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Simon AG, Lyu SI, Laible M, Wöll S, Türeci Ö, Şahin U, Alakus H, Fahrig L, Zander T, Buettner R, Bruns CJ, Schroeder W, Gebauer F, Quaas A. The tight junction protein claudin 6 is a potential target for patient-individualized treatment in esophageal and gastric adenocarcinoma and is associated with poor prognosis. J Transl Med 2023; 21:552. [PMID: 37592303 PMCID: PMC10436499 DOI: 10.1186/s12967-023-04433-8] [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: 06/23/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The prognosis of esophageal adenocarcinoma (EAC) and gastric adenocarcinoma (GAC) remains poor, and new therapeutic approaches are urgently needed. Claudin 6 (CLDN6) is an oncofetal antigen that is largely absent in healthy tissues and upregulated in several cancers, making it a promising therapeutical target. In this study, the expression of CLDN6 was assessed in an large Caucasian EAC and GAC cohort. METHODS RNA-Seq data from 89 EACs and 371 GACs were obtained from The Cancer Genome Atlas project and EAC/GAC cases were stratified by CLDN6 mRNA expression based on a survival-associated cutoff. For groups with CLDN6 expression above or below this cutoff, differential gene expression analyses were performed using DESeq, and dysregulated biological pathways were identified using the Enrichr tool. Additionally, CLDN6 protein expression was assessed in more than 800 EACs and almost 600 GACs using a CLDN6-specific immunohistochemical antibody (clone 58-4B-2) that is currently used in Phase I/II trials to identify patients with CLDN6-positive tumors (NCT05262530; NCT04503278). The expression of CLDN6 was also correlated with histopathological parameters and overall survival (OS). RESULTS EACs and GACs with high CLDN6 mRNA levels displayed an overexpression of pathways regulating the cell cycle, DNA replication, and receptor / extracellular matrix interactions. CLDN6 protein expression was associated with shorter OS in EAC and GAC, both in treatment-naïve subgroups and cohorts receiving neoadjuvant therapy. In multivariate analysis, CLDN6 protein expression was an independent adverse prognostic factor in EAC associated with a shorter OS (HR: 1.75; p = 0.01) and GAC (HR: 2.74; p = 0.028). CONCLUSIONS High expression of CLDN6 mRNA is associated with the dysregulation of distinct biological pathways regulating cell growth, proliferation, and cell-matrix interactions. Clinically, the expression of CLDN6 protein is a valuable adverse prognostic marker in EAC and GAC.
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Affiliation(s)
- Adrian Georg Simon
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Su Ir Lyu
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | | | | | | | - Hakan Alakus
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Luca Fahrig
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Zander
- Department of Internal Medicine I, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christiane Josephine Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Wolfgang Schroeder
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Florian Gebauer
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Caselli E, Pelliccia C, Teti V, Bellezza G, Mandarano M, Ferri I, Hartmann K, Laible M, Sahin U, Varga Z, Lupi C, Stracci F, Sidoni A. Looking for more reliable biomarkers in breast cancer: Comparison between routine methods and RT-qPCR. PLoS One 2021; 16:e0255580. [PMID: 34555047 PMCID: PMC8460001 DOI: 10.1371/journal.pone.0255580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/19/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Decades of quality control efforts have raised the standards of immunohistochemistry (IHC), the principle method used for biomarker testing in breast cancer; however, computational pathology and reverse transcription quantitative PCR (RT-qPCR) may also hold promise for additional substantial improvements. METHODS Herein, we investigated discrepancies in the assessment of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and marker of proliferation Ki67 comparing routinely obtained IHC (and FISH) data (ORI) with the results of manual (REV) and semi-automated (DIA) re-evaluation of the original IHC slides and then with RNA expression data from the same tissue block using the MammaTyper® (MT) gene expression assay. RESULTS Correlation for ER and PR was high between ORI IHC and the other three study methods (REV, DIA and RT-qPCR). For HER2, 10 out of 96 discrepant cases can be detected between ORI and REV that involved at least one call in the equivocal category (except for one case). For Ki67, 22 (29.1%) cases were categorized differently by either REV alone (n = 17), DIA alone (n = 15) or both (n = 10) and 28 cases (29.2%) for RT-qPCR. Most of the discrepant Ki67 cases changed from low to high between the original and following assessment and belonged to the intermediate Ki67 expression range (between 9 and 30%). CONCLUSIONS Determination of the breast cancer biomarkers ER, PR, HER2 and Ki67 at the mRNA level shows high degree of correlation with IHC and compares well with correlations between original with subsequent independent manual or semi-automated IHC assessments. The use of methods with wider dynamic range and higher reproducibility such as RT-qPCR may offer more precise assessment of endocrine responsiveness, improve Ki67 standardization and help resolve HER2 cases that remain equivocal or ambiguous by IHC/FISH. In summary, our findings seem to configure RT-qPCR as a complementary method to be used in cases of either equivocal results or presenting, at the traditional determination assays, biomarkers expressions close to the cut-off values.
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Affiliation(s)
- Emanuele Caselli
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Cristina Pelliccia
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Valeria Teti
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Guido Bellezza
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Martina Mandarano
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | - Ivana Ferri
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
| | | | | | - Ugur Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany
| | - Zsuzsanna Varga
- Institute for Pathology and Molecular Pathology, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Fabrizio Stracci
- Umbria Cancer Registry, Perugia, Italy
- Department of Medicine and Surgery, Section of Public Health, University of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy
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Laible M, Aulmann S, Etzrodt A, Schmidt M, Crozier C, Wirtz R, Bayani J, Sahin U, Bartlett JMS. Abstract P3-07-08: Comparison of MammaTyper® RT-qPCR based subtyping with simulated breast cancer prognostic signatures. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current prognostic signatures are based on measurements of numerous targets and require specialized equipment and complex calculations. While the overall prognostic capabilities of the tests may be comparable in ER+/HER2- breast cancer, side by side comparisons of different tests have shown that results differ on the individual patient level (Bartlett et al., JNCI, 2016). Here we determined risk scores and classifications in 160 tumors to the following commercial and academic prognostic tests using a custom gene panel for which the publically available algorithms were trained against the actual commercial test scores: Mammaprint®, Oncotype DX®, Prosigna® including PAM50 subtyping; and academic risk scores: IHC4-like, 95-gene score and the Genomic Grade Index. These trained risk classifiers were compared to the results of the MammaTyper® IVD-kit. Methods: RNA was extracted from FFPE tissue sections and analyzed on the Nanostring nCounter® using a probe set containing all targets and reference genes used in the original signatures (N=199). Nanostring measurements and calculations of simulated risk classifiers were carried out as described previously (Bayani et al., npj Breast Cancer, 2017) and retrained against actual commercial test scores (Bartlett et al., in prep.). MammaTyper® RT-qPCR of ERBB2, ESR1, PGR and MKI67 (normalized to CALM2) was carried out on a separate aliquot of the same RNA sample. St. Gallen surrogate subtypes were assigned based on binary mRNA expression according to pre-defined cutoffs. For calculating pairwise agreements between test categorizations, simulated test results with ternary classification were transformed to binary classifications (IHC4-like: low + int vs. high, Oncotype DX-trained: RS≤25 vs. RS>25, Prosigna-trained ROR-P: low vs. int + high). Comparison of MammaTyper® with simulated risk scores was done on the level of surrogate subtypes and on the level of continuous MKI67 and LRP score values. The MammaTyper® LRP score is a previously developed signature to predict RS ≤25 results with high specificity. Results: Marker positivity rate by RT-qPCR was 83% for ESR1, 72% for PGR, 9% for ERBB2 and 58% for MKI67 based on the pre-specified MammaTyper® cutoffs. The highest rate of low risk results was found for binary RS classification with 68.1% of RS ≤25 samples. MammaTyper® Luminal A-like result was found in 30.6% of samples a rate similar to ROR-P, Genomic Grade Index or MammaPrint-trained low risk results (35.0%, 38.1% and 38.8% respectively). The highest agreement between the simulated risk classifications was observed between binary OncotypeDX-trained RS and IHC4-like classifications with 93.1%. Prosigna-trained (ROR-P) and IHC4-like score had the lowest pairwise agreement with only 65.0% agreement. Oncotype DX-trained and the 95 gene score had the highest concordance to MammaTyper® Luminal A-like subtype with 100% and 96% of Luminal A-like samples classified as RS ≤25 and low risk also by these signatures, respectively. ROC analyses of MammaTyper®MKI67 against binary 95-gene score risk classifier resulted in an AUC of 0.949. The lowest AUC for MKI67 was achieved against simulated MammaPrint-trained classification (AUC=0.874). When applying the LRP score to ROC analysis, almost identical AUCs were achieved for IHC4-like and binary Oncotype DX-trained classifications with AUCs of 0.976 and 0.969 respectively. Conclusion: Low cost local RT-qPCR measurements by MammaTyper® show a high agreement with the scores generated by our Oncotype DX-trained scores. The academic and well validated 95-gene signature agrees well with MammaTyper®MKI67 single gene measurement. Therefore, the locally performed MammaTyper® test may serve as cost effective surrogate for complex prognostic signatures or at least enables a pre-screening for molecularly “obviously” low risk samples.
