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Larson S, McAnany B, Ladd I, Gogoi R. What do cervical cancer patients know, how do they learn, and who do they tell? A pilot study. J Eval Clin Pract 2024. [PMID: 38498396 DOI: 10.1111/jep.13964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND This study explored what patients identified with cervical cancer know about the link between human papillomavirus (HPV) and cervical cancer and where they learned this information. Patients share a great deal of information with family, friends and colleagues and we were interested in the accuracy and sources of information they are sharing. METHODS Patients identified through the EHR of a health system who had a history of cervical cancer were invited to participate in a brief survey of their experience. The sample represents an opportunity sample of patients who responded. RESULTS Generally, these patients, drawn from the Geisinger Health System in central Pennsylvania, were older (mean 57.5 years), White, and about half had annual household income of $35 K. Among all respondents about 17% had not heard of HPV, 21% did not know about an HPV vaccine, and about 38% did not know about the link between HPV and cervical cancer. Most frequently patients reported obtaining their information about HPV from television advertisements. About half received information from their oncologist. Patients reported having conversations with families about their own cancer, the cause of their cancer and HPV vaccination. It is important to note that these conversations were supported by information from many sources. CONCLUSIONS Patients may serve as a conduit for information about their condition and may be informal 'educators' in the community. It is important to make certain that these opportunities are informed by information obtained from trusted and accurate sources.
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Affiliation(s)
- Sharon Larson
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Population Health Research at the Lankenau, Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Brian McAnany
- Center for Population Health Research at the Lankenau, Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | | | - Radhika Gogoi
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
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Alvero AB, Fox A, Madina BR, Krady MM, Gogoi R, Chehade H, Nakaar V, Almassian B, Yarovinsky TO, Rutherford T, Mor G. Immune Modulation of Innate and Adaptive Responses Restores Immune Surveillance and Establishes Antitumor Immunologic Memory. Cancer Immunol Res 2024; 12:261-274. [PMID: 38078853 PMCID: PMC11027955 DOI: 10.1158/2326-6066.cir-23-0127] [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: 02/10/2023] [Revised: 05/02/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
Current immunotherapies have proven effective in strengthening antitumor immune responses, but constant opposing signals from tumor cells and the surrounding microenvironment eventually lead to immune escape. We hypothesized that in situ release of antigens and regulation of both the innate and adaptive arms of the immune system would provide a robust and long-term antitumor effect by creating immunologic memory against tumors. To achieve this, we developed CARG-2020, a genetically modified virus-like vesicle (VLV) that is a self-amplifying RNA with oncolytic capacity and encodes immune regulatory genes. CARG-2020 carries three immune modulators: (i) the pleiotropic antitumor cytokine IL12, in which the subunits (p35 and p40) are tethered together; (ii) the extracellular domain (ECD) of the protumor IL17RA, which serves as a dominant-negative antagonist; and (iii) a shRNA targeting PD-L1. Using a mouse model of ovarian cancer, we demonstrated the oncolytic effect and immune-modulatory capacities of CARG-2020. By enhancing IL12 and blocking IL17 and PD-L1, CARG-2020 successfully reactivated immune surveillance by promoting M1, instead of M2, macrophage differentiation, inhibiting MDSC expansion and establishing a potent CD8+ T cell-mediated antitumoral response. Furthermore, we demonstrated that this therapeutic approach provided tumor-specific and long-term protection against the establishment of new tumors. Our results provide a rationale for the further development of this platform as a therapeutic modality for ovarian cancer patients to enhance antitumor responses and prevent a recurrence.
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Affiliation(s)
- Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | | | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | | | | | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
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Zhang Y, Tedja R, Millman M, Wong T, Fox A, Chehade H, Gershater M, Adzibolosu N, Gogoi R, Anderson M, Rutherford T, Zhang Z, Chopp M, Mor G, Alvero AB. Adipose-derived exosomal miR-421 targets CBX7 and promotes metastatic potential in ovarian cancer cells. J Ovarian Res 2023; 16:233. [PMID: 38037081 PMCID: PMC10688490 DOI: 10.1186/s13048-023-01312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Chromobox protein homolog 7 (CBX7), a member of the Polycomb repressor complex, is a potent epigenetic regulator and gene silencer. Our group has previously reported that CBX7 functions as a tumor suppressor in ovarian cancer cells and its loss accelerated formation of carcinomatosis and drove tumor progression in an ovarian cancer mouse model. The goal of this study is to identify specific signaling pathways in the ovarian tumor microenvironment that down-regulate CBX7. Given that adipocytes are an integral component of the peritoneal cavity and the ovarian tumor microenvironment, we hypothesize that the adipose microenvironment is an important regulator of CBX7 expression. RESULTS Using conditioned media from human omental explants, we found that adipose-derived exosomes mediate CBX7 downregulation and enhance migratory potential of human ovarian cancer cells. Further, we identified adipose-derived exosomal miR-421 as a novel regulator of CBX7 expression and the main effector that downregulates CBX7. CONCLUSION In this study, we identified miR-421 as a specific signaling pathway in the ovarian tumor microenvironment that can downregulate CBX7 to induce epigenetic change in OC cells, which can drive disease progression. These findings suggest that targeting exosomal miR-421 may curtail ovarian cancer progression.
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Affiliation(s)
- Yi Zhang
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA.
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Michael Millman
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
| | - Terrence Wong
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Meyer Gershater
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Zhenggang Zhang
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
| | - Michael Chopp
- Neurology, Henry Ford Health System, 2799 W Grand Blvd., Detroit, MI, 48202, USA
- Department of Physics, Oakland University, Rochester, MI, USA
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA
| | - Ayesha B Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, 275 E. Hancock St., Detroit, MI, 48201, USA.
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Zhang Y, Tedja R, Millman M, Wong T, Fox A, Chehade H, Gershater M, Adzibolosu N, Gogoi R, Anderson M, Rutherford T, Zhang Z, Chopp M, Mor G, Alvero AB. Adipose-derived exosomal miR-421 targets CBX7 and promotes metastatic potential in ovarian cancer cells. bioRxiv 2023:2023.11.07.566022. [PMID: 37986971 PMCID: PMC10659572 DOI: 10.1101/2023.11.07.566022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Chromobox protein homolog 7 (CBX7), a member of the Polycomb repressor complex, is a potent epigenetic regulator and gene silencer. Our group has previously reported that CBX7 functions as a tumor suppressor in ovarian cancer cells and its loss accelerated formation of carcinomatosis and drove tumor progression in an ovarian cancer mouse model. The goal of this study is to identify specific signaling pathways in the ovarian tumor microenvironment that down-regulate CBX7. Given that adipocytes are an integral component of the peritoneal cavity and the ovarian tumor microenvironment, we hypothesize that the adipose microenvironment is an important regulator of CBX7 expression. Results Using conditioned media from human omental explants, we found that adipose-derived exosomes mediate CBX7 downregulation and enhance migratory potential of human ovarian cancer cells. Further, we identified adipose-derived exosomal miR-421 as a novel regulator of CBX7 expression and the main effector that downregulates CBX7. Conclusion In this study, we identified miR-421 as a specific signaling pathway in the ovarian tumor microenvironment that can downregulate CBX7 to induce epigenetic change in OC cells, which can drive disease progression. These findings suggest that targeting exosomal miR-421 may curtail ovarian cancer progression.
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Affiliation(s)
- Yi Zhang
- Neurology, Henry Ford Health, Detroit, MI
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | - Terrence Wong
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Meyer Gershater
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | | | - Michael Chopp
- Neurology, Henry Ford Health, Detroit, MI
- Department of Physics, Oakland University, Rochester, MI
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
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Udumula MP, Singh H, Rashid F, Poisson L, Tiwari N, Dimitrova I, Hijaz M, Gogoi R, Swenor M, Munkarah A, Giri S, Rattan R. Intermittent fasting induced ketogenesis inhibits mouse epithelial ovarian cancer by promoting antitumor T cell response. iScience 2023; 26:107839. [PMID: 37822507 PMCID: PMC10562806 DOI: 10.1016/j.isci.2023.107839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023] Open
Abstract
In various cancer models, dietary interventions have been shown to inhibit tumor growth, improve anticancer drug efficacy, and enhance immunity, but no such evidence exists for epithelial ovarian cancer (EOC), the most lethal gynecologic cancer. The anticancer immune responses induced by 16-h intermittent fasting (IF) were studied in mice with EOC. IF consistently reduced metabolic growth factors and cytokines that stimulate tumor growth, creating a tumor-hostile environment. Immune profiling showed that IF dramatically alters anti-cancer immunity by increasing CD4+ and CD8+ cells, Th1 and cytotoxic responses, and metabolic fitness. β-hydroxy butyrate (BHB), a bioactive metabolite produced by IF, partially imitates its anticancer effects by inducing CD8+ effector function. In a direct comparison, IF outperformed exogenous BHB treatment in survival and anti-tumor immune response, probably due to increased ketogenesis. Thus, IF and one of its metabolic mediators BHB suppress EOC growth and sustain a potent anti-tumor T cell response.
