhrel R, Murad R, Yuan M, Stapleton S, Bettegowda C, Jallo G, Eberhart CG, Garrett T, Perera RJ. Medulloblastoma cerebrospinal fluid reveals metabolites and lipids indicative of hypoxia and cancer-specific RNAs. Acta Neuropathol Commun 2022; 10:25. [PMID: 35209946 PMCID: PMC8867780 DOI: 10.1186/s40478-022-01326-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/20/2021] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in children. There remains an unmet need for diagnostics to sensitively detect the disease, particularly recurrences. Cerebrospinal fluid (CSF) provides a window into the central nervous system, and liquid biopsy of CSF could provide a relatively non-invasive means for disease diagnosis. There has yet to be an integrated analysis of the transcriptomic, metabolomic, and lipidomic changes occurring in the CSF of children with MB. CSF samples from patients with (n = 40) or without (n = 11; no cancer) MB were subjected to RNA-sequencing and high-resolution mass spectrometry to identify RNA, metabolite, and lipid profiles. Differentially expressed transcripts, metabolites, and lipids were identified and their biological significance assessed by pathway analysis. The DIABLO multivariate analysis package (R package mixOmics) was used to integrate the molecular changes characterizing the CSF of MB patients. Differentially expressed transcripts, metabolites, and lipids in CSF were discriminatory for the presence of MB but not the exact molecular subtype. One hundred and ten genes and ten circular RNAs were differentially expressed in MB CSF compared with normal, representing TGF-β signaling, TNF-α signaling via NF-kB, and adipogenesis pathways. Tricarboxylic acid cycle and other metabolites (malate, fumarate, succinate, α-ketoglutarate, hydroxypyruvate, N-acetyl-aspartate) and total triacylglycerols were significantly upregulated in MB CSF compared with normal CSF. Although separating MBs into subgroups using transcriptomic, metabolomic, and lipid signatures in CSF was challenging, we were able to identify a group of omics signatures that could separate cancer from normal CSF. Metabolic and lipidomic profiles both contained indicators of tumor hypoxia. Our approach provides several candidate signatures that deserve further validation, including the novel circular RNA circ_463, and insights into the impact of MB on the CSF microenvironment.
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Affiliation(s)
- Bongyong Lee
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Iqbal Mohamad
- grid.15276.370000 0004 1936 8091Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1395 Center Drive, Gainesville, FL 32610 USA ,grid.240145.60000 0001 2291 4776Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Rudramani Pokhrel
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Rabi Murad
- grid.479509.60000 0001 0163 8573Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Road, La Jolla, CA 92037 USA
| | - Menglang Yuan
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Stacie Stapleton
- grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Chetan Bettegowda
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.21107.350000 0001 2171 9311Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - George Jallo
- grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Charles G. Eberhart
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.21107.350000 0001 2171 9311Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205 USA
| | - Timothy Garrett
- Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1395 Center Drive, Gainesville, FL, 32610, USA.
| | - Ranjan J. Perera
- grid.21107.350000 0001 2171 9311Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St, Baltimore, MD 21231 USA ,grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
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16
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Lee B, Katsushima K, Pokhrel R, Yuan M, Stapleton S, Jallo G, Wechsler-Reya RJ, Eberhart CG, Ray A, Perera RJ. The long non-coding RNA SPRIGHTLY and its binding partner PTBP1 regulate exon 5 skipping of SMYD3 transcripts in group 4 medulloblastomas. Neurooncol Adv 2022; 4:vdac120. [PMID: 36267874 PMCID: PMC9569026 DOI: 10.1093/noajnl/vdac120] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Although some of the regulatory genes, signaling pathways, and gene regulatory networks altered in medulloblastomas (MB) are known, the roles of non-coding RNAs, particularly long non-coding RNAs (lncRNAs), are poorly described. Here we report that the lncRNA SPRIGHTLY (SPRY4-IT1) gene is upregulated in group 4 medulloblastoma (G4 MB). Methods SPRIGHTLY expression was assessed in MB subgroup patient-derived xenografts, cell lines, and patient samples. The effect of SPRIGHTLY hemizygous deletion on proliferation, invasion, apoptosis, and colony formation were assessed in vitro and on tumor growth in vivo. dChIRP pull-down assays were used to assess SPRIGHTLY-binding partners, confirmed by immunoprecipitation. SMYD3 ΔE5 transcripts were examined in cell lines and publicly available RNA-seq data. Pathway analysis was performed by phospho-kinase profiling and RNA-seq. Results CRISPR/Cas9 deletion of SPRIGHTLY reduced cell viability and invasion and increased apoptosis in G4 MB cell lines in vitro. SPRIGHTLY hemizygous-deleted G4 MB cells injected into mouse cerebellums produced smaller tumors than those derived from parental cells expressing both copies of SPRIGHTLY. SPRIGHTLY lncRNA bound to the intronic region of the SMYD3 pre-mRNA transcript. SPRIGHTLY also interacted with PTPB1 protein to regulate SMYD3 exon skipping to produce an aberrant protein. SPRIGHTLY-driven SMYD3 regulation enhanced the expression of EGFR pathway genes in G4 MB cell lines and activated cell coagulation/hemostasis-related gene expression, suggesting a novel oncogenic role in G4 MB. Conclusions These results demonstrate the importance of SPRIGHTLY lncRNA as a promoter of G4 MB and the role of the SPRIGHTLY-SMYD3-PTPB1 axis as an important oncogenic regulator in MB.
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Affiliation(s)
- Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Stacie Stapleton
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
| | - Robert J Wechsler-Reya
- Sanford Burnham Prebys Medical Discovery Institute, 10901 N. Torrey Pines Road, La Jolla, CA 92037, USA
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Ave – Ross Bldg 558, Baltimore, MD 21205, USA
| | - Animesh Ray
- Riggs School of Applied Life Sciences, Keck Graduate Institute, Claremont CA, 91711, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
- Johns Hopkins All Children’s Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA
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17
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Massimi L, Peretta P, Erbetta A, Solari A, Farinotti M, Ciaramitaro P, Saletti V, Caldarelli M, Canheu AC, Celada C, Chiapparini L, Chieffo D, Cinalli G, Di Rocco F, Furlanetto M, Giordano F, Jallo G, James S, Lanteri P, Lemarchand C, Messing-Jünger M, Parazzini C, Paternoster G, Piatelli G, Poca MA, Prabahkar P, Ricci F, Righini A, Sala F, Sahuquillo J, Stoodley M, Talamonti G, Thompson D, Triulzi F, Zucchelli M, Valentini L. Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document. Neurol Sci 2022; 43:1311-1326. [PMID: 34097175 PMCID: PMC8789635 DOI: 10.1007/s10072-021-05317-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children. METHODS A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale ("strongly disagree," "disagree," "agree," "strongly agree"). Statements that were endorsed ("agree" or "strongly agree") by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three). RESULTS Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the "definition of radiological failure 24 month post-surgery." CONCLUSIONS The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.
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Affiliation(s)
- Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Paola Peretta
- Pediatric Neurosurgery, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Solari
- Neuroepidemiology Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mariangela Farinotti
- Neuroepidemiology Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Palma Ciaramitaro
- Department of Neuroscience, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Veronica Saletti
- Department of Pediatric Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Caldarelli
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | | | - Carlo Celada
- "Associazione Italiana Siringomielia e Arnold Chiari", Garino, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniela Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and UCSC, Rome, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Federico Di Rocco
- Pediatric Neurosurgery Department, Université de Lyon, INSERM U1033, Hopital Femme Mère Enfant, Lyon, France
| | - Marika Furlanetto
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Meyer Pediatric Hospital, Florence, Italy
| | - George Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Syril James
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - Paola Lanteri
- Department of Diagnostic and Technology, Neurophysiopathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Cecilia Parazzini
- Department of Pediatric Radiology and Neuroradiology, Children Hospital V. Buzzi, Milan, Italy
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, Paris, France
| | - Gianluca Piatelli
- Department of Neurosurgery, Gaslini Children's Hospital, Genoa, Italy
| | - Maria A Poca
- Neurosurgery and Pediatric Neurosurgery, Vall d'Hebron Hospital Universitari, Neurotrauma and Neurosurgery Research Unit, and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Prab Prabahkar
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Federica Ricci
- Pediatric Neuropsychiatric Unit, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Righini
- Department of Pediatric Radiology and Neuroradiology, Children Hospital V. Buzzi, Milan, Italy
| | - Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - Juan Sahuquillo
- Neurosurgery and Pediatric Neurosurgery, Vall d'Hebron Hospital Universitari, Neurotrauma and Neurosurgery Research Unit, and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcus Stoodley
- Department of Clinical Medicine, Macquarie University Clinical Associates, Sidney, Australia
| | | | - Dominic Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Fabio Triulzi
- Department of Pathophysiology and Transplantation, Neuroradiology Unit, University of Milan, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mino Zucchelli
- Neurochirurgia Pediatrica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Valentini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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18
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Ciaramitaro P, Massimi L, Bertuccio A, Solari A, Farinotti M, Peretta P, Saletti V, Chiapparini L, Barbanera A, Garbossa D, Bolognese P, Brodbelt A, Celada C, Cocito D, Curone M, Devigili G, Erbetta A, Ferraris M, Furlanetto M, Gilanton M, Jallo G, Karadjova M, Klekamp J, Massaro F, Morar S, Parker F, Perrini P, Poca MA, Sahuquillo J, Stoodley M, Talamonti G, Triulzi F, Valentini MC, Visocchi M, Valentini L. Correction to: Diagnosis and treatment of Chiari Malformation and syringomyelia in adults: International Consensus Document. Neurol Sci 2021; 43:1483-1484. [PMID: 34786631 DOI: 10.1007/s10072-021-05724-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Palma Ciaramitaro
- CRESSC, SSD Coordinamento Neurofisiologia Clinica and Neurosurgery Unit, Department of Neuroscience, University of Torino, Torino, Italy. .,Neuroscience Dpt, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Presidio CTO, via Zuretti, 29, Torino, Italy.
| | - Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Bertuccio
- Department of Neurosurgery, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Alessandra Solari
- Neuroepidemiology Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mariangela Farinotti
- Neuroepidemiology Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Peretta
- Pediatric Neurosurgery, Ospedale Infantile ReginaMargherita, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Veronica Saletti
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Barbanera
- Department of Neurosurgery, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Diego Garbossa
- CRESSC, SSD Coordinamento Neurofisiologia Clinica and Neurosurgery Unit, Department of Neuroscience, University of Torino, Torino, Italy
| | - Paolo Bolognese
- Chiari Neuosurgical Center, Mount Sinai, South Nassau, Oceanside, NY, USA
| | - Andrew Brodbelt
- Consultant Neurosurgeon, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Dario Cocito
- Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Marcella Curone
- Casa di Cura del Policlinico, Igea Headache Center, Milan, Italy
| | - Grazia Devigili
- Department of Clinical Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Erbetta
- Service of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marilena Ferraris
- Service of Neuroradiology, Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Marika Furlanetto
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - George Jallo
- Johns Hopkins University Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Jorg Klekamp
- Christliches Krankenhaus Quakenbrück, Department of Neurosurgery, Quakenbrück, Germany
| | - Fulvio Massaro
- Department of Neurosurgery, University of Torino, Torino, Italy
| | - Sylvia Morar
- Neurosurgery Department, Reference Center Rares Diseases C-MAVEM, CHU Bicetre APHP, Paris, France
| | - Fabrice Parker
- Neurosurgery Department, Reference Center Rares Diseases C-MAVEM, CHU Bicetre APHP, Paris, France
| | - Paolo Perrini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Maria Antonia Poca
- Neurosurgery and Pediatric Neurosurgery, Vall d'Hebron Hospital Universitari, Neurotrauma and Neurosurgery Research Unit, and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sahuquillo
- Neurosurgery and Pediatric Neurosurgery, Vall d'Hebron Hospital Universitari, Neurotrauma and Neurosurgery Research Unit, and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcus Stoodley
- The Australian School of Advanced Medicine, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | | | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Consuelo Valentini
- Service of Neuroradiology, Diagnostic Imaging Department, AOU Citta' della Salute e della Scienza di Torino, Torino, Italy
| | | | - Laura Valentini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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19
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Katsushima K, Lee B, Yuan M, Kunhiraman H, Stapleton S, Jallo G, Raabe E, Eberhart C, Perera R. CSIG-32. microRNA 211, A POTENTIAL THERAPEUTIC AGENT FOR GROUP 3 MEDULLOBLASTOMA IN CHILDREN. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.158] [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: 11/12/2022] Open
Abstract
Abstract
Medulloblastoma (MB) is a central nervous system (CNS) tumor that predominantly affects children and requires aggressive therapy. Affected individuals often suffer from treatment-related side-effects and treatment-resistant recurrences associated with high morbidity and mortality rates. There are four major molecular MB subgroups: wingless-type (Wnt)-activated, sonic hedgehog (Shh)-activated, group III (G3), and group IV (G4) MBs. While the molecular pathology of Wnt- and Shh-activated MBs is well defined, rather less is known about G3 and G4 MB's genetic basis, so their molecular diagnosis and consequent management have remained challenging. MBs develop through various genetic, epigenetic, and non-coding (nc)RNA-related mechanisms, with the role of ncRNAs, particularly microRNAs, in MB tumor growth is poorly defined. We addressed this knowledge gap with an exemplar of microRNA-211 (miR-211) implicated in G3 MB tumor growth. Compared to other MB subgroups, miR-211 is significantly downregulated in G3 MB cell lines, underscoring its important role as a therapeutic agent and a biomarker. miR-211 overexpression in G3 MB cells significantly reduced cell proliferation, invasion, 3D colony formation, and induced apoptosis. Oxygen consumption rates are higher in engineered cells, and we postulate that miR-211 is involved in G3 MB mitochondrial energy metabolism. miR-211 expressed G3 MB cells injected into mouse cerebella produce smaller tumors than those derived from parental cells. We applied single-cell RNA sequencing and immune histochemical assays to characterize tumors to identify the molecular mechanism of miR-211- driven tumor reduction in G3 MBs, and our preliminary results support that miR-211 is an attractive therapeutic agent to treat this aggressive MB subtype.
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Affiliation(s)
| | - Bongyong Lee
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Menglang Yuan
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | | | - George Jallo
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Eric Raabe
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ranjan Perera
- Johns Hopkins All Children's Hospital/Johns Hopkins University School of Medicine, Department of Oncology, St. Petersburg, FL, USA
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20
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Orman G, Kralik SF, Desai NK, Meoded A, Sangi-Haghpeykar H, Jallo G, Boltshauser E, Huisman TAGM. Can MRI Differentiate between Infectious and Immune-Related Acute Cerebellitis? A Retrospective Imaging Study. AJNR Am J Neuroradiol 2021; 42:2231-2237. [PMID: 34593381 DOI: 10.3174/ajnr.a7301] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute cerebellitis is an acute neurologic condition attributable to a recent or concurrent infection or a recent vaccination or ingestion of medication, with MR imaging evidence of cerebellar edema. MR imaging can confirm an anatomic abnormality and may allow the radiologist to establish a differential diagnosis. The purpose of this research was to evaluate the MR imaging findings in children with acute cerebellitis due to infectious versus immune-related conditions, in particular whether MR imaging findings allow differentiation. MATERIALS AND METHODS Electronic medical records were reviewed between 2003 and 2020 in our quaternary children's hospital. Data included demographics and clinical records: presentation/symptoms, final diagnosis including acute cerebellitis and immune-related acute cerebellitis, length of stay, treatment, condition at discharge, and laboratory findings. Retrospective independent review of all brain MR imaging studies was performed. RESULTS Forty-three patients (male/female ratio, 28:15) were included in this study. Average age at presentation was 7.08 years (range, 0.05-17.52 years). Thirty-five children had infectious and 8 children had immune-related acute cerebellitis. Significant differences in neuroimaging were the following: 1) T2-FLAIR hyperintense signal in the brainstem (37.50% versus 2.85%, P = .016); 2) T2-FLAIR hyperintense signal in the supratentorial brain higher in the immune-related group (37.50% versus 0.00%, P = .004); and 3) downward herniation, higher in the infectious acute cerebellitis group (42.85% versus 0.00%, P = .03). CONCLUSIONS Acute cerebellitis is a rare condition, and MR imaging is helpful in the differential diagnosis. T2-FLAIR hyperintense signal in the brainstem and supratentorial brain may be indicative of immune-related acute cerebellitis, and downward herniation may be indicative of infectious acute cerebellitis.
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Affiliation(s)
- G Orman
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - S F Kralik
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - N K Desai
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - A Meoded
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - H Sangi-Haghpeykar
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas.,Department of Obstetrics and Gynecology (H.S.-H.), Baylor College of Medicine, Houston, Texas
| | - G Jallo
- Institute for Brain Protection Sciences and Department of Neurosurgery (G.J.), Johns Hopkins All Children's, St. Petersburg, Florida
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital Zürich, Zürich, Switzerland
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
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21
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Lee B, Stapleton S, Pokhrel R, Bettegowda C, Jallo G, Perera R. OMIC-04. IDENTIFICATION AND CHARACTERIZATION OF CIRCULATING RNAS (CODING AND NONCODING) AND METABOLITES IN CEREBROSPINAL FLUID IN MEDULLOBLASTOMA PATIENTS. Neuro Oncol 2021. [PMCID: PMC8168250 DOI: 10.1093/neuonc/noab090.151] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in children, and monitoring patients for treatment response and recurrence can be challenging with available current technologies in neuro-imaging and performing a biopsy to confirm response or recurrence carries risks, whereas cerebrospinal fluid (CSF) can be obtained with a little invasiveness. MB has altered cellular metabolism due to changes in gene expression, therefore, we hypothesized that any changes in MB cells lead to changes in cell-free transcripts and metabolites in CSF. To test this, we applied RNA-sequencing and mass spectrometry to analyze transcripts and metabolites including lipid in CSF from patients with different sub-groups of MB tumors (i.e., WNT, SHH, G3/4, G4, and unknown) and compared them to non-cancerous CSF. Tumor and sub-group specific transcriptomic and metabolic signatures were shown by unsupervised hierarchical clustering facilitating tumor type differentiation. By comparison with previously published tumor tissue RNA-seq data, we were able to identify a group of upregulated molecular signatures in both tumor tissue and CSF. We also identified a group of lipids that differentiate each MB sub-group from normal CSF, and Pathway analysis confirmed alterations in multiple metabolic pathways. Finally, we attempted to integrate RNA-seq data with lipidomics data, and results depict that the combinatorial analysis of CSF RNAs and metabolites can be useful in diagnosing and monitoring patients with MB tumors. (This research was conducted using samples made available by The Children’s Brain Tumor Network.)
