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Maggiulli R, Cimadomo D, Innocenti F, Soscia D, Giancani A, Canosa S, Albricci L, Fabozzi G, Stoppa M, Sanges F, Vereczkey A, Holte J, Vaiarelli A, Ubaldi F, Rienzi L. P-773 Assessment of the putative impact of culture strategies, oocyte/embryo manipulations, and operators: a retrospective analysis of 3705 blastocyst culture cycles and 2604 single blastocyst transfers. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do the culture strategies, oocyte/embryo manipulations, and operators impact blastulation-rates per cohort of metaphase-II oocytes (BR per MII-oocytes) and/or live-birth-rates per single-embryo-transfer (LBR per SET)?
Summary answer
Undisturbed culture improved the BR per MII-oocytes, while culture drop volumes ≥80ml in the well-of-the-well system were associated with increased LBR per untested/euploid blastocyst SET.
What is known already
IVF lab performance is critical to achieve success in IVF. Yet, while a consensus exists on the main key-performance-indicators (KPIs), namely BR and LBR, and their inherent benchmark values, the strategies to fulfil them are still poorly standardized. The plasticity of human embryos along with the disparities in the patient populations might mask even largely different outcomes across clinics. Therefore, clear guidelines shall outline which procedures to standardize and carefully monitor in IVF laboratories. Here we investigated different embryo culture strategies, manipulations, and operators for their effect on BR and LBR per SET, adjusting the results for all main confounders.
Study design, size, duration
Retrospective analysis of 3705 cycles with ≥1 MII-oocyte and 2604 SETs (January2019-March2021). BR per MII-oocytes and LBR per SET were the main outcomes. Embryo-twinning was also assessed. The putative impact of culture strategies, manipulations, and operators’ expertise (0-5yr,6-11yr or > 12yr) was determined via regression analyses adjusted for possible confounders (autologous/donated oocytes, age, primary/secondary infertility and duration, sperm factor; for SET: also endometrial preparation, age at transfer, number of consecutive transfer, untested/euploid blastocyst, quality, and day).
Participants/materials, setting, methods
In donation cycles, only vitrified oocytes were used. In Preimplantation-Genetic-Testing (PGT) cycles, no assisted-hatching was performed and only euploid non-mosaic vitrified-warmed blastocysts were transferred. The culture strategies assessed were undisturbed (Embryoscope, Geri and Embryoscope-plus)/disturbed (KSystems), volume and approach (drops ≤30ml with single-culture or ≥ 80ml with well-of-the-well approaches), humidified/non-humidified atmosphere and media refreshed/not-refreshed. The manipulations assessed were oocyte/blastocyst vitrification (performed/not-performed), oocyte retrieval and denudation performed with oil overlay (yes/not), laser-assisted artificial-shrinkage (performed/not-performed), trophectoderm biopsy (performed/not-performed).
Main results and the role of chance
The only confounders on BR per MII-oocytes (overall:39.1±26.6%) were sperm factor and oocyte age. The linear regressions showed benefits for humidified atmosphere (unstandardized B-coefficient:+2.9%, p = 0.01), manipulations with oil overlay (+3.9%, p = 0.03) and drops≥80ml with a well-of-the-well approach (+4.3%, p < 0.01). However, only the positive effect of undisturbed incubators was significant when adjusting for confounders [41.7±27.8% (N = 1440 cycles) versus 37.5±25.7% in a disturbed incubator (N = 2265 cycles); unstandardized B-coefficient:+5.6%, 95%CI +3.9% to + 7.3%, standardized beta-coefficient:-0.103,p<0.01].
The main confounders on LBR per SET (overall: N = 1044/2604, 40.1%) were oocyte age, number of consecutive transfer, blastocyst chromosomal status (untested/euploid), quality and day. The univariate logistic regressions showed a benefit for undisturbed incubators (OR:1.3, 95%CI 1.1-1.5, p < 0.01), humidified atmosphere (OR:1.4, 95%CI 1.1-1.7, p < 0.01) and media refresh (OR:1.3, 95% 1.01-1.8, p = 0.05). However, only the use of drops ≥80ml with a well-of-the-well approach rather than drops ≤30ml with a single-culture approach involved an improvement when adjusting for confounders (untested SETs: N = 71/171, 41.5% versus N = 434/1284, 33.8%; euploid SETs: N = 170/316, 53.8% versus N = 369/833, 44.3%; multivariate-OR:1.33, 95%CI 1.12-1.58, adjusted p-value<0.01). This result was confirmed in a sub-analysis across only first patients’ SETs.
Lastly, no feature under investigation was associated with embryo-twinning (overall: N = 23/1243, 1.9% and N = 14/1044, 1.3% per pregnancy and delivery, respectively).
Limitations, reasons for caution
Retrospective single center study. Only ICSI cycles and continuous culture media were assessed. Cleavage stage SETs were excluded. All operators had at least 3yr of experience. Perinatal and gestational outcomes were not evaluated.
Wider implications of the findings
Real-life data adjusted for confounders may unveil fluctuations in critical KPIs mainly imputable to culture strategies. An impact seldom derives from oocyte/embryo manipulations if experienced operators adopt validated protocols. An accurate interpretation of these evidence shall lead to properly designed studies with problem-solving/progress-building purposes, and guidelines to standardize culture practices.
Trial registration number
Not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Canosa
- Livet, GeneraLife IVF , Turin, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M Stoppa
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - A Vereczkey
- Versys Clinics, Human Reproduction Institute , Budapest, Hungary
| | - J Holte
- Carl von Linnè clinic, GeneraLife IVF , Uppsala, Sweden
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
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Maggiulli R, Cimadomo D, Dovere L, Innocenti F, Albricci L, Soscia D, Giancani A, Sanges F, Amendola MG, Tacconi L, Nastri G, Morgante V, Vaiarelli A, Ubaldi F, Rienzi L. P–783 Clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer are independent of cryo-storage duration. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is cryo-storage duration associated with the outcomes after vitrified-warmed euploid single blastocyst transfer?
Summary answer
Lower live-birth-rates from blastocysts cryo-stored for periods longer than 3-months are mostly imputable to the worse quality of the embryos being warmed across sequential transfers.
What is known already
Blastocyst vitrification is crucial in modern IVF. Given its widespread application, a constant comprehensive monitoring of its effect on reproductive outcomes is pivotal. For instance, the effect of cryo-storage duration on embryo implantation potential, gestational and perinatal outcomes is object of a still ongoing investigation. The evidence in this regard are contrasting especially with regard to similar or decreased live birth rates among blastocysts subject to long-term cryo-storage. When investigating the neonatal outcomes, instead, no impact of blastocyst cryo-storage duration has ever been reported to date. Yet, data on euploid blastocysts and adjusted for quality and full-blastulation day are needed.
Study design, size, duration
Retrospective observational study. We included 2688 vitrified-warmed euploid single blastocyst transfers. The primary outcome was the live-birth-rates (LBR) according to cryo-storage duration clustered as ≤ 60, 61–90, 91–180, 181–360, 361–720, 721–1080 and >1080-days. The secondary outcomes were the miscarriage rate, the rates of gestational and perinatal issues among the deliveries, and the mean gestational age and birthweight among the babies born. All data were adjusted for confounders through linear or logistic regression analyses. Participants/materials, setting, methods: We included all vitrified-warmed transfers (range:1–8) conducted between May–2013 and March–2020 by 1884 patients (age:38±3yr) undergoing one blastocyst stage PGT-A cycle and obtaining ≥1 euploid embryo at our private clinic. Among putative confounders, only the number of sequential transfer from the same patient, blastocyst quality (Gardner’s scheme) and full-blastulation day (5–7) significantly associated with the LBR through univariate regressions. No association was reported for sperm factor, maternal age, incubator, and culture media.
