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Kataria T, Rajamani S, Ayubi AB, Bronner M, Jedrzkiewicz J, Knudsen BS, Elhabian SY. Automating Ground Truth Annotations for Gland Segmentation Through Immunohistochemistry. Mod Pathol 2023; 36:100331. [PMID: 37716506 DOI: 10.1016/j.modpat.2023.100331] [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: 03/21/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
Microscopic evaluation of glands in the colon is of utmost importance in the diagnosis of inflammatory bowel disease and cancer. When properly trained, deep learning pipelines can provide a systematic, reproducible, and quantitative assessment of disease-related changes in glandular tissue architecture. The training and testing of deep learning models require large amounts of manual annotations, which are difficult, time-consuming, and expensive to obtain. Here, we propose a method for automated generation of ground truth in digital hematoxylin and eosin (H&E)-stained slides using immunohistochemistry (IHC) labels. The image processing pipeline generates annotations of glands in H&E histopathology images from colon biopsy specimens by transfer of gland masks from KRT8/18, CDX2, or EPCAM IHC. The IHC gland outlines are transferred to coregistered H&E images for training of deep learning models. We compared the performance of the deep learning models to that of manual annotations using an internal held-out set of biopsy specimens as well as 2 public data sets. Our results show that EPCAM IHC provides gland outlines that closely match manual gland annotations (Dice = 0.89) and are resilient to damage by inflammation. In addition, we propose a simple data sampling technique that allows models trained on data from several sources to be adapted to a new data source using just a few newly annotated samples. The best performing models achieved average Dice scores of 0.902 and 0.89 on Gland Segmentation and Colorectal Adenocarcinoma Gland colon cancer public data sets, respectively, when trained with only 10% of annotated cases from either public cohort. Altogether, the performances of our models indicate that automated annotations using cell type-specific IHC markers can safely replace manual annotations. Automated IHC labels from single-institution cohorts can be combined with small numbers of hand-annotated cases from multi-institutional cohorts to train models that generalize well to diverse data sources.
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Affiliation(s)
- Tushar Kataria
- Kahlert School of Computing, University of Utah, Salt Lake City, Utah; Kahlert School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Saradha Rajamani
- Kahlert School of Computing, University of Utah, Salt Lake City, Utah; Kahlert School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Abdul Bari Ayubi
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Mary Bronner
- Department of Pathology, University of Utah, Salt Lake City, Utah; Department of Pathology, ARUP Laboratories, Salt Lake City, Utah
| | - Jolanta Jedrzkiewicz
- Department of Pathology, University of Utah, Salt Lake City, Utah; Department of Pathology, ARUP Laboratories, Salt Lake City, Utah
| | - Beatrice S Knudsen
- Kahlert School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah; Department of Pathology, University of Utah, Salt Lake City, Utah.
| | - Shireen Y Elhabian
- Kahlert School of Computing, University of Utah, Salt Lake City, Utah; Kahlert School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah.
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Wilcock DM, Moore KH, Rowe L, Mahlow J, Jedrzkiewicz J, Cleary AS, Lomo L, Ruano AL, Gering M, Bradshaw D, Maughan M, Tran P, Burlingame J, Davis R, Affolter K, Albertson DJ, Adelhardt P, Kim JT, Coleman JF, Deftereos G, Gulbahce EH, Sirohi D. Quantitative Imaging Analysis Fluorescence In Situ Hybridization Validation for Clinical HER2 Testing in Breast Cancer. Arch Pathol Lab Med 2023; 147:1402-1412. [PMID: 36920020 DOI: 10.5858/arpa.2022-0372-oa] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 03/16/2023]
Abstract
CONTEXT.— Quantitative imaging is a promising tool that is gaining wide use across several areas of pathology. Although there has been increasing adoption of morphologic and immunohistochemical analysis, the adoption of evaluation of fluorescence in situ hybridization (FISH) on formalin-fixed, paraffin-embedded tissue has been limited because of complexity and lack of practice guidelines. OBJECTIVE.— To perform human epidermal growth factor receptor 2 (HER2) FISH validation in breast carcinoma in accordance with the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2018 guideline. DESIGN.— Clinical validation of HER2 FISH was performed using the US Food and Drug Administration-approved dual-probe HER2 IQFISH (Dako, Carpinteria, California) with digital scanning performed on a PathFusion (Applied Spectral Imaging, Carlsbad, California) system. Validation parameters evaluated included z-stacking, classifier, accuracy, precision, software, and hardware settings. Finally, we evaluated the performance of digital enumeration on clinical samples in a real-world setting. RESULTS.— The accuracy samples showed a final concordance of 95.3% to 100% across HER2 groups 1 to 5. During clinical implementation for HER2 groups 2, 3, and 4, we achieved a final concordance of 76% (95 of 125). Of these cases, only 8% (10 of 125) had discordances with clinical impact that could be identified algorithmically and triaged for manual review. CONCLUSIONS.— Digital FISH enumeration is a useful tool to improve the efficacy of HER2 FISH enumeration and capture genetic heterogeneity across HER2 signals. Excluding cases with high background or poor image quality and manual review of cases with ASCO/CAP group discordances can further improve the efficiency of digital HER2 FISH enumeration.
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Affiliation(s)
- Diane M Wilcock
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Kristina H Moore
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Leslie Rowe
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Jonathan Mahlow
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Jolanta Jedrzkiewicz
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Allison S Cleary
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Lesley Lomo
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Ana L Ruano
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Maarika Gering
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Derek Bradshaw
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Meghan Maughan
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Phuong Tran
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Jesse Burlingame
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Richard Davis
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Kajsa Affolter
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Daniel J Albertson
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Parisa Adelhardt
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Jong Take Kim
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Joshua F Coleman
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Georgios Deftereos
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Evin H Gulbahce
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
| | - Deepika Sirohi
- From the Institute for Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah (Wilcock, Moore, Rowe, Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Gering, Bradshaw, Maughan, Tran, Burlingame, Davis, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
- The Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City (Mahlow, Jedrzkiewicz, Cleary, Lomo, Ruano, Affolter, Albertson, Adelhardt, Kim, Coleman, Deftereos, Gulbahce, Sirohi)
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Wilcock D, Sirohi D, Albertson D, Cleary AS, Coleman JF, Jedrzkiewicz J, Mahlow J, Ruano AL, Gulbahce HE. Clinicopathologic Features of Breast Carcinoma With 2018 American Society of Clinical Oncology/College of American Pathologists Fluorescence In Situ Hybridization Group 3 (Human Epidermal Growth Factor Receptor 2 Chromosome 17 Centromere Ratio <2.0 and Average Human Epidermal Growth Factor Receptor 2 Copy Number ≥6.0) Breast Cancers. Arch Pathol Lab Med 2023:496776. [PMID: 37934954 DOI: 10.5858/arpa.2023-0275-oa] [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] [Accepted: 08/25/2023] [Indexed: 11/09/2023]
Abstract
CONTEXT.— The American Society of Clinical Oncology/College of American Pathologists 2018 update of the human epidermal growth factor receptor 2 (HER2) testing guideline includes a fluorescence in situ hybridization (FISH) group with a HER2 to chromosome 17 centromere (CEP17) ratio less than 2.0 and HER2 copy number 6.0 or greater (group 3), which requires integrated review of HER2 immunohistochemistry (IHC). OBJECTIVE.— To assess the clinicopathologic features of group 3 patients and determine features associated with HER2-positive status after workup. DESIGN.— Cases submitted for HER2 FISH between January 2019 and June 2022 were identified, and relevant clinicopathologic information was obtained. RESULTS.— One hundred forty-two HER2 FISH cases (1.6%) were group 3. In 52 cases (36.6%) IHC was negative (0/1+), in 3 (2.8%) IHC was positive (3+), and in 86 (60.6%) IHC was 2+. Annotated IHC 2+ slides were recounted by a second reviewer in targeted areas, where 16 of 86 (18.6%) had a HER2:CEP17 ratio less than 2.0 and a HER2 copy number of 4.0 or greater to less than 6.0 (HER2 negative). After combined IHC/FISH review, 74 of 142 (52.1%) were classified as HER2 positive. HER2 copy number/cell was higher in HER2-positive compared with HER2-negative cases after the workup. The extent and intensity of staining in IHC 2+ cases did not correlate with the level of gene amplification. Twenty percent of HER2-positive patients achieved pathologic complete response. CONCLUSIONS.— About half of group 3 cases were classified as HER2 positive after additional workup. Pathologic complete response rates in HER2-positive cases were lower than expected for group 1 (HER2:CEP17 ratio ≥2.0; HER2 copy number ≥4.0) patients. IHC targeted FISH recounts may be redundant and may potentially lead to classification of some patients as HER2 negative, resulting in withholding of targeted therapy.
