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Mangal N, Reebye V, Habib N, Sodergren MH. Cannabidiol's cytotoxicity in pancreatic cancer is induced via an upregulation of ceramide synthase 1 and ER stress. J Cannabis Res 2024; 6:22. [PMID: 38720356 PMCID: PMC11077855 DOI: 10.1186/s42238-024-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies with a median 5 year-survival rate of 12%. Cannabidiol (CBD) has been found to exhibit antineoplastic potential and may potentiate the anticancer effects of cytotoxic's such as gemcitabine. CBD therapy has been linked to de novo synthesis of ceramide. The sphingolipid ceramide is a potent tumour suppressor lipid with roles in apoptosis and autophagy. One of the key players involved is ceramide synthase, an enzyme with six isoforms (CerS1-CerS6), reported to have disease prognostic value. Quantitative real time PCR was used to determine mRNA expression levels of ceramide synthase isoforms, GRP78, ATF4 and CHOP. Western blotting was used to analyze protein expression of these markers and knockdown of CerS1 and GRP78 were applied via an siRNA and confirmed by the two mentioned methods. Mice with PDAC xenografts were injected via intraperitoneal method with drugs and tumours were analysed with flow cytometry and processed using H&E and IHC staining. siRNA knockdown of ceramide synthase 1 (CerS1) and analysis point to evidence of a putative CerS1 dependent pathway driven by CBD in activating endoplasmic reticulum (ER) stress target; GRP78. Upon CBD treatment, CerS1 was upregulated and downstream this led to the GRP78/ATF4/CHOP arm of the unfolded protein response (UPR) pathway being activated. In an in vivo model of PDAC in which CerS1 was not upregulated on IHC, there was no observed improvement in survival of animals, however a reduction in tumour growth was observed in combination chemotherapy and CBD group, indicating further investigations in vivo. These findings provide evidence of a potential ceramide induced cytotoxic mechanism of action of CBD in pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Nagina Mangal
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK.
- Systems and Precision Cancer Medicine Team, Division of Molecular Pathology, Institute of Cancer Research, Sutton, SM2 5NG, UK.
| | - Vikash Reebye
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Nagy Habib
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Mikael H Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
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2
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Mizandari M, Gotsiridze E, Keshavarz P, Nezami N, Azrumelashvili T, Nejati SF, Habib N, Chiang J, Raman SS. Endoportal Radiofrequency Ablation and Stent Placement in Patients with Portal Vein Tumor Thrombosis from Hepatocellular Carcinoma: A Study on Feasibility and Safety. J Clin Med 2024; 13:2128. [PMID: 38610893 PMCID: PMC11012252 DOI: 10.3390/jcm13072128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer, with 10-40% of cases involving portal vein tumor thrombosis (PVTT), leading to poor outcomes and a short survival. The effectiveness of PVTT treatment in patients with HCC is still controversial. Methods: This prospective dual-center study cohort comprised 60 patients with HCC and PVTT who underwent PVR-EPRFA-ST using a novel intravascular radiofrequency system followed by vascular stent placement across the PVTT stenosed segment under fluoroscopy guidance. Results: PVR-EPRFA-ST was technically and clinically successful in 54/60 (90%) and 37/54 (68.5%) patients, respectively. The mean tumor size, PVTT length, post-ablation luminal diameter, and median duration of the recanalized PV patency were 8.6 ± 3.4 cm, 4.1 ± 2.1 cm, 10.3 ± 1.8 mm, and 13.4 months. Higher technical and clinical success rates were associated with a longer survival (177 ± 17.3 days, HR: 0.3, 95%CI 0.12-0.71, p = 0.04; and 233 ± 18.3 days, HR: 0.14, 0.07-0.27, p < 0.001). A shorter survival was associated with Child-Pugh C (HR: 2.7, p = 0.04), multiple tumors (HR: 1.81, p = 0.03), and PVTT length (HR: 1.16, p = 0.04). Conclusions: PVR-EPRFA-ST was feasible and effective for the treatment of selected patients with PVTT, especially in patients with Child-Pugh A/B, single tumors, or a shorter PVTT length.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Elene Gotsiridze
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
- School of Science and Technology, The University of Georgia, Tbilisi 0114, Georgia
| | - Nariman Nezami
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
- Georgetown University School of Medicine, Washington, DC 20007, USA
- Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
- The Fischell Department of Bioengineering, University of Maryland College Park, College Park, MD 20742, USA
| | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Seyed Faraz Nejati
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
| | - Jason Chiang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
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Ding H, Kawka M, Gall TMH, Wadsworth C, Habib N, Nicol D, Cunningham D, Jiao LR. Robotic Distal Pancreatectomy Yields Superior Outcomes Compared to Laparoscopic Technique: A Single Surgeon Experience of 123 Consecutive Cases. Cancers (Basel) 2023; 15:5492. [PMID: 38001752 PMCID: PMC10669937 DOI: 10.3390/cancers15225492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed and compared with regard to short-term outcomes. A total of 62 consecutive LDP cases and 61 RDP cases were performed. There was more conversion to open surgeries in the laparoscopic group compared with the robotic group (21.0% vs. 1.6%, p = 0.001). The LDP group also had a higher rate of postoperative complications (43.5% vs. 23.0%, p = 0.005). However, there was no significant difference between the two groups in terms of major complication or pancreatic fistular after operations (p = 0.20 and p = 0.71, respectively). For planned spleen-preserving operations, the RDP group had a shorter mean operative time (147 min vs. 194 min, p = 0.015) and a reduced total length of hospital stay compared with the LDP group (4 days vs. 7 days, p = 0.0002). The failure rate for spleen preservation was 0% in RDP and 20% (n = 5/25) in the LDP group (p = 0.009). RDP offered a better method for splenic preservation with Kimura's technique compared with LDP to avoid the risk of splenic infarction and gastric varices related to ligation and division of splenic pedicles. RDP should be the standard operation for the resection of pancreatic tumours at the body and tail of the pancreas without involving the celiac axis or common hepatic artery.
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Affiliation(s)
- Hao Ding
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
| | - Michal Kawka
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
| | - Tamara M. H. Gall
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - Chris Wadsworth
- Department of Gastroenterology and Surgery, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; (C.W.); (N.H.)
| | - Nagy Habib
- Department of Gastroenterology and Surgery, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; (C.W.); (N.H.)
| | - David Nicol
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - David Cunningham
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - Long R. Jiao
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
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Clift AK, Drymousis P, von Roon A, Humphries A, Goldin R, Bomanji J, Leaman S, Wasan H, Habib N, Frilling A. Management of Small Bowel Neuroendocrine Tumours: 10 Years' Experience at a Tertiary Referral Centre. Cancers (Basel) 2023; 15:4438. [PMID: 37760408 PMCID: PMC10526159 DOI: 10.3390/cancers15184438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. METHOD Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. RESULTS 154 patients were identified, with a median age of 64 years (range 33-87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1-310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9-94.7%) and 82.5% (95% CI: 72.9-88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0-70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4-26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. CONCLUSIONS Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.
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Affiliation(s)
- Ashley K. Clift
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK; (A.K.C.)
- CRUK Oxford Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Panagiotis Drymousis
- Department of Surgery, Ealing Hospital, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Alexander von Roon
- Department of Surgery, University College London Hospitals NHS Foundation Trust London, London NW1 2BU, UK
| | - Adam Humphries
- Department of Gastroenterology, St Mark’s Hospital, London North West University Health Care NHS Trust, London HA1 3UJ, UK
| | - Robert Goldin
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK; (A.K.C.)
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust London, London NW1 2BU, UK
| | - Sydney Leaman
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 8WA, UK
| | - Harpreet Wasan
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK; (A.K.C.)
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK; (A.K.C.)
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK; (A.K.C.)
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Habib N, Centini G, Klebanoff JS, Fernandes R, Giorgi M, Moawad GN, Bakar J. Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression. Facts Views Vis Obgyn 2023; 15:181-187. [PMID: 37436058 PMCID: PMC10410660 DOI: 10.52054/fvvo.15.2.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient's clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.
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Keshavarz P, Mizandari M, Gotsiridze E, Azrumelashvili T, Habib N, McWilliams J, Lu D, Raman S. Abstract No. 84 Endoportal RFA Followed by Stent Implantation in Hepatocellular Carcinoma with Portal Vein Thrombosis: Feasibility and Clinical Outcomes. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.131] [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: 02/27/2023] Open
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7
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da Costa AC, Martins CR, Habib N. Hepatic Endometriosis. J Gastrointest Surg 2022; 26:2396-2398. [PMID: 35819664 DOI: 10.1007/s11605-021-05156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Adriano Carneiro da Costa
- Department of Hepatobiliary Surgery, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | - Camila Ramos Martins
- Department of Hepatobiliary Surgery, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Nagy Habib
- Department of Hepatobiliary Surgery, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Toria N, Kikodze N, Janikashvili N, Pantsulaia I, Mizandari M, Chikovani T, Habib N. A case of improved quality of life in a patient with inoperable pancreatic cancer after repeated RFA. Radiol Case Rep 2022; 17:3607-3610. [PMID: 35923339 PMCID: PMC9340145 DOI: 10.1016/j.radcr.2022.07.017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022] Open
Abstract
Radiofrequency ablation (RFA) has widespread popularity due to its immune-modulation effects in many cancers. Optimal settings to apply RFA in pancreatic cancer, in which the advanced stage of the tumor at the diagnosis makes various therapeutic approaches fail, are still demanding. We report the case of a patient with unresectable pancreatic cancer in which 3 repetitive RFA has been applied over a period of 3 months. Results revealed an improvement in the patient's clinical condition associated with the reduced incidence of CD4+CD45RO+ T lymphocytes and declined TGF-β level in serum. The good quality of life and disease-free survival were maintained for the next months. Booster application of RFA procedure might be a promising option to improve the quality of life in pancreatic cancer patients.
