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Acanda De La Rocha AM, Berlow NE, Fader M, Coats ER, Saghira C, Espinal PS, Galano J, Khatib Z, Abdella H, Maher OM, Vorontsova Y, Andrade-Feraud CM, Daccache A, Jacome A, Reis V, Holcomb B, Ghurani Y, Rimblas L, Guilarte TR, Hu N, Salyakina D, Azzam DJ. Feasibility of functional precision medicine for guiding treatment of relapsed or refractory pediatric cancers. Nat Med 2024; 30:990-1000. [PMID: 38605166 PMCID: PMC11031400 DOI: 10.1038/s41591-024-02848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/31/2024] [Indexed: 04/13/2024]
Abstract
Children with rare, relapsed or refractory cancers often face limited treatment options, and few predictive biomarkers are available that can enable personalized treatment recommendations. The implementation of functional precision medicine (FPM), which combines genomic profiling with drug sensitivity testing (DST) of patient-derived tumor cells, has potential to identify treatment options when standard-of-care is exhausted. The goal of this prospective observational study was to generate FPM data for pediatric patients with relapsed or refractory cancer. The primary objective was to determine the feasibility of returning FPM-based treatment recommendations in real time to the FPM tumor board (FPMTB) within a clinically actionable timeframe (<4 weeks). The secondary objective was to assess clinical outcomes from patients enrolled in the study. Twenty-five patients with relapsed or refractory solid and hematological cancers were enrolled; 21 patients underwent DST and 20 also completed genomic profiling. Median turnaround times for DST and genomics were within 10 days and 27 days, respectively. Treatment recommendations were made for 19 patients (76%), of whom 14 received therapeutic interventions. Six patients received subsequent FPM-guided treatments. Among these patients, five (83%) experienced a greater than 1.3-fold improvement in progression-free survival associated with their FPM-guided therapy relative to their previous therapy, and demonstrated a significant increase in progression-free survival and objective response rate compared to those of eight non-guided patients. The findings from our proof-of-principle study illustrate the potential for FPM to positively impact clinical care for pediatric and adolescent patients with relapsed or refractory cancers and warrant further validation in large prospective studies. ClinicalTrials.gov registration: NCT03860376 .
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Affiliation(s)
- Arlet M Acanda De La Rocha
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | | | - Maggie Fader
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ebony R Coats
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Cima Saghira
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Paula S Espinal
- Center for Precision Medicine, Nicklaus Children's Hospital, Miami, FL, USA
| | - Jeanette Galano
- Center for Precision Medicine, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ziad Khatib
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Haneen Abdella
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ossama M Maher
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Yana Vorontsova
- Center for Precision Medicine, Nicklaus Children's Hospital, Miami, FL, USA
| | - Cristina M Andrade-Feraud
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Aimee Daccache
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Alexa Jacome
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Victoria Reis
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Baylee Holcomb
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Yasmin Ghurani
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Lilliam Rimblas
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA
| | - Tomás R Guilarte
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Nan Hu
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Daria Salyakina
- Center for Precision Medicine, Nicklaus Children's Hospital, Miami, FL, USA
| | - Diana J Azzam
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
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Acanda De La Rocha AM, Fader M, Coats ER, Espinal PS, Berrios V, Saghira C, Sotto I, Shakya R, Janvier M, Khatib Z, Abdella H, Bittle M, Andrade-Feraud CM, Guilarte TR, McCafferty-Fernandez J, Salyakina D, Azzam DJ. Clinical Utility of Functional Precision Medicine in the Management of Recurrent/Relapsed Childhood Rhabdomyosarcoma. JCO Precis Oncol 2021; 5:PO.20.00438. [PMID: 34738048 PMCID: PMC8563073 DOI: 10.1200/po.20.00438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 08/12/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Arlet M Acanda De La Rocha
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | - Maggie Fader
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL.,Pediatric Oncology and Hematology, Nicklaus Children's Hospital, Miami, FL
| | - Ebony R Coats
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | - Paula S Espinal
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL
| | - Vanessa Berrios
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | - Cima Saghira
- Miller School of Medicine, University of Miami, Miami, FL
| | - Ileana Sotto
