1
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Krentel H, Keckstein J, Füger T, Hornung D, Theben J, Salehin D, Buchweitz O, Mueller A, Schäfer SD, Sillem M, Schweppe KW, Tchartchian G, Gilman E, De Wilde RL. Accuracy of ultrasound signs on two-dimensional transvaginal ultrasound in prediction of adenomyosis: prospective multicenter study. Ultrasound Obstet Gynecol 2023; 62:739-746. [PMID: 36920431 DOI: 10.1002/uog.26197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool for the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combinations requires further investigation. We aimed to analyze the accuracy of 2D-TVS and describe possible combinations of ultrasound signs with a high predictive value in the diagnosis of adenomyosis. METHODS This was a prospective multicenter study of patients scheduled for laparoscopic hysterectomy who had been examined using standardized 2D-TVS at nine expert centers specializing in the diagnosis and treatment of endometriosis. 2D-TVS examination included nine typical adenomyosis ultrasound features, comprising heterogeneous myometrium, myometrial linear striations, myometrial cysts, subendometrial microcysts, asymmetrical myometrial thickening, uterine enlargement, the 'question mark sign', thickening of the junctional zone and hyperechoic myometrial spots, in order to predict or exclude the presence of adenomyosis. Ultrasound examination results were compared with histology after hysterectomy. The diagnostic reliability of the nine ultrasound signs and their combinations, and the influence of concurrent fibroids on the accuracy of the results, were analyzed. RESULTS A total of 202 patients were enrolled into the study. Histopathological examination revealed adenomyosis in 130 patients (64.4%). The accuracy of prediction of adenomyosis by 2D-TVS examination using all signs was 63.4% (positive predictive value, 71.5%; negative predictive value, 48.6%; sensitivity, 71.5%; specificity, 48.6%). Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy (55.7-62.1%) as individual ultrasound signs for the prediction of adenomyosis. The combination of the most accurate ultrasound signs (subendometrial microcysts, myometrial cysts and heterogeneous myometrium) improved the specificity of prediction (86.1%) when compared with that of these three single markers (35.2-81.7%). Uterine enlargement and asymmetry showed both low sensitivity (60.8% and 52.3%, respectively) and specificity (41.7% and 49.3%, respectively) as individual sonographic signs. CONCLUSIONS Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy for the detection of adenomyosis in this study, while uterine enlargement and asymmetry led to high false-positive and false-negative results. A combination of ultrasound features including the most accurate signs increases specificity. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Academic Teaching Hospital, Bethesda Krankenhaus Duisburg, Duisburg, Germany
| | - J Keckstein
- Endometriosis Clinic, Dres. Keckstein, Villach, Austria
| | - T Füger
- MIC Zentrum, München, Germany
| | - D Hornung
- Department of Obstetrics and Gynecology, Vidia Diakonissenkrankenhaus, Karlsruhe, Germany
| | - J Theben
- Department of Obstetrics and Gynecology, St Elisabeth Hospital Köln-Hohenlind, Köln, Germany
| | - D Salehin
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | | | - A Mueller
- Department of Obstetrics and Gynecology, Städtisches Klinikum, Karlsruhe, Germany
| | - S D Schäfer
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim and Saarland University Medical Centre, Homburg, Germany
| | - K W Schweppe
- Stiftung Endometrioseforschung, Westerstede, Germany
| | | | - E Gilman
- Gilman Biometrics, Köln, Germany
| | - R L De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
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2
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Roser E, Harter P, Zocholl D, Denschlag D, Chekerov R, Wimberger P, Kurzeder C, Hasenburg A, Muallem MZ, Mustea A, Emons G, Zeimet AG, Beck F, Arndt T, Brucker SY, Kommoss S, Heitz F, Welz J, Egger EK, Kalder M, Buderath P, Klar M, Marth C, Ulrich UA, Weigel M, Traub L, Anthuber C, Strauss H, Hanker L, Link T, Kubiak K, Melekian B, Hornung D, Pölcher M, Lampe B, Krauß T, Keilholz U, Flörcken A, Pietzner K, Sehouli J. Treatment strategies in patients with gynecological sarcoma: Results of the prospective intergroup real-world registry for gynecological sarcoma in Germany (REGSA-NOGGO RU1). Int J Gynecol Cancer 2023; 33:223-230. [PMID: 36631151 DOI: 10.1136/ijgc-2022-003800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Gynecological sarcomas account for 3% of all gynecological malignancies and are associated with a poor prognosis. Due to the rarity and heterogeneity of gynecological sarcomas there is still no consensus on optimal therapeutic strategies. This study's objective was to describe the treatment strategies used in patients with gynecological sarcomas in the primary course of disease. METHODS The German prospective registry for gynecological sarcoma (REGSA) is the largest registry for gynecological sarcomas in Germany, Austria and Switzerland. Primary inclusion criteria for REGSA are histological diagnosis of sarcoma of the female genital tract, sarcoma of the breast or uterine smooth muscle tumors of uncertain malignant potential (STUMP). We evaluated data of the REGSA registry on therapeutic strategies used for primary treatment from August 2015 to February 2021. RESULTS A total of 723 patients from 120 centers were included. Data on therapeutic strategies for primary treatment were available in 605 cases. Overall, 580 (95.9%) patients underwent primary surgery, 472 (81.4%) of whom underwent only hysterectomy. Morcellation was reported in 11.4% (n=54) of all hysterectomies. A total of 42.8% (n=202) had no further surgical interventions, whereas an additional salpingo-ophorectomy was performed in 54% (n=255) of patients. An additional lymphadenectomy was performed in 12.7% (n=60), an omentectomy in 9.5% (n=45) and intestinal resection in 6.1% (n=29) of all patients. Among 448 patients with available information, 21.4% (n=96) received chemo- or targeted therapies, more commonly as single-agent treatment than as drug combinations. Information about anti-hormonal treatment was available for 423 patients, among which 42 (9.9%) received anti-hormonal treatment, 23 (54.8%) of whom with low-grade endometrial stroma sarcomas. For radiotherapy, data of 437 patients were available, among which 29 (6.6%) patients underwent radiotherapy. CONCLUSION Our study showed that treatment of patients with gynecologic sarcomas is heterogeneous. Further trials are needed along with more information on treatment modalities, therapy response and patient-reported outcomes to implement new treatment strategies.
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Affiliation(s)
- Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Christian Kurzeder
- Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
| | | | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Guenter Emons
- Department of Gynecology and Obstetrics, University Medicine Goettingen, Goettingen, Germany
| | - A G Zeimet
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Felix Beck
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Tjadina Arndt
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Sara Y Brucker
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Eva-Katharina Egger
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Clinic Gießen and Marburg, Marburg, Germany
| | - Paul Buderath
- Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital Berlin, Berlin, Germany
| | - Michael Weigel
- Department of Obstetrics and Gynecology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Lea Traub
- Department of Obstetrics and Gynecology, Technische Universität Munich, Munich, Germany
| | - Christoph Anthuber
- Department of Obstetrics and Gynecology, Klinikum Starnberg, Starnberg, Germany
| | - Hans Strauss
- Department of Obstetrics and Gynecology, University of Halle (Saale), Halle, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Luebeck, Germany
| | - Theresa Link
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Karol Kubiak
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Münster, Muenster, Germany
| | - Badrig Melekian
- Department of Obstetrics and Gynecology, Marienkliniken Siegen, Siegen, Germany
| | - Daniela Hornung
- Department of Obstetrics and Gynecology, Vidiakliniken, Standort Diakonissenkrankenhaus, Karlsruhe, Germany
| | - Martin Pölcher
- Department of Gynecologic Oncology, Rotkreuzklinikum Munich, Munich, Germany
| | - Bjoern Lampe
- Department of Obstetrics and Gynecology, Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Thomas Krauß
- Department of Obstetrics and Gynecology, Klinikum Passau, Passau, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany .,Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
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Hudelist G, Korell M, Burkhardt M, Chvatal R, Darici E, Dimitrova D, Drahonovsky J, Haj Hamoud B, Hornung D, Krämer B, Noe G, Oppelt P, Schäfer S, Seeber B, Ulrich UA, Wenzl R, De Wilde RL, Wimberger P, Senft B, Keckstein J, Montanari E, Vaineau C, Sillem M. Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study. Acta Obstet Gynecol Scand 2022; 101:1057-1064. [PMID: 35818905 PMCID: PMC9812092 DOI: 10.1111/aogs.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.