Citation Format: Mark Laible, Sebastian Aulmann, Alfred Etzrodt, Marcus Schmidt, Cheryl Crozier, Ralph Wirtz, Jane Bayani, Ugur Sahin, John MS Bartlett. Comparison of MammaTyper® RT-qPCR based subtyping with simulated breast cancer prognostic signatures [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-08.
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Affiliation(s)
| | | | | | - Marcus Schmidt
- 3Institute of Molecular Gynecological Oncology, University Medicine Mainz, Mainz, Germany
| | - Cheryl Crozier
- 4Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ralph Wirtz
- 5STRATIFYER Molecular Pathology GmbH, Köln, Germany
| | - Jane Bayani
- 4Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - John MS Bartlett
- 4Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada
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Laible M, Hartmann K, Gürtler C, Anzeneder T, Wirtz R, Weber S, Keller T, Sahin U, Rees M, Ramaswamy A. Impact of molecular subtypes on the prediction of distant recurrence in estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer upon five years of endocrine therapy. BMC Cancer 2019; 19:694. [PMID: 31307414 PMCID: PMC6631550 DOI: 10.1186/s12885-019-5890-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/20/2018] [Accepted: 06/27/2019] [Indexed: 12/24/2022] Open
Abstract
Background Current evidence suggests that patients with Luminal A early breast cancer can skip chemotherapy or extended endocrine therapy, but immunohistochemistry-based biomarker analysis for St Gallen subtyping may not be reproducible. We asked whether RT-qPCR can be used instead to address this clinical question. Methods RNA was extracted from tumor material derived from ER+/HER2- patients receiving adjuvant endocrine treatment for low-risk cancers and was semi-quantified by RT-qPCR with the MammaTyper®. St Gallen subtypes were based on the mRNA expression of ERBB2/HER2, ESR1/ER, PGR/PR and MKI67/Ki67 after dichotomizing at predefined cut-offs. Differences in distant disease-free survival (DDFS) were assessed by Kaplan Meier analysis and Cox regression. Results With a median follow up of 7.8 years, there were ten events in the group of 195 Luminal A-like tumors (5.1%) and 18 events in the remaining 127 tumors (14.1%), consisting mostly of Luminal B-like cases (N = 119). Luminal A-like had significantly better DDFS over the entire follow-up period (HR 0.35, 95% CIs 0.16–0.76, p = 0.0078) with a trend towards reduced probability of recurrences also in the late phase (> 5 years) (HR 0.20, p = 0.052). The survival advantage spanning the entire follow-up period persisted in the pN0 or pN0-N1 subgroups or after correcting for clinicopathological parameters. MKI67 alone significantly predicted for worse DDFS (HR 2.62, 95% CIs 1.24–5.56, p = 0.0088). Conclusions St Gallen Luminal A-like tumors identified by RT-qPCR display markedly low rates of distant recurrence at ten years follow-up. Patients with such tumors could be spared chemotherapy due to the obviously unfavourable benefit/toxicity ratio.
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Affiliation(s)
- Mark Laible
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany.
| | - Kerstin Hartmann
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | - Claudia Gürtler
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | | | - Ralph Wirtz
- Stratifyer Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany
| | - Stephan Weber
- ACOMED Statistik, Fockestraße 57, 04275, Leipzig, Germany
| | - Thomas Keller
- ACOMED Statistik, Fockestraße 57, 04275, Leipzig, Germany
| | - Ugur Sahin
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | - Martin Rees
- Gemeinschaftspraxis für Pathologie, Brustzentrum am St.-Johannes-Hospital, Amalienstraße 21, 44137, Dortmund, Germany
| | - Annette Ramaswamy
- Institut für Pathologie, Universitätsklinikum Giessen und Marburg, Baldingerstraße, 35043, Marburg, Germany
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Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Abstract P4-02-12: Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
During the diagnostic work-up of breast carcinomas, immunohistochemistry (IHC) is the currently used method for assessing the expression of estrogen- (ER) and progesterone-receptors (PR), human epidermal growth factor receptor 2 (HER2) as well as of Ki-67 as a marker of tumor cell proliferation. In this study, we analyzed the concordance of these four breast cancer biomarkers between the RT-qPCR- and IHC-based (evaluated by three independent pathologists) determinations.
Methods
The expression of ER/ESR1, PR/PGR, HER2/ERBB2 and Ki-67/MKI67 was determined in 269 FFPE breast cancer samples with tumor content >20% from Chinese patients. For IHC, the samples were freshly cut, stained and assessed by three independent pathologists using the same scoring methods in a blinded fashion (positivity defined as: ER/PR ≥1%, HER2 >2+ and Ki-67 ≥20%). Measurement of the markers on the mRNA level was done on total RNA extracts prepared from whole tissue sections from the same FFPE blocks using the CE-marked RT-qPCR based IVD MammaTyper® on a Cobas® z480 qPCR cycler. IHC assessments of the three pathologists were compared to each other with regard to concordance of positive/negative results. Subsequently, agreement of RT-qPCR and IHC results for each marker and in samples in which the three pathologists had a consensus positive/negative IHC result was determined. Furthermore, we compared the MammaTyper® assessments from a subset of whole FFPE sections to data obtained from paired samples enriched for invasive carcinoma via macrodissection.
Results
From the 269 samples, 256 were available for final analysis. When excluding cases with discordant IHC callings between the three pathologists (6.0% for ER; 7.4% PR; 4.1% Her2; 17.1% Ki-67)) the concordance to the RT-qPCR determination and consensus IHC-based analysis displayed an excellent agreement for ER (OPA: 95.4%, PPA: 97.5%, NPA: 91.5%, Kappa: 0.897), PR (OPA: 91.1%, PPA: 89.6%, NPA: 93.1%, Kappa: 0.820) and HER2 (OPA: 97.1%, PPA: 91.9%, NPA: 100.0%, Kappa: 0.936). For cancer MKI67 mRNA and Ki-67 protein expression, a lower but still good concordance was found (OPA: 90.1%, PPA: 91.8%, NPA: 83.3%, Kappa: 0.707). In addition, we could demonstrate an excellent agreement of quantitative RT-qPCR measurements between whole surface and paired tumor-enriched samples in 99 Chinese breast cancer patients with R2 of 0.927 for ER, 0.926 for PR, 0.923 for HER2 and 0.908 for KI67. Even under highly standardized IHC scoring conditions, the discordance rates in the RT-qPCR marker callings with 0.0% for ESR1, 5.0% for PGR, 3.0% for ERBB2, 13.1% for MKI67 were lower than disagreements by three pathologists on the identical slide.
Conclusion
Standardized determination of the breast cancer biomarkers ER, PR, HER2 and Ki-67 on the mRNA level shows high concordance to a consensus IHC determined by three experienced pathologists indicating that RT-qPCR may be a valid alternative for determining the four breast cancer biomarkers. In line with previous research we could show on a large set of samples that macrodissection is not required for reliable assessment of the four breast cancer markers in clinical FFPE samples.
Citation Format: Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-12.
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Affiliation(s)
- X Teng
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Xu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - J Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - K Hartmann
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - M Laible
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - R Hipfel
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Y Bai
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Ba
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Z Wu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - RM Wirtz
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Liu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Ugur
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
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Lehr HA, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Abstract P2-07-08: Standardized prediction of Oncotype DX® risk classes by local RT-qPCR. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent results from the prospective validation of the Oncotype DX® recurrence score (RS) have underlined the clinical validity of the assay for the prediction of chemotherapy benefit in ER+/HER2- early stage breast cancer patients. Due to health economic restrictions, some patients have no easy access to the test. A pre-selection of tumor samples may help identify patients with a high likelihood to be spared chemotherapy. Histology and semi-quantitative IHC are hence used to select samples for Oncotype testing, but these suffer from intra- and inter-observer variability, especially for Ki-67 which is a main factor in most RS prediction algorithms. We have established and validated a tool for the prediction of RS risk classes (TAILORx cutoff RS ≤25) based on highly standardized, reproducible and locally performed RT-qPCR measurements of ERBB2, ESR1, PGR and MKI67 mRNA using the CE-marked IVD MammaTyper®.
