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Cochran ED, Jacobson JC, Nehrubabu M, Qiao J, McCreery S, Chung DH. Social Determinants of Outcomes Disparity among Pediatric Patients with Solid Tumor. J Am Coll Surg 2024; 238:463-478. [PMID: 38258890 DOI: 10.1097/xcs.0000000000001010] [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: 01/24/2024]
Abstract
BACKGROUND Socioeconomic factors have a significant impact on healthcare outcomes. Metrics such as area deprivation index (ADI) are used to quantify the anticipated influence of these factors. Here, we sought to assess the impact of socioeconomic factors on clinical outcomes among pediatric patients with solid tumor in our region. STUDY DESIGN We identified 3,863 pediatric patients who were diagnosed with a malignant solid tumor in the Texas Cancer Registry between 1995 and 2019. ADI was used to quantify socioeconomic determinants of health. These outcome variables were determined: stage of disease at diagnosis, time between diagnosis and treatment initiation, and overall mortality. Statistical analysis was performed using logistic regression, linear regression, Cox proportional hazards regression, and Kaplan-Meier survival curves. RESULTS A total of 53.5% of patients were male and the average age at diagnosis was 4.5 years. Forty-seven percent of patients were White, 13.3% were Black, 36.2% were Hispanic, 1.7% were Asian, and other rare minority groups made up 1.8%. On multivariable analysis, increased risk of death was associated with Black race, rare minority race, residence in a border county, and increasing ADI score, with the risk of death at 5 years rising 4% with each increasing ADI point. CONCLUSIONS Social determinants of health are associated with disparate outcomes among pediatric patients with solid tumor. Our results suggest that patients who are part of racial minority groups and those who reside in socioeconomically disadvantaged neighborhoods or regions near the Texas-Mexico border are at an increased risk of death. This information may be useful in strategizing outreach and expanding resources to improve outcomes in at-risk communities.
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Affiliation(s)
- Elizabeth D Cochran
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Jillian C Jacobson
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Mithin Nehrubabu
- Department of Mathematical Sciences, University of Dallas, Dallas, TX (Nehrubabu)
| | - Jingbo Qiao
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Sullivan McCreery
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Dai H Chung
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
- Children's Health, Dallas, TX (Chung)
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2
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Peters CA, Chung DH. Pediatric Robotic Surgical Program: Is it Time to Embrace? Ann Surg 2023; 278:e939-e940. [PMID: 37459151 DOI: 10.1097/sla.0000000000006017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Craig A Peters
- Department of Urology, UT Southwestern Medical Center, Dallas, TX
- Department of Pediatric Urology, Children's Health, Dallas, TX
| | - Dai H Chung
- Department of Pediatric Surgery, UT Southwestern Medical Center and Children's Health, Dallas, TX
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Bumpous LA, Moe KC, Wang J, Carver LA, Williams AG, Romer AS, Scobee JD, Maxwell JN, Jones CA, Chung DH, Tansey WP, Liu Q, Weissmiller AM. WDR5 facilitates recruitment of N-MYC to conserved WDR5 gene targets in neuroblastoma cell lines. Oncogenesis 2023; 12:32. [PMID: 37336886 PMCID: PMC10279693 DOI: 10.1038/s41389-023-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
Collectively, the MYC family of oncoprotein transcription factors is overexpressed in more than half of all malignancies. The ability of MYC proteins to access chromatin is fundamental to their role in promoting oncogenic gene expression programs in cancer and this function depends on MYC-cofactor interactions. One such cofactor is the chromatin regulator WDR5, which in models of Burkitt lymphoma facilitates recruitment of the c-MYC protein to chromatin at genes associated with protein synthesis, allowing for tumor progression and maintenance. However, beyond Burkitt lymphoma, it is unknown whether these observations extend to other cancers or MYC family members, and whether WDR5 can be deemed as a "universal" MYC recruiter. Here, we focus on N-MYC amplified neuroblastoma to determine the extent of colocalization between N-MYC and WDR5 on chromatin while also demonstrating that like c-MYC, WDR5 can facilitate the recruitment of N-MYC to conserved WDR5-bound genes. We conclude based on this analysis that N-MYC and WDR5 colocalize invariantly across cell lines at predicted sites of facilitated recruitment associated with protein synthesis genes. Surprisingly, we also identify N-MYC-WDR5 cobound genes that are associated with DNA repair and cell cycle processes. Dissection of chromatin binding characteristics for N-MYC and WDR5 at all cobound genes reveals that sites of facilitated recruitment are inherently different than most N-MYC-WDR5 cobound sites. Our data reveals that WDR5 acts as a universal MYC recruiter at a small cohort of previously identified genes and highlights novel biological functions that may be coregulated by N-MYC and WDR5 to sustain the neuroblastoma state.
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Affiliation(s)
- Leigh A Bumpous
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Kylie C Moe
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Jing Wang
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37240, USA
| | - Logan A Carver
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Alexandria G Williams
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Alexander S Romer
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Jesse D Scobee
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Jack N Maxwell
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Cheyenne A Jones
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | - Dai H Chung
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, 75234, USA
| | - William P Tansey
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, 37240, USA
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, 37240, USA
| | - Qi Liu
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37240, USA
| | - April M Weissmiller
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, 37132, USA.
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Ryan ML, Mutore KT, DeLeon J, Gillory L, Chung DH, Pandya S. Improving Billing and Collections in a High-Volume Pediatric Surgery Practice: Denials-Based Approach. J Am Coll Surg 2023; 236:630-635. [PMID: 36728227 DOI: 10.1097/xcs.0000000000000559] [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: 02/03/2023]
Abstract
BACKGROUND Despite minimal coding and billing training, surgeons are frequently tasked with both in clinical practice. This often results in denials for reimbursement based on incorrect or insufficient documentation, and reduced collections for work performed. We sought to evaluate how to correct these deficits while improving reimbursement for the most frequently rejected procedures at a high-volume academic center. STUDY DESIGN Hospital billing data were analyzed for a 4-year period (2018 to 2021) to determine the CPT code denials with the largest overall cost. The denials were then stratified according to payor, reason for denial, and preventability. Assigned ICD-10 codes were categorized based on specificity as related to the procedure. The distribution of denials according to ICD-10 specificity was evaluated using the chi-square test. RESULTS A total of 8,833 denials representing $11,009,108 in billing were noted during the study period. The CPT code 44970 (laparoscopic appendectomy) was the code associated with the largest financial impact, representing 12.8% of the total denied amount ($1.41M). Of the 823 denials for CPT 44970, 93.3% were associated with nonspecific ICD-10 codes, whereas only 42.0% had been associated with procedure-specific ICD-10 codes. Of the patients with nonspecific codes, 80.7% of denials were due to criteria that could be remedied with supplemental information or timely filing, representing $1,059,968 in collections. CONCLUSIONS This is the first study to systematically evaluate a pathway for using denial data to improve collections for work performed at a high-volume academic pediatric surgery practice. Using this methodology, targets for improvement in coding and/or documentation can be identified to improve the financial performance of a surgical department. This study also provides evidence that association with nonspecific diagnostic codes is correlated with initial denial of payment by insurance companies.
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Affiliation(s)
- Mark L Ryan
- From the Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX (Ryan, Mutore, Gillory, Chung, Pandya)
| | - Kevin T Mutore
- From the Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX (Ryan, Mutore, Gillory, Chung, Pandya)
| | - Jennifer DeLeon
- the Department of Clinical Revenue, University of Texas Southwestern Medical Center, Dallas, TX (DeLeon)
| | - Lauren Gillory
- From the Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX (Ryan, Mutore, Gillory, Chung, Pandya)
| | - Dai H Chung
- From the Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX (Ryan, Mutore, Gillory, Chung, Pandya)
| | - Samir Pandya
- From the Division of Pediatric Surgery, Department of Surgery, Children's Medical Center Dallas/University of Texas Southwestern Medical Center, Dallas, TX (Ryan, Mutore, Gillory, Chung, Pandya)
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Qiao J, Liu J, Jacobson JC, Clark RA, Lee S, Liu L, An Z, Zhang N, Chung DH. Anti-GRP-R monoclonal antibody antitumor therapy against neuroblastoma. PLoS One 2022; 17:e0277956. [PMID: 36525420 PMCID: PMC9757561 DOI: 10.1371/journal.pone.0277956] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Standard treatment for patients with high-risk neuroblastoma remains multimodal therapy including chemoradiation, surgical resection, and autologous stem cell rescue. Immunotherapy has demonstrated success in treating many types of cancers; however, its use in pediatric solid tumors has been limited by low tumor mutation burdens. Gastrin-releasing peptide receptor (GRP-R) is overexpressed in numerous malignancies, including poorly-differentiated neuroblastoma. Monoclonal antibodies (mAbs) to GRP-R have yet to be developed but could serve as a potential novel immunotherapy. This preclinical study aims to evaluate the efficacy of a novel GRP-R mAb immunotherapy against neuroblastoma. We established four candidate anti-GRP-R mAbs by screening a single-chain variable fragment (scFv) library. GRP-R mAb-1 demonstrated the highest efficacy with the lowest EC50 at 4.607 ng/ml against GRP-R expressing neuroblastoma cells, blocked the GRP-ligand activation of GRP-R and its downstream PI3K/AKT signaling. This resulted in functional inhibition of cell proliferation and anchorage-independent growth, indicating that mAb-1 has an antagonist inhibitory role on GRP-R. To examine the antibody-dependent cellular cytotoxicity (ADCC) of GRP-R mAb-1 on neuroblastoma, we co-cultured neuroblastoma cells with natural killer (NK) cells versus GRP-R mAb-1 treatment alone. GRP-R mAb-1 mediated ADCC effects on neuroblastoma cells and induced release of IFNγ by NK cells under co-culture conditions in vitro. The cytotoxic effects of mAb-1 were confirmed with the secretion of cytotoxic granzyme B from NK cells and the reduction of mitotic tumor cells in vivo using a murine tumor xenograft model. In summary, GRP-R mAb-1 demonstrated efficacious anti-tumor effects on neuroblastoma cells in preclinical models. Importantly, GRP-R mAb-1 may be an efficacious, novel immunotherapy in the treatment of high-risk neuroblastoma patients.
