1
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Bernieh A, Bove K, Garcia V, Tiao G, Lazar L, Sathe M, Sanchez J, Gonzalez R, Gonzalez-Gomez I. Intrahepatic Cholangiolitis in Cystic Fibrosis (ICCF): An Under-Appreciated Cause of Persistent Cholestasis in Infancy. Pediatr Dev Pathol 2024; 27:13-22. [PMID: 37801635 DOI: 10.1177/10935266231201935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Liver histology in infants with cystic fibrosis (CF) and persistent cholestasis is seldom reported in detail. We extend previous observation of a distinctive intrahepatic cholangiopathy (ICCF) to 3 additional infants homozygous for CFTR pathological variants and a fourth infant with a heterozygous CFTR variant, summarizing our experience in 10 infants with CFTR variants and persistent cholestasis. Cholangiograms demonstrate abnormal extrahepatic ducts in 2 infants with CF, 1 with uniform dilatation interpreted as a choledochal cyst and the other with narrow patent ducts. Liver histology in 3 CF homozygotes had prominent ductular reaction with a focally destructive cholangiolitis (inflammation of small bile ducts). The CFTR heterozygote had generalized portal edema with ductular reaction and paucity but no cholangitis. Cholestasis slowly subsided in all infants. ICCF is characterized by severe ductular reaction, prominent cholangiocyte injury, and multifocal necrotizing cholangiolitis. Local aggregates of portal ceroid might suggest previous bile leakage from damaged ducts. ICCF in liver biopsies from infants with cystic fibrosis and persistent cholestasis is unrelated to the specific CFTR genotype. Liver biopsy findings and intraoperative cholangiogram help rule out biliary atresia. ICCF is an early manifestation of CF, a likely prototype for pathogenesis of cystic fibrosis liver disease later in life.
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Affiliation(s)
- Anas Bernieh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin Bove
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Victor Garcia
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Lazar
- University of Texas Southwestern, Dallas, TX, USA
| | | | | | - Raquel Gonzalez
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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2
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Yuan M, Mahmud I, Katsushima K, Joshi K, Saulnier O, Pokhrel R, Lee B, Liyanage W, Kunhiraman H, Stapleton S, Gonzalez-Gomez I, Kannan RM, Eisemann T, Kolanthai E, Seal S, Garrett TJ, Abbasi S, Bockley K, Hanes J, Chapagain P, Jallo G, Wechsler-Reya RJ, Taylor MD, Eberhart CG, Ray A, Perera RJ. miRNA-211 maintains metabolic homeostasis in medulloblastoma through its target gene long-chain acyl-CoA synthetase 4. Acta Neuropathol Commun 2023; 11:203. [PMID: 38115140 PMCID: PMC10729563 DOI: 10.1186/s40478-023-01684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
The prognosis of childhood medulloblastoma (MB) is often poor, and it usually requires aggressive therapy that adversely affects quality of life. microRNA-211 (miR-211) was previously identified as an important regulator of cells that descend from neural cells. Since medulloblastomas primarily affect cells with similar ontogeny, we investigated the role and mechanism of miR-211 in MB. Here we showed that miR-211 expression was highly downregulated in cell lines, PDXs, and clinical samples of different MB subgroups (SHH, Group 3, and Group 4) compared to normal cerebellum. miR-211 gene was ectopically expressed in transgenic cells from MB subgroups, and they were subjected to molecular and phenotypic investigations. Monoclonal cells stably expressing miR-211 were injected into the mouse cerebellum. miR-211 forced expression acts as a tumor suppressor in MB both in vitro and in vivo, attenuating growth, promoting apoptosis, and inhibiting invasion. In support of emerging regulatory roles of metabolism in various forms of cancer, we identified the acyl-CoA synthetase long-chain family member (ACSL4) as a direct miR-211 target. Furthermore, lipid nanoparticle-coated, dendrimer-coated, and cerium oxide-coated miR-211 nanoparticles were applied to deliver synthetic miR-211 into MB cell lines and cellular responses were assayed. Synthesizing nanoparticle-miR-211 conjugates can suppress MB cell viability and invasion in vitro. Our findings reveal miR-211 as a tumor suppressor and a potential therapeutic agent in MB. This proof-of-concept paves the way for further pre-clinical and clinical development.
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Affiliation(s)
- Menglang Yuan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Iqbal Mahmud
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Kandarp Joshi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Olivier Saulnier
- The Arthur and Sonia Labatt Brain Tumour Research Centre and the Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rudramani Pokhrel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Wathsala Liyanage
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Haritha Kunhiraman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Stacie Stapleton
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Ignacio Gonzalez-Gomez
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Tanja Eisemann
- National Cancer Institute-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
| | - Elayaraja Kolanthai
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL, 32826, USA
| | - Sudipta Seal
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center, Materials Science and Engineering, College of Medicine, University of Central Florida, Orlando, FL, 32826, USA
| | - Timothy J Garrett
- Department Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Saed Abbasi
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Kimberly Bockley
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Justin Hanes
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Prem Chapagain
- Department of Physics, Florida International University, Miami, FL, 33199, USA
| | - George Jallo
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA
| | - Robert J Wechsler-Reya
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre and the Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
- Texas Children's Cancer Center, Hematology-Oncology Section, Houston, TX, 77030, USA
- Department of Pediatrics-Hematology/Oncology and Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Animesh Ray
- Riggs School of Applied Life Sciences, Keck Graduate Institute, Claremont, CA, 91711, USA
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, 1650 Orleans St., Baltimore, MD, 21231, USA.
- Johns Hopkins All Children's Hospital, 600 5th St. South, St. Petersburg, FL, 33701, USA.
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Reynolds RA, Aum DJ, Gonzalez-Gomez I, Wong M, Roberts K, Dahiya S, Rodriguez LF, Roland JL, Smyth MD. Subependymal giant-cell astrocytomas in the absence of tuberous sclerosis. J Neurosurg Pediatr 2023; 32:351-357. [PMID: 37327147 DOI: 10.3171/2023.5.peds23108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Tuberous sclerosis is a rare genetic condition caused by TSC1 or TSC2 mutations that can be inherited, sporadic, or the result of somatic mosaicism. Subependymal giant-cell astrocytoma (SEGA) is a major diagnostic feature of tuberous sclerosis complex (TSC). This study aimed to present a series of cases in which a pathological diagnosis of SEGA was not diagnostic of tuberous sclerosis. METHODS The authors retrospectively reviewed a clinical case series of 5 children who presented with a SEGA tumor to Johns Hopkins All Children's Hospital and St. Louis Children's Hospital between 2010 and 2022 and whose initial genetic workup was negative for tuberous sclerosis. All patients were treated with craniotomy for SEGA resection. TSC genetic testing was performed on all SEGA specimens. RESULTS The children underwent open frontal craniotomy for SEGA resection from the ages of 10 months to 14 years. All cases demonstrated the classic imaging features of SEGA. Four were centered at the foramen of Monro and 1 in the occipital horn. One patient presented with hydrocephalus, 1 with headaches, 1 with hand weakness, 1 with seizures, and 1 with tumor hemorrhage. Somatic TSC1 mutation was present in the SEGA tumors of 2 patients and TSC2 mutation in 1 patient. Germline TSC mutation testing was negative for all 5 cases. No patient had other systemic findings of tuberous sclerosis on ophthalmological, dermatological, neurological, renal, or cardiopulmonary assessments and thus did not meet the clinical criteria for tuberous sclerosis. The average follow-up was 6.7 years. Recurrence was noted in 2 cases, in which 1 patient underwent radiosurgery and 1 was started on a mammalian target of rapamycin (mTOR) inhibitor (rapamycin). CONCLUSIONS There may be intracranial implications of somatic mosaicism associated with tuberous sclerosis. Children who are diagnosed with SEGA do not necessarily have a diagnosis of tuberous sclerosis. Tumors may carry a TSC1 or TSC2 mutation, but germline testing can be negative. These children should continue to be followed with serial cranial imaging for tumor progression, but they may not require the same long-term monitoring as patients who are diagnosed with germline TSC1 or TSC2 mutations.
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Affiliation(s)
- Rebecca A Reynolds
- 1Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Ignacio Gonzalez-Gomez
- 3Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Kaleigh Roberts
- 5Pathology, Washington University in St. Louis, St. Louis, Missouri; and
| | - Sonika Dahiya
- 5Pathology, Washington University in St. Louis, St. Louis, Missouri; and
| | - Luis F Rodriguez
- 1Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Matthew D Smyth
- 1Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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4
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Kiskaddon AL, Wilsey M, Gonzalez-Gomez I, Laks J, Miles A, Carapellucci J, Asante-Korang A. Basiliximab therapy for immune-mediated bowel disease in a pediatric heart transplant patient. Pediatr Transplant 2023; 27:e14443. [PMID: 36419214 DOI: 10.1111/petr.14443] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/17/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
In pediatric patients who undergo heart transplantation, severe immune-mediated bowel disease has been reported. Management is complex, and there are little data discussing the use of basiliximab for immune-mediated bowel disease. This case report discusses a pediatric patient who developed immune-mediated bowel disease following heart transplantation and was successfully managed with basiliximab.
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Affiliation(s)
- Amy L Kiskaddon
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Balitmore, Marlyand, USA
| | - Michael Wilsey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Ignacio Gonzalez-Gomez
- Division of Pathology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jessica Laks
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Alyssa Miles
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | | | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Balitmore, Marlyand, USA.,Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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5
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Gordon C, Quintana J, Gonzalez-Gomez I. NIMG-95. IMAGING CHARACTERISTICS OF POLYMORPHOUS LOW GRADE NEUROEPITHELIAL TUMOR (PLNTY). Neuro Oncol 2022. [PMCID: PMC9660706 DOI: 10.1093/neuonc/noac209.713] [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: 11/16/2022] Open
Abstract
Abstract
Polymorphous low grade neuroepithelial tumor of the young (PLNTY) was first described in 2017 in the pathology literature based on the unique histologic and molecular characteristics. Most of the patients in the original article presented with seizures linked to a temporal lobe lesion. We report a pediatric patient who presented with seizures found to have a lesion which was consistent with PLNTY on biopsy. We will review the radiology and pathology of this case with a quick review of the characteristic findings of PLNTY.
