1
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Müller A, Weyerhäuser P, Berte N, Jonin F, Lyubarskyy B, Sprang B, Kantelhardt SR, Salinas G, Opitz L, Schulz-Schaeffer W, Giese A, Kim EL. Concurrent Activation of Both Survival-Promoting and Death-Inducing Signaling by Chloroquine in Glioblastoma Stem Cells: Implications for Potential Risks and Benefits of Using Chloroquine as Radiosensitizer. Cells 2023; 12:cells12091290. [PMID: 37174691 PMCID: PMC10177603 DOI: 10.3390/cells12091290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Lysosomotropic agent chloroquine was shown to sensitize non-stem glioblastoma cells to radiation in vitro with p53-dependent apoptosis implicated as one of the underlying mechanisms. The in vivo outcomes of chloroquine or its effects on glioblastoma stem cells have not been previously addressed. This study undertakes a combinatorial approach encompassing in vitro, in vivo and in silico investigations to address the relationship between chloroquine-mediated radiosensitization and p53 status in glioblastoma stem cells. Our findings reveal that chloroquine elicits antagonistic impacts on signaling pathways involved in the regulation of cell fate via both transcription-dependent and transcription-independent mechanisms. Evidence is provided that transcriptional impacts of chloroquine are primarily determined by p53 with chloroquine-mediated activation of pro-survival mevalonate and p21-DREAM pathways being the dominant response in the background of wild type p53. Non-transcriptional effects of chloroquine are conserved and converge on key cell fate regulators ATM, HIPK2 and AKT in glioblastoma stem cells irrespective of their p53 status. Our findings indicate that pro-survival responses elicited by chloroquine predominate in the context of wild type p53 and are diminished in cells with transcriptionally impaired p53. We conclude that p53 is an important determinant of the balance between pro-survival and pro-death impacts of chloroquine and propose that p53 functional status should be taken into consideration when evaluating the efficacy of glioblastoma radiosensitization by chloroquine.
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Affiliation(s)
- Andreas Müller
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Patrick Weyerhäuser
- Institute of Toxicology, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Nancy Berte
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Fitriasari Jonin
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Bogdan Lyubarskyy
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Bettina Sprang
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Sven Rainer Kantelhardt
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Gabriela Salinas
- NGS Integrative Genomics Core Unit (NIG), Institute for Human Genetics, University Medical Centre, 37075 Göttingen, Germany
| | - Lennart Opitz
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, 8092 Zurich, Switzerland
| | | | - Alf Giese
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
| | - Ella L Kim
- Experimental Neurooncology Group, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany
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2
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Dörr F, Giese A, Menghesha H, Schlachtenberger G, Heldwein M, Wahlers T, Hekmat K. New Smartphone Scoring App Precisely Predicts the Dignity of Pulmonary Nodules. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F. Dörr
- University Hospital of Cologne, Köln, Deutschland
| | - A. Giese
- University Hospital of Cologne, Cologne, Deutschland
| | - H. Menghesha
- University Hospital of Cologne, Köln, Deutschland
| | | | - M. Heldwein
- University Hospital of Cologne, Cologne, Deutschland
| | - T. Wahlers
- University Hospital of Cologne, Cologne, Deutschland
| | - K. Hekmat
- University Hospital of Cologne, Cologne, Deutschland
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3
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Romano M, Alunni-Fabbroni M, Barbone G, Bartzsch S, Bouchet A, Bunk O, Dinkel J, Djonov V, Eckhardt A, Giannini C, Giese A, Hirner-Eppeneder H, Hlushchuk R, Jacques L, Laissue J, Miettinen A, Mittone A, Ricke J, Ruf V, Sancey L, Wright M, Bravin A, Coan P. Spacial Fractionation A MULTISCALE AND MULTI-TECHNIQUE APPROACH FOR THE CHARACTERIZATION OF THE EFFECTS OF SPATIALLY FRACTIONATED X-RAY FLASH IRRADIATION IN LUNGS AND BRAINS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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Zolotovskaia M, Tkachev V, Sorokin M, Garazha A, Kim E, Kantelhardt SR, Bikar SE, Zottel A, Šamec N, Kuzmin D, Sprang B, Moisseev A, Giese A, Efimov V, Jovčevska I, Buzdin A. Algorithmically Deduced FREM2 Molecular Pathway Is a Potent Grade and Survival Biomarker of Human Gliomas. Cancers (Basel) 2021; 13:4117. [PMID: 34439271 PMCID: PMC8394245 DOI: 10.3390/cancers13164117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/17/2023] Open
Abstract
Gliomas are the most common malignant brain tumors with high mortality rates. Recently we showed that the FREM2 gene has a role in glioblastoma progression. Here we reconstructed the FREM2 molecular pathway using the human interactome model. We assessed the biomarker capacity of FREM2 expression and its pathway as the overall survival (OS) and progression-free survival (PFS) biomarkers. To this end, we used three literature and one experimental RNA sequencing datasets collectively covering 566 glioblastomas (GBM) and 1097 low-grade gliomas (LGG). The activation level of deduced FREM2 pathway showed strong biomarker characteristics and significantly outperformed the FREM2 expression level itself. For all relevant datasets, it could robustly discriminate GBM and LGG (p < 1.63 × 10-13, AUC > 0.74). High FREM2 pathway activation level was associated with poor OS in LGG (p < 0.001), and low PFS in LGG (p < 0.001) and GBM (p < 0.05). FREM2 pathway activation level was poor prognosis biomarker for OS (p < 0.05) and PFS (p < 0.05) in LGG with IDH mutation, for PFS in LGG with wild type IDH (p < 0.001) and mutant IDH with 1p/19q codeletion(p < 0.05), in GBM with unmethylated MGMT (p < 0.05), and in GBM with wild type IDH (p < 0.05). Thus, we conclude that the activation level of the FREM2 pathway is a potent new-generation diagnostic and prognostic biomarker for multiple molecular subtypes of GBM and LGG.
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Affiliation(s)
- Marianna Zolotovskaia
- Omicsway Corp., Walnut, CA 91789, USA; (M.S.); (A.G.); (A.M.)
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
- Department of Oncology, Hematology and Radiotherapy, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Victor Tkachev
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
| | - Maxim Sorokin
- Omicsway Corp., Walnut, CA 91789, USA; (M.S.); (A.G.); (A.M.)
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
- Laboratory of Clinical Genomic Bioinformatics, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Andrew Garazha
- Omicsway Corp., Walnut, CA 91789, USA; (M.S.); (A.G.); (A.M.)
| | - Ella Kim
- Clinic for Neurosurgery, Laboratory of Experimental Neurooncology, Johannes Gutenberg University Medical Centre, Langenbeckstrasse 1, 55124 Mainz, Germany; (E.K.); (S.R.K.); (B.S.)
| | - Sven Rainer Kantelhardt
- Clinic for Neurosurgery, Laboratory of Experimental Neurooncology, Johannes Gutenberg University Medical Centre, Langenbeckstrasse 1, 55124 Mainz, Germany; (E.K.); (S.R.K.); (B.S.)
| | - Sven-Ernö Bikar
- StarSEQ GmbH, Joh.-Joachim-Becher-Weg 30a, 55128 Mainz, Germany;
| | - Alja Zottel
- Medical Center for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia; (A.Z.); (N.Š.); (I.J.)
| | - Neja Šamec
- Medical Center for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia; (A.Z.); (N.Š.); (I.J.)
| | - Denis Kuzmin
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
| | - Bettina Sprang
- Clinic for Neurosurgery, Laboratory of Experimental Neurooncology, Johannes Gutenberg University Medical Centre, Langenbeckstrasse 1, 55124 Mainz, Germany; (E.K.); (S.R.K.); (B.S.)
| | - Alexey Moisseev
- Omicsway Corp., Walnut, CA 91789, USA; (M.S.); (A.G.); (A.M.)
| | - Alf Giese
- Orthocentrum Hamburg, Hansastrasse 1, 20149 Hamburg, Germany;
| | - Victor Efimov
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
| | - Ivana Jovčevska
- Medical Center for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia; (A.Z.); (N.Š.); (I.J.)
| | - Anton Buzdin
- Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia; (V.T.); (D.K.); (V.E.); (A.B.)
- Laboratory of Clinical Genomic Bioinformatics, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow 117997, Russia
- European Organization for Research and Treatment of Cancer (EORTC), Biostatistics and Bioinformatics Subgroup, 1200 Brussels, Belgium
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5
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Samii A, Sorokin M, Kar S, Makovskaia L, Garazha A, Hartmann C, Moisseev A, Kim E, Giese A, Buzdin A. Case of multifocal glioblastoma with four fusion transcripts of ALK, FGFR2, NTRK2, and NTRK3 genes stresses the need for tumor tissue multisampling for transcriptomic analysis. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006100. [PMID: 34341009 PMCID: PMC8327882 DOI: 10.1101/mcs.a006100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most malignant brain tumor with patient mortality rate close to 100%, 5-yr survival rate of ∼5%, and a median survival of 14 mo. GBMs have notorious histomorphologic and molecular heterogeneities thus giving hope for development of future personalized therapies. We describe here a case of a 48-yr-old male patient with three-nodular GBM. To address the question of intratumoral molecular heterogeneity, a comparative analysis of gene expression was performed by using multiple samples collected from different tumor sites with the aid of intraoperative magnetic resonance imaging (MRI). Sixteen GBM biosamples from parietal, temporal, and temporo-polar localizations were collected from primary, recurrent, and second recurrent tumors and were obtained and investigated by RNA sequencing. Our investigations revealed that biosamples derived from different tumor sites differ in their gene expression profiles with classical or mesenchymal signatures associated with clinically distinct molecular subtypes of GBM found within the same tumor. The results also showed significant differences in the expression of genes specific for targeted therapeutics. Our investigations have enabled the identification of four novel fusion transcripts—KIF5C-NTRK3, AC016907.2-ALK, CNTNAP3-NTRK2, and ZNF135-FGFR2—each present in only one sample. We found no differences between untreated and recurrent stages in the expression levels of genes involved in fusion transcripts, suggesting the lack of association between fusion transcript and treatment response. In contrast, longitudinal changes in the expression of VEGF and MGMT genes were concordant with the tumor response to bevacizumab and temozolomide. Our study underscores the importance of integrating a multisampling approach and RNA sequencing and demonstrates the predictive merit of an integrated approach for differentiating genomic aberrations associated with untreated or post-treatment recurrent GBMs.
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Affiliation(s)
- Amir Samii
- International Neuroscience Institute, Hannover, 30625 Germany
| | - Maxim Sorokin
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991 Russia.,Omicsway Corp., Walnut, California 91789, USA.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, 117997 Russia
| | - Souvik Kar
- International Neuroscience Institute, Hannover, 30625 Germany
| | - Luidmila Makovskaia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 117997 Russia
| | | | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology at Hannover Medical School, Hannover, 30625 Germany
| | - Aleksey Moisseev
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991 Russia
| | - Ella Kim
- Clinic for Neurosurgery, Laboratory of Experimental Neurooncology, Johannes Gutenberg University Medical Centre, 55124 Mainz, 55124 Germany
| | - Alf Giese
- Orthocentrum Hamburg, Hamburg, 20149 Germany
| | - Anton Buzdin
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991 Russia.,Omicsway Corp., Walnut, California 91789, USA.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, 117997 Russia.,Moscow Institute of Physics and Technology (National Research University), Moscow, 141701 Russia
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6
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Poddubskaya E, Sorokin M, Garazha A, Glusker A, Moisseev A, Sekacheva M, Suntsova M, Kim EL, Gaifullin N, Tkachev V, Giese A, Barbara V, Borisov N, Buzdin A. Clinical use of RNA sequencing and oncobox analytics to predict personalized targeted therapeutic efficacy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13676 Background: Analysis of mutation profiles in cancer patients does not provide clinical benefits in 80-90% of cases in the US (Marquart et al., 2018). Gene expression analysis potentially complements standard detection of clinically relevant mutations. Methods: 239 adult late-stage cancer patients. RNA gene expression sequencing completed on solid tumor samples using FFPE blocks. Patient mRNA profiles were analyzed using Oncobox bioinformatics, prioritizing target drugs according to their personalized predicted efficacy. Summary reports were provided to oncologists and resulting treatment selection and outcomes were assessed. Results: As of February 2020, feedback was received from participating doctors for 224 patients; 34 patients died before therapy prescription, 52 patients received treatment other than targeted therapy (chemo, surgery, radiation, or palliative care), 75 patients received at least one targeted therapy (single or combination therapy) predicted to be effective based on Oncobox analysis (“RNAseq cohort”). 63 patients received chemo or other drug therapy predicted to be potentially ineffective from Oncobox analysis (“other cohort”). Therapeutic response was obtained on 46 patients with biopsies collected no longer than 6 months prior to analysis who had no further surgery (30 in the RNAseq cohort and 16 in the other cohort). 63% of the RNAseq cohort obtained either partial response or stable disease using Oncobox guided therapies, compared to 44% of the other cohort (19% increase of disease control). The RNAseq cohort had higher mean prior therapies (1.3) compared to the other cohort (0.8) indicating more advanced disease. The similarly designed WINTHER trial reported ~8% increase of disease control using gene expression-guided vs mutation-guided therapeutics in a cohort of advanced cancer patients averaging three prior therapies (Rodon et al., 2019). Conclusions: Collectively these data suggest that gene expression profiling provides a more clinically relevant therapeutic match, and better response rates, than mutation guided therapeutic treatments. This potentially results in improved clinical outcomes for cancer patients. Clinical trial information: NCT03724097.
