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Verduin M, Hoosemans L, Vanmechelen M, van Heumen M, Piepers JAF, Astuti G, Ackermans L, Schijns OEMG, Kampen KR, Tjan-Heijnen VCG, de Barbanson BA, Postma AA, Eekers DBP, Broen MPG, Beckervordersandforth J, Staňková K, de Smet F, Rich J, Hubert CG, Gimenez G, Chatterjee A, Hoeben A, Vooijs MA. Patient-derived glioblastoma organoids reflect tumor heterogeneity and treatment sensitivity. Neurooncol Adv 2023; 5:vdad152. [PMID: 38130902 PMCID: PMC10733660 DOI: 10.1093/noajnl/vdad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Treatment resistance and tumor relapse are the primary causes of mortality in glioblastoma (GBM), with intratumoral heterogeneity playing a significant role. Patient-derived cancer organoids have emerged as a promising model capable of recapitulating tumor heterogeneity. Our objective was to develop patient-derived GBM organoids (PGO) to investigate treatment response and resistance. Methods GBM samples were used to generate PGOs and analyzed using whole-exome sequencing (WES) and single-cell karyotype sequencing. PGOs were subjected to temozolomide (TMZ) to assess viability. Bulk RNA sequencing was performed before and after TMZ. Results WES analysis on individual PGOs cultured for 3 time points (1-3 months) showed a high inter-organoid correlation and retention of genetic variants (range 92.3%-97.7%). Most variants were retained in the PGO compared to the tumor (range 58%-90%) and exhibited similar copy number variations. Single-cell karyotype sequencing demonstrated preservation of genetic heterogeneity. Single-cell multiplex immunofluorescence showed maintenance of cellular states. TMZ treatment of PGOs showed a differential response, which largely corresponded with MGMT promoter methylation. Differentially expressed genes before and after TMZ revealed an upregulation of the JNK kinase pathway. Notably, the combination treatment of a JNK kinase inhibitor and TMZ demonstrated a synergistic effect. Conclusions Overall, these findings demonstrate the robustness of PGOs in retaining the genetic and phenotypic heterogeneity in culture and the application of measuring clinically relevant drug responses. These data show that PGOs have the potential to be further developed into avatars for personalized adaptive treatment selection and actionable drug target discovery and as a platform to study GBM biology.
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Affiliation(s)
- Maikel Verduin
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Linde Hoosemans
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maxime Vanmechelen
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- LISCO—KU Leuven Institute for Single Cell Omics, KU Leuven, Leuven, Belgium
| | - Mike van Heumen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jolanda A F Piepers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Galuh Astuti
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Olaf E M G Schijns
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
- Academic Center for Epileptology, Maastricht University Medical Center and Kempenhaeghe, Maastricht—Heeze, The Netherlands
| | - Kim R Kampen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
- Laboratory for Disease Mechanisms in Cancer, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Danielle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn P G Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Katerina Staňková
- Institute for Health Systems Science, Delft University of Technology, Delft, The Netherlands
| | - Frederik de Smet
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- LISCO—KU Leuven Institute for Single Cell Omics, KU Leuven, Leuven, Belgium
| | - Jeremy Rich
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher G Hubert
- Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gregory Gimenez
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Aniruddha Chatterjee
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ann Hoeben
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc A Vooijs
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
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2
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Broen MPG, Beckers R, Willemsen ACH, Huijs SMH, Pasmans RCOS, Eekers DBP, Ackermans L, Beckervordersandforth J, van Raak EPM, Verduin M, Anten MHME, Hoeben A, Postma AA. Temporal muscle thickness as an independent prognostic imaging marker in newly diagnosed glioblastoma patients: a validation study. Neurooncol Adv 2022; 4:vdac038. [PMID: 35475275 PMCID: PMC9034111 DOI: 10.1093/noajnl/vdac038] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have recognized temporal muscle thickness (TMT) as a prognostic marker in glioblastoma, but clinical implementation is hampered due to studies’ heterogeneity and lack of established cutoff values. The aim of this study was to assess the validity of recent proposed sex-specific TMT cutoff values in a real-world population of genotyped primary glioblastoma patients. Methods We measured TMT in preoperative MR images of 328 patients. Sex-specific TMT cutoff values were used to divide patients into “at risk of sarcopenia” or “normal muscle status”. Kaplan-Meier analyses and stepwise multivariate Cox-Regression analyses were used to assess the association with overall survival (OS) and progression-free survival (PFS). The association with occurrence of complications and discontinuation of glioblastoma treatment was investigated using odds ratios (OR). Results Patients at risk of sarcopenia had a significantly higher risk of progression and death than patients with normal muscle status, which remained significant in the multivariate analyses (OS HR = 1.437; 95%CI: 1.046–1.973; P = .025 and PFS HR = 1.453; 95%CI: 1.037–2.036; P = .030). Patients at risk of sarcopenia also had a significantly higher risk of early discontinuation of treatment (OR = 2.45; 95%CI: 1.011–5.952; P = .042) and a significantly lower chance of receiving second-line treatment (OR = 0.23; 95%CI: 0.09–0.60; P = .001). There was no association with the occurrence of complications. Conclusions Our study confirms external validity of the use of proposed sex-specific TMT cutoff values as an independent prognostic marker in newly diagnosed glioblastoma patients. This simple, noninvasive marker could improve patient counseling and aid in treatment decision processes or trial stratification.
