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Espejo-Cruz ML, González-Rubio S, Espejo JJ, Zamora-Olaya JM, Alejandre-Altamirano RM, Prieto-Torre M, Linares CI, Guerrero-Misas M, Barrera-Baena P, Poyato-González A, Sánchez-Frías M, Ayllón MD, Rodríguez-Perálvarez ML, de la Mata M, Ferrín G. Enumeration and Characterization of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Int J Mol Sci 2023; 24:ijms24032558. [PMID: 36768881 PMCID: PMC9916725 DOI: 10.3390/ijms24032558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Circulating tumor cells (CTCs), and particularly circulating cancer stem cells (cCSC), are prognostic biomarkers for different malignancies and may be detected using liquid biopsies. The ex vivo culture of cCSCs would provide valuable information regarding biological aggressiveness and would allow monitoring the adaptive changes acquired by the tumor in real time. In this prospective pilot study, we analyzed the presence of EpCAM+ CTCs using the IsoFlux system in the peripheral blood of 37 patients with hepatocellular carcinoma undergoing transarterial chemoembolization (TACE). The average patient age was 63.5 ± 7.9 years and 91.9% of the patients were men. All patients had detectable CTCs at baseline and 20 patients (54.1%) showed CTC aggregates or clusters in their peripheral blood. The increased total tumor diameter (OR: 2.5 (95% CI: 1.3-4.8), p = 0.006) and the absence of clusters of CTCs at baseline (OR: 0.2 (95% CI: 0.0-1.0), p = 0.049) were independent predictors of a diminished response to TACE. Culture of cCSC was successful in five out of thirty-three patients, mostly using negative enrichment of CD45- cells, ultra-low adherence, high glucose, and a short period of hypoxia followed by normoxia. In conclusion, the identification of clusters of CTCs before TACE and the implementation of standardized approaches for cCSC culture could aid to predict outcomes and to define the optimal adjuvant therapeutic strategy for a true personalized medicine in hepatocellular carcinoma.
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Affiliation(s)
- María L. Espejo-Cruz
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
| | - Sandra González-Rubio
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
| | - Juan J. Espejo
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Interventional Radiology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Javier M. Zamora-Olaya
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Rafael M. Alejandre-Altamirano
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María Prieto-Torre
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Clara I. Linares
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
| | - Marta Guerrero-Misas
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Pilar Barrera-Baena
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Antonio Poyato-González
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Marina Sánchez-Frías
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Pathology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - María D. Ayllón
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Manuel L. Rodríguez-Perálvarez
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Correspondence:
| | - Manuel de la Mata
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
- Department of Hepatology and Liver Transplantation, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Gustavo Ferrín
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain
- Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
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Ayllón MD, Ciria R, Gómez-Luque I, Rodriguez-Perálvarez M, Padial A, Luque A, López-Cillero P, de la Mata M, Briceño J. Use of Peritoneovenous Shunt for the Management of Refractory Ascites. Transplant Proc 2019; 51:41-43. [PMID: 30655143 DOI: 10.1016/j.transproceed.2018.04.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/05/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guidelines for the management of refractory ascites (RA) recommend transjugular intrahepatic portosystemic shunting (TIPS), diuretics, and paracentesis as the main strategies, discouraging use of surgical peritoneovenous shunts (PVSs). However, PVSs, including both Denver (DS) or saphenoperitoneal (SPS) modalities, may still have indications. Herein we report our experience with PVSs in the context of modern surgical and anesthetic management. METHODS In our unit, PVSs are offered to patients with ascites refractory to diuretics in which TIPS are contraindicated. Heart function and spontaneous bacterial peritonitis must be assessed before surgical indication. RESULTS Seven procedures were performed on 5 patients (6-DS, 1-SPS) in 2013. Their mean age was 61 (range, 54-68) years. In 3 patients, the indication was RA without options for liver transplant; 2 patients were on the waiting list for liver transplantation, which were performed to improve renal function and quality of life (QOL). The median hospital stay was 6.5 (range, 3-12) days. All patients were alive after 12 months. One patient died 2 years after the first DS and another later died due to liver insufficiency with patency of the DS. The ascites was well-controlled in 4 of 5 patients at up to 48 months of follow-up. Decreases in diuretics doses, proper weight maintenance, and a dramatic improvement in QOL (measured by a modified Ascites Symptom Inventory-7 [ASI-7] test) were observed after the procedures. CONCLUSION PVSs are useful for the treatment of patients with RA who develop resistance to common therapies, leading to a major improvement in QOL. These surgical procedures should be included in the armamentarium of experienced liver surgeons.
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Affiliation(s)
- M D Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - R Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain.
| | - I Gómez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - M Rodriguez-Perálvarez
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - A Padial
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - A Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - P López-Cillero
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
| | - M de la Mata
- Unit of Hepatology and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Córdoba, Spain
| | - J Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain
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Guerrero M, Ferrín G, Rodríguez-Perálvarez M, González-Rubio S, Sánchez-Frías M, Amado V, Pozo JC, Poyato A, Ciria R, Ayllón MD, Barrera P, Montero JL, de la Mata M. mTOR Expression in Liver Transplant Candidates with Hepatocellular Carcinoma: Impact on Histological Features and Tumour Recurrence. Int J Mol Sci 2019; 20:ijms20020336. [PMID: 30650598 PMCID: PMC6359509 DOI: 10.3390/ijms20020336] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The mammalian target of rapamycin (mTOR) pathway activation is critical for hepatocellular carcinoma (HCC) progression. We aimed to evaluate the mTOR tissue expression in liver transplant (LT) patients and to analyse its influence on post-LT outcomes. (2) Methods: Prospective study including a cohort of HCC patients who underwent LT (2012⁻2015). MTOR pathway expression was evaluated in the explanted liver by using the "PathScan Intracellular Signalling Array Kit" (Cell Signalling). Kaplan-Meier and Cox regression analyses were performed to evaluate post-LT HCC recurrence. (3) Results: Forty-nine patients were included (average age 56.4 ± 6, 14.3% females). Phospho-mTOR (Ser2448) was over-expressed in peritumoral tissue as compared with tumoral tissue (ΔSignal 22.2%; p < 0.001). The mTOR activators were also increased in peritumoral tissue (phospho-Akt (Thr308) ΔSignal 18.2%, p = 0.004; phospho-AMPKa (Thr172) ΔSignal 56.3%, p < 0.001), as they were the downstream effectors responsible for cell growth/survival (phospho-p70S6K (Thr389) ΔSignal 33.3%, p < 0.001 and phospho-S6RP (Ser235/236) ΔSignal 54.6%, p < 0.001). MTOR expression was increased in patients with multinodular HCC (tumoral p = 0.01; peritumoral p = 0.001). Increased phospho-mTOR in tumoral tissue was associated with higher HCC recurrence rates after LT (23.8% vs. 5.9% at 24 months, p = 0.04). (4) Conclusion: mTOR pathway is over-expressed in patients with multinodular HCC and is it associated with increased post-LT tumour recurrence rates.
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Affiliation(s)
- Marta Guerrero
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Gustavo Ferrín
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Sandra González-Rubio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | | | - Víctor Amado
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Juan C Pozo
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - Antonio Poyato
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Rubén Ciria
- HPB Surgery and Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - María D Ayllón
- HPB Surgery and Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain.
| | - Pilar Barrera
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - José L Montero
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
| | - Manuel de la Mata
- Department of Hepatology and Liver Transplantation, CIBERehd, Reina Sofía University Hospital, 14004 Córdoba, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba; 14004 Córdoba, Spain.
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