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Reimer P, Vilgrain V, Arnold D, Balli T, Golfieri R, Loffroy R, Mosconi C, Ronot M, Sengel C, Schaefer N, Maleux G, Munneke G, Peynircioglu B, Sangro B, Kaufmann N, Urdaniz M, Pereira H, de Jong N, Helmberger T. Factors Impacting Survival After Transarterial Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: A Combined Analysis of the Prospective CIRT Studies. Cardiovasc Intervent Radiol 2024; 47:310-324. [PMID: 38321223 PMCID: PMC10920466 DOI: 10.1007/s00270-023-03657-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with intrahepatic cholangiocarcinoma (ICC). However, optimising the timing of TARE in relation to systemic therapies and patient selection remains challenging. We report here on the effectiveness, safety, and prognostic factors associated with TARE for ICC in a combined analysis of the prospective observational CIRT studies (NCT02305459 and NCT03256994). METHODS A combined analysis of 174 unresectable ICC patients enrolled between 2015 and 2020 was performed. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every follow-up visit. Log-rank tests and a multivariable Cox proportional hazard model were used to identify prognostic factors. RESULTS Patients receiving a first-line strategy of TARE in addition to any systemic treatment had a median OS and PFS of 32.5 months and 11.3 months. Patients selected for first-line TARE alone showed a median OS and PFS of 16.2 months and 7.4 months, whereas TARE as 2nd or further treatment-line resulted in a median OS and PFS of 12 and 9.3 months (p = 0.0028), and 5.1 and 3.5 months (p = 0.0012), respectively. Partition model dosimetry was an independent predictor for better OS (HR 0.59 [95% CI 0.37-0.94], p = 0.0259). No extrahepatic disease, no ascites, and < 6.1 months from diagnosis to treatment were independent predictors for longer PFS. CONCLUSION This combined analysis indicates that in unresectable ICC, TARE in combination with any systemic treatment is a promising treatment option. LEVEL OF EVIDENCE level 3, Prospective observational.
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Affiliation(s)
- Peter Reimer
- Städtisches Klinikum Karlsruhe, Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital the University of Freiburg, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Valérie Vilgrain
- Université Paris Cité, CRI, INSERM, 1149, Paris, France
- Department of Radiology, Hôpital Beaujon APHP Nord, Clichy, France
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Tugsan Balli
- Radiology Department, Çukurova University, Balcalı Hospital, 01330, Adana, Turkey
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, CHU Dijon Bourgogne, François-Mitterrand University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maxime Ronot
- Université Paris Cité, CRI, INSERM, 1149, Paris, France
- Department of Radiology, Hôpital Beaujon APHP Nord, Clichy, France
| | - Christian Sengel
- Interventional Radiology, Centre Hospitalier Universitaire de Grenoble, Boulevard de La Chantourne, 38100, Grenoble, France
| | - Niklaus Schaefer
- Service de Médecine Nucléaire Et Imagerie Moléculaire, CHUV, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Avda. Pio XII 36, 31008, Pamplona, Spain
| | - Nathalie Kaufmann
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Maria Urdaniz
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France
- INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
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Pereira PL, Bale R, Fretland ÅA, Goldberg SN, Helmberger T, Meijerink MR, Orsi F, Stättner S, Vogl T, Kafkoula A, de Jong N, Zeka B, de Baère T. Local Tumour Control Following Microwave Ablation: Protocol for the Prospective Observational CIEMAR Study. Cardiovasc Intervent Radiol 2024; 47:121-129. [PMID: 37884801 PMCID: PMC10770225 DOI: 10.1007/s00270-023-03573-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Microwave ablation (MWA) is a treatment modality for colorectal liver metastases (CRLM). While potentially curative, more information is needed on factors that contribute to long-term local tumour control. The prospective multicentre observational study CIRSE Emprint Microwave Ablation Registry aims to prospectively collect real-world technical data and clinical outcomes on patients treated with MWA in CRLM. METHODS Eligible patients are adults with up to 9 local treatment naïve CRLM of ≤ 3 cm completely treatable with either MWA alone or MWA with resection and/or radiotherapy within 8 weeks. Data are collected, at baseline, every 3 months until 12 months, and thereafter every 6 months until the end of the study. The primary outcome measure is local tumour control. Secondary outcome measures are overall survival, (hepatic-) disease-free survival, time-to-progression untreatable by ablation, systemic therapy vacation, safety, and quality of life. Covariates related to the primary outcome measure will be assessed using a stratified log-rank test and an univariable Cox proportional hazard regression. A sample size of 500 patients with 750 lesions produces a two-sided 95% confidence interval with a precision equal to 0.057. RESULTS Between September 2019 and December 2022, 500 patients have been enrolled with at least 976 treated tumours. CONCLUSION The prospective observational CIEMAR study will provide valuable insights into the real-world use of MWA, helping in the future patient selection and clarifying factors that may contribute to long-term local tumour control. TRIAL REGISTRATION NCT03775980.