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Affiliation(s)
| | - Javier Quintana
- Johns Hopkins All Children's Hospital , St. Petersburg, FL , USA
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6
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Dey A, Peck J, Wilsey M, Walter J, Nguyen J, Gonzalez-Gomez I, Karjoo S. The Evolution of Very Early Onset Inflammatory Bowel Disease, Autoimmune Hepatitis, and Primary Sclerosing Cholangitis in a Young Girl. Case Rep Gastroenterol 2021; 15:939-947. [PMID: 34949979 PMCID: PMC8647121 DOI: 10.1159/000520184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Very early onset inflammatory bowel disease, autoimmune hepatitis (AIH), or primary sclerosing cholangitis (PSC) alone is a rare condition in young children. The combination of all 3 autoimmune disorders in a 16-month-old child is even rarer. The onset and etiology of these diseases is multifactorial and typically unknown. However, when the children are diagnosed, the accepted view point is that the inflammation was likely present for months to years prior. This case is unique because the gastrointestinal problems started from infancy, and evolved to the development of Crohn’s disease, AIH, and PSC at a very early age. This case helps bring to light that very early onset autoimmune disorders may in fact present with symptoms of feeding difficulties, growth failure, and formula intolerance. Patients may be diagnosed initially with allergic enterocolitis in infancy. Although few children with these symptoms evolve to develop autoimmune diseases at an older age, clinicians should consider following these children more closely. This case also demonstrates how hard it is to diagnose very early onset autoimmune disorders, as they mimic other illnesses.
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Affiliation(s)
- Aditi Dey
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jacquelin Peck
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Michael Wilsey
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jolan Walter
- Department of Internal Medicine, Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Johnny Nguyen
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ignacio Gonzalez-Gomez
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sara Karjoo
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Clinical Sciences, Florida State University, Tallahassee, Florida, USA
- *Sara Karjoo,
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7
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Katsushima K, Lee B, Kunhiraman H, Zhong C, Murad R, Yin J, Liu B, Garancher A, Gonzalez-Gomez I, Monforte HL, Stapleton S, Vibhakar R, Bettegowda C, Wechsler-Reya RJ, Jallo G, Raabe E, Eberhart CG, Perera RJ. The long noncoding RNA lnc-HLX-2-7 is oncogenic in Group 3 medulloblastomas. Neuro Oncol 2021; 23:572-585. [PMID: 33844835 DOI: 10.1093/neuonc/noaa235] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 02/06/2023] Open
Abstract
BACKGROUND Medulloblastoma (MB) is an aggressive brain tumor that predominantly affects children. Recent high-throughput sequencing studies suggest that the noncoding RNA genome, in particular long noncoding RNAs (lncRNAs), contributes to MB subgrouping. Here we report the identification of a novel lncRNA, lnc-HLX-2-7, as a potential molecular marker and therapeutic target in Group 3 MBs. METHODS Publicly available RNA sequencing (RNA-seq) data from 175 MB patients were interrogated to identify lncRNAs that differentiate between MB subgroups. After characterizing a subset of differentially expressed lncRNAs in vitro and in vivo, lnc-HLX-2-7 was deleted by CRISPR/Cas9 in the MB cell line. Intracranial injected tumors were further characterized by bulk and single-cell RNA-seq. RESULTS Lnc-HLX-2-7 is highly upregulated in Group 3 MB cell lines, patient-derived xenografts, and primary MBs compared with other MB subgroups as assessed by quantitative real-time, RNA-seq, and RNA fluorescence in situ hybridization. Depletion of lnc-HLX-2-7 significantly reduced cell proliferation and 3D colony formation and induced apoptosis. Lnc-HLX-2-7-deleted cells injected into mouse cerebellums produced smaller tumors than those derived from parental cells. Pathway analysis revealed that lnc-HLX-2-7 modulated oxidative phosphorylation, mitochondrial dysfunction, and sirtuin signaling pathways. The MYC oncogene regulated lnc-HLX-2-7, and the small-molecule bromodomain and extraterminal domain family‒bromodomain 4 inhibitor Jun Qi 1 (JQ1) reduced lnc-HLX-2-7 expression. CONCLUSIONS Lnc-HLX-2-7 is oncogenic in MB and represents a promising novel molecular marker and a potential therapeutic target in Group 3 MBs.
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Affiliation(s)
- Keisuke Katsushima
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Bongyong Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Haritha Kunhiraman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Cuncong Zhong
- University of Kansas, Department of Electrical Engineering and Computer Science, Lawrence, Kansas
| | - Rabi Murad
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Jun Yin
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Ben Liu
- University of Kansas, Department of Electrical Engineering and Computer Science, Lawrence, Kansas
| | | | | | | | | | - Rajeev Vibhakar
- University of Colorado School of Medicine Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado
| | - Chetan Bettegowda
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - George Jallo
- Johns Hopkins All Children's Hospital, Petersburg, Florida
| | - Eric Raabe
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles G Eberhart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranjan J Perera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins All Children's Hospital, Petersburg, Florida.,Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
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8
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Affiliation(s)
| | | | - Michael Wilsey
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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9
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Lukas C, Crenshaw M, Gonzalez-Gomez I, Potthast J, Shimony N, Jallo G, Stapleton S. MBCL-46. COMPOUND HETEROZYGOUS MUTATION OF THE PMS2 GENE IN AN INFANT WITH CONSTITUTIONAL MISMATCH REPAIR DEFICIENCY AND MEDULLOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia Lukas
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | | | | | - Joseph Potthast
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Nir Shimony
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - George Jallo
- Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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10
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De Oliveira SN, Gonzalez-Gomez I, Panigrahy A, Krieger M, McComb G, Finlay JL, Dhall G. False-positive magnetic resonance imaging findings in follow-up of pediatric patients with tumors of the central nervous system. SAGE Open Med Case Rep 2016; 4:2050313X16666232. [PMID: 27621807 PMCID: PMC5006300 DOI: 10.1177/2050313x16666232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 12/28/2022] Open
Abstract
Management of patients with central nervous system tumors relies largely on magnetic resonance imaging scans to document disease progression or recurrence. The finding of new lesions always presents the challenge of differentiating between post-surgical changes, radiation necrosis, gliosis, and tumor, submitting these patients to more aggressive therapy and more toxicity. We reviewed the medical records of three patients with primary central nervous system tumors treated at the Children’s Hospital Los Angeles who had new false-positive magnetic resonance imaging findings suggestive of tumor recurrence. All of them had complete total resection of primary tumor, had received involved-field radiation therapy, had biopsies confirming absence of viable tumor, and all three patients are long-term survivors. These cases exemplify that not everything that enhances on brain or spine magnetic resonance imaging is viable tumor, and a biopsy should always be considered in the decision-making process in evaluation of potentially recurrent central nervous system tumors in pediatric patients. A step-wise approach for such challenging cases is presented in this article.
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Affiliation(s)
| | | | - Ashok Panigrahy
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Mark Krieger
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Gordon McComb
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Girish Dhall
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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11
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Shackleford GM, Shi XH, Swanson KS, Mahdi MY, Gonzalez-Gomez I, Asgharzadeh S, D’Apuzzo M, Erdreich-Epstein A, Moats RA. BarTeL, a Genetically Versatile, Bioluminescent and Granule Neuron Precursor-Targeted Mouse Model for Medulloblastoma. PLoS One 2016; 11:e0156907. [PMID: 27310018 PMCID: PMC4911170 DOI: 10.1371/journal.pone.0156907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/20/2016] [Indexed: 01/08/2023] Open
Abstract
Medulloblastomas are the most common malignant pediatric brain tumor and have been divided into four major molecular subgroups. Animal models that mimic the principal molecular aberrations of these subgroups will be important tools for preclinical studies and allow greater understanding of medulloblastoma biology. We report a new transgenic model of medulloblastoma that possesses a unique combination of desirable characteristics including, among others, the ability to incorporate multiple and variable genes of choice and to produce bioluminescent tumors from a limited number of somatic cells within a normal cellular environment. This model, termed BarTeL, utilizes a Barhl1 homeobox gene promoter to target expression of a bicistronic transgene encoding both the avian retroviral receptor TVA and an eGFP-Luciferase fusion protein to neonatal cerebellar granule neuron precursor (cGNP) cells, which are cells of origin for the sonic hedgehog (SHH) subgroup of human medulloblastomas. The Barhl1 promoter-driven transgene is expressed strongly in mammalian cGNPs and weakly or not at all in mature granule neurons. We efficiently induced bioluminescent medulloblastomas expressing eGFP-luciferase in BarTeL mice by infection of a limited number of somatic cGNPs with avian retroviral vectors encoding the active N-terminal fragment of SHH and a stabilized MYCN mutant. Detection and quantification of the increasing bioluminescence of growing tumors in young BarTeL mice was facilitated by the declining bioluminescence of their uninfected maturing cGNPs. Inclusion of eGFP in the transgene allowed enriched sorting of cGNPs from neonatal cerebella. Use of a single bicistronic avian vector simultaneously expressing both Shh and Mycn oncogenes increased the medulloblastoma incidence and aggressiveness compared to mixed virus infections. Bioluminescent tumors could also be produced by ex vivo transduction of neonatal BarTeL cerebellar cells by avian retroviruses and subsequent implantation into nontransgenic cerebella. Thus, BarTeL mice provide a versatile model with opportunities for use in medulloblastoma biology and therapeutics.
