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Michaelis J, Himmelsbach R, Metzger P, Lassmann S, Börries M, Werner M, Miething C, Höfflin R, Illert AL, Duyster J, Becker H, Sigle A, Gratzke C, Grabbert M. Primary results of patients with genitourinary malignancies presented at a Molecular Tumor Board. Urol Int 2024:000538908. [PMID: 38626735 DOI: 10.1159/000538908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/11/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Personalized medicine poses great opportunities and challenges. While therapeutic landscape markedly expands, descriptions about status, clinical implementation and real-world benefits of precision oncology and molecular tumor boards (MTB) remain sparse, particularly in the field of genitourinary (GU) cancer. Hence, this study characterized urological MTB cases to better understand the potential role of MTB in uro-oncology. METHODS We analyzed patients with complete data sets being reviewed at an MTB from January 2019 to October 2022, focusing on results of molecular analysis and treatment recommendations. RESULTS We evaluated 102 patients with GU cancer with a mean patient age of 61.7 years. Prostate cancer (PCa) was the most frequent entity with 52.9% (54/102), followed by bladder cancer (18.6%, 19/102) and renal cell carcinoma (14.7%, 15/102). On average, case presentation at MTB took place 54.9 months after initial diagnosis and after 2.7 previous lines of therapy. During the study period 49.0% (50/102) of patients deceased. Additional MTB-based treatment recommendations were achieved in a majority of 68.6% (70/102) of patients, with a recommendation for targeted therapy in 64.3% (45/70) of these patients. Only 6.7% (3/45) of patients - due to different reasons - received the recommended MTB-based therapy tough, with 33% (1/3) of patients reaching disease control. Throughout the MTB study period, GU cancer case presentations and treatment recommendations increased, while the time interval between initial presentation and final therapy recommendation were decreasing over time. CONCLUSION Presentation of uro-oncological patients at the MTB is a highly valuable measure for clinical decision-making. Prospectively, earlier presentation of patients at the MTB and changing legislative issues regarding comprehensive molecular testing and targeted treatment approval might further improve patients' benefits from comprehensive molecular diagnostics.
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2
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Ramamoorthy S, Lebrecht D, Schanze D, Schanze I, Wieland I, Andrieux G, Metzger P, Hess M, Albert MH, Borkhardt A, Bresters D, Buechner J, Catala A, De Haas V, Dworzak M, Erlacher M, Hasle H, Jahnukainen K, Locatelli F, Masetti R, Stary J, Turkiewicz D, Vinci L, Wlodarski MW, Yoshimi A, Boerries M, Niemeyer CM, Zenker M, Flotho C. Biallelic inactivation of the NF1 tumour suppressor gene in juvenile myelomonocytic leukaemia: Genetic evidence of driver function and implications for diagnostic workup. Br J Haematol 2024; 204:595-605. [PMID: 37945316 DOI: 10.1111/bjh.19190] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Juvenile myelomonocytic leukaemia (JMML) is characterized by gene variants that deregulate the RAS signalling pathway. Children with neurofibromatosis type 1 (NF-1) carry a defective NF1 allele in the germline and are predisposed to JMML, which presumably requires somatic inactivation of the NF1 wild-type allele. Here we examined the two-hit concept in leukaemic cells of 25 patients with JMML and NF-1. Ten patients with JMML/NF-1 exhibited a NF1 loss-of-function variant in combination with uniparental disomy of the 17q arm. Five had NF1 microdeletions combined with a pathogenic NF1 variant and nine carried two compound-heterozygous NF1 variants. We also examined 16 patients without clinical signs of NF-1 and no variation in the JMML-associated driver genes PTPN11, KRAS, NRAS or CBL (JMML-5neg) and identified eight patients with NF1 variants. Three patients had microdeletions combined with hemizygous NF1 variants, three had compound-heterozygous NF1 variants and two had heterozygous NF1 variants. In addition, we found a high incidence of secondary ASXL1 and/or SETBP1 variants in both groups. We conclude that the clinical diagnosis of JMML/NF-1 reliably indicates a NF1-driven JMML subtype, and that careful NF1 analysis should be included in the genetic workup of JMML even in the absence of clinical evidence of NF-1.
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Affiliation(s)
- Senthilkumar Ramamoorthy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Lebrecht
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Denny Schanze
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Ina Schanze
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Ilse Wieland
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Hess
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Michael H Albert
- Department of Pediatric Hematology and Oncology, Dr. v. Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Immunology, University of Dusseldorf, Dusseldorf, Germany
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Valerie De Haas
- Diagnostic Laboratory/DCOG Laboratory, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Michael Dworzak
- St. Anna Children's Cancer Research Institute, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Miriam Erlacher
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jan Stary
- Department of Pediatric Hematology/ Oncology, Charles University and Univ Hospital Motol, Prague, Czech Republic
| | - Dominik Turkiewicz
- Department of Pediatric Oncology/Hematology, Skåne University Hospital, Lund, Sweden
| | - Luca Vinci
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcin W Wlodarski
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ayami Yoshimi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
| | - Martin Zenker
- Human Genetics, University of Magdeburg, Magdeburg, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Freiburg, Freiburg, Germany
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3
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Renner C, Reimer N, Christoph J, Busch H, Metzger P, Boerries M, Ustjanzew A, Boehm D, Unberath P. Extending cBioPortal for Therapy Recommendation Documentation in Molecular Tumor Boards: Development and Usability Study. JMIR Med Inform 2023; 11:e50017. [PMID: 38079196 PMCID: PMC10750236 DOI: 10.2196/50017] [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: 06/16/2023] [Revised: 09/02/2023] [Accepted: 09/17/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND In molecular tumor boards (MTBs), patients with rare or advanced cancers are discussed by a multidisciplinary team of health care professionals. Software support for MTBs is lacking; in particular, tools for preparing and documenting MTB therapy recommendations need to be developed. OBJECTIVE We aimed to implement an extension to cBioPortal to provide a tool for the documentation of therapy recommendations from MTB sessions in a secure and standardized manner. The developed extension should be embedded in the patient view of cBioPortal to enable easy documentation during MTB sessions. The resulting architecture for storing therapy recommendations should be integrable into various hospital information systems. METHODS On the basis of a requirements analysis and technology analysis for authentication techniques, a prototype was developed and iteratively refined through a user-centered development process. In conclusion, the tool was evaluated via a usability evaluation, including interviews, structured questionnaires, and the System Usability Scale. RESULTS The patient view of cBioPortal was extended with a new tab that enables users to document MTB sessions and therapy recommendations. The role-based access control was expanded to allow for a finer distinction among the rights to view, edit, and delete data. The usability evaluation showed overall good usability and a System Usability Scale score of 83.57. CONCLUSIONS This study demonstrates how cBioPortal can be extended to not only visualize MTB patient data but also be used as a documentation platform for therapy recommendations.
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Affiliation(s)
- Christopher Renner
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Niklas Reimer
- Group for Medical Systems Biology, Lübeck Institute of Experimental, Universität zu Lübeck, Lübeck, Germany
- Campus Lübeck, University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jan Christoph
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Junior Research Group (Bio-) Medical Data Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hauke Busch
- Group for Medical Systems Biology, Lübeck Institute of Experimental, Universität zu Lübeck, Lübeck, Germany
- Campus Lübeck, University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, University of Freiburg Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, University of Freiburg Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
- Partner Site Freiburg, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arsenij Ustjanzew
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- University Cancer Center, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Boehm
- Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Philipp Unberath
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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4
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Menzel M, Ossowski S, Kral S, Metzger P, Horak P, Marienfeld R, Boerries M, Wolter S, Ball M, Neumann O, Armeanu-Ebinger S, Schroeder C, Matysiak U, Goldschmid H, Schipperges V, Fürstberger A, Allgäuer M, Eberhardt T, Niewöhner J, Blaumeiser A, Ploeger C, Haack TB, Tay TKY, Kelemen O, Pauli T, Kirchner M, Kluck K, Ott A, Renner M, Admard J, Gschwind A, Lassmann S, Kestler H, Fend F, Illert AL, Werner M, Möller P, Seufferlein TTW, Malek N, Schirmacher P, Fröhling S, Kazdal D, Budczies J, Stenzinger A. Multicentric pilot study to standardize clinical whole exome sequencing (WES) for cancer patients. NPJ Precis Oncol 2023; 7:106. [PMID: 37864096 PMCID: PMC10589320 DOI: 10.1038/s41698-023-00457-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
A growing number of druggable targets and national initiatives for precision oncology necessitate broad genomic profiling for many cancer patients. Whole exome sequencing (WES) offers unbiased analysis of the entire coding sequence, segmentation-based detection of copy number alterations (CNAs), and accurate determination of complex biomarkers including tumor mutational burden (TMB), homologous recombination repair deficiency (HRD), and microsatellite instability (MSI). To assess the inter-institution variability of clinical WES, we performed a comparative pilot study between German Centers of Personalized Medicine (ZPMs) from five participating institutions. Tumor and matched normal DNA from 30 patients were analyzed using custom sequencing protocols and bioinformatic pipelines. Calling of somatic variants was highly concordant with a positive percentage agreement (PPA) between 91 and 95% and a positive predictive value (PPV) between 82 and 95% compared with a three-institution consensus and full agreement for 16 of 17 druggable targets. Explanations for deviations included low VAF or coverage, differing annotations, and different filter protocols. CNAs showed overall agreement in 76% for the genomic sequence with high wet-lab variability. Complex biomarkers correlated strongly between institutions (HRD: 0.79-1, TMB: 0.97-0.99) and all institutions agreed on microsatellite instability. This study will contribute to the development of quality control frameworks for comprehensive genomic profiling and sheds light onto parameters that require stringent standardization.
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Affiliation(s)
- Michael Menzel
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
| | - Sebastian Kral
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
| | - Patrick Metzger
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Horak
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Ralf Marienfeld
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
- Center for Personalized Medicine (ZPM), Ulm, Germany
| | - Melanie Boerries
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Wolter
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
| | - Markus Ball
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Olaf Neumann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Sorin Armeanu-Ebinger
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Uta Matysiak
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
| | - Hannah Goldschmid
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Vincent Schipperges
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Axel Fürstberger
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
- Center for Personalized Medicine (ZPM), Ulm, Germany
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Michael Allgäuer
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Timo Eberhardt
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
- Center for Personalized Medicine (ZPM), Ulm, Germany
| | - Jakob Niewöhner
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | - Andreas Blaumeiser
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carolin Ploeger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Tobias Bernd Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Timothy Kwang Yong Tay
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Olga Kelemen
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Thomas Pauli
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martina Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Klaus Kluck
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Alexander Ott
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Marcus Renner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jakob Admard
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Axel Gschwind
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Center for Personalized Medicine (ZPM), Tübingen, Germany
| | - Silke Lassmann
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
| | - Hans Kestler
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
- Center for Personalized Medicine (ZPM), Ulm, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Anna Lena Illert
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79085, Freiburg, Germany
- Medical Department for Hematology and Oncology, Klinikum Rechts der Isar, Technische Universität München, 80333, Munich, Germany
- German Cancer Consortium (DKTK) Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Personalized Medicine (ZPM), Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | | | - Nisar Malek
- Center for Personalized Medicine (ZPM), Tübingen, Germany
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Peter Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan Fröhling
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
- Division of Translational Medical Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Daniel Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Center for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
- Center for Personalized Medicine (ZPM), Heidelberg, Germany.
- German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
- Center for Personalized Medicine (ZPM), Heidelberg, Germany.
