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Ilias L, Doukas G, Kontoulis M, Alexakis K, Michalitsi-Psarrou A, Ntanos C, Askounis D. Overview of methods and available tools used in complex brain disorders. Open Res Eur 2023; 3:152. [PMID: 38389699 PMCID: PMC10882203 DOI: 10.12688/openreseurope.16244.1] [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] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 02/24/2024]
Abstract
Complex brain disorders, including Alzheimer's dementia, sleep disorders, and epilepsy, are chronic conditions that have high prevalence individually and in combination, increasing mortality risk, and contributing to the socioeconomic burden of patients, their families and, their communities at large. Although some literature reviews have been conducted mentioning the available methods and tools used for supporting the diagnosis of complex brain disorders and processing different files, there are still limitations. Specifically, these research works have focused primarily on one single brain disorder, i.e., sleep disorders or dementia or epilepsy. Additionally, existing research initiatives mentioning some tools, focus mainly on one single type of data, i.e., electroencephalography (EEG) signals or actigraphies or Magnetic Resonance Imaging, and so on. To tackle the aforementioned limitations, this is the first study conducting a comprehensive literature review of the available methods used for supporting the diagnosis of multiple complex brain disorders, i.e., Alzheimer's dementia, sleep disorders, epilepsy. Also, to the best of our knowledge, we present the first study conducting a comprehensive literature review of all the available tools, which can be exploited for processing multiple types of data, including EEG, actigraphies, and MRIs, and receiving valuable forms of information which can be used for differentiating people in a healthy control group and patients suffering from complex brain disorders. Additionally, the present study highlights both the benefits and limitations of the existing available tools.
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Affiliation(s)
- Loukas Ilias
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - George Doukas
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - Michael Kontoulis
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - Konstantinos Alexakis
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - Ariadni Michalitsi-Psarrou
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - Christos Ntanos
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
| | - Dimitris Askounis
- Decision Support Systems Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, 15773, Greece
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Papapanagiotou M, Ioannou P, Alexakis K, Maraki S, Papadokostaki E, Kofteridis DP. Streptococcus pseudoporcinus bacteremia in a patient with skin and soft tissue infection. A case report and literature review. Infez Med 2023; 31:399-403. [PMID: 37701389 PMCID: PMC10495064 DOI: 10.53854/liim-3103-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Streptococcus pseudoporcinus is a beta-hemolytic Streptococcus species arranged in short chains, which was first described in 2006. In the last years, there have been several reports of human infections by this bacterium, with five skin and soft tissue infections identified. Herein, a case of S. pseudoporcinus skin and soft tissue infection in a patient, who also developed bacteremia and was successfully treated with intravenous antibiotics, is reported. A 67-year-old man with a history of diffuse large B-cell lymphoma presented to the emergency department because of fever, redness, swelling, and pain in the left lower limb. He was admitted to the medical ward, diagnosed with severe non-purulent skin and soft tissue infection, and treated empirically with intravenous piperacillin/tazobactam at 4.5 gr thrice daily and daptomycin at 10mg/kg once daily. Blood cultures were obtained before the initiation of the antibiotics and grew S. pseudoporcinus. Treatment was de-escalated to ceftriaxone at a dose of 2 gr once daily. He completed two weeks of intravenous antimicrobial treatment. S. pseudoporcinus is an emerging pathogen associated with skin and soft tissue infections, bacteremia, and other invasive, potentially life-threatening infections. Further investigation is warranted to clarify this microorganism's pathogenesis and biological significance.
