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Achinger-Kawecka J, Stirzaker C, Portman N, Campbell E, Chia KM, Du Q, Laven-Law G, Nair SS, Yong A, Wilkinson A, Clifton S, Milioli HH, Alexandrou S, Caldon CE, Song J, Khoury A, Meyer B, Chen W, Pidsley R, Qu W, Gee JMW, Schmitt A, Wong ES, Hickey TE, Lim E, Clark SJ. The potential of epigenetic therapy to target the 3D epigenome in endocrine-resistant breast cancer. Nat Struct Mol Biol 2024; 31:498-512. [PMID: 38182927 PMCID: PMC10948365 DOI: 10.1038/s41594-023-01181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/15/2023] [Indexed: 01/07/2024]
Abstract
Three-dimensional (3D) epigenome remodeling is an important mechanism of gene deregulation in cancer. However, its potential as a target to counteract therapy resistance remains largely unaddressed. Here, we show that epigenetic therapy with decitabine (5-Aza-mC) suppresses tumor growth in xenograft models of pre-clinical metastatic estrogen receptor positive (ER+) breast tumor. Decitabine-induced genome-wide DNA hypomethylation results in large-scale 3D epigenome deregulation, including de-compaction of higher-order chromatin structure and loss of boundary insulation of topologically associated domains. Significant DNA hypomethylation associates with ectopic activation of ER-enhancers, gain in ER binding, creation of new 3D enhancer-promoter interactions and concordant up-regulation of ER-mediated transcription pathways. Importantly, long-term withdrawal of epigenetic therapy partially restores methylation at ER-enhancer elements, resulting in a loss of ectopic 3D enhancer-promoter interactions and associated gene repression. Our study illustrates the potential of epigenetic therapy to target ER+ endocrine-resistant breast cancer by DNA methylation-dependent rewiring of 3D chromatin interactions, which are associated with the suppression of tumor growth.
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Affiliation(s)
- Joanna Achinger-Kawecka
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Clare Stirzaker
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Neil Portman
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Elyssa Campbell
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Kee-Ming Chia
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Qian Du
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Geraldine Laven-Law
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shalima S Nair
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Aliza Yong
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Ashleigh Wilkinson
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Samuel Clifton
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Heloisa H Milioli
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah Alexandrou
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Elizabeth Caldon
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jenny Song
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Amanda Khoury
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Braydon Meyer
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Wenhan Chen
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Ruth Pidsley
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wenjia Qu
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Julia M W Gee
- Breast Cancer Molecular Pharmacology Group, School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Emily S Wong
- Victor Chang Cardiac Institute, Sydney, New South Wales, Australia
- School of Biotechnology and Biomolecular Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elgene Lim
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Susan J Clark
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
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Siltari A, Lönnerbro R, Pang K, Shiranov K, Asiimwe A, Evans-Axelsson S, Franks B, Kiran A, Murtola TJ, Schalken J, Steinbeisser C, Bjartell A, Auvinen A, Smith E, N'Dow J, Plass K, Ribal M, Mottet N, Moris L, Lardas M, Van den Broeck T, Willemse PP, Gandaglia G, Campi R, Greco I, Gacci M, Serni S, Briganti A, Crosti D, Meoni M, Garzonio R, Bangma R, Roobol M, Remmers S, Tilki D, Visakorpi T, Talala K, Tammela T, van Hemelrijck M, Bayer K, Lejeune S, Taxiarchopoulou G, van Diggelen F, Senthilkumar K, Schutte S, Byrne S, Fialho L, Cardone A, Gono P, De Vetter M, Ceke K, De Meulder B, Auffray C, Balaur IA, Taibi N, Power S, Kermani NZ, van Bochove K, Cavelaars M, Moinat M, Voss E, Bernini C, Horgan D, Fullwood L, Holtorf M, Lancet D, Bernstein G, Omar I, MacLennan S, Maclennan S, Healey J, Huber J, Wirth M, Froehner M, Brenner B, Borkowetz A, Thomas C, Horn F, Reiche K, Kreux M, Josefsson A, Tandefekt DG, Hugosson J, Huisman H, Hofmacher T, Lindgren P, Andersson E, Fridhammar A, Vizcaya D, Verholen F, Zong J, Butler-Ransohoff JE, Williamson T, Chandrawansa K, Dlamini D, waldeck R, Molnar M, Bruno A, Herrera R, Jiang S, Nevedomskaya E, Fatoba S, Constantinovici N, Maass M, Torremante P, Voss M, Devecseri Z, Cuperus G, Abott T, Dau C, Papineni K, Wang-Silvanto J, Hass S, Snijder R, Doye V, Wang X, Garnham A, Lambrecht M, Wolfinger R, Rogiers S, Servan A, Lefresne F, Caseriego J, Samir M, Lawson J, Pacoe K, Robinson P, Jaton B, Bakkard D, Turunen H, Kilkku O, Pohjanjousi P, Voima O, Nevalaita L, Reich C, Araujo S, Longden-Chapman E, Burke D, Agapow P, Derkits S, Licour M, McCrea C, Payne S, Yong A, Thompson L, Lujan F, Bussmann M, Köhler I. How well do polygenic risk scores identify men at high risk for prostate cancer? Systematic review and meta-analysis. Clin Genitourin Cancer 2022; 21:316.e1-316.e11. [PMID: 36243664 DOI: 10.1016/j.clgc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Genome-wide association studies have revealed over 200 genetic susceptibility loci for prostate cancer (PCa). By combining them, polygenic risk scores (PRS) can be generated to predict risk of PCa. We summarize the published evidence and conduct meta-analyses of PRS as a predictor of PCa risk in Caucasian men. PATIENTS AND METHODS Data were extracted from 59 studies, with 16 studies including 17 separate analyses used in the main meta-analysis with a total of 20,786 cases and 69,106 controls identified through a systematic search of ten databases. Random effects meta-analysis was used to obtain pooled estimates of area under the receiver-operating characteristic curve (AUC). Meta-regression was used to assess the impact of number of single-nucleotide polymorphisms (SNPs) incorporated in PRS on AUC. Heterogeneity is expressed as I2 scores. Publication bias was evaluated using funnel plots and Egger tests. RESULTS The ability of PRS to identify men with PCa was modest (pooled AUC 0.63, 95% CI 0.62-0.64) with moderate consistency (I2 64%). Combining PRS with clinical variables increased the pooled AUC to 0.74 (0.68-0.81). Meta-regression showed only negligible increase in AUC for adding incremental SNPs. Despite moderate heterogeneity, publication bias was not evident. CONCLUSION Typically, PRS accuracy is comparable to PSA or family history with a pooled AUC value 0.63 indicating mediocre performance for PRS alone.
