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Watzka FM, Meyer F, Staubitz JI, Fottner C, Schad A, Lang H, Musholt TJ. Prognostic Assessment of Non-functioning Neuroendocrine Pancreatic Neoplasms as a Basis for Risk-Adapted Resection Strategies. World J Surg 2020; 44:594-603. [PMID: 31605171 DOI: 10.1007/s00268-019-05220-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND In contrast to exocrine pancreatic carcinomas, prognosis and treatment of pancreatic neuroendocrine neoplasms (PNEN) are significantly different. The variable growth pattern and associated clinical situation of functioning and non-functioning PNEN demand an individualized surgical approach. However, due to the scarce evidence associated with the rare disease, guidelines lack detailed recommendations for indication and for the required extent of surgical resection. METHODS In a retrospective single-center study from 1990 to 2018, 239 patients with PNEN were identified. Clinical data were collected in the MaDoc database of the University Medical Center Mainz. A total of 155 non-functional PNEN were selected for further analysis. RESULTS According to the classification of NET by the WHO in 2017, 28.8% (n = 40) of the tumors were G1, 61.9% (n = 86) G2, and 9.4% (n = 13) G3. In 73 patients, hepatic metastases were present. Sixty patients had lymph node metastasis. An R0 resection was achieved in 98 cases, an R1 situation in 10 cases. Five times, a tumor debulking was carried out (R2) and 5 times the operation was aborted without any resection because of the advanced tumor stage. A relapse occurred in 29 patients. Different prognostic factors (grade, tumor size, age) were analyzed. Grade-dependent 10-year overall survival rates were 79.5% (grade 1) and 60.1% (grade 2), respectively. The survival rate of grade 3 patients was limited to 66.7% after 13 months. CONCLUSION In our study, patients with non-functioning PNEN had a longer overall survival after successful R0 resection. The risk analysis confirmed a Ki-67 cutoff value of 5%, which divided a high- and low-risk group. Patients with a PNEC G3 (Ki-67 index > 50%) had a very poor prognosis.
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Affiliation(s)
- F M Watzka
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Meyer
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - J I Staubitz
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Fottner
- Endocrinology and Metabolic Diseases, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Schad
- Institute of Pathology, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Lang
- Institute of Pathology, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T J Musholt
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Watzka FM, Meyer F, Staubitz JI, Fottner C, Schad A, Lang H, Musholt TJ. Correction to: Prognostic Assessment of Non-functioning Neuroendocrine Pancreatic Neoplasms as a Basis for Risk-Adapted Resection Strategies. World J Surg 2020; 44:1681. [PMID: 32052103 DOI: 10.1007/s00268-020-05418-0] [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: 11/30/2022]
Abstract
This article contains parts of the doctoral thesis of F. Meyer.
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Affiliation(s)
- F M Watzka
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Meyer
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - J I Staubitz
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Fottner
- Endocrinology and Metabolic Diseases, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Schad
- Institute of Pathology, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Lang
- Institute of Pathology, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T J Musholt
- Endocrine Surgery, Clinic of General, Visceral- and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Abstract
BACKGROUND Neuroendocrine Neoplasms of the small intestine have been noticed more frequently over the past 35 years. They constitute about 25% of all NENs and 29% of all tumors of the small intestine. Due to the predominantly indolent nature and overall good prognosis, the benefit of surgical treatment is still debated. METHODS In a retrospective study, data of 83 surgically treated patients with neuroendocrine neoplasms of the small intestine, 48 males and 35 females with a median age of 62 years (range 25-86 years) were analyzed. Patient data were documented in the MaDoc database for neuroendocrine tumors of the University Medical Center of Mainz. IBM SPSS Statistics 20 was used for statistical analysis. Kaplan-Meier survival curves and Log-Rank tests, censoring patients at the time of last follow-up, were used to compare the overall survival depending on potential prognostic factors (stage, grade, surgical treatment). RESULTS At the time of diagnoses, the most common clinical symptoms were abdominal pain (n = 31, 37.3%), bowel obstruction (n = 11, 13.3%), bowel perforation and peritonitis (n = 3, 3.6%), gastrointestinal bleeding (n = 9, 10.8%), weight loss (n = 11, 13.3%), and carcinoid syndrome (n = 27, 32.5%). 65 patients (78.3%) had lymph node metastasis and in 58 patients (69.9%) distant metastasis were present. Segmental bowel resection (44) was the most common surgical procedure, followed by right hemi-colectomy (32) and explorative laparotomy (7). In most patients (78.9%), lymphadenectomy (systematic/selective) was performed. The 5-year survival of patients who underwent a systematic or a selective lymphadenectomy differed significantly (82.2 vs. 40.0%). The overall 3-, 5-, and 10-year survival rates were 88.2, 80.3, and 71.0%, respectively. CONCLUSION Mesenteric lymph node metastases are almost invariably present and have significant impact on patients' prognosis. Systematic lymphadenectomy prevents complications and improves the survival. Early surgical treatment should be the goal in order to prevent complications.
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Affiliation(s)
- F M Watzka
- Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Fottner
- Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Miederer
- Clinic of Nuclear Medicine, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M M Weber
- Endocrinology and Metabolic Diseases, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Schad
- Institute of Pathology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Lang
- Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T J Musholt
- Clinic of General, Visceral- and Transplantation Surgery, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Libé R, Borget I, Ronchi CL, Zaggia B, Kroiss M, Kerkhofs T, Bertherat J, Volante M, Quinkler M, Chabre O, Bala M, Tabarin A, Beuschlein F, Vezzosi D, Deutschbein T, Borson-Chazot F, Hermsen I, Stell A, Fottner C, Leboulleux S, Hahner S, Mannelli M, Berruti A, Haak H, Terzolo M, Fassnacht M, Baudin E. Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol 2016; 26:2119-25. [PMID: 26392430 DOI: 10.1093/annonc/mdv329] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC. PATIENTS AND METHODS Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 'before surgery'; model 2 'post-surgery'. RESULTS Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥ 50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥ 20%, P = 0.06) in model 2. CONCLUSION The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.
