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Stoecklein VM, Grosu S, Nikolova T, Tonn JC, Zausinger S, Ricke J, Schlett CL, Maurer E, Walter SS, Peters A, Bamberg F, Rospleszcz S, Stoecklein S. Strong Association of Depression and Anxiety With the Presence of Back Pain While Impact of Spinal Imaging Findings is Limited: Analysis of an MRI Cohort Study. J Pain 2024; 25:497-507. [PMID: 37742905 DOI: 10.1016/j.jpain.2023.09.009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
Development of back pain is multifactorial, and it is not well understood which factors are the main drivers of the disease. We therefore applied a machine-learning approach to an existing large cohort study data set and sought to identify and rank the most important contributors to the presence of back pain amongst the documented parameters of the cohort. Data from 399 participants in the KORA-MRI (Cooperative health research in the region Augsburg-magnetic resonance imaging) (Cooperative Health Research in the Region Augsburg) study was analyzed. The data set included MRI images of the whole body, including the spine, metabolic, sociodemographic, anthropometric, and cardiovascular data. The presence of back pain was one of the documented items in this data set. Applying a machine-learning approach to this preexisting data set, we sought to identify the variables that were most strongly associated with back pain. Mediation analysis was performed to evaluate the underlying mechanisms of the identified associations. We found that depression and anxiety were the 2 most selected predictors for back pain in our model. Additionally, body mass index, spinal canal width and disc generation, medium and heavy physical work as well as cardiovascular factors were among the top 10 most selected predictors. Using mediation analysis, we found that the effects of anxiety and depression on the presence of back pain were mainly direct effects that were not mediated by spinal imaging. In summary, we found that psychological factors were the most important predictors of back pain in our cohort. This supports the notion that back pain should be treated in a personalized multidimensional framework. PERSPECTIVE: This article presents a wholistic approach to the problem of back pain. We found that depression and anxiety were the top predictors of back pain in our cohort. This strengthens the case for a multidimensional treatment approach to back pain, possibly with a special emphasis on psychological factors.
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Affiliation(s)
- Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Sergio Grosu
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Stefan Zausinger
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elke Maurer
- Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sven S Walter
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany; German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Schmutzer-Sondergeld M, Gencer A, Niedermeyer S, Quach S, Stoecklein VM, Teske N, Schichor C, Terpolilli NA, Kunz M, Thon N. Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults. Acta Neurochir (Wien) 2024; 166:39. [PMID: 38280116 PMCID: PMC10821836 DOI: 10.1007/s00701-024-05950-1] [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: 10/21/2023] [Accepted: 12/30/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults. METHODS In our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6-18 years; AG3, ≥ 18 years). RESULTS Sixty-two patients (median age 26.5 years, range 0-82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1-87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis. CONCLUSIONS In patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.
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Affiliation(s)
| | - Aylin Gencer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sebastian Niedermeyer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nicole Angela Terpolilli
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Stoecklein VM, Wunderlich S, Papazov B, Thon N, Schmutzer M, Schinner R, Zimmermann H, Liebig T, Ricke J, Liu H, Tonn JC, Schichor C, Stoecklein S. Perifocal Edema in Patients with Meningioma is Associated with Impaired Whole-Brain Connectivity as Detected by Resting-State fMRI. AJNR Am J Neuroradiol 2023:ajnr.A7915. [PMID: 37385680 PMCID: PMC10337612 DOI: 10.3174/ajnr.a7915] [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] [Received: 11/03/2022] [Accepted: 05/28/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Meningiomas are intracranial tumors that usually carry a benign prognosis. Some meningiomas cause perifocal edema. Resting-state fMRI can be used to assess whole-brain functional connectivity, which can serve as a marker for disease severity. Here, we investigated whether the presence of perifocal edema in preoperative patients with meningiomas leads to impaired functional connectivity and if these changes are associated with cognitive function. MATERIALS AND METHODS Patients with suspected meningiomas were prospectively included, and resting-state fMRI scans were obtained. Impairment of functional connectivity was quantified on a whole-brain level using our recently published resting-state fMRI-based marker, called the dysconnectivity index. Using uni- and multivariate regression models, we investigated the association of the dysconnectivity index with edema and tumor volume as well as cognitive test scores. RESULTS Twenty-nine patients were included. In a multivariate regression analysis, there was a highly significant association of dysconnectivity index values and edema volume in the total sample and in a subsample of 14 patients with edema, when accounting for potential confounders like age and temporal SNR. There was no statistically significant association with tumor volume. Better neurocognitive performance was strongly associated with lower dysconnectivity index values. CONCLUSIONS Resting-state fMRI showed a significant association between impaired functional connectivity and perifocal edema, but not tumor volume, in patients with meningiomas. We demonstrated that better neurocognitive function was associated with less impairment of functional connectivity. This result shows that our resting-state fMRI marker indicates a detrimental influence of peritumoral brain edema on global functional connectivity in patients with meningiomas.