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Affiliation(s)
- Gernot Hudelist
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Matthias Korell
- Department of Obstetrics and GynecologyJohanna‐Etienne‐HospitalNeussGermany
| | - Michael Burkhardt
- Department of Obstetrics and GynecologyMedius Klinik OstfildernOstfildernGermany
| | - Radek Chvatal
- Department of Obstetrics and GynecologyZnojmo District HospitalZnojmoCzech Republic
| | - Ezgi Darici
- Brussels IVF, Center for Reproductive Medicine Universitair Ziekenhuis BrusselVrije Universiteit BrusselBrusselsBelgium
| | - Desislava Dimitrova
- Department of Obstetrics and Gynecology with Center for Oncological SurgeryCharité – Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Jan Drahonovsky
- Department of Obstetrics and Department of GynecologyUniversity of PraguePragueCzech Republic
| | - Bashar Haj Hamoud
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany
| | - Daniela Hornung
- Department of Obstetrics and GynecologyVidiakliniken, Diakonissen Hospital KarlsruheKarlsruheGermany
| | - Bernhard Krämer
- Department of Obstetrics and Department of GynecologyUniversity of TübingenTübingenGermany
| | - Guenter Noe
- Department of Obstetrics and Department of GynecologyRhineland ClinicDormagenGermany
| | - Peter Oppelt
- Department of Gynecology and ObstetricsKepler Medical University of LinzLinzAustria
| | | | - Beata Seeber
- Department of Gynecologic Endocrinology and Reproductive MedicineMedical University of InnsbruckInnsbruckAustria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and GynecologyMartin Luther Hospital BerlinBerlinGermany
| | - Rene Wenzl
- Department of Gynecology and ObstericsMedical University of ViennaViennaAustria
| | - Rudy Leon De Wilde
- Department of Gynecology and ObstetricsPius Hospital, Universitätsmedizin Oldenburg, Carl von Ossietzky University of OldenburgOldenburgGermany
| | - Pauline Wimberger
- Department of Obstetrics and GynecologyTechnical University DresdenDresdenGermany
| | | | | | - Eliana Montanari
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Cloe Vaineau
- Department of Gynecology and ObstericsMedical University of Bern, InselspitalBernSwitzerland
| | - Martin Sillem
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany,Praxisklinik am RosengartenMannheimGermany
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Adamietz A, Boosz A, Mueller A, Hornung D, Trunk K, Beckmann MW, Dittrich R, Hack CC. Complementary and alternative medicine (CAM) in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2021; 262:7-12. [PMID: 33984728 DOI: 10.1016/j.ejogrb.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to provide an overview of the extent to which women with endometriosis are informed about, interested in, and make use of CAM, and to evaluate which of the methods are most often applied. STUDY DESIGN A retrospective, two-center cohort study was conducted using a validated questionnaire among women with laparoscopically confirmed endometriosis at two urban teaching hospitals, certified as endometriosis centres. RESULTS A total of 592 patients were included in the study and received the questionnaire; 114 (19.3 %) were included in the data analysis. Most of the women were not receiving hormone therapy at the time of the study (n = 60, 52.6 %). Most (n = 75, 65.8 %) were interested in CAM, but only a minority (n = 12, 10.5 %) had detailed knowledge about it. A total of 81 patients (71.1 %) had used at least one CAM method for disease management; the five most frequently used CAM methods were exercise (n = 55, 48.2 %), vitamins (n = 40, 35.1 %), yoga (n = 38, 33.3 %), homeopathy (n = 32, 28.1 %), and trace elements (n = 27, 23.7 %). CONCLUSIONS In our study population, women with endometriosis are strongly interested in using CAM, but have only limited information about it. Nevertheless, a majority of the patients had used at least one CAM method to relieve symptoms associated with the disease and the most often used was exercise.
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Affiliation(s)
- Alexandra Adamietz
- Department of Obstetrics and Gynaecology, Karlsruhe Municipal Hospital, Karlsruhe, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexander Boosz
- Department of Obstetrics and Gynaecology, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Andreas Mueller
- Department of Obstetrics and Gynaecology, Karlsruhe Municipal Hospital, Karlsruhe, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Daniela Hornung
- Department of Obstetrics and Gynaecology, ViDia Hospital, Karlsruhe, Germany
| | - Katharina Trunk
- Department of Obstetrics and Gynaecology, ViDia Hospital, Karlsruhe, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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5
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Fehlmann T, Kahraman M, Ludwig N, Backes C, Galata V, Keller V, Geffers L, Mercaldo N, Hornung D, Weis T, Kayvanpour E, Abu-Halima M, Deuschle C, Schulte C, Suenkel U, von Thaler AK, Maetzler W, Herr C, Fähndrich S, Vogelmeier C, Guimaraes P, Hecksteden A, Meyer T, Metzger F, Diener C, Deutscher S, Abdul-Khaliq H, Stehle I, Haeusler S, Meiser A, Groesdonk HV, Volk T, Lenhof HP, Katus H, Balling R, Meder B, Kruger R, Huwer H, Bals R, Meese E, Keller A. Evaluating the Use of Circulating MicroRNA Profiles for Lung Cancer Detection in Symptomatic Patients. JAMA Oncol 2021; 6:714-723. [PMID: 32134442 DOI: 10.1001/jamaoncol.2020.0001] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance The overall low survival rate of patients with lung cancer calls for improved detection tools to enable better treatment options and improved patient outcomes. Multivariable molecular signatures, such as blood-borne microRNA (miRNA) signatures, may have high rates of sensitivity and specificity but require additional studies with large cohorts and standardized measurements to confirm the generalizability of miRNA signatures. Objective To investigate the use of blood-borne miRNAs as potential circulating markers for detecting lung cancer in an extended cohort of symptomatic patients and control participants. Design, Setting, and Participants This multicenter, cohort study included patients from case-control and cohort studies (TREND and COSYCONET) with 3102 patients being enrolled by convenience sampling between March 3, 2009, and March 19, 2018. For the cohort study TREND, population sampling was performed. Clinical diagnoses were obtained for 3046 patients (606 patients with non-small cell and small cell lung cancer, 593 patients with nontumor lung diseases, 883 patients with diseases not affecting the lung, and 964 unaffected control participants). No samples were removed because of experimental issues. The collected data were analyzed between April 2018 and November 2019. Main Outcomes and Measures Sensitivity and specificity of liquid biopsy using miRNA signatures for detection of lung cancer. Results A total of 3102 patients with a mean (SD) age of 61.1 (16.2) years were enrolled. Data on the sex of the participants were available for 2856 participants; 1727 (60.5%) were men. Genome-wide miRNA profiles of blood samples from 3046 individuals were evaluated by machine-learning methods. Three classification scenarios were investigated by splitting the samples equally into training and validation sets. First, a 15-miRNA signature from the training set was used to distinguish patients diagnosed with lung cancer from all other individuals in the validation set with an accuracy of 91.4% (95% CI, 91.0%-91.9%), a sensitivity of 82.8% (95% CI, 81.5%-84.1%), and a specificity of 93.5% (95% CI, 93.2%-93.8%). Second, a 14-miRNA signature from the training set was used to distinguish patients with lung cancer from patients with nontumor lung diseases in the validation set with an accuracy of 92.5% (95% CI, 92.1%-92.9%), sensitivity of 96.4% (95% CI, 95.9%-96.9%), and specificity of 88.6% (95% CI, 88.1%-89.2%). Third, a 14-miRNA signature from the training set was used to distinguish patients with early-stage lung cancer from all individuals without lung cancer in the validation set with an accuracy of 95.9% (95% CI, 95.7%-96.2%), sensitivity of 76.3% (95% CI, 74.5%-78.0%), and specificity of 97.5% (95% CI, 97.2%-97.7%). Conclusions and Relevance The findings of the study suggest that the identified patterns of miRNAs may be used as a component of a minimally invasive lung cancer test, complementing imaging, sputum cytology, and biopsy tests.