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Affiliation(s)
- Martinus P G Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Rueben Beckers
- Department of Neurology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Anna C H Willemsen
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sandra M H Huijs
- Department of Neurology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Beckervordersandforth
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Maikel Verduin
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Monique H M E Anten
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ann Hoeben
- GROW- School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Alida A Postma
- Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
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3
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Vanmechelen M, Beckervordersandforth J, Pey J, Antoranz A, Nasari P, Pantano D, Bevers S, Leunissen D, Moors W, Messiaen J, Sebastian I, Milli G, Van Herck Y, Geens E, Verduin M, Hoosemans L, Claeys A, Derweduwe M, Zurhausen A, Bosisio F, Eekers D, Weyns F, Daenekindt T, Van Eyken P, Goovers M, Hovinga K, De Vleeschouwer S, Clement P, Broen M, Vooijs M, Sciot R, Hoeben A, Speel EJ, De Smet F. PATH-20. SPATIAL MAPPING OF THERAPY-INDUCED, PATHOLOGICAL CHANGES IN GLIOBLASTOMA AT SINGLE-CELL RESOLUTION. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Glioblastoma (GBM) remains a highly malignant, intrinsically resistant and inevitably recurring brain tumor with dismal prognosis. The aggressiveness and lack of effective GBM treatments can be attributed to the highly heterogeneous and plastic nature of GBM tumor cells, which easily confer resistance to standard-of-care (SOC) therapy. While tumor progression has also been attributed to interactions with the tumor microenvironment, quantitative data describing these interactions are still largely missing. Here, we used high-dimensional, multiplexed immunohistochemistry to map evolutions in the spatial, single-cell tissue architecture of 120 paired adult GBM tumor samples derived from 60 patients at diagnosis (ND) and upon recurrence (REC) following SOC treatment. We mapped the spatial distribution of a multitude of GBM tumoral subtypes across this multicentric cohort, through which we identified a high level of heterogeneity defined by specific tumoral niches within and across patients and which evolved when subjected to SOC therapy. In addition, we describe the relationship of the various tumoral niches with their local immune-infiltrates, highlighting an even more immunosuppressive environment following SOC resistance. Finally, by aligning these findings to the observed genomic aberrations and the clinical data of the patients, we are now able to more precisely describe the heterogeneous landscape of glioblastoma and how it evolves under SOC treatment at spatial, single-cell resolution.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Vooijs
- Maastricht University, Maastricht, Netherlands
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Jacquerie A, Huijs S, Moers-Hornikx VMP, van der Heijden-Montfroy AMHG, van Goor MPJ, Pasmans RCOS, Anten MHME, Verduin M, Broen MPG. P14.33 Preoperative Lactate Dehydrogenase levels as a predictor of venous thromboembolism development in glioblastoma patients. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Venous thromboembolism (VTE) is a common complication in patients with glioblastoma. Despite high incidence of up to 30% per year, concerns about bleeding complications have limited the use of primary anticoagulant prophylaxis. Finding a suitable biomarker to assess the risk of occurrence is therefore of utmost clinical interest. We performed an exploratory study of preoperative routinely used haematological markers as predictor for the development of VTE in glioblastoma patients.