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Affiliation(s)
- Philippe L Pereira
- Center of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken GmbH, Heilbronn, Germany
- Academic Hospital University Heidelberg, Heidelberg, Germany
- Eberhards-University Tübingen, Tübingen, Germany
- Danube Private University Krems, Krems a/d Donau, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location VUmc De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Franco Orsi
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, SKG Kliniken Vöcklabruck and Gmunden, Vöcklabruck, Gmunden, Austria
| | - Thomas Vogl
- Department of Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Anna Kafkoula
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Niels de Jong
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - Bleranda Zeka
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Thierry de Baère
- Departement d'Anesthésie, de Chirurgie, Et de Radiologie Interventionnelle, Gustave Roussy, 102 Rue Edourad Vaillant, Villejuif, France
- Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, 102 Rue Edourad Vaillant, Villejuif, France
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Pereira PL, Bale R, Fretland ÅA, Goldberg SN, Helmberger T, Meijerink MR, Orsi F, Stättner S, Vogl T, Kafkoula A, de Jong N, Zeka B, de Baère T. Correction to: Local Tumour Control Following Microwave Ablation: Protocol for the Prospective Observational CIEMAR Study. Cardiovasc Intervent Radiol 2024; 47:130-131. [PMID: 38010508 PMCID: PMC10769954 DOI: 10.1007/s00270-023-03618-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Philippe L Pereira
- Center of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken GmbH, Heilbronn, Germany
- Academic Hospital University Heidelberg, Heidelberg, Germany
- Eberhards-University Tübingen, Tübingen, Germany
- Danube Private University Krems, Krems a/d Donau, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location VUmc De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Franco Orsi
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, SKG Kliniken Vöcklabruck and Gmunden, Vöcklabruck, Gmunden, Austria
| | - Thomas Vogl
- Department of Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Anna Kafkoula
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Niels de Jong
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - Bleranda Zeka
- Clinical Research, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Thierry de Baère
- Departement d'Anesthésie, de Chirurgie, Et de Radiologie Interventionnelle, Gustave Roussy, 102 Rue Edourad Vaillant, Villejuif, France
- Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, 102 Rue Edourad Vaillant, Villejuif, France
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Maleux G, Albrecht T, Arnold D, Bargellini I, Cianni R, Helmberger T, Kolligs F, Munneke G, Peynircioglu B, Sangro B, Schaefer N, Pereira H, Zeka B, de Jong N, Bilbao JI. Predictive Factors for Adverse Event Outcomes After Transarterial Radioembolization with Yttrium-90 Resin Microspheres in Europe: Results from the Prospective Observational CIRT Study. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03391-4. [PMID: 36914788 PMCID: PMC10322946 DOI: 10.1007/s00270-023-03391-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Using data collected in the prospective observational study CIRSE Registry for SIR-Spheres Therapy, the present study aimed at identifying predictors of adverse events (AEs) following transarterial radioembolization (TARE) with Yttrium-90 resin microspheres for liver tumours. METHODS We analysed 1027 patients enrolled between January 2015 and December 2017 and followed up for 24 months. Four hundred and twenty-two patients with hepatocellular carcinoma (HCC), 120 with intrahepatic carcinoma (ICC), 237 with colorectal liver metastases and 248 with liver metastases from other primaries were included. Prognostic factors were calculated with a univariable analysis by using the overall AEs burden score (AEBS). RESULTS All-cause AEs were reported in 401/1027 (39.1%) patients, with AEs associated with TARE, such as abdominal pain (16.6%), fatigue (17%), and nausea (11.7%) reported most frequently. Grade 3 or higher AEs were reported in 92/1027 (9%) patients. Reports on grade ≥ 3 gastrointestinal ulcerations (0.4%), gastritis (0.3%), radiation cholecystitis (0.2%) or radioembolization-induced liver disease (0.5%) were uncommon. Univariable analysis showed that in HCC, AEBS increased for Eastern Cooperative Oncology Group (ECOG) 0 (p = 0.0045), 1 tumour nodule (0.0081), > 1 TARE treatment (p = 0.0224), no prophylactic embolization (p = 0.0211), partition model dosimetry (p = 0.0007) and unilobar treatment target (0.0032). For ICC, > 1 TARE treatment was associated with an increase in AEBS (p = 0.0224), and for colorectal liver metastases, ECOG 0 (p = 0.0188), > 2 prior systemic treatments (p = 0.0127), and 1 tumour nodule (p = 0.0155) were associated with an increased AEBS. CONCLUSION Our study confirms that TARE is a safe treatment with low toxicity and a minimal impact on quality of life.