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Wang H, Tang C, Dang ZH, Yong A, Liu L, Wang S, Zhao M. Clinicopathological characteristics of high-altitude polycythemia-related kidney disease in Tibetan inhabitants. Kidney Int 2022; 102:196-206. [PMID: 35513124 DOI: 10.1016/j.kint.2022.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022]
Abstract
High-altitude polycythemia (HAPC) is a clinical syndrome that occurs in native inhabitants or long-term residents living at altitude. The kidney is one of the most affected organs. However, the clinical and kidney histopathological profiles of HAPC-related kidney disease have rarely been reported. Here, we report kidney biopsy-based clinicopathological study on this disease. HAPC was defined as excessive erythrocytosis [females, hemoglobin 190 g/L or more; males, 210 g/L or more] in patients living above an altitude of 2500 m for more than ten years. A total of 416 Tibetan patients underwent kidney biopsy between January 1, 2016, and November 31, 2020. Of these patients 17 met the diagnostic criteria for HAPC-related kidney disease. Clinically, these patients had a median urinary protein level of 2.5 g/24-hour (range 1.81-6.85). Twelve patients had hyperuricemia, nine had hypertension, and three had kidney insufficiency. On histopathology, glomerular hypertrophy, glomerular basement membrane thickening, podocyte foot process effacement, segmental glomerulosclerosis and global glomerulosclerosis were the main features. Extraglomerular arterial/arteriolar lesions were common, presenting as intimal fibrosis, hyalinosis and endothelial cell swelling/subintimal edema. Expansion of the arterial/arteriolar medial wall area characterized by smooth muscle cell proliferation was clearly observed, potentially indicating vascular remodeling. Hypoxia-inducible factor 2α was expressed in the kidney tissues of these patients. Thus, the pathological changes of HAPC-related kidney disease encompassed both glomerular and extraglomerular vascular lesions, suggesting a key role of both chronic hypoxia itself and secondary hemodynamic changes in the pathogenesis of this disease.
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Affiliation(s)
- Hui Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Beijing 100034, P.R. China; Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing 100034, P.R. China
| | - Chen Tang
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Beijing 100034, P.R. China
| | - Zong-Hui Dang
- The People's Hospital of Tibet Autonomous region, Lhasa, Tibet, P.R. China
| | - A Yong
- The People's Hospital of Tibet Autonomous region, Lhasa, Tibet, P.R. China
| | - Lijun Liu
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Beijing 100034, P.R. China.
| | - Suxia Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Beijing 100034, P.R. China; Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing 100034, P.R. China.
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Beijing 100034, P.R. China
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Molnar S, Sirohey A, Assaf J, Bard PY, Castellaro S, Cornou C, Cox B, Guillier B, Hassani B, Kawase H, Matsushima S, Sánchez-Sesma FJ, Yong A. A review of the microtremor horizontal-to-vertical spectral ratio (MHVSR) method. J Seismol 2022; 26:653-685. [PMID: 35313617 PMCID: PMC8926454 DOI: 10.1007/s10950-021-10062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
The single-station microtremor horizontal-to-vertical spectral ratio (MHVSR) method was initially proposed to retrieve the site amplification function and its resonance frequencies produced by unconsolidated sediments overlying high-velocity bedrock. Presently, MHVSR measurements are predominantly conducted to obtain an estimate of the fundamental site frequency at sites where a strong subsurface impedance contrast exists. Of the earthquake site characterization methods presented in this special issue, the MHVSR method is the furthest behind in terms of consensus towards standardized guidelines and commercial use. The greatest challenges to an international standardization of MHVSR acquisition and analysis are (1) the what - the underlying composition of the microtremor wavefield is site-dependent, and thus, the appropriate theoretical (forward) model for inversion is still debated; and (2) the how - many factors and options are involved in the data acquisition, processing, and interpretation stages. This paper reviews briefly a historical development of the MHVSR technique and the physical basis of an MHVSR (the what). We then summarize recommendations for MHVSR acquisition and analysis (the how). Specific sections address MHVSR interpretation and uncertainty assessment.
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Affiliation(s)
- S. Molnar
- University of Western Ontario, London, ON Canada
| | - A. Sirohey
- University of Western Ontario, London, ON Canada
| | - J. Assaf
- University of Western Ontario, London, ON Canada
| | - P.-Y. Bard
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, IRD, UGE, ISTerre, Grenoble, France
| | - S. Castellaro
- Dipartimento Di Fisica E Astronomia, Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
| | - C. Cornou
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, IRD, UGE, ISTerre, Grenoble, France
| | - B. Cox
- Utah State University, Logan, UT USA
| | - B. Guillier
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, IRD, UGE, ISTerre, Grenoble, France
| | | | - H. Kawase
- Disaster Prevention Research Institute, Kyoto University, Uji, Kyoto Japan
| | - S. Matsushima
- Disaster Prevention Research Institute, Kyoto University, Uji, Kyoto Japan
| | - F. J. Sánchez-Sesma
- Instituto de Ingeniería, Universidad Nacional Autónoma de México, CDMX, Circuito Escolar s/n, Ciudad Universitaria, 04510 Coyoacán, Mexico
| | - A. Yong
- US Geological Survey, Pasadena, CA USA
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Freelander A, Laven-Law G, Eshraghi L, Chia KM, Pickering M, Yong A, Wilkinson A, Alexandrou S, Caldon CE, Hickey TE, Tilley WD, Lim E. Abstract PD2-02: Combination CDK4/6 inhibition and AR agonism suppresses the growth of CDK4/6 inhibitor resistant breast cancers. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd2-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Resistance to standard-of care-therapies is a significant clinical challenge in estrogen receptor positive (ER+) breast cancer. Cyclin dependent kinase 4/6 inhibitors (CDK4/6i) in combination with endocrine therapies (ET) is the current standard-of-care for advanced metastatic ER+ breast cancer; however, resistance to this combination is considered inevitable, leading to disease progression. The androgen receptor (AR) is expressed in up to 90% of all ER+ breast cancers, and has been associated with better patient outcome. Compelling recent pre-clinical data demonstrates that selective androgen receptor AR modulators (SARMs) act to suppress ER-driven tumour growth of endocrine-sensitive and -resistant models of ER+ breast cancer. Furthermore, a recent clinical trial evaluating the efficacy of SARMs has shown clinical benefit in patients with ER+/AR+ metastatic breast cancer (NCT02463032). We hypothesise that the SARMS, either alone or in combination with a CDK4/6i, would be an effective treatment for tumours that are sensitive and resistant to ET and CDK4/6i. We report therapeutic efficacy of combination AR agonism + CDK4/6i in CDK4/6-naïve and -resistant pre-clinical models, including cell lines and patient derived xenograft (PDX) models. We demonstrate that combination SARM + CDK4/6i potently and durably inhibited in vitro and in vivo tumour growth. Additionally, we provide evidence that in vivo treatment with the CDK4/6i Palbociclib increased AR expression and signalling, highlighting an interaction of the two signalling pathways not previously described. In conclusion, our data provides a pre-clinical rationale for combination SARM + CDK4/6i in CDK4/6i resistant ER+ breast cancer.