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Affiliation(s)
- Jingbo Qiao
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Junquan Liu
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Jillian C. Jacobson
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Rachael A. Clark
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Sora Lee
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Li Liu
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Dai H. Chung
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Surgery, Children’s Health, Dallas, Texas, United States of America
- * E-mail:
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Jacobson JC, Qiao J, Clark RA, Chung DH. Combination bromo- and extraterminal domain and poly (ADP-ribose) polymerase inhibition synergistically enhances DNA damage and inhibits neuroblastoma tumorigenesis. Discov Oncol 2022; 13:103. [PMID: 36227363 PMCID: PMC9562984 DOI: 10.1007/s12672-022-00563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE JQ1 is a bromo- and extraterminal (BET) domain inhibitor that downregulates MYC expression and impairs the DNA damage response. Poly (ADP-ribose) polymerase (PARP) inhibitors prevent DNA damage sensing and repair. We hypothesized that JQ1 would promote a DNA repair-deficient phenotype that sensitizes neuroblastoma cells to PARP inhibition. METHODS Four human neuroblastoma cell lines were examined: two MYCN-amplified (BE(2)-C and IMR-32), and two non-MYCN-amplified (SK-N-SH and SH-SY5Y). Cells were treated with JQ1 (BET inhibitor), Olaparib (PARP inhibitor), or in combination to assess for therapeutic synergy of JQ1 and Olaparib. Treated cells were harvested and analyzed. Quantitative assessment of combination treatment synergy was performed using the median effect principle of Chou and Talalay. RESULTS Combination treatment with Olaparib decreased the IC50 of JQ1 by 19.9-fold, 2.0-fold, 12.1-fold, and 2.0-fold in the BE(2)-C, IMR-32, SK-N-SH, and SH-SY5Y cell lines, respectively. In the MYCN-amplified cell lines, BE(2)-C and IMR-32, combination treatment decreased gene expression of MYCN relative to single-drug treatment alone or control. Combination treatment decreased protein expression of DNA repair proteins Ku80 and RAD51, led to accumulation of DNA damage marker phospho-histone H2A.X, and increased caspase activity. In the non-MYCN-amplified cell lines, SK-N-SH and SH-SY5Y, combination treatment induced G0/G1 cell cycle arrest. CONCLUSIONS Combination BET and PARP inhibition synergistically inhibited neuroblastoma tumorigenesis in vitro. In MYCN-amplified neuroblastoma cells, this effect may be induced by downregulation of MYCN transcription, defects in DNA repair, accumulation of DNA damage, and apoptosis. In non-MYCN-amplified cell lines, combination treatment induced cell cycle arrest.
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Affiliation(s)
- Jillian C Jacobson
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, 1935 Medical District Dr. Mailstop F3.66, Dallas, TX, 75235, USA
| | - Jingbo Qiao
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, 1935 Medical District Dr. Mailstop F3.66, Dallas, TX, 75235, USA
| | - Rachael A Clark
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, 1935 Medical District Dr. Mailstop F3.66, Dallas, TX, 75235, USA
| | - Dai H Chung
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, 1935 Medical District Dr. Mailstop F3.66, Dallas, TX, 75235, USA.
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Clark RA, Garcia IC, Jacobson JC, Chung DH. Ethnic Disparities in the Management of Pediatric Subcutaneous Abscesses. Children (Basel) 2022; 9:children9101428. [PMID: 36291364 PMCID: PMC9600215 DOI: 10.3390/children9101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Significant racial and ethnic disparities affect access to pediatric Emergency Department (ED) and surgical care across the United States. The present study sought to assess the role of racial and ethnic disparities in the management of pediatric subcutaneous abscesses. (2) Methods: A retrospective chart review was performed including ED visits for subcutaneous abscesses in patients < 18 years of age, over a 12-month period. The effects of self-reported ethnicity (Hispanic versus non-Hispanic) and race (Hispanic, Black, Caucasian and Asian) on the diagnosis and management of subcutaneous abscesses were analyzed. (3) Results: 192 patients were identified with an average age of 4.7 ± 5.3 years and 43.8% identified as Hispanic. Non-Hispanic patients were significantly more likely to receive treatment of their SSTI prior to the ED and to be admitted, compared to Hispanic patients. There was no difference in bedside versus operating room incision and drainage (I&D); however, significantly more non-Hispanic patients received procedural sedation for bedside I&D compared to Hispanic patients. There were no differences in outcomes such as recurrence or re-admission based on ethnicity or race. (4) Conclusions: Ethnic and racial disparities exist in the management of subcutaneous abscesses in the United States. Further studies are needed to address the systemic causes of these disparities such as access to tertiary healthcare facilities and systems-based analyses of unconscious bias in healthcare.
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Jacobson JC, Clark RA, Cairo SB, Murphy JT, Chung DH. Multimodality treatment of pediatric Ewing sarcoma: A single-center 10-year analysis of outcomes. Surgery 2022; 172:1251-1256. [PMID: 35933175 DOI: 10.1016/j.surg.2022.05.036] [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] [Received: 03/01/2022] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Ewing sarcoma, a malignancy originating from the bone or soft tissues most commonly diagnosed in adolescents, requires multimodality therapy. Although both surgical resection and radiation therapy are effective local control modalities, there are limited data comparing outcomes in patients treated with surgery versus radiation. We sought to determine whether there were differences in 5-year local failure-free survival, event-free survival, and overall survival based on the modality used for local control. METHODS Patients treated for Ewing sarcoma at a single tertiary pediatric hospital between 2010 and 2020 were included for retrospective analysis. Patient and tumor demographics, treatment information, and patient response to therapies were collected from the medical record. Outcome measures were local failure-free survival, event-free survival, and overall survival at 5 years from diagnosis. RESULTS Sixty-one patients met inclusion criteria. All patients received chemotherapy, and 68.9% of patients presented with localized disease. Of these, 23.8% were treated with radiation alone; the remaining 76.2% underwent resection ± radiation. A total of 52.4% of patients with localized disease achieved R0 resection. Only 3 patients experienced local progression; there was no difference between treatment groups. There was no significant association between local control modality and event-free survival or overall survival in patients with localized disease, regardless of margin status. CONCLUSION There was no significant difference in 5-year local failure-free survival, event-free survival, or overall survival in Ewing sarcoma patients treated with radiation versus surgery ± radiation, regardless of whether or not R0 resection was achieved. Future directions include a multi-institutional study to allow for further subgroup analysis and increased sample size.
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Affiliation(s)
- Jillian C Jacobson
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Rachael A Clark
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Sarah B Cairo
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Joseph T Murphy
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
| | - Dai H Chung
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX.
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Jacobson JC, Clark RA, Chung DH. Gangrenous, Suppurative, and Exudative Nonperforated Appendicitis-A Distinct Pathology? JAMA Surg 2022; 157:692. [PMID: 35648417 DOI: 10.1001/jamasurg.2022.1937] [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: 11/14/2022]
Affiliation(s)
- Jillian C Jacobson
- Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas
| | - Rachael A Clark
- Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas
| | - Dai H Chung
- Department of Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas
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Clark RA, Qiao J, Jacobson JC, Chung DH. Induction of serine hydroxymethyltransferase 2 promotes tumorigenesis and metastasis in neuroblastoma. Oncotarget 2022; 13:32-45. [PMID: 35018218 PMCID: PMC8735882 DOI: 10.18632/oncotarget.28168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022] Open
Abstract
High-risk neuroblastoma (NB) remains an extremely difficult subgroup to cure and is associated with MYCN amplification. Serine hydroxymethyltransferase 2 (SHMT2) regulates serine metabolism in a myc-dependent manner; it is upregulated in several cancers and is associated with tumor aggressiveness. Akt-2, an important regulator of MYCN via the PI3K/Akt pathway, induces metastatic potential in NB. The association between SHMT2 and PI3K/Akt in hepatocyte regeneration has been well established but its mechanistic interaction in cancer has yet to be clearly elucidated. Herein, we evaluated the exact role of SHMT2 on the PI3K/Akt pathway, in addition to NB tumorigenesis and metastatic potential in vitro. SHMT2 gene expression and overall survival (OS) were assessed. Two human NB cell lines were examined. SHMT2 silencing and overexpression were performed. The downstream effects were analyzed with immunoblotting, RT-qPCR and functional assays were performed. We found SHMT2 gene expression is associated with decreased OS and MYCN amplification. SHMT2 protein and mRNA expression are increased in MYCN-amplified cells. SHMT2 expression has a direct interaction with Akt-2 and MYCN. Induction of SHMT2 increased cellular proliferation, colony formation and cellular migration and SHMT2 expression was increased in metastatic NB cells. We conclude that SHMT2 regulates N-Myc via phosphorylation of Akt-2 and plays an important role in NB tumorigenesis by contributing to cell growth, migration, colony formation and metastasis in vitro.