Main results and the role of chance
The LBR of euploid blastocysts cryo-stored for ≤60-days was 49.4% (N = 319/646) versus 48.7% (N = 292/599; OR:0.98,95%CI:0.78–1.21,p=0.82) between 61–90-days, 42.9% (N = 291/679; OR:0.77,95%CI:0.62–0.96,p=0.02) between 91–180-days, 41.7% (N = 169/405; OR:0.73,95%CI:0.57–0.94,p=0.02) between 181–360-days, 34.7% (N = 50/144; OR:0.55,95%CI:0.37–0.79,p<0.01) between 361–720-days, 53.4% (N = 63/118; OR:1.17,95%CI:0.79–1.74,p=0.42) between 721–1080-days, and 50.5% (N = 49/97; OR:1.05,95%CI:0.68–1.60,p=0.83) for >1080-days. However, when these data were adjusted for blastocyst quality and full-blastulation day, all the multivariate-OR were not-significant. Indeed, the longer the cryo-storage period the worse the quality of the euploid blastocysts transferred (e.g. AA-blastocysts were 74% among embryos cryo-stored for ≤90-days, but always <70% for embryos cryo-stored for longer periods, p < 0.01; similarly, day5-blastocysts were ∼50% among embryos cryo-stored for ≤90-days, but always <50% for embryos cryo-stored for longer periods, p = 0.02). The miscarriage-rate (overall 14%, ranging 7–18%) was not associated with cryo-storage duration already from univariate regressions. Also the gestational (overall 6%, ranging 0–8%) and perinatal issues rates (overall 3%, ranging 0–5%) were not associated with cryo-storage duration already from the univariate regressions. Neither the gestational age nor the birthweight showed significant associations with cryo-storage duration, as confirmed by linear regressions. In fact the rate of newborns whose weight was normal-for-gestational-age was similar across all cryo-storage duration groups (overall 81%, ranging 80–83%).
Limitations, reasons for caution
The prevalence of first transfers decreases from ≥95% for procedures conducted ≤90-days from vitrification to 71%, 39%, 22% and 4% for procedures conducted between 91–180, 181–360, 361–720 and >720-days, respectively. However, also the sequential number of transfer was not associated with the LBR when adjusted for blastocyst-quality and full-blastulation day.
Wider implications of the findings: Cryo-storage by vitrification is confirmed safe in the hands of experienced operators, and its duration does not impact any outcome. This information is valuable for freeze-all cycles, but also for women cryo-preserving surplus embryos for second pregnancies; in this regard, 6.8% of the patients in this study delivered ≥2 LBs.
Trial registration number
Not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Dovere
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M G Amendola
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Tacconi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - G Nastri
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - V Morgante
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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Maggiulli R, Cimadomo D, Dovere L, Innocenti F, Albricci L, Soscia D, Giancani A, Sanges F, Amendola MG, Tacconi L, Nastri G, Morgante V, Vaiarelli A, Ubaldi F, Rienzi L. P-783 Clinical, obstetric and perinatal outcomes after vitrified-warmed euploid blastocyst transfer are independent of cryo-storage duration. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is cryo-storage duration associated with the outcomes after vitrified-warmed euploid single blastocyst transfer?
Summary answer
Lower live-birth-rates from blastocysts cryo-stored for periods longer than 3-months are mostly imputable to the worse quality of the embryos being warmed across sequential transfers.
What is known already
Blastocyst vitrification is crucial in modern IVF. Given its widespread application, a constant comprehensive monitoring of its effect on reproductive outcomes is pivotal. For instance, the effect of cryo-storage duration on embryo implantation potential, gestational and perinatal outcomes is object of a still ongoing investigation. The evidence in this regard are contrasting especially with regard to similar or decreased live birth rates among blastocysts subject to long-term cryo-storage. When investigating the neonatal outcomes, instead, no impact of blastocyst cryo-storage duration has ever been reported to date. Yet, data on euploid blastocysts and adjusted for quality and full-blastulation day are needed.
Study design, size, duration
Retrospective observational study. We included 2688 vitrified-warmed euploid single blastocyst transfers. The primary outcome was the live-birth-rates (LBR) according to cryo-storage duration clustered as ≤ 60, 61-90, 91-180, 181-360, 361-720, 721-1080 and >1080-days. The secondary outcomes were the miscarriage rate, the rates of gestational and perinatal issues among the deliveries, and the mean gestational age and birthweight among the babies born. All data were adjusted for confounders through linear or logistic regression analyses.
Participants/materials, setting, methods
We included all vitrified-warmed transfers (range:1-8) conducted between May-2013 and March-2020 by 1884 patients (age:38±3yr) undergoing one blastocyst stage PGT-A cycle and obtaining ≥1 euploid embryo at our private clinic. Among putative confounders, only the number of sequential transfer from the same patient, blastocyst quality (Gardner’s scheme) and full-blastulation day (5-7) significantly associated with the LBR through univariate regressions. No association was reported for sperm factor, maternal age, incubator, and culture media.
Main results and the role of chance
The LBR of euploid blastocysts cryo-stored for ≤60-days was 49.4% (N = 319/646) versus 48.7% (N = 292/599; OR:0.98,95%CI:0.78-1.21,p = 0.82) between 61-90-days, 42.9% (N = 291/679; OR:0.77,95%CI:0.62-0.96,p = 0.02) between 91-180-days, 41.7% (N = 169/405; OR:0.73,95%CI:0.57-0.94,p = 0.02) between 181-360-days, 34.7% (N = 50/144; OR:0.55,95%CI:0.37-0.79,p < 0.01) between 361-720-days, 53.4% (N = 63/118; OR:1.17,95%CI:0.79-1.74,p = 0.42) between 721-1080-days, and 50.5% (N = 49/97; OR:1.05,95%CI:0.68-1.60,p = 0.83) for >1080-days. However, when these data were adjusted for blastocyst quality and full-blastulation day, all the multivariate-OR were not-significant. Indeed, the longer the cryo-storage period the worse the quality of the euploid blastocysts transferred (e.g. AA-blastocysts were 74% among embryos cryo-stored for ≤90-days, but always < 70% for embryos cryo-stored for longer periods, p < 0.01; similarly, day5-blastocysts were ∼50% among embryos cryo-stored for ≤90-days, but always < 50% for embryos cryo-stored for longer periods, p = 0.02). The miscarriage-rate (overall 14%, ranging 7-18%) was not associated with cryo-storage duration already from univariate regressions. Also the gestational (overall 6%, ranging 0-8%) and perinatal issues rates (overall 3%, ranging 0-5%) were not associated with cryo-storage duration already from the univariate regressions. Neither the gestational age nor the birthweight showed significant associations with cryo-storage duration, as confirmed by linear regressions. In fact the rate of newborns whose weight was normal-for-gestational-age was similar across all cryo-storage duration groups (overall 81%, ranging 80-83%).
Limitations, reasons for caution
The prevalence of first transfers decreases from ≥95% for procedures conducted ≤90-days from vitrification to 71%, 39%, 22% and 4% for procedures conducted between 91-180, 181-360, 361-720 and >720-days, respectively. However, also the sequential number of transfer was not associated with the LBR when adjusted for blastocyst-quality and full-blastulation day.
Wider implications of the findings
Cryo-storage by vitrification is confirmed safe in the hands of experienced operators, and its duration does not impact any outcome. This information is valuable for freeze-all cycles, but also for women cryo-preserving surplus embryos for second pregnancies; in this regard, 6.8% of the patients in this study delivered ≥2 LBs.
