1
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Sisak S, Price AD, Foote DC, Montgomery KB, Lindeman B, Cho NL, Sheu NO, Postlewait LM, Smith SR, Markesbery KC, Meister KM, Kader S, Abelson JS, Anstadt MJ, Patel PP, Marks JA, Callahan ZM, Kimbrough MK, Byrd SE, Stopenski SJ, Nahmias JT, Patel JA, Wilt W, Dodwad SJM, Adams SD, Willis RE, Farr D, Harvey J, Woeste MR, Martin RCG, Al Yafi M, Sutton JM, Cortez AR, Holm TM. A multi-institutional study from the US ROPE consortium examining factors associated with endocrine surgery exposure for general surgery residents. Surgery 2024; 175:107-113. [PMID: 37953151 PMCID: PMC10906110 DOI: 10.1016/j.surg.2023.05.048] [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: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Prior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not. METHODS We analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period. RESULTS Of the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8-12, P < .01), endocrine-trained faculty (+8, confidence interval 7-10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 -8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2-6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (-10, confidence interval -12 to -8, P < .01) and endocrine-focused otolaryngologists (-3, confidence interval -4 to -1, P < .01). CONCLUSION Several characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.
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Affiliation(s)
- Stephanie Sisak
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH
| | - Adam D Price
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH
| | - Darci C Foote
- Beaumont Health, Department of Surgery, Royal Oak, MI; University of Michigan, Department of Surgery, Ann Arbor, MI
| | | | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL
| | - Nancy L Cho
- Brigham and Women's Hospital, Department of Surgery, Boston, MA
| | - Nora O Sheu
- Brigham and Women's Hospital, Department of Surgery, Boston, MA
| | | | | | | | | | - Sarah Kader
- Lahey Hospital and Medical Center, Department of Surgery, Burlington, MA
| | | | | | - Purvi P Patel
- Loyola University, Department of Surgery, Maywood, IL
| | - Joshua A Marks
- Thomas Jefferson University, Department of Surgery, Philadelphia, PA
| | | | | | - Samuel E Byrd
- University of Arkansas for Medical Sciences, Department of Surgery, Little Rock, AR
| | | | - Jeffry T Nahmias
- University of California at Irvine, Department of Surgery, Orange, CA
| | - Jitesh A Patel
- University of Kentucky, Department of Surgery, Lexington, KY
| | - Wesley Wilt
- University of Kentucky, Department of Surgery, Lexington, KY
| | | | - Sasha D Adams
- McGovern Medical School at UTHealth, Department of Surgery, Houston, TX
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, Department of Surgery, San Antonio, TX
| | - Deborah Farr
- University of Texas Southwestern Medical Center, Department of Surgery, Dallas, TX
| | - Jalen Harvey
- University of Texas Southwestern Medical Center, Department of Surgery, Dallas, TX
| | | | | | - Motaz Al Yafi
- University of Toledo, Department of Surgery, Toledo, OH
| | - Jeffrey M Sutton
- Medical University of South Carolina, Division of Oncologic and Endocrine Surgery, Department of Surgery, Charleston, SC
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH; University of San Francisco, Department of Surgery, San Francisco, CA
| | - Tammy M Holm
- Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Department of Surgery, Cincinnati, OH.
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Holm TM. Returning to Miami: Vice or virtue? Am J Surg 2023; 226:603. [PMID: 37652830 DOI: 10.1016/j.amjsurg.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/19/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Tammy M Holm
- The University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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3
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Holm TM, Yeo S, Turner KM, Guan JL. Targeting Autophagy in Thyroid Cancer: EMT, Apoptosis, and Cancer Stem Cells. Front Cell Dev Biol 2022; 10:821855. [PMID: 35846375 PMCID: PMC9277179 DOI: 10.3389/fcell.2022.821855] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Autophagy is a highly conserved recycling process through which cellular homeostasis is achieved and maintained. With respect to cancer biology, autophagy acts as a double-edged sword supporting tumor cells during times of metabolic and therapeutic stress, while also inhibiting tumor development by promoting genomic stability. Accumulating evidence suggests that autophagy plays a role in thyroid cancer, acting to promote tumor cell viability and metastatic disease through maintenance of cancer stem cells (CSCs), supporting epithelial-to-mesenchymal transition (EMT), and preventing tumor cell death. Intriguingly, well-differentiated thyroid cancer is more prevalent in women as compared to men, though the underlying molecular biology driving this disparity has not yet been elucidated. Several studies have demonstrated that autophagy inhibitors may augment the anti-cancer effects of known thyroid cancer therapies. Autophagy modulation has become an attractive target for improving outcomes in thyroid cancer. This review aims to provide a comprehensive picture of the current knowledge regarding the role of autophagy in thyroid cancer, focusing on the potential mechanism(s) through which inhibition of autophagy may enhance cancer therapy and outcomes.