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Affiliation(s)
- Bongyong Lee
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | | | - Rudramani Pokhrel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | | | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Ranjan Perera
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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22
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Katsushima K, Lee B, Kunhiraman H, Zhong C, Murad R, Yin J, Liu B, Garancher A, Gonzalez-Gomez I, Monforte HL, Stapleton S, Vibhakar R, Bettegowda C, Wechsler-Reya RJ, Jallo G, Raabe E, Eberhart CG, Perera RJ. The long noncoding RNA lnc-HLX-2-7 is oncogenic in Group 3 medulloblastomas. Neuro Oncol 2021; 23:572-585. [PMID: 33844835 DOI: 10.1093/neuonc/noaa235] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Medulloblastoma (MB) is an aggressive brain tumor that predominantly affects children. Recent high-throughput sequencing studies suggest that the noncoding RNA genome, in particular long noncoding RNAs (lncRNAs), contributes to MB subgrouping. Here we report the identification of a novel lncRNA, lnc-HLX-2-7, as a potential molecular marker and therapeutic target in Group 3 MBs. METHODS Publicly available RNA sequencing (RNA-seq) data from 175 MB patients were interrogated to identify lncRNAs that differentiate between MB subgroups. After characterizing a subset of differentially expressed lncRNAs in vitro and in vivo, lnc-HLX-2-7 was deleted by CRISPR/Cas9 in the MB cell line. Intracranial injected tumors were further characterized by bulk and single-cell RNA-seq. RESULTS Lnc-HLX-2-7 is highly upregulated in Group 3 MB cell lines, patient-derived xenografts, and primary MBs compared with other MB subgroups as assessed by quantitative real-time, RNA-seq, and RNA fluorescence in situ hybridization. Depletion of lnc-HLX-2-7 significantly reduced cell proliferation and 3D colony formation and induced apoptosis. Lnc-HLX-2-7-deleted cells injected into mouse cerebellums produced smaller tumors than those derived from parental cells. Pathway analysis revealed that lnc-HLX-2-7 modulated oxidative phosphorylation, mitochondrial dysfunction, and sirtuin signaling pathways. The MYC oncogene regulated lnc-HLX-2-7, and the small-molecule bromodomain and extraterminal domain family‒bromodomain 4 inhibitor Jun Qi 1 (JQ1) reduced lnc-HLX-2-7 expression. CONCLUSIONS Lnc-HLX-2-7 is oncogenic in MB and represents a promising novel molecular marker and a potential therapeutic target in Group 3 MBs.
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Affiliation(s)
- Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Haritha Kunhiraman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Cuncong Zhong
- University of Kansas, Department of Electrical Engineering and Computer Science, Lawrence, Kansas
| | - Rabi Murad
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Jun Yin
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Ben Liu
- University of Kansas, Department of Electrical Engineering and Computer Science, Lawrence, Kansas
| | | | | | | | | | - Rajeev Vibhakar
- University of Colorado School of Medicine Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado
| | - Chetan Bettegowda
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - George Jallo
- Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Eric Raabe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida.,Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
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23
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Katsushima K, Jallo G, Eberhart CG, Perera RJ. Long non-coding RNAs in brain tumors. NAR Cancer 2021; 3:zcaa041. [PMID: 34316694 PMCID: PMC8210177 DOI: 10.1093/narcan/zcaa041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) have been found to be central players in the epigenetic, transcriptional and post-transcriptional regulation of gene expression. There is an accumulation of evidence on newly discovered lncRNAs, their molecular interactions and their roles in the development and progression of human brain tumors. LncRNAs can have either tumor suppressive or oncogenic functions in different brain cancers, making them attractive therapeutic targets and biomarkers for personalized therapy and precision diagnostics. Here, we summarize the current state of knowledge of the lncRNAs that have been implicated in brain cancer pathogenesis, particularly in gliomas and medulloblastomas. We discuss their epigenetic regulation as well as the prospects of using lncRNAs as diagnostic biomarkers and therapeutic targets in patients with brain tumors.
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Affiliation(s)
- Keisuke Katsushima
- Department of Oncology, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21231, USA
| | - George Jallo
- Johns Hopkins All Children's Hospital, 600 5th St. South, St Petersburg, FL 33701, USA
| | - Charles G Eberhart
- Department of Oncology, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21231, USA
| | - Ranjan J Perera
- Department of Oncology, Johns Hopkins University School of Medicine, 1650 Orleans St., Baltimore, MD 21231, USA
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Katsushima K, Joshi P, Stapleton S, Garancher A, Vibhakar R, Raabe E, Eberhart C, Wechsler-Reya R, Jallo G, Perera R. MBRS-16. MYC REGULATED LONG NONCODING RNA LNC-HLX-2–7 IS A PUTATIVE MOLECULAR MARKER AND A THERAPEUTIC TARGET FOR GROUP 3 MEDULLOBLASTOMAS IN CHILDREN. Neuro Oncol 2020. [PMCID: PMC7715764 DOI: 10.1093/neuonc/noaa222.532] [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] [Indexed: 11/13/2022] Open
Abstract
Medulloblastoma (MB), a central nervous system tumor that predominantly affects children, requires aggressive therapy. Recent advances in the noncoding RNA genome could contribute to the sub-classification of medulloblastoma. The focus of this study is to identify novel long noncoding RNAs (lncRNAs) as molecular markers and potential therapeutic targets within each subgroup of MBs, in particular within Group 3. We analyzed publicly available 175 RNA-seq datasets to identify a group of putative lncRNA signatures that may be able to differentiate medulloblastoma subgroups accurately. Among those, lncRNA lnc-HLX-2–7 was highly upregulated in Group 3 MB cell lines, patient-derived xenografts, FFPE samples compared to other groups. CRISPR/Cas9 deletion of the lnc-HLX-2–7 followed by the fluorescence-activated sorting and generating monoclonal Group 3 MB cells significantly reduced the cell growth and 3-D colony formation together with the induction of apoptosis. Intracranial injection to mouse cerebellum using lnc-HLX-2–7 deleted cells resulted in reduced tumor growth compared to parental cells, and tumors were further characterized by single-cell sequencing. We identified that oncogene MYC regulates lnc-HLX-2–7 and its expression can be controlled by the small molecule JQ1, a BET-bromodomain (BRD4) inhibitor that disrupts interactions with MYC. RNA-FISH analysis using FFPE, PDX, and tissue microarrays revealed that lnc-HLX-2–7 expression is specific to Group 3 MB compared to other groups. We present supporting evidence that lnc-HLX-2–7 is a novel molecular marker and a potential therapeutic target for Group 3 MBs in children.
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Affiliation(s)
| | | | | | | | | | - Eric Raabe
- Johns Hopkins University, Baltimore, MD, USA
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Mirsky D, Prince E, Staulcup S, Hengartner A, Vijmasi T, Johnston J, Massimi L, Anderson R, Souweidane M, Naftel R, Limbrick D, Grant G, Niazi T, Dudley R, Kilburn L, Jackson E, Jallo G, Ginn K, Smith A, Chern J, Lee A, Drapeau A, Krieger M, Handler M, Hankinson T. RARE-11. QUANTITATIVE MR IMAGING FEATURES ASSOCIATED WITH UNIQUE TRANSCRIPTIONAL CHARACTERISTICS IN PEDIATRIC ADAMANTINOMATOUS CRANIOPHARYNGIOMA: A POTENTIAL GUIDE FOR THERAPY. Neuro Oncol 2020. [PMCID: PMC7715942 DOI: 10.1093/neuonc/noaa222.722] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
METHODS Through the Advancing Treatment for Pediatric Craniopharyngioma (ATPC) consortium we accumulated preoperative MRIs and tumor RNA for 50 unique ACP patients. MRIs were assessed quantitatively for 28 different features and analyzed using Multiple Factor Analysis (MFA) and optimal clustering was determined via maximization of Bayesian Information Criterion (BIC). Following bulk RNAseq, differential expression and pathway enrichment were performed using standard methodologies (i.e., DESeq2 and GSEA). RESULTS MRI features were well represented in the first 3 dimensions of MFA (variance explained=67.32%); specifically tumor/cyst size, ventricular size, and cyst fluid diffusivity. Using this three-way axis, we identified 3 patient subgroups. Transcriptional differences between these subgroups indicated one group was enriched for DNA damage response and MYC related pathways, one group enriched for SHH, and one group enriched for WNT/β-catenin and EMT-related pathways. CONCLUSION This preliminary work suggests that there may be unique gene expression variants within ACP, which may be identified preoperatively using easily quantifiable MRI parameters. These radiogenomic signatures could provide prognostic information and/or guidance in the selection of antitumor therapies for children with ACP.
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Affiliation(s)
| | - Eric Prince
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | | | - James Johnston
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luca Massimi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mark Souweidane
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Robert Naftel
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Limbrick
- Washington University School of Medicine, St. Louis, MO, USA
| | - Gerald Grant
- Lucile Packard Children’s Hospital at Stanford University, Palo Alto, CA, USA
| | - Toba Niazi
- Nicklaus Children’s Hospital, Miami, FL, USA
| | | | | | - Eric Jackson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Kevin Ginn
- Children’s Mercy Hospital, Kansas City, MO, USA
| | - Amy Smith
- Arnold Palmer Hospital, Orlando, FL, USA
| | - Joshua Chern
- Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Lee
- Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Mark Krieger
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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26
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Hengartner AC, Prince E, Staulcup S, Vijmasi T, Souweidane M, Jackson EM, Johnston JM, Anderson RCE, Naftel RP, Grant G, Niazi TN, Dudley R, Limbrick DD, Ginn K, Smith A, Kilburn L, Jallo G, Wilkening G, Hankinson T. QOL-22. MACHINE-LEARNING INFERENCE MAY PREDICT QUALITY OF LIFE SUBGROUPS OF ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2020. [PMCID: PMC7715913 DOI: 10.1093/neuonc/noaa222.684] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Due to disease and/or treatment-related injury, such as hypothalamic, visual, and endocrine damage, quality of life (QoL) scores after childhood-onset Adamantinomatous Craniopharyngioma (ACP) are among the lowest of all pediatric brain tumors. Decision-making regarding management would be aided by more complete understanding of a patients likely QoL trajectory following intervention. METHODS We retrospectively analyzed caregiver and patient-reported QoL-instruments from the first 50 patients (ages 1–17 years at diagnosis) enrolled in the international Advancing Treatment for Pediatric Craniopharyngioma (ATPC) consortium. Surveys included 205 pediatric-relevant questions and were completed at diagnosis, and 1- and 12-months following diagnosis. Using Multiple Correspondence Analysis (MCA), these categorical QoL surveys were interrogated to identify time-dependent patient subgroups. Additionally, custom deep learning classifiers were developed using Google’s TensorFlow framework. RESULTS By representing QoL data in the reduced dimensionality of MCA-space, we identified QoL subgroups that either improved or declined over time. We assessed differential trends in QoL responses to identify variables that were subgroup specific (Kolmogorov-Smirnov p-value < 0.1; n=20). Additionally, our optimized deep learning classifier achieved a mean 5-fold cross-validation area under precision-recall curve score > 0.99 when classifying QoL subgroups at 12 month follow-up, using only baseline data. CONCLUSIONs This work demonstrates the existence of time-dependent QoL-based ACP subgroups that can be inferred at time-of-diagnosis via machine learning analyses of baseline survey responses. The ability to predict an ACP patient’s QoL trajectory affords caregivers valuable information that can be leveraged to maximize that patient’s psychosocial state and therefore improve overall therapy.
