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Guan H, Toraldo G, Godley FA, Rao SR, Cerda S, McAneny D, Doherty G, Lee SL. The real-world performance of ThyroSeqV.2 to diagnose thyroid "neoplasm requiring surgery". Am J Cancer Res 2020; 10:3838-3851. [PMID: 33294271 PMCID: PMC7716163] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023] Open
Abstract
Fine-needle biopsy (FNB) predicts benign or malignant thyroid nodules. For indeterminate (ITN) FNBs, commercial molecular tests may improve the diagnostic accuracy and reduce the number of operations. These tests have had limited independent implementation studies in routine clinical practice. This is a prospective observational study. At Boston Medical Center, the 1,316 consecutive FNBs were classified to one of the six categories in the Bethesda classification system. Those ITN samples were submitted for ThyroSeqV.2 next generation sequencing panel analysis. The performance of ThyroSeqV.2 to predict "neoplasm requiring surgery" (NRS) was evaluated. ThyroSeqV.2 assay was performed in 398 FNBs on 384 cytologically ITN nodules (308 Bethesda III, 47 Bethesda IV and 29 Bethesda V). The first evaluable ThyroSeq result for each nodule was used for final analysis. Seventy-seven (72.0%) of 107 patients with a high risk molecular test underwent thyroid surgery resulting in 41 NRS (53.2%) and 36 benign nodules (46.8%). Of the 249 patients with a low risk or negative molecular analysis, 51 (20.5%) had surgery revealing 47 benign nodules (92.2%) and 4 NRS (7.8%). Based on surgical outcome of 128 ITN with evaluable ThyroSeq results, this molecular test had a sensitivity of 91% (95% CI: 79%-98%), specificity of 56% (45%-67%), positive predictive value (PPV) of 53% (42%-65%), negative predictive value (NPV) of 92% (81%-98%), and an overall accuracy of 69% (55%-85%) with a prevalence of NRS of 35% (27%-44%). ThyroSeqV.2 in this clinical use study in ITN nodules provided a similar NPV but a lower PPV than expected compared to published studies due to the detection of an array of mutations in benign nodules. The NPV of 92.0% for ITN cytology confirmed its utility as a "rule-out" test to exclude NRS.
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Affiliation(s)
- Haixia Guan
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, Guangdong, China
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical CenterBoston, MA, USA
| | - Gianluca Toraldo
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical CenterBoston, MA, USA
- Division of Endocrinology, Diabetes, and Metabolism, Lahey Hospital & Medical CenterBurlington, MA, USA
| | - Frederick A Godley
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical CenterBoston, MA, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public HealthBoston, MA, USA
| | - Sandra Cerda
- Department of Pathology, Boston Medical CenterBoston, MA, USA
| | - David McAneny
- Department of Surgery, Boston Medical CenterBoston, MA, USA
| | - Gerard Doherty
- Department of Surgery, Brigham and Women’s HospitalBoston, MA, USA
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical CenterBoston, MA, USA
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Fazeli SR, Zehr B, Amraei R, Toraldo G, Guan H, Kindelberger D, Lee S, Cerda S. ThyroSeq v2 Testing: Impact on Cytologic Diagnosis, Management, and Cost of Care in Patients with Thyroid Nodule. Thyroid 2020; 30:1528-1534. [PMID: 32349630 DOI: 10.1089/thy.2019.0191] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Novel molecular tests (MTs), such as ThyroSeq, may improve the management of thyroid nodules with indeterminate cytologic diagnoses; however, the impact of these tests on cost and outcome of management is unknown. Here, we evaluated the impact of ThyroSeq testing on the cytopathologic diagnosis, management, and cost of care in patients with thyroid nodules. Methods: In a retrospective study, using actual patient cohorts, the outcome and cost of management of patients with thyroid nodules seen before the introduction of ThyroSeq v2 at our institution (standard of care [StC] cohort) were compared with those seen after the introduction of this test (MT cohort). Results: A total of 773 consecutive patients entered the study (393 StC, 380 MT). The incidence of cytologically benign nodules decreased from 71.0% (StC) to 53.2% (MT) and those of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) increased from 8.9% (StC) to 21.3% (MT) and from 3.1% (StC) to 6.3% (MT), respectively. The overall rate of surgery did not change significantly (23.4% in StC vs. 23.2% in MT). Among patients who underwent surgery, the rate of overtreatment (surgeries performed on histologic benign nodules without clinical indication: compressive symptoms, hyperthyroidism resistant to medication, and nodule size >4 cm) slightly decreased from 18.8% (StC) to 16.7% (MT). The rate of malignancy decreased from 45.5% (StC) to 37.9% (MT) in AUS/FLUS and increased from 40.0% to 53.8% in FN/SFN. However, the overall rate of malignancy remained equal (47.8% in StC vs. 47.7% in MT). The average cost of care per patient in the AUS/FLUS and FN/SFN categories increased from $6,566 (StC) to $8,444 (MT) and from $9,313 (StC) to $10,253 (MT), respectively. Similarly, the overall average cost of care of a patient who underwent thyroid fine-needle aspiration increased from $3,088 (StC) to $4,282 (MT). Finally, the average cost per thyroid cancer detected increased from $26,312 (StC) to $38,746 (MT). Conclusions: Introduction of ThyroSeq v2 resulted in a shift toward indeterminate cytology results. The institutional rate of surgery, overtreatment, and malignancy did not change significantly. Lack of decrease in the rate of surgery along with the additional cost of ThyroSeq v2 increased the overall cost of care of patients including those with indeterminate cytology results.