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Affiliation(s)
- Rachael A Clark
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75234, USA
| | - Jingbo Qiao
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75234, USA
| | - Jillian C Jacobson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75234, USA
| | - Dai H Chung
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75234, USA.,Department of Surgery, Children's Health, Dallas, TX 75234, USA
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Clark RA, Newton M, Qiao J, Lee S, Chung DH. Reactivation of silenced α-N-catenin induces retinoic acid sensitivity in neuroblastoma cells. Surgery 2021; 170:1546-1553. [PMID: 34092372 DOI: 10.1016/j.surg.2021.04.039] [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] [Received: 01/19/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk neuroblastoma remains the most difficult pediatric solid tumor to treat and is associated with chemotherapy and radiation resistance that may be secondary to epigenetic modifications. We have previously found that α-N-catenin, a cell-adhesion protein encoded by the gene CTNNA2, plays a tumor suppressor role in neuroblastoma by inhibiting the NF-κB signaling pathway. A subset of neuroblastoma tumors that lack α-N-catenin are resistant to all-trans retinoic acid. However, the mechanism of CTNNA2 silencing in neuroblastoma remains unknown. Herein, we sought to determine the mechanism of α-N-catenin silencing in neuroblastoma. METHODS Two human neuroblastoma cell lines, SK-N-AS and BE(2)-C, were stably transfected with a plasmid expressing CTNNA2. Both cell lines were treated with the histone deacetylase inhibitor Trichostatin A alone and in combination with retinoic acid. Cell survival and colony formation were measured. Cellular differentiation and expression of cell survival signaling pathways were analyzed. Immunoblotting and reverse transcription quantitative polymerase chain reaction were used to examine protein and messenger RNA expression. RESULTS Retinoic acid treatment induced cellular differentiation and inhibited cellular proliferation in BE(2)-C cells but did not induce differentiation in SK-N-AS cells. Re-expression of α-N-catenin enhanced the sensitivity to retinoic acid-induced cell growth arrest and downregulated key cell survival pathways in both cell lines. Trichostatin A treatment induced CTNNA2 expression in SK-N-AS cells, and combination treatment with Trichostatin A induced retinoic acid sensitivity in retinoic acid-resistant cells. CONCLUSION Re-expression of α-N-catenin in retinoic acid-resistant cells induced sensitivity to retinoic acid treatment and is controlled epigenetically via histone deacetylase. α-N-catenin is a potential biomarker for retinoic acid sensitivity and combination treatment with Trichostatin A and retinoic acid may improve survival among children with high-risk, retinoic acid-resistant neuroblastoma.
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Affiliation(s)
- Rachael A Clark
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Micah Newton
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jingbo Qiao
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sora Lee
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dai H Chung
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Clark RA, Perez EA, Chung DH, Pandya SR. Predictive Factors and Outcomes for Successful Thoracoscopic Lung Resection in Pediatric Patients. J Am Coll Surg 2021; 232:551-558. [PMID: 33359619 DOI: 10.1016/j.jamcollsurg.2020.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Less than 50% of children with congenital lung lesions are treated thoracoscopically. There are variable data regarding the benefits and limited information on factors contributing to successful thoracoscopic lobectomies in pediatric patients. We sought to identify predictive factors leading to safe and efficient thoracoscopic lung resection. STUDY DESIGN We performed a single-center, retrospective chart review of patients (age <18 y) who underwent lung resection between June 2009 and July 2020. Pulmonary wedge resection was excluded. Data collected included demographics, perioperative findings, such as symptoms or infection, and postoperative outcomes. Univariate, multivariate, and sensitivity analyses were performed. RESULTS Ninety-six patients were identified. Sixty-nine patients (72%) underwent initial thoracoscopy, with 15 (22%) converting to open thoracotomy (CTO). Forty-one (43%) patients had preoperative symptoms and 15 (15.6%) had an active infection. Among symptomatic patients, 18 (43.9%) underwent thoracotomy and 23 (56%) were attempted thoracoscopically, 13 (31%) of whom were completed thoracoscopically. On univariate analysis, age >1 year, infection, preoperative symptoms, and intraoperative adhesions were associated with CTO. Older age (odds ratio [OR] = 1.041) and estimated blood loss (EBL) (OR = 2.398) were significant prognostic factors of CTO on logistic regression. Thoracoscopy was significantly associated with decreased length of stay, opioid use, chest tube duration, blood loss and need for blood transfusion. There was no difference in operative time, 30-day readmission, or mortality. CONCLUSIONS Thoracoscopy has become a standard approach for pediatric lung resection. Our findings indicate that age < 1 year and the absence of active respiratory infection and preoperative symptoms may be predictive of successful completion of the thoracoscopic approach. Thoracoscopy offers significant advantages over the traditional open thoracotomy with regard to blood loss and opioid requirements, LOS, and chest tube duration.
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Affiliation(s)
- Rachael A Clark
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eduardo A Perez
- Department of Pediatric Surgery, University of Miami Health System, Miami, FL
| | - Dai H Chung
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Samir R Pandya
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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13
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Alder AC, Chung DH. Children Are Not Little Adults When Prescribing Opioids. JAMA Surg 2020; 156:91. [PMID: 33175115 DOI: 10.1001/jamasurg.2020.5150] [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: 11/14/2022]
Affiliation(s)
- Adam C Alder
- Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Dai H Chung
- Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas
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14
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Kim KW, Qiao J, Kim JY, Park K, Chung DH. Overexpression of microRNA-145 inhibits tumorigenesis through autophagy in chemotherapy and radiation resistant neuroblastoma cells. Oncoscience 2020; 7:1-9. [PMID: 32258242 PMCID: PMC7105155 DOI: 10.18632/oncoscience.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023] Open
Abstract
MicroRNA-145 (miR-145) plays a suppressive role in the process of tumorigenesis and an important role in induction of autophagy. However, the exact role of miR-145 in therapeutically resistant neuroblastoma cells remain elusive. Herein, we sought to evaluate the effects of miR-145 overexpression in chemo‑ and radiation-resistant neuroblastoma cells. We hypothesized that miR-145 affects the aggressiveness of resistant cells by enhancing autophagy. We established Cisplatin-resistant (CDDP-R), Vincristine-resistant (Vin-R), and radiation-resistant (Rad-R) neuroblastoma cells and found that miR-145 expression was significantly decreased in the resistant cells compared to the parental cells. Exogenously expression of miR-145 inhibited oncogenic properties such as proliferation, clonogenicity, anchorage-independent growth, cell migration, and tubule formation in the resistant cells. In addition, we also found that an autophagy protein marker, LC3, was only minimally expressed in the resistant cells. In particular, when miR-145 was overexpressed in the resistant cells, LC3 I and II were expressed and an increased punctate fluorescence of LC3 protein was found indicating the induction of autophagy. Taken together, our data suggests that miR-145 inhibits tumorigenesis and aggressiveness via modulation of autophagy in neuroblastoma.
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Affiliation(s)
- Kwang Woon Kim
- UT Southwestern Medical Center, Department of Surgery, Dallas, TX, USA
| | - Jingbo Qiao
- UT Southwestern Medical Center, Department of Surgery, Dallas, TX, USA
| | - Julia Y Kim
- UT Southwestern Medical Center, Department of Surgery, Dallas, TX, USA
| | - Kyungho Park
- UT Southwestern Medical Center, Department of Surgery, Dallas, TX, USA
| | - Dai H Chung
- UT Southwestern Medical Center, Department of Surgery, Dallas, TX, USA
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15
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Bryan AF, Wang J, Howard GC, Guarnaccia AD, Woodley CM, Aho ER, Rellinger EJ, Matlock BK, Flaherty DK, Lorey SL, Chung DH, Fesik SW, Liu Q, Weissmiller AM, Tansey WP. WDR5 is a conserved regulator of protein synthesis gene expression. Nucleic Acids Res 2020; 48:2924-2941. [PMID: 31996893 PMCID: PMC7102967 DOI: 10.1093/nar/gkaa051] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022] Open
Abstract
WDR5 is a highly-conserved nuclear protein that performs multiple scaffolding functions in the context of chromatin. WDR5 is also a promising target for pharmacological inhibition in cancer, with small molecule inhibitors of an arginine-binding pocket of WDR5 (the 'WIN' site) showing efficacy against a range of cancer cell lines in vitro. Efforts to understand WDR5, or establish the mechanism of action of WIN site inhibitors, however, are stymied by its many functions in the nucleus, and a lack of knowledge of the conserved gene networks-if any-that are under its control. Here, we have performed comparative genomic analyses to identify the conserved sites of WDR5 binding to chromatin, and the conserved genes regulated by WDR5, across a diverse panel of cancer cell lines. We show that a specific cohort of protein synthesis genes (PSGs) are invariantly bound by WDR5, demonstrate that the WIN site anchors WDR5 to chromatin at these sites, and establish that PSGs are bona fide, acute, and persistent targets of WIN site blockade. Together, these data reveal that WDR5 plays a predominant transcriptional role in biomass accumulation and provide further evidence that WIN site inhibitors act to repress gene networks linked to protein synthesis homeostasis.
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Affiliation(s)
- Audra F Bryan
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Jing Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - Gregory C Howard
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Alissa D Guarnaccia
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Chase M Woodley
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Erin R Aho
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Eric J Rellinger
- Department of Pediatric General and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Brittany K Matlock
- Vanderbilt University Medical Center Flow Cytometry Shared Resource, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - David K Flaherty
- Vanderbilt University Medical Center Flow Cytometry Shared Resource, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - Shelly L Lorey
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Dai H Chung
- Department of Pediatric General and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Stephen W Fesik
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - Qi Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37240, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN 37240, USA
| | - April M Weissmiller
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
| | - William P Tansey
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37240, USA
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16
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Qiao J, Rellinger EJ, Kim KW, Powers CM, Lee S, Correa H, Chung DH. Identification of α-N-catenin as a novel tumor suppressor in neuroblastoma. Oncotarget 2019; 10:5028-5040. [PMID: 31489113 PMCID: PMC6707940 DOI: 10.18632/oncotarget.27096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022] Open
Abstract
The lost expression of α-catenin has been found in cancers, and reinstalling α-catenin inhibits tumor growth. Here we hypothesized that the α-N-catenin, a homologous member of α-catenin and neural-specific expressed, functions as a novel tumor suppressor in neural crest-derived tumor, neuroblastoma. We correlated CTNNA2 (encodes α-N-catenin) expression to neuroblastoma disease relapse-free survival probability using publicly accessible human neuroblastoma datasets in R2 platform. The result showed that it negatively correlated to relapse-free survival probability significantly in patients with neuroblastoma with non-MYCN amplified tumor. Conversely, overexpressing CTNNA2 suppressed the neuroblastoma cell proliferation as measuring by the clonogenesis, inhibited anchorage-independent growth with soft agar colony formation assay. Forced expression of CTNNA2 decreased cell migration and invasion. Further, overexpression of CTNNA2 reduced the secretion of angiogenic factor IL-8 and HUVEC tubule formation. Our results show, for the first time, that α-N-catenin is a tumor suppressor in neuroblastoma cells. These findings were further corroborated with in vivo tumor xenograft study, in which α-N-catenin inhibited tumor growth and reduced tumor blood vessel formation. Interestingly, this is only observed in SK-N-AS xenografts lacking MYCN expression, and not in BE(2)-C xenografts with MYCN amplification. Mechanistically, α-N-catenin attenuated NF-κB responsive genes by inhibiting NF-κB transcriptional activity. In conclusion, these data demonstrate that α-N-catenin is a tumor suppressor in non-MYCN-amplified neuroblastomas and it inhibits NF-κB signaling pathway to suppress tumor growth in human neuroblastomas. Therefore, restoring the expression of α-N-catenin can be a novel therapeutic approach for neuroblastoma patients who have the deletion of CTNNA2 and lack of MYCN amplification.