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Affiliation(s)
- Astrid C Hengartner
- Children’s Hospital Colorado, Division of Pediatric Neurosurgery, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Neurosurgery, Aurora, CO, USA
| | - Eric Prince
- Children’s Hospital Colorado, Division of Pediatric Neurosurgery, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Neurosurgery, Aurora, CO, USA
| | - Susan Staulcup
- Children’s Hospital Colorado, Division of Pediatric Neurosurgery, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Neurosurgery, Aurora, CO, USA
| | - Trinka Vijmasi
- Children’s Hospital Colorado, Division of Pediatric Neurosurgery, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Neurosurgery, Aurora, CO, USA
| | - Mark Souweidane
- Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York, NY, USA
- Weill Cornell Medical College, Department of Neurological Surgery, New York, NY, USA
| | - Eric M Jackson
- Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD, USA
| | - James M Johnston
- University of Alabama at Birmingham, Department of Neurosurgery, Division of Pediatric Neurosurgery, Birmingham, AL, USA
| | - Richard C E Anderson
- Columbia University, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, Department of Neurosurgery, New York, NY, USA
| | - Robert P Naftel
- Vanderbilt University Medical Center, Monroe Carell Jr, Children’s Hospital at Vanderbilt, Department of Neurological Surgery, Nashville, TN, USA
| | - Gerald Grant
- Lucile Packard Children’s Hospital at Stanford University, Department of Pediatric Neurosurgery, Palo Alto, CA, USA
| | - Toba N Niazi
- Nicklaus Children’s Hospital, Department of Pediatric Neurosurgery, Miami, FL, USA
| | - Roy Dudley
- McGill University, Department of Neurosurgery, Montreal, QC, Canada
| | - David D Limbrick
- Washington University School of Medicine, Department of Pediatrics, St, Louis, MO, USA
- Washington University School of Medicine, Department of Neurosurgery, St, Louis, MO, USA
| | - Kevin Ginn
- Children’s Mercy Hospital, The Division of Pediatric Hematology and Oncology, the Department of Pediatrics, Kansas City, MO, USA
| | - Amy Smith
- Arnold Palmer Hospital, Department of Pediatric Hematology-Oncology, Orlando, FL, USA
| | - Lindsay Kilburn
- Children’s National Health System, Center for Cancer and Blood Disorders, Washington DC, USA
- Children’s National Health System, Brain Tumor Institute, Washington DC, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, Institute of Brain Protection Sciences, St, Petersburg, FL, USA
| | - Greta Wilkening
- Children’s Hospital Colorado, Department of Pediatric Neuropsychology, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Pediatrics-Neurology, Aurora, CO, USA
| | - Todd Hankinson
- Children’s Hospital Colorado, Division of Pediatric Neurosurgery, Aurora, CO, USA
- University of Colorado School of Medicine, Department of Neurosurgery, Aurora, CO, USA
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27
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Prince EW, Whelan R, Mirsky DM, Stence N, Staulcup S, Klimo P, Anderson RCE, Niazi TN, Grant G, Souweidane M, Johnston JM, Jackson EM, Limbrick DD, Smith A, Drapeau A, Chern JJ, Kilburn L, Ginn K, Naftel R, Dudley R, Tyler-Kabara E, Jallo G, Handler MH, Jones K, Donson AM, Foreman NK, Hankinson TC. Robust deep learning classification of adamantinomatous craniopharyngioma from limited preoperative radiographic images. Sci Rep 2020; 10:16885. [PMID: 33037266 PMCID: PMC7547020 DOI: 10.1038/s41598-020-73278-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/10/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022] Open
Abstract
Deep learning (DL) is a widely applied mathematical modeling technique. Classically, DL models utilize large volumes of training data, which are not available in many healthcare contexts. For patients with brain tumors, non-invasive diagnosis would represent a substantial clinical advance, potentially sparing patients from the risks associated with surgical intervention on the brain. Such an approach will depend upon highly accurate models built using the limited datasets that are available. Herein, we present a novel genetic algorithm (GA) that identifies optimal architecture parameters using feature embeddings from state-of-the-art image classification networks to identify the pediatric brain tumor, adamantinomatous craniopharyngioma (ACP). We optimized classification models for preoperative Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and combined CT and MRI datasets with demonstrated test accuracies of 85.3%, 83.3%, and 87.8%, respectively. Notably, our GA improved baseline model performance by up to 38%. This work advances DL and its applications within healthcare by identifying optimized networks in small-scale data contexts. The proposed system is easily implementable and scalable for non-invasive computer-aided diagnosis, even for uncommon diseases.
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Affiliation(s)
- Eric W Prince
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA. .,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA. .,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.
| | - Ros Whelan
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - David M Mirsky
- Division of Pediatric Radiology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Nicholas Stence
- Division of Pediatric Radiology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Susan Staulcup
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health and Sciences Center, Memphis, 38163, USA.,Semmes Murphy Clinic, St. Jude Children's Research Hospital, Memphis, 38105, USA
| | | | - Toba N Niazi
- Department of Pediatric Neurosurgery, Nicklaus Children's Hospital, Miami, 33155, USA
| | - Gerald Grant
- Department of Pediatric Neurosurgery, Lucile Packard Children's Hospital at Stanford University, Palo Alto, 94305, USA
| | - Mark Souweidane
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York, 10065, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, 35233, USA
| | - Eric M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, 21205, USA
| | - David D Limbrick
- Department of Pediatrics, Washington University School of Medicine, St. Louis, 63110, USA
| | - Amy Smith
- Department of Pediatric Hematology-Oncology, Arnold Palmer Hospital, Orlando, 32806, USA
| | - Annie Drapeau
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, 43205, USA
| | - Joshua J Chern
- Departments of Pediatrics and Neurosurgery, Emory University School of Medicine, Atlanta, 30322, USA
| | - Lindsay Kilburn
- Children's National Health System, Brain Tumor Institute, Washington, DC, 20010, USA
| | - Kevin Ginn
- Division of Pediatric Hematology and Oncology, Children's Mercy Hospital, Kansas City, 64108, USA
| | - Robert Naftel
- Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, 37212, USA
| | - Roy Dudley
- Department of Neurosurgery, McGill University, Montreal, H3A 2B4, Canada
| | | | - George Jallo
- Institute of Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, 33701, USA
| | - Michael H Handler
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - Kenneth Jones
- University of Oklahoma Health Sciences Center, Oklahoma City, 73104, USA
| | - Andrew M Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.,Division of Pediatric Neurooncology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Nicholas K Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.,Division of Pediatric Neurooncology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA.,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA
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Coulter IC, Kulkarni AV, Sgouros S, Constantini S, Constantini S, Sgouros S, Kulkarni AV, Leitner Y, Kestle JR, Cochrane DD, Choux M, Gjerris F, Sherer A, Akalan N, Bilginer B, Navarro R, Vujotic L, Haberl H, Thomale UW, Zúccaro G, Jaimovitch R, Frim D, Loftis L, Swift DM, Robertson B, Gargan L, Bognár L, Novák L, Cseke G, Cama A, Ravegnani GM, Preuß M, Schroeder HW, Fritsch M, Baldauf J, Mandera M, Luszawski J, Skorupka P, Mallucci C, Williams D, Zakrzewski K, Nowoslawska E, Srivastava C, Mahapatra AK, Kumar R, Sahu RN, Melikian AG, Korshunov A, Galstyan A, Suri A, Gupta D, Grotenhuis JA, van Lindert EJ, da Costa Val JA, Di Rocco C, Tamburrini G, Zymberg ST, Cavalheiro S, Jie M, Feng J, Friedman O, Rajmohamed N, Roszkowski M, Barszcz S, Jallo G, Pincus DW, Richter B, Mehdorn HM, Schultka S, de Ribaupierre S, Thompson D, Gatscher S, Wagner W, Koch D, Cipri S, Zaccone C, McDonald P. Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS). Childs Nerv Syst 2020; 36:1407-1414. [PMID: 31965292 DOI: 10.1007/s00381-020-04503-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. METHODS We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. RESULTS Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. CONCLUSION ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.
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Affiliation(s)
- Ian C Coulter
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada
| | - Abhaya V Kulkarni
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada.
| | - Spyros Sgouros
- Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece.,University of Athens Medical School, Athens, Greece
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Sellers A, Meoded A, Quintana J, Jallo G, Amankwah E, Nguyen ATH, Betensky M, Mills K, Goldenberg N, Shimony N. Risk factors for pediatric cerebral sinovenous thrombosis: A case-control study with case validation. Thromb Res 2020; 194:8-15. [PMID: 32554256 DOI: 10.1016/j.thromres.2020.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/09/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cerebral sinovenous thrombosis (CSVT) represents the second most common type of venous thromboembolism (VTE) in children. Current literature includes limited evidence on risk factors for CSVT, particularly in the pediatric population. We sought to determine risk factors for CSVT in pediatric patients through a single-institutional case-control study. In addition, we evaluated thrombophilias, treatments and outcomes in CSVT among cases. METHODS A case-control study was performed at Johns Hopkins All Children's Hospital on patients admitted from March 31, 2006 through April 1, 2018. Cases were identified using diagnostic codes and confirmed based on electronic health record (EHR) and neuroimaging review. Controls were matched in a 2:1 fashion accounting for the month and year of admission. RESULTS A total of 60 CSVT cases and 120 controls were identified. Median (range) age was 4.8 years (0-21.3 years) for cases and 5.6 years (0-20.0 years) for controls. Factors putatively associated with CSVT in unadjusted analyses were: corticosteroid use, presence of a central venous catheter, mechanical ventilation, systemic infection, head/neck infection, head/neck trauma, and chronic inflammatory disease. In the multivariable model, head/neck infection (OR: 13.8, 95% CI: 4.87-38.7; P < 0.01), head/neck trauma (OR: 12.7, 95% CI: 2.88-56.2; P < 0.01), and mechanical ventilation (OR: 9.32, 95% CI: 2.35-36.9; P = 0.01) remained independent, statistically-significant risk factors. 61% of patients were subacutely treated with anticoagulants and of those, only two developed relevant bleeding after initiation of therapy. CONCLUSIONS This single-institutional case-control study reveals that head/neck infection, head/neck trauma, and mechanical ventilation are independent risk factors for pediatric CSVT. These findings will be further investigated via a cooperative registry of pediatric hospital-acquired VTE, by which a risk model for pediatric CSVT will be developed and validated, in order to inform future preventive strategies in at-risk pediatric patients.