Methods: Total RNA was extracted from whole surface 10μm sections from FFPE breast cancer samples with a known RS result and a tumor cell content ≥20%. ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR on a CFX96 qPCR cycler using the MammaTyper® kit. A prediction model for an RS ≤25 result was established using multivariable logistic regression. Based on this model and the training data two cutoffs for confident prediction of low chemotherapy benefit patients in a clinical setting were established at 95% and 97.5% specificity. The model and the cutoffs were then fixed and validated in a second, separate set of breast cancer samples. ROC analysis was used to characterize predictive power of the continuous values resulting from the prediction model. Positive and negative predictive values for detection of an RS ≤25 result were also determined on the validation samples using the two pre-defined cutoffs.
Results: The sample set for training of the prediction model encompassed 202 samples including 29 samples (14.4%) with an RS >25. In an initial multivariable model with all four markers, PGR and MKI67 were the strongest predictors while the influence of ESR in the model was lower, but still significant. ERBB2 was no significant predictor in this set of ERBB2 negative samples and was therefore excluded from the final model which was based on three markers only. This three marker model achieved an AUC of 0.920 (95% CI: 0.871-0.968) in the training samples. When applying the fixed model from the training dataset to a second separately collected set of 104 samples containing 20 samples (19.2%) with an RS >25, an AUC of 0.883 (95% CI: 0.810-0.955) was documented. When further applying the two predefined cutoffs established in the training set, 45 and 36 of the 104 validation samples (43.3% and 34.6%) had a predicted low chemotherapy benefit result (RS ≤25). Even with the less stringent cutoff, not a single one of the RS >25 cases from the validation cohort was falsely predicted as RS ≤25 sample.
Conclusion: We have established a highly reliable method for prediction of Oncotype DX® low chemotherapy benefit results based on local and cost effective mRNA measurements. This method enables local pathologies to pre-assess routine samples using a highly precise molecular tool and thereby reserve the Oncotype DX® test for cases with ambiguous cancer biology.
Citation Format: Lehr H-A, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Standardized prediction of Oncotype DX® risk classes by local RT-qPCR [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-08.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - RM Wirtz
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
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7
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Hartmann K, Schlombs K, Laible M, Gürtler C, Schmidt M, Sahin U, Lehr HA. Robustness of biomarker determination in breast cancer by RT-qPCR: impact of tumor cell content, DCIS and non-neoplastic breast tissue. Diagn Pathol 2018; 13:83. [PMID: 30342538 PMCID: PMC6195967 DOI: 10.1186/s13000-018-0760-6] [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: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background Tissue heterogeneity in formalin-fixed paraffin-embedded (FFPE) breast cancer specimens may affect the accuracy of reverse transcription quantitative real-time PCR (RT-qPCR). Herein, we tested the impact of tissue heterogeneity of breast cancer specimen on the RT-qPCR-based gene expression assay MammaTyper®. Methods MammaTyper® quantifies the mRNA expression of the four biomarkers ERBB2, ESR1, PGR, and MKI67. Based on pre-defined cut-off values, this molecular in vitro diagnostic assay permits binary marker classification and determination of breast cancer subtypes as defined by St Gallen 2013. In this study, we compared data from whole FFPE sections with data obtained in paired RNA samples after enrichment for invasive carcinoma via macro- or laser-capture micro-dissection. Results Compared to whole sections, removal of surrounding adipose tissue by macrodissection generated mean absolute 40-ddCq differences of 0.28–0.32 cycles for all four markers, with ≥90% concordant binary classifications. The mean raw marker Cq values in the adipose tissue were delayed by 6 to 7 cycles compared with the tumor-enriched sections, adding a trivial linear fold change of 1.0078 to 1.0156. Comparison of specimens enriched for invasive tumor with whole sections with as few as 20% tumor cell content resulted in mean absolute differences that remained on average below 0.59 Cq. The mean absolute difference between whole sections containing up to 60% ductal carcinoma in situ (DCIS) and specimens after dissection of DCIS was only 0.16–0.25 cycles, although there was a tendency for higher gene expression in DCIS. Observed variations were related to small size of samples and proximity of values to the limit of detection. Conclusion Expression of ESR1, PGR, ERBB2 and MKI67 by MammaTyper® is robust in clinical FFPE samples. Assay performance was unaffected by adipose tissue and was stable in samples with as few as 20% tumor cell content and up to 60% DCIS. Electronic supplementary material The online version of this article (10.1186/s13000-018-0760-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kerstin Hartmann
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany.
| | - Kornelia Schlombs
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | - Mark Laible
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | - Claudia Gürtler
- BioNTech Diagnostics GmbH, An der Goldgrube 12, 55131, Mainz, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ugur Sahin
- BioNTech AG, An der Goldgrube 12, 55131, Mainz, Germany
| | - Hans-Anton Lehr
- Institute of Pathology, Medizin Campus Bodensee, Röntgenstraße 2, 88048, Friedrichshafen, Germany
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Fasching P, Laible M, Weber K, Wirtz R, Denkert C, Schlombs K, Schmatloch S, Camara O, Lück H, Huober J, Karn T, van Mackelenbergh M, Marme F, Müller V, Schem C, Stickeler E, Sahin U, Loibl S, Untch M. Evaluation of the MammaTyper® as a molecular predictor for pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) and outcome in patients with different breast cancer (BC) subtypes. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Fasching P, Laible M, Weber K, Wirtz R, Denkert C, Schlombs K, Schmatloch S, Camara O, Lück H, Huober J, Karn T, van Mackelenbergh M, Marme F, Müller V, Schem C, Stickeler E, Sahin U, Loibl S, Untch M. Validation of the MammaTyper® pathological complete response (pCR)-score as a predictor for response after neoadjuvant chemotherapy (NACT) in patients with early breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Gürtler C, Laible M, Schwabe W, Steinhäuser H, Li X, Liu S, Schlombs K, Sahin U. Transferring a Quantitative Molecular Diagnostic Test to Multiple Real-Time Quantitative PCR Platforms. J Mol Diagn 2018; 20:398-414. [DOI: 10.1016/j.jmoldx.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/16/2018] [Accepted: 02/28/2018] [Indexed: 12/22/2022] Open
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11
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Kuner R, Laible M, Gangi-Maurici S, Walter C, Bender C, Schaefer G, Klocker H, Oed M, Bukur V, Sahin U. PO-324 Detection of high-risk prostate cancer biomarkers by RNA sequencing and qPCR method. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Vollherbst DF, Ulfert C, Neuberger U, Herweh C, Laible M, Nagel S, Bendszus M, Möhlenbruch MA. Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus. AJNR Am J Neuroradiol 2018; 39:1296-1302. [PMID: 29724762 DOI: 10.3174/ajnr.a5651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus. MATERIALS AND METHODS A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed. RESULTS Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms. CONCLUSIONS Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.
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Affiliation(s)
- D F Vollherbst
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - C Ulfert
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - U Neuberger
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - C Herweh
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - M Laible
- Neurology (M.L., S.N.), Heidelberg University Hospital, Heidelberg, Germany
| | - S Nagel
- Neurology (M.L., S.N.), Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
| | - M A Möhlenbruch
- From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.)
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13
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Laible M, Schueler S, Veltkamp R. Response to the letter by Safiri et al. Acta Neurol Scand 2018; 137:371. [PMID: 29392721 DOI: 10.1111/ane.12877] [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: 11/30/2022]
Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schueler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Lehr HA, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Abstract P1-06-11: Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Oncotype DX® recurrence score (RS) has emerged as a recommended risk classifier for patients with ER+/HER2- early-stage breast cancer. While RS is one of the most rigorously studied risk scores, it is also one of the most expensive tests, thus remaining beyond reach for a many patients.
The necessity for an affordable method for estimating risk of recurrence has motivated investigations on the correlation between RS and traditional parameters such as IHC for ER, PR and Ki67. However, semi-quantitative IHC lacks standardization across different laboratories especially for Ki67.
In this study we therefore investigated whether the standardized assessment of HER2, ER, PR, and Ki67 on mRNA level could better serve for prediction of low risk RS cases.
Methods: ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR in extracts from FFPE breast cancer samples using the MammaTyper® test. Complete data for RS, IHC, grading and mRNA measurement was available for 198 samples. Tumor subtypes according to St Gallen surrogate definition from 2013 were assigned based on binary mRNA marker classification (pos/neg) according to pre-defined cut-offs. Subtype results were compared to RS risk classes based on commercial and TAILORx-trial cut-offs. RS low risk classification (RS ≤25) based on four IHC markers and grading was estimated using the online tool breastrecurrenceestimator.onc.jhmi.edu and compared to observed RS classes.