Trial registration number
not applicable
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Affiliation(s)
- R Maggiulli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Dovere
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Albricci
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Soscia
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Giancani
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Sanges
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M G Amendola
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Tacconi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - G Nastri
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - V Morgante
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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Sanges F, Floris M, Cossu-Rocca P, Muroni MR, Pira G, Urru SAM, Barrocu R, Gallus S, Bosetti C, D'Incalci M, Manca A, Uras MG, Medda R, Sollai E, Murgia A, Palmas D, Atzori F, Zinellu A, Cambosu F, Moi T, Ghiani M, Marras V, Santona MC, Canu L, Valle E, Sarobba MG, Onnis D, Asunis A, Cossu S, Orrù S, De Miglio MR. Histologic subtyping affecting outcome of triple negative breast cancer: a large Sardinian population-based analysis. BMC Cancer 2020; 20:491. [PMID: 32487046 PMCID: PMC7268380 DOI: 10.1186/s12885-020-06998-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing "special types" to high-grade invasive breast carcinomas of no special type (IBC-NST). METHODS This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. RESULTS TNBC "special types" showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. CONCLUSIONS Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.
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Affiliation(s)
- Francesca Sanges
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Matteo Floris
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Paolo Cossu-Rocca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
- Department of Diagnostic Services, "Giovanni Paolo II" Hospital, ASSL Olbia-ATS Sardegna, Olbia, Italy.
| | - Maria R Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvana Anna Maria Urru
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
- School of Hospital Pharmacy, University of Sassari, Sassari, Italy
| | - Renata Barrocu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Maria Gabriela Uras
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Ricardo Medda
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Elisabetta Sollai
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Alma Murgia
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Dolores Palmas
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Francesca Cambosu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tiziana Moi
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Massimo Ghiani
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | | | - Luisa Canu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Enrichetta Valle
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Daniela Onnis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Anna Asunis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Sergio Cossu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Sandra Orrù
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
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5
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Floris M, Sanna D, Castiglia P, Putzu C, Sanna V, Pazzola A, De Miglio MR, Sanges F, Pira G, Azara A, Lampis E, Serra A, Carru C, Steri M, Costanza F, Bisail M, Muroni MR. MTHFR, XRCC1 and OGG1 genetic polymorphisms in breast cancer: a case-control study in a population from North Sardinia. BMC Cancer 2020; 20:234. [PMID: 32192442 PMCID: PMC7083022 DOI: 10.1186/s12885-020-06749-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite conflicting results, considerable evidence suggests the association between single nucleotide polymorphisms in MTHFR, XRCC1 and OGG1 genes and, risk of developing breast cancer. Here a case-control study is reported, including 135 breat cancer patients and 112 healthy women, all representative of Northern Sardinian population. METHODS Polymerase chain reaction/restriction fragment length polymorphism method was used to determine the genotypes of five polymorphisms: MTHFR C677T (rs1801133) and A1298C (rs1801131), XRCC1 Arg194Trp (rs1799782) and Arg399Gln (rs25487) and OGG1 Ser326Cys (rs1052133). Allelic, genotypic and haplotype association analyses with disease risk and clinicopathological parameters were performed. RESULTS A nominally significant association with breast cancer risk was observed for MTHFR C677T polymorphism heterozygous genotype in the codominant model (OR: 0.57, 95% CI: 0.32-1.00, p = 0.049) and for Cys/Cys genotype of the OGG1 Ser326Cys polymorphism in the recessive model (OR: 0.23, 95% CI: 0.05-1.11, p = 0.0465). No significant differences were found at genotype-level for A1298C polymorphism of the MTHFR gene and Arg194Trp and Arg399Gln of the XRCC1 gene. Furthermore, the OGG1 and XRCC1 rs25487 polymorphisms were nominally associated with PgR, Her2 status and with sporadic breast cancer, respectively. CONCLUSIONS Based on genetic characteristics of individuals included in this study, results suggest that MTHFR CT and OGG1 Cys/Cys genotypes have a protective effect that may have an influence on breast cancer risk in a representative Northern Sardinian population.
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Affiliation(s)
- Matteo Floris
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Daria Sanna
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Paolo Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Carlo Putzu
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - Valeria Sanna
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | | | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesca Sanges
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Antonio Azara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emanuele Lampis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Maristella Steri
- Institute for Genetic and Biomedical Research, National Research Council (CNR), Monserrato, Cagliari, Italy
| | - Flavia Costanza
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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6
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Virdis P, Migheli R, Galleri G, Fancello S, Cadoni MPL, Pintore G, Petretto GL, Marchesi I, Fiorentino FP, di Francesco A, Sanges F, Bagella L, Muroni MR, Fozza C, De Miglio MR, Podda L. Antiproliferative and proapoptotic effects of Inula viscosa extract on Burkitt lymphoma cell line. Tumour Biol 2020; 42:1010428319901061. [PMID: 32013807 DOI: 10.1177/1010428319901061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Burkitt lymphoma is a very aggressive B-cell non-Hodgkin lymphoma. Although remarkable progress has been made in the therapeutic scenario for patients with Burkitt lymphoma, search and development of new effective anticancer agents to improve patient outcome and minimize toxicity has become an urgent issue. In this study, the antitumoral activity of Inula viscosa, a traditional herb obtained from plants collected on the Asinara Island, Italy, was evaluated in order to explore potential antineoplastic effects of its metabolites on Burkitt lymphoma. Raji human cell line was treated with increasing Inula viscosa extract concentration for cytotoxicity screening and subsequent establishment of cell cycle arrest and apoptosis. Moreover, gene expression profiles were performed to identify molecular mechanisms involved in the anticancer activities of this medical plant. The Inula viscosa extract exhibited powerful antiproliferative and cytotoxic activities on Raji cell line, showing a dose- and time-dependent decrease in cell viability, obtained by cell cycle arrest in the G2/M phase and an increase in cell apoptosis. The treatment with Inula viscosa caused downregulation of genes involved in cell cycle and proliferation (c-MYC, CCND1) and inhibition of cell apoptosis (BCL2, BCL2L1, BCL11A). The Inula viscosa extract causes strong anticancer effects on Burkitt lymphoma cell line. The molecular mechanisms underlying such antineoplastic activity are based on targeting and downregulation of genes involved in cell cycle and apoptosis. Our data suggest that Inula viscosa natural metabolites should be further exploited as potential antineoplastic agents against Burkitt lymphoma.
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Affiliation(s)
- Patrizia Virdis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Rossana Migheli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Grazia Galleri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Silvia Fancello
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Piera L Cadoni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giorgio Pintore
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Irene Marchesi
- Kitos Biotech Srls, Porto Conte Ricerche, Sassari, Italy
| | - Francesco Paolo Fiorentino
- Kitos Biotech Srls, Porto Conte Ricerche, Sassari, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alessandra di Francesco
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesca Sanges
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi Bagella
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi Podda
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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7
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Angius A, Uva P, Pira G, Muroni MR, Sotgiu G, Saderi L, Uleri E, Caocci M, Ibba G, Cesaraccio MR, Serra C, Carru C, Manca A, Sanges F, Porcu A, Dolei A, Scanu AM, Rocca PC, De Miglio MR. Integrated Analysis of miRNA and mRNA Endorses a Twenty miRNAs Signature for Colorectal Carcinoma. Int J Mol Sci 2019; 20:E4067. [PMID: 31434359 PMCID: PMC6720928 DOI: 10.3390/ijms20164067] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) ranks as the most frequent carcinoma worldwide. CRC patients show strong prognostic differences and responses to treatment, and 20% have incurable metastatic disease at diagnosis. We considered it essential to investigate mechanisms that control cellular regulatory networks, such as the miRNA-mRNA interaction, known to be involved in cancer pathogenesis. We conducted a human miRNome analysis by TaqMan low density array, comparing CRC to normal colon tissue (NCT, and experimentally identified gene targets of miRNAs deregulated, by anti-correlation analysis, with the CRC whole-transcriptome profile obtained from RNASeq experiments. We identified an integrated signature of 20 deregulated miRNAs in CRC. Enrichment analyses of the gene targets controlled by these miRNAs brought to light 25 genes, members of pathways known to lead to cell growth and death (CCND1, NKD1, FZD3, MAD2L1, etc.), such as cell metabolism (ACSL6, PRPS1-2). A screening of prognosis-mediated miRNAs underlined that the overexpression of miR-224 promotes CRC metastasis, and is associated with high stage and poor survival. These findings suggest that the biology and progression of CRC depend on deregulation of multiple miRNAs that cause a complex dysfunction of cellular molecular networks. Our results have further established miRNA-mRNA interactions and defined multiple pathways involved in CRC pathogenesis.
