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Marchetti A, Pelusi S, Marella A, Malvestiti F, Ricchiuti A, Ronzoni L, Lionetti M, Moretti V, Bugianesi E, Miele L, Vespasiani-Gentilucci U, Dongiovanni P, Federico A, Soardo G, D'Ambrosio R, McCain MV, Reeves HL, La Mura V, Prati D, Bolli N, Valenti L. Impact of clonal hematopoiesis of indeterminate potential on hepatocellular carcinoma in individuals with steatotic liver disease. Hepatology 2024:01515467-990000000-00801. [PMID: 38470216 DOI: 10.1097/hep.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND AIMS Metabolic dysfunction associated steatotic liver disease (MASLD) is a global epidemic and is the most rapidly rising cause of hepatocellular carcinoma (HCC). Clonal hematopoiesis of indeterminate potential (CHIP) contributes to neoplastic and cardiometabolic disorders and is considered a harbinger of tissue inflammation. CHIP was recently associated with increased risk of liver disease. The aim of this study was to examine whether CHIP is associated with HCC development in patients with SLD. METHODS We considered individuals with MASLD-HCC (n=208) and controls with (n=414) and without (n=259) advanced fibrosis who underwent whole exome sequencing. CHIP was diagnosed when ≥2 variant callers identified a known myeloid mutation with VAF ≥2%. RESULTS CHIP was observed in 116 participants (13.1%), most frequently in DNMT3A, TET2, TP53 and ASXL1, and correlated with age (p<0.0001) and advanced liver fibrosis (p=0.001). Higher AST levels predicted non-DNMT3A-CHIP, in particular with variant allele frequency (VAF)≥10% (OR 1.14, 1.03-1.28 and OR 1.30, 1.12-1.49, respectively, p<0.05). After adjustment for sex, diabetes and a polygenic risk score of inherited MASLD predisposition CHIP was associated with cirrhosis (2.00, 1.30-3.15, p=0.02), and with HCC even after further adjustment for cirrhosis (OR 1.81, 1.11-2.00, 1.30-3.15, p=0.002). Despite the strong collinearity among aging and development of CHIP and HCC, non-DNTM3A-CHIP and TET2 lesions remained associated with HCC after full correction for clinical/genetics covariates and age (OR 2.45, 1.35-4.53; OR 4.8, 1.60-17.0, p=0.02). CONCLUSIONS We observed an independent association between CHIP, particularly related to non-DNTM3A and TET2 genetic lesions, and MASLD-HCC.
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Affiliation(s)
- Alfredo Marchetti
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Pelusi
- Transfusion Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Marella
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Francesco Malvestiti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Antony Ricchiuti
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Ronzoni
- Transfusion Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Lionetti
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittoria Moretti
- Transfusion Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Italy
| | - Luca Miele
- Dipartimento Universitario Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Area Medicina Interna, Gastroenterologia e Oncologia Medica, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Umberto Vespasiani-Gentilucci
- Clinical Medicine and Hepatology Unit, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paola Dongiovanni
- Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgio Soardo
- Clinica Medica, Department of Medicine, European Excellence Center for Arterial Hypertension, University of Udine, Udine, Italy
| | - Roberta D'Ambrosio
- Gastroenterology and Hepatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Misti V McCain
- Newcastle University Translational Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen L Reeves
- Newcastle University Translational Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vincenzo La Mura
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- General Medicine, Haemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Prati
- Transfusion Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Niccolò Bolli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Transfusion Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Biological Resource Center Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Reeves HL, Hammond JS. The hepatocellular carcinoma Early Recurrence Score (ERS)-Ready for clinical implementation? Liver Int 2023; 43:2346-2347. [PMID: 37846805 DOI: 10.1111/liv.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Helen L Reeves
- Newcastle University Translational and Clinical Research Institute, The Medical School, Newcastle-upon-Tyne, UK
- The Liver Unit, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - John S Hammond
- Department of HPB & Transplantation Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK
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Leslie J, Hunter JE, Collins A, Rushton A, Russell LG, Ramon‐Gil E, Laszczewska M, McCain M, Zaki MYW, Knox A, Seow Y, Sabater L, Geh D, Perkins ND, Reeves HL, Tiniakos D, Mann DA, Oakley F. c-Rel-dependent Chk2 signaling regulates the DNA damage response limiting hepatocarcinogenesis. Hepatology 2023; 78:1050-1063. [PMID: 36089330 PMCID: PMC10521790 DOI: 10.1002/hep.32781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death. The NF-κB transcription factor family subunit c-Rel is typically protumorigenic; however, it has recently been reported as a tumor suppressor. Here, we investigated the role of c-Rel in HCC. APPROACH AND RESULTS Histological and transcriptional studies confirmed expression of c-Rel in human patients with HCC, but low c-Rel expression correlated with increased tumor cell proliferation and mutational burden and was associated with advanced disease. In vivo , global ( Rel-/- ) and epithelial specific ( RelAlb ) c-Rel knockout mice develop more tumors, with a higher proliferative rate and increased DNA damage, than wild-type (WT) controls 30 weeks after N-diethylnitrosamine injury. However, tumor burden was comparable when c-Rel was deleted in hepatocytes once tumors were established, suggesting c-Rel signaling is important for preventing HCC initiation after genotoxic injury, rather than for HCC progression. In vitro , Rel-/- hepatocytes were more susceptible to genotoxic injury than WT controls. ATM-CHK2 DNA damage response pathway proteins were suppressed in Rel-/- hepatocytes following genotoxic injury, suggesting that c-Rel is required for effective DNA repair. To determine if c-Rel inhibition sensitizes cancer cells to chemotherapy, by preventing repair of chemotherapy-induced DNA damage, thus increasing tumor cell death, we administered single or combination doxorubicin and IT-603 (c-Rel inhibitor) therapy in an orthotopic HCC model. Indeed, combination therapy was more efficacious than doxorubicin alone. CONCLUSION Hepatocyte c-Rel signaling limits genotoxic injury and subsequent HCC burden. Inhibiting c-Rel as an adjuvant therapy increased the effectiveness of DNA damaging agents and reduced HCC growth.
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Affiliation(s)
- Jack Leslie
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Jill E. Hunter
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Amy Collins
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Amelia Rushton
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Lauren G. Russell
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Erik Ramon‐Gil
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Maja Laszczewska
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Misti McCain
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Marco Y. W. Zaki
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
- Biochemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Amber Knox
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Yixin Seow
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Laura Sabater
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Daniel Geh
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
- Department of Medicine, Freeman Hospital, Newcastle‐upon‐Tyne Hospitals NHS Foundation Trust, Newcastle‐upon‐Tyne, UK
| | - Neil D. Perkins
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Helen L. Reeves
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
- Department of Medicine, Freeman Hospital, Newcastle‐upon‐Tyne Hospitals NHS Foundation Trust, Newcastle‐upon‐Tyne, UK
| | - Dina Tiniakos
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
- Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Derek A. Mann
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
| | - Fiona Oakley
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle‐upon‐Tyne, UK
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De Souza S, Kahol de Jong J, Perone Y, Shetty S, Qurashi M, Vithayathil M, Shah T, Ross P, Temperley L, Yip VS, Banerjee A, Bettinger D, Sturm L, Reeves HL, Geh D, Orr J, Allen B, Jones RP, Sharma R. Impact of COVID-19 on 1-Year Survival Outcomes in Hepatocellular Carcinoma: A Multicenter Cohort Study. Cancers (Basel) 2023; 15:3378. [PMID: 37444488 PMCID: PMC10341300 DOI: 10.3390/cancers15133378] [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: 05/22/2023] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients' access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. METHODS A prospective cohort study was conducted from 1 March 2020 until 30 June 2020, correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at one year were reported. RESULTS The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed, but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate into reduced survival in patients. CONCLUSION Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay in therapy in those receiving curative therapy.
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Affiliation(s)
- Shuell De Souza
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK (M.V.)
| | - Jeffrey Kahol de Jong
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK (M.V.)
| | - Ylenia Perone
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK (M.V.)
| | - Shishir Shetty
- National Institute for Health Research Birmingham Liver Biomedical Research Unit and Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK (T.S.)
| | - Maria Qurashi
- National Institute for Health Research Birmingham Liver Biomedical Research Unit and Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK (T.S.)
| | - Mathew Vithayathil
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK (M.V.)
| | - Tahir Shah
- National Institute for Health Research Birmingham Liver Biomedical Research Unit and Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK (T.S.)
| | - Paul Ross
- Department of Oncology, Guys’ & St. Thomas’ and King’s College Hospitals, London SE1 9RT, UK
| | - Laura Temperley
- Department of Oncology, Guys’ & St. Thomas’ and King’s College Hospitals, London SE1 9RT, UK
| | - Vincent S. Yip
- Barts and the London HPB Centre, Royal London Hospital, Whitechapel E1 1BB, UK
| | - Abhirup Banerjee
- Barts and the London HPB Centre, Royal London Hospital, Whitechapel E1 1BB, UK
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, 79098 Freiburg, Germany
| | - Lukas Sturm
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, 79098 Freiburg, Germany
| | - Helen L. Reeves
- Newcastle University Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Daniel Geh
- Newcastle University Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - James Orr
- Department of Hepatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Benjamin Allen
- Department of Hepatology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Robert P. Jones
- School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool L3 5TR, UK
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK (M.V.)
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Ford BE, Chachra SS, Rodgers K, Moonira T, Al-Oanzi ZH, Anstee QM, Reeves HL, Schattenberg JM, Fairclough RJ, Smith DM, Tiniakos D, Agius L. The GCKR-P446L gene variant predisposes to raised blood cholesterol and lower blood glucose in the P446L mouse-a model for GCKR rs1260326. Mol Metab 2023; 72:101722. [PMID: 37031802 PMCID: PMC10182400 DOI: 10.1016/j.molmet.2023.101722] [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: 03/07/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVES The Glucokinase Regulatory Protein GKRP, encoded by GCKR, enables acute regulation of liver glucokinase to support metabolic demand. The common human GCKR rs1260326:P446>L variant within a large linkage disequilibrium region associates with pleiotropic traits, lower Type 2 diabetes risk and raised blood triglycerides and cholesterol. Whether GCKR-P446>L is causal to the raised lipids is unknown. We determined whether mouse GKRP phenocopies human GKRP:P446>L and studied a GKRP:P446L mouse to identify physiological consequences to P446>L. METHODS GKRP-deficient hepatocytes were transfected with adenoviral vectors for human or mouse GKRP:446P or 446L for cellular comprehensive analysis including transcriptomics consequent to P446>L. Physiological traits in the diet-challenged P446L mouse were compared with pleiotropic associations at the human rs1260326 locus. Transcriptomics was compared in P446L mouse liver with hepatocytes expressing glucokinase or GKRP:446P/L. RESULTS 1. P446>L substitution in mouse or human GKRP similarly compromises protein expressivity of GKRP:446L, nuclear sequestration of glucokinase and counter-regulation of gene expression. 2. The P446L knockin mouse has lower liver glucokinase and GKRP protein similar to human liver homozygous for rs1260326-446L. 3. The diet-challenged P446L mouse has lower blood glucose, raised blood cholesterol and altered hepatic cholesterol homeostasis consistent with relative glucokinase-to-GKRP excess, but not raised blood triglycerides. CONCLUSIONS Mouse GKRP phenocopies the human GKRP:P446>L substitution despite the higher affinity for glucokinase of human GKRP. The diet-challenged P446L mouse replicates several traits found in association with the rs1260326 locus on chromosome 2 including raised blood cholesterol, lower blood glucose and lower liver glucokinase and GKRP protein.
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Affiliation(s)
- Brian E Ford
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Shruti S Chachra
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Katrina Rodgers
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Tabassum Moonira
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Ziad H Al-Oanzi
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Jouf University, Clinical Laboratory Science, Sakaka, Saudi Arabia
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Jorn M Schattenberg
- Metabolic Liver Research Programm, Department of Medicine, University Hospital Mainz, Mainz, Germany
| | - Rebecca J Fairclough
- Emerging Innovations Unit, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - David M Smith
- Emerging Innovations Unit, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Dina Tiniakos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne; Newcastle NIHR Biomedical Research Center, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Dept of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Loranne Agius
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Permtermsin C, Lalchungnunga H, Nakjang S, Casement J, Ogle LF, Reeves HL, Strathdee G, Shukla R. Identification of TIAM1 as a Potential Synthetic-Lethal-like Gene in a Defined Subset of Hepatocellular Carcinoma. Int J Mol Sci 2023; 24:6387. [PMID: 37047360 PMCID: PMC10094703 DOI: 10.3390/ijms24076387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Hepatocellular carcinoma (HCC), the most common type of liver cancer, has very poor outcomes. Current therapies often have low efficacy and significant toxicities. Thus, there is a critical need for the development of novel therapeutic approaches for HCC. We have developed a novel bioinformatics pipeline, which integrates genome-wide DNA methylation and gene expression data, to identify genes required for the survival of specific molecular cancer subgroups but not normal cells. Targeting these genes may induce cancer-specific "synthetic lethality". Initially, five potential HCC molecular subgroups were identified based on global DNA methylation patterns. Subgroup-2 exhibited the most unique methylation profile and two candidate subtype-specific vulnerability or SL-like genes were identified for this subgroup, including TIAM1, a guanine nucleotide exchange factor encoding gene known to activate Rac1 signalling. siRNA targeting TIAM1 inhibited cell proliferation in TIAM1-positive (subgroup-2) HCC cell lines but had no effect on the normal hepatocyte HHL5 cell line. Furthermore, TIAM1-positive/subgroup-2 cell lines were significantly more sensitive to the TIAM1/RAC1 inhibitor NSC23766 compared with TIAM1-negative HCC lines or the normal HHL5 cell line. The results are consistent with a synthetic lethal role for TIAM1 in a methylation-defined HCC subgroup and suggest it may be a viable therapeutic target in this subset of HCC patients.
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Affiliation(s)
- Chalermsin Permtermsin
- Biosciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
| | - H Lalchungnunga
- Biosciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
| | - Sirintra Nakjang
- Bioinformatics Support Unit, Newcastle University, Newcastle NE2 4HH, UK
| | - John Casement
- Bioinformatics Support Unit, Newcastle University, Newcastle NE2 4HH, UK
| | - Laura Frances Ogle
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
| | - Helen L Reeves
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
- Liver Unit, Freeman Hospital, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne NE7 7DN, UK
| | - Gordon Strathdee
- Biosciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
| | - Ruchi Shukla
- Biosciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle NE2 4HH, UK
- Department of Applied Sciences, Northumbria University, Newcastle NE1 8ST, UK
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Lu H, George J, Eslam M, Villanueva A, Bolondi L, Reeves HL, McCain M, Chambers E, Ward C, Sartika D, Sands C, Maslen L, Lewis MR, Ramaswami R, Sharma R. Discriminatory Changes in Circulating Metabolites as a Predictor of Hepatocellular Cancer in Patients with Metabolic (Dysfunction) Associated Fatty Liver Disease. Liver Cancer 2023; 12:19-31. [PMID: 36872928 PMCID: PMC9982340 DOI: 10.1159/000525911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/06/2021] [Accepted: 06/25/2022] [Indexed: 02/19/2023] Open
Abstract
Introduction The burden of metabolic (dysfunction) associated fatty liver disease (MAFLD) is rising mirrored by an increase in hepatocellular cancer (HCC). MAFLD and its sequelae are characterized by perturbations in lipid handling, inflammation, and mitochondrial damage. The profile of circulating lipid and small molecule metabolites with the development of HCC is poorly characterized in MAFLD and could be used in future studies as a biomarker for HCC. Methods We assessed the profile of 273 lipid and small molecule metabolites by ultra-performance liquid chromatography coupled to high-resolution mass spectrometry in serum from patients with MAFLD (n = 113) and MAFLD-associated HCC (n = 144) from six different centers. Regression models were used to identify a predictive model of HCC. Results Twenty lipid species and one metabolite, reflecting changes in mitochondrial function and sphingolipid metabolism, were associated with the presence of cancer on a background of MAFLD with high accuracy (AUC 0.789, 95% CI: 0.721-0.858), which was enhanced with the addition of cirrhosis to the model (AUC 0.855, 95% CI: 0.793-0.917). In particular, the presence of these metabolites was associated with cirrhosis in the MAFLD subgroup (p < 0.001). When considering the HCC cohort alone, the metabolic signature was an independent predictor of overall survival (HR 1.42, 95% CI: 1.09-1.83, p < 0.01). Conclusion These exploratory findings reveal a metabolic signature in serum which is capable of accurately detecting the presence of HCC on a background of MAFLD. This unique serum signature will be taken forward for further investigation of diagnostic performance as biomarker of early stage HCC in patients with MAFLD in the future.