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Affiliation(s)
- Diane Wilcock
- From ARUP Laboratories, Salt Lake City, Utah (Wilcock)
| | - Deepika Sirohi
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Daniel Albertson
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Allison S Cleary
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Joshua F Coleman
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Jolanta Jedrzkiewicz
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Jonathan Mahlow
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - Ana L Ruano
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
| | - H Evin Gulbahce
- the Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute, University of Utah Health, Salt Lake City (Sirohi, Albertson, Cleary, Coleman, Jedrzkiewicz, Mahlow, Ruano, Gulbahce)
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Yathavan B, Ellis A, Jedrzkiewicz J, Subrahmanyam N, Khurana N, Pulsipher A, Alt JA, Ghandehari H. Systemic administration of budesonide in pegylated liposomes for improved efficacy in chronic rhinosinusitis. J Control Release 2023; 360:274-284. [PMID: 37353160 DOI: 10.1016/j.jconrel.2023.06.030] [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: 02/28/2023] [Revised: 05/18/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
Chronic rhinosinusitis (CRS) is a chronic inflammatory condition affecting the nasal and paranasal sinuses of approximately 11.5% of the United States adult population. Oral corticosteroids are effective in controlling sinonasal inflammation in CRS, but the associated adverse effects limit their clinical use. Topical budesonide has demonstrated clinical efficacy in patients with CRS. Herein, we investigated the systemic delivery of liposomes tethered with poly(ethylene glycol) (PEG) and loaded with budesonide in a murine model of CRS. PEGylated liposomes encapsulated with budesonide phosphate (L-BudP) were administered via tail vein injection, and the feasibility of L-BudP to reduce sinonasal inflammation was compared to that of free budesonide phosphate (F-BudP) and topical budesonide phosphate (T-BudP) treatment over a 14-day study period. Compared to a single injection of F-BudP and repeat T-BudP administration, a single injection of L-BudP demonstrated increased and prolonged efficacy, resulting in the significant improvement of sinonasal tissue histopathological scores (p < 0.05) with decreased immune cell infiltration (p < 0.05). Toxicities associated with L-BudP and T-BudP treatment, assessed via body and organ weight, as well as peripheral blood liver enzyme and differential white blood cell analyses, were transient and comparable. These data suggest that systemic liposomal budesonide treatment results in improved efficacy over topical treatment.
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Affiliation(s)
- Bhuvanesh Yathavan
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Alexa Ellis
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Nithya Subrahmanyam
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Nitish Khurana
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Abigail Pulsipher
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeremiah A Alt
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Hamidreza Ghandehari
- Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA.
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Boylan K, Kanth P, Delker D, Hazel MW, Boucher KM, Affolter K, Clayton F, Evason K, Jedrzkiewicz J, Pletneva M, Samowitz W, Swanson E, Bronner MP. Three Pathologic Criteria for Reproducible Diagnosis of Colonic Sessile Serrated Lesion Versus Hyperplastic Polyp. Hum Pathol 2023; 137:25-35. [PMID: 37044202 DOI: 10.1016/j.humpath.2023.04.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Colonic sessile serrated lesions are thought to predispose to ∼30% of colonic adenocarcinomas. This increased risk, compared to benign hyperplastic polyps, makes their distinction vitally important. However, no gold standard exists to differentiate them, and wide observer variability is reported. METHODS To better distinguish these polyps, we investigated 94 serrated polyps (53 sessile serrated lesions and 41 hyperplastic polyps), using an easy-to-apply pathologic scoring system that combines, for the first time, three established distinguishing features: polyp morphology, location, and size. As an additional novel approach, polyp size was assessed by serrated biopsy number compared to endoscopic size. RNA expression profiling served as an additional biomarker. The considerable morphologic overlap across serrated polyps was quantitated for the first time. Interobserver variability was assessed by eight expert gastrointestinal pathologists. RESULTS By ROC analysis, polyp size by biopsy number performed best, followed by polyp location and morphology (areas under the curves [AUC] 85.9%, 81.2%, 65.9%, respectively). Optimal discrimination combined all three features (AUC 92.9%). For polyp size, biopsy number proved superior to endoscopic size (AUC 85.9% versus 55.2%, p=0.001). Interobserver variability analysis yielded the highest reported Fleiss and Kappa statistics (0.879) and percent agreement (96.8%), showing great promise toward improved diagnosis. CONCLUSIONS The proposed three-criteria pathologic system, combining size by biopsy number, location, and morphology, yields an improved, easy to use, and highly reproducible diagnostic approach for differentiating sessile serrated lesions and hyperplastic polyps.
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Himbert C, Ose J, Gigic B, Viskochil R, Santuci K, Lin T, Ashworth A, Cohan JN, Scaife CL, Jedrzkiewicz J, Damerell V, Atkins KM, Gong J, Mutch MG, Bernadt C, Felder S, Sanchez J, Cohen SA, Krane MK, Hinkle N, Wood E, Peoples AR, Figueiredo JC, Toriola AT, Siegel EM, Li CI, Shibata D, Boucher K, Round JL, Ulrich AB, Schneider M, Huang LC, Hardikar S, Ulrich CM. Associations of combined physical activity and body mass index groups with colorectal cancer survival outcomes. BMC Cancer 2023; 23:300. [PMID: 37013476 PMCID: PMC10069054 DOI: 10.1186/s12885-023-10695-8] [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: 06/13/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Physical activity and BMI have been individually associated with cancer survivorship but have not yet been studied in combinations in colorectal cancer patients. Here, we investigate individual and combined associations of physical activity and BMI groups with colorectal cancer survival outcomes. METHODS Self-reported physical activity levels (MET hrs/wk) were assessed using an adapted version of the International Physical Activity Questionnaire (IPAQ) at baseline in 931 patients with stage I-III colorectal cancer and classified into 'highly active' and'not-highly active'(≥ / < 18 MET hrs/wk). BMI (kg/m2) was categorized into 'normal weight', 'overweight', and 'obese'. Patients were further classified into combined physical activity and BMI groups. Cox-proportional hazard models with Firth correction were computed to assess associations [hazard ratio (HR), 95% profile HR likelihood confidence interval (95% CI) between individual and combined physical activity and BMI groups with overall and disease-free survival in colorectal cancer patients. RESULTS 'Not-highly active' compared to 'highly active' and 'overweight'/ 'obese' compared to 'normal weight' patients had a 40-50% increased risk of death or recurrence (HR: 1.41 (95% CI: 0.99-2.06), p = 0.03; HR: 1.49 (95% CI: 1.02-2.21) and HR: 1.51 (95% CI: 1.02-2.26), p = 0.04, respectively). 'Not-highly active' patients had worse disease-free survival outcomes, regardless of their BMI, compared to 'highly active/normal weight' patients. 'Not-highly active/obese' patients had a 3.66 times increased risk of death or recurrence compared to 'highly active/normal weight' patients (HR: 4.66 (95% CI: 1.75-9.10), p = 0.002). Lower activity thresholds yielded smaller effect sizes. CONCLUSION Physical activity and BMI were individually associated with disease-free survival among colorectal cancer patients. Physical activity seems to improve survival outcomes in patients regardless of their BMI.
