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Ristow I, Kaul MG, Stark M, Zapf A, Riedel C, Lenz A, Mautner VF, Farschtschi S, Apostolova I, Adam G, Bannas P, Salamon J, Well L. Discrimination of benign, atypical, and malignant peripheral nerve sheath tumors in neurofibromatosis type 1 using diffusion-weighted MRI. Neurooncol Adv 2024; 6:vdae021. [PMID: 38468867 PMCID: PMC10926940 DOI: 10.1093/noajnl/vdae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is associated with the development of benign (BPNST) and malignant (MPNST) peripheral nerve sheath tumors. Recently described atypical neurofibromas (ANF) are considered pre-malignant precursor lesions to MPNSTs. Previous studies indicate that diffusion-weighted magnetic resonance imaging (DW-MRI) can reliably discriminate MPNSTs from BPNSTs. We therefore investigated the diagnostic accuracy of DW-MRI for the discrimination of benign, atypical, and malignant peripheral nerve sheath tumors. Methods In this prospective explorative single-center phase II diagnostic study, 44 NF1 patients (23 male; 30.1 ± 11.8 years) underwent DW-MRI (b-values 0-800 s/mm²) at 3T. Two radiologists independently assessed mean and minimum apparent diffusion coefficients (ADCmean/min) in areas of largest tumor diameters and ADCdark in areas of lowest signal intensity by manual contouring of the tumor margins of 60 BPNSTs, 13 ANFs, and 21 MPNSTs. Follow-up of ≥ 24 months (BPNSTs) or histopathological evaluation (ANFs + MPNSTs) served as diagnostic reference standard. Diagnostic ADC-based cut-off values for discrimination of the three tumor groups were chosen to yield the highest possible specificity while maintaining a clinically acceptable sensitivity. Results ADC values of pre-malignant ANFs clustered between BPNSTs and MPNSTs. Best BPNST vs. ANF + MPNST discrimination was obtained using ADCdark at a cut-off value of 1.6 × 10-3 mm2/s (85.3% sensitivity, 93.3% specificity), corresponding to an AUC of 94.3% (95% confidence interval: 85.2-98.0). Regarding BPNST + ANF vs. MPNST, best discrimination was obtained using an ADCdark cut-off value of 1.4 × 10-3 mm2/s (83.3% sensitivity, 94.5% specificity). Conclusions DW-MRI using ADCdark allows specific and noninvasive discrimination of benign, atypical, and malignant nerve sheath tumors in NF1.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Care Center Beste Trave, Bad Oldesloe, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Fisher MJ, Blakeley JO, Weiss BD, Dombi E, Ahlawat S, Akshintala S, Belzberg AJ, Bornhorst M, Bredella MA, Cai W, Ferner RE, Gross AM, Harris GJ, Listernick R, Ly I, Martin S, Mautner VF, Salamon JM, Salerno KE, Spinner RJ, Staedtke V, Ullrich NJ, Upadhyaya M, Wolters PL, Yohay K, Widemann BC. Management of neurofibromatosis type 1-associated plexiform neurofibromas. Neuro Oncol 2022; 24:1827-1844. [PMID: 35657359 PMCID: PMC9629437 DOI: 10.1093/neuonc/noac146] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plexiform Neurofibromas (PN) are a common manifestation of the genetic disorder neurofibromatosis type 1 (NF1). These benign nerve sheath tumors often cause significant morbidity, with treatment options limited historically to surgery. There have been tremendous advances over the past two decades in our understanding of PN, and the recent regulatory approvals of the MEK inhibitor selumetinib are reshaping the landscape for PN management. At present, there is no agreed upon PN definition, diagnostic evaluation, surveillance strategy, or clear indications for when to initiate treatment and selection of treatment modality. In this review, we address these questions via consensus recommendations from a panel of multidisciplinary NF1 experts.
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Affiliation(s)
- Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jaishri O Blakeley
- Division of Neuro-Oncology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian D Weiss
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Shivani Ahlawat
- Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miriam Bornhorst
- Family Neurofibromatosis Institute, Center for Neuroscience and Behavioral Medicine,Children's National Hospital, Washington, District of Columbia, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalie E Ferner
- Neurofibromatosis Service, Department of Neurology, Guy's Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Andrea M Gross
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Gordon J Harris
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Listernick
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes M Salamon
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Verena Staedtke
- Division of Neuro-Oncology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meena Upadhyaya
- Division of Cancer and Genetics, Cardiff University, Wales, UK
| | - Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Kaleb Yohay
- Grossman School of Medicine, Department of Neurology, New York, New York, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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3
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Ristow I, Madesta F, Well L, Shenas F, Wright F, Molwitz I, Farschtschi S, Bannas P, Adam G, Mautner VF, Werner R, Salamon J. Evaluation of magnetic resonance imaging-based radiomics characteristics for differentiation of benign and malignant peripheral nerve sheath tumors in neurofibromatosis type 1. Neuro Oncol 2022; 24:1790-1798. [PMID: 35426432 PMCID: PMC9527508 DOI: 10.1093/neuonc/noac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with neurofibromatosis type 1 (NF1) develop benign (BPNST), premalignant atypical (ANF), and malignant (MPNST) peripheral nerve sheath tumors. Radiological differentiation of these entities is challenging. Therefore, we aimed to evaluate the value of a magnetic resonance imaging (MRI)-based radiomics machine-learning (ML) classifier for differentiation of these three entities of internal peripheral nerve sheath tumors in NF1 patients. METHODS MRI was performed at 3T in 36 NF1 patients (20 male; age: 31 ± 11 years). Segmentation of 117 BPNSTs, 17 MPNSTs, and 8 ANFs was manually performed using T2w spectral attenuated inversion recovery sequences. One hundred seven features per lesion were extracted using PyRadiomics and applied for BPNST versus MPNST differentiation. A 5-feature radiomics signature was defined based on the most important features and tested for signature-based BPNST versus MPNST classification (random forest [RF] classification, leave-one-patient-out evaluation). In a second step, signature feature expressions for BPNSTs, ANFs, and MPNSTs were evaluated for radiomics-based classification for these three entities. RESULTS The mean area under the receiver operator characteristic curve (AUC) for the radiomics-based BPNST versus MPNST differentiation was 0.94, corresponding to correct classification of on average 16/17 MPNSTs and 114/117 BPNSTs (sensitivity: 94%, specificity: 97%). Exploratory analysis with the eight ANFs revealed intermediate radiomic feature characteristics in-between BPNST and MPNST tumor feature expression. CONCLUSION In this proof-of-principle study, ML using MRI-based radiomics characteristics allows sensitive and specific differentiation of BPNSTs and MPNSTs in NF1 patients. Feature expression of premalignant atypical tumors was distributed in-between benign and malignant tumor feature expressions, which illustrates biological plausibility of the considered radiomics characteristics.
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Affiliation(s)
- Inka Ristow
- Corresponding Author: Inka Ristow, MD, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany ()
| | - Frederic Madesta
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farzad Shenas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felicia Wright
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf
, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf
, Hamburg, Germany
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Germanidis EI, Schulz R, Quandt F, Mautner VF, Gerloff C, Timmermann JE. Intact procedural learning and motor intracortical inhibition in adult neurofibromatosis type 1 gene carriers. Clin Neurophysiol 2021; 132:2037-2045. [PMID: 34284238 DOI: 10.1016/j.clinph.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/22/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Neurofibromatosis type 1 (NF1)1 is known to cause learning deficits in affected individuals. There has been evidence linking altered gamma-aminobutyric acid (GABA)2 mediated inhibition to learning impairments in rodent models and humans with NF1. Still, evidence on the role of GABA in learning deficits associated with NF1 is inconclusive. METHODS We examined procedural learning and motor cortex excitability through intracortical facilitation and short interval intracortical inhibition and its activity dependent modulation while performing a procedural sequence learning task in 16 asymptomatic NF1 gene carriers. We aimed to analyze potential brain-behavior correlations in a carefully selected sample of gene carriers in order to minimize confounding factors. RESULTS Gene carriers did not differ from healthy controls when learning the task with their non-dominant hand over three days of training. Electrophysiological data did not reveal alterations in patients' inhibitory function of the motor cortex. CONCLUSIONS In contrast with previous publications reporting various cognitive deficits in clinically asymptomatic individuals with NF1, here asymptomatic gene carriers did not show major neuropsychological or behavioral abnormalities. SIGNIFICANCE Our results support the concept that gene carriers may not always be impaired by the condition and the population of individuals with NF1 most likely comprises different subgroups according to patients' phenotype severity.
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Affiliation(s)
- Eirene I Germanidis
- Experimental Electrophysiology and Neuroimaging (xENi) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Experimental Electrophysiology and Neuroimaging (xENi) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fanny Quandt
- Experimental Electrophysiology and Neuroimaging (xENi) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Section for Neurofibromatosis, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Experimental Electrophysiology and Neuroimaging (xENi) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan E Timmermann
- Experimental Electrophysiology and Neuroimaging (xENi) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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5
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Kluwe L, Mautner VF. Empirically downgrading 10 constitutional missense variants of the NF1 gene based on co-existing truncating variants. Am J Med Genet A 2020; 185:602-603. [PMID: 33231931 DOI: 10.1002/ajmg.a.61976] [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: 06/12/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Well L, Salamon J, Kaul MG, Farschtschi S, Herrmann J, Geier KI, Hagel C, Bockhorn M, Bannas P, Adam G, Mautner VF, Derlin T. Differentiation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1 using diffusion-weighted magnetic resonance imaging. Neuro Oncol 2020; 21:508-516. [PMID: 30496452 DOI: 10.1093/neuonc/noy199] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 12/15/2022] Open
Abstract
BACKGROUND We sought to determine the value of diffusion-weighted (DW) magnetic resonance imaging (MRI) for characterization of benign and malignant peripheral nerve sheath tumors (PNSTs) in patients with neurofibromatosis type 1 (NF1). METHODS Twenty-six patients with NF1 and suspicion of malignant transformation of PNSTs were prospectively enrolled and underwent DW MRI at 3T. For a set of benign (n = 55) and malignant (n = 12) PNSTs, functional MRI parameters were derived from both biexponential intravoxel incoherent motion (diffusion coefficient D and perfusion fraction f) and monoexponential data analysis (apparent diffusion coefficients [ADCs]). A panel of morphological MRI features was evaluated using T1- and T2-weighted imaging. Mann-Whitney U-test, Fisher's exact test, and receiver operating characteristic (ROC) analyses were applied to assess the diagnostic accuracy of quantitative and qualitative MRI. Cohen's kappa was used to determine interrater reliability. RESULTS Malignant PNSTs demonstrated significantly lower diffusivity (P < 0.0001) compared with benign PNSTs. The perfusion fraction f was significantly higher in malignant PNSTs (P < 0.001). In ROC analysis, functional MRI parameters showed high diagnostic accuracy for differentiation of PNSTs (eg, ADCmean, 92% sensitivity with 98% specificity, AUC 0.98; Dmean, 92% sensitivity with 98% specificity, AUC 0.98). By contrast, morphological imaging features had only limited sensitivity (18-94%) and specificity (18-82%) for identification of malignancy. Interrater reliability was higher for monoexponential data analysis. CONCLUSION DW imaging shows better diagnostic performance than morphological features and allows accurate differentiation of benign and malignant peripheral nerve sheath tumors in NF1.