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Affiliation(s)
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
- School of Medicine, University of Crete, Heraklion, Greece
| | - Konstantinos Alexakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Eleni Papadokostaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
- School of Medicine, University of Crete, Heraklion, Greece
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Ioannou P, Alexakis K, Maraki S, Kofteridis DP. Pseudomonas Bacteremia in a Tertiary Hospital and Factors Associated with Mortality. Antibiotics (Basel) 2023; 12:antibiotics12040670. [PMID: 37107032 PMCID: PMC10135004 DOI: 10.3390/antibiotics12040670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Pseudomonas aeruginosa is the third most commonly identified cause among gram-negative microorganisms causing bloodstream infection (BSI) and carries a very high mortality, higher than that by other gram-negative pathogens. The aim of the present study was to assess the epidemiological and microbiological characteristics of patients with BSI by Pseudomonas spp. in a tertiary hospital, characterize the resistance rates of different Pseudomonas strains to the most clinically relevant anti-microbials, estimate the mortality rate, and identify factors independently associated with mortality. In total, 540 cultures from 419 patients sent to the microbiology department of the hospital during the 8-year period of the study were positive. Patients had a median age of 66 years, and 262 (62.5%) were male. The blood culture was drawn in the ICU in 201 of the patients (48%). The infection was hospital-acquired in 329 patients (78.5%) and the median hospital day when the blood culture was drawn was 15, with a range of 0 to 267 days. Median duration of stay in the hospital was 36 days, hospital mortality was 44.2% (185 patients), and 30-day mortality was 29.6% (124 patients). The most commonly isolated Pseudomonas species were P. aeruginosa followed by P. putida and P. oryzihabitans. There was a statistically significant reduction of P. aeruginosa isolation relative to non-aeruginosa Pseudomonas species in the post-COVID-19 era. Antimicrobial resistance of P. aeruginosa in clinically relevant antimicrobials with anti-pseudomonal activity was similar before and after the onset of the COVID-19 pandemic with the exception of gentamicin and tobramycin, with P. aeruginosa being more susceptible to these two antimicrobials in the post-COVID-19 era. Rates of multi-drug resistant (MDR), extensively-drug resistant (XDR), and difficult-to-treat (DTR) P. aeruginosa isolation were lower after the onset of the COVID-19 pandemic, even though a carbapenem-focused antimicrobial stewardship program had been implemented in the meantime. Increased age, ICU-acquisition of BSI, and more days in the hospital when positive blood culture was drawn were positively associated with 30-day mortality of patients with Pseudomonas BSI. The fact that rates of MDR, XDR, and DTR P. aeruginosa isolation were lower late in the study period, with a carbapenem-focused antimicrobial stewardship intervention being implemented in the meantime, further increases the understanding that implementation of antimicrobial stewardship interventions may halt the increase in antimicrobial resistance noted previously.
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Abstract
Serratia species are facultative anaerobes, non-spore-forming, motile Gram-negative bacteria. Serratia spp. are currently thought to cause a variety of infections, such as bacteremia, urinary tract infections, and pneumonia, as well as other, less common infections, including ocular infections or skin and soft tissue infections. On the other hand, Infective Endocarditis (IE) is an infrequent disease with notable morbidity and mortality. Even though IE is rarely caused by Serratia spp., these infections can be quite problematic due to the lack of experience in their management. This study aimed to systematically review all published cases of IE by Serratia spp. in the literature. A systematic review of PubMed, Scopus, and Cochrane library (through 13th May 2021) for studies providing epidemiological, clinical, microbiological data as well as data on treatment and outcomes of IE by Serratia spp. was performed. In total, 50 studies, containing data for 72 patients, were included. A prosthetic valve was present in 18.1%. The mitral valve was the most commonly infected site, followed by the aortic valve. The diagnosis was facilitated by transthoracic echocardiography in 34.7%, while the diagnosis was set at autopsy in 22.4%. Fever, sepsis, and embolic phenomena were the most common clinical presentations, followed by heart failure. Aminoglycosides, cephalosporins, and carbapenems were the most commonly used antimicrobials. Clinical cure was noted only in 53.5%, while overall mortality was 47.2%. Having surgery along with antimicrobial treatment was independently associated with reduced overall mortality. IE by Serratia spp. was more likely to be associated with intravenous drug use, and to present with heart failure and embolic phenomena compared to IE by other non-HACEK Gram-negative bacilli, while mortality was also higher in IE by Serratia spp.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Alexakis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Despoina Spentzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Filippatos TD, Alexakis K, Mavrikaki V, Mikhailidis DP. Nonalcoholic Fatty Pancreas Disease: Role in Metabolic Syndrome, "Prediabetes," Diabetes and Atherosclerosis. Dig Dis Sci 2022; 67:26-41. [PMID: 33469809 DOI: 10.1007/s10620-021-06824-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 03/25/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Fat accumulation in the pancreas associated with obesity and the metabolic syndrome (MetS) has been defined as "non-alcoholic fatty pancreas disease" (NAFPD). The aim of this review is to describe the association of NAFPD with obesity, MetS, type 2 diabetes mellitus (T2DM) and atherosclerosis and also increase awareness regarding NAFPD. Various methods are used for the detection and quantification of pancreatic fat accumulation that may play a significant role in the differences that have been observed in the prevalence of NAFPD. Endoscopic ultrasound provides detailed images of the pancreas and its use is expected to increase in the future. Obesity and MetS have been recognized as NAFPD risk factors. NAFPD is strongly associated with non-alcoholic fatty liver disease (NAFLD) and it seems that the presence of both may be related with aggravation of NAFLD. A role of NAFPD in the development of "prediabetes" and T2DM has also been suggested by most human studies. Accumulation of fat in pancreatic tissue possibly initiates a vicious cycle of beta-cell deterioration and further pancreatic fat accumulation. Additionally, some evidence indicates a correlation between NAFPD and atherosclerotic markers (e.g., carotid intima-media thickness). Weight loss and bariatric surgery decreases pancreatic triglyceride content but pharmacologic treatments for NAFPD have not been evaluated in specifically designed studies. Hence, NAFPD is a marker of local fat accumulation possibly associated with beta-cell function impairment, carbohydrate metabolism disorders and atherosclerosis.