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Affiliation(s)
- V M Stoecklein
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Wunderlich
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - B Papazov
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - N Thon
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - M Schmutzer
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
| | - R Schinner
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Zimmermann
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - T Liebig
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - J Ricke
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Liu
- Department of Radiology (H.L.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
- Department of Neuroscience (H.L.), Medical University of South Carolina, Charleston, South Carolina
| | - J-C Tonn
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - C Schichor
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Stoecklein
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
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Weller J, Katzendobler S, Niedermeyer S, Harter PN, Herms J, Trumm C, Niyazi M, Thon N, Tonn JC, Stoecklein VM. Treatment benefit in patients aged 80 years or older with biopsy-proven and non-resected glioblastoma is dependent on MGMT promoter methylation status. J Neurooncol 2023:10.1007/s11060-023-04362-y. [PMID: 37289281 PMCID: PMC10322768 DOI: 10.1007/s11060-023-04362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Glioblastoma is associated with especially poor outcome in the elderly. It is unclear if patients aged ≥80 years benefit from tumor-specific therapy as opposed to receiving best supportive care (BSC) only. METHODS Patients with IDH-wildtype glioblastoma (WHO 2021), aged ≥80 years, and diagnosed by biopsy between 2010 and 2022 were included. Patient characteristics and clinical parameters were assessed. Uni- and multivariate analyses were performed. RESULTS 76 patients with a median age of 82 (range 80-89) and a median initial KPS of 80 (range 50-90) were included. Tumor-specific therapy was initiated in 52 patients (68%). 22 patients (29%) received temozolomide monotherapy, 23 patients (30%) were treated with radiotherapy (RT) alone and 7 patients (9%) received combination therapies. In 24 patients (32%), tumor-specific therapy was omitted in lieu of BSC. Overall survival (OS) was longer in patients receiving tumor-specific therapy (5.4 vs. 3.3 months, p < 0.001). Molecular stratification showed that the survival benefit was owed to patients with MGMT promoter methylation (MGMTpos) who received tumor-specific therapy as opposed to BSC (6.2 vs. 2.6 months, p < 0.001), especially to those with better clinical status and no initial polypharmacy. Patients with unmethylated MGMT promoter (MGMTneg) did not benefit from tumor-specific therapy (3.6 vs. 3.7 months, p = 0.18). In multivariate analyses, better clinical status and MGMT promoter methylation were associated with prolonged survival (p < 0.01 and p = 0.01). CONCLUSION Benefit from tumor-specific treatment in patients with newly diagnosed glioblastoma aged ≥80 years might be restricted to MGMTpos patients, especially to those with good clinical status and no polypharmacy.
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Affiliation(s)
- Jonathan Weller
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Sophie Katzendobler
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Sebastian Niedermeyer
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
| | - Patrick N Harter
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Maximilian Niyazi
- Department of Radiotherapy and Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, Munich, 81377, Germany.