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Affiliation(s)
- Tammy M Holm
- Department of Surgery, The University of Cincinnati, Cincinnati, OH, United States.,Vontz Center for Molecular Studies, Department of Cancer Biology, The University of Cincinnati, Cincinnati, OH, United States
| | - Syn Yeo
- Vontz Center for Molecular Studies, Department of Cancer Biology, The University of Cincinnati, Cincinnati, OH, United States
| | - Kevin M Turner
- Department of Surgery, The University of Cincinnati, Cincinnati, OH, United States.,Vontz Center for Molecular Studies, Department of Cancer Biology, The University of Cincinnati, Cincinnati, OH, United States
| | - Jun-Lin Guan
- Vontz Center for Molecular Studies, Department of Cancer Biology, The University of Cincinnati, Cincinnati, OH, United States
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4
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Delman AM, Turner KM, Griffith A, Schepers E, Ammann AM, Holm TM. Minimally Invasive Surgery for Resectable Adrenocortical Carcinoma: A Nationwide Analysis. J Surg Res 2022; 279:200-207. [PMID: 35780533 DOI: 10.1016/j.jss.2022.04.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 04/23/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The utilization of minimally invasive surgery (MIS) for adrenocortical carcinoma (ACC) remains controversial due to concerns regarding the quality of surgical resection and subsequent oncologic risks. Current guidelines recommend open resections for all cases of suspected ACC independent of size; however, there has been increased adoption of MIS for ACC over time. We sought to determine whether the rise in the utilization of MIS is associated with worse survival outcomes for ACC. METHODS The National Cancer Database was queried for patients with ACC who underwent surgical resection between 2010 and 2017. Patient selection, oncologic outcomes, and overall survival were compared among patients who received an MIS approach (laparoscopic or robotic) versus an open approach. RESULTS A total of 1483 patients underwent ACC resection with 982 (66.2%) patients undergoing an open approach and 501 (33.8%) receiving an MIS operation. The overall utilization of MIS for ACC increased significantly after 2013 (37.7% versus 29.5%, P < 0.01). There was no difference in overall survival between MIS and open resections on univariable (log-rank P = 0.12) analysis. On multivariable analysis, survival was improved in MIS patients versus open resection (Hazard ratio: 0.83, 95% CI: [0.70-0.99]). Notably, survival remained comparable among patients who underwent resection for large ACCs (6-10 cm, log-rank P = 0.66) and giant ACCs (>10 cm, log-rank P = 0.24), irrespective of operative approach. CONCLUSIONS Our findings suggest that in appropriately selected patients with ACC, MIS can be performed safely without a significant decrease in overall survival, independent of size. We recommend consideration of a minimally-invasive approach for adrenal masses despite size >6 cm.
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Affiliation(s)
- Aaron M Delman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio
| | - Kevin M Turner
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio
| | - Azante Griffith
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio
| | - Emily Schepers
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio
| | - Allison M Ammann
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio
| | - Tammy M Holm
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio.