MATERIAL AND METHODS
Data was retrospectively collected from an existing database of 307 patients diagnosed with glioblastoma by the Oncology Network South-East Netherlands (OnzoZON) between 2006 and 2020. Collected preoperative haematological markers included: haemoglobin, platelets, lactate dehydrogenase, neutrophils, lymphocytes, albumin and derived ratios. In addition, type and date of VTE were retrieved from medical records. Receiver operating curve was used to identify the optimal cut-off values of the preoperative haematological markers. Univariate and multivariate logistic regression analyses were performed to predict VTE for each haematologic marker independently. Variables included in the multivariate analyses were age, gender, type of surgery, Karnofsky performance score, MGMT status, weight, height and BMI, already available from the primary database.
RESULTS
In the total dataset, 45 patients (15%) suffered from a VTE, most common pulmonary embolism (51%) followed by deep vein thrombosis (31%). Mean time from diagnosis until VTE was 4.3 months (SD = 5.5). Preoperative haemoglobin value was available for analyses in 265 patients, platelets value in 226, lactate dehydrogenase in 98, neutrophils in 133, lymphocytes in 133 and albumin in 56 patients. A preoperative lactate dehydrogenase value > 243 U/L was found to increase the risk of VTE in both univariate and multivariate analysis (P <0.05). Seventeen out of 98 patients of whom lactate dehydrogenase level was available suffered from a VTE, most common pulmonary embolism (59%), followed by deep vein thrombosis (29%) and cerebral venous sinus thrombosis (12%). An elevated lactate dehydrogenase in serum increased the odds for getting a VTE by 3.2 (1.1–9.4). None of the other investigated haematological markers or ratios were found to be significantly correlated with the occurrence of VTE in our study.
CONCLUSION
Glioblastoma initiates locally haemostatic abnormalities, that propagate systemically though circulating mediators. Our exploratory analysis shows for the first time that preoperative lactate dehydrogenase levels might aid clinicians in identifying patients at risk for a venous thromboembolism. Ultimately this could lead to preventive measures and patient education, but larger and prospective validation of these findings is warranted.
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Affiliation(s)
- A Jacquerie
- Master Physician-Clinical Investigator, #Contributed equally, Maastricht University, Maastricht, Netherlands
| | - S Huijs
- Department of Neurology, #Contributed equally, Zuyderland Medical Center, Heerlen, Netherlands
| | | | | | - M P J van Goor
- Department of Neurology, Laurentius Hospital Roermond, Roermond, Netherlands
| | - R C O S Pasmans
- Department of Neurology, Zuyderland Medical Center, Heerlen, Netherlands
| | - M H M E Anten
- Department of Neurology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, Netherlands
| | - M Verduin
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - M P G Broen
- Department of Neurology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, Netherlands
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5
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Hope A, Verduin M, Dilling TJ, Choudhury A, Fijten R, Wee L, Aerts HJWL, El Naqa I, Mitchell R, Vooijs M, Dekker A, de Ruysscher D, Traverso A. Artificial Intelligence Applications to Improve the Treatment of Locally Advanced Non-Small Cell Lung Cancers. Cancers (Basel) 2021; 13:2382. [PMID: 34069307 PMCID: PMC8156328 DOI: 10.3390/cancers13102382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Locally advanced non-small cell lung cancer patients represent around one third of newly diagnosed lung cancer patients. There remains a large unmet need to find treatment strategies that can improve the survival of these patients while minimizing therapeutical side effects. Increasing the availability of patients' data (imaging, electronic health records, patients' reported outcomes, and genomics) will enable the application of AI algorithms to improve therapy selections. In this review, we discuss how artificial intelligence (AI) can be integral to improving clinical decision support systems. To realize this, a roadmap for AI must be defined. We define six milestones involving a broad spectrum of stakeholders, from physicians to patients, that we feel are necessary for an optimal transition of AI into the clinic.
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Affiliation(s)
- Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, ON 5MT 1P5, Canada;
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON 5MT 1P5, Canada
| | - Maikel Verduin
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Ananya Choudhury
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Rianne Fijten
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Leonard Wee
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Hugo JWL Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA;
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, 6228 ET Maastricht, The Netherlands
| | - Issam El Naqa
- Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (I.E.N.); (R.M.)
| | - Ross Mitchell
- Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (I.E.N.); (R.M.)
| | - Marc Vooijs
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Andre Dekker
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands; (M.V.); (A.C.); (R.F.); (L.W.); (M.V.); (A.D.); (D.d.R.)