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Affiliation(s)
| | | | | | | | - Alexey Moisseev
- I.M. Sechenov First Moscow Medical University, Moscow, Russian Federation
| | - Marina Sekacheva
- I.M. Sechenov First Moscow Medical University, Moscow, Russian Federation
| | - Maria Suntsova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, CA, Russian Federation
| | - Ella L Kim
- Johannes Gutenberg University Medical Centre Mainz, Mainz, Germany
| | - Nurshat Gaifullin
- M.V. Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russian Federation
| | | | - Alf Giese
- Orthozentrum Hamburg, Hamburg, Germany
| | - Viktoria Barbara
- Oncological Dispensary of the Republic of Karelia, Petrozavodsk, Russian Federation
| | - Nikolay Borisov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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7
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Kalasauskas D, Sorokin M, Sprang B, Elmasri A, Viehweg S, Salinas G, Opitz L, Rave-Fraenk M, Schulz-Schaeffer W, Kantelhardt SR, Giese A, Buzdin A, Kim EL. Diversity of Clinically Relevant Outcomes Resulting from Hypofractionated Radiation in Human Glioma Stem Cells Mirrors Distinct Patterns of Transcriptomic Changes. Cancers (Basel) 2020; 12:cancers12030570. [PMID: 32121554 PMCID: PMC7139840 DOI: 10.3390/cancers12030570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/30/2019] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 12/17/2022] Open
Abstract
Hypofractionated radiotherapy is the mainstay of the current treatment for glioblastoma. However, the efficacy of radiotherapy is hindered by the high degree of radioresistance associated with glioma stem cells comprising a heterogeneous compartment of cell lineages differing in their phenotypic characteristics, molecular signatures, and biological responses to external signals. Reconstruction of radiation responses in glioma stem cells is necessary for understanding the biological and molecular determinants of glioblastoma radioresistance. To date, there is a paucity of information on the longitudinal outcomes of hypofractionated radiation in glioma stem cells. This study addresses long-term outcomes of hypofractionated radiation in human glioma stem cells by using a combinatorial approach integrating parallel assessments of the tumor-propagating capacity, stemness-associated properties, and array-based profiling of gene expression. The study reveals a broad spectrum of changes in the tumor-propagating capacity of glioma stem cells after radiation and finds association with proliferative changes at the onset of differentiation. Evidence is provided that parallel transcriptomic patterns and a cumulative impact of pathways involved in the regulation of apoptosis, neural differentiation, and cell proliferation underly similarities in tumorigenicity changes after radiation.
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Affiliation(s)
- Darius Kalasauskas
- Laboratory for Experimental Neurooncology, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany; (D.K.); (B.S.); (A.E.); (S.V.)
- Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany;
| | - Maxim Sorokin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, 117997 Moscow, Russia; (M.S.); (A.B.)
- I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Omicsway Corp., Walnut, CA 91789, USA
| | - Bettina Sprang
- Laboratory for Experimental Neurooncology, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany; (D.K.); (B.S.); (A.E.); (S.V.)
| | - Alhassan Elmasri
- Laboratory for Experimental Neurooncology, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany; (D.K.); (B.S.); (A.E.); (S.V.)
| | - Sina Viehweg
- Laboratory for Experimental Neurooncology, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany; (D.K.); (B.S.); (A.E.); (S.V.)
| | - Gabriela Salinas
- NGS Integrative Genomics Core Unit (NIG), Institute for Human Genetics, University Medical Centre, 37077 Göttingen, Germany; (G.S.); (L.O.)
| | - Lennart Opitz
- NGS Integrative Genomics Core Unit (NIG), Institute for Human Genetics, University Medical Centre, 37077 Göttingen, Germany; (G.S.); (L.O.)
| | - Margret Rave-Fraenk
- Department of Radiotherapy and Radiooncology, University Medical Centre, 37077 Göttingen, Germany;
| | | | - Sven Reiner Kantelhardt
- Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany;
| | - Alf Giese
- OrthoCentrum Hamburg, Department of Tumor Spinal Surgery, 20149 Hamburg, Germany;
| | - Anton Buzdin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, 117997 Moscow, Russia; (M.S.); (A.B.)
- I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Oncobox ltd., 121205 Moscow, Russia
- Moscow Institute of Physics and Technology (National Research University), 141700 Moscow, Russia
| | - Ella L. Kim
- Laboratory for Experimental Neurooncology, Clinic for Neurosurgery, Johannes Gutenberg University Medical Centre, 55131 Mainz, Germany; (D.K.); (B.S.); (A.E.); (S.V.)
- Correspondence:
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Zolotovskaia MA, Sorokin MI, Petrov IV, Poddubskaya EV, Moiseev AA, Sekacheva MI, Borisov NM, Tkachev VS, Garazha AV, Kaprin AD, Shegay PV, Giese A, Kim E, Roumiantsev SA, Buzdin AA. Disparity between Inter-Patient Molecular Heterogeneity and Repertoires of Target Drugs Used for Different Types of Cancer in Clinical Oncology. Int J Mol Sci 2020; 21:E1580. [PMID: 32111026 PMCID: PMC7084891 DOI: 10.3390/ijms21051580] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Inter-patient molecular heterogeneity is the major declared driver of an expanding variety of anticancer drugs and personalizing their prescriptions. Here, we compared interpatient molecular heterogeneities of tumors and repertoires of drugs or their molecular targets currently in use in clinical oncology. We estimated molecular heterogeneity using genomic (whole exome sequencing) and transcriptomic (RNA sequencing) data for 4890 tumors taken from The Cancer Genome Atlas database. For thirteen major cancer types, we compared heterogeneities at the levels of mutations and gene expression with the repertoires of targeted therapeutics and their molecular targets accepted by the current guidelines in oncology. Totally, 85 drugs were investigated, collectively covering 82 individual molecular targets. For the first time, we showed that the repertoires of molecular targets of accepted drugs did not correlate with molecular heterogeneities of different cancer types. On the other hand, we found that the clinical recommendations for the available cancer drugs were strongly congruent with the gene expression but not gene mutation patterns. We detected the best match among the drugs usage recommendations and molecular patterns for the kidney, stomach, bladder, ovarian and endometrial cancers. In contrast, brain tumors, prostate and colorectal cancers showed the lowest match. These findings provide a theoretical basis for reconsidering usage of targeted therapeutics and intensifying drug repurposing efforts.
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Affiliation(s)
- Marianna A. Zolotovskaia
- Oncobox ltd., Moscow, 121205, Russia; (I.V.P.); (A.A.B.)
- Department of Oncology, Hematology and Radiotherapy of Pediatric Faculty, Pirogov Russian National Research Medical University, Moscow, 117997, Russia;
- Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region 141701, Russia;
| | - Maxim I. Sorokin
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
- Omicsway Corp., Walnut, CA, 91789, USA; (V.S.T.); (A.V.G.)
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, 117997, Russia
| | - Ivan V. Petrov
- Oncobox ltd., Moscow, 121205, Russia; (I.V.P.); (A.A.B.)
| | - Elena V. Poddubskaya
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
| | - Alexey A. Moiseev
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
| | - Marina I. Sekacheva
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
| | - Nicolas M. Borisov
- Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region 141701, Russia;
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
- Omicsway Corp., Walnut, CA, 91789, USA; (V.S.T.); (A.V.G.)
| | | | | | - Andrey D. Kaprin
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow 125284, Russia;
| | - Peter V. Shegay
- Center for Innovative Radiological and Regenerative Technologies of the Ministry of Health of the Russian Federation, Obninsk 249030, Russia;
| | - Alf Giese
- Orthocentrum Hamburg, Hamburg, Germany; or
| | - Ella Kim
- Johannes Gutenberg University Mainz, Mainz, Germany;
| | - Sergey A. Roumiantsev
- Department of Oncology, Hematology and Radiotherapy of Pediatric Faculty, Pirogov Russian National Research Medical University, Moscow, 117997, Russia;
| | - Anton A. Buzdin
- Oncobox ltd., Moscow, 121205, Russia; (I.V.P.); (A.A.B.)
- Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region 141701, Russia;
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia (E.V.P.); (A.A.M.)
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, 117997, Russia
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9
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Neulen A, Stein M, Pantel T, Berres M, Brockmann C, Giese A, Kantelhardt SR. Image-Guided Transcranial Doppler Ultrasound for Monitoring Posthemorrhagic Vasospasms of Infratentorial Arteries: A Feasibility Study. World Neurosurg 2019; 134:284-291. [PMID: 31678314 DOI: 10.1016/j.wneu.2019.10.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND A considerable number of patients with subarachnoid hemorrhage (SAH) develop vasospasms of the infratentorial arteries. Transcranial Doppler sonography (TCD) is used to screen for vasospasm. In this study, we used a technical modification that combines TCD with an image guidance device that the operator can use to navigate to the ultrasonic window and to predefined intracranial vascular targets. Our aim was to analyze the feasibility, spatial precision, and spatial reproducibility of serial image-guided TCD of infratentorial and-for comparison-supratentorial arteries in the clinical setting of monitoring for vasospasm after SAH. METHODS The study included 10 SAH patients, who each received 5 serial image-guided TCD examinations. Using computed tomography angiography data, trajectories to the infratentorial and supratentorial cerebral arteries were planned and loaded into an image guidance device tracking the Doppler probe. As a measure of spatial precision and spatial reproducibility, we analyzed the distances between the positions of preplanned vascular targets and optimal Doppler signals. RESULTS The mean distance between preplanned and optimal target points was 4.8 ± 2.1 mm (first exam), indicating high spatial precision. The spatial precision decreased with increasing depth of the vascular target. In all patients, image-guided TCD detected all predefined supratentorial and infratentorial vascular segments. There were no significant changes in spatial precision in serial exams, indicating high reproducibility. CONCLUSIONS Image-guided TCD is feasible for supratentorial and infratentorial arteries. It shows high spatial precision and reproducibility. This study provides a basis for future clinical studies on image-guided TCD for post-SAH vasospasm screening.
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Affiliation(s)
- Axel Neulen
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Maximilian Stein
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tobias Pantel
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Manfred Berres
- Institute of Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany; Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany; Orthocentrum Hamburg, Hamburg, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
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10
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Siller S, Lauseker M, Giese A, Tonn J, Niyazi K, Thon N, Suchorska B, Kreth F. P14.02 Influence of individual CpG methylation status on outcome in adult patients with glioblastoma multiforme receiving alkylating agent treatment. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background: Methylation of the O-6-methylguanine-DNA methyltransferase (MGMT) promotor causes gene silencing and has been associated with a favourable prognosis in patients with glioblastoma multiforme (GBM) receiving alkylating chemotherapy. However, analysis of MGMT promotor methylation is usually reported as a cut-off depending on the results of the correspondent CpG site testing. This approach disregards a possible heterogeneity concerning the methylation status within the individual CpG sites and its possible association with prognosis in GBM patients. The current study aimed at elucidating the association between methylation of CpG sites 74–98 within the MGMT promotor region and outcome in GBM patients receiving alkylating agents.
Material and Methods: Individual methylation status of 230 patients with histologically proven GBM following concomitant radio-chemotherapy with TMZ after stereotactic biopsy or open tumor resection (OTR) was assessed by the Sanger sequencing (Sseq) approach. Methylation of CpG sites 74–98 within the MGMT promotor region was defined according to a ratio of cytosine /thymine peak >50%. The total number of methylated CpG sites as well as clinical factors such as age, Karnofsky Performance Score (KPS) and mode of surgical procedure were correlated with outcome using proportional hazards models. In a subset of 34 patients, a correlation between individual CpG methylation and MGMT mRNA expression was performed.
