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Liu SJ, Chen WC, Zhang Y, Young JS, Morshed RA, Nguyen MP, Villanueva-Meyer J, Phillips J, Oberheim NA, Aghi MK, Sneed PK, Braunstein SE, de Groot J, Berger MS, Molinaro AM, Hervey-Jumper S, Raleigh D. Adjuvant Chemoradiotherapy within One Year of Resection for Molecularly Defined Astrocytoma. Int J Radiat Oncol Biol Phys 2023; 117:e130-e131. [PMID: 37784692 DOI: 10.1016/j.ijrobp.2023.06.930] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Treatments for diffuse low-grade gliomas (LGG) are controversial. Level I evidence supports the use of adjuvant radiotherapy (RT) and PCV chemotherapy for histologic LGG, but integration of molecular biomarkers in recent WHO classification and the emergence of temozolomide chemotherapy for gliomas necessitates additional investigation of the optimal treatment and timing of postoperative interventions. We hypothesized molecularly-defined LGG (IDH-mutant astrocytoma (astro) and IDH-mutant, 1p/19q-codeleted oligodendroglioma (oligo)) may have different clinical outcomes following adjuvant RT (aRT) with chemotherapy (aRT+chemo) vs observation or chemo alone. MATERIALS/METHODS A retrospective analysis of consecutive adult patients diagnosed with WHO Grade 2 astrocytoma or oligodendroglioma who underwent initial resection at a single institution from January 1998 to November 2017 was performed. Wilcoxon rank sum and Chi-squared tests were used to compare continuous and categorical variables, respectively. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards models. Patients without clinical progression or death were censored at the date of last follow-up. Pre-operative and post-operative T2 FLAIR hyperintense tumor volumes were quantified using 3D Slicer to calculate extent of resection (EOR). RESULTS A total of 342 patients with molecularly-defined LGG (178 astro, 164 oligo) were identified with a median follow up of 9.1 yr. 171 (50%) patients received RT during their treatment course, of which 31 (18%) were treated with aRT within 1 year of diagnosis. The median aRT dose was 54 Gy (range: 40-60 Gy). aRT was more likely for astro (58%) vs oligo (41%, p = 0.001) and for patients who had resections with lower median EOR (88% vs 95%, p = 0.014). 53 patients (15%) were treated with chemo alone, and 136 patients (40%) were treated with aRT+chemo. Temozolomide was used for 161 patients (85%). For astro, aRT+chemo was associated with longer PFS (median 14.9 yr) compared to observation (4.8 yr, p = 0.05), aRT without chemo (5.2 yr, p = 0.01), or chemo alone (4.7 yr, p = 0.02). For oligo, aRT+chemo was associated with longer PFS (median not reached) compared to aRT without chemo (1.6 yr, p = 0.03), but not when compared to observation (median not reached, p = 0.47), or chemo alone (7.9 yr, p = 0.45). Multivariate analysis showed preoperative tumor volume, EOR, and aRT+chemo (but not aRT or chemo alone) were independently associated with astro PFS compared to observation. Propensity matching based on pre-operative tumor volume, EOR, and age demonstrated longer astro PFS after aRT+chemo (14.9 yr) compared to observation or chemo alone (4.5 yr, p = 0.015), without significant difference in OS (18.2 vs. 11.5 yr, p = 0.40). CONCLUSION Retrospective data from a single institution support the use of adjuvant radiotherapy with chemotherapy for patients with molecular astrocytomas, while the role of this approach for oligodendrogliomas is unclear in this cohort.