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Affiliation(s)
- Andrea Angius
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Cittadella Universitaria di Cagliari, 09042 Monserrato (CA), Italy
| | - Paolo Uva
- CRS4, Science and Technology Park Polaris, Piscina Manna, 09050 Pula (CA), Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Laura Saderi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Elena Uleri
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maurizio Caocci
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Gabriele Ibba
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maria Rosaria Cesaraccio
- Department of Prevention, Registro Tumori Provincia di Sassari, ASSL Sassari-ATS Sardegna, Via Rizzeddu 21, Sassari, Italy
| | - Caterina Serra
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Alessandra Manca
- Department of Pathology, AOU Sassari, Via Matteotti 60, 07100 Sassari, Italy
| | - Francesca Sanges
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Antonia Dolei
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Antonio Mario Scanu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy.
| | - Paolo Cossu Rocca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy.
- Department of Diagnostic Services, "Giovanni Paolo II" Hospital, ASSL Olbia-ATS Sardegna, Via Bazzoni-Sircana, 07026 Olbia, Italy.
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
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8
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Castiglia P, Sanna V, Azara A, De Miglio MR, Murgia L, Pira G, Sanges F, Fancellu A, Carru C, Bisail M, Muroni MR. Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in breast cancer: a Sardinian preliminary case-control study. Int J Med Sci 2019; 16:1089-1095. [PMID: 31523170 PMCID: PMC6743281 DOI: 10.7150/ijms.32162] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/12/2019] [Indexed: 02/05/2023] Open
Abstract
Two common polymorphisms in the MTHFR gene, C677T and A1298C, are associated with reduced enzyme activity and may be associated with breast cancer susceptibility. We performed a case-control study to investigate the association between the two SNPs in the MTHFR gene and risk of breast cancer. In total, 58 breast cancer patients and 58 unaffected controls were enrolled in the study. Polymerase chain reaction/restriction fragment length polymorphism technique (PCR-RFLP) was conducted to determine the genotypes. No significant differences were found in the genotypes of the two polymorphisms of the MTHFR gene between cases and controls. The OR and 95% CI for the 677CC, 677CT and 677TT genotypes were 1.00, 0.95 (0.39-2.31) and 0.87 (0.27-2.80), respectively; those of the 1298AA, 1298AC and 1298CC genotypes were 1.00, 0.59 (0.26-1.36) and 0.78 (1.32-4.66) respectively. Furthermore, it has been shown in patients with breast cancer a risk of presenting with an aggressive biophenotype about twice or three times higher in the presence of the C677T and A1298C polymorphisms, respectively. Finally, the A1298Cpolymorphism is significantly associated with increased recurrence risk of lymph node-positive breast cancer. Our study has not shown a significant association between MTHFR gene polymorphisms and breast cancer risk. However, it highlighted the key-role played by the presence of mutant alleles for both polymorphisms in increasing the risk of developing more aggressive phenotypes; moreover, specifically in A1298C, it might also lead to a higher risk of developing lymph node metastasis.
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Affiliation(s)
- Paolo Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Valeria Sanna
- Division of Medical Oncology, AOU Sassari, Via E. De Nicola - 07100 Sassari, Italy; Sassari, Italy
| | - Antonio Azara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Maria R De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Luciano Murgia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Giovanna Pira
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Francesca Sanges
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43 - 07100 Sassari, Italy
| | - Marco Bisail
- LILT, Sassari, Via Amendola, 40/L - 07100 Sassari, Italy
| | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4 - 07100 Sassari, Italy
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9
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Angius A, Pira G, Scanu AM, Uva P, Sotgiu G, Saderi L, Manca A, Serra C, Uleri E, Piu C, Caocci M, Ibba G, Zinellu A, Cesaraccio MR, Sanges F, Muroni MR, Dolei A, Cossu-Rocca P, De Miglio MR. MicroRNA-425-5p Expression Affects BRAF/RAS/MAPK Pathways In Colorectal Cancers. Int J Med Sci 2019; 16:1480-1491. [PMID: 31673240 PMCID: PMC6818206 DOI: 10.7150/ijms.35269] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer death worldwide and about 20% is metastatic at diagnosis and untreatable. The anti-EGFR therapy in metastatic patients is led by the presence of KRAS-mutations in tumor tissue. KRAS-wild-type CRC patients showed a positive response rate of about 70% to cetuximab or panitumumab combined with chemotherapy. MiRNAs are promising markers in oncology and could improve our knowledge on pathogenesis and drug resistance in CRC patients. This class of molecules represents an opportunity for the development of miRNA-based strategies to overcome the ineffectiveness of anti-EGFR therapy. We performed an integrative analysis of miRNA expression profile between KRAS-mutated CRC and KRAS-wildtype CRC and paired normal colic tissue (NCT). We revealed an overexpression of miR-425-5p in KRAS-mutated CRC compared to KRAS-wild type CRC and NCT and demonstrated that miR-425-5p exerts regulatory effects on target genes involved in cellular proliferation, migration, invasion, apoptosis molecular networks. These epigenetic mechanisms could be responsible of the strong aggressiveness of KRAS-mutated CRC compared to KRAS-wildtype CRC. We proved that some miR-425-5p targeted genes are involved in EGFR tyrosine kinase inhibitor resistance pathway, suggesting that therapies based on miR-425-5p may have strong potential in targeting KRAS-driven CRC. Moreover, we demonstrated a role in the oncogenesis of miR-31-5p, miR-625-5p and miR-579 by comparing CRC versus NCT. Our results underlined that miR-425-5p might act as an oncogene to participate in the pathogenesis of KRAS-mutated CRC and contribute to increase the aggressiveness of this subcategory of CRC, controlling a complex molecular network.