- German Cancer Consortium (DKTK), Partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Stoecklein S, Wunderlich S, Papazov B, Winkelmann M, Kunz WG, Mueller K, Ernst K, Stoecklein VM, Blumenberg V, Karschnia P, Bücklein VL, Rejeski K, Schmidt C, von Bergwelt-Baildon M, Tonn JC, Ricke J, Liu H, Remi J, Subklewe M, von Baumgarten L, Schoeberl F. Functional connectivity MRI provides an imaging correlate for chimeric antigen receptor T-cell-associated neurotoxicity. Neurooncol Adv 2023; 5:vdad135. [PMID: 38024243 PMCID: PMC10673700 DOI: 10.1093/noajnl/vdad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Treatment of hematological malignancies with chimeric antigen receptor modified T cells (CART) is highly efficient, but often limited by an immune effector cell-associated neurotoxicity syndrome (ICANS). As conventional MRI is often unremarkable during ICANS, we aimed to examine whether resting-state functional MRI (rsfMRI) is suitable to depict and quantify brain network alterations underlying ICANS in the individual patient. Methods The dysconnectivity index (DCI) based on rsfMRI was longitudinally assessed in systemic lymphoma patients and 1 melanoma patient during ICANS and before or after clinical resolution of ICANS. Results Seven lymphoma patients and 1 melanoma patient (19-77 years; 2 female) were included. DCI was significantly increased during ICANS with normalization after recovery (P = .0039). Higher ICANS grades were significantly correlated with increased DCI scores (r = 0.7807; P = .0222). DCI increase was most prominent in the inferior frontal gyrus and the frontal operculum (ie, Broca's area) and in the posterior parts of the superior temporal gyrus and the temporoparietal junction (ie, Wernicke's area) of the language-dominant hemisphere, thus reflecting the major clinical symptoms of nonfluent dysphasia and dyspraxia. Conclusions RsfMRI-based DCI might be suitable to directly quantify the severity of ICANS in individual patients undergoing CAR T-transfusion. Besides ICANS, DCI seems a promising diagnostic tool to quantify functional brain network alterations during encephalopathies of different etiologies, in general.
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Affiliation(s)
- Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Wunderlich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Winkelmann
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Mueller
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Ernst
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viktoria Blumenberg
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Veit L Bücklein
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Hesheng Liu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Jan Remi
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Marion Subklewe
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Louisa von Baumgarten
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Florian Schoeberl
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
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Karschnia P, Weller J, Blobner J, Stoecklein VM, Dorostkar MM, Rejeski K, Forbrig R, Niyazi M, von Baumgarten L, Dietrich J, Tonn JC, Thon N. Subventricular zone involvement is associated with worse outcome in glioma WHO grade 2 depending on molecular markers. Sci Rep 2021; 11:20045. [PMID: 34625590 PMCID: PMC8501091 DOI: 10.1038/s41598-021-97714-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Neural stem cells within the subventricular zone were identified as cells of origin driving growth of high-grade gliomas, and anatomical involvement of the subventricular zone has been associated with an inferior clinical outcome. Whether the association between poor outcome and subventricular zone involvement also applies to glioma of lower grades is unclear. We therefore analysed a retrospective cohort of 182 patients with glioma grade 2 (according to the WHO 2016 classification) including 78 individuals (43%) with subventricular zone involvement. Patients with and without subventricular zone involvement did not differ in regard to demographics, histopathology, and molecular markers. Notably, subventricular zone involvement was a negative prognostic marker for malignant progression and overall survival on uni- and multivariate analysis. When patients were stratified according to the cIMPACT-NOW update 6, subventricular zone involvement was negatively associated with outcome in IDH-wildtype astrocytomas and 1p19q-codeleted oligodendrogliomas but not in IDH-mutant astrocytomas. Collectively, subventricular zone involvement may represent a risk factor for worse outcome in glioma WHO grade 2 depending on the molecular tumor signature. The present data confirm the relevance of molecular glioma classifications as proposed by the cIMPACT-NOW update 6. These findings warrant evaluation in prospective cohorts.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. .,Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jens Blobner
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Medicine III, Ludwig-Maximilians-University, Munich, Germany
| | - Robert Forbrig
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Stoecklein VM, Stoecklein S, Galiè F, Ren J, Schmutzer M, Unterrainer M, Albert NL, Kreth FW, Thon N, Liebig T, Ertl-Wagner B, Tonn JC, Liu H. Resting-state fMRI detects alterations in whole brain connectivity related to tumor biology in glioma patients. Neuro Oncol 2021; 22:1388-1398. [PMID: 32107555 DOI: 10.1093/neuonc/noaa044] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Systemic infiltration of the brain by tumor cells is a hallmark of glioma pathogenesis which may cause disturbances in functional connectivity. We hypothesized that aggressive high-grade tumors cause more damage to functional connectivity than low-grade tumors. METHODS We designed an imaging tool based on resting-state functional (f)MRI to individually quantify abnormality of functional connectivity and tested it in a prospective cohort of patients with newly diagnosed glioma. RESULTS Thirty-four patients were analyzed (World Health Organization [WHO] grade II, n = 13; grade III, n = 6; grade IV, n = 15; mean age, 48.7 y). Connectivity abnormality could be observed not only in the lesioned brain area but also in the contralateral hemisphere with a close correlation between connectivity abnormality and aggressiveness of the tumor as indicated by WHO grade. Isocitrate dehydrogenase 1 (IDH1) mutation status was also associated with abnormal connectivity, with more alterations in IDH1 wildtype tumors independent of tumor size. Finally, deficits in neuropsychological performance were correlated with connectivity abnormality. CONCLUSION Here, we suggested an individually applicable resting-state fMRI marker in glioma patients. Analysis of the functional connectome using this marker revealed that abnormalities of functional connectivity could be detected not only adjacent to the visible lesion but also in distant brain tissue, even in the contralesional hemisphere. These changes were associated with tumor biology and cognitive function. The ability of our novel method to capture tumor effects in nonlesional brain suggests a potential clinical value for both individualizing and monitoring glioma therapy.