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Affiliation(s)
- Haonan Lu
- Division of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, New South Wales, Australia
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, New South Wales, Australia
| | | | - Luigi Bolondi
- Division of Internal Medicine, University of Bologna, Bologna, Italy
| | - Helen L. Reeves
- Newcastle University Translational Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Misti McCain
- Newcastle University Translational Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Edward Chambers
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Caroline Ward
- Division of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Dewi Sartika
- Division of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Caroline Sands
- National Phenome Centre, Imperial College London, London, UK
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Lynn Maslen
- National Phenome Centre, Imperial College London, London, UK
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Matthew R. Lewis
- National Phenome Centre, Imperial College London, London, UK
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ramya Ramaswami
- Division of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Rohini Sharma
- Division of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
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Evans TJ, Basu B, Hubner R, Ma YT, Meyer T, Palmer DH, Pinato DJJ, Plummer ER, Ross PJ, Samson A, Sarker D, Kendall T, Bellamy C, Reeves HL, Thomson F, Lawless CA, Stobo J, Sansom OJ, Mann DA, Bird TG. A phase I/II study of the CXCR2 inhibitor, AZD5069, in combination with durvalumab, in patients (pts) with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
TPS631 Background: HCC is increasing rapidly in incidence worldwide driven by a rise in chronic liver disease including non-alcoholic steato-hepatitis (NASH). Most pts are not suitable for curative or loco-regional treatments and may be candidates for systemic therapies. Immune checkpoint inhibitors combined with VEGF inhibition is a standard of care in HCC. However, a meta-analysis of 3 phase III randomised trials of PD-1 or PDL-1 inhibitors (n > 1,600 pts) with HCC suggests that pts with NASH-related HCC treated with PD-1/PDL-1 inhibitors had reduced overall survival compared with other aetiologies. Neutrophils expressing the chemokine receptor CXCR2, crucial to neutrophil recruitment in acute-injury, are highly represented in NASH-HCC. In NASH-HCC murine models, lacking response to immune-checkpoint inhibitors, AZD5069 (CXCR2 inhibitor) in combination with anti-PDL-1 suppressed tumor burden and extended survival, accompanied by an increase in tumor-associated neutrophils which switched from a pro-tumor to anti-tumor progenitor-like neutrophil phenotype. We propose that inhibition of CXCR2 may potentiate the efficacy of anti-PDL-1 inhibition in pts with HCC. Methods: In this multi-centre (n = 10) study, pts with biopsy-confirmed HCC, PS ECOG < 1, Child-Pugh A, < 1 prior systemic therapies, receive 1 of escalating doses of AZD5069 (bid, po daily) with Durvalumab (1.5 gm iv on day 1) in 28-day cycles for up to 2 years to determine the recommended phase II dose using a Keyboard design, followed by an additional cohort of pts to determine the anti-tumor efficacy of this combination using a Simon’s two-stage design (min 18, max 35 pts; target objective response rate > 30%; unacceptable response rate < 10%). Dose limiting toxicities (DLTs) are assessed during cycle 1. Disease assessments are performed 8-weekly (12-weekly after 1 year). The 1st dose cohort has been completed with no DLTs. The 2nd dose cohort opened to recruitment in September 2022. Exploratory studies (blood; pre- & on-treatment tumor and non-malignant liver biopsies) include biomarkers of CXCR2 inhibition (blood); proof-of-mechanism (tumor: expression of CXCR2, PD-L1, PD-1, CD8, CD4, CD66b, CD69); proof-of-mechanism (blood: ctDNA); drug-induced changes of mRNA expression, CXCR2 ligands & signalling pathway genes, T-cell and myeloid cell pathways, neutrophil-associated genes; predictive biomarkers (blood and tumour) include biomarkers of the CXCR2/PD-L1 immune axis; aberrant CXCR2 signalling pathways; proliferation biomarkers and CD10 (neutrophils), CD68 (macrophages), CD103 (T-regs); tumour mutational status. This study is funded by a grant from Cancer Research UK (A29287) and is co-sponsored by University of Glasgow and NHS Greater Glasgow & Clyde. Study sites are supported by the Experimental Cancer Medicine Centre Network. AZD5069 and Durvalumab are provided by Astra Zeneca. Clinical trial information: 2020-003346-36 .
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Affiliation(s)
- T.R. Jeffry Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Bristi Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard Hubner
- Medical Oncology Department, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Yuk Ting Ma
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tim Meyer
- Department of Oncology, UCL Cancer Institute, University College, London & Department of Oncology, Royal Free Hospital London, London, United Kingdom
| | | | | | | | - Paul J. Ross
- Guy's and St Thomas' NHS Trust, London, United Kingdom
| | | | | | | | | | - Helen L Reeves
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | | | - Claire A Lawless
- CR-UK Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Jamie Stobo
- CR-UK Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | | | - Derek A. Mann
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Thomas G Bird
- CR-UK Beatson Institute & MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Glasgow, United Kingdom
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9
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Zaki MY, Alhasan SF, Shukla R, McCain M, Laszczewska M, Geh D, Patman GL, Televantou D, Whitehead A, Maurício JP, Barksby B, Gee LM, Paish HL, Leslie J, Younes R, Burt AD, Borthwick LA, Thomas H, Beale GS, Govaere O, Sia D, Anstee QM, Tiniakos D, Oakley F, Reeves HL. Sulfatase-2 from Cancer Associated Fibroblasts: An Environmental Target for Hepatocellular Carcinoma? Liver Cancer 2022; 11:540-557. [PMID: 36589727 PMCID: PMC9801184 DOI: 10.1159/000525375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Heparin sulphate proteoglycans in the liver tumour microenvironment (TME) are key regulators of cell signalling, modulated by sulfatase-2 (SULF2). SULF2 overexpression occurs in hepatocellular carcinoma (HCC). Our aims were to define the nature and impact of SULF2 in the HCC TME. Methods In liver biopsies from 60 patients with HCC, expression and localization of SULF2 were analysed associated with clinical parameters and outcome. Functional and mechanistic impacts were assessed with immunohistochemistry (IHC), in silico using The Cancer Genome Atlas (TGCA), in primary isolated cancer activated fibroblasts, in monocultures, in 3D spheroids, and in an independent cohort of 20 patients referred for sorafenib. IHC targets included αSMA, glypican-3, β-catenin, RelA-P-ser536, CD4, CD8, CD66b, CD45, CD68, and CD163. SULF2 impact of peripheral blood mononuclear cells was assessed by migration assays, with characterization of immune cell phenotype using fluorescent activated cell sorting. Results We report that while SULF2 was expressed in tumour cells in 15% (9/60) of cases, associated with advanced tumour stage and type 2 diabetes, SULF2 was more commonly expressed in cancer-associated fibroblasts (CAFs) (52%) and independently associated with shorter survival (7.2 vs. 29.2 months, p = 0.003). Stromal SULF2 modulated glypican-3/β-catenin signalling in vitro, although in vivo associations suggested additional mechanisms underlying the CAF-SULF2 impact on prognosis. Stromal SULF2 was released by CAFS isolated from human HCC. It was induced by TGFβ1, promoted HCC proliferation and sorafenib resistance, with CAF-SULF2 linked to TGFβ1 and immune exhaustion in TGCA HCC patients. Autocrine activation of PDGFRβ/STAT3 signalling was evident in stromal cells, with the release of the potent monocyte/macrophage chemoattractant CCL2 in vitro. In human PBMCs, SULF2 preferentially induced the migration of macrophage precursors (monocytes), inducing a phenotypic change consistent with immune exhaustion. In human HCC tissues, CAF-SULF2 was associated with increased macrophage recruitment, with tumouroid studies showing stromal-derived SULF2-induced paracrine activation of the IKKβ/NF-κB pathway, tumour cell proliferation, invasion, and sorafenib resistance. Conclusion SULF2 derived from CAFs modulates glypican-3/β-catenin signalling but also the HCC immune TME, associated with tumour progression and therapy resistance via activation of the TAK1/IKKβ/NF-κB pathway. It is an attractive target for combination therapies for patients with HCC.
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Affiliation(s)
- Marco Y.W. Zaki
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, Egypt
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Sari F. Alhasan
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruchi Shukla
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Misti McCain
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maja Laszczewska
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniel Geh
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gillian L. Patman
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Despina Televantou
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Anna Whitehead
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - João P. Maurício
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ben Barksby
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lucy M. Gee
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Hannah L. Paish
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Jack Leslie
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ramy Younes
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alastair D. Burt
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Lee A. Borthwick
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Huw Thomas
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gary S. Beale
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Olivier Govaere
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniela Sia
- Division of Liver Diseases, Department of Medicine, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Quentin M. Anstee
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dina Tiniakos
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fiona Oakley
- Newcastle Fibrosis Research Group, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Newcastle University Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Helen L. Reeves
- Newcastle University Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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González-Recio I, Simón J, Goikoetxea-Usandizaga N, Serrano-Maciá M, Mercado-Gómez M, Rodríguez-Agudo R, Lachiondo-Ortega S, Gil-Pitarch C, Fernández-Rodríguez C, Castellana D, Latasa MU, Abecia L, Anguita J, Delgado TC, Iruzubieta P, Crespo J, Hardy S, Petrov PD, Jover R, Avila MA, Martín C, Schaeper U, Tremblay ML, Dear JW, Masson S, McCain MV, Reeves HL, Andrade RJ, Lucena MI, Buccella D, Martínez-Cruz LA, Martínez-Chantar ML. Restoring cellular magnesium balance through Cyclin M4 protects against acetaminophen-induced liver damage. Nat Commun 2022; 13:6816. [PMID: 36433951 PMCID: PMC9700862 DOI: 10.1038/s41467-022-34262-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
Acetaminophen overdose is one of the leading causes of acute liver failure and liver transplantation in the Western world. Magnesium is essential in several cellular processess. The Cyclin M family is involved in magnesium transport across cell membranes. Herein, we identify that among all magnesium transporters, only Cyclin M4 expression is upregulated in the liver of patients with acetaminophen overdose, with disturbances in magnesium serum levels. In the liver, acetaminophen interferes with the mitochondrial magnesium reservoir via Cyclin M4, affecting ATP production and reactive oxygen species generation, further boosting endoplasmic reticulum stress. Importantly, Cyclin M4 mutant T495I, which impairs magnesium flux, shows no effect. Finally, an accumulation of Cyclin M4 in endoplasmic reticulum is shown under hepatoxicity. Based on our studies in mice, silencing hepatic Cyclin M4 within the window of 6 to 24 h following acetaminophen overdose ingestion may represent a therapeutic target for acetaminophen overdose induced liver injury.
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Affiliation(s)
- Irene González-Recio
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Jorge Simón
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Naroa Goikoetxea-Usandizaga
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Marina Serrano-Maciá
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Maria Mercado-Gómez
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Rubén Rodríguez-Agudo
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Sofía Lachiondo-Ortega
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Clàudia Gil-Pitarch
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Carmen Fernández-Rodríguez
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Donatello Castellana
- Research & Development, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Maria U Latasa
- Hepatology Programme, CIMA, Idisna, Universidad de Navarra, Avda, Pio XII, n 55, 31008, Pamplona, Spain
| | - Leticia Abecia
- Inflammation and Macrophage Plasticity Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), 48160, Derio, Bizkaia, Spain
- Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería. Universidad del País Vasco/ Euskal Herriko Unibertsitatea (UPV/EHU), Barrio Sarriena s/n 48940, Leioa, Spain
| | - Juan Anguita
- Inflammation and Macrophage Plasticity Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), 48160, Derio, Bizkaia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Teresa C Delgado
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, IDIVAL, Santander, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, IDIVAL, Santander, Spain
| | - Serge Hardy
- Department of Biochemistry, McGill University, H3G 1Y6, Montréal, QC, Canada
- Rosalind and Morris Goodman Cancer Research Centre, McGill Unversity, H3A 1A3, Montréal, QC, Canada
| | - Petar D Petrov
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Experimental Hepatology Joint Research Unit, IIS Hospital La Fe & Dep. Biochemistry, University of Valencia, Valencia, Spain
| | - Ramiro Jover
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Experimental Hepatology Joint Research Unit, IIS Hospital La Fe & Dep. Biochemistry, University of Valencia, Valencia, Spain
| | - Matías A Avila
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Hepatology Programme, CIMA, Idisna, Universidad de Navarra, Avda, Pio XII, n 55, 31008, Pamplona, Spain
| | - César Martín
- Biofisika Institute (UPV/EHU, CSIC) and Department of Biochemistry and Molecular Biology, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain
| | - Ute Schaeper
- Silence Therapeutics GmbH, Berlin, Robert Rössle Strasse 10, 13125, Berlin, Germany
| | - Michel L Tremblay
- Department of Biochemistry, McGill University, H3G 1Y6, Montréal, QC, Canada
- Rosalind and Morris Goodman Cancer Research Centre, McGill Unversity, H3A 1A3, Montréal, QC, Canada
| | - James W Dear
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Steven Masson
- The Liver Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Newcastle University Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Misti Vanette McCain
- The Liver Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Helen L Reeves
- The Liver Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Newcastle University Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Raul J Andrade
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - M Isabel Lucena
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, UICEC SCReN, Universidad de Málaga, Málaga, Spain
| | - Daniela Buccella
- Department of Chemistry, New York University, New York, NY, 10003, USA.
| | - Luis Alfonso Martínez-Cruz
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain.
| | - Maria L Martínez-Chantar
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Building 801A, 48160, Derio, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain.
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11
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Baselli GA, Jamialahmadi O, Pelusi S, Ciociola E, Malvestiti F, Saracino M, Santoro L, Cherubini A, Dongiovanni P, Maggioni M, Bianco C, Tavaglione F, Cespiati A, Mancina RM, D'Ambrosio R, Vaira V, Petta S, Miele L, Vespasiani-Gentilucci U, Federico A, Pihlajamaki J, Bugianesi E, Fracanzani AL, Reeves HL, Soardo G, Prati D, Romeo S, Valenti LV. Rare ATG7 genetic variants predispose patients to severe fatty liver disease. J Hepatol 2022; 77:596-606. [PMID: 35405176 DOI: 10.1016/j.jhep.2022.03.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disorders and has a strong heritable component. The aim of this study was to identify new loci that contribute to severe NAFLD by examining rare variants. METHODS We performed whole-exome sequencing in individuals with NAFLD and advanced fibrosis or hepatocellular carcinoma (n = 301) and examined the enrichment of likely pathogenic rare variants vs. the general population. This was followed by validation at the gene level. RESULTS In patients with severe NAFLD, we observed an enrichment of the p.P426L variant (rs143545741 C>T; odds ratio [OR] 5.26, 95% CI 2.1-12.6; p = 0.003) of autophagy-related 7 (ATG7), which we characterized as a loss-of-function, vs. the general population, and an enrichment in rare variants affecting the catalytic domain (OR 13.9; 95% CI 1.9-612; p = 0.002). In the UK Biobank cohort, loss-of-function ATG7 variants increased the risk of cirrhosis and hepatocellular carcinoma (OR 3.30; 95% CI 1.1-7.5 and OR 12.30, 95% CI 2.6-36, respectively; p <0.001 for both). The low-frequency loss-of-function p.V471A variant (rs36117895 T>C) was also associated with severe NAFLD in the clinical cohort (OR 1.7; 95% CI 1.2-2.5; p = 0.003), predisposed to hepatocellular ballooning (p = 0.007) evolving to fibrosis in the Liver biopsy cohort (n = 2,268), and was associated with liver injury in the UK Biobank (aspartate aminotransferase levels, p <0.001), with a larger effect in severely obese individuals in whom it was linked to hepatocellular carcinoma (p = 0.009). ATG7 protein localized to periportal hepatocytes, particularly in the presence of ballooning. In the Liver Transcriptomic cohort (n = 125), ATG7 expression correlated with suppression of the TNFα pathway, which was conversely upregulated in p.V471A carriers. CONCLUSIONS We identified rare and low-frequency ATG7 loss-of-function variants that promote NAFLD progression by impairing autophagy and facilitating ballooning and inflammation. LAY SUMMARY We found that rare mutations in a gene called autophagy-related 7 (ATG7) increase the risk of developing severe liver disease in individuals with dysmetabolism. These mutations cause an alteration in protein function and impairment of self-renewal of cellular content, leading to liver damage and inflammation.