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6
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Verduin M, Hoeben A, De Ruysscher D, Vooijs M. Patient-Derived Cancer Organoids as Predictors of Treatment Response. Front Oncol 2021; 11:641980. [PMID: 33816288 PMCID: PMC8012903 DOI: 10.3389/fonc.2021.641980] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/01/2021] [Indexed: 12/11/2022] Open
Abstract
Patient-derived cancer organoids have taken a prominent role in pre-clinical and translational research and have been generated for most common solid tumors. Cancer organoids have been shown to retain key genetic and phenotypic characteristics of their tissue of origin, tumor subtype and maintain intratumoral heterogeneity and therefore have the potential to be used as predictors for individualized treatment response. In this review, we highlight studies that have used cancer organoids to compare the efficacy of standard-of-care and targeted combination treatments with clinical patient response. Furthermore, we review studies using cancer organoids to identify new anti-cancer treatments using drug screening. Finally, we discuss the current limitations and improvements needed to understand the full potential of cancer organoids as avatars for clinical management of cancer therapy.
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Affiliation(s)
- Maikel Verduin
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marc Vooijs
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
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7
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Verduin M, Compter I, Primakov S, van Kuijk S, te Dorsthorst M, Revenich E, ter Laan M, Pegge S, Meijer A, Beckervordersandforth J, Jan Speel E, Jochems A, de Leng W, Anten M, Broen M, Ackermans L, Schijns O, Vooijs M, Tjan-Heijnen V, Lambin P, Eekers D, Jacobi-Postma L, Hoeben A. NIMG-65. PREDICTING PROGNOSIS AND CANCER HOTSPOT MUTATIONS USING QUALITATIVE MR IMAGING ANALYSIS IN GLIOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Tumor heterogeneity poses one of the major limitations in improving the treatment for glioblastoma (GBM), which calls for new clinically relevant predictive models. This study aims to investigate non-invasive diagnostic methods, including patient characteristics and qualitative imaging analysis as a prognostic classifier and predictor for druggable oncogenes.
METHODS
We performed a retrospective analysis on 143 GBM patients (discovery cohort). Diagnostic MRIs were re-analyzed for qualitative imaging features (VASARI features). DNA was extracted from formalin-fixed, paraffin-embedded GBM tissue of the discovery cohort for next-generation sequencing (Ion Torrent Cancer Hotspot panel v2Plus), TERT-promoter mutation and MGMT-methylation analysis. Multivariable regression analysis was used to determine the prognostic and predictive value of VASARI features.
RESULTS
Of the 143 patients, median age was 61.4 years (range 15.5–84.6) with a median overall survival of 12 months (range 0–142). We observed IDH1 R132H mutation in 8.5%, MGMT-promotor methylation in 26.1%, TERT-promotor mutation (C250T;C228T) in 69.5%, EGFR mutation in 20.3% and EGFR amplification in 37.5% of all patients. A set of eight VASARI features was identified to be associated with overall survival (p< 0.001), which is currently being validated in an external dataset (n= 184). Interestingly, VASARI features appeared to be associated with IDH1-mutation (four features, p=0.004), TERT-promotor mutation (five features, p-value < 0.001), EGFR mutation (five features, p-value < 0.001) and EGFR amplification (seven features, p-value < 0.001) but not with MGMT-methylation (two features, p-value=0.054). Additional cancer hotspots are currently being analyzed and internal validation is ongoing.
CONCLUSION AND FUTURE PERSPECTIVES
We propose an integrated prognostic classifier comprising MRI features, also associated with GBM-specific molecular alterations. Additionally, quantitative MRI radiomics features are being extracted from the discovery and validation set and incorporated in the prognostic classifier. Subsequently, radiomics and VASARI features will be correlated to intratumoral heterogeneity, assessed by tissue micro-array analysis of the discovery cohort.