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Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin I Geier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Bockhorn
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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7
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Fischer-Huchzermeyer S, Chikobava L, Stahn V, Zangarini M, Berry P, Veal GJ, Senner V, Mautner VF, Harder A. Testing ATRA and MEK inhibitor PD0325901 effectiveness in a nude mouse model for human MPNST xenografts. BMC Res Notes 2018; 11:520. [PMID: 30055648 PMCID: PMC6064132 DOI: 10.1186/s13104-018-3630-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/20/2018] [Indexed: 01/29/2023] Open
Abstract
Objective Malignant peripheral nerve sheath tumors (MPNST) are aggressive sarcomas characterized by high recurrence rates and early metastases. These tumors arise more frequently within neurofibromatosis type 1 (NF1) and present with resistance during standard chemotherapy leading to increased mortality and morbidity in those patients. In vitro all-trans retinoic acid (ATRA) and MEK inhibitors (MEKi) were shown to inhibit tumor proliferation, especially when applied in combination. Therefore, we established a nude mouse model to investigate if treatment of xenografts derived from NF1 associated S462 and T265 MPNST cells respond to ATRA and the MEKi PD0325901. Results We demonstrated that human NF1 associated MPNST derived from S462 but not T265 cells form solid subcutaneous tumors in Foxn1 nude mice but not in Balb/c, SHO or Shorn mice. We verified a characteristic staining pattern of human MPNST xenografts by immunohistochemistry. Therapeutic effects of ATRA and/or MEKi PD0325901 on growth of S462 MPNST xenografts in Foxn1 nude mice were not demonstrated in vitro, as we did not observe significant suppression of MPNST growth compared with placebo treatment. Electronic supplementary material The online version of this article (10.1186/s13104-018-3630-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Levan Chikobava
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Verena Stahn
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Monique Zangarini
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Volker Senner
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Victor F Mautner
- Clinics and Polyclinics of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Harder
- Institute of Neuropathology, University Hospital Münster, Münster, Germany. .,Institute of Pathology, Health Care Center, Brandenburg Hospital, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
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8
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Fischer-Huchzermeyer S, Dombrowski A, Hagel C, Mautner VF, Schittenhelm J, Harder A. The Cellular Retinoic Acid Binding Protein 2 Promotes Survival of Malignant Peripheral Nerve Sheath Tumor Cells. The American Journal of Pathology 2017; 187:1623-1632. [DOI: 10.1016/j.ajpath.2017.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 01/03/2023]
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9
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Ahlawat S, Fayad LM, Khan MS, Bredella MA, Harris GJ, Evans DG, Farschtschi S, Jacobs MA, Chhabra A, Salamon JM, Wenzel R, Mautner VF, Dombi E, Cai W, Plotkin SR, Blakeley JO. Current whole-body MRI applications in the neurofibromatoses: NF1, NF2, and schwannomatosis. Neurology 2017; 87:S31-9. [PMID: 27527647 DOI: 10.1212/wnl.0000000000002929] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/26/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration Whole-Body MRI (WB-MRI) Working Group reviewed the existing literature on WB-MRI, an emerging technology for assessing disease in patients with neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN), to recommend optimal image acquisition and analysis methods to enable WB-MRI as an endpoint in NF clinical trials. METHODS A systematic process was used to review all published data about WB-MRI in NF syndromes to assess diagnostic accuracy, feasibility and reproducibility, and data about specific techniques for assessment of tumor burden, characterization of neoplasms, and response to therapy. RESULTS WB-MRI at 1.5T or 3.0T is feasible for image acquisition. Short tau inversion recovery (STIR) sequence is used in all investigations to date, suggesting consensus about the utility of this sequence for detection of WB tumor burden in people with NF. There are insufficient data to support a consensus statement about the optimal imaging planes (axial vs coronal) or 2D vs 3D approaches. Functional imaging, although used in some NF studies, has not been systematically applied or evaluated. There are no comparative studies between regional vs WB-MRI or evaluations of WB-MRI reproducibility. CONCLUSIONS WB-MRI is feasible for identifying tumors using both 1.5T and 3.0T systems. The STIR sequence is a core sequence. Additional investigation is needed to define the optimal approach for volumetric analysis, the reproducibility of WB-MRI in NF, and the diagnostic performance of WB-MRI vs regional MRI.
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Affiliation(s)
- Shivani Ahlawat
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston.
| | - Laura M Fayad
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Muhammad Shayan Khan
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Miriam A Bredella
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Gordon J Harris
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - D Gareth Evans
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Said Farschtschi
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Michael A Jacobs
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Avneesh Chhabra
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Johannes M Salamon
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Ralph Wenzel
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Victor F Mautner
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Eva Dombi
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Wenli Cai
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Scott R Plotkin
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Jaishri O Blakeley
- From The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F., M.A.J.), Sidney Kimmel Comprehensive Cancer Center (M.A.J.), and Department of Neurology (J.O.B.), Johns Hopkins University, Baltimore, MD; Khyber Medical College (M.S.K.), Peshawar, Pakistan; Department of Radiology (M.A.B., G.J.H., W.C.), Massachusetts General Hospital and Harvard Medical School, Boston; Genomic Medicine (D.G.E.), Manchester Academic Health Science Centre, The University of Manchester, UK; Department of Neurology (S.F., V.F.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Radiology & Orthopedic Surgery (A.C.), UT Southwestern Medical Center, Dallas, TX; Department of Diagnostic and Interventional Radiology (J.M.S.), University Hospital Hamburg-Eppendorf; Radiological Practice Altona (R.W.), Hamburg, Germany; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
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Farschtschi S, Gelderblom M, Buschbaum S, Bostock H, Grafe P, Mautner VF. Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2. Muscle Nerve 2016; 55:350-358. [PMID: 27422240 DOI: 10.1002/mus.25256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The neuropathy in patients with neurofibromatosis type 2 (NF2) is difficult to quantify and follow up. In this study we compared 3 methods that may help assess motor axon pathology in NF2 patients. METHODS Nerve conduction studies in median nerves were supplemented by deriving motor unit number estimates (MUNEs) from compound muscle action potential (CMAP) scans and by high-resolution ultrasound (US) peripheral nerve imaging. RESULTS CMAP amplitudes and nerve conduction velocity were normal in the vast majority of affected individuals, but CMAP scan MUNE revealed denervation and reinnervation in many peripheral nerves. In addition, nerve US imaging enabled monitoring of the size and number of schwannoma-like fascicular enlargements in median nerve trunks. CONCLUSION In contrast to conventional nerve conduction studies, CMAP scan MUNE in combination with US nerve imaging can quantify the NF2-associated neuropathy and may help to monitor disease progression and drug treatments. Muscle Nerve 55: 350-358, 2017.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Sabriena Buschbaum
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Hugh Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Peter Grafe
- Physiological Genomics, Institute of Physiology, Ludwig-Maximilians University Munich, Pettenkoferstrasse 12, 80336, Munich, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
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11
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Hutter S, Piro RM, Waszak SM, Kehrer-Sawatzki H, Friedrich RE, Lassaletta A, Witt O, Korbel JO, Lichter P, Schuhmann MU, Pfister SM, Tabori U, Mautner VF, Jones DTW. No correlation between NF1 mutation position and risk of optic pathway glioma in 77 unrelated NF1 patients. Hum Genet 2016; 135:469-475. [PMID: 26969325 DOI: 10.1007/s00439-016-1646-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/06/2016] [Indexed: 01/08/2023]
Abstract
Neurofibromatosis type 1 (NF1) is a common monogenic disorder whereby affected individuals are predisposed to developing CNS tumors, including optic pathway gliomas (OPGs, occurring in ~15 to 20 % of cases). So far, no definite genotype-phenotype correlation determining NF1 patients at risk for tumor formation has been described, although enrichment for mutations in the 5' region of the NF1 gene in OPG patients has been suggested. We used whole exome sequencing, targeted sequencing, and copy number analysis to screen 77 unrelated NF1 patients with (n = 41) or without (n = 36; age ≥10 years) optic pathway glioma for germline NF1 alterations. We identified germline NF1 mutations in 69 of 77 patients (90 %), but no genotype-phenotype correlation was observed. Our data using a larger patient cohort did not confirm the previously reported clustering of mutations in the 5' region of the NF1 gene in patients with OPG. Thus, NF1 mutation location should not currently be used as a clinical criterion to assess the risk of developing OPGs.
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Affiliation(s)
- Sonja Hutter
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Rosario M Piro
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany.,Institute of Computer Science, Freie Universität Berlin, Berlin, Germany.,Institute of Medical Genetics and Human Genetics, Charité University Hospital, Berlin, Germany
| | - Sebastian M Waszak
- European Molecular Biology Laboratory (EMBL), Genome Biology Research Unit, Heidelberg, Germany
| | | | - Reinhard E Friedrich
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alvaro Lassaletta
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Olaf Witt
- German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jan O Korbel
- European Molecular Biology Laboratory (EMBL), Genome Biology Research Unit, Heidelberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.,Centre for Neurofibromatosis, Centre for Rare Diseases Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) Partner Site Tübingen, Tübingen, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Uri Tabori
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Victor F Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany.