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Affiliation(s)
- Gregory M. Shackleford
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Xiang-He Shi
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Kimberly S. Swanson
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Min Y. Mahdi
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Ignacio Gonzalez-Gomez
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Shahab Asgharzadeh
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Massimo D’Apuzzo
- Department of Pathology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Anat Erdreich-Epstein
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Rex A. Moats
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
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Shiroishi MS, Panigrahy A, Moore KR, Nelson MD, Gilles FH, Gonzalez-Gomez I, Blüml S. Combined MRI and MRS improves pre-therapeutic diagnoses of pediatric brain tumors over MRI alone. Neuroradiology 2015; 57:951-6. [PMID: 26141852 DOI: 10.1007/s00234-015-1553-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The specific goal of this study was to determine whether the inclusion of MRS had a measureable and positive impact on the accuracy of pre-surgical MR examinations of untreated pediatric brain tumors over that of MRI alone in clinical practice. METHODS Final imaging reports of 120 pediatric patients with newly detected brain tumors who underwent combined MRI/MRS examinations were retrospectively reviewed. Final pathology was available in all cases. Group A comprised 60 subjects studied between June 2001 and January 2005, when MRS was considered exploratory and radiologists utilized only conventional MRI to arrive at a diagnosis. For group B, comprising 60 subjects studied between January 2005 and March 2008, the radiologists utilized information from both MRI and MRS. Furthermore, radiologists revisited group A (blind review, time lapse >4 years) to determine whether the additional information from MRS would have altered their interpretation. RESULTS Sixty-three percent of patients in group A were diagnosed correctly, whereas in 10% the report was partially correct with the final tumor type mentioned (but not mentioned as most likely tumor), while in 27% of cases the reports were wrong. For group B, the diagnoses were correct in 87%, partially correct in 5%, and incorrect in 8% of the cases, which is a significant improvement (p < 0.005). Re-review of combined MRI and MRS of group A resulted 87% correct, 7% partially correct, and 7% incorrect diagnoses, which is a significant improvement over the original diagnoses (p < 0.05). CONCLUSION Adding MRS to conventional MRI significantly improved diagnostic accuracy in preoperative pediatric patients with untreated brain tumors.
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Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin R Moore
- Department of Radiology, Primary Children's Medical Center, Salt Lake City, UT, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Floyd H Gilles
- Department of Pathology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
- Rudi Schulte Research Institute, Santa Barbara, CA, USA.
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Brognaro E, Chang S, Cha J, Choi K, Choi C, DePetro J, Binding C, Blough M, Kelly J, Lawn S, Chan J, Weiss S, Cairncross G, Eisenbeis A, Goldbrunner R, Timmer M, Gabrusiewicz K, Cortes-Santiago N, Fan X, Hossain MB, Kaminska B, Heimberger A, Rao G, Yung WKA, Marini F, Fueyo J, Gomez-Manzano C, Halle B, Marcusson E, Aaberg-Jessen C, Jensen SS, Meyer M, Schulz MK, Andersen C, Bjarne, Kristensen W, Hashizume R, Ihara Y, Ozawa T, Parsa A, Clarke J, Butowski N, Prados M, Perry A, McDermott M, James D, Jensen R, Gillespie D, Martens T, Zamykal M, Westphal M, Lamszus K, Monsalves E, Jalali S, Tateno T, Ezzat S, Zadeh G, Nedergaard MK, Kristoffersen K, Poulsen HS, Stockhausen MT, Lassen U, Kjaer A, Ohka F, Natsume A, Zong H, Liu C, Hatanaka A, Katsushima K, Shinjo K, Wakabayashi T, Kondo Y, Picotte K, Li L, Westerhuis B, Zhao H, Plotkin S, James M, Kalamarides M, Zhao WN, Kim J, Stemmer-Rachamimov A, Haggarty S, Gusella J, Ramesh V, Nunes F, Rao G, Doucette T, Yang Y, Fuller G, Rao A, Schmidt NO, Humke N, Meissner H, Mueller FJ, Westphal M, Schnell O, Jaehnert I, Albrecht V, Fu P, Tonn JC, Schichor C, Shackleford G, Swanson K, Shi XH, D'Apuzzo M, Gonzalez-Gomez I, Sposto R, Seeger R, Erdreich-Epstein A, Moats R, Sirianni RW, Heffernan JM, Overstreet DJ, Sleire L, Skeie BS, Netland IA, Heggdal J, Pedersen PH, Enger PO, Stiles C, Sun Y, Mehta S, Taylor C, Alberta J, Sundstrom T, Wendelbo I, Daphu I, Hodneland E, Lundervold A, Immervoll H, Skaftnesmo KO, Babic M, Jendelova P, Sykova E, Lund-Johansen M, Bjerkvig R, Thorsen F, Synowitz M, Ku MC, Wolf SA, Respondek D, Matyash V, Pohlmann A, Waiczies S, Waiczies H, Niendorf T, Glass R, Kettenmann H, Thompson N, Elder D, Hopkins K, Iyer V, Cohen N, Tavare J, Thorsen F, Fite B, Mahakian LM, Seo JW, Qin S, Harrison V, Sundstrom T, Harter PN, Johnson S, Ingham E, Caskey C, Meade T, Skaftnesmo KO, Ferrara KW, Tschida BR, Lowy AR, Marek CA, Ringstrom T, Beadnell TJ, Wiesner SM, Largaespada DA, Wenger C, Miranda PC, Mekonnen A, Salvador R, Basser P, Yoon J, Shin H, Choi K, Choi C. TUMOR MODELS (IN VIVO/IN VITRO). Neuro Oncol 2013. [DOI: 10.1093/neuonc/not193] [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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Tuite GF, Storrs BB, Homsy YL, Gaskill SJ, Polsky EG, Reilly MA, Gonzalez-Gomez I, Winesett SP, Rodriguez LF, Carey CM, Perlman SA, Tetreault L. Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis. J Neurosurg Pediatr 2013; 12:80-6. [PMID: 23662931 DOI: 10.3171/2013.4.peds12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a "skin-CNS-bladder" reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2-3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data. Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions. This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.
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Affiliation(s)
- Gerald F Tuite
- Pediatric Neuroscience Center, All Children's Hospital, Neuroscience Institute, 601 5th Street South, Suite 511, St. Petersburg, Florida 33701, USA.
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Manwaring J, Ahmadian A, Stapleton S, Gonzalez-Gomez I, Rodriguez L, Carey C, Tuite GF. Pediatric microcystic meningioma: a clinical, histological, and radiographic case-based review. Childs Nerv Syst 2013; 29:361-5. [PMID: 23250249 DOI: 10.1007/s00381-012-1991-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Microcystic meningioma (MM) is a World Health Organization grade I tumor that is rare in the pediatric population. Meningiomas account for approximately 2-4 % of all childhood central nervous system (CNS) tumors compared to approximately 20 % of all adult CNS tumors. The authors present one of the few confirmed cases of microcystic meningioma in a child and discuss the characteristic radiographic appearance and histological findings. HISTORY We report the case of an 11-year-old boy who presented with first-time seizure and imaging consistent with brain tumor. There was significant vasogenic edema within the entire right hemisphere, disproportionate to the size of the falcine-based tumor. Histopathological analysis revealed the microcystic subtype of meningioma. DISCUSSION We review the radiographic characteristics, histopathological findings, and reported pediatric cases of MM in conjunction with our case. CONCLUSION MM has distinct radiographic characteristics (variable enhancement, lack of a dural tail, and disproportionate vasogenic edema) that can be misinterpreted in the pediatric population, suggesting a more aggressive tumor.
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Affiliation(s)
- Jotham Manwaring
- Department of Neurosurgery and Brain Repair, Morsani School of Medicine, University of South Florida, Tampa, FL, USA
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Levitt L, Messina A, Dumois J, Gonzalez-Gomez I, Berman DM. PHOTO QUIZ. A 12-month-old boy with pneumonia and hepatitis. Clin Infect Dis 2012; 54:1784, 1814-5. [PMID: 22619241 DOI: 10.1093/cid/cis134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Levitt
- Pediatric Residency Program, University of South Florida College of Medicine, Tampa, Florida, USA
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Priest JR, Andic D, Arbuckle S, Gonzalez-Gomez I, Hill DA, Williams G. Great vessel/cardiac extension and tumor embolism in pleuropulmonary blastoma: a report from the International Pleuropulmonary Blastoma Registry. Pediatr Blood Cancer 2011; 56:604-9. [PMID: 21298746 DOI: 10.1002/pbc.22583] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 03/19/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Types II and III pleuropulmonary blastoma (PPB) are aggressive sarcomas of lung and pleura in young children. Similar to cavoatrial extension of Wilms tumor, PPB may extend into thoracic great vessels and the heart and may involve both venous and arterial circulations and right and left cardiac chambers. Serious embolic complications occur. PROCEDURE Review International PPB Registry databases and literature (1) for PPB cases with vascular/cardiac extension and (2) for neoadjuvant chemotherapy results in vascular extension cases. RESULTS Among 179 Registry-confirmed and approximately 200 literature Type II and III PPB cases, 11 examples (approximately 3%) of great vessel/cardiac extension were identified; 1 case is presented in detail. Nine cases involved the left circulation, one the right and one both. Various radiographic techniques including echography, computed tomography and gated magnetic resonance imaging identified vascular tumor. Seven children had arterial embolic events: cerebrovascular accidents (six, including one femoral artery occlusion) and acute aortic occlusion (1). Six of these seven died from complications that may be attributed to vascular involvement. In three of four children with vascular involvement, neoadjuvant chemotherapy lessened the involvement; in one the effect could not be assessed. None of these four had embolic events. Effect on survival could not be assessed due to small numbers. CONCLUSIONS Involvement of thoracic great vessels and the heart is a serious complication of PPB, with fatal embolic complications possible. Radiographic evaluation of the central circulation should be performed in children with suspected or diagnosed PPB to identify this complication.