Finally, the prediction of continuous RS values by mRNA or semi-quantitative IHC measurement was compared by linear regression and subsequent ROC analysis of prediction models.
Results: The distribution of RS risk classes in the set of samples with full data was 21% RS 0-10, 39% RS 11-17, 27% RS 18-25, 7% RS 26-30 and 7% RS >30. MammaTyper® called 38% (76) of the samples as Luminal A-like. From these samples 70% and 99% had RS values below 18 and 25 respectively. Only 1 MammaTyper® Luminal A-like sample had an RS >30.
Estimation of RS according to the online tool resulted in classification of 61% (121) of the samples as low risk (RS ≤25). Of these 74% and 98% of samples had observed RS values below 18 and between 18 and 25 respectively. 2 and 1 samples called as low risk by the online tool had an RS of 26-30 and >30 and, respectively.
In linear regression analysis of IHC against RS only PR and Ki67 were significant predictors (p-values <0.0001 and 0.0128) while when using mRNA values ESR1, PGR and MKI67 were found as predictors of RS in the multivariate model (all p-values <0.0001). On a training set (67% of samples) the IHC based prediction model was correlated to the observed RS with an R2 of 0.305 whereas the mRNA based model achieved an R2 of 0.489. When the models were applied to training and validation dataset (33% of samples) for prediction of an RS >25 result, the IHC based model had AUCs of 0.887 and 0.836, respectively, while the mRNA based model achieved AUCs of 0.909 and 0.899, respectively.
Conclusion: mRNA based prediction of RS was considerably better than prediction based on IHC. As Ki67 IHC standardization is reaching its limits, local gene expression measurements with their high degree of standardization could serve as a safer way for prediction of Oncotype low risk results.
Citation Format: Lehr H-A, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-11.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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15
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Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Abstract P3-08-14: Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Estrogen receptor (ER/ESR1), progesterone receptor (PR/PGR) and epidermal growth factor receptor 2 (HER2/ERBB2) are routinely assessed by immunohistochemistry (IHC) during workup of breast cancer samples. The routine use of Ki67 (MKI67) IHC assessment in the context of breast cancer subtyping, however, remains controversial, due to poor reproducibility and lack of standardization.
The MammaTyper® test is an in-vitro diagnostic (IVD) test which measures the expression status of the four breast cancer biomarkers ERBB2, ESR1, PGR and MKI67 on the mRNA level via reverse transcription-quantitative PCR (RT-qPCR) and has demonstrated a high degree of reproducibility in the assessment of the four markers.
In this retrospective analysis we assessed the prognostic power of molecular subtyping by MammaTyper® in archived samples from low risk early breast cancers treated with adjuvant endocrine therapy only.
Methods:
ER+/HER2- (according to initial diagnosis) FFPE breast cancer samples from patients treated with adjuvant endocrine therapy only were obtained from 6 different centers. Tumor cellularity was assessed by H&E staining and RNA was extracted from samples with a tumor cell content of ≥20% using a bead-based RNA purification kit (RNXtract®). Total RNA was then used as input for MammaTyper® RT-qPCR. Expression values were classified as positive or negative for each marker based on predefined cutoff values. Tumor subtypes were assigned to each sample based on the combination of binary (pos/neg) single marker expression status according the St Gallen surrogate subtype definition. Distant disease free survival of Luminal A-like samples vs. samples with other subtypes was assessed by Kaplan Meier analysis and Cox regression using SAS version 9.4.
Results:
The final analysis included 319 samples with sufficient tumor cellularity and RNA content for reliable analysis. The rate of distant recurrence in the analyzed set was 8.5%. Median follow up was 7.8 years. The MammaTyper® test called 60% (192) of samples as Luminal-A-like (4.7% (9) distant events), 37% (119) as Luminal B-like (HER2 negative) (13.4% (16) distant events), 1.3% (4) as Triple negative (ductal) (25% (1) distant events), 0.6% (2) as “not defined according to St Gallen” (ESR1-/PGR+) (50% (1) distant events) and 0.6% (2) as Luminal B-like (HER2 positive) (no distant events).
When comparing Luminal A-like samples with the samples of the other subtypes in survival analysis, Luminal A-like samples had a significantly better distant disease free survival when assessing samples from patients with pN0 status (278) (p=0.0177, HR=0.344 (95% CI 0.137-0.866), pN1 status (0-3 affected nodes) (314) (p=0.0153, HR=0.374 (95% CI 0.163-0.855) as well as for all samples (p=0.0032, HR=0.319 (95% CI 0.143-0.711).
Conclusion:
Determination of HER2, ER, PR and Ki67 mRNA levels allows molecular subtyping according to the St Gallen surrogate subtype definition. Low risk of distant recurrence could be confirmed for the MammaTyper® Luminal A-like samples suggesting that for this patient group endocrine treatment alone may be sufficient. The high degree of standardization of mRNA measurement may drive the use of the Ki67/MKI67 biomarker in routine breast cancer pathology.
Citation Format: Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-14.
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Affiliation(s)
- M Laible
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - K Hartmann
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - C Gürtler
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Anzeneder
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - S Weber
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Keller
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - U Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
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Breyer J, Wirtz RM, Otto W, Laible M, Schlombs K, Erben P, Kriegmair MC, Stoehr R, Eidt S, Denzinger S, Burger M, Hartmann A. Predictive value of molecular subtyping in NMIBC by RT-qPCR of ERBB2, ESR1, PGR and MKI67 from formalin fixed TUR biopsies. Oncotarget 2017; 8:67684-67695. [PMID: 28978063 PMCID: PMC5620203 DOI: 10.18632/oncotarget.18804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/02/2017] [Indexed: 12/21/2022] Open
Abstract
Expression of ESR1, PGR, HER2 and Ki67 is important for risk stratification and therapy in breast cancer. Hormone receptor expression can also be found in MIBC, reflecting luminal and basal subtypes of breast cancer. Thus the purpose was to investigate on the mRNA expression of the aforementioned markers and their prognostic value in pT1 bladder cancer. Retrospective analysis of clinical data and Formalin-Fixed Paraffin-Embedded tissues (FFPE) of patients with stage pT1 NMIBC who underwent transurethral resection of the bladder was performed. mRNA expression was measured by single step RT-qPCR. Relative gene expression was determined by normalization to two housekeeping genes (CALM2, B2M) using the 40-ΔΔCT method. Correlation of mRNA expression with outcome was assessed using Kaplan-Meier analysis and multivariate Cox regression analysis. From overall 302 patients, 255 samples could be analyzed with valid measurements. Subtype distribution was Luminal-A in 11.4%, Luminal-B in 38.8%, triple negative in 36.9% and ERBB2 in 12.9%, respectively. Kaplan-Meier analysis revealed molecular subtyping being statistical significant for RFS (p=0.0408) and PFS (p=0.0039). Luminal-A patients did have the best RFS and PFS. Multivariate analysis revealed molecular subtyping to be significant for PFS (L-R Chi2 of 11.89, p=0.0078). Elevated expression of HER2 was statistically significant for PFS (p=0.0025) and discriminated among G3 tumors a high risk group (60% PFS) from a low risk risk group (90% PFS) after 5 year follow-up (p<0.001). Expression of ESR1, PGR and HER2 has predictive value in stage pT1 NMIBC and reveals potential therapeutic targets.