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Affiliation(s)
- Maikel Verduin
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Inge Compter
- Department of Radiotherapy (MAASTRO), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Sergey Primakov
- The-D-Lab: Decision Support for Precision Medicine, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maarten te Dorsthorst
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elles Revenich
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Mark ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjoert Pegge
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anton Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Ernst Jan Speel
- Department of Pathology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Arthur Jochems
- The-D-Lab: Decision Support for Precision Medicine, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Wendy de Leng
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Monique Anten
- Department of Neurology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Martijn Broen
- Department of Neurology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Olaf Schijns
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marc Vooijs
- Department of Radiotherapy (MAASTRO), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Vivianne Tjan-Heijnen
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Philippe Lambin
- The-D-Lab: Decision Support for Precision Medicine, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Danielle Eekers
- Department of Radiotherapy (MAASTRO), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center+, Maastricht, Netherlands
| | - Linda Jacobi-Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, Netherlands
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Compter I, Verduin M, Woodruff HC, Leijenaar RTH, Postma AA, Hoeben A, Eekers DBP, Lambin P. P01.117 Differentiating high grade gliomas with CT based radiomics. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Compter
- Dept. of Radiation-Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht, Netherlands
| | - M Verduin
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - H C Woodruff
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology & MCCC, Maastricht University Medical Centre, Maastricht, Netherlands
| | - R T H Leijenaar
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology & MCCC, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A A Postma
- Dept. of Radiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - A Hoeben
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - D B P Eekers
- Dept. of Radiation-Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht, Netherlands
- Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, Netherlands
| | - P Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology & MCCC, Maastricht University Medical Centre, Maastricht, Netherlands
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Verduin M, Hoeben A, Ackermans L, Eekers D, Hubert C, Rich J, Tjan-Heijnen V, Vooijs M. PO-340 Tumour heterogeneity in patient-derived glioblastoma organoids. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.852] [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: 11/04/2022] Open
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10
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Verduin M, Zindler JD, Martinussen HMA, Jansen RLH, Croes S, Hendriks LEL, Eekers DBP, Hoeben A. Use of Systemic Therapy Concurrent With Cranial Radiotherapy for Cerebral Metastases of Solid Tumors. Oncologist 2017; 22:222-235. [PMID: 28167569 PMCID: PMC5330699 DOI: 10.1634/theoncologist.2016-0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/20/2016] [Accepted: 09/02/2016] [Indexed: 12/25/2022] Open
Abstract
The incidence of brain metastases of solid tumors is increasing. Local treatment of brain metastases is generally straightforward: cranial radiotherapy (e.g., whole-brain radiotherapy or stereotactic radiosurgery) or resection when feasible. However, treatment becomes more complex when brain metastases occur while other metastases, outside of the central nervous system, are being controlled with systemic therapy (chemotherapeutics, molecular targeted agents, or monoclonal antibodies). It is known that some anticancer agents can increase the risk for neurotoxicity when used concurrently with radiotherapy. Increased neurotoxicity decreases quality of life, which is undesirable in this predominantly palliative patient group. Therefore, it is of utmost importance to identify the compounds that should be temporarily discontinued when cranial radiotherapy is needed.This review summarizes the (neuro)toxicity data for combining systemic therapy (chemotherapeutics, molecular targeted agents, or monoclonal antibodies) with concurrent radiotherapy of brain metastases. Because only a limited amount of high-level data has been published, a risk assessment of each agent was done, taking into account the characteristics of each compound (e.g., lipophilicity) and the microenvironment of brain metastasis. The available trials suggest that only gemcitabine, erlotinib, and vemurafenib induce significant neurotoxicity when used concurrently with cranial radiotherapy. We conclude that for most systemic therapies, the currently available literature does not show an increase in neurotoxicity when these therapies are used concurrently with cranial radiotherapy. However, further studies are needed to confirm safety because there is no high-level evidence to permit definitive conclusions. The Oncologist 2017;22:222-235Implications for Practice: The treatment of symptomatic brain metastases diagnosed while patients are receiving systemic therapy continues to pose a dilemma to clinicians. Will concurrent treatment with cranial radiotherapy and systemic therapy (chemotherapeutics, molecular targeted agents, and monoclonal antibodies), used to control intra- and extracranial tumor load, increase the risk for neurotoxicity? This review addresses this clinically relevant question and evaluates the toxicity of combining systemic therapies with cranial radiotherapy, based on currently available literature, in order to determine the need to and interval to interrupt systemic treatment.