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Affiliation(s)
- Nino Toria
- Department of Immunology, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, Tbilisi, 0186, Georgia
| | - Nino Kikodze
- Department of Immunology, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, Tbilisi, 0186, Georgia
- V. Bakhutashvili Institute of Medical Biotechnology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Nona Janikashvili
- Department of Immunology, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, Tbilisi, 0186, Georgia
- Corresponding author.
| | - Ia Pantsulaia
- Department of Immunology, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, Tbilisi, 0186, Georgia
- V. Bakhutashvili Institute of Medical Biotechnology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Malkhaz Mizandari
- Department of Interventional Radiology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, Tbilisi, 0186, Georgia
| | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK
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Tan C, Ryan B, Gomez V, Hodgson R, Sinigaglia L, Pizza G, Stathaki K, Hegre S, Habib R, Rossi J, Habib N. 477P MTL-STING increases STING expression and potentiates efficacy of checkpoint inhibitor in murine preclinical model. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.605] [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: 11/01/2022] Open
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Xiong Y, Ke R, Zhang Q, Lan W, Yuan W, Chan KNI, Roussel T, Jiang Y, Wu J, Liu S, Wong AST, Shim JS, Zhang X, Xie R, Dusetti N, Iovanna J, Habib N, Peng L, Lee LTO. Small Activating RNA Modulation of the G Protein-Coupled Receptor for Cancer Treatment. Adv Sci (Weinh) 2022; 9:e2200562. [PMID: 35712764 PMCID: PMC9475523 DOI: 10.1002/advs.202200562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/23/2022] [Indexed: 06/15/2023]
Abstract
G protein-coupled receptors (GPCRs) are the most common and important drug targets. However, >70% of GPCRs are undruggable or difficult to target using conventional chemical agonists/antagonists. Small nucleic acid molecules, which can sequence-specifically modulate any gene, offer a unique opportunity to effectively expand drug targets, especially those that are undruggable or difficult to address, such as GPCRs. Here, the authors report for the first time that small activating RNAs (saRNAs) effectively modulate a GPCR for cancer treatment. Specifically, saRNAs promoting the expression of Mas receptor (MAS1), a GPCR that counteracts the classical angiotensin II pathway in cancer cell proliferation and migration, are identified. These saRNAs, delivered by an amphiphilic dendrimer vector, enhance MAS1 expression, counteracting the angiotensin II/angiotensin II Receptor Type 1 axis, and leading to significant suppression of tumorigenesis and the inhibition of tumor progression of multiple cancers in tumor-xenografted mouse models and patient-derived tumor models. This study provides not only a new strategy for cancer therapy by targeting the renin-angiotensin system, but also a new avenue to modulate GPCR signaling by RNA activation.
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Affiliation(s)
- Yunfang Xiong
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
| | - Ran Ke
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
| | - Qingyu Zhang
- Department of Obstetrics and GynaecologyAffiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdong524001China
| | - Wenjun Lan
- Aix Marseille UniversitéCNRSCentre Interdisciplinaire de Nanoscience de Marseille (UMR 7325)Equipe Labellisée Ligue Contre le CancerMarseille13288France
- Centre de Recherche en Cancérologie de Marseille (CRCM)INSERM U1068CNRSAix‐Marseille Université and Institut Paoli‐CalmettesMarseille13288France
| | - Wanjun Yuan
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
| | - Karol Nga Ieng Chan
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
| | - Tom Roussel
- Aix Marseille UniversitéCNRSCentre Interdisciplinaire de Nanoscience de Marseille (UMR 7325)Equipe Labellisée Ligue Contre le CancerMarseille13288France
| | - Yifan Jiang
- Aix Marseille UniversitéCNRSCentre Interdisciplinaire de Nanoscience de Marseille (UMR 7325)Equipe Labellisée Ligue Contre le CancerMarseille13288France
| | - Jing Wu
- Aix Marseille UniversitéCNRSCentre Interdisciplinaire de Nanoscience de Marseille (UMR 7325)Equipe Labellisée Ligue Contre le CancerMarseille13288France
| | - Shuai Liu
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
| | - Alice Sze Tsai Wong
- School of Biological SciencesThe University of Hong KongPokfulam RoadHong KongChina
| | - Joong Sup Shim
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
- MOE Frontiers Science Center for Precision OncologyUniversity of MacauTaipaMacau999078China
| | - Xuanjun Zhang
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
- MOE Frontiers Science Center for Precision OncologyUniversity of MacauTaipaMacau999078China
| | - Ruiyu Xie
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
- MOE Frontiers Science Center for Precision OncologyUniversity of MacauTaipaMacau999078China
| | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille (CRCM)INSERM U1068CNRSAix‐Marseille Université and Institut Paoli‐CalmettesMarseille13288France
| | - Juan Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM)INSERM U1068CNRSAix‐Marseille Université and Institut Paoli‐CalmettesMarseille13288France
| | - Nagy Habib
- Department of Surgery and CancerImperial College LondonLondonW12 0NNUK
- MiNA Therapeutics, Translation & Innovation Hub80 Wood LaneLondonW12 0BZUK
| | - Ling Peng
- Aix Marseille UniversitéCNRSCentre Interdisciplinaire de Nanoscience de Marseille (UMR 7325)Equipe Labellisée Ligue Contre le CancerMarseille13288France
| | - Leo Tsz On Lee
- Cancer CentreFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
- MOE Frontiers Science Center for Precision OncologyUniversity of MacauTaipaMacau999078China
- Centre of Reproduction, Development, and AgingFaculty of Health SciencesUniversity of MacauTaipaMacau999078China
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Antonowicz S, Abbassi-Ghadi N, Bodai Z, Wiggins T, Markar S, Boshier P, Goh YM, Adam M, Lu H, Kudo H, Rosini F, Goldin R, Moralli D, Green C, Peters C, Habib N, Gabra H, Fitzgerald R, Takats Z, Hanna G. P-OGC39 The smell of oesophageal adenocarcinoma: opportunities for tests and treatments. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Exhaled breath analysis is a promising approach for oesophageal adenocarcinoma (OAC) early detection. The biomarkers of interest are low molecular weight metabolites including volatile aldehydes. In this translational study we investigated whether these metabolites originated from a tumoral source, and how this might impact the diagnosis and treatment of OAC patients.
Methods
The investigative strategy was directed by an unbiased informatics screen of metabolic reprogramming in OAC, and validated using complimentary gene expression assays (n = 638, including controls). Mass spectrometric methods were used to quantify corresponding metabolites and putative source compounds at a tissue level (n = 158), and also in exhaled breath for correlative purposes. Targeted in vitro experiments were performed to demonstrate the cause and effect of the proposed model of metabolic reprogramming in OAC.
Results
The unbiased screen and subsequent validation found that reduced aldehyde detoxification is an OAC hallmark. In vitro and in vivo this was associated with endogenous aldehyde accumulation. OAC tissue was generally enriched for volatile aldehydes, including the genotoxins formaldehyde, acetaldehyde, 4-hydroxy-2-nonenal and 2-butenal, and the exhaled biomarker decanal (all P < 0.0001). Decanal concentrations correlated with exhaled concentrations. Considering potential aldehyde sources, the OAC phospholipidome was characterised by desaturated and longer lipid acyls, and these spontaneously generated biomarker aldehyde species at ambient conditions. Enriched genotoxic aldehydes were detectable in base-pairing positions in DNA; this genotoxicity was therapeutically targetable with aldehyde scavengers in vitro.
Conclusions
These data support a model for enriched exhaled aldehydes based on increased production from an altered lipid phenotype, and reduced detoxification. Some aldehydes are non-reactive and thus support non-invasive detection. Others react with DNA and increase local genotoxicity; this process is druggable. These findings have implications for OAC early diagnosis and chemoprevention.
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Affiliation(s)
| | - Nima Abbassi-Ghadi
- Imperial College London, London, United Kingdom
- Royal Surrey County Hospital, Guildford, United Kingdom
| | - Zsolt Bodai
- Imperial College London, London, United Kingdom
| | - Tom Wiggins
- Imperial College London, London, United Kingdom
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | | | | | - Yan Mei Goh
- Imperial College London, London, United Kingdom
| | - Mina Adam
- Imperial College London, London, United Kingdom
| | - Haonan Lu
- Imperial College London, London, United Kingdom
| | - Hiromi Kudo
- Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Nagy Habib
- Imperial College London, London, United Kingdom
| | - Hani Gabra
- Imperial College London, London, United Kingdom
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12
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Desai K, Lawrence PV, Wadsworth C, Mangal N, Habib N, Sadanandam A, Sodergren M. Abstract PO-101: Characterization of longitudinally collected fine needle aspiration biopsies of pancreatic ductal adenocarcinoma upon endoscopic ultrasound guided radiofrequency ablation. Cancer Res 2021. [DOI: 10.1158/1538-7445.panca21-po-101] [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: Most patients with pancreatic ductal adenocarcinoma (PDAC) are metastatic at presentation with dismal prognosis warranting improved systemic therapy options. Longitudinal sampling for assessment of treatment response poses a challenge for validating novel therapies. In this proof-of-principle study, we evaluate the role of endoscopic ultrasound (EUS)-guided serial fine-needle aspiration biopsies (FNABs) to study the mechanism of action of radiofrequency ablation (RFA). Methods: Patients with stage III inoperable PDAC with prior exposure to gemcitabine were selected into ARDEO (ethically approved Phase-II prospective clinical study of EUS-RFA). Post examination, targeted RF was delivered thrice and sequential FNABs of tumor were taken before and after treatment. Transcriptomic profiling of 6 FNABs from 2 patients was performed using a custom NanoString gene panel (144 genes) consisting of cancer and cancer-associated fibroblast (CAFs) subtypes along with immune changes. CAF culture was established from one FNAB and characterised by immunofluorescence and immunoblotting. Results: RFA treatments were well tolerated without any complications and both patients had stable disease immediately after EUS-RFA. Two-course RFA led to upregulation of CD1E gene (participates in antigen presentation) in both, patient 1 and 2 (4.5 and 3.9-fold) compared to baseline. Patient 1 showed increased expression of T cell genes (CD4 – 8.7-fold, CD8 – 35.7-fold), cytolytic function (6.4-fold) and inflammatory response (8-fold) post-RFA. Greater than 2-fold upregulation of CD274 (PDL1), IDO1, PDCD1 and TNFRSF18 (GITR) was observed post 2nd RFA in both the patients. Further, two-course RFA led to increased PDGFRa (4.5 and 9-fold) in both patients along with enrichment of pCAF subtypes B and C in patient 1 and subtypes A, B and D in patient 2. Immunofluorescence staining revealed expression of PDGFRa, aSMA, VIM, POSTN and MYH11 on patient2-derived CAFs post 1st RFA; validated by immunoblotting. Finally, RFA led to downregulation of classical PDA subtype in both patients. Conclusions: This feasibility study validates longitudinal sampling by EUS-FNABs as an appropriate research tool to study tumor microenvironmental changes associated with local pancreatic immunomodulatory techniques like RFA.
Citation Format: Krisha Desai, Patrick Varun Lawrence, Christopher Wadsworth, Nagina Mangal, Nagy Habib, Anguraj Sadanandam, Mikael Sodergren. Characterization of longitudinally collected fine needle aspiration biopsies of pancreatic ductal adenocarcinoma upon endoscopic ultrasound guided radiofrequency ablation [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-101.