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Affiliation(s)
- Jingbo Qiao
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Kwang Woon Kim
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Camille M Powers
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sora Lee
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hernan Correa
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Dai H Chung
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
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17
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Phelps HM, Ndolo JM, Van Arendonk KJ, Chen H, Dietrich HL, Watson KD, Hilmes MA, Chung DH, Lovvorn HN. Association between image-defined risk factors and neuroblastoma outcomes. J Pediatr Surg 2019; 54:1184-1191. [PMID: 30885556 PMCID: PMC6628713 DOI: 10.1016/j.jpedsurg.2019.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current neuroblastoma (NBL) staging system employs image-defined risk factors (IDRFs) to assess numerous anatomic features, but the impact of IDRFs on surgical and oncologic outcomes is unclear. METHODS The Vanderbilt Cancer Registry identified children treated for NBL from 2002 to 2017. Tumor volume (TV) and IDRFs were measured radiographically at diagnosis and before resection. Perioperative and oncologic outcomes were evaluated. RESULTS At diagnosis of 106 NBL, 61% were IDRF positive. MYCN-amplified and undifferentiated NBL had more IDRFs than nonamplified and more differentiated tumors (p = 0.001 and p = 0.01). Of 86 NBLs resected, 43% were IDRF positive, which associated with higher stage, risk, and TV (each p < 0.001). The presence of IDRF at resection was also associated with increased blood loss (p < 0.001), longer operating times (p < 0.001), greater incidence of intraoperative complications (p = 0.03), more frequent ICU admissions postoperatively (p < 0.001), and longer hospital stays (p < 0.001). IDRF negative and positive tumors did not have significantly different rates of gross total resection (p = 0.2). Five-year relapse-free and overall survival was similar for IDRF negative and positive NBL (p = 0.9 and p = 0.8). CONCLUSIONS IDRFs at diagnosis were associated with larger, less differentiated, advanced stage, and higher risk NBL and at resection with increased operative difficulty and perioperative morbidity. However, the frequency of gross total resection and patient survival after resection were not associated with the presence of IDRFs. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hannah M. Phelps
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN,Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Corresponding author at: Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37232-9780. (H.M. Phelps)
| | - Josephine M. Ndolo
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kyle J. Van Arendonk
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Heidi Chen
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Katherine D. Watson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa A. Hilmes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Harold N. Lovvorn
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
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18
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Kim HW, Chung DH, Kim SA, Rhee MS. Synergistic cranberry juice combinations with natural-borne antimicrobials for the eradication of uropathogenic Escherichia coli biofilm within a short time. Lett Appl Microbiol 2019; 68:321-328. [PMID: 30801748 DOI: 10.1111/lam.13140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 01/24/2023]
Abstract
Urinary tract infections (UTI), one of the most common diseases in humans, are caused primarily by uropathogenic Escherichia coli (UPEC). Cranberry juice (CB) is a widely known prophylaxis for UTI, but the treatment of CB alone could not effectively eradicate preformed UPEC biofilms. The aim of this study was to develop enforced CB composites within a short time by adding a small quantity of natural borne antimicrobials. UPEC biofilms (initial: 6·0 log CFU per cm2 ), formed on silicone coupons in artificial urine medium, were exposed to CB (4-8%), caprylic acid (CAR; 0·025-0·05%) and thymol (TM; 0·025-0·05%) at 37°C for 1 min. Individual treatment of each compound did not show the significant antibacterial effect on UPEC biofilms (P > 0·05). Otherwise, the survivor counts of biofilms were synergistically reduced with CB containing any of the antimicrobials. For example combined treatment with CB (8%) + CAR (0·05%) + TM (0·05%) resulted in a 6 log reduction in UPEC populations in the biofilm (no detectable bacteria remained) with 4·6 log of synergistic bactericidal effect. The confocal laser scanning microscope images indicated that any composites including TM might result in biofilm detachment from the surface. The present method is cost-effective and more acceptable to consumers as it is based on the synergistic interaction of natural borne antimicrobials. The results of this study could be widely applicable in the functional food, medical and healthcare field. SIGNIFICANCE AND IMPACT OF THE STUDY: Anti-biofilm effect of cranberry juice (CB) has been focused mainly on inhibiting biofilm formation of uropathogenic Escherichia coli (UPEC); however, combined treatment with natural borne antimicrobials derived from coconut oil (caprylic acid) and oregano essential oil (thymol) could synergistically enhance its eradicating activity against biofilms. This study developed novel CB composites showing marked anti-biofilm effects (complete eradication of UPEC biofilms within just 1 min).
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Affiliation(s)
- H W Kim
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - D H Chung
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - S A Kim
- Department of Food Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - M S Rhee
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
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19
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Van Arendonk KJ, Chung DH. Neuroblastoma: Tumor Biology and Its Implications for Staging and Treatment. Children (Basel) 2019; 6:children6010012. [PMID: 30658459 PMCID: PMC6352222 DOI: 10.3390/children6010012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 01/11/2023]
Abstract
Neuroblastoma, the most common extracranial solid tumor of childhood, has widely variable outcomes dependent on the specific biology of the tumor. In this review, current biologic principles that are used to stratify risk and guide treatment algorithms are discussed. The role for surgical resection in neuroblastoma is also reviewed, including the indications and timing of surgery within the greater treatment plan.
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Affiliation(s)
- Kyle J Van Arendonk
- Department of Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Dai H Chung
- Department of Surgery, Children's Medical Center Dallas, UT Southwestern Medical Center, Dallas, TX 75235, USA.
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20
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Phelps HM, Ndolo JM, Van Arendonk KJ, Dietrich HL, Watson KD, Hilmes MA, Chung DH, Lovvorn HN. Association Between Image-Defined Risk Factors and Neuroblastoma Outcomes. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Starnes JR, Unni P, Fathy CA, Harms KA, Payne SR, Chung DH. Characterization of pediatric golf cart injuries to guide injury prevention efforts. Am J Emerg Med 2018. [DOI: 10.1016/j.ajem.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Qiao J, Grabowska MM, Forestier-Roman IS, Mirosevich J, Case TC, Chung DH, Cates JMM, Matusik RJ, Manning HC, Jin R. Activation of GRP/GRP-R signaling contributes to castration-resistant prostate cancer progression. Oncotarget 2018; 7:61955-61969. [PMID: 27542219 PMCID: PMC5308703 DOI: 10.18632/oncotarget.11326] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022] Open
Abstract
Numerous studies indicate that androgen receptor splice variants (ARVs) play a critical role in the development of castration-resistant prostate cancer (CRPC), including the resistance to the new generation of inhibitors of androgen receptor (AR) action. Previously, we demonstrated that activation of NF-κB signaling increases ARVs expression in prostate cancer (PC) cells, thereby promoting progression to CRPC. However, it is unclear how NF-κB signaling is activated in CRPC. In this study, we report that long-term treatment with anti-androgens increases a neuroendocrine (NE) hormone - gastrin-releasing peptide (GRP) and its receptor (GRP-R) expression in PC cells. In addition, activation of GRP/GRP-R signaling increases ARVs expression through activating NF-κB signaling. This results in an androgen-dependent tumor progressing to a castrate resistant tumor. The knock-down of AR-V7 restores sensitivity to antiandrogens of PC cells over-expressing the GRP/GRP-R signaling pathway. These findings strongly indicate that the axis of Androgen-Deprivation Therapy (ADT) induces GRP/GRP-R activity, activation NF-κB and increased levels of AR-V7 expression resulting in progression to CRPC. Both prostate adenocarcinoma and small cell NE prostate cancer express GRP-R. Since the GRP-R is clinically targetable by analogue-based approach, this provides a novel therapeutic approach to treat advanced CRPC.
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Affiliation(s)
- Jingbo Qiao
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Magdalena M Grabowska
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Prostate Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ingrid S Forestier-Roman
- Department of Biochemistry, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Janni Mirosevich
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Prostate Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas C Case
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Prostate Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dai H Chung
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin M M Cates
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Matusik
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Prostate Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H Charles Manning
- Institute of Imaging Science and Center for Molecular Probes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renjie Jin
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Prostate Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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23
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Song HY, Rellinger EJ, Park SH, Paul P, Qiao J, Vasilopoulos A, Ozden O, Gius D, Chung DH. Inhibition of Sirtuin 6 Induces Neuroblastoma Differentiation. Anticancer Res 2018; 38:647-654. [PMID: 29374686 DOI: 10.21873/anticanres.12268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Sirtuins (SIRTs) play crucial roles in various signaling pathways that modulate differentiation and proliferation. We sought to elucidate the role of SIRTs in differentiation and proliferation of human neuroblastoma (NB). MATERIALS AND METHODS NB cells were treated with nicotinamide (NAM), a non-specific SIRT inhibitor, SIRT-targeted short hairpin RNAs, and retinoic acid to assess cell growth and differentiation. RESULTS SIRTs are involved in proliferation and differentiation using NAM in BE(2)-C cells. Specifically, SIRT6 knockdown in BE(2)-C cells reduced cell proliferation, induced neurite extension, corresponding with induction of p21CIP1 expression and G1 cell-cycle arrest. These effects were rescued by forced re-overexpression of SIRT6. SIRT6 expression was reduced in differentiated human NB sections, and RA-induced differentiation in BE(2)-C cells. CONCLUSION SIRTs have important oncogenic properties in NB beyond its established functions in aging and genome stability. SIRT6 may represent a novel target for developing future therapeutics for the treatment of aggressive NBs.