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Affiliation(s)
- R Libé
- French Adrenal Cancer Network, Institut National du Cancer, Paris
| | - I Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - C L Ronchi
- Central Laboratory, Research Unit, University Hospital Wurzburg, Wurzburg, Germany
| | - B Zaggia
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Kroiss
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - T Kerkhofs
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - J Bertherat
- Endocrinology Unit, Cochin Hospital, Paris, France
| | - M Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - M Quinkler
- Clinical Endocrinology, Charit Campus Mitte, Charitί University Medicine Berlin, Germany
| | - O Chabre
- Endocrinology Unit, University Hospital of Grenoble, France
| | - M Bala
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - A Tabarin
- Department of Endocrinology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - F Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - D Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse
| | - T Deutschbein
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - F Borson-Chazot
- Nuclear Medicine Unit, University of Lyon 1, Hospices Civils de Lyon Bron, France
| | - I Hermsen
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - A Stell
- Melbourne eResearch Group Level 3, Doug McDonell Building, University of Melbourne, Melbourne, Australia
| | - C Fottner
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - S Leboulleux
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
| | - S Hahner
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - M Mannelli
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Florence
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - H Haak
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - M Terzolo
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Fassnacht
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - E Baudin
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
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Dünschede F, Paul N, Meyer A, Youssef M, Espinola-Klein C, Dopheide J, Fottner C, Vahl CF, Dorweiler B. [Autologous Bypass to Pedal Side Branches to Avoid a Major Amputation]. Zentralbl Chir 2016; 142:464-469. [PMID: 27011337 DOI: 10.1055/s-0041-111181] [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: 10/22/2022]
Abstract
Background: In critical limb ischaemia (CLI), a pedal vein graft bypass offers good long-term results regarding function and limb salvage. However, some cases require bypasses to branches of pedal arteries based on angiographic findings. Methods: In a retrospective database we analysed all patients who received a vein graft bypass to branches of pedal arteries for treatment of critical limb ischaemia. Results: From January 1998 to June 2014 we performed bypasses to branches of pedal arteries in 72 patients (59 men and 13 women) out of a total of 534 patients who underwent pedal bypass surgery. The proximal bypass anastomosis was above the knee in 30 cases and below the knee in 42 patients. In 6 cases the bypass connection was made to the lateral tarsal artery, in 15 cases it was made to the lateral and in 24 cases to the medial plantar artery. In 27 patients a direct connection was made to the plantar bifurcation. All reconstructions were completely autologous. The limb salvage rate after 5 and 10 years was 82 %. Conclusion: A bypass to branches of pedal arteries is a procedure recommendable for limb salvage in cases of critical ischaemia where arteries with a larger diameter are no longer available.
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Affiliation(s)
- F Dünschede
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - N Paul
- Institut für Geschichte, Theorie, Ethik der Medizin, Universitätsmedizin Mainz, Deutschland
| | - A Meyer
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - M Youssef
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | | | - J Dopheide
- II. Medizinische Klinik, Universitätsmedizin Mainz, Deutschland
| | - C Fottner
- I. Medizinische Klinik, Universitätsmedizin Mainz, Deutschland
| | - C F Vahl
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - B Dorweiler
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
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Lorenzen S, Arnold D, Fottner C, Leichsenring J, Moehler M, Seufferlein T, Vogel A, Weber MM, Reinacher-Schick A. [ASCO-update 2015 - highlights of the 51. meeting of the american society of clinical oncology/ASCO 2015]. Z Gastroenterol 2016; 54:167-72. [PMID: 26854837 DOI: 10.1055/s-0041-111632] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The field of gastrointestinal oncology is rapidly developing, on the one hand through the identification of novel molecular targets and therapeutic principles, on the other hand through the establishment and improvement of multidisciplinary treatment strategies. The following manuscript summarizes the most important trial results of the ASCO Meeting 2015 for gastrointestinal cancers. Besides trials on perioperative treatment of esophageal-, pancreatic- and colon cancer, we will present impressive data on new therapeutic strategies such as immunotherapy in gastric-, liver and microsatellite instable colorectal cancer. The trials will be put into context by the authors.
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Affiliation(s)
- S Lorenzen
- Medizinische Klinik, Klinikum rechts der Isar, München, Germany
| | - D Arnold
- Internistische Onkologie, Klinik für Tumorbiologie, Freiburg, Germany
| | - C Fottner
- Abteilung für Endokrinologie und Stoffwechselkrankheiten, Johannes Gutenberg-Universität, Mainz, Germany
| | - J Leichsenring
- Abteilung für Hämatologie und Onkologie, Med. Klinik I, Ruhr-Universität Bochum, Germany
| | - M Moehler
- I. Dept Medicine, Johannes Gutenberg University Hospital of Mainz, Germany
| | - T Seufferlein
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Germany
| | - A Vogel
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, MH-Hannover, Germany
| | - M M Weber
- Abteilung für Endokrinologie und Stoffwechselkrankheiten, Johannes Gutenberg-Universität, Mainz, Germany
| | - A Reinacher-Schick
- Abteilung für Hämatologie und Onkologie, Med. Klinik I, Ruhr-Universität Bochum, Germany
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Watzka FM, Fottner C, Miederer M, Schad A, Weber MM, Otto G, Lang H, Musholt TJ. Erratum to: surgical therapy of neuroendocrine neoplasm with hepatic metastasis: patient selection and prognosis. Langenbecks Arch Surg 2015; 400:359. [PMID: 25846243 DOI: 10.1007/s00423-015-1294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F M Watzka
- Clinic of General, Visceral and Transplantation Surgery, University Medical Center University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Watzka FM, Fottner C, Miederer M, Schad A, Weber MM, Otto G, Lang H, Musholt TJ. Surgical therapy of neuroendocrine neoplasm with hepatic metastasis: patient selection and prognosis. Langenbecks Arch Surg 2015; 400:349-58. [PMID: 25682055 DOI: 10.1007/s00423-015-1277-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/27/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with neuroendocrine neoplasms (NEN) develop hepatic metastases in 50-95 %. The aims of this study were to evaluate the outcome/prognosis of patients following hepatic surgery and to identify predictive factors for the selection of patient that benefit from hepatic tumor resection. PATIENTS AND METHODS In a retrospective single-center study (1990 to 2014), 204 patients with hepatic metastasis of NEN were included. Ninety-four were subjected to various forms of liver resection. According to the overall survival, the influence of several prognostic factors like the Ki-67 index, stage of disease, and resection status was evaluated. RESULTS The primary tumor was located in the small intestine (n = 73), pancreas (n = 58), colon (n = 26), esophagus or stomach (n = 9) and in 38 patients the primary site was unknown. The Ki-67 index was associated with significant different overall survival. Patients with an R0 resection (n = 38) of their hepatic metastasis had a very good 10-year survival of 90.4 %. Patients in whom an R1 (n = 23) or R2 (n = 33) resection of their hepatic metastasis could be achieved had a 10-year survival of 53.4 and 51.4 %, respectively. The majority of the patients (53.9 %) could not be resected and had a poor 10-year survival rate of 19.4 %. Partial or complete control of endocrine-related symptoms was achieved in all patients with functioning tumors following surgery. The overall 5- and 10-year survival rates were 77.9 and 65.2 %, respectively. CONCLUSION Surgical resection of hepatic NEN metastases can reduce symptoms and improve the survival in selected patients with a Ki-67 index less than 20 %. The expected outcome has to be compared to the outcome of alternative treatment strategies. An R0 situation should be the aim of hepatic surgery, but also patients with R1 or R2 resection show a good survival benefit.