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Affiliation(s)
- Krisha Desai
- 1Institute of Cancer Research, London, United Kingdom,
| | | | | | | | - Nagy Habib
- 2Imperial College, London, United Kingdom
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13
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Plummer R, Sodergren M, Pinato D, Sarker D, Reebye V, Spalding D, Raulf N, Sinigaglia L, Talbot T, Cortellini A, D’Alessio A, Tchakov I, Habib R, Rossi J, Habib N. 515 A phase 1 study of myeloid modulating agent MTL-CEBPA in combination with pembrolizumab in adult patients with advanced solid tumours. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundMTL-CEBPA is a novel immunotherapy targeting the myeloid cell lineage which has shown promising clinical activity as monotherapy and combination therapy with tyrosine kinase inhibitors in hepatocellular carcinoma (HCC). Immunosuppressive myeloid cells are associated with worse outcomes to checkpoint inhibitors. Pre-clinical data have shown that MTL-CEBPA potentiates the oncological effect of PD-1 inhibitors.MethodsThis phase 1A/B, first-in-human, open-label, multicenter study evaluates the safety, tolerability, PK, and efficacy of MTL-CEBPA in combination with a pembrolizumab in adult patients with advanced solid tumours across 3 dose cohorts (70mg/98mg/130mg/m2 MTL-CEBPA once weekly for 3 consecutive weeks with final week break per cycle, with 200mg pembrolizumab every 3 weeks). The primary endpoint is safety and ORR; key secondary endpoints include PK, CR rate & DCR. Key inclusion criteria: Patients with advanced solid tumours who have progressed on standard of care therapy or for whom no standard therapy is available, measurable disease, ECOG PS <2, life expectancy >3 months. A dose exploration will determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D).Results10 pts (3 men, 7 women; median age 50.5yrs), all with different tumor types (1 each of triple negative breast, methothelioma, squamous thymic, cholangiocarcinoma, eccrine, fibrolamellar hepatocellular, colorectal, pancreatic and 2 platinum resistant high-grade serous ovarian). 4 pts had ≥4 prior lines of treatment. All pts reported treatment-related AEs, 7 pts reported AEs considered related to MTL-CEBPA only and all were grade 1 or 2. The most common was nausea (n=3) followed by anaemia, headache, insomnia, neutropenia, pyrexia, transaminase increase and ventricular extrasystole (all n=1). Five pts reported AEs considered related to pembrolizumab only, 2AEs in 1 pt only were grade 3 (ALT and AST increases) There were no DLTs, SAEs or AEs leading to discontinuation or to death in the study. Tumor response was evaluated in 9 pts. 2 pts had a PR (epithelioid mesothelioma at 2 months with 83% tumour reduction, pt ongoing at 9 months & serous ovarian cancer at 2 months with 69% reduction in tumour, pt progressed at 6 months). Three pts had SD, 4 pts had PD as BOR, and 4 pts are continuing to receive treatment.ConclusionsMTL-CEBPA in combination with pembrolizumab demonstrated manageable toxicity at the dose levels tested and has shown antitumor activity. MTD was not reached and RP2D was determined at 130mg/m2 on day 1, 8 and 15 of a 28 day cycle. Enrolment into the dose expansion is ongoing.Trial RegistrationThis study was registered with ClinicalTrials.gov, number NCT04105335.Ethics ApprovalThe study was approved by the North East - Newcastle & North Tyneside 2 Research Ethics Committee, approval number 19/NE/0312.
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Abstract
INTRODUCTION Cannabinoids are a group of terpenophenolic compounds derived from the Cannabis sativa L. plant. There is a growing body of evidence from cell culture and animal studies in support of cannabinoids possessing anticancer properties. METHOD A database search of peer reviewed articles published in English as full texts between January 1970 and April 2021 in Google Scholar, MEDLINE, PubMed and Web of Science was undertaken. References of relevant literature were searched to identify additional studies to construct a narrative literature review of oncological effects of cannabinoids in pre-clinical and clinical studies in various cancer types. RESULTS Phyto-, endogenous and synthetic cannabinoids demonstrated antitumour effects both in vitro and in vivo. However, these effects are dependent on cancer type, the concentration and preparation of the cannabinoid and the abundance of receptor targets. The mechanism of action of synthetic cannabinoids, (-)-trans-Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) has mainly been described via the traditional cannabinoid receptors; CB1 and CB2, but reports have also indicated evidence of activity through GPR55, TRPM8 and other ion channels including TRPA1, TRPV1 and TRPV2. CONCLUSION Cannabinoids have shown to be efficacious both as a single agent and in combination with antineoplastic drugs. These effects have occurred through various receptors and ligands and modulation of signalling pathways involved in hallmarks of cancer pathology. There is a need for further studies to characterise its mode of action at the molecular level and to delineate efficacious dosage and route of administration in addition to synergistic regimes.
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Affiliation(s)
- Nagina Mangal
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
- Systems and Precision Cancer Medicine Team, Division of Molecular Pathology, Institute of Cancer Research, London, SM2 5NG, UK
| | - Simon Erridge
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
| | - Nagy Habib
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
| | - Anguraj Sadanandam
- Systems and Precision Cancer Medicine Team, Division of Molecular Pathology, Institute of Cancer Research, London, SM2 5NG, UK
| | - Vikash Reebye
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
| | - Mikael Hans Sodergren
- Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK.
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15
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Hashimoto A, Sarker D, Reebye V, Jarvis S, Sodergren MH, Kossenkov A, Raulf N, Vasara J, Andrikakou P, Meyer T, Huang KW, Plummer R, Chee CE, Spalding D, Pai M, Pinato DJ, Sharma R, Basu B, Palmer D, Ma YT, Habib R, Martirosyan A, Elasri N, Reynaud A, Rossi J, Cobbold M, Habib N, Gabrilovich D. Abstract 1730: Up-regulation of C/EBPα inhibits suppressive activity of myeloid cells and potentiates antitumor response in mice and cancer patients. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Tumor associated macrophages (TAM) and myeloid-derived suppressor cells (MDSC) are widely implicated in the suppression of immune responses in cancer and are associated with negative clinical outcomes. We report that in mouse tumor models, therapeutic up-regulation of the transcriptional factor C/EBPα with small activating RNA (MTL-CEBPA) blocks the suppressive activity of monocytic (M) MDSC and TAM without affecting polymorphonuclear (PMN) MDSC. MTL-CEBPA treatment demonstrated antitumor activity that was dependent on T cells. Combination of MTL-CEBPA and anti-PD1 antibody or with PMN-MDSC targeted therapy resulted in marked antitumor effect. A phase I trial was conducted in 36 patients with advanced hepatocellular carcinoma (HCC). Marked decrease in M-MDSC and the expression of genes and proteins involved in immune suppressive activity of these cells were observed. Combined treatment with MTL-CEBPA and sorafenib resulted in a 27% objective radiological response and three complete responses in patients with virally associated HCC. Tissue biopsies from these patients demonstrated decrease in M2 polarized macrophages within the tumors. Thus, therapeutic up-regulation of C/EBPα inhibited suppressive myeloid cells that resulted in potent antitumor effect in mice and with encouraging clinical response in cancer patients. We are currently recruiting to a multi-centre study of MTL-CEBPA in combination with a PD-1 inhibitor (pembrolizumab) in adult patients with advanced solid tumors (TIMEPOINT - ClinicalTrials.gov Identifier: NCT04105335).
Citation Format: Ayumi Hashimoto, Debashis Sarker, Vikash Reebye, Sheba Jarvis, Mikael H. Sodergren, Andrew Kossenkov, Nina Raulf, Jenni Vasara, Pinelopi Andrikakou, Tim Meyer, Kai-Wen Huang, Ruth Plummer, Cheng Ean Chee, Duncan Spalding, Madhava Pai, David J. Pinato, Rohini Sharma, Bristi Basu, Daniel Palmer, Yuk-Ting Ma, Robert Habib, Anna Martirosyan, Naouel Elasri, Adeline Reynaud, John Rossi, Mark Cobbold, Nagy Habib, Dmitry Gabrilovich. Up-regulation of C/EBPα inhibits suppressive activity of myeloid cells and potentiates antitumor response in mice and cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1730.
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Affiliation(s)
| | | | | | | | | | | | - Nina Raulf
- 4MiNA Therapeutics, London, United Kingdom
| | | | | | - Tim Meyer
- 5University College London Cancer Institute, London, United Kingdom
| | | | - Ruth Plummer
- 7Newcastle University, Newcastle, United Kingdom
| | - Cheng Ean Chee
- 8National University Cancer Institute, Singapore, Singapore
| | | | | | | | | | - Bristi Basu
- 9University of Cambridge, Cambridge, United Kingdom
| | - Daniel Palmer
- 10University of Liverpool, Liverpool, United Kingdom
| | - Yuk-Ting Ma
- 11University of Birmingham & University of Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | | | | | | | | | - John Rossi
- 13Beckman Research Institute of City of Hope, Duarte, CA
| | | | - Nagy Habib
- 3Imperial College, London, United Kingdom
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16
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Adib M, Maayouf RMA, Abdel-Kawy A, Fayek M, Wahba M, Habib N. Neutron transmission and reflection at a copper single crystal / Neutronentransmission und -reflexion an einem Kupfer-Einkristall. KERNTECHNIK 2021. [DOI: 10.1515/kern-1991-560320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Moawad GN, Klebanoff JS, Habib N, Bendifallah S. Colorectal endometriosis: ample data without definitive recommendations. Facts Views Vis Obgyn 2021; 13:3-7. [PMID: 33889855 PMCID: PMC8051188 DOI: 10.52054/fvvo.13.1.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynaecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centres dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.
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Affiliation(s)
- G N Moawad
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC.,The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC
| | - J S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynewood, PA
| | - N Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, Mantes-la-Jolie, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hopitaux de Paris (AP-HP), Sorbonne University, France
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18
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Pinato DJ, Cortellini A, Sukumaran A, Cole T, Pai M, Habib N, Spalding D, Sodergren MH, Martinez M, Dhillon T, Tait P, Thomas R, Ward C, Kocher H, Yip V, Slater S, Sharma R. PRIME-HCC: phase Ib study of neoadjuvant ipilimumab and nivolumab prior to liver resection for hepatocellular carcinoma. BMC Cancer 2021; 21:301. [PMID: 33757459 PMCID: PMC7988931 DOI: 10.1186/s12885-021-08033-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background After liver resection (LR), patients with hepatocellular cancer (HCC) are at high risk of recurrence. There are no approved anti-cancer therapies known to affect such risk, highlighting the acute need for novel systemic therapies to control the probability of disease relapse. Immunotherapy is expanding as a novel treatment option for HCC. Emerging data from cohort 4 of the CA209–040 study, which investigated the safety and preliminary efficacy of nivolumab/ipilimumab co-administration in advanced HCC, suggest that the combination can be delivered safely with an acceptable proportion of reversible grade 3–4 toxicities (27.1%) and a low discontinuation rate (2%) in patients with HCC. Here, we describe the design and rationale of PRIME-HCC, a two-part, multi-centre, phase Ib study to assess safety and bioactivity of the nivolumab/ipilimumab combination prior to LR in early-stage HCC. Methods The study involves an initial safety run-in phase (Part 1) to allow for preliminary safety characterisation within the first 6 patients enrolled and a subsequent expansion (Part 2). Ipilimumab will be administered once only on Day 1. Nivolumab will be administered on Day 1 and Day 22 (± 3 days) for a total of two 21-day cycles (i.e. 6 weeks of treatment). The primary objective of the study is to determine the safety and tolerability of the nivolumab/ipilimumab combination prior to LR. The secondary objective is to preliminarily characterize the efficacy of the combination prior to LR, including objective response rate (ORR) and pathologic response rates. Additional exploratory objectives include preliminary evidence of long-term disease control and to identify predictive correlates of response to the nivolumab/ipilimumab combination in HCC. Discussion The results of this study will help define the positioning of neoadjuvant nivolumab/ipilimumab combination in the perioperative management of HCC, with potential to improve survival outcomes in this patient population. Trial registration EudraCT Number: 2018–000987-27 Clinical trial registry & ID: ClinicalTrials.gov: NCT03682276. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08033-x.