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12
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Salamon J, Papp L, Tóth Z, Laqmani A, Apostolova I, Adam G, Mautner VF, Derlin T. Nerve Sheath Tumors in Neurofibromatosis Type 1: Assessment of Whole-Body Metabolic Tumor Burden Using F-18-FDG PET/CT. PLoS One 2015; 10:e0143305. [PMID: 26625155 PMCID: PMC4666520 DOI: 10.1371/journal.pone.0143305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022] Open
Abstract
Purpose To determine the metabolically active whole-body tumor volume (WB-MTV) on F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in individuals with neurofibromatosis type 1 (NF1) using a three-dimensional (3D) segmentation and computerized volumetry technique, and to compare PET WB-MTV between patients with benign and malignant peripheral nerve sheath tumors (PNSTs). Patients and Methods Thirty-six NF1 patients (18 patients with malignant PNSTs and 18 age- and sex-matched controls with benign PNSTs) were examined by F-18-FDG PET/CT. WB-MTV, whole-body total lesion glycolysis (WB-TLG) and a set of semi-quantitative imaging-based parameters were analyzed both on a per-patient and a per-lesion basis. Results On a per-lesion basis, malignant PNSTs demonstrated both a significantly higher MTV and TLG than benign PNSTs (p < 0.0001). On a per-patient basis, WB-MTV and WB-TLG were significantly higher in patients with malignant PNSTs compared to patients with benign PNSTs (p < 0.001). ROC analysis showed that MTV and TLG could be used to differentiate between benign and malignant tumors. Conclusions WB-MTV and WB-TLG may identify malignant change and may have the potential to provide a basis for investigating molecular biomarkers that correlate with metabolically active disease manifestations. Further evaluation will determine the potential clinical impact of these PET-based parameters in NF1.
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Affiliation(s)
- Johannes Salamon
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - László Papp
- Mediso Medical Imaging Systems, Budapest, Hungary
| | | | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F. Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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Abstract
UNLABELLED Neurofibromatosis type 1 (NF1) is a neurogenetic disorder. Individuals with NF1 may develop a variety of benign and malignant tumors of which peripheral nerve sheath tumors represent the most frequent entity. Plexiform neurofibromas may demonstrate a locally destructive growth pattern, may cause severe symptoms and may undergo malignant transformation into malignant peripheral nerve sheath tumors (MPNSTs). Whole-body magnetic resonance imaging (MRI) represents the reference standard for detection of soft tissue tumors in NF1. It allows for identification of individuals with plexiform neurofibromas, for assessment of local tumor extent, and for evaluation of whole-body tumor burden on T2-weighted imaging. Multiparametric MRI may provide a comprehensive characterization of different tissue properties of peripheral nerve sheath tumors, and may identify parameters associated with malignant transformation. Due to the absence of any radiation exposure, whole-body MRI may be used for serial follow-up of individuals with plexiform neurofibromas. (18)F-fluorodeoxyglucose positron-emission-tomography (FDG PET/CT) allows a highly sensitive and specific detection of MPNST, and should be used in case of potential malignant transformation of a peripheral nerve sheath tumor. PET/CT provides a sensitive whole-body tumor staging. The use of contrast-enhanced CT for diagnosis of peripheral nerve sheath tumors is limited to special indications. To obtain the most precise readings, optimized examination protocols and dedicated radiologists and nuclear medicine physicians familiar with the complex and variable morphologies of peripheral nerve sheath tumors are required. KEY POINTS Individuals with NF1 may develop benign and malignant nerve sheath tumors. Whole-body MRI is the reference standard to identify nerve sheath tumors in NF1. MRI provides a comprehensive characterization of the growth pattern, growth dynamics and extent of nerve sheath tumors. (18)F-FDG PET/CT provides a sensitivity of 100% and a specificity of 77-95% for detection of malignant transformation.
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Affiliation(s)
- J Salamon
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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Zimerman M, Wessel MJ, Timmermann JE, Granström S, Gerloff C, Mautner VF, Hummel FC. Impairment of Procedural Learning and Motor Intracortical Inhibition in Neurofibromatosis Type 1 Patients. EBioMedicine 2015; 2:1430-7. [PMID: 26629537 PMCID: PMC4634358 DOI: 10.1016/j.ebiom.2015.08.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background Cognitive difficulties are the most common neurological complications in neurofibromatosis type 1 (NF1) patients. Recent animal models proposed increased GABA-mediated inhibition as one underlying mechanism directly affecting the induction of long-term potentiation (LTP) and learning. In most adult NF1 patients, apparent cognitive and attentional deficits, tumors affecting the nervous system and other confounding factors for neuroscientific studies are difficult to control for. Here we used a highly specific group of adult NF1 patients without cognitive or nervous system impairments. Such selected NF1 patients allowed us to address the following open questions: Is the learning process of acquiring a challenging motor skill impaired in NF1 patients? And is such an impairment in relation to differences in intracortical inhibition? Methods We used an established non-invasive, double-pulse transcranial magnetic stimulation (dp-TMS) paradigm to assess practice-related modulation of intracortical inhibition, possibly mediated by gamma-minobutyric acid (GABA)ergic-neurotransmission. This was done during an extended learning paradigm in a group of NF1 patients without any neuropsychological deficits, functioning normally in daily life and compared them to healthy age-matched controls. Findings NF1 patients experienced substantial decline in motor skill acquisition (F = 9.2, p = 0.008) over five-consecutives training days mediated through a selective reduction in the early acquisition (online) and the consolidation (offline) phase. Furthermore, there was a consistent decrease in task-related intracortical inhibition as a function of the magnitude of learning (T = 2.8, p = 0.014), especially evident after the early acquisition phase. Interpretations Collectively, the present results provide evidence that learning of a motor skill is impaired even in clinically intact NF1 patients based, at least partially, on a GABAergic-cortical dysfunctioning as suggested in previous animal work. Learning of a fine motor skill is altered even in normal intelligent NF1-individuals well integrated in daily professional and social life. The decline in motor learning is mediated by a reduction in fast-online and offline learning. Decline in learning was associated with an impairment of the modulation of inhibitory intracortical neurotransmission
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Affiliation(s)
- Máximo Zimerman
- Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
- Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
- Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
| | - Maximilian J. Wessel
- Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan E. Timmermann
- Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Sofia Granström
- Section for Neurofibromatosis, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Gerloff
- Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Victor F. Mautner
- Section for Neurofibromatosis, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Friedhelm C. Hummel
- Brain Imaging and NeuroStimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
- Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
- *Corresponding author at: Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Apostolova I, Niedzielska D, Derlin T, Koziolek EJ, Amthauer H, Salmen B, Pahnke J, Brenner W, Mautner VF, Buchert R. Perfusion single photon emission computed tomography in a mouse model of neurofibromatosis type 1: towards a biomarker of neurologic deficits. J Cereb Blood Flow Metab 2015; 35:1304-12. [PMID: 25785829 PMCID: PMC4528004 DOI: 10.1038/jcbfm.2015.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 10/28/2014] [Revised: 01/21/2015] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a single-gene disorder affecting neurologic function in humans. The NF1+/- mouse model with germline mutation of the NF1 gene presents with deficits in learning, attention, and motor coordination, very similar to NF1 patients. The present study performed brain perfusion single-photon emission computed tomography (SPECT) in NF1+/- mice to identify possible perfusion differences as surrogate marker for altered cerebral activity in NF1. Cerebral perfusion was measured with hexamethyl-propyleneamine oxime (HMPAO) SPECT in NF1+/- mice and their wild-type littermates longitudinally at juvenile age and at young adulthood. Histology and immunohistochemistry were performed to test for structural changes. There was increased HMPAO uptake in NF1 mice in the amygdala at juvenile age, which reduced to normal levels at young adulthood. There was no genotype effect on thalamic HMPAO uptake, which was confirmed by ex vivo measurements of F-18-fluorodeoxyglucose uptake in the thalamus. Morphologic analyses showed no major structural abnormalities. However, there was some evidence of increased density of microglial somata in the amygdala of NF1-deficient mice. In conclusion, there is evidence of increased perfusion and increased density of microglia in juvenile NF1 mice specifically in the amygdala, both of which might be associated with altered synaptic plasticity and, therefore, with cognitive deficits in NF1.
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Affiliation(s)
- Ivayla Apostolova
- 1] Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany [2] Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Dagmara Niedzielska
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Eva J Koziolek
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Benedikt Salmen
- Neuroscience Research Center, University Medicine Charité Berlin, Berlin, Germany
| | - Jens Pahnke
- 1] Department of Neuropathology, Oslo University Hospital (OUS), University of Oslo (UiO), Oslo, Norway [2] LIED, University of Lübeck, Lübeck, Germany [3] Leibniz Institute of Plant Biochemistry, Halle, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Medicine Charité Berlin, Berlin, Germany
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16
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Jett K, Nguyen R, Arman D, Birch P, Chohan H, Farschtschi S, Fuensterer C, Kluwe L, Friedman JM, Mautner VF. Quantitative associations of scalp and body subcutaneous neurofibromas with internal plexiform tumors in neurofibromatosis 1. Am J Med Genet A 2015; 167:1518-24. [PMID: 25900062 DOI: 10.1002/ajmg.a.37068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 09/11/2014] [Accepted: 03/06/2015] [Indexed: 01/24/2023]
Abstract
Internal plexiform neurofibromas are a major cause of adverse outcomes in patients with neurofibromatosis 1 (NF1). We investigated the relationship of the numbers of subcutaneous neurofibromas of the scalp or body to internal plexiform tumor volume in 120 NF1 patients who had undergone whole body magnetic resonance imaging (MRI). We identified internal plexiform neurofibromas in 55% of patients, subcutaneous neurofibromas of the body in 75%, and subcutaneous neurofibromas of the scalp in 45%. The number of subcutaneous neurofibromas of the body and scalp were associated with each other (Spearman's Rho = 0.36; P < 0.001). The presence of internal tumors was associated with the presence (odds ratio [OR] = 4.38, 95% confidence interval [CI] 2.04-9.86, P < 0.001) and number (OR = 1.06 per neurofibroma, 95% CI 1.02-1.13, P < 0.001) of subcutaneous neurofibromas of the scalp. The total internal tumor volume was associated with the number of subcutaneous neurofibromas of the body (OR = 1.00086 per neurofibroma, 1.000089-1.0016, P = 0.029) and of the scalp (OR = 1.056 per neurofibroma, 1.029-1.083, P < 0.0001). Numbers of subcutaneous neurofibromas of the scalp and body are associated with internal plexiform tumor burden in NF1. Recognition of these associations may improve clinical management by helping to identify patients who will benefit most from whole body MRI and more intense clinical surveillance.