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Affiliation(s)
- Mary Priyanka Udumula
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Harshit Singh
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Faraz Rashid
- Metabolomics Core, Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Laila Poisson
- Department of Public Health Services and Center for Bioinformatics and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Nivedita Tiwari
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Irina Dimitrova
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Miriana Hijaz
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Radhika Gogoi
- Department of Gynecology Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Margaret Swenor
- Department of Lifestyle and Functional Medicine, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Adnan Munkarah
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Shailendra Giri
- Metabolomics Core, Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Ramandeep Rattan
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
- Department of Ob/Gyn, Michigan State University, East Lansing, MI, USA
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6
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Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Irwin ML, Ferrucci LM. Effect of exercise on body composition among women with ovarian cancer. J Cancer Surviv 2023; 17:1386-1396. [PMID: 35377104 PMCID: PMC9530065 DOI: 10.1007/s11764-022-01207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/22/2021] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Obesity is associated with a higher risk of mortality in women with ovarian cancer. Exercise has improved body composition among cancer survivors, yet no randomized controlled trial has explored the effect of exercise on body composition in women with ovarian cancer. In this analysis, we examined the effect of a six-month aerobic exercise intervention on body composition among ovarian cancer survivors in the Women's Activity and Lifestyle Study in Connecticut (WALC). METHODS Women with ovarian cancer (N = 144) were randomized in a 1:1 ratio to 6 months of an aerobic exercise intervention or attention-control, and body composition was measured as a secondary outcome at baseline and 6 months via dual-energy X-ray absorptiometry (DEXA). Women with at least one DEXA scan were included in the analysis (N = 103). RESULTS On average, participants were 57.1 (± 8.7) years old and 1.6 (± 0.9) years since diagnosis. Women randomized to exercise maintained weight during the trial (- 0.11 kg, P = 0.82), while women in attention-control gained weight (+ 1.40 kg, P = 0.03); however, the between-group difference did not reach statistical significance (P = 0.09). We found no statistically significant differences by study arm for changes in body fat percentage, bone mineral density, or lean body mass. CONCLUSIONS Weight was maintained as a result of a 6-month aerobic exercise intervention among post-treatment ovarian cancer survivors. Future exercise and healthy eating interventions should consider additional measures (e.g., computer tomography scans, D3-creatinine) to more accurately assess changes in body composition. IMPLICATIONS FOR CANCER SURVIVORS Moderate-intensity aerobic exercise may help ovarian cancer survivors maintain weight.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Fang-Yong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Linda T Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | | | | | - Peter E Schwartz
- Geisinger Health System, Danville, PA, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
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Alvero AB, Fox A, Madina B, Krady M, Gogoi R, Chehade H, Nakaar V, Almassian B, Yarovinsky T, Rutherford T, Mor G. Immune modulation of innate and adaptive responses restores immune surveillance and establishes anti-tumor immunological memory. bioRxiv 2023:2023.09.27.559828. [PMID: 37808682 PMCID: PMC10557730 DOI: 10.1101/2023.09.27.559828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Current immunotherapies have proven effective in strengthening anti-tumor immune responses but constant opposing signals from tumor cells and surrounding microenvironment eventually lead to immune escape. We hypothesize that in situ release of antigens and regulation of both the innate and adaptive arms of the immune system will provide a robust and long-term anti-tumor effect by creating immunological memory against the tumor. To achieve this, we developed CARG-2020, a virus-like-vesicle (VLV). It is a genetically modified and self-amplifying RNA with oncolytic capacity and encodes immune regulatory genes. CARG-2020 carries three transgenes: 1 ) the pleiotropic antitumor cytokine IL-12 in which the subunits (p35 and p40) are tethered together; 2) the extracellular domain (ECD) of the pro- tumor IL-17RA, which can serve as a dominant negative antagonist; and 3) shRNA for PD-L1. Using a mouse model of ovarian cancer, we demonstrate the oncolytic effect and immune modulatory capacities of CARG-2020. By enhancing IL-12 and blocking IL-17 and PD-L1, CARG-2020 successfully reactivates immune surveillance by promoting M1 instead of M2 macrophage differentiation, inhibiting MDSC expansion, and establishing a potent CD8+ T cell mediated anti-tumoral response. Furthermore, we demonstrate that this therapeutic approach provides tumor-specific and long-term protection preventing the establishment of new tumors. Our results provide rationale for the further development of this platform as a therapeutic modality for ovarian cancer patients to enhance the anti-tumor response and to prevent recurrence.
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Affiliation(s)
- Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | | | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | | | | | | | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
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Corey L, Wallbillich JJ, Wu S, Farrell A, Hodges K, Xiu J, Nabhan C, Guastella A, Kheil M, Gogoi R, Winer I, Bandyopadhyay S, Huang M, Jones N, Wilhite A, Karnezis A, Thaker P, Herzog TJ, Oberley M, Korn WM, Vezina A, Morris R, Ali-Fehmi R. The Genomic Landscape of Vulvar Squamous Cell Carcinoma. Int J Gynecol Pathol 2023; 42:515-522. [PMID: 37131274 PMCID: PMC10417246 DOI: 10.1097/pgp.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Vulvar squamous cell cancer (VSC) accounts for 90% of vulvar cancers. Next-generation sequencing studies of VSC imply human papillomavirus (HPV) and p53 status play separate roles in carcinogenesis and prognosis. We sought to describe the genomic landscape and analyze the immunologic profiles of VSC with respect to HPV and p53 status. A total of 443 VSC tumors underwent tumor profiling. Next-generation sequencing was performed on genomic DNA isolated from formalin-fixed paraffin-embedded tumor samples. PD-L1, microsatellite instability were tested by fragment analysis, IHC, and next-generation sequencing. Tumor mutational burden-high was defined as >10 mutations per MB. HPV 16/18 positive (HPV+) status was determined using whole exome sequencing on 105 samples. Three cohorts were identified from 105 samples with known HPV: HPV+, HPV-/p53wt, and HPV-/p53mt. Where HPV and p53 status were examined, TP53 mutations were exclusive of HPV+ tumors. In all, 37% of samples were HPV+. Among the 66 HPV- tumors, 52 (78.8%) were HPV-/p53mt and 14 (21.2%) were HPV-/p53wt. The HPV-/p53wt cohort had a higher rate of mutations in the PI3KCA gene (42.9% HPV-/p53wt vs 26.3% HPV+ vs. 5.8% HPV-/p53mt, q =0.028) and alterations in the PI3K/AkT/mTOR pathway (57.1% HPV-/p53wt vs. 34.2% HPV+ vs. 7.7% HPV-/p53mt, q =0.0386) than the other 2 cohorts. Ninety-eight VSC tumors with HPV16/18 information underwent transcriptomic analysis and immune deconvolution method. No differences were observed in immune profiles. The HPV-/p53wt VSC tumors had significantly higher rates of mutations in the PI3KCA gene and alterations in the PI3K/AkT/mTOR pathway, a potential target that merits further investigation in this subgroup.
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9
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Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Esserman DA, Irwin ML, Ferrucci LM. Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2326463. [PMID: 37526937 PMCID: PMC10394582 DOI: 10.1001/jamanetworkopen.2023.26463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023] Open
Abstract
Importance Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN. Objective To evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN. Design, Setting, and Participants This prespecified secondary analysis evaluated the Women's Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023. Interventions The exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society-certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member. Main Outcomes and Measure Change in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms. Results Of the 134 participants (all females; mean [SD] age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, -2.3 to -0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, -0.8 to 1.5) points in the attention control arm. The between-group difference was -1.6 (95% CI, -3.1 to -0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (-2.0; 95% CI, -3.6 to -0.5 points). Conclusions and Relevance Findings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02107066.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Linda T. Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | | | | | | | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
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10
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Cartmel B, Li F, Zhou Y, Gottlieb L, Lu L, Mszar R, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Risch HA, Irwin ML. Randomized trial of exercise on cancer-related blood biomarkers and survival in women with ovarian cancer. Cancer Med 2023; 12:15492-15503. [PMID: 37269192 PMCID: PMC10417064 DOI: 10.1002/cam4.6187] [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: 10/13/2022] [Revised: 04/13/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND In randomized trials in women with breast cancer, exercise has been shown to have beneficial effects on cancer-related circulating biomarkers that may impact survival. Such studies are lacking for ovarian cancer. METHODS This secondary analysis of a published randomized controlled trial examined the impact of a 6-month exercise intervention versus attention-control on change in prespecified circulating biomarkers (cancer antigen 125 (CA-125), C-reactive protein (CRP), insulin-like growth factor-1(IGF-1), insulin and leptin) in a subset of participants who provided a fasting blood draw (N = 104/144) at enrollment and at 6 months. Change in biomarkers between study arms was compared using a linear mixed effects model analysis. An exploratory analysis of the exercise intervention versus attention-control on all-cause mortality included all (N = 144) participants. All statistical tests were two-sided. RESULTS Participants included in the biomarker analysis were 57.0 ± 8.8 (mean ± SD) years old and 1.6 ± 0.9 years post-diagnosis. Adherence to the exercise intervention was 176.4 ± 63.5 min/week. Post intervention IGF-1 (group difference in change: -14.2 (-26.1 to -2.3) ng/mL (least squared means (95% CI))) and leptin (-8.9 (-16.5 to -1.4) ng/mL) were significantly reduced in the exercise group (N = 53) compared to those in attention-control (N = 51). No group difference in change was seen for CA-125 (p = 0.54), CRP (p = 0.95), or insulin (p = 0.37). With median follow-up of 70 months [range 6.6-105.4 months], 50/144 (34.7%) (exercise group; 24/74 (32.4%) versus attention-control group; 26/70 (37.1%)) participants died with no between group difference in overall survival (p = 0.99). CONCLUSIONS Further studies are needed to determine the clinical significance of exercise-induced changes in cancer-related circulating biomarkers in women with ovarian cancer.