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Affiliation(s)
- Johannes Breyer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Ralph Markus Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany.,Institute of Pathology at The St Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Regensburg, Germany
| | | | | | - Philipp Erben
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Robert Stoehr
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Eidt
- Institute of Pathology at The St Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Stefan Denzinger
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
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Laible M, Horstmann S, Möhlenbruch M, Schueler S, Rizos T, Veltkamp R. Preexisting cognitive impairment in intracerebral hemorrhage. Acta Neurol Scand 2017; 135:628-634. [PMID: 27502449 DOI: 10.1111/ane.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Preexisting cognitive impairment is a predictor of cognitive decline after ischemic stroke, but evidence in intracerebral hemorrhage (ICH) is limited. We aimed to determine the prevalence of premorbid cognitive impairment in patients with ICH. MATERIALS AND METHODS We included patients with acute ICH. Pre-ICH cognitive impairment was determined based on the results of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) that uses information from close relatives. Patients were assessed as having been cognitively impaired with an IQCODE score of ≥3.44; an IQCODE ≥4.00 indicated pre-ICH dementia. CT and MRI images were reviewed to determine the extent of white matter lesions and to measure the radial width of the temporal horn as marker of brain atrophy. We investigated differences of cardiovascular risk factors and imaging data between patients with and without pre-ICH cognitive impairment using correlation analyses, uni- and multivariable regression models. Functional neurological state was assessed using the modified Rankin Scale (mRS). The mRS was dichotomized at the level of 3, and a premorbid mRS of 0-2 was considered as functional independency. RESULTS Among the 89 participants, median age was 70 years (interquartile range 58-78) and 52 (58.4%) were male. IQCODE indicated pre-ICH cognitive impairment in 18.0% (16 of 89), and 83.1% were functionally independent before ICH. Cognitive impairment was associated with a premorbid mRS≥3 (chi squared test, P=0.009). In multivariable analysis, prior stroke/transient ischemic attack (OR 18.29, 95%-CI 1.945-172.033, P=.011) and hematoma volume (OR 0.90, 95%-CI 0.812-0.991, P=.033) were independently associated with pre-ICH cognitive impairment. CONCLUSIONS In conclusion, cognitive impairment frequently precedes ICH. A higher frequency of cerebrovascular events suggests a role of vascular processes in the development of cognitive impairment before ICH.
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Affiliation(s)
- M. Laible
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - S. Horstmann
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - M. Möhlenbruch
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - S. Schueler
- Institute of Medical Biometry and Informatics; University of Heidelberg; Heidelberg Germany
| | - T. Rizos
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
| | - R. Veltkamp
- Department of Neurology; Heidelberg University Hospital; Heidelberg Germany
- Department of Stroke Medicine; Imperial College London; London UK
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Varga Z, Lebeau A, Bu H, Hartmann A, Penault-Llorca F, Guerini-Rocco E, Schraml P, Symmans F, Stoehr R, Teng X, Turzynski A, von Wasielewski R, Gürtler C, Laible M, Schlombs K, Joensuu H, Keller T, Sinn P, Sahin U, Bartlett J, Viale G. An international reproducibility study validating quantitative determination of ERBB2, ESR1, PGR, and MKI67 mRNA in breast cancer using MammaTyper®. Breast Cancer Res 2017; 19:55. [PMID: 28490348 PMCID: PMC5426065 DOI: 10.1186/s13058-017-0848-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 12/05/2016] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background Accurate determination of the predictive markers human epidermal growth factor receptor 2 (HER2/ERBB2), estrogen receptor (ER/ESR1), progesterone receptor (PgR/PGR), and marker of proliferation Ki67 (MKI67) is indispensable for therapeutic decision making in early breast cancer. In this multicenter prospective study, we addressed the issue of inter- and intrasite reproducibility using the recently developed reverse transcription-quantitative real-time polymerase chain reaction-based MammaTyper® test. Methods Ten international pathology institutions participated in this study and determined messenger RNA expression levels of ERBB2, ESR1, PGR, and MKI67 in both centrally and locally extracted RNA from formalin-fixed, paraffin-embedded breast cancer specimens with the MammaTyper® test. Samples were measured repeatedly on different days within the local laboratories, and reproducibility was assessed by means of variance component analysis, Fleiss’ kappa statistics, and interclass correlation coefficients (ICCs). Results Total variations in measurements of centrally and locally prepared RNA extracts were comparable; therefore, statistical analyses were performed on the complete dataset. Intersite reproducibility showed total SDs between 0.21 and 0.44 for the quantitative single-marker assessments, resulting in ICC values of 0.980–0.998, demonstrating excellent agreement of quantitative measurements. Also, the reproducibility of binary single-marker results (positive/negative), as well as the molecular subtype agreement, was almost perfect with kappa values ranging from 0.90 to 1.00. Conclusions On the basis of these data, the MammaTyper® has the potential to substantially improve the current standards of breast cancer diagnostics by providing a highly precise and reproducible quantitative assessment of the established breast cancer biomarkers and molecular subtypes in a decentralized workup. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0848-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
| | - Annette Lebeau
- Private Group Practice for Pathology and PathoPlan GbR, Lübeck, Germany
| | - Hong Bu
- Department of Pathology and Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Arndt Hartmann
- Institute of Pathology, University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Peter Schraml
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Fraser Symmans
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Stoehr
- Institute of Pathology, University Erlangen-Nürnberg, Erlangen, Germany
| | - Xiaodong Teng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Andreas Turzynski
- Private Group Practice for Pathology and PathoPlan GbR, Lübeck, Germany
| | | | | | | | | | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Peter Sinn
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ugur Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany
| | - John Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research (OICR), Toronto, ON, Canada
| | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
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19
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Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn HP. Abstract P2-05-25: Predictive value of ultra-high ESR1 mRNA expression in early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Quantitative determination of estrogen receptor mRNA expression in luminal breast tumors is predictive for benefit from adjuvant tamoxifen compared to placebo treatment as has been shown in the large randomized NSABP B-14 trial, while protein determination by IHC or LBA is not (Kim et al JCO 2011). Interestingly, the ultrahigh expression of ESR1 mRNA (above ER score 10 by Oncotype test) has been indicative for tamoxifen benefit. This predictive cut-off value of mRNA expression is significantly higher than the diagnostic cut-off (at ER score 6.5). Here we tested wether the ultrahigh expression of ESR1 mRNA determined by commercial MammaTyper® testing is predictive for survival after neoadjuvant chemotherapy treatment of advanced breast cancer.
Materials and Methods
Pretreatment core cut biopsies from n=54 patients with PBC treated within a randomized phase II trial (2) of anthracyline/taxane based NAC with available clinical follow-up information were examined. RNA was extracted from the FFPE sections and ESR1 mRNA from each section was measured by commercial assays. For technical comparison of ESR1 mRNA values by Oncotype DX versus MammaTyper® from n=113 surgical samples were analyzed by both commercial assays in a blinded fashion. Statistical analysis was performed using the SAS JMP® 9.0.0 software.
Results
Quantification of ESR1 mRNA expression after RNA extraction from separate slices of 113 primary breast tumors and determination by different commercial RT-qPCR assays resulted in high correlation of continuous expression results (Spearman r=0,85; p<0,0001). The rate of ESR1 mRNA negative cases by both methods by predefined diagnostic cut-offs was low in this cohort (1/113 and 6/113, respectively) resulting in high concordance for positive ER status by both methods.The median expression of ER score and ESR1 40-DDCq was high (10,2 and 39,8, respectively) and almost exactly at the predictive ER score cut-off. Hence, the Tamoxifen benefit cut-off of ER score 10 by Oncotype is comparable with a 40-DDCqvalue of 39,6 for ESR1 mRNA determination by MammaTyper®, which resembles an ESR1 mRNA expression 3fold above the diagnostic cut-off. In the independent chemotherapy cohort theoptimal discrimination for overall survival could be achieved by an elevated ESR1 mRNA expression exactly at 39,6 resulting in 100% overall survival for ultra-high expressors and 75 % overall survival for lower ESR1 mRNA expression after 5 years (p=0,006).
Conclusion
Previous data suggest that ultrahigh expression of ESR1 mRNA is predictive for improved overall survival and tamoxifen benefit (1). Here we show that ultrahigh expression of ESR1 mRNA is also prognostic in more advanced breast tumors after neoadjuvant chemotherapy. These findings validate the importance of quantitative determination of estrogen receptor expression and substantiate the understanding of receptor expression being a continuous determinant with indication specific cut-off values. Ultrahigh expression of ESR1 seems to identify a distinct subset of luminal breast tumors with superior prognosis and benefit from tamoxifen treatment. These findings warrant further investigation, which are currently being done in independent large breast cancer cohorts.
Citation Format: Wirtz RM, Scheffen I, Marme F, Laible M, Sclombs K, Schumacher C, Schneeweiss A, Eidt S, Sinn H-P. Predictive value of ultra-high ESR1 mRNA expression in early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-25.