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Affiliation(s)
- Caroline Himbert
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jennifer Ose
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Richard Viskochil
- University of Utah, Salt Lake City, UT, USA
- University of Massachusetts Boston, Boston, MA, USA
| | | | - Tengda Lin
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Jessica N Cohan
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Courtney L Scaife
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jolanta Jedrzkiewicz
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - Jun Gong
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew G Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - Corey Bernadt
- Washington University School of Medicine, St. Louis, MO, USA
| | - Seth Felder
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julian Sanchez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Stacey A Cohen
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Mukta K Krane
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Nathan Hinkle
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Elizabeth Wood
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anita R Peoples
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - Erin M Siegel
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christopher I Li
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kenneth Boucher
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | | | - Lyen C Huang
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Cornelia M Ulrich
- University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
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Dong Z, Barraza G, Affolter KE, Witt BL, Jedrzkiewicz J. Distinguishing Gastrointestinal Leiomyomas From Muscularis Propria in Biopsy Specimens by Differential Expression of S100 Immunohistochemical Stain. Am J Clin Pathol 2023; 159:53-59. [PMID: 36367375 DOI: 10.1093/ajcp/aqac128] [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: 03/31/2022] [Accepted: 09/13/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Interpreting small biopsy specimens or fine-needle aspirations of gastrointestinal tract (GI) smooth muscle lesions may be challenging when the differential diagnosis includes leiomyoma vs muscularis propria (MP). We evaluated the utility of S100 staining in distinguishing GI leiomyomas from MP. METHODS A search was conducted in our laboratory information system for cases of leiomyomas arising within the GI tract (2004-2021). Site-matched controls containing MP were selected (2018-2020). Five high-power fields (hpf) were counted on S100 immunohistochemical stains by two pathologists in the resections and by three different blinded pathologists in the biopsy specimens and analyzed. RESULTS The median S100 count was 2.5/5 hpf in leiomyoma resection cases (n = 38), which was significantly lower than the median count of 548/5 hpf in MP (n = 19) with a P value of <.0001. The median S100 count in biopsy specimens (n = 16) was 1.2/5 hpf and within the expected range of 1 to 104/5 hpf (minimum-maximum value) established by the leiomyoma resections. S100 counts in the normal MP were significantly higher than those observed in leiomyomas (P < .001). CONCLUSIONS S100 staining can aid in distinguishing a leiomyoma from MP in the GI tract, which is especially helpful when evaluating cases with limited sampling.
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Affiliation(s)
- Zachary Dong
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
| | - Gonzalo Barraza
- Department of Pathology, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Kajsa E Affolter
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
| | - Benjamin L Witt
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
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8
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Himbert C, Stephens WZ, Gigic B, Lin T, Ose J, Ashworth A, Warby C, Nix D, Jedrzkiewicz J, Peoples AR, Bronner M, Pickron B, Scaife C, Cohan JN, Grady WM, Cohen SA, Krane M, Schrotz-King P, Figueiredo JC, Toriola AT, Siegel EM, Li CI, Ulrich A, Shibata D, Round JL, Huang LC, Schneider M, Hardikar S, Ulrich CM. Abstract P010: Molecular mediators of the energy balance-colorectal cancer link: evaluating the gut microbiome and pro-inflammatory biomarkers. Cancer Prev Res (Phila) 2023. [DOI: 10.1158/1940-6215.precprev22-p010] [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: 01/05/2023]
Abstract
Abstract
Background: Physical activity and BMI are convincingly associated with colorectal cancer risk, yet the underlying molecular mediators and their interplay in the energy balance-cancer link remain unclear. Possible counteracting effects of physical activity on obesity-induced metabolic changes, including systemic inflammation and changes in the gut microbiome, have yet to be studied. Here, we investigated associations of several combinations of physical activity and BMI with pro-inflammatory biomarkers and the gut microbiome and relationships between these two mediators among patients with colorectal cancer. Methods: N=579 patients with newly diagnosed colorectal cancer (stages I-IV) were included. Physical activity at baseline was assessed using an adapted International Physical Activity Questionnaire (IPAQ) and participants were classified as being ‘active’ or ‘inactive’ based on physical activity guidelines. BMI at baseline was abstracted from medical records and categorized into ‘normal weight’ and ‘overweight/obese’. Pro-inflammatory biomarkers (CRP, SAA, IL-6, IL-8, and TNF-α) were measured in pre-surgery serum samples. In a subset of patients (n=179), 16S rRNA gene sequencing was additionally performed in pre-surgery stool samples. Relative abundances were determined for each taxonomic level and used to calculate diversity metrics. Analyses were adjusted for sex, stage at diagnosis, neoadjuvant treatment, and study site. Results: ‘Obese’ patients had 88% and 17% higher CRP and TNF-α levels compared to ‘normal weight’ patients (p=0.03 and 0.02, respectively). Highest CRP levels were observed among ‘overweight or obese/inactive’ compared to ‘normal weight/active’ patients (p=0.03). Lower gut microbial diversity was observed among ‘inactive’ vs. ‘active’ patients (Shannon index: p=0.01, Simpson: p=0.03), ‘obese’ vs. ‘normal weight’ patients (Shannon index, Simpson, and Observed species: p=0.02, respectively), and ‘overweight or obese/inactive’ vs. ‘normal weight/active’ patients (Shannon index: p=0.02, Observed species: p=0.04). Two phyla and 12 genera (e.g., Actinobacteria and Fusobacteria, and Ruminococcus, Succinivibrio, Succiniclasticum) were differentially abundant across physical activity and BMI groups. High CRP and TNF-α levels were statistically significantly associated with lower alpha diversity metrics (p=0.02-0.05). Conclusions: This is the first evidence indicating that the gut microbiome may be a molecular mediator of the energy balance-colorectal cancer link. We further provide evidence of associations between physical activity and BMI groups with pro-inflammatory biomarkers. While BMI was identified as the key driver of inflammation, biomarker levels were higher among ‘inactive’ patients across BMI groups. Physical activity may offset obesity-induced inflammation and gut microbiome dysbiosis. Our results further provide new insights into the host-microbiome interactions with respect to systemic inflammation.
Citation Format: Caroline Himbert, W. Zac Stephens, Biljana Gigic, Tengda Lin, Jennifer Ose, Anjelica Ashworth, Christy Warby, David Nix, Jolanta Jedrzkiewicz, Anita R Peoples, Mary Bronner, Bartley Pickron, Courtney Scaife, Jessica N. Cohan, William M. Grady, Stacey A. Cohen, Mukta Krane, Petra Schrotz-King, Jane C. Figueiredo, Adetunji T. Toriola, Erin M. Siegel, Christopher I. Li, Alexis Ulrich, David Shibata, June L. Round, Lyen C. Huang, Martin Schneider, Sheetal Hardikar, Cornelia M Ulrich. Molecular mediators of the energy balance-colorectal cancer link: evaluating the gut microbiome and pro-inflammatory biomarkers. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P010.
