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Dogra S, Wei J, Wadowski B, Devi-Chou V, Krowsoski L, Shah RR. Terminal Ileum Lipoma Causing Ileocolic Intussusception: A Case Report and Literature Review. Cureus 2023; 15:e49562. [PMID: 38156183 PMCID: PMC10754027 DOI: 10.7759/cureus.49562] [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] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Adult intussusception is much rarer than pediatric intussusception and usually occurs secondary to a pathological lead point, most frequently neoplasm. Terminal ileum lipomas are an infrequent cause of adult ileocolic intussusception but can be seen together with the intussusception on initial imaging evaluation, which can guide appropriate diagnosis and management. We describe a case of a 42-year-old man presenting with 12 hours of severe right lower quadrant pain. CT of the abdomen and pelvis demonstrated an ileocolic intussusception with fat-density lesions within the intussusception as well as in the distal ileum. The patient went to the operating room for laparoscopic ileocolic resection, during which ileo-ileal and ileocolic intussusceptions were identified in the terminal ileum and multiple fatty masses were palpated in the terminal ileum and cecum. Following ileocecectomy, surgical pathology confirmed terminal ileum with intussusception associated with multiple submucosal lipomas. We also review the literature for cases of ileocolic intussusception caused by terminal ileum lipomas. Patients presented with both acute and chronic symptoms, and while CT was the most common modality used for diagnosis, ultrasound and colonoscopy were also able to identify the intussusception. Although the intussusception was initially reduced in two patients, all patients ultimately underwent surgical resection.
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Affiliation(s)
| | - Jason Wei
- Radiology, NYU Langone Health, New York, USA
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Severson DT, Freyaldenhoven S, Wadowski B, Hughes T, Hung YP, Jensen RV, Richards WG, Gustafson CE, Vermilya K, Innocenti S, Barlow JS, Cougar MB, Anderson J, Wang V, Dao MN, Shalek AK, De Rienzo A, Bueno R. Abstract 95: Uncommitted cells and phenotypic plasticity elucidate the complexity of the epithelial-mesenchymal molecular gradient of pleural mesothelioma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-95] [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: 04/07/2023]
Abstract
Abstract
Pleural mesothelioma (PM) comprises three major histologic types: epithelioid, sarcomatoid, and a mixture of the two types termed biphasic. We and others have investigated whole transcriptome profiles of bulk PM samples, identifying a molecular gradient with features of epithelial-mesenchymal transition, which is related to, but not redundant with, histology. To date bulk studies of heterogeneity across PM tumors have not explained how biphasic tumors contain sarcomatoid (mesenchymal) and epithelioid (epithelial) components. We hypothesized that sarcomatoid and epithelioid components arose from distinct tumor clones. We performed integrated bulk and single-cell RNA-sequencing and pathologic analyses of 93 samples from 39 patients’ surgical resections including 3 negative-control pleura cases with non-PM pathology. Single-cell sequencing analysis was performed using the Seq-Well S3 platform. Tumor clones were identified using inferCNV in R. Copy number and somatic variants were identified in adjacent bulk samples of each PM case with optical genome mapping and exome sequencing, respectively. We generated libraries from 19 epithelioid, 3 sarcomatoid, and 13 biphasic cases resulting in an average of 6,657 single cells per case (n=266,262 total cells; UMIs ≥ 300 & features ≥ 80). Among the 32,383 high quality malignant cells, we characterized epithelioid and sarcomatoid programs independent of non-malignant cells in the microenvironment. We observed malignant cells expressing both programs at low levels, termed uncommitted. Uncommitted cells were not outliers in terms of UMIs detected, genes expressed, or mitochondrial transcript content, and were detected in 96.4% of PM cases with at least 50 high quality tumor cells. Most (72.7%) uncommitted cells were isolated from biphasic tumors. Additionally, we observed that individual tumor clones from biphasic tumors exhibited all three cell phenotypes. In one biphasic tumor, five of six clones comprised cells from all three types, where these clones were well-represented across multiple sites with epithelioid content ranging from 10% to 40%. In conclusion, our integrated analysis of multi-site pleural mesothelioma samples suggests that a single tumor clone may be capable of generating all molecular subtypes. Further work aims to identify candidate drivers of this plasticity, to relate single-cell transcriptomic phenotype to histology and to further characterize uncommitted cells. We will also assess the prognostic implications of uncommitted cells content in a wider cohort.