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Affiliation(s)
- Veit M Stoecklein
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany.,German Cancer Consortium , partner site Munich, German Cancer Research Center, Heidelberg, Germany
| | - Sophia Stoecklein
- Department of Radiology, Ludwig Maximilians University Munich, Munich, Germany
| | - Franziska Galiè
- Department of Radiology, Ludwig Maximilians University Munich, Munich, Germany.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Michael Schmutzer
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, Ludwig Maximilians University, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians University, Munich, Germany
| | - Friedrich-W Kreth
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany.,German Cancer Consortium , partner site Munich, German Cancer Research Center, Heidelberg, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany.,German Cancer Consortium , partner site Munich, German Cancer Research Center, Heidelberg, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, Ludwig Maximilians University Munich, Munich, Germany.,Department of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joerg-C Tonn
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany.,German Cancer Consortium , partner site Munich, German Cancer Research Center, Heidelberg, Germany
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Karschnia P, Weller J, Blobner J, Stoecklein VM, Dorostkar MM, Rejeski KD, Forbrig R, Niyazi M, von Baumgarten L, Dietrich J, Tonn JC, Thon N. BIOM-15. SUBVENTRICULAR ZONE INVOLVEMENT IS ASSOCIATED WITH WORSE OUTCOME IN GLIOMA WHO GRADE II INDEPENDENT OF MOLECULAR MARKERS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.015] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The subventricular zone represents a niche of adult neural stem cells. Involvement of the subventricular zone is associated with decreased survival in malignant glioma. We aimed to determine whether a similar association applies to low-grade gliomas.
METHODS
A retrospective institutional database search was performed for patients with glioma WHO grade II according to the 2016 classification. Demographic data, histology and molecular signature, imaging, and therapy were recorded and outcome was analysed for tumors with and without infiltration of the subventricular zone.
RESULTS
182 patients with glioma WHO grade II were identified, including 97 oligodendrogliomas and 85 astrocytomas. 78 of 182 patients (43%) presented with subventricular zone involvement. Demographics, histopathology, and molecular signature did not differ between patients with and without subventricular zone involvement. First-line management included surgery, chemotherapy, radiotherapy, brachytherapy, and wait-and-scan approaches. Median follow-up was 43 months. Median time to malignant progression was 122 months; median overall survival was not reached. Subventricular zone involvement was a negative prognostic marker for time to malignant progression (p = 0.002) and overall survival (p = 0.023) in the entire cohort as well as in the subgroup of patients who were managed with wait-and-scan approaches. Among patients in which early therapy was provided, subventricular zone involvement was not prognostic for overall survival but for time to malignant progression. In multivariate analysis, subventricular zone involvement was associated with worse prognosis independent of molecular markers or treatment approaches including use of resection.
CONCLUSION
Subventricular zone involvement represents a key risk factor for worse outcome in glioma WHO grade II. Early first-line therapy may improve outcome in such patients.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, München, Germany
| | - Jens Blobner
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Mario M Dorostkar
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Kai D Rejeski
- Department of Medicine III, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Robert Forbrig
- Department of Neuroradiology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Bayern, Germany
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
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9
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Greve T, Stoecklein VM, Dorn F, Laskowski S, Thon N, Tonn JC, Schichor C. Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping. J Neurosurg 2019; 132:1188-1196. [PMID: 30925469 DOI: 10.3171/2018.12.jns182177] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure. METHODS The dates of inclusion in the study were 2007-2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007-2010) and after introduction of IOM (n = 138, IOM-group; 2011-2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification. RESULTS There was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%. CONCLUSIONS The assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.