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Affiliation(s)
- John R Priest
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
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Mittal R, Krishnan S, Gonzalez-Gomez I, Prasadarao NV. Deciphering the roles of outer membrane protein A extracellular loops in the pathogenesis of Escherichia coli K1 meningitis. J Biol Chem 2011; 286:2183-93. [PMID: 21071448 PMCID: PMC3023514 DOI: 10.1074/jbc.m110.178236] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/05/2010] [Indexed: 11/06/2022] Open
Abstract
Outer membrane protein A (OmpA) has been implicated as an important virulence factor in several gram-negative bacterial infections such as Escherichia coli K1, a leading cause of neonatal meningitis associated with significant mortality and morbidity. In this study, we generated E. coli K1 mutants that express OmpA in which three or four amino acids from various extracellular loops were changed to alanines, and we examined their ability to survive in several immune cells. We observed that loop regions 1 and 2 play an important role in the survival of E. coli K1 inside neutrophils and dendritic cells, and loop regions 1 and 3 are needed for survival in macrophages. Concomitantly, E. coli K1 mutants expressing loop 1 and 2 mutations were unable to cause meningitis in a newborn mouse model. Of note, mutations in loop 4 of OmpA enhance the severity of the pathogenesis by allowing the pathogen to survive better in circulation and to produce high bacteremia levels. These results demonstrate, for the first time, the roles played by different regions of extracellular loops of OmpA of E. coli K1 in the pathogenesis of meningitis and may help in designing effective preventive strategies against this deadly disease.
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Affiliation(s)
- Rahul Mittal
- From the Division of Infectious Diseases, Department of Pediatrics, and
| | | | | | - Nemani V. Prasadarao
- From the Division of Infectious Diseases, Department of Pediatrics, and
- Surgery
- Saban Research Institute, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California 90027
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Mittal R, Gonzalez-Gomez I, Prasadarao NV. Escherichia coli K1 promotes the ligation of CD47 with thrombospondin-1 to prevent the maturation of dendritic cells in the pathogenesis of neonatal meningitis. J Immunol 2010; 185:2998-3006. [PMID: 20675593 DOI: 10.4049/jimmunol.1001296] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dendritic cells (DCs) are professional APCs providing a critical link between adaptive and innate immune responses. Our previous studies have shown that Escherichia coli K1 internalization of myeloid DCs suppressed the maturation of the cells for which outer membrane protein A (OmpA) expression is essential. In this study, we demonstrate that infection of DCs with OmpA(+) E. coli significantly upregulates the expression of CD47, an integrin-associated protein, and its natural ligand thrombospondin 1 (TSP-1). Pretreatment of DCs with anti-CD47 blocking Ab or knocking down the expression of CD47 or TSP-1, but not signal regulatory protein alpha by small interfering RNA, abrogated the suppressive effect of E. coli K1. Ligation of CD47 with a mAb prevented the maturation and cytokine production by DCs upon stimulation with LPS similar to the inhibitory effect induced by OmpA(+) E. coli. In agreement with the in vitro studies, suppression of CD47 or TSP-1 expression in newborn mice by a novel in vivo small interfering RNA technique protected the animals against E. coli K1 meningitis. Reconstitution of CD47 knockdown mice with CD47(+) DCs renders the animals susceptible to meningitis by E. coli K1, substantiating the role of CD47 expression in DCs for the occurrence of meningitis. Our results demonstrate a role for CD47 for the first time in bacterial pathogenesis and may be a novel target for designing preventive approaches for E. coli K1 meningitis.
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Affiliation(s)
- Rahul Mittal
- Division of Infectious Diseases, Saban Research Institute, Children's Hospital, Los Angeles, CA 90027, USA
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Mittal R, Gonzalez-Gomez I, Panigrahy A, Goth K, Bonnet R, Prasadarao NV. IL-10 administration reduces PGE-2 levels and promotes CR3-mediated clearance of Escherichia coli K1 by phagocytes in meningitis. ACTA ACUST UNITED AC 2010; 207:1307-19. [PMID: 20498022 PMCID: PMC2882833 DOI: 10.1084/jem.20092265] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ineffectiveness of antibiotics in treating neonatal Escherichia coli K1 meningitis and the emergence of antibiotic-resistant strains evidently warrants new prevention strategies. We observed that administration of interleukin (IL)-10 during high-grade bacteremia clears antibiotic-sensitive and -resistant E. coli from blood of infected mice. Micro-CT studies of brains from infected animals displayed gross morphological changes similar to those observed in infected human neonates. In mice, IL-10, but not antibiotic or anti-TNF antibody treatment prevented brain damage caused by E. coli. IL-10 administration elevated CR3 expression in neutrophils and macrophages of infected mice, whereas infected and untreated mice displayed increased expression of FcγRI and TLR2. Neutrophils or macrophages pretreated with IL-10 ex vivo exhibited a significantly greater microbicidal activity against E. coli compared with cells isolated from wild-type or IL-10−/− mice. The protective effect of IL-10 was abrogated when CR3 was knocked-down in vivo by siRNA. The increased expression of CR3 in phagocytes was caused by inhibition of prostaglandin E-2 (PGE-2) levels, which were significantly increased in neutrophils and macrophages upon E. coli infection. These findings describe a novel modality of IL-10–mediated E. coli clearance by diverting the entry of bacteria via CR3 and preventing PGE-2 formation in neonatal meningitis.
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Affiliation(s)
- Rahul Mittal
- Division of Infectious Diseases, Department of Pathology, Childrens Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA
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Si SJ, Khatua S, Dhall G, Nelson MD, Gonzalez-Gomez I, Finlay JL. Regression of primary central nervous system germinoma after dexamethasone administration: a case report. Pediatr Hematol Oncol 2010; 27:237-43. [PMID: 20367268 DOI: 10.3109/08880010903544866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Childhood central nervous system (CNS) germinoma are highly curable brain tumors characterized pathologically by varying degrees of lymphocytic infiltration. The authors present a case of a CNS germinoma with significant regression in size following surgery and administration of dexamethasone, prior to initiation of chemotherapy or irradiation. The authors speculate the possible mechanism involved in its occurrence. Perioperative corticosteroid administration in patients with CNS germinoma may obfuscate the increase in response demonstrated with various chemotherapy regimens or with irradiation in CNS germinomas.
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Affiliation(s)
- Stephanie J Si
- Neural Tumors Program, Children's Center for Cancer and Blood Diseases, Childrens Hospital Los Angeles, Los Angeles, California, USA
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Abstract
OBJECT Intramedullary spinal cord lipomas not associated with dysraphism are infrequently reported. When present, they typically occur in children and have a predilection for the cervical and thoracic spinal cord. The authors review the presentation, treatment, and disease course in 5 pediatric patients, and compare the outcomes with previously reported cases. METHODS With institutional review board approval, a retrospective chart review was undertaken at Children's Hospital Los Angeles. RESULTS Four patients with intramedullary spinal cord lipomas and 1 patient with a lipoblastoma, none associated with dysraphism, were retrospectively reviewed. There were 2 boys and 3 girls ranging in age from 2 months to 4 years. Four patients underwent a laminectomy or laminoplasty with one or more subtotal resections. One patient initially underwent a decompressive laminoplasty without debulking. The median follow-up was 8 years (range 12 months-11 years). Two patients had regrowth of their lipoma, necessitating a second surgery in one patient and 3 debulking surgeries in the other. Postoperatively, 3 patients developed mild kyphosis, none significant enough to require orthopedic intervention. One patient underwent a stabilization procedure at the time of the initial laminectomy and tumor debulking. No patient received chemotherapy or radiation. At the most recent follow-up visit, patients demonstrated improved neurological function when compared with preoperative status. CONCLUSIONS In addition to a decompressive laminectomy, debulking of the lipoma provides the best long-term neurological outcome. Gross-total excision is not warranted and usually is not possible. Long-term follow-up is needed, and repeat debulking of the lipoma is indicated if there is an increase in tumor size due to hyperplasia of residual adipocytes, when tumor growth is associated with neurological deterioration.
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Affiliation(s)
- Karen L Fleming
- Division of Neurosurgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA.
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Song HR, Gonzalez-Gomez I, Suh GS, Commins DL, Sposto R, Gilles FH, Deneen B, Erdreich-Epstein A. Nuclear factor IA is expressed in astrocytomas and is associated with improved survival. Neuro Oncol 2010; 12:122-32. [PMID: 20150379 DOI: 10.1093/neuonc/nop044] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nuclear factor IA (NFIA) is a transcription factor that specifies glial cell identity and promotes astrocyte differentiation during embryonic development. Its expression and function in gliomas are not known. Here, we examined NFIA protein expression in gliomas and its association with clinical outcome in pediatric malignant astrocytomas. We analyzed expression of NFIA by immunohistochemistry in 88 existing glioma specimens from Childrens Hospital Los Angeles and the University of Southern California. Association between NFIA expression and progression-free survival (PFS) was examined in high-grade astrocytomas for which clinical data were available (n = 23, all children). NFIA was highly expressed in astrocytomas of all grades, but only in a minority of cells in oligodendroglial tumors. NFIA was expressed on a higher percentage of tumor cells in low-grade astrocytomas (91 +/- 5% and 77 +/- 14% in World Health Organization [WHO] I and II, respectively) compared with high-grade astrocytomas (48 +/- 18% and 37 +/- 16% in WHO III and IV, respectively; P < .001, low- vs high-grade astrocytomas). There was a significant association between NFIA expression and PFS in children with astrocytoma WHO grade III or IV (Cox regression P = .019; logrank trend test for NFIA tertiles P = .0040 and NFIA quartiles P = .014). The association was not consistently significant in this small series of patients after adjustment was made for WHO grade III or IV. This is the first study to demonstrate expression of NFIA protein in astrocytomas and its association with grades of astrocytoma and PFS, suggesting that NFIA may play a role in astrocytoma biology.