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Affiliation(s)
- Kimberly Jett
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Rosa Nguyen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatrics, University of Maryland Medical Center, Baltimore, Maryland
| | - Darian Arman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Patricia Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Harleen Chohan
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Jiang W, Mautner VF, Friedrich RE, Kluwe L. Preclinical assessment of the anticancer drug response of plexiform neurofibroma tissue using primary cultures. J Clin Neurol 2015; 11:172-7. [PMID: 25851896 PMCID: PMC4387483 DOI: 10.3988/jcn.2015.11.2.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Individualized drug testing for tumors using a strategy analogous to antibiotic tests for infectious diseases would be highly desirable for personalized and individualized cancer care. METHODS Primary cultures containing tumor and nontumor stromal cells were utilized in a novel strategy to test drug responses with respect to both efficacy and specificity. The strategy tested in this pilot study was implemented using four primary cultures derived from plexiform neurofibromas. Responses to two cytotoxic drugs (nilotinib and imatinib) were measured by following dose-dependent changes in the proportions of tumor and nontumor cells, determined by staining them with cell-type-specific antibodies. The viability of the cultured cells and the cytotoxic effect of the drugs were also measured using proliferation and cytotoxicity assays. RESULTS The total number of cells decreased after the drug treatment, in accordance with the observed reduction in proliferation and increased cytotoxic effect upon incubation with the two anticancer drugs. The proportions of Schwann cells and fibroblasts changed dose-dependently, although the patterns of change varied between the tumor samples (from different sources) and between the two drugs. The highly variable in vitro drug responses probably reflect the large variations in the responses of tumors to therapies between individual patients in vivo. CONCLUSIONS These preliminary results suggest that the concept of assessing in vitro drug responses using primary cultures is feasible, but demands the extensive further development of an application for preclinical drug selection and drug discovery.
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Affiliation(s)
- Wei Jiang
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Kobus K, Hartl D, Ott CE, Osswald M, Huebner A, von der Hagen M, Emmerich D, Kühnisch J, Morreau H, Hes FJ, Mautner VF, Harder A, Tinschert S, Mundlos S, Kolanczyk M. Double NF1 inactivation affects adrenocortical function in NF1Prx1 mice and a human patient. PLoS One 2015; 10:e0119030. [PMID: 25775093 PMCID: PMC4361563 DOI: 10.1371/journal.pone.0119030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 01/12/2015] [Indexed: 01/25/2023] Open
Abstract
Background Neurofibromatosis type I (NF1, MIM#162200) is a relatively frequent genetic condition, which predisposes to tumor formation. Apart from tumors, individuals with NF1 often exhibit endocrine abnormalities such as precocious puberty (2,5–5% of NF1 patients) and some cases of hypertension (16% of NF1 patients). Several cases of adrenal cortex adenomas have been described in NF1 individuals supporting the notion that neurofibromin might play a role in adrenal cortex homeostasis. However, no experimental data were available to prove this hypothesis. Materials and Methods We analysed Nf1Prx1 mice and one case of adrenal cortical hyperplasia in a NF1patient. Results In Nf1Prx1 mice Nf1 is inactivated in the developing limbs, head mesenchyme as well as in the adrenal gland cortex, but not the adrenal medulla or brain. We show that adrenal gland size is increased in NF1Prx1 mice. Nf1Prx1 female mice showed corticosterone and aldosterone overproduction. Molecular analysis of Nf1 deficient adrenals revealed deregulation of multiple proteins, including steroidogenic acute regulatory protein (StAR), a vital mitochondrial factor promoting transfer of cholesterol into steroid making mitochondria. This was associated with a marked upregulation of MAPK pathway and a female specific increase of cAMP concentration in murine adrenal lysates. Complementarily, we characterized a patient with neurofibromatosis type I with macronodular adrenal hyperplasia with ACTH-independent cortisol overproduction. Comparison of normal control tissue- and adrenal hyperplasia- derived genomic DNA revealed loss of heterozygosity (LOH) of the wild type NF1 allele, showing that biallelic NF1 gene inactivation occurred in the hyperplastic adrenal gland. Conclusions Our data suggest that biallelic loss of Nf1 induces autonomous adrenal hyper-activity. We conclude that Nf1 is involved in the regulation of adrenal cortex function in mice and humans.
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Affiliation(s)
- Karolina Kobus
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
- * E-mail: (MK); (KK)
| | - Daniela Hartl
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Eric Ott
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
| | - Monika Osswald
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
| | - Angela Huebner
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Denise Emmerich
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
| | - Jirko Kühnisch
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
| | - Hans Morreau
- Department of Pathology, Leiden University Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Frederik J. Hes
- Department of Clinical Genetics, Leiden University Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Victor F. Mautner
- Department of Maxillofacial Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Anja Harder
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Sigrid Tinschert
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Mundlos
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Mateusz Kolanczyk
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, FG Development & Disease, Berlin, Germany
- * E-mail: (MK); (KK)
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19
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Hutter S, Piro RM, Reuss DE, Hovestadt V, Sahm F, Farschtschi S, Kehrer-Sawatzki H, Wolf S, Lichter P, von Deimling A, Schuhmann MU, Pfister SM, Jones DTW, Mautner VF. Whole exome sequencing reveals that the majority of schwannomatosis cases remain unexplained after excluding SMARCB1 and LZTR1 germline variants. Acta Neuropathol 2014; 128:449-52. [PMID: 25008767 DOI: 10.1007/s00401-014-1311-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sonja Hutter
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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20
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Merker VL, Bredella MA, Cai W, Kassarjian A, Harris GJ, Muzikansky A, Nguyen R, Mautner VF, Plotkin SR. Relationship between whole-body tumor burden, clinical phenotype, and quality of life in patients with neurofibromatosis. Am J Med Genet A 2014; 164A:1431-7. [DOI: 10.1002/ajmg.a.36466] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/03/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Vanessa L. Merker
- Department of Neurology and Cancer Center; Massachusetts General Hospital; Boston Massachusetts
| | - Miriam A. Bredella
- Department of Radiology; Massachusetts General Hospital; Boston Massachusetts
| | - Wenli Cai
- Department of Radiology; Massachusetts General Hospital; Boston Massachusetts
| | - Ara Kassarjian
- Department of Radiology; Corades, S.L.; Majadahonda Spain
| | - Gordon J. Harris
- Department of Radiology; Massachusetts General Hospital; Boston Massachusetts
| | - Alona Muzikansky
- Biostatistics Center; Massachusetts General Hospital; Boston Massachusetts
| | - Rosa Nguyen
- Department of Pediatrics; University of Maryland; Baltimore Maryland
- Department of Neurology; University Hospital; Hamburg Germany
| | | | - Scott R. Plotkin
- Department of Neurology and Cancer Center; Massachusetts General Hospital; Boston Massachusetts
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21
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Schnabel C, Dahm S, Streichert T, Thierfelder W, Kluwe L, Mautner VF. Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1. Clin Biochem 2014; 47:560-3. [PMID: 24613576 DOI: 10.1016/j.clinbiochem.2014.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/14/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients. DESIGN AND METHODS NF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls. RESULTS 52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5nmol/l) in NF1 adults. This increase was even larger (p=0.0001) than in healthy controls (mean: 50.5 to 60.5nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer. CONCLUSIONS Only adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.
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Affiliation(s)
- Claudia Schnabel
- Institute of Clinical Chemistry, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | | | - Thomas Streichert
- Institute of Clinical Chemistry, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | - Lan Kluwe
- Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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22
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Salamon J, Veldhoen S, Apostolova I, Bannas P, Yamamura J, Herrmann J, Friedrich RE, Adam G, Mautner VF, Derlin T. 18F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUVmax cut-off. Eur Radiol 2013; 24:405-12. [PMID: 24097302 DOI: 10.1007/s00330-013-3020-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate the usefulness of normalising intra-tumour tracer accumulation on (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to reference tissue uptake for characterisation of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1) compared with the established maximum standardised uptake value (SUVmax) cut-off of >3.5. METHODS Forty-nine patients underwent FDG PET/CT. Intra-tumour tracer uptake (SUVmax) was normalised to three different reference tissues (tumour-to-liver, tumour-to-muscle and tumour-to-fat ratios). Receiver operating characteristic (ROC) analyses were used out to assess the diagnostic performance. Histopathology and follow-up served as the reference standard. RESULTS Intra-tumour tracer uptake correlated significantly with liver uptake (rs= 0.58, P = 0.016). On ROC analysis, the optimum threshold for tumour-to-liver ratio was >2.6 (AUC = 0.9735). Both the SUVmax cut-off value of >3.5 and a tumour-to-liver ratio >2.6 provided a sensitivity of 100 %, but specificity was significantly higher for the latter (90.3% vs 79.8%; P = 0.013). CONCLUSIONS In patients with NF1, quantitative (18)F-FDG PET imaging may identify malignant change in neurofibromas with high accuracy. Specificity could be significantly increased by using the tumour-to-liver ratio. The authors recommend further evaluation of a tumour-to-liver ratio cut-off value of >2.6 for diagnostic intervention planning. KEY POINTS • (18)F-FDG PET/CT is used for detecting malignancy in PNSTs in NF1 patients • An SUV max cut-off value may give false-positive results for benign plexiform neurofibromas • Specificity can be significantly increased using a tumour-to-liver ratio.
