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Kong LR, Gupta K, Wu AJ, Perera D, Ivanyi-Nagy R, Ahmed SM, Tan TZ, Tan SLW, Fuddin A, Sundaramoorthy E, Goh GS, Wong RTX, Costa ASH, Oddy C, Wong H, Patro CPK, Kho YS, Huang XZ, Choo J, Shehata M, Lee SC, Goh BC, Frezza C, Pitt JJ, Venkitaraman AR. A glycolytic metabolite bypasses "two-hit" tumor suppression by BRCA2. Cell 2024; 187:2269-2287.e16. [PMID: 38608703 DOI: 10.1016/j.cell.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/01/2024] [Accepted: 03/07/2024] [Indexed: 04/14/2024]
Abstract
Knudson's "two-hit" paradigm posits that carcinogenesis requires inactivation of both copies of an autosomal tumor suppressor gene. Here, we report that the glycolytic metabolite methylglyoxal (MGO) transiently bypasses Knudson's paradigm by inactivating the breast cancer suppressor protein BRCA2 to elicit a cancer-associated, mutational single-base substitution (SBS) signature in nonmalignant mammary cells or patient-derived organoids. Germline monoallelic BRCA2 mutations predispose to these changes. An analogous SBS signature, again without biallelic BRCA2 inactivation, accompanies MGO accumulation and DNA damage in Kras-driven, Brca2-mutant murine pancreatic cancers and human breast cancers. MGO triggers BRCA2 proteolysis, temporarily disabling BRCA2's tumor suppressive functions in DNA repair and replication, causing functional haploinsufficiency. Intermittent MGO exposure incites episodic SBS mutations without permanent BRCA2 inactivation. Thus, a metabolic mechanism wherein MGO-induced BRCA2 haploinsufficiency transiently bypasses Knudson's two-hit requirement could link glycolysis activation by oncogenes, metabolic disorders, or dietary challenges to mutational signatures implicated in cancer evolution.
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Affiliation(s)
- Li Ren Kong
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore; MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK; Department of Pharmacology, National University of Singapore, Singapore 117600, Singapore
| | - Komal Gupta
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK
| | - Andy Jialun Wu
- Cancer Science Institute of Singapore, Singapore 117599, Singapore
| | - David Perera
- MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK
| | | | - Syed Moiz Ahmed
- Cancer Science Institute of Singapore, Singapore 117599, Singapore
| | - Tuan Zea Tan
- Cancer Science Institute of Singapore, Singapore 117599, Singapore
| | - Shawn Lu-Wen Tan
- MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK; Institute of Molecular and Cell Biology (IMCB), A(∗)STAR, Singapore 138673, Singapore
| | | | | | | | | | - Ana S H Costa
- MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK
| | - Callum Oddy
- Department of Oncology, University of Cambridge, Cambridge CB2 0XZ, UK
| | - Hannan Wong
- Cancer Science Institute of Singapore, Singapore 117599, Singapore
| | - C Pawan K Patro
- Cancer Science Institute of Singapore, Singapore 117599, Singapore
| | - Yun Suen Kho
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore
| | - Xiao Zi Huang
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore
| | - Joan Choo
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Mona Shehata
- MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK; Department of Oncology, University of Cambridge, Cambridge CB2 0XZ, UK
| | - Soo Chin Lee
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore; Department of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Boon Cher Goh
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore; Department of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Christian Frezza
- MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK; University of Cologne, 50923 Köln, Germany
| | - Jason J Pitt
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore; Genome Institute of Singapore, A(∗)STAR, Singapore 138673, Singapore
| | - Ashok R Venkitaraman
- Cancer Science Institute of Singapore, Singapore 117599, Singapore; NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore 117599, Singapore; MRC Cancer Unit, University of Cambridge, Cambridge CB2 0XZ, UK; Institute of Molecular and Cell Biology (IMCB), A(∗)STAR, Singapore 138673, Singapore; Department of Oncology, University of Cambridge, Cambridge CB2 0XZ, UK; Department of Medicine, National University of Singapore, Singapore 119228, Singapore.
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Schlegel RN, Fitzgerald M, O'Reilly G, Clements W, Goh GS, Groombridge C, Johnny C, Noonan M, Ban J, Mathew J. The injury patterns, management and outcomes of retroperitoneal haemorrhage caused by lumbar arterial bleeding at a Level-1 Trauma Centre: A 10-year retrospective review. Injury 2023; 54:145-149. [PMID: 35948513 DOI: 10.1016/j.injury.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking. MATERIALS AND METHODS We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes. RESULTS Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH. CONCLUSION This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds.
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Affiliation(s)
- R N Schlegel
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia.
| | - M Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia
| | - G O'Reilly
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - W Clements
- National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University Central Clinical School, Australia
| | - G S Goh
- National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University Central Clinical School, Australia
| | - C Groombridge
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - C Johnny
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - M Noonan
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - J Ban
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - J Mathew
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; National Trauma Research Institute (NTRI), Melbourne, VIC, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
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Lambell KJ, Earthman CP, Tierney AC, Goh GS, Forsyth A, King SJ. How does muscularity assessed by bedside methods compare to computed tomography muscle area at intensive care unit admission? A pilot prospective cross-sectional study. J Hum Nutr Diet 2020; 34:345-355. [PMID: 32869430 DOI: 10.1111/jhn.12804] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/18/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Low muscularity and malnutrition at intensive care unit (ICU) admission have been associated with negative clinical outcomes. There are limited data available evaluating the validity of bedside techniques to measure muscle mass in critically ill adults. We aimed to compare bedside methods for muscle mass assessment [bioimpedance spectroscopy (BIS), arm anthropometry and subjective physical assessment] against reference technology [computed tomography (CT)] at ICU admission. METHODS Adults who had CT scanning at the third lumbar area <72 h after ICU admission were prospectively recruited. Bedside methods were performed within 48 h of the CT scan. Pearson's correlation compared CT muscle area with BIS-derived fat-free mass (FFM) (kg) and FFM-Chamney (kg) (adjusted for overhydration), mid-upper arm circumference (cm) and mid-arm muscle circumference (cm). Depleted muscle stores were determined using published thresholds for each method. Cohen's kappa (κ) was used to evaluate the agreement between bedside and CT assessment of muscularity status (normal or low). RESULTS Fifty participants were enrolled. There were strong correlations between CT muscle area and FFM values and mid-arm muscle circumference (P < 0.001). Using FFM-Chamney, all six (100%) participants with low CT muscle area were detected (κ = 0.723). FFM-BIS, arm anthropometry and subjective physical assessment methods detected 28%-38% of participants with low CT muscle area. CONCLUSIONS BIS-derived FFM using an adjustment algorithm for overhydration was correlated with CT muscle area and had good agreement with muscularity status assessed by CT image analysis. Arm anthropometry and subjective physical assessment techniques were not able to reliably detect participants with low CT muscle area.
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Affiliation(s)
- K J Lambell
- Nutrition Department, Alfred Health, Melbourne, VIC, Australia.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
| | - C P Earthman
- Department of Behavioural Health and Nutrition, University of Delaware, Newark, NJ, USA
| | - A C Tierney
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia.,School of Allied Health and Health Implementation Science and Technology Centre, University of Limerick, Limerick, Ireland
| | - G S Goh
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - A Forsyth
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
| | - S J King
- Nutrition Department, Alfred Health, Melbourne, VIC, Australia.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
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