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Affiliation(s)
| | | | - Franziska Dorn
- 2Neuroradiology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
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10
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Mastrella G, Hou M, Li M, Stoecklein VM, Zdouc N, Volmar MNM, Miletic H, Reinhard S, Herold-Mende CC, Kleber S, Eisenhut K, Gargiulo G, Synowitz M, Vescovi AL, Harter PN, Penninger JM, Wagner E, Mittelbronn M, Bjerkvig R, Hambardzumyan D, Schüller U, Tonn JC, Radke J, Glass R, Kälin RE. Targeting APLN/APLNR Improves Antiangiogenic Efficiency and Blunts Proinvasive Side Effects of VEGFA/VEGFR2 Blockade in Glioblastoma. Cancer Res 2019; 79:2298-2313. [PMID: 30718358 DOI: 10.1158/0008-5472.can-18-0881] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/19/2018] [Accepted: 01/29/2019] [Indexed: 11/16/2022]
Abstract
Antiangiogenic therapy of glioblastoma (GBM) with bevacizumab, a VEGFA-blocking antibody, may accelerate tumor cell invasion and induce alternative angiogenic pathways. Here we investigate the roles of the proangiogenic apelin receptor APLNR and its cognate ligand apelin in VEGFA/VEGFR2 antiangiogenic therapy against distinct subtypes of GBM. In proneural GBM, apelin levels were downregulated by VEGFA or VEGFR2 blockade. A central role for apelin/APLNR in controlling GBM vascularization was corroborated in a serial implantation model of the angiogenic switch that occurs in human GBM. Apelin and APLNR are broadly expressed in human GBM, and knockdown or knockout of APLN in orthotopic models of proneural or classical GBM subtypes significantly reduced GBM vascularization compared with controls. However, reduction in apelin expression led to accelerated GBM cell invasion. Analysis of stereotactic GBM biopsies from patients as well as from in vitro and in vivo experiments revealed increased dissemination of APLNR-positive tumor cells when apelin levels were reduced. Application of apelin-F13A, a mutant APLNR ligand, blocked tumor angiogenesis and GBM cell invasion. Furthermore, cotargeting VEGFR2 and APLNR synergistically improved survival of mice bearing proneural GBM. In summary, we show that apelin/APLNR signaling controls GBM angiogenesis and invasion and that both pathologic features are blunted by apelin-F13A. We suggest that apelin-F13A can improve the efficiency and reduce the side effects of established antiangiogenic treatments for distinct GBM subtypes. SIGNIFICANCE: Pharmacologic targeting of the APLNR acts synergistically with established antiangiogenic treatments in glioblastoma and blunts therapy resistance to current strategies for antiangiogenesis.See related commentary by Amoozgar et al., p. 2104.
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Affiliation(s)
- Giorgia Mastrella
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Mengzhuo Hou
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Min Li
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Nina Zdouc
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Marie N M Volmar
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Miletic
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | | | - Christel C Herold-Mende
- Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg, Germany
| | - Susanne Kleber
- Department of Molecular Neurobiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katharina Eisenhut
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Michael Synowitz
- Department of Neurosurgery, University Hospital Center Schleswig Holstein, Kiel, Germany
| | - Angelo L Vescovi
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Patrick N Harter
- Edinger-Institute (Neurological Institute), Goethe-University Medical School, Frankfurt am Main, Germany and German Cancer Consortium (DKTK), partner site Frankfurt/Mainz; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Josef M Penninger
- Institute of Molecular Biotechnology, Austrian Academy of Sciences, Vienna, Austria
| | - Ernst Wagner
- Department of Pharmacy, LMU Munich, Munich, Germany
| | - Michel Mittelbronn
- Edinger-Institute (Neurological Institute), Goethe-University Medical School, Frankfurt am Main, Germany and German Cancer Consortium (DKTK), partner site Frankfurt/Mainz; German Cancer Research Center (DKFZ), Heidelberg, Germany.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg and NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), and Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Dolores Hambardzumyan
- Department of Pediatrics and Aflac Cancer Center of Children's Health Care of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Ulrich Schüller
- Institute of Neuropathology and Department of Pediatric Haematology and Oncology, University Medical Center, Hamburg-Eppendorf and Research Institute Children's Cancer Center, Hamburg, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Josefine Radke
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, German; Berlin Institute of Health (BIH), Berlin, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Partner Site Berlin, Berlin, Germany
| | - Rainer Glass
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Walter Brendel Center of Experimental Medicine, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Roland E Kälin
- Neurosurgical Research, Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany. .,Walter Brendel Center of Experimental Medicine, Faculty of Medicine, LMU Munich, Munich, Germany
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11
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Stoecklein VM, Lummel N, Ertl L, Kunz M, Tonn JC, Mueller S. Pediatric Giant Cell Glioblastoma Mimicking Hemorrhage Secondary to Ischemic Stroke. Pediatr Neurol 2015; 53:459-61. [PMID: 26344331 DOI: 10.1016/j.pediatrneurol.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Veit M Stoecklein
- Department of Neurosurgery, Ludwig-Maximilians University, Munich, Germany
| | - Nina Lummel
- Department of Neuroradiology, Ludwig-Maximilians University, Munich, Germany
| | - Lorenz Ertl
- Department of Neuroradiology, Ludwig-Maximilians University, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, Ludwig-Maximilians University, Munich, Germany
| | - Joerg-C Tonn
- Department of Neurosurgery, Ludwig-Maximilians University, Munich, Germany
| | - Sophia Mueller
- Department of Neuroradiology, Ludwig-Maximilians University, Munich, Germany; Institute of Clinical Radiology, Ludwig-Maximilians University, Munich, Germany.