Results: Median progression-free (PFS) and overall survival (OS) were 7.8 and 14.6 months, respectively. Alongside younger age, KPS> 80 and OTR, the cumulative total number of methylated loci within the CpG sites 74–98 was strongly associated with both PFS and OS and retained its prognostic influence on outcome in multivariate models (p <0.001). Furthermore, a linear coherence between the total number of methylated CpG sites 74–98 and survival parameters could be observed. Moreover, low number of methylated CpG sites was observed in tumor specimen with a high mRNA expression and vice versa (Spearman correlation coefficient: -0.62).
Conclusion: In contrast to the concept of dichotomizing the MGMT promotor status into ‘methylated’ and ‘non-methylated’, our approach shows a clear heterogeneity within the methylation status of the CpG sites 74–98 within the GBM tumor specimens. Our data suggest a strong correlation between outcome and the total number of methylated CpG sites, thus an up-front analysis of the individual GpC site methylation status prior to initiation of alkylating chemotherapy might help to improve treatment response in GBM patients.
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Affiliation(s)
- S Siller
- University Hospital, LMU Munich, Munich, Germany
| | - M Lauseker
- University Hospital, LMU Munich, Munich, Germany
| | - A Giese
- University Hospital, LMU Munich, Munich, Germany
| | - J Tonn
- University Hospital, LMU Munich, Munich, Germany
| | - K Niyazi
- University Hospital, LMU Munich, Munich, Germany
| | - N Thon
- University Hospital, LMU Munich, Munich, Germany
| | - B Suchorska
- University Hospital, LMU Munich, Munich, Germany
| | - F Kreth
- University Hospital, LMU Munich, Munich, Germany
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11
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Buzdin A, Sorokin M, Garazha A, Glusker A, Aleshin A, Poddubskaya E, Sekacheva M, Kim E, Gaifullin N, Giese A, Seryakov A, Rumiantsev P, Moshkovskii S, Moiseev A. RNA sequencing for research and diagnostics in clinical oncology. Semin Cancer Biol 2019; 60:311-323. [PMID: 31412295 DOI: 10.1016/j.semcancer.2019.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/16/2019] [Indexed: 12/26/2022]
Abstract
Molecular diagnostics is becoming one of the major drivers of personalized oncology. With hundreds of different approved anticancer drugs and regimens of their administration, selecting the proper treatment for a patient is at least nontrivial task. This is especially sound for the cases of recurrent and metastatic cancers where the standard lines of therapy failed. Recent trials demonstrated that mutation assays have a strong limitation in personalized selection of therapeutics, consequently, most of the drugs cannot be ranked and only a small percentage of patients can benefit from the screening. Other approaches are, therefore, needed to address a problem of finding proper targeted therapies. The analysis of RNA expression (transcriptomic) profiles presents a reasonable solution because transcriptomics stands a few steps closer to tumor phenotype than the genome analysis. Several recent studies pioneered using transcriptomics for practical oncology and showed truly encouraging clinical results. The possibility of directly measuring of expression levels of molecular drugs' targets and profiling activation of the relevant molecular pathways enables personalized prioritizing for all types of molecular-targeted therapies. RNA sequencing is the most robust tool for the high throughput quantitative transcriptomics. Its use, potentials, and limitations for the clinical oncology will be reviewed here along with the technical aspects such as optimal types of biosamples, RNA sequencing profile normalization, quality controls and several levels of data analysis.
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Affiliation(s)
- Anton Buzdin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Omicsway Corp., Walnut, CA, USA; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia.
| | - Maxim Sorokin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Omicsway Corp., Walnut, CA, USA; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
| | | | | | - Alex Aleshin
- Stanford University School of Medicine, Stanford, 94305, CA, USA
| | - Elena Poddubskaya
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Vitamed Oncological Clinics, Moscow, Russia
| | - Marina Sekacheva
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ella Kim
- Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nurshat Gaifullin
- Lomonosov Moscow State University, Faculty of Medicine, Moscow, Russia
| | | | | | | | - Sergey Moshkovskii
- Institute of Biomedical Chemistry, Moscow, 119121, Russia; Pirogov Russian National Research Medical University (RNRMU), Moscow, 117997, Russia
| | - Alexey Moiseev
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Poddubskaya E, Buzdin A, Garazha A, Sorokin M, Glusker A, Aleshin A, Allina D, Moiseev A, Sekacheva M, Suntsova M, Kim EL, Gaifullin N, Tkachev V, Giese A, Barbara V, Borger P, Borisov N. Oncobox, gene expression-based second opinion system for predicting response to treatment in advanced solid tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13143 Background: Anticancer Targeted Drugs (ATDs) specifically target one or a few types of tumor-related molecules in a cell. More than two hundred of ATDs were approved worldwide. They have different mechanisms of action and are effective for different cohorts of patients. However, many individual cases remain poorly responsive and it is of great importance to identify predictive markers of ATD efficacy. Our aim was to develop a platform enabling smart selection of the most efficient ATD therapies. Methods: We generated a second-opinion platform for clinical oncologists termed Oncobox. It is based on the analysis of gene expression profile of a cancer sample in comparison with the corresponding normal tissue biosamples in order to personalize selection of targeted drugs for individual cancer patients. Based on RNA-seq gene expression data, pathway activation levels are calculated and along with the concentrations of molecular target genes products used as predictors of tumor response to ATDs. Results: The Oncobox method was tested first on the retrospective samples of advanced tumors: gastric, renal cell, ovarian and colorectal cancers, thus showing ROC AUC values > 0.7. In currently ongoing prospective trial for advanced solid tumor patients, the Oncobox tests were completed for 239 patients, primary feedback information received for 144 patients. 25 patients (17%) died before prescription of the therapy, 19% received palliative care treatment, 39% received Oncobox-recommended therapies and 25% received other therapies (February 2019). Tumor responses were estimated for 30 patients (breast, colorectal, ovarian and other cancers) receiving therapies, with disease control rate of 71% for Oncobox-recommended ATDs (Bevacizumab, Crizotinib, Trastuzumab and others) and 44% for other therapies. Our results also suggest that cancer metastases and primary tumors may have different gene expression, molecular pathway activation and drug scoring patterns, thus pointing to the importance of testing multiple tumor sites. Conclusions: Our study suggests that profound analysis of gene expression profiles of tumor tissues may be useful for ATDs treatment of advanced and metastatic cancers. Clinical trial information: NCT03724097.
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Affiliation(s)
| | | | | | - Maxim Sorokin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | | | - Daria Allina
- Pathology department, Morozov Children's City Hospital, Moscow, Russian Federation
| | | | - Marina Sekacheva
- I.M. Sechenov First Moscow Medical University, Moscow, Russian Federation
| | - Maria Suntsova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, CA, Russian Federation
| | - Ella L Kim
- Johannes Gutenberg University Medical Centre Mainz, Mainz, Germany
| | - Nurshat Gaifullin
- M.V. Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russian Federation
| | | | - Alf Giese
- Orthozentrum Hamburg, Hamburg, Germany
| | - Viktoria Barbara
- Oncological Dispensary of the Republic of Karelia, Petrozavodsk, Russian Federation
| | - Pieter Borger
- Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nikolay Borisov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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13
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Kim EL, Buzdin A, Sorokin M, Poddubskaya E, Poddubskiy A, Kantelhardt SR, Kalasauskas D, Sprang B, Bikar SE, Giese A. RNA-sequencing and bioinformatic analysis to pre-assess sensitivity to targeted therapeutics in recurrent glioblastoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13533 Background: This study developed molecular guided tools for individualized selection of chemotherapeutics for recurrent glioblastoma (rGB). A consortium involving clinical neurooncologists, molecular biologists and bioinformaticians identified gene expression patterns in rGB and quantitatively analyzed pathways involved in response to FDA approved oncodrugs. Methods: From2016 to 2018 biopsies from GB were collected using a multisampling approach. Biopsy material was used to isolate glioma stem-like cells and examined by RNA-sequencing. RNA-seq results were subjected to differential expression (DE) analysis and Oncobox analysis – a bioinformatic tool for quantitative pathway activation analysis. Results for newly diagnosed (nGB) and rGB (tissue samples and cell cultures) were compared. Oncobox analysis was further used to examine differential activation of pathways involved in response to existing chemotherapeutics. Results: 128 tissue samples and 28 cell cultures from a total of 44 GBs including 23 nGB, 19 rGB and 2 second-recurrent GBs were analyzed. 14 patient-matched pairs of nGB and rGB were obtained. DE analysis of nGB and rGB, showed a distinct “signature” associated with rGB. Oncobox analysis found down regulation of pathways related to cell cycle and DNA repair and upregulation of immune response pathways in rGB vs corresponding nGB. Specifically, pathways targeted by temozolomide, which is the first line chemotherapy for GB, were found down regulated in rGB. Among the top pathways upregulated in rGB were the pathways targeted by durvalumab and pomalidomide currently under investigation in phase II or III trials for GB. Conclusions: Specific pathway analysis revealed regional and clinical stage-associated differences in the transcriptional landscapes of nGB and rGB. Our results support a concept of treatment-induced resistance to cytotoxic therapeutics and indicate that temozolomide and radiation treatment have important impacts on gene expression changes associated with GB recurrence. Systematic molecular profiling of rGB is a promising avenue towards predicting sensitivity to targeted therapeutics in rGBs on an individual basis.
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Affiliation(s)
- Ella L Kim
- Johannes Gutenberg University Medical Centre Mainz, Mainz, Germany
| | | | - Maxim Sorokin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Artem Poddubskiy
- Federal State Autonomous Institution "N.N. Burdenko National Scientific and Practical Center for Neurosurgery", Moscow, Russian Federation
| | | | | | | | | | - Alf Giese
- Orthozentrum Hamburg, Hamburg, Germany
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14
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Dudvarski Stanković N, Bicker F, Keller S, Jones DT, Harter PN, Kienzle A, Gillmann C, Arnold P, Golebiewska A, Keunen O, Giese A, von Deimling A, Bäuerle T, Niclou SP, Mittelbronn M, Ye W, Pfister SM, Schmidt MH. EGFL7 enhances surface expression of integrin α 5β 1 to promote angiogenesis in malignant brain tumors. EMBO Mol Med 2019; 10:emmm.201708420. [PMID: 30065025 PMCID: PMC6127886 DOI: 10.15252/emmm.201708420] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma (GBM) is a typically lethal type of brain tumor with a median survival of 15 months postdiagnosis. This negative prognosis prompted the exploration of alternative treatment options. In particular, the reliance of GBM on angiogenesis triggered the development of anti-VEGF (vascular endothelial growth factor) blocking antibodies such as bevacizumab. Although its application in human GBM only increased progression-free periods but did not improve overall survival, physicians and researchers still utilize this treatment option due to the lack of adequate alternatives. In an attempt to improve the efficacy of anti-VEGF treatment, we explored the role of the egfl7 gene in malignant glioma. We found that the encoded extracellular matrix protein epidermal growth factor-like protein 7 (EGFL7) was secreted by glioma blood vessels but not glioma cells themselves, while no major role could be assigned to the parasitic miRNAs miR-126/126*. EGFL7 expression promoted glioma growth in experimental glioma models in vivo and stimulated tumor vascularization. Mechanistically, this was mediated by an upregulation of integrin α5β1 on the cellular surface of endothelial cells, which enhanced fibronectin-induced angiogenic sprouting. Glioma blood vessels that formed in vivo were more mature as determined by pericyte and smooth muscle cell coverage. Furthermore, these vessels were less leaky as measured by magnetic resonance imaging of extravasating contrast agent. EGFL7-inhibition using a specific blocking antibody reduced the vascularization of experimental gliomas and increased the life span of treated animals, in particular in combination with anti-VEGF and the chemotherapeutic agent temozolomide. Data allow for the conclusion that this combinatorial regimen may serve as a novel treatment option for GBM.