Citation Format: David T. Severson, Samuel Freyaldenhoven, Benjamin Wadowski, Travis Hughes, Yin P. Hung, Roderick V. Jensen, William G. Richards, Corinne E. Gustafson, Kimberly Vermilya, Simona Innocenti, Julianne S. Barlow, Matthew B. Cougar, Jamie Anderson, Vivian Wang, Mary N. Dao, Alex K. Shalek, Assunta De Rienzo, Raphael Bueno. Uncommitted cells and phenotypic plasticity elucidate the complexity of the epithelial-mesenchymal molecular gradient of pleural mesothelioma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 95.
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Affiliation(s)
| | | | | | - Travis Hughes
- 2Ragon Institute of MGH, Harvard, and MIT, Cambridge, MA
| | - Yin P. Hung
- 3Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | - Alex K. Shalek
- 2Ragon Institute of MGH, Harvard, and MIT, Cambridge, MA
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Wadowski B, Damani T. Cardiac tamponade after robotic hiatal hernia repair from liver sling stitch: Case report of a rare complication and literature review. Int J Surg Case Rep 2022; 98:107530. [PMID: 36084560 PMCID: PMC9482926 DOI: 10.1016/j.ijscr.2022.107530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance Cardiac tamponade following hiatal hernia repair is a rare and potentially fatal complication most often associated with the use of mechanical fixation devices for hiatal mesh reinforcement. Only three cases have been reported with sutures alone, and none following robotic hiatal surgery. Case presentation A 54-year-old patient underwent elective robotic hiatal hernia repair with Toupet fundoplication during which a sling suture was placed to elevate the left lateral segment of liver. No mesh or mechanical fixation devices were used. Eight hours postoperatively, the patient developed hemodynamic instability. Cardiac tamponade was diagnosed on bedside echocardiogram and the patient underwent emergent pericardiocentesis with subsequent stabilization. The remainder of the postoperative course was notable for pericarditis which was treated with aspirin and colchicine. Clinical discussion While the use of suture-based liver retraction has the advantages of avoiding an additional port and potential collision between retractor holder and robot arms, it constitutes a novel risk factor for cardiac tamponade. Prompt diagnosis via bedside echocardiography is essential and may facilitate percutaneous rather than operative management. Conclusion Suture-based liver retraction in minimally invasive foregut surgery should be used judiciously until further data is available. Surgeons should maintain a high index of suspicion for tamponade in the setting of postoperative hypotension after its use. Hypotension may be a sign of cardiac tamponade after robotic hiatal hernia repair. Slings or other suture techniques that abut the diaphragm may cause tamponade. Prompt diagnosis and drainage can prevent life-threatening hemodynamic compromise. Multidisciplinary care is essential to manage recurrent effusion or pericarditis.
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Wadowski B, Bueno R, De Rienzo A. Immune Microenvironment and Genetics in Malignant Pleural Mesothelioma. Front Oncol 2021; 11:684025. [PMID: 34178677 PMCID: PMC8226027 DOI: 10.3389/fonc.2021.684025] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 01/29/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with limited therapeutic options beyond surgery and cytotoxic chemotherapy. The success of immune checkpoint inhibition has been found to correlate with expression of immune-related genes such as CD274 (PD-L1) in lung and other solid cancers. However, only a small subset of MPM patients respond to checkpoint inhibition, and this response has been varied and unpredictable across several clinical trials. Recent advances in next-generation sequencing (NGS) technology have improved our understanding of the molecular features of MPM, also with respect to its genetic signature and how this impacts the immune microenvironment. This article will review current evidence surrounding the interplay between MPM genetics, including epigenetics and transcriptomics, and the immune response.