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12
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Rachinger W, Stoecklein VM, Terpolilli NA, Haug AR, Ertl L, Pöschl J, Schüller U, Schichor C, Thon N, Tonn JC. Increased 68Ga-DOTATATE uptake in PET imaging discriminates meningioma and tumor-free tissue. J Nucl Med 2015; 56:347-53. [PMID: 25635133 DOI: 10.2967/jnumed.114.149120] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED Meningiomas are known to express somatostatin receptor 2 (SSTR2). PET using the SSTR2 analog (68)Ga-DOTATATE has recently been introduced for imaging of meningiomas. However, a systematic correlation between (68)Ga-DOTATATE uptake, SSTR2 expression, and histology (including tumor-free scar tissue) is still lacking. For elucidation, we conducted this prospective study. METHODS Twenty-one adult patients with primary (n = 12) or recurrent (n = 9) meningiomas were prospectively enrolled. Preoperative MR imaging and (68)Ga-DOTATATE PET scans were fused and used for a spatially precise neuronavigated tissue-sampling procedure during tumor resection. Histopathologic diagnosis included immunohistochemical determination of SSTR2 expression. At each individual sampling site, the maximum standardized uptake value (SUVmax) of (68)Ga-DOTATATE was correlated with MR imaging findings, histology, and semiquantitative SSTR2 expression. RESULTS One hundred fifteen samples (81 tumor, 34 tumor-free) were obtained. There was a significant positive correlation between SUVmax and SSTR2 expression. Receiver-operating characteristic analysis revealed a threshold of 2.3 for SUVmax to discriminate between tumor and nontumoral tissue. Regarding the detection of tumor tissue, PET imaging showed a higher sensitivity (90% vs. 79%; P = 0.049), with specificity and positive predictive values similar to MR imaging, for both de novo and recurrent tumors. CONCLUSION (68)Ga-DOTATATE uptake correlates with SSTR2 expression and offers high diagnostic accuracy to delineate meningioma from tumor-free tissue even in recurrent tumors after previous therapy. Our findings substantiate an important role for (68)Ga-DOTATATE PET in meningioma management.