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Affiliation(s)
- Guido A Baselli
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Oveis Jamialahmadi
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Serena Pelusi
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Ester Ciociola
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Francesco Malvestiti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marco Saracino
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luigi Santoro
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Cherubini
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Dongiovanni
- General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Maggioni
- Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristiana Bianco
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Tavaglione
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Annalisa Cespiati
- General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosellina M Mancina
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Vaira
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology, PROMISE, Università di Palermo, Palermo, Italy
| | - Luca Miele
- Department of Internal Medicine, Fondazione Policlinico A. Gemelli, Università Cattolica di Roma, Rome, Italy
| | - Umberto Vespasiani-Gentilucci
- Clinical Medicine and Hepatology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Federico
- Division of Hepatogastroenterology, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Jussi Pihlajamaki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, Università di Torino, Turin, Italy
| | - Anna L Fracanzani
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Helen L Reeves
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Giorgio Soardo
- Clinic of Internal Medicine - Liver Unit, Department of Medical Area (DAME), Università degli Studi di Udine, Udine, Italy; Italian Liver Foundation, Area Science Park, Basovizza Campus, Trieste, Italy
| | - Daniele Prati
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Luca Vc Valenti
- Precision Medicine - Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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12
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Muñoz‐Martínez S, Sapena V, Forner A, Bruix J, Sanduzzi‐Zamparelli M, Ríos J, Bouattour M, El‐Kassas M, Leal CRG, Mocan T, Nault J, Alves RCP, Reeves HL, da Fonseca L, García‐Juárez I, Pinato DJ, Varela M, Alqahtani SA, Alvares‐da‐Silva MR, Bandi JC, Rimassa L, Lozano M, González Santiago JM, Tacke F, Sala M, Anders M, Lachenmayer A, Piñero F, França A, Guarino M, Elvevi A, Cabibbo G, Peck‐Radosavljevic M, Rojas Á, Vergara M, Braconi C, Pascual S, Perelló C, Mello V, Rodríguez‐Lope C, Acevedo J, Villani R, Hollande C, Vilgrain V, Tawheed A, Ferguson Theodoro C, Sparchez Z, Blaise L, Viera‐Alves DE, Watson R, Carrilho FJ, Moctezuma‐Velázquez C, D'Alessio A, Iavarone M, Reig M. Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study. Liver Int 2022; 42:1891-1901. [PMID: 35608939 PMCID: PMC9347559 DOI: 10.1111/liv.15320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. METHODS Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered. RESULTS Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection. CONCLUSIONS This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.
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Affiliation(s)
- Sergio Muñoz‐Martínez
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Victor Sapena
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic BarcelonaBarcelonaSpain
| | - Alejandro Forner
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Jordi Bruix
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - Marco Sanduzzi‐Zamparelli
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
| | - José Ríos
- Department of Clinical Farmacology Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Mohamed El‐Kassas
- Endemic Medicine DepartmentFaculty of MedicineHelwan UniversityCairoEgypt
| | - Cassia R. G. Leal
- GastroenterologyHospital Universitário Antônio Pedro, Universidade Federal FuminenseRio de JaneiroBrazil
- GastroenterologyHospital Federal do Servidores do EstadoRio de JaneiroBrazil
| | - Tudor Mocan
- 3rd Medical Department"Octavian Fodor" Institute for Gastroenterology and HepatologyCluj‐NapocaRomania
| | - Jean‐Charles Nault
- Liver unitHôpital Avicenne, Hôpitaux Universitaires Paris‐Seine‐Saint‐Denis, Assistance‐Publique Hôpitaux de ParisBobignyFrance
- Unité de Formation et de Recherche Santé Médecine et Biologie HumaineUniversité Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris CitéParisFrance
- Centre de Recherche des CordeliersSorbonne UniversitéInserm, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology. Université de Paris, team « Functional Genomics of Solid TumorsParisFrance
| | - Rogerio C. P. Alves
- GastroenterologyHospital do Servidor Publico Estadual de São PauloSao PauloBrazil
- Bp Beneficência Portuguesa de São PauloSao PauloBrazil
| | - Helen L. Reeves
- Liver UnitNewcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Newcastle University Translational and Clinical Research InstituteNewcastle upon TyneUK
| | - Leonardo da Fonseca
- Clinical OncologySao Paulo Clinicas Liver Cancer Group. Instituto do Cancer do Estado de Sao Paulo. Hospital das Clínicas. University of Sao Paulo School of MedicineSao PauloBrazil
| | - Ignacio García‐Juárez
- Gastroenterology DepartmentNational Institute of Medical Sciences and Nutrition Salvador ZubiránMexico CityMexico
| | - David J. Pinato
- Department of Surgery and CancerImperial College LondonLondonUK
| | - María Varela
- Liver Unit, Department of Digestive DiseaseHospital Universitario Central de Asturias, IUOPA, ISPA, Universidad de OviedoOviedoSpain
| | - Saleh A. Alqahtani
- Liver TransplantKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Mario R. Alvares‐da‐Silva
- GI/Liver UnitHospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Juan C. Bandi
- Hepatology UnitHospital ItalianoBuenos AiresArgentina
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Medical Oncology and Hematology UnitHumanitas Cancer Center, IRCCS, Humanitas Research HospitalRozzanoItaly
| | - Mar Lozano
- Aparato DigestivoHospital Universitario Infanta LeonorMadridSpain
| | - Jesús M. González Santiago
- Department of Gastroenterology and HepatologySalamanca University Clinic HospitalIBSAL, CIBERehdSalamancaSpain
| | - Frank Tacke
- Department of Gastroenterology and HepatologySalamanca University Clinic HospitalIBSAL, CIBERehdSalamancaSpain
- Department of Hepatology and GastroenterologyCharité‐UniversitätsmedizinCampus Virchow‐Klinikum and Campus Charité MitteBerlinGermany
| | - Margarita Sala
- GastroenterologyHepatology UnitHospital Doctor Josep Trueta, IDIBGI (Institut d'Investigació Biomèdica de Girona)CIBERehdGironaSpain
| | | | - Anja Lachenmayer
- Department of Visceral Surgery and MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
| | | | - Alex França
- MedicineFederal University of SergipeAracajuBrazil
| | - Maria Guarino
- Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Alessandra Elvevi
- Division Gastroenterology and Center for Autoimmune Liver Diseases San Gerardo Hospital University of Milano ‐ Bicocca School of MedicineMonzaItaly
| | - Giuseppe Cabibbo
- Section of Gastroenterology and HepatologyPROMISE, University of PalermoPalermoItaly
| | | | - Ángela Rojas
- SeLiver group. Institute of Biomedicine of SevilleHospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla‐CIBERehdSevilleSpain
| | - Mercedes Vergara
- Unitat d'Hepatologia, Servei d'Aparell Digestiu, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació I3PT, Universitat Autònoma de Barcelona, Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, CIBERehd. Instituto Carlos IIIMadridSpain
| | - Chiara Braconi
- Medical OncologyBeatson West of Scotland Cancer CentreUniversity of GlasgowGlasgowUK
| | - Sonia Pascual
- Liver Unit. HGU Dr. Balmis. CIBERehd. ISABIALAlicanteSpain
| | - Christie Perelló
- Gastroenterology and HepatologyUniversity Hospital Puerta de HierroMajadahondaSpain
| | | | - Carlos Rodríguez‐Lope
- Servicio de Aparato DigestivoHospital Universitario Marqués de ValdecillaIDIVALSantanderSpain
| | - Juan Acevedo
- South West Liver UnitUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | | | | | - Valérie Vilgrain
- Université de ParisParisFrance
- Department of RadiologyHôpital Beaujon, AP‐HP. NordClichyFrance
| | - Ahmed Tawheed
- Endemic Medicine DepartmentFaculty of MedicineHelwan UniversityCairoEgypt
| | - Carmem Ferguson Theodoro
- Department of GastroenterologyHospital Universitário Antônio Pedro, Universidade Federal FluminenseNiteroiBrazil
| | - Zeno Sparchez
- 3rd Medical DepartmentInstitute for Gastroenterology and HepatologyUniversity of Medicine and PharmacyCluj‐NapocaRomania
| | - Lorraine Blaise
- Liver unitHôpital Avicenne, Hôpitaux Universitaires Paris‐Seine‐Saint‐Denis, Assistance‐Publique Hôpitaux de ParisBobignyFrance
- Unité de Formation et de Recherche Santé Médecine et Biologie HumaineUniversité Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris CitéParisFrance
- Centre de Recherche des CordeliersSorbonne UniversitéInserm, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology. Université de Paris, team « Functional Genomics of Solid TumorsParisFrance
| | - Daniele E. Viera‐Alves
- GastroenterologyHospital do Servidor Publico Estadual de São PauloSao PauloBrazil
- Bp Beneficência Portuguesa de São PauloSao PauloBrazil
| | - Robyn Watson
- Newcastle University Translational and Clinical Research InstituteNewcastle upon TyneUK
| | - Flair J. Carrilho
- Sao Paulo Clínicas Liver Cancer Group. Instituto do Cancer do Estado de Sao Paulo. Division of Clinical Gastroenterology and HepatologyHospital das Clínicas, Department of GastroenterologyUniversity of Sao Paulo School of MedicineSao PauloBrazil
| | - Carlos Moctezuma‐Velázquez
- Gastroenterology DepartmentNational Institute of Medical Sciences and Nutrition Salvador ZubiránMexico CityMexico
| | - Antonio D'Alessio
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico – Division of Gastroenterology and HepatologyMilanItaly
| | - Maria Reig
- Unitat d'Oncologia hepàtica, Liver Unit, Hospital ClínicBarcelonaSpain
- BCLC group, IDIBAPSBarcelonaSpain
- CIBEREHDBarcelonaSpain
- Universitat de Barcelona (UB)BarcelonaSpain
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13
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Reeves HL, Reicher J, Priona G, Manas DM, Littler P. Selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC): informing clinical practice for multidisciplinary teams in England. Frontline Gastroenterol 2022; 14:45-51. [PMID: 36561784 PMCID: PMC9763643 DOI: 10.1136/flgastro-2022-102137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Objective Hepatocellular carcinoma (HCC) deaths are rising alarmingly. Many patients are unsuitable for available therapies. Poor response rates further hamper outcomes for those that are. Selective internal radiation therapy (SIRT) offers hope, although which patients benefit over standard approaches remains unclear. Design/method As a quality/service improvement, we audited consecutive patients treated with SIRT (2015-2020) by the Newcastle upon Tyne Hospitals National Health Service Foundation Trust HCC multidisciplinary team. Indications, Barcelona clinic liver cancer (BCLC) stage, treatment response, subsequent therapies and survival at 30 September 2021 were assessed. Results Fifty-one patients received SIRT. Thirty-day mortality was zero. Three months partial response, stable disease and progressive disease on imaging were 50%, 22% and 28%, respectively. Overall median survival was 21 months. There were four subgroups: (1) BCLC-B: HCC>7 cm too large for transarterial chemoembolisation (TACE) alone (n=21); (2) BCLC-B: HCC progressed post TACE (n=7); (3) BCLC-C: HCC with any combination of large tumour burden, branch portal vein thrombosis, non-hepatitis C virus aetiology (n=16); (4) BCLC-C: sorafenib inappropriate (n=7). In group 1, 5/21 (23.8%) of patients were downstaged to resection, 33% received subsequent medical therapies and median survival was >40 months. In BCLC-B patients treated second line (group 2), median survival was 14.2 months. In BCLC-C, median survival was 20.2 months for group 3 and 4.2 months for group 4. Conclusion SIRT outcomes for advanced HCC, often bridging patients with adverse predictive factors to subsequent surgery or medical therapies, were encouraging. A role after TACE or for BCLC-C patients requires further assessment.
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Affiliation(s)
- Helen L Reeves
- Newcastle University Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Liver Unit, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - John Reicher
- Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Georgia Priona
- Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derek M Manas
- Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Littler
- Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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14
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Orange ST, Hallsworth K, Brown MC, Reeves HL. The feasibility and acceptability of a home-based, virtual exercise intervention for older patients with hepatocellular carcinoma: protocol for a non-randomised feasibility study (TELEX-Liver Cancer). Pilot Feasibility Stud 2022; 8:113. [PMID: 35624520 PMCID: PMC9135985 DOI: 10.1186/s40814-022-01069-1] [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] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The number of incident cases and deaths from primary liver cancer, predominantly hepatocellular carcinoma (HCC), has increased markedly in the last two decades. HCC is generally diagnosed at an advanced stage, and most new cases are in people aged over 70 years with age-related comorbidities. Treatment options are often limited, with most patients receiving palliative treatment or supportive care only. As a consequence, maintaining quality of life (QoL) through symptom management is critically important and is a core objective of clinical care. Strong evidence supports the efficacy of supervised exercise training for addressing certain cancer-related symptoms, including QoL, physical function, and fatigue. However, there are many barriers to implementing supervised exercise programmes within cancer care pathways, including economic pressures on healthcare systems and personal barriers for patients. Recent advances in technology allow patients to exercise at home under the 'virtual' supervision of an exercise professional through videoconferencing software (termed 'telehealth exercise'). Despite its potential, there are uncertainties relating to the feasibility, acceptability, and safety of telehealth exercise in people living with HCC. METHODS This is a protocol for a prospective, single-centre, single-arm, pretest-posttest feasibility trial. We aim to recruit 20 patients aged 60 years or older who have received treatment for HCC and are undergoing routine clinical monitoring. Patients will be invited to take part in two online, home-based, group exercise sessions per week for 10 consecutive weeks. The 'virtual' exercise sessions will be delivered in real time by an exercise professional through videoconferencing software. Each session will comprise 30 min of aerobic and resistance exercise performed at a moderate intensity, as guided by the 10-point Borg rating of perceived exertion scale. Feasibility outcomes include recruitment, retention, adherence, intervention fidelity, and safety. Acceptability of the intervention will be assessed using a mixed-methods approach via monthly online surveys and an exit telephone interview. Physical function, accelerometry-measured physical activity, mid-upper arm circumference, and patient-reported outcome measures (PROMS) will be assessed before and after the intervention to determine the feasibility of assessing outcome measures. Physical function outcomes include the short physical performance battery and Liver Frailty Index. PROMS include the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire, Activities-specific Balance Confidence scale, Hospital Anxiety and Depression Scale, and the Godin Leisure-Time Exercise Questionnaire. DISCUSSION This mixed-methods study will address uncertainties relating to the feasibility and acceptability of delivering live, online, home-based, group exercise sessions to patients with HCC. The findings will inform whether any modifications are required to refine and optimise the intervention, and the assessment of outcome measures will provide information on the likely size and variability of intervention effects. Collectively, the data generated will inform the design of a subsequent, adequately powered, randomised controlled trial to evaluate the efficacy of the telehealth exercise intervention. TRIAL REGISTRATION ISRCTN14411809.
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Affiliation(s)
- Samuel T Orange
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Hallsworth
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Morven C Brown
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
- The Liver Unit, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
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15
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Leslie J, Mackey JBG, Jamieson T, Ramon-Gil E, Drake TM, Fercoq F, Clark W, Gilroy K, Hedley A, Nixon C, Luli S, Laszczewska M, Pinyol R, Esteban-Fabró R, Willoughby CE, Haber PK, Andreu-Oller C, Rahbari M, Fan C, Pfister D, Raman S, Wilson N, Müller M, Collins A, Geh D, Fuller A, McDonald D, Hulme G, Filby A, Cortes-Lavaud X, Mohamed NE, Ford CA, Raffo Iraolagoitia XL, McFarlane AJ, McCain MV, Ridgway RA, Roberts EW, Barry ST, Graham GJ, Heikenwälder M, Reeves HL, Llovet JM, Carlin LM, Bird TG, Sansom OJ, Mann DA. CXCR2 inhibition enables NASH-HCC immunotherapy. Gut 2022; 71:gutjnl-2021-326259. [PMID: 35477863 PMCID: PMC9484388 DOI: 10.1136/gutjnl-2021-326259] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 10/05/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is increasingly associated with non-alcoholic steatohepatitis (NASH). HCC immunotherapy offers great promise; however, recent data suggests NASH-HCC may be less sensitive to conventional immune checkpoint inhibition (ICI). We hypothesised that targeting neutrophils using a CXCR2 small molecule inhibitor may sensitise NASH-HCC to ICI therapy. DESIGN Neutrophil infiltration was characterised in human HCC and mouse models of HCC. Late-stage intervention with anti-PD1 and/or a CXCR2 inhibitor was performed in murine models of NASH-HCC. The tumour immune microenvironment was characterised by imaging mass cytometry, RNA-seq and flow cytometry. RESULTS Neutrophils expressing CXCR2, a receptor crucial to neutrophil recruitment in acute-injury, are highly represented in human NASH-HCC. In models of NASH-HCC lacking response to ICI, the combination of a CXCR2 antagonist with anti-PD1 suppressed tumour burden and extended survival. Combination therapy increased intratumoural XCR1+ dendritic cell activation and CD8+ T cell numbers which are associated with anti-tumoural immunity, this was confirmed by loss of therapeutic effect on genetic impairment of myeloid cell recruitment, neutralisation of the XCR1-ligand XCL1 or depletion of CD8+ T cells. Therapeutic benefit was accompanied by an unexpected increase in tumour-associated neutrophils (TANs) which switched from a protumour to anti-tumour progenitor-like neutrophil phenotype. Reprogrammed TANs were found in direct contact with CD8+ T cells in clusters that were enriched for the cytotoxic anti-tumoural protease granzyme B. Neutrophil reprogramming was not observed in the circulation indicative of the combination therapy selectively influencing TANs. CONCLUSION CXCR2-inhibition induces reprogramming of the tumour immune microenvironment that promotes ICI in NASH-HCC.