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Affiliation(s)
- Benjamin Wadowski
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic and Cardiovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Raphael Bueno
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic and Cardiovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Assunta De Rienzo
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic and Cardiovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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5
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Wadowski B, Hartwig MG, Kon ZN. What's in a Name? The Diminishing Value of Quality Designations for Donor Lungs. Ann Thorac Surg 2021; 113:1759. [PMID: 33839138 DOI: 10.1016/j.athoracsur.2021.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin Wadowski
- NYU Langone Health, New York, NY; Brigham and Women's Hospital, 75Francis Street. Boston, MA 02115.
| | | | - Zachary N Kon
- School of Medicine at Hofstra/Northwell, Manhasset, NY
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6
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De Rienzo A, Coleman MH, Yeap BY, Severson DT, Wadowski B, Gustafson CE, Jensen RV, Chirieac LR, Richards WG, Bueno R. Association of RERG Expression with Female Survival Advantage in Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13030565. [PMID: 33540554 PMCID: PMC7867122 DOI: 10.3390/cancers13030565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Sex differences in incidence, prognosis, and treatment response have been described for many cancers. In malignant pleural mesothelioma (MPM), a lethal disease associated with asbestos exposure, men outnumber women 4 to 1, but women consistently live longer than men following surgery-based therapy. This study investigated whether tumor expression of genes associated with estrogen signaling could potentially explain observed survival differences. Two microarray datasets of MPM tumors were analyzed to discover estrogen-related genes associated with survival. A validation cohort of MPM tumors was selected to balance the numbers of men and women and control for competing prognostic influences. The RAS like estrogen regulated growth inhibitor (RERG) gene was identified as the most differentially-expressed estrogen-related gene in these tumors and predicted prognosis in discovery datasets. In the sex-matched validation cohort, low RERG expression was significantly associated with increased risk of death among women. No association between RERG expression and survival was found among men, and no relationship between estrogen receptor protein or gene expression and survival was found for either sex. Additional investigations are needed to elucidate the molecular mechanisms underlying this association and its sex specificity.
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Affiliation(s)
- Assunta De Rienzo
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
- Correspondence: ; Tel.: +1-(617)-732-6526
| | - Melissa H. Coleman
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
- Department of Surgery, University of California San Francisco, 500 Parnassus Ave, MUW 405, Box 0118, San Francisco, CA 94143, USA
| | - Beow Y. Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;
| | - David T. Severson
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
| | - Benjamin Wadowski
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
| | - Corinne E. Gustafson
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
| | - Roderick V. Jensen
- Department of Biological Sciences, Virginia Tech, 970 Washington Street SW, Blacksburg, VA 24061, USA;
| | - Lucian R. Chirieac
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;
| | - William G. Richards
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
| | - Raphael Bueno
- Thoracic Surgery Oncology Laboratory and The International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (M.H.C.); (D.T.S.); (B.W.); (C.E.G.); (W.G.R.); (R.B.)
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Hundeyin M, Kurz E, Mishra A, Rossi JAK, Liudahl SM, Leis KR, Mehrotra H, Kim M, Torres LE, Ogunsakin A, Link J, Sears RC, Sivagnanam S, Goecks J, Islam KMS, Dolgalev I, Savadkar S, Wang W, Aykut B, Leinwand J, Diskin B, Adam S, Israr M, Gelas M, Lish J, Chin K, Farooq MS, Wadowski B, Wu J, Shah S, Adeegbe DO, Pushalkar S, Vasudevaraja V, Saxena D, Wong KK, Coussens LM, Miller G. Innate αβ T Cells Mediate Antitumor Immunity by Orchestrating Immunogenic Macrophage Programming. Cancer Discov 2019; 9:1288-1305. [PMID: 31266770 DOI: 10.1158/2159-8290.cd-19-0161] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/14/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
Unconventional T-lymphocyte populations are emerging as important regulators of tumor immunity. Despite this, the role of TCRαβ+CD4-CD8-NK1.1- innate αβ T cells (iαβT) in pancreatic ductal adenocarcinoma (PDA) has not been explored. We found that iαβTs represent ∼10% of T lymphocytes infiltrating PDA in mice and humans. Intratumoral iαβTs express a distinct T-cell receptor repertoire and profoundly immunogenic phenotype compared with their peripheral counterparts and conventional lymphocytes. iαβTs comprised ∼75% of the total intratumoral IL17+ cells. Moreover, iαβT-cell adoptive transfer is protective in both murine models of PDA and human organotypic systems. We show that iαβT cells induce a CCR5-dependent immunogenic macrophage reprogramming, thereby enabling marked CD4+ and CD8+ T-cell expansion/activation and tumor protection. Collectively, iαβTs govern fundamental intratumoral cross-talk between innate and adaptive immune populations and are attractive therapeutic targets. SIGNIFICANCE: We found that iαβTs are a profoundly activated T-cell subset in PDA that slow tumor growth in murine and human models of disease. iαβTs induce a CCR5-dependent immunogenic tumor-associated macrophage program, T-cell activation and expansion, and should be considered as novel targets for immunotherapy.See related commentary by Banerjee et al., p. 1164.This article is highlighted in the In This Issue feature, p. 1143.