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Affiliation(s)
- Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thomas Albrecht
- Department for Radiology and Interventional Therapy, Vivantes Klinikum Neukölln, Rudower Str. 48, 12351, Berlin, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Roberto Cianni
- Department of Interventional Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 85, 00149, Rome, Italy
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Avda. Pio XII 36, 31008, Pamplona, Spain
| | - Niklaus Schaefer
- Service de Médecine Nucléaire et Imagerie Moléculaire, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France.,Centre d'Investigation Clinique 1418 (CIC1418), INSERM, Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - José I Bilbao
- Interventional Radiology, Clínica Universidad de Navarra, Avenida Pio XII, No 36, 31008, Pamplona, Spain
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van Delft MAM, Aleyd E, van der Mast R, de Jong N, Boon L, Simons PJ, van Egmond M. Antagonizing FcαR1 (CD89) as treatment in IgA-mediated chronic inflammation and autoimmunity. Front Immunol 2023; 14:1118539. [PMID: 37081893 PMCID: PMC10111428 DOI: 10.3389/fimmu.2023.1118539] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/03/2023] [Indexed: 04/22/2023] Open
Abstract
Introduction Immunoglobulin A (IgA) is mostly considered as a non-inflammatory regulator at mucosal areas. However, previous work of our group showed that IgA can also be involved in disease pathology, because it provides a potent stimulus to activate neutrophils after crosslinking of surface CD89 (FcaRI), resulting in chronic inflammation and tissue damage. IgA (auto)antibodies and neutrophils are key players in various diseases, including blistering skin diseases and rheumatoid arthritis. Therefore, we generated an array of anti-CD89 monoclonal antibodies (mAbs) for therapeutic targeting of CD89. The biological activity of newly developed anti-human CD89 mAbs and their potential therapeutic capacity were investigated. Methods Human neutrophils were isolated from heparinized healthy donor blood. The ability of anti-CD89 mAbs to bind human neutrophils was investigated by flow cytometry. Furthermore, the capacity of these anti-CD89 mAbs to inhibit IgA-mediated phagocytosis, neutrophil extracellular trap (NET) release and migration was studied. To this end, neutrophils were pre-incubated with/without anti-CD89 mAbs after which they were stimulated with IgA-coated beads. The amount of phagocytosed beads, NET release and migrated neutrophils were subsequently analysed. In parallel, chemoattractant leukotriene B4 and lactoferrin (as a measure for degranulation) release were determined. Finally, the therapeutic potential of our prototypic anti-CD89 mAb clone 10E7 was in vivo tested in anti-mouse collagen XVII human IgA-treated transgenic CD89 mice, a preclinical model for autoimmune linear IgA bullous disease (LABD). Results Our results show that all generated anti-CD89 mAbs bound surface CD89 on neutrophils. Although these anti-CD89 mAbs bind to different epitopes on EC1 of CD89, they all have the capacity to inhibit IgA-mediated phagocytosis, neutrophil extracellular trap (NET) release and neutrophil migration. Moreover, IgA mediated leukotriene B4 and lactoferrin release are decreased in supernatant from anti-CD89 mAbs-treated neutrophils. Finally, anti-CD89 mAb clone 10E7, that was selected based on its selective binding profile on tissue micro arrays, reduced anti-mouse collagen XVII hIgA-induced neutrophil influx in an in vivo linear IgA bullous disease (LABD) mice model. Conclusion This study clearly indicates that our newly developed anti-CD89 mAbs inhibited IgA-induced neutrophil activation and reduced anti-autoantigen IgA-induced neutrophil influx in vivo, supporting further clinical development for the treatment of LABD.
