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Wertheimer T, Dohse M, Afram G, Weber D, Heidenreich M, Holler B, Kattner AS, Neubauer A, Mielke S, Ljungman P, Holler E, Herr W, Edinger M, Martínez AP, Fante M, Wolff D. Abatacept as salvage therapy in chronic graft-versus-host disease-a retrospective analysis. Ann Hematol 2021; 100:779-787. [PMID: 33515310 PMCID: PMC7914235 DOI: 10.1007/s00277-021-04434-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/09/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
The immunomodulatory fusion protein abatacept has recently been investigated for the treatment of steroid-refractory chronic graft-versus-host disease (cGvHD) in a phase 1 clinical trial. We analyzed the safety and efficacy of abatacept for cGvHD therapy in a retrospective study with 15 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and received abatacept for cGvHD with a median age of 49 years. Grading was performed as part of the clinical routine according to the National Institute of Health’s (NIH) consensus criteria at initiation of abatacept and 1, 3, 6, 9 and 12 months thereafter. The median time of follow-up was 191 days (range 55–393 days). Best overall response rate (ORR) was 40%. In particular, patients with bronchiolitis obliterans syndrome showed significant clinical improvement and durable responses following abatacept treatment with a response rate of 89% based on improvement in lung severity score (n = 6) or stabilized lung function (n = 4) or both (n = 3). Infectious complications CTCAE °III or higher were observed in 3/15 patients. None of the patients relapsed from the underlying malignancy. Thus, abatacept appears to be a promising treatment option for cGvHD, in particular for patients with lung involvement. However, further evaluation within a phase 2 clinical trial is required.
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Affiliation(s)
- Tobias Wertheimer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Marius Dohse
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Gabriel Afram
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Daniela Weber
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Martin Heidenreich
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Barbara Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Anna-Sophia Kattner
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ernst Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Matthias Edinger
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Antonio Pérez Martínez
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Hospital Universitario La Paz, Universidad Autonóma de Madrid, Madrid, Spain
| | - Matthias Fante
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Regensburg Center for Interventional Immunology, Regensburg, Germany
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Trenker C, Burchert A, Schumacher C, Schäfer JA, Dohse M, Timmesfeld N, Neubauer A, Sohlbach K, Michel C, Görg C. Pathologic Hepatic Contrast-Enhanced Ultrasound Pattern in Patients Undergoing Allogeneic Stem Cell Transplantation. Ultrasound Med Biol 2020; 46:1865-1871. [PMID: 32499194 DOI: 10.1016/j.ultrasmedbio.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
Veno-occlusive disease (VOD) is a severe complication of allogeneic stem cell transplantation (allo-SCT). Its diagnosis is difficult, and ultrasound (US) has not been proven to be of additional diagnostic value. In the work described here, we prospectively analyzed the hepatic contrast-enhanced ultrasound (CEUS) pattern before and after allo-SCT and correlated these results with the pre-allo-SCT VOD risk factors, clinical VOD findings and conventional US findings. Thirty consecutive patients who underwent allo-SCT and had at least one VOD risk factor were studied. B-Mode US and CEUS were longitudinally performed at defined time points before and after allo-SCT. The 1-min hepatic enhancement (OMHE) in CEUS was standardized to splenic enhancement and quantified using optical density (OD) measurement software. A hypo-OMHE was arbitrarily defined as pathologic (pOMHE) if the OD of the liver was less than 90% compared with the mean splenic OD. Twenty-one patients (70%) had a pOMHE, the occurrence of which peaked at day 10 after allo-SCT. The number of pre-treatment VOD risk factors significantly differed between the pathologic and non-pathologic OD groups. Together, patients undergoing allo-SCT frequently exhibit a pathologic hepatic CEUS pattern, which can be quantified by OD measurement and is suggestive of pre-clinical VOD or other hepatic pathologies.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany.