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Affiliation(s)
- Brenda Cartmel
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Fang‐yong Li
- Department of BiostatisticsYale School of Public HealthNew HavenConnecticutUSA
| | - Yang Zhou
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Linda Gottlieb
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Lingeng Lu
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Reed Mszar
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Maura Harrigan
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Jennifer A. Ligibel
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Radhika Gogoi
- Gynecologic Oncology, Women and Children's InstituteGeisinger Health SystemDanvillePennsylvaniaUSA
- Present address:
Department of Obstetrics & GynecologyWayne State UniversityDetroitMichiganUSA
| | - Peter E. Schwartz
- Yale Cancer CenterNew HavenConnecticutUSA
- Section of Medical Oncology, Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Harvey A. Risch
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Melinda L. Irwin
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
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11
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Adzibolosu N, Alvero AB, Ali-Fehmi R, Gogoi R, Corey L, Tedja R, Chehade H, Gogoi V, Morris R, Anderson M, Vitko J, Lam C, Craig DB, Draghici S, Rutherford T, Mor G. Immunological modifications following chemotherapy are associated with delayed recurrence of ovarian cancer. Front Immunol 2023; 14:1204148. [PMID: 37435088 PMCID: PMC10331425 DOI: 10.3389/fimmu.2023.1204148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Ovarian cancer recurs in most High Grade Serous Ovarian Cancer (HGSOC) patients, including initial responders, after standard of care. To improve patient survival, we need to identify and understand the factors contributing to early or late recurrence and therapeutically target these mechanisms. We hypothesized that in HGSOC, the response to chemotherapy is associated with a specific gene expression signature determined by the tumor microenvironment. In this study, we sought to determine the differences in gene expression and the tumor immune microenvironment between patients who show early recurrence (within 6 months) compared to those who show late recurrence following chemotherapy. Methods Paired tumor samples were obtained before and after Carboplatin and Taxol chemotherapy from 24 patients with HGSOC. Bioinformatic transcriptomic analysis was performed on the tumor samples to determine the gene expression signature associated with differences in recurrence pattern. Gene Ontology and Pathway analysis was performed using AdvaitaBio's iPathwayGuide software. Tumor immune cell fractions were imputed using CIBERSORTx. Results were compared between late recurrence and early recurrence patients, and between paired pre-chemotherapy and post-chemotherapy samples. Results There was no statistically significant difference between early recurrence or late recurrence ovarian tumors pre-chemotherapy. However, chemotherapy induced significant immunological changes in tumors from late recurrence patients but had no impact on tumors from early recurrence patients. The key immunological change induced by chemotherapy in late recurrence patients was the reversal of pro-tumor immune signature. Discussion We report for the first time, the association between immunological modifications in response to chemotherapy and the time of recurrence. Our findings provide novel opportunities to ultimately improve ovarian cancer patient survival.
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Affiliation(s)
- Nicholas Adzibolosu
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ayesha B. Alvero
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Rouba Ali-Fehmi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Radhika Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Logan Corey
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Roslyn Tedja
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hussein Chehade
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Center of Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Vir Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Robert Morris
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Julie Vitko
- Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Clarissa Lam
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Douglas B. Craig
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sorin Draghici
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Advaita Corporation, Ann Arbor, MI, United States
- Division of Information and Intelligent Systems, Directorate for Computer and Information Science and Engineering, National Science Foundation, Alexandria, VA, United States
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Gil Mor
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
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Udumula MP, Singh H, Rashid F, Hijaz M, Gogoi R, Philip P, Munkarah A, Giri S, Rattan R. Abstract 527: Targeting citric acid cycle anaplerosis reverses the immunosuppressive phenotype of CD11b+Gr1+ myeloid cells in ovarian cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Immunosuppressive myeloid cells (CD11b+Gr1+) are a major constituent of the epithelial ovarian cancer (EOC) microenvironment that confer immunosuppression and promote tumor growth. We recently showed that the EOC microenvironment can induce metabolic reprogramming inCD11b+Gr1+ cells by increasing oxidative phosphorylation via TCA cycle, resulting in increased immunosuppressive ability. Increased TCA cycle activity was due to glutamine anaplerosis, which was facilitated by the upregulation of DLST (dihydrolipoamide succinyl transferase), the E2transferase subunit of α-KGDC (alpha-ketoglutarate dehydrogenase complex). We selected CPI-613 (Devimistat), an orphan metabolic drug, being actively tested in clinical trials to target the a-KGDC complex. We utilized the syngeneic ID8p53-/− model, a high grade serous ovarian cancer, to determine if CPI-613 may regulate CD11b+Gr1+ cell metabolism and immunosuppressive function and restore an antitumor immune response that inhibits EOC. One week after inducing tumors, mice were treated with CPI-613 (2.5mg/kg body weight) twice a week by IP injections or with vehicle (corn oil, control). CPI-613 treated mice showed significantly improved overall survival (median survival 75 days versus 48 days in control), decreased tumor progression and burden.CPI-613 decreased the number of CD11b+Gr1+ myeloid cells in ascites, and more importantly, reduced the intracellular immunosuppressive markers arginase 1 and IL-1β, indicating that the immunosuppressive potential was diminished, which was also validated by reversal of T cell suppression by CPI-613. The alleviation of immunosuppression was complemented by remarkable increase in CD8+ T effector cells. Further, combination of CPI-613 with anti-PD1(100ug/mice, every 5th day for 4 weeks) significantly improved survival and potentiated the CD8+mediated anti-tumor response. CPI-613 inhibited expression of DLST and immunosuppressive markers in the CD11b+Gr1+ myeloid cells, accompanied by decreased oxidative phosphorylation and decreased glutamine anaplerosis. Interestingly CPI-613 treatment also decreased the tumor associated macrophages, increased the M1 marker CD38 and decreased M2 marker EGR2, which reflected in increased M1/M2 macrophage ratio. Increased glutamine demand and addiction have been shown in variety of cancers, including EOC. We found that DLST expression corelates with worse progression free survival in the ovarian cancer TCGA dataset, implying that DLST is important in EOC cells. As a result, DLST targeting of aberrant glutamine metabolism will have the dual benefit of reducing CD11b+Gr1+ cell-mediated immunosuppression while also directly inhibiting tumor growth. Thus CPI-613 represents an attractive drug to target glutamine addiction and reduce immunosuppressive environment plaguing ovarian cancer.
Citation Format: Mary Priyanka Udumula, Harshit Singh, Faraz Rashid, Miriana Hijaz, Radhika Gogoi, Philip Philip, Adnan Munkarah, Shailendra Giri, Ramandeep Rattan. Targeting citric acid cycle anaplerosis reverses the immunosuppressive phenotype of CD11b+Gr1+ myeloid cells in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 527.
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13
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Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Irwin ML, Ferrucci LM. Exercise adherence in a randomized controlled trial of exercise on quality of life in ovarian cancer survivors. J Cancer Surviv 2023; 17:535-543. [PMID: 36550261 PMCID: PMC10038915 DOI: 10.1007/s11764-022-01325-6] [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: 08/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Factors associated with improving exercise in ovarian cancer survivors remain unknown. We explored characteristics associated with exercise adherence among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) randomized controlled trial. METHODS We evaluated adherence among women randomized to the WALC exercise intervention (N = 74). Women had to be exercising ≤ 90 min/week and post-treatment. The intervention included 25 telephone-based exercise counseling sessions over 6 months. Adherence was defined as 150 min/week of moderate/vigorous-intensity exercise. We evaluated factors associated with exercise adherence and duration using multivariate logistic and linear regression. The number of sessions sufficient to achieve 150 min/week was modeled with an unadjusted receiver operating characteristic (ROC) curve. RESULTS Women were 57.3 ± 8.8 years old and 1.7 ± 1.0 years since diagnosis. The mean exercise time over 6 months was 166.0 ± 66.1 min/week, and 64.9% of women met the 150 min/week goal. Women attended 22.8 ± 3.6 (92%) counseling sessions. No cancer recurrence during the study (OR = 9.15, 95% CI: 1.09-44.02) and greater session attendance (OR = 1.21, 95% CI: 1.02-1.43) were related to meeting the exercise goal. Greater session attendance (P < 0.01) and higher baseline activity level (P = 0.02) were associated with greater average weekly exercise duration. The ROC curve suggested attending 18 counseling sessions was optimal to meet the exercise goal. CONCLUSIONS Women attending more counseling sessions or with no cancer recurrence during the study were more likely to meet the exercise goal. More research is needed to understand ideal counseling intensity for ovarian cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Eighteen counseling sessions are sufficient for ovarian cancer survivors to achieve 150 min/week exercise.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Fang-Yong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Linda T Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | | | | | | | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
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Udumula MP, Singh H, Faraz R, Poisson L, Tiwari N, Dimitrova I, Hijaz M, Gogoi R, Swenor M, Munkarah A, Giri S, Rattan R. Intermittent Fasting induced ketogenesis inhibits mouse epithelial ovarian tumors by promoting anti-tumor T cell response. bioRxiv 2023:2023.03.08.531740. [PMID: 36945428 PMCID: PMC10028914 DOI: 10.1101/2023.03.08.531740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Epithelial Ovarian Cancer (EOC) is the most lethal gynecologic cancer with limited genetic alterations identified that can be therapeutically targeted. In tumor bearing mice, short-term fasting, fasting mimicking diet and calorie restriction enhance the activity of antineoplastic treatment by modulating systemic metabolism and boosting anti-tumor immunity. We tested the outcome of sixteen-hour intermittent fasting (IF) on mouse EOC progression with focus on fasting driven antitumor immune responses. IF resulted in consistent decrease of tumor promoting metabolic growth factors and cytokines, recapitulating changes that creates a tumor antagonizing environment. Immune profiling revealed that IF profoundly reshapes anti-cancer immunity by inducing increase in CD4+ and CD8+ cells, paralleled by enhanced antitumor Th1 and cytotoxic responses, by enhancing their metabolic fitness. Metabolic studies revealed that IF generated bioactive metabolite BHB which can be a potential substitute for simulating the antitumor benefits of IF. However, in a direct comparison, IF surpassed exogenous BHB therapy in improving survival and activating anti-tumor immune response. Thus, our data provides strong evidence for IF and its metabolic mediator BHB for ameliorating EOC progression and as a viable approach in maintaining and sustaining an effective anti-tumor T cell response.