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Affiliation(s)
- Nevenka Dudvarski Stanković
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Bicker
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Keller
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Tw Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, Germany.,Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Arne Kienzle
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clarissa Gillmann
- Institute of Radiology, University Medical Center Erlangen, Erlangen, Germany
| | | | - Anna Golebiewska
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg
| | - Olivier Keunen
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg
| | - Alf Giese
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas von Deimling
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, Germany.,Department of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Bäuerle
- Institute of Radiology, University Medical Center Erlangen, Erlangen, Germany
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg.,KG Jebsen Brain Tumour Research Center, University of Bergen, Bergen, Norway
| | - Michel Mittelbronn
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Laboratoire National de Santé (LNS), Dudelange, Luxembourg.,Luxembourg Centre of Neuropathology (LCNP), Dudelange, Luxembourg
| | - Weilan Ye
- Vascular Biology Program, Molecular Oncology Division, Genentech, San Francisco, CA, USA
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, Germany.,Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mirko H Schmidt
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany .,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Vettermann FJ, Neumann JE, Suchorska B, Bartenstein P, Giese A, Dorostkar MM, Albert NL, Schüller U. K27M midline gliomas display malignant progression by imaging and histology. Neuropathol Appl Neurobiol 2019; 43:458-462. [PMID: 27997032 DOI: 10.1111/nan.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/25/2016] [Indexed: 01/01/2023]
Affiliation(s)
- F J Vettermann
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - J E Neumann
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany.,Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Germany.,Research Institute Children's Cancer Center, Hamburg, Germany
| | - B Suchorska
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - A Giese
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany
| | - M M Dorostkar
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany.,German center for neurodegenerative diseases (DZNE), Ludwig-Maximilians-University, Munich, Germany
| | - N L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - U Schüller
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany.,Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Germany.,Research Institute Children's Cancer Center, Hamburg, Germany.,Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Masomi-Bornwasser J, Winter P, Müller-Werkmeister H, Strand S, König J, Kempski O, Ringel F, Kantelhardt SR, Giese A, Keric N. Correction: Combination of ultrasound and rtPA enhances fibrinolysis in an In Vitro clot system. PLoS One 2018; 13:e0200456. [PMID: 29975777 PMCID: PMC6033470 DOI: 10.1371/journal.pone.0200456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Masomi-Bornwassser J, Freguia F, Müller-Werkmeister H, Kempski O, Giese A, Keric N. Effect of irrigation on fibrinolytic rtPA therapy in a clot model of intracerebral haemorrhage: a systematic in vitro study. Acta Neurochir (Wien) 2018; 160:1159-1165. [PMID: 29564653 DOI: 10.1007/s00701-018-3517-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/09/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Although fibrinolytic therapy is an upcoming treatment for intracerebral haemorrhage (ICH), standard guidelines are lacking, and some clinical issues persist. Here, we used our recently devised clot model of ICH to systematically analyse effects of irrigation and cerebrospinal fluid (CSF) on fibrinolysis. METHODS In vitro clots of human blood (25 ml) were generated and a catheter irrigation system was applied to deliver fluid/treatment. Clots were weighed before and after treatment and compared to rtPA treatment alone. First various drainage periods (15, 30 and 60 min; n = 3 each) and irrigation rates (0, 15, 90 and 180 ml/h; n = 3-5 each) were tested, followed by rtPA administration (1 mg, 15 min incubation) at each irrigation rate. Potential fibrinolytic effect of CSF was examined by incubation with 5 ml healthy vs. haemorrhagic CSF (n = 3 each). To assess a washout effect treatment with saline (0.9%), rtPA (1 mg) and high-rate irrigation (180 ml/h) were compared with measuring plasminogen level before and after. Furthermore clots were treated with a combination of plasminogen (150% serum concentration) and rtPA (1 mg). RESULTS Relative clot end weights after 60 min irrigation system treatments were 66.3 ± 3.8% (0 ml/h), 46.3 ± 9.5% (15 ml/h), 46.5 ± 7.1% (90 ml/h) and 53.3 ± 4.1% (180 ml/h). At a lower irrigation rate (15 ml/h), relative end weights were lowest (49.5 ± 4.6%) after 60 min (15 min: 62 ± 4.3%, p = 0.016; 30 min: 62.90 ± 1.88%, p = 0.012). The combination of rtPA and irrigation produced following relative end weights: 0 ml/h, 35 ± 3.2%; 15 ml/h, 32.1 ± 5.7%; 90 ml/h, 36.7 ± 6.3% and 180 ml/h, 41.9 ± 7.5%. No irrigation (0 ml/h) versus rtPA alone showed a significant difference (p < 0.0001) in higher clot weight reduction by rtPA. Similar rtPA+15 ml/h irrigation achieved a significant higher weight reduction compared to 15 ml/h irrigation alone (p = 0.0124). No differences were evident at 90 and 180 ml/h irrigation rates with and without rtPA. Healthy (55.1 ± 5%) or haemorrhagic (65.2 ± 6.2%) CSF showed no fibrinolytic activity. Plasminogen levels in clots declined dramatically (> 80% initially to < 10%) after 1 mg single rtPA dosing and high-rate (180 ml/h) irrigation. The fibrinolytic benefit of adding plasminogen to rtPA was marginal. CONCLUSIONS In our in vitro clot model, irrigation combined with rtPA (vs. rtPA alone) conferred no added lytic benefit. Likewise, exposure to haemorrhagic CSF did not increase clot lysis.
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Affiliation(s)
- Julia Masomi-Bornwassser
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Fabio Freguia
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Neuropathology, University- and Knappschaft- Hospital Bochum, Bochum, Germany
| | - Hendrik Müller-Werkmeister
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Oliver Kempski
- Institute of Neurosurgical Pathophysiology, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- OrthoCentrum Hamburg, Hansastr. 1-3, Hamburg, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Keric N, Doenitz C, Haj A, Rachwal-Czyzewicz I, Renovanz M, Wesp DMA, Boor S, Conrad J, Brawanski A, Giese A, Kantelhardt SR. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus 2018; 42:E11. [PMID: 28463624 DOI: 10.3171/2017.2.focus16552] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Recent studies have investigated the role of spinal image guidance for pedicle screw placement. Many authors have observed an elevated placement accuracy and overall improvement of outcome measures. This study assessed a bi-institutional experience following introduction of the Renaissance miniature robot for spinal image guidance in Europe. Methods The medical records and radiographs of all patients who underwent robot-guided implantation of spinal instrumentation using the novel system (between October 2011 and March 2015 in Mainz and February 2014 and February 2016 in Regensburg) were reviewed to determine the efficacy and safety of the newly introduced robotic system. Screw position accuracy, complications, exposure durations to intraoperative radiation, and reoperation rate were assessed. Results Of the 413 surgeries that used robotic guidance, 406 were via a minimally invasive approach. In 7 cases the surgeon switched to conventional screw placement, using a midline approach, due to referencing problems. A total of 2067 screws were implanted using robotic guidance, and 1857 screws were evaluated by postoperative CT. Of the 1857 screws, 1799 (96.9%) were classified as having an acceptable or good position, whereas 38 screws (2%) showed deviations of 3-6 mm and 20 screws (1.1%) had deviations > 6 mm. Nine misplaced screws, implanted in 7 patients, required revision surgery, yielding a screw revision rate of 0.48% of the screws and 7 of 406 (1.7%) of the patients. The mean ± SD per-patient intraoperative fluoroscopy exposure was 114.4 (± 72.5) seconds for 5.1 screws on average and any further procedure required. Perioperative and direct postoperative complications included hemorrhage (2 patients, 0.49%) and wound infections necessitating surgical revision (20 patients, 4.9%). Conclusions The hexapod miniature robotic device proved to be a safe and robust instrument in all situations, including those in which patients were treated on an emergency basis. Placement accuracy was high; peri- and early postoperative complication rates were found to be lower than rates published in other series of percutaneous screw placement techniques. Intraoperative radiation exposure was found to be comparable to published values for other minimally invasive and conventional approaches.
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Affiliation(s)
| | - Christian Doenitz
- Department of Neurosurgery, University Hospital Regensburg, University of Regensburg, Germany
| | - Amer Haj
- Department of Neurosurgery, University Hospital Regensburg, University of Regensburg, Germany
| | | | | | | | - Stephan Boor
- Institute of Neuroradiology, University Medical Centre, Johannes-Gutenberg University Mainz; and
| | | | - Alexander Brawanski
- Department of Neurosurgery, University Hospital Regensburg, University of Regensburg, Germany
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Unterrainer M, Winkelmann I, Suchorska B, Giese A, Wenter V, Kreth FW, Herms J, Bartenstein P, Tonn JC, Albert NL. Biological tumour volumes of gliomas in early and standard 20-40 min 18F-FET PET images differ according to IDH mutation status. Eur J Nucl Med Mol Imaging 2018; 45:1242-1249. [PMID: 29487977 DOI: 10.1007/s00259-018-3969-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/02/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE For the clinical evaluation of O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET images, the use of standard summation images obtained 20-40 min after injection is recommended. However, early summation images obtained 5-15 min after injection have been reported to allow better differentiation between low-grade glioma (LGG) and high-grade glioma (HGG) by capturing the early 18F-FET uptake peak specific for HGG. We compared early and standard summation images with regard to delineation of the PET-derived biological tumour volume (BTV) in correlation with the molecular genetic profile according the updated 2016 WHO classification. METHODS The analysis included 245 patients with newly diagnosed, histologically verified glioma and a positive 18F-FET PET scan prior to any further treatment. BTVs were delineated during the early 5-15 min and standard 20-40 min time frames using a threshold of 1.6 × background activity and were compared intraindividually. Volume differences between early and late summation images of >20% were considered significant and were correlated with WHO grade and the molecular genetic profile (IDH mutation and 1p/19q codeletion status). RESULTS In 52.2% of the patients (128/245), a significant difference in BTV of >20% between early and standard summation images was found. While 44.3% of WHO grade II gliomas (31 of 70) showed a significantly smaller BTV in the early summation images, 35.0% of WHO grade III gliomas (28/80) and 37.9% of WHO grade IV gliomas (36/95) had a significantly larger BTVs. Among IDH-wildtype gliomas, an even higher portion (44.4%, 67/151) showed significantly larger BTVs in the early summation images, which was observed in 5.3% (5/94) of IDH-mutant gliomas only: most of the latter had significantly smaller BTVs in the early summation images, i.e. 51.2% of IDH-mutant gliomas without 1p/19q codeletion (21/41) and 39.6% with 1p/19q codeletion (21/53). CONCLUSION BTVs delineated in early and standard summation images differed significantly in more than half of gliomas. While the standard summation images seem appropriate for delineation of LGG as well as IDH-mutant gliomas, a remarkably high percentage of HGG and, particularly, IDH-wildtype gliomas were depicted with significantly larger volumes in early summation images. This finding might be of interest for optimization of treatment planning (e.g. radiotherapy) in accordance with the individual IDH mutation status.
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Affiliation(s)
- M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - I Winkelmann
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - B Suchorska
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Giese
- Department of Neuropathology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - V Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F W Kreth
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J Herms
- Department of Neuropathology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J C Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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20
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Franceschini A, Strammiello R, Capellari S, Giese A, Parchi P. Regional pattern of microgliosis in sporadic Creutzfeldt-Jakob disease in relation to phenotypic variants and disease progression. Neuropathol Appl Neurobiol 2018; 44:574-589. [PMID: 29345730 DOI: 10.1111/nan.12461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/22/2017] [Indexed: 12/30/2022]
Abstract
AIMS The aim of this study was to describe the regional profiles of microglial activation in sporadic Creutzfeldt-Jakob disease (sCJD) subtypes and analyse the influence of prion strain, disease duration and codon 129 genotype. METHODS We studied the amount/severity and distribution of activated microglia, protease-resistant prion protein (PrPSc ) spongiform change, and astrogliosis in eight regions of 57 brains, representative of the entire spectrum of sCJD subtypes. RESULTS In each individual subtype, the regional extent and distribution of microgliosis significantly correlated with PrPSc deposition and spongiform change, leading to subtype-specific 'lesion profiles'. However, large differences in the ratio between PrPSc load or the score of spongiform change and microglial activation were seen among disease subtypes. Most significantly, atypical sCJD subtypes such as VV1 and MM2T showed a degree of microglial activation comparable to other disease variants despite the relatively low PrPSc deposition and the less severe spongiform change. Moreover, the mean microglial total load was significantly higher in subtype MM1 than in MM2C, whereas the opposite was true for the PrPSc and spongiform change total loads. Finally, some sCJD subtypes showed distinctive regional cerebellar profiles of microgliosis characterized by a high granular/molecular layer ratio (MV2K) and/or a predominant involvement of white matter (MVK and MM2T). CONCLUSIONS Microglial activation is an early event in sCJD pathogenesis and is strongly influenced by prion strain, PRNP codon 129 genotype and disease duration. Microglial lesion profiling, by highlighting strain-specific properties of prions, contributes to prion strain characterization and classification of human prion diseases, and represents a valid support to molecular and histopathologic typing.