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Affiliation(s)
- Shoreh R Fazeli
- Department of Pathology & Laboratory Medicine at Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bradley Zehr
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Razie Amraei
- Department of Pathology & Laboratory Medicine at Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gianluca Toraldo
- Lahey Hospital and Medical Center Endocrinology, Burlington, Massachusetts, USA
| | - Haixia Guan
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - David Kindelberger
- Department of Pathology, Harvard Vanguard Medical Associates Atrius Health, Boston, Massachusetts, USA
| | - Stephanie Lee
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Sandra Cerda
- Department of Pathology & Laboratory Medicine at Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
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Guan H, Toraldo G, Cerda S, Godley FA, Rao SR, McAneny D, Doherty G, Braverman L, Lee SL. Utilities of RAS Mutations in Preoperative Fine Needle Biopsies for Decision Making for Thyroid Nodule Management: Results from a Single-Center Prospective Cohort. Thyroid 2020; 30:536-547. [PMID: 31996097 DOI: 10.1089/thy.2019.0116] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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] [Indexed: 12/31/2022]
Abstract
Background: It has been advocated to apply individualized strategies to evaluate thyroid nodules due to the growing awareness that the pathogenesis of thyroid cancer is not uniform. Molecular markers in fine needle biopsies (FNBs) may be helpful for the diagnosis and management decisions. Unlike the detection of BRAF mutations, the clinical utility of rat sarcoma viral oncogene homolog (RAS) mutations has not been fully elucidated. This study aimed at presenting a real-world performance of RAS mutations in identifying thyroid malignancies, at investigating the nature of thyroid tumors carrying RAS mutations, and at providing an additional reference for interpreting how to utilize the presence of RAS mutations in the decision-making process of thyroid nodule management. Methods: Between February 2015 and December 2017, 1400 sequential thyroid biopsies were performed at Boston Medical Center. Of these, 546 FNBs were evaluated for RAS mutations by using a ThyroSeq next-generation sequencing panel. Nodules carrying RAS mutations were prospectively followed, and medical records were collected. Results: ThyroSeq successfully provided molecular information in 504 nodules; 173 with molecular alteration(s); and 80 positive for mutations in the Kirsten-, Neuroblastoma-, or Harvey-RAS genes. RAS gene mutations constituted up to 46.2% of the total molecular alterations found in the study. Fifty-six of the 80 RAS-positive nodules underwent surgery, 33 (58.9%) were confirmed to be benign, 7 (12.5%) were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and 16 (28.6%) were thyroid carcinomas. The positive predictive value, negative predictive value, and accuracy of RAS mutations for identifying malignancies among cytologically indeterminate nodules were 25.5%, 89.7%, and 54.0% when NIFTP was not counted as cancer. A combination of RAS and other mutations increased the risk of malignancy. Twelve histopathologically proved RAS-only-positive malignant nodules all showed low-risk features and favorable prognosis. RAS isoforms added little assistance for predicting a malignancy and the response to therapy in our series. Conclusions:RAS mutations represent the most frequently detected genetic alterations in our series. RAS mutations, when occurring alone, are not helpful markers to identify malignancy among Bethesda III/IV cytologies, but may predict favorable behavior, and hence should be considered to guide initial management.
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Affiliation(s)
- Haixia Guan
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Gianluca Toraldo
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Sandra Cerda
- Department of Pathology, Boston Medical Center, Boston, Massachusetts
| | - Frederick A Godley
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Gerard Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lewis Braverman
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
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Campagna R, Romano A, Raiola A, Masi P, Toraldo G, Cavella S. Effects of UVC treatment on re-milled semolina dough and data — driven analysis of leavening process. Food and Bioproducts Processing 2020. [DOI: 10.1016/j.fbp.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waisayanand N, Goundan P, Guan H, Toraldo G, Lee S. MON-568 Differences in Ultrasound Characteristics, Molecular Analysis, and Management of Indeterminate Thyroid Nodules (ITN) in Older vs. Younger Patients. J Endocr Soc 2019. [PMCID: PMC6550936 DOI: 10.1210/js.2019-mon-568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Thyroid nodules (TN) are common and the prevalence increases with age, however, 95% are benign. Fine-needle aspiration (FNA) is the gold standard to evaluate TN. We previously demonstrated the rate of surgery was significantly lower in the older (O) vs. younger (Y) patients in the subgroup of benign (6.5% vs. 15.7%, P < 0.01) disease. This study will determine if indeterminate TN (ITN) in the O vs. Y patients have differences in ultrasound (US) features, molecular studies and surgical management. Methods 1402 sequential TN (greater than 1 cm) were biopsied from January 2015 - December 2016. Demographic data, US characteristics, molecular studies and pathology results were compared between older ≥ 65 year-old (O) and the younger < 65 year-old (Y) patients. Results/ Discussion The 442 (31.5%) ITN (Bethesda 3, 4, 5) were included in this study. There were 101 patients (22.8%) older than 65 years. The mean age was 72.0 ± 5.6 vs. 47.0 ± 11.4 years in the O and Y groups. There was no difference in gender or TN size (2.6 ± 1.2 vs. 2.6 ± 1.3 cm, P=0.40) between the groups. The O group had less Hispanic patients (10.9% vs. 23.8%, P=0.04) and more multinodular glands (81.4% vs. 67.0%, P=0.01) compared to the Y group. ThyroSeq V.2 molecular test was performed in 96.8% of ITN. Rates of positive mutations were similar (37.6% vs. 34.6%, P=0.86) but the high risk mutations were less common in the O vs. Y group (42.1% vs. 72.9%, P< 0.01). Surgery was performed in 159 (36.0%) ITN. Surgery rates of ITN were lower in the O vs. Y group (27.7% vs 38.4%, P= 0.05). Surgical pathology of all ITN showed benign 57.8%, malignancy 24.7%, and NIFTP 9.2%. Pathology was not different in both groups (P=0.36). Although malignancy occurred in 42.9% vs. 29.8%, P=0.18, in the O vs. Y groups, the difference was not significant. Suspicious US characteristics were not affected by age group (P= 0.66). The ITN with malignant pathology was significantly associated with Bethesda 5 cytology, high risk mutations and US characteristics including hypoechogenicity, undulating/ lobulated/ infiltrative margins, micro-, macrocalcification, and high intranodular blood flow (P< 0.01). In the O group, ITN with malignant pathology was not associated with microcalcification but was associated with hypoechogenicity, abnormal margins, macrocalcification and vascular flow. Conclusions Among ITN in the elderly of our cohort, the frequency of high risk molecular mutations and the surgical rates were lower than in the young adults. The typical high risk US characteristics associated with malignancy can be used to guide the practical ITN management combined with FNA results and molecular studies in the elderly. This study suggests differences in pathology and management of ITN between older and younger patients.