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Affiliation(s)
- Mautin Hundeyin
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Emma Kurz
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Ankita Mishra
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Juan Andres Kochen Rossi
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Shannon M Liudahl
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Kenna R Leis
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Harshita Mehrotra
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Mirhee Kim
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Luisana E Torres
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Adesola Ogunsakin
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Jason Link
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon.,Brenden-Colson Center for Pancreatic Care, Oregon Health and Science University, Portland, Oregon
| | - Rosalie C Sears
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon.,Brenden-Colson Center for Pancreatic Care, Oregon Health and Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Shamilene Sivagnanam
- Computational Biology Program, Oregon Health and Science University, Portland, Oregon
| | - Jeremy Goecks
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Computational Biology Program, Oregon Health and Science University, Portland, Oregon
| | - K M Sadeq Islam
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Igor Dolgalev
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Shivraj Savadkar
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Wei Wang
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Berk Aykut
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Joshua Leinwand
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Brian Diskin
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Salma Adam
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Muhammad Israr
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Maeliss Gelas
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Justin Lish
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Kathryn Chin
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Mohammad Saad Farooq
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Benjamin Wadowski
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Jingjing Wu
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Suhagi Shah
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Dennis O Adeegbe
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Smruti Pushalkar
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | | | - Deepak Saxena
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Kwok-Kin Wong
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Lisa M Coussens
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon.,Brenden-Colson Center for Pancreatic Care, Oregon Health and Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - George Miller
- S.A. Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York. .,Department of Cell Biology, New York University School of Medicine, New York, New York
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Pushalkar S, Hundeyin M, Daley D, Zambirinis CP, Kurz E, Mishra A, Mohan N, Aykut B, Usyk M, Torres LE, Werba G, Zhang K, Guo Y, Li Q, Akkad N, Lall S, Wadowski B, Gutierrez J, Kochen Rossi JA, Herzog JW, Diskin B, Torres-Hernandez A, Leinwand J, Wang W, Taunk PS, Savadkar S, Janal M, Saxena A, Li X, Cohen D, Sartor RB, Saxena D, Miller G. The Pancreatic Cancer Microbiome Promotes Oncogenesis by Induction of Innate and Adaptive Immune Suppression. Cancer Discov 2018; 8:403-416. [PMID: 29567829 DOI: 10.1158/2159-8290.cd-17-1134] [Citation(s) in RCA: 738] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/03/2018] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
We found that the cancerous pancreas harbors a markedly more abundant microbiome compared with normal pancreas in both mice and humans, and select bacteria are differentially increased in the tumorous pancreas compared with gut. Ablation of the microbiome protects against preinvasive and invasive pancreatic ductal adenocarcinoma (PDA), whereas transfer of bacteria from PDA-bearing hosts, but not controls, reverses tumor protection. Bacterial ablation was associated with immunogenic reprogramming of the PDA tumor microenvironment, including a reduction in myeloid-derived suppressor cells and an increase in M1 macrophage differentiation, promoting TH1 differentiation of CD4+ T cells and CD8+ T-cell activation. Bacterial ablation also enabled efficacy for checkpoint-targeted immunotherapy by upregulating PD-1 expression. Mechanistically, the PDA microbiome generated a tolerogenic immune program by differentially activating select Toll-like receptors in monocytic cells. These data suggest that endogenous microbiota promote the crippling immune-suppression characteristic of PDA and that the microbiome has potential as a therapeutic target in the modulation of disease progression.Significance: We found that a distinct and abundant microbiome drives suppressive monocytic cellular differentiation in pancreatic cancer via selective Toll-like receptor ligation leading to T-cell anergy. Targeting the microbiome protects against oncogenesis, reverses intratumoral immune tolerance, and enables efficacy for checkpoint-based immunotherapy. These data have implications for understanding immune suppression in pancreatic cancer and its reversal in the clinic. Cancer Discov; 8(4); 403-16. ©2018 AACR.See related commentary by Riquelme et al., p. 386This article is highlighted in the In This Issue feature, p. 371.