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Affiliation(s)
- A Franceschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - R Strammiello
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Institute of Neurological Sciences, Bologna, Italy
| | - A Giese
- Institut für Neuropathologie und Prion Forschung, Ludwig-Maximilians-Universität München, Munich, Germany
| | - P Parchi
- IRCCS, Institute of Neurological Sciences, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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21
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Stankovic ND, Hoppmann N, Teodorczyk M, Kim EL, Bros M, Giese A, Zipp F, Schmidt MHH. No role of IFITM3 in brain tumor formation in vivo. Oncotarget 2018; 7:86388-86405. [PMID: 27835870 PMCID: PMC5349921 DOI: 10.18632/oncotarget.13199] [Citation(s) in RCA: 4] [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: 04/28/2016] [Accepted: 10/29/2016] [Indexed: 12/20/2022] Open
Abstract
Glioblastoma multiforme (GBM) is one of the most lethal solid tumors in adults. Despite aggressive treatment approaches for patients, GBM recurrence is inevitable, in part due to the existence of stem-like brain tumor-propagating cells (BTPCs), which produce factors rendering them resistant to radio- and chemotherapy. Comparative transcriptome analysis of irradiated, patient-derived BTPCs revealed a significant upregulation of the interferon-inducible transmembrane protein 3 (IFITM3), suggesting the protein as a factor mediating radio resistance. Previously, IFITM3 has been described to affect glioma cells; therefore, the role of IFITM3 in the formation and progression of brain tumors has been investigated in vivo. Intracranial implantation studies using radio-selected BTPCs alongside non-irradiated parental BTPCs in immunodeficient mice displayed no influence of irradiation on animal survival. Furthermore, gain and loss of function studies using BTPCs ectopically expressing IFITM3 or having IFITM3 down-modulated by a shRNA approach, did affect neither tumor growth nor animal survival. Additionally, a syngeneic model based on the mouse glioma cell line GL261 was applied in order to consider the possibility that IFITM3 relies on an intact immune system to unfold its tumorigenic potential. GL261 cells ectopically expressing IFITM3 were implanted into the striatum of immunocompetent mice without influencing the survival of glioma-bearing animals. Lastly, the vasculature and the extent of microglia/macrophage invasion into the tumor were studied in BTPC and GL261 tumors but neither parameter was altered by IFITM3. This report presents for the first time that IFITM3 is upregulated in patient-derived BTPCs upon irradiation but does not affect brain tumor formation or progression in vivo.
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Affiliation(s)
- Nevenka Dudvarski Stankovic
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), Johannes Gutenberg University, School of Medicine, Mainz, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Hoppmann
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Research Center for Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Marcin Teodorczyk
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Ella L Kim
- Translational Oncology Research Group, Department of Neurosurgery, Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Matthias Bros
- Department of Dermatology, Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Alf Giese
- Translational Oncology Research Group, Department of Neurosurgery, Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Research Center for Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), Johannes Gutenberg University, School of Medicine, Mainz, Germany
| | - Mirko H H Schmidt
- Molecular Signal Transduction Laboratories, Institute for Microscopic Anatomy and Neurobiology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), Johannes Gutenberg University, School of Medicine, Mainz, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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22
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Hansen-Algenstaedt N, Liem M, Holz J, Giese A. Posterior only approach to open wedge osteotomy in the thoracolumbar spine. Eur Spine J 2017; 26:560-561. [PMID: 29164330 DOI: 10.1007/s00586-017-5382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nils Hansen-Algenstaedt
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany.
| | - Melanie Liem
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Johannes Holz
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Alf Giese
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
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23
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Hansen-Algenstaedt N, Liem M, Khalifah SO, Holz J, Giese A. Minimal-invasive revision of adjacent level disease after MIS deformity surgery. Eur Spine J 2017; 26:562-564. [PMID: 29138924 DOI: 10.1007/s00586-017-5383-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nils Hansen-Algenstaedt
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany.
| | - Melanie Liem
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - SalahAddeen O Khalifah
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Johannes Holz
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Alf Giese
- Department of Spine Surgery, OrthoCentrum Hamburg, Park-Klinik Manhagen, Hansastrasse 1-3, 20149, Hamburg, Germany
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24
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Amr AN, Conrad J, Kantelhardt S, Giese A. Autostereoscopic Three-Dimensional Neuronavigation to the Sella: Technical Note. World Neurosurg 2017; 105:386-393. [DOI: 10.1016/j.wneu.2017.05.164] [Citation(s) in RCA: 2] [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: 11/24/2016] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
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25
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Archavlis E, Amr N, Kantelhardt SR, Giese A. Rates of Upper Facet Joint Violation in Minimally Invasive Percutaneous and Open Instrumentation: A Comparative Cohort Study of Different Insertion Techniques. J Neurol Surg A Cent Eur Neurosurg 2017; 79:1-8. [PMID: 28672411 DOI: 10.1055/s-0037-1603631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint. STUDY AIMS We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation. METHODS A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016. All operations were performed by the same surgeon; the patients were divided into three groups according to the method of instrumentation. Group 1 involved the robot-assisted instrumentation in 58 patients, group 2 consisted of 64 patients treated with a percutaneous transpedicular instrumentation using fluoroscopic guidance, and 72 patients in group 3 received an open midline approach for pedicle screw insertion. RESULTS Superior segment facet joint violation occurred in 2 patients in the robot-assisted group 1 (7%), in 22 of the percutaneous fluoroscopy-guided group 2 (34%), and in 6 cases of the open group (8%). The incidence of facet joint violation was present in 5% (3) of the screws in group 1, 22% (28) of the screws in group 2, and 3% (4) of the screws in group 3. CONCLUSION Meticulous surgical planning of the appropriate entry site (Weinstein's method), trajectory planning, and proper robot-assisted instrumentation of pedicle screws reduced the risk of superior segment facet joint violation.
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Affiliation(s)
- Eleftherios Archavlis
- Department of Neurosurgery, Medical University of Mainz, Mainz, Germany.,Department of Neurosurgery, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Nimer Amr
- Department of Neurosurgery, Medical University of Mainz, Mainz, Germany
| | | | - Alf Giese
- Department of Neurosurgery, Medical University of Mainz, Mainz, Germany
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26
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Nübling G, Schuberth M, Feldmer K, Giese A, Holdt LM, Teupser D, Lorenzl S. Cathepsin S increases tau oligomer formation through limited cleavage, but only IL-6, not cathespin S serum levels correlate with disease severity in the neurodegenerative tauopathy progressive supranuclear palsy. Exp Brain Res 2017; 235:2407-2412. [PMID: 28493068 DOI: 10.1007/s00221-017-4978-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
Limited cleavage promotes the aggregation propensity of protein tau in neurodegenerative tauopathies. Cathepsin S (CatS) is overexpressed in brains of patients suffering from tauopathies such as Alzheimer's disease (AD). Furthermore, CatS serum levels correlate with survival in the elderly. The current study investigates whether limited cleavage by CatS promotes tau aggregation, and whether CatS serum levels may correlate with disease severity in tauopathies. Oligomer formation of fluorescently labeled protein tau was monitored by single particle fluorescence spectroscopy after coincubation with CatS. Tau cleavage patterns were investigated by SDS-PAGE. For serum analyses, samples were collected from 42 patients with probable progressive supranuclear palsy (PSP) according to NINDS-PSP criteria. Disease severity was assessed by PSP rating scale (PSP-RS), PSP staging system (PSP-S) and Schwab and England Activities of Daily Living (SEADL). CatS, cystatin C (CysC) and interleukin 6 (IL-6) serum levels were determined by ELISA, ECLIA and turbidimetry, respectively. SDS-PAGE demonstrated a distinct cleavage pattern of protein tau after coincubation with CatS. Furthermore, tau oligomer formation was increased 2.4-fold (p < 0.05) after limited cleavage. Serum CatS and CysC levels did not correlate with disease severity in PSP. Of note, IL-6 correlated with PSP-S (r = 0.41; 95% CI 0.11-0.65; p = 0.008), SEADL (r = -0.37; 95% CI -0.61 to -0.06; p = 0.017) and the history and gait/midline subdomains of the PSP-RS. While CatS facilitates tau aggregation in vitro, serum levels of CatS appear not to correlate with disease severity. The observed correlation of IL-6 with disease severity warrants further investigation of inflammatory markers in PSP.
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Affiliation(s)
- Georg Nübling
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Palliative Care, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany.
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - M Schuberth
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - K Feldmer
- Department of Palliative Care, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - L M Holdt
- Institute of Laboratory Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - D Teupser
- Institute of Laboratory Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - S Lorenzl
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Palliative Care, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
- Endowed Professorship for Palliative Care, Salzburg, Austria
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27
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Neulen A, Pantel T, Kosterhon M, Kirschner S, Brockmann MA, Kantelhardt SR, Giese A, Thal SC. A segmentation-based volumetric approach to localize and quantify cerebral vasospasm based on tomographic imaging data. PLoS One 2017; 12:e0172010. [PMID: 28199398 PMCID: PMC5310853 DOI: 10.1371/journal.pone.0172010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/30/2016] [Accepted: 01/30/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Quantification of cerebral vasospasm after subarachnoid hemorrhage (SAH) is crucial in animal studies as well as clinical routine. We have developed a method for computer-based volumetric assessment of intracranial blood vessels from cross-sectional imaging data. Here we demonstrate the quantification of vasospasm from micro computed tomography (micro-CT) data in a rodent SAH model and the transferability of the volumetric approach to clinical data. Methods We obtained rodent data by performing an ex vivo micro-CT of murine brains after sham surgery or SAH by endovascular filament perforation on day 3 post hemorrhage. Clinical CT angiography (CTA) was performed for diagnostic reasons unrelated to this study. We digitally reconstructed and segmented intracranial vascular trees, followed by calculating volumes of defined vessel segments by standardized protocols using Amira® software. Results SAH animals demonstrated significantly smaller vessel diameters compared with sham (MCA: 134.4±26.9μm vs.165.0±18.7μm, p<0.05). We could highlight this difference by analyzing vessel volumes of a defined MCA-ICA segment (SAH: 0.044±0.017μl vs. sham: 0.07±0.006μl, p<0.001). Analysis of clinical CTA data allowed us to detect and volumetrically quantify vasospasm in a series of 5 SAH patients. Vessel diameters from digital reconstructions correlated well with those measured microscopically (rodent data, correlation coefficient 0.8, p<0.001), or angiographically (clinical data, 0.9, p<0.001). Conclusions Our methodological approach provides accurate anatomical reconstructions of intracranial vessels from cross-sectional imaging data. It allows volumetric assessment of entire vessel segments, hereby highlighting vasospasm-induced changes objectively in a murine SAH model. This method could also be a helpful tool for analysis of clinical CTA.
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Affiliation(s)
- Axel Neulen
- Department of Neurosurgery, University Medical Center of Mainz, Mainz, Germany
- * E-mail: (AN); (SCT)
| | - Tobias Pantel
- Department of Neurosurgery, University Medical Center of Mainz, Mainz, Germany
| | - Michael Kosterhon
- Department of Neurosurgery, University Medical Center of Mainz, Mainz, Germany
| | - Stefanie Kirschner
- Department of Neuroradiology, University Medical Center of Mainz, Mainz, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Center of Mainz, Mainz, Germany
| | - Sven R. Kantelhardt
- Department of Neurosurgery, University Medical Center of Mainz, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Center of Mainz, Mainz, Germany
| | - Serge C. Thal
- Department of Anesthesiology, University Medical Center of Mainz, Mainz, Germany
- * E-mail: (AN); (SCT)
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28
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Archavlis E, Serrano L, Schwandt E, Nimer A, Molina-Fuentes MF, Rahim T, Ackermann M, Gutenberg A, Kantelhardt SR, Giese A. A novel minimally invasive, dorsolateral, tubular partial odontoidectomy and autologous bone augmentation to treat dens pseudarthrosis: cadaveric, 3D virtual simulation study and technical report. J Neurosurg Spine 2017; 26:190-198. [DOI: 10.3171/2016.7.spine16244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The goal of this study was to demonstrate the clinical and technical nuances of a minimally invasive, dorsolateral, tubular approach for partial odontoidectomy, autologous bone augmentation, and temporary C1–2 fixation to treat dens pseudarthrosis.
METHODS
A cadaveric feasibility study, a 3D virtual reality reconstruction study, and the subsequent application of this approach in 2 clinical cases are reported. Eight procedures were completed in 4 human cadavers. A minimally invasive, dorsolateral, tubular approach for odontoidectomy was performed with the aid of a tubular retraction system, using a posterolateral incision and an oblique approach angle. Fluoroscopy and postprocedural CT, using 3D volumetric averaging software, were used to evaluate the degree of bone removal of C1–2 lateral masses and the C-2 pars interarticularis. Two clinical cases were treated using the approach: a 23-year-old patient with an odontoid fracture and pseudarthrosis, and a 35-year-old patient with a history of failed conservative treatment for odontoid fracture.