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Affiliation(s)
- Myrthe A. M. van Delft
- Molecular Cell Biology and Immunology, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Inflammatory Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Esil Aleyd
- Research and Development, Polpharma Biologics, Utrecht, Netherlands
| | - Richard van der Mast
- Molecular Cell Biology and Immunology, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Inflammatory Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
| | - Niels de Jong
- Research and Development, Polpharma Biologics, Utrecht, Netherlands
| | - Louis Boon
- Research and Development, Polpharma Biologics, Utrecht, Netherlands
- Research and Development, JJP Biologics, Warsaw, Poland
| | - Peter J. Simons
- Research and Development, Polpharma Biologics, Utrecht, Netherlands
| | - Marjolein van Egmond
- Molecular Cell Biology and Immunology, Amsterdam University Medical Center (UMC) location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Inflammatory Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands
- Surgery, Amsterdam University Medical Center (UMC) Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Marjolein van Egmond,
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Schaefer N, Grözinger G, Pech M, Pfammatter T, Soydal C, Arnold D, Kolligs F, Maleux G, Munneke G, Peynircioglu B, Sangro B, Pereira H, Zeka B, de Jong N, Helmberger T. Prognostic Factors for Effectiveness Outcomes After Transarterial Radioembolization in Metastatic Colorectal Cancer: Results From the Multicentre Observational Study CIRT. Clin Colorectal Cancer 2022; 21:285-296. [PMID: 36270925 DOI: 10.1016/j.clcc.2022.09.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transarterial radioembolisation (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with metastatic colorectal cancer in the liver (mCRC). A better understanding of the prognostic factors and treatment application can improve survival outcomes. METHODS We analysed the safety and effectiveness of 237 mCRC patients included in the prospective observational study CIRSE Registry for SIR-Spheres Therapy (CIRT) for independent prognostic factors for overall survival (OS), progression-free survival (PFS) and hepatic progression-free survival (hPFS) using the Cox proportional-hazard model. RESULTS The median OS was 9.8 months, median PFS was 3.4 months and median hPFS was 4.2 months. Independent prognostic factors for an improved overall survival were the absence of extra-hepatic disease (P= .0391), prior locoregional procedures (P= .0037), an Aspartate transaminase to Platelet Ratio Index (APRI) value of ≤0.40 (P< .0001) and International Normalized Ratio (INR) ≤1 (P= .0078). Partition model dosimetry resulted in improved OS outcomes compared to the body surface area model (P = .0120). Independent predictors for PFS were APRI >0.40 (P = .0416) and prior ablation (P = .0323), and for hPFS these were 2 to 5 tumor nodules (P = .0148), Albumin-bilirubin (ALBI) grade 3 (P = .0075) and APRI >0.40 (P = .0207). During the study, 95 of 237 (40.1%) patients experienced 197 adverse events, with 28 of 237 (11.8%) patients having a grade 3 or higher adverse events. CONCLUSION Including easy-to-acquire laboratory markers INR, APRI, ALBI and using partition model dosimetry can identify mCRC patients that may benefit from TARE.
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Affiliation(s)
- Niklaus Schaefer
- Service de médecine nucléaire et imagerie moléculaire, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gerd Grözinger
- Eberhard Karls University, Department of Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Cigdem Soydal
- Ankara University, Medical School, Department of Nuclear Medicine, Cebeci, Ankara, Turkey
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna Austria.