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Affiliation(s)
- T D Filippatos
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece.
| | - K Alexakis
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece
| | - V Mavrikaki
- Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece
| | - D P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, NW3 2QG, UK.,Mohammed Bin Rashid University (MBRU) of Medicine and Health Sciences, Dubai, United Arab Emirates
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Ioannou P, Alexakis K, Kofteridis DP. Endocarditis in Liver Transplant Recipients: A Systematic Review. J Clin Med 2021; 10:jcm10122660. [PMID: 34208756 PMCID: PMC8235265 DOI: 10.3390/jcm10122660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
Infective Endocarditis (IE) is associated with significant mortality. Interestingly, IE in patients with liver transplantation has not been adequately described. The aim of this review was to systematically review all published cases of IE in liver transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed, Scopus and Cochrane Library (through 2 January 2021) for studies providing epidemiological, clinical, microbiological, treatment data and outcomes of IE in liver transplant recipients was conducted. A total of 39 studies, containing data for 62 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 69.4%, fungi in 25.8%, and gram-negative microorganisms in 9.7% of cases, while in 9.3% IE was culture-negative. The aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Aminoglycosides, vancomycin and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in half of the cases. Clinical cure was noted in 57.4%, while overall mortality was 43.5%. To conclude, this systematic review thoroughly describes IE in liver transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.
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Abstract
Infective Endocarditis (IE) carries significant mortality. Bacteremia, which is a predisposing factor for IE, occurs more frequently in immunocompromised individuals. Interestingly, IE in kidney transplant recipients has not been adequately described. The aim of this study was to systematically review all published cases of IE in kidney transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed (through 13th December 2019) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE in kidney transplant recipients was performed. A total of 60 studies, containing data of 117 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 57.4%, gram-negative microorganisms in 14.8%, fungi in 20%, while in 18.9% of cases, IE was culture-negative. Aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Diagnosis was set with a transthoracic ultrasound in half the cases, followed by transesophageal ultrasound and autopsy. Fever was present in most cases, while embolic phenomena were noted in two out of five cases. Aminoglycosides, cephalosporins and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in one out of three cases. Clinical cure was noted in 60.9%, while overall mortality was 45.3%. To conclude, this systematic review thoroughly describes IE in kidney transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes. Moreover, it identifies the emerging role of Enterococci, gram-negatives and fungi in IE in this population.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Alexakis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Ioannou P, Akoumianaki E, Alexakis K, Proklou A, Psyllaki M, Stamatopoulos E, Koulentaki M, Kondili E, Kofteridis DP. Hemophagocytic lymphohistiocytosis syndrome associated with Epstein-Barr infection in an omnicompetent patient. A case study. Germs 2020; 10:266-271. [DOI: 10.18683/germs.2020.1216] [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] [Received: 04/27/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 11/08/2022]
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Pelekanou V, Notas G, Athanasouli P, Alexakis K, Kiagiadaki F, Peroulis N, Kalyvianaki K, Kampouri E, Polioudaki H, Theodoropoulos P, Tsapis A, Castanas E, Kampa M. BCMA (TNFRSF17) Induces APRIL and BAFF Mediated Breast Cancer Cell Stemness. Front Oncol 2018; 8:301. [PMID: 30131941 PMCID: PMC6091000 DOI: 10.3389/fonc.2018.00301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/18/2018] [Indexed: 01/16/2023] Open
Abstract
Recent advances in cancer immunology revealed immune-related properties of cancer cells as novel promising therapeutic targets. The two TNF superfamily members, APRIL (TNFSF13), and BAFF (TNFSF13B), which are type II membrane proteins, released in active forms by proteolytic cleavage and are primarily involved in B-lymphocyte maturation, have also been associated with tumor growth and aggressiveness in several solid tumors, including breast cancer. In the present work we studied the effect of APRIL and BAFF on epithelial to mesenchymal transition, migration, and stemness of breast cancer cells. Our findings show that both molecules increase epithelial to mesenchymal transition and migratory capacity of breast cancer cells, as well as cancer stem cell numbers, by increasing the expression of pluripotency genes such as ALDH1A1, KLF4, and NANOG. These effects are mediated by their common receptor BCMA (TNFRSF17) and the JNK signaling pathway. Interestingly, transcriptional data analysis from breast cancer cells and patients revealed that androgens can increase APRIL transcription and subsequently, in an autocrine/paracrine manner, enhance its pluripotency effect. In conclusion, our data suggest a possible role of APRIL and BAFF in breast cancer disease progression and provide evidence for a new possible mechanism of therapy resistance, that could be particularly relevant in aromatase inhibitors-treated patients, were local androgen is increased.