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Affiliation(s)
- S J Liu
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - W C Chen
- University of California San Francisco, San Francisco, CA
| | - Y Zhang
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - J S Young
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - R A Morshed
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - M P Nguyen
- University of California, San Francisco, Department of Radiation Oncology, San Francisco, CA
| | | | - J Phillips
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - N A Oberheim
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - M K Aghi
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - P K Sneed
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - S E Braunstein
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J de Groot
- University of California, San Francisco, San Francisco, CA
| | - M S Berger
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - A M Molinaro
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - S Hervey-Jumper
- University of California San Francisco, Department of Neurological Surgery, San Francisco, CA
| | - D Raleigh
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
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Fontalis A, Hughes K, Nguyen MP, Williamson M, Yeo A, Lui D, Gelfer Y. The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review. J Child Orthop 2019; 13:33-39. [PMID: 30838073 PMCID: PMC6376437 DOI: 10.1302/1863-2548.12.180094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. METHODS A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. RESULTS Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. CONCLUSION In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A. Fontalis
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - K. Hughes
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - M. P. Nguyen
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - M. Williamson
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - A. Yeo
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - D. Lui
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - Y. Gelfer
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK,St George’s University of London, London, UK, Correspondence should be sent to Y. Gelfer, MD PhD FRCS, St Georges Hospitals NHS Foundation Trust, Trauma and Orthopaedic Department, St James Wing Level 5, Blackshaw Rd, London SW170QT, UK. E-mail:
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Oda D, Nguyen MP, Royack GA, Tong DC. H2O2 oxidative damage in cultured oral epithelial cells: the effect of short-term vitamin C exposure. Anticancer Res 2001; 21:2719-24. [PMID: 11724346] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Smoking is the main etiology of oral cancer and generates oxygen free radicals in the oral cavity. Free radicals have been implicated in apoptosis and in DNA damage inducing alteration of the cell cycle. The antioxidant vitamin C (VC) is reported to inhibit damage induced by free radicals. We exposed cultures of normal human oral epithelial cells to hydrogen peroxide (H2O2) in the presence and absence of VC. Generation of hydroxyl radicals was measured by electron paramagnetic resonance (EPR), cell cycle alterations by flow cytometry, cell death by SYTO 11 and morphology by organotypic culture. Human primary cell culture was given four treatments - control, VC alone, H2O2 alone and VC followed by H2O2. Cell cycle analysis indicated cultures treated with H2O2 had fewer cells in G1 phase (26%) and higher number of cells in S phase (44%) compared to the control (G1 70% & S 14%). Cell cycle of 48 hour VC treatment followed by H2O2 was similar to H2O2 alone. SYTO 11 showed 22% cell death when treated with H2O2 alone compared to 9% of normal control. By organotypic culture H2O2 alone induced a two-fold cell proliferation, loss of maturation, nuclear hyperchromatism and nuclear crowding. Our results suggest that H2O2 is capable of altering the cell cycle and morphology of cultured normal human oral epithelial cells. Forty-eight hour exposure to Vitamin C does not prevent the cell cycle changes caused by hydroxyl radicals.
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Affiliation(s)
- D Oda
- Division of Oral and Maxillofacial Surgery, School of Dentistry, University of Washington, Seattle 98195, USA.
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Abstract
A damaged cell membrane is repaired by a seal that restricts entry or exit of molecules and ions to that of the level passing through an undamaged membrane. Seal formation requires elevation of intracellular Ca(2+) and, very likely, protein-mediated fusion of membranes. Ca(2+) also regulates the interaction between synaptotagmin (Syt) and syntaxin (Syx), which is thought to mediate fusion of synaptic vesicles with the axolemma, allowing transmitter release at synapses. To determine whether synaptic proteins have a role in sealing axolemmal damage, we injected squid and crayfish giant axons with an antibody that inhibits squid Syt from binding Ca(2+), or with another antibody that inhibits the Ca(2+)-dependent interaction of squid Syx with the Ca(2+)-binding domain of Syt. Axons injected with antibody to Syt did not seal, as assessed at axonal cut ends by the exclusion of extracellular hydrophilic fluorescent dye using confocal microscopy, and by the decay of extracellular injury current compared to levels measured in uninjured axons using a vibrating probe technique. In contrast, axons injected with either denatured antibody to Syt or preimmune IgG did seal. Similarly, axons injected with antibody to Syx did not seal, but did seal when injected with either denatured antibody to Syx or preimmune IgG. These results indicate an essential involvement of Syt and Syx in the repair (sealing) of severed axons. We suggest that vesicles, which accumulate and interact at the injury site, re-establish axolemmal continuity by Ca(2+)-induced fusions mediated by proteins such as those involved in neurotransmitter release.