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Affiliation(s)
- Tobias Fehlmann
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Mustafa Kahraman
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Nicole Ludwig
- Junior Research Group of Human Genetics, Saarland University, Homburg, Germany
| | - Christina Backes
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Valentina Galata
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Verena Keller
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Lars Geffers
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | | | - Tanja Weis
- Department of Internal Medicine, Heidelberg University, Heidelberg, Germany
| | - Elham Kayvanpour
- Department of Internal Medicine, Heidelberg University, Heidelberg, Germany
| | | | - Christian Deuschle
- Hertie Institute for Clinical Brain Research, Center of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Claudia Schulte
- Hertie Institute for Clinical Brain Research, Center of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Ulrike Suenkel
- Hertie Institute for Clinical Brain Research, Center of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Hertie Institute for Clinical Brain Research, Center of Neurology, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Christian Herr
- Department of Internal Medicine V: Pulmonology, Allergology, Intensive Care Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Sebastian Fähndrich
- Department of Internal Medicine V: Pulmonology, Allergology, Intensive Care Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marberg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - Pedro Guimaraes
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Anne Hecksteden
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Florian Metzger
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Center for Geriatric Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Caroline Diener
- Institute of Human Genetics, Saarland University, Homburg, Germany
| | | | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University, Saarbrücken, Germany
| | - Ingo Stehle
- Schwerpunktpraxis Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Sebastian Haeusler
- Department of Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Meiser
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Faculty of Medicine, Saarland University, Homburg, Germany
| | - Heinrich V Groesdonk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Faculty of Medicine, Saarland University, Homburg, Germany
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Faculty of Medicine, Saarland University, Homburg, Germany
| | - Hans-Peter Lenhof
- Center for Bioinformatics, Saarland University, Saarbrücken, Germany
| | - Hugo Katus
- Department of Internal Medicine, Heidelberg University, Heidelberg, Germany
| | - Rudi Balling
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Benjamin Meder
- Department of Internal Medicine, Heidelberg University, Heidelberg, Germany
| | - Rejko Kruger
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Parkinson's Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg
| | - Hanno Huwer
- Department of Cardiothoracic Surgery, Völklingen Heart Centre, Völklingen, Germany
| | - Robert Bals
- Department of Internal Medicine V: Pulmonology, Allergology, Intensive Care Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, Homburg, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany.,Center for Bioinformatics, Saarland University, Saarbrücken, Germany.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
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6
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehne A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2018. [PMID: 29528615 DOI: 10.4193/rhino16.248] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major
health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following:
• Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy
with small diameter endoscopes.
• Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability.
• Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour
threshold, and/or one of odour identification or discrimination.
• Comprehensive chemosensory assessment should include gustatory screening.
• Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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7
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Abstract
Background Endometriosis is a benign but chronic disease, often associated with chronic pelvic pain and sterility in reproductive age women. Definite diagnosis of endometriosis requires surgical intervention. In our study we determined the sensitivity and specificity of the routine non-invasive diagnosis of endometriosis. Methods 543 women underwent laparoscopy or laparotomy for benign gynecological reasons; of these, 156 women presented with endometriosis and 387 women presented without endometriosis. Charts were examined for preoperative prediction and diagnosis of endometriosis by gynecologists in private practice and by clinicians. Charts were also examined for the diagnosis after surgical and histological confirmation. Results Out of 101 cases, where first time endometriosis was diagnosed, in 43 patients (42.6%) the diagnosis of endometriosis was accurately predicted preoperatively by clinicians. Gynecologists in private practice suspected endometriosis in 29.7% of the cases. In the group of at least one recurrence of endometriosis (n=55), 89.1% clinic and 74.5% private practice suspected the correct diagnosis before surgery. The sensitivity for clinical diagnosis of endometriosis was calculated to be 59.0% in the clinic and 54.5% in private practice. The specificity was calculated to be 95.6% in the clinic and 96.9% in private practice. Conclusions According to the results of this study, the sensitivity of the clinical diagnosis for patients with newly detected endometriosis is very low, whereas it increases significantly for patients with recurrent disease. We recommend more investigations using non-invasive diagnostic tools. It should thereupon be possible to detect endometriosis earlier than the current delay of around nine years between the onset of symptoms and the final diagnosis.
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Affiliation(s)
- Schima Djalali
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
| | - Dietlinde Janson
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
| | - Christopher Altgassen
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
| | - Admir Agic
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
| | - Klaus Diedrich
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
| | - Daniela Hornung
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck - Germany
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8
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehner A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2017. [PMID: 28623665 DOI: 10.4193/rhin16.248] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. CONCLUSIONS We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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Affiliation(s)
- T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - P Andrews
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - A Altundag
- Department of Otorhinolaryngoglogy, Istanbul Surgery Hospital, Istanbul, Turkey
| | - C Cinghi
- Department of Otolaryngology; Eskisehir Osmangazi University, Istanbul, Turkey
| | - R M Costanzo
- Smell and Taste Disorders Center, Department of Otolaryngology Head and Neck Surgery, VCU School of Medicine, Richmond, VA, USA
| | - M Damm
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center, Cologne, Germany
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, QC, Canada
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - E Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - S C Hong
- Department of Otorhinolaryngology, Konkuk University Medical Center, Hwayang-dong, Gwangjin-gu, Seoul, South Korea
| | - D Hornung
- Dept. of Biology, St. Lawrence University, Canton, NY, USA
| | | | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - D A Leopold
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - A Macchi
- ENT Clinic, University of Insubria, ASST, sette laghi, Varese, Italy
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - R Moesges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - J Mullol
- Rhinology Unit and Smell Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - G C Passali
- Head and Neck section, Department of Aging, Neurosciences, Head and Neck and Orthopedic; Catholic University of Sacred heart, A. Gemelli Hospital Foundation, Rome, Italy
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V J Ramakrishnan
- Departments of Otolaryngology and Neurosurgery, University of Colorado, Aurora, CO, USA
| | - P Rombaux
- Universite Catholique de Louvain, Institute of Neurosciences, Unit of Otorhinolaryngology, Brussels, Belgium
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R A Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical Univeristy of South Carolina, Charleston, SC, USA
| | - B Shu
- Department of Otolaryngology, Taipei Veterans General Hospital, National Yang Ming University School of Medicine Faculty of Medicine, Taipei, Taiwan
| | - G Soler
- Division of Otorhinolaryngology, Area of Smell and Taste, Hospital de Clinicas, University of Buenos Aires, Buenos Aires City, Argentina
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
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9
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Hornung D, Biktashev VN, Otani NF, Shajahan TK, Baig T, Berg S, Han S, Krinsky VI, Luther S. Mechanisms of vortices termination in the cardiac muscle. R Soc Open Sci 2017; 4:170024. [PMID: 28405398 PMCID: PMC5383855 DOI: 10.1098/rsos.170024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/14/2017] [Indexed: 06/07/2023]
Abstract
We propose a solution to a long-standing problem: how to terminate multiple vortices in the heart, when the locations of their cores and their critical time windows are unknown. We scan the phases of all pinned vortices in parallel with electric field pulses (E-pulses). We specify a condition on pacing parameters that guarantees termination of one vortex. For more than one vortex with significantly different frequencies, the success of scanning depends on chance, and all vortices are terminated with a success rate of less than one. We found that a similar mechanism terminates also a free (not pinned) vortex. A series of about 500 experiments with termination of ventricular fibrillation by E-pulses in pig isolated hearts is evidence that pinned vortices, hidden from direct observation, are significant in fibrillation. These results form a physical basis needed for the creation of new effective low energy defibrillation methods based on the termination of vortices underlying fibrillation.