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Affiliation(s)
- Mary Priyanka Udumula
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Harshit Singh
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Rashid Faraz
- Metabolomics Core, Department of Neurology, Henry Ford Hospital, Detroit, MI 48202
| | - Laila Poisson
- Department of Public Health Services and Center for Bioinformatics and Henry Ford Cancer Institute, Detroit, MI
| | - Nivedita Tiwari
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Irina Dimitrova
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Miriana Hijaz
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Radhika Gogoi
- Department of Gynecology Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI
| | - Margaret Swenor
- Department of Lifestyle and Functional Medicine, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Adnan Munkarah
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
| | - Shailendra Giri
- Metabolomics Core, Department of Neurology, Henry Ford Hospital, Detroit, MI 48202
| | - Ramandeep Rattan
- Department of Women’s Health Services, Henry Ford Hospital and Henry Ford Cancer Institute, Detroit, MI
- Department of Oncology, Wayne State University, Detroit, MI
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Tedja R, Alvero AB, Fox A, Cardenas C, Pitruzzello M, Chehade H, Bawa T, Adzibolosu N, Gogoi R, Mor G. Generation of Stable Epithelial-Mesenchymal Hybrid Cancer Cells with Tumorigenic Potential. Cancers (Basel) 2023; 15:cancers15030684. [PMID: 36765641 PMCID: PMC9913490 DOI: 10.3390/cancers15030684] [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: 12/08/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Cancer progression, invasiveness, and metastatic potential have been associated with the activation of the cellular development program known as epithelial-to-mesenchymal transition (EMT). This process is known to yield not only mesenchymal cells, but instead an array of cells with different degrees of epithelial and mesenchymal phenotypes with high plasticity, usually referred to as E/M hybrid cells. The characteristics of E/M hybrid cells, their importance in tumor progression, and the key regulators in the tumor microenvironment that support this phenotype are still poorly understood. METHODS In this study, we established an in vitro model of EMT and characterized the different stages of differentiation, allowing us to identify the main genomic signature associated with the E/M hybrid state. RESULTS We report that once the cells enter the E/M hybrid state, they acquire stable anoikis resistance, invasive capacity, and tumorigenic potential. We identified the hepatocyte growth factor (HGF)/c-MET pathway as a major driver that pushes cells in the E/M hybrid state. CONCLUSIONS Herein, we provide a detailed characterization of the signaling pathway(s) promoting and the genes associated with the E/M hybrid state.
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Affiliation(s)
- Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
- Correspondence: (R.T.); (G.M.)
| | - Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
| | - Carlos Cardenas
- Department of Obstetrics and Gynecology, Family HealthCare Network, Porterville, CA 93257, USA
| | - Mary Pitruzzello
- Department of Dermatology, Yale Medical School, New Haven, CT 06510, USA
| | - Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
| | - Tejeshwhar Bawa
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
- Department of Physiology, Wayne State University, Detroit, MI 48201, USA
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
- Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
| | - Gil Mor
- Department of Obstetrics and Gynecology, Family HealthCare Network, Porterville, CA 93257, USA
- Correspondence: (R.T.); (G.M.)
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Chehade H, Purandare N, Fox A, Adzibolosu N, Jayee S, Singh A, Tedja R, Gogoi R, Aras S, Grossman LI, Mor G, Alvero AB. MNRR1 is a driver of ovarian cancer progression. Transl Oncol 2023; 29:101623. [PMID: 36641875 PMCID: PMC9860385 DOI: 10.1016/j.tranon.2023.101623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/05/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
Cancer progression requires the acquisition of mechanisms that support proliferative potential and metastatic capacity. MNRR1 (also CHCHD2, PARK22, AAG10) is a bi-organellar protein that in the mitochondria can bind to Bcl-xL to enhance its anti-apoptotic function, or to respiratory chain complex IV (COX IV) to increase mitochondrial respiration. In the nucleus, it can act as a transcription factor and promote the expression of genes involved in mitochondrial biogenesis, migration, and cellular stress response. Given that MNRR1 can regulate both apoptosis and mitochondrial respiration, as well as migration, we hypothesize that it can modulate metastatic spread. Using ovarian cancer models, we show heterogeneous protein expression levels of MNRR1 across samples tested and cell-dependent control of its stability and binding partners. In addition to its anti-apoptotic and bioenergetic functions, MNRR1 is both necessary and sufficient for a focal adhesion and ECM repertoire that can support spheroid formation. Its ectopic expression is sufficient to induce the adhesive glycoprotein THBS4 and the type 1 collagen, COL1A1. Conversely, its deletion leads to significant downregulation of these genes. Furthermore, loss of MNRR1 leads to delay in tumor growth, curtailed carcinomatosis, and improved survival in a syngeneic ovarian cancer mouse model. These results suggest targeting MNRR1 may improve survival in ovarian cancer patients.
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Affiliation(s)
- Hussein Chehade
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States,C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Neeraja Purandare
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Alexandra Fox
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Shawn Jayee
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Aryan Singh
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Siddhesh Aras
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Lawrence I. Grossman
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States,Corresponding author at: 275 E. Hancock St., Detroit, MI, 48201, United States.
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Ramos H, Thummala N, Jacques SM, Gogoi R. A rare case of ovarian hemangioma in a 30-year-old nulligravid woman. Radiol Case Rep 2022; 18:613-619. [PMCID: PMC9719013 DOI: 10.1016/j.radcr.2022.10.100] [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: 10/09/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 12/05/2022] Open
Abstract
A 30-year-old nulligravid woman with a history of polycystic ovarian syndrome presented for evaluation of left adnexal mass. The patient was referred to the gynecologic oncology clinic after endorsing signs of abdominal pain for a month and the pelvis ultrasound demonstrated hypoechoic solid mass in the left ovary. Magnetic resonance imaging with T1- and T2-weighted images demonstrated progressive centripetal “filling-in” of the mass suggesting a unique variation of malignant ovarian mass, similar to what is seen in hepatic hemangioma. Upon resection of the ovarian mass, pathology reported that the mass was filled with numerous small blood vessels with single later of endothelial cells confirming the diagnosis of ovarian hemangioma, capillary-type—a rare finding.
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Affiliation(s)
- Harry Ramos
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI 48201, USA,Corresponding author.
| | - Nithin Thummala
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI 48201, USA,Karmanos Cancer Institute, 4100 John R St, Detroit, MI 48201 USA
| | - Suzanne M. Jacques
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI 48201, USA,Karmanos Cancer Institute, 4100 John R St, Detroit, MI 48201 USA
| | - Radhika Gogoi
- Wayne State University School of Medicine, 540 E. Canfield Ave, Detroit, MI 48201, USA,Karmanos Cancer Institute, 4100 John R St, Detroit, MI 48201 USA
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Chehade H, Purandare N, Fox A, Gogoi R, Aras S, Grossman L, Mor G, Alvero A. Loss of MNRR1 inhibits spheroid formation and improves survival in an ovarian cancer mouse syngeneic model. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00929-7] [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: 11/03/2022]
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Corey L, Walker C, Jang H, Corey A, Konel J, Khalil A, Mattei L, Rubinsak L, Paridon A, Polan R, Kim S, Gogoi R. Blind leading the blind: Is the current peer review process really that flawed? (519). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01740-1] [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: 11/04/2022]
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Wallbillich J, Wu S, Corey L, Kheil M, Gogoi R, Huang M, Jones N, Spetzler D, Thaker P, Herzog T, Korn WM, Morris R, Winer I, Ali-Fehmi R. Transcriptomic immune profiling for cervical squamous cell carcinoma: Does HPV type matter? (170). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01397-x] [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: 11/04/2022]
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21
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Gogoi R, Wu S, Farrell A, Kim S, Wallbillich J, Winer IS, Morris R, Spetzler D, Puccini A, Jones NL, Herzog TJ, Thaker PH, Mor G, Alvero A. Exploring the nuances between BRCA1 and 2: A multiomic analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5580 Background: Emerging data suggests that key differences exist between BRCA1 and BRCA2 associated OC, including response to therapy and survival. The purpose of this study was to identify the gene expression profiles, interacting pathways and immune microenvironment of BRCA1 mutant (BRCA1mut), BRCA2 mutant (BRCA2mut) and homologous recombination wild-type (HRwt) associated high grade serous OC (HGSOC). Methods: Next-generation sequencing (592, NextSeq; WES, NovaSeq) and Whole Transcriptome Sequencing (NovaSeq) (Caris Life Sciences, Phoenix, AZ) were performed in 8196 OC tumors classified into 3 groups: BRCA1mt; BRCA2mt; and HRwt. BRCA mutations were defined as variants that result in loss-of-function of the BRCA protein and HRwt was defined as samples negative for aberrations in both BRCA1 and BRCA2, as well as for 28 other homologous recombination genes Microsatellite instability (MSI) was tested by fragment analysis, IHC and NGS. Tumor mutational burden (TMB) was measured by totaling somatic mutations (TMB-H: >10 mutations/MB). LOH cut-off >16%. Immune cell infiltrates were calculated by XCell. Differential gene expression was calculated using Limma. Significance was determined using chi-square and Wilcoxon rank sum test and adjusted for multiple comparisons (q-value < 0.05). Results: We identified 677 BRCA1mt, 439 BRCA2mt, and 7080 HRwt OC tumors. HGSOC made up the largest portion of BRCA1mt (523; 77%), BRCA2mt (306; 70%), and HRwt (4281; 60%) tumors. TP53 was most commonly mutated gene in all three groups. LOH (>16%) was highest in BRCA1mt (86.8%) compared to BRCA2mt (74.8%) and HRwt (38.4%). TMB-H was highest in BRCA2mt (6.29%) than in BRCA1mt (1.35%) and HRwt (0.91%) HGSOC (all q < 0.05). Expression of immune checkpoint genes CD80, CD86, CD274, CTLA4, HAVCR2/TIM3, IFNG, IDO1, LAG3, PDCD1 and PDCD1LG2 were significantly higher in BRCA1 and BRCA2 mt compared to HRwt HGSOC (FC: 1.12-1.59, q < 0.05). HRwt tumors had decreased infiltration of Activated Dendritic cells compared to BRCA1mt, and lower Macrophage M1 compared to both BRCA1mt and BRCA2mt (all q < 0.05). Additionally, T-inflamed score was higher in BRCA1mt compared to HRwt, while IFN score was higher in BRCA1mt compared to both BRCA2mt and HRwt (all q < 0.05). From 17,408 genes with measured expression. 522 (3.0%) differentially expressed genes (DEG) were found between BRCA2mt vs BRCA1mt; 1487 (8.54%) between BRCA2mt vs HRwt; and 9297 (53.4%) between BRCA1mt and HRwt HGSOC. Pathway analysis identified Fatty Acid Metabolism, Myc targets, ROS pathway, Oxidative Phosphorylation, and Wnt B-catenin signaling pathways as differentially regulated between the 3 groups. Conclusions: We describe the genomic, pathway and immunologic analyses in the largest cohort of BRCA1 and 2 mutated HGSOC to date. Both metabolic and immune response pathways are differentially regulated between the groups. Results can potentially inform targeted therapeutic studies based on unique BRCA genotype.