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Affiliation(s)
- RM Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - I Scheffen
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - F Marme
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - M Laible
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - K Sclombs
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - C Schumacher
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - A Schneeweiss
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - S Eidt
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
| | - H-P Sinn
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; St. Elisabeth-Hospital Köln-Hohenlnd, Cologne, Germany; National Center for Tumor Diseases, University-Hospital Heidelberg, Heidelberg, Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Pathology at the St. Elisabeth-Hospital Köln-Hohenlind, Cologne, Germany; Unibversity Clinic Heidelberg, Heidelberg, Germany
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Sinn HP, Schneeweiss A, Keller M, Schlombs K, Laible M, Seitz J, Lakis S, Veltrup E, Altevogt P, Eidt S, Wirtz RM, Marmé F. Comparison of immunohistochemistry with PCR for assessment of ER, PR, and Ki-67 and prediction of pathological complete response in breast cancer. BMC Cancer 2017; 17:124. [PMID: 28193205 PMCID: PMC5307758 DOI: 10.1186/s12885-017-3111-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 04/08/2016] [Accepted: 02/04/2017] [Indexed: 12/23/2022] Open
Abstract
Background Proliferation may predict response to neoadjuvant therapy of breast cancer and is commonly assessed by manual scoring of slides stained by immunohistochemistry (IHC) for Ki-67 similar to ER and PgR. This method carries significant intra- and inter-observer variability. Automatic scoring of Ki-67 with digital image analysis (qIHC) or assessment of MKI67 gene expression with RT-qPCR may improve diagnostic accuracy. Methods Ki-67 IHC visual assessment was compared to the IHC nuclear tool (AperioTM) on core biopsies from a randomized neoadjuvant clinical trial. Expression of ESR1, PGR and MKI67 by RT-qPCR was performed on RNA extracted from the same formalin-fixed paraffin-embedded tissue. Concordance between the three methods (vIHC, qIHC and RT-qPCR) was assessed for all 3 markers. The potential of Ki-67 IHC and RT-qPCR to predict pathological complete response (pCR) was evaluated using ROC analysis and non-parametric Mann-Whitney Test. Results Correlation between methods (qIHC versus RT-qPCR) was high for ER and PgR (spearman´s r = 0.82, p < 0.0001 and r = 0.86, p < 0.0001, respectively) resulting in high levels of concordance using predefined cut-offs. When comparing qIHC of ER and PgR with RT-qPCR of ESR1 and PGR the overall agreement was 96.6 and 91.4%, respectively, while overall agreement of visual IHC with RT-qPCR was slightly lower for ER/ESR1 and PR/PGR (91.2 and 92.9%, respectively). In contrast, only a moderate correlation was observed between qIHC and RT-qPCR continuous data for Ki-67/MKI67 (Spearman’s r = 0.50, p = 0.0001). Up to now no predictive cut-off for Ki-67 assessment by IHC has been established to predict response to neoadjuvant chemotherapy. Setting the desired sensitivity at 100%, specificity for the prediction of pCR (ypT0ypN0) was significantly higher for mRNA than for protein (68.9% vs. 22.2%). Moreover, the proliferation levels in patients achieving a pCR versus not differed significantly using MKI67 RNA expression (Mann-Whitney p = 0.002), but not with qIHC of Ki-67 (Mann-Whitney p = 0.097) or vIHC of Ki-67 (p = 0.131). Conclusion Digital image analysis can successfully be implemented for assessing ER, PR and Ki-67. IHC for ER and PR reveals high concordance with RT-qPCR. However, RT-qPCR displays a broader dynamic range and higher sensitivity than IHC. Moreover, correlation between Ki-67 qIHC and RT-qPCR is only moderate and RT-qPCR with MammaTyper® outperforms qIHC in predicting pCR. Both methods yield improvements to error-prone manual scoring of Ki-67. However, RT-qPCR was significantly more specific. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3111-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hans-Peter Sinn
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220-221, 69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Marius Keller
- Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220-221, 69120, Heidelberg, Germany
| | | | - Mark Laible
- BioNTech Diagnostics GmbH, 55131, Mainz, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Sotirios Lakis
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany
| | - Peter Altevogt
- German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sebastian Eidt
- Department of Pathology, St. Elisabeth-Krankenhaus, Werthmannstr. 1c, 50935, Köln, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Köln, Germany.,Department of Pathology, St. Elisabeth-Krankenhaus, Werthmannstr. 1c, 50935, Köln, Germany
| | - Frederik Marmé
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
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Breyer J, Otto W, Wirtz RM, Wullich B, Keck B, Erben P, Kriegmair MC, Stoehr R, Eckstein M, Laible M, Schlombs K, Eidt S, Denzinger S, Burger M, Hartmann A. ERBB2 Expression as Potential Risk-Stratification for Early Cystectomy in Patients with pT1 Bladder Cancer and Concomitant Carcinoma in situ. Urol Int 2016; 98:282-289. [DOI: 10.1159/000453670] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022]
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Laible M, Möhlenbruch M, Horstmann S, Pfaff J, Geis NA, Pleger S, Schüler S, Rizos T, Bendszus M, Veltkamp R. Peri-procedural silent cerebral infarcts after left atrial appendage occlusion. Eur J Neurol 2016; 24:53-57. [PMID: 27647674 DOI: 10.1111/ene.13129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO). METHODS In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs). RESULTS Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0-14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO. CONCLUSIONS This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed.
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Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Horstmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - N A Geis
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Pleger
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Breyer J, Wirtz RM, Laible M, Schlombs K, Erben P, Kriegmair MC, Stoehr R, Eidt S, Denzinger S, Burger M, Hartmann A, Otto W. ESR1, ERBB2, and Ki67 mRNA expression predicts stage and grade of non-muscle-invasive bladder carcinoma (NMIBC). Virchows Arch 2016; 469:547-552. [PMID: 27514658 DOI: 10.1007/s00428-016-2002-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/24/2016] [Accepted: 08/03/2016] [Indexed: 12/21/2022]
Abstract
Pathological staging and grading are crucial for risk assessment in non-muscle-invasive bladder cancer (NMIBC). Molecular grading might support pathological evaluation and minimize interobserver variability. In this study, the well-established breast cancer markers ESR1, PGR, ERBB2, and MKI67 were evaluated as potential molecular markers to support grading and staging in NMIBC. We retrospectively analyzed clinical data and formalin-fixed paraffin-embedded tissues (FFPE) of patients with NMIBC. Messenger RNA (mRNA) expression of the aforementioned markers was measured by single-step reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) using RNA-specific TaqMan assays. Relative gene expression was determined by normalization to two reference genes (CALM2 and B2M) using the 40-ΔΔCT method and correlated to histopathological stage and grade. Pathological assessment was performed by an experienced uropathologist. Statistical analysis was performed using the SAS software JMP 9.0.0 version and GraphPad Prism 5.04. Of 381 cases of NMIBC, samples of 100 pTa and 255 pT1 cases were included in the final study. Spearman rank correlation revealed significant correlations between grade and expression of MKI67 (r = 0.52, p < 0.0001), ESR1 (r = 0.25, p < 0.0001), and ERBB2 (r = 0.18, p = 0.0008). In Mann-Whitney tests, MKI67 was significantly different between all grades (p < 0.0001), while ESR1 (p = 0.0006) and ERBB2 (p = 0.027) were significantly different between G2 and G3. Higher expression of MKI67 (r = 0.49; p < 0.0001), ERBB2 (r = 0.22; p < 0.0001), and ESR1 (r = 0.18; p = 0.0009) mRNA was positively correlated with higher stage. MKI67 (p < 0.0001), ERBB2 (p = 0.0058), and PGR (p = 0.0007) were significantly different between pTa and pT1. In NMIBC expression of ESR1, ERBB2 and MKI67 are significantly different between stage and grade. This potentially provides objective parameters for pathological evaluation.
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Affiliation(s)
- Johannes Breyer
- Department of Urology, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany.