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Caren Schumacher
- Interdisciplinary Ultrasound Center, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Jonas A Schäfer
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Marius Dohse
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Kristina Sohlbach
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Christian Michel
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Ultrasound Center, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
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Trenker C, Dohse M, Ramaswamy A, Michel C, Görg C. Histological validation of pulmonary infarction detected with contrast-enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series. J Clin Ultrasound 2019; 47:461-465. [PMID: 31332794 DOI: 10.1002/jcu.22755] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/12/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this case series is to evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in patients with clinically suspected pulmonary embolism (PE), suspicious pleural lesions, and negative computed tomography pulmonary angiogram (CTPA). PATIENTS/METHODS Between January 2017 and January 2018, we examined patients with an intermediate or a high-risk Wells score and a negative CTPA with lung B-mode ultrasound (LUS). In a total of six patients, pleural defects were identified and further examined by CEUS. Nonenhancing lesions or those with inhomogeneous enhancement were considered to be suspicious for an embolic event and biopsied for histological validation. The data analysis was retrospective. RESULTS In LUS, the lesions had an average size of 2.4 cm (range 2-3 cm). Five were hypoechoic and one was complex. The shape was wedge shaped (n = 5) or round (n = 1), and the number was solitary (n = 4) or multiple (n = 2) with dorsobasal localization (n = 6). Three lesions were nonenhancing, and three had an inhomogeneous enhancement with areas with complete absence of enhancement. The histological examination showed pulmonary infarction in all six cases, and in one patient also cells of a lung carcinoma. CONCLUSION Our case series demonstrates the diagnostic potential of CEUS for detecting peripheral pulmonary infarction in patients with clinically suspected PE and negative CTPA scan regarding PE. A histological validation or a narrow follow-up might be warranted in some cases.
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Affiliation(s)
- Corinna Trenker
- Zentrum für Innere Medizin, Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Baldingerstraße, Marburg, Germany
| | - Marius Dohse
- Zentrum für Innere Medizin, Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Baldingerstraße, Marburg, Germany
| | - Anette Ramaswamy
- Pathologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Baldingerstraße, Marburg, Germany
| | - Christian Michel
- Zentrum für Innere Medizin, Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Baldingerstraße, Marburg, Germany
| | - Christian Görg
- Zentrum für Innere Medizin, Interdisziplinäres Ultraschallzentrum Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität, Baldingerstraße, Marburg
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Christen D, Sohlbach K, Metzelder SK, Wollmer E, Hoeffkes HG, Naumann R, Burchardt A, Rummel M, Trenker C, Dohse M, Mack E, Klameth A, Mann C, Kostrewa P, Brendel C, Wündisch T, Neubauer A, Wilhelm C, Burchert A. Outcome of non-mold effective anti-fungal prophylaxis in patients at high-risk for invasive fungal infections after allogenic stem cell transplantation. Leuk Lymphoma 2019; 60:2056-2061. [PMID: 30644334 DOI: 10.1080/10428194.2018.1553303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients who develop severe graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (alloSCT) have a higher risk for invasive fungal infection (IFI). At our center, fluconazole prophylaxis is standard and upfront mold-effective prophylaxis performed only in patients with specific risk constellations. A total of 290 patients undergoing alloSCT between May 2002 and August 2011 were analyzed. Patients were regarded as high-risk if they suffered from acute GvHD II-IV° or extensive chronic GvHD. The 2-year incidence of an IFI after alloSCT was 8.97% (26/290) in the entire cohort and 7.78% (7/90) in the high-risk group. Mortality due to IFI was 3.85% (1/26) without including a high-risk patient. In the multivariate analysis a pre-transplant fungal infection was the only significant risk factor for developing an IFI after alloSCT (HR = 5.298; p = .001). A fluconazole prophylaxis in patients with GvHD after alloSCT is feasible in facilities with HEPA filtration and high awareness of clinical signs for IFI.