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Affiliation(s)
- Austin Sellers
- Office of Medical Education, Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA; Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Avner Meoded
- Department of Radiology, Division of Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Javier Quintana
- Department of Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins All Children's Stroke Program, St. Petersburg, FL, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA
| | - Ernest Amankwah
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA
| | - Anh Thy H Nguyen
- Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA
| | - Marisol Betensky
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Katie Mills
- Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Neil Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Johns Hopkins All Children's Stroke Program, St. Petersburg, FL, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA; Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL, USA; Department of Medicine, Division of Hematology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins Children's Center, Baltimore, MD, USA.
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL, USA; Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA; Department of Neuroscience, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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Joshi P, Jallo G, Perera RJ. In silico analysis of long non-coding RNAs in medulloblastoma and its subgroups. Neurobiol Dis 2020; 141:104873. [PMID: 32320737 DOI: 10.1016/j.nbd.2020.104873] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Medulloblastoma is the most common malignant pediatric brain tumor with high fatality rate. Recent large-scale studies utilizing genome-wide technologies have sub-grouped medulloblastomas into four major subgroups: wingless (WNT), sonic hedgehog (SHH), group 3, and group 4. However, there has yet to be a global analysis of long non-coding RNAs, a crucial part of the regulatory transcriptome, in medulloblastoma. Here, we performed bioinformatic analysis of RNA-seq data from 175 medulloblastoma patients. Differential lncRNA expression sub-grouped medulloblastomas into the four main molecular subgroups. Some of these lncRNAs were subgroup-specific, with a random forest-based machine-learning algorithm identifying an 11-lncRNA diagnostic signature. We also validated the diagnostic signature in patient derived xenograft (PDX) models. We further identified a 17-lncRNA prognostic model using LASSO based penalized Cox' PH model (Score HR = 13.6301, 95% CI = 8.857-20.98, logrank p-value ≤ 2e-16). Our analysis represents the first global lncRNA analysis in medulloblastoma. Our results identify putative candidate lncRNAs that could be evaluated for their functional role in medulloblastoma genesis and progression or as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Piyush Joshi
- Cancer and Blood Disorder Institute, Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA
| | - George Jallo
- Institute of Brain Protection Sciences, Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701 USA
| | - Ranjan J Perera
- Cancer and Blood Disorder Institute, Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL 33701, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD 21231, USA; Sanford Burnham Prebys Medical Discovery Institute, 10901 N Torrey Pines Rd, La Jolla, CA 92037, USA.
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Meoded A, Jacobson L, Liu A, Bauza C, Huisman TAGM, Goldenberg N, Weiner H, Jallo G, Jackson E. Diffusion Tensor Imaging Connectomics Reveals Preoperative Neural Connectivity Changes in Children with Postsurgical Posterior Fossa Syndrome. J Neuroimaging 2020; 30:192-197. [PMID: 31908091 DOI: 10.1111/jon.12686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Posterior fossa syndrome (PFS), characterized by loss of language and other neurological impairments within the immediate postoperative period, occurs in approximately 25% of children who undergo surgical resection of posterior fossa tumors. Diffusion tensor imaging connectomics offer promise for elucidation of pathway-level disruption in neural connectivity of patients with this disorder. We aim to determine differences in pre- and postoperative connectomics between children with PFS and children with mild or no language deficit after surgery. METHODS Pre- and postoperative diffusion tensor imaging connectomics were applied and compared among patients with PFS, mild deficits, and intact language. RESULTS A total of 35 patients were included in the study. Twenty-three patients with preoperative data and 24 patients with postoperative data were included in the analysis. Mean ages: PFS-8.5 years, mild-3.1 years, intact language-9.4 years (P = .02). Diagnoses included medulloblastoma (44.1%), pilocytic astrocytoma (28.6%), ependymoma (8.6%), other (11.4%), and unknown (8.6%). Five (21.7%) patients had PFS, 4 (17.4%) had mild deficits, and 14 (60.9%) had intact language. The assortativity coefficient was significantly higher in patients with PFS when compared to patients with mild deficits (P = .023). In the connectometry analyses, decreased connectivity was found involving the corpus callosum, right corticothalamic pathway, and right corticostriatal pathway in patients with PFS when compared to patients with intact language. CONCLUSIONS Our findings revealed significant differences in preoperative neural connectivity involving the corticothalamic and other pathways among children who did, versus who did not, develop PFS postoperatively. Diffusion tensor imaging connectomics offers a unique opportunity to study the effect of the posterior fossa tumors on cerebello-cerebral networks and provide new insights into the mechanism of the structural plasticity/reorganization after surgery.
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Affiliation(s)
- Avner Meoded
- Edward B. Singleton Department of Radiology, Section of Pediatric Neuroradiology, Texas Children's Hospital, Houston, TX
| | - Lisa Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Colleen Bauza
- Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Section of Pediatric Neuroradiology, Texas Children's Hospital, Houston, TX
| | - Neil Goldenberg
- Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,All Children's Research Institute, and Johns Hopkins Cancer and Blood Disorders Institute, St. Petersburg, FL
| | - Howard Weiner
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - George Jallo
- Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg, FL
| | - Eric Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Katsushima K, Joshi P, Lee B, Stapleton S, Jallo G, Raabe E, Eberhart C, Perera R. GENE-09. LONG NONCODING RNA lncHLX2-7 A PUTATIVE MOLECULAR MARKER AND A THERAPEUTIC TARGET FOR GROUP III MEDULLOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.411] [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: 11/13/2022] Open
Abstract
Abstract
Medulloblastoma (MB), a central nervous system tumor that predominantly affects children, requires aggressive therapy. It can recur as resistant disease and is recurrent medulloblastoma is frequently fatal. There are four groups of MBs (WNT, SHH, Group III, and Group Ⅳ) and they are characterized by specific mutations, copy number alterations, transcriptomic profiles, and clinical outcomes. Recent advances in noncoding RNA genome could contribute to sub-classification of medulloblastoma. The focus of this study is to identify novel long noncoding RNAs (lncRNAs) as molecular markers and potential therapeutic targets within each subgroup of MBs, in particular within the Group III. We analyzed publicly available 723 microarrays and 123 RNA-seq datasets using machine-learning statistical algorithms (random-forest and Lasso) to identify a group of putative lncRNA signatures that may be able to differentiate medulloblastoma subgroups accurately. Among those, lncHLX2-7 was highly upregulated in Group III MBs compared to other groups. RNA-FISH analysis revealed that lncHLX2-7 is highly expressed primarily in Group III MB as compared to other groups and normal brain (cerebellum). Furthermore, depletion of lncHLX2-7 significantly reduced 20- 30% of cell growth together with the induction of apoptosis in MED211 and D425-MED Group III MB cell lines (n=3, p< 0.01, t-test). We present here supporting evidence that lncHLX2-7 is a novel molecular marker and potential therapeutic target for Group III MBs in children.
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Affiliation(s)
| | - Piyush Joshi
- Johns Hopkins University, St. Petersburg, FL, USA
| | - Bongyong Lee
- Johns Hopkins University, St. Petersburg, FL, USA
| | | | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Eric Raabe
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gupta N, Goumnerova LC, Manley P, Chi SN, Neuberg D, Puligandla M, Fangusaro J, Goldman S, Tomita T, Alden T, DiPatri A, Rubin JB, Gauvain K, Limbrick D, Leonard J, Geyer JR, Leary S, Browd S, Wang Z, Sood S, Bendel A, Nagib M, Gardner S, Karajannis MA, Harter D, Ayyanar K, Gump W, Bowers DC, Weprin B, MacDonald TJ, Aguilera D, Brahma B, Robison NJ, Kiehna E, Krieger M, Sandler E, Aldana P, Khatib Z, Ragheb J, Bhatia S, Mueller S, Banerjee A, Bredlau AL, Gururangan S, Fuchs H, Cohen KJ, Jallo G, Dorris K, Handler M, Comito M, Dias M, Nazemi K, Baird L, Murray J, Lindeman N, Hornick JL, Malkin H, Sinai C, Greenspan L, Wright KD, Prados M, Bandopadhayay P, Ligon KL, Kieran MW. Prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma. Neuro Oncol 2019; 20:1547-1555. [PMID: 29741745 DOI: 10.1093/neuonc/noy070] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Diagnosis of diffuse intrinsic pontine glioma (DIPG) has relied on imaging studies, since the appearance is pathognomonic, and surgical risk was felt to be high and unlikely to affect therapy. The DIPG Biology and Treatment Study (DIPG-BATS) reported here incorporated a surgical biopsy at presentation and stratified subjects to receive FDA-approved agents chosen on the basis of specific biologic targets. Methods Subjects were eligible for the trial if the clinical features and imaging appearance of a newly diagnosed tumor were consistent with a DIPG. Surgical biopsies were performed after enrollment and prior to definitive treatment. All subjects were treated with conventional external beam radiotherapy with bevacizumab, and then stratified to receive bevacizumab with erlotinib or temozolomide, both agents, or neither agent, based on O6-methylguanine-DNA methyltransferase status and epidermal growth factor receptor expression. Whole-genome sequencing and RNA sequencing were performed but not used for treatment assignment. Results Fifty-three patients were enrolled at 23 institutions, and 50 underwent biopsy. The median age was 6.4 years, with 24 male and 29 female subjects. Surgical biopsies were performed with a specified technique and no deaths were attributed to the procedure. Two subjects experienced grade 3 toxicities during the procedure (apnea, n = 1; hypertension, n = 1). One subject experienced a neurologic deficit (left hemiparesis) that did not fully recover. Of the 50 tumors biopsied, 46 provided sufficient tissue to perform the study assays (92%, two-stage exact binomial 90% CI: 83%-97%). Conclusions Surgical biopsy of DIPGs is technically feasible, associated with acceptable risks, and can provide biologic data that can inform treatment decisions.