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Affiliation(s)
- David J Pinato
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK. .,Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Via Paolo Solaroli, 17, 28100, Novara, NO, Italy.
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - Ajithkumar Sukumaran
- NIHR Imperial CRF, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Tom Cole
- NIHR Imperial CRF, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Madhava Pai
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Nagy Habib
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Duncan Spalding
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Mikael H Sodergren
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Maria Martinez
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
| | - Tony Dhillon
- Faculty of Health and Medical Sciences, University of Surrey and Department of Oncology, The Royal Surrey Hospital, Egerton Rd, Guildford, GU2 7XX, UK
| | - Paul Tait
- Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Robert Thomas
- Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Caroline Ward
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
| | - Hemant Kocher
- Barts and The London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Vincent Yip
- Barts and The London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sarah Slater
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Rohini Sharma
- Division of Cancer, Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W120HS, London, UK
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19
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Antonowicz S, Bodai Z, Wiggins T, Markar SR, Boshier PR, Goh YM, Adam ME, Lu H, Kudo H, Rosini F, Goldin R, Moralli D, Green CM, Peters CJ, Habib N, Gabra H, Fitzgerald RC, Takats Z, Hanna GB. Endogenous aldehyde accumulation generates genotoxicity and exhaled biomarkers in esophageal adenocarcinoma. Nat Commun 2021; 12:1454. [PMID: 33674602 PMCID: PMC7935981 DOI: 10.1038/s41467-021-21800-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/28/2021] [Indexed: 01/23/2023] Open
Abstract
Volatile aldehydes are enriched in esophageal adenocarcinoma (EAC) patients' breath and could improve early diagnosis, however the mechanisms of their production are unknown. Here, we show that weak aldehyde detoxification characterizes EAC, which is sufficient to cause endogenous aldehyde accumulation in vitro. Two aldehyde groups are significantly enriched in EAC biopsies and adjacent tissue: (i) short-chain alkanals, and (ii) medium-chain alkanals, including decanal. The short-chain alkanals form DNA-adducts, which demonstrates genotoxicity and confirms inadequate detoxification. Metformin, a putative aldehyde scavenger, reduces this toxicity. Tissue and breath concentrations of the medium-chain alkanal decanal are correlated, and increased decanal is linked to reduced ALDH3A2 expression, TP53 deletion, and adverse clinical features. Thus, we present a model for increased exhaled aldehydes based on endogenous accumulation from reduced detoxification, which also causes therapeutically actionable genotoxicity. These results support EAC early diagnosis trials using exhaled aldehyde analysis.
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Affiliation(s)
- Stefan Antonowicz
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zsolt Bodai
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Tom Wiggins
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Yan Mei Goh
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mina E Adam
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Haonan Lu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hiromi Kudo
- Department of Surgery and Cancer, Imperial College London, London, UK
- Centre for Pathology, Imperial College London, London, UK
| | | | - Robert Goldin
- Centre for Pathology, Imperial College London, London, UK
| | - Daniela Moralli
- Chromosome Dynamics Core, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Catherine M Green
- Chromosome Dynamics Core, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Chris J Peters
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hani Gabra
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rebecca C Fitzgerald
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK.
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20
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Qureshi H, Anwar T, Habib N, Ali Q, Haider MZ, Yasmin S, Munazir M, Basit Z, Waseem M. Multiple comparisons of diversity indices invaded by Lantana camara. BRAZ J BIOL 2021; 81:83-91. [PMID: 32236291 DOI: 10.1590/1519-6984.222147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/25/2019] [Indexed: 11/21/2022] Open
Abstract
Current study assessed the impact of Lantana camara invasion on native plant diversity in Pothohar region of Pakistan. The approach used for study was random samplings and comparisons of diversity indices [number of species (S), abundance (N), species richness (R), evenness (Jꞌ), Shannon diversity index (Hꞌ) and Simpson index of dominance (λ)] with two categorical factors i.e., invaded and non-invaded (control). Control plots harboured by an average of 1.74 more species/10m2. The control category was diverse (Hꞌ=2.56) than invaded category (Hꞌ=1.56). The higher value of species richness in control plots shows heterogeneous nature of communities and vice versa in invaded plots. At multivariate scale, ordination (nMDS) and ANOSIM showed significant magnitude of differences between invaded and control plots at all sites. The decrease in studied diversity indices in invaded over control sites indicated that plant communities become less productive due to Lantana invasion.
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Affiliation(s)
- H Qureshi
- Institute of Biological Sciences, Gomal University, Dera Ismail Khan-29050, Pakistan.,Department of Botany, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi-46300, Pakistan
| | - T Anwar
- Department of Botany, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi-46300, Pakistan
| | - N Habib
- Department of Botany, Government College University, Faisalabad-38000, Pakistan
| | - Q Ali
- Department of Botany, Government College University, Faisalabad-38000, Pakistan
| | - M Z Haider
- Department of Botany, Government College University, Faisalabad-38000, Pakistan
| | - S Yasmin
- Department of Botany, Government College for Women University, Sialkot-51310, Pakistan
| | - M Munazir
- Department of Botany, Government College for Women University, Sialkot-51310, Pakistan
| | - Z Basit
- Department of Mathematics & Statistics, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi-46300, Pakistan
| | - M Waseem
- Department of Biology, Allama Iqbal Open University, Islamabad-44000, Pakistan
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21
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Gavriilidis P, Sutcliffe RP, Roberts KJ, Pai M, Spalding D, Habib N, Jiao LR, Sodergren MH. No difference in mortality among ALPPS, two-staged hepatectomy, and portal vein embolization/ligation: A systematic review by updated traditional and network meta-analyses. Hepatobiliary Pancreat Dis Int 2020; 19:411-419. [PMID: 32753333 DOI: 10.1016/j.hbpd.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is an ongoing debate on the feasibility, safety, and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique. The aim of this study was to compare ALPPS, two-staged hepatectomy (TSH), and portal vein embolization (PVE)/ligation (PVL) using updated traditional meta-analysis and network meta-analysis (NMA). DATA SOURCES Electronic databases were used in a systematic literature search. Updated traditional meta-analysis and NMA were performed and compared. Mortality and major morbidity were selected as primary outcomes. RESULTS Nineteen studies including 1200 patients were selected from the pool of 436 studies. Of these patients, 315 (31%) and 702 (69%) underwent ALPPS and portal vein occlusion (PVO), respectively. Ninety-day mortality based on updated traditional meta-analysis, subgroup analysis of the randomized controlled trials (RCTs), and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE, PVL, and TSH cohorts. Moreover, analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts. The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters, time to operation, definitive hepatectomy, and R0 margins rates compared with the PVO cohort. In contrast, 1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort. CONCLUSIONS This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches. Furthermore, two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK.
| | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Keith J Roberts
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Madhava Pai
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Duncan Spalding
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Nagy Habib
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Long R Jiao
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Mikael H Sodergren
- Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
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22
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Argay IM, Lawrence T, Afors K, Centini G, Lazzeri L, Habib N, Amoruso N, Zupi E, Campo R, Wattiez A. 1 vs 3 days laparoscopic suturing courses: is it feasible to design a valid training curriculum? Facts Views Vis Obgyn 2020; 12:163-168. [PMID: 33123691 PMCID: PMC7580269] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Laparoscopic skills are unlikely to be achieved exclusively in the operating theatre, so simulation training has become mandatory to acquire specific psychomotor skills to be merged in a more complex procedure. OBJECTIVE To compare 3-day vs. 1-day laparoscopic suturing courses and to better address participants' needs according to their level of experience. METHODS Observational cohort study conducted between January 2017 and December 2018 including 107 participants amongst which 61 attended a 3-day and 46 the 1-day suturing course. RESULTS Data analysis showed no significant difference in the pre-test suturing scores between the two groups. On each course, when comparing the pre- and post-tests results, the participants reached a statistically significant improvement in both precision and knotting score (p< 0.01). However, when comparing the two types of courses, the data showed a better performance in the post-session test for those attending the 3-day course (p<0.05), as well as a higher mean score improvement (4.7 vs. 2.8; p<0.05) and time needed to complete exercises (-270s vs. -150s; p<0.05). Furthermore, grouping the participants according to their experience, the experts achieved a significantly better improvement attending the 3-day course, when compared to the beginners. CONCLUSIONS Both 3 and 1-day course are successful in improving laparoscopic suturing skills regardless of the participant's experience. However experienced participants benefit more from a longer course while the 1-day one should be dedicated to pre-surgical competences acquisition.
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Affiliation(s)
- IM Argay
- University of Debrecen Clinical Center, Department of Obstetrics and Gynaecology, H-4032 Debrecen, Nagyerdei Krt. 98, Hungary
| | - T Lawrence
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, United Kingdom
| | - K Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, United Kingdom
| | - G Centini
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - L Lazzeri
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - N Habib
- Obstetrics and Gynaecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - N Amoruso
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - E Zupi
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - R Campo
- Life Expert Centre, Tiensevest 168, 3000 Leuven, Belgium
| | - A Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
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23
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Debacker AJ, Voutila J, Catley M, Blakey D, Habib N. Delivery of Oligonucleotides to the Liver with GalNAc: From Research to Registered Therapeutic Drug. Mol Ther 2020; 28:1759-1771. [PMID: 32592692 PMCID: PMC7403466 DOI: 10.1016/j.ymthe.2020.06.015] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
Targeted delivery of oligonucleotides to liver hepatocytes using N-acetylgalactosamine (GalNAc) conjugates that bind to the asialoglycoprotein receptor has become a breakthrough approach in the therapeutic oligonucleotide field. This technology has led to the approval of givosiran for the treatment of acute hepatic porphyria, and there are another seven conjugates in registrational review or phase 3 trials and at least another 21 conjugates at earlier stages of clinical development. This review highlights some of the recent chemical and preclinical advances in this space, leading to a large number of clinical candidates against a diverse range of targets in liver hepatocytes. The review focuses on the use of this delivery system for small interfering RNAs (siRNAs) and antisense molecules that cause downregulation of target mRNA and protein. A number of other approaches such as anti-microRNAs and small activating RNAs are starting to exploit the technology, broadening the potential of this approach for therapeutic oligonucleotide intervention.
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Affiliation(s)
- Alexandre J Debacker
- MiNA Therapeutics, Translation & Innovation Hub, 80 Wood Lane, London W12 0BZ, UK
| | - Jon Voutila
- MiNA Therapeutics, Translation & Innovation Hub, 80 Wood Lane, London W12 0BZ, UK
| | - Matthew Catley
- MiNA Therapeutics, Translation & Innovation Hub, 80 Wood Lane, London W12 0BZ, UK
| | - David Blakey
- MiNA Therapeutics, Translation & Innovation Hub, 80 Wood Lane, London W12 0BZ, UK.
| | - Nagy Habib
- MiNA Therapeutics, Translation & Innovation Hub, 80 Wood Lane, London W12 0BZ, UK; Department of Surgery & Cancer, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, UK
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24
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Sodergren MH, Mangal N, Wasan H, Sadanandam A, Balachandran VP, Jiao LR, Habib N. Immunological combination treatment holds the key to improving survival in pancreatic cancer. J Cancer Res Clin Oncol 2020; 146:2897-2911. [PMID: 32748119 PMCID: PMC7519893 DOI: 10.1007/s00432-020-03332-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/14/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
Advances in surgery, peri-operative care and systemic chemotherapy have not significantly improved the prognosis of pancreatic cancer for several decades. Early clinical trials of immunotherapy have yielded disappointing results proposing other means by which the tumour microenvironment serves to decrease the immune response. Additionally, the emergence of various subtypes of pancreatic cancer has emerged as a factor for treatment responses with immunogenic subtypes carrying a better prognosis. Herein we discuss the reasons for the poor response to checkpoint inhibitors and outline a rationale why combination treatments are likely to be most effective. We review the therapies which could provide optimal synergistic effects to immunotherapy including chemotherapy, agents targeting the stroma, co-stimulatory molecules, vaccinations and methods of immunogenic tumour priming including radiofrequency ablation. Finally, we discuss reasons why peri-operative and in particular neoadjuvant combination treatments are likely to be most effective and should be considered for early clinical trials.