RESULTS
At 8 cadaveric levels, the mean volumetric bone removal of the C1–2 lateral masses on 1 side was 3% ± 1%, and the mean resection of the pars interarticularis on 1 side was 2% ± 1%. The median angulation of the trajectory was 50°, and the median distance from the midline of the incision entry point on the skin surface was 67 mm. The authors measured the diameter of the working channel in relation to head positioning and assessed a greater working corridor of 12 ± 4 mm in 20° inclination, 15° contralateral rotation, and 5° lateral flexion to the contralateral side. There were no violations of the dura. The reliability of C-2 pedicle screws and C-1 lateral mass screws was 94% (15 of 16 screws) with a single lateral breach. The patients treated experienced excellent clinical outcomes.
CONCLUSIONS
A minimally invasive, dorsolateral, tubular odontoidectomy and autologous bone augmentation combined with C1–2 instrumentation has the ability to provide excellent 1-stage management of an odontoid pseudarthrosis. The procedure can be completed safely and successfully with minimal blood loss and little associated morbidity. This approach has the potential to provide not only a less invasive approach but also a function-preserving option to treat complex C1–2 anterior disease.
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Affiliation(s)
| | | | | | | | | | | | - Maximilian Ackermann
- 4Institute of Anatomy, University Medical Center, Johannes Gutenberg-University Mainz
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Kosterhon M, Gutenberg A, Kantelhardt SR, Archavlis E, Giese A. Navigation and Image Injection for Control of Bone Removal and Osteotomy Planes in Spine Surgery. Oper Neurosurg (Hagerstown) 2017; 13:297-304. [DOI: 10.1093/ons/opw017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/31/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE: In contrast to cranial interventions, neuronavigation in spinal surgery is used in few applications, not tapping into its full technological potential. We have developed a method to preoperatively create virtual resection planes and volumes for spinal osteotomies and export 3-D operation plans to a navigation system controlling intraoperative visualization using a surgical microscope's head-up display. The method was developed using a Sawbone® model of the lumbar spine, demonstrating feasibility with high precision. Computer tomographic and magnetic resonance image data were imported into Amira®, a 3-D visualization software. Resection planes were positioned, and resection volumes representing intraoperative bone removal were defined. Fused to the original Digital Imaging and Communications in Medicine data, the osteotomy planes were exported to the cranial version of a Brainlab® navigation system. A navigated surgical microscope with video connection to the navigation system allowed intraoperative image injection to visualize the preplanned resection planes.
CLINICAL PRESENTATION: The workflow was applied to a patient presenting with a congenital hemivertebra of the thoracolumbar spine. Dorsal instrumentation with pedicle screws and rods was followed by resection of the deformed vertebra guided by the in-view image injection of the preplanned resection planes into the optical path of a surgical microscope. Postoperatively, the patient showed no neurological deficits, and the spine was found to be restored in near physiological posture.
CONCLUSION: The intraoperative visualization of resection planes in a microscope's head-up display was found to assist the surgeon during the resection of a complex-shaped bone wedge and may help to further increase accuracy and patient safety.
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Kalasauskas D, Renovanz M, Bikar S, Buzdin A, Enam A, Kantelhardt S, Giese A, Kim EL. Perspectives and Challenges in Molecular-Based Diagnostics and Personalized Treatment for Recurrent High-Grade Gliomas. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/2157-2518.1000290] [Citation(s) in RCA: 2] [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] [Indexed: 11/09/2022]
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Renovanz M, Hickmann AK, Coburger J, Kohlmann K, Janko M, Reuter AK, Keric N, Nadji-Ohl M, König J, Singer S, Giese A, Hechtner M. Assessing psychological and supportive care needs in glioma patients - feasibility study on the use of the Supportive Care Needs Survey Short Form (SCNS-SF34-G) and the Supportive Care Needs Survey Screening Tool (SCNS-ST9) in clinical practice. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12598] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Affiliation(s)
- M. Renovanz
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - A.-K. Hickmann
- Center for Endoscopic and Minimally Invasive Neurosurgery; Hirslanden; Zürich Switzerland
- Department of Neurosurgery Klinikum Stuttgart; Katharinenhospital; Stuttgart Germany
| | - J. Coburger
- Department of Neurosurgery; University Medical Center; Ulm/Günzburg Germany
| | - K. Kohlmann
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Janko
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - A.-K. Reuter
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - N. Keric
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Nadji-Ohl
- Department of Neurosurgery Klinikum Stuttgart; Katharinenhospital; Stuttgart Germany
| | - J. König
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - S. Singer
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
- German Cancer Consortium (DKTK); Mainz Germany
| | - A. Giese
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Hechtner
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
- German Cancer Consortium (DKTK); Mainz Germany
- German Cancer Research Center (DKFZ); Heidelberg Germany
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Kantelhardt SR, Archavlis E, Giese A. Combined suture and clipping for the reconstruction of a ruptured blister-like aneurysm. Acta Neurochir (Wien) 2016; 158:1907-11. [PMID: 27514829 DOI: 10.1007/s00701-016-2919-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/01/2016] [Indexed: 12/01/2022]
Abstract
Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challenge. While several reconstructive techniques are in use in case of acute rupture sacrifice of the parent vessel may be required. We present a combined technique of micro-sutures and clip application to repair the parent vessel in an intraoperatively ruptured blister-like aneurysm. Following temporary trapping of an intraoperatively ruptured 7-mm blister-like aneurysm four 8-0 nylon sutures were applied to adapt the vessel walls and support the branches of subsequently applied mini-clips. The combination of micro-sutures and mini-clips might be a valuable alternative to direct clipping or suturing in some cases with intraoperative rupture of blister-like aneurysms.
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Affiliation(s)
- Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Langenbeckstr. 1, 55129, Mainz, Germany.
| | - Eleftherios Archavlis
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Langenbeckstr. 1, 55129, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Langenbeckstr. 1, 55129, Mainz, Germany
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Hansen-Algenstaedt N, Khalifah S, Liem M, Holz J, Giese A. Cervical total disc replacement (TDR). Eur Spine J 2016; 25:480-482. [PMID: 27671276 DOI: 10.1007/s00586-016-4761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nils Hansen-Algenstaedt
- Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hamburg, Germany. .,Department of Orthopaedics, University Medical Hospital, Hamburg, Germany.
| | - Salah Khalifah
- Orthocentrum Hamburg, Parkklinik Manhagen, Hamburg, Germany.,Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Melanie Liem
- Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hamburg, Germany
| | - Johannes Holz
- Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hamburg, Germany
| | - Alf Giese
- Orthocentrum Hamburg, Parkklinik Manhagen, Hamburg, Germany
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Hickmann AK, Nadji-Ohl M, Haug M, Hopf NJ, Ganslandt O, Giese A, Renovanz M. Suicidal ideation, depression, and health-related quality of life in patients with benign and malignant brain tumors: a prospective observational study in 83 patients. Acta Neurochir (Wien) 2016; 158:1669-82. [PMID: 27318813 DOI: 10.1007/s00701-016-2844-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) and psychosocial burden are of relevance in patients with intracranial tumors. We investigated the prevalence of suicidal ideation (SI), depression, and their association with HRQoL in patients with intra- (IA) and extraaxial (EA) tumors during the first 9 months after diagnosis. METHODS Patients were recruited immediately following surgery, and re-evaluated after 3, 6, and 9 months (EORTC QLQ-C30/BN20, Beck Depression Inventory (BDI) and Appendix). Patients with a personal history of psychological comorbidity were excluded. Sociodemographic and clinical data were evaluated. RESULTS IA patients had lower functioning scores and experienced more symptoms. Global Health Status was significantly lower at baseline (p = 0.038), but improved over time (p < 0.001). Seventeen patients (21.5 %) admitted to having had SI at least once during the study period (IA: n = 10/EA: n = 7). The highest rates were observed after 6 (IA: 18.8 %) and 9 months (EA: 10.0 %). Patients reporting SI had significantly higher BDI scores [p = 0.22 (baseline), p = 0.031 (3 months), p < 0.001 (6 months)]. After 6 months, HRQoL differed greatest between patients with and without SI. Most patients experienced good familial support (76 %). CONCLUSIONS Patients with intracranial tumors suffer from decreased HRQoL and SI regardless of histopathology. SI is associated with higher BDI scores, but not evident depression (BDI ≥ 18). Thus, patients should be screened specifically and regularly. Lower HRQoL and greatest prevalence of SI at 6 months may help clinicians to find the right time for careful monitoring of patients at risk.
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Affiliation(s)
- Anne-Katrin Hickmann
- Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland.
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
| | - Minou Nadji-Ohl
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Markus Haug
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Nikolai J Hopf
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
- Neurochirurgicum, Center for Endoscopic and Minimally Invasive Neurosurgery, Stuttgart, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
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Conrad J, Ayyad A, Wüster C, Omran W, Weber MM, Konerding MA, Müller-Forell W, Giese A, Oertel J. Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study. J Neurosurg 2016; 125:334-45. [PMID: 26722858 DOI: 10.3171/2015.6.jns142637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. CONCLUSIONS Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area.
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Affiliation(s)
| | - Ali Ayyad
- Neurochirurgische Klinik und Poliklinik
| | | | | | | | - Moritz A Konerding
- Institut für Anatomie und Zellbiologie, Fachbereich Medizin, Johannes Gutenberg-Universität Mainz
| | | | - Alf Giese
- Neurochirurgische Klinik und Poliklinik
| | - Joachim Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Kalinina J, Ahn J, Devi NS, Wang L, Li Y, Olson JJ, Glantz M, Smith T, Kim EL, Giese A, Jensen RL, Chen CC, Carter BS, Mao H, He M, Van Meir EG. Selective Detection of the D-enantiomer of 2-Hydroxyglutarate in the CSF of Glioma Patients with Mutated Isocitrate Dehydrogenase. Clin Cancer Res 2016; 22:6256-6265. [PMID: 27340277 DOI: 10.1158/1078-0432.ccr-15-2965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 05/18/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Elevation in D-2-Hydroxyglutarate (D-2HG) has recently emerged as a mandatory byproduct of mutated Isocitrate Dehydrogenase (IDH) genes 1 and 2 in glioma patients. The goal of the present study was to demonstrate the feasibility of detection of elevated levels of D-2HG in the cerebrospinal fluid (CSF) of glioma patients that carry point substitutions in the IDH gene. EXPERIMENTAL DESIGN We developed a mass spectrometry (MS)-based platform to detect and quantify the D- and L-forms of 2HG in the CSF of glioma patients. Three independent cohorts of patients were analyzed, comprising a total of 176 samples derived from 84 patients. The levels of D- and L-2HG were used to stratify patients into IDH wild-type or IDH-mutated groups using an empirically obtained threshold of 0.69 μmol/L. RESULTS Using this platform, a greater than 17-fold mean increase in D-2HG was observed in the CSF of patients with IDH mutant versus wild-type gliomas. The means for the D-2HG levels in CSF were 0.427 μmol/L in wild-type and 7.439 μmol/L in mutant groups. The C statistic for the receiver operator curve was 0.938, with 84% sensitivity, 90% specificity, and 89% accuracy to detect D-2HG. The levels of D- and L-2HG in CSF from wild-type patients varied by location of CSF draw (cisternal > ventricular > lumbar). CONCLUSIONS Our findings demonstrate that the CSF of patients harboring IDH mutant gliomas contain increased levels of D-2HG, which can be reliably detected with a MS-based platform. Clin Cancer Res; 22(24); 6256-65. ©2016 AACR.