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Affiliation(s)
- Andrea Angius
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Cittadella Universitaria di Cagliari, 09042 Monserrato (CA), Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Antonio Mario Scanu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Paolo Uva
- CRS4, Science and Technology Park Polaris, Piscina Manna, 09010 Pula, CA, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Laura Saderi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Alessandra Manca
- Department of Pathology, AOU Sassari, Via Matteotti 60, 07100 Sassari, Italy
| | - Caterina Serra
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Elena Uleri
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Claudia Piu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maurizio Caocci
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Gabriele Ibba
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maria Rosaria Cesaraccio
- Department of Prevention, Registro Tumori Provincia di Sassari, ASSL Sassari-ATS Sardegna, Via Rizzeddu 21, Sassari, Italy
| | - Francesca Sanges
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
| | - Antonina Dolei
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43-b, 07100 Sassari, Italy
| | - Paolo Cossu-Rocca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy.,Department of Diagnostic Services, "Giovanni Paolo II" Hospital, ASSL Olbia-ATS Sardegna, Via Bazzoni-Sircana, 07026 Olbia, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy
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10
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Urru SAM, Gallus S, Bosetti C, Moi T, Medda R, Sollai E, Murgia A, Sanges F, Pira G, Manca A, Palmas D, Floris M, Asunis AM, Atzori F, Carru C, D'Incalci M, Ghiani M, Marras V, Onnis D, Santona MC, Sarobba G, Valle E, Canu L, Cossu S, Bulfone A, Rocca PC, De Miglio MR, Orrù S. Clinical and pathological factors influencing survival in a large cohort of triple-negative breast cancer patients. BMC Cancer 2018; 18:56. [PMID: 29310602 PMCID: PMC5759886 DOI: 10.1186/s12885-017-3969-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To provide further information on the clinical and pathological prognostic factors in triple-negative breast cancer (TNBC), for which limited and inconsistent data are available. METHODS Pathological characteristics and clinical records of 841 TNBCs diagnosed between 1994 and 2015 in four major oncologic centers from Sardinia, Italy, were reviewed. Multivariate hazard ratios (HRs) for mortality and recurrence according to various clinicopathological factors were estimated using Cox proportional hazards models. RESULTS After a mean follow-up of 4.3 years, 275 (33.3%) TNBC patients had a progression of the disease and 170 (20.2%) died. After allowance for study center, age at diagnosis, and various clinicopathological factors, all components of the TNM staging system were identified as significant independent prognostic factors for TNBC mortality. The HRs were 3.13, 9.65, and 29.0, for stage II, III and IV, respectively, vs stage I. Necrosis and Ki-67 > 16% were also associated with increased mortality (HR: 1.61 and 1.99, respectively). Patients with tumor histotypes other than ductal invasive/lobular carcinomas had a more favorable prognosis (HR: 0.40 vs ductal invasive carcinoma). No significant associations with mortality were found for histologic grade, tumor infiltrating lymphocytes, and lymphovascular invasion. Among lymph node positive TNBCs, lymph node ratio appeared to be a stronger predictor of mortality than pathological lymph nodes stage (HR: 0.80 for pN3 vs pN1, and 3.05 for >0.65 vs <0.21 lymph node ratio), respectively. Consistent results were observed for cancer recurrence, except for Ki-67 and necrosis that were not found to be significant predictors for recurrence. CONCLUSIONS This uniquely large study of TNBC patients provides further evidence that, besides tumor stage at diagnosis, lymph node ratio among lymph node positive tumors is an additional relevant predictor of survival and tumor recurrence, while Ki-67 seems to be predictive of mortality, but not of recurrence.
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Affiliation(s)
- Silvana Anna Maria Urru
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Technology Park Polaris, Cagliari, Italy
| | - Silvano Gallus
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via G. La Masa 19, 20156, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Tiziana Moi
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | - Ricardo Medda
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Technology Park Polaris, Cagliari, Italy
| | - Elisabetta Sollai
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | - Alma Murgia
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | - Francesca Sanges
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Dolores Palmas
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | - Matteo Floris
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Technology Park Polaris, Cagliari, Italy
| | | | | | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Maurizio D'Incalci
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Massimo Ghiani
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | | | - Daniela Onnis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | | | | | - Enrichetta Valle
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
| | - Luisa Canu
- Department of Pathology, ASL Nuoro, Nuoro, Italy
| | - Sergio Cossu
- Department of Pathology, ASL Nuoro, Nuoro, Italy
| | - Alessandro Bulfone
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia (CRS4), Technology Park Polaris, Cagliari, Italy
| | - Paolo Cossu Rocca
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | - Sandra Orrù
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL, Cagliari, Cagliari, Italy
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11
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Uva P, Cossu-Rocca P, Loi F, Pira G, Murgia L, Orrù S, Floris M, Muroni MR, Sanges F, Carru C, Angius A, De Miglio MR. miRNA-135b Contributes to Triple Negative Breast Cancer Molecular Heterogeneity: Different Expression Profile in Basal-like Versus non-Basal-like Phenotypes. Int J Med Sci 2018; 15:536-548. [PMID: 29725243 PMCID: PMC5930454 DOI: 10.7150/ijms.23402] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/05/2018] [Indexed: 01/03/2023] Open
Abstract
The clinical and genetic heterogeneity of Triple Negative Breast Cancer (TNBC) and the lack of unambiguous molecular targets contribute to the inadequacy of current therapeutic options for these variants. MicroRNAs (miRNA) are a class of small highly conserved regulatory endogenous non-coding RNA, which can alter the expression of genes encoding proteins and may play a role in the dysregulation of cellular pathways. Our goal was to improve the knowledge of the molecular pathogenesis of TNBC subgroups analyzing the miRNA expression profile, and to identify new prognostic and predictive biomarkers. We conducted a human miRNome analysis by TaqMan Low Density Array comparing different TNBC subtypes, defined by immunohistochemical basal markers EGFR and CK5/6. RT-qPCR confirmed differential expression of microRNAs. To inspect the function of the selected targets we perform Gene Ontology and KEGG enrichment analysis. We identified a single miRNA signature given by miR-135b expression level, which was strictly related to TNBC with basal-like phenotype. miR-135b target analysis revealed a role in the TGF-beta, WNT and ERBB pathways. A significant positive correlation was identified between neoplastic proliferative index and miR-135b expression. These findings confirm the oncogenic roles of miR-135b in the pathogenesis of TNBC expressing basal markers. A potential negative prognostic role of miR-135b overexpression might be related to the positive correlation with high proliferative index. Our study implies potential clinical applications: miR-135b could be a potential therapeutic target in basal-like TNBCs.
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Affiliation(s)
- Paolo Uva
- CRS4, Science and Technology Park Polaris, Piscina Manna, 09010, Pula, Cagliari, Italy
| | - Paolo Cossu-Rocca
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.,Department of Diagnostic Services, Pathology Unit, "Giovanni Paolo II" Hospital, ASSL Olbia - ATS Sardegna, Via Bazzoni-Sircana, 07026, Olbia, Italy
| | - Federica Loi
- Osservatorio Epidemiologico Veterinario Regionale, Via XX Settembre 9, OEVR, 09125, Cagliari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, 07100,Viale San Pietro 43b, Sassari, Italy
| | - Luciano Murgia
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | - Sandra Orrù
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Via Jenner 1, 09121, Cagliari, Italy
| | - Matteo Floris
- CRS4, Science and Technology Park Polaris, Piscina Manna, 09010, Pula, Cagliari, Italy
| | - Maria Rosaria Muroni
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | - Francesca Sanges
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100,Viale San Pietro 43b, Sassari, Italy
| | - Andrea Angius
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Cittadella Universitaria di Cagliari, 09042, Monserrato (CA), Italy
| | - Maria Rosaria De Miglio
- Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
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Cossu-Rocca P, Muroni MR, Sanges F, Sotgiu G, Asunis A, Tanca L, Onnis D, Pira G, Manca A, Dore S, Uras MG, Ena S, De Miglio MR. EGFR kinase-dependent and kinase-independent roles in clear cell renal cell carcinoma. Am J Cancer Res 2015; 6:71-83. [PMID: 27073724 PMCID: PMC4759398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) is associated with progression of many epithelial malignancies and represents a significant therapeutic target. Although clear cell renal cell carcinoma (CCRCC) has been widely investigated for EGFR molecular alterations, genetic evidences of EGFR gene activating mutations and/or gene amplification have been rarely confirmed in the literature. Therefore, until now EGFR-targeted therapies in clinical trials have been demonstrated unsuccessful. New evidence has been given about the interactions between EGFR and the sodium glucose co-transporter-1 (SGLT1) in maintaining the glucose basal intracellular level to favour cancer cell growth and survival; thus a new functional role may be attributed to EGFR, regardless of its kinase activity. To define the role of EGFR in CCRCC an extensive investigation of genetic changes and functional kinase activities was performed in a series of tumors by analyzing the EGFR mutational status and expression profile, together with the protein expression of downstream signaling pathways members. Furthermore, we investigated the co-expression of EGFR and SGLT1 proteins and their relationships with clinic-pathological features in CCRCC. EGFR protein expression was identified in 98.4% of CCRCC. Furthermore, it was described for the first time that SGLT1 is overexpressed in CCRCC (80.9%), and that co-expression with EGFR is appreciable in 79.4% of the tumours. Moreover, the activation of downstream EGFR pathways was found in about 79.4% of SGLT1-positive CCRCCs. The mutational status analysis of EGFR failed to demonstrate mutations on exons 18 to 24 and the presence of EGFR-variantIII (EGFRvIII) in all CCRCCs analyzed. FISH analysis revealed absence of EGFR amplification, and high polysomy of chromosome 7. Finally, the EGFR gene expression profile showed gene overexpression in 38.2% of CCRCCs. Our study contributes to define the complexity of EGFR role in CCRCC, identifying its bivalent kinase-dependent and kinase-independent functions, both potentially involved in CCRCC progression. These results might have important implications on therapeutic approaches to CCRCC, since the disruption of the interaction between EGFR/SGLT1, mediated by anti-EGFR antibodies and/or SGLT1 inhibitors, might constitute a novel therapeutic target for CCRCC treatment, and new clinical trials should be evaluated on the basis of this therapeutic proposal.