- German Cancer Consortium (DKTK), Heidelberg, Germany.
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5
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Metzger P, Hess ME, Blaumeiser A, Pauli T, Schipperges V, Mertes R, Christoph J, Unberath P, Reimer N, Scheible R, Illert AL, Busch H, Andrieux G, Boerries M. MIRACUM-Pipe: An Adaptable Pipeline for Next-Generation Sequencing Analysis, Reporting, and Visualization for Clinical Decision Making. Cancers (Basel) 2023; 15:3456. [PMID: 37444566 DOI: 10.3390/cancers15133456] [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: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Next-generation sequencing (NGS) of patients with advanced tumors is becoming an established method in Molecular Tumor Boards. However, somatic variant detection, interpretation, and report generation, require in-depth knowledge of both bioinformatics and oncology. (2) Methods: MIRACUM-Pipe combines many individual tools into a seamless workflow for comprehensive analyses and annotation of NGS data including quality control, alignment, variant calling, copy number variation estimation, evaluation of complex biomarkers, and RNA fusion detection. (3) Results: MIRACUM-Pipe offers an easy-to-use, one-prompt standardized solution to analyze NGS data, including quality control, variant calling, copy number estimation, annotation, visualization, and report generation. (4) Conclusions: MIRACUM-Pipe, a versatile pipeline for NGS, can be customized according to bioinformatics and clinical needs and to support clinical decision-making with visual processing and interactive reporting.
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Affiliation(s)
- Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Maria Elena Hess
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Andreas Blaumeiser
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg, 79110 Freiburg, Germany
| | - Thomas Pauli
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Vincent Schipperges
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Ralf Mertes
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Jan Christoph
- Junior Research Group (Bio-)Medical Data Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, 06122 Halle, Germany
- Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - Philipp Unberath
- Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany
| | - Niklas Reimer
- Medical Systems Biology Group, Lübeck Institute Für Experimental Dermatology, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| | - Raphael Scheible
- Institute for AI and Informatics in Medicine, University Hospital Rechts der Isar, Technical University Munich, 81675 Munich, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Anna L Illert
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg, 79110 Freiburg, Germany
- Department of Medicine III, Klinikum Rechts der Isar, Faculty of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, 81675 Munich, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Munich, 81675 Munich, Germany
- Center for Personalized Medicine, Klinikum Rechts der Isar, Faculty of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Hauke Busch
- Medical Systems Biology Group, Lübeck Institute Für Experimental Dermatology, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg, 79110 Freiburg, Germany
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6
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Maier D, Vehreschild JJ, Uhl B, Meyer S, Berger-Thürmel K, Boerries M, Braren R, Grünwald V, Hadaschik B, Palm S, Singer S, Stuschke M, Juárez D, Delpy P, Lambarki M, Hummel M, Engels C, Andreas S, Gökbuget N, Ihrig K, Burock S, Keune D, Eggert A, Keilholz U, Schulz H, Büttner D, Löck S, Krause M, Esins M, Ressing F, Schuler M, Brandts C, Brucker DP, Husmann G, Oellerich T, Metzger P, Voigt F, Illert AL, Theobald M, Kindler T, Sudhof U, Reckmann A, Schwinghammer F, Nasseh D, Weichert W, von Bergwelt-Baildon M, Bitzer M, Malek N, Öner Ö, Schulze-Osthoff K, Bartels S, Haier J, Ammann R, Schmidt AF, Guenther B, Janning M, Kasper B, Loges S, Stilgenbauer S, Kuhn P, Tausch E, Runow S, Kerscher A, Neumann M, Breu M, Lablans M, Serve H. Profile of the multicenter cohort of the German Cancer Consortium's Clinical Communication Platform. Eur J Epidemiol 2023; 38:573-586. [PMID: 37017830 PMCID: PMC10073785 DOI: 10.1007/s10654-023-00990-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium's (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0-20 years, 8.3% 21-40 years, 30.9% 41-60 years, 50.1% 61-80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort's data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.
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Affiliation(s)
- Daniel Maier
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Janne Vehreschild
- University Hospital Frankfurt, Frankfurt, Germany.
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Barbara Uhl
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sandra Meyer
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karin Berger-Thürmel
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Boerries
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Viktor Grünwald
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris Hadaschik
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Singer
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Stuschke
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Juárez
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pierre Delpy
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mohamed Lambarki
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hummel
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cäcilia Engels
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Andreas
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Gökbuget
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristina Ihrig
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susen Burock
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietmar Keune
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Keilholz
- Charité Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hagen Schulz
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Büttner
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Steffen Löck
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mirko Esins
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Frank Ressing
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Brandts
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel P Brucker
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gabriele Husmann
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Oellerich
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Metzger
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Voigt
- Faculty of Medicine, Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna L Illert
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine I, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Theobald
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kindler
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Sudhof
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Achim Reckmann
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Cancer Consortium (DKTK), Partner Site Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Schwinghammer
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Nasseh
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- School of Medicine, Technical University Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- University Hospital Munich, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Bitzer
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nisar Malek
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Öznur Öner
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Schulze-Osthoff
- Center for Personalized Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Bartels
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Raimund Ammann
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Anja Franziska Schmidt
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Bernd Guenther
- Comprehensive Cancer Center Hannover (Claudia von Schilling-Zentrum), Hannover Medical School, Hannover, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Sonja Loges
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Department of Personalized Medical Oncology (A420), DKFZ German Cancer Research Center, Heidelberg, Germany
| | | | - Peter Kuhn
- Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | | | | | | | | | - Martin Breu
- University Hospital of Würzburg, Würzburg, Germany
| | - Martin Lablans
- German Cancer Research Center (DKFZ), Federated Information Systems, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hubert Serve
- University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute, Frankfurt, Germany
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7
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Seidel P, Rubarth A, Zodel K, Peighambari A, Neumann F, Federkiel Y, Huang H, Hoefflin R, Adlesic M, Witt C, Hoffmann DJ, Metzger P, Lindemann RK, Zenke FT, Schell C, Boerries M, von Elverfeldt D, Reichardt W, Follo M, Albers J, Frew IJ. ATR represents a therapeutic vulnerability in clear cell renal cell carcinoma. JCI Insight 2022; 7:156087. [PMID: 36413415 PMCID: PMC9869969 DOI: 10.1172/jci.insight.156087] [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: 10/21/2021] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
Metastatic clear cell renal cell carcinomas (ccRCCs) are resistant to DNA-damaging chemotherapies, limiting therapeutic options for patients whose tumors are resistant to tyrosine kinase inhibitors and/or immune checkpoint therapies. Here we show that mouse and human ccRCCs were frequently characterized by high levels of endogenous DNA damage and that cultured ccRCC cells exhibited intact cellular responses to chemotherapy-induced DNA damage. We identify that pharmacological inhibition of the DNA damage-sensing kinase ataxia telangiectasia and Rad3-related protein (ATR) with the orally administered, potent, and selective drug M4344 (gartisertib) induced antiproliferative effects in ccRCC cells. This effect was due to replication stress and accumulation of DNA damage in S phase. In some cells, DNA damage persisted into subsequent G2/M and G1 phases, leading to the frequent accumulation of micronuclei. Daily single-agent treatment with M4344 inhibited the growth of ccRCC xenograft tumors. M4344 synergized with chemotherapeutic drugs including cisplatin and carboplatin and the poly(ADP-ribose) polymerase inhibitor olaparib in mouse and human ccRCC cells. Weekly M4344 plus cisplatin treatment showed therapeutic synergy in ccRCC xenografts and was efficacious in an autochthonous mouse ccRCC model. These studies identify ATR inhibition as a potential novel therapeutic option for ccRCC.
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Affiliation(s)
- Philipp Seidel
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Anne Rubarth
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Kyra Zodel
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Asin Peighambari
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Felix Neumann
- Translational Innovation Platform Oncology and Immuno-Oncology, the Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Yannick Federkiel
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Hsin Huang
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Rouven Hoefflin
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Mojca Adlesic
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Christian Witt
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - David J. Hoffmann
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | | | - Ralph K. Lindemann
- Translational Innovation Platform Oncology and Immuno-Oncology, the Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Frank T. Zenke
- Translational Innovation Platform Oncology and Immuno-Oncology, the Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Christoph Schell
- Institute for Surgical Pathology, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF) and
| | | | - Wilfried Reichardt
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Freiburg, Freiburg, Germany.,Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Marie Follo
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Joachim Albers
- Translational Innovation Platform Oncology and Immuno-Oncology, the Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Ian J. Frew
- Department of Internal Medicine I, Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Partner Site Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF) and,Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
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8
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Corrales E, Levit-Zerdoun E, Metzger P, Mertes R, Lehmann A, Münch J, Lemke S, Kowar S, Boerries M. PI3K/AKT signaling allows for MAPK/ERK pathway independency mediating dedifferentiation-driven treatment resistance in melanoma. Cell Commun Signal 2022; 20:187. [PMID: 36434616 PMCID: PMC9700886 DOI: 10.1186/s12964-022-00989-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/02/2022] [Accepted: 10/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Current therapeutic management of advanced melanoma patients largely depends on their BRAF mutation status. However, the vast heterogeneity of the tumors hampers the success of therapies targeting the MAPK/ERK pathway alone. Dissecting this heterogeneity will contribute to identifying key players in the oncogenic progression to tailor more effective therapies. METHODS We performed a comprehensive molecular and phenotypic characterization of a panel of patient-derived BRAFV600E-positive melanoma cell lines. Transcriptional profiling was used to identify groups of coregulated genes whose expression relates to an increased migratory potential and a higher resistance. RESULTS A decrease in sensitivity to MAPK/ERK pathway inhibition with vemurafenib or trametinib corresponded with an increasing quiescence and migratory properties of the cells. This was accompanied by the loss of transcriptional signatures of melanocytic differentiation, and the gain of stem cell features that conferred highly-resistant/mesenchymal-like cells with increased xenobiotic efflux capacity. Nevertheless, targeting of the implicated ABC transporters did not improve the response to vemurafenib, indicating that incomplete BRAF inhibition due to reduced drug uptake is not a main driver of resistance. Rather, indifference to MAPK/ERK pathway inhibition arose from the activation of compensatory signaling cascades. The PI3K/AKT pathway in particular showed a higher activity in mesenchymal-like cells, conferring a lower dependency on MAPK/ERK signaling and supporting stem-like properties that could be reverted by dual PI3K/mTOR inhibition with dactolisib. CONCLUSIONS In case of MAPK/ERK independency, therapeutic focus may be shifted to the PI3K/AKT pathway to overcome late-stage resistance in melanoma tumors that have acquired a mesenchymal phenotype. Video Abstract.
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Affiliation(s)
- Eyleen Corrales
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany ,grid.5963.9Faculty of Biology, University of Freiburg, Schänzlestr. 1, 79104 Freiburg, Germany
| | - Ella Levit-Zerdoun
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Freiburg, Germany
| | - Patrick Metzger
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Ralf Mertes
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Ariane Lehmann
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Julia Münch
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
| | - Steffen Lemke
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
| | - Silke Kowar
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Melanie Boerries
- grid.5963.9Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany ,grid.5963.9Faculty of Medicine, Medical Center-University of Freiburg, Institute of Medical Bioinformatics and Systems Medicine (IBSM), University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Freiburg, Germany
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9
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Lüchtenborg AM, Metzger P, Cosenza Contreras M, Oria V, Biniossek ML, Lindner F, Fröhlich K, Malyi A, Erbes T, Gensch N, Maurer J, Thomsen A, Boerries M, Schilling O, Werner M, Bronsert P. Krüppel-like factor 7 influences translation and pathways involved in ribosomal biogenesis in breast cancer. Breast Cancer Res 2022; 24:65. [PMID: 36192788 PMCID: PMC9531505 DOI: 10.1186/s13058-022-01562-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
Background Ribosomal biogenesis and ribosomal proteins have attracted attention in the context of tumor biology in recent years. Instead of being mere translational machineries, ribosomes might play an active role in tumor initiation and progression. Despite its importance, regulation of ribosomal biogenesis is still not completely understood.