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Affiliation(s)
- Ha Yong Song
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, IL, U.S.A
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - Seong-Hoon Park
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, IL, U.S.A
| | - Pritha Paul
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - Athanasios Vasilopoulos
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, IL, U.S.A
| | - Ozkan Ozden
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, IL, U.S.A
| | - David Gius
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago, IL, U.S.A
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, U.S.A. .,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, U.S.A
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24
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Schlegel C, Greeno A, Chen H, Raees MA, Collins KF, Chung DH, Lovvorn HN. Evolution of a level I pediatric trauma center: Changes in injury mechanisms and improved outcomes. Surgery 2018; 163:1173-1177. [PMID: 29373171 DOI: 10.1016/j.surg.2017.10.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/12/2017] [Accepted: 10/31/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trauma is the leading cause of mortality among children, underscoring the need for specialized child-centered care. The impact on presenting mechanisms of injury and outcomes during the evolution of independent pediatric trauma centers is unknown. The aim of this study was to evaluate the impact of our single center transition from an adult to American College of Surgeons-verified pediatric trauma center. METHODS A retrospective analysis was performed of 1,190 children who presented as level I trauma activations between 2005 and 2016. Patients were divided into 3 chronological treatment eras: adult trauma center, early pediatric trauma center, and late pediatric trauma center after American College of Surgeons verification review. Comparisons were made using Pearson χ2, Wilcoxon rank sum, and Kruskal-Wallis tests. RESULTS The predominant mechanism of injury was motor vehicle crash, with increases noted in assault/abuse (2% adult trauma center, 11% late pediatric trauma center). A decrease in intensive care admissions was identified during late pediatric trauma center compared with early pediatric trauma center and adult trauma center (51% vs 62.4% vs 67%, P < .001), with concomitant increases in admissions to the floor and immediate operative interventions, but overall mortality was unchanged. CONCLUSION Transition to a verified pediatric trauma center maintains the safety expected of the American College of Surgeons certification, but with notable changes identified in mechanism of injury and improvements in resource utilization.
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Affiliation(s)
- Cameron Schlegel
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Amber Greeno
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muhammad Aanish Raees
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly F Collins
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Chiu JS, Ma L, Wynn J, Krishnan U, Rosenzweig EB, Aspelund G, Arkovitz M, Warner BW, Lim FY, Mychaliska GB, Azarow K, Cusick RA, Chung DH, Chung WK. Mutations in BMPR2 are not present in patients with pulmonary hypertension associated with congenital diaphragmatic hernia. J Pediatr Surg 2017; 52:1747-1750. [PMID: 28162765 DOI: 10.1016/j.jpedsurg.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/03/2017] [Accepted: 01/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a prevalent major congenital anomaly with significant morbidity and mortality. Thirty to 40% mortality in CDH is largely attributed to pulmonary hypoplasia and pulmonary hypertension (PH). We hypothesized that the underlying genetic risk factors for hereditary PH are shared with CDH associated PH. METHODS Participants were recruited as part of the Diaphragmatic Hernia Research & Exploration; Advancing Molecular Science (DHREAMS) study, a prospective cohort of neonates with a diaphragmatic defect enrolled from 2005 to 2012. PH affected patients with available DNA for sequencing had one of the following: moderate or severe PH on echocardiography at 3months of age; moderate of severe PH at 1month of age with death occurring prior to the 3month echocardiogram; or on PH medications at 1month of age. We sequenced the coding regions of the hereditary PH genes bone morphogenetic protein receptor type II (BMPR2), caveolin 1 (CAV1) and potassium channel subfamily K, member 3 (KCNK3) to screen for mutations. RESULTS There were 29 CDH patients with PH including 16 males and 13 females. Sequencing of BMPR2, CAV1, and KCNK3 coding regions did not identify any pathogenic variants in these genes. TYPE OF STUDY Prognosis study LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Joanne S Chiu
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, 3959 Broadway, 2-Babies North, New York, NY 10032, USA.
| | - Lijiang Ma
- Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, 1150 St. Nicholas Avenue, Room 620, New York, NY 10032, USA
| | - Julia Wynn
- Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, 1150 St. Nicholas Avenue, Room 620, New York, NY 10032, USA
| | - Usha Krishnan
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, 3959 Broadway, 2-Babies North, New York, NY 10032, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, 3959 Broadway, 2-Babies North, New York, NY 10032, USA
| | - Gudrun Aspelund
- Division of Pediatric Surgery, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, USA
| | - Marc Arkovitz
- Department of Pediatric Surgery, Tel Hashomer Medical Center, Emek HaEla St 1, Ramat Gan, Israel
| | - Brad W Warner
- Division of Pediatric Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Foong-Yen Lim
- Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - George B Mychaliska
- Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kenneth Azarow
- Division of Pediatric Surgery, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA
| | - Robert A Cusick
- Division of Pediatric Surgery, University of Nebraska Medical Center, College of Medicine, 42nd St and Emile St., Omaha, NE 68198, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Doctors' Office Tower, Suite 7100, Nashville, TN 37232-9780, USA
| | - Wendy K Chung
- Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, 1150 St. Nicholas Avenue, Room 620, New York, NY 10032, USA
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26
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Rellinger EJ, Padmanabhan C, Qiao J, Craig BT, An H, Zhu J, Correa H, Waterson AG, Lindsley CW, Beauchamp RD, Chung DH. Isoxazole compound ML327 blocks MYC expression and tumor formation in neuroblastoma. Oncotarget 2017; 8:91040-91051. [PMID: 29207623 PMCID: PMC5710904 DOI: 10.18632/oncotarget.19406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022] Open
Abstract
Neuroblastomas are the most common extracranial solid tumors in children and arise from the embryonic neural crest. MYCN-amplification is a feature of ∼30% of neuroblastoma tumors and portends a poor prognosis. Neural crest precursors undergo epithelial-to-mesenchymal transition (EMT) to gain migratory potential and populate the sympathoadrenal axis. Neuroblastomas are posited to arise due to a blockade of neural crest differentiation. We have recently reported effects of a novel MET inducing compound ML327 (N-(3-(2-hydroxynicotinamido) propyl)-5-phenylisoxazole-3-carboxamide) in colon cancer cells. Herein, we hypothesized that forced epithelial differentiation using ML327 would promote neuroblastoma differentiation. In this study, we demonstrate that ML327 in neuroblastoma cells induces a gene signature consistent with both epithelial and neuronal differentiation features with adaptation of an elongated phenotype. These features accompany induction of cell death and G1 cell cycle arrest with blockage of anchorage-independent growth and neurosphere formation. Furthermore, pretreatment with ML327 results in persistent defects in proliferative potential and tumor-initiating capacity, validating the pro-differentiating effects of our compound. Intriguingly, we have identified destabilization of MYC signaling as an early and consistent feature of ML327 treatment that is observed in both MYCN-amplified and MYCN-single copy neuroblastoma cell lines. Moreover, ML327 blocked MYCN mRNA levels and tumor progression in established MYCN-amplified xenografts. As such, ML327 may have potential efficacy, alone or in conjunction with existing therapeutic strategies against neuroblastoma. Future identification of the specific intracellular target of ML327 may inform future drug discovery efforts and enhance our understanding of MYC regulation.
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Affiliation(s)
- Eric J. Rellinger
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Pediatric Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Chandrasekhar Padmanabhan
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Jingbo Qiao
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Pediatric Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Brian T. Craig
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Pediatric Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Hanbing An
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Jing Zhu
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Hernán Correa
- Department of Pathology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Alex G. Waterson
- Department of Pharmacology and Vanderbilt Institute of Chemical Biology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Craig W. Lindsley
- Department of Pharmacology and Vanderbilt Institute of Chemical Biology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - R. Daniel Beauchamp
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Cancer Biology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Cell and Developmental Biology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
| | - Dai H. Chung
- Section of Surgical Sciences, Department of Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Cancer Biology, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
- Department of Pediatric Surgery, at Vanderbilt University Medical Center, TN 37232, Nashville, USA
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27
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Rellinger EJ, Padmanabhan C, Qiao J, An H, Waterson AG, Lindsley CW, Beauchamp DR, Chung DH. Isoxazole-Based Small Molecule Induces Apoptosis and Sensitizes Ewing Sarcoma Cells to Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Paul P, Rellinger EJ, Qiao J, Lee S, Volny N, Padmanabhan C, Romain CV, Mobley B, Correa H, Chung DH. Elevated TIMP-1 expression is associated with a prometastatic phenotype, disease relapse, and poor survival in neuroblastoma. Oncotarget 2017; 8:82609-82620. [PMID: 29137288 PMCID: PMC5669914 DOI: 10.18632/oncotarget.19664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/04/2017] [Indexed: 12/26/2022] Open
Abstract
Approximately two-thirds of patients with neuroblastoma are found to have metastatic disease at time of diagnosis with frequent skeletal, lymph node, central nervous system, and liver involvement. Using a serial in vivo splenic injection model, we have isolated an aggressive subclone (BE(2)-C/LM2) from MYCN-amplified neuroblastomas that demonstrate an enhanced propensity to develop metastatic liver lesions. BE(2)-C/LM2 subclone cells demonstrate increased adherent, soft agar colony and tumorsphere growth in vitro. Components of the tumor microenvironment regulate cancer progression, via networks of cytokines and growth factors. Cytokine array analysis identified increased TIMP-1 in the plasma of mice injected with BE(2)-C/LM2 subclone cells, leading us to hypothesize that TIMP-1 may play a role in our observed prometastatic phenotype. Immunoblotting and ELISA demonstrated enhanced endogenous TIMP-1 expression in our isolated neuroblastoma subclone. Silencing endogenous TIMP-1 successfully blocked in vitro proliferation, soft agar colony formation and tumorsphere formation by BE(2)-C/LM2 cells. Stable RNA interference of endogenous TIMP-1 failed to reverse the prometastatic phenotype of our BE(2)-C/LM2 subclone in our liver metastasis model, suggesting that endogenous TIMP-1 levels may not be an essential component of this in vivo behavior. Notably, tissue microarray analysis and Kaplan-Meier by gene expression demonstrates that elevated TIMP-1 expression is correlated with increased disease relapse and mortality in patients with neuroblastoma. Taken together, our study identifies TIMP-1 as a novel soluble factor that is associated with a prometastatic phenotype in our in vivo model and adverse outcomes in patients with neuroblastoma.