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Affiliation(s)
- Paolo Cossu-Rocca
- Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
- Department of Diagnostic Services, Surgical Pathology Unit, “Giovanni Paolo II” Hospital, ASL OlbiaOlbia, Italy
| | - Maria R Muroni
- Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Francesca Sanges
- Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU SassariSassari, Italy
| | - Anna Asunis
- Department of Pathology, Azienda Ospedaliera BrotzuCagliari, Italy
| | - Luciana Tanca
- Department of Oncology, “A. Businco” Oncologic Hospital, ASL CagliariCagliari, Italy
| | - Daniela Onnis
- Department of Pathology, Azienda Ospedaliera BrotzuCagliari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of SassariSassari, Italy
| | | | - Simone Dore
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU SassariSassari, Italy
| | - Maria G Uras
- Department of Pathology, AOU SassariSassari, Italy
| | - Sara Ena
- Department of Biomedical Sciences, University of SassariSassari, Italy
| | - Maria R De Miglio
- Department of Clinical and Experimental Medicine, University of SassariSassari, Italy
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Cossu-Rocca P, Orrù S, Muroni MR, Sanges F, Sotgiu G, Ena S, Pira G, Murgia L, Manca A, Uras MG, Sarobba MG, Urru S, De Miglio MR. Analysis of PIK3CA Mutations and Activation Pathways in Triple Negative Breast Cancer. PLoS One 2015; 10:e0141763. [PMID: 26540293 PMCID: PMC4634768 DOI: 10.1371/journal.pone.0141763] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/12/2015] [Indexed: 12/19/2022] Open
Abstract
Background Triple Negative Breast Cancer (TNBC) accounts for 12–24% of all breast carcinomas, and shows worse prognosis compared to other breast cancer subtypes. Molecular studies demonstrated that TNBCs are a heterogeneous group of tumors with different clinical and pathologic features, prognosis, genetic-molecular alterations and treatment responsivity. The PI3K/AKT is a major pathway involved in the regulation of cell survival and proliferation, and is the most frequently altered pathway in breast cancer, apparently with different biologic impact on specific cancer subtypes. The most common genetic abnormality is represented by PIK3CA gene activating mutations, with an overall frequency of 20–40%. The aims of our study were to investigate PIK3CA gene mutations on a large series of TNBC, to perform a wider analysis on genetic alterations involving PI3K/AKT and BRAF/RAS/MAPK pathways and to correlate the results with clinical-pathologic data. Materials and Methods PIK3CA mutation analysis was performed by using cobas® PIK3CA Mutation Test. EGFR, AKT1, BRAF, and KRAS genes were analyzed by sequencing. Immunohistochemistry was carried out to identify PTEN loss and to investigate for PI3K/AKT pathways components. Results PIK3CA mutations were detected in 23.7% of TNBC, whereas no mutations were identified in EGFR, AKT1, BRAF, and KRAS genes. Moreover, we observed PTEN loss in 11.3% of tumors. Deregulation of PI3K/AKT pathways was revealed by consistent activation of pAKT and p-p44/42 MAPK in all PIK3CA mutated TNBC. Conclusions Our data shows that PIK3CA mutations and PI3K/AKT pathway activation are common events in TNBC. A deeper investigation on specific TNBC genomic abnormalities might be helpful in order to select patients who would benefit from current targeted therapy strategies.
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Affiliation(s)
- Paolo Cossu-Rocca
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
- * E-mail:
| | - Sandra Orrù
- Department of Pathology, “A. Businco” Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Maria Rosaria Muroni
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Francesca Sanges
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Sara Ena
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Luciano Murgia
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | | | | | - Silvana Urru
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
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Gandhi G, Allahbadia G, Kagalwala S, Allahbadia A, Ramesh S, Patel K, Hinduja R, Chipkar V, Madne M, Ramani R, Joo JK, Jeung JE, Go KR, Lee KS, Goto H, Hashimoto S, Amo A, Yamochi T, Iwata H, Morimoto Y, Koifman M, Lahav-Baratz S, Blais E, Megnazi-Wiener Z, Ishai D, Auslender R, Dirnfeld M, Zaletova V, Zakharova E, Krivokharchenko I, Zaletov S, Zhu L, Li Y, Zhang H, Ai J, Jin L, Zhang X, Rajan N, Kovacs A, Foley C, Flanagan J, O'Callaghan J, Waterstone J, Dineen T, Dahdouh EM, St-Michel P, Granger L, Carranza-Mamane B, Faruqi F, Kattygnarath TV, Gomes FLAF, Christoforidis N, Ioakimidou C, Papas C, Moisidou M, Chatziparasidou A, Klaver M, Tilleman K, De Sutter P, Lammers J, Freour T, Splingart C, Barriere P, Ikeno T, Nakajyo Y, Sato Y, Hirata K, Kyoya T, Kyono K, Campos FB, Meseguer M, Nogales M, Martinez E, Ariza M, Agudo D, Rodrigo L, Garcia-Velasco JA, Lopes AS, Frederickx V, Vankerkhoven G, Serneels A, Roziers P, Puttermans P, Campo R, Gordts S, Fragouli E, Alfarawati S, Spath K, Wells D, Liss J, Lukaszuk K, Glowacka J, Bruszczynska A, Gallego SC, Lopez LO, Vila EO, Garcia MG, Canas CL, Segovia AG, Ponce AG, Calonge RN, Peregrin PC, Hashimoto S, Amo A, Ito K, Nakaoka Y, Morimoto Y, Alcoba DD, Valerio EG, Conzatti M, Tornquist J, Kussler AP, Pimentel AM, Corleta HE, Brum IS, Boyer P, Montjean D, Tourame P, Gervoise-Boyer M, Cohen J, Lefevre B, Radio CI, Wolf JP, Ziyyat A, De Croo I, Tolpe A, Degheselle S, Van de Velde A, Tilleman K, De Sutter P, Van den