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
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Kolligs F, Arnold D, Golfieri R, Pech M, Peynircioglu B, Pfammatter T, Ronot M, Sangro B, Schaefer N, Maleux G, Munneke G, Pereira H, Zeka B, de Jong N, Helmberger T, Neukölln VK, D’Archambeau O, Balli T, Bilgic S, Bloom A, Cioni R, Fischbach R, Altona AK, Flamen P, Gerard L, Grözinger G, Katoh M, Koehler M, Kröger JR, Kuhl C, Orsi F, Özgün M, Reimer P, Ronot M, Schmid A, Vit A. Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study. JHEP Rep 2022; 5:100633. [PMID: 36593888 PMCID: PMC9804139 DOI: 10.1016/j.jhepr.2022.100633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background & Aims Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. Methods We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. Results The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. Conclusions This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes. Impact and implications Transarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE. Clinical trial number NCT02305459.
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Key Words
- ALBI, albumin-bilirubin
- BCLC, Barcelona Clinic Liver Cancer
- BSA, body surface area
- CIRSE, Cardiovascular and Interventional Radiological Society of Europe
- CIRT, CIRSE Registry for SIR-Spheres Therapy
- ECOG, Eastern Cooperative Oncology Group
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- INR, international normalized ratio
- IPTW, inverse probability of treatment weighting
- OS, overall survival
- PFS, progression-free survival
- PVT, portal vein thrombosis
- REILD, radioembolization-induced liver disease
- SIRT
- TACE, transcatheter arterial chemoembolization
- TARE, transarterial radioembolization
- Y90, Yttrium-90
- dosimetry
- hPFS, hepatic progression-free survival
- liver
- mBSA, modified body surface area
- observational
- radioembolization
- registry
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Affiliation(s)
- Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, Ankara, Turkey
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, Universitätsspital Zürich, Zürich, Switzerland
| | - Maxime Ronot
- Université Paris Cité, Paris & Service de Radiologie, APHP Nord, Hôpital Beaujon, Clichy, France
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Niklaus Schaefer
- Service de médecine nucléaire et imagerie moléculaire, CHUV, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France,INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria,Corresponding author. Address: Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna Austria; Tel.: +43 1904200347
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
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Helmberger T, Arnold D, Balli T, Golfieri R, Pech M, Ronot M, de Jong N, Sangro B. Real-world outcomes of patients with intrahepatic cholangiocarcinoma treated with trans-arterial radioembolization: Results from the CIRSE Registry for SIR-Spheres Therapy (CIRT), a large European prospective multi-center observational study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
308 Background: Trans-arterial radioembolization (TARE) is a treatment option for patients with intrahepatic cholangiocarcinoma (ICC). The CIRSE Registry for SIR-Spheres Therapy (CIRT) is the first European prospective multi-centre observational study designed to evaluate the clinical outcomes of patients treated with TARE with SIR-Spheres Y90 resin microspheres for ICC in the multi-institutional real-life clinical setting. The study was conducted by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Methods: Patients were enrolled prospectively between Jan 2015 and 31 Dec 2017. Eligible patients were adults treated with TARE with Y90 resin microspheres for ICC. Data on baseline characteristics and treatment intention/clinical context and dosimetry were collected, as well as follow-up data (every 3 months; for 24 months after treatment), including overall survival (OS), (hepatic) progression-free survival [(h)PFS], safety and Global Health Status (GHS, using the European Organisation for the Research and Treatment of Cancer QLQ-C30). Results: 120 patients were included from 18 sites in 8 European countries. Median age was 63 years (range: 29-86) and 54.2% were male. Median tumour to liver percentage was 12.8%. Median prescribed activity was 1.32 GBq for whole liver treatments (n = 49), 1.20 GBq for right lobe treatments (n = 56) and 0.82 GBq for left lobe treatments (n = 51). 97.5% of the delivered activity was within 90% of the prescribed activity. TARE treatment as a first line (L1) global strategy was applied in 39.1%, 27.4% as second line (after systemic therapy). Treatment intention was predominantly palliative (69.2%) or tumour shrinkage (20.8%). Median OS was 14.7 months (95% confidence interval (CI) 10.9 – 17.9). Median PFS was 5.7 months (95% CI 3.9 – 7.5), whereas hPFS was 6.2 months (95% CI 4.1 – 8.5). Mean GHS was 59.3 at baseline, 61.0 after 3 months, 56.0 at 6 months, 54.4 at 9 months and 63.0 after 1 year. Severe adverse events (grade 3 and 4) were found in 13 (10.8%) patients: (abdominal pain 3.3%, fatigue 1.7%, gastrointestinal ulceration 0.8%, gastritis 0.8%, radiation cholecystitis 0.8%, radiation-induced liver disease 1.7%, other 5.8%). Detailed subgroup analyses are currently being performed. Updated data describing OS, PFS and hPFS for L1 TARE vs TARE after systemic chemotherapy, as well as prognostic factors for OS, PFS and hPFS will be shown. Conclusions: The results from this large prospective multi-centre observational study shows that in the real-world context, TARE is applied early and successfully in the treatment pathway. TARE is shown to be an effective and safe treatment with no meaningful deterioration of quality of life. Clinical trial information: NCT02305459.