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5
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Ammann AM, Delman AM, Bethi M, Turner KM, Sedaghat AR, Holm TM. Gender Disparities in Academic Productivity and Promotion Among Endocrine Surgery Faculty. J Surg Res 2022; 277:335-341. [PMID: 35561649 DOI: 10.1016/j.jss.2022.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Academic rank and metrics such as total publications (pubs) and H-index are indicators to measure academic achievement. This study aims to determine whether there are gender differences in academic productivity or faculty appointments among endocrine surgeons in the United States. METHODS A database was generated from the American Association of Endocrine Surgeons (AAES) website. Community or academic practice was designated by institution affiliation and faculty appointment. Academic metrics, including pubs, H-index, and weighted-RCR (relative citation ratio), were obtained from public databases. RESULTS A total of 258 AAES members were affiliated with an academic institution. The majority were men (58%). Overall, men in endocrine surgery had higher academic metrics: pubs (56.0 [26-134], 23.0 [11-56], P < 0.0001), H-index (19.0 [11-35], 9.0 [5-21], P < 0.0001), weighted-RCR (63.5 [22-193], 24.1 [8-74], P < 0.005) and rank (associate professor or professor, P < 0.0001). Subgroup analysis accounting for time in practice found no difference in total publications, weighted RCR, or faculty appointments between genders in practice for 0-5 y. However, among surgeons in practice for 6-10 y, men had higher academic metrics (pubs: 31.0 [16-79], 18.5 [9-33]; RCR: 46.0 [14-102], 13.3 [9-34]) and faculty appointments (all P < 0.05). CONCLUSIONS There are gender disparities in academic productivity and faculty appointment among US endocrine surgeons. While junior faculty show no gender differences in most indicators of academic productivity or rank, men with 6-10 y in practice have higher average academic metrics and rank. Whether the absence of gender disparities among junior faculty is a sustainable reflection of recent efforts to encourage equal mentorship and professional opportunities or whether disparities will manifest as faculty progress remains to be determined.
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Affiliation(s)
- Allison M Ammann
- The University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Aaron M Delman
- The University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Mridula Bethi
- The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kevin M Turner
- The University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Ahmad R Sedaghat
- The University of Cincinnati, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Tammy M Holm
- The University of Cincinnati, Department of Surgery, Cincinnati, Ohio.
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6
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Holm TM. Endocrine surgery: A pain in the neck? Am J Surg 2022; 224:313-314. [DOI: 10.1016/j.amjsurg.2022.01.006] [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] [Received: 01/17/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/01/2022]
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7
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Lynch CA, Bethi M, Tang A, Lee P, Steward D, Holm TM. Thyroid nodules >4 cm with atypia of undetermined significance cytology independently associate with malignant pathology. Surgery 2021; 171:725-730. [PMID: 34742567 DOI: 10.1016/j.surg.2021.08.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The risk of malignancy from nodules with atypia of undetermined significance cytology is estimated between 5% and 15%, though more recent studies suggest rates upwards of 48%. This study sought to characterize preoperative predictors of malignancy to aid in clinical decision-making. METHODS We performed a single institution retrospective review of all adult patients with unilateral thyroid nodules demonstrating atypia of undetermined significance cytology between March 1, 2013 and June 1, 2019 who underwent surgical resection (n = 266). Univariate and multivariate logistical analysis was performed using clinical and demographic variables to identify potential preoperative characteristics associated with malignant disease. RESULTS Malignancy was identified on final pathology in 24.7% of patients with atypia of undetermined significance cytology. Age, sex, exposure to ionizing radiation, family history of thyroid cancer, Hashimoto's disease, Afirma suspicious results, and smoking were not associated with malignancy on both univariate and multivariate analysis. Nodule size >4 cm was independently associated with malignancy risk on both univariate (odds ratio 2.44, 1.09-5.43, P < .03) and multivariate (odds ratio 2.96, 1.27-6.87, P < .02) analysis. CONCLUSION The results of this study demonstrate that nodules with atypia of undetermined significance cytology >4 cm are strongly associated with malignancy. We recommend strong consideration of surgery for all patients with thyroid nodules >4 cm and atypia of undetermined significance cytology.
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Affiliation(s)
- Caroline A Lynch
- The University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mridula Bethi
- The University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alice Tang
- The University of Cincinnati, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH
| | - Paul Lee
- The University of Cincinnati, Department of Pathology, Cincinnati, OH
| | - David Steward
- The University of Cincinnati, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH
| | - Tammy M Holm
- The University of Cincinnati College of Medicine, Cincinnati, OH; The University of Cincinnati, Department of Surgery, Cincinnati, OH.