Abbeel E, Kagalwala S, Gandhi G, Allahbadia G, Kuwayama M, Allahbadia A, Chipkar V, Khatoon A, Ramani R, Madne M, Alsule S, Inaba M, Ohgaki A, Ohtani A, Matsumoto H, Mizuno S, Mori R, Fukuda A, Morimoto Y, Umekawa Y, Yoshida A, Tanigiwa S, Seida K, Suzuki H, Tanaka M, Vahabi Z, Yazdi PE, Dalman A, Ebrahimi B, Mostafaei F, Niknam MR, Watanabe S, Kamihata M, Tanaka T, Matsunaga R, Yamanaka N, Kani C, Ishikawa T, Wada T, Morita H, Miyamura H, Nishio E, Ito M, Kuwahata A, Ochi M, Horiuchi T, Dal Canto M, Guglielmo MC, Fadini R, Renzini MM, Albertini DF, Novara P, Lain M, Brambillasca F, Turchi D, Sottocornola M, Coticchio G, Kato M, Fukunaga N, Nagai R, Kitasaka H, Yoshimura T, Tamura F, Hasegawa N, Nakayama K, Takeuchi M, Ohno H, Aoyagi N, Kojima E, Itoi F, Hashiba Y, Asada Y, Kikuchi H, Iwasa Y, Kamono T, Suzuki A, Yamada K, Kanno H, Sasaki K, Murakawa H, Matsubara M, Yoshida H, Valdespin C, Elhelaly M, Chen P, Pangestu M, Catt S, Hojnik N, Kovacic B, Roglic P, Taborin M, Zafosnik M, Knez J, Vlaisavljevic V, Mori C, Yabuuchi A, Ezoe K, Takayama Y, Aono F, Kato K, Radwan P, Krasinski R, Chorobik K, Radwan M, Stoppa M, Maggiulli R, Capalbo A, Ievoli E, Dovere L, Scarica C, Albricci L, Romano S, Sanges F, Barnocchi N, Papini L, Vivarelli A, Ubaldi FM, Rienzi L, Rienzi L, Bono S, Capalbo A, Spizzichino L, Rubio C, Ubaldi FM, Fiorentino F, Ferris J, Favetta LA, MacLusky N, King WA, Madani T, Jahangiri N, Aflatoonian R, Cater E, Hulme D, Berrisford K, Jenner L, Campbell A, Fishel S, Zhang XY, Yilmaz A, Hananel H, Ao A, Vutyavanich T, Piromlertamorn W, Saenganan U, Samchimchom S, Wirleitner B, Lejeune B, Zech NH, Vanderzwalmen P, Albani E, Parini V, Smeraldi A, Menduni F, Antonacci R, Marras A, Levi S, Morreale G, Pisano B, Di Biase A, Di Rosa A, Setti PEL, Puard V, Cadoret V, Tranchant T, Gauthier C, Reiter E, Guerif F, Royere D, Yoon SY, Eum JH, Park EA, Kim TY, Yoon TK, Lee DR, Lee WS, Cabal AC, Vallejo B, Campos P, Sanchez E, Serrano J, Remohi J, Nagornyy V, Mazur P, Mykytenko D, Semeniuk L, Zukin V, Guilherme P, Madaschi C, Bonetti TCS, Fassolas G, Izzo CR, Santos MJDL, Beltran D, Garcia-Laez V, Escriba MJ, Grau N, Escrich L, Albert C, Zuzuarregui JL, Pellicer A, LU Y, Nikiforaki D, Meerschaut FV, Neupane J, De Vos WH, Lierman S, Deroo T, Heindryckx B, De Sutter P, Li J, Chen XY, Lin G, Huang GN, Sun ZY, Zhong Y, Zhang B, Li T, Zhang SP, Ye H, Han SB, Liu SY, Zhou J, Lu GX, Zhuang GL, Muela L, Roldan M, Gadea B, Martinez M, Perez I, Meseguer M, Munoz M, Castello C, Asensio M, Fernandez P, Farreras A, Rovira S, Capdevila JM, Velilla E, Lopez-Teijon M, Kovacs P, Matyas SZ, Forgacs V, Reichart A, Rarosi F, Bernard A, Torok A, Kaali SG, Sajgo A, Pribenszky CS, Sozen B, Ozturk S, Yaba-Ucar A, Demir N, Gelo N, Stanic P, Hlavati V, ogoric S, Pavicic-Baldani D, prem-Goldtajn M, Radakovic B, Kasum M, Strelec M, Canic T, imunic V, Vrcic H, Ajina M, Negra D, Ben-Ali H, Jallad S, Zidi I, Meddeb S, Bibi M, Khairi H, Saad A, Escrich L, Grau N, Meseguer M, Gamiz P, Viloria T, Escriba MJ, Lima ET, Fernandez MP, Prieto JAA, Varela MO, Kassa D, Munoz EM, Morita H, Watanabe S, Kamihata M, Matsunaga R, Wada T, Kani K, Ishikawa T, Miyamura H, Ito M, Kuwahata A, Ochi M, Horiuchi T, Nor-Ashikin MNK, Norhazlin JMY, Norita S, Wan-Hafizah WJ, Mohd-Fazirul M, Razif D, Hoh BP, Dale S, Cater E, Woodhead G, Jenner L, Fishel S, Andronikou S, Francis G, Tailor S, Vourliotis M, Almeida PA, Krivega M, Van de Velde H, Lee RK, Hwu YM, Lu CH, Li SH, Vaiarelli A, Antonacci R, Smeraldi A, Desgro M, Albani E, Baggiani A, Zannoni E, Setti PEL, Kermavner LB, Klun IV, Pinter B, Vrtacnik-Bokal E, De Paepe C, Cauffman G, Verheyen G, Stoop D, Liebaers I, Van de Velde H, Stecher A, Wirleitner B, Vanderzwalmen P, Zintz M, Neyer A, Bach M, Baramsai B, Schwerda D, Zech NH, Wiener-Megnazi Z, Fridman M, Koifman M, Lahav-Baratz S, Blais I, Auslender R, Dirnfeld M, Akerud H, Lindgren K, Karehed K, Wanggren K, Hreinsson J, Rovira S, Capdevila JM, Freijomil B, Castello C, Farreras A, Fernandez P, Asensio M, Lopez-Teijon M, Velilla E, Weiss A, Neril R, Geslevich J, Beck-Fruchter R, Lavee M, Golan J, Ermoshkin A, Shalev E, Shi W, Zhang S, Zhao W, Xue XIA, Wang MIN, Bai H, Shi J, Smith HL, Shaw L, Kimber S, Brison D, Boumela I, Assou S, Haouzi D, Ahmed OA, Dechaud H, Hamamah S, Dasiman R, Nor-Shahida AR, Wan-Hafizah WJ, Norhazlin JMY, Mohd-Fazirul M, Salina O, Gabriele RAF, Nor-Ashikin MNK, Ben-Yosef D, Shwartz T, Cohen T, Carmon A, Raz NM, Malcov M, Frumkin T, Almog B, Vagman I, Kapustiansky R, Reches A, Azem F, Amit A, Cetinkaya M, Pirkevi C, Yelke H, Kumtepe Y, Atayurt Z, Kahraman S, Risco R, Hebles M, Saa AM, Vilches-Ferron MA, Sanchez-Martin P, Lucena E, Lucena M, Heras MDL, Agirregoikoa JA, Martinez E, Barrenetxea G, De Pablo JL, Lehner A, Pribenszky C, Murber A, Rigo J, Urbancsek J, Fancsovits P, Bano DG, Sanchez-Leon A, Marcos J, Molla M, Amorocho B, Nicolas M, Fernandez L, Landeras J, Adeniyi OA, Ehbish SM, Brison DR, Egashira A, Murakami M, Nagafuchi E, Tanaka K, Tomohara A, Mine C, Otsubo H, Nakashima A, Otsuka M, Yoshioka N, Kuramoto T, Choi D, Yang H, Park JH, Jung JH, Hwang HG, Lee JH, Lee JE, Kang AS, Yoo JH, Kwon HC, Lee SJ, Bang S, Shin H, Lim HJ, Min SH, Yeon JY, Koo DB, Kuwayama M, Higo S, Ruvalcaba L, Kobayashi M, Takeuchi T, Yoshida A, Miwa A, Nagai Y, Momma Y, Takahashi K, Chuko M, Nagai A, Otsuki J, Kim SG, Lee JH, Kim YY, Kim HJ, Park IH, Sun HG, Lee KH, Song HJ, Costa-Borges N, Belles M, Herreros J, Teruel J, Ballesteros A, Pellicer A, Calderon G, Nikiforaki D, Vossaert L, Meerschaut FV, Qian C, Lu Y, Parys JB, De Vos