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Affiliation(s)
- D. Hornung
- Max Planck Institute DS, BMPG, Gottingen, Germany
| | | | - N. F. Otani
- Rochester Institute of Technology, Rochester, NY, USA
| | - T. K. Shajahan
- National Institute of Technology Karnataka, Bangalore, India
| | - T. Baig
- Max Planck Institute DS, BMPG, Gottingen, Germany
- Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, 37077 Göttingen
| | - S. Berg
- Max Planck Institute DS, BMPG, Gottingen, Germany
- Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, 37077 Göttingen
| | - S. Han
- Rochester Institute of Technology, Rochester, NY, USA
| | - V. I. Krinsky
- Max Planck Institute DS, BMPG, Gottingen, Germany
- INLN, CNRS, Valbonne, France
| | - S. Luther
- Max Planck Institute DS, BMPG, Gottingen, Germany
- Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, 37077 Göttingen
- Department of Pharmacology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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10
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Köster F, Jin L, Shen Y, Schally AV, Cai RZ, Block NL, Hornung D, Marschner G, Rody A, Engel JB, Finas D. Effects of an Antagonistic Analog of Growth Hormone-Releasing Hormone on Endometriosis in a Mouse Model and In Vitro. Reprod Sci 2017; 24:1503-1511. [PMID: 28205459 DOI: 10.1177/1933719117691140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Endometriosis is a benign gynecologic disorder causing dysmenorrhea, pelvic pain, and subfertility. Receptors for the growth hormone-releasing hormone (GHRH) were found in endometriotic tissues. Antagonists of GHRH have been used to inhibit the growth of endometriotic endometrial stromal cells. In this study, the GHRH receptor splice variant (SV) 1 was detected in human endometrial tissue samples by Western blots and quantitative reverse transcription polymerase chain reaction (qRT-PCR). The highest messenger RNA (mRNA) and protein levels of SV1 were found in eutopic endometrium from patients with endometriosis compared to ectopic endometriotic tissues and endometrium from normal patients. The highest expression for GHRH mRNA was found by qRT-PCR in ectopic endometriosis lesions. In an in vivo mouse model with human endometrial explants from patients with endometriosis, 10 μg MIA-602 per day resulted in significantly smaller human endometrial xenotransplants after 4 weeks compared to mice treated with vehicle. The endometrial tissues expressed SV1 before and after xenotransplantation. The proliferation of endometrial stromal cells as well as the endometriosis cell lines 12-Z and 49-Z was decreased by exposure to 1 μM MIA-602 after 72 hours. The protein levels of epithelial growth factor receptors in 12-Z and 49-Z cell lines were reduced 48 and 72 hours after the administration of 1 μM MIA-602. MIA-602 decreased the activation of the MAP-kinases ERK-1/2. Our study demonstrates the presence of SV1 receptor as a target for treatment with GHRH antagonist in endometriosis. Endometrial tissues respond to MIA-602 with inhibition of proliferation in vitro and in vivo. The use of MIA-602 could be an effective supplement to the treatment strategies in endometriosis.
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Affiliation(s)
- Frank Köster
- 1 Department of Gynecology and Obstetrics, University of Lübeck, Lübeck, Germany
| | - Li Jin
- 2 Department of Gynecology and Obstetrics, The International Peace Maternity & Child Health Hospital of China Welfare Institute, China
| | - Yuanming Shen
- 3 Department of Gynecology and Obstetrics, The Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, People's Republic of China
| | - Andrew V Schally
- 4 Endocrine, Polypeptide and Cancer Institute, Veterans Affairs Medical Center, Miami, FL, USA.,5 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA.,6 Divisions of Hematology/Oncology and Endocrinology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ren-Zhi Cai
- 4 Endocrine, Polypeptide and Cancer Institute, Veterans Affairs Medical Center, Miami, FL, USA.,5 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA.,6 Divisions of Hematology/Oncology and Endocrinology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Norman L Block
- 4 Endocrine, Polypeptide and Cancer Institute, Veterans Affairs Medical Center, Miami, FL, USA.,5 Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, USA.,6 Divisions of Hematology/Oncology and Endocrinology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Daniela Hornung
- 7 Department of Gynecology and Obstetrics, Diakonissenkrankenhaus Karlsruhe Rüppurr, Karlsruhe, Germany
| | - Gabriele Marschner
- 1 Department of Gynecology and Obstetrics, University of Lübeck, Lübeck, Germany
| | - Achim Rody
- 1 Department of Gynecology and Obstetrics, University of Lübeck, Lübeck, Germany
| | - Jörg B Engel
- 8 Department of Gynecology and Obstetrics, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Dominique Finas
- 9 Department of Gynecology and Obstetrics, Evangelic Hospital Bielefeld, Bielefeld, Germany
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11
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Silveira CGT, Marschner G, Canny GO, Klocke S, Hunold P, Köster F, Ahrens T, Rody A, Hornung D. Disrupting Y-Box-Binding Protein 1 Function Using OSU-03012 Prevents Endometriosis Progression in In Vitro and In Vivo Models. Reprod Sci 2016; 24:67-76. [PMID: 27217374 DOI: 10.1177/1933719116649695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of the present study was to test the ability of OSU-03012 (2-amino-N-[4-[5-phenanthren-2-yl-3-(trifluoromethyl)pyrazol-1-yl]phenyl]acetamide), a novel and potent celecoxib-derivative, to impair endometriosis progression in in vitro and in vivo models based on its ability to indirectly block Y-box-binding protein 1 (YB-1) function. 12Z human endometriotic epithelial cells and sexually mature female C57BL/6J mice were treated with OSU-03012. Cellular proliferation was quantified by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid assay. Expression of YB-1 and phosphorylated YB-1 in 12Z cells and endometriotic lesions was evaluated by Western blotting and immunohistochemistry (IHC). The IHC for proliferating cell nuclear antigen was performed. OSU-03012 treatment resulted in decreased YB-1 and its phosphorylated form in both in vitro and in vivo models. Endometriotic lesion size was significantly reduced in OSU-03012-treated mice (27.6 ± 4.0 mm3) compared to those from the control group (50.5 ± 6.9 mm3, P < .0001). A significant reduction in endometriotic epithelial cell proliferation was observed in endometriotic lesions exposed to OSU-03012 treatment ( P = .0346). In conclusion, targeting YB-1 via OSU-03012 showed a potent antiproliferative effect on endometriotic epithelial cells in vitro and in a mouse model of disease.
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Affiliation(s)
- Cássia G T Silveira
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | - Gabriele Marschner
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | | | - Silke Klocke
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | - Peter Hunold
- 3 Clinic for Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Frank Köster
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | - Thorben Ahrens
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | - Achim Rody
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany
| | - Daniela Hornung
- 1 Department of Obstetrics and Gynecology, University of Lübeck, Lübeck, Germany.,4 Department of Gynecology and Obstetrics, Diakonissenkrankenhaus Karlsruhe Rüppurr, Karlsruhe, Germany
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12
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Agic A, Xu H, Altgassen C, Noack F, Wolfler MM, Diedrich K, Friedrich M, Taylor RN, Hornung D. Relative Expression of 1,25-Dihydroxyvitamin D3 Receptor, Vitamin D 1α-Hydroxylase, Vitamin D 24-Hydroxylase, and Vitamin D 25-Hydroxylase in Endometriosis and Gynecologic Cancers. Reprod Sci 2016; 14:486-97. [PMID: 17913968 DOI: 10.1177/1933719107304565] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors demonstrate expression of the vitamin D receptor (VDR) and its hydroxylases in the endometrium and ovaries of women with and without endometriosis and endometrial or ovarian cancer. Immunohistochemistry showed strong staining of the VDR in endometriosis and endometrial cancer, with the most intense staining in epithelial cells. The VDR mRNA was significantly increased in patients with endometrial and ovarian cancer compared to the control group. There was a significantly higher 1 alpha-hydroxylase expression in the endometrium of patients with endometriosis compared to healthy controls. The observed differences in VDR and 1 alpha -hydroxylase mRNA levels were maintained at the protein level. The authors found no differences in 25-OH vitamin D levels between the serum of patients with endometriosis (25.7 +/- 2.1 ng/mL, n = 46) and healthy controls (22.6 +/- 2.0 ng/mL, n = 33, P = .31). They hypothesize that vitamin D might influence the local activity of immune cells and cytokines thought to play important pathogenic roles in the development and maintenance of endometriosis.