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8
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Holm TM, Bian ZC, Manupati K, Guan JL. Inhibition of autophagy mitigates cell migration and invasion in thyroid cancer. Surgery 2021; 171:235-244. [PMID: 34565609 DOI: 10.1016/j.surg.2021.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Autophagy is a highly conserved process for maintaining cellular homeostasis. Upregulation of autophagy promotes metastasis by promoting the cancer stem cell state while also stimulating tumor cell migration and invasion. We hypothesized that autophagy upregulation would be critical for cancer stem cell maintenance as well as cellular migration and invasion in thyroid cancer. METHODS Validated papillary (MDA-T32, MDA-T68), follicular (FTC-133), and anaplastic (ATC-8505c) human thyroid cancer cell lines in culture were first assessed for autophagic capacity after bafilomycin clamping. Cancer stem cells were quantified by flow cytometry for aldehyde dehydrogenase and thyrosphere formation assay. Scratch migration and Matrigel invasion assays were performed in the presence of known autophagy inhibitors: Lys05, chloroquine, and FIP200siRNA. RESULTS Autophagy activity was observed across all cell lines. Thyrosphere formation, aldehyde dehydrogenase activity, and CD44 expression were reduced with inhibition of autophagy in MDA-T32, MDA-T68, FTC-133, and 8505c cells. Similarly, cell migration and invasion were attenuated: 42% (FIP200siRNA), 78% (Lys05), P < .001 in MDA-T32 cells; 54% (FIP200siRNA), 67% (Lys05), P < .001 in MDA-T68 cells; 73% (FIP200siRNA), 71% (Lys05), P < .001) in FTC-133 cells; and 60% (FIP200siRNA), 90% (Lys05), P < .001 in 8505c cells. Invasion assays demonstrated a 73%, 39%, 75%, and 65.1% reduction in the presence of Lys05 in T32, T68, FTC-133, and 8505c cells, respectively. We observed similar reductions in invasion with FIP200siRNA: 61%, 62%, 55%, and 81.4% in T32, T68, FTC-133, and 8505c cells. CONCLUSION Autophagy is upregulated across multiple thyroid cancer subtypes. In thyroid cancer cell lines, inhibition of autophagy attenuates cancer stem cell viability, cell migration, and invasion suggesting a role for autophagy in the progression of thyroid cancer. Greater understanding of autophagy regulation in thyroid cancer will aid in developing targeted therapeutics.
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Affiliation(s)
- Tammy M Holm
- Department of Surgery, The University of Cincinnati, Cincinnati, OH; Department of Cancer Biology, Vontz Center for Molecular Studies, The University of Cincinnati, Cincinnati, OH.
| | - Z Christine Bian
- Department of Surgery, The University of Cincinnati, Cincinnati, OH
| | - Kanakaraju Manupati
- Department of Cancer Biology, Vontz Center for Molecular Studies, The University of Cincinnati, Cincinnati, OH
| | - Jun-Lin Guan
- Department of Surgery, The University of Cincinnati, Cincinnati, OH; Department of Cancer Biology, Vontz Center for Molecular Studies, The University of Cincinnati, Cincinnati, OH
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Delman AM, Turner KM, Ammann AM, Tang A, Steward D, Holm TM. Avoiding delays in time to renal transplantation: Pretransplant thyroid malignancy does not affect patient or graft survival after renal transplantation. Surgery 2021; 171:220-226. [PMID: 34303544 DOI: 10.1016/j.surg.2021.03.064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pretransplant malignancy is associated with decreased patient and graft survival. Current US guidelines recommend a 2- to 5-year, tumor-free waiting period before transplantation. No large studies have examined the specific, modern day risk of pretransplant thyroid malignancy on patient and graft survival after renal transplant. METHODS The United Network for Organ Sharing database was queried for all adult isolated renal transplant recipients between 2003 and 2019. Patient characteristics, rates of post-transplant malignancy, and survival were compared between patients with pretransplant thyroid malignancy and without pretransplant thyroid malignancy. RESULTS Eighty-six patients had pretransplant thyroid malignancy diagnosed after listing and before renal transplantation. Both overall and graft survival were similar between cohorts (P > .05). There was no significant association between pretransplant thyroid malignancy and patient (hazard ratio: 0.66; P = .31) or graft (hazard ratio:0.32; P = .11) survival on multivariate analysis. Waitlist duration for pretransplant thyroid malignancy patients was significantly increased (1,444 vs 438 days; P < .01), which translated to increased dialysis duration (2,234 vs 1,201 days, P < .01). Pretransplant thyroid malignancy patients did not experience increased post-transplant malignancy (P = .21). CONCLUSION Given no association with decreased patient or allograft survival, our findings suggest that pretransplant thyroid malignancy patients are unnecessarily subjected to increased wait-list duration before transplant. We recommend an individualized approach for pretransplant thyroid malignancy patients diagnosed before or after listing.