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Affiliation(s)
- M H Sodergren
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK.
| | - N Mangal
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - H Wasan
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - A Sadanandam
- Division of Molecular Pathology, Institute for Cancer Research, London, UK.,Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - V P Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, USA.,David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, USA
| | - L R Jiao
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - N Habib
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
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25
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Sarker D, Plummer R, Meyer T, Sodergren MH, Basu B, Chee CE, Huang KW, Palmer DH, Ma YT, Evans TRJ, Spalding DRC, Pai M, Sharma R, Pinato DJ, Spicer J, Hunter S, Kwatra V, Nicholls JP, Collin D, Nutbrown R, Glenny H, Fairbairn S, Reebye V, Voutila J, Dorman S, Andrikakou P, Lloyd P, Felstead S, Vasara J, Habib R, Wood C, Saetrom P, Huber HE, Blakey DC, Rossi JJ, Habib N. MTL-CEBPA, a Small Activating RNA Therapeutic Upregulating C/EBP-α, in Patients with Advanced Liver Cancer: A First-in-Human, Multicenter, Open-Label, Phase I Trial. Clin Cancer Res 2020; 26:3936-3946. [PMID: 32357963 DOI: 10.1158/1078-0432.ccr-20-0414] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/17/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Transcription factor C/EBP-α (CCAAT/enhancer-binding protein alpha) acts as a master regulator of hepatic and myeloid functions and multiple oncogenic processes. MTL-CEBPA is a first-in-class small activating RNA oligonucleotide drug that upregulates C/EBP-α. PATIENTS AND METHODS We conducted a phase I, open-label, dose-escalation trial of MTL-CEBPA in adults with advanced hepatocellular carcinoma (HCC) with cirrhosis, or resulting from nonalcoholic steatohepatitis or with liver metastases. Patients received intravenous MTL-CEBPA once a week for 3 weeks followed by a rest period of 1 week per treatment cycle in the dose-escalation phase (3+3 design). RESULTS Thirty-eight participants have been treated across six dose levels (28-160 mg/m2) and three dosing schedules. Thirty-four patients were evaluable for safety endpoints at 28 days. MTL-CEBPA treatment-related adverse events were not associated with dose, and no maximum dose was reached across the three schedules evaluated. Grade 3 treatment-related adverse events occurred in nine (24%) patients. In 24 patients with HCC evaluable for efficacy, an objective tumor response was achieved in one patient [4%; partial response (PR) for over 2 years] and stable disease (SD) in 12 (50%). After discontinuation of MTL-CEBPA, seven patients were treated with tyrosine kinase inhibitors (TKIs); three patients had a complete response with one further PR and two with SD. CONCLUSIONS MTL-CEBPA is the first saRNA in clinical trials and demonstrates an acceptable safety profile and potential synergistic efficacy with TKIs in HCC. These encouraging phase I data validate targeting of C/EBP-α and have prompted MTL-CEBPA + sorafenib combination studies in HCC.
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Affiliation(s)
| | - Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tim Meyer
- University College London Cancer Institute, London, United Kingdom
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Bristi Basu
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Cheng Ean Chee
- National University Cancer Institute Singapore, Singapore
| | | | - Daniel H Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool and Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Yuk Ting Ma
- University of Birmingham, Birmingham, United Kingdom
| | - T R Jeff Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Duncan R C Spalding
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Madhava Pai
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rohini Sharma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | | | - Joanna P Nicholls
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- MiNA Therapeutics Ltd., London, United Kingdom
| | | | | | | | | | - Vikash Reebye
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- MiNA Therapeutics Ltd., London, United Kingdom
| | - Jon Voutila
- MiNA Therapeutics Ltd., London, United Kingdom
| | | | - Pinelopi Andrikakou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Peter Lloyd
- King's College London, London, United Kingdom
| | | | | | | | - Chris Wood
- MiNA Therapeutics Ltd., London, United Kingdom
| | - Pal Saetrom
- Department of Clinical and Molecular Medicine, Department of Computer and Information Science, Bioinformatics Core Facility-BioCore, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | | | - John J Rossi
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
- MiNA Therapeutics Ltd., London, United Kingdom
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26
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da Costa AC, Sodergren M, Jayant K, Santa Cruz F, Spalding D, Pai M, Habib N. Radiofrequency combined with immunomodulation for hepatocellular carcinoma: State of the art and innovations. World J Gastroenterol 2020; 26:2040-2048. [PMID: 32536773 PMCID: PMC7267689 DOI: 10.3748/wjg.v26.i17.2040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver tumor and has been considered a very immunogenic tumor. The treatment with radiofrequency ablation (RFA) has been established as the standard ablative therapy for early HCC, and is currently recognized as the main ablative tool for HCC tumors < 5 cm in size; however, progression and local recurrence remain the main disadvantages of this approach. To solve this clinical problem, recent efforts were concentrated on multimodal treatment, combining different strategies, including the combination of RFA and immunotherapy. This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells, significantly reduces the risk of recurrence and improves survival rates compared to RFA alone. This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies, and discuss the need for further research on this topic.
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Combined Modality Therapy/methods
- Disease Progression
- Disease-Free Survival
- Humans
- Immunotherapy/methods
- Liver/immunology
- Liver/pathology
- Liver/surgery
- Liver Neoplasms/immunology
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Lymphocytes, Tumor-Infiltrating/drug effects
- Lymphocytes, Tumor-Infiltrating/immunology
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/prevention & control
- Radiofrequency Ablation/instrumentation
- Radiofrequency Ablation/methods
- Randomized Controlled Trials as Topic
- Review Literature as Topic
- Survival Rate
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Affiliation(s)
- Adriano Carneiro da Costa
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Mikael Sodergren
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Kumar Jayant
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Fernando Santa Cruz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London W12 0NN, United Kingdom
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27
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Theleritis C, Bonaccorso S, Habib N, Stahl D, Gaughran F, Vitoratou S, Atakan Z, Kolliakou A, Gardner Sood P, Dazzan P, Marques T, McGuire P, Greenwood K, Eberhard J, Breedvelt J, Ferracuti S, Di Forti M, Murray R, Smith S. Sexual dysfunction and central obesity in patients with first episode psychosis. Eur Psychiatry 2020; 42:1-7. [DOI: 10.1016/j.eurpsy.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 12/18/2022] Open
Abstract
AbstractBackgroundIn recent years the association between sexual dysfunction (SD) and obesity in the general population has drawn major attention. Although sexual dysfunction is common in psychosis, its relationship with weight gain and obesity remains unclear.AimsTo investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis.MethodSexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist–hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients.ResultsA total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β = 0.36, P = 0.01), higher leptin levels (Std. β = 0.34, P = 0.02), higher waist–hip ratio (Std. β = 0.32, P = 0.04) and lower testosterone levels (Std. β = −0.44, P = 0.002). In contrast, in females, SFQ scores were not associated with any of these factors.ConclusionsWhile sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist–hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.
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28
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Yoon S, Huang KW, Andrikakou P, Vasconcelos D, Swiderski P, Reebye V, Sodergren M, Habib N, Rossi JJ. Targeted Delivery of C/EBPα-saRNA by RNA Aptamers Shows Anti-tumor Effects in a Mouse Model of Advanced PDAC. Mol Ther Nucleic Acids 2019; 18:142-154. [PMID: 31546149 PMCID: PMC6796740 DOI: 10.1016/j.omtn.2019.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/20/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies; it preferentially metastasizes to the liver and is the main cause of death from this disease. In previous studies, small activating RNA against CCAAT/enhancer-binding protein-α (C/EBPα-saRNA) demonstrated efficacy of PDAC in a local subcutaneous tumor model. In this study, we focused on the efficacy of C/EBPα-saRNA in advanced stage PDAC. For targeted delivery, we selected a new anti-transferrin receptor aptamer (TR14), which demonstrated a high binding affinity to target proteins. The TR14 aptamer was internalized with clathrin-mediated endocytosis, distributed in early endosome, late endosome, and lysosome subcellularly. To investigate its anti-tumor effects to advanced PDAC, we conjugated C/EBPα-saRNA to TR14. Treatment of pancreatic cancer cells with the conjugates upregulated expression of C/EBPα and its downstream target p21, and inhibited cell proliferation. For in vivo assays, we established an advanced PDAC mouse model by engrafting luciferase reporter-PANC-1 cells directly into the livers of non-obese diabetic/severe combined immunodeficiency (NOD/SCID) mice. After treatment of aptamer-C/EBPα conjugates, we observed significant reduction of tumor growth in this advanced PDAC mouse model. Combinational treatment of the conjugates with gemcitabine also demonstrated enhanced anti-tumor effects in advanced PDAC. This suggests that aptamer-C/EBPα conjugates could be used as an adjuvant, along with other conventional anti-cancer drugs in advanced PDAC. In conclusion, targeted delivery of C/EBPα-saRNAs by aptamers might have potential therapeutic effects in advanced PDAC.
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Affiliation(s)
- Sorah Yoon
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Kai-Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 10051, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Pinelopi Andrikakou
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | | | - Piotr Swiderski
- DNA/RNA Synthesis Core Facility, Department of Molecular Medicine, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | | | - Mikael Sodergren
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - John J Rossi
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.
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29
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Habib N, Filardo G, Delcogliano M, Arigoni M, Candrian C. An algorithm to avoid missed open-book pelvic fractures. Eur Rev Med Pharmacol Sci 2019; 22:2973-2977. [PMID: 29863239 DOI: 10.26355/eurrev_201805_15052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In polytrauma patients, to limit the pelvic space favouring internal bleeding, the use of pelvic binders is now a standard practice. In case of external pelvic binder placement with anatomic reduction of the symphyseal and sacroiliac joints, delayed diagnosis and missed injuries could occur. The aim of this study is to document the risk of missed diagnosis, as well as to identify a possible algorithm for optimal management of traumatized patients with pelvic binders, in order to reach an early diagnosis of pelvic fractures without additional risks. CASE REPORT We report three cases of open-book pelvic fractures that were initially missed. The external pelvic binders applied had adequately reduced the fractures. The computed tomography on arrival excluded a diastasis of the symphysis pubis. On removal of the pelvic binder and repetition of the radiological imaging, the fractures were evidenced. CONCLUSIONS We have accordingly created an algorithm for polytrauma patients to determine when the pelvic binder should be released before radiological imaging and when repeated radiological imaging should be done. The use of this algorithm in trauma centers will help to reduce the number of missed injuries, and the number of late diagnoses as well as will increase the patient survival rates.