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Affiliation(s)
- Walter Rachinger
- Department of Neurosurgery, University of Munich, Munich, Germany
| | | | | | - Alexander R Haug
- Department of Nuclear Medicine, University of Munich, Munich, Germany Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Lorenz Ertl
- Department of Neuroradiology, University of Munich, Munich, Germany; and
| | - Julia Pöschl
- Center for Neuropathology and Prion Research, University of Munich, Munich, Germany
| | - Ulrich Schüller
- Center for Neuropathology and Prion Research, University of Munich, Munich, Germany
| | | | - Niklas Thon
- Department of Neurosurgery, University of Munich, Munich, Germany
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13
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Stoecklein VM, Osuka A, Ishikawa S, Lederer MR, Wanke-Jellinek L, Lederer JA. Radiation exposure induces inflammasome pathway activation in immune cells. J Immunol 2014; 194:1178-89. [PMID: 25539818 DOI: 10.4049/jimmunol.1303051] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radiation exposure induces cell and tissue damage, causing local and systemic inflammatory responses. Because the inflammasome pathway is triggered by cell death and danger-associated molecular patterns, we hypothesized that the inflammasome may signal acute and chronic immune responses to radiation. Using a mouse radiation model, we show that radiation induces a dose-dependent increase in inflammasome activation in macrophages, dendritic cells, NK cells, T cells, and B cells as judged by cleaved caspase-1 detection in cells. Time course analysis showed the appearance of cleaved caspase-1 in cells by day 1 and sustained expression until day 7 after radiation. Also, cells showing inflammasome activation coexpressed the cell surface apoptosis marker annexin V. The role of caspase-1 as a trigger for hematopoietic cell losses after radiation was studied in caspase-1(-/-) mice. We found less radiation-induced cell apoptosis and immune cell loss in caspase-1(-/-) mice than in control mice. Next, we tested whether uric acid might mediate inflammasome activation in cells by treating mice with allopurinol and discovered that allopurinol treatment completely blocked caspase-1 activation in cells. Finally, we demonstrate that radiation-induced caspase-1 activation occurs by a Nod-like receptor family protein 3-independent mechanism because radiation-exposed Nlrp3(-/-) mice showed caspase-1 activation profiles that were indistinguishable from those of wild-type mice. In summary, our data demonstrate that inflammasome activation occurs in many immune cell types following radiation exposure and that allopurinol prevented radiation-induced inflammasome activation. These results suggest that targeting the inflammasome may help control radiation-induced inflammation.
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Affiliation(s)
- Veit M Stoecklein
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
| | - Akinori Osuka
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
| | - Shizu Ishikawa
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
| | - Madeline R Lederer
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
| | - Lorenz Wanke-Jellinek
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
| | - James A Lederer
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115
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14
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Tajima G, Delisle AJ, Hoang K, O'Leary FM, Ikeda K, Hanschen M, Stoecklein VM, Lederer JA. Immune system phenotyping of radiation and radiation combined injury in outbred mice. Radiat Res 2012; 179:101-12. [PMID: 23216446 DOI: 10.1667/rr3120.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The complexity of a radionuclear event would be immense due to varying levels of radiation exposures and injuries caused by blast-associated trauma. With this scenario in mind, we developed a mouse model to mimic as closely as possible the potential consequences of radiation injury and radiation combined injury (RCI) on survival, immune system phenotype, and immune function. Using a mouse burn injury model and a (137)CsCl source irradiator to induce injuries, we report that the immunological response to radiation combined injury differs significantly from radiation or burn injury alone. Mice that underwent radiation combined injury showed lower injury survival and cecal ligation and puncture (CLP) induced polymicrobial sepsis survival rates than mice with single injuries. As anticipated, radiation exposure caused dose-dependent losses of immune cell subsets. We found B and T cells to be more radiation sensitive, while macrophages, dendritic cells and NK cells were relatively more resistant. However, radiation and radiation combined injury did induce significant increases in the percentages of CD4(+) regulatory T cells (Tregs) and a subset of macrophages that express cell-surface GR-1 (GR-1(+) macrophages). Immune system phenotyping analysis indicated that spleen cells from radiation combined injury mice produced higher levels of proinflammatory cytokines than cells from mice with radiation or burn injury alone, especially at lower dose radiation exposure levels. Interestingly, this enhanced proinflammatory phenotype induced by radiation combined injury persisted for at least 28 days after injury. In total, our data provide baseline information on differences in immune phenotype and function between radiation injury and radiation combined injury in mice. The establishment of this animal model will aid in future testing for therapeutic strategies to mitigate the immune and pathophysiological consequences of radionuclear events.
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Affiliation(s)
- G Tajima
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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15
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Abstract
Traumatic injuries induce a complex host response that disrupts immune system homeostasis and predisposes patients to opportunistic infections and inflammatory complications. The response to injuries varies considerably by type and severity, as well as by individual variables, such as age, sex, and genetics. These variables make studying the impact of trauma on the immune system challenging. Nevertheless, advances have been made in understanding how injuries influence immune system function as well as the immune cells and pathways involved in regulating the response to injuries. This review provides an overview of current knowledge about how traumatic injuries affect immune system phenotype and function. We discuss the current ideas that traumatic injuries induce a unique type of a response that may be triggered by a combination of endogenous danger signals, including alarmins, DAMPs, self-antigens, and cytokines. Additionally, we review and propose strategies for redirecting injury responses to help restore immune system homeostasis.
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Affiliation(s)
- Veit M Stoecklein
- Department of Surgery, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
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