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Affiliation(s)
- F M Watzka
- Clinic of General, Visceral- and Transplantation Surgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Fottner C, Rossmann H, Bickmann JK, Sollfranck S, Hassoun R, Neukirch C, Papaspyrou K, Mann WJ, Schneider-Rätzke B, Bartsch D, Lackner KJ, Weber MM. Definition of a new algorithm for molecular-genetic testing of patients with hereditary pheochromocytoma and paraganglioma syndromes. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336695] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Watzka FM, Laumen C, Fottner C, Weber MM, Schad A, Lang H, Musholt TJ. Resection strategies for neuroendocrine pancreatic neoplasms. Langenbecks Arch Surg 2012; 398:431-40. [DOI: 10.1007/s00423-012-1024-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/23/2012] [Indexed: 02/07/2023]
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Abstract
Neuroendocrine neoplasms of the digestive system represent a rare and heterogeneous group of malignancies with various clinical presentations and prognoses. The WHO classification for the year 2000 was updated in 2010 to take the histopathology and tumor biology of these tumors into account. Together with proliferation-based grading and the recently established staging system using the ENETS TNM classification, it forms the basis for the further diagnostic and therapeutic approach. Clinical presentation depends mainly on the primary site of the tumor and its functionality. Characteristic symptoms are seen only rarely, this being the reason these tumors are usually detected at an advanced stage. Approximately 30% of GEP-NEN are hormonally active and can cause a specific clinical syndrome. In addition to these specific hormones, chromogranin A is considered the most accurate general marker for the biochemical follow-up of these patients. In addition to commonly used radiological and endoscopic imaging modalities, somatostatin receptor-based functional imaging using either octreotide scintigraphy or novel PET-based techniques with specific isotopes such as Ga68-DOTA-octreotate play a crucial role in the detection of the primary tumor as well as in the evaluation of tumor extent and the selection of patients for receptor-based radionuclide therapy.
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Affiliation(s)
- C Fottner
- Schwerpunkt Endokrinologie und Stoffwechselerkrankungen, I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstrasse 1, Mainz
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Fottner C, Helisch A, Anlauf M, Rossmann H, Musholt TJ, Kreft A, Schadmand-Fischer S, Bartenstein P, Lackner KJ, Klöppel G, Schreckenberger M, Weber MM. 6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression. J Clin Endocrinol Metab 2010; 95:2800-10. [PMID: 20371665 DOI: 10.1210/jc.2009-2352] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Pheochromocytomas (PHEOs) and paragangliomas (PGLs) may be better detected by (18)F-fluorodihydroxyphenylalanine-positron emission tomography (FDOPA-PET) than (123)I-metaiodobenzyl-guanidine (123-I-MIBG) scintigraphy. OBJECTIVE The objective of the study was to correlate functional imaging results with immunohistochemical, molecular-genetic, and biochemical findings. DESIGN AND SETTING Thirty consecutive patients with suspected PHEO/PGL presenting at a tertiary referral centre were investigated in a prospective study. PATIENTS Twenty-five patients had confirmed PHEO/PGL. Thirteen of 25 patients had a hereditary PHEO/PGL syndrome (two multiple endocrine neoplasia II, six succinate dehydrogenase complex, subunit D, two succinate dehydrogenase complex, subunit B, one von Hippel Lindau tumor suppressor protein, two Neurofibromatosis-1), and 12 of 25 were classified as sporadic. Five patients had hormonally inactive adrenal incidentalomas. MAIN OUTCOME MEASURES In all patients computed tomography scan and/or magnetic resonance imaging as well as both 123-I-MIBG scintigraphy and FDOPA-PET were performed. Resected tumors were examined by immunohistochemistry for expression of the vesicular monoamine transporter (VMAT)-1 and -2 and other markers. RESULTS A total of 64 lesions were found with both functional imaging modalities. FDOPA-PET detected 62 lesions, whereas only 34 lesions were detected by 123-I-MIBG scintigraphy. This resulted in an overall sensitivity and specificity for FDOPA-PET of 98 and 100% and for MIBG of 53 and 91%, respectively. Comparable sensitivities were found for adrenal and extraadrenal abdominal lesions (94 vs. 97%), whereas in thoracic/cervical lesions, the sensitivity for 123-I-MIBG scintigraphy (15%) was inferior to that of FDOPA-PET imaging (100%). Immunohistochemistry demonstrated a lack of VMAT-1 expression in all MIBG-negative tumors. Clinical predictors for MIBG negativity were a predominant norepinephrine/normetanephrine secretion, an age less than 45 yr, and a hereditary cause. CONCLUSION FDOPA-PET is superior to 123-I-MIBG scintigraphy in patients with extraadrenal, predominantly noradrenaline-secreting, and hereditary types of PHEO/PGL. The lack of VMAT-1 expression predicts negativity for MIBG-scintigraphy.