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Affiliation(s)
- N Habib
- Department of Orthopaedics and Traumatology, Lugano Regional Hospital, Switzerland.
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30
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Sodergren M, Tan C, Reebye V, Habib R, Blakey D, Habib N. Targeting myeloid-derived suppressor cells and T cells: Combination treatment with MTL-CEBPA and PD-1 antibody in a mouse syngeneic CT26 model. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Brian BF, Jolicoeur AS, Guerrero CR, Nunez MG, Sychev ZE, Hegre SA, Sætrom P, Habib N, Drake JM, Schwertfeger KL, Freedman TS. Unique-region phosphorylation targets LynA for rapid degradation, tuning its expression and signaling in myeloid cells. eLife 2019; 8:e46043. [PMID: 31282857 PMCID: PMC6660195 DOI: 10.7554/elife.46043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/06/2019] [Indexed: 12/23/2022] Open
Abstract
The activity of Src-family kinases (SFKs), which phosphorylate immunoreceptor tyrosine-based activation motifs (ITAMs), is a critical factor regulating myeloid-cell activation. We reported previously that the SFK LynA is uniquely susceptible to rapid ubiquitin-mediated degradation in macrophages, functioning as a rheostat regulating signaling (Freedman et al., 2015). We now report the mechanism by which LynA is preferentially targeted for degradation and how cell specificity is built into the LynA rheostat. Using genetic, biochemical, and quantitative phosphopeptide analyses, we found that the E3 ubiquitin ligase c-Cbl preferentially targets LynA via a phosphorylated tyrosine (Y32) in its unique region. This distinct mode of c-Cbl recognition depresses steady-state expression of LynA in macrophages derived from mice. Mast cells, however, express little c-Cbl and have correspondingly high LynA. Upon activation, mast-cell LynA is not rapidly degraded, and SFK-mediated signaling is amplified relative to macrophages. Cell-specific c-Cbl expression thus builds cell specificity into the LynA checkpoint.
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Affiliation(s)
- Ben F Brian
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
| | | | - Candace R Guerrero
- College of Biological Sciences Center for Mass Spectrometry and ProteomicsUniversity of MinnesotaMinneapolisUnited States
| | - Myra G Nunez
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
| | - Zoi E Sychev
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
| | - Siv A Hegre
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Pål Sætrom
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
- Department of Computer ScienceNorwegian University of Science and TechnologyTrondheimNorway
| | - Nagy Habib
- Department of Surgery and CancerHammersmith Hospital, Imperial College LondonLondonUnited Kingdom
| | - Justin M Drake
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
- Masonic Cancer CenterUniversity of MinnesotaMinneapolisUnited States
- Department of UrologyUniversity of MinnesotaMinneapolisUnited States
| | - Kathryn L Schwertfeger
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
- Masonic Cancer CenterUniversity of MinnesotaMinneapolisUnited States
- Center for ImmunologyUniversity of MinnesotaMinneapolisUnited States
- Department of Laboratory Medicine and PathologyUniversity of MinnesotaMinneapolisUnited States
| | - Tanya S Freedman
- Department of PharmacologyUniversity of MinnesotaMinneapolisUnited States
- Masonic Cancer CenterUniversity of MinnesotaMinneapolisUnited States
- Center for ImmunologyUniversity of MinnesotaMinneapolisUnited States
- Center for Autoimmune Diseases ResearchUniversity of MinnesotaMinneapolisUnited States
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Sodergren MH, Huang KW, Reebye V, Chee CE, Zacharoulis D, Habib R, Blakey D, Rossi J, Habib N. Abstract 3211: MTL-CEBPA combined with radiofrequency ablation and immunotherapy enhances immunological anti-tumour response in an HCC mouse model. Immunology 2019. [DOI: 10.1158/1538-7445.am2019-3211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Frilling A, Clift AK, Braat AJAT, Alsafi A, Wasan HS, Al-Nahhas A, Thomas R, Drymousis P, Habib N, Tait PN. Radioembolisation with 90Y microspheres for neuroendocrine liver metastases: an institutional case series, systematic review and meta-analysis. HPB (Oxford) 2019; 21:773-783. [PMID: 30733049 DOI: 10.1016/j.hpb.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroendocrine liver metastases are clinically challenging due to their frequent disseminated distribution. This study aims to present a British experience with an emerging modality, radioembolisation with yttrium-90 labelled microspheres, and embed this within a meta-analysis of response and survival outcomes. METHODS A retrospective case series of patients treated with SIR-Spheres (radiolabelled resin microspheres) was performed. Results were included in a systematic review and meta-analysis of published results with glass or resin microspheres. Objective response rate (ORR) was defined as complete or partial response. Disease control rate (DCR) was defined as complete/partial response or stable disease. RESULTS Twenty-four patients were identified. ORR and DCR in the institutional series was 14/24 and 21/24 at 3 months. Overall survival and progression-free survival at 3-years was 77.6% and 50.4%, respectively. There were no grade 3/4 toxicities post-procedure. A fixed-effects pooled estimate of ORR of 51% (95% CI: 47%-54%) was identified from meta-analysis of 27 studies. The fixed-effects weighted average DCR was 88% (95% CI: 85%-90%, 27 studies). CONCLUSION Current data demonstrate evidence of the clinical effectiveness and safety of radioembolisation for neuroendocrine liver metastases. Prospective randomised studies to compare radioembolisation with other liver directed treatment modalities are needed.
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Affiliation(s)
- Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Ashley K Clift
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508, GA Utrecht, the Netherlands
| | - Ali Alsafi
- Department of Imaging, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Harpreet S Wasan
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Adil Al-Nahhas
- Department of Nuclear Medicine, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Robert Thomas
- Department of Imaging, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Panagiotis Drymousis
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Paul N Tait
- Department of Imaging, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
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Habib N, Mahmoodi B, Suttorp M, Kelder J, Tromp S, Sonker U. Long-term Results of Carotid Stenting and Risk Factors in Patients With Severe Carotid Artery Stenosis Undergoing Subsequent Cardiac Surgery. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.12.005] [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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Gall TMH, Gerrard G, Frampton AE, Castellano L, Ahmad R, Habib N, Spalding D, Pai M, Foroni L, Jiao LR. Can we predict long-term survival in resectable pancreatic ductal adenocarcinoma? Oncotarget 2019; 10:696-706. [PMID: 30774772 PMCID: PMC6366827 DOI: 10.18632/oncotarget.26511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/02/2018] [Accepted: 12/12/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Pancreatic ductal adenocarcinoma (PDAC) is an aggressive tumour associated with poor 5-year survival. We aimed to determine factors which differentiate short and long-term survivors and identify a prognostic biomarker. Methods Over a ten-year period, patients with resected PDAC who developed disease recurrence within 12 months (Group I) and those who had no disease recurrence for 24 months (Group II) were identified. Clinicopathological data was analysed. Ion Torrent high-throughput sequencing on DNA extracted from FFPE tumour samples was used to identify mutations. Additionally, peripheral blood samples were analysed for variants in cell-free DNA, circulating tumour cells (CTCs), and microRNAs. Results Multivariable analysis of clinicopathological factors showed that a positive medial resection margin was significantly associated with short disease-free survival (p = 0.007). Group I patients (n = 21) had a higher frequency of the KRAS mutant mean variant allele (16.93% ± 11.04) compared to those in Group II (n = 13; 7.55% ± 5.76, p = 0.0078). Group I patients also trended towards having a KRAS c.35G>A p.Gly12Asp mutation in addition to variants in other genes, such as TP53, CDKN2A, and SMAD4. Mutational status of cell-free DNA, and number of CTCs, was not found to be useful in this study. A circulating miRNA (hsa-miR-548ah-5p) was found to be significantly differentially expressed. Conclusions Medial resection margin status and the frequency of KRAS mutation in the tumour tissue are independent prognostic indicators for resectable PDAC. Circulating miRNA hsa-miR-548ah-5p has the potential to be used as a prognostic biomarker.
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Affiliation(s)
- Tamara M H Gall
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Gareth Gerrard
- Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom.,Current address: Sarah Cannon Molecular Diagnostics, HCA Healthcare UK, London WC1E 6JA, United Kingdom
| | - Adam E Frampton
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Leandro Castellano
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Raida Ahmad
- Department of Histopathology, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Duncan Spalding
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Madhava Pai
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Letizia Foroni
- Department of Histopathology, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
| | - Long R Jiao
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, United Kingdom
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Yoon S, Wu X, Armstrong B, Habib N, Rossi JJ. An RNA Aptamer Targeting the Receptor Tyrosine Kinase PDGFRα Induces Anti-tumor Effects through STAT3 and p53 in Glioblastoma. Mol Ther Nucleic Acids 2018; 14:131-141. [PMID: 30594071 PMCID: PMC6307106 DOI: 10.1016/j.omtn.2018.11.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 01/02/2023]
Abstract
Human glioblastoma (GBM) is the most aggressive malignancy of the CNS, with less than 5% survival. Despite great efforts to find effective therapeutics, current options remain very limited. To develop a targeted cancer therapeutic, we selected RNA aptamers against platelet-derived growth factor receptor α (PDGFRα), which is a receptor tyrosine kinase. One RNA aptamer (PDR3) with high affinity (0.25 nM) showed PDGFRα specificity and was internalized in U251-MG cells. Following treatment with the PDR3 aptamer, expression of the transcription factor STAT3 (signal transducer and activator of transcription 3) was inhibited, whereas the expression of the histone demethylase JMJD3 and the tumor suppressor p53 were upregulated. PDR3 also upregulated serine phosphorylation of p53, which subsequently mediated apoptosis through the death receptors: tumor necrosis factor (TNF)-related apoptosis-inducing ligand receptors 1/2 (TRAIL-R1/R2), Fas-associated via death domain (FADD), and Fas. PDR3 significantly decreased cell viability in a dose-dependent manner. Furthermore, translocation of PDR3 into the nucleus induced hypomethylation at the promoters of cyclin D2. To assess the feasibility of targeted delivery, we conjugated PDR3 aptamer with STAT3-siRNA for a chimera. The PDR3-siSTAT3 chimera successfully inhibited the expression of target genes and showed significant inhibition of cell viability. In summary, our results show that well-tailored RNA aptamers targeting the PDGFRα-STAT3 axis have the potential to act as anti-cancer therapeutics in GBM.
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Affiliation(s)
- Sorah Yoon
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - Xiwei Wu
- Integrative Genomic Core, City of Hope, Duarte, CA 91010, USA
| | | | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - John J Rossi
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA; Irell and Manella Graduate School of Biological Sciences, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA.