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Affiliation(s)
- Juliya Kalinina
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Jun Ahn
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Narra S Devi
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Liya Wang
- Department of Radiology, School of Medicine, Emory University, Atlanta, Georgia
| | - Yuancheng Li
- Department of Radiology, School of Medicine, Emory University, Atlanta, Georgia
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Thomas Smith
- Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ella L Kim
- University of Medical Center of Mainz, Mainz, Germany
| | - Alf Giese
- University of Medical Center of Mainz, Mainz, Germany
| | - Randy L Jensen
- Hunstman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Clark C Chen
- University of California, San Diego, La Jolla, California
| | - Bob S Carter
- University of California, San Diego, La Jolla, California
| | - Hui Mao
- Department of Radiology, School of Medicine, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Miao He
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Erwin G Van Meir
- Department of Neurosurgery, Emory University, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
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Abstract
ISSUE Recently, quality tools have been promoted to improve patient safety and process efficiency in healthcare. While surgeons primarily focused on surgical issues, like infection rates or implant design, we introduced pre-admission and preoperative checklists in the early 2000s. INITIAL ASSESSMENT To assess the efficiency of these tools in a neurosurgical department, we performed a survey of all spinal instrumentation patients operated in 2011 (n = 147). The results revealed several problems. CHOICE OF SOLUTION We consequently redesigned the checklists accompanied by flanking measures, such as written and online accessible standards. Furthermore, the staff was trained to use the updated quality tools. IMPLEMENTATION The measures were implemented in 2012. EVALUATION Results were re-evaluated in a second survey in 2013 (n = 162). We found that the use of pre-admission checklists significantly increased from 47 to 96%, while the use of preoperative checklists significantly decreased from 86 to 75%. Within the same period, the quality and completeness of the checklists did, however, increase, so that in 2013, 43% of the patients had a completely processed preoperative checklist, compared to 29% in 2011. LESSONS LEARNED The introduction of checklists alone did not in itself guarantee an improved workflow. The introduction must be accompanied by other measures, like written standards and regular training of employees. Otherwise, the positive effect wears off quickly. Nevertheless, we could show that the stringent application of quality tools can induce a sustainable change. Our data further suggest that the clear and traceable delegation of responsibilities is of high importance.
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Affiliation(s)
- Pamela Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes-Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany
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Switzeny OJ, Christmann M, Renovanz M, Giese A, Sommer C, Kaina B. MGMT promoter methylation determined by HRM in comparison to MSP and pyrosequencing for predicting high-grade glioma response. Clin Epigenetics 2016; 8:49. [PMID: 27158275 PMCID: PMC4858829 DOI: 10.1186/s13148-016-0204-7] [Citation(s) in RCA: 54] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The DNA repair protein O(6)-methylguanine-DNA methyltransferase (MGMT) causes resistance of cancer cells to alkylating agents and, therefore, is a well-established predictive marker for high-grade gliomas that are routinely treated with alkylating drugs. Since MGMT is highly epigenetically regulated, the MGMT promoter methylation status is taken as an indicator of MGMT silencing, predicting the outcome of glioma therapy. MGMT promoter methylation is usually determined by methylation specific PCR (MSP), which is a labor intensive and error-prone method often used semi-quantitatively. Searching for alternatives, we used closed-tube high resolution melt (HRM) analysis, which is a quantitative method, and compared it with MSP and pyrosequencing regarding its predictive value. RESULTS We analyzed glioblastoma cell lines with known MGMT activity and formalin-fixed samples from IDH1 wild-type high-grade glioma patients (WHO grade III/IV) treated with radiation and temozolomide by HRM, MSP, and pyrosequencing. The data were compared as to progression-free survival (PFS) and overall survival (OS) of patients exhibiting the methylated and unmethylated MGMT status. A promoter methylation cut-off level relevant for PFS and OS was determined. In a multivariate Cox regression model, methylation of MGMT promoter of high-grade gliomas analyzed by HRM, but not MSP, was found to be an independent predictive marker for OS. Univariate Kaplan-Meier analyses revealed for PFS and OS a significant and better discrimination between methylated and unmethylated tumors when quantitative HRM was used instead of MSP. CONCLUSIONS Compared to MSP and pyrosequencing, the HRM method is simple, cost effective, highly accurate and fast. HRM is at least equivalent to pyrosequencing in quantifying the methylation level. It is superior in predicting PFS and OS of high-grade glioma patients compared to MSP and, therefore, can be recommended being used routinely for determination of the MGMT status of gliomas.
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Affiliation(s)
- Olivier J Switzeny
- Department of Toxicology, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany
| | - Markus Christmann
- Department of Toxicology, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Clemens Sommer
- Department of Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Bernd Kaina
- Department of Toxicology, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 67, 55131 Mainz, Germany
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Neulen A, Prokesch E, Stein M, König J, Giese A. Image-guided transcranial Doppler sonography for monitoring of vasospasm after subarachnoid hemorrhage. Clin Neurol Neurosurg 2016; 145:14-8. [PMID: 27062685 DOI: 10.1016/j.clineuro.2016.03.012] [Citation(s) in RCA: 7] [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: 02/05/2015] [Revised: 03/13/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Transcranial Doppler ultrasound (TCD) is a standard method for bedside vasospasm monitoring after subarachnoid hemorrhage (SAH). Image guidance has previously been shown to reduce intra- and interobserver variability of this method. The aim of the present study was to compare image-guided and conventional TCD in vasospasm monitoring after SAH. PATIENTS AND METHODS 418 TCD exams of 24 consecutive SAH patients registered in a database were evaluated. Of these, 130 image-guided exams were identified which had been performed on the same day as conventional Doppler exams. These matched pairs were taken for statistical analysis. Data were tested statistically using the sign test applied at patient level to aggregated data. RESULTS The rate of complete exams (both M1, A1, P1 segments) was significantly higher in image-guided exams (92% vs. 74%, p<0.001), and the superiority of image-guided exams was significantly related to smaller sizes of the temporal bone window. There were more exams with Doppler sonographic vasospasm (mean flow velocity>120cm/s) in image-guided exams (38% vs. 33%) which, however, did not reach statistical significance. CONCLUSION Image-guidance leads to a standardization of serial TCD exams, which resulted in significantly more complete exams, most prominent in patients with poor temporal bone windows, and a higher detection rate of Doppler sonographic vasospasms. Image-guided TCD therefore has the capability to improve bedside vasospasm monitoring after SAH.
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Affiliation(s)
- A Neulen
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - E Prokesch
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - M Stein
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - J König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes-Gutenberg-University of Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - A Giese
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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Breuer TGK, Breuer HL, Menge BA, Giese A, Uhl W, Schmidt WE, Tannapfel A, Wild D, Nauck MA, Meier JJ. Okkultes Insulinom als Ursache rezidivierender Hypoglykämien. Internist (Berl) 2016; 57:385-9. [DOI: 10.1007/s00108-016-0020-3] [Citation(s) in RCA: 2] [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] [Indexed: 02/03/2023]
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Kantelhardt SR, Kalasauskas D, König K, Kim E, Weinigel M, Uchugonova A, Giese A. In vivo multiphoton tomography and fluorescence lifetime imaging of human brain tumor tissue. J Neurooncol 2016; 127:473-82. [PMID: 26830089 DOI: 10.1007/s11060-016-2062-8] [Citation(s) in RCA: 54] [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] [Received: 06/24/2015] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
High resolution multiphoton tomography and fluorescence lifetime imaging differentiates glioma from adjacent brain in native tissue samples ex vivo. Presently, multiphoton tomography is applied in clinical dermatology and experimentally. We here present the first application of multiphoton and fluorescence lifetime imaging for in vivo imaging on humans during a neurosurgical procedure. We used a MPTflex™ Multiphoton Laser Tomograph (JenLab, Germany). We examined cultured glioma cells in an orthotopic mouse tumor model and native human tissue samples. Finally the multiphoton tomograph was applied to provide optical biopsies during resection of a clinical case of glioblastoma. All tissues imaged by multiphoton tomography were sampled and processed for conventional histopathology. The multiphoton tomograph allowed fluorescence intensity- and fluorescence lifetime imaging with submicron spatial resolution and 200 picosecond temporal resolution. Morphological fluorescence intensity imaging and fluorescence lifetime imaging of tumor-bearing mouse brains and native human tissue samples clearly differentiated tumor and adjacent brain tissue. Intraoperative imaging was found to be technically feasible. Intraoperative image quality was comparable to ex vivo examinations. To our knowledge we here present the first intraoperative application of high resolution multiphoton tomography and fluorescence lifetime imaging of human brain tumors in situ. It allowed in vivo identification and determination of cell density of tumor tissue on a cellular and subcellular level within seconds. The technology shows the potential of rapid intraoperative identification of native glioma tissue without need for tissue processing or staining.
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Affiliation(s)
- Sven R Kantelhardt
- University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1, 55101, Mainz, Germany.
| | - Darius Kalasauskas
- University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1, 55101, Mainz, Germany
| | - Karsten König
- Department for Biophotonics and Laser Technology, Saarland University, Campus A5.1, 66123, Saarbrücken, Germany.,JenLab GmbH, Schillerstrasse 1, 07745, Jena, Germany
| | - Ella Kim
- University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1, 55101, Mainz, Germany
| | | | - Aisada Uchugonova
- Department for Biophotonics and Laser Technology, Saarland University, Campus A5.1, 66123, Saarbrücken, Germany
| | - Alf Giese
- University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1, 55101, Mainz, Germany
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Renovanz M, Keric N, Richter C, Gutenberg A, Giese A. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology]. Nervenarzt 2015; 86:1555-60. [PMID: 26610342 DOI: 10.1007/s00115-015-4473-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. METHODS The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. RESULTS Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. CONCLUSION As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.
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Affiliation(s)
- M Renovanz
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - N Keric
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - C Richter
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Gutenberg
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Giese
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Kantelhardt SR, Neulen A, Keric N, Gutenberg A, Conrad J, Giese A. Alternative radiation-free registration technique for image-guided pedicle screw placement in deformed cervico-thoracic segments. J Neurosurg Sci 2015; 61:464-472. [PMID: 26333386 DOI: 10.23736/s0390-5616.16.03311-7] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Image-guided pedicle screw placement in the cervico-thoracic region is a commonly applied technique. In some patients with deformed cervico-thoracic segments, conventional or 3D fluoroscopy based registration of image-guidance might be difficult or impossible because of the anatomic/pathological conditions. Landmark based registration has been used as an alternative, mostly using separate registration of each vertebra. We here investigated a routine for landmark based registration of rigid spinal segments as single objects, using cranial image-guidance software. METHODS Landmark based registration of image-guidance was performed using cranial navigation software. After surgical exposure of the spinous processes, lamina and facet joints and fixation of a reference marker array, up to 26 predefined landmarks were acquired using a pointer. All pedicle screws were implanted using image guidance alone. Following image-guided screw placement all patients underwent postoperative CT scanning. Screw positions as well as intraoperative and clinical parameters were retrospectively analyzed. RESULTS Thirteen patients received 73 pedicle screws at levels C6 to Th8. Registration of spinal segments, using the cranial image-guidance succeeded in all cases. Pedicle perforations were observed in 11.0%, severe perforations of >2 mm occurred in 5.4%. One patient developed a transient C8 syndrome and had to be revised for deviation of the C7 pedicle screw. No other pedicle screw-related complications were observed. CONCLUSIONS In selected patients suffering from pathologies of the cervico-thoracic region, which impair intraoperative fluoroscopy or 3D C-arm imaging, landmark based registration of image-guidance using cranial software is a feasible, radiation-saving and a safe alternative.
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Affiliation(s)
| | - Axel Neulen
- Department of Neurosurgery, University Medical Centre, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre, Mainz, Germany
| | | | - Jens Conrad
- Department of Neurosurgery, University Medical Centre, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre, Mainz, Germany
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Kantelhardt SR, Gutenberg A, Neulen A, Keric N, Renovanz M, Giese A. Video-Assisted Navigation for Adjustment of Image-Guidance Accuracy to Slight Brain Shift. Oper Neurosurg (Hagerstown) 2015; 11:504-511. [PMID: 29506163 DOI: 10.1227/neu.0000000000000921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Information supplied by an image-guidance system can be superimposed on the operating microscope oculars or on a screen, generating augmented reality. Recently, the outline of a patient's head and skull, injected in the oculars of a standard operating microscope, has been used to check the registration accuracy of image guidance. OBJECTIVE To propose the use of the brain surface relief and superficial vessels for real-time intraoperative visualization and image-guidance accuracy and for intraoperative adjustment for brain shift. METHODS A commercially available image-guidance system and a standard operating microscope were used. Segmentation of the brain surface and cortical blood vessel relief was performed manually on preoperative computed tomography and magnetic resonance images. The overlay of segmented digital and real operating-microscope images was used to monitor image-guidance accuracy. Adjustment for brain shift was performed by manually matching digital images on real structures. RESULTS Experimental manipulation on a phantom proved that the brain surface relief could be used to restore accuracy if the primary registration shifted. Afterward, the technique was used to assist during surgery of 5 consecutive patients with 7 deep-seated brain tumors. The brain surface relief could be successfully used to monitor registration accuracy after craniotomy and during the whole procedure. If a certain degree of brain shift occurred after craniotomy, the accuracy could be restored in all cases, and corticotomies were correctly centered in all cases. CONCLUSION The proposed method was easy to perform and augmented image-guidance accuracy when operating on small deep-seated lesions.