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Affiliation(s)
- Admir Agic
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Lübeck, Germany
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13
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Othman ER, Hornung D, Hussein M, Abdelaal II, Sayed AA, Fetih AN, Al-Hendy A. Soluble tumor necrosis factor-alpha receptors in the serum of endometriosis patients. Eur J Obstet Gynecol Reprod Biol 2016; 200:1-5. [DOI: 10.1016/j.ejogrb.2016.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 01/07/2023]
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14
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Fritzer N, Hudelist G, Tammaa A, Haas D, Oppelt P, Renner S, Hornung D, Wölfler M, Ulrich U. When sex is not on fire: A prospective multicentre study evaluating the long-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558374] [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] Open
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15
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Ahrens T, Silveira C, Agic A, Rody A, Hornung D. Serumlevel von YB-1 und CA12 – 5 in der Diagnostik der Endometriose. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558386] [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] Open
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16
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Ahrens T, Silveira CGT, Banz-Jansen C, Rody A, Hornung D. Evaluation of YB-1 levels in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol 2015; 191:68-71. [PMID: 26093350 DOI: 10.1016/j.ejogrb.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/29/2015] [Accepted: 05/19/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study is the evaluation of serum YB-1 levels in the diagnosis of endometriosis. STUDY DESIGN Serum samples of 12 patients with histologically confirmed endometriosis and of 10 control patients were collected. Western blot analysis was used to assess serum YB-1 levels. Groups were compared with Student's t-test or, if not normally distributed, with the Mann-Whitney test. Sensitivity and specificity for the potential diagnostic performance of serum YB-1 were assessed by receiver operating characteristic (ROC) curves. RESULTS Serum YB-1 levels were significantly higher in patients with endometriosis (=0.004). The area under the curve was 0.867 (95% confidence interval 0.714-1.019) with sensitivity and specificity of 83.3% and 70% respectively. CONCLUSIONS Serum YB-1 levels in patients with endometriosis are significantly higher compared to control patients and may be used as a potential diagnostic biomarker for endometriosis.
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Affiliation(s)
- Thorben Ahrens
- University of Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany.
| | - Cassia G T Silveira
- University of Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany; Laboratory of Clinical Immunology and Allergy-LIM60, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Achim Rody
- University of Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany
| | - Daniela Hornung
- University of Lübeck, Department of Obstetrics and Gynecology, Lübeck, Germany; Diakonissenkrankenhaus Karlsruhe Rüppurr, Department of Gynecology and Obstetrics, Karlsruhe, Germany
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Fritzer N, Haas D, Oppelt P, Renner S, Hornung D, Wölfler M, Ulrich U, Fischerlehner G, Sillem M, Hudelist G. More than just bad sex: sexual dysfunction and distress in patients with endometriosis. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374743] [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: 10/25/2022] Open
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Othman EE, Hornung D, Al-Hendy A. Cytokines and their soluble receptors in the serum of endometriosis patients, potential biomarkers? Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Diagnosis of endometriosis is surgical through laparoscopy, which is invasive, costly and associated with potential complications. OBJECTIVES A non-invasive test for diagnosis of endometriosis will focus the use of laparoscopy on women who are highly suspected of having endometriosis. This review includes studies about different biomarkers for endometriosis and their potential for the non-surgical diagnosis of this disease. METHODS This review covers studies that investigated different biomarkers in blood or endometrium. Studies that identified definite cutoff points and evaluated the diagnostic performance of the biomarker as a blood test for endometriosis are focused on. RESULTS/CONCLUSIONS Some of the markers investigated showed a good specificity, none of them showed a high sensitivity. More multi-center studies involving larger numbers of patients are required to identify the most useful biomarker.
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Fritzer N, Haas D, Oppelt P, Renner S, Hornung D, Wölfler M, Ulrich U, Fischerlehner G, Sillem M, Hudelist G. More than just bad sex: sexual dysfunction and distress in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol 2013; 169:392-6. [DOI: 10.1016/j.ejogrb.2013.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 04/07/2013] [Accepted: 04/10/2013] [Indexed: 01/23/2023]
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21
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Gori I, Rodriguez Y, Pellegrini C, Achtari C, Hornung D, Chardonnens E, Wunder D, Fiche M, Canny GO. Augmented epithelial multidrug resistance-associated protein 4 expression in peritoneal endometriosis: regulation by lipoxin A(4). Fertil Steril 2013; 99:1965-73.e2. [PMID: 23472950 DOI: 10.1016/j.fertnstert.2013.01.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the expression of the prostaglandin (PG) E(2) transporter multidrug resistance-associated protein 4 (MRP4) in eutopic and ectopic endometrial tissue from endometriosis patients with that of control subjects and to examine whether MRP4 is regulated by the antiinflammatory lipid lipoxin A(4) (LXA(4)) in endometriotic epithelial cells. DESIGN Molecular analysis in human samples and a cell line. SETTING Two university hospitals and a private clinic. PATIENT(S) A total of 59 endometriosis patients and 32 age- and body mass index-matched control subjects undergoing laparoscopy or hysterectomy. INTERVENTION(S) Normal, eutopic, and ectopic endometrial biopsies as well as peritoneal fluid were obtained during surgery performed during the proliferative phase of the menstrual cycle. 12Z endometriotic epithelial cells were used for in vitro mechanistic studies. MAIN OUTCOME MEASURE(S) Tissue MRP4 mRNA levels were quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR), and localization was analyzed with the use of immunohistochemistry. Cellular MRP4 mRNA and protein were quantified by qRT-PCR and Western blot, respectively. PGE(2) was measured in peritoneal fluid and cell supernatants using an enzyme immunoassay (EIA). RESULT(S) MRP4 was expressed in eutopic and ectopic endometrium, where it was overexpressed in peritoneal lesions and localized in the cytoplasm of glandular epithelial cells. LXA(4) attenuated MRP4 mRNA and protein levels in endometriotic epithelial cells in a dose-dependent manner, while not affecting the expression of enzymes involved in PGE(2) metabolism. Investigations employing receptor antagonists and small interfering RNA revealed that this occurred through estrogen receptor α. Accordingly, LXA(4) treatment inhibited extracellular PGE(2) release. CONCLUSION(S) We report for the first time that MRP4 is expressed in human endometrium, elevated in peritoneal endometriosis, and modulated by LXA(4) in endometriotic epithelial cells.