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Affiliation(s)
- Nalin Gupta
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Liliana C Goumnerova
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Peter Manley
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Susan N Chi
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Jason Fangusaro
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Stewart Goldman
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Tadanori Tomita
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Tord Alden
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Arthur DiPatri
- Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University, Chicago, Illinois
| | - Joshua B Rubin
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - Karen Gauvain
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - David Limbrick
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - Jeffrey Leonard
- Washington University Medical Center & St. Louis Children's Hospital, St. Louis, Missouri
| | - J Russel Geyer
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Sarah Leary
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Samuel Browd
- Seattle Children's Hospital & University of Washington, Seattle, Washington
| | - Zhihong Wang
- Children's Hospital of Michigan & Wayne State University, Detroit, Michigan
| | - Sandeep Sood
- Children's Hospital of Michigan & Wayne State University, Detroit, Michigan
| | - Anne Bendel
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Mahmoud Nagib
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | - William Gump
- University of Louisville & Norton's Children's Hospital, Louisville, Kentucky
| | - Daniel C Bowers
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bradley Weprin
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tobey J MacDonald
- Children's Healthcare of Atlanta & Emory University, Atlanta, Georgia
| | - Dolly Aguilera
- Children's Healthcare of Atlanta & Emory University, Atlanta, Georgia
| | | | | | - Erin Kiehna
- Children's Hospital Los Angeles, Los Angeles, California
| | - Mark Krieger
- Children's Hospital Los Angeles, Los Angeles, California
| | - Eric Sandler
- Nemours Children's Clinic, Wolfson's Children's Hospital & University of Florida, Jacksonville, Florida
| | - Philipp Aldana
- Nemours Children's Clinic, Wolfson's Children's Hospital & University of Florida, Jacksonville, Florida
| | - Ziad Khatib
- Nicklaus Children's Hospital, Miami, Florida
| | - John Ragheb
- Nicklaus Children's Hospital, Miami, Florida
| | | | - Sabine Mueller
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Anu Banerjee
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Amy-Lee Bredlau
- Medical University of South Carolina, South Carolina, Charleston, South Carolina
| | - Sri Gururangan
- Preston Robert Tisch Brain Tumor Center & Duke University Medical Center, Durham, North Carolina
| | - Herbert Fuchs
- Preston Robert Tisch Brain Tumor Center & Duke University Medical Center, Durham, North Carolina
| | | | | | - Kathleen Dorris
- Children's Hospital of Colorado & University of Colorado School of Medicine, Denver, Colorado
| | - Michael Handler
- Children's Hospital of Colorado & University of Colorado School of Medicine, Denver, Colorado
| | - Melanie Comito
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Mark Dias
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Kellie Nazemi
- Oregon Health & Science University & Doernbecher Children's Hospital, Portland, Oregon
| | - Lissa Baird
- Oregon Health & Science University & Doernbecher Children's Hospital, Portland, Oregon
| | - Jeff Murray
- Cook Children's Medical Center, Fort Worth, Texas
| | | | | | | | - Claire Sinai
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Karen D Wright
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Michael Prados
- UCSF Benioff Children's Hospital & University of California San Francisco, San Francisco, California
| | - Pratiti Bandopadhayay
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Broad Institute, Cambridge, Massachusetts
| | - Keith L Ligon
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark W Kieran
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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Joshi P, Katsushima K, Zhou R, Meoded A, Stapleton S, Jallo G, Raabe E, Eberhart CG, Perera RJ. The therapeutic and diagnostic potential of regulatory noncoding RNAs in medulloblastoma. Neurooncol Adv 2019; 1:vdz023. [PMID: 31763623 PMCID: PMC6859950 DOI: 10.1093/noajnl/vdz023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Medulloblastoma, a central nervous system tumor that predominantly affects children, always requires aggressive therapy. Nevertheless, it frequently recurs as resistant disease and is associated with high morbidity and mortality. While recent efforts to subclassify medulloblastoma based on molecular features have advanced our basic understanding of medulloblastoma pathogenesis, optimal targets to increase therapeutic efficacy and reduce side effects remain largely undefined. Noncoding RNAs (ncRNAs) with known regulatory roles, particularly long noncoding RNAs (lncRNAs) and microRNAs (miRNAs), are now known to participate in medulloblastoma biology, although their functional significance remains obscure in many cases. Here we review the literature on regulatory ncRNAs in medulloblastoma. In providing a comprehensive overview of ncRNA studies, we highlight how different lncRNAs and miRNAs have oncogenic or tumor suppressive roles in medulloblastoma. These ncRNAs possess subgroup specificity that can be exploited to personalize therapy by acting as theranostic targets. Several of the already identified ncRNAs appear specific to medulloblastoma stem cells, the most difficult-to-treat component of the tumor that drives metastasis and acquired resistance, thereby providing opportunities for therapy in relapsing, disseminating, and therapy-resistant disease. Delivering ncRNAs to tumors remains challenging, but this limitation is gradually being overcome through the use of advanced technologies such as nanotechnology and rational biomaterial design.
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Affiliation(s)
- Piyush Joshi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Rui Zhou
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Avner Meoded
- Pediatric Neuroradiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Stacie Stapleton
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - George Jallo
- Institute Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Eric Raabe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Sanford Burnham Prebys Medical Discovery Institute, NCI-Designated Cancer Center, La Jolla, California
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35
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Kacheris BN, Jallo G, Crooms JW, Oliver TA, Lawson MF, Beaty N. Penetrating intracranial trauma of two minors treated with endovascular technique with the use of temporary balloon occlusion for proximal arterial control. BMJ Case Rep 2019; 12:12/4/e227915. [PMID: 31040138 DOI: 10.1136/bcr-2018-227915] [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] [Indexed: 11/04/2022] Open
Abstract
We present two children treated with endovascular techniques to gain proximal arterial control of the internal carotid and vertebral artery prior to removal of penetrating objects from the skull base. Both siblings (8-month-old and 22-month-old boys) were injured by different sharp objects (knife and scissor) by a guardian. They were transported to the emergency room where vascular control, including coil embolisation and internal carotid balloon occlusion, was performed in the neuroendovascular suite for safe removal of penetrating objects. Both minors recovered and were discharged home without any focal neurological deficits. In two children with scissor and knife stab with intracranial penetration, endovascular technique allowed safe removal of objects and ensured proximal arterial control was maintained to control for possible extravasation of blood on removal from the skull base.
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Affiliation(s)
- Brian Nicholas Kacheris
- Florida State University College of Medicine, Tallahassee, Florida, USA.,Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - George Jallo
- Institute of Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - T Adam Oliver
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - Matthew F Lawson
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - Narlin Beaty
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA.,Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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Ishida W, Casaos J, Chandra A, D'Sa A, Ramhmdani S, Perdomo-Pantoja A, Theodore N, Jallo G, Gokaslan ZL, Wolinsky JP, Sciubba DM, Bydon A, Witham TF, Lo SFL. Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis. J Neurosurg Spine 2019; 30:1-11. [PMID: 30835707 DOI: 10.3171/2018.11.spine181095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVEWith the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors.METHODSA retrospective patient database review identified 103 patients with ID-EM spinal tumors who underwent tumor resection with IONM (motor evoked potentials, somatosensory evoked potentials, and free-running electromyography) from January 2010 to December 2015. Patients were classified as those without any new neurological deficits at the 6-month follow-up (group A; n = 86) and those with new deficits (group B; n = 17). Baseline characteristics, clinical outcomes, and IONM findings were collected and statistically analyzed. In addition, a meta-analysis in compliance with the PRISMA guidelines was performed to estimate the overall pooled diagnostic accuracy of IONM in ID-EM spinal tumor resection.RESULTSNo intergroup differences were discovered between the groups regarding baseline characteristics and operative data. In multivariate analysis, significant IONM changes (p < 0.001) and tumor location (thoracic vs others, p = 0.018) were associated with new neurological deficits at the 6-month follow-up. In predicting these changes, IONM yielded a sensitivity of 82.4% (14/17), specificity of 90.7% (78/86), positive predictive value (PPV) of 63.6% (14/22), negative predictive value (NPV) of 96.3% (78/81), and area under the curve (AUC) of 0.893. The diagnostic value slightly decreased in patients with schwannomas (AUC = 0.875) and thoracic tumors (AUC = 0.842). Among 81 patients who did not demonstrate significant IONM changes at the end of surgery, 19 patients (23.5%) exhibited temporary intraoperative exacerbation of IONM signals, which were recovered by interruption of surgical maneuvers; none of these patients developed new neurological deficits postoperatively. Including the present study, 5 articles encompassing 323 patients were eligible for this meta-analysis, and the overall pooled diagnostic value of IONM was a sensitivity of 77.9%, a specificity of 91.1%, PPV of 56.7%, and NPV of 95.7%.CONCLUSIONSIONM for the resection of ID-EM spinal tumors is a reasonable modality to predict new postoperative neurological deficits at the 6-month follow-up. Future prospective studies are warranted to further elucidate its diagnostic and therapeutic utility.