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Affiliation(s)
| | | | | | - Seongho Kim
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | | | | | | | | | | | - Nathaniel L. Jones
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | - Thomas J. Herzog
- University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Premal H. Thaker
- Department of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Detroit, MI
| | - Ayesha Alvero
- C.S. Mott Center for Human Growth and Development, Detroit, MI
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22
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Ramos H, Galoforo S, You Y, Winer IS, Mor G, Alvero A, Gogoi R. Connective tissue growth factor expression maintains the epithelial phenotype of ovarian cancer in early epithelial to mesenchymal transition. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17544 Background: Epithelial to Mesenchymal Transition (EMT) is essential to the process of metastasis in ovarian cancer (OC). Early expressions of proteins and pathways during EMT essential for understanding mechanism and potential therapeutic targets in OC. The aim of our study is to evaluate the role and mechanism of Connective Tissue Growth Factor (CTGF) in OC. Methods: R182 and R2615 are well-characterized epithelial OC cell lines. CTGF expression +/- Transforming Growth Factor -b (TGF-b) was determined via Western blot. R182 and R2615 CTGF knock out (KO) were derived utilizing a Cas9/CRISPR-Cas9 lentivirus plasmid vector and confirmed via PCR. Anoikis resistance and invasion assays were performed to characterize phenotypes of R182 and R2615 wild type (WT) and KO cells. For anoikis resistance, cells were plated in triplicate in an ultra-low adhesive (ULA) cell plate Promega CellTiter assay which measured cell viability quantified by absorbance at 450 nm at 0, 24, 48, and 72 hrs. For invasion assay, 3000 cells were suspended in 50% reduced growth factor Basement Membrane Extract. Human recombinant CTGF was added at 50 and 100 ng/mL concentrations. Cells were plated in tissue culture plate and placed in Cytation 5/Biospa and imaged at 4-hour interval for up to 6 days. Western blot evaluated expression of mesenchymal markers. Chemo-sensitivity was measured by half maximal inhibitory concentration (IC50) for Cisplatin between the WT and KO cells. RNA sequence analysis was performed for both R182 WT and KO cells and analyzed utilizing iPathway Guide. Results: CTGF is constitutively expressed in R182 and R2615 OC cells line as early as 6 hrs of culture and after 30 min of TGF-b treatment. Loss of CTGF promoted anoikis resistance. At 72 hr, R182 CTGF WT cells displayed 75% viability while R182 KO only have 10% viability. Further, we demonstrated that loss of CTGF increases invasion. Administration of exogeneous CTGF in KO cells suppresses invasion in a dose dependent manner demonstrated. Along with epithelial markers CK-18 and beta-catenin, the KO cells expressed the mesenchymal marker SNAIL. No difference in chemo-sensitivity to Cisplatin was seen between WT and KO in either cell line. RNA sequence analysis identified 1106 out of 14054 differentially expressed genes between the WT and KO cells. PI3KAkt, cell adhesion molecules and ECM receptor interaction were pathway that were most significantly regulated. Conclusions: CTGF expression maintains the epithelial phenotype of OC cells during EMT. Loss of CTGF allows anoikis resistance and invasion which are vital characteristics in the metastatic nature of OC. We suggest that loss of CTGF expression in OC cells could be a biomarker for more aggressive OC.
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Affiliation(s)
- Harry Ramos
- Wayne State University School of Medicine, Detroit, MI
| | - Sandra Galoforo
- C.S. Mott Center for Human Growth and Development, Detroit, MI
| | - Yuan You
- C.S. Mott Center for Human Growth and Development, Detroit, MI
| | | | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Detroit, MI
| | - Ayesha Alvero
- C.S. Mott Center for Human Growth and Development, Detroit, MI
| | - Radhika Gogoi
- Wayne State University School of Medicine, Detroit, MI
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Chehade H, Tedja R, Ramos H, Bawa TS, Adzibolosu N, Gogoi R, Mor G, Alvero AB. Regulatory Role of the Adipose Microenvironment on Ovarian Cancer Progression. Cancers (Basel) 2022; 14:cancers14092267. [PMID: 35565396 PMCID: PMC9101128 DOI: 10.3390/cancers14092267] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/08/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Adipocytes or fat cells are integral part of the ovarian tumor microenvironment. Secreted factors from adipocytes, as well as direct cell-to-cell interaction with ovarian cancer cells have been shown to directly support ovarian tumor progression. Elucidating the molecular pathways involved is crucial in the identification of relevant targets. Abstract The tumor microenvironment of ovarian cancer is the peritoneal cavity wherein adipose tissue is a major component. The role of the adipose tissue in support of ovarian cancer progression has been elucidated in several studies from the past decades. The adipocytes, in particular, are a major source of factors, which regulate all facets of ovarian cancer progression such as acquisition of chemoresistance, enhanced metastatic potential, and metabolic reprogramming. In this review, we summarize the relevant studies, which highlight the role of adipocytes in ovarian cancer progression and offer insights into unanswered questions and possible future directions of research.
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Affiliation(s)
- Hussein Chehade
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
| | - Roslyn Tedja
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
- Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Harry Ramos
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
| | - Tejeshwar Singh Bawa
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
| | - Nicholas Adzibolosu
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
| | - Radhika Gogoi
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
- Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
- Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Ayesha B. Alvero
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA; (H.C.); (R.T.); (H.R.); (T.S.B.); (N.A.); (R.G.); (G.M.)
- Karmanos Cancer Institute, Detroit, MI 48201, USA
- Correspondence:
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Corey L, Walker C, Corey A, Konel J, Khalil A, Jang H, Kim S, Gogoi R. Does Origin of Article Impact Citation Metrics in Gynecologic Oncology? Gynecol Oncol Rep 2022; 40:100958. [PMID: 35313463 PMCID: PMC8933665 DOI: 10.1016/j.gore.2022.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 10/25/2022] Open
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Rubinsak L, Kim S, Jang H, Banning K, Mor G, Wallbillich J, Gogoi R. Separating the BRCA1 and BRCA2 phenotype: a genomic pathway analysis. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00721-6] [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: 10/20/2022]
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Harper A, Fox A, Alvero A, Gogoi R, Galoforo S, Mor G. Visudyne™: a new therapeutic strategy for the treatment of ovarian cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01280-4] [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: 11/28/2022]
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Shivakumar M, Miller JE, Dasari VR, Zhang Y, Lee MTM, Carey DJ, Gogoi R, Kim D. Genetic Analysis of Functional Rare Germline Variants across Nine Cancer Types from an Electronic Health Record Linked Biobank. Cancer Epidemiol Biomarkers Prev 2021; 30:1681-1688. [PMID: 34244158 DOI: 10.1158/1055-9965.epi-21-0082] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rare variants play an essential role in the etiology of cancer. In this study, we aim to characterize rare germline variants that impact the risk of cancer. METHODS We performed a genome-wide rare variant analysis using germline whole exome sequencing (WES) data derived from the Geisinger MyCode initiative to discover cancer predisposition variants. The case-control association analysis was conducted by binning variants in 5,538 patients with cancer and 7,286 matched controls in a discovery set and 1,991 patients with cancer and 2,504 matched controls in a validation set across nine cancer types. Further, The Cancer Genome Atlas (TCGA) germline data were used to replicate the findings. RESULTS We identified 133 significant pathway-cancer pairs (85 replicated) and 90 significant gene-cancer pairs (12 replicated). In addition, we identified 18 genes and 3 pathways that were associated with survival outcome across cancers (Bonferroni P < 0.05). CONCLUSIONS In this study, we identified potential predisposition genes and pathways based on rare variants in nine cancers. IMPACT This work adds to the knowledge base and progress being made in precision medicine.
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Affiliation(s)
- Manu Shivakumar
- Biomedical & Translational Informatics Institute, Geisinger, Danville, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason E Miller
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Yanfei Zhang
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - David J Carey
- Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania
| | - Radhika Gogoi
- Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania.
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Chehade H, Fox A, Tedja R, Gogoi R, Mor G, Alvero AB. Abstract 2333: EMT programs ovarian cancer cells to survive the adipocyte-rich microenvironment. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Metabolic pathways are non-canonical targets of the EMT program. The relevance of re-programming metabolism during the metastasis cascade is underscored in ovarian cancer cells, which primarily metastasizes to the adipocyte-rich omentum. Ovarian cancer-adipocyte interaction has been shown to promote fatty acid (FA) uptake into the cancer cells. These FA are then catabolized via β-oxidation thus providing the energy required for rapid tumor growth. β-oxidation of FA requires efficient mitochondria and oxygen processing. The objective of this study is to determine if E/M status determine adaptation and survival in adipocyte-rich microenvironment.