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany.,Institute of Pathology at the St Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | | | | | - Philipp Erben
- Department of Urology, University of Mannheim, Mannheim, Germany
| | | | - Robert Stoehr
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Eidt
- Institute of Pathology at the St Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Stefan Denzinger
- Department of Urology, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
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Laible M, Schlombs K, Kaiser K, Veltrup E, Herlein S, Lakis S, Stöhr R, Eidt S, Hartmann A, Wirtz RM, Sahin U. Technical validation of an RT-qPCR in vitro diagnostic test system for the determination of breast cancer molecular subtypes by quantification of ERBB2, ESR1, PGR and MKI67 mRNA levels from formalin-fixed paraffin-embedded breast tumor specimens. BMC Cancer 2016; 16:398. [PMID: 27389414 PMCID: PMC4936300 DOI: 10.1186/s12885-016-2476-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/30/2016] [Indexed: 01/03/2023] Open
Abstract
Background MammaTyper is a novel CE-marked in vitro diagnostic RT-qPCR assay which assigns routinely processed breast cancer specimens into the molecular subtypes Luminal A-like, Luminal B-like (HER2 positive or negative), HER2 positive (non-luminal) and Triple negative (ductal) according to the mRNA expression of ERBB2, ESR1, PGR and MKI67 and the St Gallen consensus surrogate clinical definition. Until now and regarding formalin-fixed, paraffin-embedded material (FFPE), this has been a task mostly accomplished by immunohistochemistry (IHC). However the discrepancy rates of IHC for the four breast cancer biomarkers are frequently under debate, especially for Ki-67 which carries the highest degree of inter- and even intra-observer variability. Herein we describe a series of studies in FFPE specimens which aim to fully validate the analytical performance of the MammaTyper assay, including the site to site reproducibility of the individual marker measurements. Methods Tumor RNA was extracted with the novel RNXtract RNA extraction kit. Synthetic RNA was used to assess the sensitivity of the RNXtract kit. DNA and RNA specific qPCR assays were used so as to determine analyte specificity of RNXtract. For the assessment of limit of blank, limit of detection, analytical measurement range and PCR efficiency of the MammaTyper kit serial dilutions of samples were used. Analytical precision studies of MammaTyper were built around two different real time PCR platforms and involved breast tumor samples belonging to different subtypes analyzed across multiple sites and under various stipulated conditions. The MammaTyper assay robustness was tested against RNA input variations, alternative extraction methods and tumor cell content. Results Individual assays were linear up to at least 32.33 and 33.56 Cqs (quantification cycles) for the two qPCR platforms tested. PCR efficiency ranged from 99 to 109 %. In qPCR platform 1, estimates for assay specific inter-site standard deviations (SD) were between 0.14 and 0.20 Cqs accompanied by >94 % concordant single marker assignments for all four markers. In platform 2, the inter-site SD estimates were between 0.40 and 0.66 Cqs while the concordance for single marker assignments was >94 % for all four markers. The agreement reached between the two qPCR systems located in one site was 100 % for ERBB2, 96.9 % for ESR1, 97.2 % for PGR and 98.6 % for MKI67. RT-qPCR for individual markers was stable up to a 64-fold dilution for a typical clinical sample. There was no change in assay performance detected at the level of individual markers or subtypes after using different RNA isolation methods. The presence of up to 80 % of surrounding non-tumor tissue including in situ carcinoma did not affect the assay output. Sixteen out of 20 RNXtract eluates yielded more than 50 ng/μl of RNA (average RNA output: 233 ng/μl), whereas DNA contamination per sample was restricted to less than 15 ng/μl. Median recovery rate of RNA extraction was 91.0 %. Conclusions In this study the performance characteristics of MammaTyper were successfully validated. The various sources of analytical perturbations resulted in negligible variations in individual marker assessments. Therefore, MammaTyper may serve as a technical improvement to current standards for decentralized FFPE-based routine assessment of the commonly used breast cancer biomarkers and for molecular subtyping of breast cancer specimens. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2476-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Stefanie Herlein
- Institute of Pathology, University of Erlangen, Erlangen, Germany
| | - Sotiris Lakis
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Robert Stöhr
- Institute of Pathology, University of Erlangen, Erlangen, Germany
| | - Sebastian Eidt
- Institut für Pathologie am St. Elisabeth-Krankenhaus, Cologne, Germany
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen, Erlangen, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Ugur Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany
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Ratz L, Laible M, Altevogt P, Klauck S, Sültmann H. Overexpression of TMPRSS2:ERG variants activates TGF-β signaling and promotes invasion of prostate cancer cells. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wirtz RM, Sihto H, Isola J, Heikkilä P, Kellokumpu-Lehtinen PL, Auvinen P, Turpeenniemi-Hujanen T, Jyrkkiö S, Lakis S, Schlombs K, Laible M, Weber S, Eidt S, Sahin U, Joensuu H. Biological subtyping of early breast cancer: a study comparing RT-qPCR with immunohistochemistry. Breast Cancer Res Treat 2016; 157:437-46. [PMID: 27220750 PMCID: PMC4903103 DOI: 10.1007/s10549-016-3835-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/08/2016] [Accepted: 05/13/2016] [Indexed: 12/23/2022]
Abstract
The biological subtype of breast cancer influences the selection of systemic therapy. Distinction between luminal A and B cancers depends on consistent assessment of Ki-67, but substantial intra-observer and inter-observer variability exists when immunohistochemistry (IHC) is used. We compared RT-qPCR with IHC in the assessment of Ki-67 and other standard factors used in breast cancer subtyping. RNA was extracted from archival breast tumour tissue of 769 women randomly assigned to the FinHer trial. Cancer ESR1, PGR, ERBB2 and MKI67 mRNA content was quantitated with an RT-qPCR assay. Local pathologists assessed ER, PgR and Ki-67 expression using IHC. HER2 amplification was identified with chromogenic in situ hybridization (CISH) centrally. The results were correlated with distant disease-free survival (DDFS) and overall survival (OS). qPCR-based and IHC-based assessments of ER and PgR showed good concordance. Both low tumour MKI67 mRNA (RT-qPCR) and Ki-67 protein (IHC) levels were prognostic for favourable DDFS [hazard ratio (HR) 0.42, 95 % CI 0.25–0.71, P = 0.001; and HR 0.56, 0.37–0.84, P = 0.005, respectively] and OS. In multivariable analyses, cancer MKI67 mRNA content had independent influence on DDFS (adjusted HR 0.51, 95 % CI 0.29–0.89, P = 0.019) while Ki-67 protein expression had not any influence (P = 0.266) whereas both assessments influenced independently OS. Luminal B patients treated with docetaxel-FEC had more favourable DDFS and OS than those treated with vinorelbine-FEC when the subtype was defined by RT-qPCR (for DDFS, HR 0.52, 95 % CI 0.29–0.94, P = 0.031), but not when defined using IHC. Breast cancer subtypes approximated with RT-qPCR and IHC show good concordance, but cancer MKI67 mRNA content correlated slightly better with DDFS than Ki-67 expression. The findings based on MKI67 mRNA content suggest that patients with luminal B cancer benefit more from docetaxel-FEC than from vinorelbine-FEC.
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Affiliation(s)
- Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Cologne, Germany.
| | - Harri Sihto
- Laboratory of Molecular Oncology, Translational Cancer Biology Program, University of Helsinki, Helsinki, Finland
| | - Jorma Isola
- Laboratory of Cancer Biology, Institute of Medical Technology, Tampere, Finland
| | - Päivi Heikkilä
- Department of Pathology, HUSLAB, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Sirkku Jyrkkiö
- Department of Oncology, Turku University Hospital, Turku, Finland
| | - Sotiris Lakis
- STRATIFYER Molecular Pathology GmbH, Werthmannstr. 1c, 50935, Cologne, Germany
| | | | | | | | - Sebastian Eidt
- Institute of Pathology at the St-Elisabeth-Hospital, Cologne, Germany
| | - Ugur Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Wirtz RM, Scheffen I, Marme F, Laible M, Schlombs K, Hake R, Schumacher C, Schneeweiss A, Eidt S, Sinn HP. Predictive value of ultra-high ESR1 mRNA expression in early breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12045] [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: 11/20/2022] Open
Affiliation(s)
| | - Iris Scheffen
- St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Frederik Marme
- National Center for Tumor disease/Department of Gynecology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Roland Hake
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | | | | | - Sebastian Eidt
- Department of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
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Horstmann S, Möhlenbruch M, Wegele C, Rizos T, Laible M, Rauch G, Veltkamp R. Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds. Eur J Neurol 2014; 22:1355-62. [PMID: 25557113 DOI: 10.1111/ene.12608] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/07/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC. METHODS In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa. RESULTS In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001). CONCLUSIONS Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.
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Affiliation(s)
- S Horstmann
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - C Wegele
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Laible
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, University of Heidelberg, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R. Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation. Eur J Neurol 2014; 22:64-9, e4-5. [PMID: 25091540 DOI: 10.1111/ene.12528] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Chronic kidney disease (CKD) is associated with a higher risk of stroke and atrial fibrillation (AF). There are limited data on the comorbidity of renal dysfunction and AF in stroke patients. Our aim was to determine the frequency of kidney dysfunction in ischaemic stroke patients with and without AF. METHODS In a prospectively collected, single center cohort of acute ischaemic stroke and transient ischaemic attack (TIA) patients, glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease equation on admission. Renal function was graded into five categories (cat.): cat. 1, eGRF ≥90 ml/min/1.73 m(2); cat. 2, 60-89; cat. 3, 30-59; cat. 4, 15-29; cat. 5, <15. The diagnosis of AF was based on medical history, a 12-lead electrocardiogram (ECG) and 24-h Holter or continuous ECG monitoring. RESULTS In total, 2274 patients (1727 stroke, 547 TIA; median age 71.0) were included. Median eGFR was 78.6 ml/min/1.73 m(2) (interquartile range 61/95); 21.1% were in cat. 3, 2.1% in cat. 4, 0.7% in cat. 5. In all, 535 patients (23.5%) suffered from AF; 28.0% of these were in cat. 3, 2.6% and 0.8% in cat. 4 and cat. 5, respectively. In multivariable analysis, age [odds ratio (OR) 1.1], diabetes (OR 1.8), heart failure (OR 1.7) and AF (OR 1.4) were independently associated with kidney dysfunction (eGFR < 60). CONCLUSIONS Renal dysfunction is far more common in stroke patients than in the general population and more common in AF-related stroke. These findings may have implications for the choice of anticoagulants.