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Affiliation(s)
| | - Poorani Goundan
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, United States
| | - Haixia Guan
- 1st Affiliated Hosp of China Med Univ, Shenyang, , China
| | | | - Stephanie Lee
- Dept of Endo Diabetes and Nutr, Boston Medical Center, Boston, MA, United States
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Guan H, Matonis D, Toraldo G, Lee SL. Clinical Significance of Thyroid-Stimulating Hormone Receptor Gene Mutations and/or Sodium-Iodine Symporter Gene Overexpression in Indeterminate Thyroid Fine Needle Biopsies. Front Endocrinol (Lausanne) 2018; 9:566. [PMID: 30319546 PMCID: PMC6167408 DOI: 10.3389/fendo.2018.00566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine the prevalence of genetic alterations of thyroid-stimulating hormone receptor (TSHR) gene and sodium-iodine symporter (NIS) in a series of thyroid fine needle biopsy (FNB) specimens with indeterminate cytology, and to assess the correlation of the type of genetic changes with clinical features and follow-up results in the target thyroid nodule. Methods: Between February 2015 and September 2017, 388 consecutive FNBs with indeterminate cytology were evaluated for TSHR mutations and NIS gene overexpression using ThyroSeqV.2 next-generation sequencing (NGS) panel. Medical records were reviewed for target nodules. Results: Among 388 indeterminate FNBs, TSHR mutations and/or NIS overexpression were detected in 25 (6.4%) nodules. Ten nodules (2.6%) harbored TSHR mutations only, 7 nodules (1.8%) over-expressed NIS gene only, and 8 nodules (2.1%) had both alterations. The TSHR mutations were located between codons 281 and 640, with codon 453 being the most frequently affected. The allelic frequency of the mutated TSHR ranged from 6 to 36%. One nodule with NIS overexpression was simultaneously detected EIF1AX mutation and GNAS mutation. Nodules with TSHR mutations and/or NIS overexpression presented hyperfunctioning (n = 4), hypofunctioning (n = 5), and isofunctioning (n = 3) on the available thyroid scintigraphies. Eight cases accompanied with hyperthyroidism in which only 1 was caused by the target nodule. Evidence of co-existing autoimmune thyroid disease (AITD) and multinodular goiter were found in 52% and 52% of cases, respectively. Seven nodules underwent surgeries and all were benign on final pathology. None of 9 nodules with follow-up by ultrasound (3~33 mon, median 12 mon) showed grow in size. Conclusions: TSHR mutations and/or NIS overexpression can be detected in pre-operative FNB specimens using the NGS approach. These genetic alterations occurred in 6.4% thyroid nodules in this consecutive series with indeterminate cytology. They present not only in hyperfunctioning nodules but also in hypo- or iso-functional nodules, indicating their prevalence may be higher than previously expected. Co-existing AITD was common in cases with these molecular alterations. None of our patients with TSHR mutations and/or NIS overexpression manifested malignant outcomes. How to use these two molecular markers in thyroid FNBs to guide our clinical practice warrants further investigation.
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Affiliation(s)
- Haixia Guan
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, United States
- *Correspondence: Haixia Guan
| | - Danielle Matonis
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, United States
| | - Gianluca Toraldo
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, United States
| | - Stephanie L. Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, United States
- Stephanie L. Lee
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Guo W, Miller AD, Pencina K, Wong S, Lee A, Yee M, Toraldo G, Jasuja R, Bhasin S. Joint dysfunction and functional decline in middle age myostatin null mice. Bone 2016; 83:141-148. [PMID: 26549246 PMCID: PMC5461924 DOI: 10.1016/j.bone.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022]
Abstract
Since its discovery as a potent inhibitor for muscle development, myostatin has been actively pursued as a drug target for age- and disease-related muscle loss. However, potential adverse effects of long-term myostatin deficiency have not been thoroughly investigated. We report herein that male myostatin null mice (mstn(-/-)), in spite of their greater muscle mass compared to wild-type (wt) mice, displayed more significant functional decline from young (3-6months) to middle age (12-15months) than age-matched wt mice, measured as gripping strength and treadmill endurance. Mstn(-/-) mice displayed markedly restricted ankle mobility and degenerative changes of the ankle joints, including disorganization of bone, tendon and peri-articular connective tissue, as well as synovial thickening with inflammatory cell infiltration. Messenger RNA expression of several pro-osteogenic genes was higher in the Achilles tendon-bone insertion in mstn(-/-) mice than wt mice, even at the neonatal age. At middle age, higher plasma concentrations of growth factors characteristic of excessive bone remodeling were found in mstn(-/-) mice than wt controls. These data collectively indicate that myostatin may play an important role in maintaining ankle and wrist joint health, possibly through negative regulation of the pro-osteogenic WNT/BMP pathway.
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Affiliation(s)
- Wen Guo
- Research Program in Men's Health, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Andrew D Miller
- Section of Anatomic Pathology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, United States
| | - Karol Pencina
- Research Program in Men's Health, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Siu Wong
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Amanda Lee
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Michael Yee
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Gianluca Toraldo
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Ravi Jasuja
- Research Program in Men's Health, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Shalender Bhasin
- Research Program in Men's Health, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Jasuja R, Costello JC, Singh R, Gupta V, Spina CS, Toraldo G, Jang H, Li H, Serra C, Guo W, Chauhan P, Narula NS, Guarneri T, Ergun A, Travison TG, Collins JJ, Bhasin S. Combined administration of testosterone plus an ornithine decarboxylase inhibitor as a selective prostate-sparing anabolic therapy. Aging Cell 2014; 13:303-10. [PMID: 24305501 PMCID: PMC4331775 DOI: 10.1111/acel.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/26/2022] Open
Abstract
Because of its anabolic effects on muscle, testosterone is being explored as a function-promoting anabolic therapy for functional limitations associated with aging; however, concerns about testosterone's adverse effects on prostate have inspired efforts to develop strategies that selectively increase muscle mass while sparing the prostate. Testosterone's promyogenic effects are mediated through upregulation of follistatin. We show here that the administration of recombinant follistatin (rFst) increased muscle mass in mice, but had no effect on prostate mass. Consistent with the results of rFst administration, follistatin transgenic mice with constitutively elevated follistatin levels displayed greater muscle mass than controls, but had similar prostate weights. To elucidate signaling pathways regulated differentially by testosterone and rFst in prostate and muscle, we performed microarray analysis of mRNAs from prostate and levator ani of castrated male mice treated with vehicle, testosterone, or rFst. Testosterone and rFst shared the regulation of many transcripts in levator ani; however, in prostate, 593 transcripts in several growth-promoting pathways were differentially expressed after testosterone treatment, while rFst showed a negligible effect with only 9 transcripts differentially expressed. Among pathways that were differentially responsive to testosterone in prostate, we identified ornithine decarboxylase (Odc1), an enzyme in polyamine biosynthesis, as a testosterone-responsive gene that is unresponsive to rFst. Accordingly, we administered testosterone with and without α-difluoromethylornithine (DFMO), an Odc1 inhibitor, to castrated mice. DFMO selectively blocked testosterone's effects on prostate, but did not affect testosterone's anabolic effects on muscle. Co-administration of testosterone and Odc1 inhibitor presents a novel therapeutic strategy for prostate-sparing anabolic therapy.