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Reccia I, Kumar J, Habib N, Sodergren M. The use of radiofrequency ablation in pancreatic cancer in the midst of the dawn of immuno-oncology. Med Oncol 2018; 35:151. [DOI: 10.1007/s12032-018-1209-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023]
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Mazmishvili K, Jayant K, Janikashvili N, Kikodze N, Mizandari M, Pantsulaia I, Paksashvili N, Sodergren MH, Reccia I, Pai M, Habib N, Chikovani T. Study to evaluate the immunomodulatory effects of radiofrequency ablation compared to surgical resection for liver cancer. J Cancer 2018; 9:3187-3195. [PMID: 30210642 PMCID: PMC6134816 DOI: 10.7150/jca.25084] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Hepatic cancer is a highly lethal tumour with increasing worldwide incidence. These tumours are characterized by the proliferation of malignant cells, generalised immunosuppression and chronic inflammation marked with an increase in inflammatory markers as a neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and overexpression of CD4+CD39+ on T lymphocytes. The studies have outlined immunomodulatory changes in liver cancer patients as the plausible explanation for the better survival. The aim of this pilot study was understand the possible immunomodulatory effect of radiofrequency (RF) energy and liver resection (non-radiofrequency based devices; non-RF device) in relation to NLR, PLR and expression of CD4+CD39+ T lymphocytes and compare the magnitude of these changes. Material and Methods: In the present study, 17 patients with hepatic cancer were prospectively divided into treatment groups radiofrequency ablation (RFA group) and Liver resection using non-RF devices (LR group). A blood sample was collected from each patient, one month before and after the procedure and compared with the blood samples of age-matched healthy volunteers for group wise comparison. The Mann-Whitney U test, Mc Nemar test and Wilcoxon rank test were used for statistical comparisons as appropriate. Results: A decrease in NLR was reported after RFA from 4.7±3.3 to 3.8±1.8 (P=0.283), in contrary to an increase from 3.5±2.8 to 4.5±3.2 (P=0.183) in LR group. Likewise, a decrease was discerned in PLR following RFA from 140.5±79.5 to 137±69.2 respectively (P=0.386) and increase in the LR group from 116±42.2 to 120.8±29 respectively (P=0.391). A significant decrease in CD4+CD39+ lymphocytes from 55.8±13.8 to 24.6±21.1 (P=0.03) was observed in RFA group whilst a significant increase was reported in LR group from 47.6±8.8 to 55.7±33.2 (P=0.38). Conclusion: Studies have shown that decrease in the NLR, PLR and expression of CD4+CD39+ on T lymphocytes as the marker of better survival in hepatic cancer patients and our findings have confirmed that these changes can be induced following application of RF energy. Moreover, this could be the explanation of better survival observed in different studies using RFA or other RF-based devices in comparison to non-RF based liver resection techniques. However, further larger studies are needed to confirm these findings.
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Affiliation(s)
- Ketevan Mazmishvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Kumar Jayant
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nona Janikashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Nino Kikodze
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Malkhaz Mizandari
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Ia Pantsulaia
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Natela Paksashvili
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
- Department of Interventional Radiology, Tbilisi State Medical University, High Technology University Clinic, 0144 Tbilisi, Georgia
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, DuCane Road, W120HS, UK
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
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Wong JK, Seifalian A, Mohseni R, Hamidieh AA, MacLaren RE, Habib N, Seifalian AM. Emerging In Vitro 3D Tumour Models in Nanoparticle-Based Gene and Drug Therapy. Trends Biotechnol 2018; 36:477-480. [DOI: 10.1016/j.tibtech.2018.02.002] [Citation(s) in RCA: 3] [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: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 10/17/2022]
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Kumar J, Reccia I, Sodergren MH, Kusano T, Zanellato A, Pai M, Spalding D, Zacharoulis D, Habib N. Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma. Oncotarget 2018; 9:15732-15739. [PMID: 29644005 PMCID: PMC5884660 DOI: 10.18632/oncotarget.24596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Despite careful patient selection and preoperative investigations curative resection rate (R0) in pancreaticoduodenectomy ranges from 15% to 87%. Here we describe a new palliative approach for pancreaticoduodenectomy using a radiofrequency energy device to ablate tumor in situ in patients undergoing R1/R2 resections for locally advanced pancreatic ductal adenocarcinoma where vascular reconstruction was not feasible. Results There was neither postoperative mortality nor significant morbidity. Each time the ablation lasted less than 15 minutes. Following radiofrequency ablation it was observed that the tumor remnant attached to the vessel had shrunk significantly. In four patients this allowed easier separation and dissection of the ablated tumor from the adherent vessel leading to R1 resection. In the other two patients, the ablated tumor did not separate from vessel due to true tumor invasion and patients had an R2 resection. The ablated remnant part of the tumor was left in situ. Conclusion Whenever pancreaticoduodenectomy with R0 resection cannot be achieved, this new palliative procedure could be considered in order to facilitate resection and enable maximum destruction in remnant tumors. Method Six patients with suspected tumor infiltration and where vascular reconstruction was not warranted underwent radiofrequency-assisted pancreaticoduodenectomy for locally advanced pancreatic ductal adenocarcinoma. Radiofrequency was applied across the tumor vertically 5–10 mm from the edge of the mesenteric and portal veins. Following ablation, the duodenum and the head of pancreas were removed after knife excision along the ablated line. The remaining ablated tissue was left in situ attached to the vessel.
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Affiliation(s)
- Jayant Kumar
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | | | - Nagy Habib
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
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Reccia I, Sodergren MH, Jayant K, Kurz E, Carneiro A, Spalding D, Pai M, Jiao L, Habib N. The journey of radiofrequency-assisted liver resection. Surg Oncol 2018; 27:A16-A18. [PMID: 29449067 DOI: 10.1016/j.suronc.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Kumar Jayant
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Elena Kurz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Adriano Carneiro
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Long Jiao
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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Mizandari M, Kumar J, Pai M, Chikovani T, Azrumelashvili T, Reccia I, Habib N. Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction. J Cancer 2018; 9:629-637. [PMID: 29556320 PMCID: PMC5858484 DOI: 10.7150/jca.23280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Malignant biliary and/or pancreatic obstruction has often encountered in the advanced stages of periampullary and cholangicarcinomas. HabibTM Radiofrequency (RF) ablation has been successfully used in the management of various cancers of liver and pancreas. Percutaneous HPB probe (EMcision Ltd, London, UK) is a new addition to this class of tools. It is an endoluminal Radiofrequency (RF) catheter which works on the principle of ablation and induces coagulative necrosis to recanalize the obstructed duct. The aim of this study is to address the technical details of canalization, feasibilities and outcomes of percutaneous endo-luminal Radiofrequency (RF) catheter in patients with unresectable malignancy with obstructed bile and pancreatic duct (PD). Material and Method: A total of 134 patients with inoperable malignant obstruction of biliary and PD underwent RF based percutaneous endoluminal RF ablation in a tertiary referral centre between December 15th, 2010 to August 7th, 2015. This device was used in a sequential manner with an intent to recanalize the obstructed. Following the initial catheter drainage of the duct, subsequent percutaneous endobiliary RF ablation, the metallic stent was placed to recanalize the obstructed bile and PD secondary to unresectable malignancy under real-time fluoroscopic guidance. Results: The percutaneous RF based ablation of obstructed bile duct and PD with metallic stent placement was successfully achieved in 130 (97.01%) cases. The three failures were noted in cases of biliary obstruction whilst, one with PD obstruction. The patency restored in 124 and patients, where the procedure was successfully completed and revealed clinical improvement reported. Conclusion: The percutaneous endoluminal RF based ablation of obstructed duct with metallic stent placement appeared to be a safe, effective procedure and may improve survival in patients with advanced stage cancer presenting with biliary and PD obstruction. Considering the above mentioned evidence, this modality may stand ahead of stenting alone. This could be considered as viable modality in management of such patients where very limited treatment options are available.
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Affiliation(s)
- M Mizandari
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - J Kumar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Pai
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Chikovani
- Department of Immunology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - T Azrumelashvili
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - I Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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Mudan S, Kumar J, Mafalda NC, Kusano T, Reccia I, Zanallato A, Dalgleish A, Habib N. Case report on the role of radiofrequency-assisted spleen-preserving surgery for splenic metastasis in the era of check-point inhibitors. Medicine (Baltimore) 2017; 96:e9106. [PMID: 29245341 PMCID: PMC5728956 DOI: 10.1097/md.0000000000009106] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE An isolated splenic metastasis is a rare phenomenon noted in advanced stage melanoma. We report the role of radiofrequency (RF) -based splenic-preserving splenectomy in a patient with a solitary splenic metastasis from advanced stage melanoma that was managed with checkpoint inhibitors. PATIENT CONCERNS We report a case of a 60-year-old man who presented with multiple lung metastases and a solitary splenic metastasis with advanced stage melanoma following excision of primary from his trunk 2.3 years back. DIAGNOSIS Considering the diagnosis of advanced stage melanoma with multiple lung metastases and a solitary splenic metastasis, and its ongoing progressive nature. This case was discussed in the tumour board meeting. INTERVENTIONS A decision was made to commence treatment with immunotherapy in the form of PD-1 inhibitor (programmed cell death 1 receptor) pembrolizumab. Follow-up restaging computer tomography (CT) scan of the abdomen and chest showed a significant reduction in the lung and chest wall lesions, but the splenic lesion remained unchanged. Given the lack of response to treatment in the splenic metastasis and the significant decrease in lung metastases, the multidisciplinary team decided that a partial splenectomy combined with continued immunotherapy treatment would be appropriate as the success of immunotherapy was imminent within the splenic preservation. OUTCOMES The postoperative recovery was smooth and the patient was discharged from hospital on the sixth postoperative day with normal platelets and white blood cells. The histopathological analysis of the resected specimen showed a metastatic melanoma with negative margins.At 10-month follow-up after the splenic resection the patient had not experienced further tumour recurrences. LESSONS Spleen-preserving resection for an isolated, solitary splenic metastasis of melanoma is a feasible approach as it not only preserves the ongoing efficacy of checkpoint inhibitors by preserving the physiological T cell milieu, but the immunomodulation properties of RF can produce potentially additional therapeutic benefit.
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Affiliation(s)
| | - Jayant Kumar
- Department of Surgery & Cancer, Imperial College London
| | | | | | | | | | | | - Nagy Habib
- Department of Surgery & Cancer, Imperial College London
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Huang KW, Lee PH, Kusano T, Reccia I, Jayant K, Habib N. Impact of cavitron ultrasonic surgical aspirator (CUSA) and bipolar radiofrequency device (Habib-4X) based hepatectomy for hepatocellular carcinoma on tumour recurrence and disease-free survival. Oncotarget 2017; 8:93644-93654. [PMID: 29212179 PMCID: PMC5706825 DOI: 10.18632/oncotarget.21271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/14/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to evaluate the oncological outcomes of hepatocellular carcinoma patients undergoing liver resection using cavitron ultrasonic surgical aspirator (CUSA) or radiofrequency (RF) based device Habib-4X.