Citation Format: Allegra Freelander, Geraldine Laven-Law, Leila Eshraghi, Kee Ming Chia, Marie Pickering, Aliza Yong, Ashleigh Wilkinson, Sarah Alexandrou, C. Elizabeth Caldon, Theresa E Hickey, Wayne D Tilley, Elgene Lim. Combination CDK4/6 inhibition and AR agonism suppresses the growth of CDK4/6 inhibitor resistant breast cancers [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD2-02.
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Affiliation(s)
| | - Geraldine Laven-Law
- Dame Roma Mitchell Cancer Research Laboratories, University of Adelaide, Adelaide, Australia
| | - Leila Eshraghi
- The Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Kee Ming Chia
- The Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Marie Pickering
- Dame Roma Mitchell Cancer Research Laboratories, University of Adelaide, Adelaide, Australia
| | - Aliza Yong
- The Garvan Institute of Medical Research, Darlinghurst, Australia
| | | | - Sarah Alexandrou
- The Garvan Institute of Medical Research, Darlinghurst, Australia
| | | | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories, University of Adelaide, Adelaide, Australia
| | - Wayne D Tilley
- Dame Roma Mitchell Cancer Research Laboratories, University of Adelaide, Adelaide, Australia
| | - Elgene Lim
- The Garvan Institute of Medical Research, Darlinghurst, Australia
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Rubenis I, Wong C, Lowe H, Kritharides L, Yong A, Brieger D, Roy P. Incidence and Risk Factors for Early Radial Artery Occlusion Post-Coronary Procedure: A Prospective Cross-Sectional Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.595] [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: 11/15/2022]
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Rubenis I, Hyun K, Lowe H, Kritharides L, Yong A, Brieger D, Roy P. Efficacy and Safety of Contemporary PCI in the Elderly – A Prospective Two-Year Cohort Study From the Concord Hospital PCI Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Noaman S, Kaye D, Nanayakkara S, Dart A, Yong A, Ng M, Vizi D, Duffy S, Cox N, Chan W. Haemodynamic and Metabolic Adaptations in Coronary Microvascular Disease (CMD). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.592] [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: 12/01/2022]
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Aziz D, Portman N, Fernandez KJ, Lee C, Alexandrou S, Llop-Guevara A, Phan Z, Yong A, Wilkinson A, Sergio CM, Ferraro D, Etemadmoghadam D, Bowtell DD, Serra V, Waring P, Lim E, Caldon CE. Synergistic targeting of BRCA1 mutated breast cancers with PARP and CDK2 inhibition. NPJ Breast Cancer 2021; 7:111. [PMID: 34465787 PMCID: PMC8408175 DOI: 10.1038/s41523-021-00312-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/28/2021] [Indexed: 12/18/2022] Open
Abstract
Basal-like breast cancers (BLBC) are aggressive breast cancers that respond poorly to targeted therapies and chemotherapies. In order to define therapeutically targetable subsets of BLBC we examined two markers: cyclin E1 and BRCA1 loss. In high grade serous ovarian cancer (HGSOC) these markers are mutually exclusive, and define therapeutic subsets. We tested the same hypothesis for BLBC. Using a BLBC cohort enriched for BRCA1 loss, we identified convergence between BRCA1 loss and high cyclin E1 protein expression, in contrast to HGSOC in which CCNE1 amplification drives increased cyclin E1. In cell lines, BRCA1 loss was associated with stabilized cyclin E1 during the cell cycle, and BRCA1 siRNA led to increased cyclin E1 in association with reduced phospho-cyclin E1 T62. Mutation of cyclin E1 T62 to alanine increased cyclin E1 stability. We showed that tumors with high cyclin E1/BRCA1 mutation in the BLBC cohort also had decreased phospho-T62, supporting this hypothesis. Since cyclin E1/CDK2 protects cells from DNA damage and cyclin E1 is elevated in BRCA1 mutant cancers, we hypothesized that CDK2 inhibition would sensitize these cancers to PARP inhibition. CDK2 inhibition induced DNA damage and synergized with PARP inhibitors to reduce cell viability in cell lines with homologous recombination deficiency, including BRCA1 mutated cell lines. Treatment of BRCA1 mutant BLBC patient-derived xenograft models with combination PARP and CDK2 inhibition led to tumor regression and increased survival. We conclude that BRCA1 status and high cyclin E1 have potential as predictive biomarkers to dictate the therapeutic use of combination CDK inhibitors/PARP inhibitors in BLBC.
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Affiliation(s)
- Diar Aziz
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Pathology Department, College of Medicine, University of Mosul, Mosul, Iraq
| | - Neil Portman
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Kristine J Fernandez
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Christine Lee
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sarah Alexandrou
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Zoe Phan
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Aliza Yong
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Ashleigh Wilkinson
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - C Marcelo Sergio
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Danielle Ferraro
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Dariush Etemadmoghadam
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - David D Bowtell
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Paul Waring
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Elgene Lim
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Elizabeth Caldon
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia.
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
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Portman N, Milioli H, Alexandrou S, Coulson R, Yong A, Fernandez K, Chia K, Halilovic E, Segara D, Parker A, Haupt S, Haupt Y, Tilley W, Swarbrick A, Caldon L, Lim E. Abstract PS18-17: Mdm2 inhibition synergises with endocrine therapy or cdk4/6 inhibition for the treatment of estrogen receptor-positive breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps18-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Resistance to endocrine therapy is a major clinical challenge in the management of estrogen receptor (ER)-positive breast cancer. In this setting p53 is frequently wildtype and its activity may be suppressed via upregulation of its key regulator MDM2. This underlies our rationale to evaluate MDM2 inhibition as a therapeutic strategy in treatment resistant ER-positive breast cancer.
Methods: We used the MDM2 inhibitor NVP-CGM097 to treat in vitro and in vivo models alone and in combination with fulvestrant or palbociclib. We perform cell viability, cell cycle, apoptosis and senescence assays to evaluate antitumor effects in p53 wildtype and p53 mutant ER positive cell lines (MCF-7, ZR75-1, T-47D) and MCF-7 lines resistant to endocrine therapy and to CDK4/6 inhibition. We further assess the drug effects in patient-derived xenograft (PDX) models of endocrine-sensitive and -resistant ER positive breast cancer.
