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Loeffler MA, Synofzik M, Cebi I, Klocke P, Hormozi M, Gasser T, Gharabaghi A, Weiss D. Case Report: Deep brain stimulation improves tremor in FGF-14 associated spinocerebellar ataxia. Front Neurol 2022; 13:1048530. [PMID: 36588880 PMCID: PMC9795845 DOI: 10.3389/fneur.2022.1048530] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives Spinocerebellar ataxia 27 (SCA 27) is a rare heredodegenerative disorder caused by mutations in the fibroblast growth factor 14 (FGF14) and characterized by early-onset tremor and progressive ataxia later during the disease course. We investigated the effect of deep brain stimulation (DBS) of the ventralis intermedius nucleus of the thalamus (VIM) and subthalamic projections on tremor and ataxia. Methods At baseline, we studied the effects of high-frequency VIM stimulation and low-frequency stimulation of subthalamic projections on tremor and ataxia. The patient then adopted the best individual high-frequency stimulation programme at daytime and either 30 Hz-stimulation of the subthalamic contacts or StimOFF at night during two separate 5-weeks follow-up intervals. Both patient and rater were blinded to the stimulation settings. Results High-frequency stimulation of the VIM effectively attenuated tremor. At follow-up, intermittent 30 Hz-stimulation at night resulted in a superior tremor response compared to StimOFF at night. Ataxia was not affected. Discussion Stimulation of the VIM and adjacent subthalamic projections effectively attenuated tremor in a patient with confirmed SCA 27. Cycling between daytime high-frequency and night-time low-frequency stimulation led to a more sustained tremor response. This suggests to study in future if low-frequency stimulation of the subthalamic projection fibers may help overcome tolerance of tremor that is observed as a long-term limitation of VIM-DBS.
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Affiliation(s)
- Moritz A. Loeffler
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany,Moritz A. Loeffler
| | - Matthis Synofzik
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Idil Cebi
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Philipp Klocke
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mohammad Hormozi
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Thomas Gasser
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases, Centre for Neurology University Hospital and University of Tübingen, Tübingen, Germany,Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany,*Correspondence: Daniel Weiss
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Loeffler MA, Hu J, Kirchner M, Wei X, Xiao Y, Albrecht T, De La Torre C, Sticht C, Banales JM, Vogel MN, Pathil-Warth A, Mehrabi A, Hoffmann K, Rupp C, Köhler B, Springfeld C, Schirmacher P, Ji J, Roessler S, Goeppert B. miRNA profiling of biliary intraepithelial neoplasia reveals stepwise tumorigenesis in distal cholangiocarcinoma via the miR-451a/ATF2 axis. J Pathol 2020; 252:239-251. [PMID: 32710569 DOI: 10.1002/path.5514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/30/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
Distal cholangiocarcinoma (dCCA) is a biliary tract cancer with a dismal prognosis and is often preceded by biliary intraepithelial neoplasia (BilIN), representing the most common biliary non-invasive precursor lesion. BilIN are histologically well defined but have not so far been characterised systematically at the molecular level. The aim of this study was to determine miRNA-regulated genes in cholangiocarcinogenesis via BilIN. We used a clinicopathologically well-characterised cohort of 12 dCCA patients. Matched samples of non-neoplastic biliary epithelia, BilIN and invasive tumour epithelia of each patient were isolated from formalin-fixed paraffin-embedded tissue sections by laser microdissection. The resulting 36 samples were subjected to total RNA extraction and the expression of 798 miRNAs was assessed using the Nanostring® technology. Candidate miRNAs were validated by RT-qPCR and functionally investigated following lentiviral overexpression in dCCA-derived cell lines. Potential direct miRNA target genes were identified by microarray and prediction algorithms and were confirmed by luciferase assay. We identified 49 deregulated miRNAs comparing non-neoplastic and tumour tissue. Clustering of these miRNAs corresponded to the three stages of cholangiocarcinogenesis, supporting the concept of BilIN as a tumour precursor. Two downregulated miRNAs, i.e. miR-451a (-10.9-fold down) and miR-144-3p (-6.3-fold down), stood out by relative decrease. Functional analyses of these candidates revealed a migration inhibitory effect in dCCA cell lines. Activating transcription factor 2 (ATF2) and A disintegrin and metalloproteinase domain-containing protein 10 (ADAM10) were identified as direct miR-451a target genes. Specific ATF2 inhibition by pooled siRNAs reproduced the inhibitory impact of miR-451a on cancer cell migration. Thus, our data support the concept of BilIN as a direct precursor of invasive dCCA at the molecular level. In addition, we identified miR-451a and miR-144-3p as putative tumour suppressors attenuating cell migration by inhibiting ATF2 in the process of dCCA tumorigenesis. © The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Moritz A Loeffler
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jun Hu
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Xiyang Wei
- Life Sciences Institute, Zhejiang University, Hangzhou, PR China
| | - Yi Xiao
- Life Sciences Institute, Zhejiang University, Hangzhou, PR China
| | - Thomas Albrecht
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Carsten Sticht
- Medical Research Centre, University of Heidelberg, Mannheim, Germany
| | - Jesus M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain
| | - Monika N Vogel
- Diagnostic and Interventional Radiology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Anita Pathil-Warth
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Christian Rupp
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Bruno Köhler
- Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany.,Department of Medical Oncology, University Hospital Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - Christoph Springfeld
- Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany.,Department of Medical Oncology, University Hospital Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Junfang Ji
- Life Sciences Institute, Zhejiang University, Hangzhou, PR China
| | - Stephanie Roessler
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Benjamin Goeppert
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
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