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Affiliation(s)
- Hae-Ri Song
- Departments of Neurosurgery and Neurology, New York University, School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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Mittal R, Gonzalez-Gomez I, Goth KA, Prasadarao NV. Inhibition of inducible nitric oxide controls pathogen load and brain damage by enhancing phagocytosis of Escherichia coli K1 in neonatal meningitis. Am J Pathol 2010; 176:1292-305. [PMID: 20093483 DOI: 10.2353/ajpath.2010.090851] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Escherichia coli K1 is a leading cause of neonatal meningitis in humans. In this study, we sought to determine the pathophysiologic relevance of inducible nitric oxide (iNOS) in experimental E. coli K1 meningitis. By using a newborn mouse model of meningitis, we demonstrate that E. coli infection triggered the expression of iNOS in the brains of mice. Additionally, iNOS-/- mice were resistant to E. coli K1 infection, displaying normal brain histology, no bacteremia, no disruption of the blood-brain barrier, and reduced inflammatory response. Treatment with an iNOS specific inhibitor, aminoguanidine (AG), of wild-type animals before infection prevented the development of bacteremia and the occurrence of meningitis. The infected animals treated with AG after the development of bacteremia also completely cleared the pathogen from circulation and prevented brain damage. Histopathological and micro-CT analysis of brains revealed significant damage in E. coli K1-infected mice, which was completely abrogated by AG administration. Peritoneal macrophages and polymorphonuclear leukocytes isolated from iNOS-/- mice or pretreated with AG demonstrated enhanced uptake and killing of the bacteria compared with macrophages and polymorphonuclear leukocytes from wild-type mice in which E. coli K1 survive and multiply. Thus, NO produced by iNOS may be beneficial for E. coli to survive inside the macrophages, and prevention of iNOS could be a therapeutic strategy to treat neonatal E. coli meningitis.
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Affiliation(s)
- Rahul Mittal
- Division of Infectious Diseases, Department of Pathology, MS #51, Childrens Hospital Los Angeles, and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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Ghugre NR, Gonzalez-Gomez I, Butensky E, Noetzli L, Fischer R, Williams R, Harmatz P, Coates TD, Wood JC. Patterns of hepatic iron distribution in patients with chronically transfused thalassemia and sickle cell disease. Am J Hematol 2009; 84:480-3. [PMID: 19536851 DOI: 10.1002/ajh.21456] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with sickle cell disease (SCD) appear to be at lower risk of endocrinopathies and cardiac dysfunction than those with thalassemia major (TM). Circulating redox active iron is lower in these patients, possibly due to increased systemic inflammation and circulating cytokines. Hepcidin synthesis is upregulated during chronic inflammation, reducing intestinal iron absorption and promoting retention of iron in the reticuloendothelial cells. Hence, we hypothesized that livers of patients with SCD would exhibit greater iron deposition in sinusoidal spaces relative to hepatocytes and less in portal tracts when compared to patients with TM. To test this hypothesis, iron scoring analysis was performed on 70 clinically indicated liver biopsy specimens from children and young adults with the two syndromes. Sinusoidal scores were lower in around 1 of 4 patients with TM but the relative iron loading in hepatocytes, and portal tracts was identical in both diseases. Sinusoidal iron burdens saturated at low hepatic iron concentration (HIC) while hepatocyte and portal iron depots increased proportionally to HIC. Liver fibrosis was increased in patients with TM regardless of their chronic hepatitis status. Overall, liver iron distribution was relatively insensitive to differences in disease type and to the presence or absence of hepatitis.
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Affiliation(s)
- Nilesh R Ghugre
- Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027-0034, USA
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Rosol M, Harutyunyan I, Xu J, Melendez E, Smbatyan G, Finlay JL, Krieger MD, Gonzalez-Gomez I, Reynolds CP, Nelson MD, Erdreich-Epstein A, Blüml S. Metabolism of Orthotopic Mouse Brain Tumor Models. Mol Imaging 2009. [DOI: 10.2310/7290.2009.00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michael Rosol
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Ira Harutyunyan
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - JingYing Xu
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Elizabeth Melendez
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Goar Smbatyan
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Jonathan L. Finlay
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Mark D. Krieger
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Ignacio Gonzalez-Gomez
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - C. Patrick Reynolds
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Marvin D. Nelson
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Anat Erdreich-Epstein
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Stefan Blüml
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
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Rosol M, Harutyunyan I, Xu J, Melendez E, Smbatyan G, Finlay JL, Krieger MD, Gonzalez-Gomez I, Reynolds CP, Nelson MD, Erdreich-Epstein A, Blüml S. Metabolism of orthotopic mouse brain tumor models. Mol Imaging 2009; 8:199-208. [PMID: 19728974] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We used magnetic resonance spectroscopy to determine whether orthotopic mouse brain tumors grown as xenografts in immunocompromised mice either from human brain tumor cells implanted immediately after surgery or from cultured human tumor lines show metabolic profiles comparable to those of the original tumors. Using a 7 T scanner, spectra were acquired from mice with a human atypical teratoid/rhabdoid tumor (AT/RT) either implanted directly from the surgical specimen or first grown in culture, directly implanted choroid plexus carcinoma (CPC), and two medulloblastoma cell lines. The results were compared with spectra from these same tumors or tumor types in patients and with controls. Metabolic variability of tumors from a single cell line was also evaluated using the medulloblastoma lines. The main metabolic features of human tumors were qualitatively replicated in xenografts. AT/RTs in mice exhibited choline, creatine, and myo-inositol levels comparable to those observed in the patient. As in patients, choline was prominent in experimental CPC. Tumors from a single cell line were comparable. Significant correlations were found with key metabolites in humans and mice; however, differences including lower lipids in the implanted AT/RTs than in patient spectra and taurine observed in all animal spectra were also noted. The causes of these dissimilarities warrant further investigation.
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Affiliation(s)
- Michael Rosol
- Department of Radiology, Division of Hematology-Oncology, Saban Research Institute at Children's Hospital Los Angeles, USA.
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Verma SP, Stoddard T, Gonzalez-Gomez I, Koempel JA. Histologic analysis of pediatric tonsil and adenoid specimens: is it really necessary? Int J Pediatr Otorhinolaryngol 2009; 73:547-50. [PMID: 19193449 DOI: 10.1016/j.ijporl.2008.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 11/01/2008] [Accepted: 11/04/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the incidence of unexpected histologic findings in routine tonsillectomy and adenoidectomy specimens. METHODS A retrospective medical record review was performed at a tertiary care children's hospital. The pathology records of 2062 children who underwent tonsil or adenoid surgery were analyzed and the final histologic diagnosis was recorded. RESULTS Four unexpected histologic findings were found on routine tonsil and adenoid specimens. None were clinically significant. A review of the literature shows a very low rate (0.015%) of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens. CONCLUSIONS Given rarity of unexpected clinically significant diagnoses in pediatric adenotonsillectomy specimens, the cost and effort of analyzing each specimen histologically is difficult to justify.
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Affiliation(s)
- Sunil P Verma
- Children's Hospital Los Angeles, Division of Pediatric Otolaryngology, 4650 Sunset Blvd M/S #58, Los Angeles, CA 90027, United States.
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Davidson L, Gonzalez-Gomez I, McComb JG. Thoracic spinal cord tethering resulting from an exophytic hamartoma. Pediatr Neurosurg 2009; 45:244-6. [PMID: 19521140 DOI: 10.1159/000224623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 12/14/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Laurence Davidson
- Division of Neurosurgery, Childrens Hospital Los Angeles, Los Angeles, Calif., USA.
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Abstract
Atretic meningoceles are infrequent congenital malformations resulting from the herniation of meninges through a skull defect. All prior reported cases have had a subcutaneous component with or without an underlying osseous defect. We report the unusual case of a completely intraosseous atretic meningocele.
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Affiliation(s)
- Laurence Davidson
- Division of Neurosurgery, Childrens Hospital Los Angeles, Los Angeles, Calif., USA.
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Javahery RJ, Davidson L, Fangusaro J, Finlay JL, Gonzalez-Gomez I, McComb JG. Aggressive variant of a papillary glioneuronal tumor. Report of 2 cases. J Neurosurg Pediatr 2009; 3:46-52. [PMID: 19119904 DOI: 10.3171/2008.10.peds08242] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Papillary glioneuronal tumors are a newly recognized type of brain neoplasm characterized by prominent pseudopapillary structures and glioneuronal elements. All prior cases have shown that these tumors have an indolent course. The authors present 2 patients with an aggressive variant of the tumor. The first patient had dissemination of her tumor and the second had local spreading. Therefore, the authors conclude that papillary glioneuronal tumors do not always behave in a strictly benign fashion.
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Affiliation(s)
- Ramin J Javahery
- Division of Neurosurgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
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Fangusaro JR, Jubran RF, Allen J, Gardner S, Dunkel IJ, Rosenblum M, Atlas MP, Gonzalez-Gomez I, Miller D, Finlay JL. Brainstem primitive neuroectodermal tumors (bstPNET): results of treatment with intensive induction chemotherapy followed by consolidative chemotherapy with autologous hematopoietic cell rescue. Pediatr Blood Cancer 2008; 50:715-7. [PMID: 17009232 DOI: 10.1002/pbc.21032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have evaluated the response rate and survival utilizing intensified chemotherapy followed by myeloablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) and adjuvant radiation therapy in six young children with newly diagnosed brainstem primitive neuroectodermal tumors (bstPNET). Following maximum surgical resection of the tumor, patients received high dose induction chemotherapy including vincristine, cisplatin, cyclophosphamide, and etoposide. Eligible patients received a single cycle of myeloablative chemotherapy followed by AuHCR. Two patients survive at least 32 months with stable disease. This approach provides an alternative for young patients with bstPNET who in prior reports have had a uniformly fatal prognosis.