Results: We demonstrate that MDM2 inhibition results in cell cycle arrest and increased apoptosis in p53-wildtype in vitro and in vivo breast cancer models, leading to potent anti-tumour activity. We find that endocrine therapy or CDK4/6 inhibition synergises with MDM2 inhibition but does not further enhance apoptosis. Instead, combination treatments result in profound regulation of cell cycle-related transcriptional programmes, with synergy achieved through increased antagonism of cell cycle progression. Combination therapy pushes cell lines resistant to fulvestrant or palbociclib to become senescent and significantly reduces tumour growth in a fulvestrant resistant patient derived xenograft model.
Conclusions: We conclude that MDM2 inhibitors in combination with ER degraders or CDK4/6 inhibitors represent a rational strategy for treating advanced, endocrine resistant ER-positive breast cancer, operating through synergistic activation of cell cycle co-regulatory programs.
Citation Format: Neil Portman, Heloisa Milioli, Sarah Alexandrou, Rhiannon Coulson, Aliza Yong, Kristine Fernandez, KeeMing Chia, Ensar Halilovic, Davendra Segara, Andrew Parker, Sue Haupt, Ygal Haupt, Wayne Tilley, Alex Swarbrick, Liz Caldon, Elgene Lim. Mdm2 inhibition synergises with endocrine therapy or cdk4/6 inhibition for the treatment of estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-17.
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Affiliation(s)
- Neil Portman
- 1Garvan Institute of Medical Research, Sydney, Australia
| | | | | | | | - Aliza Yong
- 1Garvan Institute of Medical Research, Sydney, Australia
| | | | - KeeMing Chia
- 1Garvan Institute of Medical Research, Sydney, Australia
| | | | | | - Andrew Parker
- 1Garvan Institute of Medical Research, Sydney, Australia
| | - Sue Haupt
- 2Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ygal Haupt
- 2Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Alex Swarbrick
- 1Garvan Institute of Medical Research, Sydney, Australia
| | - Liz Caldon
- 1Garvan Institute of Medical Research, Sydney, Australia
| | - Elgene Lim
- 1Garvan Institute of Medical Research, Sydney, Australia
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Barnes C, Saraswat A, Shiekh I, Alcock R, Schultz C, Hillis G, Yong A, Spiro J. Additional Clinical Utility of Assessing the Coronary Microcirculation Among Patients Undergoing Routine FFR: The Royal Perth Hospital Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.453] [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: 11/15/2022]
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12
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Wong C, Nishi T, Ng M, Yong A, Ada C, Kakuta T, Barbato E, Waseda K, Amano T, Hirohata A, Fearon W. Elevated Microvascular Resistance in Conjunction With Reduced Coronary Flow Reserve Predicts Adverse Long-Term Outcomes After Percutaneous Coronary Intervention. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Rajaratnam D, Hyun K, Wong C, Garcia M, Lau J, Lowe H, Yong A, Kritharides L, Brieger D, Roy P. Longer-Term Safety and Efficacy of Contemporary Percutaneous Coronary Intervention – Insights from 2-Year Follow-Up of a Single Australian Centre Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Wong C, Javadzadegan A, Ada C, Svanerud J, Lau J, Bhindi R, Fearon W, Ng M, Kritharides L, Yong A. Size of low wall shear stress areas in coronary arteries is related to epicardial physiology and not to microcirculatory resistance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1278] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Wall shear stress (WSS) plays an important role in coronary atherosclerosis. Low WSS is associated with inflammation, endothelial dysfunction, and progression of atherosclerosis; while high WSS leads to vulnerable plaque transformation and future myocardial infarction. Defining the relationship between WSS and the currently available coronary physiology indices would provide valuable insights into potential mechanisms for predicting future adverse cardiac events.
Purpose
To investigate the relationship between WSS and the coronary epicardial/microvascular physiology indices.
Methods
Patients undergoing coronary angiography and physiology testing were prospectively recruited. Physiology measurements were performed under resting and hyperaemic conditions using a pressure/temperature sensor guidewire. Fractional flow reserve (FFR), non-hyperaemic pressure ratios (NHPRs), coronary flow reserve (CFR), and corrected index of microcirculatory resistance (IMR) were measured. The NHPRs including resting full-cycle ratio (RFR), resting distal/aortic pressure (Pd/Pa), instantaneous wave-free ratio (iFR), diastolic pressure ratio (dPR) and diastolic hyperaemia-free ratio (DFR) were derived offline by a blinded expert reader. Values of FFR ≤0.80, NHPR ≤0.89, CFR <2, or IMR >25 were considered ischaemic/abnormal. Computational fluid dynamics analysis was performed and fluid motion equations were solved using finite-volume based software. The inlet and outlet boundary conditions were set to the patient-specific Pa and Pd respectively. The lesion WSS, mean WSS in five segments (WSSupstream = 5mm proximal to lesion, WSSprox = proximal third of lesion, WSSmid = middle third of lesion, WSSdistal = distal third of lesion, WSSdownstream = 5mm distal to lesion), and the total area of low WSS (defined as <1 Pa) along the entire vessel were calculated (Figure A).
Results
A total of 112 vessels from 93 patients were included in the study. The total area of low WSS was significantly larger in lesions with ischaemic FFR, NHPRs, and CFR values (Figure B), and not significantly different in lesions with abnormal IMR values. There was no significant difference in lesion WSS between groups stratified by all physiology indices. Within the lesion WSS sub-segments, WSSprox was significant higher in ischaemic lesions stratified by normal/abnormal FFR, iFR, and dPR (4.2 vs 3.3 Pa, 4.2 vs 3.3 Pa, 4.3 vs 3.3 Pa respectively, all p=0.04), and not significantly different when stratified by RFR, DFR, Pd/Pa, CFR, and IMR.
Conclusion
Functionally significant coronary lesions classified by the epicardial physiology indices have significantly larger total area of low WSS and higher WSSprox which may explain the higher cardiovascular event rates in patients with ischaemic lesions. There was no significant relationship between WSS and coronary microcirculatory resistance.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of Australia Health Professional Scholarship
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Affiliation(s)
- C Wong
- Concord Repatriation General Hospital, Sydney, Australia
| | | | - C Ada
- Concord Repatriation General Hospital, Sydney, Australia
| | | | - J Lau
- Royal Adelaide Hospital, Adelaide, Australia
| | - R Bhindi
- Royal North Shore Hospital, Sydney, Australia
| | - W Fearon
- Stanford University Medical Center, Stanford, United States of America
| | - M Ng
- Royal Prince Alfred Hospital, Sydney, Australia
| | - L Kritharides
- Concord Repatriation General Hospital, Sydney, Australia
| | - A Yong
- Concord Repatriation General Hospital, Sydney, Australia
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15
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Wong C, Ng A, Ada C, Chow V, Fearon W, Ng M, Kritharides L, Yong A. A real-world comparison of outcomes between fractional flow reserve-guided versus angiography-guided percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1273] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited.