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Affiliation(s)
- Wataru Ishida
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Casaos
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arun Chandra
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam D'Sa
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seba Ramhmdani
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nicholas Theodore
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George Jallo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 4Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 2Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island
| | - Jean-Paul Wolinsky
- 3Department of Neurological Surgery, Northwestern University, Chicago, Illinois; and
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Bydon
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy F Witham
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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37
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Wright E, Amankwah EK, Winesett SP, Tuite GF, Jallo G, Carey C, Rodriguez LF, Stapleton S. Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm. J Neurooncol 2018; 141:355-361. [DOI: 10.1007/s11060-018-03039-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/27/2018] [Indexed: 12/18/2022]
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38
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Lukas C, Crenshaw M, Gonzalez-Gomez I, Potthast J, Shimony N, Jallo G, Stapleton S. MBCL-46. COMPOUND HETEROZYGOUS MUTATION OF THE PMS2 GENE IN AN INFANT WITH CONSTITUTIONAL MISMATCH REPAIR DEFICIENCY AND MEDULLOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia Lukas
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | | | | | - Joseph Potthast
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Nir Shimony
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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Kruse CA, Pardo CA, Hartman AL, Jallo G, Vining EPG, Voros J, Gaillard WD, Liu J, Oluigbo C, Malone S, Bleasel AF, Dexter M, Micati A, Velasco TR, Machado HR, Martino AM, Huang A, Wheatley BM, Grant GA, Granata T, Freri E, Garbelli R, Koh S, Nordli DR, Campos AR, O'Neill B, Handler MH, Chapman KE, Wilfong AA, Curry DJ, Yaun A, Madsen JR, Smyth MD, Mercer D, Bingaman W, Harvey AS, Leventer RJ, Lockhart PJ, Gillies G, Pope K, Giller CA, Park YD, Rojiani AM, Sharma SJ, Jenkins P, Tung S, Huynh MN, Chirwa TW, Cepeda C, Levine MS, Chang JW, Owens GC, Vinters HV, Mathern GW. Rasmussen encephalitis tissue transfer program. Epilepsia 2018; 57:1005-7. [PMID: 27286752 DOI: 10.1111/epi.13383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carol A Kruse
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Brain Research Institute, UCLA, Los Angeles, California, U.S.A
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Adam L Hartman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - George Jallo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Eileen P G Vining
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Joe Voros
- Public Health Management, Los Angeles, California, U.S.A
| | - William D Gaillard
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Judy Liu
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Chima Oluigbo
- Children's National Health System, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A
| | - Stephen Malone
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew F Bleasel
- Westmead Hospital, Westmead, New South Wales, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mark Dexter
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alex Micati
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Tonicarlo R Velasco
- Hospital Clinic of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.,University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helio R Machado
- Hospital Clinic of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.,University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Adam Huang
- University of South Alabama, Mobile, Alabama, U.S.A
| | - B M Wheatley
- University of Alberta, Edmonton, Alberta, Canada
| | - Gerald A Grant
- Stanford University School of Medicine, Stanford, California, U.S.A.,Lucile Packard Children's Hospital, Stanford, California, U.S.A
| | - Tiziana Granata
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Elena Freri
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Rita Garbelli
- Carlo Besta, Neurological Institute Foundation, Milano, Lombardia, Italy
| | - Sookyong Koh
- Emory+Children's Pediatric Research Center, Atlanta, Georgia, U.S.A
| | - Douglas R Nordli
- Children's Memorial Hospital, Chicago, Illinois, U.S.A.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | | | - Brent O'Neill
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Michael H Handler
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A.,The Children's Hospital, Aurora, Colorado, U.S.A
| | - Kevin E Chapman
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Angus A Wilfong
- Texas Children's Hospital, Houston, Texas, U.S.A.,Baylor College of Medicine, Houston, Texas, U.S.A
| | - Daniel J Curry
- Texas Children's Hospital, Houston, Texas, U.S.A.,Baylor College of Medicine, Houston, Texas, U.S.A
| | - Amanda Yaun
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, U.S.A
| | - Joseph R Madsen
- Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew D Smyth
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Deanna Mercer
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | | | - A S Harvey
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Richard J Leventer
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Paul J Lockhart
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Greta Gillies
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kate Pope
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cole A Giller
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Yong D Park
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Amyn M Rojiani
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Suash J Sharma
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Patrick Jenkins
- Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Spencer Tung
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - My N Huynh
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Thabiso W Chirwa
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Carlos Cepeda
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Michael S Levine
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Brain Research Institute, UCLA, Los Angeles, California, U.S.A
| | - Julia W Chang
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Geoffrey C Owens
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Harry V Vinters
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Gary W Mathern
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.. .,Brain Research Institute, UCLA, Los Angeles, California, U.S.A..
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Shofty B, Ben-Sira L, Kesler A, Jallo G, Groves ML, Iyer RR, Lassaletta A, Tabori U, Bouffet E, Thomale UW, Hernáiz Driever P, Constantini S. Isolated optic nerve gliomas: a multicenter historical cohort study. J Neurosurg Pediatr 2017; 20:549-555. [PMID: 28984541 DOI: 10.3171/2017.6.peds17107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Isolated optic nerve gliomas (IONGs) constitute a rare subgroup of optic pathway gliomas (OPGs). Due to the rarity of this condition and the difficulty in differentiating IONGs from other types of OPGs in most clinical series, little is known about these tumors. Currently, due to lack of evidence, they are managed the same as any other OPG. METHODS The authors conducted a multicenter retrospective cohort study aimed at determining the natural history of IONGs. Included were patients with clear-cut glioma of the optic nerve without posterior (chiasmatic/hypothalamic) involvement. At least 1 year of follow-up, 2 MRI studies, and 2 neuro-ophthalmological examinations were required for inclusion. RESULTS Thirty-six patients with 39 tumors were included in this study. Age at diagnosis ranged between 6 months and 16 years (average 6 years). The mean follow-up time was 5.6 years. Twenty-five patients had neurofibromatosis Type 1. During the follow-up period, 59% of the tumors progressed, 23% remained stable, and 18% (all with neurofibromatosis Type 1) displayed some degree of spontaneous regression. Fifty-one percent of the patients presented with visual decline, of whom 90% experienced further deterioration. Nine patients were treated with chemotherapy, 5 of whom improved visually. Ten patients underwent operation, and no local or distal recurrence was noted. CONCLUSIONS Isolated optic nerve gliomas are highly dynamic tumors. Radiological progression and visual deterioration occur in greater percentages than in the general population of patients with OPGs. Response to chemotherapy may be better in this group, and its use should be considered early in the course of the disease.
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Affiliation(s)
- Ben Shofty
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,2Division of Neurosurgery
| | - Liat Ben-Sira
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,3Pediatric Radiology
| | - Anat Kesler
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,4Division of Ophthalmology; and
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Mari L Groves
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Rajiv R Iyer
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Alvaro Lassaletta
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Uri Tabori
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Eric Bouffet
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Ulrich-Wilhelm Thomale
- 7Pediatric Neurosurgery, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Pablo Hernáiz Driever
- 7Pediatric Neurosurgery, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Shlomi Constantini
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,8Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
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Gupta N, Goumnerova L, Ayyanar K, Gump W, Bendel A, Nagib M, Bowers D, Weprin B, Bredlau AL, Gururangan S, Fuchs H, Cohen K, Jallo G, Dorris K, Handler M, Comito M, Dias M, Fangusaro JR, Goldman S, Tomita T, Alden T, DiPatri A, Gardner S, Karajannis M, Harter D, Gauvain K, Limbrick D, Leonard J, Geyer JR, Leary S, Browd S, Khatib Z, Ragheb J, Bhatia S, MacDonald T, Aguilera D, Brahma B, Manley P, Chi S, Mueller S, Banerjee A, Murray J, Nazemi K, Baird L, Robison N, Kiehna E, Krieger M, Sandler E, Aldana P, Wang J, Sood S, Neuberg D, Puligandla M, Greenspan L, Wright K, Prados M, Bandopadhayay P, Ligon K, Kieran M. PDCT-20. FEASIBILITY AND SAFETY OF SURGICAL BIOPSY FOR PATIENTS WITH DIPG: PRELIMINARY RESULTS FROM DIPG-BATS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Gupta N, Goumnerova L, Ayyanar K, Gump W, Bendel A, Nagib M, Bowers D, Weprin B, Bredlau AL, Gururangan S, Fuchs H, Cohen K, Jallo G, Dorris K, Handler M, Comito M, Dias M, Fangusaro J, Goldman S, Tomita T, Alden T, DiPatri A, Gardner S, Karajannis M, Harter D, Gauvain K, Limbrick D, Leonard J, Geyer R, Leary S, Browd S, Khatib Z, Ragheb J, Bhatia S, MacDonald T, Aguilera D, Brahma B, Manley P, Chi S, Mueller S, Banerjee A, Murray J, Nazemi K, Baird L, Robison N, Kiehna E, Krieger M, Sandler E, Aldana P, Wang J, Sood S, Neuberg D, Puligandla M, Greenspan L, Wright K, Prados M, Bandopadhayay P, Ligon K, Kieran M. TRTH-23. FEASIBILITY AND SAFETY OF SURGICAL BIOPSY FOR PATIENTS WITH DIPG: PRELIMINARY RESULTS FROM DIPG-BATS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.234] [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: 11/14/2022] Open
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43
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Abdulaziz M, Mallory GW, Bydon M, De la Garza Ramos R, Ellis JA, Laack NN, Marsh WR, Krauss WE, Jallo G, Gokaslan ZL, Clarke MJ. Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity. Neurosurg Focus 2016; 39:E8. [PMID: 26235025 DOI: 10.3171/2015.5.focus15164] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECT While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. METHODS A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. RESULTS Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7-68 years). The median follow-up was 51.5 months (range 12-243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. CONCLUSIONS A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.
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Affiliation(s)
| | | | - Mohamad Bydon
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Jason A Ellis
- Department of Neurosurgery, Columbia University, New York, New York
| | - Nadia N Laack
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - George Jallo
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Ziya L Gokaslan
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
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Tekes A, Jackson EM, Ogborn J, Liang S, Bledsoe M, Durand DJ, Jallo G, Huisman TAGM. How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center. AJNR Am J Neuroradiol 2016; 37:990-6. [PMID: 26797143 DOI: 10.3174/ajnr.a4658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/12/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months. MATERIALS AND METHODS We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase. RESULTS The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001). CONCLUSIONS Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging.