Methods Using Gene Set Enrichment Analysis of RNA sequencing and proteomical mass spectrometry data in breast cancer cells expressing Krüppel-like factor 7 (KLF7), we identified processes altered by this transcription factor. In silico analyses of a cohort of breast cancer patients in The Cancer Genome Atlas confirmed our finding. We further verified the role of KLF7 the identified ribosomal processes in in vitro assays of mammary carcinoma cell lines and analyses of breast cancer patients’ tissue slices.
Results We identified the transcription factor Krüppel-like factor 7 (KLF7) as a regulator of ribosomal biogenesis and translation in breast cancer cells and tissue. Highly significant overlapping processes related to ribosomal biogenesis were identified in proteomics and transcriptomics data and confirmed in patients’ breast cancer RNA Seq data. Further, nucleoli, the sites of ribosomal biogenesis, were morphologically altered and quantitatively increased in KLF7-expressing cells. Pre-rRNA processing was identified as one potential process affected by KLF7. In addition, an increase in global translation independent from proliferation and transcription was observed upon exogenous KLF7 expression in vitro. Importantly, in a cohort of breast cancer patients, KLF7-expression levels correlated with aggressiveness of the intrinsic breast cancer subtype and tumor grading. Moreover, KLF7 correlated with nucleolar characteristics in human breast tumor tissue, indicating a role for KLF7 in ribosomal biogenesis. Conclusion In mammary carcinoma, KLF7 is involved in ribosomal biogenesis. Alterations of ribosomal biogenesis has far reaching quantitative and qualitative implications for the proteome of the cancer cells. This might influence the aggressiveness of cancer cells. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-022-01562-8.
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Affiliation(s)
- Anne-Marie Lüchtenborg
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Metzger
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Miguel Cosenza Contreras
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine, Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Victor Oria
- Faculty of Biology, University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine, Faculty of Biology, University of Freiburg, Freiburg, Germany.,Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Martin L Biniossek
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franziska Lindner
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klemens Fröhlich
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine, Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ambrus Malyi
- 2Nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Thalia Erbes
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Nicole Gensch
- Core Facility Signaling Factory, BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany
| | - Jochen Maurer
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), Aachen, Germany
| | - Andreas Thomsen
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Oliver Schilling
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany.,Tumorbank Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Freiburg, Germany.,Core Facility for Histopathology and Digital Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Breisacher Straße 115A, 79106, Freiburg, Germany. .,Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany. .,Core Facility for Histopathology and Digital Pathology, Medical Center - University of Freiburg, Freiburg, Germany.
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10
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Devane J, Ott E, Olinger EG, Epting D, Decker E, Friedrich A, Bachmann N, Renschler G, Eisenberger T, Briem-Richter A, Grabhorn EF, Powell L, Wilson IJ, Rice SJ, Miles CG, Wood K, Trivedi P, Hirschfield G, Pietrobattista A, Wohler E, Mezina A, Sobreira N, Agolini E, Maggiore G, Dahmer-Heath M, Yilmaz A, Boerries M, Metzger P, Schell C, Grünewald I, Konrad M, König J, Schlevogt B, Sayer JA, Bergmann C. Progressive liver, kidney, and heart degeneration in children and adults affected by TULP3 mutations. Am J Hum Genet 2022; 109:928-943. [PMID: 35397207 PMCID: PMC9118107 DOI: 10.1016/j.ajhg.2022.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 12/31/2022] Open
Abstract
Organ fibrosis is a shared endpoint of many diseases, yet underlying mechanisms are not well understood. Several pathways governed by the primary cilium, a sensory antenna present on most vertebrate cells, have been linked with fibrosis. Ciliopathies usually start early in life and represent a considerable disease burden. We performed massively parallel sequencing by using cohorts of genetically unsolved individuals with unexplained liver and kidney failure and correlated this with clinical, imaging, and histopathological analyses. Mechanistic studies were conducted with a vertebrate model and primary cells. We detected bi-allelic deleterious variants in TULP3, encoding a critical adaptor protein for ciliary trafficking, in a total of 15 mostly adult individuals, originating from eight unrelated families, with progressive degenerative liver fibrosis, fibrocystic kidney disease, and hypertrophic cardiomyopathy with atypical fibrotic patterns on histopathology. We recapitulated the human phenotype in adult zebrafish and confirmed disruption of critical ciliary cargo composition in several primary cell lines derived from affected individuals. Further, we show interaction between TULP3 and the nuclear deacetylase SIRT1, with roles in DNA damage repair and fibrosis, and report increased DNA damage ex vivo. Transcriptomic studies demonstrated upregulation of profibrotic pathways with gene clusters for hypertrophic cardiomyopathy and WNT and TGF-β signaling. These findings identify variants in TULP3 as a monogenic cause for progressive degenerative disease of major organs in which affected individuals benefit from early detection and improved clinical management. Elucidation of mechanisms crucial for DNA damage repair and tissue maintenance will guide novel therapeutic avenues for this and similar genetic and non-genomic diseases.
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Affiliation(s)
- John Devane
- Department of Medicine IV, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - Elisabeth Ott
- Department of Medicine IV, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - Eric G Olinger
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Daniel Epting
- Department of Medicine IV, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany
| | - Eva Decker
- Medizinische Genetik Mainz, Limbach Genetics, 55128 Mainz, Germany
| | - Anja Friedrich
- Medizinische Genetik Mainz, Limbach Genetics, 55128 Mainz, Germany
| | - Nadine Bachmann
- Medizinische Genetik Mainz, Limbach Genetics, 55128 Mainz, Germany
| | - Gina Renschler
- Medizinische Genetik Mainz, Limbach Genetics, 55128 Mainz, Germany
| | | | - Andrea Briem-Richter
- University Medical Center Hamburg-Eppendorf, Department of Pediatrics, 20251 Hamburg, Germany
| | - Enke Freya Grabhorn
- University Medical Center Hamburg-Eppendorf, Department of Pediatrics, 20251 Hamburg, Germany
| | - Laura Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Ian J Wilson
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Sarah J Rice
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Colin G Miles
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Katrina Wood
- Histopathology Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Palak Trivedi
- NIHR Birmingham BRC, Centre for Liver and Gastrointestinal Research, University of Birmingham, Birmingham B15 2TT, UK; Liver Unit, University Hospitals Birmingham, Birmingham B15 2GW, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK; Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M6H 3M1, Canada
| | - Andrea Pietrobattista
- Hepatogastroenterology and Liver Transplant Unit and Medical Genetics Laboratory, IRCCS Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Elizabeth Wohler
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Anya Mezina
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Emanuele Agolini
- Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology and Liver Transplant Unit and Medical Genetics Laboratory, IRCCS Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Mareike Dahmer-Heath
- Department of General Pediatrics, University Hospital Münster, 48149 Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology I, University Hospital Münster, 48149 Münster, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, 79110 Freiburg, Germany; The German Cancer Consortium, Partner Site Freiburg and Cancer Research Center, 69120 Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, 79110 Freiburg, Germany
| | - Christoph Schell
- Institute for Pathology, Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, 79002 Freiburg, Germany
| | - Inga Grünewald
- Institute for Pathology, University Hospital Münster, 48149 Münster, Germany
| | - Martin Konrad
- Department of General Pediatrics, University Hospital Münster, 48149 Münster, Germany
| | - Jens König
- Department of General Pediatrics, University Hospital Münster, 48149 Münster, Germany
| | - Bernhard Schlevogt
- Department of Internal Medicine B, Gastroenterology, University Hospital Münster, 48149 Münster, Germany
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK; Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK; Newcastle Biomedical Research Centre, NIHR, Newcastle upon Tyne NE4 5PL, UK.
| | - Carsten Bergmann
- Department of Medicine IV, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany; Medizinische Genetik Mainz, Limbach Genetics, 55128 Mainz, Germany.
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11
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Corrales E, Levit-Zerdoun E, Metzger P, Kowar S, Ku M, Brummer T, Boerries M. Dynamic transcriptome analysis reveals signatures of paradoxical effect of vemurafenib on human dermal fibroblasts. Cell Commun Signal 2021; 19:123. [PMID: 34930313 PMCID: PMC8686565 DOI: 10.1186/s12964-021-00801-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vemurafenib (PLX4032) is one of the most frequently used treatments for late-stage melanoma patients with the BRAFV600E mutation; however, acquired resistance to the drug poses as a major challenge. It remains to be determined whether off-target effects of vemurafenib on normal stroma components could reshape the tumor microenvironment in a way that contributes to cancer progression and drug resistance. METHODS By using temporally-resolved RNA- and ATAC-seq, we studied the early molecular changes induced by vemurafenib in human dermal fibroblast (HDF), a main stromal component in melanoma and other tumors with high prevalence of BRAFV600 mutations. RESULTS Transcriptomics analyses revealed a stepwise up-regulation of proliferation signatures, together with a down-regulation of autophagy and proteolytic processes. The gene expression changes in HDF strongly correlated in an inverse way with those in BRAFV600E mutant malignant melanoma (MaMel) cell lines, consistent with the observation of a paradoxical effect of vemurafenib, leading to hyperphosphorylation of MEK1/2 and ERK1/2. The transcriptional changes in HDF were not strongly determined by alterations in chromatin accessibility; rather, an already permissive chromatin landscape seemed to facilitate the early accessibility to MAPK/ERK-regulated transcription factor binding sites. Combinatorial treatment with the MEK inhibitor trametinib did not preclude the paradoxical activation of MAPK/ERK signaling in HDF. When administered together, vemurafenib partially compensated for the reduction of cell viability and proliferation induced by trametinib. These paradoxical changes were restrained by using the third generation BRAF inhibitor PLX8394, a so-called paradox breaker compound. However, the advantageous effects on HDF during combination therapies were also lost. CONCLUSIONS Vemurafenib induces paradoxical changes in HDF, enabled by a permissive chromatin landscape. These changes might provide an advantage during combination therapies, by compensating for the toxicity induced in stromal cells by less specific MAPK/ERK inhibitors. Our results highlight the relevance of evaluating the effects of the drugs on non-transformed stromal components, carefully considering the implications of their administration either as mono- or combination therapies. Video Abstract.
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Affiliation(s)
- Eyleen Corrales
- Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
- Faculty of Biology, University of Freiburg, Schänzlestr. 1, 79104 Freiburg, Germany
| | - Ella Levit-Zerdoun
- Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Silke Kowar
- Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
| | - Manching Ku
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstr. 1, 79106 Freiburg, Germany
| | - Tilman Brummer
- Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany
- Centre for Biological Signalling Studies (BIOSS), University of Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany
| | - Melanie Boerries
- Institute of Molecular Medicine and Cell Research (IMMZ), University of Freiburg, Stefan-Meier-Str. 17, 79104 Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany
- Centre for Biological Signalling Studies (BIOSS), University of Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany
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12
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Reimer N, Unberath P, Busch H, Börries M, Metzger P, Ustjanzew A, Renner C, Prokosch HU, Christoph J. Challenges and Experiences Extending the cBioPortal for Cancer Genomics to a Molecular Tumor Board Platform. Stud Health Technol Inform 2021; 287:139-143. [PMID: 34795098 DOI: 10.3233/shti210833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Molecular Tumor Boards (MTBs), therapy recommendations for cancer patients are discussed. To aid decision-making based on the patient's molecular profile, the research platform cBioPortal was extended based on users' requirements. Additionally, a comprehensive dockerized workflow was developed to support the deployment of cBioPortal and connected services. In this work, we present the challenges and experiences of nearly two years of implementing and deploying an MTB platform based on cBioPortal and compare those to findings of a previous study.