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Affiliation(s)
- Ravi Jasuja
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - James C. Costello
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Rajan Singh
- Division of Endocrinology and Metabolism Charles Drew University of Medicine and Science David Geffen School of Medicine at UCLA Los Angeles CA 90059 USA
| | - Vandana Gupta
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Catherine S. Spina
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02215 USA
| | - Gianluca Toraldo
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Hyeran Jang
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Hu Li
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Carlo Serra
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Wen Guo
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Pratibha Chauhan
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Navjot S. Narula
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Tyler Guarneri
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Ayla Ergun
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Thomas G. Travison
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - James J. Collins
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02215 USA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
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Serra C, Sandor NL, Jang H, Lee D, Toraldo G, Guarneri T, Wong S, Zhang A, Guo W, Jasuja R, Bhasin S. The effects of testosterone deprivation and supplementation on proteasomal and autophagy activity in the skeletal muscle of the male mouse: differential effects on high-androgen responder and low-androgen responder muscle groups. Endocrinology 2013; 154:4594-606. [PMID: 24105483 PMCID: PMC3836062 DOI: 10.1210/en.2013-1004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Men with prostate cancer who receive androgen deprivation therapy show profound skeletal muscle loss. We hypothesized that the androgen deficiency activates not only the ubiquitin-proteasome systems but also the autophagy and affects key aspects of the molecular cross talk between protein synthesis and degradation. Here, 2-month-old male mice were castrated and treated with either testosterone (T) propionate or vehicle for 7 days (short term) or 43 days (long term), and with and without hydroxyflutamide. Castrated mice showed rapid and profound atrophy of the levator ani muscle (high androgen responder) at short term and lesser atrophy of the triceps muscle (low androgen responder) at long term. Levator ani and triceps muscles of castrated mice showed increased level of autophagy markers and lysosome enzymatic activity; only the levator ani showed increased proteasomal enzymatic activity. The levator ani muscle of the castrated mice showed increased level and activation of forkhead box protein O3A, the inhibition of mechanistic target of rapamicyn, and the activation of tuberous sclerosis complex protein 2 and 5'-AMP-activated protein kinase. Similar results were obtained in the triceps muscle of castrated mice. T rescued the loss of muscle mass after orchiectomy and inhibited lysosome and proteasome pathways dose dependently and in a seemingly IGF-I-dependent manner. Hydroxyflutamide attenuated the effect of T in the levator ani muscle of castrated mice. In conclusion, androgen deprivation in adult mice induces muscle atrophy associated with proteasomal and lysosomal activity. T optimizes muscle protein balance by modulating the equilibrium between mechanistic target of rapamicyn and 5'-AMP-activated protein kinase pathways.
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Affiliation(s)
- Carlo Serra
- Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115.
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10
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Alamdari N, Toraldo G, Aversa Z, Smith I, Castillero E, Renaud G, Qaisar R, Larsson L, Jasuja R, Hasselgren PO. Loss of muscle strength during sepsis is in part regulated by glucocorticoids and is associated with reduced muscle fiber stiffness. Am J Physiol Regul Integr Comp Physiol 2012; 303:R1090-9. [PMID: 23019215 DOI: 10.1152/ajpregu.00636.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sepsis is associated with impaired muscle function but the role of glucocorticoids in sepsis-induced muscle weakness is not known. We tested the role of glucocorticoids in sepsis-induced muscle weakness by treating septic rats with the glucocorticoid receptor antagonist RU38486. In addition, normal rats were treated with dexamethasone to further examine the role of glucocorticoids in the regulation of muscle strength. Sepsis was induced in rats by cecal ligation and puncture, and muscle force generation (peak twitch and tetanic tension) was determined in lower extremity muscles. In other experiments, absolute and specific force as well as stiffness (reflecting the function of actomyosin cross bridges) were determined in isolated skinned muscle fibers from control and septic rats. Sepsis and treatment with dexamethasone resulted in reduced maximal twitch and tetanic force in intact isolated extensor digitorum longus muscles. The absolute and specific maximal force in isolated muscle fibers was reduced during sepsis together with decreased fiber stiffness. These effects of sepsis were blunted (but not abolished) by RU38486. The results suggest that muscle weakness during sepsis is at least in part regulated by glucocorticoids and reflects loss of contractility at the cellular (individual muscle fiber) level. In addition, the results suggest that reduced function of the cross bridges between actin and myosin (documented as reduced muscle fiber stiffness) may be involved in sepsis-induced muscle weakness. An increased understanding of mechanisms involved in loss of muscle strength will be important for the development of new treatment strategies in patients with this debilitating consequence of sepsis.
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Affiliation(s)
- Nima Alamdari
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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11
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Toraldo G, Bhasin S, Bakhit M, Guo W, Serra C, Safer JD, Bhawan J, Jasuja R. Topical androgen antagonism promotes cutaneous wound healing without systemic androgen deprivation by blocking β-catenin nuclear translocation and cross-talk with TGF-β signaling in keratinocytes. Wound Repair Regen 2012; 20:61-73. [PMID: 22276587 DOI: 10.1111/j.1524-475x.2011.00757.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orchidectomy in rodents and lower testosterone levels in men are associated with improved cutaneous wound healing. However, due to the adverse effects on skeletal and sexual tissues, systemic androgen blockade is not a viable therapeutic intervention. Accordingly, we tested the hypothesis that topical application of an androgen antagonist would elicit accelerated wound healing without systemic androgen antagonism. Full-thickness cutaneous wounds were created on adult C57BL6/J mice. Daily topical application of androgen receptor antagonist, flutamide, resulted in improved gap closure similar to orchiectomized controls and faster than orchidectomized mice treated with topical testosterone. In vivo data showed that the effects of androgen antagonism on wound closure primarily accelerate keratinocytes migration without effecting wound contraction. Consequently, mechanisms of testosterone action on reepithelialization were investigated in vitro by scratch wounding assays in confluent keratinocytes. Testosterone inhibited keratinocyte migration and this effect was in part mediated through promotion of nuclear translocation of β-catenin and by attenuating transforming growth factor-β (TGF-β) signaling through β-catenin. The link between Wnt and TGF beta signaling was confirmed by blocking β-catenin and by following TGF-β-induced transcription of a luciferase reporter gene. Together, these data show that blockade of β-catenin can, as a potential target for novel therapeutic interventions, accelerate cutaneous wound healing.