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Affiliation(s)
- Ilaria Gori
- Department of Gynecology, Obstetrics, and Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
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Pellegrini C, Gori I, Achtari C, Hornung D, Chardonnens E, Wunder D, Fiche M, Canny GO. The expression of estrogen receptors as well as GREB1, c-MYC, and cyclin D1, estrogen-regulated genes implicated in proliferation, is increased in peritoneal endometriosis. Fertil Steril 2012; 98:1200-8. [DOI: 10.1016/j.fertnstert.2012.06.056] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/08/2012] [Accepted: 06/14/2012] [Indexed: 01/06/2023]
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Henze D, Doecke WD, Hornung D, Machens K, Schmitz A, Zollner T, Gashaw I. Trefoil factor 3 - a new biomarker candidate for experimental and clinical endometriosis. J Reprod Immunol 2012. [DOI: 10.1016/j.jri.2012.03.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jacob F, Ukegjini K, Nixdorf S, Ford CE, Olivier J, Caduff R, Scurry JP, Guertler R, Hornung D, Mueller R, Fink DA, Hacker NF, Heinzelmann-Schwarz VA. Loss of secreted frizzled-related protein 4 correlates with an aggressive phenotype and predicts poor outcome in ovarian cancer patients. PLoS One 2012; 7:e31885. [PMID: 22363760 PMCID: PMC3283709 DOI: 10.1371/journal.pone.0031885] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/14/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Activation of the Wnt signaling pathway is implicated in aberrant cellular proliferation in various cancers. In 40% of endometrioid ovarian cancers, constitutive activation of the pathway is due to oncogenic mutations in β-catenin or other inactivating mutations in key negative regulators. Secreted frizzled-related protein 4 (SFRP4) has been proposed to have inhibitory activity through binding and sequestering Wnt ligands. METHODOLOGY/PRINCIPAL FINDINGS We performed RT-qPCR and Western-blotting in primary cultures and ovarian cell lines for SFRP4 and its key downstream regulators activated β-catenin, β-catenin and GSK3β. SFRP4 was then examined by immunohistochemistry in a cohort of 721 patients and due to its proposed secretory function, in plasma, presenting the first ELISA for SFRP4. SFRP4 was most highly expressed in tubal epithelium and decreased with malignant transformation, both on RNA and on protein level, where it was even more profound in the membrane fraction (p<0.0001). SFRP4 was expressed on the protein level in all histotypes of ovarian cancer but was decreased from borderline tumors to cancers and with loss of cellular differentiation. Loss of membrane expression was an independent predictor of poor survival in ovarian cancer patients (p = 0.02 unadjusted; p = 0.089 adjusted), which increased the risk of a patient to die from this disease by the factor 1.8. CONCLUSIONS/SIGNIFICANCE Our results support a role for SFRP4 as a tumor suppressor gene in ovarian cancers via inhibition of the Wnt signaling pathway. This has not only predictive implications but could also facilitate a therapeutic role using epigenetic targets.
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Affiliation(s)
- Francis Jacob
- Translational Research Group, University Hospital Zurich, Zurich, Switzerland
- Gynaecological Cancer Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kristjan Ukegjini
- Translational Research Group, University Hospital Zurich, Zurich, Switzerland
| | - Sheri Nixdorf
- Gynaecological Cancer Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Caroline E. Ford
- Wnt signaling and Metastasis Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jake Olivier
- Biostatistics Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rosmarie Caduff
- Institute of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - James P. Scurry
- Hunter Area Pathology Services, John Hunter Hospital, University of Newcastle, Callaghan, Australia
| | - Rea Guertler
- Gynaecological Cancer Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daniela Hornung
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Lubeck, Germany
| | - Renato Mueller
- Department of Gynecology and Obstetrics, Spital Limmattal, Zurich, Switzerland
| | - Daniel A. Fink
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Neville F. Hacker
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, Australia
| | - Viola A. Heinzelmann-Schwarz
- Translational Research Group, University Hospital Zurich, Zurich, Switzerland
- Gynaecological Cancer Group, Lowy Cancer Research Centre, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, Australia
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Salehin D, Haugk C, Thill M, Cordes T, Hornung D, Abu-Hechle A, Hemmerlein B, Friedrich M. Serum 25-hydroxyvitamin D levels in patients with vulvar cancer. Anticancer Res 2012; 32:265-270. [PMID: 22213315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The anticarcinogenic potential of vitamin D 25(OH)D has been attributed to the inhibition of proliferation of cells from different carcinomas. Reduced serum levels of 25(OH)D are associated with an increased incidence of various types of cancer. The influence of serum 25(OH)D on the incidence and outcome of patients with vulvar cancer is unknown. PATIENTS AND METHODS The serum 25(OH)D levels in 24 patients with vulvar cancer and 24 age-matched cancer-free patients was investigated. The blood samples were collected between October 2009 and September 2010 and time of blood collection of each patient and control was matched to avoid seasonal variations between the pairs. RESULTS The median 25(OH)D serum levels in the under 50 year old group of patients were significantly lower in the vulvar cancer group than the controls. The younger cancer group also had an age-related trend of lower median serum level than the older population. In the control population the trend was vice versa, yet this finding was not statistically significant. CONCLUSION Serum 25(OH)D has a possible role in the pathogenesis and progression of vulvar cancer, but further investigations of the association of vitamin D and vulvar cancer as well as regarding its influence on patient survival and quality of life are warranted in the future.
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Affiliation(s)
- Darius Salehin
- Department of Gynecology and Obstretics, Helios Hospital Krefeld, Lutherplatz 40, 47805 Krefeld, Germany.
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Altgassen C, Bends R, Kelling K, Hornung D, Friedrich M, Salehin D, Diedrich K, Kavallaris A. Retromesenteric para-aortic lymphadenectomy in gynecologic malignancy. EUR J GYNAECOL ONCOL 2012; 33:574-578. [PMID: 23327048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED In gynecologic oncology lymphadenectomy is of prognostic and therapeutic importance because recurrence-free time and survival depend on the metastatic involvement of lymph nodes. Lymphadenectomies are not performed to such an extent as they are indicated. This might be due to a laborious or problematic preparation. The authors therefore report their experience in a seldom taught preparation of the left para-aortic compartment in the form of a learning curve. MATERIALS AND METHODS To access the left para-aortic area, the descending colon is lifted to open the retroperitoneum along the line of Toldt. The mesentery of the descending colon was separated from the kidney along the fascia of Gerota by blunt preparation. Time was measured from the incision of the peritoneum until the renal vein was clearly visible. RESULTS The authors collected the data from the first 25 preparations. Mean duration for the left para-aortic preparation was 7.8 minutes compared to 5.9 minutes for the right side. Duration of preparation of the left area dropped from 11.0 minutes within the first patients (#1 to #5) to 3.8 minutes in the last patients (#20 to #25). No complications were observed in the study group linked to the retromesenteric approach described. CONCLUSION Retromesenteric para-aortic lymphadenectomy is quick to learn. The authors needed 20 preparations to observe a significant drop in the time needed for preparation. Retromesenteric para-aortic lymphadenectomy offers an excellent overview that lightens lymphadenectomy and therefore reduces the risks for patients.
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Affiliation(s)
- C Altgassen
- Department of Obstetrics and Gynecology, UK-SH, Campus Luebeck, Germany.
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27
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Silveira CGT, Krampe J, Ruhland B, Diedrich K, Hornung D, Agic A. Cold-shock domain family member YB-1 expression in endometrium and endometriosis. Hum Reprod 2011; 27:173-82. [PMID: 22095791 DOI: 10.1093/humrep/der368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Y-box-binding protein (YB-1) is described as a potential oncogene highly expressed in tumors and associated with increased cell survival, proliferation, migration and anti-apoptotic signaling. The aim of our study was to examine the expression and role of YB-1 in human endometriosis (Eo) and its association with cell survival, proliferation and invasion. METHODS We analyzed the gene and protein expression levels of YB-1 by quantitative real-time RT-PCR and immunoassays, respectively, in peritoneal macrophages, ovarian endometrioma and eutopic endometrial tissues/cells derived from women with (n= 120) and without (n= 91) Eo. We also evaluated the functional consequences of YB-1 knockdown in the Z12 Eo cell line by measuring cell proliferation [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid cell proliferation assay], invasion (Matrigel invasion assay) and spontaneous and tumour necrosis factor (TNFα)-induced RANTES (regulated upon activation, normal T-cell expressed and secreted chemokine) expression and apoptosis (ELISA-based assay). RESULTS YB-1 gene and protein expression was statistically significantly higher in ovarian lesions, eutopic endometrium and peritoneal macrophages of patients with Eo in comparison with the control group. Interestingly, the strongest YB-1 expression was observed in the epithelial compartment of endometrial tissues. In the Z12 cell line, YB-1 knockdown resulted in significant cell growth inhibitory effects including reduced cell proliferation and increased rates of spontaneous and TNFα-induced apoptosis. Significantly, higher RANTES expression and decreased cell invasion in vitro were also associated with YB-1 inactivation. CONCLUSION High YB-1 expression could have an impact on the development and progression of Eo. This study suggests the role of YB-1 as a potential therapeutic target for Eo patients.