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Affiliation(s)
- Pritha Paul
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Eric J Rellinger
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jingbo Qiao
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sora Lee
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Natasha Volny
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Chandrasekhar Padmanabhan
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Carmelle V Romain
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bret Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hernan Correa
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Dai H Chung
- Section of Surgical Sciences, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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29
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Padmanabhan C, Rellinger EJ, Zhu J, An H, Woodbury LG, Chung DH, Waterson AG, Lindsley CW, Means AL, Beauchamp RD. cFLIP critically modulates apoptotic resistance in epithelial-to-mesenchymal transition. Oncotarget 2017; 8:101072-101086. [PMID: 29254146 PMCID: PMC5731856 DOI: 10.18632/oncotarget.19557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/26/2017] [Indexed: 12/30/2022] Open
Abstract
Epithelial cancers (carcinomas) comprise the top four causes of cancer-related deaths in the United States. While overall survival has been steadily improving, therapy-resistant disease continues to present a major therapeutic challenge. Carcinomas often exploit the normal developmental program, epithelial-to-mesenchymal transition (EMT), to gain a mesenchymal phenotype associated with increased invasiveness and resistance to apoptosis. We have previously shown that an isoxazole-based small molecule, ML327, partially reverses TGF-β-induced EMT in an immortalized mouse mammary epithelial cell line. Herein, we demonstrate that ML327 reverses much of the EMT gene expression program in cultured carcinoma cell lines. The reversal of EMT sensitizes these cancer cells to the apoptosis-inducing ligand TRAIL. This sensitization is independent of E-cadherin expression and rather relies on the downregulation of a major anti-apoptotic protein, cFLIPS. Loss of cFLIPS is sufficient to overcome resistance to TRAIL and exogenous overexpression of cFLIPS restores resistance to TRAIL-induced apoptosis despite EMT reversal with ML327. In summary, we have utilized an isoxazole-based small molecule that partially reverses EMT in carcinoma cells to demonstrate that cFLIPS critically regulates the apoptosis resistance phenotype associated with EMT.
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Affiliation(s)
- Chandrasekhar Padmanabhan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA
| | - Eric J Rellinger
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA
| | - Jing Zhu
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA
| | - Hanbing An
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA
| | - Luke G Woodbury
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville TN, 37232, USA
| | - Dai H Chung
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville TN 37232, USA
| | - Alex G Waterson
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville TN, 37232, USA
| | - Craig W Lindsley
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville TN, 37232, USA
| | - Anna L Means
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA
| | - R Daniel Beauchamp
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville TN, 37232, USA.,Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville TN 37232, USA.,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville TN, 37232, USA.,The Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN, 37232, USA
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30
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Rellinger EJ, Padmanabhan C, Qiao J, Appert A, Waterson AG, Lindsley CW, Beauchamp RD, Chung DH. ML327 induces apoptosis and sensitizes Ewing sarcoma cells to TNF-related apoptosis-inducing ligand. Biochem Biophys Res Commun 2017; 491:463-468. [PMID: 28716733 DOI: 10.1016/j.bbrc.2017.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 01/06/2023]
Abstract
Ewing sarcomas are rare mesenchymal-derived bone and soft tissue tumors in children. Afflicted children with distant metastases have poor survival despite aggressive therapeutics. Epithelial-to-mesenchymal transition in epithelial carcinomas is associated with loss of E-cadherin and resistance to apoptosis. ML327 is a novel small molecule that we have previously shown to reverse epithelial-to-mesenchymal transition features in both epithelial and neural crest-derived cancers. Herein, we sought to evaluate the effects of ML327 on mesenchymal-derived Ewing sarcoma cells, hypothesizing that ML327 initiates growth arrest and sensitizes to TNF-related apoptosis-inducing ligand. ML327 induced protein expression changes, increased E-cadherin and decreased vimentin, consistent with partial induction of mesenchymal-to-epithelial transition in multiple Ewing Sarcoma cell lines (SK-N-MC, TC71, and ES-5838). Induction of epithelial features was associated with apoptosis, as demonstrated by PARP and Caspase 3 cleavage by immunoblotting. Cell cycle analysis validated these findings by marked induction of the subG0 cell population. In vitro combination treatment with TRAIL demonstrated additive induction of apoptotic markers. Taken together, these findings establish a rationale for further in vivo trials of ML327 in cells of mesenchymal origin both alone and in combination with TRAIL.
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Affiliation(s)
- Eric J Rellinger
- Section of Surgical Sciences, Department of Surgery, United States; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | | | - Jingbo Qiao
- Section of Surgical Sciences, Department of Surgery, United States; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Andrew Appert
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Alex G Waterson
- Department of Pharmacology, Vanderbilt Institute of Chemical Biology, United States
| | - Craig W Lindsley
- Department of Pharmacology, Vanderbilt Institute of Chemical Biology, United States
| | - R Daniel Beauchamp
- Section of Surgical Sciences, Department of Surgery, United States; Department of Cancer Biology, United States; Department of Cell and Developmental Biology, United States
| | - Dai H Chung
- Section of Surgical Sciences, Department of Surgery, United States; Department of Cancer Biology, United States; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States.
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31
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Corbitt N, Rellinger EJ, Hernanz-Schulman M, Chung DH. Accessory hepatic lobes in the pediatric population: A report of three cases of torsion and literature review. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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32
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Robinson J, Gay JC, Chen Q, Pietsch JB, Chung DH. Multi-Institutional Review of Congenital Pulmonary Airway Malformations: Current Practice and Outcomes. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Rellinger EJ, Padmanabhan C, Craig BT, An H, Qiao J, Waterson AG, Lindsley CW, Beauchamp DR, Chung DH. ML327 Blocks N-MYC Expression and Tumor Formation in MYCN-Amplified Neuroblastomas. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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34
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Craig BT, Rellinger EJ, Guo Y, Qiao J, Chung DH. Growth Differentiation Factor 15 is a Novel Regulator of the Stem Cell-Like Phenotype in Neuroblastoma. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Abdullah F, Salazar JH, Gause CD, Gadepalli S, Biester TW, Azarow KS, Brandt ML, Chung DH, Lund DP, Rescorla FJ, Waldhausen JHT, Tracy TF, Fallat ME, Klein MD, Lewis FR, Hirschl RB. Understanding the Operative Experience of the Practicing Pediatric Surgeon. JAMA Surg 2016; 151:735-41. [DOI: 10.1001/jamasurg.2016.0261] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fizan Abdullah
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jose H. Salazar
- Department of Surgery, University of Maryland Medical Center, Baltimore
| | - Colin D. Gause
- Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Samir Gadepalli
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | | | - Kenneth S. Azarow
- Department of Surgery, Oregon Health and Science University, Portland
| | - Mary L. Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dennis P. Lund
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | | | | | - Thomas F. Tracy
- Department of Surgery, Brown University, Providence, Rhode Island
| | - Mary E. Fallat
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael D. Klein
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Ronald B. Hirschl
- Department of Surgery, University of Michigan Health System, Ann Arbor
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36
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Rellinger EJ, Craig BT, Craig-Owens LD, Pacheco MC, Chung DH, Danko ME. Clostridium sordellii necrotizing omphalitis: A case report and literature review. Journal of Pediatric Surgery Case Reports 2016. [DOI: 10.1016/j.epsc.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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37
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DeBerry BB, Lynch JE, Chernin JM, Zwischenberger JB, Chung DH. A survey for pain and sedation medications in pediatric patients during extracorporeal membrane oxygenation. Perfusion 2016; 20:139-43. [PMID: 16038385 DOI: 10.1191/0267659105pf801oa] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/05/2022]
Abstract
Routine administration of large amounts of pain and sedative medication is common to critically ill pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) for cardiopulmonary failure. It has been our experience that pediatric patients are the most difficult age group in which to achieve an ideal pain and sedative control due to the narrow margin of safety. The purpose of this study was to determine the general practice guideline used for pain and anxiolytic pharmacotherapy for pediatric patients at ECMO centers. We sent a survey questionnaire to all ECMO centers in the USA that treat pediatric respiratory failure patients. Of the 46 responding centers (including telephone follow-ups), 37 (80%) centers had an active pediatric ECMO programs for patients with severe respiratory failure. Fentanyl was the most commonly used pain medication and continuous infusion, administered directly to the patient, was preferred. Subjective effectiveness of various pharmacological agents was variable without clear consensus; however, midazolam was considered to be the most effective agent used.
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Affiliation(s)
- Brittany B DeBerry
- Department of Surgery, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
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38
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Craig BT, Rellinger EJ, Alvarez AL, Dusek HL, Qiao J, Chung DH. Induced differentiation inhibits sphere formation in neuroblastoma. Biochem Biophys Res Commun 2016; 477:255-9. [PMID: 27297102 DOI: 10.1016/j.bbrc.2016.06.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/09/2016] [Indexed: 01/18/2023]
Abstract
Neuroblastoma arises from the neural crest, the precursor cells of the sympathoadrenal axis, and differentiation status is a key prognostic factor used for clinical risk group stratification and treatment strategies. Neuroblastoma tumor-initiating cells have been successfully isolated from patient tumor samples and bone marrow using sphere culture, which is well established to promote growth of neural crest stem cells. However, accurate quantification of sphere-forming frequency of commonly used neuroblastoma cell lines has not been reported. Here, we show that MYCN-amplified neuroblastoma cell lines form spheres more frequently than non-MYCN-amplified cell lines. We also show that sphere formation is directly sensitive to cellular differentiation status. 13-cis-retinoic acid is a clinically used differentiating agent that induces a neuronal phenotype in neuroblastoma cells. Induced differentiation nearly completely blocked sphere formation. Furthermore, sphere formation was specifically FGF-responsive and did not respond to increasing doses of EGF. Taken together, these data suggest that sphere formation is an accurate method of quantifying the stemness phenotype in neuroblastoma.