WH, Deforce D, Deroo T, Van den Abbeel E, Leybaert L, Heindryckx B, De Sutter P, Surlan L, Otasevic V, Velickovic K, Golic I, Vucetic M, Stankovic V, Stojnic J, Radunovic N, Tulic I, Korac B, Korac A, Fancsovits P, Pribenszky C, Lehner A, Murber A, Rigo J, Urbancsek J, Elias R, Neri QV, Fields T, Schlegel PN, Rosenwaks Z, Palermo GD, Gilson A, Piront N, Heens B, Vastersaegher C, Vansteenbrugge A, Pauwels PCP, Abdel-Raheem MF, Abdel-Rahman MY, Abdel-Gaffar HM, Sabry M, Kasem H, Rasheed SM, Amin M, Abdelmonem A, Ait-Allah AS, VerMilyea M, Anthony J, Bucci J, Croly S, Coutifaris C, Maggiulli R, Rienzi L, Cimadomo D, Capalbo A, Dusi L, Colamaria S, Baroni E, Giuliani M, Vaiarelli A, Sapienza F, Buffo L, Ubaldi FM, Zivi E, Aizenman E, Barash D, Gibson D, Shufaro Y, Perez M, Aguilar J, Taboas E, Ojeda M, Suarez L, Munoz E, Casciani V, Minasi MG, Scarselli F, Terribile M, Zavaglia D, Colasante A, Franco G, Greco E, Hickman C, Cook C, Gwinnett D, Trew G, Carby A, Lavery S, Asgari L, Paouneskou D, Jayaprakasan K, Maalouf W, Campbell BK, Aguilar J, Taboas E, Perez M, Munoz E, Ojeda M, Remohi J, Rega E, Alteri A, Cotarelo RP, Rubino P, Colicchia A, Giannini P, Devjak R, Papler TB, Tacer KF, Verdenik I, Scarica C, Ubaldi FM, Stoppa M, Maggiulli R, Capalbo A, Ievoli E, Dovere L, Albricci L, Romano S, Sanges F, Vaiarelli A, Iussig B, Gala A, Ferrieres A, Assou S, Vincens C, Bringer-Deutsch S, Brunet C, Hamamah S, Conaghan J, Tan L, Gvakharia M, Ivani K, Chen A, Pera RR, Bowman N, Montgomery S, Best L, Campbell A, Duffy S, Fishel S, Hirata R, Aoi Y, Habara T, Hayashi N, Dinopoulou V, Partsinevelos GA, Bletsa R, Mavrogianni D, Anagnostou E, Stefanidis K, Drakakis P, Loutradis D, Hernandez J, Leon CL, Puopolo M, Palumbo A, Atig F, Kerkeni A, Saad A, Ajina M, D'Ommar G, Herrera AK, Lozano L, Majerfeld M, Ye Z, Zaninovic N, Clarke R, Bodine R, Rosenwaks Z, Mazur P, Nagorny V, Mykytenko D, Semeniuk L, Zukin V, Zabala A, Pessino T, Outeda S, Blanco L, Leocata F, Asch R, Wan-Hafizah WJ, Rajikin MH, Nuraliza AS, Mohd-Fazirul M, Norhazlin JMY, Razif D, Nor-Ashikin MNK, Machac S, Hubinka V, Larman M, Koudelka M, Budak TP, Membrado OO, Martinez ES, Wilson P, McClure A, Nargund G, Raso D, Insua MF, Lotti B, Giordana S, Baldi C, Barattini J, Cogorno M, Peri NF, Neuspiller F, Resta S, Filannino A, Maggi E, Cafueri G, Ferraretti AP, Magli MC, Gianaroli L, Sioga A, Oikonomou Z, Chatzimeletiou K, Oikonomou L, Kolibianakis E, Tarlatzis BC, Sarkar MR, Ray D, Bhattacharya J, Alises JM, Gumbao D, Sanchez-Leon A, Amorocho B, Molla M, Nicolas M, Fernandez L, Landeras J, Duffy S, Campbell A, Montgomery S, Hickman CFL, Fishel S, Fiorentino I, Gualtieri R, Barbato V, Braun S, Mollo V, Netti P, Talevi R, Bayram A, Findikli N, Serdarogullari M, Sahin O, Ulug U, Tosun SB, Bahceci M, Leon AS, Gumbao D, Marcos J, Molla M, Amorocho B, Nicolas M, Fernandez L, Landeras J, Cardoso MCA, Aguiar APS, Sartorio C, Evangelista A, Gallo-Sa P, Erthal-Martins MC, Mantikou E, Jonker MJ, de Jong M, Wong KM, van Montfoort APA, Breit TM, Repping S, Mastenbroek S, Power E, Montgomery S, Duffy S, Jordan K, Campbell A, Fishel S, Findikli N, Aksoy T, Gultomruk M, Aktan A, Goktas C, Ulug U, Bahceci M, Petracco R, Okada L, Azambuja R, Badalotti F, Michelon J, Reig V, Kvitko D, Tagliani-Ribeiro A, Badalotti M, Petracco A, Pirkevi C, Cetinkaya M, Yelke H, Kumtepe Y, Atayurt Z, Kahraman S, Aydin B, Cepni I, Serdarogullari M, Findikli N, Bayram A, Goktas C, Sahin O, Ulug U, Bahceci M, Rodriguez-Arnedo D, Ten J, Guerrero J, Ochando I, Perez M, Bernabeu R, Okada L, Petracco R, Azambuja R, Badalotti F, Michelon J, Reig V, Tagliani-Ribeiro A, Kvitko D, Badalotti M, Petracco A, Reig V, Kvitko D, Tagliani-Ribeiro A, Okada L, Azambuja R, Petracco R, Michelon J, Badalotti F, Petracco A, Badalotti M. Embryology. Hum Reprod 2013. [DOI: 10.1093/humrep/det210] [Citation(s) in RCA: 7] [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] [Indexed: 11/12/2022] Open
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Thornhill A, Dibouni ZA, Shah T, Wheat S, Teitelbaum M, Walker M, Bissonette F, Yuzpe AL, Leveille MC, Gysler M, Johnson M, Sprague A, Villena JG, Aparicio JL, Gimenez J, Ten J, Perez RB, Scholten I, Chambers GM, van Loendersloot L, van der Veen F, Repping S, Gianotten J, Hompes PGA, Ledger W, Mol BWJ, Dior UP, Laufer N, Granovsky-Grisaru S, Yagel S, Yaffe H, Gielchinsky Y, Nelen WLDM, Huppelschoten AG, Verkerk EW, Adang EMM, Kremer JAM, Davies M, Rumbold A, Marino J, Willson K, Moore V, Giles L, Shebl O, Ebner T, Tews G, Haas D, Oppelt P, Mayer RB, Sanges F, Maggiulli R, Albricci L, Romano S, Scarica C, Schimberni M, Giallonardo A, Vettraino G, Ubaldi F, Rienzi L, Figueira RCS, Braga DPAF, Setti AS, Iaconelli A, Borges E, Obrado EC, Barredo DR, Navarro LL, Rodriguez AV, Rague PNB, Lletget BC, Padro RT, Oron G, Sokal-Arnon T, Zeadna A, Son WY, Holzer H, Tulandi T, Nakamura Y, Hattori H, Sato Y, Kuchiki M, Sakamoto E, Doshida M, Toya M, Kyono K, Nakajo Y, Nakamura Y, Hirata K, Doshida M, Toya M, Kyono K, Xin ZM, Zhu H, Sun YP, Jin HX, Song WY, Rodriguez A, Poisot F, Rodriguez F, Coll O, Vassena R, Vernaeve V, Ye Y, Wang L, Wang N, Le F, Jin F, Zheng Y, Jin F, Lou Y, Le F, Pan PP, Wang N, Wang LY, Hu CX, Liu SY, Zheng YM, Li LJ, Liu XZ, Xu XR, Huang HF, Jin F, Lin SL, Li M, Lian Y, Chen LX, Liu P, Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ. Quality and safety of ART therapies. Hum Reprod 2013. [DOI: 10.1093/humrep/det219] [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: 11/13/2022] Open
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