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Affiliation(s)
- C G T Silveira
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburgerallee 160, 23538 Luebeck, Germany
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Finas D, Köster F, Altevogt P, Hornung D. Therapie der Endometriose durch anti-L1CAM mAb im Mausmodell. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286405] [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: 10/17/2022] Open
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29
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Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, Lazzeri L, Strowitzki T. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet 2011; 285:167-73. [PMID: 21681516 PMCID: PMC3249203 DOI: 10.1007/s00404-011-1941-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [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: 03/28/2011] [Accepted: 05/30/2011] [Indexed: 02/06/2023]
Abstract
Purpose To investigate the efficacy and safety of dienogest as a long-term treatment in endometriosis, with follow-up after treatment discontinuation. The study included women with endometriosis, who had previously completed a 12-week, placebo-controlled study of dienogest, who participated in an open-label extension study for up to 53 weeks. Thereafter, a patient subgroup was evaluated in a 24-week follow-up after treatment discontinuation. Methods A multicenter study performed in Germany, Italy and Ukraine. Women with endometriosis were enrolled at completion of the placebo-controlled study (n = 168). All women received dienogest (2 mg once daily, orally) and changes in pelvic pain (on a visual analog scale), bleeding pattern, adverse events and laboratory parameters were evaluated during and after treatment. Results The completion rate among women who entered the open-label extension study was 90.5% (n = 152). A significant decrease in pelvic pain was shown during continued dienogest treatment (P < 0.001). The mean frequency and intensity of bleeding progressively decreased. Adverse events, rated generally mild or moderate, led to withdrawal in four patients (2.4%). No clinically relevant changes in laboratory parameters were observed. During treatment-free follow-up (n = 34), the reduction in pelvic pain persisted, while bleeding frequency and intensity returned to normal patterns. Conclusions Long-term dienogest showed a favorable efficacy and safety profile, with progressive decreases in pain and bleeding irregularities during continued treatment; the decrease of pelvic pain persisted for at least 24 weeks after treatment cessation.
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Affiliation(s)
- Felice Petraglia
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Viale R. Bracci N. 16, 53100, Siena, Italy.
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Ruhland B, Agic A, Krampe J, Diedrich K, Hornung D. Innovations in conservative endometriosis treatment: an updated review. Minerva Ginecol 2011; 63:247-259. [PMID: 21654610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Endometriosis is a common, benign and chronic gynecological disorder. It is also an estrogen-dependent disorder that can result in intractable dysmenorrhea, heavy and/or irregular periods, painful bowel movements and urination during menstruation and infertility and ultimatively in repeated surgeries. Although surgery to remove endometriotic lesions is effective in relieving endometriosis-associated pain, recurrence rates are high and many women require continuous medical therapy to control symptoms. Symptom relief with palliation of pain and optimization of the quality of life should be the main aim of the medical therapy. Different pharmacologic treatment options are currently available. The most widely exerted medical therapy for endometriosis involves gonadotropin-releasing hormone (GnRH) agonists and oral contraceptives. Also progestogens and androgen derivates are used. New treatment options that are currently under investigation are selective progestogen receptor modulators (SPRMs), aromatase inhibitors (AI), GnRH- antagonists, cyclooxygenase (COX)-2 inhibitors, angiogenesis disruptor's und immune modulators. Although these new agents are promising, further confirmation in randomized clinical trials is required.
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Affiliation(s)
- B Ruhland
- University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Agic A, Diedrich K, Hornung D. Die Expression von YB-1 (Mitglied der Cold Shock Domain Familie) in Endometrium und Endometriose. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1280503] [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: 10/18/2022] Open
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Edgar DH, de Graaff AA, D'Hooghe TM, Dunselman GAJ, Dirksen CD, Hummelshoj L, EndoCost Consortium WERF, Simoens S, Garcia-Cerrudo E, Martinez-Conejero JA, Herrero L, Rodriguez S, Horcajadas JA, Remohi J, Garcia-Velasco JA, Salker MS, Christian M, Steel JH, Nautiyal J, Lang F, Brosens JJ, Mitra A, Bhattacharya J, Kundu S, Pal M, Mukhopadhyay D, Komsky A, Ben-Ami I, Strassburger D, Kasterstein E, Komarovsky D, Bern O, Maslansky B, Raziel A, Friedler S, Gidoni YS, Ron-El R, Finas D, Hunold P, Koester F, Altevogt P, Hornung D. SELECTED ORAL COMMUNICATION SESSION, SESSION 62: ENDOMETRIUM, IMPLANTATION AND ENDOMETRIOSIS Wednesday 6 July 2011 10:00 - 11:45. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.62] [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: 11/12/2022] Open
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Neumann G, Schlüter B, Hornung D, Gottschalk S, Moser A. Neurological picture. Reversible eclamptic leucoencephalopathy syndrome with severe brainstem involvement without neurological signs. J Neurol Neurosurg Psychiatry 2010; 81:1026-7. [PMID: 20581416 DOI: 10.1136/jnnp.2009.196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G Neumann
- Department of Neurology, University of Lübeck, Ratzeburger, Germany.
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Agic A, von Wussow U, Starzinski-Powitz A, Diedrich K, Altevogt P, Hornung D. Inhibition of cell proliferation, adhesion, and invasion with an anti-L1-cell adhesion molecule monoclonal antibody in an in vitro endometriosis model. Fertil Steril 2010; 94:1102-4. [DOI: 10.1016/j.fertnstert.2009.11.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/14/2009] [Accepted: 11/25/2009] [Indexed: 02/03/2023]
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Ohlsson Teague EMC, Hornung D. Session 61: Endometriosis from Pathogenesis to Non-Invasive Diagnosis. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.61] [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: 11/14/2022] Open
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Altgassen C, Müller N, Hornemann A, Kavallaris A, Hornung D, Diedrich K, Jarutat T. Immunohistochemical workup of sentinel nodes in endometrial cancer improves diagnostic accuracy. Gynecol Oncol 2009; 114:284-7. [DOI: 10.1016/j.ygyno.2009.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 04/15/2009] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
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Banz C, von Otte S, Noack F, Diedrich K, Hornung D. Primary peritoneal carcinoma in a young woman with suspected endometriosis. Fertil Steril 2009; 92:390.e5-7. [DOI: 10.1016/j.fertnstert.2009.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 02/03/2009] [Accepted: 02/04/2009] [Indexed: 11/27/2022]
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Hornemann A, von Koschitzky H, Bohlmann MK, Hornung D, Diedrich K, Taffazoli K. Isolated pyosalpinx in a 13-year-old virgin. Fertil Steril 2009; 91:2732.e9-10. [DOI: 10.1016/j.fertnstert.2008.12.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 12/30/2008] [Accepted: 12/31/2008] [Indexed: 10/21/2022]
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Djalali S, Axt-Fliedner R, Spiegler J, Diedrich K, Hornung D. Langzeitbehandlung einer Patientin mit Präeklampsie und HELLP-Syndrom in einer sehr frühen Schwangerschaftswoche. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1185752] [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] Open
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Agic A, Djalali S, Wolfler MM, Halis G, Diedrich K, Hornung D. Combination of CCR1 mRNA, MCP1, and CA125 Measurements in Peripheral Blood as a Diagnostic Test for Endometriosis. Reprod Sci 2008; 15:906-11. [DOI: 10.1177/1933719108318598] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Admir Agic
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck, Germany
| | - Schima Djalali
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck, Germany
| | - Monika M. Wolfler
- Department of Gynecology and Obstetrics, Technical University of Aachen, Aachen, Germany
| | - Gulden Halis
- Praxisklinik für Fertilität, Am Gendarmenmarkt, Berlin, Germany
| | - Klaus Diedrich
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck, Germany
| | - Daniela Hornung
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Luebeck, Germany,
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Xu X, Othman EEDR, Issaq HJ, Hornung D, Al-Hendy A, Veenstra TD. Multiplexed quantitation of endogenous estrogens and estrogen metabolites in human peritoneal fluid. Electrophoresis 2008; 29:2706-13. [PMID: 18512681 DOI: 10.1002/elps.200700837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Endogenous estrogens and estrogen metabolites (EM) in human peritoneal fluid may play an important role in health and disease, yet little is known regarding their types and levels present in human peritoneal fluid, primarily due to the lack of an analytical method that is capable of directly quantifying their absolute abundances. In this report, we describe the application of a capillary LC-MS/MS method for identifying and quantifying biologically active and total endogenous EM in human peritoneal fluid. The method requires only 50 muL of peritoneal fluid, yet can quantify 13 distinct EM. Calibration curves for each EM were linear over a 10(3)-fold concentration range and the lower LOQ was 50 fg on-column. For a charcoal stripped human peritoneal fluid sample containing 10 pg/mL of each EM, accuracy ranged from 83 to 118%, and intrabatch precision ranged from 0.2 to 4.4% RSD and interbatch precision ranged from 5.5 to 15.5% RSD. The analyses of human female peritoneal fluid shows that at least 10 biologically active and 11 total endogenous EM can be positively identified and quantitatively measured. Many of the biologically active forms are present in high abundance and possess distinct biological activities which warrant further study. Although micellar EKC gave baseline separation of a standard mixture of 10 EM, the LOQs using UV detection were not suitable for the assay of the low level estrogens in biological samples.