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Affiliation(s)
- Aaron M Delman
- Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH. https://twitter.com/AaronDelman
| | - Kevin M Turner
- Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH. https://twitter.com/KevinTurnerMD
| | - Allison M Ammann
- Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH
| | - Alice Tang
- Department of Otolaryngology-Head and Neck Surgery, The University of Cincinnati, OH
| | - David Steward
- Department of Otolaryngology-Head and Neck Surgery, The University of Cincinnati, OH
| | - Tammy M Holm
- Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH.
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Abstract
Breast cancer is the quintessential example of how molecular characterization of tumor biology guides therapeutic decisions. From the discovery of the estrogen receptor to current clinical molecular profiles to evolving single-cell analytics, the characterization and compartmentalization of breast cancer into divergent subtypes is clear. However, competing with this divergent model of breast cancer is the recognition of intratumoral heterogeneity, which acknowledges the possibility that multiple different subtypes exist within a single tumor. Intratumoral heterogeneity is driven by both intrinsic effects of the tumor cells themselves as well as extrinsic effects from the surrounding microenvironment. There is emerging evidence that these intratumoral molecular subtypes are not static; rather, plasticity between divergent subtypes is possible. Interconversion between seemingly different subtypes within a tumor drives tumor progression, metastases, and treatment resistance. Therapeutic strategies must, therefore, contend with changing phenotypes in an individual patient's tumor. Identifying targetable drivers of molecular heterogeneity may improve treatment durability and disease progression.
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Affiliation(s)
- Kevin M Turner
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Syn Kok Yeo
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tammy M Holm
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jun-Lin Guan
- Department of Cancer Biology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Tang AL, Kloos RT, Aunins B, Holm TM, Roth MY, Yeh MW, Randolph GW, Tabangin ME, Altaye M, Steward DL. Pathologic Features Associated With Molecular Subtypes of Well-Differentiated Thyroid Cancer. Endocr Pract 2020; 27:206-211. [PMID: 33655886 DOI: 10.1016/j.eprac.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/26/2020] [Revised: 08/19/2020] [Accepted: 09/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the association between pathologic features and molecular classes (BRAF-like, RAS-like, and non-BRAF-like non-RAS-like [NBNR]). METHODS Retrospective review of a merged database containing 676 patients, 84% (571/676) were assigned to a molecular class from publicly accessible sequenced data of thyroid neoplasms. RESULTS The merged cohort included 571 neoplasms: 353 (62%) BRAF-like, 172 (30%) RAS-like, and 46 (8.1%) NBNR. Lymph node metastasis (any N1 disease) was present in 166/337 (49%) of BRAF-like, 23/164 (14%) of RAS-like, and 0/46 (0%) of NBNR and are significantly different (P < .001). Gross extra-thyroidal extension was observed in 27 patients, including 24/331 (7%) of BRAF-like, 2/160 (1%) of RAS-like, and 1/46 (2%) of NBNR (P = .01). N1B lymph node metastases or T4 disease was present in 74/333 (22%) of BRAF-like, 10/160 (6%) of RAS-like, and 1/46 (2%) of NBNR (P < .0001). Distant metastasis was present in 4/151 (2.6%) of BRAF-like, 2/50 (4%) of RAS-like and 0/46 for NBNR (P = .627). Angioinvasion was present in 0/81 (0%) of BRAF-like, 3/53 (6%) of RAS-like, and 3/46 (7%) of NBNR (P = .08); and multifocality was present in 27/81 (33%) of BRAF-like, 9/53 (17%) of RAS-like, and 1/46 (2%) for NBNR (P = .0001). CONCLUSION Pathological features of metastasis, gross extra-thyroidal extension, and multifocality were more prevalent in BRAF-like samples compared to RAS-like and NBNR. A trend towards increased frequency of angioinvasion in RAS-like and NBNR cancers compared to BRAF-like samples was observed. Further studies are needed to evaluate if preoperative knowledge of molecular mutations in thyroid tumors aids in decision-making regarding extent of surgery.