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Affiliation(s)
- C Fottner
- I. Medical Clinic, Department of Endocrinology and Metabolism, University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Fottner C, Mettler E, Goetz M, Schirrmacher E, Anlauf M, Strand D, Schirrmacher R, Klöppel G, Delaney P, Schreckenberger M, Galle PR, Neurath MF, Kiesslich R, Weber MM. In vivo molecular imaging of somatostatin receptors in pancreatic islet cells and neuroendocrine tumors by miniaturized confocal laser-scanning fluorescence microscopy. Endocrinology 2010; 151:2179-88. [PMID: 20233796 DOI: 10.1210/en.2009-1313] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of the study was to evaluate real time in vivo molecular imaging of somatostatin receptors (sstrs) using a handheld miniaturized confocal laser scan microscope (CLM) in conjunction with fluorescein-labeled octreotate (OcF) in healthy mice and murine models of neuroendocrine tumors. For CLM a small rigid probe (diameter 7 mm) with an integrated single line laser (488 nm) was used (optical slice thickness 7 mum; lateral resolution 0.7 mum). OcF was synthesized via Fmoc solid-phase peptide synthesis and purified by HPLC showing high-affinity binding to the sstr2 (IC(50) 6.2 nmol). For in vitro evaluation, rat and human pancreatic cancer cells were used and characterized with respect to its sstr subtype expression and functional properties. For in vivo confocal imaging, healthy mouse pancreatic islet and renal tubular cells as well as immunoincompetent nude mice harboring sstr-expressing tumors were evaluated. Incubation of sstr-positive cells with OcF showed a specific time- and dose-dependent staining of sstr-positive cells. CLM showed rapid internalization and homogenous cytoplasmatic distribution. After systemic application to mice (n = 8), specific time-dependent internalization and cytoplasmatic distribution into pancreatic islet cells and tubular cells of the renal cortex was recorded. After injection in tumor-harboring nude mice (n = 8), sstr-positive cells selectively displayed a cell surface and cytoplasmatic staining. CLM-targeted biopsies detected sstr-positive tumor cells with a sensitivity of 87.5% and a specificity of 100% as correlated with ex vivo immunohistochemistry. CLM with OcF permits real-time molecular, functional, and morphological imaging of sstr-expressing cell structures, allowing the specific visualization of pancreatic islet cells and neuroendocrine tumors in vivo.
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Affiliation(s)
- C Fottner
- Department of Endocrinology and Metabolism, I. Medical Clinic, University of Mainz, Mainz, Germany
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Goetz M, Fottner C, Kiesslich R. [Molecular imaging of the small intestine]. Internist (Berl) 2010; 51:702-10. [PMID: 20424814 DOI: 10.1007/s00108-009-2567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Molecular imaging uses the molecular signature of cells for targeted minimally-invasive detection and characterization of gastrointestinal pathologies. Exogenous fluorescent agents serve as molecular beacons for visualization of specific surface markers or metabolic activity in the target tissue. Molecular imaging with radioactively labeled substances is well established in nuclear medicine for wide-field detection of lesions in the small intestine. In gastrointestinal endoscopy, both macroscopic detection by endogenous or exogenous fluorescence and microscopic visualization by endomicroscopy have been investigated in clinical trials, however have not yet been evaluated in larger patient cohorts. Still, molecular imaging has the potential to greatly enhance our understanding of gastrointestinal pathology and to impact on future clinical algorithms and science in gastroenterology.
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Affiliation(s)
- M Goetz
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstrasse 1, Mainz, Germany.
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15
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Fottner C, Spöttl G, Weber MM. The divergent effect of insulin-like growth factor binding protein (IGFBP) - 1 on IGF-induced Steroidogenesis in bovine adrenocortical cells is not due to its phosphorylation status. Exp Clin Endocrinol Diabetes 2007; 115:232-9. [PMID: 17479439 DOI: 10.1055/s-2007-970576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In previous studies we have shown that insulin-like growth factor (IGF)-II stimulates basal as well as ACTH-induced cortisol secretion from bovine adrenocortical cells more potently than IGF-I. The steroidogenic effect of both, IGF-I and IGF-II, is mediated through the IGF-I receptor and modified by locally produced IGF binding proteins. Further studies demonstrate that bovine adrenocortical cells do synthesize IGFBP-1 to -4 and that their secretion is regulated differentially by IGFs and ACTH. Since IGFBP-1 selectively is induced 3- to 4- fold by ACTH, the aim of the following studies was to evaluate the effect of IGFBP-1 on IGF-induced cortisol secretion from bovine adrenocortical cells in primary culture. Coincubation of bovine adrenocortical cells with purified IGFBP-1 (30 nM) induced a time--and dose-dependent potentiating effect (38+/-2%) on IGF-I-stimulated (6.5 nM) cortisol-secretion, wheras the IGF-II induced steroidogenic effect was inhibited (40+/-3%) by IGFBP-1. Similar results were found when bovine adrenocortical cells were preincubated with IGFBP-1 before stimulation experiments with IGFs were performed. In order to evaluate the influence of different phosphorylation states of IGFBP-1 on the steroidogenic effect of IGF-I and IGF-II and on the affinity to IGFs, a highly phosphorylated (pIGFBP-1) and a dephosphorylated isoform (dIGFBP-1) of IGFBP-1 have been separated by anion exchange chromatography for further incubation experiments and binding studies. No different effects on IGF-I or IGF-II-induced steroidogenesis were observed when a highly phosphorylated IGFBP-1 isoform was used, compared to the dephosphorylated IGFBP-1 isoforms. In binding studies IGFBP-1 did show high affinity binding for IGF-I with a calculated association constant (K (a)) of 2,17 x 10 (9) M (-1). Similar association constants were calculated for dIGFBP-1 and pIGFBP-1 (1,93 x 10 (9) M (-1) and 2,67 x 10 (9) M (-1) respectively) and no difference in binding capacity was observed when IGF-II was used as ligand. IN CONCLUSION, these results demonstrate that in bovine adrenocortical cells IGFBP-1 time- and dose-dependently inhibits the steroidogenic effect of IGF-II and stimulates the effect of IGF-I. The observed modulatory effect of IGFBP-1 is independent of the mode of incubation and its phosphorylation status. The previously observed stronger steroidogenic potency of IGF-II in bovine adrenocortical cells therefore can not be explained by an interaction with IGFBP-1. The mechanisms by which IGFBP-1 divergently regulates the steroidogenic effect of IGF-I and IGF-II remain unclear at present and further investigation is necessary to elucidate the mechanisms by which IGFBP-1 modulates IGF action in the adult adrenal gland.