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Affiliation(s)
- Jason R Fangusaro
- The Children's Hospital Los Angeles, New York University Medical Center, Memorial Sloan-Kettering Cancer Center, and Schneider Children's Hospital, USA.
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33
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Townsend SM, Hurrell E, Gonzalez-Gomez I, Lowe J, Frye JG, Forsythe S, Badger JL. Enterobacter sakazakii invades brain capillary endothelial cells, persists in human macrophages influencing cytokine secretion and induces severe brain pathology in the neonatal rat. Microbiology (Reading) 2007; 153:3538-3547. [PMID: 17906151 DOI: 10.1099/mic.0.2007/009316-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Enterobacter sakazakii is an opportunistic pathogen associated with contaminated powdered infant formula and a rare cause of Gram-negative sepsis that can develop into meningitis and brain abscess formation in neonates. Bacterial pathogenesis remains to be fully elucidated. In this study, the host inflammatory response was evaluated following intracranial inoculation of Ent. sakazakii into infant rats. Infiltrating macrophages and neutrophils composed multiple inflammatory foci and contained phagocytosed bacteria. Several genotypically distinct Ent. sakazakii strains (16S cluster groups 1-4) were shown to invade rat capillary endothelial brain cells (rBCEC4) in vitro. Further, the persistence of Ent. sakazakii in macrophages varied between strains. The presence of putative sod genes and SOD activity may influence the survival of acidic conditions and macrophage oxidase and contribute to Ent. sakazakii intracellular persistence. The influence of macrophage uptake of Ent. sakazakii on immunoregulatory cytokine expression was assessed by ELISA. This demonstrated that the IL-10/IL-12 ratio is high after 24 h. This is suggestive of a type 2 immune response which is inefficient in fighting intracellular infections. These findings may help explain how the diversity in virulence traits among Ent. sakazakii isolates and an unsuccessful immune response contribute to the opportunistic nature of this infection.
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Affiliation(s)
- Stacy M Townsend
- School of Biomedical and Natural Sciences, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK
| | - Edward Hurrell
- School of Biomedical and Natural Sciences, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK
| | - Ignacio Gonzalez-Gomez
- University of Southern California Keck School of Medicine Los Angeles, CA 90027, USA
- Department of Pathology, Children's Hospital Los Angeles, CA 90027, USA
| | - James Lowe
- Department of Neurology, Queen's Medical Centre NHS Trust, Nottingham NG7 2UH, UK
| | - Jonathan G Frye
- Bacterial Epidemiology and Antimicrobial Resistance Research Unit, USDA, Agricultural Research Service, 950 College Station Road, Athens, GA 30605, USA
| | - Stephen Forsythe
- School of Biomedical and Natural Sciences, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK
| | - Julie L Badger
- University of Southern California Keck School of Medicine Los Angeles, CA 90027, USA
- Department of Pathology, Children's Hospital Los Angeles, CA 90027, USA
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Saxena V, Gonzalez-Gomez I, Laug WE. A non-invasive, in vivo technique for monitoring vascular status of glioblastoma during angiogenesis. Technol Cancer Res Treat 2007; 6:641-50. [PMID: 17994795 DOI: 10.1177/153303460700600608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growth of solid tumors dependent on the process of angiogenesis in which growth factors secreted by tumor and stromal cells promote endothelial cell proliferation, migration, and maturation. This process generates a tumor-specific vascular supply and enables small or dormant tumors to grow rapidly with exponential increases in tumor volume. Determination of tumor oxygenation at the microvascular level will provide important insight into tumor growth, angiogenesis, necrosis, and therapeutic response, and will facilitate to develop protocols for studying tumor behavior. A non-invasive multi-modality approach based on near infrared spectroscopy (NIRS) technique, namely: Steady State Diffuse Optical Spectroscopy (SSDOS) along with Magnetic Resonance Imaging (MRI) is applied for monitoring the concentration of oxyhemoglobin, deoxyhemoglobin and water within tumor region and for studying the vascular status of tumor and the patho-physiological changes that occur during angiogenesis. Since, the growth of solid tumors depends on the formation of new blood vessels, an association between intramural microvessel density (MVD) and tumor oxygenation is also investigated. The relative decrease in oxygenation value with tumor growth indicates that though blood vessels infiltrate and proliferate the tumor region, a hypoxic trend is clearly present.
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Affiliation(s)
- V Saxena
- Department of Radiology, Keck School of Medicine and Children's Hospital Los Angeles, University of Southern California, Los Angeles, California 90027, USA.
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35
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Wong LJC, Brunetti-Pierri N, Zhang Q, Yazigi N, Bove KE, Dahms BB, Puchowicz MA, Gonzalez-Gomez I, Schmitt ES, Truong CK, Hoppel CL, Chou PC, Wang J, Baldwin EE, Adams D, Leslie N, Boles RG, Kerr DS, Craigen WJ. Mutations in the MPV17 gene are responsible for rapidly progressive liver failure in infancy. Hepatology 2007; 46:1218-27. [PMID: 17694548 DOI: 10.1002/hep.21799] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
UNLABELLED MPV17 is a mitochondrial inner membrane protein of unknown function recently recognized as responsible for a mitochondrial DNA depletion syndrome. The aim of this study is to delineate the specific clinical, pathological, biochemical, and molecular features associated with mitochondrial DNA depletion due to MPV17 gene mutations. We report 4 cases from 3 ethnically diverse families with MPV17 mutations. Importantly, 2 of these cases presented with isolated liver failure during infancy without notable neurologic dysfunction. CONCLUSION We therefore propose that mutations in the MPV17 gene be considered in the course of evaluating the molecular etiology for isolated, rapidly progressive infantile hepatic failure.
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Affiliation(s)
- Lee-Jun C Wong
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
Determination of tumor oxygenation at the microvascular level will provide important insight into tumor growth, angiogenesis, necrosis and therapeutic response and will facilitate to develop protocols for studying tumor behavior. The non-ionizing near infrared spectroscopy (NIRS) technique has the potential to differentiate lesion and hemoglobin dynamics; however, it has a limited spatial resolution. On the other hand, magnetic resonance imaging (MRI) has achieved high spatial resolution with excellent tissue discrimination but is more susceptible to limited ability to monitor the hemoglobin dynamics. In the present work, the vascular status and the pathophysiological changes that occur during tumor vascularization are studied in an orthotopic brain tumor model. A noninvasive multimodal approach based on the NIRS technique, namely steady state diffuse optical spectroscopy (SSDOS) along with MRI, is applied for monitoring the concentrations of oxyhemoglobin, deoxyhemoglobin and water within tumor region. The concentrations of oxyhemoglobin, deoxyhemoglobin and water within tumor vasculature are extracted at 15 discrete wavelengths in a spectral window of 675-780 nm. We found a direct correlation between tumor size, intratumoral microvessel density and tumor oxygenation. The relative decrease in tumor oxygenation with growth indicates that though blood vessels infiltrate and proliferate the tumor region, a hypoxic trend is clearly present.
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Affiliation(s)
- Vishal Saxena
- Department of Radiology, University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
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Abstract
Giant cell tumors of the bone are rare, locally aggressive lesions that primarily affect the epiphyses of long bones. These tumors can occur in the skull, principally in the sphenoid and temporal bones. Symptoms of these tumors depend on their site of origin but typically include headache, pain, visual field defects, and conductive hearing loss. Histologically, these tumors consist of three cell types: osteoclast-like multinucleated giant cells; round mononuclear cells resembling monocytes; and spindle-shaped, fibroblast-like stromal cells. Radiographically, the tumors appear osteolytic and radiolucent without a sclerotic border. These tumors typically present in the third to fourth decades of life and rarely occur in patients under 20 years of age. The small number of studies of giant cell tumors of the skull has focused on the adolescent and adult populations. The authors report two cases of giant cell tumors of the skull in pediatric patients. In the first case, a 2-year-old girl presented with swelling behind the right ear. In the second case, a 7-week-old girl presented with a mass within the external auditory canal. Both patients underwent metastatic workup and biopsy procedures before resection of the tumor. Both case reports contribute to the literature of giant cell tumors of the skull by describing this condition in pediatric patients. To the authors' knowledge, these cases represent the youngest two patients with giant cell tumors of the skull yet described.
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Affiliation(s)
- James B Elder
- Division of Neurosurgery, Childrens Hospital Los Angeles, Los Angeles, California 90033, USA.
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Sano H, Gonzalez-Gomez I, Wu SQ, Armenian SH, Jubran RF, Shimada H. A case of composite neuroblastoma composed of histologically and biologically distinct clones. Pediatr Dev Pathol 2007; 10:229-32. [PMID: 17535087 DOI: 10.2350/06-06-0117.1] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 08/19/2006] [Indexed: 11/20/2022]
Abstract
We report a case of a 12-month-old girl with stage 3 neuroblastoma composed of 2 distinct clones in the adrenal primary tumor. One clone showed neuroblastoma, poorly differentiated subtype with a low mitosis-karyorrhexis index (favorable histology), and the other was neuroblastoma, poorly differentiated subtype with a high mitosis-karyorrhexis index (unfavorable histology), according to the International Neuroblastoma Pathology Classification. Fluorescent-labeled in-situ hybridization using the formalin-fixed, paraffin-embedded material showed that the MYCN oncogene was amplified in the latter clone but not in the former clone. Lymph nodes from ipsilateral and contralateral sides contained metastatic neuroblastoma of the latter clone. It is well documented that tumors in the Ganglioneuroblastoma, nodular (composite, Schwannian stroma-rich/stroma-dominant and stroma-poor) category are composite and composed of multiple clones. To our knowledge, however, this is the 1st case report of composite tumor with biologically favorable and unfavorable clones in the Neuroblastoma (Schwannian stroma-poor) category.