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Affiliation(s)
- Alice L Tang
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Richard T Kloos
- Medical Affairs, Veracyte, Inc, South San Francisco, California
| | - Benjamin Aunins
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Tammy M Holm
- Department of Surgery University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Mara Y Roth
- Department of Medicine, University of Washington and Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David L Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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12
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Holm TM, Stathatos N, Sadow PM, Juliano AF, Cunnane MB, Carter MS, Kamani YV, Randolph GW. A Gossypiboma From Kazakhstan. Ear Nose Throat J 2019; 99:117-118. [PMID: 30955368 DOI: 10.1177/0145561319840512] [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: 11/17/2022] Open
Affiliation(s)
- Tammy M Holm
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Stathatos
- Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Margaret S Carter
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yash V Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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13
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Lubitz CC, Zhan T, Gunda V, Amin S, Gigliotti BJ, Fingeret AL, Holm TM, Wachtel H, Sadow PM, Wirth LJ, Sullivan RJ, Panka DJ, Parangi S. Circulating BRAF V600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma. Thyroid 2018; 28:328-339. [PMID: 29378474 PMCID: PMC5865613 DOI: 10.1089/thy.2017.0322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND BRAFV600E is the most common mutation in papillary thyroid carcinoma (PTC) and can be associated with aggressive disease. Previously, a highly sensitive blood RNA-based BRAFV600E assay was reported. The objective of this study was to assess the correlation of BRAFV600E circulating tumor RNA levels with surgical and medical treatment. METHODS Circulating BRAFV600E levels were assessed in (i) a murine model of undifferentiated (anaplastic) thyroid carcinoma with known BRAFV600E mutation undergoing BRAFV600E-inhibitor (BRAFi) treatment, and (ii) in 111 patients enrolled prior to thyroidectomy (n = 86) or treatment of advanced recurrent or metastatic PTC (n = 25). Blood samples were drawn for BRAFV600E analysis before and after treatment. Testing characteristics were assessed and positivity criteria optimized. Changes in blood BRAFV600E values were assessed and compared to clinical characteristics and response to therapy. RESULTS In a murine model of anaplastic thyroid carcinoma with BRAFV600E mutation, blood BRAFV600E RNA correlated with tumor volume in animals treated with BRAFi. In tissue BRAFV600E-positive (n = 36) patients undergoing initial surgery for PTC, blood BRAFV600E levels declined postoperatively (median 370.0-178.5 fg/ng; p = 0.002). In four patients with metastatic or poorly differentiated thyroid carcinoma receiving targeted therapies, blood BRAFV600E declined following therapy and corresponded with radiographic evidence of partial response or stable disease. CONCLUSIONS This study shows the correlation of blood BRAFV600E levels in response to treatment in both an established animal model of thyroid cancer and in patients with BRAFV600E-positive tumors with all stages of disease. This assay represents an alternative biomarker in patients with positive thyroglobulin antibodies, and tumors, which do not express thyroglobulin.