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Affiliation(s)
- C Fottner
- 1Schwerpunkt Endokrinologie und Stoffwechselerkrankungen, I. Medizinische Klinik und Poliklinik der Johannes Gutenberg Universität Mainz, Germany.
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Goetz M, Fottner C, Schirrmacher E, Delaney P, Gregor S, Schneider C, Strand D, Kanzler S, Memadathil B, Weyand E, Holtmann M, Schirrmacher R, Weber MM, Anlauf M, Klöppel G, Vieth M, Galle PR, Bartenstein P, Neurath MF, Kiesslich R. In-vivo confocal real-time mini-microscopy in animal models of human inflammatory and neoplastic diseases. Endoscopy 2007; 39:350-6. [PMID: 17427071 DOI: 10.1055/s-2007-966262] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Although various improvements in tissue imaging modalities have recently been achieved, in-vivo molecular and subsurface imaging in the field of gastroenterology remains a technical challenge. In this study we evaluated a newly developed, handheld, miniaturized confocal laser microscopy probe for real-time in-vivo molecular and subsurface imaging in rodent models of human disease. MATERIALS AND METHODS The minimicroscope uses a 488-nm, single line laser for fluorophore excitation. The optical slice thickness is 7 microm, the lateral resolution 0.7 microm. The range of the z-axis is 0-250 microm below the tissue surface. Imaging was performed using different fluorescent staining protocols; 5-carboxyfluorescein-labeled octreotate was synthesized for targeted molecular imaging. RESULTS Cellular and subcellular details of the gastrointestinal tract could be visualized in vivo at high resolution. Confocal real-time microscopy allowed in-vivo identification of tumor vessels and liver metastases, as well as diagnosis of focal hepatic inflammation, necrosis, and associated perfusion anomalies. Somatostatin-receptor targeting permitted in-vivo molecular staining of AR42-J-induced carcinoma and pancreatic islet cells. CONCLUSIONS Confocal mini-microscopy allows rapid in-vivo molecular and subsurface imaging of normal and pathological tissue in the gastrointestinal tract at high resolution. Because this technology is applicable to humans, it might impact on future in-vivo microsocpic and molecular diagnosis of diseases such as cancer and inflammation.
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Affiliation(s)
- M Goetz
- Medical Clinic I, University of Mainz, Mainz, Germany.
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Fottner C, Minnemann T, Wenzel JJ, Rossmann H, Lackner KJ, Musholt TJ, Weber MM. Identification of a novel germline mutation of the MEN I – gene (r.400delu) in a 24 year old patient with multifocal pancreatic insulinomas, primary hyperparathyroidism and a microprolactinoma. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972368] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fottner C, Helisch A, Anlauf M, Klöppel G, Düber C, Bartenstein P, Schreckenberger M, Weber MM. The expression of the Vesicular Monoamine Transporter type 1 (VMAT-1) is necessary for functional imaging of pheochromocytomas with [123J]-Metaiodobenzylguanidine (MIBG) scintigraphy – Superiority of 6-[18F]- Fluorodopamin Positron Emission Tomography (DOPA-PET) for the localization of VMAT-1 negative tumors. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972256] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fottner C, Helisch A, Minnemann T, Zschommler M, Galle PR, Bartenstein P, Weber MM. Targeted peptide receptor radionuclide therapy for advanced neuroendocrine tumors (NET) with 90Y-DOTATOC – tumor response and clinical benefit. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932955] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fottner C, Rossmann H, Schamberger B, Bausch B, Neumann HPH, Helisch A, Schreckenberger M, Musholt TJ, Bartenstein T, Lackner K, Weber MM. A novel succinate dehydrogenase subunit D (SDHD) gene mutation, F136frameshift, causes familial malignant extraadrenal paragangliomas. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Musholt TJ, Musholt PB, Fottner C, Garm J, Napiontek U, Keilmann A. Transient voice changes following thyroid surgery and surgical efforts to minimize postoperative dysphonia. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-933054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Fottner C, Schirrmacher E, Goetz M, Feilen P, Bartenstein P, Galle PR, Neurath MF, Weber MM, Kiesslich R. In vivo-molecular and morphological imaging of somatostatin receptors by real time confocal mini-microscopy. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932857] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Fottner C, Helisch A, Schreckenberger M, Bartenstein P, Weber MM. Superiority of 6-[18F]- Fluorodopamin Positron Emission Tomography (DOPA-PET) versus [123J]-Metaiodobenzylguanidine (MIBG) scintigraphy in the localization of extraadrenal or multifocal pheochromocytomas and paragangliomas. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932888] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Minnemann T, Fottner C, Jennewein M, Rösch F, Weber M. [68Ga] labelled DFO-octreotide is specifically internalized into somatostatin receptor positive AR42J tumor cells at comparable rates to standard [11In] DOTA-DPhe1-Tyr3-octreotide. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Musholt TJ, Weber MM, Fottner C, Helisch A, Schreckenberger M, Musholt PB. Hereditary paraganglioma syndrome PGL-1: diagnostic procedures for localisation of multifocal tumors and surgical strategy in an affected family. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862945] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Minnemann T, Fottner C, Anlauf M, Klöppel G, Weber MM. Case of a 36 year old patient with adult nesidioblastosis – successful treatment with verapamil evidenced by continuous glucose monitoring. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Fottner C, Minnemann T, Engelhardt D, Weber MM. Triiodothyronin (T3) time and dose dependently stimulates cortisol secretion from bovine adrenocortical cells in primary culture. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Auernhammer CJ, Fottner C, Engelhardt D, Bidlingmaier M, Strasburger CJ, Weber MM. Differential regulation of insulin-like growth factor-(IGF) I and IGF-binding protein (IGFBP) secretion by human peripheral blood mononuclear cells. Horm Res Paediatr 2002; 57:15-21. [PMID: 12006714 DOI: 10.1159/000057941] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent studies have shown that immunocompetent cells synthesize and express growth hormone (GH), growth hormone receptors (GH-R), insulin-like growth factor I (IGF-I), IGF-I receptors (IGF-I-R) and different insulin-like growth factor binding proteins (IGFBPs). The aim of the current study was to evaluate the regulation of IGFBP and IGF-I secretion from immunocompetent cells by different mitogens. METHODS/RESULTS We studied the in vitro secretion pattern of IGFBPs and IGF-I from human peripheral blood mononuclear cells (PBMC), derived from 10 normal adults and 8 GH-deficient patients with adult onset. In serum-free conditioned medium of unstimulated PBMC, derived from normal adults, Western ligand blotting (1D-WLB) revealed a 24-kD, a 34-kD and a 39/43-kD doublet band to be most prominent. According to their molecular weight and two-dimensional Western ligand blot analysis (2D-WLB), these bands are deglycosylated IGFBP-4, IGFBP-2 and IGFBP-3, respectively. When the cells were treated with the T-cell mitogen phytohemagglutinin (PHA) (10 microg/ml), a differential stimulation of IGFBPs was found with a 2.57 +/- 0.48-fold increase of IGFBP-4 (p < 0.01), a 1.55 +/- 0.13-fold increase of IGFBP-2 (p < 0.01), and a 1.35 +/- 0.19-fold increase of IGFBP-3 (n.s.). In contrast, treatment with the B-cell mitogen pokeweed mitogen (PWM) (10 microg/ml) caused only a modest 1.40 +/- 0.07-fold increase of IGFBP-4 (p < 0.01). Treatment with rhGH (100 ng/ml) or rhIGF-I (200 ng/ml) caused no significant induction of any specific band, respectively. In contrast to the secretion pattern of IGFBPs, IGF-I secretion of the PBMC was not stimulated by either PHA or PWM, but showed a significant increase after GH incubation (p < 0.01). A similar differentiated secretion pattern of IGFBPs and IGF-I was also observed in the conditioned medium of PBMC, derived from GH-deficient patients. CONCLUSION In summary, at least three different IGFBPs are secreted by human PBMC. Secretion of IGFBPs by PBMC is differentially regulated by different lymphocyte mitogens. Secretion of IGFBPs by PBMC is independent of GH or IGF-I, whereas the secretion of IGF-I is stimulated by GH. PBMC derived from normal adults and GH-deficient patients show similar patterns of IGF-I and IGFBPs secretion, thus indicating that the paracrine/autocrine IGF-I-IGFBPs interactions of the PBMC are not altered by pituitary GH deficiency.
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Affiliation(s)
- C J Auernhammer
- Medizinische Klinik II Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Germany
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Affiliation(s)
- F Jockenhövel
- Klinik II und Poliklinik für Innere Medizin, Universität Köln, 50924 Köln
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Fottner C, Engelhardt D, Elmlinger MW, Weber MM. Identification and characterization of insulin-like growth factor (IGF)-binding protein expression and secretion by adult human adrenocortical cells: differential regulation by IGFs and adrenocorticotropin. J Endocrinol 2001; 168:465-74. [PMID: 11241178 DOI: 10.1677/joe.0.1680465] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In previous studies we have shown that IGF-II stimulates basal as well as ACTH-induced cortisol secretion from adult human adrenocortical cells more potently than IGF-I, and that both IGFs predominantly stimulate androgen biosynthesis. The steroidogenic effect of IGF-I and IGF-II is mediated through interaction with the IGF-I receptor, and modified by locally produced IGF-binding proteins (IGFBPs). In the present study, we identified and characterized IGFBP synthesis in normal adult human adrenocortical cells in primary culture, and investigated the effect of ACTH and recombinant human IGF-I and -II on the regulation of IGFBP expression and secretion. Using RT-PCR, we identified the mRNA of all six high-affinity IGFBPs, in both adrenocortical tissue and monolayer cell cultures of adrenocortical cells. Using Western ligand and immunoblotting and two-dimensional Western ligand blotting we confirmed the secretion of IGFBP-1, -2, -3, -4 and -5 by adrenocortical cells in primary culture. The quantification of IGFBPs indicated that IGFBP-3 accounts for almost half the binding activity in conditioned medium of unstimulated cells (47%), followed by IGFBP-4 (20%), IGFBP-5 (15%), IGFBP-2 (12%) and IGFBP-1 (6%). After treatment with ACTH, the abundance of IGFBP-1 was upregulated significantly 2.6-fold, while IGFBP-3 was induced only slightly (1.3-fold). IGFBP-2, -4 and -5 remained unchanged. In contrast, IGF-I and -II (6.5 nM) predominantly induced the abundance of IGFBP-5 (2- and 1.6-fold respectively) and IGFBP-3 (2- and 1.7-fold respectively), while IGFBP-1, -2 and -4 were unaltered. The induction of IGFBP-1 and -5 by ACTH and IGFs, respectively, was paralleled by an increase in the amount of IGFBP-1 and -5 mRNA in these cells. In conclusion, all six high-affinity IGFBPs are expressed in the adult human adrenal gland, and the presence of at least five high-affinity IGFBPs has been demonstrated in conditioned medium of adult human adrenocortical cells. Furthermore, the expression and secretion of IGFBP-1 is upregulated by ACTH, whereas IGFBP-5 is induced by IGF-I and -II. Together with earlier findings, these results suggest that IGFBPs play an important modulatory role in the regulation of the differentiated adrenocortical function.
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Affiliation(s)
- C Fottner
- Medical Department II, University of Cologne, Germany
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Abstract
BACKGROUND The insulin-like growth factor (IGF) system plays a central role in the mechanism of transformation and tumourigenesis. Elevated levels of IGF-II and IGF-I have been found in adrenocortical carcinomas. MATERIAL AND METHODS We examined binding characteristics and concentrations of both IGF-receptors in normal adult human adrenocortical glands, and compared them with the IGF-I receptor binding in adrenocortical rumours of various origins. The human IGF-I receptor was overexpressed in the mouse adrenocortical tumour cell line Y1, and growth studied in response to IGF stimulation. The influence of IGF-II on adrenal morphology and function was assessed in transgenic mice that postnatally overexpress IGF-II. RESULTS While the abundance of the IGF-I receptor in adrenocortical hyperplasias and adenomas was similar to normal tissue, a strong overexpression of the intact IGF-I receptor was found in three out of four adrenocortical carcinomas. Y1 cells overexpressing the human IGF-I receptor respond to IGF-I with an increase in thymidine incorporation by 140%. Furthermore, the antiproliferative effect of ACTH is blunted. In transgenic mice postnatally overexpressing IGF-II, adrenal weight is increased, mainly due to a 50% increase in the number of zona fasciculata cells. Plasma corticosterone levels in these mice are twofold higher than in controls, in contrast to similar plasma ACTH levels, thus indicating a direct effect of IGF-II on adrenal cell hyperplasia and function. CONCLUSION There is substantial evidence that the IGF-system is involved in adrenal growth and tumourigenesis. High local levels of IGF-II in combination with elevated IGF-I receptor concentrations would represent a significant growth advantage of the adrenocortical carcinoma cell and could contribute to a highly malignant phenotype. IGF-II overexpression alone seems not to be sufficient for malignant transformation.
