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Cools M, Wolffenbuttel KP, Hersmus R, Mendonca BB, Kaprová J, Drop SLS, Stoop H, Gillis AJM, Oosterhuis JW, Costa EMF, Domenice S, Nishi MY, Wunsch L, Quigley CA, T'Sjoen G, Looijenga LHJ. Malignant testicular germ cell tumors in postpubertal individuals with androgen insensitivity: prevalence, pathology and relevance of single nucleotide polymorphism-based susceptibility profiling. Hum Reprod 2018; 32:2561-2573. [PMID: 29121256 DOI: 10.1093/humrep/dex300] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 04/25/2017] [Accepted: 09/14/2017] [Indexed: 01/29/2023] Open
Abstract
STUDY QUESTION What is the prevalence of malignant testicular germ cell tumors (TGCT) and its precursors, (pre-) germ cell neoplasia in situ (GCNIS), in late teenagers and adults who have androgen insensitivity syndrome (AIS) and the impact of an individual's genetic susceptibility to development of TGCT? SUMMARY ANSWER No GCNIS or TGCT was diagnosed, but pre-GCNIS was identified in 14 and 10% of complete and partial AIS patients, respectively, and was associated with a higher genetic susceptibility score (GSS), with special attention for KITLG (rs995030) and ATFZIP (rs2900333). WHAT IS KNOWN ALREADY Many adult women with AIS decline prophylactic gonadectomy, while data regarding the incidence, pathophysiology and outcomes of TGCT in postpubertal individuals with AIS are lacking. The relevance of genetic factors, such as single nucleotide polymorphisms (SNPs), in predisposing AIS individuals to TGCT is unknown. STUDY DESIGN, SIZE, DURATION This multicenter collaborative study on prophylactically removed gonadal tissue was conducted in a pathology lab specialized in germ cell tumor biology. PARTICIPANTS/MATERIALS, SETTING, METHODS Material from 52 postpubertal individuals with molecularly confirmed AIS (97 gonadal samples) was included; the median age at surgery was 17.5 (14-54) years. Immunohistochemical studies and high-throughput profiling of 14 TGCT-associated SNPs were performed. The main outcome measures were the prevalence of pre-GCNIS, GCNIS and TGCT, and its correlation with a GSS, developed based on the results of recent genome-wide association studies. MAIN RESULTS AND ROLE OF CHANCE The earliest recognizable change preceding GCNIS, referred to as pre-GCNIS, was present in 14% of individuals with complete and 10% of those with partial AIS at a median age of 16 years. No GCNIS or invasive TGCT were found. The median GSS was significantly greater for those with, compared to those without, pre-GCNIS (P = 0.01), with an overlap between groups. Our data suggest important roles for risk alleles G at KITLG (rs995030) and C at ATFZIP (rs2900333), among the 14 studied TGCT-associated SNPs. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION A limited number of cases were included. WIDER IMPLICATIONS OF THE FINDINGS Our data suggest that the prevalence of pre-GCNIS in individuals with AIS beyond puberty is around 15%. Genetic susceptibility likely contributes to pre-GCNIS development in AIS but factors related to malignant progression remain unclear. Although data in older patients remain scarce, malignant progression appears to be a rare event, although the natural history of the premalignant lesion remains unknown. Therefore, the practice of routine prophylactic gonadectomy in adults with AIS appears questionable and the patient's preference, after having been fully informed, should be decisive in this matter. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the Research Foundation Flanders (FWO) (to M.C.), the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq G0D6713N) (to B.B.M. and M.C.) and the European Society for Pediatric Endocrinology (ESPE), granted by Novo Nordisk AB (to J.K.). There are no competing interests.