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Affiliation(s)
- Johannes Salamon
- Department of Diagnostic and Interventional Radiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany,
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Mohan P, Castellsague J, Jiang J, Allen K, Chen H, Nemirovsky O, Spyra M, Hu K, Kluwe L, Pujana MA, Villanueva A, Mautner VF, Keats JJ, Dunn SE, Lazaro C, Maxwell CA. Genomic imbalance of HMMR/RHAMM regulates the sensitivity and response of malignant peripheral nerve sheath tumour cells to aurora kinase inhibition. Oncotarget 2013; 4:80-93. [PMID: 23328114 PMCID: PMC3702209 DOI: 10.18632/oncotarget.793] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Malignant peripheral nerve sheath tumours (MPNST) are rare, hereditary cancers associated with neurofibromatosis type I. MPNSTs lack effective treatment options as they often resist chemotherapies and have high rates of disease recurrence. Aurora kinase A (AURKA) is an emerging target in cancer and an aurora kinase inhibitor (AKI), termed MLN8237, shows promise against MPNST cell lines in vitro and in vivo. Here, we test MLN8237 against two primary human MPNST grown in vivo as xenotransplants and find that treatment results in tumour cells exiting the cell cycle and undergoing endoreduplication, which cumulates in stabilized disease. Targeted therapies can often fail in the clinic due to insufficient knowledge about factors that determine tumour susceptibilities, so we turned to three MPNST cell-lines to further study and modulate the cellular responses to AKI. We find that the sensitivity of cell-lines with amplification of AURKA depends upon the activity of the kinase, which correlates with the expression of the regulatory gene products TPX2 and HMMR/RHAMM. Silencing of HMMR/RHAMM, but not TPX2, augments AURKA activity and sensitizes MPNST cells to AKI. Furthermore, we find that AURKA activity is critical to the propagation and self-renewal of sphere-enriched MPNST cancer stem-like cells. AKI treatment significantly reduces the formation of spheroids, attenuates the self-renewal of spheroid forming cells, and promotes their differentiation. Moreover, silencing of HMMR/RHAMM is sufficient to endow MPNST cells with an ability to form and maintain sphere culture. Collectively, our data indicate that AURKA is a rationale therapeutic target for MPNST and tumour cell responses to AKI, which include differentiation, are modulated by the abundance of HMMR/RHAMM.
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Affiliation(s)
- Pooja Mohan
- Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Derlin T, Salamon J, Bannas P, Busch JD, Herrmann J, Hagel C, Friedrich RE, Adam G, Mautner VF. Intratumorale Heterogenität der Traceraufnahme in der F-18 FDG PET/CT als Charakteristikum maligner peripherer Nervenscheidentumore bei Patienten mit Neurofibromatose Typ 1. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Park SJ, Sawitzki B, Kluwe L, Mautner VF, Holtkamp N, Kurtz A. Serum biomarkers for neurofibromatosis type 1 and early detection of malignant peripheral nerve-sheath tumors. BMC Med 2013; 11:109. [PMID: 23618374 PMCID: PMC3648455 DOI: 10.1186/1741-7015-11-109] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/08/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a hereditary tumor syndrome characterized by the development of benign nerve-sheath tumors, which transform to malignant peripheral nerve-sheath tumors (MPNST) in about 8 to 13% of patients with NF1. MPNST are invasive sarcomas with extremely poor prognosis, and their development may correlate with internal tumor load of patients with NF1. Because early identification of patients with NF1 at risk for developing MPNST should improve their clinical outcome, the aim of this study was to identify serum biomarkers for tumor progression in NF1, and to analyze their correlation with tumor type and internal tumor load. METHODS We selected candidate biomarkers for NF1 by manually mining published data sources, and conducted a systematic screen of 56 candidate serum biomarkers using customized antibody arrays. Serum from 104 patients with NF1 with and without MPNST, and from 41 healthy control subjects, was analyzed. Statistical analysis was performed using the non-parametric Mann-Whitney U-test, followed by Bonferroni correction. RESULTS Our analysis identified four markers (epidermal growth factor receptor, interferon-γ, interleukin-6, and tumor necrosis factor-α) for which significantly different serum concentrations were seen in patients with NF1 compared with healthy controls. Two markers (insulin-like growth factor binding protein 1 (IGFBP1) and regulated upon activation, normal T-cell expressed and secreted (RANTES)) showed significantly higher concentrations in patients with NF1 and MPNST compared with patients with NF1 without MPNST. A correlation with internal tumor load was found for IGFBP1. CONCLUSION Our study identified two serum markers with potential for early detection of patients with NF1 at risk for developing MPNST, and four markers that could distinguish between patients with NF1 and healthy subjects. Such markers may be useful as diagnostic tools to support the diagnosis of NF1 and for timely identification of MPNST. Moreover, the data suggest that there is a systemic increase in inflammatory cytokines independently of tumor load in patients with NF1.
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Affiliation(s)
- Su-Jin Park
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
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26
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Smith MJ, Esparza S, Merker VL, Muzikansky A, Bredella MA, Harris GJ, Kassarjian A, Cai W, Walker JA, Mautner VF, Plotkin SR. Plasma S100β is not a useful biomarker for tumor burden in neurofibromatosis. Clin Biochem 2012; 46:698-700. [PMID: 23261835 DOI: 10.1016/j.clinbiochem.2012.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/26/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Neurofibromatosis 1 (NF1), NF2, and schwannomatosis are characterized by a predisposition to develop multiple neurofibromas and schwannomas. Currently, there is no blood test to estimate tumor burden in patients with these disorders. We explored whether S100β would act as a biomarker of tumor burden in NF since S100β is a classic immunohistochemical marker of astrocytes, oligodendrocytes and Schwann cells and a small study showed S100β concentrations correlate with the volume of vestibular schwannomas. DESIGN AND METHODS We calculated whole-body tumor burden in subjects with NF1, NF2, and schwannomatosis using whole-body MRI (WBMRI) and measured the concentration of S100β in plasma using ELISA. We used chi-square tests and Spearman rank correlations to test the relationship between S100β levels and whole-body tumor burden. RESULTS 127 consecutive patients were enrolled in the study (69 NF1 patients, 28 NF2 patients, and 30 schwannomatosis patients). The median age was 40years, 43% were male, and median whole-body tumor volume was 26.9mL. There was no relationship between the presence of internal tumors and the presence of detectable S100β in blood for the overall group or for individual diagnoses (p>0.05 by chi-square for all comparisons). Similarly, there was no correlation between whole-body tumor volume and S100β concentration for the overall group or for individual diagnoses (p>0.05 by Spearman for all comparisons). CONCLUSIONS Plasma S100β is not a useful biomarker for tumor burden in the neurofibromatoses. Further work is needed to identify a reliable biomarker of tumor burden in NF patients.
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Affiliation(s)
- Miriam J Smith
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Salamon J, Derlin T, Bannas P, Busch JD, Herrmann J, Bockhorn M, Hagel C, Friedrich RE, Adam G, Mautner VF. Evaluation of intratumoural heterogeneity on ¹⁸F-FDG PET/CT for characterization of peripheral nerve sheath tumours in neurofibromatosis type 1. Eur J Nucl Med Mol Imaging 2012; 40:685-92. [PMID: 23232507 DOI: 10.1007/s00259-012-2314-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/23/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the study was to evaluate the potential usefulness of intratumoural tracer uptake heterogeneity on (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT as compared to a cut-off maximum standardized uptake value (SUVmax) for characterization of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1). METHODS Fifty patients suffering from NF1 were examined by (18)F-FDG PET/CT. Intralesional tracer uptake was analysed qualitatively and semi-quantitatively by measuring the mean and maximum SUV. Uptake heterogeneity was graded qualitatively using a three-point scale and semi-quantitatively by calculating an SUV-based heterogeneity index (HISUV). Cohen's κ was used to determine inter- and intra-rater agreement. Histopathological evaluation and clinical as well as radiological follow-up examinations served as the reference standards. RESULTS A highly significant correlation between the degree of intratumoural uptake heterogeneity on (18)F-FDG PET and malignant transformation of PNSTs was observed (p < 0.0001). Semi-quantitative HISUV was significantly higher in malignant PNSTs (MPNSTs) than in benign tumours (p = 0.0002). Both intralesional heterogeneity and SUVmax could be used to identify malignant tumours with a sensitivity of 100 %. Cohen's κ was 0.86 for inter-rater agreement and 0.88 for intra-rater agreement on heterogeneity. CONCLUSION MPNSTs in patients with NF1 demonstrate considerable intratumoural uptake heterogeneity on (18)F-FDG PET/CT. Assessment of tumour heterogeneity is highly reproducible. Both tumour heterogeneity and a cut-off SUVmax may be used to sensitively identify malignant PNSTs, but the specificity is higher for the latter. A combination of both methods leads to a non-significant improvement in diagnostic performance.
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Affiliation(s)
- Johannes Salamon
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Langenbruch A, Mautner VF, Granström S, Augustin M. Disease related stress in children with Neurofibromatosis type 1 in Germany from their own and their parents´ perspective. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jaremko JL, MacMahon PJ, Torriani M, Merker VL, Mautner VF, Plotkin SR, Bredella MA. Whole-body MRI in neurofibromatosis: incidental findings and prevalence of scoliosis. Skeletal Radiol 2012; 41:917-23. [PMID: 22146869 DOI: 10.1007/s00256-011-1333-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 11/12/2011] [Accepted: 11/13/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To demonstrate incidental findings and scoliosis on whole-body MRI (WBMRI) in patients with neurofibromatosis type 1 and 2 (NF1 & NF2, respectively), and schwannomatosis. MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained for this prospective HIPAA-compliant study. A total of 247 subjects (141 with NF1, 55 with NF2, 51 with schwannomatosis; 132 women (53.5%); mean age, 41 years, range, 18-97 years) underwent WBMRI using coronal STIR (TR/TE: 4190/111 ms, TI: 150 ms) and T1-weighted images (TR/TE: 454/10 ms), 10-mm slice thickness, imaging time ~40 min. Images were reviewed for the presence of incidental findings, outside of nerve sheath tumors. The presence of scoliosis was recorded and curve morphology was assessed and quantified. RESULTS Incidental findings other than scoliosis were recorded in 104/247 (42%) patients, most often affecting the musculoskeletal system (65/247 patients, 26%). We found 16/247 (6.5%) significant incidental findings likely to affect clinical management, including avascular necrosis of bone in eight patients (five with NF2), eight insufficiency fractures, and four non-neurogenic neoplasms (Hodgkin's lymphoma, liposarcoma, dermoid cyst, large uterine myoma requiring excision). Scoliosis was seen in 50/247 patients (20%), including 8/55 with NF2 (15%) and 11/51 with schwannomatosis (22%). CONCLUSIONS Incidental findings in the neurofibromatoses frequently involve the skeleton. Given the relatively high incidence of unsuspected osteonecrosis and stress fractures, close attention to the skeleton on WBMRI is advised. In addition, knowledge of common incidental findings can help clinicians prepare patients who undergo WBMRI for potential unexpected findings.