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Affiliation(s)
- Niklas Reimer
- Group for Medical Systems Biology, Lübeck Institute of Experimental Dermatology, Universität zu Lübeck, Germany
| | - Philipp Unberath
- Group for Medical Systems Biology, Lübeck Institute of Experimental Dermatology, Universität zu Lübeck, Germany
| | - Hauke Busch
- Group for Medical Systems Biology, Lübeck Institute of Experimental Dermatology, Universität zu Lübeck, Germany
| | - Melanie Börries
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg and Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Arsenij Ustjanzew
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg-University School of Medicine, Mainz, Germany
| | - Christopher Renner
- Department of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Department of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jan Christoph
- Department of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Junior Research Group (Bio-)Medical Data Science, Martin-Luther-University Halle-Wittenberg, Faculty of Medicine, Halle, Germany
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13
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Dierks C, Seufert J, Aumann K, Ruf J, Klein C, Kiefer S, Rassner M, Boerries M, Zielke A, la Rosee P, Meyer PT, Kroiss M, Weißenberger C, Schumacher T, Metzger P, Weiss H, Smaxwil C, Laubner K, Duyster J, von Bubnoff N, Miething C, Thomusch O. Combination of Lenvatinib and Pembrolizumab Is an Effective Treatment Option for Anaplastic and Poorly Differentiated Thyroid Carcinoma. Thyroid 2021; 31:1076-1085. [PMID: 33509020 PMCID: PMC8290324 DOI: 10.1089/thy.2020.0322] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Anaplastic thyroid carcinoma (ATC) and metastatic poorly differentiated thyroid carcinomas (PDTCs) are rare aggressive malignancies with poor overall survival (OS) despite extensive multimodal therapy. These tumors are highly proliferative, with frequently increased tumor mutational burden (TMB) compared with differentiated thyroid carcinomas, and elevated programmed death ligand 1 (PD-L1) levels. These tumor properties implicate responsiveness to antiangiogenic and antiproliferative multikinase inhibitors such as lenvatinib, and immune checkpoint inhibitors such as pembrolizumab. Patients and Methods: In a retrospective study, we analyzed six patients with metastatic ATC and two patients with PDTC, who received a combination therapy of lenvatinib and pembrolizumab. Lenvatinib was started at 14-24 mg daily and combined with pembrolizumab at a fixed dose of 200 mg every three weeks. Maximum treatment duration with this combination was 40 months, and 3 of 6 ATC patients are still on therapy. Patient tumors were characterized by whole-exome sequencing and PD-L1 expression levels (tumor proportion score [TPS] 1-90%). Results: Best overall response (BOR) within ATCs was 66% complete remissions (4/6 CR), 16% stable disease (1/6 SD), and 16% progressive disease (1/6 PD). BOR within PDTCs was partial remission (PR 2/2). The median progression-free survival was 17.75 months for all patients, and 16.5 months for ATCs, with treatment durations ranging from 1 to 40 months (1, 4, 11, 15, 19, 25, 27, and 40 months). Grade III/IV toxicities developed in 4 of 8 patients, requiring dose reduction/discontinuation of lenvatinib. The median OS was 18.5 months, with three ATC patients being still alive without relapse (40, 27, and 19 months) despite metastatic disease at the time of treatment initiation (UICC and stage IVC). All patients with long-term (>2 years) or complete responses (CRs) had either increased TMB or a PD-L1 TPS >50%. Conclusions: Our results implicate that the combination of lenvatinib and pembrolizumab might be safe and effective in patients with ATC/PDTC and can result in complete and long-term remissions. The combination treatment is now being systematically examined in a phase II clinical trial (Anaplastic Thyroid Carcinoma Lenvatinib Pembrolizumab [ATLEP]) in ATC/PDTC patients.
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Affiliation(s)
- Christine Dierks
- Department of Hematology and Oncology, KIM IV, Faculty of Medicine, University Halle-Wittenberg, Halle, Germany
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Konrad Aumann
- Institute of Pathology, University of Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, University of Freiburg, Germany
| | - Claudius Klein
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- Institute of Pathology, University of Freiburg, Germany
- Department of Nuclear Medicine, University of Freiburg, Germany
| | - Selina Kiefer
- Institute of Pathology, University of Freiburg, Germany
| | - Michael Rassner
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), University Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Medical Bioinformatics and Systems Medicine and Institute of Molecular Medicine and Cell Research; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Zielke
- Outcomes Research Unit, Department of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Paul la Rosee
- Klinikum Villingen-Schwenningen, Hämatologie/Onkologie, Villingen-Schwenningen, Germany
| | - Philipp Tobias Meyer
- Department of Nuclear Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Matthias Kroiss
- Division of Endocrinology/Diabetology, Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | | | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine and Institute of Molecular Medicine and Cell Research; Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | | | - Constantin Smaxwil
- Outcomes Research Unit, Department of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- Department of Hematology/Oncology, University of Luebeck, Luebeck, Germany
| | - Cornelius Miething
- Department of Hematology and Oncology, University of Freiburg, Freiburg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Oliver Thomusch
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
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14
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Sams L, Kruger S, Heinemann V, Bararia D, Haebe S, Alig S, Haas M, Zhang D, Westphalen CB, Ormanns S, Metzger P, Werner J, Weigert O, von Bergwelt-Baildon M, Rataj F, Kobold S, Boeck S. Alterations in regulatory T cells and immune checkpoint molecules in pancreatic cancer patients receiving FOLFIRINOX or gemcitabine plus nab-paclitaxel. Clin Transl Oncol 2021; 23:2394-2401. [PMID: 33876417 PMCID: PMC8455387 DOI: 10.1007/s12094-021-02620-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/02/2021] [Indexed: 01/11/2023]
Abstract
Purpose This pilot study aimed on generating insight on alterations in circulating immune cells during the use of FOLFIRINOX and gemcitabine/nab-paclitaxel in pancreatic ductal adenocarcinoma (PDAC). Patients and methods Peripheral blood mononuclear cells were isolated before and 30 days after initiation of chemotherapy from 20 patients with advanced PDAC. Regulatory T cells (FoxP3+) and immune checkpoints (PD-1 and TIM-3) were analyzed by flow cytometry and immunological changes were correlated with clinical outcome. Results Heterogeneous changes during chemotherapy were observed in circulating T-cell subpopulations with a pronounced effect on PD-1+ CD4+/CD8+ T cells. An increase in FoxP3+ or PD-1+ T cells had no significant effect on survival. An increase in TIM3+/CD8+ (but not TIM3+/CD4+) T cells was associated with a significant inferior outcome: median progression-free survival in the subgroup with an increase of TIM-3+/CD8+ T cells was 6.0 compared to 14.0 months in patients with a decrease/no change (p = 0.026); corresponding median overall survival was 13.0 and 20.0 months (p = 0.011), respectively. Conclusions Chemotherapy with FOLFIRNOX or gemcitabine/nab-paclitaxel induces variable changes in circulating T-cell populations that may provide prognostic information in PDAC.
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Affiliation(s)
- L Sams
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Kruger
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - V Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - D Bararia
- Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Department of Internal Medicine III, Grosshadern University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S Haebe
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Department of Internal Medicine III, Grosshadern University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S Alig
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Department of Internal Medicine III, Grosshadern University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Haas
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - D Zhang
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C B Westphalen
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Ormanns
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - P Metzger
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - J Werner
- Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - O Weigert
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Department of Internal Medicine III, Grosshadern University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M von Bergwelt-Baildon
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - F Rataj
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - S Kobold
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - S Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Grosshadern University Hospital, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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15
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Hoefflin R, Lazarou A, Hess ME, Reiser M, Wehrle J, Metzger P, Frey AV, Becker H, Aumann K, Berner K, Boeker M, Buettner N, Dierks C, Duque-Afonso J, Eisenblaetter M, Erbes T, Fritsch R, Ge IX, Geißler AL, Grabbert M, Heeg S, Heiland DH, Hettmer S, Kayser G, Keller A, Kleiber A, Kutilina A, Mehmed L, Meiss F, Poxleitner P, Rawluk J, Ruf J, Schäfer H, Scherer F, Shoumariyeh K, Tzschach A, Peters C, Brummer T, Werner M, Duyster J, Lassmann S, Miething C, Boerries M, Illert AL, von Bubnoff N. Transitioning the Molecular Tumor Board from Proof of Concept to Clinical Routine: A German Single-Center Analysis. Cancers (Basel) 2021; 13:1151. [PMID: 33800365 PMCID: PMC7962829 DOI: 10.3390/cancers13051151] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
Molecular precision oncology faces two major challenges: first, to identify relevant and actionable molecular variants in a rapidly changing field and second, to provide access to a broad patient population. Here, we report a four-year experience of the Molecular Tumor Board (MTB) of the Comprehensive Cancer Center Freiburg (Germany) including workflows and process optimizations. This retrospective single-center study includes data on 488 patients enrolled in the MTB from February 2015 through December 2018. Recommendations include individual molecular diagnostics, molecular stratified therapies, assessment of treatment adherence and patient outcomes including overall survival. The majority of MTB patients presented with stage IV oncologic malignancies (90.6%) and underwent an average of 2.1 previous lines of therapy. Individual diagnostic recommendations were given to 487 patients (99.8%). A treatment recommendation was given in 264 of all cases (54.1%) which included a molecularly matched treatment in 212 patients (43.4%). The 264 treatment recommendations were implemented in 76 patients (28.8%). Stable disease was observed in 19 patients (25.0%), 17 had partial response (22.4%) and five showed a complete remission (6.6%). An objective response was achieved in 28.9% of cases with implemented recommendations and for 4.5% of the total population (22 of 488 patients). By optimizing the MTB workflow, case-discussions per session increased significantly while treatment adherence and outcome remained stable over time. Our data demonstrate the feasibility and effectiveness of molecular-guided personalized therapy for cancer patients in a clinical routine setting showing a low but robust and durable disease control rate over time.