Purpose
To investigate the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort.
Methods
All patients undergoing PCI between June 2017 and June 2018 recorded by the Centre for Health Record Linkage (CHeReL) were included in the study. The CHeReL database is one of the largest data linkage systems in Australia, capturing health data from ≥97% of all healthcare facilities in the state of New South Wales, which has a population of 7.5 million people. The PCI cohort was stratified into the FFR-guided group when a concomitant FFR procedure was performed, and the angiography-guided group when no FFR was performed. The primary endpoint was a combined endpoint of death or myocardial infarction (MI). Secondary endpoints included all-cause death, cardiovascular (CV) death, and MI.
Results
The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. There were no significant differences in age, gender, or comorbidities between the two groups. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary endpoint (3% vs 8%, P<0.001), all-cause death (1% vs 4%, P=0.001), CV death (1% vs 3%, P=0.01), and MI (2% vs 4%, P=0.01) (Figure). Multivariable Cox regression analysis demonstrated FFR-guidance to be an independent predictor of the primary endpoint (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.28–0.78, P=0.004), after adjusting for age, clinical presentation, comorbidities, and multi-vessel PCI. A sensitivity analysis was performed excluding patients that presented with acute MI, leading to a smaller cohort of 5,850 patients, of which 448 (8%) underwent FFR-guided PCI. FFR-guidance remained an independent predictor of the primary endpoint in this cohort of stable patients (HR 0.36, 95% CI 0.17–0.77, P=0.01).
Conclusion
In this real-world study of patients undergoing PCI, FFR-guidance was associated with improved clinical outcomes, driven by the lower hard endpoint of death or MI. The use of FFR-guided PCI remains limited worldwide, and efforts should be directed to increase adoption of this technique in future.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of Australia Health Professional Scholarship
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Affiliation(s)
- C Wong
- Concord Repatriation General Hospital, Sydney, Australia
| | - A Ng
- Concord Repatriation General Hospital, Sydney, Australia
| | - C Ada
- Concord Repatriation General Hospital, Sydney, Australia
| | - V Chow
- Concord Repatriation General Hospital, Sydney, Australia
| | - W Fearon
- Stanford University Medical Center, Stanford, United States of America
| | - M Ng
- Royal Prince Alfred Hospital, Sydney, Australia
| | - L Kritharides
- Concord Repatriation General Hospital, Sydney, Australia
| | - A Yong
- Concord Repatriation General Hospital, Sydney, Australia
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Portman N, Milioli HH, Alexandrou S, Coulson R, Yong A, Fernandez KJ, Chia KM, Halilovic E, Segara D, Parker A, Haupt S, Haupt Y, Tilley WD, Swarbrick A, Caldon CE, Lim E. MDM2 inhibition in combination with endocrine therapy and CDK4/6 inhibition for the treatment of ER-positive breast cancer. Breast Cancer Res 2020; 22:87. [PMID: 32787886 PMCID: PMC7425060 DOI: 10.1186/s13058-020-01318-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background Resistance to endocrine therapy is a major clinical challenge in the management of oestrogen receptor (ER)-positive breast cancer. In this setting, p53 is frequently wildtype and its activity may be suppressed via upregulation of its key regulator MDM2. This underlies our rationale to evaluate MDM2 inhibition as a therapeutic strategy in treatment-resistant ER-positive breast cancer. Methods We used the MDM2 inhibitor NVP-CGM097 to treat in vitro and in vivo models alone and in combination with fulvestrant or palbociclib. We perform cell viability, cell cycle, apoptosis and senescence assays to evaluate anti-tumour effects in p53 wildtype and p53 mutant ER-positive cell lines (MCF-7, ZR75-1, T-47D) and MCF-7 lines resistant to endocrine therapy and to CDK4/6 inhibition. We further assess the drug effects in patient-derived xenograft (PDX) models of endocrine-sensitive and endocrine-resistant ER-positive breast cancer. Results We demonstrate that MDM2 inhibition results in cell cycle arrest and increased apoptosis in p53-wildtype in vitro and in vivo breast cancer models, leading to potent anti-tumour activity. We find that endocrine therapy or CDK4/6 inhibition synergises with MDM2 inhibition but does not further enhance apoptosis. Instead, combination treatments result in profound regulation of cell cycle-related transcriptional programmes, with synergy achieved through increased antagonism of cell cycle progression. Combination therapy pushes cell lines resistant to fulvestrant or palbociclib to become senescent and significantly reduces tumour growth in a fulvestrant-resistant patient-derived xenograft model. Conclusions We conclude that MDM2 inhibitors in combination with ER degraders or CDK4/6 inhibitors represent a rational strategy for treating advanced, endocrine-resistant ER-positive breast cancer, operating through synergistic activation of cell cycle co-regulatory programmes.
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Affiliation(s)
- Neil Portman
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Heloisa H Milioli
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Sarah Alexandrou
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Rhiannon Coulson
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,Tumor Suppression Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Aliza Yong
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Kristine J Fernandez
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Kee Ming Chia
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Ensar Halilovic
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | - Davendra Segara
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Andrew Parker
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Sue Haupt
- Tumor Suppression Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ygal Haupt
- Tumor Suppression Laboratory, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Wayne D Tilley
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5001, Australia
| | - Alex Swarbrick
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - C Elizabeth Caldon
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia
| | - Elgene Lim
- Garvan Institute of Medical Research, Darlinghurst, Sydney, NSW, 2010, Australia. .,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2010, Australia.