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Affiliation(s)
- Maikel Verduin
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap D Zindler
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hanneke M A Martinussen
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob L H Jansen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander Croes
- Department of Clinical Pharmacy & Toxicology, CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Danielle B P Eekers
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Bouten CV, Koekkoek KT, Verduin M, Kodde R, Janssen JD. A triaxial accelerometer and portable data processing unit for the assessment of daily physical activity. IEEE Trans Biomed Eng 1997; 44:136-47. [PMID: 9216127 DOI: 10.1109/10.554760] [Citation(s) in RCA: 320] [Impact Index Per Article: 11.9] [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: 02/04/2023]
Abstract
The present study describes the development of a triaxial accelerometer (TA) and a portable data processing unit for the assessment of daily physical activity. The TA is composed of three orthogonally mounted uniaxial piezoresistive accelerometers and can be used to register accelerations covering the amplitude and frequency ranges of human body acceleration. Interinstrument and test-retest experiments showed that the offset and the sensitivity of the TA were equal for each measurement direction and remained constant on two measurement days. Transverse sensitivity was significantly different for each measurement direction, but did not influence accelerometer output (< 3% of the sensitivity along the main axis). The data unit enables the on-line processing of accelerometer output to a reliable estimator of physical activity over eight-day periods. Preliminary evaluation of the system in 13 male subjects during standardized activities in the laboratory demonstrated a significant relationship between accelerometer output and energy expenditure due to physical activity, the standard reference for physical activity (r = 0.89). Shortcomings of the system are its low sensitivity to sedentary activities and the inability to register static exercise. The validity of the system for the assessment of normal daily physical activity and specific activities outside the laboratory should be studied in free-living subjects.
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Affiliation(s)
- C V Bouten
- University of Technology, Division of Computational and Experimental Mechanics, Eindhoven, The Netherlands.
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Bouten CV, Sauren AA, Verduin M, Janssen JD. Effects of placement and orientation of body-fixed accelerometers on the assessment of energy expenditure during walking. Med Biol Eng Comput 1997; 35:50-6. [PMID: 9136191 DOI: 10.1007/bf02510392] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C V Bouten
- Eindhoven University of Technology, Faculty of Mechanical Engineering, The Netherlands
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Bouten CV, Verboeket-van de Venne WP, Westerterp KR, Verduin M, Janssen JD. Daily physical activity assessment: comparison between movement registration and doubly labeled water. J Appl Physiol (1985) 1996; 81:1019-26. [PMID: 8872675 DOI: 10.1152/jappl.1996.81.2.1019] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.2] [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: 02/02/2023] Open
Abstract
The use of movement registration for daily physical activity assessment was evaluated during a 7-day period in 30 free-living subjects. Body movement was registered with a Tracmor motion sensor consisting of a triaxial accelerometer and a data unit for on-line processing of accelerometer output over 1-min intervals. Average Tracmor output was correlated against four different energy estimates: 1) average daily metabolic rate (ADMR), determined with doubly labeled water; 2) ADMR-sleeping metabolic rate (SMR; determined in a respiration chamber); 3) (ADMR-SMR) per kilogram of body mass; and 4) the overall physical activity level (PAL = ADMR/SMR). The highest correlation was found for the relationship between Tracmor output and PAL (r = 0.58). After correction for Tracmor values arising from vibrations produced by transportation means, this correlation was improved to 0.73. There was no difference between Tracmor output and PAL in discriminating between overall activity levels with "low" (PAL < 1.60), "moderate" (1.60 < or = PAL < or = 1.85), and "high" (PAL > 1.85) intensity. It is concluded that the Tracmor can be used in free-living subjects to distinguish among interindividual as well as intraindividual levels of daily physical activity.
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Affiliation(s)
- C V Bouten
- Department of Human Biology, University of Limburg, Maastricht, The Netherlands.
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Bouten CV, Westerterp KR, Verduin M, Janssen JD. Assessment of energy expenditure for physical activity using a triaxial accelerometer. Med Sci Sports Exerc 1994; 26:1516-23. [PMID: 7869887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A triaxial accelerometer was used to evaluate the relationship between energy expenditure due to physical activity (EEact) and body acceleration during different types of activity. In a laboratory experiment, 11 male subjects performed sedentary activities and walked on a motor driven treadmill (3-7 km.h-1). EEact was calculated from total energy expenditure (EEtot), as measured by indirect calorimetry, and sleeping metabolic rate (SMR): EEact = EEtot--SMR. Body accelerations were measured with a triaxial accelerometer at the low back. Special attention was paid to the analysis of unidirectional and three-directional accelerometer output. During sedentary activities a linear relationship between EEact and the sum of the integrals of the absolute value of accelerometer output from all three measurement directions (IAAtot) was found (r = 0.82, P < 0.001, Sy,x = 0.22 W.kg-1). During walking EEact was highly correlated with the integral of absolute accelerometer output in antero-posterior direction (IAAx; r = 0.96, P < 0.001, Sy,x = 0.53 W.kg-1). When all examined activities were included in a regression analysis, a strong linear relationship between EEact and IAAtot was found (r = 0.95, P < 0.001, Sy,x = 0.70 W.kg-1). Using this relationship, EEact during sedentary activities as well as EEact during walking could be estimated with an accuracy of about 15%. Although sedentary activities and walking represent a large part of normal daily physical activity, the validity and usefulness of the triaxial accelerometer--measuring IAAtot--to predict EEact in daily life must be studied under free-living conditions.