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Affiliation(s)
| | | | - Biljana Gigic
- 3University Hospital Heidelberg, Heidelberg, Germany,
| | - Tengda Lin
- 1Huntsman Cancer Institute, Salt Lake City, UT,
| | | | | | | | - David Nix
- 1Huntsman Cancer Institute, Salt Lake City, UT,
| | | | | | | | | | | | | | | | | | | | | | | | | | - Erin M. Siegel
- 9H. Lee Moffitt Cancer Center & Research Institute, Tampa,
| | | | - Alexis Ulrich
- 10Rheinland Klinikum Neuss Lukaskrankenhaus, Neuss, Germany,
| | - David Shibata
- 11University of Tennessee Health Sciences Center, Memphis,
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Himbert C, Stephens WZ, Gigic B, Hardikar S, Holowatyj AN, Lin T, Ose J, Swanson E, Ashworth A, Warby CA, Peoples AR, Nix D, Jedrzkiewicz J, Bronner M, Pickron B, Scaife C, Cohan JN, Schrotz-King P, Habermann N, Boehm J, Hullar M, Figueiredo JC, Toriola AT, Siegel EM, Li CI, Ulrich AB, Shibata D, Boucher K, Huang LC, Schneider M, Round JL, Ulrich CM. Differences in the gut microbiome by physical activity and BMI among colorectal cancer patients. Am J Cancer Res 2022; 12:4789-4801. [PMID: 36381318 PMCID: PMC9641409] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2022] [Indexed: 02/22/2023] Open
Abstract
Associations of energy balance components, including physical activity and obesity, with colorectal cancer risk and mortality are well established. However, the gut microbiome has not been investigated as underlying mechanism. We investigated associations of physical activity, BMI, and combinations of physical activity/BMI with gut microbiome diversity and differential abundances among colorectal cancer patients. N=179 patients with colorectal cancer (stages I-IV) were included in the study. Pre-surgery stool samples were used to perform 16S rRNA gene sequencing (Illumina). Physical activity (MET hrs/wk) during the year before diagnosis was assessed by questionnaire and participants were classified as being active vs. inactive based on guidelines. BMI at baseline was abstracted from medical records. Patients were classified into four combinations of physical activity levels/BMI. Lower gut microbial diversity was observed among 'inactive' vs. 'active' patients (Shannon: P=0.01, Simpson: P=0.03), 'obese' vs. 'normal weight' patients (Shannon, Simpson, and Observed species: P=0.02, respectively), and 'overweight/obese/inactive' vs. 'normal weight/active' patients (Shannon: P=0.02, Observed species: P=0.04). Results differed by sex and tumor site. Two phyla and 12 genera (Actinobacteria and Fusobacteria, Adlercreutzia, Anaerococcus, Clostridium, Eubacterium, Mogibacteriaceae, Olsenella, Peptinophilus, Pyramidobacter, RFN20, Ruminococcus, Succinivibrio, Succiniclasticum) were differentially abundant across physical activity and BMI groups. This is the first evidence for associations of physical activity with gut microbiome diversity and abundances, directly among colorectal cancer patients. Our results indicate that physical activity may offset gut microbiome dysbiosis due to obesity. Alterations in gut microbiota may contribute mechanistically to the energy balance-colorectal cancer link and impact clinical outcomes.
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Affiliation(s)
- Caroline Himbert
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | | | | | - Sheetal Hardikar
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Andreana N Holowatyj
- University of UtahSalt Lake City, UT, USA
- Vanderbilt University Medical CenterNashville, TN, USA
| | - Tengda Lin
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Jennifer Ose
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | | | | | | | - Anita R Peoples
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - David Nix
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Jolanta Jedrzkiewicz
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Mary Bronner
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Bartley Pickron
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Courtney Scaife
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Jessica N Cohan
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Petra Schrotz-King
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ)Germany
| | | | | | | | | | | | - Erin M Siegel
- H. Lee Moffitt Cancer Center & Research InstituteTampa, FL, USA
| | | | | | - David Shibata
- University of Tennessee Health Science CenterMemphis, TN, USA
| | - Kenneth Boucher
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | - Lyen C Huang
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
| | | | | | - Cornelia M Ulrich
- University of UtahSalt Lake City, UT, USA
- Huntsman Cancer InstituteSalt Lake City, UT, USA
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10
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Himbert C, Warby CA, Gigic B, Ose J, Lin T, Viskochil R, Peoples AR, Ashworth A, Schrotz-King P, Scaife CL, Cohan JN, Jedrzkiewicz J, Schirmacher P, Grady WM, Cohen SA, Krane M, Figueiredo JC, Toriola AT, Siegel EM, Shibata D, Round JL, Huang LC, Li CI, Schneider M, Ulrich A, Hardikar S, Ulrich CM. Associations of individual and combined physical activity and body mass index groups with pro-inflammatory biomarkers among colorectal cancer patients. Cancer Epidemiol Biomarkers Prev 2022; 31:2148-2156. [PMID: 36099423 DOI: 10.1158/1055-9965.epi-22-0681] [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] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Physical activity and obesity are well-established factors of colorectal cancer (CRC) risk and prognosis. Here, we investigate associations of individual and combined physical activity and BMI groups with pro-inflammatory biomarkers in CRC patients. METHODS Self-reported physical activity levels were classified as 'active' (≥8.75 MET-hrs/wk) vs. 'inactive' (<8.75 MET-hrs/wk) in n=579 stage I-IV CRC patients enrolled in the ColoCare Study. BMI [normal weight (≥18.5-<25kg/m2), overweight (≥25-<30kg/m2), and obese (≥30kg/m2)] was abstracted from medical records. Patients were classified into four combinations of physical activity levels and BMI. Biomarkers (CRP, SAA, IL-6, IL-8, and TNF-α) in pre-surgery serum samples were measured using Meso-Scale-Discovery platform. Regression models were used to compute relative percent differences in biomarker levels by physical activity and BMI groups. RESULTS 'Inactive' patients had non-statistically significant higher IL-6 levels compared to 'active' patients (+36%, p=0.10). 'Obese' patients had 88% and 17% higher CRP and TNF-α levels compared to 'normal weight' patients (p=0.03 and 0.02, respectively). Highest CRP levels were observed among 'overweight or obese/inactive' compared to 'normal weight/active' patients (p=0.03). CONCLUSION We provide evidence of associations between individual and combined physical activity and BMI groups with pro-inflammatory biomarkers. While BMI was identified as the key driver of inflammation, biomarker levels were higher among 'inactive' patients across BMI groups. IMPACT This is the largest study in CRC patients investigating associations of energy balance components with inflammatory biomarkers. Our results suggest that physical activity may reduce obesity-induced inflammation in CRC patients and support the design of randomized controlled trials testing this hypothesis.
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Affiliation(s)
| | - Christy A Warby
- Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | | | - Jennifer Ose
- University of Utah, Salt Lake City, Utah, United States
| | - Tengda Lin
- Huntsman Cancer Institute, United States
| | | | - Anita R Peoples
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | | | | | | | | | | | | | - William M Grady
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | | | - Mukta Krane
- Fred Hutchinson/University of Washington Cancer Consortium, United States
| | - Jane C Figueiredo
- Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Adetunji T Toriola
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Erin M Siegel
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, United States
| | | | - Lyen C Huang
- University of Utah Hospital, Salt Lake City, UT, United States
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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11
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Jensen MM, Hatlevik Ø, Steinhauff DD, Griswold ED, Wei X, Isaacson KJ, Barber ZB, Huo E, Taussky P, Jedrzkiewicz J, Cappello J, Cheney D, Ghandehari H. Protein-Based Polymer Liquid Embolics for Cerebral Aneurysms. Acta Biomater 2022; 151:174-182. [PMID: 35948175 DOI: 10.1016/j.actbio.2022.08.003] [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: 01/04/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/01/2022]
Abstract
Cerebral aneurysms (CA), an abnormal bulge in the arteries that supply blood to the brain, are prone to rupture and can cause hemorrhagic stroke. Physicians can treat CA by blocking blood flow to the aneurysmal sac via clipping of the aneurysm neck via open procedure, or endovascular occlusion of the aneurysm with embolic materials to promote thrombus formation to prevent further inflow of blood into the aneurysm. Endovascular treatment options for CA still have significant limitations in terms of safety, usability in coagulopathic patients, and risks of device migration. Bioactive embolic therapies, consisting of non-toxic bioresorbable materials that encourage the growth of neointima across the aneurysm neck, are needed to improve the healing of CA. In this work, the bioinspired silk-elastinlike protein-based polymer (SELP 815K), was used to embolize aneurysms in a rabbit elastase model. SELP 815K effectively embolized the model aneurysms in vivo, achieving >90% occlusion, using commercial microcatheters. No device-associated adverse effects were observed in any of the animals, and SELP 815K showed no cytotoxicity. SELP embolization did not show any deleterious effects to local tissues, and features consistent with reendothelialization of the aneurysm neck were noted in histological examination one-month post-embolization. SELP 815K shows promise as an embolic treatment for unruptured CA. STATEMENT OF SIGNIFICANCE: : Unruptured cerebral aneurysms are present in approximately 3% of the population, with a fatality rate of up to 65% upon rupture. In this work a silk-elastinlike protein polymer (SELP) is explored as a liquid embolic for occlusion of cerebral aneurysms. This embolic exists as a liquid at room temperature before rapidly forming a gel at physiological temperature. This shape filling property was used to successfully occlude cerebral aneurysms in rabbits, with stable occlusion persisting for over thirty days. SELP occlusions show evidence for reendothelialization of the aneurysm sac and provide an opportunity for delivery of bioactive agents to further improve treatments.