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Affiliation(s)
- Jack Leslie
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Erik Ramon-Gil
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas M Drake
- Cancer Research UK Beatson Institute, Glasgow, UK
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Ann Hedley
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - Colin Nixon
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - Saimir Luli
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Preclinical In Vivo Imaging Facility, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Maja Laszczewska
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Roser Pinyol
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roger Esteban-Fabró
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine E Willoughby
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Philipp K Haber
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carmen Andreu-Oller
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohammad Rahbari
- Division of Chronic Inflammation and Cancer, German Cancer Research Centre, Heidelberg, Germany
| | - Chaofan Fan
- Division of Chronic Inflammation and Cancer, German Cancer Research Centre, Heidelberg, Germany
| | - Dominik Pfister
- Division of Chronic Inflammation and Cancer, German Cancer Research Centre, Heidelberg, Germany
| | - Shreya Raman
- Department of Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Niall Wilson
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Amy Collins
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Geh
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Fuller
- Flow Cytometry Facility, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - David McDonald
- Flow Cytometry Facility, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Gillian Hulme
- Flow Cytometry Facility, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrew Filby
- Flow Cytometry Facility, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Innovation, Methodology and Innovation (IMA) theme, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | | | | - Misti V McCain
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Simon T Barry
- Bioscience, Early Oncology, AstraZeneca, Macclesfield, UK
| | - Gerard J Graham
- Chemokine Research Group, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Centre, Heidelberg, Germany
- Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Helen L Reeves
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Josep M Llovet
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Leo M Carlin
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Thomas G Bird
- Cancer Research UK Beatson Institute, Glasgow, UK
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Owen J Sansom
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson Institute for Cancer Research, Glasgow, UK
| | - Derek A Mann
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- The Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Fibrofind Ltd, William Leech Building, Medical School, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology and Hepatology, School of Medicine, Koç University, Istanbul, Turkey
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16
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Geh D, Leslie J, Rumney R, Reeves HL, Bird TG, Mann DA. Neutrophils as potential therapeutic targets in hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 2022; 19:257-273. [PMID: 35022608 DOI: 10.1038/s41575-021-00568-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
The success of atezolizumab plus bevacizumab treatment contributed to a shift in systemic therapies for hepatocellular carcinoma (HCC) towards combinations that include cancer immunotherapeutic agents. Thus far, the principal focus of cancer immunotherapy has been on interrupting immune checkpoints that suppress antitumour lymphocytes. As well as lymphocytes, the HCC environment includes numerous other immune cell types, among which neutrophils are emerging as an important contributor to the pathogenesis of HCC. A growing body of evidence supports neutrophils as key mediators of the immunosuppressive environment in which some cancers develop, as well as drivers of tumour progression. If neutrophils have a similar role in HCC, approaches that target or manipulate neutrophils might have therapeutic benefits, potentially including sensitization of tumours to conventional immunotherapy. Several neutrophil-directed therapies for patients with HCC (and other cancers) are now entering clinical trials. This Review outlines the evidence in support of neutrophils as drivers of HCC and details their mechanistic roles in development, progression and metastasis, highlighting the reasons that neutrophils are well worth investigating despite the challenges associated with studying them. Neutrophil-modulating anticancer therapies entering clinical trials are also summarized.
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Affiliation(s)
- Daniel Geh
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jack Leslie
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rob Rumney
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Thomas G Bird
- Cancer Research UK Beatson Institute, Glasgow, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Derek A Mann
- Newcastle Fibrosis Research Group, Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
- Department of Gastroenterology and Hepatology, School of Medicine, Koç University, Istanbul, Turkey.
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17
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Geh D, Watson R, Sen G, French JJ, Hammond J, Turner P, Hoare T, Anderson K, McNeil M, McPherson S, Masson S, Dyson J, Donnelly M, MacDougal L, Patel P, Hudson M, Anstee QM, White S, Robinson S, Pandanaboyana S, Walker L, McCain M, Bury Y, Raman S, Burt A, Parkinson D, Haugk B, Darne A, Wadd N, Asghar S, Mariappan L, Margetts J, Stenberg B, Scott J, Littler P, Manas DM, Reeves HL. COVID-19 and liver cancer: lost patients and larger tumours. BMJ Open Gastroenterol 2022; 9:e000794. [PMID: 35450934 PMCID: PMC9023844 DOI: 10.1136/bmjgast-2021-000794] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region. OBJECTIVE To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region. DESIGN We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020). RESULTS We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection. CONCLUSION The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.
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Affiliation(s)
- Daniel Geh
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Robyn Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gourab Sen
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy J French
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Hammond
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Turner
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Hoare
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirsty Anderson
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael McNeil
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stuart McPherson
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Steven Masson
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jessica Dyson
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mhairi Donnelly
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise MacDougal
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Preya Patel
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark Hudson
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Steven White
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stuart Robinson
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy Walker
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Discovery Medicine, GlaxoSmithKline Plc, Brentford, UK
| | - Misti McCain
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne Bury
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shreya Raman
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alastair Burt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Parkinson
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Beate Haugk
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antony Darne
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nick Wadd
- Department of Oncology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Syed Asghar
- Department of Oncology, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Lavanya Mariappan
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jane Margetts
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Benjamin Stenberg
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Scott
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Littler
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derek M Manas
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Liver Unit, Department of Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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18
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Llovet JM, Pinyol R, Kelley RK, El-Khoueiry A, Reeves HL, Wang XW, Gores GJ, Villanueva A. Molecular pathogenesis and systemic therapies for hepatocellular carcinoma. Nat Cancer 2022; 3:386-401. [PMID: 35484418 PMCID: PMC9060366 DOI: 10.1038/s43018-022-00357-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) remains one of the most prevalent and deadliest cancers. The poor outcome associated with HCC is dramatically changing due to the advent of effective systemic therapies. Here we discuss the molecular pathogenesis of HCC, molecular classes and determinants of heterogeneity. In addition, effective single-agent and combination systemic therapies involving immunotherapies as standard of care are analyzed. Finally, we propose a flowchart of sequential therapies, explore mechanisms of resistance and address the need for predictive biomarkers.
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Affiliation(s)
- Josep M Llovet
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
| | - Roser Pinyol
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Robin K Kelley
- Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Anthony El-Khoueiry
- Keck School of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Helen L Reeves
- Newcastle University Translational and Clinical Research Institute and Newcastle University Centre for Cancer, Medical School, Newcastle Upon Tyne, UK
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Xin Wei Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Liver Cancer Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Augusto Villanueva
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Ye H, Chen C, Wu H, Zheng K, Martín-Adrados B, Caparros E, Francés R, Nelson LJ, Gómez Del Moral M, Asensio I, Vaquero J, Bañares R, Ávila MA, Andrade RJ, Isabel Lucena M, Martínez-Chantar ML, Reeves HL, Masson S, Blumberg RS, Gracia-Sancho J, Nevzorova YA, Martínez-Naves E, Cubero FJ. Genetic and pharmacological inhibition of XBP1 protects against APAP hepatotoxicity through the activation of autophagy. Cell Death Dis 2022; 13:143. [PMID: 35145060 PMCID: PMC8831621 DOI: 10.1038/s41419-022-04580-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 12/11/2022]
Abstract
Acetaminophen (APAP) hepatotoxicity induces endoplasmic reticulum (ER) stress which triggers the unfolded protein response (UPR) in hepatocytes. However, the mechanisms underlying ER stress remain poorly understood, thus reducing the options for exploring new pharmacological therapies for patients with hyperacute liver injury. Eight-to-twelve-week-old C57BL/6J Xbp1-floxed (Xbp1f/f) and hepatocyte-specific knockout Xbp1 mice (Xbp1∆hepa) were challenged with either high dose APAP [500 mg/kg] and sacrificed at early (1-2 h) and late (24 h) stages of hepatotoxicity. Histopathological examination of livers, immunofluorescence and immunohistochemistry, Western blot, real time (RT)-qPCR studies and transmission electron microscopy (TEM) were performed. Pharmacological inhibition of XBP1 using pre-treatment with STF-083010 [STF, 75 mg/kg] and autophagy induction with Rapamycin [RAPA, 8 mg/kg] or blockade with Chloroquine [CQ, 60 mg/kg] was also undertaken in vivo. Cytoplasmic expression of XBP1 coincided with severity of human and murine hyperacute liver injury. Transcriptional and translational activation of the UPR and sustained activation of JNK1/2 were major events in APAP hepatotoxicity, both in a human hepatocytic cell line and in a preclinical model. Xbp1∆hepa livers showed decreased UPR and JNK1/2 activation but enhanced autophagy in response to high dose APAP. Additionally, blockade of XBP1 splicing by STF, mitigated APAP-induced liver injury and without non-specific off-target effects (e.g., CYP2E1 activity). Furthermore, enhanced autophagy might be responsible for modulating CYP2E1 activity in Xbp1∆hepa animals. Genetic and pharmacological inhibition of Xbp1 specifically in hepatocytes ameliorated APAP-induced liver injury by enhancing autophagy and decreasing CYP2E1 expression. These findings provide the basis for the therapeutic restoration of ER stress and/or induction of autophagy in patients with hyperacute liver injury.
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Affiliation(s)
- Hui Ye
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- 12 de Octubre Health Research Institute (imas12), 28007, Madrid, Spain
- Department of Anesthesiology, ZhongDa Hospital Southeast University, 210009, Nanjing, China
| | - Chaobo Chen
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- 12 de Octubre Health Research Institute (imas12), 28007, Madrid, Spain
- Department of General Surgery, Wuxi Xishan People's hospital, 214105, Wuxi, China
- Department of Hepatic-Biliary-Pancreatic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical school, 210000, Nanjing, China
| | - Hanghang Wu
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
| | - Kang Zheng
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- 12 de Octubre Health Research Institute (imas12), 28007, Madrid, Spain
- Department of Anesthesiology, ZhongDa Hospital Southeast University, 210009, Nanjing, China
| | - Beatriz Martín-Adrados
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- 12 de Octubre Health Research Institute (imas12), 28007, Madrid, Spain
| | - Esther Caparros
- Departmento de Medicina Clínica, Universidad Miguel Hernández, 03550, San Juan de Alicante, Spain
- Instituto ISABIAL-FISABIO, Hospital General Universitario de Alicante, 03010, Alicante, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Rubén Francés
- Departmento de Medicina Clínica, Universidad Miguel Hernández, 03550, San Juan de Alicante, Spain
- Instituto ISABIAL-FISABIO, Hospital General Universitario de Alicante, 03010, Alicante, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Leonard J Nelson
- Institute for Bioengineering (IBioE), Human Tissue Engineering, Faraday Building, The University of Edinburgh, EH9 3DW, Edinburgh, Scotland, UK
| | - Manuel Gómez Del Moral
- Department of Cell Biology, Complutense University School of Medicine, 28040, Madrid, Spain
| | - Iris Asensio
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007, Madrid, Spain
| | - Javier Vaquero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007, Madrid, Spain
| | - Rafael Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007, Madrid, Spain
| | - Matías A Ávila
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Hepatology Program, CIMA, University of Navarra, 31008, Pamplona, Spain
- Instituto de Investigaciones Sanitarias de Navarra IdiSNA, 31008, Pamplona, Spain
| | - Raúl J Andrade
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Unidad de Gestión Clínica de Digestivo, Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, 29010, Málaga, Spain
| | - M Isabel Lucena
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Unidad de Gestión Clínica de Digestivo, Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, 29010, Málaga, Spain
| | - Maria Luz Martínez-Chantar
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Liver Disease Laboratory and Liver Metabolism Laboratory, CIC bioGUNE, CIBERehd, Bizkaia Science and Technology Park, 48160, Derio, Bizkaia, Spain
| | - Helen L Reeves
- The Liver Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, NE7 DN, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, The Medical School, Newcastle University, NE7 DN, Newcastle upon Tyne, UK
| | - Steven Masson
- The Liver Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, NE7 DN, Newcastle upon Tyne, UK
- Newcastle University Translational and Clinical Research Institute, The Medical School, Newcastle University, NE7 DN, Newcastle upon Tyne, UK
| | - Richard S Blumberg
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women´s Hospital, Harvard Medical School, Boston, and Harvard Digestive Diseases Center, 02115, Boston, MA, USA
| | - Jordi Gracia-Sancho
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Liver Vascular Biology Research Group, IDIBAPS, 08036, Barcelona, Spain
- Hepatology, Department of Biomedical Research, University of Bern, cH-3008, Bern, Switzerland
| | - Yulia A Nevzorova
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007, Madrid, Spain
- Department of Internal Medicine III, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Eduardo Martínez-Naves
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain
- 12 de Octubre Health Research Institute (imas12), 28007, Madrid, Spain
| | - Francisco Javier Cubero
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 28040, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007, Madrid, Spain.
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20
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Pinyol R, Torrecilla S, Wang H, Montironi C, Piqué-Gili M, Torres-Martin M, Wei-Qiang L, Willoughby CE, Ramadori P, Andreu-Oller C, Taik P, Lee YA, Moeini A, Peix J, Faure-Dupuy S, Riedl T, Schuehle S, Oliveira CP, Alves VA, Boffetta P, Lachenmayer A, Roessler S, Minguez B, Schirmacher P, Dufour JF, Thung SN, Reeves HL, Carrilho FJ, Chang C, Uzilov AV, Heikenwalder M, Sanyal A, Friedman SL, Sia D, Llovet JM. Corrigendum to 'Molecular characterisation of hepatocellular carcinoma in patients with non-alcoholic steatohepatitis' [J Hepatol 75 (2021) 865-878]. J Hepatol 2021; 75:1515. [PMID: 34627652 DOI: 10.1016/j.jhep.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Roser Pinyol
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Sara Torrecilla
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | | | - Carla Montironi
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Piqué-Gili
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miguel Torres-Martin
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leow Wei-Qiang
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Catherine E Willoughby
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Pierluigi Ramadori
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Carmen Andreu-Oller
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Youngmin A Lee
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Agrin Moeini
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Judit Peix
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Suzanne Faure-Dupuy
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Tobias Riedl
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Svenja Schuehle
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Claudia P Oliveira
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Venancio A Alves
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Paolo Boffetta
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | | | - Beatriz Minguez
- Liver Unit, Vall d´Hebron Hospital Universitari, Liver Diseases Research Group, Vall d´Hebron Institut of Research (VHIR), Vall d´Hebron Hospital Campus. CIBERehd, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | | | - Jean-François Dufour
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Swan N Thung
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Helen L Reeves
- Newcastle University Translational and Clinical Research Institute and Newcastle University Centre for Cancer, Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Flair J Carrilho
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Charissa Chang
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Andrew V Uzilov
- Sema4, Stamford, Connecticut, USA; Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Arun Sanyal
- Divisions of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott L Friedman
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Daniela Sia
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Josep M Llovet
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain.
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21
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Pinyol R, Torrecilla S, Wang H, Montironi C, Piqué-Gili M, Torres-Martin M, Wei-Qiang L, Willoughby CE, Ramadori P, Andreu-Oller C, Taik P, Lee YA, Moeini A, Peix J, Faure-Dupuy S, Riedl T, Schuehle S, Oliveira CP, Alves VA, Boffetta P, Lachenmayer A, Roessler S, Minguez B, Schirmacher P, Dufour JF, Thung SN, Reeves HL, Carrilho FJ, Chang C, Uzilov AV, Heikenwalder M, Sanyal A, Friedman SL, Sia D, Llovet JM. Molecular characterisation of hepatocellular carcinoma in patients with non-alcoholic steatohepatitis. J Hepatol 2021; 75:865-878. [PMID: 33992698 DOI: 10.1016/j.jhep.2021.04.049] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Non-alcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC) is increasing globally, but its molecular features are not well defined. We aimed to identify unique molecular traits characterising NASH-HCC compared to other HCC aetiologies. METHODS We collected 80 NASH-HCC and 125 NASH samples from 5 institutions. Expression array (n = 53 NASH-HCC; n = 74 NASH) and whole exome sequencing (n = 52 NASH-HCC) data were compared to HCCs of other aetiologies (n = 184). Three NASH-HCC mouse models were analysed by RNA-seq/expression-array (n = 20). Activin A receptor type 2A (ACVR2A) was silenced in HCC cells and proliferation assessed by colorimetric and colony formation assays. RESULTS Mutational profiling of NASH-HCC tumours revealed TERT promoter (56%), CTNNB1 (28%), TP53 (18%) and ACVR2A (10%) as the most frequently mutated genes. ACVR2A mutation rates were higher in NASH-HCC than in other HCC aetiologies (10% vs. 3%, p <0.05). In vitro, ACVR2A silencing prompted a significant increase in cell proliferation in HCC cells. We identified a novel mutational signature (MutSig-NASH-HCC) significantly associated with NASH-HCC (16% vs. 2% in viral/alcohol-HCC, p = 0.03). Tumour mutational burden was higher in non-cirrhotic than in cirrhotic NASH-HCCs (1.45 vs. 0.94 mutations/megabase; p <0.0017). Compared to other aetiologies of HCC, NASH-HCCs were enriched in bile and fatty acid signalling, oxidative stress and inflammation, and presented a higher fraction of Wnt/TGF-β proliferation subclass tumours (42% vs. 26%, p = 0.01) and a lower prevalence of the CTNNB1 subclass. Compared to other aetiologies, NASH-HCC showed a significantly higher prevalence of an immunosuppressive cancer field. In 3 murine models of NASH-HCC, key features of human NASH-HCC were preserved. CONCLUSIONS NASH-HCCs display unique molecular features including higher rates of ACVR2A mutations and the presence of a newly identified mutational signature. LAY SUMMARY The prevalence of hepatocellular carcinoma (HCC) associated with non-alcoholic steatohepatitis (NASH) is increasing globally, but its molecular traits are not well characterised. In this study, we uncovered higher rates of ACVR2A mutations (10%) - a potential tumour suppressor - and the presence of a novel mutational signature that characterises NASH-related HCC.