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Affiliation(s)
- M M Weber
- Medical Department II, Klinikum Grosshadern, Germany
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Weber MM, Fottner C, Schmidt P, Brodowski KM, Gittner K, Lahm H, Engelhardt D, Wolf E. Postnatal overexpression of insulin-like growth factor II in transgenic mice is associated with adrenocortical hyperplasia and enhanced steroidogenesis. Endocrinology 1999; 140:1537-43. [PMID: 10098485 DOI: 10.1210/endo.140.4.6660] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The influence of postnatal insulin-like growth factor II (IGF-II) overexpression on adrenal growth and function was investigated in 3-month-old male phosphoenolpyruvate carboxykinase (PEPCK) promoter human IGF-II transgenic mice, which are characterized by 4-to 6-fold elevated postnatal IGF-II serum levels. Plasma corticosterone levels of PEPCK-IGF-II transgenic mice were 2-fold higher than in age- and sex-matched controls, both in the morning (7.4 +/- 1.5 vs. 17.8 +/- 3.9 ng/ml, P < 0.01) and in the evening (33.3 +/- 6.5 vs. 65.3 +/- 12 ng/ml, P < 0.01). When PEPCK-IGF-II transgenic mice were subjected to an ACTH challenge, corticosterone levels were stimulated 6-fold, to 396 +/- 17 ng/ml after 60 min, compared with 230 +/- 24 ng/ml in the control group. In contrast to corticosterone, plasma ACTH levels were similar in transgenic and control mice, excluding an indirect effect of IGF-II at the hypothalamic or pituitary level. In vitro, the basal and ACTH-induced corticosterone production of adrenal glands from transgenic mice was higher (2-fold and 1.8-fold, respectively) than that of control organs. However, when normalized for adrenal weight, the in vitro corticosterone secretion was similar in both groups. At autopsy, adrenal weights of transgenic mice were significantly greater than those of control adrenal glands (3.3 +/- 0.2 vs. 2.0 +/- 0.2 mg, P < 0.01, n = 10). Furthermore, a local expression of human IGF-II could be demonstrated in transgenic adrenal glands by RT-PCR, whereas in normal adult mice, no adrenal expression of IGF-II was detected. Stereological investigation of adrenal glands from another set of PEPCK-IGF-II transgenic mice and controls (6-month-old males) demonstrated that the increase in adrenal weight in transgenic mice is mainly caused by a 50% increase in the number of zona fasciculata cells, whereas cell volume and zonation of transgenic adrenal glands remained unchanged. In conclusion, our data indicate that postnatal overexpression of IGF-II induces an increased adrenal weight and elevated corticosterone serum levels, presumably by a direct mitogenic effect of IGF-II on adrenocortical fasciculata cells.
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Affiliation(s)
- M M Weber
- Medical Department II, Klinikum Grosshadern, Munich, Germany
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Fottner C, Engelhardt D, Weber MM. Characterization of insulin-like growth factor binding proteins (IGFBPs) secreted by bovine adrenocortical cells in primary culture: regulation by insulin-like growth factors (IGFs) and adrenocorticotropin (ACTH). Horm Metab Res 1999; 31:203-8. [PMID: 10226803 DOI: 10.1055/s-2007-978720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In previous studies, we have shown that insulin-like growth factor II (IGF-II) stimulates basal as well as ACTH-induced cortisol secretion from bovine adrenocortical cells more potently than IGF-I [1]. The steroidogenic effect of both IGFs is mediated through interaction with the IGF-I receptor, and modified by locally produced IGF-binding proteins (IGFBPs). In the present study, we therefore characterized the IGFBPs secreted by bovine adrenocortical cells in primary culture, and investigated the effect of corticotropin (ACTH) and recombinant human IGF-I and IGF-II on the regulation of IGFBP synthesis. By Western ligand blotting, four different molecular forms of IGF-binding proteins were identified in conditioned medium of bovine adrenocortical cells with apparent molecular weights of 39-44 kDa, 34 kDA, 29-31 kDa, and 24 kDa. In accordance to their electrophoretic mobility, glycosylation status and binding affinity, these bands were identified by immunoprecipitation and immunoblotting as IGFBP-3, IGFBP-2, IGFBP-1, and deglycosilated IGFBP-4, respectively. Quantification of the specific bands by gamma counting revealed that, in unstimulated cells, IGFBP-3 accounts for approximately half of the detected IGFBP activity, followed by IGFBP-1, IGFBP-2 and IGFBP-4. ACTH treatment predominantly increased the abundance of IGFBP-1 and to a lesser extent IGFBP-3 in a time and dose-dependent fashion. In contrast, IGF-I or IGF-II (6.5 nM) preferentially induced the accumulation of IGFBP-3 (1.9-fold) and to a lesser extent of IGFBP-4, but did not show any effect on IGFBP-1. When ACTH and IGFs were combined, an additive stimulatory effect on the accumulation of IGFBP-3 and IGFBP-4 was observed. In contrast to their different steroidogenic potency, no significant difference in the stimulatory effect of IGF-I and IGF-II on IGFBP secretion was found. In conclusion, bovine adrenocortical cells synthesize IGFBP-1, IGFBP-2, IGFBP-3, and IGFBP-4, and their secretion is regulated differentially by ACTH and IGFs. These results, together with earlier findings, suggest that IGF-binding proteins play a modulatory role in the regulation of differentiated adrenocortical functions. Therefore, bovine adult adrenocortical cells provide a useful tissue culture model in which the complex interactions between two IGF-ligands, at least four IGF binding proteins and two IGF-receptors can be evaluated.