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Affiliation(s)
- Gianluca Toraldo
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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12
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Serra C, Tangherlini F, Rudy S, Lee D, Toraldo G, Sandor NL, Zhang A, Jasuja R, Bhasin S. Testosterone improves the regeneration of old and young mouse skeletal muscle. J Gerontol A Biol Sci Med Sci 2012; 68:17-26. [PMID: 22499765 DOI: 10.1093/gerona/gls083] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aging is associated with loss of muscle mass and strength, reduced satellite cell number, and lower regenerative potential. Testosterone increases muscle mass, strength, and satellite cell number in humans; however, the effects of testosterone on the regenerative potential of skeletal muscle are unclear. Here, we investigated the effect of testosterone on the skeletal muscle regeneration of young (2-month-old) and aged (24-month-old) male mice. We show that testosterone increases the number of proliferating satellite cells in regenerating "tibialis anterior" muscle of young and aged castrated mice 2 and 4 days postinjury. Testosterone supplementation increases the number and the cross-sectional area of regenerating fibers in both classes of age 4 days postinjury. Testosterone increases satellite cell activation and proliferation and the regeneration of both young and aged mouse muscle. These data suggest prospective application of androgens to improve the regenerating potential of the aged human skeletal muscle.
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Affiliation(s)
- Carlo Serra
- Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston, MA 02118, USA.
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13
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Ward JE, Ren R, Toraldo G, Soohoo P, Guan J, O'Hara C, Jasuja R, Trinkaus-Randall V, Liao R, Connors LH, Seldin DC. Doxycycline reduces fibril formation in a transgenic mouse model of AL amyloidosis. Blood 2011; 118:6610-7. [PMID: 21998211 PMCID: PMC3242721 DOI: 10.1182/blood-2011-04-351643] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 09/22/2011] [Indexed: 12/17/2022] Open
Abstract
Systemic AL amyloidosis results from the aggregation of an amyloidogenic immunoglobulin (Ig) light chain (LC) usually produced by a plasma cell clone in the bone marrow. AL is the most rapidly fatal of the systemic amyloidoses, as amyloid fibrils can rapidly accumulate in tissues including the heart, kidneys, autonomic or peripheral nervous systems, gastrointestinal tract, and liver. Chemotherapy is used to eradicate the cellular source of the amyloidogenic precursor. Currently, there are no therapies that target the process of LC aggregation, fibril formation, or organ damage. We developed transgenic mice expressing an amyloidogenic λ6 LC using the cytomegalovirus (CMV) promoter to circumvent the disruption of B cell development by premature expression of recombined LC. The CMV-λ6 transgenic mice develop neurologic dysfunction and Congophilic amyloid deposits in the stomach. Amyloid deposition was inhibited in vivo by the antibiotic doxycycline. In vitro studies demonstrated that doxycycline directly disrupted the formation of recombinant LC fibrils. Furthermore, treatment of ex vivo LC amyloid fibrils with doxycycline reduced the number of intact fibrils and led to the formation of large disordered aggregates. The CMV-λ6 transgenic model replicates the process of AL amyloidosis and is useful for testing the antifibril potential of orally available agents.
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Affiliation(s)
- Jennifer Ellis Ward
- Amyloid Treatment and Research Program, and Department of Medicine, Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA
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14
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Kumar R, Zakharov MN, Khan SH, Miki R, Jang H, Toraldo G, Singh R, Bhasin S, Jasuja R. The dynamic structure of the estrogen receptor. J Amino Acids 2011; 2011:812540. [PMID: 22312471 PMCID: PMC3268042 DOI: 10.4061/2011/812540] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/06/2011] [Indexed: 01/12/2023]
Abstract
The estrogen receptor (ER) mediates most of the biological effects of estrogens at the level of gene regulation by interacting through its site-specific DNA and with other coregulatory proteins. In recent years, new information regarding the dynamic structural nature of ER has emerged. The physiological effects of estrogen are manifested through ER's two isoforms, ERα and ERβ. These two isoforms (ERα and ERβ) display distinct regions of sequence homology. The three-dimensional structures of the DNA-binding domain (DBD) and ligand-binding domain (LBD) have been solved, whereas no three-dimensional natively folded structure for the ER N-terminal domain (NTD) is available to date. However, insights about the structural and functional correlations regarding the ER NTD have recently emerged. In this paper, we discuss the knowledge about the structural characteristics of the ER in general and how the structural features of the two isoforms differ, and its subsequent role in gene regulation.
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Affiliation(s)
- Raj Kumar
- Department of Basic Sciences, The Commonwealth Medical College, Scranton, PA 18510, USA
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15
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Abstract
In an attempt to elucidate the in vivo process of protein aggregation and mechanisms of amyloid organ disease, we have engineered a genetically defined mouse model of AL amyloidosis. These transgenic mice broadly expressing a human amyloidogenic lambda 6 immunoglobulin light chain (LC) using a cytomegalovirus (CMV) promoter have circulating LC and develop typical Congo red-positive amyloid deposits in the stomach, previously described at the XIth International Symposium on Amyloidosis in Woods Hole [1]. The CMV-lambda 6 transgenic mice display neurologic and metabolic phenotypes. The transgenic mice are larger and have metabolic dysregulation, accompanied by a decreased respiratory exchange ratio, indicating preferential lipid oxidation. With age, the mice develop hyperglycemia upon glucose challenge. We hypothesize that this may be due to a non-fibril-dependent effect of overexpression of LC in tissues, perhaps pancreas.