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Affiliation(s)
- Jacob L Jaremko
- Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Bäumer P, Mautner VF, Bäumer T, Schuhmann MU, Tatagiba M, Heiland S, Kaestel T, Bendszus M, Pham M. Accumulation of non-compressive fascicular lesions underlies NF2 polyneuropathy. J Neurol 2012; 260:38-46. [PMID: 22760943 DOI: 10.1007/s00415-012-6581-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/24/2012] [Accepted: 06/09/2012] [Indexed: 12/19/2022]
Abstract
A distinct polyneuropathy (PNP) syndrome affects up to 66 % of patients with neurofibromatosis II (NF2). Whether this is primarily a diffuse PNP or due to single, surgically amenable mass lesions has not yet been conclusively demonstrated. We aimed to solve this question by investigating the pathomorphological MR imaging correlate of this rare disorder. Eight patients with NF2-PNP were characterized by clinical examination, electrophysiological studies, and genetic analysis. All patients additionally underwent extended peripheral nerve imaging by a novel protocol of large-coverage high-resolution MRI. Quantitative analyses were performed by separately evaluating cross-sectional images, and by categorizing lesions into non-compressive fascicular microlesions (<2 mm), intermediate lesions (2-5 mm), and compressive macrolesions (>5 mm). The predominant imaging findings were non-compressive fascicular microlesions and intermediate lesions. Proximal-to-distal cumulative lesion burden of these lesions correlated strongly with the severity of clinical symptoms of NF2-PNP. In contrast, compressive macrolesions were not found at all in several symptomatic extremities. We conclude that proximal-to-distal accumulation of non-compressive fascicular lesions instead of compressive mass lesions predominantly underlies the clinical manifestation and severity of NF2-associated PNP. Diagnostic management may now be assisted by large-coverage high-resolution imaging of plexus and peripheral nerves. Additionally, the results underscore the feasibility of this new method, which may open up new diagnostic and investigative possibilities for other disseminated disorders of the peripheral nervous system.
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Affiliation(s)
- P Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Plotkin SR, Bredella MA, Cai W, Kassarjian A, Harris GJ, Esparza S, Merker VL, Munn LL, Muzikansky A, Askenazi M, Nguyen R, Wenzel R, Mautner VF. Quantitative assessment of whole-body tumor burden in adult patients with neurofibromatosis. PLoS One 2012; 7:e35711. [PMID: 22558206 PMCID: PMC3338705 DOI: 10.1371/journal.pone.0035711] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/20/2012] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Patients with neurofibromatosis 1 (NF1), NF2, and schwannomatosis are at risk for multiple nerve sheath tumors and premature mortality. Traditional magnetic resonance imaging (MRI) has limited ability to assess disease burden accurately. The aim of this study was to establish an international cohort of patients with quantified whole-body internal tumor burden and to correlate tumor burden with clinical features of disease. METHODS We determined the number, volume, and distribution of internal nerve sheath tumors in patients using whole-body MRI (WBMRI) and three-dimensional computerized volumetry. We quantified the distribution of tumor volume across body regions and used unsupervised cluster analysis to group patients based on tumor distribution. We correlated the presence and volume of internal tumors with disease-related and demographic factors. RESULTS WBMRI identified 1286 tumors in 145/247 patients (59%). Schwannomatosis patients had the highest prevalence of tumors (P = 0.03), but NF1 patients had the highest median tumor volume (P = 0.02). Tumor volume was unevenly distributed across body regions with overrepresentation of the head/neck and pelvis. Risk factors for internal nerve sheath tumors included decreasing numbers of café-au-lait macules in NF1 patients (P = 0.003) and history of skeletal abnormalities in NF2 patients (P = 0.09). Risk factors for higher tumor volume included female gender (P = 0.05) and increasing subcutaneous neurofibromas (P = 0.03) in NF1 patients, absence of cutaneous schwannomas in NF2 patients (P = 0.06), and increasing age in schwannomatosis patients (p = 0.10). CONCLUSION WBMRI provides a comprehensive phenotype of neurofibromatosis patients, identifies distinct anatomic subgroups, and provides the basis for investigating molecular biomarkers that correlate with unique disease manifestations.
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Affiliation(s)
- Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
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Borrego-Diaz E, Terai K, Lialyte K, Wise AL, Esfandyari T, Behbod F, Mautner VF, Spyra M, Taylor S, Parada LF, Upadhyaya M, Farassati F. Overactivation of Ras signaling pathway in CD133+ MPNST cells. J Neurooncol 2012; 108:423-34. [DOI: 10.1007/s11060-012-0852-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 03/13/2012] [Indexed: 01/06/2023]
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Blessmann M, Gröbe A, Quaas A, Kaifi JT, Mistakidis G, Bernreuther C, Sauter G, Gros S, Rawnaq T, Friedrich R, Mautner VF, Smeets R, Heiland M, Schachner M, Izbicki JR. Adhesion molecule L1 is down-regulated in malignant peripheral nerve sheath tumors versus benign neurofibromatosis type 1–associated tumors. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:239-44. [DOI: 10.1016/j.tripleo.2011.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/14/2011] [Accepted: 04/15/2011] [Indexed: 01/27/2023]
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Hummel TR, Jessen WJ, Miller SJ, Kluwe L, Mautner VF, Wallace MR, Lázaro C, Page GP, Worley PF, Aronow BJ, Schorry EK, Ratner N. Gene expression analysis identifies potential biomarkers of neurofibromatosis type 1 including adrenomedullin. Clin Cancer Res 2010; 16:5048-57. [PMID: 20739432 DOI: 10.1158/1078-0432.ccr-10-0613] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [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: 12/11/2022]
Abstract
PURPOSE Plexiform neurofibromas (pNF) are Schwann cell tumors found in a third of individuals with neurofibromatosis type 1 (NF1). pNF can undergo transformation to malignant peripheral nerve sheath tumors (MPNST). There are no identified serum biomarkers of pNF tumor burden or transformation to MPNST. Serum biomarkers would be useful to verify NF1 diagnosis, monitor tumor burden, and/or detect transformation. EXPERIMENTAL DESIGN We used microarray gene expression analysis to define 92 genes that encode putative secreted proteins in neurofibroma Schwann cells, neurofibromas, and MPNST. We validated differential expression by quantitative reverse transcription-PCR, Western blotting, and ELISA assays in cell conditioned medium and control and NF1 patient sera. RESULTS Of 13 candidate genes evaluated, only adrenomedullin (ADM) was confirmed as differentially expressed and elevated in serum of NF1 patients. ADM protein concentrati on was further elevated in serum of a small sampling of NF1 patients with MPNST. MPNST cell conditioned medium, containing ADM and hepatocyte growth factor, stimulated MPNST migration and endothelial cell proliferation. CONCLUSIONS Thus, microarray analysis identifies potential serum biomarkers for disease, and ADM is a serum biomarker of NF1. ADM serum levels do not seem to correlate with the presence of pNFs but may be a biomarker of transformation to MPNST.
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Affiliation(s)
- Trent R Hummel
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Seitz S, Schnabel C, Busse B, Schmidt HU, Beil FT, Friedrich RE, Schinke T, Mautner VF, Amling M. High bone turnover and accumulation of osteoid in patients with neurofibromatosis 1. Osteoporos Int 2010; 21:119-27. [PMID: 19415373 DOI: 10.1007/s00198-009-0933-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Although it is known that neurofibromatosis 1 (NF1) patients suffer from vitamin D deficiency and display decreased bone mineral density (BMD), a systematic clinical and histomorphometrical analysis is absent. Our data demonstrate that NF1 patients display high bone turnover and accumulation of osteoid and that supplementation of vitamin D has a beneficial effect on their BMD. INTRODUCTION Neurofibromatosis 1 results in a wide range of clinical manifestations, including decreased BMD. Although it has been reported that NF1 patients have decreased vitamin D serum levels, the manifestation of the disease at the bone tissue level has rarely been analyzed. METHODS Thus, we performed a clinical evaluation of 14 NF1 patients in comparison to age- and sex-matched control individuals. The analysis included dual X-ray absorptiometry osteodensitometry, laboratory parameters, histomorphometric and quantitative backscattered electron imaging (qBEI) analyses of undecalcified bone biopsies. RESULTS NF1 patients display significantly lower 25-(OH)-cholecalciferol serum levels and decreased BMD compared to control individuals. Histomorphometric analysis did not only reveal a reduced trabecular bone volume in biopsies from NF1 patients, but also a significantly increased osteoid volume and increased numbers of osteoblasts and osteoclasts. Moreover, qBEI analysis revealed a significant decrease of the calcium content in biopsies from NF1 patients. To address the question whether a normalization of calcium homeostasis improves BMD in NF1 patients, we treated four patients with cholecalciferol for 1 year, which resulted in a significant increase of BMD. CONCLUSION Taken together, our data provide the first complete histomorphometric analysis from NF1 patients. Moreover, they suggest that low vitamin D levels significantly contribute to the skeletal defects associated with the disease.