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Affiliation(s)
- Brian T Craig
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra L Alvarez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Haley L Dusek
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Craig BT, Rellinger EJ, Mettler BA, Watkins S, Donahue BS, Chung DH. Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome. J Pediatr Surg 2016; 51:76-80. [PMID: 26572850 DOI: 10.1016/j.jpedsurg.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Patients with hypoplastic left heart syndrome (HLHS) experience a higher risk for complications from gastroesophageal reflux, prompting frequent need for fundoplication. Patients between stage I and II palliation ("interstage") are at particularly high operative risk because of the parallel nature of their pulmonary and systemic blood flow. Laparoscopic approach for fundoplication is common for pediatric patients. However, its safety in interstage HLHS is relatively unknown. We examined the perioperative physiologic burden of a laparoscopic fundoplication in HLHS patients. METHODS All patients who underwent open or laparoscopic fundoplication during the interstage period at our institution since 2006 were reviewed. Perioperative physiologic data, echocardiographic findings, survival, and complications were collected from the anesthetic record and patient chart. RESULTS Nineteen patients with HLHS had laparoscopic fundoplication, 13 (68%) during the interstage period, compared to 64 performed by the open approach. Ten (77%) of 13 interstage patients had perioperative hemodynamic instability. Incidence of instability between open and laparoscopic groups was not different. One laparoscopic patient required ECMO support for shunt thrombosis. CONCLUSIONS Despite a high incidence of hemodynamic instability, overall outcomes are consistent with those reported in the literature for this high-risk patient population. Laparoscopic approach for fundoplication during the interstage period appears to be a relatively safe option for these patients.
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Affiliation(s)
- Brian T Craig
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bret A Mettler
- Division of Pediatric Cardiac Surgery, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Watkins
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian S Donahue
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Rellinger EJ, Craig BT, Qiao J, Kim KW, Chung DH. NADPH oxidases modulate redox-sensitive signaling pathways in neuroblastoma. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee S, Rellinger EJ, Kim KW, Craig BT, Romain CV, Qiao J, Chung DH. Bromodomain and extraterminal inhibition blocks tumor progression and promotes differentiation in neuroblastoma. Surgery 2015; 158:819-26. [PMID: 26067464 PMCID: PMC4536146 DOI: 10.1016/j.surg.2015.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/27/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND MYCN amplification is a key molecular hallmark of high-risk neuroblastoma. Previously considered an "undruggable" target, MYCN transcription can be disrupted by inhibiting the bromodomain and the extraterminal (BET) domain family of proteins that regulates MYCN transcription epigenetically. JQ1 is a potent, small-molecule BET inhibitor that induces cell-cycle arrest and initiates apoptosis in neuroblastoma. Here, we sought to validate the antitumorigenic effects of JQ1 in neuroblastoma and to evaluate whether blocking N-myc expression with JQ1 promotes neural differentiation. METHODS We determined the effects in vitro of JQ1 treatment on human neuroblastoma cell growth in both monolayer and sphere-forming conditions. Subcutaneous neuroblastoma xenografts were used for an in vivo study. Western blotting and immunohistochemistry were performed to evaluate the effects on neural differentiation and stem cell markers. RESULTS JQ1 treatment blocked neuroblastoma cell growth in both monolayer and sphere-forming conditions; JQ1 also attenuated the growth of neuroblastoma xenograft in athymic nude mice. Neurofilament expression was enhanced with JQ1 treatment, indicating that JQ1 induces neuronal differentiation. Sphere forming conditions resulted in increased expression of multiple stem cell markers; these effects were reversed with JQ1 treatment. CONCLUSION BET inhibition attenuates progression and promotes neural differentiation of neuroblastoma in vitro and in vivo in mice, providing insight into potential clinical applications of BET inhibitors in the treatment of patients with neuroblastoma.
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Affiliation(s)
- Sora Lee
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kwang Woon Kim
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Brian T Craig
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Carmelle V Romain
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN.
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Swischuk LE, Chung DH, Hawkins HK, Jadhav SP, Radhakrishnan R. Non-fecalith-induced appendicitis: etiology, imaging, and pathology. Emerg Radiol 2015; 22:643-9. [PMID: 26293120 DOI: 10.1007/s10140-015-1338-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
This study aims to document the imaging and pathology findings in non-fecalith-induced appendicitis. We reviewed the imaging and pathologic findings in 40 patients with histologically proven purulent appendicitis seen over a 2-year period. Findings documented were (1) total appendiceal involvement, (2) predominant appendiceal tip involvement, (3) presence of a fecalith, and (4) presence of lymphoid hyperplasia. There were a total of 40 patients, 28 males and 12 females. The age range was 2-18 years with a mean of 11.5 years. Twenty-two (55 %) patients demonstrated classic purulent appendicitis of the whole appendix, 20 (91 %) of these appendices had a fecalith. Eighteen (45 %) patients demonstrated purulent appendicitis confined to or predominately involving the tip of the appendix, and all 18 (100 %) patients demonstrated marked lymphoid hyperplasia. Only two (11 %) of these appendices had a fecalith. Overall, a fecalith was found in only 55 % of our cases, while 45 % demonstrated no fecalith, but rather marked lymphoid hyperplasia. Lymphoid hyperplasia appeared to be the underlying predisposing cause of purulent appendicitis in these cases.
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Affiliation(s)
- Leonard E Swischuk
- Department of Radiology and Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Dai H Chung
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Hal K Hawkins
- Department of Pathology, the University of Texas Medical Branch, Galveston, TX, USA
| | | | - Ravi Radhakrishnan
- Department of Surgery-General Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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Mobley BC, Kwon M, Kraemer BR, Hickman FE, Qiao J, Chung DH, Carter BD. Expression of MYCN in Multipotent Sympathoadrenal Progenitors Induces Proliferation and Neural Differentiation, but Is Not Sufficient for Tumorigenesis. PLoS One 2015. [PMID: 26222553 PMCID: PMC4519318 DOI: 10.1371/journal.pone.0133897] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroblastoma is a pediatric malignancy of the sympathetic ganglia and adrenal glands, hypothesized to originate from progenitors of the developing sympathetic nervous system. Amplification of the MYCN oncogene is a genetic marker of risk in this disease. Understanding the impact of oncogene expression on sympathoadrenal progenitor development may improve our knowledge of neuroblastoma initiation and progression. We isolated sympathoadrenal progenitor cells from the postnatal murine adrenal gland by sphere culture and found them to be multipotent, generating differentiated colonies of neurons, Schwann cells, and myofibroblasts. MYCN overexpression in spheres promoted commitment to the neural lineage, evidenced by an increased frequency of neuron-containing colonies. MYCN promoted proliferation of both sympathoadrenal progenitor spheres and differentiated neurons derived from these spheres, but there was also an increase in apoptosis. The proliferation, apoptosis, and neural lineage commitment induced by MYCN are tumor-like characteristics and thereby support the hypothesis that multipotent adrenal medullary progenitor cells are cells of origin for neuroblastoma. We find, however, that MYCN overexpression is not sufficient for these cells to form tumors in nude mice, suggesting that additional transforming mutations are necessary for tumorigenesis.
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Affiliation(s)
- Bret C. Mobley
- Department of Pathology, Microbiology, and Immunology, Division of Neuropathology, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
- * E-mail: (BCM); (BDC)
| | - Minjae Kwon
- Department of Pathology, Microbiology, and Immunology, Division of Neuropathology, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
| | - Bradley R. Kraemer
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
| | - F. Edward Hickman
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center; Nashville, Tennessee, the United States of America
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center; Nashville, Tennessee, the United States of America
| | - Bruce D. Carter
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, Tennessee, the United States of America
- * E-mail: (BCM); (BDC)
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Zhu Y, Paul P, Lee S, Craig BT, Rellinger EJ, Qiao J, Gius DR, Chung DH. Antioxidant inhibition of steady-state reactive oxygen species and cell growth in neuroblastoma. Surgery 2015; 158:827-36. [PMID: 26088922 DOI: 10.1016/j.surg.2015.03.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/23/2015] [Accepted: 03/31/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Reactive oxygen species (ROS) contribute to adult tumorigenesis; however, their roles in pediatric solid tumors are unknown. Here, we sought to define the steady-state ROS levels in neuroblastoma and to examine whether aggressive cellular behavior, which may predict treatment failure, is regulated by ROS. METHODS Neuroblastoma sections were assessed for 4-hydroxynonenal (4-HNE), a marker of intracellular lipid peroxidation and a byproduct of increased levels of ROS. Human neuroblastoma cell lines, MYCN-amplified BE(2)-C and MYCN-nonamplified SK-N-SH, were examined in our study. Superoxide and hydroperoxide oxidation products were detected by staining for dihydroethidium (DHE) and 5, 6-carboxy-2', 7'-dichlorodihydrofluorescein diacetate (CDCFH2), using the oxidation-insensitive analog CDCF as a negative control. Cells were treated with N-acetylcysteine (NAC; 10 mmol/L) daily for 5 days and analyzed. RESULTS Greater expression of 4-HNE was observed in undifferentiated tumor sections as compared with the more differentiated tumors. Interestingly, increased levels of ROS were detected in MYCN-amplified BE(2)-C cells. Moreover, gastrin-releasing peptide receptor-induced ROS production stimulated upregulation of the hypoxia inducible factor (HIF)-1α/vascular endothelial growth factor (VEGF) pathway and an increase in cell growth. Antioxidant NAC decreased HIF-1α/VEGF expression and inhibited BE(2)-C cell growth. CONCLUSION We report a novel observation that shifting the redox balance toward greater ROS levels results in a more aggressive neuroblastoma phenotype. Our data suggest that ROS play a critical role in refractory neuroblastoma.
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Affiliation(s)
- Yueming Zhu
- Department of Radiation Oncology, Northwestern School of Medicine, Chicago, IL
| | - Pritha Paul
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Sora Lee
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Brian T Craig
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Eric J Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - David R Gius
- Department of Radiation Oncology, Northwestern School of Medicine, Chicago, IL
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN.