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Affiliation(s)
- M Laible
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Affiliation(s)
- M Lettau
- Division of Neuroradiology, Department of Neurosurgery, University of Freiburg Medical Center, Breisacher Straße 64, 79106, Freiburg, Germany,
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Lettau M, Laible M. [Paraganglioma of the terminal filum]. ROFO-FORTSCHR RONTG 2012; 185:166-7. [PMID: 23108899 DOI: 10.1055/s-0032-1325432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Börno ST, Fischer A, Kerick M, Fälth M, Laible M, Brase JC, Kuner R, Dahl A, Grimm C, Sayanjali B, Isau M, Röhr C, Wunderlich A, Timmermann B, Claus R, Plass C, Graefen M, Simon R, Demichelis F, Rubin MA, Sauter G, Schlomm T, Sültmann H, Lehrach H, Schweiger MR. Genome-wide DNA methylation events in TMPRSS2-ERG fusion-negative prostate cancers implicate an EZH2-dependent mechanism with miR-26a hypermethylation. Cancer Discov 2012; 2:1024-35. [PMID: 22930729 DOI: 10.1158/2159-8290.cd-12-0041] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Prostate cancer is the second most common cancer among men worldwide. Alterations in the DNA methylation pattern can be one of the leading causes for prostate cancer formation. This study is the first high-throughput sequencing study investigating genome-wide DNA methylation patterns in a large cohort of 51 tumor and 53 benign prostate samples using methylated DNA immunoprecipitation sequencing. Comparative analyses identified more than 147,000 cancer-associated epigenetic alterations. In addition, global methylation patterns show significant differences based on the TMPRSS2-ERG rearrangement status. We propose the hypermethylation of miR-26a as an alternative pathway of ERG rearrangement-independent EZH2 activation. The observed increase in differential methylation events in fusion-negative tumors can explain the tumorigenic process in the absence of genomic rearrangements. SIGNIFICANCE In contrast to TMPRSS2-ERG -rearranged tumors, the pathomechanism for gene fusion-negative tumors is completely unclear. Using a sequencing-based approach, our work uncovers significant global epigenetic alterations in TMPRSS2-ERG gene fusion-negative tumors and provides a mechanistic explanation for the tumor formation process.
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Affiliation(s)
- Stefan T Börno
- Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany
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Lettau M, Laible M. [Mild form of the middle interhemispheric variant of holoprosencephaly]. ROFO-FORTSCHR RONTG 2012; 184:1059-60. [PMID: 22851296 DOI: 10.1055/s-0032-1313046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Lettau
- Neuroradiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
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Laible M, Schoenberg SO, Weckbach S, Lettau M, Winnik E, Bischof J, Franke R, Reiser M, Kramer H. Whole-body MRI and MRA for evaluation of the prevalence of atherosclerosis in a cohort of subjectively healthy individuals. Insights Imaging 2012; 3:485-93. [PMID: 22836780 PMCID: PMC3443278 DOI: 10.1007/s13244-012-0180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/04/2012] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess the prevalence of cardiovascular findings in asymptomatic individuals by means of 1.5-T whole-body magnetic resonance imaging and angiography. Methods A cohort of 138 individuals (118 men, 20 women) with a mean age of 54 years (SD ± 7.55) was referred to whole-body MRI at 1.5-T, including contrast-enhanced whole-body MR angiography (MRA) and cardiac MRI. A total of 2,065/2,070 vessel segments (99.8%) and cardiac function were evaluated. Results Approximately one-fourth of the participating individuals had vascular abnormalities. In 17 subjects (12.3% of all subjects) significant luminal narrowing was observed in at least one vascular segment. Luminal narrowing (mild to severe) was observed in 1 (0.7% of all subjects respectively) of the renal arteries, 7 (5.0%) of the carotid arteries, and 3 (2.2%) of the pelvic and upper leg arteries, and in 17 segments (12.3%) of arteries in the lower leg. In cardiac function and perfusion imaging, wall motion disorders were observed in six patients (4.3%), with additional delayed enhancement and isolated delayed enhancement present in two cases. Functional parameters differed from reference values in 55 cases. Conclusions Even in an asymptomatic cohort of middle-aged predominantly male individuals, atherosclerotic disease is not uncommon and is detectable by whole-body MRI. Main Messages In middle-aged predominantly male individuals, atherosclerotic disease is not uncommon. Even in an asymptomatic collective, approximately one fourth had vascular abnormalities. Using whole-body MR angiography (MRA), 99.8% of 2,070 vessel segments could be evaluated.
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Affiliation(s)
- M Laible
- Department of Clinical Radiology, University Hospital Munich, Grosshadern Campus, Munich, Germany,
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Lettau M, Laible M, Barrows R, Heiland S, Bendszus M, Hähnel S. 3-T contrast-enhanced MR angiography with parallel imaging in cerebral venous and sinus thrombosis. J Neuroradiol 2011; 38:275-82. [DOI: 10.1016/j.neurad.2011.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/18/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
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Lettau M, Laible M. Kallmann-Syndrom mit Hypoplasie der Hypophyse. ROFO-FORTSCHR RONTG 2011; 183:576-8. [DOI: 10.1055/s-0031-1273336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lettau M, Laible M. 3T-diffusionsgewichtete Aufnahmen mit hohen b-Werten bei hyperakuten Hirnstammischämien. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lettau M, Laible M. [A cystic tumor simulating hypophyseal necrosis]. ROFO-FORTSCHR RONTG 2011; 183:858-60. [PMID: 21442566 DOI: 10.1055/s-0031-1273204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lettau M, Laible M. [Colloid cyst in the cavernous sinus]. ROFO-FORTSCHR RONTG 2011; 183:282-4. [PMID: 21274829 DOI: 10.1055/s-0029-1245865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lettau M, Laible M. [Idiopathic hypertrophic pachymeningitis]. ROFO-FORTSCHR RONTG 2010; 182:1013-5. [PMID: 20830653 DOI: 10.1055/s-0029-1245702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lettau M, Laible M. [Rasmussen encephalitis]. ROFO-FORTSCHR RONTG 2010; 183:71-3. [PMID: 20830652 DOI: 10.1055/s-0029-1245701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Laible M, Lettau M. „Akutes Leriche-Syndrom”. ROFO-FORTSCHR RONTG 2010; 182:531-3. [DOI: 10.1055/s-0029-1245325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Laible M, Läppchen CH, Hören M, Mader I, Weiller C, Hamzei F. Was verbirgt sich hinter der Spiegeltherapie? Eine fMRT Studie. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Läppchen CH, Lange R, Laible M, Hören M, Mader I, Weiller C, Hamzei F. Die intrakortikale Inhibition verändert sich durch die „Spiegeltherapie“. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schilling C, Laible M, Läppchen CH, Mader I, Weiller C, Hamzei F. Nervus medianus Stimulation verbessert den Effekt der Spiegeltherapie bei gesunden Probanden: eine fMRT Studie. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hören M, Vry M, Läppchen C, Laible M, Hieß J, Mader I, Weiller C, Hamzei F. Pars opercularis and pars triangularis of the inferior frontal gyrus are active during action observation. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Site directed mutagenesis of whole plasmids is a simple way to create slightly different variations of an original plasmid. With this method the cloned target gene can be altered by substitution, deletion or insertion of a few bases directly into a plasmid. It works by simply amplifying the whole plasmid, in a non PCR-based thermocycling reaction. During the reaction mutagenic primers, carrying the desired mutation, are integrated into the newly synthesized plasmid. In this video tutorial we demonstrate an easy and cost effective way to introduce base substitutions into a plasmid. The protocol works with standard reagents and is independent from commercial kits, which often are very expensive. Applying this protocol can reduce the total cost of a reaction to an eighth of what it costs using some of the commercial kits. In this video we also comment on critical steps during the process and give detailed instructions on how to design the mutagenic primers.
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Affiliation(s)
- Mark Laible
- Department of Biology, Johannes Gutenberg-University Mainz, Germany
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