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Affiliation(s)
- Roser Pinyol
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Sara Torrecilla
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | | | - Carla Montironi
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Piqué-Gili
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miguel Torres-Martin
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leow Wei-Qiang
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Catherine E Willoughby
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Pierluigi Ramadori
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Carmen Andreu-Oller
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Youngmin A Lee
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Agrin Moeini
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Judit Peix
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Suzanne Faure-Dupuy
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Tobias Riedl
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Svenja Schuehle
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Claudia P Oliveira
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Venancio A Alves
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Paolo Boffetta
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | | | - Beatriz Minguez
- Liver Unit, Vall d´Hebron Hospital Universitari, Liver Diseases Research Group, Vall d´Hebron Institut of Research (VHIR), Vall d´Hebron Hospital Campus. CIBERehd, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | | | - Jean-François Dufour
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Swan N Thung
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Helen L Reeves
- Newcastle University Translational and Clinical Research Institute and Newcastle University Centre for Cancer, Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Flair J Carrilho
- Departments of Gastroenterology and Pathology, University of São Paulo - School of Medicine, São Paulo, Brazil
| | - Charissa Chang
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Andrew V Uzilov
- Sema4, Stamford, Connecticut, USA; Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Arun Sanyal
- Divisions of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott L Friedman
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Daniela Sia
- Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Josep M Llovet
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Hematology/Oncology, Department of Medicine, Department of Pathology), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain.
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22
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Affiliation(s)
- Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust/Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Helen L Reeves
- Newcastle University Translational and Clinical Research Institute, Newcastle University and The Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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23
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Fernández-Tussy P, Rodríguez-Agudo R, Fernández-Ramos D, Barbier-Torres L, Zubiete-Franco I, Davalillo SLD, Herraez E, Goikoetxea-Usandizaga N, Lachiondo-Ortega S, Simón J, Lopitz-Otsoa F, Juan VGD, McCain MV, Perugorria MJ, Mabe J, Navasa N, Rodrigues CMP, Fabregat I, Boix L, Sapena V, Anguita J, Lu SC, Mato JM, Banales JM, Villa E, Reeves HL, Bruix J, Reig M, Marin JJG, Delgado TC, Martínez-Chantar ML. Anti-miR-518d-5p overcomes liver tumor cell death resistance through mitochondrial activity. Cell Death Dis 2021; 12:555. [PMID: 34050139 PMCID: PMC8163806 DOI: 10.1038/s41419-021-03827-0] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
Dysregulation of miRNAs is a hallmark of cancer, modulating oncogenes, tumor suppressors, and drug responsiveness. The multi-kinase inhibitor sorafenib is one of the first-line drugs for advanced hepatocellular carcinoma (HCC), although the outcome for treated patients is heterogeneous. The identification of predictive biomarkers and targets of sorafenib efficacy are sorely needed. Thus, selected top upregulated miRNAs from the C19MC cluster were analyzed in different hepatoma cell lines compared to immortalized liver human cells, THLE-2 as control. MiR-518d-5p showed the most consistent upregulation among them. Thus, miR-518d-5p was measured in liver tumor/non-tumor samples of two distinct cohorts of HCC patients (n = 16 and n = 20, respectively). Circulating miR-518d-5p was measured in an independent cohort of HCC patients receiving sorafenib treatment (n = 100), where miR-518d-5p was analyzed in relation to treatment duration and patient's overall survival. In vitro and in vivo studies were performed in human hepatoma BCLC3 and Huh7 cells to analyze the effect of miR-518d-5p inhibition/overexpression during the response to sorafenib. Compared with healthy individuals, miR-518d-5p levels were higher in hepatic and serum samples from HCC patients (n = 16) and in an additional cohort of tumor/non-tumor paired samples (n = 20). MiR-518d-5p, through the inhibition of c-Jun and its mitochondrial target PUMA, desensitized human hepatoma cells and mouse xenograft to sorafenib-induced apoptosis. Finally, serum miR-518d-5p was assessed in 100 patients with HCC of different etiologies and BCLC-stage treated with sorafenib. In BCLC-C patients, higher serum miR-518d-5p at diagnosis was associated with shorter sorafenib treatment duration and survival. Hence, hepatic miR-518d-5p modulates sorafenib resistance in HCC through inhibition of c-Jun/PUMA-induced apoptosis. Circulating miR-518d-5p emerges as a potential lack of response biomarker to sorafenib in BCLC-C HCC patients.
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Affiliation(s)
- Pablo Fernández-Tussy
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Rubén Rodríguez-Agudo
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - David Fernández-Ramos
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucía Barbier-Torres
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Imanol Zubiete-Franco
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Sergio López de Davalillo
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Elisa Herraez
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.11762.330000 0001 2180 1817Experimental Hepatology and Drug Targeting (HEVEPHARM), University of Salamanca, IBSAL, Salamanca, Spain
| | - Naroa Goikoetxea-Usandizaga
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Sofia Lachiondo-Ortega
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Jorge Simón
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Lopitz-Otsoa
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Virginia Gutiérrez-de Juan
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Misti V. McCain
- grid.1006.70000 0001 0462 7212Northern Institute for Cancer Research, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Maria J. Perugorria
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.11480.3c0000000121671098Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain ,grid.424810.b0000 0004 0467 2314IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Jon Mabe
- grid.6496.d0000 0004 1763 8481Electronics and Communications Unit, IK4-Tekniker, Eibar, Spain
| | - Nicolás Navasa
- grid.420175.50000 0004 0639 2420Inflammation and Macrophage Plasticity, CIC bioGUNE, Derio, Bizkaia Spain
| | - Cecilia M. P. Rodrigues
- grid.9983.b0000 0001 2181 4263Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Isabel Fabregat
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.418284.30000 0004 0427 2257TGF-β and Cancer Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL) and University of Barcelona, Barcelona, Spain
| | - Loreto Boix
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.5841.80000 0004 1937 0247Barcelona-Clínic Liver Cancer Group, Liver Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer,Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - Victor Sapena
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.5841.80000 0004 1937 0247Barcelona-Clínic Liver Cancer Group, Liver Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer,Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - Juan Anguita
- grid.424810.b0000 0004 0467 2314IKERBASQUE, Basque Foundation for Science, Bilbao, Spain ,grid.420175.50000 0004 0639 2420Inflammation and Macrophage Plasticity, CIC bioGUNE, Derio, Bizkaia Spain
| | - Shelly C. Lu
- grid.50956.3f0000 0001 2152 9905Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - José M. Mato
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesus M. Banales
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.11480.3c0000000121671098Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain ,grid.424810.b0000 0004 0467 2314IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Erica Villa
- grid.7548.e0000000121697570Department of Gastroenterology, Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia, Modena, Italy
| | - Helen L. Reeves
- grid.1006.70000 0001 0462 7212Northern Institute for Cancer Research, The Medical School, Newcastle University, Newcastle upon Tyne, UK ,grid.420004.20000 0004 0444 2244Hepatopancreatobiliary Multidisciplinary Team, Freeman Hospital, Freeman Road, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Jordi Bruix
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.5841.80000 0004 1937 0247Barcelona-Clínic Liver Cancer Group, Liver Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer,Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - Maria Reig
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.5841.80000 0004 1937 0247Barcelona-Clínic Liver Cancer Group, Liver Unit, Institut d’Investigacions Biomèdiques August Pi I Sunyer,Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - Jose J. G. Marin
- grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ,grid.11762.330000 0001 2180 1817Experimental Hepatology and Drug Targeting (HEVEPHARM), University of Salamanca, IBSAL, Salamanca, Spain
| | - Teresa C. Delgado
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María L. Martínez-Chantar
- grid.420175.50000 0004 0639 2420Liver Disease Laboratory, Precision Medicine and Metabolism Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Lagnado A, Leslie J, Ruchaud‐Sparagano M, Victorelli S, Hirsova P, Ogrodnik M, Collins AL, Vizioli MG, Habiballa L, Saretzki G, Evans SA, Salmonowicz H, Hruby A, Geh D, Pavelko KD, Dolan D, Reeves HL, Grellscheid S, Wilson CH, Pandanaboyana S, Doolittle M, von Zglinicki T, Oakley F, Gallage S, Wilson CL, Birch J, Carroll B, Chapman J, Heikenwalder M, Neretti N, Khosla S, Masuda CA, Tchkonia T, Kirkland JL, Jurk D, Mann DA, Passos JF. Neutrophils induce paracrine telomere dysfunction and senescence in ROS-dependent manner. EMBO J 2021; 40:e106048. [PMID: 33764576 PMCID: PMC8090854 DOI: 10.15252/embj.2020106048] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Cellular senescence is characterized by an irreversible cell cycle arrest as well as a pro-inflammatory phenotype, thought to contribute to aging and age-related diseases. Neutrophils have essential roles in inflammatory responses; however, in certain contexts their abundance is associated with a number of age-related diseases, including liver disease. The relationship between neutrophils and cellular senescence is not well understood. Here, we show that telomeres in non-immune cells are highly susceptible to oxidative damage caused by neighboring neutrophils. Neutrophils cause telomere dysfunction both in vitro and ex vivo in a ROS-dependent manner. In a mouse model of acute liver injury, depletion of neutrophils reduces telomere dysfunction and senescence. Finally, we show that senescent cells mediate the recruitment of neutrophils to the aged liver and propose that this may be a mechanism by which senescence spreads to surrounding cells. Our results suggest that interventions that counteract neutrophil-induced senescence may be beneficial during aging and age-related disease.
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25
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Abstract
Due to an increase in the obesity-associated metabolic syndrome of epidemic proportions, nonalcoholic fatty liver disease (NAFLD) is becoming a leading cause of hepatocellular carcinoma (HCC) in western countries. This presents added challenges, as NAFLD-associated HCC tends to present at an advanced stage in older patients with co-morbidities. Their prognosis is generally poor with the benefits of standard therapies less certain. The pathogenesis of NAFLD-associated HCC is multifactorial and not well understood, although the risk of HCC developing undoubtedly increases as NAFLD progresses to steatohepatitis and cirrhosis. Recent advances in our understanding of the drivers of NAFLD and HCC will hopefully lead to the development of clinically relevant biomarkers, tools and strategies to aid the identification of high-risk patients, inform preventive measures, and introduction of better tolerated targeted therapies. Lifestyle modification and chemoprevention with drugs such as anti-platelets, statins and anti-diabetics are being evaluated for HCC prevention. The landmark IMBrave150 study introducing the combination of atezolizumab and bevacizumab has recently transformed the landscape of systemic therapies in HCC, with follow-up analyses and real-world data for patients with NAFLD-associated HCC eagerly anticipated. While responses may vary in ways not yet appreciated, the rate of discovery and progress suggests imminent change and opportunities.
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Affiliation(s)
- Daniel Geh
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Hepatopancreatobiliary Multidisciplinary Team, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
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26
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Eldafashi N, Darlay R, Shukla R, McCain MV, Watson R, Liu YL, McStraw N, Fathy M, Fawzy MA, Zaki MYW, Daly AK, Maurício JP, Burt AD, Haugk B, Cordell HJ, Bianco C, Dufour JF, Valenti L, Anstee QM, Reeves HL. A PDCD1 Role in the Genetic Predisposition to NAFLD-HCC? Cancers (Basel) 2021; 13:1412. [PMID: 33808740 PMCID: PMC8003582 DOI: 10.3390/cancers13061412] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 02/11/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity and non-alcoholic fatty liver disease (NAFLD) are contributing to the global rise in deaths from hepatocellular carcinoma (HCC). The pathogenesis of NAFLD-HCC is not well understood. The severity of hepatic steatosis, steatohepatitis and fibrosis are key pathogenic mechanisms, but animal studies suggest altered immune responses are also involved. Genetic studies have so far highlighted a major role of gene variants promoting fat deposition in the liver (PNPLA3 rs738409; TM6SF2 rs58542926). Here, we have considered single-nucleotide polymorphisms (SNPs) in candidate immunoregulatory genes (MICA rs2596542; CD44 rs187115; PDCD1 rs7421861 and rs10204525), in 594 patients with NAFLD and 391 with NAFLD-HCC, from three European centres. Associations between age, body mass index, diabetes, cirrhosis and SNPs with HCC development were explored. PNPLA3 and TM6SF2 SNPs were associated with both progression to cirrhosis and NAFLD-HCC development, while PDCD1 SNPs were specifically associated with NAFLD-HCC risk, regardless of cirrhosis. PDCD1 rs7421861 was independently associated with NAFLD-HCC development, while PDCD1 rs10204525 acquired significance after adjusting for other risks, being most notable in the smaller numbers of women with NAFLD-HCC. The study highlights the potential impact of inter individual variation in immune tolerance induction in patients with NAFLD, both in the presence and absence of cirrhosis.
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Affiliation(s)
- Nardeen Eldafashi
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
- Biochemistry Department, Faculty of Pharmacy, Minia University, Minia 61519, Egypt; (M.F.); (M.A.F.)
| | - Rebecca Darlay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne NE1 3BZ, UK; (R.D.); (H.J.C.)
| | - Ruchi Shukla
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (R.S.); (N.M.)
| | - Misti Vanette McCain
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - Robyn Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - Yang Lin Liu
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - Nikki McStraw
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (R.S.); (N.M.)
| | - Moustafa Fathy
- Biochemistry Department, Faculty of Pharmacy, Minia University, Minia 61519, Egypt; (M.F.); (M.A.F.)
| | - Michael Atef Fawzy
- Biochemistry Department, Faculty of Pharmacy, Minia University, Minia 61519, Egypt; (M.F.); (M.A.F.)
| | - Marco Y. W. Zaki
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
- Biochemistry Department, Faculty of Pharmacy, Minia University, Minia 61519, Egypt; (M.F.); (M.A.F.)
| | - Ann K. Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - João P. Maurício
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - Alastair D. Burt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
| | - Beate Haugk
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle NE1 4LP, UK;
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne NE1 3BZ, UK; (R.D.); (H.J.C.)
| | - Cristiana Bianco
- Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.B.); (L.V.)
| | - Jean-François Dufour
- University Clinic for Visceral Surgery and Medicine, University Hospital of Bern, 3010 Bern, Switzerland;
- Hepatology, Department of Biomedical Research, University of Bern, 3012 Bern, Switzerland
| | - Luca Valenti
- Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.B.); (L.V.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Quentin M. Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
- The Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne Hospitals NHS Foundation Trust, Heaton NE7 7DN, UK
| | - Helen L. Reeves
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; (N.E.); (M.V.M.); (R.W.); (Y.L.L.); (M.Y.W.Z.); (A.K.D.); (J.P.M.); (A.D.B.); (Q.M.A.)