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Affiliation(s)
- Deborah Christen
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Kristina Sohlbach
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Stephan K Metzelder
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Ellen Wollmer
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | | | - Ralph Naumann
- c Department of Hematology , Oncology and Palliative Care, St. Marien Krankenhaus Siegen , Siegen , Germany
| | - Alexander Burchardt
- d Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Gießen , Germany
| | - Mathias Rummel
- d Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Gießen , Germany
| | - Corinna Trenker
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Marius Dohse
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Elisabeth Mack
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Klameth
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Christoph Mann
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Philippe Kostrewa
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Cornelia Brendel
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Thomas Wündisch
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Neubauer
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Christian Wilhelm
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Burchert
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
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Trenker C, Dohse M, Metzelder S, Ramaswamy A, Hundt W, Görg C. Presentation of Gallbladder Chloroma in B-Mode Imaging and Contrast-Enhanced Ultrasound (CEUS) in a Patient with Acute Myelomonocytic Leukemia (AML M5). Ultrasound Int Open 2017; 3:E163-E164. [PMID: 29226275 DOI: 10.1055/s-0043-118527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/24/2017] [Accepted: 08/12/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Corinna Trenker
- University hospital Gießen and Marburg, Department of Haematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany
| | - Marius Dohse
- Universitäsklinikum Gießen und Marburg, Standort Marburg, Department of Pathology, Philipps-University Marburg, Marburg, Germany
| | - StephanK Metzelder
- University hospital Gießen and Marburg, Department of Haematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany
| | - Anette Ramaswamy
- Universitatsklinikum Giessen und Marburg - Standort Marburg, Dianostische Und Interventionelle Radiologie, Marburg, Germany
| | - Walter Hundt
- Universitatsklinikum Giessen und Marburg - Standort Marburg, Dianostische Und Interventionelle Radiologie, Marburg, Germany
| | - Christian Görg
- University hospital Gießen and Marburg, Interdiciplinary ultrasound center
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Trenker C, Dohse M, Metzelder SK, Rexin P, Mariss J, Goerg C. 71-Year-Old Patient with Chronic Lymphocytic Leukemia (CLL) and Hypoechoic Nodular Spleen and Liver Lesions with Fatal Outcome: Presentation of Mucormycosis in B-Mode Imaging and Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2016; 2:E100-1. [PMID: 27689177 DOI: 10.1055/s-0042-106394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/12/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- C Trenker
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - M Dohse
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - S K Metzelder
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - P Rexin
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - J Mariss
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - C Goerg
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
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7
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Dohse M, Scharenberg C, Shukla S, Robey RW, Volkmann T, Deeken JF, Brendel C, Ambudkar SV, Neubauer A, Bates SE. Comparison of ATP-binding cassette transporter interactions with the tyrosine kinase inhibitors imatinib, nilotinib, and dasatinib. Drug Metab Dispos 2010; 38:1371-80. [PMID: 20423956 DOI: 10.1124/dmd.109.031302] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Although the development of tyrosine kinase inhibitors (TKIs) to control the unregulated activity of BCR-ABL revolutionized the therapy of chronic myeloid leukemia, resistance to TKIs is a clinical reality. Among the postulated mechanisms of resistance is the overexpression of ATP-binding cassette (ABC) transporters, such as P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2), which mediate reduced intracellular drug accumulation. We compared the interactions of the TKIs imatinib, nilotinib, and dasatinib with ABCB1 and ABCG2 in ex vivo and in vitro systems. The TKIs inhibited rhodamine 123 and Hoechst 33342 efflux mediated by endogenous expression of the transporters in murine and human hematopoietic stem cells with potency order nilotinib >> imatinib >> dasatinib. Studies with ABCB1-, ABCG2-, and ABCC1-transfected human embryonic kidney 293 cells verified that nilotinib was the most potent inhibitor of ABCB1 and ABCG2. Cytotoxicity assays in stably transduced K562-ABCG2 and K562-ABCB1 cells confirmed that the TKIs were also substrates for the two transporters. Like imatinib, both nilotinib and dasatinib decreased ABCG2 surface expression in K562-ABCG2 cells. Finally, we found that all TKIs were able to compete labeling of ABCB1 and ABCG2 by the photo-cross-linkable prazosin analog [(125)I]iodoarylazidoprazosin, suggesting interaction at the prazosin-binding site of both proteins. Our experiments support the hypothesis that all three TKIs are substrates of ABC transporters and that, at higher concentrations, TKIs overcome transporter function. Taken together, the results suggest that therapeutic doses of imatinib and nilotinib may diminish the potential of ABCB1 and ABCG2 to limit oral absorption or confer resistance. Clinical data are required to definitively answer the latter question.