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Affiliation(s)
- Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Angelika Gutenberg
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Axel Neulen
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
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Kockro RA, Amaxopoulou C, Killeen T, Wagner W, Reisch R, Schwandt E, Gutenberg A, Giese A, Stofft E, Stadie AT. Stereoscopic neuroanatomy lectures using a three-dimensional virtual reality environment. Ann Anat 2015; 201:91-8. [PMID: 26245861 DOI: 10.1016/j.aanat.2015.05.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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: 09/10/2014] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Three-dimensional (3D) computer graphics are increasingly used to supplement the teaching of anatomy. While most systems consist of a program which produces 3D renderings on a workstation with a standard screen, the Dextrobeam virtual reality VR environment allows the presentation of spatial neuroanatomical models to larger groups of students through a stereoscopic projection system. MATERIALS AND METHODS Second-year medical students (n=169) were randomly allocated to receive a standardised pre-recorded audio lecture detailing the anatomy of the third ventricle accompanied by either a two-dimensional (2D) PowerPoint presentation (n=80) or a 3D animated tour of the third ventricle with the DextroBeam. Students completed a 10-question multiple-choice exam based on the content learned and a subjective evaluation of the teaching method immediately after the lecture. RESULTS Students in the 2D group achieved a mean score of 5.19 (±2.12) compared to 5.45 (±2.16) in the 3D group, with the results in the 3D group statistically non-inferior to those of the 2D group (p<0.0001). The students rated the 3D method superior to 2D teaching in four domains (spatial understanding, application in future anatomy classes, effectiveness, enjoyableness) (p<0.01). CONCLUSION Stereoscopically enhanced 3D lectures are valid methods of imparting neuroanatomical knowledge and are well received by students. More research is required to define and develop the role of large-group VR systems in modern neuroanatomy curricula.
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Affiliation(s)
- Ralf A Kockro
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland; Department of Neurosurgery, University Hospital Mainz, Germany.
| | | | - Tim Killeen
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland; Paraplegia Laboratory, University Hospital Balgrist, Zurich, Switzerland
| | - Wolfgang Wagner
- Department of Neurosurgery, University Hospital Mainz, Germany
| | - Robert Reisch
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland; Department of Neurosurgery, University Hospital Mainz, Germany
| | - Eike Schwandt
- Department of Neurosurgery, University Hospital Mainz, Germany
| | | | - Alf Giese
- Department of Neurosurgery, University Hospital Mainz, Germany
| | - Eckart Stofft
- Department of Anatomy, University Hospital, Mainz, Germany
| | - Axel T Stadie
- Department of Neurosurgery, University Hospital Mainz, Germany
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Barrantes-Freer A, Renovanz M, Eich M, Braukmann A, Sprang B, Spirin P, Pardo LA, Giese A, Kim EL. CD133 Expression Is Not Synonymous to Immunoreactivity for AC133 and Fluctuates throughout the Cell Cycle in Glioma Stem-Like Cells. PLoS One 2015; 10:e0130519. [PMID: 26086074 PMCID: PMC4472699 DOI: 10.1371/journal.pone.0130519] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 02/17/2015] [Accepted: 05/22/2015] [Indexed: 01/01/2023] Open
Abstract
A transmembrane protein CD133 has been implicated as a marker of stem-like glioma cells and predictor for therapeutic response in malignant brain tumours. CD133 expression is commonly evaluated by using antibodies specific for the AC133 epitope located in one of the extracellular domains of membrane-bound CD133. There is conflicting evidence regarding the significance of the AC133 epitope as a marker for identifying stem-like glioma cells and predicting the degree of malignancy in glioma cells. The reasons for discrepant results between different studies addressing the role of CD133/AC133 in gliomas are unclear. A possible source for controversies about CD133/AC133 is the widespread assumption that expression patterns of the AC133 epitope reflect linearly those of the CD133 protein. Consequently, the readouts from AC133 assessments are often interpreted in terms of the CD133 protein. The purpose of this study is to determine whether and to what extent do the readouts obtained with anti-AC133 antibody correspond to the level of CD133 protein expressed in stem-like glioma cells. Our study reveals for the first time that CD133 expressed on the surface of glioma cells is poorly immunoreactive for AC133. Furthermore, we provide evidence that the level of CD133 occupancy on the surface of glioma cells fluctuates during the cell cycle. Our results offer a new explanation for numerous inconsistencies regarding the biological and clinical significance of CD133/AC133 in human gliomas and call for caution in interpreting the lack or presence of AC133 epitope in glioma cells.
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Affiliation(s)
- Alonso Barrantes-Freer
- Molecular Biology of Neuronal Signals, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
- Institute of Neuropathology, University Medical Centre, Göttingen, Germany
| | - Mirjam Renovanz
- Translational Neurooncology Research Group, Department of Neurosurgery, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Marcus Eich
- Institute of Toxicology, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Alina Braukmann
- Translational Neurooncology Research Group, Department of Neurosurgery, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Bettina Sprang
- Translational Neurooncology Research Group, Department of Neurosurgery, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Pavel Spirin
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Luis A. Pardo
- Molecular Biology of Neuronal Signals, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
| | - Alf Giese
- Translational Neurooncology Research Group, Department of Neurosurgery, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Ella L. Kim
- Translational Neurooncology Research Group, Department of Neurosurgery, Johannes Gutenberg University Medical Centre, Mainz, Germany
- Translational Neurooncology Research Group, Department of Neurosurgery, University Medical Centre, Göttingen, Germany
- * E-mail:
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Grimm F, Naros G, Gutenberg A, Keric N, Giese A, Gharabaghi A. Blurring the boundaries between frame-based and frameless stereotaxy: feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 2015; 123:737-42. [PMID: 26067616 DOI: 10.3171/2014.12.jns141781] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Frame-based stereotactic interventions are considered the gold standard for brain biopsies, but they have limitations with regard to flexibility and patient comfort because of the bulky head ring attached to the patient. Frameless image guidance systems that use scalp fiducial markers offer more flexibility and patient comfort but provide less stability and accuracy during drilling and biopsy needle positioning. Head-mounted robot-guided biopsies could provide the advantages of these 2 techniques without the downsides. The goal of this study was to evaluate the feasibility and safety of a robotic guidance device, affixed to the patient's skull through a small mounting platform, for use in brain biopsy procedures. METHODS This was a retrospective study of 37 consecutive patients who presented with supratentorial lesions and underwent brain biopsy procedures in which a surgical guidance robot was used to determine clinical outcomes and technical procedural operability. RESULTS The portable head-mounted device was well tolerated by the patients and enabled stable drilling and needle positioning during surgery. Flexible adjustments of predefined paths and selection of new trajectories were successfully performed intraoperatively without the need for manual settings and fixations. The patients experienced no permanent deficits or infections after surgery. CONCLUSIONS The head-mounted robot-guided approach presented here combines the stability of a bone-mounted set-up with the flexibility and tolerability of frameless systems. By reducing human interference (i.e., manual parameter settings, calibrations, and adjustments), this technology might be particularly useful in neurosurgical interventions that necessitate multiple trajectories.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Angelika Gutenberg
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
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Gohar F, Orak B, Jeske M, Lieber M, von Bernuth H, Giese A, Weissbarth-Riedel E, Haas P, Dressler F, Holzinger D, Lohse P, Neudorf U, Lainka E, Kallinich T, Foell D, Wittkowski H. FRI0515 Neutrophil-Specific S100A12 Phenotype Correlates to Genotype in Familial Mediterranean Fever. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chilukoti RK, Giese A, Malenke W, Homuth G, Bukowska A, Goette A, Felix SB, Kanaan J, Wollert HG, Evert K, Verheule S, Jais P, Hatem SN, Lendeckel U, Wolke C. Atrial fibrillation and rapid acute pacing regulate adipocyte/adipositas-related gene expression in the atria. Int J Cardiol 2015; 187:604-13. [PMID: 25863735 DOI: 10.1016/j.ijcard.2015.03.072] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 12/14/2014] [Revised: 02/19/2015] [Accepted: 03/03/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Atrial fibrillation (AF) has been associated with increased volumes of epicardial fat and atrial adipocyte accumulation. Underlying mechanisms are not well understood. This study aims to identify rapid atrial pacing (RAP)/AF-dependent changes in atrial adipocyte/adipositas-related gene expression (AARE). METHODS Right atrial (RA) and adjacent epicardial adipose tissue (EAT) samples were obtained from 26 patients; 13 with AF, 13 in sinus rhythm (SR). Left atrial (LA) samples were obtained from 9 pigs (5 RAP, 4 sham-operated controls). AARE was analyzed using microarrays and RT-qPCR. The impact of diabetes/obesity on gene expression was additionally determined in RA samples (RAP ex vivo and controls) from 3 vs. 6 months old ZDF rats. RESULTS RAP in vivo of pigs resulted in substantial changes of AARE, with 66 genes being up- and 53 down-regulated on the mRNA level. Differential expression during adipocyte differentiation was confirmed using 3T3-L1 cells. In patients with AF (compared to SR), a comparable change in RA mRNA levels concerned a fraction of genes only (RETN, IGF1, HK2, PYGM, LOX, and NR4A3). RA and EAT were affected by AF to a different extent. In patients, concomitant disease contributes to AARE changes. CONCLUSIONS RAP, and to lesser extent AF, provoke significant changes in atrial AARE. In chronic AF, activation of this gene panel is very likely mediated by AF itself, AF risk factors and concomitant diseases. This may facilitate the development of an AF substrate by increasing atrial ectopic fat and fat infiltration of the atrial myocardium.
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Affiliation(s)
- R K Chilukoti
- University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - A Giese
- University Medicine Greifswald, Institute of Medical Biochemistry and Molecular Biology, Greifswald, Germany
| | - W Malenke
- University Medicine Greifswald, Institute of Medical Biochemistry and Molecular Biology, Greifswald, Germany
| | - G Homuth
- University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - A Bukowska
- EUTRAF Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - A Goette
- EUTRAF Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany; Cardiology and Intensive Care Medicine, St. Vincenz-Hospital, Paderborn, Germany
| | - S B Felix
- University Medicine Greifswald, Department of Cardiology, Greifswald, Germany
| | - J Kanaan
- Dr. Guth Clinics, Dept. of Cardiovascular Surgery, Karlsburg, Germany
| | - H-G Wollert
- Dr. Guth Clinics, Dept. of Cardiovascular Surgery, Karlsburg, Germany
| | - K Evert
- University Medicine Greifswald, Department of Pathology, Greifswald, Germany
| | - S Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - P Jais
- Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux II, Pessac, France
| | - S N Hatem
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Paris, France
| | - U Lendeckel
- University Medicine Greifswald, Institute of Medical Biochemistry and Molecular Biology, Greifswald, Germany.
| | - C Wolke
- University Medicine Greifswald, Institute of Medical Biochemistry and Molecular Biology, Greifswald, Germany
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Kantelhardt P, Giese A, Kantelhardt SR. Medication reconciliation for patients undergoing spinal surgery. Eur Spine J 2015; 25:740-7. [PMID: 25794699 DOI: 10.1007/s00586-015-3878-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/28/2015] [Accepted: 03/11/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, a marked increase of spinal operations prompted a debate on quality issues. Besides obvious factors, such as the surgical technique, medication safety has been identified as one of the major risk factors for patients undergoing anesthesia and surgery. While the issue has already been addressed by hospital pharmacist and anesthesiologists, the prescription of correct medication remains within the surgeons' responsibility. We, therefore, investigated medication-related errors in spinal instrumentation patients and applied current medication reconciliation strategies. METHODS We performed a data survey on all patients undergoing spinal instrumentation in 2011. Risk factors for medication safety were identified and prioritized. Specific counter-measures were introduced in 2012 and evaluated in 2013. RESULTS 147 patients were included in the 2011 and 162 in the 2013 survey. As top five risk factors we identified the preoperative stopping of medication, recording the medication history, prescription process of postoperative analgetics and anticoagulants and the medication list at discharge. Specific counter-measures included standardization of preparations, doses and the prescription process and improving access to this information (online and via a smartphone application). In elective patients, recording the medication histories was delegated to a hospital pharmacist and informative flyers and posters were used to integrate the patients themselves into the process. Counter-measures directed against the first four risk factors resulted in a significant reduction of medication errors. The last risk factor was targeted by instructing the responsible staff only, which proved to be a rather ineffective measure. CONCLUSIONS Medication safety could be significantly improved by implementation of counter-measures specific to the identified risk factors.
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Affiliation(s)
- Pamela Kantelhardt
- Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
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