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Affiliation(s)
- J E Ward
- Department of Pathology, Boston University, Gerry Amyloid Research Laboratory, Boston University School of Medicine, Boston, MA, USA
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16
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Camanni G, Toraldo G, Rosignoli D, Pippi R, Schiaroli E, Angeletti G, Baldelli F, Francisci D. Biochemical markers of bone turnover and calcium dietary intake evaluation in HIV-infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p118] [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: 11/10/2022] Open
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18
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Li Y, Toraldo G, Li A, Yang X, Zhang H, Qian WP, Weitzmann MN. B cells and T cells are critical for the preservation of bone homeostasis and attainment of peak bone mass in vivo. Blood 2007; 109:3839-48. [PMID: 17202317 PMCID: PMC1874582 DOI: 10.1182/blood-2006-07-037994] [Citation(s) in RCA: 320] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Bone homeostasis is regulated by a delicate balance between osteoblastic bone formation and osteoclastic bone resorption. Osteoclastogenesis is controlled by the ratio of receptor activator of NF-kappaB ligand (RANKL) relative to its decoy receptor, osteoprotegerin (OPG). The source of OPG has historically been attributed to osteoblasts (OBs). While activated lymphocytes play established roles in pathological bone destruction, no role for lymphocytes in basal bone homeostasis in vivo has been described. Using immunomagnetic isolation of bone marrow (BM) B cells and B-cell precursor populations and quantitation of their OPG production by enzyme-linked immunosorbent assay (ELISA) and real-time reverse transcriptase-polymerase chain reaction (RT-PCR), cells of the B lineage were found to be responsible for 64% of total BM OPG production, with 45% derived from mature B cells. Consistently B-cell knockout (KO) mice were found to be osteoporotic and deficient in BM OPG, phenomena rescued by B-cell reconstitution. Furthermore, T cells, through CD40 ligand (CD40L) to CD40 costimulation, promote OPG production by B cells in vivo. Consequently, T-cell-deficient nude mice, CD40 KO mice, and CD40L KO mice display osteoporosis and diminished BM OPG production. Our data suggest that lymphocytes are essential stabilizers of basal bone turnover and critical regulators of peak bone mass in vivo.
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Affiliation(s)
- Yan Li
- Division of Endocrinology & Metabolism & Lipids, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA
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19
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Severino G, Monetti VM, Santini A, Toraldo G. Unsaturated Transport with Linear Kinetic Sorption Under Unsteady Vertical Flow. Transp Porous Media 2006. [DOI: 10.1007/s11242-005-4424-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Ambrogini E, Toraldo G, Marcocci C. Post-menopausal osteoporosis: is it an autoimmune disease? J Endocrinol Invest 2005; 28:43-7. [PMID: 16550722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Recent studies have suggested a possible role of T-cells and tumor necrosis factor-alpha (TNF-alpha) in the pathogenesis of bone loss which occurs in systemic inflammatory diseases. The relevance of T-cells activity in bone loss due to estrogen deficiency has been investigated in recent years by Dr. Pacifici's group. They have shown that the increased presence of TNF-alpha producing T-cells is essential for the changes in bone metabolism during estrogen deficiency. Lack of estrogen increases interferon-y (INF-y) production by helper T-cells, which through complex class II an increased expression of major histocompatibility complex class II (MCHII) on antigen presenting cells, enhances the activation and proliferation of TNF-alpha producing T-cells. The protective role of estrogen on bone loss is mediated by type beta transforming growth factor (TGF-beta), which blocks T-cell activation and T-cell TNF-alpha production by repressing antigen presentation.
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Affiliation(s)
- E Ambrogini
- Department of Endocrinology and Metabolism, University of Pisa, Pisa Italy
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21
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Gao Y, Qian WP, Dark K, Toraldo G, Lin ASP, Guldberg RE, Flavell RA, Weitzmann MN, Pacifici R. Estrogen prevents bone loss through transforming growth factor beta signaling in T cells. Proc Natl Acad Sci U S A 2004; 101:16618-23. [PMID: 15531637 PMCID: PMC534514 DOI: 10.1073/pnas.0404888101] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Estrogen (E) deficiency leads to an expansion of the pool of tumor necrosis factor (TNF)-producing T cells through an IFN-gamma-dependent pathway that results in increased levels of the osteoclastogenic cytokine TNF in the bone marrow. Disregulated IFN-gamma production is instrumental for the bone loss induced by ovariectomy (ovx), but the responsible mechanism is unknown. We now show that mice with T cell-specific blockade of type beta transforming growth factor (TGFbeta) signaling are completely insensitive to the bone-sparing effect of E. This phenotype results from a failure of E to repress IFN-gamma production, which, in turn, leads to increased T cell activation and T cell TNF production. Furthermore, ovx blunts TGFbeta levels in the bone marrow, and overexpression of TGFbeta in vivo prevents ovx-induced bone loss. These findings demonstrate that E prevents bone loss through a TGFbeta-dependent mechanism, and that TGFbeta signaling in T cells preserves bone homeostasis by blunting T cell activation. Thus, stimulation of TGFbeta production in the bone marrow is a critical "upstream" mechanism by which E prevents bone loss, and enhancement of TGFbeta levels in vivo may constitute a previously undescribed therapeutic approach for preventing bone loss.
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Affiliation(s)
- Yuhao Gao
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
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22
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Cenci S, Toraldo G, Weitzmann MN, Roggia C, Gao Y, Qian WP, Sierra O, Pacifici R. Estrogen deficiency induces bone loss by increasing T cell proliferation and lifespan through IFN-gamma-induced class II transactivator. Proc Natl Acad Sci U S A 2003; 100:10405-10. [PMID: 12923292 PMCID: PMC193574 DOI: 10.1073/pnas.1533207100] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [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: 03/13/2003] [Indexed: 12/22/2022] Open
Abstract
Expansion of the pool of tumor necrosis factor (TNF)-alpha-producing T cells is instrumental for the bone loss induced by estrogen deficiency, but the responsible mechanism is unknown. Here we show that ovariectomy up-regulates IFN-gamma-induced class II transactivator, a multitarget immune modulator, resulting in increased antigen presentation by macrophages, enhanced T cell activation, and prolonged lifespan of active T cells. Up-regulation of class II transactivator derives from increased production of IFN-gamma by T helper 1 cells, resulting from enhanced secretion of IL-12 and IL-18 by macrophages. The resulting T cell expansion and bone loss are prevented in vivo by both blockade of antigen presenting cell-induced T cell activation, and silencing of IFN-gamma receptor signaling. Thus, increased IFN-gamma-induced class II transactivator expression and the resulting enhanced T cell proliferation and lifespan are critical to the bone wasting effect of estrogen deficiency.