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Affiliation(s)
- S Seitz
- Center for Biomechanics & Skeletal Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Mautner VF, Nguyen R, Kutta H, Fuensterer C, Bokemeyer C, Hagel C, Friedrich RE, Scott SR, Panse J. Bevacizumab induces regression of vestibular schwannomas leading to improved hearing in neurofibromatosis type 2 patients. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cai W, Kassarjian A, Bredella MA, Harris GJ, Yoshida H, Mautner VF, Wenzel R, Plotkin SR. Tumor Burden in Patients with Neurofibromatosis Types 1 and 2 and Schwannomatosis: Determination on Whole-Body MR Images. Radiology 2009; 250:665-673. [DOI: 10.1148/radiol.2503080700] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Brenner W, Mautner VF. Malignant Peripheral Nerve Sheath Tumors. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Friedrich RE, Hartmann M, Mautner VF. Malignant peripheral nerve sheath tumors (MPNST) in NF1-affected children. Anticancer Res 2007; 27:1957-60. [PMID: 17649804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) constitute a heterogeneous group of malignant tumors that probably arise from cells of the peripheral nerve sheath. Association of MPNST with neurofibromatosis type 1 (NF1) is frequently reported. MPNST contribute significantly to the reduced life-span of NF1-patients. At present there are only sparse data on MPNST in NF1-children. The aim of this study was to determine the outcome of children affected with NF1 who developed an MPNST. MATERIALS AND METHODS Over the period of 1985 to 2005, we followed 52 NF1 patients with MPNST at our outpatient department. All patients were diagnosed and re-evaluated according to the updated NIH diagnostic criteria for NF1. RESULTS Out of this cohort, 8 patients with MPNST were aged 1 to 17 years at the time of MPNST diagnosis (mean age: 12 years; 5 girls and 3 boys). We noticed the following characteristics: MPNST arose from plexiform neurofibromas (PNF) with invasive or displacing growth pattern on MRI. Many patients reported pain and neurological deficits at the time of presentation. Diagnosis of MPNST in this age group took longer compared to adults. This cohort did not show longer survival periods than adults with MPNST. Adjunctive treatment with chemotherapy or radiation had no lasting effect. The overall survival time of this small cohort was 30.5 months. Those children who died showed a median survival time after diagnosis of 20 months. The longest survival of 112 months was achieved for a girl who presented with MPNST of the distal upper arm and underwent amputation. The NF1 mutation analysis in the MPNST pediatric age group revealed the same mutational spectrum as the adult group. CONCLUSION Our data reveal MPNST in children with NF1. Children cannot verbalize physical alterations adequately; therefore the correct diagnosis might be hampered in these patients. Unresolved complaints of children with NF1 should be investigated thoroughly due to the risk for malignancy in NF1.
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Affiliation(s)
- R E Friedrich
- Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
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Bausch B, Borozdin W, Mautner VF, Hoffmann MM, Boehm D, Robledo M, Cascon A, Harenberg T, Schiavi F, Pawlu C, Peczkowska M, Letizia C, Calvieri S, Arnaldi G, Klingenberg-Noftz RD, Reisch N, Fassina A, Brunaud L, Walter MA, Mannelli M, MacGregor G, Palazzo FF, Barontini M, Walz MK, Kremens B, Brabant G, Pfäffle R, Koschker AC, Lohoefner F, Mohaupt M, Gimm O, Jarzab B, McWhinney SR, Opocher G, Januszewicz A, Kohlhase J, Eng C, Neumann HPH. Germline NF1 mutational spectra and loss-of-heterozygosity analyses in patients with pheochromocytoma and neurofibromatosis type 1. J Clin Endocrinol Metab 2007; 92:2784-92. [PMID: 17426081 DOI: 10.1210/jc.2006-2833] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a pheochromocytoma-associated syndrome. Because of the low prevalence of pheochromocytoma in NF1, we ascertained subjects by pheochromocytoma that also had NF1 in the hope of describing the germline NF1 mutational spectra of NF1-related pheochromocytoma. MATERIALS AND METHODS An international registry for NF1-pheochromocytomas was established. Mutation scanning was performed using denaturing HPLC for intragenic variation and quantitative PCR for large deletions. Loss-of-heterozygosity analysis using markers in and around NF1 was performed. RESULTS There were 37 eligible subjects (ages 14-70 yr). Of 21 patients with corresponding tumor available, 67% showed somatic loss of the nonmutated allele at the NF1 locus vs. 0 of 12 sporadic tumors (P = 0.0002). Overall, 86% of the 37 patients had exonic or splice site mutations, 14% large deletions or duplications; 79% of the mutations are novel. The cysteine-serine rich domain (CSR) was affected in 35% but the RAS GTPase activating protein domain (RGD) in only 13%. There did not appear to be an association between any clinical features, particularly pheochromocytoma presentation and severity, and NF1 mutation genotype. CONCLUSIONS The germline NF1 mutational spectra comprise intragenic mutations and deletions in individuals with pheochromocytoma and NF1. NF1 mutations tended to cluster in the CSR over the RAS-GAP domain, suggesting that CSR plays a more prominent role in individuals with NF1-pheochromocytoma than in NF1 individuals without this tumor. Loss-of-heterozygosity of NF1 markers in NF1-related pheochromocytoma was significantly more frequent than in sporadic pheochromocytoma, providing further molecular evidence that pheochromocytoma is a true component of NF1.
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Affiliation(s)
- Birke Bausch
- Department of Neurology, University Medical Center Freiburg, Germany
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Mautner VF, Brenner W, Fünsterer C, Hagel C, Gawad K, Friedrich RE. Clinical relevance of positron emission tomography and magnetic resonance imaging in the progression of internal plexiform neurofibroma in NF1. Anticancer Res 2007; 27:1819-22. [PMID: 17649778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Neurofibromatosis type 1 (NF1) is a frequent and inherited disease with a predisposition for malignant peripheral nerve sheath tumor (MPNST) development. MPNST are soft tissue sarcomas that arise from peripheral nerves, being one of the most aggressive malignancies in humans with extremely poor prognosis. MPNST frequently arise from a previously undetected plexiform neurofibroma (PNF). The malignant transformation of an internal PNF to an MPNST is difficult to assess and requires advanced imaging techniques like magnetic resonance imaging or positron emission tomography. Despite the high quality of current diagnostics, the changing tumor biology inside a plexiform neurofibroma cannot currently be visualized accurately. We report 4 cases of NF1 patients with PNF who showed imaging findings suspicious for malignant degeneration, but proved to have MPNST in only one case. Three tumors might represent an intermediate type between PNF and MPNST. Ablative surgery and complete histological work-up of specimens is the only way to clarify tumor status, thereby enabling provision of adequate local treatment.
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Affiliation(s)
- V F Mautner
- Section of Phacomatoses, Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
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Friedrich RE, Mautner VF, Scheuer HA. Loss of heterozygosity in tumor cells of a recurrent mandibular giant cell granuloma in neurofibromatosis type 1. Anticancer Res 2007; 27:2079-83. [PMID: 17649825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant inherited disease affecting about 1:3000 humans. Neurofibromas are benign soft tissue tumors. Giant cell granuloma (GCG) is a benign tumor-like lesion that is preferentially located in the jaws. GCG can develop in NF1 patients. A 7-year-old female NF1 patient was successfully treated for a recurrent GCG of the right mandibular premolar region. The serum levels of calcium and phosphate, alkaline phosphatase and parathormone were within the normal range. Genetic analysis of the tumor sample (GCG) and blood using 7 microsatellite markers revealed LOH of the NF1 gene in both sources. Inactivation of the NF1 gene may thus contribute to the development of GCG.
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Affiliation(s)
- Reinhard E Friedrich
- Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany.
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Mautner VF, Asuagbor F, Widemann B, Dombi E, Fünsterer C, Wenzel R, Friedmann J. Maligne periphere Nervenscheidentumore bei Neurofibromatose Typ 1 sind assoziiert mit erhöhter interner Tumorbelastung. Akt Neurol 2007. [DOI: 10.1055/s-2007-988035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mautner VF, Hartmann M, Kluwe L, Friedrich RE, Fünsterer C. MRI growth patterns of plexiform neurofibromas in patients with neurofibromatosis type 1. Neuroradiology 2006; 48:160-5. [PMID: 16432718 DOI: 10.1007/s00234-005-0033-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 09/16/2005] [Indexed: 10/25/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with an incidence of 1:3000. Approximately 30% of NF1 patients develop plexiform neurofibromas (PNF) which often cause severe clinical deficits. We studied the growth patterns of 256 plexiform neurofibromas (PNF) by magnetic resonance imaging (MRI) and associated disfigurement and functional deficits to determine whether there are definable growth types of these tumors. Retrospectively, we evaluated MRI scans obtained during 1997 to 2003 of 256 plexiform neurofibromas from 202 patients with NF1. Clinical investigation was carried out at the same time as the MRI scans. We identified three growth patterns: superficial in 59, displacing in 76, and invasive growth in 121 tumors. The majority (52%) of invasive PNF were found in the face, head and neck area. While superficial PNF primarily caused aesthetic problems, displacing PNF led in most cases to aesthetic problems and pain, while invasive PNF led mainly to functional deficits and disfigurement. Our study demonstrates that PNF have different growth patterns that are associated with specific clinical features. Classification of PNF may open new opportunities in clinical management, especially regarding decisions and options associated with surgical intervention.
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Affiliation(s)
- V F Mautner
- Section for Phakomatoses, Department of Maxillofacial Surgery, University Hospital Eppendorf, Hamburg, Germany.