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Affiliation(s)
- Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
| | - Tugsan Balli
- Radiology Department, Cukurova University, Adana, Turkey
| | - Rita Golfieri
- Radiology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Maciej Pech
- Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Maxime Ronot
- Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Niels de Jong
- Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Bruno Sangro
- Clínica Universidad De Navarra and Biomedical Research Networking Center in Hepatic and Digestive Diseases, Pamplona, Spain
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Helmberger T, Arnold D, Bilbao JI, de Jong N, Maleux G, Nordlund A, Peynircioglu B, Sangro B, Sharma RA, Walk A. Clinical Application of Radioembolization in Hepatic Malignancies: Protocol for a Prospective Multicenter Observational Study. JMIR Res Protoc 2020; 9:e16296. [PMID: 32319960 PMCID: PMC7203613 DOI: 10.2196/16296] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background Radioembolization, also known as transarterial radioembolization or selective internal radiation therapy with yttrium-90 (90Y) resin microspheres, is an established treatment modality for patients with primary and secondary liver tumors. However, large-scale prospective observational data on the application of this treatment in a real-life clinical setting is lacking. Objective The main objective is to collect data on the clinical application of radioembolization with 90Y resin microspheres to improve the understanding of the impact of this treatment modality in its routine practice setting. Methods Eligible patients are 18 years or older and receiving radioembolization for primary and secondary liver tumors as part of routine practice, as well as have signed informed consent. Data is collected at baseline, directly after treatment, and at every 3-month follow-up until 24 months or study exit. The primary objective of the Cardiovascular and Interventional Radiological Society of Europe Registry for SIR-Spheres Therapy (CIRT) is to observe the clinical application of radioembolization. Secondary objectives include safety, effectiveness in terms of overall survival, progression-free survival (PFS), liver-specific PFS, imaging response, and change in quality of life. Results Between January 2015 and December 2017, 1047 patients were included in the study. The 24-month follow-up period ended in December 2019. The first results are expected in the third quarter of 2020. Conclusions The CIRT is the largest observational study on radioembolization to date and will provide valuable insights to the clinical application of this treatment modality and its real-life outcomes. Trial Registration ClinicalTrials.gov NCT02305459; https://clinicaltrials.gov/ct2/show/NCT02305459 International Registered Report Identifier (IRRID) DERR1-10.2196/16296
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Affiliation(s)
- Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, München, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - José I Bilbao
- Interventional Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Niels de Jong
- Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Geert Maleux
- Radiologie, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Pamplona, Spain
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Cancer Institute, University College London, London, United Kingdom
| | - Agnes Walk
- Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
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van der Wagen L, Janssen J, Raijmakers R, Petersen E, de Witte M, de Jong N, Bellido M, Meijer E, Bär B, Jan Boelens J, Huitema A, Kuball J. Tyrosine kinase inhibitor levels matter in treating chronic GVHD. Bone Marrow Transplant 2019; 54:1141-1144. [PMID: 30651587 DOI: 10.1038/s41409-018-0429-5] [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] [Received: 10/18/2018] [Revised: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Lotte van der Wagen
- Department of Hematology, University Medical Center Utrecht, Room number Q05.4.301, PO Box 85500, Utrecht, GA, 3508, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julie Janssen
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Reinier Raijmakers