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Affiliation(s)
- Xia Xu
- Laboratory of Proteomics and Analytical Technologies, Advanced Technology Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD, USA
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Altgassen C, Bends R, Hornemann, MPH A, Hornung D, Diedrich K, Leitzke M. Retromesenteriale paraaortale Lymphadenektomie – eine Lernkurve. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088685] [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: 10/18/2022] Open
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Agic A, Djalali S, Wölfler MM, Halis G, Diedrich K, Hornung D. Diagnostischer Test für Endometriose: Kombination aus CCR1-mRNA, CA125- und MCP1- Bestimmung aus peripherem Blut. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089327] [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: 10/18/2022] Open
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Wölfler MM, Schwamborn K, Otten D, Hornung D, Knüchel-Clarke R, Rath W. Proteomisches Profiling von Serum und Aszites im Vergleich bei Patientinnen mit und ohne Endometriose. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089227] [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: 10/18/2022] Open
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Wölfler MM, Schwamborn K, Otten D, Hornung D, Liu H, Rath W. Mass spectrometry and serum pattern profiling for analyzing the individual risk for endometriosis: promising insights? Fertil Steril 2008; 91:2331-7. [PMID: 18555242 DOI: 10.1016/j.fertnstert.2008.03.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 03/24/2008] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether distinct patterns of serum proteins in symptomatic women are of value to predict endometriosis before laparoscopy. DESIGN Prospective exploratory cohort study. SETTING Tertiary care center. PATIENT(S) A total of 91 consecutive symptomatic patients suffering from dysmenorrhea, dyspareunia, chronic pelvic pain, or unexplained infertility. INTERVENTION(S) Collection of serum samples and a standardized protocol for patients' history before laparoscopic diagnosis. MAIN OUTCOME MEASURE(S) Protein expression was analyzed by mass spectrometric analysis according to surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) standards. The analysis of data was performed using a genetic algorithm (ClinProTools 2.0 software) and a rule-based decision-tree algorithm (XLminer software). RESULT(S) A total of 90 out of 91 samples were eligible for analysis. At laparoscopy, 51 of 90 patients (56.7%) exhibited endometriosis and 39 of 90 (43.3%) were disease free. Analyzing the serum samples, the software revealed a unique selection of mass peaks between 2,000 and 20,000 Da, which allowed for discrimination between patients suffering from endometriosis and control subjects. Overall recognition capacity was 70.8%, exhibiting a sensitivity of 81.3% (95% confidence interval [CI] 66.5-92.5) and a specificity of 60.3% (95% CI 46.1-74.2]) using the genetic algorithm, and a sensitivity of 78.4% and a specificity of 59.0% using the rule-based decision-tree algorithm. CONCLUSION(S) These findings provide direct evidence that screening for serum protein patterns using SELDI-TOF MS before laparoscopy might be of discriminative value in the prediction of disease and partly confirms recently published data. However, in this prospective setting, we found both low sensitivity and low specificity, which disqualifies the screening for serum protein patterns by SELDI-TOF MS as a "quick fix" diagnostic test.
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Affiliation(s)
- Monika M Wölfler
- Department of Obstetrics and Gynecology, RWTH Aachen University, Aachen, Germany.
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Finas D, Huszar M, Agic A, Dogan S, Kiefel H, Riedle S, Gast D, Marcovich R, Noack F, Altevogt P, Fogel M, Hornung D. L1 cell adhesion molecule (L1CAM) as a pathogenetic factor in endometriosis. Hum Reprod 2008; 23:1053-62. [DOI: 10.1093/humrep/den044] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Hornemann A, Holl-Ulrich K, Finas D, Altgassen C, Diedrich K, Hornung D. Laparoscopic management of early primary omental pregnancy. Fertil Steril 2008; 89:991.e9-11. [PMID: 17678905 DOI: 10.1016/j.fertnstert.2007.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/14/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the successful laparoscopic management of an omental pregnancy. DESIGN Case report. SETTING University of Schleswig-Holstein, Campus Luebeck, Department of Gynecology and Obstetrics. PATIENT(S) A 25-year-old patient with an omental pregnancy. INTERVENTION(S) Laparoscopic partial omentectomy. MAIN OUTCOME MEASURE(S) Successful laparoscopic management of an omental pregnancy. RESULT(S) A 25-year-old woman reported having abdominal pain. Her urine pregnancy test was positive. She had been using an intrauterine copper device for a period of 2.5 years. Gynecologic examination revealed normal results, in the uterus and fallopian tubes especially, where no signs of pregnancy were found through clinical and sonographic examination. Because the patient had had increasing pain, a laparoscopy was performed. There was approximately 500 mL of dark blood found in the cul de sac. The uterus and fallopian tubes appeared normal and without any signs of pregnancy. However, there was a cavity detected in the omentum majus. A partial omentectomy then was performed laparoscopically. An omental pregnancy was confirmed by beta-hCG-positive trophoblast cells in the omentum majus. CONCLUSION(S) Omental pregnancy can be rather difficult to identify. If there is no evidence of tubal pregnancy, laparoscopy may help to confirm the diagnosis of omental pregnancy and simultaneously offer minimal invasive therapy.
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Affiliation(s)
- Amadeus Hornemann
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Toth B, Hornung D, Scholz C, Djalali S, Friese K, Jeschke U. Peroxisome proliferator-activated receptors: new players in the field of reproduction. Am J Reprod Immunol 2007; 58:289-310. [PMID: 17681045 DOI: 10.1111/j.1600-0897.2007.00514.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peroxisome proliferator-activated receptors (PPAR) are members of the nuclear hormone receptor superfamily. Synthetic ligands to one family member, PPARgamma, are currently widely used as treatment for chronic diseases such as diabetes type II and other insulin resistances, e.g. as seen in polycystic ovary syndrome (PCOS). Moreover, novel approaches employing knock-out mice demonstrated that PPARgamma seems to play a key role in placental and fetal development. This review describes recent insights into the role of PPARs in human reproduction with specific reference to infertility, placental maturation and fetal development as well as disturbed pregnancy. Further, we highlight the current knowledge on synthetic ligands to PPARgamma used as a treatment in women with PCOS.
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Affiliation(s)
- Bettina Toth
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Grosshadern, Munich, Germany.
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Hornung D, Agic A, Djalali S, Diedrich K. Neue dignostische Tests für Endometriose aus peripherem Blut. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989155] [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] Open
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