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Affiliation(s)
- Smruti Pushalkar
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Mautin Hundeyin
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Donnele Daley
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Constantinos P Zambirinis
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Emma Kurz
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Ankita Mishra
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Navyatha Mohan
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Berk Aykut
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Mykhaylo Usyk
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Luisana E Torres
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Gregor Werba
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Kevin Zhang
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Yuqi Guo
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Qianhao Li
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Neha Akkad
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Sarah Lall
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Benjamin Wadowski
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Johana Gutierrez
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Juan Andres Kochen Rossi
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Jeremy W Herzog
- National Gnotobiotic Rodent Research Center, University of North Carolina, Chapel Hill, North Carolina
| | - Brian Diskin
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Alejandro Torres-Hernandez
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Josh Leinwand
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Wei Wang
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Pardeep S Taunk
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Shivraj Savadkar
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Malvin Janal
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Anjana Saxena
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, New York, New York
| | - Xin Li
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Deirdre Cohen
- Department of Biology, Brooklyn College and the Graduate Center (CUNY), Brooklyn, New York, New York
| | - R Balfour Sartor
- National Gnotobiotic Rodent Research Center, University of North Carolina, Chapel Hill, North Carolina.,Department of Medicine, New York University School of Medicine, New York, New York
| | - Deepak Saxena
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York. .,S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - George Miller
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York. .,Department of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina
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Wadowski B, Chadha T, Wen AY. A 15-Year-Old with Aphasia and Right Hemiparesis. J Pediatr Intensive Care 2017; 6:221-224. [PMID: 31073452 DOI: 10.1055/s-0037-1598205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/28/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022] Open
Abstract
Takayasu arteritis (TA) is the third most common vasculitis in childhood, peaking in the second to third decades of life but affecting patients as young as 6 months of age. It often presents with nonspecific systemic symptoms, although at late stages, it may present with cardiac, renal, or focal neurologic sequelae of vascular compromise. In this case, we describe a 15-year-old patient who presented acutely with stroke. In the absence of more classic rheumatological symptoms and significant laboratory abnormalities on initial testing, the diagnosis of TA was only reached through extensive vascular imaging following consultation with multiple subspecialty teams. This case demonstrates the need to maintain a high index of suspicion for vasculitis in pediatric patients presenting with new onset stroke in the absence of known predisposing factors. Doing so may reduce the time to diagnosis, hasten treatment, and optimize outcomes.
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Affiliation(s)
- Benjamin Wadowski
- Department of Pediatrics, NYU School of Medicine, New York, United States
| | - Tanya Chadha
- Division of Critical Care, Department of Pediatrics, Wolfson Children's Hospital, Jacksonville, Florida, United States.,Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Andy Y Wen
- Department of Pediatrics, NYU School of Medicine, New York, United States.,Division of Critical Care, Department of Pediatrics, NYU Langone Medical Center, New York, United States
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Affiliation(s)
| | - Denis Chang
- New York University Langone Medical Center, New York, New York
| | - Sabina Q Khan
- New York University Langone Medical Center, New York, New York
| | - Tanya Chadha
- New York University School of Medicine, New York, New York; and Division of Pediatric Critical Care,
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