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Affiliation(s)
- Rouven Hoefflin
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Adriana Lazarou
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Maria Elena Hess
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Meike Reiser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Anna Verena Frey
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Konrad Aumann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Kai Berner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Boeker
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Nico Buettner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christine Dierks
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Jesus Duque-Afonso
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Michel Eisenblaetter
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Freiburg, Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Thalia Erbes
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Fritsch
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Isabell Xiang Ge
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Anna-Lena Geißler
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Markus Grabbert
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Urology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Steffen Heeg
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Dieter Henrik Heiland
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Simone Hettmer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Gian Kayser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Keller
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Anita Kleiber
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Alexandra Kutilina
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Leman Mehmed
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Clinical Cancer Registry, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Frank Meiss
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Dermatology and Venerology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Justyna Rawluk
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Juri Ruf
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Henning Schäfer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Tzschach
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Peters
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Tilman Brummer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Martin Werner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Silke Lassmann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Cornelius Miething
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Melanie Boerries
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Anna L. Illert
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Nierlich P, Enzmann F, Metzger P, Dabernig W, Aspalter M, Akhavan F, Hitzl W, Hölzenbein T. Alternative Venous Conduits for Below Knee Bypass in the Absence of Ipsilateral Great Saphenous Vein. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Geißler C, Ge I, Hess M, Metzger P, Bronsert P, Lassmann S, Börries M, Juhasz-Böss I, Illert AL, Bossart M. Personalisierte Therapie des therapieresistenten Ovarialkarzinoms einer jungen Patientin. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Geißler
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
| | - I Ge
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
| | | | | | | | | | | | | | | | - M Bossart
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
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Jaravine V, Balmford J, Metzger P, Boerries M, Binder H, Boeker M. Annotation of Human Exome Gene Variants with Consensus Pathogenicity. Genes (Basel) 2020; 11:E1076. [PMID: 32938008 PMCID: PMC7563776 DOI: 10.3390/genes11091076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
A novel approach is developed to address the challenge of annotating with phenotypic effects those exome variants for which relevant empirical data are lacking or minimal. The predictive annotation method is implemented as a stacked ensemble of supervised base-learners, including distributed random forest and gradient boosting machines. Ensemble models were trained and cross-validated on evidence-based categorical variant effect annotations from the ClinVar database, and were applied to 84 million non-synonymous single nucleotide variants (SNVs). The consensus model combined 39 functional mutation impacts, cross-species conservation score, and gene indispensability score. The indispensability score, accounting for differences in variant pathogenicities including in essential and mutation-tolerant genes, considerably improved the predictions. The consensus combination is consistent with as many input scores as possible while minimizing false predictions. The input scores are ranked based on their ability to predict effects. The score rankings and categorical phenotypic variant effect predictions are aimed for direct use in clinical and biological applications to prioritize human exome variants and mutations.
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Affiliation(s)
- Victor Jaravine
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg im Breisgau, Germany; (J.B.); (H.B.); (M.B.)
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg im Breisgau, Germany; (J.B.); (H.B.); (M.B.)
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany; (P.M.); (M.B.)
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany; (P.M.); (M.B.)
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg im Breisgau, Germany; (J.B.); (H.B.); (M.B.)
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg im Breisgau, Germany; (J.B.); (H.B.); (M.B.)
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Kozyra EJ, Pastor VB, Lefkopoulos S, Sahoo SS, Busch H, Voss RK, Erlacher M, Lebrecht D, Szvetnik EA, Hirabayashi S, Pasaulienė R, Pedace L, Tartaglia M, Klemann C, Metzger P, Boerries M, Catala A, Hasle H, de Haas V, Kállay K, Masetti R, De Moerloose B, Dworzak M, Schmugge M, Smith O, Starý J, Mejstrikova E, Ussowicz M, Morris E, Singh P, Collin M, Derecka M, Göhring G, Flotho C, Strahm B, Locatelli F, Niemeyer CM, Trompouki E, Wlodarski MW. Synonymous GATA2 mutations result in selective loss of mutated RNA and are common in patients with GATA2 deficiency. Leukemia 2020; 34:2673-2687. [PMID: 32555368 PMCID: PMC7515837 DOI: 10.1038/s41375-020-0899-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 02/08/2023]
Abstract
Deficiency of the transcription factor GATA2 is a highly penetrant genetic disorder predisposing to myelodysplastic syndromes (MDS) and immunodeficiency. It has been recognized as the most common cause underlying primary MDS in children. Triggered by the discovery of a recurrent synonymous GATA2 variant, we systematically investigated 911 patients with phenotype of pediatric MDS or cellular deficiencies for the presence of synonymous alterations in GATA2. In total, we identified nine individuals with five heterozygous synonymous mutations: c.351C>G, p.T117T (N = 4); c.649C>T, p.L217L; c.981G>A, p.G327G; c.1023C>T, p.A341A; and c.1416G>A, p.P472P (N = 2). They accounted for 8.2% (9/110) of cases with GATA2 deficiency in our cohort and resulted in selective loss of mutant RNA. While for the hotspot mutation (c.351C>G) a splicing error leading to RNA and protein reduction was identified, severe, likely late stage RNA loss without splicing disruption was found for other mutations. Finally, the synonymous mutations did not alter protein function or stability. In summary, synonymous GATA2 substitutions are a new common cause of GATA2 deficiency. These findings have broad implications for genetic counseling and pathogenic variant discovery in Mendelian disorders.
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Affiliation(s)
- Emilia J Kozyra
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany
| | - Victor B Pastor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stylianos Lefkopoulos
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany.,Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Sushree S Sahoo
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Hematology, St. Jude Children´s Research Hospital, Memphis, USA
| | - Hauke Busch
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany.,Lübeck Institute of Experimental Dermatology and Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany.,Comprehensive Cancer Center Freiburg (CCCF), University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rebecca K Voss
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Lebrecht
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Enikoe A Szvetnik
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ramunė Pasaulienė
- Vilnius University Hospital Santaros Klinikos, Center for Pediatric Oncology and Hematology, Bone Marrow Transplantations Unit, Vilnius, Lithuania
| | - Lucia Pedace
- Department of Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Christian Klemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Patrick Metzger
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104, Freiburg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Albert Catala
- Department of Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Valerie de Haas
- Dutch Childhood Oncology Group (DCOG), Princess Máxima Centre, Utrecht, The Netherlands
| | - Krisztián Kállay
- Central Hospital of Southern Pest-National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Riccardo Masetti
- Department of Pediatric Oncology and Hematology, University of Bologna, Bologna, Italy
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Michael Dworzak
- St. Anna Children´s Hospital and Cancer Research Institute, Pediatric Clinic, Medical University of Vienna, Vienna, Austria
| | - Markus Schmugge
- Department of Hematology and Oncology, University Children's Hospital, Zurich, Switzerland
| | - Owen Smith
- Paediatric Oncology and Haematology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ester Mejstrikova
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Medical University of Wroclaw, Wroclaw, Poland
| | - Emma Morris
- Institute of Immunity and Transplantation, University College London (UCL), London, UK.,Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, UK.,Department of Immunology, Royal Free London NHS FT, London, UK
| | - Preeti Singh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Matthew Collin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre at Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marta Derecka
- Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Gudrun Göhring
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Brigitte Strahm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy.,Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eirini Trompouki
- Department of Cellular and Molecular Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany.,CIBSS-Centre for Integrative Biological Signaling Studies, Freiburg, Germany
| | - Marcin W Wlodarski
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Hematology, St. Jude Children´s Research Hospital, Memphis, USA.
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20
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Dittmann J, Haydn T, Metzger P, Ward GA, Boerries M, Vogler M, Fulda S. Next-generation hypomethylating agent SGI-110 primes acute myeloid leukemia cells to IAP antagonist by activating extrinsic and intrinsic apoptosis pathways. Cell Death Differ 2020; 27:1878-1895. [PMID: 31831875 PMCID: PMC7244748 DOI: 10.1038/s41418-019-0465-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/16/2022] Open
Abstract
Therapeutic efficacy of first-generation hypomethylating agents (HMAs) is limited in elderly acute myeloid leukemia (AML) patients. Therefore, combination strategies with targeted therapies are urgently needed. Here, we discover that priming with SGI-110 (guadecitabine), a next-generation HMA, sensitizes AML cells to ASTX660, a novel antagonist of cellular inhibitor of apoptosis protein 1 and 2 (cIAP1/2) and X-linked IAP (XIAP). Importantly, SGI-110 and ASTX660 synergistically induced cell death in a panel of AML cell lines as well as in primary AML samples while largely sparing normal CD34+ human progenitor cells, underlining the translational relevance of this combination. Unbiased transcriptome analysis revealed that SGI-110 alone or in combination with ASTX660 upregulated the expression of key regulators of both extrinsic and intrinsic apoptosis signaling pathways such as TNFRSF10B (DR5), FAS, and BAX. Individual knockdown of the death receptors TNFR1, DR5, and FAS significantly reduced SGI-110/ASTX660-mediated cell death, whereas blocking antibodies for tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) or FAS ligand (FASLG) failed to provide protection. Also, TNFα-blocking antibody Enbrel had little protective effect on SGI-110/ASTX660-induced cell death. Further, SGI-110 and ASTX660 acted in concert to promote cleavage of caspase-8 and BID, thereby providing a link between extrinsic and intrinsic apoptotic pathways. Consistently, sequential treatment with SGI-110 and ASTX660-triggered loss of mitochondrial membrane potential (MMP) and BAX activation which contributes to cell death, as BAX silencing significantly protected from SGI-110/ASTX660-mediated apoptosis. Together, these events culminated in the activation of caspases-3/-7, nuclear fragmentation, and cell death. In conclusion, SGI-110 and ASTX660 cooperatively induced apoptosis in AML cells by engaging extrinsic and intrinsic apoptosis pathways, highlighting the therapeutic potential of this combination for AML.
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Affiliation(s)
- Jessica Dittmann
- Institute for Experimental Cancer Research in Pediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Tinka Haydn
- Institute for Experimental Cancer Research in Pediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University Freiburg, Freiburg im Breisgau, Germany
- Institute of Molecular Medicine and Cell Research (IMMZ), Albert Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
- Faculty of Biology, University Freiburg, Freiburg im Breisgau, Germany
| | | | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, Faculty of Medicine, University Freiburg, Freiburg im Breisgau, Germany
- Institute of Molecular Medicine and Cell Research (IMMZ), Albert Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg im Breisgau, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Meike Vogler
- Institute for Experimental Cancer Research in Pediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Simone Fulda
- Institute for Experimental Cancer Research in Pediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- German Cancer Consortium (DKTK), Partner Site Frankfurt, Frankfurt am Main, Germany.
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21
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Buechner P, Hinderer M, Unberath P, Metzger P, Boeker M, Acker T, Haller F, Mack E, Nowak D, Paret C, Schanze D, von Bubnoff N, Wagner S, Busch H, Boerries M, Christoph J. Requirements Analysis and Specification for a Molecular Tumor Board Platform Based on cBioPortal. Diagnostics (Basel) 2020; 10:E93. [PMID: 32050609 PMCID: PMC7167859 DOI: 10.3390/diagnostics10020093] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 02/07/2020] [Indexed: 01/17/2023] Open
Abstract
Clinicians in molecular tumor boards (MTB) are confronted with a growing amount of genetic high-throughput sequencing data. Today, at German university hospitals, these data are usually handled in complex spreadsheets from which clinicians have to obtain the necessary information. The aim of this work was to gather a comprehensive list of requirements to be met by cBioPortal to support processes in MTBs according to clinical needs. Therefore, oncology experts at nine German university hospitals were surveyed in two rounds of interviews. To generate an interview guideline a scoping review was conducted. For visual support in the second round, screenshot mockups illustrating the requirements from the first round were created. Requirements that cBioPortal already meets were skipped during the second round. In the end, 24 requirements with sometimes several conceivable options were identified and 54 screenshot mockups were created. Some of the identified requirements have already been suggested to the community by other users or are currently being implemented in cBioPortal. This shows, that the results are in line with the needs expressed by various disciplines. According to our findings, cBioPortal has the potential to significantly improve the processes and analyses of an MTB after the implementation of the identified requirements.
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Affiliation(s)
- Philipp Buechner
- Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91058 Erlangen-Tennenlohe, Germany; (P.B.); (M.H.); (P.U.)
| | - Marc Hinderer
- Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91058 Erlangen-Tennenlohe, Germany; (P.B.); (M.H.); (P.U.)
| | - Philipp Unberath
- Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91058 Erlangen-Tennenlohe, Germany; (P.B.); (M.H.); (P.U.)