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Baalbaki A, Ng A, D'Souza M, Hyun K, Chow V, Kritharides L, Yong A, Brieger D. 616 Outcomes Following Cardiac Bypass Surgery (CABG) in Public vs Private Hospitals in NSW. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.623] [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: 11/17/2022]
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18
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Lee A, Ng A, Yong A, Brieger D, Kritharides L, Chow V. 524 Outcomes of Transcatheter Aortic Valve Implantation in a State-Wide Population Stratified by High-Volume Versus Low-Volume Procedural Centres. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.531] [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: 11/24/2022]
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19
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Ada C, Wong C, Fearon W, Svanerud J, Lo S, Ng M, Yong A. 858 Non-Hyperaemic Pressure Ratios Correlate With Both Coronary Flow Reserve and Resistive Reserve Ratio. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Wong C, Javadzadegan A, Ada C, Svanerud J, Lau J, Bhindi R, Fearon W, Ng M, Kritharides L, Yong A. 884 Size of Low Wall Shear Stress Areas in Coronary Arteries is Related to the Epicardial Coronary Physiology Indices. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Kantor P, Yong A, Kutsogiannis D. Behavioural Economic Nudge Policy, Organ-Donation and Heart Transplant Conversion Rates in Alberta, Canada. A Ten-Year Retrospective Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Chia KM, Milioli H, Portman N, Laven-Law G, Yong A, Swarbrick A, Caldon L, Tilley W, Hickey T, Lim E. Abstract P6-20-04: Activation of AR inhibits growth of endocrine-resistant breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-20-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Resistance to endocrine therapy is a major clinical problem in estrogen receptor positive (ER+) breast cancer. The androgen receptor (AR) is expressed in ˜90% of all ER+ breast cancers and high expression of AR is associated with a better patient outcome in this subtype. In agreement, AR activation in breast cancer cell line models reduces proliferation of cells via antagonism of ER signaling. However, uncertainty surrounding the role of AR in endocrine resistance is reflected in current clinical trials in which both AR agonists and antagonists are being investigated. In this study, we sought to investigate the optimal approach in targeting AR in endocrine-resistant breast cancer.
Methods
We evaluated the consequences of AR activation, using AR cognate ligand 5α-dihydrotestosterone (DHT) and selective AR modulator enobosarm, and AR antagonism using enzalutamide on in vitro and in vivo models of endocrine-resistance. The efficacy of these AR modulators were assessed in vitro using tamoxifen-resistant (TamR) and long-term estrogen derived (LTED) models of MCF7 cells, and in vivo using ESR1 mutant E2-dependent (HCI-005) and ESR1 wild-type E2-independent (Gar15-13) endocrine-resistant PDX models
Results
Treatment with DHT and enobosarm inhibited the growth of MCF7 TamR and LTED cells but enzalutamide had no effect. AR activation was associated with loss of ER in MCF7 TamR cells and loss of ER-regulated PR expression in MCF7 LTED which suggests that this growth suppression was mediated through the antagonism of ER signaling. Notably, an additive anti-proliferative effect was observed with the combination of enobosarm and CDK4/6 inhibitor palbocilib in the MCF7 TamR cells. A similar pattern was observed in vivo with DHT strongly inhibiting the proliferation of both PDX models. Enobosarm similarly suppressed the proliferation of HCI-005, and to a lesser extent in Gar15-13. The benefit of enobosarm in Gar15-13 was significant given that this model is fulvestrant-resistant. Antagonizing AR with enzalutamide had no effect on growth of Gar15-13 model, similar to our in vitro data. AR agonists reduced expression levels of ER and PR in HCI-005, and transcriptomic analysis of AR agonist-treated Gar15-13 identified significant negative enrichment of genes related to proliferation and estrogen response. These observations indicate that the growth-suppressive effects of AR activation in vivo were mediated through inhibiting ER signaling. We identified an AR gene signature, through RNA-seq analysis of DHT-treated Gar15-13 PDX, which is strongly associated with good outcome in the METABRIC dataset, supporting the hypothesis that an active canonical AR signaling is tumor suppressive in both endocrine-sensitive and -resistant disease contexts. Lastly, we present in vivo data demonstrating enhanced suppression of Ki-67 with the combination of enobosarm and palbociclib in the Gar15-13 PDX.
Conclusion
We have demonstrated that activating AR is an effective therapeutic approach in endocrine-resistant breast cancer, and the combination of an AR agonist with a CDK4/6 inhibitor warrants further investigation in this breast cancer subtype.
Citation Format: Chia KM, Milioli H, Portman N, Laven-Law G, Yong A, Swarbrick A, Caldon L, Tilley W, Hickey T, Lim E. Activation of AR inhibits growth of endocrine-resistant breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-20-04.
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Affiliation(s)
- KM Chia
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - H Milioli
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - N Portman
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - G Laven-Law
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - A Yong
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - A Swarbrick
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - L Caldon
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - W Tilley
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - T Hickey
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - E Lim
- Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia; Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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23
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Chia K, Milioli H, Portman N, Laven-Law G, Coulson R, Yong A, Segara D, Parker A, Caldon CE, Deng N, Swarbrick A, Tilley WD, Hickey TE, Lim E. Non-canonical AR activity facilitates endocrine resistance in breast cancer. Endocr Relat Cancer 2019; 26:251-264. [PMID: 30557851 DOI: 10.1530/erc-18-0333] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/27/2018] [Indexed: 01/01/2023]
Abstract
The role of androgen receptor (AR) in endocrine-resistant breast cancer is controversial and clinical trials targeting AR with an AR antagonist (e.g., enzalutamide) have been initiated. Here, we investigated the consequence of AR antagonism using in vitro and in vivo models of endocrine resistance. AR antagonism in MCF7-derived tamoxifen-resistant (TamR) and long-term estrogen-deprived breast cancer cell lines were achieved using siRNA-mediated knockdown or pharmacological inhibition with enzalutamide. The efficacy of enzalutamide was further assessed in vivo in an estrogen-independent endocrine-resistant patient-derived xenograft (PDX) model. Knockdown of AR inhibited the growth of the endocrine-resistant cell line models. Microarray gene expression profiling of the TamR cells following AR knockdown revealed perturbations in proliferative signaling pathways upregulated in endocrine resistance. AR loss also increased some canonical ER signaling events and restored sensitivity of TamR cells to tamoxifen. In contrast, enzalutamide did not recapitulate the effect of AR knockdown in vitro, even though it inhibited canonical AR signaling, which suggests that it is the non-canonical AR activity that facilitated endocrine resistance. Enzalutamide had demonstrable efficacy in inhibiting AR activity in vivo but did not affect the growth of the endocrine-resistant PDX model. Our findings implicate non-canonical AR activity in facilitating an endocrine-resistant phenotype in breast cancer. Unlike canonical AR signaling which is inhibited by enzalutamide, non-canonical AR activity is not effectively antagonized by enzalutamide, and this has important implications in the design of future AR-targeted clinical trials in endocrine-resistant breast cancer.