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Affiliation(s)
- Hideki Sano
- Department of Pathology and Laboratory Medicine, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
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Kuo JS, Gonzalez-Gomez I, McComb JG. Unexpected myxopapillary ependymoma within a filum terminale tethering the spinal cord. Pediatr Neurosurg 2007; 43:309-11. [PMID: 17627148 DOI: 10.1159/000103312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 05/17/2006] [Indexed: 11/19/2022]
Abstract
We present a 9-month-old neurologically normal infant with cutaneous markers for a closed neural tube defect consisting of two sacral dimples and associated tuft of hair. Magnetic resonance imaging showed that her spinal cord was tethered at S2 and associated with a large syrinx. A myelotomy was performed to address the hydrosyringomyelia and the filum terminale resected to untether the spinal cord. Histopathologic examination of the filum terminale specimen revealed the presence of an unexpected myxopapillary ependymoma. The association of a myxopapillary ependymoma with a closed neural tube defect appears to be coincidental. This patient may have presented at some future date with a clinically symptomatic myxopapillary ependymoma. The presence of microscopic myxopapillary ependymoma cells in this infant's filum supports the concept that these tumors arise from embryonic rests of ependymal cells.
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Affiliation(s)
- John S Kuo
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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40
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Townsend SM, Gonzalez-Gomez I, Badger JL. fliP influences Citrobacter koseri macrophage uptake, cytokine expression and brain abscess formation in the neonatal rat. J Med Microbiol 2006; 55:1631-1640. [PMID: 17108264 DOI: 10.1099/jmm.0.46596-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Citrobacter koseri causes neonatal meningitis frequently complicated with multiple brain abscesses. During C. koseri central nervous system infection in the neonatal rat model, previous studies have documented many bacteria-filled macrophages within the neonatal rat brain and abscesses. Previous studies have also shown that C. koseri is taken up by, survives phagolysosomal fusion and replicates in macrophages in vitro and in vivo. In this study, in order to elucidate genetic and cellular factors contributing to C. koseri persistence, a combinatory technique of differential fluorescence induction and transposon mutagenesis was employed to isolate C. koseri genes induced while inside macrophages. Several banks of mutants were subjected to a series of enrichments to select for gfp : : transposon fusion into genes that are turned off in vitro but expressed when intracellular within macrophages. Further screening identified several mutants attenuated in their recovery from macrophages compared with the wild-type. A mutation within an Escherichia coli fliP homologue caused significant attenuation in uptake and hypervirulence in vivo, resulting in death within 24 h. Furthermore, analysis of the immunoregulatory interleukin (IL)-10/IL-12 cytokine response during infection suggested that C. koseri fliP expression may alter this response. A better understanding of the bacteria-macrophage interaction at the molecular level and its contribution to brain abscess formation will assist in developing preventative and therapeutic strategies.
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41
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Otto-Duessel M, Khankaldyyan V, Gonzalez-Gomez I, Jensen MC, Laug WE, Rosol M. In vivo testing of Renilla luciferase substrate analogs in an orthotopic murine model of human glioblastoma. Mol Imaging 2006; 5:57-64. [PMID: 16954019] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
In vivo bioluminescent imaging using cells expressing Renilla luciferase is becoming increasingly common. Hindrances to the more widespread use of Renilla luciferase are the high autoluminescence of its natural substrate, coelenterazine, in plasma, the relatively high absorbance by tissue of the light emitted by the enzyme-substrate reaction; rapid clearance of the substrate; and significant cost. These factors, save for the cost, which has its own limiting effect on use, can combine to reduce the sensitivity of in vivo assays utilizing this reporter system, and methods of increasing light output or decreasing autoluminescence could be of great benefit. A number of analogs of coelenterazine are being investigated may accomplish one or both of these goals. In this study that we report on the testing of two new substrate analogs, EnduRen and ViViren, manufactured by Promega Corporation, in an orthotopic murine model of human glioblastoma expressing Renilla luciferase. We have tested these analogs in this cell line both in vitro and in vivo, and find that the substrate viviren results in significantly greater light output than the natural substrate or the other analog EnduRen. This new substrate could be valuable for studies where greater sensitivity is important.
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Affiliation(s)
- Maya Otto-Duessel
- Saban Research Institute of Childrens Hospital, Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA
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Otto-Duessel M, Khankaldyyan V, Gonzalez-Gomez I, Jensen MC, Laug WE, Rosol M. In Vivo Testing ofRenillaLuciferase Substrate Analogs in an Orthotopic Murine Model of Human Glioblastoma. Mol Imaging 2006. [DOI: 10.2310/7290.2006.00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Maya Otto-Duessel
- Saban Research Institute of Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Vazgen Khankaldyyan
- Saban Research Institute of Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Ignacio Gonzalez-Gomez
- Saban Research Institute of Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, USA
| | | | - Walter E. Laug
- Saban Research Institute of Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Michael Rosol
- Saban Research Institute of Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, USA
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Panigrahy A, Krieger MD, Gonzalez-Gomez I, Liu X, McComb JG, Finlay JL, Nelson MD, Gilles FH, Blüml S. Quantitative short echo time 1H-MR spectroscopy of untreated pediatric brain tumors: preoperative diagnosis and characterization. AJNR Am J Neuroradiol 2006; 27:560-72. [PMID: 16551993 PMCID: PMC7976960] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE Our aims were to evaluate the metabolic profiles of pediatric brain tumors with short echo time (TE) MR spectroscopy and absolute quantitation of metabolite concentrations (in mmol/kg of tissue) and to describe metabolic features that distinguish individual tumor types and that may help to improve preoperative diagnosis of specific tumors. METHODS MR imaging examinations of 60 patients with untreated brain tumors (14 medulloblastomas, 5 anaplastic astrocytomas, 3 low-grade astrocytomas, 17 pilocytic astrocytomas, 4 anaplastic ependymomas, 5 ependymomas, 3 choroid plexus papillomas, 3 choroid plexus carcinomas, and 6 pineal germinomas) were reviewed. Single-voxel proton MR spectroscopy with a TE of 35 ms was performed and absolute metabolite concentrations were determined by using fully automated quantitation. RESULTS Taurine (Tau) was significantly elevated in medulloblastomas (P < .00001) compared with all other tumors pooled (All Other). Tau was also observed consistently, at lower concentration, in pineal germinomas. Creatine (Cr) was significantly reduced in pilocytic astrocytomas, distinguishing them from All Other (P < .000001). The MR spectra of choroid plexus papillomas exhibited low Cr (P < .01) concentrations; however, myoinositol was elevated (P < .01) and total choline (tCho) (P < .0001) was reduced relative to All Other. Choroid plexus carcinomas had low Cr (P < .01 versus All Other) and the lowest Cr/tCho ratio (P < .0001 versus All Other) among all tumors studied. Guanidinoacetate was reduced in low-grade astrocytomas and anaplastic astrocytomas (P < .00001) versus All Other, whereas ependymoma and anaplastic ependymomas exhibited particularly low N-acetylaspartate (P < .00001 versus All Other). CONCLUSION Quantitative proton MR spectroscopy reveals features of pediatric brain tumors that are likely to improve preoperative diagnoses.
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Affiliation(s)
- A Panigrahy
- Department of Radiology, Childrens Hospital Los Angeles, Los Angeles, Calif 90027, USA
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Abstract
Cobalamin C disease is a rare genetic condition resulting in methylmalonic aciduria, homocystinuria, and hematologic abnormalities. Clinical characteristics include ophthalmologic findings and neurological abnormalities, such as microcephaly, seizure, and mental retardation. The authors report on a 4-month-old patient initially diagnosed with hemophagocytic lymphohistiocytosis (HLH), who was later diagnosed with cobalamin C disease.
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Affiliation(s)
- Susan Wu
- Division of Medical Genetics, Department of Pediatrics, Children's Hospital Los Angeles #90 and University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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Kovanlikaya A, Panigrahy A, Krieger MD, Gonzalez-Gomez I, Ghugre N, McComb JG, Gilles FH, Nelson MD, Blüml S. Untreated pediatric primitive neuroectodermal tumor in vivo: quantitation of taurine with MR spectroscopy. Radiology 2005; 236:1020-5. [PMID: 16118174 DOI: 10.1148/radiol.2363040856] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively investigate whether quantitation of taurine (Tau) concentrations with proton magnetic resonance (MR) spectroscopy in vivo improves the differentiation of primitive neuroectodermal tumors (PNET) from other common brain tumors in pediatric patients. MATERIALS AND METHODS The institutional review board approved this review of clinical data; it was not necessary to obtain parental consent. This study was HIPAA compliant. Single-voxel proton spectroscopy was added to the preoperative MR imaging work-up of 29 patients (12 boys and 17 girls; mean age, 6.5 years +/- 3.5) with untreated brain tumors; 13 had PNETs, and 16 had other tumors. Absolute concentrations (measured in millimoles per kilogram of brain tissue) of metabolites of the proton spectrum were determined. Student t tests were used for statistical comparisons. RESULTS Elevated absolute Tau concentration proved to be the most significant metabolite in the differentiation of PNETs from other tumors (6.09 mmol/kg +/- 2.24 vs 0.76 mmol/kg +/- 0.95, P < .001). PNETs also exhibited a higher ratio of Tau relative to choline (1.21 +/- 0.48 vs 0.28 +/- 0.39, P < .001), a higher ratio of Tau relative to creatine (1.28 +/- 0.44 vs 0.38 +/- 0.67, P < .001), a reduced a ratio of N-acetyl-aspartate relative to choline (0.20 +/- 0.20 vs 0.79 +/- 0.56, P < .001), and an increased choline concentration (5.30 mmol/kg +/- 1.64 vs 3.08 mmol/kg +/- 2.53, P < .05). Tau concentrations ranged from 2.62 to 11.15 mmol/kg in individual patients with a PNET. CONCLUSION Single-voxel quantitative (1)H MR spectroscopy performed in patients with untreated pediatric brain tumors showed that the Tau concentration was significantly elevated in PNETs and was useful in the differentiation of PNETs from other tumors.