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine and Medical Center-University of Freiburg, 79110 Freiburg, Germany;
- Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg, Germany;
| | - Till Acker
- Institute of Neuropathology, Justus-Liebig-University Giessen, 35392 Giessen, Germany;
| | - Florian Haller
- Institute of Pathology, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Elisabeth Mack
- Department of Hematology, Oncology and Immunology, Philipps-University Marburg, and University Hospital Gießen and Marburg, Marburg, Germany Baldingerstraße, 35043 Marburg, Germany;
| | - Daniel Nowak
- Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Heinrich-Lanz-Center for Digital Health, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Claudia Paret
- Pediatric Hematology/Oncology, Children’s Hospital, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- University Cancer Center (UCT) of the University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Faculty of Medicine, Otto-von-Guericke University, 39120 Magdeburg, Germany;
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany;
- German Cancer Consortium (DKTK), partner site Freiburg, 79106 Freiburg, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sebastian Wagner
- Department of Medicine 2, Hematology/Oncology, Goethe University Hospital, 60590 Frankfurt am Main, Germany;
| | - Hauke Busch
- Institute of Experimental Dermatology and Institute of Cardiogenetics, University of Lübeck, 23562 Lübeck, Germany;
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine and Medical Center-University of Freiburg, 79110 Freiburg, Germany;
- Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine and Medical Center – University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg; and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jan Christoph
- Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91058 Erlangen-Tennenlohe, Germany; (P.B.); (M.H.); (P.U.)
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22
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Hoefflin R, Geißler AL, Fritsch R, Claus R, Wehrle J, Metzger P, Reiser M, Mehmed L, Fauth L, Heiland DH, Erbes T, Stock F, Csanadi A, Miething C, Weddeling B, Meiss F, von Bubnoff D, Dierks C, Ge I, Brass V, Heeg S, Schäfer H, Boeker M, Rawluk J, Botzenhart EM, Kayser G, Hettmer S, Busch H, Peters C, Werner M, Duyster J, Brummer T, Boerries M, Lassmann S, von Bubnoff N. Personalized Clinical Decision Making Through Implementation of a Molecular Tumor Board: A German Single-Center Experience. JCO Precis Oncol 2018; 2:PO.18.00105. [PMID: 32913998 PMCID: PMC7446498 DOI: 10.1200/po.18.00105] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Dramatic advances in our understanding of the molecular pathophysiology of cancer, along with a rapidly expanding portfolio of molecular targeted drugs, have led to a paradigm shift toward personalized, biomarker-driven cancer treatment. Here, we report the 2-year experience of the Comprehensive Cancer Center Freiburg Molecular Tumor Board (MTB), one of the first interdisciplinary molecular tumor conferences established in Europe. The role of the MTB is to recommend personalized therapy for patients with cancer beyond standard-of-care treatment. METHODS This retrospective case series includes 198 patients discussed from March 2015 through February 2017. The MTB guided individual molecular diagnostics, assessed evidence of actionability of molecular alterations, and provided therapy recommendations, including approved and off-label treatments as well as available matched clinical trials. RESULTS The majority of patients had metastatic solid tumors (73.7%), mostly progressive (77.3%) after a mean of 2.0 lines of standard treatment. Diagnostic recommendations resulted in 867 molecular diagnostic tests for 172 patients (five per case), including exome analysis in 36 cases (18.2%). With a median turnaround time of 28 days, treatment recommendations were given to 104 patients (52.5%). These included single-agent targeted therapies (42.3%), checkpoint inhibitors (37.5%), and combination therapies (18.3%). Treatment recommendations were implemented in 33 of 104 patients (31.7%), of whom 19 (57.6%) showed stable disease or partial response, including 14 patients (7.1% of the entire population) receiving off-label treatments. CONCLUSION Personalized extended molecular-guided patient care is effective for a small but clinically meaningful proportion of patients in challenging clinical situations. Limited access to targeted drugs, lack of trials, and submission at late disease stage prevents broader applicability, whereas genome-wide analyses are not a strict requirement for predictive molecular testing.
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Affiliation(s)
- Rouven Hoefflin
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Anna-Lena Geißler
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Ralph Fritsch
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Rainer Claus
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Julius Wehrle
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Patrick Metzger
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Meike Reiser
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Leman Mehmed
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Lisa Fauth
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Dieter Henrik Heiland
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Thalia Erbes
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Friedrich Stock
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Agnes Csanadi
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Cornelius Miething
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Britta Weddeling
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Frank Meiss
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Dagmar von Bubnoff
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Christine Dierks
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Isabell Ge
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Volker Brass
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Steffen Heeg
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Henning Schäfer
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Martin Boeker
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Justyna Rawluk
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Elke Maria Botzenhart
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Gian Kayser
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Simone Hettmer
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Christoph Peters
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Martin Werner
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Justus Duyster
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Tilman Brummer
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Melanie Boerries
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Silke Lassmann
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
| | - Nikolas von Bubnoff
- All authors: University of Freiburg, Freiburg; Ralph Fritsch, Julius Wehrle, Cornelius Miething, Christoph Peters, Martin Werner, Justus Duyster, Tilman Brummer, Melanie Boerries, Silke Lassmann, and Nikolas von Bubnoff, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg; Rainer Claus, Augsburg Medical Center, Augsburg; and Hauke Busch, University of Lübeck, Lübeck, Germany
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Rossi F, Kambara A, Pinto I, Metzger P, Betelli C, Almeida B, Rossi C, Izukawa N, Sousa A, Thorpe P. Efficacy of Computed Tomography Venography (CTV) Screening Compared to Duplex Ultrasound (DU), Multiplanar Venography (MV), and Intravascular Ultrasound (IVUS) in Iliac Vein Compression Syndrome (IVCS). J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gassner C, Lipsmeier F, Metzger P, Beck H, Schnueriger A, Regula J, Moelleken J. Development and validation of a novel SPR-based assay principle for bispecific molecules. J Pharm Biomed Anal 2015; 102:144-9. [DOI: 10.1016/j.jpba.2014.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
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Aspalter M, Linni K, Metzger P, Hölzenbein T. Female choice for surgical specialties: development in Germany, Austria, and Switzerland over the past decade. Eur Surg 2014. [DOI: 10.1007/s10353-014-0284-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Gamal EM, Szabó A, Szüle E, Vörös A, Metzger P, Kovács G, Kovács J, Oláh A, Rózsa I, Kiss J. Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract. Surg Endosc 2014; 15:473-6. [PMID: 11353964 DOI: 10.1007/s004640000274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2000] [Accepted: 03/30/2000] [Indexed: 11/24/2022]
Abstract
BACKGROUND Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic control or with the use of choledochoscopy, but it is also possible to combine these methods. METHODS Since 1994, we have used the percutaneous video choledochoscopic technique for the removal of difficult retained biliary stones via dilated T-tube tract in 17 patients, applying the technique of percutaneous stone extraction used in urology. While waiting for the T-tube tract to mature and after the removal of the T-tube, the dilatation of its tract was 26-30 Fr. Stone removal was carried out using a flexible video choledochoscope and a rigid renoscope under fluoroscopic control, with the aid of Dormia baskets, rigid forceps, and high-pressure irrigation. RESULTS We performed 23 operative procedures, and the clearance of the biliary ducts was successful in all cases. There were no major complications or deaths. CONCLUSION Percutaneous video choledochoscopic-assisted removal of large retained biliary stones via the T-tube tract is a highly effective and safe procedure. Its advantages over other procedures include the ability to visualize the stones and noncalculous filling defects; it also guarantees that the stones can be removed under visual video endoscopic control. It has no problems related to tract or stone size.
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Affiliation(s)
- E M Gamal
- Department of Surgery, Faculty of Health Sciences, Semmelweis University, Szabolcs u. 35, 1135 Budapest, Hungary.
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Metzger P, Baloch N, Kazi G, Bile K. Tuberculosis control in Pakistan: reviewing a decade of success and challenges. East Mediterr Health J 2010. [DOI: 10.26719/2010.16.supp.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Presacral tailgut cysts are uncommon and few data exist on the outcomes following surgery. METHODS Patients undergoing tailgut cyst resection at the Mayo Clinic between 1985 and 2008 were analysed retrospectively. Demographic data, clinicopathological features, operative details, postoperative complications and recurrence were reviewed. RESULTS Thirty-one patients were identified (28 women), with a median age of 52 years. Seventeen patients were symptomatic and 28 had a palpable mass on digital rectal examination. Median cyst diameter was 4.4 cm. Four patients had a fistula to the rectum. Complete cyst excision was achieved in all patients; eight underwent distal sacral resection or coccygectomy. Postoperative complications occurred in eight patients but without 30-day mortality. Malignant transformation was present in four patients: adenocarcinoma in three and carcinoid in one. The cyst recurred in one patient after surgery for a benign lesion. CONCLUSION Presacral tailgut cysts should be removed due to the risk of malignant transformation.
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Affiliation(s)
- K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Metzger P, Baloch NA, Kazi GN, Bile KM. Tuberculosis control in Pakistan: reviewing a decade of success and challenges. East Mediterr Health J 2010; 16 Suppl:S47-S53. [PMID: 21495588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pakistan has shown drastic expansion of tuberculosis (TB) care during the past 10 years, increasing case notifications from 11 050 in 2000 to 248 115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, all requiring continued and coordinated technical and donor support.
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Affiliation(s)
- P Metzger
- World Health Organization, Country Office, Islamabad, Pakistan.
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Metzger P, Holzer B, Hofmann M, Schiessel R. 392 POSTER Technique of laparoscopic total mesorectal excision (TME) - which method for haemostasis? Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Harlan J, Chen Y, Gubbins E, Mueller R, Roch JM, Walter K, Lake M, Olsen T, Metzger P, Dorwin S, Ladror U, Egan DA, Severin J, Johnson RW, Holzman TF, Voelp K, Davenport C, Beck A, Potter J, Gopalakrishnan M, Hahn A, Spear BB, Halbert DN, Sullivan JP, Abkevich V, Neff CD, Skolnick MH, Shattuck D, Katz DA. Variants in Apaf-1 segregating with major depression promote apoptosome function. Mol Psychiatry 2006; 11:76-85. [PMID: 16231040 DOI: 10.1038/sj.mp.4001755] [Citation(s) in RCA: 35] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
APAF1, encoding the protein apoptosis protease activating factor 1 (Apaf-1), has recently been established as a chromosome 12 gene conferring predisposition to major depression in humans. The molecular phenotypes of Apaf-1 variants were determined by in vitro reconstruction of the apoptosome complex in which Apaf-1 activates caspase 9 and thus initiates a cascade of proteolytic events leading to apoptotic destruction of the cell. Cellular phenotypes were measured using a yeast heterologous expression assay in which human Apaf-1 and other proteins necessary to constitute a functional apoptotic pathway were overexpressed. Apaf-1 variants encoded by APAF1 alleles that segregate with major depression in families linked to chromosome 12 shared a common gain-of-function phenotype in both assay systems. In contrast, other Apaf-1 variants showed neutral or loss-of-function phenotypes. The depression-associated alleles thus have a common phenotype that is distinct from that of non-associated variants. This result suggests an etiologic role for enhanced apoptosis in major depression.