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Affiliation(s)
- Carrie C. Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiannan Zhan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Viswanath Gunda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Salma Amin
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Abbey L. Fingeret
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tammy M. Holm
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Heather Wachtel
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lori J. Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan J. Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - David J. Panka
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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14
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Lubitz CC, Parangi S, Holm TM, Bernasconi MJ, Schalck AP, Suh H, Economopoulos KP, Gunda V, Donovan SE, Sadow PM, Wirth LJ, Sullivan RJ, Panka DJ. Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma. J Mol Diagn 2015; 18:100-8. [PMID: 26631873 DOI: 10.1016/j.jmoldx.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/14/2015] [Accepted: 08/13/2015] [Indexed: 12/16/2022] Open
Abstract
BRAF(V600E) is a common mutation in papillary thyroid carcinoma (PTC) correlated with aggressive features. Our objective was to assess the feasibility and accuracy of a novel RNA-based blood assay to identify individuals with a high-risk tumor mutation in patients with PTC. Patients with benign or malignant thyroid disorders were included between September 2013 and July 2014 before either thyroidectomy (n = 62) or treatment of recurrent or metastatic PTC (n = 8). RNA was isolated from peripheral blood lymphocytes and reverse transcribed and followed by two rounds of nested PCR amplification with a restriction digest specific for wild-type BRAF. BRAF(V600E) levels were quantified with standardization curves. Circulating BRAF(V600E) levels were compared with BRAF mutation status from surgical pathologic DNA-based tissue assays. Testing characteristics and receiving-operator curve using tissue results as the gold standard were assessed. Matched blood and tissue assays for BRAF(V600E) were performed on 70 patients with PTC (stages I to IV, n = 48) or other (n = 22) thyroid tumors. Sixty-three percent of PTC patients tested positive for BRAF(V600E) with conventional tissue assays on surgical specimens. The correlation between the RNA-based blood assay and tissue BRAF status was 0.71. PTC patients harbor detectable BRAF(V600E) circulating tumor cells. This blood assay is feasible and has potential as a biomarker for prognosis, surveillance, clinical decision making, and assessment of treatment response to BRAF-targeted therapies.
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Affiliation(s)
- Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tammy M Holm
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Aislyn P Schalck
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Hyunsuk Suh
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Konstantinos P Economopoulos
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Viswanath Gunda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel E Donovan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - David J Panka
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Abstract
A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported.
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Affiliation(s)
- Daniel J Wong
- Yale University School of Medicine, New Haven, CT, USA
| | - Tammy M Holm
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Gates
- Department of Surgery, Division of Trauma, Burns, and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Holm TM, Habashi JP, Doyle JJ, Bedja D, Chen Y, van Erp C, Lindsay ME, Kim D, Schoenhoff F, Cohn RD, Loeys BL, Thomas CJ, Patnaik S, Marugan JJ, Judge DP, Dietz HC. Noncanonical TGFβ signaling contributes to aortic aneurysm progression in Marfan syndrome mice. Science 2011; 332:358-61. [PMID: 21493862 DOI: 10.1126/science.1192149] [Citation(s) in RCA: 350] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transforming growth factor-β (TGFβ) signaling drives aneurysm progression in multiple disorders, including Marfan syndrome (MFS), and therapies that inhibit this signaling cascade are in clinical trials. TGFβ can stimulate multiple intracellular signaling pathways, but it is unclear which of these pathways drives aortic disease and, when inhibited, which result in disease amelioration. Here we show that extracellular signal-regulated kinase (ERK) 1 and 2 and Smad2 are activated in a mouse model of MFS, and both are inhibited by therapies directed against TGFβ. Whereas selective inhibition of ERK1/2 activation ameliorated aortic growth, Smad4 deficiency exacerbated aortic disease and caused premature death in MFS mice. Smad4-deficient MFS mice uniquely showed activation of Jun N-terminal kinase-1 (JNK1), and a JNK antagonist ameliorated aortic growth in MFS mice that lacked or retained full Smad4 expression. Thus, noncanonical (Smad-independent) TGFβ signaling is a prominent driver of aortic disease in MFS mice, and inhibition of the ERK1/2 or JNK1 pathways is a potential therapeutic strategy for the disease.
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Affiliation(s)
- Tammy M Holm
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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17
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Habashi JP, Doyle JJ, Holm TM, Aziz H, Schoenhoff F, Bedja D, Chen Y, Modiri AN, Judge DP, Dietz HC. Angiotensin II type 2 receptor signaling attenuates aortic aneurysm in mice through ERK antagonism. Science 2011; 332:361-5. [PMID: 21493863 PMCID: PMC3097422 DOI: 10.1126/science.1192152] [Citation(s) in RCA: 340] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Angiotensin II (AngII) mediates progression of aortic aneurysm, but the relative contribution of its type 1 (AT1) and type 2 (AT2) receptors remains unknown. We show that loss of AT2 expression accelerates the aberrant growth and rupture of the aorta in a mouse model of Marfan syndrome (MFS). The selective AT1 receptor blocker (ARB) losartan abrogated aneurysm progression in the mice; full protection required intact AT2 signaling. The angiotensin-converting enzyme inhibitor (ACEi) enalapril, which limits signaling through both receptors, was less effective. Both drugs attenuated canonical transforming growth factor-β (TGFβ) signaling in the aorta, but losartan uniquely inhibited TGFβ-mediated activation of extracellular signal-regulated kinase (ERK), by allowing continued signaling through AT2. These data highlight the protective nature of AT2 signaling and potentially inform the choice of therapies in MFS and related disorders.