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Affiliation(s)
- KeeMing Chia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Heloisa Milioli
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Neil Portman
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Geraldine Laven-Law
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Rhiannon Coulson
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Aliza Yong
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Davendra Segara
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Andrew Parker
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Catherine E Caldon
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Niantao Deng
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Alexander Swarbrick
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Wayne D Tilley
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elgene Lim
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
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Abeid S, Yu C, Ho-Shon K, Magnussen J, Yong A, Naoum C. The Relationship Between Extra-Coronary Calcification and Coronary Artery Lesion Characteristics. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Burgess S, Bing R, Zhao J, Papapostolou S, Chan W, Juergens C, Ong A, Kurup R, Ng M, Kritharides L, Lo S, Yong A. A Rapidly Applicable Simplified SYNTAX Score Retains High Sensitivity and Specificity in Complex Coronary Artery Disease: A Multicentre Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Moshfegh A, Javadzadegan A, Qian Y, Kritharides L, Yong A. Development of a Computational Fluid Dynamics Model for Myocardial Bridging. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.601] [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: 11/24/2022]
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27
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Javadzadegan A, Lau J, Moshfegh A, Kritharides L, Yong A. Remote Ischaemic Preconditioning Safely and Effectively Induces Limb Ischaemia. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lau J, Javadzadegan A, Roy P, Lowe H, Brieger D, Kritharides L, Yong A. 1058Remote ischaemic preconditioning causes rapid increase in coronary flow reserve and reduction in microcirculatory resistance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1058] [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: 11/13/2022] Open
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29
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Adikari D, Yuan D, Bing R, Lau J, Ng A, Brieger D, Kritharides L, Yong A. One-year Quality of Life Outcomes After Balloon Aortic Valvuloplasty in High risk Patients With Severe Aortic Stenosis. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Williams KM, Ahn KW, Chen M, Aljurf MD, Agwu AL, Chen AR, Walsh TJ, Szabolcs P, Boeckh MJ, Auletta JJ, Lindemans CA, Zanis-Neto J, Malvezzi M, Lister J, de Toledo Codina JS, Sackey K, Chakrabarty JLH, Ljungman P, Wingard JR, Seftel MD, Seo S, Hale GA, Wirk B, Smith MS, Savani BN, Lazarus HM, Marks DI, Ustun C, Abdel-Azim H, Dvorak CC, Szer J, Storek J, Yong A, Riches MR. The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis. Bone Marrow Transplant 2016; 51:573-80. [PMID: 26726945 PMCID: PMC4823157 DOI: 10.1038/bmt.2015.316] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/13/2015] [Accepted: 11/01/2015] [Indexed: 11/09/2022]
Abstract
Pneumocystis jiroveci pneumonia (PJP) is associated with high morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Little is known about PJP infections after HSCT because of the rarity of disease given routine prophylaxis. We report the results of a Center for International Blood and Marrow Transplant Research study evaluating the incidence, timing, prophylaxis agents, risk factors and mortality of PJP after autologous (auto) and allogeneic (allo) HSCT. Between 1995 and 2005, 0.63% allo recipients and 0.28% auto recipients of first HSCT developed PJP. Cases occurred as early as 30 days to beyond a year after allo HSCT. A nested case cohort analysis with supplemental data (n=68 allo cases, n=111 allo controls) revealed that risk factors for PJP infection included lymphopenia and mismatch after HSCT. After allo or auto HSCT, overall survival was significantly poorer among cases vs controls (P=0.0004). After controlling for significant variables, the proportional hazards model revealed that PJP cases were 6.87 times more likely to die vs matched controls (P<0.0001). We conclude PJP infection is rare after HSCT but is associated with high mortality. Factors associated with GVHD and with poor immune reconstitution are among the risk factors for PJP and suggest that protracted prophylaxis for PJP in high-risk HSCT recipients may improve outcomes.
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Affiliation(s)
- K M Williams
- Children's Research Institute, Children's National Health System, Washington, DC, USA
| | - K W Ahn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Chen
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - A L Agwu
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A R Chen
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T J Walsh
- Division of Blood and Marrow Transplantation and Cellular Therapies, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - P Szabolcs
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J J Auletta
- Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - C A Lindemans
- Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands
| | - J Zanis-Neto
- Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil
| | - M Malvezzi
- Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Brazil
| | - J Lister
- Cell Transplantation Program, Western Pennsylvania Cancer Institute, Pittsburgh, PA, USA
| | - J S de Toledo Codina
- Paediatric Oncology, Haematology and SCT Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain
| | - K Sackey
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - J L H Chakrabarty
- Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, USA
| | - P Ljungman
- Department of Hematology, Karolinska University, Stockholm, Sweden
| | - J R Wingard
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - M D Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Seo
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - G A Hale
- Department of Hematology/Oncology, All Children's Hospital, St. Petersburg, FL, USA
| | - B Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - M S Smith
- Viracor-IBT Laboratories, Lee's Summit, MO, USA
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - D I Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - C Ustun
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - H Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - C C Dvorak
- Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - J Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - J Storek
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Yong
- Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia
| | - M R Riches
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Batchelor JM, Tan W, Tour S, Yong A, Montgomery AA, Thomas KS. Validation of the Vitiligo Noticeability Scale: a patient-reported outcome measure of vitiligo treatment success. Br J Dermatol 2015; 174:386-94. [PMID: 26409256 PMCID: PMC5019146 DOI: 10.1111/bjd.14208] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-reported outcome measures are rarely used in vitiligo trials. The Vitiligo Noticeability Scale (VNS) is a new patient-reported outcome measure assessing how 'noticeable' vitiligo patches are after treatment. The noticeability of vitiligo after treatment is an important indicator of treatment success from the patient's perspective. OBJECTIVES To evaluate the construct validity, acceptability and interpretability of the VNS. METHODS Clinicians (n = 33) and patients with vitiligo (n = 101) examined 39 image pairs, each depicting a vitiligo lesion pre- and post-treatment. Using an online questionnaire, respondents gave a global assessment of treatment success and a VNS score for treatment response. Clinicians also estimated percentage repigmentation of lesions (< 25%; 25-50%; 51-75%; > 75%). Treatment success was defined as 'yes' on global assessment, a VNS score of 4 or 5, and > 75% repigmentation. Agreement between respondents and the different scales was assessed using kappa (κ) statistics. RESULTS Vitiligo Noticeability Scale scores were associated with both patient- and clinician-reported global treatment success (κ = 0·54 and κ = 0·47, respectively). Percentage repigmentation showed a weaker association with patient- and clinician-reported global treatment success (κ = 0·39 and κ = 0·29, respectively). VNS scores of 4 or 5 can be interpreted as representing treatment success. Images depicting post-treatment hyperpigmentation were less likely to be rated as successful. CONCLUSIONS The VNS is a valid patient-reported measure of vitiligo treatment success. Further validation of the VNS is required, using larger sets of clinical pre- and post-treatment images, affecting a wider range of anatomical sites.