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL
| | - Rojesh Shakya
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | - Michelin Janvier
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL
| | - Ziad Khatib
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL.,Pediatric Oncology and Hematology, Nicklaus Children's Hospital, Miami, FL
| | - Haneen Abdella
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL.,Pediatric Oncology and Hematology, Nicklaus Children's Hospital, Miami, FL
| | - Mathew Bittle
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL
| | - Cristina M Andrade-Feraud
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | - Tomás R Guilarte
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
| | | | - Daria Salyakina
- Personalized Medicine Initiative, Nicklaus Children's Hospital, Miami, FL
| | - Diana J Azzam
- Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
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Werneck-de-Castro JP, Fonseca TL, Ignacio DL, Fernandes GW, Andrade-Feraud CM, Lartey LJ, Ribeiro MB, Ribeiro MO, Gereben B, Bianco AC. Thyroid Hormone Signaling in Male Mouse Skeletal Muscle Is Largely Independent of D2 in Myocytes. Endocrinology 2015; 156:3842-52. [PMID: 26214036 PMCID: PMC4588812 DOI: 10.1210/en.2015-1246] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/23/2015] [Indexed: 01/25/2023]
Abstract
The type 2 deiodinase (D2) activates the prohormone T4 to T3. D2 is expressed in skeletal muscle (SKM), and its global inactivation (GLOB-D2KO mice) reportedly leads to skeletal muscle hypothyroidism and impaired differentiation. Here floxed Dio2 mice were crossed with mice expressing Cre-recombinase under the myosin light chain 1f (cre-MLC) to disrupt D2 expression in the late developmental stages of skeletal myocytes (SKM-D2KO). This led to a loss of approximately 50% in D2 activity in neonatal and adult SKM-D2KO skeletal muscle and about 75% in isolated SKM-D2KO myocytes. To test the impact of Dio2 disruption, we measured soleus T3 content and found it to be normal. We also looked at the expression of T3-responsive genes in skeletal muscle, ie, myosin heavy chain I, α-actin, myosin light chain, tropomyosin, and serca 1 and 2, which was preserved in neonatal SKM-D2KO hindlimb muscles, at a time that coincides with a peak of D2 activity in control animals. In adult soleus the baseline level of D2 activity was about 6-fold lower, and in the SKM-D2KO soleus, the expression of only one of five T3-responsive genes was reduced. Despite this, adult SKM-D2KO animals performed indistinguishably from controls on a treadmill test, running for approximately 16 minutes and reached a speed of about 23 m/min; muscle strength was about 0.3 mN/m·g body weight in SKM-D2KO and control ankle muscles. In conclusion, there are multiple sources of D2 in the mouse SKM, and its role is limited in postnatal skeletal muscle fibers.
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MESH Headings
- Adipose Tissue, Brown/metabolism
- Animals
- Animals, Newborn
- Cells, Cultured
- Gene Expression
- Iodide Peroxidase/genetics
- Iodide Peroxidase/metabolism
- Male
- Mice, Knockout
- Mice, Transgenic
- Muscle Fibers, Skeletal/metabolism
- Muscle Strength/genetics
- Muscle Strength/physiology
- Muscle, Skeletal/cytology
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/physiology
- Myosin Heavy Chains/genetics
- Physical Conditioning, Animal/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoplasmic Reticulum Calcium-Transporting ATPases/genetics
- Signal Transduction
- Thyroid Hormones/metabolism
- Thyroxine/metabolism
- Time Factors
- Triiodothyronine/metabolism
- Tropomyosin/genetics
- Iodothyronine Deiodinase Type II
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Affiliation(s)
- Joao P Werneck-de-Castro
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Tatiana L Fonseca
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Daniele L Ignacio
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Gustavo W Fernandes
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Cristina M Andrade-Feraud
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Lattoya J Lartey
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Marcelo B Ribeiro
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Miriam O Ribeiro
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Balazs Gereben
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism (J.P.W.d.C., T.L.F., G.W.F., A.C.B.), Rush University Medical Center, Chicago Illinois 60612; Division of Endocrinology, Diabetes, and Metabolism (J.P.W.d.C., D.L.I., C.M.A.F., L.J.L., M.B.R.), University of Miami Miller School of Medicine, Miami, Florida 33101-6960; Biophysics Institute and School of Physical Education and Sports (J.P.W.d.C., D.L.I., M.B.R.), Federal University of Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil; Developmental Disorders Program (M.O.R.), Center for Biological and Health Sciences, Mackenzie Presbyterian University, 01302 Sao Paulo, Brazil; Department of Endocrine Neurobiology (B.G.), Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, H-1083 Hungary; and Translational Medicine (G.W.F.), Federal University of Sao Paulo, 01302-907 Sao Paulo, Brazil
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