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Affiliation(s)
- Simone Cenci
- Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, GA 30322, USA
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23
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Toraldo G, Roggia C, Qian WP, Pacifici R, Weitzmann MN. IL-7 induces bone loss in vivo by induction of receptor activator of nuclear factor kappa B ligand and tumor necrosis factor alpha from T cells. Proc Natl Acad Sci U S A 2003; 100:125-30. [PMID: 12490655 PMCID: PMC140902 DOI: 10.1073/pnas.0136772100] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.3] [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] [Indexed: 12/13/2022] Open
Abstract
IL-7, a powerful lymphopoietic cytokine, is elevated in rheumatoid arthritis (RA) and known to induce bone loss when administered in vivo. IL-7 has been suggested to induce bone loss, in part, by stimulating the proliferation of B220(+) cells, a population capable of acting as early osteoclast (OC) precursors. However, the mechanism by which IL-7 leads to differentiation of precursors into mature OCs remains unknown. We previously reported that, in vitro, IL-7 up-regulated T cell cytokines including receptor activator of nuclear factor kappaB ligand (RANKL). To demonstrate the importance of T cells to the bone-wasting effect of IL-7 in vivo, we have now examined IL-7-induced bone loss in T cell-deficient nude mice. We show that T cell-replete mice undergo significant osteoclastic bone loss after IL-7 administration, concurrent with induction of RANKL and tumor necrosis factor alpha (TNF-alpha) secretion by splenic T cells. In contrast, nude mice were resistant to IL-7-induced bone loss and showed no detectable increase in either RANKL or TNF-alpha, despite an up-regulation of B220(+) cells. Importantly, T cell adoptive transfer into nude mice restored IL-7-induced bone loss, and RANKL and TNF-alpha secretion, demonstrating that T cells are essential mediators of IL-7-induced bone loss in vivo.
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Affiliation(s)
- Gianluca Toraldo
- Division of Bone and Mineral Diseases, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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24
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Weitzmann MN, Roggia C, Toraldo G, Weitzmann L, Pacifici R. Increased production of IL-7 uncouples bone formation from bone resorption during estrogen deficiency. J Clin Invest 2003. [PMID: 12464669 DOI: 10.1172/jci0215687] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Postmenopausal bone loss stems from the inability of osteoblastic activity to match the increase in osteoclastic bone resorption induced by estrogen deficiency. However, the mechanism that uncouples osteoblast from osteoclast activities remains unexplained. We show that ovariectomy enhances the production of the osteoclastogenic cytokine IL-7, and that its neutralization in vivo prevents ovariectomy-induced bone loss. Surprisingly, serum osteocalcin levels, a biochemical marker of bone formation, suggested that the bone-sparing effects of IL-7 neutralization were due not only to inhibition of bone resorption, but also to stimulation of bone formation. Consistent with these data, addition of IL-7 to neonatal calvarial organ cultures blocked new bone formation, and injection of IL-7 into mice in vivo inhibited bone formation as measured by calcein incorporation into long bones. The antianabolic effects of IL-7 were consistent with an observed downregulation of the osteoblast-specific transcription factor core-binding factor alpha1/Runx2. Thus, because it targets both the osteoclast and the osteoblast pathways, IL-7 is central to the altered bone turnover characteristic of estrogen deficiency.
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Affiliation(s)
- M Neale Weitzmann
- Division of Bone and Mineral Diseases, Washington University School of Medicine and Barnes Jewish Hospital, St. Louis, Missouri, USA.
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25
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Weitzmann MN, Roggia C, Toraldo G, Weitzmann L, Pacifici R. Increased production of IL-7 uncouples bone formation from bone resorption during estrogen deficiency. J Clin Invest 2002; 110:1643-50. [PMID: 12464669 PMCID: PMC151629 DOI: 10.1172/jci15687] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Postmenopausal bone loss stems from the inability of osteoblastic activity to match the increase in osteoclastic bone resorption induced by estrogen deficiency. However, the mechanism that uncouples osteoblast from osteoclast activities remains unexplained. We show that ovariectomy enhances the production of the osteoclastogenic cytokine IL-7, and that its neutralization in vivo prevents ovariectomy-induced bone loss. Surprisingly, serum osteocalcin levels, a biochemical marker of bone formation, suggested that the bone-sparing effects of IL-7 neutralization were due not only to inhibition of bone resorption, but also to stimulation of bone formation. Consistent with these data, addition of IL-7 to neonatal calvarial organ cultures blocked new bone formation, and injection of IL-7 into mice in vivo inhibited bone formation as measured by calcein incorporation into long bones. The antianabolic effects of IL-7 were consistent with an observed downregulation of the osteoblast-specific transcription factor core-binding factor alpha1/Runx2. Thus, because it targets both the osteoclast and the osteoblast pathways, IL-7 is central to the altered bone turnover characteristic of estrogen deficiency.
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Affiliation(s)
- M Neale Weitzmann
- Division of Bone and Mineral Diseases, Washington University School of Medicine and Barnes Jewish Hospital, St. Louis, Missouri, USA.
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26
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Roggia C, Gao Y, Cenci S, Weitzmann MN, Toraldo G, Isaia G, Pacifici R. Up-regulation of TNF-producing T cells in the bone marrow: a key mechanism by which estrogen deficiency induces bone loss in vivo. Proc Natl Acad Sci U S A 2001; 98:13960-5. [PMID: 11717453 PMCID: PMC61149 DOI: 10.1073/pnas.251534698] [Citation(s) in RCA: 369] [Impact Index Per Article: 16.0] [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: 05/30/2001] [Accepted: 10/09/2001] [Indexed: 11/18/2022] Open
Abstract
In vivo studies have shown T cells to be central to the mechanism by which estrogen deficiency induces bone loss, but the mechanism involved remains, in part, undefined. In vitro, T cells from ovariectomized mice produce increased amounts of tumor necrosis factor (TNF), which augments receptor activator of NF-kappa B ligand (RANKL)-induced osteoclastogenesis. However, both the mechanism and the relevance of this phenomenon in vivo remain to be established. In this study, we found that ovariectomy increased the number of bone marrow T cell-producing TNF without altering production of TNF per T cell. Attesting to the essential contribution of TNF, ovariectomy induced rapid bone loss in wild type (wt) mice but failed to do so in TNF-deficient (TNF(-/-)) mice. Furthermore, ovariectomy induced bone loss, which was absent in T cell-deficient nude mice, was restored by adoptive transfer of wt T cells, but not by reconstitution with T cells from TNF(-/-) mice. These findings demonstrate the key causal role of T cell-produced TNF in the bone loss after estrogen withdrawal. Finally, ovariectomy caused bone loss in wt mice and in mice lacking p75 TNF receptor but failed to do so in mice lacking the p55 TNF receptor. These findings demonstrate that enhanced T cell production of TNF resulting from increased bone marrow T cell number is a key mechanism by which estrogen deficiency induces bone loss in vivo. The data also demonstrate that the bone-wasting effect of TNF in vivo is mediated by the p55 TNF receptor.