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Affiliation(s)
- M Cools
- Pediatrics and Genetics, Ghent University and Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - K P Wolffenbuttel
- Department of Pediatric Urology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Hersmus
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands
| | - B B Mendonca
- Department of Endocrinology, Hormone and Molecular Genetics Laboratory, LIM/42 Clinicas Hospital; University of Sao Paulo, Sao Paulo, Brazil
| | - J Kaprová
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Charles University, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - S L S Drop
- Department of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Stoop
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands
| | - A J M Gillis
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands
| | - J W Oosterhuis
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands
| | - E M F Costa
- Department of Endocrinology, Hormone and Molecular Genetics Laboratory, LIM/42 Clinicas Hospital; University of Sao Paulo, Sao Paulo, Brazil
| | - S Domenice
- Department of Endocrinology, Hormone and Molecular Genetics Laboratory, LIM/42 Clinicas Hospital; University of Sao Paulo, Sao Paulo, Brazil
| | - M Y Nishi
- Department of Endocrinology, Hormone and Molecular Genetics Laboratory, LIM/42 Clinicas Hospital; University of Sao Paulo, Sao Paulo, Brazil
| | - L Wunsch
- Department of Pediatric Urology, Universitätsklinikum Schleswig-Holstein and Universität zu Lübeck, Lübeck, Germany
| | - C A Quigley
- Pediatric Endocrinology, Indiana University, School of Medicine, Indianapolis, IN, USA
| | - G T'Sjoen
- Internal Medicine, Ghent University and Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - L H J Looijenga
- Laboratory for Experimental Patho-Oncology, Josephine Nefkens Institute and Erasmus Medical Center, Rotterdam, The Netherlands
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Wolffenbuttel KP, Hersmus R, Stoop H, Biermann K, Hoebeke P, Cools M, Looijenga LHJ. Gonadal dysgenesis in disorders of sex development: Diagnosis and surgical management. J Pediatr Urol 2016; 12:411-416. [PMID: 27769830 DOI: 10.1016/j.jpurol.2016.08.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023]
Abstract
Recent studies on gonadal histology have improved the understanding of germ cell malignancy risk in patients with disorders of sex development (DSD), and evidence-based gonadal management strategies are gradually emerging. Especially in 46,XY DSD and 45,X/46,XY DSD, which are characterized by gonadal dysgenesis, the risk of germ cell malignancy is significantly increased. This paper summarized the progress over the past 10 years in malignancy risk assessment in patients with DSD, and its implications for optimal surgical handling of the involved gonads.
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Affiliation(s)
- K P Wolffenbuttel
- Department of Urology and Pediatric Urology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - R Hersmus
- Department of Pathology, Erasmus MC, Josephine Nefkens Institute, Rotterdam, The Netherlands
| | - H Stoop
- Department of Pathology, Erasmus MC, Josephine Nefkens Institute, Rotterdam, The Netherlands
| | - K Biermann
- Department of Pathology, Erasmus MC, Josephine Nefkens Institute, Rotterdam, The Netherlands
| | - P Hoebeke
- Department of Urology and Pediatric Urology, Ghent University Hospital, Ghent, Belgium
| | - M Cools
- Department of Pediatrics, Ghent University Hospital, Ghent University, Belgium
| | - L H J Looijenga
- Department of Pathology, Erasmus MC, Josephine Nefkens Institute, Rotterdam, The Netherlands
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Oosterhuis JW, Stoop J, Rijlaarsdam MA, Biermann K, Smit V, Hersmus R, Looijenga LHJ. Pediatric germ cell tumors presenting beyond childhood? Andrology 2014; 3:70-7. [DOI: 10.1111/andr.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/17/2014] [Accepted: 10/18/2014] [Indexed: 01/22/2023]
Affiliation(s)
- J. W. Oosterhuis
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - J.A. Stoop
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - M. A. Rijlaarsdam
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - K. Biermann
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - V.T.H.B.M. Smit
- Department of Pathology; Leiden University Medical Center; Leiden The Netherlands
| | - R. Hersmus
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
| | - L. H. J. Looijenga
- Department of Pathology; Laboratory for Experimental Patho-Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center Rotterdam; Rotterdam The Netherlands
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Cools M, Hoebeke P, Wolffenbuttel KP, Stoop H, Hersmus R, Barbaro M, Wedell A, Brüggenwirth H, Looijenga LHJ, Drop SLS. Pubertal androgenization and gonadal histology in two 46,XY adolescents with NR5A1 mutations and predominantly female phenotype at birth. Eur J Endocrinol 2012; 166:341-9. [PMID: 22080441 DOI: 10.1530/eje-11-0392] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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: 01/29/2023]
Abstract
OBJECTIVE Most patients with NR5A1 (SF-1) mutations and poor virilization at birth are sex-assigned female and receive early gonadectomy. Although studies in pituitary-specific Sf-1 knockout mice suggest hypogonadotropic hypogonadism, little is known about endocrine function at puberty and on germ cell tumor risk in patients with SF-1 mutations. This study reports on the natural course during puberty and on gonadal histology in two adolescents with SF-1 mutations and predominantly female phenotype at birth. DESIGN AND METHODS Clinical and hormonal data and histopathological studies are reported in one male and one female adolescent with, respectively, a nonsense mutation (c.9T>A, p.Tyr3X) and a deletion of the first two coding exons (NCBI36/hg18 Chr9:g.(126306276-126307705)_(126303229-126302828)del) of NR5A1, both predicted to fully disrupt gene function. RESULTS LH and testosterone concentrations were in the normal male range, virilization was disproportionate to the neonatal phenotype. In the girl, gonadectomy at 13 years revealed incomplete spermatogenesis and bilateral precursor lesions of testicular carcinoma in situ. In the boy, at the age of 12, numerous germ cells without signs of malignancy were present in bilateral testicular biopsy specimen. CONCLUSIONS In SF-1 mutations, the neonatal phenotype poorly predicts virilization at puberty. Even in poorly virilized cases at birth, male gender assignment may allow spontaneous puberty without signs of hypogonadotropic hypogonadism, and possibly fertility. Patients with SF-1 mutations are at increased risk for malignant germ cell tumors. In case of preserved gonads, early orchidopexy and germ cell tumor screening is warranted. The finding of premalignant and/or malignant changes should prompt gonadectomy or possibly irradiation.