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Affiliation(s)
- J M Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - W Tan
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C Floor, South Block, Nottingham, NG7 2UH, U.K
| | - S Tour
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - A Yong
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, U.K
| | - A A Montgomery
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C Floor, South Block, Nottingham, NG7 2UH, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
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Inamoto Y, Shah NN, Savani BN, Shaw BE, Abraham AA, Ahmed IA, Akpek G, Atsuta Y, Baker KS, Basak GW, Bitan M, DeFilipp Z, Gregory TK, Greinix HT, Hamadani M, Hamilton BK, Hayashi RJ, Jacobsohn DA, Kamble RT, Kasow KA, Khera N, Lazarus HM, Malone AK, Lupo-Stanghellini MT, Margossian SP, Muffly LS, Norkin M, Ramanathan M, Salooja N, Schoemans H, Wingard JR, Wirk B, Wood WA, Yong A, Duncan CN, Flowers MED, Majhail NS. Secondary solid cancer screening following hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1013-23. [PMID: 25822223 DOI: 10.1038/bmt.2015.63] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/10/2022]
Abstract
Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.
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Affiliation(s)
- Y Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - N N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institute of Health (NIH), Bethesda, MD, USA
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - B E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A A Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - I A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - G Akpek
- Section of Hematology Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Y Atsuta
- 1] Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan [2] Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K S Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - G W Basak
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Bitan
- Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Z DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - T K Gregory
- Colorado Blood Cancer Institute at Presbyterian/St Luke's Medical Center, Denver, CO, USA
| | - H T Greinix
- Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Hamadani
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B K Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - R J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - D A Jacobsohn
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - R T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - K A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - N Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - A K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Lupo-Stanghellini
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - S P Margossian
- Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - L S Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - M Norkin
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - M Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worchester, MA, USA
| | | | - H Schoemans
- University Hospital of Leuven, Leuven, Belgium
| | - J R Wingard
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - B Wirk
- Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - W A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - A Yong
- Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia
| | - C N Duncan
- Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - M E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - N S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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Adikari D, Yuan D, Lau J, Chow V, Chung T, Yong A, Kritharides L, Ng A. The prevalence and incidence of Atrial Fibrillation (AF) in patients with acute Pulmonary Embolism (PE). Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.662] [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: 11/16/2022]
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34
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Bing R, Lau J, Yong A, Kritharides L. Beyond the epicardial coronary arteries - a case report. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Bing R, Zhao J, Papapostolou S, Burgess S, Danson E, Bhindi R, Lo S, Chan W, Ng M, Kritharides L, Yong A. The 123s and ABCs of the simplified SYNTAX score. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.454] [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: 11/15/2022]
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36
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Adikari D, Yuan D, Bing R, Lau J, Ng A, Brieger D, Kritharides L, Yong A. Outcomes of Balloon Aortic Valvuloplasty at a centre with off-site surgical support. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Chan K, Yuen S, Dunn L, Simpson P, Yong A, Hsu C, Guillou M, Bao S, Chawantanpipat C, Lim P, Yu Y, Celermajer D, Wu J, Ng M. Late-Outgrowth But Not Early Endothelial Progenitor Cells Enhance Ischaemia-mediated Neovascularisation and Coronary Collateral Formation – Implications for Therapeutic Angiogenesis. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.040] [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: 11/24/2022]
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38
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Javadzadegan A, Chang M, Yong A, Behnia M, Kritharides L. The Interaction of Different Mechanical Forces on Atherosclerotic Plaques in Coronary Lesions with Differing Degrees of Eccentricity. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Ng A, Chow V, Yong A, Chung T, Kritharides L. Prognostic Impact of Serum Sodium Fluctuations on In-hospital and Long-term Outcome Following Acute Pulmonary Embolism. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Chan K, Simpson P, Yong A, Chawantanpipat C, Hsu C, Lim P, Dunn L, Ng M. The Number and Function of Late Outgrowth Endothelial Cells Correlate with the extent of Coronary Artery Disease. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.053] [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: 12/01/2022]
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41
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Yong A, Ho M, Shah M, Chawantanpipat C, O’Connell R, Keech A, Kritharides L, Fearon W, Ng M. The Index of Microcirculatory Resistance Predicts Myocardial Infarction Related to Percutaneous Coronary Intervention. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Wong C, Yong A, Pennings G, Kritharides L. Elevated Plasma sCD147 Concentration in Non-ST Elevation Myocardial Infarction—Potential Marker of Plaque Instability. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Chan K, Simpson P, Yong A, Chawantanpipat C, Hsu C, Lim P, Dunn L, Ng M. The Number and Function of Late Outgrowth Endothelial Cells Correlate with the Extent of Coronary Collateralisation in Humans. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Bassin L, Yong A, Kilpatrick D, Hunyor S. Deep Hypothermia in Sheep Produces Right Ventricular ST Elevation. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Ying H, Yitong M, Fen L, Yining Y, Xiao-Mei L, Minghui S, Juan Y, Yong A. e0263 Epidemiological survey of hypertension in general adult population of different nationalities in Xinjiang. Heart 2010. [DOI: 10.1136/hrt.2010.208967.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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46
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Rezvani K, Mielke S, Yong A, Savani B, Jafarpour B, Eniafe R, Barrett A. PR1-Specific T Cell Responses In The First Months Following T-Cell Depleted Allogeneic Stem Cell Transplantation Occur In Both Myeloid And Non-Myeloid Malignancies But Are Only Associated With A GVL Effect In Myeloid Leukemias. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Alcock R, Yong A, Ng A, Chow V, Cheruvu C, Aliprandi-Costa B, Kritharides L, Lowe H, Brieger D. Leukocyte Count is a Predictor of Long-Term Mortality in Stable Patients But Not Non-Elective Patients Undergoing PCI. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.994] [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: 11/27/2022]
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48
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Chan K, P.Simpson, Yong A, Chawantanpipat C, Hsu C, Lim P, Dunn L, Ng M. Endothelial Progenitor Cell Populations Exhibit Differing Relationship with the Extent of Coronary Microvascular Disease and Collateralisation. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Hsu C, Chow R, Sieveking D, Chan K, Simpson P, Yong A, Dunn L, Celermajer D, Ng M. Androgens Stimulate Human Endothelial Progenitor Cell Function and Coronary Collateralization—Implications for the Role of Androgens in Men's Cardiovascular Health. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Bassin L, Yong A, Kilpatrick D, Hunyor S. The Origin of the J Wave in Hypothermia. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.887] [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: 11/15/2022]
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