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Affiliation(s)
- Mark M Jensen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | | | - D Douglas Steinhauff
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Ethan D Griswold
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Xiaomei Wei
- TheraTarget, Inc., Salt Lake City, Utah, USA
| | - Kyle J Isaacson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Zachary B Barber
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Eugene Huo
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA; Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jolanta Jedrzkiewicz
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph Cappello
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA
| | | | - Hamidreza Ghandehari
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA; TheraTarget, Inc., Salt Lake City, Utah, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA.
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Jedrzkiewicz J, Sirohi D, Uvejzovic N, Gulbahce HE. RAI1 alternate probe identifies additional gastroesophageal adenocarcinoma cases as amplified following equivocal HER2 fluorescence in situ hybridization testing: experience from a national reference laboratory. Mod Pathol 2022; 35:549-553. [PMID: 34663915 DOI: 10.1038/s41379-021-00933-4] [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] [Received: 07/15/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
The College of American Pathologists/American Society of Clinical Oncology recommends HER2 testing prior to initiation of targeted therapy for patients with advanced Gastroesophageal adenocarcinoma (GEA), using immunohistochemistry (IHC) followed by fluorescence in situ hybridization (FISH) in cases with an equivocal (score 2 + ) result on IHC. The FISH results are considered indeterminate if the HER2/CEP17 ratio is <2.0 with an average CEP17 copy number of ≥3.0 and a HER2 copy number ≥4.0 and ≤6.0 after counting additional tumor cells. Indeterminate results may be resolved by using an alternative chromosome 17 probe such as RAI1. The purpose of this study is to review our experience with RAI1 alternate probe in HER2 FISH testing of GEA in a large reference laboratory setting. Esophageal, gastroesophageal, and gastric adenocarcinomas received for HER2 FISH testing in our lab between 9/2018 and 1/2020 were included. HER2/CEP17 and HER2/ RAI1 ratios, and the average HER2, CEP17, RAI1 signals per cell were recorded. 328 GEA had HER2 testing performed in our lab during the study period. 101 (30.8%) were amplified, 169 (51.5%) were non-amplified and 58 (17.7%) were indeterminate. Following RAI1 testing, 42 (72.4%) of 58 indeterminate cases were reclassified as non-amplified and 16 (27.6%) were reclassified as amplified, increasing the total amplified cases to 117 (35.7%). The correlation between the average CEP17 and RAI1 copy number for all cases was weak (R2 = 0.095). In summary, using the alternate probe RAI1 reclassifies 27.6% of original HER2 FISH indeterminate gastroesophageal carcinomas as amplified, which makes them eligible for targeted therapies.
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Affiliation(s)
| | - Deepika Sirohi
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | | | - H Evin Gulbahce
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.
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Hatlevik Ø, Jensen M, Steinhauff D, Wei X, Huo E, Jedrzkiewicz J, Cappello J, Cheney D, Ghandehari H. Translational Development of a Silk-Elastinlike Protein Polymer Embolic for Transcatheter Arterial Embolization. Macromol Biosci 2022; 22:e2100401. [PMID: 34978152 PMCID: PMC9007042 DOI: 10.1002/mabi.202100401] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Locally blocking blood flow to tumors with embolic materials is the key to transcatheter arterial embolization for treating hepatocellular carcinoma. Current microparticle agents do not deeply penetrate target tissues and are compatible with a very limited selection of therapeutic agents. Silk-elastinlike protein polymers (SELPs) combine the solubility of elastin and the strength of silk to create an easily injected liquid embolic that transition into a solid depot amenable to loading with drugs, gene therapy agents, or biologics. SELP, injected as liquid solution, penetrates the vasculature before transitioning to a solid hydrogel. The objective of this manuscript is to evaluate SELP embolization, stability, and biocompatibility at 7-, 30-, and 90-day survival intervals in a porcine model. SELP embolics selectively block blood flow in the kidneys and livers, with no off-target infarctions. As assessed with angiography, SELP renal embolization exhibits decreasing persistence for the duration of the 90-day study period. There is an increased presence of microscopic SELP emboli in the renal setting, compared to Embosphere. Histologically scored inflammatory reactions to SELP are decreased in both the renal and hepatic implantations compared to Embosphere. In conclusion, a bioresorbable SELP liquid embolic system deeply penetrates target tissue and selectively embolizes blood vessels in vivo.
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Affiliation(s)
| | | | | | - Xiaomei Wei
- TheraTarget Inc. 36 S. Wasatch Dr., Salt Lake City, UT 84112, USA
| | - Eugene Huo
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, 36 S. Wasatch Dr., Salt Lake City, UT 884112, USA, Department of Radiology & Biomedical Imaging, University of California San Francisco, 505 Parnassus, San Francisco, CA 94143, USA
| | - Jolanta Jedrzkiewicz
- Department of Pathology and ARUP Laboratories, University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Joseph Cappello
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, 36 S. Wasatch Dr., Salt Lake City, UT 884112, USA
| | - Darwin Cheney
- TheraTarget Inc. 36 S. Wasatch Dr., Salt Lake City, UT 84112, USA, Utah Center for Nanomedicine, University of Utah, 36 S. Wasatch Dr., Salt Lake City, UT 84112, USA
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14
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Steinhauff D, Jensen MM, Griswold E, Jedrzkiewicz J, Cappello J, Oottamasathien S, Ghandehari H. An Oligomeric Sulfated Hyaluronan and Silk-Elastinlike Polymer Combination Protects against Murine Radiation Induced Proctitis. Pharmaceutics 2022; 14:pharmaceutics14010175. [PMID: 35057068 PMCID: PMC8777937 DOI: 10.3390/pharmaceutics14010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/10/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 01/23/2023] Open
Abstract
Semisynthetic glycosaminoglycan ethers (SAGEs) are short, sulfated hyaluronans which combine the natural properties of hyaluronan with chemical sulfation. In a murine model, SAGEs provide protection against radiation induced proctitis (RIP), a side effect of lower abdominal radiotherapy for cancer. The anti-inflammatory effects of SAGE have been studied in inflammatory diseases at mucosal barrier sites; however, few mechanisms have been uncovered necessitating high throughput methods. SAGEs were combined with silk-elastinlike polymers (SELPs) to enhance rectal accumulation in mice. After high radiation exposure to the lower abdominal area, mice were followed for 3 days or until they met humane endpoints, before evaluation of behavioral pain responses and histological assessment of rectal inflammation. RNA sequencing was conducted on tissues from the 3-day cohort to determine molecular mechanisms of SAGE–SELP. After 3 days, mice receiving the SAGE–SELP combination yielded significantly lowered pain responses and amelioration of radiation-induced rectal inflammation. Mice receiving the drug–polymer combination survived 60% longer than other irradiated mice, with a fraction exhibiting long term survival. Sequencing reveals varied regulation of toll like receptors, antioxidant activities, T-cell signaling, and pathways associated with pain. This investigation elucidates several molecular mechanisms of SAGEs and exhibits promising measures for prevention of RIP.
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Affiliation(s)
- Douglas Steinhauff
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; (D.S.); (E.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Mark Martin Jensen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.M.J.); (S.O.)
| | - Ethan Griswold
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; (D.S.); (E.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Joseph Cappello
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA;
| | - Siam Oottamasathien
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.M.J.); (S.O.)
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hamidreza Ghandehari
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; (D.S.); (E.G.)