Materials and Methods: RNA seq was performed in Ck18+/Twist- epithelial and Ck18-/Twist+ mesenchymal human ovarian cancer cells. Pathway and Gene Ontology analyses were performed on differentially expressed (DEX) genes (FC>2 and p<0.05) using iPathway Guide. Protein levels were determined by western blot. Oxygen consumption rate was measured using Seahorse XF Analyzer. Cell viability was quantified using CelltoxTM Green viability dye.
Results: Pathway analysis of DEX genes with focus on metabolic pathways showed the following DEX pathways: glycolysis/gluconeogenesis (p=0.008); pyruvate metabolism (0.019); fatty acid degradation (p=0.01); fatty acid elongation (0.008). Gene ontology analysis showed significant difference in GO:0006979: response to oxidative stress (p=0.007). Further analysis of DEX genes within these pathways showed upregulation in mesenchymal cancer cells of both pyruvate dehydrogenase subunits, PDHA1 (p = 0.011) and PDHB (p=0.014) and upregulation of carnitine palmitoyltransferase (CPT1; p=0.011), the rate limiting enzyme in FA β-oxidation. The upregulation of these genes was validated at the protein level by western blot analysis, which also showed increased levels of COX-IV in mesenchymal cancer cells compared to epithelial cancer cells. Moreover, mesenchymal cells exhibited enhanced maximal respiration and enhanced spare respiratory capacity. Finally, viability studies conclusively demonstrate the metabolic flexibility in mesenchymal cancer cells, which maintained viability upon nutrient deprivation suggesting metabolic plasticity. In contrast, cell death was observed epithelial cancer cells upon nutrient deprivation, which was rescued by the addition of glucose but not the FA, oleic acid.
Conclusion: Ovarian cancer cells acquire enhanced pyruvate shuttling to the TCA cycle, a more efficient FA β-oxidation machinery, as well as more efficient oxygen processing during EMT. These phenotypes are relevant in supporting survival in the adipocyte microenvironment. Further elucidation of EMT related pathways that re-program lipid metabolism may lead to better control of carcinomatosis in ovarian cancer patients.
Citation Format: Hussein Chehade, Alexandra Fox, Roslyn Tedja, Radhika Gogoi, Gil Mor, Ayesha B. Alvero. EMT programs ovarian cancer cells to survive the adipocyte-rich microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2333.
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Affiliation(s)
| | | | | | | | - Gil Mor
- Wayne State University, Detroit, MI
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Cartmel B, Hughes M, Ercolano EA, Gottlieb L, Li F, Zhou Y, Harrigan M, Ligibel JA, von Gruenigen VE, Gogoi R, Schwartz PE, Risch HA, Lu L, Irwin ML. Randomized trial of exercise on depressive symptomatology and brain derived neurotrophic factor (BDNF) in ovarian cancer survivors: The Women's Activity and Lifestyle Study in Connecticut (WALC). Gynecol Oncol 2021; 161:587-594. [PMID: 33773809 DOI: 10.1016/j.ygyno.2021.02.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Depression is one of the most prevalent mental disorders, and rates are higher among cancer survivors than the general population, and higher in ovarian cancer patients compared to cohorts of other cancer survivors. Physical activity has been associated with lower depressive symptoms in cancer survivors, yet no trial has examined this association in women with ovarian cancer. We examined the effect of exercise on depression symptomatology and serum brain derived neurotrophin factor (BDNF) which has been associated with depression, in women with ovarian cancer. METHODS We conducted a 6-month home-based randomized trial of exercise vs. attention-control (AC) in 144 ovarian cancer survivors. Depressive symptomatology was measured via the Center for Epidemiologic Studies Depression Scale (CES-D). Serum total and free BDNF was measured at baseline and 6-months. Student's t-statistic and mixed-model repeated measures analysis was used to evaluate six-month change between arms in CES-D scores and BDNF. RESULTS Women were 57.3 ± 8.6 (mean ± SD) years old, 1.7 ± 1.0 years post-diagnosis with a baseline CES-D score of 11.79 ± 10.21. The majority (55%) were diagnosed with stage III/IV ovarian cancer. CES-D scores decreased in the exercise arm by 2.7 points (95% CI: -4.4, -0.9) or a 21% decrease compared to a 0.3 point decrease (-2.2, 1.5) (3% decrease) in the AC arm (P = 0.05). There was no difference in change in total or free BDNF between the exercise and AC arms. CONCLUSIONS Ovarian cancer survivors are able to exercise at recommended levels, and exercise was associated with a significant reduction in depressive symptomatology.
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Affiliation(s)
- Brenda Cartmel
- Yale School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Meghan Hughes
- Yale School of Public Health, New Haven, CT, United States of America
| | | | - Linda Gottlieb
- Yale School of Public Health, New Haven, CT, United States of America
| | - Fangyong Li
- Yale School of Public Health, New Haven, CT, United States of America
| | - Yang Zhou
- Yale School of Public Health, New Haven, CT, United States of America
| | - Maura Harrigan
- Yale School of Public Health, New Haven, CT, United States of America
| | | | | | - Radhika Gogoi
- Geisinger Health System, Danville, PA, United States of America
| | - Peter E Schwartz
- Yale Cancer Center, New Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America
| | - Harvey A Risch
- Yale School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America
| | - Lingeng Lu
- Yale School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America
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Dasari VR, Carey DJ, Gogoi R. Synergistic enhancement of efficacy of platinum drugs with verteporfin in ovarian cancer cells. BMC Cancer 2020; 20:273. [PMID: 32245422 PMCID: PMC7318501 DOI: 10.1186/s12885-020-06752-1] [Citation(s) in RCA: 4] [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: 10/18/2019] [Accepted: 03/12/2020] [Indexed: 01/12/2023] Open
Abstract
Background Epithelial ovarian cancers (EOCs) comprises the majority of malignant ovarian neoplasms. Combination treatment with chemotherapeutic agents seems to be a promising strategy in ovarian cancer (OVCA) patients in order to overcome drug resistance. In this in vitro study, we investigated the therapeutic efficacy of verteporfin (VP) alone and in combination with cisplatin (CDDP), carboplatin (CP) and paclitaxel (Taxol). The main objectives of this study are to determine the nature of interactions between VP and CDDP/CP/Taxol and to understand the mechanism of action of VP in OVCA cells. Methods The efficacy of VP on cell proliferation, cytotoxicity, invasion and clonogenic capacity was assayed in CDDP-sensitive (COV504, OV-90) and CDDP-resistant (A2780Cis) cell lines. The cytotoxic effects of drugs either alone or in combination were evaluated using MTT assay and Cell Viability Blue assay. The effects of drugs on the metabolic functions were studied using matrigel invasion assay and clonogenic assay. Immunoblot analysis was carried out to investigate changes in YAP and cell cycle genes. Changes in the cytokines due to drug treatments were analyzed using a cytokine array. Results Treatment with VP inhibited cell proliferation, invasion and increased cytotoxicity of OVCA cells. We observed that VP chemosensitized CDDP-resistant cells, even at lower doses. When added either in constant or non-constant ratios, VP produced synergistic effects in combination with CDDP/CP/Taxol. A cytokine array identified upregulation of cytokines in OVCA cells that were inhibited by VP treatment. Conclusions Either in cisplatin-resistant cell lines or cisplatin-sensitive cell lines, VP proves to be more efficient in inhibiting cell proliferation and inducing cytotoxicity. Our results suggest that novel combinations of VP with CDDP or CP or Taxol might be an attractive therapeutic strategy to enhance OVCA chemosensitivity. The fact that lower doses of VP are effective in chemosensitizing the CDDP-resistant cells, might ultimately lead to the development of an innovative combination therapy for the treatment of OVCA patients.
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Affiliation(s)
- Venkata Ramesh Dasari
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
| | - David J Carey
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
| | - Radhika Gogoi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Medical Center, Danville, PA, USA. .,Department of Women's Health, Geisinger Medical Center, Danville, PA, USA.
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Shivakumar M, Miller JE, Dasari VR, Gogoi R, Kim D. Exome-Wide Rare Variant Analysis From the DiscovEHR Study Identifies Novel Candidate Predisposition Genes for Endometrial Cancer. Front Oncol 2019; 9:574. [PMID: 31338326 PMCID: PMC6626914 DOI: 10.3389/fonc.2019.00574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/27/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer is the fourth most commonly diagnosed cancer in women. Family history is a known risk factor for endometrial cancer. The incidence of endometrial cancer in a first-degree relative elevates the relative risk to range between 1.3 and 2.8. It is unclear to what extent or what other novel germline variants are at play in endometrial cancer. We aim to address this question by utilizing whole exome sequencing as a means to identify novel, rare variant associations between exonic regions and endometrial cancer. The MyCode community health initiative is an excellent resource for this study with germline whole exome data for 60,000 patients available in the first phase, and further 30,000 patients independently sequenced in the second phase as part of DiscovEHR study. We conducted exome-wide rare variant association using 472 cases and 4,110 controls in 60,000 patients (discovery cohort); and 261 cases and 1,531 controls from 30,000 patients (replication cohort). After binning rare germline variants into genes, case-control association tests performed using Optimal Unified Approach for Rare-Variant Association, SKAT-O. Seven genes, including RBM12, NDUFB6, ATP6V1A, RECK, SLC35E1, RFX3 (Bonferroni-corrected P < 0.05) and ATP8A1 (suggestive P < 10−5), and one long non-coding RNA, DLGAP4-AS1 (Bonferroni-corrected P < 0.05), were associated with endometrial cancer. Notably, RECK, and ATP8A1 were replicated from the replication cohort (suggestive threshold P < 0.05). Additionally, a pathway-based rare variant analysis, using pathogenic and likely pathogenic variants, identified two significant pathways, pyrimidine metabolism and protein processing in the endoplasmic reticulum (Bonferroni-corrected P < 0.05). In conclusion, our results using the single-source electronic health records (EHR) linked to genomic data highlights candidate genes and pathways associated with endometrial cancer and indicates rare variants involvement in endometrial cancer predisposition, which could help in personalized prognosis and also further our understanding of its genetic etiology.