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Brenner W, Friedrich RE, Gawad KA, Hagel C, von Deimling A, de Wit M, Buchert R, Clausen M, Mautner VF. Prognostic relevance of FDG PET in patients with neurofibromatosis type-1 and malignant peripheral nerve sheath tumours. Eur J Nucl Med Mol Imaging 2006; 33:428-32. [PMID: 16404595 DOI: 10.1007/s00259-005-0030-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 10/26/2005] [Indexed: 12/21/2022]
Abstract
PURPOSE In patients with neurofibromatosis type-1 (NF1) and malignant peripheral nerve sheath tumours (MPNSTs), survival rates are low and time to death is often less than 2 years. However, there are patients with a more favourable prognosis who develop metastases rather late or not at all. Since histopathology and tumour grading are not well correlated with prognosis, we aimed to evaluate the potential of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) for prediction of patient outcome in MPNST. METHODS FDG PET was performed in 16 patients with NF1 and MPNSTs. Standardised uptake values (SUVs) were calculated for each tumour and correlated to tumour grade and patient outcome in terms of survival or death. RESULTS Three patients with tumour grade II had an SUV <3. None of these patients developed metastases or died during a follow-up of 41-62 months. Thirteen patients with tumour grades II and III had an SUV >3. Only one of these patients is still alive after 20 months; the remaining 12 died within 4-33 months. SUV predicted long-term survival with an accuracy of 94%, compared with 69% for tumour grade. In Kaplan-Meier survival analysis, patients with an SUV >3 had a significantly shorter mean survival time, 13 months, than patients with an SUV <3, in whom the mean survival time was 52 months. Tumour grading did not reveal differences in survival time (15 vs 12 months). CONCLUSION Tumour SUV obtained by FDG PET was a significant parameter for prediction of survival in NF1 patients with MPNSTs while histopathological tumour grading did not predict outcome.
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Affiliation(s)
- Winfried Brenner
- Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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MacCollin M, Chiocca EA, Evans DG, Friedman JM, Horvitz R, Jaramillo D, Lev M, Mautner VF, Niimura M, Plotkin SR, Sang CN, Stemmer-Rachamimov A, Roach ES. Diagnostic criteria for schwannomatosis. Neurology 2005; 64:1838-45. [PMID: 15955931 DOI: 10.1212/01.wnl.0000163982.78900.ad] [Citation(s) in RCA: 301] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The neurofibromatoses are a diverse group of genetic conditions that share a predisposition to the development of tumors of the nerve sheath. Schwannomatosis is a recently recognized third major form of neurofibromatosis (NF) that causes multiple schwannomas without vestibular tumors diagnostic of NF2. Patients with schwannomatosis represent 2.4 to 5% of all patients requiring schwannoma resection and approximately one third of patients with schwannomatosis have anatomically localized disease with tumors limited to a single limb or segment of spine. Epidemiologic studies suggest that schwannomatosis is as common as NF2, but that familial occurrence is inexplicably rare. Patients with schwannomatosis overwhelmingly present with pain, and pain remains the primary clinical problem and indication for surgery. Diagnostic criteria for schwannomatosis are needed for both clinicians and researchers, but final diagnostic certainly will await the identification of the schwannomatosis locus itself.
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Affiliation(s)
- M MacCollin
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Friedrich C, Holtkamp N, Cinatl J, Sakuma S, Mautner VF, Wellman S, Michaelis M, Henze G, Kurtz A, Driever PH. Overexpression of Midkine in malignant peripheral nerve sheath tumor cells inhibits apoptosis and increases angiogenic potency. Int J Oncol 2005; 27:1433-40. [PMID: 16211240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue tumors arising sporadically although more frequently in patients with Neurofibromatosis type 1. Prognosis remains dismal as chemo- and radiotherapy have not been shown to be successful. The heparin-binding growth factor, Midkine (MK), is implicated in the tumorigenesis of benign and plexiform neurofibromas, and thereof arising MPNSTs. MK is mitogenic, anti-apoptotic, angiogenic and can promote tumorigenicity in several cell types. Thus, we investigated the role of MK in malignant biology and tumorigenicity in MPNSTs by stable transfection into MPNST cell lines. Overexpression of MK in the MPNST cell line, S462, increased cell viability and protected cells from apoptosis under serum deprivation, but did not induce proliferation. In addition, MK-transfected S462 cells were partially protected from vincristine-induced cell death. Conditioned medium of MK-transfected S462 cells was a potent mitogen for human umbilical venous endothelial cells. Furthermore, MK overexpression in S462 cells was accompanied by higher levels of VEGF mRNA. Yet, stable overexpression of MK in S462 as well as in ST88-14 cells was not sufficient to promote xenograft tumor growth in nude mice. However, increasing survival and enhanced angiogenic potency of MK-transfected S462 cells highlight the importance of developing specific inhibitors for MK as part of new therapeutic concepts against MPNSTs.
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Affiliation(s)
- Carsten Friedrich
- Department of Pediatric Oncology and Hematology, Campus Virchow Hospital, Charité-Universitätsmedizin Berlin, D-13353 Berlin, Germany
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Friedrich RE, Kluwe L, Fünsterer C, Mautner VF. Malignant peripheral nerve sheath tumors (MPNST) in neurofibromatosis type 1 (NF1): diagnostic findings on magnetic resonance images and mutation analysis of the NF1 gene. Anticancer Res 2005; 25:1699-702. [PMID: 16033085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
UNLABELLED Plexiform neurofibroma (PNF) is a typical feature of neurofibromatosis 1 (NF1). About 10% of patients with NF1 develop malignant peripheral nerve sheath tumors (MPNST), usually arising from PNF, and this is the major cause of poor prognosis. A better prognosis can be achieved if the tumors are diagnosed at an early stage. Our objective was to establish magnetic resonance imaging (MRI) criteria for MPNST, and to test their usefulness in detecting early malignant changes in PNF and to correlate the findings with the mutations of the NF1 gene. PATIENTS AND METHODS NF1 outpatients were diagnosed according to the NIH criteria. All patients underwent a complete dermatological, ophthalmological and neurological examination and ultrasound of the abdomen between 1997 and 2002. The study was approved by the Institutional Review Board and all patients gave informed consent to analyze clinical records and tumor material for scientific purposes. MRI was performed with devices at 1.5 Tesla field strength (Siemens Magnetom Symphony) or in some patients at 1.0 Tesla field strength (Siemens Impact Expert). T1- and T2-weighted sequences including STIR-sequences were acquired. Ultra-rapid image sequences with HASTE technique were performed for trunk imaging. In patients with no contraindication for the application of contrast media, Gadolinum-DTPA Magnevist was administered intravenously. RESULTS MRI was performed on 50 patients with NF1 and nerve sheath tumors, of whom 7 had atypical pain, tumor growth or neurological deficits indicative of malignancy; the other 43 were asymptomatic. On MRI, all 7 symptomatic patients had inhomogeneous lesions, due to necrosis and hemorrhage and patchy contrast enhancement. In one patient, the multiplicity of confluent tumors with inhomogeneous areas in addition to central lesions did not allow the exclusion of malignancy. Only 3 of the 43 asymptomatic patients had comparable changes; the other 40 patients had tumors of relatively homogeneous structure on T1- and T2-weighted images before and after contrast enhancement. All 3 asymptomatic patients with inhomogeneous lesions were shown to have MPNST. Analysis of mutations of the NF1 gene of the 10 MPNST patients revealed a variety of mutations. Concerning the correlation of genetic findings and MPNST in NF1, the sample size of this study group was too small to define genotype-phenotype relations. In this cohort, all types of mutations were found. CONCLUSION This study provides evidence for certain radiographic findings on MRI in PNF of NF1 patients that have to be considered as signs of malignancy, in particular indicating an MPNST. These findings are especially valuable in the long term follow-up control of patients with large tumors (plexiform neurofibromas).
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Affiliation(s)
- Reinhard E Friedrich
- Maxillofacial Surgery Clinic, Eppendorf University Hospital, University of Hamburg, Germany.
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Abstract
OBJECTIVE To determine the prevalence of neurofibromatosis 1 (NF1) among 6-year-old children in Germany. SETTING AND PATIENTS A total of 152819 children aged 6 years in 6 German states were screened for NF1 during routine medical examinations at elementary school enrollment in cooperation with local health departments in 2000 and 2001. MAIN OUTCOME MEASURE The prevalence of NF1 among 6-year-old German children was estimated to be 1:2996 (95% confidence interval, 1:2260 to 1:3984). RESULTS Fifty-one NF1 cases were identified and confirmed by evaluation by appropriate medical specialists. Seven other children were found to have multiple cafe au lait spots without other apparent features of NF1. A minimum estimate of the crude prevalence was 3.0 per 10 000 (95% confidence interval, 2.3-4.0 per 10 000 population). The incidence of NF1 in this population was probably in the range of 30 to 38 cases per 100 000 live births. CONCLUSION Our study obtained a nearly unbiased birth incidence of NF1 of approximately 1 in 2600 to 1 in 3000 and demonstrates that NF1 can be diagnosed by age 6 years in most cases by routine physical examination with special attention to the disease-associated skin stigmata.
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Affiliation(s)
- Marga Lammert
- Department of Maxillofacial Surgery, University Hospital Eppendorf, Hamburg, Germany
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Harder A, Rosche M, Reuss DE, Holtkamp N, Uhlmann K, Friedrich R, Mautner VF, von Deimling A. Methylation analysis of the neurofibromatosis type 1 (NF1) promoter in peripheral nerve sheath tumours. Eur J Cancer 2004; 40:2820-8. [PMID: 15571966 DOI: 10.1016/j.ejca.2004.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 07/08/2004] [Accepted: 07/27/2004] [Indexed: 11/15/2022]
Abstract
Peripheral nerve sheath tumours are hallmarks of neurofibromatosis type 1 (NF1). Development of plexiform neurofibromas to malignant peripheral nerve sheath tumours (MPNST) is common. The NF1 gene promoter harbours a hypomethylated CpG island. Thus, methylation changes may be involved in the development of different types of neurofibromas and malignant transformation. We investigated NF1-associated dermal (n=9) and plexiform neurofibromas (n=7), MPNST (n=5) and non-NF1 leucocyte samples (n=20) for their methylation pattern by bisulphite genomic sequencing. We could not find global hypermethylation in the NF1 promoter in our series. Nevertheless, site-specific methylation, involving transcription factor binding sites for SP1, CRE (-10), and AP-2, was observed. One region of the 5'-UTR (untranslated region) overlapping with a putative AP-2 binding site was methylated at 30-100% in 4/20 control samples. In conclusion, we did not find hypermethylation in NF1-associated tumours. Instead, low level methylation could parallel a global genomic hypomethylation in malignancy.
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Affiliation(s)
- A Harder
- Institute of Neuropathology, Charité-University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
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