- The Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne Hospitals NHS Foundation Trust, Heaton NE7 7DN, UK
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27
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Muñoz-Martínez S, Sapena V, Forner A, Nault JC, Sapisochin G, Rimassa L, Sangro B, Bruix J, Sanduzzi-Zamparelli M, Hołówko W, El Kassas M, Mocan T, Bouattour M, Merle P, Hoogwater FJH, Alqahtani SA, Reeves HL, Pinato DJ, Giorgakis E, Meyer T, Villadsen GE, Wege H, Salati M, Mínguez B, Di Costanzo GG, Roderburg C, Tacke F, Varela M, Galle PR, Alvares-da-Silva MR, Trojan J, Bridgewater J, Cabibbo G, Toso C, Lachenmayer A, Casadei-Gardini A, Toyoda H, Lüdde T, Villani R, Matilla Peña AM, Guedes Leal CR, Ronzoni M, Delgado M, Perelló C, Pascual S, Lledó JL, Argemi J, Basu B, da Fonseca L, Acevedo J, Siebenhüner AR, Braconi C, Meyers BM, Granito A, Sala M, Rodríguez-Lope C, Blaise L, Romero-Gómez M, Piñero F, Gomez D, Mello V, Pinheiro Alves RC, França A, Branco F, Brandi G, Pereira G, Coll S, Guarino M, Benítez C, Anders MM, Bandi JC, Vergara M, Calvo M, Peck-Radosavljevic M, García-Juárez I, Cardinale V, Lozano M, Gambato M, Okolicsanyi S, Morales-Arraez D, Elvevi A, Muñoz AE, Lué A, Iavarone M, Reig M. Assessing the impact of COVID-19 on liver cancer management (CERO-19). JHEP Rep 2021; 3:100260. [PMID: 33644725 PMCID: PMC7901294 DOI: 10.1016/j.jhepr.2021.100260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background & Aims The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. Methods An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. Results Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). Conclusions The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. Lay summary The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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Affiliation(s)
- Sergio Muñoz-Martínez
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Victor Sapena
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Gonzalo Sapisochin
- Abdominal Transplant & HPB Surgical Oncology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bruno Sangro
- Unidad de Hepatología, Clínica Universidad de Navarra, IDISNA, CIBERehd, Pamplona, Spain
| | - Jordi Bruix
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Tudor Mocan
- 3rd Medical Department, 'Octavian Fodor' Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mohamed Bouattour
- AP-HP, Hôpital Beaujon, Department of Digestive Oncology, Clichy, France
| | - Philippe Merle
- Department of Hepatology, Groupement Hospitalier Lyon Nord, Lyon, France
| | - Frederik J H Hoogwater
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - Saleh A Alqahtani
- Department of Liver Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Helen L Reeves
- Liver Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emmanouil Giorgakis
- Division of Transplantation, Department of Surgery, UAMS Medical Center, Winthrop P. Rockefeller Cancer Institute, Little Rock, AK, USA
| | - Tim Meyer
- Department of Oncology, Royal Free Hospital, London, UK
| | | | - Henning Wege
- Department of Internal Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Massimiliano Salati
- Department of Clinical and Experimental Medicine, University Hospital of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Beatriz Mínguez
- Liver Unit, Hospital Universitari Vall d'Hebron, Liver Diseases Research Group, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Christoph Roderburg
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - María Varela
- Department of Gastroenterology and Hepatology. Hospital Universitario Central de Asturias, IUOPA, ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Peter R Galle
- I. Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Mario Reis Alvares-da-Silva
- GI/Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jörg Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt, Germany
| | - John Bridgewater
- Department of Oncology, University College of London, London, UK
| | - Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tom Lüdde
- Clinic for Gastroenterology, Hepatology and Infectious Disease, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rosanna Villani
- Liver Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Monica Ronzoni
- Medical Oncology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Manuel Delgado
- Department of Digestive Disease, University Hospital La Coruña, La Coruña, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, University Hospital Puerta de Hierro, Majadahonda, Spain
| | | | - José Luis Lledó
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Josepmaria Argemi
- Internal Medicine - Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Leonardo da Fonseca
- Department of Clinical Oncology, Sao Paulo Clinicas Liver Cancer group, Insitituto do Cancer do Estado de São Paulo, University of São Paulo, San Paulo, Brazil
| | - Juan Acevedo
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chiara Braconi
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Brandon M Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Alessandro Granito
- Division of Internal Medicine, Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Margarita Sala
- Department of Gastroenterology, Hepatology Unit, Hospital Doctor Josep Trueta, CIBERehd, Girona, Spain
| | - Carlos Rodríguez-Lope
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lorraine Blaise
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris, France.,Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Manuel Romero-Gómez
- SeLiver group, UGC de Enfermedades Digestivas, Instituto de Biomedicina de Sevilla, Hospital Virgen del Rocío, CIBERehd, Seville, Spain
| | - Federico Piñero
- Liver Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Dhanny Gomez
- HPB Surgery and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Alex França
- Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | | | - Giovanni Brandi
- Division of Oncology - Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gustavo Pereira
- Gastroenterology and Hepatology Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Susanna Coll
- Hepatology Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carlos Benítez
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Juan C Bandi
- Department of Hepatology, Hospital Italiano, Buenos Aires, Argentina
| | - Mercedes Vergara
- Unitat d'Hepatologia, Servei d'Aparell Digestiu, Parc Taulí Sabadell Hospital Universitari, Institut d'Investigació i Innovació I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Mariona Calvo
- Oncología Médica, Institut Català d'Oncologia, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Markus Peck-Radosavljevic
- Innere Medizin & Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Ignacio García-Juárez
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Mar Lozano
- Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Martina Gambato
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.,Multivisceral Transplant Unit, Gastroenterology, Padua University Hospital, Padua, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Dalia Morales-Arraez
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Alessandra Elvevi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Alberto E Muñoz
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Alberto Lué
- Gastroenterology, Hepatology and Nutrition Unit, San Jorge General Hospital, Huesca, Spain
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granada Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy
| | - Maria Reig
- BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Geh D, Manas DM, Reeves HL. Hepatocellular carcinoma in non-alcoholic fatty liver disease-a review of an emerging challenge facing clinicians. Hepatobiliary Surg Nutr 2021; 10:59-75. [PMID: 33575290 DOI: 10.21037/hbsn.2019.08.08] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/07/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
Importance Non-alcoholic fatty liver disease (NAFLD) is a rapidly growing cause of chronic liver disease and is becoming a leading cause of hepatocellular carcinoma (HCC) in many developed countries. This presents major challenges for the surveillance, diagnosis and treatment of HCC. Objective To discuss the clinical challenges faced by clinicians in managing the rising number of NAFLD-HCC cases. Evidence Review MEDLINE, PubMed and Embase databases were searched using the keywords; NAFLD, HCC, surveillance, hepatectomy, liver transplantation, percutaneous ablation, transarterial chemoembolization (TACE), selective internal radiotherapy treatment (SIRT) and sorafenib. Relevant clinical studies were included. Findings Current HCC surveillance programmes are inadequate because they only screen for HCC in patients with cirrhosis, whereas in NAFLD a significant proportion of HCC develops in the absence of cirrhosis. Consequently NAFLD patients often present with a more advanced stage of HCC, with a poorer prognosis. NAFLD-HCC patients also tend to be older and to have more co-morbidities compared to HCC of other etiologies. This limits the use of curative treatments such as liver resection and orthotopic liver transplantation (OLT). Evidence suggests that although NAFLD-HCC patients who undergo liver resection or OLT have worse perioperative and short-term outcomes, overall long-term survival is comparable to HCC of other etiologies. This highlights the importance of careful patient selection, pre-habilitation and perioperative planning for NAFLD-HCC patients being considered for surgical treatment. Careful consideration is also important for non-surgical treatments, although the evidence supporting treatment selection is frequently lacking, as these patients tend to be poorly represented in clinical trials. Locoregional therapies such as percutaneous ablation and TACE may be less well tolerated and less effective in NAFLD patients with obesity or diabetes. The tyrosine kinase inhibitor sorafenib may also be less effective. Conclusions and Relevance This review highlights how international guidelines, for which NAFLD traditionally has made up a small part of the evidence base, may not be appropriate for all NAFLD-HCC patients. Future guidelines need to reflect the changing landscape of HCC, by making specific recommendations for the management of NAFLD-HCC.
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Affiliation(s)
- Daniel Geh
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Derek M Manas
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.,Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Clothier RH, Hulme L, Ahmed AB, Reeves HL, Smith M, Balls M. In Vitro Cytotoxicity of 150 Chemicals to 3T3-L1 Cells, Assessed by the FRAME Kenacid Blue Method. Altern Lab Anim 2020. [DOI: 10.1177/026119298801600116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cytotoxicities to 3T3-L1 cells of 150 coded chemicals, estimated by the FRAME kenacid blue method, are given as a basis for further studies on the relative in vitro toxicities of related and distinct sets of test chemicals, and as a basis for future attempts at the comparison and correlation of estimates of toxicity obtained in vitro and in vivo. The expression of the results of in vitro cytotoxicity tests is discussed, as are various ways of comparing values obtained for different chemicals. It is suggested that there should be agreement on the inclusion of a standard set of reference chemicals in all cytotoxicity test validation trials.
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Affiliation(s)
- Richard H. Clothier
- Department of Human Morphology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Lesley Hulme
- Department of Human Morphology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Aamer B. Ahmed
- Department of Human Morphology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Helen L. Reeves
- Department of Human Morphology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Moira Smith
- FRAME, 34 Stoney Street, Nottingham NG1 1NB, UK
| | - Michael Balls
- Department of Human Morphology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
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30
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Chan SL, Wong LL, Chan KCA, Chow C, Tong JHM, Yip TCF, Wong GLH, Chong CCN, Liu PH, Chu CM, Wong VWS, To KF, Reeves HL, Chan AWH. Development of a Novel Inflammation-Based Index for Hepatocellular Carcinoma. Liver Cancer 2020; 9:167-181. [PMID: 32399431 PMCID: PMC7206612 DOI: 10.1159/000504252] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/08/2019] [Accepted: 10/10/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of current study was to (1) construct and validate a novel hepatocellular carcinoma (HCC)-specific inflammatory index; (2) compare the performances of the Integrated Liver Inflammatory Score (ILIS) to existing 4 inflammatory indices in HCC; (3) explore the association between the inflammatory indices and systemic/intratumoral inflammatory markers. METHODS Two cohorts from Hong Kong (HK; n = 1,315) and Newcastle (n = 574) were studied. A novel index was constructed from the HK training set (n = 627). The index was constructed from the training set by combing independent prognostic circulating parameters, followed by validating in the validation set of HK cohort (n = 688) and the Newcastle cohort. Its prognostic performance was compared to 4 inflammatory indices, namely, the neutrophil to lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutrition index, and systemic immune-inflammation index, were compared in the HK cohort. Circulating cytokines and intratumoral gene expression were analyzed in a subset of patients with available samples and correlated with the inflammatory indices. RESULTS In the training set of the HK cohort, the ILIS, was generated: -0.057 × albumin (g/L) + 0.978 × log (Bilirubin, µmol/L) + 1.341 × log (alkaline phosphatase, IU/L) + 0.086 × Neutrophil (109/L) + 0.301 × log (alpha-fetoprotein, µg/L). With cutoff of 2.60 and 3.87, the ILIS could categorize patients into 3 risk groups in the both validation cohorts. ILIS outperforms other inflammatory indices and remains an independent prognosticator for overall survival after adjustment with Barcelona Clinic Liver Cancer (hazard ratio 31.90, p < 0.001). The ILIS had the best prognostic performances as compared to other inflammatory indices. In exploratory analyses, the ILIS correlated with circulating inflammatory cytokines (e.g., IL-8) but not with any intratumoral inflammatory gene expression. CONCLUSIONS ILIS is an HCC-specific prognostic index built on 5 readily available blood parameters. Its versatility is validated both Eastern and Western population of HCC. The score is correlated with levels of circulating cytokines.
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Affiliation(s)
- Stephen Lam Chan
- Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin-Lee Wong
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom,The Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kwan-Chee Allen Chan
- Department of Chemical Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chit Chow
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joanna Hung-Man Tong
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Po-Hong Liu
- Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Cheuk-Man Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Helen L. Reeves
- The Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anthony Wing-Hung Chan
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China,*Anthony Wing-Hung Chan, Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong (China), E-Mail
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31
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Willoughby CE, Jiang Y, Thomas HD, Willmore E, Kyle S, Wittner A, Phillips N, Zhao Y, Tudhope SJ, Prendergast L, Junge G, Lourenco LM, Finlay MRV, Turner P, Munck JM, Griffin RJ, Rennison T, Pickles J, Cano C, Newell DR, Reeves HL, Ryan AJ, Wedge SR. Selective DNA-PKcs inhibition extends the therapeutic index of localized radiotherapy and chemotherapy. J Clin Invest 2020; 130:258-271. [PMID: 31581151 PMCID: PMC6934184 DOI: 10.1172/jci127483] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
Potentiating radiotherapy and chemotherapy by inhibiting DNA damage repair is proposed as a therapeutic strategy to improve outcomes for patients with solid tumors. However, this approach risks enhancing normal tissue toxicity as much as tumor toxicity, thereby limiting its translational impact. Using NU5455, a newly identified highly selective oral inhibitor of DNA-dependent protein kinase catalytic subunit (DNA-PKcs) activity, we found that it was indeed possible to preferentially augment the effect of targeted radiotherapy on human orthotopic lung tumors without influencing acute DNA damage or a late radiation-induced toxicity (fibrosis) to normal mouse lung. Furthermore, while NU5455 administration increased both the efficacy and the toxicity of a parenterally administered topoisomerase inhibitor, it enhanced the activity of doxorubicin released locally in liver tumor xenografts without inducing any adverse effect. This strategy is particularly relevant to hepatocellular cancer, which is treated clinically with localized drug-eluting beads and for which DNA-PKcs activity is reported to confer resistance to treatment. We conclude that transient pharmacological inhibition of DNA-PKcs activity is effective and tolerable when combined with localized DNA-damaging therapies and thus has promising clinical potential.
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Affiliation(s)
- Catherine E. Willoughby
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yanyan Jiang
- Cancer Research UK and UK Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Huw D. Thomas
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elaine Willmore
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Suzanne Kyle
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anita Wittner
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicole Phillips
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yan Zhao
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Susan J. Tudhope
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lisa Prendergast
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gesa Junge
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luiza Madia Lourenco
- Cancer Research UK and UK Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - M. Raymond V. Finlay
- Medicinal Chemistry, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Paul Turner
- Medicinal Chemistry, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | - Roger J. Griffin
- Cancer Research UK Newcastle Drug Discovery Unit, Chemistry, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tommy Rennison
- Cancer Research UK Newcastle Drug Discovery Unit, Chemistry, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James Pickles
- Cancer Research UK Newcastle Drug Discovery Unit, Chemistry, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Celine Cano
- Cancer Research UK Newcastle Drug Discovery Unit, Chemistry, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David R. Newell
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen L. Reeves
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Hepatopancreatobiliary Multidisciplinary Team, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Anderson J. Ryan
- Cancer Research UK and UK Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Stephen R. Wedge
- Cancer Research UK Newcastle Drug Discovery Unit, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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32
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Reicher J, Mafeld S, Priona G, Reeves HL, Manas DM, Jackson R, Littler P. Early Experience of Trans-arterial Chemo-Embolisation for Hepatocellular Carcinoma with a Novel Radiopaque Bead. Cardiovasc Intervent Radiol 2019; 42:1563-1570. [PMID: 31455987 PMCID: PMC6775038 DOI: 10.1007/s00270-019-02317-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
Aims To evaluate early outcomes of patients with hepatocellular carcinoma (HCC) treated with a novel radiopaque bead, the 75–150 μm DC Bead LUMI™ (Biocompatibles UK Ltd). Materials and Methods This was a retrospective review of the first 40 consecutive patients at a UK tertiary hepato-biliary centre, treated for HCC with TACE using radiopaque beads, between May 2017 and March 2019. Information regarding complications, mortality, lesion response and subsequent ablation procedures was collected from electronic records and case notes. Intra- and post-operative imaging was reviewed for visibility of the embolised territory. Results Fifty-five TACE procedures were performed in 40 patients, with a median age of 70 years (range 28–88) and median lesion size of 3.8 cm (range 1.5–7.8). The median follow-up period was 30 weeks (range 6–101). Mean post-procedure hospital stay was 1.2 days. Complications of CIRSE Grade II or above occurred after 4/55 procedures (7.3%). Mortality at 30 days was zero. Objective response rates (mRECIST) at 1, 3 and 6 months were 32/35 (91.4%), 21/24 (87.5%) and 12/15 (80%), respectively. Complete response rates at 1, 3 and 6 months were 16/35 (45.7%), 12/24 (50%) and 9/15 (60%). The embolised territory was visible on intra-operative and follow-up CT imaging in all patients. The radiopaque beads were used as a fiducial marker to guide ablation in 5/40 patients (12.5%). Conclusion TACE with radiopaque beads shows promising tolerability and efficacy. The radiopaque beads ensure visualisation of the embolised lesion on intra- and post-operative imaging and, in selected cases, can act as a marker for CT-guided ablation.
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Affiliation(s)
- John Reicher
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Sebastian Mafeld
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Georgia Priona
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Helen L Reeves
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Derek M Manas
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Ralph Jackson
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Peter Littler
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Abstract
Caloric excess and sedentary lifestyle have led to a global epidemic of obesity and metabolic syndrome. The hepatic consequence of metabolic syndrome and obesity, nonalcoholic fatty liver disease (NAFLD), is estimated to affect up to one-third of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Owing to the high prevalence of NAFLD, especially in industrialized countries but also worldwide, and the consequent burden of progressive liver disease, there is mounting epidemiological evidence that NAFLD has rapidly become a leading aetiology underlying many cases of hepatocellular carcinoma (HCC). In this Review, we discuss NAFLD-associated HCC, including its epidemiology, the key features of the hepatic NAFLD microenvironment (for instance, adaptive and innate immune responses) that promote hepatocarcinogenesis and the management of HCC in patients with obesity and associated metabolic comorbidities. The challenges and future directions of research will also be discussed, including clinically relevant biomarkers for early detection, treatment stratification and monitoring as well as approaches to therapies for both prevention and treatment in those at risk or presenting with NAFLD-associated HCC.