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Affiliation(s)
- J Harlan
- Advanced Technologies, Abbott Laboratories, 100 Abbott Park Road R424/AP10, Abbott Park, IL 60064, USA
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Metzger P, Largeau C. Botryococcus braunii: a rich source for hydrocarbons and related ether lipids. Appl Microbiol Biotechnol 2004; 66:486-96. [PMID: 15630516 DOI: 10.1007/s00253-004-1779-z] [Citation(s) in RCA: 247] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 09/23/2004] [Accepted: 09/24/2004] [Indexed: 12/01/2022]
Abstract
This paper presents a review on Botryococcus braunii, a cosmopolitan green colonial microalga characterised by a considerable production of lipids, notably hydrocarbons. Strains like wild populations of this alga differ in the type of hydrocarbons they synthesise and accumulate: (1) n-alkadienes and trienes, (2) triterpenoid botryococcenes and methylated squalenes, or (3) a tetraterpenoid, lycopadiene. In addition to hydrocarbons and some classic lipids, these algae produce numerous series of characteristic ether lipids closely related to hydrocarbons. This review covers the algal biodiversity, the chemical structures and biosynthesis of hydrocarbons and ether lipids and the biotechnological studies related to hydrocarbon production.
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Affiliation(s)
- P Metzger
- Laboratoire de Chimie Bioorganique et Organique Physique, Ecole Nationale Supérieure de Chimie de Paris, 11 Rue Pierre et Marie Curie, 75231 cedex 05 Paris, France.
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Abstract
INTRODUCTION Minimally invasive approaches are increasing in popularity. We have undertaken an anatomic and radiological study of the frontal sinus that is frequently involved in the supercilliary minicraniotomy used to access the parasellar region. OBJECTIVE We wanted to evaluate the prevalence and morphological characteristics of the frontal sinus in a certain population sample. METHODS 98 randomly assigned individuals were subjected to CT examinations. The antero-posterior diameter, sagittal diameter, transverse diameter and total volume of the frontal sinus were calculated. RESULTS The frontal sinus tended to be larger in males than in females with the exception of the transverse diameter (p < 0.10). CONCLUSION Knowledge of the anatomic variations of the frontal sinus is important in surgical approaches through the superciliary arc in order to avoid complications such as infections and CSF fistula.
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Affiliation(s)
- J M Pondé
- Department of Morphology, Escola Bahiana de Medicina, Bahia, Brazil.
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Gamal EM, Metzger P, Szabó G, Bráth E, Petõ K, Oláh A, Kiss J, Furka I, Mikó I. The influence of intraoperative complications on adhesion formation during laparoscopic and conventional cholecystectomy in an animal model. Surg Endosc 2001; 15:873-7. [PMID: 11443424 DOI: 10.1007/s004640000358] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2000] [Accepted: 08/25/2000] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the extent of postoperative adhesion formation after laparoscopic and open cholecystectomy. MATERIALS AND METHODS Qualified surgeons performed 60 experimental laparoscopic cholecystectomies (LC) in dogs with the aim to acquire the laparoscopic technique. To assess the relation between the complications during the operation (bleeding, laceration of the liver bed, or gallbladder perforation) and the formation of adhesions, surviving animals were divided into four groups according to the type of complication occurred. Assessment of the results was made by second-look laparoscopy 4 weeks after LC using the adhesion index (AI; score range, 0-4). The animals then were killed so the extent of adhesion formation could be measured. As a control, open cholecystectomy was performed in 15 dogs without intraoperative complications. The Mann-Whitney rank-sum test and Dunn's method were used for statistical analysis. RESULTS No adhesion formation or intraoperative complications were registered in the laparoscopic group I. In all the cases wherein bleeding or laceration of the liver bed occurred and was managed with electrocoagulation, adhesions formed. Adhesion formation in these groups was significantly higher than in "ideal LC" or cases of gallbladder perforation alone (p < 0.01). All the animals in the control group developed significantly more adhesions than those in the experimental group (p < 0.05). CONCLUSIONS It seems that LC has a lower rate of adhesion formation than the conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can enhance adhesion formation. No adhesion formation can be mentioned in relation to gallbladder perforation during LC.
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Affiliation(s)
- E M Gamal
- Department of Surgery, Faculty of Health Sciences, Semmelweis University Budapest, 1135 Budapest, Szabolcs u. 35, Hungary.
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Gamal EM, Metzger P, Szabó G, Bráth E, Seli A, Ender F, Polányi C, Furka I, Mikó I. [How do intraoperative complications effect adhesion formation after laparoscopic cholecystectomy: a comparative animal study]. Magy Seb 2001; 54:180-4. [PMID: 11432171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the extent of postoperative formation of adhesions following laparoscopic and open cholecystectomy. MATERIAL AND METHODS 60 experimental laparoscopic cholecystectomies (LC) were performed in dogs by qualified surgeons to learn laparoscopic technique. To assess the relationship between complications occurred during the operation (bleeding, laceration of the liver bed or gallbladder perforation) and the formation of adhesions surviving animals were divided into 4 groups according to the type of complication. We assessed the results during second-look laparoscopy 4 weeks following LC using the adhesion index (AI: 0-4 score). Animals were then sacrificed to measure the extent of adhesions. As a control group open cholecystectomy was performed in 15 dogs without intraoperative complications. Mann-Whitney Rank Sum test and Dunn's Method were used for statistical analysis. RESULTS No adhesions were observed in the laparoscopic group without intraoperative complications. In all dogs with bleeding or laceration of the liver bed maintained by electrocoagulation, adhesions developed. Formation of adhesion in these groups was significantly higher than in "ideal LC" or in case of gallbladder perforation (P < 0.01). All animals in the control group developed significantly more adhesions compared to the experimental group (p < 0.05). CONCLUSION LC produces less adhesion compared to conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can increase the formation of adhesions. No formation of adhesions can be related to gallbladder perforation during LC.
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Affiliation(s)
- E M Gamal
- Semmelweis Egyetem Egészségtudományi Kar Sebészeti Klinika, 1135 Budapest, Szabolcs u. 35.
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Metzger P, Gamal EM, Zirngibl H, Stellwag-Carion F. [Laparoscopic colon surgery]. Magy Seb 2001; 54:174-9. [PMID: 11432170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We review our experience in laparoscopic colorectal surgery, with indications, technical aspects and results. Between 1992 and 31/12/2000, we performed 113 laparoscopic or laparoscopically assisted colorectal operations. Of 79 malignant cases, 37 operations were oncologically radical and therapeutic, 42 were palliative. During the immediate postoperative period two deaths occurred (2.8%), the causes of death were not related to surgery. Port site metastasis developed in one patient (1.4%). Postoperative complications developed in 18 patients (14.5%). Only one patient required conversion to laparotomy. We emphasize the importance of hand assisted laparoscopic surgery (HALS) in laparoscopic colorectal surgery, because it can increase the number of laparoscopic colorectal operations. Based on our results and experience, we recommend the routine use of laparoscopic technique in colorectal surgery.
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Affiliation(s)
- P Metzger
- Waldviertelklinikum Chirurgie, A-3580 Spitalgasse 10, Horn, Ausztria.
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Rager MN, Metzger P. Six novel tetraterpenoid ethers, lycopanerols B-G, and some other constituents from the green microalga Botryococcus braunii. Phytochemistry 2000; 54:427-437. [PMID: 10897485 DOI: 10.1016/s0031-9422(00)00118-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Six novel tetraterpenoid ethers, lycopanerols B-G, were isolated from lipidic extracts of the green microalga Botryococcus braunii (L race), along with a series of phytyl esters and alpha- and beta-tocopherols. The structures of the compounds were determined by means of spectral analyses including 2D NMR techniques. A biogenetic relationship is proposed between lycopanerols and lycopadiene, the acyclic diunsaturated tetraterpenoid hydrocarbon synthesized by the alga.
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Affiliation(s)
- M N Rager
- Service RMN, UMR CNRS 75-76, Ecole Nationale Supérieure de Chimie de Paris, France
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Unger E, Metzger P, Krupinski E, Baker M, Hulett R, Gabaeff D, Mills J, Ihnat D, McCreery T. The use of a thrombus-specific ultrasound contrast agent to detect thrombus in arteriovenous fistulae. Invest Radiol 2000; 35:86-9. [PMID: 10639040 DOI: 10.1097/00004424-200001000-00010] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [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: 01/22/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the use of a new thrombus-specific ultrasound contrast agent, MRX-408, in the ultrasonic detection of thrombus in arteriovenous (AV) fistulae. METHODS Six purpose-bred mongrels with two AV fistulae each were imaged with gray-scale ultrasound 7 weeks after graft implantation before and after the intravenous bolus injection of MRX-408 (a GPIIb receptor-targeted ultrasound contrast agent). Pre- and postcontrast videotaped segments were randomized and reviewed by four radiologists blinded to the presence of thrombus in the grafts. RESULTS After the use of MRX-408, there was improved visualization of thrombus within the grafts (P < 0.0001). This was due to the enhancement of the thrombus (P < 0.0001). The improved visualization and contrast enhancement were more marked in the grafts that contained thrombus nonhyperechoic to surrounding soft tissues. CONCLUSIONS MRX-408 demonstrated better visualization of thrombus within AV fistulae. This was shown in both patent and occluded grafts. These results are encouraging and suggest that this contrast agent merits further development.
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Affiliation(s)
- E Unger
- Department of Radiology, The University of Arizona, Tucson 85724-5067, USA
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39
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Gamal EM, Metzger P, Mikó I, Szabó G, Bráth E, Kiss J, Furka I. The judgement of adhesion formation following laparoscopic and conventional cholecystectomy in an animal model. Acta Chir Hung 1999; 38:169-72. [PMID: 10596323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION The development of postoperative adhesions remains an almost inevitable consequence of visceral and gynaecologic surgery, appearing in 50-95% of all patients. Although decreased adhesion formation is one of the accepted advantages of laparoscopic surgery, only a small number of prospective studies have been done to support this claim. AIMS OF THE STUDY To evaluate the extent of postoperative adhesion formation after laparoscopic and open cholecystectomy. MATERIAL AND METHOD 60 experimental laparoscopic cholecystectomies (LC) were performed by qualified surgeons in dogs with the aim to acquire the laparoscopic technique. To assess the relation between the complications during the operation (bleeding, injury to the liver substance or gallbladder perforation) and the formation of adhesions, the surviving animals were divided into 4 groups according to the complications occurred. The assessment of the results was made by second--look laparoscopy 4 weeks following LC using the adhesion index. As a control group open cholecystectomy was then performed in 5 dogs without intraoperative complications. RESULTS No adhesion formation was observed in the groups where no intraoperative complications occurred. In all the cases where bleeding or injury to the liver bed occurred adhesion formation occurred. No adhesion formation was observed in case of gallbladder perforation. In all the animals of the control group adhesion formation was observed. CONCLUSION It seems that LC has a reduced rate of adhesion formation when compared with the open technique. Complications such as bleeding or injury to the liver substance during LC can enhance adhesion formation. No adhesion formation can be mentioned in relation with gallbladder perforation when the laparoscopic technique is applied.