Study Design We prospectively analyzed the data of 280 patients who underwent liver resection for hepatocellular carcinoma at our institution from 2010–2012 with follow up till August 2016. The CUSA was used in the 163 patients whilst Habib-4X in 117 patients. The end points of analysis were oncological outcomes as disease recurrence, disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan–Meier method, which has been compared with all other existing literature on the survival study. Results Compared with CUSA the reported incidence of recurrence was significantly lower, in Habib-4X group; p < 0.01. The median DFS was significantly better in Habib-4X group than CUSA group (50.80 vs 45.87 months, p = 0.03). The median OS was better in Habib-4X group than CUSA group (60.57 vs 57.17 months, p = 0.12) though the lesser difference in OS between the groups might be explained by the use of palliative therapies as TACE, percutaneous RFA, etc. in case of recurrence. Conclusions RF based device Habib-4X, is safe and effective device for resection of hepatocellular carcinoma, in comparison to CUSA with better oncological outcomes, i.e., significantly lesser tumour recurrence and better DFS. This could be explained on the basis of systemic and local immunomodulatory effect involving induction of kupffer cells and effector CD-8 T cells that help in minimizing postoperative complications and bring more advantageous oncological outcomes.
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Affiliation(s)
- Kai-Wen Huang
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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Wong JKL, Mohseni R, Hamidieh AA, MacLaren RE, Habib N, Seifalian AM. Limitations in Clinical Translation of Nanoparticle-Based Gene Therapy. Trends Biotechnol 2017; 35:1124-1125. [PMID: 28822599 DOI: 10.1016/j.tibtech.2017.07.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/24/2017] [Indexed: 12/31/2022]
Abstract
Organic nanoparticle-based (ONP) gene therapy is a potential strategy to cure human cancer. However, there are still many practical barriers before the promising results from in vitro and preclinical studies can be translated to clinical success. We discuss the reasons behind the hesitant uptake by the clinic.
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Affiliation(s)
| | - Rashin Mohseni
- Hematology-Oncology and Stem Cell Transplantation Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Hematology-Oncology and Stem Cell Transplantation Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nagy Habib
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander M Seifalian
- Nanotechnology and Regenerative Medicine Centre (Ltd), The London BioScience Innovation Centre, London, UK.
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Mizandari M, Azrumelashvili T, Kumar J, Habib N. Percutaneous Image-Guided Pancreatic Duct Drainage: Technique, Results and Expected Benefits. Cardiovasc Intervent Radiol 2017; 40:1911-1920. [PMID: 28681224 DOI: 10.1007/s00270-017-1727-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 06/19/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study is to provide a technical detail and feasibility of percutaneous image-guided pancreatic duct (PD) drainage and to discuss its subtleties in a series of patients with obstructed PD. MATERIALS AND METHODS Thirty patients presenting with PD obstruction from pancreatic head tumour or pancreatitis were subjected to percutaneous image-guided PD drainage under a guidance of ultrasound or computed tomography. Following the successful puncture of PD, a locking loop drainage catheter was placed using conventional guidewire techniques under real-time fluoroscopy guidance. RESULTS The percutaneous drainage of obstructed PD was completed in 29 (96.7%) patients as an independent therapeutic intent or as a bridge to further percutaneous procedures. Clinical improvement following drainage was documented by the gradual reduction in clinical symptoms, including pain, nausea and fever and improved blood test results, showing the significant decrease of amylase concentration. The amount of pancreatic fluid drained post procedure was between 300 and 900 mL/day. No major procedure-related complications were observed. Subsequently, 14 of 29 patients underwent further procedures, including endoluminal placement of metal stent with or without radiofrequency ablation, balloon assisted percutaneous descending litholapaxy (BAPDL), endoluminal biopsy and balloon dilatation using the same drainage tract. CONCLUSION The percutaneous PD drainage appears to be a safe and effective procedure. It should be considered in patients with obstructed PD secondary to malignancy, pancreatitis etc., where endoscopic retrograde cannulation has been failed or impracticable. The procedure can also be contemplated either as an independent treatment option or as an initial step for the subsequent therapeutic endoluminal procedures.
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Affiliation(s)
- M Mizandari
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia. .,High Technology Medical Center - University Clinic, 9, Tsinandali St., 0144, Tbilisi, Georgia.
| | - T Azrumelashvili
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - J Kumar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and leading cause of cirrhosis in the United States and developed countries. NAFLD is closely associated with obesity, insulin resistance and metabolic syndrome, significantly contributing to the exacerbation of the latter. Although NAFLD represents the hepatic component of metabolic syndrome, it can also be found in patients prior to their presentation with other manifestations of the syndrome. The pathogenesis of NAFLD is complex and closely intertwined with insulin resistance and obesity. Several mechanisms are undoubtedly involved in its pathogenesis and progression. In this review, we bring together the current understanding of the pathogenesis that makes NAFLD a systemic disease.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Cherif Akladios
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Francesco Virdis
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Madhava Pai
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Nagy Habib
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Duncan Spalding
- Department of Surgery and Cancer Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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Habib N, Reebye V, Zhao X, Voutila J, Habib R, Sætrom P, Huber H, Huang KW, Rossi JJ, Blakey DC. Abstract 1508: MTL-CEBPA activates the transcription factor CEBPalpha leading to inhibition of hepatocellular cancer growth. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1508] [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
CCATT/enhancer binding protein alpha (CEBPA) is a transcription factor that can act as a tumor suppressor. Its expression is downregulated in a number of cancers including hepatocellular carcinoma (HCC). We have investigated the role of CEBPA in models of HCC using small activating RNAs (saRNA) to transcriptionally upregulate its expression.
Three liver tumor cell lines (HepG2, Hep3B, PLCPRF5) were transfected with 20nM CEBPA-saRNAs (CEBPA51). The transcriptional regulation of two key members of the CEBP family: CEBPA and CEBPB and their protein expression level were measured. The impact on cell growth was assessed by way of an SRB and WST-1 assay. To investigate the role of CEBPB in protecting cells from the activity of CEBPA, siRNAs were used to knock down CEBPB. Using i.v. delivery of CEBPA51 oligonucleotide, the impact on tumor growth was investigated in a DEN (N-nitrosodiethylamine) model of liver cancer. Rats were treated with DEN for 7 weeks, followed by a 2 week wash out and then treated with the CEBPA51 (3-4mg/kg) complexed with PAMAM-dendrimers or encapsulated in a nanoparticle formulation (SMARTCLES). The impact on CEBPA mRNA levels in the liver, tumor growth and liver functions (including, bilirubin, ALT and AST) were measured.
Transfection of CEBPA51 into HepG2, Hep3B or PLCPRF5 cells after 72hr led to a significant increase in both CEBPA mRNA (1.7-2.5 fold by qPCR) and protein expression measured by western blot in all 3 cell lines. A significant inhibition in cell growth compared to either PBS or control oligonucleotide was observed in HepG2 and Hep3B but not in PLCPRF5 cells measured by both SRB and WST-1 assays. The levels of CEBPB mRNA and protein, which may act as an antagonist of CEBPA, were found to be higher (1.4-2 fold) in PLCRF5 cells compared to HepG2 and Hep3B cells. Co-transfection of PLCPRF5 cells with siRNAs to CEBPB and CEBPA51 saRNA led to downregulation of CEBPB and senstized the PLCPRF5 cells to growth inhibition by CEBPA51. Administration of CEBPA51 complexed to either dendrimers or encapsulated in SMARTCLES nanoparticle at doses of 3-4mg/kg i.v. over 2 weeks led to a significant elevation of CEBPA mRNA in the liver. This was accompanied by a reduction (80-90%) in the size of DEN induced liver tumour nodules compared to a control oligonucleotide using both delivery vehicles. The antitumor effects following treatment with CEBPA51 using both delivery vehicles were also accompanied by reduction in markers of liver injury (bilirubin, ALT and AST).
These studies support an important role for CEBPA in suppressing progression of HCC. Activation of the CEBPα gene by saRNA leading to restoration of CEBPA levels in the liver represents a promising novel approach for inhibiting the growth of HCC whilst improving normal liver function. The SMARTCLES formulation, MTL-CEBPA, was chosen for clinical development and is currently in a Phase 1 trial in patients with liver cancer (NCT02716012).
Citation Format: Nagy Habib, Vikash Reebye, Xiaoyang Zhao, Jon Voutila, Robert Habib, Pål Sætrom, Hans Huber, Kai-Wen Huang, John J. Rossi, David C. Blakey. MTL-CEBPA activates the transcription factor CEBPalpha leading to inhibition of hepatocellular cancer growth [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1508. doi:10.1158/1538-7445.AM2017-1508
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Affiliation(s)
- Nagy Habib
- 1Imperial College London, London, United Kingdom
| | | | | | - Jon Voutila
- 2MiNA Therapeutics Ltd, London, United Kingdom
| | | | - Pål Sætrom
- 3Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - John J. Rossi
- 6Beckman Research Institute of City of Hope, Duarte, CA
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Reccia I, Kumar J, Kusano T, Zanellato A, Draz A, Spalding D, Habib N, Pai M. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel. Surg Oncol 2017; 26:296-304. [PMID: 28807250 DOI: 10.1016/j.suronc.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Ahmed Draz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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Muppala S, Xiao R, Krukovets I, Verbovetsky D, Yendamuri R, Habib N, Raman P, Plow E, Stenina-Adognravi O. Thrombospondin-4 mediates TGF-β-induced angiogenesis. Oncogene 2017; 36:5189-5198. [PMID: 28481870 PMCID: PMC5589494 DOI: 10.1038/onc.2017.140] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [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: 06/13/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022]
Abstract
TGF-β is a multifunctional cytokine affecting many cell types and implicated in tissue remodeling processes. Due to its many functions and cell-specific effects, the consequences of TGF-β signaling are process-and stage-dependent, and it is not uncommon that TGF-β exerts distinct and sometimes opposing effects on a disease progression depending on the stage and on the pathological changes associated with the stage. The mechanisms underlying cell- and process-specific effects of TGF-β are poorly understood. We are describing a novel pathway that mediates induction of angiogenesis in response to TGF-β1. We found that in endothelial cells (EC) TSP-4, a secreted extracellular matrix (ECM) protein is upregulated in response to TGF-β1 and mediates the effects of TGF-β1 on angiogenesis. Upregulation of TSP-4 does not require the synthesis of new protein, is not caused by decreased secretion of TSP-4, and is mediated by activation of SMAD3. Using Thbs4−/− mice and TSP-4 shRNA, we found that TSP-4 mediated pro-angiogenic functions on cultured EC and angiogenesis in vivo in response to TGF-β1. We observed ~ 3-fold increases in tumor mass and levels of angiogenesis markers in animals injected with TGF-β1, and these effects did not occur in Thbs4−/− animals. Injections of an inhibitor of TGF-β1 signaling SB431542 also decreased the weights of tumors and cancer angiogenesis. Our results from in vivo angiogenesis models and cultured EC document that TSP-4 mediates upregulation of angiogenesis by TGF-β1. Upregulation of pro-angiogenic TSP-4 and selective effects of TSP-4 on EC may contribute to stimulation of tumor growth by TGF-β despite the inhibition of cancer cell proliferation.
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Affiliation(s)
- S Muppala
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - R Xiao
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - I Krukovets
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - D Verbovetsky
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - R Yendamuri
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - N Habib
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - P Raman
- Department of Integrative Medical Sciences, North Ohio Medical University, Rootstown, OH, USA
| | - E Plow
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, OH, USA
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