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Affiliation(s)
- C V Bouten
- Faculty of Mechanical Engineering, Division of Fundamentals, Eindhoven University of Technology, The Netherlands
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Bär FW, van Oppen J, de Swart H, van Ommen V, Havenith M, Daemen M, Leenders P, van der Veen FH, van Lankveld M, Verduin M. Percutaneous implantation of a new intracoronary stent in pigs. Am Heart J 1991; 122:1532-41. [PMID: 1957747 DOI: 10.1016/0002-8703(91)90268-m] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sixty-two self-expanding parallel wire stainless steel stents were implanted in normal coronary arteries of 31 young pigs using a newly developed delivery system. In 57 of 62 procedures, the percutaneous coronary implant of the stent was successful; five stents were released in side branches. Implants remained in place for a few hours to 6 months. In spite of correct sizing, two stents migrated out of the coronary arteries. Seven pigs died prematurely; in six of them death might be stent-related. Although no anticoagulant and antiplatelet aggregation drugs were administered during the follow-up period, at autopsy thrombi were observed in only seven arteries (nonobstructive in four of seven arteries). All arteries except for three were patent; these three vessels occluded probably due to oversizing of the stent. Complete neointimal coverage was found within 3 weeks. Important hyperplasia was not seen. It was concluded that coronary implantation of this stent usually was easy. Obstructive thrombus formation was rather uncommon despite the absence of chronic anticoagulant and antiplatelet aggregation therapy. Hyperplasia was rare.
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Affiliation(s)
- F W Bär
- Department of Cardiology, Academic Hospital Maastricht, University of Limburg, The Netherlands
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Scholte HR, Rodrigues Pereira R, de Jonge PC, Luyt-Houwen IE, Hedwig M, Verduin M, Ross JD. Primary carnitine deficiency. J Clin Chem Clin Biochem 1990; 28:351-7. [PMID: 2199596] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Carnitine deficiency can be defined as a decrease of intracellular carnitine, leading to an accumulation of acyl-CoA esters and an inhibition of acyl-transport via the mitochondrial inner membrane. This may cause disease by the following processes. A. Inhibition of the mitochondrial oxidation of long-chain fatty acids during fasting causes heart or liver failure. The latter may cause encephalopathy by hypoketonaemia, hypoglycaemia and hyperammonaemia. B. Increased acyl-CoA esters inhibit many enzymes and carriers. Long-chain acyl-CoA affects mitochondrial oxidative phosphorylation at the adenine nucleotide carrier, and also inhibits other mitochondrial enzymes such as glutamate dehydrogenase, carnitine acetyltransferase and NAD(P) transhydrogenase. C. Accumulation of triacylglycerols in organs increases stress susceptibility by an exaggerated response to hormonal stimuli. D. Decreased mitochondrial acetyl-export lowers acetylcholine synthesis in the nervous system. Primary carnitine deficiency can be defined as a genetic defect in the transport or biosynthesis of carnitine. Until now only defects at the level of carnitine transport have been discovered. The most severe form of primary carnitine deficiency is the consequence of a lesion of the carnitine transport protein in the brush border membrane of the renal tubules. This defect causes cardiomyopathy or hepatic encephalopathy usually in combination with skeletal myopathy. In a patient with cardiomyopathy and without myopathy, we found that carnitine transport at the level of the small intestinal epithelial brush border was also inhibited. The patient was cured by carnitine supplementation. Muscle carnitine increased, but remained too low. This suggests that carnitine transport in muscle is also inhibited. Carnitine transport in fibroblasts was normal, which disagrees with literature reports for similar patients.
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Affiliation(s)
- H R Scholte
- Department of Biochemistry I, Erasmus University, Rotterdam, The Netherlands
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Snijders CJ, Verduin M. Stabilograph, an accurate instrument for sciences interested in postural equilibrium. Agressologie 1973; 14:15-20. [PMID: 4793852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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