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Affiliation(s)
- Marius Dohse
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Abstract
ABCG2, or breast cancer resistance protein (BCRP), is an ABC transporter that has been the subject of intense study since its discovery a decade ago. With high normal tissue expression in the brain endothelium, gastrointestinal tract, and placenta, ABCG2 is believed to be important in the protection from xenobiotics, regulating oral bioavailability, forming part of the blood-brain barrier, the blood-testis barrier, and the maternal-fetal barrier. Notably, ABCG2 is often expressed in stem cell populations, where it likely plays a role in xenobiotic protection. However, clues to its epigenetic regulation in various cell populations are only beginning to emerge. While ABCG2 overexpression has been demonstrated in cancer cells after in vitro drug treatment, endogenous ABCG2 expression in certain cancers is likely a reflection of the differentiated phenotype of the cell of origin and likely contributes to intrinsic drug resistance. Notably, research into the transporter's role in cancer drug resistance and its development as a therapeutic target in cancer has lagged. Substrates and inhibitors of the transporter have been described, among them chemotherapy drugs, tyrosine kinase inhibitors, antivirals, HMG-CoA reductase inhibitors, carcinogens, and flavonoids. This broad range of substrates complements the efficiency of ABCG2 as a transporter in laboratory studies and suggests that, while there are redundant mechanisms of xenobiotic protection, the protein is important in normal physiology. Indeed, emerging studies in pharmacology and toxicology assessing polymorphic variants in man, in combination with murine knockout models have confirmed its dynamic role. Work in pharmacology may eventually lead us to a greater understanding of the physiologic role of ABCG2.
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Affiliation(s)
- Robert W. Robey
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Kenneth K. K. To
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Orsolya Polgar
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Marius Dohse
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Patricia Fetsch
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Michael Dean
- Laboratory of Genomic Diversity, National Cancer Institute--Frederick, Frederick, MD, 21702
| | - Susan E. Bates
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
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Schledermann D, Andersen BT, Bisgaard K, Dohse M, Ejersbo D, Hoelund B, Horal P, Lindh M, Ryd W. Are adjunctive markers useful in routine cervical cancer screening? Application of p16(INK4a) and HPV-PCR on ThinPrep samples with histological follow-up. Diagn Cytopathol 2008; 36:453-9. [PMID: 18528890 DOI: 10.1002/dc.20822] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objectives of the study were to evaluate 1) the diagnostic sensitivity and specificity of p16(INK4a) as a marker for high-grade cervical lesions, 2) the results of a real-time polymerase chain reaction detecting high-risk human papillomavirus, and 3) the interobserver variability of the p16(INK4a) interpretation.A total of 232 ThinPrep samples were stained for p16(INK4a), and HPV-DNA PCR was performed on 107 specimens with inclusion of both benign and abnormal cytology. Histological follow-up information was collected. The diagnostic sensitivity of ASC+ with CIN2+ in histology as endpoint was 96% for p16(INK4a) and 100% for HR-HPV DNA PCR, and the diagnostic specificity was 41% and 27%, respectively. If p16(INK4a) had been used for triage of the ASC samples, then 18 patients (42%) could have been spared unnecessary follow-up procedures compared to six patients (21%) with the HR-HPV DNA test.
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Affiliation(s)
- D Schledermann
- Department of Pathology, Odense University Hospital, Odense, Denmark.