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA;
- Correspondence:
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15
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Khurana N, Yathavan B, Jedrzkiewicz J, Gill AS, Pulsipher A, Alt JA, Ghandehari H. Vascular permeability in chronic rhinosinusitis enhances accumulation and retention of nanoscale pegylated liposomes. Nanomedicine 2021; 38:102453. [PMID: 34363985 PMCID: PMC10499165 DOI: 10.1016/j.nano.2021.102453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022]
Abstract
Chronic rhinosinusitis (CRS) is a debilitating inflammatory disorder of the sinonasal mucosa that substantially diminishes patient quality of life. Progress surrounding management of this disease has been crippled by a lack of therapeutic innovation. It has been posited that increased vascularity within the diseased sinuses of patients with CRS may allow for improved systemic drug delivery via nanoscale liposomal carriers. Such a system could enhance drug distribution, accumulation, and retention within the sinuses, ultimately leading to improved patient outcomes. PEGylated liposomes loaded with indocyanine green (ICG) were synthesized, characterized and systemically administered in a mouse model of CRS. Accumulation and retention of ICG in sinonasal tissue were evaluated. Compared to healthy controls, CRS mice showed significant sinonasal tissue accumulation and retention of PEGylated liposomal ICG for up to 21 days (P < 0.001). Conversely, free ICG was eliminated from the body after 24 h in both groups.
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Affiliation(s)
- Nitish Khurana
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA
| | - Bhuvanesh Yathavan
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA
| | | | - Amarbir S Gill
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Abigail Pulsipher
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremiah A Alt
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Hamidreza Ghandehari
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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16
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Himbert C, Figueiredo JC, Shibata D, Ose J, Lin T, Huang LC, Peoples AR, Scaife CL, Pickron B, Lambert L, Cohan JN, Bronner M, Felder S, Sanchez J, Dessureault S, Coppola D, Hoffman DM, Nasseri YF, Decker RW, Zaghiyan K, Murrell ZA, Hendifar A, Gong J, Firoozmand E, Gangi A, Moore BA, Cologne KG, El-Masry MS, Hinkle N, Monroe J, Mutch M, Bernadt C, Chatterjee D, Sinanan M, Cohen SA, Wallin U, Grady WM, Lampe PD, Reddi D, Krane M, Fichera A, Moonka R, Herpel E, Schirmacher P, Kloor M, von Knebel-Doeberitz M, Nattenmueller J, Kauczor HU, Swanson E, Jedrzkiewicz J, Schmit SL, Gigic B, Ulrich AB, Toriola AT, Siegel EM, Li CI, Ulrich CM, Hardikar S. Clinical Characteristics and Outcomes of Colorectal Cancer in the ColoCare Study: Differences by Age of Onset. Cancers (Basel) 2021; 13:cancers13153817. [PMID: 34359718 PMCID: PMC8345133 DOI: 10.3390/cancers13153817] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/13/2023] Open
Abstract
Early-onset colorectal cancer has been on the rise in Western populations. Here, we compare patient characteristics between those with early- (<50 years) vs. late-onset (≥50 years) disease in a large multinational cohort of colorectal cancer patients (n = 2193). We calculated descriptive statistics and assessed associations of clinicodemographic factors with age of onset using mutually-adjusted logistic regression models. Patients were on average 60 years old, with BMI of 29 kg/m2, 52% colon cancers, 21% early-onset, and presented with stage II or III (60%) disease. Early-onset patients presented with more advanced disease (stages III-IV: 63% vs. 51%, respectively), and received more neo and adjuvant treatment compared to late-onset patients, after controlling for stage (odds ratio (OR) (95% confidence interval (CI)) = 2.30 (1.82-3.83) and 2.00 (1.43-2.81), respectively). Early-onset rectal cancer patients across all stages more commonly received neoadjuvant treatment, even when not indicated as the standard of care, e.g., during stage I disease. The odds of early-onset disease were higher among never smokers and lower among overweight patients (1.55 (1.21-1.98) and 0.56 (0.41-0.76), respectively). Patients with early-onset colorectal cancer were more likely to be diagnosed with advanced stage disease, to have received systemic treatments regardless of stage at diagnosis, and were less likely to be ever smokers or overweight.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Jane C. Figueiredo
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 37996, USA; (D.S.); (N.H.); (J.M.)
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Lyen C. Huang
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Anita R. Peoples
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Courtney L. Scaife
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Bartley Pickron
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Laura Lambert
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Jessica N. Cohan
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Mary Bronner
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Seth Felder
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - Julian Sanchez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - Sophie Dessureault
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - Domenico Coppola
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - David M. Hoffman
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Yosef F. Nasseri
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Robert W. Decker
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Karen Zaghiyan
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Zuri A. Murrell
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Andrew Hendifar
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Jun Gong
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Eiman Firoozmand
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Alexandra Gangi
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Beth A. Moore
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Kyle G. Cologne
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Maryliza S. El-Masry
- Cedars-Sinai Center, Los Angeles, CA 90048, USA; (J.C.F.); (D.M.H.); (Y.F.N.); (R.W.D.); (K.Z.); (Z.A.M.); (A.H.); (J.G.); (E.F.); (A.G.); (B.A.M.); (K.G.C.); (M.S.E.-M.)
| | - Nathan Hinkle
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 37996, USA; (D.S.); (N.H.); (J.M.)
| | - Justin Monroe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 37996, USA; (D.S.); (N.H.); (J.M.)
| | - Matthew Mutch
- Department of Surgery, Washington University St. Louis, St. Louis, MO 63130, USA; (M.M.); (C.B.); (D.C.); (A.T.T.)
| | - Cory Bernadt
- Department of Surgery, Washington University St. Louis, St. Louis, MO 63130, USA; (M.M.); (C.B.); (D.C.); (A.T.T.)
| | - Deyali Chatterjee
- Department of Surgery, Washington University St. Louis, St. Louis, MO 63130, USA; (M.M.); (C.B.); (D.C.); (A.T.T.)
| | - Mika Sinanan
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Stacey A. Cohen
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Ulrike Wallin
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
| | - William M. Grady
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
| | - Paul D. Lampe
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
| | - Deepti Reddi
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Mukta Krane
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | | | - Ravi Moonka
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
| | - Esther Herpel
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Peter Schirmacher
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Matthias Kloor
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Magnus von Knebel-Doeberitz
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Johanna Nattenmueller
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Hans-Ulrich Kauczor
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Eric Swanson
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
| | - Jolanta Jedrzkiewicz
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Stephanie L. Schmit
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - Biljana Gigic
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Alexis B. Ulrich
- Pathologisches Institut, University Hospital Heidelberg, 69120 Heidelberg, Germany; (E.H.); (P.S.); (M.K.); (M.v.K.-D.); (J.N.); (H.-U.K.); (B.G.); (A.B.U.)
| | - Adetunji T. Toriola
- Department of Surgery, Washington University St. Louis, St. Louis, MO 63130, USA; (M.M.); (C.B.); (D.C.); (A.T.T.)
| | - Erin M. Siegel
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (S.F.); (J.S.); (S.D.); (D.C.); (S.L.S.); (E.M.S.)
| | - Christopher I. Li
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
| | - Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Sheetal Hardikar
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (C.H.); (J.O.); (T.L.); (L.C.H.); (A.R.P.); (C.L.S.); (B.P.); (L.L.); (J.N.C.); (M.B.); (E.S.); (J.J.); (C.M.U.)
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (M.S.); (S.A.C.); (U.W.); (W.M.G.); (P.D.L.); (D.R.); (M.K.); (R.M.); (C.I.L.)
- Correspondence: ; Tel.: +1-(801)-213-6238
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Mahlow J, Goold EA, Jedrzkiewicz J, Gulbahce HE. What to Expect From the New ASCO/CAP Guideline Recommendations for Hormone Receptor Testing in Breast Cancer: A National Reference Laboratory Experience. Appl Immunohistochem Mol Morphol 2021; 29:245-250. [PMID: 33306617 DOI: 10.1097/pai.0000000000000891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
The new ASCO/CAP guidelines on hormone receptor testing in breast cancer recommends standard operating procedures (SOPs) established to confirm or adjudicate estrogen receptor (ER) results with weak or ≤10% staining, and the status of internal controls (ICs) reported for cases with 0% to 10% staining. The aim of this study is to determine the frequency of ER testing with weak or ≤10% staining that may require additional steps following SOPs and to identify any correlation between hormone receptor status of the tumor and the likelihood of finding IC. Breast cancer cases between January 2014 and April 2019 were included to identify negative, low-positive and weak-positive cases. The presence/absence of IC was correlated to tumor type. Following ASCO/CAP guidelines, 29.8% of cases (374/1261) will need additional steps to confirm/adjudicate results due to negative, low, or weak positive ER status. The probability of finding IC is ~50% lower in cases of ER and progesterone receptor (PgR) negative tumors. Repeat testing may be warranted in 13.1% (92/700) of all cases due to lack of IC. In conclusion, the new ASCO/CAP guidelines recommend laboratories to establish and follow SOP to confirm or adjudicate ER results for about 30% of the cases before reporting hormone receptors status. Over 40% of cases with <10% tumor ER positivity lacked IC that may need a comment per the guidelines indicating a repeat testing may be warranted. However, the presence/absence of IC may be related to the subtype of breast cancer and should not necessarily bring into question the validity of the test.