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Affiliation(s)
- M Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, University Hospital Ghent, Ghent University, Building 3K12D, De Pintelaan 185, 9000 Ghent, Belgium.
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Pleskacova J, Hersmus R, Oosterhuis JW, Setyawati BA, Faradz SM, Cools M, Wolffenbuttel KP, Lebl J, Drop SL, Looijenga LH. Tumor Risk in Disorders of Sex Development. Sex Dev 2010; 4:259-69. [PMID: 20558977 DOI: 10.1159/000314536] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- J Pleskacova
- Department of Pediatrics, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
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de Jong J, Stoop H, Gillis AJM, van Gurp RJHLM, van de Geijn GJM, Boer MD, Hersmus R, Saunders PTK, Anderson RA, Oosterhuis JW, Looijenga LHJ. Differential expression of SOX17 and SOX2 in germ cells and stem cells has biological and clinical implications. J Pathol 2008; 215:21-30. [PMID: 18348160 DOI: 10.1002/path.2332] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Combined action of SOX and POU families of transcription factors plays major roles in embryonic development. In embryonic stem cells, the combination of SOX2 and POU5F1 (OCT3/4) is essential for maintaining the undifferentiated state by activating pluripotency-linked genes, and inhibition of genes involved in differentiation. Besides embryonic stem cells, POU5F1 is also present in early germ cells, primordial germ cells, and gonocytes, where it has a role in suppression of apoptosis. Here we demonstrate that SOX2 is absent in germ cells of human fetal gonads, and as expected carcinoma in situ (CIS), ie the precursor lesion of testicular germ cell tumours of adolescents and adults (TGCTs), and seminoma. Based on genome-wide expression profiling, SOX17 was found to be present, instead of SOX2, in early germ cells and their malignant counterparts, CIS and seminoma. Immunohistochemistry, western blot analysis, and quantitative RT-PCR showed that SOX17 is a suitable marker to distinguish seminoma from embryonal carcinoma, confirmed in representative cell lines. Aberrant SOX2 expression can be present in Sertoli cells when associated with CIS, which can be misdiagnosed as embryonal carcinoma. In conclusion, this study demonstrates the absence of SOX2 in human embryonic and malignant germ cells, which express SOX17 in conjunction with POU5F1. This finding has both diagnostic and developmental biological implications. It allows the identification of seminoma-like cells from embryonal carcinoma based on a positive marker and might be the explanation for the different function of POU5F1 in normal and malignant germ cells versus embryonic stem cells.
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Affiliation(s)
- J de Jong
- Department of Pathology, Erasmus MC-University Medical Center Rotterdam, Josephine Nefkens Institute, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Hersmus R, Kalfa N, de Leeuw B, Stoop H, Oosterhuis JW, de Krijger R, Wolffenbuttel KP, Drop SLS, Veitia RA, Fellous M, Jaubert F, Looijenga LHJ. FOXL2 and SOX9 as parameters of female and male gonadal differentiation in patients with various forms of disorders of sex development (DSD). J Pathol 2008; 215:31-8. [DOI: 10.1002/path.2335] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gillis AJM, Stoop HJ, Hersmus R, Oosterhuis JW, Sun Y, Chen C, Guenther S, Sherlock J, Veltman I, Baeten J, van der Spek PJ, de Alarcon P, Looijenga LHJ. High-throughput microRNAome analysis in human germ cell tumours. J Pathol 2007; 213:319-28. [PMID: 17893849 DOI: 10.1002/path.2230] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Testicular germ cell tumours (GCTs) of adolescents and adults can be subdivided into seminomas (referred to as dysgerminomas of the ovary) and non-seminomas, all referred to as type II GCTs. They originate from carcinoma in situ (CIS), being the malignant counterparts of primordial germ cells (PGCs)/gonocytes. The invasive components mimic embryogenesis, including the stem cell component embryonal carcinoma (EC), the somatic lineage teratoma (TE), and the extra-embryonic tissues yolk sac tumour (YST) and choriocarcinoma (CH). The other type is the so-called spermatocytic seminomas (SS, type III GCT), composed of neoplastic primary spermatocytes. We reported previously that the miRNAs hsa-miR 371-373 cluster is involved in overruling cellular senescence induced by oncogenic stress, allowing cells to become malignant. Here we report the first high-throughput screen of 156 microRNAs in a series of type II and III GCTs (n = 69, in duplicate) using a quantitative PCR-based approach. After normalization to allow inter-sample analysis, the technical replicates clustered together, and the previous hsa-miRNA 371-373 cluster finding was confirmed. Unsupervised cluster analysis demonstrated that the cell lines are different from the in vivo samples. The in vivo samples, both normal and malignant, clustered predominantly based on their maturation status. This parallels normal embryogenesis, rather than chromosomal anomalies in the tumours. miRNAs within a single cluster showed a similar expression pattern, implying common regulatory mechanisms. Normal testicular tissue expressed most discriminating miRNAs at a higher level than SE and SS. Moreover, differentiated non-seminomas showed overexpression of discriminating miRNAs. These results support the model that miRNAs are involved in regulating differentiation of stem cells, retained in GCTs.