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Affiliation(s)
- Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
- The Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Helen L Reeves
- The Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
- Northern Institute for Cancer Research, Medical School, Newcastle upon Tyne, UK
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Elena Kotsiliti
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olivier Govaere
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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34
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Alsaleh M, Barbera TA, Reeves HL, Cramp ME, Ryder S, Gabra H, Nash K, Shen YL, Holmes E, Williams R, Taylor-Robinson SD. Characterization of the urinary metabolic profile of cholangiocarcinoma in a United Kingdom population. Hepat Med 2019; 11:47-67. [PMID: 31118840 PMCID: PMC6507078 DOI: 10.2147/hmer.s193996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/09/2018] [Accepted: 03/06/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Outside South-East Asia, most cases of cholangiocarcinoma (CCA) have an obscure etiology. There is often diagnostic uncertainty. Metabolomics using ultraperformance liquid chromatography mass spectrometry (UPLC-MS) offers the portent to distinguish disease-specific metabolic signatures. We aimed to define such a urinary metabolic signature in a patient cohort with sporadic CCA and investigate whether there were characteristic differences from those in patients with hepatocellular carcinoma (HCC), metastatic secondary liver cancer, pancreatic cancer and ovarian cancer (OCA). Methods: Spot urine specimens were obtained from 211 subjects in seven participating centers across the UK. Samples were collected from healthy controls and from patients with benign hepatic disease (gallstone, biliary strictures, sphincter of Oddi dysfunction and viral hepatitis) and patients with malignant conditions (HCC, pancreatic cancer, OCA and metastatic cancer in the liver). The spectral metabolite profiles were generated using a UPLC-MS detector and data were analyzed using multivariate and univariate statistical analyses. Results: The greatest class differences were seen between the metabolic profiles of disease-free controls compared to individuals with CCA with altered acylcarnitine, bile acid and purine levels. Individuals with benign strictures showed comparable urine profiles to patients with malignant bile duct lesions. The metabolic signatures of patients with bile duct tumors were distinguishable from patients with hepatocellular and ovarian tumors, but no difference was observed between CCA cases and patients with pancreatic cancer or hepatic secondary metastases. Conclusion: CCA causes subtle but detectable changes in the urine metabolic profiles. The findings point toward potential applications of metabonomics in early tumor detection. However, it is key to utilize both global and targeted metabonomics in a larger cohort for in-depth characterization of the urine metabolome in hepato-pancreato-biliary disease.
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Affiliation(s)
- Munirah Alsaleh
- Division of Surgery and Cancer, Imperial College London, London
| | | | - Helen L Reeves
- Northern Institute for Cancer Research, Medical School, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Stephen Ryder
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.,NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Hani Gabra
- Division of Surgery and Cancer, Imperial College London, London.,Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Kathryn Nash
- Liver Unit, Southampton General Hospital, Southampton, Hampshire, UK
| | - Yi-Liang Shen
- Division of Surgery and Cancer, Imperial College London, London.,Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Elaine Holmes
- Division of Surgery and Cancer, Imperial College London, London
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35
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and usually occurs in people with liver cirrhosis. Both the incidence and mortality of HCC are increasing worldwide, making it a growing public health issue. HCC diagnosed at an early stage has a far better prognosis than HCC diagnosed at a late stage, mainly because early stage HCC can be treated with potentially curative therapies such as resection and transplantation. This makes surveillance for HCC in patients with liver cirrhosis an important strategy in improving outcomes. Serial measurements of serum alpha fetoprotein (AFP) and abdominal ultrasound (US) are the established methods of surveillance. Surveillance using a combination of these techniques has reasonable sensitivity and specificity and reduces mortality from HCC by varying degrees, depending on the patient population. However, there are potential harms. The main harms result from false-positive and false-negative results. False-positive results commit patients to undergo further, potentially invasive and ultimately unnecessary diagnostic testing – which has both financial and emotional costs. False-negative results can have devastating consequences for patients who later present with more advanced HCC. Obesity is increasingly prevalent and reduces the sensitivity of US in detecting HCC. Obesity-associated non-alcoholic fatty liver disease (NAFLD) presents an additional challenge, where HCC can develop in the absence of cirrhosis. As surveillance with US and AFP is not cost-effective in NAFLD without cirrhosis, it is not advocated. These aspects will be reviewed.
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Affiliation(s)
- Daniel Geh
- Northern Institute for Cancer Research, Newcastle University Medical School, Newcastle upon Tyne, UK,
| | - Fahd A Rana
- The Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University Medical School, Newcastle upon Tyne, UK, .,The Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK,
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36
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Abstract
With the growing number of novel therapeutic approaches for liver diseases, significant research efforts have been devoted to the development of liquid biopsy tools for precision medicine. This can be defined as non-invasive reliable biomarkers that can supplement and eventually replace the invasive liver biopsy for diagnosis, disease stratification and monitoring of response to therapeutic interventions. Similarly, detection of liver cancer at an earlier stage of the disease, potentially susceptible to curative resection, can be critical to improve patient survival. Circulating extracellular vesicles, nucleic acids (DNA and RNA) and tumour cells have emerged as attractive liquid biopsy candidates because they fulfil many of the key characteristics of an ideal biomarker. In this review, we summarise the currently available information regarding these promising and potential transformative tools, as well as the issues still needed to be addressed for adopting various liquid biopsy approaches into clinical practice. These studies may pave the way to the development of a new generation of reliable, mechanism-based disease biomarkers.
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Affiliation(s)
- Jelena Mann
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ariel E Feldstein
- Department of Pediatrics, University of California, San Diego, California, USA
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37
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Margetts J, Ogle LF, Chan SL, Chan AWH, Chan KCA, Jamieson D, Willoughby CE, Mann DA, Wilson CL, Manas DM, Yeo W, Reeves HL. Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma? Br J Cancer 2018; 118:248-257. [PMID: 29123264 PMCID: PMC5785742 DOI: 10.1038/bjc.2017.386] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/04/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Irrespective of the underlying aetiology, 90% of hepatocellular carcinomas arise and progress on a background of chronic inflammation. We have explored the independent prognostic value of circulating inflammatory cells. METHODS Peripheral blood count data sets from 583 consecutive patients presenting to a single UK centre (2000-2010) were analysed for associations with tumour stage, liver function, performance status (PST) and survival. Validation was in an independent Hong Kong cohort (585 patients; 2007-2013). RESULTS In both UK and Hong Kong cohorts, neutrophils, platelets, lymphocytes, the neutrophil/lymphocyte ratio (NLR) and the Systemic Immune-Inflammation Index (SII) correlated stepwise, either increasing or decreasing (lymphocytes), with tumour node metastasis (TNM) and Childs-Pugh stage, PST and consequently with the combined Barcelona Clinic for Liver Cancer stage. Survival analyses confirmed the NLR and SII as highly significant prognostic biomarkers. Focused on individual cell types, only the neutrophil count was independently associated with both TNM stage and PST, as well as being significantly and independently associated with poorer survival. CONCLUSIONS In this study of 1168 patients, neutrophils alone, rather than lymphocytes or platelets, were independently associated with outcome. These data support further characterisation of a potentially distinctive role for neutrophils as facilitators of tumour progression and deteriorating performance.
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Affiliation(s)
- Jane Margetts
- Northern Centre for Cancer Care, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 7DN, UK
- Northern Institute for Cancer Research, The Medical School, Newcastle University, Paul O’Gorman Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Laura F Ogle
- Northern Institute for Cancer Research, The Medical School, Newcastle University, Paul O’Gorman Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Stephen L Chan
- State Key Laboratory in Oncology of South China, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, Hong Kong
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony W H Chan
- State Key Laboratory in Oncology of South China, Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - K C Allen Chan
- State Key Laboratory in Oncology of South China, Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Jamieson
- Northern Institute for Cancer Research, The Medical School, Newcastle University, Paul O’Gorman Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Catherine E Willoughby
- Northern Institute for Cancer Research, The Medical School, Newcastle University, Paul O’Gorman Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Derek A Mann
- Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK
| | - Caroline L Wilson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK
| | - Derek M Manas
- Hepatopancreatobiliary Unit, Surgical Directorate, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 7DN, UK
| | - Winnie Yeo
- State Key Laboratory in Oncology of South China, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Helen L Reeves
- Northern Centre for Cancer Care, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 7DN, UK
- The Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 7DN, UK
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Affiliation(s)
- Zeynep C Elcioglu
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Al-Oanzi ZH, Fountana S, Moonira T, Tudhope SJ, Petrie JL, Alshawi A, Patman G, Arden C, Reeves HL, Agius L. Opposite effects of a glucokinase activator and metformin on glucose-regulated gene expression in hepatocytes. Diabetes Obes Metab 2017; 19:1078-1087. [PMID: 28206714 DOI: 10.1111/dom.12910] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 01/19/2023]
Abstract
AIM Small molecule activators of glucokinase (GKAs) have been explored extensively as potential anti-hyperglycaemic drugs for type 2 diabetes (T2D). Several GKAs were remarkably effective in lowering blood glucose during early therapy but then lost their glycaemic efficacy chronically during clinical trials. MATERIALS AND METHODS We used rat hepatocytes to test the hypothesis that GKAs raise hepatocyte glucose 6-phosphate (G6P, the glucokinase product) and down-stream metabolites with consequent repression of the liver glucokinase gene ( Gck). We compared a GKA with metformin, the most widely prescribed drug for T2D. RESULTS Treatment of hepatocytes with 25 mM glucose raised cell G6P, concomitantly with Gck repression and induction of G6pc (glucose 6-phosphatase) and Pklr (pyruvate kinase). A GKA mimicked high glucose by raising G6P and fructose-2,6-bisphosphate, a regulatory metabolite, causing a left-shift in glucose responsiveness on gene regulation. Fructose, like the GKA, repressed Gck but modestly induced G6pc. 2-Deoxyglucose, which is phosphorylated by glucokinase but not further metabolized caused Gck repression but not G6pc induction, implicating the glucokinase product in Gck repression. Metformin counteracted the effect of high glucose on the elevated G6P and fructose 2,6-bisphosphate and on Gck repression, recruitment of Mlx-ChREBP to the G6pc and Pklr promoters and induction of these genes. CONCLUSIONS Elevation in hepatocyte G6P and downstream metabolites, with consequent liver Gck repression, is a potential contributing mechanism to the loss of GKA efficacy during chronic therapy. Cell metformin loads within the therapeutic range attenuate the effect of high glucose on G6P and on glucose-regulated gene expression.
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Affiliation(s)
- Ziad H Al-Oanzi
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
- Medical Laboratory Science, Aljouf University, Sakaka, Saudi Arabia
| | - Sophia Fountana
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Tabassum Moonira
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Susan J Tudhope
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - John L Petrie
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Ahmed Alshawi
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Patman
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Catherine Arden
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Loranne Agius
- Institute of Cellular Medicine and Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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40
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Donati B, Pietrelli A, Pingitore P, Dongiovanni P, Caddeo A, Walker L, Baselli G, Pelusi S, Rosso C, Vanni E, Daly A, Mancina RM, Grieco A, Miele L, Grimaudo S, Craxi A, Petta S, De Luca L, Maier S, Soardo G, Bugianesi E, Colli F, Romagnoli R, Anstee QM, Reeves HL, Fracanzani AL, Fargion S, Romeo S, Valenti L. Telomerase reverse transcriptase germline mutations and hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. Cancer Med 2017; 6:1930-1940. [PMID: 28677271 PMCID: PMC5548883 DOI: 10.1002/cam4.1078] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 01/03/2016] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 12/18/2022] Open
Abstract
In an increasing proportion of cases, hepatocellular carcinoma (HCC) develops in patients with nonalcoholic fatty liver disease (NAFLD). Mutations in telomerase reverse transcriptase (hTERT) are associated with familial liver diseases. The aim of this study was to examine telomere length and germline hTERT mutations as associated with NAFLD‐HCC. In 40 patients with NAFLD‐HCC, 45 with NAFLD‐cirrhosis and 64 healthy controls, peripheral blood telomere length was evaluated by qRT‐PCR and hTERT coding regions and intron–exon boundaries sequenced. We further analyzed 78 patients affected by primary liver cancer (NAFLD‐PLC, 76 with HCC). Enrichment of rare coding mutations (allelic frequency <0.001) was evaluated by Burden test. Functional consequences were estimated in silico and by over‐expressing protein variants in HEK‐293 cells. We found that telomere length was reduced in individuals with NAFLD‐HCC versus those with cirrhosis (P = 0.048) and healthy controls (P = 0.0006), independently of age and sex. We detected an enrichment of hTERT mutations in NAFLD‐HCC, that was confirmed when we further considered a larger cohort of NAFLD‐PLC, and was more marked in female patients (P = 0.03). No mutations were found in cirrhosis and local controls, and only one in 503 healthy Europeans from the 1000 Genomes Project (allelic frequency = 0.025 vs. <0.001; P = 0.0005). Mutations with predicted functional impact, including the frameshift Glu113Argfs*79 and missense Glu668Asp, cosegregated with liver disease in two families. Three patients carried missense mutations (Ala67Val in homozygosity, Pro193Leu and His296Pro in heterozygosity) in the N‐terminal template‐binding domain (P = 0.037 for specific enrichment). Besides Glu668Asp, the Ala67Val variant resulted in reduced intracellular protein levels. In conclusion, we detected an association between shorter telomeres in peripheral blood and rare germline hTERT mutations and NAFLD‐HCC.
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Affiliation(s)
- Benedetta Donati
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Alessandro Pietrelli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Istituto Nazionale di Genetica Molecolare (INGM), Romeo ed Enrica Invernizzi, Bioinformatics Group, Milan, 20122, Italy
| | - Piero Pingitore
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Paola Dongiovanni
- Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Andrea Caddeo
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Lucy Walker
- The Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Guido Baselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Serena Pelusi
- Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Chiara Rosso
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, 10126, Italy
| | - Ester Vanni
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, 10126, Italy
| | - Ann Daly
- The Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Rosellina Margherita Mancina
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Antonio Grieco
- Internal Medicine and Gastroenterology Area, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, 00168, Italy
| | - Luca Miele
- Internal Medicine and Gastroenterology Area, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, 00168, Italy
| | - Stefania Grimaudo
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, 90127, Italy
| | - Antonio Craxi
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, 90127, Italy
| | - Salvatore Petta
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, 90127, Italy
| | - Laura De Luca
- Clinic of Internal Medicine-Liver Unit, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, 33100, Italy
| | - Silvia Maier
- Clinic of Internal Medicine-Liver Unit, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, 33100, Italy
| | - Giorgio Soardo
- Clinic of Internal Medicine-Liver Unit, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, 33100, Italy
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, 10126, Italy
| | - Fabio Colli
- Department of Surgical Sciences, Liver Transplantation Center, University of Torino, Torino, 10126, Italy
| | - Renato Romagnoli
- Department of Surgical Sciences, Liver Transplantation Center, University of Torino, Torino, 10126, Italy
| | - Quentin M Anstee
- The Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United Kingdom.,Liver Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Helen L Reeves
- The Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United Kingdom.,Northern Institute for Cancer Research, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Silvia Fargion
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Stefano Romeo
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, SE-405 30, Sweden.,Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, 88100, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
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Willoughby CE, Thomas HD, Rennison T, Cano C, Reeves HL, Wedge SR. Abstract 1108: A novel, selective inhibitor of DNA-dependent protein kinase (DNA-PK) potentiates the effects of DNA-damaging therapies in hepatocellular carcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
DNA-dependent protein kinase (DNA-PK) is a key component in the repair of DNA double-strand breaks via non-homologous end-joining. Studies have found elevated DNA-PK expression and activity in hepatocellular carcinoma (HCC) to be strongly correlated with increased tumor grade, resistance to DNA-damaging therapies and poor survival (1,2).
We have explored the selective inhibition of DNA-PK in combination with DNA-damaging agents as a potential therapeutic approach in HCC using NDD0004 - a novel, orally-bioavailable small molecule inhibitor of DNA-PK (in vitro IC50 = 8 nM).
NDD0004 was evaluated in a panel of DNA-PK overexpressing human HCC cell lines (Hep3B, HepG2, Huh7) in combination with ionizing radiation or the topoisomerase II poison doxorubicin. DNA-PK activity was determined by Ser2056 phosphorylation status, DNA damage quantified by γH2AX levels, cell proliferation determined by SRB assays and cell survival assessed using clonogenic assays. In vivo efficacy was evaluated using a novel murine model of localized and sustained doxorubicin therapy, involving intra-tumoral injection of doxorubicin-loaded DC M1 polymer beads into established Huh7 human HCC xenografts in CD1 nude mice. Oral twice-daily treatment with 30 mg/kg NDD0004 or vehicle control was commenced 1 hour following bead implantation and continued for up to 20 days (6 mice per group).