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Affiliation(s)
- E M Gamal
- Department of Surgery, Haynal Imre University for Health Sciences, Budapest, Hungary
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Abstract
We report the case of a 68-year-old man who presented with a mass 3 x 4 cm in size located in the right adrenal gland together with extreme hypertension, tripled urine levels for normetanephrine, and normal plasmatic levels of metanephrines. The patient had suffered a fall from a height of 2.5 meters before hospitalization. [123I]MIBG-scan was repeatedly positive in the area of the right adrenal gland. At laparotomy under alpha-adrenergic blocking agents, the suspected pheochromocytoma was histologically confirmed as hematoma. After resection of the adrenal gland, blood pressure returned to normal without drug therapy as did metanephrine levels in urine. Although adrenal insufficiency after distension of the gland caused by hemorrhage has been reported, there are no data available regarding the mimicking of a hormonally active pheochromocytoma. We conclude that intra-adrenal pressure rise caused by hematoma may cause partial ischemic necrosis to the gland but may also induce reactive hyperplasia with periodic excessive secretion of catecholamines. This interpretation is consistent with the finding that plasma levels of catecholamines were normal in contrast to the urinary normetanephrines in the presented case. It might be worthwhile to investigate patients with intra-adrenal hemorrhage immediately after sustaining multiple injuries and in the posttraumatic course of several months up to 1 or more years together with verification of abnormal urinary excretion of metanephrines as a sign of impaired adrenal function.
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Affiliation(s)
- J Schmidt
- Department of Surgery, University Witten-Herdecke, Wuppertal, Germany.
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Schmidt J, Mohr VD, Lampert R, Metzger P, Zirngibl H. [Plasma separation combined with CVVHF in septic and SIRS patients]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:1080-2. [PMID: 9931796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In a prospective non-randomized trial, 59 patients with sepsis (n = 43) and SIRS (n = 16) were treated on a surgical intensive care unit. In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration (CVVHF) was administered. Lethality was 56% in the sepsis group; in the therapy group lethality was significantly lower in patients with plasmapheresis, even though in this population the organic failure rate was higher. Finally the dependency of lethality and age was similar in both groups. Lethality at 22% in the plasmapheresis group with double organ failure was significantly lower (P > 0.01) than in controls. Reduction of lethality seemed to be as high as 18% in patients with sepsis, while patients with SIRS did not profit from the additional therapy. A prospective randomized trial in sepsis and double organic failure should be projected.
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Affiliation(s)
- J Schmidt
- Lehrstuhl für Chirurgie II, Universität Witten-Herdecke, Klinikum Wuppertal
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Furka I, Gamal EM, Mikó I, Metzger P, Sándor J, Rózsa I, Kiss J. The history and the future of teaching and training of laparoscopic surgery in Hungary. Acta Chir Hung 1999; 38:159-61. [PMID: 10596320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Laparoscopic biliary surgery was introduced in Hungary at the end of the 1990. A variety of experimental training and teaching courses had been performed in basic techniques and the human field, which was followed by laparoscopic biliary surgery and various advanced fields. AIMS OF THE STUDY To review the history of teaching and training of laparoscopic surgery in Hungary in both the experimental and the human field, and to draw the consequences of this experience. MATERIAL AND METHODS In a period of 6 years 704 qualified surgeons received a full hands--on hands experimental training in laparoscopic biliary surgery, laparoscopic advanced surgery, laparoscopic gynaecologic and laparoscopic urology surgery. DISCUSSION The courses performed in the first and the second phase were of theoretical and practical components. The theoretical knowledge was based with emphasise to the new instruments and equipment, the indications, the new surgical technique. The practical knowledge gave every participant the full time to acquire this new type of surgery. At the end of the courses the successful participants received certificates to shift for training to the human field. Each institution needs to wrestle with issues concerning credentialling in advanced laparoscopic surgery. Like many technical skills, proficiency is maintained through repetition. A philosophy must be developed to determine whether each surgeon will perform this highly specialised type of surgery or whether it will be considered a general skill.
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Affiliation(s)
- I Furka
- Department of Experimental Surgery, Debrecen University of Medicine, Hungary
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Abstract
The membrane lipids of a deep-sea hydrothermal vent archaea, Thermococcus hydrothermalis, were isolated, purified, and structurally characterized. On the basis of acid methanolysis and spectroscopic studies, the polar lipids, amounting to 4.5% (w/w) of the dry cells, comprised diphytanyl glycerol diethers and dibiphytanyldiglycerol tetraethers, in a 45:55 ratio. No cyclopentane ring was present in the tetraethers. From the neutral lipids, accounting for 0.4% (w/w) of the dry cells, besides low amounts of di- and tetraethers occurring in a free form, four acyclic tetraterpenoid hydrocarbons, di- and tri-unsaturated were identified. All were structurally related to lycopane. The presence of these hydrocarbons provides some evidence that lycopane, widely distributed in oceans, could be derived, at least partially, from the hydrocarbons synthesized by some thermophilic Archaea. Finally, analysis of the uninoculated culture medium indicates that fatty acid derivatives and some steroid and triterpenoid compounds identified in the lipidic extract of the archaea originated from the culture medium.
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Affiliation(s)
- A Lattuati
- CNRS UMR 7573, Ecole Nationale Supérieure de Chimie de Paris, France
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Mikó I, Furka I, Gamal EM, Metzger P, Sápy P. Details of teaching, learning and training in laparoscopic surgery. Acta Chir Hung 1997; 36:230-2. [PMID: 9408356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors discuss the specific details of teaching, learning and training in laparoscopy in 6 main sections, on the basis of their experience gained through basic and advanced courses held for approximately 480 participants at the courses organised at the Department of Experimental Surgery of the University Medical School of Debrecen, between 1989 and 1996. The 6 section cover the following: 1. Why these courses are needed? 2. Who should participate in them? 3. When courses should be held (continuously for beginners, at an appointed time for advanced participants, and chances for training should be provided at any time, according to demand) 4. What should be taught? 5. Where teaching and training should take place (surgical learning/training centres) and 6. What methods of teaching should be used.
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Affiliation(s)
- I Mikó
- Department of Experimental Surgery, University Medical School of Debrecen, Hungary
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Sipos P, Gamal EM, Blázovics A, Metzger P, Mikó I, Furka I. Free radical reactions in the gallbladder. Acta Chir Hung 1997; 36:329-30. [PMID: 9408391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The changes in the composition of bile can lead to the process of it's crystallization in the gallbladder. In bile model it was shown that inflammation with the generation of reactive oxygen metabolites may induce and influence the cholesterol monohydrate crystal formation within supersaturated bile. The aim of this study was to investigate the ability to detect traces of reactive oxygen metabolites, thiobarbituric acid reactive compounds and dien, in order to compare cholesterol and bilirubin contents in bile and serum during different conditions of inflammation in the gallbladder's wall. In every bile sample a reference to free radical reaction was found. There was an increase in MDA during higher degree of inflammation in the gallbladder, but no alteration in the dien content was observed. In case of common bile duct stones the bilirubin in the serum and in the gallbladder was parallelly high, but in other cases there were no significant correlation. In an occluded gallbladder with hydrops the content of protein was significantly higher in 85% of the cholesterol stones. As a conclusion, free radical reactions in the wall of gallbladder as well as in bile can induce gallstone formation. Further studies are needed to clarify the time which is sufficient to change the composition of bile and the degree of inflammation which lead to the onset of stone formation.
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Affiliation(s)
- P Sipos
- Department of Surgery, Semmelweis Medical University, Teaching Hospital, Budapest, Hungary
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Gamal EM, Asztalos I, Sipos P, Mikó I, Furka I, Metzger P. Late epigastric incisional hernias following laparoscopic cholecystectomy. Acta Chir Hung 1997; 36:95-6. [PMID: 9408301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
By the introduction of laparoscopic cholecystectomy a new "gold standard" procedure became a routinely performed operation in the field of biliary tract surgery. Thus, the incision related early and late complications are thought to diminish, especially the formation of incisional hernias. Five patients had been referred to our department suffering from chronic incisional hernias following laparoscopic cholecystectomy. All of the hernias were located to the site of the epigastric trocar. The contents of the hernias proved to be omentum. The documentation's of the laparoscopic cholecystectomies revealed the extraction of thick walled gallbladders that contain large stones, and the wounds through which the extraction was performed had not been closed. Taking into consideration the fact of the "Chimney Effect" caused by the desufflation of the pneumoperitoneum at the end of the laparoscopic operation, bowel or omentum can easily escape through the relatively large wound formed during the extraction of the gallbladder, resulting in the formation of incisional hernias. This can be avoided by the complete desufflation and the prompt closure of the wound.
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Affiliation(s)
- E M Gamal
- Department of Surgery, Semmelweis University of Medical Sciences, Teaching Hospital, Budapest, Hungary
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Metzger P. Considerations for integrated case management models. J AHIMA 1996; 67:52-3. [PMID: 10156530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Metzger P, Gamal EM. Bile duct injuries in the era of laparoscopic cholecystectomy. Int Surg 1995; 80:328-31. [PMID: 8740678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
By the introduction of laparoscopic cholecystectomy a new field of surgical development has been opened, resulting in the reduction of conventional surgical trauma, and giving the chance to the patient seeking for less postoperative pain, short hospital stay and quick return to activity and work. In spite of these advantages, many laparoscopic cholecystectomy related complications occurred, especially in the period of the learning curve. Due to the special technical requirements, problems of the two dimensional vision, depth perception and hand-eye coordination guided to injuries of the bile ducts, which reached a high rate of 3%. This rate is ten times more when compared with conventional cholecystectomy. The authors present a detailed account of the causes of the injuries, their typical localisation and the best way to avoid and treat them.
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Affiliation(s)
- P Metzger
- Department of Surgery, Postgraduate Medical School, HI University of Health Sciences, Budapest, Hungary
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49
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Mendling W, Metzger P. [Determination of secretory immunoglobulin A in cervicovaginal secretions of healthy women with an ELISA method]. Geburtshilfe Frauenheilkd 1994; 54:417-20. [PMID: 7926576 DOI: 10.1055/s-2007-1022870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Secretory IgA of the cervico-vaginal secretions was determined for the first time using a modified ELISA method following the recommendations of Sohl Akerlund et al. (Scand. J. Immunol. 6 [1977] 1275). The results were compared with the total protein content of the cervico-vaginal secretions, which were within the normal limits reported in literature. Women in the middle of the menstrual cycle and those taking anti-ovulants, showed lower and those during pregnancy higher values. Secretory sIgA could not be detected in vaginal secretions of hysterectomised women.
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Affiliation(s)
- W Mendling
- Frauenklinik, Kliniken St. Antonius gGmbH Wuppertal
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Van Wimersma Greidanus TB, Maigret C, Rinkel GJ, Metzger P, Panis M, Van Zinnicq Bergmann FE, Poelman PJ, Colbern DL. Some characteristics of TRH-induced grooming behavior in rats. Peptides 1988; 9:283-8. [PMID: 3131746 DOI: 10.1016/0196-9781(88)90261-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Intracerebroventricular administration of TRH induces excessive grooming behavior that is characterized by an important contribution of the elements scratching and paw licking. As compared with other grooming inducing peptides, the pattern of TRH-induced grooming resembles that induced by beta-endorphin rather than those elicited by ACTH or bombesin. TRH-induced excessive grooming is suppressed by pretreatment with haloperidol, naloxone or neurotensin. Haloperidol suppresses TRH-induced grooming in a general way, whereas the suppressive effect of the other drugs is mainly due to a selective reduction of TRH-induced excessive scratching. Combined treatments of rats with TRH and a submaximal dose of ACTH, bombesin or beta-endorphin do not result in higher grooming scores than with single peptide treatment. Excessive grooming elicited by water immersion is not affected by TRH. It is concluded that TRH is undoubtedly an excessive grooming inducing peptide. In situations where excessive grooming is elicited by other peptides or by water immersion, TRH does not further activate the operating systems involved in the existing excessive grooming.
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