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Affiliation(s)
- A Tekes
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
| | - E M Jackson
- Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.)
| | - J Ogborn
- Department of Pediatrics (J.O.), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - S Liang
- Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science
| | - M Bledsoe
- Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science
| | - D J Durand
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
| | - G Jallo
- Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.)
| | - T A G M Huisman
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
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45
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Strowd RE, Rodriguez FJ, McLendon RE, Vredenburgh JJ, Chance AB, Jallo G, Olivi A, Ahn ES, Blakeley JO. Histologically benign, clinically aggressive: Progressive non-optic pathway pilocytic astrocytomas in adults with NF1. Am J Med Genet A 2016; 170:1455-61. [PMID: 26992069 DOI: 10.1002/ajmg.a.37622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/01/2016] [Indexed: 11/06/2022]
Abstract
Although optic pathway gliomas are the most common brain tumors associated with neurofibromatosis type 1 (NF1), extra-optic gliomas occur and may behave more aggressively with outcomes that differ by age. A retrospective case-control study was designed to describe the clinical course of adult NF1 patients with progressive extra-optic pilocytic astrocytomas (PAs) and compare to a pediatric cohort. Data for patients treated at the Johns Hopkins Comprehensive Neurofibromatosis Center from 2003 to 2013 were reviewed to identify cases (adults, age >18) and controls (pediatric, age <18) with clinically or radiographically progressive extra-optic PAs. Demographic, clinical, histologic, and radiographic data were collected. Three adult NF1 cases and four pediatric NF1 controls were identified. Mean age was 32.3 ± 9.5 years, 66% male (cases); 12.8 ± 4.2 years, 100% male (controls). Symptomatic progression occurred in two-of-three adults (67%) while the majority of pediatric patients presented with isolated radiographic progression (n = 3, 75%). Onset tended to be more rapid in adults (4 ± 1 vs. 14 ± 8.3 months, P = 0.10). Subtotal resection was the treatment for all pediatric patients. Radiotherapy (n = 2), chemotherapy (n = 2), and targeted, biologic agents (n = 2) were administered in adults. Although all pediatric patients are living, outcomes were universally poor in adults with progression to death in all (median survival 17.1 months, range 6.6-30.3). In conclusion, despite grade I histology, all three adult NF1 patients with progressive extra-optic PAs suffered an aggressive clinical course which was not seen in pediatric patients. Clinicians should be aware of this clinico-histologic discrepancy when counseling and managing adult NF1 patients with progressive extra-optic PAs. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Roger E McLendon
- Division of Neurology, Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - James J Vredenburgh
- Division of Neurology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Aaron B Chance
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alessandro Olivi
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Edward S Ahn
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Narayan A, Jallo G, Huisman TAGM. Extracranial, peritoneal seeding of primary malignant brain tumors through ventriculo-peritoneal shunts in children: Case report and review of the literature. Neuroradiol J 2015; 28:536-9. [PMID: 26443300 DOI: 10.1177/1971400915609348] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Ventriculoperitoneal shunts (VPS) have been implicated as a source of the extraneural spread of a wide variety of central nervous system tumors. The purpose is to review the literature on peritoneal seeding of central nervous system tumors from VPS in the context of a case report. METHODS Medline was searched using the phrase 'peritoneal seeding ventriculoperitoneal shunt'. Inclusion criteria included patients (<18 years) with evidence of peritoneal seeding from VPS. RESULTS Search of the literature revealed a final total of 22 articles and a total of 28 patients. CASE REPORT A 7-year-old boy presented with intermittent vomiting, headaches, photophobia; a 4.4 cm left thalamic mass (glioblastoma multiforme) was found. Occipital VPS catheters were placed for increasing hydrocephalus and the patient developed increased abdominal distention and pain. Computed tomography revealed diffuse ascites with carcinomatosis and the patient was diagnosed clinically with peritoneal metastases. DISCUSSION Our case report and literature review revealed 28 cases of central nervous system tumors demonstrating evidence of extraneural spread associated with VPS in children in a wide variety of tumors. Larger studies are required to evaluate VPS as potential risk factors for peritoneal seeding and familiarity with potential VPS-related peritoneal seeding is important for diagnostic consideration.
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Affiliation(s)
- Anand Narayan
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins Hospital, USA
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Ray P, Kim R, Kim BS, Wilson S, Kothbauer K, Abbott R, Jallo G. Endoscopic third ventriculostomy for the treatment of hydrocephalus: An alternative to shunting. J Pediatr Neurol 2015. [DOI: 10.1055/s-0035-1557343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pulak Ray
- Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
| | - Richard Kim
- Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
| | - Bong-Soo Kim
- Department of Neurosurgery, Temple University Hospital, Philadelphia, USA
| | - Sean Wilson
- Department of Medicine, Yale University, Connecticut, USA
| | - Karl Kothbauer
- Department of Neurosurgery, Katonsspital Luzern, Luzern, Switzerland
| | - Rick Abbott
- Department of Neurosurgery, Montefiore Medical Center, New York, USA
| | - George Jallo
- Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
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Ahn E, Wang J, Jackson E, Jallo G. Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency. Fluids Barriers CNS 2015. [PMCID: PMC4582258 DOI: 10.1186/2045-8118-12-s1-o22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nagle S, Musiek FE, Kossoff EH, Jallo G, Boatman-Reich D. Auditory processing following consecutive right temporal lobe resections: a prospective case study. J Am Acad Audiol 2014; 24:535-43. [PMID: 24047941 DOI: 10.3766/jaaa.24.7.2] [Citation(s) in RCA: 4] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of the right temporal lobe in processing speech is not well understood. Although the left temporal lobe has long been recognized as critical for speech perception, there is growing evidence for right hemisphere involvement. To investigate whether the right temporal lobe is critical for auditory speech processing, we studied prospectively a normal-hearing patient who underwent consecutive right temporal lobe resections for treatment of medically intractable seizures. PURPOSE To test the hypothesis that the right temporal lobe is critical for auditory speech processing. RESEARCH DESIGN We used a prospective, repeated-measure, single-case design. Auditory processing was evaluated using behavioral tests of speech recognition (words, sentences) under multiple listening conditions (e.g., quiet, background noise, etc.). Auditory processing of nonspeech sounds was measured by pitch pattern sequencing and environmental sound recognition tasks. DATA COLLECTION Repeat behavioral testing was performed at four time points over a 2 yr period: before and after consecutive right temporal lobe resection surgeries. RESULTS Before surgery, the patient demonstrated normal speech recognition in quiet and under real-world listening conditions (background noise, filtered speech). After the initial right anterior temporal resection, speech recognition scores declined under adverse listening conditions, especially for the left ear, but remained largely within normal limits. Following resection of the right superior temporal gyrus 1 yr later, speech recognition in quiet and nonspeech sound processing (pitch patterns, environmental sounds) remained intact. However, speech recognition under adverse listening conditions was severely impaired. CONCLUSIONS The right superior temporal gyrus appears to be critical for auditory processing of speech under real-world listening conditions.
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Affiliation(s)
- Stephanie Nagle
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; Department of Audiology, Speech Language Pathology and Deaf Studies, Towson University, Baltimore, MD
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Classen CF, William D, Linnebacher M, Farhod A, Kedr W, Elsabe B, Fadel S, Van Gool S, De Vleeschouwer S, Koks C, Garg A, Ehrhardt M, Riva M, De Vleeschouwer S, Agostinis P, Graf N, Van Gool S, Yao TW, Yoshida Y, Zhang J, Ozawa T, James D, Nicolaides T, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Van Gool S, De Vleeschouwer S, Al-Kofide A, Al-Shail E, Khafaga Y, Al-Hindi H, Dababo M, Haq AU, Anas M, Barria MG, Siddiqui K, Hassounah M, Ayas M, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Vugts D, Hoekstra O, van Dongen G, Kaspers G, Cockle J, Ilett E, Scott K, Bruning-Richardson A, Picton S, Short S, Melcher A, Benesch M, Warmuth-Metz M, von Bueren AO, Hoffmann M, Pietsch T, Kortmann RD, Eyrich M, Graf N, Rutkowski S, Fruhwald MC, Faber J, Kramm C, Porkholm M, Valanne L, Lonnqvist T, Holm S, Lannering B, Riikonen P, Wojcik D, Sehested A, Clausen N, Harila-Saari A, Schomerus E, Thorarinsdottir HK, Lahteenmaki P, Arola M, Thomassen H, Saarinen-Pihkala UM, Kivivuori SM, Buczkowicz P, Hoeman C, Rakopoulos P, Pajovic S, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Gould TWA, Rahman CV, Smith SJ, Barrett DA, Shakesheff KM, Grundy RG, Rahman R, Barua N, Cronin D, Gill S, Lowisl S, Hochart A, Maurage CA, Rocourt N, Vinchon M, Kerdraon O, Escande F, Grill J, Pick VK, Leblond P, Burzynski G, Janicki T, Burzynski S, Marszalek A, Ramani N, Zaky W, Kannan G, Morani A, Sandberg D, Ketonen L, Maher O, Corrales-Medina F, Meador H, Khatua S, Brassesco M, Delsin L, Roberto G, Silva C, Ana L, Rego E, Scrideli C, Umezawa K, Tone L, Kim SJ, Kim CY, Kim IA, Han JH, Choi BS, Ahn HS, Choi HS, Haque F, Rahman R, Layfield R, Grundy R, Gandola L, Pecori E, Biassoni V, Schiavello E, Chiruzzi C, Spreafico F, Modena P, Bach F, Pignoli E, Massimino M, Drogosiewicz M, Dembowska-Baginska B, Jurkiewicz E, Filipek I, Perek-Polnik M, Swieszkowska E, Perek D, Bender S, Jones DT, Warnatz HJ, Hutter B, Zichner T, Gronych J, Korshunov A, Eils R, Korbel JO, Yaspo ML, Lichter P, 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HIGH GRADE GLIOMAS AND DIPG. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou071] [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: 11/14/2022] Open
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