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Affiliation(s)
- Arzu Kovanlikaya
- Department of Radiology, Division of Neurosurgery, and Department of Neuropathology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 81, Los Angeles, CA 90027, USA
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McNatt SA, Gonzalez-Gomez I, Nelson MD, McComb JG. Synchronous Multicentric Pleomorphic Xanthoastrocytoma: Case Report. Neurosurgery 2005; 57:E191; discussion E191. [PMID: 15987556 DOI: 10.1227/01.neu.0000164174.07281.f9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 03/08/2005] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
Pleomorphic xanthoastrocytoma (PXA) is a rare, low-grade astrocytoma of adolescence. Relatively favorable outcomes have been achieved with complete surgical resection. However, few data exist regarding the treatment of recurrent, deep-seated, or multicentric lesions. We report the first case to our knowledge of synchronous multicentric PXA and discuss the related therapeutic challenges.
CLINICAL PRESENTATION:
A 13-year-old Hispanic girl presented with a 1-year history of progressive headaches, polyuria, and generalized fatigue. Findings from the neurological examination were notable only for the presence of papilledema. Results of laboratory studies revealed diabetes insipidus and hypothyroidism. The magnetic resonance imaging study revealed numerous nodular, homogeneously enhancing lesions, approximately 1 cm in size, scattered throughout both cerebral hemispheres.
INTERVENTION:
A right frontal craniotomy was performed for excisional biopsy of a superficial lesion beneath the coronal suture. Results of the histological examination were consistent with a diagnosis of PXA. The patient was treated with whole-brain radiation of 3600 cGy, with additional intensity-modulated boosts to the enhancing lesions of 1440 cGy. Three years after treatment, the patient remains neurologically nonfocal and shows no evidence of disease progression. Surgical intervention will be considered if accessible lesions progress in size on later imaging studies.
CONCLUSION:
Synchronous multicentric PXA presents unique challenges in that gross total resection would impose significant surgical morbidity; histological homogeneity among the lesions cannot be confirmed; and the well-described potential for anaplastic transformation may be increased with multiple lesions. The optimal treatment for patients with this rare and challenging diagnosis awaits further study.
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Affiliation(s)
- Sean A McNatt
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Krieger MD, Panigrahy A, McComb JG, Nelson MD, Liu X, Gonzalez-Gomez I, Gilles F, Bluml S. Differentiation of choroid plexus tumors by advanced magnetic resonance spectroscopy. Neurosurg Focus 2005; 18:E4. [PMID: 16048290] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECT The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (CNS) tumors. In this study to overcome the limitations of current noninvasive imaging modalities, the authors use novel magnetic resonance (MR) spectroscopy techniques in vivo to elucidate the identifying biochemical features of choroid plexus tumors that may facilitate diagnosis and treatment. METHODS Based on an Internal Review Board-approved protocol, six children with newly diagnosed, untreated intraventricular brain tumors were identified. On retrospective review, this series included three choroid plexus papillomas and three choroid plexus carcinomas. Single-voxel proton MR spectroscopy with a short echo time was performed, and absolute metabolite concentrations (in mmol/kg) were determined using fully automated quantitation. These results were compared with MR spectroscopy profiles obtained in 54 other untreated CNS neoplasms in children. The myo-inositol (mI) level was significantly higher in choroid plexus papillomas (> 10 mmol/kg), uniquely distinguishing these tumors from choroid plexus carcinomas and all other tumors. Choroid plexus carcinomas, on the other hand, had significantly elevated levels of choline when compared with choroid plexus papillomas. CONCLUSIONS In this study the authors find that mI is a biochemical constituent that uniquely identifies choroid plexus papillomas and can be used as a noninvasive means of diagnosis and for follow-up evaluations in patients with this disease.
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Affiliation(s)
- Mark D Krieger
- Department of Neurological Surgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Krieger MD, Panigrahy A, McComb JG, Nelson MD, Liu X, Gonzalez-Gomez I, Gilles F, Bluml S. Differentiation of choroid plexus tumors by advanced magnetic resonance spectroscopy. Neurosurg Focus 2005. [DOI: 10.3171/foc.2005.18.6.5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (CNS) tumors. In this study to overcome the limitations of current noninvasive imaging modalities, the authors use novel magnetic resonance (MR) spectroscopy techniques in vivo to elucidate the identifying biochemical features of choroid plexus tumors that may facilitate diagnosis and treatment.
Methods
Based on an Internal Review Board–approved protocol, six children with newly diagnosed, untreated intraventricular brain tumors were identified. On retrospective review, this series included three choroid plexus papillomas and three choroid plexus carcinomas. Single-voxel proton MR spectroscopy with a short echo time was performed, and absolute metabolite concentrations (in mmol/kg) were determined using fully automated quantitation. These results were compared with MR spectroscopy profiles obtained in 54 other untreated CNS neoplasms in children.
The myo-inositol (mI) level was significantly higher in choroid plexus papillomas (> 10 mmol/kg), uniquely distinguishing these tumors from choroid plexus carcinomas and all other tumors. Choroid plexus carcinomas, on the other hand, had significantly elevated levels of choline when compared with choroid plexus papillomas.
Conclusions
In this study the authors find that mI is a biochemical constituent that uniquely identifies choroid plexus papillomas and can be used as a noninvasive means of diagnosis and for follow-up evaluations in patients with this disease.
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Albers MJ, Krieger MD, Gonzalez-Gomez I, Gilles FH, McComb JG, Nelson MD, Blüml S. Proton-decoupled 31P MRS in untreated pediatric brain tumors. Magn Reson Med 2005; 53:22-9. [PMID: 15690498 DOI: 10.1002/mrm.20312] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Proton-decoupled (31)P and (1)H MRS was used to quantify markers of membrane synthesis and breakdown in eight pediatric patients with untreated brain tumors and in six controls. Quantitation of these compounds in vivo in humans may provide important indicators for tumor growth and malignancy, tumor classification, and provide prognostic information. The ratios of phosphoethanolamine to glycerophosphoethanolamine (PE/GPE) and phosphocholine to glycerophosphocholine (PC/GPC) were significantly higher in primitive neuroectodermal tumors (PNET) (16.30 +/- 5.73 and 2.97 +/- 0.93) when compared with controls (3.42 +/- 1.62, P < 0.0001 and 0.45 +/- 0.13, P < 0.0001) and with other tumors (3.93 +/- 3.42, P < 0.001 and 0.65 +/- 0.30, P < 0.0001). Mean PC/PE was elevated in tumors relative to controls (0.48 +/- 0.11 versus 0.24 +/- 0.05, P < 0.001), but there was no difference between PNET and other tumors. Total choline concentration determined with quantitative (1)H MRS was significantly elevated (4.78 +/- 3.33 versus 1.73 +/- 0.56 mmol/kg, P < 0.05), whereas creatine was reduced in tumors (4.89 +/- 1.83 versus 8.28 +/- 1.50 mmol/kg, P < 0.05). A quantitative comparison of total phosphorylated cholines (PC+GPC)/ATP measured with (31)P MRS and total choline measured with (1)H MRS showed that in tumors a large fraction of the choline signal (>54 +/- 36%) was not accounted for by PC and GPC. The fraction of unaccounted choline was particularly large in PNET (>78 +/- 7%). The pH of tumor tissue was higher than the pH of normal brain tissue (7.06 +/- 0.03 versus. 6.98 +/- 0.03, P < 0.001).
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Affiliation(s)
- Mark J Albers
- Department of Radiology, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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Yamada S, Khankaldyyan V, Bu X, Suzuki A, Gonzalez-Gomez I, Takahashi K, McComb JG, Laug WE. A method to accurately inject tumor cells into the caudate/putamen nuclei of the mouse brain. Tokai J Exp Clin Med 2004; 29:167-73. [PMID: 15717488] [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: 05/01/2023]
Abstract
OBJECTIVE To improve currently used techniques to implant tumor cells into the parenchyma of the mouse brain. MATERIALS AND METHODS The stereotactic injection of 0.5 to 5 microl of indigo carmine over 5 to 40 minutes into the caudate/putamen nuclei of the mouse was done followed by sacrifice and examination of the brain injection site. 1 microl containing 10(5) U87MG glioma cells were stereotactically implanted into the caudate/ putamen nuclei over 20 minutes. The animals were sacrificed from one hour to 63 days after implantation and the brain examined and tumor size measured. RESULTS An injection of 1 microl of indigo carmine over 20 minutes produced a spherical deposit of dye within the caudate/putamen nuclei. Larger volumes of indigo carmine or shorter injection times resulted in dye spreading along the injection tract or into the ventricles or subarachnoid space. Using the results of the dye studies, the same parameters were used to successfully inject and confine the glioma cells to the caudate/putamen nuclei in 30 of 32 mice. No tumor was found in 2 animals and appears to be explained by obstruction of the injection cannula. The tumor cells appeared viable an hour after injection. However by day three, considerable necrosis of tumor cells were noted, the effects of which resolved by day five. On day six, the injection site was comparable to that at one hour. In the early phase, until the fifth week, tumor volume doubling time was ten days while afterward it was only five days. CONCLUSION The technique described allows the highly accurate and reproducible introduction of a given number of cells into a specific area of the mouse brain. This should reduce the intragroup variability, be it control or therapeutic, allowing better assessment of outcome with fewer number of mice.
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Affiliation(s)
- Shinya Yamada
- Department of Neurosurgery, Tokai University Oiso Hospital, Japan.
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