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Affiliation(s)
- A J M Gillis
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC-University Medical Center Rotterdam, Daniel den Hoed, Rotterdam, The Netherlands
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Looijenga LHJ, Gillis AJM, Stoop H, Hersmus R, Oosterhuis JW. Relevance of microRNAs in normal and malignant development, including human testicular germ cell tumours. ACTA ACUST UNITED AC 2007; 30:304-14; discussion 314-5. [PMID: 17573854 DOI: 10.1111/j.1365-2605.2007.00765.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The dogma of genome functionality has recently been challenged by identification of non-protein-encoding RNAs, including mi(cro)RNAs. These relatively small sequences interact with mRNA and in the mammalian system, are involved in fine-tuning the process of translation. miRNAs have been found to be of crucial importance for normal development, including stem cell formation. Recent interesting fundamental observations will be discussed in this paper, as well as their impact on the genesis of human germ cell tumours (GCTs), in particular those of the adult testis, seminomas and non-seminomas (type II), and spermatocytic seminomas (type III). miRNA cluster 371-373 is specifically involved in inhibition of cellular senescence induced by oncogenic stress in the type II GCTs. This explains the unusual presence of wild type P53, characteristic of this type of solid cancer. Specific sets of differentiating miRNA were found to characterize the various differentiation lineages within the GCTs, which simulate normal embryonic development.
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Affiliation(s)
- L H J Looijenga
- Department of Pathology, Erasmus MC - University Medical Center Rotterdam, Daniel den Hoed Cancer Center, Josephine Nefkens Institute, Rotterdam, The Netherlands.
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Glassner BJ, Weeda G, Allan JM, Broekhof JL, Carls NH, Donker I, Engelward BP, Hampson RJ, Hersmus R, Hickman MJ, Roth RB, Warren HB, Wu MM, Hoeijmakers JH, Samson LD. DNA repair methyltransferase (Mgmt) knockout mice are sensitive to the lethal effects of chemotherapeutic alkylating agents. Mutagenesis 1999; 14:339-47. [PMID: 10375003 DOI: 10.1093/mutage/14.3.339] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We have generated mice deficient in O6-methylguanine DNA methyltransferase activity encoded by the murine Mgmt gene using homologous recombination to delete the region encoding the Mgmt active site cysteine. Tissues from Mgmt null mice displayed very low O6-methylguanine DNA methyltransferase activity, suggesting that Mgmt constitutes the major, if not the only, O6-methylguanine DNA methyltransferase. Primary mouse embryo fibroblasts and bone marrow cells from Mgmt -/- mice were significantly more sensitive to the toxic effects of the chemotherapeutic alkylating agents 1,3-bis(2-chloroethyl)-1-nitrosourea, streptozotocin and temozolomide than those from Mgmt wild-type mice. As expected, Mgmt-deficient fibroblasts and bone marrow cells were not sensitive to UV light or to the crosslinking agent mitomycin C. In addition, the 50% lethal doses for Mgmt -/- mice were 2- to 10-fold lower than those for Mgmt +/+ mice for 1,3-bis(2chloroethyl)-1-nitrosourea, N-methyl-N-nitrosourea and streptozotocin; similar 50% lethal doses were observed for mitomycin C. Necropsies of both wild-type and Mgmt -/mice following drug treatment revealed histological evidence of significant ablation of hematopoietic tissues, but such ablation occurred at much lower doses for the Mgmt -/- mice. These results demonstrate the critical importance of O6-methylguanine DNA methyltransferase in protecting cells and animals against the toxic effects of alkylating agents used for cancer chemotherapy.
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Affiliation(s)
- B J Glassner
- Department of Cancer Cell Biology, Harvard School of Public Health, Boston, MA 02115, USA
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