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Affiliation(s)
- Manu Shivakumar
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, United States
| | - Jason E Miller
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, United States.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Radhika Gogoi
- Weis Center for Research, Geisinger Clinic, Danville, PA, United States
| | - Dokyoon Kim
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, United States.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
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Miller JE, Metpally RP, Person TN, Krishnamurthy S, Dasari VR, Shivakumar M, Lavage DR, Cook AM, Carey DJ, Ritchie MD, Kim D, Gogoi R. Correction to: Systematic characterization of germline variants from the DiscovEHR study endometrial carcinoma population. BMC Med Genomics 2019; 12:65. [PMID: 31118041 PMCID: PMC6530188 DOI: 10.1186/s12920-019-0523-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jason E Miller
- Department of Genetics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raghu P Metpally
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Thomas N Person
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | | | | | - Manu Shivakumar
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Daniel R Lavage
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Adam M Cook
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA
| | - David J Carey
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Marylyn D Ritchie
- Department of Genetics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dokyoon Kim
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA.,Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, PA, 16802, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, USA
| | - Radhika Gogoi
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA.
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Miller JE, Metpally RP, Person TN, Krishnamurthy S, Dasari VR, Shivakumar M, Lavage DR, Cook AM, Carey DJ, Ritchie MD, Kim D, Gogoi R. Systematic characterization of germline variants from the DiscovEHR study endometrial carcinoma population. BMC Med Genomics 2019; 12:59. [PMID: 31053132 PMCID: PMC6499978 DOI: 10.1186/s12920-019-0504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/30/2018] [Accepted: 04/15/2019] [Indexed: 02/02/2023] Open
Abstract
Background Endometrial cancer (EMCA) is the fifth most common cancer among women in the world. Identification of potentially pathogenic germline variants from individuals with EMCA will help characterize genetic features that underlie the disease and potentially predispose individuals to its pathogenesis. Methods The Geisinger Health System’s (GHS) DiscovEHR cohort includes exome sequencing on over 50,000 consenting patients, 297 of whom have evidence of an EMCA diagnosis in their electronic health record. Here, rare variants were annotated as potentially pathogenic. Results Eight genes were identified as having increased burden in the EMCA cohort relative to the non-cancer control cohort. None of the eight genes had an increased burden in the other hormone related cancer cohort from GHS, suggesting they can help characterize the underlying genetic variation that gives rise to EMCA. Comparing GHS to the cancer genome atlas (TCGA) EMCA germline data illustrated 34 genes with potentially pathogenic variation and eight unique potentially pathogenic variants that were present in both studies. Thus, similar germline variation among genes can be observed in unique EMCA cohorts and could help prioritize genes to investigate for future work. Conclusion In summary, this systematic characterization of potentially pathogenic germline variants describes the genetic underpinnings of EMCA through the use of data from a single hospital system. Electronic supplementary material The online version of this article (10.1186/s12920-019-0504-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jason E Miller
- Department of Genetics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raghu P Metpally
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Thomas N Person
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | | | | | - Manu Shivakumar
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Daniel R Lavage
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Adam M Cook
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA
| | - David J Carey
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Marylyn D Ritchie
- Department of Genetics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dokyoon Kim
- Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA, 17822, USA.,Huck Institute of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, USA
| | - Radhika Gogoi
- Weis Center for Research, Geisinger Medical Center, Danville, PA, 17822, USA.
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Zhou Y, Cartmel B, Gottlieb L, Ercolano EA, Li F, Harrigan M, McCorkle R, Ligibel JA, von Gruenigen VE, Gogoi R, Schwartz PE, Risch HA, Irwin ML. Randomized Trial of Exercise on Quality of Life in Women With Ovarian Cancer: Women's Activity and Lifestyle Study in Connecticut (WALC). J Natl Cancer Inst 2019; 109:3858843. [PMID: 30053074 DOI: 10.1093/jnci/djx072] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
Background Ovarian cancer survivors experience a wide range of treatment side effects that can negatively affect health-related quality of life (HRQOL). Physical activity has been shown to improve HRQOL and cancer-related fatigue (CRF) for other cancer survivors; however, no large randomized controlled trial (RCT) has been conducted for ovarian cancer. Methods This study examined the impact of a six-month RCT of exercise vs attention control on change in HRQOL (Short Form Health Survey-36) and CRF (Functional Assessment of Cancer Therapy-Fatigue Scale) in ovarian cancer survivors. Women (n = 144) were randomly assigned to study arms between May 1, 2010, and March 20, 2014. All statistical tests were two-sided. Results A total of 74 women were randomly assigned to exercise and 70 to attention control. A total of 113 (78.5%) of the participants completed the six-month assessment. Adherence to the exercise intervention was excellent (166.0±66.1 minutes/week in the exercise arm). At six months, women in the exercise arm had improved physical HRQOL (SF-36 Physical Component Summary Score) compared with the control arm, 1.8 (SD = 1.1) vs -2.0 (SD = 1.2) , respectively (group difference = 3.7, SD = 1.2, 95% confidence interval [CI] = 0.7 to 6.8, P = .02). No group differences were seen for change in mental HRQOL. There was a statistically significant improvement in the fatigue score (Functional Assessment of Cancer Therapy-Fatigue) for exercisers (4.0, SD = 1.1, 95% CI = 1.8 to 6.2, P < .001) but not for controls (1.2, SD = 1.2, 95% CI = -1.1 to 3.5, P = .31), with a between-group difference of 2.8 (SD = 1.5, 95% CI = -0.2 to 5.7, P = .06). Conclusions We found a six-month home-based, telephone-delivered exercise intervention of primarily brisk walking to be associated with improved physical HRQOL in women with ovarian cancer. Given that higher HRQOL and exercise have both been associated with overall survival in women diagnosed with ovarian cancer, oncologists and primary care providers should recommend and refer women diagnosed with ovarian cancer to clinic- or community-based exercise programs.
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Affiliation(s)
- Yang Zhou
- Yale Cancer Center, New Haven, CT.,Yale School of Public Health, New Haven, CT
| | - Brenda Cartmel
- Yale Cancer Center, New Haven, CT.,Yale School of Public Health, New Haven, CT
| | | | | | | | | | - Ruth McCorkle
- Yale Cancer Center, New Haven, CT.,Yale School of Nursing, New Haven, CT
| | | | | | | | | | - Harvey A Risch
- Yale Cancer Center, New Haven, CT.,Yale School of Public Health, New Haven, CT
| | - Melinda L Irwin
- Yale Cancer Center, New Haven, CT.,Yale School of Public Health, New Haven, CT
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Rahm AK, Cragun D, Hunter JE, Epstein MM, Lowery J, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Burnett-Hartman AN, Gudgeon JM, Hao J, Snyder S, Gogoi R, Ladd I, Williams MS. Implementing universal Lynch syndrome screening (IMPULSS): protocol for a multi-site study to identify strategies to implement, adapt, and sustain genomic medicine programs in different organizational contexts. BMC Health Serv Res 2018; 18:824. [PMID: 30376847 PMCID: PMC6208012 DOI: 10.1186/s12913-018-3636-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 08/18/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background Systematic screening of all colorectal tumors for Lynch Syndrome (LS) has been recommended since 2009. Currently, implementation of LS screening in healthcare systems remains variable, likely because LS screening involves the complex coordination of multiple departments and individuals across the healthcare system. Our specific aims are to (1) describe variation in LS screening implementation across multiple healthcare systems; (2) identify conditions associated with both practice variation and optimal implementation; (3) determine the relative effectiveness, efficiency, and costs of different LS screening protocols by healthcare system; and (4) develop and test in a real-world setting an organizational toolkit for LS screening program implementation and improvement. This toolkit will promote effective implementation of LS screening in various complex health systems. Methods This study includes eight healthcare systems with 22 clinical sites at varied stages of implementing LS screening programs. Guided by the Consolidated Framework for Implementation Research (CFIR), we will conduct in-depth semi-structured interviews with patients and organizational stakeholders and perform economic evaluation of site-specific implementation costs. These processes will result in a comprehensive cross-case analysis of different organizational contexts. We will utilize qualitative data analysis and configurational comparative methodology to identify facilitators and barriers at the organizational level that are minimally sufficient and necessary for optimal LS screening implementation. Discussion The overarching goal of this project is to combine our data with theories and tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening in various real-world settings. Our organizational toolkit will account for issues of complex coordination of care involving multiple stakeholders to enhance implementation, sustainability, and ongoing improvement of evidence-based LS screening programs. Successful implementation of such programs will ultimately reduce suffering of patients and their family members from preventable cancers, decrease waste in healthcare system costs, and inform strategies to facilitate the promise of precision medicine. Trial registration N/A Electronic supplementary material The online version of this article (10.1186/s12913-018-3636-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alanna Kulchak Rahm
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, FL, 33612, USA
| | - Jessica Ezzell Hunter
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97202, USA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Jan Lowery
- Colorado Center for Personalized Medicine, University of Colorado, Aurora, CO, 80045, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Andrea N Burnett-Hartman
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S. Parker Rd., Ste 200, Aurora, CO, 80014, USA
| | - James M Gudgeon
- Intermountain Healthcare, Precision Genomics, IMC campus, Bldg. 2, Suite 610, 5121 S. Cottonwood Street, Murray, UT, 84107, USA
| | - Jing Hao
- Geisinger Department of Epidemiology and Health Services Research 100 N, Academy Ave Danville, Mahoning Township, PA, 17822, USA
| | - Susan Snyder
- Geisinger Department of Epidemiology and Health Services Research 100 N, Academy Ave Danville, Mahoning Township, PA, 17822, USA
| | - Radhika Gogoi
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Ilene Ladd
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Marc S Williams
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA, 17822, USA
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Gogoi R, Ladd I, Bogaczyk T, Larson S. After the cervical cancer diagnosis, who's talking about why? Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.338] [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: 11/30/2022]
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Dasari V, Bang L, Miller J, Kim D, Gogoi R. Verteporfin sensitizes endometrial cancer cells to radiation or chemo treatment. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.148] [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: 11/25/2022]
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Dasari VR, Mazack V, Feng W, Nash J, Carey DJ, Gogoi R. Verteporfin exhibits YAP-independent anti-proliferative and cytotoxic effects in endometrial cancer cells. Oncotarget 2018; 8:28628-28640. [PMID: 28404908 PMCID: PMC5438678 DOI: 10.18632/oncotarget.15614] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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: 10/07/2016] [Accepted: 01/24/2017] [Indexed: 12/28/2022] Open
Abstract
Endometrial Carcinoma (EMCA) is the most common gynecologic malignancy and the fourth most common malignancy in women in the United States. Yes-associated protein (YAP) is a potent transcription coactivator acting via binding to the TEAD transcription factor, and plays a critical role in organ size regulation. Verteporfin (VP), a benzoporphyrin derivative, was identified as an inhibitor of YAP-TEAD interaction. We investigated the therapeutic efficacy and mechanism of VP in EMCA. The efficacy of VP on cell viability, cytotoxicity and invasion was assayed in EMCA cell lines. An organoid model system was also developed to test the effect of VP on apoptotic markers in an in vitro model system. Treatment with VP resulted in a decrease in cell viability, invasion and an increase in cytotoxicity of EMCA cells. These effects occurred as early as 15 minutes following treatment. Similarly, VP treatment versus vehicle control increased apoptosis in human organoid model systems. Quantitative RT-PCR, cDNA based RTPCR array analysis and western blotting were performed to investigate the mechanism of VP action. The cytotoxic and anti-proliferative effects appeared to be independent of its effect on YAP. Our results suggest that VP is a promising chemotherapeutic agent for the treatment of endometrial cancer.