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Affiliation(s)
- Vasiliki Pelekanou
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - George Notas
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Paraskevi Athanasouli
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Konstantinos Alexakis
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Fotini Kiagiadaki
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Peroulis
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Konstantina Kalyvianaki
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Errika Kampouri
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Hara Polioudaki
- Department of Biochemistry, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Andreas Tsapis
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Elias Castanas
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
| | - Marilena Kampa
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, Heraklion, Greece
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Notas G, Pelekanou V, Kampa M, Alexakis K, Sfakianakis S, Laliotis A, Askoxilakis J, Tsentelierou E, Tzardi M, Tsapis A, Castanas E. Tamoxifen induces a pluripotency signature in breast cancer cells and human tumors. Mol Oncol 2015; 9:1744-59. [PMID: 26115764 DOI: 10.1016/j.molonc.2015.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 01/01/2023] Open
Abstract
Tamoxifen is the treatment of choice in estrogen receptor alpha breast cancer patients that are eligible for adjuvant endocrine therapy. However, ∼50% of ERα-positive tumors exhibit intrinsic or rapidly acquire resistance to endocrine treatment. Unfortunately, prediction of de novo resistance to endocrine therapy and/or assessment of relapse likelihood remain difficult. While several mechanisms regulating the acquisition and the maintenance of endocrine resistance have been reported, there are several aspects of this phenomenon that need to be further elucidated. Altered metabolic fate of tamoxifen within patients and emergence of tamoxifen-resistant clones, driven by evolution of the disease phenotype during treatment, appear as the most compelling hypotheses so far. In addition, tamoxifen was reported to induce pluripotency in breast cancer cell lines, in vitro. In this context, we have performed a whole transcriptome analysis of an ERα-positive (T47D) and a triple-negative breast cancer cell line (MDA-MB-231), exposed to tamoxifen for a short time frame (hours), in order to identify how early pluripotency-related effects of tamoxifen may occur. Our ultimate goal was to identify whether the transcriptional actions of tamoxifen related to induction of pluripotency are mediated through specific ER-dependent or independent mechanisms. We report that even as early as 3 hours after the exposure of breast cancer cells to tamoxifen, a subset of ERα-dependent genes associated with developmental processes and pluripotency are induced and this is accompanied by specific phenotypic changes (expression of pluripotency-related proteins). Furthermore we report an association between the increased expression of pluripotency-related genes in ERα-positive breast cancer tissues samples and disease relapse after tamoxifen therapy. Finally we describe that in a small group of ERα-positive breast cancer patients, with disease relapse after surgery and tamoxifen treatment, ALDH1A1 (a marker of pluripotency in epithelial cancers which is absent in normal breast tissue) is increased in relapsing tumors, with a concurrent modification of its intra-cellular localization. Our data could be of value in the discrimination of patients susceptible to develop tamoxifen resistance and in the selection of optimized patient-tailored therapies.
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Affiliation(s)
- George Notas
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece; Institute of Applied Computational Mathematics, Foundation of Research and Technology (FORTH), Heraklion, Greece.
| | - Vassiliki Pelekanou
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece; Laboratories of Pathology, University of Crete School of Medicine, Heraklion, Greece
| | - Marilena Kampa
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece
| | - Konstantinos Alexakis
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece
| | - Stelios Sfakianakis
- Institute of Computer Science, Foundation of Research and Technology (FORTH), Heraklion, Greece
| | - Aggelos Laliotis
- Department of Surgical Oncology, University Hospital, Heraklion, Greece
| | - John Askoxilakis
- Department of Surgical Oncology, University Hospital, Heraklion, Greece
| | | | - Maria Tzardi
- Laboratories of Pathology, University of Crete School of Medicine, Heraklion, Greece
| | - Andreas Tsapis
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece; INSERM U976, Hôpital Saint Louis, Paris, France; University Paris Diderot, Paris, France
| | - Elias Castanas
- Laboratories of Experimental Endocrinology, University of Crete School of Medicine, Heraklion, Greece.
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