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Affiliation(s)
- Jonathon Mahlow
- Department of Pathology, University of Utah, Salt Lake City, UT
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Steinhauff D, Jensen M, Talbot M, Jia W, Isaacson K, Jedrzkiewicz J, Cappello J, Oottamasathien S, Ghandehari H. Silk-elastinlike copolymers enhance bioaccumulation of semisynthetic glycosaminoglycan ethers for prevention of radiation induced proctitis. J Control Release 2021; 332:503-515. [PMID: 33691185 DOI: 10.1016/j.jconrel.2021.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/31/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
Radiation-induced proctitis (RIP) is a debilitating adverse event that occurs commonly during lower abdominal radiotherapy. The lack of prophylactic treatment strategies leads to diminished patient quality of life, disruption of radiotherapy schedules, and limitation of radiotherapy efficacy due to dose-limiting toxicities. Semisynthetic glycosaminoglycan ethers (SAGE) demonstrate protective effects from RIP. However, low residence time in the rectal tissue limits their utility. We investigated controlled delivery of GM-0111, a SAGE analogue with demonstrated efficacy against RIP, using a series of temperature-responsive polymers to compare how distinct phase change behaviors, mechanical properties and release kinetics influence rectal bioaccumulation. Poly(lactic acid)-co-(glycolic acid)-block-poly(ethylene glycol)-block-poly(lactic acid)-co-(glycolic acid) copolymers underwent macroscopic phase separation, expelling >50% of drug during gelation. Poloxamer compositions released GM-0111 cargo within 1 h, while silk-elastinlike copolymers (SELPs) enabled controlled release over a period of 12 h. Bioaccumulation was evaluated using fluorescence imaging and confocal microscopy. SELP-415K, a SELP analogue with 4 silk units, 15 elastin units, and one elastin unit with lysine residues in the monomer repeats, resulted in the highest rectal bioaccumulation. SELP-415K GM-0111 compositions were then used to provide localized protection from radiation induced tissue damage in a murine model of RIP. Rectal delivery of SAGE using SELP-415K significantly reduced behavioral pain responses, and reduced animal mass loss compared to irradiated controls or treatment with traditional delivery approaches. Histological scoring showed RIP injury was ameliorated for animals treated with GM-0111 delivered by SELP-415K. The enhanced bioaccumulation provided by thermoresponsive SELPs via a liquid to semisolid transition improved rectal delivery of GM-0111 to mice and radioprotection in a RIP model.
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Affiliation(s)
- D Steinhauff
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - M Jensen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - M Talbot
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - W Jia
- Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - K Isaacson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA
| | - J Jedrzkiewicz
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - J Cappello
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA
| | - S Oottamasathien
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - H Ghandehari
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, UT 84112, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA.
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19
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Khurana N, Pulsipher A, Jedrzkiewicz J, Ashby S, Pollard CE, Ghandehari H, Alt JA. Inflammation-driven vascular dysregulation in chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:976-983. [PMID: 33135871 DOI: 10.1002/alr.22723] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Altered neovascularity is typically observed in chronic inflammatory diseases with overlapping pathophysiology to that observed in chronic rhinosinusitis (CRS). However, characterization of these inflammatory-induced vascular-mediated changes in CRS is limited. Understanding the underlying vascular changes in CRS will allow for strategic design and development of new drug-delivery technologies that exploit vascular permeability for increased extravasation into the target sinonasal tissues. METHODS Patients with CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and non-CRS controls were enrolled in this prospective, observational study. The extent of angiogenesis in tissue was characterized using immunohistochemical and multiplex gene expression analyses. Vascular permeability, interendothelial junction structures, and endothelial barrier morphology were evaluated using transmission electron microscopy. RESULTS Sinonasal vascularity was increased significantly in CRSsNP and CRSwNP (p < 0.05) when compared with controls, as assessed by enumerating the platelet endothelial cell adhesion molecule (PECAM-1)-positive blood vessels. Pro-angiogenic gene expression, including PECAM1 and platelet-activating factor receptor, was elevated significantly in patients with CRSwNP when compared with controls (p < 0.05). The fenestration sizes between endothelial cells (17-280 nm) were larger in CRSwNP compared with CRSsNP (10-33 nm) patients and controls (4-12 nm). Global thinning of the endothelial cell lining was observed in CRS patients but not in controls. CONCLUSION Significant increases in vascularity, the pro-angiogenic gene, and protein expression and blood vessel morphogenesis were observed in CRS patients compared with controls. In addition, fenestration sizes between interendothelial junction structures were larger in CRS patients than in controls, suggesting inflammation-driven vascular dysregulation in CRS pathology.
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Affiliation(s)
- Nitish Khurana
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT
| | - Abigail Pulsipher
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Shaelene Ashby
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Chelsea E Pollard
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Hamidreza Ghandehari
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT
| | - Jeremiah A Alt
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT.,Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT
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20
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Mohammadpour R, Cheney DL, Grunberger JW, Yazdimamaghani M, Jedrzkiewicz J, Isaacson KJ, Dobrovolskaia MA, Ghandehari H. One-year chronic toxicity evaluation of single dose intravenously administered silica nanoparticles in mice and their Ex vivo human hemocompatibility. J Control Release 2020; 324:471-481. [PMID: 32464151 DOI: 10.1016/j.jconrel.2020.05.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
Chronic toxicity evaluations of nanotechnology-based drugs are essential to support initiation of clinical trials. Ideally such evaluations should address the dosing strategy in human applications and provide sufficient information for long-term usage. Herein, we investigated one-year toxicity of non-surface modified silica nanoparticles (SNPs) with variations in size and porosity (Stöber SNPs 46 ± 4.9 and 432.0 ± 18.7 nm and mesoporous SNPs 466.0 ± 86.0 nm) upon single dose intravenous administration to female and male BALB/c mice (10 animal/sex/group) along with their human blood compatibility. Our evidence of clinical observation and blood parameters showed no significant changes in body weight, cell blood count, nor plasma biomarker indices. No significant changes were noted in post necropsy examination of internal organs and organ-to-body weight ratio. However, microscopic examination revealed significant amount of liver inflammation and aggregates of histocytes with neutrophils within the spleen suggesting an ongoing or resolving injury. The fast accumulation of these plain SNPs in the liver and spleen upon IV administration and the duration needed for their clearance caused these injuries. There were also subtle changes which were attributed to prior infarctions or resolved intravascular thrombosis and included calcifications in pulmonary vessels, focal cardiac fibrosis with calcifications, and focal renal injury. Most of the pathologic lesions were observed when large, non-porous SNPs were administered. Statistically significant chronic toxicity was not observed for the small non-porous particles and for the mesoporous particles. This one-year post-exposure evaluation indicate that female and male BALB/c mice need up to one year to recover from acute tissue toxic effects of silica nanoparticles upon single dose intravenous administration at their 10-day maximum tolerated dose. Further, ex vivo testing with human blood and plasma revealed no hemolysis or complement activation following incubation with these silica nanoparticles. These results can inform the potential utility of silica nanoparticles in biomedical applications such as controlled drug delivery where intravenous injection of the particles is intended.