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Affiliation(s)
| | - Virginia Mazack
- Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
| | - Wen Feng
- Henry Hood Center for Health Research, Geisinger Medical Center, Danville, PA, USA
| | - John Nash
- Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
| | - David J Carey
- Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
| | - Radhika Gogoi
- Weis Center for Research, Geisinger Medical Center, Danville, PA, USA
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Welshans K, Nash J, Smith A, Gogoi R. Time is money: Does IV Tylenol decrease time to discharge in patients undergoing robotic surgery for endometrial cancer? Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.347] [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: 10/19/2022]
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Kim C, Smith A, Nash J, Gogoi R. An opportunity to collaborate: An initiative with a university mechanical engineering program to design a new morcellating device. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.452] [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: 10/19/2022]
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Dasari V, Carey D, Nash J, Gogoi R. Verteporfin: A new chemotherapeutic agent in endometrial cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.180] [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: 11/26/2022]
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Cartmel B, Zhou Y, Gottlieb L, Li F, Ercolano EA, Harrigan M, McCorkle R, Ligibel JA, Gogoi R, Schwartz PE, Risch HA, Irwin ML. Randomized trial of exercise vs. usual care on cancer biomarkers in ovarian cancer survivors: The Women’s Activity and Lifestyle Study in Connecticut (WALC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5561] [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: 11/20/2022] Open
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Kasala E, Bodduluru L, Barua C, Gogoi R, Bezbarua B, Lahkar M. 494P Chemopreventive efficacy of luteolin, a dietary flavone against benzo(a)pyrene induced lung carcinogenesis. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv533.13] [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: 11/12/2022] Open
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Kip NS, Rahm AK, Guha S, Fan A, Kaspar H, Gogoi R, Chen Z, Davis FD, Williams M. Evaluation to Include Endometrial Carcinoma in Universal Lynch Syndrome Screening at Geisinger Health System. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.234] [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: 11/13/2022] Open
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Zhou Y, Gottlieb L, Cartmel B, Li F, Ercolano EA, Harrigan M, McCorkle R, Ligibel JA, Von Gruenigen VE, Gogoi R, Schwartz PE, Risch HA, Irwin ML. Randomized trial of exercise on quality of life and fatigue in women diagnosed with ovarian cancer: The Women’s Activity and Lifestyle Study in Connecticut (WALC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tsujiura M, Mazack V, Sudol M, Kaspar HG, Nash J, Carey DJ, Gogoi R. Yes-associated protein (YAP) modulates oncogenic features and radiation sensitivity in endometrial cancer. PLoS One 2014; 9:e100974. [PMID: 24972085 PMCID: PMC4074125 DOI: 10.1371/journal.pone.0100974] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 06/01/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Yes-associated protein (YAP) is a transcriptional co-activator and regulates cell proliferation and apoptosis. We investigated the clinical and biological significance of YAP in endometrial cancer (EMCA). METHODS YAP expression in 150 primary tumor tissues from patients with EMCA was evaluated by immunohistochemistry and its association with clinicopathological data was assessed. The biological functions of YAP were determined in EMCA cell lines through knockdown/overexpression of YAP. The role of YAP in modulating radiation sensitivity was also investigated in EMCA cells. RESULTS Increased nuclear YAP expression was significantly associated with higher grade, stage, lympho-vascular space invasion, postoperative recurrence/metastasis and overall survival in estrogen mediated EMCA, called type 1 cancer (p = 0.019, = 0.028, = 0.0008, = 0.046 and = 0.015, respectively). In multivariate analysis, nuclear YAP expression was confirmed as an independent prognostic factor for overall survival in type 1 EMCA. YAP knockdown by siRNA resulted in a significant decrease in cell proliferation (p<0.05), anchorage-dependent growth (p = 0.015) and migration/invasion (p<0.05), and a significant increase in the number of cells in G0/G1 phase (p = 0.002). Conversely, YAP overexpression promoted cell proliferation. Clonogenic assay demonstrated enhanced radiosensitivity by approximately 36% in YAP inhibited cells. CONCLUSIONS Since YAP functions as a transcriptional co-activator, its differential localization in the nucleus of cancer cells and subsequent impact on cell proliferation could have important consequences with respect to its role as an oncogene in EMCA. Nuclear YAP expression could be useful as a prognostic indicator or therapeutic target and predict radiation sensitivity in patients with EMCA.
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Affiliation(s)
- Masahiro Tsujiura
- Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
| | - Virginia Mazack
- Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
| | - Marius Sudol
- Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Hanna G. Kaspar
- Geisinger Medical Laboratories, Geisinger Wyoming Valley, Wilkes-Barre, Pennsylvania, United States of America
| | - John Nash
- Division of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania, United States of America
| | - David J. Carey
- Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
| | - Radhika Gogoi
- Weis Center for Research, Geisinger Medical Center, Danville, Pennsylvania, United States of America
- Division of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania, United States of America
- * E-mail:
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Tsujiura M, Mazack V, Sudol M, Carey D, Nash J, Kaspar H, Gogoi R. Yes-associated protein (YAP) functions as a proto-oncogene and promotes radiation resistance in endometrial cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Ovarian cancer accounts for more deaths than all other gynecological malignancies combined, primarily due to advanced stage at initial presentation and our continued inability to detect early-stage disease. Multiple approaches have led to the development of new diagnostic markers for early detection, with no real success (high false positives and poor positive predictive values). Considering the rarity of this disease, the impact of poor diagnostic markers will only be detrimental to the entire early-detection process. Recent advances in proteomics, as well as breakthroughs in analytical techniques and bioinformatics, have enabled researchers to look outside the box, for a panel of proteins (protein profiles) rather than just one or two proteins, thus increasing sensitivity and specificity. This review describes current strategies in the early detection of ovarian cancer, existing markers, their clinical utilities and shortcomings, and highlights newer markers and technologies that are being pursued to improve women's healthcare.
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Affiliation(s)
- Radhika Gogoi
- New York University School of Medicine, 550 First Avenue, TH538, NY 10016, USA.
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Madueke-Laveaux OS, Gogoi R, Stoner G. Giant fibroepithelial stromal polyp of the vulva: largest case reported. Ann Surg Innov Res 2013; 7:8. [PMID: 23842282 PMCID: PMC3716997 DOI: 10.1186/1750-1164-7-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/04/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fibroepithelial stromal polyps are site-specific mesenchymal lesions that are commonly found in the vulvovaginal region in premenopausal females. These polyps usually are less than 5 cm in diameter and are most commonly identified during routine gynecological examination. Although the stromal polyp is benign, its differential diagnosis includes some malignant vulva lesions making it critical to ensure that an accurate pathologic diagnosis is made. CASE We present a case of a 21 year old female with a giant fibroepithelial stromal polyp of the vulva. Upon review of the literature this is the largest reported fibroepithelial stromal polyp to date. CONCLUSION Fibroepithelial stromal polyps can grow as large as 390 grams and can be 18.5-cm in diameter. Microscopic evaluation of the polyp is critical in the exclusion of malignancy with this diagnosis.
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Affiliation(s)
| | - Radhika Gogoi
- Gynecologic Oncology, Geisinger Medical Center, Danville, PA 17821, USA
| | - Gary Stoner
- Obstetrics-Gynecology, Geisinger Medical Center, Danville, PA 17821, USA
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Bickley T, Sudol M, Mazack V, Sun H, Nash J, Kaspar H, Gogoi R. The role of the Yes kinase-associated protein as a proto-oncogene in endometrial cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.265] [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: 10/26/2022]
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