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Affiliation(s)
- Jennifer P. Habashi
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jefferson J. Doyle
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Tammy M. Holm
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hamza Aziz
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Florian Schoenhoff
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Djahida Bedja
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - YiChun Chen
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Alexandra N. Modiri
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Daniel P. Judge
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD21205, USA
| | - Harry C. Dietz
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD21205, USA
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18
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Cohn RD, van Erp C, Habashi JP, Soleimani AA, Klein EC, Lisi MT, Gamradt M, ap Rhys CM, Holm TM, Loeys BL, Ramirez F, Judge DP, Ward CW, Dietz HC. Angiotensin II type 1 receptor blockade attenuates TGF-beta-induced failure of muscle regeneration in multiple myopathic states. Nat Med 2007; 13:204-10. [PMID: 17237794 PMCID: PMC3138130 DOI: 10.1038/nm1536] [Citation(s) in RCA: 513] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 12/14/2006] [Indexed: 12/30/2022]
Abstract
Skeletal muscle has the ability to achieve rapid repair in response to injury or disease. Many individuals with Marfan syndrome (MFS), caused by a deficiency of extracellular fibrillin-1, exhibit myopathy and often are unable to increase muscle mass despite physical exercise. Evidence suggests that selected manifestations of MFS reflect excessive signaling by transforming growth factor (TGF)-beta (refs. 2,3). TGF-beta is a known inhibitor of terminal differentiation of cultured myoblasts; however, the functional contribution of TGF-beta signaling to disease pathogenesis in various inherited myopathic states in vivo remains unknown. Here we show that increased TGF-beta activity leads to failed muscle regeneration in fibrillin-1-deficient mice. Systemic antagonism of TGF-beta through administration of TGF-beta-neutralizing antibody or the angiotensin II type 1 receptor blocker losartan normalizes muscle architecture, repair and function in vivo. Moreover, we show TGF-beta-induced failure of muscle regeneration and a similar therapeutic response in a dystrophin-deficient mouse model of Duchenne muscular dystrophy.
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Affiliation(s)
- Ronald D Cohn
- McKusick-Nathans Institute of Genetic Medicine, Baltimore, Maryland 21205, USA
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19
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Habashi JP, Judge DP, Holm TM, Cohn RD, Loeys BL, Cooper TK, Myers L, Klein EC, Liu G, Calvi C, Podowski M, Neptune ER, Halushka MK, Bedja D, Gabrielson K, Rifkin DB, Carta L, Ramirez F, Huso DL, Dietz HC. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312:117-21. [PMID: 16601194 PMCID: PMC1482474 DOI: 10.1126/science.1124287] [Citation(s) in RCA: 1248] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aortic aneurysm and dissection are manifestations of Marfan syndrome (MFS), a disorder caused by mutations in the gene that encodes fibrillin-1. Selected manifestations of MFS reflect excessive signaling by the transforming growth factor-beta (TGF-beta) family of cytokines. We show that aortic aneurysm in a mouse model of MFS is associated with increased TGF-beta signaling and can be prevented by TGF-beta antagonists such as TGF-beta-neutralizing antibody or the angiotensin II type 1 receptor (AT1) blocker, losartan. AT1 antagonism also partially reversed noncardiovascular manifestations of MFS, including impaired alveolar septation. These data suggest that losartan, a drug already in clinical use for hypertension, merits investigation as a therapeutic strategy for patients with MFS and has the potential to prevent the major life-threatening manifestation of this disorder.
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Affiliation(s)
- Jennifer P Habashi
- Howard Hughes Medical Institute and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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