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Affiliation(s)
- C Fottner
- Medical Department II, Laboratory of Endocrine Research, Klinikum Grosshadern, University of Munich
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Fottner C, Engelhardt D, Weber MM. Regulation of steroidogenesis by insulin-like growth factors (IGFs) in adult human adrenocortical cells: IGF-I and, more potently, IGF-II preferentially enhance androgen biosynthesis through interaction with the IGF-I receptor and IGF-binding proteins. J Endocrinol 1998; 158:409-17. [PMID: 9846170 DOI: 10.1677/joe.0.1580409] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although the effect of insulin-like growth factors (IGFs) in fetal adrenocortical cells has been investigated extensively, the role of the IGF system in the adult human adrenal gland remains unclear. In the present study we investigated the effect of recombinant human IGF-I and IGF-II on cortisol, dehydroepiandrosterone sulfate (DHEA-S) and cAMP synthesis in adult human adrenocortical cells in primary culture. Both IGFs stimulate basal as well as adrenocorticotropin (ACTH)-induced steroid secretion in a time- and dose-dependent fashion. While both IGFs (6.5 nM) induced only a moderate 2-fold increase in basal cortisol output after 48 h, the effect on basal DHEA-S secretion was significantly stronger, with a 2.7- and 3.7-fold stimulation by IGF-I and IGF-II respectively. Similarly, IGF-II enhanced ACTH-induced cortisol and DHEA-S secretion more potently than IGF-I. In dose-response experiments, the maximum stimulation of ACTH-induced DHEA-S secretion was induced by 1.6 nM IGF-I (2-fold increase) or IGF-II (2.9-fold increase), while the maximum response of cortisol secretion was elicited only at 13 nM IGF-I (2-fold increase) or IGF-II (2.5-fold increase). This resulted in a significant shift of the DHEA-S dose-response curves to the left, indicating a relative selective stimulation of androgen biosynthesis by physiologically low concentrations (0.4-3.2 nM) of IGF-II, and less potently by IGF-I. At all doses tested, the steroidogenic effect of IGF-II was significantly stronger than the effect of IGF-I. Although both IGF receptors are present in adult human adrenocortical cells, the steroidogenic effect of IGF-II is mediated through the IGF-I receptor, since [Arg54,55]IGF-II, which only binds to the IGF-I receptor, was equipotent with native IGF-II, whereas [Leu27]IGF-II, which preferentially binds to the type II IGF receptor, did not show any effect. In addition, [des1-3]IGF-I, which exhibits only minimal binding to IGFBPs, was significantly more potent than native IGF-I in stimulating adrenal steroid biosynthesis, and elicited almost the same maximum stimulatory effect as IGF-II and [des1-6]IGF-II. By Western ligand blotting of conditioned medium it was shown that adult human adrenocortical cells secrete various IGF-binding proteins (IGFBPs), which are induced differentially by treatment with ACTH. In conclusion, these results demonstrate that: (1)IGF-II stimulates basal as well as ACTH-induced DHEA-S and cortisol secretion from adult human adrenocortical cells more potently than IGF-I; (2) both IGFs predominantly stimulate androgen biosynthesis; (3) the steroidogenic effect of IGF-I and IGF-II is mediated through interaction with the IGF-I receptor; (4) the different steroidogenic potency of IGF-I and IGF-II might be explained by interaction of these ligands with locally produced IGFBPs. These data indicate that the IGF system plays an important role in the regulation of the differentiated function of adult human adrenocortical cells.
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Affiliation(s)
- C Fottner
- Medical Department II, Klinikum Grosshadern, University of Munich, Germany
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Weber MM, Simmler P, Fottner C, Engelhardt D. Insulin-like growth factor II (IGF-II) is more potent than IGF-I in stimulating cortisol secretion from cultured bovine adrenocortical cells: interaction with the IGF-I receptor and IGF-binding proteins. Endocrinology 1995; 136:3714-20. [PMID: 7544271 DOI: 10.1210/endo.136.9.7544271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although the stimulating effect of insulin-like growth factor I (IGF-I) on adrenal steroidogenesis has been well established, the role of IGF-II in the adult adrenal gland remains unknown. We, therefore, investigated the effect of recombinant human IGF-II on cortisol and cAMP synthesis from adult bovine adrenocortical cells. IGF-II, time and dose dependently, stimulated basal cortisol secretion maximally 3-fold. In combination with ACTH, IGF-II (13 nM) synergistically increased cortisol secretion from 1-fold (10(-8) M ACTH) to 28-fold of untreated control levels. In contrast, IGF-I at equimolar concentrations did not show an effect on basal cortisol secretion, and in combination with ACTH elicited a significant weaker stimulatory effect than IGF-II (22-fold increase). The synergistic effect of IGF-II on ACTH-promoted cortisol secretion was paralleled by accumulation of cAMP in the culture medium. Although both IGF receptors are present in adult bovine adrenocortical cells, the effect of IGF-II seems to be mediated through interaction with the IGF-I receptor, as [Arg54,55]IGF-II, which only binds to the IGF-I receptor, was equipotent to native IGF-II, whereas [Leu27]IGF-II, which preferentially binds to the type II IGF receptor, did not show any effect. By Western ligand blotting, four different molecular forms of IGF-binding proteins (IGFBPs) were identified in conditioned medium of bovine adrenocortical cells with apparent molecular masses of 39-44, 34, 29, and 24 kilodaltons. ACTH treatment increased the abundance of all binding proteins, on the average, 2.3-fold, except for the 29-kDa band, which was predominantly induced 6.8-fold. Additionally, [des1-3]IGF-I, a truncated IGF variant that exhibits only minimal binding to IGFBPs, was significant more potent than IGF-I and elicited the same maximum stimulatory effect on cortisol secretion as IGF-II and [des1-6]IGF-II. In conclusion, these results demonstrate that 1) IGF-II stimulates basal as well as ACTH-induced cortisol secretion from bovine adrenocortical cells more potently than IGF-I; 2) this effect is mediated through interaction of IGF-II with the IGF-I receptor; 3) bovine adrenocortical cells synthesize various IGFBPs that are induced differentially by ACTH; and 4) IGFBPs apparently play a modulatory role in IGF-induced stimulation of adrenal steroidogenesis. Therefore, bovine adult adrenocortical cells provide a useful tissue culture model in which the interactions among locally produced IGFs, IGFBPs, and the IGF-I receptor can be evaluated.
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Affiliation(s)
- M M Weber
- Medical Department II, Klinikum Grosshadern, University of Munich, Germany
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