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Brendel C, Scharenberg C, Dohse M, Robey RW, Bates SE, Shukla S, Ambudkar SV, Wang Y, Wennemuth G, Burchert A, Boudriot U, Neubauer A. Imatinib mesylate and nilotinib (AMN107) exhibit high-affinity interaction with ABCG2 on primitive hematopoietic stem cells. Leukemia 2007; 21:1267-75. [PMID: 17519960 DOI: 10.1038/sj.leu.2404638] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The majority of chronic phase chronic myeloid leukemia (CML) patients treated with the tyrosine kinase inhibitor (TKI) imatinib mesylate maintain durable responses to the drug. However, most patients relapse after withdrawal of imatinib and advanced stage patients often develop drug resistance. As CML is considered a hematopoietic stem cell cancer, it has been postulated that inherent protective mechanisms lead to relapse in patients. The ATP binding-cassette transporters ABCB1 (MDR-1; P-glycoprotein) and ABCG2 are highly expressed on primitive hematopoietic stem cells (HSCs) and have been shown to interact with TKIs. Herein we demonstrate a dose-dependent, reversible inhibition of ABCG2-mediated Hoechst 33342 dye efflux in primary human and murine HSC by both imatinib and nilotinib (AMN107), a novel aminopyrimidine inhibitor of BCR-ABL. ABCG2-transduced K562 cells were protected from imatinib and nilotinib-mediated cell death and from downregulation of P-CRKL. Moreover, photoaffinity labeling revealed interaction of both TKIs with ABCG2 at the substrate binding sites as they compete with the binding of [(125)I] IAAP and also stimulate the transporter's ATPase activity. Therefore, our evidence suggests for the role of ABC transporters in resistance to TKI on primitive HSCs and CML stem cells and provides a rationale how TKI resistance can be overcome in vivo.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/antagonists & inhibitors
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Antineoplastic Agents/pharmacokinetics
- Benzamides
- Binding Sites
- Drug Resistance, Neoplasm
- Hematopoietic Stem Cells
- Humans
- Imatinib Mesylate
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Piperazines/pharmacokinetics
- Protein Kinase Inhibitors
- Pyrimidines/pharmacokinetics
- Recurrence
- Transduction, Genetic
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Affiliation(s)
- C Brendel
- Department of Hematology, Oncology and Immunology, Philipps-University Marburg, Baldingerstrasse, Marburg, Germany.
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Lagasse E, Connors H, Al-Dhalimy M, Reitsma M, Dohse M, Osborne L, Wang X, Finegold M, Weissman IL, Grompe M. Purified hematopoietic stem cells can differentiate into hepatocytes in vivo. Nat Med 2000; 6:1229-34. [PMID: 11062533 DOI: 10.1038/81326] [Citation(s) in RCA: 1845] [Impact Index Per Article: 76.9] [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: 12/11/2022]
Abstract
The characterization of hepatic progenitor cells is of great scientific and clinical interest. Here we report that intravenous injection of adult bone marrow cells in the FAH(-/-) mouse, an animal model of tyrosinemia type I, rescued the mouse and restored the biochemical function of its liver. Moreover, within bone marrow, only rigorously purified hematopoietic stem cells gave rise to donor-derived hematopoietic and hepatic regeneration. This result seems to contradict the conventional assumptions of the germ layer origins of tissues such as the liver, and raises the question of whether the cells of the hematopoietic stem cell phenotype are pluripotent hematopoietic cells that retain the ability to transdifferentiate, or whether they are more primitive multipotent cells.
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Affiliation(s)
- E Lagasse
- StemCells, 525 Del Rey Avenue, Suite C, Sunnyvale, California 94085, USA.
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Berchtold P, Berger M, Greiser E, Dohse M, Irmscher K, Gries FA, Zimmermann H. Cardiovascular risk factors in gross obesity. Int J Obes (Lond) 1977; 1:219-29. [PMID: 617333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 500 obese patients (146 men, mean age 37 +/- 13 years, Broca index 147 +/- 24; 354 women, mean age 36 +/- 14 years, Broca index 151 +/- 28) cardiovascular risk factors (RF) were investigated. The most frequent RF was hypertension (71 per cent), followed by glucose intolerance (49 per cent), hypertriglyceridemia (31 per cent), hypercholesterolemia (22 per cent) and hyperuricemia (22 per cent). Only 12 per cent of the patients were without RF. These patients were younger and less obese than the patients with RF. The prevalence of RF increased with increasing age and overweight. Analysis revealed significant correlations between overweight and blood pressure, blood glucose, insulin and age. Significant correlations between age and hypertension, blood glucose cholesterol, triglycerides and overweight were detected. The correlation between overweight and the sum of all RF was higher (r = 0.35) than the one between age and the sum of all (r = 0.23). Obese patients had a high prevalence of RF. Increasing overweight and (to a lesser extent) age are both associated with increased prevalence of RF. On the basis of the prevalence of RF, patients with gross obesity (Broca index greater than around 150) were considered to be at a high risk in respect of coronary heart disease.
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