- Department of Hematology, University Medical Center Utrecht, Room number Q05.4.301, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Eefke Petersen
- Department of Hematology, University Medical Center Utrecht, Room number Q05.4.301, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Moniek de Witte
- Department of Hematology, University Medical Center Utrecht, Room number Q05.4.301, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Niels de Jong
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mar Bellido
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Brigitte Bär
- Department of Hematology, Radboud Medical Center, Nijmegen, The Netherlands
| | - Jaap Jan Boelens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pediatrics, Stem Cell Transplant and Cellular Therapies Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alwin Huitema
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, Room number Q05.4.301, PO Box 85500, Utrecht, GA, 3508, The Netherlands. .,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Knipping K, Simons PJ, Buelens-Sleumer LS, Cox L, den Hartog M, de Jong N, Teshima R, Garssen J, Boon L, Knippels LMJ. Development of β-lactoglobulin-specific chimeric human IgEκ monoclonal antibodies for in vitro safety assessment of whey hydrolysates. PLoS One 2014; 9:e106025. [PMID: 25153680 PMCID: PMC4143325 DOI: 10.1371/journal.pone.0106025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/31/2014] [Indexed: 01/12/2023] Open
Abstract
Background Cow’s milk-derived whey hydrolysates are nutritional substitutes for allergic infants. Safety or residual allergenicity assessment of these whey hydrolysates is crucial. Currently, rat basophilic leukemia RBL-2H3 cells expressing the human IgE receptor α-chain (huFcεRIα-RBL-2H3), sensitized with serum IgE from cow’s milk allergic children, are being employed to assess in vitro residual allergenicity of these whey hydrolysates. However, limited availability and inter-lot variation of these allergic sera impede standardization of whey hydrolysate safety testing in degranulation assays. Objective An oligoclonal pool of chimeric human (chu)IgE antibodies against bovine β-lactoglobulin (a major allergen in whey) was generated to increase sensitivity, specificity, and reproducibility of existing degranulation assays. Methods Mice were immunized with bovine β-lactoglobulin, and subsequently the variable domains of dissimilar anti-β-lactoglobulin mouse IgG antibodies were cloned and sequenced. Six chimeric antibodies were generated comprising mouse variable domains and human constant IgE/κ domains. Results After sensitization with this pool of anti-β-lactoglobulin chuIgEs, huFcεRIα-expressing RBL-2H3 cells demonstrated degranulation upon cross-linking with whey, native 18 kDa β-lactoglobulin, and 5–10 kDa whey hydrolysates, whereas a 3 kDa whey hydrolysate and cow’s milk powder (mainly casein) showed no degranulation. In parallel, allergic serum IgEs were less sensitive. In addition, our pool anti-β-lactoglobulin chuIgEs recognized multiple allergenic immunodominant regions on β-lactoglobulin, which were also recognized by serum IgEs from cow’s milk allergic children. Conclusion Usage of our ‘unlimited’ source and well-defined pool of β-lactoglobulin-specific recombinant chuIgEs to sensitize huFcεRIα on RBL-2H3 cells showed to be a relevant and sensitive alternative for serum IgEs from cow’s milk allergic patients to assess safety of whey-based non-allergic hydrolyzed formula.
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Affiliation(s)
- Karen Knipping
- Nutricia Research B.V., Utrecht, The Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- * E-mail: (KK); (PS)
| | - Peter J. Simons
- Bioceros Holding B.V., Utrecht, The Netherlands
- * E-mail: (KK); (PS)
| | | | - Linda Cox
- Bioceros Holding B.V., Utrecht, The Netherlands
| | | | | | - Reiko Teshima
- Division of Foods, National Institute of Health Sciences, Tokyo, Japan
| | - Johan Garssen
- Nutricia Research B.V., Utrecht, The Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Louis Boon
- Bioceros Holding B.V., Utrecht, The Netherlands
| | - Léon M. J. Knippels
- Nutricia Research B.V., Utrecht, The Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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