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Affiliation(s)
- Raziye Mohammadpour
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States
| | - Darwin L Cheney
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States
| | - Jason W Grunberger
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States
| | - Mostafa Yazdimamaghani
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States
| | - Jolanta Jedrzkiewicz
- Department of Pathology, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States
| | - Kyle J Isaacson
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, United States
| | - Hamidreza Ghandehari
- Utah Center for Nanomedicine, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, Nano Institute of Utah, and University of Utah, Salt Lake City, Utah, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States.
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21
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Jedrzkiewicz J, Tateishi Y, Kirsch R, Conner J, Bischof D, McCart A, Riddell R, Pollett A, Taylor EL, Govindarajan A. Impact of Referral Center Pathology Review on Diagnosis and Management of Patients With Appendiceal Neoplasms. Arch Pathol Lab Med 2019; 144:764-768. [DOI: 10.5858/arpa.2019-0214-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Data regarding the clinical impact of subspecialist pathology review of appendiceal neoplasms are limited.Objective.—To determine whether pathology review by gastrointestinal pathologists at a tertiary-care referral center resulted in significant changes in the diagnosis and clinical management of appendiceal neoplastic lesions.Design.—We conducted a retrospective review of all patients with an initial diagnosis of appendiceal neoplasm referred to a tertiary-care referral center in Ontario, Canada, from 2010–2016. The discordance rate between original and review pathology reports, the nature of discordances, and the impact of any discordance on patient management were recorded.Results.—A total of 145 patients with appendiceal lesions were identified (low-grade mucinous appendiceal neoplasm [n = 79], invasive mucinous adenocarcinoma [n = 12], “colorectal type” adenocarcinoma [n = 12], goblet cell carcinoid and adenocarcinomas ex goblet cell carcinoid [n = 24], and other lesions/neoplasms [n = 20]). One or more changes in diagnoses were found in 36 of 145 cases (24.8%), with changes within the same category of interpretation (n = 10), stage (n = 7), grade (n = 6), and categoric interpretation (n = 5) being the most common. In 10 of 36 patients (28%), the diagnostic change led to a significant change in management, including recommendation for additional surveillance, systemic chemotherapy, additional surgery, or discontinuation of surveillance.Conclusions.—Subspecialist pathology review of appendiceal neoplastic lesions led to a change in diagnosis in 36 of 145 cases (24.8%), of which nearly 30% (10 of 36 cases) led to a change in clinical management. The overall rate of clinically significant discordances was 7% (10 of 145). Our findings suggest that subspecialist pathology review of appendiceal neoplasms referred to specialized centers is justified.
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Affiliation(s)
- Jolanta Jedrzkiewicz
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Yoko Tateishi
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Richard Kirsch
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - James Conner
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Bischof
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | | | - Robert Riddell
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Pollett
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Emily L. Taylor
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Anand Govindarajan
- From the Department of Pathology, University of Utah, Salt Lake City (Dr Jedrzkiewicz); the Department of Pathology, Yokohama City University, Yokohama, Japan (Dr Tateishi); and the Departments of Pathology (Drs Kirsch, Conner, Riddell, and Pollett) and Surgery (Drs Bischof, McCart, and Govindarajan, and Ms Taylor), Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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Mohammadpour R, Yazdimamaghani M, Cheney DL, Jedrzkiewicz J, Ghandehari H. Subchronic toxicity of silica nanoparticles as a function of size and porosity. J Control Release 2019; 304:216-232. [PMID: 31047961 PMCID: PMC6681828 DOI: 10.1016/j.jconrel.2019.04.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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: 02/08/2019] [Revised: 04/20/2019] [Accepted: 04/28/2019] [Indexed: 12/15/2022]
Abstract
Despite increasing reports of using silica nanoparticles (SNPs) for controlled drug delivery applications, their long-term toxicity profile following intravenous administration remains unexplored. Herein, we investigated the acute (10-day) and subchronic (60-day and 180-day) toxicity of nonporous SNPs of approximately 50 nm (Stöber SNPs50) and approximately 500 nm in diameter (Stöber SNPs500), and mesoporous SNPs of approximately 500 nm in diameter (MSNPs500) upon single-dose intravenous injection into male and female immune-competent inbred BALB/c mice. The Maximum Tolerated Dose (MTD) of the particles was determined 10 days post-injection. The MTD of SNPs was administered and toxicity evaluated over 60 and 180 days. Results demonstrate that Stöber SNPs50 exhibit systemic toxicity with MTD of 103 ± 11 mg.kg-1 for female and 100 ± 6 mg.kg-1 for male mice, respectively. Toxicity was alleviated by increasing the size of the particles (Stöber SNPs500). MTD values of 303 ± 4 mg.kg-1 for female and 300 ± 13 mg.kg-1 for male were observed for Stöber SNPs500. Mesoporous SNPs500 showed considerable systemic sex-related toxicity, with MTDs ranging from 40 ± 2 mg.kg-1 to 95 ± 2 mg.kg-1 for male and female mice, respectively. Studies of SNPs showed blood toxicity as a function of physiochemical properties such as significant differences in the mean corpuscular hemoglobin (MCHC) and platelet number at day 10 and white blood cell count at day 60. Histological examination also showed size-, porosity- and time-dependent tissue toxicity. Stöber SNPs500 caused major toxic effects such as lung thrombosis, cardiac wall fibrosis and calcifications, brain infarctions with necrotizing inflammatory response, infiltrate, retinal injuries with calcification and focal gliosis, renal parenchymal damage and liver lobular inflammation dependent on the dose and time of exposure. However, tissue toxicity and accumulation of SNPs in liver observed at day 10 was greater than at day 60 and much greater than at day 180. In contrast, a dramatic increase in cytokine levels was observed at day 60. Despite the relatively high doses, SNPs did not cause subchronic toxicity at day 180 after single-dose intravenous injection. However, they showed distinct differences in the 60 day in vivo subchronic toxicity and inflammation profile as a function of surface area and size.
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Affiliation(s)
- Raziye Mohammadpour
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT, United States
| | - Mostafa Yazdimamaghani
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, United States
| | - Darwin L Cheney
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT, United States
| | | | - Hamidreza Ghandehari
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, United States; Department of Bioengineering, University of Utah, Salt Lake City, UT, United States.
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Jedrzkiewicz J, Scaife E, Hong B, South S, Alashari M. Congenital peribronchial myofibroblastic tumor: Case report and review of literature. Journal of Pediatric Surgery Case Reports 2015. [DOI: 10.1016/j.epsc.2015.02.012] [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: 10/23/2022] Open
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Allred R, Jedrzkiewicz J, Witt BL, Schmidt R. Verification Bias in Diagnostic Accuracy Studies of Salivary Gland Lesions in Otolaryngology Journals: A Systematic Review and Meta-Analysis. Am J Clin Pathol 2013. [DOI: 10.1093/ajcp/140.suppl1.165] [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: 11/15/2022] Open
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Jedrzkiewicz J, Witt BL. FNA diagnosis of a metastatic papillary thyroid carcinoma arising from a previously unknown follicular variant of papillary thyroid microcarcinoma. Diagn Cytopathol 2013; 42:711-5. [DOI: 10.1002/dc.23031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/29/2013] [Accepted: 06/11/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Jolanta Jedrzkiewicz
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT
| | - Benjamin L. Witt
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT
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Weininger O, Jedrzkiewicz J. Further research on personality dimensions and physical symptoms using the Differential Diagnostic Technique. Psychol Rep 1995; 76:656-8. [PMID: 7667479 DOI: 10.2466/pr0.1995.76.2.656] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The personality dynamics using the Differential Diagnostic Technique are delineated as part of an effort to understand their key role underlying the expression of physical symptoms. An urban sample of 40 boys and 71 girls, aged 14 and 15 years old, from regular classrooms completed the Health Survey which taps into five scales of physical symptoms of stress and the Differential Diagnostic Technique. The personality dimensions produced were very similar to those of earlier studies involving a young criminogenic sample. Expected trends for physical symptoms with ego control, rigid defensiveness, and personality organization are reported. This study provided further validity and reliability data for the Differential Diagnostic Technique as a useful instrument for assessing and interpreting the dynamics of human behaviour.
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Affiliation(s)
- O Weininger
- Department of Applied Psychology, Ontario Institute for Studies in Education, Toronto, Canada
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