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Hata JL, Correa H, Krishnan C, Esbenshade AJ, Black JO, Chung DH, Mobley BC. Diagnostic utility of PHOX2B in primary and treated neuroblastoma and in neuroblastoma metastatic to the bone marrow. Arch Pathol Lab Med 2015; 139:543-6. [PMID: 25822764 DOI: 10.5858/arpa.2014-0255-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT Neuroblastoma (NB) is the most common extracranial tumor of childhood. Although most cases have a distinctive histology, a subset of primitive cases require immunohistochemical studies to distinguish them from other small round blue cell tumors of childhood. Immunohistochemistry is also used to detect small amounts of tumor metastatic to the bone marrow and in posttreatment samples with obscuring fibrosis, calcification, or inflammation. The transcription factor PHOX2B is essential for the differentiation and survival of sympathetic neurons and chromaffin cells, and therefore is highly specific for the peripheral autonomic nervous system. OBJECTIVE To determine the diagnostic utility of PHOX2B immunohistochemistry as a marker of primary, treated, and metastatic NB. DESIGN Neuroblastoma tissue microarrays were stained with PHOX2B, CD57, and synaptophysin. Arrays containing rhabdomyosarcoma, Ewing sarcoma, and Wilms tumor were stained with PHOX2B, and negative bone marrow samples were stained with PHOX2B and CD57. RESULTS PHOX2B and CD57 were similar to synaptophysin in their ability to detect NB. PHOX2B and CD57 similarly showed robust staining in posttreatment NB and NB metastatic to the bone marrow. In contrast to the cytoplasmic staining pattern seen with synaptophysin and CD57, clear and strong nuclear PHOX2B permitted identification of individual tumor cells. PHOX2B staining was absent in all cases of rhabdomyosarcoma, Ewing sarcoma, and Wilms tumor, and in the negative bone marrow. CONCLUSIONS PHOX2B and CD57 are useful markers of NB. PHOX2B is specific for NB in its differential diagnosis with other small round cell tumors, and its nuclear staining may be helpful for accurate bone marrow tumor quantification.
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Affiliation(s)
- Jessica L Hata
- From the Departments of Pathology, Microbiology and Immunology (Drs Hata, Correa, Black, and Mobley), Pediatrics (Dr Esbenshade), and Pediatric Surgery (Dr Chung), Vanderbilt University Medical Center, Nashville, Tennessee; and the Department of Pathology, Dell Children's Medical Center, Austin, Texas (Dr Krishnan)
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Rellinger EJ, Romain C, Choi S, Qiao J, Chung DH. Silencing gastrin-releasing peptide receptor suppresses key regulators of aerobic glycolysis in neuroblastoma cells. Pediatr Blood Cancer 2015; 62:581-6. [PMID: 25630799 PMCID: PMC4339541 DOI: 10.1002/pbc.25348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/29/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Under normoxic conditions, cancer cells use aerobic glycolysis as opposed to glucose oxidation for energy production; this altered metabolism correlates with poor outcomes in neuroblastoma. Hypoxia-inducible factor-1 alpha (HIF-1α) and pyruvate dehydrogenase kinase 4 (PDK4) regulate aerobic glycolysis, while pyruvate dehydrogenase phosphatase 2 (PDP2) promotes glucose oxidation. Here, we sought to determine whether gastrin-releasing peptide receptor (GRP-R) signaling regulates glucose metabolism. PROCEDURE Neuroblastoma cell lines, BE(2)-C and SK-N-AS, were used. PCR microararay for glucose metabolism was performed on GRP-R silenced cells. Target protein expression was validated using Western blotting and VEGF ELISA. Cobalt chloride (CoCl2 ) was used to induce chemical hypoxia. Efficacy of targeting PDK regulation in neuroblastoma was assessed using dichloroacetate (DCA) by conducting cell viability assays and Western blotting for apoptotic markers. RESULTS Silencing GRP-R decreased HIF-1α expression and blocked VEGF expression and secretion in both normoxic and CoCl2 induced hypoxia. PCR array analysis identified that GRP-R silencing reduced PDK4 and increased PDP2 mRNA expression. These findings were validated by Western blotting. CoCl2 induced hypoxia increased VEGF secretion, HIF-1α, and PDK4 expression. PDK4 silencing decreased HIF-1α expression and VEGF expression and secretion. DCA treatment decreased BE(2)-C and SK-N-AS proliferation while promoting cell death. GRP-R silencing and DCA treatment synergistically halted BE(2)-C proliferation. CONCLUSIONS We report that GRP-R regulates glucose metabolism in neuroblastoma by modulating HIF-1α, PDK4 and PDP2. PDK4 regulates glucose metabolism, in part, via regulation of HIF-1α. Synergistic consequences of GRP-R inhibition and DCA treatment may suggest a novel therapeutic strategy for the treatment of aggressive neuroblastoma.
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Affiliation(s)
- Eric J. Rellinger
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Carmelle Romain
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - SunPhil Choi
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Jingbo Qiao
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Dai H. Chung
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN 37232
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Nicholson MR, Acra SA, Chung DH, Rosen MJ. Endoscopic diagnosis of duodenal stenosis in a 5-month-old male infant. Clin Endosc 2014; 47:568-70. [PMID: 25505725 PMCID: PMC4260107 DOI: 10.5946/ce.2014.47.6.568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022] Open
Abstract
Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion.
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Affiliation(s)
- Maribeth R Nicholson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sari A Acra
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael J Rosen
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. ; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Won JK, Keam B, Koh J, Cho HJ, Jeon YK, Kim TM, Lee SH, Lee DS, Kim DW, Chung DH. Concomitant ALK translocation and EGFR mutation in lung cancer: a comparison of direct sequencing and sensitive assays and the impact on responsiveness to tyrosine kinase inhibitor. Ann Oncol 2014; 26:348-54. [PMID: 25403583 DOI: 10.1093/annonc/mdu530] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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: 12/22/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation are considered mutually exclusive in nonsmall-cell lung cancer (NSCLC). However, sporadic cases having concomitant EGFR and ALK alterations have been reported. The present study aimed to assess the prevalence of NSCLCs with concomitant EGFR and ALK alterations using mutation detection methods with different sensitivity and to propose an effective diagnostic and therapeutic strategy. PATIENTS AND METHODS A total of 1458 cases of lung cancer were screened for EGFR and ALK alterations by direct sequencing and flourescence in situ hybridization (FISH), respectively. For the 91 patients identified as having an ALK translocation, peptide nucleic acid (PNA)-clamping real-time PCR, targeted next-generation sequencing (NGS), and mutant-enriched NGS assays were carried out to detect EGFR mutation. RESULTS EGFR mutations and ALK translocations were observed in 42.4% (612/1445) and 6.3% (91/1445) of NSCLCs by direct sequencing and FISH, respectively. Concomitant EGFR and ALK alterations were detected in four cases, which accounted for 4.4% (4/91) of ALK-translocated NSCLCs. Additional analyses for EGFR using PNA real-time PCR and ultra-deep sequencing by NGS, mutant-enriched NGS increased the detection rate of concomitant EGFR and ALK alterations to 8.8% (8/91), 12.1% (11/91), and 15.4% (14/91) of ALK-translocated NSCLCs, respectively. Of the 14 patients, 3 who were treated with gefitinib showed poor response to gefitinib with stable disease in one and progressive disease in two patients. However, eight patients who received ALK inhibitor (crizotinib or ceritinib) showed good response, with response rate of 87.5% (7/8 with partial response) and durable progression-free survival. CONCLUSIONS A portion of NSCLC patients have concomitant EGFR and ALK alterations and the frequency of co-alteration detection increases when sensitive detection methods for EGFR mutation are applied. ALK inhibitors appear to be effective for patients with co-alterations.
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Affiliation(s)
| | - B Keam
- Department of Internal Medicine
| | | | | | | | - T M Kim
- Department of Internal Medicine
| | - S H Lee
- Department of Internal Medicine
| | - D S Lee
- Department of Nuclear Medicine
| | - D W Kim
- Department of Internal Medicine
| | - D H Chung
- Department of Pathology Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Romain C, Choi S, Qiao J, Chung DH. Silencing Gastrin-Releasing Peptide Receptor Suppresses Key Regulators of Aerobic Glycolysis in Neuroblastoma Cells. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Activation of the Hedgehog (Hh) signaling pathway has been implicated in a variety of malignancies including neuroblastoma. Expression of Gli1, a downstream effector of Hh, correlates with a favorable prognosis in patients with neuroblastoma. Moreover, Gli1 overexpression reduces mitotic index and induces transcription of genes involved in the differentiation of neuroblastoma cells; however, much remains unknown regarding the regulation of Gli1 transcriptional activity. Here, we report a novel negative regulation of Gli1 transcriptional activity by PI3K/AKT2 signal transduction pathway. Constitutively active PI3K subunit, p110α, inhibited Gli1 transcriptional activity in neuroblastoma cells, whereas, overexpression of an inactive form of PI3K subunit, p85, enhanced its activity. Specifically, the AKT2 isoform inhibited Gli1 luciferase activity. Silencing AKT2 using siRNA increased Gli1 transcriptional activity and conversely, overexpression of constitutively active AKT2 (myr-AKT2) decreased Gli1 transcriptional activity. Furthermore, Gli1 overexpression-mediated decrease in anchorage-independent growth was rescued by AKT2 overexpression. We also demonstrated that AKT2 overexpression regulates the nuclear-cytoplasmic distribution of exogenous Gli1 protein in neuroblastoma cells by relieving a GSK3β-mediated destabilization of SUFU, a negative regulator of Gli1 nuclear translocation. Inhibition of nuclear Gli1 accumulation may explain for the suppression of the tumor-suppressive function of Gli1. Collectively, our findings suggest an important role of Gli1 as a tumor suppressor in neuroblastoma, and offer a mechanism by which AKT2 regulates the subcellular localization, and in turn, inhibits the tumor-suppressive function of Gli1 in neuroblastoma.
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Affiliation(s)
- Pritha Paul
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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