NDD0004 dose-dependently inhibited activation of DNA-PK in HCC cell lines in vitro in response to ionizing radiation, and significantly increased and sustained DNA damage following treatment. Furthermore, NDD0004 sensitized DNA-PK overexpressing HCC cell lines to doxorubicin and ionizing radiation in proliferation and survival assays by ≥ 5-fold. Combining NDD0004 with doxorubicin-loaded beads in vivo significantly inhibited the rapid growth of HCC tumors when compared to treatment with doxorubicin-loaded bead monotherapy, with the time taken for tumor volumes to quadruple (RTV4) being extended from 11 to 18 days (P<0.01, Mann-Whitney). Individual and combination treatments were well tolerated throughout. Immuno-histochemical analysis revealed γH2AX levels in hepatocytes surrounding doxorubicin-loaded beads to be significantly increased by NDD0004 co-treatment for 72-hours (P<0.02, 2-way ANOVA).
In conclusion, selective inhibition of DNA-PK catalytic activity sensitized DNA-PK overexpressing HCC cell lines to doxorubicin chemotherapy and ionizing radiation in vitro, and augmented the anti-tumor activity of localized chemotherapy in HCC xenografts in vivo. These data support the concept of combining a DNA-PK inhibitor with localized DNA-damaging therapies in the treatment of HCC.
1. Cornell et al. (2015) Clin Cancer Res. 21: 925-33
2. Evert et al. (2013) Br J Cancer. 109: 2654-64
Citation Format: Catherine E. Willoughby, Huw D. Thomas, Tommy Rennison, Celine Cano, Helen L. Reeves, Stephen R. Wedge. A novel, selective inhibitor of DNA-dependent protein kinase (DNA-PK) potentiates the effects of DNA-damaging therapies in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1108. doi:10.1158/1538-7445.AM2017-1108
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Affiliation(s)
- Catherine E. Willoughby
- 1Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Huw D. Thomas
- 1Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tommy Rennison
- 2School of Chemistry and Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Celine Cano
- 2School of Chemistry and Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen L. Reeves
- 3Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust and Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen R. Wedge
- 1Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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Willoughby CE, Reeves HL. Combination PARP and HDAC inhibition as a therapeutic strategy targeting liver cancer stem cells? Chin Clin Oncol 2016; 5:60. [DOI: 10.21037/cco.2016.03.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
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43
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Alhasan SF, Haugk B, Ogle LF, Beale GS, Long A, Burt AD, Tiniakos D, Televantou D, Coxon F, Newell DR, Charnley R, Reeves HL. Sulfatase-2: a prognostic biomarker and candidate therapeutic target in patients with pancreatic ductal adenocarcinoma. Br J Cancer 2016; 115:797-804. [PMID: 27560551 PMCID: PMC5046211 DOI: 10.1038/bjc.2016.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/13/2016] [Accepted: 07/28/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is the fifth most common cause of cancer death in the UK. Its poor prognosis is attributed to late detection and limited therapeutic options. Expression of SULF2, an endosulfatase that modulates heparan sulfate proteoglycan 6-O-sulfation and is reportedly tumourigenic in different types of cancer, was investigated. METHODS SULF2 expression was determined immunohistochemically in archival surgical resection tissue sections from 93 patients with a confirmed histological diagnosis of PDAC between 2002 and 2008 followed for a median of 9 years. Relationships with clinico-pathological parameters and patient survival were explored. RESULTS The majority of PDACs showed positive SULF2 staining in tumour cells and intratumoural or tumour-adjacent stroma. Greater than 25% SULF2-positive tumour cells was present in 60% of cancers and correlated with tumour stage (P=0.002) and perineural invasion (P=0.024). SULF2 intensity was scored moderate or strong in 81% of cancers and positively correlated with vascular invasion (P=0.015). High SULF2 expression, defined as >50% SULF2-positive tumour cells and strong SULF2 staining, was associated with shorter time to radiological progression (P=0.018, HR 1.98, CI 1.13-3.47). Similarly, by multivariate analysis, high SULF2 expression was independently associated with poorer survival (P=0.004, HR 2.10, CI 1.26-3.54), with a median survival of 11 months vs 21 months for lower PDAC SULF2. CONCLUSIONS Elevated SULF2 in PDAC was associated with advanced tumour stage, vascular invasion, shorter interval to radiological progression and shorter overall survival. SULF2 may have roles as a prognostic biomarker and as a therapeutic target for patients with PDAC.
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Affiliation(s)
- Sari F Alhasan
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Beate Haugk
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Laura F Ogle
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Gary S Beale
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Anna Long
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Alastair D Burt
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- School of Medicine, Eleanor Harrald Building, Frome Road, The University of Adelaide, Adelaide, 5000 South Australia, Australia
| | - Dina Tiniakos
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Institute of Cellular Medicine, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Despina Televantou
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Fareeda Coxon
- Hepatopancreatobiliary multidisciplinary team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - David R Newell
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Richard Charnley
- Hepatopancreatobiliary multidisciplinary team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Helen L Reeves
- Northern Institute for Cancer Research, Paul O'Gorman Building, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Hepatopancreatobiliary multidisciplinary team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
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Ogle LF, Orr JG, Willoughby CE, Hutton C, McPherson S, Plummer R, Boddy AV, Curtin NJ, Jamieson D, Reeves HL. Imagestream detection and characterisation of circulating tumour cells - A liquid biopsy for hepatocellular carcinoma? J Hepatol 2016; 65:305-13. [PMID: 27132171 DOI: 10.1016/j.jhep.2016.04.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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: 10/20/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS The lack of progress in developing and delivering new therapies for hepatocellular carcinoma (HCC) is in part attributed to the risk related avoidance of tumour biopsy at diagnosis. Circulating tumour cells (CTCs) are a potential source of tumour tissue that could aid biological or biomarker research, treatment stratification and monitoring. METHODS An imaging flow cytometry method, using immunofluorescence of cytokeratin, EpCAM, AFP, glypican-3 and DNA-PK together with analysis of size, morphology and DNA content, for detection of HCC CTCs was developed and applied to 69 patient and 31 control samples. The presence of CTCs as a prognostic indicator was assessed in multivariate analyses encompassing recognised prognostic parameters. RESULTS Between 1 and 1642 CTCs were detected in blood samples from 45/69 HCC patients compared to 0/31 controls. CTCs positive for the epithelial markers cytokeratin and EpCAM were detected in 29% and 18% of patients respectively, while an additional 28% of patients had CTCs negative for all markers other than size and evidence of hyperploidy. CTC number correlated significantly with tumour size and portal vein thrombosis (PVT). The median survival of patients with >1 CTC was 7.5months versus >34months for patients with <1 CTC (p<0.001, log-rank), with significance retained in a multivariate analysis (HR 2.34, 95% CI 1.005-5.425, p=0.049) including tumour size and PVT. CONCLUSIONS The use of multiple parameters enhanced HCC CTC detection sensitivity, revealing biological associations and predictive biomarker potential that may be able to guide stratified medicine decisions and future research. LAY SUMMARY Characteristics of tumour tissues can be used to predict outcomes for individual patients with cancer, as well as help to choose their best treatment. Biopsy of liver cancers carries risks, however, and is usually avoided. Some cancer cells enter the blood, and although they are very rare, we have developed a method of finding and characterising them in patients with liver cancer, which we hope will provide a low risk means of guiding treatment.
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Affiliation(s)
- Laura F Ogle
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - James G Orr
- The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals, NHS Foundation Trust, UK
| | | | - Claire Hutton
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Stuart McPherson
- The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals, NHS Foundation Trust, UK
| | - Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK; Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK
| | - Alan V Boddy
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Nicola J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK; The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals, NHS Foundation Trust, UK
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Hutton C, Uitrakul S, Ogle LF, Reeves HL, Greystoke A, Veal GJ, Jamieson D. Abstract 3942: Increased frequency of proliferating peripheral white blood cells in the blood of hepatocellular carcinoma patients compared with noncancer controls. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Proliferation of peripheral blood cells, including activated CD8+ T-cells, has been reported in numerous pathologies including haematopoietic cancers and solid tumours. During development of a method to detect and characterise circulating tumour cells by imaging flow cytometry it became apparent that peripheral proliferating lymphocytes, while still rare, are substantially more common than CTCs in all cancer patients and are present in everybody. We investigated the frequency of these cells in patients with hepatocellular carcinoma (HCC) and healthy volunteers, and went on to assess their utility as a surrogate tissue for proof of mechanism studies of anti-proliferative agents.
Methods
Whole blood samples (4ml) from 7 patients with hepatocellular carcinoma and 14 healthy volunteers were collected into EDTA tubes. After RBC lysis and fixation WBCs were stained with fluorochrome conjugated antibodies to Ki67 and CD45 and the nuclei were stained with DAPI to assess relative DNA content. For each sample images of 100,000 cells were collected by imaging flow cytometry. Putative G2 cells were identified as single cells with DNA content equivalent to twice the amount of the majority of cells and the same as images of doublets. The frequency of cells with nuclear localised Ki67 reactivity was assessed independently of DNA content. Whole blood from healthy volunteers was also treated by ex vivo incubation with PMA ± the CDK inhibitor Dinaciclib.
Results
The mean frequency of Ki67 positive G1 peripheral WBCs in blood from patients with HCC was 0.44%, as compared to a frequency of 0.24% in the blood from healthy volunteers (p = 0.007). Incubation of healthy volunteer blood with PMA for 20 minutes at 37°C resulted in a small but reproducible increase in the number of Ki67 positive cells and this increase was abrogated by simultaneous incubation with Dinaciclib (141 ± 41% versus 92 ± 39%, expressed as a percentage of no PMA control, p = 0.0007). Additional staining of the ex vivo samples with an antibody to pMCM2, as a potential proof of mechanism marker for CDC7 inhibitor efficacy, was carried out. Results showed that pMCM2 expression was associated with ki67 and the frequency of pMCM2 positive cells also increased with exposure to PMA
Conclusion
The frequency of proliferating WBCs is increased in patients with HCC. These cells may have utility as a predictive/prognostic biomarker, or possibly in the pharmacodynamic monitoring of anti-proliferative pharmacological agents.
Citation Format: Claire Hutton, Suriyon Uitrakul, Laura F. Ogle, Helen L. Reeves, Alastair Greystoke, Gareth J. Veal, David Jamieson. Increased frequency of proliferating peripheral white blood cells in the blood of hepatocellular carcinoma patients compared with noncancer controls. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3942.
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Affiliation(s)
- Claire Hutton
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - Suriyon Uitrakul
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - Laura F. Ogle
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - Helen L. Reeves
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - Alastair Greystoke
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - Gareth J. Veal
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle upon Tyne, United Kingdom
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Reuillon T, Alhasan SF, Beale GS, Bertoli A, Brennan A, Cano C, Reeves HL, Newell DR, Golding BT, Miller DC, Griffin RJ. Design and synthesis of biphenyl and biphenyl ether inhibitors of sulfatases. Chem Sci 2016; 7:2821-2826. [PMID: 28660059 PMCID: PMC5477036 DOI: 10.1039/c5sc03612g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/10/2016] [Indexed: 11/21/2022] Open
Abstract
Inhibitors of sulfatase-2 are putative anticancer agents, but the discovery of potent small molecules targeting this enzyme has proved challenging. Based on molecular modelling, two series of sulfatase-2 inhibitors have been developed with biphenyl and biphenyl ether scaffolds judiciously substituted with sulfamate, carboxylate and other polar groups (e.g. amino). Inhibition of aryl sulfatase A and B was also determined. The biphenyl ether derivatives were less selective for sulfatase-2 over aryl sulfatase B than the biphenyl series. All biphenyl ether derivatives inhibited aryl sulfatase A, whereas only amino derivatives inhibited aryl sulfatase B significantly. In the biphenyl series few derivatives exhibited activity against aryl sulfatase B. The trichloroethylsulfamate group was identified as a new pharmacophore enabling potent inhibition of all of the sulfatases studied.
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Affiliation(s)
- Tristan Reuillon
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Sari F Alhasan
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Gary S Beale
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Annalisa Bertoli
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Alfie Brennan
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Celine Cano
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Helen L Reeves
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - David R Newell
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Bernard T Golding
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Duncan C Miller
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
| | - Roger J Griffin
- Newcastle Cancer Centre , Northern Institute for Cancer Research , School of Chemistry , Newcastle University , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK . ; ; ; Tel: +44 (0)191 2226647
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Dent BM, Ogle LF, O'Donnell RL, Hayes N, Malik U, Curtin NJ, Boddy AV, Plummer ER, Edmondson RJ, Reeves HL, May FEB, Jamieson D. High-resolution imaging for the detection and characterisation of circulating tumour cells from patients with oesophageal, hepatocellular, thyroid and ovarian cancers. Int J Cancer 2015; 138:206-16. [PMID: 26178530 PMCID: PMC4737101 DOI: 10.1002/ijc.29680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 10/09/2014] [Accepted: 06/09/2015] [Indexed: 12/11/2022]
Abstract
Interest has increased in the potential role of circulating tumour cells in cancer management. Most cell‐based studies have been designed to determine the number of circulating tumour cells in a given volume of blood. Ability to understand the biology of the cancer cells would increase the clinical potential. The purpose of this study was to develop and validate a novel, widely applicable method for detection and characterisation of circulating tumour cells. Cells were imaged with an ImageStreamX imaging flow cytometer which allows detection of expression of multiple biomarkers on each cell and produces high‐resolution images. Depletion of haematopoietic cells was by red cell lysis, leukocyte common antigen CD45 depletion and differential centrifugation. Expression of epithelial cell adhesion molecule, cytokeratins, tumour‐type‐specific biomarkers and CD45 was detected by immunofluorescence. Nuclei were identified with DAPI or DRAQ5 and brightfield images of cells were collected. The method is notable for the dearth of cell damage, recoveries greater than 50%, speed and absence of reliance on the expression of a single biomarker by the tumour cells. The high‐quality images obtained ensure confidence in the specificity of the method. Validation of the methodology on samples from patients with oesophageal, hepatocellular, thyroid and ovarian cancers confirms its utility and specificity. Importantly, this adaptable method is applicable to all tumour types including those of nonepithelial origin. The ability to measure simultaneously the expression of multiple biomarkers will facilitate analysis of the cancer cell biology of individual circulating tumour cells. What's new? Circulating tumour cells (CTCs) are disseminated malignant cells from which biological and therapeutic information may be obtained non‐invasively. Detection of small CTC populations within the large number of normal blood cells is a challenge. This study describes a novel method for the detection and high‐resolution imaging of CTCs. Unlike most other studies, CTC detection is not reliant upon expression of a single biomarker. The method is applicable to all cancers; the authors present preliminary results from four tumour types. The high quality of the images allows biological characterisation of the tumour cells and increases the clinical potential of the approach.
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Affiliation(s)
- Barry M Dent
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Laura F Ogle
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rachel L O'Donnell
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Nicholas Hayes
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne, United Kingdom
| | - Ujjal Malik
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Nicola J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan V Boddy
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - E Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Richard J Edmondson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, The Liver Unit, Newcastle upon Tyne, United Kingdom
| | - Felicity E B May
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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Piguet AC, Saran U, Simillion C, Keller I, Terracciano L, Reeves HL, Dufour JF. Regular exercise decreases liver tumors development in hepatocyte-specific PTEN-deficient mice independently of steatosis. J Hepatol 2015; 62:1296-303. [PMID: 25623824 DOI: 10.1016/j.jhep.2015.01.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 05/30/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Unhealthy lifestyles predispose people to non-alcoholic steatohepatitis (NASH), which may further result in the development of hepatocellular carcinoma (HCC). Although NASH patients benefit from physical activity, it is unknown whether regular exercise reduces the risk of developing HCC. Therefore, we studied the effect of regular exercise on the development of HCC in male hepatocyte-specific PTEN-deficient mice (AlbCrePten(flox/flox)), which develop steatohepatitis and HCC spontaneously. METHODS Mice were fed a standardized 10% fat diet and were randomly divided into exercise or sedentary groups. The exercise group ran on a motorized treadmill for 60 min/day, 5 days/week during 32 weeks. RESULTS After 32 weeks of regular exercise, 71% of exercised mice developed nodules larger than 15 mm(3)vs. 100% of mice in the sedentary group. The mean number of tumors per liver was reduced by exercise, as well as the total tumoral volume per liver. Exercise did not affect steatosis and had no effect on the non-alcoholic fatty liver disease (NAFLD) Activity Score (NAS). Exercise decreased tumor cell proliferation. Mechanistically, exercise stimulated the phosphorylation of AMPK and its substrate raptor, which decreased the kinase activity of mTOR. CONCLUSIONS These data show a beneficial effect of regular exercise on the development of HCC in an experimental model of NASH and offer a rationale for encouraging predisposed patients to increase their physical activity for the prevention of HCC.
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Affiliation(s)
- Anne-Christine Piguet
- Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Uttara Saran
- Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Cedric Simillion
- Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Irene Keller
- Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Luigi Terracciano
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK; The Liver Group, Newcastle University, Newcastle-upon-Tyne, UK
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland; University Clinic of Visceral Surgery and Medicine, Inselspital Berne, Berne, Switzerland.
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Affiliation(s)
- Helen L Reeves
- Northern Institute for Cancer Research, Newcastle University and Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom.
| | - Alex M Aisen
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
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