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Affiliation(s)
- E Detrait
- Department of Physiology & Biophysics, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0641, USA
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Abstract
Smoking and periodontal inflammation are various conditions with the potential to induce oxidative stress and thus DNA damage in the oral cavity. In cellular defense systems, vitamin E is considered the most powerful lipid-soluble antioxidant. To investigate whether oxygen-free radicals alter normal progression of the cell cycle and whether vitamin E prevents this damage, we exposed cultured normal human oral epithelial cells to hydrogen peroxide (H2O2) in the presence or absence of vitamin E. Two primary cell lines were analyzed for the presence of hydroxyl radical, cell cycle distribution and morphology. Each cell line received five treatments: control, ethanol only, vitamin E only, H2O2 only or vitamin E followed by H2O2. Degradation of hydroxyl radicals was detected by electron paramagnetic resonance analysis, cell cycle by flow cytometry and morphology by organotypic technique. Hydroxyl radicals were generated in H2O2-treated cells at an initial concentration, which decreased over a period of time. Cell cycle analysis showed that H2O2-treated cells differed from normal cells in that the percentage of cells in the G1 phase decreased markedly (34.3 vs. 61.2% in control) and the S phase increased (35.5 vs. 15.6% in control). Organotypic cultures treated with H2O2 demonstrated nuclear hyperchromatism, loss of maturation and prominent nucleoli, features consistent with premalignant epithelial transformation. In conclusion, our data suggest that H2O2 produced hydroxyl radicals and altered the cell cycle. Also, vitamin E may have the potential to reduce oxidative damage caused by hydroxyl radicals.
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Affiliation(s)
- G A Royack
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Washington, Seattle, USA
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Webb P, Nguyen P, Shinsako J, Anderson C, Feng W, Nguyen MP, Chen D, Huang SM, Subramanian S, McKinerney E, Katzenellenbogen BS, Stallcup MR, Kushner PJ. Estrogen receptor activation function 1 works by binding p160 coactivator proteins. Mol Endocrinol 1998; 12:1605-18. [PMID: 9773983 DOI: 10.1210/mend.12.10.0185] [Citation(s) in RCA: 245] [Impact Index Per Article: 9.4] [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: 11/19/2022] Open
Abstract
Estrogen receptor-alpha contains two transactivation functions, a weak constitutive activation function (AF-1) and a hormone-dependent activation function (AF-2). AF-2 works by recruiting a large coactivator complex, composed of one or more p160s, CREB-binding protein (CBP)/p300, and P/CAF (p300 and CBP-associated factor), via direct contacts with the p160s. We report here that independent AF-1 activity also requires p160 contacts. Unlike AF-2, which binds signature NR boxes in the center of the p160 molecule, AF-1 binds to sequences near the p160 C terminus. We propose that the ability of AF-1 and AF-2 to interact with separate surfaces of the same coactivator is important for the ability of these transactivation functions to synergize.
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Affiliation(s)
- P Webb
- Metabolic Research Unit, University of California School of Medicine, San Francisco 94143-0540, USA
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Koo GC, Luk Y, Talento A, Wu J, Sirotina A, Fischer PA, Blake JT, Nguyen MP, Parsons W, Poe M. Association of serine protease with the rise of intracellular calcium in cytotoxic T lymphocytes. Cell Immunol 1996; 174:107-15. [PMID: 8954610 DOI: 10.1006/cimm.1996.0300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The precise role of the granular enzyme A (granzyme A), a serine protease, in the lytic process of cytotoxic T lymphocytes (CTL) is not clear. We have recently constructed a CTL line transfected with the antisense gene of granzyme A (a-GrA). These a-GrA CTL had lower GrA activity as well as decreased lytic activities, as measured by 51Cr and by DNA degradation assays. Furthermore, at low effector:target ratio (1:8) in prolonged lytic assays, they could not lyse targets as rapidly as the control CTL. When we examined their ability to exocytose BLT (CBZ-L-lys-thiobenzyl)-esterase in the presence of anti-CD3 antibody, the a-GrA CTL exocytosed poorly compared to the parental CTL or control transfectant with a CAT gene. Most strikingly, a-GrA cells could not release intracellular stores of Ca2+ in response to anti-CD3 induction, although the Ca2+ flux was normal when they were stimulated with ionomycin. When the parental CTL was treated with a specific benzyllactam inhibitor of BLT-esterase or N-tosyl-L-phenylalanylchloromethyl ketone, the Ca2+ flux induced by anti-CD3 was also suppressed. We propose that granzyme A is involved in the signal transduction pathway that causes the rise of the intracellular calcium.
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Affiliation(s)
- G C Koo
- Department of Immunology Research, Merck Research Laboratories, Rahway, New Jersey 07065, USA
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