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MESH Headings
- Animals
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Antigens, CD/physiology
- Bone Marrow Cells/cytology
- Bone Marrow Cells/metabolism
- Cells, Cultured
- Estrogens/metabolism
- Estrogens/physiology
- Female
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Nude
- Osteoporosis/metabolism
- Ovariectomy
- Receptors, Tumor Necrosis Factor/genetics
- Receptors, Tumor Necrosis Factor/metabolism
- Receptors, Tumor Necrosis Factor/physiology
- Receptors, Tumor Necrosis Factor, Type I
- Receptors, Tumor Necrosis Factor, Type II
- T-Lymphocytes/cytology
- T-Lymphocytes/metabolism
- Tumor Necrosis Factor-alpha/biosynthesis
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/metabolism
- Tumor Necrosis Factor-alpha/physiology
- Up-Regulation
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Affiliation(s)
- C Roggia
- Division of Bone and Mineral Diseases, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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Srivastava S, Toraldo G, Weitzmann MN, Cenci S, Ross FP, Pacifici R. Estrogen decreases osteoclast formation by down-regulating receptor activator of NF-kappa B ligand (RANKL)-induced JNK activation. J Biol Chem 2001; 276:8836-40. [PMID: 11121427 DOI: 10.1074/jbc.m010764200] [Citation(s) in RCA: 271] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The differentiation of cells of the monocytic lineage into mature osteoclasts (OC) is specifically induced by the tumor necrosis factor-related factor, RANKL (receptor activator of NF-kappaB ligand; also known as OPGL, ODF, or TRANCE). Because inhibition of osteoclastogenesis is one of the main mechanisms by which estrogen (E2) prevents bone loss, it is likely that E2 may regulate either the production of, or the target cell responsiveness to RANKL. We found that E2 decreases the differentiation into OC of both murine bone marrow monocytes and RAW 264.7 cells, a monocytic line, by down-regulating the activation of Jun N-terminal kinase 1 (JNK1). Diminished JNK1 activity results in decreased nuclear levels of the key osteoclastogenic transcription factors, c-Fos and c-Jun, and lower binding of these transcriptional inducers to DNA. Thus, one novel mechanism by which E2 down-regulates osteoclastogenesis is by decreasing the responsiveness of OC precursors to RANKL.
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Affiliation(s)
- S Srivastava
- Division of Bone and Mineral Diseases and Department of Pathology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA
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Gambelunghe G, Forini F, Laureti S, Murdolo G, Toraldo G, Santeusanio F, Brunetti P, Sanjeevi CB, Falorni A. Increased risk for endocrine autoimmunity in Italian type 2 diabetic patients with GAD65 autoantibodies. Clin Endocrinol (Oxf) 2000; 52:565-73. [PMID: 10792335 DOI: 10.1046/j.1365-2265.2000.00983.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Glutamic acid decarboxylase (GAD)65 autoantibodies (GAD65Ab) in type 2 diabetic subjects with secondary failure to sulphonylurea treatment identify the so-called latent autoimmune diabetes of the adult (LADA). The aim of our study was to estimate the risk for endocrine autoimmunity in type 2 diabetic subjects with GAD65Ab. DESIGN AND PATIENTS We analysed serum samples from 600 adult subjects with a clinical diagnosis of type 2 diabetes mellitus for the presence and levels of GAD65Ab and antibodies directed against the islet autoantigen IA-2/ICA512 (IA-2/ICA512Ab). All the patients had been treated initially with hypoglycaemic agents and/or diet for at least 1 year. GAD65Ab+ subjects were studied for the presence of thyroid peroxidase autoantibodies (TPOAb), 21 hydroxylase autoantibodies (21OHAb) and frequency of HLA class II haplotypes. RESULTS GAD65Ab were found in 67/600 (11%) and IA-2/ICA512Ab in 12/600 (2%) subjects (P < 0.0001). The presence of GAD65Ab, but not that of IA-2/ICA512Ab, was significantly associated with insulin therapy, low BMI (P < 0.0001) and low basal C-peptide (P < 0.01). Islet-cell antibodies (ICA) were detected in 43/67 (64%) GAD65Ab+ and in 10/12 (83%) IA-2/ICA512Ab + subjects. TPOAb occurred more frequently in GAD65Ab+ (16/67, 24%) than in GAD65Ab-subjects (9/174, 5%) (P < 0.0001). 21OHAb were detected only in GAD65Ab+ subjects (3/67, 4.5%) (P = 0.03 vs. GAD65Ab-subjects). None of the 21OHAb+ subjects had metabolic or clinical signs of adrenal dysfunction. HLA-DRB1*03-DQA1*0501-DQB1*0201 (DR3-DQ2) was significantly more frequent in GAD65Ab+ subjects than in healthy controls (OR = 5.42, corrected P < 0.0026). The presence of TPOAb was significantly associated with DR3-DQ2 (P = 0.024). CONCLUSIONS Our study demonstrates that the presence of GAD65Ab identifies a subgroup of type 2 diabetic patients with high risk for thyroid and adrenal autoimmunity, and that both GAD65Ab and TPOAb are associated with the presence of HLA-DR3-DQ2, in these patients.
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Affiliation(s)
- G Gambelunghe
- Department of Internal Medicine and Endocrine & Metabolic Sciences, University of Perugia, Perugia, Italy
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Barbato F, Caliendo G, La Rotonda MI, Silipo C, Toraldo G, Vittoria A. Distribution Coefficients by Curve Fitting: Application to Ionogenic Nonsteroidal Antiinflammatory Drugs. ACTA ACUST UNITED AC 1986. [DOI: 10.1002/qsar.19860050303] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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